Implications of a universal tranfusion policy in renal transplant recipients.
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Biomedical subjects
Publications and source records attributed to B A Barnes.
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This study reports the clinical and pathological findings in a patient with recurrent membranous glomerulonephritis following transplantation of an HLA-identical kidney. Such a recurrence has been previously reported only once, although membranous glomerulonephritis is a common cause of nephrotic syndrome in adults. This case confirms that membranous glomerulonephritis may occasionally recur following renal transplantation and demonstrates that immunofluorescence and electron microscopic studies may be necessary to distinguish recurrent, membranous glomerulonephritis from the membranous changes frequently seen with chronic rejection. In light of the apparent low incidence of recurrent membranous glomerulonephritis, renal transplantation remains an excellent therapeutic option in this disease.
Cost-benefit analysis (CBA) is described briefly, emphasizing the contribution this technique can make in justifying health care programs vying with other costly public programs for support. Costs and benefits of two surgical diagnostic techniques are outlined briefly as illustrations of the analysis. The first analyzes routine intraoperative cholangiography indicating the slight benefits that accrue from its use in terms of mortality and hospital expense. A more complicated example is an analysis of a policy of universal annual uterine cervical smears in asymptomatic women for cancer prevention where, granted the assumptions of the model, the costs minus the benefits of the program are estimated to be $565,000/beneficiary/year. The average beneficiary will gain 22 years of life at an average cost/year of about $26,000. The two examples are presented primarily as illustrations of a methodology which is being applied widely in medicine and public policy planning. Second, the marshalling of facts in CBA of a policy of annual uterine smears is of interest to those concerned with the justification of this screening procedure.
The results of the 1975 CAP Comprehensive Chemistry Survey of serum magnesium are presented. More than 1,260 laboratories participated in this survey. The most commonly used method for the measurement of serum magnesium concentrations is atomic absorption spectrophotometry. Colorimetric dye methods (Rapid-Stat (TM) kits, the Dupont ACA and titan yellow) follow in popularity. Variation in precision was lowest with atomic absorption and highest with titan yellow methods. All three of the dye-binding methods demonstrated either consistently negative or consistently positive biases when compared with the weighted mean concentration. The differences between the mean concentrations obtained by the dye-binding methods and atomic absorption spectrophotometry are statistically analyzed, and several conclusions are presented. As demonstrated by this survey and at the concentrations measured, the estimation of serum magnesium by any of the commonly used methods, except titan yellow, is clinically appropriate.
Lithium data from the 1975 College of American Pathologists Comprehensive Chemistry Survey program have been analyzed. The results have been organized into five method-dependent groups: four variations on emission flame spectrophotometry, and one group containing all manual atomic absorption methods. The bias observed between flame emission and atomic absorption methods was correlated with the sample mean. In addition, three paired specimens were analyzed by mean comparison. This study indicates that atomic absorption methods have a negative bias, but an apparent correlation with the sample mean indicates the probability of standardization error between the methods. This may be related to a protein depression effect and may be due to differences in viscosity between aqueous standards and serum-based samples. Both atomic absorption and flame emission methods demonstrate variability that is clinically satisfactory.
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Pregnancy in a renal homograft recipient resulted in the delivery of a 2770-g male fetus by classic cesarean section. Renal function remained stable throughout the gestation. The fetoplacental unit was monitored by the concurrent assay of 24-hour urinary estrogen excretion and human placental lactogen (hPL) in light of the spuriously low estrogen levels often found in these patients on chronic glucocorticoid immunosuppression.
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