RESUMEN
The abdominal aorta and the renal, mesenteric, and splenic arteries are frequently affected with arterial wall calcification upon increasing age; the hepatic artery is far less often found to be calcified. We report the case of a liver transplant recipient who presented with a calcified hepatic artery in the liver graft 13 years after transplantation for primary sclerosing cholangitis. Although the etiology of hepatic artery calcification was unknown, underlying causes for calcification may include chronic hemodialysis for renal insufficiency and subsequent secondary hyperparathyroidism, as well as a calcified aneurysms. However, it remained unclear whether hepatic artery calcification had to be considered an epiphenomenon or an original pathology of the liver. It thus seems unlikely that hepatic artery calcification as a single finding is to be considered a serious pathologic entity, even for a liver graft.
Asunto(s)
Calcinosis/patología , Colangitis Esclerosante/cirugía , Arteria Hepática/patología , Adulto , Calcinosis/diagnóstico por imagen , Coledocostomía , Arteria Hepática/diagnóstico por imagen , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Masculino , Diálisis Renal , Insuficiencia Renal Crónica/terapia , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Polygonum odoratum (= Persicaria odorata), known as rau ram or sang hum, is native to southeastern Asia and is a common herb in Vietnamese cuisine (1). It has been studied most extensively for its aromatic compound content (2). In Florida, rau ram commonly is grown hydroponically in greenhouses using large, cement beds with recirculated water. The plants form dense mats from which new growth is trimmed for market. During January of 2002, a severe dieback was observed in one production house in Saint Lucie County, FL. Plants with less severe symptoms were yellowed and stunted. Roots of symptomatic plants were largely decayed with root symptoms beginning as a tip necrosis. The cortex of severely affected roots slipped off easily, leaving a stringy vascular system. Plating of symptomatic tissue from 20 randomly selected plant samples was performed with multiple general and selective media including potato dextrose agar, corn meal agar with pimaricin, ampicillin, rifampicin, and pentachloronitrobenzene (PARP) (3). All colonies produced were identified as Pythium helicoides Drechsler on the basis of sporangial, oogonial, and antheridial characteristics (4). Isolates had proliferous, obovoid, papillate sporangia, and were homothallic with smooth-walled oogonia and thick-walled, aplerotic oospores. Multiple antheridial attachments per oogonium were common with the antheridium attached along its entire length. Pathogenicity tests were conducted using P. odoratum plants grown from commercial transplants. Two tests were performed. Each test was conducted using eight inoculated and eight control plants. In the first test, plants were maintained in 10-cm pots immersed in sterilized pond water for the duration of the test. Plants were inoculated with five 7- × 70-mm sections of freshly growing mycelial culture per plant using 10-day-old cultures of Pythium helicoides grown on water agar. Chlorosis was observed at approximately 2 months after inoculation. Root necrosis was observed in inoculated plants approximately 5 months after inoculation. This test was performed in the greenhouse with temperatures ranging from 20 to 30°C. The second test was performed in growth chambers at 35 to 40°C. Plants were maintained in 10-cm pots immersed in Hoagland's solution and were inoculated with four 6-mm plugs per plant. Symptoms were observed on inoculated plants at this temperature within 1 week of inoculation. No chlorosis or root decay was observed in noninoculated, immersed plants. The pathogen was reisolated from inoculated, symptomatic tissue. To our knowledge, this is the first report of root rot of P. odoratum caused by Pythium helicoides. References: (1) R. E. Bond. Herbarist 55:34, 1989. (2) N. X. Dung et al. J. Essent. Oil Res. 7:339, 1995. (3) M. E. Kannwischer and D. J. Mitchell. Phytopathology 68:1760, 1978. (4) A. J. van der Plaats-Niterink. Monograph of the Genus Pythium. Vol. 21, Studies in Mycology. Centraalbureau voor Schimmelcutltures, Baarn, The Netherlands, 1981.
RESUMEN
Vicia faba seedlings, subjected to a 10 microT 50 Hz square wave magnetic field for 40 min together with a radioactive pulse, showed a marked increase in amino acid uptake into intact roots. A more modest increase was observed with a 100 microT 50 Hz square wave. An increase in media conductivity at low field intensities from 10 microT 50 Hz square wave, 100 microT 50 Hz sine wave, and 100 microT 60 Hz square wave fields, indicated an alteration in the movement of ions across the plasma membrane, most likely due to an increase in net outflow of ions from the root cells. Similarly, marked elevation in media pH, indicating increased alkalinity, was observed at 10 and 100 microT for both square and sine waves at both 50 and 60 Hz. Our data would indicate that low magnetic field intensities of 10 and 100 microT at 50 or 60 Hz can alter membrane transport processes in root tips.
Asunto(s)
Alanina/metabolismo , Campos Electromagnéticos/efectos adversos , Vicia faba/metabolismo , 2,4-Dinitrofenol/farmacología , Transporte Biológico Activo/efectos de los fármacos , Membrana Celular/metabolismo , Concentración de Iones de Hidrógeno , Transporte Iónico , Ouabaína/farmacología , Raíces de Plantas/efectos de los fármacos , Raíces de Plantas/metabolismo , ATPasas de Translocación de Protón/metabolismo , Vicia faba/efectos de los fármacosAsunto(s)
Arginina/farmacología , Supervivencia de Injerto/fisiología , Mucosa Intestinal/fisiología , Intestino Delgado/trasplante , Metilprednisolona/farmacología , Daño por Reperfusión/prevención & control , Trasplante Isogénico/fisiología , Animales , Supervivencia de Injerto/efectos de los fármacos , Mucosa Intestinal/efectos de los fármacos , Mucosa Intestinal/trasplante , Intestino Delgado/efectos de los fármacos , Intestino Delgado/fisiología , Molsidomina/farmacología , Ratas , Ratas Endogámicas Lew , Trasplante Isogénico/patología , Vasodilatadores/farmacologíaRESUMEN
STUDY OBJECTIVE: To analyze the incidence and indications for reintubation during postoperative care following orthotopic liver transplantation (OLT). DESIGN: Retrospective chart review. SETTING: Large metropolitan teaching hospital. PATIENTS: 546 adult liver transplant recipients. MEASUREMENTS AND MAIN RESULTS: The medical charts of 546 patients who underwent OLT at our institution between January 1992 and September 1996 were reviewed for the incidence and indications of reintubation throughout primary hospitalization. Eighty-one of 546 patients (14.8%) required one or more episodes of reintubation after OLT. In the majority of cases, reintubation was performed for pulmonary complications (44.6%), followed by cerebral (19.1%) and surgical (14.5%) complications. Cardiac (9.1%) and peripheral neurologic (2.7%) complications were less frequent reasons for reintubation. Overall patient survival, according to the Kaplan-Meier estimates, was 89.9%, 87.5%, 86.5%, and 82.2% after 1, 2, 3, and 5 years, respectively. In patients with one or more episodes of reintubation, overall survival decreased to 62.5% after 1, 2, and 3 years, and to 56.4% after 5 years (p < 0.001). CONCLUSIONS: The main indications for reintubation after OLT were pulmonary, cerebral, and surgical complications. These reintubation events had a considerable influence on the patient's postoperative recovery, and were associated with a significantly higher rate of mortality, than for OLT patients who did not undo reintubation.
Asunto(s)
Intubación Intratraqueal , Trasplante de Hígado/fisiología , Cuidados Posoperatorios , Antiinfecciosos/administración & dosificación , Antiinfecciosos/uso terapéutico , Estudios de Seguimiento , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Monitoreo Fisiológico , Pruebas de Función Respiratoria , Estudios RetrospectivosRESUMEN
Symptomatic portal vein stenosis is an uncommon complication after liver transplantation. Portal vein angioplasty has been successfully established for treatment of portal vein stenosis using mesenteric or percutaneous, transhepatic approaches. We herein report on a patient who suffered from variceal bleeding due to portal hypertension 3 months after liver transplantation. After successful endoscopic sclerotherapy, an extrahepatic portal vein stenosis was diagnosed, and portal vein angioplasty was considered as primary therapeutic option. Instead of mesenteric or percutaneous, transhepatic approaches, we adopted a transjugular, intrahepatic access to introduce a 14-mm balloon catheter into the portal vein. Using this technique, angioplasty was successfully performed. After intervention, no further episodes of variceal bleeding occurred. We favour the transjugular, intrahepatic technique for portal vein angioplasty because it does not require general anesthesia, in contrast to the mesenteric approach, and it reduces the risk of intra-abdominal bleeding, compared to the percutaneous, transhepatic approach.
Asunto(s)
Angioplastia/métodos , Trasplante de Hígado/efectos adversos , Vena Porta/cirugía , Constricción Patológica , Várices Esofágicas y Gástricas/etiología , Várices Esofágicas y Gástricas/cirugía , Humanos , Hipertensión Portal/etiología , Hipertensión Portal/cirugía , Trasplante de Hígado/patología , Masculino , Persona de Mediana Edad , Vena Porta/patologíaAsunto(s)
Ciclosporina/uso terapéutico , Inmunosupresores/uso terapéutico , Trasplante de Hígado/fisiología , Ácido Micofenólico/uso terapéutico , Tacrolimus/uso terapéutico , Área Bajo la Curva , Quimioterapia Combinada , Glucocorticoides/administración & dosificación , Supervivencia de Injerto , Humanos , Ácido Micofenólico/análogos & derivados , Prednisolona/administración & dosificaciónAsunto(s)
Arteria Hepática/cirugía , Trasplante de Hígado/métodos , Hígado/irrigación sanguínea , Vena Porta/cirugía , Trombosis de la Vena/cirugía , Adulto , Derivación Arteriovenosa Quirúrgica/métodos , Síndrome de Budd-Chiari/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugíaRESUMEN
BACKGROUND: The duration of postoperative mechanical ventilation and its influence on pulmonary function in liver transplant recipients is still debated controversially. METHODS: We retrospectively analyzed the incidence of immediate tracheal extubation, prolonged mechanical ventilation (>24 h following surgery), and episodes of reintubation in 546 patients who underwent orthotopic liver transplantation (OLT) at our institution. RESULTS: Immediate tracheal extubation in the operating theater was achieved in 18.7% of patients, and prolonged mechanical ventilation was required by 11.2% of patients. In these, median time of extubation was 49.5 h, whereas the remaining 70.1% of patients required ventilation support for a median 5 h after OLT. As risk factors for prolonged mechanical ventilation we identified the indications of acute liver failure and retransplantation, as well as factors such as mechanical ventilation prior to OLT, massive intraoperative bleeding, and severe reperfusion injury of the liver graft. The incidence of reintubation was 8.8% in patients who were immediately extubated following surgery, and 13.1% in patients who underwent extubation within 24 h. The incidence was significantly increased in patients requiring prolonged mechanical ventilation (36.1%). CONCLUSIONS: Immediate tracheal extubation was safe and well tolerated. The incidence of reintubation was not increased when compared to patients in whom extubation succeeded later. However, special attention should be given to transplant recipients presenting in reduced clinical condition at the time of OLT, undergoing complicated surgery, or receiving liver allografts with severe reperfusion injury because of an increased risk for prolonged mechanical ventilation.
Asunto(s)
Intubación Intratraqueal , Trasplante de Hígado , Adolescente , Adulto , Femenino , Humanos , Trasplante de Hígado/mortalidad , Masculino , Persona de Mediana Edad , Daño por Reperfusión/complicaciones , Respiración Artificial , Tasa de Supervivencia , Factores de TiempoRESUMEN
Host defense mechanisms preventing bacterial invasion are particularly important in the gastrointestinal tract, since most gram-negative infections originate from there. Intraepithelial lymphocytes (IEL) seem to play an important role in this immune surveillance of the intestine, although their function in sepsis is not fully understood. To evaluate the characteristics of IEL in sepsis, C57BL/6 mice received a non-lethal dose of LPS and IEL were harvested at various time points thereafter. Although IEL displayed no phenotypic changes after endotoxemia, they displayed enhanced cytolytic activity and increased proliferation after LPS injection In addition, IEL from septic mice showed enhanced gamma interferon (IFN-gamma) production after LPS administration. The production of IFN-gamma may have induced the increased intestinal NOS-2 mRNA expression which was observed after endotoxemia. In conclusion, endotoxemia leads to functional activation of IEL without phenotypic changes. The activation of IEL and the subsequently increased NOS-2 expression may be important mechanisms in maintaining the mucosal barrier after sublethal LPS challenge.
Asunto(s)
Mucosa Intestinal/patología , Mucosa Intestinal/fisiopatología , Linfocitos/fisiología , Sepsis/patología , Sepsis/fisiopatología , Animales , División Celular , Citotoxicidad Inmunológica , Endotoxemia/inmunología , Endotoxemia/patología , Endotoxemia/fisiopatología , Femenino , Técnicas In Vitro , Interferón gamma/biosíntesis , Mucosa Intestinal/inmunología , Intestino Delgado/inmunología , Intestino Delgado/patología , Intestino Delgado/fisiopatología , Lipopolisacáridos/toxicidad , Subgrupos Linfocitarios/efectos de los fármacos , Subgrupos Linfocitarios/inmunología , Subgrupos Linfocitarios/patología , Subgrupos Linfocitarios/fisiología , Linfocitos/efectos de los fármacos , Linfocitos/inmunología , Linfocitos/patología , Ratones , Ratones Endogámicos C57BL , Óxido Nítrico Sintasa/genética , Óxido Nítrico Sintasa de Tipo II , ARN Mensajero/genética , ARN Mensajero/metabolismo , Sepsis/inmunologíaRESUMEN
From September 1988 through April 1998, 1,000 liver transplantations were performed on 911 patients. During the postoperative control examinations of 837 patients, we found 23 (2.74 %) with hepatic artery thromboses, 27 stenoses of the hepatic artery (3.22 %), and 6 aneurysms of the graft artery. Seventeen patients underwent retransplantation because of arterial complications. Depending on the clinical symptoms, we treated both the local situation as well as the resulting complications of inadequate arterial graft flow. The aneurysms were primarily treated surgically. The first choice of treatment of stenoses was balloon angioplasty. Early postoperative artery thromboses were also treated surgically by thrombectomy in selected cases. For the resulting biliary and local septic complications we preferred endoscopic and drainage procedures. Our clinical experiences have led us to find pretransplantation angiography recommendable, especially in the case of splanchnic artery stenoses, for bypassing from the aorta for arterial perfusion of the graft.
Asunto(s)
Aneurisma/epidemiología , Arteriopatías Oclusivas/epidemiología , Arteria Hepática , Trasplante de Hígado/estadística & datos numéricos , Complicaciones Posoperatorias , Trombosis/epidemiología , Adulto , Humanos , Incidencia , Trasplante de Hígado/mortalidad , Reoperación , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Intestino Delgado/trasplante , Preservación de Órganos/métodos , Trasplante Homólogo/patología , Trasplante Isogénico/patología , Animales , Membrana Basal/patología , Biomarcadores/sangre , Frío , Ácido Hialurónico/sangre , Mucosa Intestinal/patología , Mucosa Intestinal/trasplante , Intestino Delgado/patología , Laminina/sangre , Masculino , Ratas , Ratas Endogámicas BN , Ratas Endogámicas Lew , Daño por Reperfusión , Factores de Tiempo , Trasplante Homólogo/métodos , Trasplante Homólogo/fisiología , Trasplante Isogénico/métodos , Trasplante Isogénico/fisiologíaAsunto(s)
Interleucina-2/farmacología , Mucosa Intestinal/irrigación sanguínea , Intestinos/irrigación sanguínea , Isquemia/inmunología , Daño por Reperfusión/inmunología , Subgrupos de Linfocitos T/inmunología , Animales , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Mucosa Intestinal/inmunología , Intestinos/inmunología , Masculino , Arterias Mesentéricas/fisiología , Ratas , Ratas Endogámicas Lew , Subgrupos de Linfocitos T/efectos de los fármacos , Factores de TiempoRESUMEN
BACKGROUND AND AIMS: Dysfunction of the immune system with inappropriate responses of lymphocytes to various antigens has been implicated in the development of Crohn's disease. Therefore, the functional and phenotypic characteristics of intestinal intraepithelial lymphocytes (IEL) in comparison to peripheral blood lymphocytes (PBL) were analyzed in patients with and without Crohn's disease. PATIENTS AND METHODS: Six patients with Crohn's disease and six control patients were studied. Isolated IEL and PBL were tested for cytolytic activity against the human adenocarcinoma cells DLD-1 and the human leukemia cells K562 in a 51Cr-release assay. Two-color flow cytometry was performed for phenotype analysis of isolated lymphocytes. RESULTS: IEL from patients with Crohn's disease showed significantly increased cytolytic activity against epithelial-derived target cells when compared with IEL from control patients. In contrast, no functional changes were detectable among PBL from patients with Crohn's disease. IEL from patients with Crohn's disease contained a significantly higher percentage of CD8+ lymphocytes when compared with IEL from control patients, whereas no phenotypic changes were observed among PBL. CONCLUSIONS: In Crohn's disease, the functional and phenotypic changes of T cells are limited to lymphocytes of the intestinal mucosa. Furthermore, it is conceivable that the increased cytolytic activity of IEL contributes to the tissue damage in this disease.