Experimental Uterus Transplant in Various Models: Review of Surgical Techniques.

Uterus transplantation may become the surgical therapeutic modality of choice for uterine factor infertility. However, this procedure still faces technical, therapeutic, and immunologic challenges that limit its success and clinical application. Experimental studies are therefore still needed to address various challenges in the field of uterus transplantation. Among various laboratory animals, small animals are ideal models for the purpose of experimental uterus transplant. However, clinical success in small animal models is not generalizable to clinical application and treatment for uterine factor infertility in humans. Large animal models are necessary because their uterine anatomy and reproductive physiology closely resemble those of humans. In the literature, in general with small or large animal models, the same striking characteristic has been previous regular menstruation. Anesthesia was usually induced through inhalation and/or intraperitoneal injection in small models and intravenous injection in large models. Systemic heparinization was usually performed after preparation of uterus and vessels and before crossclamping of the vessels. Flushing of the graft was performed through the interior iliac artery or aorta. A grafted segment was frequently selected only from one horn of the uterus. The uterine artery, internal iliac artery, and aorta have been frequently used for arterial revascularization into the recipient's external iliac artery or abdominal aorta. The uterine vein, internal iliac vein, and inferior vena cava have been used for venous drainage into the recipient's inferior vena cava, external iliac vein, or uteroovarian vein. In most models, the native uterus was resected to reconstruct the grafted uterus continuity. Other models have left the native uterus in the recipient's abdomen, and stomas have been used for end of the grafted uterus.

Establishing a Porcine Model of Small for Size Syndrome following Liver Resection.

BACKGROUND: Small for size syndrome (SFSS) is responsible for a high proportion of mortalities and morbidities following extended liver resection. AIM: The aim of this study was to establish a porcine model of SFSS. METHODS: Twenty-four Landrace pigs underwent liver resection with a remnant liver volume of 50% (group A, n = 8), 25% (group B, n = 8), and 15% (group C, n = 8). After resection, the animals were followed up for 8 days and clinical, laboratory, and histopathological outcomes were evaluated. RESULTS: The survival rate was significantly lower in group C compared with the other groups (p < 0.001). The international normalized ratio, bilirubin, aspartate transaminase, alanine transaminase, and alkaline phosphatase levels increased shortly after surgery in groups B and C, but no change was observed in group A (p < 0.05 for all analyses). The histopathological findings in group A were mainly mild mitoses, in group B severe mitoses and hepatocyte ballooning, moderate congestion, and hemorrhage, along with mild necrosis, and in group C extended tissue damage with severe necrosis, hemorrhage, and congestion. CONCLUSIONS: Combination of clinical, laboratory, and histopathological evaluations is needed to confirm the diagnosis of SFSS. 75% liver resection in porcine model results in SFSS. 85% liver resection causes irreversible liver failure.

Small for Size and Flow (SFSF) syndrome: An alternative description for posthepatectomy liver failure.

Small for Size Syndrome (SFSS) syndrome is a recognizable clinical syndrome occurring in the presence of a reduced mass of liver, which is insufficient to maintain normal liver function. A definition has yet to be fully clarified, but it is a common clinical syndrome following partial liver transplantation and extended hepatectomy, which is characterized by postoperative liver dysfunction with prolonged cholestasis and coagulopathy, portal hypertension, and ascites. So far, this syndrome has been discussed with focus on the remnant size of the liver after partial liver transplantation or extended hepatectomy. However, the current viewpoints believe that the excessive flow of portal vein for the volume of the liver parenchyma leads to over-pressure, sinusoidal endothelial damages and haemorrhage. The new hypothesis declares that in both extended hepatectomy and partial liver transplantation, progression of Small for Size Syndrome is not determined only by the "size" of the liver graft or remnant, but by the hemodynamic parameters of the hepatic circulation, especially portal vein flow. Therefore, we suggest the term "Small for Size and Flow (SFSF)" for this syndrome. We believe that it is important for liver surgeons to know the pathogenesis and manifestation of this syndrome to react early enough preventing non-reversible tissue damages.

Expanding the indications of pancreas transplantation alone.

OBJECTIVES: Total pancreatectomy (TP) is associated with postoperative endocrine and exocrine insufficiency. Especially, insulin therapy reduces quality of life and may lead to long-term complications. We review the literature with regard to the potential option of pancreas transplantation alone (PTA) after TP in patients with chronic pancreatitis or benign tumors. METHODS: A MEDLINE search (1958-2013) using the terminologies pancreas transplantation, pancreas transplantation alone, total pancreatectomy, morbidity, mortality, insulin therapy, and quality of life was performed. In addition, the current book and congress publications were reviewed. RESULTS: Total pancreatectomy after benign and borderline tumors as well as chronic pancreatitis is continuously increasing. Despite improvement of exogenous insulin therapy, more than 50% of these patients experience severe glucose control problems, which cause up to 50% long-term mortality. Pancreas transplantation alone can cure both endocrine and exocrine insufficiency and reduce the associated risks. The 3-year graft and patient survival rates after PTA are up to 73% and 100%, respectively. CONCLUSIONS: Pancreas transplantation alone after TP in patients with pancreatitis or benign tumors improves the recipient's quality of life and reduces long-term mortality. Considering the amount of available organs and potential candidates, PTA can be a treatment option for patients after TP with chronic pancreatitis or benign tumors.

Relationship between junk foods intake and weight in 6-7 years old children, Shahin Shahr and Meymeh, Iran.

BACKGROUND: Healthy nutrition is very important considering the weight status especially in children. The aim of this study was to assess the relationship between junk foods intake and weight in 6-7-years old children. MATERIALS AND METHODS: This cross-sectional study was carried out in Shahin Shahr and Meymeh, Iran, in 2009. Anthropometrics measures were done and 24-hour food recall used for dietary information and analyzed with food processor 2 and then compared with dietary reference intakes 2008 (DRI). FINDINGS: 61.1 percent of the subjects were residing in dormitories and 12.7 percent were marred. Prevalence of overweight or obesity and abdominal obesity was 6.9 percent and 46.1 percent respectively. Mean (±SD) systolic blood pressure was 105.2 ± 15.6 mm/Hg and diastolic was 62.2 ± 10.4 mm/Hg. Totally, 3.9 percent of the subjects had hypertension. The analysis of food intake indicate that (B12, folate, magnesium, potassium, calcium) with level below the recommended ones, and (vitamin C, E, pantothenic acid, B1, B3, phosphate, zinc) with up levels the recommended ones, and energy intake, macronutrient, vitamin A, pyridoxine, iron, selenium were in general appropriate. CONCLUSION: These results indicated appropriate level of macronutrients intake and unbalance mainly existed in micronutrients. It is recommended to increase intake important food groups such as dairy, vegetable, fruit that include good source of micronutrients, and also it is suggested that need for strategies can improve competence in the area of nutrition.

Long-term quality of life after ileal pouch anal restorative proctocolectomy for ulcerative colitis.

Restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) has evolved as the surgical procedure of choice for ulcerative colitis (UC). The aim of our study was to evaluate the quality of life (QOL) of UC patients who underwent this procedure over 5 years ago. Thirty-nine UC patients who underwent restorative proctocolectomy with IPAA were interviewed by the validated inflammatory bowel disease questionnaire (IBDQ). Each patient was assigned a score, ranging from 32 to 224, in which the highest score indicates the best QOL. QOL for postoperative patients was good in 15 (38.5 %), regular in 23 (59 %), and bad in 1 (2.6 %) patient. QOL was not significantly influenced by age or gender of the patient. The emotional aspect received the highest score in the IBDQ and for each question that was analyzed separately; most of the patients were pleased and thankful with their lives and this question received the highest score. Long-term QOL was good in UC patients who underwent IPAA. This operation should be considered as the first choice since the patients were stable after long-term follow up.

Effects of calcium supplement therapy in women with premenstrual syndrome.

OBJECTIVE: Scientific evidence suggests that cyclic fluctuations in a variety of nutrients, especially calcium, may help to explain some features of premenstrual syndrome (PMS). We determined the efficacy of calcium supplementation in women suffering from PMS. MATERIALS AND METHODS: A double-blind clinical trial was designed to evaluate the effect of calcium supplement therapy on PMS symptoms. The study groups were selected from young female college students, based on PMS criteria. The subjects were divided in two groups; one group received placebo and the other received 500 mg of calcium carbonate twice daily for 3 months. The severity and intensity of symptoms, including early fatigability, changes in appetite, and depression, were evaluated using a standard questionnaire. Symptoms were compared before and after treatment. RESULTS: The mean age was 21.4 +/- 3.6 years. Early tiredness, appetite changes, and depressive symptoms were significantly improved in the group receiving calcium treatment compared with the placebo group. CONCLUSION: Our results showed that calcium supplements reduced early fatigability, changes in appetite, and depression in women with PMS.