pinecone/core-2020-05-10-deduplication huggingface dataset:
Goodpasture's Syndrome: Treatment With Nephrectomy and Renal Transplantation

Three young male patients developed acute glomerulonephritis and serious hemoptysis. All three had evidence of antiglomerular basement membrane (anti-GBM) antibodies in their serum and native kidneys. The pulmonary hemorrhages ceased after bilateral nephrectomy and splenectomy accompanied by irregular treatment with steroids and other immunosuppressants. Renal homotransplantation was successfully carried out from 95 to 162 days later, after circulating anti-GBM antibodies had disappeared. Two of the homografts were biopsied and the third was removed 20, 34, and 2 months posttransplantation, respectively, and contained little or no immunoglobulin. Therefore, Goodpasture's syndrome does not contraindicate renal transplantation under the stipulated conditions of staged therapy. © 1971, American Medical Association. All rights reserved
The Outcome of Kidney Retransplantation

The survival of 66 patients with retransplanted kidneys, from August 1963 to March 1973, was evaluated. The life expectancy after retransplantation is less than that after primary transplantation but the difference is mainly due to an increased early postoperative mortality. The prognosis after retransplantation is greatly improved if the second kidney is from a related donor. The prognosis is likewise improved if a longer period of time has elapsed between the two transplantations. Surprisingly, previous exposure to specific HL-A antigens does not worsen the prognosis for a subsequent transplanted kidney. © 1974, American Medical Association. All rights reserved
Infections Complicating Orthotopic Liver Transplantation: A Study Emphasizing Graft-Related Septicemia

In 93 recipients of 102 orthotopic liver homografts, the incidence of bacteremia or fungemia exceeded 70%. The graft itself was usually an entry site for systemic infection after both immunologic and nonimmunologic parenchymal injury, especially if there was defective biliary drainage. The role of the homograft itself as the special infectious risk factor has prompted increased use of defunctionalized jejunal Roux limbs to reduce graft contamination. It has also stimulated very aggressive postoperative diagnostic efforts to rule out remedial mechanical complications of the transplant. © 1976, American Medical Association. All rights reserved
Liver Allograft: Its Use in Chronic Active Hepatitis with Macronodular Cirrhosis, Hepatitis B Surface Antigen

A patient suffering from chronic active hepatitis with macronodular cirrhosis, positive for hepatitis B surface antigen (HBsAg), was treated with an orthotopic liver allograft. The HBsantigenemia, as measured with several precipitation tests and by complement fixation, became negative after transplantation and remained so for about 2½ months. During the interval, very low titers of the antigen were detectable by radioimmunoassay. At about three months after transplantation, she had an attack of acute hepatitis, at which time HBsAg became detectable by all tests. She recovered, but progressive liver disease developed during the remaining 1½ years of her life. She died of disseminated nocardiosis and candidiasis with deteriorating hepatic function. The homograft at autopsy showed no evidence of rejection, but was the site of chronic active liver disease, although of a different pathologic pattern than that affecting her native liver. The differences in histology may reflect the influence of chronic immunosuppression on the features of chronic active hepatitis. © 1979, American Medical Association. All rights reserved
Liver Resection for Hepatic Adenoma

Between 1970 and 1978, eight hepatic adenomas were resected. Four of the eight patients took oral contraceptive pills before the hepatic adenoma was identified; one patient was male. Four patients had evidence of bleeding at the time of presentation. The original histologic diagnosis in the first five patients was malignant hepatoma. There has been no known recurrence of tumor and all patients are well. The use of oral contraceptives in these patients has been prohibited. Formal anatomic resection is recommended for hepatic adenoma when this procedure can be done without mortality or serious morbidity; however, in the future, less drastic treatments, such as occlusion of the hepatic arterial circulation to the tumor or discontinuation of oral contraceptives, may prove as effective as tumor resection. © 1979, American Medical Association. All rights reserved
Should the Ruptured Renal Allograft Be Removed?

During a 16-month period when 93 renal transplants were performed, eight kidney graft ruptures were detected within 18 days of transplantation, without evidence of venous obstruction. Six grafts were removed at the time of an exploratory operation for rupture and only one showed signs of probable irreversible rejection when examined by microscopy. Two graft ruptures were repaired and one of these grafts has had good long-term function 22 months later. These observations suggest that if bleeding at the site of graft rupture can be securely controlled and if the conditions of the patient and of the graft are favorable except for the rupture, it may be possible to save more than one of eight grafts. © 1979, American Medical Association. All rights reserved
Decline in Survival After Liver Transplantation

Twenty-three recent cases of orthotopic liver transplantation were individually reviewed in an effort to determine why survival had declined from the 50% one-year survival rate of an immediately precedent series. In the series of 23, only six (26%) achieved one-year survival. Faulty case selection, technical complications, the use of damaged organs, and complications of immunosuppression were the main causes of death. Attention was directed to the possible use of preoperative lymphoid depletion to improve the effectiveness and safety of immunosuppression. © 1980, American Medical Association. All rights reserved
Is limb-sparing surgery applicable to neurogenic sarcomas of the extremities?

The presentation, treatment, and outcome of 12 patients with high-grade neurogenic sarcoma (NS) of the extremity were compared with those of 21 patients with high-grade extremity soft-tissue sarcoma of nonneural origin in a retrospective study from January 1976 to January 1988. Pain and neurologic deficit were more common in the NS group. Limb-sparing surgery was carried out with equal frequency in both groups. Local recurrence was six times more frequent in the NS group at three-year follow-up (59% vs 10%). Width of resection margin was the dominant prognostic variable bearing on local control after limb-sparing surgery. Anatomic and functional constraints tended to limit resection margin in patients with NS arising from mixed motor-sensory or predominantly motor nerves
Arterial Mycotic Aneurysm and Rupture: A Potentially Fatal Complication of Pancreas Transplantation in Diabetes Mellitus

• Mycotic aneurysm at the site of a Carrel patch arterial anastomosis occurred in four patients who had undergone whole pancreas transplantation 2.5 to 14.5 months previously. In all patients, the graft had been removed, leaving the Carrel patch on the iliac artery. The aneurysms ruptured into the intestine or the extraperitoneal space. The ruptures were sudden and life-threatening in three of four cases. This diagnosis must be suspected in patients with a history of pancreas transplantation in the immediate or distant past if they present with unexplained hypotension, cardiac arrest, or gastrointestinal tract bleeding. © 1989, American Medical Association. All rights reserved
Liver Transplantation for Polycystic Liver Disease

Four female patients with severe complications of polycystic liver disease were treated with liver replacement; two patients were also given kidneys from their liver donors. All four of the patients were suffering from extreme fatigue. Three of the recipients have survived for 8, 11, and 60 months with normal liver function and present good health. The fourth patient recovered from a liver-kidney transplantation, but 5 months later, fulminant hepatic failure developed in this patient due to hepatitis B virus, and she died despite emergency hepatic retransplantation. © 1990, American Medical Association. All rights reserved
Nonobstructing Colonic Dilatation and Colon Perforations Following Renal Transplantation

Nonobstructing colonic dilatation has not been commonly reported following renal transplantation, and colon perforations carry a high morbidity and mortality in this population. During a 7-year period, nonobstructing colonic dilatation developed in 13 adults 1 to 13 days after renal transplantation. Twelve (92%) of the 13 had poorly functioning allografts. Five (83%) of the 6 with and 2 (29%) of the 7 without colonoscopy had resolution of nonobstructing colonic dilatation. Of the seven right-sided colon perforations during this period, six were associated with nonobstructing colonic dilatation. An additional 4 patients had diverticular perforations in the left colon. Of a total of 11 patients with colon perforation, 7 had surgery within 24 hours of the perforation and 6 (86%) of these survived. Only 1 (25%) of the 4 having surgery more than 24 hours later survived. Six of the survivors retained functioning allografts. Nonobstructing colonic dilatation seems to be a potential complication of poor graft function after renal transplantation, and colonoscopy is effective in its treatment. In patients with colon perforations, early surgery and reduced immunosuppression are essential in decreasing mortality. © 1990, American Medical Association. All rights reserved
Hepatic Artery Reconstruction for Hepatic Artery Thrombosis After Orthotopic Liver Transplantation

We evaluated the efficacy of reconstruction of the hepatic artery for intraoperative or postoperative thrombosis in orthotopic liver transplantation. Of 37 grafts with artery thrombosis, 13 (35.1%, 6 intraoperative and 7 postoperative) underwent reconstruction of the hepatic artery. The arterial flow was reestablished and maintained in 5 (38.5%) of the 13. Recurrent thrombosis in the other 8 grafts developed 2 to 24 days (mean, 13.8 days) after transplantation. Reconstruction was successful in 50% (4/8) of the adults, compared with only 20% (1/5) of the children. Satisfactory results were obtained when a definitive cause of thrombosis could be identified. We conclude that early recognition and correction of the cause of hepatic artery thrombosis during or after orthotopic liver transplantation, especially in adults, is often a graft-saving and lifesaving procedure worthy of consideration. © 1990, American Medical Association. All rights reserved
A new oral lavage solution vs cathartics and enema method for preoperative colonic cleansing

Sulfate free-electrolyte lavage solution is a new osmotically balanced electrolyte gut lavage solution for colon surgery that has been formulated for improved taste and reduced water and electrolyte changes. Sixty patients were prospectively randomized to receive a 1-day preparation with sulfate free-electrolyte lavage solution or a 3-day preparation using a clear liquid diet, cathartics, and enemas. The patient groups were similar in age, race, male-female ratio, and the types of colonic resections performed. Colonic cleansing was better with sulfate free-electrolyte lavage solution (100% vs 63% \u27\u27good\u27\u27 to \u27\u27excellent\u27\u27 cleansing). Patient tolerance evaluated by a questionnaire showed more overall discomfort with sulfate free-electrolyte lavage solution but no difference between the preparations in individual symptoms of fullness, cramping, nausea, or vomiting. One patient developed a low level of serum potassium after a cathartic and enema preparation, while there were no complications with sulfate free-electrolyte lavage solution. Patient taste questionnaires showed a slight preference for sulfate free-electrolyte lavage solution (53%) over a polyethylene glycol electrolyte lavage solution (47%). This study confirms that sulfate free-electrolyte lavage solution is a safe and effective method of preoperative colonic cleansing
Liver Transplantation for Alagille's Syndrome

Twenty-three children with Alagille's syndrome and end-stage liver disease underwent liver transplantation with cyclosporine and low-dose steroid immunosuppression. Two to 9 years (mean, 4.4 years) after surgery, 13 (57%) of the children were still alive, with normal liver function. Three of the fatalities were due to cardiovascular failure secondary to associated cardiopulmonary disease. Mortality was higher among patients who had more severe cardiac disease and patients who had previously undergone a Kasai procedure. Although it has a higher than average risk, liver transplantation can be efficacious in patients with Alagille's syndrome and end-stage liver disease. (Arch Surg. 1993;128:337-339). © 1993, American Medical Association. All rights reserved
Brain abscess in solid organ transplant recipients receiving cyclosporine-based immunosuppression

Objective: To determine the incidence, clinical presentation, and outcome and confounding factors associated with the development of a brain abscess in solid organ transplant recipients. Design: A 14-year retrospective survey. Setting: A single, multiorgan, academic transplantation center. Patients: A total of 2380 liver transplant recipients, 1650 kidney transplant recipients, and 598 heart, heart-lung, or lung transplant recipients of all ages (pediatric and adult) were included. All patients were given cyclosporine-based immunosuppression during this period. Main Outcome Measure: A brain abscess was determined to be present if there was histological and/or microbiological confirmation of a brain lesion seen by a computed tomographic scan. A brain abscess was considered suspicious if radiographic findings were seen in the clinical setting of neurologic symptoms and fever without histological or microbiological confirmation. Results: A brain abscess developed in a total of 28 patients (0.61%) of the total study population. The frequency of brain abscess according to organ type was as follows: 0.63%, liver; 0.36%, kidney; and 1.17%, heart and heart- lung. The overall mortality was 86%. Complicating factors associated with fungal (Candida and Aspergillus sp) abscess formation included major subsequent operations, retransplantations, antirejection therapy, associated bacteremia or viremia, and multiorgan failure. The lung was the primary site of dissemination in 18 patients. Low-dose prophylactic amphotericin was ineffective in preventing a fungal brain abscess in 10 high-risk patients. Because of the ineffective therapy and the deadly nature of established fungal abscesses, full-dose antifungal therapy and reduced immunosuppression were warranted on identification of a high-risk clinical setting. Nonfungal abscesses (Nocardia and Toxoplasma sp) occurred in healthy graft recipients long after transplantation. The existing medical therapy is usually effective in these patients, provided that rapid tissue diagnosis is established. Conclusions: The epidemiological features of brain abscess formation after solid organ transplantation suggest 2 populations of patients exist that differ in timing, clinical setting, and response to therapy. For the chronically immunosuppressed outpatient, an established abscess should be empirically treated with sulfonamides until tissue diagnosis is confirmed. On the other hand, the acutely immunosuppressed posttransplant recipient, with defined risk factors, should receive full-dose therapy with amphotericin B and concomitantly lowered immunosuppression
Operative mortality in resource-limited settings: the experience of Medecins Sans Frontieres in 13 countries.

OBJECTIVE: To determine operative mortality in surgical programs from resource-limited settings. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of 17 surgical programs in 13 developing countries by 1 humanitarian organization, Médecins Sans Frontières, was performed between January 1, 2001, and December 31, 2008. Participants included patients undergoing surgical procedures. MAIN OUTCOME MEASURE: Operative mortality. Determinants of mortality were modeled using logistic regression. RESULTS: Between 2001 and 2008, 19,643 procedures were performed on 18,653 patients. Among these, 8329 procedures (42%) were emergent; 7933 (40%) were for obstetric-related pathology procedures and 2767 (14%) were trauma related. Operative mortality was 0.2% (31 deaths) and was associated with programs in conflict settings (adjusted odds ratio [AOR] = 4.6; P = .001), procedures performed under emergency conditions (AOR = 20.1; P = .004), abdominal surgical procedures (AOR = 3.4; P = .003), hysterectomy (AOR = 12.3; P = .001), and American Society of Anesthesiologists classifications of 3 to 5 (AOR = 20.2; P < .001). CONCLUSIONS: Surgical care can be provided safely in resource-limited settings with appropriate minimum standards and protocols. Studies on the burden of surgical disease in these populations are needed to improve service planning and delivery. Quality improvement programs are needed for the various stakeholders involved in surgical delivery in these settings
Possible Geographical Barriers to Trauma Center Access for Vulnerable Patients in the United States: An Analysis of Urban and Rural Communitie

The article of record as published may be found at http://dx.doi.org/10.1001/archsurg.2010.299Objective—To study whether traditionally vulnerable populations have worse geographic access
to trauma centers.
Design—A cross-sectional analysis using data from the American Hospital Association Annual
Survey from 2005 linked with zip code–level data from the US Census. We used a multinomial
logit model to examine the odds of having difficult as opposed to easy access to trauma centers for
a given subgroup of vulnerable populations.
Setting and Participants—Population in rural and urban communities as defined by zip codes
in the United States.
Main Outcome Measures—Each community’s distance to the nearest trauma center (levels I–
III).
Results—In urban areas, 67% of the population had easy access to trauma centers and 12% had
difficult access compared with 24% and 31% in rural areas, respectively. Areas with higher shares
of the following vulnerable population groups had higher risks (odds ratios) of facing difficult
access to trauma center services in 2005: foreign born in urban areas (1.65 for a medium share and
2.18 for a high share [both P < .01]); African American in urban and rural areas (1.25 for a
medium share and 1.35 for a high share, respectively [both P < .05]); and near-poor in urban and
rural areas (1.52 [P < .05] and 1.69 [P < .01] for a high share, respectively).
Conclusions—A significant segment of the US population (representing 38.4 million people)
does not have access to trauma care within 1 hour of driving time. Moreover, certain vulnerable
groups are at higher risk than others for worse access to trauma centers. Stakeholders and health
care planners should consider these factors in the development of trauma systems because a
mismatch of potential need and access could signal inefficiencies in the delivery of care.grant 63974 from the Robert Wood Johnson Foundation’s
Health Care Financing and Organization Initiative and the Graduate School of Business and Public Policy Direct
Funded Research Program (Dr Shen)grant KL2 RR024130 from the National Institutes of Health/National
Center for Research Resources/OD University of California–San Francisco-Clinical and Translational Science
Institute and a grant under the Robert Wood Johnson Foundation Physician Faculty Scholars Program (Dr Hsia
Surgical Approach for Long-term Survival of Patients With Intrahepatic Cholangiocarcinoma: A Multi-institutional Analysis of 434 Patients.

OBJECTIVES To examine the outcomes of a hepatectomy for intrahepatic cholangiocarcinoma (IHC) and to clarify the prognostic impact of a lymphadenectomy and the surgical margin. Large series of patients who were surgically treated for IHC are scarce. Thus, prognostic factors and long-term survival after resection of IHC remain uncertain. DESIGN Prospective study of patients who were surgically treated for IHC. Clinicopathologic, operative, and long-term survival data were analyzed. SETTING Prospectively collected data of all consecutive patients with pathologically confirmed IHC who had undergone liver resection with a curative intent at 1 of 16 tertiary referral centers were entered into a multi-institutional registry. PATIENTS All consecutive patients who underwent a hepatectomy with a curative intent for IHC (1990-2008) were identified from a multi-institutional registry. RESULTS A total of 434 patients were included in the analysis. Most patients underwent a major or extended hepatectomy (70.0%) and a systematic lymphadenectomy (62.2%). The incidence of lymph node metastases (overall, 36.9%) increased with increased tumor size, with 24.4% of patients with a small IHC (diameter ≤3 cm) having N1 disease. Almost one-third of patients required an additional major procedure to obtain a R0 resection in 84.6% of the cases. In these patients, the median time of survival was 39 months, and the 5-year survival rate was 39.8%. Lymph node metastases (hazard ratio, 2.21; P &lt; .001), multiple tumors (hazard ratio, 1.50; P = .009), and an elevated preoperative cancer antigen 19.9 level (hazard ratio, 1.62; P = .006) independently predicted an adverse prognosis. Conversely, survival was not influenced by the width of a negative resection margin (P = .61). The potential survival benefit of a lymphadenectomy was assessed with the therapeutic value index, which was calculated to be 5.9 points. CONCLUSIONS Survival rates after a hepatectomy with a curative intent for IHC at tertiary referral centers exceed the survival rates reported in most study series in single institutions, which strengthens the value of an aggressive approach to radical resection. Lymph node metastases and multiple tumors are associated with decreased survival rates, but they should not be considered selection criteria that prevent other patients from undergoing a potentially curative resection. Lymphadenectomy should be considered for all patients
Prophylactic tracheostomy in aged and poor risk general surgical patients

The most common postoperative complications are those involving respiration, and they are especially dangerous to patients classified as poor risks because of age or other handicaps. Among the 11 patients whose histories are given, some who were nearly moribund from respiratory difficulties were saved by tracheostomy; others made good recoveries from major surgery under conditions that would have been hopeless without the help afforded by prophylactic tracheostomy. If this possibility is foreseen, an orderly procedure can be carried out in the operating room instead of desperate measures on the ward. Scrupulous care of the tracheostomy is essential; this includes aseptic precautions, humidification of the inhaled air or oxygen, and the systematic but gentle use of suction to aspirate accumulating mucus. © 1959, American Medical Association. All rights reserved