Error adjustments for file linking methods using encrypted unique client identifier (eUCI) with application to recently released prisoners who are HIV+.

Incarceration provides an opportunity to test for HIV, provide treatment such as highly active anti-retroviral therapy, as well as link infected persons to comprehensive HIV care upon their release. A key factor in assessing the success of a program that links released individuals to care is the time from release to receiving care in the community (linkage time). To estimate the linkage time, records from correction systems are linked to Ryan White Clinic data using encrypted Unique Client Identifier (eUCI). Most of the records that were linked using eUCI belong to the same individual; however, in some cases, it may link records incorrectly, or not identify records that should have been linked. We propose a Bayesian procedure that relies on the relationships between variables that appear in either of the data sources, as well as variables that exists in both to identify correctly linked records among all linked records. The procedure generates K datasets in which each pair of linked records is identified as a true link or a false link. The K datasets are analyzed independently, and the results are combined using Rubin's multiple imputation rules. A small validation dataset is used to examine different statistical models and to inform the prior distributions of the parameters. In comparison with previously proposed methods, the proposed method utilizes all of the available data and is both flexible and computationally efficient. In addition, this approach can be applied in other file linking applications.

Kidney disease health literacy among new patients referred to a nephrology outpatient clinic.

BACKGROUND: Knowledge about kidney disease among the general population is poor but has not been assessed in the population selected for referral to nephrology care. AIM: This study aimed to determine patients' understanding of chronic kidney disease (CKD) when first presenting to a nephrology clinic. METHODS: Newly referred patients to a nephrology clinic were surveyed with open-ended questions about their understanding of CKD causes, symptoms and management. RESULTS: Two hundred and ten patients were surveyed. Median age was 66.5 years (interquartile range 52-77), 50.5% female and mean body mass index 29.7 ± 6.8 kg/m(2) . Prevalence of risk factors for CKD included 31% diabetic, 62% hypertension, 19% family history of CKD and 2% Aboriginal or Torres Strait Islander. CKD stage prevalence was 0 (8%), 1 (24%), 2 (11%), 3 (38.5%), 4 (18%) and 5 (0.5%). Eighty-two per cent were referred by their primary care physician and 29% had seen a nephrologist previously. Kidney Health Australia was mentioned by 2.4%. Sixteen per cent were unsure why they had been referred. CKD causes identified by patients were unsure (40%), alcohol (29%), hypertension (16%) and diabetes (14%). Symptoms identified included asymptomatic (16%), kidney pain (17%) and other (42%). Management suggested by patients was uncertain (51%), dialysis (32%) and anti-hypertensive medication (16%). Eighty-two per cent reported unsatisfactory education from their primary care physician. CONCLUSIONS: New patients referred to a renal outpatient department had poor knowledge about kidney disease. Education of patients should begin in primary care prior to referral. For most patients, education programmes need to be targeted at a simplistic level.

Right hemiliver transplant: results from living and cadaveric donors.

UNLABELLED: Although right hemiliver transplant from living donors (LD) is gaining acceptance as a way to overcome the critical organ shortage, splitting a liver for two adults from cadaveric donor (CD) is still controversial. METHODS: From May 1999 to August 2004 we performed nine right hemiliver transplants using segments 5-6-7-8 from CD and 18 from LD. RESULTS: We compared the two procedures to evaluate both the technical aspects and the patients' outcomes. In the CD group, three recipients died (33%), two of whom were UNOS Status 2A. Patient and graft survivals were 67% (median follow-up: 23 months). Among the LD group, three recipients died (17%) and two were retransplanted; one because of arterial thrombosis and the other as a consequence of small-for-size syndrome. Patient and graft survivals were 83% and 72%, respectively (median follow-up: 8 months). There were five early complications in the CD group (55%) and five (27%) in the LD group. Two patients in the LD group experienced a late stenosis of the biliary anastomosis. DISCUSSION: Data from our early experience show that better results are achieved by right hemiliver transplants from LD; the morbidity and mortality are higher among the CD group. We believe that this finding is probably a consequence of better preoperative donor evaluation, shorter ischemia time, better logistics, and learning curve. Recipient selection is crucial; this kind of graft is at high risk of poor function, technical complications, and infections. Further experience will help to clarify the reliability of right hemiliver transplants from CD.

Right hemiliver transplants from cadavers or living donors: a comparative analysis.

INTRODUCTION: The aim of this article was to compare the results of right hemiliver transplants from living versus cadaver donors in a single institution. METHODS: Between March 1999 and May 2003, we performed 10 right hemiliver transplants from living donors (LD) and 8 right hemiliver transplants from cadavers (CD). The procedure consisted of grafting liver segments 5, 6, 7, and 8. The procedure was performed with a fully perfused liver also in the CD group (in situ split). RESULTS: With follow-up between 7 days and 26 months in the LD group, 2 patients died with functioning grafts: 1 patient died because of massive pulmonary bleeding due to Rendu-Osler Syndrome; the other one died as a consequence of systemic aspergillosis. One patient underwent retransplantation due to arterial thrombosis. In the CD group with a follow-up between 31 days and 48 months, 3 patients died due to sepsis, including 2 who were status 2A. There were 4 early complications among the LD group and 5 in the CD group. The patient and graft survival rates were 80% and 70%, respectively, in the LD group; and both about 62% in the CD group. CONCLUSION: Right hemiliver grafts are at high risk due to technical and septic complications. A higher morbidity is observed in the CD group, where the vascular and biliary tree anatomy cannot be investigated with accuracy. We must avoid transplanting status 2A recipients with this kind of graft.

Right hemiliver transplants from living donors: report of 10 cases.

INTRODUCTION: A right lobe living related liver transplantation (LRLT) was performed for the first time in Italy on March 16, 2001 at our institution. METHODS: All donors underwent celiac and mesenteric axis angiography. Computed tomography scan to determinate the liver size and anatomical vascular variation, cholangio-magnetic resonance imaging, intraoperative cholangiography, and ultrasonography. All recipients were status 2B on the waiting list for cadaveric liver transplants. The surgical procedures were carried out by grafting segments 5, 6, 7, and 8 of the donor liver. RESULTS: Of the donors, all are alive; 4 had uneventful postoperative courses, 3 had moderate right pleural effusions; 3 had bilious drainage that resolved spontaneously: and 1 had a biliary leak and a pulmonary embolism. Of the recipients, 8 are alive with well-functioning grafts. One recipient has undergone retransplantation due to an arterial thrombosis and another recipient developed a stricture of the biliary anastomosis. Two recipients died: one because of pulmonary hemorrhage in Rendu-Osler syndrome, the other as a consequence of overwhelming systemic aspergillosis. CONCLUSIONS: Our experience suggests that few anatomical vascular and biliary variations are considered contraindications for right lobe LRLT. This challenging surgical procedure seems effective for well-selected recipients of United Network for Organ Sharing II B status. Appropriate recipient selection is crucial as we face a living donor.

[Pancreas transplantation. Experience in the first 50 patients at the Niguarda Hospital of Milan: clinical outcome and open questions]. / Il trapianto di pancreas. Esperienza dell'Ospedale Niguarda sui primi 50 pazienti: dubbi e certezze.

AIM: Personal experience in 50 patients who underwent combined pancreas-kidney transplantation (PKT), with particular reference to mortality and surgical complications is reported. METHODS: Between October 1993 and December 2001, 50 adult patients (36 males and 14 females), mean age 37 years (range 25-60), with chronic renal failure, and Insulin Dependent Diabetes Mellitus (IDDM), underwent 54 pancreas transplantation (4 patients retransplanted) and 52 kidney transplantation (2 patients retransplanted). Different surgical procedures have been employed during the period of 9 years. All patients underwent the same immunosuppressive regimen; the mean length of follow-up was 49 months. During the follow-up, 30 out of 43 patients who maintained a good graft function fulfilled a questionnaire about their quality of life following the criteria of the Medical Outcome Study (MOS). RESULTS: All patients became euglycemic immediately after the surgical procedure. One patient died post-operatively due to pulmorary thromboembolism after pancreas retransplantation for acute venous thrombosis; 1 other patient died 9 months after the procedure for acute myocardial infarction. Four patients developed acute venous thrombosis. All these patients underwent pancreas retransplantation, but 3 of these patients who survived the procedure lose the graft function for chronic rejection within 1 year. Fourteen patients showed acute rejection, 7 patients CMV infection. Three patients showed hyperchloremic acidosis, 12 patients bronchopulmonar infection and 7 patients urinary infection. Among surgical complications anastomotic fistula in 6 patients was also recorded. Five patients out of 50 lose the pancreatic graft function. After 1 from PKT, 83% of patients who fulfilled a questionnaire were strongly satisfied about their quality of life. No patients developed de novo tumors following chronic immunosuppression. The 5-year survival for patient, kidney and pancreas was 95.6%, 93.4% and 84.7% respectively. CONCLUSIONS: Our experience in 50 patients submitted to PKT shows no graft loss due to acute rejection. Surgical complications (acute venous thrombosis) and chronic rejection are the most important factors leading to graft loss. A graft in "head-up" position, a short portal vein of the graft, a "no-touch technique" during pancreas retrieval can be some of the most important factors which can reduce the rate of surgical complications. Combined kidney-pancreas transplantation showed in our experience a low mortality rate and a moderate incidence of morbidity and should be considered, at the moment, the treatment of choice for patients with renal failure and IDDM.

In vitro susceptibilities of field isolates of Mycoplasma agalactiae to oxytetracycline, tylosin, enrofloxacin, spiramycin and lincomycin-spectinomycin.

The minimum inhibitory concentrations (MICs) of tetracycline, enrofloxacin, tylosin, spiramycin and a lincomycin:spectinomycin 1:2 combination, against 24 Sicilian isolates of Mycoplasma agalactiae, the causative organism of contagious agalactia were determined in vitro by a broth dilution method. Enrofloxacin was the most effective antimicrobial in vitro with a range of MIC values from 0.125 to 0.500 microg/ml and an MIC(50) of 0.203 and MIC(90) of 0.365 microg/ml. Using the MIC(50) and MIC(90) values the remaining four antimicrobials are ranked in order of in vitro effectiveness as follows: tylosin (MIC(50)0.292; MIC(90)0.525 microg/ml) was slightly more effective than tetracycline (MIC(50)0.296; MIC(90)0.533 microg/ml), followed by lincomycin:spectinomycin (MIC(50)0.521; MIC(90)0.938 microg/ml) and spiramycin (MIC(50)1.583; MIC(90)2.850 microg/ml). MIC values above 1.000 microg/ml were obtained using tetracycline, tylosin and spiramycin for some M. agalactiae isolates.

[Surgical treatment of hepatocellular carcinoma: resection or transplantation? Results of a multivariate analysis]. / Trattamento chirurgico del carcinoma epatocellulare: resezione o trapianto? Risultati di un'analisi multivariata.

This retrospectively study presents the results of a large series of transplanted or resected patients, with the aim of defining the characteristics of those patients who may benefit from resection or transplantation in an era in which these two surgical options can both be offered with low risks and extremely satisfactory results. Two hundred and seventy-five patients (154 resected and 121 transplanted) with hepatocellular carcinoma were submitted to surgical treatment in our department from December 1985 to December 1999. Age, sex, presence of cirrhosis, aetiology of liver disease, Child-Pugh classification, and alpha-fetoprotein levels were considered. Twenty-two of the 121 (18.1%) transplanted patients and 7 of the 154 (4.5%) resected patients died within 3 months of surgery. All curves show an evident trend towards increased mortality or recurrence rates in the resected group after prolonged follow-up. Liver transplantation appears to offer better survival and recurrence-free rates than liver resection in patients with hepatocellular carcinoma. Liver resection should be considered a good therapeutic alternative in patients who do not fulfill the transplant criteria.

Rapid disappearance of hepatic adenoma after contraceptive withdrawal.

We present the case of a 25-year-old woman who developed a large central liver adenoma after 8 years of continuous oral contraceptive use. The first diagnosis was made by ultrasonography, after a rise in plasmatic gamma-glutamyl-transpeptidase and alkaline phosphatase levels was noted. Withdrawal of the oral contraceptive was followed by shrinkage of the adenoma, with complete disappearance 9 months after the diagnosis. Hepatic adenoma (HA) still presents problems in terms of differential diagnosis and clinical management. There are reports of complete or partial regression of an HA after discontinuation of oral contraceptives, but they are poorly documented. To our knowledge, a patient with such rapid disappearance of a large HA has never been reported.

Bovine babesiosis in Sicily: preliminary study on pathology.

In this study, the authors report the preliminary pathological features of an outbreak of spontaneous babesiosis detected in a group of thirty-five, five to six months-old Simmenthal calves imported in Sicily in November 1998. Five of them showed fever, anaemia, haemoglobinuria, inappetence, depression, thirst, swollen lymph-nodes and poor body conditions a few days after being introduced in the farm. Several ticks were present particularly at the basis of the horns and near the ears of the sick animals. Blood smears, stained with May-Grunwald-Giemsa, showed several pyriform merozoites in the red blood cells referred to Babesia bigemina parasites; all ticks collected were identified as Dermacentor marginatus. Gross post-mortem examination and histopathological observations revealed severe involvement of kidneys, liver, lungs, spleen and lymph-nodes. The pathogenesis of the referred features in a spontaneous fatal case observed is discussed.

Extended lung preservation with platelet-activating factor-antagonist TCV-309 in combination with prostaglandin E1.

BACKGROUND: Ischemia-reperfusion injury is one of the major problems in organ transplantation. The role of platelet-activating factor (PAF) in the pathophysiology of ischemia-reperfusion injury and the protective effect of a novel phospholipid PAF analog (TCV-309) alone and combined with prostaglandin E1 (PGE1) is investigated in an extended (20 hours) ex vivo lung preservation. METHODS: Forty-two swine were divided into three groups. Group A was the control. In groups B and C, the effect of PAF was blocked with TCV-309 administered 1 hour before cross-clamping for donor and recipient. Group C received PGE1 50 micrograms bolus in the donor pulmonary plegia, and the recipients received a 50 micrograms bolus plus 0.003 microgram/kg/min infusion at the time of implantation. Donor lungs were perfused with cold modified Collins solution and maintained in hypothermic storage (4 degrees C) for 20 hours. Hemodynamics, lung mechanics, gas exchange, and biochemistry were assessed before transplantation (donor) and at 30 minutes and 24 hours after reperfusion (recipient). At 24 hours after reperfusion, the histopathologic condition of transplanted lungs was evaluated. RESULTS: Radioimmunoassay demonstrated a significant (p < 0.001) increase in the production of PAF and TXB2 in transplanted lungs at 24 hours after transplantation for group A only. Hemodynamics, gas-exchange parameters, and lung compliance were significantly (p < 0.05) better after transplantation for groups B and C. Wet lung weight was significantly less (p < 0.05) for group C. Semiquantitative morphometric analysis demonstrated the highest degree of damage for group A compared with groups B and C. A strong correlation (r2 = 70) between lung weight and histologic injury scores was observed among groups. CONCLUSIONS: This study suggests that PAF is responsible in part for the deleterious effects of ischemia and reperfusion, that PAF-antagonist TCV-309 protects lungs from extended (20 hours) ischemic injury, and that PGE1 seems to have an additional beneficial effect.