Analysis of renal function in the immediate postoperative period after partial liver transplantation.

Although renal dysfunction is common after liver transplantation, postoperative renal function after split liver transplantation (SLT) has not been well studied. Renal function immediately after surgery was analyzed retrospectively in 16 patients that received a SLT (SLT group). The results were compared with corresponding data from 31 matched patients that received a full-size liver transplant (FSLT group) during the same period. Serum creatinine (SCr) was measured before surgery, and, after transplantation, daily during the first week and at days 14, 21, and 28. Renal dysfunction (RD) was defined as the requirement for renal replacement therapy (RRT) or a 100% increase in SCr if the basal value had been <1.0 mg/dL or a 50% increase in SCr if the basal value had been >1.0 mg/dL. SCr had to be at least 1.5 mg/dL for a diagnosis of RD to be considered. The classification of RD was: mild, SCr 1.5-2.4 mg/dL; moderate, SCr 2.5-4.0 mg/dL; or severe, SCr >4.0 mg/dL (the requirement for RRT). Both donor and recipient age and cold ischemia time were lower in the SLT group than in the FSLT group (P < 0.05). Length of surgery was longer in the SLT group (P < 0.05). There were no significant differences between groups with respect to Model for End-Stage Liver Disease scores, the need for transfusions, the length of admission to the intensive care unit (ICU), survival rate, individual severity index, or sepsis-related organ failure assessment scores at the time of diagnosing RD. Immunosuppression regimens were similar in both groups. RD developed in 82% of SLT patients, but in only 58% of FSLT patients (P = not significant [NS]). Among SLT patients, RD (23.0% mild, 15.5% moderate, and 61.5% severe) was more severe (P = 0.007) than in FSLT patients (63.1% mild, 15.8% moderate, and 24.1% severe). The requirement for RRT in the SLT group (43.7%) was significantly greater (P < 0.05) than that in the FSLT group (12.9%). This finding may be due to the different incidence of sepsis in the 2 groups (SLT 37.5% vs. FSLT 9.7%; P < 0.05). In conclusion, although the number of patients studied was small, our data suggest a higher incidence of RD and a greater requirement for RRT in patients that receive a split liver graft than in those that receive a full size liver graft.     

CT evaluation of Crohn's disease: effect on patient management

CT scans from 80 consecutive patients with clinically symptomatic Crohn's disease were reviewed retrospectively to determine the effect of CT diagnosis on patient management. The initial clinical impression and any subsequent change in patient management because of the CT findings were noted. In 22 (28%) of the 80 patients, significant previously unsuspected findings led to a change in medical or surgical management. These included 12 patients with fistulae, four with abscess, two with avascular necrosis of the femoral head, two with sacral osteomyelitis, and single cases of pelvic inflammatory disease and femoral vein thrombosis.     

Computed tomography findings in gastrointestinal involvement by opportunistic organisms in acquired immune deficiency syndrome

The computed tomography findings in two cases of gastrointestinal superinfection by opportunistic organisms in acquired immune deficiency syndrome are presented. Findings included thickening of the mucosal folds and the bowel wall in the small intestine and colon associated with cytomegalovirus and cryptosporidiosis. These cases indicate that it is important to look carefully at the gastrointestinal tract when performing computed tomography in this group of patients. Unsuspected bowel pathology may be demonstrated, or disease may be confirmed in clinically suspected cases.     

Echogenic Appearance of Colorectal Liver Metastases on Intraoperative Ultrasonography is Associated with Survival After Hepatic Resection

Survival after resection of colorectal liver metastases has traditionally been associated with clinicopathologic factors. We sought to investigate whether echogenicity of colorectal liver metastasis as assessed by intraoperative ultrasound (IOUS) was a prognostic factor after hepatic resection. Prospective data on tumor IOUS appearance were collected in 84 patients who underwent hepatic resection for colorectal liver metastasis. Images were digitally recorded, blindly reviewed, and scored for echogenicity (hypo-, iso-, or hyperechoic). The median tumor number was 1 and the median tumor size was 5.0 cm. At the time of surgery, the IOUS appearance of the colorectal liver metastases were hypoechoic in 35 (41.7%) patients, isoechoic in 37 (44.0%) patients, and hyperechoic in 12 (14.3%) patients. Traditional clinicopathologic prognostic factors were similarly distributed among the three echogenicity groups (all p > 0.05). Patients with a hypoechoic lesion had a significantly shorter median survival (30.2 months) compared with patients who had either an isoechoic (53.2 months) or hyperechoic (42.3 months) lesion (p = 0.005). The 5-year survival after hepatic resection of colorectal liver metastasis was also associated with the echogenic appearance of the lesion (hypoechoic 14.4 vs isoechoic 37.4 vs hyperechoic 46.2%) (p < 0.05). Intraoperative ultrasound echogenicity should be considered a prognostic factor after hepatic resection of metastatic colorectal cancer. This study was presented at the 47th annual meeting of The Society for Surgery of the Alimentary Tract, Los Angeles, CA, USA, 22 May 2006.     

The necessity for sphenoidal electrodes in the presurgical evaluation of temporal lobe epilepsy: pro position.

Whether sphenoidal electrodes should be used in the presurgical evaluation of people with refractory epilepsy has remained controversial. Many studies have been published touting their advantages, or conversely, their lack of benefit. The present paper reviews the evidence supporting the utility of sphenoidal electrodes. In principle, sphenoidal electrodes have an advantage over laterally placed scalp electrodes in detecting inferiorly directed mesial temporal discharges. Published studies demonstrate that sphenoidal electrodes are more sensitive than scalp electrodes and sometimes detect interictal spikes and seizures not seen with scalp electrodes. While the net added yield is relatively low, perhaps 5 to 10%, those patients in whom sphenoidal electrodes provide unique localizing information have much to gain. Sphenoidal electrodes may spare some patients unnecessary intracranial electrode investigation and permit surgery for others.     

Cyclosporine A inhibition of microcystin toxins

Cyclosporine A (CyA) given i.v. at a dose of 1.25 mg/mouse blocks a subsequent i.v. lethal dose (1.7-1.8 x LD50) of microcystin-LR for 24 hr, and is about 50% protective at 48 hr. Conversely, the fraction of mice that can be rescued by CyA (0.2 mg/mouse) after a lethal dose of microcystin-LR decreases rapidly with a pharmacodynamic half-time of only about 100 sec. The prophylactic action of CyA was tested against lethal doses of four microcystins. The acute lethality of 1.7-1.8 x LD50 dose of microcystin-LR, -RR, -LY, or -LA given 1 hr after administration of 0.2 mg of CyA is 0%, 0%, 58%, or 100%, respectively. Even a 0.6 mg/mouse dose of CyA is ineffective prophylaxis against a lethal dose of microcystin-LA. The inhibitory potency of CyA on microcystin toxicity can be completely reversed by the single L-amino acid substitution of alanine for arginine in the microcystin.     

Evaluation of Class I ART restorations in Brazilian schoolchildren: three-year results

Atraumetic Restorative Treatment (ART) has been adopted around the world to avoid unnecessary extractions, especially in non-industrialized countries The development of specific glass ionomer cements marketed for the ART technique has contributed to the technical success rate. In this study. Ketac-Molar^a (3M ESPE. Dental Medzn Germany) was used to restore 150 Class I cavities in 118 Brazilian public school children, aged from 7–12 years. At baseline and at subsequent recalls. CPI probes with a ball-end of 0.5 millimeters (mm) were used to assess loss of restorative material, and photographic color transparencies of restorations were made. After six months. 83 patients returned for follow-up examinations, with 71.8% of their restorations designated as acceptable. After three years. 49 patients with 57 ART-restorations were evaluated, with 21.0% of these restorations graded as acceptable Another 29.8% of their restorations had been replaced by more permanent materials. The main objective of the ART technique is tooth retention; this was achieved for 94.7% of the restored teeth in a high caries risk population who returned for recalls.     

Mr imaging of hepatic nodular regenerative hyperplasia

Nodular regenerative hyperplasia (NRH), a rare condition that is commonly associated with noncirrhotic portal hypertension, is not well described in the MR literature. Three patients at two institutions were identified who had both abdominal MR imaging and pathologic evidence of NRH. All examinations were performed at 1.5 T and included axial T1- and T2-weighted spin-echo (SE) images. The MR studies were reviewed by two radiologists in consensus. Two patients had multiple liver lesions that had high signal components on T1-weighted images and were predominantly isointense with liver on the T2-weighted images. One patient had no focal lesions identified. NRH, when visualized on MR images, appears as multifocal masses with shortened Tl and T2 similar to liver. NRH should be considered in the differential diagnosis of hepatocellular tumors, especially in patients with a predisposing condition.     

A simple method for determining metronidazole resistance of Helicobacter pylori.

The reliability of methods for determination of Helicobacter pylori resistance to metronidazole has been found to depend upon the incubation time. Because the disk diffusion method is more vulnerable than other methods to prolonged incubation, this method has not been recommended for H. pylori. However, because media designed for rapid growth of H. pylori have been introduced, the time has come to look at the clinical usefulness of this inexpensive and simple method again. The correlation of readings obtained with the E test (AB Biodisk, Solna, Sweden) and Rosco's (Taastrup, Denmark) disk diffusion method for in vitro metronidazole resistance determination for H. pylori with a short incubation time (24 to 31 h) was studied. Plates which could not be read after 24 to 31 h were reincubated for another night. Fifty-seven consecutive clinical strains were tested. Because the rate of regrowth of H. pylori depends upon the age of the colonies inoculated, the reproducibility of resistance test results for young colonies versus old colonies was also studied. Resistance plates could be read after 24 to 31 h of incubation for 28 of 29 strains when the inoculum consisted of young colonies (3 to 4 days old). For these 29 strains, a high correlation (r = -0.937) was found between results obtained with the E test and those obtained with the disk diffusion test. A poorer correlation was found for old colonies (> or = 5 days old) (r = -0.742), which required a prolonged incubation for 8 of 23 strains. In conclusion, short incubation was successfully applied with young colonies. Results obtained with the simple and inexpensive disk diffusion method correlated well with those obtained with the E test.