Simultaneous living donor liver transplant with sleeve gastrectomy for metabolic syndrome and NASH-related ESLD-First report from India.

Nonalcoholic steatohepatitis (NASH) with morbid obesity and metabolic syndrome is now a common cause of end-stage liver disease (ESLD). These patients are high-risk candidates for liver transplant, and require bariatric surgery to prevent recurrent disease in the new liver. Data reports bariatric surgery after transplant, which maybe difficult because of adhesions between the stomach and liver in living donor liver transplant (LDLT) recipient. We report the first case of combined LDLT with sleeve gastrectomy (SG) from India. A morbidly obese diabetic woman with NASH-related ESLD was planned for combined right lobe LDLT with open SG, in view of failed diet therapy, musculo-skeletal complaints, and restricted mobility. Postoperatively, with liver graft functioning adequately, bariatric diet restrictions resulted in maximum reduction of 25% weight, achieving a target BMI below 30 kg/m2 within 2 months, along with complete cure of diabetes and better ambulation. Thus, combination of LDLT and bariatric surgery in the same sitting is safe and effective in management of metabolic syndrome and associated NASH-related ESLD.

Impact of Anthocyanidins on Mitoxantrone-Induced Cytotoxicity and Genotoxicity: An In Vitro and In Vivo Analysis.

Hypothesis Anthocyanins possess well-known biological effects and suppress DNA damage induced by therapeutic topoisomerase poisons. Our study focusses on the modulatory effects of anthocyanidins-malvidin (MAL) and pelargonidin (PEL)-on topoisomerase II poison mitoxantrone (MXT)-induced cytotoxicity and genotoxicity in in vitro and in vivo conditions. Study design HepG2 cells were treated with MXT (1-10 µM), MAL (10-100 µM,) and PEL (5-640 µM) to determine cell viability. Further, experiments on cytotoxicity and apoptosis induction by single agents or combinations were performed. In vitro and in vivo antigenotoxic effect of MAL/PEL against MXT was evaluated in human lymphocytes and mouse bone marrow cells. Methods Cytotoxicity of test agents and apoptosis induction in HepG2 cells was assessed by MTT assay, trypan blue dye exclusion assay and Hoechst 33258 staining. Antigenotoxic effects of MAL/PEL against MXT were assessed in co-treated human lymphocytes and bone marrow from mice that received MXT intraperitoneally 30 minutes post MAL/PEL oral administration Results Dose-dependent cytotoxicity was observed with all 3 test agents in HepG2 cells. Highest test concentration of 100 µM MAL, 640 µM PEL, and 10 µM MXT decreased HepG2 cell viability by 80%, 30%, and 90%, respectively. The combination of 1 µM MXT + 80 µM MAL reduced cell viability better than single agents. MAL/PEL treatment significantly reduced MXT-induced genotoxicity in human lymphocytes and micronuclei formation in mice. Conclusion Combination of MAL/PEL with lower doses of MXT, especially MAL+MXT increases the cytotoxicity in cancer cells. In addition, MXT treatment with MAL/PEL reduced MXT-induced genotoxicity and protected normal cells during chemotherapy.

Congenital internal jugular vein aneurysm in an infant: A rare entity.

A 1-month old baby boy presented with a mass at the root of the neck. On investigation, a saccular aneurysm arising from the internal jugular vein was diagnosed. The aneurysm was excised after ligating the patent internal jugular vein above and below the origin of the aneurysm. Histopathology confirmed the diagnosis of a vascular malformation. Vascular malformation of the internal jugular vein, presenting as neck mass, is extremely rare with no case described in neonates. We present one such interesting case.

Antigenotoxic effects of resveratrol: assessment of in vitro and in vivo response.

Experiments were performed to evaluate the in vitro and in vivo dose response for antigenotoxic effects of resveratrol (RES). For the in vitro study, HL-60 cells were co-treated with the test genotoxin and three concentrations of RES. Thereafter, genotoxic effects were assessed in the cytokinesis-block micronucleus test. Results of the in vitro experiments using genotoxins nitroquinoline-1-oxide (NQO) and mitomycin C (MMC) showed maximum inhibition of genotoxicity with the lowest test concentration of RES. The mouse bone marrow micronucleus assay was used for evaluating the in vivo antigenotoxic effects of RES against genotoxins diepoxybutane (DEB), MMC, methyl methanesulfonate and procarbazine (PCB). The experimental animals received RES pre-treatment by gavage 30min, 24 and 48h before injecting the genotoxin intraperitoneally. The in vivo studies demonstrated efficacy of the lowest test dose of RES for exerting maximum protection against chromosomal damage induced by all four genotoxins. The antigenotoxic effect observed with 6.25mg/kg RES was significantly higher than that of 100mg/kg RES against PCB and DEB. In conclusion, the findings from the present study indicate that lower test concentrations/doses of RES are more effective in exerting antigenotoxic effects.

Protective effects of common anthocyanidins against genotoxic damage induced by chemotherapeutic drugs in mice.

Experiments were performed to assess in mice the inhibitory effects of the anthocyanidins cyanidin, delphinidin, malvidin, and pelargonidin on genotoxic damage induced by the anticancer drugs cyclophosphamide, procarbazine, and cisplatin. Each anthocyanidin was administered 30 min before injecting the drug, and genotoxicity was assessed by measuring micronucleated polychromatic erythrocytes in bone marrow cells. In addition, we monitored the effect of anthocyanidins on apoptosis induced by cyclophosphamide and procarbazine. The results showed significant protective effects of cyanidin, delphinidin, malvidin, and pelargonidin against DNA damage induced by cyclophosphamide. With delphinidin and malvidin, a biphasic dose-response was observed for protection against cyclophosphamide. Dose-related reduction of genotoxicity was observed with pelargonidin against procarbazine. However with cyanidin, the medium dose of 2 mg/kg showed maximum protection against procarbazine. Cyanidin and pelargonidin significantly reduced the chromosomal damage induced by cisplatin. Furthermore, pre-treatment with these anthocyanidins reduced the level of apoptosis induced by cyclophosphamide and procarbazine. In conclusion, this study shows that anthocyanidins can reduce the efficacy of anticancer drugs for inducing DNA damage and apoptosis.

Laparoscopic extraction of fractured Kirschner wire from the pelvis.

Kirschner wire is a sharp stainless steel guide wire commonly used in fixation of fractured bone segments. There are case reports of migrated K wire from the upper limb into the spine and chest, and from the lower limb in to the abdomen and pelvis. Here, we present a case report of accidental intra-operative fracture of K wire during percutaneous femoral nailing for sub-trochanteric fracture of right femur, which migrated in to the pelvis when the orthopaedician tried to retrieve the broken segment of the K wire. This case highlights the use of laparoscopy as minimally invasive surgical option.

Intake of anthocyanidins pelargonidin and cyanidin reduces genotoxic stress in mice induced by diepoxybutane, urethane and endogenous nitrosation.

Pelargonidin (PEL) and cyanidin (CYN) are among the six most abundant anthocyanidins which provide red, blue and purple colors to fruits and vegetables. Health benefits associated with intake of anthocyanins have been attributed mainly to antioxidant activity of these color pigments. The aim of our present study was to assess in mice the impact of PEL and CYN intake on genotoxic stress induced by DNA damaging environmental toxicants. These anthocyanidins were administered by gavage to mice before exposure to genotoxic carcinogens diepoxybutane (DEB) and urethane (URE). In addition, the inhibitory effect of PEL and CYN on endogenous nitrosation was evaluated by using a model nitrosation reaction mixture consisting of methyl urea (MU)+sodium nitrite (SN) which reacts in the stomach to form the carcinogenic methyl nitrosourea (MNU). All the test doses of PEL (2.5-20 mg/kg) and CYN (1-4 mg/kg) significantly reduced the genotoxicity of DEB. A dose-related increase was observed for antigenotoxicity of PEL against URE. The lowest test-dose of CYN showed maximum protection against URE. Co-administration of PEL/CYN with the nitrosation reaction mixture led to reduction in genotoxicity. CYN was more effective as an inhibitor of endogenous nitrosation. Combination of PEL with ascorbic acid (AA) enhanced the antinitrosating effect when compared to that with each phytochemical alone. The results of our present study indicate that common anthocyanidins PEL and CYN can play a major role in reducing genotoxic stress induced by environmental toxicants.

Ascorbic acid and dietary polyphenol combinations protect against genotoxic damage induced in mice by endogenous nitrosation.

We investigated whether combinations of ascorbic acid (AA) plus dietary polyphenols can protect in vivo against genotoxic damage induced by endogenous nitrosation. A nitrosation reaction mixture consisting of methylurea (MU) plus sodium nitrite (SN), which can react to form N-nitroso-N-methylurea in the stomach, was administered orally to mice, together with AA and one of the dietary polyphenols ferulic acid (FA), gallic acid (GA), chlorogenic acid (CA), or epigallocatechin gallate (EGCG). Genotoxic damage in bone marrow cells was assessed by measuring micronucleated polychromatic erythrocytes (Mn PCEs) and metaphase chromosome aberrations. When compared to damage induced by MU plus SN alone, co-administration with AA, FA, GA, CA, or EGCG resulted in significant protective effects. Combinations of AA plus EGCG or AA plus CA showed a further protective effect. Reduction in the frequency of Mn PCEs to the control level was obtained following co-administration of a combination of AA, FA, GA, and CA with MU plus SN. A similar trend was observed for metaphase chromosome aberrations. Co-administration of AA, FA, GA, or CA with N-nitroso-N-methylurea (MNU) did not show any significant reduction in genotoxicity, indicating the absence of a protective effect against a preformed N-nitroso compound. Our work demonstrates the protective effects of the 'antinitrosating' combination of AA and dietary polyphenols FA, GA, or CA against genotoxic damage induced by an endogenously formed N-nitroso compound.