Living unrelated donor kidney transplantation between spouses

From November 3, 1975 to November 3, 1990, 874 kidney transplants were performed at our centers. Of these, 675 (77.2%) were from living donors and 199 (22.8%) were from cadaver donors. Five hundred eighty (66.4%) of the living donors were first degree related while 99 (11.3%) were unrelated or second degree related donors, 29 of which were spouses. All donor recipient pairs were ABO-compatible, with the exception of one pair. Donor recipient relations were wife to husband in 25 cases and husband to wife in 4 cases. All were first grafts and started functioning during surgery. In this series, the follow-up for the recipients was 4 to 64 months (mean 33.5 ± 4.5 months). One-year patient survival and graft survival rates were 92.4% and 81.9%, respectively. Two-year patient survival and graft survival rates were 92.4% and 78.2%, respectively. The single ABO-incompatible case is also doing well, 21 months postoperatively. This study demonstrates that the interspouse kidney transplantation may be used when cadaver organ shortage is a problem. While providing the couple with a better quality of life, interspouse kidney transplantation also enables the couple to share the joy of giving and receiving the gift of life from one another.

---

Resumen En nuestro centro se efectuaron 874 trasplantes renales entre noviembre 3 de 1975 y noviembre 3 de 1990; 675 (77.2%) fueron de donantes vivos y 199 (22.8%) de donantes cadavéricos; 580 (66.4%) de los donantes vivos fueron familiares de primer grado y 99 (11.3%) fueron donantes no relacionados familiarmente o familiares de segundo grado, de los cuales 29 eran cónyuges. Todas las parejas donante-recipiente exhibieron compatibilidad ABO, con excepción de una. La relación donante-recipiente fue esposa a esposo en 25 casos y esposo a esposa en 4 casos. Todos los injertos eran de primera vez y todos comenzaron a funcionar en la mesa de cirugía. El seguimiento osciló entre 4 y 64 meses (33.5 ± 4.5). Las tasas de sobrevida a un año del paciente y del injerto fueron 92.4% y 81.9% respectivamente; las tasas a dos años fueron 92.4% y 78.2% respectivamente. El único caso ABO no compatible también se encuentra bien, a 21 meses en la actualidad. El presente estudio demuestra que el trasplante renal entre esposos puede ser utilizado cuando haya escases de órganos cadavéricos. Al tiempo que permite una mejor calidad de vida, el procedimiento da a la pareja la oportunidad de gozar el hecho de otorgar y de recibir el regalo de la vida entre uno y otro.

---

Résumé Nous avons effectué 874 transplantations rénales dans nos centres de transplantation entre le 3 Nov, 1975 et le 3 Nov, 1990. Parmi celles-ci, 675 (77.2%) provenaient de donneurs vivants et 199 (22.8%) des reins provenaient de cadavres. Cinq cent quatre vingt des donneurs vivants (66.4%) étaient parents au premier degré alors que 99 (11.3%) étaient parents au 2è degré ou n'étaient pas parents, parmi lesquels 29 étaient des époux. Tous les couples donneur/receveur, sauf un, étaient compatibles dans le système ABO. Le couple donneur/receveur était femme à mari dans 25 cas et mari à femme dans quatre. Il s'agissait dans tous les cas d'une première greffe et qui a commencé à bien fonctionner sur la table d'opération. Dans cette série, le suivi des receveurs allait de 4 à 64 (33.5 ± 4.5) mois. Les taux de survie des malades et des greffes à un an étaient respectivement de 92.4% et 81.9%. Les taux de survie des malades et des greffes à deux ans étaient respectivement de 92.4% et 78.2%. Le seul cas avec incompatabilité ABO va très bien avec un recul de 21 mois. Cette étude montre que la transplantation entre époux est une solution valable en cas de manque de reins. En plus d'améliorer la qualité de survie du receveur et par là même du couple, cette variété de transplantation donne également au couple la possibilité d'avoir la joie de donner et de recevoir un cadeau de vie de leur époux.

     

Somatostatin infusion withdrawal in the diagnosis of childhood growth hormone deficiency

OBJECTIVE: An evaluation of growth hormone (GH) testing for GH deficiency (GHD) in childhood is confounded by the lack of a world-wide consensus on the definition of GHD. Although a single GH test remains the most powerful biochemical tool in the evaluation of a child with growth failure, the test remains far from ideal. Withdrawal of somatostatin (SS) infusion is followed by a rebound rise of GH thought to be mediated by endogenous GH-releasing hormone (GHRH) function. This study was designed to compare the GH response to 90 min SS infusion in children with normal GH secretion versus children with GH deficiency. METHODS: Ten children with GHD and 10 healthy controls (NC) have been evaluated for GH response to somatostatin infusion withdrawal (SSIW) and compared with response of two provocative tests, glucagon plus propranolol test and L-Dopa test. All children received constant infusion of somatostatin for 90 min (3 microg/kg per h, Stilamin, Serono, Aubonne, Switzerland). In order to determine GH, blood samples were obtained 90 min before the SS infusion and 0, 15, 30, 45, 60, 75, and 90 min after the cessation of infusion. RESULTS: Growth hormone peak levels with SSIW were significantly lower in GH deficient children than in healthy children (2.5 +/- 1.2 ng/dL, vs 21.9 +/- 5.3 ng/dL, respectively, P < 0.01). No adverse effects were observed during or after somatostatin infusion. CONCLUSION: In the present study, SSIW elicited a significant GH rise in healthy children but not in children with GH deficiency. Although further controlled studies using more data are necessary to expand these findings, the results suggested that children with GH deficiency can be reliably discriminated from healthy children by SSIW.     

Comparison of preputial sac and urine cultures in healthy children

The aim of the present study was to examine subpreputial bacteriology and to compare it with the urine cultures of healthy male children. Seventy-two male children were divided into two groups as A and B according to age. In both groups preputial sac and urine cultures were taken simultaneously. Gram (+) enteric cocci were the most common isolated pathogens from the preputial sac in group B. Enterobacter, E. coli and staphylococci species were isolated from the urine cultures of three patients in group B. We could not find any difference between the preputial sac swabs of group A and B patients, but the isolation rate of urine cultures of group A patients was significantly higher than group B (p < 0.05). The findings of the present study support a potential role of the prepuce acting as a reservoir of faecal bacteria in the pathogenesis of UTI in male infants, especially in the first year of life. Improved penile hygiene after the first year of life does not alter the subpreputial bacteriology, but significantly decreases the contamination of urine. This revised version was published online in August 2006 with corrections to the Cover Date.     

The contracting and relaxing responses of human internal mammary artery grafts harvested by two different methods

Perioperative spasm of internal mammary artery is a common experience in coronary artery bypass grafting. Many techniques were described of harvesting the internal mammary artery to prevent vasospasm. We investigated the comparison of the contracting and relaxing responses of human internal mammary artery grafts harvested by two different methods. Patients were divided into two groups depending on the harvesting technique. In the first and second groups arteries were harvested by classical and carbon dioxide insufflation techniques, respectively. In both groups, endothelial function of arteries was assessed by precontracting the rings with phenylephrine (10(-5)M) and dilatating them by cumulative acetylcholine (10(-8) to 10(-5)M) concentrations. Cumulative concentration-response curves for phenylephrine (10(-8) to 10(-4)M), noradrenaline (10(-9) to 10(-4)M), and 5-hydroxytryptamine (10(-9) to 10(-4)M) were obtained in all groups. Endothelial integrity of arteries were histopathologically evaluated. In both groups, acetylcholine caused concentration-dependent relaxations in rings precontracted with phenylephrine (10(-5)M). In arteries harvested by carbon dioxide insufflation technique, acetylcholine caused significantly higher relaxations compared to the rings obtained by classical technique (p<0.05). In all rings of study groups, phenylephrine, noradrenaline and 5-hydroxytryptamine caused concentration-dependent contractions. There was not any significant difference in concentration-dependent responses of these contracting pharmacological agents between the groups. Histopathological evaluation revealed no major arterial damage in both groups. Carbon dioxide insufflation technique does seem not only to protect the integrity of the endothelium and the whole vessel, but also prevent the possible vasospasm of the internal mammary artery segments.     

Complementary findings in clinical and epidemiologic features of mumps and mumps meningoencephalitis in children without mumps vaccination

BACKGROUND: Mumps vaccine has not yet been included in the routine vaccination programme, for this reason mumps is still one of the most common infections for children in Turkey. One of the major complication of mumps is meningoencephalitis, which although usually heals spontaneously, it may cause neurologic complications. METHODS: This study was undertaken to investigate epidemiologic and demographic characteristics in children with mumps and mumps meningoencephalitis and clinical/laboratory findings in children with mumps meningoencephalitis diagnosed over a 11 year period. A total of 2422 mumps and 135 mumps meningoencephalitis cases were covered in this study which constitutes one of the largest series of mumps meningoencephalitis in the literature. The mean age of mumps and mumps meningoencephalitis cases were 6.6 +/- 2.7 and 7.6 +/- 2.6 years, respectively. RESULTS: There was a male predominance both among the cases of mumps and mumps meningoencephalitis. The age and seasonal distributions were similar in the mumps and mumps meningoencephalitis groups. The most common symptoms of mumps meningoencephalitis were fever (97%), vomiting (94%) and headache (88.8%). The mean cerebrospinal fluid (CSF) total cell count and lymphocyte count were 540 +/- 460/mm(3) and 300 +/- 330/mm(3), respectively. The mean CSF protein and glucose levels were found to be 56.97 +/- 27.94 mg/dL and 53.67 +/- 15.46 mg/dL, respectively. The mean of CSF/blood glucose ratio was 0.53 +/- 0.16. The mean duration of hospitalization in mumps meningoencephalitis cases was found to be 5.1 +/- 2.4 days and this was longer in boys (P < 0.05). CONCLUSION: In patients with mumps meningoencephalitis, higher CSF protein levels and lower CSF glucose/blood glucose ratio were associated with longer hospitalization periods. There was no death.     

Maternal mortality rates in the last eight years: A university hospital-based study from Turkey.

OBJECTIVE: To analyze the cause of changing maternal mortality ratios (MMRs) in a tertiary women's health center in Turkey in the last eight years. MATERIALS AND METHODS: Charts of patients seen between 1998 and 2005 were retrospectively reviewed. Statistical analysis was performed using the Chi-square test. The results were accepted to be significant when the p value was <0.05. RESULTS: During this period, 27 pregnancy-related deaths were identified via hospital death records. The MMR was found to have decreased in rate by approximately 50% from 822.2/100,000 live births in the previous report including the years 1978-1997 to 412.0/100,000 during the last eight years (p < 0.01). Pregnancy-induced hypertension was still the most frequent cause of maternal death. The decrease in MMR was due to the decrease in the ratio of maternal infection (26.4% in 1978-1997 to 7.4% in 1998-2005, p < 0.01). CONCLUSION: Although treatment in the antenatal care and health service has decreased maternal deaths, it was discovered that the MMR has not reached the optimum levels found in developed countries in the last eight years. Also the percentage of direct obstetric deaths (with the exception of those caused by infection) showed no change and was similar to that found in the previous report (1978-1997).     

Successful management of a cornual pregnancy with a single high-dose laparoscopic methotrexate injection

Cornual (interstitial) pregnancy, a very rare form of ectopic pregnancy, accounts for 2–4% of all tubal pregnancies in which conception is located in the proximal interstitial portion of the fallopian tube. Cornual resection by laparotomy is generally the preferred method of treatment, although more conservative approaches have also been described. We report a case of cornual pregnancy that was successfully treated with a single dose of 100 mg methotrexate injected into the mass of the ectopic cornual pregnancy. The serum human chorionic gonadotropin (hCG) level decreased to undetectable levels on the 60th post-operative day.