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.

Influence of selected factors on veins' permeability for albumin in vitro.

We present the results of a study on the influence of albumin and prolactin concentrations and intravascular fluid pH on vein permeability for albumin. Permeability conditions were simulated depending on albumin concentration, pH value and prolactin concentration. In research model an in vitro method was applied using natural membrane - porcine vena cava inferior. Vein permeability was in the 0.63% to 5.69% range. In control variant permeability was ~2.54% and increased ~2 fold at decreased albumin and PRL concentrations. At increased albumin concentration permeability was decreased 4-fold. Albumin concentration significantly influences albumin permeability.

Comparing the effect of Biolasol® and HTK solutions on maintaining proper homeostasis, indicating the kidney storage efficiency prior to transplantation.

BACKGROUND: Maintaining proper homeostasis involving normal physiological level of extra- and intracellular solutions is one of the factors that determine restoring the life functions of a transplanted organ. The aim of this study was to demonstrate the effectiveness of the newly developed Biolasol(®) solution in kidney storage and to compare its protective effect to the standard HTK solution. MATERIAL/METHODS: Isolated porcine kidneys were perfused, preserved (24 and 48 h) and reperfused with Biolasol(®) and HTK solutions. The perfusate samples were used to analyze pH; the amount of released indicator enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH); and the concentration of sodium, potassium and magnesium. RESULTS: Kidney storage in the HTK liquid may cause metabolic acidosis after 24 and 48 hour preservation (pH drop below 6.8). pH of perfusates sampled after perfusion and reperfusion with Biolasol(®) solution was within the range 6.8-7.7. The content of sodium ions during perfusion and reperfusion was the closest to the reference values while using the Biolasol(®) solution. Only Biolasol(®) ensured normal homeostasis of Mg2+ ions. In the presence of the HTK solution their level was significantly (more than 1000%) higher than the normal physiological value. For both solutions, ALT and AST activities were within the normal range or differed only slightly. CONCLUSIONS: Biolasol(®) and HTK solutions protect kidneys against ischemic damage. Still, Biolasol(®) offers better homeostasis maintenance, which may suggest it more effectively preserves kidneys prior to transplantation.

Influence of trace elements on stabilization of aqueous solutions of ascorbic acid.

Together with vitamin C, zinc, selenium, manganese, and magnesium play a vital role in the preservation of organs scheduled for transplantation. In the present study, it is shown that addition of 1 mg/l of these elements influences the stability of 0.3 mM ascorbic acid solutions. The solution's stability was estimated using an accelerated stability test. The concentration of vitamin C was measured using a validated spectrophotometric method, which uses the reduction of 2,6-dichlorophenoloindophenol by ascorbic acid. Elevated temperatures, the factor accelerating substances' decomposition reaction rate, were used in the tests. The research was conducted at two temperatures at intervals of 10 °C: 80 ± 0.1 and 90 ± 0.1 °C. It was stated that the studied substances' decomposition occurred in accordance with the equation for first-order reactions. The function of the logarithmic concentration (log%C) over time was revealed to be rectilinear. This dependence was used to determine the kinetics of decomposition reaction rate parameters. The stabilization of vitamin C solutions was measured as the time in which 10 % of the substance decomposed at 20 and 0 °C. Addition of Se(IV) or Mg(II) ions significantly increase the stability of ascorbic acid solution (∼34 and ∼16 %, respectively), but Zn(II) causes a significant decrease in stability by ∼23 %. Addition of Mn(II) has no significant influence on vitamin C stability.

A model for calcium permeation into small intestine.

An in vitro model was used to simulate the intestinal permeation of calcium ions depending on the type of salt (carbonate, fumarate, citrate, or gluconate), its concentration (1.0, 2.5, 5.0, or 10 mM/l), and pH (1.3, 4.2, 6.2, or 7.5). To simulate the conditions for calcium permeation in a patient in a fasting state, the solutions were placed in contact with segments of small intestine of pig: stomach, duodenum, jejunum, and ileum. The percent permeation, its rate, and half-time were measured in each case. In all cases, the maximum permeation was seen at 1 mM concentration, depending on pH: 100% for carbonate at pH 1.3; 82% for fumarate, pH 6.2; 79.5% for citrate at pH 4.2, and 81% for gluconate at pH 7.4. The maximum rate of permeation (% h(-1)) was also observed at 1 mM: 2.16 for carbonate at pH 1.3, 0.29 for fumarate at pH 6.2, 0.26 for citrate at pH 4.2, and 0.28 for gluconate at pH 7.4. The shortest half-time permeation (t (1/2), h) for 1 mM solutions depended also on pH (in parentheses): carbonate 0.3 (1.3), fumarate 2.4 (6.2), citrate 2.6 (4.2), and gluconate 2.5 (7.4). The results suggest that calcium carbonate and citrate can be recommended to patients with normal gastric acidity and hyperacidity while fumarate and gluconate to patients with hypoacidity.

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.

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.

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.