Elizabeth Marti

Progressive multifocal leukoencephalopathy after stem cell transplantation, unsuccessfully treated with cidofovir

We report a patient with progressive multifocal leukoencephalopathy (PML) after autologous stem cell transplantation (SCT) for non-Hodgkins lymphoma (NHL). This is an unusual association, and to date only seven cases have been reported. This is the first case of PML after SCT treated with cidofovir, and the fifth case treated with this drug in a patient without human immunodeficiency virus (HIV) infection. In the previous four patients treated with cidofovir the outcome was discouraging, as was the case in this patient.

Hypersensitivity and hyperalgesia in somatoform pain disorders

OBJECTIVE In psychiatry, pain disorders not explained by structural lesions have been classified for decades as somatoform pain disorders, the underlying concept being somatization. In a parallel move, somatic medicine has defined an expanding group of similar pain disorders, known as functional pain syndromes. Functional pain syndromes are characterized by enhanced pain sensitivity. The aim of our study was to investigate the proportion of patients with somatoform pain disorders who also meet the criteria of functional pain syndromes and the extent to which patients with somatoform pain disorders also show enhanced pain sensitivity. METHODS Data on pain sensitivity in 120 hospitalized patients were obtained by means of two algometric methods. The group of patients with somatoform pain disorders was further divided into two subsets: patients with and those without a co-diagnosis of a functional pain syndrome. Patients with nociceptive pain served as control group. RESULTS Of the 120 in-patients selected, 67 fulfilled the criteria of a somatoform pain disorder of which 41 (61%) also met the co-diagnosis of a functional pain syndrome. Patients with somatoform pain disorder differed from controls in that they showed enhanced pain sensitivity, irrespective of whether a functional pain syndrome was concomitantly present (P<.001). CONCLUSIONS Somatoform pain disorders show considerable overlap with functional pain syndromes, including enhanced pain sensitivity. This suggests the relevance of integrating somatosensory aspects of pain into a modified understanding of somatoform pain disorders.

Renal Resistance Index in Renal Allograft Recipients: A Role for ADMA

BACKGROUND Renal resistance index, a predictor of kidney allograft function and patient survival, seems to depend on renal and peripheral vascular compliance and resistance. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase and therefore influences vascular resistance. STUDY DESIGN We investigated the relationship between renal resistance index, ADMA, and risk factors for cardiovascular diseases and kidney function in a cross-sectional study. SETTING & PARTICIPANTS 200 stable renal allograft recipients (133 men and 67 women with a mean age of 52.8 years). PREDICTORS Serum ADMA concentration, pulse pressure, estimated glomerular filtration rate and recipient age. OUTCOME Renal resistance index. MEASUREMENTS Renal resistance index measured by color-coded duplex ultrasound, serum ADMA concentration measured by liquid chromatography-tandem mass spectrometry, estimated glomerular filtration rate (Nankivell equation), arterial stiffness measured by digital volume pulse, Framingham and other cardiovascular risk factors, and evaluation of concomitant antihypertensive and immunosuppressive medication. RESULTS Mean serum ADMA concentration was 0.72 +/- 0.21 (+/-SD) micromol/L and mean renal resistance index was 0.71 +/- 0.07. Multiple stepwise regression analysis showed that recipient age (P < 0.001), pulse pressure (P < 0.001), diabetes (P < 0.01) and ADMA concentration (P < 0.01) were independently associated with resistance index. ADMA concentrations were correlated with estimated glomerular filtration rate (P < 0.01). LIMITATIONS The cross-sectional nature of this study precludes cause-effect conclusions. CONCLUSIONS In addition to established cardiovascular risk factors, ADMA appears to be a relevant determinant of renal resistance index and allograft function and deserves consideration in prospective outcome trials in renal transplantation.

Pain drawings in somatoform-functional pain

BackgroundPain drawings are a diagnostic adjunct to history taking, clinical examinations, and biomedical tests in evaluating pain. We hypothesized that somatoform-functional pain, is mirrored in distinctive graphic patterns of pain drawings. Our aim was to identify the most sensitive and specific graphic criteria as a tool to help identifying somatoform-functional pain.MethodsWe compared 62 patients with somatoform-functional pain with a control group of 49 patients with somatic-nociceptive pain type. All patients were asked to mark their pain on a pre-printed body diagram. An investigator, blinded with regard to the patients’ diagnoses, analyzed the drawings according to a set of numeric or binary criteria.ResultsWe identified 13 drawing criteria pointing with significance to a somatoform-functional pain disorder (all p-values ≤ 0.001). The most specific and most sensitive criteria combination for detecting somatoform-functional pain included the total number of marks, the length of the longest mark, and the presence of symmetric patterns. The area under the ROC-curve was 96.3% for this criteria combination.ConclusionPain drawings are an easy-to-administer supplementary technique which helps to identify somatoform-functional pain in comparison to somatic-nociceptive pain.

Donor Effect on Cortical Perfusion Intensity in Renal Allograft Recipients: A Paired Kidney Analysis

Background: The contributions of donor- and recipient-related factors to renal allograft hemodynamics are difficult to dissect due to methodological reasons. We analyzed 28 pairs of kidneys (each pair from the same donor) transplanted to 56 different recipients in order to define the contributions of the donor and the recipient to allograft hemodynamics. Methods: Two different techniques based on color-coded duplex ultrasound were used: renal resistance index (RI; measured in 3 different segmental arteries) and cortical perfusion intensity (PI; calculated as the average PI of selected cortical parenchymal regions during one heart cycle in standardized registered and processed ultrasound videos). All measurements were performed during the same study visit. Results: Donor age was 56 years (median, range 17–78) and recipient age at examination 54 years (range 30–77). Median time after transplant (at the date of examination) was 2.4 years (range 0.7–5.5). RI correlated with pulse pressure (r = 0.64; p < 0.001) and recipient age (r = 0.42; p < 0.03), but not with donor age or transplant function expressed as estimated glomerular filtration rate (eGFR) or PI. In within- and between-pairs ANOVA, donor-derived factors determined eGFR (p < 0.02) and cortical PI (p < 0.03), but not RI. Conclusions: Intrinsic donor-derived factors are associated with GFR and cortical parenchymal perfusion intensity, but not the RI of segmental arteries in renal allografts.