Evolution of Native Kidney Function After Pancreas Transplantation Alone

peer reviewedIntroduction. This study investigated changes in kidney function over time among a cohort of patients undergoing pancreas transplantation alone (PTA) from January 2002 to December 2011. Patients and Methods. Ten of eighteen PTA patients bearing functioning grafts for at least 1 year were recruited for the analysis. Primary endpoints were changes in mean serum creatinine (SCr, mg/L) and mean estimated glomerular filtration rate (eGFR) using the 4-variable Levey-MDRD equation (mL/min/1.73 m2) comparing baseline (pretransplantation) to 6-month, 1-year, 3-year, and 5-year posttransplantation values. Mean follow-up time was 75.7 20.5 months (range, 46–106.5). Results. Baseline eGFR was 89.3 27.9 (range, 58–145). eGFR decreased to 75.7 26.2, 71 20.6, 66.5 14.8, and 62.1 11.2 at 6 months, 1, 3, and 5 years representing 15.2%, 20.5%, 15.8%, and 22.6% percentage decreases respectively (P .05 for all pairwise comparisons). The Baseline SCr was 8.6 2.3 mg/L (range, 5–13). SCr progressively increased to 10.1 3, 10.5 3.1, 10.9 3.1, and 11.3 1.7 at 6 months, 1, 3, and 5 years a 17.1%, 22%, 16.6%, and 19.9% increase respectively (P .05 for all pairwise comparisons). One of ten, 2/8, and 3/7 patients displayed an eGFR 60 at transplantation versus 3 and 5 years thereafter, respectively. No patient developed a SCr 25 mg/L or eGFR 30 or needed dialysis or kidney transplantation. Five of ten patients had micro-albuminuria or proteinuria before transplantation. Tacrolimus levels were within recommended therapeutic ranges over time. Conclusion. Kidney function deteriorated significantly after PTA. Understanding of risk factors for the development of renal impairment is important to preserve kidney function and to select appropriate candidates for PTA

LA RADIOTHÉRAPIE DANS LE CANCER DU RECTUM : quand, comment et pourquoi ?

peer reviewedDepuis plusieurs décades, la radiothérapie préopéra - toire ou postopératoire joue un rôle important dans le contrôle local de l’adénocarcinome du rectum. Cette dernière décennie, avec la systématisation de la chirurgie d’exérèse en totalité du mésorectum (TME), le profil de récidive locale du cancer du rectum a été fortement modifié. Dans un tel contexte, la place de la radiothérapie doit être réévaluée en tenant compte de ces modifications. Dans cet article, nous proposons de faire la revue des différentes grandes études concernant les techniques et les indications d’un traitement de radiothérapie pré- ou post opératoire dans le contexte d’une chirurgie rectale TME

Early Post-Operative Endoscopy Is Associated with Lower Surgical Recurrence of Crohn's Disease: A Retrospective Study of Three Successive Cohorts.

peer reviewed[en] BACKGROUND: The severity of endoscopic recurrence during the first year after intestinal resection for Crohn's disease is predictive of clinical recurrence. The aim of our study was to assess the impact of the implementation of an ileocolonoscopy during the first year after surgery on surgical recurrence. METHODS: All patients who underwent a first intestinal resection for Crohn's disease between 1992 and 2018 at the University Hospital of Liège were retrospectively included. The time to surgical recurrence was compared in three successive groups of patients operated on in the period 1992-2001 (group A), 2002-2011 (group B), and 2012-2020 (group C) using the Kaplan-Meier method and the Log-Rank test. To identify independent prognostic factors, a multivariate analysis was used via the Cox model. RESULTS: 223 patients (group A = 69, group B = 94, group C = 60) were included. Probabilities of surgical recurrence were significantly lower in group C (2.2% and 4.7% at 3 and 5 years, respectively) compared with group B (4.2% and 7.6% at 3 and 5 years, respectively) and with group A (9% and 18.2% at 3 and 5 years, respectively) (p = 0.0089). Ileocolonoscopy during the year after surgery was associated with a significantly reduced surgical recurrence rate in univariate and multivariate analysis (HR = 0.31, p = 0.0049). CONCLUSION: The implementation of an early ileocolonoscopy after surgery for Crohn's disease since early 2000 has been associated with a reduced surgical recurrence over the last 30 years

A comparative study of eleven protein systems in tamarins, genus Saguinus (Platyrrhini, Callitrichinae)

The genetic variability of six tamarin taxa, genus Saguinus, was analyzed comparatively using protein data from eleven systems coded by 15 loci. S. fuscicollis weddelli and S. midas midas were the most polymorphic taxa, and S. bicolor the least. The results of the phylogenetic analyses (UPGMA and neighbor-joining) and the genetic distances between taxa were generally consistent with their geographic and probable phylogenetic relationships. Analyses of the S. bicolor and S. midas populations suggested that they represent no more than three subspecies of a single species, S. midas, with the bicolor forms belonging to a single subspecies, S. midas bicolor. If supported by additional studies, this would have important implications for the conservation of the bicolor form, which is endangered with extinction. The genetic similarity of S. fuscicollis and S. mystax was also consistent with their geographical and morphological proximity, although more data from a larger number of taxa will be required before the taxonomic relationships within the genus can be defined.A variabilidade genética de seis taxa de tamarins, gênero Saguinus, foi analisada comparativamente usando-se dados protéicos de onze sistemas codificados por quinze loci. S. fuscicollis weddelli e S. midas midas foram os taxa mais polimórficos, enquanto S. bicolor foi o menos. Os resultados da análise filogenética (UPGMA e neighbor-joining) e as distâncias genéticas entre os taxa foram em geral consistentes com suas relações geográficas e filogenéticas. As análises das populações de S. bicolor e S. midas indicaram que eles podem representar não mais do que três subespécies de uma única espécie, S. midas, com as formas de bicolor pertencendo a uma única subespécie, S. midas bicolor. Se apoiado por estudos adicionais, este fato teria implicações importantes para a conservação da forma de bicolor, que está em perigo de extinção. A similaridade genética de S. fuscicollis e S. mystax foi também consistente com sua proximidade geográfica e morfológica, embora mais dados sobre um número maior de taxa seriam necessários antes de se definirem as relações taxonômicas dentro do gênero

Clinical Case of the Month. Autoimmune Cirrhosis Treated by Liver Transplantation Using the Right Hepatic Lobe from a Living Related Donor

peer reviewedThe authors describe the case of a 17-year-old girl who suffered from end-stage liver failure due to chronic autoimmune hepatitis. Liver failure was complicated by severe portal hypertension, hypersplenism and refractory ascites. Liver transplantation was indicated. She was listed for cadaveric whole liver transplantation, but her infrequent blood group (B) increased waiting time. Her condition deteriorated to Child C liver failure and living related liver transplant was considered. Her father was compatible and proposed himself for donation. Right lobe procurement was decided in order to provide sufficient liver mass. No transfusion of red cells, platelets, or fresh frozen plasma was used either in the donor or the recipient. Both recipient and donor left the ward at postoperative day 14, without complication. They were both asymptomatic and with normal liver tests at one year follow-up. Living related liver transplantation using the right lobe may offer an alternative to liver transplant candidates in this period of organ donor shortage

PERFIL DOS CASOS DE SÍFILIS EM GESTANTES NO PERÍODO DE 2008 A 2018 NO MUNICÍPIO DE PARNAÍBA-PI

Introduction: Syphilis is a STI and despite having a well-established diagnosis and therapeutic resource and at a lower cost, it is considered a public health problem by the WHO. General objective: To know the profile of cases of gestational syphilis in the city of Parnaíba-PI in the years 2008 to 2018. Methods: This is a descriptive, retrospective documentary research with a quantitative approach, identifying the profile of pregnant women with syphilis, through the data that were obtained through the Investigation forms of gestational syphilis. Results and discussions: It was found that in the period 2008 to 2018, an amount of 139 cases of syphilis in pregnant women was reported, with this increase in the age group from 20 to 34 years old with a total of 92 cases, 44 with incomplete primary education , 107 considered themselves brown, 117 lived in urban areas, 43 had the primary stage of infection, of which 71 were diagnosed in the second trimester of pregnancy, 59 pregnant women used penicillin G benzathine 2,400,000UI and 33 of the partners did not undergo the treatment. Final considerations: Therefore, it is expected that this work awakens in health professionals the importance of carrying out the measures recommended by the MS, as well as correctly filling out the notification forms, to facilitate the implementation of measures to combat the disease.Introducción: La sífilis es una ITS y a pesar de presentar un recurso diagnóstico y terapéutico bien establecido y de menor coste es considerado un problema de salud pública por la OMS. Objetivo general: Conocer el perfil de casos de sífilis gestacional en el municipio de Parnaíba-PI en los años 2008 a 2018. Métodos: Se trata de una investigación documental descriptiva, retrospectiva con enfoque cuantitativo, identificando el perfil de gestantes con sífilis, a través de datos que se lograron a través de formularios de investigación de sífilis gestacional. Resultados y discusiones: Se encontró que de 2008 a 2018 se reportaron 139 casos de sífilis en mujeres embarazadas, y este incremento se reportó en el grupo de edad de 20 a 34 años, con un total de 92 casos, 44 con educación primaria incompleta, 107 se consideraron morenos, 117 vivían en el área urbana, 43 tenían la fase primaria de infección, de las cuales 71 fueron diagnosticadas en el segundo trimestre del embarazo, 59 mujeres embarazadas usaron penicilina G benzatenina 2,400,000 UI y 33 de las parejas no se sometieron a tratamiento. Consideraciones finales: Por ello, se espera que esta labor despierte en los profesionales sanitarios la importancia de realizar las medidas recomendadas por el Ministerio de Sanidad, así como de rellenar correctamente los formularios de notificación, para facilitar la implementación de medidas de lucha contra la enfermedad.Introdução: A sífilis é uma IST e apesar de apresentar diagnóstico e recurso terapêutico bem estabelecido e de custo inferior é considerada um problema de saúde pública pela OMS. Objetivo geral: Conhecer o perfil dos casos de sífilis gestacional no município de Parnaíba-PI nos anos de 2008 a 2018. Métodos: Trata-se de uma pesquisa de caráter documental do tipo descritiva, retrospectiva com abordagem quantitativa, identificando o perfil de gestantes com sífilis, por meio dos dados que foram alcançados através das fichas de Investigação de sífilis gestacional. Resultados e discussões: Constatou-se que foi notificado no período de 2008 a 2018, um montante de 139 casos de sífilis em gestante, sendo esse aumento na faixa etária de 20 a 34 anos com o total de 92 casos, 44 com ensino fundamental incompleto, 107 se consideravam pardas, 117 residiam na área urbana, 43 possuíam a fase primária da infecção, dos quais 71 foram diagnosticadas no segundo trimestre de gestação, 59 gestantes fizeram uso de penicilina G benzatina 2.400.000UI e 33 dos parceiros não realizaram o tratamento. Considerações finais: Portanto, espera-se que esse trabalho desperte nos profissionais de saúde a importância de realizar as medidas preconizadas pelo MS, assim como preenchimento correto das fichas de notificações, para facilitar a implantação de medidas para combate da doença