Rhabdomyolysis with acute kidney injury in deceased donors is not a contraindication for kidney donation

Purpose

Deceased patients with acute kidney injury (AKI) from rhabdomyolysis can be considered as potential kidney donors.

Methods

We performed a retrospective chart review from January 2005 to January 2011 of three donors with AKI from rhabdomyolysis and the four recipients of the donated kidneys. Three donors had AKI from rhabdomyolysis as evidenced by elevated serum creatinine levels, myoglobinuria, and plasma creatinine kinase levels greater than five times the upper limit of normal. All grafts were maintained on pulsatile machine perfusion (MP) prior to transplantation. In one of the patients, serial venous perfusate myoglobin levels were measured from the donor kidney while on MP.

Results

Three of the four recipients had delayed graft function, but all had normalized creatinine function after 1?month. One recipient had a creatinine of 1.2 after 79?months, the longest documented follow-up of this kind. Although we measured venous perfusate myoglobin levels from one of the grafts, we found the levels to decrease with increasing time spent on MP.

Conclusion

Potential donors with AKI secondary to rhabdomyolysis should not be restricted from the donor pool. MP may play a role in minimizing the effects of AKI in these types of donors.     

Percutaneous tumor ablation therapy for the advanced stage of HCC

We have performed percutaneous tumor ablation (PTA) including percutaneous ethanol injection therapy (PEIT) for 90% of the patients with hepatocellular carcinoma. Until December 1998, the 793 patients received PTA, 5 years survival rate reached 39.8%. Excluding the patients with Child C whose hepatic function were extremely low, 5 years survival rate reached to the level of 41.2%. Since 5 years survival rate in stage IV-A reached 24.4%, the patients of stage IV-A may be considered to have an indication for PTA. We have confirmed the effectiveness of the local treatment including radiotherapy for advanced hepatocellular carcinoma with portal vein invasion. We are attempting to perform PTA for the extra-hepatic lesions that had no indication of other treatment. However the indication of PTA is limited by the presence of diffuse nodules, exacerbation of the hepatic function, or tumor invasion to portal vein, bile duct, inferior vena cava.     

Chemotherapy sensitivity of gynecologic malignancies determined by the human tumor stem cell assay (HTSCA)

HTSCA was used to study the chemotherapy sensitivity of gynecological malignant tumors. 34 specimens were obtained from 32 patients. 11 of the 34 specimens (32%) yielded a sufficient number of colonies for testing. On these, 51 separate drug assays were done, each at the 1/10 peak plasma level. 20 drugs were identified as active among 51 drugs tested. Clinical correlations of sensitivity (S) and resistance (R) were studied in 6 patients treated with combination therapies, including drugs selected on the basis of in vitro sensitivity. (formula; see text) We conclude that HTSCA can aid in identifying active drugs for use in designing treatment protocols. However, because of difficulty in preparing a single cell suspension, and the small proportion of tumors suitable for testing, HTSCA will not be used in routine drug sensitivity testing until these drawbacks are eliminated.     

Antenatal blood donation for pregnant Nigerian mothers: the husbands' perspective.

This cross-sectional study was designed to evaluate the knowledge, attitude and motivation of husbands of pregnant mothers towards antenatal blood donation. A total of 700 husbands of pregnant mothers in Abakaliki, south-east Nigeria were interviewed over a 1-year period using a questionnaire. A total of 640 respondents completed the questionnaires giving a response rate of 91%. They had a mean age of 26.2 +/- 4 years with a range of 21 - 50 years. All the respondents had heard about blood donation but only 39% were well informed about it. One-third (33.1%) of respondents were willing to donate blood and the main motivating factor was their wives' previous experience with bleeding during pregnancy/delivery. Other motivating factors to blood donation included previous donation, information on blood donation and husband participation in antenatal programme. Two-thirds of respondents were unwilling to donate because of fear, misconception and availability of paid blood donors. Higher educational status was significantly associated with willingness to donate blood (p < 0.05). The willing blood donors showed a more positive attitude towards blood donation and were of the view that the donated blood if not used for their wives would benefit others. The non-donors on the other hand had a selfish attitude and would prefer to procure blood only when their wives needed blood transfusion. An intensive donor recruitment campaign, including mobilising husbands of pregnant mothers and providing information and education on all aspects of blood donation, will help correct some of the misconceptions about blood donation. This will increase the number of voluntary blood donors and thus increase available banked blood for pregnant women.     

Natural bactericidal activity of human serum against strains of Campylobacter jejuni isolated in Lagos, Nigeria

The sensitivity of Campylobacter jejuni strains LA4, LA12, LA36, LA53, LA1214, LA1308 and LA1309 constituting the most prevalent strains of C. jejuni isolated in Lagos, Nigeria to the bactericidal activity of normal human serum was determined using microtiter technique. Results obtained shows that only strains LA 36 and LA53 were serum resistant while others (strains LA4, LA12, LA1214, LA1308 and LA1309) were serum sensitive. This finding is important epidemiologically and is the first report on serum sensitivity of local isolates of C.jejuni in Nigeria.     

Dot enzyme immunoassay for visual detection of peste-des-petits-ruminants virus antigen from infected caprine tissues.

An enzyme-linked immunosorbent microassay using nitrocellulose paper as the solid-phase support was developed for the detection of peste-des-petits-ruminants virus antigens in infected caprine tissue homogenates. Dots of tissue homogenates were applied to nitrocellulose papers, and any unreacted sites were blocked with 5% skim milk powder in triethanolamine-buffered saline. After incubation of the papers in tissue culture supernatant monoclonal antibody against the peste-des-petits-ruminants virus, the antigen-antibody reaction was detected with peroxidase-conjugated anti-mouse immunoglobulin G and the enzyme substrate 4-chloro-1-naphthol. Positive results were visualized as blue dots. Results of the dot enzyme immunoassay compared favorably with those of the standard enzyme-linked immunosorbent assay. Incorporation of Nonidet P-40 in the washing solution did not improve the sensitivity of the dot enzyme immunoassay, and pretreatment of homogenates with Nonidet P-40 before application to the nitrocellulose paper inhibited the binding of the antigen to the paper and reduced the intensity of the color development.     

The pattern of childhood malignancy in eastern Nigeria

The pattern of childhood malignancies in the developing countries of Africa is characterized by a high incidence of lymphoma and a low incidence of leukaemia. The converse is the case in the developed countries of Europe and North America. A high incidence of lymphoma with low incidence of leukaemia has been associated with poor living standards. The clinical records of 257 children admitted with malignant disease to the University of Nigeria Teaching Hospital, Enugu between January 1978 and December 1982 were studied retrospectively to determine the pattern of malignant diseases amongst these children. The lymphomas were the commonest tumours, constituting nearly 40% of the total, followed by Wilm's tumour (14.0%), leukaemia (12.9%) and CNS tumours (9.7%). However, the incidence of lymphoma was lower while the incidence of leukaemia was higher than in previous reports from other parts of Nigeria and Africa. The rarity of Ewing's tumour, histocytosis-X and testicular tumours in African children is confirmed in the present study.     

Heavy metal hazards of sachet water in Nigeria

The authors assessed sachet water samples sold in Eastern Nigeria. Using an atomic absorption spectrophotometer, they analyzed levels of lead, cadmium, copper, and nickel. They also analyzed other parameters, such as nitrates, sulfates, chlorides, salinity, total hardness, biological oxygen demand, total dissolved solids, and pH level. Lead levels ranged from 0.002 to 0.036 mg/L in the samples; 5 samples (12.2%) had lead levels above the maximum contaminant level (MCL; 0.015 mg/L). Lead was not detectable in 20 samples (48.8%). Cadmium levels ranged from 0.002 to 0.036 mg/L and exceeded the MCL of 0.005 mg/L in 8 samples (19.5%); it was not detectable in 23 samples (56.1%). Copper was not detected in 2 (0.05%) of the samples. Its range was between 0.018 and 1.401 mg/L. Two samples (0.05%) had copper levels above the MCL (1.30 mg/L). Nickel levels ranged from 0.003 to 0.050 mg/l. The biological oxygen demand of the samples ranged from 3.20 to 36.80 mg/L. Other parameters were normal. The authors found that some of the sachet waters contain heavy metals, and consumers may be exposed to hazards.     

Metal contamination and infiltration into the soil at refuse dump sites in Awka, Nigeria

Awka has been the site of increased human activities since it became a state capital in 1991. Because refuse dumps have hitherto been a disregarded environmental menace in Nigeria, the authors sought to find out how much of the current environmental metal pollutant load comes from refuse dumps. They investigated the metal contamination of the refuse dumps in Awka. The authors collected four soil samples (from the surface and from depths of 0.45 m, 0.90 m, and 1.35 m) from 5 dumpsites digested with nitric acid and perchloric acid, and they analyzed iron, sodium, arsenic, lead, magnesium, potassium, cobalt, zinc, nickel, copper, chromium, and cadmium by using an atomic absorption spectrophotometer. Sites A and C showed the highest levels of arsenic (2300 mg/kg) and lead (2467 mg/kg), respectively. Site D had highest level of both iron (72,200 mg/kg) and sodium (3561 mg/kg), whereas Site E had the lowest level of lead (572 mg/kg). The metal levels exceed the limits set forth by the US Environmental Protection Agency. This study suggests that the refuse dumps in Awka may increase the level of environmental heavy metals in Nigeria.