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Selected AbstractsPlantar pressures in diabetic patients with foot ulcers which have remained healedDIABETIC MEDICINE, Issue 11 2009T. M. Owings Abstract Aims, The recurrence of foot ulcers is a significant problem in people with diabetic neuropathy. The purpose of this study was to measure in-shoe plantar pressures and other characteristics in a group of neuropathic patients with diabetes who had prior foot ulcers which had remained healed. Methods, This was an epidemiological cohort study of patients from diabetes clinics of two Swedish hospitals. From a database of 2625 eligible patients, 190 surviving patients with prior plantar ulcers of the forefoot (hallux or metatarsal heads) caused by repetitive stress were identified and 49 patients agreed to participate. Barefoot and in-shoe plantar pressures were measured during walking. Data on foot deformity, activity profiles and self-reported behaviour were also collected. Results, Mean barefoot plantar peak pressure at the prior ulcer site (556 kPa) was lower than in other published series, although the range was large (107,1192 kPa). Mean in-shoe peak pressure at this location averaged 207 kPa when measured with an insole sensor. Barefoot peak pressure only predicted ,35% of the variance of in-shoe peak pressure, indicating variation in the efficacy of the individual footwear prescriptions (primarily extra-depth shoes with custom insoles). Conclusions, We propose that the mean value for in-shoe pressures reported in these patients be used as a target in footwear prescription for patients with prior ulcers. Although plantar pressure is only one factor in a multifaceted strategy to prevent ulcer recurrence, the quantitative focus on pressure reduction in footwear is likely to have beneficial effects. [source] Seizure Outcome after Resection of Supratentorial Cavernous Malformations: A Study of 168 PatientsEPILEPSIA, Issue 3 2007Christian R. Baumann Summary:,Purpose: The optimal management of cerebral cavernous malformations (CCMs) with epileptic seizures is still a matter of debate. The aim of our study was to examine seizure outcome in the largest published series of surgically treated patients with epilepsy due to a supratentorial CCM, and to define predictors for good surgical outcome. Methods: We retrospectively studied 168 consecutive patients with a single supratentorial CCM and symptomatic epilepsy in a multicenter study. Pre- and postoperative clinical examinations, age at epilepsy onset, age at operation, type of symptoms due to the CCM (seizures, headache, hemorrhage, focal deficits), type and frequency of epileptic seizures, and the localization and size of the CCM were assessed. Seizure outcome was determined in the first, second, and third postoperative years. Results: The CCM was completely resected in all patients. More than two thirds of the patients were classified as seizure free in the first 3 postoperative years. Predictors for good seizure outcome were age older than 30 years at the time of surgery, mesiotemporal CCM localization, CCM size <1.5 cm, and the absence of secondarily generalized seizures. No mortality occurred in our series, but only mild postoperative neurologic deficits in 12 (7%) patients. Conclusions: Considering the natural history of CCMs, the favorable neurologic and seizure outcome, surgical resection of CCMs should be considered in all patients with supratentorial CCMs and concomitant epilepsy, irrespective of the presence or absence of predictors for a favorable seizure outcome. [source] Uncertainties in central England temperature 1878,2003 and some improvements to the maximum and minimum seriesINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 9 2005David Parker Abstract We assess the random and systematic uncertainties affecting the central England temperature (CET) record since 1878 on daily, monthly and annual time scales. The largest contribution to uncertainty in CET on all these time scales arises from areal sampling, followed for annual and monthly CET by thermometer calibration. For the daily series, random thermometer precision and screen errors are the second largest source of uncertainty. Annual CETs are least uncertain, whereas daily CETs are most uncertain. Despite the uncertainties in annual mean CET, the trend of 0.077 °C per decade since 1900 is significant at the 1% level. In an additional investigation, we detect biases in the published series of central England maximum and minimum temperatures, and implement systematic adjustments of up to ±0.2 °C to the values up to 1921 and up to ±0.1 °C to the values since 1980. These adjustments are of opposite sign in maximum and minimum temperature, so they do not affect mean CET, but they improve the homogeneity of the diurnal temperature range, which then shows little trend before 1980 and a reduced rising trend thereafter. The uncertainties in maximum and minimum temperature make the data inadequate for the task of establishing the magnitude of the recent increase of diurnal range. © Crown Copyright 2005. Reproduced with the permission of Her Majesty's Stationery Office. Published by John Wiley & Sons, Ltd. [source] A systematic review of hand-assisted laparoscopic live donor nephrectomyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2004P. Dasgupta Summary We provide a systematic review of hand-assisted laparoscopic live donor nephrectomy (HALDN), a relatively new procedure. Medline search of HALDN between 1995 and 2002 was conducted. Published studies were scored by two independent assessors using a modified form of 11 generic questions. All questions required one of three responses: 0 , criterion not reported, 1 , criterion reported but inadequate, 2 , criterion reported and adequate. The studies were placed according to their scoRes in category A (score 20,22), category B (17,19) and category C (16 or less). Higher scores indicate better quality of studies. Where possible, statistical analysis of comparative data was performed. Most reports of HALDN are expert series, some comparative and a few prospective. There was good correlation between the assessors (r = 0.91), and of the seven published series on HALDN, two fell into category B and five into category C. At present, there is only one published randomised-controlled trial of HALDN vs. open donor nephrectomy; this is the only such trial in laparoscopic urology. HALDN allows kidneys to be harvested with short operating and warm ischaemia times and fewer ureteric complications. HALDN is a relatively new and effective technique, designed to make kidney donation more attractive and minimally invasive without affecting recipient outcomes. More prospective data of this technique is needed, and wide variation in reported outcome parameters need to be standardised to allow meaningful comparison. [source] Retroperitoneal laparoscopic decortication of simple renal cysts using the bipolar PlasmaKinetic scissorsINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2006AHMET TEFEKLI Objectives:, To analyse the efficacy, safety and feasibility of retroperitoneal laparoscopic decortication of simple renal cysts using bipolar PlasmaKinetic scissors. Methods:, Records of 19 patients who underwent laparoscopic decortication of simple renal cysts, performed with bipolar PlasmaKinetic scissors without additional fulguration of the base or the margin of resection, were retrospectively reviewed. Long-term symptomatic and radiological outcomes were assessed. Results:, One single cyst was treated in fourteen (73.7%) cases, two cysts in three (15.8%) cases, three cysts in one (5.2%) case and multiple cysts in one case with autosomal dominant polycystic kidney disease. They were peripherally located in thirteen, peripelvic in three, and parenchymal in two cases. An average of 3.1 trochars were used for each procedure. The mean operating time was 82.5 ± 16.7 min (range, 50,135). Neither open conversion nor blood transfusion was necessary. A total of six minor complications were encountered. Mean hospital stay 2.3 ± 0.9 days (range, 1,4). After a mean follow up of 14.3 ± 5.9 months (range, 3,24), symptomatic success was achieved in 89.5%, and radiological success was accomplished in 88.2%. An asymptomatic cyst recurrence was observed in one (5.9%) case, and one (5.9%) case with residual pain had new cyst formation at another site of the kidney. Conclusions:, Retroperitoneal laparoscopic cyst decortication using bipolar PlasmaKinetic scissors is a feasible and efficient method, eliminating further fulguration of the base and the margins of the cysts. Operating times are shorter than previously published series and highly satisfactory long-term success rates are achieved. [source] Early and Late Results of Partial Left Ventriculectomy: Single Center Experience and Review of the LiteratureJOURNAL OF CARDIAC SURGERY, Issue 3 2003Raimondo Ascione M.D. Methods: From February 1996 to August 2001, 24 patients with dilated cardiomyopathy (DCM) (12 idiopathic, 12 ischemic) underwent PLV. Perioperative and follow-up data were prospectively entered into a database and analyzed. An observational analysis of the literature was carried out of all the published series of PLV reporting on ,15 patients. Results: In our series there were 22 males with amean age of 65 years (range 49 to73]). Of the 22, there were 3 (12.5%) in-hospital deaths. Mean duration of follow-up was 26 months (range 3 to 71) with 9 late deaths (38%), 6 in the idiopathic group. The five-year actuarial survival was 74% in the ischemic group and 33% in the idiopathic group. The observational analysis of literature included a total of 506 patients (425 males, age 50.2 ± 5.2 years)]. The etiology was idiopathic in 255 (50.4%), and ischemic in 89 (17.6%) patients. Baseline characteristics of the whole population include: ejection fraction 18.9 ± 3.9%, NYHA functional class 3.7 ± 0.2, and LVEDD of 7.7 ± 0.4 cm. Severe mitral regurgitation was present in 368 (72.7%) patients. There were 88 (17.4%) in-hospital deaths. Cause of death included 55 due to (62.5%) low cardiac output, 10 (11.3%) due to severe bleeding, 7 (7.95%) caused by malignant arrhythmias, 8 (9%) due to sepsis, and 5 (5.7%) as a result of stroke. Ten of the selected series (overall 386 patients) reported late outcome. There were 89 (22.9%) late deaths, 12 (13.5%) were not cardiac-related, 50 (56.2%) were due to recurrence of congestive heart failure (CHF), 20 (22.5%) caused by sudden arrhythmias, 5 (5.6%) due to infections, and 2 (2.2%) from strokes. Overall, there were 248 (64.2%) survivors, of whom 179 (72.17%) were reported to be in NYHA functional class I or II. All 10 papers reported one-year survival ranging from 50% to 85%. Seven reported a two-year survival of 45% to 72%, and 4 reported a three-year survival of 33% to 64%. Conclusions: Our results and the review of the literature seem to suggest a relatively high early mortality with satisfactory late results of PLV in patients with dilated cardiomyopathy.(J Card Surg 2003;18:190-196) [source] Transcatheter Closure of Patent Foramen Ovale in Patients with Paradoxical Embolism.JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2008Follow-up Results after Implantation of the Starflex® Occluder Device with Conjunctive Intensified Anticoagulation Regimen, Procedural Background:Prevalence of patent foramen ovale (PFO) is higher in patients with paradoxical embolism and associated with increased risk for recurrent thromboembolic events. By percutaneous closure of PFO, surgical closure or permanent oral anticoagulation can be avoided. So far, published series included different occluder systems and various indications and regimens of postprocedural anticoagulation. The aim of the present study was to evaluate the short- and long-term results after implantation of the Starflex® occluder in patients with PFO using an intensified anticoagulation regimen. Methods and Results:154 patients with PFO (94 men; age: 44 ± 13 years) and >1 thromboembolic event were included. Other causes for embolism were excluded. PFO closure was successful in 147 patients (95.5%). All patients were treated with phenprocoumon (INR 2.5) and aspirin (100 mg/die) for 6 months. Transesophageal echocardiography (TEE) was repeated at 6 months. Mean clinical follow-up period was 26 ± 18 months. After 6 months, five patients had a significant residual shunt, and five patients had suspected thrombus formation on the occluder. In three of these five patients, the occluder was surgically removed and foreign body reaction was noted. During follow-up, nine patients suffered from neurological events (two strokes, seven transient ischemic attacks [TIA]), though complete closure of the PFO was documented by TEE. Two patients died during follow-up; three patients had bleeding complications. Conclusion:Percutaneous closure of PFO in symptomatic patients by Starflex® occluder represents an effective therapy with a low incidence of periinterventional complications and recurrent thromboembolism. However, thrombus formation at the occluder system may occur in some patients despite an aggressive anticoagulation regimen. [source] Guidelines for the use of recombinant activated factor VII (rFVIIa) in uncontrolled bleeding: a report by the Israeli Multidisciplinary rFVIIa Task ForceJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 4 2005U. MARTINOWITZ Summary.,Background:,Recombinant activated factor VII (rFVIIa) has been approved by the U.S. Food and Drug Administration (FDA) for almost a decade for hemophilic patients with inhibitors. Its off-label use as a hemostatic agent in massive bleeding caused by a wide array of clinical scenarios is rapidly expanding. While evidence-based guidelines exist for rFVIIa treatment in hemophilia, none are available for its off-label use. Objectives:,The aim of this study is to develop expert recommendations for the use of rFVIIa in patients suffering from uncontrolled bleeding (with special emphasis on trauma) until randomized, controlled trials allow for the introduction of more established evidence-based guidelines. Methods:,A multidisciplinary task force comprising representatives of the relevant National Medical Associations, experts from the Medical Corps of the Army, Ministry of Health and the Israel National Trauma Advisory Board was established in Israel. Recommendations were construed based on the analysis of the first 36 multi-trauma patients accumulated in the prospective national registry of the use of rFVIIa in trauma, and an extensive literature search consisting of published and prepublished controlled animal trials, case reports and series. The final consensus guidelines, together with the data of the first 36 trauma patients treated in Israel, are presented in this article. Results:,Results of the first 36 trauma patients: The prolonged clotting assays [prothrombin time (PT) and partial thromboplastin time (PTT)] shortened significantly within minutes following administration of rFVIIa. Cessation of bleeding was achieved in 26 of 36 (72%) patients. Acidosis diminished the hemostatic effect of the drug, while hypothermia did not affect it. The survival rate of 61% (22/36) seems to be favorable compared with published series of similar, or less severe, trauma patients (range 30%,57%). Conclusions:,As a result of the lack of controlled trials, our guidelines should be considered as suggestive rather than conclusive. However, they provide a valuable tool for physicians using rFVIIa for the expanding off-label clinical uses. [source] De novo breast cancer in patients with liver transplantation: University of Pittsburgh's experience and review of the literatureLIVER TRANSPLANTATION, Issue 1 2004M.Tahir Oruc De novo malignancies are one of the current problems in patients with organ transplantation. The incidence has been considered to be higher as a result of increases of oncogenic viruses in immunosuppressed organ recipients. Published reports have shown increased incidence of de novo tumors such as malignant lymphomas and cutaneous neoplasms but decreased incidence of breast cancer. A variety of factors affect de novo breast cancer development in organ recipients, including immunosuppression, viruses, and underlying disease. The aims of this review are to evaluate the incidence and management of patients with de novo breast cancer by giving the University of Pittsburgh's data, and to evaluate the incidence of de novo breast cancer in published reports in light of an age-adjusted rate. According to age-adjusted rates presented by the National Cancer Institute's Surveillance, Epidemiology and End Results data, we found increased incidence rate of de novo breast cancer in the previously published series. The University of Pittsburgh's incidence rate of de novo breast cancer was determined in a fashion similar to that for the Surveillance, Epidemiology and End Results data. Eighty-three percent of all patients were diagnosed at early stages, and it appeared to take longer for de novo breast cancer to develop in patients treated with tacrolimus than in patients treated with cyclosporine. In conclusion, surgical treatment of breast cancer in liver recipients is the same as treatment of breast cancer in patients without transplantation. However, the effects of chemotherapy, radiotherapy, and/or tamoxifen remain unclear in transplanted patients and need to be evaluated in larger studies. (Liver Transpl 2004;10:1,6.) [source] A single center comparison of one versus two venous anastomoses in 564 consecutive DIEP flaps: Investigating the effect on venous congestion and flap survival,MICROSURGERY, Issue 3 2010Morteza Enajat M.D. Background: Venous complications have been reported as the more frequently encountered vascular complications seen in the transfer of deep inferior epigastric artery (DIEA) perforator (DIEP) flaps, with a variety of techniques described for augmenting the venous drainage of these flaps to minimize venous congestion. The benefits of such techniques have not been shown to be of clinical benefit on a large scale due to the small number of cases in published series. Methods: A retrospective study of 564 consecutive DIEP flaps at a single institution was undertaken, comparing the prospective use of one venous anastomosis (273 cases) to two anastomoses (291 cases). The secondary donor vein comprised a second DIEA venae commitante in 7.9% of cases and a superficial inferior epigastric vein (SIEV) in 92.1%. Clinical outcomes were assessed, in particular rates of venous congestion. Results: The use of two venous anastomoses resulted in a significant reduction in the number of cases of venous congestion to zero (0 vs. 7, P = 0.006). All other outcomes were similar between groups. Notably, the use of a secondary vein did not result in any significant increase in operative time (385 minutes vs. 383 minutes, P = 0.57). Conclusions: The use of a secondary vein in the drainage of a DIEP flap can significantly reduce the incidence of venous congestion, with no detriment to complication rates. Consideration of incorporating both the superficial and deep venous systems is an approach that may further improve the venous drainage of the flap. © 2009 Wiley-Liss, Inc. Microsurgery, 2010. [source] Use of Spinal Cord Stimulation in the Treatment of Phantom Limb Pain: Case Series and Review of the LiteraturePAIN PRACTICE, Issue 5 2010Ashwin Viswanathan MD Abstract Introduction: Despite technical advances in spinal cord stimulation (SCS), there is a paucity of recent literature regarding SCS for phantom limb pain. Methods: Between January 2003 and May 2008, four patients at M.D. Anderson Cancer Center underwent SCS for intractable phantom limb pain. A retrospective chart review was performed to assess outcomes and complications. A PubMed search was performed to review previously published series regarding the efficacy of SCS for phantom limb pain. Results: Postoperatively, all patients subjectively reported excellent pain relief (>80%). Patients were all followed with the Brief Pain Inventory. Patients 1 to 3 each reported a two-point decrease in their usual amount of pain using the numerical rating scale. Patient 4's numerical pain scale was unchanged. When using an 11-point scale to assess other symptomology along 10 dimensions, patients 1 to 3 demonstrated a decrease in their total symptom score by 13, 14, and 4 points, respectively. Patient 4 reported an increase by 5 points in his total symptom score. With regard to complications, patient 2 developed an allergic dermatitis to the generator requiring revision with a polyfluoroethylene (GorTex) pouch. Patient 3 developed a surgical site infection after an implantable pulse generator change. Patients 2 to 4 were very satisfied with their stimulator and would choose to undergo implantation again, with patient 1 having an equivocal response. Conclusions: For selected patients who have not obtained adequate relief with medical management, SCS for phantom limb pain can prove an effective intervention.,, [source] Screening for Wilms tumor and hepatoblastoma in children with Beckwith-Wiedemann syndromes: A cost-effective model,PEDIATRIC BLOOD & CANCER, Issue 4 2001D. Elizabeth McNeil MD Abstract Background We undertook a cost-benefit analysis of screening for Wilms tumor and hepatoblastoma in children with Beckwith-Wiedemann syndrome (BWS), a known cancer predisposition syndrome. The purpose of this analysis was twofold: first, to assess whether screening in children with BWS has the potential to be cost-effective; second, if screening appears to be cost-effective, to determine which parameters would be most important to assess if a screening trial were initiated. Procedures We used data from the BWS registry at the National Cancer Institute, the National Wilms Tumor Study (NWTS), and large published series to model events for two hypothetical cohorts of 1,000 infants born with BWS. One hypothetical cohort was screened for cancer until a predetermined age, representing the base case. The other cohort was unscreened. For our base case, we assumed: (a) sonography examinations three times yearly (triannually) from birth until 7 years of age; (b) screening would result in one stage shift downward at diagnosis for Wilms tumor and hepatoblastoma; (c) 100% sensitivity and 95% specificity for detecting clinical stage I Wilms tumor and hepatoblastoma; (d) a 3% discount rate; (e) a false positive result cost of $402. We estimated mortality rates based on published Wilms tumor and hepatoblastoma stage specific survival. Results Using the base case, screening a child with BWS from birth until 4 years of age results in a cost per life year saved of $9,642 while continuing until 7 years of age results in a cost per life-year saved of $14,740. When variables such as cost of screening examination, discount rate, and effectiveness of screening were varied based on high and low estimates, the incremental cost per life-year saved for screening up until age four remained comparable to acceptable population based cancer screening ranges (<,$50,000 per life year saved). Conclusions Under our model's assumptions, abdominal sonography examinations in children with BWS represent a reasonable strategy for a cancer screening program. A cancer screening trial is warranted to determine if, when, and how often children with BWS should be screened and to determine cost-effectiveness in clinical practice. Med Pediatr Oncol 2001;37:349,356. Published 2001 Wiley-Liss, Inc. [source] Robot Assisted Laparoscopic Pyeloplasty: a review of the current statusTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 1 2007Ketul K. Shah Abstract Background Over the last decade minimally invasive endourologic and laparoscopic techniques have become the first line therapies for primary UPJ obstruction. Robotic assisted laparoscopic pyeloplasty for the correction of ureteropelvic junction has achieved outcomes comparable to those of open and laparoscopic techniques. We present a comprehensive review of the current literature of robotic assisted pyeloplasty. Methods We performed a systemic review of all the current literature examining demographic data, intra operative parameters and post-operative outcomes. Results In most published series in the literature, the operative time ranges from 122 to 300 minutes and the operative time ranges from 27 to 77 ml. Most series considers subjective improvement in the symptoms and improved drainage on post-operative diuretic renal scan as the measures of success. The reported success rates vary from 89 to 100%. Conclusion Robotic pyeloplasty is a feasible alternative to laparoscopic pyeloplasty. Short-term results indicate equivalent outcomes with the laparoscopic procedure. Long-term studies are still needed to compare robotic and open pyeloplasty outcomes, and to define the role of robotic pyeloplasty in a cost prohibitive health care system. Copyright © 2007 John Wiley & Sons, Ltd. [source] Radial Forearm Osteocutaneous Free Flap in Maxillofacial and Oromandibular ReconstructionsTHE LARYNGOSCOPE, Issue 9 2005J H. Kim MD Abstract Objectives/Hypothesis: The radial forearm osteocutaneous free flap is an excellent reconstructive modality for oromandibular and maxillofacial reconstruction in certain well-defined circumstances. The initial concern over donor site morbidity and the ability of the bone to reconstruct mandibular defects have led to only a few published series. Study Design: Retrospective study of the experience of two tertiary medical centers with radial forearm osteocutaneous free flap. Methods: Retrospectively, 52 patients were studied who underwent radial forearm osteocutaneous free flap reconstruction for cancer (49 cases) and trauma (3 cases). Bone length and skin paddle harvested, general morbidity (hematoma, wound infection, and dehiscence), recipient site morbidity (nonunion of neomandible, flap failure, and bone or plate exposure), and donor site morbidity (radius bone fracture, plate exposure, and skin graft failure) were reviewed. Results: The average skin paddle size was 55.1 cm2 (range, 15,112 cm2). The average radius bone harvest length was 6.3 cm (range, 2.5,11 cm). Donor site complications included tendon exposure (3 cases), radius bone fracture (1 case), and exposure of the plate (0). Recipient site complications included nonunion of the mandible (4), exposed mandible (1), exposed mandibular plates (2), exposed maxillary plates or bone (0), venous compromise (1), and flap failure (1). Two patients had perioperative deaths. Conclusion: Radial forearm osteocutaneous free flap is a valuable and viable option for oromandibular and maxillofacial reconstruction. [source] The Platysma Myocutaneous Flap: Underused Alternative for Head and Neck Reconstruction,THE LARYNGOSCOPE, Issue 7 2002Wayne M. Koch MD Abstract Objectives The use, advantages, and disadvantages of the platysma flap were assessed. Study Design Retrospective review of the medical records of patients undergoing platysma flap reconstruction of the upper aerodigestive tract from 1987 to 2001. Methods Information regarding the tumor, surgical procedure, flap design, and outcome emphasizing complications and function was extracted. Associations between putative risk factors for flap failure and outcome were assessed using the ,2 test. Results Thirty-four patients underwent reconstruction with platysma flaps. Surgical defects included the oropharynx, oral cavity, and hypopharynx. Nine patients had had prior radiation therapy and all had some dissection of the ipsilateral neck. There were 5 postoperative fistulas (15%), flap desquamation was noted in 6 cases (18%), and 2 patients experienced loss of the distal skin closing the donor site. Complications were not associated with prior radiation. Hospital stay ranged from 5 to 21 days (mean, 10 d). There were no returns to the operating room or need for additional reconstruction. All but 1 patient resumed a normal diet within 3 months of surgery. There were no recurrences of cancer in the dissected neck regions. Conclusions The platysma flap is simple and versatile with properties similar to the radial forearm free flap. The rate of complications is similar to other published series, and problems encountered were manageable using conservative methods with excellent functional and cosmetic outcomes. These facts support the contention that the platysma myocutaneous flap can serve as a viable alternative to free tissue transfer and has advantages over pectoralis major pedicled flaps for reconstruction of many head and neck defects. [source] Anonymous Living Liver Donation: Donor Profiles and OutcomesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010T. W. Reichman There are no published series of the assessment process, profiles and outcomes of anonymous, directed or nondirected live liver donation. The outcomes of 29 consecutive potential anonymous liver donors at our center were assessed. We used our standard live liver assessment process, augmented with the following additional acceptance criteria: a logical rationale for donation, a history of social altruism, strong social supports and a willingness to maintain confidentiality of patient information. Seventeen potential donors were rejected and 12 donors were ultimately accepted (six male, six female). All donors were strongly motivated by a desire and sense of responsibility to help others. Four donations were directed toward recipients who undertook media appeals. The donor operations included five left lateral segmentectomies and seven right hepatectomies. The overall donor morbidity was 40% with one patient having a transient Clavien level 3 complication (a pneumothorax). All donors are currently well. None expressed regret about their decision to donate, and all volunteered the opinion that donation had improved their lives. The standard live liver donor assessment process plus our additional requirements appears to provide a robust assessment process for the selection of anonymous live liver donors. Acceptance of anonymous donors enlarges the donor liver pool. [source] Anti-E in pregnancyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2000P. Moran Research Registrar Since the introduction of anti-Rhesus (Rh) D prophylaxis for RhD-negative women, other Rh and non-Rh red cell alloantibodies have become relatively more important and are now responsible for the greater proportion of haemolytic disease of the newborn. Anti-C and anti-E are the most commonly implicated non-D Rh antibodies in the pathogenesis of haemolytic disease of the newborn1. In 1977 Pepperell et al.2 reported the outcome of 44 women with anti-E. This is the only published series that investigates the implications of anti-E during pregnancy. The present report presents a retrospective study of the outcome of 122 pregnancies in which anti-E was the sole alloantibody detected. [source] A retrospective study of outcome of Mohs' micrographic surgery for cutaneous squamous cell carcinoma using formalin fixed sectionsBRITISH JOURNAL OF DERMATOLOGY, Issue 4 2000R.J. Turner The surgical management of recurrent or large squamous cell carcinoma (SCC) can be challenging as tumours often extend beyond visible margins. Micrographic surgery is a potentially effective method of ensuring complete clearance of tumour. A retrospective study of all cases of SCC treated by micrographic surgery in this department between 1986 and 1996 has been done. Sixty-one patients were treated using a formalin-fixed paraffin-embedded tissue technique with a median follow-up of 4 years. In two cases there was local recurrence and in three others metastasis to local lymph nodes. The overall cure rate was 92% (56 of 61), which compares favourably with published series using chemosurgery and frozen tissue techniques. The results show that this technique of micrographic surgery is a satisfactory and cost-effective alternative to conventional frozen section techniques in the treatment of SCC. The formalin-fixed tissue method has the advantage of providing high-quality permanent histological sections using existing conventional pathology services. [source] | ||||||||||