Pediatric kidney transplantation: Siriraj Hospital experience.

We reported six children with end stage renal disease (ESRD) who received kidney transplantation in our unit from 1996 to 2000. They were 5 boys and 1 girl and their mean age was 9.7 +/- 2.7 years (range 6.8 to 13.2). Etiologies of ESRD were congenital anomalies (3 patients), chronic glomerulonephritis (2 patients), and rapidly progressive glomerulonephritis (1 patient). Prior to the transplantation, chronic peritoneal dialysis was used in 5 patients, including one who had to switch to hemodialysis due to chronic exit site infection and 1 had preemptive kidney transplantation. All children received a kidney from living-related donors, 4 from their fathers, 1 from his mother, and 1 from his elder brother. Triple immunosuppressive drug therapy (prednisolone, azathioprine, and cyclosporine A) was initially given to all patients. Serum creatinine returned to normal within the first week in all patients and 4 patients were discharged home by the end of the second week post operation. Immediate complications included severe hypertension (all patients), ureteral leakage (2 patients), neutropenia (3 patients) and nephrotic syndrome (1 patient). Azathioprine was discontinued in 2 patients due to persistent neutropenia. Cyclosporine A was discontinued in 1 patient due to hepatotoxicity, this patient was maintained on mycophenolate mofetil and prednisolone. Serum creatinine levels at last follow-up (mean 24.3 +/- 19.0 months, range 8-55) were normal in 5 patients and slightly increased (1.5 mg/dl) in one. Five patients returned to school full time within 1 year after kidney transplantation. Height standard deviation score improved markedly as early as 6 months post transplant. The cost of maintenance of the immunosuppressive drugs was similar to adults, i.e. 6,859.1 +/- 1,151.8 Baht per month at 6 months post kidney transplantation. We concluded that kidney transplantation can be performed successfully in selected Thai children with very good results and similar cost of treatment as for adults.

Embryonic testicular regression syndrome: a case report.

A case of testicular regression syndrome was reported. The patient was an 18 year old girl presenting with primary amenorrhoea. Physical examination revealed normal female external genitalia and underdeveloped secondary sexual characteristics. Hormonal profile indicated gonadal failure. Chromosome analysis revealed 46,XY karyotype. Diagnostic laparoscopy demonstrated undeveloped internal genital organs. Remnants of epididymis, vas deferens and seminiferous tubule were uncovered during exploratory laparotomy. Ontogeny of sexual differentiation and pathogenesis of testicular regression syndrome were reviewed and discussed.

Suprapubic prostatectomy for benign prostatic hypertrophy at Siriraj Hospital during 1986-1988.

A three-year retrospective analysis of patients with benign prostatic hypertrophy being treated by suprapubic prostatomy at Siriraj Hospital during 1986-1988 was carried out in order to determine the epidemiological characteristic of diseases and the results of treatment. There were 91 patients whose average age was 70.9 years. The significant symptoms of the patients were prostatism (100%), retention of urine (36.3%) and gross haematuria (15.4%). The abnormal laboratory findings before surgery were anaemia, azotemia, serum acid phosphatase above normal value and bacteriuria encountered in 3.2, 6.5, 20.0 and 62.7 percent of the cases respectively. The significant complications were bleeding during surgery (51.6%) and wound infection (27.5%) ; the mortality rate was 2.2 percent. Most of the patients (85.4%) could be discharged from the hospital before 14 days.