A New Strategy and System for the Ex Vivo Ovary Perfusion and Cryopreservation

Childern and young adults, who suffer from cancer, receive gonadotoxic therapy, which destroys their fertile abilities after survival.

Ovarian cryopreservation and transplantation provides the promising solution to this problem, where the ovary can be removed before the gonadotoxic therapy and reimplanted after patient's survival, where the ovary is to be cryopreserved during the period of the therapy.

However, cryopreservation of the whole ovary is still facing great obstacles, namely the ischemic reperfusion injury and the defective cryopreservation related to the defective ability to universally deliver the cryopreservation/warming solutions through the ovarian vascular bed.

PDF LINK

Right Versus Left Laparoscopic Donor Nephrectomy: Initial 3 year Experience from a Single Centre Transplant Program

Laparoscopic living donor nephrectomy is the standard of care at high volume transplant centers. Despite this there is still reticence to harvest the right kidney laparoscopically because of concerns regarding the shorter renal vein, higher complexity of dissection and potentially higher complication rates and worse renal allograft outcomes.

The aim of this single-center study of 72 consecutive laparoscopic donor nephrectomies was to compare left versus right-sided laparoscopic donors in terms of surgical difficulty, complication rates and outcomes.There were 56 left-sided and 16 right-sided donors. There was no significant difference in surgical outcomes or complication rates.

Similarly, the recipient surgery complication rates and allograft outcomes were no different between kidneys procured laparoscopically from the left or the right.

PDF LINK

Obesity and Transplantation

The obesity epidemic continues unabated, especially in children and adolescents, in spite of extensive multidisciplinary approaches to curb this societal scourge.

An elevated body mass index (BMI), especially leading to an overweight or obese body habitus, has been clearly linked to the development and progression of chronic kidney disease (CKD) in adults.

This is due to the higher prevalence of diabetes and hypertension, but also likely due to the inflammation that can be induced by adipose tissues. Further compounding this problem is the higher morbidity and mortality that is seen in once these patients develop severe enough CKD to need a renal transplant

PDF LINK

Right Versus Left Laparoscopic Donor Nephrectomy: Initial 3 year Experience from a Single Centre Transplant Program

Laparoscopic living donor nephrectomy is the standard of care at high volume transplant centers. Despite this there is still reticence to harvest the right kidney laparoscopically because of concerns regarding the shorter renal vein, higher complexity of dissection and potentially higher complication rates and worse renal allograft outcomes.

The aim of this single-center study of 72 consecutive laparoscopic donor nephrectomies was to compare left versus right-sided laparoscopic donors in terms of surgical difficulty, complication rates and outcomes.There were 56 left-sided and 16 right-sided donors.

There was no significant difference in surgical outcomes or complication rates. Similarly, the recipient surgery complication rates and allograft outcomes were no different between kidneys procured laparoscopically from the left or the right.

PDF LINK

Dynamic Lumbar Stabilization with Peek Rod/Titanium to Prevent Adjacent Disc Pathology

Over the last decades segmental spinal fusion has become the standard surgical procedure for lumbar degenerative spondyloarthropathy.

Its evolution towards the most modern instrumentation techniques has achieved a very high percentage of success in spinal fusion in the lumbar region.

This varies between 72 and 91%, depending on the technique used. But the success of lumbar fusion has been seen to be accompanied by the appearance of what is known as adjacent segment disease.

PDF LINK

Noninvasive Flap Monitoring using Sidestream Dark Field Microscan: A Method for Real-Time Observation of Submilimmetric Vessels

A timely diagnosis of vascular compromise improves free flap survival. The aim of this study was to determine the feasibility of monitoring flap vascular patency through noninvasive microcirculation monitoring using SDF.

An experimental study was performed in five volunteers. A radial forearm flap was simulated in both upper extremities and cutaneous microcirculation assessment devices were used (SDF and NIRS), and compared with clinical and doppler evaluation.

Conditions of venous occlusion (VO) and total vascular occlusion (TVO) were mimicked by using a cuff. The results of the Microscan SDF monitoring during VO and TVO showed a reduced microcirculatory flow at 16.5 (6-30) and 6 (2-11) seconds respectively.

PDF LINK

Evaluation on the Effectiveness of the Different Modes of Publicity for Tissue Donation among Healthcare Professionals in Singapore

In Singapore, the donation of tissues is governed by the Medical (Therapy, Education and Research) Act. For past years, our tissue banks have engaged in various publicity methods. The objective of this study is to evaluate the effectiveness of our publicity strategies among healthcare professionals.

A 6-questions survey was conducted among doctors, nurses, allied health and support services staff from Singapore General Hospital and National Heart Centre Singapore. Sample size was calculated in accordance to the occupation ratio.

Of the 450 respondents who completed the survey, most did not see, read or heard about tissue donation. Newspaper articles were their main source of information amongst those who encountered tissue donation message.

PDF LINK

Extensor Tendon Injury in the Distal Forearm of Right Hand Owing to Accident

A Bangladeshi 24 year old man was admitted to the hospital with a right hand injury. The examination showed that the tendons of the right hand of the patient were severely injured. X-ray report showed no bone injury.

Within 24 h of the accident surgery was performed but the patient was unable to move the thumb. Therefore a second time surgery was performed.

In the second surgery extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), abductor pollicis brevis (APB), extensor pollicis brevis (EPB) were found defected and all separated tendons were repaired effectively.

PDF LINK

Ureteral Valve Masquerading as Obstructive Megaureter

Primary obstructed megaureter is a common urological condition in the pediatric age group. It is one of the differentials for congenital anomalies of the kidney and urinary tract that include a myriad of structural anomalies of the urinary tract.

The obstructive conditions are usually managed conservatively unless there is deterioration in renal function, repeated urinary tract infection, or any other symptom such as abdominal pain on ipsilateral side and hypertension.

Presented here is a case of left lower ureteral valve that was diagnosed as primary obstructed megaureter with pain in abdomen and reduced ipsilateral renal function wherein ureteral valve was detected incidentally intraoperatively.

PDF LINK

National Transplant Network Information System of US and England

National Transplant Network leads to integration of transplant activities chain amongst participating centers. Co-ordinate and timely information exchange among those centers is a key requirement of integration which is made possible by information system.

The present research studied US and England National Transplant Network Information System. In National Transplant Network of US, United Network for Organ Sharing, American Association of Tissue Banks, and National Marrow Donor Program have safe and online information systems which deal with the management of data associated with organs, tissues, and cells transplants respectively.

The American Division of Transplantation in the department of Health and Human Services supervises the activities of these systems.

PDF LINK

Success in the Treatment of Periapical Implant Lesion: Case Report

Discomfort of groin bulging after huge inguinal henioplasty occurs quite frequently, and it's not easy to control its development and to choose proper treatment of it accordingly.

The patient often feel some foreign body bulging when they enhance their abdominal pressure. Some serious situations always mean the upcoming hernia recurrence, which push both the patients and the surgeons into a dilemma. These presentations have aroused surgeons’ attention.

The definite cause of groin bulging after surgery is still unclear. In general, huge groin hernia (hernia size >15 cm × 20 cm) may prone to result in the phenomenon of bulging due to large defective anatomy, weak transversals fascia, or relaxed peritoneal due to huge ascites or chronic cough.

PDF LINK

Success in the Treatment of Periapical Implant Lesion: Case Report

The Implant periapical lesion (IPL=Implant Periapical Lesion) is an infectious-inflammatory alterations surrounding an implant apex. The diagnosis is based on the clinical manifestations as pain, swelling, presence of fistula and radiological findings, where a radiolucent lesion can be seen in the periapical area.

It is apparent that IPL has a multifactorial background, mainly caused by the presence of a pre-existing microbial pathology or surgical trauma during implant surgery.

To date, there are no clinical protocols for managing IPL. This case report presents a case history related to IPL, which was caused by a pre-existing lesion. For the treatment of the infected form of IPL, a sequential surgical therapy can be utilized, if there is no loss of the implant stability.

PDF LINK

Surgical Apgar Score, Predictor of Post-Emergency Abdominal Surgery Outcome

The surgical team always tries to provide consistently low incidence of major complications for patient undergoing any operation.

Recognizing patients at high risk of developing a complication will contribute substantially to quality of operation and of cost reduction in surgery. In operating room, surgical apgar score (SAS) has helped surgeons for objective assessment of the operative course for postoperative prognostication instead of their "gut- feeling".

Here we prospectively evaluated postoperative complications according to SAS. This was a hospital based, single centre longitudinal prospective observational study from October 2014 to March 2015 including 66 patients.

PDF LINK

Problems and Possibilities in Tissue Engineering

Organ and tissue transplantation in developed countries is in steady increase. We are living in fast changing world with path-breaking technological advancements as a norm of the day.

Development of the field of organ and tissue transplantation has accelerated remarkably since the human major histocompatibility complex (MHC) was discovered.

The major histocompatibility complex (MHC) contains a set of cell surface molecules responsible for binding peptide fragments derived from pathogens and display them on the cell surface for recognition by the appropriate T cells.

PDF LINK

Commentary: Current Status and Future of Corneal Xenotransplantation

Corneal transplantation is the treatment of choice for late stage of corneal decompensation.

According to “Cost-benefit analysis of corneal transplant”, which has been prepared by Eye Bank Association of America (EBAA) and reported by the Lewin group in 2013, net lifetime benefit from the transplantation is $118,000, while, the medical cost of the transplant is $16,500.

However, corneal donation does not meet the demand for corneal transplantation in developing countries and the number of the eligible cornea will be reduced in the future aged societies of the developed countries

PDF LINK

Pilon Fractures of Middle Phalanx Managed with Lag Screw and Early Mobilisation

Proximal interphalangeal (PIP) joint injuries are commonly seen in athletes and especially the pilon fractures are quite common due to axial loading injuries.

It is associated with volar lip fragment with dorsal subluxation of middle phalanx with varying degree of comminution of the base of middle phalanx.

Varied treatment options have been described ranging from extension block splint, external frame finger distraction and open reduction internal fixatio. The key is in restoring the joint congruity with early controlled mobilisation thereby preventing joint stiffness or deformity.

PDF LINK

Surgical Treatment of Transplant Renal Artery Aneurysm: Case Report and Review of Literature

Authors report a case of transplant renal artery aneurysm. The aneurysm developed within three months of living unrelated kidney transplantation surgery.

The aneurysm involved origin of the transplant renal artery proximally and extended up to its bifurcation. The aneurysm was not amenable to endovascular corrective approach.

Surgical resection of the aneurysm was carried out; renal arteries were repaired and re-anastomosed with the right iliac artery. Allograft function recovered after a brief period of acute kidney injury.

PDF LINK

A Short Communication on the Need for Interdisciplinary Action with Families with Deaf Children Who Use Bilateral Cochlear Implants

Bilateral Cochlear Implantation (BCI), both simultaneous and short interval sequenced, is a widely advantageous and valuable resource with respect to unilateral cochlear implantation and long interval bilateral sequenced cochlear implantation,  generating new concerns for families with deaf children.

Lammers et al.Recently found more statistically significant results regarding the perception of sound and the expressive linguistic development of children with Simultaneous Cochlear Implantation (SCI) compared to those with sequential bilateral cochlear implantation after 1 year of hearing experience with the devices.

Moreover, the available data show that there is no proliferation in the risks associated to SCI, assuming that only one surgical, hospital episode was recorded.In this sense, relevant advances over BCI in deaf children are evident.

PDF LINK

Preventable Urological Complications Post Kidney Transplant with Modified Lich-Gregoir Technique

Various ureteroneocystostomy techniques for kidney transplant have been described with Lich-Gregoir (LG) being widely employed. However, even with multiple modifications on this technique, urine leakage and ureteric stenosis remain as most common complications. This study aims to evaluate urological complications by using our modified LG technique after kidney transplant.

From 26th January 2010 to 30th May 2014, 206 consecutive kidney transplants were performed at our institute. 124 were deceased-donor and 69 were live-donor kidney transplants; 13 patients received a small tumour excised kidney graft.

All transplants except one were done by conventional open surgery. The modification involves an additional stitch placed at proximal part of bladder muscular incision with peri ureteric tissue at the entrance of ureter to bladder. Urological complications were defined as urine leakage or ureteral stricture. The patients were followed-up from 12 to 64 months.

PDF LINK

Non Confluent Pulmonary Arteries with Bilateral Patent Ductus Arteriosus: Unifocalization and Concomitant Bilateral Bidirectional Glenn Procedure

Patent ductus arteriosus (PDA) is a common congenital cardiac lesion usually encountered one side. Rarely both left and right aortic arches may persist giving rise to bilateral PDA.

Embryologically the distal pulmonary arteries arise from respective lung buds, which join the proximal portion of the sixth aortic arch while the main pulmonary artery is derived from pulmonary arterial portion of truncoaortic sac.

We recently encountered a patient with bilateral PDA along with non -confluent pulmonary arteries. This patient also had a double outlet right ventricle (DORV), pulmonary atresia, right aortic arch and bilateral superior vena cavae (SVC), further adding to its rarity.

PDF LINK

A Rare Case of Renal Cell Carcinoma in Left Renal Ectopia with Cervical Spine Metastasis Presented as Quadriparesis

Renal Cell Carcinoma (RCC) is the most common solid tumor affecting adults, accounting 2% of the cancers worldwide.

The incidence of renal cell carcinoma in a pelvic kidney which represents the most common form of ectopic kidney is extremely rare.

We describe a case where an incidental pelvic kidney with a large sized renal cell carcinoma was diagnosed when a patient presented with cervical spondylitis myelopathy due to cervical metastasis.

PDF LINK

Postoperative Biological and Physiological Gastrointestinal Changes after Whipple Procedure

In the last years there was an increased interest towards the pancreatic cancer, especially considering its growing incidence (rapidly becoming the fifth cause of death by cancer in the developed countries), lack of any sustainable markers and/or risk factors and the chilling fact that almost 95% of the patients with this disorder are presenting to the hospital in the advanced and unresectable stages.

Even more, although known and developed for almost 70 years, the surgical approach for the pancreatic cancer is a subject of debate because its efficacy and postoperative biological changes.

It is known that the most common surgery in chronic pancreatitis and pancreatic cancer is represented by the Whipple pancreatico duodenectomy.

PDF LINK

Life-threatening Capillary Leak Syndrome in an Adult with Refractory Acute Myeloid Leukemia during Allogeneic Transplantation: a Case Report and Review of Literature

Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) offers the possibility of cure for hematological malignancies, various complications have been described.

Capillary leak syndrome (CLS) has been previously observed in HSCT patients. CLS is a rare disease characterized by recurrent episodes of generalized edema and severe hypotension along with hypoproteinemia.

A 27-year-old Chinese man, diagnosed with refractory acute myeloid leukemia, was treated with a haploidentical stem cell transplant combined with an unrelated umbilical cord blood unit. The patient developed fatal CLS during the 9th day of the conditioning therapy.

PDF LINK

Role of Sentinel Lymph Node in Early Stage of Uterine Cervical Cancer

Cervical cancer is currently the second most common form of neoplasia worldwide and third in the female population.

Dissemination can occur directly (isthmus, parametrium, vagina, urinary bladder and/or rectum), through the lymphatic system (parametrium, internal iliac, external iliac, common iliac, obturator lymph nodes and rarely in the inferior gluteus, superior gluteus, superior rectum, sacrum, aortic lymph nodes) and through the circulatory system (lung, mediastinum, bones, liver).

 The risk of pelvic lymph nodes invasion in stage IB (FIGO) is 9-17%. The standard surgical treatment, for stages IA2-IIA, is radical hysterectomy with pelvic lymphadenectomy.

PDF LINK

Right Versus Left Laparoscopic Donor Nephrectomy: Initial 3 year Experience from a Single Centre Transplant Program

Laparoscopic living donor nephrectomy is the standard of care at high volume transplant centers.

Despite this there is still reticence to harvest the right kidney laparoscopically because of concerns regarding the shorter renal vein, higher complexity of dissection and potentially higher complication rates and worse renal allograft outcomes.

The aim of this single-center study of 72 consecutive laparoscopic donor nephrectomies was to compare left versus right-sided laparoscopic donors in terms of surgical difficulty, complication rates and outcomes.There were 56 left-sided and 16 right-sided donors.

PDF LINK

A Pediatric Case of Very Late Onset Non-infectious Pulmonary Complication (LONIPC) after Allogeneic Hematopoietic Stem Cell Transplantation

17-months old infant with Wiskott-Aldrich syndrome was transplanted with genetically two-locus mismatched unrelated cord blood cells under the conditioning regimen of busulfan, cyclophosphamide and anti-thymocyte globulin.

GVHD prophylaxis was cyclosporine (CSP) plus short-term methotrexate with prednisolone (1 mg/kg). Acute and chronic GVHD were not observed during the course.

About six years later, he suffered from severe cough and dyspnea with no fever, and diagnosed as late onset non-infectious pulmonary complications (LONIPC).

PDF LINK

Hidden Penis in Children: Evaluation of Outcomes and Review of the Literature

There are many categories in hidden penises usually differentiation among the terms includes: concealed (before circumcision), trapped (cicatricial or scarred) after circumcision), and buried (associated with adolescence and obesity).

Methods: From December 2014 to August 2015, we evaluated 10 patients (6 months–10 years old) with buried penises, concealed penises, trapped penises and webbed penises that were surgically. All the patients were scheduled for regular follow-up at 1, 4, and 12 weeks postoperatively.

Results: l0 patients underwent surgical repair, all buried and concealed patients had penile degloving and penile fixation. All patients reported much improved urinary function, and all patients stated that they were pleased or very happy with their outcome.

PDF LINK

Off-Road Motorbike and All-Terrain Vehicle/Quadbike Accidents in Rural New South Wales

Motorized off-road vehicles are a common form of transportation used by the rural community. These vehicles are rugged and relatively inexpensive, making them practical and versatile in mining, logging and farming communities.

They are ideal modes of transport especially on farms where there is little or no paved roads as the bikes can easily navigate over uneven surfaces. There are two main forms of off-road vehicles used in rural communities.

The first main form of off-road vehicle is the off-road motorbikes. These bikes are specifically designed for off-road riding and are also known commonly as ‘dirtbikes’.

PDF LINK