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ABO Incompatibility: Indications and Management

Introduction The transplantation of ABO-identical or ABO-nonidentical ABO-compatible grafts has for decades been the mainstay of organ transplantation. As post-transplant survival improves and the demand for organ transplants grows, several attempts have historically been made to transplant liver grafts from ABO-incompatible (ABOi) donors, particularly in emergency situations, both in children and adults. Historically, the transplantation of the kidney first broke the ABO blood group barrier, and…

Living Donor Liver Transplantation in Children

Introduction From the beginning of clinical transplantation, back in the 1950s, clinicians struggled to reconcile the contradictory interests in living-related donor transplantation. Murray and Merrill contributed to identifying the three basic principles to be promoted in the use of live donor organs: (1) a significant chance for a successful outcome for the recipient, (2) low risk to the donor, and (3) an informed consent from the…

Psychological/Social Aspects

The phenomenal success of pediatric liver transplantation (LT) for the treatment of end-stage liver disease over the last 30 years has changed how we define their optimal outcome. Increasing surgical experience and safer and more efficient immunosuppression have led to survival rates of 86% at 5 years. Current research is focused on quality of life, long-term outcomes, and weaning immunosuppression, whereas the indications for transplantation have…

Preparation for Pediatric Liver Transplant: Medical Aspects

Introduction Optimal preparation for pediatric liver transplantation (PLT) is accepted to be one of the cornerstones of favorable outcomes. Preparation depends on many factors spanning timely referral to emergent management at the time of an organ offer. Most of these factors will be covered in this chapter and are summarized in Fig. 6.1 . Timely referral depends on the diagnosis, with earlier referral generally preferred by…

Indications and Contraindications for Pediatric Liver Transplant

Introduction Liver transplantation has become the standard of care for children with an array of disease processes. Collectively, progressive hepatic disease with complications of end-stage liver disease (ESLD), metabolic disease with and without hepatic structural involvement, pediatric acute liver failure (PALF), and unresectable hepatic malignancies constitute the majority of current indications for liver transplant in children. Improvement in both patient and graft survival, in addition to…

Managing a Scarce Resource in Pediatric Liver Transplantation

Introduction For many end-stage organ diseases, transplantation remains the most effective and often the only option for curative treatment. This is especially true for liver disease, where supportive care and disease-specific therapies are the only treatment options readily available for fulminant liver failure outside of transplant. While alternatives are under investigation, there are currently no proven extracorporeal systems that can replace the liver function as dialysis…

Health System Requirements for Pediatric Liver Transplantation

Introduction The ultimate goal for a pediatric liver transplant (LT) program is for transplant recipients to live a normal lifespan free from disease recurrence or long-term morbidity. The healthcare needs of transplant recipients range in extremes from critical care early on to the maintenance of allograft and patient health in the years following transplant. The needs of patients are distinct over the phases of transplant care,…

What Is Different Between Pediatric and Adult Liver Transplantation?

Introduction Clinical liver transplantation stems from the pioneering work of Professor Thomas Starlz in Denver, Colorado, where he attempted the first human liver transplantation on March 1, 1963. The recipient was a 3-year-old child with biliary atresia, who unfortunately died in the operating room with overwhelming intraabdominal bleeding. A few other attempts followed shortly after, but, in view of dismal results, the transplantation program was stopped…

Brief History of Pediatric Liver Transplantation

Principal Historical Milestones and Breakthroughs Technical Aspects The basic technique of orthotopic liver transplantation was developed in dogs by Thomas E. Starzl in the early 1960s; the dog I watched myself when I was a research fellow with him in 1965 to 1966 lived for over 13 years under steroids and Imuran and served as the proof of concept. This original technique was successfully transposed to…

Foot and Ankle

Foot and Ankle General Guidelines Preoperative antibiotics are given half an hour before the incision is made Placing a bump beneath the appropriate hip can facilitate access to the desired part of the foot/ankle, which is especially important when considering the sequence of multiple procedures: a bump beneath the ipsilateral hip allows access to the lateral calcaneus for medial displacement osteotomy and then is removed to…

Knee and Lower Leg

Regional Anatomy Osteology Distal Femur ( Fig. 7-1 ) The femur (the largest bone in the body) flares distally and forms two condyles—a larger medial condyle and a longer and more narrow lateral femoral condyle The intercondylar area serves as the region for cruciate attachments—the lateral, anterior cruciate ligament (ACL) and the medial, posterior cruciate ligament (PCL) The superficial medial collateral ligament (MCL) attaches adjacent to…

Hip and Pelvis

Regional Anatomy and Surgical Intervals Regional Anatomy Osteology Pelvis ( Figs. 6-1 and 6-2 ) Iliac crest (palpable throughout its entire length) Landmark for several skin incisions External lip Iliac tubercle (outer surface of iliac crest about 5 cm posterior to the anterior superior iliac spine [ASIS]) Site for external fixator pin ASIS and posterior superior iliac spine (PSIS) Landmarks for incisions and for bone grafting Proximal…

Spine

Regional Anatomy and Surgical Intervals Regional Anatomy Osteology Occiput ( Fig. 5-1 ) Foramen magnum External occipital protuberance (inion) Thickest portion of bone (4-18 mm) Supreme, superior, and inferior nuchal lines Transverse sinus Cervical Vertebrae ( Fig. 5-2 ) C1 (Atlas) A ring that lacks a centrum and spinous process The groove for the vertebral artery sits posterior and superiorly C2 (Axis) Dens (odontoid process) Predental space…

Wrist and Hand

Regional Anatomy and Surgical Intervals Regional Anatomy Osteology ( Fig. 4-1 ) Distal Radius Radial styloid process Two fossae for carpal articulation Scaphoid fossa Lunate fossa Sigmoid notch—articulation with the distal ulna Lister's tubercle, which is between the second and third extensor compartments, acts as a pulley for the extensor pollicis longus (EPL) tendon Distal Ulna Ulna styloid process Fovea—depression at the base of the ulnar…

Elbow and Forearm

Regional Anatomy and Surgical Intervals Regional Anatomy Osteology ( Figs. 3-1 and 3-2 ) Distal Humerus Widens and flattens distally into medial and lateral supracondylar ridges, then medial and lateral epicondyles The extensor carpi radialis longus (ECRL) originates on the lateral supracondylar ridge Common flexor muscles and pronator teres originate on the medial epicondyle Common extensor muscles originate on the lateral epicondyle The capitulum articulates with…

Shoulder and Arm

Regional Anatomy and Surgical Intervals Regional Anatomy Osteology Scapula ( Fig. 2-1 ) A broad flat bone that serves as an attachment for 17 muscles and 4 ligaments The glenoid is typically retroverted 1.2 degrees with a normal range between 2 degrees of anteversion and 9 degrees of retroversion; glenohumeral osteoarthritis typically results in increased glenoid retroversion The scapular spine is the superior aspect of the…

Approach to the Surgical Patient

This book uses a bulleted text format and original color illustrations paired side by side with operative photographs to present orthopaedic anatomy and surgical approaches clearly. Regional Anatomy Regional anatomy for each section is presented in the following order: Osteology (Bones) There are 206 bones in the human skeleton ( Fig. 1-1 ) 80 in the axial skeleton 126 in the appendicular skeleton Arthrology (Joints) Diarthrodial…

Abbreviations

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Outlines of Common Surgical Notes

Pre-OP Note ∗ Date and time: ∗ See also Chapter 24. Pre-op diagnosis: Procedure planned: Staff surgeon: Pre-op examination: Pertinent pre-op laboratory studies: List of routine medications/therapies: Blood products available: -Confirm availability with a phone call to the blood bank the night before surgery Bowel preparation (if any): Pre-op antibiotics: VTE prophylaxis: Steroid preparation (if applicable): Other special therapies needed: -PAR statement (a brief statement that…

Reading X-Rays, Reading ECGs

Reading X-Rays ( Fig. A.1 and A.2 ) Reading ECGs Rate Multiply the number of QRS complexes in a 6-second period (30 large squares) (between the two large dots) by 10 = beats/minute ( Fig. A.3 ). Normal = 60 to 100 beats/minute Tachycardia = >100 beats/minute Bradycardia = <60 beats/minute Rhythm Is the rhythm regular? Is there a P wave preceding every QRS complex? Is…