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We report a cardiac allograft recipient who conceived 5 months after transplantation and spontaneously delivered a full term healthy baby girl. Pregnancy in cardiac transplant recipients is gradually becoming a more frequent issue as more patients in this population consider child bearing. In order to advise patients on potential adverse outcomes due to pregnancy, we reviewed the literature on pregnancy after cardiac transplantation. Published reports show that pregnancy in this population carry a higher risk for complications, in particular there is a higher incidence of pregnancy-induced hypertension, preeclampsia, premature labor, premature and low birth weight infants. The risk for these complications, however, is not higher than for pregnancies of renal or liver transplant recipients, to which pregnancy is not invariably advised against. Despite a greater frequency of complications during pregnancy, successful delivery of a healthy infant is the rule, without any detectable long-lasting adverse effects on both mother and offspring. Thus, while cardiac transplant recipients who wish to become pregnant should be counseled on possible complications, it appears that a satisfactory outcome can generally be expected. Additionally, we discuss further issues pertinent to the care of such patients, including hemodynamic changes, immunosuppression, and rejection surveillance during their pregnancies.
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STUDY PURPOSE: To evaluate drug management of acute cocaine toxicity in a new animal model. The study null hypothesis was that no drug would affect outcome compared with a placebo control. MODEL: Chronically instrumented, conscious, unrestrained rats subjected to an LD50 dose (1.4 mg/100 g body wt) of IV cocaine. METHODS: Rapid injection of IV cocaine by IV vascular access port followed by injection of therapeutic study drugs. Outcome (survival vs death) with drug treatment was compared with a placebo group. PHARMACOLOGIC INTERVENTIONS: Normal saline placebo (0.2 mL/100 g), diazepam (0.5 mg/100 g), chlorpromazine (0.2 mg/100 g), propranolol (1.0 mg/100 g), labetalol (3.0 mg/100 g), or verapamil (0.1 mg/100 g) was given. There were ten rats in each treatment group. Allocation to treatment groups was nonrandomized. STATISTICAL METHODS: Fisher's exact test. RESULTS: IV injection of cocaine was followed by tonic-clonic seizure activity in all treatment groups. No study drug significantly improved survival compared with the placebo group. However, no animal treated with propranolol survived (P less than .05 vs saline control), and only one of ten animals treated with labetalol survived (P = .14 vs placebo group). CONCLUSION: In this conscious animal model subjected to an LD50 IV cocaine insult, chlorpromazine and diazepam, previously shown to be of value in other animal models, had no effect on survival. Verapamil also did not affect outcome. Outcome was adversely affected by treatment with beta-blocking agents.
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Recent reports showing that the presence of positive tests for hepatitis B surface antigen (HBsAg) is associated with prohibitively high morbidity and mortality suggest that such patients should not be considered for kidney transplantation. The clinical outcome and serology including hepatitis B DNA assays of 11 patients who were HBsAg-positive at the time of transplantation, as well as the hepatic complications in all 200 kidney transplantations during the same period, were analyzed. In the 11 HBsAg-positive patients, no clinical or laboratory evidence suggesting deterioration in liver function over a mean follow-up period of 8.0 +/- 1.7 years was found. Of six patients with fatal or severe chronic liver disease, only one was HBsAg-positive at the time of transplantation and showed no deterioration over 9 years. Two immunosuppressed patients developed anti-HBs antibodies after acute hepatitis B infection. A review of the literature leads to the conclusion that previous reports of poor patient prognosis may represent patients who first showed HBsAg positivity after transplantation or who had preexisting HBsAg-related liver disease. The present findings suggest that asymptomatic patients with positive tests for HBsAg should not be excluded from kidney transplantation programs.
Supracondylar fractures of the femor or humerus and fractures of the radius, ulna, tibia or fibula, plus crush injuries of the limbs, most likely should not be manipulated in the field because of the potential for traumatizing adjacent nerves, veins and arteries. An emergency splinting system that allows immobilization without repositioning has been developed. Furthermore, fractures in or about the elbow, wrist, knee, or ankle should not be subjected to reduction in the field, unless there are compelling reasons to justify the risk of producing significant additional trauma. Conservative immobilization without repositioning may yield a more positive prognosis for the patient.