Effects of different doses of statins on liver regeneration through angiogenesis and possible relation between these effects and acute phase responses

Background

We examined the effects of two doses of statins on liver regeneration through angiogenesis and its possible relation to acute phase responses.

Materials and Methods

Seventy-two rats were randomly divided into three groups: controls; low-dose atorvastatin (0.5 mg/kg/d); high-dose atorvastatin (2.5 mg/kg/d). Statin was administered daily by oral gavage for 7 days. After atorvastatin treatment, all animals in the three groups underwent 70% hepatectomy. Thereafter animals were subdivided into three subgroups, to evaluate the characteristics of liver regeneration proliferating cell nuclear antigen (PCNA), angiogenesis (KDR/Flk-1 [vascular endothelial growth factor-2]) and acute phase response (serum interleukin [IL]-6) at 12, 24, and 72 hours.

Results

At the 24 hours posthepatectomy, low-dose compared with high-dose atorvastatin increased liver regeneration (P = .004) and angiogenic responses compared also to controls (P = .026 and P = .059). However, there appeared no difference in IL-6 expression (P = .159). At the 72 hours posthepatectomy, low-dose atorvastatin treatment increased liver regeneration compared with controls (P = .047), but it showed no significant difference from the high-dose treatment (P = .109). Low doses of statin increased angiogenic responses compared with both control and high-dose animals (P = .016 and P = .002). Moreover, the high-dose group displayed decreased angiogenic responses compared with the control group (P = .044). Serum IL-6 expression was significantly greater among both low- and high-dose groups compared with controls (P = .005 and P = .003, respectively).

Conclusions

Low-dose statin treatment increased KDR/Flk-1-dependent angiogenesis, which resulted in an increased regeneration response. In contrast, high-dose statin therapy decreased angiogenesis without affecting long-term regeneration responses. Finally, statin therapy may contribute to liver regeneration due to prolonged IL-6 expression independent of statin doses.     

Prophylaxis of cytomegalovirus disease in mismatched patients after heart transplantation using combined antiviral and immunoglobulin therapy

Background

Cytomegalovirus (CMV) is a common cause of infection and morbidity after heart transplantation. Seronegative recipients (R−) of seropositive donor hearts (D+) are at high risk for CMV disease. We compared three different CMV prophylaxis regimens using combined antiviral and immunoglobulin therapy.

Methods

In 99 patients who survived more than 30 days after heart transplant, all received induction with antilymphocytic therapy and triple-drug therapy. In group A, D+R− patients received one dose of intravenous immunoglobulin (IVIG) followed by one dose of CMV-specific immunoglobulin (CMV-IVIG), and intravenous ganciclovir (GCV) for 4 weeks followed by 11 months of oral acyclovir (ACV). In group B, D+R− patients received one dose IVIG followed by five doses of CMV-IVIG and intravenous GCV for 14 weeks followed by 9 months of oral ACV. In group C, D+R− patients were treated with the same regimen as for group B, except oral ACV was replaced with oral GCV.

Results

The actuarial freedom from CMV disease for D+R− patients at 1 month, 1 year, and 2 years after transplantation in group A was 100%, 25% ± 15%, and 25% ± 15%, respectively; group B was 100%, 67% ± 27%, and 67% ± 27%; group C was 100%, 83% ± 15%, and 83% ± 15% (P < .01, groups B and C vs group A). By comparison, the actuarial freedom from CMV disease for seropositive recipients (D−R+ or D+R+) at 1 month, 1 year, and 2 years in group A was 100%, 87% ± 7%, and 82% ± 8%, respectively; group B was 100%, 88% ± 8%, and 75% ± 11%; group C was 100%, 72% ± 9%, and 72% ± 9% (P = NS among groups). Rejection rates did not differ among the three groups.

Conclusions

A longer course of intravenous GCV with multiple doses of CMV-IVIG was a more effective prophylaxis regimen against CMV disease for the high-risk group of seronegative recipients of seropositive donor hearts.     

One-year follow-up of en bloc renal transplants from pediatric donors in adult recipients

Objectives

The optimal use of kidneys from small pediatric cadaveric donors remains controversial. The aim of this study was to analyze short-term graft and patient survivals of en bloc kidney transplantations compared with single cadaveric adult donor kidney transplantations.

Patients and methods

We compared the 1-year evolution of 14 adult recipients of en bloc pediatric kidney donors (EBKT) of median age 13.5 ± 14.5 months (range = 3 days to 48 months) with 182 recipients of ideal adult cadaveric donors (ADT) showing a median age of 30 ± 21 years (range = 14-45 years).

Results

Besides the different age and weight of the donors, EBKT recipients were more commonly women (P = .05) and received thymoglobulin induction treatment (P = .00). Delayed graft function was higher in EBKT (46.2% vs 22.2%, P = .05), with no differences in the incidences of acute rejection episodes. Mean serum creatinine values at 3, 6, and 12 months after transplantation were 1.1 ± 0.3, 1.1 ± 0.2, and 1.0 ± 0.2 mg/dL in the EBKT group, compared with 1.3 ± 0.5 (P = .16), 1.3 ± 0.5 (P = .02), and 1.3 ± 0.6 (P < .01) in the ADT group. Vascular allograft complications were more frequent among EBKT. Graft survival rate at 1 year was 92% in both groups, with no differences in patient survival (100% in EBKT vs 92% in ADT; P = .49).

Conclusions

EBKT from small pediatric donors show excellent graft function and 1-year survival and should be considered for transplantation into adults.     

Tranexamic Acid and Hyaluronate/Carboxymethylcellulose Create Cell Injury

Background and Objectives:

Postoperative pelvic adhesions are associated with chronic pelvic pain, dyspareunia, and infertility. The aim of this study was to evaluate the adhesion prevention effects of tranexamic acid (TA) and hyaluronate/carboxymethylcellulose (HA/CMC) barrier in the rat uterine horn models on the basis of macroscopic and microscopic adhesion scores and histopathological as well as biochemical parameters of inflammation.

Methods:

Twenty-one Wistar rats were randomly divided into 3 groups. Ten lesions were created on the antimesenteric surface of both uterine horns by bipolar cautery. Three milliliters of 0.9% sodium chloride solution were administered in the control group. A single layer of 2 × 2 cm HA/CMC was plated in group 2. Two milliliters of TA was applied in the last group. All rats were sacrificed at postoperative day 21.

Results:

No significant difference was found among the control group, the HA/CMC group, and the TA group in terms of macro-adhesion score (P = .206) and microadhesion score (P = .056). No significant difference was found among the 3 groups in terms of inflammation score (P = .815) and inflammatory cell activity (P = .835). Malondialdehyde levels were significantly lower in the control group than in the TA group and HA/CMC group (P = .028). Superoxide dismutase and glutathione S-transferase activities were found to be higher in the control group than in the TA group (P = .005) and HA/CMC group (P = .009).

Conclusions:

TA and HA/CMC had no efficacy in preventing macroscopic or microscopic adhesion formation and decreasing inflammatory cell activity or inflammation score in our rat models. TA and HA/CMC increased the levels of free radicals and reduced the activities of superoxide dismutase and glutathione S-transferase enzymes, which act to reduce tissue injury.     

Is peritoneal drainage necessary in childhood perforated appendicitis?--a comparative study

Purpose/Background

In this study, we aimed to evaluate the effect of peritoneal drainage (PD) on postoperative infective complications in cases with perforated appendicitis.

Method

One hundred nine patients (with PD) were evaluated retrospectively and 117 cases (with no drainage [ND]) were evaluated prospectively regarding complications like wound infection (WI), intraabdominal abscess (IAA), and small bowel obstruction caused by adhesions (SBO) in perforated appendicitis cases. The abdomen was irrigated with isotonic NaCl solution and the wounds were closed primarily in all patients.

Results

The total number of patients was 226 (male, 66.4%; female, 33.6%), with a mean age of 8.6 ± 3.4 years (range, 1-15 years). The WI rates in PD and ND groups were 28.4% to 16.2%, respectively. The ratio of IAA in the PD group was 12.8% which decreased to 3.4% in the ND group. The difference was statistically significant (P < .05). The postoperative hospitalization period in the PD and ND groups were 10.2 ± 6.5 and 8.3 ± 3.3 days, durations of antibiotic use were 9.5 ± 5.5 and 7.7 ± 2.7 days, durations of NG tube usage were 3.2 ± 1.5 and 2.2 ± 1.2 days, time to oral feeding was 3.7 ± 1.7 and 2.5 ± 1.4 days, and time to normalization of the body temperatures was 3.7 ± 2.3 vs 2.3 ± 1.7 days. All differences were statistically significant (P < .05). The ratio of SBO increased from 2.8% to 3.4% in the ND group, but this result was not statistically significant.

Conclusions

As a result of this study, we recommend that peritoneal drainage should be abandoned in childhood appendicitis.     

Natural course and outcome of cystic lesions in the pancreas

Background

The number of patients identified with cysts of the pancreas is increasing. The current study was undertaken to assess the natural course and malignant potential of pancreatic cysts.

Methods

From 1995 to 2008, radiology records were reviewed for the presence of cystic lesions of the pancreas (CLP) characteristics, patient demographics, and follow-up.

Results

Eighty-two patients met the study inclusion criteria, with a mean age at time of diagnosis of 64.4 ± 16.7 years. Mean cyst size was 1.36 ± 1.05 cm, with 75.6% of patients having a solitary cyst. Thirteen patients underwent surgery. Operative intervention was statistically related to symptomatic, loculated cysts with the presence of calcifications (all P <.05). Malignancy was statistically related to symptomatic (P <.05), loculated cysts (P <.01), and male gender (P <.05).

Conclusions

Our data show that most pancreatic cysts found on radiographic imaging are asymptomatic, solitary, and small and can be followed safely radiographically.     

A comparison of laparoscopic and open Nissen fundoplication and gastrostomy placement in the neonatal intensive care unit population

Introduction

The aim of this study was to compare outcomes after laparoscopic and open techniques for Nissen fundoplication and gastrostomy placement in the neonatal intensive care unit (NICU) population.

Methods

The medical records for NICU inpatients who underwent laparoscopic and open Nissen fundoplication and gastrostomy placement from August 2002 to August 2008 were reviewed after Institutional Review Board approval. Each technique was compared with regard to operative time, estimated blood loss, postoperative 24-hour narcotic requirements, time to goal feeds, and complication rates. Analysis of variance was used to determine statistical significance. Data are quoted as mean ± SEM.

Results

Fifty-seven NICU patients underwent fundoplication and gastrostomy placement (25 laparoscopic and 32 open). The time to goal feeds was significantly shorter for the laparoscopic group (4.3 ± 0.4 vs 6.1 ± 0.6 days, P = .04). The 24-hour postoperative narcotic requirement was significantly lower in the laparoscopic group (0.24 ± 0.05 vs 0.55 ± 0.08 mg/kg, P = .007). Operation times (111 ± 5 [open] vs 113 ± 5 minutes, P = .76) and estimated blood loss (13 ± 2 [open] vs 11 ± 1 mL, P = .33) were comparable for both groups.

Conclusion

Laparoscopic and open techniques for Nissen fundoplication with gastrostomy placement are safe and appropriate treatment methods with equivalent operating times for the treatment of gastroesophageal reflux in the NICU population.     

The effects of local and sustained release of fibroblast growth factor on wound healing in esophageal anastomoses

Background/Purpose

Postsurgical complications, such as anastomotic leaks in patients with esophageal atresia, have remained unchanged during the last 3 decades. Growth factors enhance healing in several wound-healing models. Therefore, an experimental study was used to evaluate the effects of local and sustained release of basic fibroblast growth factor (FGF) on wound healing in esophageal anastomoses.

Materials and Methods

Twenty-four male Wistar albino rats, which were subjected to a 1-cm segmental resection of the abdominal esophagus followed by end-to-end anastomosis, were allocated into 3 groups. Group I, the control group, had no gelatin film applied to the anastomosis. In group II (gelatin film without FGF) and group III (gelatin film with FGF), anastomoses were covered with unloaded and 2.55 μg FGF-loaded gelatin films, respectively. On postoperative day 7, bursting pressures, histopathologic collagen deposition, and tissue hydroxyproline concentrations of the anastomoses were then analyzed and compared.

Results

Mean bursting pressures, mean submucosal and muscular collagen deposition scores, and mean tissue hydroxyproline concentrations differed significantly between groups. Mean bursting pressures were 22.5 ± 3.1 mm Hg in group I, 29 ± 1.6 mm Hg in group II, and 63.2 ± 6.8 mm Hg in group III (P < .001). Mean submucosal collagen deposition scores (group I: 0.7 ± 0.2, group II: 0.7 ± 0.1, group III: 1.5 ± 0.2; P = .02) and mean muscular collagen deposition scores (group I: 0.8 ± 0.2, group II: 0.8 ± 0.1, group III: 1.8 ± 0.1; P = .01) were significantly higher in FGF animals than the other in the other 2 groups. Mean tissue hydroxyproline concentrations were 2.4 ± 0.5 μg/mg in group I, 3.9 ± 0.4 μg/mg in group II, and 6.0 ± 1.0 μg/mg in group III (P = .007).

Conclusion

Local and sustained release of FGF enhanced wound healing in esophageal anastomoses in this animal model.     

A combination antioxidant therapy prevents age-related hearing loss in C57BL/6 mice

Objective

Age-related hearing loss (ARHL) is characterized by gradual, progressive sensorineural hearing loss, which impairs communication, lending to clinical depression and social withdrawal. There are currently no effective treatments for ARHL. The purpose of this study is to evaluate the potential of a combination antioxidant therapy in preventing ARHL.

Study Design

Randomized controlled trial.

Setting

Animal study.

Subjects and Methods

C57BL/6 mice, a recognized animal model of ARHL, were assigned to one of three groups: early treatment (n = 12), late treatment (n = 9), or control group (n = 9). Treatment groups of mice were fed with a combination agent comprising six antioxidant agents that target four sites within the oxidative pathway: L-cysteine-glutathione mixed disulfide, ribose-cysteine, NW-nitro-L-arginine methyl ester, vitamin B12, folate, and ascorbic acid. Auditory brainstem response (ABR) thresholds were recorded at baseline and every three months following initiation of treatment.

Results

Threshold shifts from baseline were decreased in the treatment groups when compared to the control group at all tested frequencies (P < 0.001). The ABR threshold shift at 12 months of age for the control group was 34.7 dB with a 95% confidence interval (CI) of ±1.6. The mean threshold shifts for the early and late treatment groups were 7.5 dB (±0.87, 95% CI) and 9.2 dB (±1.6, 95% CI).

Conclusion

Combination antioxidant therapy effectively decreased threshold shifts on ABR within an animal model of ARHL. Combination antioxidant therapy, with further research and investigation, may provide a safe and cost-effective method of preventing presbycusis in the growing elderly population.     

The antiproteinuric effects of green tea extract on acute cyclosporine-induced nephrotoxicity in rats

Background

It has been reported that the proteinuria is an early useful marker to detect cyclosporine (CsA) nephrotoxicity. The aim of this study was to investigate the antiproteinuric effects of green tea extract (GTE) on CsA-induced acute renal injury in rats.

Methods

The rats (n = 28) were divided into four groups (n = 7/group); controls intraperitoneally (IP) injected with 0.9% saline; CsA group IP injected CsA (50 mg/kg); inducible nitric oxide synthase (iNOS) inhibitor group administered in addition NG-nitro-L-arginine-methyl ester (12 mmol/L) subcutaneously and CsA-GTE group of CsA IP plus GTE (100 mg/kg) subcutaneously.

Results

The 24-hour urine proteins were significantly increased among the CsA (22.6 ± 3.1 mg/d) compared with the control (7.1 ± 1.5 mg/d) and significantly decreased in the CsA-GTE group (8.2 ± 1.8 mg/d, P < .01). Nitric oxide production induces by CsA treatment was significantly suppressed by GTE and iNOS inhibitor. Renal tissue malondialdehyde level was significantly increased in the CsA compared with controls and significantly decreased in the CsA-GTE group. The antioxidant enzyme activities of superoxide dysmutase and catalase, which were significantly suppressed in the CsA compared with the control group, were restored in the CsA-GTE cohort.

Conclusion

GTE treatment of rats showed meaningful antiproteinuric effects through antioxidative activity in kidneys from CsA-induced acute renal injury.     

Repair of ischemic mitral regurgitation does not increase mortality or improve long-term survival in patients undergoing coronary artery revascularization: a propensity analysis

Background

The purpose of this study was to compare operative mortality and midterm outcome of patients with ischemic mitral regurgitation (MR) undergoing either coronary artery bypass grafting (CABG) alone or CABG with mitral valve (MV) repair.

Methods

From 1996 to 2001, 51 consecutive patients underwent CABG with MV repair for ischemic MR. All patients in this group were matched to similar patients with ischemic MR undergoing CABG alone during the same 6-year period using propensity analysis (considering 24 covariates, including severity of MR and New York Heart Association [NYHA] class).

Results

Propensity score matching yielded 51 closely matched control patients. Preoperative MR severity was 3+ or 4+ in 94% of CABG with MV repair and 96% of CABG-alone patients, and 86% of patients in each group were NYHA class III or IV. Operative mortality was 3.9% ± 2.8% in both groups. Survival was also similar between CABG with MV repair and CABG alone at 1 year (84% ± 5% versus 82% ± 5%) and 3 years (70% ± 7% versus 71% ± 7% (p = 0.43). Among survivors, NYHA class improved at follow-up (50 ± 20 months) from 3.4 ± 0.7 to 1.7 ± 1.0 for CABG with MV repair (p < 0.001) and from 3.4 ± 0.7 to 1.8 ± 1.0 for CABG alone (p < 0.001).

Conclusions

Operative mortality, midterm survival, and late functional class were similar between two well-matched groups of patients undergoing CABG for ischemic MR, differing only in the addition of MV repair. Whereas MV repair can be added safely to CABG in this group of high-risk patients without increasing mortality, its impact on late survival and functional class may be limited.     

Laparoscopically assisted anorectal pull-through for high imperforate anus in infants: intermediate results

Purpose

The aim of this study was to evaluate the clinical outcomes and postoperative anal function in infants with congenital high imperforate anus treated with laparoscopically assisted anorectal pull-through (LAARP).

Methods

From January 2004 to July 2007, 33 patients (28 boys and 5 girls, age ranging from 3 to 10 months) with high imperforate anus underwent LAARP. Clinical data of the LAARP group were retrospectively compared with those treated by posterior sagittal anorectoplasty (PSARP; n = 28) during the same time period. Anorectal function of these patients was evaluated using the following 3 methods: the Kelly score, anorectal vector volume manometry, and magnetic resonance imaging between the ages of 3.1 and 4.4 years.

Results

The mean operative time in LAARP and PSARP groups was 112.5 ± 12.4 and 120.4 ± 18.5 minutes (P > .05), respectively. The mean length of hospital stay in the LAARP group was shorter than that of PSARP group (11.3 ± 2.1 vs 14.6 ± 2.3 days, P < .01). No significant difference was observed between LAARP and PSARP groups regarding the Kelly score (3.52 ± 1.42 vs 3.49 ± 0.82). Although magnetic resonance imaging revealed lower malposition rates of rectum in the LAARP group than those of the PSARP group at both I-line (3.0% vs 14.3%) and M-line (3.0% vs 10.7%) levels, this was not statistically different (P > .05). Compared with the PSARP group, lower asymmetric index, larger vector volume, and higher anal canal pressure at rest and during voluntary squeeze were observed in LAARP group (P < .05). However, there were no significant differences in the length of high-pressure zone (15.2 ± 5.8 vs 15.1 ± 6.2 mm) and the presence of rectoanal relaxation reflex (84.8% vs 85.7%).

Conclusions

Satisfactory fecal continence can be achieved in patients with high-type imperforate anus after LAARP. Laparoscopically assisted anorectal pull-through has advantages over PSARP, including shorter hospital stay and better position of rectum. However, long-term follow-up is necessary to compare the benefits of LAARP against PSARP.     

Carbon dioxide pneumoperitoneum prevents intraperitoneal adhesions after laparotomy in rats

Purpose

The aim of this study was to assess whether carbon dioxide insufflation (CDI) pneumoperitoneum prevents intraperitoneal adhesions (IPAs).

Methods

Laparotomy was performed in 40 8-week-old Lewis rats and their bowels delivered through the wound and manipulated. The rats were divided into 4 groups, namely, those that would have laparotomy (Lp group, n = 15), Lp with CDI (Lp-CDI group, n = 15), Lp and bowel anastomosis (LpBA group, n = 5), and LpBA with CDI (LpBA-CDI group, n = 5). LpBA and LpBA-CDI group rats had 1 cm of ileum excised and end-to-end anastomosis performed. To accelerate IPA formation, all rats then had their bowels heated to 45°C for 40 seconds and 0.5 mL of Lewis rat blood spilled over them. Rats in the control group (n = 5) had Lp alone without heating or blood spillage. Pneumoperitoneum involved insufflating carbon dioxide into the peritoneal cavity through a cannula at the time of final abdominal closure to create pneumoperitoneum to a pressure of 5 mm Hg. All rats had relaparotomy 10 days after surgery and IPAs were assessed blindly using an IPA severity score (IPASS: 0 = no adhesions, 1 = no serosal tears during adhesiolysis, 2 = serosal tears during adhesiolysis, 3 = bowel perforation during adhesiolysis). Only the worst IPA in each rat was scored. Rats were killed after the peritoneum and bowels were excised for histopathology.

Results

Pneumoperitoneum resolved in approximately 5 days. There were no associated side effects. The Lp-CDI group had significantly lower IPASS than the Lp group (0.23 ± 0.46 vs 1.07 ± 1.18, P < .05), and the LpBA-CDI group had significantly lower IPASS than the LpBA group (1.50 ± 0.61 vs 2.40 ± 0.55, P < .05). Histopathology showed pneumoperitoneum had no effect on the peritoneum or bowels.

Conclusions

Our results suggest that CDI pneumoperitoneum appears to prevent IPA, especially between bowel-bowel IPA.     

Intra-abdominal administration of bevacizumab diminishes intra-peritoneal adhesions

Aim

To determine the effect of a single dose of bevacizumab on adhesion formation in the rat cecum abrasion model.

Methods

The cecum and parietal peritoneum of 38 male Wistar rats were abraded to promote adhesion formation. The rats were randomized into 2 groups: group 1 received bevacizumab (2.5 mg/kg) intraperitoneally, and group 2 received saline. On day 30 animals were killed, adhesions scored, and histopathological samples taken.

Results

There was no wound dehiscence; there were 2 incision hernias (5.3%), 1 per group. Thirty-seven animals developed adhesions (97.4%). Adhesion grade and severity scores were significantly different between groups 1 and 2 at 2.7:1.6 (P = .018) and 3.8:2.7 (P = .007), respectively. There was no difference in adhesion square area (27.7:25.0%; P = .16), location (P = 1.00), or number (2.1:1.3; P = .06). Histopathology confirmed the statistical difference between groups (P = .049), and a highly significant correlation between results was shown (r = .758; P = .0001).

Conclusion

A single dose of intraperitoneal bevacizumab significantly reduces grade and severity of abdominal adhesions in the cecum abrasion rat model.     

Evaluation of a bioabsorable polylactide film in a large animal model for the reduction of retrosternal adhesions

Objectives

An adult pig model of retrosternal adhesion formation via an inferior hemisternotomy was used to evaluate the formation and development of pericardial and retrosternal adhesions, as well as adhesion reduction using two thicknesses of a bioabsorbable polylactide film.

Materials and methods

Twenty-five adult female pigs (70 kg) were allocated to either a control group or four different treatments using two thicknesses (0.02 or 0.05 mm) of a polylactide film. In each animal, the film was placed either inside the pericardium or inside and outside the pericardium.

Results

All animals demonstrated adhesions between the posterior and lateral surfaces of the heart and pericardium. Thick fibrous retrosternal adhesions and pericardial adhesions were noted in the control animals with complete obliteration of the anatomical plane. The polylactide films preserved the anatomical planes and reduced the adhesion response.

Conclusions

A reproducible animal model was used to examine the formation and reduction of retrosternal and pericardial adhesions. A polylactide film placed inside the pericardium or between the heart and sternum was able to limit adhesion formation and maintain the anatomical planes, which would facilitate reentry.     

Clinical outcome of laparoscopically assisted endorectal pull-through in Hirschsprung's disease: comparison of abdominal and perineal approaches

Background/Purpose

Laparoscopically assisted endorectal pull-through (EPT) via a perineal approach using a prolapsing technique (PA) for Hirschsprung’s disease (HD) has been reported. However, the clinical outcome after this approach has not been reported. The purpose of this study was to compare the clinical outcome of PA and the conventional transabdominal approach (TA).

Methods

In the period between 1990 and 2001, 20 cases of HD underwent EPT with TA (group O), and 21 underwent EPT with PA (group L). There was no difference in age and weight distribution between the 2 groups. Clinical outcome was assessed 3 years after surgery.

Results

The operation time was comparable in the 2 groups (4.9 ± 0.8 v 5.2 ± 0.8 hr), whereas blood loss (98 ± 52 v 36 ± 30 mL) and postoperative complications requiring surgical intervention (26% v 0%) were significantly lower in group L. The incidence of postoperative enteritis (27% v 28%) and voluntary defecation (more than once every/2 days) were compatible in the 2 groups (70% v 87%). Soiling (small amount of involuntary stooling; >1 per month) was significantly less frequent in group L (45% v 14%).

Conclusions

Laparoscopically assisted ETP with PA is less invasive and can provide a better clinical outcome compared with TA in terms of postoperative soiling.     

Heart transplantation under cyclosporine or tacrolimus combined with mycophenolate mofetil or everolimus

Objective

In this study, we examined whether cyclosporine was effective when combined with everolimus in clinical heart transplantation (HT).

Patients and Methods

From August 2004 to July 2007, 108 adult patients underwent primary HT. The main exclusion criteria were: donors >60 years; cold ischemia times >6 hours; recipients of multiorgan transplantation or a previous transplantation; and panel-reactive antibodies ≥25%. The cyclosporine plus everolimus regimen (group CE, n = 32) was suggested first; upon refusal or if the recipient or donor was positive for hepatitis B surface antigen or PCR + hepatitis C infection, then patient was randomly assigned to success cyclosporine plus mycophenolate mofetil (MMF; group CM, n = 24) or tacrolimus plus MMF (group TM, n = 25). All patients underwent similar operative procedures and postoperative care with protocol endomyocardial biopsies.

Results

No 30-day mortality was noted in any group. The efficacy failure rates were 3%, 25%, and 16% in groups CE, CM, and TM, respectively (P = .04 between groups CE and CM). The 1-year survivals were 96.7% ± 18.1%, 89.7% ± 29.8%, and 81.0% ± 35.5% for groups CE, CM, and TM, respectively (P = .04 between groups CE and TM). The 3-year survival rates were 91.9% ± 28.3%, 79.8% ± 46.0%, and 81.0% ± 35.5% in groups CE, CM, and TM, respectively.

Conclusions

The 3 immunosuppressive regimens offered good efficacy after HT. The cyclosporine plus everolimus regimen showed a significantly better result with less efficacy failure (compared with cyclosporine plus MMF: 3% vs 25%) and better 1-year survival compared with tacrolimus plus MMF: 96.7% vs 81.0%.     

Modern wound care for the poor: a randomized clinical trial comparing the vacuum system with conventional saline-soaked gauze dressings

Background

A clinical randomized trial was performed to determine whether a simple homemade wound vacuum-dressing system (HM-VAC) is a feasible alternative to the use of conventional saline-soaked gauze dressings (WET) for the treatment of complex wounds in a resource-poor hospital.

Methods

Forty patients were analyzed to compare the HM-VAC and the WET dressings. The HM-VAC was assembled with tools available in most operating room worldwide. The primary outcome measure was the time of complete wound healing. Additionally, the costs of both methods were calculated.

Results

The time required to achieve complete healing was 16 days in the HM-VAC group compared with 25 days in the WET group (P = .013). The HM-VAC costs US $360 per case, and the WET technique costs US $271 per case (P = .008).

Conclusions

The HM-VAC should be considered in underdeveloped countries to provide modern management for complex wounds because healing is significantly faster compared with conventional wound care. Although the HM-VAC is more costly than the conventional approach, it is probably affordable for most resource-poor hospitals.