Access of non-residents to transplantation of deceased donor organs: practices and strategies in the European setting.

The access of non-resident patients to the deceased donor waiting list (DDWL) poses different challenges. The European Committee on Organ Transplantation of the Council of Europe (CD-P-TO) has studied this phenomenon in the European setting. A questionnaire was circulated among the Council of Europe member states to inquire about the criteria applied for non-residents to access their DDWL. Information was compiled from 28 countries. Less than 1% of recipients of deceased donor organs were non-residents. Two countries never allow non-residents to access the DDWL, four allow access without restrictions and 22 only under specific conditions. Of those, most give access to non-resident patients already in their jurisdictions who are in a situation of vulnerability (urgent life-threatening conditions). In addition, patients may be given access: (i) after assessment by a specific committee (four countries); (ii) within the framework of official cooperation agreements (15 countries); and (iii) after patients have officially lived in the country for a minimum length of time (eight countries). The ethical and legal implications of these policies are discussed. Countries should collect accurate information about residency status of waitlisted patients. Transparent criteria for the access of non-residents to DDWL should be clearly defined at national level.

Single ventricle, bicuspid aorta and interatrial wall aneurysm as a rare complex adult congenital heart disease: a case report.

BACKGROUND: Single ventricle, bicuspid aortic valve and interatrial wall aneurysm in adulthood are a rare and unique case in medical literature. This presented case with congenital heart disease has never been treated surgically and clinical consequences seriously presented in adulthood. CASE PRESENTATION: A 27 year old man with complex congenital heart disease presented. At the age of six, the single ventricle was ultrasonographly diagnosed, but at age 27 clinical consequences started to be seriously present. We explored his history, clinical course, physical examination, laboratory findings, medical treatments and actual patient condition. CONCLUSION: The possibilities for surgical evaluation are presented.

Expression of estrogen receptors alpha and beta, and progesterone receptors A and B in human mucinous carcinoma of the endometrium.

BACKGROUND AND AIM: Endometrial carcinoma is the most common female pelvic genital malignancy. The strong association between the development of endometrial cancer and influence of steroid hormones (especially estrogen) was demonstrated in many studies. Mucinous carcinoma is an uncommon type of endometrial carcinoma. Most cancers are low grade and have a relatively good prognosis. The expression of one type of estrogen (ER) and progesterone receptor (PR) has been well documented. Recently, two new types of receptors (ER-beta and PR-B) were demonstrated. The aim of this study was to determine the expression of all four steroid receptors (ER-alpha, ER-beta, PR-A and PR-B) in human mucinous carcinoma of the endometrium. PATIENTS AND METHODS: An immunohistochemical hormone receptor assay using specific monoclonal antibodies against estrogen receptors (ER-alpha, ER-beta) and progesterone receptors (PR-A and PR-B ) was used to study formalin-fixed and paraffin-embedded slides of 12 patients, diagnosed with primary endometrial mucinous carcinoma of different histological grades (G1 n = 9; G2 n = 3; G3 = 0). RESULTS: Three types of steroid receptors (ER-alpha, PR-A and PR-B) were frequently expressed in mucinous adenocarcinoma. ER-beta was weakly expressed in only one analyzed case. The immunohistochemical expression of PR-B demonstrated a statistically significant decrease in G1 neoplasms in comparison to G2 (p < or = 0.001). CONCLUSION: We demonstrated the expression of four different steroid receptors in mucinous endometrial carcinoma. No significant differences between different histological grades of tumor with respect to ER-alpha and ER-beta expression were observed. Interestingly, a statistically significant increase in expression of PR-B in G2 neoplasms compared to G1 was demonstrated. The higher expression of PR-B in G2 tumors suggests a substantial function of progesterone, and thus progesterone receptor, in the malignant transformation of mucinous endometrial cancer. Therefore, PR-B expression might be utilized as a tumor marker to distinguish between G1 and G2 mucinous tumors. However, additional studies are necessary to evaluate whether these parameters could be used as tumor markers for endometrial cancer.

Association between levels of Toll-like receptors 2 and 4 and CD14 mRNA and allergy in pregnant women and their offspring.

The microbial environment in early infancy or even in utero may modulate the risk to develop allergic disease. Since Toll-like receptors (TLR) recognize microbial products, we hypothesized that maternal allergies may be associated with decreased levels of TLR2, TLR4 and CD14 mRNA in mothers and their offspring. 185 healthy pregnant women from Germany (n = 48), Hungary (n = 50) and Spain (n = 87) were enrolled in a European multicenter study. Levels of TLR2, TLR4 and CD14 mRNA were quantified in maternal peripheral blood samples taken at delivery and placental cord blood samples. Numbers of TLR2+, TLR4+ and CD14+ monocytes were quantified by flow cytometry in 42 cord blood samples obtained from the German participants. Bivariate and multivariate regression analyses were performed. Maternal allergies were associated with significantly lower levels of TLR2/4/CD14 mRNA in maternal blood and cord blood samples. Maternal and fetal TLR2/4/CD14 mRNA levels were significantly correlated with each other (TLR2 r = 0.42; TLR4 r = 0.58; CD14 r = 0.54). The results suggest that maternal allergy status may affect allergic risk in offspring through a decreased expression of fetal TLR2/4/CD14.