Improvement of clinical outcome by early nephrology referral in type II diabetics on hemodialysis

OBJECTIVES: To evaluate the influence of early nephrology referral on clinical outcome in type II diabetes mellitus patients on maintenance hemodialysis dialysis. PATIENTS AND METHODS: This study retrospectively analyzed the type II diabetic patients entering our PD program from February 1988 to June 2001. Patients who were presented to a nephrologist more than 6 months before starting dialysis were defined as early referral (ER). Patients were considered late referral (LR) if they were transferred to the nephrology department within 6 months before initial dialysis. RESULTS: Hundred and fifteen type II diabetic patients receiving HD for at least 3 months were enrolled in this study. Sixteen of the 53 patients (46.1%) were in the ER group and 62 of the 115 (53.9%) were in the LR group. In univariate analysis by Cox proportional hazards mode, the early referral (Exp (Coef) = 0.423, p < 0.01), good glycemic control (Exp (Coef) = 0.16, p < 0.05), and age at dialysis (Exp (Coef) = 1.026, p < 0.05 (had significantly influenced the patient survival. The residual renal function in the ER group, estimated by creatinine clearance (Ccr), significantly exceeded that of the LR group (ER vs. LR: 4.46 +/- 1.56 vs. 2.51 +/- 1.70 mL/min, p < 0.001). The patients with early referral had significantly better survival (p < 0.05). Five-year survival improved significantly in the early referral group compared to the late referral group (ER: 72.4%; LR: 35.2%, p < 0.05). CONCLUSIONS: We demonstrate that the time of referral before starting dialysis is a predictor of survival for type II diabetics on HD. Patients with early referral are associated with longer survival. The beneficial effect might be associated with the timely initiation of the chronic HD program. These results suggest that early referral before dialysis is important in determining the long-term prognosis in type II diabetics on HD.     

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.     

Application of proteomics technology to the field of neurotrauma

Near-completion of the Human Genome Project has stimulated scientists to begin looking for the next step in unraveling normal and abnormal functions within biological systems. Consequently, there is new focus on the role of proteins in these processes. Proteomics is a burgeoning field that may provide a valuable approach to evaluate the post-traumatic central nervous system (CNS). Although we cannot provide a comprehensive assessment of all methods for protein analysis, this report summarizes some of the newer proteomic technologies that have propelled this field into the limelight and that are available to most researchers in neurotrauma. Three technical approaches (two-dimensional gel electrophoresis, direct analysis by mass spectrometry, including two-dimensional chromatography coupled to mass spectrometry and isotope coded affinity tags, and antibody technologies) are reviewed, and their advantages and disadvantages presented. A discussion of proteomic technology in the context of brain and spinal cord trauma follows, addressing current and future challenges. Proteomics will likely be very useful for developing diagnostic predictors after CNS injury and for mapping changes in proteins after injury in order to identify new therapeutic targets. Neurotrauma results in complex alterations to the biological systems within the nervous system, and these changes evolve over time. Exploration of the "new nervous system" that follows injury will require methods that can both fully assess and simplify this complexity.     

Power rolloff during interactive radiofrequency ablation can enhance necrosis when treating hepatocellular carcinoma

OBJECTIVE: The purpose of this study was to compare the efficacy between standard and interactive radiofrequency ablation for treatment of hepatocellular carcinoma. SUBJECTS AND METHODS: Of 97 patients with 112 nodular hepatocellular carcinomas, 59 hepatocellular carcinomas were ablated using a standard algorithm and 53 hepatocellular carcinomas, using an interactive algorithm. For the procedure using the interactive algorithm, the electrode's array was partially retracted or fully deployed depending on the change of impedance. Complete tumor necrosis was defined as the lack of enhancement on single-detector helical CT at least 4 months after the last radiofrequency ablation. RESULTS: Complete necrosis was achieved in 101 (90%) of 112 hepatocellular carcinomas, with complete necrosis being achieved more frequently in hepatocellular carcinomas undergoing interactive ablation (96%) than standard ablation (85%) (p = 0.034). Power rolloff (a clinical end point in which power decreases as impedance increases) occurred in all of the 53 hepatocellular carcinomas that underwent interactive ablation, whereas power rolloff occurred in 48 (81%) of the 59 hepatocellular carcinomas that underwent standard ablation (p = 0.00053). Complete necrosis occurred more frequently when rolloff was achieved (96%) than without rolloff (36%) (p < 0.0001). Multivariate analysis determined that power rolloff was an independent factor in achieving complete necrosis of hepatocellular carcinomas (p < 0.0001). CONCLUSION: The use of interactive radiofrequency ablation increased the frequency of power rolloff and the rate of complete necrosis in the treatment of hepatocellular carcinoma. Power rolloff was a significant determinant of whether complete necrosis was achieved in hepatocellular carcinomas treated with radiofrequency ablation.     

Chemical burn caused by povidone-iodine alcohol solution--a case report

Burns associated with chemical disinfectants for skin preparation are rare. Skin irritation and maceration associated with pressure factors may contribute to its occurrence. We report a 24-year-old female with thyroid tumor who was admitted for subtotal thyroidectomy. After anesthetic induction, the patient was placed in the supine position with the trunk elevated to 20 degree. The skin over the anterior neck was sterilized with 10% Povidone-iodine (PI) alcohol solution. After a 3-hour surgery, the patient complained of burning pain over the back at the recovery room. Physical examination revealed a 9 x 11 cm area of skin lesion partially thickened amid on the middle of the back suggestive of chemical burn. After conservative treatment, she was discharged uneventfully 4 days later. Upon follow-up, the wound was seen to heal with minimal scarring within 3 weeks.     

Reduced Phagocytosis of Colloidal Carriers Using Soluble CD47

Purpose. This study was designed to illustrate the feasibility of using soluble CD47 protein to antagonize phagocytosis of colloidal drug carriers by macrophages. Methods. Expression of CD47-streptavidin (CD47-SA) fusion protein was achieved in B21CodonPlus host cells following IPTG induction. Murine macrophage cell line J774A.1, expressing high levels of SIRP, was selected as the biologic model system for phagocytosis. FITC-labeled perfluorocarbon (PFC) emulsions were used as the colloidal carriers to trigger phagocytosis. Microscopy (inverted light and UV-fluorescence) and flow cytometry were used to qualitatively and quantitatively determine the degree of phagocytosis, respectively. Results. The bacterially expressed, purified CD47-SA had neither cytotoxic nor cytostatic effects when incubated with J774A.1 cells up to a concentration of 400 nM for 24 h. Phagocytosis of FITC-labeled PFC emulsions was significantly diminished when macrophages were pretreated with 100 nM CD47-SA for 1 h. Conclusions. We demonstrated that soluble CD47-SA antagonized phagocytosis of colloidal carriers to a significant degree by interaction with macrophage SIRP.