There is a lack of universally accepted clinical parameters to guide the utilization of donation after cardiac death (DCD) donor livers and it is unclear as to which patients would benefit most from these organs. We reviewed our experience in 141 patients who underwent liver transplantation using DCD allografts from 1993 to 2007. Patient outcomes were analyzed in comparison to a matched cohort of 282 patients who received livers from donation after brain death (DBD) donors. Patient survival was similar, but 1-, 5-and 10-year graft survival was significantly lower in DCD (69%, 56%, 44%) versus DBD (82%, 73%, 63%) subjects (p < 0.0001). Primary nonfunction and biliary complications were more common in DCD patients, accounting for 67% of early graft failures. A donor warm ischemia time >20 min, cold ischemia time >8 h and donor age >60 were associated with poorer DCD outcomes. There was a lack of survival benefit in DCD livers utilized in patients with model for end-stage liver disease (MELD) ≤30 or those not on organ-perfusion support, as graft survival was significantly lower compared to DBD patients. However, DCD and DBD subjects transplanted with MELD >30 or on organ-perfusion support had similar graft survival, suggesting a potentially greater benefit of DCD livers in critically ill patients.

A prospective randomized douhle-hlind trial comparing Opsite alone, Opsite after application of hupivacaine, scarlet ointment dressing alone and scarlet ointment after hupivacaine was done to assess the effect of these four dressing regimens on split skin donor site pain and healing. Significantly less pain was reported by those dressed with Opsite and this was thought to he due to the immobility of an Opsite dressing. Many of the patients dressed with scarlet ointment felt no pain. It was concluded that movement of dressings is the main factor in pain production and that hupivacaine appeared to have no effect. There was no difference, in healing rates between those treated with Opsite and those treated with scarlet ointment. It is concluded that using Opsite is a convenient way of preventing donor site pain, hut that to gain maximum advantage from this it should not he applied under tension.

A case of myeloma of the oesophagus is presented. A search of the literature has revealed no other. The tumour was treated by local resection and postoperative treatment with cyclophosphamide was attempted. The patient died 14 months after operation from a massive myocardial infarct and at necropsy no tumour was found in any organ.

Piperacillin was administered in eighteen patients with mixed Infections. Three had osteomyelitis, two had peritonitis, two had gangrenous toes, one had bronchopneumonia, and the other ten had leg ulcers of various types accompanied by cellulitis. In eleven patients one of the infecting organisms was Pseudomonas aeruginosa, and another had Pseudomonas maltophilia. All had appropriate surgical treatment, which in nine patients included skin grafting in the presence of Pseudomonas aeruginosa. All the patients were clinically cured except for one with osteomyelitis who relapsed and was found to have a residual sequestrum. None of the skin grafts failed. In other patient who underwent grafting, cloxacillin was also given because she had a beta‐lactamase‐produclng staphylococcus. The only adverse reaction was thrombophlebitis of the vein used for drug administration in 15 out of 18 patients. One hundred and five other isolates of Pseudomonas aeruginosa were tested in the laboratory against piperacillin and resistance to the drug was found to be rare. It was concluded that piperacillin is a safe drug to use, is effective against a wide range of organisms, and is particularly effective in preventing the destruction of skin grafts by Pseudomonas aeruginosa. It is likely to be ineffective against beta‐lactamase‐produclng staphylococci, and when these are present also, it would be wise to use another drug such as cloxacillin in addition.

Isolated adrenal metastasis: the role of laparoscopic surgery. World J Surg 2006; 30: 888-892. 2 Sarela AI, Murphy I, Coit DG, Conlon KC. Metastasis to the adrenal gland: the emerging role of laparoscopic surgery.