Investigation of prevalence and characteristics of mesiodens in a non-syndromic 11256 dental outpatients.

AIM: To investigate the prevalence of mesiodens in a sample of Turkish dental patients and their distribution among genders. PATIENTS AND METHODS: A retrospective study was performed using panoramic radiography of 11256 patients, who ranged in age from 15 to 55 years old. All data (age, sex and or syndrome) were obtained from the patient files and analyzed for mesiodens. Statistical evaluation of the presence of mesiodens related to gender was performed by the Pearson chi-squared test. RESULTS: Mesiodens was detected in 15 subjects (0.13%). The prevalence of mesiodens for females and males was 0.20% and 0.057%, respectively (p = 0.037). The most commonly observed mesiodens was maxillary canine-like type (60%). Most of the mesiodens (67%) were found in the vertical position, followed by horizontal position (33%). The age and sex distribution, number of mesiodens per patient, shape, direction, size, and effect on permanent maxillary incisors are also presented in this study. The most common complication caused by mesiodens was midline of the permanent incisors. CONCLUSIONS: Mesiodens is an uncommon developmental anomaly in Turkish dental patients. Early diagnosis allows the most appropriate treatment, often reducing the extent of surgery, orthodontic treatment and possible complications.

Prevalence of root dilacerations in Central Anatolian Turkish dental patients.

OBJECTIVE: The aim of this study was to determine, retrospectively, the prevalence and distribution of the dilaceration of the root for each tooth-type in a sample of Central Anatolian Turkish population by using panoramic radiographs. METHOD: Panoramic radiograhs of 6912 patients (3860 women and 3052 men, mean age 29.04 years, range, 15 to 50 years) were examined for the presence of root dilacerations. Chi-square test was also used to compare the prevalence of dilacerations between male and female subjects and upper and lower jaws. RESULTS: Data showed that 1108 (16.0%) of these subjects had one or more teeth that were dilacerated and these were detected in 466 (15.2%) males and 642 (16.6%) females. Statistical analysis (chi2 test) showed a significant difference in the prevalence of dilaceration among male and female patients. Mandibular third molars were dilacerated most often (3.76%), followed by mandibular second molars (1.81%). Dilaceration was found in 1.23% of maxillary second premolars and 1.23% of mandibular second molars. CONCLUSION: Root dilacerations are not uncommon among Turkish dental patients, and their early detection could be important in treatment problems associated with it. However further larger scale studies are required to assess its prevalence in the general population in order to compare it with other ethnic groups.

The relationship of preoperative hematologic parameters to invasion of anatomic structures and recurrence in tenosynovial giant-cell tumor of the digits.

Although the pathogenesis of Teno-Synovial Giant Cell Tumor (TSGCT) is not known, inflammation is thought to play a role in the etiology beside some other factors. Many researchers have found a close relationship between hematological parameters such as Mean Platelet Volume (MPV), Platelet/MPV Ratio (Plt/MPV), Monocyte/Neutrophil Ratio (MNR), Neutrophil/Lymphocyte Ratio (NLR), Platelet/Lymphocyte Ratio (PLR) and certain inflammatory, autoimmune and neoplastic diseases. The aim of the present study was to assess the relationship of hematological parameters (NLR, MNR and Plt/MPV) to tumor recurrence and spread after TSGCT surgery. Data from 102 patients who matched the inclusion criteria comprised preoperative hematological parameters, tumor size, anatomic region, side, presence of bone invasion, proximity to joints or neurovascular structures, and postoperative recurrence and complications. The mean follow-up was 54.2 months (±26.5). Recurrence was observed in 12 (11.8%) of the 102 cases. No significant correlation was found between recurrence and hematologic parameter, age, laterality (right-left) or zone (volar-dorsal). There were no significant differences in NLR, Plt/MPV or MNR between patients with and without bone, capsular, nerve or total involvement. The study thus showed that the various inflammatory parameters (NLR, Plt/MPV and MNR) calculated from blood count were not predictive of tumor invasion into anatomical structures or of digital TSGCT recurrence.

Comparison of the results of percutaneous and open screw fixation in the treatment of scaphoid nonunion fractures.

OBJECTIVE: Our study aims to compare the clinical results of percutaneous screw fixation and non-vascularized bone grafting with open screw fixation in patients who did not achieve union due to failure in diagnosis and treatment after a scaphoid fracture. PATIENTS AND METHODS: Forty-three patients with scaphoid nonunion fractures corresponding to the first three Slade and Dodds classification were divided into two groups. Non-vascularized bone grafting with open reduction and internal fixation (ORIF) was applied to 24 patients in the first group, and 19 patients in the second group were treated with a closed reduction and internal fixation (CRIF) (percutaneous screw fixation). The patients were followed up for preoperative and postoperative functional scores and time to union. RESULTS: Our study found that the scaphoid was most commonly fractured in the waist of the scaphoid. In our study, we found that distal scaphoid fractures had the highest union rate (100%), followed by the waist fractures (93.2%) and the weakest union (50%) in the proximal pole fractures. We observed that the fastest union had occurred in the fractures of the waist. We also observed that the union was completed earlier in patients who operated with ORIF than those with CRIF. We found union in 87.5% of patients who underwent ORIF, in 84.2% of patients who underwent CRIF. CRIF operation duration was shorter than expected from ORIF operation duration. CONCLUSIONS: We found that similar union rates could be achieved in the patient groups who underwent percutaneous and open screw fixation by selecting the appropriate patient in scaphoid nonunion fractures. Union was faster and functional results were more satisfactory in the ORIF group. The operation time was shorter in the CRIF group.

Multidisciplinary treatment and functional outcome evaluation of combined injuries of nerves, vessels, and flexor tendons: spaghetti wrist.

OBJECTIVE: In this study, we aimed to evaluate the effectiveness of the modified Kessler technique in managing spaghetti wrist lacerations by multidisciplinary treatment. PATIENTS AND METHODS: Patients who were operated and followed up with the diagnosis of spaghetti wrist tears in our clinic between January 2012 and December 2020 were included in the study. In the postoperative follow-ups, the parameters evaluating the functionality of the patients were examined. RESULTS: Patients were 105 male (86.7%) and 16 women (13.2%), with a mean age of 36.83 ± 16.38 years. At the final follow-up, functional outcomes were assessed. The most common injury mechanism was glass-related injuries (35.5%). The mean starting surgery time of the patients was 4.64±2.98 hours. The most frequently involved structures were the palmaris longus with a rate of 51% and the flexor digitorum superficialis with a rate of 45%. There were significant differences regarding intrinsic function and grip strength between male and female patients (p = 0.04, p = 0.21, respectively). There were significant differences regarding sensation and grip strength between smoker and nonsmoker patients (p = 0.03, p = 0.01, respectively). The number of the damaged structures was negatively correlated with postsurgical functional outcomes of four tests, including tendon function, opposition, intrinsic function, and grip strength. The physical therapy period was correlated to hand function tests (r = 0.756, p < 0.05). Nerve damage was negatively correlated with sensation (p = 0.011, r = -0.932). CONCLUSIONS: The modified Kessler technique is reliable with functional outcomes for spaghetti wrist injuries involving tendons, nerves, and arteries. Meticulous and early surgical treatment within the first 8 hours of spaghetti wrist injury and early initiation and long-term physical therapy are vital in patients' functional outcomes.

Relationship between polymorphism in the manganese superoxide dismutase gene and breast cancer.

Manganese superoxide dismutase (MnSOD) acts as an antioxidant and protects cells from the harmful effects of reactive oxygen species. We investigated the relationship between the MnSOD Ala-9Val polymorphism and breast cancer. Genotypes of 250 cases and 330 controls were determined by use of PCR-RFLP. Compared with the MnSOD Val/Val genotype, the MnSOD Val/Ala or MnSOD Ala/Ala genotype was not significantly associated with the overall risk for breast cancer. The risk increased in women with MnSOD Ala allele-containing genotypes as well as higher level of education (Ala/Ala: OR, 6.00; 95% CI, 1.02-35.33), BMI >or= 25 kg/m(2) (Val/Ala: OR, 1.74; 95% CI, 1.10-2.76), late age at first pregnancy (Val/Ala: OR, 1.52; 95% CI, 1.01-2.42), and premenopausal status (Val/Ala: OR, 1.78; 95% CI, 1.03-3.10). In conclusion, the MnSOD Ala-9Val polymorphism may contribute to an increased risk for breast cancer development, particularly in the presence of a higher level of education, high BMI, late age at first pregnancy, and premenopausal status.

Nerve conduction studies of the axillary, musculocutaneous and radial nerves in elite ice hockey players.

AIM: The peripheral nerves of the upper extremity are exposed to acute and chronic mechanical injuries in ice hockey players, because of the high repetition of motions, high muscular forces and extreme shoulder positions. This study was performed to evaluate the effect of ice hockey playing on the axillary, musculocutaneous and radial nerves crossing the upper arm region. METHODS: The ice hockey group consisted of 20 first-division male ice hockey players and the control group consisted of 20 non-active males. The neurophysiological study consisted of motor nerve conduction latency of the axillary, musculocutaneous and radial nerves. RESULTS: The values of distal motor latency (DML) of the axillary, radial and musculocutaneous nerves were significantly prolonged in the ice hockey players compared with the controls. Ice hockey can repetitively stress the upper extremity during shooting, because of forceful throwing to move the puck from the stick blade to the opponent's net. The mechanism of prolonged DML in the axillary nerve may both tract and compress as the axillary nerve stretches across the humerus during movement. From this study it emerged that using the biceps and coracobrachialis muscles can create notable muscle compartment pressure on the musculocutaneus nerve. The significant differences detected in the neurophysiologic study of the musculocutaneous nerve between the ice hockey players and controls may reflect the fact that the forces acting on the shoulder and the elbow during ice hockey matches can effectively influence DML. CONCLUSIONS: The authors suggest two plausible causes for prolonged radial nerve DML: direct compression by the hypertrophied triceps muscle and stretching of the arm. The study suggests it is likely that a combination of skeletal muscle hypertrophy and excessive biomechanical demands on neurological structures during ice hockey matches may be a major etiologic factor in compression of the axillary, musculocutaneous and radial nerves.

One center's experience with antithymocyte globulin treatment for acute rejection in renal transplantation.

Antithymocyte globulin (ATG) is a polyclonal antibody used in renal transplantation for prevention and treatment of acute rejection. In this study we have presented the outcomes of 23 cases treated with ATG due to steroid-resistant acute rejection episodes in 17 male and 6 female recipients. Sixteen transplantations were performed from cadaver donors and the other 7 from living-related donors. The mean recipient age was 31.9 +/- 9 years and the mean donor age was 56.3 +/- 10.8 years. ATG treatment was administered in doses of 3-5 mg/kg/d for 10 or 14 days. All patients received the same premedication before the ATG treatment; we did not encounter any ATG-related side effects. ATG doses were adjusted according to the T-lymphocyte levels. All recipients were followed up for infectious complications, for graft function, and for immunologic parameters of CD3 levels, CD4 levels, CD3/CD4 ratios, lymphocyte, and polymorphonuclear leukocyte numbers. According to the Banff criteria introduced in 1997, 4 patients displayed humoral rejection: 3 had type 3; 5 had type 2; and 11 had type 1 acute rejection episodes. Nine patients developed infectious complication during the follow-up. Three had pulmonary aspergillosis; 2 had cytomegalovirus infection; and 4 had bacterial infections. One patient who experienced aspergillosis died with a functioning graft, and the remaining 8 patients were treated successfully. Graft function improved in 19 (83%) cases. The other 4 patients returned to hemodialysis. Mean creatinine levels decreased from 4 +/- 1.7 to 2.1 +/- 0.2 mg/dL. We did not observe any relationship between the immunologic parameters and infectious complications. In conclusion, although ATG is a powerful drug to treat steroid-resistant acute rejection episodes, there was no precise way to monitor the intensity of immunosuppression to prevent infectious complications.

Acute rejection rates and survival of renal transplant recipients with Alport's Syndrome.

Alport's syndrome, a hereditary disorder characterized by a combination of nephritis and deafness, was first described in 1927. Herein, we have presented 20 cases of Alport's syndrome in renal transplant recipients. Between November 1975 and September 2006, we performed 1602 transplantations. 22 including 20 recipients (1.24%) with Alport's syndrome. The recipients were 16 males and 4 females of overall mean age 21.3 +/- 5.6 years (range, 14-35 years). Seventeen received kidneys from living-related and 5 from cadaveric donors. We retrospectively assessed recipient features: age, gender, physical examination, routine blood biochemistry, histopathological results, and audiometric test results, as well as postoperative complications in each of these 20 recipients. Ten instances of acute rejection occurred in 8 recipients. There were 3 postoperative complications, all of which were lymphoceles. We had no vascular or urinary system complications. At the time of this report, 19 recipients are alive; the other 1 died due to Kaposi's sarcoma. Sixteen recipients display good renal function and creatinine levels ranging from 0.8 to 2.9 mg/dL during a mean follow-up of 8.4 +/- 4.8 years (range, 1 to 20 years). Three of 19 recipients returned to hemodialysis at 17, 13, and 6 years after their first graft, respectively. Retransplantation was performed on 2 recipients at 18 and 7 years, respectively, after their first transplantation. In conclusion, although the number of patients in our series was small, in light of their uneventful postoperative periods and the good posttransplantation renal function in our recipients, we consider Alport's syndrome recipients as good candidates for transplantation.

Comparison of tissue Doppler echocardiography parameters in patients with end-stage renal disease and renal transplant recipients.

BACKGROUND: Tissue Doppler echocardiography has been introduced as a useful tool to assess systolic myocardial function. In this study we sought to compare patients with end-stage renal disease (ESRD), with renal transplantations and control subjects with regard to tissue Doppler parameters. METHODS: Thirty recipients with functional grafts of overall mean age 36 +/- 7 years included 24 men. An equal number of patients with ESRD of overall mean age 35 +/- 7 years included 20 men. A third cohort was comprised of 20 age- and gender matched control subjects. Tissue Doppler imaging from the septal and lateral mitral annulus of the left ventricle and free wall of the right ventricle was performed from a 4-chamber view. RESULTS: Mean systolic and diastolic blood pressures were similar among the groups during imaging. Peak systolic velocity (S wave) at the septal annulus was similar in control subjects and recipients. S waves were significantly lower among ESRD patients compared with recipients (10.3 +/- 2.1 vs 12.0 +/- 2.5 cm/s, P = .04, respectively). Isovolumic contraction velocity of the septum and the right ventricular wall were significantly lower in ESRD patients than recipients or controls: 10.2 +/- 2.6 vs 12.5 +/- 2.8 vs 11.4 +/- 1.8 cm/s for septal wall (P = .008) and 13.9 +/- 3.6 vs 17.9 +/- 5.1 vs 16.8 +/- 5.8, for right ventricle (P = .01). CONCLUSION: Systolic indices of tissue Doppler echocardiography in recipients demonstrated similar values as control subjects and increased values compared with ESRD patients. These results suggested improvement in systolic myocardial function following renal transplantation.

Results of kidney transplantation between spouses: a single-center experience.

The shortage of cadaveric kidneys is growing in Turkey despite intensive efforts to find a solution. Living related donors are the primary source of kidneys in developing countries. When a first-degree relative of the patient is not available, a second-degree relative or a genetically unrelated but emotionally related donor, such as a spouse, becomes an alternative. From November 1985 to June 2006, 81 living unrelated kidney transplantations were performed between spouses at our hospital. Seventy-one of the donors were women, and 10 were men. The mean donor age was 33.9 +/- 8.5 years and the mean patient age was 38.5 +/- 8.8 years. The posttransplantation patient and graft survival rates were. 1 year: 93% patient survival, 83% graft survival; 3 years: 90% patient survival, 78% graft survival; and 5 years: 83% patient survival, 76% graft survival. During the posttransplantation period (mean, 82.5 +/- 61.4 months range, 6-216 months), seven patients died: three from sepsis, one from gastrointestinal hemorrhage, two from myocardial infarction, and one from pancreatitis. Three of those seven patients died with a functioning graft, and the seven other grafts were lost because of chronic rejection. To obstruct the underground trade in organs sold for transplantation, our center does not accept living unrelated organ donor candidates other than a spouse. Interspousal kidney transplantation is an important option with good clinical results. It provides the couple with a better quality of life, offers the opportunity to share the joy of giving, and enables a husband and wife to receive the "gift of life" from each other.

Clinical course of hepatitis C virus infection in renal transplant recipients.

UNLABELLED: Patients with end-stage renal disease are at high risk for exposure to hepatitis C virus (HCV) infection. Although both viral replication and liver disease progression are accelerated after renal transplantation, the long-term impact of chronic HCV infection is unclear. Our aim was to analyze the course of HCV infection in renal transplant recipients and the effects of HCV reactivation on patient and graft survival. METHODS: We retrospectively examined the 21-year (1985-2006) data of 1274 renal transplant recipients, 43 of whom were anti-HCV positive at the time of transplantation. RESULTS: The mean posttransplant follow-up of 43 patients was 62.0 +/- 7.3 months. At the time of transplantation, HCV RNA was positive in 11 (25.6%) patients and negative in 32 (74.4%) patients. HCV reactivation was seen in 19 (45.2%) patients at a mean time of 20.8 +/- 5.7 months. In 31 (72%) patients, acute rejection occurred, whereas graft loss occurred in 10 (23%) patients. Three (7%) patients died. Among 43 patients, 22 (51.2%) were treated with interferon before transplantation. There was a statistically significant association between pretransplant interferon therapy and pretransplant HCVRNA level (P=.024), but no significant association of HCV reactivation and graft rejection, mortality, or kidney survival. CONCLUSION: HCV reactivation occurred in nearly half of the renal transplant recipients, mostly in the second year. Patient survival and graft survival were not affected by HCV reactivation. Anti-HCV positivity should not preclude chronic renal failure patients from renal transplantation.

Effect of the interval between organ donor brain death and organ harvesting on kidney graft function after transplantation.

We hypothesized that providing a longer resuscitation period (>12 hours) for a brain-dead organ donor (BDOD) to attenuate the detrimental effects of sympathetic discharge that occur during this event would improve graft function. We reviewed the medical records of patients who had received a kidney transplant from a BDOD between November 2001 and June 2006. The patients were divided into two groups according to whether the interval between the brain death of the organ donor and organ harvest was >12 hours (group 1 n=12) or .05). When compared with patients in group 2, those in group 1 demonstrated a significant trend toward improved renal graft function in terms of serum creatinine levels, BUN levels, and urine output. Five patients in group 2 and two patients in group 1 required hemodialysis during the early posttransplantation period (P>.05). Our results indicate that longer in situ resuscitation of the graft kidney in BDODs may improve posttransplant function.

Predictors of mortality and morbidity in acute obstructive jaundice: implication of preventive measures.

BACKGROUND/AIMS: The afferent events in acute obstructive jaundice (AOJ) are characterized by endotoxemia-induced decrease in systemic vascular resistance and bile salt mediated natriuresis and diuresis leading to diminished effective plasma volume. METHODOLOGY: A prospective protocol aimed at preventing those alterations was carried out in 104 consecutive patients with AOJ. The preoperative risk factors that predict postoperative mortality and morbidity were reevaluated and correctable factors were identified. RESULTS: The average duration between the initiation of jaundice and surgery was 9.3 days. The perioperative mortality was 0%. The essentials of the treatment protocol were lactulose and cefazolin administration respectively for the prevention of portal endotoxemia and biliary sepsis and maintenance of body weight with adequately replaced fluid and electrolytes. Clinically relevant nutritional deficit was not observed in any of the patients during the perioperative period. The unique factor that predicted late mortality was the preoperative alanine transaminase value. Renal hemodynamics and hematologic parameters were completely correctable before the operation and patients with malignant or benign biliary strictures benefited and responded to the treatment similarly. CONCLUSIONS: Measures taken to prevent the activation and progression of the afferent events in AOJ, have resulted in excellent clinical outcomes.

Indicators of acute rejection on Tc-99m DTPA renal scintigraphy.

INTRODUCTION: Specific criteria for diagnosing an acute rejection episode (ARE) are not present on renal scintigraphy. However, a deterioration in renal function observed on serial imaging is suggestive of an ARE during the early posttransplantation period. In this study, we evaluated Tc-99m DTPA renal scintigraphy findings among patients with renal allograft dysfunction. The aim was to define criteria for ARE on a single imaging study alone. MATERIALS AND METHODS: This study included 82 patients with renal allograft dysfunction, each of whom had a specific biopsy-proven pathology. From the background-corrected Tc-99m DTPA renal time-activity curves, the following parameters were computed: the ratio of counts at peak perfusion to that at plateau (P:PL) and the ratio of counts at peak perfusion to that at peak uptake (P:U). The images were inspected visually for excretion patterns and other morphological changes. RESULTS: A specific renogram pattern, that is an increase in perfusion to uptake ratio together with a nearly flat uptake curve and preserved peak/plateau pattern, was observed in 67% of low-grade AREs. In contrast, a flat uptake curve usually occurred together with a loss of peak/plateau pattern in a high-grade ARE. The findings that were highly specific for ARE on visual inspection were little or no collecting system activity, pelvic hypoactivity, and indistinctness of the corticomedullary junction. CONCLUSIONS: Our results indicate that in low-grade ARE, there is decreased filtration relative to perfusion as evidenced by a decrease in the perfusion-to-uptake ratio with loss of a peak/plateau pattern. A hypoactive pelvis with little activity in the collecting systems may be due to edema in the renal interstitium and pelvicalyceal structures.

Comparison of Tc-99m DTPA and Tc-99m MAG3 perfusion time-activity curves in patients with renal allograft dysfunction.

AIM: The perfusion time-activity curve on DTPA renal scintigraphy shows a peak and plateau pattern which is usually absent or less marked when using tubular agents such as MAG3. The exact mechanism that results in this difference between the two tracers is not well understood. A descending pattern on MAG3 has been proposed to be due to decreased extraction. In this study we compared the diagnostic utility of perfusion patterns obtained with DTPA and MAG3 among patients with renal allograft dysfunction. MATERIALS AND METHODS: This study included 48 patients with renal allograft dysfunction and 18 recipients with normal graft function. Every recipient had renal scintigraphy with Tc-99m MAG3 and Tc-99m DTPA 1 day apart. The second phase of the perfusion curve after the initial rise was classified as ascending, flat, or descending. In patients with a descending curve on DTPA study, we calculated the ratio of counts at peak perfusion to that at plateau (P:PL). Impaired perfusion was based on a deterioration of the peak-to-plateau pattern on DTPA and the presence of a flat-descending curve on MAG3. RESULTS: In patients with dysfunction, impaired perfusion was observed in 77% of DTPA and in 54% of MAG3 studies. A flat-descending curve on MAG3 was present in 44% of patients with normal graft function. By MAG3, 67% of acute rejection and 28% of chronic allograft nephropathy (CAN) cases showed deteriorated perfusion. The corresponding values for DTPA were 67% and 94%, respectively. A flat-ascending pattern on DTPA was more frequent in CAN than it was in acute rejection (33% and 17%, respectively). CONCLUSION: The sensitivity of DTPA perfusion pattern for diagnosing dysfunction was significantly greater than that for MAG3. Our results suggest that the major determinant of a curve pattern on DTPA or MAG3 study is the extraction relative to perfusion. Thus for patients with CAN, extraction is higher relative to perfusion, resulting in a lower P:PL ratio or an ascending curve on DTPA. Although the extraction of DTPA is less than that of MAG3, this level of extraction renders DTPA more sensitive to serial changes in renal function and pathophysiological mechanisms related to kidney function.

De novo glomerulonephritis in renal allografts with hepatitis C virus infection.

The purpose of this study was to examine the influence of hepatitis C virus (HCV) infection on the occurrence of posttransplant de novo glomerulonephritis (GN). Of 165 patients selected for the study, 44 were HCV positive and 121 HCV negative. Light and immunofluorescence microscopy were performed on all biopsies and clinical and laboratory findings reviewed. Fifteen (34%) of the 44 HCV positive patients showed de novo GN (4 membranous, 11 membranoproliferative) at a mean of 47 +/- 22 months. But only 8 (6.6%) of 121 HCV negative patients showed de novo GN (5 anti-glomerular basement membrane nephritis in recipients with Alport's disease, 2 membranous GN, 1 membranoproliferative GN) at a mean of 60 +/- 39 months. The risk of development of de novo GN was higher among patients with HCV infection (P < .001). The presence of de novo GN in HCV positive patients impaired graft survival compared with HCV positive patients without de novo GN (P < .01). The incidence of recurrence of primary disease, mainly focal segmental glomerulosclerosis, membranous glomerulonephritis, membranoproliferative glomerulonephritis, and IgA nephropathy, was higher in HCV negative patients (29%) compared with HCV positive patients (6.8%; P = .001), namely, 50%, 57.6%, 25%, and 69%, respectively. In conclusion, HCV infection showed a strong influence on the development of de novo GN. For this reason, it is important to follow HCV positive recipients with a renal biopsy even when there are no significant clinical or laboratory findings.

Pulmonary function in renal transplant recipients and end-stage renal disease patients undergoing maintenance dialysis.

The aim of this study was to reveal the pulmonary function status of renal transplant recipients and chronic renal failure patients on hemodialysis or continuous ambulatory peritoneal dialysis. The study involved 73 subjects, including 49 patients who were either on peritoneal dialysis (n = 22) or hemodialysis (n = 27), and 24 renal transplant recipients. The spirometry results revealed significantly higher residual volume and total lung capacity in the hemodialysis and peritoneal dialysis groups than in the transplantation group. Forced expiratory flow between 25% and 75% of vital capacity was slightly below normal in the dialysis patients. Preservation of diffusion capacity of the lung for carbon monoxide was noted in the hemodialysis group (112.4%). Inspiratory and expiratory muscle strength was reduced in all groups. Only type of dialysis was correlated with this reduction. Inspiratory muscle strength in the peritoneal dialysis group (49.9%) was significantly lower than in the transplantation and hemodialysis groups (54.7% and 66.5%, respectively). The spirometry findings suggest that small-airway disease causes increased residual volume and total lung capacity (hyperinflation) in hemodialysis and peritoneal dialysis patients and that this airway obstruction subsides after renal transplantation. Preserved diffusion capacity in the hemodialysis group was attributed to the use of biocompatible dialyzer membranes. Renal failure complications may be the main explanation for global respiratory muscle weakness in dialysis patients, whereas corticosteroid therapy might be the primary cause in kidney graft recipients. Significantly lower inspiratory muscle strength in the peritoneal dialysis group suggests that presence of intra-abdominal dialysate might interfere with diaphragmatic contraction.

Recurrent glomerular diseases after renal transplantation.

INTRODUCTION: Recurrent glomerular diseases are important causes of graft dysfunction after renal transplantation. As the outcomes of transplantation continue to improve, the problem of recurrent diseases in the transplanted kidney have become evident. The purpose of our study was to determine the risk factors for and the incidence of recurrence in the posttransplant period as well as their impact on graft survival rates. METHOD: We retrospectively analyzed 49 patients with glomerular diseases due to membranoproliferative glomerulonephritis (n = 26); focal segmental glomerulosclerosis (FSGS, n = 18); and systemic lupus erythematosus (n = 5). The mean follow-up was 9.5 years. RESULTS: Recurrent disease was detected in 30 of 49 patients after a mean posttransplant follow-up of 28.1 months (range = 1 to 157) and their average graft survival was 41.3 months. Nineteen patients were recurrence-free with a mean graft survival of 79.4 (range = 15 to 158) months (P < .05). One patient with FSGS, showed disease-recurrence in her third transplant after having experienced recurrences in the former grafts. In all six patients with HLA haplotype B8, recurrence was observed at a mean of 19.5 +/- 9.8 months. The only risk factor that was identified was this HLA haplotype. CONCLUSION: Recurrent disease a significant problem after renal transplantation is associated with decreased graft survival. The donor HLA type may be associated with risk, which should be clearly discussed with both the living donor and the recipient candidate.