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Fernando M, Tillakaratne S, Gunetilleke B, Liyanage C, Appuhamy C, Weerasuriya A, Uragoda B, Welikala N, Ranaweera L, Ganewatte E, Dissanayake J, Mudalige A, Siriwardana R. Challenges faced in establishing a pediatric liver transplant program in a lower-middle-income country with free healthcare service. Pediatr Transplant 2024; 28:e14681. [PMID: 38317346 DOI: 10.1111/petr.14681] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/06/2023] [Accepted: 12/08/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Liver transplant is the cure for children with liver failure. Sri Lanka is a lower-middle-income country with a predominant free, state health system. Pediatric liver transplant program in Sri Lanka is still in the budding state where the initial experience of the program is yet to be documented. METHODS A retrospective review was performed including the clinical characteristics of all pediatric liver transplant recipients of Colombo North Centre for Liver Diseases since the inception of the program from June 2020 to May 2023. RESULTS There were 14 PLT performed in 3 years. The median recipient age and weight were 8 years (6 months-15 years) and 23.3 kg (6.4-49.2), respectively. The majority were boys (64%). All were from low-income backgrounds. Indications for LT were acute liver failure (5/14), decompensated chronic liver disease (5/14), and acute on chronic liver failure (4/14). Underlying liver diseases were Wilson disease (6/14), autoimmune liver disease (3/14), biliary atresia (2/14) and progressive familial intrahepatic cholestasis type 3 (1/14), and unknown etiology (2/14). The majority were living donor liver transplants (86%). Of the living donors, 42% (5/12) were Buddhist priests. There were three immediate deaths and two late deaths. The 3-month survival was 78%, and overall survival was 64%. Living donor transplants carried a higher success rate (92%) compared to diseased donor transplants (0%; 2/2). CONCLUSIONS Initial experience of pediatric liver transplant program of Sri Lanka is promising despite being established in a free healthcare system amidst the crisis circumstances.
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Affiliation(s)
- Meranthi Fernando
- Colombo North Centre For Liver Diseases, Ragama, Sri Lanka
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
| | - Suchintha Tillakaratne
- Colombo North Centre For Liver Diseases, Ragama, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Bhagya Gunetilleke
- Colombo North Centre For Liver Diseases, Ragama, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
- Division of Anaesthesia, Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | - Chinthaka Appuhamy
- Colombo North Centre For Liver Diseases, Ragama, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Aruna Weerasuriya
- Colombo North Centre For Liver Diseases, Ragama, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | - Nadeeshya Welikala
- Colombo North Centre For Liver Diseases, Ragama, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
- Division of Anaesthesia, Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | | | | | | | - Rohan Siriwardana
- Colombo North Centre For Liver Diseases, Ragama, Sri Lanka
- Colombo North Teaching Hospital, Ragama, Sri Lanka
- Department of Surgery, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
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Muacevic A, Adler JR. Initial Experience of Transthoracic Echocardiography at a Newly Operational Satellite Center in Hyderabad, Pakistan. Cureus 2019; 11:e5735. [PMID: 31723496 PMCID: PMC6825457 DOI: 10.7759/cureus.5735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Transthoracic echocardiography (TTE) is the primary noninvasive imaging modality for quantitative and qualitative evaluation of cardiac anatomy and function. The Hyderabad satellite center of National Institute of Cardiovascular Diseases (NICVD), Pakistan has recently started its operations, including TTE; therefore, it is imperative to assess the initial experience for the process improvement of the center. Therefore, the aim of this clinical audit was to review our initial experience of TTE at this newly operational satellite center. Methods In this clinical audit, we reviewed the records of patient undergone TTE at the echocardiography department of NICVD Hyderabad satellite center from May 2018 to October 2018. Demographic characteristics, clinical history, indications for the TTE, and echocardiographic diagnoses were reviewed. Results A total of 2,177 TTE procedures were performed during the study period of six months out of which 68.7% (1,496) were performed in male patients. Mean age of the patients was 50.83 ± 12.44 years with 48.2% (1,050) patients above 50 years of age. The most frequent indication for the procedure was cardiomyopathy, 54.1% (1,177), among other indications, native valve regurgitation was in 49.8% (1,085), ischemic heart disease in 23.2% (504), heart murmurs in 17.3% (377), cardiac masses in 14.3% (312), pericardial disease in 8.5% (184), pulmonary disease in 7.3% (160), infective endocarditis in 6.4% (139), aortic and major disease in 6.3% (138), and native valve stenosis in 5.4% (177) of the patients. Procedures were performed before coronary artery revascularization in 2.2% (47) and for prosthetic valve assessment in 1.7% (38) patients. The TTE was normal in 36.6% (796) patients, while the most frequent diagnosis was cardiomyopathy, 53.8% (1,172), among the other TTE findings valvular heart disease was in 21.8% (475), ischemic heart disease (IHD) in 21.6% (470), pericardial disease in 8.0% (175), and congenital heart disease (CHD) in 1.4% (30) patients. Conclusion This clinical audit showed the effective use of TTE as a noninvasive imaging modality for quantitative and qualitative evaluation of cardiac anatomy and function at a newly operational satellite center of a resource-limited country with normal TTE findings in only 36.6% of the patients.
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Niu JM, Zhang J, Qiu XJ, Wang J, Pei YH, Wang YL, Wang T. Application of Micro-Tech stents in malignant carinal stenosis. Oncol Lett 2019; 17:3990-3996. [PMID: 30930995 DOI: 10.3892/ol.2019.10051] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 02/01/2019] [Indexed: 11/06/2022] Open
Abstract
Malignant carinal stenosis is a disease process that is not always suitable for treatment with a Y-shaped stent. When one of the main bronchi is completely obstructed and cannot be recanalized, or its distal lung tissue has lost function, inserting a Y-shaped stent is infeasible. In this complex condition, a cone-shaped stent is selected to maintain the patency of the trachea and the other main bronchus. The efficacy of the bare cone-shaped Micro-Tech stent to treat malignant carinal stenosis was evaluated in the current study. The medical records of 47 patients with malignant carinal stenosis who underwent Micro-Tech stent placement between January 2004 and October 2017 in Beijing Tian Tan Hospital (Beijing, China) were analyzed retrospectively. A total of 47 bare Micro-Tech stents (28 Y-shaped and 19 cone-shaped) were successfully inserted in the patients. Following stent placement, immediate satisfactory results were achieved in all patients, especially an improvement of dyspnea (100%), cough (81.1%) and stridor (100%). The Karnofsky scores were significantly increased (P<0.001), and the American Thoracic Society Dyspnea Index values were significantly decreased (P<0.001). Following a median of 88 days, initial bronchoscopic interventions were performed for tumor overgrowth (84.6%), stent fracture (7.7%) and granulation tissue (7.7%). Restenting was performed in two patients due to tumor progression (n=1) and stent fracture (n=1). Removal of a Y-shaped stent was attempted in one patient, but failed, as the stent had become partly embedded in the airway mucosa. In conclusion, cone-shaped Micro-Tech stent placement maintained tracheal-unilateral main bronchus patency and benefitted patients with malignant carinal stenosis in whom Y-shaped stents were not suitable for insertion.
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Affiliation(s)
- Jin-Mu Niu
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Jie Zhang
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Xiao-Jian Qiu
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Juan Wang
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Ying-Hua Pei
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Yu-Ling Wang
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Ting Wang
- Department of Respiration, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, P.R. China
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He Z, Zeng L, Zhang C, Wang L, Wang Z, Rustam A, Du C, Lv W, Hu J. Initial experience of Da Vinci robotic thoracic surgery at the First Affiliated Hospital of Zhejiang University. J Vis Surg 2018; 3:153. [PMID: 29302429 DOI: 10.21037/jovs.2017.09.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/20/2017] [Accepted: 09/14/2017] [Indexed: 11/06/2022]
Abstract
Robot-assisted thoracic surgery (RATS) is a relatively new but rapidly adopted technique, pioneered by the urological and gynecological departments. The primary objective of this study is to present the current status, a series of improvement and innovation of Da Vinci robotic surgery in the Department of Thoracic Surgery at First Affiliated Hospital of Zhejiang University. In addition, we discuss the prospect of robotic surgical technology.
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Affiliation(s)
- Zhehao He
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Liping Zeng
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Chong Zhang
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Luming Wang
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Zhitian Wang
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Azmat Rustam
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Chengli Du
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Wang Lv
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jian Hu
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
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Kurokawa M, Watanabe Nemoto M, Harada R, Kobayashi H, Horikoshi T, Kanazawa A, Togasaki G, Abe Y, Chazono H, Hanazawa T, Okamoto Y, Uno T. Initial experience of radiotherapy plus cetuximab for Japanese head and neck cancer patients. J Radiat Res 2015; 56:849-855. [PMID: 26160181 PMCID: PMC4577007 DOI: 10.1093/jrr/rrv038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/19/2015] [Accepted: 05/23/2015] [Indexed: 06/04/2023]
Abstract
In Japan, cetuximab with concurrent bioradiotherapy (BRT) for squamous cell carcinoma of head and neck (SCCHN) was approved in December 2012. We herein report our initial experience of BRT, with special emphasis on acute toxicities of this combination therapy. Thirty-one non-metastatic SCCHN patients who underwent BRT using cetuximab between July 2013 and June 2014 were retrospectively evaluated. All patients received cetuximab with a loading dose of 400 mg/m(2) one week before the start of radiotherapy, followed by 250 mg/m(2) per week during radiotherapy. The median cycle of cetuximab was seven cycles and the median dose of radiotherapy was 70 Gy. Twenty-five patients (80.6%) accomplished planned radiotherapy and six cycles or more cetuximab administration. Six patients (19.4%) discontinued cetuximab. Grade 3 dermatitis, mucositis and infusion reaction occurred in 19.4%, 48.3% and 3.2%, respectively. One patient experienced Grade 3 gastrointestinal bleeding caused by diverticular hemorrhage during BRT. Grade 3 drug-induced pneumonitis occurred in two patients. The response rate was 74%, including 55% with a complete response. BRT using cetuximab for Japanese patients with SCCHN was feasible as an alternative for cisplatin-based concurrent chemoradiation, although longer follow-up is necessary to evaluate late toxicities.
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Affiliation(s)
- Marie Kurokawa
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Miho Watanabe Nemoto
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Rintaro Harada
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Hiroki Kobayashi
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Takuro Horikoshi
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Aki Kanazawa
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Gentaro Togasaki
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Yukinao Abe
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Hideaki Chazono
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Toyoyuki Hanazawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
| | - Takashi Uno
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, Japan
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Muallem MZ, Feldheiser A, Sehouli J. Laparoscopic radical hysterectomy and lymph node dissection learning experience at campus Virchow - Charite. Anticancer Res 2013; 33:3449-3453. [PMID: 23898118] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM The purpose of this study was to establish and analyze the laparoscopic technique of radical hysterectomy and para-aortic and pelvic lymphadenectomy and to retrospectively evaluate its feasibility and morbidity. PATIENTS AND METHODS During a one-year period 12 patients underwent laparoscopic radical surgical procedures for cervical or endometrial cancer. All our patients underwent radical pelvic lymphadenectomy, whereas we performed radical para-aortic lymphadenectomy-alone in five patients and radical type-C hysterectomy in eight patients. RESULTS The mean operating time for para-aortic and pelvic lymphadenectomy was 120 and 152 minutes respectively, and 153.75 minutes for type C hysterectomy. A mean of 41.6 pelvic lymph nodes and 21.2 para-aortic lymph nodes were removed. The mean extensions of parametrium in laparoscopic radical hysterectomy type C were 45×30 mm. CONCLUSION Following a short learning curve, laparoscopic para-aortic and pelvic lymphadenectomy is a safe and effective technique for staging cervical, and endometrial cancer.
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Affiliation(s)
- Mustafa Zelal Muallem
- Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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