Kidney Transplantation From Donors After Cardiac Death: An Initial Report of 71 Cases From China

Shortage of deceased donors is a severe problem in recent years in China especially in a culture in which brain death criteria is not widely accepted. Donation after cardiac death (DCD) has been reported to expand the donor pool despite higher rates of primary nonfunction (PNF) and delayed graft function (DGF) after transplantation. We collected 71 DCD kidney transplants performed at our hospital between February, 2007 and June, 2012 with aims to demonstrate the feasibility of DCD donation in China. All patients were followed up, and postoperative complications and graft loss were recorded. The PNF rate was 2.8%, and DGF rate was 28.2%. The 1‐ and 3‐year graft survival was 95.7% and 92.4%. In conclusion, graft survival of DCD kidney transplantation in China is excellent despite of higher rates of PNF and DGF after transplantation.     

Coronary Revascularization in Lung Transplant Recipients With Concomitant Coronary Artery Disease

Coronary artery disease (CAD) is not uncommon among lung transplant candidates. Several small, single‐center series have suggested that short‐term outcomes are acceptable in selected patients who undergo coronary revascularization prior to, or concomitant with, lung transplantation. Our objective was to evaluate perioperative and intermediate‐term outcomes in this patient population at our institution. We performed a retrospective, observational cohort analysis of 898 lung transplant recipients between 1997 and 2010. Pediatric, multivisceral, lobar or repeat transplantations were excluded, resulting in 791 patients for comparative analysis, of which 49 (median age 62, 79.6% bilateral transplant) underwent concurrent coronary artery bypass and 38 (median age 64, 63.2% bilateral transplant) received preoperative percutaneous coronary intervention (PCI). Perioperative mortality, overall unadjusted survival and adjusted hazard ratio for cumulative risk of death were similar among both revascularization groups as well as controls. The rate of postoperative major adverse cardiac events was also similar among groups; however, concurrent coronary artery bypass was associated with longer postoperative length of stay, more time in the intensive care unit and more postoperative days requiring ventilator support. These results suggest that patients with CAD need not be excluded from lung transplantation. Preferential consideration should be given to preoperative PCI when feasible.     

Spontaneous recovery of myocardial function after ligation of Ameroid-stenosed coronary artery

Objectives. We aimed to assess the spontaneous healing of myocardial function after occlusion of a chronically stenosed coronary vessel in a porcine model. Design. Ischemia and infarction was produced by Ameroid constrictor placement and a subsequent ligation of the left circumflex artery. Cardiac MRI and 18FDG-PET were performed one and five weeks later. Ki67 staining was used to identify proliferating cells. Results. Restoration of perfusion defect was detected by MRI (p=0.0065), reduced systolic function of the lateral segment spontaneously recovered (p=0.03). There was also a suggestive raise in impaired ejection fraction (p=0.06). Left ventricular early diastolic filling and peak filling rate were substantially improved (p=0.039 and p=0.0078). Scar size reduced (p=0.03). On the 18FDG-PET, deranged metabolism was alleviated (p=0.03). Cardiomyocytes with positive Ki-67 staining were located principally in the non-infarcted myocardium as compared to the infarction or border areas (p=0.037). Conclusions. We demonstrated spontaneous functional healing of ischemic and infarcted left ventricle, suggesting border zone perfusion recovery. Scar reduction was detected. Different pattern of myocyte proliferation between infarction and non-ischemic myocardium was seen.     

Cardiac disease in pregnancy

Cardiac disease is a significant cause of maternal mortality. In the UK in the last maternal mortality report, it was the leading cause of maternal death (2.3 deaths per 100,000 maternities). Some mothers are leaving having a family until later in life and present with a variety of acquired heart conditions and there are increasing numbers of patients with corrected congenital heart disease surviving to childbearing age. It is essential to have a good knowledge of the cardiac conditions, how pregnancy affects these conditions and an understanding of the physiological changes during pregnancy. These patients can turn up on any delivery suite or in any hospital at any time.     

Strategy for 3-D Computed Tomography Diagnosis and Treatment of Small Pulmonary Arteriovenous Fistula

In a patient with left hemianopsia, computed tomography (CT) and magnetic resonance imaging revealed an intracranial space-occupying lesion in the right occipital region. A cerebral abscess was removed at craniotomy. Enhanced pulmonary CT showed a small coin lesion in the peripheral lingula, and at 3-D CT two nidi with feeding arteries and draining veins were seen, indicating pulmonary arteriovenous fistula. Lingular segmentectomy was performed.     

改良机器人手术方式行房间隔缺损修补术22例

目的 总结使用“达芬奇”（da Vinci S）机器人手术系统行体外循环下房间隔缺损修补或房间隔缺损修补＋三尖瓣成形术的经验体会.方法 2013年7月至2013年10月回顾性研究,使用da Vinic S机器人系统,体外循环下完成继发孔型房间隔缺损修补或房间隔缺损修补＋三尖瓣成形术22例.患者女16例,男6例;年龄平均（36.5±5.8）岁.房间隔缺损直径为2.5～4.1 cm,平均（3.8±1.3）cm,左向右分流,2例伴有三尖瓣中度关闭不全,2例伴有右侧胸膜腔部分粘连.手术经股动、静脉插管,于右侧胸壁打3个孔,采用我院成熟全腔镜心脏手术技术建立体外循环,阻断升主动脉,切开右心房后,再连接机器人手术系统,术者于操作台前遥控机器臂进行房间隔缺损修补,三尖瓣中度关闭不全患者同期行三尖瓣成形术.其中直接缝合房间隔缺损20例,补片修补房间隔缺损2例,同期三尖瓣成形及胸膜粘连松解各2例.结果 22例均成功接受机器人房间隔缺损修补术或房间隔缺损修补＋三尖瓣成形术,手术时间1.5 ～ 3.5 h,平均（2.3±0.6）h;后10例手术时间体外循环（58.6±18.3） min,升主动脉阻断（26.8±8.6） min,术后呼吸机辅助（5.8±1.6）h.胸液引流量50 ～ 300 ml,平均（150±32） ml,平均1～2d拔除胸腔闭式引流管.术后住院时间（5.6±1.4）d.均无中转开胸、院内死亡及术后并发症发生.全组术后3～5d超声心动图示手术效果满意,患者均顺利出院.随访1个月～3个月,无残余分流,下肢静脉血栓形成,心功能均为Ⅰ级,超声心动图检查结果满意.结论 改良达芬奇S机器人手术方式体外循环下房缺修补术安全可靠,疗效满意,且进一步缩短手术时间,创伤小、恢复快,具有良好的发展前景.     

Rinsing of allograft bone does not improve implant fixation

Background and purpose Impacted morselized allograft bone is a well-established method for reconstructing bone defects at revision surgery. However, the incorporation of bone graft is not always complete, and a substantial volume of fibrous tissue has been found around grafted implants. We hypothesized that rinsing the bone graft may improve graft incorporation by removing the majority of immunogenic factors present in blood, marrow, and fat.

Methods We implanted a cylindrical (10- × 6-mm) porous-coated Ti implant into each proximal tibia of 12 dogs. The implants were surrounded by a 2.5-mm gap into which morselized fresh frozen allograft bone was impacted. The bone graft was either (1) untreated or (2) rinsed in 37°C saline for 3 × 1 min. After 4 weeks, the animals were killed and implant fixation was evaluated by mechanical push-out and histomorphometry.

Results The groups (rinsed vs. control) were similar regarding mechanical implant fixation (mean (SD)): shear strength (MPa) 2.7 (1.0) vs. 2.9 (1.2), stiffness (MPa/mm) 15 (6.7) vs. 15 (5.6), and energy absorption (kJ/m²) 0.5 (0.2) vs. 0.6 (0.4), The same was evident for the new bone formation on the implant surface and around the implant: ongrowth (%) 6 vs. 7 and ingrowth (%) 9 vs. 9. Although not statistically significant, a 61% reduction in fibrous tissue ongrowth and 50% reduction in ingrowth were found in the rinsed group.

Interpretation Within the limits of this experimental model, we did not detect any benefits of rinsing morselized allograft bone prior to impaction grafting.     

Nerve ultrasound in a case of chronic inflammatory demyelinating neuropathy

Introduction: Chronic inflammatory demyelinating polyneuropathy (CIDP) is the most common acquired immune‐mediated inflammatory disorder of the peripheral nervous system. The diagnosis is based mainly on the clinical presentation and electrophysiological detection of demyelination. Methods: Several MRI studies have demonstrated hypertrophy and abnormal enhancement of spinal nerve roots or brachial plexus in CIDP, but there have been only anecdotal reports of similar sonographic findings. Results: This article reports the sonographic findings of a CIDP case and includes a review of the literature and previously reported cases. Conclusions: This case report highlights the importance of sonography in the localization and recognition of focal nerve enlargements in patients with CIDP. This method could be a helpful tool in the diagnosis of conduction block in CIDP, especially in cases where a nerve segment cannot be explored easily with the inching technique. Systematic data are needed to confirm this observation. Muscle Nerve 47:443‐446, 2013