bluuebunny/crossref_metadata_2025 huggingface dataset:
A rhetorical field theory: Background, communication, and change
Authors: Kornprobst Markus , Senn Martin
Published: January 2017

Develops a rhetorical field theory that conceptualises the relationship between background ideas and foreground communication Distinguishes between two layers of background ideas ( nomos and topoi) that underpin communicative encounters in a field Conceptualises communicative opportunities and moves through which actors change the nomos of a field Illustrates the added value of a rhetorical field theory by inquiring into nomic change in the nuclear-weapons field

A burgeoning literature in International Relations draws on Bourdieu’s theory of social fields to address the question of how actors make and unmake order in world politics. Inquiring into deeply seated background ideas constituting order, this literature often neglects how communication reproduces and (de)contests background ideas. Our article seeks to remedy this shortcoming by outlining a rhetorical field theory. This theory puts background ideas and foreground communication on an equal footing and conceptualises their relationship in detail. We distinguish between two layers of background ideas ( nomos and topoi) and address the crucial question of how nomic change becomes possible. We introduce a typology of nomic change (destabilisation, adaption, disorientation, shift) and conceptualise the interplay of rhetorical opportunities and rhetorical moves that bring about particular types of nomic change. We probe this theoretical framework by analysing the recent nomic change in the nuclear-weapons field. This empirical analysis provides evidence for our theoretical framework.
Dupuytren'S Contracture; Increased Cellularity — Proliferation, is There Equality?
Authors: Forsman M. , Kallioinen L. , Kallioinen M. , Ryhänen J.
Published: January 2017

Background:

Dupuytren's disease is a chronic inflammatory process which causes contractures of the fingers by shortening and thickening the palmar fascia. During the proliferative phase, fibroblasts transform into myofibroblasts apparently under the influence of several different factors. The disease usually develops slowly, but in some patients it tends to develop aggressively. The pathogenesis of Dupuytren's disease remains unsolved. In this study, we analyzed some histological characteristics that seem to predict rapid recurrence.

Material and Methods:

21 patients were divided into two groups. In 11 patients the disease was classified as aggressive because it had recurred within two years after an operation. In 10 cases it was non-aggressive, as no recurrence had been seen. Five control samples were taken from healthy palmar aponeurosis. The differences in cellularity, collagen, Ki-67, MSA, alpha-SMA and tenascin between the specimens were analyzed using immunohistochemistry.

Results:

Alpha-SMA and Ki-67 were present more often in the aggressive specimens. Immunohistochemical stainings for macrophages and lymphocytes were negative.

Conclusion:

There may be differences in the histology and/or immunohistochemical appearance of pathological palmar connective tissue cords in aggressive and normal Dupuytren's disease. Further studies are needed to elucidate the pathogenesis of this disease.
Simultaneous Colorectal and Liver Resections for Synchronous Colorectal Metastases
Authors: Sasanuma H. , Yasuda Y. , Mortensen F. V. , Yamashita K. , Nihei Y. , Houjou N. , Chiba H. , Shimizu A. , Okada M. , Nagai H.
Published: January 2017

Background:

The surgical strategy for the treatment of colorectal cancer and synchronous hepatic metastases remains controversial. Many surgeons fear anastomotic leakage and intraperitoneal abscesses when performing a one-step procedure. They prefer a two-step procedure with a liver resection 2 to 3 months after resection of the colorectal primary lesion.

Subjects and Methods:

We analysed medical records from April 1994 to April 2002 for a total of 42 patients with colorectal cancer and synchronous liver metastases who underwent simultaneous liver and colorectal resections with a primary anastomosis. Special attention was paid to data on surgical procedures, postoperative morbidity, and mortality.

Results:

Forty-two patients, 24 men and 18 women, were studied. Median operating time was 6.50 hours (3.75–11.0 hours), and median blood loss was 1522 ml (range 288 to 5650 ml). Postoperative complications included pleural effusion in 4 patients, ileus in 3, anastomotic leakage in 2, intraperitoneal pelvic abscesses in 1, pneumonia in 1, bile leakage in 1, atelectasis in 1, and wound infection in 1. There was no perioperative mortality.

Conclusion:

Simultaneous colorectal resection with a primary anastomosis and hepatectomy for synchronous liver metastases is considered a safe procedure.
Feasibility of Axillary Ultrasound in the Quality Assessment of Sentinel Node Biopsy in Breast Cancer Surgery
Authors: Paajanen H. , Kilponen V.-M. , Heikkinen J. , Sammalkorpi H. , Helle M.
Published: January 2017

Background and Aims:

The purpose of this study was to evaluate the efficacy of high-resolution axillary ultrasound (AU) in detecting the rate of recurrence after anegative sentinel node (SN) biopsy in patients with breast cancer and without additional axillary dissection.

Materials and Methods:

The operating oncologic surgeon performed 196 consequent sentinel node biopsies during surgery of breast cancer. The sentinel nodes were identified by using preoperative lymphoscintigraphy, intraoperative gamma probe and Patent Blue® dye. A routine postoperative follow-up of the patients were performed every 3rd month including clinical examinations, blood chemistry and mammography. After 31 months (range 14–49 months), a high-resolution AU was performed for 107 patients with a negative sentinel node during surgery and without axillary dissection, to visualize any abnormal lymph nodes in the axilla. If necessary, large core biopsies were undertaken to obtain histology of abnormal axillary nodes.

Results:

The SNs were visualized during preoperative lymphoscintigraphy in 167/196 (85%) and found during the surgery in 163/167 (98%) of patients. The mean number of removed SN were 1.7 ±0.8. The SN metastasis were found in 29% (56/196) of patients. During the follow-up, abnormal nodes were identified during AU in only 4/107 patients. Core biopsies confirmed benign histology in three patients and one case of lymphoma was detected.

Conclusions:

There were no axillary recurrences of breast cancer after a negative SN biopsy during the 2.6 year follow-up. Axillary ultrasound is a useful tool in the quality control of patients with negative SN biopsy and without diagnostic axillary dissection.
Molecular Pathobiology of Gastric Cancer
Authors: Yasui W. , Sentani K. , Motoshita J. , Nakayama H.
Published: January 2017

Gastric carcinogenesis is a multistep process, during which numerous genetic and epigenetic alterations accumulate: there are abnormalities of growth factors/receptors, angiogenic factors, cell cycle regulators, DNA mismatch repair genes etc. These abnormalities define, at the same time, the biological character of the cancer cell and may thus serve as therapeutic targets. Genetic instability may cause accumulation of genetic abnormalities. The most important epigenetic alterations are DNA methylation, histone modification and chromatin remodeling. Some of these changes are common in gastric cancer, regardless of subtype, and some differ by histological type or (gastric or intestinal) mucin phenotype. Genetic polymorphism is a crucial endogenous cause and fundamental aspect of cancer risk. Importantly, genetic polymorphisms are also associated with the therapeutic efficacy and toxicity of anti-cancer drugs. Genomic science and technology such as Serial Analysis of Gene Expression (SAGE) allows the identification of novel genes and molecules specifically up-regulated or down-regulated in gastric cancer, e.g., RegIV and claudin-18 can be identified. Advances in our understanding of the genetic and molecular bases lead to improved diagnosis, personalised medicine and prevention of gastric cancer.
Emergency Thoracotomy in Trauma: Rationale, Risks, and Realities
Authors: Søreide K. , Petrone P. , Asensio J. A.
Published: January 2017

Emergency department thoracotomy (EDT) may serve as a life-saving tool when performed for the right indications, in selected patients, and in the hands of a trained surgeon. Critically injured patients ‘in extremis‘ arrive at an increasing rate in the trauma bay, as an effect of improved pre-hospital trauma systems and rapid transport. Any patient in near, or full cardiovascular shock prompts the trauma surgeon to rapidly perform a thoracotomy. The EDT procedure is managed best by surgeons familiar with, and experienced in, penetrating cardiothoracic injuries. However, the geographical differences in trauma epidemiology lends no, or only scarce, experience with this procedure in most European trauma centres. Consequently, mandatory training is imperative for success. The rationale for performing an EDT is to: (I) resuscitate the agonal patient with penetrating cardiothoracic injuries; (II) release cardiac tamponade by evacuation of pericardial blood; (III) immediately control hemorrhage and repair cardiac or pulmonary injury; (IV) perform open cardiac massage; and (V) place a thoracic aortic cross-clamp to redistribute the remaining blood volume, and perfuse the carotids and coronary arteries. The prevalence rates of blood-borne viruses reported in critically injured patients in the USA (10–20%) exceed the prevalence in the Nordic countries (HIV prevalence <1% in general population). However, risk is not negligible and mandated universal precautions are needed. the literature is rich in series describing the use of EDT, however, the best evidence is derived from a few prospective trials. EDT saves about one in every five patients with isolated penetrating cardiac injury, while >98% die after blunt injury. Based on an updated review of the current available literature, this paper presents the current evidence regarding the rationale, risk, and outcomes for employing EDT in the field of trauma surgery.
Organisation and Early Outcomes of Major Upper Gastrointestinal Cancer Surgery in Denmark 1996–2004
Authors: Jensen L. S. , Bendixen A. , Kehlet H.
Published: January 2017

Background:

To assess the relationship between hospital volume and early postoperative outcome the incidence and early outcome of all esophagectomies, pancreaticoduodenectomies and gastric resections in Denmark from 1996 to 2004 was described.

Methods:

The National Patient Registry and discharge information from all hospital departments were analysed for all the operations due to a malignant diagnosis. All information was examined for postoperative length of stay and hospital mortality.

Results:

During the study period 26 departments performed at least one esophageal resection, 13 departments performed at least one Whipple procedure and 37 departments performed at least one gastric resection. Four departments performed more than 20 esophageal resections per year, whereas one department performed more than 20 Whipple procedures and one more than 20 gastric resections per year. The overall mean length of stay was 21.6 days, 24 days and 18 days for esophageal, pancreatic and gastric resections, respectively, with no difference between high and low volume departments. The hospital mortality was 8.6%, 8.9% and 8.2%, respectively.

Conclusion:

The overall high mortality and long postoperative stay in patients undergoing upper gastrointestinal cancer surgery in Denmark calls for improvement by regionalisation into 3–4 departments and monitoring of results.
FDG-PET Improves Management of Patients with Colorectal Liver Metastases Allocated for Local Treatment: A Consecutive Prospective Study
Authors: Sørensen M. , Mortensen F. V. , Høyer M. , Vilstrup H. , Keiding S. ,   The Liver Tumour Board at Aarhus University Hospital
Published: January 2017

Background and Aim:

Colorectal cancer is a common cancer in the Nordic countries and 50% of the patients develop liver metastases. Liver resection may result in long term survival. Proper staging is therefore essential and CT is the standard imaging modality. We examined whether additional FDG-PET improves therapeutic management of patients with colorectal liver metastases.

Patients and Methods:

Fifty-four consecutive patients were enrolled. Each patient had a treatment plan made based on our standard evaluation. The patients then had a PET scan and the treatment plan was re-evaluated, taking these results into account.

Results:

In 76% of the cases, PET did not change the treatment plan due to complete concordance with CT. In another 19% of the cases, the plan was altered due to finding of more liver lesions by PET than by CT (four patients), fewer or no liver lesions (three patients), and extrahepatic lesions not visible on CT (three patients). In 5% of the cases, non-concordance between PET and CT did not change the therapeutic plan.

Conclusion:

Pre-treatment FDG-PET, used supplementary to CT, improved the treatment plan in one fifth of the patients with colorectal liver metastases.
Clinical and MRI Evaluation of Meniscal Tears Repaired with Bioabsorbable Arrows
Authors: Tielinen L. , Lindahl J. , Koskinen S. , Hirvensalo E.
Published: January 2017

Background and Aims:

Excision of meniscal tissue has been shown to increase the risk of degenerative changes of the knee joint. Whenever possible, meniscus repair has become the procedure of choice for treatment of meniscal tears.

Materials and Methods:

The present retrospective study evaluated the healing results of 77 meniscal ruptures treated with the an all-inside technique (Biofix meniscus arrow). The study group consisted of 73 patients with 77 longitudinal, vertical meniscal ruptures treated at Helsinki University Hospital between the beginning of January 1997 and the end of March 2001. The patients who had not received secondary surgery for failed repair during the follow-up period were examined clinically and with MRI.

Results:

Fifty-one out of 77 meniscal ruptures (66%) healed clinically. In repairs performed in conjunction with ligament reconstruction the healing rate was higher (79%) than in the isolated tears (56%). The poorest results were seen in the very long vertical tears with luxation of the meniscus (38% healing rate).

Conclusions:

Bioabsorbable arrows offer a good alternative for treatment of meniscal ruptures, but the arrows alone do not seem to be sufficient to provide a reliable long-lasting result in the repair of very unstable meniscal ruptures.
Incidence of HIP Fractures among the Elderly in Satakunta, Finland
Authors: Jaatinen P. T. , Panula J. , Aarnio P. , Kivelä S.-L.
Published: January 2017

Background and Aims:

The aim was to describe the incidence rate of hip fractures in the elderly in a specific region in Finland and circumstances around them.

Material and Methods:

Retrospective analysis of 461 women and men aged 65 or older undergoing an operation for hip fracture during a two-year period between 1999 and 2000. 80 variables in all were obtained from the hospital discharge register and patient documents.

Results:

The age-specific incidence of hip fractures was higher in women than in men (women 6.88/1000 person/y vs. 3.50/1000 person/y). Prior to the fracture, patients were primarily doing well; 63.4% lived at home and 65.1% used no mobility equipment or aids. Altogether 41.9% of hip fractures occurred in institutions. Both women and men more often suffered their injury indoors (91.1% and 75.7% respectively), and only a slight seasonal variation was observed. More than every fourth (26.9%) had experienced a previous fracture.

Conclusions:

The age-specific incidence of hip fractures was higher in women than in men. The fractures took place mostly indoors and often in institutions. Therefore the measures that impact on indoor safety are particularly important for the elderly.
Small Bowel Fistulas and the Open Abdomen
Authors: Becker H. P. , Willms A. , Schwab R.
Published: January 2017

Over the last 15 years, the contemporary strategies to treat the open abdomen have reduced the lethal complications. Systematic intensive care and modern wound management in conjunction with a plastic barrier to protect the viscera and topical negative pressure on the soft tissues have reduced the development of small bowel fistulas. The literature selected for this review shows that the surgical handling of the exposed bowel, the choice of the material for temporary coverage and early progressive closure of the defect are crucial for the prevention of fistulas. At present, surgeons worldwide have adopted these principles leading to an increase of primary or delayed closure rates. When a small fistula occurs, biological dressings like human acellular dermal matrix and fibrin glue may help to seal the orifice and to treat the patient conservatively. In case of a large fistula, vacuum-assisted wound management is recommended as well. Through a separate hole in the vacuum sponge matching to the fistula, the enteric contents are sucked off while the wound bed heals and is prepared for split thickness skin graft. Surgical resection of established fistula unresponsive to conservative measures should only be performed on patients well-nourished and free of infection with a delay of at least six months. for patients with an open abdomen, surgical expertise and a well-structured management plan offer the best chances to overcome this potentially devastating condition — with or without fistula.
Wrist Osteoarthritis
Authors: Talwalkar S. C. , Hayton M. J. , Stanley J. K.
Published: January 2017

Osteoarthritis of the wrist is one of the commonest conditions encountered in clinical orthopaedic practice. This article looks at our approach to this problem including clinical assessment, radiographic analysis and the management of wrist osteoarthritis.
Evolution of Robot-Assisted Radical Prostatectomy
Authors: Orvieto M. A. , Patel V. R.
Published: January 2017

Introduction and Objective:

Open radical prostatectomy (RRP) is the gold standard and most widespread treatment for clinically localized prostate cancer. However, in recent years robot-assisted laparoscopic prostatectomy (RARP) is rapidly gaining acceptance among urologists worldwide. We sought to outline our surgical technique of robotic radical prostatectomy and provide practical recommendations based on available reports and personal experience. We also critically review the current experience on RARP world-wide and compare the available data with the gold standard open RRP series.

Material and Methods:

A systematic review of the literature was performed for all published manuscripts between 1997 and 2008 using the keywords — ‘robotic radical prostatectomy, ‘robot-assisted radical prostatectomy’, ‘laparoscopic radical prostatectomy’ and ‘robotic” using the Medline database.

Results:

A total of 226 original manuscripts on RARP were identified. Manuscripts were selected according to their relevance to the current topic (i.e. original articles, number of patients in the series, prospective data collection) and incorporated into this review.

Conclusions:

Eight years after the first RARP, multiple series are mature enough to demonstrate safety, efficiency and reproducibility of the procedure, as well as oncologic and functional outcomes comparable to its open counterpart. Further prospective, randomized studies comparing both surgical techniques are necessary in order to draw more definitive conclusions.
Robotic Surgery in Gynecology
Authors: Holloway R. W. , Patel S. D. , Ahmad S.
Published: January 2017

Advanced laparoscopic procedures for gynecologic surgery have not been widely adopted in clinical practice despite nearly 20 years of improvements in laparoscopic technology. The da Vinci® robotic surgical system was cleared for use in gynecologic surgery in the U.S in 2005. Many surgeons have embraced da Vinci® technology over conventional laparoscopy because of its technologic advantages of wristed instrumentation, high definition 3-D optics, ergonomics, and autonomy of camera control. Furthermore, many surgeons with limited advanced laparoscopic skills have successfully converted their practice from primarily laparotomy to minimally invasive surgery using the da Vinci® System. The purpose of this article is to review the development of robotic procedures in gynecology through the current literature. This article reviews recent peer-reviewed literature concerning robotic-assisted laparoscopic procedures including hysterectomy, myomectomy, radical hysterectomy, pelvic and aortic lymphadenectomy, trachelectomy, parametrectomy, tubal anastamosis, sacrocolpopexy, and others. The majority of this literature consists of descriptive retrospective case series from the investigator's early experience; in fact these early reports represent innovation of a new operative technique. Some reports compare outcomes to open and standard laparoscopic procedures. Future prospective studies comparing complications, pain, return to routine activity, and long-term clinical outcomes with open and laparoscopic procedures will be necessary to completely appreciate the impact of robotic technology.
Acute Lower Gi Bleeding for the Acute Care Surgeon: Current Diagnosis and Management
Authors: Lee J. , Costantini T. W. , Coimbra R.
Published: January 2017

Lower gastrointestinal bleeding is a common cause for hospital admission that results in significant morbidity and mortality. After initial resuscitation of the patient, the diagnosis and treatment of lower gastrointestinal bleeding remains a challenge for acute care surgeons. Identifying the source of bleeding can be difficult since many patients bleed intermittently or stop bleeding spontaneously. It is therefore important for the acute care surgeon to be familiar with the different diagnostic and therapeutic modalities and their advantages and disadvantages in order to guide the management of the acutely bleeding patient. This review summarizes the current methods available for the diagnosis and treatment of acute lower gastrointestinal bleeding and proposes an algorithm for the management of these patients.
Peritoneal Microdialysis. Earlydiagnosis of Anastomotic Leakage after Low Anterior Resection for Rectosigmoid Cancer
Authors: Pedersen M. Ellebæk , Qvist N. , Bisgaard C. , Kelly U. , Bernhard A. , Pedersen S. Møller
Published: January 2017

Background:

The aim of the present study was to evaluate the efficacy and safety of intraperitoneal microdialysis in early detection of anastomotic leakage after low anterior resection for rectosigmoid cancer.

Methods:

In a series of 116 consecutive patients scheduled for low anterior resection for rectosigmoid cancer, a total of 50 patients consented to participate. Peritoneal microdialysis was performed by a 1 mm thin catheter anchored in close proximity to the anastomosis. Five patients were excluded due to catheter malfunction. Average microdialysis time in the remaining 45 patients was 177.6 (80–252) hours. Samples were collected every 4-hours, and the concentration of glucose, lactate, pyruvate and glycerol was measured.

Results:

Four patients developed symptomatic anastomotic leakage. Two patients developed non-abdominal sepsis. In 38 patients the postoperative course was uncomplicated, considering major complications, and they served as controls. In three patients with late (≥ 10 days) anastomotic leakage a significant increase in concentration of lactate and lactate/pyruvate ratio (L/P-ratio) was seen several days prior to development of clinical symptoms. In one patient with early anastomotic leakage it coincided with the development of clinical symptoms. In the two patients with non-abdominal sepsis the values were within normal range.

Conclusion:

Peritoneal microdialysis is a safe and promising tool in early diagnosis of anastomotic leakage after low anterior resection for rectosigmoid cancer.
Modeling the Length of the Care Episode after Hip Fracture: Does the Type of Fracture Matter?
Authors: Sund R. , Riihimäki J. , Mäkelä M. , Vehtari A. , Lüthje P. , Huusko T. , Häkkinen U.
Published: January 2017

Background and Aims:

Hip fractures are common events that require intensive operative hospital care and a lengthy rehabilitation. The effect of hip fracture type on successful rehabilitation is not well known. The aim of this study is to model and compare the length of the care episodes between intra- and extracapsular hip fractures in Finland.

Material and Methods:

15544 hip fracture patients living at home in Finland 1998–2001 were followed using register-based data. Patient characteristics, outcomes, and length of stay (LOS) distributions were analyzed using a Bayesian nonparametric multilayer perceptron (MLP) network model.

Results:

Mortality was similar in intra- and extracapsular hip fractures. Patients were more likely to need long-term care after extracapsular hip fracture. The average LOS at the surgical ward was similar for intra- and extracapsular fractures (1.7 weeks), but there was a considerable difference for the total inpatient LOS between the groups (5.2 weeks vs. 6.9 weeks). Intracapsular fractures had a simple unimodal LOS distribution, whereas the LOS distribution for the extracapsular fractures was multimodal with two clear peaks. Patients with more comorbidities required a longer LOS.

Conclusions:

The causes for differences in LOS between fracture types were most likely due to the different surgical methods and rehabilitation practices for the fracture types. As national guidelines suggest similar rehabilitation for all hip fracture patients, there is a need for early and aggressive rehabilitation of patients with extracapsular fractures, including full-weight bearing for all but selected patients.
Sub-Lobar Lung Resection of Peripheral T1N0M0 NSCLC Does Not Affect Local Recurrence Rate
Authors: De Giacomo T. , Stasio M. Di , Diso D. , Anile M. , Venuta F. , Coloni G. Furio
Published: January 2017

Background and Aims:

The use of sub-lobar resection versus lobectomy for stage I non small cell lung cancer is still controversial. This study was undertaken to compare the results of limited resection in terms of survival and local recurrence rate to lobectomy in patients with peripheral stage I non small cell lung cancer.

Material and Methods:

During the 8 year period from 1999 to 2007, 152 consecutive patients with stage I non-small cell lung cancer underwent lung resection at our thoracic surgery unit. In 116 cases we performed a standard lobectomy while in the remaining 36 cases we did sub lobar resection through mini-thoracotomy or video-assisted thoracoscopy. The survival, local recurrence rate and the clinical outcome were analyzed and compared.

Results:

Fifty-one patients were staged as T1 N0 M0, 22 in the sub-lobar resection group (61,1%) and 29 (25%) in the lobectomy group. The remaining were staged as T2 N0 M0. Although the patient population undergone to sub-lobar resection was older, with poorer lung function and more co-morbidities, the Kaplan-Meier survival proportion at 5 year did not differ significantly between the two groups: 64% for lobectomy group vs 66,7% for sub-lobar resection group. Overall local recurrence did approach significance in favour of lobectomy group but analyzing only T1 patients, no differences in terms of survival and local recurrence rate were observed.

Conclusions:

The results of this study indicate that in patients with peripheral T1N0M0 non small cell lung cancer the outcome of limited resection is comparable with that of pulmonary lobectomy.
Minimally Invasive Optimization of Organ Donor Resuscitation: Case Reports
Authors: Torre Andrew N. de la , Fisher Adrian , Wilson Dorian J. , Reitsma William , Goerlitz Frederick , Koneru Baburao
Published: January 2017

Increased use of expanded donors requires optimal organ perfusion to prevent graft damage. In this regard, pulmonary artery catheters have been advocated to monitor hemodynamic status. Cost, catheter placement, and inconsistent management preclude broad use of pulmonary artery catheters. Esophageal Doppler monitoring also monitors hemodynamic status and can be instituted in minutes by an organ procurement coordinator. Concomitant assessment of acid-base balance using base excess and/or anion gap can help determine resuscitation efficacy. Esophageal Doppler monitoring is described to help salvage 2 hemodynamically deteriorating donors. Anion gap and corrected base excess identified poor resuscitation status in both donors and normalized after improvement in hemodynamic status. Compared to pulmonary artery catheters, esophageal Doppler monitoring may provide a more accessible means to assess and improve hemodynamic status. Base deficit and/or anion gap may determine resuscitation efficacy by exposing acid-base imbalance resulting from poor tissue perfusion. The full efficacy of this approach remains to be determined.
Decision Making in Intestinal Transplantation
Authors: Florman Sander , Kaufman Stuart S. , Fishbein Thomas
Published: January 2017

Intestinal transplantation is an accepted lifesaving option to treat appropriately selected patients with end-stage failure of the gastrointestinal tract. The evaluation of each candidate involves complex judgments. When to perform an isolated intestinal transplantation versus a combined transplantation with the liver and/or other organs often requires thoughtful considerations and an individualized approach. In addition, performing venous drainage of the isolated graft is potentially complex. We discuss the significant advances in surgical and medical decision making in the evaluation and management of patients with intestinal failure.
Kidney Graft Survival in Italy and Factors Influencing it
Authors: Pugliese Orsola , Quintieri Francesca , Mattucci Dino Alberto , Venettoni Sante , Taioli Emanuela , Costa Alessandro Nanni
Published: January 2017

Purpose

National registry data are often a suitable basis for examination of transplant outcomes. Using data supplied by the Italian National Transplant Registry, established in 1995, we performed the first nationwide analysis of this kind.

Methods

A retrospective analysis of 4893 recipients of cadaveric kidneys transplanted in all Italian centers from 1995 through 2000 was done to study 5-year graft survival. The association between some donor and recipient variables and outcomes in renal transplantation was analyzed. Graft survival was 93% at 3 months, 89% at 1 year, 82% at 3 years, and 80% at 5 years after transplantation.

Results

A significant association between graft survival and donor age (old vs young, relative risk [RR] = 1.62, 95% CI 1.27–2.06) and recipient age (old vs young, RR = 1.25, 95% CI 1.02–1.53). Graft survival was also associated with cold ischemia time (24–36 hours, RR=1.39, 95% CI 1.05–1.85 and >36 hours, RR=1.94, 95% CI 1.32–2.86 vs 0–24 hours) and donor/recipient sex mismatch (female/male vs male/male, RR=1.50, 95% CI 1.17–1.93).

Conclusion

The quality of kidney transplantation in Italy is satisfactory and is comparable to that in other developed countries. Furthermore, our experience confirms that both donor and recipient factors are major determinants of renal allograft function.
Approaching End-of-Life Care in Organ Transplantation: The Impact of Transplant Patients' Death and Dying
Authors: Wright Linda , Pape Deborah , Ross Kelley , Campbell Michael , Bowman Kerry
Published: January 2017

Despite the success of transplantation, many transplant candidates and transplant recipients die each year. Some die awaiting transplants and some die months or years after receiving an organ. Quality end-of-life care can play a valuable role in easing the impact of death and dying in transplantation, as it focuses on enhancing patients' quality of life near death. Quality end-of-life care recognizes the values and preferences of patients and their families, and involves a process of shared decision making about patients' healthcare treatment in collaboration with healthcare practitioners. Advance care planning involves discussions with patients about their wishes and values about care, in the event that the patient becomes incapable of making such decisions. This article focuses on the application to transplantation of quality end-of-life care and advance care planning and identifies the effects that death and dying of transplant patients have on others. The information herein encourages healthcare practitioners to view and deliver quality end-of-life care as part of transplant patients' overall treatment management.
An International Perspective: Job Satisfaction among Transplant Nurses
Authors: Russell Cynthia L. , Van Gelder Frank
Published: January 2017

Context

The high demand for transplant nurses across the world leads us to examine job design and job satisfaction because job satisfaction is linked to better outcomes for patients.

Objective

To describe international transplant nurses' perspectives of job design and job satisfaction by using Herzberg's theory of motivation.

Methods

Descriptive, correlational design. An electronic version of the Job Design and Job Satisfaction survey was mailed to all members of the International Transplant Nurses Society.

Results

A total of 331 members of the International Transplant Nurses Society responded to the survey. The mean age of respondents was 44.12 years, they had worked a mean of 19.12 years in nursing and 10.22 years in transplantation, and 50.6% of respondents were transplant nurse coordinators. Respondents were very satisfied overall with their jobs; they perceived that transplant nursing requires a high level of nonrepetitive, complex skills, autonomy in personal initiative and judgment, cooperation and collaboration with others, and that the job allows for completion of the work. Respondents were satisfied with pay, fringe benefits, and supervision. The feeling that the job could positively and significantly affect others was very strong.

Conclusions

Results of this study provide empirical evidence supporting the perceived benefits and challenges of working in transplantation and support Herzberg's theory that motivators leading to job satisfaction include achievement, recognition, the work itself, responsibility, and advancement. Transplant nursing includes many of these motivators and desirable characteristics, including autonomy and working with a multidisciplinary team on a clear, patient-centered goal.
Optimal Transplant Education for Recipients to Increase Pursuit of Living Donation
Authors: Waterman Amy D. , Barrett Ann C. , Stanley Sara L.
Published: January 2017

Context

Inadequate transplant education may stop kidney patients from beginning or completing evaluation or limit recipients from considering living donation.

Objective

To learn about recipients' decision making about living donation and preferred transplant education resources.

Design

Retrospective, cross-sectional survey. Patients—304 kidney recipients.

Main Outcome Measures

Living donation comfort, concerns, education preferences.

Results

Recipients spent 10 median hours learning about transplant, primarily by speaking to medical staff (2–3 hours) and reading transplant brochures (0–1 hour). Twelve percent had not received any education before coming to the transplant center. At least 75% wanted education discussing the evaluation, surgery, and medical tests required of recipients and donors, as well as common transplant-related fears. Recipients who received living donor transplants were more interested in information about donors' evaluation ( P< .001), surgery ( P< .001), medical tests ( P< .001), and donation concerns ( P= .004) than were other recipients. Recipients who had living donors evaluated were more comfortable accepting family members or friends who volunteered rather than asking potential donors because of concerns about pressuring donors (85%), harming their health (83%), or causing them pain or inconvenience (76%). Besides providing accurate medical information, education that addresses recipients' fears about transplantation, explains living donors' donation experiences, and teaches patients how to pursue living donation may increase recipients' pursuit of living donation.
Living Kidney Donation among Hispanics: A Qualitative Examination of Barriers and Opportunities
Authors: Alvaro Eusebio M. , Siegel Jason T. , Turcotte Dana , Lisha Nadra , Crano William D. , Dominick Alexander
Published: January 2017

Context

Despite their increasing need for kidneys and low nonliving donation rates, minimal research has been conducted to ascertain the perceptions of Hispanic Americans about living organ donation and the process of asking for such a donation.

Objective

To examine perceptions of Hispanics regarding barriers to and benefits of living donation as well as the process of asking someone to be a living donor.

Design

A qualitative study consisting of 10 focus groups conducted in 2 series.

Participants

Adult Spanish-language-dominant Hispanic members of the general population of Tucson, Arizona.

Results

The main barriers to living organ donation were a lack of knowledge or information and fear of the donation process. Knowing that one has helped save or improve another's life was the central benefit. Most participants reported being willing to ask a relative to be a living donor if they were ever in need. Two main responses typified these individuals: no concern about asking because of a strong desire to fight for one's health and for one's family, or asking despite difficulties and concerns about the process. A significant minority of participants indicated they would not ask for a donation, because of either a desire to avoid harming others or the expectation that a relative would initiate an offer.
Effects of Information, Education, and Communication Training about Organ Donation for Gatekeepers: Clerks at the Department of Motor Vehicles and Organ Donor Registries
Authors: Harrison Tyler R. , Morgan Susan E. , Corcia Mark J. Di
Published: January 2017

Context

Clerks at the Department of Motor Vehicles (DMV) serve as gatekeepers in the quest to fill organ donor registries. Most people who join organ donor registries do so through their local driver's license bureau.

Objective

To improve knowledge, attitudes, and behavior toward organ donation among DMV clerks, and to improve strategies for communicating with the public about organ donation, resulting in more people joining DMV-based organ donor registries.

Setting

DMV offices in 8 counties in a southern state.

Participants

A general survey of 1504 participants in 8 counties was conducted to assess knowledge, attitudes, beliefs, and behaviors toward organ donation. All 76 DMV clerks in those counties participated in surveys before and after a training intervention.

Interventions

DMV clerks received a 1-hour training intervention focused on the nature of the new organ donor registry, information about organ donation, and communication strategies for interacting with the public.

Main Outcome Measures

Knowledge, attitudes, beliefs, behaviors, and behavioral intentions toward organ donation were measured for the general public survey and for DMV clerks.

Results

Clerks were more knowledgeable about brain death and religious stances on organ donation than the general public, but otherwise both groups shared similar knowledge, attitudes, beliefs, behaviors, and behavioral intentions toward organ donation. Overall the general public and clerks had favorable attitudes toward organ donation but low to moderate knowledge, beliefs, and behaviors and behavioral intentions. Training significantly increased DMV clerks' knowledge, attitude, beliefs, and behavioral intention toward donation. Organ donor registration rates were a mean of 14% higher in counties where clerks were trained than in control counties and were 9% higher than statewide.

Conclusions

Training DMV clerks is an effective way to increase knowledge, attitudes, and beliefs for gatekeepers of organ donor registries and may increase donor registration rates among the public.
The Kidney Transplant Failure Experience: A Longitudinal Case Study
Authors: Gill Paul , Lowes Lesley
Published: January 2017

Purpose

To explore participants' experiences of kidney transplant failure.

Background

Kidney transplants are effective and efficient but not without complications. About 7% to 12% of kidney transplants fail within a year, and rates of failure increase over time. Graft failure can have profound effects, often resulting in depression and, occasionally, suicidal feelings. Despite these issues, the personal dimensions of graft failure have been poorly researched.

Methods

One donor-recipient couple experienced irreversible graft rejection immediately after a kidney transplant. This article is a longitudinal case study of this family's experiences. Data were collected through 3 semistructured interviews, conducted before the transplant and at 3 and 10 months after the transplant. Interviews were recorded, transcribed verbatim, and data coded into categories arising from the participants' accounts.

Results

Transplantation represented a significant source of hope. Fear of transplant failure was a major concern, but was dealt with by using emotion-focused coping mechanisms. Graft rejection was devastating, causing feelings of grief, loss, suicide, and depression. Depression improved as physical health and a sense of personal control improved. The recipient felt inadequately prepared for graft failure and poorly supported by health professionals.

Conclusion

The primary source of grief and depression appeared to be related to the recipient's “loss of imagined future” (ie, the life that she anticipated after transplant). Study findings have potential implications for the provision of care, i nformation, and support for patients and their families before and after transplantation and for future related research.
Improving Donation Outcomes: Hospital Development and the Rapid Assessment of Hospital Procurement Barriers in Donation
Authors: Siminoff Laura A. , Traino Heather M.
Published: January 2017

Context

Deficiencies in the donation process continue to contribute to the shortage of organs available for transplant. Continuous quality improvement of hospitals' donation processes is needed to identify and correct the problems.

Objective

To test the Rapid Assessment of Hospital Procurement Barriers in Donation (RAPiD), a direct observation technique with a focused ethnographic strategy, for assessing hospitals' donation processes and identifying areas in need of continuous quality improvement interventions.

Design

A pre-post assessment of hospitals' barriers to patient identification and referral, and family consent to donation.

Setting and Participants

Seventeen hospitals within the catchment area of a Northeastern organ procurement organization were assessed by using the RAPiD method. Hospital administrators, health care providers, and staff (N = 537) were interviewed as part of the assessments.

Intervention

Interventions, including on-site training and education, and the use of in-house coordinators, were specifically tailored to each hospital's unique set of barriers to donation. The interventions were delivered to the hospitals in the form of recommendations. The participating organ procurement organization was responsible for implementation of the interventions.

Results

The RAPiD hospital evaluations revealed gaps in respondents' knowledge of organ donation, brain death, and referral criteria; a reluctance to declare brain death; and a rocky relationship between the hospitals and the organ procurement organization. As a result of the interventions, 9 hospitals' environments for organ donation improved, 7 showed no change, and 1 was worse.
Exploring Transplant Opportunities in Hmong Culture: A Case Report
Authors: Neidich Alon , Mahanty Harish D. , Bramstedt Katrina A.
Published: January 2017

A clinical case is used to explore the ethical complexities of solid organ donation and transplantation within the Hmong community in the United States. Although many cultures can present various ethical issues, the challenges of the Hmong belief system are unique and distinctly complex. Ways for the medical team to integrate with the Hmong value system to attempt to create an environment of transcultural respect and appreciation are described.
Trifocal Monomyelomeric Spinal Cord Arteriovenous Fistulae in a Seven-Year-Old Boy
Authors: Piske R. , Sampaio M. , Campos C. , Nunes J.A. , Lima S.S.
Published: January 2017

We describe a rare case of multiple arteriovenous fistulae of the spinal cord (SCAVF) in the same myelomer in a five-year-old boy. This case report consists of a trifocal SCAVF at the Th12 myelomeric level without communication between the three different fistulae. Two AVF were located posteriorly, bilateraly, in the spinal cord, fed by left and right posterior radiculopial arteries and one anteriorly in the anterior spinal axis. The venous drainage was independent for each lesion. The patient presents associated lesions characterized by cutaneous stain and inferior limb asymmetry. A metameric distribution is the explanation for the multiplicity of these lesions in a syndromic association related to Cobb syndrome. The patient was treated by transarterial embolization using glue with occlusion of the three different fistulae. The patient achieved a good improvement in neurological status.
What to Do When the Doctor Sees Double: Identical Twins with Nearly Identical Aneurysms
Authors: Porter P.J. , Tymianski M. , Muller P.J. , terBrugge K.G.
Published: January 2017

This report details the case of identical twins, both of whom had an aneurysm in the same anatomic location. Such aneurysms should be considered as a discrete subset of familial aneurysms. The implications for patient management are discussed.
Cervicofacial Venous Malformations
Authors: Konez O. , Burrows P. E. , Mulliken J.B.
Published: January 2017

We retrospectively evaluated 53 consecutive patients with cervicofacial venous malformation who had sclerotherapy. This review included a demographic analysis, MRI reexamination and tabulation of interventional therapeutic strategies. All patients whose MRI studies were included in this review demonstrated characteristic findings: space occupying lesion with hyperintense T2 signal abnormality, patchy contrast enhancement, and no flow signal on the gradient echo images. We concluded that a complete MRI work-up of these patients requires post-contrast scanning and gradient-echo imaging in addition to the standard T1 and T2 weighted spin echo imaging. The majority of patients had sporadic (non-familial) venous anomalies. Sinus pericranii (SP) was identified in six patients (11%) and blue rubber bleb nevus syndrome (BRBNS) was found in two patients (4%). MRI findings of sinus pericranii are discussed in detail. Although sodium tetradecyl and/or absolute ethanol are the most commonly used sclerosants, a wide variety of therapeutic strategies (depending on the nature of the abnormality) are also needed for these patients.
Clinical Course and Angioarchitecture of Cerebrofacial Arteriovenous Metameric Syndromes
Authors: Jiarakongmun P. , Alvarez A. , Rodesch G. , Lasjaunias P.
Published: January 2017

Bonnet-Dechaume-Blanc or Wyburn-Mason disease has been considered a rare condition and mysterious disease for the last century. It was recently introduced as a spectrum of disease expression of cerebrofacial vascular structures related by the same neural crest origin, named “Cerebrofacial Arteriovenous Malformations Syndrome” (CAMS) by JJ Bhattacharya. We illustrate the special observations of reported cases in the literature and our three demonstrative cases of CAMS in terms of natural history including progressive appearance of the AVMs, clinical presentation, angioarchitecture, clinical risk of retinal AVMs, AVMs along the optic pathways, intracranial AVMs and proper investigation in the suspicious case.