Underground railroads: citizen entitlements and unauthorized mobility in the antebellum period and today

In recent years, some scholars and prominent political figures have advocated the deepening of North American integration on roughly the European Union model, including the creation of new political institutions and the free movement of workers across borders. The construction of such a North American Union, if it included even a very thin trans-state citizenship regime, could represent the most significant expansion of individual entitlements in the region since citizenship was extended to former slaves in the United States. With such a possibility as its starting point, this article explores some striking parallels between the mass, legally prohibited movement across boundaries by fugitive slaves in the pre-Civil War period, and that by current unauthorized migrants to the United States. Both were, or are, met on their journeys by historically parallel groups of would-be helpers and hinderers. Their unauthorized movements in both periods serve as important signals of incomplete entitlements or institutional protections. Most crucially, moral arguments for extending fuller entitlements to both groups are shown here to be less distinct than may be prima facie evident, reinforcing the case for expanding and deepening the regional membership regime

Renal association clinical practice guideline in post-operative care in the kidney transplant recipient

These guidelines cover the care of patients from the period following kidney transplantation until the transplant is no longer working or the patient dies. During the early phase prevention of acute rejection and infection are the priority. After around 3-6 months, the priorities change to preservation of transplant function and avoiding the long-term complications of immunosuppressive medication (the medication used to suppress the immune system to prevent rejection). The topics discussed include organization of outpatient follow up, immunosuppressive medication, treatment of acute and chronic rejection, and prevention of complications. The potential complications discussed include heart disease, infection, cancer, bone disease and blood disorders. There is also a section on contraception and reproductive issues.Immediately after the introduction there is a statement of all the recommendations. These recommendations are written in a language that we think should be understandable by many patients, relatives, carers and other interested people. Consequently we have not reworded or restated them in this lay summary. They are graded 1 or 2 depending on the strength of the recommendation by the authors, and AD depending on the quality of the evidence that the recommendation is based on

Immunoglobulin A (IgA) associated glomerulonephritis

Immunoglobulin A (IgA) associated glomerulonephritis. Adequate tissue from 153 glomerulonephritic patients was examined by direct immunofluorescence for glomerular-bound immunoglobulins, β1C, and fibrinogen. Ninety-six specimens contained immunoglobulins; 15 (16%) that contained significant amounts of IgA were from patients without systemic lupus erythematosus or other identifiable systemic disease. IgA, usually visualized in association with other immunoglobulins, was the most plentiful; in three biopsies it was the only immunoglobulin. IgA deposition was primarily mesangial, and to a lesser degree along peripheral glomerular capillary loops; electron-dense deposits and cellular proliferation also were principally mesangial in location. All patients had persistent microhematuria, while seven had at least one episode of gross hematuria; renal failure occurred in two patients and nephrotic syndrome in one of them. No clinical event was related to the onset of renal disease in these patients. Although three had low circulating levels of β1C, and three sera were positive for rheumatoid factor, none had cryoglobulins, antinuclear antibodies or abnormal immunoglobulin concentrations. Sera tested by hemagglutination for antiIgA antibodies and biopsies tested for antiIgG antibodies were negative. Eluates from three needle biopsies failed to bind to normal human kidney sections in vitro; an eluate from a nephrectomy organ contained IgA which fixed weakly to non-basement membrane intraglomerular components.Glomérulonéphrite associée à l'immunoglobuline A (IgA). Du tissu rénal de 153 malades atteints de glomérulonéphrite a été examiné en immunofluorescence pour détecter les immunoglobulines le β1C et le fibrinogène déposés sur le glomérule. Quatre vingt seize échantillons contenaient des immunoglobulines; 15 (16%) qui contenaient des quantités importantes d'IgA provenaient de malades atteints de lupus érythémateux disséminé ou d'autres maladies de système identifiables. L'IgA, habituellement associée à d'autres immunoglobulines, était la plus abondante. Dans trois biopsies elle était la seule immunoglobuline. Les dépôts d'IgA étaient principalement mésangiaux et, à un moindre degré, le long des anses capillaires périphériques. Des dépôts denses en microscopie électronique et une prolifération cellulaire étaient aussi principalement mésangiaux. Tous les malades avaient une hématurie microscopique persistante, sept d'entre eux eurent au moins une hématurie macroscopique; deux malades eurent une insuffisanse rénale et un malade un syndrome néphrotique. Aucun évènement clinique n'était contemporain de l'installation de la néphropathie chez ces malades. Quoique trois d'entre eux avaient des concentrations basses de β1C et que trois sérum étaient positifs pour le facteur rhumatoïde, aucun n'avait de cryoglobulins, d'anticorps antinucléaires ou de concentrations anormales d'immunoglobuline. Les sérums testés par hémaglutination pour les anticorps anti IgA et les biopsies testées pour les anticorps anti IgG étaient négatifs. Les éluats de trois biopsies à l'aiguille ne se sont pas déposés sur des coupes de rein humain normal in vitro. Un éluat de rein néphrectomisé contenait de l'IgA qui s'est fixé faiblement sur des constituants glomérulaires différents de la membrane basale

The effect of chronic hypotonic volume expansion on the renal regulation of acid-base equilibrium

Balance studies have been carried out to evaluate the influence of vasopressin-induced volume expansion on acid-base equilibrium in normal dogs and in dogs with steady-state metabolic acidosis induced by the administration of 5-7 mmoles/kg per day of hydrochloric acid. Hypotonic expansion in dogs with metabolic acidosis (mean plasma bicarbonate concentration 14 mEq/liter) produced a marked increase in renal acid excretion that restored plasma bicarbonate concentration to normal (20-21 mEq/liter) despite continued ingestion of acid. When water was restricted during the vasopressin period, and fluid retention thus prevented, no increase in acid excretion or plasma bicarbonate concentration occurred. From these findings we conclude that hypotonic expansion is a potent stimulus to renal hydrogen ion secretion and greatly facilitates the renal removal of an acid load. Normal dogs subjected to expansion demonstrated no change in net acid excretion or in plasma bicarbonate concentration even in the face of a marked diuresis of sodium and chloride and a reduction in plasma sodium concentration to approximately 110 mEq/liter. The animals did, however, regularly lose potassium, a finding that clearly indicates an acceleration of distal sodiumcation exchange. On the basis of these observations, and the findings in the expanded acidotic dogs, we suggest that in the expanded normal dogs acceleration of sodium-hydrogen exchange was responsible for preventing a bicarbonate diuresis and for stabilizing plasma bicarbonate concentration. These studies clearly demonstrate that chronic hypotonic expansion exerts a major influence on the renal regulation of acid-base equilibrium. The exact nature of the mechanism responsible for the increase in sodium-hydrogen exchange during hypotonic expansion remains to be determined

Valacyclovir for the prevention of cytomegalovirus disease after renal transplantation

Background Cytomegalovirus (CMV) disease is a major complication of organ transplantation. We hypothesized that prophylactic treatment with valacyclovir would reduce the risk of CMV disease. Methods A total of 208 CMV-negative recipients of a kidney from a seropositive donor and 408 CMV-positive recipients were randomly assigned to receive either 2 g of valacyclovir or placebo orally four times daily for 90 days after transplantation, with the dose adjusted according to renal function. The primary end point was laboratory-confirmed CMV disease in the first six months after transplantation. Results Treatment with valacyclovir reduced the incidence or delayed the onset of CMV disease in both the seronegative patients (P<0.001) and the seropositive patients (P=0.03). Among the seronegative patients, the incidence of CMV disease 90 days after transplantation was 45 percent among placebo recipients and 3 percent among valacyclovir recipients. Among the seropositive patients, the respective values were 6 percent and 0 percent. At six months, the incidence of CMV disease was 45 percent among seronegative recipients of placebo and 16 percent among seronegative recipients of valacyclovir; it was 6 percent among seropositive placebo recipients and 1 percent among seropositive valacyclovir recipients. At six months, the rate of biopsy-confirmed acute graft rejection in the seronegative group was 52 percent among placebo recipients and 26 percent among valacyclovir recipients (P=0.001). Treatment with valacyclovir also decreased the rates of CMV viremia and viruria, herpes simplex virus disease, and the use of inpatient medical resources. Hallucinations and confusion were more common with valacyclovir treatment, but these events were not severe or treatment limiting. The rates of other adverse events were similar among the groups. Conclusions Prophylactic treatment with valacyclovir is a safe and effective way to prevent CMV disease after renal transplantation. (N Engl J Med 1999; 340:1462-70.) (C) 1999, Massachusetts Medical Society