Donor bile duct evaluation with magnetic resonance cholangiography in living-donor liver transplantation: a novel anatomical classification for predicting surgical techniques.

PURPOSE: To propose a novel, inclusive classification that facilitates the selection of the appropriate donor and surgical technique in living-donor liver transplantation (LDLT). METHODS: The magnetic resonance cholangiography examinations of 201 healthy liver donors were retrospectively evaluated. The study group was classified according to the proposed classification. The findings were compared with the surgical technique used in 93 patients who underwent transplantation. The Couinaud, Huang, Karakas, Choi, and Ohkubo classifications were also applied to all cases. RESULTS: There were 118 right-lobe donors (58.7%) and 83 left-lateral-segment donors (41.3%). Fifty-six (28.8%) of the cases were classified as type 1, 136 (67.7%) as type 2, and 7 (3.5%) as type 3 in the proposed classification; all cases could be classified. The number of individuals able to become liver donors was 93. A total of 36 cases were type 1, 56 were type 2, and 1 was type 3. Of the type 1 donors, 83% required single anastomosis during transplantation, whereas six patients classified as type 1 required two anastomoses, all of which were caused by technical challenges during resection. Moreover, 51.8% of the cases classified as type 2 required additional anastomosis during transplantation. The type 3 patient required three anastomoses. The type 1 and type 2 donors required a different number of anastomoses (P < 0.001). CONCLUSION: The proposed classification in this study includes all anatomical variations. This inclusive classification accurately predicts the surgical technique for LDLT.

Pancreatic steatosis is an independent risk factor for post-transplant diabetes mellitus in kidney transplant patients.

BACKGROUND AND AIM: Post-transplant diabetes mellitus (PTDM) is associated with an increased risk of post-transplant cardiovascular diseases, and several risk factors of PTDM have been shown in the literature. Yet, the relationship between hepatic and pancreatic steatosis with post-transplant diabetes mellitus remains vague. We aimed to evaluate pancreatic steatosis, a novel component of metabolic syndrome, and hepatic steatosis association with post-transplant diabetes mellitus in a single-center retrospective cohort study conducted on kidney transplant recipients. METHOD: We have performed a single-center retrospective cohort study involving all kidney transplant recipients. We have utilized pretransplant Fibrosis-4, nonalcoholic fatty liver disease fibrosis score, and abdominal computed tomography for the assessment of visceral steatosis status. RESULTS: We have included 373 kidney transplant recipients with a mean follow-up period of 32 months in our final analysis. Post-transplant diabetes mellitus risk is associated with older age (p < .001), higher body-mass index (p < .001), nonalcoholic fatty liver disease-fibrosis score (p = .002), hepatic (p < .001) or pancreatic (p < .001) steatosis on imaging and higher pre-transplant serum triglyceride (p = .003) and glucose levels (p = .001) after multivariate analysis. CONCLUSION: Our study illustrates that recipients' pancreatic steatosis is an independent predictive factor for post-transplant diabetes mellitus including in kidney transplant patients.

Hepatocellular Carcinoma in ADA-SCID Patient After Hematopoietic Stem Cell Transplantation.

Adenosine deaminase (ADA) deficiency is one of the most prevalent forms of severe combined immunodeficiency and results in the accumulation of toxic substrates which creates a systemic metabolic disease. It predisposes patients to the development of malignancies, most commonly lymphoma. We report an 8-month-old infant with ADA deficient severe combined immunodeficiency who developed progressive liver dysfunction and hepatocellular carcinoma after successful hematopoietic stem cell transplantation. This is the first case report of an ADA-deficient patient who presented with hepatocellular carcinoma and gives an insight into the complex etiology that can lie behind liver dysfunction in these patients.

As a Rare Reason of Alveolar Consolidation, Negative Pressure Pulmonary Edema: Case Report.

In this paper we describe two cases with negative pressure pulmonary edema (NPPE). Excessive negative airway pressures against an obstructed airway has been reported to cause fluid filtration into alveoli and lung edema. The patients are generally young adults without any medical problems. The condition involves central interstitial area of both lungs and is treated by nonnvasive mechanical ventilation and corticosteroids.

Comparison of the Trendelenburg position versus upper-limb tourniquet on internal jugular vein diameter.

BACKGROUND: Central venous cannulation is a necessary invasive procedure for fluid management, haemodynamic monitoring and vasoactive drug therapy. The right internal jugular vein (RIJV) is the preferred site. Enlargement of the jugular vein area facilitates catheterization and reduces complication rates. Common methods to enlarge the RIJV cross-sectional area are the Trendelenburg position and the Valsalva maneuver. OBJECTIVE: Compare the Trendelenburg position with upper-extremity venous return blockage using the tourniquet technique. DESIGN: Prospective clinical study. SETTING: University hospital. SUBJECTS AND METHODS: Healthy adult volunteers (American Society of Anesthesiologists class I) aged 18-45 years were included in the study. The first measurement was made when the volunteers were in the supine position. The RIJV diameter and cross-sectional area were measured from the apex of the triangle formed by the clavicle and the two ends of the sternocleidomastoid muscle, which is used for the conventional approach. The second measurement was performed in a 20° Trendelenburg position. After the drainage of the veins using an Esbach bandage both arms were cuffed. The third measurement was made when tourniquets were inflated. MAIN OUTCOME MEASURE(S): Hemodynamic measurements and RIJV dimensions. RESULTS: In 65 volunteers the diameter and cross-sectional area of the RIJV were significantly widened in both Trendelenburg and tourniquet measurements compared with the supine position (P < .001 for both measures). Measurements using the upper extremity tourniquet were significantly larger than Trendelenburg measurements (P=.002 and < .001 for cross-sectional area and diameter, respectively). CONCLUSION: Channelling of the upper-extremity venous return to the jugular vein was significantly superior when compared with the Trendelenburg position and the supine position. LIMITATIONS: No catheterization and study limited to healthy volunteers.

Primary Giant Echinococcosis of the Neck.

The authors report an isolated echinococcosis in a 17-year-old girl presented with swelling of right neck approximately 12 cm in diameters with no evidence of the disease elsewhere in the body. A thorough search of the literature revealed only a few cases of isolated cervical echinococcosis. Surgical procedure was planned for our case with the guidance of the magnetic resonance imaging, which showed right cystic mass and within a laminar membrane. Histopathologic report confirmed echinococcosis. In summary, this current study shows that in the differential diagnosis of the cystic masses localized in the neck in the endemic regions, echinococcosis should be suggested. In these patients, the careful assessment of the magnetic resonance imaging evaluation before the surgery would extremely facilitate either the diagnosis or the surgery planning.

Brachiocephalic artery anomaly at the neck: importance during minimally invasive video-assisted parathyroidectomy.

A 76-year-old woman was referred to our hospital for evaluation of a parathyroid adenoma, detected on sonography. It had been located posteroinferiorly to the right thyroid lobe. Parathyroid scintigraphy confirmed the right inferior parathyroid adenoma. During physical examination of the neck, a pulsatile mass in the anterior inferior right was determined, and because of suspicion for a vascular anomaly, a computed tomography angiography was performed. The computed tomography showed that the right brachiocephalic artery ascended vertically to the level of the inferior border of right thyroid lobe and dividing into the right common carotid artery and subclavian artery at this level. Right subclavian artery after its origin brought about a curve by means of turning first posteromedially and then anterolaterally. Parathyroid adenoma remained between the right thyroid lobe, right common carotid artery, and right brachiocephalic artery. Minimally invasive video-assisted parathyroidectomy was performed and no complication appeared.

Ectopic multinodular goiter: multidetector computed tomography findings.

The thyroid is the first endocrine gland to form during embryogenesis. At this stage, incomplete or anomalous migration of thyroid tissue causes ectopic localization of the gland. In our case, a 55-year-old woman who was evaluated via ultrasonography (USG) and multi-detector computed tomography (MDCT) had no thyroid gland at the normal location, but did have ectopic thyroid tissue in the left submandibular and submental regions.