Socioeconomic status and ethnicity of deceased donor kidney recipients compared to their donors.

Public perception and misperceptions of socioeconomic disparities affect the willingness to donate organs. To improve our understanding of the flow of deceased donor kidneys, we analyzed socioeconomic status (SES) and racial/ethnic gradients between donors and recipients. In a retrospective cohort study, traditional demographic and socioeconomic factors, as well as an SES index, were compared in 56,697 deceased kidney donor and recipient pairs transplanted between 2007 and 2012. Kidneys were more likely to be transplanted in recipients of the same racial/ethnic group as the donor (p < 0.001). Kidneys tended to go to recipients of lower SES index (50.5% of the time, p < 0.001), a relationship that remained after adjusting for other available markers of donor organ quality and SES (p < 0.001). Deceased donor kidneys do not appear to be transplanted from donors of lower SES to recipients of higher SES; this information may be useful in counseling potential donors and their families regarding the distribution of their organ gifts.

SU-D-213CD-04: Dosimetric Evaluation of HexaPOD as a Tool for Patient Setup Verification Accuracy.

PURPOSE: To quantify the dosimetric accuracy of 6 degrees vs. 3 degrees of motion for patient positioning for cone-beam CT and HexaPOD Evo RT system (Elekta, Inc.) using the ArcCHECK (Sun Nuclear Corporation, software v.6.0) QA phantom. METHODS: The average absolute values of our daily reported patient hexapod shift data were recorded and averaged for 18 patients. Using the CT scans of ArcCHECK, a QA plan was created in the Pinnacle (v.9.0) treatment planning system. By setting up ArcCHECK according to the QA plan and measuring the dose on Elekta Synergy, the baseline data was established. Next, an artificial shift was introduced in our phantom setup. A cone-beam CT scan of the phantom was obtained and images adjusted. The resulting translational and rotational shifts were recorded. The table was then moved according to the translational shifts only, and another measurement was taken. Next, using hexapod translational and rotational shifts, the table was moved in 6 degrees of motion, and the dose was re-measured. RESULTS: For 18 IMRT patients, the average translational shifts were: x= 0.53 cm, y=0.38 cm and z= 0.516 cm, and average rotational shifts were pitch=0.979°, roll=0.8° and yaw= 0.67°. The ArcCHECK phantom measured results were quantified using 3%, 3mm distance to agreement gamma analysis criteria when comparing measured to planned dose. Our measurements showed that an average 97.3% of the points agreed in plans with no shift. After the artificial shift was introduced, and cone-beam CT translational shifts were applied, 76.3% of points agreed. When both rotational and translational shifts were applied using Hexapod, an average of 93.4% of points agreed. CONCLUSIONS: Using hexapod for imaging and patient positioning results in a significantly more accurate dose delivery as compared to using only CBCT, as shown by our ArcCHECK QA phantom results.

Association between systemic calcified atherosclerosis and bone density.

Both atherosclerosis and osteoporosis are responsible for significant morbidity and mortality, are independent predictors of cardiovascular disease (CVD) events, and may share common regulatory mechanisms as well as histopathology. Multiple reports of weak or null relationships between traditional CVD risk factors and calcified atherosclerosis have heightened interest in novel predictors of arterial calcium. One such hypothesis is for an inverse relationship between bone mineral density (BMD) and calcified coronary atherosclerosis. Although contrary findings have been reported, the majority of cross-sectional and all prospective studies have demonstrated a significant inverse association between arterial calcium deposits and BMD. The few studies that include men are equivocal, and, to date, no study has investigated the relationship between BMD and systemic arterial calcium. The aim of this study was to test the hypothesis that lumbar BMD is significantly associated with the presence of arterial atherosclerotic calcium in the carotid, coronary, and iliac vascular beds as well as the aorta.

Acute fulminant fungal sinusitis: clinical presentation, radiological findings and treatment.

Acute fulminant fungal sinusitis is characterized by acute symptoms and rapid progress with a mortality rate of 60-80%. A large number of survivors have permanent neurological, visual and cosmetic disabilities. This clearly underscores the need of early recognition of this disease in at risk population in order to start urgent treatment. The at-risk population of diabetics, AIDS and other immunosuppressed is likely to increase, as will the incidence of acute fulminant fungal sinusitis. In the present study we have reviewed nine cases of acute fulminant fungal sinusitis to determine clinical presentation, related radiological picture and optimum treatment. Most common presenting features were fever, headache, facial swelling and proptosis. Many patients presented with blindness, facial paralysis and meningitis. Predisposing causes were uncontrolled diabetes with ketoacidosis in four out of six cases, post renal transplant immunosuppression and leukemia. All patients were treated with amphotericin B or liposomal amphotericin B (AmBisome). Diagnosis was confirmed by biopsy and culture of sinus mucosa, soft tissues of cheek, or orbit. Mucor (Zygomycetes) was identified on culture or histopathology in all cases. Surgical debridement was performed in seven cases. Six out of nine patients survived but morbidity was high: only two patients survived without any permanent disability.

Fine needle aspiration cytology (FNAC) in the management of thyroid pathology--the Aga Khan University Hospital experience.

OBJECTIVE: To report the efficacy of FNAC in patients with thyroid disease. METHODS: Between January 1990 and December 1994 the records of all patients treated surgically for thyroid disease at ENT Head and Neck Surgery of Aga Khan University were reviewed. All the patients had pre-operative FNAC as the first line of evaluation and the histopathologist examined post-operative thyroid specimen. RESULTS: Forty-five patients (36 female and 9 male) had thyroid surgery. In 26 patients out of 45, FNAC was conclusive in diagnosing the nature of disease, while in 19 patients the FNAC was inconclusive because of the presence of follicular cell neoplasia. CONCLUSION: Our results indicate that the FNAC is very accurate and a reliable test in the diagnosis of thyroid pathology, however, to distinguish follicular adenoma from follicular carcinoma final histology is required. FNAC is cost effective method of evaluating thyroid pathology pre-operatively and plays a vital role in planning the surgical management of thyroid nodule.

A critical review of chemical lymph node clearance and staging of colon and rectal cancer at Ferguson Hospital, 1977 to 1982.

A unique opportunity to evaluate the method of chemical lymph node clearance for colorectal cancer exists at Ferguson Hospital. Lymph node clearance has been used at the institution since 1977, and this retrospective analysis was undertaken to ascertain its validity there. Furthermore, the node positive group was evaluated to ascertain if the current staging system (Turnbull, 1967) is prognostically accurate for the Dukes' C group. Specifically evaluated for possible prognostic variance was the survival of those patients whose tumors demonstrated partial bowel wall penetration and only one to four positive nodes, a "C1 subset," previously reported to have favorable prognosis. Eight hundred sixty-four cases of colon and rectal cancer treated surgically from 1977 to 1982 were analyzed. There was a mean of 27 lymph nodes retrieved per specimen and a mean of 4.5 positive nodes per Dukes' C specimen. There were 43 C1 and 201 C2 cases with five-year survival rates of 73 and 38 percent, respectively. The results of chemical clearance at Ferguson Hospital were found to be comparable with that of other centers using chemical clearance and superior to hand dissection. The C1 subset clearly is noted to have prognostic advantage and should occupy a separate designation in any staging system.

Anorectal and colonic disease and the immunocompromised host.

The immunocompromised host is becoming increasingly ubiquitous in the authors' patient population. There are growing numbers of long-term transplant recipients, and combination chemotherapy is producing many long-term survivors. Of greatest concern is that the number of patients with human immunodeficiency virus (HIV) causing immunosuppression is increasing. The literature is reviewed to produce a current summary of conditions affecting the anorectum and colon and arising as a direct consequence of the immunocompromised host. Pathophysiology and theoretic considerations are mentioned where applicable and current therapy is discussed. The conditions are classified under infectious, neoplastic, iatrogenic, and congenital. Although the colorectal surgeon will encounter most of these conditions sometime during a career, many are infrequent, and a current review is provided herein to provide categorization and updated information.

Spontaneous thrombosis of the internal jugular vein.

The internal jugular vein is an uncommon site of deep venous thrombosis. Infection, prolonged central venous catheterization, and trauma are the usual causes of this condition. We present an unusual case of spontaneous thrombosis of the internal jugular vein. The evaluation of this case included a search for possible anatomic, hematologic, and oncologic conditions which could predispose to hypercoagulability and thrombosis. Anticoagulation therapy resulted in complete resolution of thrombosis and subsequent recanalization of the internal jugular vein.