Complications of e-PTFE Grafts in LDLT; Evaluation of Case Series.

BACKGROUND: The expanded polytetrafluoroethylene (ePTFE) grafts are used to drain anterior sector veins during the living donor liver transplantation procedure. We aimed to analyze the potentially life-threatening complications, such as the infection and migration of ePTFE grafts. METHODS: A total of 1264 liver transplantations (LTs) were performed for 1097 adult and 167 pediatric liver failure cases. In total, 1169 living and 95 cadaveric liver transplantation procedures were performed between 2011 and 2021. Right liver transplantation was performed in 1016 cases, including 1002 living donors and 14 cadaveric split right livers. Cadaveric LT was performed in 81 cases. RESULTS: For 1002 right living liver grafts, 905 vascular grafts were used during the backtable for anterior sector outflow venoplasty. The most commonly drained segments were 5 and 8 (472 cases); there were isolated (5 or 8) and multiple drained segments. Vascular graft migration was described in 7 of 905 (0.77%) patients. CONCLUSIONS: Although complication rates regarding ePTFE grafts are low, there are serious life-threatening causes of morbidity and mortality. We recommend cushioning the vascular graft with the omentum, which is effective in preventing graft migration.

Comparing the Outcomes of Pediatric Liver Transplantation.

BACKGROUND: Liver transplantation is a life-saving treatment for end-stage pediatric liver failure. We aimed to present the results of pediatric liver transplants performed in our center in the last 11 years (between 2012 and March 2022) in association with prognostic factors affecting survival. METHODS: Demographic characteristics, etiologic reasons, previous operations (Kasai procedure), morbidity, mortality, survival, and bilio-vascular complication rates were determined, and outcomes were evaluated. In the postoperative period, the duration of mechanical ventilation and intensive care unit stay and surgical and other complications were evaluated. Graft and patient survival rates were determined, and univariate and multivariate factors affecting these rates were evaluated. RESULTS: In the last 10 years, 229 pediatric liver transplantaion (Pe-LT)/1513 adult liver taransplantation (Ad-LT) (21.35%) were performed in our center. This ratio (Pe-LT/Ad-LT ratio) is 1741/15,886 (10.95%) for our country. A total of 229 liver transplants were performed in 214 pediatric patients. Retransplantation was performed in 15 patients (6.55%). Cadaveric liver transplantation was performed in 9 patients. Graft survival rates were 87%, 83%, 78%, 78%, 78%, and 78% at <30 days, 30 to 90 days, 91 to 364 days, 1 to 3 years, and >3 years, respectively. Patient survival rates for <30 days, 30 to 90 days, 91 to 364 days, 1 to 3 years, and >3 years were 91.5%, 85.7%, 82%, 81.5%, and 81.5%, respectively. Our 5-year survival rates in metabolic diseases and the acute fulminant failure group are 93.8% and 100%, respectively. CONCLUSIONS: The fact that the 1- and 5-year survival rates are the same shows that when patients overcome biliary vascular and infectious problems, their survival is prolonged.

Comparing the Outcomes of Deceased-Donor and Living-Donor Liver Re-Transplantation In Adult Patients.

BACKGROUND: Patients with liver graft failures have an extremely low chance of finding a cadaveric graft in countries with a scarcity of deceased donors. We compared the outcomes of liver re-transplantation with living-donor liver grafts (re-LDLT) and deceased-donor liver grafts (re-DDLT) in adult patients (>18 years). METHODS: The medical records of 1513 (1417 [93.6%] LDLT and 96 [6.3%] DDLT) patients who underwent liver transplantation at Memorial Hospital between January 2011 and October 2022 were reviewed. Forty patients (24 adults and 16 pediatric) were re-transplanted (2.84%); 24 adult patients (2.72%: 25 re-LDLT, 1 patient with second re-LDLT) were divided into 2 groups: re-DDLT (n = 6) and re-LDLT (n = 18). The groups were compared in demographics, pre-, peri-, postoperative characteristics, and outcomes. RESULTS: The overall survival rates were 91.7%, 79.2%, 75.0%, and 75% for <30 days, 31 to 90 days, 1, and 3 years, respectively. The LDLT group was significantly younger (P = .022), had smaller graft weight (P = .03), shorter mechanical ventilation (P = .036) but longer operation time (P = .019), and hospitalization period (P = .003). The groups were otherwise comparable. There was no statistically significant difference in survival rates between the groups (P = .058), although the re-LDLT group had an evidently higher survival rate (88.9% and 83.3 % vs 50.0%). CONCLUSION: Re-LDLT has shown comparable outcomes to re-DDLT, if not better (even not far from significance P = .058). These results may encourage performing re-LDLTs in patients with indications for re-LT without worrying about low chances of survival, especially in countries with limited sources of deceased donors.

Gastrointestinal perforations and associated risk factors in children after liver transplantation.

In this study, possible risk factors of gastrointestinal perforations (GIP) that increase mortality after liver transplantation in children were investigated. One hundred and thirty-one pediatric patients who underwent 139 liver transplants between January 2016 and February 2020 were evaluated retrospectively based on preoperative and surgical data. Furthermore, cases with biliary atresia, which constitute 26.7% (35) of the patients, were compared within themselves and with other groups. It was found that the cases that developed perforations were younger, lower in weight, and had higher number of surgeries than those who did not, while the mortality and morbidity rates were higher in these patients. When cases with biliary atresia were analyzed within themselves, no significant difference was found between perforated biliary atresia and non-perforated cases in terms of age, weight, and previous surgery. When biliary atresia and other etiologies were compared, biliary atresia cases were found to be transplanted at a younger age, at a lower weight, and this group had a higher risk for perforation. Early laparotomy should be performed in order to reduce mortality in GIPs. Patients that are younger, underweight, previously operated, and using mesh must be closely monitored.

Hepatocellular Carcinoma and Liver Transplantation: A Single-Center Experience.

BACKGROUND: Liver transplantation (LT) is the best treatment in selected patients with hepatocellular carcinoma (HCC). Morphologic criteria alone are not sufficient to predict survival. In this study, we investigated the clinical, biochemical, and pathologic factors affecting survival in patients who underwent LT due to HCC. METHODS: Between October 2011 and January 2018, 165 of 749 LT for HCC cases performed at the Memorial Atasehir Hospital were evaluated retrospectively. Survival, demographic characteristics and etiology, preoperative alpha-fetoprotein (AFP) level, Model for End-Stage Liver Disease (MELD) score, prognostic staging, and morphologic and histologic properties were evaluated. RESULTS: One hundred and thirty-nine cases of 165 were living donor liver transplantation (LDLT). The mean age was 57.7 ± 7.3 years, the mean follow-up period was 27.8 ± 20 months, and 41 patients (24%) died before follow-up. Recurrence of HCC was detected in 23 (14%) cases. Overall survival was 85%, 71%, and 64% for 1, 3, and 5 years, respectively. In terms of 1-, 3-, and 5-year survival within vs beyond Milan criteria was 90%, 80%, and 76% vs 75%, 66%, and 44%, respectively. In the University of California San Francisco criteria, it was 86%, 76%, and 70% vs 76%, 60%, and 30% compared with 1-, 3-, and 5-year survival. While histopathological poor differentiation and AFP elevation affected the course negatively. Good differentiation did not have a significant effect on survival. It was determined that poor differentiation, lymphovascular invasion, and an increased number of nodules significantly affected survival in both within and beyond cases. CONCLUSION: A transplant decision is controversial in patients with HCC with other than previously defined morphologic criteria. In these cases, AFP level and histologic differentiation determine survival. The results were not satisfactory in both high and/or poorly differentiated cases.

Plantar Sweating as an Indicator of Lower Risk of Compensatory Sweating after Thoracic Sympathectomy.

Background Hyperhidrosis is a dysfunction of the autonomic nervous system that results in regional excessive sweating, mostly in the hands, armpits, and feet. A permanent and effective treatment of hyperhidrosis can be achieved by interruption of the thoracic sympathetic chain with endoscopic thoracic sympathectomy (ETS). However, some side effects, particularly compensatory sweating (CS), are the limitations of this procedure. The mechanism of CS and the associated risk factors are still controversial. The aim of this retrospective study was to determine the relationship with various parameters associated with CS in patients undergoing ETS. Materials and Methods ETS was performed on a total of 95 patients for palmar hyperhidrosis, axillary hyperhidrosis and facial blushing by the same surgeon. The mean age of the patients was 26.41 (± 7) years, and 54 (56.8%) were males. Palmar hyperhidrosis was present in 54 (56.8%) patients, axillary hyperhidrosis in 33 (34.7%) patients, and facial blushing in 8 (8.5%) patients. Moreover, 38 (40%) patients also had plantar sweating. The severity of CS was rated into three scales as less, moderate, and severe. Results Regarding the severity of CS, 55 (57.9%) patients had no or less CS, 28 (29.5%) had moderate CS, and 12 (12.6%) patients had severe CS. Higher age group had a significant increased risk of severe CS (p = 0.03) (r = 0.262). Patients with body mass index (BMI) > 25 kg/m2 had a statistically significantly increased risk of severe CS (p = 0.016). Facial blushing resulted in severe CS in a significantly higher proportion of patients than by palmar and axillary hyperhidrosis (p = 0.001). The level of surgery was another important risk factor for CS, with the T2 level showing an increased risk of severe CS compared with T3 level (p < 0.001). Furthermore, plantar sweating was inversely and significantly related to the development of CS. Patients with plantar sweating had a significantly decreased incidence of developing CS (p = 0.015). Conclusion CS after thoracic sympathectomy for primary hyperhidrosis is the most displeasing and restrictive side effect. This study demonstrates that older age, operation level, facial blushing, and high BMI are risk factors for CS, as have been shown in several similar studies. An interesting finding of the present study is that there was a decreased incidence of CS among patients with plantar sweating. This situation may help us to distinguish high risk for CS before ETS operation.

Co-existence of a rare dyspnea with pericardial diaphragmatic rupture and pericardial rupture: a case report.

Pericardial-diaphragmatic rupture is a rare condition which occurs after blunt trauma and involves the herniation of abdominal organs into the pericardium. A 77-year-old female patient presenting with complaints of palpitation and difficulty in breathing was admitted to the emergency room. Left lateral thoracotomy revealed the herniation of abdominal organs into the thorax. A pericardial-diaphragmatic rupture and a pericardial rupture were found to co-exist. The diaphragm and the pericardium were repaired primarily. The case is presented here because herniation of abdominal organs into the pleural cavity through the pericardium is a rare condition.

Liver transplantation from living donors with Gilbert's syndrome is a safe procedure for both donors and recipients.

Liver transplantation (LT) has become a favorable therapeutic option for patients with end-stage liver diseases. Gilbert's syndrome (GS) is a benign condition characterized by intermittent mild jaundice due to unconjugated hyperbilirubinemia. It is not obvious whether living-donor liver transplantation (LDLT) from a donor with GS could result in a normal outcome for both the recipient and the donor. We aimed to determine whether right lobe hepatectomy is a safe procedure for living donors with GS and LT recipients. Between September 2011 and March 2015, 305 LDLT procedures using right lobe grafts were performed at Atasehir Memorial Hospital, Istanbul, Turkey. Nineteen of 305 LT candidates who had been diagnosed with GS were included in the current study. After a 12-h overnight fast, total and indirect bilirubin levels of donors and recipients were measured. The median follow-up after transplant was 16 months (range 3-36 months). The median age of donors was 25 (range 20-55 yr). Four donors (21%) were female, and 15 donors (89%) were male. The median age of donors was 51 (range 23-68 yr). Eleven recipients (57%) were female, and 8 (43%) were male. The median preoperative total bilirubin level of donors was 1.69 mg/dL (range 1.26-2.43 mg/dL) (normal range <1.2 mg/dL). The median total bilirubin level of donors on postoperative day 7 was 1.04 mg/dL (range 0.71-3.23 mg/dL). As our study has included a large number of donors with GS, it produced reliable evidence that right lobe hepatectomy is a safe procedure for living donors with GS and LT recipients.

Increased serum S-TRAIL level in newly diagnosed stage-IV lung adenocarcinoma but not squamous cell carcinoma is correlated with age and smoking.

BACKGROUND: Lung cancer is the leading cause of cancer mortality in the world. Many factors can protect against or facilitate its development. A TNF family member TRAIL, has a complex physiological role beyond that of merely activating the apoptotic pathway in cancer cells. Vitamin D is converted to its active form locally in the lung, and is also thought to play an important role in lung health. Our goal was to investigate the possible clinical significance of serum sTRAIL and 1,25-dihydroxyvitamin D(3) levels in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Totals of 18 consecutive adenocarcinoma and 22 squamous cell carcinoma patients with stage-IV non-small cell lung cancer referred to our institute were included in this study. There were 12 men and 6 women, with ages ranging from 38 to 97 (mean 60.5) years with adenocarcinoma, and 20 men and 2 women, with ages ranging from 46 to 80 (mean 65) years with squamous cell carcinoma. Serum levels of sTRAIL and 1,25-dihydroxyvitamin D(3) were measured in all samples at the time of diagnosis. RESULTS: sTRAIL levels in NSCLC patients were higher than in the control group. Although there was no correlation between patient survival and sTRAIL levels, the highest sTRAIL levels were correlated with age and cigarette smoking in the adenocarcinoma patients. sTRAIL level in healthy individuals were correlated with serum 1,25-dihydroxyvitamin D(3). CONCLUSIONS: Serum sTRAIL concentrations were increased in NSCLC patients, and correlated with age and smoking history, but not with overall survival.

Liver alveolar echinococcosis metastasized to the breast.

BACKGROUND: Alveolar echinococcosis (AE) is a potentially fatal and chronically progressive infestation produced by the multivesicular metacestode of Echinococcus multilocularis, which most commonly affects the liver, lungs, and brain. CASE REPORT: We present a case of AE in which an alveolar cyst, as a result of exophytic growth, adhered to intra-abdominal and pelvic organs and metastasized to the breast. Exploration showed that the exophytic cyst in the liver filled the entire abdominal cavity, reaching to the uterus and bladder, and was adherent to the neighboring tissues and organs. This cystic lesion was totally excised, as was the 7×6 cm cystic lesion in the right breast. CONCLUSIONS: The liver is the most common site for echinococcal cysts of the pastoral strains (>65%), followed by the lungs (25%); the cyst is seen less frequently in the spleen, kidneys, heart, bone, and central nervous system. AE must be considered in areas where liver cysts are endemic and in the presence of a liver cyst, and the organs where a metastasis is possible must be thoroughly investigated. Furthermore, in these areas, when cystic disorders of the breast are present, AE should not be discounted among possible definitive diagnoses.

An interesting journey of an ingested needle: a case report and review of the literature on extra-abdominal migration of ingested foreign bodies.

Swallowed foreign bodies encounter a major problem especially in children, but fortunately they mostly do not cause any related complication and are easily passed with the stool. In this paper, an interesting journey of a needle is presented. A 20-year old female admitted to our emergency service after she had swallowed a sewing machine needle, which is initially observed in the stomach in the plain abdominal radiography. During the follow-up period, the needle traveled through bowels, and surprisingly was observed in the left lung on 10th day of the follow-up. It was removed with a thoracotomy and pneumotomy under the fluoroscopic guidance. The postoperative period was uneventful and the patient was discharged from the hospital on the day 5. We also review the literature on interesting extra-abdominal migrations of swallowing foreign bodies.

Sarcoidosis presenting as cold thyroid nodules: report of two cases.

Sarcoidosis is a systemic disease characterized by noncaseating granulomas. Thyroid involvement is rare in sarcoidosis. In this paper, two sarcoidosis patients who demonstrated cold thyroid nodules are presented. A 42-year-old woman presented with multinodular goiter and was diagnosed as having sarcoidosis when noncaseating granulomas were observed during the pathological examination of the thyroidectomy specimen. Enlarged mediastinal lymph nodes were observed in the routine preoperative chest X-ray in another 53-year-old woman, while she was being prepared to undergo a thyroidectomy. The pathological examination of the thyroid specimens showed noncaseating granulomas in both patients, and the diagnosis was confirmed by either hepatic biopsy or chest X-ray findings. In conclusion, thyroid involvement should be suspected in sarcoidosis patients who present with cold nodules in the thyroid. Furthermore, if noncaseating granulomas are observed in thyroid specimens after a thyroidectomy in an otherwise healthy person, the patient should be evaluated further for sarcoidosis.

[PROGNOTIC FACTORS EFFECTING MORTALlTY IN TRAUMATIC DIAPHRAGMA INJURY]. / TRAVMATIK DIYAFRAGMA RUPTURLERINDE MORTALITEYE ETKILI PROGNOSTIK FAKTORLER.

BACKGROUND: Traumatic diaphragma rupturesare difficult to diagnose and generally with associated organe injuries. The aim ofthe study is to evaluate the factors effect on mortality. METHODS: Twenty-three patients with traumatic diaphragma injuries, admitted to our hospital were retrospectively evaluated for demographics, diagnosis, otherorgan injuries, treatment, mortalityand morbidity. RESULTS: All patients were male and the mean age was 24.7 10.0. The diaphragma injuries were observed during laparatomy in 19 patients (%82.6), during laparatomy and thoracotomy in 2 (%8.7). The injuries were diagnosed with fluid drainage from thorax tube during peritoneal lavage in 2 patients (%8. 7). All patients, but one, had other organ injuries (%95.7), most commonly in stomach, spleen and liver. Seven patients died during peroperative or postoperative peiod (%30.4). When these seven patients were compared to survived patients, it was observed that age and trauma score were statistically related to mortality rate (p<0.05), but the lenght ofthe diaphragmatic injury was not related to mortality rate (p > 0.05). CONCLUSION: Traumatic diaphragma injuries are generally diagnosed during laparatomy and associated with other organ injuries. The high mortality rate in patients with traumatic diaphragma injuries, is not related to the characteristics ofthe diaphragma injury, but it is closely related to concomitant problems such as patient is age and trauma score.