scholarly journals Therapeutic Management of Trauma-related Acute Pancreatitis in a Heart Transplant Recipient

2019 ◽  
Vol 70 (9) ◽  
pp. 3100-3102
Author(s):  
Cosmin Banceu ◽  
Simona Gurzu ◽  
Marius Harpa ◽  
Klara Brinzaniuc ◽  
Mihaela Ispas ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Heart Transplant ◽  
Immunosuppressive Treatment ◽  
Heart Transplant Recipient ◽  
Cardiac Transplant ◽  
Life And Death ◽  
Disease Mortality ◽  
The Difference

Acute pancreatitis is a very mortal disease, mortality that increases even more in patients with cardiac transplantation. Medical-surgical management of acute pancreatitis in transplanted patients can make the difference between life and death. The aim of this paper was to highlight the severity of this pathology especially because the patient is immunosuppressed after cardiac transplant. A case of 36-year-old man, known with heart transplant, immunosuppressive treatment and chronic renal frailer, who arrived to Emergency Department, with severe abdominal pain and abdominal distention which started after a traumatic accident. Investigations revealed acute pancreatitis that needed three surgeries for acute necrotic hemorrhagic pancreatitis, acute bleeding, left subphrenic abscess and intensive care therapy. With favorable postoperative evolution, patient is discharged 60 days later He�s follow up reveled no gastrointestinal or cardiac complication with an improved quality of life.

scholarly journals BK virus nephropathy in a heart transplant recipient

2021 ◽  
Author(s):  
John Fredy Nieto-Ríos ◽  
Diego Armando Benavides-Henao ◽  
Arbey Aristizabal-Alzate ◽  
Carol Morales-Contreras ◽  
Diana Carolina Chacón-Jaimes ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Dysfunction ◽  
Heart Transplant ◽  
Immunosuppressive Treatment ◽  
Heart Transplant Recipient ◽  
Bk Virus ◽  
Transplant Recipients ◽  
Bk Virus Nephropathy ◽  
Stable Renal Function

Abstract BK virus nephropathy in kidney transplantation is widely recognized as an important cause of graft dysfunction and loss. In the case of transplants of organs other than kidney, BK virus nephropathy in native kidneys has been recognized as a cause of chronic kidney disease, which is related with immunosuppression; however, the diagnosis is usually late because the renal dysfunction is attributed to other causes, such as toxicity by anticalcineurinic drugs, interstitial nephritis due to medications, hemodynamic changes, diabetes, hypertension, etc. We report a case of BK virus nephropathy in a patient who underwent heart transplantation due to peripartum cardiomyopathy. The kidney biopsy reported active chronic tubulointerstitial nephritis associated with late stage polyomavirus nephritis and the blood viral load for BK virus was positive (logarithm 4.5). The immunosuppressive treatment was reduced, and after two years of follow-up, the patient had stable renal function with a serum creatinine of 2.5 mg/dL (GFR of 23.4 mL/min/1.73m2). We recommend that the BK virus be considered as a cause of renal dysfunction in heart transplant recipients, with the aim of detecting its replication in time to reduce immunosuppressive therapy before irreversible compromise of renal function may manifest.

scholarly journals THE DISCRIMINATE ABILITY OF THE PEDIATRIC ADOLESCENT SHOULDER SURVEY (PASS)

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0018
Author(s):  
Tracey Bastrom ◽  
Andrew Pennock ◽  
Eric W. Edmonds
Keyword(s):  
Surgical Treatment ◽  
Shoulder Instability ◽  
Shoulder Function ◽  
Compensatory Mechanisms ◽  
Minimal Impact ◽  
Shoulder Dysfunction ◽  
Operative Outcomes ◽  
The Difference

Purpose: The purpose of this study was to examine whether improvements in the Pediatric and Adolescent Shoulder Survey (PASS) are seen at 3 months following surgical treatment for shoulder instability and whether the PASS can discriminate between patients with differing outcomes based on clinical exam and the single assessment numeric evaluation (SANE). Performance of the PASS was contrasted with an adult validated tool, the quickDASH. Methods: Patients who underwent surgical treatment for shoulder instability with completed PASS forms available at pre-operative and 3 months post-operative (range 2.5-4.5mos) were included in this review. The PASS consists of 13 questions that assess (in child friendly language) symptoms, limitations, need for compensatory mechanisms, and emotional distress related to shoulder dysfunction. Responses are on a 0-5 or 0-10 scale with a score calculation based on percentage of total possible points (100% indicates no/minimal impact on quality of life from shoulder dysfunction). Patients were grouped based on range of motion or strength (within 10 degrees to contralateral extremity or no discrepancy in strength score was considered no deficit) and SANE score (=80% vs <80%) at the 3-month visit. Alpha was set at p<0.05 to declare significance. Results: 50 patients with a mean age of 16 years (range 13.5-18 yrs) were identified in this review with a mean post-operative follow-up of 3.2 ± 0.5 months. Scores on the PASS improved significantly from pre-operative (57 ± 16%) to post-operative (74 ± 16%, p<0.001). The quickDASH similarly showed improvement (27 ± 16 pre vs 18 ± 16 post, p=0.003) although the magnitude of the effect for the PASS was larger (f=0.84 for PASS vs f=0.48 for quickDASH). Ceiling effect (>15% reporting the highest score) was observed at 3 months with the quickDASH (16% with top score), but not with the PASS (4%, p=0.03). While both tools were able to discriminate between patients with SANE score =80% vs <80%, the difference in quickDASH score between patients with/without diminished motion did not reach significance (p=0.07, Table). Conclusion: The PASS shows anticipated improvements in shoulder function following surgical intervention for instability without ceiling effects. The PASS is able to discriminate between patients with differing post-operative outcomes at 3 months following surgery. [Table: see text]

Identifying Effectors of Outcomes in Patients with Large Umbilical Hernias

2016 ◽  
Vol 82 (7) ◽  
pp. 613-621 ◽  
Author(s):  
Steven A. Groene ◽  
Davis W. Heniford ◽  
Tanushree Prasad ◽  
Amy E. Lincourt ◽  
Vedra A. Augenstein
Keyword(s):  
Umbilical Hernia ◽  
Defect Size ◽  
Long Term Outcomes ◽  
Preoperative Pain ◽  
The Mean ◽  
The Difference ◽  
One Year

Quality of life (QOL) has become an important focus of hernia repair outcomes. This study aims to identify factors which lead to ideal outcomes (asymptomatic and without recurrence) in large umbilical hernias (defect size ≥9 cm2). Review of the prospective International Hernia Mesh Registry was performed. The Carolinas Comfort Scale was used to measure QOL at 1-, 6-, and 12-month follow-up. Demographics, operative details, complications, and QOL data were evaluated using standard statistical methods. Forty-four large umbilical hernia repairs were analyzed. Demographics included: average age 53.6 ± 12.0 and body mass index 34.9 ± 7.2 kg/m2. The mean defect size was 21.7 ± 16.9 cm2, and 72.7 per cent were performed laparoscopically. Complications included hematoma (2.3%), seroma (12.6%), and recurrence (9.1%). Follow-up and ideal outcomes were one month = 28.2 per cent, six months = 42.9 per cent, one year = 55.6 per cent. All patients who remained symptomatic at one and two years were significantly symptomatic before surgery. Symptomatic preoperative activity limitation was a significant predictor of nonideal outcomes at one year ( P = 0.02). Symptomatic preoperative pain was associated with nonideal outcomes at one year, though the difference was not statistically significant ( P = 0.06). Operative technique, mesh choice, and fixation technique did not impact recurrence or QOL. Repair of umbilical hernia with defects ≥9 cm2 had a surprising low rate of ideal outcomes (asymptomatic and no recurrence). All patients with nonideal long-term outcomes had preoperative pain and activity limitations. These data may suggest that umbilical hernia should be repaired when they are small and asymptomatic.

scholarly journals Study protocol for resolution of organ injury in acute pancreatitis (RESORP): an observational prospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040200
Author(s):  
Ahmed E Sherif ◽  
Rory McFadyen ◽  
Julia Boyd ◽  
Chiara Ventre ◽  
Margaret Glenwright ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Acute Pancreatitis ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Observational Prospective Cohort Study ◽  
New Onset

IntroductionSurvivors of acute pancreatitis (AP) have shorter overall survival and increased incidence of new-onset cardiovascular, respiratory, liver and renal disease, diabetes mellitus and cancer compared with the general population, but the mechanisms that explain this are yet to be elucidated. Our aim is to characterise the precise nature and extent of organ dysfunction following an episode of AP.Methods and analysisThis is an observational prospective cohort study in a single centre comprising a University hospital with an acute and emergency receiving unit and clinical research facility. Participants will be adult patient admitted with AP. Participants will undergo assessment at recruitment, 3 months and 3 years. At each time point, multiple biochemical and/or physiological assessments to measure cardiovascular, respiratory, liver, renal and cognitive function, diabetes mellitus and quality of life. Recruitment was from 30 November 2017 to 31 May 2020; last follow-up measurements is due on 31 May 2023. The primary outcome measure is the incidence of new-onset type 3c diabetes mellitus during follow-up. Secondary outcome measures include: quality of life analyses (SF-36, Gastrointestinal Quality of Life Index); montreal cognitive assessment; organ system physiological performance; multiomics predictors of AP severity, detection of premature cellular senescence. In a nested cohort within the main cohort, individuals may also consent to multiparameter MRI scan, echocardiography, pulmonary function testing, cardiopulmonary exercise testing and pulse-wave analysis.Ethics and disseminationThis study has received the following approvals: UK IRAS Number 178615; South-east Scotland Research Ethics Committee number 16/SS/0065. Results will be made available to AP survivors, caregivers, funders and other researchers. Publications will be open-access.Trial registration numbersClinicalTrials.gov Registry (NCT03342716) and ISRCTN50581876; Pre-results.

scholarly journals Patients with psychiatric diagnoses have lower quality of life than other patients with juvenile rheumatic disease: a prospective study

Rheumatology ◽  
2021 ◽  
Author(s):  
Silja Kosola ◽  
Heikki Relas
Keyword(s):  
Quality Of Life ◽  
Disease Activity ◽  
Transition Phase ◽  
University Hospital ◽  
Psychiatric Diagnoses ◽  
Adult Care ◽  
The Difference ◽  
Lower Hrqol

Abstract Introduction Transition of adolescents with chronic diseases from pediatric healthcare to adult care requires attention to maintain optimal treatment results. We examined changes in health-related quality of life (HRQoL) and disease activity among juvenile idiopathic arthritis (JIA) patients with or without concomitant psychiatric diagnoses after transfer to an adult clinic. Methods We prospectively followed 106 consecutive patients who were transferred from the New Children’s Hospital to the Helsinki University Hospital Rheumatology outpatient clinic between April 2015 and August 2019 and who had at least one follow-up visit. HRQoL was measured using 15D, a generic instrument. Results The patients’ median age at transfer was 16 years and disease duration 4.0 years. Patients were followed for a median of 1.8 years. Disease activity and overall HRQoL remained stable, but distress (dimension 13 of 15D) increased during follow up (P=0.03). At baseline, patients with at least one psychiatric diagnosis had lower overall 15D scores (0.89±0.14 vs. 0.95±0.05, P&lt;0.01) and higher disease activity (Disease Activity Score 28; 1.88±0.66 vs. 1.61±0.31, P=0.01) than patients without psychiatric diagnoses. The difference in overall 15D persisted over the study period. Conclusions Transition phase JIA patients with psychiatric diagnoses had lower HRQoL than other JIA patients. Despite reduced disease activity and pain, HRQoL of patients with psychiatric diagnoses remained suboptimal at the end of follow-up. Our results highlight the necessity of comprehensive care and support for transition phase JIA patients.

Selective Recertification of Pilots Who Have Undergone a Cardiac Transplant

2020 ◽  
Vol 91 (9) ◽  
pp. 732-736
Author(s):  
Ann Norris ◽  
Valerie Skaggs ◽  
David Kaye ◽  
James De Voll ◽  
David McGiffin
Keyword(s):  
Heart Transplant ◽  
Adverse Outcome ◽  
Federal Aviation Administration ◽  
Heart Transplant Recipient ◽  
Transportation Safety ◽  
Cardiac Transplant ◽  
Aviation Accidents ◽  
Workflow System ◽  
Class Level ◽  
Control And Prevention

BACKGROUND: From 2007, the Federal Aviation Administration (FAA) permitted pilots who have had a heart transplant to be considered for recertification under special issuance at the third-class level. The objective of this study was to evaluate certification safety and determine if any adverse outcome occurred in this airman group as a consequence of this policy.METHODS: Methods involved collecting data from the FAA Document Imaging Workflow System to identify airmen undergoing cardiac transplantation since 2007, and examining medical and safety-related outcomes through the National Transportation Safety Board-related accident database and the Centers for Disease Control and Prevention National Death Index.RESULTS: Included in the study were 36 airmen, with 16 recertified at the class 3 level and 20 denied certification. No aviation accidents or recorded deaths occurred in the group of 16 airmen undergoing recertification. Of these airmen, 13 underwent a second successful recertification and 6 underwent a third attempt, with 5 being successful. Two airmen have declared their intention to fly under BasicMed. Of the 20 airmen denied recertification, 16 were denied for failure to provide information. There were three deaths in this denied group.DISCUSSION: The policy allowing third-class heart transplant recipient recertification appears to be safe. Aviation safety is not being compromised by allowing these airmen to resume flying, with the exception that recertification should continue under the special issuance system and not through BasicMed.Norris A, Skaggs V, Kaye D, De Voll J, McGiffin D. Selective recertification of pilots who have undergone a cardiac transplant. Aerosp Med Hum Perform. 2020; 91(9):732736.

Abstract 17197: Donor Circumstance and Mechanism of Death: Evolving Effects on Heart Transplant Recipient Survival

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Benjamin Smood ◽  
J. Trent Magruder ◽  
Amit Iyengar ◽  
William L. Patrick ◽  
Jason J. Han ◽  
...  
Keyword(s):  
Overall Survival ◽  
Transplant Recipient ◽  
Heart Transplant ◽  
Motor Vehicle ◽  
Isolated Heart ◽  
Heart Transplant Recipient ◽  
Drug Intoxication ◽  
Transplant Outcomes ◽  
First Time

Introduction: Since 2000, suicide rates have dramatically increased, while deaths from motor vehicle accidents (MVAs) have declined. Poisoning has surpassed MVAs as the leading cause of preventable death, largely due to the opioid epidemic. Analyses regarding the forensic pathology of donor death and heart transplant recipient outcomes are lacking. We sought to determine how donor mechanisms (e.g. drug intoxication, asphyxiation) and circumstances (e.g. suicide, MVA) of death have affected heart transplant outcomes over the last 20 years. Methods: The UNOS database was queried for all first-time isolated heart transplants occurring between January 2000 through March 2019. First-time recipients were included. Donor, recipient, and procurement variables were screened by univariable logistic analysis to identify potential independent predictors of survival with freedom from transplantation at 1 year after heart transplant. A final parsimonious multivariable regression model was created, including all causes, mechanisms and circumstances of donor death. The primary endpoint of analysis was survival with freedom from retransplantation at last follow-up. Analyses were conducted for 2000-19, and stratified by decade (2000-09 and 2010-19). Results: 34,373 patients met inclusion criteria. Median follow-up was 4.3 (IQR1.3-8.9) years. From 2000-19, death by suicide has had worse overall survival (HR 1.27; CI 1.1-1.5). A similar association is seen prior to 2010 (HR1.36; CI1.06-1.74). Since 2010, death by asphyxiation has been associated with improved survival (HR0.7; CI0.5-0.9). Death by MVA has become associated with early (i.e. 30-day) mortality (HR1.7; CI1.1-2.7), and worse survival among patients surviving 1-year after transplant. Donor death from drug intoxication has had no significant effect on recipient outcomes in the past 20 years. Conclusions: Since 2010, donors who died by MVA have worse early survival in heart transplant. Death by asphyxiation now appears to have a protective effect on overall survival. Suicide is no longer associated with poorer outcomes. Further study into how public health initiatives, policy, and epidemics effect transplant outcomes may improve donor selection and organ allocation in heart transplantation.

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