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The question of whether single people are entitled to adopt arises quite frequently. This may arise where a step parent, now single due to death or other causes, wishes to [...]

Het Rijksvaccinatieprogramma (RVP) in Nederland is officieel in 1957 gestart met vaccinatie tegen vier ziekten (difterie, tetanus, kinkhoest en polio). Het huidige RVP omvat vaccinatie tegen twaalf ziekten. Een hoge vaccinatiegraad is van belang voor groepsbescherming, zodat kwetsbare (nog) niet gevaccineerden ook beschermd zijn. De vaccinatiegraad is hoog (≥90%) voor pasgeborenen, kleuters en schoolkinderen, maar is in de afgelopen jaren wel met 2 tot 3% gedaald. De HPV-vaccinatiegraad voor adolescente meisjes is de afgelopen twee jaar gedaald van 61 naar 45,5%. Introductie van het RVP heeft geleid tot een afname in het voorkomen van ziekte- en sterfgevallen. Toch komen sommige ziekten nog geregeld voor, zoals kinkhoest en invasieve pneumokkokkenziekte bij ouderen. Ook zien we de afgelopen jaren een toename van meningokokken W‑ziekte. Meningokokken ACWY-vaccinatie wordt sinds 2018 aangeboden en in 2019 wordt het RVP uitgebreid met maternale kinkhoestvaccinatie, vaccinatie van 60-plussers tegen pneumokokkenziekte en rotavirusvaccinatie voor risicogroepen. Ontwikkelingen in de epidemiologie van de ziekten, nieuwe wetenschappelijke inzichten en de ontwikkeling van nieuwe vaccins en doelgroepen vragen om continue monitoring en optimalisatie van het programma en vaccinatieschema. Ook de daling in vaccinatiegraad vraagt om maatregelen om de kans op toekomstige uitbraken van RVP-ziekten te reduceren.

De afgelopen twee jaar is de vaccinatiegraad voor het humaan papillomavirus (HPV) voor adolescente meisjes sterk gedaald in Nederland. Dit artikel beschrijft wat bekend is over opkomstverhogende maatregelen met betrekking tot de HPV-vaccinatiegraad. Er is literatuuronderzoek gedaan naar de organisatie van de HPV-vaccinatie in landen uit de Europese Unie of het Europees Economisch gebied (EU/EEA), naar wereldwijde effecten van opkomstverhogende maatregelen en specifiek naar de effecten van toediening van vaccinaties op scholen en van aanbeveling van het vaccin door zorgverleners. Daarnaast werden bijeenkomsten over de daling van de HPV-vaccinatie van het Europese regiokantoor van de Wereldgezondheidsorganisatie bijgewoond. Ook werden interviews gehouden met collega’s van de publieke gezondheidsinstituten uit Ierland en Denemarken, waar de HPV-vaccinatiegraad sinds 2015 sterk gedaald is. In de EU/EEA landen varieert de leeftijd waarop meisjes gevaccineerd worden van 9 tot 15 jaar. De plaats waar wordt gevaccineerd loopt sterk uiteen. Ierland en Denemarken ontwikkelden voorlichting op maat voor publiek en professionals, zetten een alliantie op met stakeholders en waren zeer actief op sociale media. Literatuur laat zien dat het inzetten van reminders (voorafgaand aan het vaccinatiemoment), een no-show-beleid (na het vaccinatiemoment indien men niet is geweest), voorlichting op maat, terugkoppelen van de vaccinatiegraad aan professionals en het makkelijker maken om vaccinaties te halen, tot een verhoging van de HPV-vaccinatiegraad tussen 10 tot 20 % kan leiden. Het blijft erg belangrijk dat gezondheidswerkers het vaccin aanbevelen en misvattingen over HPV-vaccinaties weerleggen.

In Nederland zijn de afgelopen jaren minder kinderen gevaccineerd binnen het Rijksvaccinatieprogramma (RVP). Hoewel de daling voor de meeste vaccinaties beperkt is, is deze aanzienlijk voor de humaan papillomavirus (HPV) vaccinatie die meisjes wordt aangeboden. Er is nog geen sluitende verklaring gevonden voor de dalende vaccinatiegraad. Het Rijksinstituut voor Volksgezondheid en Milieu (RIVM) onderzocht met een vragenlijst onder jeugdgezondheidsorganisaties, aangevuld met gegevens uit bestaande bronnen, of organisatorische veranderingen in de jeugdgezondheidszorg (JGZ) hier mogelijk op van invloed zijn. De JGZ is immers verantwoordelijk voor het toedienen van de RVP-vaccinaties, meestal georganiseerd via de consultatiebureaus. Uit het onderzoek bleek dat er in de JGZ tussen 2013 en 2017 organisatorische veranderingen zijn geweest. Er werd echter geen verband gevonden met de daling in het aantal gevaccineerden voor verschillende vaccinaties in het RVP. Ongeveer twee derde van de JGZ-organisaties heeft aan het onderzoek meegedaan. Gezien de regionale verschillen in zowel organisatie van het RVP als de hoogte van de vaccinatiegraad zijn de uitkomsten mogelijk niet geheel representatief voor heel Nederland. De uitkomsten van dit onderzoek dienen daarom met de nodige voorzichtigheid te worden geïnterpreteerd.

Many patients with acute devastating brain injury die outside intensive care units and could go unrecognized as potential organ donors. We conducted a prospective observational study in seven hospitals in the Netherlands to define the number of unrecognized potential organ donors outside intensive care units, and to identify the effect that end‐of‐life care has on organ donor potential. Records of all patients who died between January 2013 and March 2014 were reviewed. Patients were included if they died within 72 h after hospital admission outside the intensive care unit due to devastating brain injury, and fulfilled the criteria for organ donation. Physicians of included patients were interviewed using a standardized questionnaire regarding logistics and medical decisions related to end‐of‐life care. Of the 5170 patients screened, we found 72 additional potential organ donors outside intensive care units. Initiation of end‐of‐life care in acute settings and lack of knowledge and experience in organ donation practices outside intensive care units can result in under‐recognition of potential donors equivalent to 11–34% of the total pool of organ donors. Collaboration with the intensive care unit and adjusting the end‐of‐life path in these patients is required to increase the likelihood of organ donation. Initiation of end‐of‐life care in acute settings, as well as lack of knowledge and experience in organ donation practices, results in underrecognition of patients who could be organ donors.

abstractA persistent clinical demand exists for a suitable arterial prosthesis. In this study, a vascular conduit mimicking the native 3-layered artery, and constructed from the extracellular matrix proteins type I collagen and elastin, was evaluated for its performance as a blood vessel equivalent.A tubular 3-layered graft (elastin-collagen-collagen) was prepared using highly purified type I collagen fibrils and elastin fibers, resembling the 3-layered native blood vessel architecture. The vascular graft was crosslinked and heparinised (37 ± 4 μg heparin/mg graft), and evaluated as a vascular graft using a porcine bilateral iliac artery model. An intra-animal comparison with clinically-used heparinised ePTFE (Propaten®) was made. Analyses included biochemical characterization, duplex scanning, (immuno)histochemistry and scanning electron microscopy.The tubular graft was easy to handle with adequate suturability. Implantation resulted in pulsating grafts without leakage. One week after implantation, both ePTFE and the natural acellular graft had 100% patencies on duplex scanning. Grafts were partially endothelialised (Von Willebrand-positive endothelium with a laminin-positive basal membrane layer). After one month, layered thrombi were found in the natural (4/4) and ePTFE graft (1/4), resulting in occlusion which in case of the natural graft is likely due to the porosity of the inner elastin layer. In vivo application of a molecularly-defined tubular graft, based on nature's matrix proteins, for vascular surgery is feasible.

Monte Carlo simulation and theoretical results for the short-time dynamics and the statics of hexagonal self-avoiding tethered membranes in free space or confined in a slit are compared. In particular the initial decay rate of the dynamic structure factor and the static structure factor are determined. It is shown that for small scattering vector lengths the tethered membrane has the shape and short-time diffusion constants of a flat disc. Further it is shown that the decay rate for intermediate scattering vector lengths suggests that the membrane primarily relaxes through its out-of-plane modes, implying that the membrane behaves as a rather stiff sheet. For a membrane confined to a slit both the structure factor and the decay rate with the scattering vector parallel to the membrane surface are in better agreement with theory than for a free membrane due to suppression of edge fluctuations. The influence of hydrodynamic interactions of the membrane with the slit walls on the decay rate is discussed.

The elastohydrodynamic force on two slightly deformable bodies approaching one another head on is calculated in the limit of small gap sizes and small deformations by combining Hertz's theory of deformation and lubrication theory. An expression for the lubrication force analyticalin the deformation and gap size is obtained. The effect of the gap size, the elasticity and the velocity of approach on the lubrication force is demonstrated. Further, the lubrication force with a pressure dependent viscosity is calculated.

Monte Carlo simulations of self-avoiding random walks surrounded by aligned rods on a square lattice and a simple cubic lattice were performed to address the topological constraints involved for dilute solutions of flexible polymers in a highly oriented nematic solvent. The nematic constraint exerted by the solvent is modelled by requiring that the distance between nearest neighbour chain segments in the direction of the director of the nematic solvent is such that a discrete number of rods, representing the perfectly ordered nematic solvent, fits exactly in between. Rod lengths of one or two lattice spacings are used. In this case interesting scaling behaviour for the radius of gyration and the end-to-end distance is found. Perpendicular to the director the coil behaves as a two- (or- one- in the case of a square lattice) dimensional self-avoiding walk, whereas parallel to the director it behaves as a random walk. The conformations have a disk-like shape with the radius of gyration perpendicular to the director being considerably larger than the parallel component. These simulations address only one aspectof flexible polymers in nematic solvents. In reality the presence of the coil also reduces the entropy of the solvent which has exactly the opposite effect on the shape of the polymer coil.

Hypothermic preservation is a prerequisite for kidney exchange in transplantation. The severity of tissue damage caused by hypothermic preservation influences the level of ischemiareperfusion injury and subsequent graft function. With the purpose of reviewing the implications of prolonged cold ischemia time (CIT) in kidney transplantation, its pathophysiology, effects on early and late outcome of transplantation for different types of deceased organ donors, and preservation methods are discussed based on recent literature.

Late stent graft failure is a serious complication in endovascular repair of aortic aneurysms. Better understanding of the motion characteristics of stent grafts will be beneficial for designing future devices. In addition, analysis of stent graft movement in individual patients in vivo can be valuable for predicting stent graft failure in these patients. To be able to gather information on stent graft motion in a quick and robust fashion, an automatic segmentation method is required. In this work we compare two segmentation methods that produce a geometric model in the form of an undirected graph. The first method tracks along the centerline of the stent and segments the stent in 2D slices sampled orthogonal to it. The second method used a modified version of the minimum cost path (MCP) method to segment the stent directly in 3D. Using annotated reference data both methods were evaluated in an experiment. The results show that the centerline-based method and the MCP-based method have an accuracy of approximately 65% and 92%, respectively. The difference in accuracy can be explained by the fact that the centerline method makes assumptions about the topology of the stent which do not always hold in practice. This causes difficulties that are hard and sometimes impossible to overcome. In contrast, the MCP-based method works directly in 3D and is capable of segmenting a large variety of stent shapes and stent types.

Purpose: To quantify dynamic changes in aortoiliac dimensions using dynamic electrocardiographically (ECG)-gated computed tomographic angiography (CTA) and to investigate any potential impact on preoperative endograft sizing in relation to observer variability.Methods: Dynamic ECG-gated CTA was performed in 18 patients with abdominal aortic aneurysms. Postprocessing resulted in 11 datasets per patient: 1 static CTA and 10 dynamic CTA series. Vessel diameter, length, and angulation were measured for all phases of the cardiac cycle. The differences between diastolic and systolic aneurysm dimensions were analyzed for significance using paired ttests. To assess intraobserver variability, 20 randomly selected datasets were analyzed twice. Intraobserver repeatability coefficients (RC) were calculated using Bland-Altman analysis.Results: Mean aortic diameter at the proximal neck was 21.4±3.0 mm at diastole and 23.2±2.9 mm at systole, a mean increase of 1.8±0.4 mm (8.5%, p<0.01). The RC for the aortic diameter at the level of the proximal aneurysm neck was 1.9 mm (8.9%). At the distal sealing zones, the mean increase in diameter was 1.7±0.3 mm (14.1%, p<0.01) for the right and 1.8±0.5 mm (14.2%, p<0.01) for the left common iliac artery (CIA). At both distal sealing zones, the mean increase in CIA diameter exceeded the RC (10.0% for the right CIA and 12.6% for the left CIA).Conclusion: The observed changes in aneurysm dimension during the cardiac cycle are small and in the range of intraobserver variability, so dynamic changes in proximal aneurysm neck diameter and aneurysm length likely have little impact on preoperative endograft selection. However, changes in diameter at the distal sealing zones may be relevant to sizing, so distal oversizing of up to 20% should be considered to prevent distal type I endoleak.

The adoption of a non-uniform dopant profile has substantially increased the tolerance to high mode deformations of our baseline indirect-drive design. In addition, a low deuterium-tritium (DT) gas density, obtained by 'dynamic quenching' at 2.3?K below triple point, could partly compensate for the decrease in robustness due to DT ageing. Finally, the net margin regarding all laser and target technological defects is about 2. As soon as a sufficient amount of laser beams and diagnostics is available, we will shoot pre-ignition experiments to tune the point design. We are studying new targets which need less energy for these campaigns.

Although clinical data suggest its existence, little is known about the effect of rapamycin derivatives on wound repair. This study aims to delineate the influence of the mammalian target of rapamycin inhibitor everolimus on wound healing in the rat intestine.

After cadaveric kidney transplantation, preservation-reperfusion damage results in glomerular and tubular proteinuria. There are no data on the time course of proteinuria after living-donor (LD) transplantation.

Current evidence-based acute treatments of cluster headache are limited to oxygen inhalation and subcutaneous sumatriptan. Intranasal sumatriptan is a new formulation with better tolerability than the subcutaneous route. Two open-label studies suggested efficacy of intranasal sumatriptan in cluster headache.

CACCC-boxes are recognised by transcription factors of the Sp/Krüppel-like Factor (Sp1/KLF) family. Here we describe one member of this family, KLF8/ZNF741/BKLF3 (KLF8). KLF8 contains a characteristic C-terminal DNA-binding domain comprised of three Krüppel-like zinc fingers, but also has limited homology to another family member, KLF3/Basic Krüppel-like Factor (KLF3/BKLF), in its N-terminus. Most significantly, it shares with KLF3/BKLF a Pro-Val-Asp-Leu-Ser/Thr motif. In KLF3/BKLF this motif mediates contact with the co-repressor protein C-terminal Binding Protein (CtBP). We demonstrate that the KLF8 Pro-Val-Asp-Leu-Ser motif also contacts CtBP. We show that the N-terminus of KLF8 functions as a repression domain and that its activity relies on the integrity of the CtBP recognition motif. We demonstrate that the zinc fingers of KLF8 recognize CACCC elements in DNA and that full-length KLF8 can repress a CACCC-dependent promoter. Finally we determine that KLF8 is broadly expressed in human tissues. These results establish KLF8 as a CACCC-box binding protein that associates with CtBP and represses transcription.

For the diagnosis of allograft artery stenosis in recipients of a renal transplant with hypertension a noninvasive investigation such as echo‐ Doppler is preferable to invasive methods such as angiography. Therefore we analyzed our experience with echo‐Doppler diagnosis of renal allograft artery stenosis. In 131 renal transplant recipients with hypertension echo‐Doppler examinations were performed. During the examinations several features indicative of stenosis were measured, and intrarenal Doppler spectra were quantitatively analyzed with a user‐written program. Four patients showed signs of iliac artery stenosis. In 12 patients a renal allograft artery stenosis was suspected on echo‐Doppler examination. In 8 of these 12 patients angiography was performed. All these showed a stenosis, 6 of which had more than >75% stenosis. In 8 patients with normal echo‐Doppler findings angiography was performed because of highly suggestive clinical signs of stenosis. In 7 of these no stenosis was found and in one a 50% stenosis was found. Comparison of quantitative Doppler spectrum features from patients with (n=6) and without severe (>75%) stenosis on angiography (n=10) showed significant differences in several Doppler parameters. Subsequently an analysis of the best differentiation between these to groups on the basis of quantitative Doppler criteria was performed. In conclusion, echo‐Doppler examinations with quantitative analysis of Doppler spectra enables reliable identification of renal allograft artery stenosis.

Early vascular complications were studied in 1300 consecutive renal transplantations performed in 1065 patients in a single institution. Vascular complications requiring surgical reintervention in the first 10 postoperative days occurred in 68 patients (5.2%). There were 33 instances of graft vessel thrombosis, 6 anastomotic and 30 extra‐anastomotic hemorrhages. The overall mortality as a result of these complications was 0.08%. Transplant nephrectomies were performed in 45/68 cases (66%), accounting for 3.5% graft loss of the complete series. Multiple renal arteries and veins, their reconstruction and multiple arterial or venous anastomoses were not associated with an increased chance of graft loss. The absence of an aortic patch, renal artery and vein lesions and extravascular graft anomalies did not exert a negative influence on the graft outcome. Intraoperative events leading to complete or partial revision of the venous anastomosis or repair of a troublesome venous hemorrhage proved to be associated with the occurrence of vascular complications requiring surgical reintervention. Vascular complications ensued most frequently when size discrepancy of graft and recipient was present.

Allograft thrombosis occurred in 44 cases (4.8%) among 915 consecutive cadaveric renal transplantations performed in a single center over a 13‐year peirod. Multiple logistic regression analysis of risk factors revealed that continuous ambulatory peritoneal dialysis (CAPD) was the only independent variable associated with renal allograft thrombosis. When CAPD was used for prior renal replacement therapy graft thrombosis occurred in 7.3% (22/303), whereas hemodialysis was associated with 3.6% (22/612) of graft thromboses (p<0.02). No differences in transplant characteristics, including hemodynamics, hematological parameters, immunosuppressive therapy, graft anatomy and preservation, were observed between the cases with graft thrombosis and a matched control group (n=88). CAPD treatment appears to be a risk factor in the development of renal allograft thrombosis that requires further perioperative coagulation studies in order to design an effective prophylaxis.

The outcome of renal transplantation with an arterial anastomosis to a vascular prosthesis in the aortofemoral tract is evaluated. All 7 Dutch transplant centers were invited to review their experience. Among a total of 5791 cadaveric renal transplantations performed between 1978 and 1994, 13 cases (0.2%) in 3 different centres were identified. In 6 cases the vascular reconstruction and transplant operation were performed simultaneously, and in 7 cases separately, with a mean interval of 3.5 yr. The indications for vascular reconstruction were aneurysmal disease in 4 and obstructive disease in 9 cases. The early vascular complications of these procedures were hemorrhage in 4 and renal vein thrombosis in 1 and led to graft loss in 3 cases. The perioperative mortality was 2/13 (15%). The graft and patient survival were 68 and 83% respectively after 1 yr and 17 and 37% after 5 yr. Late mortality was mainly due to cardiovascular disease. Renal transplantation with an arterial anastomosis to a vascular prosthesis in the aortofemoral tract is a hazardous procedure with relatively poor shortand long‐term results. These observations shoud be considered in the choice of renal replacement therapy in this special patient population.

To relieve the persistent shortage of cadaveric donor organs for transplantation, organ harvesting may become a routine procedure in all general hospitals. Because of that prospect, the selection of donors, donor management, techniques of nephrectomy, hepatectomy, and pancreatectomy, and preservation procedures are described. Finally, criteria for the establishment of regional procurement programs, involving a professional transplant coordinator, are elucidated.

Abstract: Besides a brief review of the INEEL, examples of chemical separation activities in environmental management are presented in this paper. Under development at the INEEL are separation technologies for the treatment of radioactive wastes, including highly radioactive liquid wastes, solid calcined wastes and mixed wastes, as well as contaminated groundwater and soils. An overview of these technologies, specific applications of the technologies, and the benefits from their use are discussed.

To study the relationship between ischaemia-reperfusion and multiple organ dysfunction syndrome (MODS), a new anaesthesia method was required to be applied to C57BL/6 mice. These mice are also used in a well accepted, standardized model for MODS using intraperitoneally administered zymosan (zymosan induced general inflammation, ZIGI). The aim was to develop a new model for ischaemia-reperfusion with 6 h of anaesthesia. This and further specific requirements for the combination of ischaemia-reperfusion and the ZIGI method, made us select inhalational anaesthesia using isoflurane in oxygen. This study evaluates whether long-term anaesthesia confounds the results of ischaemia-reperfusion and the ZIGI model. In addition the benefits of using the analgesic buprenorphine were evaluated. Ischaemia was induced with a tourniquet around the hindlimb. Ischaemia and reperfusion were verified by imaging a radioactive tracer with a gamma-camera. It was established that anaesthesia with isoflurane in oxygen caused little perturbation of body temperature and respiratory rate. A survival rate of 89% without noteworthy influence on organs was obtained. Buprenorphine proved to provide adequate analgesia and had no influence on measured parameters. In our experimental setting, this model with long duration anaesthesia allowed us to induce ischaemia and reperfusion of the hindlimb without perturbation of measurements. It also allowed good exposure of the abdomen and facilitated combination with the ZIGI model.

Early and late mortality of 313 ICU patients and the quality of life of 118 long term ICU survivors was studied to assess the effectiveness of intensive care for critically ill patients. The survival rate at discharge from the ICU was 76%, falling to 61% at 6 months and to 58% at 1 year. A simplified acute physiology score (SAPS) was recorded on ICU admission, as well as age, length of ICU-stay and the number of complications during intensive care. Information on housing, drug use, hospital admissions, physical condition and functional status 2 years after ICU discharge was collected by means of a questionnaire. No changes in housing occurred, but drug use and the number of hospital admissions were significantly increased. In 21% of the patients a deteriorated physical condition was found, 77% remained unchanged and 2% were improved 2 years after ICU discharge, compared to their condition prior to the acute illness. Major functional impairment was found in 38% of the patients. Although the longterm physical condition and functional status correlated with SAPS and age on ICU admission, the best indicator for quality of life after intensive care proved to be the health status prior to the acute illness.

To determine the relationship between ankle/brachial indices (ABIs) and morbidity and mortality in patients with peripheral arterial disease (PAD), a historical cohort study was performed. A total of 154 patients who had undergone noninvasive arterial assessment of the lower extremities in 1989 and 1990 were selected for this purpose. Selection criteria were age >40 years at the time of investigation, a resting ABI <0.90 and the availability of an ABI after exercise or arterial occlusion. Mortality and vascular events were recorded after an average follow-up period of 6 years. A vascular event was defined as an intervention because of PAD, the occurrence of a nonfatal myocardial infarction or stroke, a transient ischaemic attack or a coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) procedure. During the period studied, 44 patients died and 111 patients suffered a vascular event. The relative risk for mortality was 3.1 per 0.50 decrease of the ABI at rest (95% confidence interval (CI) 1.1–8.7, p= 0.03) and 2.4 per 0.50 decrease of the ABI after exercise or arterial occlusion (95% CI 0.9–6.4, p= 0.08). The relative risk for mortality or the occurrence of a vascular event was 3.3 per 0.50 decrease of the resting ABI (95% CI 1.7–6.3, p<0.001) and 2.5 per 0.50 decrease of the ABI after exercise or occlusion (95% CI 1.5–4.4, p<0.001). After standardization, the prognostic power of the two types of ABIs was equivalent. The cumulative survival after 5 years was 63% for patients with resting ABIs <0.50, 71% for patients with ABIs 0.50–0.69 and 91% for those with ABIs of 0.70–0.89. There were obvious differences between the mean initial ABIs of patients who suffered a vascular event and/or died and those of survivors, who did not suffer an event. A relatively simple measurement like the determination of the resting ABI can give valuable information about the prognosis for vascular related morbidity and mortality. This can be of help in the approach of patients with PAD and assist in therapeutical decision making. Determination of the ABI after exercise or occlusion has no additional value for this purpose.

Ling Zhi-8 (LZ-8) is a protein derived from the fungus Ganoderma lucidumand has immunomodulatory capacities. It was shown to be mitogenic toward mouse splenocytes in vitro and immunosuppressive in vivo by reducing antigen-induced antibody formation and by preventing completely the incidence of autoimmune diabetes in nonobese diabetic mice. In this study, the mitogenic effects of LZ-8 on human mono-nuclear cells are reported. In accordance to its mitogenic effect on mouse splenocytes, LZ-8 proved to be mitogenic for human PBMC. This mitogenic effect of LZ-8 apparently required the presence of monocytes. We also demonstrated it to be immunosuppressive in vitro in a human MLC performed in the absence of monocytes, using purified T cells and EBV-trans-formed allogeneic B cells. Furthermore, we tested LZ-8 for its possible suppressive effects in 2 different models of allogeneic tissue transplantation. LZ-8 proved to have a significant effect on cellular immunity, since its administration in an allografted mouse skin model resulted in an increased survival time. In a model of transplanted allogeneic pancreatic rat islets, LZ-8 was effective in delaying the rejection process of allografted islets. More frequent or continuous administration resulted in a further prolongation of survival time. No serious side effects of LZ-8 could be discerned in these experiments.

The purpose of this study was to determine whether lower doses of dexamethasone for treatment of brain tumor edema are as effective as the conventional dose of 16 mg/d. We consecutively executed two double-blind randomized trials in patients with CT-proven brain metastasis and Karnofsky scores of 80 or less. In the first series, we compared 8 mg dexamethasone per day versus 16 mg/d; in the second series, 4 mg/d versus 16 mg/d. Standardized evaluation of quality of life and side effects took place at days 0, 7, 28, and 56. We randomized a total of 96 patients and evaluated eighty-nine. The Karnofsky score improved in the 8-mg group, which had improvement of 8.0 ± 10.1 (mean ± SD) points at day 7 versus 7.3 ± 14.2 points in the 16-mg group. In the second series, the 4-mg group had improvement of 6.7 ± 11.3 points at day 7 and 7.1 ± 18.2 points at day 28 versus 9.1 ± 12.4 and 5.6 ± 18.5 points in the 16-mg group. Toxic effects occurred more frequently in the 16-mg group (p < 0.03). We conclude that administration of 4 mg dexamethasone per day for treatment of brain tumor edema results in the same degree of improvement as does administration of 16 mg/d after 1 week of treatment in patients who have no signs of impending herniation. Toxic effects are dose-dependent and, during a 4-week period, occurred more frequently in patients using 16 mg/d. Following radiotherapy to the brain or other antitumor therapy, tapering of dexamethasone from 4 mg/d should preferably be temporized over about 4 weeks.

Abstract: To explain an occasionally observed transient swelling of the ipsilateral leg in renal transplant recipients in the absence of deep vein thrombosis, we took serial measurements of venous outflow resistance and duplex examinations of both legs. Fourteen recipients of a living related donor kidney graft were submitted to strain gauge plethysmography and duplex examination before transplantation and 1 and 6 weeks thereafter. Venous outflow resistance and venous flow were measured and the veins were assessed for thrombosis. Strain gauge plethysmography showed a significant increase in venous outflow resistance in the leg on the side of the renal transplant 1 week after transplantation [0.28 0.13 vs 0.40 0.15 mmHg.s (ml/100 ml)–1; P < 0.05]. Six weeks later, the venous outflow resistance had returned to preoperative values [0.30 0.11 mmHg.s (ml/100 ml)–1; P = NS]. On the contralateral side, no significant differences were found. Duplex examinations showed no signs of thrombosis. Venous flow measurements in the common femoral vein showed no significant differences. We conclude that the additional blood supply to the iliac veins results in an increase in venous outflow resistance in the ipsilateral leg, which can explain the observed swelling of this leg and may have implications for the preferred method of diagnosis of venous thrombosis after renal transplantation.

Following a one-month prospective study of antimicrobial drug use in surgical departments, new guidelines were implemented. The review was repeated after two years. In both study periods, one third of patients were prescribed antimicrobial drugs. Prophylactic antibiotic consumption decreased from 0.75 to 0.53 defined daily doses/operation. Compliance with guidelines improved from 32% to 79%. Duration of prophylaxis > 24 h decreased from 21% to 8%. Single dose prophylaxis increased from 34% to 80%. Quality of the prophylactic courses improved, as evaluated by experts using established criteria. For prophylaxis, cost savings amounted to 57%. Better quality of therapeutic courses was associated with a cost increase of 15%. Indicators of satisfactory outcome with the new policy were a stable median length of stay (5.5 days in the first review and 5.0 days after intervention) and a reduction in the number of nosocomial infections treated with antimicrobial drugs/100 bed days (1.0 before intervention vs 0.77 after intervention).

Mortality, averaging about 30% of young born throughout the year, was severest at 5-10 weeks of age, from just before weaning until about 4 weeks after, especially in large litters of 10-11 young. The organism most characteristically associated with enteritis was Escherichia coli. Preliminary experiments suggested that restriction of food decreases the death rate from enteritis among young rabbits.

We present the case of a patient with a persisting type II endoleak after endovascular repair of an iliac aneurysm with an iliaco-caval fistula. We describe the pathophysiological mechanism behind this phenomenon and discuss why conservative treatment is unlikely to seal this type of endoleak. A more aggressive treatment strategy is therefore advocated.

In cadaveric organ transplantation there is a risk of transfer of infectious agents from donor to recipient.The consequences can be fatal for immuosuppressed recipients. This is illustrated by a case history in which an infection with the fungus Monosporium apiospermum was transferred from a donor to two cadaveric kidney recipients, of whom one died and the other surviced with the loss of the graft.These events led to a review of the literature to determine methods of demonstrating possible contamination of donor organs. Analysis of the case history of potential donors, a history taken from relatives or the family doctor, autopsy and laboratory examinations are considered useful. Victims of drowning, patients with severe burns and patients who have been ventilated for a long time are high risk donors.

• Transplantation results after kidney preservation by means of cold storage and machine perfusion were analyzed. Graft survival and function of 75 machine-perfused kidneys were the same as those of 2,686 kidneys preserved by cold storage. Cold storage, a relatively simple, safe, and inexpensive procedure, was preferred for the preservation of kidneys that had not been subjected to prolonged periods of warm ischemia. Machine perfusion could be used for kidneys damaged by ischemia, although its advantage over cold storage in these circumstances was not firmly established.(Arch Surg 1983;118:1166-1168)

The effects on pancreatic islet allograft survival of donor-specific blood transfusions (DST) in combination with pre- and posttransplant immunosuppression were studied. A total of 12 groups of rats (n=105) with chemically induced diabetes underwent islet allotransplantation. Multiple DST or third-party blood transfusions (TPT) were given prior to transplantation. Pretransplant immunosuppression consisted of azathioprine and prednisolone, and low-dose cyclosporin A was used for posttransplant immunosuppression. TPT, as well as separate or combined pre- and posttransplant immunosuppression without blood transfusions, did not prolong islet allograft survival. DST resulted in either primary nonfunction of the islet allografts or a markedly decreased islet allograft survival. These findings contrast with the beneficial effect of DST on whole-organ allograft survival in rats previously described by others.

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