We could demonstrate for the first time in a systematic investigation, that the quantity of crystalloid infusion, applied intraoperatively, has a significant impact on functional (bursting pressure) and structural (hydroxyproline) stability of intestinal anastomoses in the early postoperative period. Because the stability and quality of an intestinal anastomosis have an impact on insufficiency rates, it should be noted that volume overload may have deleterious effects on anastomotic healing and postoperative complications in digestive surgery, possibly because of a marked bowel wall edema.

Our trial shows that CWEPs are effective at reducing the incidence of SSIs in elective and clean or clean-contaminated open abdominal surgery.

Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide, with a poor prognosis and limited therapeutic options. Therefore, the development of novel therapeutic strategies is of high priority. ␣-Fetoprotein (AFP) is overexpressed in the majority of HCCs. Priming of immune responses against AFP results in significant protective antitumoral T cell responses in the mouse model. Little information is available about the hierarchy, breadth, frequency, and peripheral versus intrahepatic distribution of AFP-specific CD8 ؉ T cell responses in patients with HCC. To address these important issues we comprehensively analyzed CD8 ؉ T cell responses against full-length AFP in peripheral blood, tumor liver tissue, and nontumor liver tissue from patients with HCC using overlapping AFP peptides. The AFP-specific CD8 ؉ T cell response was also tested in peripheral blood and liver from patients chronically infected with hepatitis C virus (HCV) and compared to the HCV-specific CD8 ؉ T cell response. The majority of patients with HCC showed AFP-specific responses, with many responses directed against previously unreported epitopes. These responses were primarily detectable in the HCC tissue and mainly targeted the C-terminus of AFP. Interestingly, AFP-specific T cells were not only found in patients with HCC but also in patients with chronic HCV infection, other liver diseases, and less frequently in healthy subjects. Conclusion: In patients with HCC, a high frequency of AFPspecific CD8 ؉ T cells directed against different epitopes suggests that AFP has a strong and broad immunogenicity. Further, CD8 ؉ T cells specific for the self-antigen AFP are present in the normal T cell repertoire and are not centrally or peripherally deleted. Our results provide support for strategies to boost AFP-specific CD8 ؉ T cell responses in patients with HCC but also demonstrate a diversity of immune responses that may be needed for protection. (HEPATOLOGY 2008; 48:1821-1833 H epatocellular carcinoma (HCC) is one of the most common tumors in the world, with a global incidence of 500,000 new cases per year. 1 HCC is up to four times more common in men than in women and 60%-90% of these tumors develop in a cirrhotic liver. If untreated, most patients die within 3-6 months after diagnosis and, even if treated, the 5-year survival rate is low. [1][2][3] Therefore, new strategies to treat patients with HCC have a high clinical priority. Immunotherapy aimed at inducing or activating HCC-specific immune responses is one such concept; its rationale is based on the presence of high numbers of tumor-infiltrating T cells in HCC tissue, 4 the correlation between the density of lymphocytic infiltrates in HCC lesions and prognosis, 5,6 and most importantly, the finding that adoptive immunotherapy with anti-CD3 and interleukin-2 (IL-2) stimulated autologous lymphocytes lowers postsurgical HCC recurrence rates in humans. 7

These data show that the degree of organ damage in clinical pancreas transplantation is directly related to an impairment of microcirculation in the early reperfusion period. These data also support the idea that grafts from older donors have a higher probability to develop graft pancreatitis and that this might be due to an increased incidence of microcirculatory disturbances in these organs.

Endoscopic tube decompression of acute colonic obstruction is an easy and cost-effective possibility for avoiding emergency operations with all their sequelae. Emergency surgery can be converted to semielective or elective surgery, markedly reducing the rate of staged operations.

Surgical resection seems to be the treatment of choice. Local recurrence is scarce. Due to the very limited number of cases, data regarding the long-term survival of patients are lacking.

This study was undertaken to examine the impact of ischemia-reperfusion (I/R) injury on microcirculation and apoptosis in experimental pancreas transplantation. Pancreatic grafts were subjected to different preservation solutions and cold ischemia times (CITs): University of Wisconsin (UW), 6-h CITs (group U6); UW, 18-h CITs (group U18); normal saline, 6-h CITs (group S6); and normal saline, 6-h CITs with Z-Asp-2,6-dichlorobenzoyloxymethylketone (pan-caspase inhibitor; group S6 & CI). Nontransplanted animals served as controls. At 1-and 2-h reperfusion microcirculation was assessed by means of intravital microscopy. Apoptosis was detected by in situ nick end-labeling method (TUNEL) at 2-h reperfusion. Deterioration of microcirculation was lowest in group U6 and highest in groups S6 and S6 & CI compared with controls. The apoptotic index (cells per high power fields) of groups U6, U18 and S6 correlated well with functional capillary density (r = − 0,70, p < 0.0001) and leucocyte sticking (r = 0,69, p < 0.0001) at 1-h reperfusion. Caspase inhibition had no impact on microcirculation but significantly reduced AI compared with group S6 (p < 0.001). These data suggest that pancreatic I/R injury-induced apoptotic cell death well predicts the extent microcirculatory impairment. Caspase inhibition might be a promising strategy in reducing I/R injury in pancreas transplantation.Key words: Apoptosis, caspase inhibition, intravital microscopy, ischemia-reperfusion injury, microcirculation, pancreas transplantation Abbreviations: AI, apoptotic index; CI, caspase inhibition; CIT, cold ischemia time; DMSO, dimethylsulfoxide; FCD, functional capillary density; hpf, high power fields; ICE, interleukin-1b -converting enzyme; IVM, intravital fluorescence microscopy; LAV, leucocyte sticking to postcapillary venules; OFR, oxygen free radicals; PBS, phosphate-buffered saline; TUNEL assay, terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate digoxygenin nick-end labeling; UW, University of Wisconsin; Z-Asp-CH 2 -DCB, Z-Asp-2,6-dichlorobenzoyloxymethylketone.

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