Pulmonary Valvotomy: An Alternative Method

An alternative technique of pulmonary valvotomy for patients with pulmonary atresia and intact ventricular septum is presented. The method is simpler and safer than open valvotomy with inflow occlusion or with cardiopulmonary bypass. It is more precise and controlled than closed valvotomy.     

Late-Onset Allograft Aspergillosis in an HIV-Positive Renal Transplant Recipient: A Case Report

Aspergillus infection of the allograft in renal transplant patients is rare and associated with a high mortality. We report a case of a 21-year-old, human immunodeficiency virus–positive, deceased-donor kidney recipient who presented 1 year after transplant with oliguric kidney injury. A nuclear medicine renal scan revealed absence of flow to the transplanted kidney, and a urine fungal culture was positive for Aspergillus flavus. The diagnosis was confirmed with the presence of fungal hyphae along with thrombosis in the vascular structures in renal allograft pathology. We found no evidence of disseminated aspergillosis or involvement of any other organ in the patient. To our knowledge, this case is the first reported in the literature of late-onset non-disseminated renal-limited aspergillosis in a human immunodeficiency virus–positive renal transplant patient.     

Serum Cefazolin Levels during Cardiopulmonary Bypass

This study was done to assess the adequacy of a regimen using cefazolin as a prophylactic antibiotic for patients undergoing open-heart operation. At the time of the preoperative medication, adult patients received 1 gm of cefazolin intramuscularly, and pediatric patients were given a dose of 20 mg per kilogram of body weight. Group I consisted of 10 adults undergoing a variety of cardiac procedures. The mean serum cefazolin level after institution of cardiopulmonary bypass was 27.36 μg/ml (range, 13.1 to 40.3 μg/ml). This level remained fairly stable throughout cardiopulmonary bypass. Group II consisted of 10 pediatric patients undergoing cardiac procedures for repair of a variety of congenital anomalies. The mean serum cefazolin level after institution of cardiopulmonary bypass was 20.01 μg/ml (range, 11.4 to 28.9 μg/ml) and remained stable for the duration of the procedure. In both groups perfusion pressure, urinary output, and body temperature did not seem to have any influence on these levels.It is concluded that the administration of one dose of cefazolin intramuscularly before operation results in an adequate and stable serum cefazolin level in patients undergoing cardiopulmonary bypass for up to three hours, possibly longer.     

Controlled Trial of Routine Administration of Platelet Concentrates in Cardiopulmonary Bypass Surgery

Prophylactic administration of platelet concentrates to patients undergoing their first cardiopulmonary bypass operation (coronary artery bypass grafting or uncomplicated valve replacement) was evaluated in a controlled randomized study of 28 patients. Four units of platelet concentrates administered at the end of bypass prevented prolongation of the bleeding time seen in patients not receiving platelets. However, chest tube blood loss, transfusion requirements, and clinical outcome were not improved. Moreover, thrombocytopenia and prolongation of bleeding time did not correlate with blood loss or transfusion needs. Mild thrombocytopenia (to 58,000 platelets per microliter) and transient platelet dysfunction after bypass do not require administration of platelet concentrates, and prophylactic use of this blood component in the surgical setting of bypass is not indicated.     

Cystic kidneys: an enigma evolves

Substantial contributions to the field of RCD have been made over the past 15 years. Most intriguing is a growing awareness of acquired RCD and its complications. Data have been published and are reviewed here in support of a possibility that APKD and RCD acquired during hemodialysis are premalignant lesions. More data are needed before the possibility can be confirmed or denied. The collection of these data is an immediate need in the field of RCD.     

Use of a sagittal oscillating saw for repeat sternotomy: a safer and simpler technique

A method of repeat sternotomy using a microsagittal oscillating saw is described. We have found this method to be safer and simpler than previously described techniques. We have used this technique in more than 50 repeat sternotomies without a single complication related to the mediastinal reentry procedure.     

Renal Allograft Aspergillus Infection Presenting With Obstructive Uropathy: A Case Report

Background

Isolated renal allograft aspergillosis is rare and usually presents with fever and decreased glomerular filtration rate. Presentation with obstructive uropathy caused by aspergillus fungal balls is much less common. We report a young male patient who presented with obstructive uropathy secondary to isolated renal allograft aspergillus infection 6 weeks after transplant. He was treated with nephrectomy and antifungal medications.

Living Donor Kidney Transplantation After Brachytherapy for Prostate Cancer: Case Report

Introduction

There is no obvious criterion about kidney transplantation for patients with pretransplant malignancy. Minimum tumor-free waiting periods differ according to type of cancer, staging, site of occurrence, response to therapy, and risk of cancer recurrence. We report a case of living donor kidney transplantation (LDKT) in a patient after brachytherapy for prostate cancer.

Blastomyces dermatitidis in a Renal Transplant Recipient: A Case Report

Fungal infections have an important role in organ transplant recipients, and in some cases can be lethal. Blastomycosis is rare in kidney transplantation. We present a case of cutaneous blastomycosis in a kidney transplant recipient in Tunisia, a country outside the known endemic countries. This case, with the very uncommon and unexpected diagnosis of blastomycosis, demonstrates the diversity of infections in transplant recipients and reflects the importance of histologic and serologic tests in the immunocompromised patient.     

Case Report of Salmonella gallinarum Urinary Tract Infection in a Renal Allograft Recipient

Urinary tract infections (UTIs) caused by nontyphoidal Salmonella in a renal allograft recipient are a rare occurrence. Although there is some existing literature on Salmonella typhi bacteriuria and non-typhoidal bacteriuria, none of the cases has been reported in a renal transplant patient. This case report describes a rare instance in which group D Salmonella was isolated from a renal allograft recipient's urine culture and the patient was successfully treated with antibiotics.     

Prostate Cancer in Renal Transplant Recipients: Diagnosis and Treatment

Background

We currently know that prostate cancer (Pca) risk is reduced in patients undergoing kidney transplantation. However, its impact and treatment are not widely studied.

Safety and Efficacy of Immune Checkpoint Inhibitors in Patients With Metastatic Cancer Post Solid Organ Transplantation: A Case Report and Review of the Literature

Immunotherapy is expanding its role in cancer therapy, and in various tumor types it has now become the frontline treatment. Though generally better tolerated than traditional chemotherapy, its mechanism of activating the immune system results in a unique set of adverse reactions that maybe disastrous in the setting of post solid organ transplantation. We herein describe a case report of a patient who was post–renal transplant, developed metastatic, relapsed, refractory renal cell carcinoma, and was successfully treated with nivolumab for 6 cycles while maintaining renal graft function. We also reviewed the published case reports of immunotherapy administered in the post–renal transplantation setting.     

Condyloma Acuminata of the Urethra in a Male Renal Transplant Recipient: A Case Report

Background

Condyloma acuminatum (CA) is a common sexually transmitted disease associated with human papilloma virus (HPV). CA occurring in the urethra is rare and has not been reported in male renal transplant recipients. In addition, despite immunosuppressive conditions and increased risk of HPV-related malignant neoplasms in transplant recipients, HPV testing in male transplant recipients has been uncommon. Here we report a case of urethral CA in a male deceased donor renal transplantation recipient and discuss the importance of HPV testing in male transplant recipients.

Trichoblastoma Cutis in a Renal Transplant Recipient: A Case Report

Trichoblastoma is rare, benign skin neoplasm that may be difficult to distinguish from malignant baso-cellular skin cancer. Renal transplant recipients are at increased risk for development of skin malignancies. Resection and histopathological evaluation of a suspicious lesion is mandatory to determine malignant skin changes. We present the first reported case of trichoblastoma in a renal transplant recipient. Proper diagnosis enables less aggressive resection and maintenance of the same immunosuppressive protocol.     

Mucormycosis Presented with Facial Pain in a Renal Transplant Patient: A Case Report

IntroductionMucormycosis is a severe infection in renal transplant recipients. Here, we report a case of maxillary sinus mucormycosis in a patient who presented with a facial pain complaint.CaseA 51-year-old female patient with renal transplantation due to autosomal dominant, polycystic kidney disease and diabetic nephropathy was admitted to our hospital with facial pain and minimal edema of the left half of her face on the 8th month of transplantation. On physical examination, there was only tenderness and slight edema on the left half of the face. On the paranasal computed tomography, extensive soft tissue densities involving septations, filling the left maxillary sinus, extending to the nasal cavity, and obliterating the left osteometeal unit were observed. Because facial pain was not relieved by antibiotics and several, potent analgesic drugs on the second day, mucormycosis infection with bone involvement was suspected. A left maxillary sinus excision was performed. Microscopic examination of the debridement specimen revealed necrotic bone interspersed with fungal hyphae, and culture isolated Rhizopus oryzae. Liposomal amphotericin B was started. The patient was on tacrolimus, prednisolone, and mycophenolate mofetil. Tacrolimus was switched to cyclosporine to regulate serum glucose levels. The left maxillary sinus was washed with liposomal amphoterin B daily and curetted with intervals. The patient started dialysis because of severe renal function loss. The patient was discharged on the 96th day of liposomal amphotericin B.ConclusionIt should be kept in mind that mucormycosis may be present in the sinuses even if there is no evidence for nasal, oral, and dental examination in renal transplant patients with facial pain.