Delayed rupture of a splenic artery pseudoaneurysm after biliopancreatic diversion.

Splenic artery pseudoaneurysm (SAP) is a known but rare complication of pancreatitis and blunt abdominal trauma. SAP caused by operative trauma has been rarely reported. We present a patient who presented with massive upper gastrointestinal (GI) bleed in shock.

Repeat surgical bowel lengthening with the STEP procedure.

Background: Feasibility of repeat lengthening has been demonstrated in animals, but in humans, none of the three clinical case reports have achieved enteral autonomy after secondary lengthening with serial transverse enteroplasty (STEP).

Patients And Methods: Institutional Review Board approved retrospective review of a single center series of repeat intestinal lengthening after prior Bianchi lengthening or STEP. Outcome measures examined include patient survival, weaning from parenteral nutrition, and need for intestinal transplantation.

Experience with the duodenal switch operation in the presence of intestinal malrotation.

The presence of intestinal malrotation (IM) may pose unexpected problems during bariatric operations. We reviewed the records of patients with IM undergoing bariatric operations at our institution over the last 5 years. Three patients underwent four procedures.

Healon5 sandwich technique for phacoemulsification in vitrectomized eyes.

We have developed a safe approach to phacoemulsificaiton in post-vectromized eyes. The technique, called the Healon5 sandwich, uses the viscoadaptive properties of sodium hyaluronate 2.3% (Healon5) to prevent a posterior chamber dehiscence.

Short bowel syndrome after continence-preserving procedures.

The short bowel syndrome (SBS) can result from a variety of conditions, including postoperative complications and malignancy. Continence-preserving operations are generally performed for either ulcerative colitis (UC) or familial polyposis (FAP). These procedures can be associated with high morbidity and the potential for future malignancy.

Comparison of intestinal lengthening procedures for patients with short bowel syndrome.

Objective: Review the clinical results of 24 years of intestinal lengthening procedures at one institution.

Methods: Retrospective review of a single center experience comparing the outcome of 2 intestinal lengthening procedures (Bianchi and serial transverse enteroplasty [STEP]) in terms of survival, total parenteral nutrition (TPN) weaning, and complications.

Results: Sixty-four patients, including 14 adults, underwent 43 Bianchi and 34 STEP procedures between 1982 and 2007.

Treatment of intestinal failure: intestinal transplantation.

Over the past 15 years, intestinal transplantation for the treatment of intestinal failure has changed from a desperate last-ditch effort into a standard therapy for which a good outcome is expected. Patient survival after intestinal transplantation has improved in the past 3-5 years and now approaches that of other solid organ allograft recipients, including liver and kidney, and is similar to survival on permanent therapy with parenteral nutrition. Complications are more common and often more severe during the initial hospitalization period after intestinal transplantation than they are after transplantation of other solid organs.

Leishmania chagasi: homogenous metacyclic promastigotes isolated by buoyant density are highly virulent in a mouse model.

Homogenous metacyclic promastigotes of Leishmania chagasi were isolated by buoyant density from in vitro heterogeneous cultures and used for biochemical characterization of isoforms of the major surface protease (MSP). Compared to stationary phase promastigotes, metacyclic cells had three times more MSP, produced 3-fold higher parasite loads in a mouse model in vivo, and were more resistant to complement-mediated lysis in vitro. These metacyclic L.

Role of an intestinal rehabilitation program in the treatment of advanced intestinal failure.

Objective: To analyze outcomes in children with intestinal failure treated by our Intestinal Rehabilitation Program (IRP) in a 4-year period.

Patients And Methods: A total of 51 parenteral nutrition (PN)-dependent patients (20 male) were enrolled in the IRP. Median age was 1.

Calprotectin: a novel noninvasive marker for intestinal allograft monitoring.

Objective: To identify a noninvasive screening test for intestinal allograft monitoring.

Summary Background Data: Intestinal allograft rejection is difficult to distinguish from other causes of diarrhea and can rapidly lead to severe exfoliation or death. Protocol biopsies are standard for allograft monitoring but may cause serious complications.

Mild donor liver steatosis has no impact on hepatitis C virus fibrosis progression following liver transplantation.

Background: This study examines the impact of donor liver macrovesicular steatosis on recurrence of hepatitis C virus (HCV) disease after liver transplantation.

Methods: Between 1998 and 2004, 113 patients underwent liver transplantation for HCV-related cirrhosis. Time to histologic recurrence (fibrosis score >or=2) was the primary endpoint of the study.

Robotically assisted biliary pancreatic diversion with a duodenal switch: a new technique.

Background: Minimally invasive surgical techniques decrease the length of hospitalization and the morbidity for general surgery procedures. Application of minimally invasive techniques to obesity surgery had previously been limited to stapled techniques used primarily for the Roux-en-Y gastric bypass and laparoscopic band placement. The authors present the technique for totally intracorporeal robotically assisted biliary pancreatic diversion with a duodenal switch (BPD/DS) using five ports.

Short bowel syndrome following bariatric surgical procedures.

Background: Short bowel syndrome (SBS) is a potential postoperative complication that is occurring with increasing frequency after bariatric procedures (BP). As long-term follow-up data are available, unusual long-term complications are being identified. Our goal was to examine the mechanisms and outcomes of patients with SBS following BP.

Treatment of acute myelogenous leukemia with outpatient azacitidine.

Background: Patients older than 55 years of age with acute myelogenous leukemia (AML) are less likely to achieve complete remission and more likely to experience toxicity with conventional induction chemotherapy than younger patients. Azacitidine administered in the outpatient setting is well tolerated and can induce complete hematological remission in patients with myelodysplastic syndromes (MDS). At higher doses, azacitidine has activity in AML.

Predicting outcome of procedures to slow intestinal transit.

Procedures designed to slow intestinal transit in patients with the short-bowel syndrome (SBS) have unpredictable outcomes. Our aim was to evaluate the outcome and predictive factors for this complication in SBS patients. Ten patients (37-61 years) underwent reversed segment (n = 9) or nipple valve creation (n = 1).

Isolated liver transplantation in infants with end-stage liver disease due to short bowel syndrome.

Infants with short bowel syndrome (SBS) and associated liver failure are often referred for combined liver/intestinal transplantation. We speculated that in some young children, nutritional autonomy would be possible with restoration of normal liver function. Features we believed to predict nutritional autonomy include history of at least 50% enteral tolerance, age less than 2 yr, and no underlying intestinal disease.

Inflammatory bowel disease after liver transplantation: risk factors for recurrence and de novo disease.

Inflammatory bowel disease (IBD) is associated with primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) and can recur or develop de novo after orthotopic liver transplantation (OLT). The aim of this study was to investigate the incidence and severity of IBD after liver transplantation and to perform a multivariate analysis for possible risk factors. In this retrospective study, 91 patients transplanted for PSC or AIH, without prior colectomy, were included.

Ubiquitous presence of beta-glucuronidase (GUS) in plants and its regulation in some model plants.

The enzyme beta-glucuronidase (GUS) is well characterized in animals and microbes. However, this enzyme is not well studied in plants and is widely assumed to be absent in them. In this study we document the ubiquitous presence of GUS in the model plants Arabidopsis thaliana, Oryza sativa, Nicotiana tabacum and Zea mays and record its expression pattern.

The pharmacokinetics of a single rectal dose of paracetamol (40 mg x kg(-1)) in children with liver disease.

Background: The aim of our study was to measure the serum paracetamol concentrations achieved following a single rectal loading dose of 40 mg x kg(-1) in children with chronic liver disease.

Methods: We recruited 17 children (3-15 years, 10.6-75 kg) undergoing minor surgical procedures under general anesthesia.

Cost and quality of life after intestinal transplantation.

Intestinal transplantation has become a standard treatment for intestinal failure in patients with life-threatening complications of TPN. Although the long-term survival of patients with continued parenteral nutrition is higher than after intestinal transplantation, the 1 and 2 year survival is comparable. Here we examine other aspects of the treatment options available for patients with intestinal failure including the cost of the therapy and the quality of life.

Living and deceased donor liver transplantation for unresectable hepatoblastoma at a single center.

Hepatoblastoma (HB) is the most common malignant liver tumor in children. The application of living donor liver transplantation (LDLT) in the management of unresectable HB may add new therapeutic opportunities. We evaluated the outcomes of patients who underwent liver transplantation for treatment of unresectable HB in the period between August 1985 and June 2003.