The First 2 Years of Activity of a Specialized Organ Procurement Center: Report of an Innovative Approach to Improve Organ Donation.

The number of patients requiring organ transplants continues to outgrow the number of organs donated each year. In an attempt to improve the organ donation process and increase the number of organs available, we created a specialized multidisciplinary team within a specialized organ procurement center (OPC) with dedicated intensive care unit (ICU) beds and operating rooms. The OPC was staffed with ICU nurses, operating room nurses, organ donor management ICU physicians, and multidisciplinary staff. All organ donors within a designated geographic area were transferred to and managed within the OPC. During the first 2 years of operation, 126 patients were referred to the OPC. The OPC was in use for a total of 3527 h and involved 253 health workers. We retrieved 173 kidneys, 95 lungs, 68 livers, 37 hearts, and 13 pancreases for a total of 386 organs offered for transplantation. This translates to a total of 124.6 persons transplanted per million population, which compares most favorably to recently published numbers in developed countries. The OPC clearly demonstrates potential to increase the number of deceased donor organs available for transplant. Further studies are warranted to better understand the exact influence of the different components of the OPC on organ procurement.

Cerebral blood flow velocity increases when propofol is changed to desflurane, but not when isoflurane is changed to desflurane in children.

BACKGROUND: Children may exhibit delayed emergence following maintenance of anesthesia with propofol or isoflurane. Desflurane is often used towards the end of procedures to facilitate emergence. This study evaluated the effect on middle cerebral artery blood flow velocity (Vmca) in anesthetized children when propofol or isoflurane was substituted with desflurane. METHODS: Forty-two healthy children aged 1-6 years were enrolled. A standardized anesthetic induction was used. Anesthesia was maintained with remifentanil (0.5 microg.kg(-1) bolus followed by an infusion of 0.2 microg.kg(-1).min(-1)) and a randomly selected sequence of propofol/desflurane/propofol, desflurane/propofol/desflurane, isoflurane/desflurane/isoflurane or desflurane/isoflurane/desflurane. Propofol was administered to maintain a steady-state serum concentration of 3 microg.ml(-1). Desflurane and isoflurane were administered at age-corrected 1 MAC. Hemodynamic stability was maintained. Transcranial Doppler sonography was used to measure Vmca. Hemodynamic variables as well as Vmca were measured 30 min after skin incision and repeated 30 min after each change in anesthetic maintenance agent. RESULTS: The mean age and weight was 2.3 +/- 1.3 years and 13.0 +/- 3.7 kg, respectively. The Vmca (mean) increased by 35% from 37.7 +/- 10.5 cm s(-1) to 57.8 +/- 14.6 cm s(-1) (P < 0.0001) when propofol was changed to desflurane but was unaffected when desflurane replaced isoflurane. CONCLUSION: When propofol is changed to desflurane, cerebral blood flow velocity increases significantly in normal children. This cerebral vasodilatory effect may have important implications in the neurosurgical setting.

Non-neoplastic lesions in beluga whales (Delphinapterus leucas) and other marine mammals from the St Lawrence Estuary.

In a 3-year (1988-1990) pathological study, 24 carcasses of beluga whales from the St Lawrence Estuary, Québec, Canada, showed numerous severe lesions, many of which had never been reported in cetaceans. The most common lesions were found in the digestive tract (21 animals) and consisted mainly of periodontitis and of erosions and ulcers in the oesophagus and the first two gastric compartments. Pneumonia, usually of parasitic origin, was also a common finding (12 animals). The adrenal glands often contained nodules (five animals) or cysts (seven animals), and mastitis was observed in five females. Overall, the incidence of degenerative, infectious, hyperplastic or necrotic lesions, in addition to numerous neoplasms described in another paper, was considerably higher than that found in marine mammals elsewhere or in other species of marine mammal from the same waters.

Pathology and toxicology of beluga whales from the St. Lawrence Estuary, Quebec, Canada. Past, present and future.

An indigenous population of 450-500 beluga whales (Delphinapterus leucas) inhabiting the St. Lawrence Estuary has been exposed chronically for more than 50 years to a complex mixture of industrial pollutants including organochlorinated compounds (OC), polycyclic aromatic hydrocarbons (PAH) and heavy metals. From 1983 to 1990, we have necropsied 45 well preserved carcasses out of a total of 120 beluga whales reported dead over this period. Of these 45 animals, nine were affected by 10 malignant neoplasms. Fifteen animals (33%) were affected by pneumonia. Milk production was compromised in eight of 17 mature females (41%), by inflammatory changes (seven animals) and cancer (one animal) which affected the mammary glands. Opportunistic bacteria were found in pure culture, and/or in significant amounts in at least two organs in 20 belugas (44%). The concentrations of both total PCBs and highly chlorinated PCB congeners were much higher in St. Lawrence animals than in Arctic beluga whales. OC-induced immunosuppression has been repeatedly demonstrated in a wide variety of animal species. Therefore, it is probable that the immune functions of St. Lawrence beluga whales are impaired. Benzo[a]pyrene adducts were detected in 10 of the 11 St. Lawrence beluga whales of which tissues (six livers, 10/11 brains) were analyzed by a method based on HPLC. No such adducts were found in four Arctic animals. Since benzo[alpha]pyrene is one of the most potent chemical carcinogens known to man, these compounds might be responsible for some of the cancers observed in that population. Overall, our findings contrast vividly with those of others who found that cancers are exceedingly rare in free-ranging odontocete populations and that the major causes for mortalities in these populations are bacteria, parasites, and trauma.

The anatomy of the male genital system of the beluga whale, Delphinapterus leucas, with special reference to the penis.

The genital organs of four male adult beluga whales and one newborn animal were dissected and the main characteristics are described. As in other species of cetaceans, the testes and the greatest part of the penis are located inside the abdominal cavity. The penis has a sigmoid flexure and belongs to the fibroelastic type with a thick tunica albuginea and a small amount of vascular spaces in the erectile tissue. The prostate gland, found in other cetaceans, was not seen macroscopically, but only small prostate rudiments could be identified histologically. The os penis and the other accessory glands are absent as in other whales.

Tumors in St. Lawrence beluga whales (Delphinapterus leucas)

A population of 450-500 belugas (Delphinapterus leucas) resides in the polluted estuary of the St. Lawrence River. Stranded carcasses of this endangered population were recovered and necropsied. High concentrations of organochlorines, heavy metals, and benzo-a-pyrene exposure were demonstrated in tissues of these whales. Between 1988 and 1990, 21 tumors were found in 12 out of 24 carcasses. Among these tumors, six were malignant and 15 were benign. The animals were between 1.5 and > 29 years of age, and the ages of animals with and without tumors did not differ when two juvenile animals (1.5 and 3.5 years of age) were excluded. Seven other neoplasms had been reported previously in six out of 21 well-preserved carcasses examined in the same laboratory between 1982 and 1987. Overall, 28 of the 75 confirmed tumors reported so far in cetaceans (37%) were from this small population of beluga whales in the St. Lawrence Estuary. Such a high prevalence of tumors would suggest an influence of contaminants through a direct carcinogenic effect and/or a decreased resistance to the development of tumors in this population.

True hermaphroditism in a St. Lawrence beluga whale (Delphinapterus leucas).

A hermaphrodite beluga whale (Delphinapterus leucas) was found in the St. Lawrence Estuary, Québec, Canada. This animal had two testicles, two separate ovaries, and the complete ducts of each sex; cervix, vagina and vulva were absent. Mature spermatozoa were found in the lumen of seminiferous tubules in the testicles, and numerous involuted corpora lutea were recognized in the ovaries. This represents the first case of true hermaphroditism in a cetacean, and is the fourth hermaphrodite mammal with two testicles and two separate ovaries.

Cutaneous hemangiosarcoma with pulmonary metastasis in a horse.

A 6-year-old Thoroughbred mare had a 7-cm ulcerated mass on the cranial aspect of the left cervical area. Ultrasonography revealed the mass to be < 1 cm thick and composed of small lobules that were filled by material hypoechoic to the surrounding muscle tissues. Fine-needle aspiration of the mass yielded blood, and cytologic examination revealed a few epithelial cells with neoplastic changes. Thoracic radiography revealed an interstitial pattern with several disseminated nodules. A diagnosis of cutaneous hemangiosarcoma with pulmonary metastases was made. The diagnosis was confirmed at necropsy.

Pathology of stranded beluga whales (Delphinapterus leucas) from the St. Lawrence Estuary, Québec, Canada.

From June 1983 to May 1986, thirteen carcasses of stranded beluga whales from a polluted area of the St. Lawrence River, Canada were necropsied. High performance liquid chromatography was performed on the brains of three other animals to determine concentrations of benzo a pyrene (BaP). Two juvenile animals had severe multisystemic lesions one of which, a severe necrotizing dermatitis, was associated with a Herpesvirus-like particle. Four adults had five varieties of tumours. An adult had a systemic nocardiosis and a juvenile was affected ty a non 0:1 Vibrio cholerae septicemia. High concentrations of BaP adducts were found in the brains which were analyzed. Occurrence of BaP adducts in the brain of three whales of this population coincides with the high incidence of tumours. This and the previous finding of high concentrations of organochlorine in the tissues of these animals suggest an important role of industrial contaminants in the recent decrease of this population.

Adenomatoid tumor of uterus: presentation in endometrial curettings.

A case of adenomatoid tumor of the uterus with an unusual initial presentation is reported. The patient, a 25-year-old female, underwent a dilatation and curettage during investigation for infertility. Endometrial curettings revealed infiltration of the stroma by epithelioid and signet-ring-type tumor cells. Subsequent hysterectomy revealed a large, somewhat ill-defined posterior myometrial tumor that on the basis of histologic, histochemical, and ultrastructural investigation proved to be an adenomatoid tumor with infiltration into the endometrium.

Spontaneous External Endometriosis in a Gorilla (Gorilla gorilla).

The present report describes a case of external endometriosis in a 28 year old female gorilla (Gorilla gorilla). Microscopical examination of a pelvic mass observed at necropsy revealed ovarian tissue together with uterine glands and stroma, fibrous tissue and many siderophages. Theories of pathogenesis of external endometriosis are briefly reviewed.