Are the Post-transplant Outcomes of Kasai's Early Failure and Late Failure Comparable to the Primary Liver Transplantation?

It is uncertain whether prior Kasai procedures negatively impact the outcomes of liver transplantation (LT). The prior meta-analysis did not distinguish between Kasai early failure (K-EF) and late failure (K-LF). Numerous studies have been recently published; therefore, we perform a systematic review and meta-analysis. We searched PubMed and Embase databases to identify studies comparing the outcomes of biliary atresia (BA) patients undergoing primary LT versus patients with prior Kasai procedures. Subgroup analysis was done at the time of Kasai failure (early vs. late). Twenty-five studies comprising 6,408 patients receiving LT were included in the analysis. We found a statistically significant increase in one-year graft survival in K-LF versus primary liver transplant (pLT) (P = 0.0003). One-year patient survival was also increased in K-LF, although not statistically significant (P = 0.09). No difference in the one- and five-year graft and patient survival, reoperation rate, infection, and biliary complication was seen in pLT vs overall prior Kasai (K-EF and K-LF). These results suggest that prior kasai procedure does not negatively impact the outcome of LT. In addition, BA patients with prior Kasai undergoing LT later in life tend to perform better than primary liver transplants.

COVID-19 seroprevalence in military police force, Southern Brazil.

BACKGROUND: Limited data is available regarding the frequency of COVID-19 in populations that are highly exposed to SARS-CoV-2. In this cross-section study we evaluated COVID-19 seroprevalence in military police forces of 10 major cities in Rio Grande do Sul, South of Brazil. METHODS: Sampling was randomly performed in clusters, in respect to the number of professionals at service per city and military unit. Research subjects were evaluated on July 23, 2020 (first wave peak in Brazil). Clinical information was obtained, and venous blood was taken for ELISA testing (IgA, and IgG antibodies). Sample size consisted of 1,592 military workers (33.6% of study population). They were mostly man (81.2%) and young (median 34 years-old). Most had been asymptomatic (75.3%) during pandemic, and 27.5% reported close contact with COVID-19 cases (after a median time of 21 days). Antibodies were detected in 3.3% of the participants, mostly IgA (2.7%), and IgG (1.7%). After 3 weeks, 66.7% of IgA and IgG results turned negative, in addition to 78.3% and 100% of borderline IgA and IgG results, respectively. CONCLUSION: The seroprevalence of COVID-19 amongst military police was at least 3.4 higher than the findings of other studies performed in the general population, in the same cities and dates. Most detectable antibodies were of IgA class, which implies recent exposure. Asymptomatic people were more prone to have negative antibody titters in the second run.

Early hepatic arterial thrombosis in liver transplantation: Systemic intravenous alteplase as a potential rescue treatment after failed surgical revascularization.

eHAT is one of the most dreaded post-LT complication. Treatment approaches include retransplantation, revascularization, or observation. Systemic thrombolytic therapy is used in pediatric patients with thromboembolic events. However, there is no previous study reporting on the use of systemic r-tPA to treat eHAT. The treatment strategies used in patients with eHAT are described, focusing on two children who failed SR and were treated with systemic heparinization plus systemic r-tPA infusion. r-tPA-RP consists of intravenous systemic infusion at a dose of 0.3 mg/kg/h during 6 hours, for 5 days. First case (3-year) was transplanted with a whole liver, and second case (6-year) received a LLS from a living donor. HAT was diagnosed by doppler US and confirmed by angioCT scan in both patients in the first day after LT. They underwent SR and were clinically stable. Re-thrombosis occurred in both patients the day after, and r-TPA-RP was started-one patient required two r-TPA-RP for HAT recurrence. They presented minor bleeding, without repercussion. Hepatic artery recanalized after 10 and 3 days in the first and second patient, respectively. Retransplant was avoided, and one developed biliary strictures, successfully managed in the follow-up. r-TPA-RP avoided retransplantation after eHAT in these cases. To our knowledge, this is the first report of the use of systemic r-TPA to treat eHAT in children. This strategy may compose an algorithm to treat eHAT that failed SR in stable patients.

The role of double-strand break repair, translesion synthesis, and interstrand crosslinks in colorectal cancer progression-clinicopathological data and survival.

BACKGROUND AND OBJECTIVES: DNA repair is a new and important pathway that explains colorectal carcinogenesis. This study will evaluate the prognostic value of molecular modulation of double-strand break repair (XRCC2 and XRCC5); DNA damage tolerance/translesion synthesis (POLH, POLK, and POLQ), and interstrand crosslink repair (DCLRE1A) in sporadic colorectal cancer (CRC). METHODS: Tumor specimens and matched healthy mucosal tissues from 47 patients with CRC who underwent surgery were assessed for gene expression of XRCC2, XRCC5, POLH, POLK, POLQ, and DCLRE1A; protein expression of Polk, Ku80, p53, Ki67, and mismatch repair MLH1 and MSH2 components; CpG island promoter methylation of XRCC5, POLH, POLK, POLQ, and DCLRE1A was performed. RESULTS: Neoplastic tissues exhibited induction of POLK (P < .001) and DCLRE1A (P < .001) expression and low expression of POLH (P < .001) and POLQ (P < .001) in comparison to healthy paired mucosa. Low expression of POLH was associated with mucinous histology and T1-T2 tumors (P = .038); low tumor expression of POLK was associated with distant metastases (P = .042). CRC harboring POLK promoter methylation exhibited better disease-free survival (DFS) (P = .005). CONCLUSIONS: This study demonstrated that low expression or unmethylated POLH and POLK were related to worse biological behavior tumors. However, POLK methylation was associated with better DFS. POLK and POLH are potential prognostic biomarkers in CRC.

Carnoy solution versus GEWF solution for lymph node revealing in colorectal cancer: a randomized controlled trial.

PURPOSE: This study aimed to compare the performance of two lymph node revealing solutions. METHODS: This randomized clinical trial (NTC02704988) investigated patients with colon or rectal cancer who underwent surgical resection with D2 lymphadenectomy. Specimens submitted for conventional pathological examination were randomly assigned for additional fixation with Carnoy or GEWF solution, and dissection was performed to examine the missed lymph nodes. The number of lymph nodes retrieved, additional identified metastatic lymph nodes, lymph node upstaging, and complementary indication of adjuvant therapy were investigated. RESULTS: The number of lymph nodes retrieved was significantly higher with the use of lymph node revealing solutions than with the conventional method in colon cancer (GEWF: 29.5 vs 27; p < 0.001; Carnoy: 27.7 vs 25.2; p < 0.001) and rectal cancer (GEWF: 25.8 vs 23.6; p < 0.001; Carnoy: 23.1 vs 20.8; p < 0.001). There were no differences between the solutions and conventional examination with respect to the median number of additional metastatic lymph nodes identified (0 in all arms), the number of patients with lymph node upstaging (colon cancer: 1 in the Carnoy arm, 0 in the GEWF arm; rectal cancer: 1 in the GEWF arm, 0 in the Carnoy arm), or the number of patients with complementary indication of adjuvant therapy (colon cancer: 1 in the Carnoy arm, 0 in the GEWF arm; rectal cancer: 0 in both arms). CONCLUSION: Despite the higher number of lymph nodes retrieved, neither solution resulted in significant changes in patient staging or treatment. Both solutions exhibited equal performance with respect to all outcomes. TRIAL REGISTRATION: NTC02704988.

Oxidative Stress in Aortas of Patients with Advanced Occlusive and Aneurysmal Diseases.

BACKGROUND: Aortoiliac occlusive disease (AOD) and abdominal aortic aneurysm (AAA) are very important cardiovascular diseases that present different aspects of pathophysiology; however, oxidative stress and inflammatory response seem be relevant in both of them. Our objective was to evaluate oxidative damage and degree of inflammatory infiltrate in aortas of patients surgically treated for AOD and AAA. MATERIALS AND METHODS: Levels of reactive oxygen species (ROS), nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity, and myeloperoxidase (MPO) expression as well as nitrite levels and superoxide dismutase (SOD) and catalase (CAT) activities were evaluated in aortas of patients with AOD (n = 16) or AAA (n = 14), while the control group was formed by cadaveric organ donors (n = 10). We also analyzed the degree of inflammatory infiltrate in these aortas. RESULTS: There was an increase in ROS levels and NADPH oxidase activity in patients with AOD and AAA when compared with the control group, and the AOD group demonstrated higher ROS production and NADPH oxidase activity and also nitrite levels when compared with the AAA group (P < 0.001). On the other hand, an increase of SOD activity in the AOD group and CAT activity in the AAA group was observed. Inflammatory infiltrate and MPO expression were higher in the AOD group when compared with the control group (P < 0.05). CONCLUSIONS: Oxidative stress is relevant in both AOD and AAA, though AOD presented higher ROS levels and NADPH activity. Increased activities of antioxidant enzymes may be a compensatory phenomenon which occurs in aortas of patients with AOD and AAA. Perhaps, a relationship between oxidative stress and degree of inflammatory infiltrate may exist in the pathophysiology of AOD and AAA.

Clinical importance of DNA repair in sporadic colorectal cancer.

Colorectal cancer (CRC) is the third major cause of cancer-related deaths worldwide. However, despite the scientific efforts to provide a molecular classification to improve CRC clinical practice management, prognosis and therapeutic decision are still strongly dependent on the TNM staging system. Mismatch repair system deficiencies can occur in many organs, but it is mainly a hallmark of CRC influencing clinical outcomes and response to therapy. This review will discuss the effect of the modulation of other DNA repair pathways (direct, excision and double strand break repairs) in the clinical and pathological aspects of colorectal cancer and its potential as prognostic and predictive biomarkers.

Base excision repair imbalance in colorectal cancer has prognostic value and modulates response to chemotherapy.

Colorectal cancer (CRC) is prevalent worldwide, and treatment often involves surgery and genotoxic chemotherapy. DNA repair mechanisms, such as base excision repair (BER) and mismatch repair (MMR), may not only influence tumour characteristics and prognosis but also dictate chemotherapy response. Defective MMR contributes to chemoresistance in colorectal cancer. Moreover, BER affects cellular survival by repairing genotoxic base damage in a process that itself can disrupt metabolism. In this study, we characterized BER and MMR gene expression in colorectal tumours and the association between this repair profile with patients' clinical and pathological features. In addition, we exploited the possible mechanisms underlying the association between altered DNA repair, metabolism and response to chemotherapy. Seventy pairs of sporadic colorectal tumour samples and adjacent non-tumour mucosal specimens were assessed for BER and MMR gene and protein expression and their association with pathological and clinical features. MMR-deficient colon cancer cells (HCT116) transiently overexpressing MPG or XRCC1 were treated with 5-FU or TMZ and evaluated for viability and metabolic intermediate levels. Increase in BER gene and protein expression is associated with more aggressive tumour features and poor pathological outcomes in CRC. However, tumours with reduced MMR gene expression also displayed low MPG, OGG1 and PARP1 expression. Imbalancing BER by overexpression of MPG, but not XRCC1, sensitises MMR-deficient colon cancer cells to 5-FU and TMZ and leads to ATP depletion and lactate accumulation. MPG overexpression alters DNA repair and metabolism and is a potential strategy to overcome 5-FU chemotherapeutic resistance in MMR-deficient CRC.

Efficient liver surgery planning in 3D based on functional segment classification and volumetric information.

Anatomic hepatectomies are resections in which compromised segments or sectors of the liver are extracted according to the topological structure of its vascular elements. Such structure varies considerably among patients, which makes the current anatomy-based planning methods often inaccurate. In this work we propose a strategy to efficiently and semi-automatically segment and classify patient-specific liver models in 3D. The method is based on standard CT datasets and allows accurate estimation of functional remaining liver volume. Experiments showing effectiveness of the method are presented, and quantitative and qualitative results are discussed.

Cited Brazilian papers in general surgery between 1970 and 2009.

OBJECTIVES: To identify the most cited articles in general surgery published by Brazilian authors. INTRODUCTION: There are several ways for the international community to recognize the quality of a scientific article. Although controversial, the most widely used and reliable methodology to identify the importance of an article is citation analysis. METHODS: A search using the Institute for Scientific Information citation database (Science Citation Index Expanded) was performed to identify highly cited Brazilian papers published in twenty-six highly cited general surgery journals, selected based on their elevated impact factors, from 1970 to 2009. Further analysis was done on the 65 most-cited papers. RESULTS: We identified 1,713 Brazilian articles, from which nine papers emerged as classics (more than 100 citations received). For the Brazilian contributions, a total increase of about 21-fold was evident between 1970 and 2009. Although several topics were covered, articles covering trauma, oncology and organ transplantation were the most cited. The majority of classic studies were done with international cooperation. CONCLUSIONS: This study identified the most influential Brazilian articles published in internationally renowned general surgery journals.

Cited Brazilian papers in general surgery between 1970 and 2009

OBJECTIVES: To identify the most cited articles in general surgery published by Brazilian authors. INTRODUCTION: There are several ways for the international community to recognize the quality of a scientific article. Although controversial, the most widely used and reliable methodology to identify the importance of an article is citation analysis. METHODS: A search using the Institute for Scientific Information citation database (Science Citation Index Expanded) was performed to identify highly cited Brazilian papers published in twenty-six highly cited general surgery journals, selected based on their elevated impact factors, from 1970 to 2009. Further analysis was done on the 65 most-cited papers. RESULTS: We identified 1,713 Brazilian articles, from which nine papers emerged as classics (more than 100 citations received). For the Brazilian contributions, a total increase of about 21-fold was evident between 1970 and 2009. Although several topics were covered, articles covering trauma, oncology and organ transplantation were the most cited. The majority of classic studies were done with international cooperation. CONCLUSIONS: This study identified the most influential Brazilian articles published in internationally renowned general surgery journals.

Derivação meso-porta (shunt Rex): tratamento atual da obstrução extra-hepática da veia porta / Meso-portal bypass (Rex shunt): current treatment of extrahepatic portal vein obstruction

Objetivo: Apresentar a caso de uma criança brasileira, provavelmente a primeira, portadora de obstrução extra-hepática da veia porta (OEHVP), submetida ao shunt Rex (derivação cirúrgica meso-porta) para tratamento da hipertensão porta pré-hepatica. Descrição: Menino de um ano e nove meses, 11 kg, previamente hígido, apresentou hematemese e melena. Foi realizada endoscopia digestiva alta, que demonstrou varizes de esôfago sangrantes grau III. Foi iniciado tratamento com propranolol e escleroterapia. Apresentou mais três episódios de sangramento importante e sinais laboratoriais de hiperesplenismo e aumento da amônia sérica. Realizado diagnóstico de cavernoma da veia porta. Foi indicado tratamento cirúrgico, após avaliação da coagulação e biopsia hepática normais. Foi feita opção pela derivação meso-porta ou shunt Rex, que consiste na colocação de um enxerto de veia jugular entre a veia mesentérica superior e o ramo esquerdo intra-hepatico da veia porta, restaurando o fluxo sanguíneo portal para o fígado. O paciente foi submetido com dois anos e seis meses, em março de 2004, à cirurgia no Children's Hospital de Chicago, sem intercorrências, tendo recebido alta no quinto dia pós-operatório. Retornou após um mês da cirurgia ao Brasil, onde seguiu fazendo controles periódicos. Atualmente, quase três anos apos o shunt Rex, o menino tem vida normal, com provas de função hepática normais, sem esplenomegalia, sem varizes e nem sinais de hipertensão porta. O shunt encontra-se pérvio e com bom fluxo pela ultra-sonografia. Conclusões: A cirurgia de derivação mesoporta e uma opção terapêutica recente e, muito provavelmente, tornar-se-á o método de escolha no manejo da hipertensão porta pré-hepática, por OEHVP. É superior aos outros procedimentos cirúrgicos, já que elimina totalmente a hipertensão porta e suas seqüelas.

Alternativa técnica de drenagem peritoneal adicional a utilizaçäo de tubos trans-hepáticos / Technical alternative of peritoneal orainage in transhepatic intubation

O aumento do número de coleçöes subfrênicas é uma das críticas feitas aos tubos trans-hepáticos. Com o objetivo de prevenir esta complicaçäo, alguns autores colocam, sobre o tubo, outro com diâmetro maior desde a superfície do fígado até o exterior. O trabalho relata uma alternativa técnica de drenagem nestes tubos, usando dreno de Penrose sobre os mesmos, salientando algumas vantagen, pelo menos sob o ponto de vista teórico, sobre os tubos rígidos

Colangite eclerosante localizada primária em criança / Localized chronic sclerosing cholangitis in children

A Colangite Esclerosante Primária é uma doença rara, havendo cerca de 20 casos descritos em crianças até o presente momento. Os autores apresentam a experiência com um paciente de 6 anos portador da forma localizada nos ductos biliares extra-hepáticos. Tomou-se por conduta a hepaticojejunostomia em Y de Roux com tubo transhepático de Silastic para ambos os canais biliares. Após dezoito meses de seguimento o paciente permanece assintomático, todavia com os tubos no interior das vias biliares. As opçöes terapêuticas e diagnósticos e uma ampla revisäo na literatura formam o objetivo deste trabalho

Derrames cavitários pancreáticos / Pancreatic ascites and pleural effusion

O traumatismo esplênico é freqüente em nosso meio. Nos últimos anos tem se dadoênfase à conservaçäo explênica, em substituiçäo à esplenectomia. Apresentamos um caso de esfacelamento esplênico após traumatismo abdominal em criança de 10 anos, na qual realizamos implante autólogo heterotópico em bolsa omental de fragmento esplênico, e após exame cintilográfico houve captaçäo de material radioativo (Tc99), que sugere alguma atividade fagocítica de tecido esplênico. Outras técnicas de preservaçäo explênica säo mencionadas, assim com detalhes importantes da técnica do implante esplênico

Hepaticojejunostomia no tratamento da colestase causada por pancreatite crônica / Hepaticojejunostomy in the treatment of cholestasis due to chronic pancreatitis

Numa série cirúrgica de 60 pacientes com pancreatite crônica alcoólica, 12 foram operados, eletivamente, devido a pseudocisto de pâncreas e 48, fundamentalmente, à dor intratável, sofrendo intervençäo direta sobre o parênquima pancreático. Do grupo total, 11 pacientes tinham, concomitantemente, estenose do colédoco terminal, sendo que cinco destes apresentavam pseudocisto cefálico. Nesta série, a hepaticojejunostomia em alça isolada foi a cirurgia de escolha