SULPHUR-CONTAINING AMINO ACIDS METABOLISM IN EXPERIMENTAL HYPER- AND HYPOTHYROIDISM IN RATS.

Hyper- and hypothyroidism are some of the most common endocrinopathies that cause many metabolic disorders including amino acids metabolism. However, a specific molecular mechanism of thyroid hormones influence on sulphur-containing amino acids metabolism has not been established. The aim of our research was to investigate experimentally the influence of thyroid gland functional state on the main enzymatic systems of sulphur-containing amino acids metabolism in liver and kidneys, the content of homocysteine, cysteine and H2S in blood. The rats were administered with L-thyroxine and mercazolil to simulate the states of hyper- and hypothyroidism, which were confirmed by the content of fT3, fT4 and TSH in the blood. In liver and kidneys of the animals with hypothyroidism we observed the decrease in the activity of enzymes of remethylation cycle of S-adenosylmethioninsyntase, S-adenosylhomocysteinhyhdrolase, betaine-homocysteine methyltransferase. Suppression of transsulfuration transformation of homocysteine to cysteine in hypothyroidism was mainly due to the inhibition of cystathionine synthase activity of cystathionine-ß-synthase, wherein cystathionase activity of cystathionine-γ-lyase was not changed. In animals with hypothyroidism we also noticed the inhibition of cysteine desulfunation reactions: the activity of enzymes of cystathionine-ß-synthase, cystathionine-γ-lyase and cysteine aminotransferase significantly decreased in liver and kidneys. Experimental hyperthyroidism was accompanied by increase in activity of remethylation cycle enzymes, increase in cystationine synthase activity of cystathionine-ß-synthase in liver and activity of these enzymes in kidneys. The simulation of hyperthyroidism led to the decrease of homocysteine concentration, and of hypothyroidism - to the increase of homocysteine and cysteine concentrations and reduced H2S content in blood of the animals. Thus, the significant risk factors for the development of atherosclerosis, endothelial dysfunction and hypercoagulation in hypothyroid conditions may be the disorders in the processes of remethylation, transsulfuration, and desulfuration of sulphur-containing amino acids in organs.

Management of Portal Hypertension After Liver Transplantation.

INTRODUCTION: Post-transplantation portal hypertension has severe complications, such as esophageal varix bleeding, therapy refractory ascites, extreme splenomegaly, and graft dysfunction. The aim of our study was to analyze the effectiveness of the therapeutic strategies and how to visualize the procedure. METHODS: A retrospective study involving liver transplantation patients from the Semmelweis University Department of Transplantation and Surgery was performed between 2005 and 2015. The prevalence, etiology, and leading complications of the condition were determined. The applied interventions' effects on the patients' ascites volume, splenic volume, and the occurrence of variceal bleeding were determined. Mean portal blood flow velocity and congestion index values were calculated using Doppler ultrasonography. RESULTS: The prevalence of post-transplantation portal hypertension requiring intervention was 2.8%. The most common etiology of the disease was portal anastomotic stenosis. The most common complications were esophageal varix bleeding and therapy refractory ascites. The patients' ascites volume decreased significantly (2923.3 ± 1893.2 mL vs. 423.3 ± 634.3 mL; P < .05), their splenic volume decreased markedly. After the interventions, only one case of recurrent variceal bleeding was reported. The calculated Doppler parameters were altered in the opposite direction in cases of pre-hepatic versus intra- or post-hepatic portal hypertension. After the interventions, these parameters shifted towards the physiologic ranges. CONCLUSION: The interventions performed in our clinic were effective in most cases. The patients' ascites volume, splenic volume, and the prevalence of variceal bleeding decreased after the treatment. Doppler ultrasonography has proved to be a valuable imaging modality in the diagnosis and the follow-up of post-transplantation portal hypertension.

Role of Contrast-Enhanced Ultrasound in the Follow-up of Kidney Transplant Patients.

BACKGROUND: Contrast-enhanced ultrasound combines the advantages of native ultrasound and other contrast-enhanced imaging modalities. In selected cases it can be preferable to computerized tomographic scan among kidney transplant recipients. METHODS: We performed a retrospective study involving patients of Semmelweis University Department of Transplantation and Surgery who underwent contrast-enhanced ultrasound examination from 2011 to 2015. During this period, 251 examinations were performed, including 45 on kidney transplant patients. A Toshiba Aplio XU ultrasound device was used, and 1-1.5 mL contrast agent (Sonovue) was administered intravenously for each patient. The indications of these evaluations can be divided into 3 groups: characterization of circumscribed kidney lesions, control after radiofrequency ablation therapy, and examination of graft perfusion. RESULTS: Fully 93% of the examinations were conclusive. In the 1st group of the 37 cases where tumor-suspect lesions were investigated, 13 examinations suggested the presence of a space-occupying lesion. Of those 13 cases, 2 patients had a negative biopsy, nephrectomy was performed in 11 cases, and histologic evaluation verified a tumor in 8 samples. In the 2nd group, the ablation control examination detected a residual tumor in none of the 6 cases. Finally, in 1 of the 2 grafts where the circulation was investigated, blood flow was satisfactory, and in the other it was low. CONCLUSIONS: The contrast-enhanced ultrasound examination was conclusive in most cases. The applied contrast material is not nephrotoxic, and the method uses nonionizing radiation. These features make contrast-enhanced ultrasound highly suitable for the examination of kidney transplant patients.

Predictors of laterality of motor block during epidural analgesia in a mixed surgical population.

BACKGROUND: Predictors of laterality of motor block during epidural analgesia are currently unknown, as studies so far have yielded conflicting results. We aimed to evaluate predictors of post-operative asymmetric lower extremity motor blockade in a mixed surgical population. METHODS: This is a retrospective analysis of 578 consecutive patients with post-operative epidural analgesia for a variety of surgical procedures. A priori determined potential predictors of unilateral motor block were age, gender, body mass index, type of surgical procedure, vertebral level of puncture, catheter insertion depth into the epidural space and concentration of local anaesthetic. Logistic regression analysis was employed for evaluating predictors of laterality. RESULTS: Unilateral motor block occurred in 29.2% of the patients. Univariate logistic regression analysis showed that young age, female gender, gynaecologic procedures, a low puncture level, an increased depth of catheter insertion and a high ropivacaine concentration (2 mg/ml vs. less than 2 mg/ml) were significantly associated with increased incidence of laterality. Multivariate analysis revealed that age (OR = 0.73 per decade increase, P = 0.00001), the vertebral level of epidural puncture (OR = 1.37 per lowering vertebral level, P < 0.000001) and the depth of catheter insertion (OR = 1.46 per centimetre deeper, P = 0.001) were independent predictors of unilateral motor block. CONCLUSION: These results suggest that young patients with lumbar epidural analgesia or deep catheter insertion should be frequently monitored for the occurrence of laterality of motor block. Also, these results provide support for a prospective study to determine the optimal catheter insertion depth to decrease the risk of unilateral motor block.