Demographics of 353 laparoscopic renal donor and recipient pairs at the Johns Hopkins Medical Institutions

BACKGROUND AND PURPOSE: The demographics of laparoscopic donor nephrectomy (LDN) have not been characterized in detail. The aim of this study was to review our LDN experience with respect to donor and recipient demographic characteristics and trends. PATIENTS AND METHODS: Over a 6-year period, 353 patients underwent LDN. A retrospective chart review was performed to identify the donor and recipient demographic characteristics and trends associated with the procedure. RESULTS: Among the donors, the mean age was 41 years, with a predominance of females (59.2%), whites (76.2%), and blood relations (72%). Siblings were the most common related-donor-to-recipient relationship, and spouses were the most common unrelated relationships. Among the recipients, the mean age was 43 years, with a predominance of males (58.4%), whites (73.7%), and dialysis-dependent patients (55%). Diabetes mellitus and hypertension were the most common causes of end-stage renal failure. With the introduction of laparoscopy, there was a nearly twofold increase in the total number of live renal donations, and there was a significant expansion in the unrelated-donor pool. CONCLUSIONS: Laparoscopic harvest of donated kidneys is associated with new trends that may help alleviate the current organ shortage.     

Use of a silastic silo for closure of the abdominal wall in a pediatric patient receiving a cadaveric split liver

Presented is the successful management of a difficult abdominal wall closure after pediatric liver transplantation. A 5-week-old boy with biliary atresia underwent urgent cadaveric split liver transplantation. The left lateral segment of an adult donor was utilized. Postoperatively, abdominal skin and fascia could not be closed. A SILASTIC® (Dow Corning, Midland, MI) silo was applied, and complete closure was possible 6 days later.     

Work organization and patient care staff injuries: the impact of different care models for "alternate level of care" patients

BACKGROUND: The number of elderly patients who do not have acute-care needs has increased in many North American hospitals. These alternate level care (ALC) patients are often cognitively impaired or physically dependent. The physical and psychosocial demands on caregivers may be growing with the increased presence of ALC patients leading to greater risk for injury among staff. METHODS: This prospective cohort study characterized several models for ALC care in four acute-care hospitals in British Columbia, Canada. A cohort of 2,854 patient care staff was identified and followed for 6 months. The association between ALC model of care and type and severity of injury was examined using multinomial and ordinal logistic regression. RESULTS: Regression models demonstrated that the workers on ALC/medical nursing units with "high" ALC patient loads and specialized geriatric assessment units had the greatest risk for injury and the greatest risk for incurring serious injury. Among staff caring for ALC patients, those on dedicated ALC units had the least risk for injury and the least risk for incurring serious injury. CONCLUSIONS: The way in which ALC care is organized in hospitals affects the risk and severity of injuries among patient care staff.     

Users of a Psychosocial Care Center: a study of their social outcomes about psychiatric treatment

The purpose of this study is to identify and analyze representations users of a psychosocial care center construct about psychiatric treatment. Interviews were held with 11 individuals at a Psychosocial Care Center. Data were analyzed through content analysis, according to Bardin, using the Moscovician social representation theory as a methodological-theoretical reference framework. Data analysis allowed us to define three categories. The first category--treatment is to be medicated--contains issues like medication as psychiatric treatment, the effects of treatment, various professionals involved and their participation in treatment. The second category--treatment is to be cared for (or not)--was outlined as: care in psychiatric treatment, violence and closed institutions. The third category--treatment is to be active--was based on: treatment and occupational therapy, psychiatric treatment and work. We concluded that the representations about psychiatric treatment are closely linked to the use of medication and to the physician as the precursor of the treatment.     

Characterization of HLA class I specific antibodies by ELISA using solubilized antigen targets: II. Clinical relevance

Until recently, the nature of humoral sensitization to HLA has been characterized by data from lymphocyte-based assays, predominantly cytotoxicity tests. We have examined the characteristics, determined by enzyme-linked immunosorbent assay (ELISA), of sera from 191 subjects known to have produced HLA-specific antibody. We found that ELISA detected higher frequencies compared with cytotoxicity of many (74.5%), but not all, HLA-specific antibodies; in many cases (42.6%) the frequencies of these antibodies were higher than predicted from population frequencies whereas some antibodies (23.4%) occurred with lower than expected frequencies. Some of the increase in frequencies can be accounted for by crossreactivity, i.e., sensitization to epitopes shared among two or more allelic products. The presence of epitopes shared between a recipient's antigen and a mismatched antigen in a donor also tended to narrow the specificity of antibody produced. However the data also indicate differences in immunogenicity among different antigens suggesting that crossreactive group matching would be beneficial in some but not all cases. Finally, we present case studies to illustrate the value of ELISA in predicting humoral rejection episodes and in monitoring the efficacy of rejection therapies.     

The history of the Psychiatric Nursing in Rio Grande do Sul, Brazil: Part II

The purpose of this article is contributing to the historiography and history of Psychiatric Nursing in Rio Grande do Sul, Brazil by reconstructing the process that culminated in the closing of the Nursing Professional School, which functioned from 1939 to 1952, at Hospital S?o Pedro, Porto Alegre, Brazil. Documentary research and oral history were the primary sources of information. The reports of various witnesses of this process helped to detect the diverse political-partidary, corporative and inter-institutional factors that led to the extinction of that establishment.     

Interstitial cystitis: a chronic inflammatory bladder condition

 Interstitial cystitis (IC) is a chronic inflammatory condition of the bladder wall, characterized by urinary frequency and urgency, and severe suprapubic and/or pelvic pain. Symptoms of IC resemble those of ordinary urinary tract infections. However, standard urine cultures are negative and antibiotic therapy offers no relief. Recent research indicates that IC may be much more common than was previously thought, affecting over 700,000 people in the US. More than 90% of those affected are women, many of whose lives are thoroughly disrupted by severe pain. Long overlooked and misdiagnosed, IC is only now beginning to be understood. Although there is no specific diagnostic test or marker for IC and no uniformly effective treatment, little more than a decade of research has yielded promising results. New diagnostic tests are currently being developed and new therapeutic modalities are in clinical trials. While science searches for answers to this devastating disease, patients living with pain deserve relief.     

Simple Fast Graft-to-Vessel Connection Preventing Blood Leakage, Stricture, and Aneurysm Formation (Ratner-Connection)

A new simple method of graft-to-vessel anastomosis using a stent technique that prevents blood leakage, stricture, and aneurysm formation is proposed herein. The advantages and problems related to its usage are also discussed. Received: March 10, 2000 / Accepted: September 26, 2000