Polymorphism in the P-glycoprotein drug transporter MDR1 gene in renal transplant patients treated with cyclosporin A in a Polish population

P-glycoprotein (P-gp), the product of MDR1 gene, is a protein which mediates transmembrane transport of a great number of xenobiotics including cyclosporin A used as an immunosuppressive drug in patients with allogenic kidney grafts. The P-gp activity and expression is dependent on the MDR1 gene polymorphism in position C3435T of exon 26. In this study, C3435T polymorphism was analyzed in 116 patients with allogenic kidney graft treated with cyclosporin Aand 144 randomly selected healthy individuals. The prevalence of MDR1 gene genotypes 3435CC, 3435CT, 3435TT were also compared in patients after allogenic kidney graft with both acute and chronic graft rejection (48 patients with acute and 76 with chronic graft rejection) and control groups (respectively 139 and 112). The results of the study demonstrated that the allelic frequency and MDR1 genotype distribution were similar in all evaluated groups. It was revealed that MDR1 gene polymorphism was not a predisposing factor for terminal kidney failure leading to renal transplantation. Moreover, evaluation of C3435T polymorphism of MDR1 gene will probably not be useful for characterization of groups of patients at increased risk of acute and chronic kidney graft rejection.     

The role of intramedullary nailing in polytraumatized patients]

The authors present the results and methods of long bone fracture treatment by means of intramedullary nailing in polytraumatized patients. The study involved 34 patients hospitalized at The Department of Orthopaedics and Traumatology of Pomeranian Medical University of Szczecin between 2001 and January 2003. The results were estimated both in early period and 12 months after surgery. One year treatment period gave us full recovery and mobility of operated limbs in 20 patients, in 9 there was inability to move resulting from coexisting brain injury, 3 of the whole group presented with bone infections and 5 died due to the extent of trauma.     

Spinal tumours: recommendations of the Polish Society of Spine Surgery,the Polish Society of Oncology,the Polish Society of Neurosurgeons,the Polish Society of Oncologic Surgery,the Polish Society of Oncologic Radiotherapy,and the Polish Society of Orthopaedics and Traumatology

Purpose

The purpose of these recommendations is to spread the available evidence for evaluating and managing spinal tumours among clinicians who encounter such entities.

Methods

The recommendations were developed by members of the Development Recommendations Group representing seven stakeholder scientific societies and organizations of specialists involved in various forms of care for patients with spinal tumours in Poland. The recommendations are based on data yielded from systematic reviews of the literature identified through electronic database searches. The strength of the recommendations was graded according to the North American Spine Society’s grades of recommendation for summaries or reviews of studies.

Results

The recommendation group developed 89 level A-C recommendations and a supplementary list of institutions able to manage primary malignant spinal tumours, namely, spinal sarcomas, at the expert level. This list, further called an appendix, helps clinicians who encounter spinal tumours refer patients with suspected spinal sarcoma or chordoma for pathological diagnosis, surgery and radiosurgery. The list constitutes a basis of the network of expertise for the management of primary malignant spinal tumours and should be understood as a communication network of specialists involved in the care of primary spinal malignancies.

Conclusion

The developed recommendations together with the national network of expertise should optimize the management of patients with spinal tumours, especially rare malignancies, and optimize their referral and allocation within the Polish national health service system.

     

The prevalence and character of neurologic deficit relating to clinical forms of cervical spondylosis]

The research was performed on 86 male patients between 41 and 83 years who were either hospitalised or treated in the out-patients clinic due to cervical spondylosis. The aim of the research was to evaluate the frequency and advance of neurologic, complications relating to the type and severity of lesions in cervical spine. The study showed significant relation between the degree of advance of cervical spondylosis and age, pain as well as prevalence and severity of neurologic deficit in the tested group. The authors have emphasized the need of precise evaluation and differentiation of presented forms of degenerative spine disease.     

Is retrieval of bone material from multiorgan donors effective enough to cover demand for biostatic bone tissue grafts in Poland?

In Poland there is growing demand for biostatic allogeneic bone transplantation mostly for traumatologic operations and orthopedic reconstructions. The bone material is primarily harvested during postmortem examinations in forensic and pathology laboratories. Nevertheless, the collected amounts are not sufficient, so that material needs to be acquired from alternative sources, such as multiorgan donors. Between 1998 and 2003, 2331 potential donors were registered by the Transplantation Coordinating Center in Warsaw, which was adjusted to 1794 donors who would have been accepted as donors of the bone tissue. Unfortunately, due to denials from family members and public prosecutors, the sample was only 1416 donors, which would cover about 40% of the clinical orthopedic demand in Poland.     

Imitation of metastatic lesions in patients with brown tumor]

The authors have presented two cases of hyperparathyroidism in male patients at the age of 52 and 77 years in whom radiological findings imitated osteolytic, metastatic bone lesions. It has been emphasised that the difficulties with proper diagnosis of brown tumor often occur and the final diagnosis is based on the exact pathology test. In patients with pathological fracture resection with margins and intramedullary fixation, as well as total hip replacement were performed. Postoperative observation revealed that the pain and radiological changes stopped after parathyroid gland resection as the main reason of the brown tumor. The authors have confirmed that open biopsy should be a routine procedure in patients with suspicion of brown tumor.     

The new bone formation and bone metabolism in Forestier disease

The study was performed on 36 male patients between 65 and 83 years who were either hospitalised or treated in the out-patients clinic due to Forestier's disease. The aim of the study was to evaluate the advance of ectopic bone formation process in cervical spine and bony metabolic changes in treated patients. The study showed reverse corelation between the degree of advance of cervical hyperostosis and the prevalence of osteoporosis and metabolic disorders in the tested group. The authors have emphasized the need of precise evaluation and differentiation of Forestier's disease and degenerative spine disease.     

Interleukin-6 gene polymorphism in renal transplant patients with and without gingival overgrowth

OBJECTIVE: To determine whether there is an association between genotypes of interleukin-6 (IL-6) and gingival overgrowth in kidney transplant patients. METHODS: Sixty-three unrelated kidney transplant patients suffering from gingival overgrowth as well 125 control transplant patients without overgrowth were enrolled into the study. Gingival overgrowth was assessed by two independent periodontal specialists at 6 months after transplantation. During the post-transplant period, all patients were given medication, which included cyclosporin A, diltiazem or verapamil, prednisone, and azathioprine. IL-6 polymorphism was determined using the polymerase chain reaction-restriction fragment length polymorphism assay. RESULTS: In kidney transplant patients suffering from gingival overgrowth mean score of gingival overgrowth was 1.41+/-0.64, whereas in control subjects it was 0.0. Patients with gingival overgrowth induced by immunosuppressive medication were characterized by genotypes similar to the controls distribution of IL-6. There were no significant differences of analyzed genotypes' distribution, i.e. -174G/G, -174G/C and -174C/C between patients with gingival overgrowth 33.3%, 39.7%, 27.0% and without gingival overgrowth 30.4%, 49.6% and 20.0%, respectively. The risk of gingival overgrowth was the highest among patients carrying -174C/C genotype (OR 1.48), but did not differ markedly from the other genotypes, i.e. -174G/G (OR 1.15) and -74G/C (OR 0.67). Similar to genotypes, the distribution of alleles was similar in patients with gingival overgrowth and healthy gingiva. The -174G allele was found in 53.2% and 46.8% of subjects whereas -174C allele was revealed in 46.8% and 44.8% of patients with and without gingival overgrowth, respectively. The evaluated risk of gingival overgrowth in patients with -174G allele was 1.09 versus those with healthy gingiva. The medication regimen administered in both groups of the study was comparable. CONCLUSION: No association between the IL-6 gene polymorphism and gingival overgrowth was revealed in kidney transplant patients administered cyclosporin A as a principal immunosuppressive agent.