A Tribute to Jean Hamburger's Contribution to Organ Transplantation

Jean Hamburger, one of the pioneers of scientific medicine in the mid‐20th century, who was involved in the inception of intensive care, nephrology, hemodialysis and scientific clinical research, has also been one of the very few fathers of human organ transplantation. He was involved in the primary French kidney transplantations in 1950, and in 1952, he realized the first allotransplantation in the world of a kidney removed from a voluntary living donor. At the same time, he was the first to describe the various clinical and pathological aspects of acute rejection. He suggested the use of cortisone for the treatment of rejection as early as 1950 and promoted nonlethal body irradiation, which was successfully used in 1959 both by John Merrill in Boston and by himself in Paris, to prevent allograft rejection. In October 1962, in collaboration with Maurice Goulon, he was the first to use a kidney removed from an individual in ‘coma dépassé’. He and his group contributed to transplant immunosuppression, to transplant immunology, to organ preservation, to acute and chronic rejection pathology and so on. As early as 1956–1957, he understood the potential importance of Jean Dausset's discovery for transplantation.     

Creating a model to predict time intervals from induction of labor to induction of anesthesia and delivery to coordinate workload

BackgroundInduction of labor continues to become more common. We analyzed induction of labor and timing of obstetric and anesthesia work to create a model to predict the induction-anesthesia interval and the induction-delivery interval in order to co-ordinate workload to occur when staff are most available.MethodsPatients who underwent induction of labor at a single medical center were identified and multivariable linear regression was used to model anesthesia and delivery times. Data were collected on date of birth, race/ethnicity, body mass index, gestational age, gravidity, parity, indication for labor induction, number of prior deliveries, time of induction, induction agent, cervical dilation, effacement, and fetal station on admission, date and time of anesthesia administration, date and time of delivery, and delivery type.ResultsA total of 1746 women met inclusion criteria. Associations which significantly influenced time from induction of labor to anesthesia and delivery included maternal age (anesthesia P <0.001, delivery P =0.002), body mass index (both P <0.001), prior vaginal delivery (both P <0.001), gestational age (anesthesia P <0.001, delivery P <0.018), simplified Bishop score (both P <0.001), and first induction agent (both P <0.001). Induction of labor of nulliparous women at 02:00 h and parous women at 04:00 or 05:00 h had the highest estimated probability of the mother having her first anesthesia encounter and delivering during optimally staffed hours when our institution’s specialty personnel are most available.ConclusionsTime to obstetric and anesthesia tasks can be estimated to optimize induction of labor start times, and shift anesthesia and delivery workload to hours when staff are most available.     

一种修复股骨近段骨缺损的新方法

本文报道了５例股骨近段良性和恶性肿瘤，年龄２０～３２岁，平均２６．７岁。瘤段切除后骨缺损最长为１６．２ｃｍ，最短１０．８ｃｍ，平均１２．４ｃｍ。均采用冷冻异体骨段移植修复骨缺损、加压钢板内固定、髋关节融合术治疗。经１２～３７个月随访，Ｘ线片显示：无螺钉松动及钢板断裂，其中４例达骨性融合，融合率为８０％。本术式的最佳指征为股骨近段良性或低恶性肿瘤切除后骨缺损的年轻患者。该手术具有内固定牢靠、不需外固定、护理方便和融合率较高等优点。     

关注患者生存质量展望烧伤康复未来

After 50 years' development,a rather comprehensive burn care system has been built up in China,and it has played key roles in wound healing and salvaging victims of burn trauma.Since survival is no lon...     

Fatigue. Measures and relation to pain

Fatigue describes reduced capacity to sustain force or power output, reduced capacity to perform multiple tasks over time and simply a subjective experience of feeling exhausted, tired, weak or having lack of energy. Pain and fatigue have several components in common, such as being subjective, prevalent in most patients with cancer and caused by multiple factors of both a physical and psychological nature. In order to explore the relationship between fatigue and pain, data from five studies were used: two random samples from the Norwegian population (n=2323 and n=1965), Hodgkin's disease survivors (n=459), palliative care patients (n=434) and patients with bone metastases (n=94). All patients had completed one or more of the following instruments: EORTC QLQ-C30, SF-36 and/or Fatigue Questionnaire. The level of fatigue was much higher in the two palliative care populations (54.4 and 63.2) as compared to the normal population samples (25.0). Patients with bone metastases had significantly more pain (72.0) than the patients in the palliative care trial (47.4) and norms (20.5). In the two palliative care and bone metastases populations fatigue was almost unchanged over time, while pain was reduced. In the palliative care population a high level of fatigue (80.3) and pain (57.8) was reported 0-1 month before death. The relationship between pain, fatigue and the health-related quality of life domains should be explored in more detail, especially in follow-up studies in order to assess possible changes over time. In addition, the validity of the existing instruments measuring fatigue should be investigated for use in patients with advanced disease and short life expectancy.     

Osteoporosis Treatment: When to Discontinue and When to Re-start

A number of effective therapies for the treatment of osteoporosis have become available in recent years. However, uncertainty exists regarding their long-term use and effectiveness. Bisphosphonate treatment, unlike hormone replacement, denosumab or teriparatide, is associated with benefits extended even after treatment discontinuation. The extended benefits are most apparent for alendronate (ALN) and zoledronate (ZOL). A drug holiday might be considered in patients at low-moderate risk and who have been fully compliant with treatment, and who have had a response to treatment. In patients at low-moderate risk of fractures the decision to consider a drug holiday should be balanced also with the safety profile of each treatment.     

The origins of surgery. 2: From barbers to surgeons*

The art, craft and science of surgery is a highly interpersonal skill, central to a variety of traditions and cultures throughout human history. The development of surgery parallels the evolution of the human race from prehistory to the present time. This review attempts to examine the changing concepts and practices in surgery from the earliest era, enshrouded in mysticism and magic, through a manual craft performed by barbers and artisans, to a dignified profession based on science and technology. The evolution of surgery in the previous millennia is reviewed against the culture and morals, the politics and religion, and the philosophy and science of its period; in so doing assessing its perspective on the threshold of a new millennium.      

The origins of surgery: 1. From prehistory to Renaissance*

The art, craft and science of surgery is a highly interpersonal skill, central to a variety of traditions and cultures throughout human history. The development of surgery parallels the evolution of the human race from prehistory to the present time. This review attempts to examine the changing concepts and practices in surgery from the earliest era, enshrouded in mysticism and magic, through a manual craft performed by barbers and artisans, to a dignified profession based on science and technology. The evolution of surgery in the previous millennia is reviewed against the culture and morals, the politics and religion, and the philosophy and science of its period; in so doing assessing its perspective on the threshold of a new millennium.      

The response to medical litholytic treatment of gallstones according to their specific gravity

Summary The buoyancy of gallstones was observed by taking anterior-posterior scout X-ray films of two patients standing during endoscopic retrograde cholangiography. In case 1, the large and small gallstones differed in buoyancy, and ursodeoxycholic acid treatment dissolved the floating small stones while failing to dissolve the nonfloating large stone. In case 2, both the large and small stones floated and are being dissolved by ursodeoxycholic acid treatment. Since floating or nonfloating and the plane of flotation depend on the specific gravity of the gallstone, the above findings suggest that a gallstone with a low specific gravity is more readily dissolved than one with a high specific gravity. The present method of estimating the buoyancy of gallstones was therefore considered extremely useful in selecting patients for medical litholytic treatment.     

Intracranial saccular aneurysm unrelated to bifurcations

Summary Based on the histological findings in the intracranial arterial system of a patient with anterior cerebral artery aneurysms unrelated to bifurcations, the authors assume that such aneurysms may develop from media gaps having their origin in a special kind of multifocal media degeneration unassociated with arteriosclerotic, inflammatory, or infectious processes.     

A method to prepare bone-implant specimens for laboratory analysis

Summary A method for the preparation of bone samples containing metallic implants is presented. Technics are detailed for samples to be analyzed by mechanical, microradiographical and microangio-graphical means, and by tetracycline labeled fluorescent and polarized light microscopy.     

设立病区质控组长防范护理管理疏漏

目的探讨护理专业骨干人员参与护理管理,防范病区护理管理疏漏的方法。方法在各病区选拔优秀护理人员担任质控组长,经过统一培训后按制定的岗位职责及工作流程在病区协助护士长开展质量控制。结果设立质控组长前后病区一般护理缺陷、严重护理缺陷、意外事件及患者满意率比较,差异有统计学意义（P〈0．05,P〈0．01）。结论设立质控组长是护士长病房管理的有力补充．是防范病区护理管理疏漏,提高护理质量的有效方法。     

Gastric response to severe head injury

We studied the gastric response to severe head injury and multiple trauma in 53 patients admitted to the surgical intensive care unit at the University of Louisville. Twenty-two of the 32 patients with severe head injury could have endoscopy. Each patient had gastritis or duodenitis. Patients with severe head injury had a slightly higher rate of gastric acid secretion than did the other trauma patients without severe head injury, but the difference was not significant. Serum gastrin levels were normal in both groups and did not correlate with intracranial pressure. Pancreatic polypeptide levels were significantly higher in patients with severe head injury compared with the control trauma patients without head injury. Elevations in pancreatic polypeptide may be linked to increases in intracranial pressure. We conclude that erosive gastritis occurs commonly in patients with severe head injury and that severe head injury is associated with a marked increase in pancreatic polypeptide levels in the fasted, nongut-stimulated state. Gastrin levels are within normal limits. Head injury appears to specifically increase pancreatic polypeptide release, probably by influencing autonomic centers in the mid brain. Because the cephalic phase of pancreatic polypeptide release is vagalcholinergic, the data are consistent with the hypothesis that severe head injury increases vagal activity. Participation of vagal adrenergic fibers in this process cannot be excluded.