Endovascular management of vascular complications in pancreatic transplants

Vascular complications after pancreatic transplantation carry a high rate of graft loss. Endovascular management of these complications is confined to stent placement for iliac artery inflow disease and embolization for arteriovenous fistulae (AVFs), pseudoaneurysms, or active bleeding. The current study describes the endovascular management of pancreatic transplant venous thrombosis (N = 1), arterial stenosis (N = 5), thrombosis (N = 3), pseudoaneurysms (N = 1), and AVF (N = 2). In addition, embolization of nonfunctioning grafts is described as an endovascular alternative to pancreatectomy.     

Clinical characteristics of adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia

BackgroundThe clinical spectrum of COVID-19 has a great variation from asymptomatic infection to acute respiratory distress syndrome and eventually death. The mortality rates vary across the countries probably due to the heterogeneity in study characteristics and patient cohorts as well as treatment strategies. Therefore, we aimed to summarize the clinical characteristics and outcomes of adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia in Istanbul, Turkey.MethodsA total of 722 adult patients with laboratory-confirmed COVID-19 pneumonia were analyzed in this single-center retrospective study between March 15 and May 1, 2020.ResultsA total of 722 laboratory-confirmed patients with COVID-19 pneumonia were included in the study. There were 235 (32.5%) elderly patients and 487 (67.5%) non-elderly patients. The most common comorbidities were hypertension (251 [34.8%]), diabetes mellitus (198 [27.4%]), and ischemic heart disease (66 [9.1%]). The most common symptoms were cough (512 [70.9%]), followed by fever (226 [31.3%]), and shortness of breath (201 [27.8%]). Lymphocytopenia was present in 29.7% of the patients, leukopenia in 12.2%, and elevated CRP in 48.8%. By the end of May 20, 648 (89.7%) patients had been discharged and 60 (8.5%) patients had died. According to our study, while our overall mortality rate was 8.5%, this rate was 14.5% in elderly patients, and the difference was significant.ConclusionsThis case series provides characteristics and outcomes of sequentially adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia in Turkey.     

Temporary Cardiac Pacemaker in the Treatment of Junctional Rhythm and Hypotension Due to Imipramine Intoxication

Tricyclic antidepressants (TCAs) account for approximately 3% of all pediatric hospitalizations due to poisoning. TCAs remain a common cause of fatal drug poisoning because of their cardiovascular toxicity as manifested by electrocardiogram (ECG) abnormalities, arrhythmias, and hypotension. We report a 15-year-old girl with junctional escape rhythm and resistant hypotension caused by severe imipramine intoxication. Initial ECG showed junctional escape rhythm (46 bpm) with no atrial activity, low QRS voltage, widening of the QRS complex (160 ms) with a right bundle branch-like pattern, R wave > 3 mm in aVR (6 mm), and prolongation of the QT interval (QTc 550 ms). Despite intravenous fluids and inotropic support, she had resistant hypotension and acute renal failure. Junctional rhythm was successfully terminated by using temporary cardiac pacemaker. Hemodialysis and hemoperfusion were also performed. She was discharged on the day 5 without any complications. During follow-up, no ECG abnormalities were noted. We reported successful use of temporary cardiac pacemaker for treatment of junctional rhythm and resistant hypotension in imipramine intoxication. The conventional methods of activated charcoal, alkalinization, and symptomatic treatment of complications are usually enough for nonlethal doses of TCA intoxication. However, in imipramine intoxication with serious arrythmias and hypotension, using temporary cardiac pacemaker, hemodialysis, and hemoperfusion can be a life-saving therapeutic approach.     

Colorectal Cancer Localization in Young Patients: Should We Expand the Screening Program?

We sought to investigate the frequency and distribution of colorectal cancer (CRC) in patients by age and to evaluate whether there is a difference between young (<40 years of age) and older patients (≥40 years of age) with regard to cancer localizations. From a total of 5165 colonoscopies, 314 (6.0%) cases were identified to have colorectal carcinoma. Forty-one (13%) of 314 CRC patients were young, with a mean age of 31.1±5.7 years. When cancer localizations were compared with reference to age, it was seen that CRCs in young patients were mostly localized at the right colon, versus at the left colon and rectum (P=013) in patients >40 years of age. Tumor localizations in colon cancer patients change with age. In our study, young patients tended to have right-sided colon tumors, but those in patients >40 years of age were frequently localized at the left colon and rectum.     

Acute electrophysiologic effect of pulsed gallium-arsenide low energy laser irradiation on configuration of compound nerve action potential and nerve excitability

BACKGROUND AND OBJECTIVES: We evaluated the acute electrophysiologic effects of low-energy pulsed laser irradiation, measured by extracellular recording technique on compound action potential configuration and nerve excitability in the isolated frog sciatic nerve STUDY DESIGN/MATERIALS AND METHODS: A pulsed gallium-arsenide (GaAs) laser (wavelength, 904 nm; pulse duration, 220 nanoseconds; peak power per pulse, 27 W; spot size, 0.28 cm(2); total applied energy density, 0.005-2.5 J/cm(2)) was used for the experiment. Sixty isolated nerves were divided into six groups (n = 10), each of which received a different repetition frequency. In each group, action potentials were recorded, before laser irradiation, which served as the control data. The extracellular action potentials were recorded for each combination of 1, 3, 5, 7, 10, 13, and 15 minutes of irradiation time and 4, 8, 16, 32, 64, 128 repetition frequency by using a BIOPAC MP 100 Acquisition System Version 3.5.7 (Santa Barbara USA). Action potential latency, duration of depolarization and repolarization, and the stimulating voltage were measured. Statistical evaluation was performed using linear correlation analysis by SPSS 9.05. RESULTS: Although there was no correlation between applied energy density and action potential latency, the duration of depolarization and repolarization phases (P > 0.05), there was a weak correlation between applied energy density and stimulating voltage. CONCLUSIONS: The study showed that low-energy GaAs irradiation at 42 different energy density between 0.005 and 2.5 J/cm(2) generates no effect on action potential configuration and nerve excitability.     

Passive transfer of fibromyalgia symptoms from patients to mice

Fibromyalgia syndrome (FMS) is characterized by widespread pain and tenderness, and patients typically experience fatigue and emotional distress. The etiology and pathophysiology of fibromyalgia are not fully explained and there are no effective drug treatments. Here we show that IgG from FMS patients produced sensory hypersensitivity by sensitizing nociceptive neurons. Mice treated with IgG from FMS patients displayed increased sensitivity to noxious mechanical and cold stimulation, and nociceptive fibers in skin-nerve preparations from mice treated with FMS IgG displayed an increased responsiveness to cold and mechanical stimulation. These mice also displayed reduced locomotor activity, reduced paw grip strength, and a loss of intraepidermal innervation. In contrast, transfer of IgG-depleted serum from FMS patients or IgG from healthy control subjects had no effect. Patient IgG did not activate naive sensory neurons directly. IgG from FMS patients labeled satellite glial cells and neurons in vivo and in vitro, as well as myelinated fiber tracts and a small number of macrophages and endothelial cells in mouse dorsal root ganglia (DRG), but no cells in the spinal cord. Furthermore, FMS IgG bound to human DRG. Our results demonstrate that IgG from FMS patients produces painful sensory hypersensitivities by sensitizing peripheral nociceptive afferents and suggest that therapies reducing patient IgG titers may be effective for fibromyalgia.