Successful Three‐Way Kidney Paired Donation with Cross‐Country Live Donor Allograft Transport

Providing transplantation opportunities for patients with incompatible live donors through kidney paired donation (KPD) is seen as one of the important strategies for easing the crisis in organ availability. It has been estimated that an additional 1000—2000 transplants per year could be accomplished if a national KPD program were implemented in the United States. While most of these transplants could be arranged within the participants' local or regional area, patients with hard‐to‐match blood types or broad HLA sensitization would benefit from matching across larger geographic areas. In this case, either patients or organs would need to travel in order to obtain maximum benefit from a national program. In this study, we describe how a triple KPD enabled a highly sensitized patient (PRA 96%) to receive a well‐matched kidney from a live donor on the opposite coast. The kidney was removed in San Francisco and transported to Baltimore where it was reperfused 8 h later. The patient had prompt function and 1 year later has a serum creatinine of 1.1 mg/dl. This case provides a blueprint for solving some of the complexities that are inherent in the implementation of a national KPD program in a large country like the United States.     

Unusual emission conditions and treatment cases at a central emergency and intensive care department

Any increase of daily requests for care at a hospital emergency room in Berlin (capital of the GDR) were not reported during the days of extraordinary immission situation (Smog) in January 1982 and 1985. But a special attention is necessary for people over 75 years. The information is based on the analysis of 13,000 acute internal affections from 1981 to 1985 recorded in a hospital emergency room.     

The ultraendurance triathlete: a physiological profile

To better characterize the athletes who participate in ultraendurance triathlons, 14 triathletes in training for the Hawaii IRONMAN triathlon were studied. A physical and physiological profile was developed from anthropometric measurements and oxygen uptake during maximal exercise on a treadmill, cycle ergometer, and arm ergometer. A comparison of the maximal values among exercise modes and between males and females was made. A comparison of height, weight, and percent body fat of these triathletes with elite athletes from the sports of swimming, cycling, and running showed the physique of triathletes to be most similar to that of cyclists. Oxygen uptake at maximal exercise was, for males and females, respectively: 68.8 ml X kg-1 X min-1, 65.9 ml X kg-1 X min-1 on the treadmill; 66.7 ml X kg-1 X min-1, 61.6 ml X kg-1 X min-1 on the cycle ergometer; and 49.1 ml X kg-1 X min-1, 39.7 ml X kg-1 X min-1 on the arm ergometer. When comparing the highest oxygen uptake attained at maximal exercise in any one of the three exercise modes, the male triathletes are comparable to swimmers, but have a lower aerobic capacity than cyclists or distance runners. The female triathletes studied were able to attain oxygen uptake values greater than those previously reported for female athletes.     

Haemophilus infection in cystic fibrosis.

Twenty seven patients with cystic fibrosis under the age of 12 years and 27 matched patients with asthma were followed up in a prospective study for one year. The isolation rate of non-capsulated strains of Haemophilus influenzae from cough swabs and sputum specimens taken at routine clinic visits every two months was significantly greater in cystic fibrosis than in asthma. Haemophilus para-influenzae was equally common in both groups. During exacerbations the isolation rate of H influenzae in cystic fibrosis was significantly greater than at other times, whereas in asthma there was no significant difference. The distribution of biotypes of H influenzae and H parainfluenzae was similar in the two groups. In cystic fibrosis, biotype I was associated with exacerbations. Biotype V was more common than in previous studies, but was not associated with exacerbations.     

Endurance exercise in the presence of heart disease

Although patients with heart disease have successfully completed marathon runs, the immediate cardiac effects of similar and greater distance endurance exercise competition are unknown. Two such cases are presented, demonstrating that vigorous exercise and extreme levels of fitness are not precluded in the cardiac patient.