Living donor liver transplantation and its effect on the donor-recipient relationship--a qualitative interview study with donors.

An important aspect in the preoperative evaluation and a legal precondition for an living donor liver transplantation (LDLT) is a family or emotionally close relationship between donor and recipient. We investigated the development of the donor-recipient relationship after LDLT. We conducted semi-structured clinical interviews with 18 donors as part of a regular postoperative follow-up and analyzed them using the method of Grounded Theory. The donation does not lead to any major changes in the donor-recipient relationship, probably due to careful pre-selection. It does however enhance the existing positive or conflicting character of the relationship. Donors sometimes downplay negative aspects in the relationship and emphasize the improvement as a way of dealing with a major life event. A donation cannot fulfill expectations linked to it and it is unfavorable to be used to improve the relationship. Potential misuse or instrumentalization of the donation by the donor are possible. Postoperative feelings of gratitude are an issue after surgery. A good relationship enhances a better management of the postoperative course. The preoperative donor-recipient relationship should be as free of conflict as possible. A thorough preoperative evaluation of the donor-recipient relationship is particularly important to assess the donors' suitability and clarify conflicts and unrealistic expectations.

Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age.

We have investigated, in a prospective study, the outcome of a valgus osteotomy of the tibia in patients less than 60 years of age with arthrosis of the medial compartment and a varus angle of no more than 177.7 degrees . Included in the study were 44 high tibial osteotomies (HTO) performed in 42 patients from 1981 until 1996. There were 35 females (2 bilateral) and 7 males, with an average age of 51 years (range: 30-60 years). Only patients in the first three grades, according to Ahlback's classification, were included. During a mean follow-up period of 10 years (range: 5-17 years), all but 2 patients experienced pain relief. The average loss of postoperative correction at 10 years was 2.4 degrees . The average postoperative Hospital for Special Surgery Knee Rating System score (HSSK) for patients with excellent or good results was 83.5 points. Survivorship analysis showed a success rate of 80% and 66% at 10 and 15 years respectively, and over 52.8% at 17 years of follow-up. HTO results in redistribution of the main stresses towards normal levels, although normal values are never attained. This is probably the reason why patients experienced good results only in the medium term.

[Psychological and somatic aspects of living liver donors: preoperative assessment and postoperative course]. / Psychische und somatische Aspekte der Leberlebendspende: Präoperative Evaluation und postoperativer Verlauf.

BACKGROUND AND OBJECTIVE: Living donor liver transplantation (LDLT) has been gaining importance in the treatment of end-stage liver disease in adults as a partial solution to the growing organ shortage. Thus far, only few empirical studies have been published on the situation of donors who are faced with the risk of medical complications after resection of the right hepatic lobe. PATIENTS AND METHODS: 87 potential donors were preoperatively assessed in the years 2000 and 2001 at the Charité Berlin. 41 potential donors were excluded, 46 donors (31 women, 15 men, mean age 41 [19 - 67] years) underwent liver surgery and were re-assessed 6 months after the operation. The frequency of postoperative complications and the course of psychosocial parameters were investigated. Donors' moods were analysed with the Berlin Mood Questionnaire, the physical complaints were assessed with the Giessen Complaint Questionnaire. The preoperative interviews of 20 potential donors were analysed according the current social qualitative research methods. RESULTS: In 11 % (n = 10) of potential donors transplantation was not recommended for psychosocial reasons because they showed a marked ambivalence towards the operation. After operation, 22 % (n = 12) of donors had postoperative complications. Most relevant single causes of severe impairment were temporary and reversible biliary leakages from the cutting edge. There were no long- term complications. 26 % (n = 10) of donors showed postoperative high values for anxious depression and physical complaints. CONCLUSIONS: The resection of the right hepatic lobe holds promise of a good psychosocial outcome for most donors, irrespective of donation-related complications. The psychosocial impairment and physical complaints of some donors after transplantation are yet not clearly understood. Further psychosocial studies will be necessary to develop criteria for an evidence based medical care of living donors.

Willingness to donate: an interview study before liver transplantation.

OBJECTIVES: The introduction of the living donation in organ transplantation introduces important new psychological conflicts and ethical questions in the transplantation process. Operation related risks, as well as dependencies in the family structure, generate considerable pressure on potential donors. The aim of the study was to reconstruct the determinants of willingness to donate before transplantation. METHODS: Evaluation of 20 taped and transcribed interviews oriented to current approaches in qualitative interview research. The approach used is based on grounded theory, qualitative content analysis, and the concept of the ideal type. RESULTS: Before surgery, "openly motivated" donors push for an operation, leaving no room for ambivalence in the evaluation process. They idealise the relationship with the recipient, and link their donation with the individual-partly in subconscious expectations and wishes. In contrast, "openly ambivalent" donors formulate their anxieties and express arguments against donation. CONCLUSIONS: Statements that claim ambivalence towards donation or utterance of arguments against donation indicate earlier coercion. Before transplantation, potential donors should have the opportunity to discuss their emotional situation to help their decision making process.

Aqueous humor penetration of ciprofloxacin in the human eye.

Two doses of ciprofloxacin were administered intravenously, 200 mg every 12 hours, to 25 patients undergoing cataract surgery. Plasma and aqueous humor were obtained at 1, 3, 5, 7, and 9 hours after the administration of the second dose of the drug. Peak intraocular concentrations (mean +/- SD), 0.21 +/- 0.1 mg/L, were detected at one hour following ciprofloxacin administration. A time-dependent decrease of the penetration was observed, and by nine hours after the administration, ciprofloxacin levels were 0.05 mg/L. These results illustrate that ciprofloxacin may be an effective antimicrobial agent for prophylactic use in ophthalmologic surgery and also for the treatment of intraocular infections due to susceptible organisms.

[Value of triiodothyroacetic acid as suppressive treatment of the thyrotropin secretion in thyroid pathology]. / Intérêt de l'acide triiodothyroacétique comme traitement freinateur de la sécrétion thyréotrope en pathologie thyroïdienne.

Fifty-six patients were treated with triiodothyroacetic acid (TRIAC) for its suppressive effect on the pituitary-thyroid function. Thirty of these patients had undergone partial thyroidectomy for benign goitre, and among these 14 had developed hyperplasia of the remaining thyroid tissue (group I); 18 presented with homogeneous or nodular goitre (group II); 8 had been thyroidectomized for carcinoma (group III). Before TRIAC was prescribed, thyroid hormones had been used in 33 patients, exerting a suppressive effect on the thyrotropic hormone in 4 patients of group III and producing signs of intolerance in 24 cases. TRIAC was administered in doses of 700-1,750 micrograms/day to all patients of group I and II, and combined with LT4 100 micrograms/day to group III patients. Suppression of the thyrotropic secretion was obtained in all group III patients and in 88 p. 100 of groups I and II patients. Thyroid gland hypertrophy regressed or disappeared in 21 patients of groups I and II, and no relapse or metastasis was observed in group III. TRIAC was well tolerated in all but one patients.

T3 kinetics in euthyroid Graves' disease patients who exhibit hyper-responsiveness to TRH after radioiodine treatment.

A major reduction in T3 turnover has been demonstrated previously in clinically hypothyroid patients. We have used non-compartmental (NC) and monocompartmental (MC) analysis to study ten patients with Graves' disease who, following treatment with radioactive iodine (RAI), are now clinically euthyroid but who showed hyper-responsiveness to TRH although serum T3 and T4 concentrations are within the normal range. T3 production rate (PR), metabolic clearance rate (MRC) and fractional-turnover (K) were all significantly reduced in patients compared with seven controls (P less than 0.01). T3, MCR and PR were consistently higher, and T3 K lower, when calculated by MC, than values calculated by NC analysis. The difference in T3 production rates between patients (mean 16.6 nmol/day) and controls (mean 38.9 nmol/day) raises the question of replacement therapy in patients who are apparently euthyroid but TRH hyper-responsive.