Literature supporting the use of this technique comes from a single-center, retrospective case series and also from a prospective open-label, non-randomized study. Both studies described embedded esophageal stents, not biliary stents, and demonstrated the effectiveness of using an internal stent to induce pressure STA-9090 in vitro necrosis of epithelial overgrowth. To our knowledge, this represents the first

report demonstrating the success of a stent-in-stent technique to remove an embedded metal biliary stent and we recommend its use for this rare complication. “
“The recent review by Gustot et al.1 did not emphasize the important, common, and frequently lethal phase of illness that is immunoparesis, caused by the compensatory anti-inflammatory response syndrome (CARS). A term coined by Bone et al.,2 CARS describes prolonged elevations in anti-inflammatory mediators and immune dysregulation with defects in both the innate and adaptive immune responses. Studies in patients without cirrhosis have shown that the severity of this phase determines outcome beyond the initial “cytokine storm” associated selleckchem with the systemic inflammatory response syndrome (SIRS).3, 4 In cirrhosis, it is common for patients to suffer repeated episodes of nosocomial sepsis following

an initial episode of infection. Defects in both innate and adaptive5 arms of the immune response have been demonstrated, and there is increasing evidence that monitoring of monocyte function by assessing the expression of antigen presentation apparatus, such as human leukocyte antigen-DR is of prognostic value.6, 7 Early studies in the animal model of L-gulonolactone oxidase cirrhosis have determined that Toll-like

receptor expression is up-regulated,8 predisposing the organism to an exaggerated SIRS, followed by an equally exaggerated and prolonged CARS. In the current era, when organ support strategies are capable of allowing patients to weather the “cytokine storm,” we believe further emphasis should be placed on this harmful sequel to severe sepsis. “
“The probability that a waiting liver transplant candidate will receive a deceased donor liver offer is defined by both allocation and distribution policy. Allocation policy sets the ranking rules for a given set of waiting candidates, and distribution policy determines the group of waiting candidates over which the allocation rules will be applied. In 1999, the Organ Procurement and Transplantation Network (OPTN) required that donor organs be shared across entire regions when a patient meets the most urgent, status 1 criteria. This policy resulted in a significant reduction in wait list deaths for status 1 patients without an adverse effect on other waiting candidates or posttransplantation survival.