John L. Hussey

Effect of dialysis on serum carnitine, free fatty acids, and triglyceride levels in man and the rat

Serum free carnitine, free fatty acid and triglyceride values were followed in patients with end-stage renal disease on maintenance dialysis therapy. During dialysis a decrease in serum carnitine was documented. Whereas the elevated triglyceride concentration remained constant, there was a sharp rise in free fatty acids during the dialysis procedure. This pattern occurred whether patients were subjected to hemodialysis or intermittent peritoneal dialysis. Peritoneal dialysis was performed in a rat model and produced results similar to those observed in human subjects. Furthermore, it could be demonstrated that peritoneal dialysis initiated the hypertriglyceridemia in the otherwise normal animal within a short time period. Whereas the abnormalities observed in carnitine and fatty acid metabolism may or may not be causally related in rat or man, they both seem to result from dialysis therapy.

Nodular regenerative hyperplasia: a controversial indication for orthotopic liver transplantation

Abstracts Nodular regenerative hyperplasia of the liver is an uncommon cause of portal hypertension. Patients with nodular regenerative hyperplasia have signs and symptoms of portal hypertension, without evidence of hepatocellular failure or encephalopathy. We report the case of a 44‐year‐old woman with recurrent esophageal bleeding and refractory ascites who had a history of hemosiderosis, hepatitis C, and chronic renal allograft rejection. Our preoperative diagnosis was cirrhotic end‐stage liver disease and end‐stage renal disease for which the patient underwent combined hepatic and renal transplantation. Her portal hypertension symptoms resolved, and her renal function has been normal for 18 months of follow‐up. Histologic examination of the liver revealed nodular regenerative hyperplasia, and a review of the literature regarding the surgical management of patients with nodular regenerative hyperplasia revealed that various shunting procedures are generally recommended. After the failure of medical management in patients with nodular regenerative hyperplasia, portosystemic shunting may be indicated before proceeding to hepatic transplantation.

Liver transplantation in patients with situs inversus

Abstract Situs inversus has been considered an absolute contraindication to liver transplantation due to technical difficulties. Associated vascular malformation and distorted anatomy may make the procedure even more complicated or impossible. Only three cases of patients with abdominal situs inversus who underwent successful liver transplantation have been reported in the English literature. We describe two additional patients with situs inversus who suffered from biliary atresia and underwent successful liver transplantation. The preoperative evaluation and the operative procedure are presented, and technical difficulties are discussed. Since biliary atresia is associated with polysplenia syndrome, including vascular malformation and visceral malposition, we suggest that each case be extensively evaluated preoperatively to determine the size requirement for the donor liver and the feasibility of reconstruction.

Depletion of heart and skeletal muscle carnitine in the normal rat by peritoneal dialysis

Abstract Serum carnitine values are markedly reduced during dialysis in patients with end-stage renal disease. In an effort to obtain more evidence for dialysis induced carnitine depletion in tissue an antimal model was developed. It was found that a relatively short term peritoneal dialysis treatment in the normal rat led to a 50% decrease in serum carnitine and a 50% reduction of carnitine in the heart and skeletal muscle. The concentration of carnitine in liver did not change. The results indicate that this model may be suitable for determining specific effects of carnitine depletion in heart and skeletal muscle as well as studying the effects of dialysis under various experimental conditions.

Bowel-gas explosion: An unusual surgical complication

Summary o 1. A case of bowel gas explosion at the time of thoracoabdominal surgery is presented. 2. Causative factors are discussed. 3. Conclusions are drawn to provide other surgeons with the facts necessary to avoid this complication.

Mixed Leukocyte Culture Incompatibility Index for Donoh-Recipient Selection in Kidney Transplantation

The mixed leukocyte culture test has been applied to selection of histocompatibility non-identical donor-recipient pairs for renal transplantation. The clinical course of transplant recipients who have histocompatibility mismatches but low mixed leukocyte culture stimulation is similar to that of mixed leukocyte culture and histocompatibility identical recipients. Living donor-recipient pairs with high mixed leukocyte culture stimulation had no better graft survival than cadaver recipients. An incompatibility index derived from mixed leukocyte culture may aid in the selection of satisfactory non-identical living related donors and may help avoid use of immunologically unsatisfactory living donors.

Idiopathic inferior mesenteric venous thrombosis demonstrated by angiography.

Idiopathic thrombosis of the inferior mesenteric vein, not associated with portal vein thrombosis, is an uncommonly diagnosed lesion. We are reporting a case of inferior mesenteric vein thrombosis diagnosed preoperatively by angiography. We believe this to be the first case in the literature of this particular lesion demonstrated conclusively by angiography before surgery.

Conduit placement for hemodialysis

The complications of infection and clotting are frequent enough as to make vascular access sites and their preservation a prime consideration in the management of patients who require long-term maintenance hemodialysis for support of end-stage renal disease. Utilization of the described technique during placement of subcutaneous conduits on the volar surface of the forearm for hemodialysis purposes tends to minimize the complications of infection and clotting and prolong the usable life of the conduit fistulas.