Showing papers in "Southern Medical Journal in 2010"

Burnout in medical students: examining the prevalence and associated factors.

Abstract: Objective:Burnout has been described as a syndrome of emotional exhaustion, depersonalization, and decreased personal accomplishment, and may originate during medical school. The objective of this study is to determine the prevalence of burnout and contributing factors in medical students.Methods:A

Acute radiation syndrome: assessment and management.

Abstract: :Primary care physicians may be unprepared to diagnose and treat rare, yet potentially fatal, illnesses such as acute radiation syndrome (ARS). ARS, also known as radiation sickness, is caused by exposure to a high dose of penetrating, ionizing radiation over a short period of time. The time

Pain management by primary care physicians, pain physicians, chiropractors, and acupuncturists: a national survey.

Abstract: Objectives:Chronic pain is a serious public health problem and is treated by diverse health care providers. In order to enhance policies and programs to improve pain care, we collected information about the distribution of pain patients among four major groups of pain management providers: primary c

Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy.

Abstract: Chronic metformin use results in vitamin B12 deficiency in 30% of patients. Exhaustion of vitamin B12 stores usually occurs after twelve to fifteen years of absolute vitamin B12 deficiency. Metformin has been available in the United States for approximately fifteen years. Vitamin B12 deficiency, which may present without anemia and as a peripheral neuropathy, is often misdiagnosed as diabetic neuropathy, although the clinical findings are usually different. Failure to diagnose the cause of the neuropathy will result in progression of central and/or peripheral neuronal damage which can be arrested but not reversed with vitamin B12 replacement. To my knowledge, this is the first report of metformin-induced vitamin B12 deficiency causing neuropathy.

Effect of Helicobacter pylori eradication on insulin resistance, serum lipids and low-grade inflammation.

Abstract: Background/Aim: Many studies have revealed a close relationship between Helicobacter pylori (HP) infection and insulin resistance. The aim of this study was to investigate the effects of HP eradication on insulin resistance, serum lipids and low-grade inflammation. Materials and Methods: This was a prospective, open-label, single-center study which consisted of 159 patients. The patients with HP infection received a 14-day sequential regimen. A HOMA-IR (homeostasis model assessment of insulin resistance) level was used to assess insulin resistance. Results: Eighty-eight patients with HP infection and seventy-one patients without HP infection were studied. HOMA-IR, total cholesterol (TC), triglyceride (TG), LDL cholesterol (LDL-C) and C reactive protein (CRP) levels were significantly higher and HDL-cholesterol (HDL-C) levels were significantly lower in patients with HP infection compared to the patients without HP infection (P < 0.05). The HP eradication rates with a sequential regimen in dyspeptic patients were 53.4%. Six weeks after the end of eradication therapy, the mean fasting insulin, HOMA-IR, TC, TG, LDL-C, and CRP levels in patients with successful eradication were significantly decreased from the pretreatment levels (P < 0.05) and HDL-C level was significantly increased from the pretreatment levels (P < 0.05). The mean fasting insulin, HOMA-IR, TC, TG, LDL-C, CRP levels and HDL-C levels in patients with unsuccessful eradication were not significantly changed from pretreatment levels (P < 0.05). Conclusion: This study showed beneficial effects of HP eradication on insulin resistance, atherogenic lipid abnormalities and low-grade inflammation. The results suggest that HP eradication may prevent coronary artery disease and metabolic syndrome.

Effects of Vitamin D Supplementation on Blood Pressure

Abstract: Objective:Inconsistent findings from epidemiological studies have continued the controversy over the role of oral vitamin D supplementation in reducing blood pressure in normotensive or hypertensive populations.Methods:We performed a literature search up to December 2009, with no restrictions. Only

Improved quality of life, immunoglobulin G levels, and infection rates in patients with primary immunodeficiency diseases during self-treatment with subcutaneous immunoglobulin G.

Abstract: Objectives:Primary immunodeficiency diseases (PIDDs) include a large class of genetically heterogeneous disorders which predispose patients to significant risk of serious and chronic/recurrent infections, as well as reduced quality of life (QoL). Intravenous immunoglobulin (IVIG) therapy improves th

Disability and health-related quality of life after breast cancer surgery: relation to impairments.

Abstract: Background The aim of this study was to determine the prevalence of impairments relevant to upper extremity following breast cancer surgery and its impact on disability and health-related quality of life. Methods Sixty-seven female patients being treated with modified radical mastectomy or breast conserving surgery were included. They were evaluated for impairments (arm edema, loss of handgrip strength, limited shoulder joint range of motion, and pain), physical disability using the disabilities of the arm, shoulder, and hand (DASH) questionnaire, and for health related quality of life by means of the functional assessment of cancer therapy-breast+4 (FACT-B+4). Results The most common impairment observed was arm pain on motion; the cause of 20% variance in disability score (r = 0.203, P = 0.000). Arm pain on motion, anterior chest wall pain, loss of grip strength, and shoulder flexion were significant factors in different domains of quality of life according to the FACT-B+4 questionnaire. Conclusion Pain relief should be the priority of treatment along with the prevention of joint movement restriction to ensure a sufficient quality of life for surgically treated breast cancer patients.

Cisplatin-induced renal salt wasting syndrome.

Abstract: Cisplatin was the first platinum compound to be introduced as a chemotherapeutic agent with antineoplastic activity against a wide variety of solid tumors. Renal impairment with a decline in glomerular filtration has been the classical nephrotoxicity of cisplatin. Renal salt wasting syndrome is yet another, though it is not common. Previous studies were identified by searching the Pubmed database using the following keywords: cisplatin, cisplatin nephrotoxicity, renal salt wasting, and salt loosing nephropathy. Renal salt wasting syndrome has been described in 17 case reports since 1984. It is a rare side effect of cisplatin that manifests with polyuria, hypovolemia, and hyponatremia, and, because of similarities in clinical settings and laboratory values, it is frequently misdiagnosed as a syndrome of inappropriate antidiuretic hormone. Other causes of polyuria and hyponatremia should be excluded. Treatment aims at restoring the lost water and salt. Substituting cisplatin with carboplatin depends on individual clinical settings. Prognosis is excellent, as recovery was the rule in all the reported cases.

Access to medical care, dental care, and prescription drugs: the roles of race/ethnicity, health insurance, and income.

Abstract: Background:After accounting for socioeconomic factors and other demographic characteristics, racial/ethnic disparities in access to care were examined.Methods:Using nationally representative data on 34,403 individuals from the 2004 Medical Expenditure Panel Survey (MEPS), multiple logistic regressio

Overuse of acid suppression therapy in hospitalized patients

Abstract: Background Acid suppression therapy (AST) is one of the most commonly prescribed classes of medications in hospitalized patients. Multiple studies have shown that AST is overused during inpatient admissions. However, minimal data is available regarding the frequency and patient characteristics of those discharged on unnecessary AST. The aims of the study were to examine administration of AST on admission, to characterize the patient population discharged on unnecessary AST and to determine predictive factors for inappropriate administration of AST in hospitalized patients. Methods A retrospective chart review of randomly selected patients admitted to the general medicine service at University of Florida Health Science Center/Jacksonville from August to October 2006 for appropriateness of AST was done. The admitting diagnosis, indications for starting AST, type of AST used, and discharge on these medications was recorded on a case by case basis. Results Seventy percent of patients were started on AST on admission. Of these, 73% were unnecessary. Stress ulcers prophylaxis in low risk patients or the concomitant use of ulcerogenic drugs motivated initiation of therapy most frequently. Sixty nine percent of patients started on inappropriate AST were discharged on the same regimen. Admitting diagnosis, age of patient, length of stay, or concomitant use of ulcerogenic drugs did not predict continuation of unnecessary AST at discharge. Conclusion AST is overused in hospitalized patients. This primarily occurred in low risk patients and was compounded by continuation at discharge. This significantly increases cost to the health care system and the risk of drug interactions.

Postoperative instrumented spine infections: a retrospective review.

Abstract: Background Postoperative infection following posterior instrumentation of the spine is not uncommon and is a potentially catastrophic complication. Removal of the instrumentation is ideal for eradicating infection. However, removal is not always possible from a structural standpoint. An alternative is to treat the patient with antibiotics in combination with irrigation and debridement. Materials and methods All patients undergoing posterior instrumentation of the thoracolumbar spine from a single institution between 1996 and 2004 that developed an infection were retrospectively reviewed. The goal of this study was to determine the effectiveness of treating postoperative spinal instrument infections with antibiotics and irrigation and debridement alone without removal of the hardware. Results Out of a total of 737 spinal surgeries, 26 cases of postoperative infection were found. Nineteen of the patients had early onset infection, and 7 were late onset. Seventeen (90%) of the 19 patients with early onset infections successfully received long term antibiotics with initial retention of instrumentation. Six out of the 7 patients with late onset infection required removal of instrumentation for cure. All patients were considered cured with at least 36 months follow up with one patient still on oral antibiotics using this approach. Conclusions The management of infected spinal instrumentation is dependent on the time of onset. Early onset infections can be successfully treated without instrumentation removal and 4-6 weeks of IV antibiotics followed by a course of oral antibiotics of 4-12 weeks. Late onset infections require instrumentation removal.

Types of hair loss and treatment options, including the novel low-level light therapy and its proposed mechanism.

Abstract: Androgenetic alopecia (AGA) is the most common form of hair loss in men, and female pattern hair loss (FPHL) is the most common form of hair loss in women. Traditional methods of treating hair loss have included minoxidil, finasteride, and surgical transplantation. Currently there is a myriad of new and experimental treatments. In addition, low-level light therapy (LLLT) has recently been approved by the United States Food and Drug Administration (FDA) for the treatment of hair loss. There are several theories and minimal clinical evidence of the safety and efficacy of LLLT, although most experts agree that it is safe. More in vitro studies are necessary to elucidate the mechanism and effectiveness at the cellular level, and more controlled studies are necessary to assess the role of this new treatment in the general population.

Anti-immunoglobulin e in the treatment of refractory atopic dermatitis.

Abstract: Atopic dermatitis (AD) is a common diagnosis seen in both children and adults, and it is often the first manifestation of atopic disease. Research has shown a strong correlation between serum IgE levels, the severity of atopic dermatitis, and co-existing asthma and/or allergic rhinitis. Omalizumab (Xolair, East Hanover, NJ; Genentech, South San Francisco, CA) is a monoclonal antibody to human IgE and is currently Food and Drug Administration (FDA) approved for the treatment of asthma. We present 3 patients with severe, treatment resistant atopic dermatitis whose cutaneous symptoms significantly improved by treatment with omalizumab.

Change in Bilirubin Level Following Acute Myocardial Infarction Is an Index for Heme Oxygenase Activation

Abstract: Objectives Heme oxygenase 1 (HO-1) is rapidly induced by stress, degrading pro-oxidant heme into carbon monoxide, bilirubin, and free iron (Fe). Induction of HO-1 is an important defense mechanism against tissue injury. Here, we tested the hypothesis that HO-1 is activated in the myocardium after acute myocardial infarction (AMI) in humans. Methods Changes in the HO-1 activity after AMI were analyzed by measuring serum levels of bilirubin and Fe. Blood samples were collected in patients with AMI (n = 41) serially after the interventional therapy and compared with non-AMI subjects (n = 18). HO-1 protein levels were measured in a sample of AMI patients (n = 12). Results In AMI patients, but not in non-AMI subjects, serum levels of bilirubin (1.57 fold, P 0.5 mg/dL) had richer collateral flow into the ischemic myocardium. Conclusions These results suggest that heme oxygenase (HO) was activated following AMI, and it was detectable in the serum. Our data provide the first evidence of HO-1 induction following stress in humans. The change in bilirubin level may be a novel index for high collateral flow formation following AMI.

Evaluation and management of shoulder pain in primary care clinics.

Abstract: Shoulder pain is a frequent clinical problem facing primary care physicians. Despite its common occurrence, many clinicians are unfamiliar with the diagnosis and treatment of many common shoulder ailments. Because therapy for most shoulder disorders can be made at the initial consultation, a good history and physical remain paramount. The purpose of this paper is to review the basic approach to diagnosis and management of shoulder pain. It will summarize a pragmatic approach to the initial history, with particular attention to differentiating extrinsic and intrinsic etiologies. Physical exam techniques for evaluating shoulder pain will be reviewed, including provocation testing for specific disorders. Specific disorders covered include supraspinatus tendonitis, subdeltoid bursitis, frozen shoulder, biceps tendonitis, and acromioclavicular (AC) joint arthritis.

Obesity and mortality in persons with obstructive lung disease using data from the NHANES III.

Abstract: Objectives: The objective of this study was to determine the relationship between obesity and all-cause mortality among participants with obstructive lung disease in the National Health and Nutrition Examination Survey (NHANES III). Methods: Public data from a retrospective cohort of the 33,994 participants in NHANES III was analyzed to determine the relationship between obesity and all-cause mortality among participants with obstructive lung disease. Results were analyzed using proportional hazard models and controlled for age, sex, race, smoking status, current oral corticosteroid use, and severity of airway obstruction. Secondary analysis considered time until death from respiratory disease or time until death from chronic lower respiratory disease (excluding asthma). Results: The subset used in the analysis consisted of 2439 persons with 844 documented deaths. Extreme obesity (body mass index [BMI] >40) was significantly associated with increased respiratory disease mortality (hazard ratio [HR] 5.78; 95% confidence interval {CI} [1.09 to 30.61]) and chronic lower respiratory disease mortality (HR 13.69; 95% CI [1.45 to 129.29]). In addition, underweight status (BMI < 18.5) was significantly associated with increased all-cause mortality (HR 2.42; 95% CI [1.31 to 4.46]), respiratory disease mortality (HR 7.10; 95% CI [1.94 to 26.00]) and chronic lower respiratory disease mortality (HR 14.80; 95% CI [2.24 to 97.99]). Conclusion: Underweight adults had increased risk of death from all causes and respiratory conditions, compared to class I obese adults. Extreme obesity was associated with increased risk of death from respiratory conditions, but not all-cause mortality. Additional research is needed to explain the complex relationship between BMI and specific causes of mortality in the context of pulmonary disease.

Adverse drug reactions: Part I.

Abstract: Pharmacovigilance is the process of identifying, monitoring, and effectively reducing adverse drug reactions. Adverse drug reactions (ADRs) are an important consideration when assessing a patient's health. The proliferation of new pharmaceuticals means that the incidence of ADRs is increasing. The goal for all health care providers must be to minimize the risk of ADRs as much as possible. Steps to achieve this include understanding the pharmacology for all drugs prescribed and proactively assessing and monitoring those patients at greatest risk for developing an ADR. Groups at greatest risk for developing ADRs include the elderly, children, and pregnant patients, as well as others. Pharmacovigilance must be effectively practiced by all health care providers in order to avoid ADRs.

Acute adult supraglottitis: current management and treatment.

Abstract: Acute adult supraglottitis can be a serious, life-threatening disease because of its potential for sudden upper airway obstruction. Symptoms and signs of this disease may be nonspecific and may resemble those of upper respiratory tract infection. Unexplained sore throat with tenderness of the anterior neck over the hyoid bone warrant careful examination by flexible laryngoscopy to rule out laryngeal congestion and edema. Laboratory tests are usually not helpful in picking up the diagnosis. Following diagnosis, patients should be hospitalized, started on intravenous antibiotics and their airway closely monitored, as airway obstruction may develop.

Usefulness of CRP and ESR in Predicting Septic Joints

Abstract: Objective:To determine whether erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), or a combination of both was better in diagnosing a septic joint.Methods:A retrospective chart review was done in all patients who had serum assays for ESR or CRP as well as joint fluid analysis over a two

Skin cancer: knowledge, behaviors, and attitudes of college students.

Abstract: Objectives Knowledge, attitudes, and behaviors of college students regarding melanoma and skin protection were examined. Methods We surveyed 492 students at a mid-sized southern university. The Melanoma Risk Behavior Survey was administered in lecture classes. Results Mean knowledge score was 10.6 ± 3.8 (24 questions). A majority of participants knew that sun exposure increases the risk for skin cancer; however, only 29% correctly identified behaviors that reduce this risk. Mean attitude score was 5.26 ± 2.73 (11 questions). Sixty-nine percent agreed that all people should take precautions against skin cancer; however, only 51% believed they themselves should practice sun safe behaviors. Mean behavior score was 1.29 ± 1.22 (9 possible). Only 3.1% reported avoiding the sun during peak hours, and only 5.1% regularly use sunscreen when exposed to the sun. Conclusion Campus programs for increasing awareness of skin cancer risk are warranted. Changing attitudes and behaviors regarding exposure and protective measures is increasingly important.

Amiodarone and thyroid dysfunction.

Abstract: Amiodarone is a potent antiarrhythmic drug associated with thyroid dysfunction. Its high iodine content causes inhibition of 5'-deiodinase activity. Most patients remain euthyroid. Amiodarone-induced thyrotoxicosis (AIT) or amiodarone-induced hypothyroidism (AIH) may occur depending on the iodine status of individuals and prior thyroid disease. AIT is caused by excess iodine-induced thyroid hormone synthesis (type I AIT) or by destructive thyroiditis (type II AIT). If the medical condition allows it, discontinuation of the drug is recommended in type I AIT. Otherwise, large doses of thioamides are required. Type II AIT is treated with corticosteroids. Mixed cases require a combination of both drugs. Potassium perchlorate has been used to treat resistant cases of type I AIT but use is limited by toxicity. Thyroidectomy, plasmapheresis, lithium, and radioiodine are used in select cases of AIT. AIH is successfully treated with levothyroxine. Screening for thyroid disease before starting amiodarone and periodic monitoring of thyroid function tests are advocated.

Why Do Physicians Prescribe Stress Ulcer Prophylaxis to General Medicine Patients

Abstract: Background: Little is known about why physicians prescribe inappropriate stress ulcer prophylaxis (SUP) among nonintensive care unit (ICU) hospitalized patients without supporting evidence. This study seeks to understand which factors influence physician prescribing behavior regarding SUP. Design: We designed a cross sectional web-based survey to assess physicians knowledge, beliefs, and behavior surrounding the prescribing of SUP for non-ICU patients. The survey was emailed to internal medicine residents and hospitalists at a university-affiliated tertiary care hospital. Clinically relevant bivariable associations were examined in logistic regression to determine whether these associations remained after adjustment for potential confounding factors. Results: Sixty-nine percent of physicians reported prescribing SUP to 25% of patients. In multivariable analyses, the following factors were associated with higher level of prescribing (25%) of SUP: fear of gastrointestinal bleeding (OR 2.7, 95% CI 1.07, 7.28) and of the legal repercussions of not prescribing SUP (OR 3.02, 95% CI 1.07, 8.56), whereas knowledge of SUP indications (OR 0.39, 95% CI 0.20, 0.74) and concern about side effects (OR 0.24, 95% CI 0.09, 0.61) were associated with low prescribing behavior. Level of training was not associated with prescribing rate. Less than half of respondents were able to identify a single side effect of proton pump inhibitor therapy. Conclusion: Fear of legal repercussions and ignorance of the side effects of acid suppressive therapy were strongly associated with inappropriate prescribing of SUP. Educating physicians about the adverse effects of acid suppression therapy and about existing national guidelines might reduce inappropriate prescribing.

Resolution of statin-induced myalgias by correcting vitamin D deficiency.

Abstract: Correction of hyperlipidemia with statins is often limited by the side-effect of statin-induced myalgias. Vitamin D deficiency is also associated with myalgias that resolve with correction of the vitamin D deficiency. Myalgias associated with statin therapy may also resolve with correction of vitamin D deficiency. This case report presents a case where cardioprotective lipid levels were achieved with a powerful statin only after correction of vitamin D deficiency.

Very mild stroke patients benefit from intravenous tissue plasminogen activator without increase of intracranial hemorrhage.

Abstract: BACKGROUND: Intravenous recombinant tissue plasminogen activator (IV rt-PA) is an effective medication currently used to treat acute ischemic stroke within three hours of symptom onset in patients with an identifiable clinical deficit measured using the National Institute of Health Stroke Scale (NIHSS). METHODS: We compared the outcomes of 27 identified patients with an NIHSS of 6 or less who received IV rt-PA for acute ischemic stroke treatment within three hours of symptom onset in our center with 24 historic controls from the nationally available National Institute of Neurological Disorders and Stroke (NINDS) study database. RESULTS: The mean initial NIHSS was not significantly different in patients and control groups (mean +/- SD: 4.52 +/- 1.25 and 4.71 +/- 1.4) (P = 0.45). The mean modified Rankin score (mRS) at the time of discharge in patients and control group were 0.78 +/- 1.19 and 1.75 +/- 1.75, respectively. The mRS at discharge demonstrated a statistically significant (P < 0.03) improved clinical outcome for IV rt-PA treated group. The rate of intracranial hemorrhage (ICH) in the IV rt-PA group and control group was not significantly different (P = 1, odds ratio: 0.88, CI: 0.05-14.09). CONCLUSION: This retrospective study demonstrates that administering intravenous rt-PA to patients with a very mild stroke (NIHSS of 6 or less) can lead to improved clinical outcome when compared to patients with similar NIHSS who have not received similar treatment.

Antineoplastic agent-associated serpentine supravenous hyperpigmentation: superficial venous system hyperpigmentation following intravenous chemotherapy.

Abstract: Purpose To review the clinical characteristics and associated antineoplastic agents in patients who developed hyperpigmentation of the superficial venous system after chemotherapy. Background Serpentine supravenous hyperpigmentation was the term coined by Hrushesky to describe increased pigmentation of the skin immediately overlying the venous network used for intravenous infusion of 5-fluorouracil. Subsequently this phenomenon has been observed in individuals treated with other chemotherapeutic agents. Methods A 45-year-old woman with breast cancer who developed serpentine supravenous hyperpigmentation after intravenous 5-fluorouracil is described. Published reports of other individuals who developed antineoplastic agent-associated serpentine supravenous hyperpigmentation are reviewed. Results Serpentine supravenous hyperpigmentation has most commonly been associated with 5-fluorouracil. Other chemotherapy drugs including alkylating agents, antibiotics, anti-microtubules, and proteasome-inhibitors have also caused this distinctive pattern of pigmentation. Serpentine supravenous hyperpigmentation occurs predominately in men who are receiving treatment for solid tumors. Conclusions Serpentine supravenous hyperpigmentation is an uncommon sequelae of antineoplastic therapy. Treatment with the associated drug may be continued since this adverse reaction to the chemotherapeutic agent is benign and self-limiting. The hyperpigmented streaks gradually resolve spontaneously after the medication has been stopped.

Primary language and cultural background as factors in resident burnout in medical specialties: a study in a bilingual US city.

Abstract: Objective:The aim of this study was to identify the degree of burnout among resident physicians enrolled in seven postgraduate training programs at Texas Tech University Health Sciences Center (TTUHSC), Paul L Foster School of Medicine, El Paso, Texas, as it related to residents' age, gender, marit

Influenza vaccination acceptance and refusal rates among health care personnel.

Abstract: Objectives The primary aim of this study was to determine reasons why health care personnel (HCP) in a public health department chose or refused free influenza vaccinations offered at the worksite. Methods In an internal review board-approved study, we offered, through a health nurse at the site, self-administered surveys designed to evaluate HCPs' reasons for choosing or refusing influenza vaccination, HCP knowledge of vaccination recommendations, and other items such as demographic information. We tested for differences between the vaccinated and non-vaccinated cohorts, and conducted multiple logistic regression analysis to identify likely predictors of future vaccine acceptance. Results Predictors of vaccine noncompliance were fear of needles (P ≤ 0.042), fear of getting sick from the vaccine (P ≤ 0.000), disbelief that the vaccine is effective (P ≤ 0.000), ignoring vaccination as a healthy behavior (P ≤ 0.000), and younger age (P ≤ 0.026). Nonvaccinated HCP were less likely than vaccinated HCP to report. Vaccines are encouraged because of (a) minimizing sick days and loss of productivity (P ≤ 0.000); (b) sick patients are exposed to influenza by HCP (P ≤ 0.000); or (c) note any reason (P ≤ 0.006). Conclusion The non-vaccinated group refused the vaccine primarily for reasons related to misconceptions regarding the effectiveness and health risks of the vaccine, as well as a belief that the vaccine is unnecessary. Conversely, the vaccinated cohort chose the vaccine for the primary reasons that the vaccine is effective, a vaccine is demonstrative of healthy behavior choices, and influenza is transmitted both to and from sick patients.

Challenges of abdominal organ transplant in obesity.

Abstract: Obesity is a worldwide epidemic and public health crisis associated with severe comorbidity leading to end organ dysfunction and poorer transplant outcome. Large population studies show decreased patient and graft survival in obese kidney transplant patients. Despite the poorer outcomes, kidney transplant is considered because of the survival benefit as compared to the wait-listed dialysis patients. In liver transplantation, the benefit of transplant as compared to remaining on the list is obvious because there is no viable liver dialysis at this time.Obesity in potential organ donors impacts both medical and surgical issues. Obesity-related kidney disease affects both the remaining and transplanted kidney. Pancreas donor organs are associated with decreased early graft survival. Liver donor organs with significant steatosis lead to an increased risk for delayed function or nonfunction of the organ.Immunosuppressive drugs with variable lipophilicity and altered volume of distribution can greatly affect the therapeutic usefulness of these drugs.Transplant candidates benefit from a multidisciplinary team approach to their care. As the epidemic progresses and less invasive treatments for metabolic surgery evolve, we are likely to see more patients lose weight before transplant as we continue to strive for improved outcomes.

18F-FDG PET/CT evaluation of lymphoma with renal involvement: comparison with renal carcinoma.

Abstract: Objective Lymphoma can arise at any anatomic site, but it is rare to find kidney involvement. The aim of this study was to assess the role of F-flourodeoxyglucose (F-FDG) positron emission tomography (PET)/computed tomography (CT) in detecting lymphoma with renal involvement. Reports of such use of F-FDG PET/CT are limited. Methods Twelve lymphoma patients with renal involvement and 12 renal carcinoma patients were studied with F-FDG PET/CT. Intense F-FDG uptake, suggestive of positivity, was measured in mean standardized uptake values (standardized uptake values [SUV] mean). Results The results of PET/CT were validated by bone marrow, biopsy tissue and/or surgery. F-FDG PET/CT detected lymphoma with renal involvement lesions or renal carcinoma lesions in at least one site in the 24 patients. F-FDG uptake by the lymphoma lesions was much higher than the F-FDG uptake by the renal clear cell carcinomas (SUV mean 6.37 +/- 2.28 vs 2.58 +/- 0.62), and similar to that of renal cell carcinoma and renal collecting duct carcinoma (SUV mean 6.37 +/- 2.28 vs 6.27 +/- 1.15). There were dissimilar morphological changes in the homologous CT. Differing from renal cancer, lymphoma in the spleen, uterus, and bone marrow can easily be diagnosed by F-FDG PET/CT. Conclusion The lesions of lymphoma with renal involvement, and especially those of primary renal lymphoma, are F-FDG avid. PET/CT appears to be useful in comparing these lesions with those of renal carcinoma, especially for primary renal lymphoma.