Biomedical subjects
S V Beath
Publications and source records attributed to S V Beath.
Recovery after severe oxprenolol overdose complicated by rhabdomyolysis.
The first recorded case of beta-blocker overdose complicated by rhabdomyolysis is described.
Closure and summary of Ninth International Small Bowel Transplantation Symposium.
The highlights of The Ninth International Small Bowel Transplantation Symposium included the latest results from the Intestinal Transplant Registry (ITR), which demonstrated that the number of transplants performed annually continued to rise to 180 per year, most of which were performed in the United States, where the greatest number of home parenteral nutrition (PN) patients live (a prevalence of around 40 per million or 10,000 individuals). The three largest programs in the United States all use anti-CD25 monoclonal antibodies, but three different forms of lymphocyte depletion are employed in induction protocols: (1) humanized monoclonal anti-thymocyte globulin; (2) pretreatment of the recipient with Campath; (3) pretreatment of the small bowel allograft with anti-lymphocyte globulin. The main gain in these new approaches has been in the reduction in tacrolimus and steroid exposure. Indeed, the Pittsburgh team reduced tacrolimus to alternate-day dosing and stopped steroids altogether at 6 months in some patients, recording 100% survival in the past 2 years. The ITR demonstration of a difference in survival between adult patients who are hospitalized (40% to 60%) versus those who are still at home (80% to 100% survival) when called to transplant makes it almost unethical to delay evaluating patients for small bowel transplantation once they start experiencing complications on home PN. The input of gastroenterologists is also crucial in making recommendations about isolated liver transplantation for individuals with a potential to come off PN. Several important papers with useful prognostic clinical data with respect to selecting patients for isolated liver transplant were presented. It is evident from demographic surveys that only 2% to 5% adult patients and 5% to 15% children in large, well-resourced PN programs will be unlucky enough to develop life-threatening complications, but they must have rapid access to small bowel transplantation in this event. It is therefore important that the collaboration between gastroenterologists and the intestinal transplant teams continues. These excellent results for small bowel transplantation mean that the time is right for a large cost-effectiveness study comparing small bowel transplantation with PN.
Is serum gentamicin level a good predictor of graft injury in intestinal transplantation?
INTRODUCTION: Following intestinal transplant (SBT), the early diagnosis and treatment of rejection is a major management aim. The diagnosis of rejection is based on histology of stomal biopsies. Oral gentamycin (2.5 mg/kg) was used for selective decontamination of the digestive system. Our hypothesis was that gentamycin might be absorbed in the presence of graft dysfunction. AIM: Our goal was to assess the correlation between serum gentamycin level and the health of the intestinal graft. SUBJECTS AND METHODS: Among 33 SBT performed from 1993 to 2005, serum gentamycin levels were performed once weekly or more often when there was a suspicion of rejection. All data were analyzed retrospectively. RESULTS: Adequate trough levels were achieved for only 23 patients, six of whom had histologically proven rejection and only one did not have a raised gentamycin content. Five patients with raised levels but no rejection included two with severe intestinal ischemia and three with bowel obstruction/ileus. Four of the five patients required laparotomies. CONCLUSION: We concluded that in our study raised serum gentamycin levels were a good predictor of rejection or significant injury to the graft.