Liver transplantation in Indian Armed Forces—initial experience

Background

This study retrospectively analyses the initial experience of liver transplantation (LT) in the Indian Armed Forces.

Methods

Fifty-three patients underwent LT at Army Hospital (R&R) Delhi Cantt. between March 2007 and March 2011. Of these 35 patients underwent deceased donor liver transplantation (DDLT) and living donor liver transplantation (LDLT) was carried out in 18 patients. The surgical techniques, complications and mortality were analysed.

Results

A high consent rate of 35.9% for organ donation was achieved by the Armed Forces Organ Retrieval and Transplantation Authority (AORTA). Biliary complications occurred in five patients (9.4%). However, most of them could be managed by endoscopic interventions. Hepatic artery thrombosis (HAT) occurred in five patients (9.4%). Of these, two DDLT grafts were revascularised following HAT, by creating extra-anatomic arterial conduits with excellent outcome. The overall mortality was 18.8% (n = 10). There was no significant difference in the overall complications or mortality in patients undergoing DDLT or LDLT.

Conclusion

The overall survival and morbidity in this study is comparable to those from other centres. Urgent revascularisation of grafts following HAT should be attempted as it can salvage grafts with satisfactory outcome. There is a reduction in the incidence of biliary complications with refinements in surgical techniques.Key Words: AORTA, DDLT, Indian Armed Forces, LDLT     

Hypertension in the Progression of Renal Damage

Aprogressivedeteriorationinrenalfunctioninexorablyoccursinmostformsofchronicrenalinsufficiencyfollowingacriticalreductioninfunctioningrenalmass.Thisprogressionofrenalinsufficiency,thatfrequentlycanbelinearlyexpressed,maytakeplaceevenwhentheoriginalcauseof…     

Clinical experience with kidney transplantation in patients older than 65 years

Objective: To explore the peculiarities of kidney transplantation in elderly patients and define the perioperative managements. Methods: The clinical data of kidney transplantation in 29 patients older than 65 years were reviewed, the eldest being 84 years old and the mean age 68.1 years. Results : Four episodes of a-cute rejection (13.80%) were encountered. FK506 toxicity occurred in one case (3. 40%) and lung infection in another (3.40%), who (along with the former 4 patients) all were cured subsequently. In one case, the kidney graft was removed for thrombogenesis of the renal artery. The 1- and 3-year patients/grafts survival of 100% and 96. 5% respectively was achieved, with the longest survival exceeding 5 years. Conclusions: Old age was not the absolute contraindication for kidney transplantation. Strict observance of the indications of kidney transplantation and donor selection with well-matched tissue-typing are crucial in elderly patients. Adequate application of immunosuppressants and effective long-term follow-up are also major factors for long-term allograft survival.     

Autologous stem cell transplantation in myeloma: the St James’s Hospital experience, 1997–2003

Background

High-dose treatment with autologous stem cell transplantation (ASCT) has become the standard of care for patients with myeloma below the age of 65 years.

Aims

We report an audit of 60 patients (median age: 52.5 years) who underwent ASCT in the National Bone Marrow Transplant centre in St James’s Hospital in Dublin between 1997 and 2003 inclusive.

Methods

Clinical and laboratory data were retrieved from patient medical records and hospital information management systems.

Results

Thirty-six patients had IgG, 11 IgA, 1 IgD, 9 light chain and 3 non-secretory MM. Fifty-seven (95%) patients received anthracycline-corticosteroid combination chemotherapy prior to autografting. There was no transplant-related mortality (TRM). Complete (CR) and Partial Responses (PR) were seen in 16 (29.6%) and 29 (53.7%) of those evaluable (n = 54 (90%)). The actuarial Progression-Free (PFS) and Overall Survival (OS) rates at five years are 13% and 55% respectively.

Conclusion

Centre outcome is comparable to published international series and supports the use of ASCT in the treatment of this malignancy.     

A study on oliguric standard in the elderly.

Water deprivation test was done in 44 healthy elderly persons, 26 were male, and 18 were female. They were deprived of the intake of water for 25 hours. The results showed that the maximal renal concentration function both in the elderly males and females was 887 ± 91 mmol / L and 888 ± 127 mmol / L respectively. The renal excretion of waste products in 24 hours both in the elderly males and females was 815 170 mmol / d and 620 132 mmol / d respectively. On the basis of point estimation, the minimal essential urine volume per day in the elderly males and females was 926 ml / d and 708 ml / d respectively, if the daily urine volume of the elderly is less than this level, then, the metabolic products generated per day can not be excreted by the kidney, and it would result in disorders of internal environment. Therefore, the oliguric standard in elderly males and females must be less than 926 ml / d and 708 ml per day respectively.     

Renal Tuberculosis in Children

Renal tuberculosis in children is obviouslyless common and some clinical features of     

Clinical experience with the cordis coronary stent in the Chinese population

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Jaundice in Renal Transplant Recipients

ＪａｕｎｄｉｃｅｉｎＲｅｎａｌＴｒａｎｓｐｌａｎｔＲｅｃｉｐｉｅｎｔｓＸｕＺｈｅｎｑｕａｎ（徐正铨）ＱｉａｎＬｉｘｉｎ（钱立新）ＳｕｉＹｕａｎｇｅｎｇ（眭元庚）ＹｏｕＧｕｏｃａｉ（尤国才）ＺｈｕＸｉａｏｐｉｎｇ（朱孝平）ＤｅｐａｒｔｍｅｎｔｏｆＵｒｏ...     

Clinical features of multiple organ failure in the elderly.

Multiple organ failure (MOF) in the elderly is a new syndrome evolved from multiple organ chronic diseases on the basis of multiple organ dysfunction in the aged. Its characteristics are clinically different from those of MOF due to serious trauma. 122 cases of MOF were analysed retrospectively and their clinical features discussed. MOF with a long course is the natural presentation in many of the elderly before death. Its main precipitating factors are pulmonary infection, metastatic carcinoma, cardiac attack, etc. The sequence of a failure in organs is heart, lung, kidney, liver, etc. The mortality is similar to that of MOF due to trauma. However, those suffering from 4-organ failure can still survive, and instead, the renal failure can be mostly fatal. More attention should be paid to the prevention of MOF in the elderly so as to shorten its developing course.

     

Is point of care testing in Irish hospitals ready for the laboratory modernisation process? An audit against the current national Irish guidelines

Background

The Laboratory modernisation process in Ireland will include point of care testing (POCT) as one of its central tenets. However, a previous baseline survey showed that POCT was under-resourced particularly with respect to information technology (IT) and staffing.

Aims

An audit was undertaken to see if POCT services had improved since the publication of National Guidelines and if such services were ready for the major changes in laboratory medicine as envisaged by the Health Service Executive.

Methods

The 15 recommendations of the 2007 Guidelines were used as a template for a questionnaire, which was distributed by the Irish External Quality Assessment Scheme.

Results

Thirty-nine of a possible 45 acute hospitals replied. Only a quarter of respondent hospitals had POCT committees, however, allocation of staff to POCT had doubled since the first baseline survey. Poor IT infrastructure, the use of unapproved devices, and low levels of adverse incident reporting were still major issues.

Conclusions

Point of care testing remains under-resourced, despite the roll out of such devices throughout the health service including primary care. The present high standards of laboratory medicine may not be maintained if the quality and cost-effectiveness of POCT is not controlled. Adherence to national Guidelines and adequate resourcing is essential to ensure patient safety.     

Surgery in the elderly: is age a risk factor?

This prospective, observational one-year study analyzed 623 patients who were 60 years and older, out of a cohort of 2375 patients who were admitted consecutively to the general surgery wards of the University Hospital of the West Indies (UHWI). Even though only 9.7% of the Jamaican population are 60 years and older, this age group accounted for 26.2% of total admissions. Comparison of elderly and non-elderly patients showed no differences in gender, but less elderly patients were emergency admissions (52% vs 64%, p < 0.001), more underwent surgery (68% vs 60%, p < 0.001), their mean hospital stay was longer (11.5 vs 8.0 days, p < 0.001) and their mortality rate was higher (8.8% vs 1.9%, p < 0.001). Emergency admissions (52%) exceeded elective admissions in the elderly. Forty-four (80%) of the 55 deaths in the elderly group were admitted as emergencies compared to elective admissions (p < 0.001). There were 11 deaths among the 296 elective admissions (3.7%) but 44 deaths among the 327 emergency admissions (13.5%), a significant difference in mortality rates (p < 0.001). Overall, the death rate for males was higher. Cancer was the commonest admission diagnosis (21%) and that amongst mortalities. Steps to improve the opportunities for earlier admission and optimization of care of elderly surgical patients would not only benefit them but would be an important step towards a more efficient use of already scarce resources.     

Progress in the treatment of myocardial infarction with stem cells transplantation

1Introduction Myocardialinfarctionisischemicmyocardial necrosisresultedfromabruptreductionincoronary bloodflowtoasegmentofmyocardium.Myocardial infarctioncaninducecardiacremoldingandresultin heartfailure.Generalmethodsincludingthrombolytic therapy,PTCA,CABGandTMGcanonlyredredge theobturatlybloodvessel,improvemyocardialis chemiaandsavecardiacmuscleclosingtoputres cence,buttheycannotregeneratenecroticcardiac muscle.Thelong datedprognosisisnotgood.Heart transplantationisprobablythebestaltern…     

Dialysis Strategies in Acute Renal Failure

AcuteRenalFailure(ARF),irrespectiveofitscauses,altershomeostasyandtheresultingacuteuremicsyndromeisacomplexentitythatreflectstheintensityofassociatedbiologicalandclinicaldisturbances.Inmanyinstances,atemporaryRenalReplacementTherapy(RRI)willbenecessarytor…     

Maternal brain death — an Irish perspective

Background  

Brainstem death is a concept used in cases in which life-support equipment obscures the conventional cardiopulmonary criteria of death. Brainstem death during pregnancy is an occasional and tragic occurrence.