Pancreas Transplantation With Grafts From Donors Deceased After Circulatory Death: 5 Years Single-Center Experience.

BACKGROUND: Donation after circulatory death (DCD) pancreas transplantation has been shown to be an additional way to deal with donor organ shortages. The results of 5-year DCD pancreas transplantation are presented. METHODS: A retrospective, single-center analysis (2011-2015) was performed to compare the results of donation after brain death (DBD) to DCD pancreas transplantation. RESULTS: During the study period, 104 pancreas transplantations (83 from DBD and 21 from DCD) were performed. Median Pancreas Donor Risk Index (PDRI) was 1.47, (DBD, 1.61 vs DCD, 1.35; P = 0.144). Without the factor DCD, PDRI from DCD donors was significantly lower (DBD, 1.61 vs DCD, 0.97; P < 0.001). Donor age was the only donor-related risk factor associated with pancreas graft survival (Hazard ratio, 1.06; P = 0.037). Postoperative bleeding and kidney delayed graft function occurred more frequently in recipients from DCD (P = 0.006). However, DCD pancreata had a lower incidence of thrombosis. Kidney and pancreas graft survival were equally good in both groups. CONCLUSIONS: Pancreas transplantation from DCD donors yields comparable results to DBD donors when PDRI of DCD is relatively low. Most DCD donors are younger donors with trauma as cause of death. These DCD pancreas grafts may be a better option to cope with increasing organ shortages than exploring the limits with older (and higher PDRI) DBD donors.

Increasing the participation of intensive care unit nurses to promote deceased donor organ donation.

INTRODUCTION: Intensive care unit (ICU) nurses are viewed to have an important role in identifying potential donors to increase the donor pool. Our objectives were to assess their knowledge about organ donation, their attitudes concerning their presumed role in organ donation, and their motivation toward a more prominent role by 3 questionnaires administered before and after training on promotion of organ donation. METHODS: Twelve nurses from 3 different ICU departments were selected to participate in a prospective evaluation. Their perceptions and attitudes on organ donation were assessed by means of 3 questionnaire forms that focused on "knowledge of organ donation," "attitudes toward endorsement of organ donation," and "motivation in promoting organ donation." Two video-illustrated lectures were given. A re-evaluation using the same 3 questionnaire forms was done to analyze the effect of training on their knowledge, attitude, and motivation. RESULTS: A marked gain in knowledge (P<.001), change in attitude (P<.001), and increase in motivation (P<.001) were seen after training. Nurses understood the need to promote organ donation and the crucial role of nurses in early detection of possible deceased organ donors. They agreed to encourage the patients' relatives consent to donation of their beloved one's organs. CONCLUSION: Active participation of ICU nurses in the identification of potential deceased donor organs and their direct participation in organ procurement though continuous re-education and video- illustrated lectures may promote an increased number of deceased donor organs.

Pseudo-tumoral hepatic tuberculosis: a report of two cases.

Tuberculosis involving the liver in the absence of active pulmonary or miliary tuberculosis is very rare. The inflammatory pseudo-tumoral form is an entity difficult to diagnose. We report two patients, who underwent laparoscopic segmentectomy for suspected malignant tumour. Pathology showed tuberculoid granuloma with central caseous necrosis in both patients. The diagnosis in the first patient was made retrospectively on the resection specimen, whereas an active pre-operative work-up for tuberculosis diagnosis (biopsy and Polymerase Chain Reaction) remained futile in the second patient. The management of pseudo-tumoral hepatic tuberculosis needs a multidisciplinary concertation and a surgical approach is often the best way to ensure the diagnosis.

Laparoscopic treatment in acute complicated diverticulitis: a review of 11 cases.

AIMS: We wanted to test the role of laparoscopy in complicated diverticulitis. METHODS: All acute complicated sigmoid diverticulitis cases were reviewed during the last 6 years (December 1999 to 2006). Patients whose medical treatment had failed and patients admitted with peritonitis underwent emergency surgery. However, only laparoscopic procedures were included in the study. Patients were programmed 2 to 4 months later for laparoscopic elective colon resection if they underwent first lavage and drainage of the peritoneal cavity. RESULTS: Eleven patients were treated by laparoscopic procedures out of a total of 37 who underwent emergency surgical therapy for acute perforated diverticulitis. Laparoscopic resection with primary anastomosis was performed in 2 patients (Hinchey I and IIA). Laparoscopic lavage and drainage was performed in the remaining 9 patients (one stage IIA, three stage IIB and five stage III). Three conversions into open Hartmann were needed (stage III). One patient (stage IIB) was lost during follow-up and reappeared 16 months later in general peritonitis. Two patients needed earlier resection because of persistent symptoms. Three remaining patients had a 2nd stage resection at the allocated time. No postoperative death was encountered. Long-term follow-up (mean 6 months) showed one incisional hernia in a converted patient. DISCUSSION: In perforated diverticular disease, even though laparoscopic lavage and drainage avoids a colostomy and facilitates a 2nd stage resection, few patients have complete resolution of the inflammatory process. Resection remains mandatory after 8 to 12 weeks. In Hinchey stage III, the success rate still remains to be investigated and weighed against the Hartmann procedure or primary resection. Faecal peritonitis and instable patients should not be considered for laparoscopy.

Hepatocellular carcinoma with distant double bile duct tumoral thrombus: a case report.

The authors report a case of a 3 cm hepatocellular carcinoma at the junction of segments VI and VII with double bile duct tumoral thrombi (Types I and III). The type I thrombus was suspected during the pre-operative workup, but the type III bile duct tumoral thrombus (BDTT) was an intra-operative additional finding on cholangiography. The patient underwent a bisegmental posterolateral resection to remove the primary tumour and the first tumoral thrombus located in the posterolateral intrahepatic duct. A choledocotomy was also performed to remove, by balloon catheter, the floating thrombus located in the common bile duct just over the papilla. The authors discuss their diagnostic and therapeutic approach and review the literature.

Absorption and disposition kinetics of chlorothiazide in protein-calorie malnutrition.

The influence of dietary protein deficiency on the absorption and disposition kinetics of chlorothiazide was investigated in male Sprague-Dawley rats fed for 4 weeks on a 23 per cent (control) or a 5 per cent (low) protein diet ad libitum. Chlorothiazide in plasma and urine was determined by a sensitive and specific HPLC assay. Following an intravenous dose of 10 mg kg-1 chlorothiazide, there was a significant decrease in the total plasma clearance (Cl) per kg of body weight from 1.80 +/- 0.15 to 1.29 +/- 0.15 l h-1 kg-1 and apparent steady-state volume of distribution from 0.65 +/- 0.13 to 0.38 +/- 0.07 l kg-1 in the protein-deficient rats. However, no significant difference was found in the two groups of animals with respect to mean residence time (MRT) and free fraction of drug in plasma. The mean harmonic half-life was increased from 72 to 91 min in the protein-deficient rats. The urinary recovery of unchanged chlorothiazide in 48 h was essentially complete in both groups of animals. The absorption of chlorothiazide, as assessed by the mean urinary recovery of unchanged drug after oral administration, was 66 per cent and 68 per cent in normal and protein-deficient rats, respectively.