Comparison of laparoscopic evaluation of hepatosteatosis with ultrasound findings.

OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) is a condition characterized by abnormal liver function because of lipid accumulation. NAFLD can range from simple fatty liver, which is usually harmless, to a more severe condition called non-alcoholic steatohepatitis (NASH), which involves inflammation, liver cell damage, cirrhosis, and liver cancer. Liver biopsy is considered the gold standard for diagnosing and staging hepatosteatosis, but it is an invasive and expensive procedure. Non-invasive methods, such as ultrasound, and magnetic resonance imaging (MRI), can provide useful information without the need for an invasive procedure. This study aimed to compare laparoscopic findings of hepatosteatosis with ultrasound data to create a classification that can identify individuals with NASH in operated patients. PATIENTS AND METHODS: 120 patients who applied to the General Surgery Department of Istinye University Faculty of Medicine between 06/2022 and 12/2022 were included in the study. They were evaluated for hepatosteatosis with preoperative ultrasound. Demographic, physical examination (BMI), laboratory, and radiological findings of the patients were recorded retrospectively. In addition, laparoscopy video recordings were reviewed retrospectively, and the findings were evaluated. Statistical analysis of the findings was made. The p-value was calculated using the Chi-square test; p-value <0.05 was considered statistically significant. RESULTS: The mean age of 120 patients was 39.04 years, the mean BMI was 34.9 kg/m², and 63.3% of them were female patients. Cholecystectomy was performed in 60 of 120 patients, and sleeve gastrectomy in 60 of them. It has been observed that there is a high correlation between the ultrasound grade and the laparoscopic stage of hepatosteatosis (r=0.849) (p<0.05). CONCLUSIONS: Laparoscopy results to be an effective method in the diagnosis and classification of NASH.

Effects of coenzyme Q10 in a propofol infusion syndrome model of rabbits.

Background: Coenzyme Q (CoQ) might be the main site of interaction with propofol on the mitochondrial respiratory chain in the propofol infusion syndrome (PRIS) because of the structural similarity between coenzyme Q10 (CoQ10) and propofol. Aim: To investigate the effects of CoQ10 on survival and organ injury in a PRIS model in rabbits. Methods: Sixteen male New Zealand white rabbits were divided into 4 groups: (1) propofol infusion group, (2) propofol infusion and CoQ10, 100 mg/kg was administered intravenously, (3) sevoflurane inhalation was administered, and (4) sevoflurane inhalation and CoQ10, 100 mg/kg intravenously, was administered. Arterial blood gas and biochemical analyses were repeated every 2 h and every 12 h, respectively. Animals that were alive on the 24th hour after anesthesia induction were euthanized. The organ damages were investigated under light and transmission electron microscopy (TEM). Results: The propofol infusion group had the highest troponin T levels when compared with the other three groups at the 12th hour. The propofol + CoQ10 group had lower troponin T levels when compared with the propofol and sevoflurane groups (P < 0.05). Administration of CoQ10 decreased total liver injury scores and total organ injury scores both in the propofol and sevoflurane groups. The propofol and sevoflurane organ toxicities were attenuated with CoQ10 in liver, gallbladder, urinary bladder, and spleen. Conclusion: The addition of CoQ10 to propofol and sevoflurane anesthesia prevented the propofol-associated increase in troponin T levels at the 12th hour of infusion and decreased anesthetic-induced total liver and organ injury scores.

A single-center kidney transplantation experience in children with low weight: is low weight a contraindication?

OBJECTIVE: Kidney transplantation (KT) might be difficult for underweight kids (under 15 kg). Our goal was to convey information on KT in underweight children. PATIENTS AND METHODS: The study's target population consisted of children (age 18) weighing 15 kg or fewer who received KT at our facility between January 2018 and June 2021. A retrospective analysis was performed on demographic and clinical data, including age, gender, primary disease, pretransplant dialysis status, recipient weight, recipient body mass index (BMI), surgical approach type (intraperitoneal/extraperitoneal), complications, graft status (functioning/failed), patient survival, and immunological data. RESULTS: There were 94 pediatric KTs completed. Thirty-three patients were included when the selection criteria were applied. The mean recipient weight was 11.45 [6.7-15] kg, and the average patient age was 3.36 [1-7]. Three (9.9%) patients had kidney transplants from dead adult donors, whereas thirty (90.1%) patients underwent live donor kidney transplantation (LDKT). While the intraperitoneal (IPA) technique was used in 19 cases, the extraperitoneal (KT) strategy was used on 14 patients (EPA). The donor BMI was 28.24 [19.6-42] kg/m2, and the mean donor weight was 78.13 [55-109] kg. Bridectomy was necessary because five individuals experienced ileus. IPA was performed in each of these patients during LDKT. Following IPA, a 2-year-old patient with a BMI of 16 kg/m2 had renal allograft compartment syndrome and required graft nephrectomy. CONCLUSIONS: Pediatric patients weighing 15 kg or fewer can get kidney transplants successfully. Gastrointestinal problems are relatively uncommon with EPA, even though there is no agreement on the best surgical strategy.

Idiopathic acute massive pulmonary embolism in childhood.

Acute pulmonary embolism (PE) is an uncommon clinical condition in childhood. We hereby present a case report of a 10-year-old child who presented to the emergency department with an acute massive PE. He was transferred by ambulance to our emergency department for dyspnea and perioral cyanosis. His parents denied any previous history of illness or familial disease. Arterial blood gas analysis, electrocardiography, and clinical symptoms and signs collectively raised a suspicion of a probable PE. A contrast-enhanced pulmonary computed tomography scan revealed a massive thrombus in the distal part of the right pulmonary artery with no contrast passage into upper, middle, and lower lobar arteries. Upon ascertaining, the diagnosis of PE, intravenous saline infusion, 3 L/min oxygen through nasal route, and subcutaneous enoxaparin 0.4 cc was administered promptly. As our hospital lacked a pediatric intensive care unit and a further need for administration of pharmacological thrombolysis was anticipated, we transferred the patient to a tertiary care center. PE should always be kept in mind as a differential diagnosis in emergency departments even in pediatric patients.

Experimental flow studies in exact-replica phantoms of atherosclerotic carotid bifurcations under steady input conditions.

Extensive flow studies are conducted in two carotid bifurcation flow phantoms. These phantoms exactly replicate the lumen of the plaque excised intact from two patients with severe carotid atherosclerosis. The input flow into the phantom's common carotid artery is steady. Novel scanning techniques for flow visualization and particle image velocimetry are used. In addition, a novel boundary treatment technique is employed in velocimetry to extract first order accurate velocity gradients at walls. The data show that the flow fields are highly three-dimensional. Numerous separation and recirculation zones dominate the flow domain, except at the lowest Reynolds numbers. The separation regions are often so severe that highly directed internal jets form. At high Reynolds numbers, the flows become unsteady and chaotic, even though the input flow is steady. Flow fields have large regions of energetic flow and almost stagnant recirculation zones. These recirculation zones range in size from the full size of the arteries to zones within crevasses smaller than 1 mm. Velocity field and streamline patterns conform well to the lumen geometry. The streamlines are highly tortuous. Stagnation points correlate well with the topological features of the stenosis. Vorticity maps confirm the highly complex and three dimensional nature of the flow. Wall shear stresses at the stenoses are estimated to be on the order of 10 Pa. These studies conclusively show that the nature of the flow in the diseased bifurcation is primarily dictated by the lumen geometry.