Mortality and morbidity of pancreatic injury

Pancreatic trauma, regardless of etiology, has been consistently associated with a mortality of 20 percent and enormous morbidity. Twenty-five pancreatic injuries, including four solitary wounds of the pancreas, were analyzed to determine why pancreatic trauma should have such an adverse prognosis. Eleven patients were victims of blunt trauma and fourteen sustained gunshot wounds. There were no stab wounds. The important determinants of mortality were associated injuries to major vessels, wounds of the head of the gland, and failure to adequately control leaking exocrine secretion. All four deaths were directly related to massive hemorrhage; in two instances leakage of pancreatic juice was also implicated. With the exception of benign solitary blunt wounds of the pancreas to the body of the gland immediately ventral to the spinal column, an injury of the pancreas is evidence that the abdomen has been subjected to severe trauma, which predisposes the patient to a high mortality and morbidity. The pancreatic injury, interacting with other abdominal injuries, is likely to be a cause of significant mortality and to result in complications that will prolong the patient's hospitalization.     

Purification of two rat hepatic proteins with A-esterase activity toward chlorpyrifos-oxon and paraoxon

A-esterases are calcium-dependent hydrolases that can detoxify the active metabolites (oxons) of organophosphorus insecticides such as chlorpyrifos and parathion. A-esterases from rat liver have previously been shown to hydrolyze chlorpyrifos-oxon but not paraoxon at low substrate concentrations. Two A-esterases were extracted by ammonium sulfate fractionation from solubilized rat liver microsomes followed by gel filtration chromatography and preparative scale isoelectric focusing. The proteins displayed similar characteristics and were difficult to separate; both had similar high molecular mass and isoelectric point range and exhibited A-esterase activity toward high and low concentrations of chlorpyrifos-oxon and high concentrations of paraoxon. Sufficient amounts of the higher molecular mass protein were obtained for kinetic studies, which yielded a Km of 0.93 mM toward high concentrations of chlorpyrifos-oxon and a Vmax of 369 nmoles product formed/mg protein-min. The protein hydrolyzed phenyl acetate, chlorpyrifos-oxon and paraoxon, suggesting that arylesterase and A-esterase activities are attributable to the same liver protein(s). Assays of purified protein and kinetic studies of microsomes suggested that the activity toward high (320 microM) and low (相似文献   

Living unrelated renal donation: the University of Wisconsin experience

BACKGROUND: Living unrelated renal donation (LURD) has the potential to reduce the current waiting list significantly for kidney transplantation. The purpose of this study was to examine the long-term results of 150 LURDs performed at our center during a 16-year period. METHODS: From Dec 23, 1981, to Feb 13, 1998, 150 LURDs, 219 human leukocyte antigen (HLA)-identical, 577 haploidentical, and 1789 cadaveric kidney transplant procedures were performed. Surgical complications, rejection episodes, infectious complications, and the cause of graft loss and death were examined. Ten-year patient and graft survival rates between groups were compared. RESULTS: Fourteen surgical complications including lymphocele (n = 7), ureteral stricture (n = 4), and ureteral leak (n = 3) were seen. Seventy-eight patients (52%) had 123 rejection episodes and 66 patients (44%) had 1 or more infections. Thirty-six allografts were lost and 25 deaths occurred. Patient survival rates at 10 years for HLA-identical, haploidentical, LURD, and cadaveric transplant procedures were 86%, 82%, 63%, and 64%, respectively. Allograft survival rates at 10 years for HLA-identical, haploidentical, LURD, and cadaver transplant procedures were 75%, 59%, 56%, and 44%, respectively. CONCLUSIONS: Long-term LURD allograft survival rates are lower than those for HLA-identical but equivalent to those of haploidentical and better than those of cadaveric kidney transplantations. Spousal and nonspousal LURDs should be actively encouraged to help alleviate the current donor kidney shortage.     

Surgery on patients receiving anticoagulants

Patients on anticoagulants may undergo surgery if the anticoagulants are carefully controlled and if contraindications are respected. Patients being treated for thromboembolism should have their clotting times maintained at close to two times normal levels if they are on heparin, or their prothrombin times similarly maintained if they are an oral anticoagulants.     

Prevention of fuel rod ballooning in nuclear power plants

Possible means of eliminating ballooning as a mode of failure of fuel rods due to overheating are described. Ballooning tends to block cooling passages and hence render energency cooling inoperative. Means proposed involve altering the shape of the yield locus so that the plastic strain increment vector lies in the axial rather than the circumferential direction of the fuel rod. Proposed changes in yield locus are accomplished by texturing of the zirconium cladding or by grooving or by wrapping the fuel rod.