En bloc and dual kidney transplantation: two initial cases from a new kidney transplantation center

AIM

The aim of this study was to share our initial successful experiences with en bloc dual kidney transplantation.

CASES

En bloc kidney were obtained, for case 1 from a 3-year-old deceased pediatric donor who had undergone cadaveric liver transplantation due to fulminant hepatitis A virus infection 1 week prior. The donor length was 97 cm and weight 13 kg. According to the age and weight of the donor, we selected a 50-year-old respectively. For case 2, a kidney was retrieved from a 20-month-old pediatric donor after development of hypoxic brain injury secondary to status epilepticus. The donor length and weight were 75 cm and 13 kg respectively. A 30-year-old female patient was of 162 cm and 59 kg. The suprarenal aorta, suprarenal vena cava, and caval and aortic lumbar branches were closed with running sutures during the backtable procedures. After the classic Gibson incision, the donor aorta was anastomosed to the recipient right common iliac artery, and the donor inferior vena cava to the recipient right common iliac vein in end-to-side fashion. The ureters were implanted with mucosa-to-mucosa ureteroneocystostomies separately according to the Lich-Gregoir technique. After the vascular anastomoses the kidneys had immediate good perfusion in both cases. Postoperative recovery was rapid, the recipients were discharged uneventfullly.

CONCLUSION

En bloc dual kidney transplantation from young pediatric patients to adult recipients can be performed with low mortality and morbidity even by new centers.

Can an extended right lobe be harvested from a donor with Gilbert's syndrome for living-donor liver transplantation? Case report

Gilbert's syndrome (GS) is a common cause of inherited benign unconjugated hyperbilirubinemia that occurs in the absence of overt hemolysis, other liver function test abnormalities, and structural liver disease. GS may not affect a patient's selection for living-donor liver transplantation (LDLT). Between February 2005 and April 2011, 446 LDLT procedures were performed at our institution. Two of the 446 living liver donors were diagnosed with GS. Both donors underwent extended right hepatectomies, and donors and recipients experienced no problem in the postoperative period. Their serum bilirubin levels returned to the normal range within 1-2 weeks postoperatively. In our opinion, extended right hepatectomy can be performed safely in living liver donors with GS if appropriate conditions are met and remnant volume is >30%. Livers with GS can be used successfully as grafts in LDLT recipients.

Relationship of ultrasonographic findings with synovial angiogenesis modulators in different forms of knee arthritides

Angiogenesis is controlled by a variety of angiogenesis stimulators and inhibitors. The increased power Doppler (PD) signals determined by ultrasonography is an indirect marker of synovial vascularity in arthritis. We aimed to investigate relationship between ultrasonographic findings and synovial angiogenesis modulators. Thirteen Behcet's disease (BD), 15 spondyloarthropathy, 21 rheumatoid arthritis (RA), and 15 osteoarthritis (OA) patients with knee arthritis were included. Cumulative effusion, synovial hypertrophy, and PD signal scores were calculated in arthritic joints. In synovial fluid samples, angiogenesis inhibitors (angiostatin, thrombospondin-1, and endostatin) and stimulators [bFGF (basic fibroblast growth factor), angiopoietin-1] were studied. The comparisons between groups were made by Kruskal-Wallis test, and correlation analysis was calculated with Pearson and Spearman tests. Effusion scores were significantly higher in inflammatory arthritis than in OA. Synovial hypertrophy scores were higher in RA and spondylarthritis than in OA and BD. PD scores were not different between the groups. Synovial angiostatin and bFGF levels were significantly higher in patients with inflammatory arthritis than in OA. Cumulative effusion scores were positively correlated with angiopoietin-1, angiostatin, and bFGF and negatively correlated with thrombospondin-1 levels. Synovial hypertrophy scores were positively correlated with angiostatin and bFGF levels and negatively correlated with thrombospondin-1. No correlation was found between PD scores and modulators of angiogenesis. In large joints like knee, detecting PD signals alone was not sufficient to assess the angiogenesis. However, cumulative activity scores were positively correlated with angiogenesis stimulators. Therefore, when investigating the angiogenesis, PD technique should be added to gray-scale examinations.

Chronic graft-versus-host disease after liver transplantation: a case report

Graft-versus-host disease (GVHD) after orthotopic liver transplantation (OLT) is a rare but significant complication, occurring in 1%-2% of cases with a mortality rate of 85%- 90%. It occurs when donor passenger lymphocytes mount an alloreactive response against the host's histocompatibility antigens. It presents as fever, rash, and diarrhea with or without pancytopenia. Between March 2002 and September 2011, among 656 OLT patients 1 (0.15%) had acute GVHD. A biopsy at the 7th posttransplantation month revealed chronic GVHD. Consequently, in the cases that had fever, rash, and/or desquamation of the any part of body after liver transplantation, GVHD must be considered and skin biopsies must be planned for the diagnosis.

Is routine sternotomy necessary for organ recovery from deceased donors? A comparative retrospective study

BACKGROUND

Traditionally, sternotomy and laparotomy are performed to recover thoracoabdominal organs from deceased donors; however, recovering abdominal organs without sternotomy is possible. We evaluated and compared organ recovery from deceased donors, with and without sternotomy.

METHODS

Between February 2006 and November 2011, organ recovery was performed in 68 deceased donors by our transplantation team. The recovery procedure was carried out using standard techniques in 31 donors (with sternotomy; Group A) and with modified techniques in 37 donors (without sternotomy; Group B). Average age, gender, body mass index (BMI), and time to cold ischemia were compared retrospectively in both groups. The demographic and clinical parameters were compared using a Student t test and chi-square test. The level of statistical significance was set at P < .05.

RESULTS

Organ recovery was performed on 31 of 67 (45.6%) deceased donors with sternotomy (Group A) and 37 of 67 (54.4%) without sternotomy (Group B). Thirty-six donors were male and 32 were female. The average donor age was 40.4 ± 3.4 years in Group A and 52.4 ± 4.6 years in Group B (P < .02). The average BMI of donors was 26.2 ± 0.8 kg/m(2) in Group A and 23.9 ± 0.8 kg/m(2) in Group B. The average time to cold ischemia was 127 ± 6.2 minutes in Group A and 47.5 ± 1.8 minutes in Group B (P < .0001).

CONCLUSION

The transition time to cold ischemia can be shortened by harvesting organs without sternotomy in unstable donors, or under conditions in which intrathoracic organs are not recovered.

Radiographic and histologic evaluation of platelet-rich plasma and bovine-derived xenograft combination in bilateral sinus augmentation procedure

There is currently a great interest regarding the use of platelet-rich plasma (PRP) in combination with various bone graft materials in sinus lift procedures. The purpose of this study was to assess and compare the radiographic and histological results of sinus augmentation procedures following treatment with PRP/bovine-derived xenograft (BDX) vs. BDX/collagen membrane. Using a split mouth design, 10 patients, with ≤5 mm of residual alveolar bone in the vertical direction, were treated with PRP/BDX or BDX/collagen membrane. At 8 months after surgery, both graft materials led to a satisfactory increase in vertical dimensions of bone. Bone biopsies were taken from the augmented sites during the implant placement. Histological analysis demonstrated that majority of the trabecula contained orderly layered lamellar bone in the PRP/BDX group, whereas mainly woven bone with a haphazard arrangement of collagen fibers were noticed in the BDX /collagen membrane group. It can be concluded that both combinations resulted with a satisfactory bone height, but more prominent and mature bone formation was observed at sites treated with PRP/BDX.

Cerebrofacial venous anomalies, sinus pericranii, ocular abnormalities and developmental delay

The clinical implications of venous cerebrovascular maldevelopment remain poorly understood. We report on the association of cerebrofacial venous anomalies (including sinus pericranii), ocular abnormalities and mild developmental delay in two children. In addition, one child had a seizure disorder. Complex cerebrofacial slow-flow vascular anomalies may herald an underlying developmental aberration affecting the cerebrofacial and orbital regions.

FDG PET/CT in monitoring treatment of retroperitoneal fibrosis

Retroperitoneal fibrosis is an uncommon disease characterized by inflammatory fibrosis typically surrounding abdominal aorta and iliac arteries. The glucose analogue F18-fluorodeoxyglucose can be used to image inflammatory cell activity non-invasively by PET. In this report we investigated the usefulness of the FDG PET/CT in the disease activity and therapy response evaluation of retroperitoneal fibrosis.

Syncope or seizure? The diagnostic value of synchronous tilt testing and video-EEG monitoring in children with transient loss of consciousness

Syncope and seizure are frequently encountered problems in daily neurology practice, and they also share common findings such as transient loss of consciousness and atonia. Sometimes, it is difficult to make a differentiation between the two entities using only clinical findings. In this study, nineteen patients aged between 5 and 20 years who had recurrent transient loss of consciousness and occasional atonic events were examined with synchronous tilt testing and video-EEG recordings. Eleven patients were initially diagnosed with epilepsy, and they were given antiepileptic drugs. Eight patients displayed neurally mediated syncope during examination. Four of the eight patients had cardioinhibitory syncope type 2B. Three-fourths of the patients with syncope had been initially diagnosed with epilepsy and were prescribed antiepileptic drugs. One patient with cardioinhibitory syncope who had prolonged asystole and frequent attacks needed a cardiac pacemaker. Following implantation, she had no new attacks. Synchronous tilt testing and video-EEG recordings give more information than doing them separately, and they are helpful in the differential diagnosis of syncope and seizure.

Insight into eukaryotic topoisomerase II-inhibiting fused heterocyclic compounds in human cancer cell lines by molecular docking

Etoposide is effective as an anti-tumour drug by inhibiting eukaryotic DNA topoisomerase II via establishing a covalent complex with DNA. Unfortunately, its wide therapeutic application is often hindered by multidrug resistance (MDR), low water solubility and toxicity. In our previous study, new derivatives of benzoxazoles, benzimidazoles and related fused heterocyclic compounds, which exhibited significant eukaryotic DNA topoisomerase II inhibitory activity, were synthesized and exhibited better inhibitory activity compared with the drug etoposide itself. To expose the binding interactions between the eukaryotic topoisomerase II and the active heterocyclic compounds, docking studies were performed, using the software Discovery Studio 2.1, based on the crystal structure of the Topo IIA-bound G-segment DNA (PDB ID: 2RGR). The research was conducted on a selected set of 31 fused heterocyclic compounds with variation in structure and activity. The structural analyses indicate coordinate and hydrogen bonding interactions, van der Waals interactions and hydrophobic interactions between ligands and the protein, as Topo IIA-bound G-segment DNA are responsible for the preference of inhibition and potency. Collectively, the results demonstrate that the compounds 1a, 1c, 3b, 3c, 3e and 4a are significant anti-tumour drug candidates that should be further studied.

Simultaneous complex regional pain syndrome of the upper and lower limb in a stroke patient. Case report

Complex regional pain syndrome (CRPS) is a clinical condition charactarized by localised or diffuse pain accompanied with vasomotor, sudomotor and trophic changes in the affected part of the body. CRPS type-1 (CRPS-1) is a disabling problem after stroke and it is frequently reported in plegic upper limb. Although hemiplegia also involve the lower limb only a small number of patients reported to have CRPS-1 in the ipsilateral lower limb simultaneously in the literature. In this article a 70 year-old left hemiplegic woman secondary to ischemic stroke who had a complaint of constant and severe pain in quality of sharp stinging of left arm and leg for approximately 2 months and diagnosed as CRPS-1 in both upper and lower plegic limb simultaneously is presented. By the combination of medical and physical therapy the symptoms and signs resolved within 5 weeks and increased participation to the rehabilitation program is observed.

A descriptive analysis of 188 liver transplant patient visits to an emergency department

BACKGROUND

The aim of the study is to seek the causes of application, the demographic and clinical characteristics of liver transplant patients and to share the experiences of our Emergency Department.

MATERIALS AND METHODS

One hundred eighty-eight Emergency Department visits of ninety patients who underwent liver transplant operations between 2002 and 2009 were evaluated retrospectively.

RESULTS

The patients applied to the Emergency Department with the complaints of fever 28.2% and abdominal pain 30.9%. It was detected that the final diagnosis of 52.4% of the patient visits was associated with the gastrointestinal system. It was observed that the most common treatment was drug therapy by 45.2% and that antibiotics treatment was the most applied method in drug treatment. Alanine aminotransferase (ALT) median value of hospitalized patients (45.5 U/L) is significantly higher than that of discharged patients (35 U/L) (p = 0.04). From the records of the patients, positive correlations between the length of hospitalization and levels of total bilirubin, direct bilirubin, ALT and fever during the visit were detected (p = 0.001, p < 0.001, p = 0.01, p = 0.01, respectively).

CONCLUSIONS

Most frequently liver transplant recipients visited the Emergency Departments with the complaints of fever and abdominal pain. The diagnosis was generally associated with gastrointestinal system disorders. The percentage of hospitalization was high and the length of stay at the hospital was long. The treatment of these patients required a multidisciplinary approach and antibiotics constituted the most used drug treatment. Also, fever and liver function tests examined at the time of admittance to the Emergency Department affected the length of hospitalization.

Determining the optimal fentanyl dose for dilation and curettage procedures

AIM

This study attempted to determine an optimal dose of fentanyl, a drug frequently used in dilation and curettage (D&C) procedures, which is commonly performed as a brief outpatient intervention.

METHODS

The optimal fentanyl dose was determined using Dixon's up-and-down method. The study was accomplished with a beginning fentanyl dose of 1 microg kg(-1) with a step size of 0.1 microg kg(-1) fentanyl.

RESULTS

The ED50 [95% confidence interval (CI)] for fentanyl for successful anesthesia in D&C procedures was found to be 0.45 (0.35-0.55) microg kg(-1) and the ED95 value was 0.50 (0.45-0.60) microg kg(-1).

CONCLUSION

This dose is considerably lower than the standard dose that is used at present, which is 1 microg kg(-1). To the best of our knowledge, the current study is the first to show that a significantly reduced dose of fentanyl can be as effective as higher doses in D&C procedures using Dixon's up-and-down method.