Cutaneous aspergillosis in a renal transplant recipient

Aspergillosis is a serious infection in renal transplant patients especially if dissemina-tion occurs. We report a case of primary cutaneous aspergillosis, an extremely rare entity described in only four cases in renal transplant. It should be sought when surgical wound shows a rapidly growing necrotizing features early post transplant and without evidence of hematogeneous or contiguous tissue or organ involvement. Early suspicion, diagnosis, extensive surgical debridement as well as rapid institution of Amphotericin B can minimize the risk of dissemination

Tertiary hyperparathyroidism in patients on hemodialysis for chronic renal failure: subtotal parathyroidectomy or conservative treatment?

To report our experience in novel surgical strategy in the treatment of tertiary hayperparathyroidism in hemodialysis patients for chronic renal failure and to assess the impact of this type of surgery on postoperative clinical and laboratory variables in this population. methods: Fifteen hemodialysis [12 female and 3 male] patients with chronic renal failure were operated on for tertiary hyperparathyroidism. Cervical ultrasound was performed in all patients [n = 15]. Preoperative cervical ultrasound showed one enlarged parathyroid gland [n = 4] or few enlarged parathyroid glands [n = 11]. Group I consisted of four patients with single parathyroid gland enlargement on ultrasound. These patients underwent resection of only the enlarged gland; three by unilateral approach under local anesthesia and one by cervicotomy under general anesthesia. Group II consisted of 11 patients with enlargement of all parathyroid glands on ultrasound. These patients were assumed to have hyperplasia and underwent subtotal parathyroidectomy [3.5 glands] and thymectomy by cervicotomy under general anesthesia. Postoperatively, patients in group I were normocalcemic [n = 4] and patients in group II were normocalcemic [n = 4] or had transient hypocalcemia [n = 7]. The pathology showed an adenoma in patient of group I [n = 4] and hyperplasia in patients of group II [n = 11]. postoperatively, both patients in Group I and II had a similar resolution of their symptoms. Tertiary hyperparathyroidism secondary to chronic renal failure may be treated by parathyroidectomy of one or few enlarged parathyroid gland[s]. Parathyroidectomy by unilateral approach under local anesthesia may be of value when preoperative localization studies show a single parathyroid gland enlargement

Handicap et reeducation fonctionnelle chez les hemodialyses hospitalises: Etude descriptive a propos de 20 patients

Twenty hemodialyzed patients, received rehabilitation while they were hospitalized. They were all handicapped in the beginning; when they left the hospital, 10 patients were completely independent, six needed help at home and 4 were completely dependent. The authors search, from their own practice, the etiologies of handicap with hemodialyzed patients and how to prevent this handicap, with the target of giving to their patients the best quality of life. The rehabilitation is very important in the strategies of global care of these patients