Transplantation proceedings
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The sudden death of a person is one of the most extreme and painful experiences for the relatives, and doctors require special communication skills to deal adequately with the bereaved. The Dutch European Donor Hospital Education Programme was developed to train doctors and nurses in talking to the bereaved relatives and to make the donation request. In Germany, the one-day workshop has been adapted to the German language, law, and clinical practice. ⋯ The main effects reported were that two thirds of the participants rated that relatives could be helped, talked with, and cared for in a better way. The workshop participants also reported that they themselves were better able to cope with the situation and were more inclined to take on the task following the workshop. Finally, the necessities and limits of psychosocial training for doctors and their staff are discussed.
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Adrenal medullary chromaffin cells secrete several neuroactive substances including catecholamines and opioid peptides that produce analgesic effects in the central nervous system. This study was designed to investigate whether intrathecal microencapsulated chromaffin cells could release analgesic materials producing antiallodynic effects on the chronic neuropathic pain in rats induced by chronic constriction injury (CCI) of the sciatic nerve. Prior to intrathecal implantation, chromaffin cells were encapsulated with alginate and poly-L-lysine to protect them from the host immune system. ⋯ CSF levels of catecholamines and metenkephalin in the rats that received implants were higher than the controls. In addition, we observed chronic survival of implants. These results suggested that intrathecal microencapsulated chromaffin cells may represent a new approach to chronic neuropathic pain management.
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Ischemia-reperfusion (I/R) injury may influence graft function following transplantation. Ulinastatin, a urinary trypsin inhibitor has been shown to attenuate I/R injury in various organs such as intestine, heart, and kidney in animals. The present experiment was designed to evaluate the effect of pretreatment with ulinastatin on I/R-induced lung injury. ⋯ Ulinastatin attenuated I/R-induced lung injury. This function is partly related to the capacity of the agent to inhibit myeloperoxidase activity in lung tissue and decrease systemic expression to TNF-alpha.
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Living donor kidney transplantation is the optimum treatment for the uremic patient. Successful kidney transplantations started in 1953 in Boston and in Sweden in 1964. ⋯ Finally, new groups of donors such as blood group-incompatible donors and anonymous donors have been accepted, each of whom have their own programs. This article also discussed our responsibilities as renal specialists or transplant surgeons for kidney donors at surgery and postsurgery.
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Kidneys transplanted from non-heart-beating donors (NHBDs) have been exposed to varying degrees of ischemic damage after death. Category III donors have invariably been managed, treated, and investigated in a hospital setting prior to arrest and death. Some therefore exhibit evidence of renal dysfunction and even acute renal failure (ARF) before death. ⋯ The mean GFR at 3 months was 45.4 and 43.8 for the ARF and normal group, respectively. At 12 months the GFR was 42.2 and 44.7 in the ARF and normal groups, respectively. Thus evidence of ARF pre-arrest does not preclude successful category III NHBD renal transplantation.