Orpitt: a computerized chart for intraoperative real time management of liver transplant data.
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Biomedical subjects
Publications and source records attributed to S Agnes.
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Cerebral death is often associated with haemodynamic changes which include a decrease in cardiac output and peripheral resistance. Brain-death following head injury may also lead to acquired diabetes insipidus with secondary water and electrolyte derangement. It is therefore necessary to prevent and correct these alterations, particularly when long-term maintenance is required, in order to keep kidney function within the normal range. Computerized monitoring of renal function and electrolyte and water derangements has been adopted. In all cases where early data of renal failure or oliguria were present infusions of dopamine and fluids were started. When indicated, the optimal dose of dopamine was calculated using a computerized system to allow drug dosages and the time of haemodynamic derangement to be minimized. When acquired central diabetes insipidus was present and urine output greater than 4 ml kg-1 h-1 desamino-cis-D-arginine vasopressin (DDAVP) was administered.
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In vitro hepatic synthesis of lipids starting from (1-14C)acetate was investigated for 14 days in rats with biliary obstruction by ligation of the common bile duct using radio-thin-layer chromatography (radio-TLC). This study was correlated with a quantitative assay of the various hepatic lipids using TLC correlated with photodensitometry. Hepatic total lipid synthesis increased progressively with time. With concern to the single fractions, the major modifications were verified on the 3rd day with a decreased incorporation of the labelled acetate into the triglycerides. On the other hand, using photodensitometry, they demonstrated a percentage increase. These variations can be justified by the presence of a feedback mechanism. The syntheses of cholesterol and the other fractions were maximum during this period. Histologic examination revealed, especially on the 3rd day, a neoformation of biliary ductules and on the 14th day, a regression of these histological changes.
Twenty autotransplantations and five allotransplantations were performed in female pigs; exocrine secretion was suppressed by injecting an acrylic glue into the ductal system; pancreatic segment was transplanted extraperitoneally in the iliac fussa. We describe an original technique most suitable to the morfologic caratheristics of pancreatic gland in pigs.
An original microsurgical technique of pancreatic transplantation in the rat using the intact organ without duodenum is presented. Exocrine secretion was blocked by injection of an acrylate glue in the ductal system. This model seems to be simple and suitable to transplantation and metabolic research.
Twenty isolated pancreas allotransplantations were performed in "inbred" diabetic rats, after suppression of the exocrine secretion by injecting an acrylate glue into the ductal system. Metabolic investigations have demonstrated that the transplanted organ is able to restore the glycidic balance, whole histologic studies have shown that the acrylate glue produces pancreatic exocrine athrophy, without damaging Langerhans islets.
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Two hundred seventy-six liver transplants were retrospectively reviewed to analyze 6-month graft survival in relation to the combination of donor quality (standard donor vs nonstandard donor) and risk related to the severity of recipient liver disease low-risk, ie, United Network for Organ Sharing [UNOS] status 3/2b; high-risk, ie, UNOS status 1/2a). The overall 6-month survival rate of 82% was stratified into 4 classes: (1) standard donor to low-risk recipient = 88%; (2) standard donor to high-risk recipient = 86%; (3) nonstandard donor to low-risk recipient = 84%; and (4) nonstandard donor to high-risk recipient = 67%. According to the observed graft survival in the 4 different classes, 2 simulations were performed: the "match simulation" (transplantation of all low-risk recipients using standard donors, and transplantation of all high-risk recipients using nonstandard donors), and the "mismatch simulation" (transplantation of all the high-risk patients using low-risk donors and transplantation of low-risk patients using high-risk donors). The 6-month survival rates, calculated using the match simulation, were 74% and using the mismatch simulation, 84%. The authors suggest that, in the era of marginal donors, the recipient should be selected in relation to the characteristics of the donor according to the mismatch model.
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