Annals of surgery
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Comparative Study Clinical Trial
What causes center effects in kidney transplantation.
Results in 195 renal transplants were compared for two distinct patient populations, those from the out-of-town surrounding rural region and those from the local large metropolitan center. The 1-year cadaver kidney survival was strikingly higher in the group from out-of-town (62% vs. 43%, p less than 0.001). This was partially due to better patient survival in the out-of-town patients. ⋯ Other relevant factors were not different between the two groups. This strong dialysis center effect, which exerts a major influence on the subsequent likelihood of success, derives from some factor related to the derivation of the recipient. In addition to its possible implications for patient care, further study of this phenomenon would also be useful with regard to recent interest on the part of government and other third-party payment groups in transplant center results.
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This study represents the personal experience of a general surgeon in 70 cases of penetrating injuries of the heart. Eighteen patients with no signs of life on admission were subjected to a thoracotomy on the stretcher with a mortality of 94%. ⋯ In the author's opinion, percardiocentesis has no place in the diagnosis or treatment of cardiac injuries. Particular attention has been paid to the management of coronary artery injuries and the high incidence of air embolism in certain patients.