Interferon-alpha treatment of haemodialysis patients with chronic viral hepatitis and its impact on kidney transplantation

Injury to the extra-hepatic biliary system in blunt abdominal trauma is rare and difficult to diagnose. In adults, all reported cases were treated surgically. We report a case of a traumatic tear of the left hepatic duct that was treated successfully by endoscopic retrograde cholangiopancreatography and stenting.     

Increased oxidative stress in patients with congestive heart failure

OBJECTIVES: We sought to study the markers of lipid peroxidation and defenses against oxidative stress in patients with varying degrees of heart failure. BACKGROUND: Despite advances in other areas of cardiovascular disease, the morbidity and mortality from congestive heart failure (CHF) are increasing. Data mainly from animal models suggest that free radical injury may promote myocardial decompensation. However, there are no studies in humans correlating the severity of heart failure with increased free radical injury and antioxidants. METHODS: Fifty-eight patients with CHF and 19 control subjects were studied. In addition to complete clinical and echocardiographic evaluations, the prognosis of these patients was established by measuring the levels of soluble tumor necrosis factor-alpha receptors 1 and 2 (sTNF-R1 and sTNF-R2). Oxidative stress was evaluated by measuring plasma lipid peroxides (LPO), malondialdehyde (MDA), glutathione peroxidase (GSHPx) and vitamin E and C levels. RESULTS: The patients' age range, cause of heart failure and drug intake were comparable across the different classes of heart failure. Heart failure resulted in a significant increase in LPO (p < 0.005), MDA (p < 0.005), sTNF-R1 (p < 0.005) and sTNF-R2 (p < 0.005). There was a significant positive correlation between the clinical class of heart failure and LPO, MDA, sTNF-R1 and sTNF-R2 levels. There was an inverse correlation between GSHPx and LPO. With increased lipid peroxidation in patients with CHF, the levels of vitamin C decreased, but vitamin E levels were maintained. CONCLUSIONS: These data demonstrate a progressive increase in free radical injury and encroachment on antioxidant reserves with the evolution of heart failure; they also suggest that oxidative stress may be an important determinant of prognosis. The therapeutic benefit of administering antioxidant supplements to patients with CHF should be evaluated.     

Meal-generated oxidative stress in type 2 diabetic patients

OBJECTIVE: Free radical production has been reported to be increased in diabetic patients and to be involved in the pathogenesis of diabetic complications. In this study, a standardized meal was administered to 10 type 2 diabetic patients and 10 healthy matched normal subjects to evaluate its effects on plasma oxidative stress generation. RESEARCH DESIGN AND METHODS: In diabetic patients, at baseline and after the meal, plasma malondialdehyde (MDA), vitamin C, protein SH groups, uric acid, vitamin E, and total plasma radical-trapping parameter, which evaluates plasma antioxidant capacity due to known and unknown antioxidants present in the plasma as well as their mutual cooperation, were measured. RESULTS: After the meal, plasma MDA and vitamin C increased, while protein SH groups, uric acid, vitamin E, and total plasma radical-trapping parameter decreased more significantly in the diabetic subjects than in control subjects. CONCLUSIONS: This finding shows that in the absorptive phase, free radicals are produced in diabetic patients. Since plasma glucose, but not insulin, rose significantly more in diabetic subjects than in control subjects, hyperglycemia may play an important role in the generation of postprandial oxidative stress in diabetic patients.     

A study of plasmalogen as an index of oxidative stress in patients with chronic renal failure. Evidence of increased oxidative stress in malnourished patients

BACKGROUND: The incidence of premature cardiovascular disease is high in patients with chronic renal failure (CRF). Free-radical-induced tissue damage is thought to play a major role in the pathogenesis of atherosclerosis and several reports indicate increased oxidative stress in patients with CRF. However, the cause of such stress in CRF is not exactly known. Plasmalogens, a group of phospholipids with a vinyl ether bond in the sn-1 position, are supposed to be sensitive markers of oxidative stress. METHODS: The fasting relative plasmalogen levels of erythrocyte membranes (DMA 16/C16:0 and DMA 18/C18:0), as well as of vitamin E and serum lipids, were determined in a cohort of 105 patients (mean age 51+/-2 years) with advanced CRF (creatinine clearance 9+/-1 ml/min) before starting dialysis treatment. Twenty-nine healthy controls (47+/-2 years) were also investigated. RESULTS: Significantly lower relative plasmalogen levels (DMA 16/C16:0 and DMA 18/C18:0) were found in erythrocytes of predialysis patients than in controls. When the patients were divided on the basis of subjective global assessment of nutritional status (SGA), the malnourished patients (SGA 2-4) had significantly (P<0.05) lower relative plasmalogen levels than the well-nourished predialysis patients (SGA 1). In the prospective part of the study, we found that a 12-month dialysis treatment in 38 patients was associated with significant increases in both erythrocyte DMA 16/C16:0 (P<0.001) and DMA18/C18:0 (P<0.05) ratios. CONCLUSION: The present results suggest that predialysis patients are exposed to an augmented oxidative stress which is partially reversed by 12 months of dialysis treatment. The present study also demonstrates lower relative plasmalogen levels in erythrocyte membranes in malnourished than in well-nourished predialysis patients. One could speculate that an increased oxidative stress may be a factor contributing to the high prevalence of cardiovascular disease documented in malnourished CRF patients.     

Culture and psychology in organ transplantation

Neurological, cardiac, and systemic complications during the first days to weeks after ischaemic stroke can cause substantial morbidity and mortality. The reported 30-day case fatality rate for cerebral infarction varies between 10 and 17%. The incidence and effects of the various complications vary with time after stroke: transtentorial herniation and other cerebral complications prevail during the 1st week, whereas medical complications are more prominent in the weeks thereafter. Many complications are treatable, and some are preventable. The goal of this report is to provide information on their incidence, consequences, and management.     

Group therapy and organ transplantation

Group therapy for organ transplantation patients is in its infancy but has a promising future. Overextended transplantation service providers are interested in its potential for cost-efficient and effective forms of psychosocial intervention. This article summarizes the biomedical and psychosocial aspects of solid organ transplantation, one institution's group therapy program, common group themes, and specific demands on the group therapist working with this population.     

Radionuclide imaging in organ transplantation

This article addresses the utility of radionuclide imaging for evaluating functional and anatomic integrity of transplanted liver, kidney, pancreas, heart, and lung. Information about how to interpret routine nuclear medicine procedures for vascular and surgical complications as well as rejection after transplantation is also presented. The role of new radiopharmaceuticals is discussed briefly.     

Interferon treatment for hepatitis C virus infection in patients on haemodialysis

BACKGROUND: This study examined the efficacy and tolerability of interferon alpha-2b (IFN) in the treatment of chronic hepatitis C virus (HCV) infection in patients on maintenance haemodialysis. METHODS: A 24-month prospective cohort study was performed in 11 HCV RNA-positive haemodialysis patients, who were treated with IFN at 3 MU thrice weekly for 6 months. Serial biochemical and virological monitors included serum alanine aminotransferase levels, and HCV RNA by both qualitative PCR assay and quantitative bDNA assay. HCV genotypes were determined by PCR and nucleotide sequencing. Ten patients had baseline liver biopsy. RESULTS: HCV genotypes 1b and 2b were identified in 10 and one patients respectively. Six (55%) patients had biochemical and/or histological features of chronic active hepatitis before treatment. All 11 patients became HCV RNA-negative by PCR, with normalization of deranged aminotransferase levels, within 2-8 weeks of IFN therapy. HCV RNA reappeared in eight (73%) patients 2-8 weeks after the cessation of IFN, while biochemical relapse occurred in six (55%) patients. Sustained eradication of HCV was achieved in three (27%) patients. Sustained responders were characterized by pretreatment HCV RNA level < 3.5 x 10(5) Eq/ml as determined by the bDNA assay, and less severe histological abnormalities ('Total score' 1.7 +/- 1.2 compared to 5.4 +/- 2.2 in relapsers, P < 0.05). HCV RNA levels were similar before and after IFN treatment in non-responders and relapsers. Persistent malaise and poor appetite were noted in eight (73%) patients during IFN therapy. Other side-effects of IFN included the exacerbation of anaemia, induction of resistance to erythropoietin, weight loss, and reduced serum albumin level. CONCLUSIONS: Eradication of chronic HCV infection with IFN can be achieved in 27% of haemodialysis patients. Predictors of sustained response include low baseline HCV RNA level and mild liver pathology. Virological relapse can occur despite normal liver biochemistry. Exacerbation of anaemia, erythropoietin resistance, and malnutrition constitute the side-effects of IFN that deserve special attention in uraemic subjects.     

Influence of puberty on endothelial dysfunction and oxidative stress in young patients with type 1 diabetes

OBJECTIVE: To examine the influence of puberty on endothelial dysfunction and oxidative stress in children and young people with type 1 diabetes. RESEARCH DESIGN AND METHODS: There were 51 young patients with type 1 diabetes, including 12 prepubertal children, 16 adolescents, and 23 young adults who had no clinical diabetic angiopathy, studied; none had microalbuminuria. The three groups were matched for glycemic control, and systolic and diastolic blood pressures and cholesterol levels were not significantly different between the groups. Endothelium-dependent vasodilatation was assessed by laser Doppler flowmetry after iontophoresis of acetylcholine (ACh) to the skin of the dorsum of the right foot. Soluble E-selectin, intercellular cell adhesion molecule-1 (ICAM-1), von Willebrand factor (vWF), plasma thiol (PSH), red cell glutathione (GSH), and red cell superoxide dismutase (SOD) were measured in blood samples obtained in the early morning. RESULTS: Skin vascular responses to ACh were significantly reduced in the young adult group compared with the prepubertal group (P < 0.05, analysis of variance). The levels of soluble ICAM-1 and E-selectin were significantly higher in the adolescent group compared with the young adult group: 338 (267-415) and 89 (64-106) ng/ml (median [interquartile range]), respectively, versus 255 (222-284) and 58 (54-71) ng/ml (P < 0.01 and P < 0.005, Mann-Whitney U test). SOD levels were significantly higher in the prepubertal group at 250 (238-282) micro/ml, when compared with the adolescent, 217 (171-249) micro/ml (P < 0.04), and young adult, 217 (157-244) micro/ml (P < 0.02), groups. GSH tended to be lower in the adolescent group, 1,192 (1,047-1,367) micromol/l, when compared with the young adults, 1,286 (1,145-1,525) pmol/l, and levels of vWF tended to be higher in the adolescent group, but these failed to reach statistical significance (both P = 0.09). PSH was not different between the three groups. CONCLUSIONS: These results suggest that puberty modulates endothelial function and antioxidant mechanisms in childhood diabetes, which may have implications for therapy and intervention.     

Silicon and aluminium interactions in haemodialysis patients

BACKGROUND: Aluminium toxicity in dialysis patients is well described. Aluminium has a close chemical affinity with silicon. Silicon may have a role in protection against aluminium toxicity. METHODS: We measured serum aluminium and silicon levels from haemodialysis patients from four different centres. RESULTS: Though no relationship was seen across all centres combined, in one centre there was a reciprocal relationship in patients on home haemodialysis (who did not require reverse osmosis). Median (range) aluminium levels were higher, 2.2 (0.4-9.6) micromol/l when serum silicon was less than 150 micromol/l, and lower, 1.1 (0.2-2.8) micromol/l when serum silicon levels were greater than 150 micromol/l (P = 0.03). CONCLUSIONS: In patients treated by haemodialysis without reverse osmosis high serum silicon concentrations were associated with lower serum aluminium concentrations than those with low serum silicon. Further work needs to confirm a preventative role for silicon in the accumulation and subsequent toxicity of aluminium in dialysis patients.     

Psychological stress symptoms before and after autologous bone marrow transplantation in patients with solid tumors

This study sought to examine patterns of changes of psychological stress symptoms in autologous bone marrow transplantation (ABMT) recipients. Forty-nine patients affected by solid tumors were assessed using the Symptom Questionnaire on admission to hospital (before high-dose chemotherapy and ABMT) and before discharge. Symptoms of anxiety and anger tended to decrease and relaxation of improve over time. Nevertheless, on admission to hospital 30-50% of the patients reported severe to moderate symptoms of anxiety and depression. Before discharge, the prevalence was still high (20-35%). The implications of these findings are discussed in terms of the need to monitor the evolution of emotional functioning of cancer patients undergoing ABMT.