Faecal microbiota transplantation.

The use of faeces for the treatment of gastrointestinal diseases was described in 4th century Chinese medicine for the treatment of severe diarrhoea.1 More recently there has been renewed interest in this unconventional biological therapy, particularly for the treatment of recurrent Clostridium difficile infection (CDI) and to a lesser extent inflammatory bowel diseases (IBD). Faecal microbiota transplantation† (FMT) involves the introduction of enteric bacteria from the faeces of healthy donors in order to restore a healthy balance of bacteria in the gut.2 In March 2014, the National Institute for Health and Care Excellence (NICE) issued guidance on the use of FMT for the treatment of recurrent CDI that has failed to respond to antibiotics and other treatments.2 Here we review the use of FMT in CDI and IBD.

Micronutrient deficiencies in pediatric and young adult intestinal transplant patients.

Intestinal transplant recipients are at risk of micronutrient deficiency due to the slow process of post-transplant adaptation. Another contributing factor is calcineurin inhibitor-induced renal tubular dysfunction. Patients are typically supplemented with micronutrients during PN; however, the risk of deficiency may persist even after a successful transition to FEN. The goal was to determine the prevalence of, and associated risk factors for, iron, zinc, magnesium, phosphorus, selenium, copper, folate, and vitamins A, D, E, and B12 deficiency in pediatric intestinal transplant recipients after successful transition to FEN. A retrospective review of prospectively collected data from children who underwent intestinal transplantation at Cincinnati Children's Hospital Medical Center was done. Deficiencies of various micronutrients were defined using the hospital reference values. Twenty-one intestinal transplant recipients, aged one to 23 yr, who were successfully transitioned to FEN were included in the study. The prevalence of micronutrient deficiency was 95.2%. The common deficient micronutrients were iron (94.7%) and magnesium (90.5%). Age ≤ 10 yr (p = 0.002) and tube feeding (p = 0.02) were significant risk factors for micronutrient deficiencies. Pediatric intestinal transplant recipients have a high risk of micronutrient and mineral deficiencies. These deficiencies were more common among younger patients and those who received jejunal feeding.

ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS).

Cardiovascular disease (CVD) due to atherosclerosis of the arterial vessel wall and to thrombosis is the foremost cause of premature mortality and of disability-adjusted life years (DALYs) in Europe, and is also increasingly common in developing countries.1 In the European Union, the economic cost of CVD represents annually E192 billion1 in direct and indirect healthcare costs. The main clinical entities are coronary artery disease (CAD), ischaemic stroke, and peripheral arterial disease (PAD). The causes of these CVDs are multifactorial. Some of these factors relate to lifestyles, such as tobacco smoking, lack of physical activity, and dietary habits, and are thus modifiable. Other risk factors are also modifiable, such as elevated blood pressure, type 2 diabetes, and dyslipidaemias, or non-modifiable, such as age and male gender. These guidelines deal with the management of dyslipidaemias as an essential and integral part of CVD prevention. Prevention and treatment of dyslipidaemias should always be considered within the broader framework of CVD prevention, which is addressed in guidelines of the Joint European Societies' Task forces on CVD prevention in clinical practice.2 ­ 5 The latest version of these guidelines was published in 20075; an update will become available in 2012. These Joint ESC/European Atherosclerosis Society (EAS) guidelines on the management of dyslipidaemias are complementary to the guidelines on CVD prevention in clinical practice and address not only physicians [e.g. general practitioners (GPs) and cardiologists] interested in CVD prevention, but also specialists from lipid clinics or metabolic units who are dealing with dyslipidaemias that are more difficult to classify and treat.

Small case series of gastric stimulation for the management of transplant-induced gastroparesis.

BACKGROUND: Gastroparesis is a recognized complication following organ transplantation with incidences reported between 24 and 83%. Gastroparesis can complicate medical management in these patients leading to the inability to take medications and possibly chronic transplant rejection. Gastric electrical stimulation (GES) has been shown in both controlled and uncontrolled studies to reduce the frequency of nausea and vomiting and lead to weight gain in patients with gastroparesis refractory to standard medical treatment; however, there is little evidence to support the use of GES in transplant recipients. The goal was to evaluate the response of transplant patients with gastroparesis to GES and compare to nontransplant recipients. MATERIALS AND METHODS: A questionnaire consisting of 11 questions was administered to investigate symptoms. Patients were asked to score these symptoms before and after surgery using a 0-5 Likert scale. RESULTS: Thirteen consecutive patients underwent placement of the Enterra (Medtronic, Minneapolis, MN) device with a mean follow-up of 12 +/- 6.1 months. All three transplant patients (100%) reported an improvement in quality of life. Similarly, transplant patients were as likely as the diabetic or idiopathic patients to demonstrate improvements in symptoms of nausea, vomiting, and retching and prandial symptoms following Enterra therapy. In fact, transplant patients reported improvement in appetite and bloating symptoms more frequently than diabetics (P = 0.055 and P = 0.037, respectively). CONCLUSION: Posttransplantation gastroparesis responds to therapy with Enterra GES as well as in patients with idiopathic or diabetic gastroparesis. Enterra therapy should be prospectively investigated in this population of patients.

Importance of alfacalcidol in clinical conditions characterized by high rate of bone loss.

In postmenopausal osteoporosis, the administration of alfacalcidol to women resulted in an increase in trabecular bone mineral density (BMD), prevention of cortical bone loss, and a significant reduction in the incidence of further vertebral fractures. There is now robust evidence that alfacalcidol may be particularly active in conditions characterized by an increased rate of bone loss. Alfacalcidol 1 microg/day fully prevented vertebral bone loss over 3 years in women after the first year of menopause. In a large cohort of individuals starting treatment with high dose corticosteroid (CS, 46.6 mg equivalent prednisolone per day), the spinal bone loss observed in untreated patients was fully prevented by administration of 1 microg/day alfacalcidol. In patients with established CS-induced osteoporosis, with or without prevalent vertebral fractures, 1 microg/day of alfacalcidol, given for 3 years, increased lumbar spine density, reduced back pain, and showed a significant reduction in the rate of new vertebral fractures, compared to native vitamin D. In cardiac transplant recipients, alfacalcidol and calcium reduced spinal and femoral bone loss, compared to a control group treated with etidronate and calcium. Alfacalcidol-treated patients experienced fewer new vertebral fractures over the 2-year followup. When alfacalcidol and vitamin D3 were compared in elderly women with radiologic evidence of vertebral fracture, fractional calcium absorption was increased after 3 months with alfacalcidol but was unchanged with vitamin D3. In a recent metaanalysis of 14 studies of native vitamin D and 19 studies of D-hormone analogs (alfacalcidol and calcitriol), the D-analogs exerted a higher preventive effect on bone loss and fracture rates in patients with no exposure to CS. In head-to-head studies comparing D-analogs and native vitamin D in patients receiving CS, this metaanalysis identified significant effects favoring D-analogs for femoral neck BMD and spinal fractures. In conclusion, improvement in bone turnover, increase in BMD, and reduction in fracture rates have been described during alfacalcidol treatment in situations characterized by a high rate of bone loss, including CS-induced osteoporosis, early postmenopausal bone loss, and organ transplant. Compared to plain vitamin D, alfacalcidol exerts higher bone-protective effects, thus allowing the doses to be minimized and lowering the risk of adverse effects, including hypercalcemia.

[Transplantation and explantation from a psychosomatic perspective]. / Transplantation und Explantation aus psycho- somatischer Sicht.

At first glance, transplantation medicine and psychosomatic medicine seem little related. This survey points out the possible contributions of psychosomatics to transplantation medicine. Special attention is given to organ donors, who in articles on transplantation medicine hardly receive the consideration they deserve.

[Psychosomatic medicine and transplant patients - what is known and what is needed]. / Psychosomatische Betreuung von Transplantationspatienten - Fakten und Notwendigkeiten -

Psychosomatic research has resulted in a huge pool of data concerning the psychic state of transplant patients and their relatives during the course of organ transplantation. It has been possible as well to describe important psychosocial prognostic factors, influencing both somatic and psychosocial outcome after transplantation. The following review article gives an overview of the results that are relevant to daily psychosomatic practice in transplantation medicine. It mainly deals with the problems of transplant patients and their relatives. The special issues of living related organ donation cannot be subject of this review. Finally the article tries to show perspectives for the development of psychosomatic interventions in the treatment of organ transplant patients.

Mycobacterium haemophilum: microbiology and expanding clinical and geographic spectra of disease in humans.

Reports of the association of Mycobacterium haemophilum with disease in humans have greatly increased. At least 64 cases have now been reported, with symptoms ranging from focal lesions to widespread, systemic disease. The organism is now known to cause primarily cutaneous and subcutaneous infection, septic arthritis, osteomyelitis, and pneumonitis in patients who are immunologically compromised and lymphadenitis in apparently immunocompetent children. Underlying conditions in the compromised patients have included AIDS; renal, bone marrow, and cardiac transplantation; lymphoma; rheumatoid arthritis; marrow hypoplasia; and Crohn's disease. Reports have originated from diverse geographic areas worldwide. The epidemiology of M. haemophilum remains poorly defined; there appears to be a genetic diversity between strains isolated from different regions. The organism is probably present in the environment, but recovery by sampling has not been successful. M. haemophilum has several unique traits, including predilection for lower temperatures (30 to 32 degrees C) and requirement for iron supplementation (ferric ammonium citrate or hemin). These may in the past have compromised recovery in the laboratory. Therapy has not been well elucidated, and the outcome appears to be influenced by the patient's underlying immunosuppression. The organisms are most susceptible to ciprofloxacin, clarithromycin, rifabutin, and rifampin. Timely diagnosis and therapy require communication between clinician and the laboratory.

[Use of ampicillin trihydrate in transplantation surgery]. / Primenenie ampitsillina-trigidrata v transplantatsionnoi khirurgii.

Ampicillin trihydrate was used for the treatment of 29 patients with purulent inflammatory processes, such as peritonitis, suppurating operative wound, urinary tract infection after the kidney allotransplantation. The antibacterial activity of ampicillin was preliminarily tested on 517 microbial strains, i.e. staphylococci, streptococci, E. coli, Proteus and Ps. aeruginosa isolated from the surgical patients. The strains of penicillin sensitive staphylococci, streptococci and E. coli were most sensitive to the drug effect, the MIC ranging from 0.03 to 16 gamma/ml. It was shown that the blood retention time of the antibiotic was much more prolonged in the patients with a decreased excretion function of the kidneys. The treatment was performed under control of the clinical, bacteriological and biochemical parameters. The drug was used in a dose of 0.5 g 6--8 times a day for 5 to 15 days. A satisfactory therapeutic effect was registered in 73 per cent of the cases.