Renal transplantation from elderly living donors

A worldwide shortage of cadaveric donors has led to the increased utilization of elderly living donors, with controversial results. In an attempt to assess the effect of donor age on graft survival and subsequent renal function, we analyzed our clinical results in 276 consecutive recipients of living related renal transplants spanning both the cyclosporine and the azathioprine eras, of whom a total of 44 recipients received kidneys from donors over 55 years old. All recipients were otherwise similar in age, race, haplotype mismatch, number of retransplants, and number of pretransplant transfusions, apart from an increased number of diabetics among the CsA-treated recipients of elderly kidneys (38% vs. 14%). The cumulative patient and graft survival rates at 1 and 5 years were independent of donor age whether CsA or AZA was utilized. Nor was the incidence of rejection or infection significantly different in the older donor group when compared with the younger cohort. Short-term and intermediate-term renal function, as assessed by serum creatinine, was however poorer but stable in the older donor group when compared with the younger one. The mean serum creatinine levels at 1 year in the CsA- and AZA-treated recipients of kidneys from older donors were 2.4 and 2.0 mg/dl, respectively, compared with 1.6 and 1.4 mg/dl, respectively, when the donor age was less than 55 years (P less than 0.001). Since renal function at the end of the first posttransplant year is considered a determinant of long-term graft survival, this is a cause for concern, but in view of the universal shortage of organs and the negligible morbidity to donors, renal transplantation from elderly living donors remains an acceptable practice.     

Immunomodulation of Delayed Hypersensitivity to Methylated Bovine Serum Albumin (MBSA) in Mice Using Subliminal and Normal Sensitization Procedures

Delayed hypersensitivity (DH) was induced in the footpads of mice sensitized to methylated bovine serum albumin (MBSA). The magnitude of this DH response increased with increasing sensitizing concentration of MBSA. Levamisole administered 1 hr prior to MBSA challenge stimulated the DH response and this was optimal using subliminal sensitizing concentrations of antigen. A number of antirheumatic agents, immunomodulators mediator antagonists and antiallergies were subsequently examined using the subliminal sensitizing concentration of MBSA. The same drugs were also evaluated using a normal sensitizing procedure. These studies indicate that the sensitizing concentration of antigen is critical in establishing whether a drug will stimulate or suppress a DH response.     

Arthroscopic assisted rotator cuff repair: preliminary results

Arthroscopic assisted rotator cuff repair is a method of performing an arthroscopic subacromial decompression with repair of the rotator cuff through a limited deltoid splitting approach. We evaluated 25 patients with a minimum of 1 year follow-up. Based on the UCLA shoulder rating, 80% of the patients were rated as excellent or good. There was significant improvement in pain, function, motion, and strength. Ninety-six percent of the patients were satisfied with the procedure. Of the patients with small or moderate size tears, 100% received a satisfactory rating. Arthroscopic assisted rotator cuff repair is presented as an attractive alternative in treating symptomatic patients with complete tears of the rotator cuff.     

Assessment of global and regional left ventricular function and volumes with 64-slice MSCT: a comparison with 2D echocardiography.

BACKGROUND: In patients with coronary artery disease (CAD), LV function and volumes are important parameters for long-term prognosis. Multislice computed tomography (MSCT) allows noninvasive assessment of the coronary arteries, but the accuracy of 64-slice MSCT for the assessment of left ventricular (LV) volumes and function is unknown. METHODS AND RESULTS: A head-to-head comparison between 64-slice MSCT and 2-dimensional (2D) echocardiography was performed in 40 patients with known or suspected CAD. The LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) were determined and the LV ejection fraction (LVEF) was derived. Regional wall motion was assessed visually using a 17-segment model. A 3-point scoring system was used to assign to each segment a wall motion score: 1 = normokinesia, 2 = hypokinesia, 3 = akinesia or dyskinesia. Two-dimensional echocardiography served as the gold standard. MSCT agreed well with 2D echocardiography for assessment of LVEDV (r = 0.97; p < .0001) and LVESV (r = 0.98; p < .0001). An excellent correlation between MSCT and 2D echocardiography was shown for the evaluation of LVEF (r = 0.91; p < .0001). Agreement for the assessment of regional wall motion was excellent (96%, kappa = 0.82). CONCLUSIONS: An accurate assessment of global and regional LV function and volumes is feasible with 64-slice MSCT.     

Developing the future nurse leaders of Fiji.

BACKGROUND: Nurse leaders in Fiji are currently involved in meeting the challenges of being at the forefront of an AusAID supported Health Sector Improvement process. Fiji is experiencing the same shortages of health professionals (including nurses) as is occurring internationally, while simultaneously striving to improve the quality of its health services. PRIMARY ARGUMENT: This paper provides information about the current situation in relation to health services in Fiji, and describes strategies being undertaken by the nurse leaders of Fiji to meet the challenge of leading an exciting reform process. James Cook University, School of Nursing Sciences, has been privileged to support the provision of contemporary leadership and management education for current and future nurse leaders in the Fiji Health Sector as a component of a current education program to educate registered nurses to bachelor level. This paper will provide an overview of the current Fiji Health Sector Improvement Program, with a particular focus on the preparation of nurse leaders. CONCLUSION: There is an ongoing need to understand beliefs and values, and styles of interaction and communication, and indeed, ideas about time. With collaboration between Australian academics and Fiji tutors from the Fiji School of Nursing, the program appears to be remarkably successful.