Impact of donor cardiopulmonary resuscitation on the outcome of simultaneous pancreas–kidney transplantation—a retrospective study

Previous cardiac arrest in brain-dead donors has been discussed as a potential risk factor in pancreas transplantation (PT), leading to a higher rate of organ refusal. This study aimed to assess the impact of cardiopulmonary resuscitation (CPR) in brain-dead donors on pancreas transplant outcome. A total of 518 type 1 diabetics underwent primary simultaneous pancreas–kidney (SPK) transplantation at our center between 1994 and 2018. Patients were divided into groups, depending on whether their donor had been resuscitated or not. A total of 91 (17.6%) post-CPR donors had been accepted for transplantation (mean duration of cardiac arrest, 19.4 ± 15.6 min). Those donors were younger (P < 0.001), had lower pancreas donor risk index (PDRI, P = 0.003), and had higher serum creatinine levels (P = 0.021). With a median follow-up of 167 months (IQR 82–229), both groups demonstrated comparable short- and long-term patient and graft survival. The resuscitation time (<20 min vs. ≥20 min) also showed no impact, with similar survival rates for both groups. A multivariable Cox regression analysis suggested no statistically significant association between donor CPR and patient or graft survival. Our results indicate that post-CPR brain-dead donors are suitable for PT without increasing the risk of complications.     

Acute kidney injury in pregnancy—a single center experience

Abstract

Background: Acute kidney injury (AKI) is a serious complication in pregnancy, resulting in significant maternal morbidity/mortality and fetal loss. Although the incidence of pregnancy-related acute kidney injury (PRAKI) has decreased in developed countries, it is still common in developing nations. Methods: A prospective observational study was done between January 2010 and December 2014 to report the incidence, clinical spectrum, maternal and fetal outcome of AKI in pregnancy. Results: Total number of patients: 130; mean age: 25.4?±?4.73 years. The incidence of AKI in pregnancy was 7.8%. Most of the AKI was noted in postpartum period (68%). Etiology of AKI was sepsis (39%), pre-eclampsia (21%), placental abruption (10%), acute diarrheal disease complicating pregnancy (10%), thrombotic microangiopathy (TMA) (9%), postpartum hemorrhage (2%) and glomerular diseases (9%). Renal biopsy (n?=?46) done in these patients showed renal cortical necrosis (16), TMA (11), acute tubular injury (9), acute tubulointerstitial disease (1) and glomerular disease (9). Live births occurred in 42% of patients with vaginal delivery in 34% cases. Thirty-four patients were managed conservatively, while 96 required dialysis. Complete recovery occurred in 56% and about 36% had persistent renal failure at 3 months. Mortality rate observed was 8%. In univariate analysis, low mean platelet count, higher peak serum creatinine, dialysis dependency at presentation and histopathologically presence of cortical necrosis and TMA predicted the progression to chronic kidney disease. Conclusion: AKI in pregnancy was common in postpartum period and sepsis being the commonest cause.     

Spinal arachnoid web—a distinct entity of focal arachnopathy with favorable long-term outcome after surgical resection: analysis of a multicenter patient population

BACKGROUND CONTEXTSpinal arachnoid web (SAW) is a rare condition characterized by focal thickening of the arachnoid membrane causing displacement and compression of the spinal cord with progressive symptoms and neurological deficits. Recent reports and clinical experience suggest that SAW is a distinct entity with specific radiological findings and treatment strategies distinguishable from other arachnopathies and potential differential diagnoses.PURPOSETo better define the diagnostic and clinical features, treatment options and outcomes of surgically treated SAW.STUDY DESIGNMulticentric retrospective cohort study.PATIENT SAMPLETwelve cases of SAW surgically treated at three different centers.OUTCOME MEASURESSelf-reported and neurological outcome measurements (pain, sensory-motor deficits, vegetative dysfunctions) were assessed at follow-up timepoints.METHODSRetrospective review of prospectively collected data on all patients surgically treated for SAW from three participating neurosurgical centers between 2014 and 2020. Clinicopathological data, including neurological presentation, radiological and histological findings and outcome data were analyzed.RESULTSTwelve radiologically and surgically confirmed cases of SAW were analyzed. Mean patient age was 54.7 [±12.7], 67% were male. All SAWs were located in the posterior thoracic dural sac. On magnetic resonance imaging (MRI), the “scalpel sign” - a characteristic focal dorsal indentation of the spinal cord resembling a scalpel blade - was identified in all patients. A focal intramedullary syrinx was present in 83%. Preoperative clinical symptoms included signs of myelopathy, pain, weakness and sensory loss, most commonly affecting the trunk/upper back or lower extremities. Laminectomy or laminoplasty with intradural excision of the SAW was the surgical treatment of choice in all cases. Intraoperative ultrasound was valuable to visualize the cerebrospinal fluid (CSF) flow obstruction, confirm the SAW location before dura incision and to control adequacy of resection. After surgery, sensory loss and weakness in particular showed significant improvement.CONCLUSIONSThe present study comprises the largest series of surgically treated SAW, underscoring the unique clinical, radiographic, histopathological, and surgical findings. We want to emphasize SAW being a distinct entity of spinal arachnopathy with a favorable long-term outcome if diagnosed correctly and treated surgically. Intraoperative ultrasound aids visualizing the SAW before dural incision, as well as verifying restored CSF flow after resection.     

Conversion to sirolimus of patients with chronic allograft nephropathy—a retrospective analysis of outcome and influencing factors

Purpose

The purpose of this study was to analyse the outcome and its influencing factors in patients whose therapy was converted from calcineurin inhibitors (CNI) to sirolimus (SRL) due to chronic allograft nephropathy (CAN).

Materials and methods

Therapies of 78 patients (44 men) with CAN from three European transplant centres were converted from CNI therapy to SRL and followed 24 months. Slopes for creatinine clearance before and after conversion were calculated. Influencing factors were analysed by a multivariance analysis.

Results

The slope of the creatinine clearance improved significantly (?0.90 vs. ?0.34 ml min^?1 month^?1; p?<?0.01). In patients whose therapy was converted from cyclosporine A (CyA) to SRL, the slope improved significantly, whereas conversion from Tacrolimus (Tac) to SRL did not affect the slope. The benefit was more pronounced in (1) patients with low or moderate baseline creatinine clearance, (2) patients receiving SRL after conversion without additional mycophenolate mofetil and (3) patients with low or moderate proteinuria.

Conclusion

Conversion from CyA to SRL but not from Tac to CRL is associated with a reduced loss of renal allograft function in patients with CAN.     

Mini-craniotomy as the primary surgical intervention for the treatment of chronic subdural hematoma—a retrospective analysis

Background

The incidence of chronic subdural hematoma (CSDH) is increasing, but optimal treatment remains controversial. Recent meta-analyses suggest burr hole (BH) drainage is the best treatment because it provides optimal balance between recurrence and morbidity. Mini-craniotomy may offer supplementary technical advantages while maintaining equal or better outcomes. This study investigates the outcome of mini-craniotomy as the sole treatment in patients with CSDH.

Method

We analyzed all patients operated on for CSDH with mini-craniotomy in our neurosurgical center between 2005–2010. Baseline patient characteristics (age, sex, comorbidities, imaging characteristics, known risk factors for development of CSDH and neurological examination at presentation) and outcomes (mortality, complications, recurrence and neurological examination at discharge) were recorded.

Results

One hundred twenty-six adult patients were included, mean age was 73.9 (range 18 to 95) years old, and the sex ratio (M:F) was 2:1. Eighty-four percent of the patients showed clinical improvement at discharge, as shown by a decrease in the Markwalder score postoperatively (with 57 % Markwalder 0 and 23 % Markwalder 1). Recurrence rate was 8.7 %. Overall complication rate was 34.1 % (27.8 % medical complications and 6.3 % surgical complications). In-hospital mortality was 13.5 % (8.7 % due to pulmonary infections and 1.6 % to surgical complications). Preoperative Markwalder grade correlated significantly with complication rate, as did the presence of a neurodegenerative disease (p?=?0.018). Factors significantly related to mortality in univariate analysis were arterial hypertension (p?=?0.038), heart failure (p?=?0.02), renal failure (p?=?0.017), neurodegenerative disease (p?=?0.001), cerebrovascular accident (p?=?0.008) and coagulopathy (p?=?0.019). Multivariate analysis was not able to confirm any significant relationship.

Conclusion

This is the first published series of CSDH in which all consecutive patients were operated on by mini-craniotomy. The invasiveness and complication rate of mini-craniotomy are equal to those of burr hole treatment, but visualization is superior, resulting in lower recurrences. A randomized controlled trial is indicated to identify the best surgical strategy for the treatment of CSDH.     

Complications of titanium cranioplasty—a retrospective analysis of 174 patients

Background

Titanium cranioplasty (TC) has been associated with high complication rates, but abundant data are lacking. We aimed to determine the incidence and type of complications following TC and risk factors for complications.

Methods

A retrospective review was performed on 174 patients who underwent TC at two London units over a seven year period. Data were collected on demographics, primary pathology, perioperative details, complications and functional outcome. Skull defect size was estimated using 3-dimensional computed tomographic reconstructions.

Results

The overall complication rate was 26.4 % (46/174), and plate removal rate10.3 % (18/174). The commonest complication was infection, which accounted for 69 % of plate removals. Patients who had undergone craniectomy for trauma had a higher complication rate (35 vs 21 %; p?=?0.043) and plate removal rate (16 vs 7 %; p?=?0.049) than others. There was a non-significant trend towards the association of craniectomy-to-cranioplasty interval of 4–8 months with the lowest complication rate and shortest postoperative hospital stay. Patients with a skull defect larger than 100 cm² had the highest complication rate (p?<?0.001), highest plate removal rate (p?=?0.039), and longest postoperative hospital stay (p?=?0.019). Bifrontal versus unilateral cranioplasty was associated with a significantly higher complication rate (40 vs 14 %) and length of hospital stay (5.0 vs 2.9 days). There was no perioperative mortality and no change between pre-operative and post-operative functional outcome.

Conclusion

In the largest UK study on cranioplasty to date, we have demonstrated that size of defect, traumatic aetiology and bifrontal insertion are risk factors for complications. Our results suggest that the timing of cranioplasty may be important with late (> 12 months) TC associated with a higher rate of complications, although further prospective studies on the optimal timing of TC are required to establish the observed trend. Our data can help clinicians stratify risk to inform the consent process and aid pre-operative planning.     

The impact of abdominal complications on the outcome after thoracic transplantation—a single center experience

Background

Abdominal complications after thoracic transplantation (Tx) are potentially associated with an increased risk of mortality. We recently reported about the severe outcome after bowel perforation in patients following lung transplantation (LuTx). The aim of the present study was to likewise identify the risk factors with an impact on patient survival following heart transplantation (HTx).

Methods

A retrospective analysis for the frequency and outcome of abdominal interventions following HTx was performed in 342 patients, and these data thereafter compared to a re-evaluated pool of 1,074 patients following LuTx. All patients were transplanted at Hanover Medical School, Germany, between January 2000 and October 2011.

Results

The incidence for abdominal surgery was comparable between patients following HTx (n?=?33; 9.6 %) and LuTx (n?=?90; 8.4 %). Elective operations were more frequently performed in patients after HTx (8.5 vs. 5.1 %). In contrast, the incidence of emergency interventions was higher after LuTx (5.3 %) than that following HTx (2.3 %). Herewith associated was the mortality observed in these transplant recipients (15.3 and 9.9 % for LuTx and HTx, respectively). Leading diagnosis for emergency surgery was bowel perforation (n?=?18, regarding all cases). In 11 of these patients, perforation occurred within the first 6 months after Tx and eight of them died in the course of this complication (one patient after HTx and seven patients after LuTx).

Conclusions

Abdominal complications after HTx are less frequently than after LuTx but equally correlate with a high mortality rate. In finding or even reasonable suspicion of an acute abdomen after thoracic Tx, a broad practice for extended diagnostics and a low barrier for an early explorative laparotomy thus are recommended.     

A radial head prosthesis that aligns with the forearm axis of rotation: a retrospective multicenter study

BackgroundAdvancements in technique and devices and a better understanding of forearm kinematics have contributed to the improvement in outcomes following radial head arthroplasty. The results of radial head arthroplasty depend on the inherent variability of the proximal radial anatomy and on the subsequent difficulties in attaining anatomic positioning of the prosthesis. A monobloc prosthesis with an anatomical head that is aligned with the patient’s axis of forearm rotation has been recently introduced. We report the clinical and radiographic outcomes for patients across multiple centers who received this radial head implant with a minimum of 2-year follow-up.MethodsThis was a multi-institution retrospective follow-up including 6 centers and multiple surgeons. A total of 114 cases were performed prior to July 20, 2019, of which 52 (46%) responded to request for follow-up. Data collected included Mayo Elbow Performance Score, Disabilities of the Arm, Shoulder and Hand scores, visual analog scale (VAS) for pain, major complications, and reoperations. Major complications were defined as any prosthesis-related event which may or may not have required reoperation.ResultsThe mean Mayo Elbow Performance Score was 87.0 (range, 55-100), with 46% (24/52) scoring a 100. The mean VAS for pain at rest was 0.9 (range, 0-10), and the mean VAS for pain while unscrewing a bottle cap was 1.9 (range, 0-10). The mean Disabilities of the Arm, Shoulder and Hand score was 19.6 (range, 0-88.6). We recorded a total of 4 major complications, 3 of which required reoperations, for a rate of 7.6% and 5.7%, respectively.DiscussionThe current results, collected from 6 institutions and multiple surgeons, are comparable to those of other similar series for radial head prostheses. Our series had lower rates of complications and reoperations. There were no cases of stem loosening. The alignment of the radial head to the forearm axis of rotation may restore forearm kinematics. This design may lead to radiocapitellar contact pressures that are more physiologic in load transmission.     

Minimally invasive repair of pectus carinatum: a retrospective analysis based on a single surgeon’s 10 years of experience

Objectives

Over the past decade, minimal invasive surgery for correction of pectus carinatum has gained worldwide acceptance. This study reviews our clinical experience with minimally invasive repair of pectus carinatum (MIRPC) since 2008.

Methods

Between 2008 and 2018, 101 patients (77 male, 24 female) underwent correction of pectus carinatum with the MIRPC technique. The mean age of the patients was 14.7?±?4.8 (3–38) years. Over an 8 years’ experience we slightly modified the original Abramson technique. All patients presented with cosmetic complaints and all had a flexible chest wall on “compression test”. Early follow-up was on postoperative day 15 and 30.

Results

The mean operative time was 42.1?±?16.9 min. The mean hospital stay was 4.2?±?0.9 days. Postoperative complications included pneumothorax (n?=?2, 1.9%), wound infection (n?=?2, 1.9%), skin perforation (n?=?2, 1.9%), intolerable pain (n?=?1, 0.9%), skin hyperpigmentation (n?=?1, 0.9%), and overcorrection (n?=?1, 0.9%). Initial postoperative results were excellent in all patients. The bars were removed at a median of 24.8?±?4.5 months in 44 of 101 patients. 43 of 44 (97.7%) patients whose bar were removed reported excellent results.

Conclusions

MIRPC is a feasible procedure with low morbidity and excellent cosmetic results in the treatment of pectus carinatum deformities in selected patients.

     

Complications following hip arthroscopy: a retrospective review of the McMaster experience (2009–2012)

Background

The use of hip arthroscopy has been steadily rising as technology, experience and surgical education continue to advance. Previous reports of the complication rate associated with hip arthroscopy have varied. The purpose of this study was to report our experience with hip arthroscopy complications at a single Canadian institution (McMaster University).

Methods

We performed a retrospective chart review of 2 hip arthroscopists at the same institution to identify patients who had undergone the index surgery and had been followed for a minimum of 6 months postoperatively. We used a standard data entry form to collect information on patient demographic and clinical characteristics, including age, sex, surgical indication and type of complication if any.

Results

A total of 211 patients underwent 236 hip arthroscopies. The mean age at time of surgery was 37 ± 13 years and mean follow-up was 394 ± 216.5 days. The overall complication rate associated with hip arthroscopy was 4.2% (95% confidence interval 2.3%–7.6%). We identified 4 major and 6 minor complications.

Conclusion

Overall, hip arthroscopy appears to be safe, with minor complications occurring more frequently than major ones. However, surgeons should recognize the possibility of serious complications associated with this procedure. Future research should focus on prospective designs looking for potential prognostic factors associated with hip arthroscopy complications.     

Treatment of unstable spinopelvic fractures: outcome of three surgical techniques—a retrospective single-center case series

Purpose

The aim of our retrospective study is to analyze how spinopelvic dissociations (SPDs) were treated in a single center trying to better understand how to improve surgical and non-surgical options.

Methods

Twenty patients of a single center surgically treated for SPDs between 2013 and 2021 were retrospectively included in this study. Three surgical techniques have been used: modified triangular stabilization, triangular stabilization and double iliac screws stabilization. Follow-up was assessed for up to 11.6 ± 9.9 months through ODI, MRS, NRS, IIEF or FSFI, a CT scan and whole spine X-ray examination.

Results

Twenty patients were admitted to our ER for traumatic spinopelvic dissociation. Surgical treatment for spinopelvic dissociation has been performed on average 11.5 ± 6.7 days after the trauma event. Eighteen fractures were C3 type and two C2 types. Neurological examination showed nerve root injury (N2) in 5 patients, incomplete spinal cord injury (N3) in 4 patients and cauda equina syndrome in two patients (N4). In case of neurologic deficits, routinary nerve decompression was performed. Three different surgical techniques have been used: 8 triangular fixations (Group 1), 6 modified triangular stabilization (Group 2) and 6 double iliac screws triangular fixation (Group 3).

Conclusion

In patients with post-traumatic neurological deficit, decompression surgery and fracture reduction seem to be associated with clinical improvement; however, sexual disorders seem to be less responsive to the treatment. Some open stabilization techniques, such as the double iliac screw, could help in restoring the sagittal balance in case of severe deformities.

     

Epidemiology and outcome analysis of facial burns: A retrospective multicentre study 2011–2015

BackgroundThe head and neck regions are frequent sites of burns, but few studies have analysed and reported the epidemiology of facial burns. As the face is the centre of one’s identity and persona, facial injuries often result in physical and psychological morbidity. The aim of this article is to describe the epidemiology and outcome of facial burns in China and to suggest future preventive strategies.MethodsThis retrospective analysis included all patients with facial burns in a database at eight institutions from 2011–2015. The data collected included sex, age, month distribution, aetiology, location, presence of inhalation injury, total burn surface area, burn surface area with full-thickness and outcome including Post-traumatic stress disorder Checklist-Civilian Version scores and mortality. SPSS 19.0 software was used to analyse the data.ResultsA total of 1126 patients were included; 65.63% (739) had facial burns, of which 546 (73.88%) were male patients and 193 (26.12%) were female patients. Predictors of facial burns were being of male sex, working-related place, flame burns, total body surface area, and full-thickness burns. In addition, total body surface area and full-thickness burns increased the risk of poor prognosis for post-traumatic stress disorder and mortality.ConclusionsFacial burns benefit not only the healing of wound, but also the prevention of their incidence and PTSD symptom. This study may contribute to the elaboration of strategies to prevent facial burns and the establishment of a nationwide burn database in China.     

Clinical presentations and outcome analysis of renal transplant in elderly patients——A single center retrospective study

Objective To analyze the characteristics and prognosis of elderly renal transplant recipients. Methods The authors included 130 recipients older than or equal to 60 years at the time of operation in elderly group, and the paired 130 patients receiving contralateral renal transplants from the same donors and younger than 60 years in control group. All the patients received renal transplant in Kidney Disease Center of the First Affiliated Hospital of Zhejiang University from Nov 1994 to Dec 2013. Results The average age of the patients of elderly group was (63±3) years old, whereas the patients in control group were (41±10) years old. There was no significant difference in sex, type of dialysis, number of mismatched HLA, level of panel reactive antibodies (PRA), percentage of receiving induction therapy or immunosuppressive regimen between elderly group and control group, except that the patients in old group had a longer duration of dialysis. The patients of elderly group had a lower level of serum creatinine than control at the follow up times from 6 months to 24 months after transplant. The doses of immunosuppressives were lower in elderly group compared with the control group whereas the concentration of tacrolimus or cyclosporine was same. The dose of prednisone in old group was lower compared with control after 6 months post - transplantation. The patients of elderly group had high percentages of pulmonary infection and new-onset diabetes mellitus compared with the control group. Until June 2014, the follow-up rate of all patients was 85.4%; the median follow-up time was 70.4 months in elderly group and 79.9 months in control group. There was no significant differencein mortality rate or graft loss rate between elderly group and control group. Pulmonary infection (HR=2.981, P=0.018), hepatitis C virus infection (HR=5.797, P=0.003) and malignancies (HR=5.228, P=0.005) were correlated with the survival rate of the elderly group. Conclusions Elderly renal transplant recipients have a similar prognosis compared with the younger ones. Pulmonary infection, hepatitis C virus infection and malignancy are related risk factors for the survival rate of elderly patients.     

Pediatric combined liver–kidney transplantation: a single-center experience of 18 cases

Background

Experience in combined liver–kidney transplantation (CLKT) in children is limited.

Methods

We conducted a retrospective study of all pediatric CLKTs performed at our medical institution between 1992 and 2013.

Results

We identified 18 pediatric patients (9 girls) who had undergone CLKT at our institution during the study period. The median age [range] and body weight [range] of this patient group was 3.6 [1.0–18.6] years and 13 [10–40] kg, respectively; 11 patients weighed <15 kg at the time of CLKT. Indications for CLKT were primary hyperoxaluria (PH1; n?=?14), association of hepatic fibrosis and end-stage renal disease (n?=?3) and methylmalonic acidemia (n?=?1). In the early postoperative period, eight patients required dialysis. Median stay in the pediatric intensive care unit was 10 [6–29] days. One patient died from cardiovascular disease 10 years after CLKT. There were no liver graft losses despite six acute liver rejection episodes, whereas four kidney grafts were lost. At last follow-up (6 [0.5–21] years) for patients with a functioning renal graft, the glomerular filtration rate was 71 [26–146] mL/min/1.73 m². In PH1 patients, urine oxalate normalized in six patients within 3 years after CLKT, but three patients still presented with elevated oxaluria at 1, 2 and 3 years after CLKT.

Conclusions

Pediatric CLKT provides encouraging results in the long term, even in the youngest patients.

     

Endoscopic submucosal dissection versus surgical resection for early gastric cancer: a retrospective multicenter study on immediate and long-term outcome over 5 years

Background

Endoscopic submucosal dissection (ESD) is an alternative to surgical resection for treating early gastric cancer (EGC). However, there have been limited reports on the long-term outcome of ESD compared to that of surgical resection. The aim of this study was to evaluate the immediate and long-term clinical and oncologic outcomes of ESD compared to surgical resection.

Method

We retrospectively reviewed data of patients in five centers who were treated with ESD or surgical resection for EGC within expanded criteria for ESD from 2006 to 2008.

Result

ESD group had significantly shorter procedure times, shorter fasting period, and shorter hospital stay than the surgical resection group. Immediate complications in the surgical resection group were more common compared to those in the ESD group. Five-year cancer recurrence rate of the ESD group was 12.3 % and significantly higher than 2.1 % of the surgical resection group (P = 0.001). Five-year disease-free survival rate of the surgical resection group was 97 %, which was significantly higher than 85 % of the ESD group (P = 0.001). Metachronous lesions were equally found every year during the follow-up period in the ESD group. Five-year overall survival rates were 100 % for both groups.

Conclusion

ESD might be an acceptable and effective treatment for EGC considering overall survival rates with fewer early complication rates and shorter duration of hospital stay compared to surgical resection. However, intensive and persistent endoscopic surveillance should be performed after ESD for early detection of metachronous lesions.