Developing normothermic machine liver perfusion for improvement of marginal donor graft quality

The studies incorporated in this thesis examined ways to develop ex situ normothermic machine perfusion (NMP) of the liver as a tool to enhance the reconditioning of high-risk extended criteria donor (ECD) organs. Two possible alternatives were investigated: (1) The use of hypothermic oxygenated machine perfusion as a therapeutic intervention preceding NMP; and (2) the delivery of a pharmacological combination of drugs targeting hepatic lipid metabolism during NMP. Using human donor livers discarded for transplantation, the feasibility of a combined protocol of hypothermic oxygenated perfusion (HOPE) and NMP was shown. HOPE optimised hepatic mitochondrial bioenergetic and oxidative status as well as mitigated ischaemia-reperfusion injury, while NMP maintained the organs’ metabolism thus allowing the assessment of its metabolic functions. This combined protocol was facilitated with the use of a single acellular haemoglobin-based oxygen carrier (HBOC)-based perfusate throughout the entire perfusion, using a cold-to-warm machine perfusion protocol. These combined protocols enabled superior recovery of metabolic functions of ECD livers compared to NMP alone. The delivery of a combination of drugs targeting the hepatic lipid metabolism during NMP was also investigated. This approach reduced the intracellular lipid content of discarded human donor livers via enhancement of fatty-acids β-oxidation and solubilisation of lipids in the perfusate. The boosted lipid metabolism improved the metabolic status of the organs optimising their functional recovery and halted oxidative stress-related hepatobiliary injury. These findings are promising and guarantee future clinical investigation, opening a window of opportunity to improve the reconditioning of ECD livers

Evaluation Of Recurrence Predictors And Survival Probability After Liver Transplantation For Hepatocellular Carcinoma: Analysis Of A Single Center

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Megaduodenum associated with gastric strongyloidiasis

Gastric strongyloidiasis and megaduodenum are rare diseases. Gastrointestinal (GI) strongyloidiasis has many clinical features. One of them is megaduodenum. We describe a case of a 32-years-old man who has come to us from an endemic area for Strongyloides stercoralis. He had had megaduodenum diagnosed in his childhood. We submitted him to two surgeries. He has recovered just after the second surgery, a Roux-en-Y partial gastrectomy. After that, his follow-up was uneventful and the patient has gained 10 kg in weight. Histopathology confirmed gastric strongyloidiasis. In conclusion, if patients arrive from an endemic area of S. stercoralis and if they present GI symptoms or a previous diagnosis of megaduodenum, they must be considered for a histological evaluation for gastric strongyloidiasis. (C) 2014 The Authors. Published by Elsevier Ltd. on behalf of Surgical Associates Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).11717

Megaduodenum associated with gastric strongyloidiasis

AbstractGastric strongyloidiasis and megaduodenum are rare diseases. Gastrointestinal (GI) strongyloidiasis has many clinical features. One of them is megaduodenum. We describe a case of a 32-years-old man who has come to us from an endemic area for Strongyloides stercoralis. He had had megaduodenum diagnosed in his childhood. We submitted him to two surgeries. He has recovered just after the second surgery, a Roux-en-Y partial gastrectomy. After that, his follow-up was uneventful and the patient has gained 10kg in weight. Histopathology confirmed gastric strongyloidiasis. In conclusion, if patients arrive from an endemic area of S. stercoralis and if they present GI symptoms or a previous diagnosis of megaduodenum, they must be considered for a histological evaluation for gastric strongyloidiasis

Modernising case finding for α-antitrypsin deficiency by DNA sequencing of COPD patients.

Tubulovillous adenomas of the duodenal ampulla are rare neoplasms. The present report describes a case with radiological-endoscopic and pathological correlation in which the patient underwent duodenal pancreatectomy with good postoperative progression. With advanced imaging methods, especially magnetic resonance and endoscopic ultrasound, locoregional aspects and extraluminal, lymphovascular, and metastatic invasion have been increasingly discussed as contributors to therapeutic decision making. This progression improves lesion staging and is especially useful in selecting eligible candidates for endoscopic treatment