Organizzazione Centro-Sud Trapianti: outcome analysis 1999 to 2002.

BACKGROUND: The Organizzazione Centro-Sud Trapianti (OCST), which was created in 1998, is organized into eight regional areas, each referring to a local Regional Transplant Coordinating Center. Organs are primarily allocated to meet the demands of transplant centers in each regional area. Urgencies, pediatric grafts, and paybacks are managed by an Interregional Transplant Coordinating Center. The aim of the current work is to report on the impact of introduction of OCST on organ donation and transplant activity over the period from 1999 to 2002. MATERIALS AND METHODS: A retrospective analysis of donor and transplant data charts over the period from 1999 to 2002 focused on outcome analysis based on donor epidemiological data, cause of death, reasons for discards and grafts performed at OCST local transplant centers. RESULTS: From 1999 to 2002, we observed a remarkable increase in organ donation from 8.8 to 22.5 donors per million people. Donor epidemiology showed an increase in median age and stroke incidence rates and a decrease in trauma cases. The nonharvested donor rate rose steadily over the study period, plateauing at 58%, which was compensated for by a threefold increase in donation. Family oppositions ranged as high as 35.5% on average, despite public efforts to support donation. Transplant activity rose by 76%. CONCLUSIONS: The institution of OCST and the efforts from central and regional authorities have yielded a significant increase in organ donation and transplant activity rates over the period from 1999 to 2002. Major areas of concern are the high opposition rate and the decreasing quality of harvested grafts. Long-term analysis is underway to assess the impact of OCST on the quality of transplants performed in the catchment area.

The risk of gallbladder perforation at laparoscopic cholecystectomy.

BACKGROUND: The best policy to prevent the potential hazard of bile and stones spilled at laparoscopic cholecystectomy (LC) is to avoid inadvertent gallbladder (GB) perforations. No study so far has investigated the mechanisms of GB rupture and its predictive risk factors. To address these issues and help define the best strategies to reduce undesirable long-term sequelae, we did a retrospective review of the first 350 consecutive LC performed by a single surgeon at our institution. METHODS: The clinical and surgical records of our first 350 consecutive LC were reviewed. The significant variables identified on univariate analysis were eventually validated through Spearman's correlation for ordered data and finally correlated to the risk of GB perforation by means of a casewise deletion multiple regression. The equation of the linear regression thus obtained was used to predict the probability of GB perforation by number of risk factors. RESULTS: Three risk factors predictive of GB perforation were identified: chronic cholecystitis with thickened walls >7 mm on preoperative ultrasound (US), GB hydrops (GB > 8 x 4 x 4 cm on US), and previous laparotomies. The incidence of GB perforation rose from a low of 3.5% in the absence of any risk factor to a high of 25% for patients with all three of the independent variables. GB hydrops yielded the highest diagnostic accuracy and probability of perforation (OR = 4.9). CONCLUSIONS: Inflammation and a positive history of previous laparotomies play a crucial role in GB perforation at LC. Hydropic GB was the most accurate predictor of rupture. A prospective trial is needed to confirm the data.

OSHA criteria for laboratory proficiency in blood lead analysis.

The OSHA lead standard, 29 CFR 1910.1025, was established to protect the health of workers exposed to the hazards of lead. The standard lists specific requirements to ensure that blood lead analyses--critical indicators of workers at risk--be performed reliably by laboratories. Employers must be laboratories that meet OSHA performance criteria in blood lead proficiency testing programs monitored by the Centers for Disease Control and certain States. This proficiency testing requires that, as a minimum, laboratories must report the equivalent of eight out of nine samples within acceptable limits for the most recent three quarters or similar period. For compliance purposes, OSHA circulates to its staff a "List of Laboratories Approved for Blood Lead Analysis" each quarter.