Living donor intestinal transplant using a standardized technique: first report from India

Aim

We describe the first living donor intestinal transplant (LDIT) in India and discuss the indications and problems of this complex procedure.

Methods

A 43-year-old male patient required massive bowel resection for gangrene due to thrombosis of the superior mesenteric artery. He was maintained on parenteral nutrition but developed cholestasis and well as repeated catheter related infections with progressive loss of venous access due to thrombosis of central veins. A LDIT was performed using 200?cm of small intestine from the patient's son. The graft was based on the continuation of the superior mesenteric vessels beyond the ileocolic branch. The artery was anastomosed directly to the aorta and the vein to the venacava.

Results

The graft functioned well and he was weaned off parenteral nutrition. However, he later developed complications (wound dehiscence and enterocutaneous fistula) and developed sepsis. He succumbed to sepsis with a functioning graft 6?weeks after the transplant. The donor recovered uneventfully and was discharged on the 4th postoperative day.

Conclusions

LDIT can be life saving in patients with intestinal failure and failure of parenteral nutrition. There is a need to introduce this modality in India. In a setting of scarcity of deceased donor organs the living donor option has advantages.     

Retrospective review of rectal cancer surgery in northern Alberta

Introduction

Previous studies, including research published more than 10 years ago in Northern Alberta, have demonstrated improved outcomes with increased surgical volume and subspecialisation in the treatment of rectal cancer. We sought to examine contemporary rectal cancer care in the same region to determine whether practice patterns have changed and whether outcomes have improved.

Methods

We reviewed the charts of all patients with rectal adenocarcinoma diagnosed between 1998 and 2003 who had a potentially curative resection. The main outcomes examined were 5-year local recurrence (LR) and disease-specific survival (DSS). Surgeons were classified into 3 groups according to training and volume, and we compared outcome measures among them. We also compared our results to those of the previous study from our region.

Results

We included 433 cases in the study. Subspecialty-trained colorectal surgeons performed 35% of all surgeries in our study compared to 16% in the previous study. The overall 5-year LR rate and DSS in our study were improved compared to the previous study. On multivariate analysis, the only factor associated with increased 5-year LR was presence of obstruction, and the factors associated with decreased 5-year DSS were high-volume noncolorectal surgeons, presence of obstruction and increased stage.

Conclusion

Over the past 10 years, the long-term outcomes of treatment for rectal cancer have improved. We found that surgical subspecialization was associated with improved DSS but not LR. Increased surgical volume was not associated with LR or DSS.     

Recurrent unilateral pleural effusion in a hypertrophic cardiomyopathy patient secondary to atrial arrhythmias and the role of radiofrequency ablation

Heart failure (HF) is a common cause of pleural effusion. Atrial tachyarrhythmias (ATa) can precipitate HF. ATa precipitating unilateral pleural effusion (PLE) has not been reported. We report a case of ATa in a patient with hypertrophic cardiomyopathy with recurrent unilateral rightsided PLE and resolution of effusion with catheter ablation of the arrhythmia.     

Specular microscopy in clinical practice

Specular microscopy is a noninvasive diagnostic tool that allows for in vivo evaluation of corneal endothelium in health and various diseased states. Endothelial imaging helps in the diagnosis and management of several endothelial disorders. The review focuses on the principles of specular microscopy, limitations of endothelial imaging, and its interpretation in common conditions seen in the clinical practice. A thorough PubMed search was done using the keywords specular microscopy, corneal endothelium, and endothelial imaging.     

Fabrication of a reversible thermochromism based temperature sensor using an organic–inorganic composite system

Temperature is considered a crucial physical parameter for several applications ranging from our day to day life to industrial applications. Studies have been reported to monitor the temperature by using various methods. Here, the present study demonstrates the fabrication of a simple and inexpensive temperature sensor based on the phenomenon of thermochromism, that is, the temperature can be monitored by the visual change in the sensor''s color without using any additional circuitry. The mechanism of color change is associated with the difference in the coordination number of the complex compound due to the loss of crystal water in the organic–inorganic composite system. The screen printing process has been used to fabricate thin films of varying compositions in order to optimize the thermochromism in the temperature range of interest. Moreover, the reversibility of the color with a decrease in temperature allows the reusability and longevity of the sensor thus developed.

A simple, inexpensive and reusable temperature sensor based on screen printed flexible thin films.     

Standard of Care for Neuropsychological Monitoring in Pediatric Neuro‐Oncology: Lessons From the Children's Oncology Group (COG)

As the mortality of pediatric cancers has decreased, focus on neuropsychological morbidities of treatment sequelae have increased. Neuropsychological evaluations are essential diagnostic tools that assess cognitive functioning and neurobiological integrity. These tests provide vital information to support ongoing medical care, documenting cognitive morbidity and response to interventions. We frame standards for neuropsychological monitoring of pediatric patients with CNS malignancy or who received cancer‐directed therapies involving the CNS and discuss billing for these services in the United States in the context of clinical research. We describe a cost‐effective, efficient model of neuropsychological monitoring that may increases access to neuropsychological care. Pediatr Blood Cancer © 2015 Wiley Periodicals, Inc.