Pa Ents Research Articles

Comparison between OPEN STONE SURGERY vs PERCUTENOUS NEPHROLITHOTOMY in Management of Renal Stones By Using S.T.O.N.E Nephrolithometry Scoring System

Abstract Background In spite of Percutaneous nephrolithotomy (PCNL) became the first-line treatment option for patients with large and complex renal stones, there still remains a need of using open stone surgery (OSS) for removal of stones as a second or third line of treatment option. To date, 3 scoring systems have been proposed utilizing different metrics including the Guy’s Stone Score, S.T.O.N.E. nephrolithometry and the Clinical Research Office of the Endourological Society (CROES) nomogram, and that used to assess and estimate the treatment success rate. Aim of the Work To evaluate and compare between OSS and PCNL in the management of renal stones by using the S.T.O.N.E. nephrolithometry scoring system to predict and assess the stone free rate and the correlation with peri-operative complications in that two procedures. Patients and Methods A total 100 patients who need surgical intervention for renal stones were treated with OSS (35 pa ents) and PCNL (65 pa ents) from January 2019 ll the end of October 2019, were invited to participate in the present study. This was a multicenter, comparative, prospective cohort controlled study. This study was controlled by the standard results recorded in the previous literatures. Only adult(>18 ys. Old) patients with renal stone size ≥ 20mm were involved in the study. Peri-operative and follow-up data included stone free rate and complications were collected for all patients and were compared between both procedures. S.T.O.N.E nephrolithometry scoring systems was applied to preoperative non-contrast computed tomography(CTUT) for all cases and compared the results of both procedures. Stone-free rate was diagnosed using early postoperative kidney, ureter, bladder X-rays(KUB) and another CTUT on the postoperative day30. Results There was a significant difference between the PCNL group and the OSS group in the primary stone free rate (90% and 97.5% respec vely, p-value=0.021), peri-operative major complications (3% and 14.3% respectively, p-value=0.033), opera ve me (123.46 ± 34.61 and 175.71 ± 55.10 respec vely, p-value=0.000) and postopera ve hospital stay (3.52 ± 0.84 and 5.23 ± 1.00 respec vely, p-value=0.000), while there was no significant difference in the intra-opera ve bleeding requiring blood transfusion (10.8% and 14.3% respec vely, pvalue=0.124). S.T.O.N.E score showed a significant difference between PCNL and OSS groups ( 7 (6-11) and 10 (7-12) respectively, p-value=0.000) and it also had a significant rela on with the outcome SFR (p-value=0.000) a er both PCNL and OSS(r= -0.581 and r= -0.567 respec vely), the higher the score, the lower the SFR and the higher the possibility of OSS choice. While this score had on relation with the peri-operative complications. Conclusion The S.T.O.N.E. nephrolithometry score was predictive of the stone-free status in both surgical procedures (PCNL and OSS) and can be used as an formal guidance for surgical planning and patient counseling. This score would be classified into two categories “low” score range from 5 to 8 recommend PCNL procedure with expec ng SFR of 88% to 97% and “high” score range from 9 to 12 recommend Open Stone Surgery with expec ng SFR of 90% to 96%, to reach the most acceptable results for each procedures to sa sfy the patient and the doctor. The S.T.O.N.E score was not associated with the peri-operative complications in both procedures.

Formation of culture of communication in the student environment of the higher medical education institution

The ar cle intensifies the idea of preparing future doctors for professional communica on with colleagues and pa ents in the context of healthcare reform and higher medical educa on. There is a discrepancy between the needs of society in highly skilled medical professionals and the lack of a high level of culture of communica on between doctors and pa ents. The concept of “communica on culture of future docors” as a personality-professional neoplasm of the personality is specified. The results of the survey of higher educa on applicants are analyzed in order to iden fy the reasons that hinder the forma on of communica on culture in the student environment. The scien fic novelty consists of the pedagogical condi ons of forming the culture of communica on of future doctors, determined by the author, as: the content and character of the teacher’s ac vity should promote the development of the communica ve quali es of higher educa on applicants; crea ng an interac ve environment that promotes a culture of communica on; the teacher has his own example of demonstra ng a high level of communica on culture both in the educa onal and in the extracurricular me. Prac cal importance is the proposals to use the educa onal and educa onal poten al of the social and humanitarian disciplines to increase the level of culture of communica on of future doctors; recommenda ons for developing and conduc ng a quest on the topic: “Ethics of doctor’s professional communica on with pa ents” for teachers and higher educa on graduates of different educa onal levels.

A method for assessing the results of survival of an auto-fat graft after lipofilling in patients with breast cancer during surgical rehabilitation

Purpose.Determine the survival of the auto-fat gra a er lipofi lling in the process of reconstruc on in pa ents with breast cancer.Paents and methods. The study included 60 pa ents who underwent lipofi lling both at the fi rst stage of recons tu on and at its fi nal stages. The ar cle describes the procedure for performing the lipofi lling procedure, monitoring and evalua on of the degree of survival of the autologous transplant.Results.As a result of the study, we determined the average survival rate of adiposessue in the recipient zone, which was 76.50% (p <0.00001), which further posi vely aff ects the subsequent stages of reconstruc on and the fi nal result as a whole.Conclusion.Given the good survival of the auto-gra , lipofi lling is part of the surgical rehabilita on of pa ents a er combined / complex / surgical treatment. The procedure is applicable in the fi rst stage of delayed reconstruc on, with the replacement of the ssue expander with a silicone endoprosthesis and as a correc ve method at the fi nal stage of reconstruc on.

Modern approaches to the diagnosis of placental insufficiency according to cardiotocography

Purpose.The goal is to determine the real possibili es of assessing the fetal condi on in the ante- and intranatal periods according to the data of cardiotocography.Paents and methods.73 pa ents with physiological pregnancy at 24-40 weeks were prospec vely examined. The prac cal signifi cance of the g6b plus General MEDITECH automated fetal monitor, which allows to determine the condi on of the mother and fetus at the same me, was evaluated.Results.The average blood pressure in the examined women was 127.2 ± 3.6 by 73.7 ± 2.3 mm. gt; pillars, pulse – 76 ± 1,5 beats/min. As for the contrac le capacity of the uterus, 47 (64,4%) pregnant women in 24–30 weeks. associated with diagnosis, and 19 (26%) – are harbingers of the forthcoming birth. The average SpO2was 99.12 ± 0.11%. Regardless of the gesta onal age, in 7 (9.6%) pregnant women – 97%, 40 (54.8%) – 99% and 21 (28.8%) – 100%. In order to assess the fetal condi on by the nature of his heartbeat, we performed an automated CTG analysis according to W. Fisher, D. Redman, FIGO: according to W. Fisher, depending on the gesta onal age of 6–7 points, 12 (16.4%) pregnant women in 25–26 weeks and 9 (12.3%) – 40 weeks, which according to the ball scale corresponds to a suspicious type. The Doze–Redman criteria were met in 47 (64.4%) pregnant women and were not met – in 26 (35.6%). Interpreta on according to FIGO guidelines as normal was detected in 64 (87.7%) pregnant women and in 9 (12.3%) – doub ul. Depending on the period of pregnancy, this group consisted of the same 9 (12.3%) pregnant women in a period of 40 weeks.Conclusion.Automated analysis allows for the correla on between the main indicators of the well-being of the maternal organism (SpO2, blood pressure, pulse, body temperature, ECG) and fetal CTG parameters (Fisher scale, Dowz Redman criteria and FIGO guidelines) to develop obstetric tac cs for each specifi c pa ent during pregnancy and childbirth.

Psychoemotional stress in somatically burdened oncological surgery patients as one of the factors of postoperative complications

Planned surgical interven ons account for more than half of all opera ons in the Russian Federa on, of which more than 20–30% are performed for oncological diseases. Characteris c is an increase in the number of operated pa ents in older age groups with severe concomitant pathology and a high percentage of postopera ve complica ons, including due to psychoemo onal pathology, which can be excluded or adjusted at the preopera ve stage.Purpose.Evalua on of the infl uence of the psychoemo onal state of the oncochirical soma cally burdened patient on the lethality and revealing the possibility of correc on of the psychoemo onal state at the preopera ve stage.Paents and methods. In the period from 2006 to 2016 in the departments of therapy and oncology of the Regional Clinical Hospital of the City Clinical Hospital No. 40 of the Moscow City Health Department, AI.Burnazyan The FMBA of Russia analyzed the treatment of 958 soma cally burdened pa ents with various oncopathology who underwent opera ve interven on in a planned manner. An analysis of the psychoemo onal state of pa ents before and aft er surgery was performed using Hamilton diagnos c scales.Results.After a retrospec ve evalua on, it was determined that prac cally all patients of the oncosurgical profi le undergo various psychoemo onal strains of varying strength and dura on, both before and after surgery. This can disrupt the blood fl ow in the organs andssues, and lead to various complica ons, which manifests itself in the form of hypoxia and ischemia, which, in turn, jus fy the development of postopera ve delirium and myocardial infarc on.Conclusions.Clear distinctions between the anxiety severity in groups on outcomes of hospitaliza on of the oncosurgical patient were determined, and the tendency of the rela onship between the level of the anxiety state and the postopera ve complica ons that had been ridden in the early postopera ve period in soma cally burdened pa ents was determined. Patients of the oncosurgical profi le without fail are shown psychopharmacotherapy in the pre- and postopera ve periods, depending on the revealed pathology.

High-intensity focused ultrasonic ablation of breast cancer

Breast cancer is the most frequent and socially signifi cant malignant tumor disease of the female popula on of the Russian Federa on. At present, for the treatment of this pathology, the methods of the organ-preserving surgical manual allowing to achieve the maximum cosme c eff ect along with the observance of the principles of cancer safety are ge ng more and more developed,. In recent decades, researchers from diff erent countries demonstrate the feasibility and technical safety of various mini-invasive methods of thermal abla on of early stages of breast cancer, characterized by rela ve simplicity of implementa on, excellent cosme c results, short-term rehabilita on of pa ents. These include hyperthermic techniques (radiofrequency, microwave, laser abla on) and hypothermic method (cryoabla on). Each technique has unique characteris cs of impact on the tumor and is performed under the control of ultrasound, computer tomography or magne c resonance imaging. The technical success of these abla on techniques is achieved in 93–98% of cases. Complete tumor necrosis a er radiofrequency abla on is observed in 76–100% of pa ents with breast cancer, laser abla on – in 13–76%, microwave abla on – in 0–8%, cryoabla on – in 36–83%. The frequency of development of specifi c complica ons of local thermal destruc on is 4–13%. To date, there is only one method of noninvasive extracorporeal thermal abla on of tumors of diff erent localiza on – high-intensity focused ultrasound therapy, the eff ec veness and safety of which as a method of local destruc on of benign and malignant tumors of the breast demonstrated by many authors. Like all methods of thermal abla on, high-intensity focused ultrasound therapy has its limita ons, complica ons and disadvantages. This ar cle presents a literary review that highlights the possibili es of this method of local destruc on in pa ents with malignant tumors of the breast.

EGFR inhibitors in the treatment of colorectal cancer

This ar cle discusses the use of EGFR inhibitors in the treatment of pa ents with colorectal cancer. The mechanisms of their ac on, speci fi c manifesta ons of toxicity are considered. A review of current literature data on the use of both approved for clinical use (cetuximab, panitumumab) and an -EGFR an bodies at the stage of clinical trials is presented. EGFR inhibitors are one of the main groups of targeted drugs used to treat pa ents with colorectal cancer. The correla on between toxicity and e ffi cacy of these drugs is discussed separately. The scope of their applica on is limited to the treatment of disseminated forms of the disease, but in the future the number of available an -EGFR an bodies may grow, the possibility of their use in new condi ons, including in the framework of chemoradiotherapy.

Comparative Evaluation of IL-16 mRNA level and rs1131445 polymorphism of IL-16 gene in Peripheral Blood Mononuclear Cells of patients with Inflammatory Bowel Diseases

Aberrant immune response in a gene cally susceptible host is acknowledged in the pathogenesis of In ammatory Bowel Diseases (IBD) including Crohn’s disease (CD) and Ulcerative colitis (UC). Here we aimed to evaluate IL-16 mRNA level, as the immune component and rs1131445 polymorphism of IL- 16 gene, as the gene c susceptibility component of IBD development in PBMC sample. A total of 97 IBD patients (13 CD and 84 UC) and 100 healthy controls were included. Peripheral Blood Mononuclear Cells (PBMCs) were extracted. Polymorphism evaluation was performed by polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP) and the results were confirmed by sequencing method. Comparative Real- time PCR method was used for IL-16 mRNA assessment. A 3.92-fold increase was observed in the expression level of IL-16 in PBMC of IBD patients compared to the controls (p<0.0001). IL-16 expression was not signi cantly di erent in di erent IBD forms and pathological phases. Distribu on of rs1131445 polymorphism was not significantly different between controls and pa ents (P=0.825). Distribu on of CC genotype was signi cantly higher in CD patients (P=0.016). Although IL-16 mRNA level was considerably lower in CC genotype, this difference was not statistically significant (p=0.537). Lower IL-16 mRNA level was observed in CC genotype of rs1131445 SNP which was not in accordance with the expectations and needs to be further investigated. These data suggest that IL-16 level could be considered as a prognostic marker in Iranian IBD patients.

Genotype-phenotype association of TGF-β1 and GST with chemo-radiotherapy induced toxicity

Background: Normal �ssue toxicity con�nues to remain as a major challenge for radia�on oncologists for delivering the total dose to the tumour cells in cancer pa�ents. Cellular, molecular and plasma based early biomarkers to predict the overreac�ons and non-overreac�ons of normal �ssue toxicity before the ini�a�on of radiotherapy can be valuable for personalised treatment. The aim of the current study was to analyse the interrela�onship between polymorphisms in Glutathione S- Transferases (GSTs) and Transforming Growth Factor-β1 (TGF-s1), the plasma level/ac�vity of these proteins with the development of chemo-radiotherapy induced oral mucosi�s and skin reac�on in head and neck cancer (HNC) pa�ents. Materials and Methods: We analysed polymorphisms in TGF-β1 and GST by restric�on diges�on of the PCR amplified products and we also assessed circula�ng TGF- β1 levels and GST ac�vity by Enzyme Linked Immunosorbent Assay (ELISA). Results: The results indicate that pre-radiotherapy plasma TGF-β1 levels and total GST ac�vity has no correla�on with radia�on induced normal �ssue skin reac�on and oral mucosi�s in HNC pa�ents. Conclusion: The selected polymorphisms in TGF-β1 and GST had no influence on TGF-β1 levels and total GST ac�vity. Plasma TGF-β1 and GST ac�vity was not affected by the presence of selected polymorphisms and lacks significance in predic�ng skin reac�on and oral mucosi�s prior to chemo-radiotherapy.

Management of Astigmatism in Cataract

With the recent advances in the instrumentation and intraocular lens (IOL) technology, cataract surgery has, over the past few years, become quite akin to refractive surgery allowing greater control over the patients’ refractive and visual outcome. Now the patients expect perfect vision after cataract surgery and surgeons strive hard to deliver the same. In this respect residual astigmatism after cataract surgery is viewed as an undesirable outcome both by the patients and surgeons. In a general cataract population, approximately 10% of patients have astigmatism with greater than 2 D of cylinder, 20% have between 1 and 2 D, and 70% have less than 1 D.1-4 Therefore one may consider treating pre-existing astigmatism in about one out of every three patients. The aim would be to leave the patient with a refractive outcome, for both sphere and cylinder, of 0.50 D or less. However, some surgeons advocate a litt le less aggressive approach to the reduction of residual cylinder as a litt le astigmatism could, in fact, improve uncorrected near vision. Traditionally it has been perceived that residual myopic against the rule cylinder may improve uncorrected near vision.5 In a study conducted recently at our centre, it was seen that myopic astigmatism, up to 1D, in any axis, helps to partially restore uncorrected near visual acuity to some extent but with a proportional loss of distance acuity in pseudophakic eyes with monofocal IOL implant. However, uncorrected myopic astigmatism more than 1 D results in a large loss of distance acuity at no additional benefi t to near acuity. Also, uncorrected hyperopic astigmatism, in any axis, results in deterioration of both distance and near acuities of pseudophakic eyes.6 So a myopic astigmatism less than 1.0 D may be considered benefi cial for near vision by some surgeons, but of doubtful value beyond that. Various approaches have been advocated for tackling preexisting astigmatism in patients having cataract surgery. These include on-axis corneal incision (OCI), limbal relaxing incisions (LRI), paired opposite clear corneal incisions (OCCI), Toric IOLs and fi nally Over the past few years, cataract surgery has, become quite akin to refrac ve surgery allowing greater control over the pa ents’ refrac ve and visual outcome. Now the pa ents expect perfect vision a er the cataract surgery and surgeons strive hard to deliver the same. In this respect a residual as gma sm a er the cataract surgery is viewed as an undesirable outcome both by the pa ents and surgeons. Various approaches have been advocated for tackling the pre-exis ng as gma sm in pa ents having cataract surgery. These include on-axis corneal incision (OCI), limbal relaxing incisions (LRI), paired opposite clear corneal incisions (OCCI), Toric IOLs and fi nally biop cs, where one exploits the advanced technology and exquisite accuracy of excimer laser. A number of popular nomograms are currently available for making accurate correc on in the as gma sm during cataract surgery among which, the nomograms by Nichamin and Donnenfeld are more popular for LRIs and commonly used. The online availability of these nomograms as well as that of Toric IOLs calculators have made the pre-op planning for the as gma sm correc ons much easier than before. Based on the eff ec ve results of all these techniques, one can consider the simple stepladder approach to guide as gma sm management at the me of cataract management. A surgeon may become more comfortable with one par cular technique as compared to another and should, therefore, choose an approach which works best in his or her hands. Recent Advances

Radiation doses from 131I treated hyperthyroidism patients versus life style: - a survey

Background : Radioacve iodine is widely used for the treatment of various thyroid disorders. Safety issues are oen a source of worry and anxiety for the paents, their families and comforters. The paents are advised to restrict their social and work related acvies. Th e work presented in this study describes the results of a structured survey conducted on paents vising our hospital. Materials and Methods : The total number of paents inducted was 419. The paents were asked about their housing condions, family set up, number of children, travelling modes and travellingme back to home. The hospital leaving exposure rates from the paents were measured and radiaon doses to others were esmated . Results : Paents residing in joint family system were 93%. The measured dose rate at one meter were 5.7, 11.0, 15.7, 18.7, 23.0 and 28.0 µSvh -1 for the administered 131 I acvity of 185, 370, 555, 740, 925 and 1100 MBq respecvely. The corresponding radiaon doses to others from the paent were esmated as 0.76, 1.53, 2.29, 3.06, 3.82 and 4.58 mSv. The paents using public transport were 78.04% whereas 21.96% used private transport. There were 11.93% of the paents with no children and 88.07% of the pae nts had children residing with them. It was observed that 1.67% of the paents had no toilets at home and 98.33% had mulple toilets available. Conclusion : The radiaon protecon advice and regulatory requirements need to be formulated keeping in view the individual paent life styles and other living condions.

Three Dimensional Study of Upper Airway in Different Antero-posterior Jaw Relationships through Cone Beam Computed Tomography

Introduction: This study aims at examining the difference of pharyngeal airways in patients with different occlusion postures, hoping to improve diagnostic methods and provide a stable treatment plan for orthodontic patients. Materials and Methods: The data were gathered through CBCT radiographies of patients from a specialized center for radiology. In each occlusion group according to the performed pilot study, 30 people (90 people in 3 groups of class I, II and III, male and female each) were chosen as the sample. The two-dimentional cephalometric radiographs were obtained from 3D-radiographs, and the patients’ malocclusion postures were determined according overjet and ANB angle, and finally grouped. Next, airway volume and dimensions were measured in cross sectional. Results: Statistical studies showed there is a significant relationship between anteroposterior positions of mandible and the volume of pharyngeal airway. Also, the volume of pharyngeal airway in class III patients is more than those of patients in class I. The volume of pharyngeal airway in class II patients is also less than those of class1 pa ents. Conclusion: Pharyngeal airway in class III is larger and in class II smaller. Therefore, considering this subject can lead to improving diagnostic ways, especially orthognatic surgery treatments, and providing a stable treatment plan for patients who need orthodentic treatment

Spontaneous Resolution of Traumatic Macular Hole in a Child

There are several published reports on spontaneous closure of idiopathic macular hole but informa on regarding spontaneous closure of trauma c macular hole is limited. We present a case of spontaneous resolu on of post trauma c macular hole in a 9 year old child with associated visual recovery. The child was followed up for seven months and the morphological changes were documented on op cal coherence tomography. The case study illustrates the role of conserva ve management of trauma c macular hole in selected young pa ents, thus preven ng the need for surgical interven on and its possible diffi cul es and complica ons. Del J Ophthalmol 2012;23(4):289-291.

Sclerosing Agents in Ophthalmology

Sclerotherapy is a surgical procedure used for vascular and lympha c malforma ons, in all age groups, wherein a sclerosing agent is injected into a vessel to make it shrink. It involves injec on of the agent intravascularly intralesionally or topically, under direct vision or under the guidance of radiological imaging. Sclerotherapy has primarily been used in ophthalmology for treatment of arteriovenous malforma ons like hemangiomas and caro co-cavernous fi stulas, and lympha c abnormali es like lymphangiomas. Sclerosing agents are chemical compounds which cause endothelial injury leading to infl amma on and vascular thrombosis. They may be classifi ed into various categories like detergents, hyperosmo c agents, cor costeroids, cytotoxic agents etc. A short descrip on on beta-blockers has also been included in this ar cle, even though beta-blockers are not sclerosants per se. Polyvinyl alcohol, sodium tetradecyl sulphate (STS) and ethanol may be used for arterio-venous malforma ons, while for lymphangiomas agents like sodium morrhuate, STS, doxycycline and OK-432 are used. In hemangioma pa ents, cor costeroids and beta-blockers are amongst the fi rst line therapy. Del J Ophthalmol 2012;23(3):219-224.

Assessment of Cone-Beam Computed Tomography (CBCT) Findings in Facial Asymmetric Patients

Introduction: Due to the complexity of facial asymmetry, the diagnosis of different aspects of asymmetry via conventional radiographs is not precise. In this study, we investigated findings of facial asymmetry by using cone- beam computed tomography (CBCT) images. Materials and Methods: In this descriptive study, we evaluated CBCT fi ndings of 18 pa ents i.e. a group of 14 females and 4 males having a mean age of 22.7 years who referred to a maxillofacial radiology clinic due to facial asymmetry from 2010 to 2011. Findings of asymmetry were investigated using axial, coronal and sagittal views. Results: As detected in axial view, 9 of 18 p aents had yaw in the maxilla. Approximately 14 and 11 pa ents had yaw in the mandible and zygoma respectively. Differences were observed between the medio-lateral dimensions of the condylar heads in 7 pa ents. We also detected the cervical spine devia on in 9 cases. Moreover, a difference in the antero-posterior position of the glenoid fossa in 10 pa ents was observed. In coronal view, “roll” i.e “cant” in the maxilla, mandible and orbital cavi es was found in 14, 12 and 1 patient respectively. Differences in the condylar neck height in 9 pa ents and in the level of the glenoid fossa in 11 pa ents were observed. Conclusion: CBCT is effective in evaluating the details of asymmetry and its effects on facial structures. In addition, three-dimensional approaches for the analysis of asymmetry transform it from a simple and predictable phenomenon into an incredibly complicated process. Pursuing orthodontic treatment plan without considering these complexities and details is not successful.

281 Leflunomide: A Novel Therapeutic Agent for Ganciclovir-Resistant Cytomegalovirus in Kidney Transplant Recipients

LEFLUNOMIDE: A NOVEL THERAPEUTIC AGENT FOR GANCICLOVIRRESISTANT CYTOMEGALOVIRUS IN KIDNEY TRANSPLANT RECIPIENTS Eram Shahira, Beje Thomas, Manish Talwar, Maria Salazar, Takamitsu Saigusa, Sarat Kuppachi, M. Francesca Egidi Medical University Of South Carolina, Charleston, South Carolina. Cytomegalovirus (CMV) is the most common viral infec on in solid organ transplant; 20%-60% of transplanted pa ents develop symptoma c CMV infec on despite specific prophylaxis. First line treatment for CMV reac va on and disease presently includes ganciclovir or valganciclovir. Cidofovir and foscarnet because of their nephrotoxicity should be considered in case of failure of the tradi onal treatment. Leflunomide is a drug approved for the treatment of rheumatoid arthri s that has been shown to have an CMV ac vity without nephrotoxicity. We report our experience with four pa ents who developed CMV reac va on and subsequent disease and failed treatment with ganciclovir and immunosuppression (IS) reduc on. Leflunomide (LF) was ini ated at the dose of 40 mg PO/daily. All of the pa ents received cadaveric renal transplants, had T-cell deple ng agent induc on (Thymoglobulin) and maintenance IS consis ng in prednisone, cellcept and tacrolimus. The viremia was monitored and detected with rou ne CMV/PCR screening. The pa ents’ characteris cs and results are shown in the table. Age at the Transplant Race/Gender CMV status (IgG) D/R Diagnosis from transplant (Months) Time to response to Leflunomide (Weeks) Pt.LB 49 C/F +/6 4 Pt.CB 38 AA/M +/2 4 Pt.CH 41 C/M +/6 5 Pt .SA 51 C/M +/+ 24 3 In conclusion our preliminary results show that LF offers an alterna ve to tradi onal an -CMV therapies for the transplant recipient with an viral resistance.

125 Acute Rejection in Renal Allografts With Delayed Graft Function (DGF) in the Era of T Cell Depleting Induction

ACUTE REJECTION IN RENAL ALLOGRAFTS WITH DELAYED GRAFT FUNCTION (DGF) IN THE ERA OF T CELL DEPLETING INDUCTION Usama T Hussein MD , Carlos R Franco MD, Juan C Calle MD, Fernando G Cosio MD, Hatem Amer MD. on Division of Nephrology and Hyper tension and the William J v Liebig Transplant Center, Mayo Clinic, Rochester MN, USA Introduc on: DGF is associat ed with worse long term renal allogra survival. With poor early allogra func on there is always concern for undiagnosed acute rejec on (AR). We rou nely biopsy DGF allogra s in the first week. With T cell deple ng agents we ost hypothesized that AR would be u nlikely in the first week p transplant Methods: Between January 2005 and December 2009 we performed 725 kidney alone trans plants who were ABO compa ble and with nega ve pre-transplant flow cross match. Sixteen (2.2%) pa ents had DGF, defined as dialysis within one week of transp lant, and had a biopsy. Results: Age 52.3 ± 13.2 year, Caucasians 15 (93.7 %), male 12 (75 %), deceased donor source 10 (62. 5%), re-transplant 4(25%). T cell deple ng agents were used in all pa ents, Alemtuzumab followed by tacrolimus and myco phenolate mofe l in 2 (12.5%) the remainder, rabbit An -thymocyte Globulin followed by tacrolimus mycophenolate mofe l, and cor costeroids. DGF was more common in recipients of deceased donor kidneys 20.4 % vs. 0.9 % p <0.001. AR was seen in 2 (12.5%) cases one AR 2A and the second was an body mediated rejec on. Other findings on ) biopsy included: 11 (68.7%) ATN, 1 (6.25%) normal and 2(12.5% biopsies showed donor transmi ed histological changes. Conclusion: In this study we con firm that ATN is the commonest histological finding in pa ents with DGF and more likely to occur in recipients of deceased donor kid neys. AR is uncommon early post ransplant with T cell deple ng agent induc on but can not be xcluded without performing early biopsies. t e

365 Acute Tubulo-Intersttial Nephritis in a Patient With Hepatitis B on Tenofovir

ACUTE TUBULO-INTERSTTIAL NEPHRITIS IN A PATIENT WITH HEPATITIS B ON TENOFOVIR. Hima Bindu Yalamanchili, Bridgeport Hospital, Bridgeport, Connec cut, USA, Sandeep Ravi, Gilbert W. Moeckel, George Abdelsayed, Irwin Feintzeig. We are repor ng a pa ent who presented with acute renal failure secondary to acute tubulo-inters al nephri s in temporal associa on with tenofovir. 67 year-old African American male with past medical history of chronic ac ve Hepa s B infec on treated with tenofovir and hypertension presented to our hospital with a one week history of nausea, poor appe te, poor oral intake and generalized weakness. His medica ons were atorvasta n, hydrochlorothiazide, and atenolol. There were neither any new medica ons nor any dosage changes prior to current presenta on. Laboratory data disclosed BUN 173mg/dL, serum crea nine 18.6mg/dL (a baseline crea nine 1.23), sodium 126mmol/L, potassium 3.5mmol/L, chloride 82mmol/L, bicarbonate 22mmol/L, calcium 6.6mg/dL, phosphorus 12.5 mg/dL, crea nine phosphokinase of 741 IU/l and the anion gap was 23. Renal ultrasound, complement levels, ANA, ANCA and HIV were normal or nega ve. Urine analysis was nega ve for casts with rare urine eosinophils. Renal biopsy demonstrated acute tubulo-inters al nephri s with focal glomerulosclerosis. His renal func on gradually improved with transient hemo-dialysis (10 days), Tenofovir discon nua on and 3-day course of pulsed methylprednisolone followed by prednisone taper. To our knowledge acute tubulo-inters al nephri s due to tenofovir was not previously described in literature. Few previous case reports of AIN were reported in pa ents with HIV on combina on of tenofovir and atazanavir. Tenofovir alone was associated with Fanconi's syndrome and proximal tubular dysfunc on. With this case report we want to emphasize that acute tubule inters al nephri s should be considered in the differen al diagnosis of renal failure associated with tenofovir and early discon nua on of tenofovir is essen al for recovery of renal func on.