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Salt Lake City, UT, United States

Soin A.S.,Medicity
Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology | Year: 2014

ABO incompatibility is the commonest reason for rejection of donors in living donor liver transplantation (LDLT). The donor pool could be expanded by 25 % to 35 % if the ABO barrier is overcome. In the absence of pre-conditioning, transplantation across the blood groups is fraught with the almost universal risk of antibody-mediated rejection (AMR) that rapidly leads to graft loss. However, AMR can be prevented by removal of preformed antibodies and reducing their production by B cells. We describe our initial experience of three cases of ABO-incompatible (ABO-i) LDLT: a 42-year-old male, an 8-month-old male and a 28-month-old female, all of blood group O+ who received blood group B + right lobe, B + left lateral segment, and A + left lateral segment liver grafts, respectively. Pre-LDLT conditioning included administration of anti-CD20 antibody (Rituximab(®)) to the adult 4 weeks prior, and four to seven sessions of double-filtration plasmapheresis to all, to remove preformed antibodies and achieve anti-donor blood group antibody (ADA) titers of ≤ 1:16 IgG and ≤ 1:8 IgM, respectively. In addition, cases 1 and 3 received mycophenolate mofetil for 7 days prior to LDLT. After LDLT, all three patients achieved normal graft function over 8-17 days with no evidence of AMR and without the need for further plasmapheresis. Postoperative complications included portal vein thrombosis (one successfully re-explored), CMV (one), Pseudomonas and Klebsiella sepsis (one each), and abdominal collection (one treated with percutaneous drainage). All are currently well with normal graft function and low ADA titers at 8, 16, and 19 months after ABO-i LDLT.


Barreto S.G.,Medicity | Windsor J.A.,Auckland City Hospital
The Lancet Oncology | Year: 2016

Interest in radical surgery to achieve complete resection and improve long-term survival in patients undergoing pancreatoduodenectomy for ductal adenocarcinoma has been renewed. This surgery includes extended lymphadenectomy, multivisceral resections, and synchronous arterial and venous resections. The evidence that these surgeries improve long-term survival is poor, except perhaps for synchronous venous resection, which can be justified if a margin negative (R0) resection is achieved without increased morbidity and mortality, and if there is no invasion of the vein wall. The recognition of patients with borderline resectable pancreatic cancer and the increasing use of neoadjuvant treatment makes it more difficult to know if the vein is invaded, increases reliance on trial dissection to establish resectability, and might increase the number of synchronous venous resections done. This Personal View seeks to review the justification for pancreatoduodenectomy with synchronous venous resection to promote debate and draw attention to the gaps in knowledge for further research. © 2016 Elsevier Ltd.


Patent
Medicity | Date: 2013-12-16

A system and method for managing patient consent. A Master Matching Index (MMI) includes a collection of patient information and identifiers. An MMI adapter is coupled to the MMI for sending queries to the MMI for a health related entity. The MMI adapter comprises a data access manager that includes a lookup module, an authorization engine, an auditing module, a report module and a user interface engine. The user profile engine generates and updates user profile information. The lookup module enables a user to query patient information. The authorization engine determines whether the user has authorization to access patient information. The auditing module logs and monitors user activity. The report module generates reports related to user activity. The user interface engine generates user interfaces for displaying the user profiles, patient profiles and patient data.


Patent
Medicity | Date: 2012-01-09

A system and method for managing patient consent. A data access manager includes a controller, a lookup module, a clinical authorization engine, a logging/auditing unit, a user profile engine, a report module and a user interface engine. The controller manages the core functions and the transmission of data between the data access manager components. The lookup module enables a user to query patient data. The clinical authorization engine authorizes access to patient data. The logging/auditing unit logs and monitors user activity. The user profile engine accesses and updates user profile information. The patient profile engine accesses and updates patient profile information. The report module generates reports related to the user activity. The user interface engine generates user interfaces for displaying the user profiles and patient information data.


Patent
Medicity | Date: 2014-11-14

A system and method for managing patient consent. A data access manager includes a controller, a lookup module, a clinical authorization engine, a logging/auditing unit, a user profile engine, a report module and a user interface engine. The controller manages the core functions and the transmission of data between the data access manager components. The lookup module enables a user to query patient data. The clinical authorization engine authorizes access to patient data. The logging/auditing unit logs and monitors user activity. The user profile engine accesses and updates user profile information. The patient profile engine accesses and updates patient profile information. The report module generates reports related to the user activity. The user interface engine generates user interfaces for displaying the user profiles and patient information data.

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