The aim of this retrospective study was to assess parathyroid function after renal transplantation in patients with good renal function (creatinine < 133 mumol/l).Of 1,628 patients on whom we performed renal transplantation, 210 have stable good renal function as defined above. Total calcium (Ca), creatinine, albumin and parathyroid hormone (PTH) values were obtained from patient records at varying intervals after transplantation, and in 91/210 patients pre-transplant values were available. Patients who had undergone parathyroidectomy before the transplant were excluded from the study. Follow-up ranged from 6 months to 24 years.These 210 patients were divided into 4 groups according to PTH and Ca levels. Group 1 consisted of 118 patients (56%) with normal Ca and PTH levels and group 2 of 69 patients (33%) with normal Ca but persistently high PTH levels, of whom 25 persistently have Ca levels in the high normal range. The reason for the inappropriate PTH levels is not obvious. In group 3 there were 18 patients (8%) with high Ca and PTH levels. They have disease requiring parathyroidectomy. Group 4 comprised 5 patients (3%) with low Ca and high PTH levels. In the 91 patients for whom pre-transplant PTH values were available, 16/46 patients with tertiary hyperparathyroidism (3 degrees HPT) have normalised after transplant, 12/46 patients have ongoing 3 degrees HPT post transplant, while 4/45 patients with less severe disease (secondary HPT) have developed 3 degrees HPT (P < 0.059).In 56% of patients with good renal function after transplant parathyroid function is normal. Thirty-three per cent have high PTH levels with normal Ca, but 36% of these are in the high normal range. Eight per cent have persistent 3 degrees HPT. Post-transplant parathyroid dysfunction correlates with the severity of pre-transplant disease.
Fifty-two consecutive patients with upper gastrointestinal haemorrhage, shock (systolic blood pressure less than 100 mmHg) and a peptic ulcer showing endoscopic stigma of recent haemorrhage underwent attempts at endoscopic haemostasis. The ulcers were injected with a dilute solution of adrenaline followed by 5% ethanolamine oleate. Active bleeding was present in 22 patients (42%) at initial endoscopy. Bleeding was controlled in 40 patients (77%) in hospital. Failure occurred more frequently in duodenal ulcers than gastric ulcers (46% v. 7%; P < 0.004), and in giant (more than 2 cm diameter) duodenal ulcers (6/7) than smaller duodenal ulcers (3/15). We recommend early surgery for large posterior duodenal ulcers in preference to endoscopic injection methods.
Introduction : Incorporating a feldspar chemical bond between alumina filler particles is expected to increase the wear-resistant and flexural strength properties.
Aims and objectives : An investigation was carried out to evaluate the influence of the feldspar chemical bonding between alumina filler particles on wear and flexural strength of experimental alumina/feldspar dental composites. It was hypothesized that wear resistance and flexural strength would be significantly increased with increased feldspar mass.
Methods : Alumina was chemically sintered and bonded with 30% and 60% feldspar mass, silanized and infiltrated with UDMA resin to prepare the dental restorative composite material.
Results and conclusions : Higher wear-resistant characteristics resulted with increased feldspar mass of up to 60% (p 0.05). Feldspar chemical bonding between the alumina particles may improve on the wear-resistance and flexural strength of alumina/feldspar composites.
Primary bacterial peritonitis is a rare condition and one which carries a mortality rate in excess on 50%. Recently a patient with clinical features of primary bacterial peritonitis who had had an IUD in situ while receiving immunosuppressive drugs was treated. The 13-year-old white girl underwent successful renal transplantation in 1979 for renal failure due to chronic glomerulonephritis. After an uneventful pregnancy in 1984 she was provided with a copper-containing IUD for contraception. In April 1985 she presented with abdominal pain fever and signs of peritopnitis which was confirmed at laparotomy. The cause of the peritonitis could not be established at laparotomy and in particular the fallopian tubes were macroscopically normal. Bacteriological cultures of the peritoneal pus grew Strepococcus pyogenes Staphylococcus epidermidis and eptostreptococcus spp. but preparation of endocervical cultures of a profuse yellow-green vaginal discharge was delayed until removal of the IUD after commencement of antibiotic therapy and yielded no growth. Response to antibiotic therapy was complete. Primary bacterial peritonitis is a bacterial infection of the peritoneum which develops in the absence of evidence of direct extension from abdominal organs. It appears that depressed defense mechanisms are a prerequisite for its development. The patient was maintained on an immunosuppresive regimen of prednisone and azathioprine and is therefore likely to have been predisposed to develop infection. The IUD also may have played a role by providing a source of infection. The organisms isolated from the peritoneal fluid cultures are consistent with a vaginal source and although the patient denied gynecological symptoms a profuse yellow-green vaginal discharge was noted on removal of the IUD. Therapeutic serum antibiotic levels precluded laboratory confirmation of the vaginal presence of these same organisms. It is now the policy of these physicians to avoid the IUD as a means of contraception in female transplant recipients and to advise instead the use of barrier methods and oral contraceptives when temporary contraception is desired.
Experience with angio-access in patients with chronic end-stage renal failure undergoing haemodialysis, including those with arteriovenous fistulas constructed within the past 3 years, is reviewed. In patients in group 1, 137 fistulas were constructed; the patency rate at 2 years was 66% and at 4 years 47%. Complications were due to thrombosis, aneurysm and poor operative technique. In group 2 fistulas were constructed from synthetic material in 33 patients; the patency rate at 2 years was 44% and at 4 years 36%. Complications were due to thrombosis and sepsis. No correlation was found between raised fibrinogen levels and fistula or graft failures. Dialysis needles of different gauges were compared; the 16-gauge Terumo needle was found to cause no hemolysis and was adequate for use in dialysis.
At 6 months after kidney transplantation 59 adults with impaired renal function were divided into three groups according to their serum creatinine level: group I 150-199 mumol/l; group II 200-299 mumol/l; and group III greater than or equal to 300 mumol/l. These patients were followed up for 5 years or to graft loss when it became apparent that the eventual outcome was related to the degree of renal impairment at 6 months. Age of donor and age of recipient did not have a bearing on the eventual outcome nor did the frequency of acute tubular necrosis or rejection episodes. Patients with severely impaired renal function with serum creatinine levels greater than or equal to 300 mumol/l have a poor outlook but there are no particular prognostic features on which to base a forecast for the individual patient.
Orientation : South Africa is facing a critical shortage of artisans. Therefore it is important to investigate which factors contribute to the retention of artisans by organisations.
Research purpose : The objective of this study was to investigate the factors that are important for artisan retention at a South African organisation.
Motivation for the study : Organisations that employ artisans need to understand what the main reasons are for keeping or losing artisans from the perspective of the artisans themselves. This information can be used to plan and implement interventions to deal with artisan retention in organisations.
Research design, approach and method : A qualitative design was used and a purposive sample was taken (n = 14). A biographical questionnaire was administered and semi-structured interviews were conducted to gather data from artisans.
Main findings : Remuneration had the highest rank of all the factors for the retention of artisans, closely followed by development opportunities. Other factors that were perceived as important for artisan retention included equality, recognition, management and the working environment, and working relationships.
Practical implications : Organisations that employ artisans should especially attend to their remuneration and development opportunities.
Contribution : The results of this study add to the knowledge of why artisans remain with a specific organisation.
'%3e%3cpath fill='%23001489' d='M0 0v6h9V0z'/%3e%3cpath fill='%23e03c31' d='M0 0v3h9V0z'/%3e%3cg stroke='%23fff' stroke-width='2'%3e%3cpath id='d' d='m0 0 4.5 3L0 6m4.5-3H9'/%3e%3cuse xlink:href='%23b' stroke='%23ffb81c' clip-path='url(%23c)'/%3e%3c/g%3e%3cuse xlink:href='%23d' fill='none' stroke='%23007749' stroke-width='1.2'/%3e%3c/g%3e%3c/svg%3e)