Benign Pneumatosis Intestinalis with Subcutaneous Emphysema in a Liver Transplant Recipient

Pneumatosis intestinalis (PI) occurred in a pediatric liver transplant recipient experiencing chronic rejection. Signs and symptoms included abdominal distention, subcutaneous emphysema, fever, and malaise. Antibiotic treatment and nasogastric decompression resulted in prompt relief of symptoms, and surgery was not necessary. The etiology, pathophysiology, and therapy of this rare condition are discussed.     

The role of the spleen in regulating the plasma levels of factor VIII-- von Willebrand's factor after DDAVP

Organ transplantation and perfusion studied indicate that the spleen plays an important role in the regulation of plasma levels of factor VIII-von Willebrand's factor (FVIII-vWF). To better understand the mechanisms that regulate the FVIII-vWF increases after infusion of 1- deamino-8-D-arginine vasopressin (DDAVP), we have measured factor VIII coagulant activity (FVIII:C) and antigen (FVIII:CAg) and von Willebrand's factor antigen (vWF:Ag) and ristocetin cofactor (vWF:RCof) in 9 asplenic subjects with normal baseline concentrations, in 7 asplenic subjects with high concentrations, and in 14 normal controls with intact spleens. In "normal" aasplenics, all the FVIII-vWF-related measurements increased significantly over baseline values, indicating that responsiveness to DDAVP is not abolished by splenectomy. The maximal vWF:Ag and vWF:RCof responses were no different from those of normal controls, suggesting that DDAVP releases vWF from storage sites other than the spleen. The FVIII:C response was significantly lower than in normal controls, but FVIII:CAg did not differ, making FVIII:CAg higher than FVIII:CAg in "normal" asplenics. These findings suggest that the spleen, rather than being a storage site for FVIII, is the organ in which a partially inactive form of FVIII acquires full coagulant activity. In "high" asplenics, all the FVIII-vWF-related measurements increased less than in "normal" splenics, indicating that long-term elevations of plasma concentrations of FVIII-vWF are accompanied by decreased release from those storage pool(s) mobilized by DDAVP.     

Insulin glargine dosing before next-day surgery: comparing three strategies

Study ObjectiveTo evaluate three evening insulin glargine dosing strategies for achievement of target (100–179 mg/dL; 5.5 - 9.8 mmol/L) and widened (80–249 mg/dL; 4.4 - 13.7 mmol/L) preoperative fasting blood glucose (FBG) ranges on the day of surgery.DesignProspective, randomized, open trial.SettingPreoperative units at two sites of a suburban hospital system.Patients401 adult, ASA physical status 3 and 4 patients with type 1 and type 2 diabetes, undergoing elective noncardiac surgery.InterventionsPatients were divided into two groups according to absence of daily rapid-acting/short-acting insulin (insulin glargine-only group) or presence of daily rapid-acting/short-acting insulin (insulin glargine plus bolus group). Subjects were then randomized to three evening insulin glargine dosing strategies: (a) take 80% of usual dose, (b) call physician for dose, or (c) refer to dosing table, based on self-reported usual FBG and insulin regimen. In the prehospital setting, patients administered the instructed insulin glargine dose on the evening before surgery.MeasurementsVenous blood glucose values were recorded in the preoperative holding area on the day of surgery.Main ResultsNo significant differences in target preoperative FBG achievement were detected among strategies in the insulin glargine-only group (n = 174) or the insulin glargine plus bolus group (n = 227). In widened preoperative FBG achievement, no significant difference was noted among strategies in the insulin glargine-only group. In the insulin glargine plus bolus group, fewer subjects following the dosing table had FBG > 249 mg/dL (> 13.7 mmol/L; P = 0.031).ConclusionsTarget preoperative FBG achievement was similar among strategies in both insulin glargine groups. An insulin glargine adjustment strategy based on usual glycemic control may better prevent severe preoperative hyperglycemia in patients receiving basal/bolus regimens.     

Characteristics of clinical course of myocardial infarct in young persons under conditions of an industrial city in the Far North]

Study of the clinical course of myocardial infarction, the mortality of ischemic heart disease and its morphological manifestations showed the "rejuvenation" of myocardial infarction and an increase in its incidence depending on the duration of residence under conditions of Norilsk. The pecularities of the clinical course of myocardial infarction are determined and attention is drawn to the essential pathogenetic role of arterial hypertension in the formation and manifestation of ischemic heart disease in young residents of Norilsk.