The Mount Sinai journal of medicine, New York
-
Review
Laboratory aspects of tick-borne diseases: lyme, human granulocytic ehrlichiosis and babesiosis.
Lyme disease, human granulocytic ehrlichiosis (HGE) and babesiosis are emerging infections in the northeastern and midwestern United States, where Ixodes scapularis ticks are prevalent. Lyme disease and babesiosis have also been reported on the West Coast, but less frequently. Lyme disease presents frequently with a skin lesion known as erythema migrans (EM), and diagnostic tests are not necessary if the lesion is classical. ⋯ Culture appears to have the greatest sensitivity of the three tests. Babesiosis can be diagnosed by peripheral blood examination for the intraerythrocytic parasites, PCR or serology. Co-infections with these agents exist, but they should be documented by detection of the organisms rather than by serology, since seroprevalence rates are high in endemic areas.
-
Over the last decade, there have been extraordinary developments in the field of transplantation science. As a result, organ transplantation enjoys a success that is unparalleled since its introduction nearly 50 years ago. Progress in the laboratory has translated into less toxic, more effective immunosuppressive therapies that have improved both allograft survival and patient quality of life. ⋯ While the transplantation of non-vital organs is technically feasible, as demonstrated by the recent success of a human laryngeal transplant, a variety of ethical concerns must be confronted before tracheal and laryngeal transplantation can be offered to patients as a reconstructive option. When considering the risks and benefits of non-vital organ transplantation, one must consider the immeasurable impact of a procedure on the patient s quality of life. The focus of this article is on quality of life and the role of laryngotracheal transplantation in contemporary medicine.
-
The hand is a very special organ, with unique functions and versatility in the human body. Our hands are pivotal in manipulating our environment, receiving feedback from our surroundings and communicating our unspoken words by gestures. Thus, the loss of a hand is a tragic, disfiguring event with profound personal, vocational, financial and social implications. ⋯ The scientific background, and the potential risks, benefits, and ethical aspects of this procedure are discussed. Successful transplantation to amputees of fully integrated and functional hands is a worthy goal. Hopefully, at some point in the future, hand transplantation will become another safe and viable option for amputees to consider.
-
Until recently, only life and death situations warranted organ transplantation. Nonvital transplantation, to further a patient s wishes and goals, was not considered justified. It can be argued, however, that this distinction is not morally significant. ⋯ Furthermore, it should be possible to remove the transplanted uterus from the recipient after successful pregnancies, so the patient would not be subjected to lifelong antirejection medications. Since animal uterus transplantation has been done successfully, human uterus transplantation might be considered for select cases. One such case has been reported.
-
Selected orthopedic surgical procedures, such as total joint arthroplasty and spinal instrumentation, have some of the highest perioperative transfusion rates of all surgical procedures. Blood transfusions carry the risk of complications, including the transmission of disease, immunomodulation, and hemolytic and non-hemolytic reactions. Strategies that reduce or remove the risk of allogeneic transfusion include preoperative autologous donation, acute normovolemic hemodilution, perioperative cell salvage techniques, deliberate hypotension, and pharmacologic interventions. This paper will review the current status of these therapies in the orthopedic surgical patient.