Objective To study kidney transplantation in the aged and its perioperative management. Methods Scrutinized screening of heart,lung and liver were carried out before renal transplantation for 29 patients,aged 65～84.Color Doppler B type ultrasonic inspection was used to determine the status of arteriae iliaca externa and arteriae iliaca interna.Tissue match included HLA and PRA measurement.Warm ischemia time of donor kidney was within 5 minutes and cold ischemia time 10 hours.The dose of MP was under 2.0 g during the period of operation and the immunosuppressive regimen was CsA or FK506+MMF+Pred.The general condition,blood electrolytes,whole blood CsA or FK506 concentration and immune index were monitored. Results There were 4 cases of AR,1 cases of FK506 toxicity and 1 case of lung infection.All these 6 patients were cured.1 kidney graft was removed because of thrombogenesis of renal artery.Up to now,the other 28 have been surviving with the graft functioning well for 1 to 5 years. Conclusions Abide to the indications of kidney transplantation,donor kidney of good quality and well tissue match were important in the elderly patients.With comprehensive monitoring and adequate management,kidney transplant in old patients can achieve sa tisfying outcome.Rational application of immunosuppressants and effective long term follow up are major factors for long term allograft survival.

0.05). The body surface area of recipients was positively correlated and the ratio of allograft weight to body surface area negatively correlated with the mean sCr in the 2～7 days after transplantation( P

Objective: To investigate the capability of Streptococcus sanguis(S.s) producing hydrogen peroxide (HP) and screen the strains of S.s with high yield of hydrogen peroxide.Methods: S.s were isolated from supergingival plaque of people with healthy periodontium. The microorganisms were cultivated anaerobically or aerobically, then washed and incubated with KCl buffer. Hydrogen peroxide and bacterial proteins were assayed spectrophotometrically. S.oralis ATCC 10557 was used as the controls. Results: In anaerobical culture the HP production (nmol/?g) of S.s and S.oralis was 118.22?69.92 and 338.60?192.14( P

0. 05) in a year, respectively. Conclusions FK506 was an effective and high safe basic immunosuppressant in long-term application in renal transplant recipients, especially suitable for children and old recipients. To those patients with DM, FK506 had almost the same influence on the glucose metabolism as the CsA.

32,16,16.Combined with azithromycin were8,16,16,8.MEM,CAZ,CIP combined with AMK were 1,4,8.AMK combined with CIP were 4.Conclusion Compared with sole,MEM,CAZ,CIP combined with azithromycin can reduce the MPC and SI of antibiotics alone to pseudomonas aeruginosa and restrain the drug-resistant mutants.But the capacity of preventing mutants arise were weaker than combined with AMK.AMK combined with azithromycin can't reduce the SI.But when combined with CIP,the SI of AMK were reduced greatly.

Objective To evaluate whether serum cystatin C (SCys C) could be used as an ideal index to assess renal function of renal transplant recipients during posttransplant follow-up.Methods Seventy patients who were followed up for at least 6 months after renal transplantation in our centre were recruited in the study. SCys C and serum creatinine (SCr) were determined during the follow-up period, and glomerular filtration rate (GFR) was measured using an isotope Tc99m DTPA.The correlation between SCys C, SCr and GFR was analyzed. The performance of SCys C and SCr in diagnosing the mild impairment of renal allgraft function (GFR ＜ 1 ml/s) was evaluated using ROC curve. Results Both SCys C and SCr had a linear negative correlation with GFR (r = -0. 82 and -0. 66 respectively, P＜0. 01 ). The sensitivity, specificity and positive predictive values (PPV) of SCys C for diagnosing the mild impairment of renal allgraft function were higher than those of SCr,but the AUC of SCys C did not differ from that of SCr significantly (0. 935 vs. 0. 877, P＞0. 05).Conclusion SCys C could be used an ideal index to evaluate the allograft renal function for its better correlation with actual GFR.

Objective To report our experience in surgical technique of pediatric renal transplantation and administration of immunosuppressive agents for improvement of recipient/graft survival. Methods Twenty six pediatric recipients (less than 18 years) received cadaveric renal allografts between June 1980 and March 2001.A retrospective analysis was made in these 26 cases with respect to the technical consideration of transplant,immunosuppressive regimens and long term survival. Results Two cases (8%)had delayed graft function,11(42%)had acute rejection and 10 (38%)had chronic rejection.One case develo ped recurrent nephritis,which was pathologically confirmed to be focal segment glomerulosclerosis (FSGS).The recipient/graft survival rates of 1,3,5 years were 96%/88%,92%/73% and 88%/62% respectively,with mortality of 12%. Conclusions In pediatric renal transplantations,good tissue matching,appropriate technique of vessel anastomosis,early diagnosis of acute rejection and optimal adjust ment of blood level for immunosuppressants are keys to success.

OBJECTIVE To study whether the ciprofloxacin(CIP)combined with amikacin(AMK)will decrease the drug-resistant mutants of Escherichia coli(ECO)in vitro.METHODS The MIC of CIP and AMK alone was determined by agar plates dilution method,and the combined MIC by checkerboard method.The mutant prevention concentration(MPC)both alone and combined was determined by the method of agar plates dilution method,and then the value of selectiveity index(SI)(MPC/MIC)would be acquired.RESULTS The SI of two antibiotics separatedly were 16(CIP)and 32(AMK).When two antibiotics combined,if the concentration of AMK and CIP reached 2MIC could restrain the mutants.After these two antibiotics combined,the value of SI(MPCcombined/MICcombined)came to be 8(0.008/0.001)and 8(2.0/0.25).CONCLUSIONS Compared with alone,CIP and AMK combined can decrease the MPC and SI to ECO,and have the more effect to AMK.In this way,we can reduce the drug-resistant mutants.

Parasitism characteristics of spirometra mansoni sparganum in the living donor kidney are analyzed by present cases and relevant literatures. A female aged 49 years voluntarily donated a kidney to her son. Results of healthy evaluation were accorded with the standards of living donor kidney. During repairing kidney, a sliver cyst was found in the adipose capsule on the kidney ventral surface, near to the renal hilum. The cyst was incised, and a ivory white girdle-shaped worm was obtained. After identification, the worm was identified spirometra mansoni sparganum (living body). Pathological examination showed that the cyst developed granulomatous inflammation, combined with neutrophil and eosinophilic granuiocyte infitration. Following surgery, the donor and recipient were treated with praziquantel. No proglottid or worm ovum was detected by dung detection within 3 months, without any discomfortable symptom. The infection mode and pathway may be by eating unmatured paratenic host meat or infected cyclops. The donor and recipient should be examined for parasitic infection of sparganosis mansoni prior to transplantation. No significant symptom could be detected following parasitism of sparganosis mansoni in the kidney, so it was seldom found. Worm ovum was examined in feces, which could be the evidence for sparganosis mansoni and for case history inquisition. Eosinophilia in the blood always indicated that chronic parasitic infection. Zoogenetic infection test could be tested when necessary. Sparganum antigen could be used for various immunological tests, which could provide evidence for auxiliary diagnosis of immunology. The diagnosis was usually confirmed by obtaining a polypide by surgery or histological examination. CT scanning and magnetic resonance imaging have diagnostic value of renal sparganosis mansoni.

BACKGROUND: Post-transplantation diabetes mellitus has the same characteristics as type II diabetes mellitus; however, correlation between human leucocyte antigen (HLA) and post-transplantation diabetes mellitus remains unclear among Han population in Hunan and Jiangxi provinces. OBJECTIVE: To analyze the correlation between HLA and post-transplantation diabetes mellitus, to determine predisposing genes and protecting genes of post-transplantation diabetes mellitus, and to provide reference data for personalized medicine of post-transplantation diabetes mellitus. DESIGN, TIME AND SETTING: A survey analysis was performed at Department of Urological Organ Transplantation, the Second Xiangya Hospital of Central South University from May 2007 to July 2008. PARTICIPANTS: Patients with kidney transplantation selected from Department of Urological Organ Transplantation, the Second Xiangya Hospital of Central South University between 2003 and 2008 were followed-up on individual information, testing results before and after transplantation, and zygosity. Among 195 included cases, there were 22 patients with post-transplantation diabetes mellitus and 173 with non-post-transplantation diabetes mellitus. Methods: METHODS: χ~2 was used to compare frequency of HLA antigen between post-transplantation diabetes mellitus and non-post-transplantation diabetes mellitus groups. The 195 patients were divided into ciclosporin A group and tacrolimus group according to immunosuppressive regimen, and the incidence of post-transplantation diabetes mellitus were compared usingχ~2 test. All the patients were then divided into elderly group (age ≥ 40) and low-age group (age < 40), and the incidences of post-transplantation diabetes mellitus were calculated and compared usingχ~2 test.MAIN OUTCOME MEASURES: Following-up was performed including age, blood pressure, urine volume, blood and urine routine test, liver and kidney function, blood glucose, and blood drug level. RESULTS: HLA-A30 and HLA-DR7 might be the predisposing genes of post-transplantation diabetes mellitus in south China; however, protecting genes were not found. Low dosage and low blood drug level of calcineurin inhibitors were applied in this study, and there was no significant difference in the incidence of post-transplantation diabetes mellitus between ciclosporin A and tacrolimus groups (P > 0.05). The incidence of post-transplantation diabetes mellitus in elderly group was significantly higher than that in low-age group (P < 0.05).CONCLUSION: HLA-A30 and HLA-DR7 might be the predisposing genes of post-transplantation diabetes mellitus in south China; therefore, they should be paid much attention on levels of blood glucose and urine glucose after transplantation so as to adjust the types and dosages of immunosuppressive drug in time. Low-dosage and low-concentration tacrolimus was not increased incidence of post-transplantation diabetes mellitus remarkably. However, the incidence of post-transplantation diabetes mellitus in the elderly patients was high; moreover, the incidence of cardio-cerebrovascular disease was also high. Therefore, post-transplantation diabetes mellitus might easily cause the onset of cardio-cerebrovascular disease. It was important for elderly patients to monitor blood glucose and urine glucose levels and set up an individual immunosuppression program following transplantation.