Successful resuscitation of cardiac arrest due to postreperfusion syndrome during orthotopic liver transplantation: a case report.

A patient with alcohol induced end-stage liver disease developed cardiac arrest immediately after reperfusion during orthotopic liver transplantation. In our case, advanced age of the patient, alcohol-related severe liver disease with high ASA score, and myocardial dysfunction, combined with acute metabolic and hemodynamic changes throughout the surgery may have contributed to the development of postreperfusion syndrome resulting in cardiac arrest. Our patient required a total of 5 mg epinephrine, 200 mg lidocaine, 100 mEq NaHCO3, and 40 mEq calcium gluconate together with direct cardiac compressions and ventilation enriched 100% oxygen to regain sinusoidal rhythm. In conclusion, during severe postreperfusion syndrome, the collaboration between the surgical and anesthesia teams is crucial to overcome cardiac arrest. In an open abdomen, direct cardiac compressions through the transdiaphragmatic pericardial window instead of chest compressions were important to restore effective circulation during advanced life support.

Liver transplantation of a child with child a cirrhosis and severe hepatopulmonary syndrome.

Hepatopulmonary syndrome (HPS) is a clinical state defined by a chronic hepatic disorder, intrapulmonary vascular dilatation, and altered gas exchange resulting in hypoxemia. Cirrhosis of the liver is the most common condition associated with HPS. A 3-year-old boy who presented with end-stage liver disease and severe hepatopulmonary syndrome underwent orthotopic liver transplantation (OLT). The findings of HPS resolved immediately after OLT. His status is within normal limits at 6 months after liver transplantation.

The prevention of bone fractures after liver transplantation: experience with alendronate treatment.

OBJECTIVE: The aim of this study was to prevent fractures in the first postoperative year. METHODS AND PATIENTS: We studied 59 patients (48 men, 11 women) aged 42.6+/-11.4 years, who underwent liver transplantation. All patients received oral alendronate 70 mg weekly and calcium 1 g and calcitriol 0.5 mug daily. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at the lumbar spine and proximal femur at baseline as well as at 6 and 12 months after transplantation for comparison with an historical control group (n=31). Spinal radiographs were obtained to assess vertebral fractures at the same time. Additionally, serum osteocalcin, serum parathyroid hormone (PTH), urinary deoxypyridinoline (DPD), and biochemical parameters were determined every 3 months. RESULTS: At baseline, femoral total BMD of men was significantly greater than that of women (P<.05, .85+/-.1 vs .74+/-.1). A significant increase in BMD was observed at 12 months (P<.05), no patient developed a bone fracture. Comparison analysis of genders showed that there was a significant difference in favor of men (P<.05). The lumbar BMD, neck T-, and Z-scores were significantly higher among patients treated with alendronate than historical controls (P<.05). After 3 months, serum PTH was increased and serum osteocalcin and urinary DPD were reduced. No severe side effects from alendronate treatment were observed during the study. CONCLUSION: A direct sign of the success of our study was no fracture observed during the first postoperative year. Alendronate should be considered for patients with low bone mass after liver transplantation.

Determination of Rational Drug Use Behaviors of Adult Individuals - A Cross-Sectional Study from Turkey.

PURPOSE: The aim of this study was to determine rational drug usage behaviour of adults. MATERIAL/METHODS: The study was descriptive and cross-sectional. The study was conducted between January-March 2014 in Mustafa Kemal Pasa Cevizli Family Health Center in the province of Bursa, Turkey. The sample of study was composed 129 individuals who 18 years and over, had not the communication problem with place, and time orientation and accepted a voluntary basis in the study. In the collection of study data, individual identification questionnaire and questionnaire for rational drug use which by researchers in the direction of literature was used. RESULTS: It was found that 30.2% (n: 39) of the individuals enrolled in the study were in the 18-30 age range, 57.4% (n: 74) were male, 42.6% (n: 55) were graduated from primary school, 34.9% (n: 45) were housewife, and 32.6% (n: 42) have chronic disease. 52.7% (n: 68) of the individuals, found that they used irregular their drugs, 70.6% (n: 48) did not comply the hours of taking drug, 23.3% (n: 30) used drug before consulting a doctor, 69% (n: 89) read the prospectus of drugs, 73,5% (n: 95) was prescribed the most analgesic drugs, and 65.9% (n: 85) didn't stop before the end of the antibiotic group drugs. It was found that there did have a significant difference between the presence of chronic disease of the individuals who participated in the study and their habits of regular drug using and their situation of drug prospectus reading (p<0.05). CONCLUSIONS: As a result, it was found that individuals do not comply for rational drug use. In this respect; it is recommended to organize training programs the individuals to increase awareness about rational drug use and to perform the study on the most the sample.

Our First Experience With Negative Pressure Incision Management System Implemented on the Clean Surgical Incision in the Renal Transplantation Recipient: A Case Report.

Multiple comorbidities and environmental factors increase the complications of incisional wounds in patients. It was demonstrated in previous prospective and randomized studies that negative pressure wound therapy (NPWT) reduced wound infection and other complications in clean, closed surgical incisions. In this case report, the Prevena incision management system was implemented on the clean, closed surgical incision of a 52-year-old female patient, who was given a renal transplantation from cadaver postoperatively in the operating theater. It was removed from the patient on the fifth day after the operation. Following the removal of Prevena, the wound and surrounding skin of the patient were observed. Wound healing was complete, and no skin lesion or tool-related complication was found around the wound due to NPWT. The Prevena NPWT system can be conveniently and safely implemented on the operational incision in renal transplant recipients in order to prevent surgical wound complications.

Successful kidney transplantation from a cadaveric donor unsuitable for other centers due to acute renal failure: a case report.

The demand for kidney transplantation due to improved recipient outcomes has stimulated surgeons to expand the criteria for usable donors, but still the use of organs from deceased donors with terminal acute renal failure is uncommon. We report 2 kidney transplant recipients from a cadaveric donor who was not accepted by other centers because of acute renal failure. The donor, a 24-year-old man with an intracerebral hemorrhage, displayed a serum creatinine (SCr) value of 0.6 mg/dL on hospital admission, which increased to 7.3 mg/dL on the fourth hospital day. After the diagnosis of brain death and refusal of the kidneys by other regional centers, we decided to transplant the 2 kidneys. Recipient 1, a 31-year-old man on an 11-year dialysis program, discontinued hemodialysis after 7 days of delayed graft function. The SCr level decreased gradually and was stable at 1.08 mg/dL on postoperative day (POD) 45. The contralateral graft was transplanted into a 30-year-old man (recipient 2) undergoing dialysis treatment for 7 years. After 10 days of delayed graft function, the SCr decreased gradually with continued hemodialysis until POD 24. The SCr level has been stable at 1.34 mg/dL on POD 52. At the end of the third month the SCr levels in recipients 1 and 2 were 1.1 mg/dL and 1.4 mg/dL, respectively. In conclusion, one may safely expand the donor pool with kidneys from deceased donors with acute renal failure (ARF) with good short-term outcomes.