Old-for-Old Kidney Allocation Allows Successful Expansion of the Donor and Recipient Pool

Allocation of kidneys from donors older than 64 years to recipients older than 64 years was started in 1999 to improve use of older donor kidneys. Kidneys are allocated locally without HLA-matching to keep cold ischemia short. We compared survival and rejection rates in elderly patients allocated in the old-for-old program (ESP) to patients aged 60 years and older based on HLA-matching, expected ischemia and waiting time (ETKAS). The 69 ESP patients were older (67.9 +/- 2.5 vs. 63.9 +/- 2.9 years), had older donors (71.2 +/- 3.9 vs. 44.6 +/- 14.5 years) and more HLA-mismatches (4.2 +/- 1.2 vs. 1.6 +/- 1.7) than the 71 ETKAS patients, while ischemia was shorter (7.8 +/- 3.4 vs. 14.2 +/- 5.5 h). ESP and ETKAS had similar graft (1-year: 83.6% vs. 86.9%) and patient survival (85.2% vs. 89.5%). With the introduction of ESP, use of older recipients and donors rose from less than 2% to 16% and 11%, respectively. Incidence of acute rejections was significantly higher in the ESP group (1 year: 43.2% vs. 27.4%) and significantly correlated with the degree of HLA-matching. Introduction of old-for-old allocation allows successful expansion of the donor and recipient pool without affecting patient and graft survival. HLA-matching should not be ignored, as the risk of acute rejection in elderly patients is substantial.     

Suggested guidelines for reporting clinical results in transplantation trials

Randomized controlled trials are essential for decision making and improving patient care. Although the number of published clinical trials in the field of transplantation is constantly rising, recent publications addressed problems of proper reporting of study results. Far too often, not even the key data (patient and graft survival, rejection rates, transplant relevant characteristics of the population, and details on the immunosuppressive therapy) were given. Good reporting should include primary and secondary outcomes, graft and patient survival, acute rejection rates (biopsy proven acute rejections and all treated), and clear accounting of the participant number throughout the different stages of a study. Several recent attempts (Consolidated Standards of Reporting Trials guidelines, submission of the study protocol, registry database) failed to improve or improved only partly the reporting quality. To improve reporting quality of randomized controlled trials in the future, we propose to use a comprehensive checklist with modified criteria of the Consolidated Standards of Reporting Trials guidelines to better reflect the special needs in the field of transplantation.     

Allometric analysis of organ weights: II. Beagle dogs.

A statistical analysis of organ growth was performed in 141 beagle dogs. Applying the allometric function, the correlation between organ and body weight could be described statistically. In the age range between 14 and 567 days, a significant linear, positive correlation was found between organ and body weight increase in all investigated organs, excepting the thymus. For each of the 12 organs allometric curves were established and the related tolerance limits and growth constants were calculated. In some organs sex-related differences were seen. The ratio of organ to body weight (relative organ weight) could not be described statistically as a function of age. Therefore, the use of allometric data is recommended instead of relative organ weights for the evaluation of organ weight changes.     

Long-term treatment of bradycardia by means of an atropine ester (SCH 1000). Electrophysiological and clinical results]

Electrophysiological effects of the atropin ester Ipatropiumbromide (SCH 1000) were investigated in 15 patients by His electrocardiography and high frequency atrial stimulation. Heart rate increased by 50% of base line heart rate, PA- and AH-intervals and sinus node recovery time decreased, the HF-interval remained unchanged. Physiological av-block by atrial stimulation occurred at significant higher stimulation frequencies with SCH 1000 than without medication. Additional 15 patients were treated for a longer follow-up period. Increase of resting heart rate averaged 15%. Equivocal effects on heart rate were found with exercise after SCH 1000. Non-cardiac side effects were found in 5 patients.     

Diagnosis and therapy of acquired heart valve defects in patients of advanced age

Advantages and disadvantages of elective cardiothoracic surgery in patients over the age of 60 with acquired heart valve defects are shown in table 8. An important improvement in survival rates can be noticed in patients with decompensated aortic and mitral valve defects. Quality of life is ameliorated in all patients who need an operation because of valvular heart defect, mainly in aortic stenosis, which on principle can be considered as operable.     

Nonendoscopic techniques for manipulating Sacks-Vine gastrostomy tubes: Technical note

A technique for obviating endoscopic guidance in the manipulation of Sacks-Vine gastrosomy tubes is presented.     

Preliminary experience with the catheter dilatation of coronary artery stenoses (author's transl)]

The method of percutaneous transluminal coronary angioplasty (PTCA) may in selected cases dramatically improve myocardial blood supply. Seven attempts were made between September and December 1978 at the Gollwitzer-Meier Institute of Cardiology; three dilatations were unsuccessful, two were moderately successful and two highly successful. The problems as to methodology and selection of patients submitted to this procedure are discussed.     

Triple catheter aortoiliac angioplasty in a patient with a horseshoe kidney: Technical note

A method is described for protecting a nonstenotic anomalous artery to the left-lower pole of a horseshoe kidney that originated from a stenotic left common iliac artery. Using a triple catheter technique, injury to this anomalous renal artery was prevented while using “kissing balloons” to dilate bilateral proximal common iliac artery stenoses.     

Drug-induced long QT syndrome: hERG K+ channel block and disruption of protein trafficking by fluoxetine and norfluoxetine

BACKGROUND AND PURPOSE: Fluoxetine (Prozac) is a widely prescribed drug in adults and children, and it has an active metabolite, norfluoxetine, with a prolonged elimination time. Although uncommon, Prozac causes QT interval prolongation and arrhythmias; a patient who took an overdose of Prozac exhibited a prolonged QT interval (QTc 625 msec). We looked for possible mechanisms underlying this clinical finding by analysing the effects of fluoxetine and norfluoxetine on ion channels in vitro. EXPERIMENTAL APPROACH: We studied the effects of fluoxetine and norfluoxetine on the electrophysiology and cellular trafficking of hERG K+ and SCN5A Na+ channels heterologously expressed in HEK293 cells. KEY RESULTS: Voltage clamp analyses employing square pulse or ventricular action potential waveform protocols showed that fluoxetine and norfluoxetine caused direct, concentration-dependent, block of hERG current (IhERG). Biochemical studies showed that both compounds also caused concentration-dependent reductions in the trafficking of hERG channel protein into the cell surface membrane. Fluoxetine had no effect on SCN5A channel or HEK293 cell endogenous current. Mutations in the hERG channel drug binding domain reduced fluoxetine block of IhERG but did not alter fluoxetine's effect on hERG channel protein trafficking. CONCLUSIONS AND IMPLICATIONS: Our findings show that both fluoxetine and norfluoxetine at similar concentrations selectively reduce IhERG by two mechanisms, (1) direct channel block, and (2) indirectly by disrupting channel protein trafficking. These two effects are not mediated by a single drug binding site. Our findings add complexity to understanding the mechanisms that cause drug-induced long QT syndrome.     

Treatment of intravertebral pseudarthroses by balloon kyphoplasty

OBJECTIVE: This paper presents an open prospective investigation of the efficacy of balloon kyphoplasty in the treatment of intravertebral pseudarthrosis. Several described intravertebral radiolucent lines-the so-called vacuum phenomenon-originated from degenerative diseases. Pain arose from intravertebral dynamic mobility and local kyphosis. METHODS: We reduced and stabilized 24 intravertebral pseudarthroses with the balloon kyphoplasty. Pain and disability showed a rapid and distinct decrease. Radiologic features and life quality were compared with respect to the different shapes of fractures type A1, A3.1, and A3.3. The follow up was 2 years. RESULTS: The patients with fractures type A3.3 were older than those of type A1 and A3.1. In pseudarthrosis of type A3.1 fractures, the kyphotic wedge could be reduced to 13 degrees and the height could be increased to 85% with balloon kyphoplasty. In the A3.3 group, the wedge could be reduced to 8 degrees but the height could be increased only to 75%. No restoration of deformity was achieved in fractures type A1. A long-lasting effect on pain and disability was seen only after balloon kyphoplasty of fractures type A3.1. CONCLUSIONS: The treatment of intravertebral dynamic mobility with balloon kyphoplasty is useful in fractures type A3.1. In pseudarthroses type A1, the negligible reduction and only short-lasting reduction of pain stands against the costs. In pseudarthroses type A3.3, the lack of a long-lasting benefit could be the consequence of the disadvantageous shape of the vertebral body, the higher age of patients or the primary diseases.