Post-renal transplantation Leser-Trélat sign associated with carcinoma of the gallbladder: a rare association

The sign of Leser-Trélat represents the sudden appearance of multiple seborrheic keratoses in association with an underlying malignancy. The most common associated neoplasms belong to the gastrointestinal tract, mainly the stomach and colon. In the literature, there is only one case of gallbladder carcinoma associated with the Leser-Trélat sign. Thus, the hallmark of our patient is post-renal transplant malignancy-associated Leser-Trélat, which has not been reported before. Here, we report on a 57-year-old man who presented with a sudden increase in the number and size of seborrheic keratoses, particularly on sun-exposed areas 24 years after renal transplantation. The search for an underlying malignancy showed the presence of an adenocarcinoma of the gallbladder which had metastasized to the liver.     

The Role of Zinc Sulfate and Metallothionein in Protection Against Ethanol-Induced Gastric Damage in Rats

In this study, the effects of zinc sulfate against ethanol-induced acute gastric damage in rats were investigated, morphologically and biochemically. In addition, the present investigation has demonstrated the distribution of metallothionein stimulated by zinc in gastric mucosal tissues, immunohistochemically. The gastric damage was induced by intragastric administration of 1 ml absolute ethanol per rat. Rats received zinc sulfate (100 mg/kg/day) for 3 consecutive days 2 hr prior to the administration of absolute ethanol. Acute ethanol exposure caused degenerative morphological changes, a decrease in metallothionein immunreactivity; an increase in lipid peroxidation (LPO) levels, and a decrease in reduced glutathione (GSH) levels in gastric mucosa. On the other hand, zinc sulfate administration to ethanol-treated rats caused a significant reduction in the histological damage, an increase in metallothionein immunreactivity, a decrease in LPO levels, and an increase in GSH levels in gastric mucosa. As a result, the present study indicates that zinc sulfate has a protective effect against ethanol-induced acute gastric damage. In addition, we might say that the zinc given as exogenous protection against acute gastric damage has a protective effect both by stimulation of metallothionein synthesis and through GSH as well as having antioxidative potential.     

Evaluation of the learning curve of pediatric kidney transplantation anesthesia

Background/aim Pediatric kidney transplantation (PKT) anesthesia brings some different challenges than adult kidney transplantation (KT) anesthesia and there are still no studies analyzing the role of experience on PKT outcomes. In this study, we aimed to evaluate the anesthesia learning curve in pediatric kidney transplants performed in our institution and the effect of increasing experience on renal transplantation-related data.Materials and methods Patients age ≤ 18 years who underwent KT were included in the study, while patients age >18 years were excluded. Patients were divided into 3 groups according to the date of transplant, as the first 10 patients in Group 1, the second 10 patients in Group 2, and the final 11 in Group 3. Groups were compared according to recorded data.Results Thirty-one patients were included in the study. Age, sex, and body mass index were matched between the 3 groups. The mean durations of dialysis were 75.0 ± 63.0, 22.4 ± 27.9, and 5.7 ± 4.5 months for Group 1, Group 2, and Group 3, respectively (p = 0.009). Blood loss, duration of postoperative mechanical ventilation, and length of stay in the intensive care unit (ICU) were comparable between the groups. The duration of anesthesia gradually shortened from Group 1 to Group 3 but there was no significant difference between the groups. The mean number of red blood cell (RBC) transfusion was 0.9 ± 0.7 unit in group 1. It decreased to a mean of 0.6 ± 0.7 unit for group 2, and afterward significant decrease occurred down to 0 for group 3 (p = 0.004).Conclusion Our results demonstrate that considering the decrease in preoperative dialysis duration and operative RBC transfusion, 20 patients may be enough for anesthesia competency. Transplantation anesthesia experience before PKT, anesthesia technique, and patient characteristics may differ between institutions. Therefore, further prospective studies with established learning curve goals, larger patient volumes, and more variables are needed to validate our results.