Late pancreas retransplantation

Pancreas retransplantation, excluding immediate retransplantation for graft thrombosis, is a technically treacherous operation with the added challenges of adhesions from the prior transplant and difficulties identifying usable recipient vessels. The goal of this study was to review our single‐center experience with late pancreas retransplantation. Charts for all pancreas transplant recipients between 01/2003 and 04/2013 were reviewed for demographics, graft and patient survival, length of stay (LOS), readmissions, and technical complications. Of 473 pancreas transplants, there were 20 late pancreas retransplants compared to 441 first transplants. There were no significant differences in donor or recipient demographics. There was no significant difference in graft or patient survival. The mean and median lengths of stay were 22 and nine d, respectively (range 5–175 d), and 11 recipients required readmission within the first three months post‐transplant. Five patients were reexplored in the early postoperative period for an enteric leak at the site of the primary allograft (n = 1), complications of percutaneous gastrostomy tube placement (n = 1), hemorrhage (n = 1), and negative laparotomy for hyperglycemia (n = 2). Pancreas retransplantation is technically challenging but can be safely performed with graft and recipient survival comparable to primary transplants.     

Relationships among client-therapist personality congruence, working alliance, and therapeutic outcome

Despite the importance of the working alliance in therapeutic outcome, little is known about the factors associated with its formation. We advance that personality similarity between client and therapist is one such factor pertinent to the working alliance. In this study, personality similarity in 32 client-therapist dyads was examined for its relations to the bond, task, and goal elements of the working alliance (Bordin, 1979, Psychotherapy: Theory, Research, and Practice, 16, 252-260) and therapeutic outcome. Personality similarity was conceptualized using Holland's (1997, Making vocational choices [3rd ed.]) congruence construct. Therapists completed the Self-Directed Search pretreatment and clients completed the Working Alliance Inventory-Short Revised and Self-Directed Search after the third session. Results indicated that (a) client-therapist personality congruence was associated with the bond, (b) bond was associated with task and goal, and (c) task and goal were associated with therapeutic outcome. Congruence was not associated with task, goal, or therapeutic outcome. Holland's theory provides a framework for adapting to clients of varying personality types. By understanding how client-therapist personalities relate to each other in therapy, client-therapist bonds may be more efficiently realized.     

Association of trauma exposure with psychiatric morbidity in military veterans who have served since September 11, 2001

Objective

This study examined the association of lifetime traumatic stress with psychiatric diagnostic status and symptom severity in veterans serving in the US military after 9/11/01.

Method

Data from 356 US military veterans were analyzed. Measures included a standardized clinical interview measure of psychiatric disorders, and paper-and-pencil assessments of trauma history, demographic variables, intellectual functioning, posttraumatic stress disorder (PTSD) symptoms, depression, alcohol misuse, and global distress.

Results

Ninety-four percent of respondents reported at least one traumatic stressor meeting DSM-IV criterion A for PTSD (i.e., life threatening event to which the person responded with fear, helplessness or horror), with a mean of four criterion A traumas. Seventy-one percent reported serving in a war-zone, with 50% reporting occurrence of an event meeting criterion A. The rate of current psychiatric disorder in this sample was: 30% PTSD, 20% major depressive disorder, 6% substance abuse or dependence and 10% for the presence of other Axis I psychiatric disorders. After accounting for demographic covariates and combat exposure, childhood physical assault and accident/disasters were most consistently associated with increased likelihood of PTSD. However, PTSD with no comorbid major depressive disorder or substance use disorder was predicted only by combat exposure and adult physical assault. Medical/unexpected-death trauma and adult physical assault were most consistently associated with more severe symptomatology.

Conclusions

Particular categories of trauma were differentially associated with the risk of psychiatric diagnosis and current symptom severity. These findings underscore the importance of conducting thorough assessment of multiple trauma exposures when evaluating recently post-deployed veterans.     

Practical and technical considerations in establishing an intraoperative radiation therapy program in the community practice

The Radiation Oncology Center in Sacramento, California, has developed a procedure for establishing an intraoperative radiation therapy facility in a community practice. The logistics pertaining to personnel, equipment, physical measurements, and quality assurance are presented. Particular emphasis is given to the most effective means of acquiring the large quantity of data needed to ensure a program of acceptable quality.     

Superficial- and deep-tissue temperature increases in anesthetized dogs during exposure to high specific absorption rates in a 1.5-T MR imager

Superficial- and deep-tissue heating was measured in five dogs during high-specific-absorption-rate radiofrequency (RF) irradiation to see whether significant temperature changes could be produced by a 1.5-T clinical magnetic resonance imager. The RF power output employed was 6.3 times that required for routine imaging. Temperature probes were placed in both deep and superficial tissues, and temperatures were recorded before, during, and after exposure. In each dog, there was a linear temperature increase of several degrees during RF exposure; the maximal average change was 4.6 degrees C in the urinary bladder. The temperature increase was slightly greater in deep tissues than in superficial tissues. The calculated specific absorption rate, based on the temperature change, averaged 7.9 W/kg for all five dogs. These findings argue for continued caution in the design and operation of imagers capable of high specific absorption rates, particularly when they are used for imaging infants or patients with altered thermoregulatory capability.     

Volumetric rendering techniques: applications for three-dimensional imaging of the hip

Volumetric rendering is a new approach to three-dimensional (3D) imaging that overcomes many of the drawbacks of currently available surface-rendering systems. Its application on the Pixar Imaging System in two cases of acetabular fracture was assessed to illustrate the features of the technique. The fast-computing architecture and large memory of this system allow rapid generation of a series of high-quality 3D images in each plane of rotation (x or spinal axis, z or somersaulting axis) that can be viewed as independent static images or as an animated real-time video loop. Editing to remove the normal contralateral hemipelvis enhances appreciation of acetabular abnormalities. Every pixel of computed tomographic data is preserved, allowing representation of both soft tissue and bone as translucent overlap. The presentation of data also allows detection of subtle abnormalities and features and minimizes the artifact generation common in surface-rendered images.     

Frostbite: experimental assessment of tissue damage using Tc-99m pyrophosphate. Work in progress

We designed an experimental model using a new method of freezing to study the pathogenesis and treatment of frostbite. Frostbite was simulated in a manner that closely resembles that which occurs in a natural environment. We used a radionuclide imaging technique to monitor the evolution and extent of tissue damage relative to temperature, rate of freezing, and controlled rewarming. Characteristic sequential changes were demonstrated on sequential nuclear scans. Nonperfusion, followed by perfusion, and finally again by nonperfusion occurred in all areas in which necrosis developed. The reappearance of nonperfusion corresponded to vascular injury and thrombosis evidenced at pathologic examination. We determined that lack of tissue perfusion corresponded to tissue injury. We believe that our experimental model provides an effective means of evaluating potential therapeutic regimens.