BACKGROUND:Liver regeneration is vital for the survival of patients submitted to extensive liver resection as a treatment of hepatocellular carcinoma (HCC). Sorafenib is a multikinase inhibitor of angiogenesis and cell division, both of which are integral components of liver regeneration. We investigated the effect of preoperative treatment with sorafenib, a drug used for the treatment of HCC, on liver regeneration and angiogenesis in healthy rats, after two-thirds partial hepatectomy (PH2/3).METHODS:In total 48 Wistar rats received intragastric injections of sorafenib (30 mg/kg/d) or vehicle, underwent PH2/3, and were sacrificed at 48, 96 or 168 hours after that. The regenerative index of the liver remnant was studied, as well as the mitotic index. DNA synthesis and angiogenesis were estimated by immunohistochemistry for the Ki-67 and CD34 antigens, respectively.RESULTS:Sorafenib reduced significantly the regenerative index at all time points but not the mitotic index at 48, 96 or 168 hours. Deoxyribonucleic acid (DNA) synthesis and angiogenesis were not affected significantly either.CONCLUSIONS:Sorafenib, when administered preoperatively, reduces incompletely and transiently the regeneration of the liver after PH2/3 in rats. This could mean that sorafenib can be used as neoadjuvant treatment of patients with HCC prior to liver resection, but further experimental and clinical studies are needed to establish the safety of this treatment. Hippokratia 2015; 19 (3): 249-255.

Introduction. The aim of this study was to evaluate infection complications as the reason for intensive care unit (ICU) admission among transplant recipients.Methods. We studied all renal transplant recipients with infectious complications admitted to our ICU from 1992 to 2012:44.3% of all renal transplant recipients admitted to ICU. The epidemiology and prognosis of infectious complications requiring ICU admission were evaluated with analysis of mortality factors.Results. The 22 men and 5 women included in this study showed a mean age of 42.7 +/- 12.3 years. The Acute Physiologic and Chronic Health Evaluation II and Seguential Organ Failure Assessment scores on ICU admission were 20 +/- 4.6 and 8.6 +/- 3.9, respectively. The main infections complications requiring ICU admission were cytomegalovirus pneumonia (n = 15) and aspergillus pneumonia (n = 4). Sixteen patients required hemodialysis and 14, catecholamine support upon ICU admission owing to septic shock. The mortality rate among study patients was 62.9%, versus 26.5% for noninfectious renal transplant recipients requiring ICU admissions. Catecholamine support at ICU admission was independently related to mortality.Conclusion. The mortality rate of renal transplant recipients admitted to ICU owing infection complications was higher than that of noninfected renal transplant patients. These data suggest that infections and septic shock in renal transplant recipients requiring ICU admission worsen their outcome significantly.

BACKGROUND:Liver transplantation represents the main treatment for alcoholic cirrhosis. The goal of this article is to review the results of liver transplantation for alcoholic cirrhosis in Greece over the last 2 decades.METHODS:Among 247 patients who underwent liver transplantation between 1991 and 2007, 34 (13.7%) experienced alcoholic cirrhosis as the primary diagnosis. We reviewed their demographic data, stage of liver disease, and outcomes regarding survival via a Kaplan-Meier curve. Also we analyzed the causes of death and the postoperative complications.RESULTS:Mean Model for End-Stage Liver Disease (MELD) score was 18.4. Other diagnoses included hepatitis C virus (HCV; 23.5%), hepatitis B virus (HBV; 14.7%), and hepatocellular carcinoma (8.8%). Eleven patients died the most frequent causes being primary graft nonfunction (n = 3), hepatic artery thrombosis (n = 2), sepsis (n = 2), and portal vein thrombosis (n = 2). Complications included rejection (32.4%), infection (26.5%), hepatic graft dysfunction (11.8%), and recurrent HCV, recurrent HBV, and renal failure (8.8% each). Recurrence of alcoholism was observed in 3 patients (8.8%) with mild effects on liver function tests. There has been a significant increase in the number of liver transplantations for alcoholic cirrhosis in the last 6 years, namely 25 patients versus 9 in the previous 10 years.CONCLUSIONS:We observed a significant increase in the frequency of alcoholic cirrhosis leading to liver transplantation in the last several years in Greece.

A115 Aims: Rocuronium is a new neuromuscular blocking drug with a duration of action similar to that of vecuronium but with a more rapid onset of effect. The aim of the present study was to determine the time for maximum block for intubation and duration of relaxation in patients undergoing renal transplantation and in patients with normal renal function. Methods: We studied twenty patients with end-stage renal disease undergoing renal transplantation (group 1) and twenty patients with normal renal function (group 2), with the approval of Ethics Committee. Any patient receiving medication known to interfere with neuromuscular transmission was excluded from the study. Anesthesia was indused with fentanyl 2γ/kg, midazolam 0,02mg/kg, etomidate 0,2mg/kg IV and intubation was performed with rocuronium 0,9mg/kg in both groups. Anesthesia was maintained with 67%N2O in oxygen and 0,5-1% isoflurane and further increments of fentanyl as required. Neuromuscular function was monitored by stimulating ulnar nerve in train of four (T.O.F) mode of stimulation.Intubation was performed when none of the four answers of T.O.F were received (T1) and next dose of rocuronium was administered when we received the second answer of T.O.F.(T2). The Mann-Whitney test was used for statistical analysis and p<0,05 was considered significant.FigureComparing the two groups there were no statistical difference: T1 p:0,14, T2 p:0,69. Conclusions: The onset of action and the duration of relaxation of rocuronium were not altered in patients with renal failure undergoing renal transplantation.