Factors predicting duration of delayed graft function in non-heart-beating donor kidney transplantation

Non-heart-beating donors (NHBDs) are an important potential source of donor organs, but kidneys from such donors are prone to delayed graft function (DGF) and primary nonfunction, which are multifactorial in origin but believed to be mainly due to warm ischemic injury. This retrospective study examined a series of 88 transplants from Maastricht category II and III NHBDs to examine the role of factors to predict the duration of DGF. The main factors affecting duration of DGF were total warm ischemic time, cold ischemic time, product of perfusate GST concentration and donor age, quality of postoperative graft perfusion, incidence of acute rejection, recipient cardiovascular risk score, maximum pressure on machine perfusion, and weight gain during machine perfusion. Primary nonfunction was not accurately predicted from these factors for kidneys that had passed the viability assessment.     

20-MHz ultrasound and its value in imaging of lacrimal plugs

BACKGROUND: High-frequency B scan ultrasonography is a proven method for the assessment of anterior segment diseases. Only few studies have used sonography to examine the lacrimal drainage system. We examined the proximal lacrimal drainage system by high-resolution 20-MHz ultrasound to verify the possibility to identify intracanalicular lacrimal plugs. METHODS: Eight patients who had received 12 lacrimal plug implants were examined by high-resolution ultrasound. A 20-MHz sector scanner was used for detection and localization of 2 types of intracanalicular plugs (Herrick) lacrimal silicone plug, Smart trade mark acrylic polymer plug) and 1 punctum plug. Ultrasound examinations were performed 1-24 months after plug placement. Cross-sections of the lacrimal canaliculi were obtained. RESULTS: The various intracanalicular implants were successfully viewed using the 20-MHz ultrasound sector scanner. Intracanalicular plugs were located at the appropriate position as intended. The silicone plugs could be seen as areas of higher reflectivity. In contrast, acrylic polymer plugs were seen as low-reflective inner structures. In a longitudinal echogram, the interface between the acrylic polymer plug and the lacrimal canaliculus produced a strong acoustic impedance. In patients with an intracanalicular acrylic polymer plug, the caliber of the plug could be ascertained and the diameter measured. CONCLUSION: High-resolution ultrasound with a 20-MHz sector scanner is helpful in detecting intracanalicular plugs and is a valuable tool to assess the migration of lacrimal plugs through lacrimal canaliculi. A 20-MHz sector scanner can be used to identify and locate lacrimal plugs in the proximal drainage system even if biomicroscopic signs or clinical data are absent.     

The efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain

This article is a review of the efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain. Endometriosis is the cause of pelvic pain (dysmenorrhea, dyspareunia) and infertility in more than 35% of women of reproductive age. Complete resolution of endometriosis is not yet possible but therapy has essentially three main objectives: (1) to reduce pain; (2) to increase the possibility of pregnancy; (3) to delay recurrence for as long as possible. It could be concluded that a consensus will probably never be reached on minimal and mild endometriosis. Nevertheless, because the Canadian study reported a large number of cases, we strongly support the view that visible endometriosis must be removed at the time of surgery. In cases of moderate and severe endometriosis-associated infertility, the combined approach (operative laparoscopy with GnRH-a) must be considered as 'first-line' treatment. The mean pregnancy rate of 50% reported in the literature following surgery provides scientific proof that operative treatment should be undertaken first to give our patients the best chance of conceiving naturally.     

Does additional surgical training increase participation in randomized controlled trials?

BACKGROUND: The prospective randomized controlled trial (PRCT) is agreeably the gold standard in reporting data on patient management. This study evaluates the impact of specialty training on the leadership, development, and enrollment in PRCT. METHODS: Questionnaires were sent to surgical oncology as well as general surgery graduates from 1985 to 1999. RESULTS: A total of 67% (201 of 300) of the surgeons responded, with one half of the respondents completing a surgical oncology (SO) fellowship (50%, 100 of 201), 33% (66 of 201) another type of fellowship (OF), and 17% (35 of 201) general surgery (GS) training alone. The utilization of PRCT in the decision making of their clinical practice was reported by a majority of SO graduates (99%) as well as GS graduates (88%) with a smaller number (77%) of OF trained surgeons. The opinions on PRCT were evenly distributed with breast disease, colorectal cancer, and melanoma having the greatest impact on surgeons practicing in these fields. A greater percentage of SO (89%) reported participation in a PRCT than did the GS (42%) or OF (54%). The most frequent reason for the lack of participation in a PRCT by both GS and OF trained graduates was absence of active recruitment (80%) to participate with the second most common being no time available (18%). CONCLUSIONS: PRCT are utilized and continue to change surgeons' decision making for a majority of the surgeons surveyed. There are certain disease sites for which PRCT have failed to influence practice decisions. Unfortunately, few surgeons take a leadership role in PRCT. Emphasizing the existence of PRCT at both meetings, and in journals, with a more aggressive recruitment of participating surgeons with minimal time commitment, should enhance the patients included in prospective randomized controlled trials.     

Nonpharmacologic group treatment of insomnia: a preliminary study with cancer survivors

This study describes, and examines the initial efficacy of, a sleep therapy programme developed for cancer patients with insomnia. The six-session group programme included stimulus control therapy, relaxation training, and other strategies aimed at consolidating sleep and reducing cognitive-emotional arousal. The 12 final participants were patients of a regional cancer centre; mean age was 54.7 years (S.D. 10.4); median time from cancer diagnosis was 33.6 months; all had high performance status. Participants kept sleep diaries and rated their sleep quality, mood and functioning at baseline, week 4 and week 8. Significant improvement over baseline was observed at weeks 4 and 8 in the number of awakenings, time awake after sleep onset, sleep efficiency, sleep quality ratings, and scores on European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 role functioning and insomnia. Total sleep time and fatigue were significantly improved at week 8. The sleep therapy programme was associated with improved sleep, reduced fatigue and enhanced ability to perform activities in relatively well individuals attending a cancer centre. This is preliminary evidence of the efficacy of the programme. Further research is required to examine the programme's effectiveness and suitability for a wider range of people with cancer. Options for providing cancer patients with access to nonpharmacologic treatments for insomnia are discussed.