Transmission of breast cancer by a single multiorgan donor to 4 transplant recipients

We report 4 cases of breast cancer transmission to transplant recipients from a single organ donor that occurred years after donation. The diagnosis of breast cancer was occult at the time of donation. All of the recipients developed a histologically similar type of breast cancer within 16 months to 6 years after transplantation. Three out of 4 recipients died as a result of widely metastasized disease. One of the recipients survived after transplant nephrectomy followed by cessation of immunosuppression and chemotherapy. This extraordinary case points out the often fatal consequences of donor‐derived breast cancer and suggests that removal of the donor organ and restoration of immunity can induce complete remission.     

One time quantitative PCR detection of Pseudomonas aeruginosa to discriminate intermittent from chronic infection in cystic fibrosis

Background

Chronic airway infection with Pseudomonas aeruginosa is a major risk factor of progression of lung disease in patients with cystic fibrosis (CF). Chronic P. aeruginosa infection evolves from intermittent infection that is amenable to antibiotic eradication, whereas chronically adapted P. aeruginosa becomes resistant to antibiotic therapy. Discrimination of intermittent versus chronic infection is therefore of high therapeutic relevance, yet the available diagnostic methods are only partly satisfactory. The aim of the present study was, therefore, to evaluate the usage of quantitative PCR (qPCR) to measure pathogen abundance and to discriminate between intermittent and chronic Pseudomonas infection in patients with CF.

Early-stage impairments and limitations of functioning from the geriatric ICF core set as determinants of independent living in older patients after discharge from post-acute rehabilitation.

OBJECTIVE: To identify the impairments and limitations that indicate loss of independence in older patients after discharge from post-acute rehabilitation. DESIGN: Prospective cohort study. SUBJECTS/PATIENTS: A total of 128 patients in the development cohort and 137 patients in the validation cohort. METHODS: Data on functioning and previous living situation were collected at admission; data on prospective living situation were collected at discharge. Multivariable logistic and non-parametric (CART) analyses were carried out with the development cohort. The resulting models were validated in a validation cohort. RESULTS: Development cohort: mean age was 80.3 years (95% confidence interval (CI) 79.1-81.6), 52% of patients experienced loss of independence. The International Classification of Functioning, Disability and Health (ICF) category d465 "moving around using equipment"(odds ratio (OR) = 2.7, 95% CI 1.2-5.8) and a dichotomous indicator variable for fractures or joint replacement (OR = 2.3, 95% CI 1.1-4.9) remained in the logistic model. CART yielded the ICF categories d465 "moving around using equipment", and b765 "involuntary movement functions" conditional on d465. Validation cohort: mean age was 72.6 years (95% CI 70.3-74.9). 40% experienced loss of independence. d465 (OR = 7.6, 95% CI 1.6-35.5) and b765 (OR = 5.9, 95% CI 2.6-13.4) were also significant predictors in the logistic model. CONCLUSION: Older patients who are not able to move around with the help of equipment at the beginning of post-acute rehabilitation are 3 times as likely to lose independence when discharged. It may be important for patients' independent living to encourage the use of wheelchairs and walking aids at very early stages of rehabilitation.     

Robot-assisted laparoscopic Y-V plasty in 12 patients with refractory bladder neck contracture

We present preliminary results of a case series on refractory bladder neck contracture (BNC) treated with robot-assisted laparoscopic Y-V plasty (RAYV). Between 01/2013 and 02/2016, 12 consecutive adult male patients underwent RAYV in our hospital. BNC developed after transurethral procedures (n = 9), simple prostatectomy (n = 2) and HIFU therapy of the prostate (n = 1). Each patient had had multiple unsuccessful previous endoscopic treatments. All RAYV procedures were performed using a transperitoneal six-port approach (four-arm robotic setting). There were no intraoperative or major postoperative complications. During a median follow-up of 23.2 months two cases of refractory BNC were observed. In both cases a postoperative International Prostate Symptom Score (IPSS) of 20 and 25 was reported, respectively. In contrast, amongst the patients without evidence of refractory BNC the median IPSS was 6.5 reflecting an only mildly impaired voiding function in most cases, thus, suggesting a treatment success in 83.3% of patients. To the best of our knowledge, this is the first report on RAYV for refractory BNC. In our series RAYV was feasible in all patients, and only two cases of refractory BNC were reported during a median follow-up of almost 2 years. At the same time, no intraoperative or major postoperative complications were observed. More clinical data with a longer follow-up are needed in this promising field to reveal the actual efficacy and relevance of RAYV.     

Value of gadolinium-enhanced magnetic resonance imaging in patients with Tako-Tsubo-like left ventricular dysfunction.

We present gadolinium-enhanced cardiac magnetic resonance imaging (CMRI) in Tako-Tsubo-like left ventricular dysfunction showing the findings in acute phase and in follow-up. Gadolinium-enhanced CMRI allows to distinguish between myocardial infarction and other myocardial alterations, e.g., myocarditis. CMRI may thus permit to non-invasively identify patients with Tako-Tsubo syndrome by ruling out myocardial infarction or myocarditis in the setting of wall motion abnormalities (WMA).     

Design and evaluation of an interactive training system for scrub nurses

Objective

The current trend toward increasingly integrated technological support systems and the rise of streamlined processes in the OR have led to a growing demand for personnel with higher levels of training. Although simulation systems are widely used and accepted in surgical training, they are practically non-existent for perioperative nursing, especially scrub nursing. This paper describes and evaluates an interactive OR environment simulation to help train scrub nurses.

Methods

A system comprising multiple computers and monitors, including an interactive table and a touchscreen combined with a client–server software solution, was designed to simulate a scrub nurse’s workplace. The resulting demonstrator was evaluated under laboratory conditions with a multicenter interview study involving three participating ear, nose, and throat (ENT) departments in Germany and Switzerland.

Results

The participant group of 15 scrub nurses had an average of 12.8 years hands-on experience in the OR. A series of 22 questions was used to evaluate various aspects of the demonstrator system and its suitability for training novices.

Discussion

The system received very positive feedback. The participants stated that familiarization with instrument names and learning the instrument table setup were the two most important technical topics for beginners. They found the system useful for acquiring these skills as well as certain non-technical aspects.

Conclusions

Interactive training through simulation is a new approach for preparing novice scrub nurses for the challenges at the instrument table in the OR. It can also improve the lifelong training of perioperative personnel. The proposed system is currently unique in its kind. It can be used to train both technical and non-technical skills and, therefore, contributes to patient safety. Moreover, it is not dependent on a specific type of surgical intervention or medical discipline.

     

Accessibility and usability in housing: construct validity and implications for research and practice

Purpose: The aim of this study was to validate the conceptual definitions of accessibility and usability, and to explore differences between objective accessibility assessments and subjective ratings of usability in different client groups.

Method: The Housing Enabler and the Usability in My Home instruments were used for 131 persons above 18 years of age, living in ordinary housing and receiving a housing adaptation grant. Covariation between accessibility in four different housing sections and three different usability aspects were explored, for the total sample and for six sub-samples reflecting person-environment-activity transactions or demographic factors.

Results: Significant correlations were found in the total sample, among clients aged 75 - 84, women, clients living alone, as well as among clients with high dependence in personal and instrumental ADL and in outdoor activities. Subjective usability evaluations of activity aspects and physical environmental aspects were correlated to accessibility indoors and outdoors, while personal and social aspects of usability were correlated to outdoor accessibility.

Conclusions: Accessibility and usability are concluded to be different but related concepts. The results indicate that e.g. age, civil status and ADL dependence affect how clients assess aspects of their housing situation. For efficient planning and evaluation of housing adaptations, assessment of housing accessibility, usability, and dependence in ADL is recommended.