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Objective: To summarize the experience in modified reconstruction of the hepatic outflow tract during piggyback liver transplantation at our hospital., Methods: The clinical data on 67 patients undergoing piggyback liver transplantation with modified hepatic outflow tract reconstruction from January 1999 to October 2002 were analyzed retrospectively., Results: In this group, 7 patients (10.45%) died perioperatively. Complications included: pulmonary infection (38 patients); multiple organ system failure (10), intraperitoneal bleeding (6), acute respiratory distress syndrome (14), thrombosis of the hepatic artery (1), and bile leakage (1). No hepatic outflow occluded. Two recipients survived for over 3 years, 8 over 2 years, and 19 over a year., Conclusion: Modified hepatic outflow reconstruction in piggyback liver transplantation may increase the success rate of liver transplantation and decrease technical complications.

A new flocculant-producing bacterium Paenibacillus polymyxa BY-28 was isolated from soil. The optimal culture media for flocculant production were 2% glucose, 0.3% KH2PO4, 0.1% bean cake powder, 0.05% CaC12 and 0.05% (w/v) MgSO4.7H2O. Optimal culture temperature was 30 degrees C and pH was 6-8. Flocculants produced under optimal conditions efficiently aggregated various organic and inorganic suspensions in simulated water as well as in wastewater by addition of bivalent and trivalent cations Ca2+. From Zeta-potential measurement, the dominant role of microbial flocculant in the flocculation process is based on the bridging mechanism, and the role of CaCl2 is to decrease the negative electrical charge of the Kaolin clay particles.

Objective: To prevent and manage biliary complications after orthotopic liver transplantation (OLT)., Methods: Ninety-five patients of OLT performed at our institute from February, 1999 to December 2002 were retrospectively analysed. Recipient operation was performed using standard method combined with veno-venous bypass in 12 patients and piggyback method in 78 patients and living-related liver transplantation in 5 patients. Biliary reconstruction was performed by end-to-end choledochocholedochostomy (C-C) over a T-tube in 55 patients and without a T-tube in 36 patients while the remaining 4 patients underwent Roux-en-Y choledochojejunostomy (CRY). C-C and CRY were performed by the interrupted or continuous suture with 5 - 0 or 6 - 0 Vicryl or PDS. Routine examination of liver function, Doppler ultrasonography and cholangiography were performed during the follow-up period., Results: Biliary complications occurred in 7 patients (7.3%). Two patients with bile leakage at the anastomotic site developed biliary peritonitis on the seventh and tenth postoperative day and needed reoperation. One patient developed anastomotic biliary stricture one month after the operation and was cured by endoscopic stenting. Two patients developed bile leakage after T-tube removal. One of the two patients was treated conservatively and the other underwent a exploratory laparotomy to ligate the T-tube tract and drain the peritoneal cavity. One patient died of biliary vast syndrome five months after OLT and one patient died of biliary tract necrosis secondary to hepatic artery thrombosis on the tenth postoperative day. One - 42-month (mean 11.4 months) follow-up revealed no biliary stricture in 74 patients. No biliary stone and biliary sludge were detected by Doppler ultrasound and/or cholangiography. Serological examinations proved that liver grafts functioned well in these patients., Conclusions: To prevent biliary complications, it is crucial to protect biliary mucosa and arterial blood supply of the common bile duct while harvesting the graft and to obtain perfect mucosa-to-mucosa apposition of no-tension end-to-end anastomosis of the bile duct. Endoscopic dilation and stenting are effective for post-OLT extrahepatic biliary stricture.