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The optimal management of small bowel obstruction (SBO) remains a matter of debate and treatment varies internationally. In Denmark, a more surgically aggressive strategy has traditionally been used, but to what extent patient outcomes differ from international reports is unknown. This study aimed to describe the current management and outcomes of patients admitted with SBO in Denmark.This was a prospective cohort study conducted at six acute hospitals in Denmark over a 4-month period. Patients aged ≥ 18 years with a clinical or radiological diagnosis of SBO were eligible. Primary outcomes were 30 day morbidity and mortality rates.316 patients were included during the study period. The median age was 72 years and 56% were female. Diagnosis was made by computed tomography (CT) in 313 patients (99.1%), with the remaining three diagnosed clinically. Non-operative management was the initial strategy in 152 patients (48.1%) and successful in 119 (78.3%). Urgent surgery was performed in the remaining 164 (51.9%), with a laparoscopic approach used in 84 patients (51.2%). The entire cohort had a 30 day mortality rate of 7.3% and a 30 day morbidity rate of 17.1%.The management of SBO in Denmark differs markedly to previous international reports, with an almost ubiquitous use of CT for diagnosis and a high proportion of patients undergoing urgent surgery. Despite higher rates of surgery, patient outcomes are broadly similar to reports of more conservative strategies, perhaps due to a reduction in delayed operations.Trial registration number: NCT04750811. Trial registration date: 11/02/2021.

OBJECTIVE The aim of this review was to describe how the coronavirus disease 2019 (COVID-19) lockdown affected the self-care behaviors of people living with type 2 diabetes. METHODS A systematic rapid review was conducted using four electronic databases. Studies reporting on the lockdown’s impact on at least one of the self-care behaviors that were published from January 2020 through October 2021 were included. Findings were synthesized narratively, using the Association of Diabetes Care & Education Specialists ADCES7 Self-Care Behaviors as a framework. The methodological level of evidence and quality ratings of the articles were assessed using the Joanna Briggs Institute Appraisal Checklist. RESULTS Fifteen articles were included. Most studies reported on at least five of the self-care behaviors. There were reported increases in diabetes-related stress, as well as in increases in dietary intake and changes in the timing of meals. Physical activity was reported to decrease. Overall, taking medications and glycemic self-monitoring of blood glucose (SMBG) were unaffected by the lockdown. Of the studies reporting glycemic outcomes, the lockdown appeared to have little negative effect. None of the articles assessed all the self-care behaviors. The self-care behavior of SMBG was the least assessed. Most articles had a medium level of evidence and a medium to high quality rating (scores >60%). CONCLUSION The findings from this review found the COVID-19 lockdown had a variable impact on diabetes self-care behaviors. Because the potential for future COVID-19 surges and/or other virulent transmissible diseases remains a concern, health care providers should continue to address the importance of self-care behaviors to mitigate the risk of poor health outcomes in people with diabetes.

Uterus transplantation (UTx) is a promising treatment option for women who wish to give birth but suffer from absolute uterine factor infertility. This paper presents an interim analysis of a trial focusing on the causes, prevention, diagnosis, and management of graft thrombosis. Our team analyzed 10 cases of UTx (recipients numbered 1 to 10). Early thrombosis developed in 2 of 10 (20 %) recipients, and thrombectomy and temporary viability preservation were achieved in both cases. However, re-thrombosis developed in both cases, and a graft hysterectomy was carried out. In recipient number 2, vascular changes might have contributed to graft thrombosis. The histopathological finding of the explant revealed subintimal excentric fibrosis with focal sclerotic changes. In recipient number 8, thrombosis was facilitated by external compression of the vascular pedicles by the hematoma as well as production of de novo donor-specific antibodies. Thrombosis led to graft loss in both cases despite an attempt at a thrombectomy. Therefore, the focus must be on the prevention including a thorough evaluation of the donor candidate. In the postoperative course, perfusion is closely followed-up with an ultrasound, Doppler flow monitoring, and macroscopic evaluation of the cervix. In the case that findings are unclear, a relaparotomy should be promptly indicated. If thrombosis is revealed, a thrombectomy and an attempt to salvage of the graft are indicated; however, the role of this strategy is questionable due to the low chance of long-term success. The indication of upfront graft removal and early retransplantation in the treatment of uterine graft remains debatable., This study was supported by the project National Institute for Research of Metabolic and Cardiovascular Diseases (Programme EXCELES, Project No. LX22NPO5104) - Funded by the European Union - Next Generation EU. The authors appreciate contributions by Alena Langerova (Gennet, Prague), Jaromir Masata (Department of Obstetrics and Gynecology, General University Hospital, Prague), Stepan Machac (IVF Clinic, Olomouc), and Radovan Pilka (Department of Obstetrics and Gynaecology, Olomouc University Hospital). They provided essential gynecological and obstetrical expertise. We also wish to thank Brian Kavalir for his proofreading services.

Drowning is a global health problem and deeper knowledge about the extent and causes is of utmost importance for implementing preventative actions. The aim of this study was to describe the incidence and characteristics of drowning in Sweden over time, including both non-fatal and fatal cases.All cases identified as drowning (ICD-10 coding) at a national level in Sweden between 2003-2017 were collected. Three sources of data from the Swedish National Board of Health and Welfare were extracted via the Cause of Death Register and the National Patient Register.Over 15 years, a total of 6609 cases occurred, resulting in an annual incidence of 4.66 per 100 000. The median age was 49 years (IQR 23-67) and 67% were males. Non-fatal drownings represented 51% (n = 3363), with an overall non-fatal to fatal ratio of 1:1, this being 8:1 for children (0-17 years of age). Non-fatal cases were more often female (36% vs. 30%; p 0.001), younger 30 (IQR 10-56) vs. 60 (IQR: 45-72) (p 0.001) and of unintentional nature (81% vs. 55%; p 0.001). The overall incidence decreased over time from 5.6 to 4.1 per 100 000 (p 0.001). The highest rate of 30-day survival was found in females 0-17 years (94%, 95% CI 91.1-95.5) and the lowest in males66 years (28.7%, 95% CI 26.2-31.2). Although the incidence in children 0-4 years increased from 7.4 to 8.1 per 100 000 (p 0.001), they demonstrated the highest non-fatal to fatal ratio (13:1).Drowning is declining but remains a consistent and underestimated public-health problem. Non-fatal drowning cases represent about half of the burden and characteristics differ from fatal drowning cases, being younger, more often female and of unintentional nature.

Background Submersion time is a strong predictor for death in drowning, already 10 min after submersion, survival is poor. Traditional search efforts are time-consuming and demand a large number of rescuers and resources. We aim to investigate the feasibility and effectiveness of using drones combined with an online machine learning (ML) model for automated recognition of simulated drowning victims. Methods This feasibility study used photos taken by a drone hovering at 40 m altitude over an estimated 3000 m2 surf area with individuals simulating drowning. Photos from 2 ocean beaches in the south of Sweden were used to (a) train an online ML model (b) test the model for recognition of a drowning victim. Results The model was tested for recognition on n = 100 photos with one victim and n = 100 photos with no victims. In drone photos containing one victim (n = 100) the ML model sensitivity for drowning victim recognition was 91% (95%CI 84.9%–96.2%) with a median probability score that the finding was human of 66% (IQR 52−71). In photos with no victim (n = 100) the ML model specificity was 90% (95%CI: 83.9%–95.6%). False positives were present in 17.5% of all n = 200 photos but could all be ruled out manually as false objects. Conclusions The use of a drone and a ML model was feasible and showed satisfying effectiveness in identifying a submerged static human simulating drowning in open water and favorable environmental conditions. The ML algorithm and methodology should be further optimized, again tested and validated in a real-life clinical study.

This paper examines the role of regional airports in regional and municipal crisis preparedness based on evidence from a case study in Sweden. During the summer of 2018, Sweden experienced some of the most extensive wildfires in modern time. Aerial suppression, for which airports provided the essential preconditions, played an important role in extinguishing these fires. This study includes analyses of public policies that shape the Swedish airport system as well as evidence from interviews and a workshop with stakeholders. The results show that an efficiently operated network of regional airports is critical not only for crisis management but also to ensure important societal services such as health care in sparsely inhabited regions. Moreover, access toquick transportation by air is necessary for the Swedish Prison and Probation Service, tourism industry, public institutions and private businesses. Additionally intensified by effects of both the public debate on flight shame and the COVID-19 pandemic on air-based transportation, the insights arising from this study emphasise that the currently one-sided focus on the number of passengers is an insufficient foundation for the Swedish airport system to construct a resilient base for regional development, crisis management and civil defense. Regionala flygplatser Perspektiv på tillgänglighet

Failures in the power supply threaten the safety of developed countries, as they are increasingly dependent on electricity to maintain important societal functions through critical infrastructure. To protect electricity-dependent critical infrastructure, Sweden has implemented a multi-level planning, called Styrel, which involves national-, regional- and local-level actors. This study focuses on interactions among key actors and their roles in the planning as well as the Swedish crisis management system. With evidence from interviews and a survey among the actors, analyses indicate blind spots in the current proceeding, such as the reliance of the outcome of the process on the actors’ commitment to achieve a common understanding of the importance of infrastructure assets and participate in collaborations. This paper reveals that actors lack awareness, knowledge, capability and resources to fulfil their roles in the national planning for critical infrastructure protection. By highlighting interrelations, this study contributes to the international discussion of identification, prioritisation and protection of critical infrastructure to mitigate consequences of power failures for a depending society.

Modern society has developed a growing dependence on electricity in order to carry out important societal functions. This implies the risk of cascading failures to society in the case of power shortage. The creation of a resilient and sustainable power energy system is therefore crucial. Equal crucial is the preparedness for the event of power shortage. As a part of the Swedish crisis management system, the Swedish Energy Agency (EM) has developed a planning system, Styrel, to identify social important objects in order to ensure important social functions in the case of power shortage. This article examines Styrel as a policy network and as a planning system to ensure a sustainable and resilient power supply. The study focus on the design of the system, the implementation of the system based on the results from the two rounds completed in 2010 and 2014. Using interviews with coordinators at the local and regional level in three counties and a survey including all 21 coordinators at the regional level, it indicates that the design of the planning system reviles opportunities for improvements of the planning system. The study also indicates that the coordinators at the local level lack trust in the planning system depending on both the lack of resource and the lack of feedback. This in turn indicates challenges for the system from a resilient and sustainability point of view. Från myndighet till medborgare och tillbaka: En studie av samverkan och kommunikation inom ramen för Styrel

This paper highlights major methodological obstacles to studying and performing critical infrastructure protection (CIP) in general and CIP governance in particular. The study simultaneously examines a research project on and practice in the context of Swedish CIP. The complex planning approach of interest is called Styrel, a Swedish acronym for Steering Electricity to prioritised power consumers. It aims to identify and prioritise power consumers of societal importance, collectively referred to as critical infrastructure (CI), to provide an emergency response plan for the event of a national power shortage. Methodologically, the investigation uses material from document studies, interviews and a survey, which involved many actors from the Swedish case. For the analysis of the methodological obstacles, this study applies an abstracted research and development process that encompasses four steps: data collection, data assessment, decision-making and evaluation. The paper mutually maps the insights from the research project to the empirical evidence from the case study. Through this reflective analysis, the findings contribute to a deeper understanding of the challenges that significantly impede research and practice in the context of national and international CIP, for example, insufficient information sharing and knowledge exchange among parties, a lack of integrated and advanced methods, and uncertainty in policies that induces a variety of local approaches. In addition, since empirical research on implemented CIP plans is limited, this paper addresses this gap. It reveals five general obstacles for both research and practice: a) the access to high-quality data, b) the loss of knowledge over time, c) the interpretation and evaluation of processes and methods, d) the transferability and comparability of data, results and insights; whereas all culminate in 5) a lack of collective intelligence. The accumulation of these obstacles hinders a detailed assessment of decision-making for CIP and its consequences on society. For this reason, this study emphasises the need for enhancing mutual understanding among the various parties in the area of CIP while respecting relevant security issues when inventing novel methods that facilitate collective intelligence.

Airports provide the basal infrastructure for air-based transportation. Adequate access to time-critical transportation, in particular, can enhance the resilience of a region. However, common appro ...

Central to policies relating to risk governance at the regional and local levels is the interaction between the public and private sectors also referred to as networked governance. At the same time, the role of political actors in general and policy entrepreneurs in particular, in terms of policy change, has gained considerable traction in recent policy scholarship. The purpose of this study was to investigate the change in governance arrangements resulting in the formation of a coordination network in regional flood risk management-the first of its kind in Sweden. Our research is guided by the following questions: first, would the policy change (the establishment of the networks)have taken place if a policy entrepreneur were not part of the policy transfer process? Second, what is the role of policy entrepreneurship in the implementation of the policy after its nationwide adoption? Third, what other factors played a role in the variation of the results in the implemented policy that is, the enforced networks? We find the role of a policy entrepreneur key in the policy transfer from the regional to the national level. In order to investigate the resultant networks, we draw from B. Guy Peters (1998) and his conceptualization of factors which affect the politics of coordination. In addition to the presence of a policy entrepreneur, we compare: (i) pluriformity of network members;(ii) member interdependence; (iii) redundancy of structures, and (iv) degree of formality (in terms of meetings). Our findings suggest that entrepreneurs contribute to the variation in the functionality of the enforced river groups, though other factors play a significant role as well.Most importantly, perhaps, we did not identify entrepreneurs in any of the river groups which were not functional.

Background Strenuous and chronic exercise training can have detrimental effects on cardiac morphology and function. Our aim was to evaluate the cardiac adaptation between 2 different specialties' endurance athletes: marathon runners (M) and ultra-trailers (UT). Methods 47 M (age 45±7, men 32; training: 18 (9-53) years*days/week), 41 UT (age 42±9, men 38, training: 30 (15-66) years*days/week) were submitted in rest condition to conventional 2D echocardiography and Speckle-Tracking echo (STE) (Beyond Diogenes 2.0, AMID) during agonistic season and compared with 15 age matched sedentary individuals (S) (age 43±6, men 10). Results Left ventricle (LV) global longitudinal strain (GLS) and global radial strain (GRS) were increased in M and UT compared to S (see table) without differences in LV anatomy and function. Right ventricle (RV) end-diastolic area (p=0.026), fractional area changing (p=0.008) and RV GLS were increased in UT compared to M. Moreover UT showed larger right atrium (RA) volume compared to M (p=0.03) and S (p=0.003). RA GLS was reduced in UT compared to M while the RA Global Circumferential Strain was significantly increased in UT. After adjusted for age, sex and HR as covariates, UT showed a reduced RA GLS (OR 0.907; CI 0.856-0.961) and increased RV FAC (OR 1.172; CI: 1.044-1.317) compared to M; while when compared to S subjects, UT showed increased RA volume (OR 1.048; CI 1.002-1.096) and RV GLS (OR 0.667; CI 0.490-0.907). Conclusion UT showed higher RV and RA morphological and functional remodeling in comparison with M. 2D-STE is a useful tool to investigate the deformation dynamic in different sport specialties. Further studies will be necessary to clarify the long-term consequences for cardiac health due to myocardial perturbations. MUTSpLV GLS-28.59±3.43*-27.64±4.18*-24.82±4.53

This paper highlights difficulties in studying the Swedish crisis management system with a specific focus on the planning process STYREL. This process seeks to identify and prioritize vital objects ...

Electricity is critical to almost all other critical infrastructure. Disturbance in the power supply would likely have devastating effects on all areas in society. Assurance of electricity to vital societal functions requires policies to manage power shortages. Such policies exist in only a handful of countries. This study focuses on one of those countries. In Sweden, the policy for power shortages, Styrel, includes all levels of society, all responsible institutions, and expert organisations. The policy is governed from the top down. We are primarily interested in how Styrel affects municipalities in their planning processes and supports decision making at the local level. The study is an interview study with key informants at the municipal level. The results show that the policy is supportive under certain conditions, depending on how the actors carried out previous processes. Lack of knowledge and support, and time pressure, characterise the process, although participants also have a sufficiently positive attitude to allow a more relaxed method of handling the process. The study provides insights on challenges that municipalities must manage in their work with policies for critical infrastructure protection.

With its growing dependence on electricity, modern society faces the risk of cascading failureof interconnected societal functions. To protect societal functions during an event of power shortage,S ...

This article examines the Swedish experience of network governance in managing flooding and high water flows. The aim was to study the regional responsibility for coordinating risk awareness and risk analysis in terms of information, prevention and actions. The focus was on differences between the Swedish river groups from the coordinators perspective, including their organization and approaches to decision-making. The conclusions reached here are based on interviews with the coordinators of county administrative boards. We argue that the absence of central guidelines in the organization of the river groups and the fact that they are enforced by the government rather than spontaneously formed have had implications for the networks’ effectiveness and for exchanges of experience among the networks.

The inquiry is focusing on why island autonomy occurs. Our point of departure considers four possible conditions such as geographical distance, ethnicity, GDP/capita and size according to population leading towards island autonomy. We use two sample groups in our study: one encompassing autonomous islands deriving from different parts of the world, with three main islands illustrating what we mean by island autonomy. These consist of the Azores, the Faroe Islands and Isle of Man. The second group consists of so called non-autonomous islands scattered around the world.The analysis is carried out with a specific technique within the Qualitative Comparative Analysis (QCA) family and that is Multi-Value QCA (MVQCA). MVQCA is an extension of the Crisp-Set QCA (CSQCA) and withholds a dichotomous dependent variable, while the possible explanatory variables (independent variables) can have multi-values. As a second technique Fuzzy-Set QCA (FSQCA) is employed as a control technique only. While assessing these techniques we receive combinations of conditions leading to the outcome in question. Results show that with MVQCA we receive four different paths towards island autonomy. Ethnicity as the only explanation is one route towards the outcome. A second path is small or large size. Long geographical distance combined with no ethnic diversity is a third way towards island autonomy. The fourth path is long geographical distance combined with the lower or upper middle income group. All the paths are equally valid.

There has been a need to be able to grade the "degree of sickness" in patients with acute and chronic hepatic failure. The Model for End-Stage Liver Disease (MELD) score was developed as a tool to give a more objective estimate of the degree of sickness in patients with chronic liver disease. In this study the MELD score was compared retrospectively in adult patients accepted for liver transplantation (OLT) at our institution in 1994, 1999, and 2004. Gender, age, and MELD score associated with different indications for OLT were analyzed for the same period. The MELD scores were unchanged between the examined years, and there was no difference between male and female patients accepted for OLT. Comparing MELD score between male and female patients, there was a potential risk for discrimination of female patients due to their reduced muscle mass, resulting in a lower serum creatinine and a lower MELD score. There was no difference in MELD score comparing 1994, 1999, and 2004 for patients with cirrhosis. Patients with acute hepatic failure had the highest MELD scores while patients undergoing OLT because of malignancy had the lowest MELD score. MELD score seemed to be a useful tool for retrospective analyzes of potential OLT recipients.

This paper describes the design and implementation of a 16-bit fixed point DSP processor. The processor is intended as a platform for hardware accelerators and allows additional computational units and assembler instructions to be added. The I/O facilities can also be customized to the needs of a specific application. Benchmarking has shown that the processor, without any hardware accelerators, has a performance comparable to single MAC commercial DSP processors. The architecture has been successfully synthesized in a 0.13 /spl mu/m process, resulting in a net-list of about 23000 gates, and a clock frequency of 195 MHz, making the performance/gate count ratio very competitive. It is also small enough to integrate 100 heterogeneous processors on a chip for example for communication infrastructure applications. The complete design time, including architecture and instruction set planning, assembler, debugger, instruction set simulator, RTL code and complete verification was about half a person-year.

This paper describes a significant improvement in complexity for the higher bit rate, 6.3 kbit/s, speech coding algorithm G.723.1. The solution is to reduce the number of multiplications of the most computing extensive part of the algorithm. This part stands for around 50% of the total complexity. This is done by identifying and excluding multiplication with zeros. G.723.1 is one of the proposed speech coders in the H.323 standard. The work has been done by thoroughly examining the fixed point source code from ITU, International Telecommunication Unions. A hardware structure for an application specific instruction set processor (ASIP) is proposed to increase the performance.

During a fifteen-year period, 500 liver transplantations have been performed at Sahlgrenska University Hospital in Göteborg. The results have improved, and factors influencing outcome are discussed. A one-year survival rate over 90% and a 5-year survival rate close to 80% can now be expected for most indications. Long-term complications as well as special problems occurring in different groups of recipients are discussed. New indications for liver transplantation such as liver metastasis of endocrine tumors are described. This article also describes our experience of in situ splitting and living-related liver transplantation as well as other innovations such as cavoportal hemitransposition and multivisceral transplantation.

Biopsies are difficult to perform in rodent heart transplant models without compromising the graft function and therefore other means to evaluate the grafts repeatedly and noninvasively are warranted. The goal of the present study was to measure changes in ratios of high energy phosphorus containing metabolites detected with in vivo 31Phosphorous Magnetic Resonance Spectroscopy ((31)P MRS) in a xenotransplantation model and to investigate if these ratios correlated to histological signs of acute xenograft rejection. Thirty-five heart transplantations were performed (NMRI-mice to Lewis (RT1(1)) rats). Thirteen heart transplants underwent repeated daily in vivo (31)P MRS measurements and 22 grafts were measured on any of 4 postoperative days and thereafter sacrificed for histology. A modified scoring system based on Billingham's criteria was used to stage the rejection process. The median graft survival was 3.0 +/- 0.44 (median +/- SD) days (n = 17). Significant differences, both overall and interday, could be calculated for the phosphocreatine (PCr)/beta-adenosine triphosphate (beta-ATP) ratios and for the rejection score. The decreases in PCr/beta-ATP ratios correlated significantly to the progressive acute rejection process in the sacrificed grafts (P = 0.01). Further studies are indicated to establish the potential of (31)P MRS in immunosuppressed recipients of vascularized xenotransplants with prolonged graft survival.

In the present study, the nature of hyperacute xenograft rejection was closely studied in a vascularized mouse-to-rat transplantation model. Antibodies against mouse heart, erythrocytes and lymphocytes and against the Forssman antigen were raised in the rat. Upon heterotopic heart transplantation the respective antisera were intravenously (i.v.) injected. Passive transfer of antiheart, antierythrocyte or antilymphocyte serum resulted in hyperacute rejection of the transplanted mouse heart. Subfractionation of the antiheart serum showed that the capacity to induce hyperacute rejection was carried by the immunoglobulin (Ig)G fraction. When antierythrocyte serum adsorbed with mouse erythrocytes was administered the cardiac grafts remained beating. To the contrary, antilymphocyte serum adsorbed with erythrocytes still had the capacity to induce hyperacute rejection. None of the rats that had previously been challenged with the Forssman antigen rejected their grafts hyperacutely. Subsequent investigations by electron microscopy revealed that the Forssman antigen is expressed on dendritic cells (DC) adjacent to the vessels, but not on the vascular endothelium, thus explaining the inability of the anti-Forssman serum to induce hyperacute rejection. Taken together, we have demonstrated the existence of several xenoantigens that can be targets for antibody-mediated rejection, suggesting that more than one relevant xenoantigen exists also in more distantly related combinations, such as the pig-to-human combination.

Several neuroendocrine tumours, such as carcinoids and pancreatic endocrine tumours, may manifest relatively slow tumour growth. The patients may suffer from severe hormonal symptoms, largely due to liver metastases which sometimes are amenable to cytoreductive surgery. If residual tumour after primary tumour resection is multilobar, liver transplantation may be one way to treat hormonal symptoms and possibly prolonging survival. Early long-term outcome of liver transplantation in patients with neuroendocrine tumours suggests prognosis to be more favourable for carcinoids than for endocrine pancreatic tumours. It is suggested that liver transplantation may be appropriate for patients with isolated hepatic tumour disease in the following situations: 1, tumour recurrence after liver surgery for cure; 2, non-resectable liver disease, especially in cases of severe hormonal symptoms; and 3, disease progression after hepatic arterial embolisation and medical therapy. These indications are discussed in the light of three case reports.

End-stage liver disease is accompanied by a hyperkinetic circulation sometimes combined with hypoxaemia. Nitric oxide overproduction has been described as a possible cause by dilating the vasculature and decreasing cardiac afterload. The aim of this study was to evaluate haemodynamics, ventilation/perfusion matching, alveolar and alveolar dead space ventilation and resistance of systemic and pulmonary vasculature during liver transplantation.Ten liver transplantation patients were studied. Cardiac output, CO, was measured with thermodilution technique. Pulmonary shuntflow was calculated from standard formulas. Effective cardiac output, COeff, was defined as the CO in contact with alveolar ventilation, VA. Effective alveolar ventilation, VAeff, was defined as VA in contact with pulmonary circulation. Measurements were performed during dissection, anhepatic and reperfusion phases.During the dissection phase the shunt was 23 +/- 3%, COeff was 7.9 +/- 0.6 l/min, SVR was 620 +/- 67 dyn.s/cm5, VAeff was 3.4 +/- 0.5 l/min, SaO2 was 98 +/- 1% and SvO2 was 86 +/- 2%. Corresponding values during the anhepatic phase were 16 +/- 2%, 5.6 +/- 0.4 l/min, 931 +/- 78 dyn.s/cm5, 3.1 +/- 0.2 l/min, 99 +/- 1% and 88 +/- 1%. During the reperfusion phase the values returned to levels close to that of the dissection phase. The reduction of COeff between the dissection and the anhepatic phase was significant (P0.01).The low vascular resistance is accompanied by a high cardiac output. In spite of the high shunt fraction, these patients were not hypoxaemic. This is explained by the fact that the increased cardiac output leads to a decrease in arterio-mixed venous oxygen content difference and an increase in mixed venous oxygenation level, SvO2 86-88%, normal value approximately 70%. The VAeff/COeff in this study was approximately 0.5, i.e. the effective cardiac output, COeff is 235, 180 and 197% of the effective alveolar ventilation, VAeff during the three phases. Thus, about twice the amount blood is oxygenated as compared to a normodynamic situation, which compensates for the effect of the shunt flow on oxygenation.

Liver transplantation is the sole treatment option for children with chronic liver failure, a patient category previously characterised by high mortality due to the lack of suitable organs. The introduction of new surgical techniques used in 'in situ splitting' of a donor liver, and in living related donor transplants has enabled mortality to be reduced. The article consists gives an account of the first five procedures where the in situ split technique was used in cadaveric livers, and of the first living related liver transplant performed in Sweden. The technique will improve the outcome of liver transplantation in children, and reduce the risk of death due to long waiting lists.