Variations in living donor graft rates by dialysis clinic: effect on outcome and cost of chronic renal failure therapy.

OBJECT: Examination of nephrology practice variations in living donor renal grafts to determine their influence on organ supply, quality, and cost of chronic renal failure therapy. MATERIALS: Saskatchewan chronic dialysis, cadaveric, and living donor renal grafts in 1983-1994 inclusive. RESULTS: Saskatchewan has three dialysis (I, II, III) and one transplant clinic. In the period the renal graft incidences/million population by these dialysis clinics by organ source were; Cadaveric: 23.1, 23.2, 21.1 (p = ns). Living: 5.4, 21.7, 8.3 (I or III vs II p < 0.000, I vs III p < 0.061). Total: 28.7, 44.7, 29.4. Living donor series A is 79 grafts in patients under age 60 with primary renal disease. Series B is 20 grafts in patients with secondary renal disease or over age 59. Series A ten-year actuarial patient survival is 92% and B 44%. Series A ten-year actuarial graft survival (including regrafts) is 77% and B 39%. Rehabilitation rate in patients with functioning grafts is 88.5%. Province-wide extension of the Clinic II living-donor graft rate in 1983-1994 would have produced 160 more renal grafts or 59% of those receiving chronic dialysis in 1994. The annual maintenance for a graft with the initial grafting cost taken over five years was $10,825 and the dialysis cost $40,100. CONCLUSIONS: (1) nephrology practice variations caused a 2.5-4.0-fold difference in living donor renal graft rates, indicating patient education by the attending nephrologist influences the living donor transplantation rate, (2) with such education the combined living donor and the cadaveric organ supply virtually meets graft demand, (3) living donor renal grafts yield a better quantity and quality of life and better cost control than dialysis with their annual cost being one-quarter that for dialysis.

[Laparoscopic sigmoid resection]. / Laparoskopische Sigmaresektion.

Laparoscopic colorectal surgery not only presupposes knowledge in conventional surgery of the large bowel but also requires extensive experience in laparoscopic techniques. Furthermore every individual of the operating team should have suitable experience to guarantee effective co-operation. The presented study reports on 41 laparoscopic resections of sigmoid colon and upper rectum. The operations were carried out on 31 patients with benign and 10 patients with malignant diseases. In 1 case we had to change to an open procedure. Postoperative complications were seen in 10 patients, one of whom died (secondary haemorrhage 2; anastomotic leakage 1, Douglas haematoma 1, inflammation of the drainage tract 6). Preoperative management, intraoperative procedures and postoperative results are described and discussed.

Marathon runners presented lower serum cholesteryl ester transfer activity than sedentary subjects.

Acute exercise promotes raised HDL cholesterol concentrations by lipolysis stimulation, but this effect is insufficient to explain the more permanent HDL increases seen during regular exercise. During training periods in a group of marathon runners, we measured lipid transfer protein I (LTP-I)-mediated cholesteryl ester transfer activity (CETA) and its relationship to their HDL concentrations. Runners of both sexes showed significantly lower CETA values than those of sedentary controls. Male runners also had significantly lower serum concentrations of triglyceride, VLDL cholesterol and apolipoprotein B, and significantly higher concentrations of HDL cholesterol and apolipoprotein A-I than male controls. Results indicate that regular practice of aerobic exercise promotes modifications of lipoprotein metabolism related not only to lipolysis, but also to lower CETA. Such modifications are associated with reduced risk of atherosclerosis.

[Clinical aspects and therapy of Bureau-Barrière syndrome. Observations of 17 cases with review of the literature]. / Klinik und Therapie des Bureau-Barrière-Syndroms. Beobachtungen an 17 Fällen mit Literaturübersicht.

Bureau-Barrière syndrome can affect various organ systems. It is defined by the triad: painless ulcers at mechanically irritated and hyperkeratotic plantar areas of the feet, sensitive polyneuropathy of the lower legs and osteolysis in the forefoot area. The condition mainly affects middle-aged men suffering from alcoholism, liver disease, obesity or metabolic disorders such as diabetes mellitus. Successful treatment of the Bureau-Barrière syndrome requires an interdisciplinary approach.

[Two superficially spreading malignant melanomas on nevus spilus]. / Zwei superfiziell spreitende maligne Melanome auf Naevus spilus.

A case of a 49-year-old patient with two superficial spreading melanomas arising from a naevus spilus is presented. Although opinions differ on the potential for malignant transformation in naevi spili, they should be carefully watched, and if changes are found these lesions should be subjected to histopathologic examination.

[Pigmented basalioma as pseudomelanoma of the breast]. / Pigmentiertes Basaliom als Pseudomelanom der Mamille.

We report on a patient with a pigmented basal cell carcinoma of the nipple. Despite its rarity, it is important to know about this tumour because it is so easy to confuse it with malignant melanoma.

[Molecular biology of familial hypercholesterolemia]. / Biología molecular de la hipercolesterolemia familiar.

The causes and mechanisms of production of familial hypercholesterolemia at molecular level is reviewed. This is a monogenic hereditary disease that frequently affects the human being it is one of the supports in the existing relationship between hypercholesterolemia and acute heart infarction. Important advances in the diagnosis and treatment of this disease have been achieved with the profound knowledge of the biochemical alteration.