Liver transplantation for acute liver failure: are there thresholds not to be crossed?

Factors predicting survival after liver transplantation (LT) for irreversible acute liver failure (ALF) are rare. The aim of this study was to identify prognostic preoperative factors of patients with ALF that predict mortality after LT to avoid futile transplantation. From chart review, we identified 57 patients receiving transplants for ALF from 12/2000 to 09/2010. Recipient and donor data were analyzed and correlated with in‐hospital mortality and patient survival by univariable/multivariable logistic regression and Cox proportional hazards. The survival rates at 30 days and 12 months were 77.2% and 64.9%, respectively. The in‐hospital mortality rate was 29.8%. Follow‐up of patients discharged from the hospital alive showed 30‐day and 12‐month survivals of 100% and 92.5%, respectively. Multivariable analysis of factors known preoperatively showed that the lowest pH of the recipient before LT (P = 0.03) was independently associated with in‐hospital mortality, and the recipient's BMI (P = 0.03) and the lowest pH before LT (P = 0.03) were independently associated with patient survival. A pH of 7.26 was the calculated cutoff (ROC) for increased in‐hospital mortality. Donor factors did not affect patient survival. Patients with ALF and a pH ≤ 7.26 have the worst outcome after liver transplantation. Therefore, emergency liver transplantation should be critically discussed for each individual.     

Where to set limits in (end-of-life) medicine? Historical,cultural, philosophical and medical aspects in a Dutch-German comparison

Medicine, Health Care and Philosophy -     

Vaginal removal of prolapsed pedunculated submucosal myoma during pregnancy

Pedunculated submucosal myomas are generally associated with infertility and are most often encountered during the preconception period. This report describes a 38-y-old pregnant woman in whom a pedunculated submucosal myoma resulted in preterm labor and was successfully removed vaginally at 26 wk gestation. The procedure described here is simple and quick and can be performed during pregnancy, if necessary.     

Severe neurological events following liver transplantation

BACKGROUND: Problems related to the central nervous system may have major impact on morbidity and mortality. The aim of this retrospective study was to evaluate the nature and incidence of serious neurologic events in patients following liver transplantation. METHODS: Between January 2001 and May 2004, 168 patients (105 female, 63 male) requiring transplantation for alcoholic cirrhosis, hepatitis B and C, and acute liver failure were admitted to the Intensive Care Unit (ICU) of University Hospital Essen after liver transplantation. We identified the reason for the neurologic events, the underlying disease, type of immunosuppression, and the survival rate. RESULTS: Severe neurologic events occurred in 46 (27.3%) of the patients. The length of stay of these patients in the ICU (18.4 +/- 19.7 days) was longer in comparison to the total patients (8.3 +/- 9.5 days, p < 0.05). The most common neurological complications were encephalopathy (18.5%) and seizures (5.4%). The survival rate after liver transplantation with neurological events was lower compared to patients without, but not significantly different (73.9 vs. 79.5%). The calcineurin inhibitor used had no impact on neurological events [cyclosporine (25.5%); tacrolimus (32.5%)]. CONCLUSIONS: There was a high incidence of serious neurologic events after liver transplantation. The major neurologic manifestation in our patients was encephalopathy followed by seizures.     

Survey of environmental exposure to asbestos in the town of Buyuktatlar, Turkey

Asbestos-related cases admitted to Chest Diseases Clinic of Kahramanmaras Sutcu Imam University Medical Faculty generally came from Buyuktatlar, a town adjacent to the Afsin district of Kahramanmara? city. This led us to screen for lung pathologies due to exposure to environmental asbestos in the town of Buyuktatlar. Six hundred and eighty-five inhabitants older than 30 years living in the town were identified as the study group and 488 persons (71·2%) were accepted for evaluation. Then, chest X-rays of these cases were taken and bilateral pleural plaque, bilateral pleural thickening, reticular lung infiltrations, and costophrenic angle obliteration were evaluated as asbestos-related disorders (ARD). ARD were diagnosed in 56 (11·5%) of the 488 chest X-rays that were assessed and no differences were observed between genders. Twenty-five of the cases were investigated by high-resolution computed tomography. Twenty-four were confirmed as ARD. In addition, chrysotile fiber was found in two of four soil samples taken from the town.