Neurologic complications of renal transplant.

OBJECTIVES: Neurologic problems have a major effect on the survival and quality of life in renal transplant recipients. This study sought to review the incidence and character of neurologic complications after renal transplant. MATERIALS AND METHODS: Medical records of 319 renal transplant recipients admitted to the Transplant Outpatient Clinic were reviewed retrospectively for neurologic complications. RESULTS: Of the 319 transplant recipient patients reviewed, 124 patients (39%) were women and 193 patients (61%) were men. The mean patient age was 41 ± 11 years, and the transplanted kidney was received from deceased donors in 161 patients (51%) and living donors in 158 patients (49%). There were 50 patients (16%) who had neurologic complications, most commonly herpes zoster infection associated with immunosuppressive medication. Only 1 patient, who had glioblastoma multiforme, died. Treatment included corticosteroids in 296 patients (93%) and calcineurin inhibitors (including tacrolimus) in 111 patients (35%). CONCLUSIONS: Neurologic complications are common after renal transplant. Most complications are associated with immunosuppressive medications.

An unusual complication of immunosuppression in myasthenia gravis: progressive multifocal leukoencephalopathy.

We present a 44-year-old female patient with generalised myasthenia gravis who developed progressive multifocal leukoencephalopathy. She was receiving high dose corticosteroids, azathioprine 200mg daily and high dose intravenous immunoglobulin during relapses. Two months after thymectomy she presented with progressive cognitive decline, asymmetric quadriparesis and ataxia. Two months later she was bedridden. Cranial MRI showed large asymmetric T2 and FLAIR hyperintense lesions in cortical and subcortical structures. Positive CSF PCR of JC virus confirmed the diagnosis. The patient survives with severe sequela which confirms slow progression as typical in nonAIDS cases. This is the second case of progressive multifocal leukoencephalopathy in a myasthenic patient.

Carpal tunnel syndrome in the Turkish steel industry.

AIM: Certain occupations are reported to be associated with a high risk for carpal tunnel syndrome (CTS). In this study, we investigated the development of CTS in iron-steel industry workers. METHODS: Subjects were recruited from a factory of 650 workers and assessed by means of history, physical examination and electrophysiological testing. RESULTS: Seventy-nine subjects from the factory and 53 healthy controls with occupations unrelated to heavy physical work were assessed. None of the worker group had electrophysiological evidence of CTS. One subject in the control group has electrophysiological evidence of CTS. In the worker group, all sensory nerve conduction velocities and ulnar nerve action potential amplitudes in both hands and distal motor latencies were statistically different. CONCLUSIONS: In our study, among a group of heavy labourers, no cases of CTS were detected. However, all electrophysiologic parameters of workers were different from controls. Our results point to a diffuse, but subclinical injury of peripheral nerves under heavy physical work conditions, instead of a local effect such as CTS.

Avascular necrosis of the bones: an overlooked complication of pulse steroid treatment of multiple sclerosis.

The most common cause avascular osteonecrosis (AVN) is corticosteroid medication. However, the impact of pulse steroid therapy on AVN development is not known properly. We intended to investigate the effect of this therapy on AVN development in multiple sclerosis (MS) patients. MS patients without AVN, chronic alcoholism, thrombophilia, sickle cell anemia, inflammatory bowel disease, cytotoxic drug usage history participated in the study. All of the patients were ambulatory (EDSS < 4). Thirty-three MS patients who received pulse steroid therapy at least 10 g or at least 15 g during the course of the whole disease, were the treatment group and 27 MS patients who did not receive any steroid therapy were the control group. There was no statistical difference between groups for age, sex and disease duration. Bilateral femoral magnetic resonance imaging (MRI) was performed to the both groups. In the treatment group, five patients (15.5%) had AVN whilst no AVN was found in the control group. In conclusion, it is interesting to find AVN at such a high rate in the MS patients who received pulse steroid therapy without any AVN history or complaint. The neurologists have to be more careful about AVN which early diagnosis is important to prevent the complications.