Preoperative evaluation of biliary anatomy in adult live liver donors with volumetric mangafodipir trisodium enhanced magnetic resonance cholangiography.

Accurate preoperative depiction of biliary anatomy is not always adequately accomplished by imaging techniques in living donor liver transplantation (LDLT). We present the results of a prospective study designed to evaluate the ability of mangafodipir trisodium (Mn-DPDP)-enhanced magnetic resonance (MR) cholangiography (MRC) for this purpose in a series of 25 adult living liver donors (LLDs). We also analyze if a simple or a more complex surgical procedure can be preoperatively suggested for biliary reconstruction in the recipients. Findings on MRC were compared with operative cholangiography (OC). A conventional distribution with a right hepatic duct (RHD) longer than 1 cm anticipated a simple procedure (duct-to-duct anastomosis or hepaticojejunostomy [HJ]). A shorter RHD or any variant were predictors of a more complex surgery (bench ductoplasty or multiple anastomoses). Agreement between MRC and OC in assessing the biliary anatomy was measured using the kappa statistic, and differences between the kind of surgery predicted at MRC and the biliary anastomosis performed were evaluated with Fisher's exact test. Normal variants were present in 16 / 25 donors (64%). MRC was accurate in depicting the pattern of bile duct distribution observed at OC in 22 / 25 (88%) donors (kappa = .831), and correctly predicted the complexity of biliary anastomosis in the recipient in 22 / 25 (88%) donors. No significant differences were observed between complexity of biliary surgery proposed at MRC and the final surgery performed (P = .002). In conclusion, Mn-DPDP-enhanced MRC is highly accurate in depicting the biliary duct anatomy and can be used preoperatively for surgical planning in LDLT.     

On the mechanism of sodium 2-5-4 chlorophenylpentyloxirane-2-carboxylate (POCA) inhibition of hepatic gluconeogenesis

Inhibition of hepatic long chain fatty acid oxidation by 2-5-4 chlorophenylpentyloxirane-2-carboxylate (POCA) leads to decreased gluconeogenic rates from lactate or from low concentrations of pyruvate. The inhibitory effect is fully overcome by concentrations of pyruvate above 0.8 mM or by the simultaneous administration of a medium chain fatty acid. At low pyruvate availability the energy cost of gluconeogenesis is mainly supported by fatty acid oxidation and POCA-induced inhibition of glucose production is secondary to a decreased energy availability. This is supported by the following observations: (i) POCA decreases hepatic respiration and phosphorylation potential: (ii) the rate of pyruvate-induced respiration was the same regardless of whether gluconeogenesis was inhibited or not by POCA: and (iii) concentrations of pyruvate above 0.8 mM, at which gluconeogenesis is not inhibited, prevented the POCA-induced decrease in the phosphorylation potential. It is concluded that inhibition of long chain fatty acid oxidation by POCA leads to a switch of energy fuel, and results in the oxidation of more pyruvate to meet the cellular energy demands. When pyruvate availability is low and thus, presumably, its mitochondrial transport restricted, pyruvate carboxylation most probably becomes limiting as a result of the increased flux through pyruvate dehydrogenase, in the presence of POCA.     

Distinct pH homeostatic features in lymphoblasts from Alzheimer's disease patients

Epstein-Barr–transformed lymphocytes from Alzheimer's disease patients showed the following distinct features in controlling the intracellular pH compared with cells from normal age-matched controls: (1)The αIgM-induced intracellular acidification was more pronounced in Alzheimer's disease than control cells and this effect appears to be associated with a loss of effectiveness of a Ca²⁺/ calmodulin-dependent mechanism in controlling the activity of the Na⁺/H⁺ exchanger; and (2) the intracellular H⁺-buffering capacity and the rate of proton efflux in response to an acid load were both decreased in Alzheimer's disease cells. It is concluded that the amplitude of the intracellular pH changes under acidloading conditions will always be greater in Alzheimer's disease than in control cells.     

Trisomy 2 due to a 3:1 segregation in an abortion studied by QF-PCR and CGH

Balanced reciprocal translocation is one of the known causes of recurrent spontaneous abortions. Cytogenetic studies of unbalanced miscarriages are difficult due to the growth failure of early loss and usually macerated abortions. We present a molecular study of an abortion in which the father carries a balanced reciprocal translocation t(2;17)(q32.1;q24.3) using QF-PCR and CGH techniques. DNA analysis showed the presence of a trisomy 2 due to a 3:1 interchange segregation. Recombinant events could also be investigated by comparing DNA samples from the family. We propose QF-PCR in addition to CGH as an efficient diagnostic method to improve our knowledge of unbalanced offspring in balanced translocation carriers.     

Living donor kidney transplantation: helical CT evaluation of candidates

ObjectivesComputed tomography (CT) is a diagnostic tool that has won acceptance in the past years for the vascular evaluation of living renal donor (LRD) candidates. We show the findings observed in a series of 102 candidates consecutively evaluated in our centre and present the correlation with the surgical data obtained in those individuals finally operated.MethodsFrom May 1995 to June 2005, 102 LRD candidates were evaluated with CT. Eighteen were also studied with digital subtraction angiography (DSA). Fifty-eight donors underwent nephrectomy. Prevalence of arterial and venous variants found on CT exams were analyzed, as well as the correlation with surgical and DSA data when they were obtained.oResultsForty-four percent candidates showed multiple renal arteries at least in one kidney. Seventy-one percent of right kidneys and 76% of left kidneys had a single arterial pedicle. Early branching was observed in 7.8% and 15.7% in right and left kidneys respectively. Venous variants were present in 17.5% and the 13.7% in right and left sides respectively. Sensitivity, specificity and accuracy of CT to detect accessory arteries were 89%, 100% and 97% respectively when it was compared to DSA. Correlation with surgical data raised 93% for the presence of arterial variants.ConclussionsVascular variants in renal pedicle showed a high prevalence. Helical CT can effectively achieve all the information required prior to surgery as a sole imaging procedure in LRD candidates.     

Long-term assessment of the treatment of recurrent tracheoesophageal fistula with fibrin glue associated with diathermy

Purpose

Recurrent tracheoesophageal fistula (RTF) is a serious common complication of the surgical treatment of esophageal atresia. We report the results of our technique of bronchoscopic treatment of RTF with fibrin glue (Tissucol), with a follow-up of over 1 decade.

Methods

A retrospective review between 1993 and 2004 was conducted, including all patients diagnosed with RTF and treated bronchoscopically with Tissucol, with over 1 year of follow-up. The procedure was implemented under general anesthesia using a rigid neonatal bronchoscope. A magnification chamber and previous diathermia using a urethral catheter were used in the latter 4 patients. The fibrin glue was injected through a clear catheter. The number of endoscopic sessions per patient was limited to 3.

Results

Seven patients were treated, with evidence of fistular closure in 6 (85%). One patient with satisfactory results, but a follow-up of 4 months, was not included. The age at bronchoscopy ranged from 14 to 20 days (mean, 16.7 days), and a total of 12 sessions were required (mean, 1.7). In the latter 4 patients, diathermia was associated with good results in all and a lower number of sessions (mean, 1.5). All patients were evaluated clinically and radiologically, and a control endoscopy was performed in 4 patients. The follow-up lasted from 2 to 11 years (mean, 7.4 years).

Conclusions

Because we started to use Tissucol (1994), other authors have reported successful isolated cases, but a relatively large series and a long-term follow-up were lacking. We consider that the success of the procedure depends on several technical factors such as an early diagnosis, before epithelium is formed in the fistula, and the use of initial diathermia, associated in the latter 4 patients. The results obtained with 85% success with a follow-up over 1 year show that the fibrin adhesive is the reference substance for the treatment of RTF; we recommend its endoscopic application associated with diathermia as initial measure.     

Cytogenetic and clinical findings in ten 45, X/46, XY patients*

We report ten cases with 45, X/46, XY karyotype. Cytogenetic and clinical findings have been compared. No constant relationship was found either between blood and gonadal karyotype, or between karyotype and gonadal morphology.     

Prenatal diagnosis on fetal cells from maternal blood: practical comparative evaluation of the first and second trimesters

Objectives- Several attempts have been made to determine the gestational period in which the maximum number of fetal cells can be found in maternal blood and consequently which is the best week in which to perform a reliable non-invasive prenatal diagnosis. Most studies conclude that the number of nucleated red blood cells (NRBC) increases in line with gestation, but the number of cells that are fetal in origin (FNRBC) decreases in the third trimester. The aim of the present study was to make a practical comparative evaluation of the first and second trimesters to ascertain the period in which a greater number of FNRBC can be found of the total number of NRBC identified. Methods- Double density gradient and a posterior positive selection (CD71) by magnetic activated cell sorting (MACS) were employed. In the final fraction, erythroblasts were identified using Kleihauer staining and were studied using the fluorescence in situ hybridization (FISH) interphasic technique. Results- There was a significant difference (p<0.05) between the mean number of FNRBC found in the first and second trimesters. Conclusions- The number of FNRBC increases from the first to the second trimester. It appears that the optimum week in which to perform a reliable non-invasive prenatal diagnosis is around the 15th week.     

High serum concentrations of dimeric inhibins A and B in normal newborn girls

OBJECTIVE: To establish the serum pattern of dimeric inhibins in normal girls during the newborn period and to examine its relationship with the postnatal gonadotropic surge. DESIGN: Retrospective study. SETTING; Division of endocrinology of a children's hospital. PATIENT(S): Thirty-one girls 4 to 65 days of age. MAIN OUTCOME MEASURE(S): Serum levels of FSH, LH, and inhibin A and B. RESULT(S): High serum concentrations of both dimeric inhibins were detected during the first weeks of life. Concentrations tended to decrease through the second month of age. Inhibin A and B concentrations positively correlated with age only during the first 2 weeks of life (r =.57, P<.05 and r =.70, P<.01, respectively). Inhibin A and B were positively and significantly correlated with LH (r =.57, P<.05 and r =.52, P<.05, respectively) and with each other (r =.68, P<.0001). No correlation was found between dimeric inhibins and FSH. CONCLUSION(S): The high inhibin concentrations observed in newborn girls, which indicate advanced follicular development and granulosa cell differentiation, may be useful markers for congenital gonadal disorders.