Improving pancreas graft utilization through importation

Background

We analyze our outcomes utilizing imported allografts as a strategy to shorten wait list time for pancreas transplantation.

Methods

This is an observational retrospective cohort of 26 recipients who received either a locally procured (n = 16) or an imported pancreas graft (n = 10) at our center between January 2014 and May 2017. Wait list times of this cohort were compared to UNOS Region 9 (New York State and Western Vermont). Hospital financial data were also reviewed to analyze the cost‐effectiveness of this strategy.

Results

Imported pancreas grafts had significantly increased cold ischemia times (CIT) and peak lipase (PL) levels compared to locally procured grafts (CIT 827 vs 497 minutes; P = .001, PL 563 vs 157 u/L; P = .023, respectively). There were no differences in graft or patient survival. The median wait time was significantly lower for simultaneous kidney‐pancreas transplants at our center (518 days, n = 21) compared to Region 9 (1001 days, n = 65) P = .038. Despite financial concerns, the cost of transport for imported grafts was offset by lower standard acquisition costs.

Conclusions

Imported pancreas grafts may be a cost‐effective strategy to increase organ utilization and shorten wait times in regions with longer waiting times.     

A novel risk score for severe ARDS patients undergoing ECMO after retrieval from peripheral hospitals

Background

Extracorporeal Membrane Oxygenation in severe ARDS unresponsive to conventional protective ventilation is associated with elevated costs, resource and complications, and appropriate risk stratification of candidate patients could be useful to recognize those more likely to benefit from ECMO. We aimed to derive a new outcome prediction score for patients retrieved by our ECMO team from peripheral centers, including systematic echocardiographic evaluation before ECMO start.

Methods

Sixty‐nine consecutive patients with refractory ARDS requiring ECMO transferred from peripheral centers to our ICU (a tertiary ECMO referral center), from 1 October 2009 to 31 December 2015, were assessed.

Results

All patients were transported on ECMO (distance, median 77, range 4–456 km) The mortality rate was 41% (28/69). Our new risk score included age ≥ 42 years, BMI < 31 kg/m², RV dilatation, and pH < 7.35. The proposed cut off (Youden's index method) of nine had a sensitivity of 96% and a specificity of 30% (AUC‐ROC: 0.85, 95% CI: 0.76–0.94, P < 0.001). When assessing the discriminatory ability of our risk score in the population of local patients, survivors had a mean value of 15.4 ± 8.6, whereas non‐survivors showed a mean value of 20.1 ± 7.4 (P < 0.001).

Conclusions

Our new risk score shows good discriminatory ability both in patients retrieved from peripheral centers and in those implanted at our center. This score includes variables easily available at bedside, and, for the first time, a pathophysiologic element, RV dilatation.     

Mid- to long-term outcomes of cardiovascular tissue replacements utilizing homografts harvested and stored at Japanese institutional tissue banks

Purpose  

We reviewed our clinical experiences with cardiovascular homografts harvested and preserved at our institutional tissue banks.     

Laparoscopic correction of peritoneal catheter dysfunction

Purpose  

To present our experiences with laparoscopic repair of peritoneal catheter dysfunction     

Management of complex urogenital fistulae in the female

Objective  

To present our experience in the management of complex genitourinary fistulae in the female.     

Application of hormonal treatment in hypogonadotropic hypogonadism: more than ten years experience

Objective  

To demonstrate the efficacy of hormone treatment on the patients with hypogonadotropic hypogonadism (HH), we summarized our more than 10 years experience.     

Surgical treatment of intrathoracic hydatid disease: A 5-year experience in an endemic region

Purpose  

To present our recent surgical experience in treating patients with intrathoracic hydatidosis.     

Survival in prostate cancer patients ≥70 years after radical prostatectomy and comparison to younger patients

Purpose  

The purpose of our study was to evaluate and compare the survival in prostate cancer (PCa) patients who underwent radical prostatectomy (RP) < and ≥70 years.     

Survival and complications following Gamma Knife radiosurgery or enucleation for ocular melanoma: a 20-year experience

Background  

We present our experience in treating ocular melanoma at the National Centre for Stereotactic Radiosurgery in Sheffield, UK over the last 20 years.     

Results of locked flexible intramedullary nailing of metacarpal fractures: a case series

Purpose  

We present our case series on the use of flexible locked intramedullary nails in the management of metacarpal fractures.     

Traumatic extremity amputation in a Nigerian setting: patterns and challenges of care

Purpose  

We aimed to determine the epidemiological pattern and highlight challenges of managing traumatic amputation in our environment.     

Primary Midgut Volvulus in Adults: Report of Two Cases and Review of the Literature

Introduction  

This is a report of two male patients (35 and 54 years old, respectively) admitted to our surgical department with signs of small-bowel obstruction.     

The use of the Lima reverse shoulder arthroplasty for the treatment of fracture sequelae of the proximal humerus

Background  

Experience treating proximal humerus fracture sequelae with reverse total shoulder arthroplasty is limited. We report our results.     

Less invasive approaches for the treatment of cervical schwannomas: our experience

Purpose  

The purpose of our paper is to illustrate our experience with minimally invasive approaches for the treatment of cervical schwannomas. Moreover, a brief review of the literature was conducted.     

Biliopancreatic Diversion with Roux-en-Y Gastric Bypass and Long Limbs: Advances in Surgical Treatment for Super-obesity

Background  

Over the past 14 years, we have used different malabsorptive bariatric operations to treat super-obesity. We compared the efficacy and safety of our preferred procedure for the last 8 years with previous methods used in super-obese.     

Retrospective and consecutive analysis of the long-term outcomes of the SBG stem: a 15-year follow-up study

Background  

In 1991, 230 cementless total hip arthroplasties (THAs) with anatomical Stolzalpe-Buchner-Graf (SBG) stems were implanted in 230 patients at our hospital. Patients were examined retrospectively and consecutively 15 years after the operations.     

Natura Abhorret a Vacuo—use of fibrin glue as a filler and sealant in neurosurgical “dead spaces”. Technical note

Objective  

The objective of this study is to report our experience and illustrate our technique in the use of fibrin glue in the treatment of post-operatory cerebrospinal fluid (CSF) leaks and collections following different neurosurgical procedures.     

The significance of age on success of surgery for patients with varicocele

Objectives  

The aim of our study was to assess the impact of patient age on sperm characteristics, and hormonal levels following varicocelectomy.     

Clinical features and surgical treatment of trigeminal neuralgia caused solely by venous compression

Purpose  

To summarize our experience and lessons of microvascular decompression surgery for trigeminal neuralgia caused solely by venous compression.     

The clinical characteristics of female patients with Fournier’s gangrene

Introduction and hypothesis  

Our aim was to review our experience with Fournier’s gangrene in female patients.