Tissue and corneal donation and transplantation in the UK.

NHS Blood and Transplant (NHSBT) was established in 2005 as a Special Health Authority when the National Blood Authority and UK Transplant merged. This helped to bring tissue banking and organ transplantation services under one umbrella organization. This merger means that ~!95% of all deceased donors (whether tissue, organ or both) are now facilitated by one organization. NHSBT Tissue Services is the largest tissue establishment in the UK, and is a multi-tissue bank that specializes in the consent, retrieval, processing, storage, and dispatch of donated tissue coordinated from a purpose built, state-of-the-art tissue bank in Liverpool. Tissue donations can come from either tissue-only donors or solid organ donors who also donate tissue. Annually there are ~450 multi-tissue donors and 2500 eye donors in the UK, resulting in many thousands of transplants, including 3564 cornea transplants in 2010-2011. The separation of tissue- and organ-specific donors is largely artificial, and while organ transplantation can be life-saving, tissue transplantation can also have a dramatic effect on a patient's quality of life. It is hoped that all donors, both organ and tissue, will be recognized for the gift they make to society after their death.

The "ART" mandibular nerve block: a new approach to accomplishing regional anesthesia.

A new technique involving the use of a local block to anesthetize the inferior alveolar nerve (V3), a branch of the mandibular division of the trigeminal or fifth cranial nerve, is described. Clinicians fail to administer a successful mandibular block in as many as 15 per cent of all cases. This paper reviews and outlines some of the more common reasons for this failure, and how to avoid them. A short description of other techniques are presented, some of which should be reserved for isolated cases and not used on a routine basis. By avoiding or eliminating the reasons for mandibular block failure, and using the new block described in this paper, clinicians should be able to reduce the failure rate to much lower levels.

Clear cell adenocarcinoma of the urinary bladder: report of a case of probable müllerian origin.

A 35-yr-old woman with a history of endometriosis and several recent episodes of hematuria was found to have an exophytic tumor arising from the mucosa of the posterior bladder wall. Microscopic examination showed a typical clear cell adenocarcinoma with a predominant tubulo-cystic pattern. A radical cystectomy was performed. Pathologic examination showed no residual tumor, but grossly visible intramural cysts at the site of the tumor had features of endometriosis on microscopic examination, strongly suggesting that the clear cell adenocarcinoma arose from endometriosis and was of müllerian derivation. Only one other adenocarcinoma of the bladder, an endometrioid adenocarcinoma, has had a probable müllerian origin. Although rare, these cases indicate that some vesical adenocarcinomas are of müllerian type.

Age related flow rate nomograms in a normal pediatric population.

Uroflow studies in a normal pediatric population were analysed statistically. Single studies for 511 subjects (272 boys and 239 girls) were reviewed. Nomograms relating peak flow to volume voided and age were established. An acceptable lower limit for peak flow was obtained from the data and a volume voided range was calculated so that both criteria could be used with 90% probability to define the normal voiding situation. The mean values of peak flow rate increased with volume voided in both sexes and also with age in the male population. Different sets of nomograms, which are necessary for daily clinical evaluation, are given. They define the normal values in the normal population.

Body surface related flow rate nomograms in a normal pediatric population.

Uroflow studies for 511 normal pediatric subjects (272 boys, 239 girls) were analyzed statistically. Nomograms relating peak flow to volume voided and body surface were established. An acceptable lower limit for peak flow was obtained from the data and a volume voided range was calculated so that both criteria could be used with 90% probability to define the normal voiding situation. Body surface area was found to be a more reliable index than age in the establishment of nomograms. In the male population the 90% probability applied to a significantly greater volume voided reliability. In the female population mean peak flow rate rose with increased body surface. Finally, in both sexes the 10% lower limit was closer to the regression mean, allowing a tighter distribution around this value.

Endoscopic bladder neck suspension for stress urinary incontinence.

Endoscopic vesicourethral suspension is an acceptable procedure for the treatment of true stress urinary incontinence, and is associated with a high success rate and little morbidity. Endoscopic vesical neck suspension was performed in 60 patients, with cure of the incontinence in 49 (82 per cent). A higher success rate was achieved in patients without a prior hysterectomy and/or surgical procedure to correct incontinence. Abnormalities on urodynamic testing may be somewhat suggestive of outcome. However, these studies cannot be used to predict success or failure.

Radiologic investigation of the urinary tract in the neonate with myelomeningocele.

A significant number of neonates with myelomeningocele are born with potentially damaging abnormalities of the urinary tract. Therefore, it is logical to investigate these patients aggressively and initiate therapy as early as possible to preserve renal function and maintain lower tract integrity for future continence management. Results of excretory urograms and voiding cystourethrograms were reviewed in 68 consecutive neonates with myelomeningocele. They indicate clearly that only a third of the patients with normal excretory urograms had a normal voiding cystourethrogram, which implies that both studies be performed for complete evaluation of the urinary tract. In other words, of these 68 patients 55 (80.9 per cent) had a normal excretory urogram but only 17 (30.9 per cent) had a normal voiding cystourethrogram. Of the 13 patients (19.1 per cent) with an abnormal excretory urogram 12 (92.3 per cent) had an abnormal voiding cystourethrogram. Reflux occurred in 16.2 per cent of patients; 6 of 7 patients with grade II reflux and 1 of 3 patients with grade III reflux had a normal excretory urogram.

Recurrence of the hemolytic uremic syndrome in a 3 1/2-year-old child, 4 months after second renal transplantation.

Terminal renal failure secondary to the hemolytic uremic syndrome (HUS) developed 18 months after initial transplantation and 4 1/2 months after the child received his second cadaveric renal allograft. Recurrence of the syndrome was evidenced by gross hematuria and hypertension after a 'flu-like' illness, sudden decrease in platelet count and hemoglobin, and erythrocyte fragmentation. Renal biopsy findings were compatible with HUS. Evidence is presented that the HUS was a recurrence of the original disease.

Renal vein compression.

Duodenal compression by the superior mesenteric artery is the postulated cause of the superior mesenteric artery syndrome. Our case, as well as 2 other cases of renal vein compression reported in the literature, suggests that this is uncommon but should occur more frequently in this syndrome because it is anatomically as vulnerable to compression.