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A Spital

Publications and source records attributed to A Spital.

At least 19 recordsLinked to original sources
PubMed1992

Mandated choice. The preferred solution to the organ shortage?

BACKGROUND: A critical shortage of organs is perhaps the major barrier facing transplantation today. Adopting a system of presumed consent or mandated choice are among the solutions proposed. Under presumed consent, organs may be removed after death without explicit consent, unless the deceased had previously objected or the family objects at the time of death. Under mandated choice, all adults would be required to decide for themselves whether they wish to donate on their deaths and their decisions would be controlling. METHODS: To see if educated young people would support these proposals, I carried out two surveys at the University of Maryland, College Park, Md, of a total of 418 students who were at least 18 years of age. RESULTS: An overwhelming 90% would support mandated choice while a smaller percentage, just over 60%, would support presumed consent. The vast majority believe that the family should not be able to override the previously expressed wishes of their recently deceased loved one. Unfortunately, only a minority of respondents had discussed organ donation with their families and even fewer had signed donor cards. CONCLUSIONS: Even young, educated people frequently fail to consider organ donation prospectively and this is a major barrier to organ retrieval. While presumed consent and mandated choice are designed to deal with this serious problem, mandated choice seems preferable and would likely receive widespread support. Therefore, I suggest that a small scale trial of mandated choice be undertaken as soon as possible in the hope of finding an acceptable system that will quickly and efficiently increase the supply of desperately needed organs.

Adult↗
PubMed1992

Uncomplicated cystitis: diagnosis and treatment at college health centers.

The results of recent studies have led to valuable new recommendations regarding optimal diagnosis and treatment of acute uncomplicated cystitis in women. To investigate to what degree these recommendations have been incorporated into clinical practice, we conducted a survey of all college health centers belonging to the American College Health Association regarding their current management of suspected uncomplicated cystitis. Sixty-one percent responded. The results confirm that acute cystitis is indeed frequent among college women. Nonetheless, our data show that there is a wide variation in the approach to this common problem and that many centers have not yet adopted the new recommendations for optimal diagnosis and treatment. If we are to improve the management of uncomplicated cystitis in women, we must not only learn the best medical approaches, but we must also find reliable ways of transmitting this information to clinicians.

Acute Disease↗
PubMed1991

Severe hyperkalemia during magnesium sulfate therapy in two pregnant drug abusers.

Severe hyperkalemia developed in two pregnant intravenous drug abusers during prolonged parenteral magnesium sulfate therapy in the absence of any obvious cause. The serum potassium concentration returned to normal after magnesium therapy was discontinued. Hypermagnesemia, acting through several possible mechanisms, was probably responsible for the reversible hyperkalemia observed.

Adult↗
PubMed1990

Indomethacin does not impair cellular potassium uptake in the rat.

Based primarily on a single case study, it has been suggested that nonsteroidal antiinflammatory drugs (NSAIDs) may impair cellular potassium uptake, and that this effect may contribute to NSAID-induced hyperkalemia. To explore this possibility, we studied rats that had been pretreated with indomethacin or normal saline and subsequently bilaterally nephrectomized and potassium loaded. There were no significant differences between the indomethacin and control groups in the baseline, final, or increment in plasma potassium concentration after a potassium load. Similar results were obtained whether potassium was given intraperitoneally (IP) or intravenously (IV). Serum indomethacin levels confirmed that indomethacin was well absorbed transperitoneally. We conclude that in nephrectomized but otherwise healthy rats, high-dose indomethacin does not impair the cellular uptake of an acute potassium load.

Animals↗
PubMed1989

Extrarenal potassium adaptation: the role of aldosterone.

1. Prior adaptation to a high potassium (HK) diet reduces the increment in plasma potassium after nephrectomy and acute potassium loading. Previous work has suggested that this 'extrarenal potassium adaptation' is due to direct stimulation of cellular potassium uptake by chronic hyperaldosteronism. 2. In contrast, we have shown that when dietary potassium is withdrawn from HK rats, large urinary potassium losses persist, resulting in 'paradoxical potassium depletion'. This potassium depletion facilitates cellular potassium uptake and is, at least in part, responsible for extrarenal potassium adaptation. 3. To try to reconcile these observations, we explored further the role of aldosterone in extrarenal potassium adaptation. When dietary potassium was withdrawn from chronically adrenalectomized HK rats, paradoxical potassium depletion was markedly blunted and extrarenal potassium adaptation could not be demonstrated. Similarly, urinary potassium losses and potassium depletion were reduced when acute adrenalectomy was performed concomitantly with dietary potassium withdrawal. 4. We were unable to confirm previous studies showing extrarenal potassium adaptation in the absence of potassium depletion. Thus, extrarenal potassium adaptation did not occur after pretreatment with chronic high-dose mineralocorticoid, after prior adaptation to a sodium-free diet, or after prior adaptation to an extremely HK diet in the absence of dietary potassium withdrawal. 5. We conclude that chronic hyperaldosteronism is important in extrarenal potassium adaptation, but probably not via direct enhancement of cellular potassium uptake. Rather, in HK animals, hyperaldosteronism magnifies urinary potassium losses during fasting and thus promotes potassium depletion, which in turn facilitates the uptake of an acute potassium load.

Adaptation, Physiological↗
PubMed1989

Unconventional living kidney donors--attitudes and use among transplant centers.

The organ shortage remains a major barrier to renal transplantation in the United States today. The use of unconventional living donors, including genetically unrelated adults and related minors, could help increase the number of kidneys available for transplantation. Although these donor sources had generally been discarded, recent developments (including improved success and the demonstration of minimal risk) have caused some to reconsider this policy. Therefore, we surveyed all U.S. transplant centers regarding their attitudes toward unconventional living kidney donors. Of the nearly 60% responding: 76% would consider using spouses and 48% would even consider adult friends; 64% would consider using monozygotic twin minors and 43% would consider closely related non-twin minors; the mean minimum donor age accepted was 16 +/- 3 years, and the range was wide. On the other hand, many centers expressed reservations about these donor sources and indicated that such donors are seldom used. We conclude that under certain circumstances many U.S. transplant centers would consider accepting unconventional living kidney donors. Yet, at the same time, the centers appear uneasy about actually using these donors and no clear consensus exists. Our data indicate a need to openly readdress these issues.

Age Factors↗
PubMed1988

Living kidney donation. Attitudes outside the transplant center.

Many transplant centers are opposed to the use of living unrelated kidney donors and donors at added risk. To see how the public and nontransplant physicians view these issues, we surveyed samples of these groups in Rochester, NY. We found that the majority of respondents supports the use of unrelated donors and believes that donors should be allowed to accept added risk. Our findings were confirmed by a Gallup Poll of a random sample of the US adult population. It appears that many transplant centers are out of step with public opinion, as well as that of other members of the medical profession. We hope our data will induce the centers to become more attuned to public attitudes and give donors a greater voice in determining their own suitability. If this occurs, more donors will likely become available and the number of patients with end-stage renal disease receiving transplants will increase.

Adult↗