Cadaver transplantation in Recent Era: Is Cadaveric Graft Survival Similar to Living Kidney Transplantation?

BACKGROUND

Renal transplantation is the procedure of choice for most of patients with end-stage renal disease. The graft, however can be procured from either cadaver or living donors.

OBJECTIVE

To compare graft and patient survival among patients who underwent kidney transplantation from cadaver donor vs. living donor.

METHODS

From April 2002 to February 2010, we performed 138 cadaver kidney transplantations. We reviewed and compared one-year graft and patient survival with 138 living kidney transplantations.

RESULTS

One-year graft and patient survivals in cadaveric groups were 93% and 96%, respectively, and in living groups were 92% and 97%, respectively.

CONCLUSION

There was no significant difference in one-year graft and patient survival between living and cadaver donor kidney transplantation.

Renal Allograft Accumulation of Technetium-99m Sulfur Colloid as a Predictor of Graft Rejection

Differentiation between rejection (the most common cause) and many other possibilities for detrimental effects on graft function represents a difficult issue to diagnose the cause of renal allograft dysfunction. This study was designed to determine whether technetium-99m sulfur colloid (TSC) accumulation predicted graft rejection. We prospectively studied 54 episodes of allograft dysfunction in 53 kidney transplant recipients who underwent TSC scintiscanning and graft biopsy. Visual analysis of TSC uptake compared uptake, in the allograft with that in the marrow of the fifth lumbar vertebra (L5). A 3+ result meant that allograft uptake was greater than L5 marrow uptake; 2+, the same; 1+, less and finally 0, no allograft uptake. Transplant accumulation of 2+ or more was considered consistent with rejection (P = .01). Allograft biopsies interpreted based on the Banff Working Classification showed rejection in 45 of 54 renal biopsies with 42 the biopsy-proven rejection episodes showing at least 2+ graft uptake. Furthermore, this nuclear medicine technique had a sensitivity of 93.3%, a specificity of 44.4%, a positive predictive value of 89.3%, a negative value of 57.1% and an efficiency of 83.3% for the diagnosis of renal allograft rejection.

Transureteral lithotripsy in pediatric practice

PURPOSE

The present study reviews ureteroscopy intervention for the treatment of ureteral stones in pediatric patients in the last 6 years at three institutions in Iran.

PATIENTS AND METHODS

Sixty-six ureteroscopies were performed in 66 prepubertal patients (mean age 9 years; range 2-15 years) with a male/female ratio of 31/35. Ultrasonography, plain film, or intravenous urography was performed in all cases. The mean stone size was 8 mm (range 5-15 mm). All the interventions were performed under general anesthesia with semirigid ureteroscopes of 8F to 11.5F. The stone was located in the left ureter in 32 patients and in the right in 34 patients. Stones were located in the distal ureter in 59 patients, in the midureter in 5, and in the proximal ureter in 2. Before ureteroscopy, ureteral dilatation with a balloon was done to 12F if necessary. If the calculus could not be removed with the basket (stone.8 mm), lithotripsy using ultrasonic, electrohydraulic (EHL), or pneumatic equipment was performed.

RESULTS

Ureteroscopy with an 11.5F, 9F, 8.5F, or 8F ureteroscope were performed in 26, 14, 5, and 21 patients, respectively, and ureteral dilatation was necessary in 23, 0, 0, and 2 cases, respectively. We were unable to introduce the ureteroscope into the ureter in three patients (two boys with an 11.5F ureteroscope and one girl with an 8.5F ureteroscope) with distal ureteral stones. The stones moved to the kidney in four patients. Stone management was with basketing alone in 14, EHL in 3, ultrasonic lithotripsy in 8, and ballistic lithotripsy in 34 patients. The stone-free rate was 88% (58 patients) at 48 hours postprocedure. The complication rate was 23% and included renal colic (1), gross hematuria (11), and pyelonephritis (3). No patient had obvious perforation or stricture of the ureter at 3-month follow-up.

CONCLUSION

Our series demonstrates the high success rate that can be achieved with ureteroscopic removal of ureteral calculi in children. Ureteroscopic treatment, especially with a small-caliber ureteroscope, should be considered the first choice for treatment of calculi in the distal ureter in children.

A case of fulminant human immunodeficiency virus dementia

Human immunodeficiency virus (HIV) dementia is characterized by cognitive, motor, and behavioral abnormalities that develop over weeks or months. Fulminant presentations are not well described in the literature. In this report we describe a patient with HIV dementia who presented with acute changes in mental status that occurred over 2 days, resulting in rapid deterioration and death in 1 month.

Disseminated cutaneous infection due to Mycobacterium tuberculosis in a person with AIDS

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Heterochronic Effects of Teopod 2 on the Growth and Photosensitivity of the Maize Shoot

Teopod 2 (Tp2) is a semidominant mutation of maize that prolongs the expression of juvenile vegetative traits, increases the total number of leaves produced by the shoot, and transforms reproductive structures into vegetative ones. Here, we show that Tp2 prolongs the duration of vegetative growth without prolonging the overall duration of shoot growth. Mutant shoots produce leaves at the same rate as wild-type plants and continue to produce leaves after wild-type plants have initiated a tassel. Although Tp2/+ plants initiate a tassel later than their wild-type siblings, this mutant tassel ceases differentiation at the same time as, or shortly before, the primary meristem of a wild-type tassel completes its development. To investigate the relationship between the vegetative and reproductive development of the shoot, Tp2/+ and wild-type plants were exposed to floral inductive short day (SD) treatments at various stages of shoot growth. Tassel initiation in wild-type plants (which normally produced 18 to 19 leaves) was maximally sensitive to SD between plastochrons 15 and 16, whereas tassel branching was maximally sensitive to SD between plastochrons 15 and 18. Tassel initiation and tassel morphology in Tp2/+ plants (which normally produced 21 to 26 leaves) were both maximally sensitive to SD between plastochrons 15 and 18. Thus, the constitutive expression of a juvenile vegetative program in Tp2/+ plants does not significantly delay the reproductive maturation of the shoot.