A comparison of nutritional status in three time points of liver transplant

Patients undergoing liver transplantation (LT) often experience dietary restrictions that may influence their nutritional status. With the objective of comparing the status of liver transplant patients pre- versus in the early and late postoperative periods, a retrospective study evaluated 33 adults (63.6% men and 36.4% women) mean age 47 years for body mass index (BMI), current body weight/ideal body weight (%CBW/IBW), current body weight/usual body weight (%CBW/UBW), adequacy of tricipital skin fold (%TSF), generalized adipose reserve (%F), adequacy of mid-upper arm muscle circumference (%MMC), and serum albumin. The elapsed time between nutritional evaluation and LT was 446 days for the pre-LT group, 31 for the early post-LT group, and 244 for the late post-LT group; 30.3% were Child C and 63.6% B in the pre-LT phase. The median value to %TST in pre-LT, early LT, and late LT were 91.7%, 70.8%, and 78.0%, respectively. The analysis of mean value of %F was 25.9% in the pretransplant, 23.3% in early postoperative, and 25.3% in late postoperative stages %MMC was 85.5% for pretransplant patients, it was 86.6% in the early versus 89.9% in the late stages. While BMI was 24.9 kg/m(2) in the preoperative 22.9 kg/m(2) in early, and 24.2 kg/m(2) in late phases. Similarly, concerning %CBW/UBW the mean values were 96.2% in the preoperative group, 64.1% in early, and 101.9% in late groups. The %CBW/IBW mean values were 113.9% in the pre- versus 104.6% in the early and 111.2% in the late periods. The values of serum albumin and %CBW/UBW were statistically different for Child B,C as well as when the patients were not classified by the Child criteria. There was a deterioration in status from pretransplant period to early postoperative with improvement in the late period.     

Gonadotropin-releasing hormone agonist treatment before abdominal myomectomy: a controlled trial

OBJECTIVE: To ascertain whether adjuvant gonadotropin-releasing hormone (GnRH) agonist therapy decreases blood loss during abdominal myomectomy. DESIGN: Randomized controlled trial. SETTING: Academic reproductive surgery center. PATIENT(S): One hundred premenopausal women requiring first-line conservative surgery for symptomatic intramural or subserous fibroids. INTERVENTION(S): Eight weeks of treatment with depot triptorelin before myomectomy or immediate surgery. MAIN OUTCOME MEASURES: Intraoperative blood loss, operating time, degree of difficulty of the procedure, and short-term rate of fibroid recurrence. RESULT(S): Mean (+/-SD) intraoperative blood loss was 265 +/- 181 mL in triptorelin recipients and 296 +/- 204 in patients who had immediate surgery (mean difference, -31 mL [95% CI, -108 to 46 mL]). No significant differences were observed in blood loss according to uterine volume, number of fibroids removed, or total length of myometrial incisions. Most procedures in either group were of routine difficulty. On ultrasonography 6 months after myomectomy, four women in the GnRH agonist group and one in the immediate surgery group had tumor recurrence. CONCLUSION(S): Treatment with a GnRH agonist before abdominal myomectomy has no significant effect on intraoperative blood loss. Thus, systematic use of medical therapy before abdominal myomectomy does not seem to be justified.     

Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study

OBJECTIVE: To determine whether the frequency and severity of dysmenorrhea are reduced in women with symptomatic endometriosis in whom a levonorgestrel-releasing intrauterine device (Lng-IUD) is inserted after operative laparoscopy compared with those treated with surgery only. DESIGN: Open-label, parallel-group, randomized, controlled trial. SETTING: A tertiary care and referral center for patients with endometriosis. PATIENTS(S): Parous women with moderate or severe dysmenorrhea undergoing first-line operative laparoscopy for symptomatic endometriosis. INTERVENTION(S): Randomization to immediate Lng-IUD insertion or expectant management after laparoscopic treatment of endometriotic lesions.Proportions of women with recurrence of moderate or severe dysmenorrhea in the two study groups 1 year after surgery and overall degree of satisfaction with treatment.Moderate or severe dysmenorrhea recurred in 2 of 20 (10%) subjects in the postoperative Lng-IUD group and 9/20 (45%) in the surgery-only group. Thus, a medicated device inserted postoperatively will prevent the recurrence of moderate or severe dysmenorrhea in one out of three patients 1 year after surgery. A total of 15/20 (75%) women in the Lng-IUD group and 10/20 (50%) in the expectant management group were satisfied or very satisfied with the treatment received. CONCLUSION(S): Insertion of an Lng-IUD after laparoscopic surgery for symptomatic endometriosis significantly reduced the medium-term risk of recurrence of moderate or severe dysmenorrhea.     

Sequential Liver-Kidney Transplantation for Recurrent Liver Cysts Infection in a Patient With Autosomal Dominant Polycystic Kidney Disease: A Case Report

Autosomal dominant polycystic kidney disease (ADPKD) is the most prevalent hereditary kidney disorder. Liver cysts are the most common extrarenal manifestation of the disease and usually remain asymptomatic. Liver cyst infection is rare, and its treatment is challenging. Liver transplantation (LT) is the only curative therapeutic option in symptomatic polycystic liver disease associated with ADPKD. Only a few cases of LT for recurrent liver cyst infection have been published. To our knowledge, we report the first case of sequential liver-kidney transplantation for recurrent liver cysts infection in a patient with ADPKD. A 55-year-old woman with ADPKD who had a kidney transplantation (KT) presented with multiple liver cysts infection 9 months after her KT. These episodes started after biliary tract complications due to an ampullary adenoma necessitating multiple endoscopic interventions. Her general status gradually degraded because antibiotic treatment was not effective, and she underwent LT for recurrent liver cysts infection 1 year and 9 months after her KT. LT in this setting turned out to be challenging but was possible. We think that better biliary tract workup before KT may prompt better care in these patients.     

Association of optical cataract indices with cataract severity and visual function

International Ophthalmology - The purpose of this study is to determine the correlation between subjective and optical measurements used during cataract evaluation, including the iTrace...     

Prevalence and risk factors of musculoskeletal symptoms among dental students and dental practitioners in Riyadh City,Saudi Arabia

This study assessed the nature, prevalence, and risk factors of musculoskeletal symptoms (MS) in dental clinics. A self-administered questionnaire was completed by 515 dental students and dentists about nature of work and prevalence and frequency of MS symptoms. Chi-square and logistic regression were used to determine the association of MS with a number of important variables. Pain in the lower back (64%) and neck (60%) were the most prevalent MS. Working in the dental colleges' clinics was associated with increased risk of MS (adjusted OR 2.30, 95% CI [1.27, 4.18]). A stronger association was observed for dentists working in the private clinics (adjusted OR 2.58, 95% CI [1.28, 5.17]). Female dentists were at more risk of MS than male participants (OR 1.63, 95% CI [1.02, 2.59]). The higher risk of reported MS symptoms in women and for those working in the dental colleges and private clinics underscores the importance of recognition and prevention of MS symptoms even early in the dental profession.     

Gadolinium-induced nephrogenic systemic fibrosis: the rise and fall of an iatrogenic disease

BACKGROUND.: In 2006, nephrologists in Denmark unexpectedly identified chronic kidney disease (CKD) patients with a new syndrome, nephrogenic systemic fibrosis (NSF). Subsequently, 1603 NSF patients were reported to the Food and Drug Administration. Sixty hospitals in the USA account for 93% of these cases, and two hospitals in Denmark account for 4% of these reports. We review Denmark's identification and subsequent rapid eradication of NSF. METHODS.: NSF reports from clinicians, the Danish Medicines Agency (DMA) and gadolinium-based contrast agents (GBCAs) manufacturers were reviewed (2002-11). RESULTS.: In 1994, the DMA approved a non-ionic linear GBCA, gadodiamide (0.1 mmol/kg), for magnetic resonance imagings (MRIs), with a renal insufficiency contraindication. In 1996, 0.3 mmol/kg dosing received DMA approval. In 1998, the DMA removed renal contraindications. In 1997 and 2002, radiologists at Skejby Hospital and Herlev Hospital, respectively, began performing gadodiamide-enhanced magnetic resonance angiography scans (0.3 mmol/kg) of CKD patients. In 2005, Herlev clinicians requested assistance in evaluating etiological causes of NSF occurring among 10 CKD patients who had developed NSF. This investigation, focusing on infectious agents, was inconclusive. In 2006, Herlev clinicians reported that of 108 CKD patients who had received gadodiamide-enhanced MRI, 20 had developed probable NSF. Herlev radiologists voluntarily discontinued administering gadodiamide to all patients and no new NSF cases at Herlev Hospital developed subsequently. After meeting with Herlev radiologists, Skejby radiologists also discontinued administering gadodiamide to all patients. In 2007, the European Medicines Agency and the DMA contraindicated gadodiamide administration to CKD patients. In 2008, in response to these advisories, radiologists at the other 36 Danish hospitals discontinued administering gadodiamide to all patients, following on practices adopted at Skejby and Herlev Hospitals. In 2009, clinicians at Skejby Hospital reported that a look-back survey identified 33 CKD patients with NSF developing after undergoing GBCA-enhanced MRIs between 1999 and 2007. In 2010, an independent review, commissioned by the Minister of Health, concluded that the DMA had erred in rescinding gadodiamide's renal insufficiency contraindication in 1998 and that this error was a key factor in the development of NSF in Denmark. In 2011, three NSF cases associated with macrocyclic GBCA-associated NSF and three NSF patients with Stages 3 and 4 CKD disease from Skejby Hospital were reported. CONCLUSION.: A confluence of factors led to the development and eradication of NSF in Denmark.