OBJECTIVE -Corneal confocal microscopy (CCM) is a rapid, noninvasive, clinical examination technique that quantifies small nerve fiber pathology. We have used it to assess the neurological benefits of pancreas transplantation in type 1 diabetic patients. RESEARCH DESIGN AND METHODS-In 20 patients with type 1 diabetes undergoing simultaneous pancreas and kidney transplantation (SPK) and 15 control subjects, corneal sensitivity was evaluated using noncontact corneal esthesiometry, and small nerve fiber morphology was assessed using CCM.RESULTS -Corneal sensitivity (1.54 Ϯ 0.28 vs. 0.77 Ϯ 0.02, P Ͻ 0.0001), nerve fiber density (NFD) (13.8 Ϯ 2.1 vs. 42 Ϯ 3.2, P Ͻ 0.0001), nerve branch density (NBD) (4.04 Ϯ 1.5 vs. 26.7 Ϯ 2.5, P Ͻ 0.0001), and nerve fiber length (NFL) (2.23 Ϯ 0.2 vs. 9.69 Ϯ 0.7, P Ͻ 0.0001) were significantly reduced, and nerve fiber tortuosity (NFT) (15.7 Ϯ 1.02 vs. 19.56 Ϯ 1.34, P ϭ 0.04) was increased in diabetic patients before pancreas transplantation. Six months after SPK, 15 patients underwent a second assessment and showed a significant improvement in NFD (18.04 Ϯ 10.48 vs. 9.25 Ϯ 1.87, P ϭ 0.001) and NFL (3.60 Ϯ 0.33 vs. 1.84 Ϯ 0.33, P ϭ 0.002) with no change in NBD (1.38 Ϯ 0.74 vs. 1.38 Ϯ 1.00, P ϭ 1.0), NFT (15.58 Ϯ 1.20 vs. 16.30 Ϯ 1.19, P ϭ 0.67), or corneal sensitivity (1.23 Ϯ 0.39 vs. 1.54 Ϯ 00.42, P ϭ 0.59).CONCLUSIONS -Despite marked nerve fiber damage in type 1 diabetic patients undergoing pancreas transplantation, small fiber repair can be detected within 6 months of pancreas transplantation using CCM. CCM is a novel noninvasive clinical technique to assess the benefits of therapeutic intervention in human diabetic neuropathy. Diabetes Care 30:2608-2612, 2007S omatic polyneuropathy is one of the most common long-term complications of diabetes and is the main initiating factor for foot ulceration and lower extremity amputation (1,2). As 80% of amputations are preceded by foot ulceration, an effective means of detecting and treating peripheral neuropathy would have a major medical, social, and economic impact. With the exception of optimal glycemic control, there are currently no licensed treatments that prevent, slow, or arrest the development of neuropathy (1). The development of new treatments is of paramount importance, but they are hampered by a lack of clinically relevant surrogate end points favored by regulatory authorities (1). We have relied on tests that quantify predominantly large nerve fiber dysfunction, which were principally developed to aid diagnosis and not to assess nerve repair and hence a therapeutic response (3). Thus, nerve conduction studies are useful but only detect an abnormality in large myelinated nerve fibers, whereas thermal and pain thresholds assess thinly myelinated (A␦) and unmyelinated (C) fiber function. Heart rate variability during respiratory stimuli indicates parasympathetic vagal efferent function, and blood pressure change during orthostatic manipulation evaluates sympathetic vasomotor efferents.Although these tests correlate with axonal los...

This study demonstrates that it is feasible to safely transplant potential PT recipients aged 50 and above. However, good medical assessment and careful patient selection is strongly recommended.

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The indications and timing of native nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) is controversial, especially for those undergoing renal transplantation. Post‐transplant unilateral native nephrectomy appears to be the preferred intervention compared to pre‐transplant native nephrectomy. There seems to be substantial additive risk to bilateral over unilateral nephrectomy, especially prior to transplantation. Pre‐transplant native nephrectomy should only be carried out when there are clear indications such as massive size preventing allograft placement, severe pain, early satiety, recurrent bleeding and infections, or suspected malignancy. OBJECTIVE To analyse indications, timing and outcomes of native nephrectomy in autosomal dominant polycystic kidney disease (ADPKD) patients listed for kidney transplantation. PATIENTS AND METHODS A retrospective analysis of all ADPKD patients who had a native nephrectomy prior to or following transplantation between January 2003 and December 2009 at a single centre, including those undergoing the sandwich technique (removal of the most severely affected native kidney prior to transplantation, and the other afterwards), was undertaken. RESULTS There were 35 individuals in our cohort (M : F = 16 : 19), with a median age of 51.5 years (range 43–65). Twenty patients were in the pre‐transplant nephrectomy group, 12 in the post‐transplant group, and three underwent the sandwich technique. Indications for nephrectomy varied but were most commonly pain/discomfort, space for transplantation, ongoing haematuria, recurrent infections, and gastrointestinal pressure symptoms (early satiety). Seven individuals in the pre‐transplant group and three in the post‐transplant group required critical care admission after nephrectomy. Transient renal graft dysfunction occurred in two post‐transplant bilateral nephrectomy patients. Two patients in the bilateral nephrectomy pre‐transplant group and one in the bilateral nephrectomy post‐transplant group died in the immediate post‐operative period. No complications were noted in the sandwich technique group. CONCLUSION Native nephrectomy in ADPKD is a major undertaking associated with significant morbidity especially in the pre‐transplant group. Post‐transplant unilateral nephrectomy appears to be the safest approach with fewest complications.

Bitter Melon (Momordica charantia) is a widely used traditional remedy for hyperglycemia. While the medicinal properties of this plant have been studied extensively using in vitro and animal models, the clinical efficacy and safety in humans is largely unknown. This review discusses the benefits and limitations of bitter melon supplementation in the context of epidemic levels of insulin resistance and pre-diabetes throughout the world.

Left ventricular (LV) pseudoaneurysm is a rare complication that is reported in less than 0.1% of all patients with myocardial infarction. It is the result of cardiac rupture contained by the pericardium and is characterized by the absence of myocardial tissue in its wall unlike true aneurysm which involves full thickness of the cardiac wall. The clinical presentation of these patients is nonspecific, making the diagnosis challenging. Transthoracic echocardiogram and cardiac magnetic resonance imaging are the noninvasive modalities whereas coronary arteriography and left ventriculography are invasive modalities used for the diagnosis. As this condition is lethal, prompt diagnosis and timely management is vital.

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Transplantation into an ileal conduit is an established option for patients with end-stage renal failure and a nonfunctioning urinary tract. Urinary fistulae are more common following these complex transplants. Urinary fistula in this scenario can cause substantial morbidity and even result in graft loss. The management options depend on the viability of the transplant ureter, the level of local sepsis and the overall condition of the patient. Urinary diversion with a nephrostomy and ureteric stents has been described in aiding the healing of urinary leaks in renal transplants into a functioning urinary tract. We describe the successful use of negative wound pressure therapy to eradicate the local sepsis and help the healing of a recurrent urinary fistula following kidney transplantation into an ileal conduit. To our knowledge these are the first such cases reported in the literature.Key words: Ileal conduit, negative pressure wound therapy, renal transplantation, urinary fistula Abbreviations: HLA, human leucocyte antigen; MAG-3, mercaptuacetyltriglycine; NWPT, negative pressure wound therapy.

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