Short- and long-term outcomes of kidney donors: a report from Tunisia

Kidney transplantation remains the best treatment option of end-stage renal disease. Kidney donations are of particular interest with the currently increasing practice of living-donor transplantation. The purpose of this study was to analyze retrospectively the general health status as well as renal and cardiovascular consequences of living-related kidney donation. A total of 549 living-related kidney donors had donated their kidneys between 1986 and 2007. We attempted to contact all donors to determine short- and long-term outcome following kidney donation. All kidney donors who responded underwent detailed clinical and biochemical evaluation. The data were compared with age-matched health tables of the Tunisian general population. In all, 284 donors (52%) had a complete evaluation. They included 117 men and 167 women with a mean age of 42 ± 12 years. The major peri-operative complications that occurred in these donors included four cases of pneumothorax, six cases of surgical site infection, one case of phlebitis and one case of pulmonary embolism. None of the study cases died. The median length of hospital stay after donor nephrectomy was 6.5 days (range: 3-28 days). The median follow-up period was eight years. The mean creatinine clearance after donation was 90.4 ± 25 mL/min in men and 81.5 ± 27.2 mL/min in women. Proteinuria was >300 mg/24 h in 17 cases (5.9%). Fifty-eight (20.4%) donors became hypertensive and 19.6% of the men and 37.2% of the women became obese. Diabetes mellitus developed in 24 (8.4%), and was more common in patients who had significant weight gain. Our study suggests that kidney donors have minimal adverse effects on overall health status. Regular follow-up identifies at-risk populations and potentially modifiable factors. Creation of a national registry of living donors and their monitoring are an absolute necessity.     

Biokinetics and dosimetry of 111In-DOTA-NOC-ATE compared with 111In-DTPA-octreotide

Purpose

The biokinetics and dosimetry of ¹¹¹In-DOTA-NOC-ATE (NOCATE), a high-affinity ligand of SSTR-2 and SSTR-5, and ¹¹¹In-DTPA-octreotide (Octreoscan?, OCTREO) were compared in the same patients.

Methods

Seventeen patients (10 men, 7 women; mean age 60?years), referred for an OCTREO scan for imaging of a neuroendocrine tumour (15), thymoma (1) or medullary thyroid carcinoma (1), agreed to undergo a second study with NOCATE. Whole-body anterior–posterior scans were recorded 0.5 (100?% reference scan), 4, 24 and 48?h (17 patients) and 120?h (5 patients) after injection. In 16 patients the OCTREO scan (178?±?15?MBq) was performed 16?±?5?days before the NOCATE scan (108?±?14?MBq) with identical timing; 1 patient had the NOCATE scan before the OCTREO scan. Blood samples were obtained from 14 patients 5?min to 48?h after injection. Activities expressed as percent of the initial (reference) activity in the whole body, lung, kidney, liver, spleen and blood were fitted to biexponential or single exponential functions. Dosimetry was performed using OLINDA/EXM.

Results

Initial whole-body, lung and kidney activities were similar, but retention of NOCATE was higher than that of OCTREO. Liver and spleen uptakes of NOCATE were higher from the start (p?<?0.001) and remained so over time. Whole-body activity showed similar α and β half-lives, but the β fraction of NOCATE was double that of OCTREO. Blood T _1/2β for NOCATE was longer (19 vs. 6?h). As a result, the effective dose of NOCATE (105?μSv/MBq) exceeded that of OCTREO (52?μSv/MBq), and the latter result was similar to the ICRP 106 value of 54?μSv/MBq. Differential activity measurement in blood cells and plasma showed an average of <5?% of NOCATE and OCTREO attached to globular blood components.

Conclusion

NOCATE showed a slower clearance from normal tissues and its effective dose was roughly double that of OCTREO.     

Primary sporadic Burkitt lymphoma of the orbit,clinical characteristics,management, and outcomes: a case study

Background

Involvement of the orbit with Burkitt’s lymphoma is a very rare presentation of extra-nodal lymphoma.

Illustrative case

We report a case of a 2-year-old female presented an unusual location of sporadic Burkitt’s lymphoma arising in the orbital region. Diagnostic magnetic resonance imagining identified an oval-shaped mass on the lateral rectus of the right orbit that caused dislocation of eyeball, for which she underwent a biopsy from the periorbital swellings.The mass was histologically confirmed as Burkitt’s lymphoma, and postoperative aggressive chemotherapy was initiated.We describe clinical diagnosis, histological aspects, radiological features, and current management of this rapidly growing malignant tumor.

Conclusion

Because of the rapid progression of Burkitt lymphoma, and considering that it responds well to treatment, early recognition and appropriate management are important factors for survival and to preserve visual function.

     

Cooccurrence of Multiple AmpC β-Lactamases in Escherichia coli,Klebsiella pneumoniae,and Proteus mirabilis in Tunisia

Over a period of 40 months, plasmid-mediated AmpC β-lactamases were detected in Tunis, Tunisia, in 78 isolates (0.59%) of Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. In 67 isolates, only one ampC gene was detected, i.e., bla_CMY-2-type (n = 33), bla_ACC (n = 23), bla_DHA (n = 6) or bla_EBC (n = 5). Multiple ampC genes were detected in 11 isolates, with the following distribution: bla_MOX-2, bla_FOX-3, and bla_CMY-4/16 (n = 6), bla_FOX-3 and bla_MOX-2 (n = 3), and bla_CMY-4 and bla_MOX-2 (n = 2). A great variety of plasmids carrying these genes was found, independently of the species and the bla gene. If the genetic context of bla_CMY-2-type is variable, that of bla_MOX-2, reported in part previously, is unique and that of bla_FOX-3 is unique and new.     

Peritoneal amyloidosis: unusual localization of gastrointestinal amyloidosis

Amyloidosis is a rare disease that results from the extracellular deposition of amorphous fibrillar protein. It is usually observed in a systemic form. Gastrointestinal involvement is frequent but peritoneal localization is unusual. A 43-year-old male was investigated for nephritic colic. Morphologic explorations revealed small intestine agglomerans in the periumbilical region, infiltration of peritoneal fat and multiple coelio-mesenteric lymph nodes. There were no clinical or biological abnormalities and endoscopic examinations were normal. The patient then underwent an exploratory laparoscopy. Macroscopically false membranes were seen throughout the peritoneum and small bowel without ascites. Anatomopathologic examination diagnosed peritoneal amyloidosis. After several investigations a diagnosis of a primary peritoneal amyloidosis was confirmed. The patient was treated with melphalan and prednisone with a favorable outcome. Our case illustrates a particular presentation of peritoneal amyloidosis. Despite improved imaging methods, peritoneal biopsy remains essential for diagnosis.     

Metabolic syndrome is associated with gastroesophageal reflux disease based on a 24‐hour ambulatory pH monitoring

Several studies have focused on the relationship between metabolic syndrome and gastroesophageal reflux disease (GERD). They were based on GERD complications, whereas little is known about the association between metabolic syndrome and objectively measured esophageal acid exposure. The aim of our study was to assess the relationship between metabolic syndrome and GERD based on a 24‐hour pH testing. It was a cross‐sectional study including 100 consecutive patients who underwent a 24‐hour pH‐metry monitoring and were assessed for the five metabolic syndrome components as well as for body mass index (BMI). Among the 100 patients, 54 had a pathological acid GERD. The 46 GERD‐free patients represented control group. Sex distribution was comparable between both groups but GERD patients were older than controls (44.59 vs. 37.63 years, P= 0.006) and more often obese or with overweight (83.3 vs. 60.9%, P= 0.01). Frequency of metabolic syndrome as a whole entity was higher among patients with GERD than those without GERD (50 vs. 19.56%; P= 0.002) with a crude odds ratio of 4.11 (95% confidence interval: 1.66–10.14). Multivariate regression analysis showed that metabolic syndrome as well as an age ≥30 years were independent factors associated to GERD but not BMI and sex. Abnormal waist circumference and fasting glucose level ≥100 mg/L were the only independent factors among the five components of metabolic syndrome. Metabolic syndrome but not BMI was an independent factor associated to GERD. These results confirm the hypothesis that central obesity is associated to GERD.     

Correlation of C-Reactive Protein with Clinical and Endoscopic Activity in Patients with Ulcerative Colitis

Background and Aims  

Evaluating disease activity is important in ulcerative colitis. Laboratory markers should be a non-invasive alternative to endoscopy for patients. The objective of our study was to scrutinize the correlation between C-reactive protein (CRP) levels and clinical and endoscopic activity in ulcerative colitis patients.