Incidence, management and outcomes in hepatic artery complications after paediatric liver transplantation: protocol of the retrospective, international, multicentre HEPATIC Registry.

INTRODUCTION: Hepatic artery complications (HACs), such as a thrombosis or stenosis, are serious causes of morbidity and mortality after paediatric liver transplantation (LT). This study will investigate the incidence, current management practices and outcomes in paediatric patients with HAC after LT, including early and late complications. METHODS AND ANALYSIS: The HEPatic Artery stenosis and Thrombosis after liver transplantation In Children (HEPATIC) Registry is an international, retrospective, multicentre, observational study. Any paediatric patient diagnosed with HAC and treated for HAC (at age <18 years) after paediatric LT within a 20-year time period will be included. The primary outcomes are graft and patient survivals. The secondary outcomes are technical success of the intervention, primary and secondary patency after HAC intervention, intraprocedural and postprocedural complications, description of current management practices, and incidence of HAC. ETHICS AND DISSEMINATION: All participating sites will obtain local ethical approval and (waiver of) informed consent following the regulations on the conduct of observational clinical studies. The results will be disseminated through scientific presentations at conferences and through publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: The HEPATIC registry is registered at the ClinicalTrials.gov website; Registry Identifier: NCT05818644.

Five year experience of gallbladder polyp surveillance and cost effective analysis against new European consensus guidelines.

BACKGROUND: Gallbladder polyp (GBP) surveillance seeks to identify early neoplasms, but practice varies amongst surgical units. Recent European consensus guidelines have recommended an evidence-based GBP surveillance strategy. In a tertiary centre Hepato-Pancreato-Biliary unit we examine GBP surveillance, malignant yield, and assess cost-effectiveness of the new European consensus guidelines. METHODS: Respective data were collected from all patients with ultrasonography-detected GBPs between January 2008 and January 2013. RESULTS: 558 patients had GBPs detected on ultrasonography. Following initial ultrasonography, 304 (54.5%) had further ultrasonography surveillance of which 168 were in a formal GBP surveillance programme. Pre-malignant/malignant pathology yield was 1.97% with an annual detection rate of 12.0 cases per 1000 GBPs surveyed. Cost-effectiveness analysis of European consensus guidelines calculated annual savings of £209 163 per 1000 GBPs surveyed. Compliance with these guidelines would result in an additional 12.5% of patients under surveillance requiring cholecystectomy. CONCLUSION: GBP surveillance uptake was suboptimal at 32.8%. The incidence of pre-malignant/malignant lesions in GBPs emphasises the importance of surveillance for early detection and management with a view to avoiding the poor outcomes associated with more advanced gallbladder cancer. Adherence to the new European consensus guidelines would be clinically cost-effective with significant potential savings demonstrated in this study.

The use of polyacrylamide gel in soft-tissue augmentation: an experimental assessment.

BACKGROUND: An increasing number of soft-tissue filler substances that lack experimental and clinical data have been introduced into plastic surgery practice outside the United States. One of these substances is polyacrylamide gel. It contains 2.5% polyacrylamide and 97.5% water. It is homogenous and stable, and has optimum viscosity and elasticity. METHODS: One milliliter of polyacrylamide gel was injected into the subcutaneous layer of the right ear in 28 rabbits. The rabbits were divided into two groups, according to when the material was harvested and evaluated. Material was harvested at 4 months in 15 rabbits and 7 months in 13 rabbits. Each group underwent volumetric ultrasound evaluation, magnetic resonance imaging, and histological evaluation with hematoxylin and eosin and CD68 staining. RESULTS: Results were easily observed because of the superficial position of the injected material. There were no systemic or local complications. The samples harvested showed a clear and jelly-like consistency similar to that of the initially injected material. The volume was constant after 6 weeks, after an initial period of acute stretching. Ultrasound volumetric analysis was also constant in all groups. At 7 months, a stable volume of 1.0 +/- 0.2 ml was observed. Magnetic resonance imaging scanning showed that the material was stable and that there was no inflammatory reaction. Histological analysis revealed a minimal foreign-body reaction, and the injected material was occasionally surrounded by a thin collagen membrane. The material remained in place. CONCLUSIONS: Polyacrylamide gel has a long-lasting effect, with minimal volume variation. It remains soft to the touch and in place.

Assessment of cleft lip and palate patients treated with presurgical orthopedic correction and either primary bone grafts, gingivoperiosteoplasty, or without alveolar grafting procedures.

The effects of alveolar grafting on the development of the craniofacial complex have been reported by numerous investigators. The reported results vary in the literature from significant to very little impediment of maxillary growth. The present work evaluates and compares facial form at age six years in complete unilateral cleft lip and palate patients treated with presurgical orthopedic correction and primary reconstruction with (1) primary bone grafts (n = 14), (2) gingivoperiosteoplasty (n = II), or (3) without alveolar grafting procedures at the time of lip repair (n = 13). The cohort groups were analyzed with a one-way analysis of variance (ANOV A). Statistical analysis revealed significant differences between the three groups for only one of the 12 parameters analyzed. The primary bone grafted group demonstrated less vertical descent-of the anterior maxilla compared to the gingivoperiosteoplasty and non-grafted groups (P = .0027).