View Entire Collection
By Clinical Topic
Diabetes – Summer 2012
Future of Nursing Initiative
Heart Failure - Fall 2011
Influenza - Winter 2011
Nursing Ethics - Fall 2011
Trauma - Fall 2010
Traumatic Brain Injury - Fall 2010
Fluids & Electrolytes
The regimen of antirejection drugs taken by heart transplant patients hasn't changed much in 25 years. The standard immunosuppressants are calcineurin inhibitors-drugs such as cyclosporine and tacrolimus. But because calcineurin inhibitors cause kidney dysfunction, 10% of patients need hemodialysis or a kidney transplant within 5 to 10 years of heart transplant, researchers said. And 50% of patients develop coronary artery disease (CAD) within 10 years of transplant, leading to a second heart transplant or death.
Researchers at the Mayo Clinic studied 78 heart transplant patients over 4 years. The patients spent 6 months on calcineurin inhibitors, then were gradually transitioned to sirolimus, an immunosuppressant with no calcineurin inhibition activity. This strategy helped improve kidney function and reduce the development of CAD without raising the heart rejection rate or affecting heart function.
The findings were reported at the recent meeting of the International Society for Heart & Lung Transplantation in San Francisco, Calif.
Although often considered a last resort, decompressive craniectomy may help children with traumatic brain injury, according to results of a study reported at the recent American Association of Neurological Surgeons' meeting in Washington, D.C. Removing a section of bone from the skull lets the brain expand, reducing intracranial pressure (ICP) and improving cerebral perfusion.
Researchers looked at records of 23 pediatric patients treated with decompressive craniectomy between January 1995 and April 2006. Postoperative control of ICP was achieved in 19 patients. The mean patient age at the time of craniectomy was about 12 years. Seven patients died during or after surgery. Thirteen of the surviving patients recovered well enough to resume school. Of the seven surviving patients who are now over age 18, three are living independently and four are or have been employed.
Overall, researchers found that 65% of patients receiving craniectomy had favorable outcomes (defined as good recovery or moderate disability) and 9% had severe disability on long-term follow-up. Researcher Jay Jagannathan, MD, of the University of Virginia Health Sciences Center, said that craniectomy can help control ICP in children with traumatic brain injury and may help them achieve a reasonable quality of life.
Sign up for our free enewsletters to stay up-to-date in your area of practice - or take a look at an archive of prior issues
Join our CESaver program to earn up to 100 contact hours for only $34.95
Explore a world of online resources
Back to Top