Safety and efficacy of living donor liver preservation with HTK solution

BACKGROUND

In living donor liver transplantation (LDLTx) organ procurement is usually well controlled, and allows to assess liver preservation and graft function under standardized conditions. Because publications on histidine-tryptophan-ketoglutarate (HTK) solution are limited, we prospectively studied its safety and efficacy in a consecutive series of LDLTx.

METHODS

Twenty-four patients received 22 right, 1 left, and 1 left lateral lobe graft. Liver preservation was done by gravity perfusion with HTK through portal vein, and hepatic artery, and flushing of bile ducts. Total ischemia time was 191 +/- 68 minutes.

RESULTS

There was no primary nonfunction, and all partial liver grafts showed good recovery: peak aspartate aminotransferase 577 U/L, total bilirubin 15.15 mg/dL, and partial thromboplastin time 49.37 seconds. One graft was lost from parenchymal fracture secondary to portal hyperperfusion after 6 days, and the patient was salvaged with retransplantation. Thirty-day mortality, including sudden cardiac death, pancreatitis, and hepatic artery rupture, was not related to graft dysfunction. Eight of 24 recipients developed early biliary leakage. There was no late ischemic type biliary lesion.

CONCLUSION

These results confirm that HTK solution is safe and effective when used in LDLTx. Potential advantages of HTK in comparison to other preservation solutions are low potassium concentration, low viscosity, no particles, in situ perfusion, no need to flush before reperfusion, improved biliary protection, better recovery of microcirculatory changes, ready to use, and lower costs. Because the risk-benefit ratio is of particular importance in LDLTx the use of HTK solution should be encouraged.

Longer aPTT values in healthy children than in adults: no single cause

We have shown that activated partial thromboplastin time values in children are considerably longer than in adults, but the causes for this observation remained unclear. Therefore, we investigated the correlation between activated partial thromboplastin time values and concentrations of clotting factors, quotients and titers of the tissue thromboplastin inhibition test, and antiphospholipid antibodies in healthy children, children with recurrent infections, and adults. Concentrations of factors VIII, IX, and HMWK were significantly lower in children than in adults. Simple linear regression analysis failed to show a correlation between the concentration of a single clotting factor and the activated partial thromboplastin time values. No significant correlation was found between activated partial thromboplastin time and elevation of the tissue thromboplastin inhibition test quotients or titers, or antiphospholipid antibodies values. The determined activated partial thromboplastin time was best described by a function including all measured coagulation factors. Our study suggests, that no single clotting factor or lupus anticoagulants are responsible for the longer activated partial thromboplastin time in healthy children, but that activated partial thromboplastin prolongation is caused by the combination of several slightly lower clotting factors.

Kawasaki disease presenting as focal colitis

Kawasaki disease (mucocutaneous lymph node syndrome) typically presents with fever, rash, lymphadenitis, and mucositis. The colon is rarely involved and, to date, colitis has not been described as the presenting symptom. We report the imaging findings of a child with Kawasaki disease who presented with fever and focal left colitis.

Particle concentration fluorescence immunoassay chemosensitivity assay for human epithelial ovarian cancer

We adapted particle concentration fluorescence immunoassay technology to develop a new chemosensitivity assay. Six human epithelial ovarian cancer cell lines were incubated with cisplatin for 24 hours. Cells were then labeled with a fluorophore for 30 minutes. Removal of supernatant, washing of tumor cells, and reading of epifluorescence was performed automatically. Percent cell lysis was calculated simultaneously by chromium release assay. The particle concentration fluorescence chemosensitivity assay detected cell lysis in all six cell lines. The chemosensitivity assay detected a larger percent lysis than the chromium release assay in each of the cell lines. The advantages of our chemosensitivity assay are plating efficacy, speed, efficiency, safety, and accuracy.

Single-strand conformation polymorphism analysis coupled with stratified DNA sequencing reveals reduced sequence variation in the su(s) and su(wa) regions of the Drosophila melanogaster X chromosome

Single-strand conformation polymorphism (SSCP) analysis followed by DNA sequencing of stratified sub-samples was used to survey DNA polymorphism in the su(s) and su(wa) regions in a natural population of Drosophila melanogaster. su(s) and su(wa) are located near the telomere of the X chromosome, where the rate of crossing over per kilobase of DNA monotonically decreases toward the tip. SSCP was assessed in 12 noncoding segments amplified from the su(s) region (3213 bp) and in 8 noncoding segments amplified from the su(wa) region (1955 bp). Sets of segments were multiplexed in a single electrophoretic lane to increase the number of base pairs assayed per lane. Eight segments were monomorphic, and the other 12 segments exhibited two to four SSCP classes. Only four within-SSCP-class DNA sequence differences (a single nucleotide substitution) were observed among 24,360 bp compared within classes. The between-SSCP-class DNA sequence comparisons revealed 27 substitutions and 9 insertion/deletion polymorphisms. The average numbers of substitutional differences per site were 0.0010 and 0.0021 for su(s) and su(wa), respectively. These values are intermediate between those reported for the more distal y-ASC region (0.0004) and the more proximal Pgd locus (0.0024). This observation is consistent with the prediction of the hitchhiking-effect model-i.e., a monotonic increase in polymorphism as a function of crossing over per kilobase.

Nature screen: an efficient method for screening natural populations of Drosophila for targeted P-element insertions

The efficiency of molecular techniques is making it increasingly necessary to rely on reverse genetics to understand the function of genes. Tissue-specific libraries allow one to identify numerous genes that can be cloned, sequenced, and mapped and whose temporal and tissue-specific pattern of expression are well characterized but whose function remains unknown. In such cases, it is desirable to generate targeted mutations to examine the phenotype of loss-of-function lesions. Here we describe a method for identifying naturally occurring variants of Drosophila melanogaster with specific genes tagged by a nearby P element. Imprecise P-element excision can then be used to generate a series of small deletions in or near the gene. In the method described here, large numbers of wild-caught males were crossed to balancer females, and inserts were identified in pooled samples by the polymerase chain reaction with one primer from each target gene and one primer from the P-element terminal repeat. We present the calculations for the probability of successfully tagging a gene and show that it is greatly improved by simultaneously screening inserts into several genes. If a large natural population is available, a nature screen is faster and easier than inducing P-element transposition in the laboratory, but the resulting lines, being genetically heterogeneous, may require more subsequent work to isolate. Using this method to screen the genomes of approximately 10,400 males, we found P-element inserts in close proximity to 3 of 10 genes that were screened.

The fertility effects of pericentric inversions in Drosophila melanogaster

Heterozygotes for pericentric inversions are expected to be semisterile because recombination in the inverted region produces aneuploid gametes. Newly arising pericentric inversions should therefore be quickly eliminated from populations by natural selection. The occasional polymorphism for such inversions and their fixation among closely related species have supported the idea that genetic drift in very small populations can overcome natural selection in the wild. We studied the effect of 7 second-chromosome and 30 third-chromosome pericentric inversions on the fertility of heterokaryotypic Drosophila melanogaster females. Surprisingly, fertility was not significantly reduced in many cases, even when the inversion was quite large. This lack of underdominance is almost certainly due to suppressed recombination in inversion heterozygotes, a phenomenon previously observed in Drosophila. In the large sample of third-chromosome inversions, the degree of underdominance depends far more on the position of breakpoints than on the inversion's length. Analysis of these positions shows that this chromosome has a pair of "sensitive sites" near cytological divisions 68 and 92: these sites appear to reduce recombination in a heterozygous inversion whose breakpoints are nearby. There may also be "sensitive sites" near divisions 31 and 49 on the second chromosome. Such sites may be important in initiating synapsis. Because many pericentric inversions do not reduce the fertility of heterozygotes, we conclude that the observed fixation or polymorphism of such rearrangements in nature does not imply genetic drift in very small populations.

Hepatic hemangiomas vs metastases: MR differentiation at 1.5 T

We retrospectively studied the value of MR imaging at 1.5 T in distinguishing hepatic hemangiomas (n = 15) from metastases (n = 15) by using (1) lesion/liver signal-intensity ratios, (2) contrast/noise ratios, and (3) T2 relaxation time on long TR/TE spin-echo (SE) sequences. Lesion/liver margin sharpness, lesion shape, and overall lesion morphologic pattern were evaluated also. Univariate logistic regression analysis of the quantitative data showed that T2 was the only statistically significant (p less than .02) variable for distinguishing a hemangioma from a metastasis. A receiver-operator-characteristic plot of T2 produced an area of 0.80 (+/- 0.08). T2 values for these lesions still overlapped with those for metastases. Morphologically, hemangiomas were sharply marginated (80%), rounded or oval (93%), homogeneous, hyperintense lesions (73%), whereas metastases were poorly marginated (66%) and inhomogenous (67%) lesions. The marked, hyperintense appearance was present in 27% of metastases. Retrospective, multivariate logistic regression analysis of T2 and the presence of hyperintense morphology did not improve results based on T2 alone. Morphologic criteria are helpful in differentiation, as some metastases have a prolonged T2 and are not homogenous, hyperintense lesions. In cases where T2 or morphology are equivocal, other diagnostic tests may help confirm the MR findings. We currently use a T2 of greater than 88 msec and the presence of hyperintense morphology to diagnose hemangiomas. Despite both quantitative and qualitative analysis, data for these hemangiomas and metastases still overlap.

Limited improvement of tumour diagnosis by the simultaneous determination of carcinoembryonic antigen (CEA) and of a tumour-associated CEA-related antigen of Mr 128,000 in serum

Two biotin-avidin based enzyme immunoassays were developed using three monoclonal anti-CEA antibodies with distinct epitope- and antigen-specificities. A broadly cross-reactive monoclonal anti-CEA antibody (T84.1) was immobilized on a solid support. Either monoclonal antibody T84.66 or CEA.11 was used as the second, biotin-labeled monoclonal antibody. Both antibodies do not cross-react with normal granulocytes or bile canaliculi. Monoclonal antibody CEA.11 binds to CEA and to an antigen with a relative molecular mass of 128,000 present in extracts from solid carcinomas. Monoclonal antibody T84.66 does not cross-react with the antigen of Mr 128,000. After adsorption of tumour extracts to a CEA-specific immunosorbent, residual activity was measurable by the CEA.11 assay, but not by the T84.66 assay. Serum samples (n = 726) from patients with malignant and non-malignant disease, as well as from healthy volunteers, were analysed by both immunoassays and by two commercial CEA immunoassays. In comparison with the T84.66 assay and the commercial assays, the CEA.11 assay did not significantly increase the sensitivity or specificity of tumour diagnosis.

An in vivo comparison of the step-back technique versus a step-back/ultrasonic technique in human mandibular molars

This study compared the in vivo debridement efficacy of the step-back preparation versus a step-back/ultrasound preparation in the mesial root canals of vital human mandibular molars. Group 1 consisted of 15 teeth prepared with a step-back technique using intermittent irrigation with 5.25% sodium hypochlorite. Group 2 consisted of 23 teeth prepared with a step-back technique as in group 1 followed by 3 min of ultrasonic instrumentation (Cavi-Endo) using 5.25% sodium hypochlorite (30 ml per min). Group 3 consisted of 21 teeth which were uninstrumented and served as controls. Following extraction and histological preparation, the 1- and 3-mm levels of the canal and isthmus were evaluated for percentage of tissue removal using a compensating polar planimeter. At the 3-mm level, there were no statistical differences in canal or isthmus cleanliness between the step-back group and the step-back/ultrasound group. At the 1-mm apical level, statistical analysis indicated that the step-back/ultrasonic technique was superior to the step-back technique in canal (99.6% versus 88%) and isthmus (86% versus 10%) cleanliness.

An evaluation of volumes and concentrations of lidocaine in human inferior alveolar nerve block

The purpose of this study was to evaluate, with the electric pulp tester, the anesthetic efficacy of 1.8 ml of 2% lidocaine with 1:100,000 epinephrine, 3.6 ml of 2% lidocaine with 1:200,000 epinephrine, and 1.8 ml of 4% lidocaine with 1:100,000 epinephrine in human inferior alveolar nerve block. Thirty subjects randomly received each of the solutions at three successive appointments. The first molar, canine, lateral incisor, and contralateral canine were tested with the pulp tester at various time intervals up to 55 min. Complete anesthesia was defined as an 80/80 reading with the pulp tester. No significant differences in anesthetic success or failure were found among the three solutions. Potential anesthetic problems (failure, noncontinuous anesthesia, slow onset, and short duration) occurred in 43 to 57% of the molars, in 43 to 60% of the canines, and in 57 to 80% of the lateral incisors. Complete anesthesia in the mandible is a meaningful clinical problem.

Hepatic adenoma: MR appearance mimicking focal nodular hyperplasia

A hepatic adenoma (HA) nearly isointense to normal liver on short and long repetition and echo time spin echo pulse sequences is presented. Contrary to previous expectations, the case shows that a single hepatic mass with these signal characteristics on magnetic resonance without a scar may represent either HA or focal nodular hyperplasia.

[Significance of basal TSH and free T3 as compared with an extended in vitro diagnosis in the understanding of functional disorders of the thyroid]

Data of 411 untreated patients undergoing thyroid investigations were stored in a data base system. Three combinations of thyroidal hormone parameters were compared with respect to their clinical value. In patients with concordant basal TSH (bTSH) and free T3 (fT3)-values (e.g. bTSH normal and fT3 normal, bTSH decreased and fT3 increased) it could be demonstrated that the predictive value of the combined evaluation of basal TSH (supersensitive) and free T3 alone (97% in normal thyroid function, 98% in thyrotoxicosis, and 97% in hypothyroidism) was sufficient. Additional determinations of T4 parameters did not increase predictive value (e.g. TT4: 95% in thyrotoxicosis). Thus, thyroid disorders may currently be diagnosed by the combined evaluation of basal TSH and free T3, saving costs without loss of diagnostic efficacy.

Effect of apolipoproteins on the induction of hepatic steatosis in rats

The incorporation of apolipoprotein E isolated from human very low density lipoproteins on a triglyceride emulsion produced a substantial increment in hepatic triglyceride after 1 h of in vitro perfusion through the isolated liver of a fasted rat. Both gross and microscopic morphology confirmed a substantial steatosis. Perfusions with triglyceride emulsions which contained no apoipoproteins resulted in a modest increment in hepatic triglyceride although considerably less than emulsions with the E protein, and no morphologic features of steatosis. The steatosis induced in the in vitro perfused fasted livers by the emulsions with E protein could be prevented when CIII-1 apoprotein was also incorporated on the emulsion. A fed rat liver perfused with the E-enriched emulsion accumulated significantly less triglyceride than the fasted preparation. These data suggest that the apoprotein patterns of the plasma triglyceride-rich lipoproteins are of considerable importance for the partition of triglyceride between liver and plasma.

Effect of apoproteins on hepatic uptake of triglyceride emulsions in the rat

The addition of apoprotein E isolated from human very low density lipoproteins to both rat lymph chylomicrons and a triglyceride emulsion significantly increased the hepatic uptake of these particles in a nonrecycling isolated rat liver perfusion system. The cleared triglyceride was removed without apparent hydrolysis by the hepatocyte. When lymph chylomicrons were loaded with both Apo E and Apo C proteins by exposure to rat plasma, no increment in hepatic clearance was observed. Sequential evalutions of the influence of the C apoproteins on the hepatic clearance of both emulsions and chylomicrons revealed that the CIII (CIII-1) protein had a pronounced inhibitory effect on hepatic removal. The inhibition was observed for both Apo E-enriched chylomicrons and those containing little of this apoprotein.