CT angiography of potential renal transplant donors

Renal transplantation has grown rapidly over the past 30 years, resulting in an inadequate supply of organs to meet the ever-increasing demand. This has led to an increase in the number of living-related donors. Advances in imaging technology now allow safe, rapid, and relatively noninvasive evaluation of potential donors. Helical computed tomographic (CT) angiography is a fast, minimally invasive procedure that is quickly becoming the imaging modality of choice for preoperative evaluation of potential renal transplant donors. Helical CT, combined with low-osmolar intravenous contrast materials, has enabled CT angiography to depict arterial and venous anatomy accurately. Between July 1995 and March 1997, CT angiography was performed in 205 potential renal donors. Correlation with surgical findings in 136 donor nephrectomies helped confirm a high level of accuracy for CT angiography in the assessment of the renal vasculature: Sensitivity and specificity for identifying specific vessels was 99.6% and 99.6% for main renal arteries, 76.9% and 89.9% for polar arteries, and 98.7% and 95.5% for main renal veins, respectively. CT angiography allows the radiologist to provide the transplant surgeon with precise preoperative anatomy of the renal vasculature, thus reducing the risks and complications associated with the harvesting procedure and improving the chances for a successful outcome. However, accurate radiologic interpretation depends on the radiologist's experience level, attention to detail, and commitment to careful image evaluation.     

A rapid organ recovery program for non-heart-beating donors

We report a successful method for rapid organ recovery from the non-heart-beating donor, which can open a new resource of organs for transplantation. The RORP is not controversial, is simple in design and execution, and results in kidneys that are viable for transplantation. Special personnel and equipment are needed but are easily incorporated in the overall budget of an OPO or donor hospital. Clearly more research is needed to rebuild ischemically damaged cells ex vivo and to develop new agents/methods to minimize the reperfusion response. When these processes are better understood and managed, the full potential of the NHBD as a donor resource will be fully achieved. We agree with others that the donor shortage could be entirely relieved by routine organ recovery from NHBD trauma victims.     

Transmission of cancer from organ donors

One hundred and seventeen of 270 (43%) recipients of organs obtained from donors with malignancies had evidence of transmitted cancers. In 9 instances these were removed from renal allografts immediately prior to transplantation. Including these cases there were 45 recipients of organs in which a neoplasm involved the allograft, 6 others in whom adjacent structures were invaded, and another 66 patients who had distant metastases. Precautions to prevent cancer transmission include meticulous preoperative screening of donors, careful examination of all organs at the time of harvesting, biopsy of any suspicious lesions, and routine donor autopsy, if possible.     

Transcranial Doppler assessment of brain death in children

Airborne dust in pig houses causes health problems for humans with full-time employment in pig houses. Many attempts have been made to reduce the dust burdens, but often without sufficient results. At Research Centre Bygholm ten different possibilities for dust reduction have been tested in the test section, and the results are evaluated on the basis of results obtained simultaneously in an identical control section. Until now, the two most efficient methods are addition of fat to the pigs' diet and spraying a thin layer of rape seed oil in the animal house. By adding 4% of fat to the diet, a reduction of 50% can be seen, and by spraying 5 g of rape seed oil daily per pig place, the aerial dust concentration can be reduced to about 75%. The costs are about 1 DM/pig at a price of rape seed oil of 2 DM/l.     

Transvaginal color Doppler in early pregnancy: rational and clinical potential

Remarkable hemodynamics changes that occur in the maternal circulation, the continuous growth and development of the feto-placental circulation is now studied by transvaginal Doppler. This seems to give more light in understanding of the early pregnancy pathophysiology. For the first time, it seems that ultrasound might be able to distinguish different forms of gestational trophoblastic disease. Due to its non-invasiveness and relatively simple and easily performed technique, transvaginal color Doppler might be of considerable clinical value. The other important point is that study results are available immediately for clinical judgement. From our study, we can conclude that transvaginal ultrasound with color and pulsed Doppler is potentially valuable diagnostic tool to differentiate forms of the gestational trophoblastic diseases. On the basis of Doppler findings, the complete mole can be reliably distinguish from the invasive mole or choriocarcinoma. The degree of myometrial invasion can be also assessed. This can be an objective foundation for therapeutical approach. There is no doubt that studies of maternal-fetal circulation in early pregnancy may help for better understanding of physiological and pathophysiological hemodynamic changes. Investigation of maternal (main uterine, arcuate, radial and spiral) arteries; placental (umbilical, chorionic arterioles) vessels and fetal (aorta and intracranial circulation) arteries flow patterns may help in order to diagnose abnormal implantation. More studies are necessary in order the Doppler technique to be used for clinical judgment in early pregnancy. Safety aspects should also be considered. However, potentials of these technique are more then obvious.     

Transcranial power mode Doppler duplex sonography of intracranial aneurysms

Recent events have challenged our health system to increase access to and provide high quality care for patients near the end of life. Simultaneously, Medicare is developing review policies to determine eligibility for hospice patients with select noncancer diagnoses. The purpose of this study was to determine whether the proposed policies met one of their chief goals: accurate identification of patients with a less-than-six-months prognosis. Only 35 percent of 104 patients who died within six months of admission to the hospice used for this study, LifePath Hospice, met the Medicare proposed criteria for hospice eligibility. The median and mean survival time of the sample was 14 and 30 days respectively. Based on this review, it is recommended that Medicare alter their proposed review policies and not limit access to hospice eligible patients who desire and are in need of such services.     

Transcranial Doppler in the evaluation of internal carotid artery dissection

BACKGROUND AND PURPOSE: A subject with dissection of the internal carotid artery (ICA) may present with a variety of symptoms, from headache to stroke. Thus far, it has not been possible to identify the subset of patients at risk for cerebral ischemia. Because the majority of these ischemic events are secondary to embolic phenomena, we used transcranial Doppler (TCD) evaluation with emboli monitoring to study 17 consecutive patients with ICA dissection treated at Harborview Medical Center, Seattle, Wash, during a 2-year period from 1992 until 1994. METHODS: Ten patients with ICA dissection secondary to trauma and seven with spontaneous ICA dissection were diagnosed by carotid angiography and studied by TCD from the time of diagnosis through initiation of therapy. Emboli monitoring was performed in the middle cerebral artery (MCA) ipsilateral to the dissection at the initial evaluation and intermittently thereafter to ensure that the emboli stopped with treatment. RESULTS: Emboli were detected in the MCA distal to the dissection in 10 of 17 patients (59%). Patients with microemboli detected by TCD presented with a stroke (70%) much more frequently than those without emboli (14%) (P=.0498). The presence of a pseudoaneurysm did not increase the risk of either microemboli or stroke. CONCLUSIONS: We have demonstrated a high incidence of intracranial microemboli in the MCA distal to carotid dissections and a significant correlation between the presence of emboli and stroke. TCD can therefore be used as an adjunctive tool to manage patients with suspected carotid dissection and may prove useful in evaluating the efficacy of treatment in reducing microemboli and subsequent stroke.     

Transcranial Doppler monitoring and causes of stroke from carotid endarterectomy

A dysfunction in the intracellular signal transduction pathways may be implicated in the pathophysiology of bipolar disorder. In particular, the phosphatidylinositol (PI) signal transduction pathway may be a possible site of dysfunction. Platelets, peripheral cells, and post-mortem brain samples have been used as models in preliminary studies aimed at investigating this hypothesis. Emerging findings from clinical studies are consistent with a hyperfunction in the PI pathway in the manic state, which could be state-related. Findings of increased protein kinase C (PKC) activity in the manic state, and increased intracellular Ca2+ responsiveness in the manic and possibly depressed states, are also consistent with a hyperactive PI pathway in this disorder. Future research should attempt to replicate and extend these preliminary findings further.     

A method for estimating solid organ donor potential by organ procurement region

OBJECTIVES: This study sought to develop a methodology for estimating potential solid organ donors and measuring donation performance in a geographic region based on readily available data on the hospitals in that region. METHODS: Medical records were reviewed in a stratified random sample of 89 hospitals from 3 regions to attain a baseline of donor potential. Data on a range of hospital characteristics were collected and tested as predictors of donor potential through the use of hierarchical Poisson regression modeling. RESULTS: Five hospital characteristics predicted donor potential: hospital deaths, hospital Medicare case-mix index, total hospital staffed beds, medical school affiliation, and trauma center certification. Regional estimates were attained by aggregating individual hospital estimates. Confidence intervals for these regional estimates indicated that actual donations represented from 28% to 44% of the potential in the regions studied. CONCLUSIONS: This methodology accurately estimates organ donor potential within 3 geographic regions and lays the foundation for evaluating organ donation effectiveness nationwide. Additional research is needed to test the validity of the model in other geographic regions and to further explore organ donor potential in hospitals with fewer than 50 beds.     

Transcranial Doppler ultrasonography to evaluate need for cerebrospinal fluid drainage in hydrocephalic children

We measured the metabolic changes in aldose and phosphorus metabolites in rabbit lenses incubated with tissue culture medium 199 (TCM 199) containing 20 mM glucose-1-13C, using 13C, 31P-NMR Spectroscopy (13C, 31P-MRS). Then we investigated the effects of aldose reductase inhibitor (ARI) on those metabolic changes, using the same method. In the incubated rabbit lenses, rapid increases were recognized in sorbitol, sorbitol-3-phosphate, and alpha-glycerophosphate. The levels of glucose, lactate, and adenosin triphosphate (ATP) did not change significantly. Once ARI was added, the levels of sorbitol and sorbitol-3-phosphate were reduced immediately, but the reduction of alpha-glycerophosphate needed some time after the addition of ARI. On the other hand, the levels of lactate increased approximately two-fold, and the levels of glucose and ATP did not change significantly. Considered with our other observations on the metabolic changes in alloxan induced diabetic rabbit lenses, and in rabbit lenses incubated with high concentrations (5-40 mM) of glucose-TCM 199 or 20 mM galactose-TCM 199, these results suggest that aldose reductase not only activates the polyol pathway but also controls the Embden-Meyerhof pathway, energetic metabolic changes, or phospholipid-associated metabolic changes.     

The feasibility of organ salvage from non-heart-beating trauma donors

BACKGROUND: Blunt trauma patients without vital signs on admission are potential non-heart-beating donors. OBJECTIVE: To review the feasibility of postmortem visceral perfusion and organ donation in blunt trauma patients without vital signs. DESIGN: A retrospective case series of blunt trauma victims who were declared dead in the emergency department. SETTING: A level I trauma center. MAIN OUTCOME MEASURES: Factors potentially precluding donation and potential donor yield. RESULTS: The mean trauma-to-death interval was 71 minutes (< 60 minutes in 57% of the cases). Injuries likely to interfere with in situ perfusion were present in 41% of the cases. The tissue donation consent rate was 45%. Assuming a similar organ donation consent rate, the potential donor yield was 9% after excluding victims who were younger than 60 years of age, warm ischemia times that were less than 60 minutes, and patients who had injuries precluding perfusion. CONCLUSIONS: The potential organ yield from non-heart-beating, blunt trauma victims is low, which highlights the ethical and legal problems of this approach.     

Ethical issues in psychological evaluation of patients for organ transplant surgery.

Psychological assessment of patients seeking organ transplant surgery presents the potential for ethical conflict. Here confidentiality, informed consent, multiple loyalties, dual relationships, social justice, collaboration with families, responsibilities to donors, honesty, and avoidance of imposition of irrelevant moral values are discussed as they relate to the psychologist's relationship to the patient and to the enterprise of organ transplantation. The case examples of a 33-yr-old man with autoimmune hepatitis and a 55-yr-old woman with alcoholic cirrhosis highlight these issues. Relevant standards from the Ethical Principles of Psychologists and the Code of Conduct of the American Psychological Association are applied, as are principles of biomedical ethics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The potential pool of non-heart-beating kidney donors

Entry of Shigella flexneri into epithelial cells and lysis of the phagosome involve the secreted IpaA-D proteins. A complex containing IpaC and IpaB is able to promote uptake of inert particles by epithelial cells. This suggested that Ipa proteins, either individually or as a complex, might interact with the cell membrane. We have purified IpaC and demonstrated its interaction with lipid vesicles. This interaction is modulated by the pH, which might be relevant to the dual role of Ipa proteins, in induction of membrane ruffles upon entry and lysis of the endosome membrane thereafter.     

Guidelines for early identification of Alzheimer Disease

BACKGROUND: The emergence of methicillin-resistant Staphylococcus aureus and its multidrug-resistant property has led to the search for an effective antibiotic to combat staphylococcal sepsis. At present, vancomycin remains the most effective antibiotic. This study evaluated the in vitro efficacy of netilmicin (an aminoglycoside) and compared its activity with 4 other antibiotics, viz. vancomycin, amikacin, tobramycin and ofloxacin. METHODS: The minimum inhibitory concentration of the antibiotics was determined by the agar dilution method. Thirty strains each of methicillin-resistant and -susceptible S. aureus isolated from pus and blood cultures were included. RESULTS: The susceptibility to netilmicin was found to be 100% and was the same as that observed for vancomycin. CONCLUSION: All the methicillin-resistant S. aureus strains tested showed 100% susceptibility to netilmicin, suggesting its use in patients with such infections as an alternative to vancomycin. However, this finding needs to be verified in the clinical setting.