Results of en bloc renal transplants of pediatric deceased donors into adult recipients.

UNLABELLED: Various strategies have evolved to expand the donor pool due to the extreme shortage of organs. Herein we reviewed our experience with en bloc pediatric kidney transplantation since 1998. METHODS: From January 1998 to December 2004, nine adult patients underwent kidney transplantation using en bloc kidneys from donors <5 years old (range, 1 to 4). The mean age of the recipients was 45.1 years (range, 34 to 57). RESULTS: In recipients of en bloc pediatric transplantation, cold ischemia time ranged from 14 to 26.2 hours (mean, 21.3 hours). Mean serum creatinine at 3, 6, and 12 months after transplantation was 1.53 +/- 0.57, 1.27 +/- 0.27, and 1.15 +/- 0.26 mg/dL compared with 1.93 +/- 1.35, 1.81 +/- 1.17, and 1.73 +/- 0.85 (P = .08) in recipients of single kidneys from ideal cadaveric donors (UNOS criteria, n = 368). Patient and graft survival at 1 year were 88.8% compared with 91.2% and 85% with ideal donors (P = NS), respectively. Three cases required additional surgery. There was one death due to a cerebral vascular accident. CONCLUSION: The present study confirmed the excellent results achieved with transplantation using en bloc kidneys from young donors.

[Women caring for women: a study at the "Viva Maria" shelter, Porto Alegre, Rio Grande do Sul, Brazil]. / Mulheres cuidando de mulheres: um estudo sobre a Casa de Apoio Viva Maria, Porto Alegre, Rio Grande do Sul, Brasil.

This research was conducted in Porto Alegre, Rio Grande do Sul, with a sample of battered women selected from a government shelter called the "Casa Viva Maria". We analyzed data on 110 women staying at the shelter during the previous two years (January 1996-June 1998). The profile of the women was as follows: abused women were young (mean age 29 years), all had low socioeconomic status, 12% were illiterate, 21% were black, 80% reported frequent abuse by their partners, and 18% had returned to violent homes. The researchers visited 34 former lodgers from the shelter and invited them to participate in a series of evaluation workshops. A total of 118 persons, including mothers and children, attended three evaluation meetings. During this process, researchers encouraged participants to express opinions, perceptions, and feelings about their past experience in the shelter and their own concept of violence. Finally, a focal group was organized with the "Viva Maria" staff members. Female workers reported how their job had been helpful for their personal development and had helped change their own lives.

Is epistaxis evidence of end-organ damage in patients with hypertension?

OBJECTIVES/HYPOTHESIS: To study the association between history of mild to severe epistaxis with different stages of hypertension and with other evidence of target organ damage in a sample of patients attending an outpatient hypertension clinic, controlling for potential confounding factors. STUDY DESIGN: A survey of adult patients with hypertension. METHODS: A consecutive sample of 323 adults with hypertension was studied. The main outcome measures were history of adult epistaxis, high blood pressure, duration of hypertension, nasal abnormalities, and fundoscopic and electrocardiogram abnormalities. RESULTS: Ninety-four patients (29.1% of the whole sample) reported at least one episode of nosebleed after 18 years of age. Of these, 59 (62.8%) needed medical assistance to control at least one of the episodes. The history of epistaxis was not associated with blood pressure classified according to the World Health Organization/International Society of Hypertension paradigm or classified as severe or not severe. There was a trend of an association between history of epistaxis and duration of hypertension. The history of severe epistaxis (epistaxis that needed medical assistance) was not associated with blood pressure classified as severe or not severe and with duration of hypertension. More patients with left ventricular hypertrophy had a positive history of adult epistaxis. There was no association between history of epistaxis or history of severe epistaxis and fundoscopic abnormalities. Among the abnormalities detected at rhinoscopy, only the presence of enlarged septal vessels was associated with history of epistaxis. The presence of enlarged septal vessels was strongly and independently associated with history of epistaxis in the logistic regression model. Duration of hypertension and left ventricular hypertrophy showed a trend for an association with the history of epistaxis in the adult life. CONCLUSIONS: A definite association between blood pressure and history of adult epistaxis in hypertensive patients was not found. The evidence for an association of duration of hypertension and left ventricular hypertrophy with epistaxis suggests that epistaxis might be a consequence of long-lasting hypertension. The association between the presence of enlarged vessels at rhinoscopy with history of epistaxis in hypertensive patients is a novel observation that needs to be addressed in future observations.