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Haysom A, Loveday WH, Ratneswaran K, Nerantzis G, Hakim N, Dineva D, Richards A. Improving availability and accuracy of the junior doctors' on-call handover through digitalisation. BMJ Open Qual 2024; 13:e002615. [PMID: 38485114 PMCID: PMC10941170 DOI: 10.1136/bmjoq-2023-002615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
Clinical handovers from out-of-hours activity are essential for relaying information about events such as new admissions, outstanding or complete investigations, physical health reviews, ward jobs and risk. This information enables the day team to effectively prioritise and follow-up any necessary tasks.Junior doctors at a hospital site in the London Borough of Newham were aware that the existing handover system, constituted of a word document circulated via email, was lacking robustness and that the handover was not sent out reliably on a daily basis.Quality improvement (QI) methods including process mapping, PDSA ('Plan, Do, Study, Act') cycles, driver diagrams and run charts were used to understand the issue, create a more robust process and measure the improvements made, all supported by regular QI project meetings. The change ideas included moving from an informal Microsoft (MS) Word document, which was emailed out, to an Excel spreadsheet stored centrally on MS Teams. Column headers were added for admissions, ward jobs, seclusion reviews, matters relating to mental health law and Accident and Emergency (A&E) assessments, as well as defined columns for outstanding jobs and standard tasks that need to be completed for all admissions. Responsibility for circulating the handover list was given to the incoming day duty doctor if the night doctor was too busy, with admin support to chase the circulation of the handover. Results were studied for the following 18 months.The percentage of handovers being appropriately sent out increased from a median of 80% to 100% during the project period, and the availability of handover data where the data were visible to doctors on MS Teams but had not been sent out also increased from a median of 80% to 100%. The system was deemed safe, effective and easy to use, and has already been replicated at neighbouring hospitals.
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Affiliation(s)
| | | | | | | | - Nahid Hakim
- East London NHS Foundation Trust, London, UK
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Hakim N, Alsini N, Kutbi H, Mosli R, Eid N, Mulla Z. Knowledge of dietary guidelines and portion sizes in Saudi Arabian mothers. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Amran I, Alias S, Shahril N, Basuki H, Mohd Salleh A, Khalil F, Hakim N, Mohamed Rus M. Heart Failure Admissions and its Associated Factors, Complications and Treatment. Int J Cardiol 2019. [DOI: 10.1016/j.ijcard.2019.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roslan A, Kamsani SH, Nay TW, Tan KL, Hakim N, Tan AM, Megat Samsudim WN, Tan KL, Jauhari AT, Krishnan M, Leong D, Supramaniam T, Tan LK, Nuruddin AA. Echocardiographic and electrocardiographic presentations of patients with endomyocardial biopsy-proven cardiac amyloidosis. Med J Malaysia 2018; 73:388-392. [PMID: 30647209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Cardiac amyloidosis is under diagnosed and its prevalence is unknown. This is a retrospective, nonrandomised, single centre study of patients with endomyocardial biopsy-proven cardiac amyloidosis focusing on their echocardiographic and electrocardiogram (ECG) presentations. This is the first case series in Malaysia on this subject. METHODS We identified all of our endomyocardial biopsyproven cardiac amyloidosis patients from January 2010 to January 2018 and reviewed their medical records. All patients echocardiographic and ECG findings reviewed and analysed comparing to basic mean population value. RESULTS In total there are 13 biopsy-proven cardiac amyloidosis patients. All of the biopsies shows light chain (AL) amyloid. Majority of the patients (8, 61.5%) is male, and most of our patients (8, 61.5%) is Chinese. All seven patients on whom we performed deformation imaging have apical sparing pattern on longitudinal strain echocardiogram. Mean ejection fraction is 49.3%, (SD=7.9). All patients have concentric left ventricular hypertrophy and right ventricular hypertrophy. Diastolic dysfunction was present in all of our patients with nine out of 13 patients (69.2%) having restrictive filling patterns (E/A ≥2.0 E/e' ≥15). On electrocardiogram, 12 (92%) patients have prolonged PR interval (median 200ms, IQR 76.50ms) and 9 (69.2%) patients have pseudoinfarct pattern. CONCLUSION Echocardiography plays an important role in diagnosing cardiac amyloidosis. The findings of concentric left ventricular hypertrophy with preserved ejection fraction without increased in loading condition should alert the clinician towards its possibility. This is further supported by right ventricular hypertrophy and particularly longitudinal strain imaging showing apical sparing pattern.
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Affiliation(s)
- A Roslan
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia.
| | - S H Kamsani
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - T W Nay
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - K L Tan
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - N Hakim
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - A M Tan
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - W N Megat Samsudim
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - K L Tan
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - A T Jauhari
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - M Krishnan
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - D Leong
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - T Supramaniam
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - L K Tan
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
| | - A A Nuruddin
- Institut Jantung Negara, Department of Cardiology, Non Invasive Cardiac Laboratory, Kuala Lumpur, Malaysia
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Mummadi SM, Darr A, Hakim N, Din S, Bhimrao SK. A rare case of Schneiderian papilloma of the middle ear presenting with pulsatile tinnitus. Ann R Coll Surg Engl 2018; 100:e109-e111. [PMID: 29607726 DOI: 10.1308/rcsann.2018.0035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Schneiderian papillomas (ISP) of the middle ear are uncommon conditions, with only 45 cases published within literature. They are locally aggressive tumours, with a high rate of recurrence and associated malignancy. We present a rare case of a 53-year-old man presenting with unilateral pulsatile tinnitus, otorrhoea, aural fullness, pruritis and hearing loss. Angiography was employed to exclude a glomus tumour and the patient underwent a modified radical mastoidectomy. Tissue samples confirmed a histological diagnosis of ISP of the middle ear. Follow-up magnetic resonanc imaging one year postoperatively showed no evidence of disease recurrence.
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Affiliation(s)
- S M Mummadi
- University Hospitals of North Midlands NHS Trust , Stoke on Trent , UK
| | - A Darr
- University Hospitals of North Midlands NHS Trust , Stoke on Trent , UK
| | - N Hakim
- Princess Royal University Hospital , Orpington, Kent , UK
| | - S Din
- University Hospitals of North Midlands NHS Trust , Stoke on Trent , UK
| | - S K Bhimrao
- University Hospitals of North Midlands NHS Trust , Stoke on Trent , UK
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Hakim N, Darr A, Rajgor A. Extensive Intracranial Langerhans Cell Histiocytosis Manifesting as Otitis Externa. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rajgor A, Hakim N, Darr A, Hughes R, George A. Predictive Factors for 30-Day Morbidity in Head and Neck Surgery. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Miras AD, Herring R, Vusirikala A, Shojaee-Moradi F, Jackson NC, Chandaria S, Jackson SN, Goldstone AP, Hakim N, Patel AG, Umpleby AM, Le Roux CW. Measurement of hepatic insulin sensitivity early after the bypass of the proximal small bowel in humans. Obes Sci Pract 2016; 3:95-98. [PMID: 28392935 PMCID: PMC5358071 DOI: 10.1002/osp4.76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/14/2016] [Accepted: 09/17/2016] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Unlike gastric banding or sleeve gastrectomy procedures, intestinal bypass procedures, Roux-en-Y gastric bypass in particular, lead to rapid improvements in glycaemia early after surgery. The bypass of the proximal small bowel may have weight loss and even caloric restriction-independent glucose-lowering properties on hepatic insulin sensitivity. In this first human mechanistic study, we examined this hypothesis by investigating the early effects of the duodeno-jejunal bypass liner (DJBL; GI Dynamics, USA) on the hepatic insulin sensitivity by using the gold standard euglycaemic hyperinsulinaemic clamp methodology. METHOD Seven patients with obesity underwent measurement of hepatic insulin sensitivity at baseline, 1 week after a low-calorie liquid diet and after a further 1 week following insertion of the DJBL whilst on the same diet. RESULTS Duodeno-jejunal bypass liner did not improve the insulin sensitivity of hepatic glucose production beyond the improvements achieved with caloric restriction. CONCLUSIONS Caloric restriction may be the predominant driver of early increases in hepatic insulin sensitivity after the endoscopic bypass of the proximal small bowel. The same mechanism may be at play after Roux-en-Y gastric bypass and explain, at least in part, the rapid improvements in glycaemia.
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Affiliation(s)
- A D Miras
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism Imperial College London London UK
| | - R Herring
- CEDAR Centre Royal Surrey County Hospital Guildford Surrey UK
| | | | - F Shojaee-Moradi
- Diabetes and Metabolic Medicine, Faculty of Health and Medical Sciences University of Surrey Guildford UK
| | - N C Jackson
- Diabetes and Metabolic Medicine, Faculty of Health and Medical Sciences University of Surrey Guildford UK
| | | | - S N Jackson
- Diabetes Complications Research Centre, UCD Conway Institute University College Dublin Dublin Ireland
| | - A P Goldstone
- Centre for Neuropsychopharmacology, Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences Imperial College London London UK
| | - N Hakim
- Faculty of Medicine, Department of Surgery and Cancer Imperial College London London UK
| | - A G Patel
- Hepatobiliary and minimal access surgery King's College Hospital NHS Foundation Trust London UK
| | - A M Umpleby
- Diabetes and Metabolic Medicine, Faculty of Health and Medical Sciences University of Surrey Guildford UK
| | - C W Le Roux
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism Imperial College London London UK; Diabetes Complications Research Centre, UCD Conway Institute University College Dublin Dublin Ireland
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Rufa M, Antonitsis P, Winkler B, Kiessling AH, Ulrich C, Bennett MJ, Kehara H, Asopa S, Alexopoulos C, Zavaropoulos P, Alexopoulos C, Ganushchak YM, McLean LA, Borrelli U, Antonitsis P, Gifford D, Reineke D, Antonitsis P, Bennett M, Schubel J, Schubel J, Ulrich C, Schaarschmidt J, Tiliscan C, Bauer A, Hausmann H, Asteriou C, Argiriadou H, Deliopoulos A, Gatzos S, Anastasiadis K, Zenklusen U, Döbele T, Kohler B, Grapow M, Eckstein F, May M, Keller H, Diefenbach M, Reyher C, Moritz A, Bauer A, Eberle T, Schaarschmidt J, Lucy J, Hausmann H, Larsen M, Asopa S, Webb G, Wright A, Lloyd C, Takano T, Fujii T, Gomibuchi T, Nakahara K, Ohhashi N, Komatsu K, Ohtsu Y, Terasaki T, Wada Y, Seto T, Fukui D, Amano J, Bennett M, Webb G, Lloyd C, Hakim N, Zografos P, Protopapas E, Zavaropoulos P, Kirvassilis G, Sarris G, Alexopoulos C, Hakim N, Zografos P, Protopapas E, Kirvassilis G, Sarris G, Hakim N, Zografos P, Protopapas E, Zavaropoulos P, Kirvassilis G, Sarris G, Körver E, Yamamoto Y, Weerwind P, Medlam W, Bell J, Bennett R, Bennett R, Turner E, Jagannadham K, Westwood E, Silvestri A, Detroux M, Nottin R, Al-Attar N, Pappalardo A, Gabrielli M, Gripari C, Scala A, Mercurio S, Gustin G, Fasolo D, Deliopoulos A, Gatzos S, Mimikos S, Kleontas A, Grosomanidis V, Kyparissa M, Tossios P, Anastasiadis K, Colah S, Farid S, Irons J, Gilhouly M, Moorjani N, König T, Meszaros K, Sodeck G, Erdoes G, Englberger L, Czerny M, Carrel T, Mimikos S, Kostarelou G, Kleontas A, Deliopoulos A, Gatzos S, Foroulis C, Tossios P, Anastasiadis K, Asopa S, Webb G, Gomez-Cano M, Lloyd C, Xhymshiti A, Ulrich C, Schaarschmidt J, Eberle T, Rufa M, Bauer A, Hausmann H. 1st International Symposium on Minimal Invasive Extracorporeal Circulation Technologies, Thessaloniki, Greece, 13–14 June 2014001EMERGENCY CORONARY ARTERY BYPASS GRAFT SURGERY IN PATIENTS WITH OR WITHOUT ACUTE MYOCARDIAL INFARCTION USING THE MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION002IS THERE A LEARNING CURVE WHEN USING MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION IN CORONARY REVASCULARIZATION PROCEDURES?003MINIMAL EXTRACORPOREAL CIRCULATION ASSURES PERFORMANCE OUTCOME004CORONARY ARTERY REVASCULARIZATION WITH A MINIMAL EXTRACORPOREAL CIRCULATION TECHNIQUE: SHOTGUN ANALYSIS IN A PROSPECTIVE, RANDOMIZED TRIAL WITH THREE DIFFERENT PERFUSION TECHNIQUES005EFFECTS OF CELL SALVAGED AND DIRECTLY RETRANSFUSED MEDIASTINAL SHED BLOOD ON THE POSTOPERATIVE COMPETENCY OF THE COAGULATION SYSTEM AFTER CORONARY ARTERY BYPASS GRAFT SURGERY006THE RELATIVE INFLUENCE OF MINIATURIZED CARDIOPULMONARY BYPASS AND OTHER PERIOPERATIVE FACTORS ON BLOOD TRANSFUSION REQUIREMENT AFTER HEART SURGERY007LOWER PLATELET AGGREGATION MIGHT REDUCE PERIOPERATIVE BLEEDING IN MINI-CIRCUIT CARDIOPULMONARY BYPASS COMPARED TO CONVENTIONAL CARDIOPULMONARY BYPASS0085-YEAR EXPERIENCE OF BLOOD TRANSFUSION IN CORONARY ARTERY BYPASS GRAFT SURGERY PATIENTS USING MINIATURIZED EXTRACORPOREAL CIRCULATION009PAEDIATRIC CARDIAC EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT: IMPROVED OUTCOME WITH EVOLVING TECHNOLOGY AND PRACTICE REFINEMENTS OVER 16 YEARS010THE USE OF ARTERIOVENOUS PCO 2DIFFERENCE (Delta PCO 2) AS AN INDEX OF THE DENSITY OF CAPILLARY PERFUSION DURING PAEDIATRIC CARDIOPULMONARY BYPASS AND EXTRACORPOREAL MEMBRANE OXYGENATION011‘ETERNAL ECMO’: THE CHALLENGE OF PROLONGED POST-CARDIOTOMY EXTRACORPOREAL MEMBRANE OXYGENATION012A VERSATILE MINIMIZED SYSTEM: THE STEP TOWARDS SAFE PERFUSION013HOW WE DEVELOPED A SAFER MINI BYPASS SYSTEM WITH THE USE OF A STOCKERT HEART LUNG BYPASS MACHINE AND MEDTRONIC FUSION OXYGENATOR014MINIMALIZING THE CARDIOPULMONARY BYPASS CIRCUIT AND THE CONSOLE015IS THREE-STAGE VENOUS CANNULA SUPERIOR TO DUAL-STAGE DURING SURGERY WITH MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION?016BENEFITS OF CLOSED MINIATURIZED CARDIOPULMONARY BYPASS017COGNITIVE BRAIN FUNCTION AFTER CORONARY BYPASS GRAFTING WITH MINIMIMAL INVASIVE EXTRACORPOREAL CIRCULATION018MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION REDUCES GASEOUS MICROEMBOLI AND PRESERVES NEUROCOGNITIVE FUNCTION: A SINGLE-CENTRE PROSPECTIVE RANDOMIZED STUDY019THE INFLUENCE OF PERIOPERATIVE FACTORS TO GENERATE ‘OUTLIERS’ IN CARDIAC SURGERY ASSOCIATED ACUTE KIDNEY INJURY: A PRELIMINARY INVESTIGATION INCLUDING DIABETES AND METHOD OF CARDIOPULMONARY BYPASS020MINIMAL INVASIVE EXTRACORPOREAL CIRCULATION IN 64 COMPLEX CARDIAC PROCEDURES: IS IT FEASIBLE AND SAFE? Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Willicombe M, Sandhu B, Brookes P, Gedroyc W, Hakim N, Hamady M, Hill P, McLean AG, Moser S, Papalois V, Tait P, Wilcock M, Taube D. Postanastomotic transplant renal artery stenosis: association with de novo class II donor-specific antibodies. Am J Transplant 2014; 14:133-43. [PMID: 24354873 DOI: 10.1111/ajt.12531] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/20/2013] [Accepted: 09/20/2013] [Indexed: 01/25/2023]
Abstract
In this study, we analyze the outcomes of transplant renal artery stenosis (TRAS), determine the different anatomical positions of TRAS, and establish cardiovascular and immunological risk factors associated with its development. One hundred thirty-seven of 999 (13.7%) patients had TRAS diagnosed by angiography; 119/137 (86.9%) were treated with angioplasty, of which 113/137 (82.5%) were stented. Allograft survival in the TRAS+ intervention, TRAS+ nonintervention and TRAS- groups was 80.4%, 71.3% and 83.1%, respectively. There was no difference in allograft survival between the TRAS+ intervention and TRAS- groups, p = 0.12; there was a difference in allograft survival between the TRAS- and TRAS+ nonintervention groups, p < 0.001, and between the TRAS+ intervention and TRAS+ nonintervention groups, p = 0.037. TRAS developed at the anastomosis, within a bend/kink or distally. Anastomotic TRAS developed in living donor recipients; postanastomotic TRAS (TRAS-P) developed in diabetic and older patients who received grafts from deceased, older donors. Compared with the TRAS- group, patients with TRAS-P were more likely to have had rejection with arteritis, odds ratio (OR): 4.83 (1.47-15.87), p = 0.0095, and capillaritis, OR: 3.03 (1.10-8.36), p = 0.033. Patients with TRAS-P were more likely to have developed de novo class II DSA compared with TRAS- patients hazard ratio: 4.41 (2.0-9.73), p < 0.001. TRAS is a heterogeneous condition with TRAS-P having both alloimmune and traditional cardiovascular risk factors.
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Affiliation(s)
- M Willicombe
- Imperial College Kidney and Transplant Centre, Hammersmith Hospital, London, UK
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Ali AM, Rajagoppal P, Sayed A, Hakim N, David T, Papalois P. Transplant of kidneys with small renal cell carcinoma in incompatible, heavily immunosuppressed recipients. Ann R Coll Surg Engl 2012; 94:e189-90. [PMID: 22943317 PMCID: PMC3954357 DOI: 10.1308/003588412x13373405384738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Renal cell carcinoma (RCC) is considered a contraindication for transplant. However, an increasing number of cases of transplant kidneys with RCC have been reported with encouraging results. We present our experience of two cases of transplanting kidneys with small RCCs. Donors and recipients were aware of the presence and possible consequences of RCC in the transplanted kidney before transplantation. Cases were discussed in the multidisciplinary team meetings. Regular, 6-12 monthly follow-up of donors and recipients was carried out with ultrasonography and/or computed tomography to detect recurrence of RCC or new tumours in the recipients' transplant kidneys or the donors' native kidneys. The outcome was recorded. There were no suspicious masses in the any of the kidneys during the follow-up period. The transplant kidneys are functioning.
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Affiliation(s)
- A M Ali
- Imperial College Healthcare Trust, UK.
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Rajagopal P, Hakim N. The Use of a Powdered Polysaccharide Hemostat (HemoStase) in Live Donor Nephrectomies Controls Bleeding and Reduces Postoperative Complications. Transplant Proc 2011; 43:424-6. [DOI: 10.1016/j.transproceed.2011.01.079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ramaswamy N, Arruda T, Wen W, Hakim N, Saha M, Gullá A, Mukerjee S. Enhanced activity and interfacial durability study of ultra low Pt based electrocatalysts prepared by ion beam assisted deposition (IBAD) method. Electrochim Acta 2009. [DOI: 10.1016/j.electacta.2009.06.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
OBJECTIVE To determine the efficacy and safety of liposorber D low-density lipoprotein (LDL) apheresis system in high-risk cardiac patients. DESIGN Retrospective analysis of 466 treatments undertaken in eight patients with coronary heart disease. Five patients had severe heterozygous familial hypercholesterolaemia (FH), one had severe hypertriglyceridaemia and two were cardiac transplant recipients with FH intolerant to statins. Acute reductions during single sessions and preprocedural long-term changes in lipoprotein subfractions, laboratory safety parameters, adverse events and clinical outcome were recorded. RESULTS In 352 treatments performed in seven patients, acute reductions averaged 52.8% (standard deviation: 8.61%) for total cholesterol (TC), 61.8% (10.13%) for LDL-cholesterol (LDL-C), 21.1% (9.66%) for high-density lipoprotein cholesterol (HDL-C), 71.1% (median) for lipoprotein (a) [Lp(a)] and 44.5% (14.42%) for triglycerides (p < 0.05). Long-term reductions of TC, LDL-C, Lp(a) and triglycerides by 18.1%, 21.7%, 9.4% (median) and 19.8%, respectively, were achieved. HDL-C was increased by 7.5%. Results from the patient with severe hypertriglyceridaemia were analysed separately because of markedly elevated TC and triglycerides. Technical and clinical complications were mild and showed an incidence of 16.65% and 12.45% respectively. The most common clinical event was transient hypotension (5.8%), whereas vascular access difficulties (11.3%) represented a common technical problem. All patients demonstrated clinical improvement. However, two patients treated via a central line developed septicaemia, resulting in endocarditis in one of them. CONCLUSION Liposorber D is a simple, safe and effective modality in reducing atherogenic lipoproteins in dyslipidaemic high-risk cardiac patients. The treatment via an arteriovenous fistula is the preferred vascular access in this type of patient.
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Affiliation(s)
- S Archontakis
- Cardiology Department, Harefield Hospital, Royal Brompton and Harefield NHS Trust, Harefield, Middlesex, UK
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Gerstenkorn C, Papalois VE, Thomusch O, Maxwell AP, Hakim N. Surgical management of multiple donor veins in renal transplantation. Int Surg 2006; 91:345-7. [PMID: 17256434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
The surgical aspects of renal transplantation have been standardized for decades regarding normal anatomy of donor kidneys. In certain situations, as in multiple donor veins, there are still challenges regarding the technical management. In > 95%, there is only one renal vein, or the additional vein/veins are so small that they can be ligated without hesitation. In < 5%, there are two main draining veins, and they can be similar in diameter. The management of these cases varies. Some surgeons implant both veins separately, leave them on a common caval patch, or implant the smaller vein into the larger vein as an end-to-side anastomosis, allowing for one venous anastomosis in the recipient. We describe two cases of donor kidneys with two similar-sized veins and conclude that ligation of the smaller vein, even if its size is substantial (up to 1 cm), can be the safest option to avoid surgical complications.
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Affiliation(s)
- C Gerstenkorn
- Department of Transplantation, Belfast City Hospital, Queen's University, Belfast, Northern Ireland, United Kingdom.
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Borrows R, Chusney G, Loucaidou M, James A, Lee J, Tromp JV, Owen J, Cairns T, Griffith M, Hakim N, McLean A, Palmer A, Papalois V, Taube D. Mycophenolic acid 12-h trough level monitoring in renal transplantation: association with acute rejection and toxicity. Am J Transplant 2006; 6:121-8. [PMID: 16433766 DOI: 10.1111/j.1600-6143.2005.01151.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Studies of renal transplantation utilizing trough plasma level monitoring of mycophenolic acid (MPA) have shown inconsistent associations with toxicity and rejection. In this study, 5600 12-h trough MPA samples from 121 renal transplant recipients immunosuppressed with mycophenolate mofetil (MMF) and tacrolimus in a steroid sparing protocol (steroids for 7 days only) were sequentially analyzed. Higher MPA levels were associated with lower hemoglobin concentrations and anemia (hemoglobin <10 g/dL). Similarly, higher MPA levels were associated with lower total white cell counts and an increased incidence of leucopenia (total white cell count <4.0 x 10(9)/L). Hypoalbuminemia and renal impairment were also associated with hemotoxicity. MMF-associated diarrhea and viral infection were associated with higher MPA levels. Conversely, biopsy-proven acute rejection within the first month post-transplantation was associated with lower MPA levels. Anti-CD25 antibody induction was also associated with reduced rejection rates. No association was seen between MPA levels and platelet count, thrombocytopenia or bacterial infection. An MPA level of 1.60 mg/L early post-transplantation best discriminated patients with and without rejection, and an MPA level of 2.75 mg/L best discriminated patients with and without toxicity later post-transplantation.
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Affiliation(s)
- R Borrows
- Renal and Transplant Units, St. Mary's Hospital, Paddington, London W2 1NY, UK.
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Haritopoulos K, Hakim N. Ureteral stents and their current use. Int Surg 2006; 91:9-11. [PMID: 16706095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Stents in urology have been used for a long time in the management of nephro-ureterolithiasis. However, the indications for stent insertion have increased during the last few years and they are now used both diagnostically and therapeutically in a variety of cases. A brief history of the name is presented along with a review of the indications and the complications of stent usage.
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Loucaidou M, Borrows R, Cairns T, Griffith M, Hakim N, Palmer A, Papalois V, Taube D, McLean AG. Late steroid withdrawal for renal transplant recipients on tacrolimus and MMF is safe. Transplant Proc 2005; 37:1795-6. [PMID: 15919469 DOI: 10.1016/j.transproceed.2005.02.094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We conducted a study to assess the safety of staged, late steroid withdrawal in kidney or kidney/pancreas transplant recipients on steroids, tacrolimus, and mycophenolate mofetil (MMF). MATERIALS AND METHODS We studied 50 patients including 33 recipients of cadaveric kidneys, eight living donor kidneys, and nine kidney-pancreas transplants. The mean time posttransplantation was 5.1 years (range 2.1 to 7.9 years). All patients were induced on prednisolone, tacrolimus, and MMF; steroids were withdrawn over 5 to 6 months. The rate of steroid reduction was altered in the face of typical steroid withdrawal symptoms (limb-girdle arthralgia/myalgia). RESULTS No rejection episodes occurred during steroid withdrawal. No patient required transplant biopsy for graft dysfunction. Six patients failed steroid withdrawal: five due to arthralgia/myalgia and one due to recurrent pulmonary sarcoidosis. The unexplained rise in serum creatinine following steroid withdrawal described in several other steroid withdrawal studies was not observed in this patient cohort. The mean serum creatinine was 137 micromol/L with deltacreatinine -6.8 micromol/y per year prior to steroid cessation versus 132 micromol/L with deltacreatinine -5.9 micromol/y in the year post-steroid cessation. There were 14 patients with posttransplant diabetes mellitus in this cohort: eight on gliclazide and six on insulin. We observed a reduction in their daily insulin/gliclazide requirements from 52 units to 41 units, and 73 mg to 65 mg, respectively. Two patients became gliclazide-independent at the time of steroid cessation. CONCLUSIONS Careful steroid withdrawal from a platform of tacrolimus and MMF is safe and not associated with a significant risk of rejection or graft dysfunction.
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Affiliation(s)
- M Loucaidou
- Renal and Transplant Unit, St Mary's Hospital, London, UK.
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20
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Loucaidou M, Stitchbury J, Lee J, Borrows R, Marshall SE, McLean AG, Cairns T, Griffith M, Hakim N, Palmer A, Papalois V, Welsh K, Taube D. Cytokine Polymorphisms Do Not Influence Acute Rejection in Renal Transplantation Under Tacrolimus-Based Immunosuppression. Transplant Proc 2005; 37:1760-1. [PMID: 15919456 DOI: 10.1016/j.transproceed.2005.03.151] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Acute rejection remains an important cause of graft loss after renal transplantation. It has been suggested that cytokine genotyping may play a predictive role in identifying individuals who are at higher risk of acute rejection with a view to individualizing their immunosuppression. The aim of this study was to investigate any possible associations between acute rejection and certain cytokine polymorphisms. METHODS We genotyped 91 cadaveric renal transplant recipients on tacrolimus-based immunosuppression and 84 of their donors. The cytokine polymorphisms studied were the following: tumor necrosis factor (TNF)-alpha-1032 T/C, TNF-alpha-865 C/A, TNF-alpha-859 G/A, interleukin (IL)1-R1-970 C/T, IL-10 haplotype [-1082, -819, -592], and IL-6-174 C/G. RESULTS We found no association between any polymorphism and the incidence of acute rejection. This was true for both the recipient and donor population. CONCLUSION Cytokine polymorphisms did not influence acute rejection in our study. We conclude that in the modern era of immunosuppression cytokine genotyping is not a significant predictor of acute rejection in renal transplantation.
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Affiliation(s)
- M Loucaidou
- Renal and Transplant Unit, St Mary's Hospital, London, United Kingdom.
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Borrows R, Loucaidou M, Van Tromp J, Singh S, Cairns T, Griffith M, Hakim N, McLean A, Palmer A, Papalois V, Taube D. Steroid Sparing in Renal Transplantation With Tacrolimus and Mycophenolate Mofetil: Three-Year Results. Transplant Proc 2005; 37:1792-4. [PMID: 15919468 DOI: 10.1016/j.transproceed.2005.03.150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although renal transplantation with a 7-day steroid-sparing regimen, tacrolimus and mycophenolate, is associated with good short-term outcomes, late allograft dysfunction and failure remain concerns. In this study 101 consecutive patients underwent renal transplantation using this immunosuppressive regimen. In addition, anti-CD25 monoclonal antibody was used in 25 high-risk patients (regrafts, two-antigen human leukocyte antigen (HLA)-DR mismatch or sensitized with anti-HLA panel reactivity >30%). After a median follow-up of 39 months (range 29 to 49), overall patient survival is 98%, with two cardiac deaths. Three other graft losses occurred, one each to early venous thrombosis, polyoma viral nephropathy, and late rejection due to noncompliance. Therefore, overall graft survival is 95%. The acute rejection rate at 6 and 12 months was 19% (no rejection occurred between months 6 and 12). Late rejection was uncommon, with only two further episodes beyond 12 months. Mean creatinine at 12 months was 144 micromol/L and mean estimated glomerular filtration rate (GFR) of 55 mL/min. Graft function was stable at 3 years with a mean creatinine of 142 micromol/L and mean estimated GFR 56 mL/min. During the study, five patients developed posttransplant diabetes mellitus (two cases beyond 12 months). Tissue-invasive cytomegalovirus disease and BK viral nephropathy each occurred in three patients, with all episodes in the first 12 months. Mean weight gain is 3.3 kg and mean blood pressure is 135/81 on an average of 1.5 antihypertensive agents. This steroid-avoidance regimen is associated with excellent medium-term patient and graft outcomes and a low incidence of side effects.
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Affiliation(s)
- R Borrows
- Renal Unit, St. Mary's Hospital, Paddington, London, United Kingdom.
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Borrows R, Chusney G, Loucaidou M, Singh S, James A, Stichbury J, Van Tromp J, Cairns T, Griffith M, Hakim N, McLean A, Palmer A, Papalois V, Taube D. Tacrolimus Monitoring in Renal Transplantation: A Comparison Between High-Performance Liquid Chromatography and Immunoassay. Transplant Proc 2005; 37:1733-5. [PMID: 15919448 DOI: 10.1016/j.transproceed.2005.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
It is recommended that specific methods of tacrolimus monitoring rather than immunoassays, which overestimate tacrolimus levels, should be used in transplant recipients. Direct comparison of these techniques, however, has not been conducted in renal transplantation. In this study, 40 renal transplant recipients with tacrolimus monitoring by microparticle enzyme immunoassay (MEIA; target trough level 10 to 15 ng/mL) were compared with 40 patients monitored by high-performance liquid chromatography with tandem mass spectrometry (HPLC-MS; target trough level 8 to 13 ng/mL). All patients received anti CD25 antibody induction and mycophenolate mofetil in a steroid-sparing protocol. No differences were seen between MEIA and HPLC-MS groups in patient demographics. All patients were followed for 6 months. Patient survival was 100% in both groups; graft survival was 100% in the MEIA group and 97.5% in the HPLC-MS group. The groups did not differ in the number of dose changes required in the first 6 months or in the number of patients displaying tacrolimus levels within target range at 3 and 6 months. Delayed graft function occurred in 14 patients in the MEIA group and 12 patients in the HPLC-MS group (P = NS). Biopsy-proven acute rejection occurred in four patients in the MEIA group and one patient in the HPLC-MS group (P < .2). No differences were seen for the following parameters at 3 or 6 months: biopsy-proven tacrolimus nephrotoxicity, serum creatinine or estimated creatinine clearance, systolic or diastolic blood pressure, cholesterol, cytomegalovirus disease, posttransplant diabetes, or tremor. This study suggests that renal transplantation with HPLC-MS monitoring of tacrolimus is safe and effective.
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Affiliation(s)
- R Borrows
- Renal and Transplant Units, St. Mary's Hospital, Paddington, London, United Kingdom.
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Abstract
Hand transplantation may become an important procedure for upper limb functional restoration. To date, 18 patients have been undergone 24 hand operations in the world. Initial results are extremely promising; the functional results are apparently superior to those obtained with prostheses. We report on the combined French and Italian experience of six patients (eight hands), which is based on a jointly devised protocol and represents the largest available clinical series. Six male patients aged 43, 33, 35, 32, 33, and 22 years received either a single right hand-dominant transplantation (four cases) or a simultaneous double hand transplantation (two cases). The time since the amputation ranged from 3 to 22 years. The level of transplantation was at the wrist in five cases (six hands) and at the distal forearm in two cases (two hands). Cold ischemia averaged 11.5 hours. Three patients simultaneously received additional full-thickness skin taken from the donor and transplanted onto their left hip area. This skin served as a source for biopsies and as an additional area to monitor rejection (distant sentinel skin graft). The immunosuppressive protocol included polyclonal antibodies (three patients) or monoclonal anti-CD 25 antibody (three patients), tacrolimus, mycophenolate mofetil, and prednisolone. No surgical complications occurred. Skin rejection occurred at least once in all patients at a mean of 40 days postoperatively. Three patients recovered protective and some discriminative sensation in their palm and fingers. Two patients are recovering sensation, but are still in the early phases of the regenerative process, due to the short time since the transplantation. One patient was not compliant with the immunosuppressive therapy, and underwent uncontrolled rejection and reamputation.
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Affiliation(s)
- M Lanzetta
- Service de Chirurgie de Transplantation, Hospital Edouard Herriot, Lyon, France.
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24
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Affiliation(s)
- N Hakim
- St. Mary's Hospital, London, United Kingdom.
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25
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Loucaidou M, McLean AG, Cairns TDH, Griffith M, Hakim N, Palmer A, Papalois V, Van Tromp J, Loucaides C, Welsh KI, Taube D. Five-year results of kidney transplantation under tacrolimus-based regimes: the persisting significance of vascular rejection. Transplantation 2003; 76:1120-3. [PMID: 14557763 DOI: 10.1097/01.tp.0000076474.76480.a4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Acute rejection has been the major risk factor for medium-term kidney graft loss because of chronic allograft nephropathy. We investigated whether the use of improved immunosuppression has altered the relationship between acute and chronic rejection by analyzing data from 245 renal transplant patients receiving Tacrolimus-based immunosuppression. RESULTS Five-year graft survival (censored for death with functioning graft) was 88.8% with no significant difference between living and cadaveric kidney transplants. The only significant predictor of medium-term graft loss was acute vascular rejection. CONCLUSION Under Tacrolimus-based immunosuppression, the occurrence of acute interstitial rejection, even when occurring late, repeatedly, or with failure of graft function to return to baseline, was not associated with chronic allograft nephropathy or medium-term graft loss. Vascular rejection remains the major immunological obstacle to long-term transplant success. Five-year overall survival rates with a functioning graft of 80% with 90% graft survival censored for death with function seem to be realistic and achievable goals.
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Affiliation(s)
- M Loucaidou
- Renal and Transplant Unit, St Mary's Hospital, Praed Street, London W2 1NY, United Kingdom.
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Dubernard JM, Henry P, Parmentier H, Vallet B, Vial D, Badet L, Petruzzo P, Lefrançois N, Lanzetta M, Owen E, Hakim N. [First transplantation of two hands: results after 18 months]. Ann Chir 2002; 127:19-25. [PMID: 11833300 DOI: 10.1016/s0003-3944(01)00668-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM OF THE STUDY The previous results achieved in single hand transplantations confirmed the feasibility of this procedure and encouraged us to perform the first human double hand transplantation, which was performed in January 2000. In the present study we reported the results obtained eighteen months after transplantation. PATIENT AND METHODS The recipient was a 33-year old man suffering from a traumatic amputation of both hands in 1996. Surgery included procurement of the upper extremities from a 18-year old multiorgan cadaveric donor, preparation of the graft and recipient's stumps, transplantation of the hands, which included bone fixation, arterial and venous anastomoses, nerve suture, joining of tendons and muscles, and skin closure. Immunosuppressive protocol included tacrolimus, prednisone and mycophenolate mofetil. An intensive rehabilitation program was performed. Follow-up included immunological tests, skin biopsies, arteriography, bone scintigraphy, electromyography and brain functional magnetic resonance imaging. RESULTS No surgical complications, infectious complications and graft-versus-host-disease occurred. Two episodes of acute skin rejection were demonstrated and they were completely reversed increasing steroid dose. Nerve regeneration and cortical reorganization were shown. Sensorimotor recovery was encouraging and life quality improved. CONCLUSION This double hand transplantation showed that conventional immunosuppressive protocol is effective and safe as well as that functional results are at least as good as those achieved in replanted upper extremities.
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Affiliation(s)
- J M Dubernard
- Service de chirurgie et de médecine de la transplantation, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
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Lanzetta M, Nolli R, Borgonovo A, Owen ER, Dubernard JM, Kapila H, Martin X, Hakim N, Dawahra M. Hand transplantation: ethics, immunosuppression and indications. J Hand Surg Br 2001; 26:511-6. [PMID: 11884098 DOI: 10.1054/jhsb.2001.0635] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- M Lanzetta
- Hand Surgery and Reconstructive Microsurgery Unit, San Gerardo Hospital, University of Milan-Bicocca, Italy.
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Dubernard JM, Owen E, Lefrançois N, Petruzzo P, Martin X, Dawahra M, Jullien D, Kanitakis J, Frances C, Preville X, Gebuhrer L, Hakim N, Lanzettà M, Kapila H, Herzberg G, Revillard JP. First human hand transplantation. Case report. Transpl Int 2001; 13 Suppl 1:S521-4. [PMID: 11112064 DOI: 10.1007/s001470000288] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J M Dubernard
- Service d'Urologie et de Chirurgie de la Transplantation, Hôpital Edouard Herriot, Lyon, France
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McKane W, Kanganas C, Preston R, Cairns T, Hakim N, Palmer A, Taube D. Treatment of calcineurin inhibitor toxicity by dose reduction plus introduction of mycophenolate mofetil. Transplant Proc 2001; 33:1224-5. [PMID: 11267268 DOI: 10.1016/s0041-1345(00)02396-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- W McKane
- Renal and Transplant Unit, St Mary's Hospital, London, United Kingdom
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31
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Papalois VE, Lee J, McKane W, Browning N, Palmer A, Hakim N, Cairns T, Taube D. Pig-to-rabbit islet transplantation as an immunologic model of pig-to-human islet xenografts. Transplant Proc 2000; 32:1070. [PMID: 10936362 DOI: 10.1016/s0041-1345(00)01128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- V E Papalois
- Brent Laboratory, St Mary's Hospital, London, United Kingdom
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32
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Dubernard JM, Owen E, Herzberg G, Martin X, Guigal V, Dawahra M, Pasticier G, Mongin-Long D, Kopp C, Ostapetz A, Lanzetta M, Kapila H, Hakim N. [The first transplantation of a hand in humans. Early results]. Chirurgie 1999; 124:358-65; discussion 365-7. [PMID: 10546388 DOI: 10.1016/s0001-4001(00)80007-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The first hand allograft was performed on September 23, 1998. The right distal forearm and hand of a brain dead donor was transplanted to a 48 year old recipient who had undergone a traumatic amputation of the distal third of his right forearm. The donor's arm was irrigated with organ preservation solution (UW) and transported to Lyon in a cool container. Two teams simultaneously dissected the donor's limb and the recipient's stump to identify anatomical structures. Transplantation involved bone fixation, arterial and venous anastomoses, nerve sutures, joining of the muscles and tendons, and skin closure. Immunosuppression consisted of anti-lymphocyte, polyclonal and monoclonal antibodies, tacrolimus, mycophenolic acid, and prednisone. Mild clinical and histological signs of rejection occurred at week 9 after surgery. They disappeared with adjustments of the immunosuppressant doses. Seven months after surgery the patient was in good general condition. Intensive physiotherapy led to satisfactory progress of motor function. Sensory progress is excellent, reaching the fingertips. A longer follow-up is necessary to appreciate the final result. In the absence of further rejection, the functional prognosis of the graft should be similar to that reported after successful autoreconstruction.
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Affiliation(s)
- J M Dubernard
- Service de chirurgie de la transplantation et d'urologie, hôpital Edouard-Herriot, Lyon, France
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Preston R, Ball S, Cairns T, Contis J, Hakim N, Palmer A, Papalois V, Taube D. FK 506 as primary immunosuppressive therapy in renal transplantation. Transplant Proc 1998; 30:1214-5. [PMID: 9636493 DOI: 10.1016/s0041-1345(98)00215-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- R Preston
- Renal Unit, St Mary's Hospital, Paddington, London, England
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Gruessner RW, Sutherland DE, Troppmann C, Benedetti E, Hakim N, Dunn DL, Gruessner AC. The surgical risk of pancreas transplantation in the cyclosporine era: an overview. J Am Coll Surg 1997; 185:128-44. [PMID: 9249080 DOI: 10.1016/s1072-7515(01)00895-x] [Citation(s) in RCA: 129] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pancreas transplants are still associated with the highest surgical complication rate of all routinely performed solid organ transplants. To date, the impact of serious surgical complications in the cyclosporine era on perioperative patient morbidity, graft and patient survival, and hospital costs has not been analyzed in detail. STUDY DESIGN We retrospectively studied surgical complications after 445 consecutive pancreas transplants (45% simultaneous pancreas-kidney [SPK], 24% pancreas after kidney [PAK], and 31% pancreas transplant alone [PTA]). Of these, 80% were primary transplants, 20% were retransplants. Cadaver donors were used in 92%, living related donors in 8%. To develop guidelines for their prevention and management, we studied the impact of significant surgical complications (intra-abdominal infections, vascular graft thrombosis, and anastomotic leak) requiring relaparotomy on graft and patient survival. RESULTS Relaparotomy was required after 32% of all pancreas transplants (SPK: 36%, PAK: 25%, PTA: 16% [p = 0.04]). Perioperative mortality was 9%. Graft and patient survival rates were significantly lower for recipients with (versus without) relaparotomy. The most common procedures were drainage of intra-abdominal abscess with graft necrosectomy (50% of all relaparotomies) and transplant pancreatectomy (34%). The most common causes of relaparotomy were intra-abdominal infection, vascular graft thrombosis, and anastomotic leak. Intra-abdominal infection occurred in 20% (SPK: 18%, PAK: 24%, PTA: 20% [p = NS]). The rate was significantly higher for living related donor (42%) versus cadaver donor (18%) recipients and for those with enteric-drained (39%) versus bladder-drained (18%) transplants. Graft and patient survival rates were significantly lower for recipients with (versus without) intra-abdominal infection. Outcome was better after bacterial (versus fungal) infections. For SPK recipients, those not on dialysis before the transplant had significantly higher graft survival than those on dialysis. Vascular graft thrombosis occurred in 12% of all recipients. The rate was significantly higher for PAK (21%) than for PTA (10%) and SPK (9%) recipients. It was significantly lower for recipients of grafts with donor iliac Y-graft reconstruction (versus all other types of arterial reconstruction) and with right-sided (versus left-sided) graft placement. Of note, patient survival was not different for recipients with versus without vascular graft thrombosis. The incidence of anastomotic or duodenal stump leaks was 10%; of these recipients, 70% required relaparotomy. Patient and graft survival rates were no different for recipients with versus without leaks. CONCLUSIONS Serious surgical complications occurred in 35% of pancreas recipients and had a significant impact on patient and graft survival. Based on multivariate risk factor analyses, we recommend the following: donors over 45 years and those dying of cerebrocardiovascular disease should not be used; recipients over 45 years and those with a history of cardiac disease should be considered for a kidney transplant alone (KTA); surgical technique for graft procurement, preparation, and implantation should be meticulous; right-sided implantation and arterial Y-graft reconstruction should be performed when possible, since they had the highest success rates; when complications require relaparotomy, the focus must switch from graft salvage to life preservation; and the threshold for pancreatectomy should be low. Diagnosis should be timely, and treatment and relaparotomy expeditious. These cornerstones of success should help decrease the risk of surgical complications and mortality after pancreas transplants.
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Affiliation(s)
- R W Gruessner
- Department of Surgery, University of Minnesota, Minneapolis 55455, USA
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35
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Abstract
Patients with end-stage renal and hepatic failure may be treated with combined liver and kidney transplantation (CLKTx). We reviewed the indications and outcomes of 16 CLKTx performed at the University of Minnesota between 1980 and 1994. The majority of the recipients (87.5%) were young patients affected by congenital hepatic anomalies and concomitant end-stage renal failure. Fourteen were treated with cyclosporin-based immunosuppression and had an excellent outcome: with an average of 6 years of follow-up, patient survival was 85.7%, liver graft survival 85.7%, and kidney graft survival 72%. The incidence of rejection episodes was similar to the rate of rejection in our solitary kidney and liver transplants. In conclusion, our experience supports the value of CLKTx in treating patients with simultaneous failure of both organs or with congenital enzymatic hepatic deficits leading to renal failure.
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Affiliation(s)
- E Benedetti
- Department of Surgery, University of Illinois at Chicago, College of Medicine 60612, USA
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36
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Benedetti E, Pirenne J, Troppmann C, Hakim N, Moon C, Gruessner RW, Sharp H, Matas AJ, Payne WD, Najarian JS. Combined liver and kidney transplantation. Transpl Int 1996; 9:486-91. [PMID: 8875792 DOI: 10.1007/bf00336827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Patients with end-stage renal and hepatic failure may be treated with combined liver and kidney transplantation (CLKTx). We reviewed the indications and outcomes of 16 CLKTx performed at the University of Minnesota between 1980 and 1994. The majority of the recipients (87.5%) were young patients affected by congenital hepatic anomalies and concomitant end-stage renal failure. Fourteen were treated with cyclosporin-based immunosuppression and had an excellent outcome: with an average of 6 years of follow-up, patient survival was 85.7%, liver graft survival 85.7%, and kidney graft survival 72%. The incidence of rejection episodes was similar to the rate of rejection in our solitary kidney and liver transplants. In conclusion, our experience supports the value of CLKTx in treating patients with simultaneous failure of both organs or with congenital enzymatic hepatic deficits leading to renal failure.
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Affiliation(s)
- E Benedetti
- Department of Surgery, University of Illinois at Chicago, College of Medicine 60612, USA
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Pirenne J, Benedetti E, Gruessner A, Moon C, Hakim N, Fryer JP, Troppmann C, Nakhleh RE, Gruessner RW. Combined transplantation of small and large bowel. FK506 versus cyclosporine A in a porcine model. Transplantation 1996; 61:1685-94. [PMID: 8685944 DOI: 10.1097/00007890-199606270-00004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Clinically, FK506 is superior to CsA after solitary small bowel transplantation (SBTx). Development of diarrhea after SBTx has been the rationale for adding the colon to small bowel grafts. However, the additional lymphoid and bacterial content transferred with total small plus large bowel transplants (TBTx) might aggravate the alloimmune response-rejection and graft-versus-host disease (GVHD)-and increase the risk of infection. We studied the incidence of rejection, GVHD, and infection after TBTx and the impact of CsA versus FK506. We performed orthotopic TBTx with portal drainage after total enterectomy in outbred Yorkshire Landrace pigs, divided into 3 groups: control pigs (n=6) received no immunosuppression; CsA pigs (n= 14) received CsA (5 mg/kg), antilymphocyte globulin (10 mg/kg for 10 days), prednisone (2 mg/kg), and AZA (2.5 mgtkg); and FK506 pigs (n=9) received FK506 (0.2 mg/kg) and prednisone (2 mg/kg). Trough CsA whole blood levels were >400 ng/ml for the first 7 days and >200 ng/ml thereafter. FK506 levels were > 15 ng/ml. We excluded from further analysis 5 early deaths (<3 days) due to anesthesiologic (n=2) or technical reasons (n=3). Median survival of control pigs was 9.5 days (range, 4-13). Cyclosporine did not extend survival: median, 9 days (range, 5-31) (P=0.6). FK506 prolonged survival: median, 37 days (range, 21-49) (P<0.001 vs. control and CsA pigs). Of FK506 pigs, 60% gained weight (+75 g/day), whereas 100% of controls and 75% of CsA pigs lost weight (-550 g/day and -300 g/day, respectively). All control pigs died of rejection within 2 weeks versus none of the FK506 pigs. However, 36% of CsA pigs died of rejection. Groupwise comparison showed less rejection in FK506 versus control pigs (P<0.001) and in FK506 versus CsA pigs (P<0.03), but no difference between CsA and control pigs. None of the control pigs died of GVHD versus 18% of CsA pigs (by day 31) and 37% of FK506 pigs (by day 49). Groupwise comparison showed increased GVHD in FK506 versus control pigs (P<0.001) and a tendency toward increased GVHD in FK506 versus CsA pigs (P=0.08). None of the control pigs died of infection alone versus 22% of CsA pigs (by day 31) and 67% of FK506 pigs (by day 49). Groupwise comparison showed increased infection in FK506 versus control pigs (P<0.001). We detected significant endotoxemia early and late postoperatively. But we saw no specific correlation between endotoxemia, rejection, GVHD, or infection. Based on this study, we have drawn several conclusions: (1) In untreated pigs, TBTx provokes a severe rejection response, but no lethal GVHD. (2) Cyclosporine and particularly FK506 pigs have a high incidence of infection and lethal GVHD, a complication that we had not seen after solitary SBTx. (3) FK506 is superior to CsA in controlling rejection and in prolonging graft and recipient survival; FK506, however, does not reduce GVHD, but rather tends to augment it. (4) TBTx causes endotoxemia. As with solitary SBTx, FK506 is superior to CsA after TBTx. However, longterm survival is difficult to achieve on FK506 recipients because of the development of GVHD and infection.
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Affiliation(s)
- J Pirenne
- Department of Surgery and the School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Cairns T, Lee J, Goldberg LC, Hakim N, Cook T, Rydberg L, Samuelsson B, Taube D. Thomsen-Friedenreich and PK antigens in pig-to-human xenotransplantation. Transplant Proc 1996; 28:795-6. [PMID: 8623404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- T Cairns
- Renal and Transplant Unit, St. Mary's Hospital, London, England
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Goldberg LC, Lee J, Cairns T, Weymouth-Wilson A, Simpson P, Lawson C, Hacking A, Nilsson R, Hakim N, Taube D. Polymorphism within the human anti-pig repertoire. Transplant Proc 1996; 28:549-50. [PMID: 8623261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- L C Goldberg
- Renal and Transplant Unit, St. Mary's Hospital, London, England
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Pirenne J, Benedetti E, Kashtan CE, Llédo-Garcia E, Hakim N, Schroeder CH, Cook M, Sutherland DE, Matas AJ, Najarian JS. Kidney transplantation in the absence of the infrarenal vena cava. Transplantation 1995; 59:1739-42. [PMID: 7604445 DOI: 10.1097/00007890-199506270-00018] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- J Pirenne
- Department of Surgery, University of Minnesota, Minneapolis, USA
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Benedetti E, Pirenne J, Troppmann C, Hakim N, Gruessner R, Cochrane R, Irmiter R, Payne W, Belani K. A percutaneous technique for venous return cannula insertion for veno-venous bypass in hepatic transplantation. Transplantation 1995; 59:789-91. [PMID: 7886810 DOI: 10.1097/00007890-199503150-00027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- E Benedetti
- Department of Surgery, University of Minnesota, Minneapolis
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Troppmann C, Benedetti E, Papalois BE, Gruessner AC, Pirenne J, Hakim N, Sutherland DE, Gruessner RW. Impact of vascular reconstruction technique on posttransplant pancreas graft thrombosis incidence after simultaneous pancreas-kidney transplantation. Transplant Proc 1995; 27:1331-2. [PMID: 7878903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- C Troppmann
- University of Minnesota, Department of Surgery, Minneapolis
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Benedetti E, Matas AJ, Hakim N, Fasola C, Gillingham K, McHugh L, Najarian JS. Renal transplantation for patients 60 years of older. A single-institution experience. Ann Surg 1994; 220:445-58; discussion 458-60. [PMID: 7944657 PMCID: PMC1234414 DOI: 10.1097/00000658-199410000-00004] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The authors reviewed renal transplant outcomes in recipients 60 years of age or older. BACKGROUND Before cyclosporine, patients older than 45 years of age were considered to be at high risk for transplantation. With cyclosporine, the age limits for transplantation have expanded. METHODS The authors compared patient and graft survival, hospital stay, the incidence of rejection and rehospitalization, and the cause of graft loss for primary kidney recipients 60 years of age or older versus those 18 to 59 years of age. For those patients > or = 60 years transplanted since 1985, the authors analyzed pretransplant extrarenal disease and its impact on post-transplant outcome. In addition, all surviving recipients > or = 60 years completed a medical outcome survey (SF-36). RESULTS Patient and graft survival for those > or = 60 years of age versus those 18 to 59 years of age were similar 3 years after transplant. Subsequently, mortality increased for the older recipients. Death-censored graft survival was identical in the two groups. There were no differences in the cause of graft loss. Those 60 years of age or older had a longer initial hospitalization, but had fewer rejection episodes and fewer rehospitalizations. Quality of life for recipients 60 years of age or older was similar to the age-matched U.S. population. CONCLUSION Renal transplantation is successful for recipients 60 years of age or older. Most of them had extrarenal disease at the time of transplantation; however, extrarenal disease was not an important predictor of outcome and should not be used as an exclusion criterion. Post-transplant quality of life is excellent.
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Affiliation(s)
- E Benedetti
- Department of Surgery, University of Minnesota, Minneapolis 55455
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Isakov E, Mizrahi J, Susak Z, Ona I, Hakim N. Influence of prosthesis alignment on the standing balance of below-knee amputees. Clin Biomech (Bristol, Avon) 1994; 9:258-62. [PMID: 23916237 DOI: 10.1016/0268-0033(94)90008-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/1993] [Accepted: 06/14/1993] [Indexed: 02/07/2023]
Abstract
The effect of alignment of the prosthesis on the standing balance of below knee amputees was investigated in this work. Alignment variations consisted of varus and valgus tilt and plantar- and dorsiflexions. The foot-ground reaction forces measured in the anteroposterior, mediolateral, and vertical directions as well as global parameters describing the total sway activity, asymmetry, and weight-bearing imbalance were used to compare the various alignment positions studied. The results indicate the presence of a common standing pattern in below-knee amputees, where activity of the foot-ground reaction forces in the anteroposterior direction is significantly higher in the contralateral limb compared with the amputated limb. It was also found that the varus and valgus alignments were the least stable of all alignments.
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Affiliation(s)
- E Isakov
- Biomechanics Laboratory, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
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Minzly J, Mizrahi J, Hakim N, Liberson A. Stimulus artefact suppressor for EMG recording during FES by a constant-current stimulator. Med Biol Eng Comput 1993; 31:72-5. [PMID: 8326768 DOI: 10.1007/bf02446897] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- J Minzly
- Loewenstein Rehabilitation Hospital, Raanana, Israel
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Isakov E, Mizrahi J, Ring H, Susak Z, Hakim N. Standing sway and weight-bearing distribution in people with below-knee amputations. Arch Phys Med Rehabil 1992; 73:174-8. [PMID: 1543414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Upright stability in humans has been found to decrease with age, certain diseases, or trauma. We investigated stability of standing in people with below-knee amputations (BKA) and in able-bodied controls. Body sway was evaluated during standing on a set of two Kistler force plates, first with eyes open and then with eyes closed. People with BKA were tested twice--first, one to two days after receiving their prostheses, and second, on completing their prosthetic rehabilitation. The results indicate that both able-bodied people and those with BKA sway more with their eyes closed. However, people with BKA are significantly less stable when they stand with either closed eyes or open eyes. We demonstrated that the differences between the groups studied are due to a proprioceptive deficit as a result of partial limb loss. We also found that there was a gradual process of compensation and adaptation, as some people with BKA sway less at the end of the rehabilitation period.
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Affiliation(s)
- E Isakov
- Orthopaedic Rehabilitation Department, Loewenstein Hospital, Ra'anana, Israel
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Hakim-Aalam, Hakim N. Enjoyable Visit. West J Med 1956. [DOI: 10.1136/bmj.1.4979.1367-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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