Search PubMed⌕ Search

Biomedical subjects

P McMaster

Publications and source records attributed to P McMaster.

At least 271 records · Page 15Linked to original sources
PubMed1979

Bile studies after liver transplantation.

An analysis of bile composition following orthotopic liver transplantation in the rhesus monkey showed that during rejection only small quantities of viscid bile were produced and that this was associated with increased cholesterol saturation. Bile composition in patients after liver transplantation also showed that bile was supersaturated with cholesterol in the early postoperative period while the enterohepatic circulation of bile acids was interrupted by a draining T tube. However, further study of patients showed a poor correlation between bile composition and the development of biliary complications. An analysis of bile 'sludge' showed that after transplantation two types were encountered. The first, containing large quantities of unconjugated bilirubin, was present when intrabiliary obstruction was associated with long-standing mechanical obstruction. The second type, present in patients developing masses of intrabiliary 'sludging' shortly after transplantation, consisted mainly of necrotic donor biliary tract due to damage during preservation. An intrabiliary perfusion technique was developed which in animal models reduced the extent of donor biliary damage.

Animals↗
PubMed1979

Is it really worth re-transplanting patients?

Increasingly patients whose first renal transplant fails are being re-transplanted. A study of patients in one unit was undertaken to assess whether second kidney grafts were as successful as first allografts and whether certain factors determined the outcome of secondary transplants. Second and subsequent grafting can be performed with confidence of a successful outcome provided a careful selection of patients is made. The outcome of subsequent grafts should show no significant difference from the overall results of first renal allografts.

Graft Rejection↗
PubMed1978

Biliary sludging following liver transplantation in man.

Following orthotopic liver transplantation in man biliary, obstruction has been produced by masses of inspissated bile--biliary "sludge." Bile studies in two groups of patients following transplantation show that bile is lithogenic in the early postoperative period but that reestablishment of the entero-hepatic circulation of bile salts corrects this. Such changes, however, do not appear to be important in sludge formation and biochemical and histological studies of bile sludge show a major constituent to be necrotic collagen from the donor bile duct walls.

Alkaline Phosphatase↗
PubMed1978

Rupture of the allografted kidney--is repair possible?

Allograft rupture after transplantation is an uncommon but serious complication. A review of the literature suggests a significant mortality and very high incidence of graft loss. Data will be presented which suggests that conservative management of the allograft rupture is possible.

Adult↗
PubMed1977

Total hepatic ischaemia in the Rhesus monkey.

During operations for major hepatic trauma it may be necessary temporarily to deprive the liver of its blood supply by occlusion of the hepatic artery and portal vein. The maximum 'safe period' of total hepatic ischaemia in man is unknown. In the monkey the ischaemic liver 'leaks' potassium, and levels of this element in the hepatic veins rise during ischaemia reaching a peak immediately after blood supply to the liver is restored. However, critical systemic levels of potassium are never reached and severe biochemical disturbance does not occur until 2 h following revascularization in animals having experienced ischaemic periods of longer than 20 min.

Animals↗
PubMed1977

Observations on preservation, bile drainage and rejection in 64 human orthotopic liver allografts.

The combined Cambridge/King's College Hospital series of 64 orthotopic liver grafts' experience dates back to 1968. Many patients were referred for liver grafting late in the course of their diseases and were operated on when they were too ill or died before suitable livers could be found. Complications of biliary drainage were the most frequent causes of death. In the past two years we have acquired experience of a method of liver preservation which permits up to 8 hours of safe storage without any complicated machines and we have been able to transport 22 livers by air and road from other institutions to our own unit. This has enlarged the pool of potential donors and therefore reduced the average waiting time for a liver transplant. A new method of biliary drainage has been employed in 24 patients using the vascularised gall bladder as a conduit between the donor and recipient common ducts. This has resulted in a marked reduction in early postoperative complications of biliary fistula and obstructed bile drainage. Now that survival has improved, it has become clear that uncontrollable rejection of the allografted liver in man is much less severe than that experienced with kidney transplants. The results of liver grafting in our unit during the past year are better than those obtained with kidneys from cadaver donors.

Common Bile Duct↗
PubMed1977

Management of inferior vena caval injury in liver trauma.

The management of patients with severe hepatic trauma and damage to the inferior vena cava presents many difficulties. Our experience suggests that vena caval injury is more common than has previously been reported. In spite of the severity of the injuries a period for resuscitation is usually available and operation must not be started until full supportive measures are ready. We have evolved a technique of vascular isolation of the liver aboiding the use of internal vena caval shunts that permits repair of the damaged vena cava.

Humans↗
PubMed1976

Hepatic trauma involving the hepatic veins and vena cava.

The control of massive haemorrhage in major hepatic injury with caval damage is extremely difficult. Our experience with 5 such patients is reported. The management and operative techniques involved are discussed. In 3 patients control was obtained and repair effected without recourse to internal caval shunting. One of these patients survived in spite of extensive injuries.

Abdominal Injuries↗