Transplantation proceedings
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Yttrium-90 microspheres radioembolization (Y90-RE) has been recently introduced as promising modality of treatment in patients with hepatocellular carcinoma (HCC) who are not otherwise candidates for local ablation, surgical resection, or liver transplantation (OLT). However, its use in downstaging HCC or as a bridge for OLT is still unclear. Herein, we have presented a case where Y90-RE was used to both downstage and to serve as a bridge for OLT. ⋯ The use Y90-RE in HCC may be useful for downstaging or as a bridge to liver transplantation.
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To retrospectively evaluate postoperative morphine requirements in healthy living donors undergoing partial hepatectomy and patients with end-stage hepatocellular carcinoma or end-stage liver disease undergoing liver transplantation. ⋯ Although others have reported decreased morphine requirements on PODs 1, 2, and 3, our results indicated that morphine requirements were significantly less only on POD 1.
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Sodium, chloride, and lactic acid load may be responsible for acidosis during surgery; complex disorders may not have a single, identifiable causative anion, with only the strong ion gap (SIG) being elevated. We studied the effects of fluids infused during various phases of liver transplant surgeries on acid-base and electrolyte changes using the Henderson-Hasselbach and Stewart equations. ⋯ Avoiding large quantities of sodium chloride-containing fluids may help to decrease the incidence of hyperchloremic acidosis among this group of patients. The changes in SIG but not in bicarbonate during liver transplant procedures were highly correlated with pH changes.
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Orthotopic liver transplantation (OLT) patients are known to show decreased intraoperative anesthetic requirements compared with patients undergoing other liver surgeries. The aim of this study was to determine the relationship between inhalational anesthetic requirements and the severity of liver disease among OLT patients. ⋯ OLT patients with high MELD scores showed less inhalational anesthetic requirements during the preanhepatic and the anhepatic periods than those with low MELD scores.
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Increasing the participation of intensive care unit nurses to promote deceased donor organ donation.
Intensive care unit (ICU) nurses are viewed to have an important role in identifying potential donors to increase the donor pool. Our objectives were to assess their knowledge about organ donation, their attitudes concerning their presumed role in organ donation, and their motivation toward a more prominent role by 3 questionnaires administered before and after training on promotion of organ donation. ⋯ Active participation of ICU nurses in the identification of potential deceased donor organs and their direct participation in organ procurement though continuous re-education and video- illustrated lectures may promote an increased number of deceased donor organs.