Dialysis modality and delayed graft function after cadaveric renal transplantation

The purpose of this investigation was to compare outcomes in the immediate posttransplant period for hemodialysis (HD) and peritoneal (PD) dialysis patients who received cadaveric renal transplantation. Data were obtained from the United Network of Organ Sharing on all cadaveric graft recipients who were dialysis-dependent at the time of transplantation between April 1994 and December 1995. Baseline characteristics were compared between groups, and multivariate logistic regression was performed with outcome measures including urine production in the first 24 h posttransplantation (U24), requirement for dialysis in the first week posttransplant (FWDIAL), and treatment for acute rejection during the initial hospitalization. The odds of oliguria (not producing urine in the first 24 h) were 1.49 (1.28 to 1.74) times higher in HD versus PD patients. After adjustment for other comorbid conditions including age, gender, race, HLA mismatch, time on dialysis, panel-reactive antibodies, and cold and warm ischemia time, the odds of oliguria were 1.60 (1.14 to 2.25) times higher in black HD patients compared with PD patients and 1.29 (1.06 to 1.57) times higher in white HD patients. In a similar manner, after adjustment for significant comorbid conditions, the odds of requiring dialysis in the first week were 1.56 (1.22 to 2.0) times higher in black HD patients versus PD patients and 1.40 (1.21 to 1.60) times higher in white HD patients. The rate of acute rejection was similar during the first hospitalization. These results suggest that there is an association between hemodialysis and delayed graft function. Differences in biocompatibility between the two modalities could potentially be responsible.     

Complications of blepharoplasty

Although blepharoplasty is a technically straightforward procedure, many postoperative complications may occur. Some of the untoward effects may be only a transient nuisance for the patient, such as mild ocular dryness, whereas other sequelae can lead to severe visual loss. An extensive review of the prevention, diagnosis, and management of complications associated with blepharoplasty is presented.     

Vasoreactivity and prostacyclin release in streptozotocin-diabetic rats: effects of insulin or aldose reductase inhibition

1. Alterations in vasoreactivity and endothelial cell function could underlie some of the vascular abnormalities in diabetes. To examine aspects of these phenomena we studied the effects of 4-6 weeks streptozotocin-induced diabetes in the rat on basal and angiotensin II (AII)-stimulated prostacyclin release from isolated lung, perfused at constant flow. In addition, pressure was monitored throughout the lung perfusion as an index of vasomotor tone. 2. The experiment also included lungs from groups of diabetic rats treated with either insulin or an aldose reductase inhibitor (imirestat), to determine whether these treatments influenced the development of any defects seen in untreated diabetes. 3. Despite some indication of a trend towards reduced prostacyclin release in lungs from diabetic rats, neither the basal nor AII-stimulated release was significantly different from that seen in tissues from control animals. There were no significant differences between groups in the average basal perfusion pressure and in either the absolute pressure response to AII or the time of this peak. 4. The area under the perfusion pressure curve during AII infusion was greater in lungs from diabetic animals than in controls indicating a prolonged vasoconstrictor response. This increased pressor response may indicate increased sensitivity of diabetic tissue to AII or a reduced production of vasodilators in response to the vasoconstriction. 5. Whichever mechanism was responsible, this alteration was prevented by insulin treatment but not by aldose reductase inhibition, implicating mechanisms probably unrelated to exaggerated polyol pathway flux.     

Models for release of chlorpheniramine and a noninteracting compound from an inert, heterogeneous matrix containing an anionic surfactant

Diffusional models in which the mole ratio of surfactant to medicinal compound does not exceed one are applied to the release of chlorpheniramine maleate from chlorinated poly(propylene) matrixes and from matrixes containing anionic surfactants (sodium lauryl sulfate, dioctyl sodium sulfosuccinate) that interact to form a poorly water-soluble complex. The release of a second, noninteracting compound (sodium benzoate) from these matrixes is also considered in the models. The models suggest that the rate of release is slowed by complexation reducing the amount of medicinal compound in solution and concomitantly increasing the tortuosity and decreasing the porosity of the matrix.     

Outcome of tunneled hemodialysis catheters placed by radiologists

PURPOSE: To compare the outcomes of hemodialysis catheters placed by interventional radiologists with those placed by surgeons. MATERIALS AND METHODS: The outcomes were retrospectively analyzed of 237 hemodialysis catheters placed in 140 patients by a radiology service from January 1991 through December 1992. Follow-up data were available for 222 catheters (94%). Catheter secondary patency and freedom from infection were analyzed statistically and by means of life-table analysis. RESULTS: Pneumothorax occurred after the placement of six catheters (2.5%); in two patients, a chest tube was required for decompression. Other short-term complications included air embolism with no clinical sequelae (two procedures) and prolonged oozing from the tunnel (two procedures). Long-term complications included infection and catheter failure. Infection occurred in 26 patients (18%) with 32 catheters (14%) and resulted in removal of 25 catheters. Ninety-three catheters (42%) failed, and 63 catheters (28%) were removed because of failure. CONCLUSION: Hemodialysis catheters placed by radiologists do not have a higher rate of complications or failure than catheters placed by surgeons.     

Successive transperitoneal migration of ova in a woman with extensive pelvic adhesions

Our case report describes three conceptions after transperitoneal migration of the ovum in a woman with only one ovary, the contralateral oviduct, and extensive postoperative pelvic adhesions obliterating the Douglas cul-de-sac. This suggests that anatomic integrity of the pelvis is not always essential for ovum pick-up.     

An intercomparison of measurement techniques for the determinationof the dielectric properties of solids at near millimetre wavelengths

The results of a measurement intercomparison aimed at assessing the systematic errors in near-millimetre-wavelength dielectric measurements on reasonably transparent solid specimens are presented and discussed. Various monochromatic, broad band, guided wave and free space measurement methods were intercompared in the frequency region from 30 to 900 GHz using round-robin measurements of the refractive index and absorption coefficient of seven specimens. Typically, systematic errors of up to 1% were found in the refractive index results, while very much larger systematic errors were found in the absorption results