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J L Lichtor

Publications and source records attributed to J L Lichtor.

52 records · Page 3Linked to original sources
PubMed1990

Application of reduced-size liver transplants as split grafts, auxiliary orthotopic grafts, and living related segmental transplants.

The University of Chicago program in pediatric liver transplantation continues actively to seek innovative surgical solutions to problems related to the management of children with end-stage liver disease. Among the most important problems facing these children is a shortage of donor organs, which results from three factors in addition to the actual supply of pediatric donors: the concentration of pediatric liver disease in the population younger than 2 years; the necessity for a graft that is small enough; and the epidemiology of accidents and other events that lead to organ donation. Transplantation using a liver lobe as a graft overcomes size disparity and shifts the available supply of organs from older donors to younger recipients. This work describes the technical aspects of recent innovations in the use of liver lobes in pediatric transplantation, simple reduced-size liver transplantation (RLT), split-liver transplantation (SLT), orthotopic auxiliary liver grafting (ALT), and transplantation using a living related donor (LRLT), and compares their results. Since November 1986 a total of 61 procedures have been performed in which a liver lobe was used as a graft: 26 RLT; 30 SLT, 25 in children and 5 in adults; 5 LRLT; and 1 ALT. Overall 62% of transplants performed in children have involved using a liver lobe as a graft. The rates of complications are somewhat higher than with whole-liver transplantation, but this may not be entirely the result of the complex procedures. Split liver transplantation is associated with the highest mortality and complication rates. Living related liver transplantation has been associated with complications in donors and recipients, but to date survival is 100%. Orthotopic auxiliary liver transplantation effectively corrected the metabolic defect in one patient with ornithine transcarbamylase deficiency. Overall the various modalities of using graft reduction have resulted in postoperative results similar to those achieved with full-size grafts, while pretransplantation mortality has been limited to less than 2%. Thus the use of grafts as liver lobes accomplishes the goal of reducing global mortality among children with end-stage liver disease, but at the cost of increased surgical complexity and more postoperative complications.

Adult↗
PubMed1989

Right heart dysfunction, pulmonary embolism, and paradoxical embolization during liver transplantation. A transesophageal two-dimensional echocardiographic study.

In 16 adult patients, we performed continuous intraoperative two-dimensional transesophageal echocardiography (2DTEE) to help elucidate the mechanism of myocardial dysfunction that accompanies liver transplantation. In 4 of the 16 patients "paradoxical" motion of the interventricular septum consistent with right ventricular failure was seen. An additional three of the 16 patients showed right atrial enlargement and right-to-left deviation of the interatrial septum. Two patients showed evidence of paradoxical embolization (one of whom had right ventricular and right atrial enlargement), and a third patient (who had right atrial enlargement) embolized a large right atrial thrombus into the pulmonary circulation. Two-dimensional transesophageal echocardiography demonstrated that isolated right ventricular failure might account for some of the hemodynamic instability seen during liver transplantation. Venous, pulmonary, and paradoxical embolization of air and thrombi documented by transesophageal echocardiography likely contribute to right heart failure.

Adolescent↗
PubMed1988

Transcutaneous monitors during one-lung ventilation: are they reliable?

During one-lung ventilation, levels of oxygen and carbon dioxide in the blood are commonly assessed by intermittent blood gas sampling. Transcutaneous PO2 (tcPO2) and transcutaneous PCO2 (tcPCO2) have been reported to accurately reflect arterial PO2 (PaO2) and arterial PCO2 (PaCO2) in hemodynamically stable patients. Transcutaneous monitors appear to be ideal for detecting trends toward hypoxia and hypercarbia, conditions that may not be evident when using intermittent blood gas sampling, while pulse oximetry, since it reflects saturation, may not detect hypoxia until it has already occurred. Thirty: one patients undergoing one-lung ventilation were monitored using both transcutaneous electrodes applied to the upper arm (group 1) or chest (group 2) and arterial blood gas sampling. Arterial blood gases were sampled while tcPO2 and tcPCO2 values were being recorded. Regression, correlation, and covariance analyses were performed. Correlation coefficients of PaO2 to tcPO2 varied from .05 to .99 for each patient. The slopes of individual regression lines varied from 0.03 to 1.16. Correlation coefficients of PaCO2 to tcPCO2 varied from .01 to .99, while the slopes of individual regression lines ranged from 0.02 to 5.89. Covariance analyses revealed considerable variation in PaO2 to tcPO2 and PaCO2 to tcPCO2 in individual patients even under stable hemodynamic conditions. Analysis of covariance also demonstrated that in group 2 the slopes comparing arterial and transcutaneous values were significantly different for PaO2 <100 mmHg and PaO2 >200 mmHg. In group 1, for PaO2 <100 mmHg, there was no difference in slopes but y-intercepts were significantly different (P < .05). However, transcutaneous indices were significantly different in both groups for PaO2 <100 mmHg and PaO2 >200 mmHg. It is concluded that transcutaneous monitoring is useful to indicate trends in arterial values in some patients, but blood gas analysis is still necessary to verify the reliability of such monitoring.

Adult↗
PubMed1988

Liver transplantation, including the concept of reduced-size liver transplants in children.

Since the establishment of a clinical program in liver transplantation in 1984, 162 liver transplants have been performed in 131 patients (78 adults, 53 children). The patient mortality rate while waiting for a suitable organ has been 8% for adults and only 4% for children (25-46% reported in the literature). The low pediatric mortality is a result of the use of reduced-size liver transplants. A total of 14 procedures have been performed in recipients whose clinical condition was deteriorating and for whom no full-size graft could be located. Of 14 children, 13 were less than 3 years of age. Patient survival is 50%, comparable to survival of high-risk recipients of full-size livers. Using reduced-size liver grafting in a transplant program can lower mortality for children awaiting a transplant by overcoming size disparity. Reduced-size liver grafting will allow more effective use of donor resources and provide a potential avenue of research for organ splitting and living related donation.

Adolescent↗
PubMed1988

Liver transplantation with reduced-size donor organs.

Orthotopic liver transplantation (OLT) of the pediatric patient is often limited by the availability of a size-matched donor organ. Use of reduced liver transplantation (RLT) can increase the proportion of candidates transplanted and may reduce overall mortality. We report herein the initial clinical application of RLT in the United States. Indications for RLT included fulminant hepatic failure (n = 2), acute hepatic artery thrombosis (n = 3), and chronic liver disease unresponsive to inpatient support and more than 30 days on transplant list (n = 4). Donor hepatectomy was performed using standard techniques. Formal hepatic resection was performed ex-vivo to create a size-matched graft, from the larger donor organ, which was implanted in the orthotopic position. Between 11/84 and 4/87, 70 pediatric patients were evaluated for OLT, and 33 of these were transplanted. During this period only 5 patients (7%) died awaiting OLT. Of 33 patients treated at the University of Chicago, 5 received RLT. Donor: recipient weight ratios ranged from 2:1 to 8.1:1. For RLT median operative blood loss was 1.7 blood volumes (range 0.5-11.7) with an operative time of 9.3 + 3.5 hr. Acceptable early graft function was observed in five patients, all of whom were discharged from the hospital. Four of these five patients are alive between 2 and 48 months after transplantation. Marginal graft function with cholestasis and coagulopathy was associated with acute intracranial hemorrhage and neurologic death in one case. One patient died intraoperatively with non-function caused by the use of a liver from a donor with steatosis and a poor size match. Another patient died on day 5 with primary nonfunction and persistent hemorrhage. Systemic cytomegalovirus infection was the cause of death in the other two cases. RLT can provide life-sustaining liver function in urgent clinical settings. The graft can serve as a temporary or permanent liver replacement. With evolution of the technique RLT could eventually be offered to more elective candidates and increase the utilization of available donors by reducing size limitations in OLT.

Adolescent↗
PubMed1983

Cardiovascular effects of inhalation induction with isoflurane in infants.

We evaluated hemodynamic changes during inhalation induction of isoflurane anesthesia in 60 healthy infants aged 5-26 weeks who were randomly divided into two groups of 30 patients each. In group 1 anesthesia was induced using isoflurane in concentrations that were increased to 3.5%. In group 2, 0.02 mg/kg of atropine was given intramuscularly before induction of anesthesia, as in group 1. In both groups, N2O (3 L/min) and O2 (2 L/min) were administered using a nonrebreathing system. Heart rate (HR) and blood pressure (BP) were recorded at 1-min intervals for 20 min. HR decreased 32% in group 1 and 20% in group 2; BP decreased 40% in group 1 and 38% in group 2. During isoflurane induction in infants, both HR and BP are depressed. Premedication with atropine minimizes the depression of HR, but does not affect the change in BP.

Anesthesia, Inhalation↗
PubMed1982

Cardiovascular depression during halothane anesthesia in infants: study of three induction techniques.

Hemodynamic changes during three techniques for induction of halothane anesthesia were studied in 90 healthy infants aged 5 to 26 weeks who were randomly divided into three groups of 30 patients each. In group I, anesthesia was induced using halothane in concentrations that were increased to 3%. In group II, atropine, 0.02 mg/kg, was given intramuscularly before induction, followed by induction as in group I. In group III, halothane in concentrations that were increased to 1.25% was followed by intramuscular succinylcholine, 2 mg/kg, 90 seconds after the start of induction. In all three groups N2O 3 L/min and O2 2 L/min were employed using a non-rebreathing system. Heart rate (HR) and blood pressure (BP) were recorded at 1-minute intervals for 20 minutes. HR decreased 30% in group I, 18% in group II (p less than 0.01), and 29% in group III. BP decreased 50% in group I (p less than 0.01), 34% in group II, and 33% in group III. During halothane induction in infants, bradycardia can be minimized with preoperative atropine; the degree of hypotension can be diminished with either preoperative atropine or the use of intramuscular succinylcholine combined with lower concentrations of halothane.

Anesthesia, Inhalation↗
PubMed1981

Indirect measurement of blood pressure in neonates and infants utilizing an automatic noninvasive oscillometric monitor.

An indirect automatic blood pressure (BP) monitor utilizing the oscillometric principle and a microprocessor is now available for use in infants. This device was evaluated by comparing its systolic BP determinations with simultaneous Doppler systolic BP determinations in neonates and infants undergoing general anesthesia. Five determinations each were made in 125 babies who were grouped according to age. Correlation coefficients of the paired BP determinations were: in 27 premature neonates, r = 0.82; in 24 term neonates, r = 0.93; in 47 infants aged 5 to 13 weeks, r = 0.92; and in 27 infants aged 14 to 26 weeks, r = 0.94. The device was also evaluated by comparing its BP determinations with those of indwelling arterial lines present in 20 additional infants (five determinations each). Correlation coefficients were 0.96 for systolic determinations and 0.94 for diastolic determinations. No morbidity or significant technical problems were noted. It was concluded that the device is an accurate, safe, and easy noninvasive method for monitoring BP in infants.

Blood Pressure Determination↗