Anesthetic considerations for nontransplant procedures in lung transplant patients

Lung transplantation has become an accepted option for many patients with end-stage pulmonary diseases. Anesthesia and surgery following lung transplantation may be required for various diseases that may affect both systemic organs and the transplanted graft. When a patient with a lung transplant undergoes surgery, there is the potential for interference with lung function, depending on the type of intervention and its anatomical site. Accurate preoperative evaluation, an understanding of the physiology of the transplanted lung, proper airway instrumentation, individualized management of intraoperative ventilation, and fluid balance are essential for a positive perioperative outcome.     

The additive value of sarcopenia,myosteatosis and hepatic encephalopathy in the predictivity of model for end-stage liver disease

BackgroundSince the use of the Model for End-Stage Liver Disease (MELD) score for establishing the prognosis of cirrhotic patients has been introduced, questions have been raised whether complications of liver cirrhosis would provide additional information. Myosteatosis, sarcopenia and hepatic encephalopathy (HE) are frequent in cirrhosis and may affect prognosis.Aim of the study was analyzing if these factors are independently related to survival and may improve the accuracy of MELD.Methods249 cirrhotics that underwent abdominal CT-scan were enrolled. For each patient, information about previous episodes of HE and muscle alterations were obtained. Patients were followed until transplantation or death.ResultsHistory of HE, MELD, sarcopenia and myosteatosis were independently associated with mortality. The MELD-Sarco-Myo-HE score added accuracy to the MELD score alone for 6- and 3-months mortality. By removing HE, as the only not quantifiable parameter of the model, no relevant decrease in accuracy for 6- and 3-months mortality detection was observed.ConclusionsThe accuracy of MELD in predicting 3- and 6-months mortality may be improved by considering the muscle alterations. A model considering the above parameters may classify more accurately over 30% of the patients.     

Magnetic resonance imaging of the knee after medial unicompartmental arthroplasty

Objective

We evaluated safety and potential diagnostic value of magnetic resonance (MR) imaging of the knee treated with medial unicompartmental arthroplasty (MUA).

Methods

The treated knee of 8 patients who underwent MUA was studied with four different 1.5-T MR sequences. Two radiologists independently evaluated eleven anatomical items using a score from 0 (not assessable) to 3 (completely assessable). The sum of the scores for each sequence was divided by the potential maximal sum, obtaining a percentage visibility index (PVI) for each item.

Results

No adverse effect was reported during or within 30 min after the exam. Posterior cruciate ligament was unseen in all patients by both observers. The following PVIs were reported for the remaining ten items: femoral–patellar relationship 83–100%; femoral–patellar cartilage 92–100%; Hoffa's fat pad 75–92%; patellar ligament 79–100%; lateral meniscus 100%; femoral–tibial lateral joint 100%; lateral collateral ligament 96–100%; anterior cruciate ligament 54–83%; femoral–tibial lateral cartilages 92–100%; posterolateral corner 100%. Agreement between readers was found in 331/352 (94%) evaluations (k = 0.74–0.78).

Conclusions

MR imaging after MUA offers a safe and reproducible evaluation of residual knee anatomy except for cruciate ligament, and can be used to follow-up these patients.     

Novel soy germ pasta improves endothelial function, blood pressure, and oxidative stress in patients with type 2 diabetes

OBJECTIVE

To compare the effects of a novel soy germ–enriched pasta, containing isoflavone aglycons, with conventional pasta on endothelial function and cardiovascular risk markers in patients with type 2 diabetes (T2D).

RESEARCH DESIGN AND METHODS

This randomized controlled double-blind crossover study compared one serving/day of soy germ pasta and conventional pasta for 8 weeks for effects on brachial artery flow-mediated vasodilation, blood pressure, plasma lipids, oxidized LDL cholesterol, 8-iso-PGF2α, total antioxidant capacity (TAC), glutathione (GSH), and homocysteine.

RESULTS

Isoflavone-enriched pasta significantly improved arterial stiffness (P = 0.005) and reduced systolic (P = 0.026) and diastolic (P = 0.017) blood pressures. Plasma TAC increased (P = 0.0002), oxidized LDL cholesterol decreased (P = 0.009), 8-iso-PGF2α decreased (P = 0.001), GSH levels increased (P = 0.0003), and homocysteine decreased (P = 0.009) consistent with a reduction in oxidative stress. No significant changes were observed with conventional pasta.

CONCLUSIONS

Pasta enriched with biologically active isoflavone aglycons improved endothelial function and had beneficial effects on cardiovascular risk markers in patients with T2D.The risk of cardiovascular disease and stroke is 3–4 times greater in patients with type 2 diabetes (T2D) than in the general population (1). It results from loss of normal endothelial function and is associated with increased oxidative stress, production of reactive oxygen species (2), and a decrease in antioxidative defense systems (3). Hypertension, dyslipidemia, and hyperhomocysteinemia also contribute to overall morbidity and mortality. In a recent study of patients with hypercholesterolemia, a soy germ–enriched pasta containing isoflavones, in mainly the biologically active aglycon form, significantly improved serum lipids and other markers of cardiovascular risk, including arterial reactivity, beyond that of an American Heart Association Step II diet alone (4). Our objective was to determine whether similar effects from this novel food could be attained in patients with T2D.