Josep Martí

Ischemic pre-conditioning in deceased donor liver transplantation: a prospective randomized clinical trial.

To assess the immediate and long‐term effects of ischemic preconditioning (IPC) in deceased donor. liver transplantation (LT), we designed a prospective, randomized controlled trial involving 60 donors: control group (CTL, n = 30) or study group (IPC, n = 30). IPC was induced by 10‐min hiliar clamping immediately before recovery of organs. Clinical data and blood and liver samples were obtained in the donor and in the recipient for measurements. IPC significantly improved biochemical markers of liver cell function such as uric acid, hyaluronic acid and Hypoxia‐Induced Factor‐1alpha (HIF‐1α) levels. Moreover, the degree of apoptosis was significantly lower in the IPC group. On clinical basis, IPC significantly improved the serum aspartate aminotransferase (AST) levels and reduced the need for reoperation in the postoperative period. Moreover, the incidence of primary nonfunction (PNF) was lower in the IPC group, but did not achieve statistical significance. We conclude that 10‐min IPC protects against I/R injury in deceased donor LT.

Laparoendoscopic single-site surgery appendectomy

BackgroundLaparoscopic appendectomy via the three-trocar technique is widely used for appendectomy. This report describes the initial experience with laparoendoscopic single-site surgery (LESS) appendectomy.MethodsBetween December 2008 and March 2009, patients with acute appendicitis admitted to the General Surgery and Emergency Unit of the authors’ institution who agreed to undergo LESS appendectomy were included in a prospective study. All operations were performed by the same surgical team specially trained in this type of emergency surgery. The umbilicus was the sole point of entry for all patients, and the same operative technique was used in all cases. The data for patients undergoing LESS appendectomy were compared with the data from an uncontrolled group of patients undergoing standard laparoscopic appendectomy during the same study period.ResultsThe LESS and standard appendectomy groups included 15 patients each. The LESS procedure was performed successfully for all the patients, and none required conversion to an open procedure or a conventional laparoscopic appendectomy by the addition of more entry ports. The mean operating time of 51xa0min in the LESS group was not significantly different from the 46xa0min in the standard laparoscopic appendectomy group.ConclusionsIn this study, LESS appendectomy was technically feasible and safe, representing a reproducible alternative to standard laparoscopic appendectomy.

Introduction to a rational design of chiral thiazolium salts

Abstract A rational design of chiral thiazolium salts to be used in chiral benzoin condensations is possible from the proposal that bis (thiazolin-2-ylidene)s are the actual catalytic species in the benzoin condensation.

Use of Octogenarian Donors for Liver Transplantation: A Survival Analysis

Use of very old donors in liver transplantation (LT) is controversial because advanced donor age is associated with a higher risk for graft dysfunction and worse long‐term results, especially for hepatitis C virus (HCV)‐positive recipients. This was a retrospective, single‐center review of primary, ABO‐compatible LT performed between 2001 and 2010. Recipients were stratified in four groups based on donor age (<60 years; 60–69 years; 70–79 years and ≥80 years) and their outcomes were compared. A total of 842 patients were included: 348 (41.3%) with donors <60 years; 176 (20.9%) with donors 60–69 years; 233 (27.7%) with donors 70–79 years and 85 (10.1%) with donors ≥80 years. There was no difference across groups in terms of early (≤30 days) graft loss, and graft survival at 1 and 5 years was 90.5% and 78.6% for grafts <60 years; 88.6% and 81.3% for grafts 60–69 years; 87.6% and 75.1% for grafts 70–79 years and 84.7% and 77.1% for grafts ≥80 years (pu2009=u20090.065). In the group ≥80 years, the 5‐year graft survival was lower for HCV‐positive versus HCV‐negative recipients (62.4% vs. 85.6%, pu2009=u20090.034). Based on our experience, grafts from donors ≥80 years may provide favorable results but require appropriate selection and allocation policies.

Optimization of liver grafts in liver retransplantation: A European single-center experience

BACKGROUNDnLiver retransplantation (ReLT) is the only therapeutic option that offers a chance at long-term survival when a liver graft fails. Careful analysis of the results and potential benefits is needed to justify its role in the current era of donor shortage and economical concerns. We reviewed all retransplants performed in our hospital and tried to determine if there is a high risk group of patients in whom its use would be contraindicated.nnnMETHODSnBetween June 1988 and January 2006, 1,226 liver transplants were performed in 1,118 patients at our institution. Among them, 108 retransplants (8.8%) were performed in 98 patients. Preoperative, intraoperative, and postoperative data were gathered from our prospectively collected liver transplant database. The entire series of patients was divided between two periods of equal duration and patients were also classified according to the interval between retransplantation and the previous transplant.nnnRESULTSnConcerning indications, only chronic rejection was a more frequent etiology in the first period versus the second period. When comparing first and second periods, 1-, 5-, and 10-year graft survival was 66%, 45%, and 40% and 76%, 69%, and 69%, respectively (P = .014). No significant differences in post-ReLT survival were found when the indication was HCV recurrence versus other non-urgent causes (1-, 5-, and 10-year graft survival: 70%, 57%, and 57% vs 72%, 50%, and 45%). According to the UNOS Rosen risk score, patients in the low-risk group showed significantly greater survival with respect to patients in the high-risk group though 5-year survival in the high-risk group was still greater than 50%.nnnCONCLUSIONSnReLT indications have changed over time, with better results being achieved in more recent years. Candidate selection in elective ReLT is critical to improve the results, though current criteria do not allow for the identification of a single patient subset in which ReLT would be contraindicated.

Prognostic Value of Serum Neutrophil Gelatinase-Associated Lipocalin in Metastatic and Nonmetastatic Colorectal Cancer

BackgroundNeutrophil gelatinase-associated lipocalin (NGAL) expression is increased in epithelial cancer patients, but studies showing its relation to prognosis are scarce. We aimed to test the ability of preoperative serum NGAL levels (pNGAL) to predict recurrence in metastatic and nonmetastatic colorectal cancer (CRC) patients.MethodsThis retrospective study determined pNGAL levels in 60 healthy individuals, 47 patients with nonmetastatic CRC, and 70 patients with metastatic CRC undergoing curative neoplastic resection. Patients were divided into low- and high-pNGAL groups using a median series-based cutoff.ResultsThe meanxa0±xa0SD pNGAL in CRC patients (nonmetastatic and metastatic) was 102.3xa0±xa066.6 (median 91.4). Nonmetastatic CRC and metastatic CRC patients had higher pNGAL than healthy controls (88xa0±xa064 and 112xa0±xa067 vs. 0.6xa0±xa00.3, respectively, both pxa0<xa00.0001). Nonmetastatic CRC patients with deeper tumor invasion and metastatic CRC patients with shorter disease-free interval after CRC resection had higher pNGAL. pNGAL levels correlated with neoplastic tissue volume. CRC patients with recurrence had higher pNGAL than those without recurrence (118xa0±xa064 vs. 88xa0±xa066, pxa0=xa00.013), and high-pNGAL patients had a higher recurrence rate (59.3 vs. 36.2xa0%, pxa0=xa00.016). Median pNGAL-based risk classification had a sensitivity of 62.5xa0% for predicting neoplastic progression in CRC patients and 74.3xa0% for predicting neoplastic progression during the first year after metastatic CRC resection.ConclusionspNGAL is higher in CRC patients than in the healthy population, which indicates a potential screening role. High-pNGAL levels are associated with higher neoplastic tissue volume, characteristics of neoplastic invasion, and recurrence, showing a prognostic utility mainly in metastatic CRC patients.

Suprapubic single-incision laparoscopic appendectomy: a nonvisible-scar surgical option.

BackgroundAt the present time, and given the increasing concern about body image, laparoscopic surgeons are faced with an increasing number of patients who want to conserve the umbilicus free of scars for cosmetic reasons. Single-incision laparoscopic surgery (SILS) using the suprapubic approach for appendectomy, while keeping the advantages of SILS through an umbilical incision, leaves the visible abdomen without scars. Moreover, insertion of an additional port in patients with retrocecal or purulent or gangrenous acute appendicitis requiring intra-abdominal drainage is avoided. This report describes the initial experience with suprapubic SILS appendectomy.MethodsBetween September 2009 and December 2010, patients with acute appendicitis admitted to the General Surgery and Emergency Unit of the authors’ institution and who agreed to undergo SILS appendectomy through the suprapubic approach were included in a prospective study. Demographics, clinical characteristics, and surgical outcome were recorded.ResultsA total of 20 patients (12 men and 8 women) with a mean age of 30xa0±xa03xa0years underwent suprapubic SILS appendectomy. The mean duration of the operation was 40xa0±xa07xa0min. Placement of a suction drain was necessary in four patients. The mean length of hospital stay was 2xa0±xa00.5xa0days. The operation was completed successfully in all patients, and conversion to either multiport or open surgery was not required. No intraoperative or postoperative complications occurred. In all patients, the appearance of the suprapubic wound was good at 7xa0days after surgery.ConclusionSuprapubic SILS appendectomy offers better, cosmetically appealing results than the standard umbilical access. In case of retrocecal or purulent or gangrenous acute appendicitis, the view provided via the suprapubic approach makes access to and dissection of the appendix easy, and it also enables exteriorization of a drain without adding new lateral incisions.

Clinical trial on the cost‐effectiveness of T‐tube use in an established deceased donor liver transplantation program

Abstract:u2002 The aim of our study was to assess the advantages and disadvantages of T‐tube use in liver transplantation, with also paying attention to the economic costs derived from its use. Patients were prospectively randomized to T tube or no T tube. One hundred and seven patients, 53 with T tube and 54 without T tube, were analyzed. Minimum follow‐up was three months. Nine patients (8.4%) had bile leak: six in the T‐tube group (11.3%) and three in the group without T tube (5.5%), pu2003=u2003ns. Four patients (3.5%) had anastomotic biliary stenosis: one in the T‐tube group (1.8%) and three in the group without T tube, pu2003=u2003ns. Twenty of the 53 patients (37.7%) with T tube had T‐tube‐related complication. The number of diagnostic and therapeutic resources were higher in the T‐tube group compared with non‐T tube (81 and 17 vs. 18 and 10, respectively, pu2003<0.05). The costs of therapeutic procedures required for the treatment of complications were 28u2003232 € in the T‐tube group vs. 16u2003088 € in the no T‐tube group, pu2003<0.05. In conclusion, the systematic use of the T tube in biliary reconstruction in liver transplantation cannot be justified.

Outcome of patients following hepatic resection for metastatic cutaneous and ocular melanoma

Background/purposeThe aim of this study was to analyze the outcome of patients undergoing hepatic resection for melanoma liver metastases.MethodsPatients undergoing liver resection for melanoma metastases at the Hospital Vall d’Hebron and Hospital Clinic, Barcelona, were reviewed. Selection criteria were: good performance status, feasibly complete and safe resection, and absence of visceral extrahepatic metastases.ResultsBetween 1994 and 2007, 14 liver resections were performed for melanoma liver metastases. The primary tumor was cutaneous in 8 patients and ocular in 6. Two patients underwent urgent liver surgery due to tumor bleeding. In these patients, complete melanoma staging was not performed and extrahepatic metastases were found during surgery or during the postoperative course. Six of 13 patients (46.2%) developed liver recurrence during follow-up. One- and 3-year actuarial patient survivals were 77 and 49%, respectively. Excluding the patients who underwent urgent liver surgery, the 1- and 3-year actuarial patient survivals in those with primary ocular and cutaneous melanoma were 83 and 56% and 80 and 60%, respectively.ConclusionsLiver resection may be considered as part of oncosurgical treatment in patients with melanoma liver metastases, since prolonged survival was observed, albeit with a high recurrence rate. Nevertheless, it should be taken into account that our study included only a small number of patients.

New evidence supporting bis(thiazolin-2-ylidene)s as the actual catalytic species in the benzoin condensation.

Abstract Polymethylene-bridged (n= 2-8) thiazolium and benzothiazolium salts (plus bases) are used as catalysts for the benzoin condensation and it is found that catalytic activity depends strongly on the methylene bridge length. This result supports a previous postulation that bis (thiazolin-2-ylidene)s, and not thiazolin-2-ylidenes, are the catalytic species in the benzoin condensation catalyzed by thiazolium salts plus base.