Prevalence, determinants, and clinical significance of hyperhomocyst(e)inaemia in renal-transplant recipients

Background: Previous studies have demonstrated that hyperhomocyst(e)inaemia is present in patients with impaired renal function and is correlated with cardiovascular disease. Because conflicting data are available on the prevalence, determinants, and clinical significance of hyperhomocyst(e)inaemia in renal-transplant recipients, we conducted the largest cross-sectional study on homocysteine determinants and clinical correlates in renal transplant recipients. Methods: Plasma homocyst(e)ine concentrations and factors known to influence homocysteine metabolism were analysed in 224 renal transplant recipients. Atherosclerotic complications were evaluated with respect to plasma homocysteine concentrations. Results: Mean plasma homocyst(e)ine was 21.3±9.7 &mgr;mol/l. After adjusting for age, gender, transplant duration and creatinine clearance, patients with and without cyclosporin A (CsA) had similar plasma homocyst(e)ine concentrations (16.9±5.9 &mgr;mol/l in CsA(+) patients vs 16.3±5.2 &mgr;mol/l in CsA(-) patients; P=0.3). We found a significant inverse relationship between plasma homocyst(e)ine and folate concentrations in both CsA(+) (r=-0.243; P<0.005) and CsA(-) (r=-0.396; P<0.05) patients. Patients with a past history of cardiovascular events had higher plasma homocyst(e)ine concentrations (25.2±11.7 mmol/l vs 20.5±8.8 mmol/l; P<0.005). Conclusion: Homocyst(e)inaemia is closely related to renal function and folate concentration in renal-transplant recipients. CsA does not seem to have direct effects on homocysteine metabolism. Hyperhomocyst(e)inaemia is associated with cardiovascular disease in renal-transplant recipients. Prospective placebo-controlled homocysteine-lowering therapy studies are required in this patient category.     

Traumatic rupture of the urinary tract in a patient presenting nephrogenic diabetes insipidus associated with hydronephrosis and chronic renal failure: case report and review of the literature.

We report the case of a 34-year-old Japanese man suffering from a nephrogenic diabetes insipidus (NDI) associated with bilateral hydronephrosis, hydroureters and enlarged trabeculated bladder without obstruction. He also presented with chronic renal failure which has rarely occurred in similar cases. The patient was admitted after a traumatic rupture of the left urinary tract which had never been described until now in NDI. He was treated successfully by transient peritoneal and vesical drainages. This paper focuses on the very rare complication of chronic renal failure secondary to hydronephrosis in cases of NDI. The literature of this association is reviewed.     

Kidney retransplantation: results and prognostic factors]

48 non primary renal transplants were performed in 40 recipients during the 1973-1990 period in our institution (40 second grafts, 6 third grafts and 1 four and fifth grafts). Despite poor HLA matching our second graft survival rates compare favorably with others (80% and 70%, 1 and 5 year graft survival rates). The type of immunosuppression (including ciclosporine A or not) and the duration of the first graft had an influence on the outcome of second grafts. Our experience with repeated retransplantation is limited, but graft survival appears to be poor: most of the grafts were rejected within 2 years (or less). However patient survival was not affected by overimmunosuppression following multiple grafts.     

Women's experiences of sexual functioning in the early weeks of breast cancer treatment

This study describes women's sexual functioning in the early weeks of breast cancer treatment and the possible sexual changes that women may experience compared with pre‐treatment functioning. Seventy‐five patients filled out a questionnaire on sexual functioning and participated in a semi‐structured interview on changes in sexual life and intimacy after treatment. Sixty‐two women were sexually active before treatment; three post‐treatment patterns of sexual behaviour were identified: 22.6% of these women were as active as before treatment, 35.5% stopped any sexual activity and 41.9% experienced quantitative and qualitative changes. Analyses showed that each pattern had specific characteristics regarding current sexual functioning, the kinds of changes reported (e.g. decreased frequency and increased tenderness) and the reasons for these changes (e.g. tiredness and sex not a priority). Even in the immediate post‐surgical period, women may react in very different ways to treatment in terms of sexual functioning. Most women experience changes, but cessation of sexual activity is not inevitable. Positive changes (growing tenderness and affection) also exist. These important interindividual differences require a person‐centred approach when the topic of sexuality is being addressed, and practitioners need to be sensitive to individual perceptions of change. Early detection of sexual changes may prevent the crystallisation of difficulties over time.     

Hemostatic disturbances induced by two hollow-fiber hemodialysis membranes.

The effects on hemostasis of two high-flux membranes in hollow-fiber configuration, polyamide (PAM) and polyacrylonitrile (AN69), were analyzed in a cross-over study involving ten chronic hemodialyzed patients. Blood samples were obtained at arterial and venous sites of the extracorporeal circuit before dialysis and at 15, 30 and 180 min. Primary hemostasis: PAM induced an early significant drop in platelet counts, but at 180 min there was no longer any difference between membranes. Beta-thromboglobulin release by PAM was significantly higher at all time points. Coagulation: thrombin-antithrombin III complexes (TAT) and fibrinopeptide A increased significantly, the highest values being found with AN69. With both membranes the arterio-venous differences in TAT levels were negative throughout the sessions. Fibrinolysis: no significant differences were observed. In conclusion, both membranes induced hemostatic changes. Although these two hollow-fiber dialyzers look relatively similar, the changes observed were different, polyamide acting mainly on primary hemostasis and polyacrylonitrile on coagulation.     

Plasma Exchange and Immunosuppression for Rapidly Progressive Glomerulonephritis: Prognosis and Complications

Rapidly progressive glomerulonephritis frequently leads to deathor dialysis. In 21 cases treated by plasma exchange and immunosuppressionwe observed seven deaths, with 12 others progressing to chronicrenal failure within 3 months. Patients who died were olderthan those who survived (57.5±17.7 vs 40.5±16.5years, mean ±SD, P=0.05), but had similar clinical symptoms(hypertension, haematuria, proteinuria, extrarenal signs) andbiochemical presentation (initial creatininaemia). They requiredthe same degree of haemodialysis, of plasma exchanges and ofbolus methylprednisolone. The causes of death were infection(three cases), cardiac arrhythmia (two cases) and gastrointestinalbleeding (two cases). Among the 14 remaining patients, onlytwo recovered normal renal function. Twelve had chronic renalfailure, six of them requiring chronic dialysis or transplantation.Severe renal failure at entry and anuria were more frequentlyobserved in patients whose renal function did not improve duringtreatment. Plasma exchange and steroid bolus infusions alsoseemed to have a beneficial effect on renal function.     

Renal retransplantation in Switzerland: poor HLA matching of first and subsequent allografts does not appear to affect overal graft survival

In Switzerland graft survival after primary renal transplantation can be considered as satisfactory, although our current policy does not favour HLA compatibility except for acute rejectors or sensitized patients. This low level of HLA matching could result in increased sensitization and affect subsequent graft survival. A total of 318 non-primary renal transplants were performed in 293 recipients during the period 1981–1990. Of these, 271 were second transplants, 40 were third transplants and seven were fourth or fifth transplants. Survival rates at 1, 2 and 5 years were 75%, 68% and 60% for second grafts, and 72%, 60% and 54% for third grafts, respectively. Results after multiple grafts were poor, but our experience was limited. The number of sensitized patients (peak PRA > 50%) awaiting retransplantation slightly increased (51 to 69), but decreased as a proportion (72% to 66%). Our policy of relying only marginally on HLA compatibility does not appear to have affected our results adversely.     

Invasive meningococcal and pneumococcal disease in Switzerland: cost-utility analysis of different vaccine strategies

We performed a cost-utility analysis for various vaccination strategies against meningococcal and pneumococcal diseases (MenC or MenC/PCV-9) in Switzerland. The analysis compared the current recommendations of vaccinating only children with medical risks to the introduction of the vaccination with either the MenC or the MenC/PCV-9 vaccine, administered at 12 or 2, 4 and 6 months of age, into the existing immunisation programme. For a birth cohort of 80,000 children and assuming a vaccine coverage of 80%, the introduction of a generalised vaccination would be cost-effective. The strategy using three doses of MenC/PCV-9 would achieve the highest health benefit, with 440 quality-adjusted life years (QALYs) gained at costs of 34,000 per QALY.     

Sleep telemetry in the rat: I. a miniaturized FM--AM transmitter for EEG and EMG.

The article describes a miniature 2-channel FM-AM transmitter for recording EEG and EMG in unrestrained, small animals. Field changes during head movements yield a signal which can serve as a measure of motor activity.