Rhabdomyolysis with acute kidney injury in deceased donors is not a contraindication for kidney donation

Purpose

Deceased patients with acute kidney injury (AKI) from rhabdomyolysis can be considered as potential kidney donors.

Methods

We performed a retrospective chart review from January 2005 to January 2011 of three donors with AKI from rhabdomyolysis and the four recipients of the donated kidneys. Three donors had AKI from rhabdomyolysis as evidenced by elevated serum creatinine levels, myoglobinuria, and plasma creatinine kinase levels greater than five times the upper limit of normal. All grafts were maintained on pulsatile machine perfusion (MP) prior to transplantation. In one of the patients, serial venous perfusate myoglobin levels were measured from the donor kidney while on MP.

Results

Three of the four recipients had delayed graft function, but all had normalized creatinine function after 1?month. One recipient had a creatinine of 1.2 after 79?months, the longest documented follow-up of this kind. Although we measured venous perfusate myoglobin levels from one of the grafts, we found the levels to decrease with increasing time spent on MP.

Conclusion

Potential donors with AKI secondary to rhabdomyolysis should not be restricted from the donor pool. MP may play a role in minimizing the effects of AKI in these types of donors.     

Depression among Nigerian women following pregnancy loss

Objective

To determine the level of depression in Nigerian women following spontaneous pregnancy loss and the coping strategies used.

Methods

A questionnaire survey of 202 Nigerian women who had involuntary pregnancy loss over a 1-year period. The Zung Self-Rating Depression Scale was used to assess the women.

Results

Two-thirds of the pregnancy losses occurred before 20 weeks of gestation and one-third occurred after 20 weeks. The majority of respondents (74.3%) had minimal depressive symptoms (scoring 50-59 on the depression scale), 3% had moderate symptoms (scoring 60-69), and 13.9% had severe symptoms (scoring 70-80). Risk factors for moderate to severe depression included being married, previous pregnancy loss, loss of a male fetus, childlessness, and losses after 20 weeks (P < 0.05). Presence of a woman's husband, children, parents and relatives, friends, and religious observance were identified as positive coping strategies.

Conclusion

Most Nigerian women suffer some level of depression following pregnancy loss, with no living children and losses after 20 weeks being the most significant risk factors.     

Detection of potential risk of wastewater effluents for transmission of antibiotic resistance from Vibrio species as a reservoir in a peri-urban community in South Africa

We assessed the antibiogram characteristics of some Vibrio species isolated from wastewater final effluents in a typical peri-urban community of South Africa. Marked resistances were noted against erythromycin (100%), chloramphenicol (100%), nitrofurantoin, cefuroxime and cephalothin (90-95%) in V. parahaemolyticus, V. fluvialis and V. vulnificus, respectively. Fourteen antibiotypes were identified, with multiresistance to 8-10 antibiotics being common. The antibiotypes AMP, PEN, STR, SUL, TMP, COT, CHL, ERY, CIP and PB demonstrated by V. fluvialis were the most prevalent (17.24%). Eight putative antibiotic resistance genes were identified with floR being the mostly (100%) detected in all the three species while tet(A) was the least with 65% prevalence in V. vulnificus, 7.14% in V. parahaemolyticus and none in V. fluvialis. These results demonstrate that the treated effluent system are reservoirs for various antibiotic resistance genes which could be disseminated to inhabitants downstream the plant and pose health risk to the communities who are dependent upon the watershed for domestic and recreational purposes.     

Protective effect of eurystatins A and B, new prolyl endopeptidase inhibitors, on scopolamine-induced amnesia in rats.

Eurystatins A and B, which are produced by Streptomyces eurythermus R353-21, potently inhibited Flavobacterium prolyl endopeptidase (PED) with IC50 values of 0.004 and 0.002 micrograms/ml, respectively, while no inhibition was observed against another 5 proteases, even at 100 micrograms/ml. The protective effect of eurystatins A and B against scopolamine (3 mg/kg, i.p.)-induced amnesia in rats was evaluated by the step-through one-trial passive avoidance method. When administered i.p. 30 min prior to the acquisition trial, both eurystatins A, at 2-8 mg/kg, and B, at 4-8 mg/kg, significantly protected rats from the amnesic effect of scopolamine without behavioral side effects.     

Intratracheal instillation of perfluorocarbon rescued mice with primary pulmonary hypoplasia

The aim of this study was to investigate the effect of perfluorocarbon on the respiratory status of newborn mice with pulmonary hypoplasia without diaphragmatic defects, following intrauterine exposure to nitrofen. Three groups of newborn mice were compared: pups exposed to nitrofen antenatally without (group A) or with (group B) perfluorocarbon treatment and pups not exposed to nitrofen as a control (group C). Respiratory evaluation was performed by scoring, pressure-volume analysis, and histological examination. At 40 minutes after birth, the survival rates in groups A, B, and C were 51%, 94%, and 95%, respectively. The clinical scores of group B mice at 40 minutes were significantly better than those of group A mice in which pulmonary hypoplasia was induced. In group B, the hysteresis ratio was significantly higher than that in group A, and lung histology showed a significant increase in airspace. An immunohistochemical examination showed that perfluorocarbon did not alter the expression of mature surfactant protein B and surfactant proprotein C. This study demonstrated that treatment with perfluorocarbon was useful in stabilizing critically ill mice with primary pulmonary hypoplasia during the early phase of therapy.     

Factors predisposing to poorly differentiated hepatocellular carcinoma and its recurrence

BACKGROUND/AIMS: We investigated the clinical factors predisposing moderately or poorly differentiated hepatocellular carcinoma and analyzed which clinical and histological factors are associated with poorly differentiated hepatocellular carcinoma (HCC) recurrence. METHODOLOGY: Percutaneous fine-needle biopsy was taken from the liver tumor of 191 consecutive patients between January 1994 and September 1996. The histological degree of differentiation of hepatocellular carcinoma at the first time of initial treatment and at the time of second recurrence was classified according to the criteria of Edmondson and Steiner. RESULTS: At the time of the first therapy, 86 patients, 81, 24, and 0 patients had liver tumors classified as Edmondson (Ed), 1, 2, 3, and 4, respectively. The prognosis of patients with Ed-3/4 HCC was worse than and the tumor sizes were larger than that of Ed-1/2 HCC patients. Of the 167 patients classified as Ed-1/2 at the time of first therapy, HCC recurred in 95 of the patients during the mean follow-up period of 3.4 years. Multivariate analysis revealed that only tumor size (P=0.035) and TACE therapy (P=0.0009) were independently significant factors in predicting future Ed-3/4 or multiple HCC recurrence. CONCLUSIONS: Tumor size and TACE therapy were clinical predisposing factors for Ed-3/4 or multiple HCC recurrences.     

Early detection of haemobilia associated with percutaneous ethanol injection for hepatocellular carcinoma

OBJECTIVE: Haemobilia often results from iatrogenic injury caused by therapeutic procedures. The objective of this study was to evaluate the efficacy of early diagnosis of haemobilia based on ultrasonography in patients with hepatocellular carcinoma undergoing percutaneous ethanol injection. PATIENTS AND METHODS: A combination retrospective and prospective study on the early detection of haemobilia caused by percutaneous ethanol injection was conducted on 365 patients in 1995-1996. The retrospective study reviewed the clinical, laboratory and imaging data of 172 patients who had undergone ethanol injection therapy in 1995. The results showed that ultrasonographic changes in the gallbladder, namely the rapid appearance of echogenic material in the gallbladder lumen, are a useful early sign of haemobilia. Based on the results of the retrospective study, a prospective study on the early detection of haemobilia was carried out in 1996. In the prospective study, percutaneous ethanol injection was halted as soon as haemobilia was detected. RESULTS: The incidence of haemobilia in the prospective group (3.6%) was not different from that in the retrospective group (4.7%). However, the mean duration between percutaneous ethanol injection and diagnosis of haemobilia was only 0.3 +/- 0.2 days in the prospective group, compared with 2.8 +/- 2.1 days in the retrospective group (P < 0.001), and the mean duration of jaundice in the prospective group (4.3 days) was significantly shorter than in the retrospective group (40.0 days) (P< 0.05). CONCLUSION: Early diagnosis of haemobilia based on ultrasonographic findings of the gallbladder lumen effectively reduces the severity of haemobilia-related complications due to immediate interruption of the interventional procedure.