Serum albumin level during intestinal exfoliative rejection: a potential predictor of graft recovery and patient outcome

Exfoliative rejection is a severe complication after intestinal transplant. The assessment of mucosa histology is restricted to the area reached by endoscopy. We aim to evaluate the serum albumin (SA) value as a parameter of graft damage and clinical prognosis in intestinal exfoliative rejection (ExR). The present study is a retrospective analysis of 11 episodes of ExR occurred in a cohort of 26 patients. SA levels were measured 24 h after diagnosis and twice a week thereafter and then correlated with parameters of clinical and graft histological recovery (HR). During ExR, all patients had very low SA levels, reaching a minimum average of 1.9 ± 0.3 g/dL. According to the value of albumin levels at ExR diagnosis, the patients were grouped finding a correlation with their clinical evolution. Six ExR episodes presented with severe hipoalbuminemia (<2.2 g/dL; p < 0.05) that correlated with worse patient and graft outcome, ranging from graft loss and need for re‐transplantation to delayed clinical and HR. SA at ExR diagnosis may be an indicator of the severity of the ExR process, and it could also be used as an early predictor of patient and graft outcome.     

Vasculite testicular – uma manifestação rara de artrite reumatoide

Testicular vasculitis is a very rare extra-articular manifestation of rheumatoid arthritis (RA). We describe the case of a 53-year-old man diagnosed with RA for eight years, who was poorly controlled and developed rheumatoid vasculitis, which manifested as leg ulcers and peripheral polyneuropathy. The patient also had acute neutrophilic meningitis and was treated with antibiotics and intravenous pulse therapy with methylprednisolone (500 mg daily) for three days, followed by oral cyclophosphamide (2 mg/kg daily) and prednisone. Overall improvement was observed, and the patient was discharged. But 15 days later, the meningitis recurred, and the patient was readmitted and treated again with antibiotics. Three days later, he developed pain and enlargement of his left testicle with gangrene. Unilateral orchiectomy was performed, revealing lymphocytic vasculitis. The patient died two days later due to aspiration pneumonia. This case illustrates a rare and severe manifestation of rheumatoid vasculitis.     

Characteristics of Asthma Patients Admitted to an Intermediate Respiratory Care Unit

IntroductionIntermediate respiratory care units (IRCU) provide continuous monitoring and non-invasive mechanical ventilation (NIMV) in patients with severe respiratory failure who are usually admitted to intensive care units (ICUs). The usefulness of IRCU in managing severe asthma exacerbations has never been evaluated.MethodsClinical data were prospectively and systematically compiled from patients admitted to the IRCU with a principal diagnosis of bronchial asthma exacerbation. We assessed therapeutic failure (intubation or exitus) and patient evolution up until 6 months after discharge compared with a group of patients admitted to a conventional hospital ward, paired for age and sex, and with the same principal diagnosis.ResultsA total of 74 asthma patients were included (37 admitted to IRCU and 37 to the hospital ward) with a mean age (±SD) of 58 ± 20, who were predominantly women (67%), with previous diagnosis of asthma and persistent asthma treatment. The main cause of admittance to the IRCU was severe respiratory failure. The patients who were admitted to the IRCU presented more radiological affectation (alveolar infiltrates) and had significantly higher pCO₂. Ten patients admitted to the IRCU required non-invasive mechanical ventilation (NIMV). There were no differences between the two groups regarding either therapeutic failure or the 6-month follow-up after discharge.ConclusionsPatients with severe asthma exacerbations can be managed in an IRCU while avoiding hospitalization in an ICU and demonstrating a prognosis similar to milder exacerbations treated in conventional hospital wards.     

A Benign Renal Cyst Containing Liesegang Rings Mimicking a Renal Cell Carcinoma: A Case Report

Liesegang rings are uncommon pathological findings which may cause diagnostic dilemmas for pathologists. Awareness of their appearance is important to avoid over diagnosis of parasitic infection, algal contamination and psammoma bodies. Liesegang rings are benign, lamellar structures with radial striations and a central amorphous core. They are found in a variety of tissues and fluids in both an intra- and extra-cellular sites. We present here a case of a cystic renal lesion containing Liesegang rings mimicking a renal cell carcinoma.Key Words: Liesegang rings, Kidney, Pseudotumor     

Psychological and family-related facts of suffering in patients with chronic diseases

Illnesses that limit life or functioning have the potential to cause significant distress and lead to suffering. Suffering is a subjective and multidimensional experience that results from the person's appraisal of threat and exhaustion of coping resources. Detection and management of suffering in patients who are chronically ill have become of great interest in the last few years as relief from suffering was established as one of palliative care main goals. Psychological, sociocultural, and family issues that contribute to suffering are discussed. Also, assessment strategies and instruments, as well as interventions toward relief from suffering, are described. Therapeutic approaches should be individualized and include issues in the physical, psychological, sociocultural, and spiritual domains to plan for comprehensive interventions suited to the patient's needs and to attain better symptom control. Regarding family suffering, interventions that reinforce the perceived social support, facilitate communication and emotional disclosure, effect on the family's level of cohesion and flexibility, and enable role distribution, resilience, and meaning of the illness as a learning experience will reinforce adaptation and alleviate suffering.     

Correspondence: Cox inhibitors and bone healing

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