[Effects of reduced total intraoperative fluid intake plus rapid normal saline infusion upon vascular anastomosis on graft function and acidbase status in kidney transplant surgery]

Infusion of large volumes of normal salinc is recommended for facilitating graft function during kidney transplantation surgery but it can cause severe metabolic acidosis. Here we studied the effects of intraoperative rapid normal saline infusion on vascular anastomosis, acid base, electrolytes and graft function. In this study 30 patients were evaluated during kidney transplantation. In fusion of normal saline was started and increased from 10 ml/kg/h to 50 ml/kg/h during vessel anastomosis. Acid base balance electrolytes and anion gap measured at the beginning and end of surgery serum creatinine and urine output was measured up to 48 hours after surgery. Data analyzed was performed by statistical method. Serum creatinine at 24 and 48 hours after surgery were 3.04 +/- 1.59 and 2.22 +/- 1.53 mg/dl respectively. PH changed mg the surgery was not significant [p=0.818] but serum chloride increased from 94.23 +/- 3.95 to 99.37 +/- 3.84 [P< 0.001]. Base excess aid anion gap decreased respectively from -3.55 +/- 3.47 to -8.40 +/- 2.65 [P<0.001] and from 30.46 +/- 7.72 to 26.15 +/- 8.25 [P=0.023] respectively. Rapid infusion of normal saline to vessel anastomosis during the kidney transplantation is a risk h r development of metabolic acidosis while it has beneficial effects on graft function

Transhiatal esophagectomy without mediastinal manipulation for lower third esophageal and cardial cancers: the first experience of a new technique

Considering the poor survival rate of patients with esophageal cancers, mainly due to the disease effects and surgical co morbidities, we have aimed to introduce a new method of Transhiatal Esophagectomy [THE] without mediastinal manipulation for lower third esophageal and cardial cancers. It has suggested that using this technique would decrease mentioned complications. In this prospective study, patients with esophageal cancer who referred for surgical treatment have enrolled and undergone to new method of THE, without mediastinal manipulation. Pre and post-operative morbidities as well as the duration of procedure, duration of hospital and ICU stay have recorded. All patients have followed up or 4-40 months. In this study 53 patients with mean age of 55.2 +/- 10.3 years have undergone esophagectomy, and then in 50 of them the new method has performed. Median operative time and volume of blood loss was 120 minutes and 130 ml, respectively. Median duration of hospital and ICU stay was 7 and 1 day, respectively. There were no Pre-operative mortalities, arrhythmia, hemodynamic instability and mediastinal vessels injury. The most common co morbidities have related to our new method were mediastinal pleura injury, anastomotic leaks and anastomotic narrowing with 20%, 16% and 10% reported rate, respectively. The findings of current study have indicated that transhiatal esophagectomy without mediastinal manipulation, has represented a safe and effective method for treatment of lower third esophageal and cardial cancers due to its potential advantages of decreased blood loss, being a less traumatic procedure, minimal cardiopulmonary complications and low rate of hospital mortality

effects of isoproterenol and propranolol on cytokine profile secretion by cultured tumor-infiltrating lymphocytes derived from colorectal cancer patients

Anti-tumor immunity and cytokine profiles have important roles in the development of cancer. Norepinephrine [NE] release due to sympathetic activation leads to a Th2 deviation via the beta-2 adrenergic receptor [beta -2AR] and could increase cancer progression. This study intends to determine the effects of isoproterenol [ISO; betaagonist] and propranolol [PRO; beta-antagonist] on the production of IFN-gamma, IL-4, and IL-17. Cytokine levels have been examined in tumor-infiltrating lymphocytes [TILs] and peripheral blood mononuclear cells [PBMCs] of patients with colorectal cancer [CRC]. The beta-2AR expression on lymphocyte subsets was also assessed. In this experimental study, TILs were isolated from fresh CRC tissue and patient PBMCs were obtained just prior to surgery. The cells were cultured in medium for 72 hours. Concomitantly, cells were stimulated with 10 micro g/ ml phytohemagglutinin [PHA] alone or in the presence of either 1 micro mol/L of PRO or 1 micro mol/L ISO. The concentration of cytokines in the supernatants was measured by ELISA. Three-color flow cytometry was used to determine the expression of beta-2AR on the lymphocyte subsets. Statistical analyses were performed via paired or independent t-test. Levels of IFN-gamma, IL-4 and IL-17 were elevated after PHA-stimulation of PBMCs and TILs. However, the elevation of IFN-gamma and IL-17 production by TILs in response to PHA was significantly lower than PBMCs. In the presence of ISO, the IFN-gamma/IL-4 ratio reduced in all groups, but this reduction was very low in TILs. Interestingly, the effects of PRO on cytokine production were, at least partially, comparable to those of ISO. Depressed levels of beta-2AR expression were demonstrated on CD4+IFN-gamma+ and CD4+IL-17+ lymphocytes in patients' PBMCs and TILs. This study has demonstrated the effects of ISO and PRO on cytokine production by TILs and determined beta-2AR expression on these cells. ISO failed to induce a shift toward the expected Th2 cytokine profile in CRC patients' TILs, which might be due to the downregulation of beta-2AR expression on TILs. Additionally, in this study, PRO induced a shift to a Th2 profile in PBMCs

40 years old woman with monolobar Caroli's syndrome treated by left hepatic lobectomy

Caroli's disease [CD] is a rare congenital abnormality characterized by dilatation of intra hepatic bile ducts, which causes stone formation, recurrent cholangitis and higher risk for biliary malignancy. Association of this anomaly with congenital hepatic fibrosis is named Caroli's syndrome [CS]. The monolobar involvement of CS is a very rare condition, curable by partial hepatectomy. We report a 40-year-old woman with recurrent epigastric pain without icterus with normal AST, ALT and alkaline phosphates for 5 years due to left lobe Caroli syndrome which was diagnosed by CT scan and MRCP. Then, the patient underwent successful operation [left hepatic resection]. After 8 months follow up, she was symptom free. Because the presentation of unilobar CS may be as late as middle age, this congenital anomaly should be considered in differential diagnosis of patients with recurrent epigastric pain without icterus in this age group and MRCP is a useful diagnostic tool

Association between HLA-DRB1 *01 and HLA-Cw*08 and outcome following HTLV-I infection

Human T cell lymphotropic virus type I [HTLV-I]-associated rnyelopa-thy/tropical spastic paraparesis [HAM/TSP] is an inflammatory disease which occurs in less than 2% of HTLV-I -infected individuals. High proviral load, high HTLV-I-specific CD8[+] cytotoxic T lymphocyte frequency [CTL] and host genetic factors such as HLA all appear to be associated with HTLV-I infection. Previous studies have shown that HLA-DRB1*01 increases the risk of HAM/TSP in Japanese HTLV-1 infected individuals. To investigate the association between HLA class II DRB1 alleles and HLA class I alleles [HLA-Cw*08, B54, A*02 and A-30] in HTLV-I infected individuals in Mashhad. Here we determined the frequency of HLA class II DRBl, using INNO-LIPA reverse hybridization line probe assay, and HLA class I alleles [HLA-Cw*08,B54, A*02 and A-30] by PCR-SSCP method in healthy controls, HAM/TSP patients and HTLV-I infected individuals born and resident in Mashhad. The frequency of HLA-DRB1*01 alleles in this population was different from other areas of Iran. The frequency of HLA-DRB1*01 was significantly increased in HAM/TSP patients compared with carriers [p 0.028; OR=9.4]. The frequency of HLA-Cw*08 was also significantly increased in HAM/TSP patients compared with controls [p=0.03; OR=13.5]. Our results may suggest that possession of HLA-DRB1*01 increases the risk of HAM/TSP in HTLV-I-infected individuals and HLA-Cw*08 correlates with low CTL immune response in HAM/TSP patients