Impact of cyclosporin on the incidence and prevalence of chronic rejection in renal transplants.

Over a 14-year period, 435 patients underwent renal transplantation. Chronic rejection has occurred in 58 (13%) of all grafts and has accounted for 18% of all graft losses. After the first 6 months following transplantation, chronic rejection was the most common cause of graft failure, accounting for 40% of losses. The median time (interquartile range) from transplantation to graft failure was 3 years (2-5.5 years). Comparison of azathioprine versus cyclosporin treated patients showed no significant difference in the incidence of graft loss (Cox regression score 2.55, P = 0.11). Furthermore, there were significantly more grafts with deteriorating function owing to chronic rejection in cyclosporin-treated patients (n = 16, 11% of surviving grafts) than in azathioprine-treated patients (n = 2, 3% of surviving grafts). These data suggest that cyclosporin does not prevent the development of chronic rejection in renal transplants.

Traumatic arteriovenous fistula of the superficial temporal vessels: a case for protective headgear when playing squash?

A 35 year old semiprofessional squash player developed the symptoms and signs of an arteriovenous fistula of the left superficial temporal vessels after a squash ball injury. This was sufficiently symptomatic to halt his intensive training programme and required exploration, ligation and excision. Although a rare injury from any cause this would have been prevented by protective headgear.

Magnesium flux during and after open heart operations in children.

Hypomagnesemia and depletion of the body's magnesium stores is known to be associated with an increased incidence of both cardiac arrhythmias and neurological irritability. In a two-part prospective study we have evaluated whether magnesium deficiency is a significant occurrence in children treated in the intensive care unit after open heart operations, and subsequently have sought to identify how intraoperative metabolic changes were related to the resultant findings. In 41 children studied after operation the plasma magnesium concentration showed a significant decrease from 0.92 mmol/L (10th to 90th centile, 0.71 to 1.15 mmol/L) immediately after operation to 0.77 mmol/L (0.65 to 0.91 mmol/L) on the following morning. The subsequent change in grouped values was not significant but 14 (34.2%) and 7 (17.1%) possessed values of less than 0.7 mmol/L and 0.6 mmol/L, respectively. The occurrence of cardiac arrhythmias was not statistically related to the occurrence of hypomagnesemia. In 21 children perioperative changes in extracellular and tissue magnesium, potassium, and calcium content were measured. It was found that hemodilution with a prime low in magnesium caused a reduction from a median of 0.81 mmol/L to 0.61 mmol/L (p < 0.01). Plasma potassium level, however, was elevated from 3.7 mmol/L to 4.15 mmol/L (p < 0.05) and the ionized calcium content from 1.17 mmol/L (1.07 to 1.25 mmol/L) to 1.49 mmol/L (1.25 to 2.56 mmol/L) (p = 0.0009). The myocardial content of magnesium did not change significantly but skeletal muscle content was depleted from 6.75 mumol/g (2.85 to 8.35 mumol/g) to 5.65 mumol/g (2.45 to 7.2 mumol/g) (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Operative insertion of a transvenous left atrial pressure monitoring line.

We describe a technique for the insertion of a left atrial pressure monitoring line during open heart operations in infants. The procedure requires central venous cannulation with a long catheter, followed by intraoperative placement of the catheter tip through the interatrial septum into the left atrium. The technique has been used successfully in 35 infants.