ABSTRACT
All patients referred for diarrhoea over a 2-year period were studied to determine the relative frequency of organic diarrhoea and functional disorder. One hundred and nine patients had diarrhoea of established aetiology at admission. Two hundred and one patients with diarrhoea of unestablished aetiology at admission were interviewed about symptoms, and faecal output was measured. An organic or other explanation was eventually found in 78 patients (39%), whereas the bowel symptoms were categorized as functional or transient in 58%. Chronic diarrhoea of unknown origin was seen in 3%. Only 40% of the patients referred for diarrhoea had faecal output greater than 200 g/day. A reliable differentiation between organic and functional diarrhoea based solely on history and a physical examination at admission was not possible, as the initial diagnostic guess was only confirmed in 42% of the patients. More sensitive and specific indicators of functional diarrhoea are needed before the patients can be safely classified without the need for thorough diagnostic study.
Subject(s)
Diarrhea/etiology , Feces , Medical History Taking , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Physical Examination , Predictive Value of Tests , Prospective Studies , Referral and ConsultationABSTRACT
The course of 48 consecutive cadaveric renal transplantations immunosuppressed with Cyclosporine-A (CyA) as monotherapy in 3 different doses was retrospectively analysed. CyA doses were based on clinical observations. Overall one-year graft survival was 52% and for grafts immediate diuresing 82%. A dosage schedule of 12 mg CyA/kg/day seemed to secure graft function without any side effects to the patient.
Subject(s)
Cyclosporins/administration & dosage , Graft Survival/drug effects , Kidney Transplantation , Nephritis/surgery , Adult , Chronic Disease , Dose-Response Relationship, Drug , Female , Humans , MaleABSTRACT
The clinical indications for and the timing of removal of non-functioning cadaver kidney transplants were studied in 49 of 58 kidneys which had never functioned or which ceased to function in the period 1979-1982. The reason for graftectomy was rejection in 32 cases, rejection and graft infection in eight, surgical complications in eight cases and infection in one case. Nine of the 58 failed kidney grafts were not removed. Graftectomy was performed within a week after diagnosis of graft failure in 24 of the 49 cases. The clinical indications for graftectomy were compared with the morphologic observations in the grafts. Discrepancy was greatest in regard to diagnosis of rejection and primary renal artery thrombosis. Severe complications related to graft failure aggravated the condition in 17 patients and resulted in eight deaths. Based on the findings, a management schedule is proposed. It facilitates postponement or avoidance of graftectomy and minimizes the risk of complications relating to failure of graft function.
Subject(s)
Graft Rejection , Kidney Transplantation , Postoperative Complications/surgery , Humans , Postoperative Complications/pathology , Renal Artery/pathology , Thrombosis/pathologyABSTRACT
Persistent elevation of the intestinal fraction of the alkaline phosphatase (API) as an isolated finding has to our knowledge not been reported previously. It was found in a boy followed during a period of 5.5 years. The only symptom was transient periodic fatigue observed at home, but not apparent during hospitalization. His blood type was O, RH+, Le (a-, b+) and he was a secretor of H-substance, which may be associated with rising API activity after fat-loading. In this case API was unchanged after fat-loading. Neither intestinal nor liver diseases were found, and no other cause for the elevated phosphatase activity could be demonstrated.
