Relationship between decreased bone mineral density and subclinical atherosclerosis in postmenopausal women.

OBJECTIVES: The study aimed to compare measurements of coronary artery calcification (CAC) and bone mineral density (BMD) in postmenopausal women. METHODS: The CAC of the women was measured with electron beam tomography using a GE Imatron C150 XP EBT scanner. Subjects with calcium scores above 0 were classified as CAC(+); those without detectable coronary calcium were classified as CAC(-). BMD was measured by dual-energy X-ray absorptiometry (DEXA). Patients were divided into two groups, depending on the T scores of their lumbar spine, into those with normal bone and those with osteopenia-osteoporosis. RESULTS: The proportions of patients classified as CAC(+) were 20% in the normal group and 60% in the osteopenia-osteoporosis group (p = 0.037). BMD values in L1-4 were 1.13 +/- 2.29 and 0.98 +/- 2.79 g/cm(2) in the normal group and osteopenia-osteoporosis group, respectively and the mean total CAC scores were 1.34 +/- 1.2 and 69.0 +/- 20.5, respectively. The CAC scores of patients with osteopenia-osteoporosis were significantly higher compared with those of the normal group (p = 0.014). CONCLUSION: The study shows that postmenopausal women with decreased bone mineral density may have higher risk of subclinical coronary atherosclerosis.

Comparison of the effects of amlodipine and verapamil on autonomic activity in hypertensive patients.

Background: Many studies have shown that autonomic activation is one of the major factors in the etiology of hypertension. Furthermore, sympathovagal imbalance may be responsible for arrhythmias and sudden cardiac death. The aim of the present study was to compare and to evaluate the effects of short-term therapy with amlodipine and verapamil on heart rate variability (HRV) in patients with essential hypertension. Methods: Forty patients with essential hypertension (11 men and 29 women, mean age 50.5+/-10.4 years) were included in the study. Patients with cardiac, metabolic, or any other systemic disease were excluded. Patients were randomized to receive either amlodipine (10 mg; n=20) or verapamil (240 mg; n=20). Patients underwent 24-h Holter monitoring assessment before treatment and after the 4-week treatment period. Standard deviation of normal RR intervals (SDNN), standard deviation of all 5-min mean normal RR intervals (SDANN), square root of the mean of the sum of the squares of differences between adjacent RR intervals (r-MSSD), and pNN50 (time domain variables) and TF, high-frequency power (HF), low-frequency power (LF), and sympathovagal balance (LF/HF; frequency domain variables) were analyzed before and after treatment. Results: Blood pressure (BP) was reduced to a similar degree, from 182/104 to 128/85 mmHg with verapamil and from 174/100 to 124/86 mmHg with amlodipine (verapamil p<0.001; amlodipine p<0.001). This study revealed that amlodipine had no significant effect on any of the time or frequency domain parameters. In contrast, in patients on verapamil, there were significant increases in all time domain parameters, and the LF/HF ratio was significantly decreased (p<0.05). Conclusions: These results suggest that verapamil may have additional positive effects on sympathico-parasympathetic control beyond lowering blood pressure compared with amlodipine, even after short-term treatment in hypertensive patients.

Kidney transplantation from elderly living donors.

Because of the inadequate numbers of organ donors, transplant surgeons are obliged to search for new horizons. Also, traditional beliefs are changing. The shortage of organs for transplantation, has led us to try certain arrangements so that suitable elderly organ donors may be included, as in many other transplant centers. We have now done 34 kidney transplantations from living related donors, who were 60 years of age and older. Donor-specific transfusions and low-dose triple drugs were used for all recipients. The overall patient survival was 97.5% and graft survival was 85.29%. In the light of these results we conclude that elderly living donor kidneys can be used satisfactorily with low-dose triple therapy.

Treatment of steroid-resistant renal allograft rejection with OKT-3 and plasmapheresis.

The murine monoclonal antibody (OKT-3) and plasmapheresis therapy were applied in combination to treat acute renal allograft rejection in 31 patients who were not responsive to conventional bolus steroid treatment. Six of them were living related but ABO incompatible; another 25 patients were ABO compatible (1 was from a cadaver, 7 were from living unrelated donors, and 17 were from living related donors). Of these 31 patients, 25 (80.65%) showed perfect improvement in their graft function. These 25 patients had a mean follow-up time of 8 months, and had mean creatinine values of 1.2 mg% (0.8-2.8 mg%). It is concluded that OKT-3 and plasmapheresis combination therapy is very effective in reversing steroid-resistant rejections in high-risk patients such as ABO-incompatible cases.

ABO-incompatible kidney transplantation with donor-specific skin graft.

From November 3, 1975, to May 31, 1989, 711 (548 living-related and 163 cadavers) kidney transplantations were performed in our centers. In the final 2 years, 15 ABO-incompatible living related kidney transplantations were performed. In 4 cases, the recipient's blood groups was O and the donor's A1. In 3 cases the blood group of the recipient was A1 and the donor's AB, two patients were B with the donors A1 and the other 2 were O with donors B. The other 3 recipients group was B and the donors' were AB. The donors' and recipients' HLA-AB typing showed one haplotype matching in 12 and two haplotypes matching in 3 patients. The donors were mothers in 7 cases, sibling in 5, and father in 3 cases. At least 3 weeks before the renal transplantation, donor-specific skin grafts and subsequently splenectomy were performed on 9 recipients, but on 6 recipients without splenectomy. Following the skin graft, cross-match was done starting from the 15th day and then continued every week. The immunosuppression, which consisted of triple drugs (0.5 mg/kg prednisolone, 2 mg/kg cyclosporin-A and 2 mg/kg azathioprine) was followed by skin graft. Renal transplantation was performed according to cross-match and skin graft results, and all recipients prior to surgery received at least two sessions of plasmapheresis. Regular dose of immunosuppression that included triple drugs were used after the kidney transplantation and then Orthoclone OKT-3 and plasmapheresis were applied during the rejection episodes without bolus therapy. All patients were followed for 5 to 24 months (ave. 14,13 months).(ABSTRACT TRUNCATED AT 250 WORDS)