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| Sunday, 21 March 2004 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius Rejection-free kidney transplant procedure Indian doctors claim that for the first time in the world they have devised a modified pre transplant immune modification technique which combines Splenic radiation and plasmapheresis so that high risk donors can also be used as donors and rejection is almost nil. They are confident that with this technique there cannot be any rejection. In the previous older regimen the risk of rejection comes to around 10 to 15 per cent whereas with this method costing just few thousand rupees more they claim almost 100 per cent success rate. Dr. P. Ravichandran, Chief Consultant Nephrologist, Kidney Diseases and Institute of Organ transplantation, BR Hospital, Chennai T. Nagar who claims to have done the maximum number of high risk cases using this new procedure with successful results, discusses the procedure and some of his success stories. Transplantation or dialysis is the only course available for kidney failure patients. Many patients who have related donors are rejected for reasons such as no matching of tissue or different blood group or multiple blood supply or advanced age of donor.
It was in Japan that the concept of transplantation in individuals with positive cross match and across the barrier (That is with different blood group) followed in the 80's but without much success. With the advent of newer immunosuppressive drugs and techniques it has become a distinct possibility. The first patient was from Malaysia. He was a 17-year-old poor boy whose father is a plantation worker and was referred to me by the Youth Wing of Malaysian Indian Congress and they raised funds. Though his mother was willing to donate a kidney she was rejected as she had a different blood group from the patient he had a high risk of rejection of kidney if the transplant was carried out in the conventional manner. The immunology of the patient was thus modified by our regimen - devised by us for the first time and followed successfully in more than 48 cases. Procedure This regimen is a modification of splenectomy followed in Japan. Here instead of surgical removal of spleen, which is the training center for antibody, it is radiated. After this we then remove the antibody already formed in the body by what is called plasmapheresis technique and then the kidney of the donor is transplanted into the patient with newer dose modification and newer drugs. The results showed a remarkable improvement in kidney function and showed lesser rejection and better graft survival. The data have been sent to the forthcoming world Immunology conference to be held in Austria are to be published soon (Copy Enclosed). We have seen dramatic results with this procedure, which is safe and cost effective. Long term study is also being done to see if in long run these transplanted kidney get adapted into body so that the costly drugs after surgery is avoided and organ works as self or chimerism. In future protocol are devised where before transplant the stem cells or the seed of cells from donor is pushed into the recipient so that they do not need costly medicines to keep their kidney working. With growing need for live related donors such a technique will help to use more live donation with relatives who in others circumstances would have been rejected. Similarly our surgical team is now fully trained in United Kingdom to undertake laparoscopic donor kidney removal where the donor can stay in hospital for just three days and resume function in short time. We are now moving in new direction where older regimens will be changed and revolutionary techniques will take shape, backed by strong hospital set up and research. This will lead to reduction in the waiting list for transplant and go long way for family members to donate even if the cross match or HLA match is not good. **** Kidney failure - What causes it? Inability of kidney to clean the blood resulting in accumulation of dirt in blood and leading to many body parts unable to function anymore. Dialysis Is a process where the blood is cleaned by artificial means using machines or fluids. Kidney Transplantation It is a procedure where kidney of one individual is fixed to a person with kidney failure and made to work with use of drugs to prevent rejection of the kidney. Cross matching Kidney of one person cannot be given to another person with different blood group. Kidney of one with same blood group can be given to another with the same group. Sometimes a kidney of one person with the same blood group cannot be given to another when there are antibody to the person. To see if kidney will be accepted or not cross matching is done, where the blood of patient and donor are mixed together and seen as how many cells are destroyed by the patient to that of donor.Cross match is positive if more than 20 per cent or 30 per cent cells of donor are killed by patient blood. HLA matching In previous era HLA was important that is the DNA matching to see how many DNA other than blood group is matched. More useful for cadaver kidney or high Risk patient. High Risk Patients Those who are more than 60; those who are with different blood groups; those with positive cross match. Spleen Is the organ, which is compared to a training center for the defense cells and tells them how to use and produce antibody. Antibody Is comparable to weapons that are present in the blood circulation and used when some new foreign cells enters the body to attack them. Splenectomy Is surgical removal of spleen so that the body cannot be effective in training the antibody producing cells. Splenic radiation Radiation given to spleen so that it is similar to surgery but here the damage is temporary and function regains. Plasmapheresis This is removal of the preformed antibody or similar to removal of weapons from the body so that the body loses its capacity to fight till new antibody is formed. Combining splenic radiation and plasmapheresis. Is similar to removing 'weapons' as well as destroying the 'training center' so that till they pick up function. The new organ gets adjusted to the foreign body. *************** AIDS and Homeopathy by Dr. A. M. Aboobucker Clinically HIV infection is classified into four stages as follows: Stage I - Acute infection Stages I and II are usually asymptomatic. However, a small proportion of patients develops a syndrome resembling glandular fever, or symptoms of encephalopathy or other disorders of the nervous system. These symptoms which usually develop after 3 to 12 weeks of the infection resolve spontaneously after one to three weeks. In these stages many people can remain well for periods up to six years. During the third stage persistent generalized lymphadenopathy (disease of the lymph nodes) develops; they lymph nodes in the body, particularly in the two extra-inguinal sites become enlarged and persist for more than three months. The enlarged glands are usually discrete, firm and may be slightly tender. In this stage some patients may remain well for years without exhibiting any significant change in their general health. Some patients who are approaching the next stage may exhibit other symptoms such as fatigability, fever and diarrhoea. Laboratory investigation may show some minor haematological changes. During the fourth stage AIDS related complex (ARC) manifests and AIDS, the final phase of HIV infection begins to develop. During the manifestation of ARC the patient reveals various symptoms including loss of body weight, night sweat, persistent fever, constant diarrhoea, herpes zoaster, hairy leukoplakia of the tongue, oral and oesophageal candidiasis and a variety of dermatological problems. In some patients this stage may be asymptomatic at all or it may present as a febrile type of illness without other symptoms. Laboratory investigation at this stage may often show anaemia and thrombocytopenia (reduction in the number of platelets in the blood). During the fifth and terminal phase of HIV infection (AIDS) the patient is affected by a variety of dangerous diseases, with a fatal end. The time taken for AIDS to develop is variable; in some cases it develops within three years of infection but in others it often does not manifest for 5 to 8 years; in a few cases it takes longer. The clinical manifestations of AIDS include lung disorders (caused by infection or non-infective pulmonary lesions), Kaposi's sarcoma (usually in the skin and oral cavity), alimentary tract disorders (including candidiasis of the oral cavity, diarrhoea with malabsorption, anorectal ulceration, and anal warts), neurological disorders (including encephalitis, meningitis, retinitis and leucoencephalitis), oral cavity diseases (such as Kaposi's sarcoma, candidosis, herpetic ulceration, aphthosis, gingivitis, etc., hepatobiliary disease, skin diseases (such as seborrhoea, dermatitis, tinea, psoriasis, molluscum contagiosum, pityriasis rosea, etc.) and malignant lymphoma. The appearance is terrible and pathetic, with severe wasting associated with gastrointestinal disturbances and malabsorption. The prognosis of his illness is usually fatal. In this stage the patient cannot live longer; according to the severity of disorders he will die within a few months or years. Homoeopathic concept of AIDS According to the philosophy of homeopathy, AIDS is not a new disease but a new dimension of the primitive venereal disease as well as a manifestation of the ill-striken vital force (soul). Until recent time it was latent in human beings and was known under the garb of various diseases. Now it is manifested in those who are sexually immoral. Syphilitic miasm, one of the three miasms which originally cause chronic diseases in human beings is the primary cause of AIDS, according to the homoeopathic philosophy. The persons who have in their whole organism taint of syphilitic miasm which was inherited from their ancestors are easily attacked by HIV virus when they expose themselves to the influence of its secondary causes. If the treatment given to the patient is effective to extirpate this miasm, the disease can be cured easily and permanently. Treatment The patient should first be isolated from all sexual contacts in order to prevent the spread of infection to others. He should also be prevented from other factors which can transmit the disease. One of the following homoeopathic remedies may be given according to the totality of symptoms, with occasional doses of Syphilinum (higher potency), for a long period. Early stages: Bary c.,Cal.c., Cal.phos., Carb.an., Merc.sol., Merc.i.r. Merc.i.fl., Phyt., Sil., Syphil. Third stage: Ars.alb., Bary.carb., Ars.iod., Aur.met., Arg.iod., Kali bic., Merc.sol. Sul., Syphil., Thuj. Final stage: Ars.alb., Merc.sol., Nit.ac., Sul., Syphil., Typhoid., Thuj *************** Non-pharmacological therapy for hypertension (high blood pressure) by Dr. D.P. Atukorale
The positive lifestyle changes may include regular exercise, weight reduction, stopping smoking, reduction or stoppage of alcohol and restriction of salt intake. All these may have additive effects on lowering blood pressure (B.P.) achieved with weight loss. Aerobic exercise training is often recommended as an effective non-pharmacological approach of controlling H.B.P. Exercise: There is scientific evidence to prove the aerobic exercise is an effective mean to lower B.P. This effect has been demonstrated in almost all subjects, both with normal B.P. and those with H.B.P., in women as well as in men, in the obese as well as the elderly. Physical exercises such as brisk walking, jogging, bicycling, swimming, playing games such as tennis and badminton are recommended to bring down the weight. But sudden severe strenuous exercises may be harmful in patients suffering from H.B.P. as a significant proportion of these patients have marked coronary artery disease. Therefore all middle-aged and elderly H.B.P. patients especially, those who are sedentary, should consult their family physicians before starting any type of strenuous exercise. In those who take regular aerobic exercises, the increased weight too, comes down with regular exercise. Salt restriction: There is a clear relationship between high salt intake and B.P. All the controlled trials have shown consistently that B.P. decreases with sodium restriction. Smoking: Overwhelming evidence supports the causal relationship between cigarette smoking and various diseases including hypertension and hyperlipidaemia (high serum levels of cholesterol and triglycerides) which in turn increases the risk of heart attacks and strokes. Smoking causes an acute increase in B.P. and heart rate and has been found to be associated with malignant hypertension. Weight reduction: Being overweight or weight gain is associated with hypertension in many individuals. Indeed, being overweight increases the prevalence of hypertension threefold and the incidence of weight related hypertension is growing in parallel with the epidemic of obesity especially in the developed countries. Indeed, excess body fat remains the biggest single contribution to B.P. elevation. Nurses Health Study showed that there is a five percent increase in hypertension for every 1 Kg gain in weight. There is growing evidence that weight loss is effective in reducing B.P. or obese hypertensive individuals. However, a problem with weight reduction to reduce B.P. is that patient's adherence to weight loss is often poor. Alcohol reduction: Heavy alcohol consumption or binge drinking increases cardiovascular risk especially haemorrhage stroke. Overall alcohol reduction was associated with significant reduction in mean systolic B.P. and diastolic B.P. Transcendental meditation: Because of the association of H.B.P. with western society and its low incidence in certain less developed cultures, attempts have been made to lower B.P. by meditation or mental relaxation. There is evidence that biofeedback can reduce B.P. Several groups have reported successful use of biofeedback in the voluntary control of heart rate and B.P. These types of techniques need dedication and time. Vegetarian diet: There is evidence to show that the incidence of hypertension is low in vegetarians as compared to non-vegetarians. Stress: It is known that the day-to-day stresses and anxiety affect our B.P. and this affects men more than women. *************** A case study Santosh Kumar who is 32-years-old had a bright future when he got a job in Egypt but suddenly kidney failure struck him from the blue and all his dreams came to an end after he learned that he had developed end-stage kidney failure and needed transplantation. He was sent back to Ernakulam, India and asked to undergo treatment here. He was on haemodialysis and option for kidney transplantation was dashed when he learnt that all his relatives except his mother had different blood group hence they were ruled out to donate kidney. Since he was given four units of blood he developed antibody against his mother kidney and to use her as donor was also a risky affair as the chances of rejection was high. Apart from this his mother was around 56 years and her kidneys had double artery supply on the left side and two veins on the right side a very difficult situation surgically. He was considered a high-risk patient medically as chances that he would reject his mother kidney was high and similarly mother was considered high-risk donor as she had multiple blood supply and surgically it is taxing as it takes more time to handle the operation especially considering her age. Unable to find any other donor they approached Dr. P. Ravichandran Chief consultant Nephologist Kidney diseases and Institute of Organ transplantation B R Hospital Chennai T. Nagar who has done the maximum number of such high-risk cases and for the first time in the world presented data about splenic radiation and plasmapheresis in tackling such high-risk patients that includes those who have different blood groups. The patient was selected for the new procedure and he underwent splenic radiation under the guidance of Dr. Sekar radiation Oncologist at Sri Ramachandra and Apollo Cancer Hospital Chennai. Following splenic radiation his antibodies were removed from the blood by modified plasmapheresis procedure, which is different from double filtration method. By this method his body ability to reject his mother kidney became remote and then he was screened by our surgical team who have maximum experience in doing such high-risk surgery. Decision was taken to take the left kidney with two blood supply. The surgery was a success and as expected the kidney worked like magic. One week postoperative both are doing fine and hopefully one day he will be able to go back to work and look after his mother and father. *************** Medical update : Catch a cold, cure skin cancer The common cold virus most people try them hardest to avoid is very likely to be the cure for malignant melanoma, Australian scientists have discovered in a major breakthrough announced recently. A team of researchers at the University of Newcastle believe they have made an exciting discovery in the treatment of the usually deadly skin cancer of which Australia, with its fair-skinned people and hot sun, has the highest rate in the world. "We have established that melanoma cells can be destroyed by infecting them with a common cold virus," the lead researcher, associate professor Darren Shafren said. "We believe this is a significant breakthrough in the development of the treatment of melanoma. We are very excited about it." "The results we have had using human cells and also in animal studies have been very exciting. If we can replicate this success in human trials then it could be available within a year or two". (AFP) |
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| Editorial | Security Produced by Lake House |
Diabetes, High Blood pressure and kidney failure incidence is on the
rise. The treatment for kidney failure is dialysis or transplantation.
Transplantation in many countries is decreasing due to lack of donors.
Although pharmacological treatment for high blood pressure (HBP)
significantly reduces morbidity and mortality for heart disease and
strokes, long-term treatment with drugs can have undesirable side effects
and these patients have to be under continued supervision by doctors. Thus
lifestyle intervention for hypertension remains vital strategy for
controlling H.B.P.
