Sirolimus use in recipients of expanded criteria donor kidneys.

With changing donor characteristics and the growing shortage in organ supply, renal transplant practitioners have sought to optimize the use of expanded criteria donor (ECD) kidneys, which have poorer outcomes than standard criteria donor (SCD) kidneys. The outcomes may represent an acceptable trade-off if ECD transplants offer enhanced overall patient survival by reducing waiting times. ECD kidneys may be more susceptible to toxicity associated with calcineurin inhibitors (CNIs); therefore, a potential strategy to improve outcomes in this growing demographic is the use of CNI-free immunosuppressive protocols.

Transport refusal by hypoglycemic patients after on-scene intravenous dextrose.

Objectives: Administration of intravenous (IV) dextrose to hypoglycemic patients is delegated to advanced care paramedics in Ontario. Following a quality assurance review, which revealed that 47% of patients refused transport after receiving IV dextrose, the authors studied whether such patients seek additional medical care in the three days following the initial refusal.

Methods: Sequential ambulance call reports for on-scene treatments of hypoglycemia were examined, and a standardized telephone survey of the patients was conducted.

Exercise at menopause: a critical difference.

Even at menopause, fitness can reduce the risk of heart disease, osteoporosis, and diabetes, yet only 38% of women over age 19 exercise regularly. A sports medicine expert recommends that exercise be encouraged and prescribed, even for women with a variety of comorbidities.

Mechanisms of resistance of human tumours to anticancer drugs of the platinum family: a review.

The introduction of cisplatin and its less toxic analog carboplatin into anticancer chemotherapy regimens has greatly improved the initial response rate of various solid tumours, including squamous cell carcinoma of the head and neck. However, relapse of a drug-resistant tumour occurs with a high frequency, and remains the greatest impediment to successful chemotherapy treatment. Studies of cultured, drug-selected, resistant cell lines from numerous laboratories have suggested a variety of potential mechanisms of resistance, the most common of which are (1) reduced intracellular accumulation of drug, (2) enhanced removal of platinum adducts from DNA, (3) increased cellular glutathione, and (4) increased cellular metallothionein.

Acoustic neuroma management: a six-year review.

The purpose of this investigation is to review the outcome of 83 consecutive acoustic neuroma patients, managed solely or in part by the Department of Otolaryngology at University Hospital, London, Ontario, over a 6-year period (1987 to 1993). The majority of patients underwent operative intervention, utilizing the middle cranial fossa, suboccipital, or most commonly, the translabyrinthine approach depending on the tumour size and level of residual hearing. Demographic, preoperative, intraoperative, and postoperative data are analyzed including complications of surgery.

Nutritional status in head and neck cancer patients.

The nutritional status of patients with head and neck cancer has been suspected as being a significant risk factor for surgical complications and cancer recurrence. Clinical dietary assessment was performed on a mixed group of 42 previously untreated, head and neck cancer patients scheduled to receive surgery with curative intent. Cox regression analysis was performed to investigate the relationship between demographic and tumour factors and nutritional status.

The association of human papillomavirus with Schneiderian papillomas: a DNA in situ hybridization study.

Human papillomavirus has been identified with DNA hybridization techniques in Schneiderian papillomas, though results reported in the literature have been conflicting. This study investigated 33 cases of Schneiderian papilloma (26 inverted papillomas, seven fungiform papillomas). In situ hybridization using a cocktail of human papillomavirus (HPV) probes 6/11, 16/18, 31/33/35 failed to identify HPV genome in any of the inverted papillomas.

Carcinoid tumour of the middle ear: case report and review of the literature.

This is a case report of middle-ear carcinoid tumour in a patient with a 20-year history of aural tinnitus, fullness, and hearing loss. The patient was treated surgically, with no evidence of recurrence 20 months later. The natural history of this tumour appears to be relatively benign, with a long clinical course and little destruction of surrounding tissues.

Changes in residents' self-assessed competences during a two-year family practice program.

Purpose: To compare changes in self-assessed clinical confidence over a two-year residency between two groups of family practice residents, one starting in a family practice center and the other starting in a hospital.

Method: All 44 entering residents at the University of Western Ontario in either 1984 or 1985 were eligible. Forty-two participated at baseline, and 24 (57%) provided completed responses after two years.

Biceps tendon blocks reduction of isolated radial head dislocation.

A case of an unreducible radial head dislocation found in a 7-year-old girl illustrates the frequent delay in diagnosis associated with radial head dislocation. Her initial radiographs showed the radial neck access not passing through the center of the capitulum, which is diagnostic of radial head dislocation. She had no associated injuries to the elbow joint or neurovascular structures.