Water conservation: an emerging but vital issue in hemodialysis therapy

Water conservation refers to reducing the usage of water and recycling of wastewater for different purposes such as irrigation, laundry and sanitation. As water scarcity increases worldwide, dialysis facilities should be focused on salvaging water. However, most of them still ignorantly discard to the sewer huge volumes of this reusable resource. This article reviews the current water conservation techniques in hemodialysis and the potential benefits drawn when using this technology.     

Venous glucose and arterial lactate as biochemical predictors of mortality in clinically severely injured trauma patients—A comparison with ISS and TRISS

Background

Early assessment of injury severity is important in trauma. Trauma scores are calculated after the fact and are useful for audit and research, but not in the emergency clinical setting. Glucose metabolism is altered in trauma, and we hypothesised that alterations in glucose and lactate levels would be an early predictor of mortality.

Methods

Review of trauma registry data identified 1197 patients between May 2000 and September 2006 who had a trauma-team call out. Data collected included trauma scores, venous glucose (gluc), and arterial lactate (lact) on arrival. The predictive value of these variables was compared by ROC curves.

Results

The mortality rate for patients with gluc >11.0 mmol/L was 13.4% compared to 1.8% in those with gluc ≤11.0 mmol/L (p < 0.0001). Gluc had a specificity of 93.2% and a sensitivity of 37.9% for death. 13.0% of patients with lact >2.0 mmol/L died, versus 2.7% with lact ≤2.0 mmol/L, (p 0.0003, specificity 56.8% and sensitivity 81.0%). Glucose was the better biochemical predictor of mortality compared to lactate (ROC area 0.845 and 0.716, respectively). The TRISS (trauma and injury severity score) was a very accurate predictor (ROC 0.963), whereas the ISS (injury severity score) significantly less so (ROC 0.854). There was a significant correlation between gluc, ISS, and TRISS (p 0.01), as well as lactate and ISS (p 0.01).

Conclusion

Glucose and lactate can predict mortality in severe trauma. The predictive value of glucose is comparable to that of ISS, and can be more easily employed in the clinical setting.     

The radial forearm free flap: a review of microsurgical options

The radial forearm free flap, highly regarded in head and neck reconstructive surgery, is known to be one of the most reliable and versatile flaps. The microsurgery is usually easy to perform due to large vessels and a long pedicle; the double superficial and deep venous networks allow many microsurgical options. The sensory nerve coaptation, still debated for weight-bearing foot reconstruction and its sensory restoration, has recently undergone technical refinements. The authors review the microsurgical options for microvascular anastomosis and for sensory restoration.     

Interferon therapy for chronic hepatitis B

This article summarizes the results obtained with interferon alfa and pegylated interferon alfa, as monotherapy and in combination with lamivudine, in the treatment of chronic hepatitis B.     

Preoperative maximal exercise oxygen consumption test predicts postoperative pulmonary morbidity following major lung resection

BACKGROUND AND OBJECTIVE: Pulmonary resection carries a significant morbidity and mortality. The utility of maximal oxygen uptake test (VO(2)max) to predict cardiopulmonary complications following major pulmonary resection was evaluated. METHODS: Following standard preoperative work-up and VO(2)max testing, 55 patients (49 male; mean age 59 years, range 20-74) underwent major pulmonary surgery: lobectomy (n = 31), bilobectomy (n = 6) and pneumonectomy (n = 18). An investigator blinded to the preoperative assessment prospectively collected data on postoperative cardiopulmonary complications. Patients were divided into two groups according to preoperative VO(2)max and also according to FEV(1). The frequency of postoperative complications in the groups was compared. RESULTS: Complications were observed in 19 (34.5%) patients, 11 of which were pulmonary (20%). There were two deaths (3.6%), both due to respiratory failure. Preoperative FEV(1) failed to predict postoperative respiratory complications. Five of 36 patients with a preoperative FEV(1) > 2 L suffered pulmonary complications, compared with six of 19 patients with FEV(1) < 2 L. Cardiopulmonary complications were not observed in patients with VO(2)max > 15 mL/kg/min (n = 27); however, 11 patients with VO(2)max < 15 mL/kg/min (n = 28) suffered cardiopulmonary complications (P < 0.05). CONCLUSION: VO(2)max predicts postoperative pulmonary complications following major lung resection, and the risk of complications increases significantly when the preoperative VO(2)max is less than 15 mL/kg/min.     

Liver fibrosis in women with chronic hepatitis C: evidence for the negative role of the menopause and steatosis and the potential benefit of hormone replacement therapy

BACKGROUND AND AIMS: The rates of fibrosis progression in chronic hepatitis C are significantly different between males and females. The antifibrogenic effect of oestrogen has been proposed, possibly via inhibition of stellate cells. The aim of this study was to evaluate the severity of chronic hepatitis C in women, in relation to the menopause, steatosis and hormone replacement therapy (HRT). METHODS: From November 2003 to October 2004, women with chronic hepatitis C were enrolled prospectively. A questionnaire was completed prospectively and a blood sample was obtained on the day of biopsy. We identified characteristics associated with moderate/severe fibrosis using univariate and multivariate analysis. RESULTS: 251 women were included in the study. 122 women (52%) were menopausal and 65 were receiving HRT. 61 (24%) women with moderate/severe fibrosis (F2-F4, Metavir score) had a longer known duration of infection (>15 years), a higher body mass index and presented with steatosis more frequently than 190 (76%) women with mild fibrosis (F0-F1). Women with F2-F4 were more often menopausal (67% v 47%). The probability of fibrosis F2-F4 was lower for menopausal women receiving HRT (p = 0.012). Steatosis was more frequent and more severe in menopausal women. CONCLUSIONS: Severity of fibrosis was associated with a longer duration of infection (>15 years), a higher body mass index, advanced steatosis and the menopause. Menopausal women receiving HRT presented with a lower stage fibrosis. These results reinforce the hypothesis of a protective role of oestrogens in the progression of fibrosis. Steatosis may be implicated in the progression of fibrosis after the menopause.     

Genetics, genomics, and proteomics: implications for the diagnosis and the treatment of chronic hepatitis C

Hepatitis C virus (HCV) is a major cause of chronic liver disease worldwide. The severity of disease varies widely from mild illness to cirrhosis and hepatocellular carcinoma. The progression of liver fibrosis in HCV patients determines the prognosis and, thus, the need for and urgency of therapy. In addition to viral and environmental behavioral factors, host genetic diversity is believed to contribute to the spectrum of clinical outcomes of patients chronically infected with HCV. The sequencing of the human genome together with the development of high-throughput technologies has provided opportunities to distinguish discrete subsets of HCV disease and predict the disease outcome or the response to therapy. This article reviews genetic, genomic, and proteomic aspects associated with the natural history of HCV infection (i.e., viral clearance, fibrosis progression) and the response to therapy.     

The healing potential in cauda equina syndrome secondary to traumatic posterior L5-S1 dislocation. A case report with 16 years follow-up

Cauda equina syndrome is the result of any lesion that compresses or paralyzes cauda equina roots which are both motor and sensory. It is an uncommon syndrome, which features low back pain, sciatica, variable lower extremity motor and sensory loss with possible bladder and bowel dysfunction. It is an emergency situation as it may cause significant morbidity such as permanent paralysis, impaired bladder and/or bowel control or loss of sexual sensation. We present the case of a patient who was admitted to the emergency department with a traumatic posterior L5-S1 dislocation, low back pain and bladder dysfunction 8 days following an initial trauma. Open L5-S1 reduction and posterior stabilization was performed and the dural sac was decompressed. Most of the patient's neurological deficits resolved over several years, following the initial surgery.