ABSTRACT
A national conference on organ donation after cardiac death (DCD) was convened to expand the practice of DCD in the continuum of quality end-of-life care. This national conference affirmed the ethical propriety of DCD as not violating the dead donor rule. Further, by new developments not previously reported, the conference resolved controversy regarding the period of circulatory cessation that determines death and allows administration of pre-recovery pharmacologic agents, it established conditions of DCD eligibility, it presented current data regarding the successful transplantation of organs from DCD, it proposed a new framework of data reporting regarding ischemic events, it made specific recommendations to agencies and organizations to remove barriers to DCD, it brought guidance regarding organ allocation and the process of informed consent and it set an action plan to address media issues. When a consensual decision is made to withdraw life support by the attending physician and patient or by the attending physician and a family member or surrogate (particularly in an intensive care unit), a routine opportunity for DCD should be available to honor the deceased donor's wishes in every donor service area (DSA) of the United States.
Subject(s)
Death, Sudden, Cardiac , Tissue and Organ Procurement/ethics , Adolescent , Adult , Child , Humans , Liver Transplantation/mortality , Liver Transplantation/statistics & numerical data , Middle Aged , Patient SelectionABSTRACT
Access to timely, risk-adjusted measures of transplant center outcomes is crucial for program quality improvement. The cumulative summation technique (CUSUM) has been proposed as a sensitive tool to detect persistent, clinically relevant changes in transplant center performance over time. Scientific Registry of Transplant Recipients data for adult kidney and liver transplants (1/97 to 12/01) were examined using logistic regression models to predict risk of graft failure (kidney) and death (liver) at 1 year. Risk-adjusted CUSUM charts were constructed for each center and compared with results from the semi-annual method of the Organ Procurement and Transplantation Network (OPTN). Transplant centers (N = 258) performed 59 650 kidney transplants, with a 9.2% 1-year graft failure rate. The CUSUM method identified centers with a period of significantly improving (N = 92) or declining (N = 52) performance. Transplant centers (N = 114) performed 18 277 liver transplants, with a 13.9% 1-year mortality rate. The CUSUM method demonstrated improving performance at 48 centers and declining performance at 24 centers. The CUSUM technique also identified the majority of centers flagged by the current OPTN method (20/22 kidney and 8/11 liver). CUSUM monitoring may be a useful technique for quality improvement, allowing center directors to identify clinically important, risk-adjusted changes in transplant center outcome.
Subject(s)
Kidney Transplantation/standards , Liver Transplantation/standards , Adolescent , Adult , Aged , Cadaver , Creatinine/blood , Humans , Kidney Transplantation/adverse effects , Liver Transplantation/adverse effects , Living Donors/statistics & numerical data , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , Quality Assurance, Health Care , Quality Control , Risk Assessment , Tissue Donors/statistics & numerical dataABSTRACT
Computed tomography examinations were performed on 74 patients who presented to the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania with a known or suspected diagnosis of primary or secondary soft tissue sarcoma. Focal masses were detected on computed tomography study in 59 patients. These masses were classified into three broad categories: centrally necrotic masses with a large predominantly liquefactive center and higher density periphery (29); multilocular, septated masses with distinct linear bands or striations (21); and miscellaneous masses (9). The miscellaneous category included six inhomogeneous and three homogeneous masses. The apparent density differences within these sarcomas were best appreciated on dynamic postcontrast scans. The computed tomography appearance of these sarcomas may be explained by the pathologic findings of cystic degeneration, extensive necrosis, central cavitation, focal hemorrhage, and myxoid changes.
Subject(s)
Sarcoma/diagnostic imaging , Soft Tissue Neoplasms/diagnostic imaging , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , Carcinosarcoma/diagnostic imaging , Child , Child, Preschool , Contrast Media , Histiocytoma, Benign Fibrous/diagnostic imaging , Humans , Infant , Leiomyosarcoma/diagnostic imaging , Liposarcoma/diagnostic imaging , Middle Aged , Neoplasm Recurrence, Local/diagnostic imaging , Rhabdomyosarcoma/diagnostic imagingABSTRACT
Yersinia enterocolitica is becoming increasingly recognized as a source of abscess formation in patients with numerous underlying disease entities, most notably hepatic and hematologic disorders. Patients ranging in age from infancy to adulthood can become infected with this worldwide pathogen, which seems to be relatively rare in the United States. We present the appearance of a Yersinia abscess on computed tomography in the hope that an increased awareness of this infection will result in earlier diagnosis and improved therapeutic management.
Subject(s)
Abscess/diagnostic imaging , Thalassemia/complications , Tomography, X-Ray Computed , Yersinia Infections/diagnostic imaging , Abscess/etiology , Adult , Female , Humans , Yersinia Infections/etiologySubject(s)
Facial Neoplasms/diagnostic imaging , Neurofibromatosis 1/diagnostic imaging , Orbital Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Child , Child, Preschool , Eye/diagnostic imaging , Female , Humans , Male , Middle Aged , Orbit/diagnostic imagingABSTRACT
The therapy and prognosis of bronchioloalveolar carcinoma vary greatly with the solitary versus the diffuse form of the disease. Solitary disease demonstrates a high resectability rate with good long term prognosis. This contrasts with the rapidly fatal course associated with the diffuse form. To date, categorization of patients into either the solitary or the diffuse form has been based solely on conventional radiography. Multiple authors have reported cases of disease not demonstrated radiographically but discovered at surgery or autopsy. With the superiority of chest computed tomography (CT) for demonstrating parenchymal abnormalities, we propose that preoperative CT may be crucial in the workup of patients with presumed solitary bronchioloalveolar cell carcinoma. Early identification of diffuse disease or confirmation of the presence of solitary disease by CT may allow the institution of proper therapy and better evaluation of patient prognosis.