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- Can Kidney Deceased Donation Systems Be Optimized? A Retrospective Assessment of a Country PerformancePublication . Domingos, M; Gouveia, M; Nolasco, F; Pereira, JBACKGROUND: The intensive requirement of organs for transplantation generates the need for higher rates of donation. METHODS: Using the national database of diagnosis-related groups for 2006, the global annual 2006 in-hospital mortality of 34 hospitals with organ-retrieval schemes was evaluated. Potential donors were estimated excluding patients aged <1 year or >70 years and presenting International Classification of Diseases, Ninth Revision codes that contraindicated organ donation. RESULTS: We identified 3838 potential donors (12.6% of in-hospital deaths); 46% came from eight hospitals, 80% came from the larger hospitals and 21% from intensive care units (ICU). In hospitals with a neurosurgical department, an office coordinator of procurement and transplantation (OCPT), a transplant centre and co-location of neurosurgical and transplant centre, we identified, respectively, 54, 30, 32 and 30% of all potential donors. The causes of death were 23% cerebrovascular disease, 3% cerebral tumour, 2.6% anoxic lesion and 2.5% head trauma. In the same period, there were 189 effective deceased kidney donors with traumatic diseases as the main cause of death. The mean conversion rate was 4.9% and was associated with demographical and hospital characteristics. Age of potential donors, existence of OCPT or transplant centre, ratio between ICU and hospital acute beds and mortality from labour accidents were predictors of being an effective donor. CONCLUSIONS: Health policies need to maximize the conversion of potential to effective donors and the performance of organ donation systems must be considered as an index of the quality of care.
- Juvenile Gout: Rare and AggressivePublication . Coelho Henriques, C; Monteiro, A; Lopéz, B; Sequeira, L; Panarra, A; Riso, N
- Ophthalmic Artery Doppler Waveform Changes Associated with Increased Damage in Glaucoma PatientsPublication . Abegão Pinto, L; Vandewalle, E; De Clerck, E; Marques-Neves, C; Stalmans, IPURPOSE: To characterize Doppler waveform variables (early systolic acceleration [ESA] and systolic/diastolic mean velocity ratios [Sm/Dm]) of the Ophthalmic Artery (OA) by color Doppler imaging (CDI) in eyes with primary open-angle glaucoma (POAG). METHODS: Analysis of CDI examinations of the retrobulbar circulation of patients with POAG (n = 102), normal tension glaucoma (NTG, n = 89), and healthy controls (n = 59) by a condition-masked investigator. One-way ANOVA, chi-square, and Spearman's rank correlation tests were used to determine differences, establish comparisons, and to explore associations between variables, respectively. RESULTS: The overall Doppler waveform presented a shift to the right in the glaucoma groups, with significantly lower Sm/Dm ratios when compared to the control group (healthy: 2.94 ± 0.86, POAG: 2.60 ± 0.67, NTG: 2.63 ± 0.84; P = 0.01). ESA was significantly lower in the glaucoma groups (healthy: 688.8 ± 484 cm·s(-2), POAG: 548.1 ± 419 cm·s(-2), NTG: 548.5 ± 337 cm·s(-2); P = 0.03). No statistical differences were, however, detected in the OA velocities or resistance index (P ranged between 0.08 and 0.96). In the glaucoma groups, waveform parameters such as ESA, acceleration time, and systolic mean velocities correlated with systemic blood pressure variables (P < 0.05). In these groups, negative correlations were detected between Sm/Dm ratios and the degree of visual field defects (POAG: P = 0.01; r = -0.25) and retinal nerve fiber layer thickness (NTG: P = 0.02; r = -0.25). CONCLUSIONS: The pattern of blood flow velocities in the OA throughout the cardiac cycle seems to be altered in glaucoma patients. Further studies on how systemic blood pressure affects waveform variables in glaucoma patients may provide a better understanding of an underlying vascular dysfunction.