Modified Chevrel technique for abdominal closure in critically ill patients with abdominal hypertension and limited options for closure.

Abdominal compartment syndrome is a potentially life-threatening condition seen in critically ill patients, and most often caused by acute pancreatitis, postoperative abdominal vascular thrombosis or mesenteric ischemia. A decompressive laparotomy is sometimes required, often resulting in hernias, and subsequent definitive wall closure is challenging. AIM: This study aims to describe short term results after a modified Chevrel technique for midline laparotomies in patients witch abdominal hypertension. MATERIALS AND METHODS: We performed a modified Chevrel as an abdominal closure technique in 9 patients between January 2016 and January 2022. All patients presented varying degrees of abdominal hypertension. RESULTS: Nine patients were treated with new technique (6 male and 3 female), all of whom had conditions that precluded unfolding the contralateral side as a means for closure. The reasons for this were diverse, including presence of ileostomies, intraabdominal drainages, Kher tubes or an inverted T scar from previous transplant. The use of mesh was initially dismissed in 8 of the patients (88,9%) because they required subsequent abdominal surgeries or active infection. None of the patients developed a hernia, although two died 6 months after the procedure. Only one patient developed bulging. A decrease in intrabdominal pressure was achieved in all patients. CONCLUSION: The modified Chevrel technique can be used as a closure option for midline laparotomies in cases where the entire abdominal wall cannot be used.

Use of Nonvascularized Fascia in Liver Transplantation.

Abdominal wall transplant is developed in the context of intestinal and multivisceral transplant, in which it is often impossible to perform a primary wall closure. Despite the fact that abdominal wall closure is not as consequential in liver transplant, there are circumstances in which it might determine the success of the liver graft, especially in situations that compromise the abdominal cavity and facilitate an abdominal compartment syndrome. CASE 1: A 14-year-old girl suffering from cryptogenic cirrhosis with severe portal hypertension that causes ascites and severe malnutrition. Uneventful liver transplant, with a graft procured from a 14-year-old donor. At the time of wall closure it was decided to implant a nonvascularized fascia graft to supplement the right side of the transverse incision, with a 17 x 7 cm defect. This required reintervention after 4 months for biliary stricture. At that point, the wall graft was almost completely integrated into the native tissue. CASE 2: A 63-year-old man, transplanted for hepatitis C virus+ hepatocellular carcinoma+ nonocclusive portal thrombosis. Thirty-six hours after transplant the patient developed portal thrombosis. Thrombectomy and closure with biological mesh were performed. After 24 hours he was reoperated on for abdominal compartment syndrome and temporary closure with a Bogotá bag. Six days later he underwent omentectomy, intestinal decompression, and left components separation, identifying a 25 x 20 cm defect. For definitive closure, a nonvascularized fascia graft procured from a different donor was used, accomplishing a reduction in intra-abdominal pressure. Nonvascularized fascia transplantation is an interesting alternative in liver transplant recipients with abdominal wall closure difficulties.

Morbidly Obese Patients Awaiting Liver Transplantation-Sleeve Gastrectomy: Safety and Efficacy From a Liver Transplant Unit Experience.

BACKGROUND: The prevalence of obesity has increased dramatically, even in the population awaiting a liver transplantation. Despite their associated complications, we cannot consider morbid obesity any longer as an absolute contraindication to liver transplantation. Dietary approaches alone are usually completely ineffective. Bariatric surgery is the gold-standard treatment for morbid obesity and can be performed before, during, or after transplantation. MATERIALS AND METHODS: At our Liver Transplantation Unit, a single surgeon performed a sleeve gastrectomy in 8 patients with liver cirrhosis due to nonalcoholic steatohepatitis, alcohol, or HCV. The Child score was A in 6 patients and B in the remaining 2 patients. Two of our patients had portal hypertension with mild esophageal varices. The procedure was performed laparoscopically in 7 cases (87.5%); in the other case, it was performed by open approach due to portal hypertension and according to patient preferences. RESULTS: Patients showed no postoperative morbidity or mortality. The mean postoperative body mass index of our patients was 37.4, 33.3, and 30.3 kg/m2 at 3, 6, and 12 months after surgery, respectively. The mean percentage excess weight loss of our patients was 42.9%, 62.2%, and 76.3% at 3, 6, and 12 months. Two of the patients have already undergone a successful liver transplant. CONCLUSION: Bariatric surgery in selected patients with compensated cirrhosis and without significative portal hypertension is reasonable. There are not clear guidelines on the use of bariatric surgery in patients with cirrhosis. In our experience, the sleeve gastrectomy is safe and effective in the treatment of patients with compensated cirrhosis; in a short time, the sleeve gastrectomy can improve candidacy in morbidly obese patients awaiting transplantation.

Everolimus monotherapy or combined therapy in liver transplantation: indications and results.

INTRODUCTION: Everolimus is a potent immunosuppressant with several advantages over calcineurin inhibitors, such as good tolerance, preventive effects on cardiovascular morbidity, and mortality and cancer prevention as it inhibits cell proliferation. PATIENTS AND METHODS: Between April 1986 and December 2010, we performed 1500 liver transplants (OLT) in 1341 recipients, including 57 patients who were prescribed everolimus 24 (42.1%) as monotherapy and 33 (57.9%) as treatments combined with other immunosuppressants. We performed a retrospective analysis of our experience with conversion to everolimus in OLT recipients. RESULTS: The 43 men and 14 women had a mean overall age at transplantation of 59.1 ± 10 years. The most frequent indication for OLT was hepatocellular carcinoma (HCC; 53.8%). Everolimus was introduced to prevent HCC recurrence (53%), development of de novo tumors (33%), address renal dysfunction (7%), or overcome side effects of other immunosuppressants (7%). We observed a significant improvement in renal function using the estimated glomerular filtration rate (Crockcroft-Gault formula) from 68.5 mL/min before to 74.5 mL/min after switching to everolimus. The 72% of recipients who developed ≥1 adverse event, most frequently showed hyperlipidemia (34.4%). CONCLUSION: Both monotherapy and combined everolimus regimens were well-tolerated immunosuppressive regimens in liver transplant recipients with recurrent or de novo malignancies. Everolimus improved renal function. The most common side effects were hyperlipidemia, edema, and mouth ulcerations, which were well controlled with anti-lipidemic agents or decreased everolimus dosages.

Split liver transplantation: where? when? how?

Donor scarcity is among the greatest concerns in the transplantation community. Dividing a liver graft theoretically offers a double benefit for candidates on the waiting list. Split liver transplantation entails a higher logistic and technical complexity that is extensively compensated, not only with an increase in the accessibility for child and adult candidates on the liver transplant waiting list, but also acceptable survival results.

Physiological variability arising from in vitro propagation of Nothofagus obliqua

As with cuttings, the microcuttings produced from in vitro generated shoots could be affected by topophysis. Very little research has been done about such in vitro effect. This paper reports the influence of the topophysis on the regeneration response (shoot multiplication, microcutting rooting and plantlet acclimation) of explants on the in vitro culture of juvenile N. obliqua trees. The results showed that the main responsible of the physiological variability arising from all the in vitro propagation stages is topophysis. This influence was found in the first culture and can be extended to the next subculture (multiplication stage). Growth of the obtained plants was also affected (rooting of microcuttings and plantlet acclimation). The multiplication rate was lower in apical portion (1:3.66) than basal portion (1:5.8) while rooting was 48.6 and 27.0 respectively. By the way, length of acclimated explants was 52.4 mm in the apical rooted explants and 28.7 mm in the basal ones at the 30th day. In order to reduce such variability, it is necessary to take into account the initial position of the explants during the establishment and multiplication stages of micropropagation of forest trees

Physiological variability arising from in vitro propagation of Nothofagus obliqua

As with cuttings, the microcuttings produced from in vitro generated shoots could be affected by topophysis. Very little research has been done about such in vitro effect. This paper reports the influence of the topophysis on the regeneration response (shoot multiplication, microcutting rooting and plantlet acclimation) of explants on the in vitro culture of juvenile N. obliqua trees. The results showed that the main responsible of the physiological variability arising from all the in vitro propagation stages is topophysis. This influence was found in the first culture and can be extended to the next subculture (multiplication stage). Growth of the obtained plants was also affected (rooting of microcuttings and plantlet acclimation). The multiplication rate was lower in apical portion (1:3.66) than basal portion (1:5.8) while rooting was 48.6 and 27.0 respectively. By the way, length of acclimated explants was 52.4 mm in the apical rooted explants and 28.7 mm in the basal ones at the 30th day. In order to reduce such variability, it is necessary to take into account the initial position of the explants during the establishment and multiplication stages of micropropagation of forest trees

Physiological variability arising from in vitro propagation of Nothofagus obliqua.

As with cuttings, the microcuttings produced from in vitro generated shoots could be affected by topophysis. Very little research has been done about such in vitro effect. This paper reports the influence of the topophysis on the regeneration response (shoot multiplication, microcutting rooting and plantlet acclimation) of explants on the in vitro culture of juvenile N. obliqua trees. The results showed that the main responsible of the physiological variability arising from all the in vitro propagation stages is topophysis. This influence was found in the first culture and can be extended to the next subculture (multiplication stage). Growth of the obtained plants was also affected (rooting of microcuttings and plantlet acclimation). The multiplication rate was lower in apical portion (1:3.66) than basal portion (1:5.8) while rooting was 48.6% and 27.0% respectively. By the way, length of acclimated explants was 52.4 mm in the apical rooted explants and 28.7 mm in the basal ones at the 30th day. In order to reduce such variability, it is necessary to take into account the initial position of the explants during the establishment and multiplication stages of micropropagation of forest trees.

[Health without boundaries and boundaries in health]. / La salud sin fronteras y las fronteras en la salud.

This paper presents a general picture of the relationship between health and borders, analyzing the particular case of Mexico. The concept of international health is discussed, and the role of the multinational organizations created to approach it -WHO, PHO, UNICEF, etcetera- is described.

Production of solasodine by calli from different parts of Solanum eleganifolium Cav. plants.

Callus tissues from different explants (hypocotyl, cotyledon, root, leaf and fruit) of Solanum eleagnifolium Cav. were cultured on a modified Murashige-Skoog medium, with 1 mg.1(-1) 2,4-D as the sole growth regulator. The presence of the alkaloid solasodine was determined by spectrophotometric and TLC methods. Its concentration ranged from 1.00 to 2.15 mg.g(-1) DW. The calli from different explants showed a direct association between the solasodine production and their growth, although they have a different production rate. It was also observed that about the seventh week of culture the metabolite concentration decreased in all cases.