Bilateral accessory renal arteries with retroaortic left renal vein: report of an elderly cadaver case.
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Abnormalities, Multiple↗
Biomedical subjects
T Colak
Publications and source records attributed to T Colak.
Lamivudine therapy in kidney allograft recipients who are seropositive for hepatitis B surface antigen.
BACKGROUND: There are numerous recent reports on the use of lamivudine for hepatitis B virus (HBV) infection after renal transplantation. However, the optimal strategy (prophylactic, preemptive, or salvage approach) for starting lamivudine treatment in this patient group has not been determined. The aim of this study was to assess how the timing of lamivudine therapy affected the HBV serological status and the transaminase levels in renal allograft recipients with chronic HBV infection. METHODS: We investigated outcomes for patients who were seropositive for hepatitis B surface antigen (HBsAg) and underwent transplantation before or after October 2004 (the date our institution implemented a prophylactic lamivudine treatment strategy against HBV). The data included serum liver enzyme levels and polymerase chain reaction (PCR) screening results for HBV-DNA in serum. RESULTS: Fifteen patients (11 before October 2004, four after October 2004) were included in the study. Preoperatively all patients had normal transaminases levels and 2 of 15 patients had detectable HBV-DNA on PCR. Eight of the 15 total HBsAg-positive patients in our series were not placed on lamivudine at the time of renal transplantation. Half of those who were not treated initially showed transaminase elevations in the first year of follow-up requiring lamivudine therapy at that time. In contrast, all seven individuals who received lamivudine at the time of transplantation were negative for HBV-DNA throughout the follow-up. CONCLUSION: To prevent viral replication in HBsAg-positive patients who are scheduled for renal transplantation, it is best to initiate lamivudine therapy before or immediately after transplantation.
Antiviral Agents↗
Effects of immunosuppressive drugs on serum lipid levels in renal transplant recipients.
BACKGROUND: Hyperlipidemia is an important metabolic disorder that is common among renal transplant recipients. This study investigated the possible effects of transplantation and immunosuppressive drugs on lipid profiles in this patient group. METHODS: We retrospectively evaluated the records of 179 patients who underwent renal transplantation between 1996 and 2000, recording lipid profile findings-total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), and triglyceride (TG)-before and at least 6 months after transplantation. We also recorded patient demographics, underlying renal disorder, and immunosuppressive drug regimens. RESULTS: Sixty-nine (38.5%) patients were women and 110 men (61.5%). The mean age (+/- SD) of the 179 recipients was 35.7 +/- 11.8 years (range, 11 to 62 years). The respective pre- versus posttransplantation lipid profile findings were: TC, 171.6 +/- 42.4 mg/dL versus 204.7 +/- 45.3 mg/dL, P < .001; LDLc, 114.5 +/- 34.5 mg/dL versus 142.2 +/- 39.7 mg/dL, P < .001; HDLc, 46.7 +/- 13.6 mg/dL versus 42.5 +/- 12.3 mg/dL, P = .001; TG, 142.9 +/- 55.7 mg/dL versus 178.8 +/- 71.8 mg/dL, P < .001. Increased lipid levels were found to be independent of patient age, sex, donor type, and immunosuppressive drug regimen. CONCLUSION: The results suggested that antihyperlipidemic drugs should be administered routinely to renal transplant recipients irrespective of the immunosuppressive drug regimen or graft source.
Adolescent↗
Pulmonary function in renal transplant recipients and end-stage renal disease patients undergoing maintenance dialysis.
The aim of this study was to reveal the pulmonary function status of renal transplant recipients and chronic renal failure patients on hemodialysis or continuous ambulatory peritoneal dialysis. The study involved 73 subjects, including 49 patients who were either on peritoneal dialysis (n = 22) or hemodialysis (n = 27), and 24 renal transplant recipients. The spirometry results revealed significantly higher residual volume and total lung capacity in the hemodialysis and peritoneal dialysis groups than in the transplantation group. Forced expiratory flow between 25% and 75% of vital capacity was slightly below normal in the dialysis patients. Preservation of diffusion capacity of the lung for carbon monoxide was noted in the hemodialysis group (112.4%). Inspiratory and expiratory muscle strength was reduced in all groups. Only type of dialysis was correlated with this reduction. Inspiratory muscle strength in the peritoneal dialysis group (49.9%) was significantly lower than in the transplantation and hemodialysis groups (54.7% and 66.5%, respectively). The spirometry findings suggest that small-airway disease causes increased residual volume and total lung capacity (hyperinflation) in hemodialysis and peritoneal dialysis patients and that this airway obstruction subsides after renal transplantation. Preserved diffusion capacity in the hemodialysis group was attributed to the use of biocompatible dialyzer membranes. Renal failure complications may be the main explanation for global respiratory muscle weakness in dialysis patients, whereas corticosteroid therapy might be the primary cause in kidney graft recipients. Significantly lower inspiratory muscle strength in the peritoneal dialysis group suggests that presence of intra-abdominal dialysate might interfere with diaphragmatic contraction.
Adrenal Cortex Hormones↗
Subjective global assessment is a useful method to detect malnutrition in renal transplant patients.
Adequate nutrition is essential for the well-being of renal transplant patients. While body weight gain is a common widely investigated finding, a considerable fraction of patients exhibit poor nutritional status after successful kidney transplantation. In the present study, the prevalence association with nutritional parameters and clinical data of malnutrition among kidney transplant patients were determined based upon a subjective global assessment. This cross-sectional study in the transplant outpatient clinic included 47 patients (10 women, 37 men) of mean age 37.6 +/- 10.2 years. The same dietitian performed the assessment on all patients, including anthropometric measurements of body mass index (BMI), mid-arm circumference, and triceps skinfold thickness. The patient data including medications, number of hospitalizations in the preceding year, and presence of chronic allograft failure were collected from medical records. The mean laboratory values during the last 6 months included hemoglobin, creatinine, albumin, phosphorus, C-reactive protein levels, and lipid profile. The patients were classified into 3 groups defined as A (n = 31, 66%), B (n = 11, 23.4%), and C (n = 5, 10.6%), namely, A, no malnutrition versus B/C, moderate or severe malnutrition. Comparison of the 2 groups revealed the serum albumin (P < .0001), body mass index (P = .02), and mid-arm circumference (P = .02) to be higher in group A than groups B/C. Group B/C patients showed higher levels of C-reactive protein (P < .0001). When compared to the pretransplantation period, the 31 patients in group A included 26 who had increased body mass index after transplantation versus only 3 of 16 patients in groups B/C had (P < .0001). The hospitalization rates were significantly lower in group A (P = .02). Additionally, the patients in group A tended to have a lower frequency of chronic allograft rejection when compared to group B/C subjects (P = .13). In conclusion, assessment of nutritional status of renal transplant patients combined with intervention in the nutritional intake may decrease the morbidity rates in this patient group.
Adult↗
De novo glomerulonephritis in renal allografts with hepatitis C virus infection.
The purpose of this study was to examine the influence of hepatitis C virus (HCV) infection on the occurrence of posttransplant de novo glomerulonephritis (GN). Of 165 patients selected for the study, 44 were HCV positive and 121 HCV negative. Light and immunofluorescence microscopy were performed on all biopsies and clinical and laboratory findings reviewed. Fifteen (34%) of the 44 HCV positive patients showed de novo GN (4 membranous, 11 membranoproliferative) at a mean of 47 +/- 22 months. But only 8 (6.6%) of 121 HCV negative patients showed de novo GN (5 anti-glomerular basement membrane nephritis in recipients with Alport's disease, 2 membranous GN, 1 membranoproliferative GN) at a mean of 60 +/- 39 months. The risk of development of de novo GN was higher among patients with HCV infection (P < .001). The presence of de novo GN in HCV positive patients impaired graft survival compared with HCV positive patients without de novo GN (P < .01). The incidence of recurrence of primary disease, mainly focal segmental glomerulosclerosis, membranous glomerulonephritis, membranoproliferative glomerulonephritis, and IgA nephropathy, was higher in HCV negative patients (29%) compared with HCV positive patients (6.8%; P = .001), namely, 50%, 57.6%, 25%, and 69%, respectively. In conclusion, HCV infection showed a strong influence on the development of de novo GN. For this reason, it is important to follow HCV positive recipients with a renal biopsy even when there are no significant clinical or laboratory findings.
Adult↗
Indicators of acute rejection on Tc-99m DTPA renal scintigraphy.
INTRODUCTION: Specific criteria for diagnosing an acute rejection episode (ARE) are not present on renal scintigraphy. However, a deterioration in renal function observed on serial imaging is suggestive of an ARE during the early posttransplantation period. In this study, we evaluated Tc-99m DTPA renal scintigraphy findings among patients with renal allograft dysfunction. The aim was to define criteria for ARE on a single imaging study alone. MATERIALS AND METHODS: This study included 82 patients with renal allograft dysfunction, each of whom had a specific biopsy-proven pathology. From the background-corrected Tc-99m DTPA renal time-activity curves, the following parameters were computed: the ratio of counts at peak perfusion to that at plateau (P:PL) and the ratio of counts at peak perfusion to that at peak uptake (P:U). The images were inspected visually for excretion patterns and other morphological changes. RESULTS: A specific renogram pattern, that is an increase in perfusion to uptake ratio together with a nearly flat uptake curve and preserved peak/plateau pattern, was observed in 67% of low-grade AREs. In contrast, a flat uptake curve usually occurred together with a loss of peak/plateau pattern in a high-grade ARE. The findings that were highly specific for ARE on visual inspection were little or no collecting system activity, pelvic hypoactivity, and indistinctness of the corticomedullary junction. CONCLUSIONS: Our results indicate that in low-grade ARE, there is decreased filtration relative to perfusion as evidenced by a decrease in the perfusion-to-uptake ratio with loss of a peak/plateau pattern. A hypoactive pelvis with little activity in the collecting systems may be due to edema in the renal interstitium and pelvicalyceal structures.
Acute Disease↗
Comparison of Tc-99m DTPA and Tc-99m MAG3 perfusion time-activity curves in patients with renal allograft dysfunction.
AIM: The perfusion time-activity curve on DTPA renal scintigraphy shows a peak and plateau pattern which is usually absent or less marked when using tubular agents such as MAG3. The exact mechanism that results in this difference between the two tracers is not well understood. A descending pattern on MAG3 has been proposed to be due to decreased extraction. In this study we compared the diagnostic utility of perfusion patterns obtained with DTPA and MAG3 among patients with renal allograft dysfunction. MATERIALS AND METHODS: This study included 48 patients with renal allograft dysfunction and 18 recipients with normal graft function. Every recipient had renal scintigraphy with Tc-99m MAG3 and Tc-99m DTPA 1 day apart. The second phase of the perfusion curve after the initial rise was classified as ascending, flat, or descending. In patients with a descending curve on DTPA study, we calculated the ratio of counts at peak perfusion to that at plateau (P:PL). Impaired perfusion was based on a deterioration of the peak-to-plateau pattern on DTPA and the presence of a flat-descending curve on MAG3. RESULTS: In patients with dysfunction, impaired perfusion was observed in 77% of DTPA and in 54% of MAG3 studies. A flat-descending curve on MAG3 was present in 44% of patients with normal graft function. By MAG3, 67% of acute rejection and 28% of chronic allograft nephropathy (CAN) cases showed deteriorated perfusion. The corresponding values for DTPA were 67% and 94%, respectively. A flat-ascending pattern on DTPA was more frequent in CAN than it was in acute rejection (33% and 17%, respectively). CONCLUSION: The sensitivity of DTPA perfusion pattern for diagnosing dysfunction was significantly greater than that for MAG3. Our results suggest that the major determinant of a curve pattern on DTPA or MAG3 study is the extraction relative to perfusion. Thus for patients with CAN, extraction is higher relative to perfusion, resulting in a lower P:PL ratio or an ascending curve on DTPA. Although the extraction of DTPA is less than that of MAG3, this level of extraction renders DTPA more sensitive to serial changes in renal function and pathophysiological mechanisms related to kidney function.
Acute Disease↗
Recurrent glomerular diseases after renal transplantation.
INTRODUCTION: Recurrent glomerular diseases are important causes of graft dysfunction after renal transplantation. As the outcomes of transplantation continue to improve, the problem of recurrent diseases in the transplanted kidney have become evident. The purpose of our study was to determine the risk factors for and the incidence of recurrence in the posttransplant period as well as their impact on graft survival rates. METHOD: We retrospectively analyzed 49 patients with glomerular diseases due to membranoproliferative glomerulonephritis (n = 26); focal segmental glomerulosclerosis (FSGS, n = 18); and systemic lupus erythematosus (n = 5). The mean follow-up was 9.5 years. RESULTS: Recurrent disease was detected in 30 of 49 patients after a mean posttransplant follow-up of 28.1 months (range = 1 to 157) and their average graft survival was 41.3 months. Nineteen patients were recurrence-free with a mean graft survival of 79.4 (range = 15 to 158) months (P < .05). One patient with FSGS, showed disease-recurrence in her third transplant after having experienced recurrences in the former grafts. In all six patients with HLA haplotype B8, recurrence was observed at a mean of 19.5 +/- 9.8 months. The only risk factor that was identified was this HLA haplotype. CONCLUSION: Recurrent disease a significant problem after renal transplantation is associated with decreased graft survival. The donor HLA type may be associated with risk, which should be clearly discussed with both the living donor and the recipient candidate.
Drug Therapy, Combination↗
Nerve conduction study of ulnar nerve in volleyball players.
Ulnar neuropathy at the elbow is a common disorder seen in the throwing athlete. The purpose of our study was to determine whether asymptomatic physically active volleyball players and non-actives demonstrate distinct differences in nerve conduction of the ulnar nerve at the elbow. Nerve conduction studies were performed on both arms of 24 male volleyball players and 24 male non-actives. Nerve conduction velocity at the above to below elbow segment of the ulnar motor nerve were slower in the volleyball players compared with controls and their non-dominant arms. There were no statistical differences in latencies and conduction velocity of the ulnar nerve on the forearm, both in volleyball players and in the controls. In the evoked responses of the ulnar nerve, the amplitude was the same as corresponding normal values in both sensory nerve and muscle action potentials. We conclude that abnormal ulnar (motor) nerve conduction at the elbow segment may suggest a subclinical entrapment neuropathy as a result of strenuous elbow movements in volleyball players.
Action Potentials↗
Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease.
BACKGROUND: The purpose of the study was to compare the outcome of excision and primary closure with that of rhomboid excision and the Limberg flap procedure in patients with primary sacrococcygeal pilonidal disease (SPD). METHODS: Two hundred consecutive patients with SPD were randomly allocated to undergo either excision and primary closure (group 1, n = 100) or rhomboid excision and the Limberg flap procedure (group 2, n = 100). Duration of operation, postoperative pain, time to first mobilization, length of hospital stay, postoperative complications, time to resumption of work, recurrence and time to recurrence were recorded for all patients. RESULTS: : Duration of operation was longer in group 2 than in group 1 (P = 0.001). However, postoperative pain was less (P < 0.001), mobilization earlier (P < 0.001), duration of hospital stay shorter (P < 0.001), time to resumption of work shorter (P < 0.001) and postoperative complications fewer (P < 0.001) in group 2. During a median follow-up of 28 months, no recurrence was detected in patients in group 2 versus 11 patients in group 1 (P = 0.001). CONCLUSION: Because of its low complication rate and acceptable long-term results, rhomboid excision and the Limberg flap procedure is preferable to simple excision and primary closure in the treatment of SPD.
Adolescent↗
The effect of anesthetic technique on early postoperative renal function after donor nephrectomy: a preliminary report.
General and regional anesthesia may both be used successfully in donor nephrectomy although the use of regional anesthesia is rare. We compared the remaining kidney function during general (n = 10) versus combined spinal-epidural (n = 10) anesthesia for donor surgery. Blood biochemistry data were collected preoperatively and postoperatively, while renal function was assessed by scintigraphy and urine levels of microalbumin, creatinine, Na, K, Ca and creatinine clearance rate were measured/calculated in 24-hour urine samples collected preoperatively and on postoperative day 2. There were no differences preoperatively and on postoperative day 2 with respect to glomerular filtration rate, microalbuminuria, or creatinine clearance rate (P > .05 for all). There were also no differences between the groups with respect to other scintigraphic findings preoperatively and on postoperative day 2 (P > .05 for all). The results suggest that general or combined spinal-epidural anesthesia for donor nephrectomy have similar effects on the remaining donor kidney function.
Anesthesia, Epidural↗
Effect of amyloidosis on long-term survival in kidney transplantation.
Amyloidosis is characterized by the accumulation of an amorphous material in various organs and tissues secondary to a variety of inflammatory, immune, infectious, and hereditary diseases. Since 1975, our transplantation team has performed 1470 renal transplantations. Between 1985 and July 2004, among 1159 kidney transplantations, 953 (82.3%) were from living donors and 206 (17.7%) from cadaveric donors. There were 32 recipients (28 men, 4 women; mean age, 31.4 +/- 1.7 years; range, 21 to 48 years) with amyloidosis, including, 28 (87.5%) who received grafts from living donors and 4 (12.5%) from cadaveric donors. Amyloidosis was secondary to familial Mediterranean fever in 22 (68.7%) patients and rheumatoid arthritis in 1 (3.1%). The remaining 9 (28.1%) patients had primary amyloidosis. The mean follow-up time was 51.2 +/- 5.7 months (range, 2-124 months). Mean HLA mismatch rate was 2.2 +/- 1. Twenty-six (81.2%) patients are alive at this time with functioning grafts, and a mean serum creatinine value of 2.1 +/- 1.5 ng/dL. The 1- and 5-year patient and graft survival rates were 90.6% and 84.3%, and 81.2% and 68.7%, respectively. We conclude that patients with amyloidosis may undergo kidney transplantation safely expecting outcomes similar to those patients who receive transplantations for other reasons.
Adult↗
Switchability of neoral and equoral according to Food and Drug Administration rules and regulations.
According to the US Food and Drug Administration (FDA), if a drug product contains a drug substance that is chemically identical and is delivered to the site of action at the same rate and extent as another drug product, then it is equivalent and can be substituted (switchable) for that drug product. Methods used to define bioequivalence as stated by the FDA rules (FDA 21 CFR 320, 24) are (1) pharmacokinetic (PK) studies in healthy volunteers, (2) comparative clinical trials, and (3) pharmacodynamic (PD) studies (bioactivity). We evaluated the switchability of Equoral (IVAX-USA) with Neoral (Novartis Switzerland using all FDA rules. In a single oral dose, we undertook a comparative bioavailability study of Equoral (IVAX, USA) Neoral (Novartis, USA), and Neoral (Novartis UK). The pharmacokinetics of Equoral and Neoral were determined with blood levels at 0, 0.25, 0.5, 0.75, 1, 1.25, 1.5, 1.75, 2, 2.5, 3, 3.5, 4, 5, 6, 8, 10, 12, 16, 24, 30, 36, 42, and 48 hours. The area under curve (AUC), AUC extrapolated to infinity (AUC0-inf), rate of absorption (Tmax), extent of absorption (Cmax), half time (t1/2) of Equoral and Neoral were all within the 90% confidence interval of 80% to 125% boundaries. A comparative multinational multicenter clinical trial in stable renal transplant patients included 70 patients (22 women and 48 men) of mean age of 33 years (range, 26 to 43) was performed in Turkey, Lebanon, and Pakistan. In this study the ratios of LSM and the 90% confidence intervals for the Nontransformed/Parameters (AUC0-t, AUCinf, Tmax, and Cmax) of Equoral and Neoral SGC were 98% and 95%, respectively, which are within the 80% to 125% FDA acceptance range. For immunosuppressive drugs, the site of action is the lymphocyte and the measurable response is the decrease in lymphocyte count caused by the relative concentration of the drug in the lymphocyte. In a controlled switch, fixed-dose study, both Equoral and Neoral achieved the same concentration in the lymphocytes and caused the same degree of lymphocyte count reduction. The results of the testing (bioavailability-bioequivalence, clinical studies, and pharmacodynamic-bioactivity) required by FDA for interchangeability ("switchability") of immunosuppressive agents suggests that Neoral and Equoral are switchable.
Adult↗
The significance of Tc-99m DTPA renal scintigraphy for the demonstration of progressive functional changes that accompany chronic allograft nephropathy.
OBJECTIVES: Chronic allograft nephropathy (CAN) is usually progressive; its natural course can only be modified in the initial stages. In this study, we graded Tc-99m diethylenetriaminepentaacetic acid (DTPA) renogram curves with respect to the perfusion/uptake pattern and correlated these findings with biopsy results in patients with CAN. METHODS: This study included 63 renal allograft recipients with biopsy-proven CAN. The agent used for renal scintigraphy was Tc-99m DTPA. Quantitative evaluation of perfusion included calculation of the ratio of peak perfusion counts divided by plateau counts (P:PL). Deterioration of renal function was accompanied with a gradual loss of a peak and plateau pattern. For the evaluation of uptake in relation to perfusion pattern, we graded the renogram curves into four based on the presence of a peak and plateau pattern and the presence of an uptake peak. RESULTS: In patients with CAN, the mean P:PL was significantly lower than that of the control group. The serial changes in successive grades of CAN in respect to uptake-perfusion pattern was a gradual loss of peak and plateau pattern followed by a decline in uptake. In recipients with high-grade CAN, an uptake peak was absent. CONCLUSIONS: Evaluation of Tc-99m DTPA time-activity curves revealed a progressive change in perfusion-uptake pattern in patients with CAN. According to our results, deterioration of perfusion preceded the decline in uptake. Serial renogram changes are thought to reflect initial hypoperfusion followed by increased intraglomerular pressure and finally glomerulosclerosis. These findings have implications for the pathophysiology and management of CAN.
Biopsy↗
Relationship between leptin and bone mineral density in renal transplant recipients.
INTRODUCTION: Leptin plays an important role in regulating appetite and energy expenditure and also functions in the neuroendocrine, hematopoietic, and immune systems, among others. Leptin may be involved in modulating bone mineralization. The relationship between leptin and bone mineral density (BMD) is not clear. This study examined the relationship between BMD and serum leptin levels in renal transplant recipients. MATERIALS AND METHODS: Forty-one patients (28 men and 13 women; age 16 to 55 years) were grouped according to percentile of serum leptin level hypoleptinemic (<5th percentile, n = 14), normoleptinemic (between the 5th and 95th percentiles, n = 19), or hyperleptinemic (>95th percentile, n = 8). The patients also were grouped according to lumbar z score) and total femur z scores (>-2 vs <-2 for both). RESULTS: The groups with different leptin statuses were compared with respect to age, sex distribution, and body mass index. Mean lumbar z score and mean lumbar BMD were higher in the hyperleptinemic group than in the normo- and hypoleptinemic groups (P < .05 for all). Considering the 42 patients overall, those with lumbar z scores >-2 had higher mean serum leptin/BMI than those with lumbar z scores <-2 (0.55 +/- 0.65 vs 0.18 +/- 0.23, respectively, P < .05). Serum leptin/BMI ratio was correlated with lumbar z score (r = .38, P < .05) and lumbar BMD (r = .32, P < .05). CONCLUSION: In conclusion, the data indicate that elevated leptin level is associated with increased bone mass at lumbar sites in renal transplant recipients. This suggest that increased leptin has a bone-sparing effect, especially in the lumbar region, in this patient group.
Adolescent↗
Role of donor age and acute rejection episodes on long-term graft survival in cadaveric kidney transplantations.
Cadaveric donors can provide an effective solution to the problem of organ shortage, and many factors that may affect the functioning and survival of cadaveric kidneys have been studied. We aimed to clarify the impact of donor age and acute rejection episodes on long-term graft and patient survival in patients receiving cadaveric renal transplants. We retrospectively evaluated the long-term outcomes of 207 patients who had received cadaveric renal transplants between 1985 and 2004. Mean recipient age, HLA mismatch, mean donor age, delayed graft function (DGF), mean cold ischemia time, acute rejection episodes in the first 6 months after transplantation, and 1-, 3-, and 5-year graft survivals were evaluated. Two study groups were created according to donor age: group 1 (n = 126) was composed of patients receiving kidneys from donors younger than 50 years, and group 2 (n = 81) was composed of patients receiving kidneys from donors 50 years of age or older. Mean recipient age, HLA mismatch, and mean cold ischemia time between groups were not different. The DGF rate in group 1 was 40% (n = 50) and in group 2 was 46% (n = 37) (P > .05). The 1-, 3-, and 5-year survival rates of patients without acute rejection within the first 6 months after transplantation in group 1 (58/126; 46%) versus those in group 2 (46/81; 57%) were 95% versus 90%, 65% versus 60%, and 40% versus 35%, respectively (P > .05). The 1-, 3-, and 5-year graft survival rates of patients with acute rejection within the first 6 months in group 1 (n = 68) versus those in group 2 (n = 35) were 93% versus 89%, 71% versus 55%, and 44% versus 28%, respectively (P = .005). There was no significant difference in 1-, 3-, and 5-year survival rates between patients with DGF in both groups. Acute rejection episodes within the first 6 months after cadaveric transplantation, especially in patients receiving kidneys from donors older than 50 years, were shown to affect 5-year survival of the kidney graft. However, cadaver age alone had no negative effect on 5-year graft survival rates. Cadaveric donors older than 50 years may be a solution to the organ shortage in the treatment of end-stage renal disease.
Age Factors↗
Comparison of nerve conduction velocities of lower extremities between runners and controls.
Peripheral nerve injuries can occur in runners, but large numbers of nerve injuries remain subclinical. Identification of nerve injuries needs an understanding of common sites of entrapment in running. Fourteen asymptomatic male middle-distance runners and 14 non-active subjects participated in this study. The neurophysiologic study consisted of motor and sensory nerve conduction of medial and lateral plantar nerves, sensory nerve conduction of sural and superficial peroneal nerves, and motor nerve conduction of common peroneal nerve. Active range of motion and muscle strength assessment (dorsi flexion/plantar flexion; inversion/eversion) as measured using a Biodex System3 Dynamometer were observed to be within normal limits for both groups. The medial plantar (sensory) nerve and sural nerve distal latencies were significantly prolonged and sensory conduction velocities were significantly delayed in the runners compared with the control subjects. Many of the asymptomatic runners with abnormal nerve conduction tests in this study may represent presymptomatic or asymptomatic neuropathy similar to the type of subclinical entrapment neuropathy.
Adult↗