Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 8 Articles
There is currently a lack of standard kidney-only procurement technique. Known\ntechniques such as kidney-only procurement using the standard multi-organ procurement\ntechnique could potentially cause more iatrogenic injuries due to less adequate\nexposure. An alternative using the live open kidney donation technique could\nalso be less than ideal due to prior unknown anatomical variation and potential the\ninability to adequately topically cool the kidneys. We describe here a novel easy kidney-\nonly technique leading to an improved exposure, better cold perfusion and topical\ncooling. Herein we show how total bowel evisceration can be achieved by stapling\nthe hepatic hilum, superior mesenteric artery and coeliac trunk. There is a need of a\nkidney only procurement in order to increase the quality of deceased kidney donation\nin our opinion. Results have to be compared in the future to determine the potential\nbenefits....
Background: Patients often suffer from physical and mental stress in dental implant surgery. The aim of this\nprospective study is to investigate the relationship between patient character and blood pressure in dental implant\nsurgery.\nMethods: Fifteen patients were recruited for the present study. All patients had never received implant treatment\nin the past. To evaluate the patientsâ�� personality trait, NEO-Five Factor Inventory (NEO-FFI) was used. All patients\nanswered 50 questions at the first visit and divided in five dimensions: neuroticism, extraversion, openness,\nagreeableness, and conscientiousness. The index of physical stress was evaluated by blood pressure and pulse rate.\nResults: Ten females and five males (mean 55.5 �± 10.6 years) were evaluated in this study. A significant positive\ncorrelation was found between elevation rate of diastolic blood pressure/mean blood pressure and neuroticism\nscore (rs = 0.584, 0.526, p < 0.05). On the other hand, there was no significant correlation between systolic blood\npressure elevation and neuroticism score.\nConclusions: In this limited study, there was significant correlation between neuroticism character and diastolic\nblood pressure or mean blood pressure rising in patients who received implant surgery....
Background: Acute pancreatitis (AP) following KT is a rare and often fatal complication of the early post-transplant\nperiod. Common causative factors for AP are rare after KT; anti-rejection drugs as CyA, prednisone and MMF have\nbeen implicated, although evidence is not strong and we found no reports on possible causative role for mTOR\ninhibitors.\nCase presentation: A 55-year-old Caucasian man with end-stage renal disease due to idiopathic membranoprolipherative\nglomerulonephritis underwent single kidney transplantation (KT) from cadaveric donor. Anti-rejection\nprotocol was based on Basiliximab induction followed by prednisone and mycophenolate mophetil (MMF) and\nCyclosporine; Everolimus (Eve) was scheduled to substitute MMF at week 3. At day 1 he had an asymptomatic\nelevation of pancreatic enzymes, spontaneously resolved. The further course was unremarkable and on day 19 he\nstarted Eve, with following asymptomatic rise in pancreatic enzymes. At day 33 the patient presented with\nabdominal pain and a marked elevation in serum amylase (1383 U/l) and lipase (1015 U/l), normal liver enzymes\nand bilirubin, no hypercalcemia, mild elevation in triglycerids; RT-PCRs for Cytomegalovirus or Epstein-Barr virus\nwere negative. The patient had no history of alcohol abuse; ultrasound, CT and MRI found no evidence of biliary\nlithiasis. CT scans showed a patchy fluid collection in the pancreatic head area, consistent with idiopathic\nnecrotizing pancreatitis. The patient was treated medically and Eve was withdrawn 1 week after. Patient underwent\nguided drainage of the fluid collection, but developed bacterial sepsis; surgical intervention was required with\ndebridement of necrotic tissue, lavage and drainage; immunosuppression was totally withdrawn. Following course\nwas complicated with multiple systemic infection. Transplantectomy for acute rejection was performed, and patient\nentered hemodialysis.\nConclusions: Our patient had a presentation that is consistent for a causative role of Eve. A predisposing condition\n(acute pancreatic insult during transplant surgery) spontaneously resolved, relapsed and evolved rapidly\nin AP after the initiation of treatment with Eve with a consistent time latency. None of the well-known\ncommon causative factors for AP was present. We discourage the use of Eve in patients with recent\nepisodes of sub-clinical pancreatitis, since it may represent a precipitating factor or interfere with resolution....
A 65-year-old woman, who had been suffering from inflexibility, neck and eye pain\nas well as general discomfort and stiffness, experienced an improvement in her\nsymptoms upon the removal of a dental miniscrew implant. However, her symptoms\nreturned when the implant was placed near her foot. Her symptoms continued to\nimprove for 6 months. We hypothesize that the cause of her symptoms is linked to\nelectromagnetic waves attracted by the implant. However, the exact underlying mechanism\nremains unclear, and further research is required in cooperation with the\ndental, medical, and related fields....
Background: Implantable cardioverter defibrillator (ICD) is an effective treatment for secondary prevention of ventricular\ntachycardia/ventricular fibrillation (VT/VF). Left ventricular (LV) remodeling may develop before ICD implant and over time.\nHowever, it remains unclear how LV remodeling affects subsequent risk for recurrence VT/VF in ICD recipients under\noptimal medical therapy.\nMethods: From May of 2004 to June of 2015, 144 patients received ICD implantation for secondary prevention were\nenrolled in this study. All information interrogated from ICD devices during follow-up or ICD therapy history (antitachycardia\npacing and shock therapy) were reviewed and validated the occurrences of VT/VF.\nResults: At a mean follow-up of 1110.5 �± 860.6 days, 53 patients (36.8%) had recurrence of VT/VF episodes and 91\npatients had no recurrence of VT/VF episode after ICD implant. Left ventricular end-diastolic volume (LVEDV) > 163.5 mL\nhad significant predictive value for VT/VF recurrence (area under the curve: 0.602, p = 0.041). Moreover, the percentage of\npatients with LVEDV >163.5 mL was significantly higher in patients with recurrent VT/VF than patients without recurrent\nVT/VF (62.3 vs 40.0%, p = 0.010). Left ventricular ejection fraction â�¤ 30% (p = 0.031), LVEDV > 163.5 mL (p = 0.012) and QRS\nwidth > 125 msec (p = 0.049) were significant predictors for VT/VF recurrence by univariate Cox regression analysis.\nHowever, only LVEDV > 163.5 mL (hazard ratio: 2.549, 95% confidence interval: 1.249 ~ 5.201, p = 0.010) and QRS width\n> 125 msec (hazard ratio: 2.173, 95% confidence interval: 1.030 ~ 4.586, p = 0.042) were independent predictors for\nrecurrence of VT/VF after multivariable adjustment.\nConclusion: LV remodeling and QRS width > 125 msec were independent predictors for VT/VF recurrence in secondary\nprevention ICD recipients under optimal medical therapy, independent of LV ejection fraction....
Background: The use of HCV-positive livers for HCV-positive recipients is becoming more common. Our aim is to\nevaluate long-term outcomes in liver transplant recipients transplanted with HCV antibody-positive organs.\nMethods: From the Scientific Registry of Transplant Recipients (1995ââ?¬â??2013), we selected all adult liver transplant\nrecipients with HCV, and cross-sectionally compared long-term graft loss and mortality rates between those who\nwere transplanted from HCV antibody-positive (HCV+) vs. HCV antibody-negative donors.\nResults: We included 33,668 HCV+ liver transplant recipients (54.0 Ã?± 7.7 years old, 74.1% male, 71.0% white, 23.6%\nwith liver malignancy). Of those, 5.7% (N = 1930) were transplanted from HCV+ donors; the proportion gradually\nincreased from 2.9% in 1995 to 9.4% in 2013. Patients who were transplanted from HCV+ positive donors were\nmore likely to be discharged alive after transplantation (95.4% vs. 93.9%, p = 0.006), but this difference was completely\naccounted for by a greater proportion of HCV+ donors in more recent study years (p = 0.10 after adjustment for the\ntransplant year). After transplantation, both mortality in HCV patients transplanted from HCV+ donors (12.5% in 1 year,\n24.2% in 3 years, 33.0% in 5 years) and the graft loss rate (2.2% in 1 year, 4.8% in 3 years, 7.5% in 5 years) were similar to\nthose in HCV patients transplanted from HCV-negative donors (all p > 0.05).\nConclusions: Over the past two decades, the use of HCV+ organs for liver transplantation has tripled. Despite this, the\nlong-term outcomes of HCV+ liver transplant recipients transplanted from HCV+ donors were not different from those\nwho were transplanted with HCV-negative organs....
Background: Over the last years, less invasive surgical techniques with soft tissue preservation for bone conduction\nhearing implants (BCHI) have been introduced such as the linear incision technique combined with a punch. Results\nusing this technique seem favorable in terms of rate of peri-abutment dermatitis (PAD), esthetics, and preservation of skin\nsensibility. Recently, a new standardized surgical technique for BCHI placement, the Minimally Invasive Ponto Surgery\n(MIPS) technique has been developed by Oticon Medical AB (Askim, Sweden). This technique aims to standardize surgery\nby using a novel surgical instrumentation kit and minimize soft tissue trauma.\nMethods: A multicenter randomized controlled trial is designed to compare the MIPS technique to the linear incision\ntechnique with soft tissue preservation. The primary investigation center is Maastricht University Medical Center. Sixty-two\nparticipants will be included with a 2-year follow-up period. Parameters are introduced to quantify factors such as loss of\nskin sensibility, dehiscence of the skin next to the abutment, skin overgrowth, and cosmetic results. A new type of\nsampling method is incorporated to aid in the estimation of complications. To gain further understanding of PAD, swabs\nand skin biopsies are collected during follow-up visits for evaluation of the bacterial profile and inflammatory cytokine\nexpression.\nThe primary objective of the study is to compare the incidence of PAD during the first 3 months after BCHI placement.\nSecondary objectives include the assessment of parameters related to surgery, wound healing, pain, loss of sensibility of\nthe skin around the implant, implant extrusion rate, implant stability measurements, dehiscence of the skin next to the\nabutment, and esthetic appeal. Tertiary objectives include assessment of other factors related to PAD and a health\neconomic evaluation.\nDiscussion: This is the first trial to compare the recently developed MIPS technique to the linear incision technique with\nsoft tissue preservation for BCHI surgery. Newly introduced parameters and sampling method will aid in the prediction of\nresults and complications after BCHI placement....
Central to the humoral theory of transplantation is production of antibodies by the recipient against mismatched HLA antigens\nin the donor organ. Not all mismatches result in antibody production, however, and not all antibodies are pathogenic. Serologic\nHLA matching has been the standard for solid organ allocation algorithms in current use. Antibodies do not recognize whole\nHLA molecules but rather polymorphic residues on the surface, called epitopes, which may be shared by multiple serologic HLA\nantigens. Data are accumulating that epitope analysis may be a better way to determine organ compatibility as well as the potential\nimmunogenicity of given HLA mismatches. Determination of the pathogenicity of alloantibodies is evolving. Potential features\ninclude antibody strength (as assessed by antibody titer or, more commonly and inappropriately, mean fluorescence intensity) and\nability to fix complement (in vitro by C1q or C3d assay or by IgG subclass analysis). Technical issues with the use of solid phase\nassays are also of prime importance, such as denaturation of HLA antigens and manufacturing and laboratory variability. Questions\nand controversies remain, and here we review new relevant data....
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