Sleep disturbances and quality of life in patients after living donor liver transplantation.

BACKGROUND: Following improvements in patient and graft survival after liver transplantation (LT), the recipients' quality of life has become an important focus of patient care. Sleep is closely related to physical and mental health; however, sleep disturbances in LT patients have not yet been evaluated. METHODS: We assessed 59 LT patients (aged ≥18 years) between September 2011 and September 2012. The patients completed the restless legs syndrome (RLS), 36-item short-form health survey (SF-36), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) questionnaires. In addition, laboratory data were obtained and neuropsychological tests (NPT) were performed during study entry. RESULTS: Thirty-eight patients (64%) were included in the poor sleep group (PSQI ≥6 or ESS ≥10). The SF-36 scores were lower in the poor sleep group than in the good sleep group. Eleven patients (18%) had RLS. An NPT score ≥3 indicated minimal hepatic encephalopathy (MHE3). The MHE3 group consisted of 22 patients (43%). The time after LT was shorter; serum albumin, branched chain amino acid/tyrosine molar ratio (BTR), and role limitations due to poor physical health were lower; and serum ammonia levels were higher in the MHE3 group than in the MHE0-2 group. When the poor sleep group was divided into subgroups (control, MHE, RLS, and unknown), MHE patients had high model for end-stage liver disease scores, high ammonia levels, and low BTR, whereas RLS patients showed a short time after LT. CONCLUSION: Sixty-four percent of recipients were classified as poor sleepers. SF-36 scores were lower for poor sleepers than good sleepers. RLS and MHE are major diseases that cause sleep disturbances in patients after LT.

Influence of surgery for ischemic heart disease on early postoperative left ventricular function.

The pre- and postoperative systolic time intervals, hemodynamics and serum catecholamines were studied in 30 patients with successful myocardial revascularization surgery or left ventricular aneurysmectomy and the influence of the surgery on the left ventricular function was evaluated. 1. Significant depression of left ventricular performance was recognized in the group of patients with left ventricular aneurysm as compared to the patients with angina pectoris with or without previous myocardial infarction before the operation. 2. At 2 hours after the operation, signigicant decrease of ET/PEP, cardiac index and stroke work index and marked elevation of systemic vascular resistance were seen in the group of patients with aortocoronary bypass surgery who had previous myocardial infarction and with left ventricular aneurysmectomy as compared to the group of patients without previous myocardial infarction. 3. At 2 hours after the operation, ET/PEP seemed to reflect the left ventricular stroke work and the depression of the left ventricular function was mainly affected by the elevation of systemic vascular resistance due to the hypersecrection of serum catecholamines. 4. Reduction of systemic vascular resistance by vasodilator brought an improvement of EG/PEP, cardiac index and stroke work index.

Study of hemodynamic changes with oxygen inhalation in VSD associated with pulmonary hypertension.

Pre- and postoperative pulmonary hemodynamic changes were studied in 28 cases with ventricular septal defect, in whom pulmonary-systemic blood pressure ratio was more than 70%. Pp/Ps decreased and Qp/Qs increased in majority of cases and Rp/Rs decreased in all cases after 100% oxygen inhalation. In survivors, Rp/Rs decreased to under 0.5 and Qp/Qs increased to more than 2.0 after oxygen inhalation or radical operation. In nonsurvivors, Rp/Rs decreased but stayed over 0.5, and Qp/Qs increased but stayed under 2.0. It is emphasized that when Rp/Rs falls down to under 0.5 after oxygen inhalation, it will be an enough indication for operation even pulmonary hypertension is so advanced in the ventricular septal defect.