Liver Transplantations and Brain Dead Donors With Alcohol Abuse.

BACKGROUND AND AIM: Liver grafts from donors with chronic and active history of alcohol abuse are usually immediately ruled out for use in liver transplantation (LT). The aim of our study is to evaluate the use of those grafts. METHODS: From 2011 to 2016, a study group (Group 1) composed of 5 adult LT patients transplanted with livers from donors with alcohol abuse, was compared with a control group (Group 2) of 10 randomly matched patients who received liver transplants. Preoperative, intraoperative, and postoperative data were compared. RESULTS: Among donors, serum gamma-glutamyl transferase values were significantly higher in Group 1. In recipients, post-LT laboratory exams showed significantly higher peak values of aspartate transaminase and alanine transaminase in Group 1; higher values of aspartate aminotransferase, alanine aminotransferase, and total bilirubin in Group 1 were also recorded on day 0. Early allograft dysfunction occurred at higher rates in Group 1 (80% vs 20%, P = .025), with no differences in early rejection episodes or early surgical repeat interventions. All patients from both groups were alive after 20 ± 10 (range 6-35) months from LT. CONCLUSION: Despite higher rates of early allograft dysfunction, selected liver grafts from donors with alcohol abuse can be accepted for LT with good clinical results.

Predictors of prolonged dysphagia following acute stroke.

Dysphagia following acute stroke frequently necessitates prolonged enteral feeding. There is evidence that early enteral feeding via percutaneous endoscopic gastrostomy (PEG) is both beneficial and safe. The aim of this study was to identify predictors of prolonged dysphagia. The subjects were 149 consecutive patients admitted with acute stroke. Clinical findings and imaging results were prospectively collected, and subsequent progress recorded. Subjects were divided into 3 groups for analysis: no dysphagia; transient dysphagia (< or =14 days); or prolonged dysphagia (>14 days). Validity of the water swallow test as a predictor of aspiration pneumonia was confirmed. Significant associations for prolonged dysphagia were seen with stroke severity, dysphasia and lesions of the frontal and insular cortex on brain imaging. These results indicate that it may be possible to predict patients who will develop prolonged significant dysphagia following acute stroke thereby facilitating referral for insertion of PEG at an earlier time point.

Kinetics and mechanisms of reactions of methyldioxorhenium(V) in aqueous solutions: dimer formation and oxygen-atom abstraction reactions.

The stable compound CH3ReO3 (MTO), upon treatment with aqueous hypophosphorous acid, forms a colorless metastable species designated MDO, CH3ReO2(H2O)n (n = 2). After standing, MDO is first converted to a yellow dimer (lambda max = 348 nm; epsilon = 1.3 x 10(4) L mol-1 cm-1). That reaction follows second-order kinetics with k = 1.4 L mol-1 s-1 in 0.1 M aq trifluoromethane sulfonic acid at 298 K. Kinetics studies as functions of temperature gave delta S++ = -4 +/- 15 J K-1 mol-1 and delta H++ = 71.0 +/- 4.6 kJ mol-1. A much more negative value of delta S++ would be expected for simple dimerization, suggesting the release of one or more molecules of water in forming the transition state. If solutions of the dimer are left for a longer period, an intense blue color results, followed by precipitation of a compound that does, even after a long time, retain the Re-CH3 bond in that aq. hydrogen peroxide generates the independently known CH3Re(O)(O2)2(H2O). The blue compound may be analogous to the intensely colored purple cation [(Cp*Re)3(mu 2-O)3(mu 3-O)3ReO3]+. If a pyridine N-oxide is added to the solution of the dimer, it is rapidly but not instantaneously lost at the same time that a catalytic cycle, separately monitored by NMR, converts the bulk of the PyO to Py according to this stoichiometric equation in which MDO is the active intermediate: C5H5NO + H3PO2-->C5H5N + H3PO3. A thorough kinetic study and the analysis by mathematical and numerical simulations show that the key step is the conversion of the dimer D into a related species D* (presumably one of the two mu-oxo bonds has been broken); the rate constant is 5.6 x 10(-3) s-1. D* then reacts with PyO just as rapidly as MDO does. This scheme is able to account for the kinetics and other results.