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Singh N, Lentine KL, Fleetwood VA, Woodside KJ, Odorico J, Axelrod D, Alhamad T, Maher K, Xiao H, Fridell J, Kukla A, Pavlakis M, Shokouh-Amiri HM, Zibari G, Cooper M, Parsons RF. Indications, Techniques, and Barriers for Pancreas Transplant Biopsy: A Consensus Perspective From a Survey of US Centers. Transplantation 2024; 108:e129-e138. [PMID: 38467588 DOI: 10.1097/tp.0000000000004960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND Pancreas transplant biopsy practices for the diagnosis of rejection or other pathologies are not well described. METHODS We conducted a survey of staff at US pancreas transplant programs (March 22, 2022, to August 22, 2022) to assess current program practices and perceptions about the utility and challenges in the performance and interpretation of pancreas allograft biopsies. RESULTS Respondents represented 65% (76/117) of active adult pancreas transplant programs, capturing 66% of recent pancreas transplant volume in the United States. Participants were most often nephrologists (52%), followed by surgeons (46%), and other staff (4%). Pancreas allograft biopsies were performed mostly by interventional radiologists (74%), followed by surgeons (11%), nephrologists (8%), and gastroenterologists (1%). Limitations in the radiologist's or biopsy performer's comfort level or expertise to safely perform a biopsy, or to obtain sufficient/adequate samples were the two most common challenges with pancreas transplant biopsies. Pancreas transplant biopsies were read by local pathologists at a majority (86%) of centers. Challenges reported with pancreas biopsy interpretation included poor reliability, lack of reporting of C4d staining, lack of reporting of rejection grading, and inconclusive interpretation of the biopsy. Staff at a third of responding programs (34%) stated that they rarely or never perform pancreas allograft biopsies and treat presumed rejection empirically. CONCLUSIONS This national survey identified significant variation in clinical practices related to pancreas allograft biopsies and potential barriers to pancreas transplant utilization across the United States. Consideration of strategies to improve program experience with percutaneous pancreas biopsy and to support optimal management of pancreas allograft rejection informed by histology is warranted.
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O'Riordan E, Maher K, O'Hagan Z, Martin-Loeches I. Direct discharge from the intensive care unit improved patient flow in a resource-pressured health system. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2023; 3:39. [PMID: 37864236 PMCID: PMC10588071 DOI: 10.1186/s44158-023-00124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
Critical care practice is constantly evolving. Pressures for bed availability in publicly funded healthcare systems have led to an increase in patients delayed in their discharge from critical care to the wards. This has resulted in more patients discharged directly home (DDH) from the intensive care unit (ICU). However, few formal pathways for DDH exist. We have performed a retrospective audit of the patients discharged home from our unit in the largest tertiary referral hospital in the Republic of Ireland from 2017 to 2022 to investigate their characteristics and the safety of this practice, given the understandable patient safety concerns raised.Results In total, 84 patients have been DDH from our unit between 2017 and 2022 from a total of 4747 patients. The overall rate of DDH increased year on year, and the vast majority of these patients were initially admitted from the emergency department or following elective major surgery. Most patients had an APACHE score of less than 11 points, and the majority were admitted for less than 3 days, with single organ failure. There was a gender divide, as greater than 60% of the patients admitted were male, with a mean age of 44.Conclusion DDH has been an important tool in improving patient flow through the hospital, avoiding unnecessary de-escalation to the ward for a select group of critical care patients. The re-admission rate in the year post-ICU discharge was very low, showing that DDH has not adversely impacted patient safety.
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Caliskan Y, Hippen BE, Axelrod DA, Schnitzler M, Maher K, Alhamad T, Lam NN, Anwar S, Kute V, Lentine KL. International Practices on COVID-19 Vaccine Mandates for Transplant Candidates. KIDNEY360 2022; 3:1754-1762. [PMID: 36514724 PMCID: PMC9717656 DOI: 10.34067/kid.0004062022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/15/2022] [Indexed: 01/12/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic created unprecedented challenges for solid organ transplant centers worldwide. We sought to assess an international perspective on COVID-19 vaccine mandates and rationales for or against mandate policies. Methods We administered an electronic survey to staff at transplant centers outside the United States (October 14, 2021-January 28, 2022) assessing the reasons cited by transplant centers for or against implementing a COVID-19 vaccine mandate. Each responding center was represented once in the analysis. Results Respondents (N=90) represented 27 countries on five continents. Half (51%) of responding transplant center representatives reported implementing a COVID-19 vaccine mandate, 38% did not, and 12% were unsure. Staff at centers implementing a vaccine mandate cited efficacy of pretransplant vaccination versus post-transplant vaccination, importance for public health, and minimizing exposure of other patients as rationale for the mandate. Of centers with a mandate, the majority (81%) of the centers mandate vaccination regardless of prior SARS-CoV-2 infection status and regardless of prevaccination spike-protein antibody titer or other markers of prior infection. Only 27% of centers with a vaccine mandate for transplant candidates also extended a vaccine requirement to living donor candidates. Centers not implementing a vaccine mandate cited concerns for undue pressure on transplant candidates, insufficient evidence to support vaccine mandates, equity, and legal considerations. Conclusions The approach to pretransplant COVID-19 vaccination mandate policies at international transplant centers is heterogeneous. International transplant centers with a vaccine mandate were more willing to extend vaccine requirements to candidates' support persons, cohabitants, and living donors. Broader stakeholder engagement to overcome vaccine hesitancy across the world is needed to increase the acceptance of pretransplant COVID-19 vaccination to protect the health of transplant patients.
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Hippen BE, Axelrod DA, Maher K, Li R, Kumar D, Caliskan Y, Alhamad T, Schnitzler M, Lentine KL. Survey of current transplant center practices regarding COVID-19 vaccine mandates in the United States. Am J Transplant 2022; 22:1705-1713. [PMID: 35143100 PMCID: PMC9111251 DOI: 10.1111/ajt.16995] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 01/25/2023]
Abstract
An electronic survey canvassing current policies of transplant centers regarding a COVID-19 vaccine mandate for transplant candidates and living donors was distributed to clinicians at US solid organ transplant centers performing transplants from October 14, 2021-November 15, 2021. Responses were received from staff at 141 unique transplant centers. These respondents represented 56.4% of US transplant centers, and responding centers performed 78.5% of kidney transplants and 82.4% of liver transplants in the year prior to survey administration. Only 35.7% of centers reported implementing a vaccine mandate, while 60.7% reported that vaccination was not required. A minority (42%) of responding centers with a vaccine mandate for transplant candidates also mandated vaccination for living organ donors. Centers with a vaccine mandate most frequently cited clinical evidence supporting the efficacy of pre-transplant vaccination (82%) and stewardship obligations to ensure organs were transplanted into the lowest risk patients (64%). Centers without a vaccine mandate cited a variety of reasons including administrative, equity, and legal considerations for their decision. Transplant centers in the United States exhibit significant heterogeneity in COVID-19 vaccination mandate policies for transplant candidates. While all centers encourage vaccination, most centers have not mandated COVID-19 vaccination for candidates and living donors, citing administrative opposition, legal prohibitions, and concern about equity in access to transplants.
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Fleetwood VA, Maher K, Satish S, Varma CR, Nazzal M, Randall H, Al-Adra DP, Caliskan Y, Bastani B, Rub FAA, Lentine KL. Clinician and patient attitudes toward use of organs from hepatitis C viremic donors and their impact on acceptance: A contemporary review. Clin Transplant 2021; 35:e14519. [PMID: 34672392 DOI: 10.1111/ctr.14519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/10/2021] [Accepted: 10/15/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The use of Hepatitis C (HCV) NAT positive allografts remains unusual and is clustered at few centers. We conducted a contemporary literature review to assess whether patient and clinician attitudes toward viremic organs impact acceptance. METHODS Databases including PubMed, MEDLINE, and SCOPUS databases were reviewed to identify studies focused on evaluating patient and provider perceptions of HCV NAT positive organ use within the DAA era (January 2015-April 2021). Search included MeSH terms related to Hepatitis C, transplantation, and patient and clinician attitudes. Two investigators extracted study characteristics including information on willingness to accept viremic organs, HCV-specific outcomes knowledge, HCV-specific concerns, and factors that contributed to acceptance or non-acceptance. RESULTS Eight studies met all inclusion criteria. These included three pretransplant patient-directed studies, two post-transplant patient-directed studies, one pre- and post-transplant patient-directed study, and two clinician-directed studies. Common themes identified were concerns regarding HCV cure rates, viremic organ quality, DAA cost, stigma, and the possibility of HCV transmission to household members. The perception of decreased waitlist time was associated with viremic organ acceptance. Physician trust played a mixed role in acceptance patterns. CONCLUSIONS Knowledge of high cure rates, shorter waitlist times, and higher organ quality appear to have the highest impact on organ acceptance.
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Pezaro S, Maher K, Bailey E, Pearce G. Problematic substance use: an assessment of workplace implications in midwifery. Occup Med (Lond) 2021; 71:460-466. [PMID: 34537842 DOI: 10.1093/occmed/kqab127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Problematic substance use (PSU) poses occupational, personal and professional risks. As an occupational group, midwives have been under-represented in research on PSU. AIMS The aim of this study was to assess self-reported occurrences of PSU, help-seeking behaviours and barriers, and perceptions of impairment in UK-based midwives. METHODS Self-selecting registered midwives were anonymously surveyed using the Tobacco, Alcohol, Prescription Medications, and Substance Use/Misuse (TAPS) tool, the Perceptions of Nursing Impairment Inventory (PNII) and open-ended/closed questions. Quantitative data were used to explore PSU, help-seeking and attitudes to impairment. Qualitative responses were used to provide richer understandings. RESULTS From 623 completed surveys, 28% (n = 176) self-reported PSU in response to work-related stress and anxiety, bullying, traumatic clinical incidents and maintenance of overall functioning. PSU was related to alcohol and a range of restricted drugs. While 11% of those affected indicated they had sought help, 27% felt they should seek help but did not. Reported barriers to help-seeking included fear of repercussions, shame, stigma, practicalities and a perceived lack of support either available or required. Perceptions of impairment were predominantly compassionate with a minority of stigmatizing attitudes displayed. CONCLUSIONS Overall, 10% of the sample reported they had attended work under the influence of alcohol, and 6% under the influence of drugs other than tobacco or those as prescribed to them. Furthermore, 37% indicated concern about a colleague's substance use. As stigmatizing attitudes and punitive actions can dissuade help-seeking, changed perceptions and policies which favour alternatives to discipline are suggested to reduce the risk overall.
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Maher K, Spooner H, Hoffman R, Haffner J. The influence of whole-body vibration on heart rate, stride length, and bone mineral content in the mature exercising horse. COMPARATIVE EXERCISE PHYSIOLOGY 2020. [DOI: 10.3920/cep190073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Research in humans suggests whole-body vibration (WBV) aids in maintaining bone mineral content (BMC) yet results in the horse are less favourable. Anecdotally, WBV is reported to reduce pain and improve performance. This study was designed to test the effect of WBV on exercising horses, hypothesising that WBV would lower heart rate (HR) during treatment, increase BMC, modify markers of bone metabolism, and increase stride length. Eleven horses were randomly assigned into control (CON, n=5) or WBV (VIB, n=6) groups for a 28-day treatment period. Both groups exercised for 1 h, 6 d/wk on a mechanical exerciser. VIB horses received 50 Hz WBV for 45 min, 5 days/wk. Third metacarpal radiographs were taken at 0 and 28 days, and BMC determined via radiographic bone aluminium equivalence (RBAE). Blood samples taken at day 0 and 28 were analysed for serum pyridinoline cross-links (PYD) and osteocalcin (OC). Heart rate was analysed on day 23 for 4 horses per group. Stride length was determined while trotting in hand on day 0 and 28. No influence of WBV on RBAE of any bone cortices, PYD or OC was observed (P>0.10); stride length was also unaffected (P=0.88). A period effect was observed for a decrease in RBAE of the lateral cortex (P=0.01), and a trend towards a decrease was noted in total density (P=0.05), likely an effect of stalling. Compared to baseline, ΔHR declined during treatment (P=0.06) in VIB (-4.8±2.8 bpm) compared to control CON (3.0±2.8 bpm). The results suggest, in normal exercising horses, WBV does not increase BMC, influence markers of bone metabolism, or increase stride length.
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Essehli R, Maher K, Amin R, Abouimrane A, Mahmoud A, Muralidharan N, Petla RK, Yahia HB, Belharouak I. Iron-Doped Sodium Vanadium Oxyflurophosphate Cathodes for Sodium-Ion Batteries-Electrochemical Characterization and In Situ Measurements of Heat Generation. ACS APPLIED MATERIALS & INTERFACES 2020; 12:41765-41775. [PMID: 32809791 DOI: 10.1021/acsami.0c11616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sodium-ion batteries (NaIBs) are increasingly being envisioned for grid-scale energy-storage systems because of cost advantages. However, implementation of this vision has been challenged by the low-energy densities delivered by most NaIB cathodes. Toward addressing this challenge, the authors report the synthesis and characterization of a new iron-doped Na3Fe0.3V1.7O(PO4)2F2 cathode using a novel facile hydrothermal route. The synthesized material was characterized using scanning electron microscopy, X-ray diffraction, and Mössbauer spectroscopy techniques. The obtained discharge capacity in the half-cell configuration lies from 119 to 125 to 130 mA h/g at C/10 while tested using three different electrolyte formulations, dimethyl carbonate-ethylene carbonate (EC)-propylene carbonate (PC), diethyl carbonate-EC, and EC-PC, respectively. The synthesized cathodes were also evaluated in full-cell configurations, which delivered an initial discharge capacity of 80 mA h/g with NaTi2(PO4)3MWCNT as the anode. Ionic diffusivity and interfacial charge transfer kinetics were also evaluated as a function of temperature and sodium concentration, which revealed that electrochemical rate performances in this material were limited by charge-transfer kinetics. To understand the heat generation mechanism of the Na/Na3Fe0.3V1.7O(PO4)2F2 half-cell during charge and discharge processes, an electrochemical isothermal calorimetry measurement was carried out at different current rates for two different temperatures (25 and 45 °C). The results showed that the amount of heat generated was strongly affected by the operating charge/discharge state, C-rate, and temperature. Overall, this work provides a new synthesis route for the development of iron-doped Na3Fe0.3V1.7O(PO4)2F2-based high-performance sodium cathode materials aimed at providing a viable pathway for the development and deployment of large-scale energy-storage based on sodium battery systems.
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Maher K, Spooner H, Hoffman R, Haffner J. The effect of whole-body vibration on bone density and other parameters in the exercising horse. J Equine Vet Sci 2017. [DOI: 10.1016/j.jevs.2017.03.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Trusty P, Tree M, Vincent D, Naber J, Maher K, Yoganathan A, Deshpande S. In Vitro Examination of the VentriFlo™ True Pulse Pump for Failing Fontan Support. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Deshpande S, Hastings S, Wagoner S, Ku D, Maher K. New Insights into Thrombosis in ECMO: Circuits: Where, How and Why? J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Essehli R, Belharouak I, Ben Yahia H, Maher K, Abouimrane A, Orayech B, Calder S, Zhou XL, Zhou Z, Sun YK. Alluaudite Na2Co2Fe(PO4)3 as an electroactive material for sodium ion batteries. Dalton Trans 2015; 44:7881-6. [DOI: 10.1039/c5dt00971e] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Na2Co2Fe(PO4)3 crystallizes with the alluaudite-type structure (S.G. C2/c) and plays a dual anode/cathode behavior in sodium ion batteries.
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Ruane NM, Bolton-Warberg M, Rodger HD, Colquhoun DJ, Geary M, McCleary SJ, O'Halloran K, Maher K, O'Keeffe D, Mirimin L, Henshilwood K, Geoghegan F, Fitzgerald RD. An outbreak of francisellosis in wild-caught Celtic Sea Atlantic cod, Gadus morhua L., juveniles reared in captivity. JOURNAL OF FISH DISEASES 2015; 38:97-102. [PMID: 24261672 DOI: 10.1111/jfd.12210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/15/2013] [Accepted: 10/16/2013] [Indexed: 06/02/2023]
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Alsoufi B, Deshpande S, Kogon B, Maher K, Mahle W, Kanter K. 282 * OUTCOMES AND RISK FACTORS FOR HEART TRANSPLANTATION IN CHILDREN WITH END-STAGE CARDIOMYOPATHY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Deshpande S, Alsoufi B, Kogon B, Mahle W, Maher K, Kanter K. 277 * RESULTS OF HEART TRANSPLANTATION FOLLOWING FAILED STAGED PALLIATION OF HYPOPLASTIC LEFT HEART SYNDROME AND RELATED SINGLE VENTRICLE ANOMALIES. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Demerdash Z, El Baz H, Mahmoud F, Mohamed S, Maher K, Gaafar T, Shawky S, Hassan M, Abdelhady D, Taha T. Enhancing ex vivo expansion of cord blood-derived unrestricted somatic stem cells for clinical applications. Cell Prolif 2014; 46:628-36. [PMID: 24460716 DOI: 10.1111/cpr.12070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 08/12/2013] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To study effects of serum-containing medium (SCM) versus serum-free medium (SFM) and influence of seeding density, on rate of expansion of cord blood (CB) unrestricted somatic stem cells (USSCs), as a prerequisite for evaluating their therapeutic potential in ongoing clinical trials. MATERIAL AND METHODS Isolation, propagation and characterization of USSCs from CB samples were performed and followed by their passage 3 culture in SCM and SFM, at cell densities of 5, 50, 500 and 5000 cells/cm(2) . RESULTS The cells were CD44(+) , CD90(+) , CD73(+) , CD105(+) , CD34(-) , CD45(-) , and HLA-DR, with Oct4 & Sox2 gene expression; they were differentiated into osteoblasts and adipocytes. USSCs cultured in SCM had significantly higher population doubling levels (P < 0.01) than those cultured in SFM. Those cultured in SCM at 5 cells/cm(2) and those cultured in SFM at 50 cells/cm(2) had significantly higher population doubling (P < 0.01) levels than those cultured at higher cell densities. CONCLUSIONS For scaling up of USSCs from 106 (?) to 1012 (?) in 6 weeks, culturing of CB-derived cells of early passage (≤P3) in SCM at low cell seeding density (5 cells/cm(2) ) is suggested for increasing cell count with lower passaging frequency, followed by culture of expanded USSCs at 50 cells/cm(2) in SFM, to avoid undesirable effects of bovine serum in clinical applications.
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Marin F, Pleşca M, Bordea CI, Voinea SC, Burlănescu I, Ichim E, Jianu CG, Nicolăescu RR, Teodosie MP, Maher K, Blidaru A. Postoperative surgical complications of lymphadenohysterocolpectomy. J Med Life 2014; 7:60-6. [PMID: 24653760 PMCID: PMC3956099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 10/22/2013] [Indexed: 10/27/2022] Open
Abstract
UNLABELLED Rationale The current standard surgical treatment for the cervix and uterine cancer is the radical hysterectomy (lymphadenohysterocolpectomy). This has the risk of intraoperative accidents and postoperative associated morbidity. Objective The purpose of this article is the evaluation and quantification of the associated complications in comparison to the postoperative morbidity which resulted after different types of radical hysterectomy. METHODS AND RESULTS PATIENTS WERE DIVIDED ACCORDING TO THE TYPE OF SURGERY PERFORMED AS FOLLOWS: for cervical cancer - group A- 37 classic radical hysterectomies Class III Piver - Rutledge -Smith ( PRS ), group B -208 modified radical hysterectomies Class II PRS and for uterine cancer- group C -79 extended hysterectomies with pelvic lymphadenectomy from which 17 patients with paraaortic lymphnode biopsy . All patients performed preoperative radiotherapy and 88 of them associated radiosensitization. Discussion Early complications were intra-abdominal bleeding ( 2.7% Class III PRS vs 0.48% Class II PRS), supra-aponeurotic hematoma ( 5.4% III vs 2.4% II) , dynamic ileus (2.7% III vs 0.96% II) and uro - genital fistulas (5.4% III vs 0.96% II).The late complications were the bladder dysfunction (21.6% III vs 16.35% II) , lower limb lymphedema (13.5% III vs 11.5% II), urethral strictures (10.8% III vs 4.8% II) , incisional hernias ( 8.1% III vs 7.2% II), persistent pelvic pain (18.91% III vs 7.7% II), bowel obstruction (5.4% III vs 1.4% II) and deterioration of sexual function (83.3% III vs 53.8% II). PRS class II radical hysterectomy is associated with fewer complications than PRS class III radical hysterectomy , except for the complications of lymphadenectomy . A new method that might reduce these complications is a selective lymphadenectomy represented by sentinel node biopsy . In conclusion PRS class II radical hysterectomy associated with neoadjuvant radiotherapy is a therapeutic option for the incipient stages of cervical cancer. ABBREVIATIONS PRS- Piver Rutledge-Smith, II- class II, III- class III.
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Maher K, Chamberlain CP. Hydrologic Regulation of Chemical Weathering and the Geologic Carbon Cycle. Science 2014; 343:1502-4. [DOI: 10.1126/science.1250770] [Citation(s) in RCA: 316] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Hollmark HM, Maher K, Saadoune I, Gustafsson T, Edström K, Duda LC. Resonant inelastic X-ray scattering and X-ray absorption spectroscopy on the negative electrode material Li0.5Ni0.25TiOPO4 in a Li-ion battery. Phys Chem Chem Phys 2011; 13:6544-51. [DOI: 10.1039/c0cp02668a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Maher K, de Vries K. An exploration of the lived experiences of individuals with relapsed multiple myeloma. Eur J Cancer Care (Engl) 2010; 20:267-75. [PMID: 20950368 DOI: 10.1111/j.1365-2354.2010.01234.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The experience of living with relapsed Multiple Myeloma (myeloma) for eight patients accessing treatment within a haematology unit in a large London hospital is explored in this study. Myeloma is recognised as incurable and is sometimes described as an 'incurable chronic disease' with a main treatment option of chemotherapy. Hermeneutic phenomenology was the methodology used in conducting the study and data were collected through open-ended, unstructured interviews. Findings suggest that living with relapsed myeloma in the context of a chronic illness causes an ever-shifting perspective between illness and wellness consequently maintaining a state of uncertainty. The patients in this study placed importance on the emotional aspect of their experience. Hope, intuitive knowing and a fighting spirit were expressed as required positive elements that enabled living with relapsed myeloma. These assisted in maintaining normality, coping with bad news and adjusting to the illness. Pervading through the themes was the need to control uncertainty. Having strong support from significant others provided something to live for and the necessary social support required to promote a new orientation to life.
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Morrissey I, Maher K, Hawser S. Activity of iclaprim against clinical isolates of Streptococcus pyogenes and Streptococcus agalactiae. J Antimicrob Chemother 2008; 63:413-4. [DOI: 10.1093/jac/dkn505] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Farrell DJ, Felmingham D, Shackcloth J, Williams L, Maher K, Hope R, Livermore DM, George RC, Brick G, Martin S, Reynolds R. Non-susceptibility trends and serotype distributions among Streptococcus pneumoniae from community-acquired respiratory tract infections and from bacteraemias in the UK and Ireland, 1999 to 2007. J Antimicrob Chemother 2008; 62 Suppl 2:ii87-95. [DOI: 10.1093/jac/dkn355] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Morrissey I, Maher K, Williams L, Shackcloth J, Felmingham D, Reynolds R. Non-susceptibility trends among Haemophilus influenzae and Moraxella catarrhalis from community-acquired respiratory tract infections in the UK and Ireland, 1999-2007. J Antimicrob Chemother 2008; 62 Suppl 2:ii97-103. [DOI: 10.1093/jac/dkn356] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abdel Wahab M, Ezz Elarab L, Maher K. Skeletal events of Anastrazole versus Tamoxifen on bone mineral density and bone biomarker Osteocalcin in post menopausal women with early breast cancer. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70567-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Oberste MS, Maher K, Patterson MA, Pallansch MA. The complete genome sequence for an American isolate of enterovirus 77. Arch Virol 2007; 152:1587-91. [PMID: 17497234 DOI: 10.1007/s00705-007-0978-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Accepted: 03/26/2007] [Indexed: 10/23/2022]
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