Living donor liver transplantation with dual grafts -- a case report.

BACKGROUND: Living donor liver transplantation (LDLT) exposes to risks both the donor, due to a potential small residual liver volume, and the recipient, who faces the risk of small-for-size graft syndrome. In order to overcome these drawbacks, liver grafts from two different donors can be used. This paper presents a case of dual graft LDLT using a right hemiliver and a left lateral section from related donors. CASE PRESENTATION: A 14-year old female diagnosed with chronic hepatic failure due to Wilson's disease with Model-for-End- Stage-Liver-Disease score of 25, underwent a dual graft LDLT, receiving a right hemiliver with a reconstructed middle hepatic vein from her sister, and a left lateral section from her mother. None of the grafts complied with a satisfactory graft-to-recipient weight ratio (GRWR), if they would have been independently transplanted. The combined GRWR was 1.10. The donors and the recipient have been followed-up for over 1 year. RESULTS: The donors had no postoperative complications. The donors and the recipient were discharged 8 and 19 days after surgery, respectively. After 12-month follow-up, both donors and the recipient were alive, with normal graft function. CONCLUSION: Dual graft LDLT can be a feasible solution to overcome the risk of small-for-size graft syndrome. ABBREVIATIONS: BSA = body surface area, GRWR = graft-to-recipient weight ratio, GV SLV = recipient standard liver volume, HA = hepatic artery, HD = hepatic duct, HV = hepatic vein, LDLT = Living donor liver transplantation, LL = left lobe, LLS = left lateral section, MELD = Model for End-Stage Liver Disease, POD = postoperative day, PV = portal vein, RL = right lobe, SFS = small-for-size graft, SLV = standard liver volume, WD = Wilson's disease.

[Preliminary results for intraperitoneal chemotherapy in abdominal cancers]. / Date preliminare despre chimiohipertermia intraperitoneala (CHIP) în cancerele organelor intraabdominale.

The paper presents a review of the the last 20 years experience of some important oncologic and surgical centers all over the world on IntraPeritoneal Hyperthermic Chemotherapy (IPHC) applied by well known specialists in this domain: Sugarbaker P. (SUA), Takeshi S. (Japan, Elias D. (France), Deraco M. (Italy) and others. Then 20 cases of abdominal cancers with or without peritoneal metastases are presented, in which IPCH was applied using a Romanian apparatus of drainage - lavage with hyperthermic solutions of 5 Fluorouracil, alone or combined with cisplatin, over a 3 years period. The results are encouraging although the follow-up of this group is in progress.

Combined liver and islet transplantation using steroid-free immunosuppression.

Due to a vicious circle in which HCV favors insulin resistance and, alternatively, insulin resistance facilitates the persistence of HCV, HCV patients have often diabetes associated with liver cirrhosis. We present the case of combined liver and pancreatic islets transplantation performed in a patient with HCV liver cirrhosis associated with insulin-dependent diabetes. This is also the first case of islet allotransplantation in Romania. A 40-year-old male diagnosed with liver cirrhosis due to HCV infection and insulin dependent diabetes underwent combined liver and islet transplantation. Our therapeutic design was based on data provided by both the use of Edmonton immunosuppressive steroid-free protocol in islets cell transplantation and the findings of international studies on the effects of this protocol in liver transplantation for patients with HCV infection. Good metabolic control of the diabetes was obtained. The absence of anti beta cell autoimmunity could explain also the good tolerance for the transplanted islets, proved by the rapid and durable decrease of the insulin need, from 64 U/day to 20 U/day at one month post-transplantation, dose that was maintained for 16 months when the patient died due to recurrent HCV hepatitis. Islet transplantation can be associated to liver transplantation in order to improve the associated diabetes in cirrhotic patients.

[The role of intraoperative ultrasound in the diagnosis and treatment of hydatid liver disease]. / Rolul ecografiei intraoperatorii in diagnosticul si tratamentul bolii hidatice hepatice.

Liver hydatid disease still represents a frequent condition in Romania, especially among population of Dobrogea County, which may lead to life-threatening complications. To assess the role of intraoperative ultrasound (IOUS) in the diagnosis and treatment algorithms of liver hydatid disease. We could not find any similar studies in the literature in order to compare the results. The paper represents a retrospective study of IOUS performed for liver hydatid disease on a group of 43 patients admitted in the 2nd Clinic of Surgery - Clinical Emergency Hospital of Constanta. IOUS was intraabdominal (36 cases), transdiaphragmatic (7 cases) and was able to diagnose infected liver HC (7 cases), locate bilio-cystic fistulas (6 cases), hydatic cysts (18 cases) or relation with important anatomic elements (12). Ultrasound-guided frenotomy was performed in 5 cases and ultrasound-guided puncture in 9 cases. In 26 out of 43 patients (60.47%), IOUS influenced decision making during surgery. These data recommends IOUS in managing hydatid disease, allowing a complete diagnosis and optimal treatment, thus reducing postoperative morbidity.

[Pancreatic islets isolation from the brain death donors]. / Izolarea de insule pancreatice de la donator în moarte cerebrala.

The paper analyzes a number of 5 cases of pancreatic islet cells isolation, purification and culture extracted from the pancreas of brain-dead donors. For the isolation stage the authors used the "two-step" digestion method. The isolated pancreatic islet cells were morphologically and functionally analyzed by assessing their viability and purity. For the in-vivo experiments the authors used animals with Streptozotocin induced diabetes. The data clearly indicated a high efficiency of collection providing an optimal number of transplantable pancreatic islet cells.

[Preliminary data on post-pancreatectomy diabetes mellitus treated by islet-cell autotransplantation]. / Date preliminare despre tratamentul diabetului postpancreatectomie prin autotransplant de insule pancreatice.

The present study describes the first islet autotransplant program in Romania, and the first 3 cases of subtotal pancreatectomy for chronic pancreatitis combined with islet autotransplant. The primary objective was to pain relief by pancreatic resection, but also to preserve the endocrine function by islet autotransplant. Extensive distal pancreatectomy is effective in relieving pain, but should be limited to patients with small duct disease, in whom more conservative methods have failed, because of severe metabolic consequences. Islets were prepared by Liberase digestion of the excised pancreas, and infused unpurified into the portal vein in one case and in the omental pouch and peritoneum in two cases. All patients were relieved of pain, have achieved insulin independence, and positive C peptide levels, but one patient died of a acute bronchopneumonia 60 days post-transplantation. The mean islet yields were 2100 islet equivalents/Kg body weight. Islet autotransplantation can be considered a useful therapeutic option serving to prevent the occurrence of surgically-induced diabetes. The results have indicate that the omental pouch is a viable site for islet autotransplantation, that can accommodate a large tissue volume, is easy to access to implant, and the IBMIR (instant blood mediated inflammatory reaction) may be less severe.

[The anal incontinence-- study on 20 operated cases]. / Incontinenta anala--studiu pe 20 cazuri operate.

The authors present 20 cases operated for anal incontinence. Two techniques were performed: direct repair (18 cases) and Musset-Cottrell procedure (2 cases). The results were excellent in 12 cases, good in 5 cases and satisfactory in 3 cases. The method of choice seems to be the direct repair of the anal sphincter after a proper local and general preparation.

[Urinary complications after anorectal surgery]. / Tulburari urinare postoperatorii în chirurgia ano-rectala.

The prevalence of urinary complications after various anorectal operations was studied in a group of 273 patients. The overall prevalence of urinary complications was 26.7%; most of these complications affected men between 41 and 50, mainly after hemorrhoidectomy. In 10.6% of patients, bladder catheterization was needed. These urinary complications result from nervous reflexes originating from the anus and determined by the operative trauma and/or rectal distinction. In the treatment of these urinary complications, the role of the muses is essential for reassuring the patients. Parasympathomimetic drugs are often efficient. Urinary catheterization must be delayed until the 18th hour. Fluid restriction may be useful to prevent urinary retention.