Study of factors that affect complications after renal transplantation

There are no multifactorial studies of complications after renal transplant in the Hispanic population. The objective of this study was to identify which factors are associated with the development of complications after renal transplantation. This retrospective study was performed on all patients transplanted in the Puerto Rico Transplant Program during 2002. Independent variables included preoperative albumin, white blood cell (WBC) count, hemoglobin, creatinine, weight, height, body mass index (BMI), type of dialysis, time on dialysis, and urine production after transplant. Dependent parameters included posttransplant diuresis, wound infection, wound dehiscence, lymphoceles, acute tubular necrosis, length of stay, postoperative weight, graft survival, and patient survival. Data were analyzed with parametric and nonparametric techniques using STAT 200 software. Sixty-four patients were included in the study: 37 male, 27 female. No significant differences in complication rate or length of stay were found with age, preoperative albumin, WBC count, hemoglobin, creatinine, weight, height, dialysis modality, and donor type. Significant factors included type of dialysis, time on dialysis, and BMI. Preoperative albumin if > 3 was not a prognostic indicator for the development of surgical complications following renal transplantation. Only preoperative weight, BMI, and dialysis duration were significant factors in the development of postoperative complications and prolonged hospital stay in this sample Hispanic transplant population. These data are important in formulating selection, education, and transplant management policy.     

Radiation-induced sarcomas of bone: factors that affect outcome

We identified 42 patients who presented to our unit over a 27-year period with a secondary radiation-induced sarcoma of bone. We reviewed patient, tumour and treatment factors to identify those that affected outcome. The mean age of the patients at presentation was 45.6 years (10 to 84) and the mean latent interval between radiotherapy and diagnosis of the sarcoma was 17 years (4 to 50). The median dose of radiotherapy given was estimated at 50 Gy (mean 49; 20 to 66). There was no correlation between radiation dose and the time to development of a sarcoma. The pelvis was the most commonly affected site (14 patients (33%)). Breast cancer was the most common primary tumour (eight patients; 19%). Metastases were present at diagnosis of the sarcoma in nine patients (21.4%). Osteosarcoma was the most common diagnosis and occurred in 30 cases (71.4%). Treatment was by surgery and chemotherapy when indicated: 30 patients (71.4%) were treated with the intention to cure. The survival rate was 41% at five years for those treated with the intention to cure but in those treated palliatively the mean survival was only 8.8 months (2 to 22), and all had died by two years. The only factor found to be significant for survival was the ability to completely resect the tumour. Limb sarcomas had a better prognosis (66% survival at five years) than central ones (12% survival at five years) (p = 0.009). Radiation-induced sarcoma is a rare complication of radiotherapy. Both surgical and oncological treatment is likely to be compromised by the treatment received previously by the patient.     

important social factors that affect organ transplantation in Islamic countries

Social attitudes and beliefs have direct and strong impact on people's acceptance of organ donation and brain death, and therefore affect the entire practice of organ transplantation. The views differ from one society to another, and they at least partially explain regional variations in the world with respect to success of organ transplantation. Social attitudes and ethics in Islamic countries are closely intertwined with Islamic tradition, teachings and heritage. These positions are strongly adhered to in many Islamic countries, and by Moslems who live in countries that are not predominantly Islamic. We feel that transplant physicians and transplant coordinators should be aware of these factors when dealing with potential donors and recipients. Decision-making can be facilitated if these issues are considered prior to consulting with a donor's family and if an appropriate compassionate explanation of need for transplantation and basis of brain death diagnosis is provided based on a knowledge of underlying social constraints. Such steps can make the donation process smoother for both health care workers and the family.     

Soluble forms of CD95 and CD95 ligand after living related liver transplantation

BACKGROUND: Soluble forms of CD95 and CD95 ligand (sCD95 and sCD95L, respectively) can increase in the serum of patients with some inflammatory disease. In this study, we investigated the serum levels of sCD95 and sCD95L in liver transplantation recipients. METHODS: Serum levels of sCD95 and sCD95L in living related liver transplant recipients were analyzed by ELISA and their relation to the clinical findings estimated. RESULTS: Serum samples from the recipients did not show detectable levels of sCD95L but showed significantly increased levels of sCD95. The increase of sCD95 was positively associated with that of total-bilirubin and incidence of rejection, infection, and graft ischemia. CONCLUSIONS: The present results indicate an existence of sCD95 in the recipients of living related liver transplants. The increased serum levels of sCD95 may modify the immunological situation of the recipients after transplantation or represent the ongoing graft damage.     

The management of chronic wounds: factors that affect nurses' decision-making

This study sought to determine how registered nurses make decisions regarding the management of chronic wounds. A self-administered questionnaire consisting of both Likert-type and open-ended questions was used to survey registered nurses working in hospitals and community services in a large Australian city. A total of 140 questionnaires were returned from a variety of clinical settings. The study revealed that registered nurses had a significant role in chronic wound management. However, they relied primarily on their own experience and that of colleagues for decision making in which they had varying degrees of autonomy. The authors conclude that nurses and medical staff require more objective, research-based education on wound assessment and management.     

Perioperative factors that affect long-term adjustment to an incontinent ostomy.

PURPOSE: We sought to identify perioperative factors associated with long-term adjustment to an incontinent ostomy. METHODOLOGY: The Ostomy Adjustment Scale (OAS), a demographic form, and a $5 gift certificate were mailed to 200 ostomates. Associations between items from the Survey of Perioperative Factors of Ostomy Adjustment, demographic forms, and total OAS scores were assessed using bivariate and multiple linear regression analysis. RESULTS: The survey response rate was 74%. About half (70/146, 49%) of the respondents were women, 99% (144/145) were Caucasian, and 74% (109/146) were married. Their mean age was 65+/-14 years. Fifty-six percent (79/141) of the respondents had an ileostomy, 28% (39/141) had a colostomy, and 15% (21/141) had a urostomy. The mean OAS score for all the respondents was 159.5+/-26.2, indicating a good overall adjustment to an incontinent ostomy. In bivariate analyses, the factor associated with a lower OAS score indicating poorer adjustment was distress related to affording and obtaining ostomy supplies. The more helpful the ostomates found the preoperative education provided by a wound, ostomy, and continence specialist nurse, the better was their adjustment as indicated by a higher OAS score. Having ongoing/recurrent illness and having an ostomy created by a specialty surgeon were also associated with better adjustment. When multiple factors were considered in a stepwise regression analysis, adjustment was lowered by distress about obtaining ostomy supplies. Adjustment was improved when preoperative education provided by a wound, ostomy, and continence specialist nurse was considered helpful for the ongoing/ recurrent illness. CONCLUSION: Many ostomates have a good long-term adjustment to ostomy surgery and value education provided by a wound, ostomy, and continence nurse. Perioperative patient education and addressing patient distress over obtaining supplies are areas that can benefit from wound, ostomy, and continence nurse intervention.     

Evolution of soluble forms of CD86, CD95 and CD95L molecules in liver transplant recipients

Co-stimulatory factors such as CD86 and apoptotic molecules such as CD95 and CD95L required to start and to turn off the allogenic immune response may also be present as soluble proteins. To determine the role of the soluble forms of CD86 (sCD86), CD95 (sCD95) and CD95L (sCD95L) in the outcome of liver transplants, we analyzed the circulating levels of these molecules in patients subjected to liver transplantation in the pre-operative period and during the first month post-transplantation. Serum samples were obtained from sixty-nine first orthotopic liver transplants (OLT). The patients were classified into acute rejection (AR=24) and not acute rejection (NAR=45), or considering the presence of chronic active hepatitis B or C (VP=30) or other primary liver diseases (VN=39). The levels of sCD86, sCD95 and sCD95L were analyzed by solid phase sandwich enzyme-linked immunoabsorbent assays. Our results first showed that the pre-transplantation serum levels of sCD86 in the AR group were significantly higher than in the NAR group (1007±82U/mL vs. 739±46U/mL, p=0.006), and in the post-transplantation period these levels decreased sharply. Second, the levels of sCD95L and sCD95 in the pre-transplantation period did not point to statistically significant differences between the AR and NAR groups. Considering primary liver disease, the pre-transplantation levels of sCD86 and sCD95L in the VP group were significantly higher than those of the VN group (VP, 977±69U/mL vs. VN, 722±51U/mL, p<0.002, and VP, 482±78pg/mL vs. VN, 221±31pg/mL, p=0.002, respectively). Multivariate analysis revealed that only the pre-transplantation levels of sCD86 were independently associated with the development of episodes of acute rejection (p=0.005, OR=2.1, IC 95%=1.27-3.47). In conclusion, the present work shows that primary liver disease could influence the pre-transplantation levels of sCD86 and sCD95L. High pre-transplantation serum levels of sCD86 could favor the development of episodes of acute rejection.     

Prognostic factors that affect survival after the treatment of early stage cervical carcinoma

The aim of this study was to investigate the presence of risk factors for predicting survival and to evaluate the efficacy of the radical surgery in patients with early stage cervical carcinoma. A total of 200 women who underwent radical hysterectomy and bilateral pelvic lymph node dissection for early stage cervical carcinoma were retrospectively analysed. We found that lymph node involvement (P <0.0015) and lymphovascular invasion (P <0.05) were the best prognostic factors for disease-free survival in our cases. The depth of cervical invasion, lymphovascular invasion and parametrial spread were closely related with lymph node involvement. Parametrial spread was shown in 38 patients (19%), assessed as stage Ia-IIa pre-operatively. Seventy-six stage Ib patients, at high-risk of recurrence, received adjuvant radiotherapy. Although there was some local tumour recurrence in the control group, adjuvant radiotherapy did not improve the overall survival in stage Ib patients. As a consequence, primary surgery would be definitive in estimating survival from histopathological evaluation. This study demonstrates that lymph node involvement and lymphovascular space infiltration were the best predictor factors for survival.     

Factors that affect keratotomy depth

The authors investigated nine factors which can affect the depth of incisions performed during refractive keratotomy: (1) vertical vs oblique-cutting edge of the knife blade, (2) direction of cutting, (3) cutting velocity, (4) American vs Russian technique, (5) intraocular pressure (IOP), (6) initial vs final incisions, (7) sharpness of knife blade, (8) single vs double footplate, and (9) square vs double-edged blade. These variables were examined independently, performing at least 40 incisions for each experimental parameter studied. The depth of the resulting incisions was measured histologically using the micrometer eyepiece. The average and the standard deviation were calculated. The paired Student's t-test was used to establish significant differences between the two conditions investigated for each parameter. Factors that were demonstrated to increase significantly the depth of the incisions included: the vertical-cutting edge, the triple-edged diamond knife, the sharpness of the knife, and the single foot knife. High velocity in performing the incisions and, to a lesser extent, low IOP were the main factors that induced irregularity in depth.     

Clinical factors that affect the outcomes after anatomical versus non-anatomical resection for hepatocellular carcinoma

Purpose

For hepatocellular carcinoma (HCC), the superiority of anatomical resection (AR) over non-anatomical resection (NR) is still controversial. In this study, we assessed the potential benefits of AR for HCC.

Methods

We enrolled 173 consecutive patients with HCC who underwent hepatectomy in our hospital from August 2003 to May 2013 and compared the outcomes for the AR group (n = 125) with those for the NR group (n = 48).

Results

The median observational period was 790 days. The 1- and 2-year overall survival (OS) rates were 92.1 and 85.8 %, respectively; the 1- and 2-year disease-free survival (DFS) rates were 78.2 and 63.0 %, respectively. The AR and NR groups did not significantly differ in the OS or DFS. However, the 2-year DFS was significantly better for the AR group than the NR group among HCV patients (68.2 vs. 32.2 %; P = 0.004) and patients with alpha-fetoprotein (AFP) within the normal range (<20 ng/ml; 76.7 vs. 60.9 %; P = 0.031), total bilirubin <0.8 mg/dl (70.8 vs. 47.0 %; P = 0.034), and tumors 2–5 cm in diameter (82.0 vs. 62.5 %; P = 0.025).

Conclusions

If a patient is HCV-negative, has low AFP, low total bilirubin, or a tumor diameter of 2–5 cm, AR is recommended.

     

CD95、CD95L mRNA在肾移植、肝移植以及肝肾联合移植受者外周血中表达的意义

检测肾移植、肝移植以及肝肾联合移植受者外周血淋巴细胞CD95、CD95L mRNA的表达水平,评估其预测移植术后急性排斥反应(acute rejection,AR)的价值.方法 采用SYBR 荧光实时定量逆转录聚合酶链反应(RT-PCR)法检测132例肾移植受者、59例肝移植受者以及18例肝肾联合移植受者外周血T淋巴细胞CD95、CD95L mRNA的表达水平.根据术后1个月内有否出现AR将209例受者分为排斥组和无排斥组.对两组受者外周血T淋巴细胞CD95、CD95L mRNA的表达情况进行分析.结果 在肾移植组、肝移植组以及肝肾联合移植组中,发生AR的移植受者的外周血CD95、CD95L mRNA表达水平均显著升高(均为P<0.01),且时间早于患者出现临床症状以及实验室指标异常,提前(2.5±0.9)d.结论 CD95、CD95L mRNA表达升高与肾移植、肝移植以及肝肾联合移植术后发生AR密切相关,并且早于患者出现实验室指标异常.SYBR 荧光实时定量RT-PCR法检测外周血T淋巴细胞CD95、CD95L mRNA,方法准确、易行,可作为移植器官发生AR的预测和诊断指标.     

Clinical and biochemical factors that affect DPOAE expressions in children with middle ear effusion.

OBJECTIVES: To evaluate the clinical and biochemical characteristics of middle ear effusion (MEE) that affect distortion product otoacoustic emissions (DPOAE) responsiveness and to investigate the possible role of DPOAE as a tool to know the characteristics of MEE preoperatively. STUDY DESIGN AND SETTING: Prospective analysis of children with MEE effusion in a tertiary referral center. DPOAE results were compared with other audiologic tests, the character, amount of MEE, the amount of total protein, and TNF-alpha in the effusion. RESULTS: The negative DPOAE with MEE group had much more thick mucous fluid in their middle ears than that of positive DPOAE with MEE group. The levels of total protein and TNF-alpha in MEE were significantly higher in the negative DPOAE group than those of the positive DPOAE group (P < 0.01). CONCLUSIONS AND SIGNIFICANCE: The measurement of DPOAE in the children with MEE may predict the amount and the characteristics of MEE, which may help to decide the treatment methods.     

The neurosurgical wound and factors that can affect cosmetic,functional, and neurological outcomes

Surgically accessing pathological lesions located within the central nervous system (CNS) frequently requires creating an incision in cosmetic regions of the head and neck. The biggest factors of surgical success typically tend to focus on the middle portion of the surgery, but a vast majority of surgical complications tend to happen towards the end of a case, during closure of the surgical site incisions. One of the most difficult complications for a surgeon to deal with is having to take a patient back to the operating room for wound breakdowns and, even worse, wound or CNS infections, which can negate all the positive outcomes from the surgery itself. In this paper, we discuss the underlying anatomy, pharmacological considerations, surgical techniques and nutritional needs necessary to help facilitate appropriate wound healing. A successful surgery begins with preoperative planning regarding the placement of the surgical incision, being cognizant of cosmetics, and the effects of possible adjuvant radiation therapy on healing incisions. We need to assess patient's medications and past medical history to make sure we can optimise conditions for proper wound reepithelialisation, such as minimizing the amount of steroids and certain antibiotics. Contrary to harmful medications, it is imperative to optimise nutritional intake with adequate supplementation and vitamin intake. The goals of this paper are to reinforce the mechanisms by which surgical wounds can fail, leading to postoperative complications, and to provide surgeons with the reminder and techniques that can help foster a more successful surgical outcome.