Moral and ethical issues in living-donor liver transplant in Egypt.

OBJECTIVES: Since brain-death criteria are not accepted in Egypt, only organs acquired from living donors can be used for transplant. Our objective was to highlight the ethical issues raised by living-donor liver transplant. MATERIALS AND METHODS: The study was conducted by reviewing publications from centers performing living-donor liver transplant in Egypt and by consulting with a group of experts in the fields of liver transplantation, clinical ethics, and religious scholarship. RESULTS: The first successful living-donor liver transplant in Egypt was performed at the National Liver Institute in 1991; however, this program did not continue because of poor early results. In August 2002, transplants began at Dar-Al-Foaud Hospital; since then, almost 500 cases of living-donor liver transplant have been performed at 9 centers. Although the donor risk is estimated to be low, 2 donors died (0.4%). The ethical principle that best applies to living-donor liver transplant is primum non nocere (first, not to harm), as the donor derives emotional benefit fromdonation and the opportunity to save a life. It is important to stress that the alternative to living-donor liver transplant in Egypt is not deceased-donor liver transplant. There are no doubts that this is a beneficial procedure for the recipient with acceptable risks to the donor. CONCLUSIONS: It is ethically appropriate to perform liver transplant using living donors.

Non-invasive assessment of human multifidus muscle stiffness using ultrasound shear wave elastography: A feasibility study.

There is a lack of numeric data for the mechanical characterization of spine muscles, especially in vivo data. The multifidus muscle is a major muscle for the stabilization of the spine and may be involved in the pathogenesis of chronic low back pain (LBP). Supersonic shear wave elastography (SWE) has not yet been used on back muscles. The purpose of this prospective study is to assess the feasibility of ultrasound SWE to measure the elastic modulus of lumbar multifidus muscle in a passive stretching posture and at rest with a repeatable and reproducible method. A total of 10 asymptotic subjects (aged 25.5 ± 2.2 years) participated, 4 females and 6 males. Three operators performed 6 measurements for each of the 2 postures on the right multifidus muscle at vertebral levels L2-L3 and L4-L5. Repeatability and reproducibility have been assessed according to ISO 5725 standard. Intra-class correlation coefficients (ICC) for intra- and inter-observer reliability were rated as both excellent [ICC=0.99 and ICC=0.95, respectively]. Reproducibility was 11% at L2-L3 level and 19% at L4-L5. In the passive stretching posture, shear modulus was significantly higher than at rest (µ < 0.05). This preliminary work enabled to validate the feasibility of measuring the shear modulus of the multifidus muscle with SWE. This kind of measurement could be easily introduces into clinical routine like for the medical follow-up of chronic LBP or scoliosis treatments.

Pancreaticoduodenectomy in a tertiary referral center in Saudi Arabia: a retrospective case series.

CONTEXT: Perioperative outcome of pancreaticoduodenectomy is related to work load volume and to whether the procedure is carried out in a tertiary specialized hepato-pancreatico-biliary (HPB) unit. OBJECTIVE: To evaluate the perioperative outcome associated with pancreaticoduodenectomy in a newly established HPB unit. PATIENTS: Analysis of 32 patients who underwent pancreaticoduodenectomy (PD) for benign and malignant indications. DESIGN: Retrospective collection of data on preoperative, intraoperative and postoperative care of all patients undergoing PD. RESULTS: Thirty-two patients (16 male and 16 female) with a mean age of 59.5±12.7years were analyzed. The overall morbidity rate was high at 53%. The most common complication was wound infection (n=11; 34.4%). Pancreatic and biliary leaks were seen in 5 (15.6%) and 2 (6.2%) cases, respectively, while delayed gastric emptying was recorded in 7 (21.9%). The female sex was not associated with increased morbidity. Presence of co-morbid illness, pylorus-preserving PD, intra-operative blood loss ⩾1L, and perioperative blood transfusion were not associated with significantly increased morbidity. The overall hospital mortality was 3.1% and the cumulative overall (OS) and disease free survival (DFS) at 1year were 80% and 82.3%, respectively. The cumulative overall survival for pancreatic cancer vs ampullary tumor at 1year were 52% vs 80%, respectively. CONCLUSION: PD is associated with a low risk of operative death when performed by specialized HPB surgeons even in a tertiary referral hospital. However, the postoperative morbidity rate remains high, mostly due to wound infection. Further improvement by reducing postoperative infection may help curtail the high postoperative morbidity.