BACKGROUND New-onset diabetes after transplantation (NODAT) is a complication of solid organ transplantation. We sought to determine the extent to which NODAT goes undiagnosed over the course of 1 year following transplantation, analyze missed or later-diagnosed cases of NODAT due to poor hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) collection, and to estimate the impact that improved NODAT screening metrics may have on long-term outcomes. MATERIAL AND METHODS This was a retrospective study utilizing 3 datasets from a single center on kidney, liver, and heart transplantation patients. Retrospective analysis was supplemented with an imputation procedure to account for missing data and project outcomes under perfect information. In addition, the data were used to inform a simulation model used to estimate life expectancy and cost-effectiveness of a hypothetical intervention. RESULTS Estimates of NODAT incidence increased from 27% to 31% in kidney transplantation patients, from 31% to 40% in liver transplantation patients, and from 45% to 67% in heart transplantation patients, when HbA1c and FBG were assumed to be collected perfectly at all points. selleck products Perfect screening for kidney transplantation patients was cost-saving, while perfect screening for liver and heart transplantation patients was cost-effective at a willingness-to-pay threshold of $100 000 per life-year. CONCLUSIONS Improved collection of HbA1c and FBG is a cost-effective method for detecting many additional cases of NODAT within the first year alone. Additional research into both improved glucometric monitoring as well as effective strategies for mitigating NODAT risk will become increasingly important to improve health in this population.BACKGROUND Cytochrome P450 (CYP) genes are necessary for the production or metabolism of fetal sex hormones during pregnancy. The second-to-fourth digit ratio (2D 4D) is formed in the early stage of human fetal development and considered an indicator reflecting prenatal sex steroids levels. We explored the association between 2D 4D and single-nucleotide polymorphisms (SNPs) of CYP. MATERIAL AND METHODS Correlation analysis between 2D 4D and 8 SNPs, rs2687133 (CPY3A7), rs7173655 (CYP11A1), rs1004467, rs17115149, and rs2486758 (CYP17A1), and rs4646, rs2255192, rs4275794 (CYP19A1), was performed using data from 426 female and 412 male Chinese university students. SNP genotyping was conducted using PCR. Digit lengths were photographed and measured by image processing software. RESULTS rs2486758 (CYP17A1) correlated with left hand 2D 4D in men (P=0.026), and rs1004467 (CYP17A1) correlated with right hand 2D 4D in men (P=0.008) and the whole population (P=0.032). In men, allele G rs1004467 decreased right hand 2D 4D, while allele C of rs2486758 increased left hand 2D 4D. In women, left hand 2D 4D was higher in genotypes with allele A of SNP rs4646 (CYP19A1) under the dominant genetic model; female DR-L was higher in genotypes with allele T of rs17115149 (CYP11A1). SNPs rs2687133 (CYP3A7) and rs1004467 (CYP17A1) were significantly correlated with right hand 2D 4D (P=0.0107). CONCLUSIONS SNPs rs1004467 and rs2486758 of CYP17A1 are significant in the relationship between 2D 4D and CYP gene polymorphisms under different conditions. SNP interactions between CYP genes probably impact 2D 4D. The correlation between 2D 4D and some sex hormone-related diseases may be due to the effect of CYP variants on the 2 phenotypes.The incidence of colorectal cancer (CRC) after liver transplantation is 0.5%-4%. Laparoscopic surgery is the standard-of-care treatment, however it is rarely performed in patients who had previously undergone liver transplantation. Few reports exist regarding minimally invasive surgery in such context and none about laparoscopic right colectomy. We present the case of a 64-year-old female with a history of liver transplantation in 2001 and who developed a right-sided CRC. A laparoscopic right colectomy was successfully performed, and the post-operative course was uneventful. Given the known benefits, we believe that laparoscopic approach should be considered in such patients.Postpartum retroperitoneal or pelvic haematomas are rare after vaginal delivery. The clinical presentation can vary from being an incidental finding to the development of life-threatening bleeding. Due to their rarity, there are no established guidelines for the management of these postpartum haematomas. The reported treatments vary from watchful observation to emergent laparotomy. We report a case of postpartum pre-sacral haematoma after uneventful vaginal delivery managed successfully by laparoscopic drainage after the failure of conservative treatment.Horseshoe kidney (HSK) is a rare congenital malformation of the kidneys and is commonly associated with other anomalies of the renovascular and ureteropelvic systems. These anomalies present a surgical challenge, especially for surgeries involving the retroperitoneum. We present the case of a 56-year-old male patient with biopsy-proven rectal cancer who had completed neoadjuvant chemoradiation and was planned for curative resection. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis revealed the presence of an HSK. Reconstructed three-dimensional (3D) images of the renal vasculature revealed the presence of an accessory renal artery originating directly from the aorta and supplying the isthmus of the HSK without any other venous or ureteral anomalies. Laparoscopic abdominoperineal resection with total mesorectal excision was done without any untoward complications. The presence of HSK per se is not a contraindication for laparoscopic operations involving the retroperitoneum. Pre-operative 3D CECT helps to identify the presence of anatomical variations and guides surgical resection.Choledochal cysts can present with abdominal pain, jaundice and stones.MRI is the standard imaging tool and the type of biliary enteric anastomosis depends on the cyst type.
Laparoscopic-Warshaw technique (lap-WT) may be selected as a function-preserving operation for malignant border lesions in the tail region of the pancreas. However, previous reports showed that there are complications such as infection and abscess formation due to lack of blood flow to the spleen after surgery. To overcome the problems, we have performed real-time vessel navigation by using indocyanine green (ICG) fluorescence during lap-WT.
We report our experience of three patients with pancreatic tumour who underwent real-time vessel navigation during lap-WT at Hokkaido University from May 2017 to September 2018.
The median operating time was 339 min (174-420). The median intraoperative bleeding was 150 ml (0-480). There were no incidences of complications. There were no cases with post-operative spleen ischaemia or abscess formation and varices formation.
We believe that laparoscopic real-time vessel navigation using indocyanine green fluorescence during lap-WT could contribute in reducing the post-operative spleen-related complications.selleck products
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