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December 23, 2004 Vol. 351 No. 26
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The Swedish Obese Subjects Study followed obese subjects treated with gastric surgery and contemporaneously matched, conventionally treated obese controls. Surgically treated subjects who were enrolled for at least 2 years (4047 subjects) or 10 years (1703 subjects) had a lower incidence of diabetes, hypertriglyceridemia, and hyperuricemia; differences in the incidence of hypercholesterolemia and hypertension were not significant.
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This prospective study of asymptomatic people 50 years of age or older compared a fecal DNA panel with a fecal occult-blood test (Hemoccult II) for colorectal-cancer screening. Colonoscopy was the reference standard. The fecal DNA panel detected 52 percent of cancers, whereas Hemoccult II detected only 13 percent. The sensitivity of the fecal DNA panel for any advanced neoplasia was 18 percent, as compared with 11 percent for Hemoccult II. The two tests had similar specificity.
Suppression of allograft rejection is central to successful organ transplantation; thus, immunosuppressive agents are crucial for successful allograft function. Immunosuppressive drugs are used for induction (intense immunosuppression in the initial days after transplantation), maintenance, and reversal of established rejection. This review considers the use of immunosuppressive drugs in organ transplantation, focusing on renal transplantation.
Organ transplantation often depends on obtaining functioning organs from a donor who has recently died. This review presents a structured approach to management of the care of the brain-dead donor so as to achieve the greatest chance of a successful outcome in the recipient of the organs. Hypotension, hypothermia, diabetes insipidus, and cardiac dysfunction are common challenges to management. Brain death affects both hormone production and physiological responses in the donor.
A 52-year-old woman was admitted to the hospital because of cough and dyspnea. She had had several hospitalizations for similar problems in the past decade. She was a long-term heavy smoker and had a schizoaffective disorder. Chest radiographs showed ground-glass opacities and increased interstitial markings and computed tomography of the chest showed a “crazy-paving pattern.” A diagnostic procedure was performed.
A half-century has elapsed since the first transplantation, and this procedure is now accepted as the treatment of choice for end-stage organ failure. This article reviews the many developments since that historic moment. Although tremendous progress has contributed to the success of this form of therapy, several challenges remain if transplantation is to be widely available with minimal risks and optimal outcomes.
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