Relative clinical value of coronary computed tomography and stress echocardiography-guided management of stable chest pain patients: a propensity-matched analysis

AIMS

The European Society of Cardiology recommends coronary computed tomography (CCT) for the assessment of low-risk patients with suspected stable angina. We aimed to assess in a real-life setting the relative clinical value of stress echocardiography (SE)- and CCT-guided management in this population.

METHODS AND RESULTS

Patients with stable chest pain and no prior history of coronary artery disease (CAD) who underwent CCT or SE as the initial investigative strategy were propensity-matched (990 patients each group-age: 59 ± 13.2 years, males: 47.9%) to account for baseline differences in cardiovascular risk factors. Inconclusive tests were 6% vs. 3% (P < 0.005) in CCT vs. SE. Severe (≥70% stenosis) on CCT and inducible ischaemia on SE detected obstructive CAD by invasive coronary angiography in 63% vs. 57% patients (P = 0.33). Over the follow-up period (median 717, interquartile range 93-1069 days) more patients underwent invasive coronary angiography (21.5% vs. 7.3%, P < 0.005), revascularization (7.3% vs. 3.5%, P < 0.005), further functional testing 33.4% vs. 8.7% (P < 0.005), but more patients were prescribed statins 8.8% vs. 3.8% (P < 0.005) in the CCT vs. the SE arm, respectively. Combined all-cause mortality and acute myocardial infarction was low-CCT-2.3% and SE-3.3%-with no significant difference (P = 0.16).

CONCLUSION

Initial SE-guided management was similar for the detection of obstructive CAD, demonstrated better resource utilization, but was associated with reduced prescription of statins although with no difference in medium-term outcome compared to CCT in this very low-risk population. However, a randomized study with longer follow-up is needed to confirm the clinical value of our findings.

Coronary computed tomography versus stress echocardiography-guided management of stable chest pain patients: a propensity matched analysis

Background

Recent recommendations by national and international societies advocate the use of coronary computed tomography (CCT) as the first-line test for the assessment of low-risk patients with suspected stable angina. However limited real-life data exist regarding its relative clinical value versus stress echocardiography (SE)-guided management.

Purpose

We aimed to assess in a real-life setting the clinical value of stress echocardiography (SE)-guided versus CCT-guided management in patients presenting with stable chest pain and no prior history of coronary artery disease (CAD).

Methods

We compared the relative feasibility, efficacy and the proportion of patients undergoing downstream testing including revascularisation and their impact on outcome (mortality and myocardial infarction) when CCT versus SE were used as the first line test for the assessment of stable chest pain.

Of the patients who underwent CCT (N=2192) or SE (N=2081) between October 2013 and October 2014 only those with suspected stable angina and without previous CAD were selected. The population was propensity-matched (total 1980 patients-990 patients each group) to account for differences in the baseline cardiovascular risk factors.

Results

The mean age of the population was 59±13.2 years and 949 (47.9%) patients were male. Inconclusive tests were 6% versus 3% (p&lt;0.005) in CCT versus SE. Severe (&gt;70%) luminal stenosis on CCT and inducible ischemia on SE detected obstructive CAD by invasive coronary angiography in 63% versus 57% patients (p=0.33). Over the entire follow-up period (median 717 (IQR 93–1069) days) significantly more patients underwent invasive coronary angiography (21.5% versus 7.3%, p&lt;0.005) and revascularisation (33.5% versus 3.5%, p&lt;0.005) respectively in the CCT versus the SE group. Following their initial assessment 336 (33.9%) patients in the CCT and 86 (8.7%) in the SE group underwent further functional testing (SE, stress cardiac MRI, exercise electrocardiography) (p&lt;0.005) (Figure 1A). There was no difference in all-cause mortality (p=0.26) or death and myocardial infarction (p=0.16) between the two groups (Figure 1B).

Conclusions

SE when used for the assessment of patients with stable angina and no prior CAD resulted in more conclusive tests, similar detection of obstructive CAD, less overall invasive coronary angiography and revascularization and less subsequent functional tests compared with CCT.

Figure 1

Funding Acknowledgement

Type of funding source: None

Pneumonitis secondary to alemtuzumab in a patient with multiple sclerosis - A non-infectious cause of breathlessness

The most common adverse events associated with the monoclonal antibody alemtuzumab are infusion associated reactions and secondary autoimmune disease. Respiratory complications are unusual following treatment with alemtuzumab, but can be precipitated by an infectious cause. We describe a case of a sub-acute steroid responsive non-infectious pneumonitis affecting a 51 year old woman, who presented one month after initiation of therapy for multiple sclerosis with alemtuzumab.

Mandibular lengthening in a juvenile camel by distraction osteogenesis

A three-year old bactrian camel was surgically treated by means of distraction osteogenesis for the correction of a severe mandibular brachygnathia. The mandible was osteotomized in two fragments at the diastema. An external fixator frame, composed of five 1/3rd rings connected by three connecting bars and two transporting rods, was used to achieve stability and optimize sequential fragment distraction during bone healing. After a period of four months, adequate healing had occurred and 35 mm of new bone had formed. Although a significant lengthening was accomplished, the final result was not optimal. We describe the technique used and discuss the suitability and limitations of this technique for its use in large animals.

Mandibular lengthening by means of distraction osteogenesis is described in a juvenile camel. Bone lengthening was accomplished over a period of time making this technique suitable for large animal species. However structural adjustments to the external lengthening device are necessary to obtain optimal results.

Does performance level affect initial ball flight kinematics in finger and wrist-spin cricket bowlers?

Spin bowling plays a fundamental role within the game of cricket yet little is known about the initial ball kinematics in elite and pathway spin bowlers or their relationship to performance. Therefore, the purpose of this study was to record three-dimensional ball kinematics in a large and truly high level cohort of elite and pathway finger-spin (FS) and wrist-spin (WS) bowlers, identifying potential performance measures that can be subsequently used in future research. A 22-camera Vicon motion analysis system captured retro-reflective markers placed on the seam (static) and ball (dynamic) to quantify ball kinematics in 36 FS (12 elite and 24 pathway) and 20 WS (eight elite and 12 pathway) bowlers. Results indicated that FS bowlers delivered the ball with an increased axis of rotation elevation, while wrist-spin bowlers placed greater amounts of revolutions on the ball. It also highlighted that ball release (BR) velocity, revolutions and velocity/revolution index scores for both groups and seam stability for FS bowlers, and seam azimuth angle and spin axis elevation angle for WS bowlers, were discriminators of playing level. As such these variables could be used as indicators of performance (i.e. performance measures) in future research.

Ball Speed and Release Consistency Predict Pitching Success in Major League Baseball

Whiteside, D, Martini, DN, Zernicke, RF, and Goulet, GC. Ball speed and release consistency predict pitching success in Major League Baseball. J Strength Cond Res XX(X): 000-000, 2015-This study aimed to quantify how ball flight kinematics (i.e., ball speed and movement), release location, and variations therein relate to pitching success in Major League Baseball (MLB). One hundred ninety starting MLB pitchers met the inclusion criteria for this study. Ball trajectory information was collected for 76,000 pitches and inserted into a forward stepwise multiple regression model, which examined how (a) pitch selection, (b) ball speed, (c) ball movement (horizontal and lateral), (d) release location (horizontal and lateral), (e) variation in pitch speed, (f) variation in ball movement, and (g) variation in release location related to pitching success (as measured by fielding independent pitching-FIP). Pitch speed, release location variability, variation in pitch speed, and horizontal release location were significant predictors of FIP and, collectively, accounted for 24% of the variance in FIP. These findings suggest that (a) maximizing ball speed, (b) refining a consistent spatial release location, and (c) using varied pitch speeds should be primary foci for the pitching coach. However, between-pitcher variations underline how training interventions should be administered at the individual level, with consideration given to the pitcher's injury history. Finally, despite offering significant predictors of success, these three factors explained only 22% of the variance in FIP and should not be considered the only, or preeminent, indicators of a pitcher's effectiveness. Evidently, traditional pitching metrics only partly account for a pitcher's effectiveness, and future research is necessary to uncover the remaining contributors to success.

Predictors of Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers

BACKGROUND

Ulnar collateral ligament (UCL) reconstruction surgeries in Major League Baseball (MLB) have increased significantly in recent decades. Although several risk factors have been proposed, a scientific consensus is yet to be reached, providing challenges to those tasked with preventing UCL injuries.

PURPOSE

To identify significant predictors of UCL reconstruction in MLB pitchers.

STUDY DESIGN

Case control study; Level of evidence, 3.

METHODS

Demographic and pitching performance data were sourced from public databases for 104 MLB pitchers who underwent UCL reconstruction surgery and 104 age- and position-matched controls. These variables were compared between groups and inserted into a binary logistic regression to identify significant predictors of UCL reconstruction. Two machine learning models (naïve Bayes and support vector machine) were also employed to predict UCL reconstruction in this cohort.

RESULTS

The binary linear regression model was statistically significant (χ(2)(12) = 33.592; P = .001), explained 19.9% of the variance in UCL reconstruction surgery, and correctly classified 66.8% of cases. According to this model, (1) fewer days between consecutive games, (2) a smaller repertoire of pitches, (3) a less pronounced horizontal release location, (4) a smaller stature, (5) greater mean pitch speed, and (6) greater mean pitch counts per game were all significant predictors of UCL reconstruction. More specifically, an increase in mean days between consecutive games (odds ratio [OR], 0.685; 95% CI, 0.542-0.865) or number of unique pitch types thrown (OR, 0.672; 95% CI, 0.492-0.917) was associated with a significantly smaller likelihood of UCL reconstruction. In contrast, an increase in mean pitch speed (OR, 1.381; 95% CI, 1.103-1.729) or mean pitches per game (OR, 1.020; 95% CI, 1.007-1.033) was associated with significantly higher odds of UCL reconstruction surgery. The naïve Bayes classifier predicted UCL reconstruction with an accuracy of 72% and the support vector machine classifier with an accuracy of 75%.

CONCLUSION

This study identified 6 key performance factors that may present significant risk factors for UCL reconstruction in MLB pitchers. These findings could help to enhance the prevention of UCL reconstruction surgery in MLB pitchers and shape the direction of future research in this domain.

Spatial characteristics of professional tennis serves with implications for serving aces: A machine learning approach

This study sought to determine the features of an ideal serve in men's professional tennis. A total of 25,680 first serves executed by 151 male tennis players during Australian Open competition were classified as either aces or returned into play. Spatiotemporal (impact location, speed, projection angles, landing location and relative player locations) and contextual (score) features of each serve were extracted from Hawk-Eye data and used to construct a classification tree model (with decision rules) that predicted serve outcome. k-means clustering was applied to the landing locations to quantify optimal landing locations for aces. The classification tree revealed that (1) serve directionality, relative to the returner; (2) the ball's landing proximity to the nearest service box line and (3) serve speed classified aces with an accuracy of 87.02%. Hitting aces appeared more contingent on accuracy than speed, with serves directed >5.88° from the returner and landing <15.27 cm from a service box line most indicative of an ace. k-means clustering revealed four distinct locations (≈0.73 m wide × 2.35 m deep) in the corners of the service box that corresponded to aces. These landing locations provide empirically derived target locations for players to adhere to during practice and competition.

Matchplay characteristics of Grand Slam tennis: implications for training and conditioning

The purpose of this study was to probe the sex-based differences in the stroke and movement dynamics of Grand Slam hard-court tennis. Player and ball tracking data were collated for 102 male and 95 female players during the 2012-2014 Australian Open tournaments. Serve, serve return, groundstroke and movement data were compared between sexes. Serve statistics were the subject of the largest differences, with males achieving significantly faster speeds, aces and unreturned serves while also winning a greater percentage of service points. When returning serve, women contacted the ball closer to the net, lower to the ground and achieved flatter ball trajectories than males. Groundstroke frequencies were similar between sexes, although males hit with greater speed, flatter trajectories and impacted more shots inside the baseline. Distance covered per set or during points won or lost was not sex dependent, yet men exhibited faster average movement speeds. These findings highlight the need for sex-specific training and practice designs that cater to the different stroke dynamics, particularly in relation to the first serve and serve-return, as well as movement speeds.

KNOWLEDGE OF PRESCRIBING IN PARKINSONISM AMONG JUNIOR DOCTORS

Junior doctors are primarily responsible for prescribing medications for patients with parkinsonism attending a district general hospital. We assessed levels of confidence and knowledge of appropriate prescribing in a variety of circumstances among 30 junior doctors at Ealing Hospital, using a 5 part questionnaire. Only 10% felt confident in prescribing a regimen for patients with parkinsonism who are unable to take their usual medications orally. 60% could not select a suitable anti-emetic, and just 2 respondents answered all assessment questions correctly. Confidence in prescribing improved with seniority but overall scores in the assessment section did not.

We have designed a protocol to assist doctors when managing patients with parkinsonism on the ward, and are conducting teaching sessions to improve understanding. The impact of these interventions will be assessed and presented at the Annual Meeting.

Femoroacetabular Impingement in Elite Ice Hockey Goaltenders: Etiological Implications of On-Ice Hip Mechanics

BACKGROUND

Femoroacetabular impingement (FAI) is particularly prevalent in ice hockey. The butterfly goalie technique is thought to involve extreme ranges of hip motion that may predispose goaltenders to FAI.

PURPOSE

To quantify hip mechanics during 3 common goaltender movements and interpret their relevance to the development of FAI.

STUDY DESIGN

Descriptive laboratory study.

METHODS

Fourteen collegiate and professional goaltenders performed skating, butterfly save, and recovery movements on the ice. Hip mechanics were compared across the 3 movements.

RESULTS

The butterfly did not exhibit the greatest range of hip motion in any of the 3 planes. Internal rotation was the only hip motion that appeared close to terminal in this study. When subjects decelerated during skating—shaving the blade of their skate across the surface of the ice—the magnitude of peak hip internal rotation was 54% greater than in the butterfly and 265% greater than in the recovery. No movement involved levels of concomitant flexion, adduction, and internal rotation that resembled the traditional impingement (FADIR) test.

CONCLUSION

The magnitude of internal rotation was the most extreme planar hip motion (relative to end-range) recorded in this study (namely during decelerating) and appeared to differentiate this cohort from other athletic populations. Consequently, repetitive end-range hip internal rotation may be the primary precursor to symptomatic FAI in hockey goaltenders and provides the most plausible account for the high incidence of FAI in these athletes. Resection techniques should, therefore, focus on enhancing internal rotation in goaltenders, compared with flexion and adduction. While the butterfly posture can require significant levels of hip motion, recovering from a save and, in particular, decelerating during skating are also demanding on goaltenders' hip joints. Therefore, it appears critical to consider and accommodate a variety of sport-specific hip postures to comprehensively diagnose, treat, and rehabilitate FAI.

Ball flight kinematics, release variability and in-season performance in elite baseball pitching

The purpose of this study was to quantify ball flight kinematics (ball speed, spin rate, spin axis orientation, seam orientation) and release location variability in the four most common pitch types in baseball and relate them to in-season pitching performance. Nine NCAA Division I pitchers threw four pitching variations (fastball, changeup, curveball, and slider) while a radar gun measured ball speed and a 600-Hz video camera recorded the ball trajectory. Marks on the ball were digitized to measure ball flight kinematics and release location. Ball speed was highest in the fastball, though spin rate was similar in the fastball and breaking pitches. Two distinct spin axis orientations were noted: one characterizing the fastball and changeup, and another, the curveball and slider. The horizontal release location was significantly more variable than the vertical release location. In-season pitching success was not correlated to any of the measured variables. These findings are instructive for inferring appropriate hand mechanics and spin types in each of the four pitches. Coaches should also be aware that ball flight kinematics might not directly relate to pitching success at the collegiate level. Therefore, talent identification and pitching evaluations should encompass other (e.g., cognitive, psychological, and physiological) factors.

On-Ice Functional Assessment of an Elite Ice Hockey Goaltender After Treatment for Femoroacetabular Impingement

BACKGROUND

Femoroacetabular impingement (FAI) is a major cause of performance inhibition in elite-level athletes. The condition is characterized by pain, osseous abnormalities such as an increased alpha angle, and decreased range of motion at the affected hip joint. Arthroscopic surgical decompression is useful in reshaping the joint to alleviate symptoms. Functional kinematic outcomes of sport-specific movements after surgery, however, are presently unknown.

HYPOTHESIS

The ability of an ice hockey goaltender to execute sport-specific movements would improve after arthroscopic surgery.

STUDY DESIGN

Clinical research.

LEVEL OF EVIDENCE

Level 5.

METHODS

An ice hockey goaltender was evaluated after arthroscopic correction of FAI on the symptomatic hip. Passive range of motion and radiographic parameters were assessed from a computed tomography-derived 3-dimensional model. An on-ice motion capture system was also used to determine peak femoral shock and concurrent hip joint postures during the butterfly and braking movements.

RESULTS

Maximum alpha angles were 47° in the surgical and 61° in the nonsurgical hip. Internal rotation range of motion was, on average, 23° greater in the surgically corrected hip compared with contralateral. Peak shock was lower in the surgical hip by 1.39 g and 0.86 g during butterfly and braking, respectively. At peak shock, the surgical hip demonstrated increased flexion, adduction, and internal rotation for both tasks (butterfly, 6.1°, 12.3°, and 30.8°; braking, 14.8°, 19.2°, and 41.4°).

CONCLUSION

On-ice motion capture revealed performance differences between hips after arthroscopic surgery in a hockey goaltender. Range of motion and the patient's subjective assessment of hip function were improved in the surgical hip. While presenting as asymptomatic, it was discovered that the contralateral hip displayed measurements consistent with FAI. Therefore, consideration of preemptive treatment in a presently painless hip may be deemed beneficial for young athletes seeking a long career in sport, and future work is needed to determine the costs and benefits of such an approach.

CLINICAL RELEVANCE

Surgical treatment of symptomatic FAI can achieve pain relief and improved kinematics of the hip joint with athletic activities. Additional studies are necessary to determine whether improved kinematics enhance the longevity of the native hip and alter the progression of osteoarthritic changes in those with asymptomatic FAI deformity.

A kinematic comparison of the overhand throw and tennis serve in tennis players: how similar are they really?

Tennis coaches often use the fundamental throwing skill as a training tool to develop the service action. However, recent skill acquisition literature questions the efficacy of non-specific training drills for developing complex sporting movements. Thus, this study examined the mechanical analogy of the throw and the tennis serve at three different levels of development. A 500 Hz, 22-camera VICON MX motion capture system recorded 28 elite female tennis players (prepubescent (n = 10), pubescent (n = 10), adult (n = 8)) as they performed flat serves and overhand throws. Two-way ANOVAs with repeated measures and partial correlations (controlling for group) assessed the strength and nature of the mechanical associations between the tasks. Preparatory mechanics were similar between the two tasks, while during propulsion, peak trunk twist and elbow extension velocities were significantly higher in the throw, yet the peak shoulder internal rotation and wrist flexion angular velocities were significantly greater in the serve. Furthermore, all of these peak angular velocities occurred significantly earlier in the serve. Ultimately, although the throw may help to prime transverse trunk kinematics in the serve, mechanics in the two skills appear less similar than many coaches seem to believe. Practitioners should, therefore, be aware that the throw appears less useful for priming the specific arm kinematics and temporal phasing that typifies the tennis serve.

Effect of a common task constraint on the body, racket, and ball kinematics of the elite junior tennis serve

The development of a powerful and accurate serve is a priority for most tennis players. Various drills are proposed to enhance characteristics of the serve such as ball speed and spin, yet research has failed to address their efficacy. The aim of this study was therefore to compare the kinematics of a flat serve with that of a service drill, where the player serves from the knees in an endeavour to promote specific changes in trunk, arm, racket, and ball motion. A 22-camera 250 Hz VICON MX motion analysis system captured the trunk, arm, racket, and ball kinematics of eight high-performance junior players hitting flat serves and knee serves. Paired t-tests assessed within-group kinematic differences between the two serve conditions. Changes in ball toss, trunk, arm, and racket kinematics were a manifestation of the constraints presented by the knee serve. These changes effected an increased angle of attack of the racket but without greater frontal plane trunk rotation, which represented primary objectives of the knee serve. In sum, partial support was offered to the use of the knee serve as an intervention that promotes immediate, specific changes in trunk and racket kinematics in the service actions of elite junior players.

Serving to different locations: set-up, toss, and racket kinematics of the professional tennis serve

The serve, as the most important stroke in tennis, has attracted considerable biomechanical interest. Of its component parts, the swing has received disproportionate research attention and consequently, little is known regarding toss kinematics. Indeed, the age-old question of whether players serve to different parts of the court from the same toss remains unanswered. Six right-handed professionally ranked players hit first serves (FSs) and second serves (SSs) to three 2 x 1 m target areas reflecting the landing locations of T, body and wide serves, respectively, on the deuce court. A 22 camera, 250 Hz VICON MX motion analysis system captured racket, ball, foot, and h and kinematics. Repeated measures ANOVAs assessed within-player differences in foot, racket, and ball kinematics within the FS and SS as a function of landing location. The positions of the front foot, ball zenith, and ball impact were significantly different in the FS, while kinematics across all SS were consistent. Front foot position was closer to the centre mark in the T FS and players impacted the ball further left in the wide FS compared to the T FS. This study discusses the findings in the context of the development of the serve as well as potential implications for the return.

Effect of skill decomposition on racket and ball kinematics of the elite junior tennis serve

Whole body kinematics of the tennis serve have been reported extensively in the literature, yet comparatively less information exists regarding the kinematic characteristics of the swing and toss. In attempting to develop consistency in placement of the toss and racket trajectory, coaches will often decompose the serve and practice it in separate parts. A 22-camera VICON MX motion analysis system, operating at 250 Hz, captured racket, ball and hand kinematics of the serves of five elite junior players under three conditions. The conditions were flat first serves (FS) directed to a 1 x 1 m target bordering the 'T' of the deuce service box, a ball toss (BT) in isolation and a free swing (SW) in isolation. Players were instructed to perform BT and SW as in the FS. Paired t-tests assessed within-group differences in hand, racket and ball kinematics between the discrete skill and the two decomposed conditions. Vertical displacement of the ball at its zenith increased significantly during BT compared with the FS and temporal associations between racket and ball motion during the FS (r = 0.861) were affected during task decomposition. This study questions the pervasive use of task decomposition in the development of the tennis serve.

Preliminary assessment of reproductive technologies in wood bison (Bison bison athabascae): Implications for preserving genetic diversity

Since the high prevalence of bovine tuberculosis and brucellosis in free-ranging wood bison in the Canadian north poses a threat to nearby healthy bison populations, commercial bison and cattle ranches, and potentially to humans, there is considerable impetus to salvage the genetics of infected bison and maintain a disease-free herd. In that regard, there is a great need to develop appropriate reproductive technologies. Therefore, the objective of this study was to develop protocols to produce and cryopreserve wood bison embryos (based on protocols used for cattle). Cumulus oocyte complexes (COC) aspirated from ovaries recovered after slaughter were matured in vitro, and fertilized with either frozen-thawed semen or chilled epididymal spermatozoa. Although both sources of spermatozoa resulted in acceptable rates of fertilization (64.4%, n=45; 89.2%, n=28, respectively) and cleavage (75.0%, n=40; 92.5%, n=40), production of morulae (7.5%, n=40; 25.0%, n=40) and blastocysts (7.5%, n=40; 10.0%, n=40) was low. Morulae- and blastocyst-stage embryos were frozen-stored by vitrification. To our knowledge, this is the first report regarding the in vitro production and cryopreservation of bison embryos for genetic recovery of diseased wood bison. These techniques have substantial potential for conserving and managing the genetic diversity of wild bison, and may also have important management implications for genetic salvage of diseased bison populations in North America.

Time course of amphetamine-induced locomotor stereotypy in an open field

Gamma (gamma) is a recently proposed statistic that quantifies and describes the repetitive patterns of locomotion (locomotor stereotypy) exhibited by amphetamine-treated rats in an open field. The time-course of locomotor stereotypy after 1, 2, 3, and 4 mg/kg amphetamine was investigated in this research. Locomotor stereotypy was often evident during the first observation period after amphetamine. Lower doses of amphetamine produced qualitatively different locomotor stereotypy than higher doses. Rats given higher doses of amphetamine exhibited locomotor stereotypy during the "hyperactivity" phase of the three-phase response produced by higher doses of amphetamine (hyperactivity; absence of locomotions, increased sniffing, biting etc.; hyperactivity). Contrary to expectations, rats injected with 2 mg/kg amphetamine exhibited the highest and most sustained increase in gamma. We conclude that locomotor stereotypy is an important component of the behavioral effects of amphetamine in rats. Whether locomotor stereotypy and focused stereotypy are similar phenomena is still unclear.

Ice storage versus perfusion for preservation of kidneys before transplantation

The results of simple ice storage and prolonged perfusion storage of kidneys were compared in two series, each of 100 cadaver kidney transplants. There was a similar warm ischaemia time for both groups, but the average total storage time was 17 hours for the perfused kidneys as compared to three and a half hours for those stored in ice. The results of transplantation (as shown by transplant function at three and 12 months) were the same for both groups. There was no evidence of damage due to prolonged perfusion. The extra time, however, enabled a more convenient operation time to be chosen and more extensive tissue matching to be undertaken.