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The automation of medical laboratories will be heightened with the development of a laboratory automation platform which will effectively integrate instrumentation and workstations in clinical laboratories. The laboratory automation platform will be featured with conveyance belts or robots to transport specimen, bar coded-specimens for easier tracking and a software package which will define specimen movement in coordination with robots and other equipment., Take a walk through the laboratory of the not-too-distant future. ADVANCES in science and technology are driving the evolution of medical practice and its reliance upon the clinical laboratory. As [...]

In an analysis of surgical complications following 500 consecutive orthotopic liver transplants, we identified 12 patients who developed the syndrome of multiple bowel perforations that was not due to iatrogenic injury. All cases occurred in small children (mean weight: 9.0 kg), who represented 7% of the pediatric population. Each patient had a minimum of three perforations. The typical intraoperative findings were pin-point perforations in areas of normal-appearing bowel. With only one possible exception (a patient with cytomegalovirus enteritis), no specific etiology could be determined. Management was based on multiple exploratory laparotomies and individualized operative procedures. All patients are currently alive (mean follow-up: 34.9 months). The pathogenesis of the syndrome of multiple bowel perforations remains unclear but is possibly multifactorial or related to high doses of steroids. Aggressive surgical management with semiopen treatment of peritonitis and frequent explorations has afforded excellent results., Patients who currently undergo liver transplant surgery experience longer survival as a result of improvements in anesthesia techniques and critical care. However, there is still a relatively high incidence of postoperative complications. An analysis of 500 liver transplant patients identified 12 patients who developed a syndrome of multiple bowel (intestine) perforations following liver transplant. These perforations were not due to injury during surgery. All bowel perforations occurred in very young children, ranging in age from two weeks to five years. These children represent 7 percent of the 500 children who underwent liver transplant at the University of Nebraska Medical Center from 1985 to 1990. A study was undertaken to identify the possible cause of the syndrome and describe the course of the affected patients. Patients had at least three perforations, typically pinpoint perforations in normal-appearing intestine. The children underwent many exploratory operations and specific operative procedures. At average follow-up of 34.9 months, all patients are alive. The cause of this syndrome remains unclear; it appears to have multiple causes, but may be related to high-dose steroid therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Liver transplants are associated with a high incidence of fungal infections - as high as 28 percent. Prolonged use of antibiotics, indwelling catheters and immunosuppressive therapy may predispose the transplant recipient to these fungal infections. A retrospective study was undertaken of 307 liver transplant patients to determine the incidence and severity of these fungal infections, identify risk factors, and evaluate outcome and treatments. There were 91 infections identified in 72 liver transplants (23.8 percent). Candida, an organism normally found in the gastrointestinal tract and other areas of the body, was responsible for 83.5 percent of the infections. The infections included generalized infection (19 cases), inflammation of the abdominal cavity (17), and inflammation of the lungs (15). The infection was identified within the first two months in 84.7 percent of cases; the average was 16 days after transplant. Early identification is a problem; the main clinical problem was widespread infection. Risk factors identified included: retransplantation, reintubation, need for blood transfusion during surgery, urgent need for the operation, as well as number of steroid doses given, bacterial infection with antibiotic treatment, and vascular complications. Fungal infection was associated with decreased survival; 50 percent, versus 16.5 percent of patients without fungal infection. Treatment with amphotericin B was successful in 63 cases (74.1 percent). These findings indicate that fungal infection is a major cause of morbidity and mortality in liver transplant patients; this is related to specific risk factors, suggesting the need for effective preventive measures. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cytomegalovirus (CMV) has become the most important infectious agent in patients who undergo organ transplantation, due, in large measure, to the immunocompromised condition of the host. Infection with CMV may be the result of exposure to infected blood products or the transplanted organ, of reactivation of latent virus, or of reinfection. Liver transplant patients often develop infections, which are a serious cause of illness and death. To learn more about CMV disease among liver transplant recipients, the records of 211 patients (127 adults, 84 children) at one medical facility were reviewed. Patients were followed-up for an average of 13 months. Thirty-seven retransplantation procedures were performed for the whole group. When CMV disease was diagnosed, antiviral therapy with intravenous ganciclovir was initiated and patients' clinical, viral, and tissue biopsy results noted. Results showed that 73 patients (34.6 percent) experienced at least one episode of CMV disease, with a slightly higher incidence among adults. The diseases that necessitated liver transplantation are enumerated; in adults, there was no diagnosis consistently associated with subsequent CMV disease. In children, however, postnecrotic cirrhosis (a degenerative condition associated with tissue death) tended to be followed by CMV disease more than other disorders, with a lower CMV disease frequency among children with metabolic disorders. The risk of CMV disease was highest in patients who received livers from donors whose blood tested positive for CMV, from those who underwent treatment with agents to suppress lymphocyte proliferation for immunosuppression, and from those who underwent retransplantation. Primary disease (11 people) usually developed in the transplanted liver and had a high recurrence rate; however, it responded to ganciclovir in all cases. Control of CMV disease by this drug was achieved in approximately 94 percent of all cases. A discussion is provided of CMV disease in transplant recipients, and the lack of information regarding the effects of ganciclovir on liver transplant recipients is noted. Prompt diagnosis and preventive therapy are the key elements of treating this disorder in such patients. (Consumer Summary produced by Reliance Medical Information, Inc.)