Epidemiology of end-stage renal disease before starting hemodialysis and factors influencing hemodialysis survival

BACKGROUND: The incidence of end-stage renal failure is high and it is responsible for the increase of the rate of morbidity and mortality rates among our patients. AIM:The objective is to study patient characteristics before starting hemodialysis and to evaluate factors influencing their short and long term survival. METHODS: This is a prospective study of 127 patients starting hemodialysis between June and December 2001. On May 31, 2005, their survival was analyzed according to different parameters. RESULTS: Patients were 77 males and 50 females. Their mean age was 51.4 +/- 16.1 years (15 to 78 years). Diabetes was observed in 33.9% of cases. Only 70.9% of patients were covered by a social service. Chronic renal failure was diagnosed at the end stage in 34.6% of cases. Before starting hemodialysis, only 4 patients were vaccinated against B hepatitis and arteriovenous fistula were not made in any patients. Pericarditis was observed in 9.4% of patients. Albuminemia was < 35 g/l in 60.5% of patients. First hemodialysis session was programmed in 53.5% of patients and realized urgently in 46.3% of patients. Patients were hemodialysed 4, 8 and 12 hours per week respectively in 16.5%, 15.8% and 67.7% of cases. On May 31, 2005, 35.4% of patients died. Their actuarial survivals at 3 months, 1 year and 4 years were respectively at 87.5%, 79.5% and 64.4%. Acturial survival was bad in patients with pericarditis, diabetes, hemodialysed less than 12 hours/week and when the first hemodialysis session was started urgently. CONCLUSION: The diagnosis of renal failure was frequently made at end-stage. There are no preparations before starting hemodialysis. We have to reinforce prevention programmes and increase the number of nephrologists and nephrology departments.     

Adult discoid lupus erythematosus

BACKGROUND: Discoid lupus erythematosus is a particular form of systemic lupus in which manifestations are confined to the skin. AIM: Our purpose was to evaluate the epidemiology trends, presenting clinical manifestations, therapeutic features and outcome of patients with discoid lupus erythematosus (DLE). METHODS: It's a retrospective study, done in the dermatology department of Habib Thameur Hospital over an 8 years period. We included only the cases of DLE confirmed by the histology and/or the direct immunofluorescence. RESULTS: We identified 26 patients mean aged 46.19 years. All of them were adults. The lesions were localized on the face for 25 patients, neck (7 patients), scalp (6) and hands (6). Eleven patients presented a generalized DLE. The mean period of follow-up was 3 years raging from 1 month to 20 years. After a 15 year evolution, 1 patient presented degeneration in squamous cell carcinoma of 2 lesions. CONCLUSION: Unfortunately, there is still in our country a long delay before the first consultation, which, added to an absence of adequate photoprotection, can obscure the prognosis of DLE.     

A case of preserved fertility in an hemodialyzed patient with systemic lupus erythematosus

BACKGROUND: Pregnancy and child birth in haemodialysis remains a rare event, even more, when pregnancy occurs in patient with systemic lupus erythematosus (SLE). AIM: We report a case of a patient with end stage renal failure secondary to SLE and who carried out 3 pregnancies. CASE REPORT: She was a woman with proliferative and diffuse lupus glomerulonephritis since 1985 treated by corticosteroids and cyclophosphamide. In 1995, she developed chronic renal failure. In 1996, she underwent a 1st full term spontaneous pregnancy with normal birth weight. In 2001, she underwent a second spontaneous pregnancy while she was on periodic haemodialysis. She had a full term baby birth with a birth weight at 1 Kg 700 and who died 4 days later. In 2002, she had a third pregnancy with voluntary abortion at 8 weeks. CONCLUSION: Our patient had conserved fertility despite treatment by cyclophosphamide, chronic renal failure and haemodialysis. The two successful deliveries may be attributed to the control of SLE activity and to the adequacy of haemodialysis.     

Current status of magnetic resonance imaging (MRI) and ultrasonography fusion software platforms for guidance of prostate biopsies

Prostate MRI is currently the best diagnostic imaging method for detecting PCa. Magnetic resonance imaging (MRI)/ultrasonography (US) fusion allows the sensitivity and specificity of MRI to be combined with the real‐time capabilities of transrectal ultrasonography (TRUS). Multiple approaches and techniques exist for MRI/US fusion and include direct ‘in bore’ MRI biopsies, cognitive fusion, and MRI/US fusion via software‐based image coregistration platforms.