Southern medical journal
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Southern medical journal · Sep 1984
Case ReportsRenal transplantation in a developing country: anesthesia and other considerations.
The Renal Transplant Team at Tulane University Medical Center has been involved in training a multispecialty group of Guatemalan physicians to perform renal transplantations in Guatemala. The purpose is to train the physicians in their own country, using available equipment and personnel so that they can perform successful operations in our absence. This paper is a review of the considerations involved in the initial renal transplantation done in Guatemala by the Tulane Renal Transplant Team. ⋯ The recipient was a 22-year-old man with end-stage renal disease due to chronic glomerulonephritis. The donor was a healthy 33-year-old brother. This article is not intended to review renal transplantation in the United States, but to show what is feasible in a developing country where many drugs and equipment are not available.
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Southern medical journal · Sep 1984
Adult respiratory distress syndrome: radiologic manifestations and course.
During a 36-month period, the serial chest x-ray films of 26 patients with the adult respiratory distress syndrome (ARDS) were evaluated for the patterns of onset, course, and follow-up appearance when possible. An exudative phase appearance can be recognized, which can clear. The exudative phase appearances are (1) a bilateral, homogeneous, white-out alveolar appearance; (2) an asymmetric consolidative appearance; and (3) a central perihilar ("bat-wing") consolidative appearance. This progresses to a proliferative phase manifested on chest x-ray film as an interstitial appearance that must not be confused with fibrosis, as the chest x-ray film may return to normal.
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Southern medical journal · Sep 1984
Impact of early recognition on outcome in nonpenetrating wounds of the small bowel.
During a recent ten-year period, 20 patients were treated for nonpenetrating, small-bowel trauma requiring resection. Despite the relative infrequency of this injury, jejunoileal trauma must be suspected in all patients sustaining blunt force to the abdomen. Physical signs suggesting major intra-abdominal wounds usually occur at admission or immediately thereafter, provided the patient is alert. ⋯ Plain roentgenography is indicated, but was diagnostic in only 20% of patients in this series. The high incidence of associated injuries accounts for the substantial morbidity (70%) in this series. Early operation improves survival.
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During a six-month period, 552 infants were admitted to a level III Neonatal Intensive Care Unit (NICU) and four level II units. Of the 953 cross matches of blood components requested from the blood bank, 83% were administered. Forty-four percent of the infants received multiple blood transfusions from multiple blood donors (mean 3.9 donors, range two to 11). ⋯ The mean total volume of blood given was 22.5 ml (range 3 to 120 ml), exclusive of blood used for exchange transfusions. Seventy percent of the blood components were given to infants weighing less than 2,500 gm, and 44% were given to infants weighing less than 1,500 gm. Hospitals having only level II units must have the same blood banking facilities as hospitals with level III units, since 21% of the infants given transfusion received the blood component while receiving level II care.
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Because of the declining incidence and severity of acute rheumatic fever reported in the United States and Europe, we reviewed our clinical experiences with 128 cases of acute rheumatic fever. No decline in the rate of admissions for patients with rheumatic fever was found in our hospital. The most common major manifestation of rheumatic fever in our patients was carditis, followed by arthritis. ⋯ Carditis was severe in 26% of the patients, moderate in 27%, and mild in 47%. A high percentage of our patients had residual cardiac lesions, and the mortality was higher than what has been reported in the rest of the country. We conclude that primary prevention of rheumatic fever in areas like ours should be continued.