Feasibility and effectiveness of laparoscopic incisional hernia repair after liver transplantation.

BACKGROUND: Incisional hernia is a frequent problem after liver transplantation. It is related to immunosuppression, use of steroids, obesity, as well as the type of incision. Laparoscopic repair shows a lower rate of complications in terms of infection and recurrence, as well as reduced postoperative pain and faster recovery. METHODS: We reviewed our experience with laparoscopic incisional hernia repair (LIHR) in patients after liver transplantation, using the BARD Composix mesh which is composed of two layers of polypropylene and polytetrafluoroethylene (PTFE) and fixed with metal ProTack. RESULTS: Between March 2002 and April 2010, we performed 20 LIHR in 17 male and three female subjects of overall mean age of 58.3 years, and body mass Index of 31.05 kg/m(2). The mean size of the defects was 215.25 cm(2). All patients had undergone bilateral subcostal incisions with a midline extension, and seven had additional operations after the transplantation for various reasons. There were no differences in immunosuppression. Three patients had needed steroid boluses for acute graft rejection episodes. There was no conversion of therapy. The size of mesh was 18 × 23 cm in seven cases and 20 × 25 in 12 cases. The mean postoperative hospital stay was 2.1 days. Oral feeding was initiated a few hours after surgery, and routine immunosuppression was not discontinued. There were no major early complications. During follow-up, we identified one patient with a mesh infection (5%) and one with a recurrence (5%). CONCLUSION: LIHR is safe and feasible even for major hernias after liver transplantation with few complications.

Effect of proinflammatory cytokines (IL-6, TNF-alpha, IL-1beta) on hemodynamic performance during orthotopic liver transplantation.

BACKGROUND: Proinflammatory cytokines (IL-6, IL-1beta, TNF-alpha) released during liver transplantation may affect hemodynamic stability. The aim of the present study was to analyze the association between IL-6, TNF-alpha, and IL-1beta and systemic vascular resistance during the phases of liver transplantation. MATERIAL AND METHODS: The proinflammatory cytokines IL-6, IL-1beta, and TNF-alpha were analyzed in the blood of 20 consecutive patients who underwent transplantation. Blood samples were drawn from the pulmonary artery at serial times during surgery. Hemodynamic parameters were determined using a cardiac output monitor. Correlations between parameters were analyzed using the Spearman's rho and Kendall's tau-b methods. RESULTS: Both in the vena cava and the pulmonary artery, significant association was observed between basal values of IL-6 during hepatectomy and systemic vascular resistance during the phases of liver transplantation: hepatectomy phase (r=.76, P=.02), anhepatic phase (r=.78, P=.03) and reperfusion phase (r=.87, P=.005). CONCLUSIONS: Basal values of IL-6 may be considered a prognostic factor for hemodynamic performance during the phases of liver transplantation.

Marker-assisted selection of a neuro-behavioural trait related to behavioural inhibition in the SHR strain, an animal model of ADHD.

The search for the molecular bases of neuro-behavioural traits in Spontaneously Hypertensive Rats (SHR), an animal model of Attention Deficit Hyperactivity Disorder (ADHD), led to the discovery of two quantitative trait loci related to the locomotor activity in the centre of the open field. In the present study, rats from an F2 intercross between the SHR and Lewis strains were selected with markers on the basis of their genotype at these two loci. We obtained a 'high line' in which rats have the alleles increasing the trait, and a 'low line' with the lowering alleles. In activity cages with a dim light, the low line was more active than the high line. The reverse was found in the open field, and the inhibition of locomotor activity in the low line (as compared to the high line) was directly related to the aversiveness of the situation (larger in the centre than in the periphery, and in high light than in low light), and was more intense in males than in females. This inhibition is not attributable to a classical 'anxiety' factor as measured in the elevated plus maze, in which the open arms behaviours were not different between the lines. The high line also showed a deficit in prepulse inhibition of the acoustic startle reflex. The present data show that the two loci previously described in a SHR x Lewis intercross as related to the activity in the centre of the open field are indeed involved in a behavioural inhibition trait. The marker-based selected lines described here are unique tools for the study of the neurobiological bases of this trait and the molecular foundations of its variability of genetic origin.

[Intraperitoneal desmoid tumors and polyposis coli (presentation of 2 cases)]. / Poliposis coli y tumores desmoides intraperitoneales (a propósito de dos casos).

Two patients with polyposis coli, developed intraperitoneal desmoid tumours after colectomy. The tumours in both cases, were inoperable. Death occurred in one patient and the other required ileostomy.