Improvement of acute and chronic renal dysfunction in liver transplant patients after substitution of calcineurin inhibitors by mycophenolate mofetil

BACKGROUND: Renal dysfunction caused by treatment with the calcineurin inhibitors (CNI) is a major problem in the long-term course after liver transplantation. PATIENTS: In 22 liver graft recipients with renal dysfunction and stable graft function between 3 weeks and 12 years after transplantation, CNI were substituted by MMF at a final dose of 1.5-3 g/day between October 1996 and October 1998. METHODS: In a prospective non-randomized study, the development of renal function, the side effects of MMF medication, and the stability of liver function were analyzed for a mean follow-up of 15 months. Results. (1) MMF was withdrawn in four patients for major side effects between 1 and 7 months after study entry; eight patients had minor side effects. (2) Six months after study entry, renal function had improved in 17 of the 22 study patients; mean serum creatinine +/-SD (micromol/L) was 201+/-77 at entry and 153+/-65 after 3 months (P<0.001). (3) Improvement occurred in 11 of 15 patients with creatinine elevation > or =12 months and in 6 of 6 patients with creatinine elevation < or =6 months. (4) One patient developed transient liver dysfunction and a second required retransplantation for progressive cholestasis but without signs of rejection. CONCLUSIONS: In patients who undergo liver transplantation, substitution of CNI by MMF leads to improvement of acute as well as chronic renal dysfunction in most cases. Side effects of MMF may be limiting in some patients, and the immunological consequences remain to be studied.     

Effects of alcohol dependence on shock-induced fighting: action of muscimol and homotaurine.

We have applied the electroshock-induced fighting behavior to the study of experimental alcohol dependence. Adult Wistar rats were intoxicated chronically with ethanol (10 g/kg/24 h) for 13 days. Electroshock-induced fighting behavior was studied during chronic intoxication and withdrawal in comparison with normal rats receiving a water-carbohydrate solution isocaloric to ethanol. Rats were divided into groups receiving respectively muscimol (0.25 mg/kg), a GABAA agonist; homotaurine (140 mg/kg) a GABA mimetic; and physiological saline (10 ml/kg), intraperitoneally. During chronic intoxication, rats showed an increase in defensive-fighting behavior. Withdrawal accentuated the aggressive behavior and muscimol and homotaurine inhibited it. These results confirm the relevance of the electroshock-induced defensive fighting behavior test in chronic intoxication with alcohol, but to show the involvement of GABAergic transmission in the behavioral effects of alcohol withdrawal, additional experiments with other GABA mimetics and with GABA antagonists should be considered.     

Noise sources and levels in the evgenidion hospital intensive care unit

Noise sources and levels were evaluated in a six-bed intensive care unit (ICU) in Athens, Greece. Ten patients (six males, four females) completed specifically designed questionnaires, and at the same time nine 8-h sound measuring sessions took place. A Bruel and Kjaer 2231 sound-meter was used on the decibel-A scale combined with observation. Human activity, operating equipment and construction engineering of the hospital building were identified as sources of noise. Noise levels were elevated [LEQ = 60.3–67.4 dB(A)]. No reliable information was obtained from the questionnaires. ICU noise levels were higher by 27 dB(A) than recommended hospitals levels. To counteract noise pollution in ICUs, staff awareness and sensitivity are needed. Received: 6 November 1997 Accepted: 15 May 1998     

Living-donor liver transplantation: impact on donor's health-related quality of life

Objective

The aim of this study was to evaluate the health-related quality of life of living liver donors after living-donor liver transplantation (LDLT).

Methods

Health-related quality of life (HRQOL) in 55 living liver donors operated on at our center between 2002 and 2009 was assessed using the German Version of the 36-Item Health Survey (SF-36).

Results

Donors after full right-lobe hepatectomy (n = 18) scored similarly to and without statistically significant difference from the German reference population, whereas donors after left lateral segmentectomy (n = 37) revealed statistically significant higher average score values (P < .005) in the categories of physical functioning, bodily pain, and general health compared with the German reference population. In the analysis between donors after full right-lobe hepatectomy and donors after left lateral segmentectomy no statistically significant difference was observed in any of the SF-36 categories. Postoperative complications of the donors and postoperative recipient mortality were particularly revealing regarding HRQOL. Donors who developed postoperative complications presented a lower HRQOL, especially in the categories of role physical, bodily pain, and social functioning, where statistically significant differences (P < .005) were observed. Similarly, postoperative recipient mortality correlated with lower mean score values in all SF-36 categories, but a statistically significant difference (P < .005) was reached only in the categories of role emotional and mental health.

Conclusions

Donors did not regret their decision to donate, because HRQOL was not negatively affected by the donation procedure. Living liver donors scored as well as or even better than the German reference population, but it was clearly shown that the development of postoperative donor complications and the postoperative recipient mortality had a negative effect on the HRQOL of donors.     

Identification of the resection severity index as a significant independent prognostic factor for early mortality and observed survival >5 and >10 years after liver resection for hepatocellular carcinoma

Background and objectives

This study evaluates predictive factors for observed long-term survival of more than 5 and 10 years for patients after liver resection for hepatocellular carcinoma and compares their life expectancy to the normal national population matched for sex, year of birth and age at resection.

Salvage chemotherapy with docetaxel and pegylated liposomal doxorubicin in pretreated patients with platinum- and taxane-sensitive ovarian cancer: a multicenter phase II trial of the Hellenic Oncology Research Group (HORG)

Purpose

To evaluate the safety and antitumor activity of docetaxel (DOC) and pegylated liposomal doxorubicin (PLD) combination in patients with platinum- and taxane-sensitive ovarian cancer.

Patients and methods

Twenty-three patients were enrolled. DOC was administered at the dose of 40 mg/m² intravenously (i.v.) and PLD at 20 mg/m² i.v. on days 1 and 15 in cycles of 28 days. The study was closed prematurely due to slow accrual.

Results

Seven (30.4 %) patients achieved objective response (three complete, four partial), while five (21.7 %) others experienced stable disease (overall disease control rate 52.1 %). The median progression-free survival was 4.8 months and the median overall survival 18.8 months. Grade 3–4 neutropenia occurred in two (8.7 %) and one (4.3 %) patients, respectively. Febrile neutropenia occurred in two patients. The most common non-hematological grade 3 toxicity was hand-foot syndrome (13 % of patients). There was no treatment-related death.

Conclusions

The combination of pegylated liposomal doxorubicin and docetaxel is a well tolerated and a relatively active regimen in pretreated patients with platinum- and taxane-sensitive advanced ovarian cancer.     

Follow-up study results of Bassini-Kirschner inguinal hernia operations

During a 7-year period 686 adult male patients underwent Bassini-Kirschner operations for inguinal hernia. All patients received prophylactic physical therapy preoperatively, they were given elastic stockings and low-dose heparin therapy and all were ambulated on the first postoperative day. We used Mersilene for all sutures in 179 patients, Mersilene for the Bassini sutures and Dexon for the Kirschner sutures in 215 patients, sole Dexon sutures in 292 patients. Early and late complications occurred most frequently with nonresorbable (Mersilene) materials, less frequently with Dexon. We encountered recurrent inguinal hernias in 23 patients (4,7%). Review of relevant references indicates a recurrence rate of 2,6 to 14,8% with other methods.     

Agreement among three examiners of colour Doppler imaging retrobulbar blood flow velocity measurements

Purpose: To assess the agreement among three masked examiners on central retinal artery (CRA) and ophthalmic artery (OA) blood flow velocity measurements performed with colour Doppler imaging (CDI) in healthy volunteers. Methods: The study included 30 eyes of 15 healthy volunteers. Prior to the study, all examiners underwent intensive CDI training by an expert to facilitate uniformity in performing measurements according to a specific protocol. Following the eligibility visit, three masked examiners performed CDI measurements assessing the CRA and OA in both eyes of all subjects. All CDI images were analysed by a masked grader. Intraclass correlation coefficients (ICC) were calculated for peak systolic velocity (PSV) and end diastolic velocity (EDV) in the CRA and OA among the examiners. p‐values < 0.05 were considered statistically significant. Results: The study included seven men and eight women (mean age 30.9 ± 4.5 years). In right eyes, ICCs for PSV and EDV in the CRA ranged from 0.917 to 0.961 and from 0.937 to 0.980, respectively. ICCs for PSV and EDV in the OA ranged from 0.802 to 0.926 and from 0.611 to 0.891, respectively. In left eyes, all ICCs for PSV and EDV were >0.9, both in the CRA and the OA. All p‐values calculated for ICCs were statistically significant. Conclusion: Expert training and execution of a specific protocol for CDI of ocular blood flow velocity measurements provide highly reproducible results in healthy volunteers. This is important for long‐term studies assessing ocular hemodynamics, where multiple examiners may be involved.