What's new in transplantation

Bio-electrospraying the nematode Caenorhabditis elegans: studying whole-genome transcriptional responses and key life cycle parameters

Bio-electrospray, the direct jet-based cell handling approach, is able to handle a wide range of cells (spanning immortalized, primary to stem cells). Studies at the genomic, genetic and the physiological levels have shown that, post-treatment, cellular integrity is unperturbed and a high percentage (more than 70%, compared with control) of cells remain viable. Although, these results are impressive, it may be argued that cell-based systems are oversimplistic. Therefore, it is important to evaluate the bio-electrospray technology using sensitive and dynamically developing multi-cellular organisms that share, at least some, similarities with multi-cell microenvironments encountered with tissues and organs. This study addressed this issue by using a well-characterized model organism, the non-parasitic nematode Caenorhabditis elegans. Nematode cultures were subjected to bio-electrospraying and compared with positive (heat shock) and negative controls (appropriate laboratory culture controls). Overall, bio-electrospraying did not modulate the reproductive output or induce significant changes in in vivo stress-responsive biomarkers (heat shock proteins). Likewise, whole-genome transcriptomics could not identify any biological processes, cellular components or molecular functions (gene ontology terms) that were significantly enriched in response to bio-electrospraying. This demonstrates that bio-electrosprays can be safely applied directly to nematodes and underlines its potential future use in the creation of multi-cellular environments within clinical applications.

Improvements in hepatic parenchymal transection for living related liver donor

INTRODUCTION

To eliminate mortality and morbidity risk in living related liver donors, we developed a new surgical technique to resect hepatic parenchyma using an ultrasonic surgical aspirator in association with a monopolar floating ball cautery.

METHODS

We performed 17 right hepatectomies and 2 left hepatectomies using this technique. We performed a retrospective analysis of perioperative mortality, length of hospitalization (LOS), blood transfused during surgery (IBT), intraoperative blood lost (IBL), biliary complications (BC), and aspartate aminotransferase (AST)/alanine aminotransferase (ALT) peak in the first postoperative week. This group of patients (Group A) was compared, using the analysis of variance (ANOVA) test (P < .05) with 2 different groups of 19 patients: Group B with liver neoplasms that had the same technique as Group A, and Group C wherein a crushing clamp technique was used.

RESULTS

All of the analyzed variables showed significative statistical differences, especially between Group A and Group C (IBL, P < .000; IBT, P < .006; LOS, P < .028; BC, P < .000; AST peak, P < .041; and ALT peak, P < .023).

DISCUSSION

The association of these 2 techniques seems to reduce the LOS, and the need for intraoperative blood transfusions. Moreover, the surgical complications (biliary leaks) and the postoperative parenchymal cytonecrosis seem to be less using this technique.

Preliminary report on surgical technique in hepatic parenchymal transection for liver tumors in the elderly: a lesson learned from living-related liver transplantation

BACKGROUND AND OBJECTIVES

Availability of hi-tech surgical devices has elaborated the technique of parenchymal transection during hepatectomy from classic crushing clamp technique 1,2 to a combination of an ultrasonic dissection with special type of cautery 3,4. We have developed a new technique to resect hepatic parenchyma using an ultrasonic surgical aspirator in association with a monopolar floating ball. This combination has been utilized in 42 liver resections.

METHODS

A retrospective analysis of perioperative mortality, length of hospitalization, and blood transfusion during surgery in two patient groups who underwent liver resection was carried out. We divided the patient population into Group A (42 patients), who underwent the new technique, and Group B (107 patients), who experienced the crushing clamp technique. A second analysis was performed, where we divided the same patient population group in Group 1 with age less than 65, and Group 2 including patients older than 65 years.

RESULTS

We found that the new technique reduced length of stay, procedure length, and use of perioperative blood. We determined that the two age groups performed similarly in comparison to LOS, length of procedure, blood use, and complications.

CONCLUSION

This enforces the fact that the elderly can receive such surgical treatment without hesitation.

Living donor surgery: overview of surgical and anesthesia issues

Organ transplantation occupies the center stage in the treatment of many forms of end-stage organ disease. When the limits of conventional medical care are exhausted, bridging therapies, cadaveric transplantation, and posttransplant medical care come to the fore. Living donor transplantation has grown out of the numerical and immunosuppression limitations of this process. Living donor transplantation medicine and surgery encompass two of the most fascinating and compelling social and ethical dilemmas of modern health care. This article provides an overview of medical and ethical concerns for those who decide to become living donors and those who care for them in the perioperative period.

New technique in hepatic parenchymal transection for living related liver donor and liver neoplasms

BACKGROUND

Many different surgical techniques have been described for hepatic parenchymal transection. A retrospective analysis of perioperative mortality, length of hospitalization and blood transfused during operation in two patient groups undergoing liver resection was carried out. In group A, we developed a new technique to resect hepatic parenchyma, using an ultrasonic surgical aspirator with monopolar floating ball cautery, while in group B the crushing clamp technique was used.

METHODS

In all, 42 patients with liver resection were enrolled in group A and 107 resections in group B. All patients had hepatic neoplasms except for seven living transplant donors. In group A 43% of resections involved >or=3 segments and 57% involved <or=2 segments; in group B 36.4% involved >or=3 segments and 63.6% consisted of <or=2 segments. Statistical analysis utilised independent T square (Pearson Q square) and Mann-Whitney U test.

RESULTS

In group A 2.4% of patients died perioperatively, while 3.7% died in group B; mean length of stay (LOS) was 10.9 days in group B and 8.0 days in group A. The length of procedure was 7.5 h in group B and 6.7 h in group A. In group A, 79% did not undergo blood transfusion intraoperatively as opposed to 61% in group B. A mean of 0.5 U of blood was utilized in group A and 1.60 U in group B.

DISCUSSION

The new method of parenchymal transection seems to reduce the LOS, length of procedure and need for intraoperative blood transfusion.