Surgical Management of Encapsulating Peritoneal Sclerosis: A Case Report in Kidney Transplant Patient

Introduction. Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome of progressive fibrotic change in response to prolonged, repetitive, and typically severe insult to the peritoneal mesothelium, often occurring in the setting of peritoneal dialysis (PD). Clear guidelines for successful management remain elusive. We describe the successful surgical management of EPS in a 28-year-old male s/p deceased donor kidney transplant for end-stage renal disease (ESRD) secondary to focal segmental glomerulosclerosis (FSGS). This patient received PD for 7 years but changed to hemodialysis (HD) in the year of transplant due to consistent signs and symptoms of underdialysis. EPS was visualized at the time of transplant. Despite successful renal transplantation, EPS progressed to cause small bowel obstruction (SBO) requiring PEG-J placement for enteral nutrition and gastric decompression. The patient subsequently developed a chronic gastrocutaneous fistula necessitating chronic TPN and multiple admissions for pain crises and bowel obstruction. He was elected to undergo surgical intervention due to deteriorating quality of life and failure to thrive. Surgical management included an exploratory laparotomy with extensive lysis of adhesions (LOA), repair of gastrocutaneous fistula, and end ileostomy with Hartmann’s pouch. Postoperative imaging confirmed resolution of the SBO, and the patient was transitioned to NGT feeds and eventually only PO intake. He is continuing with PO nutrition, gaining weight, and free from dialysis. Conclusion. Surgical intervention with LOA and release of small intestine can be successful for definitive management of EPS in the proper setting. In cases such as this, where management with enteral nutrition fails secondary to ongoing obstructive episodes, surgical intervention can be pursued in the interest of preserving quality of life

Reliability of intravitreal nepafenac in rabbits

PubMed ID: 25285465Purpose: The purpose of this experiment was to investigate the possible toxic effects of Nepafenac, a nonsteroidal anti-inflammatory molecule, after its intravitreal application in various concentrations. Methods: Forty pigmented rabbits were randomly divided into 4 groups, each including 10 rabbits. The active ingredient Nepafenac was prepared to be applied in different doses, for intravitreal use. Under topical anesthesia, following pupil dilatation, 0.3, 0.5, 0.75, and 1.5mg doses of Nepafenac was applied intravitreally into the right eye. In each rabbit, the right eye was considered to be the study group. Saline was injected intravitreally into the left eye of each rabbit, and these eyes were considered to be the control group. Immediately after the injection and at the 1st, 4th, and 8th weeks, fundus examination by indirect ophthalmoscopy and intraocular pressure measurement were conducted. Furthermore, electroretinographic (ERG) recordings were taken at the 4th and 8th weeks. At the end of the 8th week, eyes of the surviving 26 rabbits were enucleated, and then animals were sacrificed. Following necessary fixation procedures, histopathological investigations were conducted by using a light and electron microscope. In the histological cross sections, differences between the eyes with injection and the control group were evaluated, and total retinal thickness, inner nuclear layer thickness, and outer nuclear layer thickness were measured. Results: No pathology was found by clinical examination of either group. In the photopic and scotopic full-field ERG, conducted before the injection and in the 4th and 8th weeks after the injection, no statistically significant difference was determined between the study group and the control group. In the histological evaluation of the preparations, there were no statistically significant differences in the retina thickness of control and study groups. In the electron microscopic examinations, there were no toxicity findings in the eyes with injection. Conclusions: Our data show that intravitreal application of 0.3, 0.5, 0.75, and 1.5mg doses of Nepafenac active substance is nontoxic to the rabbit retina. © 2015 Mary Ann Liebert, Inc.

Allocating deceased donors using local vs. imported renal allografts: Logistics are more important than distance

Background: The deceased donor kidney allocation system (KAS) aims to optimize and equalize organ access for candidates nationwide and facilitate organ matching for candidates who are harder to match due to biological reasons. In March 2021, UNOS implanted a new allocation of KT based on distance from the donor hospitals. A distance within 250 nautical miles will receive additional proximity points to access KT. Material and Method: This retrospective single-center study assessed the Cold ischemic time (CIT) and Delayed graft function (DGF) in allograft kidneys from January 2014 to December 2020. We studied 221 import KT, compared the outcomes to locally procured KT (n = 160), and finally compared the patients and graft survival rates in 1-year and 5-years. Results: Donor and recipient demographics were similar in both groups. Induction and maintenance immunosuppression was similar in both groups. CIT was significantly higher in the imported group (27.6 vs. 15.9 h, p< 0.0001). However, distance did not impact CIT significantly (R2= 0.07) in the imported KTs. Distance also did not impact the rate of DGF in both groups (imported 21% vs. 22%, p = 0.74). Patient and graft survivals were similar in the imported vs. local group. Conclusions: We conclude that distance alone does not correlate with CIT and DGF and it is not a great single predictable factor for the outcomes. There are many logistical factors and OPO factors that have a significant impact on CIT and DGF occurrence, which should be considered, and the new UNOS allocation changes can help in terms of equal distribution of available allografts