Biomedical subjects
Lynt B Johnson
Publications and source records attributed to Lynt B Johnson.
Biliary-colonic fistula: a case report and literature review.
We report the occurrence of common bile duct obstruction and biliary-colonic fistula after open cholecystectomy. Although it is a very unusual complication after cholecystectomy, biliary-colonic fistula should be part of the differential diagnosis for patients presenting with sepsis after open or laparoscopic cholecystectomy. After confirmation and characterization of the injury by endoscopic retrograde cholangiopancreatography and cholangiogram, assessment for undrained collections by computed tomography scan, control of sepsis and coagulopathy, and nutritional support, surgical repair was undertaken. The patient underwent fistula take-down between the common bile duct and the colon at the hepatic flexure, primary closure of the colon enterotomy, and a Roux-en-Y end-to-side hepaticojejunostomy at the confluence of the right and left hepatic ducts. Recovery was uneventful and the patient was doing well at the 6-month follow-up. Surgical repair should be undertaken by surgeons with extensive experience in hepatobiliary reconstruction.
Nonischemic cardiomyopathy after orthotopic liver transplantation: a report of three cases and a review of the literature.
In 2002 there were more than 5,000 liver transplantations performed in the United States. As of February 2004 there were more than 17,000 registrations for liver transplantation. As more organs are transplanted and surgical techniques improve, unique causes of morbidity and mortality will become apparent. We describe three cases of postoperative nonischemic dilated cardiomyopathy in patients who underwent orthotopic liver transplantation (OLT), one of whom underwent diagnostic myocardial biopsy. This paper will discuss the three patients, including biopsy results, and briefly review the relevant literature.
Intraoperative fluid management during orthotopic liver transplantation.
OBJECTIVE: To assess clinical safety of a low central venous pressure (CVP) fluid management strategy in patients undergoing liver transplantation. DESIGN: Retrospective record review comparing 2 transplant centers, one using the low CVP method and the other using the normal CVP method. SETTING: University-based, academic, tertiary care centers. PARTICIPANTS: Patients undergoing orthotopic cadaveric liver transplantation. INTERVENTIONS: Each center practiced according to its own standard of care. Center 1 maintained an intraoperative CVP <5 mmHg using fluid restriction, nitroglycerin, forced diuresis, and morphine. If pressors were required to maintain systolic arterial pressure >90 mmHg, phenylephrine or norepinephrine was used. At center 2, CVP was kept 7 to 10 mmHg and mean arterial pressure >75 mmHg with minimal use of vasoactive drugs. MEASUREMENTS AND MAIN RESULTS: Data collected included United Network for Organ Sharing status, surgical technique, intraoperative transfusion rate, preoperative and peak postoperative creatinine, time spent in intensive care unit and hospital, incidence of death, and postoperative need for hemodialysis. Principal findings include an increased rate of transfusion in the normal CVP group but increased rates of postoperative renal failure (elevated creatinine and more frequent need for dialysis) and 30-day mortality in the low CVP group. CONCLUSIONS: Despite success in lowering blood transfusion requirements in liver resection patients, a low CVP should be avoided in patients undergoing liver transplantation.
Impact of body mass index on graft failure and overall survival following liver transplant.
GOALS: To assess the influence of body mass index (BMI) in the outcome of liver transplantation. BACKGROUND: Body mass index appears to affect liver transplantation, independently of several risk factors. STUDY: A review of the United Network for Organ Sharing database included 32 515 liver transplants from 1992 through 2000 with at least one follow-up visit, of which 26 920 had information for determining BMI. The overall impact of elevated BMI (>25), and the impact of increasingly elevated BMI (25-40+) on graft failure rates and overall survival rates are assessed using proportional hazards regression. RESULTS: Controlling for follow-up time, age, gender, race, number of comorbidities, and status 1 designation, the impact of BMI on survival was mixed. The risk of death was elevated for patients with low BMI (<19) and BMI values of >/=40. Compared with patients with BMI of 19-22, those with BMI > 25 had a decreased likelihood of death. This decrease was seen among patients with BMI of 25-34. CONCLUSION: BMI did not significantly affect rates of graft failure. Compared with patients with a BMI in the 'normal' range, those with moderately elevated BMI had decreased likelihood of death while patients with low BMI or extremely high BMI had increased likelihood of death.
The bile duct--the Achilles' heel of living donor liver transplantation.
Explore the source record for details and available documents.
Role of gender and race mismatch and graft failure in patients undergoing liver transplantation.
Previous data have suggested an increased risk of graft failure in male recipients of female livers, and in nonwhite recipients of orthotopic liver transplantation. United Network for Organ Sharing records of liver transplantations from 1992 through 2000 with at least one follow-up visit were reviewed. Analysis of these data was performed with proportional hazards regression, controlling for follow-up time, age, gender, ethnicity, number of comorbidities, functional status at time of transplant, and status 1 designation. Separate analyses comparing transplants among whites and blacks only and matched versus mismatched transplants for male and female recipients were performed. The results revealed that gender-mismatched patients (n = 13,992) had a higher likelihood of graft failure when compared with gender matched transplants (n = 18,522) (12.2% versus 11.3% respectively, P =.013). After controlling for the above potential confounders, gender-mismatched patients were found to have a 6.9% increase in likelihood of graft failure, (P =.042). Female recipients receiving male organs had no significant change in the risk of graft failure (11.5%; P =.368). A worse outcome was found in male recipients receiving female organs (12.9%; P =.0003). Graft failure rate among patients with donors matched by race (white to white or nonwhite to nonwhite; n = 21,818) was 11.6% versus 11.9%, and among unmatched patients (n = 10,697), the difference was not significant (P =.33). Multivariate regression analysis controlling for potential confounders confirmed that this difference was not significant (P =.21). Mismatch between black donors and white recipients was found to increase the risk of liver graft failure (27.4%, P = <.0001), independently of gender, number of comorbidities, and functional status at time of transplant.
MR angiography and preoperative evaluation for laparoscopic donor nephrectomy.
OBJECTIVE: The purpose of our study was to evaluate the effectiveness of gadolinium-enhanced MR imaging in imaging arterial, venous, and ureteric anatomy in a group of potential laparoscopic renal donors and to compare our findings with those established at surgery. SUBJECTS AND METHODS: Sixty-four consecutive patients underwent successful laparoscopic donor nephrectomy. Imaging of the kidneys was performed before surgery with MR imaging and breath-hold three-dimensional gadolinium-enhanced MR angiography. All studies were reviewed prospectively by one of two attending radiologists. Results were compared with findings at the time of laparoscopic nephrectomy. RESULTS: Of the 64 patients, MR imaging and MR angiography identified 30 patients with normal arterial, venous, and ureteric anatomy, and concordance was found at surgery in 29 of these patients. Vascular anomalies were depicted on MR imaging in 34 patients, with complete concordance at surgery in 29 patients. The use of MR angiography for revealing arterial anomalies had a sensitivity of 89.4%, specificity of 94.1%, and accuracy of 90.6%. For venous anomalies, there was a sensitivity of 98.3%, specificity of 100%, and accuracy of 98.4%. No important utereric anomalies were identified at surgery or on MR imaging. CONCLUSION: Renal MR imaging and gadolinium-enhanced MR angiography provide a safe, accurate, and minimally invasive means of comprehensive assessment of the potential living renal donor.
Some of the challenges of encouraging organ donation among minority populations.
Explore the source record for details and available documents.