Mycophenolate mofetil dose reduction in renal transplant recipients: a 5-year follow-up study.

OBJECTIVE: Mycophenolate mofetil (MMF), an immunosuppressant that is widely used in renal transplantation, is associated with several dose-dependent hematologic and gastrointestinal side effects that may require dose reduction or even discontinuation. The aim of this study was to compare renal allograft function and acute rejection episodes among kidney allograft recipients who were on 2 regimens of MMF for at least 5 years. MATERIALS AND METHODS: This prospective cohort of 55 kidney allograft recipients was followed for deterioration of allograft function, evidence of acute rejection, and allograft survival. Twenty-two patients (40%) underwent MMF dose reduction to 1.35 to 0.23 g/d due to perceived side effects or economic reasons (group 1). The mean time for this change was 4.2 +/- 2.1 months after kidney transplantation. The remaining patients (group 2, n = 33) were continued on MMF (2 g/d). All patients were followed for at least 5 years after transplantation. Renal function tests (blood urea and serum creatinine) were measured monthly for 2 years and then every 2 months. Statistical analysis was performed using SPSS 11.0 (Student t test). P .05); mean serum creatinine values were 1.32 +/- 0.14 and 1.38 +/- 0.21 mg/dL, respectively (P > .05). There were 2 graft losses and 1 patient loss in group 2. There were also 2 graft losses among group 1 patients. CONCLUSION: Our study showed that MMF dose reduction was not associated with an increased risk of acute renal allograft rejection or impaired allograft function at 5 years.

Transcutaneous ultrasound guided nephrolithotomy: the first report from Iran.

PURPOSE: To evaluate the safety and efficacy of transcutaneous ultrasound guided nephrolithotomy. MATERIALS AND METHODS: From December 1999 to December 2000, 12 patients with renal stone were selected for PCNL. Six patients had failed ESWL and the remainder had multiple and large stones in pelvis and lower calyx. Ultrasonography was used in 11 patients during the entrance to the system and dilatation of the tract. Entrance to the system was impossible in one case for which open surgery with dorsal lumbotomy was performed. RESULTS: The stone was removed by just one session of PCNL in 8 and the residual stone was less than 1 cm in the 3 other cases. Repeated PCNL from the same tract was performed in one case and ESWL was carried out in the other 2 cases. After three months, all of the 11 patients were stone free. CONCLUSION: It seems that ultrasonography could replace fluoroscopy in patients with dilated collective urinary system and a single large stone in calyx or pelvis.

Construction and analysis of bacterial artificial chromosome libraries from a marine microbial assemblage.

Cultivation-independent surveys of ribosomal RNA genes have revealed the existence of novel microbial lineages, many with no known cultivated representatives. Ribosomal RNA-based analyses, however, often do not provide significant information beyond phylogenetic affiliation. Analysis of large genome fragments recovered directly from microbial communities represents one promising approach for characterizing uncultivated microbial species better. To assess further the utility of this approach, we constructed large-insert bacterial artificial chromosome (BAC) libraries from the genomic DNA of planktonic marine microbial assemblages. The BAC libraries we prepared had average insert sizes of 80 kb, with maximal insert sizes > 150 kb. A rapid screening method assessing the phylogenetic diversity and representation in the library was developed and applied. In general, representation in the libraries agreed well with previous culture-independent surveys based on polymerase chain reaction (PCR)amplified rRNA fragments. A significant fraction of the genome fragments in the BAC libraries originated from as yet uncultivated microbial species, thought to be abundant and widely distributed in the marine environment. One entire BAC insert, derived from an uncultivated, surface-dwelling euryarchaeote, was sequenced completely. The planktonic euryarchaeal genome fragment contained some typical archaeal genes, as well as unique open reading frames (ORFs) suggesting novel function. In total, our results verify the utility of BAC libraries for providing access to the genomes of as yet uncultivated microbial species. Further analysis of these BAC libraries has the potential to provide significant insight into the genomic potential and ecological roles of many indigenous microbial species, cultivated or not.

Spectrophotometric determination of osmium based on its catalytic effect on the oxidation of carminic acid by hydrogen peroxide.

A highly sensitive spectrophotometric method is described for the determination of trace amounts of osmium(VIII), based on its catalytic effect on the oxidation of carminic acid by hydrogen peroxide. The reaction was monitored spectrophotometrically by measuring the decrease in absorbance of carminic acid at 540 nm after 3 min of mixing the reagents. The optimum reaction conditions were 1x10(-4) mol l(-1) carminic acid, 0.013 mol l(-1) hydrogen peroxide and pH 10 at 25 degrees C. By using the recommended procedure, the calibration graph was linear from 0.1 to 1.5 ng ml(-1) of osmium; the detection limit was 0.02 ng ml(-1); the RSD for five replicate determinations of 0.2-1.4 ng ml(-1) was in the range of 1.8-4.7%. The influence of several foreign ions on osmium determination were studied and the effect of interfering ions were removed by extracting osmium into isobuthyl methyl ketone and back extracting into sodium hydroxide solution.

True complete diphallia.

In a case of true complete diphallia, the orthotopic penis was normal in length, shape and urethra, whereas the ectopic, perianal, penis had a blind-ending urethra, the significant distance between the two making the malformation of an extremely rare type. Right renal agenesis and orthopaedic malformations were also present.