Annals of surgery
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Comparative Study
Important risk factors of allograft survival in cadaveric renal transplantation. A study of 426 patients.
Multiple risk factors contribute to the allograft survival of patients who have cadaveric renal transplantation. A retrospective review of 19 such factors in 426 patients identified race, DR match, B + DR match, number of transplants, and preservation time to have a significant influence. The parametric analysis confirmed the effect to be primarily in the early phase, i.e., first 6 months. ⋯ Patients receiving first grafts had better graft survival (68%) than those undergoing retransplantation (58%) (p = 0.05). Organ preservation less than 12 hours influenced allograft survival with a 78% 1-year survival rate compared with 63% for kidneys with 12-18 hours of preservation. Despite the benefits of B + DR typing, short preservation time, and first transplants to the white recipient, the allograft survival in the black recipient remained uninfluenced by these parameters.
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Long-term survival, the prognostic effects of race, age, tumor size, number of positive nodes, and presence of grave signs (fixation, peau d'orange/edema, dimpling/retraction, satellite nodules, and ulceration) in this distribution of estrogen receptors (ERs) and progesterone receptors (PRs) were studied in 2480 patients (1815 blacks, 665 whites) diagnosed with localized or regional breast cancer at Charity Hospital of Louisiana at New Orleans (CHNO) from 1948 to 1985 and followed up in the CHNO Tumor Registry. Breast cancer-specific survival rates were 57%, 45%, 41%, 39%, 38%, and 35% at 5, 10, 15, 20, 25, and 30 years, respectively. Size of tumor, clinical status of nodes, and degree of fixation were important prognostic clinical factors, and number of nodes was an important pathologic factor with no additional value of the "grave signs." Size and fixation were related. ⋯ The excess mortality from breast cancer at later intervals from diagnoses was small compared with mortality from other causes. Some, but not all, clinical findings were important prognostic indicators. ER and PR were related to some variables with unclear meaning.
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During the past 11 years, 31 patients with major juxtahepatic venous injuries were treated with the atriocaval shunt. Penetrating injuries occurred in 27 patients (87%), and injuries from blunt trauma occurred in four patients. Shock was present on admission in 28 patients (90%). ⋯ Major juxtahepatic venous injuries are highly lethal. The atriocaval shunt will permit the salvage of some patients where other methods are not possible. Avoidance of delay and alternative shunting techniques that eliminate difficult maneuvers may improve survival in the future.