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Rhabdomyolysis after midazolam administration in a cirrhotic patient treated with atorvastatin

World Journal of Gastrointestinal Pharmacology and Therapeutics 2014年第3期5卷 196-199页

作者： Antonietta Gigante gianluca di lazzaro giraldi Maria Ludovica Gasperini Biagio Barbano Marta Liberatori Liborio Sardo Francesca di Mario Antonella Giorgi Filippo Rossi-Fanelli Antonio Amoroso Department of Clinical Medicine "Sapienza" University of Rome00185 RomeItaly

The administration of statins in patients with liver disease is not an absolute contraindication. Hepatotoxicity is a rare and often dose-related event and in the literature there are only a few described cases of fatal rhab-domyolysis in patients with chronic liver disease after statin administration. During treatment with 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors,the factors responsible for myopathy may either be related to the patient,or due to interactions with other medications that are metabolic substrates of the same isozymes and therefore able to increase blood statin concentration. The most important side effects consist of increased transaminase levels,abdominal pain or muscle weakness,increased serum levels of creatine kinase and rhabdomyolysis. In this article we report a case of fatal rhabdomyolysis with acute renal failure after gastric endoscopy,where midazolam was used as a sedation agent in a patient with chronic liver disease treated with a high dose of atorvastatin. Therefore,we suggest paying particular attention to the potential risks of associating atorvastatin and midazolam in patients with chronic liver disease who need to undergo gastric endoscopy.

关键词： Rhabdomyolysis Chronic liver disease Statins Midazolam Alcoholic liver cirrhosis

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Effectiveness and versatility of biological prosthesis in transplanted patients

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World Journal of Transplantation 2017年第1期7卷 43-48页

作者： Giovanni Vennarecci gianluca Mascianà Edoardo De Werra Giovanni Battista Levi Sandri Daniele Ferraro Mirco Burocchi Giovanni Tortorelli Nicola Guglielmo Giuseppe Maria Ettorre division of Surgical Oncology and Liver Transplantation San Camillo Hospital POIT San Camillo-INMI Lazzaro Spallanzani

AIM To emphasize the effectiveness and versatility of prosthesis, and good tolerance by patients with incisional hernia(IH). METHODS From December 2001 to February 2016, 270 liver transplantations were performed at San Camillo Hospital. IH occurred in 78 patients(28.8%). IH usually appeared early within the first year post-orthotopic liver transplantation. In the first era, fascial defect was repaired by primary closure for defects smaller than 2.5 cm or with synthetic mesh for greater defects. Recently, we started using biological mesh(Permacol?, Covidien). We present a series of five transplanted patients submitted to surgery for abdominal wall defect correction repaired with biological mesh(Permacol?, Covidien). RESULTS In our cases, the use of biological prosthesis(Permacol?, Covidien) have proven to be effective and versatile in repairing hernia defects of different kinds; patients did not suffer infections of the prosthesis and no recurrence was observed. Furthermore, the prosthesis remains intact even in the years after surgery. CONCLUSION The cases that we presented show that the use of biological mesh(Permacol?, Covidien) in transplanted patients may be safe and effective, being careful in the management of perioperative immunosuppression andrenal and graft function, although the cost of the product itself has been the main limiting factor and there is need for prospective studies for further evaluations.

关键词： Incisional hernia Liver transplantation Heart transplantation Biological mesh Surgery Morbidity Risk factors Immunosuppression Infection Recurrence

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