PubMed · 7699178
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H Saudny-Unterberg, K Gray-Donald. 1995. RD intervention improved nutritional status.. https://doi.org/10.1016/s0002-8223(95)00105-0
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BACKGROUND: Small children represent a challenging patient group in kidney transplantation (KTx). The aim of this study was to analyze patient and donor data influencing outcome in children that weighed <15 kg. METHODS: Sixty-eight kidneys were transplanted in 64 children that weighed <15 kg. In 44 cases, kidneys came from cadaveric donors (CAD) and in 24 cases from living-related donors (LRD). Grafts were placed transperitoneally via midline incision (n=16) or extraperitoneally to the iliac fossa (n=52). Vascular anastomoses were routinely performed to the aorta and vena cava even when the extraperitoneal approach was used. RESULTS: Vascular thrombosis was observed in two (3%), urinary leaks in five (7%), and stenosis in four (6%) patients. In six children receiving organs from adults to the iliac fossa, wound closure was performed using an absorbable mesh to avoid organ compression. Initial graft function occurred in 60 cases (88%). Frequency of initial graft function was significantly higher after KTx from LRD (100%) compared with CAD (82%). The 1-, 5-, and 10-year patient survival was 93%, 91%, and 91%, respectively, and the 1-, 5-, and 10-year graft survival was 92%, 85%, and 85%, respectively. There was no significant difference in patient and graft survival when KTx from LRD and CAD were compared. Within the CAD group, graft survival was improved using kidneys from donors >12 years compared with younger donors. CONCLUSION: Despite size discrepancy between recipients and grafts, KTx is feasible in children that weigh <15 kg by using an improved surgical technique even when adult organs are placed to the iliac fossa.
More than 60 percent of adults in the United States are overweight or obese, and obese persons are more likely to be ill than those who are not. Obesity presents challenges to physicians and patients and also has a negative impact on health status. Some patients who are obese may delay medical care because of concerns about disparagement by physicians and health care staff, or fear of being weighed. Simple accommodations, such as providing large-sized examination gowns and armless chairs, as well as weighing patients in a private area, may make the medical setting more accessible and more comfortable for obese patients. Extremely obese patients often have special health needs, such as lower extremity edema or respiratory insufficiency that require targeted evaluation and treatment. Although physical examination may be more difficult in obese patients, their disproportionate risk for some illnesses that are amenable to early detection increases the priority for preventive evaluations. Physicians can encourage improvements in healthy behaviors, regardless of the patient's desire for, or success with, weight loss treatment.