We assessed the quality of life of 859 patients undergoing dialysis or transplantation, with the goal of ascertaining whether objective and subjective measures of the quality of life were influenced by case mix or treatment. We found that 79.1 per cent of the transplant recipients were able to function at nearly normal levels, as compared with between 47.5 and 59.1 per cent of the patients treated with dialysis (depending on the type). Nearly 75 per cent of the transplant recipients were able to work, as compared with between 24.7 and 59.3 per cent of the patients undergoing dialysis. On three subjective measures (life satisfaction, well-being, and psychological affect) transplant recipients had a higher quality of life than patients on dialysis. Among the patients treated with dialysis, those undergoing treatment at home had the highest quality of life. All quality-of-life differences were found to persist even after the patient case mix had been controlled statistically. Finally, the quality of life of transplant recipients compared well with that of the general population, but despite favorable subjective assessments, patients undergoing dialysis did not work or function at the same level as people in the general population.

Patient attributes associated with increased risk for mortality vary widely among dialysis facilities. Adjustment for these differences did not, however, substantially change either the degree of variation in mortality risks or the relative ranking of a facility's mortality.

Plasma sampies from 14 insulin treated diabetic subjects were subjected to Sephadex gel filtration before and after acid-alcohol extraction. The findings were consistent with the presence of insulin antibodies, which on dissociation, released !arge amounts of immunoreactive material, eluting in positions consistent with proinsulin-like material (PLM) as weil as insulin. Because the percentages of PLM were high (compatible with values seen in patients with islet cell tumors), the sources of this material were investigated. Using a specific human C-peptide assay, it was shown in 6 patients that up to 30% of the PLM was of a human pro insulin, demonstrating residual B-cell function in certain insulin treated diabetics. Since 70% of the PLM bound to antibody was exogenous, studies of the behavior of injected labelled proinsulin were made. The half-time disappearance of labelled proinsulin bound to antibody in 2 subjects was shown to be 31 hours compared with only 1.9 hours for insulin bound to antibody. It is concluded that endogenous and exogenous pro insulin, proinsulin-binding antibody and markedly prolonged turnover time for pro insulin bound to antibody account for the elevations of PLM seen in insulin treated diabetics.

ifitiyzal. Ibln an thyroid & liwr dysflrctim; tTe of Pr 50% & cB::rffi9Erl thyroid h:::r:mre J.eo.eJs i.n:Iicate an imrfrliate clisfa\.a:able 0Jtr0re. ICF-I J.eo.eJs irI::ra>93::I after a:r. 'Il:ffitnmt with m fI'Ood

The fetus of sheep a species that evolved in lowlands, responds to hypoxemia (H) by maintaining cardiac output and umbilical-blood flow, increasing heart, brain and adrenal blood flow and decreasingittoother organs. The response to H of the fetus of the llama, thas has evolved in high altitudes, is not fully understood. We postulate that the systemic responses to H in the fetal llama are less marked and that the main adaptation occurs at the cellular and tissue levels. Our aim was to compare cardiac output and its distribution at 0 min (B) and after 20 min of fetal H (22-27% Sathb and 3-6 m102/dl in descending aorta) in-8 fetal sheep and 8 fetal llamas at 0.8 gestation. The results (x + SEM) were: