Glycohydrolases are a group of enzymes contained predominantly within lysosomes, which are released during Kupffer cell activation or death. One of these, beta -galactosidase, has been proposed as a ...marker of ischemia-reperfusion injury in the liver because Kupffer cell activation represents a primary event in the injurious reperfusion cascade. In this study, we compared B-galactosidase with more traditional indicators of liver injury and function in a porcine model of liver preservation. Porcine livers were allocated into two groups: group C (n = 5), preserved in University of Wisconsin solution by standard cold storage for 24 hours, and group W (n = 5), perfused with oxygenated autologous blood on an extracorporeal circuit for 24 hours. Both groups were subsequently tested on the circuit during a 24-hour reperfusion phase. The perfusate was sampled for levels of beta -galactosidase, as well as traditional markers of liver injury and function. A sharp increase in beta -galactosidase levels was seen on reperfusion of cold preserved livers to a level of 1,900 IU/mL. This contrasted dramatically with normothermically preserved livers, in which the level never exceeded 208 IU/mL (P = .002). beta -Galactosidase levels showed much earlier and greater increases compared with transaminase levels in livers injured by ischemia. A rapid elevation in beta -galactosidase levels corresponded well with poor liver function and more liver injury. Measurement of beta -galactosidase is a simple test that quantifies ischemia-reperfusion injury of preserved livers. It is more sensitive than transaminases, with faster and larger increases in levels after ischemic injury. It can be useful in assessing the viability of a liver during machine preservation. (Liver Transpl 2002;8:21-26.)
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The aggressive nature of pancreatic cancer makes surgical control of disease an arduous challenge. Tumor seeding during resection is a feared complication during operations performed for this ...disease. Recurrence within the peritoneal cavity commonly occurs after resection for curative intent. Cutaneous metastasis, however, is a rare event. The majority of skin metastasis reported in the literature occurred after palliative procedures, in which the tumor burden remains. In this report, we describe an unusual case of cutaneous recurrence at the site of a surgical drain after resection for curative intent and discuss the impact of surgery on tumor-growth characteristics.
Renal grafts from NHBDs result in long-term function that does not compromise current clinical standards and therefore make the NHBD a viable way to expand the donor pool. Several programs around the ...world are beginning to use NHBD livers in clinical transplantation; thus, there is certain to be a surge of reports appearing in the literature in the near future. It appears from available data to date that NHBD livers retrieved in a controlled fashion from category 3 donors may offer a safe source for more organs. Further research and clinical experience with NHBD transplantation for both kidney and liver should help define reproducible and acceptable methods. However, until an alternative source of organs becomes available, the NHBD represents an increasingly important means to alleviate the growing demand for transplant organs.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
455.
Image of the Month St Peter, Shawn D; Leslie, Kevin O; Heppell, Jacques P
Archives of surgery (Chicago. 1960),
05/2004, Volume:
139, Issue:
5
Journal Article
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
457.
Nissen Fundoplication St Peter, Shawn D.; Holcomb, George W.
Essentials of Pediatric Endoscopic Surgery
Book Chapter
Gastroesophageal reflux disease is commonly managed using the laparoscopic Nissen fundoplication technique in a large number of pediatric centers worldwide. The procedure is performed with ease using ...minimal access techniques; however attention has to be paid to the technical aspects to avoid complications. The chapter explains the procedure of laparoscopic Nissen fundoplication and outlines the operation room setup, positioning of the patient, special instruments required for the procedure and the port placement sites. The indications, contraindications, preoperative considerations and technical considerations for laparoscopic Nissen fundoplication have also been listed. Possible procedural variations have been outlined. The surgical procedure has been explained using sequential high quality images.
Gallbladder Disease Peter, Shawn D. St; Holcomb, George W. III
Pediatric Surgery
Book Chapter
Gallbladder disease is being diagnosed more frequently in children, although it is not seen nearly as often as in adults. The disease processes contributing to gallbladder pathology are different in ...children compared with adults. There is a much higher incidence of black pig-mented gallstones due to hemolytic disease in children. Moreover, acute and chronic cholecystitis with severe infl ammation and/or scarring of the gallbladder and surrounding tissues are far less common in children. Aside from these fundamental differences, lessons gained from the vast published experience in adults can be useful in managing children with gallbladder disease.
Introduction
Patients with Hirschsprung's disease (HSCR) remain at risk of developing Hirschsprung-associated enterocolitis (HAEC) after surgical intervention. As inpatient management remains ...variable, our institution implemented an algorithm directed at standardizing treatment practices. This study aimed to compare the outcomes of patients pre- and post-algorithm.
Methods
A retrospective review of patients admitted for HAEC was performed; January 2017–June 2018 encompassed the pre-implementation period, and October 2018–October 2019 was the post-implementation period. Demographics and outcomes were compared between the two groups.
Results
Sixty-two episodes of HAEC occurred in 27 patients during the entire study period. Sixteen patients (59%) had more than one episode. The most common levels of the transition zone were the rectosigmoid (50%) and descending colon (27%). Following algorithm implementation, the median length of stay (2 vs. 7 days,
p
< 0.001), TPN duration (0 vs. 5.5 days,
p
< 0.001), and days to full enteral diet (6 days vs. 2 days,
p
< 0.001) decreased significantly. Readmission rates for recurrent enterocolitis were similar pre- and post-algorithm implementation.
Conclusion
The use of a standardized algorithm significantly decreases the length of stay and duration of intravenous antibiotic administration without increasing readmission rates, while still providing appropriate treatment for HAEC.
Level of evidence
III level.
Type of study
Retrospective comparative study.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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