Predictive Value of Unenhanced Computerized Tomography for Detecting Hepatosteatosis in Living Liver Donors.

OBJECTIVE: Macrovesicular hepatosteatosis is related to post-transplantation complications, so preoperative hepatosteatosis determination plays a critical role in donor selection. The aim of this study was to evaluate the efficacy of unenhanced computerized tomography (CT) in determining hepatosteatosis in liver donor candidates. METHODS: Information about donor candidates was retrospectively reviewed. In this screening, 27 donor candidates who underwent liver biopsy because of suspected hepatosteatosis in routine abdominal CT examination before transplantation, were reviewed. Liver biopsies and CT images were reevaluated by an experienced pathologist and radiologist. Macrovesicular hepatosteatosis was graded according to percentage and divided into 3 groups. Three radiologic liver attenuation indices were used: 1) hepatic attenuation value (CT(L)); 2) the difference between hepatic attenuation and spleen attenuation (CT(L-S)); and 3) the ratio of hepatic attenuation to splenic attenuation (CT(L/S)). RESULTS: CT(L), CT(L-S), and CT(L/S) values of donors with hepatosteatosis were significantly higher than the donors without hepatosteatosis. In receiver operating characteristic analysis, the optimal cutoff value of these indices for determining hepatosteatosis were; 42.5, -5, and 0.98, respectively. At these cutoff values, the sensitivity and specificity of these indices were calculated to be 80% and 75%, 93.3% and 83.3%, and 93.3% and 83.3%, respectively. There were no statistical differences between their diagnostic performances. When these 3 indices were used for detect significant hepatosteatosis (>20%) it was observed that hepatosteatosis of only one donor could not be determined whereas it was seen that specificity was decreased markedly. CONCLUSIONS: Despite the high diagnostic yield of unenhanced CT, it is not suitable to use alone for assessment of hepatosteatosis in clinical practice.

Quality of life in patients with spinal cord injury--basic issues, assessment, and recommendations.

INTRODUCTION: Spinal cord injury (SCI) often causes severe disabilities. The degree of functional impairment strongly depends on the level and completeness of lesion (tetraplegic, paraplegic). But evaluation of outcomes also needs to consider the broader concept of health-related quality of the life (HRQL) for SCI patients. A multinational group of clinicians and researchers assessed this concept and reviewed the available instruments for measurement of quality of life in this group of patients. TIME POINTS: Phase I is in the acute clinic; phase II during rehabilitation; phase III after discharge home. Annual follow-up investigations should be maintained. The phase of initial care (phase 0) is important for prognosis and should, therefore, be part of the documentation. INSTRUMENTS: Criteria used to evaluate current QoL measures: reliability, validity, responsiveness, availability of translations, application in SCI patients, existing population norms. Several specific instruments or subscales exist for the following domains: physical and psychological functioning, pain, and handicap. Well-known generic measures of HRQL also have been applied to SCI patients, and a disease-specific instrument has been developed (SCIQL-23). A variety of subjective quality of life measures were evaluated as well. GROUP CONSENSUS/GUIDELINE: Prior to discharge from rehabilitation, the group suggested the use of the Functional Independence Measure, the Hospital Anxiety and Depression Scale and a Visual Analogue Scale for pain. Following discharge from the acute clinic, the SF-36, the Craig Handicap Assessment and Reporting Technique, the Quality of Well-being Scale, or the Life Satisfaction questionnaire were proposed. However, the evidence supporting the use of these instruments is sparse.

Cytoprotective effect of trimetazidine on 60 minutes of intestinal ischemia-reperfusion injury in rats.

Trimetazidine (TMZ), a potent antioxidant agent, has been used to protect the myocardium, liver and kidney from ischemia reperfusion (IR) injury. We investigated the effect of TMZ, a cellular anti-ischemic agent and a free radical scavenger, on 60 min of warm intestinal IR injury in rats. Sprague-Dawley rats were divided into three groups: a sham-operated group (no IR injury, n = 8), an ischemic control group (control, n = 8), and a TMZ-treated group (3 mg/kg, n = 8). Malondialdehyde (MDA) levels, myeloperoxidase (MPO) activity, and mucosal damage were investigated after 120 min of reperfusion. MDA levels and MPO activity were more elevated and histopathological damage more severe in the control group than in the sham group (P < 0.05). MDA levels and MPO activity were lower and there was less histopathological damage in the TMZ group than in the control group (P < 0.05). Accumulation of lipid peroxidation products and neutrophils in mucosal tissues were significantly inhibited by TMZ treatment. We conclude that pretreatment of rats with TMZ before intestinal ischemia attenuates but does not prevent, histological damage.

Antithrombin III prevents 60 min warm intestinal ischemia reperfusion injury in rats.

We investigated the effect of antithrombin III on 60 min warm intestinal ischemia-reperfusion (IR) injury in rats. Sprague-Dawley rats, weighing 220-250 g, were divided into three groups: group 1 sham-operated group (no IR injury, n = 8), group 2 ischemic control group (control, Ringer's lactate infused, n = 8), group 3 Antithrombin III treated group (250 U/kg before ischemia, n = 8). Intestinal ischemia was induced in rats by occluding the superior mesenteric artery for 60 min. Malondialdehyde (MDA) levels, myeloperoxidase activity (MPO) and mucosal damage were investigated after 120 min reperfusion. Elevated MDA levels and MPO activity and severe histopathological damage were observed in the control group compared with the sham group (P < 0.05). Decreased MDA levels and MPO activity and less histopathological damage were detected in group 3 compared with the control group (P < 0.05). Accumulation of lipid peroxidation products and neutrophils in mucosal tissues were significantly inhibited by antithrombin III treatment. We conclude that treatment with antithrombin III before intestinal ischemia prevents histological damage in rats.

Efficiency of ultrasound in the detection of the viability of hydatid cysts in the liver.

The aim of the present study was to establish the relationship between viability of the hydatid cyst and its ultrasonic appearance (Gharbi classification). To evaluate cyst viability, the criteria that were reported by the World Health Organization in 1982 for both the microbiological evaluation of the cystic fluid and the pathological evaluation of the cyst wall were used. In this study, the possibility of being viable was high in Type I cysts; the possibility of being dead was high in Type IV cysts. It is concluded that there is a relationship between ultrasonic appearance and the evolution of hydatid cysts.

Effect of nitric oxide on postoperative adhesion formation.

Peritoneal adhesions continue to be a significant cause of postoperative complications. The purpose of the present study was to investigate the effect of nitric oxide in preventing postoperative adhesion formation in rats. Three randomized groups of Sprague-Dawley rats were subjected to a standardized lesion by cecal abrasion and parietal peritoneal defect. 0.9% NaCl (control, group 1), L-arginine (300 mg/kg, group 2) and Nomega-nitro arginine methyl ester (L-NAME; 25 mg/kg, group 3) were administered intraperitoneally before abdominal closure and during 3 consecutive days after surgery. Two weeks after surgery, a relaparotomy was performed and the extent of adhesion formation was determined. In groups 1 and 3 heavy adhesions were detected. In the L-arginine group, adhesion formation was significantly less than in the other groups (p < 0.05). This study showed that L-arginine reduced adhesion formation.

The effect of L-arginine and pentoxifylline on postoperative adhesion formation.

BACKGROUND: Postoperative intraperitoneal adhesion formation is a major cause of infertility, pain, intestinal obstruction, and subsequent intraoperative complication. We investigated the effects of L-arginine and pentoxifylline for preventing postoperative adhesion in rats. METHODS: Forty Sprague-Dawley rats were subjected to a standardized lesion by serosal trauma of the uterine horn and parietal peritoneal defect. The agents were administered intraperitoneally at the end of surgery. The rats were assigned randomly into control (saline treated), L-arginine, pentoxifylline and L-arginine with pentoxifylline groups. Two weeks after surgery, a second laparotomy was performed and the extent of adhesion formation was determined. The data were analyzed by Mann Whitney U test. RESULTS: In L-arginine and pentoxifylline administered groups, adhesion formation scores were significantly lower than the control group (p<0.05). However, the efficacy of L-arginine used together with pentoxifylline is not superior to those of L-arginine or pentoxifylline alone. CONCLUSION: This study showed that L-arginine and pentoxifylline administered at the end of surgery reduced adhesion formation.

Posterior approaches in groin hernia repair with prosthesis: open or closed.

UNLABELLED: Laparoscopic herniorraphies have been used to reduce the pain and convalescence associated with open approaches. However, there is still not any consensus of the best approach. We compared open preperitoneal and laparoscopic total extraperitoneal approaches in groin hernia repair. METHODS: Thirty-two patients underwent open preperitoneal herniorraphy (Group I) and other 32 patients underwent total extraperitoneal repair (Group II). Time of surgery was noted. Visual Analogue Scale (VAS) was applied to evaluate the postoperative pain intensity. RESULTS: Operation time was 35 (20-65) minutes in Group I and 58 (40-85) minutes in Group II (p < 0.05). The difference of complication ratios between two groups was not significant. Laparoscopic approach was associated with less pain within postoperative 24 hours as compared to the open technique. However, after the first postoperative day, there was no longer statistically significant difference between both groups. No recurrence has yet been seen in follow-up period of 15 (4-24) months. CONCLUSION: Laparoscopic herniorraphy is associated with better results in term of postoperative pain within the first 24 hours as compared to open technique.