As of October 1, 2007, 25 North American medical institutions and one European islet transplant center reported detailed information to the Registry on 315 allograft recipients, of which 285 were islet alone (IA) and 30 were islet after kidney (IAK). Of the 114 IA recipients expected at 4 years after their last infusion, 12% were insulin independent, 16% were insulin dependent with detectable C-peptide, 40% had no detectable C-peptide, and 32% had missing C-peptide data or were lost to follow-up. Of the IA recipients, 72% achieved insulin independence at least once over 3 years and multiple infusions. Factors associated with achievement of insulin independence included islet size >1.0 expressed as IEQs per islet number [hazard ratio (HR) = 1.5, p = 0.06], additional infusions given (HR = 1.5, p = 0.01), lower pretransplant HbA(1c) (HR = 1.2 each %-age unit, p = 0.02), donor given insulin (HR = 2, p = 0.003), daclizumab given at any infusion (HR = 1.9, p = 0.06), and shorter cold storage time (HR = 1.04, p = 0.03), mutually adjusted in a multivariate model. Severe hypoglycemia prevalence was reduced from 78-83% preinfusion to less than 5% throughout the first year post-last infusion, and to 18% adjusted for missing data at 3 years post-last infusion. In Year 1 post-first infusion for IA recipients, 53% experienced a Grade 3-5 or serious adverse event (AE) and 35% experienced a severe AE related to either an infusion procedure or immunosuppression. In Year 1 post-first infusion, 33% of IA subjects and 35% of IAK subjects had an AE related to the infusion procedure, while 35% of IA subjects and only 27% of IAK subjects had an AE related to the immunosuppression therapy. Five deaths were reported, of which two were classified as probably related to the infusion procedure or immunosuppression, and 10 cases of neoplasm, of which two were classified as probably related to the procedure or immunosuppression. Islet transplantation continues to show short-term benefits of insulin independence, normal or near normal HbA(1C) levels, and sustained marked decrease in hypoglycemic episodes.

Objective/Background: SSIs remain a significant cause of morbidity and mortality after surgery. One in eight patients develop SSI after exploratory laparotomies making it one of the major factors responsible for post-operative mortality and morbidity. Atypical mycobacteria are responsible for a spectrum of diseases ranging from superficial skin infections to widely disseminated systemic infections. Health care associated infections due to non-tuberculous mycobacteria is on the rise due to contaminated hospital water supplies, solutions, improperly sterilized instruments and devices. Our case is of an atypical mycobacterial infection in a patient with abdomino-thoracic trauma who underwent multiple surgeries. Case presentation: A 24 year old gentleman presented with a penetrating stab injury to the abdomen and left hemi-thorax following an assault. Patient underwent an emergency exploratory laparotomy which revealed a 4 x 4 cm defect in the left hemi-diaphragm, through which the stomach was herniating into the left thoracic cavity. During the 2nd post-operative week, patient developed empyema thorax, for which pigtail drain was placed initially and later thoracotomy with decortication and intercostal drainage were performed. Following discharge after 2 weeks, he presented with fever, body pain and pus discharge from the previously inserted intercostal drain site. Pus obtained was positive for acid fast bacilli and gene expert was negative. Atypical mycobacterial infection was diagnosed based on high index of suspicion and he received treatment for 6 months. Conclusion: This case highlights that identification of atypical mycobacterial infections in post-operative patients require a high index of suspicion. Management requires multi-drug approach and surgical intervention wherever necessary. Even with the existing sterilization techniques and preventive measure, atypical mycobacterial infection cannot be completely eliminated from a hospital set-up and hence must be considered in all nosocomial infections.

Context: Haematological toxicities are seen in rectal cancer patients receiving concurrent chemoradiotherapy (CRT) with capecitabine. Aims: To compare dose volume histogram (DVH) parameters and acute haematological toxicities using RapidArc with or without bone marrow constraints for rectal cancer patients receiving pelvic chemoradiation as part of curative treatment. Setting and designs: This is a prospective randomised controlled study including patients with rectal cancer initiated on chemoradiation. Patients were stratified into two arms, bone marrow sparing (BMS) arm and non-bone marrow sparing arm (NBMS). Materials and methods: DVH parameters and weekly toxicity data were collected. Grade 2 or more anaemia, leucopenia, neutropenia, or thrombocytopenia, any blood transfusions, colony-stimulating factor injection, platelet transfusions were considered as an event in acute haematological toxicity (HT). Statistical analysis: Independent t-test was used to compare quantitative parameters, and Mann–Whitney U-test was used for ordinal parameters between groups. Results: A total of 43 patients were enrolled. Bone marrow constraints were achieved without compromising the target coverage. There was a significant reduction in the bone marrow dose with BMS technique (p < 0·05). A 16·7% reduction in the HT (33·3% versus 50%) and a 21·9% reduction in the grade 2 or more anaemia (19% versus 40·9%) were noted in the BMS arm when compared to NBMS arm, though not statistically significant. However, in the preoperative setting, a significant reduction in grade 2/more anaemia (7·1% versus 41·1%, p = 0·035) was noticed in the BMS arm. Conclusions: Pelvic BMS radiotherapy may benefit patients receiving chemoradiation for locally advanced carcinoma rectum as part of curative treatment.

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