Implementation of a User-Friendly, Flexible Expert System for Selecting Optimal Set of Kidney Exchange Combinations of Patients in a Transplantation Center.

INTRODUCTION: For end-stage renal disease patients, kidney transplantation is the only long-term solution. The number of deceased donors is limited. Living kidney donation is subject to strict regulations, limiting possible donors only to the extended family of the patient for preventing the organ trade. There may be incompatibilities between the patients and their related donors, such as ABO blood type incompatibility, positive cross-match, and so on. METHODS: Pairwise exchanges between donors and recipients increase both the quality and the quantity of feasible transplantations. The maximum benefit in kidney exchanges could only be yielded by developing a central kidney exchange program supported by a nation wide living donor pool database. In the absence of a central kidney exchange program, each transplantation center arranges the kidney allocations using spreadsheets manually. Selecting best possible combination of exchanges simultaneously is a difficult task when performed manually. It is a proven NP-Hard combinatorial optimization problem. However, using mixed integer programming methods the best combination can be found in seconds. RESULTS: We developed a user-friendly decision support system that can be used in transplantation centers, facilitating their operations. CONCLUSIONS: The decision support system can be modified for according to the matching preferences of transplantation centers and it can be used as a simulation tool for analyzing different allocation methods.

A critical analysis of low molecular weight heparin use during pregnancy in a tertiary referral centre.

The aim of this study was to analyse low molecular weight heparin (LMWH) use during pregnancy in terms of patient evaluation, treatment indication and social and financial costs. This was a retrospective analysis of patients using LMWH in their pregnancies. A total of 147 women were included in the study. The most common indications were thrombophilia (55/147, 37.4%); recurrent pregnancy loss (RPL); (47/147, 32.0%) and previous single pregnancy loss (18/147, 12.2%). In the RPL group, 53.1% of patients were not evaluated with standard tests; 31.9% of women were incompletely evaluated and 15% were properly evaluated. Out of 104 women screened for thrombophilia, 32 (32/104, 30.8%) were tested during pregnancy. Despite published guidelines and increasing scientific evidence against their use in some indications, LMWHs are prescribed widely during pregnancy for a variety of indications. Public and healthcare providers' education to change this attitude should be implemented.

The thin cross finger skin flap.

The cross-finger flap has been used successfully for decades. Traditionally, the flap is elevated in the plane lying superficial to the extensor tendon. This damages the delicate subcutaneous tissues, which are important for the lengthening capacity of the skin of the dorsum of the fingers during flexion and extension. In this report, we present a modification of elevation of the cross-finger flap in a plane superficial to the dorsal veins of the fingers. This modification prevents donor finger complications such as poor graft take, extensor tendon adhesion to the graft and reduced range of finger joint movement and contour deformities. We have used this technique in six digits in four patients with successful results.

Carpal tunnel syndrome: comparison of intraoperative structural changes with clinical and electrodiagnostic severity.

The aim of this study is to grade the intraoperative findings seen in carpal tunnel syndrome (CTS) based on severity, and compare it with clinical and electrodiagnostic severity. Thirty-one hands surgically treated for CTS were graded according to the severity of clinical signs, and electrodiagnostic tests. Oedema, vascularisation, and fibrosis were graded on a scale of 1-3. Pseudoneuroma or 'hour-glass' formation were graded as either 0 or 1. The hands were allocated by an observer into an assumptive severity group, from grade 1 to 3. Clinical severity and electrodiagnostic severity were statistically compared with each other, and with each intraoperative severity criteria. A high statistical correlation (p < 0.01) was found between clinical severity and vascularisation, fibrosis, and the assumptive intraoperative severity. No correlation could be demonstrated between electrodiagnostic severity and the intraoperative criteria. Intraoperative grading should be regarded as a supportive measure to the clinical evaluation in order to obtain a sound base for surgical intervention and internal neurolysis.

Pedunculated lipofibroma.

Pedunculated lipofibroma is a relatively rare form of nevus lipomatosus superficialis. The lesions are large, slow growing, pedunculated tumors. Histologically, groups and strands of fat cells are found embedded among the collagen bundles of the dermis. We presented a woman diagnosed with a pedunculated lipofibroma clinically and histopathologically.

Ulnar nerve lesion due to cutaneous anthrax.

Anthrax is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. Anthrax is most common in agricultural regions, where it occurs in animals. It can also infect humans. Cutaneous anthrax infections occur when the bacterium enters a cut or abrasion on the skin. A case of cutaneous anthrax infection of the arm is presented. The patient needed to undergo a skin graft. He subsequently developed an ulnar nerve lesion after severe edema in his arm and hand.

Surgical management of cutaneous anthrax.

Cutaneous anthrax in humans is a very rare disease caused by Bacillus anthracis. Humans become infected with this spore-forming bacterium when they come into contact with an infected animal. The disease usually develops on exposed sites like the hands and the face. The authors present 4 patients with cutaneous anthrax: 2 of the hands and 2 of the eyelids. All patients needed plastic surgical help via skin grafting after excision of the black eschar. No complications occurred after surgery. Because they are so rare in Europe and the United States, sporadic cases of anthrax are easily overlooked because the diagnosis often is not considered. Cutaneous anthrax should be considered in any patient with a painless ulcer or black eschar who has a history of exposure to animals.

Multiple occurrence of pilomatrixoma.

Multiple occurrences of pilomatrixoma are rare. Although it has been known as a benign lesion, there are reports of some tumors that have histopathologic features of malignancy. A case of a 68-year-old Caucasian women with multiple pilomatrixoma is presented. She was operated on to remove three other pilomatrixomas on the arms 3 years after the initial excision from the face. Two years after excision of the lesions on the arms, no recurrences were evident.