Circumferential Fence With the Use of Polyethylene Terephthalate (Dacron) Vascular Graft for All-in-One Hepatic Venous Reconstruction in Right-Lobe Living-Donor Liver Transplantation

Integration of hepatic vein tributaries with a diameter ≥ 5 mm into the drainage system in right-lobe living-donor liver transplantation (LDLT) is of vital importance for graft function. Recently, the most commonly emphasized hepatic venous reconstruction model is the all-in-one reconstruction model. In the final stage of this model that aims to form a common large opening, allogeneic vascular grafts are almost always used to construct a circumferential fence. To date, no other study has reported the use of polyethylene terephthalate (Dacron) vascular graft as a circumferential fence in LDLT. We aimed to present the 1st 4 cases of circumferential fences created with Dacron vascular graft. Four right-lobe grafts weighing 522-1,040 g were used. A polytetrafluoroethylene vascular graft was used for the integration of segment 5 vein and segment 8 vein into the drainage model, whereas a Dacron graft was used to creating a circumferential fence. The patency of hepatic outflow evaluated with the use of multidetector computerized tomography at postoperative day 7. Venous outflow obstruction was not detected in any cases. This study suggested that owing to its flexible structure the polyethylene terephthalate vascular graft can be an alternative to allogeneic vascular grafts in forming circumferential fence.

Histopathologic Findings of Cholecystectomy Specimens in Patients Who Underwent Donor Hepatectomy for Living Donor Liver Transplantation

BACKGROUND

The aim of this study was to discuss the macroscopic and microscopic properties of gallbladder specimens obtained from living liver donors.

METHODS

The study retrospectively analyzed the clinical and histopathological data of 1088 donors who underwent living donor hepatectomy between March 2005 and September 2014 at Inonu University Faculty of Medicine, Liver Transplantation Center. Age, sex, macroscopic, and microscopic properties of the gallbladder (bladder length, diameter, content, and histopathological properties) were recorded by 2 researchers.

RESULTS

A total of 1009 donors aged 17 to 66 years (31.1 ± 9.5) met the inclusion criteria, whereas 79 donors were excluded due to missing data. In total, 587 donors were male (30.5 ± 9.1 years [16-63 years]) and 422 were female (31.8 ± 9.8 years [18-66 years]). Preoperative tests revealed Gilbert syndrome in 3 subjects, whereas other donors' biochemical tests were within normal ranges. The macroscopic examination of gallbladders revealed mean gallbladder wall thickness, length, and width of 1.82 ± 0.8 mm (1-10 mm), 72 ± 11.4 mm (40-120 mm), and 52.5 ± 14 mm (15-90 mm), respectively. The microscopic gallbladder examination showed that 740 donors had a normal gallbladder, 193 had chronic cholecystitis (1 donor had antral metaplasia and 1 had intestinal metaplasia), 40 had cholesterolosis (1 donor had both tubular adenoma and intestinal metaplasia), 15 had minimal chronic cholecystitis (1 donor had pyloric metaplasia), 14 had cholelithiasis, 2 had adenomyosis, 2 had muscular hypertrophy, 1 had papillary hyperplasia, 1 had microdiverticulitis, and 1 had mucosal lymphatic ectasia.

CONCLUSION

The results of this study reflect the actual gallbladder pathologies that can be detected in healthy people. Clearer conclusions can be reached about the epidemiological data on gallbladder as the number of living liver donors increases in the future.

Postoperative Pulmonary Complications After Liver Transplantation: Assessment of Risk Factors for Mortality

BACKGROUND

The aim of this study was to identify the risk factors related to mortality in liver transplant (LT) patients with post-transplantation pulmonary complications.

METHOD

Patients who underwent liver transplantation in our clinic between January 2010 and January 2012 were retrospectively reviewed for post-transplantation pulmonary complications. Demographic, clinical, radiologic, and postoperative chart data of 153 patients with pulmonary complications were analyzed using an independent samples Student t test, Pearson's χ(2) test, Fisher's exact test, and Yate's corrected χ(2) test. Mortality was analyzed using a multiple logistic regression model. The best-fit breakpoint resulting in a cut-off value for the variables of interest was determined using ROC curves and the Youden index.

RESULTS

The 153 patients with pulmonary complication were divided into 2 groups: mortality (n = 53) and survival (n = 100). Univariate analyses showed significant differences between these 2 groups with respect to MELD score (P = .035), duration of mechanical ventilation (P > .001), pneumonia (P = .01), and endotracheal culture results (P = .001). In the multivariate analysis, hemoglobin (P = .03, odds ratio [OR]: 1.239), MELD score (P = .027, OR: 1.064), duration of mechanical ventilation (P = .003, OR: 1.091), and age (P = .042, OR: 1.001) were significant risk factors for mortality. The best-fit breakpoint analysis yielded cut-off values for hemoglobin (>11.2, sensitivity: 50.9%, specificity: 70%), MELD score (>16, sensitivity: 73.6%, specificity: 42%) and duration of mechanical ventilation (>3, sensitivity: 62.3%, specificity: 76%).

CONCLUSION

Advanced age, high hemoglobin level, high MELD score, and long-term mechanical ventilation are significant risk factors for mortality in liver transplant patients with postoperative pulmonary complications.

Cross-Cultural Adaptation, Reliability, and Validity of the Turkish Version of the Compliance Questionnaire on Rheumatology in Patients With Behçet's Disease

PURPOSE

The aim of this study was to examine the psychometric properties of the Turkish versionof the Compliance Questionnaire on Rheumatology (CQR-T) for patients with Behçet's disease (BD).

METHOD

A sample of 105 Turkish patients with BD participated in this study. The scale was cross-culturally adapted through a process including translation, comparison with versions in other languages, back translation, and pretesting. Construct validity was evaluated by factor analysis, and criterion validity was evaluated using the Morisky Medication Adherence Scale.

RESULTS

The CQR-T demonstrated acceptable internal consistency (Cronbach's α = .832), adequate test-retest reliability (intraclass correlation coefficient = .630), and correlations with Morisky Medication Adherence Scale scores (r = -.389, p< .001), indicating convergent validity.

CONCLUSION

The CQR-T was found to be a valid and reliable instrument for evaluating the compliance of Turkish BD patients with prescribed medications.

IMPLICATIONS FOR PRACTICE

The CQR-T might be a helpful tool in two ways: for determining the level of compliance of patients with BD and for adjusting their management and follow-up based on the results.

Association between serum 25-hydroxyvitamin D levels and TTN

AIM

To investigate the association between serum 25-hydroxyvitamin D (25(OH)D3) levels and transient tachypnea of the newborn (TTN).

METHODS

Calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), parathormone (PTH) and serum 25(OH)D3 levels were measured in 51 infants diagnosed with TTN and 59 healthy control infants for comparison. Demographic factors including gestational age, birth weight, gender, delivery mode, parity, vitamin D supplementation during pregnancy and severity of TTN were recorded.

RESULTS

The serum levels of 25(OH)D3 were significantly lower in infants with TTN compared to infants with no respiratory distress (p < 0.01). There was no statistically significant difference in serum Ca, P and ALP levels between the groups while the serum levels of PTH were significantly higher in the study group (p < 0.01). No correlation was found between the serum 25(OH)D3 levels and severity of TTN. Vitamin D supplementation (400 IU/day) during pregnancy did not affect the serum levels of newborns.

CONCLUSION

Our data suggests that lower 25(OH)D3 serum levels are associated with an increased risk of TTN and vitamin D may have a role in the pathogenesis of TTN.

Saphenous nerve injury after endovenous laser ablation of incompetent greater saphenous vein: An electroneuromyography study

AIM

To determine whether endovenous laser ablation of incompetent greater saphenous vein causes a detectable impairment in saphenous nerve conduction.

MATERIAL AND METHODS

Thirty-five patients (mean age: 44.78 ± 8.6, male/female ratio: 16/19) who were operated on for incompetent greater saphenous veins, underwent electroneuromyography before and two weeks after the operation. Dysesthesia was questioned as to whether having unpleasant abnormal sensation after the operation. Positive electroneuromyography findings for saphenous nerve injury included a sensory nerve action potential amplitude <2 µV or a nerve conduction velocity <48.0 m/s or a latency onset >5.0 ms.

RESULTS

Thirty-four patients were available at two-week follow-up. All patients achieved complete proximal closure. Three patients (8.8%) had dysesthesia at two weeks. Mean electroneuromyography values were not significantly different between preoperative and postoperative period. Postoperatively, none of the patients had abnormal sensory nerve action potential or latency onset, whereas nerve conduction velocity decreased below the lower limit in two patients. These two patients were not among those having dysesthesia and they had no other complaints.

CONCLUSION

Injury to saphenous nerve seems not likely during endovenous laser ablation of incompetent greater saphenous veins, as evidenced by normal electroneuromyography values found after the operation.

Living related donor liver transplantation with atrio-caval anastomosis of inferior vena cava graft stored in deep-freeze for budd-Chiari syndrome

We have previously reported our experience in inferior vena cava resection and reconstruction techniques during liver transplantation for Budd-Chiari syndrome. Herein, we present on a case that demonstrates the importance of experience in complex vascular reconstruction techniques for living donor liver transplantation. A 15-year-old boy was scheduled for living donor liver transplantation for Budd-Chiari syndrome. Venous occlusion was extended up to the right atrial orifice of the supra-hepatic vena cava. Retro- and supra-hepatic segments of the vena cava was resected. Inferior vena cava graft stored in deep-freeze was available. Venous reconstruction was performed with end-to-end atrio-caval anastomosis. Surgical treatment was completed with the implantation of the right liver lobe donated by the patient's mother. Post-surgical course was uneventful.

Optic disc drusen mimicking papilledema in an infant with Joubert syndrome

Joubert Syndrome is a rare autosomal recessive disorder characterized by absence or underdevelopment of the cerebellar vermis. Various ocular and oculomotor findings are frequently seen in cases with Joubert Syndrome. However, only three adolescent patients with Joubert Syndrome were diagnosed with optic disc drusen. Here we present an infant case of Joubert Syndrome referred with papilledema and diagnosed with optic disc drusen.

Progressive Multifocal Leukoencephalopathy after Three Consecutive Liver Transplantations

Progressive multifocal leukoencephalopathy (PML) is a lytic infection of the central nervous system caused by the reactivation of John Cunningham Virus (JCV) in severely immunosuppressed patients. Occurrence of PML after solid organ transplantations, especially after liver transplantation, is rare. If a patient has poor prognostic factors such as atypical radiological involvements or high viral load in cerebrospinal fluid (CSF), overall survival rates could be poor. Herein, we report on a patients who underwent liver transplantation three times and developed PML with unexpected radiological findings; he was also positive for JCV DNA with a high viral load. Although there are limited data about efficacy of cytarabine against JCV, it was given to the patient for five days. Despite the initiation of cytarabine and complete cessation of the immunosuppressive therapy, we lost the patient, unfortunately.

Low cord blood serum levels of vitamin D: cause or effect of fetal macrosomia?

Aim: The aim of the study was to compare cord blood vitamin D levels of macrosomic large for gestational age (LGA) and appropriate gestational age (AGA) newborns.

MATERIALS AND METHODS

Seventy-nine healthy, normal term newborns were included in the study. They were divided by birth weight into two groups: 37 in the LGA group above 4,000 g, and 42 newborns in the AGA group birth weight between 3,000 g and 4,000 g. Cord blood samples from groups were collected. Circulating 25(OH)D was measured as 25 hydroxyvitamin D3 (25(OH)D3) by high-performance liquid chromatography (HPLC) in serum using a kit.

RESULTS

Maternal characterstics (age, body mass index [BMI], and gestational age) did not differ between the AGA and LGA groups. Cord blood 25 OH vitamin D levels were significantly low in neonates with LGA (p = 0,02).

CONCLUSIONS

The authors found that macrosomic infants had low levels of vitamin D. Providing vitamin D supplements to pregnant women may prevent macrosomia. Randomized controlled trials are needed to prove this assertion.

Retained Foreign Body in Transplanted Liver

Liver transplantation is a technically complex and long surgical procedure. A large quantity of various materials such as catheters, sutures, needles and clips are frequently used during the procedure. These materials may enter in the liver from the vascular or biliary orifices inadvertently. A 50-year-old patient who had hepatic failure due to HBV underwent a deceased-donor liver transplantation. The deceased donor was a 75-year-old HbsAg(+) man. The recipient had subfebrile fever and leukocytosis post-operatively. A control computed tomography revealed a cuneiform ischemic area, and a foreign body inside the right anterior portal vein branch proximal to this ischemic region. A 10-F Nelaton catheter, 5-cm long, was removed from the portal vein by surgery. Retrospectively, we understood that the portal vein was cut during the back-table procedure and the portal vein catheter was replaced with a larger one for better irrigation. Most probably, the original catheter was cut together with the portal vein, and the tip of the catheter was retained in the portal system and migrated into the liver. As far as we know, such a complication of liver transplantation has never been described previously.

Binding site feature description of 2-substituted benzothiazoles as potential AcrAB-TolC efflux pump inhibitors in E. coli

The resistance-nodulation-division (RND) family efflux pumps are important in the antibiotic resistance of Gram-negative bacteria. However, although a number of bacterial RND efflux pump inhibitors have been developed, there has been no clinically available RND efflux pump inhibitor to date. A set of BSN-coded 2-substituted benzothiazoles were tested alone and in combinations with ciprofloxacin (CIP) against the AcrAB-TolC overexpressor Escherichia coli AG102 clinical strain. The results indicated that the BSN compounds did not show intrinsic antimicrobial activity when tested alone. However, when used in combinations with CIP, a reversal in the antibacterial activity of CIP with up to 10-fold better MIC values was observed. In order to describe the binding site features of these BSN compounds with AcrB, docking studies were performed using the CDocker method. The performed docking poses and the calculated binding energy scores revealed that the tested compounds BSN-006, BSN-023, and BSN-004 showed significant binding interactions with the phenylalanine-rich region in the distal binding site of the AcrB binding monomer. Moreover, the tested compounds BSN-006 and BSN-023 possessed stronger binding energies than CIP, verifying that BSN compounds are acting as the putative substrates of AcrB.

Association of choroidal thickness with eye growth: a cross-sectional study of individuals between 4 and 23 years

BACKGROUND AND AIMS

We aimed to evaluate the association of subfoveal choroidal thickness (SFCT) with age and to determine its relationship with axial length (AL) and ocular biometric parameters, in children and young adults during growth period.

METHODS

One hundred and sixty patients (80 male, 80 female) aged between 4 and 23 years were included. Patients were classified into five groups according to their ages as group 1 (4-7 years of age), group 2 (8-11 years), group 3 (12-15 years), group 4 (16-19 years), and group 5 (20-23 years). SFCT was assessed using spectral-domain optical coherence tomography (3D OCT-2000). The measurements were taken at the same daytime (1000-1200 hours) to avoid diurnal fluctuation. Ocular AL and anterior segment parameters were measured using optical biometry (Lenstar LS900)).

RESULTS

The average SFCT was 308.1±47.6 μm, ranging from 206 to 410 μm. The mean SFCT values in group 1 to 5 were measured as 306.8±42.0, 297.8±48.1, 283.2±38.9, 326.9±57.4, and 325.8±35.9 μm, respectively. The mean CT of group 3 was significantly thinner than group 4 and 5 (P<0.05 for two groups), however, there was no statistical significance compared with group 1 (P=0.227) and group 2 (P=0.693). On stepwise regression analysis, age exhibited a positive association with SFCT (B=2.8, P<0.001) and AL exhibited a negative association with choroidal thickness (B=-16.7, P<0.001).

CONCLUSIONS

We found that SFCT shows no age-related difference until age of 15, whereas 16-23-year old participants had thicker SFCT compared with the younger ones. In that aspect, a thicker choroid associated with age in certain age groups suggests an age period of SFCT increase to a plateau in young adulthood. Larger studies are warranted to elucidate the age-related changes in SFCT in childhood, as improved evaluation of normal choroidal thicknesses during eye growth should assist in the diagnosis of choroidal abnormalities associated with eye disease.