1,721,097 research outputs found
Is Extending Criteria for Pancreas Donor Programs the Best Way to Shorten Waiting Lists?
No full textThe growing waiting list for pancreas transplantation both in USA and in Eurotransplant countries reflects the critical need for new strategies for the management of patients affected by type 1 diabetes mellitus with indication for transplantation.
As well as other solid organs, the extension of the donor selection criteria for pancreas transplantation was proposed in the last decades, but only few studies have been published about this issue to date. Indeed, in a period in which donor age of 45 years or more was considered a relative contraindication for pancreas transplantation, in 2005 one of the first studies about the extended donor criteria1 reported on pancreas transplantation from donors with a mean age > 45 year. The 1-and -5-years survival rates of patients (87,5% at both time points) and grafts survival rates (81,2% and 67,7% respectively), were comparable to the current literature data, underlining the importance of an appropriate general donor assessment evaluation more than the age parameter alone. A local allocation policy in order to reduce the ischemia time also played and more recently continues to play a pivotal role in this context.
Only after more than ten years, the prospective “EXPAND study” by Proneth et al.2 confirmed these results, achieving a 1-year graft survival rate of 83,3% after transplants using extended donor criteria (EDC) on age (between 50 and 60), which was equal to the rate attained using standard criteria (83.5%) with donor age averaging 31,7 years). These results can give a new impulse to the application of donor extension criteria for pancreas transplantation. However, it is mandatory to underline that, due to the very delicate nature of both diabetic patients and of pancreas graft, strongly prone to complications and to long term high failure rate, the importance to obtain the 5-year’s results after pancreatic transplant from EPD as well as of the graft should be stressed, in order to establish if an extended pancreas deceased donors program could really represent the best option to increase life expectancy and improve the quality of life for many patients with juvenile diabetes. Indeed, although the importance of this work is that it represents the first prospective multicenter study on this issue, the results are not so different from the past, despite the progress of the surgical technique and of the immunosuppressant therapies in the last years, and other strategies such as the islet transplantation and living donor pancreas transplantation have been improved, amplifying the question of which option really represents the best way to shorten the waiting list for pancreas transplantation.
Without a doubt, while living donor still raise ethical and results concerns, clinical pancreatic islet transplantation is becoming a more widely available option for patients with type 1 diabetes mellitus and eventually a potential cure, being considered one of the safest and least invasive transplant procedures. With more than 1500 patients treated since 2000, remarkable progress has occurred in both the technical aspects of islet cell processing and the outcomes of clinical islet transplantation, so that this therapeutic strategy has moved from a curiosity to a realistic treatment option for selected patients with type 1 diabetes3.
In conclusion, the continuously growing demand of pancreas transplantation and the concomitant lack of ideal donors induce surgeons and clinicians to make more and more efforts to find new strategies to shorten the waiting lists. However, the question whether or not the extension of the donor criteria for solid organ transplantation really represents today the best option to follow still remains “a question” unsolved
Teenagers with obesity: Long-term results of laparoscopic adjustable gastric banding
No full textBackground: Obesity is a rapidly spreading chronic disease worldwide. Long-term results are critical to assess the effectiveness of a bariatric procedure, particularly in young patients who have long life expectancy. Methods: A retrospective study on adolescents with morbid obesity who underwent Laparoscopic Adjustable Gastric Banding (LAGB) at our institute from 1995 to 2018 was made. Primary endpoints were efficacy, in term of weight loss and comorbidity resolution, occurrence of complications and reoperations. Results: Fifty-nine patients underwent LAGB between 1995 and 2018. Intra- and post-operative mortality was absent. The patients' presence at follow-up at 5, 10 and 15 years was 38/50 (76%), 18/25 (72%) and 5/8 (63%), respectively. At those times the mean excess weight loss percentage was 61.7 ± 29.4, 48.1 ± 50.4 and 55.8 ± 51.2, respectively. Comorbidity resolution rates were 100% for patients with diabetes, 78% for patients with hypertension, 75% for joint pain suffers, 69% for patients with sleep apnea and 57% for patients with anxiety and depression. Total reoperation rate was 30.5%. The band was removed in 8 patients: 3 due to erosions, 3 by patients' choice and 2 conversions to other bariatric procedures. Conclusion: LAGB, in combination with the patients' close follow-up performed by an interdisciplinary team, can be an effective long-term surgical treatment for teenagers with morbid obesity. Level of Evidence: Level I
Technical Details and Result of a Minimally Invasive Management of Gastric Band Erosions: a Series of 47 Patients
No full textIntroduction: Laparoscopic adjustable gastric banding (LAGB) is proven to be a safe and effective treatment option for obesity in the long term. However, in recent decades, LAGB prevalence progressively decreased worldwide principally due to the incidence and the management of the complications. Understanding the optimal management of the complications becomes therefore of primary importance. The aim of this study is to describe a personal technical, laparoscopic solution of band erosion and to analyze outcomes in 47 patients. Methods: From October 1995 to January 2019, 3697 LAGB were performed at our institution. Since November 2011, an original laparoscopic gastric banding removal technique was introduced. All the bands placed in these patients were Lap-Band AP System (Allergan, Irvin, CA). The data of the patients who underwent gastric band removal because of band erosion were retrieved from a prospectively collected institutional database, and used for the present retrospective evaluation. Result: Ninety-four patients (2.5% of the entire casuistic) with eroded band were diagnosed and treated at our institution. Forty-seven patients were treated with the laparoscopic gastric banding removal technique introduced in November 2011. All the operations have been performed laparoscopically with no conversion or intraoperative complications. There were neither major complications nor peri-operative (30 days) mortality. Conclusion: Proper preoperative management and a standardized minimally invasive technique could help to cope with erosion, the most frightening complication of LAGB. Understanding the optimal management of complications and safe reoperation techniques can contribute to a rational use of the LAGB, reversing the current declining tendency
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Contrast enhanced ultrasound for the diagnosis of bilateral renal lymphangiectasia: literature review and contrast enhanced ultrasound findings
No full textRenal lymphangiectasia (RLmp) is a rare benign lymphatic malformation which should be distinguished from other more common pathologies. Ultrasound (US) examination can define the first diagnostic suspicion, but the definitive diagnosis is usually reached with a second level imaging such as computed tomography (CT) or magnetic resonance imaging (MRI). We herein describe for the first time in literature, the use of the contrast enhanced ultrasound (CEUS) in disclosing the nature of peri-renal anechoic lesions in a 27-years old woman, that were initially confused with parenchymal cysts at B-Mode US. The diagnosis of RLmp may be particularly demanding due to its rarity and different clinical presentations. We suggest a possible role of CEUS as a real time, cost saving and easily accessible second level diagnostic tool, that can represent an appealing alternative in the diagnostic work up of suspected RLmp, respect to other imaging modalities
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