Post-transplant lymphoproliferative disorder after kidney transplantation: time to adopt monitoring of Epstein-Barr virus?

Although post-transplant lymphoproliferative disorder is a classical complication encountered after kidney transplantation, its diagnosis can still be challenging and its outcome life-threatening. Most cases are related to Epstein-Barr virus (EBV) infection and occur mainly in the first year post-transplant, favoured by the seronegative EBV status of the recipient transplanted with a kidney from a seropositive donor, and strong immunosuppression. We report the case of a young kidney-pancreas transplant recipient who developed post-transplant lymphoproliferative disorder (PTLD) early after transplantation, with a rapid fatal issue. We review the pathogenesis, clinical presentation, and management of PTLD with a focus on prevention.

Calciphylaxis: an uncommon manifestation of primary hyperparathyroidism. A case report.

Calciphylaxis is a rare disorder which mainly affects patients with end-stage renal disease and secondary hyperparathyroidism. We report here a case of calciphylaxis in a 56-year-old woman with primary hyperparathyroidism, a much more uncommon association. Skin biopsy revealed the characteristic pictures of the disease. Soon after parathyroidectomy, the parameters of the phosphorus-calcium metabolism normalised but the cutaneous lesions persisted for several months.

Catalytic hydrothermal processing of microalgae: decomposition and upgrading of lipids.

Hydrothermal processing of high lipid feedstock such as microalgae is an alternative method of oil extraction which has obvious benefits for high moisture containing biomass. A range of microalgae and lipids extracted from terrestrial oil seed have been processed at 350 °C, at pressures of 150-200 bar in water. Hydrothermal liquefaction is shown to convert the triglycerides to fatty acids and alkanes in the presence of certain heterogeneous catalysts. This investigation has compared the composition of lipids and free fatty acids from solvent extraction to those from hydrothermal processing. The initial decomposition products include free fatty acids and glycerol, and the potential for de-oxygenation using heterogeneous catalysts has been investigated. The results indicate that the bio-crude yields from the liquefaction of microalgae were increased slightly with the use of heterogeneous catalysts but the higher heating value (HHV) and the level of de-oxygenation increased, by up to 10%.

Potential yields and properties of oil from the hydrothermal liquefaction of microalgae with different biochemical content.

A range of model biochemical components, microalgae and cyanobacteria with different biochemical contents have been liquefied under hydrothermal conditions at 350 °C, ∼200 bar in water, 1M Na(2)CO(3) and 1M formic acid. The model compounds include albumin and a soya protein, starch and glucose, the triglyceride from sunflower oil and two amino acids. Microalgae include Chlorella vulgaris,Nannochloropsis occulata and Porphyridium cruentum and the cyanobacteria Spirulina. The yields and product distribution obtained for each model compound have been used to predict the behaviour of microalgae with different biochemical composition and have been validated using microalgae and cyanobacteria. Broad agreement is reached between predictive yields and actual yields for the microalgae based on their biochemical composition. The yields of bio-crude are 5-25 wt.% higher than the lipid content of the algae depending upon biochemical composition. The yields of bio-crude follow the trend lipids>proteins>carbohydrates.

The quality of life following liver transplantation: a preliminary report.

Quality of life is a multidimensional construct that encompasses functional behavioral and cognitive capacities, health status, emotional well-being, and psychosocial adjustment. A program of interdisciplinary investigation at the University of Pittsburgh Health Sciences Center has been directed at studying the outcome of liver transplantation with respect to the impact of such surgery on improving life quality. The data obtained have been subjected only to descriptive and univariate analyses but indicate that liver transplantation surgery results in a sharp improvement in quality of life relative to one's pretransplant status, although it does not return the recipient to their premorbid baseline. Following transplantation, a substantial reversal of identified pretransplant neuropsychological impairments also occurs, although performance does not appear to return to normal levels. Specifically, visuopractic impairments, which are the most salient neuropsychologic concomitants of hepatic encephalopathy, are still detectable 3 years after transplantation. Nonetheless, normal or near normal functioning on measures of cognitive capacity, health status, emotional well-being and social, vocational, and behavioral competency are found in liver transplant survivors.

Diagnosis and management of acute bronchitis and pneumonia in the ambulatory setting.

Acute bronchitis and pneumonia are frequently encountered by primary care providers in an outpatient setting. The primary care nurse practitioner plays an active role in the diagnosis and management of acute bronchitis and pneumonia. Certain elements of the history and physical examination help separate infectious causes of acute cough from non-infectious causes. If an infectious cause is established by etiology, history and physical factors also help to identify whether acute bronchitis or pneumonia is present. Certain diagnostic tests are necessary to aid in making the diagnosis and in establishing the causative agent upon which the appropriate therapy is based. The primary care nurse practitioner must also be attuned to identifying those clients in whom respiratory illness can be a severe syndrome necessitating hospitalization and those for whom vaccination is recommended. This article addresses the practice needs of the clinician.