While the number of patients listed for liver transplant has increased, the pool of donor organs has remained constant. Questions have arisen regarding equitable access to organs. The purpose of this study was to analyze factors associated with access to liver transplantation (LT) using a large, population-based, hospital discharge database. The primary hypothesis was that a variety of factors other than medical need could be associated with access to LT. The rate of LT was defined as the number of liver transplants per admission for liver disease. The data sources were selected to allow a population-based, time-series analysis of all patients admitted with liver disease and those receiving liver transplants in all 157 nonfederal hospitals in North Carolina from 1988 to 1993. The hypotheses of this study were that age, gender, payment source, type of liver disease, distance from the transplant center, and rural county of residence were associated with patients' likelihood of access to LT. During the six years studied, 56,803 patients were admitted with liver disease and 126 underwent liver transplantation (LT). The rate of LT increased from 0.07% to 0.27%. Age, gender, source of payment, type of liver disease, rural county of residence, and distance of residence from the transplant center were associated with rates of transplantation. In the multivariate model, source of payment appeared to have the strongest association with the likelihood of LT. These findings raise important questions associated with equitable access to health care, need for physician education, and transplant center regionalization.
We are concerned that CTA or MRA may overlook mild cases of DSA-detectable FMD. All seven FMD patients had single left renal arteries and would have undergone left donor nephrectomy. This would have resulted in their remaining right native kidneys having mild to moderate FMD in six of seven patients and in four donor kidneys having mild to moderate FMD. The need for antihypertensive medications in two of these seven potential donors within 4 years of their evaluation supports previous literature reports.
We report the early results of laparoscopic incisional hernia repair in a small group of immunosuppressed patients and compare these results with a cohort of patients with open repair. We describe a modification used to secure the cephalad portion of the Gore-Tex A mesh in high epigastric incisional hernias often encountered after liver transplantation. Data were gathered retrospectively for all incisional hernia repairs by our group from March 1996 to January 2001. Twelve of 13 attempted patients had successful completion of their laparoscopic hernia repairs with no reported recurrences to date. Two of these procedures were performed for recurrent hernias. We completed nine of nine attempted laparoscopic hernia repairs in liver transplant patients with epigastric incisional hernias. We repaired two of three attempted lower midline incisional hernias in renal disease patients. One of these patients was soon able to reuse his peritoneal dialysis catheter. A total of 15 patients, 12 with liver transplants, underwent open repair of their incisional hernias. These patients had seven recurrences and/or serious mesh infections with five patients electing repeated operations. In our initial series, laparoscopic mesh repair of incisional hernias is practical and safe in the abdominal organ transplant population with a low incidence of early recurrence and serious infections.
The relationships between experimentally induced deciduoma formation, circulating estradiol (E) and progesterone (P) levels and alterations in uterine blood flow (UBF) were studied between days 4 and 15 of pseudopregnancy (PSP: day 0 = ovulation) in rats. Blood flow was measured with an electromagnetic blood flow monitor and serum analyzed for E and P levels by radioimmunoassay. Neither uterine trauma on day 4 of PSP nor the site of trauma had any direct influence on altering UBF. A dramatic increase in UBF occurred in response to stromal proliferation on days 5–6 and continued to remain above sham-operated control levels through day 9. These vascular changes correlated temporally with the day 9 peak in uterine weight resulting from deciduoma formation. Both uterine weight and vascular fluctuations in deciduoma-bearing rats were related to the cyclic changes in E/P ratios between days 5 and 8 of PSP. A decline in UBF preceded deciduoma regression between days 9 and 15 of PSP. These results suggest that an increase in UBF is causally associated with the formation and maintenance of deciduoma in the PSP rat and that deciduoma regression may result from a subsequent decline in UBF rates. Both factors may be directly dependent on fluctuating E/P ratios.
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