RESUMO
PURPOSE: Life expectancy of cancer patients determine the regimen of treatment. There is no feasible marker that determines the survival other than the stage of the disease or other patients related factors. Bilirubin can be a revealing marker for these. The effect of bilirubin may be due to the fact that the genetic and biochemical processes of bilirubin also modulate the tumour microenvironment. Radiotherapy and bilirubin can produce an effect similar to metformin via AMPK pathway. MATERIALS AND METHODS: This analysis was performed retrospectively in a cohort of 80 patients with a diagnosis of locoregional lung cancer with bilirubin levels in the accepted range. Receiver operating characteristic curve (ROC) analysis was performed to determine the optimal cut-off points. Pre-treatment serum total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL) levels and tumour volumes in the prognosis of the patients were investigated. RESULTS: The cut-off points for serum TBIL, DBIL and IBIL were 0.565 mg/dL, 0.105 mg/dL and 0.415 mg/dL,respectively. High TBIL 47.5 %, high DBIL and high IBIL were observed in 45 % of the entire patient population. The overall survival was three times longer in the high TBIL group than in the low TBIL group (OS; Hazard Ratio (HR), 0.33; 95% CI 0.16-0.70; p <0.001), locoregional free survival (LRFS; HR, 0.44; 95% CI 0.27-0.71; p <0.001) and distant metastasis-free survival (DMFS; HR, 0.44; 95% 0.25-0.80; p < 0.001). Similarly, high DBIL and high IBIL levels have been associated with longer OS, LRFS, and DMFS with significant differences. In addition, in the survival analysis of the cohort stratified with gross tumour volume (GTV) 128.5cc and TBIL 0.565 cut-off values; In the comparison of high TBIL and low TBIL groups, a significantly longer OS was observed in the high TBIL group in the patients with a GTV volume greater than128.5cc (p <0.001). CONCLUSION: Plasma bilirubin level at the time of diagnosis affects the survival of the patients independent of cancer stage and tumour volume. Possible additive interactions of radiotherapy and bilirubin are discussed with their pathophysiological mechanisms (Tab. 2, Fig. 7, Ref. 26).
Assuntos
Neoplasias Pulmonares , Metformina , Proteínas Quinases Ativadas por AMP , Bilirrubina , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Metformina/uso terapêutico , Estudos Retrospectivos , Microambiente TumoralRESUMO
AIM: Sepsis is a systemic infection reaction and intravascular volume therapy plays a crucial role in it's treatment. Acute respiratory distress syndrome (ARDS) occurs in the lungs, the most affected organ. This study aimed to investigate the different effects of fluid therapy on ARDS caused by sepsis. METHOD: To form a sepsis model, cecal ligation and puncture (CLP) procedure were performed on 44 adult rats. Divided into six groups; normal, CLP group, those treated with 40 ml/kg 0.9 % NaCl, 3 % NaCl (hypertonic saline), Ringer Lactate and Hydroxyethyl starch. After 24 hours treatments, histopathological examination of the lungs were done, and the plasma levels of CRP, TNF-α and IL-6 and paO2 were measured. RESULTS: The scores of all histological parameters of the group treated with hypertonic saline were significantly lower than of the other groups (p < 0.001). Likewise, according to the arterial blood gas results, paO2 was significantly higher (p < 0.01) in the hypertonic saline group compared to the other groups, and paCO2 was significantly lower (p < 0.01). CRP, TNF-α and IL-6 levels of inflammatory markers were also significantly lower in hypertonic saline groups compared to other groups (p < 0.001). CONCLUSIONS: Our study shows that treatment with hypertonic saline reduces the progression of ARDS in sepsis (Tab. 3, Fig. 4, Ref. 49).
Assuntos
Lesão Pulmonar Aguda , Sepse , Lesão Pulmonar Aguda/tratamento farmacológico , Animais , Modelos Animais de Doenças , Hidratação , Pulmão , Ratos , Solução Salina Hipertônica/uso terapêutico , Sepse/tratamento farmacológico , Sepse/terapia , Fator de Necrose Tumoral alfaRESUMO
BACKGROUND: Studies reporting outcomes of endoscopic treatment methods in children who underwent liver transplantation (LT) is very limited. We present our outcomes, as a high-volume transplant center where endoscopic methods are preferred as the first choice in the treatment of biliary complications in children. METHODS: Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) as the first treatment approach for biliary complications after LT between 2005 and 2017 were included. Clinical data included patient demographics, ERCP indications (stricture or leak), and treatment outcomes, including the need for percutaneous and surgical intervention. RESULTS: ERCP was performed in 49 patients who had a duct-to-duct anastomosis (38 living donor liver transplantation (LDLT), 11 deceased donor liver transplantation (DDLT)). The most common biliary complication was stricture. Our endoscopic success rate was 66.7% (18/27) and 75% (6/8) in LDLT and DDLT patients with stricture (p > 0.05), respectively. While our endoscopic success rate was 75% (3/4) in patients with leak alone after LDLT, it was 25% (1/4) in patients with leak and stricture in this group. The endoscopic success rate was 50% in two patients who had leak alone after DDLT. CONCLUSIONS: ERCP should be considered as a preferential treatment option for the management of biliary complications in pediatric liver transplant patients with duct-to-duct anastomosis, as in adults.
Assuntos
Anastomose Cirúrgica , Ductos Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Transplante de Fígado/métodos , Complicações Pós-Operatórias/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Masculino , Reoperação , Estudos RetrospectivosRESUMO
AIM: The aim of this study was to evaluate the efficacy of trimetazidine(TMZ) after end-to-end repair in a peripheral nerve injury model. METHOD: We performed end-to-end primary repair of sciatic nerves in rats and showed TMZ's regenerative effect. For this objective 30 male Sprague Dawley albino rats were used. Surgery+water group, rats were assigned to a placebo group and were given water by oral gavage. Surgery+TMZ group, rats were given trimetazidine by oral gavage. All medications were given for 12 weeks. Motor function test was performed. Afterwards, electromyography (EMG) recording was done. Finally, blood samples were taken, the animals were euthanized andsciatic nerve was removed. RESULTS: The amplitudes of compound muscle action potential (CMAP) increased significantly in the Surgery+TMZ group when compared with the group that have been given Surgery+Water. Nerve growth factor (NGF) immunoexpression in the Schwann cell was significantly increased in the Surgery+TMZ group compared with the Surgery+Water group. Moreover, fibrosis score was reduced in the Surgery+TMZ group compared to the Surgery+Water group.CONCLUSIONS: In conclusion, we demonstrated the superiority of TMZ on nerve healing in our experimental study which was evaluated with comparative groups (Tab. 3, Fig. 2, Ref. 31).
Assuntos
Regeneração Nervosa/efeitos dos fármacos , Traumatismos dos Nervos Periféricos/tratamento farmacológico , Nervo Isquiático/lesões , Trimetazidina/farmacologia , Animais , Masculino , Ratos , Ratos Sprague-DawleyRESUMO
BACKGROUND AND AIMS: Radiation colitis typically emerges during radiotherapy of intra-abdominal malignancies. While the underlying mechanism remains unclear, it is considered that free oxygen radicals act like cellular mediators to cause colonic damage. Apocynin (APO) prevents oxidative stress and apoptotic cell death by inhibiting NADPH oxidase, and preventing the formation of free oxygen radicals. The aim of the present study was to investigate the protective effect of APO, a strong antioxidant and antiinflammatory agent, on radiation induced colonic oxidative damage in rats. MATERIALS AND METHODS: Rats were randomly divided into four groups (n = 8/group). Group I (control group); Group II (Group RAD) received a single dose of 800 cGy ionizing radiation to the whole abdomen with a linear accelerator (LINAC); Group III (Group APO) received a single dose of 20 mg/kg of APO intraperitoneally for five days; Group IV (Group APO+RAD) received APO for five days before radiation exposure (similar to Group III), (similar to Group II). RESULTS: APO treatment prior to radiation led to protection in the biochemical and histopathological parameters. CONCLUSIONS: Our study shows that APO treatment before radiation improves radiation induced colonic injury in rats, by decreasing oxidative stress and apoptosis.
Assuntos
Acetofenonas/farmacologia , Colite/prevenção & controle , Lesões Experimentais por Radiação/prevenção & controle , Protetores contra Radiação/farmacologia , Animais , Antioxidantes/farmacologia , Apoptose/efeitos dos fármacos , Apoptose/efeitos da radiação , Colite/etiologia , Feminino , Intestinos/efeitos dos fármacos , Intestinos/efeitos da radiação , Estresse Oxidativo/efeitos dos fármacos , Estresse Oxidativo/efeitos da radiação , Ratos , Ratos WistarRESUMO
OBJECTIVE: Diagnosing benign vs. malignant extrahepatic cholestasis is challenging despite the currently available advanced imaging and endoscopic techniques. This study aims to determine the predictive accuracy of initial biochemical data and bile duct dilatation findings in transabdominal ultrasound (US) to differentiate between benign and malignant disease in patients with extrahepatic cholestasis. PATIENTS AND METHODS: We reviewed the case records of 814 patients who had undergone endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (in cases of unsuccessful ERCP) for extrahepatic cholestasis. The etiology of biliary obstruction was determined based on ERCP, endoscopic ultrasonography, radiology, cytology, biopsy, and/or clinical follow-up at one year. The patients were divided into benign and malignant groups according to the underlying etiology of biliary obstruction. A complete biochemical profile, transabdominal ultrasonography at presentation, and other demographic data were recorded. RESULTS: Alkaline phosphatase (p = 0.002), aspartate aminotransferase (p = 0.038), and bilirubin levels were significantly higher in malignant patients. The mean age of patients with malignancy was 69.5 years, vs. 60.6 years in benign patients (p < 0.001). The likelihood of malignancy increased with the increased bilirubin levels (> 200 µmol/l: 30.0% sensitivity, 97.6% specificity). The total bilirubin level predicting malignancy as the best cut-off value was 111 mmol/L with optimum sensitivity and specificity (61.8% and 83.8%, respectively) and area under the curve = 0.756, (p < 0.001). Intrahepatic bile duct (IHBD) dilatation was significantly higher in malignant patients (p < 0.001). CONCLUSIONS: A serum bilirubin level of 111 µmol/L or higher and the detection of IHBD dilatation on abdominal ultrasonography are important predictors in the differential diagnosis of benign and malignant causes of extrahepatic cholestasis.
Assuntos
Colestase Extra-Hepática , Colestase , Neoplasias , Idoso , Humanos , Bilirrubina/análise , Colangiopancreatografia Retrógrada Endoscópica , Colestase/diagnóstico por imagem , Colestase/etiologia , Colestase Extra-Hepática/diagnóstico , Colestase Extra-Hepática/etiologia , Diagnóstico Diferencial , Neoplasias/complicações , Neoplasias/diagnóstico , Neoplasias/patologia , Estudos Retrospectivos , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The aim of this study was to evaluate the neuroprotective efficacy of trimetazidine (TMZ) in a diabetic neuropathy model of the sciatic nerve. MATERIALS AND METHODS: We performed intraperitoneal (IP) single-dose streptozotocin (STZ) injection for a diabetes mellitus neuropathy model in 24 rats; 8 rats were in the control group, and no chemical administration was performed. 24 diabetic rats were randomly divided into 3 groups: Group 1 rats (n = 8; diabetes and saline groups) were given 1 ml/kg saline treatment. Diabetes and trimetazidine (TMZ)-treated rats (n = 8) were given TMZ 10 mg/kg/day i.p. in Group 2. Group 3 rats were given TMZ 20 mg/kg/day by i.p. for 4 weeks. At the end of the study, EMG and inclined plane testing were used, and blood samples were taken. RESULTS: Amplitudes of CMAP increased significantly in the TMZ treatment group when compared with the group that had been given saline treatment. The latency of CMAP was significantly shortened in the TMZ treatment group as compared to the saline treatment group. When compared to the saline treatment group, 10 mg/kg and 20 mg/kg TMZ treatment significantly reduced HMGB1, Pentraxin-3, TGF-beta, and MDA levels. CONCLUSIONS: We demonstrated the neuroprotective effect of TMZ on diabetic polyneuropathy in rats via modulation of soluble HMGB1.
Assuntos
Diabetes Mellitus Experimental , Neuropatias Diabéticas , Proteína HMGB1 , Trimetazidina , Ratos , Animais , Trimetazidina/farmacologia , Trimetazidina/uso terapêutico , Ratos Sprague-Dawley , Neuropatias Diabéticas/tratamento farmacológico , Diabetes Mellitus Experimental/tratamento farmacológicoRESUMO
The aim of this research was to determine the anti-inflammatory effect of betaine on sepsis-induced acute respiratory distress syndrome (ARDS) in rats through histopathological examination, radiologic imaging, and biochemical analysis. Eight rats were included in the control group, and no procedure was performed. Feces intraperitoneal procedure (FIP) was performed on 24 rats to create a sepsis-induced ARDS model. These rats were separated into three groups as follows: FIP alone (sepsis group, n=8), FIP + saline (1 mL/kg, placebo group, n=8), and FIP + betaine (500 mg/kg, n=8). Computed tomography (CT) was performed after FIP, and the Hounsfield units (HU) value of the lungs was measured. The plasma levels of tumor necrosis factor (TNF)-α, interleukin-1ß (IL-1ß), IL-6, C-reactive protein, malondialdehyde (MDA), and lactic acid (LA) were determined, and arterial oxygen pressure (PaO2) and arterial CO2 pressure (PaCO2) were measured from an arterial blood sample. Histopathology was used to evaluate lung damage. This study completed all histopathological and biochemical evaluations in 3 months. All evaluated biomarkers were decreased in the FIP + betaine group compared to FIP + saline and FIP alone (all P<0.05). Also, the parenchymal density of the rat lung on CT and histopathological scores were increased in FIP + saline and FIP alone compared to control and these findings were reversed by betaine treatment (all P<0.05). Our study demonstrated that betaine suppressed the inflammation and ameliorated acute lung injury in a rat model of sepsis.
Assuntos
Lesão Pulmonar Aguda , Lesão Pulmonar , Síndrome do Desconforto Respiratório , Sepse , Ratos , Animais , Antioxidantes/uso terapêutico , Betaína/uso terapêutico , Ratos Sprague-Dawley , Lesão Pulmonar Aguda/tratamento farmacológico , Lesão Pulmonar Aguda/etiologia , Lesão Pulmonar Aguda/prevenção & controle , Pulmão/patologia , Anti-Inflamatórios/uso terapêutico , Síndrome do Desconforto Respiratório/tratamento farmacológico , Síndrome do Desconforto Respiratório/patologia , Fator de Necrose Tumoral alfa , Sepse/complicações , Sepse/tratamento farmacológico , Tomografia Computadorizada por Raios X , Lesão Pulmonar/patologiaRESUMO
OBJECTIVE: This study aims to investigate potential differences in the presence of Transforming Growth Factor-Beta 1 (TGF-ß1) between the vein walls of patients with varicocele and those of healthy individuals. PATIENTS AND METHODS: The study comprised a total of 40 participants, divided into two groups. The control group (Group 1) consisted of 20 patients who underwent coronary bypass surgery, while the varicocele group (Group 2) included 20 patients scheduled for varicocelectomy. The cytoplasmic and nuclear staining patterns of TGF-ß1 immunohistochemistry were assessed in tissue samples under light microscopy, identifying any differences in TGF-ß1 presence between varicocele patient vein walls and normal (saphenous) veins. RESULTS: The varicocele group demonstrated lower nuclear and cytoplasmic TGF-ß1 staining rates compared to the control group. After controlling for the independent factor of age, significantly lower nuclear and cytoplasmic staining was still observed in the varicocele group. CONCLUSIONS: This study is the first of its kind to compare TGF-ß1 staining in the vein walls of varicocele patients and healthy individuals. Previous studies focusing on varicose veins reported elevated TGF-ß1 expression. Contrarily, our study observed lower TGF-ß1 expression in varicocele patient veins, marking a unique contribution to the field.
Assuntos
Varicocele , Varizes , Humanos , Masculino , Veia Safena , Fator de Crescimento Transformador beta/metabolismo , Fator de Crescimento Transformador beta1/metabolismo , Varicocele/cirurgia , Varicocele/metabolismo , Varizes/cirurgia , Procedimentos Cirúrgicos VascularesRESUMO
Children with congenital anomalies such as Goldenhar syndrome affecting the airway can be a problem for the anaesthesiologist. We present the case of an 18 month-old child with Goldenhar syndrome, in whom the ProSeal Laryngeal Mask Airway was successfully used for inguinal hernia surgery.
Assuntos
Manuseio das Vias Aéreas/instrumentação , Anestesia Geral/instrumentação , Síndrome de Goldenhar/complicações , Hérnia Inguinal/cirurgia , Máscaras Laríngeas , Desenho de Equipamento , Hérnia Inguinal/complicações , Humanos , Lactente , MasculinoRESUMO
BACKGROUND: Neuroaxial blockade for ambulatory transurethral resection of the prostate is a well established technique. Patients in this group are often at high risk for perioperative complications from concurrent diseases. The purpose of this study was to compare the elderly patients who received intrathecal fentanyl alone or intrathecal fentanyl plus bupivacaine or epidural anesthesia for transurethral resection of prostate surgery. MATERIAL AND METHODS: Ninety-nine patients were prospectively randomized to receive fentanyl 25 microg (Group F), fentanyl 25 microg plus hyperbaric bupivacaine 2.5 mg (Group BF), or epidural anesthesia adding fentanyl 50 microg (Group E) by combined spinal epidural anesthesia technique. RESULTS: The amount of local anesthetics used until when the sensorial block reached the level of T10 was significantly lower in the Group BF than in the Group E and the Group F (p < 0.001). Maximum level of sensory block was significantly lower in the Group BF than in the Group E and the Group F (p = 0.01). The time elapsed until the sensory block reached T10, the regression of sensory block to L5 level were significantly lower in the Group BF than in the Group E and the Group F (p = 0.005, p < 0.001, respectively). Compared to the basal values, mean arterial pressures were significantly lower in the Group BF than in the Group E and the Group F (p < 0.05). The occurrence of hypotension was significantly lower in the Group BF (9.4%) than in the Group E (18.2%) and the Group F (24.2%). CONCLUSIONS: Intrathecal hyperbaric bupivacaine 2.5 mg plus fentanyl 25 microg administration provides shorter motor block onset time, less local anesthetic usage and adequate hemodynamic stability in elderly patients.
Assuntos
Anestesia Epidural/métodos , Raquianestesia/métodos , Anestésicos Intravenosos/administração & dosagem , Fentanila/administração & dosagem , Hemodinâmica/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Anestésicos Intravenosos/efeitos adversos , Anestésicos Locais , Pressão Sanguínea/efeitos dos fármacos , Estatura/fisiologia , Peso Corporal/fisiologia , Bupivacaína , Fentanila/efeitos adversos , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Náusea e Vômito Pós-Operatórios/epidemiologia , Ressecção Transuretral da PróstataRESUMO
Despite the various and newly developed chemotherapeutic agents in recent years, cisplatin is still used very frequently as a chemotherapeutic agent, even though cisplatin has toxic effects on many organs. The aim of our study is to show whether ghrelin reduces the liver toxicity of cisplatin in the rat model. Twenty-eight male Sprague Dawley albino mature rats were chosen to be utilized in the study. Group 1 rats (n = 7) were taken as the control group, and no medication was given to them. Group 2 rats (n = 7) received 5 mg/kg/day cisplatin and 1 ml/kg/day of 0.9% NaCl, Group 3 rats (n = 7) received 5 mg/kg/day cisplatin and 10 ng/kg/day ghrelin, Group 4 rats (n = 7) received 5 mg/kg/day cisplatin and 20 ng/kg/day ghrelin for 3 days. Glutathione, malondialdehyde (MDA), superoxide dismutase (SOD), plasma alanine aminotransferase (ALT) levels, and liver biopsy results were measured in rats. It was determined that, especially in the high-dose group, the MDA, plasma ALT, and SOD levels increased less in the ghrelin group as compared to the cisplatin group, and the glutathione level decreased slightly with a low dose of ghrelin, while it increased with a higher dose. In histopathological examination, it was determined that the toxic effect of cisplatin on the liver was reduced with a low dose of ghrelin, and its histopathological appearance was similar to normal liver tissue when given a high dose of ghrelin. These findings show that ghrelin, especially in high doses, can be used to reduce the toxic effect of cisplatin.
Assuntos
Antineoplásicos/toxicidade , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Cisplatino/toxicidade , Grelina/uso terapêutico , Substâncias Protetoras/uso terapêutico , Alanina Transaminase/sangue , Animais , Doença Hepática Induzida por Substâncias e Drogas/sangue , Doença Hepática Induzida por Substâncias e Drogas/metabolismo , Doença Hepática Induzida por Substâncias e Drogas/patologia , Grelina/farmacologia , Glutationa/metabolismo , Fígado/efeitos dos fármacos , Fígado/metabolismo , Fígado/patologia , Masculino , Malondialdeído/metabolismo , Substâncias Protetoras/farmacologia , Ratos Sprague-Dawley , Superóxido Dismutase/metabolismoRESUMO
Methotrexate (MTX) is widely used for treating cancers and inflammatory diseases; it is a potential anti-metabolite and folate antagonist. We investigated potential protective effects of benfotiamine on MTX damage. We used a rat model of MTX induced gastric injury to assess changes in gastric histopathology, oxidative stress and visfatin levels due to MTX treatment. Rats were divided into four groups: an untreated control group, an MTX group treated with a single dose of MTX, a benfotiamine group treated with benfotiamine daily for two weeks, and a benfotiamine + MTX group treated with a single dose of MTX followed by benfotiamine daily for two weeks. Total tissue antioxidant status (TAS), total oxidant status (TOS) and visfatin levels were measured at the end of the experiment. At the end of the experiment, we investigated both visfatin expression and the histopathology of gastric tissues. The mean visfatin level was lower in the MTX group than in the benfotiamine group. The mean tissue TOS levels were higher in MTX group than in the control, benfotiamine or benfotiamine + MTX groups. Significant gastric gland dilation, and erosion and loss of mucosa were found on the gastric surface in the MTX group compared to the control group. The dilation, erosion and mucosal loss were decreased significantly in the benfotiamine + MTX group compared to the MTX group. Compared to the control group, visfatin immunoreactivity was reduced significantly in the MTX group. Decreased visfatin levels appear to play a role in the mechanism of gastric damage. Benfotiamine may be useful for preventing MTX induced gastric injuries.
Assuntos
Antioxidantes , Metotrexato , Animais , Antioxidantes/farmacologia , Metotrexato/toxicidade , Estresse Oxidativo , Ratos , Ratos Wistar , Tiamina/análogos & derivadosRESUMO
BACKGROUND AND AIM: Intestinal barrier dysfunction has been implicated in the development of infectious complications of acute pancreatitis. Nucleotide-Binding Oligomerization DomainContaining Protein 2 (NOD2) plays an important role in the proper functioning of intestinal defense mechanisms. Here, we investigated the frequency of NOD2 variants in patients with mild and severe acute pancreatitis. MATERIALS AND METHODS: Groups 1, 2 and 3 comprised healthy participants and patients with mild and severe pancreatitis, respectively. Four NOD2 variants and serum interleukin-6 (IL-6), Tumor Necrosis Factor-a (TNF-a) and lipopolysaccharide-binding protein (LBP) levels were analyzed. RESULTS: Three patients (3/32, 9.4%) in the severe pancreatitis group were positive for the p.R702W variant. This variant was negative in other groups. One, three and three patients in the healthy (1/27, 3.7%), mild (3/36, 8.3%) and severe pancreatitis (3/32, 9.4%) groups tested positive for the 1007fs variant, respectively. No significant differences in the frequencies of NOD2 variants were evident among the groups. Serum IL-6, TNF-a and LBP levels were markedly higher in the severe pancreatitis than the healthy and mild pancreatitis groups (all p<0.001). We observed no significant correlation between cytokine levels and NOD2 variants. CONCLUSION: Our results support an association between the presence of the p.R702W variant and severe pancreatitis.
Assuntos
Proteínas de Transporte/sangue , Interleucina-6/sangue , Glicoproteínas de Membrana/sangue , Proteína Adaptadora de Sinalização NOD2/metabolismo , Pancreatite/sangue , Fator de Necrose Tumoral alfa/sangue , Doença Aguda , Proteínas de Fase Aguda/metabolismo , Proteínas de Transporte/metabolismo , Estudos de Casos e Controles , Voluntários Saudáveis , Humanos , Interleucina-6/metabolismo , Intestinos , Glicoproteínas de Membrana/metabolismo , Nucleotídeos , Pancreatite/diagnóstico , Índice de Gravidade de Doença , Fator de Necrose Tumoral alfa/metabolismoRESUMO
BACKGROUND AND AIM: Biliary complications are an important cause of mortality and morbidity after living donor liver transplantation (LDLT). We present our endoscopic treatment results after LDLT as a single center with high volume. METHODS: Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) after LDLT between 2005 and 2015 were included. Clinical data included patient demographics, ERCP indications (stricture or leak), and treatment outcomes, including need for percutaneous and surgical interventions. RESULTS: ERCP was performed in 446 (39.2%) patients with duct-to-duct anastomosis of 1136 LDLT patients. The most common biliary complication was stricture ± stone (70.6%, 315/446). Stricture and leak occurred in 60 (13.4%) patients. Only biliary leak was found in 40 (8.9%) patients. Our endoscopic treatment success rate in patients with biliary stricture after LDLT was 65.1%. Overall endoscopic success rates in our patients were 55.0% in patients with both leak and stricture, and only leak. In all, our percutaneous transhepatic biliary interventions (PTBI) and ERCP success rate was 90.6% in patients with biliary complications after LDLT. CONCLUSIONS: Endoscopic treatments are highly effective for biliary complications after LDLT. Effective use of percutaneous interventions in collaboration with endoscopic treatments significantly reduces the need for surgical treatment.
Assuntos
Doenças Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Transplante de Fígado/métodos , Doadores Vivos , Complicações Pós-Operatórias/cirurgia , Anastomose Cirúrgica , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , TurquiaRESUMO
Alpha 1 antitrypsin (AAT) deficiency is a hereditary disorder leading to severe lung and liver diseases worldwide. An accumulation of insoluble heterodimer AAT molecules in hepatocytes is the main cause of liver disorders. The most commonly detected allele worldwide is the PIMM allele, which fulfills the AAT function. The most common missing variant is PiZZ. Serum AAT level is a beneficial but not a reliable determinant for diagnosis. Liver biopsy yields more reliable results. AAT deficiency has no specific treatment. The only treatment modality in children with end stage liver disease is the hepatic transplant. We wanted to present in our article four cases from same family, diagnosed alpha-1 antitrypsindeficiency in adulthood.
Assuntos
Fígado/patologia , Deficiência de alfa 1-Antitripsina/diagnóstico , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Tomografia Computadorizada por Raios XRESUMO
Free iron leads to the formation of pro-oxidant reactive oxygen species (ROS). Humic acids (HAs) enhance permeability of cellular wall and act as a chelator through electron transferring. This study was designed to test chelator effect of HA on iron as well as its anti-oxidant effect against the iron-induced hepatotoxicity and cardiotoxicity. The rats used were randomly divided into four groups (n = 8/group): group I (the control group); group II (the HA group), humic acid (562 mg/kg) was given over 10 days by oral gavage; group III (the iron group), iron III hydroxide polymaltose (250 mg/kg) was given over 10 days by intraperitoneal route; and group IV (the HA plus iron group), received the iron (similar to group II) plus humic acid (similar to those in groups II and III) group. Blood and two tissue samples both from liver and heart were obtained for biochemical and histopathological evaluations. Iron deposition, the iron-induced hepatotoxicity, and cardiotoxicity were demonstrated by histopathological and biochemical manner. However, no significant differences were observed in the serum biochemical values and the histopathological results among the iron and the HA plus iron groups in the liver tissue but not in the heart tissue. The protective effects of humic acid against iron-induced cardiotoxicity were shown but not against hepatotoxicity in our study.
Assuntos
Antioxidantes/farmacologia , Quelantes/farmacologia , Coração/efeitos dos fármacos , Substâncias Húmicas , Ferro/metabolismo , Fígado/efeitos dos fármacos , Administração Oral , Animais , Antioxidantes/administração & dosagem , Quelantes/administração & dosagem , Feminino , Compostos Férricos/administração & dosagem , Compostos Férricos/sangue , Compostos Férricos/toxicidade , Injeções Intraperitoneais , Fígado/metabolismo , Fígado/patologia , Ratos , Ratos Wistar , Espécies Reativas de Oxigênio/metabolismoRESUMO
BACKGROUND AND AIMS: Percutaneous endoscopic gastrostomy (PEG) is insertion of a tube to stomach through abdominal wall for provision of nutrition in patients who couldn't be fed by oral route. In the present study, it was aimed to evaluate PEG procedures performed in our facility regarding indication, complication and effectiveness and to determine whether these characteristics have a relationship with advancing age. MATERIAL AND METHODS: In this descriptive study, we reviewed clinical and endoscopic records of 300 patients who underwent PEG procedure between May 2009 and December 2011. The patients were divided into 2 groups(group 1 > 75, group 2 < 75 years). All patients were retrospectively reviewed regarding demographic data, indications, biochemical parameters (Hemoglobin, total protein and albumin) at baseline and 3 months after procedure, complications and mortality. RESULTS: The most common indication for PEG was neurological (67.3%). Wound infection (6.0%) was most common early complication while tube occlusion (4.7%) was most common late complication. No significant difference was detected between groups regarding morbidity and mortality (p < 0.05). It was seen that there were significant improvement in all biochemical parameters (p < 0.001). The most significant improvement was observed in total protein values (p < 0.05). However, no significant difference was detected in individual parameters (p > 0.05). CONCLUSIONS: PEG should be preferred at early period in patients who couldn't be fed by oral route for prolonged time as it is a minimally invasive, simple, inexpensive, highly effective, physiologic and safe. PEG was found to have no relationship with advancing age regarding indications, morbidity, mortality rate and effectiveness.
RESUMO
3,4-methylenedioxymethamphetamine (MDMA), an amphetamine derivative known as ecstasy, has stimulating and hallucinogenic properties. It has become a substance that is widely used especially by young people. Hepatotoxicity is one of the rare side effects of this substance and can be fatal. Ecstasy-induced fulminant hepatitis has been reported in case reports. The clinical course and the prognosis of the cases may differ. In this article, two cases in whom ecstasy-induced fulminant hepatic failure had developed and who were treated with liver transplantation, and one case which recovered with treatment, have been presented.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Alucinógenos/efeitos adversos , Falência Hepática Aguda/induzido quimicamente , N-Metil-3,4-Metilenodioxianfetamina/efeitos adversos , Adolescente , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Doença Hepática Induzida por Substâncias e Drogas/sangue , Doença Hepática Induzida por Substâncias e Drogas/patologia , Evolução Fatal , Humanos , Coeficiente Internacional Normatizado , Fígado/patologia , Falência Hepática Aguda/sangue , Falência Hepática Aguda/patologia , Masculino , Albumina Sérica , Adulto JovemRESUMO
BACKGROUND: The safety of healthy volunteer donors is one of the most important issues in living-donor liver transplantation. Use of the Pringle maneuver during donor hepatectomy can result in liver ischemia-reperfusion (IR) injury. The objective of this study was to examine the effects of isoflurane and propofol on IR injury caused by the Pringle maneuver during donor hepatectomy. METHODS: A total of 70 American Society of Anesthesiology I-II donors aged 18-65 years who underwent hepatectomy were included in the study. The patients were randomly divided into 2 groups: propofol and isoflurane. Plasma superoxide dismutase (SOD), malondialdehyde (MDA), total oxidative status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI) were measured before surgery (t0) and after surgery (t1). RESULTS: There were no statistically significant differences in demographic features, anesthesia, and times of surgery between the groups (P > .05). Plasma TAC levels at t0 and t1 were significantly lower in the propofol group than in the isoflurane group (P < .05). OSI at t1 was significantly higher in the propofol group than in the isoflurane group (P < .05). MDA levels were significantly higher in the propofol group than in the isoflurane group at t0 (P < .05). MDA levels level were significantly higher in the isoflurane group than in the propofol group at t1 (P < .05). CONCLUSIONS: Propofol may have protective effects against IR injury caused by the Pringle maneuver during donor hepatectomy in living-donor transplantations. However, the effectiveness of propofol for clinical use needs to be investigated further.