Outcomes of Living Donor Liver Transplantation for Patients with Preoperative Portal Vein Problems

Background

Portal vein thrombosis (PVT) is a common complication for patients with end-stage liver disease. The presence of PVT used to be a contraindication to living donor liver transplantation (LDLT). The aim of this study is to evaluate the influence of preoperative PVT on perioperative and long-term outcomes of the recipients after LDLT.

Methods

We reviewed the data of patients who underwent LDLT during the period between 2004 till 2017.

Results

During the study period, 500 cases underwent LDLT. Patients were divided into three groups. Group I included non-PVT, 446 patients (89.2%); group II included attenuated PV, 26 patients (5.2%); and group III included PVT, 28 patients (5.6%). Higher incidence of hematemesis and encephalopathy was detected in PVT (p?=?0.001). Longer anhepatic phase was found in PVT (p?=?0.013). There were no significant differences between regarding operation time, blood loss, transfusion requirements, ICU, and hospital stay. The 1-, 3-, and 5-year overall survival (OS) rates of non-PVT were 80.5%, 77.7%, and 75%, and for attenuated PV were 84.6%, 79.6%, and 73.5%, and for PVT were 88.3%, 64.4%, and 64.4%, respectively. There was no significant difference between the groups regarding OS rates (logrank 0.793).

Conclusion

Preoperative PVT increases the complexity of LDLT operation, but it does not reduce the OS rates of such patients.

     

Correlation between severity of coronary artery stenosis and perfusion defect assessed by SPECT myocardial perfusion imaging

Numerous non-invasive techniques are developed to assess the severity of coronary artery disease (CAD). Coronary angiography (CAG) is an established method for the diagnosis and to quantify the severity of coronary artery stenosis. Single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) using Technetium-99m (Tc-99m) tetrofosmin is also a useful established technique for the assessment of severity of CAD. This prospective observational study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU) to assess the severity of coronary artery stenosis using Tc-99m Single Photon Emission Computed Tomography myocardial perfusion imaging (SPECT-MPI) in comparison with CAG. Eighty two (82) consecutive patients with mean age 53.51(SD+/-7.08) years and Candian Cardiovascular Society (CCS) class I and II severity of chest pain, male: female ratio (4.8:1) was studied. Tc-99m SPECT-MPI was performed by one-day exercise stress and rest protocol. A total of two hundred and forty six coronary artery territories examined in this study. By CAG normal coronary arteries were found in seventy six, moderate stenosis in twenty four and severe stenosis in one hundred and forty-six coronary artery territories whereas SPECT-MPI found normal perfusion in twenty seven, mild perfusion abnormality in seventeen, moderate perfusion abnormality in thirty two and severe perfusion abnormality in one hundred and sixty five coronary artery territories. Sensitivity and specificity of SPECT-MPI using Tc-99m tetrofosmin in detecting coronary artery stenosis were 87.09% and 80.95% respectively. The positive predictive value, negative predictive value and accuracy of the test were 91.01%, 73.91% and 85.18% respectively. From this study it can be concluded that Tc-99m SPECT-MPI was a safe, effective and excellent non-invasive tool for the detection of severity of coronary artery lesion and can be used to predict severity of CAD.     

Psychometric properties of the apathy evaluation scale in patients with Parkinson's disease

Parkinson's disease (PD) frequently entails non‐motor symptoms, worsening the course of the disease. Apathy is one of the core neuropsychiatric symptoms that has been investigated in recent years; research is however hampered by the limited availability of well‐evaluated apathy scales for these patients. We evaluated the psychometric properties of the Apathy Evaluation Scale (AES) in a sample of PD patients. Psychometric properties, convergent and discriminant validity and sensitivity/specificity were evaluated in patients with (n = 582) or without dementia/depression (n = 339). Internal consistency was high in the entire sample as well as in patients without dementia/depression. Correlations were moderate for convergent validity (UPDRS I item 4: motivation). While apathy could be differentiated from cognitive decline, it was related to depression (Geriatric Depression Scale, GDS‐15). The overall classification accuracy based on the UPDRS I item 4 was comparable for AES and GDS scores. The AES exhibits good psychometric properties in PD patients with and without dementia and/or depression. Commonly used screenings on the presence of apathy had low detection rates compared to the AES and reflected both apathetic and depressive symptoms. Psychometric evaluation of available instruments will support further research on the clinical relevance of apathy for disease progression and treatment approaches in PD patients.     

Metabolic syndrome in collection and disposal of solid waste sector

Objectives  

This study aims to assess the frequency and factors relevant to metabolic syndrome in workers employed in the collection and disposal of solid waste sector.     

Sinonasal epithelial-Myoepithelial carcinoma-A rare entity

Epithelial-myoepithelial carcinoma is a rare salivary gland tumor. It comprises less than 1% of all salivary gland tumors. It generally arises from the parotid gland. Unusual sites of occurrence include sinonasal tract, lung, trachea, lacrimal gland and breast. Histopathologically epithelial-myoepithelial carcinoma comprises a dual population of ductal and myoepithelial cells. We report an extremely rare case of epithelial-myoepithelial carcinoma occurring in the sinonasal tract of young man.     

The effect of postplacental insertion of the spiked and the standard Lippes loop on uterine involution

The spiked Lippes loop was inserted in 53 women and the standard loop in 55 women immediately following the delivery of the placenta after normal vaginal delivery. A group of 50 recently delivered women with no IUD was studied as a control. The cases were followed up for 1 year. Ultrasonic scanning was performed during the 6th week after insertion for 47 cases with the spiked loop and 43 cases with the standard loop. All loops were correctly positioned within the uterine cavity except in two cases; one using the spiked and the other using the standard loop. The loops were found displaced downwards and as there was excessive bleeding, the devices were removed. Regarding the effect of the IUD on uterine involution, it was found that the fundus to internal os length for the cases with IUDs was shorter than that among the controls, also this length among the standard loop users was significantly shorter than that of the controls (P less than 0.01). Postplacental IUD insertion did not delay uterine involution, on the contrary, it helped involution. Regarding the effect of lactation, the fundus to internal os length for the fully lactating women either using a loop or not, was found to be significantly shorter than that of the non-lactating cases (P less than 0.002).