New Perspectives on Desensitization in the Current Era - An Overview

Blood group and tissue incompatibilities remain significant barriers to achieving transplantation. Although no patient should be labeled “un-transplantable” due to blood group or tissue incompatibility, all candidates should be provided with individualized and realistic counseling regarding their anticipated wait times for deceased donor or kidney paired donation matching, with early referral to expert centers for desensitization when needed. Vital is the careful selection of patients whose health status is such that desensitizing treatment is less likely to cause serious harm and whose anti-HLA antibody status is such that treatment is likely to accomplish the goal of increasing organ offers with an acceptable final crossmatch. Exciting new developments have re-energized the interest and scope of desensitization in the times ahead.

Download Full-text

Management of Ovarian Dermoid Cysts by Laparoscopy Compared With Laparotomy

Diagnostic and Therapeutic Endoscopy ◽

10.1155/dte.3.19 ◽

1996 ◽

Vol 3 (1) ◽

pp. 19-27 ◽

Cited By ~ 1

Author(s):

Pang Liyi ◽

Hiroshi Sasaki ◽

Liu Chang Qing ◽

Minoru Akiyama ◽

Akihiko Watanabe ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Blood Loss ◽

Hospital Stay ◽

Selection Criteria ◽

Operating Time ◽

Operative Laparoscopy ◽

The Times ◽

Selection Of Patients ◽

Criteria For Selection ◽

Selection Of

Thirty patients with ovarian dermoid cysts removed by laparoscopic surgery were compared with 42 patients with ovarian dermoid cysts removed by laparotomy, with respect to the selection criteria, surgical procedures, operating time, intraoperative and postoperative complications, blood loss, and hospital stay. Although the operating time for unilateral cystectomy, unilateral salpingo-oophorectomy, and bilateral cystectomy performed by laparoscopic surgery was longer (120.3 ± 43.7 min, mean ± SD) than those for the same procedures performed by laparotomy (73.9 ± 21.6 min, p < 0.01), we observed a learning curve with a remarkable declining tendency (linear regression model, p < 0.01). At the end of this study, the times taken for laparoscopic procedures were almost the same as those for laparotomy. Less blood loss (18.2 ± 1.7 ml versus 105.9 ± 84.3 ml, p < 0.01) and shorter hospital stay (5.9 ± 1.9 days versus 12.0 ± 2.9 days, p < 0.01) were also found to be advantages of laparoscopic surgery. This article discusses the technical procedures of laparoscopic surgery. The efficiency and safety of operative laparoscopy as an alternative access route for the management of ovarian dermoid cysts were recognized. We stress that strict criteria for selection of patients should always be followed and the necessity of retraining schedules for gynecologists and nursing staff in the speciality of laparoscopic surgery.

Download Full-text

Current Approaches to Desensitization in Solid Organ Transplantation

Frontiers in Immunology ◽

10.3389/fimmu.2021.686271 ◽

2021 ◽

Vol 12 ◽

Author(s):

Carrie Schinstock ◽

Anat Tambur ◽

Mark Stegall

Keyword(s):

Organ Transplantation ◽

Solid Organ Transplantation ◽

Organ Transplant ◽

Deceased Donor ◽

Antibody Detection ◽

Solid Organ ◽

Detection Techniques ◽

Kidney Paired Donation ◽

Hla Incompatible ◽

Hla Antibody

Major advancements in the development of HLA antibody detection techniques and our understanding of the outcomes of solid organ transplant in the context of HLA antibody have occurred since the relevance of sensitization was first recognized nearly 50 years ago. Additionally, kidney paired donation programs (KPD) have become widespread, deceased donor allocation policies have changed, and several new therapeutic options have become available with promise to reduce HLA antibody. In this overview we aim to provide thoughtful guidance about when desensitization in kidney transplantation should be considered taking into account the outcomes of HLA incompatible transplantation. Novel therapeutics, desensitization endpoints, and strategies for future study will also be discussed. While most of our understanding about desensitization comes from studying kidney transplant candidates and recipients, many of the concepts discussed can be easily applied to desensitization in all of solid organ transplantation.

Download Full-text

Scintigraphic Evaluation of Intrathecal Infusion Systems: Selection of Patients for Surgical or Medical Management

Yearbook of Anesthesiology and Pain Management ◽

10.1016/s1073-5437(08)70222-5 ◽

2007 ◽

Vol 2007 ◽

pp. 247

Author(s):

S.E. Abram

Keyword(s):

Medical Management ◽

Infusion Systems ◽

Selection Of Patients ◽

Intrathecal Infusion ◽

Selection Of

Download Full-text

Selection of patients for portal-systemic shunts

JAMA ◽

10.1001/jama.196.12.1039 ◽

1966 ◽

Vol 196 (12) ◽

pp. 1039-1044 ◽

Cited By ~ 1

Author(s):

R. E. Hermann

Keyword(s):

Selection Of Patients ◽

Selection Of

Download Full-text

Perioperative acute internal carotid thrombosis after general surgery

Perspectives in Surgery ◽

10.33699/pis.2020.99.3.136-140 ◽

2020 ◽

Vol 99 (3) ◽

pp. 136-140

Keyword(s):

Cardiac Surgery ◽

Internal Carotid ◽

Right Hemicolectomy ◽

Diagnostic Assessment ◽

Left Carotid Artery ◽

Perioperative Stroke ◽

Internal Carotid Occlusion ◽

Acute Brain Ischemia ◽

Selection Of Patients ◽

Selection Of

Introduction: The average incidence of perioperative stroke during major non-cardiac surgery is less than 1%, suggesting that it is rarely a major problem for the vast majority of patients. Methods: In our paper we present a 46-year-old patient undergoing acute right hemicolectomy who developed right-sided hemiparesis in the perioperative setting. Immediate CTAg examination showed an ischemic stroke in the left hemisphere as a result of left internal carotid thrombosis. A surgical procedure to recanalize the left carotid artery was performed 14 hours from the onset of neurological symptomatology and the neurological deficit gradually recovered fully. Conclusion: Our case report supports studies showing that a thorough diagnostic assessment allows the selection of patients who may benefit from urgent revascularization of acute internal carotid occlusion during the phase of acute brain ischemia.

Download Full-text