Ender Dulundu

Duct-to-duct biliary reconstruction in adult living-donor liver transplantation

Background. Bile duct-to-duct reconstruction is now used in living-donor liver transplantation (LDLT) for adult patients. Methods. The results of duct-to-duct reconstruction were retrospectively analyzed. The subjects were 81 adult patients who underwent LDLT at the University of Tokyo Hospital with a follow-up period of at least 1 year. The hilar plate of the recipient was dissected to at least the second-order branch of the bile ducts. Duct-to-duct anastomosis was performed with interrupted sutures, and an external stent tube was inserted from the orifice opposite the hilar plate. Results. During the observation period (median, 664 days), biliary complications were observed in 26 cases (32%). The complications included bile juice leakage at the anastomosis or dissection plane of the graft in 12 patients, anastomotic stenosis in 10 patients, and tube trouble in 6 patients. Two patients had bile juice leakage followed by stenosis. Of the 26 patients, 21 required surgical revision. Conclusions. The current technique did not reduce morbidity as expected. Further technical advancement and refinement are needed for better results.

Protective Potential of Montelukast Against Hepatic Ischemia/Reperfusion Injury in Rats

Ischemia and reperfusion (I/R) injury is characterized by significant oxidative stress, characteristic changes in the antioxidant system and organ injury leading to significant morbidity and mortality. This study was designed to assess the possible protective effect of montelukast, a selective antagonist of cysteinyl leukotriene receptor 1 (CysLT1), on hepatic I/R injury in rats. Wistar albino rats through clamping hepatic artery, portal vein, and bile duct, were subjected to 45 min of hepatic ischemia followed by 60 min reperfusion period. Montelukast (10 mg/kg; i.p.) was administered 15 min prior to ischemia and immediately before reperfusion period. At the end of the reperfusion period, the rats were killed by decapitation. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) activity, and proinflammatory cytokines (TNF-alpha and IL-1beta) were determined in blood samples. Malondialdehyde (MDA), and glutathione (GSH) levels and myeloperoxidase (MPO) and Na+, K+-ATPase activities were determined in the liver tissue samples while formation of reactive oxygen species was monitored by using chemiluminescence (CL) technique with luminol and lucigenin probes. Tissues were also analyzed histologically. Serum ALT, AST, and LDH activities were elevated in the I/R group, while this increase was significantly decreased by montelukast treatment. Hepatic GSH levels and Na+, K+-ATPase activity, significantly depressed by I/R, were elevated back to control levels in montelukast-treated I/R group. Furthermore, increases in tissue luminol and lucigenin CL, MDA levels, and MPO activity due to I/R injury were reduced back to control levels with montelukast treatment. Since montelukast administration alleviated the I/R-induced liver injury and improved the hepatic structure and function, it seems likely that montelukast with its anti-inflammatory and antioxidant properties may be of potential therapeutic value in protecting the liver against oxidative injury due to ischemia-reperfusion.

Caffeic acid phenethyl ester (CAPE) prevents methotrexate-induced hepatorenal oxidative injury in rats

Objectives  This study aimed to investigate the antioxidant and anti‐inflammatory effects of caffeic acid phenethyl ester (CAPE) on the methotrexate (MTX)‐induced hepatorenal oxidative damage in rats.

Protective Effects of Lycopene on Cerulein-Induced Experimental Acute Pancreatitis in Rats

BACKGROUND The purpose of our study was to evaluate the protective effect of the strong antioxidant and anti-inflammatory agent, lycopene, on oxidative stress in a rat model of cerulein-induced acute edematous pancreatitis. METHODS Sprague-Dawley rats were pretreated with lycopene (50 mg/kg, i.p.) or saline 15 min before cerulein was given 20 μg/kg (i.p.) at 1-h intervals within 4 h. Twelve hours after cerulein or saline injections, the animals were killed by decapitation. Blood samples were collected to analyze amylase, lipase, and proinflammatory cytokines (TNF-α and IL-1ß). Pancreatic tissues were taken for the determination of tissue glutathione (GSH) and malondialdehyde (MDA) levels, Na(+)/K(+)-ATPase, and myeloperoxidase (MPO) activities. Tissue samples were also examined histologically. RESULTS Acute pancreatitis caused significant decrease in tissue GSH levels and Na(+)/K(+)-ATPase activity, while pancreatic MDA levels and MPO activity were increased. Furthermore, TNF-α, IL-1ß, and amylase lipase levels were also significantly increased. On the other hand, lycopene pretreatment reserved all these biochemical indices as well as histopathologic alterations that were induced by cerulein. CONCLUSIONS According to the results, lycopene protects the pancreatic tissues from oxidative damage induced by cerulein, and this effect possibly involves the inhibition of neutrophil infiltration and lipid peroxidation. These results suggest that high dietary intake of tomatoes may have protective effects against acute pancreatitis.

Antioxidant and Anti-inflammatory Effects of Curcumin Against Hepatorenal Oxidative Injury in the Experimental Sepsis Model Created in Rats

BACKGROUND To investigate the effects of curcumin, an antioxidant and anti-inflammatory agent, on free oxygen radicals and lipid peroxidation in an experimental sepsis model, as well as to determine the role of curcumin in preventing hepatorenal tissue damage caused by sepsis. METHODS The rats were randomly divided into three groups (n=8) as follows: control group (group 1); sepsis group (group 2); and sepsis + curcumin group (group 3). Sepsis was created using the cecal ligation and perforation (CLP) method. Curcumin was administered intraperitoneally (200 mg/kg) in two equal doses just after the perforation and at twelve hours post-perforation. RESULTS Serum TNF-a and IL-1ß, and tissue MDA and MPO values were higher, whereas tissue GSH and Na+/K+-ATPase values were lower, in group 2 as compared to group 1. These values in group 3 were the inverse of those in group 2. As compared to group 1, histopathological evaluation of group 2 showed damaged hepatocytes, glomeruli, and tubules, whereas the damage was significantly reduced in group 3 as compared to group 2. CONCLUSION The strong antioxidant and anti-inflammatory effects of curcumin against potential hepatorenal damage were shown using an experimental sepsis model in rats.

Beneficial effects of alpha lipoic acid on cerulein-induced experimental acute pancreatitis in rats

BACKGROUND The present study aimed to determine the effects of alpha lipoic acid (ALA) on blood and tissue biochemical parameters, as well as tissue histopathology, in an experimental rat model of cerulein-induced acute pancreatitis (AP). METHODS Three groups consisting of eight rats each were used, as follows: Group 1, controls; Group 2, cerulein-induced pancreatitis group treated with saline; and Group 3, cerulein-induced pancreatitis group treated with ALA. AP was induced by intraperitoneal administration of cerulein (20 µg/kg) 4 times at 1-hour intervals. The animals were decapitated 12 hours after the last dose of cerulein. Blood amylase, lipase, interleukin (IL)-1ß, and tumor necrosis factor (TNF)-α levels, pancreas tissue glutathione (GSH) and malondialdehyde (MDA) levels, as well as myeloperoxidase (MPO) and Na+-K+-ATPase activity were measured. Pancreatic tissue samples were also evaluated histopathologically under a light microscope. RESULTS While plasma amylase, lipase, IL-1ß, and TNF-α levels, and tissue MDA and MPO levels significantly increased in rats with cerulean-induced AP, tissue GSH and Na+-K+-ATPase activity significantly reduced. These changes were reversed and improved with ALA treatment. CONCLUSION Our findings suggest that ALA may significantly reduce morbidity and mortality by preventing organ dysfunction induced by free radicals in the pancreas.

Incarcerated abdominal wall hernia surgery: relationship between risk factors and morbidity and mortality rates (a single center emergency surgery experience)

BACKGROUND The aim of the present study was to investigate morbidity and mortality-related risk factors in patients undergoing surgery due to incarcerated abdominal wall hernia. METHODS The patients were grouped according to the type of hernia (inguinal, umbilical, incisional, femoral), and these groups were evaluated in terms of risk factors affecting morbidity and mortality such as age, gender, American Society of Anesthesiologists (ASA) score, type of anesthesia, concomitant diseases, and the presence of intestinal strangulation and necrosis. RESULTS Inguinal hernia was frequent in males, whereas femoral hernia was frequent in females (p<0.001). The rate of intestinal resection due to strangulation and necrosis was found significantly higher among femoral hernias as compared to the other types of hernia (p<0.005 and p<0.001, respectively). Advanced age (≥ 65 years), concomitant disease, strangulation, necrosis, high ASA score (III-IV), time from the onset of symptoms, and time to hospital admission were found to have significant influences on morbidity and mortality. General anesthesia was found to be a risk factor for morbidity as well (p<0.05). CONCLUSION Incarcerated abdominal wall hernias are surgical problems with high morbidity and mortality rates. Therefore, surgery should be planned under elective conditions when hernia is detected.

Short hepatic vein reconstruction in biliary atresia patients with absent inferior vena cava

Abstract:  Liver transplantation in patients with biliary atresia and polysplenia syndrome requires some technical adjustments. During eight yr, 75 biliary atresia patients underwent living donor liver transplantation. Of these, two patients were complicated by absent inferior vena cava with azygos continuation. Both patients received hemi‐liver grafts with short hepatic veins. Outflow was reconstructed using a cryopreserved vena cava. In both patients, the short hepatic vein was anastomosed to the vein graft end‐to‐end and the end of the vein graft was anastomosed with the common orifices of recipients hepatic veins. Both of the patients survived the operation with satisfactory graft function. A hemi‐liver graft with short hepatic veins can be used for patients with biliary atresia with inferior vena cava agenesia using the current technique.

The Factors Affecting the Awareness about Transplantation and Decision of Organ Donation in Istanbul, Turkey

Introduction Nearly 42000 people in Turkey are waiting for organ transplantation. However, each year approximately 2000 people die while waiting for organ transplantation. In 2015, only 472 organs were donated from 1969 patients with brain death, with family permission. Aim Aim of study is to investigate reasons of low organ donation rate in Turkey and propose recommendations to increase organ donation. Material and Methods Number of people participated in this descriptive study was 538. Data was collected during Organ Donation Week via a structured survey in Istanbul. SPSS 23.0 program was used for statistical analysis. Chi-square test was used for comparisons between categorical variables. Logistic regression model used to find independent predictors affecting people’s statements regarding organ donation. P value <0.05 was considered statistically significant. Results and Discussion Of participants 53.8% were female (n = 257). Mean age of participants was 27.98 (sd=10.8) (15-67). Majority of participants had university education (41.7% n =184). 54.4% of participants (n=280) stated they had information about organ donation. Participants stated organ donation could be made from a living human (60.8% n =309), cadavers (58.3% n=295), animals (5.3% n=27), laboratory (10.8% n =58). Source of information about organ donation was reported as mass media (41.8% n =198), social environment (21.3% n=101), hospital (17.5% n=83) or other sources (19.4% n=92). Participants with relatives waiting for organ transplantation were more likely to state they would donate their organs (73.0% n=27), than participants without relatives who needed transplantation (63.8% n=275), this difference was statistically not significant (p=0.263). Similarly, women were more likely to express they would donate their organs (72.5% n=169) than men (53.5% n=108) (p<0,001). As education level of participants increases, percentage of statement that they have knowledge about organ donation increases (p <0,001). Participants who expressed they have knowledge about organ transplantation were more likely to express they would donate their organs (75% n=192) than participants who expressed little or no knowledge (52.4% n=111) (p<0,001). According to logistic regression model, statement on organ donation was independently associated with gender (p=0.002 Odds Ratio (OR)= 3.057; 95% Confidence interval (CI):1,522-6,141) and knowledge about organ transplantation (p=0.003 OR=2.797; 95% CI: 1.418-5.518). Conclusion While education, having a relative waiting transplantation increase knowledge regarding organ transplantation; promotion of public awareness and coverage of knowledge about organ transplantation is needed. Mass media messages addressing organ transplantation and specific, well-structured education for patients visiting hospitals, family health centers can increase awareness about organ transplantation. Any intervention should especially cover, target population with low education and men.