Objective To assess the effects of liposomal prostaglandin E1 (Lipo PGE1) on hepatic arterial and portal vein inflow early after orthotopic liver transplantation (OLT).Methods Fifty-six patients were divided randomly into two groups who received a primary liver transplant: normal control group and PGE1-treated group. Lipo PGE1 was infused by 20??g/d from day 1 to 14 after OLT in the PGE1-treated group. Measurements of hepatic arterial and portal vein inflow were taken on post-operative day 1, 3, 5, 7, 9 and 14 by color Doppler image (CDI).Results In control and PGE1-treated groups, hepatic artery velocity (HAV) was gradually increased during postoperative 2 weeks, but portal vein flow volume (PVFV) showed a decreased trend. HAV in PGE1-treated group was higher than normal control group during postoperative 5 days, but there was no significant difference in PVFV between two groups.Conclusion Lipo PGE1 can improve hepatic arterial inflow early after OLT, but not significantly influence portal vein inflow.

Objective To study the clinical feature and treatment of cytomegalovirus(CMV) pneumonia in the orthotopic liver transplantation(OLT) recipients.Methods The clinical data of 451 patients after OLT in our hospital from Oct.2003 to June 2005 were retrospectively analyzed.The prevention,clinical feature and treatment of CMV pneumonia were discussed.Results Seven patients((1.66 %)) developed CMV pneumonia after OLT.The symptoms presented much earlier than signs.All patients had high fever,and followed with cough,polypnea,dyspnea one week later.Blood-gas analysis showed hypoxemia.CMV pp65 antigen detection was helpful for early diagnosis.All the infected patients received ganciclovir and foscarnet treatment.At the same time,immunosuppressive drugs were withdrawn and complex treatment including high dose immunoglobulin,low does thymulin and broad-spectrum antibiotec were given.Six patients((85.7 %)) were cured.Conclusions The early onset of CMV pneumonia is not specific but still regular.CMV pp65 antigen detection is specific and sensitive.Ganciclovir and foscarnet treatment is effective and complex therapy necessary for CMV pneumonia.

OBJECTIVE: To explore the diagnostic role of computed tomographic dacryocystography (CTDCG) in lacrimal path damage and provide operative approach guidance for the endoscopic transnasal dacryocystorhinostomy (DCR). METHOD: Twenty-eight cases with lacrimal path damage underwent CTDCG. The following reconstruction techniques including volume rendering (VR), multiple planar reconstruction (MPR), maximum intensity projection (MIP) and three-dimensional reconstruction (3-d R) were done on the real-time workstation. The morphology of dacryocyst, displacement fracture of the lacrimal fossa (FS) and the relationship between the uncinate process (UP) and the FS were observed. The thickness of inner walls of anterosuperior and posteroinferior aspects of lacrimal fossa was measured. RESULT: The morphology of dacryocyst, the displacement fracture of the lacrimal fossa and the block site of the lacrimal passage could be displayed clearly by CTDCG with the following reconstruction techniques including VR, MPR, MIP and 3-d R, 6 cases of canaliculus obstruction, 14 cases of lacrimal sac obstruction, 8 cases of lacrimonasal duct obstruction were showed. Meanwhile the relationship between the UP and the FS could also be showed clear. The average bony thickness of the anterosuperior part of FS was (2.96 +/- 0.30) mm, while the bony thickness of the posteroinferior half was (0.02 +/- 0.005) mm, and the distance between the top and bottom of dacryocyst to the operculum of the middle turbinated (OMT) are (6.80 +/- 1.50) mm, (4.00 +/- 1.80) mm respectively (P < 0.05). CONCLUSION The morphology of dacryocyst, the displacement fracture of the lacrimal fossa, block site of the lacrimal passage and the relationship between the UP and FS can be clearly displayed by CTDCG, which provide operative approach guidance for the endoscopic transnasal dacryocystorhinostomy.
Adolescent ; Adult ; Dacryocystorhinostomy ; Endoscopy ; Female ; Humans ; Lacrimal Apparatus ; diagnostic imaging ; injuries ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods ; Young Adult

Objective To improve the ethics review process and ethical standards,strengthen the implantation of ethical review of research involving human subject in our hospital.Methods Evaluating the review practice of research involving human subject in our hospital practices,learn and bring in the latest international experiences.Results As China's Ethical Committee is in its initial stage,the regulatory ability is still in defective and insufficient.A healthy and operable ethic review mechanism needs to be perfected gradually along with the practice.Conclusions In the aspect of improving the ethical review work of human subject research,some new methods and ideas were discussed.In addition to strengthen the current organizational system,we should clarify the elements of the review of different types of research and carry out multi level ethical trainings.The establishment of a unified,specific evaluative system,combined with this information platform is continuously monitoring the clinical study.This will ensure the human research projects comply with ethical requirements,and further promote the sustainable development of clinical research.

0.05 ). Conclusion Individual immunosuppression regime can prolong the survival of the recipients with high risk factors and is proved to be more safe and reliable.

Objective To evaluate the efficacy and indications of salvage liver transplantation for patients with recurrent hepatecellular carcinoma(HCC)after liver resection.MethodsThe clinical data of 35 HCC patients who received salvage liver transplantation after liver resection at the Third Affiliated Hospital of Sun Yatsen University from October 2003 to March 2006 were retrospectively analyzed.All patients were divided into the salvage liver transplantation(SLT)group(n = 19)and extended SLT group(n = 16).Perioperative condition,postoperative complications and prognosis of the 2 groups were compared.The survival rate was analyzed and compared by the Kaplan-Meier method and Log-rank test,respectively.Results The anhepatic phase,ischaemic time,operation time,intraoperative blood loss,packed red blood cell transfusion,fresh frozen plasms transfusion,mobidity and retransplantation rate were(32 ± 9)minutes,(8.0 ± 2.1)hours,(7.6 ± 1.5)hours,2300 ml,8 U,23 U,6/19 and 2/19 in the SLT group,and(34 ± 7)minutes,(7.4 ± 2.3)hours,(7.4 ± 2.0)hours,2750 ml,12 U,20 U,4/16,1/16 in the extended SLT group,respectively,with no significant difference between the 2 groups(t=0.726,-0.804,-0.366,Z=-0.348,-0.549,-0.149,x2 =0.184,0.203,P＞0.05).The perioperative mortality,tumor recurrence rate were 0 and 2/19 in the SLT group,and 4/16 and 9/16 in the extended SLT group,with significant differences between the 2 groups(x2 = 5.363,8.426,P ＜ 0.05).The 1-,3-,5-year cumulative survival rates were 100%,84% and 84% in the SLT group,and 75%,33% and 33% in the extended SLT group.The 1-,3-,5-year tumor-free survival rates were 100%,89% and 89% in the SLT group,and 48%,29% and 19% in the extended SLT group.There were significant differences in the cumulative and tumor-free survival rates between the2 groups(x2 =11.58,19.31,P＜0.05).Conclusions The efficacy of SLT is satisfactory in the treatment of recurrent HCC.The optimal indication for SLT is Milan criteria.

Objective To investigate the prevention of gram-positive cocci infection by oral administration of vaBeomvcin after liver transplantation. Methods Eighty patients who underwent liver transplantation from September 2005 to September 2006 were divided into vaneomycin group and control group.All the patients were intravenously infused with piperacillin + tazobatam to prevent infection after liver transplantation.Patients in vancomycin group were given vancomycin orally in the first 7 days after liver transplantation and vancomycin concentration in the blood were measured at the same time.Infection and stool cocci and bacilli ratio of the patients in the 2 groups were observed.Results Seven patients in vancomycin group and 15 patients in control group(including 3 and 10 patients infected with methicillin resistant staphylococcus aureus in each group)were infected with grampositive cocci,respectively,with statistical difference(x2=4.501,P＜0.05).Three patients in vancomycin group and 10 patients in control group presented with imbalance of gastrointestinal flora,with statistical difference (x2=4.501,P＜0.05).No statistical difference was found in the patients infected with gram-negative bacilli or fungi between the 2 groups(x2=0.065,0.251,P＞0.05).The vancomycin concentration was 0 in the blood of patients who simply took vancomycin.Conclusions It is safe and effective to take vancomycin orally to prevent gram-positive cocci infection and imbalance of gastrointestinal flora after liver transplantation.

Objective To summarize our experience in hepatic artery reconstruction in adult-to-adult right lobe living donor liver transplantation(LDLT).Methods A retrospective analysis was made for 17 cases undergoing LDLT in our center from May 2007 to Oct 2008.Results All the 17 right lobe graft of the liver was supplied by single right hepatic artery and the mean diameter of right hepatic artery was 3.1 mm.The hepatic artery for segment 4 was mainly originated from left hepatic artery(12/17,70.1%).The recipient right or left hepatic artery was used in 14 cases of reconstruction,proper hepatic artery was used in 2 cases,and gastroduodenal artery was used in one case.Anastomosis was performed with interrupted 8-0 prolene and 12-16 stitches were made on the posterior wall first and then the anterior wall to avoid turning over the vessel.The mean anastomosis time was(51±26) minutes and all hepatic arteries were patent immediately after anastomosis.Hepatic arterial complications including hepatic artery thrombosis (HAT)did not occur after LDLT.Conclusions Detailed evaluation and careful protection of the hepatic artery of segment 4 are the key to successful reconstruction of hepatic artery in LDLT.Anastomosis was performed without flipping the artery wall helped to reduce the difficulty of operation remarkably and with a good result.

Objective To investigate the effects of recombinant human thioredox ( rhTrx) on primary cultured hepatocytes. Methods The cDNA coding hTrx was amplified by using RT-PCR. The objective protein was expressed in E. Coli. The activity of purified rhTrx protein was determined by IgM and insulin disulfide reduction assay. DNA synthesis was determined by 3H-TdR mixing assay to realize the proliferating roles of rhTrx in murine primary cultured hepatocytes. Cell viability was assessed by lactate dehydrogenase ( LDH) releasing assay. Results The cloning hTrx open reading frames cDNA was confirmed by sequence analysis. The soluble recombinant hTrx are expressed efficiently in the prokaryotic expression system. The recovery ratio was 23. 20% of total bacteria protein with a purity of the expressive protein of 96. 30%. The rhTrx had stronger IgM and insulin reduced activity compared with the controls (P

ObjectiveTo investigate the etiology of epileptic seizures after orthotopic liver transplantation and preventive measures.MethodClinical data of 83 patients receiving orthotopic liver transplantation from May 1998 to December 2001 were retrospectively studied.ResultsSix cases suffered seizures with an incidence of 7.23%.The interval between transplantation and clinical diagnosis of seizures ranged from 4 to 15 days with a meadian time of 9.3?1.2 days. Tonic-clonic seizure was the most common type of seizures. Three patients had a previous history of seizure. Computed tomographic(CT) scan revealed strokes in 2 patients. Seizure related mortality was 3.61% in this group of 83 cases.ConclusionSeizures are not infrequent neurological complication after liver transplantation and it may indicate an underlying CNS lesions. Cyclosporine and tacrolimus neurotoxicity, metabolic abnormalities and pneumonia are factors contributing to the onset of seizures. Proper mangement and comprehensive therapy may improve the prognosis.