Effects of recombinant human granulocyte colony‐stimulating factor on leucopenia in zidovudine‐treated patients with AIDS and AIDS related complex, a phase I/II study

Summary. Twelve male patients, eight with the acquired immunodeficiency syndrome (AIDS) and four with AIDS related complex (ARC), who had zidovudine associated neutropenia (<1 x 109 neutrophils/l) were treated with recombinant human granulocyte colony‐stimulating factor (G‐CSF) in a phase I/II study. Treatment consisted of daily subcutaneous injections with G‐CSF in a weekly increasing dose of 0·4, 2, 5 or 10 μg/kg body weight until a neutrophil count of more than 3 x 109 neutrophils/l was observed. This effective dose was continued for up to 4 weeks, followed by 4 weeks observation period without G‐CSF treatment. Two patients (both with ARC) reached target neutrophil counts at the lowest G‐CSF dose, whereas nine patients needed 2 μg/kg. One patient discontinued treatment before he reached target neutrophil counts. Mean(±SD) neutrophil counts before and after 1 and 4 weeks of effective dose treatment were 0·65(±0·188) × 109, 6·016(±2·595) x 109 and 5·54(±4·237) x 109/l respectively (P<0·01). The number of monocytes increased from 0·171(±0·113) to 0·501(±0·274) and 0·474(±0·374) x 109/l after 1 and 4 weeks of treatment (P<0·01). Other haematologic parameters did not change significantly. Two weeks post‐treatment the numbers of neutrophils and monocytes had returned to pre‐treatment values. Mild side effects consisting of bone, joint or muscle pain were observed in three patients. Two patients (both with AIDS) did not complete the study. One patient stopped treatment because of fever and malaise, attributable to a generalized cytomegalovirus (CMV) infection and one patient had to stop zidovudine treatment because of severe thrombocytopenia. We conclude that G‐CSF increases the number of circulating neutrophilic granulocytes in zidovudine‐treated patients at relatively low doses and with few side‐effects

Cardiac disease in young adult patients with end-stage renal disease since childhood: A Dutch cohort study

Background. Cardiovascular disease is the most important cause of death in patients with pediatric end-stage renal disease (ESRD). Yet, few data exist on cardiac function in these patients. We assessed the extent of cardiac abnormality and analyzed its association with potential determinants in young adult patients with pediatric ESRD in a long-term follow-up study. Methods. All Dutch living adult patients with ESRD onset at age of 0 to 14 years between 1972 and 1992 were invited for echocardiography and blood pressure assessment. Special attention was paid to evidence of left ventricular hypertrophy (LVH), diastolic dysfunction, and aortic valve calcification. We collected data on determinants by review of all medical charts. Results. Of all the 187 living patients, 140 participated in the study. Of those, 110 patients had received a transplant and 30 patients were on dialysis. Mean age was 29.2 (20.7 to 41.8) years. Left ventricular mass index (LVMI) exceeded 150 g/m(2) in 47% of all male patients and 120 g/m(2) in 39% of all female patients, both consistent with LVH. Diastolic dysfunction, defined as an early over atrial transmitral blood flow velocity (E/A ratio) <1, was found in 18 (13%) patients; 27 (19%) had aortic valve calcification. Multiple regression analysis revealed the following: a high LVMI was associated with a current high blood pressure (β = 0.46, P <0.001) and male gender (beta = 0.21, P = 0.009), a low E/A ratio with aging (beta = -0.28, P <0.001) and a glomerular filtration rate (GFR) <25 mL/min/1.73 m(2) (beta = -0.29, P <0.001), and aortic valve calcification with prolonged peritoneal dialysis (β = 0.36, P <0.001). Conclusion. Young adult patients with pediatric ESRD are at risk for LVH caused by hypertension and for aortic valve calcification. Diastolic function decreases with age and is enhanced by a current low GFR. Prolonged peritoneal dialysis may enhance aortic valve calcificatio

Myocardial contrast echocardiography for the detection of coronary artery stenosis : a prospective multicenter study in comparison with single-photon emission computed tomography.

The purpose of this study was to compare myocardial contrast echocardiography (MCE) with single-photon emission computed tomography (SPECT) for the detection of significant coronary artery disease (CAD) in patients with symptoms suggestive of CAD