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Biomedical subjects

A G Sheil

Publications and source records attributed to A G Sheil.

At least 91 records · Page 5Linked to original sources
PubMed1994

Effects of total hepatectomy: studies in a porcine model.

The effects of total hepatectomy in a porcine model were studied. A portacaval shunt was constructed prior to hepatectomy, and the excised segment of inferior vena cava was replaced with a Dacron graft as soon as the liver had been removed. While the vena cava was clamped, venous return from the lower body to the heart was maintained using an extracorporeal veno-venous bypass system. The results of the study revealed that surprisingly few haemodynamic, biochemical or coagulation disturbances occur within the first 5 h following total hepatectomy in the pig, an animal with remarkably close anatomical and physiological similarities to man. In the anhepatic period which follows total hepatectomy during clinical liver transplantation, the situation is more complex, because pre-existing liver disease and portal hypertension, as well as major blood loss, often provide other reasons for metabolic and haemodynamic instability and coagulation disorders. The possible relevance of the findings in this large animal model to events that occur following total hepatectomy in the clinical situation is discussed.

Alkaline Phosphatase↗
PubMed1994

Pneumocystis carinii pneumonia after liver transplantation in adults.

Proven Pneumocystis carinii pneumonia (PCP) occurred in 8 (5.2%) of 154 adult liver transplant recipients between January 1986 and December 1992. The interval between transplantation and PCP ranged from 69 to 131 days with a mean of 95 days (SD 20 days). The PaO2 breathing room air at diagnosis ranged from 40 mmHg to 75 mmHg with a mean of 59.6 mmhg (SD 13 mmHg). Bronchial washings taken at bronchoscopy stained positively for Pneumocystis carinii and confirmed the diagnosis. Transbronchial biopsy was unnecessary for diagnosis. One patient died from PCP while the remainder recovered. Patients transplanted immediately before the index patients served as controls. Patients who developed PCP had more episodes of rejection (p < 0.05), received more OKT3 (p < 0.05), and were receiving more prednisone (p < 0.05) than controls. They also had lower levels of albumin (p < 0.01), and higher levels of alkaline phosphatase (p < 0.05), alanine (p < 0.01), and aspartate aminotransferase (p < 0.001), and gamma-glutamyltranspeptidase (p < 0.02). This study raises the possibility of selecting patients at risk of PCP for chemoprophylaxis.

Adult↗
PubMed1994

The risk of ano-genital malignancies in dialysis and transplant patients.

The incidence of anogenital malignancies is greatly increased in patients who have received a renal transplant, but this has not been well studied in patients receiving maintenance dialysis. Our aim was to assess the incidence of these malignancies in patients on dialysis and compare these to transplanted patients. The age standardized incidence ratio (SIR) for anogenital malignancies was calculated by comparing the observed number of malignancies to the expected number. The expected number was calculated by multiplying the age specific incidence rates for each malignancy by the person years at risk in 5-year age cohorts. Of 15,820 patients in the Australia and New Zealand data base, 8,215 had received a renal transplant. A total of 39,750 person years at risk were contributed by patients who had received a renal transplant, while 29,276 person years at risk were contributed by dialysis patients who had not received a renal transplant. For dialysis patients, vulval cancer occurred more commonly than expected (2 observed, 0.48 expected) giving a SIR of 4.2 (95% confidence interval = 0.4-11.9). Cervical cancer occurred less commonly with a SIR of 0.74 (95% Cl = 0.07-2.11). No cases of either anal or penile cancer occurred although these are rare tumors, with only 0.13 and 0.23 cases expected respectively. In transplant recipients 44 anogenital malignancies occurred while 4.3 could have been expected. The SIR ranged from 3.3 (95% Cl 1.7-5.8) for cervical cancer to 55.8 (95% Cl 35.8-83.0) for vulval cancer. To investigate the possible effect of chronic uremia before dialysis began, SIR was calculated to include an additional 24 months of observation before dialysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

The first five years' clinical experience of the Australian National Liver Transplantation Unit.

OBJECTIVE: To report the first five years' clinical experience of the Australian National Liver Transplant Unit. PATIENTS: Three hundred and seventy patients were referred--292 adults (79%) and 78 children (21%). The major causes of liver failure in the adults were chronic active hepatitis (25%), primary biliary cirrhosis (12%), primary sclerosing cholangitis (12%), alcoholic cirrhosis (9%) and malignancy (9%). Ten per cent of patients were referred in fulminant hepatic failure. In children, the major causes were biliary atresia (40%) and inborn errors in metabolism (27%). RESULTS: Two hundred and sixty-three patients (71%) were accepted for transplantation. Of 158 (43%) accepted for early transplantation, 22 (14%) died before a donor became available. Four hundred and forty-three suitable organ donors were referred. One hundred and twenty-six patients, including 32 children (25%), received 137 grafts. Three patients with renal failure due to hyperoxaluria type 1 received concurrent renal grafts. Ninety-two patients survived (73%). For all recipients, one-year survival was 75%. Two, three and four-year survivals were 69%. One to four-year survivals for adults with benign conditions were 77%, contrasting with results for those with hepatic malignancy (40% one-year survival). Children weighing more than 8 kg had good outcomes whether they received whole grafts or reduced-size grafts (83% one to five-year survival in both cases). Infants weighing less than 8 kg who received reduced adult grafts did significantly worse (37% one to-five year survival, P less than 0.05). Thirteen (87%) of 15 patients with fulminant hepatic failure who received grafts survived. Five of these patients were given ABO-incompatible grafts and two subsequently required retransplantation. All three patients with concurrent renal and hepatic grafts survived. Rehabilitation of survivors was excellent with 95% of adults and 100% of children pursuing normal activities. Only three grafts (2%) failed with primary non-function, all in infants because of graft infarction. Graft survival was significantly worse (P less than 0.01) in patients with a positive result to a direct cross match test against the donor. CONCLUSIONS: The need for liver transplantation in Australia is approximately eight per million of population per year. More donor offers are required to prevent deaths of patients on the waiting list. Reduced-size livers are successful for children and have alleviated considerably the critical shortage of paediatric donor livers. Successful treatment by liver transplantation can now be achieved in more than 80% of patients with non-malignant liver disorders including those with fulminant hepatic failure not responding to conservative therapy.

Adolescent↗
PubMed1992

Thrombocytopenia post liver transplantation. Correlations with pre-operative platelet count, blood transfusion requirements, allograft function and outcome.

This study reports that thrombocytopenia is a universal phenomenon post hepatic transplantation. In 53 consecutive adult patients undergoing liver transplantation the platelet count fell by a mean of 63% (157 x 10(9)/l to 50 x 10(9)/l). The platelet count reached a nadir at Day 5 post-transplant but returned to pre-operative levels by Day 14. Non-parametric regression analysis found that pre-operative platelet count, blood transfusion requirements and maximum post-operative ALT values were independent predictors of the percentage fall in platelet count. No correlation was seen with length of graft cold ischaemic time or the use of University of Wisconsin (UW) solution. The nadir day correlated with maximum post-operative bilirubin and ALT, graft ischaemic time and use of UW solution. Maximum post-operative ALT was also an independent predictor of nadir platelet count. It was observed that patients who did not survive the hospital admission had lower post-operative platelet counts and these did not return to pre-operative levels by Day 14. The percentage fall in platelet count was an independent predictor of survival. Severe thrombocytopenia was associated with cerebral haemorrhage in 3 patients. This report provides evidence that allograft dysfunction (maximum post-operative bilirubin and/or AST/ALT) was the most consistent independent predictor of the nadir platelet count, nadir day and percentage fall in platelet count post liver transplantation although the exact mechanism(s) of the platelet changes remain uncertain.

Blood Transfusion↗
PubMed1992

Successful reversal of primary graft non-function in a liver transplant patient treated with prostaglandin E1.

A 63 year old woman with liver failure received a transplant from a 21 year old male diagnosed as brain dead following a motor accident. After the operation, bile production was virtually absent and aspartate transaminase (AST) values rose dramatically 40 h postoperatively. Primary non-function of the graft was diagnosed, and the patient put on an urgent list for retransplantation. At the same time a continuous intravenous infusion of PGE1 was administered. Aspartate transaminase levels decreased within 9 h and reached normal levels by the sixth postoperative day, when bile production began to increase. Liver function subsequently returned to normal.

Alprostadil↗
PubMed1992

Temporary wound closure with expanded polytetrafluoroethylene in pediatric liver transplantation.

A shortage of donor organs of appropriate size causes lengthy delays for many children awaiting liver transplantation, and results in the death of some children on the active waiting list. A major contribution to overcoming this problem has been the use of reduced livers from adult donors. However, reduced adult livers are frequently too large to be used for small pediatric recipients ( less than 8 kg) because of the serious problems which occur when too tight an abdominal closure is attempted. We report a technique which we have used successfully in 2 children, involving the insertion of a temporary patch graft of expanded polytetrafluoroethylene. This allowed comfortable abdominal wound closure, which would not otherwise have been possible. Delayed primary closure of the abdomen 4-5 days later was achieved without difficulty in each case, the liver grafts having decreased markedly in size by this time. The technique allows greater flexibility in the use of donor livers for pediatric recipients, and thus has the potential to reduce waiting times and deaths on the waiting list for small children requiring liver transplantation.

Biliary Atresia↗