Cadaveric & living organ donation. Natural limitations. Possible solutions. Singapore experience.

Singapore is a country with different cultures and beliefs. Over the last thirty eight years since independance, it has blossomed close to being a developed nation. Having performed the first cadaver donor renal transplantation in 1970, there has been a tremendous amount of health literacy injected into the Singaporeans, with the able support of the National Kidney Foundation. Never ending waiting list for organ donation has facilitated a march of events from Volunatary Organ Pledging under the Medical Therapy, Education and Research Act to passing the Human Organ Transplant Act to extension of the presumed consent law to include Heart, Liver and Cornea and non-accidental brain deaths. In the years to come, Singapore will certainly see an increase in the number of organ transplantations both Cadaveric and Living related.

Rhabdomyolysis and acute renal failure complicating detergent ingestion.

Rhabdomyolysis should be considered in the aetiology of all patients with unexplained acute renal failure (ARF). Early recognition provides the opportunity to initiate therapy aimed at preventing or limiting nephrotoxicity from the released heme pigment, myoglobin. We report an adult patient who developed ARF following the ingestion of a large amount of household detergent which, as far as we are aware, has not been previously described. The report illustrates the importance of measuring muscle enzyme levels and urinary myoglobin to confirm the possibility of rhabdomyolysis in any unusual presentation of ARF.

Natural history and response to treatment of minimal change nephrotic syndrome.

This study is a retrospective analysis of 177 patients of minimal change nephrotic syndrome seen between 1985 and 1989. Fifty nine of these had renal biopsy done and the others were diagnosed on clinical grounds. Short courses of prednisolone were used for three episodes in one year. If a fourth episode occurred in any 12 month period, cyclophosphamide was started. This was needed in 26 patients and was also used in 9 patients who did not respond to 8 weeks of prednisolone. Follow up ranged from 4 months to 5 years (mean 1.4 years). Thirty nine percent of patients sustained remission after the first course of steroids. Histological variations (presence or absence of diffuse mesangial proliferation or IgM deposits) and age made no difference to the response to treatment and subsequent relapses.

Subclavian vein catheters for haemodialysis with and without a subcutaneous tunnel.

We have retrospectively analysed the usefulness of a subcutaneous tunnel in patients undergoing haemodialysis through a double lumen subclavian catheter; 194 catheters were used in 145 patients. In 105 patients a subcutaneous tunnel was created. Entry site infection was significantly higher in the no tunnel group (30%; P < 0.02). There was no statistically significant difference in the incidence of septicaemia in the two groups. Eighty five percent of episodes of septicaemia and 67% of entry site infections were due to Staphylococcus aureus. All responded to removal of the catheter and to antibiotics. The average duration the catheter was in place was 20.39 and 21.94 days in the groups with and without tunnel respectively. The average number of dialyses was 9.13 and 9.33 per catheter in the tunnel and no tunnel groups respectively. Three patients had pneumothorax. Subclavian vein thrombosis was suspected clinically in 3 cases. There was no catheter related mortality. We concluded that while entry site infection occurred more frequently in the no tunnel group, the overall incidence of septicaemia was not different in the two groups. Creation of a subcutaneous tunnel has no added advantage.

Short term study on relative merits of acetate and bicarbonate dialysis.

We did a double blind, crossover, prospective study comparing bicarbonate and acetate containing solutions in haemodialysis. Thirty stable patients with end stage renal disease on maintenance haemodialysis while awaiting a renal transplant were each studied on three dialysis with acetate and three with bicarbonate. Nine patients developed symptoms like headache, nausea, vomiting, giddiness, and malaise and developed hypotension during acetate dialysis and three patients during bicarbonate dialysis. There were symptoms during 16.66% of acetate dialysis sessions and 5.55% of bicarbonate dialysis sessions. (P less than 0.05). There was a statistically significant decrease in PaO2 and PaCO2 on acetate dialysis at 30 minutes after initiation of dialysis. There was no significant difference in weight loss on dialysis, or in blood pressure and correction of acidosis. We conclude that bicarbonate dialysis is better tolerated, but acetate intolerance is not a major problem since we use small surface area dialysers (0.8 M2).

Efficacy of praziquantel against Schistosoma nasale infection in cattle.

Cattle naturally infected with nasal schistosomiasis were treated with a single oral dose of praziquantel at 20 mg/kg body weight. The drug was highly effective causing a considerable reduction in egg counts, cessation of clinical signs and progressive regression of the nasal granulomatous growths.