Highlights of this issue

Xenotransplantation

Xenotransplantation, or the transfer of living tissues or organs between species, has become a possible solution to the ever-growing demand for transplant organs, but it raises many ethical, social and health issues. In 2000, Health Canada provided funding for a series of public consultations on the issue. For over a year, an advisory group travelled the country consulting with Canadians about their views. The result was a public report presented to the federal minister of health recommending that xenotransplantation clinical trials be banned, for now. In a commentary, James R. Wright Jr. examines the consultation process and challenges the validity of the recommendations. In a related commentary, Adrian Ivinson and Fritz Bach suggest that, although the consultation process was imperfect, it allowed valid public concerns to be raised about this controversial new technology.

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See pages 40 and 42

Infective endocarditis and perivalvular abscess

Perivalvular abscess is a serious complication of bacterial endocarditis, but little is known about the long-term outcome of patients in whom it develops. Kwan-Leung Chan reviewed the charts of 43 consecutive patients (32 men, 11 women) with infective endocarditis and perivalvular abscess admitted to a tertiary care centre who were followed up for at least 4 years. Thirty-one patients were treated surgically, and 12 medically. The 2 treatment groups were similar in terms of age, infective organisms and survival rates. Complications of perivalvular abscess, including pseudoaneurysms and fistulae, were common, occurring in all of the medically treated patients and in 10 of the 24 surgically treated patients who underwent transesophageal echocardiography. The authors conclude that perivalvular abscess is associated with significant long-term morbidity and mortality, despite early surgical intervention in many cases. In a related commentary Stephen Shafran contrasts the above findings with studies that suggest the outcome is likely improved by surgery. He suggests that transesophageal echocardiography may ultimately allow earlier diagnosis and treatment of such perivalvular abscesses.

See pages 19 and 38

Hip fracture care

Elderly people with hip fractures are at increased risk of death or impaired function and ambulation. In a randomized controlled trial Gary Naglie and colleagues studied elderly patients with a hip fracture to see whether those receiving specialized interdisciplinary geriatric care postoperatively (n = 141) had improved outcomes over those receiving usual care (n = 138). Follow-up at 3 and 6 months determined the number of patients who were living with no decline in ambulation or ability to transfer in and out of a chair or bed and no decline in residential status. At 6 months, 56 patients (39.7;) in the interdisciplinary care group and 47 (34.1%) in the usual care group were alive with no decline in ambulation, transfers or residential status. The primary outcome measure did not differ significantly between the 2 groups at 3 or 6 months, nor did the mean length of stay in an institution (including hospital, inpatient rehabilitation and nursing home). The authors conclude that postoperative inpatient interdisciplinary care does not appear to improve long-term outcomes for elderly patients with hip fractures.

See page 25

Factor V Leiden and pregnancy

Pregnant women who carry the factor V Leiden mutation are predisposed to serious venous thromboembolic events. In a review, Dena Bloomenthal and colleagues discuss the implications of factor V Leiden mutations in pregnancy, including recurrent venous thromboembolism, early onset gestational hypertension, severe placental abruption and fetal growth disturbances. They discuss approaches to the diagnosis and management of pregnant women with this genetic mutation, including the possible role of antithrombotic therapy.

See page 48

Scooter safety

Thousands of people, most of them under the age of 15, seek emergency care each year for scooter-related injuries, including fractures, dislocations, lacerations, contusions and sprains. In this issue's Public Health column Erica Weir discusses the challenge of encouraging the safe use of scooters while not discouraging kids from being physically active.