Skin and kidney histological changes in graft-versus-host disease (GVHD) after kidney transplantation.

Kidney transplantation (Ktx) is generally performed during end stage renal disease due to a loss of the kidneys' ability to filter wastes from the circulatory system. Acute graft-versus-host disease (GVHD) after Ktx is a life-threatening complication that progresses to organ failure, systemic complications, and death. The current study evaluated the significance of histologic findings of GVHD as obtained from skin biopsies following Ktx in swine. A swine model of Ktx with tacrolimus-based immunosuppression was used to assess possible correlations between acute-graft-cellular rejection and skin histological findings for prediction of GVHD. Animals were divided into a Ktx treatment group or a control group with no Ktx and skin and kidney biopsies were histologically assessed at postoperative days 0, 15, 30, 45 and 60. Skin samples were analyzed and classified from grade 1 to 4 of skin GVHD and the major histopathological changes of kidney acute cellular rejection were described using Banff's score system. We observed a significant linear correlation between the histological grading values of skin biopsy changes and the histological grading values of kidney biopsies (Kendall's tau_b=0.993) in the Ktx experimental group. No histological changes were observed in controls. Our findings demonstrate the diagnostic value of staging skin GVHD after Ktx and suggest it's future utility for monitoring long term Ktx-induced changes.

Surgical outcome after pancreatoduodenectomy: effect of preoperative biliary drainage.

BACKGROUND/AIMS: Depth of jaundice has been associated with increased risk of complications following operations. The value of preoperative biliary drainage has already been studied with contradictory results. In the present analysis we tried to determine the association between preoperative biliary drainage and postoperative complications in a nonselected series of patients. METHODOLOGY: Patients, who have undergone duodenopancreatectomy for periampullary adenocarcinoma, were included in the study. Patient data consisted of age, gender, diabetes mellitus, preoperative risk assessment according to ASA, preoperative biliary drainage, preoperative bilirubin level, operative time, type of duodenopancreatectomy, postoperative morbidity and mortality. Mann-Whitney exact test, Fisher's exact test and logistic-regression model were used for statistical analysis. RESULTS: Inclusion criteria for the study met 87 patients operated on from January 1996 till January 2000. Preoperative biliary drainage was not associated with mortality, rate of reoperation or length of hospital stay. Morbidity in these patients was slightly higher comparing to patients, who were not preoperatively drained, but this difference was not statistically important (p=0.3). In multivariate analysis, duration of operation was statistically the most significant predictor for postoperative complications (p=0.03). CONCLUSIONS: In patients with a resectable periampullary mass and obstructive jaundice, preoperative biliary drainage is not warranted. It may even be associated with increased risk of postoperative infectious complications. Biliary drainage should be done only in patients, who are not candidates for resection.

An experimental model of reproducible liver trauma.

The aim of the study was to create an experimental model of reproducible and controllable liver trauma in pigs. The few reported experimental models of liver trauma use the "clamp and crush" mechanism of injury and do not cause reproducible liver injury. In the present study, force was applied through the thoracic wall to mimic a chest injury. Nine pigs were used as experimental animals. In anaesthetised animals, blunt liver trauma was caused with a crossbow using an arrow with a spherical aluminium head as a projectile. Liver injuries of stages II to III according to liver injury scale were inflicted on all the animals. The stage of liver trauma was proportional to the pressure impulse (ratio between the product of the arrow's mass (m) and the velocity (v) and the contact surface area of the arrow (S)). The presented model of controllable liver injury will enable the study of various aspects of liver trauma since the experiment can be designed in such a way to produce a spectrum of liver injuries.

Cyclin D1 and bax influence the prognosis after pancreatoduodenectomy for periampullary adenocarcinoma.

BACKGROUND/AIMS: The outcome of patients undergoing pancreatoduodenectomy for periampullary adenocarcinoma is influenced by various clinicopathological factors, chemo/radiotherapy and expression of various oncogenes, tumor suppressor genes, growth factors and factors controlling apoptosis. The aim of this study was to define clinicopathological predictors of survival in periampullary adenocarcinoma, and to determine the prognostic significance of cyclin D1, p27kip1 and bax expression in these tumors. METHODOLOGY: Prospectively, we collected clinicopathological data for patients operated on between January 1995 and December 1998. Cyclin D1, p27kip1 and bax expression was assessed immunohistochemically. The potential influence of clinicopathological factors and cyclin D1, p27kip1 and bax expression on survival was investigated. Univariate analyses were performed using the Kaplan-Meier method and log-rank test. For multivariate analysis Cox proportional hazards regression was used. RESULTS: Fifty-five patients were included in the study. The actuarial 5-year survival was 30%: 11% for pancreatic adenocarcinoma and 46% for distal bile duct/papillary adenocarcinoma Univariate analysis identified diabetes mellitus, blood transfusion, diameter of the tumor, histological type of the tumor, lymphatic invasion, neural invasion, lymph node metastasis, overexpression of cyclin D1 and lower expression of bax and p27kip1 as factors that significantly decrease survival rates. In multivariate analysis, the histological type of the tumor (p=0.001), lymph node involvement (p=0.03) and overexpression of cyclin D1 (p=0.02) independently influenced survival, whereas decreased expression of bax nearly reached statistical significance (p=0.054). CONCLUSIONS: Our findings confirm the association between cyclin D1 and bax expression and aggressive biological behavior of periampullary adenocarcinomas. Moreover, these parameters were identified as independent prognostic indicators in these tumors.