Comparative study of continuous and pulsed CO2 laser on tissue healing and fertility outcome in tubal anastomosis

Continuous wave (CW) CO2 laser using a power of 20 W and a spot size of 0.2 mm was used to cut the left uterine horn in 15 rats. Pulsed CO2 laser using a power of 14 W, pulse repetition rate of 400 pps, and a spot size of 0.2 mm was used to cut the left uterine horn in 16 rats. The right uterine horn was sham-operated and used as a control in each group. Microsurgical anastomosis of the cut horn was performed. The effect on fertility showed a pregnancy rate of 66.6% and 81.25% for the CW and pulsed CO2 laser, respectively. Histopathology studies of the anastomotic site revealed thinning of muscularis with fibrosis of both muscularis and subserosal layers in the CW CO2 laser-treated group. There was no thinning, disruption, or fibrosis of muscularis in pulsed laser-treated group. Adhesion score was not different in the two groups.     

Living-Related Versus Deceased Donor Pediatric Liver Transplantation: A Multivariate Analysis of Technical and Immunological Complications in 235 Recipients

Timely access to a living donor (LD) reduced pretransplant mortality in pediatric liver transplantation (LT). We hypothesized that this strategy may provide better posttransplant outcome. Between July 1993 and April 2002, 235 children received a primary LT from a LD (n = 100) or a deceased donor (DD) (n = 135). Demographic, surgical and immunological variables were compared, and respective impact on posttransplant complications was studied using a multivariate analysis. Five-year patient survival rates were 92% and 85% for groups LD and DD, respectively (p = 0.181), the corresponding graft survival rates being 89% and 77% (p = 0.033). At multivariate analysis: (1) type of donor (DD) was correlated with higher rate of artery thrombosis (p < 0.012); (2) biliary complication rate at 5 years was 29% and 23% for groups LD and DD, respectively (p = 0.451); (3) lower acute rejection incidence could be correlated with type of donor (DD) (p = 0.001), and immunosuppressive therapy (tacrolimus) (p < 0.001). We conclude that (1) according to the multivariate analysis, LT with LD provided similar patient and graft outcome, when compared to DD; (2) a higher rate of artery thrombosis and a lower rate of rejection were observed in group DD; (3) this study confirms the efficacy of tacrolimus for immunoprophylaxis, whatever the type of organ donor is.     

Permanent access to the portal system for cellular transplantation using an implantable port device.

A novel application of the implantable Port-a-Cath (PAC) system is described in the context of cellular transplantation. A silicone catheter was inserted in a collateral branch of the portal vein and connected to a port device positioned subcutaneously on the left thoracic cage. This permanent vascular access allowed iterative intraportal infusions of allogenic hepatocytes without the need of repeated transhepatic catheterization of the portal vein. Using this technique, repeated infusions of cryopreserved and / or fresh hepatocytes were successfully carried out in 3 children with inborn errors of liver metabolism, with the aim of progressively providing a sufficient mass of transplanted liver cells to stabilize the metabolic condition of the patients. We suggest that this technique might also be valuable in pancreatic islet cell transplantation.     

Ontogeny of the VIP system in the gastro-intestinal tract of the Axolotl,Ambystoma mexicanum: successive appearance of co-existing PACAP and NOS

Evidence for the presence and potential co-existence of vasoactive intestinal polypeptide (VIP), pituitary adenylate cyclase-activating polypeptide (PACAP) and nitric oxide synthase (NOS) in gastro-intestinal endocrine cells and/or nerve fibers is conflicting and very few results exist on development. This immunofluorescence study aims to clarify the appearance and localization of VIP, PACAP and NOS in the gastro-intestinal tract of the Axolotl, Ambystoma mexicanum, during ontogeny. VIP-immunoreactivity appeared in nerve fibers as early as on day 3 after hatching likely indicating a particular role, such as a trophic action, of VIP in very early development. PACAP-immunoreactivity was observed 3 days later within the VIP-immunoreactive (-IR) fibers. From this time on, VIP- and PACAP-immunoreactivity exhibited complete co-existence. VIP/PACAP-IR fibers were found throughout the gastro-intestinal tract. They were most prominent in the myenteric plexus and the muscle layers and less frequent in the submucosa. NOS-immunoreactivity appeared as late as at the 1st (64 days) juvenile stage in a subpopulation of the VIP/PACAP-IR fibers that contacted submucosal arteries. We found only very few VIP/PACAP-IR perikarya, indicating that part of the VIP/PACAP-IR fibers is of extrinsic origin. On day 12 and in the 1st and 2nd (104 days) juvenile stage, infrequent PACAP-IR entero-endocrine cells were noted, while neither VIP- nor NOS-immunoreactivity occurred in endocrine cells at any stage of development. The complete coexistence of neuronal PACAP- and VIP-immunoreactivities and their very early appearance in ontogeny may suggest important and coordinated roles of both peptides in the control of Axolotl gastro-intestinal activity, while the VIP/ PACAP/NOS-IR fibers may be involved in the regulation of submucosal blood flow.     

The effect of CO2 laser laparoscopy for treatment of pelvic endometriosis on serum concentrations of antiendometrial antibodies

This study uses antiendometrial antibodies as an indicator for follow-up of patients with endometriosis after surgical treatment. This is a prospective study of 32 patients with endometriosis. The patients were used as their own controls. Serum samples were obtained before surgery and 1 month, 3 months, and 6-9 months following surgery. All patients were treated with CO2 laser laparoscopy. Serum concentrations of antiendometrial antibodies decreased significantly at 1 month, 3 months, and 6-9 months following treatment in each group. There was no correlation between baseline concentration of antibodies and stage of the disease. This study confirms the value of using antiendometrial antibodies as an indicator for follow-up of endometriosis patients. Surgical treatment with CO2 laser laparoscopy is effective in lowering the antigenic effect of the disease in these patients. This beneficial effect is maintained for up to 9 months after treatment.     

Hepatitis E antibodies in Egyptian adolescent females: their prevalence and possible relevance

Hepatitis E virus has been implicated as a frequent cause of acute sporadic hepatitis among Egyptian children. Moreover, an extraordinarily high seroprevalence rate was previously reported in a semiurban Nile Delta population. A conspicuous feature of hepatitis E is the high morbidity and mortality it can cause among infected pregnant women. We therefore evaluated the prevalence of HEV antibodies in adolescent females using a solid-phase enzyme linked immunoassay based on two recombinant hepatitis E virus antigens. A high prevalence rate (38.9%) was found in 95 apparently healthy adolescent females. The mean age of the study subjects was 21.81 +/- 2.5 (SD) range 16-25 years. Eighty (84.2%) subjects resided in Alexandria, while 15 (15.8%) came from semiurban villages of Alexandria Governorate. An increased prevalence was noted with age, as anti-HEV antibodies were detected in 32.1% and 41.8% of study participants in the second and third decades of life, respectively. Similarly, those illiterate or having received less than primary education exhibited a higher HEV prevalence than those with higher education (46.3% vs 29.3%). The majority of subjects having serological evidence of HEV infection denied previous history of jaundice which shows that HEV infection was subclinical in those cases. Ten (55.6%) pregnant females participating in the study, as well as 48 (62.3%) non pregnant females lacked serological evidence of HEV infection; i.e., 60.01% (10 + 48 out of 95) of women in the childbearing age may be susceptible to infection. This report suggests that HEV is endemic in Alexandria, Egypt; the epidemiologic risk factors associated with HEV infection need further exploration.