Outcome after liver transplantation for NASH cirrhosis.

Nonalcoholic steatohepatitis (NASH) associated cirrhosis is an increasing indication for liver transplant (LT). The aim of this study was to determine outcome and poor predictive factors after LT for NASH cirrhosis. We analyzed patients undergoing LT from 1997 to 2008 at a single center. NASH was diagnosed on histopathology. LT recipients with hepatitis C, alcoholic or cholestatic liver disease and cryptogenic cirrhosis acted as matched controls. Ninety-eight LT recipients were identified with NASH cirrhosis. Compared to controls, NASH patients had a higher BMI (mean 32.3 kg/m2), and were more likely to be diabetic and hypertensive. Mortality after transplant was similar between NASH patients and controls but there was a tendency for higher earlier mortality in NASH patients (30-day mortality 6.1%, 1-year mortality 21.4%). Sepsis accounted for half of all deaths in NASH patients, significantly higher than controls. NASH patients > or =60 years, BMI > or =30 kg/m2 with diabetes and hypertension (HTN) had a 50% 1-year mortality. In conclusion, patients undergoing LT for NASH cirrhosis have a similar outcome to patients undergoing LT for other indications. The combination of older age, higher BMI, diabetes and HTN are associated with poor outcome after LT. Careful consideration is warranted before offering LT to these high-risk patients.

Evaluating Retention of Skin Cancer Education in Kidney Transplant Recipients Reveals a Window of Opportunity for Re-education.

BACKGROUND: Skin cancer is the most common malignancy after solid organ transplant and can lead to significant morbidity. The likelihood of developing squamous cell carcinomas and melanomas is 100 and 2.4 times more likely, respectively, in kidney transplant recipients when compared with the general population. There are few data regarding the assessment and influence of solid organ transplant recipient (SOTR) knowledge of skin cancer and its effect on short- and long-term awareness and behavior. METHODS: The purpose of this study was to assess the baseline knowledge of SOTR immediately after transplantation, and then to reassess their knowledge following a 5-minute educational video. We also wanted to determine whether lifestyle modifications had been implemented 4 to 8 months after the intervention. RESULTS: Forty patients were enrolled within 2 months of transplantation. Eighty-seven percent of patients were renal transplant recipients, and 75% of patients were available for long-term follow-up. There was a significant increase in knowledge in the immediate postintervention period, which was sustained at 4- to 8-month follow-up, as assessed by patient questionnaire. Patients appeared to be applying this knowledge by participating in lifestyle risk modification and positive sun-protective behavior. CONCLUSIONS: Our study suggests that incorporating additional skin cancer education into the early transplant timeline (perhaps in the first one or two outpatient follow-up visits) with an easy to administer educational video and question and answer form increases patient knowledge and influences positive sun-protective behavior.

Apical hypertrophic cardiomyopathy in Pakistan: electrocardiographic, echocardiographic and myocardial scintigraphic features.

Apical hypertrophic cardiomyopathy is a recently recognised entity, with typical electrocardiographic, echocardiographic and myocardial scintigraphic features. Thallium imaging is more sensitive than echocardiography, but electrocardiogram appears to be an important clue to its diagnosis which shows changes in the mid precordial leads in most of the patients.

Chediak-Higashi syndrome: Report on five Saudi Arab children and review of the literature.

Five cases of the Chediak-Higashi Syndrome (CHS) among Saudi Arab children were diagnosed between June 1978 and December 1990. All patients were males, ages 18 months to ten years, born to first degree consanguineous parents. All showed the typical somatic and laboratory characteristics of this syndrome with characteristic hyperpigmented irides in four patients. Three patients were in the accelerated phase, two of whom responded to a combination chemotherapy (vincristine and prednisone) and one improved after splenectomy. All patients died before they passed the first decade of their lives. This report is the first detailed description of CHS among Arab children in the Arabian peninsula.

Closure of tracheoesophageal fistulas with primary chemotherapy in patients with esophageal cancer.

BACKGROUND: In patients with tracheoesophageal fistula, radiation is thought to be contraindicated because cytoreduction enlarges the size of the fistula. The same caveat should also apply to cytoreduction with chemotherapy, but there are few data addressing this issue. METHODS: The records of 16 patients with esophageal cancer who received chemotherapy in 1991 were evaluated in the Medical Oncology Section of the Veterans Administration Medical Center, Washington, DC. All patients were staged radiographically and endoscopically. Four of these 16 were seen initially with or developed tracheoesophageal fistulas during therapy. Two patients whose fistulas closed during chemotherapy are presented. RESULTS: All four patients with tracheoesophageal fistulas had midesophageal squamous cell carcinomas. Objective complete responses with closure of tracheoesophageal fistulas occurred in two of four patients after three and four cycles of chemotherapy, respectively. One of these fistulas first developed, then healed during treatment, whereas the other presented at the time of diagnosis with fistula. CONCLUSION: The findings indicated that patients with tracheoesophageal fistulas should not be excluded from chemotherapy solely on the basis of having this condition. The treatment of patients with tracheoesophageal fistulas with chemotherapy needs to be reexamined.