Analysis of surgical outcomes in 102 patients with renal cell carcinoma with venous tumor thrombus: A retrospective observational single-center study.

The aim of the study was to assess short- and long-term results following radical nephrectomy with renal vein and inferior vena cava thrombectomy in patients with renal cell cancer with venous thrombus and to investigate impact of various demographical, clinical and histological factors on overall survival (OS). The medical records of 102 adult patients with renal cell cancer with venous thrombus admitted for surgery in Department of General, Vascular and Transplant Surgery from 2012 to 2019 were retrospectively analyzed. The tumor was more frequently located on the right side compared to the left one (55 vs. 47). According to Neves Zincke classification, the levels of venous thrombus were as follows: 1 to 48 (47%), 2 to 47 (46%), 3 to 6 (6%), and 4 to 1 (1%). Postoperative complications were noted in 16 (15.7%) patients. One (3%) patient (Neves Zincke 2) died of intraoperative pulmonary embolism during hospitalization. Clear cell carcinoma was the most common pathological type reported in 92 (90.2%) patients. Thirty nine (38.2%) patients were alive at the time of last follow-up. The median OS was 21.50 (0-101.17) months. The 1-year OS was 75.5%. Significantly better OS (median 38.03 months) was noted in patients with RCC Neves Zincke 1 compared to OS (median 14.79 months) in patients with Neves Zincke 2-4 VT (P = .008). Higher tumor staging (T3 vs. T4) (P = .038), nodal staging (N0 vs. N1) (P = .0008), Fuhrman histological grading (G1-2 vs. G3-4) (P = .033) were associated with a shorter OS. Patients with renal cell cancer with venous thrombus, with an acceptable perioperative risk, should be treated surgically, because radical nephrectomy with thrombectomy performed in a high volume surgical center is a safe procedure. Neves Zincke 2-4 venous thrombus, higher tumor and nodal staging, as well higher Fuhrman histological grading are associated with a shorter OS.

Liver transplantation as an option of treatment for a giant primary hepatic neuroendocrine tumour.

There are no clear guidelines for the treatment of hepatic neuroendocrine tumours. Surgical resections - though rarely radical - seem to be the treatment of choice. Thermoablation, chemoembolisation, or cytoreductive surgery of hepatic focal lesions are often recommended. Pharmacological treatment is based on somatostatin analogues. Liver transplantation is available for a strictly selected group of patients with hepatic neuroendocrine tumours [5]. In the case described above, there were a number of factors that affected the decision about eligibility: first of all - very slow growth of the tumour, its size, and typical multifocality, which made it impossible to perform resection, lack of neoplastic focus outside the liver, and low Ki-67 proliferation index of ≤ 2%. The surgical risk was escalated due to the giant tumour mass and the laparotomy, which was performed twice.

Prolactin (PRL) reduces the release of transaminases from the isolated pig liver.

BACKGROUND: This study investigated methods of increasing the effectiveness of preservation solutions. Recently, it has been reported that solution effectiveness can be improved by the addition of prolactin (PRL). This study determines the effect of prolactin (PRL) on the amount and release rate of alanine aminotransferase (ALAT) and aspartate aminotransferase (AST) from liver during its 24-hour preservation period. MATERIAL/METHODS: Isolated porcine liver was kept in the HTK (histidine-tryptophan-ketoglutaric acid) solution with and without PRL. Once infusion and the 24-hour preservation period had been finished, samples of the preservation solution were taken and the amounts of released indicator enzymes were determined. RESULTS: Aminotransferases were released from hepatocytes to the preservation solution at various rates. ALT was released much faster into the solution without PRL (k=-0.1230 [U/l/h-1]) and slower with PRL (k=-0.0895 [U/l/h-1]). The enzyme was released into the solution with PRL at a 27% slower rate. Similar results were obtained when the release rate of AST was analyzed. AST was more quickly released into the solution without PRL (k=-0.0642 [U/l/h-1]), and more slowly with PRL (k=-0.0205 [U/l/h-1]). The enzyme was released into the PRL-containing solution at a 68% slower rate. CONCLUSIONS: The obtained results indicate that the addition of PRL significantly lowers the amount of aminotransferases released from hepatocytes and also lessens their release rate, as it significantly affects the time of efficient in vitro storage of the liver.

Study of prolactin permeation through the pericardium and its bioavailability.

The prolactin (PRL) permeation through the pericardium depending on the species of origin (porcine, bovine and ovine) was studied, and the parameters of its bioavailability were calculated. An in vitro model using pericardium as a natural membrane and Frantz cell method was applied. Significant differences in permeation were observed depending on the species of origin. Within 5 h, 17.5% of bovine PRL, 27.2% of porcine PRL and 90.3% of ovine PRL permeated the pericardium. The amount of permeated ovine PRL was 3.3-fold higher than porcine PRL and 5.2-fold higher than bovine PRL. The maximum concentration of permeated PRL was reached in the thirtieth minute of the experiment and was the highest for ovine PRL (C(max) = 677.21 µg/cm²) and the lowest for bovine PRL (C(max) = 259.97 µg/cm²). Bioavailability of PRL through the pericardium is 3.3-fold greater for ovine PRL in comparison to porcine or bovine PRL. The relative extent of bioavailability for bovine and ovine prolactin versus the porcine PRL standard was 85.6% and 229.3%, respectively.

Factors determining changes in concentrations of pro-inflammatory markers in blood serum in the initial period after kidney transplantation from dead donor.

BACKGROUND: The main aim of this paper is to determine scope of changes in concentration of selected pro-inflammatory factors in blood serum in the initial period after the kidney transplantation from the brain death donor and attempt of establishing which of them are connected with delayed function of the organ, initial condition of both the donor and the recipient. MATERIAL/METHODS: The prospective examination carried out in group of 20 patients that underwent kidney transplantation from 10 donors diagnosed brain death. Blood samples were drawn before the transplantation procedure, 4 hours after procedure and in 4(th) day after the procedure. The blood serum analysis included: interleukin-6 (IL-6), tumor necrosis factor-alpha, interleukin-1beta (IL-1b) and C-reactive protein (CRP). RESULTS: In perioperative period the dynamic changes of all observed markers were noticed, especially in 4 th hour after the transplantation procedure. Generally, apart from TNFalpha, their concentration in blood serum was raising (the most significantly for IL-6) and then in 4(th) day reached the level equal to or lower than before transplantation. CONCLUSIONS: The delayed graft function is accompanied by high CRP level in donors before grafting and sustaining rise of IL-1b content in blood serum in 4(th) day after the transplantation procedure. The IL-6 content in this period revealed similar tendency in recipients' pairs that have been given the kidney from one donor, reflecting the condition of an organ that has been transplanted.

Iliac artery stenosis as a cause of posttransplant renovascular hypertension: report of two cases.

Stenosis of renal artery (TRAS) or iliac artery proximal to the anastomosis (pTRAS) results in an impairment of kidney graft perfusion, arterial hypertension and in consequence decrease of glomerular filtration. In this report we present two patients with pTRAS and renovascular hypertension after kidney transplantation (KTx), treated successfully with percutaneous transluminal angioplasty (PTA) with stenting. Resistant hypertension, decrease of diuresis and increase of serum creatinine concentration were observed in both presented patients. Also in both cases pTRAS was diagnosed by Doppler ultrasonography and confirmed by angiography. Iliac artery angioplasty with stenting was successfully applied in these patients, resulting in a decrease of blood pressure, restoration of diuresis and a decrease of serum creatinine concentration. These observations confirm that PTA of iliac arteries with stenting is an effective method of treatment in patients with pTRAS.