Serum ionic fluoride levels in haemodialysis and continuous ambulatory peritoneal dialysis patients

High serum fluoride (F-) in patients with chronic renal failure (CRF) and end-stage renal disease (ESRD) is associated with risk of renal osteodystrophy and other bone changes. This study was done to determine F- in normal healthy controls and patients with ESRD on haemodialysis (HD) or peritoneal dialysis (PD). Seventeen healthy controls (12 males, 5 females) and 39 ESRD patients on dialysis (17 males, 22 females) were recruited in the study in a community with 47.4 +/- 3.28 microM/l (range 44-51 microM/l) of F- content in drinking water. Control subjects showed a mean serum F- concentration of 1.08 +/- 0.350 microM/l. Males in control group showed slightly higher F- levels (1.15 +/- 0.334, range 0.55-1.9 microM/l) than females (0.92 +/- 0.370, range 0.6-1.5 microM/l). Mean serum F- concentration did not correlate significantly with age and sex among control subjects, whereas such correlation was observed in patients with ESRD on dialysis. Mean serum F- concentration was significantly higher in patients on dialysis (2.67 +/- 1.09, range 0.8-5.2 microM/l) than normal controls. When grouped according to sex, the mean serum F- concentration in males (3.05 +/- 1.04, range 1.8-5.2 microM/l) was significantly higher than females (2.38 +/- 1.08, range 0.8-5.2 microM/l). When patients were grouped according to age, it was observed that F- concentration was significantly higher in patients with age groups 21-70 (2.86 +/- 1.05) than those with age group 13-20 years (1.42 +/- 0.531). Thus F- concentration correlated with age and sex, being higher in males and above 20 years. Despite appreciable clearance of F- (39-90%) across the peritoneum, patients on CAPD showed higher serum F- concentration than those on HD (3.1 +/- 1.97 vs 2.5 +/- 1.137 microM/l). Of the total 39 patients on dialysis 39% had their serum F- concentration above 3.0 microM/l, posing the risk of renal osteodystrophy.      

A review of 2975 consecutive operations by one surgeon in an accredited outpatient plastic surgicentre: A Canadian experience

The present paper constitutes a retrospective review of 2975 consecutive operations performed by the author, one of the three owners of the Saskatoon Plastic Surgicentre. The unit opened in 1987; therefore, the study spans 17 years. Patients are not kept overnight, and the Surgicentre is approved and equipped as a level C facility for general anesthesia. Only patients who score 1 or 2 according to the American Association of Anesthesiologists are treated. Only certified anesthesiologists are used. Of the patients with postoperative complications, only two required transfer to a hospital. One developed a pneumothorax, which was treated on arrival at the intensive care unit with no sequelae. The other collapsed following facelift surgery. She was transferred to University of Saskatchewan hospital and died later that evening with a massive pulmonary embolus. In a properly established outpatient centre, a large number of patients can be safely treated with very few complications. However, despite placing patient safety as the first consideration and adhering strictly to the highest standards, death can occur.     

Urban Adolescents: What Are Their Health Needs?

Abstract A health needs assessment of inner-city, low-income adolescents was conducted by the staff of a nurse-managed, community-oriented primary care clinic. A multiethnic sample of 568 high school students was studied. The findings indicated that the most commonly used source of health care was the family doctor. Barriers to receiving care were fear and costs. Subjects reported insufficient knowledge about many health-related topics, and desired services in the areas of drug and substance use, reproduction and sexuality, family relations, mental health, and dental health. Eighty-four percent of the subjects were interested in using the services of a neighborhood clinic specifically for teens. Survey results were used for decision making, program planning, and implementation of a teen health clinic.     

Late ultrastructural changes in the retina of the rat following low-dose X-irradiation

This study describes ultrastructural changes in the pigmented hooded Lister rat retina, 3–12 months following X-irradiation with single doses of between 200 and 2000 cGy. The extreme radiosensitivity of the photoreceptor cells was underlined by the continued manifestation of fine structural changes and cell death up to 6 months post-radiation in animals receiving doses above 500 cGy. The retinal pigment epithelial (RPE) cells were more radioresistant than photoreceptors and RPE cell loss was only observed at doses of more than 1500 cGy. One year after irradiation with 1500 cGy the retinal vasculature showed capillary occlusion with some evidence of recanalisation. Telangiectasia was observed in the large retinal veins. Although the inner retinal neurones and glia1 cells showed no evidence of direct radiation damage, the nerve fibre layer adjacent to occluded retinal vessels demonstrated ultrastructural evidence of ischaemic neuropathy and retinal oedema. At doses above 1500 cGy the choriocapillaris showed platelet aggregation and capillary loss.     

Leading a New Generation

We all work in a multigenerational workforce. With extremes in generations, skills are needed to foster understanding among staff. There are many myths and realities about the age-related generations. While there are challenges in working in a multigenerational workforce, the generational differences tend to be exaggerated while the similarities are overlooked. A better understanding of these generations allows us to prevent communication breakdown and to close the communication gaps where they exist, creating a unit of harmony rather that discontent.     

Does desmopressin acetate prophylaxis reduce blood loss after valvular heart operations? A randomized, double-blind study.

The effectiveness of prophylactic desmopressin acetate in reducing hemorrhage after cardiopulmonary bypass operations is controversial. We conducted a prospective, randomized, placebo-controlled, double-blind trial to determine its effectiveness and safety in such patients. Eighty-three evaluable patients undergoing valvular heart operations were randomized to receive desmopressin (0.3 microgram/kg) (41) or placebo (42) after cardiac bypass. Demographic characteristics were similar in both groups. There was no significant difference in total 24-hour blood loss between groups (desmopressin 1064.8 +/- 647.1 ml versus placebo 844.4 +/- 507.6 ml; p greater than 0.05), or in the requirement for red blood cell, platelet, or fresh frozen plasma transfusion, or for reexploration for control of hemorrhage. Neither was there a difference in the occurrence of thrombotic complications between groups. Analysis of factor VIII activity, von Willebrand factor, or von Willebrand factor multimers failed to show significant correlations with blood loss or differences between groups except for factor VIII activity, which was significantly higher in the desmopressin group 1 hour after operation than in the placebo group. A detailed comparative analysis of similar trials to determine the reasons for different outcomes suggests that desmopressin should not be used routinely as a prophylactic agent to reduce postsurgical hemorrhage, but that it may be beneficial when used in patients who already manifest excessive bleeding postoperatively.