bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of Infrainguinal Angioplasty in the Treatment of Critical Limb Ischaemia
Authors: Eskelinen E. , Lepäntalo M.
Published: January 2017

Objective:

To review the published papers reporting on the use of infrainguinal angioplasty in the treatment of critical limb ischaemia (CLI).

Methods:

A MEDLINE (1966–2005) and Cochrane library search for articles relating to the use of infrainguinal angioplasty in the treatment of CLI.

Results:

Recent papers reporting on the results of infrainguinal angioplasty as treatment for CLI patients show excellent limb salvage rates regardless of the patency rates. The Cochrane Database of systematic reviews has accepted two prospective randomised trials comparing bypass operations and angioplasty among CLI patients. Pooling both trials showed no overall significant difference in amputation rates between the surgery and PTA groups. A multicentre, randomised controlled trial, the BASIL (bypass versus Angioplasty in Severe Ischaemia of the Leg) trial showed that in the medium term (after six months), the outcomes after angioplasty or surgery among CLI patients did not differ significantly with respect to amputation-free survival, all-cause mortality and quality of life.

Conclusions:

Infrainguinal PTA is feasible in CLI patients. Data from the BASIL trial show the similar ability of bypass surgery and balloon angioplasty in preserving both life and limb in short term. These results are, however, not applicable for the majority of CLI patients as only 15% (70/456) of the patients with severe limb ischaemia were considered candidates for the trial.
Surgical Critical Care: From Old Boundaries to New Frontiers
Authors: Stawicki S. P. , Gracias V. H. , Lorenzo M.
Published: January 2017

The surgical specialty of critical care has evolved into a field where the surgeon manages complex medical and surgical problems in critically ill patients. As a specialty, surgical critical care began when acutely ill surgical patients were placed in a designated area within a hospital to facilitate the delivery of medical care. As technology evolved to allow for development of increasingly intricate and sophisticated adjuncts to care, there has been recognition of the importance of physician availability and continuity of care as key factors in improving patient outcomes. Guidelines and protocols have been established to ensure quality improvement and are essential to licensing by state and national agencies. The modern ICU team provides continuous daily care to the patient in close communication with the primary operating physician. While the ultimate responsibility befalls the primary physician who performed the preoperative evaluation and operative procedure, the intensivist is expected to establish and enforce protocols, guidelines and patient care pathways for the critical care unit. It is difficult to imagine modern surgical ICU care without the surgical critical care specialist at the helm.
Ligasure Vessel Sealing System versus Conventional Vessel Ligation in Thyroidectomy
Authors: Lepner U. , Vaasna T.
Published: January 2017

The Ligasure Vessel Sealing System (LVSS) is a new surgical technology which has been used to secure haemostasis in various fields of surgery. There is little information in the literature about the use of the LVSS in thyroid surgery and the results of these studies are controversial. The aim of this study was to report our experience with the LVSS in thyroid surgery and to compare it with our experience with conventional vessel ligation.

The non-randomized retrospective review included 403 consecutive patients who underwent primary thyroid surgery. A conventional suture-ligation technique was used in 199 patients (conventional group) and the LVSS was used in 204 patients (ligasure group). The following data were collected: patients' demographics, thyroid pathology, type of thyroidectomy, operating time and complications.

The mean operating time for lobectomy, subtotal thyroidectomy and total thyroidectomy was significantly shorter in the Ligasure group compared with the conventional group. Average saving in operating time in the Ligasure group was 25.8 minutes (95% CI 19.5—32.2; p<0.0001) with relative reduction being 26.6%. Among all types of complications only postoperative transient hypoparathyroidism demonstrated a significantly lower incidence in the Ligasure group (2.5% vs 7.0%; p=0.022).

We found that the LVSS is a safe method with minimal complications in thyroid surgery. Use of the LVSS for all types of thyroidectomy ensures a significantly shorter operating time.
Clinical Outcome after D1 vs D2–3 Gastrectomy for Treatment of Gastric Cancer
Authors: Danielson H. , Kokkola A. , Kiviluoto T. , Sirén J. , Louhimo J. , Kivilaakso E. , Puolakkainen P.
Published: January 2017

Background:

Clinical benefit from extended lymphadenectomy for gastric cancer remains controversial as a considerable variation exists between results of different studies.

Methods:

562 patients were treated at HUCH between 1987–2003, whereof 223 underwent gastrectomy with curative intent. Of these, 114 patients underwent subtotal/total gastrectomy with D1 (standard) lymphadenectomy and 109 patients had D2–3 (extended) lymph node dissection. The clinical outcome of these patients was analysed retrospectively.

Results:

The incidence of surgical complications was 33.0% in D2–3 and 16.8% in D1 lymphadenectomy groups (p = 0.008). Abscess was the most common complication (11.0%) among D2–3 operated patients and haemorrhage (4.4%) in D1 group. Hospital mortality was 3.7% in D2–3 and 1.8% in D1 group (p = 0.438). The only statistically significant factor influencing the rate of complications was D2–3 lymphadenectomy (OR 2.620, 95% C.I. 1.375 to 4.991). D2–3 was associated with a longer postoperative hospital stay and operation time, greater blood loss and increased need for blood transfusions compared to D1. The 5-year survival was not statistically different between lymphadenectomy groups.

Conclusion:

It is justified to perform a D2–3 gastrectomy in Europe with a acceptable postoperative mortality but with a significant morbidity. Further studies are needed to assess the value of extended lymphadenectomy in gastric cancer
Intraoperative Ultrasonography in Detecting and Assessment of Colorectal Liver Metastases
Authors: Kulig J. , Popiela T. , Kłęk S. , Milanowski W. , Kołodziejczyk P. , Szybiński P. , Richter P.
Published: January 2017

Objective:

to assess the clinical value of intraoperative ultrasonography (IOUS) in detecting and assessment of liver metastatic tumours in colorectal cancer patients.

Methods:

a study is a retrospective analysis of 388 patients operated on for colorectal carcinoma between 1997 and 2004. In all the patients intraoperative ultrasound was performed. The authors analyzed of sensitivity, specificity, PPV, NPV and accuracy of pre-and intraoperative ultrasonography in detecting and staging of colorectal metastatic lesions.

Results:

Intraoperative ultrasonography showed the highest sensitivity, specificity and accuracy in both, tumor detection (99.1, 98.5 and 98.9%, respectively) and assessment (95.4, 99.5 and 99.1%, respectively). Overall sensitivity of IOUS was significantly better in detection and staging compared with preoperative ultrasonography 91.1 and 72.2%, respectively).

Conclusions:

IOUS should be used as routine diagnostic modality in colorectal cancer patients with hepatic metastases or suspected metastases. Transabdominal ultrasonography cannot be used as the only diagnostic tool in the evaluation of liver lesions, but may be helpful in preoperative screening.
Resection Rectopexy for External Rectal Prolapse Reduces Constipation and Anal Incontinence
Authors: Johnson E. , Stangeland A. , Johannessen H.-O. , Carlsen E.
Published: January 2017

Background and Aims:

The main aim was to examine constipation and anal incontinence in patients before and after resection for external rectal prolapse.

Material and Methods:

Twenty patients had ligament preserving suture rectopexy and sigmoid resection (resection rectopexy) for external rectal prolapse by laparoscopic (n = 15) or open (n = 5) technique during 2001–2005. They were prospectively evaluated for constipation and anal incontinence using validated incontinence and KESS-constipation scores.

Results and Conclusions:

Constipation score was significantly reduced from mean 7.7 (5.4–9.9) to 4.5 (2.5–6.4) after median 4 months (1–19) and to 4.3 (2.2–6.3) after median 17 months (4–51). Six and four patients were constipated preoperatively and 17 months postoperatively, respectively. The four symptoms feeling incomplete evacuation of stool, minutes in lavatory per attempt, use of enemas/digitation and painful evacuation effort were significantly reduced, whilst stool consistency increased. Fourteen patiens (70%) had anal incontinence. Corresponding and significant reduction in their scores were from mean 12.5 (9.4–15.5) to 5.1 (2.1–8.1) and to 3.6 (1.3–5.9). Incontinence was improved in 13 and unaltered in one patient(s). Two patients with worse outcome had increased stool consistency and constipation scores. Resection rectopexy for rectal prolapse reduced anal incontinence and constipation.
Emergency Room Arteriography: An Updated Digital Technology
Authors: Ball C. G. , Nicol A. J. , Beningfield S. J. , Navsaria P. H.
Published: January 2017

Background:

Emergency room arteriography (ERA) is a safe, accurate, simple and cost-effective method of defining arterial injuries. Limitations include the difficulty of evaluating limb vasculature distal to the suspected site of injury. Statscan is a novel, low-dose digital X-ray machine that can rapidly obtain a whole body image in a single scan. Our goal was to evaluate the role of Statscan technology in ERA.

Methods:

A 24 month retrospective review of all patients who underwent a Statscan assisted ERA at the Groote Schuur Hospital Trauma Unit was completed. Indications for ERA included a hemodynamically stable patient with hard signs of a vascular injury in conjunction with the clinical assessment of a threatened limb. Contraindications encompassed instability, massive bleeding or a rapidly expanding hematoma.

Results:

Ten patients underwent Statscan assisted ERA of their lower limbs. Eight had cold, pulseless limbs with impaired neurological examinations. Common femoral, superficial femoral and popliteal artery lacerations were displayed. Three patients had no identifiable injury and were observed. Seven patients underwent operative management for threatened limbs. Two had Statscan evidence of arterial emboli distal to the site of injury leading to further exploration and distal embolectomy.

Conclusions:

Statscan ERA is safe, rapid, simple and accurate. It has the advantage of providing arteriography distal to the site of injury. This directly altered patient care in 20% of cases, primarily by detecting distal arterial emboli. Thirty percent of patients with normal ERA also avoided an unnecessary operation. This study demonstrates a new role for Statscan technology.
Continuous Retention Suture for the Management of Open Abdomen: A High Rate of Delayed Fascial Closure
Authors: Gäddnäs F. , Saarnio J. , Ala-Kokko T. , Laurila J. , Koivukangas V.
Published: January 2017

Background and Aims:

Open abdomen is most often a consequence of damage control surgery, abdominal decompression or intra-abdominal infections. Ventral hernia after unsuccessful closure of open abdomen causes marked disability to the patient. Several methods for delayed fascial closure have been developed. Patients treated with continuous retention suture were evaluated to find out how often fascial closure was achieved, and what complications were related to the technique.

Method:

A retrospective analysis of 16 open abdomen patients treated with continuous retention suture.

Results:

The most common cause of open abdomen was abdominal infection. Complete fascial closure was achieved in nine of the eleven surviving patients. Closure failed in one patient. Partial closure was also achieved in one patient. The median time between leaving the abdomen open and starting the process of closure was twelve days. The longest period of open abdomen before successful fascial closure was 29 days. Five patients died before the process of closure was complete.

Conclusion:

Delayed fascial closure can be accomplished by using the retention suture method described here.
Vasopressin, When Added to Norepinephrine, Was Not Associated with Increased Predicted Mortality after Cardiac Surgery
Authors: Suojaranta-Ylinen R. T. , Vento A. E. , Pätilä T. , Kukkonen S. I.
Published: January 2017

Background and Aims:

Arginin vasopressin (AVP) is a potent vasoconstrictor which has been used in vasodilatory shock when therapy with catecholamines and fluids has failed. In this study we evaluated the association of AVP with organ failure and mortality in cardiac surgical patients suffering from vasodilatory shock refractory to norepinephrine (NE) treatment.

Material and Methods:

Cardiac surgical patients who received AVP in addition to NE (N=33, AVP-group) and 33 control patients (NE group) who were treated with an equal dose of NE compared with AVP patients when AVP infusion started. Data on preoperative risk factors according to EuroSCORE and predicted mortality calculated by logistic EuroSCORE were collected preoperatively. Data on hemodynamics, organ dysfunctions, length of intensive care unit stay and mortality were collected.

Results:

EuroSCORE did not differ between the groups, AVP:10,4 ± 3,9 vs NE 8,9 ± 4.0. Observed 30 day mortality was lower than predicted in both groups, AVP: 7 (21,7%) vs. predicted mortality 25.9% and NE: 2 (6.1%) vs. 16.0%, respectively. There were more renal complications (36.4% vs. 9.1%, p=0,008) and infections (30.3% vs. 3.0%, p=0.003) in patients receiving AVP. Cardiovascular complications did not differ between the groups.

Conclusions:

In this prospectively observed cohort of cardiac surgical patients, AVP did not increase mortality predicted by Euroscore. Anyhow renal and infection complications were common.
Oblong Cup in the Management of Aseptic Loosening of the Acetabular Component in Total Hip Replacement
Authors: Fousek J. , Vašek P.
Published: January 2017

Background and Aims:

At present, revision surgery of a total hip replacement is a major problem that must be dealt with by all orthopedic facilities. Aseptic loosening of the acetabular component is often associated with destruction of the original spherical shape of the acetabulum and the formation of bone defects. An orthopedist faces the challenge of acetabular revision and stable fixation of the new acetabular component in an effort to re-establish the functioning of the hip replacement.

Material and Methods:

The authors evaluated a group of 74 patients in whom they implanted an oblong revision cup due to aseptic loosening of the acetabular component from August 2000 until December 2003. The mean duration of the follow-up period was 63 months (ranging from 38 to 78 months).

Results and Conclusions:

The authors reported very good results from the use of this implant, where osteointegration and good functional outcome evaluated according to the Harris Hip Score (HHS) were achieved in 95% of cases. The long-term outcome should be the subject of further investigation.
Feasibility of Comparing Core Data from Existing Trauma Registries in Scandinavia. Reaching for a Scandinavian Major Trauma Outcome Study (MTOS)
Authors: Ringdal K. G. , Lossius H. M. ,   The SCANTEM ad hoc group on Scandinavian MTOS and Trauma Registry
Published: January 2017

Background:

The organisation of trauma care in Scandinavia has several similarities, including trauma registries, but so far there are limited amount of research on efficiency and outcome. Data and results from trauma outcome studies like the US MTOS are not fully applicable to the Scandinavian trauma population.

Aims:

To reveal the feasibility of using data from existing trauma registries of major hospitals in Scandinavia, for a minimal common dataset, in a joint, prospective Scandinavian MTOS.

Material and Methods:

We collected data points, data point definitions, and inclusion/exclusion criteria, from the major trauma registries of the Swedish trauma registry standard, three university hospitals in Denmark, one university hospital in Finland, and the Norwegian National Trauma Registry. The collected material was compared to reveal common data points, inclusion criteria, and the compatibility of data point definitions.

Results:

The median number of data points was 147 (range 71–257; interquartile range = 90–205). Most registries lacked precise data definition catalogues. Only 16 data points could be considered as common, of which just a few were core trauma data. Four data points had the same data category options but were not considered having the same data point definitions. The inclusion criteria were not uniform.

Conclusions:

Trauma registries in Scandinavia have few common core data and data point definitions. There were data points for calculating the Trauma and Injury Severity Score (TRISS) but the inclusion criteria varied too much to ensure a valid comparison. A consensus process for a joint trauma core data set will be initiated by the Scandinavian Networking Group for Trauma and Emergency Management (SCANTEM) to increase research on trauma efficiency and outcome.
Operative Treatment of Distal Radius Fractures
Authors: Vasenius J.
Published: January 2017

The incidence of distal radius fractures is increasing together with the average age of population. Intra-articular incongruity is the most probable cause of unsatisfactory outcome of distal radius fractures in younger and more active patients. Thus, the main goal in the treatment of distal radius fractures should be restoration of articular congruence. A computed tomography (CT) is recommended to help surgeon in preoperative planning in the treatment of comminuted intra-articular fractures. New implants have been designed to provide stable enough fixation for early mobilisation after surgery and to lower rather high complication rates related to conventional fixation methods such as external fixation and dorsal plating. The most common complications related to volar fixed angle plating such as flexor and extensor tendon problems, median nerve neuropathy, and screw diplacement into the radiocarpal joint are surgeon related and are avoidable with proper education. More randomized prospective studies are needed to prove superiority of any fixation method to another.
Techniques of Peripheral Nerve Repair
Authors: Dahlin L. B.
Published: January 2017

Nerve injuries extend from simple nerve compression lesions to complete nerve injuries and severe lacerations of the nerve trunks. A specific problem is brachial plexus injuries where nerve roots can be ruptured, or even avulsed from the spinal cord, by traction. An early and correct diagnosis of a nerve injury is important. A thorough knowledge of the anatomy of the peripheral nerve trunk as well as of basic neurobiological alterations in neurons and Schwann cells induced by the injury are crucial for the surgeon in making adequate decisions on how to repair and reconstruct nerves. The technique of peripheral nerve repair includes four important steps (preparation of nerve end, approximation, coaptation and maintenance). Nerves are usually repaired primarily with sutures applied in the different tissue components, but various tubes are available. Nerve grafts and nerve transfers are alternatives when the injury induces a nerve defect. Timing of nerve repair is essential. An early repair is preferable since it is advantageous for neurobiological reasons. Postoperative rehabilitation, utilising the patients' own coping strategies, with evaluation of outcome are additional important steps in treatment of peripheral nerve injuries. In the rehabilitation phase adequate handling of pain, allodynia and cold intolerance are emphasised.
Current Concepts in Reconstruction of Hand Function in Tetraplegia
Authors: Fridén J. , Reinholdt C.
Published: January 2017

Several recent developments in the field of reconstructive hand surgery in tetraplegia have created a foundation for further refinements of both surgical techniques and postoperative training strategies to improve the outcome of restoration of upper extremity functions. A remarkable means of improving function is the immediate activation of transferred muscle after surgery. Early active training of new motors not only prevents the formation of adhesions but facilitates the voluntary recruitment of motors powering new functions before swelling and immobilization-induced stiffness restrain muscle contractions. A common observation internationally over the past years is that the number of incomplete tetraplegics increases. This shift towards more incomplete injuries with spasticity as a common feature in addition to the paralysis has expanded and changed the spectrum of surgeries in this group of patients and also emphasizes the need for a revisit and further development of the different strategies for reconstruction of hand function.
Robotic-Assisted Laparoscopic Surgery in Pediatric Urology: An Update
Authors: Casale P. , Kojima Y.
Published: January 2017

Laparoscopic procedures for urological diseases in children, such as nephrectomy, pyeloplasty and orchiopexy, have proven to be safe and effective with outcome comparable to the open procedure. However, main drawback has been the relatively steep learning curve for this procedure because of technical difficulties of suturing and anastomosis. More recently, robotic-assisted laparoscopic surgery (RAS) has gained enormous popularity in adult urology and is increasingly being adopted around the world; however, few pediatric urology series have been reported. RAS has several advantages over conventional laparoscopic surgery, with the main advantage being simplification and precision of exposure and suturing because of allowing movements of the robotic arm in real time with increased degree of freedom and magnified 3-dimentional view. These features render RAS ideal for complex reconstructive surgery in a pediatric urological population. This review discusses the role of RAS in pediatric urology, and provides some technical aspects of RAS and a critical summary of current knowledge on its indications and out-come. Almost all operations that are classically performed as open or conventional laparoscopic reconstructive surgery for children with urological anomalies could be replaced by RAS, which may be established as an alternative minimally invasive surgery in the future.
The Evolution of Robotic General Surgery
Authors: Wilson E. B.
Published: January 2017

Surgical robotics in general surgery has a relatively short but very interesting evolution. Just as minimally invasive and laparoscopic techniques have radically changed general surgery and fractionated it into subspecialization, robotic technology is likely to repeat the process of fractionation even further. Though it appears that robotics is growing more quickly in other specialties, the changes digital platforms are causing in the general surgical arena are likely to permanently alter general surgery. This review examines the evolution of robotics in minimally invasive general surgery looking forward to a time where robotics platforms will be fundamental to elective general surgery. Learning curves and adoption techniques are explored. Foregut, hepatobiliary, endocrine, colorectal, and bariatric surgery will be examined as growth areas for robotics, as well as revealing the current uses of this technology.
A Clinical Evaluation of Endoscopicallyplaced Self-Expanding Metallic Stents in Patients with Acute Large Bowel Obstruction
Authors: Pommergaard H.-C. , Vilmann P. , Jakobsen H. L. , Achiam M. P.
Published: January 2017

Background and Aims:

Self-expanding metallic stents (SEMS) have since 1991 established themselves as an option in the treatment of large bowel obstruction. The aim of this study was to evaluate the use of SEMS in management of acute colorectal obstructions at a Danish Surgical Gastroenterology center.

Material and Methods:

Retrospective review of charts from all patients who, in the period Marts 2002 to December 2007 underwent insertion of a SEMS for an acute large bowel obstruction.

Results:

Of 45 patients included, SEMS was intended as a bridge to surgery in 20 patients and as palliation in 25 patients. For malignant etiology, the SEMS procedure was a technical and clinical success in 97.4% of the cases. Complications occurred in 21%, mortality rate 2,6%. For benign etiology, the SEMS procedure was a technical success in 85.7%, and a clinical success in 71.4%. Complications occurred in 71.4% of the benign cases with a mortality rate of 28,6%.

Conclusions:

placement of SEMS for acute large bowel obstruction with malignant etiology is an effective and safe procedure with low mortality and morbidity. However results for benign obstructions are questionable and more research is needed to determine the role of SEMS.
Heading for a Fall — Moped and Scooter Accidents from 2002 to 2007
Authors: Kosola S. , Salminen P. , Laine T.
Published: January 2017

Background and Aims:

Mopeds and scooters have become increasingly popular among Finnish teenagers. The aim of this retrospective study was to assess incidence of and injury patterns associated with moped and scooter accidents in adolescents.

Materials and Methods:

All 222 patients treated for moped and scooter-related injuries at Helsinki Children's Hospital and Töölö Trauma Centre from January 2002 to December 2007 were included. Information was drawn from patient records and compared with nation-wide Finnish data gathered from public data-bases.

Results:

The annual number of patients at our centres increased from 14 to 76 and the proportion of girls increased from 7% to 25%. A similar trend was found on a national level. In our material, collisions between mopeds and other motorized vehicles accounted for 52% of accidents, and 33% of patients were injured from falling. Seventy-five percent of patients were hospitalized, and 50% needed at least one procedure requiring general anaesthesia. Five percent of the patients were under the influence of alcohol. Trauma of the head occurred in 22%; helmets did not protect against severe trauma. On a national level the proportion of 15- to 17-year-old road traffic victims has doubled in five years. Among this age group, more than half of all road-traffic accidents involve mopeds and scooters.

Conclusions:

Over a time span of six years, moped accidents among adolescents have become very common. Our results suggest that measures should be taken to diminish the number of moped and scooter accidents and to improve driver safety.
Helicobacter Pylori in Alcohol Induced Acute Pancreatitis
Authors: Khan J. , Pelli H. , Lappalainen-Lehto R. , Järvinen S. , Sand J. , Nordback I.
Published: January 2017

Background and Aims:

The objective of this study was to measure the association of Helicobacter pylori infection with alcoholic acute pancreatitis.

Material and Methods:

This study comprised of 50 patients with their first alcoholic pancreatitis and 50 alcoholic controls with no history of pancreatitis but similar alcohol use recruited from an alcohol rehabilitation center. Helicobacter infection was measured using Enzygnost EIA IgG-test. Complications and length of hospital stay were also recorded in patients with alcoholic pancreatitis.

Results:

The seroprevalence of Helicobacter pylori was 10/50 (20%) in the pancreatitis group and 15/50 (30%) in the control group (p = NS). The median length of hospital stay of pancreatitis patients was 7 days, 11 days for those tested positive (range 6–25) and 6 days for those tested negative (range 3–47) for Helicobacter pylori, p = 0.013. As determined with the Atlanta criteria, seropositive patients tended to have more often severe pancreatitis, 4/10 (40%) vs. 6/40 (15%), OR 3.78 (95% CI 0.815–17.52), p = 0.097.

Conclusions:

This study suggests that Helicobacter pylori infection is not associated clinically significantly with the development of alcoholic pancreatitis. However, Helicobacter pylori infection may be associated with longer hospital stay due to more severe disease, which needs to be studied in a larger series of patients.
Long-Term Results after Anterior Sphincteroplasty for Anal Incontinence
Authors: Mevik K. , Norderval S. , Kileng H. , Johansen M. , Vonen B.
Published: January 2017

Objective:

To assess the long term incontinence and quality of life (Qol) results after elective anterior sphincteroplasty for anal incontinence.

Materials and Methods:

Short and long term follow-up included respectively 28 and 25 of the 29 patients who were operated between 1989 and 1998 in our institution. Qol was assessed with gastro intestinal quality of life index (GIQLI). Incontinence was graded according to Parks score supplied with St Mark's score at long term follow-up.

Results:

21 (73%) patients had a history of obstetric sphincter tears. Mean age at operation was 45 years (range 6–77). Median time from operation to short term follow-up was 26 months (mean 38 months, range 2–113) and 84 months (mean 105, range 74–185) to long term follow-up. At short term follow-up 19 of 28 patients (68%) were continent for stool compared with nine of 25 patients (36%) at long term follow-up. Nine of 17 (53%) who were continent for stool at short term follow-up remained continent for stool at long term follow-up. Patients with a history of obstetric sphincter tear had less severe incontinence at long term follow-up compared to women with other causes of incontinence (St. Mark's score 8 and 16 respectively, p = 0,015). Patients with no incontinence or gas incontinence only, had higher quality of life score at both follow-ups than those who where incontinent for stool (p = 0,007 and p = 0,014 respectively).

Conclusion:

More than half of the patients remained continent for stool at long term follow-up. Continence for stool was associated with high Qol score.
Hypospadias: A 30-Year Personal Journey
Authors: Koyle M. A.
Published: January 2017

Hypospadias represents a spectrum. As such, every child with hypospadias requires a dedicated surgeon who exercises appropriate judgment, and has the experience to correct each variant surgically. Over the past 3 decades, the approach to the boy with hypospadias has evolved due to the employment of newer surgical techniques, in association with an increased understanding of the embryology and anatomy of the penis, embracement of psychological advances, and with the increased safety of anesthesia. Many questions remain unanswered, and thus, surgeons must be amenable to change, as advances continue. Only by properly questioning the long-term results of past and current techniques, will we be able to truly assess the products of our toils.
Empathy and Callous–Unemotional Traits in Different Bullying Roles: A Systematic Review and Meta-Analysis
Authors: Zych Izabela , Ttofi Maria M. , Farrington David P.
Published: January 2017

Bullying is an extremely damaging type of violence that is present in schools all over the world, but there are still many gaps in knowledge regarding different variables that might influence the phenomenon. Two promising research lines focus on empathy and callous–unemotional traits but findings from individual studies seem to be contradictory. This article reports the results of a systematic review and a meta-analysis on empathy and callous–unemotional traits in relation to school bullying based on 53 empirical reports that met the inclusion criteria. Bullying perpetration is negatively associated with cognitive (odds ratio [ OR] = 0.60) and affective ( OR = 0.51) empathy. Perpetration is also positively associated with callous–unemotional traits ( OR = 2.55). Bully-victims scored low in empathy ( OR = 0.57). There is a nonsignificant association between victimization and empathy ( OR = 0.96), while the relationship between callous–unemotional traits and victimization is significant but small ( OR = 1.66). Defenders scored high on cognitive ( OR = 2.09) and affective ( OR = 2.62) empathy. These findings should be taken into account in explaining and preventing bullying.
Effects of Interviewer Support on Children’s Memory and Suggestibility: Systematic Review and Meta-Analyses of Experimental Research
Authors: Saywitz Karen J. , Wells Christine R. , Larson Rakel P. , Hobbs Sue D.
Published: January 2017

The accuracy of children’s reports of abuse has been hotly debated in the press, academia, and the courtroom. Yet, children’s accuracy depends, in part, on the context in which children are interviewed. Guidelines often recommend creating a supportive psychosocial context to promote open, honest responding; however, there is also concern that support promotes social desirability and acquiescence to suggestion, leading children to report more of what they perceive adults want to hear than the truth. The question remains as to whether there is a sufficient body of scientific research to determine whether interviewer supportiveness improves interview outcomes while minimizing children’s stress or whether it increases suggestibility and impairs accuracy. Using a systematic search strategy and meta-analyses, this study identifies and reviews findings from experimental studies of the effects of interviewer supportiveness on the accuracy of children’s reports. Although the number of studies in the evidence base is small ( n = 15), the studies are of relatively good quality. Results suggest noncontingent interviewer support bolsters children’s accuracy. Children are more resistant and less acquiescent to suggestive questions when interviewers are supportive as compared to nonsupportive or neutral. Effects are in the moderate range. Interviewer support is also associated with fewer errors on nonsuggestive questions. Discussion focuses on implications for practice; directions for future research; identifying vulnerable subgroups; and underlying cognitive, social, and emotional mechanisms.
The Prevalence of Military Sexual Trauma: A Meta-Analysis
Authors: Wilson Laura C.
Published: January 2017

Due to methodological heterogeneity, the exact prevalence of military sexual trauma (MST) is unknown. To elucidate our understanding of the pervasiveness of this important social issue, a meta-analysis was conducted. A computerized database search in PsycINFO, PubMed, and PILOTS revealed 584 unique citations for review. Of these identified studies, 69 met the inclusion criteria for the meta-analysis. The results revealed that 15.7% of military personnel and veterans report MST (3.9% of men, 38.4% of women) when the measure includes both harassment and assault. Additionally, 13.9% report MST (1.9% of men, 23.6% of women) when the measure assesses only assault and 31.2% report MST (8.9% of men, 52.5% of women) when the measure assesses only harassment. Regardless of the type of victimization incident (i.e., harassment or assault), women evidenced significantly larger prevalence rates compared to men. Self-report measure and interviews were associated with higher prevalence rates than the review of veterans affair (VA) medical records when measuring both harassment and assault and only harassment. No significant differences were observed among prevalence rates based on VA, non-VA, or both VA and non-VA recruitment. Ultimately, the findings suggest that MST is a pervasive problem, among both men and women in the military, highlighting the importance of this line of research.
Organ Donation and Transplantation: A Survey of Critical Care Health Professionals in Nontransplant Hospitals
Authors: Chernenko Susan Marie , Jensen Louise , Newburn-Cook Christine , Bigam David L.
Published: January 2017

Context

Exploration of the role of critical care professionals in improving organ donation within Canada has been limited to tertiary care centers while donor potential in smaller nontransplant hospitals remains unknown.

Objective

To gain an understanding of the knowledge, attitudes, and perceived barriers that healthcare professionals in 5 nontransplant hospitals in Alberta have toward organ donation and transplantation, and to identify factors that influenced participation in the donation process.

Design

A descriptive survey of critical care professionals.

Setting

Five nontransplant hospitals in Alberta, Canada.

Results

Of the 135 respondents, 98 were critical care nurses, 32 were physicians, and 5 were hospital administrators. Respondents were least knowledgeable about transplant statistics and religious beliefs regarding donation, although overall, attitudes reflected positive support for organ donation. Respondents exhibited reluctance in approaching a potential donor family, and believed inadequate resources were allocated for organ donation.

Conclusions

Educational programs are needed to increase knowledge of organ donation and transplantation as well as the development of an in-house coordinator program in nontransplant hospitals for critical care personnel.
Organ Scarcity and the Psychological Pre—Heart Transplant Evaluation: A Simulation Study Using Community Residents
Authors: Todaro John F. , Sears Samuel F. , Rodrigue James R. , Musto Kristin
Published: January 2017

Context

Although research examining medical outcomes in heart transplantation has progressed, there are few studies examining the impact of organ scarcity and wait list demand on the transplant candidate evaluation process.

Objective

To examine the influence of transplant knowledge pertaining to organ scarcity and wait list demand on simulated ratings of psychological distress provided by community residents participating in a simulated pre–heart transplant evaluation.

Design

A randomized, controlled design. We used a vignette simulation to experimentally manipulate the effect of transplant knowledge pertaining to organ scarcity in a group of community residents with no previous knowledge or experience with the transplant selection process.

Participants

One hundred forty-three community residents visiting a department of motor vehicles office in north central Florida were recruited. Community residents were randomly assigned to 1 of 2 experimental conditions, with either mention (n = 66) or no mention (n = 77) of organ scarcity and wait list demand statistics in their assigned vignette. Participants then served as actors and completed measures of psychological distress as part of a mock psychological pre–heart transplant evaluation. Results Participants with mention of organ scarcity reported significantly fewer symptoms of anxiety and depression compared to those with no mention of organ scarcity. This relationship remained significant even after controlling for relevant covariates, including age and simulated ratings of social desirability.

Conclusion

Transplant knowledge pertaining to organ scarcity and wait list demand may influence transplant candidates to report fewer symptoms of psychological distress. Clinical suggestions for dealing with underreporting of psychological distress are discussed.
Liver Transplant Recipients' First Year of Posttransplant Recovery: A Longitudinal Study
Authors: Jones Jill B.
Published: January 2017

A longitudinal study of 20 liver transplant recipients was conducted to investigate their posttransplant recovery experience. Data were collected using semistructured interviews at 6 weeks, 6 months, and 1 year after transplantation. Qualitative analysis of data revealed physical, psychological, social, economic, and spiritual dimensions of recovery. Findings reflect ongoing improvement of physical health and functionality for most recipients. Those with continuing health problems often suffered from preexisting health conditions. Psychological adjustment was uneven, with intermittent periods of fear, anxiety, and depression. Some recipients reported short-lived split identities and personality changes. Social support of family was critical in the hospital and at home. Economic issues became primary by the 1-year interview, with all recipients questioning whether they could afford ongoing healthcare and medicines. Spiritual needs were met in secular and nonsecular activities. Findings suggest that healthcare personnel should attend to the lived experience of liver transplant recipients.
“It's Not a Job; It's a Lifestyle”: The Experience of Being a Donation Coordinator
Authors: Blumenthal Patricia A.
Published: January 2017

Lifesaving organ transplantations cannot be performed without the donation of organs from another human being. The donation coordinator in an organ procurement organization has the responsibility of coordinating this “gift of life”—a highly stressful, but inherently rewarding occupation. Although numerous studies have examined the medical and social implications of organ donation, little has been written about the experiences of donation coordinators. This qualitative study examines the experiences of donation coordinators at a large metropolitan organ procurement organization, to understand how they perform under stress, the ways that they cope with this stress, and the meaning that they attribute to their roles. Implications for organ procurement organizations are discussed to assist such organizations in recruiting donation coordinators and in developing supportive interventions for current employees. Suggestions to help donation coordinators maintain good mental health are also offered.
Emergency Consults in the Setting of Transplant Medicine: Dilemmas for Social Workers and Bioethicists
Authors: Bramstedt Katrina A. , Chalfant Annette , Wright Carol
Published: January 2017

Transplant medicine is a setting filled with emotions and uncertainty. The clinical cases are frequently complex and affected by psychosocial and ethics variables as well as time constraints. For the nonurgent patient, there is usually ample time to complete the necessary evaluations. In urgent situations, however, time is limited and social workers and ethicists often find themselves racing to conduct assessments that provide information that is important for decision making regarding a patient's suitability for organ transplantation. The same can be said for decisions about insertion of ventricular assist devices and living organ donation. Using 2 cases, we explore the practice of emergency consultation (distinguished from “curbside consultation”) and offer guidance for conducting these assessments.
Changes in Weight during the First Year after Kidney Transplantation
Authors: Cashion Ann K. , Sánchez Zoila V. , Cowan Patricia A. , Hathaway Donna K. , Costello Agnes Lo , Gaber A. Osama
Published: January 2017

Context

Obesity frequently occurs following kidney transplantation and is of concern because of the associated risk for cardiovascular complications.

Objective

To examine weight gain over the first year after kidney transplantation to determine associations with gender, ethnicity, and cardiovascular risk factors.

Design

A retrospective analysis was completed on patients who had received transplants between January 1998 and January 2002 and who had matching baseline and 1-year follow-up data and a functional graft.

Participants

The sample consisted of 171 recipients (33% women, 58% African Americans, and 39% whites) with a mean age of 44 ± 12.2 years.

Main Outcome Measures

Outcome measures included fasting blood sugar, triglycerides, creatinine levels, and body mass index categorized as normal, overweight, or obese.

Results

The total group showed a significant increase in mean weight (6.2 ± 10.7 kg) and body mass index (2.1 ±3.8). Although equivalent at baseline, by 1 year after transplantation there were significantly more obese than normal-weight recipients, regardless of gender or ethnicity, with African Americans increasing more than whites and women more than men. At baseline, those characterized as obese versus normal weight were older (47 vs 41 years; P <.05), with a higher fasting blood sugar. At 1 year, differences in age and fasting blood sugar disappeared; however, the obese group had higher triglycerides (235 vs 165, P = .01).

Conclusions

Weight gain after transplantation was not explained by demographic and clinical factors. We speculate additional variables such as genetic factors influence weight gain and warrant study.
Liver Transplantation for Hepatic Epithelioid Hemangioendothelioma: A Case Series
Authors: Bufton Sally , Haydon Geoffrey , Neil Desley
Published: January 2017

Epithelioid hemangioendothelioma is a rare soft-tissue tumor with unpredictable malignant potential. This type of tumor can occur in the liver but is very rare. Signs and symptoms are often nonspecific, and even if the problem is not misdiagnosed, arriving at a clear diagnosis can take some time. This article describes 3 patients who had very different signs and symptoms, all of whom were referred to a specialist center for liver transplantation in 1 year. All 3 patients proceeded to transplantation and made a good recovery. They have regular follow-up at the transplant center, and to date, no recurrence of hepatic epithelioid hemangioendothelioma has been seen in these 3 patients.
Improving Equity of Access to Deceased Donor Kidneys in New Zealand
Authors: Faire Bridget , Dittmer Ian
Published: January 2017

Before 1999, deceased donor kidneys in New Zealand were allocated by local nephrologists on the basis of local needs and factors thought to be beneficial to graft outcome—in particular, matching tissue type. Waiting times were much longer for patients whose tissue type was different from that of our mainly white population of deceased donors. A National Kidney Allocation System was developed that improved equity of access for our unique population base in New Zealand, taking into account not only tissue-type matching but time spent waiting.
When the Donor Says Yes and the Family Says No
Authors: Howard Richard J. , Cornell Danielle L. , Koval Charles B.
Published: January 2017

Signed donor cards clearly demonstrate the donor's intention to donate organs after death. In many states, this donation cannot be rescinded by the next of kin, and organs can be recovered from the donor even if the family objects. The family usually does not object if the donor has signed an organ donor card, especially if the donor had discussed the issue with the family. In some situations, however, the family objects to donation despite the signed organ donor card. If the organ procurement organization pursues donation, adverse publicity and even legal action are possible. It can be a challenge for organ procurement personnel to deal with families who object to donation in the face of a signed organ donor card in a manner that will lead to successful organ recovery without adverse consequences. This article describes 4 cases where the donor had a signed organ donor card but the family initially objected to donation. Ultimately organs were recovered from 3 of these donors.
Consideration of Psychosocial Factors in the Evaluation of Living Donors
Authors: Schroder Nina M. , McDonald Laurie A. , Etringer Geri , Snyders Michele
Published: January 2017

Results of donor outcome studies indicate that most living donors report a positive psychosocial response to donation. However, negative psychosocial outcomes have also been reported. Evaluation guidelines have been proposed, although a standardized evaluation specific to living donors is not yet available. In an effort to determine what psychosocial factors should be considered in a comprehensive evaluation of living donors, an extensive literature review was undertaken that was focused on previously proposed guidelines for the psychosocial evaluation of living donors, research on outcomes among living donors, and other relevant psychosocial data.
Milestones in Transplantation
Authors: Ohler Linda , Coscia Lisa , Armenti Vincent
Published: January 2017

The patient was admitted to the Boston Lying-in Hospital to await delivery. To avoid any possible trauma to the transplanted kidney as the vertex engaged, it was decided to deliver the patient by cesarean section. This was performed under spinal anesthesia on March 10, 1958, a time arbitrarily regarded as the 41st week of gestation. A normal male infant weighing approximately 3300 grams was delivered.1