Utility of a modified components separation for abdominal wall reconstruction in the liver and kidney transplant population

BACKGROUND: Incisional hernia is a common complication following visceral organ transplantation. Transplant patients are at increased risk of primary and recurrent hernias due to chronic immune suppression and large incisions. We conducted a retrospective review of patients with a history of liver or kidney transplantation who underwent hernia repair to analyze outcomes and hernia recurrence. METHODS: This is a single center, retrospective review of 19 patients who received kidney and/or liver transplantation prior to presenting with an incisional hernia from 2011 to 2017. All hernias were repaired with open component separation technique (CST) with biologic mesh underlay. RESULTS: The mean age of patients was 61.0±8.3 years old, with a mean body mass index of 28.4±4.8 kg/m², 15 males (78.9%), and four females (21.1%). There were seven kidney, 11 liver, and one combined liver and kidney transplant patients. The most common comorbidities were hypertension (16 patients, 84.2%), diabetes (9 patients, 47.4%), and tobacco use (8 patients, 42.1%). Complications occurred in six patients (31.6%) including hematoma (1/19), abscess (1/19), seroma (2/19), and hernia recurrence (3/19) at mean follow-up of 28.7±22.8 months. With the exception of two patients with incomplete follow-up, all patients healed at a median time of 27 days. CONCLUSIONS: This small, retrospective series of complex open CST in transplant patients shows acceptable rates of long-term hernia recurrence and healing. By using a multidisciplinary approach for abdominal wall reconstruction, we believe that modified open CST with biologic mesh is a safe and effective technique in the transplant population with complex abdominal hernias.

Retrospective Review of Chemotherapy Treatment of Locally Advanced and Metastatic Penile Cancer in the North West of England.

Aims: To examine current practices in the UK in the use of chemotherapy in advanced penile cancer and investigate the treatment outcomes of this group of patients. Study Design: Retrospective series. Place and Duration of Study: The study population received chemotherapy at Clatterbridge Cancer Centre, The Christie Hospital or Lancashire Teaching Hospital between January 1999 and January 2009. Methodology: Patients undergoing chemotherapy for histologically confirmed squamous cell carcinoma of the penis within the designated time period were identified retrospectively. Through case note review, data were collected on chemotherapy regimens, tolerability, response to treatment and survival. Response to chemotherapy was categorized by the investigators according to RECIST (version 1.0) criteria. Chemotherapy given concurrently with radiotherapy was excluded. Results: 40 patients were treated with chemotherapy for locally advanced or metastatic penile cancer. Prior to the inception of a Supra-regional Multidisciplinary Team (SMDT), seven different chemotherapy regimens were used first line. After introduction of the SMDT Cisplatin/5-Fluoruracil (5FU) was almost exclusively prescribed outside of clinical trials. 12/40 (30%) patients completed the planned course of chemotherapy. 27/40 (67%) discontinued treatment prematurely, 14/40 (35%) due to progressive disease, and 13/40 (32%) due to declining performance status and/or toxicity. Response to chemotherapy was assessed radiologically in 23/40 patients and categorised by the investigators according to RECIST criteria. There were three complete responses and eight partial responses (objective response rate 28%). Median survival was 15 months from diagnosis and 5 months from commencing first line chemotherapy. Conclusion: This supra-regional collaboration highlighted varying use of chemotherapy historically in penile cancer. Development of a supra-regional MDT has reduced much of the variability. Response rates are modest and survival outcomes are poor. This reinforces the urgent need for clinical trials to establish a framework for novel, more active regimens and to guide patient selection.

Plasmodium falciparum strains from Papua New Guinea: culture characteristics and drug sensitivity.

Seven strains of Plasmodium falciparum from Papua New Guinea have been established in continuous in vitro culture. Samples with a high initial parasitaemia were more likely to form continuous lines, possibly due to the time required for transport of infected blood samples from Papua New Guinea to laboratories in Australia. Most but not all established lines were resistant to chloroquine and all were resistant to pyrimethamine, possibly reflecting the parasite strain characteristics in that region.