No abstract available.
Cyclosporine*

No abstract available.
Kidney Transplantation* ; Urinary Diversion*

No abstract available.

No abstract available.
T-Lymphocytes* ; Transplantation*

Posttransplant erythrocytosis (PTE) is a common complication of renal transplantation. It afflicts 5-15 % of renal transplant recipients with good renal function and is associated with an increased incidence of thromboembolic events. Traditional therapies for PTE include serial phlebotomy and native nephrectomy, neither of which has proved optimal. Recently, angiotensin converting enzyme (ACE) inhibitors have been developed as an alternative for PTE treatment. The aim of the study was to evaluate the therapeutic effect of an ACE inhibitor, enalapril, on PTE by the measurement of serum erythropoietin (EPO) level. Ninety consecutive cyclosporine (CsA)-treated recipients who have received living donor kidneys were investigated during the first two years. Eleven recipients (12.2%) had developed PTE, and ten of them were prospectively treated with enalapril (5-10 mg/day) for 1 year for PTE. The average age for the nine men and one woman was 32+/-7.8 years . All retained their native kidneys. Seven recipents were hypertensive, 5 on diuretics, and 2 were smokers. Serum creatinine was 1.4+/-0.3 mg/dl. Onset of PTE occured 9.8+/-5.5 months posttransplant. Duration of PTE was 7.7+/-6.8 mos (range 1-24 mos). Three had undergone 1-2 phlebotomies during the previous year. None had experienced thromboembolic event. In 10 recipients, hematocrit (HCT) during 3 clinic visits before treatment was 55.8+/-3.4 %. After the application of enalapril, HCT in all recipients decreased. Mean HCT at 3 months was decresed to 44.1+/-3.3 % (p<0.001 vs. pre-enalapril values). One patient became anemic (HCT<40 %). One patient who had initially responsed to enalapril stopped using the drug due to dry cough and suffered a recurrence of PTE. Serum EPO levels (RIA) decresed significantly, from a mean of 15.6+/-6.7 to 8.7+/-3.8 mU/ml at 2 month (p<0.05), although the values were within the normal range for our laboratory. Regardless of pre-enalapril EPO level, the HCT normalized in all patients. Mean arterial pressure decreased (105.2+/-14 vs. 97.2+/-12 mmHg, p<0.05) at 12th month. Serum creatinine did not change (1.4+/-0.3 vs. 1.5+/-0.4 mg/dl) during the study period. No patient required phlebotomy after starting enalapril. We conclude that enalapril administration resulted in a reversible decline of HCT to normal levels in renal transplant recipients with PTE. Clinically, enalapril is a safe and effective alternative to traditional treatment of PTE.
Ambulatory Care ; Arterial Pressure ; Cough ; Creatinine ; Cyclosporine ; Diuretics ; Enalapril* ; Erythropoietin ; Female ; Hematocrit ; Humans ; Incidence ; Kidney ; Kidney Transplantation* ; Living Donors ; Male ; Nephrectomy ; Peptidyl-Dipeptidase A ; Phlebotomy ; Polycythemia* ; Prospective Studies ; Recurrence ; Reference Values ; Transplantation

BACKGROUND: To evaluate the success rate of balloon dilation and the factors possibly influencing the outcomes of balloon dilation for the ureteric strictured portion of ureteroureterostomy (UUS) site in patients with post-gynecologic surgeries.METHODS: A single institution data base was screened for the patients who received balloon dilation for a treatment of ureteral stricture diagnosed after gynecologic surgery. Overall 114 patients underwent primary intra-operative UUS due to ureteral injury during gynecologic surgery. Among them, 102 patients received balloon dilation, and their medical records were retrospectively reviewed. Success of balloon dilation was defined as the condition that requires no further clinical interventions after 6 months from balloon dilation.RESULTS: The ureter injury rate of women treated with open radical abdominal hysterectomy was highest (32 cases, 31.4%). 60 patients (60.8%) showed successful outcomes regarding dilation. All patients underwent technically successful dilation with a full expansion of balloon during the procedure, but 40 patients (39.2%) were clinically unsuccessful as they showed a recurrence of ureteral stricture on the previous balloon dilation site after the first dilation procedure. Univariate logistic regression analyses showed that stricture length >2 cm was a significant predictor of successful dilation (odds ratio, 0.751; 95% confidence interval, 0.634–0.901; p-value, 0.030), but it failed to achieve independent predictor status in multivariate analysis.CONCLUSION: Balloon dilation can an effective alternative treatment option for strictured portion of the primary UUS in post-gynecologic surgery patients when its length is < 2 cm.
Constriction, Pathologic ; Female ; Gynecologic Surgical Procedures ; Humans ; Hysterectomy ; Logistic Models ; Medical Records ; Multivariate Analysis ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Ureter

BACKGROUND: To evaluate the success rate of balloon dilation and the factors possibly influencing the outcomes of balloon dilation for the ureteric strictured portion of ureteroureterostomy (UUS) site in patients with post-gynecologic surgeries. METHODS: A single institution data base was screened for the patients who received balloon dilation for a treatment of ureteral stricture diagnosed after gynecologic surgery. Overall 114 patients underwent primary intra-operative UUS due to ureteral injury during gynecologic surgery. Among them, 102 patients received balloon dilation, and their medical records were retrospectively reviewed. Success of balloon dilation was defined as the condition that requires no further clinical interventions after 6 months from balloon dilation. RESULTS: The ureter injury rate of women treated with open radical abdominal hysterectomy was highest (32 cases, 31.4%). 60 patients (60.8%) showed successful outcomes regarding dilation. All patients underwent technically successful dilation with a full expansion of balloon during the procedure, but 40 patients (39.2%) were clinically unsuccessful as they showed a recurrence of ureteral stricture on the previous balloon dilation site after the first dilation procedure. Univariate logistic regression analyses showed that stricture length >2 cm was a significant predictor of successful dilation (odds ratio, 0.751; 95% confidence interval, 0.634–0.901; p-value, 0.030), but it failed to achieve independent predictor status in multivariate analysis. CONCLUSION Balloon dilation can an effective alternative treatment option for strictured portion of the primary UUS in post-gynecologic surgery patients when its length is < 2 cm.

BACKGROUND AND OBJECTIVES: Biochemical markers are useful for the prediction of cardiac events in patients with acute coronary syndrome (ACS). The N-terminal fragment of the BNP prohormone (NT-proBNP), which is synthesized by cardiac ventricles in response to increased wall stress, may be a prognostic marker in ACS. The relation between the NT-pro BNP levels on admission and major adverse cardiovascular events (MACEs) were assessed in a cohort of patients with ACS. SUBJECTS AND METHODS: Between October 2002 and April 2004, blood samples for the determination of NT-proBNP level were obtained on admission from 78 patients with ST-elevation myocardial infarction (STEMI), 32 with non-ST elevation MI(NSTEMI) and 66 with unstable angina (UA). Patients were followed concerning MACEs (death, MI, heart failure, stroke and revascularization) for a median of 7 months in median. RESULTS: 22 patients (13%) had events. The mean NT-proBNP level was significantly lower in the event-free survivors than in those with events (1342+/-1598 versus 6129+/-6522 pg/mL, p<0.0001). The optimal cut-off value of the NT-proBNP level using a receiver-operating-characteristic curve was 1445 pg/mL. The unadjusted risk ratio of patients with an NT-proBNP level greater than the threshold was 7.0 (95% confidence interval, 2.6 to 19.0). In a multivariate Cox regression model, including clinical background factors and other biochemical markers, the NT-proBNP level was the most powerful indicator of MACEs (risk ratio, 8.0 [95% confidence interval, 1.7 to 37.1]). The coronary angiographic Gensini score was also a predictor of prognosis in ACS (risk ratio, 3.8 [95% confidence interval, 1.0 to 14.0]). CONCLUSION: A single measurement of the NT-proBNP level on admission appears to be useful as a prognostic factor in the prediction of MACEs in patients after ACS.
Acute Coronary Syndrome* ; Angina, Unstable ; Biomarkers ; Cohort Studies ; Heart Failure ; Heart Ventricles ; Humans ; Myocardial Infarction ; Odds Ratio ; Prognosis ; Stroke ; Survivors