Human organ and tissue transplantation in Pakistan; when a regulation makes a difference

Organ transplantation must be viewed in relation to the prevailing cultural, religious and socio-economic conditions of a nation. Over the past two decades, Pakistan has emerged as one of the largest centres for commercial renal transplantation. Government efforts, supported by professional associations, civil society organizations and the media, along with World Health Organization technical assistance, have led to the development of legislation regulating this practice and curbing organ trade in conformity with international guidelines. Although only two years have passed since the enactment of the law, there is evidence that conditions have significantly improved, raising hopes for ethical and safe organ transplantation in Pakistan. This study reviews the salient features of the legislation and lists the foreseeable evolving challenges and opportunities

ESWL monotherapy of renal calculi

To study efficacy of extracorporeal shock wave lithotripsy [ESWL] monotherapy for renal calculi. Three hundred patients with renal stones less than 3.5 cm in diameter were selected. All were treated in supine position. Dornier HM4 machine was used for the study. JJ stent was placed in cases with complex and larger than 2.5cm size stones. Pregnant women and patients with pacemaker were excluded from the study. ESWL monotherapy was performed on three hundred patients and three hundred sixteen renal units between Jan. 98 and Dec. 98. Almost 50% of the stones were larger than 2 cm. Post ESWL complications were seen in 49 [16.2%] of the cases. Overall success rate of ESWL was 98.8%. Extracorporeal shock wave lithotripsy is a preferable treatment option for small and medium sized stones. Prophylactic JJ stenting helped in treating patients from far off areas. Complex renal calculi with low stone bulk could be treated with lithotripsy with JJ stent in situ

Prevalence of genitourinary tuberculosis

The purpose of study was to diagnose and treat genitourinary tuberculosis in the Pakistani population and to save the organs before they were irreversibly damaged. Patient and methods: A total number of 45 cases were included in the two year study. All the cases were treated as out patients unless some surgery was required. Diagnosis was based on positive urine cultures for tuberculosis, typical histological findings or both. In few cases diagnosis was presumptive and subject to response to empirically given anti-tuberculosis therapy, was diagnostic. Chemotherapy was given for 6 months. Of the forty five cases 29 were males and 16 females. The commonest clinical presentation were non-specific bladder symptoms. Low grade pyrexia was not very common. Pyuria was present in 78% of cases, and of these 49% had sterile pyuria. In 47% urine stain for AFB was possible while urine culture for AFB was positive in 38% cases. Genitourinary tuberculosis should be suspected in presence of sterile pyuria, chronic cystitis, epididymitis, haemospermia and chronic discharging scrotal sinuses

Acute renal failure [ARF] following snake bite: a study of 35 cases

Objectives To study the prevalence, common presentation and factors causing mortality in snake bite induced ARF. Methods From January 1990 to December 1998, a total of 1716 cases of ARF were registered at SlUT [criteria of defining ARF was a rise in creatinine of> 2 mg% and normal size kidneys on ultrasound in a person without any previous systemic illness]. In 35 patients there was a history of snake bite preceeding ARF. Results of laboratory investigations and modalities of renal replacement therapy and outcome were analysed. Results Among 1716 cases of ARF, 764[43.4%] were due to medical causes, 485[28.2%] surgical, 298[17.3%] obstetrical and 169 [9.8%] due to miscellaneous and unknown causes. Thirty five patients, 22 males, 13 females, age range from 6- 65 years from the medical group, developed ARF after snake bite. The most common presentation was anuria and bleeding diathesis. Haemodialysis was started immediately after admission in 31 and peritoneal dialysis in 2 patients and two died before initiation of therapy. Twenty three [66%] patients recovered from renal failure in 2-3 weeks, 6 [17%] required long term dialysis [five of them had cortical necrosis], and 6 [17%] patients expired. Conclusion Bleeding diathesis induced by snake envenomation carries bad prognosis both in terms of mortality and morbidity with irreversible renal failure being the cause. Early initiation of dialysis therapy leads to rapid renal recovery