The role of spontaneous portosystemic shunts in the course of orthotopic liver transplantation

Spontaneous portosystemic shunts are commonly found in cirrhotic patients. Not yet established is their role after orthotopic liver transplantation (OLTx), especially when an increase in portal pressure develops, as during early acute rejection. In this study, 34 cirrhotic patients in a series of 70 OLTx are considered. Each patient had preoperative angiographic assessment, and, in 21 (62%), large spontaneous portosystemic shunts were evident. In 12 cases the shunts were not affected by the surgical procedure and were present during the postoperative period; in 9 the hepatectomy itself involved interruption of the shunts. The patient population was divided into two groups: patients with postoperative shunts (n=12) and those without (n=22). The two groups were similar in age, sex, Child's stage, transplantation variables, and number and grade of rejection episodes. However, mean transaminases (AST) values in the first 2 weeks were significantly higher levels in shunt versus nonshunt patients (421±335 vs 183±126; P<0.025), and this was even more evident when rejection occurred (626±375 vs 195±129; P<0.001). Furthermore, during an acute rejection reaction, three cases showed a true steal phenomenon through the large reopened shunts with ischemic damage to the grafts. The data indicate a possible detrimental effect of the spontaneous shunts on graft perfusion and suggest the prophylactic surgical interruption of the residual shunts during the transplantation.     

中国南海粗疣棘柳珊瑚中倍半萜成分研究

目的：对采自中国南海的粗疣棘柳珊瑚(Acanthogorgia vagae)的化学成分进行研究，从中寻找有生物活性的次生代谢产物。方法：用硅胶柱层析对粗疣棘柳珊瑚的乙醚提取物进行分离纯化；根据其化学性质，结合现代波谱技术(MS，NMR等)，对得到的化合物进行结构鉴定。结果：分离得到4个呋喃倍半萜化合物，其结构分别鉴定为1indenene(1)，1indestrene(2)，bebryazulene(3)及franodiene(4)。结论：本文系首次对该珊瑚化学成分进行研究；4个倍半萜成分亦均为首次从该生物中分离得到。其中，1indenene(1)的碳谱数据为首次报道，并首次对化合物1indenene(1)及franodiene(4)氢谱数据进行了全归属。另外，对文献报道的bebryazulene(3)及franodiene(4)的碳谱数据进行了童新归属.     

Cancer Patterns in the Middle East Special Report from the Middle East Cancer Society

To update its cancer statistics, the newly established Middle East Cancer Society examined the cancer frequency patterns in Egypt and the Gaza Strip. The results revealed differing overall patterns. For men the highest frequencies were found for lymphoma, bladder cancer and cancers of the oral cavity and pharynx in Egypt, and for lung cancer, leukaemia and lymphoma in Gaza. For women, breast cancer had the highest frequency in both areas, followed by cancers of the oral cavity and pharynx in Egypt, and leukaemia and lymphoma in Gaza. The distribution of cancer occurrence by organ system also varied. In the light of the different ethnicities, lifestyles, socioeconomic levels and carcinogenic exposure among the countries of the Middle East, this kind of comparison can provide the background for more sophisticated approaches for discerning risk factors in cancer. We believe that further cooperation among participating countries will overcome the present limitations in data collection, registration and access.     

Multicore myopathy: respiratory failure and paraspinal muscle contractures are important complications

Three ambulant males with multicore myopathy, a rare congenital myopathy, are reported with nocturnal hypoventilation progressing to respiratory failure at the age of 9, 13, and 21 years. Deterioration in these individuals occurred over several months without any precipitating event. Patients had clinical evidence of nocturnal hypoventilation with hypoxaemia and hypercapnia. Forced vital capacity was significantly reduced (20 to 43% of predicted level). These parameters improved on institution of overnight ventilation using a BiPAP pressure support ventilator with face mask or nasal pillows with O2 saturation maintained above 90% overnight and an increase in forced vital capacity by as much as 100% (0.3 to 0.6 litres). This was matched by a symptomatic and functional improvement. Also present in these patients and not previously reported is the association of multicore myopathy with paraspinal contractures which produce a characteristic scoliosis described as a 'side-sliding' spine. This may be improved by spinal bracing or surgery.     

Dual Pathology in a Patient with Right Lower Quadrant Pain

Meckel diverticula are remnants of the omphalomesenteric duct. They have 2% incidence in the general population, are usually asymptomatic, and tend to be diagnosed incidentally. The generally held principle had been that asymptomatic cases do not require resection, as exemplified by a 2008 systematic review of over 200 studies. However, a recent series reported an increased risk of malignancies, and recommended mandatory resection. We present a case of Meckel diverticulitis with concurrent infiltrative appendiceal carcinoid in a patient with right lower quadrant pain.     

Bacteremia in the Spinal Cord Injury Population

Abstract

Positive blood cultures were found in 41 patients on the Spinal Cord Injury Service at the Milwaukee VAMC during the period of July, 1980 to December, 1985 giving an incidence of bacteremia of 1.3%. Mortality rate was 17%. Most common pathogens were E. Coli, Proteus mirabilis, Serratia marcescens and Staphylococcus aureus. A review of 29 available charts revealed genitourinary and respiratory tracts as the most common sources of infection (72.4% and 10.3% respectively). Other sources of infection were skin, postoperative, intravenous catheter site and cellulitis. Initial febrile response was seen in 93.1% of patients with 48.1% having temperature greater than 38.3°C. Hypotension (blood pressure less than 90/50 mm Hg) was noted in five out of the 29 (17.1%) patients. Clinical diagnosis of disseminated intravascular coagulation was made in two out of the 29 (6.9%) patients. Underlying risk factors were poor nutrition, respirator dependency, indwelling Foley catheters and manipulative procedures. Incidence and mortality rates are similar to the non-SCI population as reported elsewhere. The risk factors are different; therefore preventive management is extremely important.     

One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies

One-stage and two-stage revision strategies are the two main options for treating established chronic peri-prosthetic joint infection (PJI) of the hip; however, there is uncertainty regarding which is the best treatment option. We aimed to compare the risk of re-infection between the two revision strategies using pooled individual participant data (IPD). Observational cohort studies with PJI of the hip treated exclusively by one- or two-stage revision and reporting re-infection outcomes were retrieved by searching MEDLINE, EMBASE, Web of Science, The Cochrane Library, and the WHO International Clinical Trials Registry Platform; as well as email contact with investigators. We analysed IPD of 1856 participants with PJI of the hip from 44 cohorts across four continents. The primary outcome was re-infection (recurrence of infection by the same organism(s) and/or re-infection with a new organism(s)). Hazard ratios (HRs) for re-infection were calculated using Cox proportional frailty hazards models. After a median follow-up of 3.7 years, 222 re-infections were recorded. Re-infection rates per 1000 person-years of follow-up were 16.8 (95% CI 13.6–20.7) and 32.3 (95% CI 27.3–38.3) for one-stage and two-stage strategies respectively. The age- and sex-adjusted HR of re-infection for two-stage revision was 1.70 (0.58–5.00) when compared with one-stage revision. The association remained consistently absent after further adjustment for potential confounders. The HRs did not vary importantly in clinically relevant subgroups. Analysis of pooled individual patient data suggest that a one-stage revision strategy may be as effective as a two-stage revision strategy in treating PJI of the hip.