ABSTRACT
Renal transplantation is successfully implemented in patients undergoing coronary bypass surgery. We performed concomitant coronary bypass surgery and renal transplantation in a patient found to have a left main coronary artery lesion after coronary angiography, which was performed in our clinic during preoperative evaluation of renal transplantation. We suggest the application of coronary-artery bypass grafting (CABG) or stent implantation 2 months after renal transplantation in asymptomatic patients with coronary artery disease. But, if severe coronary artery disease is detected in symptomatic patients, we suggest the concurrent application CABG and renal transplantation.
Subject(s)
Coronary Artery Bypass/methods , Coronary Stenosis/complications , Coronary Stenosis/diagnosis , Coronary Stenosis/surgery , Kidney Transplantation/methods , Renal Insufficiency/complications , Renal Insufficiency/surgery , Combined Modality Therapy/methods , Humans , Male , Middle Aged , Renal Insufficiency/diagnosis , Treatment OutcomeABSTRACT
BACKGROUND: Tumor cells frequently contaminate autologous stem cell products in a variety of malignancies, but their clinical significance remains controversial. We retrospectively monitored tumor contamination in stem cell harvests from patients with Ewing family of tumors (EFT) all harboring the specific translocation EWS-FLI-1 that characterize these tumors. PROCEDURE: Twenty- seven harvests from 11 patients were included in the study. In addition, 6 and 19 bone marrow (BM) or peripheral blood (PBL) samples were available before and after transplantation, respectively, for RT-PCR and nested PCR analyzes. RESULTS: All 11 patients had contaminating tumor cells in their harvests. All samples prior to transplantation were RT-PCR positive. Two out of the 11 patients who underwent transplantation died of complications. Out of the remaining nine patients, two are alive and well 68 and 84 months from diagnosis, and are the only patients with no detectable tumor cells in their samples after transplantation. One of these patients harbored contaminating tumor cells in only one of the two harvests collected. Seven patients relapsed after transplant, and in four patients BM/PBL samples were available prior to the clinical relapse. All these samples harbored contaminating tumor cells. CONCLUSIONS: We suggest a possible correlation between the amount of contaminating cells in the harvest and relapse after transplantation. Quantitative RT-PCR studies of the chimeric transcripts are underway to explore this issue.
Subject(s)
Hematopoietic Stem Cell Transplantation , Leukapheresis , Neoplastic Cells, Circulating/pathology , Sarcoma, Ewing/pathology , Sarcoma, Ewing/therapy , Adolescent , Adult , Child , DNA-Binding Proteins/genetics , Female , Humans , Infant , Male , Prognosis , Proto-Oncogene Protein c-fli-1 , RNA, Neoplasm/analysis , RNA-Binding Protein EWS/genetics , Recurrence , Retrospective Studies , Sarcoma, Ewing/genetics , Trans-Activators/genetics , Translocation, Genetic , Transplantation, AutologousABSTRACT
The objectives of this study were (1) to examine differences in resting metabolic rate (RMR) and cardiovascular risk factors among aerobically trained (n = 36), resistance-trained (n = 18), and untrained (n = 42) young males; and (2) to investigate the influence of body composition, dietary intake, and VO2max as possible modulators of differences in cardiovascular risk among groups. Results showed that RMR, adjusted for differences in fat-free weight (FFW), was 5% higher in aerobically trained males compared with resistance-trained males (P < .01), and 10% higher than that in untrained males (P < .01). Plasma levels of cholesterol and low-density lipoprotein cholesterol (LDL-C) were comparable between resistance-trained and aerobically trained males, but were lower (P < .05) than those in untrained males. (The percent intake of dietary fat was related to plasma cholesterol [r = .32, P < .01] and LDL-C [r = .30, P < .01].) When compared with untrained males, fasting triglyceride (TG) levels were 39% and 43% lower (P < .01) in resistance-trained and aerobically trained males, respectively. When compared with untrained males, the fasting insulin to glucose ratio (I/G) was 45% and 53% lower (P < .01) in resistance- and aerobically trained males, respectively. Mean arterial pressure (MAP) was 7% lower (P < .01) in aerobically trained compared with untrained males. Statistical control for differences in percent body fat or percent intake of dietary fat diminished the differences among the groups for plasma lipids, blood pressure, and the I/G ratio. We conclude that aerobically trained and resistance-trained males have higher resting energy requirements independent of FFW compared with untrained males. Aerobically trained and resistance-trained young males have comparable and favorable cardiovascular disease risk profiles compared with untrained males, and this appears to be related to their low level of adiposity and low intake of dietary fat.
