Ketamine does not inhibit interleukin-6 synthesis in hepatic resections requiring a temporary porto-arterial occlusion (Pringle manoeuvre): a controlled, prospective, randomized, double-blinded study

AbstractIntroductionPrevious studies have shown that interleukin-6 (IL-6) levels correlated with mortality in critically ill patients.GoalTo determine the effect of ketamine on IL-6 levels in liver resections patients with a temporary porto-arterial occlusion (Pringle manoeuvre).Materials and methodsControlled, prospective, randomized, double-blinded study. One group (n=21) received ketamine whereas the other group (n=17) received placebo. IL-6 levels were obtained at baseline, 4, 12, 24h, 3 and 5 days.ResultsThere were no significant differences in IL-6 levels between the groups (basal P=089, 4h P=0.83, 12h P=0.39, 24h, P=0.55, 3 days P=0.80 and 5 days P=0.45). Both groups had elevated IL-6 levels that became almost undetectable by day 5. There was no major morbidity and no mortality in either group.ConclusionsKetamine does not seem to have an effect on plasma levels of IL-6. This could be interpreted as a potential finding associated with outcome as we did not encounter any deaths or major complications. Further studies will likely be needed to determine the range of IL-6 levels associated with survival and mortality, and whether it could be a predictor of survival

Intrapancreatic Accessory Spleen: Two Case Reports of a Rare Entity

Intrapancreatic accessory splenic tissue constitutes a very unusual anatomical variation. It is encountered mostly in the splenic hilum or within the pancreatic tail. Given the diagnostic difficulty in excluding a pancreatic malignancy, a distal pancreatectomy is usually performed. We herein report two cases of intrapancreatic accessory spleen. The first patient presented with left upper quadrant abdominal pain radiating to the back, caused by a 2-cm focal lesion in the pancreatic tail. The second patient underwent a distal pancreatectomy due to a postsplenectomy symptomatic pseudocyst that could not be treated conservatively. In both cases, the histopathological examination of the specimens revealed a 2-cm accessory spleen within the pancreatic tail. Intra and peripancreatic spleens represent 10-16% of all accessory spleens, and their sizes range from a few millimeters up to 2-3 cm. CT, MRI, and nuclear scintigraphy are all useful in establishing the diagnosis. It is occasionally difficult to differentiate accessory spleens from hypervascular pancreatic neoplasms, metastatic lesions, or splenic hilar lymphadenopathy. The surgical resection of an intrapancreatic spleen is only indicated in the case of diagnostic uncertainty or spleen-related hemato-oncological conditions such as immune thrombocytopenia (ITP)

Approach to the Pretransplant Evaluation of the Living Kidney Donor

Evaluation of the potential kidney donor is a complex activity that differs substantially from other types of preoperative assessments. The well being of the donor, who derives no medical benefit from this surgery, must be assured in both the short term and long term, and the potential adverse consequences to the recipient must be determined as well. The criteria that must be met for a person to donate a kidney are rigorous and include medical, social, psychosocial, ethical, and legal issues. Donor evaluation can be divided into assessments to protect the health and safety of the donor and assessments to protect the health and safety of the recipient. This article provides an approach to evaluating a donor, focusing on the complex issues that an evaluator is faced with. A careful assessment of risks and benefits to both the donor and recipient can lead to favorable outcomes

Totally laparoscopic left hepatectomy using the Torsional Ultrasonic Scalpel

Minimal invasive techniques have allowed for major surgical advances. We report our initial experience of performing total laparoscopic left hepatectomy (segments II-IV) with the Lotus (laparoscopic operation by torsional ultrasound) Ultrasonic Scalpel. The perioperative and postoperative courses of the young female patient were uneventful and she is in a good general condition without complaints 18 mo after surgery. To the best of our knowledge, this is the first total laparoscopic hemihepatectomy to be performed in Greece, as well as the first laparoscopic liver resection using Lotus shears. (C) 2013 Baishideng. All rights reserved