Endovascular Management of Mycotic Pseudoaneurysm After Pancreas Transplantation: Case Report and Literature Review.

INTRODUCTION: Mycotic pseudoaneurysm is a rare complication of pancreas transplantation. Successful management relies on early diagnosis and expedient treatment comprising surgery and antibiotics. While the standard of care in recipients of pancreatic transplants is open repair of pseudoaneurysm with or without excision of the allograft, endovascular management has been reported. Endovascular repair is a less invasive treatment option with advantages of expedient control of hemorrhage, avoidance of adhesions with an open repair, and greater suitability for elderly and frail patients. MATERIAL AND METHODS: We report a case of a 40-year-old recipient of a pancreas transplant who had a mycotic pseudoaneurysm managed with endovascular repair. A systematic search of PubMed-MEDLINE, Embase, and Cochrane Library was performed of all cases of mycotic aneurysms following pancreas or kidney transplantation managed with endovascular repair. RESULTS: There were 14 cases of mycotic aneurysms in transplant recipients managed with endovascular repair in the literature. Of those who received an endovascular stent as the only initial management strategy, 6 (54.5%) required a subsequent graft excision. Four (28.6%) patients required excision of their stent due to continued sepsis. There was 1 death from unrelated causes. CONCLUSIONS: Endovascular repair was a reasonable bridging technique to further definitive surgical treatment in our case. Endovascular management may be used with caution in high-risk patients. We advocate for prolonged antibiotic therapy combined with vigilant surveillance of the clinical response, and a low threshold for allograft excision in the event of clinical deterioration.

Tumor depth of invasion versus tumor thickness in guiding regional nodal treatment in early oral tongue squamous cell carcinoma.

OBJECTIVES: Tumor thickness (TT) and tumor depth of invasion (DOI) correlate with the risk of regional lymph node metastases in early oral tongue squamous cell carcinoma (OTSCC). We aimed to determine optimal cutoff points to guide elective nodal treatment in early OTSCC. STUDY DESIGN: This retrospective study included 145 patients treated between 1995 and 2012 for histologically proven OTSCC (<4 cm). The minimum P value method was used to calculate the cut-point values of TT and DOI that predicted for nodal disease. The utility of the DOI cut-point value and the 5-mm DOI currently used for staging were then compared. RESULTS: Logistic regression analysis demonstrated that DOI (P = .00036) and TT (P = .0001) were highly correlated with nodal disease and each other. The cut-points that best predicted for nodal disease were 4.5 mm for DOI and 8 mm for TT. There was no difference in utility between DOIs of 4.5 mm and 5 mm. CONCLUSIONS: TT and DOI were highly correlated with nodal risk but had different cut-points for prediction. Our findings highlight the need to recognize these parameters as discrete entities and to report them appropriately. This study's findings support the use of the 5-mm DOI, currently used for staging, as also the threshold value to guide elective nodal treatment.

Rare occurrence of small bowel volvulus following laparoscopic appendicectomy for perforated appendicitis.

Intestinal volvulus is a rare complication following laparoscopic surgery. We present the case of a young boy who had developed a small bowel obstruction following laparoscopic appendicectomy for perforated appendicitis. He had no evidence of any congenital malrotation on initial laparoscopy, yet was subsequently found to have a midgut volvulus requiring emergency laparotomy. No resection was required and subsequent convalescence was uncomplicated. This case highlights the importance of recognition of this uncommon but potential early complication of laparoscopy that warrants urgent surgical intervention.

Randomised controlled trial of a brief theory-based intervention promoting breakfast consumption.

The present study sought to test the efficacy of a brief theory-based intervention to promote regular consumption of breakfast, and to expand previous results suggesting that the theory of planned behaviour (TPB) can be meaningfully applied to breakfast consumption. A four-armed randomised controlled trial was conducted. Participants (n=349) were allocated to receive either a (1) positively framed attitude intervention, (2) negatively framed attitude intervention, (3) Perceived Behavioural Control (PBC) intervention, or (4) control task. Attitude, subjective norm, PBC and behaviour were measured at baseline and 4-week follow-up. All three interventions employed persuasive communication and an implementation intention task. The intervention did not result in expected increases in breakfast consumption, or in changes in attitude, subjective norm or PBC. However, baseline attitude, subjective norm and PBC predicted 39.3% of baseline intention. Baseline intention in turn predicted 33% of breakfast consumption at 4 weeks. Change in breakfast consumption was predicted by change in attitude, subjective norm, and PBC between baseline and follow-up. Despite a lack of intervention effects, the TPB provided a good model of breakfast consumption over the four-week follow-up period. By expanding on previous work investigating breakfast consumption using the TPB, this study provides further support for the argument that that theory based interventions could result in meaningful increases in breakfast consumption.