Levothyroxine Dosing Following Bariatric Surgery.

BACKGROUND: Based on the mechanisms of drug absorption, increased levothyroxine requirements are expected after bariatric surgery. However, there are conflicting data on this topic. This review evaluates the effects of bariatric surgery on levothyroxine dosing. METHODS: Data were obtained from PubMed, Scopus, and review of published bibliographies. RESULTS: Six of 10 studies demonstrated decreased postoperative requirements. Most demonstrated correlations between weight loss and dose. Only 3 case reports and 1 case series demonstrated increased levothyroxine requirements, attributed to malabsorption. CONCLUSIONS: The loss of both fat and lean body mass may counteract malabsorptive effects from surgery, resulting in decreased postoperative levothyroxine requirements. In addition, the reversal of impaired levothyroxine pharmacokinetics and an altered set point of thyroid hormone homeostasis may also contribute to postoperative levothyroxine reductions.

International emergency medicine: a review of the literature.

The field of international emergency medicine has grown rapidly over the past several decades, with an increase in the number of interested individuals and in the range of topics included under its rubric. One of the greatest obstacles, however, faced by international emergency medicine researchers and practitioners alike remains the lack of a high-quality, consolidated, and easily accessible evidence base of literature. In response to this perceived need, members of the Emergency Medicine Residents' Association International Emergency Medicine Committee, in conjunction with members of the Society for Academic Emergency Medicine International Interest Group, embarked on the task of creating a recurring review of international emergency medicine literature. Articles for this first annual review, covering research published in 2005, were selected according to explicit, predetermined criteria that included both methodological quality and perceived impact of the research. It is our hope that this annual review will act as a forum for disseminating best practices, while also stimulating further research in the field of international emergency medicine.

Echocardiography improves detection of rejection after heterotopic mouse cardiac transplantation.

BACKGROUND: Current assessments of cardiac rejection in murine transplant models rely on subjective estimates of the force of the palpable heart beat that have limited sensitivity and precision. METHODS: We used 2-dimensional echocardiography to evaluate changes in left ventricular posterior wall thickness (PWT) in a heterotopic cardiac mouse transplant model of rejection. Nine allografts and 6 isografts were imaged daily for 6 days and harvested. Thirteen allografts were imaged daily and harvested at day 3. RESULTS: Intraobserver variability on PWT was 0.003 +/- 0.09 mm, interobserver variability 0.09 +/- 0.11 mm. Allograft PWT increased after transplantation (0.74 +/- 0.02 mm to 1.28 +/- 0.05 mm at day 5, P <.0001). For isografts, PWT remained constant (0.73 +/- 0.03 mm to 0.85 +/- 0.01 mm) after an initial increase at day 1. Palpation failed to identify rejection at day 3 whereas PWT was already increased (1.15 +/- 0.02 mm in the allografts at day 3 vs 0.85 +/- 0.02 mm in the isografts, P <.0001). There was a relation between histologic score and PWT (P <.0001). CONCLUSION: Two-dimensional echocardiography allows the noninvasive detection and follow-up of cardiac rejection after transplantation. It eliminates the subjectivity of palpation and provides quantitative and reliable indices of rejection.