Increasing transplant mass results in long-term allograft survival and recovery from transplant vasculopathy

Late allograft rejection due to transplant vasculopathy continues to be a major clinical problem. Increasing the ratio of donor transplant size to recipient weight has been shown to reduce the incidence of late allograft failure. Using a murine pancreas transplant model we have tested the hypothesis that increasing the donor transplant size in a recipient can promote long-term allograft survival by promoting recovery from transplant vasculopathy. Recipients of an allograft that showed extensive vasculopathy were transplanted with a second donor transplant. The effect of the second allograft on the vasculopathy present in the first graft was measured. Transplanting a second allograft reversed all signs of ongoing rejection, including transplant vasculopathy, resulting in long-term survival of the first graft. Vasculopathy was only reversed if the first and second grafts were from the same mouse strain, suggesting an antigen-specific mechanism. However, the recovery of the first graft was not associated with antigen-specific peripheral tolerance.     

Leukocyte-reduced transfusions in cardiac surgery results of an implementation trial

An implementation trial of leukocyte-reduced transfusions in cardiac surgery (primary coronary artery bypass graft and valve replacement) was performed from July to December 1998; comparisons were made with data from the same period in 1997. Patients from both periods were similar in important preoperative and intraoperative variables (age, sex, weight, number of units of RBCs transfused, ejection fraction). The mean total number of complications was statistically significantly decreasedfrom 0.26 complications per patient in the non-leukocyte-reduced to 0.19 in the leukocyte-reduced recipients. Overall, the mean +/- ISD costs of care per patient decreasedfrom 1997 ($27,615 +/- $33,973) to 1998 ($27,038 +/- $24,107). Mean costs decreased $1,700 per patient for recipients of leukocyte-reduced blood in 1998 compared with recipients of non-leukocyte-reduced blood in 1997 Mean costs increased $4,000 per patient in patients who did not receive transfusions in 1998 compared with 1997. Hospitalization costs decreased when leukocyte-reduced transfusions were implemented for patients undergoing cardiac surgery in our institution. Implementation of leukocyte reduction may be cost neutral or cost saving in at least some settings.     

Myoepitheliom des Weichgewebes

Zusammenfassung Der Fall eines Myoepithelioms des tiefen Weichgewebes wird mit klinisch-pathologischen, ultrastrukturellen und genetischen Befunden vorgestellt. Bei einem 30-jährigen Patienten fand sich ein Weichgewebstumor am rechten Unterschenkel innerhalb der tiefen Wadenmuskulatur mit Ausmaßen von 13,2x8,2x9 cm. Histologisch lagen Strukturen eines Myoepithelioms mit lobulärer, teils trabekulärer und nestartiger Lagerung der blanden epitheloiden und spindeligen Tumorzellen in einer fibromyxoiden, teils chondroiden Matrix vor mit immunhistochemischer Expression von Panzytokeratinen, S100-Protein sowie Calponin, fokal auch GFAP und EMA. Ultrastrukturell fanden sich Glykogeneinlagerungen und subplasmalemmale Verdichtungsstrukturen, wobei eindeutige Myofilamente nicht zu sichern waren (bei immunhistochemisch fehlender Aktinexpression). Mit Hilfe der komparativen genomischen Hybridisierung (CGH) konnte ein Zugewinn am Y-Chromosom nachgewiesen werden. Ein 17p-Verlust war zwar nicht eindeutig zu detektieren, kann aber bei der geringen Auflösung der CGH auch nicht ausgeschlossen werden. Der Patient war 25 Monate nach vollständiger Tumorresektion krankheitsfrei.Myoepitheliome bzw. Mischtumoren des Weichgewebes stellen seltene Weichgewebsneoplasien dar, die — wie im dargestellten Fall — eine erhebliche Größe erreichen können und andere Weichgewebstumoren oder -sarkome klinisch-radiologisch imitieren können. Bei einer Lokalrezidivrate von 20% nach Angaben der Literatur ist eine vollständige chirurgische Entfernung mit Nachbeobachtung zu empfehlen.Gewidmet Herrn Dr. Heinrich Dickmans.     

Self-reported illness and general practice consultations in Asian-born and British-born residents of West London

Summary Using data collected in a large scale community survey, some aspects of illness behaviour were compared in Asian-born and British-born residents of West London. Asian-born men were found to be far more likely to consult a general practitioner than British men, although the former group reported less long-standing illness and emotional distress than the latter. Self-assessed health among Asian men was significantly worse than among native men, and it was this health measure which was found to have the greatest effect on general practice consultations when a linear model was constructed. Differences in illness behaviour between Asian-born an indigenous women were not significant.     

The use of segmented regression for evaluation of an interrupted time series study involving complex intervention: the CaPSAI project experience

Health Services and Outcomes Research Methodology - An interrupted time series with a parallel control group (ITS-CG) design is a powerful quasi-experimental design commonly used to evaluate the...