Older living kidney donors: surgical outcome and quality of life

BACKGROUND: Older living kidney donors remain controversial because of their physiological decline in glomerular filtration rate and their increased susceptibility of surgical complications. Little is known about the quality of life (QOL) of this elderly group. The purpose of this study is to examine surgical outcome and the QOL in older living donors. PATIENTS AND METHODS: All 105 consecutive living donors who underwent a laparoscopic donor nephrectomy between June 2002 and February 2006 were prospectively included in the study. Intra- and postoperative complications were measured. Quality of life was recorded preoperatively and at several endpoints postoperatively. Older donors were defined as 55 years and older. RESULTS: There were no significant differences in intra- and postoperative complication rates and 1-year graft survival rate between both groups. Elderly donors (n=34) had both a significant lower postoperative pain at rest at day 1 compared with the younger group (P=0.019) and a lower total pain score in the analysis for the whole follow-up period (P=0.002). Although small solitary significant differences in Short Form-36 Health Survey, Multidimensional Fatigue Inventory-20 and visual analogue scale measuring pain, between both groups were detected, in general QOL of older donors was not different than of younger donors. CONCLUSION: Although small solitary significant differences exist with respect to pain, social functioning and mental health older donors, in general, have similar surgical outcome and quality of life when compared with younger donors. There is no need to exclude older donors in screening programs for transplantation.     

Usefulness of three-dimensional phase contrast MR angiography on arteriovenous malformations

Prospective three-dimensional phase contrast (3D-PC) MR angiography was obtained in 34 patients with arteriovenous malformations (AVM) and comparison was made between digital substraction angiography (DSA) and three-dimensional time-of-flight (3D-TOF) methods. Velocity encoding (VENC) for 3D-PC was adjusted to 60 and 10 cm/sec., and was changed only when adequate information was not obtained. VENC 60 cm/sec. demonstrated the main feeders in 100 % of cases and the nidus in 86 % of cases whereas VENC 10 cm/sec. showed the draining vein in 78 % of cases. The detection rate of feeder, nidus and drainer was 60 %, 40 % and 13 % respectively by the TOF technique. The mean size of the nidus as compared with DSA as standard was 130 % with MRI,108 % with 3D-PC and 92 % with the TOF technique and this difference was not statistically significant. 3D-PC was clearly superior in detecting AVM in the presence of hemosiderin, hematoma or surgical clips. It also showed gradual disappearance of the lesion after radiosurgery We found 3D-PC superior to 3D-TOF in the diagnosis, therapeutic planning and follow-up of AVM.     

Fiberbronchoscopy in smear-negative miliary tuberculosis

Twenty-two patients with smear-negative miliary tuberculosis underwent fiberbronchoscopy and brush smears; bronchial aspirates and transbronchial lung biopsy specimens were obtained. A definite diagnosis of tuberculosis was made in 16 (73 percent) patients. A rapid diagnosis was established in 14 of these 16 patients either from brush smears alone (three) or bronchial aspirate smear alone (one) or exclusively by histopathologic study of biopsy specimens (seven). Both brush smears and biopsy histopathology results provided the diagnosis in three patients. Bronchial aspirate culture was the only positive specimen in two patients. No serious complication resulted from the procedure. Our experience substantiates previous reports of the value and safety of fiberbronchoscopy in the rapid diagnosis of smear-negative miliary tuberculosis.     

A high-molecular-weight squid neurofilament protein contains a lamin-like rod domain and a tail domain with Lys-Ser-Pro repeats.

Previous studies have shown that two low molecular-weight neurofilament (NF) proteins (NF-60 and NF-70) from the squid Loligo pealei are translated from mRNAs that are splice variants of a single squid NF gene. In this study, we report the isolation and characterization of cDNA clones encoding a high-molecular-weight squid NF protein (NF-220), the mRNA of which derives from the same squid NF gene. All three proteins are identical in their amino-terminal and lamin-like rod domains but differ in their carboxyl-terminal tail regions. In contrast to the short tail domains of NF-60 and NF-70, the NF-220 protein has a longer tail domain containing an acidic cluster of amino acids immediately followed by repeated copies of the sequence motif Lys-Ser-Pro. The Lys-Ser-Pro domain is similar to that of mammalian medium NF (NF-M) and high NF (NF-H) proteins, where the serines are highly phosphorylated. Except for these Lys-Ser-Pro motifs, there is surprisingly little structural similarity between the squid NF-220 protein and mammalian NF-M and NF-H proteins. Furthermore, the location of introns in squid NF-220 protein shows that it is more closely related to nuclear lamins and type III intermediate-filament proteins than to vertebrate NF proteins.