Patients undergoing hemodialysis have a lower survival rate than those who receive a kidney transplant. Mortality among hemodialysis patients is approximately 14.5% compared with 1.5% for transplant recipients. One of the exclusion criteria for renal transplant is severe iliac artery calcification. We performed an aortofemoral bypass in these patients to make them eligible for renal transplantation. Eleven patients were selected to receive an aortofemoral bypass. All had severe calcification of iliac arteries. Eight patients required a bypass from the thoracic aorta and two from the infrarenal level. Revascularization was successful in 10 patients. Patency was 100%. Surgery could not be performed in one owing to severe calcification of the femoral artery. One patient died owing to gastrointestinal bleeding. Two patients developed complications; one needed a splenectomy, and the other developed meningitis and paralytic ileus. To date, four patients have received transplants, and the viability of the transplanted kidney is good in all cases. Renal transplantation is the only method known to improve survival and quality of life for hemodialysis patients. We consider that if patients with severe iliac calcification are well informed of the morbidity and mortality risk of an aortic bypass, this intervention can be justified in this setting.
Although the feasibility of reimplantation has increased greatly with the development of new surgical techniques, long-term functional prognosis is unpredictable. Injury to a major nerve is an important factor in long-term outcome, and prolonged ischemia time also has a negative effect. We present a 26-year-old woman whose right arm was sectioned above the elbow in an accident. The limb presented a complete section, with soft tissue loss of the humeral artery and vein, basilic vein, and cephalic vein. Median and radial nerve tissue was missing, and a supracondylar fracture with substantial loss of the humerus was also observed. During reimplantation surgery, a temporary arterial shunt reduced ischemia time. A venous and arterial bypass was performed, and the 12-month results were good.
IntroductionThe use of mobile applications in the treatment of health issues is more frequently becoming common practice. Apps are fast, versatile, and manageable tools that allow the empowerment of patients and professionals, and can reduce the possible stigmatization suffered by some patients, mainly in mental health. There are more than 325,000 health apps on the market, but their impact remains unclear. There are several initiatives to define how health applications should be assessed, however, all of them address only partial aspects of the evaluation. The theoretical frameworks existing to date highlight the need to develop new tools and methodologies to assess mobile applications whose objective is the management of specific pathologies.MethodsThe primary goal of the EvalDepApps project is to develop and pilot an assessment tool for mobile applications whose main objectives are the treatment, monitoring or social support of people suffering from depression. The project is inspired by the results and lessons learnt from a previous project, EVALAPPS, whose central aim was to develop a tool to assess health apps targeted toward the management of overweight and obesity. The first steps of the EvalDepApps project are: (i) to explore and characterize the current landscape of mobile applications available in the market to treat depression through a systematic appraisal, and (ii) to review the existing evidence about the effectiveness and safety of these applications through systematic research of the existing evidence.ResultsPreliminary results show that all the depression management studies were by design based on cognitive-behavioral therapy (CBT) interventions (n=17) and the main management tools included in the services (web or apps) are psychoeducation and coaching (14), together with self-monitoring and feedback messaging (13).ConclusionsMoreover, although health apps seem to be an interesting strategy to treat depression, there are very few apps available on the markets (30) and the supporting evidence is very limited. This result uncovers a need for further systematic and clinically oriented validation and testing of such apps.
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