The effect of a positive T-lymphocytotoxic crossmatch on clinical outcomes in adult-to-adult living donor liver transplantation / 대한외과학회지

PURPOSE: There is controversy concerning the effect of a positive T-lymphocytotoxic crossmatch (TLC) on clinical outcomes in adult living donor liver transplantation (LDLT). The aim of this study was to investigate the effect of TLC on clinical outcomes in LDLT and to determine how long a pretransplant positive TLC continues after liver transplantation (LT). METHODS: Between January 2005 and June 2010, 219 patients underwent adult LDLT at National Cancer Center. The TLC test was routinely performed before LDLT. TLC test results were positive in 8 patients (3.7%). Patients were divided into 2 groups according to the result of TLC: positive TLC (n = 8) and negative TLC (n = 211) groups. All patients with a pretransplant positive TLC (n = 6) underwent a TLC test every week until negative conversion of TLC, except 2 patients who refused to receive the TLC test. RESULTS: Acute cellular rejection, surgical complications and patient or graft survival were not significantly different between both groups. All patients with a positive TLC (n = 6) had a posttransplant negative TLC. The median time to negative conversion of TLC was 1.5 weeks (range, 1 to 3 weeks). CONCLUSION: A pretransplant positive TLC does not affect clinical outcomes in adult LDLT. Moreover, T-lymphocytotoxic cross-reactivity disappeared within 3 weeks (range, 1 to 3 weeks) after LT.

Jejunal varix bleeding with extrahepatic portal vein obstruction after pylorus-preserving pancreatoduodenectomy: report of two cases

We present 2 patients showing afferent jejunal varix bleeding around hepaticojejunostomy caused by extrahepatic portal vein obstruction after pylorus-preserving pancreatoduodenectomy (PPPD). The case 1 was a 58-year-old woman who had recurrent anemia and hematochezia 3 years after undergoing PPPD. On the portography, the main portal vein was obliterated and collaterals around hepaticojejunostomy were developed. After percutaneous transhepatic balloon dilatation and stent placement through the obliterated portal vein, jejunal varices had disappeared and thereafter no bleeding occurred for 32 months. The case 2 was a 71-year-old man who had frequent melena 7 years after PPPD. Portal stent insertion was first tried, but failed due to severe stenosis of the main portal vein. Therefore, meso-caval shunt operation was attempted in order to reduce the variceal flow. Although an episode of a small amount of melena occurred one month after the shunt operation, there was no occurrence of bleeding for the next 8 months. For the treatment of jejunal varices, a less invasive approach, such as the angiographic intervention of stent insertion, balloon dilatation, or embolization is recommended first. Surgical operations, such as a shunt or resection of the jejunal rim, could be considered when noninvasive approaches have failed.

Resection of Hepatic Metastasis of Gastric Cancer

PURPOSE: The benefit of surgical resection for hepatic metastasis from gastric cancer still remains unclear. We planned this study to estimate the surgical outcome of hepatic metastasis from gastric cancer. METHODS: Sixteen patients underwent hepatic resections for metastasis from gastric cancer between December 1991 and May 2005. We analyzed 11 patients who had no gross residual tumor after their operations. The clinical and pathological factors were evaluated with the surgical outcomes. RESULTS: Six patients had synchronous metastasis and 5 had metachronous metastasis. The number of hepatic metastases was one in 9 patients, two in 1 patient and four in 1 patient. There was no bilobar metastasis. The extents of the hepatic resections were 3 lobectomies, 4 segmentectomies and 4 wedge resections. There was no operative mortality. There was one postoperative complication, an intra-abdominal abscess, which was cured with percutaneous drainage. The mean survival was 18 months, the median survival was 13 months and the 1-year survival rate was 52.0%. One female patient is still alive 80 months after resection for metachronous hepatic metastasis. There was no statistically significant prognostic factor except for the patients' gender. (p = 0.0378) CONCLUSION: We consider that hepatic resection is a safe and valuable option for the treatment of metastatic gastric cancer.

Exercise Therapy for Hypertensive Patients

Hypertensive patients tend to experience cardiac diseases such as myocardial infarction more frequently than the normotensive subjects. Exercise training in hypertensive patients alliviates their symptoms, improves their cardiopulmonary endurance, and decreases their cholesterol levels. Regular exercise in hypertensive patients decreases the development of their symptoms, therefore makes patients comfortable due to the decreased sympathetic tones and increased parasympathetic tones. To prescribe exercise to hypertensive patients, it is essential to evaluate the patients' blood pressure while exercising. The components of exercise prescription include the mode, intensity, duration, and frequency of exercise, The best exercise for hypertensive patients is aerobic exercise which improves cardiopulmonary functions. It makes the patients take less medications. The aerobic exercise includes cycling, walking, and running. The intensity of the aerobic exercise should be 45~60% of their VO2max value. While the patient is taking medication, the prescription of exercise should be cautious, because most antihypertensive agents decrease exercise endurance, and thus make it difficult to continue exercise, compared with those without medication.