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Background: Terlipressin improves renal function in some patients with type-1 hepato-renal syndrome (HRS). Renal contrast-enhanced ultrasound (CEUS), a novel imaging modality, may help to predict terlipressin responsiveness. Objectives: We used CEUS to estimate the effect of terlipressin on the renal cortical microcirculation in type-1 HRS. Methods: We performed renal CEUS scans with destruction-replenishment sequences using Sonovue® (Bracco, Milano Italy) as a contrast agent at baseline and after the intravenous administration of 1 mg of terlipressin, in four patients with type-1 HRS. We analyzed video sequences offline using dedicated software. We derived a perfusion index (PI) at each time point for each patient. Results: Patients 1 and 2 had severe presentation and were admitted to the intensive care unit. Both showed a marked increase in PI (+216% and + 567% of baseline) in response to terlipressin. Patients 3 and 4 had less severe presentations and had a decrease in PI (−53% and −20% of baseline) in response to terlipressin. Patients 1, 2, and 4, but not patient 3, responded to terlipressin therapy with a decrease in serum creatinine to <150 µmol/L. Conclusions: CEUS detected changes in renal cortical microcirculation in response to terlipressin and demonstrated heterogeneous microvascular responses to terlipressin. These initial proof-of-concept findings justify future investigations. [ABSTRACT FROM AUTHOR]

Managing post-operative surgical patients can be complex, with many patients at risk of complications and mortality. We piloted a model for co-management of high risk surgical patients: the post-operative surveillance team (POST). We conducted a survey to test the proposition that POST would be popular with nurses and junior doctors. We conducted a questionnaire survey of nurses and doctors involved with the POST programme. Fifty-three nurses and 10 doctors responded to the survey: 60% response rate. Of 63 respondents: 62 (98%; 95% CI: 92-100%) agreed that POST was valuable, 61 (97%; 95% CI: 89-99%) agreed that POST should continue, and 61 (97%; 95% CI: 89-99%) agreed that they enjoyed working with POST. In open ended responses 39% commented that POST provided supervision, mentoring, education, or collaboration. We conclude that POST was popular with surgical ward nurses and doctors. This popularity is one factor supporting a permanent service. [ABSTRACT FROM AUTHOR]