Ex-vivo Resection and Small-Bowel Auto-transplantation for the Treatment of Tumors at the Root of the Mesentery.

BACKGROUND: Tumors involving the root of the mesentery are generally regarded as "unresectable" with conventional surgical techniques. Resection with conventional surgery may end in life-threatening complications in these patients. Ex-vivo resection and auto-transplantation avoids excessive bleeding and prevents ischemic related damage to the small intestine and other organs. OBJECTIVE: To share our experience of ex-vivo resection of the tumors with involvement of small bowel mesentery followed by small bowel auto-transplantation. METHODS: In this study, medical records of all the patients who underwent ex-vivo resection and auto-transplantation at our center were retrospectively analyzed. RESULTS: The most common indication for the procedure in our series was locally advanced pancreatic carcinoma. Our survival rate was 50% with a mean±SD follow-up of 10.1±9.8 (range: 0-26) months. Causes of early in-hospital mortality were multi-organ failure, sepsis, and cerebrovascular accident. Recurrence of disease was noted in one patient while one patient developed hepatic metastasis after 20 months of surgery. CONCLUSION: Ex-vivo resection of the tumor and auto-transplantation is the surgical treatment of choice for the locally advanced abdominal tumors involving the root of the mesentery.

Multivisceral and small bowel transplantation at shiraz organ transplant center.

BACKGROUND: Multivisceral transplantations were initially done in animal models to understand the immunological effects. Later on, in human beings, it has been considered a salvage procedure for unresectable complex abdominal malignancies. With advancement in surgical techniques, availability of better immunosuppressive drugs, and development of better post-operative management protocols, outcomes have been improved after these complex surgical procedures. OBJECTIVE: To analyze and report results of multivisceral, modified multivisceral, and small bowel transplantations done at Shiraz Organ Transplant Center, Shiraz, southern Iran. METHODS: Medical records of all patients who underwent multivisceral, modified multivisceral, and small bowel transplants were retrospectively analyzed. RESULTS: There were 18 patients. The most common indications for the procedure in our series were unresectable carcinoma of pancreas followed by short bowel syndrome. 10 patients were alive after a median follow-up of 8.7 (range: 3-32) months. The remaining 8 patients died post-operatively, mostly from septicemia. CONCLUSION: Multivisceral and small bowel transplantations are promising treatments for complex abdominal pathologies.

A renal transplantation model for developing countries.

The estimated incidence of end-stage renal disease (ESRD) in Pakistan is 100 per million population. Paucity and high costs of renal replacement therapy allows only 10% to get dialysis and 4-5% transplants. Our center, a government organization, started a dialysis and transplant program in 1980s where all services were provided free of charge to all patients. It was based on the concept of community government partnership funded by both partners. The guiding principles were equity, transparency, accountability and development of all facilities under one roof. This partnership has sustained itself for 30 years with an annual budget of $25 million in 2009. Daily 600 patients are dialyzed and weekly 10-12 receive transplants. One- and 5-year graft survival of 3000 transplants is 92% and 85%, respectively. The institute became a focus of transplantation in Pakistan and played a vital role in the campaign against transplant tourism and in promulgation of transplant law of 2007, and also helped to increase altruistic transplants in the country. This model emphasizes that in developing countries specialized centers in government sector are necessary for transplantation to progress and community support can make it available to the common man.

Haems as potential reagents for carbon monoxide.

A study of the potential of a myoglobin model system based on dipiperidyltetraphenylporphinatoiron(II) for the spectrophotometric determination of carbon monoxide is reported. At room temperature, oxygen does not bind strongly at the iron centre and does not interfere. Nitric oxide, hydrogen sulphide and carbon dioxide interfere and must be removed before the determination if present in significant amounts. The main disadvantage of this novel method is the low sensitivity (about 300 ppm CO). Possible means of modifying the system to enhance the sensitivity and to further reduce the number of interfering species are discussed.

The stability of porphyrin and metalloporphyrin molecular complexes in solution.

Stability constants for the molecular complexes formed by protoporphyrin IX dimethyl ester and its metal chelates with Co2+, Ni2+, Cu2+, Zn2+, Mg2+ and Fe3+ with nitroarene acceptors are determined in non-aqueous solvents. The stability of the complexes is found to be largely insensitive to variations in the central metal ions provided they are in the same oxidation state. Solvent-solute interactions are seen as being important in the formation of such complexes giving rise to large variations in their apparent stability. Some of the other factors that affect the stability of the molecular complexes are also evaluated. No evidence has been found for the appearance of any intermolecular charge-transfer absorption bands. Infrared studies, however, have provided some evidence for a substantial loss of electron density from the porphyrin ring upon interactions with the acceptors.