IntroductionAcute kidney injury (AKI) occurs frequently after liver transplantation and is associated with significant morbidity and mortality. Recent evidence has linked the predominant usage of ‘chloride-liberal’ intravenous fluids, such as 0.9% saline to the development of renal dysfunction in general critically ill patients. We compared the effects of perioperative fluid types on AKI in liver transplant recipients.MethodsAn observational analysis of liver transplant recipients over a 33-month period, between January 2010 and September 2013, was performed. Intensive care unit database and patient records were analyzed for determinants of early postoperative AKI. Univariate and multivariate regression analysis was carried out using a two-tailed P value less than 0.05 to establish significance. The institutional Research Ethics Committee approved the study methodology (RAC no. 2131 073).ResultsOne hundred and fifty-eight liver transplants were performed, AKI developed in 57 (36.1%) patients: 39 (68.4%) fully recovered, 13 (22.8%) developed chronic renal failure and 10 (17.5%) required long-term hemodialysis. On univariate regression analysis, AKI was significantly associated with greater than 3,200 ml of chloride-liberal fluids infused within the first postoperative day (HR 5.9, 95% CI 2.64, 13.2, P <0.001), greater than 1,500 ml colloids received in the operating room (hazard ratio (HR) 1.97, 95% CI 1.01, 3.8, P = 0.046), vasopressor requirement for 48 hours posttransplant (HR 3.34, 95% CI 1.55, 7.21, P = 0.002), hyperchloremia at day 2 (HR 1.09, 95% CI 1.01, 1.18, P = 0.015) and preoperative model for end-stage liver disease (MELD) score (HR 1.08, 95% CI 1.03, 1.13, P <0.001).After stepwise multivariate regression, infusion of greater than 3,200 ml of chloride-liberal fluids (HR 6.25, 95% CI 2.69, 14.5, P <0.000) and preoperative MELD score (HR 1.08, 95% CI 1.02, 1.15, P = 0.004) remained significant predictors for AKI.ConclusionsIn a sample of liver transplant recipients, infusion of higher volumes of chloride-liberal fluids and preoperative status was associated with an increased risk for postoperative AKI.

L-LLS is a safe procedure that can be standardized and successfully taught to surgeons with large experience in donor hepatectomy through a proctored learning curve.

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BACKGROUND: Closed injury to the finger flexor pulley system is found frequently in rock climbers. There are no evidence-based published guidelines on the diagnosis and treatment of these injuries. OBJECTIVES: The present systematic review was undertaken to answer the following questions: what are the most commonly recommended diagnostic criteria for finger flexor pulley injury in rock climbers; and, based on the available evidence, what is the best diagnostic test for these injuries? METHODS: Four electronic databases were searched using specific key terms, with limits set for language and date. Two reviewers independently identified potentially relevant titles based on inclusion criteria. Inter-reviewer variability was assessed using the Kappa statistic. The scientific quality of articles was assessed using validated scales. RESULTS: Of the 93 articles identified, 29 were included in the present analysis. The inter-rater agreement for selection of potentially relevant titles was 88% (kappa=0.74). The most commonly cited diagnostic criterion for closed finger pulley injury was clinical bowstringing of the flexor tendons over the volar aspect of the proximal interphalangeal joint. However, the best study of diagnostic accuracy for these injuries supports the use of dynamic ultrasound. CONCLUSIONS: Dynamic ultrasound is recommended for the diagnosis of closed finger pulley injuries in rock climbers. The prevailing notion that these injuries can be diagnosed by testing for clinical bowstringing is not supported by evidence.

Background: Latissimus dorsi muscle is considered as a key stone most important muscle in plastic surgery used for many reconstructive surgical procedures varying from facial reanimation and breast reconstruction to lower limb reconstruction. it is essential to have knowledge about The branching pattern and length of the thoracodorsal nerve which is the nerve supply of this precious latissimus dorsi distal to the splitting of this nerve. For innervated functional muscle transplant procedures, the length of nerve pedicles available for nerve anastomosis is crucial Aim of the Work: Is to investigate the topography and branching pattern of the thoracodorsal and also measure its length distal to its splitting. Materials and Methods: Sixteen latissimus dorsi muscles were dissected in eight adult embalmed human specimens in Anatomy department Faculty of medicine Alexandria university. The thoracodorsal neurovascular bundle was dissected and the pattern of branching of the thoracodorsal nerve was identified The branches were dissected up to the latissimus dorsi muscle and further intramuscularly. All lengths were measured using a vernier caliber. Surgically, in total, 10 patients with recurrent squamous cell carcinoma were undergone surgery permitting simultaneous cancer resection and harvesting of latissimus dorsi flap in Plastic surgery department, Faculty of medicine, Menufia University, Informed written individual consent was obtained for all the patients. Results: The median length of the medial branch was 3.45 cm (range, 1.80 to 5.5 cm; mean, 3.60 cm; SD, 1.04 cm). As regard the branching pattern of the thoracodorsal nerve distal to its splitting it varied from three branches pattern in 75%, two branches pattern in 23% of the specimens and in one case continued as one branch on the lateral border of latissimus dorsi muscle In one other specimen thoracodorsal nerve distal to its split gave many branches and in this specimen abreast mass was noticed on the corresponding side of this thoraco dorsal nerve. The veins and arteries showed a similar pattern, with a median length that is similar to that of the thoracodorsal nerve. The median length of the middle branch was3.50 cm (range, 2.4 5 to 4.65 cm; mean3.45 cm; SD, 0.88 cm), The lateral branch showed a median length of 3.99 cm (range, 2.5 5 to 5.95 cm; mean, 3.85 cm; SD, 0.95 cm). The mean length of the thoracodorsal nerve measured from the posterior root to the split was 12.5 cm.Surgically, by surface area the latissimus dorsi is the largest muscle in the body. It can be as large as 20 x 40cms, enabling latissimus dorsi flaps to cover very large defects after resection of squamous cell carcinoma in head and neck region especially in temporal and scalp regions. Conclusions: The separate neurovascular branches and its minimal pedicle length make the latissimus dorsi muscle very suitable for single functional free muscle transfer, using only the lateral part of the latissimus dorsi muscle, and double functional free muscle transfer using only one vascular pedicle. Thi...