ABSTRACT
We examined the effect of alemtuzumab and basiliximab induction therapy on patient survival and freedom from bronchiolitis obliterans syndrome (BOS) in double lung transplantation. The United Network for Organ Sharing database was reviewed for adult double lung transplant recipients from 2006 to 2013. The primary outcome was risk-adjusted all-cause mortality. Secondary outcomes included time to BOS. There were 6117 patients were identified, of whom 738 received alemtuzumab, 2804 received basiliximab, and 2575 received no induction. Alemtuzumab recipients had higher lung allocation scores compared with basiliximab and no-induction recipients (41.4 versus 37.9 versus 40.7, p < 0.001) and were more likely to require mechanical ventilation before to transplantation (21.7% versus 6.5% versus 6.2%, p < 0.001). Median survival was longer for alemtuzumab and basiliximab recipients compared with patients who received no induction (2321 versus 2352 versus 1967 days, p = 0.001). Alemtuzumab (hazard ratio 0.80, 95% confidence interval 0.67-0.95, p = 0.009) and basiliximab induction (0.88, 0.80-0.98, p = 0.015) were independently associated with survival on multivariate analysis. At 5 years, alemtuzumab recipients had a lower incidence of BOS (22.7% versus 55.4 versus 55.9%), and its use was independently associated with lower risk of developing BOS on multivariate analysis. While both induction therapies were associated with improved survival, patients who received alemtuzumab had greater median freedom from BOS.
Subject(s)
Alemtuzumab/therapeutic use , Antibodies, Monoclonal/therapeutic use , Bronchiolitis Obliterans/mortality , Graft Rejection/mortality , Lung Diseases/mortality , Lung Transplantation/adverse effects , Recombinant Fusion Proteins/therapeutic use , Adult , Antineoplastic Agents/therapeutic use , Basiliximab , Bronchiolitis Obliterans/drug therapy , Bronchiolitis Obliterans/etiology , Female , Follow-Up Studies , Graft Rejection/drug therapy , Graft Rejection/etiology , Graft Survival , Humans , Immunosuppressive Agents/therapeutic use , Induction Chemotherapy , Lung Diseases/surgery , Male , Middle Aged , Postoperative Complications , Prognosis , Risk Factors , SyndromeABSTRACT
The surgical treatment of Crohn's disease of the colon is distinct from that used in treating ulcerative colitis. Crohn's disease often involves the small bowel and is not "cured" by colorectal resection. The popular ileo-anal pouch procedures used in the management of ulcerative colitis generally are not used for the treatment of Crohn's colitis, because of higher complication rates. Commonly performed operations include ileostomy, segmental colon resection, subtotal colectomy, and proctocolectomy. The general surgeon, therefore, is provided with many options when faced with complications of Crohn's colitis. This article examines the attributes of and results reported for each of these options.
Subject(s)
Colonic Diseases/surgery , Crohn Disease/surgery , Colectomy , Colonic Diseases/complications , Crohn Disease/complications , Humans , Ileostomy , Intestinal Fistula/etiology , Patient Selection , Proctocolectomy, Restorative , Treatment OutcomeSubject(s)
Organ Transplantation , Adult , Artificial Organs , Child , Cytomegalovirus Infections/etiology , Graft Rejection , Health Services Accessibility , Heart Transplantation/adverse effects , Heart-Assist Devices , Hepatitis B/etiology , Hepatitis C/etiology , Histocompatibility Testing , Humans , Immunosuppression Therapy , Islets of Langerhans Transplantation , Kidney Transplantation/adverse effects , Kidney Transplantation/immunology , Liver Transplantation/adverse effects , Lung Transplantation/adverse effects , Neoplasms/etiology , Pancreas Transplantation , Recurrence , Tissue DonorsABSTRACT
We report on thoracoscopic plication of the the paralyzed right hemidiaphragm of a 33-year-old woman with a history of reactive airway disease. The paralysis was secondary to transection of the phrenic nerve during right first rib resection for thoracic outlet syndrome 1 year prior to evaluation. By use of video-assisted thoracoscopic surgery (VATS), the diaphragm was plicated as with open thoracotomy. Postoperative recovery was uneventful, with minimal pain and early discharge. Preoperative symptoms of exertional dyspnea and orthopnea were significantly improved.
Subject(s)
Diaphragm/surgery , Laparoscopy/methods , Paralysis/surgery , Phrenic Nerve/injuries , Respiratory Paralysis/surgery , Thoracotomy/methods , Adult , Female , Follow-Up Studies , Humans , Laparoscopes , Paralysis/diagnosis , Paralysis/etiology , Respiratory Function Tests , Respiratory Paralysis/etiology , Thoracic Outlet Syndrome/surgery , Thoracotomy/adverse effects , Video RecordingABSTRACT
Artificial hearts have been used for temporary and permanent replacement of failing human hearts. Attempts at permanent implantation during the 1980s were complicated by a high incidence of infection and thromboembolism, combined with a low quality of life for recipients. Given the success of cardiac transplantation, the artificial heart was relegated to temporary use in critically ill patients who were waiting for a donor heart. Continued difficulties with complications, combined with the success of ventricular assist devices for this purpose, dramatically reduced the use of the artificial heart. However, the recent development of compact electromechanical artificial hearts powered by transcutaneous energy systems has led to renewed hope for the possibility of permanent implantation. Some of these devices have been successful in animal studies and are approaching human trials. After years of hope and disappointment, artificial heart technology may be on the verge of efficacy. The history, status, and future of the artificial heart are discussed.
