Management of subcapsular hematoma of the graft after living donor liver transplantation

Subcapsular hematoma of the graft is a serious complication of liver transplantation (LT), and there has been no discussion in the literature about optimal management except in sporadic case reports. The aim of this work is to review our experience of subcapsular hematoma in living donor liver transplantation (LDLT) and to introduce our management strategy. Among the 818 cases of adult-to-adult LDLT between February 1997 and November 2005, there have been 4 cases of subcapsular hematoma. Two of these developed after percutaneous liver biopsy and the other 2 developed after percutaneous transhepatic biliary drainage (PTBD). Two developed immediately after the procedure, whereas the other 2 developed 8 and 12 days after the procedure, respectively, due to rupture of a pseudoaneurysm. Our management strategy was as follows; after performing dynamic computed tomography for initial diagnosis, these 3 steps were taken: 1) hepatic arteriography and selective embolization of bleeding focus; 2) pigtail catheter drainage (PCD) of subcapsular hematoma; and 3) hepatic vein stenting if there was a sign of outflow disturbance due to compression by a large hematoma. All 4 of our patients recovered from the insult of subcapsular hematoma. In conclusion, our results indicate that patients who develop subcapsular hematoma after LDLT can be treated nonsurgically.

[Cerebrospinal fluid (CSF) cytochemistry of acute cerebrovascular diseases with clear CSF: observation of nonspecific esterase activity of mononuclear phagocytes]

CSF nonspecific esterase (ANAE) activities of mononuclear phagocytes of 35 patients with intracerebral hematoma (ICH) with clear CSF and 25 with cerebral thrombosis and 17 normals were observed. The ANAE activities of ICH were much higher than those of thrombosis significantly (P less than 0.01). Furthermore, the distributions of ANAE activities of all cases suggested that there were few overlaps between both diseases. The CSF cytochemical detection was obviously superior to routine CSF cytological examination in differentiating strokes with clear CSF. The authors concluded that these results provided a simple inexpensive and relatively accurate method to differentiate hemorrhagic from ischemic cerebrovascular diseases in case of without CT.

Diagnostic value of lactate dehydrogenase isoenzymes in cerebrospinal fluid

To evaluate the diagnostic value of lactate dehydrogenase (LD) isoenzymes in cerebrospinal fluid (CSF), 93 consecutive CSF specimens were analyzed. These specimens were from patients of four categories: tumors, infections, hemorrhages, and others. It was found that the isoenzyme patterns overlapped among different categories, but they differed within each category and were thus helpful in differential diagnosis. For instance, metastatic tumors showed prominent LD-5, whereas a primary brain tumor demonstrated an increase in all fractions. Viral encephalitis revealed an increase in the first three isoenzymes and bacterial meningitis, the last two. In acquired immune deficiency syndrome (AIDS) cases, however, LD isoenzyme changes were demonstrated in CSF when only cryptococcal meningitis and not when encephalitis was present. Both subdural and subarachnoid hemorrhages showed elevation of all fractions in our study. Elevation of the first three fractions was usually due to brain tissue damage or hemorrhage, as proven by our isoenzyme study of hemolysate mixed with CSF. The prominence of the last two fractions was related to anaerobic metabolism in the central nervous system or to granulocytic infiltration. In conclusion, LD isoenzyme analysis in CSF is helpful in differential diagnosis of various CNS disorders, although its sensitivity awaits further improvement.

Hemoglobin-degrading enzymes in experimental subcutaneous hematomas

The activities of heme oxygenase and biliverdin reductase were determined in subcutaneous (s.c.) hematomas of rats after different periods of vital time. The postmortem stabilities of the heme-degrading enzymes were also studied by keeping the rats with vital hematomas for 1-5 days at temperatures of +4 degrees C and +22 degrees C. A tenfold increase of heme oxygenase activity over the starting level was observed in 2-9-day-old vital hematomas, when the specimens were taken immediately after death. Biliverdin reductase showed only negligible changes. Postmortally, heme oxygenase activity started to decrease in hematomas immediately at +22 degrees C and from day 2 on at +4 degrees C.

The mechanical, enzymatic and morphological changes in acute pulmonary insufficiency following the production of a haematoma in rabbits

The production of a haematoma in the hindleg of rabbits represents a simplification of post-traumatic models. The lungs, one of the target organs, show similar micromorphological alterations to those described in traumatised human beings. The lungs of rabbits, bearing a hindleg haematoma for 24 hr, showed a significantly increased incidence of micromorphological lung alterations compared to the control group. Moreover, measurement revealed a significantly decreased lung compliance within the haematoma groups. It was demonstrated that whether the haematoma was subcutaneous or intramuscular, similar alterations were seen in lung histology, and in lung compliance values. Studies on the activity of superoxide dismutase in lung tissue homogenates demonstrated a significant decrease in those rabbits having had a haematoma intramuscularly for 24 hr.

[Diagnosis of myocardial infarct by means of a quick determination of the MB fraction of serum creatinephosphokinase]

A rapid method of determining creatine phosphokinase (CPK) isoenzymes using dithiothreitol, a reducing agent which activates the main fractions of the CPK molecule (MM and MB), was assessed in 68 subjects (34 with myocardial infarction, 18 with skeletal muscle lesions, 16 normal). In acute myocardial infarction, the mean peak of CPK-MB in serum increases to 13.3% of the total CPK (range 8.8% to 21%) from the 18th to the 24th hour after onset of symptoms, whereas in skeletal muscle lesions CPK-MB reaches only 1% of total CPK (range 0% to 2.9%), and in normal subjects CPK-MB is absent. This highly significant difference (p less than 0.001) makes it possible to distinguish accurately between myocardial infarction and skeletal muscle lesions (trauma, hematoma, myositis, hypothyroidism). By its sensitivity (100%) and specificity (97%) this rapid and inexpensive method finds its optimal sphere of application in emergency wards and coronary care units.

Serum enzyme changes after intramuscular bleeding in patients with haemophilia and Christmas disease

Serum creatine kinase, lactate dehydrogenase, aspartate and alanine transaminases, and aldolase were determined in 41 hospital inpatients with haemophilia or Christmas disease and no significant differences from the normal ranges were found.(3) Levels of these enzymes in a further 10 such patients who had sustained muscle haematomata were determined: in all of these there was a consistent rise in the level of creatine kinase, the peak occurring between 36 and 96 hours. In bleeding disorders a rise in serum creatine kinase levels may be useful as a diagnostic test for intramuscular haemorrhage.