Simple Separate Sutures Versus Continuous Sutures on Hepatic Artery Anastomosis in Liver Transplant: A Prospective Study.

OBJECTIVES: Liver transplant is the definitive treatment for liver failure of various causes. There are various operation methods, of which the conventional approach is most frequently performed. In the conventional technique, 4 anastomoses are required, and different subtleties in these techniques are known to cause different rates of complications. We assessed the outcome of a simple separate (ie, interrupted) suture technique compared with a the continuous suture technique in 194 patients. MATERIALS AND METHODS: There were 194 patients included in this single-center, controlled study. The exclusion criteria were patients who died during the surgical procedure and patients with incomplete medical records. The data recorded were age, sex, past medical history of liver disease, tobacco use, comorbidities, and whetherthe livertransplant was for the first time or retransplant. All patients included in this study were recipients of liver transplants from deceased donors. The patients were categorized as those who received either simple sutures (n = 16) or continuous sutures (n = 178). The continuous suture operations were performed first, and the simple suture operations were performed at a later time (ie, the 2 groups were temporally separated). The results included the duration of surgery, hepatic artery thrombosis rate, hepatic artery stenosis rate, 2-year survival, and further complications. RESULTS: No evidence of hepatic artery thrombosis or hepatic artery stenosis was observed in the study groups. The duration of surgery was equal in both groups. The 2-year mortality rate was significantly higher in the simple suture group. CONCLUSIONS: The continuous suture method seems to be accompanied by a similar duration of operation and rate of complications compared with the simple suture process.

Albendazole ameliorates inflammatory response in a rat model of acute mesenteric ischemia reperfusion injury.

BACKGROUND: Acute mesenteric ischemia is known as a life threatening condition. Re-establishment of blood flow in this condition can lead to mesenteric ischemia reperfusion (MIR) injury which is accompanied by inflammatory response. Still, clear blueprint of inflammatory mechanism underlying MIR injury has not been provided. Interestingly, Albendazole has exhibited notable effects on inflammation and cytokine production. In this study, we aimed to evaluate outcomes of MIR injury following pretreatment with Albendazole with respect to assessment of mesenteric inflammation and ischemia threshold. METHODS: Male rats were randomly divided into sham operated, vehicle treated, Albendazole 100 mg/kg and Albendazole 200 mg/kg groups. MIR injury was induced by occlusion of superior mesenteric artery for 30 min followed by 120 min of reperfusion. Samples were utilized for assessment of epithelial survival and villous height. Immunohistochemistry study revealed intestinal expression of TNF-α and HIF-1-α. Gene expression of NF-κB/TLR4/TNF-α/IL-6 was measured using RTPCR. Also protein levels of inflammatory cytokines in serum and intestine were assessed by ELISA method. RESULTS: Histopathological study demonstrated that pretreatment with Albendazole could ameliorate decline in villous height and epithelial survival following MIR injury. Also, systemic inflammation was suppressed after administration of Albendazole. Analysis of possible participating inflammatory pathway could demonstrate that intestinal expression of NF-κB/TLR4/TNF-α/IL-6 is significantly attenuated in treated groups. Eventually, IHC study illustrated concordant decline in mesenteric expression of HIF-1-α/TNF-α. CONCLUSION: Single dose pretreatment with Albendazole could ameliorate inflammatory response and enhance ischemia threshold following induction of MIR injury. More studies would clarify existing causality in this phenomenon.

Chronic gastrointestinal bleeding caused by a Dieulafoy's lesion in the small intestine: a case report.

INTRODUCTION: Dieulafoy's lesion, first found by Paul Georges Dieulafoy, is an infrequent but important cause of recurrent upper gastrointestinal bleeding. The bleeding is usually severe, but patients rarely present with chronic, occult gastrointestinal bleeding. CASE PRESENTATION: In this article, we discuss the case of a 68-year-old caucasian man with a history of recurrent hematemesis and chronic anemia with evidence of extravasation of contrast in the lumen of the bowel loop on computed tomography angiography. The patient was taken to the operating room, and a laparotomy procedure was performed. CONCLUSION: Due to the infrequency of Dieulafoy's lesion compared with other causes of gastrointestinal bleeding, it is often missed in the process of differential diagnosis. In this article, we have demonstrated the importance of this disease and different approaches to the treatment of this lesion, considering the location of the lesion among other factors.

Endovascular abdominal aortic aneurysm repair in a patient with previous history of simultaneous orthotopic liver kidney transplantation.

Management of abdominal aortic aneurysms (AAA) tends to be an issue in patients with a previous history of abdominal transplantation surgeries. Open surgery poses the risk of ischemia to the grafted tissue. Additionally, these patients have comorbidities that make them unable to endure such procedures. As a result, endovascular repair is becoming the accepted procedure in the transplanted population. Herein, we describe a patient with a previous history of simultaneous orthotopic liver-kidney transplantation who successfully underwent EVAR for AAA correction.

Study of re-transplantation and prognosis in liver transplant center in Iran.

AIM: This this study aimed to investigate the causes and prognoses of liver re-transplantation in patients referred to Imam Khomeini Hospital Liver Transplantation Center. BACKGROUND: Organ shortage is a major problem in the world, a high demand for liver transplantation has exacerbated this problem. Thus, providing more information on the causes of liver re-transplantation, its prognosis, and other issues related to this procedure is of great importance. METHODS: This study was conducted in 2018 as a historical cohort. In this study, the records of liver transplantation patients at Imam Khomeini Hospital Liver Transplantation Center between 2000 and 2016 were studied, and data was extracted from the records of patients undergoing liver transplantation. Patient data was entered into SPSS 20 software and analyzed. RESULTS: In this study, 1030 patients with a mean age of 43.15 ± 14.57 years were studied. There were 426 women (41.4%) and 604 men (58.6%). The number of primary transplants was 966 with a mean age of 43.19 ± 14.72, and the number of re-transplants was 64 with a mean age of 42.56 ± 12.82. Significant differences were found between the two groups in terms of MELD and CHILD scores, cold ischemic time, total and direct bilirubin levels, liver function factors (ALT, AST, and alkaline phosphatase), hemoglobin, and WBC. There was no significant difference between the two groups in terms of age, sex, or platelets (> 0.05). The mortality rate was 241 (23.39%) in all patients and the mortality rate was 206 (21.32%) and in liver transplant patients was 35 (54.68%). The mortality rate in the transplant group was statistically higher (p<0.001). Secondary was primary non-functional graft (PNF) (37.5%) with 1-, 3, and 5-year survival rates of 82%, 81%, and 70% in primary group and 59%, 43% and 32% in re-transplantation, respectively. There was a significant difference in survival between the two groups (p <0.05). Hemoglobin and alkaline phosphatase were predictors of survival rates in transplant patients. CONCLUSION: The results of this study showed that the survival rate of re-transplant patients was significantly lower than that of primary transplant patients, and the mortality rate in re-transplant patients was significantly higher.