Causes of death after liver transplantation in children treated with cyclosporine and steroids.

Two-hundred-and-twenty-seven children underwent orthotopic liver transplantation between March 1980 and March 1986. Seventy (31 %) patients died during the study period. Four patients who died within 24 hours of the initial liver transplant and 5 patients who died outside of our institution were excluded from the analysis. Liver failure, related to either thrombosis of the hepatic artery, primary non-function of the graft or rejection accounted for 25 of the remaining 61 deaths. In 21 patients death was related to overwhelming sepsis while 7 patients died from excessive bleeding. Eight of the deaths were due to a miscellaneous group of causes. Twenty percent of the 150 patients who received a single liver transplant died compared to a death rate of 50% in patients who underwent three transplants. Eighty-five percent of the deaths occurred within 6 months after the initial liver transplant. Liver failure was the cause in the majority of the early deaths whereas the later deaths were more likely to be due to sepsis. This detailed analysis of the causes of death after pediatric liver transplantation in a large group of patients has revealed that advances in certain areas could lead to even better results.

Drug interaction between rifampicin and sirolimus in transplant patients.

We report two cases of drug interaction between rifampicin and sirolimus in renal trans-plant patients who were diagnosed with tuberculosis after transplantation and induction of immuno-suppressive therapy with sirolimus. The dosage of sirolimus had to be increased, in one case up to six-fold and in the second case up to five-fold, to maintain serum levels after starting the rifampicin. The two patients tolerated the treatment well, with no signs of tuberculosis and good renal function.

Does examiner bias in undergraduate oral and clinical surgery examinations occur?

OBJECTIVE: Oral and long case clinical examinations are open to subjective influences to some extent, and students may be marked unfairly as a result of gender or racial bias or language problems. These concerns are of topical relevance in South Africa. The purpose of this study was to assess whether these factors influenced the marks given in these examinations. METHODS: Final-year surgery examination results from the University of Cape Town from 2003 to 2006 were reviewed. These each consisted of a multiple choice paper, an objective structured clinical examination, a long case clinical examination and an oral examination. RESULTS: The marks of 604 students were analysed. Students who spoke English as a home language performed better in all examination modalities. Female students scored slightly higher than males overall, but they scored similarly in the clinical and oral examinations. There were significant differences in the marks scored between the various population groups in all examination modalities, with white students achieving the highest scores, and black students the lowest. These differences were most marked in multiple choice examinations, and least marked in oral and clinical examinations. CONCLUSION: We could find no evidence of systemic bias in the oral and clinical examinations in our department, which reinforces the need for ongoing academic support for students from disadvantaged educational backgrounds, and for those who do not speak English as a home language.