Living Donor Liver Transplantation in Budd-Chiari Syndrome: A Single-Center Experience
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.Transplantation Proceedings (Impact Factor: 0.98). 04/2010; 42(3):839-42. DOI: 10.1016/j.transproceed.2010.02.045
Budd-Chiari syndrome (BCS), which is characterized by hepatic venous outflow obstruction due to occlusion of the major hepatic vein and/or the inferior vena cava (IVC), is rare. Traditionally, a caval resection is advocated for these patients; however, such a maneuver renders living donor liver transplantation (LDLT) impossible. We encountered BCS in 4/377 LDLT patients during a 5-year period (January 2003 to December 2007). This report examine the various surgical modifications in these 4 patients, who underwent to LDLT for BCS. Resection of right hepatic vein (RHV) with an adjacent fibrotic part of the IVC with direct anastomosis of the graft RHV to the IVC was performed in 2 patients. One patient underwent retrohepatic IVC excision and reconstruction with a cryopreserved autologous IVC graft. The fourth patient, with a preexisting mesoatrial shunt for BCS, underwent conversion of this to a RHV atrial shunt. Graft and patient survivals were 100%. There were few complications in either donors or recipients. LDLT for BCS can be performed safely with adequate venous drainage techniques and with anticoagulant therapy and good follow-up for early diagnosis and treatment of recurrence leading to excellent long-term results.
Conference Paper: Similaritons: A new regime of femtosecond fiber lasers[Show abstract] [Hide abstract]
ABSTRACT: We have recently demonstrated theoretically that similaritons can exist in a laser oscillator. Initial attempts to observe and exploit the self-similar regime of operation produced excellent results. A Yb-doped fiber laser designed to approximate the similariton regime produces the parabolic chirped pulses and unique sharp-edged spectrum that are the signatures of self-similar propagation. Optimum performance was obtained by slightly deviating from the self-similar regime, and 50-fs pulses with 5-nJ energy were generated after dechirping. These results represent twice the pulse energy, twice the average power, 5 times the peak power of the previous best femtosecond fiber lasers. In addition, the laser is probably the most efficient femtosecond laser: 240 mW output power is obtained with 500 mW of pump power.
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ABSTRACT: Treatment of inferior vena cava (IVC) over-long segmental occlusion in Budd–Chiari syndrome (BCS) remains challenging. IVC segmental occlusion in BCS is often associated mainly with hepatic vein lesions in BCS, while the accessory hepatic vein (AHV) is typically patent and more intrahepatic collateral vessels are widely well-developed. Herein, we report our use of angioplasty for hepatic venous or the accessory hepatic vein for long segmental occlusion of the IVC in two BCS cases, rather than opening the IVC, in cases with a well-developed intrahepatic collateral.This method provides satisfactory outcome in short follow-up period of 8 and 5 months respectively, and is practical and feasible.
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ABSTRACT: Budd-Chiari syndrome (BCS) is a rare disease whose management should follow a step by step strategy. Anticoagulation and medical therapy should be the first line treatment. Revascularization or TIPS are indicated in case of no response to medical therapy. OLT should be indicated as a rescue therapy and anticoagulation be started soon after OLT. However, no clear indication can actually be given about the timing of different treatments. Moreover, there is some concern about treatment of some subgroup of patients, especially regarding the risk of recurrence after liver transplantation. The topic of this paper is to critically review the actual knowledge of BCS management.
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