bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of A9 Antigen and Loss of Blood Group Antigens as Determinants of Survival in Patients with Head and Neck Squamous Carcinoma
Authors: Carey Thomas E. , Wolf Gregory T. , Hsu S. , Poore J. , Peterson K. , McClatchey K. D.
Published: July 2017

The murine monoclonal antibody (A9), raised to the human squamous cell carcinoma (SCC) cell‐line UM‐SCC‐1, defines a squamous cell antigen associated with aggressive biologic behavior of SCC cell lines in vivo and in vitro. In the present investigation, A9 antigen was detected in tissue sections from 37 consecutive, previously untreated patients with SCC of the head and nack. All tumors were positive for A9 binding, although three distinct patterns (reflecting different intensities of A9 expression) were identified. The intensity of A9 expression was independent of primary tumor site, tumor differentiation, keratinization, or growth pattern. The frequency of high expression (Pattern 1) grew with increasing T class, N class, and tumor stage, and was associated with loss of blood group expression in the tumor and with low levels of lymphocyte infiltration In the tumor. Strong A9 expression had a statistically signification association with low nuclear grade (i.e., tumors with more mature and fewer enlarged nuclei, P = 0.019), low vascular/stromal response (i.e., patchy response rather than continuous, P = 0.014), and impaired in vitro lymphokine production by peripheral blood leukocytes (P = 0.0011). Of greatest interest, however, was the strong association of high A9 expression with shortened disease‐free interval (DFI) (P = 0.085) and survival (P = 0.081) relative to patients with weak A9 tumor staining (Patterns 2 and 3). Similarly, the loss of blood group antigen expression was strongly associated with decreased DFI (P = 0.038) and survival (P = 0.062). While neither Pattern 1 A 9 expression nor loss of blood group reach statistical significance in prediction of survival, the combination of Pattern 1 A 9 expression and loss of blood group expression in primary tumors was significantly associated, both with decreased disease‐free interval (P = 0.017) and with decreased overall survival (P = 0.011) (median length of follow‐up = 22 months). The length of follow‐up (LFU) ranged from 2 to 38 months, with a median LFU of 22 months. While the number of patients (37) is small, the significant association between the expression of these cell‐surface markers with relapse and survival indicates that immunohistologic staining of the primary tumor will be an important prognostic indicator useful in identification of individual patients at greatest risk of recurrence or early death from head and neck cancer, independent of tumor size, site, or stage at presentation. These markers may thus provide means of selecting patients who should receive adjuvant therapy and more intensive monitoring for the early detection of recurrent disease.
Primary Adenocarcinoma of the Temporal Bone Mimicking Paragangliomas: Radiographic and Clinical Recognition
Authors: Goebel Joel A. , Smith Peter G. , Kemink John L. , Graham Malcolm D.
Published: July 2017

Three cases of primary adenocarcinoma of the temporal bone which simulated a glomus jugulare tumor (on the basis of a thorough preoperative evaluation) are detailed. In each case, a vascular mass was seen beneath an intact tympanic membrane and angiography revealed the presence of a highly vascular mass centered on the jugular bulb. Computed tomography revealed erosive changes within the jugular fossa that were characteristic of a glomus jugulare tumor; in two cases, a significant posterior fossa extension was documented. The intraoperative findings failed to suggest a lesion different from paraganglioma in two of the cases; in the remaining case, the erosion of both bone and dura was diffuse and more suggestive of a malignant neoplasm. A discussion of the clinical behavior of adenocarcinomas of the middle ear is included in order to emphasize the importance of differentiating these lesions preoperatively from the more commonly encountered paragangliomas.
Magnetic Resonance Imaging of the Facial Nerve During Bell's Palsy
Authors: Murphy Terrence P. , Teller David C.
Published: July 2017

Twenty‐five patients with Bell's palsy were evaluated to assess the efficacy of gadolinium (Gd +)‐enhanced MRI in determining: (1) the site of facial nerve enhancement, (2) the relationship between EMG findings and Gd + MRIs, and (3) the usefulness of Gd + MRI in predicting recovery of facial function. Eighteen of twenty‐five patients had enhancement of the facial nerve during Gd + MRI whereas seven did not. The most common areas of facial nerve enhancement were the labyrinthine, geniculate ganglion, and proximal tympanic segments of the facial nerve. EMGs were performed on ten patients who lost nerve excitability. The segments of facial nerve enhanced during Gd + MRI varied in location and intensity in patients who maintained nerve excitability and in patients who lost nerve excitability. There was no correlation between EMG findings and location of facial nerve enhancement in patients who lost nerve excitability. The location of facial nerve enhancement during Gd + MRI was not useful in predicting recovery of facial paralysis.
Orbital Wall Fractures: Evaluation and Management
Authors: Osguthorpe J. David
Published: July 2017

Over a 49‐month period, 121 orbital wall fractures were treated and 92 were followed for a median of 6.5 months (minimum, 3 months). Associated injuries included a 17% incidence of serious globe or optic nerve injuries and 13% incidence of lacrimal drainage disruption. Diplopia occurred in 23% and dystopia in 11%. Management was by observation alone in 14% and exploration in the remainder, with layered gelfilm for defects smaller than 4 cm2, alloplastic sheeting for defects to 6 cm2, and outer cortex of parietal bone for larger dehiscences. There were no decrements in vision from operation, dystopias were corrected to within 2 mm of normal, and diplopia persisted only in those with extraocular muscle paresis. There was no benefit to exploration of orbital wall defects smaller than 2.5 cm2 or with reduction of other midfacial fractures (e.g., malar) when neither dystopia nor entrapment was present, because defects not obturated in such cases had no sequelae.
Intraoperative Electrocochleography during Endolymphatic Sac Surgery: Clinical Results
Authors: Bojrab Dennis I. , Bhansali Sanjay A. , Andreozzi Mark P.
Published: July 2017

Thirty‐eight patients who underwent endolymphatic shunt surgery with intraoperative electrocochleography were questioned regarding control of symptoms. The average follow‐up period was 2 years (range, 7 to 40 months). Sixteen (42%) patients showed improvement in the intraoperative electrocochleography potential, 12 (32%) showed worsening, and 10 (26%) showed no change. Complete or substantial control of dizziness was achieved in 36 (95%) patients, and insignificant control in only 2 (5%) patients. Hearing Improvement was noted in 4 (11%) patients, and hearing loss in 13 (34%). No correlation was found between intraoperative electrocochleography improvement and dizziness control. However, three of the four patients who had hearing improvement also had the greatest improvement in intraoperative electrocochleography recording. Intraoperative electrocochleography may help the surgeon more accurately identify the true endolymphatic sac and duct.
Surgical Anatomy of the Petrous Apex as it Relates to the Enlarged Middle Cranial Fossa Approaches
Authors: Naguib Maged B. , Aristegui Miguel , Saleh Essam , Cokkeser Yasar , Landolfi Mauro , Taibah Abdelkader , Russo Alessandra , Sanna Mario
Published: July 2017

This work was designed to study the surgical anatomy of the petrous apex as it relates to the enlarged middle cranial fossa approaches, on 25 temporal bones. In this study we suggest dividing the petrous apex into two topographic areas: an anterior triangular and a posterior quadrangular area with respect to the posterior border of the Gasserian ganglion. Anatomic descriptions endorsed by relevant measurements of these areas are provided in this study.
Effect of Anemia on Survival of Myocutaneous Flaps in the Pig
Authors: Kim Kun Z. , Thompson David H. , George Thomas F. , McQuillan Patrick M. , Kao Tzu‐Cheg
Published: July 2017

The decision to transfuse patients after major head and neck reconstructive surgery has been influenced by the dictum that a hematocrit level of 30% or more is necessary for the survival of surgical flaps. Pedicled myocutaneous flaps are among the most frequently used methods of reconstruction after major head and neck oncologic surgery. No studies have addressed the survival of myocutaneous pedicied flaps in anemic animals. In this study survival of latissimus dorsi myocutaneous flaps in pigs was evaluated in anemic and control groups. A total of 26 pigs were randomly divided into two groups. The pigs in the anemic group were exsanguinated to normovolemic anemia (average hematocrit, 19%), followed by elevation of a latissimus dorsi myocutaneous flap. In the control group the same operation was performed without exsanguination. All other variables were kept constant. The flap survival was judged on postoperative3 days 7, and 14 by two evaluators. Ten pigs from each group were found to have 100% flap survival on postoperative day 14. There was no significant difference in mean flap survival rates between two groups for postoperative3 days 7, and 14. It is concluded that normovolemic anemia does not adversely affect the survival of the myocutaneous flaps. This finding may save unnecessary transfusions in postoperative patients.
Nasopharyngeal Radium Irradiation: Fundamental Considerations
Authors: Royal Henry D.
Published: July 2017

This article discusses the potential carcinogenic effects of radiation exposure from nasopharyngeal radium irradiation exposure and issues to consider when deciding whether to recommend screening for asymptomatic patients who have been treated by nasopharyngeal radium irradiation. The radiation exposure from the radium is primarily the result of γ‐rays, which are very penetrating. β‐Particles would affect only the tissues located within 1 cm of the eustachian tube orifice. On the basis of a quantitative risk assessment, the lifetime risk of brain cancer developing was estimated to be approximately 3 per 1000 persons, and the lifetime risk of a fatal cancer 5.6 per 1000 persons. When the medical benefits of screening asymptomatic patients are assessed, several factors, including the medical risks and benefits and cost‐effectiveness of follow‐up, should be considered.
Otolaryngologist's Role in Transtracheal Oxygen Therapy: The Minitrach Procedure
Authors: Upkin Alan F. , Christopher Kent L. , Diehl Stephanie , Yaeger Eric S. , Jorgenson Susan
Published: July 2017

The modified Seldinger technique for transtracheal oxygen catheter insertion it relatively straightforward, but tract problems during subsequent oxygen therapy are not uncommon. With the modified Seldinger technique method, transtracheal oxygen is not initiated until 1 week after the procedure. Six to 8 weeks are required for tract epithellalization, which allows routine catheter removal and cleaning by the patient. Without removal, mucus tends to collect and form balls on the catheter tip, creating a management problem. Previous studies suggest a significant incidence of tracheal chondritis, keloid formation, and inadvertent catheter dislodgment. In 7% to 10% of patients, the epithelial tract cannot be recovered by medical personnel, and complete closure occurs. We have developed a surgical technique for the creation of a controlled tracheocutaneous tract. Highlights of the minitrach include skin flap elevation, cervical lipectomy, resection of a small window of tracheal cartilage, and approximation of the skin flaps to the window. We evaluated 33 patients who underwent the minitrach procedure as an access method for receiving transtracheal oxygen. When compared with results from 64 patients followed up for a similar period with me modified Seldinger technique, results with minitrach showed that transtracheal oxygen could be instituted sooner (<24 hours), and symptomatic mucus balls were reduced because the tract matured more quickly (approximately 14 days). With the minitrach there were no inadvertent catheter disiodgments, as compared with 41% of modified Seldlnger technique patients who had one or more episodes of catheter disiodgment. Twelve percent of minitrach patients had a single episode of chondritis, as compared with 25% of the modified Seldinger technique patients, who had one or more episodes. The minitrach was well tolerated in this group of patients with severe pulmonary and/or cardiovascular disease. In 12 of these patients, a minitrach revision of their previous modified Seldinger technique tracts resolved recurrent problems with chondritis, lost tracts, and keloids. We conclude that the minitrach promotes early institution of transtracheal oxygen, simplifies an intense postprocedure educational and management process, facilitates tract maturation, and reduces the incidence of problems related to mucus balls, lost tracts, chondritis, and keloids. The minitrach can be used as a revision procedure to resolve tract problems encountered with modified Seldinger technique. We are now using the minitrach as the preferred procedure for the institution of transtracheal oxygen. The minitrach greatly improves and simplifies the transtracheal oxygen program, and the otolaryngologist becomes an important member of the transtracheal oxygen team.
Efficacy of Cold‐Steel Uvulopalatoplasty
Authors: Casiano Roy R. , Sheth Shishir
Published: July 2017

Sevan patients underwent cold‐steel uvulopalatoplasty with tissue removal similar to that being performed with laser‐assisted uvulopalatoplasty. The severity and length of postoperative pain, days out of work, postoperative complications, and efficacy in reducing snoring were assessed. The minimum follow‐up period was 6 months. The average length of postoperative pain (inability to eat a completely normal diet) was 6 days. All but one patient underwent only one session of cold‐steel uvulopalatoplasty with satisfactory relief of snoring. The remaining patient required two sessions. One patient had some mild postoperative bleeding which resolved with silver nitrate. Improvement in snoring goes as follows: marked improvement in three patients, moderate improvement in three patients, and slight improvement in one patient. None of the patients had complete resolution or the same degree of snoring. Patients who underwent concomitant oropharyngeal procedures (i.e., tonsillectomy) in addition to cold‐steel uvulopalatoplasty tended to have pain for a longer period of time and required a longer convalescence period. Cold‐steel uvulopalatoplasty is an inexpensive and viable option to outpatient laser‐assisted uvulopalatoplasty for the reduction of snoring in select patients.
Quality of Life Outcomes Associated with Variable Posttransplant Prednisone Dosing Regimens
Authors: Hathaway Donna K , Winsett Rebecca P , Milstead E Jean , Wicks Mona N , Gaber A Osama
Published: July 2017

Prednisone tapering has become more common in the management of transplant recipients. Benefits of this practice, however, must be weighed against the risks. This study identified outcomes associated with variable low dose prednisone protocols. The study sample included 98 kidney and kidney-pancreas transplant recipients 1 year after transplant. Graft function, side effects of steroid therapy, and quality of life were recorded on patients receiving 0 (n=5), 1 to 5 (n=4), 5 to 7.5 (n=5), 7.5 to 10 (n=21), and greater than 10 mg/d prednisone (n=63). Despite the fact that patients were assigned to the low dose groups because they were at risk for or already experiencing steroid induced side effects, the low dose groups presented side effect and quality of life profiles similar to or better than those of the standard dose group.
Perspectives on Communication Issues among Transplant and Procurement Professionals, Transplant Recipients, and Donor Families
Authors: Politoski Gigi , Coolican Margaret , Casey Kathleen
Published: July 2017

Communication among professionals, donor families, and transplant recipients is a controversial topic. Traditionally, transplant and procurement professionals have made the decision about the type and frequency of information that a donor family and transplant recipient receive regarding one another, and relationships that might develop as a result. Information obtained through questionnaires demonstrated inconsistency in addressing donor family and transplant recipient needs for initial and follow-up information and communication—not only between clinical transplant and procurement donation coordinators, but within organizations involved in the care and support of these people. This wide variance regarding communication among all disciplines demonstrated a need for standardization of practice guidelines. Guidelines are being developed through collaboration of the major organizations involved in the care of donor families and transplant recipients to standardize communication practices throughout the United States.
Nurse Management of Posttransplant Hypertension in Liver Transplant Patients
Authors: Schwartz Lora , Augustine Jo , Raymer Joann , Canzanello Vincent , Taler Sandra , Textor Stephen
Published: July 2017

Hypertension develops soon after organ transplantation using cyclosporine- or FK506-based immunosuppression. Sustained rises in blood pressure require intervention to reduce the risk of intracranial bleeding and other cardiovascular complications. Antihypertensive treatment is complicated by reduced renal function and potential interference with absorption and/or metabolism of cyclosporine or FK506. To manage early and long-term hypertension related to immunosuppression with cyclosporine or FK506 and prednisone following orthotopic liver transplantation, a comprehensive nurse-managed hypertension clinic was developed. Blood pressure, heart rate, and antihypertensive and immunosuppressive regimens were evaluated according to a standard protocol at 1, 4, 12, 24, and 36 months after orthotopic liver transplantation. Data indicate that posttransplantation hypertension develops within the first months after orthotopic liver transplantation and persists indefinitely. If comprehensively managed by the hypertension nurse-clinician, the percentage of controlled hypertension patients can increase over time.
Liver Transplantation for Hepatocellular Carcinoma: One Center's Experience, 1987–1994
Authors: Dick Debbie , Regenstein Fredric , Blazek Jamie , Farr Gist
Published: July 2017

A retrospective review was done to evaluate the detection of hepatocellular carcinoma preoperatively, using ultrasonography and α-fetoprotein in patients awaiting orthotopic liver transplantation. Sixteen of the 187 patients who underwent 209 orthotopic liver transplantations at the Ochsner Transplant Center from 1987 to 1994 were diagnosed with hepatocellular carcinoma, 3 preoperatively and 11 at the time of pathological inspection of the liver explant. Two developed metastatic hepatocellular carcinoma while awaiting orthotopic liver transplantation. Ultrasonography detected abnormalities in the region where hepatoma was identified in 5 of 11 (45%) patients with incidental hepatocellular carcinoma, in all 3 with overt hepatocellular carcinoma, and in neither of the 2 who developed metastatic hepatocellular carcinoma while awaiting orthotopic liver transplantation. Hepatocellular carcinoma was present in 5 of 23 (22%) patients with an α-fetoprotein greater than 20 ng/mL and in 3 of 10 (30%) with an α-fetoprotein greater than 50 ng/mL.
Considerations for Using Ketoconazole in Solid Organ Transplant Recipients Receiving Cyclosporine Immunosuppression
Authors: Chapman Scott A , Lake Kathleen D , Solbrack Diane F , Milfred Sherry K , Marshall Peter S , Kamps Melissa A
Published: July 2017

Drug interactions involving cyclosporine following transplantation are a challenging issue for the transplant clinician. This is especially true when ketoconazole is the second agent used in conjunction with cyclosporine. Because both agents are metabolized by the cytochrome P-450 IIIA4 enzyme system, cyclosporine levels rise dramatically in the presence of ketoconazole. Many other agents interact with ketoconazole, either by competitive enzyme inhibition in the liver and gastrointestinal tract, or by reducing the absorption of ketoconazole by agents that increase the pH of the gastrointestinal tract. Despite the potential cost savings when using ketoconazole to reduce cyclosporine doses, adverse effects associated with ketoconazole put patients at risk when using this combination. Close monitoring of cyclosporine levels is imperative when adding ketoconazole to cyclosporine, and once the dosage adjustments are complete, the addition of a third drug that interacts with either cyclosporine or ketoconazole could result in an unexpected rejection episode or toxic cyclosporine side effect.
Transplantation in Italy
Authors: Quintieri Francesca , Macellari Velio
Published: July 2017

Organ procurement and transplantation have been difficult in Italy for many years. However, recent initiatives at the organizational level led to the establishment of the National Reference Centre, which is working hard to accomplish its tasks. We describe the transplantation activity of the past 2 years, which shows an improved situation that is encouraging. We include a brief history on transplantation in Italy and give some information to enhance understanding of the changes that have occurred and their impact on transplantation.
Evaluation of a Small Organ Procurement Organization in the Basque Country, Spain
Authors: Darpon Jon , Arrieta Javier , Elorrieta Pilar , Olaizola Pilar , Lavari Rosa , Aranzabal Joseba
Published: July 2017

A limited supply of organs is the main obstacle for organ transplantation. The shortage reflects not only a shortage of donors but also a failure to make use of existing donors. The Basque Country Transplant Coordination Team is an organ procurement organization that operates in the Basque country, an area of 7260 km2 with 2.1 million inhabitants. From January 1, 1990, to December 31, 1995, the number of potential cadaveric organ donors found by the team increased, to 70 donors per million inhabitants in 1995. Since 1993, the organization has had more than 30 donors per million persons and has procured more than 90 cadaveric organs, including more than 60 cadaveric kidneys, per million persons. Because of these rates, the team coordinated 61.7 cadaveric kidney transplants per million persons during 1995. This paper describes some characteristics of the Basque organ procurement organization that might explain these results.
Risk Factors for Premature Coronary Heart Disease after Successful Liver Transplantation in Adults
Authors: Smith Susan L
Published: July 2017

As solid-organ transplantation has evolved into a highly effective treatment for end-stage organ disease, the long-term health implications of chronic exposure of recipients to immunosuppressants and other pharmacological agents are becoming more apparent. Coronary heart disease has long been known to plague kidney transplant recipients and more recently has been found to affect heart transplant recipients disproportionately. Coronary heart disease after liver transplantation, however, is less well known. The purpose of this study was to examine risk factors for premature coronary heart disease in asymptomatic adult recipients of liver transplants. Nutrition-related risk factors for coronary heart disease (obesity and hyperlipidemia) were measured in 29 patients before and after liver transplantation. Changes with respect to primary immunosuppression protocol (cyclosporine plus corticosteroid vs tacrolimus plus corticosteroid) were compared. Risk factors that had not been present before transplantation were apparent in both groups by 6 months after transplantation. Although obesity and hyperlipidemia were not found to be independent risk factors for coronary heart disease, they were clinically important when considered in combination. Cyclosporine was associated with significantly higher serum lipid concentrations than was tacrolimus.
Planning and Implementing a Research Project: Part 1
Authors: Wood Geri L.
Published: July 2017

This article is the first in a series of three focused on the steps in the development of a research proposal. This first article presents the beginning steps of identification of a problem, statement of the research question and hypotheses, and review of the literature. The series of articles is meant to provide an overview of how to accomplish each of the steps. The discussion of the steps focuses the reader on helpful hints pertinent to each step. Additional references are provided for a more in-depth discussion of the process.
Texas Non—Donor-Hospital Project: A Program to Increase Organ Donation in Community and Rural Hospitals
Authors: Shafer Teresa J. , Durand Roger , Hueneke Martha J. , Wolff William S. , Davis Kimberly D. , Ehrle Ron N. , Van Buren Charles T. , Orlowski Jeffrey P. , Reyes DeAnn H. , Gruenenfelder Robert T. , White Carolyn K.
Published: July 2017

Identifying and recovering donors from community and rural hospitals present a challenge to organ procurement organizations. A study of non-donor hospitals in the United States was undertaken at Johns Hopkins University, which identified 31 hospitals (in one service area) with the facilities to accommodate organ donation, though an organ donor had not been produced in 3 years. The purpose of this study was to determine whether donors could be produced from these hospitals. A large, geographically dispersed OPO initiated a program consisting of (1) in-house coordinators, and (2) routine notification of all hospital deaths. Following implementation of this program, organ donation increased 387% among the targeted 25 hospitals. The number of hospitals producing at least 1 organ donor increased 133%. The number of organs recovered in the project increased 449%. In-house coordinators, by identifying potential donors and facilitating an organ donor awareness program, can increase the number of organ donors in hospitals with low, but real, donor potential.
Attitudes and Beliefs concerning Organ Donation among Native Americans in the Upper Midwest
Authors: Danielson Barbara L , LaPree Amy J , Odland Mark D , Steffens Eugenia K
Published: July 2017

Because of increasing access to renal replacement therapy and the high incidence of renal disease among Native Americans largely due to type 2 diabetes mellitus, it is important to determine attitudes and beliefs in this population toward organ donation. In a study conducted on reservations in the upper Midwest during traditional powwows and health fairs, it was discovered that willingness to donate was more likely to occur if Native Americans were approached by a healthcare worker from their culture, if they had already signed a donor card, or if they knew someone with diabetes. Willingness to be a living donor (81%) was greater than willingness to donate after death (ie, as a cadaveric donor) (54%). These findings indicate that cultural-specific information about organ failure rates and organ donation, when presented by knowledgeable individuals within the culture, could increase donation in the Native American population.
Obesity and Hypercholesterolemia following Heart Transplantation
Authors: Augustine Sharon M. , Baumgartner William A. , Kasper Edward K.
Published: July 2017

Successful strategies for avoiding obesity and hypercholesterolemia are difficult to validate because of imprecise problem identification. The purpose of this study was to describe the incidence, severity, and onset of obesity and hypercholesterolemia among heart transplant recipients and identify relationships between demographic variables and weight or cholesterol levels during the first year following transplantation. Data were collected from retrospective chart review. Forty-two patients were randomly selected from 224 patients who were undergoing heart transplantation at the Johns Hopkins Hospital between July 1983 and December 1995. Significant differences were found in weight and cholesterol level during the first 12 months. Patients with ideal body weight less than 110%, compared with greater than 110%, survived longer. Relationships were identified between prednisone dose and weight, cumulative prednisone dose and weight, and weight change and change in total cholesterol level 1 year following transplantation. Multivariate analysis showed cumulative prednisone as an independent predictor of weight. Obesity and hypercholesterolemia were significant problems within 3 months of transplantation. Although prednisone dosage should be adjusted to the lowest possible dose, dietary and lifestyle changes remain the foundation of effective management of these posttransplant complications.
Model Organ Description Protocols for Completion by Transplant Surgeons Using Organs Procured from Medical Examiner Cases
Authors: Zugibe Frederick T. , Costello James , Breithaupt Mark , Segelbacher Joseph
Published: July 2017

A significant number of donor organs emanate from the medical examiner's or coroner's offices, because victims of head injuries from vehicular accidents, falls, assaults, gunshot injuries, and unattended cerebrovascular accidents fall under the jurisdiction of the medical examiner or coroner. Unfortunately, many organ procurement organizations may not fully understand the legal responsibilities of the medical examiner. Most of the medical examiner or coroner cases could be used without compromising the medical-legal responsibilities of the medical examiner or coroner if a reliable description of the respective organ could be made after surgical removal by either having a pathologist present or by having the surgeon prepare a description of the respective organ. The objective of this paper is to present a series of protocols that have been designed to describe the heart, lungs, liver, kidney, and spleen for use by organ transplant surgeons. These protocols have proven to be highly successful in making more organs available for transplantation.
Bone Densitometry Should Be Included in the Evaluation of Candidates for Lung Transplantation
Authors: Dodd Vicki Addesso , Staron Ronald B. , Papadopoulos Anastasios , Evans Landee , Schulman Larry L. , Jorgensen Birgit , Gerow-Smith Roxanne , Shane Elizabeth
Published: July 2017

Bone loss and fractures are common complications of heart and liver transplantation, and are likely related to high-dose immunosuppressive therapy. We have previously demonstrated that many patients with end-stage lung disease already have osteoporosis and may be at even greater risk for fracture after lung transplantation. The purpose of this study is to determine the incidence of fracture in lung transplant recipients on osteoporosis prevention regimens, the relationship of fracture to pretransplant bone mineral density, and the impact of fracture on quality of life after lung transplantation. Twenty-one lung transplant candidates were prospectively evaluated with spine radiographs and bone mineral densitometry. Bone density was expressed as T scores, the number of standard deviations from the mean bone density of a young normal population of the same gender. Of 21 patients, 8 (38%) fractured during the first year. The mean pretransplant lumbar spine T score was significantly lower in the fracture patients ( P=.03). Four of the 7 surviving fracture patients and 1 of the 10 patients who survived without fracture believed that chronic pain diminished their quality of life ( X2=4.408; P=.04). These findings suggest that bone mineral density should be routinely included in the evaluation of lung transplant candidates. Patients with extremely low bone density or osteoporotic fracture should be counseled about the increased risk of fracture after transplantation.
Outpatient Housing following Kidney Transplantation
Authors: Scholz Kristen A. , Turrisi Katherine L.
Published: July 2017

The purpose of this article is to describe the efforts of a medium-sized kidney transplant program in the southeastern United States to reduce the inpatient length of stay by moving toward the outpatient arena, thereby reducing the overall cost of the transplant experience. An outpatient transplant unit was created to house patients who were medically stable but still required further monitoring and education prior to being discharged. The development and implementation of the transplant outpatient unit significantly reduced inpatient length of stay following kidney transplantation from 14 to 5 days. The benefits and outcomes of the transplant outpatient unit were impressive.
Comparison of Consent Rates between Hospital-Based Designated Requestors and Organ Procurement Coordinators
Authors: Bires Maria H.
Published: July 2017

Recent legislation in our service area has put restrictions on who is allowed to approach families about donation. Many hospitals have therefore requested training for designated requestors to speak with families. The organ procurement organization followed the consent rate of 2 hospitals to evaluate the effectiveness of the designated requestors in the consent process. This article compares the success of the hospital-based designated requestor program in obtaining consent with that of another hospital, which relies solely on the organ procurement coordinator to approach families. Thirteen staff members in hospital A received the 8-hour designated requestor training. A decrease in the consent rate at hospital A prompted the organ procurement organization to interview the 13 requestors. Possible reasons for the decline ranged from lack of experience to the lack of identification as donor family advocate. Both hospitals were encouraged to consider a multidisciplinary approach, which includes the organ procurement coordinator in the request process.
No Simple Answers: Ethical Conflicts in Pediatric Heart Transplantation
Authors: Suddaby Elizabeth C.
Published: July 2017

Ethical issues in pediatric heart transplantation are encountered daily in the work of the transplant coordinator. Issues such as use of resources in a just world, less-than-ideal candidates, and informed consent are challenges to the transplant professional. This article explores those issues using the language of ethics to analyze the conflicts they present. Resolutions will not necessarily be offered, as there are no simple answers.
He is Nothing but a Cheat! (A Not-so-fictitious Story)
Authors: Rimm Sylvia , Maas Kathy
Published: July 2017

Not-so fictitious stories bring together real life experiences of gifted children in story form. None of the stories are completely true but most of the incidents within each story have actually occurred. Thus a not-so-fictitious story is a composite of real incidents tied together by fiction rather than a true description of the life of any one gifted child. Since not-so-fictitious stories are reality based, they can be useful for discussions or role playing for parents, teachers or students.
Algorithm for Predicting Disease Likelihood From a Submaximal Exercise Test
Authors: Kim Chul-Ho , Hansen James E , MacCarter Dean J , Johnson Bruce D
Published: July 2017

We developed a simplified automated algorithm to interpret noninvasive gas exchange in healthy subjects and patients with heart failure (HF, n = 12), pulmonary arterial hypertension (PAH, n = 11), chronic obstructive lung disease (OLD, n = 16), and restrictive lung disease (RLD, n = 12). They underwent spirometry and thereafter an incremental 3-minute step test where heart rate and SpO2 respiratory gas exchange were obtained. A custom-developed algorithm for each disease pathology was used to interpret outcomes. Each algorithm for HF, PAH, OLD, and RLD was capable of differentiating disease groups ( P < .05) as well as healthy cohorts (n = 19, P < .05). In addition, this algorithm identified referral pathology and coexisting disease. Our primary finding was that the ranking algorithm worked well to identify the primary referral pathology; however, coexisting disease in many of these pathologies in some cases equally contributed to the cardiorespiratory abnormalities. Automated algorithms will help guide decision making and simplify a traditionally complex and often time-consuming process.
Magneto-Hydrodynamic Couplestress Squeeze Film Lubrication of Circular Stepped Plates
Authors: Naduvinamani N B , Fathima S T , Hanumagowda B N
Published: July 2017

The theoretical analysis of the effect of transverse magnetic field on the couplestress squeeze film lubrication between circular stepped plates is presented. The modified Reynolds equation is derived. The closed-form expressions are obtained for the squeeze film pressure, load-carrying capacity, and squeeze film time. The squeeze film characteristics are presented for different operating parameters. It is observed that the effect of applied magnetic field on the squeeze film lubrication between circular stepped plates with couplestress fluids is to increase the load-carrying capacity significantly and to delay the time of approach considerably as compared to the corresponding non-magnetic case.
Friction and Wear Performance of An Aluminium Alloy in Artificial Seawater
Authors: Ding H-Y , Zhou G-H , Hui D
Published: July 2017

The corrosion wear behaviours of an aluminium alloy 2024Al flat specimen against a 440C stainless-steel counter ball specimen were evaluated in artificial seawater by using a ball-on-flat configuration with 300 μm amplitude at room temperature for 1 h. Reference experiments were also performed in distilled water. The worn surface of the specimen was observed using scanning electron microscopy. The three-dimensional morphology and wear volume loss were determined using a non-contact optical profilometer. Potentiodynamic anodic polarization was used to measure the corrosion behaviours of 2024Al before and after the corrosion wear test. The influences of the aqueous medium on the corrosion resistance, coefficient of friction, and wear loss were analysed. Results show that 2024Al exhibits a dominant pitting corrosion mechanism in seawater and corrosion is accelerated by wear. Seawater can reduce the friction coefficient, whereas the wear loss in seawater is higher than that in distilled water, which can be attributed to a higher Cl— percentage. This implies that the wear is accelerated by corrosion. There is a positive synergism between corrosion and wear for 2024Al sliding in seawater. The wear mechanism of 2024Al is dominant corrosion fatigue in seawater due to the distinct electrochemical reaction. The profile of wear concave gradually changes from ‘V’ shape into ‘U’ shape with the increase of load or frequency.
Falls and Fractures in Postmenopausal Women: A Review
Authors: Geusens Piet , Milisen Koen , Dejaeger Eddy , Boonen Steven
Published: July 2017

Older people are a major risk group for falls. 35–40% of over-65s living at home fall at least once a year, and between a third and a half of these fall twice or more. The figure rises to 50% for the over-80s. Falls contribute to the occurrence of fractures. Of all the fractures linked to osteoporosis and falls, hip fractures are the most important in terms of early death, functional dependence, and costs of care. Many identifiable risk factors have been shown to contribute to hip fracture risk, including low bone density, previous fractures, clinical risk factors for falls, and low body weight. Interaction has been found between falls and osteoporosis in the occurrence of fractures. Prospective studies are needed to evaluate whether a combined bone- and fall-directed therapy can further decrease the risk for fractures in patients with low bone density and an increased fall risk.
Assessment of Urinary Incontinence
Authors: Balmforth James , Linda Cardozo
Published: July 2017

Urinary incontinence is a highly prevalent condition in women in their post-reproductive years. It is becoming an increasingly common presenting complaint as population demographics continue to change and further emphasis is placed on improving quality of life in this group of women. A wide variety of tools are available to assess the extent of the clinical problem and the impact that this has on psychosocial function. Many different health specialities are involved in caring for this group of patients, including general practitioners, gynaecologists, urologists, physiotherapists, and continence nurses. It is important to individualise each patient's assessment starting with a medical history and examination and leading on to appropriate specialist investigations.
The Frequency and Pattern of Headache in Menopausal Women
Authors: Hodson Jean , Al-Azzawi Farook
Published: July 2017

Objective

To assess the frequency and pattern of headache in perimenopausal women.

Study design

A questionnaire survey performed on 200 consecutive women attending Leicester Royal Infirmary menopause clinic during May 1997.

Main outcome measures

The main areas considered included frequency, duration and severity of headache, type and effectiveness of treatment used, interference with daily activities, and the effect of menopause and HRT on headache.

Results

38 women (19%) never experienced headaches whereas 158 (79%) reported recurrent headaches. The majority of these women (106) reported at least one headache in the preceding week with a small number (9) reporting daily headache. Stress (106), tiredness (75) and menstrual cycle (54) were common trigger factors. Most women used simple analgesics for treatment with few using sumatriptan (4) or prophylactic therapy (9). Women were not asked to classify headache but 18 (9%) reported vomiting and are likely to represent the minimum incidence of migraine. Headaches produced considerable morbidity and interference with daily activities social events and work. The effect of menopause and HRT (99 users) on headache was assessed and a group of “hormone sensitive” women identified.

Conclusion

The problem of menopausal headache is substantial; it is probably under-estimated, under-treated and poorly understood. It certainly deserves further attention.
Medicine, Age and Gender: The Menopause in History
Authors: Moscucci Ornella
Published: July 2017

Attitudes to the menopause in Western Europe and America have been shaped by changing ideas about age and gender. No concept of a biological process specific to the human female and due to the cessation of menstruation existed before 1821: doctors did not differentiate between the male and female ageing process, and the word “climacteric” was used to indicate the transition from one epoch of human life to the next, regardless of gender. In the 19th century, however, sharp boundaries were drawn between male and female, and reproduction became the defining quality of femininity. The construction of womanhood that emerged at this time served to focus the attention on the menopause as a crisis that had to be negotiated.

During the Victorian period leeching, cold baths and sedatives were prescribed for the menopause, and the importance of hygiene and moral management was emphasised. By the early 20th century, ovarian extracts were also employed in clinical practice, although their efficacy was often disputed. The development of reproductive endocrinology in the 1920s led to the isolation of oestrogen, and hormonal preparations were soon developed for the treatment of menopausal symptoms. Hormonal therapy receded in importance after the Second World War as psychoanalytic theory briefly replaced the hormonal paradigm as a tool for understanding the menopausal syndrome. In the 1960s, however, the psychoanalytic model was once again displaced by the growing importance of endocrinological explanations.

Both old and new notions of gender and age have affected medical and lay perceptions of the menopause in the 20th century: in particular the cult of youth that emerged in the early part of this century has dominated images of ageing and the menopause, influencing the messages women receive about the mid-life period.
The Active Control of Altitude over Differing Texture
Authors: Wolpert Lawrence
Published: July 2017

Earlier passive judgment studies showed that detection of loss in altitude was more accurate over texture consisting of stripes parallel to the direction of flight, than over texture consisting of perpendicular stripes or a combination of both, i.e., a square pattern. The current experiment required the participants to actively control and maintain a constant altitude over similar texture in the presence of a pseudorandom windgust. Results corresponded to those of the earlier judgment study with altitude being better controlled when flight took place over parallel texture, than over perpendicular or square texture. Theoretical and applied implications of these findings are discussed.
Incident Analysis of the Effects of Pyridostigmine Bromide
Authors: Gawron Valerie , Schiflett Samuel , Miller James , Ball John
Published: July 2017

The effects of a chemical defense protective drug, pyridostigmine bromide (PB), on inflight aircrew performance were assessed using the Total In-Flight Simulation (TIFS) aircraft. This aircraft was used as both a ground and inflight simulator supplying appropriate control feel, handling characteristics, and cockpit instrumentation for a tactical-transport simulation. Twenty-one C-130 pilots flew two familiarization and four data flights. As part of this study, video recordings of aircrew behavior from preflight through landing were analyzed using an incident analysis technique. Behaviors were grouped in 23 categories including irritability, humor, and accidental activation. The frequencies of occurrences of each of these behaviors by drug (PB or placebo) and crew position (pilot or copilot) are presented as well as an assessment of the utility of the incident analysis technique in drug research.
Previous Experience in Manned Space Flight: A Survey of Human Factors Lessons Learned
Authors: Woolford Barbara , Chandlee George O.
Published: July 2017

Three major manned-space programs have been conducted since the mid-1960's: the Apollo, Skylab, and Space Shuttle programs. Each program has contributed significant new data to the field of human factors and to gaining a greater understanding of how humans operate, function, behave, and adapt to the environment encountered in space. This study summarizes relevant human factors data bearing on the lessons learned from previous manned space flights. Our objective is to gather information available from relevant sources, to develop a taxonomy of human factors data, and to provide a centralized source of data that can be used in the future for those individuals involved in the design of manned-spacecraft operations.

Our results have significance for the establishment and design of manned space vehicles. Methods developed in the collection and archival of human factors data during the course of this study also bear directly on questions of ways in which to systematically compile and characterize human factors data in other areas of research.
Stereopsis in Cockpit Display — A Part-Task Test
Authors: Way Thomas C.
Published: July 2017

The benefit of adding retinal disparity to color raster display was tested with two formats. Six pilots flew a tracking task and periodically responded to “failures” in the two represented systems, providing a total of 4320 trials. Response time and error frequency were both reduced when disparity augmented monocular cues to “real world” depth. Response time and error frequency were not affected when disparity was used to make an element of an otherwise flat display more noticeable.