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PubMed2004

Morbid obesity is not a contraindication to kidney transplantation.

BACKGROUND: Concern that morbidly obese (body mass index [BMI] 35) kidney transplant recipients have worse outcomes than non-morbidly obese recipients leads many transplant centers to deny them the benefit of kidney transplantation. These concerns are supported by guidelines recently published by the American Society of Transplantation. However, successfully transplanted morbidly obese persons have a survival advantage over those that remain on dialysis. It is our practice to evaluate morbidly obese transplant candidates for transplantation under the same criteria used for nonobese candidates. This report reviews our experience with morbidly obese kidney transplant recipients having a three year follow-up. METHODS: Outcomes for 23 morbidly obese (BMI 35, range 37 to 56) kidney transplant recipients transplanted between January 1995 and February 2000 were compared with 224 nonobese (BMI 25) kidney recipients transplanted during the same period. RESULTS: Patient and graft survivals were similar between both groups. Although 3-year graft survival for morbidly obese recipients of cadaver organs was 75% compared with 90% for the nonobese group, this finding was not statistically significant, and 3-year graft survival was 100% for morbidly obese recipients of living donor organs compared with 91% for nonobese recipients. Morbidly obese recipients had significantly longer hospital stays, higher readmission rates, and a higher wound infection rate than nonobese recipients. CONCLUSIONS: We found that morbidly obese persons have 3-year graft and patient survivals similar to nonobese persons. Although they also have greater complications and greater numbers of days in the hospital, we believe these reasons are not sufficient to deny morbidly obese persons the survival and quality-of-life advantages of kidney transplantation.

Actuarial Analysis↗
PubMed2004

Surgery for acute type A aortic dissection: is advanced age a contraindication?

BACKGROUND: With the general increase in human lifespan, cardiac surgeons are faced with treating an increasing number of elderly patients. The purpose of this study was to demonstrate early and late results of surgery for aortic dissection in patients older than 70 years of age compared with those younger than 70 years and to clarify the clinical problems related to this subset of patients. METHODS: Between 1976 and 2001, 315 patients underwent emergency operation for acute type A dissection: 245 were younger than 70 years (group 1) and 70 patients were 70 years of age and older (group 2). Early and late outcomes of both groups were compared. RESULTS: The hospital mortality rates were 20.5% in group 1 and 17.6% in group 2 (p = 0.751). The mean extracorporeal circulation time was 192.6 +/- 65.2 minutes and 185.7 +/- 58.4 minutes in groups 1 and 2, respectively (p = 0.42). The mean cross-clamp time was 116.3 +/- 45.8 minutes and 100 +/- 36.7 minutes in groups 1 and 2, respectively (p = 0.009). Actuarial survival rates were 77.1% after a mean follow-up time of 259 +/- 9 months for patients of group 1 and 80% after 77 +/- 5 months for patients of group 2, without any statistically significant difference (p = 0.619). CONCLUSIONS: No significant differences were observed in the 30-day mortality and actuarial survival between the two groups. Therefore we believe that surgery for type A acute aortic dissection in patients 70 years of age or older can be performed with acceptable risk of death and satisfactory results.

Actuarial Analysis↗
PubMed2007

Is extracorporeal life support contraindicated in elderly patients?

BACKGROUND: Extracorporeal life support (ECLS) using percutaneous extracorporeal membrane oxygenation (ECMO) is now considered an important means of resuscitation for patients suffering from refractory cardiogenic shock. The indications for the use of ECLS have yet to be established, however, and its use for elderly patients is still controversial. We retrospectively evaluated the impact of ECLS on the survival of patients with cardiogenic shock to determine the validity of using ECLS in elderly patients (> or = 75 years of age). METHODS: Between 2000 and 2004, 91 patients were emergently placed on percutaneous ECMO. The patients were divided into two groups by age (group 1, n = 79: less than 75 years; group 2, n = 12: 75 years or older), which were compared for clinical outcome. Logistic regression analysis of the variables was performed to identify predictors of ability to be weaned from ECLS. RESULTS: Weaning from ECLS was achieved in 50 patients in group 1 (63.3%) and 6 patients in group 2 (50%; p = 0.37). Thirty-five patients in group 1 (44.3%) and 5 patients in group 2 (41.7%) were discharged from the hospital (p = 0.86). Logistic regression analysis revealed that patients with a body surface area of more than 1.50 m2, patients with cardiomyopathy, and patients who underwent interventions under ECMO support were more likely to be successfully supported by ECMO. CONCLUSIONS: Extracorporeal life support using percutaneous ECMO systems provides excellent cardiac support. It is also effective in resuscitating elderly patients, yielding hospital survival similar to that for younger patients.

Adolescent↗
PubMedDate not supplied

Contraindications and complications with the use of botulinum toxin.

Cosmetic use of BTX has skyrocketed in recent years, especially since the approval of BTX-A for treatment of glabellar lines. Complications and adverse reactions can easily arise, particularly for the novice injector. This paper provides insights from an experienced physician on how to avoid these complications, and how to treat them when and if they occur. The main cosmetic uses for BTX are analyzed for possible complications and adverse events. Injection techniques are discussed. Comparisons between BTX-A and BTX-B are given to point out the need for different injection techniques based on the product being used. Treatment recommendations for the Glabella, Brow, Crow's Feet, Upper Lip Wrinkling/Lines, Depressor Anguli Oris, Nasolabial Folds, Mentalis, Neck and Hyperhidrosis are discussed, as well as systemic complications. It is important for the injecting physician to be familiar with these potential complications, even though the use of BTX has been safe and generally well tolerated, because it will lead to even greater success with the use of BTX.

Botulinum Toxins, Type A↗
PubMed2004

Adverse effects of direct current cardioversion on cardiac pacemakers and electrodes Is external cardioversion contraindicated in patients with permanent pacing systems?

Use of pacing in sick sinus syndrome and recent developments in pacemaker therapy for intermittent atrial fibrillation raise the question of whether external electrical cardioversion should be used for termination of atrial fibrillation. This paper analyzes three cases of pacemaker and/or electrode dysfunction appearing after direct current (DC) cardioversion for termination of atrial fibrillation. Despite similar conditions during cardioversion in all cases, different dysfunctions reflecting damage to the pulse generator and/or a rise of the stimulation threshold in both, atrial and ventricular leads, have been observed. The possible mechanisms for these effects are discussed and recommendations for the management of cardioversion in patients with permanent pacemaker systems are given.

Aged↗