BACKGROUND AND OBJECTIVES: Blood centres often use the '30 or 60-min rule' for accepting RCC exposed to room temperature (RT) back into inventory. Effective monitoring of these temperature deviations is however lacking.
MATERIALS AND METHODS: A Timestrip PLUS® TP153 10°C (TS + 10) TTI was attached to RCC units after preparation of the unit in the blood bank or on issue to the ward, to track the CET > 10°C during laboratory processing and outside the transfusion laboratory.
RESULTS: The mean CET of 153 RCC tracked within the laboratory was 56 min. Sixty-four (41.8%) and 34 (22.2%) of RCC had core temperature (CT) >10°C for more than 30 and 60 min, respectively. Among the 69 RCC that were returned unused, 27 (39.1%), 17 (24.6%) and 5 (7.2%) RCC units had CT >10°C for more than 30, 60 and 120 min respectively.
CONCLUSION: A large proportion of RCC have CT >10°C exceeding 30 min during handling within the transfusion laboratory, as well as when RCC are returned unused from transfusion locations. Corrective measures should be implemented to better manage the cold chain to avoid undesirable consequences to blood transfusion. A temperature sensitive device that can also indicate CET can be employed to objectively monitor the period that RCC remained at a CT that exceeds 10°C.
METHODS: An online systematic review of MEDLINE, Embase, PubMed, and the Cochrane Library from inception to January 7, 2022, was completed. Studies outlining the care of a patient with acrometastases of the hand were included. Data extracted included age, sex, site of primary tumor and metastasis, presence of other metastases, time from primary diagnosis to acrometastasis diagnosis, misdiagnosis, treatment, and survival.
RESULTS: Between 1889 and present, 871 lesions were described in 676 patients who met the inclusion criteria. There was no predilection for hand dominance or site of previous trauma. The mean age among patients was 59.5 (1.5-91) years, and male sex was more common (64.6%). The most common primary cancer source was the lung (39.2%), followed by the kidney (10.8%). The distal phalanx was the most frequently cited tumor location (33.7%). Mean survival after diagnosis of acrometastasis was 6.3 months (0.25-50) ± 11.5 months.
CONCLUSION: Acrometastasis remains an uncommon presentation of metastatic disease with poor prognosis. Treatment currently focuses on pain management and optimizing functional outcomes. Our review led to the development of 7 treatment recommendations when managing these patients.
CASE REPORT: In this case series, we report on two cases of WT which had poor response to pre-operative chemotherapy. Both cases underwent surgery after pre-operative chemotherapy and recovery was uneventful during a two-year follow-up.
DISCUSSION: Both patients had chemotherapy prior planned surgery, but had unfortunate poor tumour response. The tumour progressed in size which required a radical nephrectomy. The histology report for the first case had more than 60% blastemal cells remaining despite giving pre-operative chemotherapy with no focal anaplasia. This showed poor response to chemotherapy evidenced by the high number of blastemal cells. The second case was a stromal type WT which is known for poor response and may lead to enhancement of growth and maturation induced by chemotherapy. These were the possible reason of poor response of WT in these two cases.
METHOD: The protocol of this review is registered on PROSPERO(CRD42020190882). A comprehensive literature search was performed on Medline, Embase and Cochrane CENTRAL using MeSH terms and keywords for randomised controlled trials and observational studies on the topic. Risks of biases were assessed using the Cochrane RoB tool and the Newcastle-Ottawa Scale. For localised RCC, immediate surgery [including partial nephrectomy (PN) and radical nephrectomy (RN)] and delayed surgery [including active surveillance (AS) and delayed intervention (DI)] were compared. For metastatic RCC, upfront versus deferred cytoreductive nephrectomy (CN) were compared.
RESULTS: Eleven studies were included for quantitative analysis. Delayed surgery was significantly associated with worse cancer-specific survival (HR 1.67, 95% CI 1.23-2.27, p
METHODS: We retro-spectively reviewed all TP nephrectomies performed in the Hospital Sultanah Bahiyah Alor Setar, Kedah between January 2016 and July 2017.
RESULTS: A total of 36 eligible cases were identified, 10 of which were for renal tumours and the others for nonfunctioning kidneys. There were no statistically significant differ-ences between the two groups in terms of demographics and comorbidities. We also did not identify any sta-tistically significant differences between the two groups in terms of operating time, blood loss, need for transfusion, septic complications and postoperative recovery. The only significant difference between the groups was the postoperative rise in serum creatinine, which was higher in the tumour disease group (mean rise 23.4 vs 5.35µmol/l; p = 0.012).
CONCLUSIONS: Our study showed that laparoscopic nephrectomy is both feasible and safe for the treatment of tumour and non-tumour renal disease with low complication rates in both groups.