Retransplantation in patients with graft loss caused by polyoma virus nephropathy

The characteristics and outcome in 10 patients who underwent retransplantation after losing their renal grafts to BK virus-associated nephropathy (BKAN) are described. The patients underwent retransplantation at a mean of 13.3 months after failure of the first graft. Nephroureterectomy of the first graft was performed in seven patients. Maintenance immunosuppression regimens after the first and second grafts were similar, consisting of a combination of a calcineurin inhibitor, mycophenolate mofetil, and prednisone. BKAN recurred in one patient 8 months after retransplantation, but stabilization of graft function was achieved with a decrease in immunosuppression and treatment with low-dose cidofovir. After a mean follow-up of 34.6 months, all patients were found to have good graft function with a mean creatinine of 1.5 mg/dL. From this collective experience from five transplant centers (although the follow-up after retransplantation was not extensive), it can be concluded that patients with graft loss caused by BKAN can safely undergo retransplantation. The risk of recurrence does not seem to be increased in comparison with the first graft.     

Multiple complex coronary plaques in a patient with acute myocardial infarction

 This report describes the case of a patient who developed acute myocardial infarction with ST segment elevation in anterior and inferior leads, simultaneously. After treatment with systemic thrombolysis, and after an initial short-lasting symptomatic improvement, chest pain and ST segment elevation recurred. Coronary angiography revealed severe complex stenotic lesions at both the right coronary artery and the left anterior descending (LAD) coronary artery. Percutaneous coronary angioplasty and stent implantation were successfully performed at both lesions. This case supports the concept that, at least in some patients, acute coronary artery disease reflects a diffuse pathophysiologic process that may lead to multifocal plaque instability associated with clinical instability at multiple sites. Received: November 12, 2001 / Accepted: February 16, 2002     

Behavioral symptoms in preschool children at the time of school entrance from the perspective of parents--data regarding prevalence and risk factors in an epidemiological study

Behavioral and emotional problems based on parents information from the Child Behavior Checklist (CBCL) were investigated in a large epidemiological sample of 4363 six year old pre-school children from the area of Heidelberg and Rhein-Neckar county. An overview about symptom frequencies of boys and girls is given, taking age specific evaluations into account. Considering symptoms and syndromes, externalizing and attention problems show high prevalence, especially for boys. Family problems are the most important predictors of child global symptomatology, explaining about 10% of variance of the CBCL total score. Other factors like gender, chronical illness, adverse living conditions, family constellation or amount of TV consumption prove as additional independent predictors. An overall model explains about 20% of variance of child symptomatology. Results are discussed from the view of normal child development, developmental psychopathology, changing norms and altered socio-cultural conditions.     

Changes in test norms of spelling achievement and nonverbal intelligence

The norms of the spelling test R-T Form C "Moselfahrt" (Althoff et al. 1974) from the year 1968 and of the nonverbal intelligence test CFT 20 (form A/part 1) from the year 1977 (Weiss 1987) are evaluated for their actual validity. In 1995, both original tests were being administered to an epidemiological sample (N = 592) of adolescents and young adults in the age of 16 to 30 years having passed at least their obligatory amount of school years. These results are being compared to those of the original norm samples. Using the norms for the CFT 20 from 1977 adolescents and young adults achieve in the year 1995 a mean IQ of 110.8 points, equaling a yearly IQ-gain of 0.6 IQ-points. This exceeds the expected gain of 0.33 IQ-points annually according to the literature and indicates a distinct change of norms. There were no significant gender differences found. The distribution of mistakes in the spelling test R-T "Moselfahrt" compared to the original norm sample from 1968 changes considerably as well and requires revised test norms. With an increase from 9-11 mistakes (depending on the age norm) to 19.8 mistakes the mean amount of mistakes is almost being doubled. Extremely high numbers of mistakes occurred more frequent and could not be differentiated according to the old norms. Using the original norms from 1968 in the year of 1995 12.4% of the sample achieve with a T-score of 20 the lower limit of the measured value scale and the overall mean has decreased by 1.2 standard deviations to T-score = 38.48% of the sample reach a result that equates percentage 10 or less which is interpreted as insufficient school mark. Women's mean spelling achievement is significantly better than men's. Causes and implications of this scissors-like development of deteriorated spelling achievement and increased nonverbal intelligence are being discussed. Tables containing the new standardization scores are included in the appendix.