Combined transplantation of the heart and liver

The technique of combined transplantation of the heart and liver is described and illustrated, emphasizing modifications that were used in a successful case. Two other unsuccessful attempts are reported, and the importance of relative size of donor and recipient is discussed. There may be an immunological advantage to transplanting two organs in combination from the same donor

Veno-venous bypass without systemic anticoagulation for transplantation of the human liver

A technique of veno-venous bypass without heparin has been developed for use during the anhepatic phase of transplantation of the liver. With this method, the ability to compress the temporarily obstructed vena caval and portal venous systems has made hepatic transplantation an easier procedure

Reversibility of lymphomas and lymphoproliferative lesions developing under cyclosporin-steroid therapy

Post-transplant lymphomas or other lymphoproliferative lesions, which were usually associated with Epstein-Barr virus infections, developed in 8, 4, 3, and 2 recipients, respectively, of cadaveric kidney, liver, heart, and heart-lung homografts. Reduction or discontinuance of immunosuppression caused regression of the lesions, often without subsequent rejection of the grafts. Chemotherapy and irradiation were not valuable. The findings may influence policies about treating other kinds of post-transplantation neoplasms

A flexible procedure for multiple cadaveric organ procurement

Techniques have been developed which permit removal of the kidneys, liver, heart and other organs from the same donor without jeopardy to any of the individual grafts. The guiding principle is avoidance with all organs of warm ischemia. This is achieved by carefully timed and controlled infusion of cold solutions into anatomic regions, the limits of which are defined by preliminary dissection

Advantages of venous bypass during orthotopic transplantation of the liver.

Venous bypass restores normal hemodynamic physiology during the critical anhepatic phase of orthotopic transplantation of the liver. Its routine use in adults undergoing transplantation in Pittsburgh has resulted in lower operative blood losses, a lower frequency of postoperative renal failure, and a greater probability of survival for all but the highest risk patients. Because it allows for a longer anhepatic phase, the surgeon has the option of tailoring the native hepatectomy to the needs of the individual case, even to the point, in difficult cases, of obtaining most of the hemostasis after removal of the native liver, but before sewing in the donor organ. Selective use of bypass in children may offer similar advantages

HEART-LIVER TRANSPLANTATION IN A PATIENT WITH FAMILIAL HYPERCHOLESTEROLAEMIA

A girl aged 6 years 9 months with severe heart disease secondary to homozygous familial hypercholesterolaemia underwent orthotopic cardiac transplantation and her liver was replaced with the liver of the same donor. In the first 10 weeks after transplantation serum cholesterol fell to 270 mg/dl from preoperative concentrations of more than 1000 mg/dl. © 1984

Tibial shaft fractures in football players

© 2007 Chang et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Tectonic influences on late Holocene relative sea levels from the central-eastern Adriatic coast of Croatia

Differential tectonic activity is a key factor responsible for variable relative sea-level (RSL) changes during the late Holocene in the Adriatic. Here, we compare reconstructions of RSL from the central-eastern Adriatic coast of Croatia with ICE-7G_NA (VM7) glacial-isostatic model RSL predictions to assess underlying driving mechanisms of RSL change during the past ∼ 2700 years. Local standardized published sea-level index points (n = 23) were combined with a new salt-marsh RSL reconstruction and tide-gauge measurements. We enumerated fossil foraminifera from a short salt-marsh sediment core constrained vertically by modern foraminiferal distributions, and temporally by radiometric analyses providing sub-century resolution within a Bayesian age-depth framework. We modelled changes in RSL using an Errors-In-Variables Integrated Gaussian Process (EIV-IGP) model with full consideration of the available uncertainty. Previously established index points show RSL rising from −1.48 m at 715 BCE to −1.05 m by 100 CE at 0.52 mm/yr (−0.82-1.87 mm/yr). Between 500 and 1000 CE RSL was −0.7 m below present rising to −0.25 m at 1700 CE. RSL rise decreased to a minimum rate of 0.13 mm/yr (−0.37-0.64 mm/yr) at ∼1450 CE. The salt-marsh reconstruction shows RSL rose ∼0.28 m since the early 18th century at an average rate of 0.95 mm/yr. Magnitudes and rates of RSL change during the twentieth century are concurrent with long-term tide-gauge measurements, with a rise of ∼1.1 mm/yr. Predictions of RSL from the ICE-7G_NA (VM7) glacial-isostatic model (−0.25 m at 715 BCE) are consistently higher than the reconstruction (−1.48 m at 715 BCE) during the Late Holocene suggesting a subsidence rate of 0.45 ± 0.6 mm/yr. The new salt-marsh reconstruction and regional index points coupled with glacial-isostatic and statistical models estimate the magnitude and rate of RSL change and subsidence caused by the Adriatic tectonic framework. © 2018 Elsevier Lt

Hospital outbreak of carbapenem-resistant Enterobacterales associated with a bla OXA-48 plasmid carried mostly by Escherichia coli ST399

A hospital outbreak of carbapenem-resistant Enterobacterales was detected by routine surveillance. Whole genome sequencing and subsequent analysis revealed a conserved promiscuous blaOXA-48 carrying plasmid as the defining factor within this outbreak. Four different species of Enterobacterales were involved in the outbreak. Escherichia coli ST399 accounted for 35 of all the 55 isolates. Comparative genomics analysis using publicly available E. coli ST399 genomes showed that the outbreak E. coli ST399 isolates formed a unique clade. We developed a mathematical model of pOXA-48-like plasmid transmission between host lineages and used it to estimate its conjugation rate, giving a lower bound of 0.23 conjugation events per lineage per year. Our analysis suggests that co-evolution between the pOXA-48-like plasmid and E. coli ST399 could have played a role in the outbreak. This is the first study to report carbapenem-resistant E. coli ST399 carrying blaOXA-48 as the main cause of a plasmid-borne outbreak within a hospital setting. Our findings suggest complementary roles for both plasmid conjugation and clonal expansion in the emergence of this outbreak