Journal of the American College of Surgeons
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The aim of this study was to determine if an intraoperative injection of iodine-125-labeled methylene blue ((125)I-MB) is a sensitive and effective method for detecting SLNs in women with breast cancer. ⋯ Iodine-125-labeled methylene blue can be mixed and administered in the operating room, improving hospital efficiency. Patient satisfaction is higher with (125)I-MB than with the technetium 99m sulfur colloid procedure because (125)I-MB does not produce localized burning and other adverse reactions associated with the traditional method, and 125I-MB is administered with the patient under anesthesia. Iodine-125 emits a lower-energy gamma ray than technetium 99m, lowering the surgeon's radiation exposure. Iodine-125-labeled methylene blue SLN identification is safe, cost effective, and produces equivalent outcomes compared with the traditional technique, making it an attractive alternative.
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Kidney transplantation from deceased donors with terminal acute kidney injury (AKI) is not widely accepted. ⋯ Although AKI donor kidneys more commonly have DGF, the higher rate of DGF does not worsen graft outcomes. Kidneys from deceased donors with terminal AKI transplanted into appropriately selected patients have excellent medium-term outcomes and represent a method to safely expand the donor pool.
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Our aim was to analyze our single-center experience with orthotopic liver transplantation for metabolic lethal genetic syndromes in children and adults. ⋯ Orthotopic liver transplantation achieved excellent long-term survival in pediatric and adult patients with lethal genetic syndromes and represents a model of personalized genomic medicine by providing gene therapy through solid organ transplantation.
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The increased use of marginal donors, an aging recipient population, and Diagnosis-Related Group (DRG) cost restraints place significant pressures on kidney transplant centers to maintain financial viability while sustaining high quality outcomes. We engaged in a quality initiative in delayed graft function (DGF) kidney transplant recipients aimed at improving safe and efficient discharge. ⋯ These results demonstrate that health care value can be significantly improved in kidney transplant recipients, particularly in DGF patients, by implementing a multidisciplinary initiative aimed at safely and efficiently discharging patients.
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Routine use of operative (primary) drains after pancreaticoduodenctomy (PD) remains controversial. We reviewed our experience with PD for postoperative (secondary) drainage and postoperative pancreatic fistula (POPF) rates based on use of primary drains. ⋯ Placement of closed suction drains during pancreaticoduodenectomy does not appear to decrease the rate of secondary drainage procedures or reoperation, and may be associated with increased pancreatic fistula formation and overall morbidity. These data support foregoing routine primary operative drainage at time of pancreaticoduodenectomy.