Use of N-acetylcysteine during liver procurement: a prospective randomized controlled study.

Antioxidant agents have the potential to reduce ischemia/reperfusion damage to organs for liver transplantation (LT). In this prospective, randomized study, we tested the impact of an infusion of N-acetylcysteine (NAC) during liver procurement on post-LT outcomes. Between December 2006 and July 2009, 140 grafts were transplanted into adult candidates with chronic liver disease who were listed for first LT, and according to a sequential, closed-envelope, single-blinded procedure, these patients were randomly assigned in a 1/1 ratio to an NAC protocol (69 patients) or to the standard protocol without NAC [71 patients (the control group)]. The NAC protocol included a systemic NAC infusion (30 mg/kg) 1 hour before the beginning of liver procurement and a locoregional NAC infusion (300 mg through the portal vein) just before cross-clamping. The primary endpoint was graft survival. The graft survival rates at 3 and 12 months were 93% and 90%, respectively, in the NAC group and 82% and 70%, respectively, in the control group (P = 0.02). An adjusted Cox analysis showed a significant NAC effect on graft survival at both 3 months [hazard ratio = 1.65, 95% confidence interval (CI) = 1.01-2.93, P = 0.04] and 12 months (hazard ratio = 1.73, 95% CI = 1.14-2.76, P ≤ 0.01). The incidence of postoperative complications was lower in the NAC group (23%) versus the control group (51%, P < 0.01). In the subgroup of 61 patients (44%) receiving suboptimal grafts (donor risk index > 1.8), the incidence of primary dysfunction of the liver was lower (P = 0.09) for the NAC group (15%) versus the control group (32%). In conclusion, the NAC harvesting protocol significantly improves graft survival. The effect of NAC on early graft function and survival seems higher when suboptimal grafts are used.

Twelve years of experience treating Spigelian hernia.

BACKGROUND AND AIMS: A Spigelian hernia (SH) is an acquired ventral hernia that most commonly occurs in the Spigelian belt. Patients may experience pain or a bulge in the abdominal area, but in most cases there are no symptoms. If left untreated the hernia may become strangulated, which could lead to bowel obstruction. MATERIAL AND METHODS: We reviewed 28 surgical patients with SH between January 2002 and December 2013. We evaluated the incidence of complications, recurrences, and the length of hospital stay with comorbidities, body mass index, clinical presentation, and operative techniques. RESULTS: The 28 patients included 10 males and 18 females, with a mean age of 67 years. Seven patients (26.9%) received emergency operations, and the remaining patients received elective operations. An "open-direct" operative approach was used in 16 cases and a laparoscopic approach in 12. The overall complication rate was 7.6% and the recurrence rate was 3.8% with a median follow-up of 3 years. The median hospital stay was 1 day (range, 1-7). Only the presence of local complications at diagnosis showed a significant impact on length of hospital stay. None of the considered variables had a significant impact on hernia recurrence. CONCLUSION: No differences were noted among the operative techniques, wound infections, complications rate, and length of hospital stay. Laparoscopy seems to cause more early postoperative pain that reverses in about 2 weeks.

Effects of ursodeoxycholic acid on photodynamic therapy in a murine tumor model.

We previously reported that the efficacy of photodynamic therapy (PDT) in cell culture was enhanced by ursodeoxycholic acid (UDCA), a nontoxic bile acid. In this study, we examined the ability of UDCA to promote tumor control by PDT in the mouse, using the radiation-induced fibrosarcoma tumor and the photosensitizing agent tin etiopurpurin (SnET2). These experiments revealed that the addition of UDCA to a PDT protocol promoted inhibition of tumor growth, a phenomenon unrelated to either altered SnET2 biodistribution or the level of vascular shutdown during irradiation. These results indicate that UDCA acts solely by promoting direct tumor cell kill by PDT.

Clinical and radiological outcome after endovascular abdominal aortic aneurysm repair: comparison of different grafts. preliminary single-center experience.

Endovascular repair (EVAR) represents a useful and validated alternative to conventional surgery in selected patients with abdominal aortic aneurysm (AAA) because it is associated with a significantly lower long-term AAA-related mortality. Data regarding a series of 91 patients (88 men, 3 women, median age 71 years, range 65-82 years) is reported. The patients were divided into three groups, according to the type of implanted stent (Endurant, Excluder and Talent). High American Society of Anesthesiologists Physical Status Classification System (ASA) was important in increasing the likelihood of an early complication (p=0.0007), while it did not have any effect on later adverse events, which were more closely related to the size of the aneurysm (p=0.006). As expected, the aneurysm diameter influenced the endoleak incidence (p=0.011), aneurysmal sac expansion (p=0.029), re-intervention risk (p=0.031) and the success of treatment (p=0.006). A significantly lower tendency for the development of endoleak (p=0.035) and other late complications (p=0.048) was observed in patients with Endurant device. This group seems to be more likely destined to achieve therapeutic success, but the difference was not significant. A borderline significance (p=0.071) with regard to early complications was also recorded. However, the use of this type of device did not affect survival, which was exclusively related to ASA (p=0.040). No other statistically significant differences were found between groups. Since open surgery for elective suprarenal AAA repair is still associated with considerable mortality, EVAR may offer several advantages over open repair surgery, including a less invasive operative procedure, and shortened intensive care unit and hospital stay. The technological improvements of the prosthesis for EVAR will likely reduce complications related to this technique in the near future.

Endothelin receptor A -231 G>A polymorphism: no linkage to primary pediatric headache.

OBJECTIVE: To assess whether the biallelic -231 G>A polymorphism of the endothelin type A receptor (EDNRA) gene, previously shown to be a marker of increased risk for developing migraine, has a role in the susceptibility to primary pediatric headache. BACKGROUND: Several studies suggest that endothelin has a role in migraine. A recent association study has shown that the biallelic -231 G>A polymorphism of the EDNRA gene is associated to migraine in an elderly population. METHODS: A total of 126 consecutive unrelated pediatric patients affected by primary headache, classified according to the International Headache Society criteria in migraine (migraine with aura, n = 3; migraine without aura, n = 80), and tension-type headache (episodic tension-type headache, n = 36; chronic tension-type headache, n = 7) patients, were recruited to the study. Sixty-seven healthy blood donors were used as a control group. Genomic DNA was extracted from buccal swabs or blood samples and analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for the above-mentioned polymorphism. Allele and genotype frequencies for primary headache patients were analyzed in comparison with the control group. RESULTS: No significant differences were found in the distribution of the EDNRA -231 G>A polymorphic variant when considering both genotype (migraine chi2 = 2.78, P = .25; tension-type headache chi2 = 3.58, P = .17) and allelic frequencies (migraine chi2 = 1.48, P = .22; tension-type headache chi2 = 0.39, P = .56). Furthermore, no significant genotype-related difference was found in relation to clinical features, such as age at onset, frequency, and length of the attacks. CONCLUSIONS: Our study shows that the -231 G>A polymorphism in the EDNRA gene is neither associated with primary juvenile headache nor significantly correlated with main clinical features characteristic of the headache pathology in pediatric settings.

Genetic risk factors in primary paediatric versus adult headache: complexities and problematics.

Numerous candidate genes for migraine have been proposed on the basis of their possible functional role in its pathogenesis. Genetic polymorphisms have been evaluated in association studies, some of which have been suggested to be susceptibility markers for adult migraine. To date, however, none of the identified polymorphisms in adult migraine susceptibility have been investigated in children, raising the possibility that they may not be necessarily involved in paediatric migraine susceptibility. This paper reviews studies of the genetic basis of migraine and summarises our experience in genetic association studies in primary paediatric headache susceptibility.