Case series: hemolytic uremic syndrome--another cause of transplant dysfunction.

BACKGROUND: Renal transplantation is the optimal treatment for suitable patients with end-stage renal disease (ESRD). However, acute graft dysfunction occurs in 5%-35% of patients. This is commonly due to acute rejection, drug toxicity, ureteric obstruction, or infection. Atypical hemolytic uremic syndrome (aHUS), either recurrent or de novo, is uncommon after transplantation. CASES: We highlight three cases of acute transplant dysfunction in which transplant biopsy revealed HUS without associated clinical or hematologic clues to the etiology. Two cases had recurrent HUS and 1 had de novo HUS secondary to tacrolimus therapy. Screenings for ADAMTS-13 and gene mutations of complement regulatory proteins were negative. Thrombocytopenia and red blood cell fragments on blood film appeared some days later. TREATMENT: Treatment comprised a combination of plasma exchange with fresh-frozen plasma and switching immunosuppressive therapy, which led to the recovery of the above hematologic features but salvaged graft function in only 1 case. CONCLUSIONS: Classical hematologic findings of HUS appeared late in these cases. HUS should be considered in cases of allograft dysfunction where there is no obvious cause, and biopsy should be performed. This enables early initiation of therapy to gain rapid recovery of hematologic parameters and potentially of transplant function.

Effect of season on the reproductive organs of the female African giant rat (Cricetomys gambianus) in Zaria, Nigeria / Efecto estacional en los órganos reproductores de la rata gigante Africana (Cricetomys gambianus) hembra en Zaria, Nigeria

The study was carried out to determine the effect of season on the female reproductive organs of the African Giant rat using the standard methods, with the aim of obtaining the base-line values. The weights of the oviduct/uterus, vagina and the entire tubular organ were consistently higher during the harmattan season (0.789 +/- 0.07 g, 2.708 +/- 0.19 g and 3.455 +/- 0.25 g, respectively) than the hot ­ dry (0.591 +/- 0.02 g, 2.239 +/- 0.13 g and 2.831 +/- 0.14 g, respectively) and the rainy season (0.723 +/- 0.04 g, 2.412 +/- 0.01 g and 3.148 +/- 0.12 g, respectively). The mean weight and length of the ovary were not significantly different throughout the season, suggesting that the AGR may breed throughout the year. The slight increase in the weight of the tubular organ during the harmattan (November ­ February) and the rainy (June ­ October) season suggests that the seasons may be favourable for breeding, probably because of the abundance of food available to the rodents in the wild during the seasons. The decrease in weights of the organs during the hot-dry season (March ­ May) was, apparently, due to the unfavourable climatic conditions and food scarcity during the season. In conclusion, the results of the present study provide base -line morphometric data on the female reproductive organs of the AGR across the seasons.

Este estudio se llevó a cabo para determinar el efecto de las estaciones en los órganos reproductores femeninos de la rata gigante Africana mediante los métodos estándar, con el objetivo de obtener los valores basales. El peso del oviducto/útero, vagina y el órgano tubular completo fueron consistentemente más altos durante harmattan (la estación seca en Nigeria) (0,789 +/- 0,07 g, 2,708 +/- 0,19g y 3,455 +/- 0,25, respectivamente) que la estación seca-calurosa (0,591 +/- 0,02 g, 2.239 +/- 0,13g y 2.831 +/- 0,14, respectivamente) y la estación de lluvias (0,723 +/- 0,04 g, 2,412 +/- 0,01 y 3,148 +/- 0,12 g, respectivamente). La media de peso y longitud del ovario no fueron significativamente diferentes a lo largo de las estaciones, lo que sugiere que la rata gigante africana puede reproducirse durante todo el año. El ligero aumento en el peso del órgano tubular en las estaciones de harmattan (noviembre - febrero) y de lluvias (junio-octubre), sugiere que las estaciones pueden ser favorables para la reproducción, probablemente debido a la abundancia de alimentos disponibles para los roedores silvestres durante estas temporadas. La disminución en el peso de los órganos durante la estación cálida y seca (marzo - mayo) fue, al parecer, debido a las desfavorables condiciones climáticas y la escasez de alimentos durante la estación. En conclusión, los resultados de este estudio proporcionan una línea base de datos morfométricos para los órganos reproductores de la rata gigante africana hembra a través de las estaciones.

Use of bare-mounted Palmaz-Schatz stents employing the stent saddle technique on the delivery balloon: a single center experience.

The major limitations of the Palmaz-Schatz stent stem from the design of its stent delivery system (SDS). The SDS is bulky and has poor trackability in lesions with proximal tortuosity and/or vessel calcification. The use of bare-mounted Palmaz-Schatz stents on low profile balloons represents an alternate approach for lesions that are not accessible for stenting with the SDS. Thus we evaluated the indications, procedural success rate, and in-hospital complications of patients undergoing bare stenting at a single center between 1 October 1995 through 30 September 1996. A total of 363 coronary interventions were performed during this period, including coronary stenting in 194 vessels. In 18 of these 194 vessels, bare-mounted Palmaz-Schatz stents were used. The indications for bare stenting were: inability to deliver the Palmaz-Schatz stent on SDS for suboptimal angioplasty results or acute/threatened abrupt closure; use of half stents; stenting in vessels < 3.0 mm; intermediate disease in the proximal segment that would have precluded optimal visualization of stent placement; and use of guides 7 French or smaller. Bare stenting was successful in 15 of the 18 patients (vessels) in whom it was attempted. There were no deaths, myocardial infarctions, stent thrombosis, repeat interventions, or significant bleeding in patients with successful bare stent delivery. The stents were successfully retrieved in the three patients in whom the stent could not be advanced into the target coronary segment. One of these patients had a propagated spiral dissection prior to attempts at bare stenting and required emergent bypass surgery. The remaining two patients with failed deployment had suboptimal angioplasty results but had an uncomplicated hospital course. Thus bare stenting represents an alternate percutaneous approach to tackle suboptimal procedural results and/or complications in patients who have failed stent deployment with the standard sheathed stent delivery system currently available in the United States.

High dose rate intracoronary radiation for inhibition of neointimal formation in the stented and balloon-injured porcine models of restenosis: angiographic, morphometric, and histopathologic analyses.

PURPOSE: We examined the effects of intracoronary irradiation delivered at a high dose rate on neointimal hyperplasia after injury induced by two methods: balloon overstretch injury, and stent implantation in a porcine model of coronary restenosis. METHODS AND MATERIALS: In 34 Hanford miniature swine, a segment of each coronary artery was targeted for injury and treatment. The artery segments were treated with 192Ir at doses of 10 Gy over 4 min (eight animals), 15 Gy over 6 min (nine animals), 25 Gy over 10 min (nine animals) or control (simulation wire only; eight animals). The treated segments were subjected to stent implantation (left anterior descending and right coronary artery) or balloon overstretch (circumflex) injury. Twenty-eight days later, repeat coronary angiography and sacrifice were done. Quantitative coronary angiography, morphometry, and extensive histopathologic analyses were carried out in a blinded fashion. RESULTS: The change in minimal lumen diameter from postinjury to presacrifice in the stent-injured left anterior descending was -0.79 +/- 0.34 (mean: +/- SD) mm in the control group, compared to -0.43 +/- 0.35 mm in the 15 Gy (p = 0.04) and -0.21 +/- 0.50 mm in the 25 Gy (p = 0.01) groups; and in the balloon-injured circumflex was -0.31 +/- 0.22 mm in the control group compared to -0.03 +/- 0.18 mm in the 10 Gy (p = 0.05) and 0.00 +/- 0.33 in the 15 Gy (p = 0.01) groups. Percent area stenosis in the left anterior descending was 36 +/- 9% in the control group compared to 18 +/- 12% in the 15 Gy (p = 0.003) and 11 +/- 11% in the 25 Gy (p < 0.001) groups; and in the circumflex was 16 +/- 10% in the control groups, compared to 5 +/- 5% in the 15 Gy (p = 0.02) and 2 +/- 2% in the 25 Gy (p = 0.009) groups. Histopathology showed a striking reduction in the amount of neointima in the irradiated arteries compared with control vessels. Other radiation effects were stromal fibrin exudate, thinning of the media, and adventitial fibrosis and leukocyte infiltration in the radiated arterial segments. CONCLUSIONS: High dose rate intracoronary irradiation with 192Ir effectively inhibits intimal proliferation after stent-induced as well as balloon-overstretch injury. This shorter treatment time (4 to 10 min) may provide a clinically practical approach to the prevention of restenosis after angioplasty.