Assessment of external dose indoors in Lithuania.

The aim of this paper was an assessment of external exposure indoors and its dependence on construction materials and indoor radon concentrations in Lithuanian living houses. Relationship of absorbed dose rate in air indoors and activity indexes of the most commonly used construction materials (wood, concrete and bricks) have been studied using results received in measurements done in >4700 rooms in 1995-2005. Possible connections of dose rate indoors with indoor radon concentrations are also discussed. Findings of this study helped to make an assessment of the mean value of effective dose of Lithuanian population due to external exposure indoors which is equal to 0.58 mSv y-1. The received data might also be used in improvement of quality of personal dosimetric measurements done in premises constructed of different construction materials.

Investigation of heavy metals transportation from soil to the pine tree.

The Scots pine (Pinus sylvestris L.) is the most common tree in Lithuanian forests. Research on the impact of pollutants on pines allows us to evaluate pollutants in a major part of Lithuanian forests. Heavy metals (HMs) are among the major pollutants entering forest ecosystems in different ways: in their wet and dry form they come from local or distant sources of emission by being transported from seas alongside with nutrients and sea salt, washed up from the dead plants accumulated in soil, and together with mineral particles brought by wind or water. During the period of investigation, a decrease in the Cr concentration in pine rings is seen. High Zn concentrations (in 1987--1989 Zn concentration was 27.6 mg x kg(-1)) in the pine may be caused by emissions from heavy traffic. The results have shown that Mn has the highest concentration as compared with that of other HMs in the soil around the pine (at the depth of 30-40 cm, Mn concentration is 780 mg x kg(-1)). In comparison with other HMs, Cu and Zn have the largest factor of transport from the soil to the wood (0.39 and 0.49 respectively).

Combined analysis of cytokine genotype polymorphism and the level of expression with allograft function in African-American renal transplant patients.

Cytokine gene polymorphism and expression levels were evaluated in a group of African-American patients who had undergone renal transplantation. It was hypothesized that possession of specific cytokine alleles might be influential in predisposing the recipient to allograft rejection. Thus, we sought to establish a relationship between cytokine gene polymorphism, the levels of cytokine expression, and the outcome of allograft function. Cytokine genotypes and mRNA transcript levels of IL-2, TNF-alpha, TGF-beta1, IL-10, IL-6 and IFN-gamma were determined using peripheral blood cells. Genomic DNA samples from 77 transplant recipients and 77 controls were tested by a multiplex PCR with specific primers for the above cytokines. The frequency distributions of cytokines were analyzed in respect to the clinical characterization, including delayed graft function (DGF), rejection episodes (REs) and stable graft function (SGF). The mRNA transcript level was tested both at pre- and early post-transplantation (day 1 and day 4) with primers for coding regions of the above cytokines in a RT-PCR assay. The majority of recipients with successful graft function were matched with their donors for only three out of the six HLA alleles. We have shown that the TGF-beta1 T/C G/G high producer and IFN-gamma T/A intermediate producer genotypes were associated with allograft rejection, whereas low IFN-gamma producer and high IL-10 producer genotypes were significantly protective of the allograft. There was some correlation between the TGF-beta1 high producer genotype and DGF, but it was not statistically significant. Overall, 77% of those who experienced REs carried the TGF-beta1 T/C G/G, high producer genotype as compared with 52% who experienced DGF, 39% with SGF (P<0.01, RR=2.0), and 27.3% of controls (P<0.003, RR=2.6). The IFN-gamma T/A intermediate producer genotype was found in 69.2% of patients with REs as compared with 26.8% of patients with SGF (P<0.008, RR=2.85). The IL-10, ATA/ATA low producer genotype was found in 38.5% of recipients with REs and 14.6% of recipients without REs (P<0.04, RR=0.53). Expression levels of mRNA transcript were correlated with genotype data, except for the TGF-beta1 high producer genotype where there was no significant difference between the level of mRNA transcript at pre- and post-transplantation. Low DRbeta1 and high DPbeta1 expression by recipient peripheral blood mononuclear cells before transplantation was associated with more SGF, whereas high DRbeta1 and low DPbeta1 expression at pretransplantation was associated with more REs (DRbeta1, P<0.001 and DPbeta1, P<0.05, respectively). We concluded that, dual analysis of cytokine genotype and expression levels by peripheral cells may be an important clue to understanding the contribution of the recipient's immune response to an allograft pre- and post-transplantation. Identification of peripheral markers diagnostic of rejection could allow advance anticipation of clinical outcome, and might reduce the need for tissue biopsy.

Variations of the ambient dose equivalent rate in the ground level air.

The ambient dose equivalent rate is caused by ionizing radiation of radionuclides in the atmosphere and on the ground surface as well as by cosmic radiation. Seasonal and diurnal variations of the ambient dose equivalent rate (ADER) in the ground level air are influenced by the concentration of 222Rn daughters. The 222Rn concentration in the ground level atmosphere, in turn, depends on the rate of the 222Rn exhalation from soil and turbulent air mixing. Its diurnal and seasonal variations depend on meteorological conditions. The aim of this study is to estimate the influence of variations of the rate of the 222Rn exhalation from soil and its concentrations in the ground level air on variations of ADER in the ground level air, as well as the dependence of these parameters on meteorological conditions. The 222Rn diffusion coefficient and its exhalation rate in undisturbed loamy soil have been determined. The 222Rn concentration in the soil air and its concentration in the ground level air correlate inversely (correlation coefficient is r = -0.62). The main factors determining the 222Rn exhalation from soil are: the soil temperature (r = 0.64), the difference in temperature of soil and air (r = 0.57), and the precipitation amount (r = 0.50). The intensity of gamma radiation in the ground level air is mostly related to the 222Rn concentration in the air (r = 0.62), while the effect of the exhalation rate from soil is relatively low (r = 0.36). It has been shown that ADER due to 222Rn progeny causes only 7-16% of the total ADER and influences its variation. The comparison of variations of ADER due to 222Rn progeny and the total ADER during several years shows that these parameters correlate positively.

Effect of poverty and other socioeconomic variables on renal allograft survival.

BACKGROUND: Socioeconomic variables including low income and noncompliance impact negatively upon long-term renal allograft survival, especially in African Americans. We sought to determine whether other socioeconomic variables contributed to noncompliance and allograft survival. METHODS: A detailed history of socioeconomic variables was made at the time of renal transplant evaluation in 450 consecutive candidates, 128 of whom (89 African American, 39 Caucasian) have thus far undergone transplantation. Variables evaluated included household income, zip code income, insurance coverage, years of education, literacy, marital status, pretransplantation compliance, and history of substance abuse as well as the usual pre- and posttransplantation demographics. RESULTS: Immunologic graft loss occurred primarily in young African Americans with income below the federal poverty level, whereas nonimmunologic graft loss was distributed across racial, income, and other socioeconomic variables. Immunologic graft loss was also associated with a greater number of HLA mismatches, lower levels of education, and noncompliance with transplant medications and follow-up visits. Recipients with gross illiteracy, however, had excellent graft survival. Pretransplantation substance abuse, but not pretransplantation compliance, was predictive of posttransplantation noncompliance. By multivariate analysis, posttransplantation compliance emerged as the single most important factor predictive of graft survival. CONCLUSIONS: Immunologic graft loss in our population is related to noncompliance with transplant medications, which occurred primarily in recipients with a pretransplantation history of substance abuse and is not related to an inability to pay for medications at the time of graft loss. A change in criteria for acceptance of transplant candidates with a prior history of substance abuse might significantly improve graft survival in this patient population.

Prospective pretransplant ultrasound screening in 206 patients for acquired renal cysts and renal cell carcinoma.

BACKGROUND: Numerous studies have reported an increased prevalence of renal cell carcinoma in association with acquired cystic kidney disease (ACKD). In 1995, the clinical practice guidelines of the American Society of Transplant Physicians for evaluation of renal transplant candidates recommend not screening for ACKD and renal cell carcinoma, on the basis of the low frequency of cancer and reported regression of ACKD after transplantation. The objective of this study was to prospectively evaluate the prevalence of ACKD and renal cancer during renal transplant evaluation. METHODS: A total of 206 consecutive adult patients evaluated for renal transplantation underwent a routine renal ultrasound. Patients with a suspicious ultrasound underwent a contrasted computed tomographic scan of the kidneys followed by excision of kidneys with solid, enhancing (>10 Hounsfield units) lesions. RESULTS: Sixty-three (30.6%) of 206 patients had ACKD, with a greater proportion being male, African-American, and dialysis-dependent for a longer duration. Eight patients (3.8%) had histologically proven localized cancer (six unilateral, two bilateral), seven in association with ACKD and one in association with autosomal dominant polycystic kidney disease. With a mean follow-up of 14 months (range, 3-33 mo), there has been no recurrence. The positive predictive value of a solid lesion on ultrasound was 100% (8 of 8 patients). CONCLUSION: With the high prevalence (3.4%) of renal cell carcinoma in association with ACKD and the concern that immunosuppression accelerates the growth of preexisting cancers, we continue to recommend ultrasound screening of the native kidneys before renal transplantation.

Recurrent nocardiosis in a renal transplant recipient.

As the case presented here illustrates, nocardiosis, like other infections in which cell-mediated immunity plays a large defensive role, can relapse after apparent cure and occasionally at times remote from the original infection. Although relapse in patients with transplants has been cited as a reason for continued prophylaxis, only a few of these cases are adequately documented. This case supports the advice of those authors who give suppressive antibiotic therapy for the duration of immunosuppression in transplant recipients recovering from infections due to Nocardia sp. Alternatively, many transplant centers are routinely using TMP/SMX chemoprophylaxis in all solid organ transplantations to prevent opportunistic infections with Pneumocystis and Listeria sp. Primary prophylaxis has also been associated with a decreased incidence of nocardial infections.

Fatal disseminated Conidiobolus coronatus infection in a renal transplant patient.

A case of fatal disseminated fungal infection due to Conidiobolus coronatus in a patient with a renal transplant is described. This organism, known to cause localized infections in otherwise healthy individuals in the tropics, is now recognized as a cause of fatal infection in immunosuppressed hosts. Histologically, localized infections are characterized by lack of vessel invasion and the presence of an eosinophilic sleeve around fungal elements, called the Splendore-Hoeppli phenomenon. The histologic findings in the present case were more typical of mucormycosis, and the correct diagnosis was established only after the organism was isolated and identified in culture.

Racial differences in the survival of cadaveric renal allografts. Overriding effects of HLA matching and socioeconomic factors.

BACKGROUND: The long-term survival of cadaveric renal allografts is lower in black recipients than in white recipients, although the one-year graft survival is similar in these racial groups. We sought to determine what factors account for this disparity. METHODS: We studied 100 consecutive recipients of primary cadaveric renal allografts (57 were black and 43 white) at least 1 year after transplantation (mean, 40 months); all had received identical immunosuppressive therapy. We evaluated differences in the cause and duration of end-stage renal disease, the number of pretransplantation transfusions, age, matching for HLA-A, B, and DR antigens, race of the donor, insurance coverage, and compliance to assess their effect on graft survival in both groups. RESULTS: Allograft survival after one year was significantly lower in black than in white patients (P = 0.025). According to univariate analysis, only the recipient's age at transplantation, the number of mismatches for HLA antigens, the type of insurance coverage, the source of referral for transplantation, and the degree of compliance correlated significantly with the rate of graft survival. The frequency of all variables that reduced graft survival was higher among the blacks. According to proportional-hazards analysis, the only factors contributing to a lower rate of graft survival were age of less than 30 years at transplantation (relative risk, 2.3; 95 percent confidence interval, 1.3 to 4.6), mismatches for all six HLA antigens as compared with three or fewer mismatches (relative risk, 5.6; 95 percent confidence interval, 3.3 to 9.6), and coverage by Medicaid or Medicare (relative risk, 2.2; 95 percent confidence interval, 1.5 to 3.2). Race had no additional effect. Noncompliance was more frequent among blacks (16 percent vs. 2 percent) and could substitute for insurance status in the model. CONCLUSIONS: When immunosuppression is equivalent in black and white transplant recipients, apparently race-related differences in the long-term survival of renal cadaveric allografts appear to be related to other factors that affect graft survival unfavorably, notably poor HLA matching and unfavorable socioeconomic factors.

Retrieval of renal function by revascularization of renovascular disease.

Renal dysfunction due to renal artery occlusive disease is potentially reversible and this diagnosis should be considered in all patients with renal failure, especially in patients with other manifestations of occlusive peripheral vascular disease, those with severe hypertension, and those over 45 or under 20 years of age at the onset of hypertension (i.e., older or younger than the usual age for onset of "essential" hypertension). Renovascular disease should also be suspected in hypertensive patients with mild to modest impairment of renal function who demonstrate a sudden worsening of renal function following administration of an angiotensin-converting enzyme inhibitor. Effective and safe techniques for renal revascularization are available in almost all cases to achieve greater longevity and improved quality of life, as well as to reduce the economic impact of chronic renal failure and renovascular hypertension.

Renal transplantation in Mississippi.

The present article reviews the results of cadaveric renal transplantation and organ donation in Mississippi during the years 1984-88. Patient and graft survival in cadaveric renal transplantation have continued to improve since the introduction of cyclosporine as an immunosuppressive agent. In the Mississippi Transplant Program recipients of primary cadaveric renal transplants currently demonstrate 93% patient and 82.3% graft survival rates. Despite this improvement in outcome slightly more than 1% of ESRD patients in the state undergo transplantation annually compared to 7.5% nationally.

Captopril-associated acute interstitial nephritis.

A 57-year-old male with mild impairment of renal function secondary to diabetic glomerulosclerosis developed acute renal failure (creatinine 32.4 mg/dl) associated with a generalized desquamative skin rash and peripheral eosinophilia shortly after initiation of antihypertensive therapy with captopril. An acute interstitial nephritis was demonstrated on renal biopsy, and improvement was temporally related to initiation of therapy with prednisone. A review of the literature revealed 5 similar cases in whom acute deterioration of renal function occurred following initiation of captopril and in whom there were features of a hypersensitivity reaction, including skin rash, fever, eosinophilia, azotemia, eosinophiluria, and a Coombs-positive hemolytic anemia. Renal biopsy, where available, revealed an acute interstitial nephritis. Observations from these cases suggest that, of the angiotensin-converting enzyme inhibitors, this syndrome appears to be specific for captopril, begins within the 1st month of therapy, is not dose-dependent, and generally resolves on cessation of therapy. Steroids may hasten recovery, but sufficient data are not available to confirm their efficacy.

Anti-class II antibody production prolongs renal allograft survival.

It is widely accepted that transfusions are beneficial to the outcome of renal allotransplantation. Whereas some investigators suggested that transfusions may induce both specific and nonspecific suppression of the cell-mediated immune response, others disagree. To lend clarity to this discrepancy, we collected 40 serum samples before and after blood transfusion therapy of first-time cadaveric renal allograft recipients and evaluated each for T cell and B cell cytotoxic antibodies using an Amos modified complement-dependent microlymphocytotoxicity assay. When greater than 10% of the panel cells reacted with a grade 4 or better, the panel was considered significant, and when a lymphocyte specificity was lysed by antibody-rich serum greater than 50% of the time, the antibody was considered specific. Control T and B cell PRA assays employed sera from 27 normal nontransfused volunteers of similar age and sex. Survival distributions of differences in the PRA before and after blood transfusions and posttransfusion PRA levels were compared using the Gehan generalized Wilcoxon test. Other factors which influence allograft survival such as HLA-A, -B and -DR matches, number of blood transfusions, immunosuppressive therapy, age, sex, parity, previous positive crossmatch, circulating cytotoxic antibodies matching the graft, prior dialysis, length of time on the waiting list, lapse of time between transfusion and transplantation and the underlying primary diagnosis were also considered using the Gehan generalized Wilcoxon test or the chi 2 approximation. Transfusion-related B cell cytotoxic antibodies, HLA-DR monospecific or multispecific antibodies and HLA-A, -B matching extended graft survival in a significant manner. Sex influenced the production of B and T cell transfusion-related cytotoxic antibodies with females producing greater quantities of antibodies than males. Parity and the production of monospecific or multispecific antibody were associated with an increase in transfusion-related B cell cytotoxic antibody. A difference in sex was not linked to the production of monospecific or multispecific HLA-DR antibodies. The majority of males failed to respond to multiple blood transfusions with the production of B cell cytotoxic antibodies although more than half were successfully grafted. All females and males who responded with the production of B cell cytotoxic antibodies monospecific or multispecific, with the exception of 1 female, demonstrated an allograft survival of greater than 1 year. In conclusion, differences between pre- and post-transfusion B cell PRAs and monospecific or multispecific HLA-DR antibodies identified in patient sera following transfusions were good predictors of renal allograft survival in both males and females.(ABSTRACT TRUNCATED AT 400 WORDS)

Treatment and prevention of basal cell carcinoma with oral isotretinoin.

Twelve patients with multiple basal cell carcinomas resulting from varying causes were treated with high-dose oral isotretinoin (mean daily dosage: 3.1 mg/kg/day) for a mean of 8 months. Of the 270 tumors monitored in these patients, only 8% underwent complete clinical and histologic regression. All patients developed moderate to severe acute toxicities, leading five patients to withdraw from the study. Retinoid skeletal toxicity was identified in two patients who were examined after long-term therapy. Lower doses of isotretinoin (0.25 to 1.5 mg/kg/day) were ineffective for chemotherapy but demonstrated a chemopreventive effect in a subset of three patients who received these lower doses for 3 to 8 years. Two of these three patients have been observed after discontinuation of therapy. In one patient with a history of arsenic exposure, only one new tumor has appeared in a 27-month posttreatment observation period; in the other patient with the nevoid basal cell carcinoma syndrome, 29 new tumors have appeared within a 13-month period. This suggests that the need for long-term maintenance therapy with isotretinoin for chemoprevention of basal cell carcinoma may depend on the underlying cause of the skin cancers.

Plasma kinin levels in acute renovascular hypertension in dogs.

The role of kinins in the hypertensive response to acute renal artery constriction (RAC) was examined in the dog. RAC resulted in an increase in systemic arterial pressure (SAP) from 144 +/- 6 to 155 +/- 4 mm HG (p less than 0.05). Simultaneously, arterial plasma bradykinin decreased from 2.3 +/- 0.2 to 1.4 +/- 0.1 ng/ml (p greater than 0.01), while renal venous bradykinin remained unchanged (2.3 +/- 0.2 to 2.0 +/- 0.4 ng/ml, p greater than 0.05). At the same time urinary kallikrein decreased from 55 +/- 6 to 33 +/- 4 milliesterase units (mEU)/min (p less than 0.05), while urinary kinin decreased from 3.2 +/- 0.4 to 1.9 +/- 0.3 ng/min (p less than 0.05). There was a significant correlation between the decrease in arterial bradykinin and the rise in SAP induced by RAC (p less than 0.01). Administration of the dipeptidyl hydrolase inhibitor SQ20881 during RAC reduced angiotensin-converting enzyme levels from 578 +/- 86 to 10 +/- 0.0 mU/ml (p less than 0.005). There was an associated increase in arterial bradykinin (1.4 +/- 0.1 to 5.8 +/- 0.8 ng/ml, p less than 0.001), renal venous bradykinin (2.0 +/- 0.4 to 5.7 +/- 0.5 ng/ml, p less than 0.005), and urinary kinin (1.9 +/- 0.3 to 5.0 +/- 0.7 ng/min, p less than 0.01) in conjunction with return of SAP to control levels. Urinary kallikrein, however, remained depressed following SQ20881 (33 +/- 4 to 30 +/- 5 mEU/min, p greater than 0.05). These results suggest that (1) decreases in circulating BK may potentiate the vasoconstrictor effect of angiotensin II and contribute to the hypertension induced by RAC, and (2) urinary kallikrein is an unreliable marker of changes in plasma bradykinin in this model of hypertension.

Epidemic hemorrhagic fever with renal syndrome. A broadening horizon.

A virus identical to or closely related to the viruses of the epidemic hemorrhagic fevers and/or nephropathia epidemica has been demonstrated serologically in rats from geographically separate areas of this country by three groups of investigators. This information suggests a previously unrecognized health threat that should be considered in the differential diagnosis of patients initially seen with febrile illnesses and acute renal failure. The salient features of these viral diseases and the clues that should alert the clinician to seek serologic confirmation of Hantaan or an immunologically related virus are discussed herein.