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The aim of this paper is to disclose the nexus of dislocation and ecology in the work of two Caribbean poets, Derek Walcott and Lorna Goodison. It shows how they deal with the founding experiences of the wider Caribbean community, such as diaspora and the process of creolisation, by drawing on the vegetation imagery. The concept of transplantation is central to this reading, as it refers to the history of forced removal, while also celebrating the biological and cultural hybridity of the region. Arguably, the shared preoccupation with island vegetation can be associated with the importance of naming for the Caribbean writers – hence the constant references to language in their representations of local plants. If geographic dislocation caused linguistic dislocation, it is only through the repossession of language that the poet is able to enact a return to her/his homeland. In Walcott and Goodison, however, this aim is pursued through further dislocation. [ABSTRACT FROM PUBLISHER]

Alausa M, Almagro U, Siddiqi N, Zuiderweg R, Medipalli R, Hariharan S. Refractory acute kidney transplant rejection with CD20 graft infiltrates and successful therapy with rituximab.Clin Transplant 2004 DOI: 10.1111/j.1399-0012.2004.00292.x© Blackwell Munksgaard, 2004Acute rejection is an expected event after transplantation and has been associated with poor long-term kidney transplant outcome. The presence of B cells in the kidney graft with acute rejection is thought to be an omnious sign, as it has been associated with poor graft outcome. There is no definitive treatment for acute rejection with B cells in the graft. Rituximab, a humanized monoclonal antibody against CD20, has been used in the treatment of B cell lymphoma. We present the case of a 49-yr-old Caucasian male with early acute kidney allograft rejection that was refractory to high doses of steroids and rabbit anti-thymocyte globulin (thymoglobulin). Repeat renal biopsy revealed T cell and B cells in the kidney graft and responded to the combination of rituximab and muromonab (a mouse monoclonal antibody to CD3 receptor). Over 9 months post-transplant, the patient remains rejection free with a serum creatinine of 1.7 mg/dL. [ABSTRACT FROM AUTHOR]

Opportunistic infections, and in particular tuberculosis (TB), carry substantial morbidity and mortality in solid organ transplant recipients. We report a 39-year-old man who underwent a cadaveric renal transplant. Three months postoperatively, he was diagnosed to have tuberculous infection of his graft kidney manifested as fever and renal impairment. The diagnosis was confirmed by renal biopsy, which showed granuloma formation and positive stain for acid-fast bacilli (AFB). His systemic symptoms responded well to a complete course of anti-tuberculous therapy, but his renal function continued to deteriorate. Graft nephrectomy was performed and the patient underwent a second kidney transplant 1 year later. He remained well and a symptomatic thereafter. No signs of recurrence of tuberculous infection were noted up until the present time. This case illustrates that TB remains an important threat to transplant recipients. Although reactivation of dormant TB is the usual mode of infection, acquisition from the donor graft is also possible. The latter may account for the infection in our case, as our patient had a negative tuberculin skin test and normal chest radiograph prior to transplant. The identification of AFB in the kidney graft less than 3 months postoperatively also suggested that causal relationship. While diagnosing TB in post-transplant recipients is difficult and may require renal biopsy, as in our case, treatment on the other hand is no different from the standard protocols. However, no consensus has been reached on the safety of retransplantation. Also, the need for graft nephrectomy and chemoprophylaxis remains unclear. [ABSTRACT FROM AUTHOR]

Charpentier KP, Brentnall TA, Bronner MP, Byrd D, Christopher M. A new indication for pancreas transplantation: high grade pancreatic dysplasia. Clin Transplant 2004: 18: 105–107. © Blackwell Munksgaard, 2004 A 42-yr-old male presented with a family history of pancreatic carcinoma inherited an autosomal dominant pattern. The development of endocrine and exocrine pancreatic insufficiency served as early markers for neoplastic transformation. Screening endoscopic ultrasound and ERCP showed abnormalities suggestive of pancreatic dysplasia. Total pancreatectomy was performed and pathology confirmed carcinoma in situ, also known as high-grade pancreatic ductal dysplasia or Pan IN-3. The patient's post-operative course was complicated by life threatening, brittle diabetes. Pancreas transplantation was successfully performed. One year following transplantation, the patient has excellent pancreas graft function. He remains insulin free and has no signs of malignancy. Total pancreatectomy followed by pancreas transplantation is a viable therapeutic option for patients in the dysplastic but still pre-malignant phase of familial pancreatic adenocarcinoma who develop hypoglycemic unawareness following total pancreatectomy. [ABSTRACT FROM AUTHOR]