Method for tissue clearing: temporal tissue optical clearing

Light absorption and scattering in biological tissue are significant variables in optical imaging technologies and regulating them enhances optical imaging quality. Optical clearing methods can decrease light scattering and improve optical imaging quality to some extent but owing to their limited efficacy and the potential influence of optical clearing agents on tissue functioning, complementing approaches must be investigated. In this paper, a new strategy of optical clearing proposed as time-dependent or temporal tissue optical clearing (TTOC) is described. The absorption and scattering in light interaction with tissue are regulated in the TTOC technique by altering the pulse width. Here, the dependence of optical properties of matter on the pulse width in a gelatin-based phantom was investigated experimentally. Then, a semi-classical model was introduced to computationally study of Ultra-short laser/matter interaction. After studying phantom, the absorption and scattering probabilities in the interaction of the pulse with modeled human skin tissue were investigated using the proposed model for pulse widths ranging from 1µs to 10fs. The propagation of the pulse through the skin tissue was simulated using the Monte Carlo technique by computing the pulse width-dependent optical properties (absorption coefficient µ_a, scattering coefficient µ_s, and anisotropy factor g). Finally, the penetration depth of light into the tissue and reflectance for different pulse widths was found.     

Appendiceal hydatid cyst: a case report and review of literature

Hydatid cyst has a predilection to involve liver and lungs. Most of the reported cases of appendiceal hydatid cyst are primary, and secondary involvement has been rarely reported in the English-language literature. Herein, we report a 47-year-old man who presented with abdominal pain, fatigue, and anorexia since 6 months ago. He had history of surgery for hepatic hydatid cyst 7 years ago. Diagnosis of secondary hydatidosis was made upon positive indirect hemagglutination assay and abdominopelvic computed tomography scan, which showed involvement of liver, appendix, and spleen. Albendazole was started, and surgical cystectomy, appendectomy, and splenectomy were performed. Albendazole was continued postoperatively for 6 months. During this period, liver function test and abdominal sonography were normal. Despite its rarity, our case emphasizes that primary care physicians should have high index of clinical suspicion of secondary hydatidosis of appendix when they detect cystic mass, especially in patients with previous hepatic hydatid disease.     

Comparison of Child-Turcotte-Pugh and pediatric end-stage liver disease scoring systems to predict morbidity and mortality of children awaiting liver transplantation

BACKGROUND: The pediatric end-stage liver disease (PELD) scoring system has been used widely for prioritizing children awaiting orthotopic liver transplantation (OLT). The aim of the present study was to compare the Child-Turcotte-Pugh scoring system with PELD to predict morbidity and mortality of children scheduled for OLT before the organ was available. MATERIALS AND METHODS: From 1999 to 2006, 83 infants and children were evaluated and scheduled for OLT. Child and PELD scores were determined according to the initial assessment at the time of listing. Outcome was examined using records and follow-up data. RESULTS: Among 83 patients, 12% were Child A; 53%, Child B; and 35%, Child C. The mean PELD score at listing was 19.8+/-12.8. Patients with Child scores A, B, and C displayed mean PELD scores of 7.1+/-4.9, 15.7+/-9.3, and 30.5+/-11.7, respectively. Child classification and scoring showed a positive correlation with the PELD score (Spearman's correlation coefficient: 0.666, P=.001). A higher PELD score was associated with greater morbidity and mortality. CONCLUSION: Child classification has several shortcomings; therefore, PELD scores appear to be the best metric to prioritize children listed for OLT.     

Comparison of early outcome and histologic findings of enteric drainage with bladder drainage in pancreas transplantation of dogs

BACKGROUND: The clinical and pathological findings of enteric-drained (ED) versus bladder-drained (BD) pancreas transplantation are still controversial. In this study, we compared early outcome and histological findings of these 2 methods. METHODS: In an experimental animal model, after diabetization, 16 dogs were randomly divided into 2 groups. In the first group, the pancreas was transplanted with enteric drainage, and in the second group, with bladder drainage. We evaluated early clinical and pathological outcomes. RESULTS: The mean survival time was 11.25 +/- 5.0 (range, 5-20) days for group 1 and 13.6 +/- 7.2 (range, 3-23) days for group 2 (P>.05). Fasting blood sugar values (FBS) before transplantation were 279 +/- 26.8 mg/dL versus 278 +/- 41.6 mg/dL, respectively (P>.05). Two weeks postoperative serum FBS had decreased to 84.9 +/- 2.9 versus 84.2 +/- 0.98, respectively (P>.05). Serum amylase in the BD and ED groups were 378.5 +/- 328 versus 422.6 +/- 54.7 mg/dL, respectively (P>.05). Early leakage was not observed in dogs with BD, whereas it was 37.5% among dogs with ED (P<.05). Clinical and pathological evidences of pancreatic necrosis occurred in 37.5% of dogs with BD versus 62.5% of dogs with ED (P>.05). DISCUSSION: Although the early outcomes of these drainage methods (ED vs BD) were statistically similar more dogs with ED experienced early complications than with BD.     

Transplantation of a cadaveric liver allograft with right lobe cavernous hemangioma, without back-table resection: a case report

The use of extended criteria liver donors has become a necessity in an era of organ scarcity for transplantation. We present here a case report of orthotopic liver transplantation using a liver with a giant right lobe hemangioma without backtable resection. CASE REPORT: There were no data regarding the liver mass before organ procurement. The donor liver function tests and electrolyte profile were normal. During donor exploration a hemangioma was identified in segments V-VI, occupying approximately 20% of the total liver volume. It was prepared for transplantation on a sterile backtable without performing backtable hemangioma resection. A standard orthotropic liver transplant procedure was performed uneventfully, without veno-veno bypass. There was no bleeding from the hemangioma. The ischemic time was 9 hours and 20 minutes. Postoperative course was uneventful and the patient was discharged at 19 days after the operation. The hemangiomas showed evolution with some decrease in size upon later follow-ups. No clinically important complication was observed. CONCLUSION: Our case and other previous reports show that even large hemangiomas should not be considered to be a contraindication to organ procurement. These benign lesions either could be left in situ and observed or resected.     

Are large nonfunctional kidneys risk factors for posttransplantation urinary tract infection in patients with end-stage renal disease due to autosomal dominant polycystic kidney disease?

OBJECTIVES: The objective of this study was to evaluate the effect of bilateral nephrectomy on posttransplantation urinary tract infection (UTI) among patients with end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (ADPKD). METHODS: In a retrospective case-control design, 62 patients with ESRD with ADPKD were divided into 2 groups: (A) 24 patients who underwent bilateral nephrectomies, and (B) 38 patients in whom bilateral nephrectomies had not been done. Pretransplantation and posttransplantation urine cultures were evaluated for UTI. RESULTS: Sixty-two patients with ESRD with ADPKD were enrolled in this study. The average age was 42 years (range, 6-60 years). Forty patients (64.5%) were male and 22 (35.5%) were female. The mean duration of hemodialysis was 24 months (range, 2-120 months), which was the same for both groups. Bilateral nephrectomies were done for 24 participants (38.7%). There were 38 patients (61.3%) in group B who did not have the operation. UTI occurred in 23 patients (37.1%): 6 patients (25%) in group A and 17 patients (44.7%) in group B. The incidence of UTI was not statistically different between the 2 groups (P>.05). Furthermore, no relationship was found between age, gender, blood group, and UTI in patients with ADPKD (P>.05). CONCLUSION: According to our study, the presence of large nonfunctional kidneys is not a risk factor for posttransplantation UTI in patients with ADPKD and ESRD.     

Does donor's fatty liver change impact on early mortality and outcome of liver transplantation

BACKGROUND: The effect of donor fatty liver on graft survival is still uncertain. The aim of this study was to determine the influence of steatosis on the outcomes of OLT among our recipients. METHODS: In this retrospective study, we evaluated the effect of donor liver steatosis on postoperative liver function and prognosis. Data obtained from liver transplantation data registry of our organ transplant center. Liver biopsies taken before transplantation were reviewed by two pathologists. Pathology reports were divided into four groups: normal pathology; mild fatty change (10%-30%); moderate (30%-60%); and severe steatosis (>60%). Livers with severe steatosis were excluded from transplantation. Factors determining transplantation outcome, such as early mortality, duration of intensive care unit (ICU) and hospital stay, clinical rejection episodes, and graft surgical complications, were compared between subjects who received donor liver, with various degrees of steatosis. RESULTS: Three-month survival rates in recipients without donor liver fatty change, subjects with mild fatty change (10%-30%) and those with moderate (30%-60%) steatosis were 68%, 72%, and 76%, respectively, which were not significantly different (P>.05). Furthermore, short-term (hospital) mortality (20%, 14.3%, and 21.2%), hospital stay (30.89, 29.93, and 23.62 days), and length of ICU admission (5.06, 5.89, and 4.39 days) were not significantly different. In addition, Child score of recipients, pre- and postoperative liver function enzyme changes were similar. CONCLUSION: Mild-to-moderate (up to 60%) liver fatty change was not found to be associated with a worse prognosis in OLT.     

Non-Marginal Donor C-Loop Ulcers as a Cause of Gastrointestinal Bleeding After Pancreas Transplantation: Three Case Reports

Unfortunately, pancreas transplantation (PTx) has been associated with the highest surgical complication rate of all the routinely performed organ transplant procedures. Complications can arise not only from the pancreas itself but also from the simultaneously transplanted duodenum. One of these complications is gastrointestinal bleeding, which might be from anastamotic site ulcer, pseudoaneurysm, arterioenteric fistula, severe rejection, or cytomegalovirus infection. In this case series, we present three patients presented with severe anemia 3 to 6 months after PTx with enteric drainage by end-to-end anastomosis of ascending loop of a Roux-en-Y to donor duodenal C-loop. The source of bleeding in all three cases was non-marginal donor duodenal C-loop ulcers. High donor pancreas exocrine output associated with relatively low drainage of a small end-to-end anastomosis may be the cause of these ulcers. It is recommended to use a side-to side anastomosis to prevent this complication.