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Transplanting the Highly Sensitized Patient: The Emory Algorithm 总被引:4,自引:0,他引:4
R. A. Bray J. D. L. Nolen C. Larsen T. Pearson K. A. Newell K. Kokko A. Guasch P. Tso J. B. Mendel H. M. Gebel 《American journal of transplantation》2006,6(10):2307-2315
Renal transplant patients sensitized to HLA antigens comprise nearly one-third of the UNOS wait-list and receive 14% of deceased donor (DD) transplants, a rate half that of unsensitized patients. Between 1999 and 2003, we performed 492 adult renal transplants from DD; 120 patients (approximately 25%) had a panel reactive antibody (PRA) of >30%, with nearly half (n = 58) having a PRA of >80%. Our approach is based upon high-resolution solid-phase HLA antibody analysis to identify class I/II antibodies and a 'virtual crossmatch' to predict compatible donor/recipient combinations. Recipients are excluded from the United Network for Organ Sharing match run if donors possess unacceptable antigens. Thus, when sensitized patients appear on the match run, they have a high probability of a negative final crossmatch. Here, we describe our 5-year experience with this approach. Five-year graft survival ranged from 66% to 70% among unsensitized (n = 272), moderately sensitized (PRA < 30%, n = 100) and highly sensitized (>30% PRA; n = 120) patients, equal to the average national graft survival (65.7%). The application of this approach (the Emory Algorithm) provides a logical and systematic approach to improve the access of sensitized patients to DD organs and promote more equitable allocation to a highly disadvantaged group of patients awaiting renal transplantation. 相似文献
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Clinical versus ultrasonographic evaluation of scrotal disorders 总被引:1,自引:0,他引:1
B Kromann-Andersen L B Hansen P N Larsen K Lawetz P Lynge D Lysen S P Nielsen K H Stockholm P Foged 《British journal of urology》1988,61(4):350-353
Clinical and ultrasonographic examinations of scrotal disorders were compared in 166 patients in order to determine their ability to distinguish between those diseases requiring surgery and those requiring clinical follow-up only. Ultrasound examinations were efficient in discriminating between normal and pathological findings. Extra-testicular lesions were readily differentiated from testicular ones. Although both clinical and ultrasonographic examinations had high sensitivity (90%) in detecting testicular cancer, the number of false positive findings was smaller after ultrasound examination. This gave a predictive value of a positive test of 53% after ultrasound examination but only 33% after clinical examination. Ultrasound examination may, therefore, reduce the number of surgical explorations in the scrotum and should be performed in patients with suspected testicular pathology based on history and palpatory findings. 相似文献
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P Rubin S Holm L Friberg P Videbech H S Andersen B B Bendsen N Str?ms? J K Larsen N A Lassen R Hemmingsen 《Archives of general psychiatry》1991,48(11):987-995
To measure prefrontal and subcortical activity during a cognitive task, we examined 19 newly diagnosed schizophrenics and patients with schizophreniform psychosis. Seven healthy volunteers served as controls. The patients were drug naive or had received neuroleptics for a few days only. Cerebral blood flow distribution was depicted by single photon emission computed tomography at rest and during activation with the Wisconsin Card Sorting Test. A significant relative activation deficit in the left inferior-prefrontal region was revealed during the Wisconsin Card Sorting Test in the patient group. Furthermore, the patients had impaired striatal suppression on the left side during the cognitive task. The test performance was significantly impaired in the patients. The inability to reduce striatal activity may be due to a lack of corticostriatal feedback during prefrontal activation. 相似文献
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Recurrent hip dislocation in intermediate spinal atrophy 总被引:1,自引:0,他引:1
Recurrent hip dislocation after corrective orthopaedic surgery in children and teenagers with intermediate spinal atrophy has not been reported in the literature. Four cases with long-term follow-up are presented. These represent the only cases surgically treated in 30 years of following spinal atrophy patients. Thus, it seems significant that all hips redislocated after the surgical procedure. In addition, two patients had second operations with subsequent dislocation. Pelvic obliquity should not be the basis for the surgery, as spinal fusion is generally necessary for wheelchair users. The sagacity of performing surgery for hip dislocations is raised. 相似文献
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杨兴旺 《眼外伤职业眼病杂志》1994,16(3):202-204
采用综合治疗,抗炎,散瞳,局部治疗与全身应用免疫抑制疗法,治疗319例352眼外伤获得了满意的疗效,眼球挫伤104例,眼球穿孔伤93例,化学烧伤71例,眼炸伤46例。眼热烧伤5例,治疗包括及时清创胶粘或缝合,清除前房出血合理用皮质类固醇和免疫抑制剂等。眼球挫伤治愈率97.12%,穿透伤93.18%,热烧伤66.67%。319例眼外伤治愈率94.67%好转5.33%,并对各种治疗方法进行了讨论。 相似文献
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The time aspects of daily use of a clinical database system in an endoscopy department were studied. The SADE database system for endoscopic procedures was introduced for daily use at Ullev?l Hospital on 1 January 1989. The average weekly programme of the endoscopy unit includes 57 gastroduodenoscopies, 23 colonoscopies and 12 ERCP/EPTs. During three consecutive weeks of the study the mean physician input time was 4 min 17 sec per patient (range 57 sec to 15 min), individual variation depending mainly on the extent of the report. Assistants spent a mean time of 4 min 23 sec for each patient. Thus, a total of 8 min 40 sec was spent for every patient seen. Endoscopic units should analyze their routines and needs before introducing an electronic data base manager. 相似文献