Yao-Li Chen

Extracorporeal membrane oxygenation support in potential organ donors for brain death determination.

BACKGROUND Extracorporeal membrane oxygenation (ECMO) must be applied in early stages to perfuse organs before donation in order to expand the donor pool. The aim of this study was to examine the benefits of ECMO for potential organ donors with multiple complications. MATERIALS AND METHODS This retrospective review describes patients with ECMO support who were on the verge of brain death and therefore potential subjects for organ donation. RESULTS Six organ donors with severe neurological damage under ECMO support completed the procedures, namely, two women and four men of ages 19 to 58 years (mean, 32 years). Three donors completed the brain-death determination procedure, one failed the procedure, and two experienced cardiac asystole prior to the procedure and were unable to be declared dead even after resuscitation. Nine kidneys and three livers were successfully retrieved from 5/6 donors, leading to 11 successful transplantations: eight kidneys, two livers, and one simultaneous kidney-liver transplantations. The organs functioned well and the recipients made full recoveries. CONCLUSIONS ECMO allows for the maintenance of abdominal organ tissue perfusion without warm ischemia before organ procurement, providing sufficient time for safe organ donation procedures and reducing the risk of unpredictable cardiac arrest that could result in the donor death and graft loss.

Non-heparinized ECMO serves a rescue method in a multitrauma patient combining pulmonary contusion and nonoperative internal bleeding: a case report and literature review

Pulmonary contusion and acute respiratory distress syndrome (ARDS) is a common manifestation in polytraumatic patients. Although mechanical ventilation is still the first choice of treatment, a group of patients are still unable to maintain their oxygenation. The role of extracorporeal membrane oxygenation (ECMO) has been more clarified when the lung is extensively damaged and when conventional modality failed. ECMO provides the lung an opportunity to rest by permitting reduced ventilator settings and limiting further barotraumas. However, ECMO is still considered contraindicated in polytramatic patients combining pulmonary contusion and other organ hemorrhage because of systemic anticoagulation during the treatment. We herein report a patient who successfully survive a multitrauma combining pulmonary contusion and grade IV liver laceration using non-heparinized venovenous extracorporeal membrane oxygenation (vv-ECMO). The associated literature were reviewed.

Hepatic resection for bilateral hepatolithiasis: a 20-year experience

There is increasing evidence showing that hepatic resection is probably the best definitive treatment for unilateral hepatolithiasis. However, the role of hepatic resection for bilateral hepatolithiasis is rarely mentioned in the literature.

A lower costly laparoscopic appendectomy: Our experience of more than 2000 cases

Many authors emphasize the advantages of laparoscopic techniques in their experience, including the excellent cosmetic results, reduced postoperative pain, rapid functional recovery, lower incidence of adhesions, wound infections and believe that laparoscopic appendectomy is a reliable operation for treating acute appendicitis. Laparoscopic appendectomy has become a standard procedure in the treatment of acute appendicitis in our department since it was introduced in 2003. There are 414 patients underwent laparoscopic appendectomy and 37 patients underwent open appendectomy in our department in 2008. More than 2000 laparoscopic appendectomies were performed in our department during 2003-2009. However, open appendectomy is still the standard procedure in many Taiwan and worldwide hospitals. One of the reasons is that the operating costs incurred for laparoscopic appendectomy are higher than that of open appendectomy. We describe, herein, an access technique utilizing existing instrumentation that is reliable and easy.

Liver Transplantation in Patients Infected With Gram-Negative Bacteria: Non–Acinetobacter baumannii and Acinetobacter baumannii

BACKGROUND The current study investigated risk factor related to gram-negative bacterial (GNB) infection by Acinetobacter baumannii and non-A baumannii groups, in liver transplantation (OLT) recipients. MATERIALS AND METHODS All patients with OLT and their living donors were analyzed retrospectively. After excluding those with Gram-positive and fungal infections 89 patients remained in the study including 59 who were noninfected and 30 with GNB infection. The risk factors for GNB infection were classified into the preoperative versus the postoperative periods. RESULTS GNB-infected patients were classified as non-A baumannii versus A baumannii (15 patients per group). A significant difference was observed in the numbers of intensive care and hospitalized days, hemodialysis requirement, and reoperation frequency compared with the noninfected group. Infection also correlated with hospital mortality, overall survival, and Model for End-Stage Liver Disease (MELD) scores with significance upon univariate but only the last feature on multivariate analysis. CONCLUSIONS Preoperative MELD scores were more likely to be higher among the non-A baumannii compared with the A baumannii-infected group. However, the 1-year survival of the A baumannii-infected subjects was lower than that of the non-A baumannii infected group.