ABSTRACT
Renal transplant patients sensitized to HLA antigens comprise nearly one-third of the UNOS wait-list and receive 14% of deceased donor (DD) transplants, a rate half that of unsensitized patients. Between 1999 and 2003, we performed 492 adult renal transplants from DD; 120 patients (approximately 25%) had a panel reactive antibody (PRA) of >30%, with nearly half (n = 58) having a PRA of >80%. Our approach is based upon high-resolution solid-phase HLA antibody analysis to identify class I/II antibodies and a 'virtual crossmatch' to predict compatible donor/recipient combinations. Recipients are excluded from the United Network for Organ Sharing match run if donors possess unacceptable antigens. Thus, when sensitized patients appear on the match run, they have a high probability of a negative final crossmatch. Here, we describe our 5-year experience with this approach. Five-year graft survival ranged from 66% to 70% among unsensitized (n = 272), moderately sensitized (PRA < 30%, n = 100) and highly sensitized (>30% PRA; n = 120) patients, equal to the average national graft survival (65.7%). The application of this approach (the Emory Algorithm) provides a logical and systematic approach to improve the access of sensitized patients to DD organs and promote more equitable allocation to a highly disadvantaged group of patients awaiting renal transplantation.
Subject(s)
Algorithms , B-Lymphocytes/immunology , Graft Rejection/immunology , Immunity, Cellular , Immunization/methods , Kidney Transplantation/immunology , T-Lymphocytes/immunology , Female , Flow Cytometry , Follow-Up Studies , Graft Rejection/prevention & control , Graft Survival , HLA Antigens/immunology , Histocompatibility Antigens Class I/immunology , Histocompatibility Antigens Class II/immunology , Humans , Immunosuppressive Agents/therapeutic use , Male , Retrospective Studies , Risk Factors , Transplantation, HomologousABSTRACT
The authors evaluated the accuracy of "black blood" magnetic resonance (MR) angiography for depicting disease involving the extracranial carotid arteries. Two- and three-dimensional flow-compensated gradient-echo sequences were employed to create "bright blood" images. A thin-section spin-echo sequence with flow presaturation allowed the creation of black blood images. Projection angiograms were made from bright and black blood images with application of a maximum- or minimum-intensity projection algorithm, respectively. These methods were used in 13 healthy volunteers and 17 patients, and a prospective blinded comparison of MR angiography and conventional angiography was performed. Normal carotid arteries were well shown with both bright and black blood methods; in patients, both methods were sensitive for detecting carotid disease. However, bright blood angiography exaggerated the severity of carotid lesions in 13 of 33 arteries, mostly in severe disease; this problem was not encountered with black blood angiography. The authors conclude that bright blood angiography is a sensitive method for screening carotid disease; when a significant abnormality is found, black blood angiography should be performed for more precise delineation of the lesion.
Subject(s)
Carotid Arteries/pathology , Carotid Artery Diseases/diagnosis , Magnetic Resonance Imaging/methods , Adult , Aged , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/diagnostic imaging , Blood , Carotid Arteries/diagnostic imaging , Carotid Artery Diseases/diagnostic imaging , Humans , Middle Aged , RadiographyABSTRACT
Seventy-five patients with suspected testicular torsion who had scintiscans and adequate clinical follow-up were analyzed retrospectively. The scintiscans diagnosed 12/13 cases of surgically proven missed torsion and 3/3 cases of surgically proven acute complete torsion. The scintiscans successfully distinguished all 35 cases of epididymo-orchitis, 14 cases of torsion of the appendix testes and 8 other miscellaneous conditions from testicular torsion. The incidence of testicular torsion in our patients undergoing scrotal scintigraphy was approximately 24%.
Subject(s)
Spermatic Cord Torsion/diagnostic imaging , Adolescent , Age Factors , Child , Diagnosis, Differential , Epididymitis/diagnostic imaging , Epididymitis/therapy , Humans , Infant, Newborn , Male , Orchitis/diagnostic imaging , Orchitis/therapy , Radionuclide Imaging , Retrospective Studies , Sodium Pertechnetate Tc 99m , Spermatic Cord Torsion/surgery , Testis/diagnostic imagingABSTRACT
In radiation therapy of patients with breast carcinoma, the ipsilateral internal mammary lymph nodes are either irradiated by a separate anterior field or included by isocentric opposing tangential fields, which also treat the breast and chest wall. To determine the acceptability of a particular treatment setup, the positions of the nodes must be determined with respect to the treatment fields. For the anterior field technique the problem is two-dimensional and is solved by simply superimposing the treatment field onto an anterior lymphoscintigram. For treatment by opposing tangential fields the problem is three-dimensional and more complex. The solution described in this note is to project the three-dimensional lymph node positions, obtained by a stereo-lymphoscintigraphic procedure, onto the tangential field radiographs. A mathematical expression is given to perform the required projection of the node positions onto the radiographs.
