Validation of 20-meter corridor for the 6-minute walk test in men on liver transplantation waiting list

Background

Guidelines established by the American Thoracic Society recommend the use of corridors 30 m in length for the 6-minute walk test (6MWT). However, not all institutions have such long corridors, which hinders or prevents 6MWT performance and use of its benefits.

Objective

To compare the distances walked by male patients with cirrhosis on the liver transplantation waiting list, we performed 6MWT on corridors 20 and 30 m long.

Methods

This prospective study included 10 patients on the waiting list for liver transplantation. They underwent 2 walk tests: the first test in a 20 m corridor and the second in a 30 m corridor. We assessed physiologic variables (heart rate, oxygen saturation, arterial blood pressure) and the subjective sensation of dyspnea at rest at 6 and 9 minutes after each walk. Statistical analysis was performed using the Wilcoxon test.

Results

Data are expressed as mean ± sd. Patient age was 59 ± 10 years. The distances walked by the patients were shorter than those predicted for their age and gender (586 ± 45 m) in both tests, no significant difference was observed between the first and the second 6MWT (437 ± 101 m vs 465 ± 80 m; P = .131) or among the physiologic variables.

Conclusion

We concluded that a 20 m corridor can be used safely and effectively as an alternative to 30 m for the 6MWT for male patients with cirrhosis on the liver transplantation waiting list.     

Cytomegalovirus, human herpesvirus-6, and human herpesvirus-7 in adult liver transplant recipients: diagnosis based on antigenemia

Human herpesvirus (HHV)-6, HHV-7, and cytomegalovirus (CMV) that remain latent after primary infection can be reactivated during immunosuppression following organ transplantation in liver transplant recipients. The aim of this study was to monitor active infections for HHV-6, HHV-7, and CMV among adult liver transplantation recipients using antigenemia detected by an immunoperoxidase staining. Twenty-eight adult liver transplant patients were monitored using antigenemia in blood samples obtained at the time of transplantation, as well as weekly in the first month and once a month for 6 months. Of these patients, 28.5% showed positive CMV antigenemia; 39.2%, HHV-6 antigenemia; and 14.2%, HHV-7 antigenemia. The detection of the three viruses was considered to be independent of one another (P>.05). The results described above showed that few patients remain free of beta herpesviruses after liver transplantation. Most patients were infected sequentially and not concurrently. Antigenemia has been considered useful to detect active HHV-6 and HHV-7 infections. Antigenemia can be more efficiently interpreted when compared with polymerase chain reaction results, although other studies are necessary to establish the reference of HHV-6 and HHV-7 antigenemia.     

Yellow fever disease in a renal transplant recipient: Case report and literature review

Yellow fever (YF) is a viral disease, with clinical presentation among immunosuppressed patients not fully understood. YF vaccination (YFV), a live vaccine, is contraindicated in patients receiving immunosuppressive treatment due to the risk of developing the disease after vaccination. We report a case of a 50‐year‐old male recipient who presented wild‐type YF five years after a deceased donor kidney transplant. He lived in a YF endemic area and inadvertently received YFV. One day after YFV, the patient presented nausea, vomiting, fever, diarrhea, polyarthralgia, thrombocytopenia, and increased levels of liver function enzymes. The serological test was compatible with YF disease, and quantitative viral load confirmed the diagnosis of wild‐type YF. The patient received supportive care for twelve days, with hospital discharge in good clinical condition and stable renal function. One month after discharge, the patient developed de novo donor‐specific anti‐HLA antibodies (DSA) and histological evidence of endothelial lesion, with a diagnosis of acute antibody‐mediated rejection (AMR), treated with plasmapheresis and human IVIg therapy. Six months after therapy, he presented normal renal function with a reduction of DSA MFI. In the reported case, we observed a clinical wild‐type YF diagnosed even after YF vaccine administration, with good clinical outcome. De novo DSA and AMR occurred after the recovering of disease, with an adequate response to therapy and preserved allograft function. We reviewed the published literature on YF and YFV in solid organ transplantation.     

Diaphragm Muscle Surface Electromyography in Patients Submitted to Liver Transplant and Eligible for Extubation

Introduction

Liver disease induces many organic and metabolic changes, leading to malnutrition and weight and muscular function loss. Surface electromyography is an easily applicable, noninvasive study, through which the magnitudes of the peaks on the charts depict voluntary muscle activity.

Vascular complications in systemic sclerosis: a prospective cohort study

Clinical Rheumatology - Two major complications in scleroderma patients that cause substantial morbidity and mortality are ischemic digital lesions (DL) and pulmonary hypertension (PH). The...     

Vascular diaphragmatic hernia in a patient with cirrhosis first case report

We report the case of an adult patient recently diagnosed with cirrhosis. The ultrasound evaluation described a multinodular inhomogeneous liver, requiring a magnetic resonance imaging scan for further characterization. The performed magnetic resonance imaging examination confirmed the diagnosis of cirrhosis associated with portal hypertension and detected a vascular left transdiaphragmatic hernia. Although various types of diaphragmatic hernias have been described - congenital or acquired - to the best of our knowledge, this type of pathology has never been reported.     

Jugular venous thrombosis: MR imaging

Magnetic resonance (MR) imaging of jugular venous thrombosis was investigated in three patients who had symptoms suggestive of this condition; the diagnosis was later confirmed by computed tomography, by venography, and clinically. Bright intraluminal signal intensity was seen throughout the course of the affected jugular vein on MR images in all three patients, in sharp contrast to the lack of signal from the corresponding site in the uninvolved venous system. Temporal changes in signal intensity from the acute to subacute stage of thrombosis were evaluated for one patient. A relative increase in signal intensity for the subacute phase was believed to be related to a decrease in the T1 relaxation time. MR may be the imaging modality of choice in the investigation of venous thrombosis.     

Later Evaluation of Ischemia and Reperfusion by the Pringle Maneuver in Wistar Rats,Demonstrating That Hepatic Lesions Can Be Reversible

Objective

There has been much research on hepatic ischemia and reperfusion by means of short or longer interruption of the portal triad. The aim of this work was to evaluate the mitochondrial respiratory activity and liver histology at 2 different times after the Pringle maneuver.