Native portal vein embolization for persistent hyperoxaluria following kidney and auxiliary partial liver transplantation

Type 1 primary hyperoxaluria (PH1) causes renal failure, for which isolated kidney transplantation (KT) is usually unsuccessful treatment due to early oxalate stone recurrence. Although hepatectomy and liver transplantation (LT) corrects PH1 enzymatic defect, simultaneous auxiliary partial liver transplantation (APLT) and KT have been suggested as an alternative approach. APLT advantages include preservation of the donor pool and retention of native liver function in the event of liver graft loss. However, APLT relative mass may be inadequate to correct the defect. We here report the first case of native portal vein embolization (PVE) to increase APLT to native liver mass ratio (APLT/NLM-R). Following initial combined APLT-KT, both allografts functioned well, but oxalate plasma levels did not normalize. We postulated the inadequate APLT/NLM-R could be corrected by trans-hepatic native PVE. The resulting increased APLT/NLM-R decreased serum oxalate to normal levels within 1 month following PVE. We conclude that persistently elevated oxalate levels after combined APLT-KT for PH1 treatment, results from inadequate relative functional capacity. This can be reversed by partial native PVE to decrease portal flow to the native liver. This approach might be applicable to other scenarios where partial grafts have been transplanted to replace native liver function.

[Febrile algo-eruptive illness in a French foreign legionnaire returning from Djibouti: gonococcal arthritis]

A French foreign legionnaire returning from Djibouti developed feverish polyarthritis with acral purpura. Diagnostic workup demonstrated gonococcemia contracted during unprotected fellatio. Based on this case report, diagnostic and therapeutic management is described.

[Congenital hemolytic anemia due to glucose-6-phosphate dehydrogenase deficiency]

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common enzyme defect with a wide range of clinical manifestations that can be severe. A variety of factors including many medications can induce hemolytic episodes. Screening for G6PD deficiency is required before use of some drugs especially primaquine or dapsone.

[Tethered cord syndrome: an unusual cause of adult bladder dysfunction]

Tethered cord syndrome is a complication of spinal dysraphism. The tethering of the cord does not permit the normal cranial migration of the conus within the vertebral canal. The result is a neural dysfunction due to a traction neuropathy. Although this condition commonly presents in childhood, less severe degrees of tethering may remain asymptomatic until adult life. The authors report a new case of tethered cord syndrome in a 25-years-old young girl, cause of bladder dysfunction. Clear improvement of urinary repercussions is obtained after surgery.

Therapeutic options in patients with Barrett's esophagus

The rising incidence of esophageal adenocarcinoma has focused attention on the only known risk factor: Barrett's esophagus. Practice guidelines for the diagnosis, surveillance and management of Barrett's esophagus were published recently. Although the ultimate goal in the management of this premalignant condition would be the permanent elimination of Barrett's mucosa, current therapeutic options are limited or still in the investigational stages. This review summarizes current medical and surgical treatment options and introduces endoscopic ablative modalities currently under investigation.