required both for the liver unit including a high dependency area and the intensive care unit. Rehabilitation requires the use of facilities outside the liver unit and has profound implications on the department.

Conclusion The purpose of this article was to increase the awareness

of physiotherapists of liver transplantation which is an increasing surgical option for selected patients wi th end- stage cirrhotic disease and fulminant hepatic failure. Physiotherapists play an active role in the management of these patients, helping to define those at risk from pulmonary disease. Respiratory complications are common and include pleural effusions and atypical viral and fungal infections as well as the more general conditions experienced after any upper abdominal surgery. Chest physiotherapy is an integral part of the management of these patients. If the patients survive the immediate post-operative period, they require rehabilitation which can be complicated by the loss of muscle bulk or more rarely myopathies and both peripheral and central neuropathies.

Triple organ transplantation of lungs, heart and liver is now a surgical option for cystic fibrosis. As the selection criteria widen, some patients require both kidney and liver transplantation for metabolic disorders. Since both the operative mortality and one-year survival rate continue to improve, liver transplantations will increase and the developments over the next few years will be fascinating.

REFERENCES Carithers, R L e t a / (1989). 'Post-operative care' in: Maddrey, W C

(ed) Transplantation of the Liver, Elsevier, New York, 111-142. Craig, D B (1981). 'Post-operative recovery of pulmonary function',

Anaesthesia and Analgesia, 60, 1, 45 - 52. Crosbie, W J and Sim, D T (1986). 'The effects of postural

modification on some aspects of pulmonary function following

surgery of the upper abdomen', Physiotherapy, 60, 1, 46-52 . Erikson, L S e ta / (1990). 'Hypoxaemia cured by liver transplantation',

Transplantation Proceedings, 22, 1, 172-173. Grenvik, A and Gordon, R (1987). 'Post-operative care and

problems in liver transplantation', Transplantation Proceedings,

Hough, A (1984). 'The effect of posture on lung function', Physiotherapy, 70, 3, 101 -104.

Jenkins, S C, Soutar, S A and Moxham, J (1988). 'The effects of posture on lung volumes in normal subjects and in patients pre- and post-coronary artery surgery', Physiotherapy, 74, 10,

Jensen, W A e t a/ (1986). 'Pulmonary complications of liver transplantation', Transplantation, 42, 5, 484-490.

Kirby, R M e t a/ (1987) 'Orthotopic liver transplantation: Post- operative complications and their management', British Journal of Surgery, 74, 1, 3-11.

Kumar, S, Stauber, R E, Gavaler, J S, Basista, M H, Dindzans, V J e t a/ (1990). 'Orthotopic liver transplanation for alcoholic liver disease', Hepatology, 11, 2, 159-164.

McMaster, P and Buist, L J (1989). Liver Transplantation from Surgeiy no 64, M Stearn, The Medicine Group (UK) Ltd

McMaster, P e t a / (1986). 'The current state of liver and pancreas transplantation', in: Polak, J M, Bloom, J R, Wright, N A and Butler, A G (eds), Disease of the Gut, Glaxo Research Ltd, Ware, Hertfordshire, pp 389-399.

Neuberger, J M (1987). 'When should patients be referred for liver transplantation?' British Medical Journal, 295, 565- 566.

Neuberger, J M and Williams, R (1987). 'Indications and assessment for liver grafting' in: Calne, R (ed) Liver Transplantation (2nd edn), Grune and Stratton Limited, New York, pp 63 -75 .

O'Grady, J G and Williams, R (1989). 'Aspects of intensive care following liver transplanation', Care of the Critically 111, 5, 2,

Schenker, S, Perkins, H S and Sorrell, M F (1990). 'Should patients wi th end stage alcoholic liver disease have a new liver?' Transplantation Proceedings, 22, 1, 172-173.

Starzl, T E, Van Thiel, D, Tzakis, A G, Iwaksuki, S, Todo, S e t a l (1988). 'Orthotopic liver transplantation for alcoholic cirrhosis', Journal of the American Medical Association, 2609, 17, 2542-44.

Webber, B A and Gaskell, D V (1988). The Brompton Hospital Guide to Chest Physiotherapy 15th edn), Blackmore Publications Ltd, London .

19, 4, SUPPI 3, 26-33 .

492-496.

pp 1528-36.

67-69 .

Publications What Everyone Should Know About Assisting a Wheelchair User. Leonard Cheshire Foundation, Leonard Cheshire House, 26-28 Maunsel Street, London SWlP 2QN, 1990. 16 pages.

Heavily illustrated, this booklet is packed with information about the components of a wheelchair, the needs of users, safety in various situations and some t ips on maintenance. It takes care to recommend that manufacturers' instructions should be studied, therapists should be asked for further help if required, and the user of the wheelchair should always be treated with respect.

Abuse of Elderly People: Guide lines for ac t ion and In fo rmat ion fo r Carers. Distribution Services Department, Age Concern England, 1268 London Road, London SW16 4EJ, 1990. 8-page guide lines booklet 25p. single sheet for carers free on receipt of 17p SAE.

A working group of six professional and voluntary agencies produced these related publications. The booklet for professionals is a guide to identifying abuse and suggests ways of preventing i t and action to take when it has occurred.

The paper for carers encourages safe ways of releasing tension, followed by an

assessment of the situation and ways of alleviating problems and the possibility of abrogating responsibility if the situation is intolerable.

Northern Health in Figures. Northern Regional Health Authority, Benfield Road, Newcastle upon Tyne NE6 4PY. 1990. 12-page pull-out leaflet.

Very thick and glossy, this two-colour spreadsheet gives clear statistics for the Northern Region on populations, mortality ratios (worse than the average for England and Wales), hospitals and treatments, and revenue allocations. Of compelling interest to those living in the area and an example to anyone elsewhere of how such figures can be attractively presented.

Heart-Lung Transplantation for Patients wi th Cystic Fibrosis, by T Higenbottam, P Helms and M E Hodson. Department HIL, Cystic Fibrosis Research Trust, Alexandra House, 5 Blythe Road, Bromley, Kent BR1 3RS, 1990. 10 pages. Free but donation towards postage welcome.

Written by three physicians responsible for the hospital care of heart-lung patients, before and after operation, this booklet is for patients who may have the operation and their relatives.

It pulls no punches in describing the severity of the procedures and the care which has to go into any decisions in this

I

field of surgery. The layout is attractive wi th large readable type and the content and its promise of further help from many sources should be helpful to most people faced with this possibility.

Care of Old People: A framework for progress - occasional paper 45. Royal College of General Practitioners, 14 Princes Gate, Hyde Park, London SW7 lPU, 1990 (ISBN 0 85084 151 8). 2 4 pages. f 7 post free.

The average person over the age of 7 5 sees a general practitioner six times a year and at any one time about 95% of old people are in the care of a general practitioner at home. This paper identifies the demographic trends, pinpoints the areas of concern and reviews recent research. It includes guide lines on good practice and a check list for GP assessment of the over-75s.

A FramewDrk for Action: Developing Services for People wi th Severe Physical and Sensory Disabilities - Living Options in Practice project paper 1, by Barrie Fielder and Diana Twitchen. Living Options in Practice, 126 AlbervStreet, London NW1 7NF. 1990. 18 pages. €2.50 post free.

The components of an effective service system for disabled people are described and the document suggests a strategy for achieving good service, based on the practical work under way in the eight Living Options in Practice localities.

Physiotherapy, Januav 1991, vol77, no 1 65