Medical Students' Attitude Toward Organ Donation: Understanding Reasons for Refusal in Order to Increase Transplantation Rates.

OBJECTIVES: To assess, among medical students, the willingness to donate their own organs or those of a family member, and to establish reasons for refusal. MATERIALS AND METHODS: During the 2016 academic year, an anonymous survey was conducted among University of Buenos Aires School of Medicine second-year students. RESULTS: Of the total 1012 respondents, 81.92% would agree to donate and 18.08% would not. Thirty two percent would not authorize donation of a family member's organ. Almost all (94.1%) students reported they had little information about organ donation. Reasons for refusal included: fears about the possibility of not being really dead when considered for organ ablation (36.4%); lack of confidence in (25.8%) or lack of information about the organ procurement and transplantation system (14.6%); no interest in organ donation (9.3%); and religious reasons (6%). Brain death was considered irreversible by 59.7% of donors and by only 51% of non-donors (P = .036). Contact with a transplanted person was more frequent in the donor group (30.9% vs 21.3%, P = .01). More donors were found among the group who discussed the subject with their families than among the group who did not (69.1% vs 62.9%, P = .053). CONCLUSIONS: A considerable percentage of medical school students would not be willing to donate their own or a family member's organs. Main reasons are mistrust of the system, lack of information about donation programs, and poor understanding of the brain death concept. Contact with an organ recipient and discussing the subject in the family both favored donation.

Physical Activity Among Organ Recipients: Data Collected From the Latin American Transplant Games.

BACKGROUND: Cardiovascular complications after transplantation are an important cause of non-transplant-related deaths. Depression and anxiety are not unusual among organ recipients. Physical activity reduces cardiovascular risk and promotes a sensation of well-being. The aims of the study were to examine how exercise affects psychological well-being sensation in organ recipients and to describe the physician's role in promoting and controlling safe sport training in transplanted patients. METHODS: A descriptive study was conducted. A questionnaire was answered by participants of the "2012 Latin American Transplant Games." RESULTS: One hundred sixty-six organ recipients completed the questionnaire. Eleven percent heard about the transplant games from a physician. Seventy percent had not received a proper medical pre-competitive evaluation. Only 39% trained in a supervised manner and 53% had experienced some kind of sport-related injury. Self-perception of global health was reported as excellent by 19.75%, very good by 43.95%, good by 30.67%, and regular or poor by 5.73%. An excellent or very good health perception was reported by 47.8% of those who practiced only one kind of sport versus 71.5% of those who practiced more than one sport and by 89.6% of those who performed isometric activity versus 59.3% of those who did not perform isometric activity. CONCLUSIONS: Diversity of practiced sports and isometric activity are associated with a better self-reported health condition. Most participants had not received a proper medical pre-competitive evaluation; they trained in an unsupervised manner, and injuries were common.

Preliminary evaluation of a hydrogel liquid bandage in 30 dogs undergoing tibial plateau levelling osteotomy surgery.

AIMS: To compare the prevalence of minor incisional complications in canine patients undergoing tibial plateau levelling osteotomy (TPLO) surgery that had a hydrogel liquid bandage (HLB) applied to their incision, with patients that had a light adhesive bandage applied. METHODS: Thirty dogs undergoing TPLO surgery were randomly assigned to either application of a light adhesive bandage to the incision, with removal 18-24 hours later, or application of a clear-drying polyethylene glycol HLB to the incision. Erythema, swelling, discharge, and dehiscence were assessed 1 day (Day 1) and 10-14 days (Days 10-14) postoperatively. All persons completing the assessment were blinded to the treatment. Outcomes were compared for the two groups using Fisher's Exact Test. RESULTS: On both Day 1 and Days 10-14, the distribution of dogs with erthemyma or swelling did not differ between the two groups (p≥0.4). The prevalence of erythema was the same in the bandage and HLB groups at Day 1 (11/15; 73%) and was similar at Days 10-14 (3/11 (27%) and 2/11 (18%), respectively). Prevalence of swelling was also the same in the two groups on Day 1 (11/15; 73%) and was similar at Days 10-14 (3/11 (27%) and 6/11 (55%), respectively). On Day 1, 2/15 (13%) dogs in the HLB group and none of the dogs in the bandage group had incisional discharge (p=0.483). No dogs were observed with discharge on Days 10-14. No dehiscence, infection, or any other major incisional complication was observed in either group at any point in the study. CONCLUSIONS: Preliminary results suggest that prevalence of minor incisional complications after TPLO surgery treated with HLB or with a traditional adhesive bandage may be comparable. No major adverse effects were seen with the use of HLB. CLINICIAL RELEVANCE: Due to several disadvantages of traditional bandaging, which can require post-operative maintenance and removal, lasts only a short time, and be painful when removed, an alternative with fewer drawbacks is desirable. HLB may present such an alternative.

Nonoperative salvage of subcutaneous hemodialysis fistulae.

During a 7-month study period 11 chronic hemodialysis patients presented with thrombosis of their arteriovenous grafts or fistulae. They were prospectively entered in a protocol to evaluate the efficacy of low-dose streptokinase and percutaneous angioplasty for reopening the hemodialysis access. All patients were evaluated with a fistulagram and had local, low-dose streptokinase (10,000 U/h) infused directly into the fistula, until the thrombus dissolved or for 36 h. If repeat fistulagram demonstrated stenoses, percutaneous transluminal angioplasty was attempted. 5 patients were successfully treated, and 4 have remained patent without complication for a minimum follow-up of 9 months. 4 patients had the streptokinase stopped prematurely: 1 died (myocardial infarct), 1 was operated upon (perforated diverticulum), and 2 patients had perigraft complications. There were no major complications, although minor complications were common. Significant systemic effects on the coagulation profile did not occur. The regimen of locally infused, low-dose streptokinase and percutaneous transluminal angioplasty was found to be a safe and effective alternative for the treatment of thrombosed hemodialysis arteriovenous grafts or fistulae. If this regimen is unsuccessful, it does not preclude operative revision.

Difference between 1-84 parathyroid hormone and the 1-34 fragment on renal tubular calcium transport in the dog.

Acute clearance studies were performed in chronically thyroparathyroidectomized dogs to determine similarities and differences between the effects of 1-34 and 1-84 parathyroid hormone (PTH) on urinary calcium excretion. In a small (physiological) dose, 1-84 PTH caused no mean change in percentage calcium excretion, while the 1-34 fragment was frankly calciuric. At this dose, the two hormone preparations were equally phosphaturic. Fragments of PTH in the range 25-84 did not alter calcium or phosphate transport. We conclude that the entire molecule is required in order for the distal nephron effect of the hormone to enhance net calcium transport in the kidney to become manifest.

Focal segmental glomerulosclerosis in Hodgkin's disease.

Development of Nil disease and focal segmental glomerulosclerosis (FGS) in sequential renal biopsies is reported in a patient with Hodgkin's lymphoma. Although steroid resistance was demonstrated, a complete and sustained clinical remission of the renal lesion followed anti-Hodgkin's chemotherapy. These findings support the hypothesis that Nil disease and FGS are manifestations of the same clinical entity.

Parathyroid hormone: effects of the 3-34 fragment in vivo and vitro.

The biologically active fragment ofparathyroid hormone, consisting of residues 1-34, and its in vitro antagonist, fragment 3-34, were administered separately or in combination to chronically thyroparathyroidectomized dogs. These fragments were also studied in vitro with dog renal cortical membranes. Fragment 3-34 inhibited the stimulation of adenylate cyclase by fragment 1-34 in vitro, but had no agonist or antagonistic effects on renal phosphate transport in vivo.

Potentiation by calcium of the proximal tubular transport effects of parathyroid hormone.

Previous studies from this laboratory have demonstrated that a low ('physiological') dose of parathyroid hormone (PTH) effects a phosphaturia in chronically thyroparathyroidectomized (TPTX), hypocalcemic dogs, similar in magnitude to that seen in normal intact animals, without altering proximal tubular reabsorption. In addition, cyclic AMP did not increase following this amount of PTH, despite the phosphaturia. Since calcium is an important modulator of transport events, we studied the effects of restoring serum calcium (Ca) to normal before administering a physiological dose of PTH (0.3-0.5 U/kg). In hypocalcemic dogs given only physiological amounts of PTH, percentage phosphate excretion (%EPO4) rose from 3.81 +/- 1.48 to 18.29 +/- 5.69% (p less than 0.025) without any alteration in proximal tubular function. Ca infusion alone likewise did not change %EPO4 or proximal tubular transport. However, calcium-infused dogs given a physiological dose of PTH showed a reduction in proximal tubular fractional phosphate reabsorption from 0.73 +/- 0.04 to 0.63 +/- 0.04 (p less than 0.005), as well as an increase in %EPO4 (from 5.64 +/- 1.69 to 15.86 +/- 2.82%, p less than 0.001), without any increase in urinary or tissue cyclic AMP. We conclude that the elevation of the serum Ca to normal restores the ability of PTH in physiological amounts to alter proximal tubular PO4 transport. The data also suggest that this action of PTH is mediated by Ca, rather than by the adenylate cyclase system.

Hydrothorax in a patient receiving continuous ambulatory peritoneal dialysis: successful treatment with intermittent peritoneal dialysis.

A 51-year-old woman had end-stage renal failure from polycystic kidney disease. Two years after she started receiving peritoneal dialysis, a large right pleural effusion developed in the patient that was secondary to a pleuroperitoneal connection as demonstrated by a radionuclide scan. The patient was switched from continuous ambulatory peritoneal dialysis (CAPD) to intermittent peritoneal dialysis (IPD) with resolution of the effusion that recurred when she was rechallenged with CAPD one month later. We believe the large ultrafiltrate volume of CAPD with prolonged dwelling times may have ruptured microscopic defects in the diaphragm due to increased abdominal pressure. With the smaller ultrafiltrate volume of IPD and the semisitting position, the patient was able to continue receiving peritoneal dialysis with resolution of the pleural effusion.

Inhibition of the renal tubular effects of parathyroid hormone on phosphate transport by prostaglandin E2.

The infusion of PGE2 into TPTX dogs abolishes the phosphaturic action of PTH in vivo. This effect occurs only if PGE2 infusion precedes the administration of PTH. The infusion of PGE2 in vivo induces a state of refractoriness of PTH-sensitive adenylate cyclase in renal middle medulla from TPTX dogs in vitro. These results suggest that PGE2 inhibits the biological effects of PTH, in part by altering the events related to PTH activation of renal adenylate cyclase. These effects of PGE2, a local mediator, suggest that the renal tubular cell may modulate its responses to multiple and antagonistic stimuli by altering local renal prostaglandins.