Identification of current smokers among renal transplant recipients.

BACKGROUND: In renal transplant recipients, smoking is associated with a high burden of cardiovascular disease and a higher risk of graft loss. Surprisingly, the results of measurement of cotinine serum level, the gold standard for the detection of active smoking, have not been confronted with self-reported smoking history in this group. The aim of our study was to identify and characterize the smoking group of renal transplant recipients. METHODS: Cotinine serum level was measured and all patients were asked to fill out an anonymous questionnaire on smoking history. RESULTS: Out of 233 renal transplant recipients, 106 (45%) reported to be lifetime and current non-smokers: cotinine serum level was below detection limit in all; among the 127 renal transplant recipients (55%) with a lifetime history of smoking, cotinine level was diagnostic of current smoking in 32 (25%). Only 21 of the current smokers (66%) declared to the nephrologist that they had continued smoking whereas 11 (34%) claimed to be non-smokers. Current smokers were younger (P=0.01) than former smokers. CONCLUSION: The identification of current smokers among renal transplant recipients should start with questioning about lifetime history of smoking and if positive, measurement of cotinine serum level. Indeed up to 34% of current smokers do not acknowledge they are active smokers and would otherwise not offer to participate in programmes to stop smoking.     

Dialysis‐related Amyloidosis: Is It Gone or Should It Be?

The prevalence and severity of dialysis‐related amyloidosis (DRA) appear to have decreased significantly over the last two decades, although recent, large‐scale epidemiological studies show that DRA continues to occur. Recent experimental findings have documented a direct cellular toxicity of β2microglobulin (β2m) fibrils but the mechanisms of β2m fibrillogenesis remain incompletely understood. Although a high plasma concentration of β2m is still considered as a prerequisite for developing DRA, other factors have been clearly incriminated such as older age at dialysis onset and longer dialysis vintage, or suspected effects such as proinflammatory effects of bioincompatible dialysis techniques. Improved dialysis technology has definitely played a role in delaying the onset of the disease, although the respective contributions of high‐flux biocompatible membranes, use of convective mode, and ultrapure dialysate remain imperfectly defined. Importantly, DRA still does exist and no current dialytic modality seems able to fully prevent it. Awaiting further progress in the understanding of DRA pathogenesis, the use of biocompatible high‐flux membranes and ultrapure dialysate is strongly recommended in order to minimize or delay its onset. Convective regimens may provide an additional benefit.     

Diagnostic yield of 18F‐FDG PET/CT imaging and urinary CXCL9/creatinine levels in kidney allograft subclinical rejection

Subclinical kidney allograft acute rejection (SCR) corresponds to “the unexpected histological evidence of acute rejection in a stable patient.” SCR detection relies on surveillance biopsy. Noninvasive approaches may help avoid biopsy‐associated complications. From November 2015 to January 2018, we prospectively performed positron emission tomography/computed tomography (PET/CT) after injection of F¹⁸‐fluorodeoxyglucose (¹⁸F‐FDG) in adult kidney transplant recipients with surveillance biopsy at ~3 months posttransplantation. The Banff‐2017 classification was used. The ratio of the mean standard uptake value (mSUVR) between kidney cortex and psoas muscle was measured. Urinary levels of CXCL‐9 were concomitantly quantified. Our 92‐patient cohort was categorized upon histology: normal (n = 70), borderline (n = 16), and SCR (n = 6). No clinical or biological difference was observed between groups. The mSUVR reached 1.87 ± 0.55, 1.94 ± 0.35, and 2.41 ± 0.54 in normal, borderline, and SCR groups, respectively. A significant difference in mSUVR was found among groups. Furthermore, mSUVR was significantly higher in the SCR vs normal group. The area under the receiver operating characteristic curve (AUC) was 0.79, with 83% sensitivity using an mSUVR threshold of 2.4. The AUC of urinary CXCL‐9/creatinine ratios comparatively reached 0.79. The mSUVR positively correlated with ti and acute composite Banff scores. ¹⁸F‐FDG‐PET/CT helps noninvasively exclude SCR, with a negative predictive value of 98%. External validations are required.     

Acute interstitial nephritis after cocaine sniffing

We report the case of a 42-year-old man who developed biopsy-confirmed acute interstitial nephritis (AIN) after cocaine sniffing. He required a few hemodialysis sessions but fully recovered within 3 weeks after cocaine withdrawal and a short course of corticosteroids. AIN should be recognized as a potential cause of acute renal failure in cocaine users, and a history of cocaine use should be carefully elicited in patients with unexplained AIN.     

Complete Mesh Expulsion as a Complication of Vaginally Assisted Laparoscopic Cervicosacropexy with Subtotal Hysterectomy: A Case Report

We report the first case of complete mesh expulsion after laparoscopic subtotal hysterectomy associated with sacral suspension of the cervix for pelvic organ prolapse.     

Didelphic uterus and obstructed hemivagina: recurrent hematometra in spite of appropriate classic surgical treatment

We report the case of a young girl with uterus didelphys, obstructed vagina and ipsilateral renal agenesis treated by diagnostic laparoscopy and resection of the vaginal septum by a vaginal approach in order to drain the distended uterus. Despite classic surgery, the myometrium on the treated side never recovered its normal function, with subsequent persistence of recurrent hematometra. Laparoscopic subtotal hemihysterectomy had to be performed to avoid retention of hematometra and secondary pelvic inflammatory disease.     

Posthysterectomy pelvic adenomyotic masses observed in 8 cases out of a series of 1405 laparoscopic subtotal hysterectomies

STUDY OBJECTIVES: To analyze the prevalence of an unexpected complication due to morcellation and to describe the appearance of this complication on magnetic resonance imaging, as well as its therapy. DESIGN: A well-designed controlled trial without randomization (Canadian Task Force classification II-1). SETTING: Academic hospital. PATIENTS: One thousand four-hundred five patients who underwent laparoscopic subtotal hysterectomy (LASH) in our department from 1990 through 2005 by surgeons using the same technique. INTERVENTION: Morcellation was performed using Steiner's 15-mm electric morcellator. MEASUREMENTS AND MAIN RESULTS: After 1405 LASH procedures, we encountered 8 cases (0.57%) of deep dyspareunia and pelvic pain caused by heterogeneous masses (median size 45 mm, range 20-80 mm). Symptoms appeared between 2 and 9 years after surgery. Vaginal examination revealed a painful pelvic mass in all 8 patients. The median CA 125 level was 52 IU/mL (range 19.4-128 IU/mL). Magnetic resonance imaging revealed heterogeneous masses containing hyperintense signals on T1-weighted images with saturation of fatty tissue. Injection of gadolinium revealed vascularization of the masses. Laparoscopic excision was performed, and extensive dissection of the rectum and pararectal fossa was required to isolate the masses. Histologic examination showed adenomyosis. Such complications occurred after electric morcellation of myomatous uterine corpora associated with adenomyosis. CONCLUSION: These lesions probably result from the growth of missed fragments of uterine corpus after previous morcellation, culminating in the development of symptomatic iatrogenic adenomyomas. For this reason, the abdominal cavity must be meticulously inspected after electric morcellation, especially in patients with adenomyotic uteri.     

Laparoscopic treatment of gallbladder duplication

Background: Gallbladder duplication is a rare congenital condition, which can now be detected preoperatively by imaging studies. Methods: We report a case of duplicated gallbladder with symptomatic unilobar gallstones. Appropriate biliary workup (ultrasound, oral cholecystography, and intravenous cholangiography) allowed a correct preoperative diagnosis. Results: Laparoscopic treatment included selective removal of the diseased accessory gallbladder. However, postoperative acute cholecystitis and symptomatic gallstone occurred in the remaining main gallbladder, and laparoscopic reintervention was required 27 months later. Conclusions: This case illustrates the need for complete removal of both gallbladders during initial surgery. Precise intraoperative recognition of vascular and biliary anatomy—including abnormalities—is highlighted to avoid mistakes during surgery.