Kidney transplantation in children: a 50-case experience

OBJECTIVES: The aim of this article was to report our experience with kidney transplantation in children. MATERIALS AND METHODS: From June 1980 to December 2003, 690 kidney transplants were performed in our institution, among which 50 were in patients with less than 18 years old. Technical aspects as well as clinical and surgical evolution were reviewed in this study. RESULTS: Patient's mean age was 12 years (2-17 years). Twenty-nine patients were male and 21 female. Live related donors were responsible for 75 percent of the cases (38 patients) and 25 percent (12 patients) came from cadaver donors. The main complications were ureteral fistula in 6 patients (12 percent), arterial stenosis in 2 (4 percent), wall infection and dehiscence in 1 case (2 percent). The overall rate of surgical complication was 20 percent. No case of hyperacute rejection was reported. During the follow-up 20 grafts were lost due to chronic rejection and 2 patients died. No loss of graft due to surgical complications was reported. The graft survival rate was 71 percent in 1 year, 64 percent in 3 years and 57 percent in 5-year follow-up. CONCLUSIONS: Kidney transplantation in children is a viable treatment option for terminal kidney disease presenting success and surgical complication rate similar to kidney transplantation in adults.

Remoçäo percutânea de cálculo em ureter de rim transplantado em paciente grávida / Percutaneous removal of an ureteral calculous from a transplanted kidney in a pregnant patient

We report a case of nephro-ureteral lithiasis causing obstruction in a pregnant woman at 23 weeks of gestation, treated successfully by percutaneous surgery. The kidney was punctured and dilated to 18 Fr. The ureter was antegrade accessed with a rigid ureteroscope (11.5 Fr) and the calculous was fragmented and retrieved with stone forceps. A double-J cateter was left in place and a nephrostomy tube was placed. The patient did well and the pregnancy was uneventful until a health newborn at term

Complicaçöes cirúrgicas pós-transplantes renais: análise de 356 casos / Surgical complications of renal post-transplantations: analysis of the 356 cases

No período de dezembro de 1977 a setembro de 1995 foram realizados 400 transplantes renais (Tx-r), dos quais 356 foram analisados retrospectivamente, com a finalidade de avaliar a incidência de complicaçöes cirúrgicas, classificadas em urológicas, vascularese e gerais (hematomas, abscessos perienxerto, ferida operatória). Para verificar possíveis modificaçöes no perfil de incidência dessas complicaçöes no decorrer do programa de Tx-r, dois grupos de pacientes foram analisados e comparados: G1 (os primeiros 200 Tx-r) G2 (de 201 a 400 Tx-r). Na análise global, observou-se que a complicaçäo mais frequente foi a urológica (10,7 por cento), seguida de hematoma ou abscesso perienxerto (5 por cento), complicaçöes de ferida operatória (5 por cento) e vasculares (4,5 por cento). As complicaçöes urológicas e vasculares mais incidentes foram: fístula ureteral (8,1 por cento) e estenose arterial (1,7 por cento). Analisando-se separadamente os grupos, foi encontrada reduçäo estatisticamente significativa do índice de fístula urinária e estenose arterial (G1 = 11,7 por cento, G2 = 4,5 por cento - p = 0,012, G1 = 2,8 por cento, G2 = 0,6 por cento - p < 0,001, respectivamente). Nossos dados demonstram a importância da utilizaçäo de esteróides em baixas dosagens no protocolo de imunossupressäo e o aprimoramento da técnica operatória como redutores do índice de complicaçöes cirúrgicas dos Tx-r

Apendicite aguda e tumor carcinóide de apêndice cecal / Acute appendicitis and carcinoid tumor of cecal appendix

Relato de um caso de apendicite aguda por tumor carcinóide de apêndice cecal, com revisäo bibliográfica, observando-se a incidência, freqüencia e tratamentos propostos

Divertículo de Meckel hemorrágico / Hemorrhagic Meckel's diverticulum

É relatado um caso de Divertículo de Meckel Hemorrágico que sofreu ampla investigaçäo radiológica e endoscópica, sem resultado diagnóstico, necessitando o paciente de Laparotomia Exploradora de urgência frente aos sinais e sintomas persistentes. Säo analisados a incidência do Divertículo de Meckel e a freqüência de complicaçöes hemorrágicas