Effects of red-cell storage duration on patients undergoing cardiac surgery.

Background: Some observational studies have reported that transfusion of red-cell units that have been stored for more than 2 to 3 weeks is associated with serious, even fatal, adverse events. Patients undergoing cardiac surgery may be especially vulnerable to the adverse effects of transfusion.

Methods: We conducted a randomized trial at multiple sites from 2010 to 2014.

Polymorphous low-grade adenocarcinoma of the upper lip with metachronous myoepithelioma of the buccal mucosa.

Examples of multiple minor salivary gland tumors, synchronous or metachronous, are uncommon. We report a patient who initially presented with polymorphous low-grade adenocarcinoma (PLGA) and subsequently with myoepithelioma. A 91-year-old white woman presented in 2009 with a 1-cm, firm, nontender, well-circumscribed nodule of the left side of the upper lip extending to the anterior buccal mucosa.

White matter 'potholes' in early-onset schizophrenia: a new approach to evaluate white matter microstructure using diffusion tensor imaging.

There is considerable evidence implicating white matter abnormalities in the pathophysiology of schizophrenia. Many of the recent studies examining white matter have utilized diffusion tensor imaging (DTI) using either region of interest (ROI) or voxel-based approaches. Both voxel-based and ROI approaches are based on the assumption that the abnormalities in white matter overlap spatially.

Diffusion tensor imaging in psychiatric disorders.

Objectives: Since the development of diffusion tensor imaging (DTI) nearly a decade ago, it has been extensively applied to a number of different psychiatric disorders. Its rapid assimilation into psychiatric research has stemmed from its unique property to measure the coherence and direction of neuronal fiber tracts. The goal of this article is to provide an overview of DTI and its application to psychiatric disorders.

Out of the ordinary: nursing in Peru.

A high school friendship inspired a love of other cultures and a desire to pursue missionary nursing in South America. As a parish nurse in a remote village in Peru, the author trained village health workers in the basics of hygiene, first aid, and disease prevention.

Accuracy of herpes simplex virus detection in liquid-based (SurePath) Papanicolaou tests: a comparison with polymerase chain reaction.

A review of our institution's Papanicolaou test records over an 11-yr period showed that liquid-based Papanicolaou tests (LBPTs) had a significantly higher frequency of diagnoses of Herpes simplex virus (HSV)-related cellular changes compared to conventional Papanicolaou smears (77/302,841, 0.026% vs. 56/376,173, 0.

Limbic structures and networks in children and adolescents with schizophrenia.

Studies of adults with schizophrenia provide converging evidence for abnormalities in the limbic system. Limbic structures that show consistent patient/control differences in both postmortem and neuroimaging studies include the anterior cingulate and hippocampus, although differences in the amygdala, parahippocampal gyrus, and fornix have also been observed. Studies of white matter in children and adolescents with schizophrenia tend to show findings that are more focal than those seen in adults.

Living donor kidney transplants: personal reflections.

Short- and long-term living kidney donor morbidity and mortality are discussed herein. The analysis includes over 3000 living donor kidney transplants from 1963 through 2002 at a single institution. The category of living donors includes living related donors, such as fathers, mothers, siblings, offspring, and other genetically related donors, as well as living unrelated donors, such as spouses, friends, or altruistic strangers.

Addition of MMF to dual immunosuppression does not increase the risk of malignant short-term death after liver transplantation.

Immunosuppression is often incriminated for the increased risk of post-transplant malignancies. To examine whether triple- (MMF+Tacro+CS) versus dual-drug therapy (Tacro+CS) is associated with an increased incidence of malignancy, or death due to malignancy, data from a large registry of liver transplant recipients were analyzed. Data from adult primary liver recipients reported to the Scientific Registry of Transplant Recipients between June 1, 1995, and April 30, 2004, and recorded at transplant on triple-drug (n = 9180) or dual-drug (n = 10 099) therapy were included.

Education and internationally adopted children: working collaboratively with schools.

Families who adopt internationally often need assistance in determining which factors they need to consider when making educational decisions for their child, and they frequently seek guidance from their physician. Understanding how the education system functions, how it differs from the medical system, and how children who have been adopted internationally can succeed in school is important for health care providers, because this information helps parents in making proactive decisions for their children. Internationally adopted children have the best chance of maximizing their learning potential when medical and educational professionals work together to assist families as they plan for their child's education.

Utility of cardiac magnetic resonance imaging in the diagnosis of hypertrophic cardiomyopathy.

Background: Two-dimensional echocardiography is currently the standard test for the clinical diagnosis of hypertrophic cardiomyopathy (HCM). The present study was undertaken to determine whether cardiac MRI (CMR) affords greater accuracy than echocardiography in establishing the diagnosis and assessing the magnitude of left ventricular (LV) hypertrophy in HCM.

Methods And Results: Forty-eight patients (age 34+/-16 years) suspected of having HCM (or with a confirmed diagnosis) were imaged by both echocardiography and CMR to assess LV wall thickness in 8 anatomic segments (total n=384 segments) and compared in a blinded fashion.

Mycophenolate mofetil combination therapy improves long-term outcomes after liver transplantation in patients with and without hepatitis C.

To evaluate the impact of mycophenolate mofetil (MMF) on long-term outcomes of tacrolimus and corticosteroids, we analyzed data reported to the Scientific Registry of Transplant Recipients for 11,670 adult patients (3463 with hepatitis C [HCV]) who underwent primary, single-organ, liver transplantation between 1995 and 2001. Patients who were discharged from the hospital on tacrolimus-based immunosuppression with (n = 4466; n = 1323 HCV) or without MMF (n = 7204; n = 2140 HCV) were included in the analysis. Recipients treated at discharge with MMF, tacrolimus, and corticosteroids had significantly increased patient survival (81.

Ethical decision making in first trimester pregnancy screening.

Many couples enter pregnancy without an intricate understanding of the potential maternal and fetal/newborn complications. While it is reasonable for expectant couples to consider only the positive outcomes, it is the role of the healthcare professional to educate the parents on the options for fetal screening and testing. Once couples have this information, it is their opportunity to consider the options according to their beliefs and values.

Weight and body mass index in Parkinson's disease patients after deep brain stimulation surgery.

A retrospective chart review characterizing changes in 17 male and 10 female Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) surgery indicated that 6 mo before surgery, patients lost a mean of 5.1 lbs, whereas in the 6 mo after surgery, subjects gained a mean of 10.1 lbs; 22% gained more than 14 lbs.

Pulmonary complications after bone marrow transplantation: an autopsy study from a large transplantation center.

Context: Bone marrow transplantation (BMT) is used to treat various malignant and nonmalignant disorders. Pulmonary complications are some of the most common causes of mortality in BMT recipients. Poor general health and bleeding tendency frequently preclude the use of definitive diagnostic tests, such as open lung biopsy, in these patients.

An outbreak of bacteremias associated with Mycobacterium mucogenicum in a hospital water supply.

Objective: To investigate and determine the cause of an outbreak of Mycobacterium mucogenicum bacteremias in bone marrow transplant (BMT) and oncology patients.

Design: Case-control study and culturing of hospital water sources. Isolates were typed using molecular methods.

Span of control matters.

Prompted by manager concerns about span of control, a large, integrated health system set out to determine if span of control really mattered. Was there something to it, or was it just an excuse for poor performance? A team of middle managers studied the problem and ultimately demonstrated a strong relationship between span of control and employee engagement. Consequently, it was decided to add 4 management positions to note the effect.

Twenty-two nondirected kidney donors: an update on a single center's experience.

At the University of Minnesota, we have defined 'nondirected donation' as organ donation by a volunteer who offered to donate an organ to anyone on the cadaver waiting list. From October 1, 1997, through October 31, 2003, we have had 360 inquiries about nondirected donation, have completed 42 detailed nondirected donor (NDD) evaluations for kidney donation, and have performed 22 NDD transplants. We herein review our program policies and how they have evolved, describe our evaluation and the motivation of our potential donors, summarize the outcome of NDD transplants, and raise issues requiring further attention and study.

Educating nurses into the perioperative arena.

PROVIDING PERIOPERATIVE experience for those new to the OR is a vital necessity, especially because many nursing schools provide limited OR experiences. AN ALTERNATIVE to a traditional course is a condensed version that incorporates the material for a 10-week course into a two-weekend format that encompasses both didactic and laboratory experiences. RESPONSE TO THIS CONDENSED program has been so positive that it has edged out the 10-week program in the curriculum.