Gastric lavage with normal saline: Effects on serum electrolytes

PubMedID: 20586149Objective: The aim of this study is to determine the intensity of changes in serum calcium, ionized calcium, and magnesium levels after gastric lavage with normal saline in patients with amitriptyline intoxication. Material and methods: In this study, thirty patients older than 16 years with the history of intoxication with amitriptyline were included. After the baseline serum calcium, ionized calcium, and magnesium levels had been measured, gastric lavage with normal saline was performed. Serum levels of calcium, ionized calcium, and magnesium were monitored at 15 minutes, 6 hours, and 12 hours. Results: Serum calcium levels decreased significantly from 9.32±0.47 mg/dL to 8.40±0.61 mg/dL (15 minutes, p<0.001), 8.92±0.54 mg/dL (6 hours, p<0.001), and 8.93±0.54 mg/dL (12 hours, p<0.001). Serum ionized calcium levels decreased significantly from 1.26±0.10 mmol/L to 1.20±0.07 mmol/L (15 minutes, p=0.004), 1.21 ±0.08 mmol/L (6 hours, p=0.024), and 1.21 ±0.08 mmol/L (12 hours, p=0.034). Serum magnesium levels decreased from 2.41 ±0.43 mg/dL to 2.04±0.25 mg/dL (15 minutes, p<0.001), 2.14±0.26 mg/dL (6 hours, p<0.001), and 2.16±0.25 mg/dL (12 hours, p<0.001). Conclusion: Our study demonstrated that gastric lavage with normal saline can cause a statistically significant decrease in serum calcium, ionized calcium, and magnesium

Comparison of two different forms of bovine-derived hydroxyapatite in sinus augmentation and simultaneous implant placement: An experimental study

PubMedID: 19885412The aim of this study was to compare two different forms of bovine-derived hydroxyapatite (HA) in sinus augmentation and simultaneous implant placement. Materials and Methods: The schneiderian membranes of 12 domestic pigs were elevated bilaterally through an extraoral approach. One sinus of each pig was grafted with bovine-derived granular HA (GHA) and the other was grafted with bovine-derived spongiosa block HA (BHA) (Unilab Surgibone). One dental implant was placed simultaneously into each grafted sinus. Animals were sacrificed after 6 months of healing. Primary implant stability (ISQi) and secondary implant stability (ISQf) were measured by resonance frequency analysis. Undecalcified sections were prepared for histomorphometric analysis. Results: Mean ISQi values for implants placed in sinuses grafted with BHA and GHA were 68.8 ± 5.0 and 68.2 ± 3.7, respectively (P > .05). The mean ISQf value for implants in GHA increased to 72.0 ± 5.1 and for implants in BHA decreased to 52.3 ± 8.8 (P .05). In augmented bone, mean BIC percentages were 20.6% ± 2.1% and 35.6% ± 1.8% for BHA and GHA, respectively (P = .002). Mean percentages of connective tissue were 61.9% ± 9.5% and 48.4% ± 10.7% (P = .036), new bone formation percentages were 12.8% ± 5.5% and 27.9% ± 4.6% (P = .012), and percentages of graft material around the implants were 25.3% ± 5.8% and 22.4% ± 6.2% (P > .05) for BHA and GHA, respectively. Conclusion: The form of graft material affects the osseointegration of implants in sinus augmentation and simultaneous implant placement. © 2009 by Quintessence Publishing Co Inc

Anorganic bovine-derived hydroxyapatite vs b-tricalcium phosphate in sinus augmentation: A comparative histomorphometric study

PubMedID: 23072285The choice of augmentation material is a crucial factor in sinus augmentation surgery. Bovine-derived hydroxyapatite (BHA) and beta-tricalcium phosphate (b-TCP) have been used successfully in sinus augmentation procedures. Choosing one of these materials for sinus augmentation is still controversial. The aim of this clinical study was to compare the biological performance of the new BHA graft material and the well-known synthetic b-TCP material in the sinus augmentation procedure. The study consisted of 23 patients (12 male and 11 female) who were either edentulous or partially edentulous in the posterior maxilla and required implant placement. A total of 23 two-step sinus-grafting procedures were performed. BHA was used in 13 patients, and b-TCP was used in 10 patients. After an average of 6.5 months of healing, bone biopsies were taken from the grafted areas. Undecalcified sections were prepared for histomorphometric analysis. The mean new bone formation was 30.13% 6 3.45% in the BHA group and 21.09% 6 2.86% in the b-TCP group (P=.001). The mean percentage of residual graft particle area was 31.88% 6 6.05% and 34.05% 6 3.01% for the BHA group and b-TCP group, respectively (P =.047). The mean percentage of soft-tissue area was 37.99% 6 5.92% in the BHA group and 44.86% 6 4.28% in the b-TCP group (P =.011). Both graft materials demonstrated successful biocompatibility and osteoconductivity in the sinus augmentation procedure. However, BHA appears to be more efficient in osteoconduction when compared with b-TCP

The embryonic development of Xenopus laevis under a low frequency electric field

PubMedID: 22723004The aim of this study was to determine the effects of a low frequency electric field on the early embryonic development of frogs. The embryos of African clawed toads, Xenopus laevis, were exposed to a 20-µA electric current during the cleavage stages. The developmental processes of embryos during and after electric field exposure were monitored for teratogenic effects. All the embryos continuously exposed to the electric field died without undergoing any developmental processes. However, when the embryos were exposed to the electric field for 20-min periods (four times/over 2 d), the embryos developed into both normal tadpoles (70 %) and malformed tadpoles with light edema, reduced pigmentation, or axial anomalies, such as crooked tails. After exposure, the control embryos were at development stage 35.5 (2 d 2 h), while the normal embryos of the assay group were at developmental stage 41(3 d 4 h). There was a 1 d 2 h difference between the two developmental stages, revealing the importance of that time period for embryogenesis. In conclusion, the effects of electric current on Xenopus embryos are dependent on the initial developmental stage and the duration of exposure. © The Society for In Vitro Biology 2012

Dyslipidemia and weight gain secondary to lifestyle changes in living renal transplant donors

PubMedID: 16387071We evaluated renal function, lipid profile, body weight, and physical activity of living donors in long-term follow-up after nephrectomy. A total of 121 living donors were compared with 81 healthy subjects with normal renal function and no history of any surgery or disease. Before and after donor nephrectomies, we recorded age, body weight, systolic and diastolic blood pressures, serum creatinine, creatinine clearance, lipids, and serum glucose levels of the donors. Preoperative (baseline) and postoperative (last visit) physical activities of donors and controls were evaluated through the Modified Baecke Questionnaire (occupational activities, sports activities, leisure-time activities). There were no differences between donors and controls for age (P = .772), gender (P = .927), and follow-up period (P = .564). According to baseline levels, blood pressure and serum creatinine were increased and creatinine clearance was decreased (P < .001 for all). The mean increases in body weight (P = .012), LDL (P = .004), and triglyceride (P < .001) were higher in donors than in controls. But the mean decrease in HDL was not different between controls and donors (P = .057). Indices of sports and total activities were lower in donors than in controls on the last visit (P < .001). Indices of occupational and leisure-time activities were similar on the last visit in donors and in controls (P = .126, P = .083). The alterations in total cholesterol and total activity showed significant negative correlations in donors (r = -.581, P < .001). Also, the alterations in total cholesterol and body weight showed a significant correlation (r = .25, P = .02). We followed donors together with serum lipid levels, body weight, and total physical activities as well as blood pressure and renal function tests. © 2005 by Elsevier Inc. All rights reserved

Effects of cyclosporine and tacrolimus on maintenance therapy after renal transplantation

The immunosuppressive agents cyclosporine A and tacrolimus have demonstrated efficacy in preventing acute organ rejection after renal transplantation, but no comparative studies of these 2 agents have been published. This study compared the effects of tacrolimus and cyclosporine A on the renal function, blood pressure, and serum glucose and lipid levels of patients who underwent cyclosporine A therapy and C2 monitoring or tacrolimus therapy and standard monitoring during the first 24 months after transplantation. By the end of the follow-up period, no significant difference between either treatment group was noted in the measures of creatine clearance; BUN, glucose, uric acid, and lipid levels; or diastolic blood pressure (P&gt;.05 for all), which were maintained at normal values throughout the study. Systolic blood pressure was significantly lower in the cyclosporine A group at the end of the 1st month (P&lt;.025) but this difference was not evident at months 6, 12, and 24 (P&gt;.05). These results indicate that tacrolimus and cyclosporine (when combined with C2 monitoring) were equally effective and safe in preventing acute organ rejection.FreeText:In addition to tacrolimus or Sandimmun, the immunosuppressive treatment protocol used by all patients in the study could also include prednisone (4-8 mg daily) and either mycophenolate mofetil (1-2 g daily) or azathioprine (2 mg/kg daily). Patients were also permitted to undergo concurrent antihypertensive, antidiabetic, and antihyperlipidemic therapy. Serum Sandimmun concentrations, which were targeted at 1700 ng/mL at month 1; 1500 ng/mL at month 2; 1300 ng/mL at month 3; 1100 ng/mL at months 4 through 6; 900 ng/mL at months 7 through 12; and 800 ng/mL at months 13 through 24 were measured. Serum tacrolimus concentrations, which were targeted at 15 to 20 ng/mL during weeks 1 through 2; 10 to 15 ng/mL during weeks 3 through 4; 5 to 10 ng/mL during months 2 through 12; and 5 to 7 ng/mL during months 12 through 24 were measured. At the start of the follow-up period, the patients' age, sex, donor source, treatment protocol, and history of acute rejection attacks were recorded. At the 1st, 6th, 12th and 24th months after the initiation of immunosuppressive therapy, patients underwent testing of serum glucose, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride, blood urea nitrogen, and uric acid levels; creatinine clearance and blood pressure.Patients:79 patients. Sandimmun group n=11 (8 males, 3 females; mean age, 36 ± 11.3 years; cadaver donor 3, and living donor 8), TAC group n=19 (13 males, 6 females; mean age, 32.2 ± 11.3 years; cadaver donor 5, and living donor 14). Follow-up 24 months.TypeofStudy:Comparative study on the effects of standard tacrolimus (TAC) therapy and monitoring with those of Sandimmun therapy and C2 monitoring (2 hours after Sandimmun was taken) on serum glucose and lipid levels, renal function, and blood pressure of patients who underwent renal transplantation. Prospective cohort clinical study.DosageDuration:Dosage not stated, duration 24 months.Results:All patients in both groups were also augmenting their immunosuppressive therapy with prednisone and with either mycophenolate mofetil (TAC group n=16 patients, Sandimmun group n=8) or azathioprine (3 patients in the Sandimmun group). In addition, antihypertensive drugs were currently being used by 15 patients in the TAC group and by 9 in the Sandimmun A group and antilipemic agents were used by 1 and 2 patients, respectively. Acute rejection was not detected in either of the groups after postoperative first month. Among patients in the Sandimmun group, the mean ± SD Sandimmun level was 1382.85 ± 536.29 ng/mL at month 1; 1066.43 ± 448.69 ng/mL at month 6; 774.85 ± 202.24 ng/mL at month 12; and 821.60 ± 144.17 ng/mL at month 24. Among patients in the TAC group, the mean ± SD drug level was 14.21 ± 6.83 ng/mL at month 1; 10.60 ± 5.89 ng/mL at month 6; 8.55 ± 4.66 ng/mL at month 12; and 10.67 ± 7.93 ng/mL at month 24. Throughout the 12-month follow-up period, no significant differences between the treatment groups were demonstrated in the measures of creatinine clearance; blood urea nitrogen; serum glucose, lipid, and uric acid levels; and diastolic blood pressure (P>.05 for all). Systolic blood pressure was significantly different only after the first month (P.05).ComparativeDrug:Tacrolimus, dosage not stated, duration 24 months.AdverseEffects:No evidence of hyperglycemia was demonstrated. 2 patients required drug therapy for hyperlipidemia.AuthorsConclusions:Renal transplant patients who underwent immunosuppressive therapy with either tacrolimus or cyclosporine A (the latter combined with C2 monitoring) demonstrated a normal and similar metabolic profile, well-controlled blood pressure, and no adverse effects during the 24 months following their procedure. C2 monitoring appeared to benefit patients who received cyclosporine A, who did not demonstrate the hyperglycemia or hyperlipidemia observed in other studies involving similar populations who did not undergo such monitoring.Indications:Kidney graft rejection prophylaxis in 11 patients who underwent kidney transplantation

Avascular osteonecrosis and accompanying anemia, leucocytosis, and decreased bone mineral density in renal transplant recipients

PubMedID: 21486616Background: Avascular osteonecrosis (AVN) is a complication of renal transplantation. In this study, we present 12 cases of AVN associated with renal transplantation. Methods: Renal transplant recipients (RTRs) with AVN (group I [GI]) were evaluated by using magnetic resonance imaging and blood urea nitrogen, creatinine, glucose, calcium, phosphorus, magnesium, alkaline phosphatase, parathyroid hormone, and urine analysis. We evaluated bone mineral density (BMD) of the femoral neck and lumbar vertebrae. All patients were treated with steroids, cyclosporine, or tacrolimus plus mycophenolate mofetil. Twenty-six RTRs (GII) without AVN were randomly selected as control subjects. Results: The mean ages of GI and GII, were 33.81 ± 6.72 and 34.00 ± 7.65 years respectively (P > .05). The mean interval between transplantation and development of AVN was 12.08 ± 6.48 months. Although levels of blood urea nitrogen, creatinine, calcium, magnesium, and parathyroidhormone, as well as glucocorticoid doses in the first 12 months were similar in GI and GII, there were significant differences in serum alkaline phosphatase, hemoglobin levels, and white blood cell count between GI and GII (P < .05 for each). BMD T score <-1.5 was observed in 8/9 GI and 15/26 patients in GII. All of the patients with AVN except 1, were followed with conservative measures including calcium, magnesium, and vitamin D replacement therapies, bisphosphonate, and reduced or ceased glucocorticoid treatment. Although T scores of the femoral head were similar in GI and GII, the lumbar vertebral T score was significantly lower in GI than in GII (P < .052). Conclusion: AVN developed within the first year after transplantation. Decreased lumbar vertebral BMD, which can be an indicator of glucocorticoid effect, accompanied AVN in nearly all patients. Despite the absence of renal dysfunction, increased bone destruction, anemia, and leucocytosis were coincidental or accompanying findings in our patients with AVN. © 2011 Elsevier Inc. All rights reserved

Long-term comparative results of C0 and C2 monitoring of CyA in renal transplanted patients

PubMedID: 16060128The purpose of this study was to evaluate the effects of CyA monitoring using C0 monitoring (fasting level after 12 h from last dose), and C2 monitoring (2 h after morning dose) on renal functions, lipid levels, CyA levels, and daily dosages of CyA in renal transplanted patients in the posttransplant period from the first month to the 36th month. In our center between 1992-2003, 37 of the 54 renal transplanted patients were treated with CyA, prednisolone, and mycophenolate mofetil or azathioprine. The mean age was 32.36 ± 10.32 and 35.00 ± 10.23 (p = 0.39) in C0 (M/F: 18/7) and in C2 (9/3), respectively. Cadaveric donor (d), living related d, and living unrelated d were in four patients (p), 17 p and four p in C0, and two p, seven p, and three p in C2, respectively (p = 0.79). Chronic allograft nephropathy (CAN) developed in 13 p (52%) and one p (8.3%) in C0 and in C2, respectively (p = 0.013). Creatinine clearance values were 72.31 ± 23.10 mL/min and 78.73 ± 22.42 mL/min (p:0.621) at first month, 64.97 ± 22.58 mL/min and 78.00 ± 19.90 mL/min (p:0.065) at sixth month, 56.50 ± 19.62 mL/min and 76.62 ± 21.06 mL/min (p:0.006) at 12th month, 50.28 ± 24.79 mL/min and 80.87 ± 18.24 mL/min (p&lt;0.001) at 24th month, and 55.15 ± 19.21 mL/min and 86.65 ± 14.97 mL/min (p:0.004) at 36th month in C 0 and C2, respectively. The mean daily dosages of CyA were 354.35 ± 122.63 and 266.67 ± 64.95 mg/d (p:0.031) at first month, 277.17 ± 77.94 and 250.00 ± 73.31 mg/d (p:0.228) at sixth month, 247.92 ± 58.48 and 211.36 ± 62.61 mg/d (p:0.09) at 12th month, 232.95 ± 56.90 and 170.45 ± 41.56 mg/d (p:0.003) at 24th month, and 240.63 ± 52.34 and 153.57 ± 46.61 mg/d (p:0.002) at 36th month in C0 and C2, respectively. In C2, systolic and diastolic blood pressure, uric acid, total cholesterol (C), LDL-C, and triglyceride levels were lower than those monitored with C0. In C2, HDL-C levels were also higher than those monitored with C 0. None of these patients returned to dialysis or died in this period. In conclusion, during the first 36 months with monitoring C2, preservation of renal function, control of blood pressure serum lipids and uric acid were better than those with monitoring C0. In addition, daily dose of CyA was lower in C2 method and, at the same time, this effect of C2 can be accepted as cost effective. Copyright © 2005 Taylor &amp; Francis Inc