Advances in pancreas transplantation

The potential to reverse diabetes has to be balanced against the morbidity of long-term immunosuppression associated with transplantation. For a patient with renal failure, the treatment of choice is often a simultaneous transplant of the pancreas and kidney or pancreas after kidney. For a patient with glycaemic instability, choices between a solid organ or islet transplant have to be weighed against benefits and risks of remaining on insulin. Results of simultaneous transplant of the pancreas and kidney transplantation are comparable to other solid-organ transplants, and there is evidence of improved quality of life and life expectancy. There is some evidence of benefit with respect to the progression of secondary diabetic complications in patients with functioning transplants for several years.     

Irreversible Electroporation for Focal Ablation at the Porta Hepatis

Patients with chemotherapy-refractory liver metastases who are not candidates for surgery may be treated with focal ablation techniques with established survival benefits. Irreversible electroporation is the newest of these and has the putative advantages of a nonthermal action, preventing damage to adjacent biliary structures and bowel. This report describes the use of irreversible electroporation in a 61-year-old man with a solitary chemoresistant liver metastasis unsuitable for radiofrequency ablation as a result of its proximity to the porta hepatis. At 3?months, tumor size was decreased on computed tomography from 28?×?19 to 20?×?17?mm, representing stable disease according to the response evaluation criteria in solid tumors. This corresponded to a decrease in tumor volume size from 5.25 to 3.16?cm³. There were no early or late complications. Chemoresistant liver metastases in the proximity of the porta hepatis that are considered to be too high a risk for conventional surgery or thermal ablation may be considered for treatment by the novel ablation technique of irreversible electroporation.     

Symptoms and health complaints and their association with perceived stress: students from seven universities in England, Wales and Northern Ireland

Aim

This research assessed the relationships between perceived stress and a range of self-reported symptoms and health complaints in a representative sample of students across UK universities.

Subjects and methods

The data comprised 3,706 students and was collected between 2007 and 2008 simultaneously at seven universities in three countries of the UK: England, Wales, and Republic of Northern Ireland. A self-administered questionnaire measured health complaints (22 symptoms) and Cohen’s Perceived Stress Scale. Sociodemographic and lifestyle data were also collected. Factor analysis developed four groups of health complaints: psychological, circulatory/breathing, gastro intestinal, and pains/aches.

Results

The symptoms most often reported as having occurred sometimes/very often in the last 12 months were fatigue (61.0 %), headache (59.5 %) and difficulties to concentrate (54.4 %), while back (43.3 %) and neck/shoulder pain (39.4 %) were also frequent. Multinominal logistic regression revealed a clear association and a linear trend between increasing level of stress and a higher frequency of psychological symptoms which remained significant after adjustment for many other factors. For circulatory/breathing symptoms and for pains/aches, associations with perceived stress were only significant at higher perceived stress levels. There was no association between perceived stress and gastrointestinal symptoms. For most symptoms, poor health was consistently associated with higher frequency of symptoms across all four symptom groups. Similarly, better quality of life was associated with lower frequency of psychological and circulatory/breathing symptoms, but not for the other two symptom groups.

Conclusions

The different profiles of reported complaints and their association with perceived stress, poor health and low quality of life should give rise to tailored interventions in this young population.     

Changes in shoulder muscle size and activity following treatment for breast cancer

Background Morbidity of the shoulder after breast cancer is a well-known phenomenon. MRI studies have shown muscle morbidity in cervical cancer and prostate cancer. In breast cancer clinical observations and patient reports include muscle morbidity in a number of muscles acting at the shoulder. Several of these muscles lie in the field of surgery and radiotherapy. Timed interaction between muscles that stabilise the shoulder and those acting as prime movers is essential to achieve a smooth scapulohumeral rthythm during functional elevation of the arm. Method: Cross-sectional study Seventy-four women treated for unilateral carcinoma of the breast were included in the study. All patients filled out the Shoulder Pain and Disability Index (SPADI). EMG activity of four muscles was recorded during scaption on the affected and unaffected side. Muscle cross sectional area and signal intensity was determined from MRI scans. The association between EMG and covariates was determined using multiple linear regression techniques. Results Three of the 4 muscles on the affected side demonstrated significantly less EMG activity, particularly when lowering the arm. Upper trapezius demonstrated the greatest loss in activity. Decreased activity in both upper trapezius and rhomboid were significantly associated with an increase in SPADI score and increased time since surgery. Pectoralis major and minor were significantly smaller on the affected side. Conclusion Muscles affected in the long term are the muscles associated with pain and disability yet are not in the direct field of surgery or radiotherapy. Primary muscle shortening and secondary loss of muscle activity may be producing a movement disorder similar to the ‘Dropped Shoulder Syndrome’. Exercise programmes should aim not only for range of movement but also for posture correction and education of potential long-term effects.     

The requirement for a disease-specific patient-reported outcome measure of dysphagia in oculopharyngeal muscular dystrophy

Introduction: There is no patient-reported outcome (PRO) questionnaire specifically designed to assess oropharyngeal dysphagia in oculopharyngeal muscular dystrophy (OPMD). To select a suitable questionnaire, content validity of the existing questionnaires must be assessed. This study sought (1) to identify dysphagia-related symptoms in OPMD and (2) to assess content validity of currently available PRO for the assessment of dysphagia severity in OPMD. Methods: A two-step literature review was conducted of dysphagia-related symptom identification and oropharyngeal dysphagia-related PRO. Symptoms were validated with an expert panel by using a Delphi survey. Content validity of PRO questionnaires was documented through content analysis. Results: Ten PRO questionnaires were identified. None of the questionnaires cover the entire symptom spectrum in OPMD and thus lack content validity. Discussion: The development and validation of a new PRO questionnaire to assess dysphagia in OPMD is required to establish the importance of symptomatic relief from new treatments. Muscle Nerve 59:445–450, 2019     

Three-dimensional scapulothoracic motion following treatment for breast cancer

Varying levels of shoulder morbidity following treatment for breast cancer have been reported. Patients report pain, weakness, tightness and reduced functional capacity. Normal painfree motion of the arm and shoulder requires mobility in the scapulothoracic, glenohumeral, acromioclavicular and sternoclavicular joints. Under healthy conditions elevation of the arm is accompanied by scapula retraction, lateral rotation and posterior tilt. However, when scapulothoracic motion is disproportionate to glenohumeral motion, the potential exists for microtrauma and long term pain. A number of studies on women treated for breast cancer have shown limitations in glenohumeral range of movement and a recent report from our laboratory has shown decreased muscle activity in four key muscles acting on the scapula. However, no study has measured the effect of treatment on three-dimensional (3-D) scapulothoracic motion in relation to glenohumeral motion. 152 women treated for unilateral carcinoma of the breast were included in the study. All patients filled out the Shoulder Pain and Disability Index (SPADI). 3-D—kinematic data for the humerus and scapula was recorded during scaption on the affected and unaffected side. The association between kinematic data, SPADI and covariates was determined using random effects multiple regression techniques. All scapula kinematic parameters were significantly altered on the side of the carcinoma in breast cancer survivors. Both reported levels of pain and dysfunction were associated with altered kinematics. High levels of pain and disability were reported for up to 6 years post surgery. Patients with the left side affected reported higher levels of pain and demonstrated more significant scapulathoracic dysfunction independent of dominance. Altered movement patterns were different for left versus right side affected. Left side affected patients need to be considered as a group of patients at risk of experiencing higher levels of pain and showing greater shoulder dysfunction. Whether cause or effect, pain reports are accompanied by 3-dimensional scapula dysfunction which mimics that of many other shoulder conditions.     

Hepatitis C virus and peripheral neurological complications in Egyptian patients

Background and study aimsNeurological complications in HCV-infected patients occur predominantly in the peripheral nervous system. Vasculitic neuropathy is the most firmly linked neurologic illness associated with HCV infection. This type of neuropathy occurs frequently in the presence of cryoglobulinemia. HCV-related cranial neuropathies have been also reported. This study was conducted to investigate the various peripheral neurological complications of chronic hepatitis C infection and their possible pathogenetic mechanisms.Patients and methodsThis study was conducted on 160 patients with chronic hepatitis C infection comprised two subgroups: group I, composed of 80 chronic hepatitis C patients with clinically apparent neurological complication(s), and group II, composed of 80 chronic hepatitis C patients neurologically asymptomatic. Patients were subjected to clinical evaluation, estimation of hepatitis markers, cryoglobulins, anticardiolipin antibodies, antinuclear antibodies and nerve conduction studies.ResultsPeripheral neuropathies represented the most commonly encountered neurological disorders, occurring in 25 patients (31.25%). The sensory peripheral neuropathy was the most common type, representing 32% of neuropathic patients (8/25). A statistically significant difference was found between groups I and II regarding the presence of cryoglobulin and anticardiolipin antibody, being more common in group I. Antinuclear antibody was more common in group I than in group II. Results of nerve conduction studies showed nerves were more affected in group I and in cryoglobulin and ANA positive patients.ConclusionPeripheral neuropathies represent the most common HCV-related peripheral neurological disorders especially when associated with cryoglobulins and ANA antibodies.