Recipient body size does not matter in pediatric liver transplantation

Background and purposeIt is controversial whether small size recipient is associated with adverse outcome in liver transplantation. This study aims to evaluate the outcomes of pediatric liver transplantation according to body weight of recipients.MethodsLiver transplant recipients (age < 18 years, from 1993 to 2011) were studied retrospectively. They were categorized according to the body size at the time of transplantation (A: < 6 kg; B: between 6 kg to 10 kg; C: > 10 kg).ResultsA total of 113 patients (83 LDLTs and 30 DDLTs) were studied. Thirteen (11.5%) belonged to group A, 56 (49.6%) belonged to group B, and 44 (38.9%) belonged to group C. The best graft and patient survivals were found in group A (Figs. 1 and 2), and none of the patients required re-laparotomy for general surgical complications, while 32 patients (32%) in groups B and C did. Regarding transplant-related complications, although group A patients had the highest incidence of biliary tract complications (38.5%, n = 5), the incidence of vascular complications (hepatic artery: 7%, portal vein: 0%, hepatic vein: 0%) in this group was the lowest among the three groups.ConclusionOutcomes of small-sized recipients are not inferior. Less technical-related vascular complications, which may lead to early graft loss, were observed. This could be patient-related (less advanced cirrhosis) or surgeon-related (additional attention paid).     

Smartphone versus knee ligament arthrometer when size does not matter

Purpose

The use of available mechanical methods to measure anterior tibial translation (ATT) in anterior cruciate ligament (ACL)-deficient knees are limited by size and costs. This study evaluated the performance of a portable device based on a downloadable electronic smartphone application to measure ATT in ACL-deficient knees.

Methods

A specific smartphone application (SmartJoint) was developed for this purpose. Two independent observers nonsequentially measured the amount of ATT during execution of a maximum manual Lachman test in 35 patients with an ACL-deficient knee using KT 1000 and SmartJoint on both involved and uninvolved knees. As each examiner performed the test three times on each knee, a total of 840 measurements were collected. Statistical analysis compared intertest, interobserver and intra-observer reliability using the interclass correlation coefficient (ICC). An ICC > 0.75 indicates excellent reproducibility among measurements.

Results

Mean amount of ATT on uninvolved knees was 6.1 mm [standard deviation (SD?=?2)] with the KT 1000 and 6.4 mm (SD?=?2) with SmartJoint. Mean side-to-side difference was 8.1 mm. (SD?=?4) with KT 1000 and 8.3 mm (SD?=?3) with SmartJoint. Intertest reliability between the two methods yielded an ICC 0.797 [95 % confidence interval (CI) 0.717–0.857] for the uninvolved knee and of 0.987 (CI 0.981–0.991) for the involved knee. Interobserver ICC for SmartJoint and KT 1000 was 0.957 (CI 0.927–0.976) for the uninvolved knee and 0.992 (CI 0.986–0.996) for the involved knee and 0.973 (CI 0.954–0.985) for the uninvolved knee and 0.989 (CI 0.981–0.994) for involved knee, respectively.

Conclusion

The performance of SmartJoint is comparable and highly correlated with measurements obtained from KT 1000. SmartJoint may provide a truly portable, noninvasive, accurate, reliable, inexpensive and widely accessible method to characterize ATT in ACL-deficient knee     

Percutaneous central access in patients younger than 5 years: size does matter

Purpose

The purpose of this study was to determine, in a pediatric population less than 5 years of age, which size catheter is ideal for central venous access via the subclavian and internal jugular vein based on the children’s age, weight, and height.

Methods

This was a retrospective chart review of children less than 5 years of age at The Children’s Hospital in Denver, Colorado who underwent subclavian or internal jugular central venous catheter placement from January 1, 1998 through December 31, 2001. Age, height, weight, primary disease, access site, type of central venous catheter, size of central venous catheter, and complications were recorded. Age, weight, and height were stratified and compared with catheter size to determine any correlation between age, weight, height, and complications.

Results

There were 430 central venous catheters placed via the subclavian or internal jugular vein in 331 patients less than 5 years old. One hundred ninety-five catheters (45.4%) were less than 6F in size, and 235 (54.6%) catheters were ≥6F in size. Children, who were between 0.5 and 0.99 years old, 5 to 7.49 kg in weight, 7.5 to 9.99 kg in weight, and 60 to 74.9 cm in height had higher complication rates (P < .05) when catheters ≥6F were inserted. Children who were greater than 1 year of age, greater than 10 kg in weight, and longer than 75 cm in height did not experience a significant difference (P > .05) in complications versus catheter size.

Conclusions

The choice of central venous catheter size should be predicated, not only on the primary disease, but also on the child’s age, weight, and height. Insertion of central venous catheters larger than 6F in children less than 1 year of age, less than 10 kg in weight, or less than 75 cm in height, was associated with higher complications compared with other settings.     

Does size matter?

Sir, In the November 2006 issue of JASN, Opelz et al. published theiranalysis of the association of ACEI/ARB with patient and graftsurvival after renal transplantation utilizing the CTS registry[1]. In contrast to our study, published in JASN in March 2006,Opelz     

Varicocele: temporal considerations

The pathophysiology of the abnormal spermatogenesis seen in the presence of the varicocele has not been elucidated in spite of extensive study. Furthermore, no satisfactory explanation exists for the bilateral abnormal spermatogenesis seen in a process which is felt to be unilateral in the majority of cases. The present study was designed to determine if a surgically produced unilateral varicocele would lead to ipsilateral testicular changes prior to the onset of contralateral testicular alterations. Utilizing the rat model and microsurgical techniques, the effects of the varicocele on ipsilateral and contralateral spermatogenesis was studied at intervals over 49 days. Mean seminiferous tubular diameter measurements and flow cytometric analysis of testicular tissue were utilized to assess spermatogenesis. A statistically significant decrease in mean seminiferous tubular diameter was seen between day 1 and day 49 in the left testicle. The right testicle tended to demonstrate similar changes but these were not significant by the method of analysis used. Flow cytometric analysis of testis DNA content also revealed a statistically significant difference in the percentage of haploid, diploid and tetraploid cells in the left testis on day 1 as compared to day 49. The right testis again tended to demonstrate similar but not significant changes. Though primarily a unilateral process, bilateral spermatic vein abnormalities were also visualized in some animals. This observation may contribute to the bilateral effect observed. These studies demonstrate that a surgically created left varicocele will result in bilateral testicular alterations. Within the time frame of the study, the ipsilateral alterations progressed to a greater degree.