[Systemic inflammatory response syndrome as a prognostic index in cirrhosis]

There is some evidence to suggest that the systemic inflammatory response syndrome [SIRS] contributes to the poor outcome of cirrhotic patients. We studied 95 cirrhotic patients admitted to Almouassat and Al-assad University Hospitals assessing prevalence of SIRS and its relationship with short term outcome. Presence of SIRS was assessed on admission and during hospital stay. First end point was death and development of portal hypertension-related complications within their in-hospital stay. Second end point was death within 90 days from admittion, only 60 patients were followed to the second end point. About one-half the patients met SIRS criteria. SIRS was correlated with complications in general [p = 0.003], high serum bilirubin levels [p = 0.008], high international normalized ratio [p = 0.004], low serum albumin [p=0.004], and high model of endstage liver disease [MELD] score [p = 0.0003], During a follow-up of 7 +/- 2 days, 8 patients died [8.4%], 11 developed portal hypertension-related bleeding [11.6%], 26 hepatic encephalopathy [27.4%], and 9 hepatorenal syndrome type-1 [9.5%]. SIRS was correlated both to death [p = 0.03] and to portal hypertension related complications [p = 0.003]. From the patients who were followed to 90 days after admissions; SIRS was significantly correlated to death [p = 0.0005]. SIRS frequently occurs in patients with advanced cirrhosis and is associated with a poor outcome

Kapsoi sarcoma after kidney transplantation: a study of 10 cases from a series of 580 kidney transplantations in a University Hospital in Damascus, Syria

To identify the common causes of injuries among children in this region and suggest preventative strategies. This is a hospital based retrospective review of the files of children under the age of 14 years who presented to the general emergency department at Al-Thawra General Hospital with acute injury and were admitted to the hospital between January 1, 2003 and December 31, 2004. All charts were reviewed for age, sex, place and mechanism of injury, body area injured, and length of stay in the hospital. The total number of children was 421. The mean age was 6.5 years [range 0-14], 62.2% [n=262] were boys and 37.8% [n=159] were girls. The most common trauma type was head injury n=125 [29.7%]. The head injury was of two types; inflicted [intentional] n=112, [89.6%] and traffic accidents [accidental] n=13 [10.4%]. Among the inflicted type, contusion [33.03% in males, 11.60% in females] was the most common mechanism of injury, followed by falls from heights [FFH] 8.92% in males, 5.35% in females, then sharp objects [8.03% in males, 3.57% in females]. Roads were the most common place of trauma in the study, n=256 [60.80%]. In this category, 74[59.2%] of 125 head injuries occurred in roadways. In the age group between 5-10 years, n=182 [43.2%], the commonest cause of trauma was traffic accidents [69.23%]; however, only 13 [10.4%] caused head injuries. The head was the most common body area injured and the main cause of hospital admission [29.69%]. The mortality rate among the children was 35.15% [67.56% male, 32.43% female]. Traffic accidents [RTA], falls, and home injuries are the commonest causes of morbidity and mortality for children in our community. The highest proportions of deaths and severe injuries were observed in the school age group. Prevention strategies must consider this high-risk age group

Renal vein thrombosis after kidney transplantation: a study of 3 cases from a series of 635 kidney transplantations

Background and renal vein thrombosis [RVT] after kidney transplantation [KT] is a rare and early complication. It had been noted to occur in 4-6% of cases. The object of this study is to report the incidence of RVT after KT in our experience, presenting symptoms, modality of diagnosis, types of treatment, and outcome of our cases. Patients and between October 1985 and July 2003, 635 KT were performed in two centers, the Al Mouassat University Hospital [478 cases from living related donors] and the Kidney Hospital [157 cases from living and unrelated donors]. Pulsed and color Doppler ultrasound was available for our patients after April 1998. It was routinely performed for every patient in the post-operative period and repeated when there was any renal disorder. All cases of RVT in this series were studied whether they were diagnosed by surgery or by color Doppler. 3 cases of RVT were diagnosed in our series [0.47% 2 cases from Al-Mouassat University Hospital and one case from the Kidney Hospital]. All of these patients are treated with CsA. RVT was related to anatomical factors in two patients. The symptoms included anuria two hours after transplantation in patient number 1, hematuria then anuria 24 hrs after transplantation in patient number 2, and pain and anuria 48 hrs after transplantation in patient number 3. The diagnosis was suspected clinically in patient number 1 with immediate laparatomy and removal of the clot, which allowed the salvage of the transplant. In the second and third patients, the diagnosis was made by pulsed and color Doppler, 1 with subsequent transplant nephrectomy. the incidence rate of RVT in our series is less than reported in the literature possibly because we do not have a program of cadaver transplantation. Pulsed and color Doppler imaging permits early and easy diagnosis. Emergency surgery may salvage the graft when it is performed within 1-2 hours after the formation of the thrombosis. Transplant nephrectomy is often done because of the delay in the diagnosis. This prevents graft rupture and relieves the patient's pain

Renal artery stenosis after kidney transplantation: a study of 6 cases from a series of 501 kidney transplantations

Objective: renal artery stenosis [RAS] occurs in 0.4-12% of cases after kidney transplantation [KT]. The objective of this study is to report the incidence of RAS after KT in our experience, the presenting symptoms, and the modality of diagnosis, the types of treatment, and the outcomes

Methods: between October 1985 and December 2003, 501 KTs from living related donors [LRD] were performed at Al-Mouassat University Hospital, Damascus, Syria. Renal artery stenosis was diagnosed in six patients. All cases of RAS in this series were studied whether they were diagnosed by color Doppler, MRI, or arteriogram

Results: six cases of RAS out of 501 KTs has been diagnosed [1.2%]. The age of the patients at the time of diagnosis ranged between 27 and 60 years [mean 36.8]. There were 4 males and two females. The delay between the time of KT and diagnosis of RAS was from 2.5 to 24 months [mean 13.5]. The diagnosis was suspected clinically based on arterial hypertension and elevated blood creatinine in all cases, by color Doppler ultrasound in five cases, and by MRI in two cases. It was confirmed by selective arteriogram in 6 cases. Conservative treatment was applied to all patients. Transluminal angioplasty without stenting was performed in three cases. It was successful in two cases and complicated by renal artery rupture with subsequent kidney transplant resection in 1 case. Successful surgical treatment was applied in three patients. The follow-up ranged between two to 61 months [mean: 20.6]. All cases except one have a normal blood arterial pressure and normal blood creatinine level at discharge and on follow-up

Conclusion: RAS after KT should be suspected clinically in case of arterial hypertension resistant to medical treatment associated with elevated blood creatinine level. The color Doppler ultrasound is a very effective mean for diagnosis. Transluminal angioplasty is the treatment of choice and should be performed by experienced interventional radiologists. Surgical treatment in experienced hands has very good results