Effectiveness of White test versus conventional saline test in minimizing biliary leak in partial liver resection in living donor liver transplant

Background Intra-operative bile leakage testing is very important in partial liver resection in living donor liver transplant as it allows detection of bile leaking points on the cut surface and decreases postoperative bile leak which is one of the most dreadful complication following liver transplant surgery. In this study we tried to assess the Effectiveness of White test versus conventional saline test in minimizing biliary leak in partial liver resection in living donor liver transplant. Objective In this study, we assess whether the White test is better than the conventional saline test for the intraoperative detection of biliary leakage in patients who will undergo partial liver resection as living donor liver transplant. Methodology In this study, we assess whether the White test is better than the conventional saline test for the intraoperative detection of bile leakage in patients who underwent partial liver resection as a living donor liver transplant. This study included 60 patients who received partial liver resection as a living donor liver transplant. The conventional saline test (injecting an isotonic sodium chloride solution through the cystic duct) was carried out in 30 patients and the White test (injecting a fat emulsion solution through the cystic duct) was carried out in 30 patients Results Incidence of postoperative bile leakage was compared between the conventional method and the White test. Bile leakage occurred in 8 patients (26.7%) in the conventional method group and in 2 patients (6.7%) in the White test group. In addition, the White test detected intraoperative a significantly higher number of bile leakage sites compared with the conventional method. The White test is better than the conventional test for the intraoperative detection of bile leakage. Conclusion Based on our study, we recommend that surgeons investigating bile leakage sites during liver resections should use the White test instead of the conventional saline test.

White test versus conventional saline test in detecting intra-operative bile leakage in liver resection

Background Hepatic surgery will be always one of the most challenging surgical procedures due to its anatomical and pathophysiologic varieties. Various problems may complicate the post-operative course. Bile leak remains a serious complication after hepatectomy. Bile leaks can significantly impact morbidity, mortality, and cost of treatment. Bile leak increases risk of sepsis, need for further intervention, either radiological or return to theatre, prolongs duration of intensive care unit and hospital stay, and can precipitate liver failure and death. Objective To assess the post-operative bile leak complication after using white test versus conventional saline test Patients and Methods A prospective study on 50 Hepatectomy cases divided into two groups, the first group consist of 25 cases using white test and the second group consist of 25 cases using conventional saline test from January 2019 to January 2020, at Hepatobiliary unit of the general surgery department of Ain Shams university hospitals. Results The White test has clear advantages in comparison with other bile leakage tests: it precisely detects bile leakages, regardless of size; it does not stain the resection surface, allowing it to be washed off and repeated ad infinitum; and it is safe, quick, and inexpensive. The white test is a feasible and sensitive bile leakage test with no obvious disadvantages. It could be a possible standardized method to prevent bile leakage in major liver resection. Conclusion Now after we discussed our study and reviewed other opinions discussing the optimal methods for intraoperative bile leakage testing, we have now settled on White test using fat emulsion solution to be best of all tests.

Incidence of hyperkalemia during hypertonic saline test for the diagnosis of diabetes insipidus

Objective Hyperkalemia has been reported upon different hypertonic saline infusion protocols. Since hypertonic saline test has recently been validated for the differential diagnosis of diabetes insipidus (DI), we aimed to investigate the course of plasma potassium during the test. Design We analyzed data of 90 healthy volunteers and 141 patients with polyuria–polydipsia syndrome (PPS) from two prospective studies evaluating the hypertonic saline test. Our primary outcome was the incidence rate of hypertonic saline-induced hyperkalemia > 5 mmol/L. Methods Participants received a 250 mL bolus of 3% NaCl solution, followed by 0.15 mL/min/kg body weight continuously infused targeting a plasma sodium level of 150 mmol/L. Blood samples and clinical data were collected every 30 min. Results Of the 231 participants, 16% (n = 37/231) developed hyperkalemia. The incidence of hyperkalemia was higher in healthy volunteers and in patients with primary polydipsia (25.6% (n = 23/90) and 9.9% (n = 14/141), respectively), and only occurred in 3.4% (n = 2/59) of patients with diabetes insipidus. Hyperkalemia developed mostly at or after 90-min test duration (81.1%, n => 30/37). Predictors of hyperkalemia (OR (95% CI)) were male sex (2.9 (1.2–7.4), P => 0.02), a plasma potassium at baseline > 3.9 mmol/L (5.2 (1.8–17.3), P => 0.004), normonatremia at 30-min test duration (3.2 (1.2–9.5), P => 0.03), and an increase in potassium levels already at 30-min test duration as compared to baseline (4.5 (1.7–12.3), P => 0.003). Hyperkalemia was transient and resolved spontaneously in all cases. Conclusion The hypertonic saline test can lead to hyperkalemia, especially in patients with primary polydipsia who experience a longer test duration. Monitoring potassium levels in these patients is recommended.

GCT-55. INTRACRANIAL GERMINOMA ORIGINATING FROM ATYPICAL LOCATION WITH SUBCLINICAL ADH INSUFFICIENCY

INTRODUCTION Intracranial germinomas are rare tumors which usually develop in the midline structures and affect in 90% of cases the pineal gland and suprasellar regions. Sometimes they involve basal ganglia, septum pellucidum, and other regions. We report a very unusual presentation of an intracranial germinoma originating from the lateral ventricle. METHODS A 10-year-old boy presented with a 1-year history of polydipsia and polyuria. During the hypertonic saline test, a low ADH was detected and established the diagnosis of subclinical ADH insufficiency. MRI showed a heterogeneously enhancing periventricular lesion in the lateral ventricle, but no other abnormal findings, including hypophyseal stalk. Initially, the correlation of imaging findings and clinical symptoms were not clear. With suspected subependymoma, tumor removal was performed by small craniotomy. Since the intra-operative pathological diagnosis was germinoma, we performed only partial removal of the tumor. After establishing the histological diagnosis of germinoma, the patient received chemotherapy using carboplatin and etoposide, followed by radiation therapy. MRI showed no recurrence for five years after treatment. RESULTS/ CONCLUSION Our case presents two atypical features. First, intracranial germinoma originating from the lateral ventricle is quite rare. Though the cases with intracranial germinoma originating from septum pellucidum and corpus callosum have been reported, this case is even different. Second, imaging findings did not match clinical symptoms. The cause of subclinical ADH deficiency may be the occult hypophyseal germinoma. In conclusion, we report a 10-year-old case with a very unusual presentation of an intracranial germinoma originating from the lateral ventricle.

In the Refractory Hypertension “Labyrinth”. Focus on Primary Hyperaldosteronism

Primary hyperaldosteronism is an existence of a functional autonomous source with increased aldosterone production (full or partial) in relation to the renin-angiotensin system. Increased production of aldosterone by the adrenal cortex is the most common form of a secondary hypertension despite the low attention of internists to the problem. The success of a treatment and a prognosis of these patients depend on correct choice of screening (aldosterone/renin ratio) and clarifying diagnostic methods. There are clear algorithms for conducting these tests in accordance with Russian and International recommendations in the respective groups of patients. The purpose of this case report is to demonstrate the long way to diagnosis of primary hyperaldosteronism in a young patient with refractory hypertension, right adrenal adenoma, and clinical (convulsions, weakness) and laboratory signs of hypokalemia. It should not only have made the diagnosis easy, but it could have also absolutely justified the surgical tactics. Unfortunately, the final verification of the disease by carrying out a saline test was accomplished 13 years after the debut of hypertension and 10 years after the primary visualization of the adrenal adenoma.

Effect of Incorporated ZnO Nanoparticles on the Corrosion Performance of SiO2 Nanoparticle-Based Mechanically Robust Epoxy Coatings

This paper presents the studies of the development of a high-performance epoxy coating for steel substrates. To this end, it investigated the synergistic effect of incorporating zinc oxide (ZnO) nanoparticles into nanosilica containing epoxy formulations. The mechanical properties of the epoxy coating formulations were improved by modifying the surfaces of the silica nanoparticles (5 wt.%) with 3-glycidoxypropyl trimethoxysilane, which ensured their dispersal through the material. Next, the ZnO nanoparticles (1, 2, or 3 wt.%) were incorporated to improve the corrosion performance of the formulations. The anticorrosive properties of the coatings were examined by electrochemical impedance spectroscopy (EIS) of coated mild steel specimens immersed in 3.5% NaCl solution over different time intervals (1 h to 30 days). Incorporation of the ZnO nanoparticles and the nanosilica into the coating formulation improved the corrosion resistance of the epoxy coating even after long-term exposure to saline test solutions. Finally, to evaluate how the nanoparticles affected the chemical and morphological properties of the prepared coatings, the coatings were characterized by scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, and X-ray diffraction (XRD).

Accelerated ageing as a vigour test on chickpea seeds

The objective of this work was to establish the temperature and the period of exposure needed to perform the traditional accelerated ageing test with saturated NaCl salt solution on chickpea seeds. Eight seed lots from two cultivars, including four seeds each, were subjected to germination and vigour tests for initial characterization. Following the methodology of the traditional accelerated ageing test. The seeds were placed on stainless steel screens in boxes with 40 mL deionized water. They were kept at 41 and 45º Celsius for 24 and 48 hours. Furthermore, the accelerated ageing test using [40 g of NaCl in 100 mL of water, thus providing 76% of relative humidity in air] NaCl (salt) solution in place of the deionized water was performed. Aged seeds were sowed in germination paper and kept in a germination chamber at 41º and 45º Celsius. The evaluations were performed five and eight days after sowing. The statistical analysis was performed with a completely randomized design and four replications. The traditional ageing of both cultivars showed a water content higher than the tolerated limits at 48 hour period and 41 and 45 °C. In the saturated saline test, the cultivar BRS Aleppo produced consistent results at temperatures 45 °C for 24 h. The cultivar Cícero showed a low correlation with the initial characterization as the results of accelerated ageing. Thus, for ‘BRS Aleppo’, the recommended accelerated ageing methodology was application of saturated saline solution, when seed exposed to 41 °C for 24 hours with germination evaluation at the first count date. For 'Cicero', satisfactory results were not obtained, and new studies are required to establish a methodology.