Intrarenal Resistance Index as a Prognostic Parameter in Patients with Liver Cirrhosis Compared with Other Hepatic Scoring Systems

Background and Aims: Patients with advanced liver cirrhosis who develop renal dysfunction have a poor prognosis. Elevated intrarenal resistance indices (RIs) due to renal vascular constriction have been described before in cirrhotic patients. In the current study, we prospectively investigated the course of intrarenal RIs and compared their prognostic impact with those of the Model for End-Stage Liver Disease (MELD) and the Child-Pugh scores. Methods: Sixty-three patients with liver cirrhosis underwent a baseline visit which included a sonographic examination and laboratory tests. Forty-four patients were prospectively monitored. The end points were death or survival at the day of the follow-up visit. Results: In 28 patients, a follow-up visit was performed after 22 8 months (group 1). Sixteen patients died during follow-up after 12 8 months (group 2). Group 2 patients showed a significantly higher baseline RI (0.76 +/- 0.05) than group 1 patients (RI = 0.72 +/- 0.06; p < 0.05). As shown by receiver operating characteristic analysis, the RI and the MELD score achieved similar sensitivity and specificity {[}area under the curve (AUC): 0.722; 95% confidence interval (95% CI): 0.575-0.873 vs. AUC: 0.724; 95% CI: 0.575-0.873, z = 0.029, n.s.] in predicting survival and were superior to the Child-Pugh score (AUC: 0.677; 96% Cl: 0.518-0.837). Conclusion: The RI is not inferior in sensitivity and specificity to the MELD score. Cirrhotic patients with elevated RIs have impaired short- and long-term survival. The RI may help identify high-risk patients that require special therapeutic care. Copyright (C) 2012 S. Karger AG, Base

Technical feasibility and clinical success of direct "free hand" EUS-guided gastroenterostomy in patients with gastric outlet obstruction

Background and study aims  Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with lumen-apposing metal stents (LAMS) appears to be a promising intervention in management of gastroduodenal out obstruction (GOO), particularly for patients for whom surgery is high risk or in a palliative setting. This study aimed to evaluate the technical feasibility, procedure-associated adverse events (AEs), and clinical outcome of direct "free hand" EUS-GE. Patients and methods  This retrospective two-center study included patients who underwent direct "free hand" EUS-GE (April 2017 to March 2021) investigating technical success (correctly placed LAMS), clinical outcome (successful oral nutrition), and management of procedure-associated AEs. "Free hand" was defined as the use of the electrocautery enhanced stent delivery system alone without additional guidewire-assistance for EUS-GE creation. Results  Forty-five patients (58 % women/42 % men; mean age 65 years) with malignant (n = 39), benign (n = 4) or unclear (n = 2) GOO underwent direct "free hand" EUS-GE. The technical success rate was 98 % (44/45). Of the patients, 95% (42/44) had less vomiting and increased ability to tolerate oral food intake after the intervention. In one patient, a second EUS-GE was necessary to achieve sufficient clinical improvement. Procedure-associated AEs were observed in 24 % (11/45) of cases including stent misplacement (n = 7), leakage (n = 1), development of a gastrojejunocolic fistula (n = 1), and bleeding (n = 2), which could be all managed endoscopically. Conclusions  Direct EUS-GE has a favorable risk-benefit profile for patients with GOO, showing high technical success rates, manageable AEs, and rapid symptom relief

Determination of intrarenal resistance index (RI) in patients with multiple myeloma

<p>Abstract</p> <p>Background</p> <p>Renal impairment is a common complication of multiple myeloma occuring in up to 50% of patients at some stage in their disease. Due to occurrence of cast nephropathies we hypothesized circulatory dysregulation (vasoconstriction) in the kidneys with measurable elevation of the resistance index among these patients which would have a diagnostic impact.</p> <p>Subjects and methods</p> <p>36 patients with treated multiple myeloma (21 females, 15 males, mean age 61.6 ± 8.5 years) were prospectively examined by conventional abdominal ultrasound with focussed investigation of the kidneys. First, length of the organs, parenchymal width and characterization of parenchymal echogenicity were determined. Then, intrarenal RI values were measured in segmental and arcuate arteries, respectively, in both kidneys. Additionally, serum creatinine, BUN and GFR of each patient were evaluated. RI values were compared to values of 78 healthy control subjects.</p> <p>Results</p> <p>Mean renal RI was 0.68 ± 0.07 which was slightly higher than in controls with 0.62 ± 0.05, but without statistical significance. Due to the laboratory analyses patients were subdivided in those with normal (group 1, n = 21) and those with impaired (group 2, n = 15) renal function. In both groups kidney size and parenchymal width were normal. Significant more group 2 patients (60%) revealed hyperechogenic par enchyma than group 1 patients (24%) (p < 0.01). Mean renal RI indices were 0.67 ± 0.06 (right) and 0.69 ± 0.06 (left) in group 1 patients and 0.71 ± 0.08 (right) and 0.71 ± 0.07 (left) in group 2 patients and showed no significant difference (p = 0.06 and 0.15).</p> <p>Conclusion</p> <p>Renal RI values are not significantly elevated in patients with multiple myeloma even in those with renal impairment so that no hints to a relevant vasoconstriction could be evaluated. RI seems not to be a relevant parameter for the diagnosis of cast nephro pathy of multiple myeloma patients. Routinely performed ultrasound examination should be more focussed on the qualification of parenchymal echogenicity.</p

Grundlagen der Solarenergieumwandlung auf der Basis von Fluoreszenzkollektoren.

Der Schwerpunkt der Arbeiten lag in der Messung und Untersuchung von Fluoreszenzfarbstoffen und transparenten Matrixmaterialien hinsichtlich ihrer Eignung für den Einsatz in Fluoreszenzkollektoren. Im sichtbaren Spektralbereich konnte dabei auf neue Farbstoffentwicklungen aus dem Displayanwendungsgebiet zurückgegriffen werden. Insgesamt zeigte es sich, daß im sichtbaren Spektralbereich die Kombination von organischem Farbstoff und Plexiglas zu brauchbaren Ergebnissen sowohl hinsichtlich des Wirkungsgrades wie auch der Stabilität führen kann. In beiden Teilbereichen konnten im Laufe des Vorhabens Verbesserungen erzielt werden. Ein praktischer Einsatz ist jedoch.derzeit noch nicht möglich. Erste Versuchskollektoren befinden sich im Dauerversuch auf einem Freiluftmeßstand. Im roten bzw. infraroten Spektralbereich sind die Eigenschaften der Farbstoffe bzw. Kollektoren noch nicht ausreichend. Eine spezielle Farbstoffentwicklung auf diesem Gebiet hat im Frühjahr 1980 bei der Industrie begonnen

Fluoreszenzfarbstoffe mit großen Stokes-Shifts - eine einfache Synthese von [2,2-Bipyridin]-3,3-diol

[2,2-Bipyridin]-3,3-diol (4) wird aus Furoin (8) in einem Schritt über die Zincke-Umlagerung in 32proz. Ausbeute erhalten. Die Fluoreszenzquantenausbeute des Farbstoffs beträgt in Chloroform 50% - Absorptions- und Fluoreszenzspektrum sind vollständig getrennt (TZ 1011). Für den großen Stokes-Shift ist ein intramolekularer Protonentransfer nach dem Förster- Mechanismus verantwortlic

Biliary diseases in heart transplanted patients: a comparison between cyclosporine a versus tacrolimus-based immunosuppression

A cyclosporine (CsA)-based immunosuppression is associated with an increased incidence of cholelithiasis after heart transplantation. It is not known if tacrolimus (Tac) has comparable biliary side effects in humans

Partial purification and characterization of glutathione S-transferase isozymes from the leaves of Juniperus communis, Larix decidua, and Taxus baccata.

Glutathione S-transferases (GST, EC 2.5.1.18) are dimeric enzymes capable to detoxify electrophilic xenobiotics in animals and plants. GST activity for the conjugation of several model compounds including CDNB and DCNB is constitutive in the needles of the coniferous species Juniperus communis, Larix decidua, and Taxus baccata. The enzyme activity was distributed throughout several enzyme isoforms. These isoenzymes could be separated and partially purified in a four step procedure to apparent homogeneity. In the needles of T. baccata, three GST isozymes were present, whereas in the needles of the other species four isoenzymes seemed to be constitutive. All enzymes exhibited acidic pls between 6.3 and 4.0 after isoelectric focusing. The subunit size of the isozymes was between 23 and 29 kD. Whereas GST from crops and weeds are thought to be predominantly homodimeric, we are able to demonstrate that larch and yew tree possess heterodimeric GST isoforms of 26 + 29 kD and 24 + 25 kD, respectively. The catalytic constants for GSH were low and comparable between enzymes and species, but the Km values for CDNB varied substantially. Larch GST was the only GST which showed activity against the potent GST inhibitor ethacrynic acid