Annals of internal medicine
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Advances in surgical and immunosuppressive techniques as well as increased public awareness have made organ transplantation a well-accepted therapy. To meet the increased need for transplantable organs, medical staff need to recognize which dying patients may be suitable organ donors and how to optimally maintain that donor. We present an overview of the absolute and relative contraindications to organ donation as well as a review of the problems that may be encountered when managing organ donors and how they can best be solved. These guidelines will help increase the number of suitable organ donors and optimize the condition of the transplanted organs.
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A nosocomial outbreak of fulminant hepatitis B infection at a medical center in Haifa, Israel, between 7 and 26 June 1986, involved five patients who had been hospitalized previously in the medical ward in late April and early May (first generation). This outbreak had an unusual clinical course, with fulminant hepatic failure associated with acute renal failure from acute glomerulonephritis, leading to death within a few days. The onset dates of hepatitis were tightly clustered temporally and incubation periods were short. ⋯ A sixth patient died in August 1986 (second generation), after his initial admission in June that coincided with the terminal hospitalizations of three first-generation patients. Those patients had marked coagulopathies, and transmission to the sixth patient most probably occurred through environmental contamination by patients or through cross-contamination between patients through staff. The unusually high mortality rate (5 of 6) in this outbreak has not been definitely explained.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Methylprednisolone therapy in patients with severe alcoholic hepatitis. A randomized multicenter trial.
To determine the efficacy of a corticosteroid in reducing the short-term mortality of patients with severe alcoholic hepatitis. ⋯ Methylprednisolone therapy decreases short-term mortality in patients with severe alcoholic hepatitis manifested either by spontaneous hepatic encephalopathy or a markedly elevated discriminant function value.