The correlation between sarcopaenia and post-transjugular intrahepatic portosystemic shunt hepatic encephalopathy: a single-institution review.

INTRODUCTION: Sarcopaenia, or muscle wasting, can be used to objectively quantify malnutrition in cirrhotic patients. MATERIAL AND METHODS: In this retrospective study, a list of all patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) procedure at Westchester Medical Centre from September 2009 to July 2018 was obtained, and individual chart reviews were performed. RESULTS: In total, 90 charts were reviewed. Fifty-six patients satisfied our inclusion criteria. Using PMA cut-off values determined in prior studies, we found that 50 of the 56 patients in our study were sarcopaenic. The majority of the patients were male (n = 45). The most common aetiology of cirrhosis was alcoholic cirrhosis (n = 27), followed by viral hepatitis (n = 10), and the most common indication for TIPS was refractory ascites (n = 34). The mean age in the sarcopaenic group was 60.1 years compared to 57.4 years in the non-sarcopaenic group. Mean MELD-Na scores and albumin levels were comparable in both groups. Only one patient was deceased at 6 months post-TIPS. Of the 56 patients included, 18 developed clinically significant hepatic encephalopathy within 6 months of their TIPS procedure. All 18 patients belonged to the sarcopaenic group; 6 patients were not sarcopaenic, and none of them were noted to develop HE within 6 months of their TIPS (p = 0.074). CONCLUSIONS: Based on our results, we concluded that sarcopaenia correlates with the development of hepatic encephalopathy within 6 months of a TIPS procedure; however, the results did not reach statistical significance.

Total laryngectomy for management of chronic aspiration pneumonia in a myopathic dog.

A 5-month-old female pit bull terrier dog evaluated for ataxia, progressive regurgitation, and recurrent aspiration pneumonia had markedly elevated creatine kinase activity, non-inflammatory generalized myopathy, and severe esophageal dysmotility. A narrow-field total laryngectomy was performed. The dog is doing well 30 months after surgery, and no longer has episodes of aspiration pneumonia, despite intermittent regurgitation. This case represents the first application of total laryngectomy for the prevention of chronic recurrent aspiration pneumonia in the dog.

Laryngectomie totale pour la gestion d'une pneumonie par aspiration chronique chez un chien myopathique. Une chienne Pit Bull Terrier âgée de 5 mois évaluée pour de l'ataxie, de la régurgitation progressive et une pneumonie par aspiration récurrente présentait une activité de la créatine kinase particulièrement élevée, une myopathie généralisée non inflammatoire et un trouble de motilité de l'œsophage grave. Une laryngectomie totale à champ étroit a été réalisée. La chienne se porte bien 30 mois après la chirurgie et n'a plus d'épisodes de pneumonie par aspiration, malgré une régurgitation intermittente. Ce cas représente la première application d'une laryngectomie totale pour la prévention d'une pneumonie par aspiration chronique récurrente chez un chien.(Traduit par Isabelle Vallières).

Adenin-1-ium hydrogen isophthalate di-methyl-formamide monosolvate.

In the title proton-transfer organic salt, C5H6.3N5 (+)·C8H4.7O4 (-)·C3H7NO, the adeninium moiety is protonated at the N atom in the 1-position of the 6-amino-7H-purin-1-ium (adeninium) cation. In the solid state, the second acidic proton of isophthalic acid is partially transferred to the imidazole N atom of the adeninium cation [refined O-H versus N-H ratio = 0.70 (11):0.30 (11)]. Through the partially transferred proton, the adeninium cation is strongly hydrogen bonded (N-H⋯O/O-H⋯N) to the isophthalate anion. This strong inter-action is assisted by another N-H⋯O hydrogen bond originating from the adeninium NH2 group towards the isophthalate keto O atom, with an R (2) 2(8) graph-set motif. This arrangement is linked via N-H⋯O hydrogen bonds to the O atoms of the carboxyl-ate group of an isophthalate anion. Together, these hydrogen bonds lead to the formation criss-cross zigzag isophthalate⋯adeninium chains lying parallel to (501) and (50-1). The adeninium cations and the isophthalate anions are arranged in infinite π stacks that extend along the c-axis direction [inter-planar distance = 3.305 (3) Å]. Mol-ecules are inclined with respect to this direction and within the stacks they are offset by ca. half a mol-ecule each. Combination of the N-H⋯O and O-H⋯N hydrogen bonds with the π-π inter-actions forms infinitely stacked isophthalate⋯adeninium chains, thus leading to a two-dimensional supra-molecular structure with parallel inter-digitating layers formed by the π stacked isophthalate⋯adeninium chains. The DMF mol-ecules of crystallization are bonded to the adeninium cations through strong N-H⋯O hydrogen bonds and project into the lattice space in between the anions and cations. There are also C-H⋯O hydrogen bonds present which, combined with the other inter-actions, form a three-dimensional network. The crystal under investigation was found to be split and was handled as if non-merohedrally twinned.

Dimethyl-ammonium 3-carb-oxy-benzoate.

The asymmetric unit of the title organic salt, C(2)H(8)N(+)·C(8)H(5)O(4) (-), consists of two dimethyl-ammonium cations and two 3-carb-oxy-benzoate anions. The 3-carb-oxy-benzoate anions are linked via strong inter-molecular and nearly symmetrical O-H⋯O hydrogen bonds forming infinite chains parallel to [111]. Neighbouring chains are further connected by the dimethyl-ammonium cations via N-H⋯O bonds, resulting in a double-chain-like structure. The dihedral angles of all carboxylate groups with respect to the phenylene rings are in the range 7.9 (1)-20.48 (9)°.