ABSTRACT
BACKGROUND: Obstructive jaundice induces oxidative changes in the brain parenchyma and plays significant role in clinical manifestations of hepatic encephalopathy. We aim to study the progression of the brain oxidative status over time and the differences of its pattern over the hemispheres, the brainstem and the cerebellum. We use an experimental model in rats and measuring the oxidative stress (OS) specific biomarkers protein malondialdehyde (PrMDA) and protein carbonyls (PrC = O). RESULTS: Hyperbilirubinemia has been confirmed in all study groups as the result of common bile duct obstruction. We confirmed increase in both PrMDA and PrC = O biomarkers levels with different type of changes over time. We also confirmed that the oxidative process develops differently in each of the brain areas in study. CONCLUSIONS: The present study confirms the progressive increase in OS in all brain areas studied using markers indicative of cumulative protein modification.
ABSTRACT
Blood transfusion is often utilized in surgery. Greece is the second-highest consumer of blood components in Europe. It has been shown that at least half of all transfusions are unnecessary and could be avoided. Jehovah's Witnesses (JWs) are a Christian religion that do not accept transfusion of whole blood or the four primary components of blood-namely, red blood cells, white blood cells, platelets, and plasma. This a retrospective study from September of 2015 to January of 2018, analyzing all JWs who underwent an elective operation at the Second Department of Propaedeutic Surgery in Laiko University Hospital. Twenty-nine (Rogers et al. in NCCN Guidelines Version 2.2014 Cancer- and Chemotherapy-Induced Anemia. NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network, Fort Washington, 2013) JW patients, 23 females (74.1%) and eight males, were operated on during the aforementioned period. The median ASA score was 1 (range 1-3), and only two of the patients needed postoperative monitoring in the ICU. Almost half of the patients (45.1%) needed iron infusion and EPO injection preoperatively. Two patients presented with postoperative complications, with no postoperative deaths. In conclusion, we found that surgery, in our small group of JW patients, was safe and successful despite the lack of blood transfusion. Techniques developed to treat JW patients should be more widely used to improve clinical outcomes and reduce costs to the healthcare system.
Subject(s)
Jehovah's Witnesses , Blood Transfusion , Christianity , Europe , Female , Humans , Male , Retrospective StudiesABSTRACT
BACKGROUND: Organ procurement from deceased donors is usually a standard procedure. Nevertheless, the performing surgeon is often confronted with demanding situations, such as atherosclerotic or aneurysmatic aortic disease or even other pathologies, which may alter the surgical steps. We report on an interesting case of solid organ harvesting from a donor with a biventricular assist device (BiVAD) due to global heart failure. CASE REPORT: A 42-year-old male donor with a BiVAD, enlisted for heart transplantation, died of intracerebral hemorrhage. Dressing the surgical field was challenging because the extracorporal portions of all 4 tubes and the pump device rested on the donor's body, covering his whole abdomen. To ensure enough space, the pump and tubes had been covered with sterile swabs and drapes. The second surgical assistant was tasked with holding the device slightly deviated to the left and the ankle elevated at 45°, to avoid any tube kinking. The dissection of the main vessels distally was performed using the standard technique. No encirclement of the proximal aorta beneath the diaphragm was necessary, as the cardiac output could be arrested by clamping the left ventricle's outflow tube. Once the perfusion was completed, the procedure continued in the standard fashion. CONCLUSION: So far, the literature has no data on organ harvesting from deceased donors with BiVAD. Although such a retrieval is quite challenging and requires an experienced team, the transplantation of the corresponding organs can be performed without any further special technical problems.