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Objective: To evaluate the application of ultrasound (US) for the surgical intervention in patients with moderate and severe secondary hyperparathyroidism (SHPT), and to identify the risk of prolonged hypocalcemia after parathyroidectomy (PTX). Methods: A consecutive series of moderate and severe SHPT patients (n = 64) underwent ultrasound evaluation of parathyroid glands. Among the 64 patients who received 6-month medication therapies, ten patients with parathyroid hormone (PTH) 300~500 pg/mL were excluded from the study while 32 patients unresponsive to medication therapy (PTH > 500 pg/mL) received surgical interventions and 22 patients with PTH < 300 pg/mL received medication treatment alone. The correlations between the number, location, volume, sonographic features of parathyroid glands (PTGs), laboratory examinations, the duration of dialysis and the surgical necessity were analyzed. Total parathyroidectomy with synchronous auto-transplantation (PTX + AT) was performed in the surgical group. In both the surgical and medication group, patients with hyper-vascularity of the PTGs dominated (≥50%) were classified as a hyper-vascular subgroup, and the others as a hypo-vascular subgroup. The differences of post-operative calcium (Ca2+) levels and the incidence of prolonged hypocalcemia between hyper- and hypo- vascular subgroups were assessed. Results: Sonographic evaluations revealed that the numbers of detectable PTGs were higher in the surgical group than that of the medication group (p < 0.05). The detection of supernumerary PTGs was higher in the surgical group than that in the medication group (13/121, 10.7% vs. 2/71, 2.8%, p < 0.05). Baseline PTH, >2 detectable PTGs, detection of supernumerary PTGs, patients with hyper-vascular, and the duration of dialysis were positively associated with the necessity of surgical intervention. For patients in the hyper-vascular subgroup, the serum Ca2+ level was lower than that in the hypo-vascularity subgroup (p < 0.01). Conclusion: Ultrasonic features can provide useful information for management of surgical intervention of SHPT and prediction of the risk of prolonged hypocalcemia after PXT.

Large animal studies of long-term ischemia reperfusion are hampered by the use of immunosuppressive drugs to inhibit the influence of the allogeneic response. In small animals, this can be controlled by using inbred strains of the animal. For obvious reasons, this is not possible in large animals such as pigs. Since studies in pigs usually are the last step before first-in-man studies, this remains a problem trying to resemble a clinical situation. In the following short paper, we describe a novel auto kidney transplantation model that can be used for long term ischemia reperfusion studies. We also suggest a control setting to balance out the possible influence of an increased surgical trauma.

Laparoscopic renal autotransplantation has serious perturbations on the body's homeostasis due to its non physiological positioning, use of pneumoperitoneum, changing fluid strategy at different points of time and on-going steps to maintain optimal environment for the transplanted kidney. Generally speaking, the anaesthetic management of renal auto-transplantation by open technique is not very complex and the perioperative management can be categorized in the intermediate level of clinical skill requirement. Adding to the comfort of the anaesthesiologist is the fact that these patients are not in end stage renal disease state and does not manifest the comorbidities, multisystem involvement and technical complexities of long term renal dysfunction and renal replacement therapy. In our case report surgeons used the da Vinci surgical robotic system for laparoscopic transplantation of the kidney at a new site. In this article we discuss the anaesthetic challenges of robot assisted laparoscopic renal auto-transplantation along with a description of our index case.

The significant changes in coagulation status during chroniodialysis, performed in patients with secondary hyperparathyroidism require completion of meticulous surgical hemostasis in order to prevent active bleeding in the postoperative period.Aim: To present our experience with harmonic scalpel application in the surgical treatment of secondary hyperparathyroidism.Patients and Methods: 112 patients with secondary hyperparathyroidism (77 males and 35 females, aged from 23 to 60 years) have been operated on in our institution for 10 years period. All patients were on chroniodialysis. Hemostasis was achieved using conventional instruments and electrocautery in 46 patients and in 66 patients harmonic scalpel of Ethicon EndoSurgeryCare has been used. All patients had serum levels of parathormone above 2500ng/l. Ultrasonic examination revealed at least 2 parathyroid glands larger than 10mm in all cases. The amount of blood loss, necessity and type of drainages used, frequency of postoperative complications, postoperative hospital stay were comparatively evaluated.Results: In 12 patients parathyroidectomy with autotransplantation was carried out, in 62 patients subtotal parathyroidectomy was performed. In the rest 35 cases- three of the parathyroid glands were removed (because of the impossibility to identify the fourth parathyroid gland, using ultrasonic and intraoperative methods). All patients were proven to have a sharp decrease in parathormone and Calcium serum levels. In the group of patients, where conventional instruments and electrocautery for hemostasis have been used, corrugated and tube drainages were applied as a rule. For the patients, in whom hemostasis was performed using a harmonic scalpel, simple glove drainages were used. In all patients in the pre-operative and post-operative period serial hemodialysis was done with LMW heparin administration. Significantly lower blood loss from the surgical wound was found in the group, where harmonic scission was used. Conclusions: We consider that the application of harmonic scalpel in the surgical treatment of patients with secondary hyperparathyroidism on chroniodialysis leads to safer hemostasis, lower postoperative complications rate and thus shortens the postoperative hospital stay.

Objective: We evaluated structural and functional changes of fresh and frozen-thawed adult mouse spermatogonial stem cells following auto-transplantation into gamma-irradiated testes.Materials and Methods: In this experimental research, the right testes from adult mice (n=25) were collected, then Sertoli and spermatogonial cells were isolated using two-step enzymatic digestion, lectin immobilization and differential plating. Three weeks after cultivation, the Bromodeoxyuridine (BrdU)-labeled spermatogonial cells were transplanted, via rete testis, into the other testis of the same mouse, which had been irradiated with 14Gy. The mice were transplanted with: fresh cells (control 1), fresh cells co-cultured with Sertoli cells (control 2), the frozen-thawed cells (experimental 1) and frozen-thawed cells co-cultured with Sertoli cells (experimental 2). The morphological changes between different transplanted testes groups were compared in 8 weeks after transplantation. The statistical significance between mean values was determined by Kruskal Wallis and one-way analysis of variance in efficiency of transplantation.Results: The statistical analysis revealed significant increases in the mean percentage of testis weight and normal seminiferous tubules following spermatogonial stem cells transplantation in the recipient’s testes. The normal seminiferous tubules percentage in the co-culture system with fresh cells and frozen-thawed groups were more than those in non-transplanted and fresh cell transplanted groups (p≤0.001).Conclusion: Our results demonstrated that spermatogonial stem cells in the colonies could result sperm production in the recipient’s testes after autologous transplantation.

Laparoscopic renal autotransplantation has serious perturbations on the body's homeostasis due to its non physiological positioning, use of pneumoperitoneum, changing fluid strategy at different points of time and on-going steps to maintain optimal environment for the transplanted kidney. Generally speaking, the anaesthetic management of renal auto-transplantation by open technique is not very complex and the perioperative management can be categorized in the intermediate level of clinical skill requirement. Adding to the comfort of the anaesthesiologist is the fact that these patients are not in end stage renal disease state and does not manifest the comorbidities, multisystem involvement and technical complexities of long term renal dysfunction and renal replacement therapy. In our case report surgeons used the da Vinci surgical robotic system for laparoscopic transplantation of the kidney at a new site. In this article we discuss the anaesthetic challenges of robot assisted laparoscopic renal auto-transplantation along with a description of our index case. [ABSTRACT FROM AUTHOR]

Objective: We evaluated structural and functional changes of fresh and frozen-thawed adult mouse spermatogonial stem cells following auto-transplantation into gamma-irradiated testes. Materials and Methods: In this experimental research, the right testes from adult mice (n=25) were collected, then Sertoli and spermatogonial cells were isolated using two-step enzymatic digestion, lectin immobilization and differential plating. Three weeks after cultivation, the Bromodeoxyuridine (BrdU)-labeled spermatogonial cells were transplanted, via rete testis, into the other testis of the same mouse, which had been irradiated with 14Gy. The mice were transplanted with: fresh cells (control 1), fresh cells co-cultured with Sertoli cells (control 2), the frozen-thawed cells (experimental 1) and frozen-thawed cells cocultured with Sertoli cells (experimental 2). The morphological changes between different transplanted testes groups were compared in 8 weeks after transplantation. The statistical significance between mean values was determined by Kruskal Wallis and one-way analysis of variance in efficiency of transplantation. Results: The statistical analysis revealed significant increases in the mean percentage of testis weight and normal seminiferous tubules following spermatogonial stem cells transplantation in the recipient's testes. The normal seminiferous tubules percentage in the co-culture system with fresh cells and frozen-thawed groups were more than those in non-transplanted and fresh cell transplanted groups (p≤0.001). Conclusion: Our results demonstrated that spermatogonial stem cells in the colonies could result sperm production in the recipient's testes after autologous transplantation. [ABSTRACT FROM AUTHOR]