transplanted since the "alcohol contract" was implemented (February 2007) and 68 patients transplanted before. Results Overall (n¼100; 62 male, median age 54), 37 patients reported some alcohol intake post-OLT. The proportion of patients returning to any alcohol was 35.3% before the "alcohol contract" and 40.6% after (NS; p¼0.66). For heavy drinking (>21 units [168 g ethanol]/week) this was 16.2% and 15.6%, respectively (NS; p¼1.0). Four patients underwent OLT despite pre-transplant liver histology consistent with active ALD. After OLT, one of these returned to heavy drinking and another denied drinking but had a positive blood alcohol. At explant, 10 patients had features of active ALD: six of these returned to drinking post-OLT. Blood alcohol was measured in only 24 of 63 patients reporting abstinence. Two had positive tests; one of these subsequently disclosed heavy drinking. During follow-up, 23 patients died. Most deaths (87%) occurred in those (63%) who did not return to drinking. Only one death in 673 patient-years of follow-up could be directly attributed to alcohol intake. Conclusion Post-OLT recidivism is higher in our cohort than other published series but the impact of drinking on post-transplant survival remained low. The introduction of an "alcohol contract" may have value in improving public perception of transplantation in ALD patients but is insufficient to alter rates of recidivism. Random blood alcohol testing is inadequate to detect post-transplant drinking. More robust abstinence support and better assessment measures might improve outcomes.

Objective: To assess the correlation between inferior vena cava(IVC) diameter and central venous pressure (CVP) in critical patients admitted in ICU. Study Design and Setting: The cross-sectional pilot study was conducted at Radiology Department of PNS SHIFA Hospital. Methodology: 18-80 years patients were included and patients with severe orthopnea, unable to lie in supine position, morbid obese, pneumothorax, mass in mediastinum, tricuspid regurgitation and intra-cerebral bleeds were excluded. Results: The mean age of 50 patients was 41.44±16.73 years. Mean measurement of CVP was considered as 10.41±4.18 mm. Mean diameter of IVC was 12.65±2.22 mm. The study results showed weak negative correlation between the CVP and IVC (r= - 0.110, p=0.04). It was also predicted that patients with age =50 years showed weak negative correlation between the CVP and IVC (r=-0.290, p=0.034). Similarly, in patients with age >50 years there was strong negative correlation between CVP and IVC (r=-0.680, p=0.045). The study results also showed that in male patients there was weak negative correlation between the CVP and IVC i.e. (r=-0.045, p=0.048). However, in female patients there was moderate positive correlation (r=0.685, p=0.001). Conclusion: Weak negative correlation was found between inferior vena cava diameter on ultrasonography and central venous pressure measurement among critically ill patients.

Background: Loop duodenal switch with sleeve gastrectomy is reported to be associated with accepted rates of diabetes remission in obese patients suffering from type II diabetes. We conducted this study to assess the metabolic outcomes of this operation on obese diabetic patients. Study type: Prospective longitudinal cohort study. Patients and methods: Twenty-five cases were included in the study with mean BMI of 61.15 kg/m 2 . All cases underwent open loop duodenal switch with sleeve gastrectomy. Patients were followed for up after operation for diabetic and metabolic changes. Results: The mean age of the included cases was 34.16 years. Patient weight and BMI were significantly decreased at follow up (p < 0.001). Lipid profile showed a marvelous improvement compared to baseline levels preoperatively. Blood glucose and HbA1c levels were significantly improved (p < 0.001). No significant changes were detected regarding bilirubin or calcium levels. Diabetes full remission was detected in 12 cases (48%) and 8 cases (32%) at 1 and 2 years respectively whereas diabetic control was found 4 cases (16%) at the previously mentioned follow up visits. Regarding complications, GERD was detected in 2 cases (8%) while leakage and intestinal obstruction were detected in one case (4%) for each complication. Conclusion: Based on the results of our study, it is evident that loop duodenal switch with sleeve gastrectomy is effective surgical method in the management of diabetes in obese individuals with accepted morbidity and mortality rates.