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Biomedical subjects

B W Shaw

Publications and source records attributed to B W Shaw.

At least 145 records · Page 8Linked to original sources
PubMed1989

Pontine and extrapontine myelinolysis following liver transplantation. Relationship to serum sodium.

The relationship between central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) and serum sodium changes in the setting of orthotopic liver transplantation (OLT) is examined. Postmortem examination of 14 patients with end-stage liver disease who underwent liver transplantation revealed CPM in four, of which three also had EPM. A retrospective review of clinical and laboratory data was performed on all patients. There were marked perioperative rises (21-32 mEq/L) in the serum sodium concentration in all four patients who developed myelinolysis. In contrast, the largest increase in sodium in patients without demyelination was 16 mEq/L. We conclude that perioperative rises in the serum sodium concentration increase the risk of myelinolysis. CPM and EPM should be considered if the patient develops mental status changes or focal neurological deficits several days after OLT.

Adult↗
PubMed1989

Distal splenorenal shunt for portal vein thrombosis after liver transplantation.

A 17-yr-old female received a liver transplant for type I glycogen storage disease. A year later, when she experienced variceal gastrointestinal hemorrhage, an angiogram revealed thrombosis of the portal vein with hepatopetal collateral channels. A distal splenorenal shunt was performed because of failure of sclerotherapy to control subsequent bleeding episodes and the fact that the liver function was normal. This patient continues to have normal hepatic function with a patent splenorenal shunt 4 yr after the shunting procedure. This case illustrates the feasibility of a distal splenorenal shunt to alleviate portal hypertension in cases of thrombosis of the portal vein following hepatic transplantation if the liver function is normal.

Adolescent↗
PubMed1989

Main autopsy findings in liver transplant patients.

The major autopsy findings from 22 patients (6 children, 16 adults) having undergone therapeutic orthotopic liver transplant are summarized. The mean age for children was 4.2 yr (range 4 mo to 9 yr) and 41 yr (range 20 to 57 yr) for adults. The mean posttransplant survival time in these patients was 16.7 d for children and 72.5 d for adults. The changes present in hepatic allograft included graft rejection (13), viral infections (11), massive necrosis due to hepatic arterial thrombosis (6), and recurrent hepatitis B (3). Infectious complications were present in 20 of 22 patients. The extrahepatic organs primarily involved by infection were lungs and brain. Bronchopneumonia and abscess formation were the most common lung findings, whereas cerebral edema and herniation, and infection occurred in the brain. Cardiac findings included acute myocardial infarction, mycotic mural thrombus and cytomegalovirus myocarditis. The gastrointestinal tract, adrenals, and kidneys were virtually spared. No significant changes were found in the pancreas and urogenital tract.

Adult↗
PubMed1988

Neurosurgical complications of pediatric orthotopic liver transplantation.

Liver transplantation is the only definitive treatment of end-stage liver disease. The University of Nebraska began its hepatic transplantation program in July 1985. Since that time, 43 children and 48 adults have undergone orthotopic liver transplantation (OLTx) with survival rates to date of 79.1% and 79.2%, respectively. Eight children developed complications of neurosurgical interest (18.6% incidence). Hemorrhagic complications were the most frequent. Neurosurgical salvage was achieved in five patients, but delayed complications of the transplant caused the death of two of these children. Two survivors are functioning well at home and in kindergarten, one child is doing well but is still hospitalized, and one child is vegetative. Aggressive management of life-threatening CNS problems is thus appropriate in this population. The authors review the pathophysiology of these complications, as well as potential pitfalls in their management.

Brain Abscess↗
PubMed1988

The role of nontransplant procedures for sclerosing cholangitis.

Twenty-five of 38 patients with sclerosing cholangitis underwent operative therapy at our institution. Seven patients with primarily extrahepatic obstruction had biliary bypass procedures and maintained normal liver function for 1 to 96 months. Biliary procedures were performed in 11 patients with combined intrahepatic and extrahepatic disease. Seven patients underwent subsequent liver transplantation because of deteriorating hepatic function, and two patients died before transplantation could be performed. Although there were no significant differences in outcome of liver transplantation whether or not a biliary procedure had been performed previously, previous biliary tract procedures influenced the type of biliary reconstruction performed, and two complications occurred as direct results of prior operations. Nontransplant procedures should be restricted to those patients with primarily extrahepatic obstruction, whereas liver transplantation should be considered the initial procedure of choice for patients with diffuse sclerosing cholangitis.

Adolescent↗
PubMed1988

Complications requiring operative intervention after orthotopic liver transplantation.

Survival rates after liver transplantation continue to improve, but the postoperative morbidity in these patients remains significant. The clinical courses of 96 consecutive patients who received transplants were reviewed retrospectively. Forty-two patients experienced complications requiring surgical intervention. These complications were primarily related to biliary tract reconstruction, bowel complications, and septic complications. None of the factors examined, except a second transplant procedure, proved helpful in identifying those patients most likely to experience surgical complications; however, a risk factor scoring system was found to accurately identify that group of patients at highest risk of dying in the postoperative period. Only 2 of 21 deaths could be attributed directly to the surgical complication. We believe that a policy of prompt, aggressive surgical intervention, coupled with careful tailoring of immunosuppression to both the patient and the clinical situation, can lead to a low mortality rate in patients who require reoperation.

Adult↗
PubMed1988

Rapid identification of cytomegalovirus in liver allograft biopsies by in situ hybridization.

Identifying the etiology of hepatic dysfunction in liver transplant patients is critical to their clinical management and in maintaining graft survival. While cytomegalovirus (CMV) is a well-known cause of posttransplant hepatitis, the morphologic diagnosis of CMV hepatitis in liver biopsies can be difficult. Because conventional tissue culture for CMV requires days to weeks, the final results often arrive too late to be clinically useful. In this study, 44 liver allograft biopsies from 21 patients with hepatic dysfunction were evaluated for CMV by routine light microscopy, conventional tissue culture, and in situ DNA hybridization (IH) using commercially available biotinylated CMV-specific DNA probes. Whereas 38.6% of the biopsy specimens were positive by IH, 15.9% were culture-positive biopsies and 13.6% were positive by routine light microscopy. Assuming tissue culture to be the standard, IH demonstrated a sensitivity of 100% and a specificity of 73%. In comparison, routine light microscopy showed a sensitivity of 71.4% and specificity of 97.3%. In addition, three biopsy specimens positive only by IH were from three patients who had other liver biopsies positive for CMV by either light microscopy or viral culture. In situ DNA hybridization allows rapid detection (5-6 h) of CMV in paraffin-embedded liver allograft biopsies; it also has a sensitivity that surpasses routine histologic examination and perhaps even tissue culture.

Adolescent↗
PubMed1987

Linear growth following pediatric liver transplantation.

The linear growth of 29 patients was evaluated from two to 41/2 years after liver transplantation. All patients received cyclosporine and low-dose prednisone. Eight patients (28%) displayed acceleration of linear growth velocity and were above the fifth percentile at the end of the evaluation period. Four patients (14%) grew normally prior to transplantation and continued to grow normally after the surgical procedure. Only four patients (14%) dropped from higher levels to below the fifth percentile. Thirteen patients (45%) were less than the fifth percentile before and after surgery; ten of these 13 patients have attained normal or accelerated growth velocity. Good linear growth has been achieved in more than three fourths of patients who underwent liver transplantation.

Adolescent↗
PubMed1987

Hepatocarcinoma in a child with the Alagille syndrome.

A child with the Alagille syndrome of intrahepatic bile duct paucity developed hepatocarcinoma. Disabling cirrhosis had rendered this child a suitable candidate for transplantation before the discovery of carcinoma. However, the extension of the tumor outside the liver precluded the performance of this potentially life-saving operation. Serial monitoring of the serum alpha-fetoprotein concentration may be of value in the early identification of tumors in pediatric candidates for transplantation.

Abnormalities, Multiple↗
PubMed1987

Nutritional support for the infant with extrahepatic biliary atresia.

Some infants with biliary atresia obtain dramatic improvement for prolonged periods after the performance of hepatic portoenterostomy. Such infants may have life styles not substantially different from those of normal children. In others, the benefit from this operation, if any, is short lived. These infants are very vulnerable to the debilitating effects of severe, prolonged malabsorption and ultimately require orthotopic liver transplantation to sustain life. The physician caring for infants awaiting liver transplantation can do much, not only to prolong survival but to maintain satisfactory growth and development. The key consideration is to provide adequate nitrogen and nonnitrogen calories, liberally utilizing modern methods of enteral alimentation when necessary. In addition, attention must be directed toward several vitamin and mineral deficiencies, particularly those of the fat-soluble vitamins, that inevitably accompany severe malabsorption in children. Management of extrahepatic biliary atresia in infants is difficult and requires meticulous attention to details. Nevertheless, the long-term cure of this disorder provided by liver transplantation makes their care a rewarding experience.

Biliary Atresia↗