Biocompatible membranes do not promote graft recovery following cadaveric renal transplantation.

BACKGROUND: Controversy surrounds the role of biocompatible membrane dialyzers in treatment of acute renal failure. Studies that have shown a benefit have involved critically ill patients where renal recovery and patient mortality are influenced by other comorbid disease. The aim of the present work is to clarify this issue in a more homogeneous population of patients with acute renal failure following cadaveric renal transplantation. METHODS: All patients with delayed graft function between January 1996 and February 1998 were randomized to receive either a biocompatible (BCM, polysulfone) membrane or bioincompatible (BICM, cuprophane) membrane for dialysis until onset of graft function. RESULTS: Forty-one patients were randomized, 23 to receive BCM and 18 BICM. Five patients (2 BCM, 3 BICM; p = NS) with primary non-function of graft were excluded from analysis, leaving 36 cases of acute tubular necrosis (ATN). Patient and donor characteristics were similar in both groups. The BCM group had significantly longer periods of dialysis dependency compared to the BICM group (14 vs 10 days; p = 0.03). There was a tendency towards higher serum creatinine levels in the short term in the BCM group (318 vs 164 micromol/l at 1 month (p = 0.1), 190 vs 169 micromol/l at latest visit (p = 0.07)) and a greater number of acute rejection episodes in the BCM group (3.7 vs 1.7 episodes per 100 days of dialysis dependency, p = 0.1). With an intention-to-treat analysis of all 41 patients originally randomized, there was no significant difference in time to graft recovery between the 2 groups (p = 0.18). CONCLUSIONS: In the setting of ARF posttransplantation, we have found no evidence to support the use of biocompatible membranes for dialysis. Rather, our study provides argument against a large benefit for the use of BCM in the recovery of ARF, as suggested by earlier studies.

Nursing involvement in research: an academic pursuit or relevant to nursing practice?

It is said that nursing is 'informed by research'. We evaluated the effect a clinical research project had on the nursing procedure of a nonrotating, permanent continuous ambulatory peritoneal dialysis (CAPD) team involved primarily in patient care. A trial of the overnight solute clearance as a simple measure of the adequacy of CAPD was carried out and its effect on the following aspects of nursing practice was assessed: 1. Teamwork-Can research be successfully incorporated within the team's work structure in a clinical environment? 2. Nurse's role-Duties of the nurse involved in the research (selection of patients, organization of appointments, collection of samples, and calculation of results). 3. Nurse/patient relationship-Individual knowledge of patients' needs and communication skills employed (necessity for true informed consent). The experience showed us that the participation in research is not only possible, but also interesting from the nurses' viewpoint and of direct benefit to the patients.

Gypsum compatibility of antimicrobial alginates after spray disinfection.

PURPOSE: This investigation examined the gypsum compatibility of two antimicrobial alginates after spray disinfection. Subjective compatibility evaluations were compared with objective quantitative profilometer readings of gypsum cast surface roughness. MATERIALS AND METHODS: COE Hydrophilic Gel Alginate, Jeltrate Plus, Antimicrobial Alginate, and their nonantimicrobial counterparts, Coe Alginate and Jeltrate Plus, were used in this study. After spray disinfection with water (control), Alcide LD, Biocide, OMC II, and 0.5% NaOCI, impressions of the American National Standards Institute/American Dental Association (ANSI/ADA) specification no. 18 detail reproduction die and impressions made simultaneously of a smooth glass die were cast in Microstone, Silky-Rock, and Die-Keen. Five specimens were made for each alginate/disinfectant/gypsum combination for a total of 300 samples each for both the subjective and objective analyses. For the subjective analysis of gypsum compatibility, the specimens made from the ANSI/ADA specification no. 18 test die were evaluated by using a 1-to-4 visual rating system at magnification x12. For the objective analysis, the arithmetic average surface roughness of each specimen made from the smooth glass die was recorded three times with a 200-mg skidless stylus instruments. RESULTS: The results of the ANSI/ADA specification no. 18 testing for gypsum compatibility showed that 11 of 60 possible combinations did not pass the test. All impressions made with nonantimicrobial COE Alginate passed the test regardless of the disinfectant/gypsum combination. The results of the three-factor analysis of variance for the subjective and objective analyses showed significant interactions between alginates, disinfectants, and stones at the P < .05 level. To further delineate these differences, unpaired t tests (P < .05) within brands for each disinfectant/gypsum combination were performed. CONCLUSIONS: The addition of 1% chlorhexidine diacetate to COE Hydrophilic Gel Alginate has decreased its compatibility with the dental stones and disinfectants tested when compared with its nonantimicrobial counterpart. In terms of gypsum compatibility, the nonantimicrobial COE Alginate was compatible with all disinfectant and gypsum combinations tested. The addition of 1.70% didecyldimethyl ammonium chloride to Jeltrate Plus Antimicrobial Alginate has increased its compatibility with all the dental stones tested. A strong positive correlation (r = 0.7398) was found between visual gypsum compatibility evaluation scores and surface roughness of gypsum casts.

Carotid sinus syndrome. Report of five cases and review of the literature.

Five cases of carotid sinus syndrome are presented. The syndrome is defined by spontaneous attacks of dizziness and fainting which can be reproduced by graded pressure on one carotid sinus. Three forms of the clinical syndrome, cardioinhibitory, vasodepressor, and cerebral, are discussed. The hyperactive carotid sinsu reflex, in which there is ventricular asystole lasting at least 3 seconds or a decrease of more than 50 mm Hg in systolic and diastolic blood pressure, should be differentiated from this syndrome. Treatment modalities include reassurance, drugs, radiotherapy, cardiac pacemakers, and surgical approaches. Carotid sinus syndrome should be considered in the differential diagnosis of unexplained syncope, arteriovenous block, or inappropriate sinus bradycardia.