Psychiatric disorders in patients undergoing intestinal transplantation.

Background: Psychiatric disorders are common in chronic disease states; intestinal transplantation recipients may therefore be at high risk for psychiatric disorder (PD). We sought to investigate the frequency and type of PD in our cohort of patients undergoing transplantation between 2007 and 2012.

Results: The notes of 25 patients who had undergone transplantations since 2007 were available for analysis.

Prothrombotic disorders in a cohort of 25 patients undergoing transplantation: investigation and management implications.

Background: Many patients referred for intestinal transplantation have a history of thrombosis. We undertook an analysis of transplanted patients to describe the history and frequency of thrombosis, clinical course, and management strategies used.

Results: Twenty-five patients underwent transplantation of intestine containing blocks between 2007 and 2012; 20 of 25 are still alive.

Adult small intestinal and multivisceral transplantation: lessons through the "retrospecto-scope" at a single UK centre from 1991 to 2013.

The first intestinal transplantation in the United Kingdom was performed in Cambridge in 1991. Thirty-eight intestinal transplantations have since been performed in 35 patients. All deaths in the first postoperative month related to hemorrhage, in 2 cases to severe portal hypertension (SPH) and poor venous access in 2.

Quality of life and performance status before and after small intestinal transplantation.

Introduction: Intestinal transplantation (IT) is considered for patients with irreversible intestinal failure who develop life-threatening complications of parenteral nutrition or have extensive intra-abdominal disease requiring evisceration. Developing indications may include quality of life (QOL) considerations and therefore assessment of QOL and performance status (PS) after IT is important. We report QOL and PS before and after IT in our cohort.

Occult invasive aspergillosis infection following multivisceral transplantation.

Patients undergoing multivisceral transplantation are particularly susceptible to post-operative infections due to immunosuppression and the inclusion of bowel in the transplanted graft. These patients typically receive broad-spectrum antimicrobial and antifungal agents as prophylaxis and treatment. However, evidence for this is limited due to the small number of patients undergoing the procedure.

Use of the alpha glucosidase inhibitor acarbose in patients with 'Middleton syndrome': normal gastric anatomy but with accelerated gastric emptying causing postprandial reactive hypoglycemia and diarrhea.

Postprandial reactive hypoglycemia, early satiety and diarrhea are well-recognized side effects following full or partial gastrectomy or gastric bypass. It has only recently been realized, however, that patients with normal gastric anatomy may experience similar symptoms and signs due to primary accelerated gastric emptying (Middleton syndrome). In previous case studies, patients responded well to the use of dietary modification (frequent small-volume meals) alone.

Preoperative comorbidity correlates inversely with survival after intestinal and multivisceral transplantation in adults.

We investigated the relationship between preoperative comorbidity and postoperative survival after intestinal transplantation. Each patient received a score for preoperative comorbidity. Each comorbidity was given a score based on the degree it impaired function (score range 0-3).

The 'not so short-bowel syndrome': potential health problems in patients with an ileostomy.

Aim: The study aimed to determine whether an ileostomy compromises nutritional, hydration and electrolyte status and bone mineral density.

Method: Body weight, body mass index (BMI) and fat and lean body mass (LBM) were measured in 60 patients with an ileostomy [14 small-bowel resection (SBR); 46 non-small-bowel resection (NSBR)] and in 60 age- and sex-matched normal controls. Measurement of plasma sodium, potassium, calcium, magnesium, urea and creatinine and 24-h urinary output of water, Na, K, Ca and Mg was made in 45 NSBR and 14 SBR ileostomists and in all the controls.

A slippery surface... can photographic images of pain improve communication in pain consultations?

Aim: To ascertain the influence of images depicting different qualities of pain on unselected outpatient pain clinic consultations.

Methods: A resource of 64 colour images depicting different qualities of pain was given to patients in clinic waiting rooms, which they could take into consultations and use as a focus for discussion with clinicians. A questionnaire enquiring into the value of such images was completed at the end of each consultation separately and anonymously by clinicians and patients.

A Comparison of the Dynamics and Pharmacokinetics of Ropivacaine 7.5 mg/mL with and without Epinephrine Used for Epidural Anaesthesia in Urological Surgery.

Objective: To investigate the effects of adding a vasoconstrictor to ropivacaine for epidural anaesthesia.

Patients And Methods: This randomised, double-blind study included 44 adults scheduled for urological surgery. Patients received either 20mL ropivacaine 7.

Generalizing from a controlled trial: the effects of patient preference versus randomization on the outcome of inpatient versus outpatient chronic pain management.

Patients accepting randomization in a randomized controlled trial (RCT) may not be representative of the clinical population from which they are drawn, calling into question the generalizability of study findings. Comparison of randomized and non-randomized inpatient and outpatient samples at baseline and in treatment outcomes up to one year was made to determine whether the findings of the RCT generalized to non-randomized patients in the same treatment program. One hundred and twenty one patients with intractable pain, randomized between inpatient, outpatient and waiting list control, were compared with 128 who elected for either inpatient or outpatient treatment.

A comparative study of iatrogenesis, medication abuse, and psychiatric morbidity in chronic pain patients with and without medically explained symptoms.

We report a case control study comparing patients attending a pain clinic whose symptoms were not considered medically explained (cases) with those whose symptoms were considered medically explained (controls). Principal comparisons were psychiatric morbidity, medication use, and iatrogenic factors assessed by interview, and questionnaire measures of anxiety, depression, functional impairment, coping strategies and pain beliefs. Medically unexplained symptoms were associated with the presence of psychiatric morbidity (odds ratio = 3.

Iatrogenic factors and chronic pain.

Objective: Although it is accepted that the etiology of chronic pain is multifactorial, little attention has been given to the possible role of iatrogenesis. The aim of the present study is to identify possible iatrogenic factors in chronic pain patients.

Methods: We report a cross-sectional study of 125 patients attending specialist pain clinics in South London.

Medication misuse, abuse and dependence in chronic pain patients.

We report the prevalence of drug use, misuse, abuse, and dependence in 125 chronic pain patients attending specialist pain clinics in South London. A total of 110 patients (88%) were taking medications for their pain problem. Opioid analgesics (69.

Inpatient vs. outpatient pain management: results of a randomised controlled trial.

Inpatient and outpatient cognitive behavioural pain management programmes for mixed chronic pain patients were compared. Patients were randomly allocated to the 4 week inpatient programme or to the 8 half day per week outpatient programme, or to a waiting list control group. Staff, teaching materials, and setting were the same for the two treatment groups.

The development of a battery of measures for assessing physical functioning of chronic pain patients.

The physical performance of chronic pain patients is of major concern both for their assessment and for treatment evaluation. However, there are few widely used physical tests, a shortage of reliability and validity data on published tests, and an over-reliance on self-report or on clinical measures of dubious generalisability. A set of tests was designed to cover speed and endurance in walking, stair climbing, standing up from a chair, sit-ups, arm endurance, grip strength, and peak flow.

Opiate reduction in chronic pain patients: a comparison of patient-controlled reduction and staff controlled cocktail methods.

This study compares the effectiveness of two methods of opiate reduction in 108 chronic pain patients during a 4 week inpatient pain management programme, and at 1-month and 6-month follow-up. Patients chose either the patient-controlled reduction (PCR) or cocktail reduction method, aiming to complete withdrawal by discharge. Use of opiates and other drugs was recorded, and psychological measures taken, at admission, at discharge, and at follow-ups.