PURPOSE: We report the results of replantations which was intentionally delayed for a certain period of time in patients with an amputation of multiple digits, both hands or the single digit presented at night. MATERIALS AND METHODS: Two staged intentianlly delayed replantations were performed in twenty patients. Three patients had amputations of four or more fingers, two had bilateral hand amputations and fifteen had a single digit amputation. RESULTS: The mean warm ischemic time was 3 hours and 58 minutes. The mean cold ischemic time was 2 hours and 36 minutes for the first operation, and 15 hours and 13 minutes for the second operation. Twenty digits out of 28 digits (85%) survived completely. At the mean follow-up of months, functional results according to Chen's criteria were rated as excellent in six patients, good in eight, and fair in five. CONCLUSION: When the patients had multiple finger amputations, bilateral hand amputations or presented late at night, intentional delay of the replantation also provide satisfactory outcomes.
Amputation ; Cold Ischemia ; Fingers ; Follow-Up Studies ; Hand ; Humans ; Intention ; Replantation ; Warm Ischemia

BACKGROUND: Digital replantation has become a well-established technique that has revolutionized hand surgery. One of the most important factors to a successful replantation is less than 12 hours of warm and 24 hours of cold ischemia time. The purpose of this article was to present a concept of door-to-surgery time and test the hypothesis that success in distal digital replantation is associated with this time. METHODS: Forty-five patients with 49 distal amputations were included in the study. Data regarding patient demographics, amputation characteristics, ischemia time, and surgical outcome were collected. Factors related to a successful replantation were analyzed. Fisher's exact test was used for statistical analysis. RESULTS: Type I, II, and III Yamano classification were noted in 11 (22.4%), 11 (22.4%), and 27 (55.1%) amputations. All the digits had arterial anastomoses while 19 (38.8%) digits were replanted without venous anastomosis. The mean door-to-surgery time was 229 minutes. The overall success rate was 77.6%. There were no differences in the survival rates between replantations with or without venous anastomosis. Patients with less than 180 minutes of door-to-surgery time had a significantly better survival rate compared to patients with greater time. CONCLUSION: The overall success rate was 77.6%. Patients with less than 180 minutes of door-to-surgery time had a significantly greater success rate (95.0%) compared to patients with longer door-to-surgery time (65.5%). Further effort must be made to achieve this goal in digital replantation.
Amputation ; Classification ; Cold Ischemia ; Demography ; Hand ; Humans ; Ischemia ; Replantation ; Survival Rate

Great improvements in patient selection, surgical techniques, perioperative care, and immunosuppression have been made for the optimization of liver transplantation. To increase the number of organs available for liver transplantation, transplant centers have used marginal donors, split livers, living donors, or non-heart-beating donors (NHBDs). Despite recent enthusiasm for NHBDs in liver transplantation, warm ischemic injury to recovered organs has been an obstacle for the wide acceptance of NHBD. In the present case, we have conducted a liver transplantation from a Maastricht Category 4 NHBD. Warm ischemic time was 20 minutes and cold ischemic time was 5 hour 43 minutes. Consequently, the liver was successfully transplanted into the recipient.
Anesthesia ; Cold Ischemia ; Humans ; Immunosuppression ; Liver ; Liver Transplantation ; Living Donors ; Patient Selection ; Perioperative Care ; Tissue Donors ; Transplants ; Warm Ischemia

"Biliary cast syndrome" describes a cast formed from retained lithogenic material, and this cast is morphologically confined to the bile duct; this develops in 4~18% of liver transplant recipients. The pathogenesis of cast formation is not clearly understood. The proposing etiological factors for biliary cast syndrome include acute cellular rejection, a prolonged cold ischemic time, use of postoperative biliary drainage tubes and biliary infection. These casts are more likely to develop in the setting of hepatic ischemia and biliary stricture. Endoscopic and percutaneous cast extraction might achieve favorable results and this should be attempted before surgical therapy. We report here on a case of biliary cast syndrome that was secondary to orthotopic liver transplantation; this was successfully treated via percutaneous choledochoscopic removal. We also include a review of the literature.
Bile Ducts ; Cold Ischemia ; Constriction, Pathologic ; Drainage ; Humans ; Ischemia ; Liver Transplantation* ; Liver* ; Superior Mesenteric Artery Syndrome ; Transplantation

A retrospective study was conducted to determine the incidence of major complications after liver transplantations which had been performed at Asan Medical Center from August 1992 to October 1996. Among the 43 orthotopic liver transplantations(OLTs), 27 were cadaveric donor liver transplantation(CDLT) including one retransplantation, 16 were living donor liver transplantation(LDLT). The over-all incidence of major complication was 52.4%, and there were no statistical difference between CDLT and LDLT. But the one-year cumulative survival was better in LDLT than CDLT(86.2% vs 63.3% : p < 0.1). To reduce the incidence of major complications after OLT, proper management of donors, early transplantation of recipients and shortening of cold ischemic time are mandatory especially in CDLT.
Cadaver ; Chungcheongnam-do ; Cold Ischemia ; Humans ; Incidence ; Liver Transplantation* ; Liver* ; Living Donors ; Retrospective Studies ; Tissue Donors

In cadaveric renal transplantation, the graft survival from multiorgan donor (MOD) and kidney donor alone (KDA) can be suspected to be different due to a different situation. In MOD, more complicated procurement procedure and least priority of kidney can be a negative impact on graft survival. While in KDA, poor donor status can be an negative factor for graft survival. We have evaluated the characteristics of MOD and KDA group, and analyzed to find out whether there is a disparity in graft survival between the two groups. Among the 137 cadaveric renal allografts from 1991 to 1997, 80 patients(58%) underwent renal allograft from MOD and 57(42%) from KDA. Because of the limited organ resources, we managed every donor carefully as a potential multiorgan donor and final decision to harvest multiorgans was made during the exploration. The average donor age of MOD was younger than that of KDA(26yr vs 32yr, p=0.02) and proportion of category A (donors who had spent less than 6 days in the ICU and had received dopamine less than 5 microgram/kg/min and had not experenced cardiac arrest) was higher in MOD(p=0.03). There were fewer recepients with the ABO minor mismatching in the MOD group (p=0.04). Mean cold ischemic time for both groups did not differ significantly (9.5 hr vs 8.1 hr, p=0.9). Postoperative ATN (33.8% vs 38.6%, p=0.6) and rejection (22.5% vs 24.6%, p=0.7) did not differ significantly in both groups. The one -and 5-year graft survival of MOD group were 88% and 85% compared with 89% and 84% in KDA group. From these results, we can conclude that graft survival did not show any difference between the two groups, regardless of multifactorial differences in renal allograft between MOD and KDA.
Allografts* ; Cadaver* ; Cold Ischemia ; Dopamine ; Graft Survival ; Humans ; Kidney Transplantation ; Kidney* ; Tissue Donors*

BACKGROUND: Identifying the donor and isolation-related factors during the islet isolation would be greatly helpful to improve the result of human islet isolation for successful clinical islet transplantation. METHODS: Sixty-nine pancreata from cadaveric donors were isolated with standard protocol and analyzed to identify the donor factors and isolation variables for successful isolation. Islet isolations recovered > or = 100,000 Islet Equivalent (IEQ, n=53) were compared to islet mass less than 100,000 IEQ (n=16). RESULTS: The mean islet recovery was 216.0 x 10(3) +/- 173.7 x 10(3) (IEQ) before purification and 130.6 x 10(3) +/- 140.2 x 10(3) (IEQ) after purification. Mean purity was 54 +/- 31%. Mean age of donor was 31.2 +/- 13.2 year and mean cold ischemic time was 6.9 +/- 6.2 hour. Quality of isolated islets was acceptable in terms of bacterial culture, viability and secretory function in vitro and in vivo. In univariate analysis on successful isolation, status of pancreas was the only significant factor and sex, duration of collagenase expansion and digestion time were marginal factors. Stepwise multivariate logistic regression analysis showed donor sex, status of pancreas and digestion time were significant factors for the successful islet isolation. CONCLUSION: This study confirms some donor factors and variables in isolation process can influence the ability to obtain the successful isolation of human islet. Enough experiences and pertinent review of donor and isolation factors can make islet isolation successful, supporting the clinical islet transplantation without spending of cost.
Cadaver ; Cold Ischemia ; Collagenases ; Digestion ; Humans* ; Islets of Langerhans Transplantation ; Logistic Models ; Pancreas* ; Tissue Donors

Liver transplantation is an accepted and successful mode of treatment for pediatric end-stage liver disease. Living related liver transplatation(LRLT) in child has certain potential advantages, such as short cold ischemic time, accurate graft size and vessel diameter match based on elective preoperative preparations. Recently, introduction of microvasular surgery technique to hepatic artery reconstruction has been used, but still remained the possibility of hepatic artery thrombosis. Herein, We report a LRLT case, which showed hepatic artery stenosis postoperatively, successfully dilated by ballon angioplasty technique.
Angioplasty ; Child ; Cold Ischemia ; Constriction, Pathologic ; Hepatic Artery ; Humans ; Liver ; Liver Diseases ; Liver Transplantation ; Thrombosis ; Transplants

OBJECTIVETo evaluate the efficacy and the mechanism of application of selective head cooling on neuronal morphological damage during postischemic reperfusion in a rabbit model.

METHODS168 New Zealand rabbits were randomized into three groups. Group I [n = 24, (38 +/- 0.5) degrees C, non-ischemic control]; Group II [n = 72, (38 +/- 0.5) degrees C, normothermic reperfusion]; Group III [n = 72, (28 +/- 0.5) degrees C, selective head cooling, initiated at the beginning of reperfusion). Animals in three subgroups (n = 24, each) of Group II and Group III had reperfused lasting for 30, 180 and 360 min respectively. Using computerized image analysis technique on morphological changes of nucleus, the degree of neuronal damage in 12 regions were differentiated into type A (normal), type B (mild damaged), type C (severely damaged) and type D (necrotic). Fourteen biochemical parameters in brain tissues were measured.

RESULTSAs compared with Group I, the counts of type A neuron decreased progressively, and those of type B, C and D increased significantly in Group II during reperfusion (P < 0.01). In Group II, vasoactive intestinal peptide, b-endorphine, prostacyclin, T3 and Na+, K(+)-ATPase were correlated with the changes of type A; b-endorphine and thromboxane with type B; glucose and vasopressin with type C; Na+, K(+)-ATPase, glutamic acid, T3 and vasoactive intestinal peptide with type D (P < 0.05). As compared with Group II, the counts of type A increased, and those of type C and D significantly decreased in Group III (P < 0.01). In Group III, Ca2+, Mg(2+)-ATPase were correlated with the changes of type A, C and D (P < 0.01).

CONCLUSIONSelective head cooling for sex hours during postischemic reperfusion does improve neuronal morphological outcomes in terms of morphological changes.

Animals ; Brain Ischemia ; pathology ; Cold Temperature ; Neurons ; pathology ; Rabbits ; Reperfusion Injury ; prevention & control ; Resuscitation ; methods

PURPOSE: We report a new method of tumor exposure through a minilaparotomy window and cold ischemia using a LapSac(R) during partial nephrectomy by video-assisted minilaparotomy surgery (VAMS). MATERIALS AND METHODS: Partial nephrectomy was performed by VAMS in a total of 31 patients during a period ranging from January 2004 to June 2006, and tumor exposure and cold ischemia were achieved by using a LapSac(R). We investigated the tumor size and location, mean operative time, mean estimated blood loss, mean cold ischemic time, and pathologic outcomes retrospectively. We evaluated preoperative and postoperative renal function with the estimated creatinine clearance rate by the MDRD equation. RESULTS: The mean tumor size was 2.59+/-1.30 cm and mean surgical time was 182.5+/-44.5 minutes. Mean cold ischemic time was 31.84+/-8.43 minutes. Mean estimated blood loss was 445.65+/-202.77 ml (range, 100-800 ml), and 3 patients required transfusion. A histopathologic examination confirmed a diagnosis of renal cell carcinoma in 22 patients (71%). The surgical margin was positive in 1 patient. Twenty-one patients had a mean follow-up of 53+/-8.19 months. Nineteen patients survived without any disease recurrence, 1 patient survived with lung metastasis within 5 months, and 1 patient died of unrelated cause. There was no significant difference between the preoperative and postoperative estimated creatinine clearance rate by using the MDRD equation. CONCLUSIONS: Tumor exposure and cold ischemia were attempted in a partial resection of the kidney by VAMS with a LapSac(R). This technique for partial nephrectomy by VAMS might be an effective, safe modality.
Carcinoma, Renal Cell ; Cold Ischemia ; Cold Temperature ; Creatinine ; Follow-Up Studies ; Humans ; Kidney ; Laparotomy ; Lung ; Neoplasm Metastasis ; Nephrectomy ; Operative Time ; Recurrence ; Retrospective Studies ; Video-Assisted Surgery