Cardiopulmonary Arrest Outcome in Nemazee Hospital, Southern Iran

Abstract Background: Many factors are important determinants in the outcome of cardiopulmonary resuscitation (CPR) such as quality of CPR, age of patients, co morbidities, time and location of arrest, and skill of rescuers. This study was conducted to evaluate the efficacy of CPR in Shiraz, southern Iran

Very High Dose Epinephrine for the Treatment of Vasoplegic Syndrome during Liver Transplantation

AbstractA 55-year-old man with hepatitis B and hepatocellular carcinoma was treated with liver transplantation without veno-venous bypass. During the procedure his arterial blood pressure remained at 55/30 mm Hg and did not respond to increasing doses of norepinephrine. Vasoplegia was managed aggressively with the intravenous infusion of high doses of epinephrine

Non-Marginal Donor C-Loop Ulcers as a Cause of Gastrointestinal Bleeding After Pancreas Transplantation: Three Case Reports

Unfortunately, pancreas transplantation (PTx) has been associated with the highest surgical complication rate of all the routinely performed organ transplant procedures. Complications can arise not only from the pancreas itself but also from the simultaneously transplanted duodenum. One of these complications is gastrointestinal bleeding, which might be from anastamotic site ulcer, pseudoaneurysm, arterioenteric fistula, severe rejection, or cytomegalovirus infection. In this case series, we present three patients presented with severe anemia 3 to 6 months after PTx with enteric drainage by end-to-end anastomosis of ascending loop of a Roux-en-Y to donor duodenal C-loop. The source of bleeding in all three cases was non-marginal donor duodenal C-loop ulcers. High donor pancreas exocrine output associated with relatively low drainage of a small end-to-end anastomosis may be the cause of these ulcers. It is recommended to use a side-to side anastomosis to prevent this complication

A new ataxia-telangiectasia mutation in an 11-year-old female

Ataxia-telangiectasia (A-T), a rare inherited disorder, usually affects the nervous and immune systems, and occasionally other organs. A-T is associated mainly with mutations in the ataxia telangiectasia mutated (ATM) gene, which encodes a protein kinase that has a major role in the cellular response to DNA damage. We report here a novel ATM mutation (c.3244_3245insG; p.His1082fs) in an 11-year old female. This subject presented with typical features, with the addition of chest manifestations including mediastinal lymphadenopathy and diffuse bilateral micronodular infiltration of the lungs, along with a high EBV titer. The subject died as a result of rapid B-cell lymphoma progression before chemotherapy could be initiated. This case highlights the need for the rapid diagnosis of A-T mutations and the detection of associated life-threatening outcomes such as cancers

Transperitoneal Laparoscopic Living Donor Nephrectomy: 2 Years' Experience

Background. Due to the shortage of organ donations and the rising number of patients with terminal renal insufficiency, living donor kidney donation has become increasingly important during recent years. Hand-assisted laparoscopic living donor nephrectomy (LLDN) is an alternative to the conventional open approach and may decrease the surgical trauma to the donor. The aim of this study was to report our experience with this technique. Materials and methods. We reviewed demographic data, operative duration, hospital stay, and postoperative complications among 100 LLDNs performed from August 2006 to July 2008. We also performed a retrospective analysis of chemical and biochemical data of recipients. Results. Thirty female and 70 male subjects of mean age of 35.88 +/- 12.21 years were operated on during this period. The mean operative time for donor nephrectomy was 138.30 +/- 31.92 minutes (range 60-205) and for recipients, 87.66 +/- 11.79 minutes (range = 75-120), with a mean warm ischemia time of 5.19 +/- 1.76 minutes (range = 2-8). The donors' mean hospital stay was 28.34 +/- 8.31 hours (range = 24-72). Five donor operations were converted to open nephrectomy because of uncontrolled bleeding or abnormal anatomy. There was no need for blood transfusions or reoperations in the donors. Mean hospital stay for the recipients was 9.44 +/- 3.61 days (range = 5-22). Creatinine and blood urea nitrogen decreased from preoperative values of 10.46 +/- 3.73 and 66.10 +/- 25.16 to 1.39 +/- 0.38 and 29.64 +/- 8.83 mg/dL at discharge. The renal graft was rejected in two cases due to immunologic causes without any response to therapy. There was no vascular thrombosis in the transplanted kidneys. Conclusion. LLDN is a viable alternative to the standard open nephrectomy. It may have a positive impact on the donor pool by minimizing disincentives to living donation. The results of our program were acceptable; this approach may be the procedure of choice in the future in our center

Experience of Living Donor Liver Transplantation in Iran: A Single-Center Report

Background. Living donor liver transplantation (LDLT) has been accepted as a valuable treatment for patients with end-stage liver disease seeking to overcome the shortage of organs and the waiting list mortality. The aim of this study was to report our experience with LDLT. Methods. We retrospectively analyzed 50 LDLTs performed in our organ transplant center from January 1997 to March 2008. We reviewed the demographic data, family history, operative and hospital stay durations as well as postoperation complications among donors and recipients. We also performed a retrospective analysis of recipient chemical and biochemical data. Results. Among 50 patients (30 males and 20 females) of overall mean age of 7.21 +/- 5.35 who underwent LDLT (10 right lobe, 38 left lobe, and 2 left lateral segments), 47 received a liver graft from their parent, two from a brother, and one from an uncle. The most common indications for LDLT were end-stage liver disease due to Wilson's disease (16%), cryptogenic cirrhosis (16%), tyrosinemia (14%), biliary atresia (12%), autoimmune hepatitis (12%), and progressive familial intrahepatic cholestasis (12%). The mean follow-up was 16.91 +/- 23.74 months. There were 13 (26%) recipient mortalities including vascular complications; three to sepsis after bowel perforation, two from liver dysfunction, two from chronic rejection due to noncompliance, and one from diffuse aspergillosis. The morbidity rate was 50%, including 19 reexplorations during the hospital course and five biliary complications. Conclusion. This study demonstrated that LDLT can decrease the number of patients awaiting liver transplantation especially in the pediatric group. However, because of relatively high mortality and morbidity, we must improve our treatment outcomes