Cytokine gene polymorphisms in renal transplant recipients

OBJECTIVE

Acute rejection remains an important cause of graft loss after renal transplantation, and cytokines are key mediators in the induction and effector phases of all immune and inflammatory responses. However, the influence of gene polymorphisms on the functional immune response of transplant recipient outcomes remains controversial.

MATERIALS AND METHODS

The amplification refractory mutation system polymerase chain reaction was used to detect the interleukin-10 (IL-10) (-1082 G/A), tumor necrosis factor-alpha (TNF-alpha) (-308 G/A), and interferon-gamma (IFN-gamma) (+874 T/A) single nucleotide polymorphisms in 100 of the first adult kidney recipients at our institution who were receiving cyclosporine-based immunosuppressive therapy. The diagnosis of acute rejection was based on clinical and histologic findings according to the Banff criteria.

RESULTS

The results of multivariate analyses showed no significant association between episodes of acute rejection and single nucleotide polymorphisms in IL- 10, TNF-alpha genes, or dinucleotide repeat polymorphisms in the IFN-gamma gene.

CONCLUSIONS

Our results demonstrate that cytokine gene polymorphisms did not influence the early outcome of kidney transplantation.

Surgical management of carotid body tumours: a 24-year surgical experience

BACKGROUND

Carotid body tumours (CBT) are rare tumours, best treated by complete surgical resection. However, there is no uniform agreement on the method of resection. The aim of this study was to review our 24 years' experience of meticulous subadventitial excision of CBT.

METHODS

A retrospective study, from March 1980 to September 2004 of patients with CBT was undertaken, detailing presentation, diagnosis and treatment and postoperative complications.

RESULTS

Twenty-five patients (six men and 19 women) with an age range of 23-72 years had been operated on, and all were treated by surgical excision. All patients had neck mass. No patient had a positive family history. Angiography was the main method of diagnosis. All of the patients had unilateral tumours. There was no postoperative permanent neurological deficit. Temporary neurological problems developed in only four patients. External carotid artery was ligated in three patients to facilitate excision of the tumour. Surgical care limited blood loss to an average of 480 mL.

CONCLUSIONS

Subadventitial excision, carried out meticulously, allowed complete resection to be achieved in all of the patients with minimal morbidity and no surgical mortalities. This method is therefore recommended. Facilities for shunting and arterial repair should always be available.

Difficult Vascular Access in Patients With End-Stage Renal Failure

BACKGROUND/AIM

End-stage renal failure patients requiring long-term hemodialysis need a durable vascular access. The arteriovenous fistula (AVF) with its long patency rate and low complication profile is usually the first choice for vascular access creation. However, when superficial veins are not suitable for AVF creation or all have been exhausted as a result of repeated AVF procedures, arteriovenous grafts (AVGs) using expanded polytetraflouroethylene (ePTFE) is an alternative. This study reviewed our experience in using PTFE AVGs for vascular access in patients requiring chronic hemodialysis.

MATERIALS AND METHODS

In a prospective study, from September 2002 to October 2004, 21 PTFE AVGs were placed in 21 patients. We evaluated the complications and patency.

RESULTS

There were 12 female and nine male patients of mean age 58+/-8.7 years (range=45 to 76 years). Nine patients (43%) had hypertensive nephrosclerosis, 6 (29%) diabetic, 2 (10%) glomerulonephritis, 3 (14%) systemic lupus erythematosis requiring long-term steroids, and 1 (4.7%) unknown cause. The patency rate at 24 months was 85.7%. Complications included graft thrombosis (three; 14.3%), wound infection (three; 14.3%) and graft infection (one; 4.8%).

CONCLUSION

ePTFE AVGs offer reasonable patency and serviceability rates as a vascular access modality, but in view of their complication profile, the native vein arteriovenous fistula should continue to be the first choice for vascular access for patients requiring chronic hemodialysis.

Hypoglycemia, the first presenting sign of hepatocellular carcinoma

Hypoglycemia is a well-known paraneoplastic manifestation of hepatocellular carcinoma usually occurring in the terminal stages of the disease. However, during initial presentation this manifestation is uncommon. We report a 77-year-old man who presented with signs and symptoms of severe hypoglycemia for example drowsiness. After clinical work-ups, we detected a large mass in the liver. Interestingly, after surgical excision of the tumor, the attacks of decreased level of consciousness and hypoglycemia seized.