Steroid and azathioprine versus steroid, cyclosporine, and azathioprine therapies in primary haplo-identical living donor kidney transplantation Twenty-year experience

Achievements in short-term graft survival since the introduction of cyclosporine has not been matched by improvement in long-term graft function, and chronic allograft nephropathy remains the second commonest cause of graft attrition over time. We aimed to evaluate the long-term results of conventional immunosuppression by steroid and azathioprine in comparison with cyclosporine-based triple therapy in living donor kidney transplants. We evaluated the long-term follow-up data of 369 living related kidney transplant recipients that were on prednisolone-azathioprine immunosuppressive therapy [group 1] or triple therapy by prednisolone, cyclosporine, and azathioprine [group 2]. All recipients were followed-up for more than 10 years [mean, 240 +/- 12 months]. Comparative analyses included patient and graft survival rates, condition at last follow-up, graft rejection, and graft function. There were 130 patients in group 1 and 239 in group 2. The overall frequency of acute rejection episodes was not significantly different between the two groups. However, the proportion of patients with chronic allograft nephropathy was significantly higher in group 2 [21% versus 35%, P = .001]. Graft survival rates were 85.3% versus 92.4% at 1 year, 69.9% versus 71.9% at 5 years, and 52.5% versus 50.8% at 10 years in groups 1 and 2, respectively [P = .03]. The two groups were comparable regarding posttransplant malignancies, diabetes mellitus, serious bacterial infections, and hepatic diseases. However, hypertensive patients were significantly more frequent in group 2. Chronic allograft nephropathy was significantly higher in patients receiving cyclosporine, possibly due to the risk of drug-induced nephrotoxicity, glomerular disease recurrence, and hypertension. Nowadays, it is possible to achieve excellent calcineurin inhibitors-free regimen using newer maintenance immunosuppressive agents

Noninvasive treatment of benign prostatic hyperplasia. Where do we stand in 2005

Noninvasive treatment of lower urinary tract symptoms [LUTS] due to benign prostatic hyperplasia [BPH] includes self-management and medical treatment. Self-management should be encouraged as an initial step for all men with uncomplicated LUTS/BPH. It consists of 3 elements, namely: education and reassurance, lifestyle modification of fluid intake and concurrent medical therapy and finally behavioral interventions including management of post-void dribbling and bladder retraining. If self-management fails, medical or surgical interventions are required. Further, research is required to define and test the effectiveness of self-management either as a primary intervention or to augment existing medical therapies. Benign prostatic hyperplasia patients in need of rapid onset of symptom relief and those with small prostates benefit from the use of alpha-blockers. Although 5-alpha-reductase inhibitors [5 ARIs] provide symptomatic benefits, the onsets of these are slower than those observed with the alpha-blockers. Amongst available therapies, only 5 ARIs have been shown to reduce the risk of acute urine retention [AUR] and BPH-related surgery compared to placebo. The Medical Therapy of Prostatic Symptoms [MTOPS] Study provides rational basis for combined alpha-blockers plus 5 ARIs in patients with a high index of disease progression [prostate volume >30 g and prostate-specific antigen >1.6 ng/ml]. Preliminary studies suggest that anticholinergics could be safe in LUTS/BPH and can help to alleviate irritative bladder symptoms due to overactive bladders commonly associated with BPH

placebo-controlled double-blind study of tadenan the treatment of benign prostatic obstruction

This study was carried out to report the experiment with tadenan [a plant extract of Pygeum africanum] in the treatment of men with symptomatic benign prostatic hyperplasia [BPH]. 100 patients with symptomatic BPH were enrolled into this study. In a double-blind prospective randomized manner, the patients were divided into 2 equal groups receiving either Tadenan 25 mg or an identical-looking placebo. The patients were asked to take 2 capsules at morning and evening for 8 weeks. The patients were assessed by calculation of symptom score, physical examination, uroflowmetry tests, measurement of post-voiding residual urine and transrectal ultrasonography. These studies were performed before treatment, at the end of the 8-week course of treatment and 8 weeks after treatment. If compared with pretreatment values, patients of both Tadenan and placebo groups showed a significant improvement in the total Boyarsky score, a significant increase in the peak flow rate, and a significant reduction in the post voiding residual urine. However, the changes in all of these parameters were comparable in patients of both groups at the end of the treatment and 8 weeks after treatment. The prostatic weight showed no change after treatment in both groups