Transplantation of horseshoe kidneyinto single recipient

A case of successful en bloc transplantation of a horseshoe kidney into a single recipient is reported. The literature is briefly reviewed. The use of horseshoe kidneys in transplantation is recommended in selected cases.     

Platelet dosing.

Many patients with thrombocytopenia require transfusion of platelet concentrates, and numerous factors may influence the observed response to transfusion. One factor gaining growing recognition in recent years is the consideration of the dose of platelets to administer. Review of the available data regarding the effect of platelet dose on transfusion outcome is presented in this summary, with attention to those situations that seem to require higher platelet doses. Appropriate dosing may not only improve the immediate response to transfusion, but also lead to a decrease in further platelet transfusion requirements. Recommendations supported by actual clinical data are outlined, but controlled studies are needed to determine optimum platelet doses for many common clinical situations.     

A Web-Based Health Promotion Program for Older Workers: Randomized Controlled Trial

BackgroundRecent evidence supports the efficacy of programs that promote improvements in the health practices of workers 50 years and older who are at higher risk for chronic diseases than younger workers are. Internet-based programs that promote healthy practices have also shown promise and, therefore, should be especially appropriate for workers aged 50 years and older.ObjectiveThe purpose of the research was to evaluate the effectiveness of HealthyPast50, a fully automated Web-based health promotion program based on social cognitive theory and aimed specifically at workers 50 years and older.MethodsThe randomized controlled trial was conducted across multiple US offices of a large global information technology company. The sample included 278 employees aged 50 to 68 who were recruited online and randomly assigned to the Web-based HealthyPast50 program or to a wait-list control condition. Self-report measures of diet, physical activity, stress, and tobacco use were collected online before and 3 months after the program group was given access to the program. Use data included number of log-ins and number of pages accessed. The primary analysis was multiple linear regression, following intent-to-treat principles with multiple imputation using the Markov chain Monte Carlo (MCMC) approach for nonmonotone missing data. Potential moderators from demographic characteristics and program dosage effects were assessed using multiple linear regression models. Additional analyses were conducted on complete (nonimputed) cases, excluding program participants who used the program for less than 30 minutes.ResultsRetention rates were good for both groups: 80.4% (111/138) for the program group and 94.3% (132/140) for the control group. Program group participants spent a mean of 102.26 minutes in the program (SD 148.32), logged in a mean of 4.33 times (SD 4.28), and viewed a mean of 11.04 pages (SD 20.08). In the analysis of the imputed dataset, the program group performed significantly better than the control group on diet behavioral change self-efficacy (estimated adjusted difference [Δ]=0.16, P=.048), planning healthy eating (Δ=0.17, P=.03), and mild exercise (Δ=1.03, P=.01). Moderator and dosage analyses of the dataset found no significant program effects. Analyses of the nonimputed dataset comparing program users with controls found additional significant program effects on eating practices (Δ=0.09, P=.03), exercise self-efficacy (Δ=0.12, P=.03), exercise planning (Δ=0.18, P=.03), and aging beliefs (Δ=0.17, P=.01). Moderator analysis of this dataset also found significant moderator effects of gender on multiple measures of exercise.ConclusionsA Web-based health promotion program showed promise for making a significant contribution to the short-term dietary and exercise practices of older working adults. Gender effects suggest that the program effects on exercise are due mainly to improvements among women.     

MR imaging as the sole preoperative imaging modality for right hepatectomy: a prospective study of living adult-to-adult liver donor candidates

OBJECTIVE: Our aim was to investigate the feasibility of MR imaging as a comprehensive preoperative imaging test for examination of liver donor candidates for adult-to-adult right lobe transplantation. SUBJECTS AND METHODS: Twenty-five consecutive donor candidates were examined at 1.5 T using a torso phased array coil with breath-hold T1- and T2-weighted imaging of the abdomen, MR cholangiography using T2-weighted turbo spin-echo imaging, and MR angiography and venography of the liver using two interpolated three-dimensional spoiled gradient-echo sequences (average dose of gadolinium contrast material, 0.17 mmol/kg). Images were interpreted for liver parenchymal and extrahepatic abnormalities; measurements of right and left lobe liver volumes; definition of hepatic arterial, portal venous, and hepatic venous anatomy; and definition of the biliary branching pattern. Findings were compared with those of conventional angiography in 13 patients, 11 of whom also had surgical findings for comparison. RESULTS: Nine patients were excluded as candidates for donation on the basis of MR imaging findings that included parenchymal or extrahepatic abnormalities in five patients, vascular anomalies in two, and biliary anomalies in three. Two patients who did not undergo surgery underwent conventional angiography that confirmed MR angiographic findings except for a small (<2 mm) accessory left hepatic artery missed on MR imaging. Of the nine patients who underwent successful right hepatectomy, all MR imaging findings were corroborated intraoperatively. In two patients, right hepatectomy was aborted at laparotomy because of intraoperative cholangiography findings; in one of them, the biliary finding was unsuspected on MR imaging. CONCLUSION: A comprehensive MR imaging examination has the potential to serve as the sole preoperative imaging modality for living adult-to-adult liver donor candidates provided improvements in definition of intrahepatic biliary anatomy can be achieved.     

Optimal parameters for CO2 laser reconstruction of urethral tissue using a protein solder.

This study was designed to determine the optimal laser parameters for welding urethral tissue and to develop further understanding of the welding process. A partial transection of the pendulous rat urethra was repaired using laser powers of 80, 120, and 160 milliwatts with shutter speeds of 50 milliseconds, 100 milliseconds, and in a continuous wave mode. Repairs were made using the laser alone and the laser plus a protein solder. Measurements of intraluminal bursting strength, percentage stricture and histology were performed. The highest bursting strength with the least amount of tissue damage was achieved using a power of 120 milliwatts with 100 milliseconds pulses and the addition of a protein solder. The average percentage stricture was lowest with the laser plus solder repair (4.2%) when compared to laser only repair (14%). Intraluminal bursting strength was similar in both types of repairs. Histology demonstrated marked changes in collagen organization after laser application in all models.     

Fifteen-year series of skin-sparing mastectomy for stage 0 to 2 breast cancer

BACKGROUND: In 1989, skin-sparing mastectomy started at a number of breast centers in the United States because of an increasing demand for immediate reconstruction and a desire for better cosmetic outcomes. METHODS: To ensure the safety of this new approach, we have reviewed the personal series of a single surgeon using a standardized skin-sparing technique during 1989 to 2004. RESULTS: Skin-sparing mastectomy with immediate reconstruction was performed on 225 patients, and standard mastectomy was performed on 1,022 patients. The age distribution was 8 years younger on average in the reconstructed group. The average follow-up for each group was 49 months. The local recurrence for each group was 1.7% and 1.5% (P > .80). The regional recurrence was 3.8% and 3.9% (P > .80). The average time to local recurrence was similar in each group (33.1 and 32.6 months, P > .80). CONCLUSIONS: A skin-sparing mastectomy does not change the local, regional, or systemic risk to breast cancer patients.