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H Isoniemi

Publications and source records attributed to H Isoniemi.

At least 55 records · Page 3Linked to original sources
PubMed1996

Cyclosporine in severe interstitial cystitis.

PURPOSE: Cyclosporine is a widely used immunosuppressive drug in organ transplantation and recently it has been used in several autoimmune disorders with good results. Because interstitial cystitis may have an autoimmune etiology, we wished to determine whether cyclosporine has any effect on symptoms in patients with severe interstitial cystitis. MATERIALS AND METHODS: A total of 11 patients, who fulfilled the criteria for interstitial cystitis according to an international accrual form, received cyclosporine for 3 to 6 months at an initial dose of 2.5 to 5 mg./kg. daily and a maintenance dose of 1.5 to 3 mg./kg. daily. Blood pressure, serum creatinine and cyclosporine concentrations were monitored regularly. The patients completed frequency-volume charts at 2-week intervals. RESULTS: The frequency-volume charts showed favorable effects. Micturition frequency decreased (p<0.01), and mean and maximum voided volumes increased significantly (p<0.001 and p<0.01, respectively). Bladder pain decreased or disappeared in 10 patients, allowing for storage of large urine volumes. Serum creatinine did not change with the dosages used. Mild hypertension occurred in 2 patients and resolved after the cyclosporine dose was lowered. After cessation of treatment symptoms recurred in the majority of patients. CONCLUSIONS: The findings revive the concept of interstitial cystitis as an autoimmune disease.

Adult↗
PubMed1994

Histological chronic allograft damage index accurately predicts chronic renal allograft rejection.

Chronic rejection has emerged as a major problem in renal transplantation, and clinical trials for prophylaxis and therapy are underway. Use of graft and patient survival as endpoints in prophylactic studies requires long follow-ups to read the endpoint. There is also an obvious need for a starting point for intervention studies. Previously, we formed a histological chronic allograft damage index (CADI), based on numerical scoring of histological alterations compatible with chronic rejection. Using protocol core needle biopsies of 89 functioning grafts 2 years after transplantation and a follow-up of 6 years, we demonstrate now that (a) the CADI at 2 years correlates significantly (r = 0.717, P = 0.0001) with transplant function at 6 years, and (b) that the CADI at 2 years reliably (P = 0.001) predicts the patients who will proceed to clinical chronic rejection later. As protocol core biopsy is an early predictive parameter for chronic rejection, our results suggest that a protocol core biopsy (at 2 years or possibly even earlier) should be included in all clinical investigative protocols dealing with chronic renal allograft rejection.

Biopsy↗
PubMed1994

Risk factors predicting chronic rejection of renal allografts.

Chronic rejection is clinically defined as a gradual but progressive impairment of renal allograft function in the absence of other specific causes. The risk factors predisposing to chronic rejection are incompletely known. In this prospective single-center project, logistic regression analysis was used to study the long-term outcome of 94 consecutive first renal allografts in relation to 10 potential risk factors. Whether serum lipid levels, histopathological changes or the mode of immunosuppressive therapy had a predictive value for chronic rejection was of special interest. The risk factors for renal allograft outcome were determined 2 years after the transplantation, when graft function was still normal, and the results were evaluated 2 years later. Occurrence of acute rejections, cold ischemia time, the high-density lipoprotein cholesterol level, and the high-density lipoprotein and total cholesterol ratio were not significant predictors of graft outcome. In a univariate analysis, triglyceride, total cholesterol, and low-density lipoprotein cholesterol level, and donor age were significantly related to graft outcome. In a logistic regression analysis, triple immunosuppressive therapy was better than any double-drug regimen in preventing the deterioration of renal allografts. Incipient histological changes in graft biopsy, quantitated as the "chronic allograft damage index," was the most important single predictor of chronic rejection. The effect of both the histological changes and low-density lipoprotein cholesterol on adverse graft outcome was level dependent.

Adult↗
PubMed1994

Neurological recovery after liver transplantation: a prospective study of 22 patients.

A group of 22 liver transplantation patients were examined pre- and postoperatively using clinical neurological, neurophysiological and neuroradiological methods. After the operation improvement was observed in neurological symptoms, and in neuropsychological and neurophysiological test results. Our study shows that liver recipients have a high prevalence of nervous system dysfunction and that successful transplantation is followed by significant improvement.

Adult↗
PubMed1994

Biliary complications in 100 adult liver transplantations: a retrospective clinical study.

Biliary complications were reviewed in 100 consecutive adult liver transplantations. Included in the study were 92 patients surviving for more than 1 month. In 86 transplantations biliobiliary anastomosis was performed with (n = 25) or without (n = 61) a T-tube. In six cases biliodigestive anastomosis (Roux-en-Y) was performed. Biliary stricture caused by hepatic arterial thrombosis was not included. Biliary complications were seen in 17 cases: seven anastomotic strictures, four T-tube-related leakages, four anastomotic leakages, one leakage of unknown origin and one late cholangitis. Nine were surgically treated (six strictures and three leakages). Patients with primary sclerosing cholangitis had the highest biliary complication rate (36%). Early anastomotic strictures were associated with a higher rate of major bacterial infections (P = 0.03) and CMV disease (P = 0.08) than those without biliary complications. Biliobiliary anastomosis with a T-tube was associated with more complications (28%) than anastomoses without a T-tube (13%). To date, total patient survival including all 100 transplantations was 71% (median follow-up 3.3 years). We conclude that biliary complications are rather common but they do not affect survival and can be treated. Biliary T-tubes can be omitted.

Adult↗
PubMed1994

A simple method for predicting bone fractures in PBC patients after liver transplantation.

We introduce a simple serum test to predict which patients will have bone problems after liver transplantation. The crosslinked part of collagen I (s-ICTP) was measured in 21 patients with primary biliary cirrhosis before transplantation. Those with postoperative fractures had increased pretransplant values of s-ICTP compared with those without fractures.

Biomarkers↗
PubMed1994

Improved outcome of renal transplantation in amyloidosis.

We report our results in 96 patients with amyloidosis who received 105 cadaveric renal allografts. The graft survival of amyloidosis patients has improved with time and with improved immunosuppression. The graft survival of amyloidosis patients is comparable to the results in another systemic disease, i. e., diabetes, and only slightly inferior to those in primary renal disease, even though amyloidosis patients tolerate complications poorly and the patients are at high risk of dying during the first 3 months.

Adolescent↗
PubMed1994

Expression of ICAM-1 and HLA class II in acute cellular and vascular rejection of human kidney allografts.

We studied the relationship between ICAM-1 and class II expression on graft tubular cells and the relationship with graft inflammation in 50 kidney transplants monitored with serial aspiration biopsies after transplantation. Of the 50 grafts, 26 had an acute rejection 17 +/- 10 days after transplantation, 5 also had acute vascular rejection (AVR) and 24 had no rejection. The initial post-transplant ICAM-1 and class II expression was low in all grafts. All 21 grafts with acute cellular rejection (ACR) displayed ICAM-1 induction, with a peak at the beginning of acute blastogenic rejection and declining over 20 days to prerejection levels. Class II expression reached a peak later and also declined later to prerejection levels. In the grafts with irreversible AVR both ICAM-1 and class II expression remained elevated. The 24 grafts with no rejection displayed no ICAM-1 or class II induction on tubular cells during the follow-up. The differences between ICAM-1 and classs II expression in biopsies with rejection and with no rejection were statistically significant. The results demonstrate that ICAM-1 was induced early during ACR on the graft tubular cells and that it disappeared rapidly in reversible rejections. The induction of class II antigens was slightly slower but quantitatively greater. In the irreversible rejections with a combination of ACR and AVR both ICAM-1 and class II expression remained elevated.

Acute Disease↗
PubMed1994

Relationship between renal histology and later graft outcome.

We have created the chronic allograft damage index (CADI), which quantifies the early histopathological changes in renal allografts. In this study we showed that the CADI at 2 years after renal transplantation predicted the graft outcome 4 years later and that the CADI identified the risk group that proceeded to chronic rejection during subsequent years.

Biopsy↗
PubMed1994

Thirty years of renal transplantation in Helsinki.

During triple-drug immunosuppression, consisting of azathioprine, steroids, and cyclosporine, the number of acute rejections was low. Close monitoring of the patient and the graft during the early posttransplant weeks with regular cytological and histological analyses was the cornerstone of early diagnosis and a favorable outcome of acute rejection. Genetic homogeneity of our patient population, third-party transfusion program, and use of well HLA-matched kidney grafts may have been additional factors behind the low rate of acute rejection. Acute rejection within the first three postoperative months did not predispose the renal graft to chronic rejection in the long term. The histologically determined allograft damage index was a reliable predictor of future graft survival. Recipients with systemic diseases such as diabetes and amyloidosis, as well as elderly patients, could be transplanted safely with results only slightly inferior to those achieved with primary kidney disease. Results in diabetic recipients have steadily improved, encouraging the continuation of critical evaluation of the patients' pretransplant status and the preference for cadaveric transplants. Renal transplantation in small children yielded superior patient and graft survival rates. We consider the use of living donors justifiable in these cases. The five million population of Finland offers an ideal size for a transplant center. Continuous education of medical personnel and the general public is crucial for the cadaver transplant program.

Adolescent↗