Isolated renal mucormycosis after liver transplantation: an unusual case report

Mucormycosis is a rare complication of immunosuppression. Most of the reported cases have been rhinocerebral or disseminated. Isolated renal involvement is extremely rare and until now less than 30 patients have been reported in the English literature. Isolated renal mucormycosis with renal artery rupture in a liver transplant patient has not been reported so far. Herein we report an extremely rare case of isolated renal mucormycosis in a liver transplant patient who was successfully treated with nephrectomy

En-bloc transplantation: an eligible technique for unilateral dual kidney transplantation

Kidney transplantation is the best available treatment for patients with end-stage renal disease. To evaluate the en bloc anastomosis technique for unilateral dual kidney transplantation [DKT]. From May to October 2011, 5 patients [4 women and 1 man] with mean age of 31.8 years underwent unilateral DKT with this technique in which distal end of the aorta and proximal end of inferior vena cava [IVC] were closed with running sutures. Then, proximal end of the aorta and distal end of the IVC were anastomosed to internal [or external] iliac artery and external iliac vein, respectively. Post-operative course was uneventful. No vascular and urologic complications developed; all patient had acceptable serum creatinine at discharge time and up of 2-6 months of post-operation follow up. Unilateral DKT is a safe method for performing DKT. The proposed en bloc anastomosis can improve the outcome of the graft by reducing the cold ischemia and the operation time

Evaluation of cytomegalovirus infection after six months of liver transplantation in children in Shiraz, Southern Iran

Liver transplantation [LT] is a life-saving treatment for end-stage liver diseases [ESLD]. Cytomegalovirus [CMV] infection is one of the important causes of morbidity after LT. To evaluate the incidence of late-onset [after 6 months of LT] CMV infection in pediatric recipients. A retrospective analysis was conducted to evaluate 50 pediatric patients who underwent LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We retrospectively investigated episodes of CMV infection after 6 months of LT proven by CMV antigenemia test. Three recipients [6%] developed late-onset CMV infection. These patients finally responded to ganciclovir. CMV infection is one of the most common post-LT viral infections that usually occurs in the first six months of LT. Our study shows that the incidence of late-onset CMV infection is relatively low, but it still remains a significant problem. Therefore, monitoring and management is crucial for improving the survival of children

Liver transplantation and aortic valve replacement

Surgical procedures involving heart and liver are rare and have been limited to either combined heart and liver transplantation or coronary artery bypass graft surgery [CABG] or aortic valve surgery and orthotopic liver transplantation [OLT]. Aortic valve replacement [AVR] and pulmonary valve vegetectomy for bacterial endocarditis after OLT have also been reported. There are only five cases with aortic stenosis and cirrhosis reported to have combined AVR and liver transplantation. In the presence of cirrhosis, AVR has a significant risk for mortality because of bleeding from coagulopathy, renal failure, infection, and poor post-operative wound healing. Herein, we report on a case and management analysis of combined sequential AVR, and OLT in a 40-year-old cirrhotic man with Child and MELD score of C and 29, respectively. Echocardiography detected severe aortic insufficiency [AI] with enlarged left ventricle. Due to severe AI, the cardiologist recommended AVR prior to transplantation. The patient underwent metallic AVR. 4 months later, he received OLT. Both operations were successful and uneventful. Prioritizing AVR before OLT was successful in this patient. However, each patient must be evaluated individually and multiple factors should be assessed in pre-operation evaluation

Effect of salicylic acid on antioxidant activity in milk thistle hairy root cultures

Elicitors can trigger defense responses and activate specific genes involved in secondary metabolite biosynthesis. For understanding SA-treatment signaling pathway we determined defense-related compounds and enzymes in S. marianum hairy root cultures. 28 day old hairy roots were treated by salicylic acid [6 mg/50 ml culture] for different times [24, 48, 72, 96 and 120 h]. The antioxidant activity was assayed by the 1-diphenyl-2-picrylhydrazyl stable free radical method and results were calculated based on the IC[50] H[2]O[2], peroxidase and ascorbate peroxidase activity and total tocopherol content was measured in treated and non-treated hairy root cultures. The highest accumulation of H[2]O[2] was 86.60 micro mol g[-1] DW that was obtained 120 h after elicitation [2-times of non-treated hairy roots]. IC[50] increased upon treatment and was 1.15- times higher than the control 24h after elicitation. The content of total tocopherol content under SA treatment was lower than the control experiments. Maximum activity of peroxidase and ascorbate peroxidase were 0.17 and 1.50 micro mol min[-1] mg[-1] protein, 96 and 72 h after elicitation, respectively. Oxidative stress defends system can be activated by salicylic acid in Silybum marianum hairy root cultures. This study suggested that exogenous SA can increase H[2]O[2] content of hairy roots, and induce the expression of antioxidant enzymes and increase secondary metabolite accumulation

Liver transplantation in the presence of old portal vein thrombosis

Portal vein thrombosis [PVT] has been mentioned as a potential obstacle to liver transplantation [LTx]. To review the impact of PVT on orthotopic liver transplant [OLT] outcome. Between January 2006 and April 2009, 440 OLT were performed in Shiraz Transplant Unit of whom, 35 [7.9%] cases had old PVT with recanalization. Data were retrospectively collected regarding the demograph- ics, indication for OLT, Child-Turgot-Pugh classification, pre-transplant diagnosis of PVT, perioperative course and managements, relapse of PVT, early post-operative mortality and morbidity. All patients received liver from deceased donors, underwent thrombendvenectomy with end-to-end anastomosis without interposition graft and evaluated daily for 5 days and thereafter, biweekly by duplex sonography during the follow-up period for 2 months. They were treated by therapeutic doses of heparin followed by warfarin to maintain an INR of 2-2.5. The causes of end-stage liver disease were hepatitis B in 11, cryptogenic cirrhosis in 11, primary scle- rosing cholangitis in 5 and other causes in 8 recipients. Extension of thrombosis was through confluence of superior mesenteric and splenic vein in 32 and to superior mesenteric vein in 3 patients. The mean +/- SD op- eration time was 7.2 +/- 1.5 hrs. The mean +/- SD transfusion requirement was 5.4 +/- 2.8 units of packed cells. The mean +/- SD duration of hospital stay in these patients was 17.7 +/- 10.9 days. Eight patients died; 1 developed early in-hospital PVT, 1 had hepatic vein thrombosis, and 1 died of in-hospital ischemic cerebrovascular ac- cident, despite a full anticoagulant therapy. The mean +/- SD follow-up period for those 28 patients discharged from hospital was 16.6 +/- 7.9 months; none of them developed relapse of PVT. The overall mortality and mor- bidity was 28% and 32%, respectively. There was no relapse of PVT in the other patients. The presence of PVT at the time of OLT is not a contraindication for the operation but those with PVT have a more difficult surgery, develop more postoperative complications, and experience a higher in-hospital mortality

Overview on tissue culture, regeneration and gene transfornation to Artemisia annua L.

Artemisia annua L. a highly aromatic annual herb is a widely dispersed through out the temperate region containing the main active anti malaria compound artemisinin a sesquiterpene lactone. Because of low artemisinin level, unsuccessful chemical synthesis and slightly improvement of molecular breeding methods, biosynthesis of this valuable compound was noticed by using the tissue culture and Genetic Engineering in these years. The rate transformation could be varies with different factors like genotype, age, explant type and agrobacterium strain. The results recently was shown that explants in tissue cultures are very sensitive to kanamycin concentration and even it could be late shoot and root formation. Hairy root culture is another subject that is in these years was niticed as a alternative method by designing the new bioreactor for production if this secondrary metabolite

Effect of oral D-penicillamine on intraperitoneal adhesions

The most common cause of intraperitoneal adhesion bands is previous abdominal surgery. Postoperative adhesion formation results from a fibroproliferative inflammatory reaction. The possibility of involvement of fibrogenic process in adhesion formation and the antifibrogenic effect of D-penicillamine led us to test the effectiveness of this drug as a possible preventive method for intraperitoneal adhesions. Eighty female rats were randomly divided into four equal groups of 20 rats. Generation of adhesion in rats introduced by intra peritoneal injection of 2.5 millilitre of a 10% sterile talc solution. The first group served as control, group 2 received oral D-penicillamine 35 milligram per kilogram per day, group 3 received oral colchicines 0.02 milligram per kilogram per day and group 4 received both drugs for three weeks. Formation of adhesion bands was then quantitatively graded in each group according to Nair classification. Severe adhesions [grade 3 and 4] were found in 20% of the D-penicilliamine administered group [group 2], whereas these types of adhesions were observed in 33% and 84% of colchicine administered groups [group 3] and the control group [group 1] respectively [p < 0.003]. Group 4 that had received both D.penicillamine and colchicine was omitted from the study due to a high mortality rate. Adhesion bands in D-penicillamine group were thinner and smoother in comparison to other groups. Lower grades of adhesions were found in the D-penicillamine group in comparison to the colchicine and control groups. Therefore it seems that D-penicillamine may be effective in the prevention of formation of adhesion bands in the rat

Surgical experiences of hyperparathyroidism

This retrospective article reports the diagnostic experiences of forty six cases of hyperparathyroidism confirmed by operation and pathologic examination. From 1976 to 2002, all the patients who had conventional neck exploration for hyperparathyroidism were investigated. Eleven surgeons performed the operations by doing only 1 up to 18 procedures. Experience of surgeon and the result of frozen section were determined adequacy of procedure and completeness of operation. The clinical presentation was divided into four types: 24 cases [52.17%] with bone resorption; 15 cases [32.60%] with bone lesions plus urinary calculus; 4 cases [8.69%] with urinary calculus and 3 cases [6.52%] with asymptomatic hypercalcemia. The mean age of 46 patients [35 women, 11 men] was 44 [range 1 month to 67] years. Mean preoperative serum calcium was 13 [range 10.5 to 30] mg/ 100ml. Two patients in one family had neonatal primary hyperparathyroidism. One patient had chronic renal failure. Neck sonography was done in 18 and parathyroid [Sestamibi] scan was done in 3 with accuracy of 66.66% and 100% subsequently. The pathological diagnosis was parathyroid adenoma in 37, hyperplasia in 5, parathyroid carcinoma in 1 and negative exploration in 3. The clinical picture of PHPT in south of Iran is similar to that recognized previously in west. We are expecting routine measurement of serum calcium and high suspicioun by the physician in patients with symptoms of musculoskeletal system or renal stone can lead to early diagnosis. By using parathyroid scan and sonography of neck localization of most parathyroid adenoma is possible. Therefore minimal access adenomectomy can be replaced by conventional neck exploration