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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The long term complications of renal transplantation were assessed in 36 patients who had lived for 10 or more years with a functioning renal transplant. Thirty-three patients were alive with a mean plasma creatinine of 0.13 mmol/L (SD 0.07). A 62 year old women died from a myocardial infarction 11 years after transplantation and two women developed chronic rejection and returned to dialysis after 17 years. Nineteen patients have required antihypertensive therapy, five have suffered ischaemic heart disease and two a cerebrovascular event. Malignancy has developed in 13 patients, with four having two or more organs involved. Skin cancers (9 squamous cell, 4 basal cell) were present in all 13 patients and recurred in six. The other malignancies included carcinoma of cervix (2), cervix and bladder (1) and thyroid (1). Three patients have required parathyroidectomy for autonomous hyperparathyroidism, two splenectomy for hypersplenism, and one bilateral hip replacement for avascular necrosis of the femoral heads. The development of hypertension, vascular disease and malignancy are the most important long term complications after renal transplantation. Strategies must be formulated to reduce the morbidity and mortality from these causes.
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PMID:Long term complications following renal transplantation. 189 Nov 32

Health problems at a heavy metal mining Superfund site were surveyed using prevalence information from 1980-85. Current environmental exposures include lead and cadmium in drinking water, mine wastes, and surface soils. Age- and sex-specific illness rates in whites in an exposed town (Galena) were compared with similar rates in two control towns. Multivariate analyses of morbidity data examined statistically significant risk factors for relevant illness in the three towns. Mortality rates for 1980-85 for white residents of Galena and for the U.S. were compared using univariate analysis. Among residents of the three towns who had lived there at least 5 years prior to 1980, there was either a statistically significant or borderline excess reported prevalence in Galena of chronic kidney disease (females aged greater than or equal to 65), heart disease (females aged greater than or equal to 45), skin cancer (males aged 45-64), and anemia (females aged 45-64). Multivariate analyses revealed statistically significant associations of stroke, chronic kidney disease, hypertension, heart disease, skin cancer, and anemia with variables related to Galena exposure. Personal physicians were contacted to confirm the information provided by the subjects; validity was good for all reported illnesses except chronic kidney disease. A statistically significant excess of deaths from hypertensive disease (females aged greater than or equal to 65), ischemic heart disease (males and females aged greater than or equal to 65), and stroke (females aged greater than or equal to 65) was found in residents of Galena City. This study confirms that environmental agents in Galena are associated with, and may have contributed to, the causation of several chronic diseases in residents of this community. Further studies are recommended.
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PMID:Health problems in Galena, Kansas: a heavy metal mining Superfund site. 236 37

The influence of family history on DNA repair synthesis, unscheduled DNA synthesis (UDS), was assessed in volunteers with or without a family history of cancer. UDS, following treatment of mononuclear leukocytes with N-acetoxy-2-acetylaminofluorene, was measured as the incorporation of [3H]thymidine into DNA in the presence of hydroxyurea. The positive family history group (n = 71) had an average of 2.4 first-degree relatives with cancer, defined as any major cancer, excluding skin cancer: 31 participants reported that cancer occurred in both their parents. The "no family history' comparison group (n = 29) had no family history of cancer through the second degree. There was a significant reduction in UDS in cells from individuals with family history, compared to those with no family history (P greater than 0.002). This relationship was not explained by factors known to influence UDS, such as age, smoking or hypertension. We conclude that reduced UDS in mononuclear leukocytes is associated with a family history of any major cancer, and is not confined to a history of cancer of any single organ site. This conclusion is further supported by the observation that individuals (n = 13) with parents who had an earlier onset of cancer (less than 60 years) also had a significantly lower DNA repair synthesis than those (n = 18) whose parents had later diagnosis of cancer (greater than 60 years).
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PMID:DNA repair synthesis in individuals with and without a family history of cancer. 270 17

The complications of cadaveric renal transplantation in a group of 10-year survivors are presented. Fifty-two (44%) of 119 graft recipients survived more than 10 years, 48 with their original allograft. The major causes of death in the others were bacterial (24%) and other (10%) infections, cerebral (12%) and myocardial (7.5%) vascular disease. Serious morbidity in the survivors included infectious episodes (55%), skin cancer (40%), vascular disease (30%), cataracts (45%) and aseptic necrosis of bone (13%). Only six (12%) patients had no complications. Although complications were frequent, 34 patients (72%) were fully rehabilitated to work or household duties. Several recipients have become parents. Prevention of the late complications of transplantation must be aimed at reducing the known risk factors early in the course of renal failure. These include hypertension, obesity, cigarette smoking and sun exposure.
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PMID:Delayed complications of renal transplantation and their prevention. 675 92

Utilizing cause-of-death information and responses to questionnaires addressed to survivors, mortalities and health impairments in a cohort of workers occupationally exposed to pesticides were compared to occurrences in workers not pesticide exposed, over the period 1971-1977. Seventy-two percent of 2,620 pesticide-exposed workers, and 75% of 1,049 "controls", recruited in 1971-73, were accounted for either by returned questionnaire or mortality. Disease incidence rates were studied in relation to broadly defined occupational subclasses, and to serum concentrations of organochlorine pesticides (OCl) measured at the time of recruitment. Death by accidental trauma was unusually frequent among pesticide applicators. Mortalities from cancer and arteriosclerosis were not detectably different from those observed in the controls. Among survivors, dermatitis and skin cancer were unusually common in structural pest-control operators. Internal cancer was no more frequent in the intensively pesticide-exposed workers than in the controls, but it appeared to occur at an unusually high rate in workers characterized as "possibly pesticide-exposed". There were apparent associations between high serum pesticide OCl levels measured in 1971-73 and the subsequent appearance of hypertension, arteriosclerotic cardiovascular disease, and possibly diabetes. This could imply a causal role of any of the pesticidal and other environmental stresses to which these workers were exposed. The limitations of this type of followup study are discussed.
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PMID:Morbidity and mortality in workers occupationally exposed to pesticides. 739 57

To evaluate long-term benefits and risks of CyA therapy in renal transplantation, we analyzed the 10-year experience with all 59 patients who had received a first cadaveric renal graft until August 1983 and were immunosuppressed with CyA. We compared their actual graft survival with that of all 213 patients who had received a first cadaveric graft from 1967 until August 1983, but were immunosuppressed initially with azathioprine and prednisone (AzaP). For comparison of p-creatinine, proteinuria, blood pressure, lipids, uric acid and skin malignancies we evaluated the patients staying unchanged on initial therapy for 10 years (CyA = 12, AzaP = 53). RESULTS. (1) Actual graft survival at 10 years was 34% (20/59) with CyA and 27% (58/213) in AzaP treated patients (intention to treat) (P = .09 = ns). At 1 to 5 years, graft survival was 15% superior with CyA, but after 7 years the survival curve of the CyA-group has closely joined the chronic decline seen in the AzaP group. This behaviour could neither be explained by chronic CyA-nephrotoxicity nor by chronic rejection after switching from CyA to AzaP. (2) P-creatinine at 10 years was significantly (P < .03), but mildly elevated under CyA (130 +/- 52; AzaP = 109 +/- 65). (3) Proteinuria (g/d) at 10 years was not significantly different (CyA = 0.41 +/- 0.58, versus AzaP = 0.83 +/- 1.61). (4) Systolic blood pressure was higher at 10 years under CyA (152 +/- 19) than under AzaP (136 +/-) (P < .02), but diastolic pressure was not (89 +/- 10 versus 84 +/- 12; ns). Antihypertensive drug/patient was twice as high under CyA (1.25 versus 0.64 P < .02). (5) Cholesterol, triglyceride, HDL were not different. 75% of the CyA-patients were steroid free at 10 years, none of the AzaP-patients. (6) P-uric acid was not significantly different in both groups (494 +/- 192 vs 400 +/- 124), but 42% of CyA-patients were on uric acid lowering drug (given after at least one gout attack) as compared to 9% under AzaP (P < .006). (7) Seventeen percent of patients under CyA for 10 years had at least one skin cancer, not different from 15% of AzaP-patients. CONCLUSIONS. The main benefit of CyA was the better graft survival up to 5 years and the chance to stay free of steroids. The main risks of CyA were nephrotoxicity, hypertension and symptomatic hyperuricemia. No difference was found for hyperlipidemia and skin-malignancies.
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PMID:Long-term benefits and risks of cyclosporin A (sandimmun)--an analysis at 10 years. 794 Jul 65

The progress of surgical techniques and the development of more potent immunosuppressive drugs have increased the success rate of renal transplantation such that the quality of life for kidney transplant patients is at the present time superior to that for dialysed patients. However, both renal and extrarenal complications may develop. Acute rejection episodes are the main factor governing long-time renal survival and its treatment with reinforced immunosuppressive therapy may lead to severe infections. Surveillance of kidney transplant patients should include the thorough search for side effects of immunosuppressive therapy and potential drug interactions. Progressive loss of graft function is observed in the majority of patients. Cardiovascular complications, related to the increased incidence of hypertension and hyperlipidemia, remains the main cause of death in kidney transplant patients. Long-term immunosuppression also increases the incidence of cancer, in particular of skin cancer and lymphoma. Despite these potential complications, major efforts must be made to improve organ donation, as both on medical and economical grounds, renal transplantation appears to be the best method available for kidney function replacement.
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PMID:[After care following kidney transplantation]. 801 6

Although hepatic transplantation is now a well-accepted treatment modality for end-stage liver diseases there are little detailed data on the clinical profile of patients who survive beyond 1 year following transplantation. The aim of this study was to develop a cross-sectional profile on 53 adults who have survived beyond 2 years following liver transplantation. These patients have been followed for a mean of 43.5 months (range 24-84) since the time of transplant. Nineteen patients had persisting liver enzyme abnormalities, 11 due to chronic viral hepatitis (seven hepatitis C virus, three hepatitis B virus), four due to biliary disease. Two had post severe rejection, one steatosis secondary to obesity while in one the aetiology was unclear. Nineteen (36%) of patients required anti-hypertensive medications. The median doses of Prednisone, Cyclosporin and Imuran were 7.5, 300 and 50 mg daily, respectively. The mean serum creatinine was 117 +/- 27 mumol/L. However 22 (41%) had an elevated serum creatinine (> 120 mumol/L) but in only seven was the serum creatinine > 150 mumol/L. Fourteen (26%) of patients were obese (body mass index > 30) whilst 46% had a higher than recommended serum cholesterol (mean level 5.6 +/- 1.5 mumol/L). There has only been one case of internal malignancy (lymphoma) although 19 patients attend regular dermatological review for skin cancer surveillance. Forty-eight patients had a Karnofsky Score > 80. In conclusion, the vast majority of these patients have excellent clinical function but some caution is required with respect to renal function, hypertension, obesity and mild hypercholesterolaemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A follow up of 53 adult patients alive beyond 2 years following liver transplantation. 828 Aug 46

Beliefs about the extent to which health problems can be prevented reflect an understanding that preventive measures can reduce adverse health events and the level of control individuals perceive that they hold over the factors that affect their health. A population survey of 1659 people conducted in 1995 in south western Sydney, Australia, found that only child drownings, tooth decay, skin cancer, and burns and scalds were considered all or mostly preventable by more than 50% of the sample. The majority of respondents did not believe that heart attacks, cervical cancer, high blood pressure, serious road injury, lung cancer and asthma deaths were all or mostly preventable. Logistic regression analysis showed that people born in an English speaking country, those with more than 10 years of education and men were significantly more likely to recognize a number of key conditions as highly preventable. The findings suggest that, in spite of the range of prevention efforts in Australia to date, these are not matched by strong beliefs within the community that prevention is possible. Communication of the opportunities and methods for prevention needs to be improved, particularly among certain population groups. The findings also indicate a need to examine social and environmental factors which are potentially reducing confidence, and subsequently and adoption of preventive behaviours.
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PMID:Lay beliefs about the preventability of major health conditions. 1053 24

The tea plant Camellia sinesis is cultivated in >30 countries. Epidemiologic observations and laboratory studies have indicated that polyphenolic compounds present in tea may reduce the risk of a variety of illnesses, including cancer and coronary heart disease. Most studies involved green tea, however; only a few evaluated black tea. Results from studies in rats, mice, and hamsters showed that tea consumption protects against lung, forestomach, esophagus, duodenum, pancreas, liver, breast, colon, and skin cancers induced by chemical carcinogens. Other studies showed the preventive effect of green tea consumption against atherosclerosis and coronary heart disease, high blood cholesterol concentrations, and high blood pressure. Because the epidemiologic studies and research findings in laboratory animals have shown the chemopreventive potential of tea polyphenols in cancer, the usefulness of tea polyphenols for humans should be evaluated in clinical trials. One such phase 1 clinical trial is currently under way at the MD Anderson Cancer Center in collaboration with Memorial Sloan-Kettering Cancer Center. This study will examine the safety and possible efficacy of consuming the equivalent of > or =10 cups (> or =2.4 L) of green tea per day. The usefulness of tea polyphenols may be extended by combining them with other consumer products such as food items and vitamin supplements. This "designer-item" approach may be useful for human populations, but it requires further study.
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PMID:Tea polyphenols: prevention of cancer and optimizing health. 1083 21


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