Acute Disease ; Humans ; Male ; Middle Aged ; Occupational Diseases ; therapy ; Plasma Exchange ; Propane ; analogs & derivatives ; poisoning

Objective To investigate the methods and techniques for organ procurement from donation after cardiac death (DCD),and to evaluate post-transplant outcomes.Methods In this retrospective study,clinical data of 26 cases of DCD organ procurements were analyzed through either epigastric multivisceral organ harvesting or solitary organ harvesting.Results Twenty livers,44 kidneys and 2 multivisceral grafts were procured,followed by 24 cases of liver transplantation,42 cases of kidney transplantation,and 2 cases of multivisceral transplantation.The operations were successful and all transplanted organs were satisfactorily recovered with no primary nonfunction or other complications observed.Conclusion Our methods and techniques for organ procurement from DCD donors require experienced surgery skills,while can maximatily shorten donor organ ischemic time,guarantee procurement of high quality of organs and ensure a favourable transplant outcomes.

Objective To evaluate the effect of endoscopic retrograde cholangiopancreatography (ERCP) in treatment of biliary complications after liver transplantation. Methods Data of 39 patients who underwent ERCP between January 2005 and December 2007 because of biliary complications after liver trans-plantation were retrospectively evaluated. Endoscopic sphincterotomy, dilatation, nasal-biliary drainage (ENBD) and stent placement were performed in 25 patients with biliary strictures (14 at anastomosis site and 11 at non-anastomosis site). ENBD and stent placement were applied in 6 patients with biliary leakage, while endoscopic sphincterotomy, ENBD and stone extraction with baskets were performed in 16 patients with biliary stones. Procedures were repeated when necessary. Results ERCP was successfully performed at a rate of 95.9% (94/98) without any severe complications. Strictures at anastomosis site were resolved in all patients (100%, 14/14), while for strictures at non-anastomosis site, only 27.3% (3/11) were cured. Biliary leakage was resolved in 83.3% (5/6) patients. Complete bile duet clearance was achieved in 81.3% (13/16) of the patients with biliary stones. Conclusion ERCP proves to be safe and effective in the treatment of post liver transplantation biliary complications with low incidence of severe complications.

Objective: To stuby the effects of baicalin on r at hepatocyte apoptosis induced by tumornecrosis factora (TNF-α) and actinomyc in D (Act D) in vitro. Methods: Hepatocytes were cultared with different concentrations of baicalin and the cell apoptosis was induced by TNF -α and Act D in vitro. After culturing for 24 h, the activity of hepatocyts wa s examined by MTT assay and the function of hepatocytes for secreting albumin w as detected by bromocresolum Viride method. Agarose gelelectrophoresis and flowc ytometric analysis were used to determine the apoptotic cells. Results: The activety of the hepatocyte (A) and content of albumin (ALB) in the supematant of cultured cells in the groups of 0.2 μg*ml-1 and 2.0 μg* ml-1 of baicaline were significantly higher than those in apoptotic model group (A:P<0.01; ALB:P<0.01);respectively Even the ALB value in the grou p of 0.2 μg*ml-1 baicalin was higher that of black control group (P< 0.01); The clear “ladder-like” streak-band of DNA fragments was foundonly in the apoptosis model group by the agarose gel electrophoresis. The flow cytomet ry showed that all the apoptosis rates in the three baicalin groups were lower t han that of the apoptotic model group (P<0.01)。Conclusion: Baicaline can restrain rat hepatocyte apoptosis induced by TNF-α and ActD in vitro.

Objective To explore the clinical efficacy of the upper abdomen organ transplantation in the treatment of end stage liver disease and type 2 diabetes mellitus (T2DM).Methods The clinical data of 7 cases receiving liver-duodeno-pancreatic organ cluster transplantation in patients with end-stage liver disease and T2DM were retrospectively analyzed.The pancreas and the whole digestive tract of the recipients were reserved during operation,simple liver excision was executed,and abdominal multiple organs including pancreas,duodenum and part of jejunum were transplanted.The liver and kidney functions,blood glucose,C peptide,infection,rejection,vascular complications,biliary complications and other indicators were monitored postoperatively.Results No insulin was used in all the patients 1-7 days after operations,the blood glucose levels returned to almost normal, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin became normal after 1 week,and C peptide levels reached the normal range in 1 to 2 weeks.Among 7 patients,one died of graft-versus-host disease 1 month after operation,one got acute renal failure,one suffered from pulmonary infection, one had pancreatic leakage but recovered after unobstructed drainage,and no obvious complications were observed in the remaining patients.So far 6 live recipients were followed up for 1-39 months,the functions of the liver and pancreatic grafts were normal without hepatitis B and tumor recurrence, and the quality of life in the patients was satisfactory.Conclusion Liver-duodeno-pancreatic organ cluster transplantation is technically feasible and an effective method for the treatment of end-stage liver disease with T2DM.

Objective To evaluate the surgical techniques and short-term clinical results of simultaneous pancreaticoduodenum-kidney transplantation(SPK)with the enteric drainage(ED)of exocrine secretions of the pancreas.Method From Jan 2005 to Jun 2009,ten diabetic patients with uremia diabetes underwent SPK.The pancreas graft was placed intraperitoneally with exocrine secretions drained into the proximal iejunum by side-to-side anastomosis.The multivisceral cluster grafts(liver,kidney,pancreas and duodenum)were procured after simultaneously rapid perfusion with cool UW solution through donor's abdominal aorta and superior mesenterie vein in 10 no heart beating cadeveric donors.Quadruple immunosuppressive therapy with anti-CD25 monoclonal antibody,tacrolimus,mycophenolate mofetil and steroids was adopted.Results SPK was successfully performed in all cases.The mean warm ischemia time of donor organ was(5.9 ±2.6)min,the mean cold ischemic time of the kidney was(5.2 ±2.2)hours and that of the pancreas was(9.3±3.6)hours.Patient and graft survival rates were 90.0% and 90% at 6 month after transplant,respectively.None of the grafts lost due to enteric or pancreatic leakage or intraabdominal infection.The most common surgical complications were wound infection(n=3),and enteric anastomostic hemorrage(n=2),which were all cured by nonoperative management.Three biopsy-proven acute renal rejection episodes occurred within 12 months postoperation,2 of them were reversed Successfully.and 1 died of cerebral complication during the recovery from continuous renal replacement therapy(CRRT)after the failure of aggressive antirejection treatment.Other patients(n=9)became insulin-free euglycemie at(9.3±3.8)day postoperatively,and are well and insulin-free at a follow-up of 6～12 months.Conclusions High quality procurement of donor grafts and suitable arterioplasty are prerequisites for a successful combination kidney and pancreas transplantation.Enteric exocrine drainage by direct side-to-side anastomosis seems to be a simple and reliable technique.

Objective To investigate the efficacy and safety of sirolimus in treating calcineurin inhibitor-related renal insufficiency after liver transplantation. Methods Eleven patients with calci-neurin inhibitor-related renal insufficiency after liver transplantation received sirolimus conversion.Simultaneously, the dose of tacrolimus was decreased or tacrolimus was withdrawn. Blood creatinine,sirolimus level, tacrolimus level, liver function, rejection episodes and drug side-effect were moni-tored. Results All the 11 patients survived today with 6 to 20 months of follow-up. All patients showed improvement of renal function after conversion to sirolimus. Blood creatinine level was reduced from (163.8±47.9)μmol/L to(108.1±26.6)μmol/l. (P<0.05). One patient's liver function had an acute rejection episode that was successfully treated with increase of dose of tacrolimus. The side-effects of sirolimus included hyperlipidemia (4 patients), anaemia (1) and mouth ulcers (2).Conclusion Siolimus can be effectively and safely used in liver transplant recipients suffering from ta-crolimus-related renal insufficiency.

Objective To summarize the clinical characteristics and make genetic diagnosis in the patients with hereditary spinocerebellar ataxia type 7 (SCA7).Methods Pedigree analysis and clinical examination were performed in one family with SCA7 by clinical findings,of which retinal morphology and visual electrophysiology were available on part numbers.The polymorphic cytosine adenine guanine (CAG) repeats in the encode region of SCA7 gene were detected by combining polymerase chain reaction with deoxyribonucleic acide (DNA) sequencing on 19 familial numbers and 12 controls.Results 6 patients were identified,who manifesting cerebellar ataxia,decreased visual acuity and colour vision defect,as was pigmentary retinopathy on fundoscopy;The 6 patients had not only extinction of the electroretinogram (ERG) but also remarkably reduced amplitudes of oscillatory potentials and flash-visual evoked potentials. On normal alleles CAG repeat size ranges from 8 to 25 repeats,wherease on mutated alleles of the 6 numbers it ranges from 50 to 97 repeats.The 6 numbers were diagnosised as SCA7 patients.One asymptomatic individual of this family,who displayed a normal allele with 18 CAG repeats and another containing abnormal expantion of 56 repeats,was diagnosised as a asymptomatic carrier whose age maybe still below the age of onset.Conclusion The clinical manifestations of SCA7 are heterogeneous,and the detection of CAG repeats can provide an effective way for the gene diagnosis and the prediction of asymptomatic patients.

Objective Modified upper abdominal cluster transplantation (MCT), which was inspired by the classical cluster transplant technique, has been proven more effective and feasible in the treatment of patients with end stage liver diseases associated with insulin-dependent diabetes mellitus (DM) than orthotopic liver transplantation (OLT) alone. In this study, we summarized our experience with MCT in 5 consecutive patients suffering from end stage liver diseases associated with insulin-dependent type 2 DM in our single center.Methods Five patients with hepatitis B-related chronic liver cirrhosis and insulin dependent type 2 DM received MCT in our single center. The biliary and exocrine pancreatic drainage reconstructions were achieved by a Roux-en-Y duodenojejunostomy or a side-to-side duodenojejunostomy. A quadruple immunosuppressive regimen based on tacrolimus including Basiliximab induction, mycophenolate mofetil (MMF) and steroids was used in the early stage post-transplant, and then converted to tacrolimus monotherapy.Results All of the patients experienced an uneventful post-operative recovery. They were rendered independent from insulin therapy shortly after transplantation. The fasting glucose and glycosylated hemoglobin levels were within normal range. In addition, the fasting C-peptide value was increased from much lower than the normal range pre-transplant to within normal range post-transplant and maintained stable since then. However, the third patient suffered from graft verse host disease (GVHD) 20 days post-operatively and died from severe infection on the post-operative 47 days. The other 4 patients had returned to work and a normal lifestyle over 22, 15, 5 and 4 months of follow-up.Conclusion MCT is an effective method in treating patients suffering from end stage liver diseases combined with insulin-dependent type 2 DM. Whether a cluster graft would increase the risk of GVHD needs further investigation.

Objective To report the modified liver mobilization technique in management of renal cell carcinoma with intrahepatic inferior vena cava thrombus. Methods 10 cases (7 men and 3 women at the average age of 49 years) of renal cell carcinoma with intrahepatic inferior vena cavs thrombus were reviewed.The operations were carried by using father clamp to control inferior vena cava,combined with hepatic portal blocking. Results There was no postoperative complication.The average blood loss was 800 ml.The mean hospital stay was 13 days.The time of follow-up ranged from 1 to 48 months. Conclusions The technique of using father clamp to control suprahepatic inferior vena cava combined with hepatic portal blocking is feasible for the treatment of the renal cell carcinoma with intrahepatic inferior vena cava thromhosis.