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1.
Objectives
In renal transplant recipients, the risk of developing bladder cancer and rate of diagnosis of advanced staged bladder cancer are generally higher than the general population. Also, it is more challenging to treat renal transplant recipients than the regular patient population. We aimed to evaluate the efficacy and safety of radical cystectomy (RC) and urinary diversion with ileal conduit in renal transplant recipients.Methods
We identified 2 patients with prior history of renal transplantation who underwent RC and ileal conduit urinary diversion for bladder cancer. Preoperative clinical and demographic data were presented and outcomes were assessed.Results
The RC and ileal conduit urinary diversion were performed in the first patient 56 months after renal transplantation and in the second patient 64 months after renal transplantation. Clinical staging was high-grade T2 transitional cell cancer of the bladder for patient 1 and T2 with pure squamous cell cancer of the bladder for patient 2. No perioperative or postoperative complication and no graft dysfunction occurred in either patient.Conclusion
Our experience demonstrated that RC with ileal conduit reconstruction in renal transplant recipients is safe and feasible. 相似文献2.
T. Bessede Y. Hammoudi D. Bedretdinova B. Parier H. Francois A. Durrbach G. Benoit 《Transplantation proceedings》2017,49(9):2018-2024
Background
Only surgically irrelevant risk factors including sex, African-American ancestry, or exceptional U-stitch anastomosis have been identified to associate with urinary complications after kidney transplantation. The objective was to identify modifiable and nonmodifiable risk factors associated with urinary complications after kidney transplantation.Methods
A single-center study of 3,129 kidney transplants performed over 40 years was conducted to identify independent risk factors using χ2 tests and logistic regression analysis.Results
We identified the quality of the transplant's ureter, cystographic abnormalities in the recipient, and repeat transplantations as independent risk factors for overall urinary complications occurring after kidney transplantation in multivariable analysis. Obesity was associated with an increased risk of urinary fistula, while the presence of a JJ stent was associated with a reduced risk of urinary fistula. The risk of urinary surgical complications for kidney transplantations was reduced when the kidney was recovered from a living related compared to a deceased donor.Conclusions
The risk factors identified in the present study will allow candidates for kidney transplantation to be more informed and will also allow for surgical modifications to limit the occurrence of urinary complications. 相似文献3.
W.M. Bennett E.L. Simonich A.M. Garre K.M. McEvoy M.A. Farinola T.D. Batiuk 《Transplantation proceedings》2017,49(8):1779-1782
Introduction
Between January 2013 and September 2015, 135 consecutive renal transplant patients were screened prospectively with ultrasound for renal cell carcinoma (RCC).Results
Eighteen ultrasound abnormalities were identified with 4 solid lesions detected. Fifty-six other patients were screened retrospectively by referring nephrology groups, with 6 additional malignancies found.Conclusion
As a result of our data, we recommend and have instituted annual ultrasound screening of native kidneys in all renal transplant patients. 相似文献4.
D.Z. Khan M.E. Kelly J. O&#x;Reilly W. Khan R. Waldron K. Barry I.Z. Khan 《The surgeon》2017,15(4):206-210
Introduction
Diverticulitis is a common surgical admission that presents with a wide range of symptoms and severity. Overall there has been a shift to conservative management practices, including the consideration of non-antibiotic treatment approaches in select cases.Methods
A national survey of all consultant surgeons evaluating their practices was performed. Reasons for changes in management, use of radiological imaging, role of non-antibiotic treatment approaches and indications for elective surgical management were evaluated.Results
Response rate for this survey was 67.7% (n = 67/99). An overwhelming 92.5% stated that computed tomography imaging was routinely used to investigate acute presentations. Interestingly, 22.4% stated they would consider a non-antibiotic treatment approach in uncomplicated diverticulitis. Main reasons for adopting this approach was low inflammatory markers with short duration of symptoms. Co-amoxiclav was the most common antibiotic used for acute diverticulitis, with considerable variability in duration of treatment. Additionally, there was considerable heterogeneity regarding how many recurrences were necessary before surgical management was required.Conclusion
This review highlights substantial variation in the management of diverticulitis across Ireland. Shifts to non-antibiotic treatment approaches for uncomplicated cases are observed, but less so than in Northern Europe. National guidelines are required to establish uniform treatment protocols including indications for surgical resection. 相似文献5.
Background
De novo gastric cancer is a rare complication of liver transplantation.Methods
Surgical treatments of 16 cases with different outcomes were reported in the English literature.Results
De novo gastric cancer (stage II) was diagnosed as the result of epi-gastric discomfort in a recipient 10 years after liver transplantation. The patient received chemotherapy alone and remained well for 26 months.Conclusions
De novo gastric cancer of liver transplantation recipients is a severe complication; early detection and relevant intervention will benefit these recipients. 相似文献6.
Background
The global rise in infectious disease has led the Center for Disease Control and Prevention and the World Health Organization to release new guidelines for the prevention of surgical site infection.Methods
In this article, we summarize current recommendations based on level of evidence, review unresolved and unaddressed issues, and supplement them with new literature.Results
Although the guidelines discuss major issues in reducing surgical site infection, many questions remain unanswered.Conclusion
These guidelines will hopefully help in setting a standard of care based on best evidence available and focus investigators on areas where evidence is lacking. 相似文献7.
Sunil K. Narang Kenneth Keogh Nasra N. Alam Samir Pathak Ian R. Daniels Neil J. Smart 《The surgeon》2017,15(1):30-39
Aim
In 2007 the ACPGBI published a position statement on the management of cryptoglandular fistula in ano. Over the last seven years a number of new treatments have been developed and the aim of this systematic review was to assess their effectiveness.Method
A systematic review of all English language literature relevant to novel treatment strategies for cryptoglandular fistula in ano, published between 1 January 2007 and 31 Dec 2014 was carried out using MEDLINE (PubMed and Ovid), EMBASE (Ovid) and the Cochrane Library of Systematic Reviews/Controlled Trials for relevant literature. Technical notes, commentaries, letters and meeting abstracts were excluded. The different treatments were assessed with regards to fistula closure rate in relation to length of follow up and reported complications.Results
Seventy potential articles published between 1 January 2007 and 31 December 2014 were identified from the initial literature search. Twenty-one articles were included for final analysis although only two were randomized controlled trials, the remainder being retrospective or prospective series.Conclusion
This systematic review has demonstrated that whilst there have been technological advances to treat complex cryptoglandular fistula in ano, these are in an early stage of evolution and although early results were promising they are difficult to reproduce. Longer follow up data is not currently available and these treatments should not be introduced without further evidence. 相似文献8.
R. Leal H. Pinto A. Galvão L. Rodrigues L. Santos C. Romãozinho F. Macário R. Alves M. Campos A. Mota A. Figueiredo 《Transplantation proceedings》2017,49(4):783-786
Introduction
Rehospitalization early post–kidney transplant is common and has a negative impact in morbidity, graft survival, and health costs. Infection is one the most common causes, and identifying the risk factors for early readmission due to infectious complications may guide a preventive program and improve outcome. The aim of this study was to evaluate the incidence, characterize the population, and identify the risk factors associated with early readmission for infectious complications post–kidney transplantation.Methods
We performed a retrospective cohort study of all the kidney transplants performed during 2015. The primary outcome was readmission in the first 3 months post-transplant due to infectious causes defined by clinical and laboratory parameters.Results
We evaluated 141 kidney transplants; 71% of subjects were men, with an overall mean age of 50.8 ± 15.4 years. Prior to transplant, 98% of the patients were dialysis dependent and 2% underwent pre-emptive living donor kidney transplant. The global readmission rate was 49%, of which 65% were for infectious complications. The most frequent infection was urinary tract infection (n = 28, 62%) and the most common agent detected by blood and urine cultures was Klebsiella pneumonia (n = 18, 40%). The risk factors significantly associated with readmission were higher body mass index (P = .03), diabetes mellitus (P = .02), older donor (P = .007), and longer cold ischemia time (P = .04). There were 3 graft losses, but none due to infectious complications.Conclusion
There was a high incidence of early rehospitalization due to infectious complications, especially urinary tract infections to nosocomial agents. The risk factors identified were similar to other series. 相似文献9.
T. Niikura A. Kobayashi M. Kawabe A. Katsuma T. Yamakawa H. Katsumata A. Mafune Y. Nakada I. Yamamoto Y. Tanno I. Ohkido M. Okumi H. Ishida H. Yamamoto T. Yokoo K. Tanabe 《Transplantation proceedings》2017,49(1):78-83
Background
Previously, we explored the histopathologic characteristics of medullary ray injury (MRI) inducing interstitial fibrosis and tubular atrophy (IF/TA) to determine its etiologies, which include calcineurin inhibitor (CNI) toxicity and urologic complications. However, we did not examine the effects of these etiologies on long-term kidney allograft prognosis, because biopsy timing differed among cases.Aim
We examined the influence of early MRI on kidney allograft prognosis using protocol biopsies taken within a 3-month time frame.Methods
We defined early MRI as tubular degeneration with interstitial edema or mild fibrosis localized to the medullary ray. We divided 53 protocol biopsies into 2 groups, with and without early MRI. Early MRI+ cases with isometric vacuolization were classified as CNI toxicity; those with Tamm-Horsfall protein in the interstitium and a thyroidlike appearance were classified as urinary tract system abnormalities; remaining cases were classified as “others.” We compared changes in serum levels of creatinine (sCr) over 3 years and fibrosis extent at 1 year.Results
The sCr levels were significantly higher in the MRI+ group than the MRI? group at 3 years (P = .024). Examining the 3 MRI+ subgroups, only the MRI+ urinary tract system abnormalities group had significantly high sCr levels compared to the MRI? group (P = .019). The MRI+ group showed significant signs of IF/TA at 1 year.Conclusions
Early MRI after kidney transplantation was significantly more likely to develop IF/TA at 1 year and had higher sCr levels at 3 years. In such cases, intervention might preserve graft function over the long term. 相似文献10.
Jonathan Robinson John I. Shin James E. Dowdell Calin S. Moucha Darwin D. Chen 《The Journal of arthroplasty》2017,32(8):2370-2374
Background
Impact of gender on 30-day complications has been investigated in other surgical procedures but has not yet been studied in total hip arthroplasty (THA) or total knee arthroplasty (TKA).Methods
Patients who received THA or TKA from 2012 to 2014 were identified in the National Surgical Quality Improvement Program database. Patients were divided into 2 groups based on gender. Bivariate and multivariate analyses were performed to assess associations between gender and patient factors and complications after THA or TKA and to assess whether gender was an independent risk factor.Results
THA patients consisted of 45.1% male and 54.9% female. In a multivariate analysis, female gender was found to be a protective factor for mortality, sepsis, cardiovascular complications, unplanned reintubation, and renal complications and as an independent risk factor for urinary tract infection, blood transfusion, and nonhome discharge after THA. TKA patients consisted of 36.7% male and 62.3% female. Multivariate analysis revealed female gender as a protective factor for sepsis, cardiovascular complications, and renal complications and as an independent risk factor for urinary tract infection, blood transfusion, and nonhome discharge after TKA.Conclusion
There are discrepancies in the THA or TKA complications based on gender, and the multivariate analyses confirmed gender as an independent risk factor for certain complications. Physicians should be mindful of patient's gender for better risk stratification and informed consent. 相似文献11.
Background
Pancreatic fistula (PF) is the major cause for morbidity and mortality following pancreaticoduodenectomy. The primary aim of this study was to compare the occurrence rate of postoperative PF between isolated Roux-en-Y reconstruction (RYR) and conventional reconstruction (CR) after pancreaticoduodenectomy.Methods
Data of 43 patients who underwent RYC were compared with those of a pair-matched equal number of patients undergoing CR. We also performed a meta-analysis of comparative studies of the two procedures.Results
The case-matched analysis showed no significant difference in PF occurrence between RYR and CR groups (23.3% versus 25.6%; P = 0.80). Meta-analysis of 1498 patients further confirmed this finding, showing a pooled odds ratio of 1.14 (95% confidence intervals, 0.82–1.58; P = 0.43).Conclusion
The use of RYR for pancreaticojejunostomy does not seem to decrease the occurrence rate of postoperative PF in patients undergoing pancreaticoduodenectomy. 相似文献12.
N. Nakamura M. Tanaka M. Tsukamoto Y. Shimano M. Yasuhira J. Ashikari 《Transplantation proceedings》2017,49(1):16-25
Background
Kidneys from non–heart-beating donors are thought to be marginal, and careful evaluation is required. Mass analyzed data are limited, and each transplant surgeon must evaluate these organs on the basis of their own experience.Methods
We analyzed the data of 589 kidneys used for kidney transplantation from 304 non–heart-beating donors from January 2002 through December 2013 at the Japan Organ Transplant Network West Japan Division. The age of the donors, cause of death, and total ischemic time of more than 24 hours were factors that influenced the graft survival of the organs.Results
On the other hand, the final serum creatinine level before donation (maximum, 12.4 mg/dL), the presence and duration of anuria (maximum, 92 hours), and the presence of cannulation did not influence the graft survival rate.Conclusions
In multivariate analysis of Cox proportional hazards regression analysis, graft survival was significantly related to the age of the donor (over 70 years of age), cause of death (atherosclerotic disease), and total ischemic time of more than 24 hours. 相似文献13.
Western Vascular Society guidelines for transfer of patients with ruptured abdominal aortic aneurysm
Matthew W. Mell Benjamin W. Starnes Larry W. Kraiss Peter A. Schneider William C. Pevec 《Journal of vascular surgery》2017,65(3):603-608
Introduction
When a patient with ruptured abdominal aortic aneurysm (rAAA) presents at a facility ill-equipped to provide care, transfer may provide the best chance for survival. Large distances and long travel times provide challenging barriers to prompt and appropriate care in the western United States.Methods
The Western Vascular Society (WVS) adopted a set of guidelines in considering transfer of a patient with an rAAA using published literature, membership survey and input, and existing recommendations. This article reports the guidelines and describes the process and rationale behind their development.Results
Fifteen guidelines for transfer and care of rAAAs were endorsed by the WVS.Conclusions
When local care cannot be provided, transfer guidelines may standardize care for rAAAs and may be applicable across may practice settings. 相似文献14.
Charles M. Lawrie Alvin C. Ong Victor H. Hernandez Samuel Rosas Zachary D. Post Fabio R. Orozco 《The Journal of arthroplasty》2017,32(12):3748-3751
Background
The objective of this study is to determine the risk factors for postoperative urinary retention (POUR) following total hip arthroplasty (THA) under spinal anesthesia.Methods
Consecutive patients who underwent a primary THA without preoperative catheterization under spinal anesthesia were identified in a prospectively collected institutional patient database. All patients were monitored postoperatively for urinary retention on the basis of symptoms and the use of bladder ultrasound scans performed by a hospital technician. If necessary, straight catheterization was performed up to 2 times prior to indwelling catheter insertion.Results
One hundred eighty patients were included in the study. Six patients who required indwelling catheterization for intraoperative monitoring were excluded. Seventy-six patients experienced POUR and required straight catheterization. Fourteen patients ultimately required indwelling catheterization. One patient who was not catheterized developed a urinary tract infection versus none of the patients who were catheterized. POUR was significantly associated with intraoperative fluid volume and a history of urinary retention (P = .018 and .023, respectively). Intraoperative fluid volumes of 2025, 2325, 2875, and 3800 mL were associated with a specificity for POUR of 60%, 82.7%, 94.9%, and 98%, respectively. No significant associations were found among catheterization and gender, body mass index, American Society of Anesthesiologists class, history of polyuria, history of incontinence, postoperative oral narcotics use, or surgical duration.Conclusion
Patients with a history of prior urinary retention and those who receive high volumes of intraoperative fluid volume are at higher risk for POUR following THA performed under spinal anesthesia. 相似文献15.
J.A. Fridell R.S. Mangus C.M. Thomas C.A. Kubal J.A. Powelson 《Transplantation proceedings》2017,49(10):2310-2314
Introduction
Transplantation of pancreas allografts procured from donation after circulatory death (DCD) remains uncommon. This study reviews a series of pancreas transplants at a single center to assess the donor and recipient characteristics for DCD pancreas transplant and to compare clinical outcomes.Methods
DCD procurement was performed with a 5-minute wait time from pronouncement of death to first incision. In 2 patients, tissue plasminogen activator was infused as a thrombolytic during the donor flush. All kidney grafts were placed on pulsatile perfusion.Results
There were 606 deceased donor pancreas transplants, 596 standard donors and 10 DCD donors. Of the 10 DCD transplants, 6 were simultaneous pancreas-kidney and 4 were pancreas transplant alone. The average time from incision to aortic cannulation was less than 3 minutes. The median total ischemia time for the DCD grafts was 5.4 hours, compared with 8.0 hours for standard donors (P = .15). Median length of hospital stay was 7 days for both groups, and there were no episode of acute cellular rejection in the first year post-transplant for the DCD group (4.2 % for standard group, P = .65). There was no difference in early or late graft survival, with 100% graft survival in the DCD group up to 1 year post-transplant. Ten-year Kaplan-Meier analysis shows similar graft survival for the 2 groups (P = .92).Conclusions
These results support the routine use of carefully selected DCD pancreas donors. There were no differences in graft function, postoperative complications, and early and late graft survival. 相似文献16.
S. Abu-Sultaneh M.J. Hobson A.C. Wilson W.C. Goggins M.E. Nitu R. Lutfi 《Transplantation proceedings》2017,49(9):2060-2064
Introduction
Advances in organ allocation, surgical technique, immunosuppression, and long-term follow-up have led to a significant improvement in kidney transplant outcomes. Although there are clear recommendations for several aspects of kidney transplant management, there are no pediatric-specific guidelines for immediate postoperative care. The aim of this survey is to examine practice variations in the immediate postoperative care of pediatric kidney transplant patients.Methods
We surveyed medical directors of Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)-affiliated pediatric intensive care units regarding center-specific immediate postoperative management of pediatric kidney transplantation.Results
The majority of PALISI centers admit patients to the pediatric intensive care unit postoperatively, and 97% of the centers involve a pediatric nephrologist in immediate postoperative care. Most patients undergo invasive hemodynamic monitoring; 97% of centers monitor invasive arterial blood pressure and 88% monitor central venous pressure. Most centers monitor serum electrolytes every 4 to 6 hours. Wide variation exists regarding blood pressure goal, fluid replacement type, frequency of obtaining kidney ultrasound, and use of prophylactic anticoagulation.Conclusion
There is consistent practice across PALISI centers in regards to many aspects of immediate postoperative management of pediatric kidney transplantation. However, variation still exists in some management aspects that warrant further discussions to reach a national consensus. 相似文献17.
Objective
To summarise current knowledge of Internal anal sphincter.Background
The internal anal sphincter (IAS) is the involuntary ring of smooth muscle in the anal canal and is the major contributor to the resting pressure in the anus. Structural injury or functional weakness of the muscle results in passive incontinence of faeces and flatus. With advent of new assessment and treatment modalities IAS has become an important topic for surgeons. This review was undertaken to summarise our current knowledge of internal anal sphincter and highlight the areas that need further research.Method
The PubMed database was used to identify relevant studies relating to internal anal sphincter.Results
The available evidence has been summarised and advantages and limitations highlighted for the different diagnostic and therapeutic techniques.Conclusion
Our understanding of the physiology and pharmacology of IAS has increased greatly in the last three decades. Additionally, there has been a rise in diagnostic and therapeutic techniques specifically targeting the IAS. Although these are promising, future research is required before these can be incorporated into the management algorithm. 相似文献18.
Background
Extravesical Lich-Gregoir ureteroneocystostomy (UC) is the most widely used method for urinary reconstruction during kidney transplantation. Sometimes it is difficult to perform UC in cases with disused atrophic bladder. Pyelo-ureteral anastomosis (PUA) and uretero-ureteral anastomosis (UUA) may be preferred to UC for these patients.Methods
We retrospectively reviewed the charts of 833 kidney transplant recipients operated on by our transplantation team between July 2010 and November 2014. The patients were divided into two groups: Group I consisted of 16 patients who underwent end-to-side UUA and Group II consisted of 20 patients who underwent end-to-end UUA. The two groups were compared in terms of efficacy, safety, and graft function.Results
As we performed end-to-side UUA as a relatively new technique compared with end-to-end UUA, the post-transplantation follow-up period of Group II was significantly longer than Group I (P = .000), but all the patients in both groups had at least 1 year of follow-up. Because the first two patients in Group II, who underwent native ureteral ligation without nephrectomy, developed hydronephrosis in their native kidneys, requiring nephrectomy in the post-transplantation period, we performed native nephrectomy in all of the remaining patients in this group. That is why the mean operative time was significantly longer in Group II compared with Group I (P = .000). There was no significant difference between the two groups in terms of postoperative surgical complications, post-transplantation urinary infections, and graft function.Conclusion
End-to-side UUA without native ureteral ligation is a safe surgical technique for urinary tract reconstruction during kidney transplantation in patients with disused atrophic bladder. 相似文献19.
G.S. Wu Q.C. Zhao Z.S. Li Y. Wu W.Z. Wang M.B. Li H. Shi M. Wang D.L. Chen J.Y. Zheng X. Wang D.M. Fan 《Transplantation proceedings》2017,49(1):232-236
Background
Antibody-mediated rejection (ABMR) has recently surfaced as a potential form of graft dysfunction after intestinal transplantation.Methods
We present a case of an intestinal transplant recipient who developed late-onset ABMR 12 years after living-donor transplantation. An 18-year-old male recipient with a history of extensive intestinal resection secondary to acute bowel volvulus exhibited an excellent baseline immune profile for transplantation, including ABO-identical and HLA-haploidentical to the donor; a negative cross-match with a panel reactive antibody of 3.0%.Results
Post-transplantation immunosuppression consisted of tacrolimus, mycophenolate mofetil (MMF), and prednisone within the first year, followed by tacrolimus and MMF in the second year, and maintenance with tacrolimus monotherapy thereafter. The recipient experienced a single episode of indetermined acute cellular rejection 3 months after transplantation. Since then, he did not require any parenteral nutrition and had completely reintegrated with society. Twelve years later, the patient developed persistent diarrhea associated with transplant biopsy diffuse C4d deposition and circulating donor-specific antibodies. After the use of rituximab and intravenous immunoglobulin, the recipient stabilized 17 years after transplantation with complete recovery of intestinal mucosal damage.Conclusion
Late-onset ABMR can emerge after transplantation and must be considered a possible cause of graft dysfunction in long-term intestinal transplantation survivors. 相似文献20.
M. Lejman K. Drabko B. Styka D. Winnicka M. Babicz I. Jaszczuk J.R. Kowalczyk 《Transplantation proceedings》2017,49(8):1903-1910