Variation in the levels of inflammatory cytokines depending on ischemic time: effects on respiratory variables.

OBJECTIVES: We sought to evaluate the association between ischemic times, cytokines-interleukin (IL)-6, IL-1b, tumor necrosis factor-alpha, sIL-2r, IL-8, and IL-10-and alterations in gaseous exchange. MATERIALS AND METHODS: This prospective study of 42 orthotopic liver transplantation (OLT) recipients examined ischemic times and respiratory variables measured as alterations in intrapulmonary shunt and in the Po(2)/Fio(2) ratio. Centrifuged blood samples were frozen at -80 degrees C for storage. The Inmulite-One system (Euro/Dpc, Gwynedd, UK) was used to determine the concentration of cytokines. For statistical analysis, we used the Pearson correlation coefficient. RESULTS: The average cold ischemic time was 478 minutes (range, 35-929) and warm ischemic time was 69.58 minutes (range, 20-180). The warm ischemic time affected the degree of shunt at the end of the operation (P < .027) and the levels of IL-10 (P < .018) and IL-6 (P < .000). The final degree of shunting and IL-10 (P < .044) showed a correlation. The cold ischemic time affected IL-1 (P < .046) and IL-8 levels (P < .023). The reperfusion syndrome was correlated with the final levels of IL-10 (P < .064) and of IL-8 (P < .066). CONCLUSION: Warm and cold ischemic times affect the final cytokine levels and the degree of intrapulmonary shunt.

Best blood sample draw site during liver transplantation.

BACKGROUND: The present study sought to identify whether there were higher inflammatory cytokine levels in blood samples drawn from the pulmonary artery, radial artery, portal vein, or reperfused graft during each transplantation phase to determine the best site. METHODS: We examined 39 consecutive patients undergoing liver transplantation for their blood cytokine levels at various sites. Comparison of levels permitted us to select the best blood sample draw site, considering the best site to be the one showing the highest cytokine levels. RESULTS: During hepatectomy and neohepatic phases, the best site was the radial artery; during the anhepatic phase, the portal vein; and during reperfusion, the reperfused graft. CONCLUSIONS: The radial artery constituted, an optimal sample draw site, considering the best one to show the highest cytokine levels.

Recurrence of inflammatory pseudotumor in the distal bile duct: lessons learned from a single case and reported cases.

Inflammatory myofibroblastic tumors (IMTs) or inflammatory pseudotumors (IPs) have been extensively discussed in the literature. They are usually found in the lung and upper respiratory tract. However, reporting of cases involving the biliopancreatic region has increased over recent years. Immunohistochemical study of these lesions limited to the pancreatic head or distal bile duct seems to be compatible with those observed in a new entity called autoimmune pancreatitis, but usually intense fibrotic reaction (zonation) predominates producing a mass. When this condition is limited to the pancreatic head, the common bile duct might be involved by the inflammatory process and jaundice may occur often resembling adenocarcinoma of the pancreas. We have previously reported a case of IMT arising from the bile duct associated with autoimmune pancreatitis which is an extremely rare entity. Four years after Kaush-Whipple resection, radiological examination on routine follow-up revealed a tumor mass, suggesting local recurrence. Ultrasound-guided FNA confirmed our suspicious diagnosis. This present case, as others, suggests that persistent follow-up is necessary in order to prevent irreversible liver damage at this specific location.