Skip to main content Accessibility help
×
  1. Home
  2. Browse subjects
  3. Medicine
  4. Surgery
  5. Content listing

Refine search

Refine search

Access:
Content type:
Publication date:
Apply   From and To filters
Subject: Show more
Journals Show more
Publishers: Show more
Societies Show more
Series: Show more
Collections: Show more

Actions for selected content:

Select all | Deselect all
  • View selected items
  • Export citations
  • Download PDF (zip)
  • Save to Kindle
  • Save to Dropbox
  • Save to Google Drive

Save Search

You can save your searches here and later view and run them again in "My saved searches".

Please provide a title, maximum of 40 characters.
Cancel
×

3823 results in Surgery

Page 114 of 192

  • Chapter 26 - Pediatric liver transplantation

  • from Section 4 - Liver
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 220-230

  • Summary

    Bilateral lung transplantation (BLT) has evolved into a routine procedure and is the most frequently performed method. Traditionally single lung transplantation (SLT) has been the procedure of choice in patients with non-infective end-stage lung disease such as chronic obstructive pulmonary disorder (COPD) and idiopathic pulmonary fibrosis (IPF). Most common incisions for SLT are the posterolateral thoracotomy, anterolateral thoracotomy and median sternotomy, which are usually used if cardiopulmonary bypass (CPB) has to be employed. The preferred surgical incision for BLT is a bilateral transverse thoracotomy joint across the middle, best known as a clamshell incision. Cannulation for CPB is achieved using the ascending aorta and both the inferior vena cava (IVC) and superior vena cava (SVC) with tapes around for sealed occlusion. After intensive animal research and clinical experience gained from kidney and liver donation, the technique of lung donation after cardiac death (DCD) has been established successfully in recent years.

  • Chapter 28 - Sensitization of kidney transplant recipients

  • from Section 5 - Kidney
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 238-247

  • Summary

    This chapter focuses on postoperative fluid management and early complications of lung transplantation (LT). Patients with emphysema who undergo single LT (SLT) require special attention to airway pressures and the compliance difference between the allograft and the native lung. Postoperative antimicrobial coverage should be modified if pathogens are identified in the sputum of the donor that is not already covered by the recipient-specific regimen. Postoperative hemodynamic instability has been common in patients with underlying pulmonary hypertension. Maintaining optimal nutrition in the postoperative period is essential and may improve operative outcomes. Early complications of LT can be classified into four categories: complications of the surgery itself, re-implantation response and primary graft dysfunction (PGD), immunologic complications including rejection, and organ-specific complications of the immunosuppressive agents. Standard therapy is recommended in the early post-transplant setting, although a focal structural abnormality may require surgical removal if it becomes the source of recurrent infection.

  • Chapter 40 - UK and European service – legal and operational framework

  • from Section 8 - The transplant service
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 335-346

  • Summary

    This chapter considers the importance of recipient sensitization with particular reference to renal transplantation. It considers the clinical relevance of both human leukocyte antigen (HLA) and non-HLA antibodies in graft outcomes. Measurement of panel-reactive antibodies (PRA) by complement-dependent cytotoxicity cross-match (CDC) has been largely replaced by more sensitive and less cumbersome solid-phase assays, which report a calculated PRA or population-reactive antibodies. Factors relating to donor, recipient, and locally available resources play a role in the final decision regarding what constitutes an acceptable level of risk and how it is managed. Virtual cross-match has applications in pretransplant risk assessment and can assist with the process of organ allocation. The accuracy of immunological risk assessment has improved the options available for the successful transplantation of highly sensitized recipients has increased. The options include paired-donation programs, acceptable mismatch programs, and desensitization. In HLAi transplants, donor-specific antibody (DSA) levels are monitored using solid-phase assays.

  • Chapter 17 - Management during surgery

  • from Section 3 - Lung
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 138-144

  • Summary

    Mechanical circulatory support devices (MCSD) include the use of extra corporeal circulatory support, implantable ventricular assist devices (VAD), and total artificial hearts. The need for smaller implantable devices, with control systems that facilitated return to community living, motivated the next generation of devices. The International Registry for Mechanically Assisted Circulatory Support (INTERMACS) has developed a classification system of heart failure (HF) that best identifies their urgency and status and is tailored to the indications of MCS. Careful selection of patients is a cornerstone in a successful VAD program. VADs provide left-, right-, or bi-ventricular support. MCSD are classified according to the duration of support, low characteristics, and/or pump mechanism. Preoperative preparation should focus on optimizing end-organ function and right ventricle (RV) function. Outpatient management represents more efficient use of health care resources and is of high importance for patient quality of life.

  • Chapter 33 - Pediatric kidney transplantation

  • from Section 5 - Kidney
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 278-285

  • Summary

    Careful selection of both donor and recipient is crucial in preventing donor complications and optimizing recipient outcomes. Hepatocellular carcinoma (HCC) patients usually have less portal hypertension and lower chemical Model for End-Stage Liver Disease (MELD) scores. Donor selection criteria vary slightly among different programs. Donor safety is the primary concern; therefore, the ideal graft is the one that leaves a donor a future liver remnant (FLR) above 35% and at the same time provides a graft with an adequate size with respect to the recipient. Despite donor safety being of paramount importance in living donor liver transplantation (LDLT), finite morbidity and mortality rates has been reported worldwide. Intraoperative hemodynamic studies are emerging in recent years as a tool to guide implantation technique and in low modulation. The severity of liver disease and recipient status along with severe portal hypertension also affects the risk of small-for-size syndrome (SFSS).

  • Chapter 34 - Pancreatic transplantation

  • from Section 6 - Other abdominal organs
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 286-294

  • Summary

    A successful liver transplant requires a number of procedures, including donor hepatectomy, preparation of the donor liver, recipient hepatectomy, and implantation of the liver graft. A midline laparotomy and sternotomy are performed and can be extended using transverse abdominal incisions to maximize surgical access. Preparation of the liver for transplantation is usually performed following a period of efficient cooling in an ice box and transportation to the recipient center. The hepatectomy begins with division of the left triangular ligament, falciform ligament, and lesser omentum before moving to the hilum. The greatest challenge when performing the portal venous anastomosis is the presence of portal vein thrombosis (PVT), which was originally an absolute contraindication to liver transplantation, but is now part of standard practice. Reperfusion of the liver is often the most dangerous part of the transplant procedure, and close communication between surgeon and anesthetist is crucial.

  • Chapter 36 - Intestinal transplantation

  • from Section 6 - Other abdominal organs
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 303-312

  • Summary

    The most common causes of death after the first year following liver transplantation are recurrent and de novo malignancy, return of the original liver disease in the graft, sepsis, cardiovascular disease, and chronic rejection. Review frequency varies between centers and depends partly on patient morbidity. The aim of follow-up is to screen for graft dysfunction and the late complications of liver transplantation. Complications of immune suppression may be related to the original etiology or unrelated and similar to other organs. Azathioprine (AZA) or mycophenolate mofetil (MMF) are often used as long-term maintenance immunosuppression. Up to 45% of liver transplant recipients have metabolic syndrome that includes excessive weight gain, hypertension, diabetes, and hyperlipidemia. Biliary stricture and incisional hernia are the most common late surgical complications after liver transplantation. Psychosocial health should be considered as an important facet in the long-term management of liver transplant recipient.

  • Chapter 35 - Pancreatic islet transplantation

  • from Section 6 - Other abdominal organs
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 295-302

  • Summary

    This chapter outlines the pathophysiology of liver disease as it affects patient selection and management in the peri-operative period and key aspects of anesthetic, surgical, and early postoperative care. The most important early complications are primary non-function, hepatic artery thrombosis, and bleeding. Pulmonary hypertension is seen in up to 20% of adult liver transplant candidates and is usually identified by transthoracic echocardiography. Full multi-system assessment should be performed before listing for transplantation, and the patient reviewed when a donor liver becomes available. Management of liver transplant recipients between transplantation and discharge is usually undertaken by a multi-disciplinary team that includes intensivists, hepatologists, and transplant surgeons. Most liver recipients are transferred to the intensive care unit (ICU) for postoperative care. Sepsis is common after transplant and is frequently associated with liver dysfunction. Culture results from the donor and targeted antimicrobial treatment should be considered in recipients with unusual presentations of sepsis.

  • Chapter 2 - Immunological principles of acute rejection

  • from Section 1 - General
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 9-18

  • Summary

    This chapter outlines the events involved in the adaptive and innate immune responses to a transplant and the subsequent mechanisms of rejection, concluding with current clinical and experimental strategies to protect transplants from immune-mediated damage. The recognition of foreign antigens by naive host (recipient) T cells is a principal step in the rejection process. Allorecognition in the presence of costimulation results in the activation and expansion of T-cells that recognize the mismatched donor alloantigens. Immunosuppressive therapy can be credited with the vast improvements in transplant survival. The chapter explores the underlying mechanisms of action in relation to the immunobiology. Newer monoclonal antibodies include alemtuzumab, rituximab, basiliximab, and daclizumab, which target specific T-cell surface proteins. The advances in immunosuppression have improved short- and medium-term graft survival rates and reduced the rates of acute rejection, but this has not been followed by a comparable reduction in long-term graft dysfunction rates.

  • Chapter Chapter 30 - Surgical procedure

  • from Section 5 - Kidney
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 253-257

  • Summary

    This chapter addresses aspects of lung transplantation (LT) that are unique to infants, children, and adolescents. The primary diagnoses leading to LT in the pediatric age group are cystic fibrosis (CF) and pulmonary hypertension, either idiopathic or related to congenital heart disease. The main difference in surgical technique relates to the increased use of bypass. The vast majority of pediatric LT recipients receive two lungs; for those with CF and other suppurative diseases, the decision is based on the infection risk. Transbronchial biopsies (TBBx) are also more challenging in pediatrics, particularly in infants and toddlers. Graft failure and infection are important causes of death in the first year after transplant. In pediatrics, as few centers perform enough transplants each year to adequately power outcome studies, uniform treatment strategies and multi-center collaborations helps to identify strategies for earlier diagnosis and allow assessment of treatment efficacy.

  • Section 5 - Kidney

  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 231-285

  • Summary

    The preoperative evaluation of kidney transplant candidates involves transplant surgeons, nephrologists, mental health professionals, social workers, dieticians, financial coordinators, and transplant coordinators. There are several absolute and relative contraindications to kidney transplantation. Immunologic evaluation begins with a thorough history of potential antigen exposure, including prior transplantation of any kind, blood product transfusion, and, in female candidates, prior pregnancy. Cardiovascular disease is the leading cause of death, and therefore graft loss, in the first year post transplant. Depending on the malignancy, a disease-free period of between 2 and 5 years is generally accepted as adequate. As the transplanted kidney usually drains into the native lower urinary tract, underlying urologic disease can affect the transplant outcome. In the future, diabetes management via islet cell transplantation, coupled with kidney transplantation, may be considered. A multi-disciplinary approach considering cognitive and other psychosocial factors is necessary to ensure successful transplantation.

  • Chapter 20 - Pediatric lung transplantation

  • from Section 3 - Lung
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 164-172

  • Summary

    In the immediate postoperative period, close attention must be paid to hemodynamic stability by focusing on preventing right ventricular failure and maintaining chronotropic competence. Preoperative support of the recipient circulation by mechanical assist devices appears to significantly increase the risk of post-transplantation primary graft failure. Primary cardiac allograft failure accounts for 40 percentage of mortality within 30 days of heart transplantation (HT). Following HT, the use of intraoperative and peri-operative corticosteroids remains the mainstay of early therapy. Monitoring of therapeutic drug levels is important but there is some controversy in how best to monitor the target levels of calcineurin inhibitors (CNIs). Early after transplantation, particularly in the first 3 months when the risk of rejection is highest, invasive biopsies are recommended at decreasing intervals. Close vigilance for re-emergence of circulating antibodies is needed, and newer approaches using complement inhibitors or intensive B-cell modulating drugs such as bortezomib are being studied.

  • Chapter 37 - Composite tissue allotransplantation

  • from Section 7 - Other
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 313-319

  • Summary

    Liver transplantation (LT) is the accepted treatment for a wide variety of liver diseases in children. Some children develop hepatorenal or hepatopulmonary syndrome, which often reverses after LT. Acute liver failure (ALF) is rare in children, but is associated with significant mortality. Donor liver grafts for children are most commonly obtained from donation after brain death (DBD) donors. Split LT provides two grafts from a single donor, the left lateral segment for a child and the right lobe for an adult. Tacrolimus (TAC) is now the preferred agent for maintenance immunosuppression in pediatric LT. Immunosuppression generally requires the use of steroids, which are rapidly weaned or withdrawn in the majority of children. Common causes for retransplantation are hepatic artery thrombosis (HAT), primary graft dysfunction (PGD), chronic rejection and biliary complications. Health-related quality of life (HRQOL) assesses markers of overall well-being and functional outcomes, including physical, psychological, and social functions.

  • Chapter 39 - Corneal transplantation

  • from Section 7 - Other
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 330-334

  • Summary

    Corneal transplantation, or keratoplasty, is the surgical procedure most commonly used in the management of blinding opacification of the normally transparent cornea. When donor eyes are transported to eye banks, cornea is removed for storage at either 4ºC for up to 10 days in chondroitin sulphate-based medium or 34º C in serum-based medium. Anterior lamellar surgery can be sufficient to restore transparency in those corneas with stromal opacity but healthy endothelium; conversely, posterior lamellar replacement may sluice in those with healthy stroma. Both the anterior chamber together with the peripheral recipient corneal bed and allogeneic donor cornea itself enjoy relative immune privilege. Some features of the immunobiology of corneal rejection differ from allogeneic rejection of other transplanted tissues. The key to successful treatment of corneal graft rejection is early recognition of the rejection episode by the patient and clinician.

  • Chapter 42 - Conclusions

  • from Section 8 - The transplant service
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 355-356

  • Summary

    The most common surgical approach used for cadaveric donor nephrectomy is the en bloc technique through a large abdominal incision. Transplantation using organs from cadaveric donors is always performed with the over-riding need to minimize the cold ischemic time of the organ. There are a number of techniques for anastomosing the ureter to the bladder. These include the Leadbetter-Politano or a direct vesico-ureteric anastomosis. Many patients with renal failure have significant atherosclerosis, with calcification resulting in noncompressible solid arteries that cannot be clamped. Careful preoperative assessment by computed tomography scanning should allow identification of calcified arteries before listing for transplantation. The preferred donor procedure is a laparoscopic nephrectomy, with mobilization of the kidney assisted by the use of a hand port, usually through a small infra-umbilical midline incision through which the kidney is removed. Late vascular complications are usually stenosis of the arterial anastomosis.

  • Section 4 - Liver

  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 173-230

  • Summary

    A stringent process of selection of appropriate candidates for liver transplantation is necessary for a number of reasons. This chapter discusses deceased organ transplantation in adults. In liver transplant practice, a distinction needs to be made between the process of selection of appropriate candidates for transplant, which is the main focus of the chapter, and that of organ allocation for those candidates who have been placed on the waiting list for the procedure. Both of these processes are underpinned by similar considerations with respect to the relevant clinical end points and ethical standpoints. The practice of candidate selection and organ allocation is predicated on two fundamental ethical principles: justice (or equity) and utility. Most liver transplant programs have adopted the Milan criteria for selecting patients with hepatocellular carcinoma (HCC) for transplantation. Rarely, patients with heart and liver failure will be considered for combined heart-liver or heart-lung-liver transplant.

  • Chapter 4A - Major complications – cancer

  • from Section 1 - General
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 31-37

  • Summary

    This chapter is based on the study of data collected by Cincinnati Transplant Tumor Registry (CTTR) and the available literature published by both North American and European organ transplant centers. It reviews the characteristics of the most important de novo malignancies in organ allograft recipients. The most frequent cancers in transplant recipients are skin and lip cancer, solid organ malignancies, and post-transplant lymph proliferative disorder (PTLD). Two epidemiological studies have shown a 20- to 40- fold increased incidence of hepatocellular carcinoma (HCC) in transplant recipients compared with age-matched controls. Sarcomas, breast carcinoma, bladder, and bowel cancers are particularly seen after transplantation. Skin cancer is the second most common malignancy after PTLD, and melanomas comprised 16% of all skin cancers in children compared with 5% among adults. Understanding the increased risk of malignancy of transplant recipients, careful surveillance and screening for selected malignancy should be undertaken.

  • Chapter 11 - Postoperative care and early complications

  • from Section 2 - Heart
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 94-101

  • Summary

    Chronic rejection is widely regarded as difficult to diagnose, of obscure etiology, untreatable, and irreversible. The immunological basis of transplant arteriopathy (TA) is under active investigation. The belief that the process is immunologically mediated is based on the observations that TA rarely arises in auto grafts. Three separate and possibly synergistic pathways have been identified: T-cells, antibody-mediated injury, and natural killer (NK) cells. The majority of late kidney graft losses are associated with donor-specific antibodies (DSA) and/or C4d deposition, and the risk of subsequent graft failure is significantly worse after a C4d+ biopsy. Transient lobular hepatitis may also be a feature of chronic rejection and is potentially reversible, although vanishing bile duct syndrome (VBDS) and TA are resistant to current therapy. The lesions of chronic rejection in the lung consist of TA and a lesion occluding airways that is termed obliterative bronchiolitis (OB).

Page 114 of 192