MR cholangiography in orthotopic liver transplantation: sensitivity and specificity in detecting biliary complications

Boraschi P, Donati F, Gigoni R, Volpi A, Salemi S, Filipponi F, Falaschi F. MR cholangiography in orthotopic liver transplantation: sensitivity and specificity in detecting biliary complications.
Clin Transplant 2010: 24: E82–E87.
© 2009 John Wiley & Sons A/S. Abstract: Background: To assess the diagnostic value of magnetic resonance cholangiography (MRC) when evaluating biliary complications in a large series of liver transplants. Methods: One hundred and twenty‐nine patients prospectively underwent magnetic resonance (MR) imaging and MR cholangiography at 1.5‐T device after orthotopic liver transplantation (OLT). After the preliminary acquisition of axial T1‐ and T2‐weighted images, MRC involved respiratory‐triggered, thin‐slab (2 mm), heavily T2‐weighted fast spin‐echo and breath‐hold, thick‐slab (10–50 mm), single‐shot T2‐weighted sequences. MR images were blindly evaluated by two experienced readers in conference to determine the biliary anatomy and the presence of complications, whose final diagnosis was based on endoscopic retrograde cholangiography, percutaneous trans‐hepatic cholangiography, and by integrating clinical follow‐up with ultrasound and/or MR findings. Results: Biliary complications were found in 60 patients (46.5%) and were represented by ischemic‐type biliary lesions (n = 21); anastomotic strictures (n = 13); non‐anastomotic strictures (n = 5); anastomotic strictures associated to lithiasis (n = 6); lithiasis (n = 6); papillary dysfunctions (n = 9). The sensitivity, specificity, positive predictive value, and negative predictive value of the reviewers for the detection of all types of biliary complications in patients with OLT were 98%, 94%, 94%, and 98%, respectively. Conclusions: MRC is a reliable technique for detecting post‐OLT biliary complications and should be recommended before planning therapeutic interventions.     

To what extent does leg length discrepancy impair motor activity in patients after total hip arthroplasty?

The aim of this study was to evaluate the effects of limb lengthening up to 20 mm after THA on symmetry of hip kinematics and kinetics during common activities of daily living. Twenty patients (age range 49–80 years) operated on with Link Lubinus II THA, with lateral access and a mean follow-up of 16 months, were assessed by gait analysis during level walking, stair ascending and descending. The time-distance, hip kinetics and kinematics values were statistically compared between the operated side and the non-operated side in order to assess symmetry. The 12-item Questionnaire was used to assess satisfaction and personal perception of limb lengthening. Mean value of limb lengthening after THA was 11 mm (SD 6). Minor abnormalities were found in the kinematics and kinetics of the operated and non-operated hips during level walking and stair climbing. The score of the questionnaire corresponded to a high level of satisfaction after THA and only two patients complained of limping independent from the amount of discrepancy. From this study we can conclude that a leg length inequality in the range of 1–20 mm does not impair the symmetry of time–distance parameters and of hip kinematics and kinetics during gait and stairs walking. Although objective, gait analysis data did not correspond to patient’s perception of discrepancy, which is subjective and irrespective of the amount of lengthening. There is biomechanical evidence that a limb lengthening of up to two centimetres after THA in general does not need to be corrected by means of a contralateral shoe lift. Individual decisions to the contrary need to be justified.     

Rosai-Dorfman disease involving the neurohypophysis

Rosai-Dorfman disease is a rare, histiocytic proliferative disorder of unknown etiology commonly affecting lymph nodes. Extranodal lesions with or without nodal involvement also occur. We report the case of a 63 year-old woman with disseminated Rosai-Dorfman disease involving the neurohypophysis and associated with adenohypophysial PRL cell hyperplasia.     

Pp65 antigenemia,plasma real-time PCR and DBS test in symptomatic and asymptomatic cytomegalovirus congenitally infected newborns

Background  

Many congenitally cytomegalovirus-infected (cCMV) neonates are at risk for severe consequences, even if they are asymptomatic at birth. The assessment of the viral load in neonatal blood could help in identifying the babies at risk of sequelae.     

Assessment of the effectiveness of low-level laser therapy on the hands of patients with rheumatoid arthritis: a randomized double-blind controlled trial

Assess the effectiveness of low-level laser therapy on pain reduction and improvement in function in the hands of patients with rheumatoid arthritis. A randomized double-blind controlled trial was carried out on 82 patients with rheumatoid arthritis. The experimental group was submitted to the application of laser therapy, whereas the control group received a placebo laser. Aluminum gallium arsenide laser was used, at a wavelength of 785 nm, dose of 3 J/cm² and mean power of 70 mW. The groups were homogenous at the beginning of the study with regard to the main variables (p > 0.05). There were no statistically significant differences between groups in most of the measurements taken at the end of the intervention including the primary variables; the following variables were the exceptions: favoring the experimental group—inflammation of the interphalangeal joint of the right thumb (p = 0.012) and perimetry of the interphalangeal joint of the left thumb (p = 0.013); and favoring the control group—flexion of the proximal interphalangeal joint of the right fifth finger (p = 0.021), perimetry of the third proximal interphalangeal joint of the right hand (p = 0.044), grip strength in the left hand (p = 0.010), and the work domain of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire (p = 0.010). We conclude that low-level aluminum gallium arsenide laser therapy is not effective at the wavelength, dosage, and power studied for the treatment of hands among patients with rheumatoid arthritis.     

Amiodarone-related pneumonitis and peripheral neuropathy in an elderly patient

Amiodarone, which has been used since 1967 as an antiarrhythmic drug, gives rise to a variety of cardiac and extracardiac adverse side-effects. Among these, pulmonary toxicity is considered the most frequent and serious extracardiac side-effect, since it may occur in various atypical forms and often limits the drug's clinical use. We encountered a 67-year-old white male patient with suspected amiodarone pneumonitis characterized by multiple lung nodules associated with pleural and pericardial effusion and peripheral neuropathy. Because differential diagnosis with pulmonary infectious diseases may be extremely difficult, the attending physician should therefore bear in mind the possibility of amiodarone pneumonitis whenever the drug is given.     

Long-term deterioration of quality of life in adult patients with celiac disease is associated with treatment noncompliance

Background

Deterioration of quality of life in the long term has been suggested for celiac disease patients on a gluten-free diet.

Aims

To determine long-term quality of life of celiac disease patients and to assess the benefits of gluten-free diet compliance.

Patients

We prospectively evaluated 53 newly diagnosed adult celiac disease patients.

Methods

The Short Form 36 Health Survey, the Gastrointestinal Symptoms Rating Scale and the Beck Depression Inventory were employed at the time of diagnosis, 1 year, and beyond 4 years (median: 53 months) on treatment.

Results

At 1 year, a significant improvement from baseline in quality of life indicators was observed (p < 0.001 to p < 0.0001) with comparable scores to healthy subjects. At 4 years, the Short Form 36 Health Survey scores (p < 0.002 to p < 0.0002) and Beck Depression Inventory score (p < 0.002) show significant deterioration compare with 1 year. Most scores remained significantly better than those at diagnosis (p < 0.03 to p < 0.0005). No changes were detected in the Gastrointestinal Symptoms Rating Scale scores. The long-term impairment of quality of life was attributable to the deterioration of most dimensions in patients who were not strictly compliant with the gluten-free diet (p < 0.05 to p < 0.001).

Conclusions

Long-term deterioration of quality of life outcomes after the first year of gluten-free diet was associated with the lack of strict compliance with the diet.