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Biomedical subjects

S V Lynch

Publications and source records attributed to S V Lynch.

83 records · Page 5Linked to original sources
PubMed1991

Malnutrition in children with chronic liver disease accepted for liver transplantation: clinical profile and effect on outcome.

The nutritional profiles of 37 children (aged 0.5-14.0 years) with chronic liver disease at the time of acceptance for orthotopic liver transplantation (OLTP) have been evaluated using clinical, biochemical and body composition methods. Nutritional progress while waiting for a donor has been related to outcome, whether transplanted or not. At the time of acceptance, most children were underweight (mean standard deviation (s.d.) weight = -1.4 +/- 0.2) and stunted (mean s.d. height = -2.2 +/- 0.4), had low serum albumin (27/35) and had reduced body fat and depleted body cell mass (measured by total body potassium--mean % expected for age = 58 +/- 5%, n = 15). Mean ad libitum nutrient intake was 63 +/- 5% of recommended daily intake (RDI). Those who died while waiting (n = 8) had significantly lower mean initial s.d. weight compared with those transplanted. The overall actuarial 1 year survival of those who were transplanted (mean waiting time = 75 days) was 81% but those who were initially well nourished (s.d. weight greater than -1.0) had an actuarial 1 year survival of 100%. There were no significant differences in actuarial survival in relationship to age, type of transplant (whole liver or segmental), liver biochemistry or the presence or absence of ascites. Of the total group accepted for OLTP, whether transplanted or not, the overall 1 year survival for those who were relatively well nourished was 88% and for those undernourished (initial s.d. weight less than -1.0) was 38% (P less than 0.003). Declining nutritional status during the waiting period also adversely affected outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

The relationship of cognitive skills performance to activities of daily living in stroke patients.

This article reports on two studies that examine the relationship between measurements of activities of daily living (ADL) and cognitive skills performance. Study 1 is a post hoc analysis of ADL improvement scores collected on acute stroke patients who were either given or not given cognitive skills remediation. An examination of individual ADL scores showed significantly higher personal hygiene, bathing, and toilet activity improvement scores for patients receiving cognitive skills remediation. In Study 2, cognitive skills and ADL pre- and posttest scores for stroke patients were measured by occupational therapists, who also implemented an ADL as well as a cognitive skills remediation program as part of the patient's therapy. Some significant positive correlations between initial cognitive skills measurements and ADL outcome were found. The best correlate of patients' ADL performance at discharge was performance on an auditory attention task. Verbal comprehension correlated with overall ADL improvement, and overall cognitive skills improvement correlated with overall ADL improvement. Implications of these two studies are discussed.

Activities of Daily Living↗
PubMedDate not supplied

Continuing management of liver transplant patients after discharge.

The management of liver transplant patients after discharge is a complex balance between immunosuppression and the side-effects and toxicity of such medications. The Queensland Liver Transplant Service (QLTX) has performed 72 transplants in 67 patients; 49 patients (73%) are alive. The actuarial 1-year survival rate is 72%. Death after the first year in patients transplanted for benign HBsAg negative disease has not occurred. The most common technical complications are biliary stenosis and hepatic artery thrombosis. Long-term immunosuppression is with cyclosporin and low dose prednisolone. Regular trough cyclosporin levels and liver function tests are vital. The most limiting side-effect of cyclosporin is nephrotoxicity. Constant vigilance, aggressive investigation, and management of pyrexia and biochemical liver dysfunction by the primary care physician in consultation with the transplant team will ultimately determine long-term outcome. The principles and important details of the management of these patients by the QLTX are presented as a guide to referring practitioners.

Bile Duct Diseases↗
PubMedDate not supplied

Hemodynamic changes in blood flow through the denervated liver in pigs.

We investigated the effects of liver denervation on hemodynamic circulation in seven anesthetized pigs. Simultaneous measurements of the hepatic artery and portal vein were performed with an ultrasound Doppler flow meter before and after liver denervation. Neither resting systemic nor hepatic hemodynamics changed following liver denervation. However, temporary occlusion of the portal vein resulted in a significant increase in hepatic artery flow in the innervated liver (from 123 +/- 15 ml/min to 177 +/- 17 ml/min, p < .01), whereas, in the denervated liver, a significant decrease was observed (from 128 +/- 11 ml/min to 106 +/- 19 ml/min, p < .05). Thus, the reciprocity between the hepatic artery and portal vein in the hepatic artery flow during portal vein occlusion might intensify symptoms of portal vein thrombosis in liver transplantation. In the denervated liver, a significant decrease also occurred in systolic blood pressure and central venous pressure from 1 to 3 min after portal vein occlusion. Since the liver plays a crucial role in the maintenance of cardiovascular homeostasis during blood loss, it is likely that denervation at the porta hepatis induced a lack of vasoconstriction in the portal territory. Liver denervation might further exacerbate this response to hypotension. The current study confirms that the hepatic nerves play an important role in hepatic arterial and portal venous interactions aimed at maintaining a constant blood flow through the liver. We also suggest that the hepatic nerves are important for cardiovascular homeostasis.

Animals↗
PubMedDate not supplied

Surgical complications and long-term outcome in pediatric liver transplantation.

BACKGROUND/AIMS: Liver transplantation has been widely accepted for the treatment of children with end-stage liver disease over the last 10 years particularly with the advent of reduced-size liver transplant technique. This study reviewed the perioperative and long-term results in the pediatric program of the Queensland Liver Transplant Service, Brisbane, Australia. METHODOLOGY: Retrospective analysis was performed in 153 children who received 176 liver grafts between 1985 and 1995, including 109 (62%) reduced-size and 67 (38%) whole liver grafts. Median follow-up period was 5.3 years. RESULTS: One-, 5-, and 10-year patient and graft survival rates were 82% and 74%, 75% and 63%, and 70% and 60%, respectively. Normal physical and intellectual development was observed in 98% of survivors. There were no significant differences in patient or graft survival rates between transplants using reduced-size and whole liver grafts. Portal vein thrombosis was the most common vascular complication, occurring in 8%. Hepatic artery thrombosis occurred in 7%, including 11% of children less than 1 year old and 8% of those under 10 kg. Biliary complication was found in 16% and posttransplant gastrointestinal perforation in 19%. CONCLUSIONS: Liver transplantation has the potential to cure and allow development in children with end-stage liver disease.

Adolescent↗
PubMedDate not supplied

Child-Pugh class, nutritional indicators and early liver transplant outcomes.

BACKGROUND/AIMS: Patients with chronic liver disease undergoing liver transplantation have reduced body fat and muscle mass. The extent to which nutritional indicators and Child-Pugh class are predictive of postoperative outcome in adults is unclear. The aims of this study were to determine in adult patients undergoing transplant 1) the influence of preoperative Child-Pugh class and nutritional indicators on early transplant outcomes and one-year survival, 2) the relationship between nutritional indicators and Child-Pugh class and disease type. This study included 80 patients (1990-1994). METHODOLOGY: The nutritional indicators utilized were grip strength, triceps skinfold thickness and uncorrected mid-arm muscle area. Measured outcomes were ventilator time, intensive care stay, postoperative hospital stay and one-year survival. RESULTS: Early morbidity was determined in survivors. Child-Pugh class C patients required longer ventilation and spent more time in the intensive care unit than Child-Pugh classes A and B. No significant relationships were found for length of hospital stay. Relationships between the nutritional indicators (when controlled for Child-Pugh class) and early morbidity could not be determined due to insufficient data. No relationship was established between one-year survival and Child-Pugh class or the nutritional indicators. Grip strength and mid-arm muscle area were lower in the patients in Child-Pugh classes B and C. Parenchymal liver disease was associated with lower grip strength and mid-arm muscle area when compared to cholestatic disease. CONCLUSIONS: Child-Pugh class C is associated with greater early postoperative morbidity. Advanced Child-Pugh class is also associated with diminished muscle status and parenchymal disease.

Adolescent↗