Effect of omega-3 on hepatic regeneration in adult living donors undergoing hepatic resections for liver transplantation: A randomized controlled trial.

BACKGROUND: Omega-3 polyunsaturated fatty acids (ω-3 PUFAs) have been shown to improve liver regeneration in experimental models. Aim was to evaluate the effects of ω-3 PUFAs on hepatic regeneration in adult living donors undergoing partial hepatectomy for liver transplantation (LDLT). METHODS: Forty LDLT donors were categorized into 2 groups: received either intravenous ω-3 PUFA-enriched lipid emulsion 20% infusion 7 mL/kg once a day for 2 days before surgery and postoperative day (POD) 0 (S group) or glucose 5% (C group). Hepatic regeneration was assessed by volume of the liver after 1 month using computed tomography, and serial serum levels of hepatocyte growth factor were measured at POD 1, 3, and 5. RESULTS: Liver volume after 1 month was significantly larger in the S group than the C group (1286.75 ± 122.781 cm(3) vs 1169.15 ± 128.3, respectively; P = .00). Both the regeneration index and the regeneration percentage were significantly higher in the S group than the C group (P = .02 and P = .00, respectively). Serum levels of hepatocyte growth factor were significantly higher in the S group on POD 1, 3, and 5 than the C group ([in pg/mL] 188.10 ± 74.25 vs 123.30 ± 13.56, P = .00; 127.55 ± 32.40 vs 109.25 ± 8.89, P = .02; and 109.45 ± 21.44 vs 96.70 ± 5.57, P = .01; respectively). CONCLUSION: Omega-3 polyunsaturated fatty acids effectively promoted liver regeneration and functional recovery following portal hypertension in the setting of LDLT.

THE BENEFICIAL VALUES OF TRANSOESOPHAGEAL DOPPLER IN INTRAOPERATIVE FLUID GUIDANCE VERSUS STANDARD CLINICAL MONITORING PARAMETERS IN INFANTS UNDERGOING KASAI OPERATION.

BACKGROUND: Fluid overload in infants can result from inappropriate volume expansion (VE). The aim of this work was to evaluate the beneficial values of Transoesophageal Doppler TED in intraoperative fluid guidance versus standard clinical monitoring parameters in infants undergoing Kasai operation. METHODS: Forty infants scheduled for Kasai procedure were randomly allocated into two groups (Doppler and clinical group). In Doppler group decided to provide VE (10-30 m1/kg of Hydroxyethyl starches HES) when the index stroke volume decreased by ≥ 15% from the baseline value, in clinical group, hemodynamic variables triggering colloid administration mean arterial blood pressure (MAP) less than 20% below baseline or central venous pressure (CVP) < 5 cmH2O in both groups: Ringer's acetate was infused at constant rate (6 m 1/kg/h). Standard and TED-derived data were recorded before and after VE. Follow up the postoperative outcome and hospital stay. RESULTS: There were significantly lower mean volume of HES (42.85 ± 3.93 versus 84 ± 14.29 ml) and percent of infants required it (30% versus 90%) associated with earlier tolerance to oral feeding (2 ± 0.66 versus 3.4 ± 0.51), shorter hospital stay (5.30 ± 0.47 versus 6.7 ± [symbols: see text] days) and lower rate of chest infection (15% versus 30%) in Doppler group than clinical group. There was no difference between the two studied groups regarding heart rate, MAP. CONCLUSIONS: TED guided intraoperative fluid intake in infants undergoing Kasai operation optimize fluid consumption and improve outcome associated with shorter hospital stay.

Effectiveness of intravenous infusion of N-acetylcysteine in cirrhotic patients undergoing major abdominal surgeries.

BACKGROUND: Postoperative acute kidney injury (AKI) is common in patients with chronic liver disease. We prospectively evaluated effectiveness of the N-acetylcysteine (NAC) in preserving postoperative renal functions in cirrhotic patients undergoing major abdominal surgeries. MATERIALS AND METHODS: A total of 60 cirrhotic patients child A to B were randomized into two groups of 30 each. NAC groupwas received intravenous infusion of NAC (1200 mg/12h starting immediately before surgery and continued for 72h h postoperative) and controls group received a similar volume of glucose 5% solution as a a placebo. Systemic hemodynamics, hepatic and renal functions, serum cystatin C and cystatin C glomerular filtration rate (GFR) (GFR) were compared between both groups. RESULTS: Serum level of cystatin C was raised significantly above the basal value at postoperative day 1 and day 3 associated with significantly decreased in cystatin C GFR below the basal value in the control group (P = 0.001). 6 (20%) (PP = 0.03) in control group developed AKI based on cystatin C GFR criteria (GFR <55 ml/min/1.73m(2)). Mean values of alanine aminotransferase and aspartate aminotransferase were increased significantly above the basal values in both groups, but the increases were significantly lower in NAC group (P = 0.00). Chest infection was significantly lower associated with shorter hospital stay in the NAC group than the control group. CONCLUSION: Intravenous administration of NAC NAC in cirrhotic patients undergoing major abdominal surgeries reduces the incidence of cystatin C GFR-based AKI, postoperative renal and liver functions were well-preserved and improved outcome.

THE BENEFICIAL VALUES OF TRANSOESOPHAGEAL DOPPLER IN INTRAOPERATIVE FLUID GUIDANCE VERSUS STANDARD CLINICAL MONITORING PARAMETERS IN INFANTS UNDERGOING KASAI OPERATION.

BACKGROUND: Fluid overload in infants can result from inappropriate volume expansion (VE). The aim of this work was to evaluate the beneficial values of Transoesophageal Doppler TED in intraoperative fluid guidance versus standard clinical monitoring parameters in infants undergoing Kasai operation. METHODS: Forty infants scheduled for Kasai procedure were randomly allocated into two groups (Doppler and clinical group). In Doppler group decided to provide VE (10-30 mI/kg of Eydroxyethyl starches HES) when the index stroke volume decreased by ≥ 15% from the baseline value, in clinical group, hemodynamic variables triggering colloid administration mean arterial blood pressure (MAP) less than 20% below baseline or central venous pressure (CVP) < 5 cmH2O in both groups: Ringer's acetate was infused at constant rate (6 m l/kg/h). Standard and TED-derived data were recorded before and after VE. Follow up the postoperative outcome and hospital stay. RESULTS: There were significantly lower mean volume of HES (42.85 ± 3.93 versus 84 14.29 ml) and percent of infants required it (30% versus 90%) associated with earlier tolerance to oral feeding (2 ± 0.66 versus 3.4 ± 0.51), shorter hospital stay (5.30 ± 0.47 versus 6.7 ± 0.92 days) and lower rate of chest infection (15% versus 30%) in Doppler group than clinical group. There was no difference between the two studied groups regarding heart rate, MAP. CONCLUSIONS: TED guided intraoperative fluid intake in infants undergoing Kasai operation optimize fluid consumption and improve outcome associated with shorter hospital stay.