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Numerous studies have shown that osteoporosis is common in kidney transplant recipients. However, the change in bone mineral density after kidney transplantation (KT) is not fully understood.Thirty-nine kidney transplant recipients with bone densitometry at pretransplant and 24 months after KT were reviewed.The recipients' median age (44.5 ± 10.7 years) and dialysis duration before KT (4.2 ± 3.4 years) were recorded. The T-scores of the lumbar spine and femur neck at 24 months after KT were positively associated with the respective pretransplant T-score (P .001 in the lumbar spine and P .001 in the femur neck). However, the T-score after KT did not show significant change (P = .680 in lumbar spine, P = .093 in femur neck). Changes in the T-scores of the lumbar spine and femur neck over 24 months (delta T-score) were negatively associated with the respective pretransplant T-scores (P = .001 in lumbar spine, P = .026 in femur neck). Changes in the T-scores of the lumbar spine and femur neck over 24 months (delta T-score) were also associated with the pretransplant T-scores after the adjustment of other variables.The change of bone mineral density was related with pretransplant bone mineral density. Careful follow-up of bone densitometry for KT recipients was needed.

Arterial stiffness is associated with cardiovascular disease in end-stage renal disease (ESRD) and after kidney transplantation. We examined how kidney transplantation influences brachial-ankle pulse-wave velocity (baPWV) in ESRD patients.The prospective observational study enrolled 67 patients who underwent successful kidney transplantation. Serial baPWV and biochemical parameters were measured before surgery and 6 months, 1 year, and 2 years after transplantation.baPWV prior to kidney transplantation and 6 months, 1 year, and 2 years after transplantation was 1533 ± 261 cm/s, 1417 ± 254 cm/s, 1414 ± 285 cm/s, and 1384 ± 233 cm/s, respectively. baPWV and biochemical parameters including alkaline phosphatase, intact parathyroid hormone, and 1,25 hydroxyvitamin D improved significantly at 6 months (P .05), but there were no changes between 6 months and 2 years after transplantation. The majority of patients (73%) improved, whereas the remainder showed progression of baPWV after transplantation. Sixty-three percent of all kidney transplantation patients displayed higher baPWV than the healthy control subjects at 6 months after transplant.In the majority of patients, baPWV improved soon after kidney transplantation but overall remained higher than in the generally healthy population.

Besides the initial description of IgG4-related pancreatic disease, other sites are now commonly involved. However, occurrence of IgG4-related disease is rare in organ transplanted patients. A 57-year-old man who received a kidney transplantation presented with recurrent dyspnea on exertion. A computed tomography scan of the chest revealed bilateral interlobular septal thickening and multiple tubular and branching small nodular lesions in the right upper lobe, and mass-like consolidation of the left middle lobe. Despite no elevation of serum IgG4 level, a percutaneous core needle biopsy on consolidative mass showed interstitial fibrosis and infiltration of IgG4-positive plasma cells to be more than > 20 per high power field. After treatment with glucocorticoids and rituximab, the consolidative mass of the left middle lobe disappeared.

Numerous studies have shown that vitamin D deficiency is common in end stage renal disease patients. However, change of the vitamin D deficiency after kidney transplantation is not fully understood.Twenty-five kidney transplant (KT) recipients with serum 25-hydroxyvitamin D (25D) level, 1,25-dihydroxyvitamin D (1,25D) level, parathyroid hormone (PTH) level before and 6, 12, and 24 months after transplantation were reviewed.Serum PTH level and 1,25D level showed significant changes at 6 months after transplantation, but did not show further change at 12 months. 25D level did not increase within 6 months after transplantation. However, 25D level showed gradual increase after 6 months. The proportion of recipients with 25D deficiency (10 ng/mL) was 68%, 40%, and 28% before, 12 months after, and 24 months after transplantation, respectively. Patients with vitamin D deficiency at 24 month were younger at transplantation (37.7 ± 9.6 y vs 48.2 ± 8.0 y; P = .029) and had lower 25D level before transplantation (7.96 ± 1.74 ng/mL vs 10.59 ± 4.35 ng/mL; P = .041).25D deficiency is persistent in almost kidney transplant recipients even 12 months after transplantation, although serum PTH levels decrease and serum 25D levels increase after transplantation.

Background There is controversy regarding the best method and benefit of cardiac evaluation of asymptomatic renal transplant candidates. The positive predictive value of ischemia on a noninvasive stress test was ∼5%–10% in Kidney Disease Outcomes Quality Initative (KDOQI), American Society of Transplantation (AST), and Lisbon guidelines. We compared prediction of cardiac events with the use of simple transthoracic echocardiography versus a noninvasive stress test in asymptomatic candidates. Methods We selected asymptomatic patients with good functional capacity who would be recommended a cardiac stress test by both KDOQI and AST guidelines, we excluding those with a history of cardiovascular disease. Group A (n = 124) underwent only echocardiography, and group B (n = 41) underwent echocardiography and noninvasive stress test. We measured the incidences of cardiac events and cardiac death within 3 years after transplantation. Results The mean age of group A was 39 ± 7 and group B 40 ± 5 years. Diabetic patients among groups A and B were 8.8% (11/124) and 9.7% (4/41), respectively. The mean duration of dialysis was 2.9 ± 5 years. Only 4 group B patients showed a positive result on the noninvasive stress test, but they had no obstructive disease on coronary angiograms. The incidences of ischemic heart disease after transplantation of groups A and B were 4% (5/124) and 4.8% (2/41), respectively ( P = .88). There was no death due to cardiac events in either group. Conclusions In this study, simple echocardiography showed an ability similar to stress test to predict ischemic heart disease in asymptomatic renal transplant candidates with good functional capacity, relatively younger age, lower prevalence of diabetes, and shorter duration of dialysis.

Objective To determine the long-term efficacy and complications of sacral nerve stimulation as an alternative therapy for functional unobstructive urinary retention, often considered to be psychogenic and effectively treated by clean intermittent catheterization, but for which pelvic floor dysfunction has been recognized as a possible cause. Patients and methods Twenty patients (17 women and three men, mean age 48 years) with idiopathic, unobstructive functional urinary retention and in whom other forms of therapy had failed, had a pulse generator implanted (Medtronic, Minneapolis, MN, USA) and a sacral nerve implant. Their mean duration of symptoms was 68 months; 13 patients had chronic pelvic and perineal pain associated with their obstructive voiding symptoms. All patients were managed with clean intermittent catheterization and pharmacological therapy (α-blockers) before the procedure. All patients had a percutaneous nerve evaluation before the permanent implant, which showed> 50% improvement in their symptoms. All patients were evaluated at 1, 6 12, 18 and 24 months, then yearly thereafter. The results were assessed both subjectively by patient's symptoms and objectively by checking the postvoid residual volume (PVR) and voided volume. Results Eighteen patients were able to void spontaneously with a mean increase in voided volume from 48 to 198 mL, and a significant decrease in PVR from 315 to 60 mL. Eighteen of the patients had a ≥ 50% improvement in their symptoms and said they would recommend the therapy to a friend or relative. Complications occurred in six patients. Conclusion Sacral nerve stimulation is an effective and durable new approach to functional urinary retention, with few associated complications. Test stimulation provides a valuable tool for selecting patients.

PD were reviewed in this retrospective study. Age, gender, primary diseases, procedure, preoperative (PrO-) BMI, PrO-PNI and PrO-GNRI were examined. Postoperative 1 month (PoO1-) BMI, PoO1-PNI and PoO1-GNRI were also calculated after a month of primary operation in all cases. In 8 cases that survived more than one year without recurrence, these indexes were also calculated (PoO12-BMI, PoO12PNI and PoO12-GNRI). Results: Nine male and 2 female patients with mean age 71.1 were included in this study. The mean PrO-BMI, PrO-PNI and PrOGNRI were 22.5, 44.7 and 94.6, respectively. After one month from primary operation, PoO1-BMI, PoO1-PNI and PoO1-GNRI were 20.5, 41.1 and 86.0, respectively. In patients that survived more than one year without recurrence, PoO12-BMI, PoO12-PNI and PoO12-GNRI were 21.0, 54.7 and 102.1, respectively. Image

The mRNA expression of nucleophosmin/B23 in gastric cancers (T) and the matched adjacent "normal" gastric mucosa (N) obtained from patients without any preoperative treatment were determined. Telomerase activity was detected in tumor tissues from six of seven patients. Analysis of the adjacent "normal" gastric mucosa in the same patients revealed all seven were negative for telomerase activity. In comparing clinical data for all seven patients, the stages of cancer seemed to be associated with T/N nucleophosmin/B23 mRNA expression. Cancers of later stages seemed to have higher T/N nucleophosmin/B23 mRNA ratio. After 3–4 days of 1 mM indomethacin treatment about 60–85% of gastric cultured KATO III cancer cells exhibited the features with highly condensed nuclei and decrease in cell size. Concomitant with the increase in the percentage of KATO III cells exhibiting the morphological features of apoptosis, there was a decrease in the viability of cells as determined by exclusion of trypan blue. A decline in telomerase activity in indomethacin-treated versus untreated cells was observed over times (2–4 days). The steady-state level of nucleophosmin/B23 mRNA, as determined by the levels of radioactivity of the hybridizing bands also decreased during the indomethacin treatment. At some times after the removal of indomethacin, cell growth and telomerase activity resumed in little extent (approx. 60%). When nucleophosmin/B23 antisense oligonucleotide was included in the cell culture upon removal of indomethacin, virtually no recovery of cell growth and telomerase activity were observed.

Lung function in cases of chronic airflow obstruction (CAO) due to tuberculous destroyed lung, which is still common in Korea, has not been objectively investigated. We evaluated lung functions and postbronchodilator responses in 21 CAO patients with a forced expiratory volume in 1 s (FEV1) of 30-65% of the predicted value, and compared some of these results with those of age-, sex- and FEV1% predicted-matched patients with chronic obstructive pulmonary disease (COPD). In addition, we analyzed the lung functions of CAO patients with respect to wheezing. The forced vital capacity (FVC) (P < 0.05) and postbronchodilator FEV1 of CAO patients were lower than those of COPD patients (P < 0.05). When a positive bronchodilator response was defined as an absolute change of FEV1 (FEV1 delta(abs)) of more than 0.2 l (P < 0.05) and a percentage of initial FEV1 (FEV1 delta%init) of more than 12%, the positive rates in CAO patients were lower than in COPD patients (P < 0.05). Among the CAO patients, patients with wheezing showed lower forced expiratory flow 25%-75% (FEF(25-75%)) (P < 0.05) and higher airway resistance than those without wheezing (P < 0.05). CAO patients with wheezing were more responsive to bronchodilator than those without wheezing. Although the pathophysiology of CAO differs from that of COPD, bronchodilator therapy could be useful for treating CAO, especially in cases presenting with wheezing.