[Vascular prostheses and renal transplantation]

International audienceOBJECTIVE: To evaluate the complications, the morbidity and mortality of renal transplantation in patients with a vascular prosthesis inserted either prior to or at the same time as renal transplantation. PATIENTS AND METHOD: Between January 2001 and January 2006, six renal transplantations were performed in patients with arterial vascular prostheses or requiring concomitant insertion of a vascular prosthesis during renal transplantation. The mean age was 58 years [range: 47-69 years]. In each case, we evaluated operative difficulties, complications and postoperative course (morbidity, mortality) and the renal functional result. RESULTS: The mean operating time was 230 minutes [range: 130-380 minutes] with a mean blood loss of 390 ml [175-750 ml]. Three patients required another surgical operation for femoral thrombosis, iliofemoral thrombosis and compressive haematoma. The median length of hospital stay was 21 days [range: 9-78 days]. Graft function was restored immediately in all six patients, and one case of graft loss was observed. The morbidity was higher than that usually observed after renal transplantation. With a mean follow-up of 26 months, the vascular and renal results are satisfactory. CONCLUSION: Renal transplantation in patients with a history of vascular prosthesis or requiring replacement of the vascular prosthesis at the same time as renal transplantation can be performed with satisfactory results but with an increased morbidity. The vascular treatment must be part of a multidisciplinary strategy in the context of transplantation

[Vascular prostheses and renal transplantation]

International audienceOBJECTIVE: To evaluate the complications, the morbidity and mortality of renal transplantation in patients with a vascular prosthesis inserted either prior to or at the same time as renal transplantation. PATIENTS AND METHOD: Between January 2001 and January 2006, six renal transplantations were performed in patients with arterial vascular prostheses or requiring concomitant insertion of a vascular prosthesis during renal transplantation. The mean age was 58 years [range: 47-69 years]. In each case, we evaluated operative difficulties, complications and postoperative course (morbidity, mortality) and the renal functional result. RESULTS: The mean operating time was 230 minutes [range: 130-380 minutes] with a mean blood loss of 390 ml [175-750 ml]. Three patients required another surgical operation for femoral thrombosis, iliofemoral thrombosis and compressive haematoma. The median length of hospital stay was 21 days [range: 9-78 days]. Graft function was restored immediately in all six patients, and one case of graft loss was observed. The morbidity was higher than that usually observed after renal transplantation. With a mean follow-up of 26 months, the vascular and renal results are satisfactory. CONCLUSION: Renal transplantation in patients with a history of vascular prosthesis or requiring replacement of the vascular prosthesis at the same time as renal transplantation can be performed with satisfactory results but with an increased morbidity. The vascular treatment must be part of a multidisciplinary strategy in the context of transplantation

[Management of renal colic in pregnant women, based on a series of 48 cases]

International audienceINTRODUCTION: Urinary stones are relatively frequent in pregnant women and raise specific diagnostic and therapeutic problems. The authors conducted a retrospective review of the management of this disease in their establishment. PATIENTS AND METHODS: Between January 1999 and December 2003, out of a total of 10,398 parturients, 48 pregnant women were hospitalised for renal colic, that is, incidence of 0.04%. The medical records of these patients were retrospectively reviewed and clinical, laboratory, treatment and outcome data were analysed. RESULTS: Standard analgesic treatment, comprising paracetamol and an antispasmodic, achieved pain relief in 84% of cases. A concomitant short course of corticosteroid therapy in cases of renal colic refractory to standard treatment was effective in 71% of patients and allowed deferral of surgical management in five out of seven cases. A double J stent was placed in all patients requiring urinary diversion, followed by closer ultrasound and bacteriological monitoring throughout pregnancy. Only two patients required surgical management of their stone after delivery. The only obstetric event related to renal colic was induction of labour at term in two cases because of foetal distress. CONCLUSION: The authors propose a two-stage management plan for renal colic in pregnant women resulting in a low maternal and foetal complication rate

Optimal Methionine-Free Diet Duration for Nitrourea Treatment: A Phase I Clinical Trial

In animal models, methionine (MET) restriction in association with chloroethylnitrosoureas led to a substantial improvement. On this basis, we initiated a Phase I clinical trial of dietary MET restriction in association with chloroethylnitrosourea (cystemustine) treatment for patients with recurrent glioma or metastatic melanoma. Our purpose was 1) to determine the optimal METfree diet duration for a maximum depletion of plasma MET an

Accuracy of ultrasonography in diagnosis of testicular rupture after blunt scrotal trauma.

International audienceOBJECTIVES: The aim of this study is to determine the accuracy of ultrasonography for the diagnosis of testis rupture after scrotal trauma and its sensitivity and specificity for testis rupture, tunica albuginea breach, testicular hematoma, testis avulsion, epididymis injuries, and hematocele. METHODS: Between 1996 and 2006, 33 patients underwent surgical exploration for blunt scrotal trauma. All these patients had an emergency scrotal ultrasonography with the use of a 7.5 or 10 MHz linear transducer. Ultrasonographic findings were compared with surgical findings to calculate sensitivity and specificity of ultrasonography for each type of lesion. RESULTS: Of 33 patients, 16 presented a testis rupture. Testis rupture was in all cases suspected ultrasonographically by the loss of contour of the testis and heterogeneous parenchyma. Tunica albuginea breach was visualized in only 8 patients. Sensitivity and specificity of ultrasound for testis rupture were 100% and 65%, respectively. Moreover, ultrasonography allowed diagnosis of hematocele (sensitivity: 87% and specificity: 89%), testicular hematoma (sensitivity: 71%, specificity: 77%), and testis avulsion (sensitivity: 100%, specificity: 97%). Ultrasonography results for epididymis injuries were poor. On 7 patients, 3 epididymis lesions were misdiagnosed by ultrasound examination. CONCLUSIONS: Ultrasonography can distinguish various scrotal injuries. Testicular rupture is probably the most severe injury that needs early surgical treatment to improve testis salvage rate. In our work, ultrasonography is highly sensitive in the diagnosis of testis rupture and can provide information on the scrotal contents integrity that can help the physician to determine the optimal treatment

Occupational Exposures to Ebola Virus in Ebola Treatment Center, Conakry, Guinea

We report 77 cases of occupational exposures for 57 healthcare workers at the Ebola Treatment Center in Conakry, Guinea, during the Ebola virus disease outbreak in 2014−2015. Despite the high incidence of 3.5 occupational exposures/healthcare worker/year, only 18% of workers were at high risk for transmission, and no infections occurred