Right living donor liver transplantation: an option for adult patients: single institution experience with 74 patients

OBJECTIVE: To present an institutional experience with the use of right liver grafts in adult patients and to assess the practicability and efficacy of this procedure by analyzing the results. SUMMARY BACKGROUND DATA: Living donor liver transplantation (LDLT) for the pediatric population has gained worldwide acceptance. In the past few years, LDLT has also become feasible for adult patients due to technical evolution in hepatobiliary surgery and increased experience with reduced-size and split-liver transplants. Nevertheless, some graft losses remain unexplained and are possibly due to unrecognized venous outflow problems. METHODS: From April 1998 to September 2002, we performed 74 right LDLTs (segments 5-8). The 74 donors were selected from 474 candidates according to standard protocol. The median age of the donors was 35 years (range 18-58 years) and 51 years (range 18-64 years) in recipients. Standard and extended indications for transplantation were considered. Over the period reported, technical modifications in the bile duct anastomosis (duct-to-duct, end-to-end, or end-to-side) and a new graft implantation technique that provides maximized venous outflow, leading to outcome improvement, were developed. RESULTS: 64.9% of patients had liver cirrhosis and 35.1% had malignancy. While 44 donors (59.5%) presented an uneventful postoperative course, 27% minor (pleural effusion, pneumonia, venous thrombosis, wound infection, incisional hernia) and 13.5% major (biliary leakage, death of a donor due to unrecognized hereditary liver disease, and consecutive liver insufficiency) complications were documented. In recipients, 23% biliary complications and 6.8% hepatic artery thrombosis occurred. The overall patient and graft survival rate after 1 year was 79.4% and 75.3%, respectively. In cases with extended indication, the patient survival rate was 74% and the graft survival rate 68% at 12 months. Using technical modifications in the last 10 recipients, including 2 critically decompensated cirrhotics, the survival rate was 100% at a median follow-up of 3.5 months. CONCLUSIONS: In our transplant program, living donor liver transplantation has become a standard option in the adult patient population. The critical issue of this procedure is donor morbidity. Technical improvements in the harvesting and implantation of right grafts can also offer hope to patients with challenging forms of end-stage liver disease or malignant liver tumors.     

Mercury Biomagnification in a Tropical Black Water,Rio Negro,Brazil

The population living along the riverbanks of the Amazon basin depends heavily on fish for nutritional support. Mono-methyl-mercury (MMHg) concentrates in fish, which can contaminate humans, the risk depending not only on fish MMHg concentration but also on the amount of fish consumed. We sampled nine locations of the Rio Negro basin, differing in water pH, Hg concentrations, and dissolved organic carbon (DOC), and determined total Hg from 951 fish samples of species representative of the food web: herbivorous, detritivorous, omnivorous, and piscivorous. Mercury concentrations varied widely in all species but showed a trend that depended on fish feeding strategies. The highest mean concentration was found in the piscivorous species (688.90 ng/g^–1), followed by omnivorous (190.30 ng/g^–1), detritivorous (136.04 ng/g^–1), and herbivorous (70.39 ng/g^–1). Fish Hg concentrations exceeding current safe limits (500 ng/g^–1) for human consumption were found mainly in the piscivorous species (60%). Significant positive correlation between fish weight and Hg concentration was seen for the piscivorous Serrasalmus spp. (n = 326; r = 0.3977; p < 0.0001), Cichla spp. (n = 125; r = 0.4600; p < 0.0001), and Pimelodus spp. (n = 12; r = 0.8299; p = 0.0008), known locally as Piranha, Tucunaré, and Mandi, respectively. However, a negative correlation was seen for nonpiscivorous Potamorhina latior (n = 30; r –0.3763; p = 0.0404) and Leporinus spp. (n = 44; r = –3987; p = 0.0073), known as Branquinha (detritivorous) and Aracu (omnivorous). Fish-Hg concentrations in the acidic waters (pH range, 4.09–6.31) of the Rio Negro habitat, with its wide gradient of Hg concentrations (3.4–11.9 g/L^–1) and DOC (1.85–15.3 mg/L^–1)—but no history of gold mining activity—are comparable to other Amazonian rivers. Opportunity fish catches in the Rio Negro habitat show high muscle-Hg derived from natural sources, but no systematic association with site-dependent geochemistry.     

Socioeconomic status and maternal cigarette smoking before, during and after a pregnancy

Abstract: Research suggests that cigarette use declines when women find out they are pregnant, increasing again after the birth. Pregnancy may provide many women with a substantial impetus to stopping smoking. Also, rates of smoking cessation and reduction may be class-related, with the highest socioeconomic-status groups manifesting higher rates of reduction. Using data from the Mater Hospital-University of Queensland Study of Pregnancy, we report family income related to rates of smoking before, during and after a pregnancy. Before becoming pregnant, 45.9 per cent of women in the sample were smokers. This declined to 34.7 per cent of women at their first clinic visit. Rates of heavy smoking (20 or more cigarettes per day) had returned to earlier levels by the six-month (after birth) follow-up. Women in the lowest family-income group had the highest rates of cigarette use before, during and after their pregnancy. Of the lowest family-income group, 8.4 per cent were heavy smokers before, during and after their pregnancy, compared with 2.8 per cent of women in the highest family-income group. Smoking cessation rates were highest in the highest family-income group (those who smoked least), but relapse rates after the birth were similar for all income groups. Arresting rates of smoking relapse by pregnant women should be seen as a major public health priority     

Rothmund-Thomson Syndrome (Thomson-Type) and Myelodysplasia

Rothmund-Thomson syndrome (RTS) is a genetic disease characterized by developmental abnormalities and poikilodermatous skin changes that appear in infancy. An association with myelodysplastic syndromes is rarely reported in RTS, even though impairment of immune function and recurrent infections are described in the literature. A case of Thomson-type RTS in a 14-year-old girl with trilinear myelodysplasia is presented. The patient was kept under hematologic surveillance for myelodysplastic syndrome. Bone marrow transplantation was considered unnecessary at present.     

Studies of fish consumption as source of methylmercury should consider fish-meal-fed farmed fish and other animal foods

The co-occurrence of fish MeHg and omega-3 fatty acids in wild species can indeed be optimized by choosing certain species. Farmed finfish and shellfish that are fed fish-meal, however, can bioconcentrate both MeHg (in muscle) and organohalogen pollutants passed on in the fat components [Dorea, J.G., 2006. Fish meal in animal feed and human exposure to persistent bioaccumulative and toxic substances. J. Food Prot. 69, 2777-2785); when fish-meal is used to feed farm animals it may offer the worst of both worlds: saturated fat (with organohalogen pollutants) and MeHg. It is time to address the dietary sources of Hg derived from animals raised on fish-meal that may contribute to increase tissue Hg concentrations.     

Accidental hypothermia in a child

We report a case of severe accidental hypothermia (24.8 degrees C) in a seven-year-old child due to prolonged exposure to low temperatures and temporary contact with river water. When the patient was seen in hospital, bradycardia (30.min-1), bradypnoea (5. min-1), scarcely reacting pupils, and Glasgow Coma Scale=3 were noted. For rewarming minimally invasive techniques (humidified warmed gases and intravenous solutions at 40 degrees C) were employed with a very successful outcome.     

Indirect Determination of Dichlorodiphenyltrichloroethane (DDT) After Dechlorination with Magnesium/Palladium Bimetallic Particles and Potentiometric Measurements

Determination of chlorine ions of pesticides was performed after dechlorination reaction using a palladium/magnesium system. Chlorine ions were quantified by potentiometry with ion-specific electrode. Rates of dechlorination of 100 μg of DDT as a function of reaction time and percent (wt/wt) of palladium deposited on the magnesium particles were determined. The best reaction conditions to DDT dechlorination were achieved with an acetone/water (1:1) solution and DDT reaction with a 0.27% (wt/wt) palladium/magnesium bimetallic system at room temperature for 10 min. The detection limit was of 0.24 μg/mL. This low cost method showed an efficiency of 92% in determining chlorine ions derived from DDT, it is fast, requiring no specialized laboratory equipment.     

Dramatic Response of Scarring Scalp Discoid Lupus Erythematosus (DLE) to Intravenous Methylprednisolone, Oral Corticosteroids, and Hydroxychloroquine in a 5-Year-Old Child

Abstract:  Discoid lupus erythematosus (DLE) is rare in childhood. We report the case of a 5-year-old girl who presented with erythematous scaly plaques, with scarring alopecia, involving approximately 40% of her scalp. Histopathology confirmed the diagnosis of DLE. Treatment with intravenous methylprednisolone, hydroxychloroquine, oral prednisone, topical corticosteroids, and sunscreen lead to reversal of scarring alopecia and re-growth of hair.     

Histiocytic erythema multiforme

Erythema multiforme is histologically characterized by liquefactive degeneration along the dermal-epidermal junction, necrotic keratinocytes and a lymphocytic infiltrate. We report a 10-year-old boy with recurrent erythema multiforme major of undetermined etiology with unusual histologic findings. A skin biopsy taken at day 2 of his eruption revealed histologic features otherwise characteristic of erythema multiforme, but mediated instead by a CD68-positive infiltrate, resembling cutaneous Kikuchi's disease. To the best of our knowledge this is the first reported case of 'histiocytic' erythema multiforme.