Abdominal transplantation for unresectable tumors in children: the zooming out principle

Purpose

To present our experience in abdominal transplantations to manage unresectable abdominal neoplasms in children and to describe the role of extensive surgeries in such cases.

Methods

This is a retrospective study of 22 abdominal transplantations in 21 patients for abdominal tumors over 16 years. Transplantation techniques included liver transplant (LT), multivisceral transplant (MVTx), and intestinal autotransplant (IA). Follow-up intervals ranged from 0.3 to 168 months (median 20 months).

Results

LT alone was performed in 15 patients for primary malignant (11) and benign (4) liver tumors. Pathological classification included HB hepatoblastoma (6), HCC hepatocellular cancer (3), hepatic epithelioid hemangioendothelioma HEH (1), angiosarcoma (1), benign vascular tumors (3), and adenoma (1). IA was performed in four patients for lesions involving the root of the mesentery; tumors of the head of pancreas (3) and mesenteric hemangioma (1). MVTx was performed in 2 patients for malignancies; pancreaticoblastoma (1), recurrent hepatoblastoma (1), and in one patient as a rescue procedure after IA failure. Four of the eleven patients who underwent LT for malignant liver tumor had metastatic disease at presentation. Six of them died of recurrent neoplasm (3), transplant-related complications (2), and underlying disease (1). All LT patients who had benign tumors are alive with functioning grafts. All IA patients survived and are on an oral diet, with one patient requiring TPN supplementation. One of the three patients who underwent MVTx died of metastatic disease.

Conclusions

Allo/auto transplantation for abdominal tumors is a valuable modality when conventional treatments fail or are not feasible.

     

Long-term study of dendritic spines from hippocampal CA1 pyramidal cells, after neuroprotective melatonin treatment following global cerebral ischemia in rats

Melatonin reduces pyramidal neuronal death in the hippocampus and prevents the impairment of place learning and memory in the Morris water maze, otherwise occurring following global cerebral ischemia. The cytoarchitectonic characteristics of the hippocampal CA1 remaining pyramidal neurons in brains of rats submitted 120 days earlier to acute global cerebral ischemia (15-min four vessel occlusion, and melatonin 10mg/(kg h 6h), i.v. or vehicle administration) were compared to those of intact control rats in order to gain information concerning the neural substrate underlying preservation of hippocampal functioning. Hippocampi were processed according to a modification of the Golgi method. Dendritic bifurcations from pyramidal neurons in both the oriens-alveus and the striatum radiatum; as well as spine density and proportions of thin, stubby, mushroom-shaped, wide, ramified, and double spines in a 50 microm length segment of an oblique dendrite branching from the apical dendrite of the hippocampal CA1 remaining pyramidal neurons were evaluated. No impregnated CA1 pyramidal neurons were found in the ischemic-vehicle-treated rats. CA1 pyramidal neurons from ischemic-melatonin-treated rats showed stick-like and less ramified dendrites than those seen in intact control neurons. In addition, lesser density of spines, lower proportional density of thin spines, and higher proportional density of mushroom spines were counted in ischemic-melatonin-treated animals than those in the sinuously branched dendrites of the intact control group. These cytoarchitectural arrangements seem to be compatible with place learning and memory functions long after ischemia and melatonin neuroprotection.     

No effect of menstrual cycle on LDL oxidizability and particle size

OBJECTIVES: Premenopausal women have a lower incidence of cardiovascular disease than men, but this female advantage disappears after menopause, suggesting that female sex hormones exert some cardioprotective effects. One of the mechanisms proposed to explain this cardioprotection is the antioxidant properties of estrogens. The aim of this work was to assess whether fluctuations in ovarian hormones, particularly 17beta-estradiol (E(2)), during the menstrual cycle were associated with changes in the low-density lipoprotein (LDL) particle size, fatty acyl composition, alpha-tocopherol content and in vitro oxidizability. METHODS: Twenty-eight healthy premenopausal women (mean age: 32.2 years) participated in the study. Blood was drawn on days 3 (menstrual phase), 14 (follicular phase) and 22 (luteal phase) of the menstrual cycle for plasma determinations and LDL isolation. Plasma E(2), progesterone, follicle-stimulating hormone and luteinizing hormone were determined by immunoassay. LDL oxidation by Cu(2+)- and 2,2'-azobis (2-amidinopropane) was measured by the formation of conjugated dienes, LDL particle size by quasi-elastic light scattering, fatty acyl composition by gas chromatography, alpha-tocopherol by reversed phase HPLC. A within-subjects analysis of variance was performed to determine significant differences of the variables over the course of a subject's menstrual cycle. RESULTS: The LDL oxidizability indices (lag time before the onset of propagation and the maximal oxidation rate) did not change during the menstrual cycle. The LDL particle size (24.8+/-1.7 nm diameter), alpha-tocopherol (11.7+/-3.7 nmol/mg LDL protein) and fatty acyl composition also remained constant. CONCLUSIONS: The LDL physicochemical properties and oxidizability are not affected by menstrual cycle phase.     

Youth health outcomes from the Connect-to-Protect coalitions to prevent adolescent HIV infections

We assessed the relationships among HIV-related social and behavioral outcomes resulting from an adolescent-focused HIV structural change initiative in eight urban sites operating Connect-to-Protect coalitions. Over a 4-year period, annual cross-sectional panels of adolescents (N = 2248) completed an audio-computer-assisted interview, providing data on satisfaction with their communities as adolescent-supportive environments, internalized HIV stigma, lifetime HIV-testing, lifetime sexual risk-taking and number of sexual partners in the prior year. We used structural equation modeling to estimate hypothesized links between time since coalition mobilization to our social and behavioral outcomes. Over the 4 years, adolescents perceived their communities to become more supportive (p < .05). Positive perceptions of community support were associated with lower lifetime HIV sexual risk (p < .05). The effect of time on risk behavior was mediated by perceptions of community support. Stigma was unchanged over time. Stigma had damaging effects on risk behavior, effects which were also mediated by perceptions of community support. Special efforts are needed to address the deleterious effect of HIV stigma on high-risk urban adolescents.     

From clinician to researcher--a first-hand account

While teaching and clinical care may be somewhat intuitive, research is much less so, and a lack of research experience or opportunity to do research can be frustrating to the faculty member who is trying to become well-rounded. In an effort to ease the transition from clinical teacher to clinical researcher, the faculty of dentistry at Dalhousie University has developed a research mentorship program. The purpose of this paper is to report on the opportunities and challenges that 2 dental clinicians experienced when they participated in the pilot phase of an epidemiologic survey of the oral health status of seniors. In their academic role, these 2 clinical examiners, who were full-time faculty members, concentrated on classroom and clinical teaching. Although neither had previous clinical research experience, both were interested in broadening their horizons by engaging in research in the hope of attaining a variety of positive outcomes.     

Bench Validation of a Handcrafted Prototype Catheter for Intra-gastric Pressure Monitoring

Background

Abdominal compartment syndrome is a sustained intra-abdominal pressure (IAP) >20 mm Hg associated with new organ dysfunction. In order to prevent its development and related complications, IAP monitoring should be performed in patients with risk factors. Although techniques for its monitoring have been developed, they are of high cost and not always available in low- and lower–middle-income countries. Therefore, we aim to develop and validate in a bench model a handcrafted catheter to be used as an alternative method to measure the intra-gastric pressure (IGP) as a surrogate of the IAP.

Methods

We used an acrylic water container as a model of the abdomen and four handcrafted catheters made of a 16 Fr Levin tube with a globe finger tied with silk in the distal end, inflated with 1 cm of air. They were placed on the bottom of the container where the water pressure was directly measured as a gold standard. The agreement between the two measures was assessed with the Bland–Altman method.

Results

We performed 120 simultaneous measures. The mean pressure difference was 0.218 (95% CI 0.074 to 0.363).

Conclusions

The handcrafted prototype catheter and the direct measure were highly correlated. The new catheter is a reliable and reproducible tool for pressure monitoring. However, before it can be used in the clinical setting for IAP monitoring, validation in human models in a real clinical setting needs to be performed.