Rectus muscle flap for repair of refractory bladder fistula following renal transplantation: a case report

We report a case of refractory bladder fistula in a diabetic renal allograft recipient that recurred shortly after conventional operative repair without any detectable external cause. After reoperation and use of a vascularized rectus muscle flap the fistula closed and the patient has retained excellent graft function. It is suggested that this technique should be considered as the primary repair modality for bladder fistulas in diabetic recipients, when wound healing is impaired seriously as a consequence of the combined effects of diabetic microangiopathy and steroid therapy.     

Immunological consequence of renal transplantation and immunosuppression. I. Alterations in human natural killer-cell activity

The role and activity of natural killer (NK) cells following renal transplantation remain unknown. To monitor NK activity, a⁵¹Cr release of K-562 targets in prednisone-and azathioprine-treated patients receiving renal allografts was utilized. In 18 patients in whom NK activity was measured prior to and after transplantation, a significant diminution in NK activity within 3 weeks following transplantation was demonstrated compared to pretransplant values (34.71 vs 12.20%, respectively;P<0.001). In 11 subjects who had NK activity assayed at various intervals after transplantation but not prior to allografting, mean NK values were markedly lower (mean, 14.2%) than those of normal volunteers or patients maintained on hemodialysis (P<0.001). The latter two control groups demonstrated no difference (P = NS) in mean NK activity (39.46 vs 35.82%, respectively). In 5 of the 29 patients evaluated with good long-term graft function (mean, 2.7 years), restitution of normal NK activity was demonstrated. In two patients with bacterial infections, NK activity increased from 39.29 to 51.7% and from 13.54 to 20.00%. After infection, these values were 35.3% in the former and 3.39% in the latter. Viral infection did not appear to affect NK activity significantly. NK activity was increased in only one of seven patients with documented rejection episodes. In three of such patients, NK activity declined significantly following pulse methylprednisolone therapy. These results indicate that (1) NK-cell activity significantly decreases immediately after transplantation, probably as a result of immunosuppressive therapy; (2) NK activity does not appear to be stimulated by the alloreactive rejection process; (3) NK activity may be augmented in the course of bacterial but not viral infections; and (4) long-term allograft survival may be associated with a restoration of NK-cell levels in certain recipients.     

Periodontal disease and oral hygiene in Israeli youth (14–17 years of age)

abstract The purpose of the present study was to obtain current information regarding periodontal disease, and oral hygiene status. The survey was conducted in Israel among 9th–12th grade students, 14–17 years of age. A total of 1,320 schoolchildren were examined. During the examination only periodontal status and oral hygiene were checked. Periodontal status was recorded according to Russell's Periodontal Index (PI). Oral cleanliness was assessed according to Greene & Vermillion's Simplified Oral Hygiene Index (OHI-S). The mean PI found was 0.22. The results indicated an increase in the mean PI with age. No difference was found in average PI values between girls and boys. On the other hand, significantly lower mean OHI-S values were recorded for girls as compared with boys in the total study population and within the different age groups. Mean OHI-S decreased with age, indicating improvement.     

A COMPARISON OF TWO ORAL HYGIENE INDEXES FOR MEASURING THE EFFECTIVENESS OF DENTAL FLOSS IN PLAQUE REMOVAL

The purpose of the present study was to compare the OHI-S and the two versions of PHP Index in measuring the effectiveness of dental floss in the removal of dental plaque. The study demonstrated that the PHP Index provides a higher sensitivity than the OHI-S in measuring the effectiveness of approximal cleansing aids, such as dental floss. This, it seems that using the PHP Index in dental floss studies is preferable to using the OHI-S.     

Application of the Periodontal Treatment Need System (PTNS) in a group of young Israeli adults

The Periodontal Treatment Need System (PTNS) was applied to a group of young Israeli adults, 18-25 years of age, to test the system in the field. A total of 830 persons were examined. Their periodontal treatment needs were assessed. One of the aspects investigated was that of treatment needs according to distribution by sex. Only 2.7% of young adults studied were free of plaque, calculus and gingival inflammation. All the rest (97.3%) needed some kind of periodontal treatment. The time required for treatment needed was also calculated. It was found that on the average 2.4 h per person would be required to deliver the periodontal treatment needs of the group. A close association between sex and PTNS was established in this study.     

Prevalence of dental decay in Jewish and Arab schoolchildren in the Jerusalem area

The purpose of this survey was to gather up-to-date information on the prevalence of dental decay in schoolchildren in the Jerusalem area. Close to 650 Arab and Jewish schoolchildren aged 6-8 yr underwent oral examinations. The relationship between caries prevalence and treatment supplied with some secondary factors was studied. The results show that 92% of the children were affected by decay. Compared to former years there is an increase in the prevalence of dental caries throughout the population. No significant differences were found when sex, ethnic population or socioeconomic factors were related to caries prevalence. However, when DMF is broken down into its components, Arab children were seen to have a greater number of teeth affected by caries and in need of treatment (D). In contrast, treatment need has been met to a much greater degree among Jewish children than among Arab children. Data and explanations are offered.     

Malakoplakia in renal transplantation: an expression of altered tissue reactivity under immunosuppression

This report describes the successful treatment in a transplant recipient of a case of MK originating from the native urinary tract. As demonstrated, MK may pursue unexpected patterns to which conventional therapeutic guidelines may not be applicable. The type of surgical intervention used must be dictated by the extent and location of the disease and its complications. Withdrawal of immunosuppressive medication was useful in improving the patient's prognosis.