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A high incidence of shoulder involvement was seen in severely disabled young people suffering from juvenile chronic polyarthritis who were undergoing surgical procedures on the lower limbs. The progressive nature of the radiological changes is described. Possible lines of surgical management are considered.

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A technique of arterial reconstruction suitable for patients with extensive arterial occlusions and for previous failed arterial surgery is described. The "hitch-hike" graft consists of a proximal limb of 6-mm velour Dacron prosthesis and a distal limb of autogenous vein. The intermediate prosthesis-to-vein anastomosis is made into an endarterectomized segment of upper popliteal artery. The results in the first 16 limbs are described. Eleven grafts are functioning from 2 to 14 months after operation and 5 of these have functioned for more than 1 year. The advantages of the technique are: long arterial occlusions may be bridged; autogenous vein is used to cross the knee joint; good measured blood flows may be demonstrated at operation; acceptable patency rates may be obtained up to 1 year.

A high incidence of shoulder involvement was seen in severely disabled young people suffering from juvenile chronic polyarthritis who were undergoing surgical procedures on the lower limbs. The progressive nature of the radiological changes is described. Possible lines of surgical management are considered.

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Background: Despite increasingly sicker patients and changes in perioperative techniques, the contemporary era of simultaneous heart kidney transplantation (HKT) has not been well described. We report intraoperative characteristics, postoperative medical management and causes of death in patients undergoing HKT at a single center. Methods: Patients undergoing HKT between 2009 and 2015 at Temple University Hospital were identified through review of the electronic medical record and the UNOS registry. Demographics, cause of cardiomyopathy and renal failure, comorbidities and need for preoperative dialysis, mechanical circulatory support (MCS) and inotropes were identified. Cardiac allograft ischemic time and type of immunosuppression therapy were collected. Incidence of treated rejection and death was measured. Results: Six patients underwent HKT, with average age of 61.7 ± 9.1 years. Four were male. Causes of cardiomyopathy included transplant vasculopathy (n = 3), ischemic cardiomyopathy (n = 2) and non ischemic cardiomyopathy (n = 1). Overlapping causes of renal failure were identified, including the cardiorenal syndrome (n = 3), diabetic nephropathy (n = 1), drug toxicity (one calcineurin, one vancomycin), and acute tubular necrosis (n = 2). Prior to HKT, two patients required inotropes, two MCS and two dialysis. All patients received induction immunosuppression (two basiliximab and four alemtuzumab). Average cardiac allograft ischemic and pump times were 157.6 ± 35.5 min and 185.6 ± 58.5 min respectively. One patient was treated for cardiac rejection and one for kidney rejection within the first year. One was initiated on dialysis more than 5 years after HKT. Two patients died within the first year due to sepsis and multiorgan failure. The remaining four were alive at the last clinic visit, median 801 days after HKT. Conclusions: At our center, most patients undergoing HKT required advanced hemodynamic support, with either MCS or inotropes. Causes of cardiomyopathy and renal failure were varied. One year mortality remains high in the first year after transplant and appears related to infectious complications in this sick population. Further research is required to delineate the ideal perioperative strategy regarding immunosuppression and Intraoperative management.