Laparoscopic Peritoneal Dialysis Surgery is Safe and Effective in Patients with Prior Abdominal Surgery.

BACKGROUND: Despite the lower cost, improved early survival, and preservation of the remaining kidney function, peritoneal dialysis is used by only 8.8% of the dialysis population in the USA. Intraabdominal adhesions reported in 70-90% of patients with prior abdominal surgery (PAS) reduce the peritoneal surface area and may increase the intraoperative and postoperative morbidity. The objective of this study is to evaluate the outcomes of laparoscopic peritoneal dialysis (LPD) catheter placement in patients with and without PAS. METHODS: Patients who had LPD catheters placed between January 2014 and August 2016 were retrospectively reviewed. A Kaplan-Meier analysis was performed to assess the revision-free catheter survival (RFCS) and revision-assisted catheter survival (RACS) between the 2 groups. RESULTS: One hundred forty-two patients had had LPD catheter placed during the study time, 82 (58%) with PAS. Lysis of adhesions (LOA) was required in 26 patients (28%) with PAS. Demographics and comorbidities were similar, but more women had PAS (65% vs. 35%, P < 0.001). Seventeen patients (12%) required revision, with no difference between the 2 groups. Both RFCS and RACS were similar in patients without and with PAS (P = 0.38 and 0.98, respectively). RFCS was 73% vs. 64% at 1 year (no PAS versus PAS) and 62% vs. 51% at 2 years, whereas RACS was 84% vs. 77% at 1 year (no PAS versus PAS) and 69% vs. 68% at 2 years. Only 2 intraoperative complications occurred, namely a superficial liver injury and pelvic hematoma. Three complications (0.02%) occurred within 30 days, namely 1 peritonitis and 2 catheter malfunctions. Overall complication rate was 25%, predominantly poor drainage (17% and 22% for PAS and no PAS, respectively), and there were no differences between the subgroups. No deaths occurred within a year of surgery during the study follow-up. CONCLUSIONS: LPD and LOA can be performed safely in patients with multiple PAS. When possible, LPD catheters should be part of the vascular surgery training armamentarium and offered to patients with PAS.

Prognostic impact of inappropriate defibrillator shocks in a population cohort.

BACKGROUND: There is a relative paucity of data linking inappropriate implantable cardioverter-defibrillator (ICD) shocks to adverse clinical outcomes. OBJECTIVE: To examine the association between inappropriate ICD shocks and mortality or heart transplantation in a large population cohort. DESIGN, SETTING, PATIENTS: A cohort study which included all subjects who underwent ICD implantation between 1998 and 2008 and were followed up at our institution. MAIN OUTCOME MEASURES: Multivariable Cox regression analyses were conducted to investigate the effect of inappropriate shocks on the risk of death and heart transplantation. Appropriate and inappropriate ICD therapies were modelled as time-dependent covariates. RESULTS: A total of 1698 patients were included. During a median follow-up of 30 months, there were 246 (14.5%) deaths and 42 (2.5%) heart transplants. The incidence of inappropriate shocks was 10% at 1 year and 14% at 2 years. In the adjusted model, inappropriate shocks were not associated with death or transplantation (HR=0.97, 95% CI 0.70 to 1.36, p value=0.873). In contrast, appropriate shocks were associated with adverse outcomes (HR=3.11, 95% CI 2.41 to 4.02, p value<0.001). The lack of association between inappropriate shocks and outcomes persisted for those with severely impaired left ventricular function (ejection fraction <30%) and for those receiving multiple inappropriate treatments. CONCLUSIONS: In this study, we observed no association between inappropriate ICD shocks and increased mortality or heart transplantation, even among those with severely impaired cardiac function. These findings question whether inappropriate ICD shocks lead to adverse outcomes.

Reconstructing euglenoid evolutionary relationships using three genes: nuclear SSU and LSU, and chloroplast SSU rDNA sequences and the description of Euglenaria gen. nov. (Euglenophyta).

Using Maximum Likelihood and Bayesian analyses of three genes, nuclear SSU (nSSU) and LSU (nLSU) rDNA, and chloroplast SSU (cpSSU) rDNA, the relationships among 82 plastid-containing strains of euglenophytes were clarified. The resulting tree split into two major clades: clade one contained Euglena, Trachelomonas, Strombomonas, Colacium, Monomorphina, Cryptoglena and Euglenaria; clade two contained Lepocinclis, Phacus and Discoplastis. The majority of the members of Euglena were contained in clade A, but seven members were outside of this clade. Euglena limnophila grouped with, and was thus transferred to Phacus. Euglena proxima was a single taxon at the base of clade one and is unassociated with any subclade. Five members of Euglena grouped together within clade one and were transferred into the newly erected genus Euglenaria. The monophyly of the remaining genera was supported by Bayesian and Maximum Likelihood analyses. Combining datasets resolved the relationships among ten genera of photosynthetic euglenoids.