ABSTRACT
Anecdotal reports have suggested that transplantation of hepatitis C virus (HCV) antibody positive (Ab+)/nucleic acid test negative (NAT-) donor kidneys into HCV negative recipients is not associated with HCV transmission. We reviewed our center's outcomes of 32 HCV negative patients who received kidney allografts from 25 donors who were HCV Ab+/NAT-. The mean recipient age was 56.9 ± 12.1 years and the mean donor age was 41.5 ± 14 years, with a median Kidney Donor Profile Index (KDPI) of 68%. Twelve donors (48%) met Public Health Service (PHS) increased risk status. All patients received antithymocyte globulin induction followed by tacrolimus, mycophenolate mofetil, and steroid maintenance immunosuppression. With a mean follow-up posttransplant of 10 ± 2.7 months, 1- and 3- month serum creatinine levels were 1.7 ± 0.8 and 1.3 ± 0.4, respectively, and patient and graft survival rates were 100% and 97%, respectively. Fourteen patients (44%) seroconverted and became HCV Ab+ posttransplant. However, all 32 patients were HCV RNA negative at 1- and 3- months posttransplant, and 27 and 8 patients tested at 6- and 12-months posttransplant, respectively, remain HCV RNA negative. In conclusion, transplantation of HCV Ab+/NAT- kidneys to HCV negative recipients frequently causes HCV Ab seroconversion but not HCV viremia.
Subject(s)
Hepatitis C Antibodies/blood , Hepatitis C/transmission , Kidney Transplantation/adverse effects , RNA, Viral/genetics , Seroconversion , Tissue Donors/supply & distribution , Viremia/immunology , Adult , Female , Follow-Up Studies , Hepacivirus/genetics , Hepacivirus/isolation & purification , Hepatitis C/virology , Humans , Kidney Failure, Chronic/surgery , Male , Middle Aged , Postoperative Complications , Prognosis , Retrospective Studies , Risk Factors , Tissue and Organ Procurement/standards , Viral Load , Viremia/pathology , Viremia/virologyABSTRACT
PURPOSE: Cardiac or major vascular perforation is a rare but serious risk of ECMO. We sought to determine if perforation rates are related to cannula design. METHODS: We utilized three methods to evaluate perforation on ECMO. 1. The ELSO registry was queried to establish the historical rate of hemorrhagic pericardial tamponade. 2. ELSO centers were surveyed regarding cannula related perforation events and brands of cannulas used over a four year time period (January 2008-March 2012). 3. The FDA's MAUDE database was reviewed looking for adverse events related to ECMO cannulas. RESULTS: The historical rate of hemorrhagic pericardial tamponade in the ELSO registry was 0.53% (~1985-2010, ELSO registry). In the survey there were eleven reports of cannula-related perforation, 0.74% (11/1482 p-value=0.29) at 7 different ELSO centers with 23 ELSO centers responding (17% response rate). The incidence of perforation was much higher for the wire-reinforced bicaval design 3.6% (10/279) as compared to catheters designed for the atrial position, 0.1% (1/1203, p-value<0.0001). Review of the FDA's MAUDE database revealed 19 adverse events related to the bicaval cannula design, 16 of which were hemorrhagic pericardial effusions or tamponade. CONCLUSION: These findings suggest a relatively high rate of cardiac perforation associated with the dual lumen bicaval cannula. This may be related to inherent differences in cannula design or the IVC positioning required by the design.
Subject(s)
Cardiac Tamponade/etiology , Catheters , Extracorporeal Membrane Oxygenation/adverse effects , Extracorporeal Membrane Oxygenation/instrumentation , Heart Injuries/etiology , Vena Cava, Superior/injuries , Adult , Child , Databases, Factual , Equipment Design , Health Care Surveys , Heart Atria/injuries , Heart Injuries/prevention & control , Hemorrhage/etiology , Humans , Infant, Newborn , Radiography, Interventional/methods , Registries , Retrospective Studies , RiskABSTRACT
BACKGROUND: Since its introduction as an alternative intestinal lengthening technique, serial transverse enteroplasty (STEP) has been increasingly used as the surgical treatment of choice for patients with refractory short bowel syndrome (SBS). While primary STEP for the treatment of congenital conditions was proposed in the original description of the procedure, emphasis was placed on a delayed or staged approach to these patients. To date, a comprehensive review of the outcomes from this sub-population has not been reported by the International STEP Data Registry. METHODS: A retrospective review of the International STEP Data Registry was performed to identify all patients who underwent STEP as a primary operative procedure for the treatment of congenital SBS. Changes in pre- and post-STEP values were assessed using paired t-tests with significance set at p<0.05. Data are presented as mean ± standard deviation. RESULTS: Fifteen patients underwent primary STEP for congenital SBS between September 1, 2004, and April 10, 2012. Thirteen patients had follow-up information available. Causes of congenital SBS included closing gastroschisis, small bowel atresia, and midgut volvulus. Twelve patients had pre- and post-STEP bowel measurements taken. Average pre- and post-STEP bowel lengths were 32 ± 16 cm and 47 ± 22 cm, respectively. Intestinal length was increased by a mean of 15 ± 12 cm for a relative small bowel length increase of 50.4 ± 27.3% (p<0.001). Only one patient required an ostomy at the time of primary STEP. A second patient required a temporary ostomy at 3months of age that was later closed. There was one death from intestinal failure associated liver disease (IFALD). Another patient experienced IFALD progression and required liver and intestinal transplantation. The most commonly reported complication following primary STEP was obstruction or bowel re-dilatation requiring additional operative interventions. Nine patients underwent second STEP procedures under these circumstances. Eight patients remain dependent on parenteral nutrition, while three patients achieved enteral autonomy. CONCLUSIONS: Primary STEP is a feasible and safe surgical option for the treatment of congenital conditions resulting in SBS. Primary STEP establishes early bowel continuity, creates intestinal length from congenitally dilated bowel, and appears to obviate the need for interval stomas and their associated loss of bowel length in neonates with congenital SBS. However, with recent changes in SBS management emphasizing intestinal rehabilitation, additional studies are needed to assess the long-term impact on intestinal adaptation of STEP performed in the neonatal period prior to adoption of this technique.
Subject(s)
Intestine, Small/abnormalities , Intestine, Small/surgery , Short Bowel Syndrome/surgery , Tissue Expansion/methods , Follow-Up Studies , Gastroschisis/complications , Gestational Age , Humans , Infant, Newborn , Intestinal Atresia/complications , Intestinal Volvulus/complications , Liver Failure/epidemiology , Liver Failure/surgery , Liver Transplantation , Ostomy/statistics & numerical data , Parenteral Nutrition/statistics & numerical data , Postoperative Complications/epidemiology , Registries , Retrospective Studies , Short Bowel Syndrome/etiology , Treatment OutcomeABSTRACT
In cases of Kawasaki's disease (KD) presenting as acute surgical abdomen, rarely has the presence of acute appendicitis been found. We report two cases of histologically confirmed acute appendicitis in the presence of KD and a review of the literature as it pertains to acute abdomen and atypical presentations of KD.
Subject(s)
Appendicitis/complications , Appendicitis/surgery , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/diagnosis , Acute Disease , Anti-Inflammatory Agents/therapeutic use , Aspirin/therapeutic use , Child , Child, Preschool , Coronary Vessels/diagnostic imaging , Diagnosis, Differential , Echocardiography/methods , Female , Follow-Up Studies , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , Mucocutaneous Lymph Node Syndrome/drug therapy , Pericardial Effusion/diagnostic imaging , Pericardial Effusion/drug therapy , Pericardial Effusion/etiology , Platelet Aggregation Inhibitors/therapeutic useABSTRACT
We document a previously unreported case of a pulmonary artery pseudoaneurysm (PAP) that developed in a pediatric patient initially presenting with Methicillin-resistant Staphylococcus aureus hip joint sepsis. This is the first reported case of PAP of infectious origin in a pediatric patient, and this case is unique as the evolution of the PAP was documented by computed tomography.
Subject(s)
Aneurysm, False/diagnostic imaging , Arthritis, Infectious/complications , Bacteremia/complications , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Multidetector Computed Tomography , Pulmonary Artery/diagnostic imaging , Staphylococcal Infections/complications , Aneurysm/diagnosis , Aneurysm, False/etiology , Aneurysm, False/surgery , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/drug therapy , Arthritis, Infectious/microbiology , Arthritis, Infectious/surgery , Bacteremia/drug therapy , Bacteremia/microbiology , Chest Tubes , Child , Combined Modality Therapy , Contraindications , Diagnosis, Differential , Drainage , Embolization, Therapeutic , Empyema, Pleural/etiology , Empyema, Pleural/microbiology , Hemoptysis/etiology , Hip Joint/microbiology , Hip Joint/surgery , Humans , Male , Pneumonectomy/methods , Pneumothorax/etiology , Pneumothorax/surgery , Pulmonary Artery/surgery , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Pulmonary Embolism/microbiology , Pulmonary Embolism/surgery , Reoperation , Respiratory Distress Syndrome/etiology , Staphylococcal Infections/diagnostic imaging , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Staphylococcal Infections/surgery , ThoracotomyABSTRACT
Cases of rare-earth magnet ingestions have been increasingly reported in the literature. However, these descriptions have focused on the severity of the injuries, rather than the clinical presentation and/or therapeutic approach. We report a series of eight children, ranging in age from 2 to 10 years, who ingested powerful rare-earth magnets. The rare-earth magnets were marketed in 2009 under the trade name Buckyballs(®) (Maxfield & Oberton, New York, NY). They are about 5 mm in size, spherical, and brightly colored, making them appealing for young children to play with and place in their mouths. Three children presented within hours of ingestion, and the magnets were successfully removed via endoscopy in two, whereas the third child required laparoscopy. No fistulas were found in these children. A fourth child presented 2 days after ingestion with evidence of bowel wall erosion, but without fistula formation; the magnets were removed via laparoscopy. A fifth child ingested nine magnets in a ring formation, which were removed via colonoscopy without evidence of injury or fistula formation. The three remaining children presented late (5-8 days after ingestion) and were found to have associated fistulas. They were treated successfully with a combination of endoscopy and laparoscopy with fluoroscopy. None of the children in our series required an open surgical procedure. All children were discharged home without complications. This case series highlights the potential dangers of rare-earth magnet ingestion in children. Our experience suggests that prompt intervention using minimally invasive approaches can lead to successful outcomes.
Subject(s)
Endoscopy, Gastrointestinal , Foreign Bodies/surgery , Laparoscopy , Magnets , Metals, Rare Earth , Child , Child, Preschool , Eating , Humans , Remission InductionABSTRACT
Chilaiditi syndrome is a rare condition defined by the presence of gastrointestinal symptoms associated with the radiological finding of segmental interposition of the bowel between the liver and the diaphragm. While it is infrequently indentified as a source of abdominal pain, Chilaiditi syndrome carries clinical significance as it can lead to a number of serious complications including intestinal obstruction, perforation, and ischemia. A 58-year-old woman presented with Chilaiditi syndrome immediately following colonoscopic evaluation. Conservative measures failed to alleviate the patient's symptoms, and the patient ultimately elected to have operative management. Pexy of the cecum and ascending colon led to full resolution of her symptoms. To our knowledge, this is the first documented case of Chilaiditi syndrome iatrogenically induced by colonoscopy. Identification of this syndrome as a complication of colonoscopy and a source of post-procedural pain bears significance for providers involved in the peri-operative care of patients with factors predisposing them to the development of this condition.