Global trends of hand and wrist trauma: A systematic analysis of fracture and digit amputation using the Global Burden of Disease 2017 Study

Background: As global rates of mortality decrease, rates of non-fatal injury have increased, particularly in low Socio-demographic Index (SDI) nations. We hypothesised this global pattern of non-fatal injury would be demonstrated in regard to bony hand and wrist trauma over the 27-year study period. Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 was used to estimate prevalence, age-standardised incidence and years lived with disability for hand trauma in 195 countries from 1990 to 2017. Individual injuries included hand and wrist fractures, thumb amputations and non-thumb digit amputations. Results: The global incidence of hand trauma has only modestly decreased since 1990. In 2017, t

Long-term outcomes of kidney transplants with multiple renal arteries: A retrospective study

PubMed ID: 22841246Objective: The aim of this study was to investigate whether kidney transplantations performed using grafts with multiple arteries negatively affected renal function or increased the risk of vascular or urologic complications. Methods: Among 249 kidney transplant patient followed for at least 1 year between 2000 and 2005, we retrospectively evaluated their donor renal artery anatomy to compare postoperative vascular and urologic complications: creatinine clearance at 1, 2, and 5 years, as well as graft survival at 3 and 5 years. Results: While 214 (85.9%) displayed a single artery (group 1), 35 (14.1%) showed multiple renal arteries (group 2). Thirty-one of the group 2 allografts had two, three donors had three, and one had four arteries. The postoperative vascular and urologic complications and the creatinine clearance values at 1, 2, and 5 years of both groups were similar. The 3- and 5-year graft survivals among group 1 were 95% and 90%, whereas those of group 2 were 94% and 91% respectively (P <.05). Conclusion: Our study indicated that multiple renal arteries did not adversely affect postoperative urologic or vascular complications or kidney allograft or patient survival compared with single renal artery cases. © 2012 Elsevier Inc. All rights reserved

What kind of changes occurred in clinical characteristics of deceased kidney donor recipients after national allocation system in Turkey? A single-center retrospective analysis

PubMed ID: 22841223Objective: Clinical characteristics of recipients of deceased donor renal transplantations were evaluated in the period before versus after implmentation of The National Allocation System (NAS). Patients and Methods: We evaluated retrospectively clinical profiles of the 42 after NAS (June 2008-December 2010) versus 42 consecutive deceased donor renal transplantation patients before NAS. Patient and graft survival rates were assessed using the Kaplan-Meier method; graft function was assessed based on creatinine clearance with the Cockcroft Gault equation. Patient and donor data were obtained from medical records. Results: Recipients were older in the pre-NAS group (39 ± 8 vs 33 ± 8 years, respectively; P =.001) and median duration of preoperative dialysis was longer in the post-NAS group (103 ± 61 months vs 50 ± 36 months, respectively; P =.000). The average number of human leukocyte antigen-mismatched antigens were pre-NAS 3.4 ± 1.0 versus post-NAS 3.9 ± 1.2 (P =.05). Considering the recipients serological status 9 were hepatitis C virus (HCV)(+) and 2 hepatitis B virus (HBV)(+) among the post-NAS versus no HBV(+) and only 1 HCV(+) patient pre-NAS. Kaplan-Meier analysis of graft survival rates showed 90% at 1 and 85% at 3 years pre-NAS. Similar to 95% at 1 and 86% at 3 years for the post-NAS group (P >.05). Likewise, patient survival rates for both groups at 1 and 3 years were 97%. The mean parameter of donor age, allograft loss, cold ischemia time, patient death, number of retransplantations, HBV(+) patients, and delayed graft function were similar between groups (P >.05). Discussion: After NAS the transplant recipients were older, had a longer duration of dialysis, greater number of HLA mismatched antigens and, more HCV(+). No differences were observed in short-term patient and graft survival rates. © 2012 Elsevier Inc. All rights reserved

Acoustic Radiation Force Impulse Elastography May Predict Acute Rejection in Kidney Transplantation

PubMed: 32507711Background: Allograft biopsy that is done as indicated by clinical and laboratory clues about graft rejection provides a definitive diagnosis. Noninvasive methods that may be useful for predicting or diagnosing rejection are important for early diagnosis of possible rejection. Purpose: The aim of this study is to investigate the relationship between changes in shear wave velocity (SWV) values and renal allograft kidney biopsy findings. Material and Methods: Thirty-four end-stage renal failure patients who underwent living donor renal transplantation between January 2015 and July 2015 were enrolled in this prospective cohort study. Implantation, sixth-month protocol, and biopsies that were performed with suspicion of acute rejection were evaluated with renal Doppler ultrasound and elastography findings of recipients’ preimplantation donor ultrasonography findings. Results: Comparison of renal ultrasound and elastography findings of 2 groups revealed a significant elevation in the resistive index (0.81 vs 0.63, P = .005) and pulsatility index (2.08 vs 1.20, P = .008) values in the rejection group, and no significant difference in the SWV values between the 2 groups. Delta (?)-SWV was calculated using the difference between acute rejection values and preimplantation, implantation, and sixth-month values showed a positive correlation between acute rejection (?-sixth month, r = 0.498, P = .030), tubulitis (?-pretransplant, r = 0.509, P = .037), and inflammation (?-pretransplant, r = 0.657, P = .004) scores. However, there were no correlations between ?-SWV values and glomerulitis and peritubular capillaritis score. Conclusion: Changes in SWV may predict acute rejection in kidney transplantation patients if the reference measurements were done at a more stable time after the transplantation. © 2020 Elsevier Inc

Recovery of chronic dialysis hypotension after kidney transplantation: A case report

Chronic dialysis hypotension is described as low systolic blood pressure (<100 mmHg) during interdialytic period. The presence of low predialysis systolic blood pressure, typically <110 mmHg, is significantly associated with increased mortality. Kidney transplantation is the preferred model of renal replacement therapy in the treatment of end-stage renal disease (ESRD) as it improves quality of life and survival. In this article, a long-term hemodialysis (HD) patient with chronic hypotension improved after kidney transplantation is presented. A 39-year-old male patient received a deceased donor kidney transplant. The patient was on HD for 23 years. The patient had suffered from chronic persistent hypotension for the last 8 years. Blood pressure was 70/50 mmHg before dialysis and 60/40 mmHg after dialysis. In the post-transplant period, blood pressure was maintained above 110/70 mmHg by intermittent infusion of dopamine. Hypotension was improved after 24 days and dopamine was discontinued. Various etiologies may cause chronic hypotension in patients receiving long-term HD treatment. Kidney transplantation may improve survival and quality of life by correcting hypotension in these patients. Therefore kidney transplantation should not be avoided as renal replacement therapy in ESRD patients with hypotension

Use of kidney donors with hepatitis B, hepatitis C, or brain tumor: A single-center experience

PubMed ID: 22841224Introduction: With the rapid increase in the number of patients on the waiting lists, the idea of using organs from donors who were previously classified as "marginal" has emerged. The aim of this study was to evaluate the clinical outcomes of the patients who received kidneys from donors with hepatitis B, hepatitis C, or brain tumors. Patients and Method: Between 2003 and 2010, 27 transplantations were performed from donors with hepatitis B, hepatitis C or brain tumors between 2003 and 2010. Demographic and clinical characteristics of donors and recipients were retrospectively collected from medical files. Results: Fifteen patients received kidneys from donors with hepatitis B: 9 from deceased donors having a positive hepatitis B surface antigen (HBsAg) and six from living donors with positive HBsAg having negative results of qualitative hepatitis B DNA analysis. Two of the fifteen recipients were previously diagnosed with chronic active mild hepatitis B infection. The remaining 13, who were HBsAg (-)/anti-HBs(+) at the time of transplantation, underwent hepatitis B immune globulin and lamivudine therapy. Median follow up time was 40 ± 35 months. One patient developed decompensated liver disease owing to noncompliance to lamivudine therapy. Five patients who received grafts from anti-HCV(+) deceased donors were anti-HCV(+) at the time of transplantation with alanine aminotransferase (ALT) levels <40 U/L. All grafts remained functional at a median of 70 months. Seven subjects received grafts from deceased donors with brain tumors, none of whom had a history of a craniotomy or a ventriculoperitoneal shunt. All recipients had serious vascular access problems. No graft loss or de novo malignancies was observed among these patients after a median follow-up of 69 ± 26 months. Conclusion: With appropriate patient selection, the donated organ pool can be expanded by addition of donors with hepatitis or brain tumors. © 2012 Elsevier Inc. All rights reserved

Factors CD10, cytokeratin 19 and staging-grading systems in predicting the prognosis of pancreatic neuroendocrine tumors (PNET)

Objective. This study was undertaken to examine prognostic factors in patients with pancreatic neuroendocrine tumors (PNET) undergoing surgical treatment to evaluate the prognostic value of recently introduced immunohistochemical staining methods of CD10 and cytokeratin 19. Materials and Methods. Tumors were classified on the basis of 2004 WHO Classification Guidelines and European Neuroendocrine Tumor Society (ENETS) grading system. Immunohistochemical staining with Ki- 67, CD10 and cytokeratin 19 was performed. Results. A total of 36 patients with a mean age of 53.7 ± 12.0 years were included. Overall, 33 patients had a long-term follow-up with 10 patients (30.3%) experiencing recurrence. Seven patients (21.1%) died. Clinical parameters that were associated with recurrence included liver metastasis at the time of surgery and extra-pancreatic invasion (p < 0.005). Positive surgical margins, extra-pancreatic invasion, and multi-focal disease were associated with reduced survival (p < 0.05). In addition, there was an association between survival and WHO 2004 classification (p < 0.05). Conclusions. Although vascular and peripancreatic invasion showed increased risk of recurrence, they were unrelated to survival. Of the histopathological examinations, Ki-67 and mitotic activity showed a correlation with both recurrence and survival, while immunohistochemical staining with cytokeratin 19 and CD 10 did not provide adequate prognostic information