Orthotopic placement of a segmental pancreas graft for transplant: a case report

Garcia‐Roca R, Humar A, Sturdevant M, Kobayashi T, Dunn T, Kandaswamy R, Sutherland D. Orthotopic placement of a segmental pancreas graft for transplant: a case report.
Clin Transplant 2010: 24: 424–428. © 2009 John Wiley & Sons A/S. Abstract: Pancreas retransplantation has become more frequent and represents a technical challenge for surgeons. Knowledge of alternative surgical options could be useful in difficult cases. We present a case of brutal diabetes mellitus in a patient with severe vascular disease that underwent a third pancreas transplant. Difficulties in obtaining arterial inflow were solved utilizing the native splenic vessels, placing the graft in orthotopic position, and a combination of historical surgical techniques in pancreas transplantation; that is, segmental grafts and duct injection for exocrine management made transplantation successful.     

Modeling breathing-zone concentrations of airborne contaminants generated during compressed air spray painting

This paper presents a mathematical model to predict breathing-zone concentrations of airborne contaminants generated during compressed air spray painting in cross-flow ventilated booths. The model focuses on characterizing the generation and transport of overspray mist. It extends previous work on conventional spray guns to include exposures generated by HVLP guns. Dimensional analysis and scale model wind-tunnel studies are employed using non-volatile oils, instead of paint, to produce empirical equations for estimating exposure to total mass. Results indicate that a dimensionless breathing zone concentration is a nonlinear function of the ratio of momentum flux of air from the spray gun to the momentum flux of air passing through the projected area of the worker's body. The orientation of the spraying operation within the booth is also very significant. The exposure model requires an estimate of the contaminant generation rate, which is approximated by a simple impactor model. The results represent an initial step in the construction of more realistic models capable of predicting exposure as a mathematical function of the governing parameters.     

Gynaecological and Sexuality Profile of New Patients attending a Family Planning Clinic

2067 first-time attenders (70% of all new patients during the 9-month study period) at a Family Planning Association clinic in Victoria, Australia, completed a questionnaire aimed at obtaining data on the age at onset of sexual activity and contraceptive use patterns. The mean age of study respondents was 23 years; only 13% were married. 86% of the women reported a history of sexual intercourse. The average age at 1st intercourse was 17.4 years, and over 50% were sexually active before 18 years of age. 51% did not use contraception at the time of 1st intercourse, and this rate was lower (37%) among women aged 15 years or less at coitarche. Of those who had used contraception, the most common methods were condoms (52%) and oral contraceptives (37%). When asked to rate the quality of their 1st act of sexual intercourse, 12% indicated the experience was better than they expected, 50% said it was as good as expected, and 38% indicated it was worse than anticipated. 90% claimed that the quality of their sexual experiences has improved since the 1st time. In terms of current frequency of sexual intercourse, 60% reported sexual relations less than twice a week, 26% have sex 2-3 times a week, and 14% have intercourse more than 3 times a week. When asked about their recent contraceptive practice, 47% reported contraception is always used, 26% use contraception most of the time, 10% use contraception sometimes, 5% rarely use such methods, and 12% never use family planning. Since these subjects were either already sexually active or were planning to initiate sexual activity, they are not representative of Australia's female population as a whole. However, they are an important target for family planning education programs.     

Population-based trends in ambulatory surgery for urinary incontinence

Introduction and hypothesis

Surgical procedures for stress urinary incontinence (SUI) have become progressively less invasive and easier to perform with the development of new technologies such as the midurethral sling. For these reasons, it seems logical to conclude that midurethral slings would supplant other surgical treatments for incontinence. The purpose of this study was to assess the impact of this technology on trends in ambulatory surgery for incontinence over the past decade.

Methods

We searched Current Procedure Terminology codes and the State Ambulatory Surgery Database from 2001 through 2009 to identify all ambulatory procedures for incontinence. Next, we calculated age-adjusted rates separately for each procedure. We then fit a multilevel model to characterize patient and regional factors associated with the preferential use of midurethral slings over alternative treatments.

Results

Midurethral slings and submucosal injections comprised >90 % of all ambulatory procedures for SUI during the time period examined. Age-adjusted rates of midurethral slings increased dramatically, from 2.36 to 9.45/10,000 population (p?<?0.001), whereas rates of submucosal injections remained relatively stable, from 1.75 to 1.41/10,000 population (p?=?0.226). Not surprisingly, older ([odds ratio (OR) 0.61; 95 % confidence interval (CI) 0.56–0.66] and more infirm patients (OR 0.60; CI 0.44–0.83) were more likely to receive submucosal injection therapy than to receive midurethral slings.

Conclusions

Rates of midurethral slings have increased significantly by fourfold. Rates of submucosal injections, however, have remained fairly stable during this time period, suggesting that sling dissemination has led to an increase in rates of incontinence procedures as opposed to replacing old technologies in the ambulatory setting.     

Endotoxin promotes synergistic lethality during concurrent Escherichia coli and Candida albicans infection.

Previous studies have suggested that the lipopolysaccharide (LPS, endotoxin) component of the gram-negative bacterial cell wall is a key virulence factor that serves to enhance mortality during infections in which fungi and gram-negative bacteria are copathogens. To test this hypothesis, mice were challenged ip with Escherichia coli 0111:B4, Candida albicans, or both, and the effect of administration of anti-E. coli 0111:B4 LPS monoclonal antibody (mAb) 8G9 on endotoxemia, bacteremia, and mortality was assessed. E. coli (2 x 10(7) colony-forming units (CFU)) plus C. albicans (6 x 10(7) CFU) infection produced 100% mortality at 7 days, compared to the relatively low mortality caused by infection with either E. coli or C. albicans alone (20 and 3%, respectively, P less than 0.01). Administration of mAb 8G9 to animals receiving both pathogens reduced mortality (100% versus 14%, P less than 0.05), endotoxemia (3653 +/- 3187 versus 2 +/- 2 endotoxin units (EU), P less than 0.01), and bacteremia (4.2 +/- 2.3 versus 1.1 +/- 2.1 log(CFU/ml), P less than 0.01) compared to animals receiving saline alone. In a separate series of experiments, purified E. coli 0111:B4 LPS was administered in place of viable E. coli. The simultaneous injection of 200 micrograms E. coli LPS and C. albicans (6 x 10(7) CFU) produced 93% mortality at 7 days, compared to the low mortality that occurred following injection with either E. coli 0111:B4 LPS or C. albicans alone (21 and 3% respectively, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Assessment of β-Cell Mass and α- and β-Cell Survival and Function by Arginine Stimulation in Human Autologous Islet Recipients

We used intravenous arginine with measurements of insulin, C-peptide, and glucagon to examine β-cell and α-cell survival and function in a group of 10 chronic pancreatitis recipients 1–8 years after total pancreatectomy and autoislet transplantation. Insulin and C-peptide responses correlated robustly with the number of islets transplanted (correlation coefficients range 0.81–0.91; P < 0.01–0.001). Since a wide range of islets were transplanted, we normalized the insulin and C-peptide responses to the number of islets transplanted in each recipient for comparison with responses in normal subjects. No significant differences were observed in terms of magnitude and timing of hormone release in the two groups. Three recipients had a portion of the autoislets placed within their peritoneal cavities, which appeared to be functioning normally up to 7 years posttransplant. Glucagon responses to arginine were normally timed and normally suppressed by intravenous glucose infusion. These findings indicate that arginine stimulation testing may be a means of assessing the numbers of native islets available in autologous islet transplant candidates and is a means of following posttransplant α- and β-cell function and survival.     

Neighbourhood deprivation and regional inequalities in self-reported health among Canadians: Are we equally at risk?

Individual-level data from the Canadian Community Health Survey was combined with area-level data from the 2001 Canada Census to explore the relationship between neighbourhood deprivation and regional inequalities in self-reported health (n=120,290). While neighbourhood deprivation was a significant predictor of fair/poor health in all geographic regions (OR=1.11; 95% CI: 1.08, 1.14), living on the Atlantic and Pacific coasts exacerbated the detrimental effects of neighbourhood deprivation on the perceived health of respondents (OR=1.21; 1.28). By failing to explore regional variations in risk, we could fail to identify areas where provincial policies may interact with neighbourhood factors to reinforce health inequalities amongst deprived communities.