Progression of alterations in lipid metabolism in kidney transplant recipients over 5 years of follow-up.

BACKGROUND: Alterations in lipid metabolism frequently affect kidney transplant recipients and contribute to the onset of metabolic and cardiovascular diseases that threaten graft integrity. The purpose of this research study was to investigate the pattern of hyperlipidaemia and its progression, as well as to study potential risk factors in kidney transplant recipients. METHODS: In this study, 119 kidney transplant recipients of both sexes were monitored over a period of 5 years in our posttransplant clinic. During this period, all patients had pretransplant and posttransplant blood tests to measure levels of the following: total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL) and triglycerides. Furthermore, the subjects were also weighed and their height measured. Their body mass index was then calculated using the weight (kg)/height (m(2) ) formula. RESULTS: In the 5 years following the transplant, the patients experienced a significant increase in the levels of their biochemical markers as well as in their BMI. Consequently, a greater number suffered from dyslipidaemia, diabetes and hypertension. CONCLUSIONS: Kidney transplants can often trigger hyperlipidaemia, as reflected in higher levels of total cholesterol, low-density lipoproteins and high-density lipoproteins. The results of our study also showed that despite statin therapy, the patients had higher triglyceride levels, which made them more vulnerable to diabetes, hypertension, cardiovascular disease and graft rejection.

Radiographic evaluation of the bicipital groove morphology does not predict intraarticular changes in the long head of biceps tendon.

INTRODUCTION AND OBJECTIVES: This study aimed to examine the clinical utility of the radiographic evaluation of the bicipital groove in predicting long head of biceps tendon (LHBT) pathology. MATERIAL AND METHODS: A prospective study was conducted, and sixty consecutive patients proposed to shoulder arthroscopic surgery were selected. Before surgery, a radiographic evaluation was performed with a supine and a Fisk radiograph. Most supine radiographs (>75%) were non-interpretable and were excluded from the study. As some Fisk radiographs (26.7%) were also non-interpretable, that left 44 interpretable radiographs in the study. These were measured for medial opening angle, total opening angle, width and depth of the bicipital groove. The radiographic measurements and the presence of LHBT pathology, as assessed at arthroscopy, were correlated. RESULTS: Radiographic evaluation of the bicipital groove showed a mean medial opening angle of 53 ±â€¯15° (23-90), a mean total opening angle of 80 ±â€¯26° (30-135), a mean width of 10.3 ±â€¯2.5 mm (6-19) and a mean depth of 4.1 ±â€¯1.5 mm (1-8). Men had higher medial opening angle (60 vs 50°, p = 0.044) and wider grooves (11.9 vs 9.7 mm, p = 0.019). Twenty-five patients (56.8%) were found to have an abnormal LHBT. No correlation was found between the radiographic measurements and LHBT pathology. Only age was correlated with a LHBT lesion (61.8 vs 46.3 years, p < 0.001). CONCLUSIONS: Our results show that there is no correlation between radiographic morphologic evaluation of the bicipital groove and LHBT pathology.

Prognostic scores in a gastroenterology intensive care unit.

BACKGROUND: Several prognostic systems have been developed and validated in general Intensive Care Units (ICUs). No assessment of these scores was performed in specialized Gastroenterology Intensive Care Units (GICUs). AIM: To assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) scores systems to predict mortality in a GICU. METHODS: Retrospective study of 300 consecutively admissions in a GICU. Demographics, indication for admission, APACHE II, SAPS II and SOFA scores and survival at GICU discharge were recorded. Discrimination was evaluated using receiver operations characteristic (ROC) curves and area under a ROC curve (AUC). Calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. RESULTS: Overall GICU mortality was 5.3%. APACHE II, SAPS II and SOFA mean scores of nonsurvivors (21.9, 46.2 and 9.3, respectively) were found to be significantly higher than those of survivors (11.9, 26.7 and 2.2, respectively) (p < 0.001). Discrimination was excellent for all the prognostic systems, with AUC = 0.900, 0.903 and 0.965 for APACHE II, SAPS II and SOFA, respectively. Similarly, APACHE II, SAPS II and SOFA scores achieved good calibration, with p = 0.671, 0.928 and 0.775, respectively. Among the three scores, SOFA showed the best performance, with overall correctness of prediction of 94.0%, while it was 86.2% for APACHE II and 82.7% for SAPS II. CONCLUSIONS: in GICU, APACHE II, SAPS II and SOFA scores have excellent prognostic accuracy and, among the three scores, SOFA has the greatest overall correctness of prediction.

Radiographic evaluation of the bicipital groove morphology does not predict intraarticular changes in the long head of biceps tendon. / La evaluación radiográfica de la morfología del surco intertubercular no pronostica cambios intraarticulares en el tendón de la porción larga del bíceps.

INTRODUCTION AND OBJECTIVES: This study aimed to examine the clinical utility of the radiographic evaluation of the bicipital groove in predicting long head of biceps tendon (LHBT) pathology. MATERIAL AND METHODS: A prospective study was conducted, and sixty consecutive patients proposed to shoulder arthroscopic surgery were selected. Before surgery, a radiographic evaluation was performed with a supine and a Fisk radiograph. Most supine radiographs (>75%) were non-interpretable and were excluded from the study. As some Fisk radiographs (26.7%) were also non-interpretable, that left 44 interpretable radiographs in the study. These were measured for medial opening angle, total opening angle, width and depth of the bicipital groove. The radiographic measurements and the presence of LHBT pathology, as assessed at arthroscopy, were correlated. RESULTS: Radiographic evaluation of the bicipital groove showed a mean medial opening angle of 53±15o (23 - 90), a mean total opening angle of 80±26o (30 - 135), a mean width of 10.3±2.5mm (6 - 19) and a mean depth of 4.1±1.5mm (1 - 8). Men had higher medial opening angle (60 vs 50o, p=0.044) and wider grooves (11.9 vs 9.7mm, p=0.019). Twenty-five patients (56.8%) were found to have an abnormal LHBT. No correlation was found between the radiographic measurements and LHBT pathology. Only age was correlated with a LHBT lesion (61.8 vs 46.3 years, p <0.001). CONCLUSIONS: Our results show that there is no correlation between radiographic morphologic evaluation of the bicipital groove and LHBT pathology.

First Report of Pitch Canker on Pines Caused by Fusarium circinatum in Portugal.

In November of 2007, dieback symptoms (basal needle dieback, wilting, and dieback of terminal shoot) were observed on plant groups of Pinus radiata and P. pinaster in a tree nursery located in Anadia in the central region of Portugal (40°26'N, 08°23'W). Two containers with a total of 112 plants per pine species (with and without symptoms) were collected. Small pieces (5 mm long; two from the roots, stem at the soil level, and the aerial part, totaling six pieces) of 20 symptomatic plants were sterilized with 3% sodium hypochlorite, and isolations were performed on potato dextrose agar (PDA) supplemented with 0.5 mg/ml of streptomycin sulfate. A species of Fusarium was isolated from all infected tissues and pure cultures were obtained by single hyphal tip transfers on PDA and Spezieller Nährstoffarmer agar and incubated at 25°C for 10 days with a 12-h photoperiod. The species was identified as Fusarium circinatum Nirenberg & O'Donnell (= F. subglutinans Wollenweb & Reinking) on the basis of morphological and cultural characteristics (2). They produced white, aerial mycelia, violet pigment, typically three-septate macroconidia with slightly curved walls, single-celled microconidia, and characteristic sterile, coiled hyphae. Microconidia were ovoid or allantoid and born in false heads on aerial polyphialides. The identification was confirmed by PCR with specific primers CIRC1A/CIRC4A, resulting in a 360-bp DNA fragment of the two nuclear ribosomal intergenic spacer regions (3). Pathogenicity tests were performed by inoculating 5- and 9-month-old P. pinaster and P. radiata seedlings, respectively. Plants belonging to P. pinea species (8-month-old), the second most important pine in the country, were also included in the tests. Small strips of bark (10 × 1 mm) were cut from the stems and similar-sized pieces of PDA colonized by two isolates of F. circinatum were placed in contact with the open wounds and covered with Parafilm. Ten seedlings for each pine species, isolate, and control (with sterile PDA) were provided in a total of 90 plants. First symptoms, basal needle and shoot dieback, were observed in P. radiata 8 days after inoculation. One month later, all P. radiata and 70% of the P. pinaster plants were dead. In all P. pinea plants, needles turned red along the main stem, from center to periphery, but only 2% of these plants presented wilting of the terminal shoot after 1 month. No symptoms were observed on control seedlings. F. circinatum was reisolated from symptomatic plants of the three species tested. To our knowledge, this is the first report of F. circinatum in Portugal. Pitch canker, caused by Gibberella circinata (anamorph F. circinatum), is one of the most aggressive pathogens on several pine species in the world (1). In 2005, the fungus was detected in the European continent affecting P. radiata and P. pinaster in northern Spain. References: (1) E. Landeras et al. Plant Dis. 89:1015, 2005. (2) H. I. Niremberg and K. O'Donnell. Mycologia 90:434, 1998. (3) W. Schweigkofler et al. Appl. Environ. Microbiol. 70:3512, 2004.

[Wood dust exposure in handicraft companies in Lazio: preliminary findings]. / Esposizione a polveri di legno in aziende artigiane del Lazio: risultati preliminari.

The aim of this study is to evaluate the wood dust exposures characterizing the working more to risk. Two selectors for inhalable fraction were been used: IOM sampler (Institute Occupational Medicine) and conical sampler. The sampling time is choosen by environmental airborne dust and it has varied around three and four hours. The surveys involved some companies of the Lazio that carried out the second working of wood that predict the transformation in ultimate products. The woodworking processes investigated have been grouped in three different classes: wood dissection; planning and moulding; sanding. The results have shown that the medium concentration of wood dusts, obtained in three processes investigated ranges from 2 mg/m3 to 4 mg/m3. The higher amounts is of 16 mg/m3 and it have been obtained during the sanding. Moreover the dust collected by IOM sampler was always higher than by conical sampler probably it is due to large particulates that were projected into IOM causing an overestimate of the amount of wood dust particulate that was inhalable. This study need to of more personal sampling for being able to carry out an exhaustive statistical analysis.

Esophageal perforation--associated risk with balloon tamponade after endoscopic therapy. Myth or reality?

BACKGROUND/AIMS: Variceal bleeding is still associated with high mortality and balloon tamponade may be a lifesaving measure when endoscopic therapy is not available or feasible. The risk of esophageal perforation with balloon tamponade after endoscopic therapy is still uncertain. The aims of the study were to investigate balloon tamponade effectiveness and safety after endoscopic therapy. METHODOLOGY: Retrospective analysis of 100 consecutive episodes of acute variceal bleeding treated with the Sengstaken-Blakemore tube. RESULTS: Balloon tamponade had an overall effectiveness of 61%. The Child-Pugh score was significantly higher in patients who failed balloon tamponade. In 48 cases balloon tamponade was preceded by failure of endoscopic therapy. Balloon tamponade was more effective if a previous attempt to perform endoscopic therapy happened (75% vs. 48%; p = 0.006). Aspiration was the most frequent complication. No cases of esophageal perforation were registered. CONCLUSIONS: Currently balloon tamponade is only used as a temporary bridge to other strategies, when other forms of hemostatic therapies do not succeed. Balloon tamponade was more effective in patients with less severe hepatic dysfunction. Previous attempts to perform endoscopic therapy may augment tamponade effectiveness without increasing the risk of esophageal perforation.

"Downhill" varices. A rare cause of esophageal hemorrhage.

"Downhill" varices or upper esophageal varices are a rare cause of proximal digestive tract hemorrhage with only 16 cases described in the literature. In our series, hemorrhage due to "downhill" varices represents 0.1% of all acute esophageal variceal bleeding. Their etiology differs from that of the usual "uphill" varices secondary to portal hypertension, and the clinical management should be directed to vascular obstruction if present. We report a case of an 89-year-old male with hemorrhagic "downhill" varices not associated, as usually, with superior vena cava obstruction or compression, but with severe pulmonary hypertension and drug-related hemorrhagic risk factors, whose removal proved sufficient to prevent rebleeding.

Comparison of the effects of pressure support ventilation delivered by three different ventilators during weaning from mechanical ventilation.

OBJECTIVE: To compare the effects of pressure support ventilation (PSV) delivered at the same level by three different ventilators on patients' work of breathing (WOB), breathing pattern and gas exchange. DESIGN: Prospective, self-controlled clinical study. SETTING: Intensive care unit of a tertiary university hospital. PATIENTS: Nine intubated adult patients during weaning from mechanical ventilation. INTERVENTIONS: Patients were randomly connected to one of three ventilators: the Siemens Servo 900 C (SC), the Ohmeda CPU 1 (CPU), and the Engström Erica (EE) during both zero cmH2O PSV and 15 cmH2O PSV. MEASUREMENTS AND RESULTS: During zero PSV, there was no significant difference in terms of WOB, VT, VE, or auto-PEEP among the three ventilators, although there was a trend towards higher levels of WOB with EE. During 15 cmH2O PSV, WOB was significantly less with SC than with EE or CPU (0.47 +/- 0.48 J/l for SC, 1.0 +/- 0.48 for EE and 0.78 +/- 0.51 for CPU1, p = 0.003). WOB was 64% less than at zero PSV with SC but only 38% less with EE. This was associated with a different pressurization shape, as assessed by the interior surface of Paw-VT loops (1.23 +/- 0.09 J/l for SC, 0.9 +/- 0.02 for EE, and 0.79 +/- 0.18 for CPU; p < 0.001). At 15 cmH2O PSV, auto-PEEP was significantly lower with SC than with EE (1.7 +/- 2.1 cmH2O for SC, 4.7 +/- 3.6 for EE, and 2.8 +/- 0.3 for CPU; p = 0.04). External expiratory resistances, in cmH2O/l/s, were significantly higher with EE than with CPU or SC (12.9 +/- 3.2 EE, 7.5 +/- 2.4 CPU, 5.9 +/- 0.5 SC; p < 0.001). CONCLUSION: During PSV, the different working principles of different mechanical ventilators profoundly affect patient's WOB. Among the various factors, velocity of pressurization of PSV may play a role in its efficacy in unloading the respiratory muscles.

Ticlopidine-induced prolonged cholestasis: a case report.

We report a case of ticlopidine-induced prolonged cholestasis in a 60-year-old man with no previous hepatobiliary disease who presented with sudden right upper abdominal pain, jaundice and pruritus three months after starting ticlopidine therapy. Other drugs taken by the patient were not considered probable causes. The diagnostic evaluation showed no biliary obstruction and other possible causes of intra-hepatic cholestasis were excluded. The liver biopsy showed a cholestatic hepatitis with bile duct damage. The disease ran a severe and protracted course, but symptoms and jaundice eventually subsided five months after drug withdrawal. More than a year later, relevant abnormalities of liver function tests consistent with anicteric cholestasis still persist, fulfilling criteria for a minor form of drug-induced prolonged cholestasis. This syndrome has been reported infrequently in relation to several drugs, mainly chlorpromazine, and only once with ticlopidine.

Fosinopril-induced prolonged cholestatic jaundice and pruritus: first case report.

We report a case of fosinopril-induced prolonged cholestatic jaundice and pruritus in a 61-year-old man, with no previous hepatobiliary disease, who presented with asthenia, jaundice and itching 3 weeks after starting fosinopril therapy. Other drugs taken by the patient were not considered probable causes. The diagnostic evaluation showed no biliary obstruction and other possible causes of intra-hepatic cholestasis were excluded. Liver biopsy showed cholestasis without bile duct damage. The disease ran a severe course during the 2 months of hospitalization, with prolonged itching for 6 months, eventually controlled with oral naltrexone. Jaundice subsided after 4 months, with anicteric cholestasis persisting for more than 18 months. Similar occurrences have been reported with other inhibitors of angiotensin-converting enzyme (mostly captopril), but this is the first case of an important adverse reaction to fosinopril.

Mesenteric arteriovenous fistula causing portal hypertension and bleeding duodenal varices.

We report a case of portal hypertension associated with a non-traumatic arteriovenous fistula, presenting with bleeding duodenal varices. The patient was admitted for melaena. Emergency endoscopy showed oesophageal varices with no signs of recent bleeding and with no blood in the upper gastrointestinal tract. Arteriography of the coeliac axis and superior mesenteric artery failed to detect any bleeding source. Endoscopy was repeated because of persistent bleeding and revealed active bleeding from varices in the distal duodenum. The patient underwent surgery and a large paraduodenal varicose vein associated with an arteriovenous fistula was found. Resection of the paramural varix and surgical occlusion of the arteriovenous fistula were effective in the control of bleeding. Liver biopsy revealed mild portal fibrosis without cirrhosis. Three years after surgery the patient still has oesophageal varices but has not had recurrent bleeding. There was regression of intraduodenal varices.

[Apolipoprotein A1 and biliary lithiasis in hepatic cirrhosis]. / Apolipoproteína A1 e litíase biliar na cirrose hepática.

A prospective study was performed in 67 male patients with cirrhosis, admitted in our Department during one year. Biliary lithiasis was found in 37% of patients. The occurrence of lithiasis was not related to age, weight or severity of liver disease. Seric total bilirubin was higher in lithiasic patients (p < 0.05). Apolipoprotein A1 levels were lower in those ones with lithiasis (p < 0.005). Apolipoprotein A1 was the only factor associated independently with the finding of lithiasis.