Utility of Polyethylene Terephthalate (Dacron) Vascular Grafts for Venous Outflow Reconstruction in Living-Donor Liver Transplantations.

BACKGROUND: Venous outflow reconstruction of modified right-lobe liver grafts has been shown to prevent the occurrence of graft congestion and subsequent complications, including graft loss. In the present study, we aimed to investigate the safety and efficacy of Dacron grafts for venous reconstruction in living donor liver transplantation (LDLT). METHODS: Between January 2016 and January 2018, Dacron grafts were used in 148 liver transplants. Of these, 104 patients who had a follow-up computerized tomography (CT) scan were enrolled into the study. A total of 179 outflow hepatic veins including V5, V8, partial middle hepatic vein, and accessory inferior right hepatic veins (IRHV) were reconstructed using synthetic Dacron grafts. Graft patency was evaluated with both intraoperative Doppler ultrasonography following reconstruction, and a follow-up CT was performed on the postoperative day 7 (±1). Retrospective data collection included demographics, parameters for small-for-size (laboratory tests [bilirubin, International Normalized Ratio] and ascites) syndrome, postoperative morbidity, and mortality. RESULTS: Follow-up CT revealed graft patency in 155 out of 179 (86.6%) vascular grafts. Postoperative seventh-day patency rates for each reconstructed vein were as follows: V5, 87.5% (70/80); V8, 87.7% (50/57); partial middle hepatic vein, 100% (11/11); and IRHV, 77.4% (24/31). No major graft-related complications (early graft dysfunction, graft infection) or graft-related mortality were observed. None of the recipients developed small-for-size syndrome based on laboratory tests and clinical findings. CONCLUSIONS: Dacron vascular grafts appear as an advantageous and useful alternative for venous outflow reconstruction in LDLT.

Diagnostic tools in ocular allergy.

Ocular allergy (OA) includes a group of common and less frequent hypersensitivity disorders frequently misdiagnosed and not properly managed. The diagnosis of OA is usually based on clinical history and signs and symptoms, with the support of in vivo and in vitro tests when identification of the specific allergen is required. To date, no specific test is available for the diagnosis of the whole spectrum of the different forms of OA. The lack of recommendations on diagnosis of OA is considered a medical need not only for allergists but also for ophthalmologists. This position paper aims to provide a comprehensive overview of the currently available tools for diagnosing OA to promote a common nomenclature and procedures to be used by different specialists. Questionnaires, sign and symptom grading scales, tests, and potential biomarkers for OA are reviewed. We also identified several unmet needs in the diagnostic tools to generate interest, increase understanding, and inspire further investigations. Tools, recommendations, and algorithms for the diagnosis of OA are proposed for use by both allergists and ophthalmologists. Several unmet needs in the diagnostic tools should be further improved by specific clinical research in OA.

K-ras oncogene mutation in pterygium.

PurposePterygium is claimed to be a benign proliferation triggered by prolonged exposure to ultraviolet radiation. The frequency of K-ras oncogene mutation, which is among the initial mutations in tumorigenesis, is evaluated in this study.Patients and methodsIn this prospective randomized clinical, trial pterygium tissues and normal conjunctiva tissue specimens are obtained from the superotemporal quadrant of patients who underwent primary pterygium excision with autograft transplantation. DNA extraction from tissues was performed using the QIAamp DNA FFPE tissue kit. A PCR reaction was performed to amplify sequences containing codons 12, 13, and 61 of the K-ras gene in DNA. These PCR products then underwent the 'pyrosequencing' procedure for mutations at these codons.ResultsPterygium and normal conjunctival tissue samples of 25 patients (10 females, 15 males) were evaluated in the study. The mean age of the patients was 54.54±13.13 years. Genetic analysis revealed no K-ras mutations in normal conjunctival tissues, whereas pterygium tissues of the same cases demonstrated mutation at codon 12 in one case and mutations at codon 61 in seven cases, which was statistically significant (P<0.05). The point missense mutations at codon 61 were glutamine to arginine (Glu61Arg CAA>CGA) in four cases and glutamine to leucine (Glu61Leu CAA>CTA) in three cases.ConclusionThe significantly higher frequency of codon 61 mutation of the ras oncogene in primary and bilateral pterygium specimens compared with normal conjunctiva supports the tumoral origin of pterygium, and thus set the stage for research into a targeted therapy for pterygium with better outcomes than surgical excision.

Biocompatibility evaluation of orthodontic composite by real-time cell analysis.

INTRODUCTION: The aim of this study was to evaluate the cytotoxic effects of three different light-cured orthodontic composites. MATERIAL AND METHODS: Light Bond (Reliance orthodontic products), Grengloo (Ormco corporation), and Kurasper F (Kuraray Europe GmbH) were selected for the experiment. Specimens were prepared according to the manufacturers' instructions, measuring 5 mm in diameter and 2 mm in thickness. Fibroblast cells were obtained from healthy gingival connective tissues. The composite cylinders were incubated in Dulbecco's modified Eagle's culture medium for 72 h according to ISO 10993-5 standards. The xCELLigence method was used to evaluate fibroblast cell vitality. After seeding 200 mL of the cell suspensions into the wells (20,000 cells/well) of the E-plate 96, gingival fibroblasts were treated with bioactive components released by the orthodontic composite materials and monitored every 15 min for 121 h. RESULTS: There were no significant differences between the human gingival fibroblast (HGF) cell indexes of the control and all testing groups (p > 0.05) at 24 and 48 h. Light Bond demonstrated statistically significant decrease in HGF index (p < 0.05) at 72 h, but there was no significant difference among the Kurasper F, Grengloo, and untreated control groups (p > 0.05). Light Bond (p < 0.001) and Grengloo (p < 0.05) groups had lower HGF cell index values when compared to untreated control group, but Kurasper F demonstrated no significant differences between the control groups at 96 h (p > 0.05). CONCLUSION: Orthodontic composite materials include biologically active components and may change oral tissue. So, biocompatible orthodontic bonding composites should be used.

Marginal Donors in Renal Transplantation.

BACKGROUND: Kidney transplantation is the therapy of choice for a patient with end-stage renal disease. Although the number of patients with end-stage renal disease is in constant increase, the total number of renal transplants stays almost the same. METHODS: This gap between wait-listed patients for transplantation and the limited number of donations has forced transplant centers to consider kidneys normally refused for transplantation. This so-called expended criteria or marginal donors includes suboptimal quality grafts from cadaver, non-heart-beating donors, or living donors from elderly; hypertensive, diabetic, nephrolithic, or obese patients; or living donors with a history of malignancy, with potential transmissible infections or with renal cysts. RESULTS: The most common problems with the use of suboptimal kidneys in renal transplantation are delayed graft function and graft failure in the short- and long-term after transplantation. There are many contradictory reports in literature on the results of expanded criteria kidney transplantations. This review aims to summarize positive and negative short- and long-term outcomes of the most commonly used types of marginal kidney donations on renal transplantation, mostly focusing on the recent literature. CONCLUSIONS: We conclude that when both patient and/or living marginal donor accepting nephropathy are well-informed on potential risks taken, renal transplantation from a suboptimal kidney can be a better choice for certain patients with end-stage renal disease.

Our First Experience With Negative Pressure Incision Management System Implemented on the Clean Surgical Incision in the Renal Transplantation Recipient: A Case Report.

Multiple comorbidities and environmental factors increase the complications of incisional wounds in patients. It was demonstrated in previous prospective and randomized studies that negative pressure wound therapy (NPWT) reduced wound infection and other complications in clean, closed surgical incisions. In this case report, the Prevena incision management system was implemented on the clean, closed surgical incision of a 52-year-old female patient, who was given a renal transplantation from cadaver postoperatively in the operating theater. It was removed from the patient on the fifth day after the operation. Following the removal of Prevena, the wound and surrounding skin of the patient were observed. Wound healing was complete, and no skin lesion or tool-related complication was found around the wound due to NPWT. The Prevena NPWT system can be conveniently and safely implemented on the operational incision in renal transplant recipients in order to prevent surgical wound complications.

Methylene blue as an antioxidant agent in experimentally-induced injury in rat liver.

BACKGROUND: We aimed to test the methylene blue (MB) as a dye and also to test its antioxidant activities in devascularization-induced liver injury. METHODS: Twenty rats weighing 240-280 g were randomly divided into two groups, each containing 10 rats. High-grade liver injury was induced by using a pair of long pliers with blades. MB was injected into portal vein of the rats with no hepatic injury (Group 1; control group) and those with injured livers (Group 2; injury group). Liver and hepatic function tests, paraoxonase, stimulated paraoxonase, arylesterase activity, total antioxidant, and oxidant status were evaluated before and 24 h after MB injection. RESULTS: MB did not stain the non-perfused area. Total antioxidant status decreased significantly in Group 2 at hour 24 compared to Group 1. In Group 2, total antioxidant status was lower at hour 24 compared to hour 0. Total oxidant status in Group 2 at hour 0 increased significantly compared to Group 1. Total oxidant status in Group 2 at hour 24 was lower compared to that at hour 0. Lipid peroxidation parameters did not alter due to devascularization. CONCLUSION: MB is useful in defining the devascularization area. Moreover, it showed to have a beneficial effect on oxidant status (Tab. 3, Fig. 3, Ref. 25).

A neglected cause for chronic spontaneous urticaria in children: Helicobacter pylori.

BACKGROUND: The aetiology of chronic urticaria is usually considered idiopathic. There is a paucity of research both on the prevalence of Helicobacter pylori infection in the aetiology of chronic spontaneous urticaria (CU) in children and also on which patients H. pylori should be investigated. METHODS: All paediatric and adult patients who presented to the allergy outpatient clinic due to CU between January 2011 and July 2012 were included in this prospective, randomised study. Stool samples from all patients were examined for the H. pylori antigen. Paediatric and adult patients who had a positive stool test for the H. pylori antigen were reassessed following eradication therapy. RESULTS: Thirty-two children with CU and 35 adults with CU were enrolled in the study. Ten of the 32 (31.2%) children and 18 of the 35 (51.4%) adults were H. pylori positive (p=0.09). All children with positive-H. pylori were older than eight years of age. There was a significant positive correlation between age and the frequency of H. pylori infection (p<0.001; r=0.61). The presence of H. pylori was not significantly associated with the presence of GI (gastrointestinal) symptoms (p>0.05). Following H. pylori eradication, urticarial symptoms recovered in 15 of the adults (83.3%) and 10 of the paediatric (100%) patients (p=0.172). CONCLUSION: In the current study we found that H. pylori is common among children with CU, particularly after eight years of age. We suggest that CU patients with an unknown aetiology should be routinely screened for H. pylori even if they do not present with GI symptoms and that those with H. pylori-positive results may receive treatment.

A patient with steroids and antihistaminic drug allergy and newly occurred chronic urticaria angioedema: what about omalizumab?

In this case report, successful use of omalizumab in the treatment of chronic urticarial and angioedema in a 24-year-old female patient with an allergic reaction history to almost every drug including steroids and antihistamines was presented. She also had allergy against a large number of foods, which were confirmed by oral provocation, specific Immunoglobulin E and allergy skin test.

Drug allergy in tertiary care in Turkey: results of a national survey. The ADAPT study: adult drug allergy perception in Turkey.

BACKGROUND: No data are available on the incidence of drug hypersensitivity (DH) reactions in outpatient settings of tertiary allergy/immunology clinics. Our aims were to document the frequency of outpatient hospital admissions due to DH reactions to allergy/immunology clinics in adults and the management of these reactions in real life. We also investigated whether drug allergy affected social and medical behaviours of the patients. METHODS: This multi-centre study was performed for one year with the participation of 11 out of 16 tertiary allergy/clinical immunology clinics in Turkey. The study group consisted of the patients with DH reactions. Results of a questionnaire including drug reactions and management were recorded. RESULTS: Among 54,863 patients, 1000 patients with DH were enrolled with a median of 2.1% of all admissions. In real life conditions, the majority of approaches were performed for finding safe alternatives (65.5%; 1102 out of 1683) with 11.7% positivity. Diagnostic procedures were positive in 27% (154/581) of the patients. The majority of the patients had higher VAS scores for anxiety. A total of 250 subjects (25%) reported that they delayed some medical procedures because of DH. CONCLUSION: Our results documented the frequency of admissions due to DH reactions to allergy/clinical immunology clinics for the first time. Although physicians mostly preferred to perform drug tests in order to find safe alternatives, considering the fact that DH was confirmed in 27% of the patients, use of diagnostic tests should be encouraged, if no contraindication exists in order to avoid mislabelling patients as DH.

Relationship between skin prick and atopic patch test reactivity to aeroallergens and disease severity in children with atopic dermatitis.

BACKGROUND: The immunological mechanism in aetiology of atopic dermatitis (AD) shows significant differences from other allergic diseases. Allergen inhalation exacerbates AD lesions and AD patients' complaints decrease in house dust mite (HDM) low level environments, which reveals the importance of inhalant allergens. OBJECTIVE: We evaluated the skin prick test (SPT) and atopy patch test (APT) positivity rates with aeroallergens and studied the effect of test results, and aimed to determine the value of allergic test reactivity on the clinical characteristics of children with AD. METHODS: Forty-five children aged 2-15 years with AD were included to study between May 2006 and May 2007 in GATA Haydarpasa Teaching Hospital, Allergy Department. The reactivity to inhalant allergens using SPT and APT was evaluated. The severity of AD, which was assessed with SCORAD, was compared with aeroallergen hypersensitivity. RESULTS: The highest positivity of APT was seen against HDM (48.9%). HDM SPT positivity and subjective symptoms score were statistically correlated (P<0.05). Patients with strong SPT positivity to HDM had a higher total SCORAD score (P<0.05). Although there was no statistical correlation between HDM APT and SCORAD parameters, APT positive patients had generally higher SCORAD parameters. The statistical significance was only shown between the extent of the disease and strong APT positive reactions to Dermatophagoides pteronyssinus. CONCLUSION: HDM allergens play an important role in determining the clinical severity of AD and strong APT positivity could be more meaningful clinically.

Evaluation of necessity for mechanical bowel preparation before Milligan-Morgan hemorrhoidectomy: a randomized prospective clinical study.

AIM: In this randomized prospective clinical study, we aimed to evaluate the effect of mechanical bowel preparation (MBP) before Milligan-Morgan hemorrhoidectomy on intraoperative procedures and postoperative complication rates to determine whether MBP is adventageous or not before elective anorectal surgeries. METHODS: Forty patients who had internal grade III or IV hemorrhoidal disease and who would underwent open hemorrhoidectomy were randomized into two groups: non-MBP group (female:male, 11:9; mean age, 33.8±9.57 years) that would not receive MBP before the surgery, and MBP group (female:male, 12:8; mean age, 34.7±11.37 years) that would be given one Fleet enema on the morning of Milligan-Morgan hemorrhoidectomy. Intraoperative variables and postoperative complications were compared between two groups. RESULTS: MPB had no effect on both intraoperative and postoperative variables, such as operating time, intraoperative bleeding, visual analogue scale (VAS) score for the comfort of the surgeon during operation, the presence of stool or enema remnants in anal canal, the presence of mucosal edema of the anal canal intraoperatively, the rates of postoperative bleeding and infection, VAS score for the pain on third day postoperatively, time to first stool after the operation, VAS score for the pain during first stool after the operation, and number of analgesics during one week postoperatively (P>0.05 for all). CONCLUSION: MBP performed before surgery does not provide introperative or postoperative benefit for Milligan-Morgan hemorrhoidectomy, thus MBP is not necessary before elective anorectal surgeries.

Cytotoxicity of hemostatic agents on the human gingival fibroblast.

BACKGROUND: Achieving of moisture control especially gingival bleeding control is great challenge in clinical practice. Various hemostatic agents and techniques have been promoted for bleeding control during dental operation. But few studies have focused on the cytotoxicity of hemostatic solutions. AIM: The aim of this study was to evaluate cytotoxic effect of hemostatic agents on human gingival fibroblast cells by using real-time cell analysis method. MATERIALS AND METHODS: Two hemostatic solutions, Hemoban (Sultan Healthcare, Hackensack, NJ, USA) and Hemasatic Solutions (W.P. Dental, Hamburg, Germany) that includes mainly aluminum chloride were used with different concentration. Gingival fibroblasts were isolated from gingival connective tissue during crown lengthening surgery of systemically healthy subjects. Gingival fibroblasts were maintained with Dulbecco's modified eagle medium containing 10% fetal bovine serum. A real-time cell analyzer (RT-CES, xCELLigence; Roche Applied Science, Mannheim, Germany, and ACEA Biosciences, San Diego, CA, USA) was used to evaluate cell survival. After seeding 200 mL of the cell suspensions into the wells (10,000 cells/well) of the E-plate 96, gingival fibroblasts were treated with hemostatic solutions (1/2, 1/4 and 1/8 dilutions) and monitored every 15 minutes for 72 hours. For the proliferation experiments, the statistical analyses used were 1-way analysis of variance (ANOVA) and Tukey HSD multiple comparisons tests. RESULTS: According to statistically analysis, when evaluated at 48 and 72 hours, there were significant differences between the cell indexes of the control and all hemostatic agents groups (p < 0.001). Agent reduced cell index value significantly when compared to untreated control group. CONCLUSIONS: The results indicate that using of Hemoban or Hemostatic Solutions as astringent solutions have a significant cytotoxic effect on gingival fibroblast cells.

Correlation of thyroid fine-needle aspiration with final histopathology: a case series.

AIM: The aim of this study was to evaluate the correlation between preoperative thyroid fine-needle aspiration result and final histopathology in patients with thyroid nodules. METHODS: The medical records of 298 patients (mean age, 47.7±12.3 years; 79.5% females) who underwent fine-needle aspiration for thyroid nodules and who were operated and have final pathological diagnosis were retrospectively reviewed. For reporting fine-needle aspiration specimen pathology, the Bethesda thyroid fine-needle aspiration classification was used. Tyroglobulin (Tg) and anti-Tg and anti-thyroid peroxidase (anti-TPO) antibody levels were determined preoperatively. RESULTS: Thyroid nodules were non-diagnostic, benign or atypia (Bethesda groups 1-3) in 76.8% of patients; and follicular neoplasm, suspicious for malignancy or malignant (Bethesda groups 4-6) in 23.1% of patients. Final pathology of surgery specimen was most commonly nodular goiter (36.6%) and papillary carcinoma (35.6%). Nodular goiter was significantly more prevalent in Bethesda 1 group while papillary carcinoma was more common in Bethesda 3 group (P<0.05). Tg level is significantly higher in the nodular goiter group (90.49±126.93 ng/mL), while anti-Tg and anti-TPO levels are significantly higher in the lymphocytic thyroiditis goiter group (229.77±494.42 U/mL and 282.86±360.77 U/mL, respectively) than the other pathology groups (P<0.05 for all). CONCLUSION: Papillary carcinoma is more common in Bethesda thyroid fine-needle aspiration classification 3 group. Therefore, preoperative fine-needle aspiration for thyroid nodules is predictive of final pathology and should be applied for diagnosis and follow-up.

Favorable outcome of renal grafts with multiple arteries: a series of 198 patients.

OBJECTIVE: We sought to report the postoperative complications, vascular reconstruction techniques and graft outcomes among our series of renal transplantations performed using grafts with multiple renal arteries. METHODS: We reviewed retrospectively the medical records of 196 renal transplant patients of mean age 35.6 ± 13.3 years (range, 6-68) including 130 males and 66 females whose grafts from living (n = 164) or deceased (n = 32) donor with multiple arteries between 2006-2012. We noted the number of renal arteries, graft function, surgical technique, as well as vascular, urological and other complications. RESULTS: Of the 196 patients, 182 had 2 and 14 had ≥ 3 renal arteries. The surgical technique was separate anastomosis of renal arteries to the external and/or common iliac artery in the majority of patients (86.2%), while 13.8% of patients underwent anastomosis as a single renal artery after cuff reconstruction. Three patients experienced a lymphocele and only 1, a urinary leak from lower end of ureter, which was repaired surgically. Graft survival was 96.9% with losses in 6 cases due to rejection. CONCLUSIONS: Grafts bearing multiple renal arterial displayed low postoperative complication rates and good outcomes.

Patient and graft survival after pre-emptive versus non-pre-emptive kidney transplantation: a single-center experience from Turkey.

OBJECTIVE: We sought to report the graft and patients survival of pre-emptive and non-pre-emptive kidney transplantations performed in our center. METHODS: The 859 subjects showed a mean age of 36.1 years and included 64.6%; males, who received grafts from living (n = 665) or deceased (n = 194) donors between January 2008 and June 2011. We reviewed their medical records retrospectively, to separately pre-emptive versus non-pre-emptive recipients for year transplant outcomes. RESULTS: Among the 859 patients, 153 (17.8%) underwent pre-emptive and 706 (82.2%), non-pre-emptive kidney transplantations. The rate of living donors was higher in the pre-emptive group (97.4% vs 73%, respectively). The 1-year graft survivals were 99.3% and 95.8% in pre-emptive and non-pre-emptive transplantation groups, respectively (P > .05). There was no significant difference between groups with respect to patient survival at 1 year (P > .05). CONCLUSION: In conclusion, graft and patient survival rates between pre-emptive and non-pre-emptive kidney transplantation cases were comparable at 1 year. Pre-emptive kidney transplantation, which eliminates hemodialysis costs and complications, should be preferred as the optimal renal replacement therapy for end-stage renal disease patients.

The response of cementoblasts to calcium phosphate resin-based and calcium silicate-based commercial sealers.

AIM: To investigate cell viability and gene expression of cementoblasts (OCCM.30) exposed to extractable components released by resin-based sealers with different chemical composition Hybrid Root Seal (HRS), SimpliSeal (SS), Real Seal (RS) and AH Plus (AH) and by a MTA-based sealers Tech Biosealer Endo (TBE). METHODOLOGY: Discs of all materials were prepared and allowed to set in humid conditions at 37° for 48 h. The discs were then incubated for 72 h at 37 °C to obtain material extracts (1/1) in DMEM. The extracts containing the components released by the sealers were filtered and other dilutions (1/2, 1/4) were prepared from the original solution (1/1). Original and diluted solutions were tested on the cementoblasts. Impedance-based real-time cell analysis (RTCA) was used to evaluate cell viability, quantitative real-time polymerase chain reaction (QRT-PCR) was used to examine the expression of mineralization-related genes (osteocalcin; OCN, Runt-related transcription factor-2; Runx2, collagen type 1; COL I, alkaline phosphatase; ALP). For statistical analysis, one-way analysis of variance (anova) and Tukey's honestly significant difference (HSD) tests were used. RESULTS: TBE (1/2), RS (1/2, 1/4), and HRS (1/2, 1/4) significantly decreased cell viability (P < 0.001). AH (1/2, 1/4) and SS (1/2, 1/4) had similar cell viability to the control at 30 h. All tested materials significantly decreased cell viability when compared to the control group except AH (1/2, 1/4) and SS (1/4) at 90 h. All of the tested sealers reduced COL I mRNA expressions when compared to the control. SS was associated with significant increases in OCN and Runx2 mRNA expressions when compared to the control (P < 0.001). Whereas all of the dilutions of TBE, RS and HRS significantly decreased BSP mRNA expressions (P < 0,001), 1/2 and 1/4 dilutions of SS increased BSP mRNA expression (P < 0,001). Except the 1/4 dilutions of AH and SS, all the sealer dilutions significantly reduced ALP mRNA expression in cementoblasts (P < 0,001). CONCLUSIONS: SimpliSeal and AH Plus resulted in more favourable response to cementoblasts because of their regulation potential on the mineralized tissue-associated protein's mRNA expressions.

Warburg micro syndrome in two children from a highly inbred Turkish family.

Warburg Micro syndrome (WMS) was first reported by Warburg in 1993. The cardinal features are microcephaly, microphthalmia, congenital cataract and intellectual disability. We report on two children from a highly inbred family with microcephaly, congenital cataract, optic atrophy, hypotonia and severe psychomotor retardation. This phenotype is similar to other reported rare entities and especially to the family reported by Warburg. Four other children in the same family may also have been affected. In this report, the symptoms and features of our cases are compared with the Warburg Micro syndrome patients in literature.