ABSTRACT
BACKGROUND: Venous outflow reconstruction of modified right-lobe liver grafts has been shown to prevent the occurrence of graft congestion and subsequent complications, including graft loss. In the present study, we aimed to investigate the safety and efficacy of Dacron grafts for venous reconstruction in living donor liver transplantation (LDLT). METHODS: Between January 2016 and January 2018, Dacron grafts were used in 148 liver transplants. Of these, 104 patients who had a follow-up computerized tomography (CT) scan were enrolled into the study. A total of 179 outflow hepatic veins including V5, V8, partial middle hepatic vein, and accessory inferior right hepatic veins (IRHV) were reconstructed using synthetic Dacron grafts. Graft patency was evaluated with both intraoperative Doppler ultrasonography following reconstruction, and a follow-up CT was performed on the postoperative day 7 (±1). Retrospective data collection included demographics, parameters for small-for-size (laboratory tests [bilirubin, International Normalized Ratio] and ascites) syndrome, postoperative morbidity, and mortality. RESULTS: Follow-up CT revealed graft patency in 155 out of 179 (86.6%) vascular grafts. Postoperative seventh-day patency rates for each reconstructed vein were as follows: V5, 87.5% (70/80); V8, 87.7% (50/57); partial middle hepatic vein, 100% (11/11); and IRHV, 77.4% (24/31). No major graft-related complications (early graft dysfunction, graft infection) or graft-related mortality were observed. None of the recipients developed small-for-size syndrome based on laboratory tests and clinical findings. CONCLUSIONS: Dacron vascular grafts appear as an advantageous and useful alternative for venous outflow reconstruction in LDLT.
Subject(s)
Hepatic Veins/transplantation , Liver Transplantation/methods , Plastic Surgery Procedures/methods , Polyethylene Terephthalates/therapeutic use , Vascular Grafting/methods , Adult , Blood Vessel Prosthesis , Female , Humans , Liver/blood supply , Liver/diagnostic imaging , Liver/surgery , Living Donors , Male , Middle Aged , Postoperative Complications/surgery , Postoperative Period , Retrospective Studies , Tomography, X-Ray Computed , Transplants/blood supply , Transplants/diagnostic imaging , Transplants/surgery , Treatment Outcome , Ultrasonography, DopplerABSTRACT
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Subject(s)
Humans , Male , Child, Preschool , Necrosis/surgery , Circumcision, Male/adverse effects , Hyperbaric Oxygenation , Postoperative Complications , Pentoxifylline/therapeutic useSubject(s)
Circumcision, Male/adverse effects , Hyperbaric Oxygenation , Ischemia/therapy , Penis/blood supply , Pentoxifylline/therapeutic use , Vasodilator Agents/therapeutic use , Child, Preschool , Combined Modality Therapy , Humans , Infusions, Intravenous , Ischemia/drug therapy , Ischemia/etiology , Male , Necrosis , Oxygen/pharmacokinetics , Penis/pathology , Pentoxifylline/administration & dosage , Vasodilator Agents/administration & dosageABSTRACT
OBJECTIVES: Patients who receive tumour necrosis factor-alpha (TNF-alpha) blockers are mostly immunosuppressed. A study was performed to investigate whether an interferon-gamma (IFN-gamma) assay could represent an alternative approach to the tuberculin skin test (TST) for the diagnosis of latent tuberculosis infection (LTBI) in these patients. DESIGN: We prospectively enrolled 106 individuals into the study in two groups. Group 1 consisted of 38 healthy individuals and Group 2 included 68 patients with chronic inflammatory diseases evaluated for LTBI before the use of TNF-alpha blockers. RESULTS: Of all participants, nine had indeterminate IFN-gamma test results. Agreement between the two tests was poor in both groups (kappa values respectively -0.54 and 0.18). In a total of 97 subjects, 10 (10.3%) were positive by the IFN-gamma test and 49 (50.5%) by TST. CONCLUSION: We found poor agreement between TST and the IFN-gamma test in our study. Our limited preliminary data should be accepted as a basis for designing future studies that will be helpful for physicians to decide whether the IFN-gamma test is more sensitive than the TST test in detecting LTBI before the use of TNF-alpha blockers.
Subject(s)
Enzyme-Linked Immunosorbent Assay , Interferon-gamma/metabolism , Tuberculosis/diagnosis , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adult , BCG Vaccine , Female , Humans , Immunocompromised Host , Male , Tuberculin Test , Tuberculosis/metabolismABSTRACT
BACKGROUND: The effects of the macrolides cannot be ascribed to their antibacterial action alone. Their immunoregulatory and anti-inflammatory functions are significant too. They are frequently used in the treatment of diffuse panbronchiolitis and cystic fibrosis (CF). AIM: To evaluate the effects of a macrolide antibiotic [clarithromycin (CAM)] on the process of inflammation [by measuring IL-8, TNF-alpha, IL-10 levels and cell profiles in bronchoalveolar lavage (BAL) fluid], pulmonary function and sputum production in children with steady-state bronchiectasis, secondary to causes other than CF or primary immunodeficiencies. METHODS: Seventeen patients randomized to the treatment group received CAM and supportive therapies for 3 months and 17 patients in the control group were given supportive therapies only. RESULTS: Compared with the control group, the treatment group showed a significant decrease in IL-8 levels, total cell count, neutrophil ratios in BAL fluid and daily sputum production at the end of the third month. There was also a significant increase in the treatment group's BAL fluid macrophage ratios. The differences in pulmonary function test parameters were not significant. CONCLUSION: Use of CAM in children with steady-state bronchiectasis results in laboratory improvement by reducing the inflammatory processes in the lungs. No corresponding clinical improvement could be shown but although this is possible with long-term use, trial validation is necessary.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bronchiectasis/drug therapy , Clarithromycin/therapeutic use , Adolescent , Bacteria/isolation & purification , Bacterial Infections/drug therapy , Bronchiectasis/metabolism , Bronchoalveolar Lavage Fluid/chemistry , Bronchoalveolar Lavage Fluid/cytology , Bronchoalveolar Lavage Fluid/microbiology , Child , Colony Count, Microbial , Female , Humans , Interleukin-10/analysis , Interleukin-8/analysis , Leukocyte Count , Male , Respiratory Function Tests , Sputum , Tumor Necrosis Factor-alpha/analysisABSTRACT
The blood stream is affected by viscosity and many other haemorheological factors such as lipid peroxidation in the plasma and red blood cells. The aim of this study was to investigate the changes of haemorheological parameters after submaximal exercise in trained and untrained subjects. The results indicated that heart rate, lymphocyte count, erythrocyte deformability, plasma lipid peroxide levels and erythrocyte glutathione peroxidase activity are increased after submaximal exercise.