Early cyclosporine withdrawal associated with sirolimus administration is followed by an improvement in renal function, a reduction in the progression of chronic pathologic allograft lesions, and a lower incidence of new cases and severity of CAN during the first year after transplantation. This benefit may result in better long-term graft outcome.

Background Symptoms of gastroparesis based on patient recall correlate poorly with gastric emptying. Aim To determine if symptoms recorded during gastric emptying scintigraphy (GES) correlate with gastric emptying and with symptoms based on patient recall. Methods Patients undergoing GES completed the Patient Assessment of GI Symptoms (PAGI-SYM) assessing symptoms over the prior 2 weeks and a questionnaire for which patients graded six symptoms during GES. A Symptom Severity Index (SSI) represented the mean of six symptoms at each time point. Key Results 560 patients underwent GES for clinical evaluation of symptoms. Of 388 patients included in the study: 232 patients had normal GES (NGES), 156 delayed GES (DGES), and 11 rapid GES (RGES). SSI increased pre- to postprandial for each group: NGES: 0.51±0.07 to 0.92±0.03, DGES: 0.60±0.09 to 1.13±0.05, and RGES: 0.56±0.12 to 0.79±0.13. DGES patients had a higher postprandial SSI than NGES patients (1.13±0.05 vs 0.92±0.03, p<0.05). Postprandial symptoms of stomach fullness (1.9±0.12 vs 1.5±0.09; p=0.011), bloating (1.4±0.11 vs 1.1±0.09; p =0.033), and abdominal pain (1.1±0.08 vs 0.7±0.12; p=0.012) were higher in DGES than NGES. Symptom severity based on PAGI-SYM for 2 weeks prior to GES correlated with symptoms during the test for nausea (NGES r=0.61, DGES r=0.70), stomach fullness (NGES r=0.47, DGES r=0.60), and bloating (NGES r=0.62, DGES r=0.66). Conclusions & Inferences Stomach fullness, bloating, and abdominal pain recorded during GES were higher in patients with delayed gastric emptying than in patients with normal gastric emptying. Symptoms recorded during GES correlated with those during daily life by patient recall.

SUMMARYTwo groups of 32 laying hens (Hyssex Brown) and two groups of 32 23-day-old (Hybro) broiler chickens were fed 2.5 and 5 parts/10 6 of aflatoxin in their diet for 4, 8, 16 and 32 days; 16 hens and 32 chicks were maintained as control groups (0 parts/10 6 ). After the intoxication period, a clearance period was established of 1, 2, 4 and 8 days. Relative weights of liver and kidneys significantly increased in intoxicated hens, but not in broiler chickens. Histological lesions in both types of bird consisted of hepatic cell vacuolation with fatty infiltration. There was a significant decrease (P< 0.001) in egg production in the 5 parts/10 6 group, which started to recover during the clearance period. No morbidity or mortality due to the aflatoxicosis were observed in either type of bird. In intoxicated laying hens, cholesterol levels were not significantly (P> 0.05) different from control values, but triglyceride levels decreased (P< 0.001) in both intoxicated groups. The effect of aflatoxin on calcium and phosphorus levels was important, because on the 4th day their values decreased significantly. Aspartate aminotransferase (AST) serum levels remained normal, whereas alanino aminotransferase (ALT) activity decreased in both intoxicated groups. The activity of serum lactic dehydrogenase (LDH) and gammaglutamil transferase (GGT) increased significantly. In intoxicated broiler chickens, aflatoxins did not alter (P> 0.05) the biochemical parameters studied, except that the serum calcium concentration was lower in the 5 parts/10 6 group. These data indicated that in intoxicated laving hens, a severe clinical biochemical alteration was produced, and that this together with the hepatic lesions observed in hens and broilers may aid disease diagnosis.

bronchial tree or after endoscopic dilatation of a benign anastomotic stricture. Other causative factors have only been reported as solitary cases. 4 Among these, we have found in the literature just 1 other case in which the tracheogastric fistula presented in association with an auto-expandable esophageal wall-stent prosthesis. 5 Symptoms at presentation may range from mild to life-threatening. 3,4 Yet the possibility of a rapid deterioration of the patient's general condition should always be kept in mind. Just on suspicion, a barium esophagogram should promptly be performed for diagnosis. Treatment is always challenging and has to be individually tailored. It will depend on the severity of symptoms, on the size and location of the fistula, and on accompanying conditions. If surgery is required, the procedure of choice is excision of the fistula and closure of the tracheal and esophageal defects. Interposition of a pedicled pleural, omental, or muscle flap has proved to be useful in preventing recurrence of the fistula. The gastric tube should be left in place unless judged as an unviable option. In such case, colonic interposition is indicated to restore the continuity of the gastrointestinal tract. If mediastinitis is present, elimination of the septic focus and extensive drainage of the mediastinum are mandatory. 3,4