Interaction between cyclosporine A and verapamil, felodipine, and isradipine.
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Adult↗
Biomedical subjects
A Yildiz
Publications and source records attributed to A Yildiz.
Tuberculosis after renal transplantation: experience of one Turkish centre.
BACKGROUND: In this study, renal transplant recipients with tuberculosis of different organs, were retrospectively analysed with respect to prevalence, outcome and drug toxicity. PATIENTS AND METHODS: In 520 patients, 22 (4.2%) tuberculosis of various organs was diagnosed. The time interval between transplantation and diagnosis of tuberculosis was 44.4 +/- 33.5 (range 3-111) months. In 18 (82%) of the patients, tuberculosis was detected after the first year of transplantation. The most common form was pleuro/pulmonary tuberculosis (54%), and other localizations included jejunum, liver, bone, and urogenital tract. RESULTS: Sixteen of the 22 patients responded favourably to the treatment and maintain excellent allograft function, whereas six patients (27.2%) died. Toxic hepatitis was seen in four (18%) patients, and one case was complicated with acute hepatocellular failure due to isoniazide (INH). However, of the 23 patients at risk of tuberculosis who had had INH prophylaxis for 1 year, neither tuberculosis, nor hepatotoxicity was observed. CONCLUSION: Tuberculosis is a common infection of renal transplant recipients in developing countries. The peak incidence is after the first year of transplantation and mortality is considerable. Hepatoxicity is a considerable risk of treatment, possibly as a result of additive toxic effects of immunosuppressive drugs.
Adult↗
Improvement of uremic autonomic dysfunction after renal transplantation: a heart rate variability study.
Autonomic dysfunction in hemodialysis patients is one of the components of uremic neuropathy. In this prospective study, we investigated the effect of renal transplantation on uremic autonomic dysfunction with long-term time-domain and frequency-domain heart rate variability. Fourteen hemodialysis patients (10 male, 4 female; mean age 33 +/- 11 (range 16-50) years) were examined before and at the early after transplantation period (mean 4.6 +/- 1.5 (range 3-7. 5) months). The mean time spent on hemodialysis was 16.7 +/- 15.6 (range 6-65) months. In time-domain analysis, significant increases in all parameters except pNN50 (SD, SDANN, SDNN, rMSSD) were observed after renal transplantation (p < 0.01). In frequency-domain analysis, low-frequency (LF) (0.04-0.15 Hz) and high-frequency (HF) (0.15-0.40 Hz) spectral power were found to be significantly increased after renal transplantation (4.54 +/- 1.04 vs. 12.58 +/- 8. 69 for LF (p = 0.005), 2.80 +/- 1.0 vs. 6.50 +/- 3.55 for HF (p = 0. 005)), but the LF/HF ratio was not different from a pretransplant period (1.71 +/- 0.349 vs. 1.85 +/- 0.49, p = 0.26). It was concluded that autonomic dysfunction in hemodialysis patients is reversible and renal transplantation reverses the sympathetic and parasympathetic autonomic dysfunction simultaneously and at a relatively early stage.
Adolescent↗
Tuberculin responsiveness in hemodialysis patients.
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Adult↗
Effect of acute exercise on skin potential in sedentaries and trained athletes.
Endosomatic electrodermal activity (skin potential level and skin potential response) as an indirect indicator of sympathetic nervous system activity was measured in 35 sedentary male students and 22 trained athletes of two groups during resting and after an acute exercise. The aim of this study was to investigate the difference of skin potential parameters between sedentaries and trained athletes before and after the acute exercise in bicycle ergometer. In sedentaries' group while skin potential level (SPL) and latency showed no significant variations, skin potential response (SPR) decreased significantly after the exercise (P < 0.001). In athletes' group SPL increased (P < 0.01) and SPR decreased (P < 0.05) after the exercise but latency had no significant difference. In addition, athletes had significantly higher SPL and lower SPR values before and after the exercise comparing with the sedentaries. The increase of SPL in athletes' group was thought to depend on sweat duct pores which have been more active and open than sedentaries. Also the decrease in SPR in athletes' group was thought to depend on the lower sweating threshold in athletes.
Adolescent↗
Fever in dialysis patients with recently rejected renal allografts.
INTRODUCTION: Fever of unknown origin is a complex problem in dialysis patients with recently rejected renal allografts, due to the contribution of the newly withheld immunosuppressive agents to the immunosuppression of uremia, resulting in an atypical presentation of infections, a main cause of fever in these cases. MATERIALS AND METHODS: Two dialysis patients with recently rejected renal allografts who were hospitalized because of fever of unknown origin are reported. Biochemical, bacteriological and imaging studies were performed for specific diagnosis. RESULTS: Extensive laboratory investigations failed to yield any diagnosis and allograft nephrectomy was performed in one patient, with a probable diagnosis of inflammation of the allograft, which resulted in no improvement. Eventually, both patients were found to have adrenal insufficiency responsible for the fever, which improved after steroid replacement. CONCLUSIONS: Adrenal insufficiency should be suspected in all dialysis patients presenting with fever and atypical symptoms, but only after other potential causes are eliminated; since steroid administration may normalize fever regardless of the etiology, it may mask the signs and symptoms and delay the treatment of other (if any) underlying disorder(s).
Adult↗
Transplantation in renal amyloidosis.
In this report, the results of renal transplantation in patients with renal amyloidosis were retrospectively analysed and compared with the control group. Fifteen (3.04%) of the 493 renal transplant recipients whom were followed up in Istanbul School of Medicine transplant outpatient clinic, between 1983 and 1997, were included in the study. The etiology of amyloidosis was familial Mediterranean fever in all patients. The mean follow-up period was 38.3 +/- 31.8 (range 7-65) months. Twelve of the patients were male and 3 female with the mean age 34.13 +/- 10.87 (range 21-60) years. Seven patients had living related, 4 living-unrelated and 4 cadaveric donors. Five patients were lost because of different complications: Three patients died from cardiac amyloidosis all with well functioning grafts, 2, 3 and 36 months after the operation. Sepsis and cardiovascular failure was the probable cause of death in 1 patient who also had chronic rejection. Another one patient with chronic rejection died from hepatic failure. Acute rejection developed in 2 patients. Renal functions of these patients improved by anti-rejection therapies. Chronic rejection developed in 3 patients. In the control group, acute rejection and chronic rejection were diagnosed in 5 and 1 patients, retrospectively. While 1 patients returned to hemodialysis in control group, the others are alive with satisfactory graft function. There was no death in control group. The 5-yr graft and patient survival rates in amyloidosis and the control groups were 75, 77, 95 and 100%, respectively. It was concluded that although transplantation is not a contraindication for the treatment of end stage renal failure in patients with renal amyloidosis, it carries high risk of cardiac complications in the postoperative period. Detailed preoperative cardiovascular evaluations are mandatory in these patients and this intervention should improve the prognosis by excluding the patients who have already been complicated with this problem.
Adult↗
Kaposi's sarcoma after renal transplantation in Turkey.
In this report, incidence and clinical characteristics of Kaposi's sarcoma (KS) were retrospectively analyzed among renal transplant recipients who were being followed-up in the outpatient clinic of the Istanbul School of Medicine. Between October 1983 and December 1997, 17 cases of KS were diagnosed among 557 patients (3%). Of the total 25 post-transplant malignancies, KS was the most common tumor, representing a rate of 68%. Diagnosis was suspected with typical skin lesions and was confirmed by biopsy. Gastroduodenal endoscopy was applied to 7 patients in order to assess gastrointestinal tract involvement. Of the total number of patients diagnosed with KS 14 were male and 3 female, with the mean age of 40 +/- 15 (range 13-68) yr. The mean duration between the date of transplantation and diagnosis of KS was 15.9 +/- 20.3 (range 1-65) months. The lesions were limited to the skin in 13 patients, while skin and gastrointestinal tract were involved in 2 patients and generalized disease was noted in 2 patients. The initial therapeutic approach was to withdraw cyclosporine and to reduce azathioprine. In the case of progression of the lesions azathioprine was also stopped. Besides, surgical excision of the lesions, radiotherapy and/or chemotherapy were performed according to the clinical picture. Remission was observed in 14 patients after this therapy protocol. The 2 patients with gastrointestinal involvement and 1 patient with generalized KS died in spite of the above-mentioned therapeutic interventions. One of the patients on remission died of pneumonia. It was concluded that KS carried a high risk of morbidity and mortality in renal transplant recipients, and tapering of immunosuppression, especially withdrawal of cyclosporine, affected the prognosis favorably.
Adolescent↗
Radionuclide hysterosalpingography with radiolabeled spermatozoa.
OBJECTIVE: To evaluate the efficiency of radionuclide hysterosalpingography (HSG) by using 99mTc hexamethyl propyleneamine oxime (HMPAO)-labeled human spermatozoa in the assessment of fallopian tube patency in infertile couples. DESIGN: Fifteen infertile female patients were inseminated with their husbands' radiolabeled spermatozoa immediately after cessation of menses. SETTING: University-based academic hospital. MAIN OUTCOME MEASURE(S): The time course of radioactivity and scintigraphic images of the uterus and the parauterine tissues implying tubal patency were evaluated and compared by using laparoscopy and HSG. RESULT(S): We demonstrated Tmax (time to peak radioactivity at periovarian sites) for right and left tubes to be 6.74 +/- 2.66 and 5.91 +/- 2.93 minutes (means +/- SD), respectively. We also found 72% sensitivity and 75% specificity of spermatozoa labeled radionuclide HSG compared with laparoscopic findings for tubal patency. CONCLUSION(S): Radionuclide HSG with the husband's spermatozoa seems to be a potentially useful method of assessing patency of the fallopian tubes. The safety dose of this procedure is comparable to conventional HSG. However, more comparative studies are needed to evaluate advantages and disadvantages of this technique.
Adult↗
Small diameter versus conventional laparoscopy: a prospective, self-controlled study.
The objective of this study was to determine visual quality, diagnostic accuracy, and surgical merits of small diameter laparoscopy (SDL). Thirty-seven patients were randomly selected. The indications for laparoscopy were infertility, desire for tubal sterilization or chronic pelvic pain. Patients underwent SDL, followed by conventional laparoscopy (CL) as a control under general anaesthesia. Findings at operation were compared. The mean time for diagnostic work-up was longer with SDL than CL, 11.7 +/- 5.6 versus 7.6 +/- 3.2 min respectively (P < 0.04). Visual quality was scored from 4 to 1 by the operator; mean visual quality, mean endometriosis score and mean adnexal adhesions score were slightly lower with SDL than CL. Sensitivity of SDL in diagnosing endometriosis, adhesions, ovarian, uterine and pouch of Douglas lesions were 71, 58, 81, 89 and 73% respectively; specificity was 100, 96, 100, 100, 100% in the same order. Suction irrigation, cyst aspiration, tissue biopsies, simple adhesiolysis, tubal ligation and cauterization were easily performed with SDL. We conclude that SDL seems a good alternative to CL in diagnosing macro-pelvic anatomy and coarse pelvic pathologies and may also be good in performing surgical procedures such as: tubal ligation, biopsies and differential diagnosis of pelvic fluids. But SDL must be used cautiously in micro-oriented, functional conditions such as infertility, pelvic pain, endometriosis and adhesion scoring or treatment. SDL may be regarded as a less invasive but less sensitive tool with limited surgical merits.
Adult↗
Heart rate variability in patients with secondary amyloidosis.
Heart rate variability (HRV) is increasingly being used to evaluate the function of the autonomic nervous system. Although autonomic dysfunction has been described in primary amyloidosis patients, this has not been established for patients with secondary amyloidosis. This study examines the autonomic function of 23 biopsy-proven secondary amyloidosis patients (10 male, 13 female) and compares it with 19 healthy (8 male, 11 female) sex- and age-matched controls (Group III), using frequency- and time-domain HRV analysis. The study group was further divided according to renal function; Group I (14 nonuremic patients with serum creatinine level < 1.4 mg/dl) and Group II (9 uremic patients with serum creatinine level > 1.4 mg/dl). In time domain analysis, standard deviation and mean of the standard deviation of all normal R to R intervals, and standard deviation of the average normal R to R interval were significantly lower in Groups I and II as compared to Group III. In frequency domain analysis, low frequency power (LF), representing sympathetic function, was significantly lower in Groups I and II as compared to Group III, but high frequency power (HF), representing parasympathetic function, and the LF/HF ratio, as an index of sympathovagal balance, were not different among the groups. In conclusion, in patients with secondary amyloidosis, sympathetic components of heart rate variables decreased before the onset of uremia and the change became more prominent with the appearance of uremia despite not reaching statistical significance.
Adult↗
Posttransplant malaria.
The frequency and clinical characteristics of plasmodium infection were reported in 420 renal transplant recipients who were followed in the Transplantation Unit and Out-Patient Clinic of the Medical School of Istanbul. Plasmodium infection was diagnosed in eleven (9 male, 2 female) of the 420 patients (2.6%). Ten of the patients were transplanted in India, and one in our institution. The mean duration between the transplantation and the diagnosis of malaria was 21.7 + 44.4 days in patients who were transplanted in India. All of the patients were taking triple immunosuppressive drugs (CsA, AZA, PRED). Plasmodium falciparum was diagnosed in 6 patients, P vivax in 1 patient and P malariae in 1 patient. Also mixed infection with P falciparum and P malariae was diagnosed in 3 patients. After definite diagnosis, the patients were hospitalized. Chloroquine phosphate plus primaquine phosphate was administered for P vivax infection, whereas chloroquine phosphate alone was given for P falciparum and P malariae infection as a first line antimalarial therapy. As a result of therapy, infection improved clinically and the plasmodia disappeared rapidly from the thick blood film in 10 of the patients. Severe hemolysis and acute renal failure developed in one patient, who improved after hemodialysis therapy and exchange transfusions. It was concluded that malaria is quite a frequent infection of transplant recipients who get their allografts from donors living in high-risk areas, and all transplant recipients having this kind of transplantations should be suspected and examined for malaria. This may help to diagnose and treat the complication in the early period, thus resulting in an improved prognosis for this potentially life-threatening complication of the posttransplant period.
Adult↗
Comparison of Tc-99m HIG and Ga-67 citrate in the evaluation of bacterial abscess in a rat model.
Tc-99m labeled polyclonal human immunoglobulin (HIG) has been shown to be able to localize an inflammatory site. There are several possible explanations for HIG accumulation at focal infection sites such as increased vascular permeability, binding of the Fc part of Ig to Fc receptors of leucocytes and binding directly to bacteria. In this study, we compared Tc-99m HIG and Ga-67 citrate scintigraphy in localizing acute bacterial abscesses induced by E. coli and S. aureus. Serial scintigrams were performed at 1, 4, 24 hr after injection. Tc-99m HIG showed greater accumulation at all times with both infections agents than Ga-67 citrate (p < 0.05). While Tc-99m HIG showed greater accumulation in S. aureus than E. coli (p < 0.05), there was no statistically significant difference between E. coli and S. aureus (p > 0.05) by Ga-67 citrate. Our study suggests that Tc-99m HIG is a superior agent to Ga-67 and bacterial affinity can be a factor responsible for HIG accumulation at focal sites of inflammation.
Abscess↗
Bone loss rate in the lumbar spine: a comparison between natural and surgically induced menopause.
OBJECTIVE: To compare the bone loss between natural and surgically induced menopause by dual photon absorbsiometry (DPA) and quantitative computed tomography (QCT). METHODS: The study group included 365 women, who were in menopause for at least 6 months. Of all patients, 272 became menopausal naturally and 93 surgically. Spinal bone mineral density (BMD) of the women was determined by DPA in 201 patients and by QCT in 164. Regression analysis was used to correlate BMD and months since menopause. RESULTS: Measurements with DPA did not show any significant difference in bone loss between natural and surgical menopause patients, whereas in the group of patients of whom BMD is measured by QCT, a relatively increased bone loss rate is found in surgically induced menopause patients. CONCLUSIONS: Oopherectomized women seemed to suffer a relatively higher bone loss rate compared with natural menopause.
Absorptiometry, Photon↗
Successful treatment of Kaposi's sarcoma in a renal allograft recipient.
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Graft Rejection↗
An investigation on plasma progesterone levels during pregnancy and at parturition in the Ivesi sheep.
In this study, plasma progesterone concentrations in a total of 45 Ivesi sheep were investigated during pregnancy and at parturition. Blood samples were collected from all the sheep studied every 20 days commencing on the 30th day of pregnancy. Plasma progesterone levels were determined by radioimmunoassay. During the second half of the pregnancy, progesterone concentrations in the sheep giving birth to one, two and three lambs were 2.02 +/- 0.08 ng/ml, 3.24 +/- 1.18 ng/ml and 4.90 +/- 0.85 ng/ml, respectively. There was no significant variation in progesterone levels between sheep with male and female offspring. At parturition, plasma progesterone concentrations did not differ significantly between the animals. The present results indicate that plasma progesterone levels could be used not only to determine the pregnancy status of the animal but also to predict the number of fetuses after the second half of the pregnancy.
Animals↗
Complications of cordocentesis in high-risk pregnancies: effects on fetal loss or preterm delivery.
Between 1990 and 1993, 166 cases underwent cordocentesis and were followed for at least the following 4 weeks in the Prenatal Diagnosis and Therapy Centre of Vienna University. The indications for the procedure were structural malformations in 46.4 per cent of the cases, other high-risk diagnosis in 48.8 per cent, and maternal age over 35 years in only 4.8 per cent. We investigated retrospectively all cases of complications resulting in fetal loss or preterm labour. Abortion, intrauterine fetal death, chorioamnionitis, and preterm delivery occurred in 0.6, 5.4, 0.6 and 9.0 per cent of these cases, respectively, adding up to a total of 26 cases (15.7 per cent). Although this rate looks relatively high, 20 of the 26 cases had already displayed signs implying a complicated prognosis. Neither maternal age, gestational age, number of attempts, nor placental location correlated with fetal loss or preterm delivery. Significantly higher rates of fetal loss or preterm delivery were observed when cordocentesis was performed in cases diagnosed as duodenal/intestinal stenosis or hydrops-ascites-hydrothorax/hygroma colli (P = 0.0488 and P = 0.0005). The frequency of complications did not decrease as the experience of the operators increased.
Abortion, Spontaneous↗
Sample adequacy in detecting Chlamydia trachomatis.
OBJECTIVE: Chlamydia trachomatis is an important etiological agent in female genital infection and may result in infertility. In recent years rapid diagnostic methods have become widely used as alternatives to cell culture. Our objective was to evaluate the technique of direct fluorescence assay (DFA) in estimating the presence of C. trachomatis. METHODS: Specimens taken from 40 infertile and 20 fertile women were examined by DFA for the presence of C. trachomatis. RESULTS: Six of forty (15%) infertile women were found to be positive whereas no positive specimens were detected in the control group. When the specimens were grouped into those which were adequate or inadequate, 19 and five specimens, respectively, were adequate in the infertile and healthy groups. If only adequate specimens are included in estimating the presence of Chlamydia, the percentage is 31.6%. CONCLUSIONS: In order to use DFA as a more reliable and rapid diagnostic test of C. trachomatis in female genital infection, false-negativity must be eliminated. Specimens must be collected adequately and concentrated in order to achieve optimal diagnostic success.
Cervix Uteri↗