Heterogeneity of glomerular size in normal donor kidneys: impact of race

Glomerular size has been the subject of many studies and, in a number of settings, has a direct association with the development of glomerular sclerosis. However, the normal distribution of glomerular size has not been thoroughly evaluated in the general population in the United States. To address this issue, we analyzed the baseline biopsy specimens of 103 human donor kidneys to determine the maximal planar area (MPA) of the glomerular tuft in a heterogeneous human population. The MPA of each glomerulus was determined by measurement of sections through the vascular pole and/or origin of the proximal tubule, and was determined on each section by two methods: point counting and computer planimetry. There was very high agreement between these two methods. Multivariate analysis was used to identify significant correlates with MPA. Overall, younger donors had smaller glomeruli (P < 0.0001). Black donors had a larger MPA (23.4+/-8.6 mm2 x 10(-3)) than white donors (17.9+/-6.7 mm2 x 10(-3); P < 0.001), independent of donor age. MPA was not significantly different between genders. This heterogeneity in glomerular size may confound clinical studies if not recognized and may help explain differences in glomerular structure and function in response to injurious processes.     

A BPA survey of recently appointed consultants

A postal survey of recently appointed consultant paediatricians was undertaken to determine whether they perceived their training had adequately equipped them for their current job. The response rate was 69% (207/299). After excluding replies from consultants trained outside the UK the analysis was carried out on 167 replies. Trainees held a mean 5.2 posts during general and higher professional training, necessitating a mean 1.8 house moves. Altogether 82% felt moves were beneficial to training but 46% found moves 'very disruptive' to family life. Only 12% of district general hospital and 22% of teaching hospital senior registrars took two research sessions a week. Supervision and training in research was absent or poor for more than 60%; 24% felt major changes and 55% moderate changes were needed to current training. Training in non-clinical skills was particularly in demand and a curriculum for both trainers and trainees with regular appraisals is required. Research at senior registrar level needs review and educational methods improved to achieve better training in a shorter period.     

Cardiac injuries due to nonpenetrating thoracic trauma

This paper reviews 25 consecutive patients treated for injuries involving the pericardium, myocardium, valves, or cardiac conduction mechanism. The severity of cardiac trauma varied from cardiac contusion without sequelae to cardiac rupture requiring urgent surgical intervention. A successful outcome depended upon prompt recognition, supportive measures, and definitive therapy. Definitive therapy ranged from pericardicentesis to open-heart operation. Examples of cardiac trauma treated successfully include: myocardial contusion, atrial fibrillation, ruptured myocardium, rupture of interventricular septum, and rupture of the tricuspid valve. Three deaths occurred in patients with ventricular herniation, ruptured aortic valve, and myocardial contusion; 2 were because of severe associated trauma and 1 because of delayed recognition.     

Percutaneous extraction of retained biliary T-tubes: a new technique

Retained T-tubes are rare complications after biliary surgery. The authors present three cases of retained T-tubes in patients with transplanted liver that could not be removed by a standard manual traction. The authors describe a new simple percutaneous method that allows removal of these T-tubes without complication.     

The internet and the global monitoring of emerging diseases: lessons from the first 10 years of ProMED-mail

Now in its eleventh year, ProMED-mail is a robust and sensitive mechanism for the discovery of emerging disease outbreaks involving humans, animals, and plants around the world and for rapid dissemination of information. Fast reporting translates into quicker arrival of prevention and control assistance from other countries, better advance warning to neighboring countries and intending travelers, and other benefits to public health such as heightened awareness of health workers to the threat, time to prepare countermeasures and to react in an appropriate manner rather than a reflex emergency response.