α-lipoic acid reduces postreperfusion syndrome in human liver transplantation - a pilot study.

A double-blind randomized controlled trial was performed to compare the safety and efficacy of α-lipoic acid (ALA) in liver transplantation (LT). The grafts were randomized to receive ALA or placebo before the cold ischemia time. Furthermore, patients transplanted with the ALA-perfused graft received 600 mg of intravenous ALA, while patients with the nonperfused graft received the placebo just before graft reperfusion. Hepatic biopsy was performed 2 h postreperfusion. Blood samples were collected before, during and 1 and 2 days after reperfusion. Quantitative polymerase chain reaction (qPCR) analysis was performed on biopsies to assess genes involved in the response to hypoxia, apoptosis, cell growth, survival and proliferation, cytokine production and tissue damage protection. Nine of 40 patients developed postreperfusion syndrome (PRS), but seven of them belonged to the control group. There was a decrease in PHD2 and an increase in alpha subunit of hypoxia-inducible factor-1 (HIF-1α) and baculoviral IAP repeat containing 2 (Birc2) transcript levels in the biopsies from the ALA-treated versus the control group of patients. Additionally, plasma levels of alarmins were lower in ALA-treated patients than control patients, which suggests that ALA-treated grafts are less inflammatory than untreated grafts. These results showed that ALA is safe for use in LT, induces gene changes that protect against hypoxia and oxidative stress and reduces the appearance of PRS.

Peritoneal surface area: measurements of 40 structures covered by peritoneum: correlation between total peritoneal surface area and the surface calculated by formulas.

BACKGROUND: We have not found studies that have measured the peritoneal surface area of each of the walls, organs, mesos, omenta, and peritoneal ligaments in a group of non-eviscerated human cadavers. OBJECTIVES: The objectives of this study were to obtain in fixed non-eviscerated cadavers: (1) the surface values of walls, organs, mesos, omenta, and peritoneal ligaments of each one and all the areas mentioned in the anatomy bibliography and their contribution to supra- and infra-colic portions, visceral and parietal portions of the supra- and infra-colic portions and the total peritoneal surface area, and (2) the relationship between the peritoneal surface values by direct measurement and the values obtained applying the formulas usually used in clinical practice to obtain body surface area. METHODS: The peritoneal surface area of ten female human bodies presenting no abdominal pathologies were measured. They were fixed in 5% formaldehyde solution without the use of perfusion pumps and non-eviscerated, thus maintaining all structures intact. Cellophane was placed directly in situ onto all organs, mesos, omenta, ligaments and parietal walls. Digital imaging was obtained by scanning the models. A length reference was included and the surface was determined by the Scion Image program for Windows. RESULTS: This paper provides for the first time data on each one and all the areas covered by the peritoneum. The total peritoneal surface area was (mean +/- SE) 14,323.62 +/- 824.37 cm(2). The two greater surfaces of peritoneum (39.21% of the total surface) correspond to the jejunum-ileum and its mesentery. The diaphragmatic peritoneum represented the greater area of parietal peritoneum. The supracolic surface was 4,487.46 +/- 196.21 cm(2) (31.79 +/- 1.50%) and the infracolic one of 9,836.16 +/- 732.67 cm(2) (68.21 +/- 1.50%). An interesting result of this work is that the surface of the parietal peritoneum in the supracolic abdomen (1,786.67 +/- 92.58 cm(2), 68.56%) is more than twice that of the infracolic region (756.62 +/- 55.91 cm(2), 31.44%). The visceral peritoneal surface (81.89 +/- 0.99% of the total) was much higher than that of the parietal peritoneum (18.11 +/- 0.99%). This difference is 12 times bigger in the infracolic abdomen. The peritoneal surface area measured in this study in non-eviscerated cadavers represents more than 96% of the one estimated by the above-mentioned formulas. CONCLUSION: The values shown in this paper would provide non-existing information for basic anatomy, and would contribute either to the study of pathologies involving the peritoneum or to their diagnosis and therapies.