The effect of N-acetylcysteine on the levels of copper, zinc and expression of matrix metalloproteinases in the liver.

This study was conducted to consider the effect of cadmium (Cd) on the liver and serum levels of zinc (Zn) and copper (Cu), and the role of N-acetylcysteine (NAC) in preserving cells against Cd toxicity. Rats were randomly divided into five groups, including G1 (control), G2 (single dose of Cd), G3 (continuous administration of Cd), G4 (single dose of Cd + continu- ous administration of NAC), and G5 (continuous administration of Cd + continuous administra- tion of NAC). Rats in G2 and G4 groups were exposed with single dose of Cd on the first day of study. Continuous administration of Cd and NAC was used every day for 4 weeks. Levels of Zn and Cu were measured by atomic absorption spectroscopy. Expression of matrix metallo- proteinases-2 (MMP2) and MMP9 genes was evaluated using RT-PCR. The mean level of Cd in serum and liver tissue of G2 group increased significantly by about 26-27%, whereas in G3 group, it increased significantly by about 50-60%. While NAC treatment significantly raised Zn and Cu values, Cd levels significantly decreased in the serum and tissue samples of rats exposed to single or continuous Cd. Exposure to single and continuous administration of Cd caused a significant increase in MMP2 expression by 10.14-fold (P=0.016) and 27.61-fold (P⟨0.001), respectively. Single and continuous administration of Cd led to a significant increase in MMP9 expression by 3.63-fold (P=0.046) and 43.12-fold (P⟨0.001), respectively. NAC treatments decreased the expression of MMP2 and MMP9 in rats exposed to single or continuous Cd. Cd exposure was strongly associated with Zn and Cu depletion, and overexpression of MMP2 and MMP9. NAC can protect the liver against Cd toxicity by elevating Zn and Cu contents and down-regulating proteolytic enzymes.

Assessment of viability of the pancreas for transplantation using contrast-enhanced ultrasound.

INTRODUCTION: The main concern in pancreas transplantation is potential thrombosis of the graft due to poor perfusion. AIM: To assess the viability of the pancreas before transplantation by using contrast-enhanced ultrasound scan (CEUS). METHODS: Ten harvested pancreatas were studied using an iU22 (Philips, Bothell, USA) scanner together with an L9-3 linear probe for the CEUS. The ultrasound contrast agent SonoVue (Bracco spa, Milan), which is a commercially available second-generation microbubble-based agent, can be visualized in real time at low acoustic pressure (mechanical Index of 0.06). Prior to transplantation, the pancreas is placed in Via Span solution (Bristol-Mayer Squibb AB, Bromma, Sverige). Baseline conventional scale sonography is first performed to assess the parenchyma, which appears as homogenous soft tissue. The donor pancreas arterial supply is cannulated (16 gauge) and infused with Via Span solution. Two milliliters of SonoVue is slowly injected and the pancreas is scanned using the low MI nonlinear imaging mode to visualize the microbubbles enhancement of the pancreas to ensure uniform perfusion of the whole organ. Perfusion was scored visually (0 to 5) subjectively by two observers. RESULTS: Four grafts were not transplanted for different reasons. Lack of a recipient was the cause in one case with a high score (case 1). Cases 4 and 5 were turned down based on clinical evaluation, and arterial thrombosis was the cause in case 7. The last three cases showed a low mean perfusion score of 1.2. Of the six transplanted pancreatas, the four, that were successfully transplanted displayed a mean perfusion score of 4, compared with a mean score of 1.5 for the two cases who suffered rejection following transplantation. CONCLUSION: CEUS offers the potential to assess the perfusion of the pancreas transplant preoperatively, which may improve the selection criteria and potentially impact the outcomes of transplantation.

A fast and safe living donor "finger-assisted" nephrectomy technique: results of 359 cases.

OBJECTIVE: To determine operative parameters and complications, using a modified approach to mini-incision living donor nephrectomy. METHODS: Three hundred fifty-nine consecutive living donor procedures were performed between October 2000 and November 2008 using the finger-assisted, mini-incision living donor nephrectomy. Patient demographics, intraoperative parameters, and postoperative complications were prospectively recorded, including operative time, blood loss, incision length, warm ischemia time, and intraoperative adverse events. RESULTS: Mean donor age was 44.2 +/- 12.3 years (range, 21-75 years), with an average body mass index of 28.2 +/- 5.3 kg/m(2) (range, 17.1-44.9 kg/m(2)). Right-sided donor nephrectomies were performed on 23 patients (6%), and 41 donors (11%) were found to have multiple renal arteries. Median incision length was 6.8 cm (range, 3.5-15 cm). Average operative time was 117 minutes (range, 50-265 minutes), with a median blood loss of 109 mL (range, 20-500 mL) and an average warm ischemia time of 4.5 minutes (range, 1.5-10 minutes). Four patients (1%) required perioperative blood transfusions. There were no other intraoperative complications, no patients required reexploration, and there were no donor deaths. Thirteen patients (4%) developed minor postoperative complications, including two incisional herniae, but no patients developed chronic wound pain, over a median follow-up period of 19 months (range, 2-97 months). CONCLUSION: This prospective series demonstrated that a modified approach to open mini-incision nephrectomy can result in a smaller incision length while maintaining patient safety, with few postoperative complications.