[Fine-needle aspiration and puncture biopsies in the diagnosis of lesions of kidney transplants]. / Tonkoigol'naia aspiratsionnaia i punktsionnaia biopsiia v diagnostike porazhenii pochechnykh transplantatov.

270 fine needle aspiration and 41 puncture biopsies were fulfilled after 92 cadaveric renal transplantations to diagnose the status of the grafts. With the clinical and ultrasonographic data, the first method proved to be effective in diagnosing acute graft rejection in 79.9% of cases and in determining the status of graft reversibility or irreversibility, but the fine needle aspiration biopsy failed to differentiate the cellular or vascular types of the rejection. The method was also effective in diagnosing the tubular necrosis, acute cyclosporin nephrotoxicity, infectious transplant complications. The paracentetic biopsy essentially supplements the fine needle one and allows one to diagnose chronic cyclosporin nephrotoxicity and chronic transplant rejection. It appears to be the only method revealing the magnitude of graft rejection during oligoanuria caused by ischemic graft lesion. It was concluded that the results of fine needle aspiration biopsy were the most informative within the first postoperative month because later on it becomes difficult to obtain biopsy specimens adequate to interpret the results correctly.

[Experience in treating metabolic osteopathies with 1 alpha-hydroxyvitamin D3 (oksidevit)]. / Opyt lecheniia metabolicheskikh osteopatii 1 al'fa-gidroksivitaminom D3 (oksidevitom).

The action of 1 alpha-hydroxycholecalciferol (oxydevit) was estimated in 204 patients with renal osteodystrophy, osteoporosis of varying etiology, osteomalacia because of malabsorption, congenital rickets-like diseases. The drug was shown to be highly effective in the treatment of secondary hyperparathyroidism in uremia, steroidal and senile osteoporosis. The treatment involved replacement therapy.

[The use of recombinant erythropoietin with patients on programmed hemodialysis]. / Primenenie rekombinantnogo éritropoétina u bol'nykh, nakhodiashchikhsia na programmnom gemodialize.

The authors analyze the 6-month experience with the use of recombinant erythropoietin drugs to correct anemia in patients with chronic renal failure (CRF) on programmed hemodialysis. 7 patients received recormon, the mean dose was 26.0 +/- 6.0 Units/kg bw given subcutaneously thrice a week. 6 patients were given eprex, the mean dose was 34.6 +/- 4.8 Units/kg bw given intravenously three times a week. The control group was made up of 8 persons. The data obtained indicate that the use of recombinant erythropoietin in patients with CRF treated by programmed hemodialysis results in anemia elimination and appreciable improvement of the general health status, permitting blood transfusions to be avoided. Subcutaneous administration allows the use of the lower drug doses, being especially preferable in patients who are to undergo long treatment with maintenance doses.

[The diagnosis of cyclosporin nephrotoxicity in patients after kidney transplantation]. / Diagnostika nefrotoksichnosti tsiklosporina u bol'nykh posle transplantatsii pochki.

The authors review possibilities of thin needle aspiration biopsy of renal allotransplants in the diagnosis of cyclosporin nephrotoxicity. 151 thin needle aspiration biopsy specimens were explored in 55 patients following kidney transplantation. According to the authors, this method when applied in the early postoperative period may turn an informative one. However, if the time elapsed after operation exceeds 3 months, they recommend performing puncture biopsy of renal transplants.

[Clinico-anatomical evaluation of donor kidneys unsuitable for transplantation]. / Kliniko-anatomicheskaia otsenka donorskikh pochek, neprigodnykh dlia transplantatsii.

The authors conducted clinicoanatomical analysis of 112 donor kidneys which clinicians found to be unfit for transplantation. The procedure of preparing the donors in these cases did not differ from that commonly accepted. An essential moment was prolonged arterial hypotension (6.0 +/- 0.8 hours), in donors whose kidneys were used for transplantation it lasted 2.0 +/- 0.2 hours. Examination showed that in 90% of cases the kidneys were unfit because of congenital or acquired diseases. It is concluded that the existing clinical methods for appraising the fitness of donor kidneys are adequate.

[Changes in the spectra of lipoproteins and phospholipids in the blood serum of patients with chronic renal failure placed on programmed hemodialysis]. / Izmeneniia spektrov lipoproteidov i fosfolipidov syvorotkki krovi bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu, nakhodiashchikhsia na programmnom gemodialize.

Lipid metabolism was examined over time in patients with chronic renal failure placed on programmed hemodialysis. Altogether 22 patients were examined, with the times of dialysis treatment lasting from 6 months to 3 years. In addition to routine studies of lipid metabolism, this patients' group was assessed for changes in the spectra of lipoproteins and phospholipids. It was revealed that the content of total lipids in blood serum increased because of the rise of the content of cholesterol and triglycerides, the content of low density and very low density lipoproteins and the cholesterol coefficient of atherogeneity also rose. During typing according to Friedereichson IIA, IIB and IV hyperlipidemia types were defined. During typing of normolipidemia according to T. F. Pirogova and B. L. Dundure, alpha 3A and alpha 3C normolipidemia types were identified. According to diffuse electrophoresis in polyacrylamide gel, redistribution of lipoprotein fractions towards increase of low density lipoproteins was discovered, accompanied by the reduction of the percentage of phospholipids in these fractions.

[Treatment of severe postmenopausal osteoporosis]. / Lechenie tiazhelogo postmenopauzal'nogo osteoporoza.

The paper is concerned with the results of therapy of a severe form of postmenopausal osteoporosis in 5 patients using the combination of estrogens, 1-alpha-hydroxycholecalciferol and calcitonin. The treatment with the above drugs was accompanied by marked improvement of the general status. It was characterized by an increase in daily calcium excretion with urine, normalization of the concentration of calcium, inorganic phosphorus and serum alkaline phosphatase activity. A conclusion was made that the combined use of estrogens and 1-alpha-hydroxycholecalciferol produced a more marked clinical effect than each drug separately.

[Transplantation of pancreatic islet cell cultures in the treatment of suppurative surgical diseases in patients with diabetes mellitus]. / Transplantatsiia kul'tur ostrovkovykh kletok podzheludochnoi zhelezy pri lechenii gnoinykh khirurgicheskikh zabolevanii u bol'nykh sakharnym diabetom.

The authors have analyzed the possibility to use transplantation of the pancreatic islet cell cultures of pig embryos as a method of preoperative preparing patients with type II diabetes mellitus having pyo-surgical diseases.

[Treatment of labile forms of diabetes mellitus by transplantation of cultured pancreatic islet cells]. / Lechenie labil'nykh form sakharnogo diabeta transplantatsiei kul'tur ostrovkovykh kletok podzheludochnoi zhelezy.

The authors presented data on the transplantation of human fetal and pig pancreatic islet cell cultures to 89 patients with type I diabetes mellitus of a labile course. Allo- and xeno-transplantations of pancreatic islet cell cultures in combination with exogenous insulin administration were shown to improve the patients' general status raising their working capacity. As a result of 118 islet cell transplantations hypoglycemic comas either stopped or became milder and were better corrected. Stabilization of metabolic processes was observed in the patients. Clinicobiochemical indices and subjective signs of diabetes stabilization were observed within 12-15 months after transplantation.

[Means for decreasing the incidence of postoperative tubular necrosis in kidney transplants]. / Puti snizheniia chastoty posleoperatsionnykh kanal'tsevykh nekrozov pochechnykh transplantatov.

An analysis of the work on transplanting 264 cadaver kidneys has shown a considerable decrease of delayed functions of the transplants due to an adequate anti-ischemic defense in the donor's organism and during operation in the recipient's organism. An exact scheme of medicamentous management of the potential donors and the corresponding transfusion therapy during transplantation of the kidney has reduced the percentage of delayed functions in renal transplants from 54.4 to 25.8%.

[Renal osteodystrophy and its possible correction in patients on chronic hemodialysis]. / Pochechnaia osteodistrofiia i vozmozhnosti ee korrektsii u bol'nykh, nakhodiashchikhsia na khronicheskom gemodialize.

Results of diagnosis and treatment of renal osteodystrophy are discussed concerning 162 patients with chronic renal failure treated by hemodialysis. In most cases (15%) osteopenia and hyperparathyroidism were revealed. Roentgenologic investigation revealed metastatic calcification mostly in foot vessels, whereas microscopic study of internal organs in the lungs. The increase of calcium concentration in dialysate from 1.75 to 2.5 Mmol/l was not followed by greater calcinosis in patients with hyperphosphatemia. Uremic pruritus was treated by ultraviolet irradiation and administration of prednisolone for 3-5 days. The effect of I alpha-hydroxy-vitamin D3 was studied in 30 patients. Improvement of clinical status and, principally, relief of muscular pains in the extremities was observed as well as positive changes in blood serum biochemical indices.

[Treatment of gastrointestinal hemorrhage in patients following kidney transplant]. / Lechenie zheludochno-kishechnykh krovotechenii u bol'nykh posle transplantatsii pochki.

In 179 patients there were 218 operations of transplantation of the cadaveric kidney. Gastro-intestinal hemorrhages were found to develop in 16 of them (8.9%) at different terms after operations. Four patients were reoperated, 3 of them died. Twelve patients were treated by conservative methods. Eight patients survived. The transplant was functioning in 6 of them. Analysis of the material showed the conservative treatment to be the method of choice in gastrointestinal hemorrhages in the posttransplantation period. In such cases the transplant function should be given up for the sake of the patient's life. Before transplantation it is necessary to select a group of "high risk" patients. Part of them should be treated by hemodialysis only.

[Structure of the causes of fatal outcome and functional disorder of grafts in patients following kidney transplantation]. / Struktura prichin smertel'nykh iskhodov i narusheniia funktsii transplantatov u bol'nykh posle peresadki pochki.

The postmortem analysis of 146 kidney transplantations that have been performed in the Latvian centre for kidney transplantation from 1974 to 1980 is presented. The following three groups of complications as the direct causes of death are found: the complications of the immunosuppressive therapy, those of uncorrected arterial hypertension and uremic complications. These results indicate the necessity of a rational approach to the choice of immunosuppressant doses, the control and correction of the arterial pressure as well as an early programmed hemodialysis of patients with non-functioning transplanted kidneys.