OBJECTIVETo assess the value of color Doppler flow imaging (CDFI) in monitoring vascular complications following orthotopic liver transplantation (OLT).

METHODSSeven hundred ninety-two patients who received OLT from April 2002 to December 2006 in the Organ Transplantation Center, General Hospital of Chinese People's Armed Police Forces, Beijing, and underwent CDFI examinations in different periods after OLT were enrolled in this study. Their vascular complications were monitored by CDFI and confirmed by angiography or spiral CT.

RESULTSOf the 792 patients, 54 were diagnosed with vascular complications that occurred 1-360 days after their OLT operations. These complications occurred within 1-30 days, 31-60 days, 61-90 days, 91-180 days, 181-360 days, with the proportions of 46.30%, 22.22%, 14.81%, 9.26% and 7.41% respectively. The proportion of hepatic artery and portal vein complications and outflow occlusions were 61.11%, 35.19% and 3.70% respectively.

CONCLUSIONMost vascular complications occurred within six months after the OLT operation. The continuous and careful monitoring by CDFI is beneficial in an early diagnosis of vascular complications after OLT.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Infant ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Postoperative Complications ; Ultrasonography, Doppler, Color ; methods ; Vascular Diseases ; diagnostic imaging ; etiology ; Young Adult

OBJECTIVETo summarize the Patho-typing and the clinical manifestation of biliary cast syndrome (BCS) in patients after orthotopic liver transplantation.

METHODSThe clinical manifestation, findings,therapeutic means and efficacy of 103 patients with biliary cast syndrome after orthotopic liver transplantation were retrospectively analyzed. According to the injury level of biliary duct epithelium, patients were divided into different groups. All cases were followed up for twelve months. The place, degree and time after operation would be recorded when non-anastomotic biliary stricture was found.

RESULTSThere were 59 BCS cases in the general hospital of armed police force of China. The incidence rate of BCS was 9.1%. Many BCS patients showed symptoms such as jaundice, deep urine color, gray stools, itch of skin and fever. Some were asymptomatic. In laboratory test, the liver functional enzyme in serum were increased, the total white cell count in peripheral blood was increased either. Cholangiography via T tube of biliary tract might show filling defect. According to the change degree of the biliary tract tree, there were four types filling defect concluded from all the presentation in BCS patients. Solid obturation of biliary tract were found by the check with optical fiber choledochoscope in all BCS patients, necrosis of biliary tract epithelium were observed in partial BCS patients. According to the injury level of biliary duct epithelium (gradually aggravated), BCS patients were divided into six groups (type I, type II, type III, type IV, type V and type VI). Fourteen cases were found in type I and 18 in type II. No clinical symptom was found in these two groups, a few indicators in serum (alanine aminotransferase ALT, total bilirubin TBIL, direct bilirubin DBIL) were in normal range, and others (gamma-glutamyl transferase GGT, alkaline phosphatase ALP) were heightened in 5 patients. There was no biliary cast (BC) found anymore in the period of follow-up in two groups. No stricture was found in both group. Twenty-seven cases in type III and 23 cases in type IV, it was found there were about 33.4% patients accompanied with fever and 25.9% accompanied with jaundice in type III. Paralleled,there were about 30.4% and 34.8% patients in type IV. The liver functional enzyme in serum were found increased in both type. After supporting treatment for 3-6 months,there were 5 and 3 patients present as mild non-anastomotic biliary stricture in type III and type IV group. In the group type V, there were 13 patients. The detected liver functional indicators in serum were increased. After supporting treatment for 6-12 months,there were 4 patients present as moderate non-anastomotic biliary stricture in this group. There were 18 patients in type VI group, all indicators of the liver functional enzyme in serum before the treatment were elevated conspicuously. All patients in this group were found serious stricture up to three places that have not been sustained in the period of follow-up. Nine died of MOSF, 1 died of AOSC, 8 had undergone retransplantation. In the retransplantation patients, 4 died of post operation MOSF, 3 recovered to normal, 1 patient was found BCS once more 15 d after the retransplantation and the third-transplantation was performed 7 months after the second transplantation, no BCS was found again. The deaths total rate was 13.6%, death rate of retransplantation was 44.0%, total cure rate was 54.0%, total improvement rate was 71.0% and total stenosis rate was 29.0%.

CONCLUSIONS(1) According to the check with optical fiber choledochoscope, there are 6 types of patho-typing in BCS patients. The clinical manifestation includes jaundice and fever. The filling defect of the biliary tract tree might showed 4 appearances. (2)The patho-typing contributes to the clinical manifestation and the filling defect of the biliary tract tree.

Adult ; Aged ; Biliary Tract Diseases ; etiology ; pathology ; therapy ; Female ; Follow-Up Studies ; Humans ; Liver Transplantation ; Male ; Middle Aged ; Postoperative Complications ; etiology ; pathology ; therapy ; Prognosis ; Retrospective Studies

Child, Preschool ; Female ; Follow-Up Studies ; Homozygote ; Humans ; Hyperlipoproteinemia Type II ; genetics ; surgery ; Infant ; Liver Transplantation ; methods ; Living Donors ; Male

Percutaneous transluminal coronary angioplasty(PTCA) has been widely applied in patients with coronary artery disease since 1977. Although coronary angioplasty has beeb shown to be safe and effective treatment strategy, acute closure & restenosis remain as major limitations of PTCA. Acute occlusion due to intracoronary thrombus accumulation during or immediately after coronary angioplasty is serious complication of PTCA, also, Intracoronary urokinase has been used to treat acute occlusion by intracoronary thrombus that complicated in PTCA and proved to be effective in restoring vessel preventing acute myocardial infarction. We report a case in which embolism of left anterior descending artery was complicated during angioplasty of left circumflex artery and managed with intracoronary infusion of urokinas.
Angioplasty* ; Arteries* ; Coronary Artery Disease ; Embolism ; Humans ; Myocardial Infarction ; Thrombocytosis ; Thromboembolism* ; Thrombosis ; Urokinase-Type Plasminogen Activator

BACKGROUNDAlthough liver transplantation has become a standard therapy for end-stage liver diseases, the experience of pediatric liver transplantation is limited in China. In this article we report our experience in pediatric liver transplantation, and summarize its characters in their indications, surgical techniques, and postoperative managements.

METHODSThirty-one children (< or = 18 years old) underwent liver transplantation in our centers. The mean age at transplantation was 12.4 years old (ranged from 5 months to 18 years) with 7 children being less than 4 years of age at transplantation. The most common diagnosis of patients who underwent liver transplantation were biliary atresia, Wilson's disease, primary biliary cirrhosis, glycogen storage disease, hepatoblastoma, urea cycle defects, fulminant hepatic failure, etc. The surgical procedures included 12 standard (without venovenous bypass), 6 pigyback, 6 reduced-size, 3 split, 3 living donor liver transplantation, and 1 Domino liver transplantation. The triple-drug (FK506, steroid, and mycophenolate mofetil) immunosuppressive regimen was used in most of patients. Patients were followed up for a mean of 21.8 months.

RESULTSFive of the 31 patients died during perioperative time; mortality rate was 16.1%. The reasons of death were infections, primary non-function, heart failure, and hypovolemic shock. Postoperative complications in 10 patients included biliary leakage, acute rejection, abdominal infection, hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, and pulmonary infection. Overall patient cumulative survival rate at 1-, 3-, and 5-year was 78.1%, 62.6%, 62.6%, respectively.

CONCLUSIONSThe most common indications of pediatric liver transplantation were congenital end-stage liver diseases. According to patients' age and body weight, standard, piggyback, reduced-size, split, or living donor liver transplantation should be performed. Pediatric liver transplantation especially requires higher surgical skills. The early postoperative management is the key to success. Postoperative bile leak was common, but most patients underwent liver transplantation had a better prognosis.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Liver Transplantation ; adverse effects ; mortality ; Male ; Postoperative Complications ; etiology ; Retrospective Studies ; Survival Rate

OBJECTIVETo summarize the clinical efficacy of pediatric liver transplantation, and investigate the characters of pediatric liver transplantation in their indications, surgical procedures and postoperative management.

METHODSFrom August 2000 to March 2007, 23 liver transplantations were performed on 20 children, aging from 6 months to 13 years old. The most common indications were biliary atresia, Wilson's disease, glycogen storage disease and urea cycle defects. Surgical procedures included 4 living donor liver transplantations, 1 Domino liver transplantation, 5 split grafts, 10 reduced liver grafts and 3 whole cadaveric grafts. The triple-drug (FK506, steroid and MMF) immunosuppressive regimen was used in 19 children, except one children using cyclosporine.

RESULTSThree children died of primary non-function, heart failure and abdominal infections respectively during peri-operative period, and the mortality was 15.0%. Nine children showed different post-operative complications including 2 hepatic artery thrombosis, 1 portal vein thrombosis, 1 acute rejection, 3 biliary leakage, 2 biliary stricture, 2 intestinal fistula, 3 abdominal infection, 1 pulmonary infection and 1 heart failure. Cumulative patient survival rates at 6-month, 1-and 2-year were 80.0%, 73.9% and 73.9%, respectively.

CONCLUSIONSLiver transplantation is an effective option to cure the liver disease of children with end-stage. Different surgical procedure could be chosen according to the children's age and body weight.

Adolescent ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Immunosuppressive Agents ; administration & dosage ; Infant ; Liver Transplantation ; methods ; Male ; Postoperative Complications ; therapy ; Retrospective Studies ; Survival Rate ; Treatment Outcome

OBJECTIVETo evaluate the efficacy and safety of hepatitis B immunoglobulin (HBIG) by different medicating ways in patients with liver transplantation and to explore the methods for calculating the intravenous loading dosage of HBIG.

METHODSThe patients enrolled were randomized into three groups (i.v group, i.m group and domino group). Under the combined utilization with Lamivudine, HBIG was given in different ways during anhepatic phase and the postoperative six days. The physical examination was done, the serum conversion rate of HBsAg was studied, the serum level of HBsAb titer, WBC, PLT, AST, GGT, TBIL, DBIL, CR, PT and PTA were tested daily within the postoperative seven days. The preoperative body weight, serum HBsAg and HBeAg titer were analyzed with the intravenous loading dosage of HBIG by multiple-factor linear regression (Stepwise).

RESULTSBoth the average negative-conversion rate of serum HBsAg and the average increasing rate of serum HBsAb titer are significantly faster in i.v group and domino group than that in i.m group within the postoperative four days (P < 0.05). The regression equation to calculate the i.v loading dosage of HBIG (IU) by preoperative criteria was drawn as 1123 + 3.4 x serum HBsAg titer (IU/L) +73 x body weight (kg). There was no linear correlation found between the level of HBeAg and the loading dosage of HBIG. There were no significant difference in body temperature, pulse rate, respiratory rate, blood pressure, WBC, PLT, AST, GGT, TBIL, DBIL, CR, PT and PTA among the three groups within the postoperative seven days (P < 0.05). The rate of the second elevation of serum ALT was 10.3% (3/29), 3.4% (1/29) and 6.7% (2/30) in i.v group, i.m group and domino group, respectively (P < 0.05), and the rate of the local complications (sclerosis, edema, pain) at the injection site was 0, 89.6% (26/29) and 0, respectively (P < 0.05).

CONCLUSIONSBased on the combined utilization of lamivudine and HBIG, the qualified intervention efficacy, less complications could be obtained by medicating HBIG in a domino way (i.v first, followed by i.m), which is worthy to be promoted.

Alanine Transaminase ; blood ; Antiviral Agents ; administration & dosage ; therapeutic use ; Combined Modality Therapy ; Drug Therapy, Combination ; Hepatitis B ; blood ; prevention & control ; therapy ; Hepatitis B Antibodies ; blood ; Hepatitis B Surface Antigens ; blood ; Humans ; Immunization, Passive ; methods ; Immunoglobulins ; administration & dosage ; therapeutic use ; Lamivudine ; therapeutic use ; Linear Models ; Liver Transplantation ; Secondary Prevention ; Treatment Outcome

Pilocarpine-induced rat epilepsy model is an established animal model that mimics medial temporal lobe epilepsy in humans. The purpose of this study was to investigate neuroimaging abnormalities in various stages of epileptogenesis and to correlate them with seizure severity in pilocarpine-induced rat epilepsy model. Fifty male Sprague-Dawley rats were subject to continuous video and electroencephalographic monitoring after inducing status epilepticus (SE) and seizure severity was estimated by frequency and total durations of class 3 to 5 spontaneous recurrent seizures (SRS) by modified Racine's classification. The 7.0 Tesla magnetic resonance imaging (MRI) with high resolution flurodeoxyglucose positron emission tomography (FDG-PET) was performed at 3 hours, 1, 3, 7 days and 4 weeks after the initial insult. The initial SRS was observed 9.7±1.3 days after the pilocarpine injection. MRI revealed an abnormal T2 signal change with swelling in both hippocampi and amygdala in acute (day 1 after injection) and latent phases (days 3 and 7), in association with PET hypometabolism in these areas. Interestingly, the mean frequency of class 3 to 5 SRS was positively correlated with abnormal T2 signals in hippocampal area at 3 days. SRS duration became longer with more decreased glucose metabolism in both hippocampi and amygdala at 7 days after pilocarpine injection. This study indicates that development and severity of SRS at chronic phase could be closely related with structural and functional changes in hippocampus during the latent period, a pre-epileptic stage.
Amygdala ; Animals ; Classification ; Epilepsy* ; Epilepsy, Temporal Lobe ; Glucose ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Male ; Metabolism ; Models, Animal ; Neuroimaging ; Pilocarpine ; Positron-Emission Tomography ; Rats ; Rats, Sprague-Dawley ; Seizures ; Status Epilepticus

Next-generation sequencing (NGS) is becoming essential in the fields of precision oncology. With implementation of NGS in daily clinic, the needs for continued education, facilitated interpretation of NGS results and optimal treatment delivery based on NGS results have been addressed. Molecular tumor board (MTB) is multidisciplinary approach to keep pace with the growing knowledge of complex molecular alterations in patients with advanced solid cancer. Although guidelines for NGS use and MTB have been developed in western countries, there is limitation for reflection of Korea’s public health environment and daily clinical practice. These recommendations provide a critical guidance from NGS panel testing to final treatment decision based on MTB discussion.