Mild hepatic steatosis is not a major risk factor for hepatectomy and regenerative power is not impaired

BACKGROUND: An understanding of the regeneration power and operative risk of steatotic livers after hepatectomy is still unclear. We evaluated the volume regeneration and outcome of steatotic livers after donor hepatectomy. METHODS: Fifty-four, consecutive living liver donors from September 2002 to December 2003 were evaluated prospectively by volumetric analysis, liver-spleen ratio, and liver attenuation index; the latter has been shown by serial computed tomographic scanning to be correlated strongly with histologic steatosis. Donors were followed up completely for at least 1 year (460-915 days) and were allocated according to histologic degree of macrovesicular steatosis: group 1, <5% (n = 36); group 2, 5%-30% (n = 18). RESULTS: No mortality or hepatic failure was observed, and no donor required reoperation or intraoperative transfusion. The results of serial liver function tests, and major and minor morbidities were comparable between groups. Liver-spleen ratio and liver attenuation index remained at a constant level above normal values postoperatively in group 1, but increased rapidly above normal values in group 2. No difference in the rate of liver regeneration at 10 days after hepatectomy was found between the groups (P = .487), but the liver regeneration rate at 3 months after hepatectomy in group 1 was slightly higher than that in group 2 (P < .044). However, no difference was observed between the 2 groups at 1 year after hepatectomy (P = .4). CONCLUSIONS: Mild hepatic steatosis is cleared immediately after hepatectomy, and early regeneration power is impaired, but the long-term regenerative power is comparable. Hepatectomy in donors with mild steatosis can be performed with low morbidity.     

Three-dimensional computed tomography is not indicated for the classification and characterization of calcaneal fractures

This study determined inter- and intra-observer reliability for measurement of the angles of Böhler and Gissane, for the decision between surgical or conservative management and for the three mostly used classification systems for calcaneal fractures with the use of 2D-CT imaging versus 2D- and 3D-CT imaging.     

Homocysteine, a risk factor for carotid atherosclerosis, is not a risk factor for early recurrent carotid stenosis following carotid endarterectomy

Homocysteine has been proposed as a risk factor for atherosclerotic disease and recurrent coronary stenosis due to neointimal hyperplasia following angioplasty. In order to evaluate homocysteine's role in human carotid neointimal hyperplasia, we have compared homocysteine levels in patients who have not developed restenosis with those who have within 2 years of carotid endarterectomy (CEA). One hundred and fifty-four patients were divided into 3 groups based on duplex scans performed 2 years after CEA. Group I (88) were patients in whom all scans showed no evidence of restenosis. Group II (35) patients exhibited some restenosis, but this did not exceed 49% diameter reduction based on our duplex criteria. Group III (31) patients developed a restenosis of > 50% within 2 years. One hundred and thirteen Dacron patches (73 Group I [83%], 22 Group II [63%], and 18 Group III [58%]) were used according to surgeon preference but did not affect the statistical relevance of homocysteine evaluation. The groups were otherwise identical in terms of age, sex, smoking history, and cholesterol levels. All patients were receiving antiplatelet medication postoperatively, and none had consumed added pharmacologic folate. The average homocysteine value for the entire study group was elevated at 12.5 micromol/L. The homocysteine values for the 3 groups were not statistically different (p > 1): (I, 12.5; II, 12.2; and III, 12.9 micromol/L).Elevated homocysteine levels (> 10 micromol/L) appear to be associated with carotid atherosclerosis, but at levels < 30 micromol/L do not appear to play a role in restenosis following CEA.     

Peritoneal computed tomography attenuation values reflect the severity of peritonitis caused by gastrointestinal perforations

Background

The aim of this study was to evaluate the peritoneal computed tomography (CT) attenuation values and relate them to the severity of peritonitis in patients with gastrointestinal tract (GI) perforations.

Methods

A total of 56 consecutive patients with GI perforations who underwent CT scan and emergency laparotomy in our hospital were enrolled in this study. The CT attenuation values of the peritoneum were measured on a workstation by 2 independent investigators, and were investigated in relation to the severity of illness and hospital mortality.

Results

Peritoneal CT attenuation values in hospital nonsurvivors were significantly lower than those in survivors. There was significant negative correlation between peritoneal CT attenuation values and sequential organ failure assessment score, acute physiology and chronic health evaluation II score, and the Mannheim peritonitis index.

Conclusions

The evaluation of peritoneal CT attenuation values in patients with peritonitis is simple and can be used for objective assessment of the severity of peritonitis.     

Quantitative computed tomography for prediction of vertebral fracture risk

Vertebral trabecular mineral content and peripheral cortical bone mineral were measured in 94 female and 44 male osteoporotic patients and compared to vertebral mineral values obtained for 323 control subjects in a cross-sectional study. The rate of change of spinal trabecular mineral with age (measured by quantitative computed tomography) in control females averaged 1.2% per year from age 20 to 80, with an accelerated loss demonstrated at the menopause. Trabecular bone mass in male controls declined an average 0.72% per year. Female osteoporotics had a mean decrement of 48 mg cm-3 (39%) compared to age-matched controls, whereas males were decreased 66 mg cm-3 (50%). Radial cortical bone was correlated with spinal mineral in osteoporotics for both males (r = 0.48) and females (r = 0.62). Vertebral compression fractures or wedging was generally absent in patients with vertebral mineral values above 110 mg cm-3, whereas almost all patients with values below 65 mg cm-3 had fractures. Quantitative computed tomography for measurement of vertebral trabecular bone mineral density is useful for defining those patients in whom the risk of vertebral fracture is increased.     

Diabetes is not a risk factor for hospital mortality following contemporary coronary artery bypass grafting

The outcome of coronary artery bypass grafting (CABG) in diabetic patients has traditionally been worse than in non-diabetic patients. Recent studies have suggested an improvement in outcome in diabetic patients undergoing contemporary CABG. However, the direct impact of diabetes on mortality and morbidities following CABG remains unclear. We retrospectively analyzed prospectively collected data of 2725 CABG patients from January 1998 to December 2005: one thousand and eighty-five (40%) diabetics and 1640 (60%) non-diabetics [mean age 65+/-11 years, 1882 (69%) male]. Subgroup analysis was performed for two study periods (1998-2002 vs. 2003-2005). The overall hospital mortality was 1.8% [n=50; diabetics: 2.4%, non-diabetics: 1.5% (P=0.07)]. The mortality rate among diabetics decreased from 3.1% in 1998-2002 to 1.0% in 2003-2005 (P=0.021). Diabetes was not an independent predictor of hospital mortality but predicted the occurrence of deep sternal wound infection (OR=3.77). Diabetes significantly decreased long-term survival [1-year and 5-year survival 94.7+/-0.7% and 81.9+/-1.4% for diabetic vs. 95.4+/-0.5% and 85.9+/-1.0% for non-diabetic patients (P=0.01)]. Excellent results following contemporary CABG can be expected in diabetics with a similar mortality compared to non-diabetics. Therefore, our data suggest that diabetes may, in fact, not be a risk factor for adverse outcome following CABG. However, long-term survival in diabetics remains significantly inferior compared to non-diabetics.     

Advanced donor age alone is not a risk factor for graft survival in kidney transplantation

Background

The use of kidneys from elderly deceased donors has substantially increased organ supply, although it is associated with worse graft function and survival rates. The risk of kidneys from elderly donors as well as expanded criteria donors (ECDs) on kidney transplant outcome was investigated.

Patients and methods

Seventy-five kidney transplants from ECDs over a 5-year period were reviewed retrospectively. Old age and increased donor risk variables were analyzed separately in relation to graft function and survival.

Results

Sixty-four of 75 (85.3%) recipients had functioning grafts 5 years posttransplant. The overall actuarial graft survivals from 1 to 5 years were 87.5%, 68.1%, 57.3%, 55.4%, and 47.3%, respectively. Early graft function gave 47 (62.7%) kidneys remarkable actuarial survivals of 100.0%, 88.3%, 75.8%, 75.8%, and 68.4% at 1 to 5 years posttransplant, and 28 (37.3%) kidneys had delayed graft function with substantially decreased actuarial survival rates, ranging from 66.7% to 23.2%. Kidneys from elderly donors had considerable actuarial graft survival rates of 100.0%, 83.3%, 76.9%, 76.9%, and 67.0% from 1 to 5 years, respectively; these were the best graft survival rates compared with kidneys from the other donor categories. The other donor risk variables when associated with advanced age of any had an adverse effect on recipient graft function and survival, but no single risk variable alone, or a combination of any two, showed any statistically significant variability.

Conclusion

Elderly kidney donors provided a substantial organ pool expansion without affecting patient and graft survival in many patients. ECDs can be utilized safely if adequate measures are taken.     

Pelvic floor dysfunction is not a risk factor for febrile urinary tract infection in adults

Study Type – Therapy (case control)
Level of Evidence 3b

OBJECTIVE

To determine whether pelvic floor dysfunction (PFD) might be a risk factor for or consequence of febrile urinary tract infection (UTI), as UTI in adults is a common infection in which an underlying urological abnormality is often considered, and as in children, PFD is also thought to have a pathophysiological role in adults with UTI.

PATIENTS AND METHODS

A multicentre case‐control study was conducted at 26 primary‐care centres and at six Emergency Departments of regional hospitals. Cases were consecutive patients aged ≥18 years, who presented with febrile UTI. Controls were randomly selected subjects who visited their general practitioner for reasons other than UTI or fever. A validated pelvic floor questionnaire (the Pelvic Floor Inventories Leiden, PelFIs) was used to assess pelvic floor function.

RESULTS

Between October 2006 and December 2007, 153 cases were included; of these, the completed questionnaires of 102 (response rate 67%) were compared to those of 100 of 110 (response rate 91%) controls. The median age of cases and controls was 65 and 58 years, respectively; 40% of cases and controls were men. The percentage of PelFIs outcomes consistent with PFD were comparable between cases and controls, at 21% vs 23%, respectively (odds ratio 0.9, 95% confidence interval, CI, 0.4–1.78). In the multivariate analysis, comorbidity (odds ratio 4.9, 95% CI 2.2–11.1) and a history of UTI (odds ratio 2.5, 95% CI 1.0–6.1) were independent significant risk factors for febrile UTI, whereas PFD was not (odds ratio 1.0, 0.5–2.2). Within the group of cases, PFD was not associated with bacteriuria during assessment of PelFIs (odds ratio 1.1, 95% CI 0.4–3.5) and inversely related to a history of UTI within the previous year (odds ratio 0.2, 0.1–0.9).

CONCLUSIONS

PFD is common among adults but it does not seem to be a risk factor for febrile UTI.     

Hepatic portal venous gas identified by computed tomography in a patient with blunt abdominal trauma: a case report

An abdominal computed tomographic (CT) scan in a middle-aged man injured in a high-speed motor vehicle accident demonstrated the presence of portal venous gas. Findings on initial peritoneal lavage were entirely negative. Exploratory celiotomy performed because of increasing abdominal pain and leukocytosis revealed gangrene of the cecum. This report illustrates the importance of the finding of portal venous gas on CT scan in patients with blunt abdominal trauma.