Liver transplantation： Yesterday, today and tomorrow

With the advances in technical skills, management of postoperative complications and improvements in immunosuppressive drugs, liver transplantation is the standard treatment for many patients with chronic liver disease. Today, shortage of donor organs seems to be the major limiting factor for the application of liver transplantation. This review focuses on five issues that are challenging to clinical practice of liver transplantation and relevant to gastroenterologists. These include living donor liver transplantation, recurrent viral hepatitis, non-heart-beating donors, hepatocellular carcinoma, and ABO incompatible liver transplantation. Living donor and non-heart beating donor transplantations were initiated as a solution to increase the donor organ pool and it is expected that there will be an increase in the number of these donors. Recurrent hepatitis C and hepatocellular carcinoma following liver transplantation are among major problems and ongoing research in these diseases may lead to better outcomes in these recipients.     

Neurosecretory synapses, yesterday and today

The concept of peptidergic neurotransmission in the central nervous system ranks high in contemporary neurobiology. It was first formulated by J. Barry when reporting, in 1954-55, his observation with light microscopy of the existence of "Gomori-positive" synapses in sections of the mammalian brain. However, this important discovery had virtually no impact on the scientific community for about twenty years because of an extremely restrictive definition of "neurosecretion" during this period by the practitioners of the new field known as neuroendocrinology. The rejection of Barry's finding raises numerous epistemological questions; it provides another example of a "premature discovery", such as those of A.A. Berthold (testicular transplant studies) and of J.G. Mendel (artificial plant hybridization) during the last century.     

Heart valve surgery

Progress in valve repair and replacement continued over the past year. Aortic valve repair for aortic insufficiency appears promising, and aortic decalcification may still be a useful alternative in certain cases of aortic stenosis. Mitral valve repair, well accepted for myxomatous valves, presents a challenge in ischemic disease. Balloon mitral valvotomy offers significant short-term hemodynamic improvement, but needs to be properly compared with surgical treatment of mitral stenosis. Although aortic valve replacement with homografts and pulmonary autografts yields excellent results, enthusiasm for the stentless porcine xenograft is increasing. Clinical results reported for the Carpentier-Edwards pericardial valve (Baxter Healthcare Corp., Edwards Div., Santa Ana, CA) and the Bjork-Shiley monostrut valve (Shiley Inc., Irvine, CA) are excellent. Acute endocarditis continues to be a challenging problem but early aggressive debridement appears to offer patients the best chance of cure, regardless of what valve replacement is used.     

Leeches, today and yesterday present parasites

Leeches are flattened annelids or segmented worms that live in still, warm waters of the pond or in land. They feed of blood or body fluids. Medicinal leeches (Hirudo medicinalis) have been used in medicine for thousands of years to treat a wide range of ailments. Nowadays, leeches are used successfully for only a few conditions, notably in the field of reconstructive or microsurgery, to salvage tissue flaps and skin grafts whose viability is threatened by venous congestion. However, it is also important to keep it in mind as a differential diagnosis in some circumstances. This review pretends to give an actualize view of a subject that is a part of medical history.     

Heart valve surgery in octogenarians: operative and long-term results

This study was performed to evaluate surgical outcomes in octogenarian patients undergoing valve surgery. Sixty patients (mean age 82.3 ± 1.9 years) who underwent valve surgery were reviewed. Aortic valve disease was found in 65% of the patients. Preoperatively, 20% of the patients were in NYHA class IV. An urgent operation and concomitant coronary artery bypass grafting were performed in ten patients each. A bioprosthetic valve was exclusively used for valve replacement except in two patients. Mitral valve repair was done in seven patients. Operative mortality was 13.3% for the period. No risk factors for operative mortality were detected by multivariate analysis; however, urgent operation, preoperative NYHA class IV, preoperative renal dysfunction, perioperative use of an intra-aortic balloon pumping, and prolonged cardiopulmonary bypass time had significant effects on operative mortality. The actuarial survival rate at 1 and 3 years after surgery was 82.6 and 71.5%, respectively, and 97.6% of late survivors reported that their activity level was equal to or better than the preoperative level. Valve surgery can be performed in octogenarian patients with acceptable mortality, good long-term results, and good quality of life. Early referral to surgery should be important to obtain a better postoperative outcome.