"Hanging donors": are we still skeptical about the lungs?

BACKGROUND: Suicidal hanging may cause compression of the neck blood vessels and the airway leading, to hypoxic brain damage caused by cerebral ischemia and respiratory distress. Hanging engenders global tissue hypoxia, particularly affecting the lungs as the result of pulmonary edema and barotrauma. There is scant evidence about outcomes of transplantation with the use of lungs from "hanging donors." This study evaluates the outcomes of lung transplantations (LTx) that use organs from this group. METHODS: We retrospectively analyzed lung "organ offers" and LTx at our center between January 2007 and November 2013. The outcomes of LTx with lungs from donors with hanging as the cause of death ("hanging group") were compared with those with donors having other causes of death (control group), with the use of an unadjusted model as well as propensity score matching. RESULTS: LTx (n = 302) were performed during this period and were grouped on the basis of the cause of death in donors: the hanging group (n = 8) and the control group (n = 294). No statistically significant difference was found in the donor characteristics except for the incidence of cardiac arrest, which was significantly higher in hanging donors. Preoperative characteristics in recipients in both groups were comparable. Intra-operative and post-LTx variables including PaO2/FiO2 ratios, duration of mechanical ventilation, and intensive care unit and hospital stays were comparable. One-year and 3-year survival rates were also comparable in both groups. Two recipients in the hanging group required extracorporeal life support after LTx and could not survive. CONCLUSIONS: Suicidal hanging is a relatively rare cause of death for potential organ donors. Because it does not appear to negatively affect outcomes after LTx, it should not be considered per se a contraindication for lung donation. A word of caution is necessary until we gather larger experience with lungs from hanging donors.

Outcomes in patients receiving HeartMate II versus HVAD left ventricular assist device as a bridge to transplantation.

OBJECTIVE: Ventricular assist devices have become a standard treatment for patients with advanced heart failure. We present data comparing results after implantation of HeartMate II (HM II) versus HVAD (HW) left ventricular assist devices (LVADs) for the past 7 years at our institution. METHODS: From July 2006 to August 2012, 121 consecutive patients underwent LVAD implantation: 70 (57.9%) received HM II and 51 (42.1%) HW. Patient demographics, perioperative characteristics, and laboratory parameters as well as postoperative outcome were compared retrospectively. RESULTS: Patients in the HM II group were significantly younger (P < .01), with more deranged liver function (higher bilirubin [P = .02] and alanine aminotransferase [P = .01] levels), and had a significantly higher rate of preoperative infections requiring antibiotic treatment (P = .02) and a higher body core temperature (P < .01). Other demographic and preoperative parameters did not show statistical differences. Most postoperative characteristics were also similar between the two groups. HM II patients had a significantly higher transfusion rate, but there were no differences in incidence of resternotomy (P = .156). Recovery and VAD explantation were more likely in the HM II group (P = .02). Although there was no significant difference in survival (log rank test: P = .986; Breslow test: P = .827), HM II patients were more likely to develop a percutaneous site infection (P = .01). CONCLUSIONS: Both HM II and HW provide similar early postoperative outcome and good long-term survival. The differences observed between the groups may be related to demographic and preoperative factors rather than the type of the device used.

Pulmonary resection for airway complication after lung transplantation in a patient with cystic fibrosis: a case report.

We report a case of the interdisciplinary management of recurring bronchial stenosis after bilateral sequential single-lung transplantation (BSSLT) in a 35-year-old female with cystic fibrosis. Initial bronchoscopic therapy including balloon dilatation, stenting, and cryotherapy for granulation tissue overgrowth was unsuccessful in maintaining airway patency. In view of the persistent left lower lobe (LLL) atelectasis and fibrosis predisposing to recurrent infections, she was submitted for left lower lobectomy.

Domestic abuse before, during and after pregnancy in Jahrom, Islamic Republic of Iran.

We conducted a cross-sectional study among 300 women with a child aged 6 to 18 months, to determine the prevalence and determinants of domestic abuse against women in Jahrom; before, during and after pregnancy. The prevalence of abuse during pregnancy (42%) was lower than during the 1 year before pregnancy (51.7%) and after delivery (53.5%). The overall prevalence of emotional abuse, sexual abuse and physical abuse was 53.5%, 34.7% and 26.7% respectively. Abuse during any previous period was a strong risk factor for subsequent abuse. Other risk factors associated with abuse were: woman previously witnessing domestic violence, opium use by husband, woman's education < or = 12 years, age at marriage of woman < 18 years, husband's education < or = 12 years, woman's economic dependency and living in an extended family. Routine screening of abuse in maternity clinics should be considered.

Domestic abuse before, during and after pregnancy in Jahrom, Islamic Republic of Iran

We conducted a cross-sectional study among 300 women with a child aged 6 to 18 months, to determine the prevalence and determinants of domestic abuse against women in Jahrom; before, during and after pregnancy. The prevalence of abuse during pregnancy [42%] was lower than during the 1 year before pregnancy [51.7%] and after delivery [53.5%]. The overall prevalence of emotional abuse, sexual abuse and physical abuse was 53.5%, 34.7% and 26.7% respectively. Abuse during any previous period was a strong risk factor for subsequent abuse. Other risk factors associated with abuse were: woman previously witnessing domestic violence, opium use by husband, woman's education </= 12 years, age at marriage of woman < 18 years, husband's education </= 12 years, woman's economic dependency and living in an extended family. Routine screening of abuse in maternity clinics should be considered

Zirconia and alumina ceramics in comparison with stainless-steel heads. Polyethylene wear after a minimum ten-year follow-up.

Although alumina has been used in orthopaedic surgery since the 1970s, the long-term clinical results of zirconia have not been well documented in vivo. We studied hips with these two different ceramics during the same period and with a minimum follow-up of ten years. Because the size of the alumina and zirconia heads was different, hips with 32 mm alumina heads and those with 28 mm zirconia heads were compared with control hips with stainless-steel heads of the same size. Our aim was to compare the two ceramics. There was an increased linear rate of penetration of the femoral heads into the liner between years five and 12 for the zirconia and the stainless-steel groups. This was severe in the zirconia group (0.4 mm/year compared with 0.13 mm/year for the stainless-steel group). During the same 12-year period there was, however, no significant change in the rate of wear in the alumina group (0.07 mm/year). The mean wear at the most recent follow-up was 1360 mm3 for the 28 mm zirconia group, 683 mm3 for the 28 mm stainless-steel group, 755 mm3 for the 32 mm alumina group and 1314 mm3 for the 32 mm stainless-steel group. The monoclinic content rose on the surface of three zirconia heads which were retrieved at revision. This change was associated with an increase in the surface roughness. A change in the roundness with an increase in the sphericity deviation was also observed both in the articular and non-articular parts of the femoral heads. The increase in rate of wear in the zirconia group was only evident after eight years and may be linked to a long-term biodegradation of zirconia in vivo, associated with the altered roughness and roundness which was observed on the retrieved heads.

Repair of anterior leaflet prolapse by papillary muscle repositioning: a new surgical option.

BACKGROUND: Although mitral valve repair is considered the gold standard for treating mitral regurgitation, anterior leaflet prolapse may still remain a challenging problem. This challenge is even greater for posterior commissural prolapse. We have used papillary muscle repositioning to treat anterior leaflet prolapse and suggest it as an alternative technique for all other methods previously described. METHODS: From 1989 to 1999 we performed 253 mitral valve repairs, among which 132 involved anterior leaflet prolapse. In this population there were two groups: group I (n = 92) treated with papillary muscle repositioning and group II (n = 40) treated with chordal shortening. There was no statistical difference between the two groups concerning age, functional class, and left ventricular function. Etiology was similar in both groups, a degenerative process being predominant. At echocardiography, regurgitation was graded 3.4/4 in both groups. There was no statistical difference concerning preoperative ejection fraction, end-systolic and end-diastolic left ventricular diameter. RESULTS: There were one in-hospital death in group I and two deaths in group II not related to mitral valve repair. Mean follow up is 36.4 +/- 29.2 months in group I and 70.5 +/- 9.5 months in group II. No patient was lost to follow-up. Mean regurgitation at follow-up was 0.75 +/- 0.67 in group I and 0.8 +/- 0.8 in group II (p = not significant). There was no statistical difference between the two groups concerning postoperative ejection fraction, end-systolic and end-diastolic left ventricular diameter. There was no late cardiac death in either group and there were no thromboembolic events. Actuarial survival rate is 98.9% and 96.3% in group I and 92.5% and 88.1% in group II at 3 and 8 years, respectively. CONCLUSIONS: Therefore, we conclude that papillary muscle repositioning is a safe technique that provides excellent results at mid-term follow-up and facilitates treatment of anterior leaflet prolapse.

Interleukin-6 in the blood of patients with total hip arthroplasty without loosening.

Patients with total hip arthroplasty were screened for the presence of proinflammatory cytokines in the systemic circulation. Only increased levels of interleukin-6 were detected in patients having had total hip arthroplasty more than 10 years ago. These increased levels of interleukin-6 were associated with a decrease in bone mineral density associated with polyethylene wear and with radiologic osteolysis in some patients. These abnormalities were not found in control subjects without total hip arthroplasty or in patients who had a prosthesis in place for less than 6 years. The elevation in interleukin-6 levels found in patients with the oldest prostheses could constitute a marker for periprosthetic osteolysis.

[Total hip prostheses, friction lever and wear]. / Prothèses totales de hanche, couple de frottement et usure.

The increased number of joint prostheses now being implanted into younger and active patients has made wear on polyethylene more apparent. This wear is the consequence of the bearing surface of polyethylene against metal. Research into the problem of wear is complex and other models such as metal-on-metal implants, ceramic-on-ceramic implants are tried to decrease the amount of particles accumulated after wear and avoid inflammatory reactions leading to bone lysis and implant loosening between 10 and 20 years.