Neurological complications after liver transplantation

This was a single-centre, prospective study to assess the frequency of neurological complications and their impact on prolonged hospitalization in 137 liver transplant patients presenting between September 1997 and June 2010. Neurological complications were seen in 22 (16%) patients during their postoperative stay in the intensive care unit. Complications included new-onset, recurrent headache (five patients), generalized seizures (four patients), dysarthria (two patients), delirium with agitation (three patients), persistent flapping tremor (two patients), alteration in level of consciousness (three patients), central pontine myelinolysis (one patient), myopathy (one patient) and visual hallucinations (one patient). Seizures were associated with immunosuppressive drug toxicity (tacrolimus). Myopathy presenting as quadriplegia was diagnosed by muscle biopsy. The patient with central pontine myelinolysis lived in a persistent vegetative state for 2 years and died of pneumonia. In conclusion, neurological complications are frequently encountered after liver transplantation, and are an important cause of severe morbidity and prolonged intensive care unit and hospital stay.     

Zoledronic acid concurrent with either high- or reduced-dose palliative radiotherapy in the management of the breast cancer patients with bone metastases: a phase IV randomized clinical study

Introduction

In this prospective study, the efficacy and safety of radiotherapy combined with zoledronic acid was evaluated.

Materials and methods

Breast cancer patients with painful bone metastases were randomized to either high- or reduced-dose radiotherapy. All patients received zoledronic acid (4 mg) every 28 days from the beginning of radiotherapy. Analgesic and pain scores in addition to visual analog score (VAS) for treatment satisfaction and whole-body bone scintigraphy were evaluated.

Results and conclusion

No significant differences could be found in analgesic or pain scores and bone scintigraphy results between the groups. Our results suggest that reduced-dose radiotherapy produces similar response rates and response durations when used concomitantly with zoledronic acid.     

A prospective comparative study of the relationship between different types of ring and microbial hand colonization among pediatric intensive care unit nurses

Objectives

The aim of the study is to assess the effect of ring wearing and ring types on hand contamination and efficacy of alcohol-based hand disinfection among nurses working in intensive care settings.

Methods

Hand cultures were obtained from 84 nurses providing direct patient care in intensive care units of a pediatric hospital. Colony counts were compared depending on ring wearing and the type of ring worn. Twenty-eight nurses were asked to a wear plain wedding ring, 28 to wear rings with stones and 28 not to wear any rings, starting 15 days before and continuing throughout the study. Cultures were obtained by using sterile gloves containing phosphate-buffered-saline solution (PBS) after an alcohol-based hand disinfectant was used and bacteria were identified with standard laboratory tests.

Results

The nurses wearing rings had more Gram-positive, Gram-negative and total bacterial colonization on their hands than the nurses without rings despite using an alcohol-based rub (p = 0.001). When comparing the two groups with rings (plain wedding rings and rings with stones), colony counts of Gram-positive, Gram-negative and total bacteria did not differ (p > 0.05).

Conclusions

Ring wearing increases the bacterial colonization of hands and alcohol-based hand disinfection might not significantly reduce contamination of the ring-wearing hands. The type of ring did not cause any significant difference on the bacterial load. Wearing rings could increase the frequency of transmission of potential nosocomial pathogens.     

The Effect of K-ATP Channel Blockage During Erythropoietin Treatment in Renal Ischemia-Reperfusion Injury

ATP dependent K channels (K-ATP) take part in the Erythropoietin (EPO) induced cardioprotection but these channel activations have role in cytoprotective role of EPO in the renal ischemia reperfusion (IR) damage is still unknown. For this purpose rats were pretreated with EPO (500 IU/kg) and/or K-ATP channel blocker glibenclamide (40mM/kg) i.p. before bilateral renal IR damage. Renal tissues were used for histological examination and measurement of caspase-3 and TNF-α levels. Renal functions were evaluated by glomerular filtration rate (GFR) fractional excretion of sodium (FENa) and potassium (FEK). Renal TNF-α and caspase-3 levels were decreased in both glibenclamide and EPO-treated IR rats compared to untreated rats. The protection afforded by the pretreatment with EPO alone was greater than that of administering glibenclamide alone. Application of glibenclamide at the same time partly abolished the cytoprotective effect of EPO treatment. K-ATP mediated cytoprotection is not the main mechanism of protective effect of EPO.     

Bronchial Hyper‐Reactivity in Migraine Without Aura: Is It a New Clue for Inflammation?

Objective.— We attempted to investigate the relationship between migraine without aura (MwoA) and bronchial hyper‐reactivity to postulate inflammation as an underlying mechanism in migraine. Background.— Comorbidity of migraine and atopic diseases such as asthma has been an argument for suspected immune system dysfunction in migraineurs. Methods.— Twenty patients with MwoA and 5 control subjects without history of atophy and asthma were included in study. Subjects with abnormal physical examination and chest radiographs were excluded. After a normal spirometry, methacholine bronchoprovocation test was performed in all subjects and controls according to 5 breath dosimeter methods. Results.— Sixteen of 20 patients and 2 of 5 control subjects were women. Mean ages were 37.5 (19‐56) and 33.8 (26‐43) years, respectively. Methacholine bronchoprovocation test was positive in 3 patients (15%) but was normal in all controls (0%). Conclusions.— The relationship between MwoA and bronchial hyper‐reactivity may help to postulate the inflammation in migraine as an underlying mechanism.     

A case of nodular posterior scleritis mimicking choroidal mass

The aim of this study is to report clinical and imaging findings, and treatment outcomes of a patient with nodular posterior scleritis. A 41-year-old woman was diagnosed as nodular posterior scleritis in the light of clinical and imaging findings. At first admission best corrected visual acuity was 20/50 in her right eye. Fundus examination revealed an amelanotic subretinal mass under the superior temporal arcade associated with subretinal fluid surrounding it. B-scan ultrasonography, optical coherence tomography, fluorescein angiography, and indocyanine green angiography findings confirmed the diagnosis. As treatment, nepafenac eye drops 3 times a day, and flurbiprofen tablet 100 mg twice a day were prescribed. After 4 weeks of treatment, the ocular pain was relieved, BCVA improved to 20/20, and subretinal mass totally regressed. Although the diagnosis of nodular posterior scleritis may be confusing, it has to be kept in mind in patients with a subretinal/choroidal mass. Multimodal fundus imaging may be helpful in differential diagnosis. The condition is usually curable with non-steroidal anti-inflammatory drugs and/or systemic steroids.