Polylactic acid and polyethylene glycol prevent surgical adhesions.

OBJECTIVES: Re-mediastinoscopy could be risky because of adhesions from the previous mediastinoscopy. The aim of this study was to evaluate the efficacy of a bio-resorbable barrier on adhesion formation in a re-mediastinoscopy rat model. METHODS: Mediastinal dissection similar to mediastinoscopy was done in twenty-eight rats and a polymeric film comprising of polylactic acid and polyethylene glycol (Repel-cv®, SyntheMed Inc., NJ, USA) was placed on trachea in the study groups. Group 1 (sham, sacrificed at day 30), Group 2 (single barrier, sacrificed at day 30), Group 3 (single barrier, sacrificed at day 60), Group 4(double layer barrier, sacrificed at day 60). Mediastinal adhesions, degree of inflammation, vascular proliferation, foreign body reaction and fibroblast proliferation was compared. RESULTS: Macroscopic dissection showed significantly dense adhesions in Sham Group and Group 3 (p < 0.05). Histopathologic examination showed that there was a significant difference between groups when the foreign body reaction and fibroblast proliferation was evaluated (p0.05). CONCLUSIONS: This unique experimental study showed that adhesion barrier was effective as single layer application at day 30 and double layer application at day 60. At clinical conversion, by the application of barrier, the formation of adhesions might be decreased to provide a safe re-mediastinoscopy (Tab. 2, Fig. 4, Ref. 23).

Spectrum of histopathologic diagnosis of lymph node biopsies after liver and kidney transplant.

OBJECTIVES: Our aim was to review our single center experience regarding histopathologic features arising from enlarged lymph nodes following solidorgan transplant. MATERIALS AND METHODS: In 2148 people who had solid-organ transplant from 1985 to 2013, there were 34 patients (1.58%) who developed lymphadenopathy. A retrospective review was performed to evaluate demographic, clinical, and histopathologic features of medical and pathologic records. RESULTS: Nonneoplastic lesions were more common, comprising 70.5% (n = 24) all cases which included nonspecific reactive lymphoid hyperplasia in 8 patients (33.3%), tuberculous lymphadenitis in 6 patients (25%), amyloid lymphadenopathy in 4 patients (16.6%), dermatopathic lymphadenopathy in 2 patients (8.3%), Kikuchi-Fujimoto disease in 1 patient (4.16%), hemangioma in 1 patient (4.16%), plasmacytic form of Castleman disease and amyloid lymphadenopathy in 1 patient (4.16%), and sea blue histiocytosis in 1 patient (4.16%). Neoplastic lesions comprised 29.41% (n = 10) cases which included posttransplant lymphoproliferative disorder in 6 patients (60%), Kaposi sarcoma in 2 patients (20%), posttransplant lymphoproliferative disorder and Kaposi sarcoma in 1 patient (10%), and metastatic carcinoma in 1 patient (10%). CONCLUSIONS: Detecting enlarged lymph nodes in solid-organ transplant recipients is an infrequent occurrence. Infectious diseases, posttransplant lymphoproliferative disorder, and malignancies related to transplant should be considered in the differential diagnosis when enlarged lymph nodes in solid-organ transplant recipients are encountered.

Pathological findings of liver allografts evaluated at autopsy.

OBJECTIVES: We review the pathological findings as determined by autopsy of the liver allografts. MATERIALS AND METHODS: We retrospectively analyzed 408 patients who had a liver transplant between January 1990 and December 2012. Thirteen of the 408 patients underwent postmortem examination. Clinicopathologic findings including the age at death, causes of death, and main pathological findings were evaluated. RESULTS: The study group of 13 patients who underwent a liver transplant had a mean age of 29 years at the time of death. Mean survival was 6 ± 1 months (range, 10-72 mo). Ten of 13 patients (76.9%) died 90 days after the liver transplant. The remaining 3 patients died, 1 case in 1 year, in 2 cases after 1 year. Causes of the deaths were infection (9 cases), respiratory distress (1 cases), multiorgan failure (1 cases), primary graft failure (1 cases), and massive intra-abdominal bleeding (1 cases). The causes of the infection were bacterial infection in 6 cases (67%) and invasive fungal infection in other 3 cases (33%). The main pathological finding was hepatic infarction in 9 cases (69%). Bridging fibrosis (3 cases) and hematoma (1 case) were obtained in the remaining cases. CONCLUSIONS: Our results emphasize that infections are the main cause of death and hepatic infarction is the main histopathologic findings among these 13 patients within the first year of transplant. We consider postmortem examination to have important role in determining the primary graft failure and other causes that increased mortality in liver transplant recipients. An autopsy can provide understanding of the main causes and cause of death.

Can dantrolene protect spinal cord against ischemia/reperfusion injury? An experimental study.

BACKGROUND: The aim of this experimental study was to investigate the possible protective effect of dantrolene on neuronal injury induced by aortic ischemia/reperfusion (I/R). METHODS: Nineteen rabbits were divided into three groups: sham (group 1, n = 5, no I/R), control (group 2, n = 7, only I/R) and dantrolene (group 3, n = 7, dantrolene + I/R). Abdominal aortic occlusion between the renal arteries and iliac bifurcations was carried out for 30 min. The spinal cord functions of the subjects were assessed using the Tarlov Scale. Blood and cord tissue samples were taken for biochemical and histopathological evaluation. RESULTS: Tarlov scores in group 3 were significantly higher than in group 2 ( P < 0.05). In group 3, the MDA levels of the spinal cord decreased significantly compared to those of group 2 ( P < 0.05). In rabbits with I/R (group 2), the GSH levels of the spinal cord decreased significantly compared to those of group 1 ( P < 0.01), but dantrolene pretreatment significantly prevented a decrease in GSH levels. Histopathological examination showed that group 3 had less vascular proliferation, hemorrhage, edema and neuron loss than group 2. CONCLUSIONS: It was concluded that dantrolene applied after ischemia might help protect the spinal cord against ischemia/reperfusion injury.