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Objective:To evaluate the clinical efficacy and safety of ex vivo liver resection and autotransplantation (ELRA) by using a Bayesian single-arm Meta-analysis.Methods:Databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang were searched from January 1, 1990 to December 30, 2021 on ELRA studies. The Bayesian one-arm Meta-analysis was performed by using the statistical software of R (V4.1.2) and the Markov chain-Monte Carlo method was used to simulate the posterior distribution. The mortality rate within 30 days after operation, 1-year survival rate, major postoperative complications, R 0 resection rate and other related indexes were analyzed. Results:A total of 20 studies with 436 patients were included. Bayesian single-arm Meta-analysis showed that the 1-year survival rate after ELRA was 83.24% [95% highest posterior density ( HPD): 72.40%-92.05%]. The 1-year survival rates after surgery were 88.66% (95% HPD: 81.52%-94.50%) for patients with hepatic alveolar echinococcosis and 61.29% (95% HPD: 38.53%-93.68%) for patients with hepatic malignancies, respectively. The mortality rate within 30 d after surgery, the incidence of significant postoperative complications, and the R 0 resection rate were 6.96% (95% HPD: 4.47%-10.15%), 27.91% (95% HPD: 19.00%-38.30%), and 99.84% (95% HPD: 37.61%-100.00%), respectively. Renal failure was the most frequent cause of death after ELRA. Conclusion:ELRA is indicated for hepatic malignancies and hepatic alveolar echinococcosis when intrahepatic resection cannot be accomplished in vivo. The greatest benefit is observed in patients with hepatic alveolar echinococcosis, while only some patients with hepatic malignancies can benefit. The indications for ELRA for hepatic malignancies need to be further studied to define the subgroup of patients who can benefit from this operation.
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Abstract A 45-year-old woman with known hypothyroidism and no other comorbidities was incidentally found to have multiple right renal artery aneurysms. The largest aneurysm measured 5 x 4.5 cm and arose from an inferior segmental branch while two smaller aneurysms arose from an upper segmental branch of the right renal artery. We performed an ex-vivo repair with reverse saphenous vein graft under cold preservation followed by orthotopic kidney auto-transplantation. Her postoperative course was unremarkable and at 1-year follow-up her right kidney is preserved. In this article, we report successful treatment of complex multiple right renal artery aneurysms and describe the surgical technique used for successful repair.
Resumo Uma mulher de 45 anos com hipotireoidismo conhecido e sem outras comorbidades teve achado incidental de múltiplos aneurismas da artéria renal direita. O maior aneurisma media 5 x 4,5 cm e tinha origem no ramo segmentar inferior, juntamente com dois pequenos aneurismas originários do ramo segmentar superior da artéria renal direita. Realizamos o reparo ex vivo com enxerto reverso de veia safena, sob preservação a frio, seguido de autotransplante renal ortotópico. O pós-operatório ocorreu sem intercorrências, e a paciente teve o rim direito preservado no seguimento de 1 ano. Neste artigo, relatamos o tratamento bem-sucedido de múltiplos aneurismas complexos da artéria renal direita e descrevemos a técnica cirúrgica utilizada para o reparo bem-sucedido.
Subject(s)
Humans , Female , Middle Aged , Renal Artery , Transplantation, Autologous , Aneurysm/surgery , Saphenous Vein , Vascular Surgical Procedures , Hypothyroidism , KidneyABSTRACT
A 52-year-old man was admitted with an incidentally detected right renal artery aneurysm (RAA). Computed tomographic angiography with three-dimensional reconstruction revealed that the aneurysm was 2.2 cm in diameter and located at the renal hilum. We performed hand-assisted laparoscopic nephrectomy with ex vivo repair of the RAA and auto-transplantation with minimal elongation of Gibson incision. The operation and postoperative course were uneventful. At last follow-up, the patient was alive with a well-functioning auto-transplant. Hand-assisted laparoscopic nephrectomy and auto-transplantation is a useful treatment option for hilar RAA.
Subject(s)
Humans , Middle Aged , Aneurysm , Angiography , Follow-Up Studies , Hand-Assisted Laparoscopy , Nephrectomy , Renal ArteryABSTRACT
Objective To establish the vein bypass assisted porcine liver auto transplantation model and study the methods of liver cold storage during the operation , in order to provide experience for the clini-cal application of liver auto transplantation and experimental evidence for liver machine perfusion .Methods A total of 5 pigs were operated to establish the portal-vein bypass by inserting cannula into vena jugularis in-terna, femoral vein and splenic vein , with liver being hypothermic perfused and stored in situ by 4℃ UW solution through hepatic artery and portal vein .Vital signs and clinical outcomes were monitored during the operation, and the changes of liver function indexes such as aminotransferase , total bilirubin and albumin were detected at different time points .Results During the operation , the vital signs kept steady and liver were perfused well , achieving fully blood supply after reperfusion .All animals survived over 120 h.Both al-anine aminotransferase and aspartate transaminase peaked at 24 h after blood reperfusion (69.8 ±16.2 U/L and 457.7 ±50.1 U/L), and then dropped within normal range at 96 ho after reperfusion.Total bilirubin peaked at 48 h after blood reperfusion (7.1 ±3.3μmol/L), and then decreased rapidly .The plasma albu-min kept falling after blood reperfusion , reaching the minimum of 11.1 ±2.7 g/L at 4 h after reperfusion, and then rose to normal level steadily at 16 h.Conclusions The vein bypass assisted liver auto transplanta-tion could guarantee the steady vital signs and survival rate , which may supply an experimental basis for de-veloping new efficient liver preservation and restoration methods .
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Loin pain haematuria syndrome (LPHS) is an uncommon clinical entity that has divided renal physicians, pain practitioners, and even psychiatrists since its initial description. A relative paucity of data exists regarding the condition, with best practice guidelines lacking amid the existing threads of anecdotal experiences and variable follow-up observations. The aim of this article was to review the cumulative published experience of pain relief strategies for LPHS.
Subject(s)
Analgesia , Denervation , Follow-Up Studies , Pain Management , Practice Guidelines as Topic , PsychiatryABSTRACT
Aims: For the orthodontic treatment of the complex cases, the interdisciplinary team work is of utmost importance, which leads to the predictable outcome with excellent treatment. The prime aim of this rare case report is to demonstrate the combined orthodontic-surgical-endodonticprosthodontic interdisciplinary management. Presentation of Case: This report describes the case of a 19 years old Malay male patient with the clinical problems of median diastema, mesio-buccally rotated maxillary left 1st premolar, mild mandibular incisor crowding along with impacted maxillary left lateral incisor and canine. Discussion: With the advantages of the orthodontic fixed appliance, auto-transplantation of maxillary upper left lateral incisor and canine, the case was completed in an ideal orthodontic occlusion along with improved oral condition, masticatory function and esthetics. The treatment outcomes were due to orthodontic-surgical-endodontic-prosthodontic treatment with stable occlusion in sequels visits. Conclusion: An Interdisciplinary management achieved successful functional and esthetic results in the present case.
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Introduction : Le but de la présente étude est d'évaluer le taux de succès et les facteurs affectant le pronostic de l'auto-transplantation immédiate de la troisième molaire mandibulaire, au site de la première ou la deuxième molaire homolatérale après un suivi clinique et radiologique sur une période de trois ans. Matériel et méthodes : Un total de 90 troisièmes molaires mandibulaires ont été immédiatement transplantées pour remplacer la première ou la deuxième molaire homolatérale jugées non restaurables. Le stade de développement des molaires auto-transplantées varie de 3 à 7 selon la classification de Moorrees. Pour les molaires matures, le traitement canalaire est réalisé 1 à 2 semaines plus tard. A l'issue des contrôles cliniques et radiographiques des troisièmes molaires transplantées échelonnés selon un calendrier prédéfini, des statistiques descriptives ainsi que l'analyse du taux de réussite et des facteurs affectant le pronostic ont été réalisées. Résultats : L'âge moyen des patients était de 22,80 ans. Le taux de succès est de 87,8%. Le taux de réussite de l'auto-transplantation des troisièmes molaires immatures et matures est respectivement de 91,2% et de 81,8%. Le taux d'échec est de 12,2%.Le temps extra-alvéolaire apparait comme la cause principale des complications. Parmi les 11 transplantations considérées comme un échec, la résorption radiculaire externe est la manifestation principale représentée par 8 cas, suivi de 2cas d'ankylose et d'un cas d'expulsion du transplant. Conclusion : L'auto-transplantation immédiate des troisièmes molaires mandibulaires au site de la première ou de la deuxième molaire homolatérale est une solution viable et une alternative à la réhabilitation prothétique conventionnelle ou au traitement implantaire d'un point de vue thérapeutique et économique.
Introduction: The aim of the present study was to evaluate the success rate and to the factors affecting the prognosis of the immediate auto-transplantation of the mandibular third molar, in homolateral first or second molar site after clinical and radiological follow-up over a period of three years. Material and methods: A total of 90 mandibular third molars were immediately autotransplanted to replace homolateral lost first or second molar. The development stage of autotransplanted molars varied from 3 to 7 according to Moorrees. Root canal treatment began for mature molars 1 to 2 weeks later. Clinical and radiographic checkup of the transplanted third molars were done according to predesigned record form. Descriptive statistics and statistical analysis about success rate and to the factors affecting the prognosis were performed. Results: The mean age of treated patients was 22.80 years. The success rate was 87.8%. The success rates of the auto-transplantation of third immature and mature molars were 91.2% and 81.8%, respectively. The failure rate is 12.2% and extra-alveolar time appears as the main cause of complications. In all, 11 transplants were considered a failure. External radicular resorption appeared to be the principal manifestation with 8 cases, followed by 2 cases of ankylosis and 1 of transplant expulsion. Conclusion: Immediate auto-transplantation of the mandibular third molar teeth in homolateral first or second molar site is an interesting treatment alternative to conventional prosthetic rehabilitation or implant treatment in cases of lost molars from both a therapeutic and an economic point of view.