En-bloc transplantation: an eligible technique for unilateral dual kidney transplantation

Kidney transplantation is the best available treatment for patients with end-stage renal disease. To evaluate the en bloc anastomosis technique for unilateral dual kidney transplantation [DKT]. From May to October 2011, 5 patients [4 women and 1 man] with mean age of 31.8 years underwent unilateral DKT with this technique in which distal end of the aorta and proximal end of inferior vena cava [IVC] were closed with running sutures. Then, proximal end of the aorta and distal end of the IVC were anastomosed to internal [or external] iliac artery and external iliac vein, respectively. Post-operative course was uneventful. No vascular and urologic complications developed; all patient had acceptable serum creatinine at discharge time and up of 2-6 months of post-operation follow up. Unilateral DKT is a safe method for performing DKT. The proposed en bloc anastomosis can improve the outcome of the graft by reducing the cold ischemia and the operation time

[Randomized trial of intravitreal bevacizumab alone or combined with triamcinolone versus macular photocoagulation in diabetic macular edema]

To compare the results of intravitreal bevacizumb [IVB] injection alone or in combination with intravitreal triamcinolone acetonide [IVT] versus macular laser photocoagulation [MPC] as primary treatment of diabetic macular edema [DME]. In this randomized clinical trial, 150 eyes of 129 patients with clinical DME and no previous treatment were enrolled. The eyes were randomly assigned to one of the three study arms: the IVB group received 1.25 mg IVB [50 eyes]; the IVB/IVT group received 1.25mg of IVB and 2 mg of IVT [50 eyes]; and the MPC group underwent focal or modified grid laser [50 eyes]. Retreatment was performed at 12-week intervals whenever indicated. Visual acuity [VA] changes among the groups were statistically significant at 6 [P<0.001] and 24 [p=0.012] weeks. VA change was significant only in the IVB group at 12 weeks. VA changes +/- standard deviation at 36 weeks were -0.28 +/- 0.25, -0.04 +/- 0.33, and +0.01 +/- 0.27 LogMAR in the IVB, IVB/IVT, and MPC groups, respectively [P=0.053]. Significant reduction in central macular thickness [CMT] was observed in all groups only up to 6 weeks; however, CMT changes were not significantly different among the groups in all visits. Overall, retreatment was required for 27 eyes up to 36 weeks [14 in the IVB group, 10 in the IVB/IVT group, and 3 in the MPC group]. In the IVB group, in which greater VA improvement was observed, only one injection was required in 72% of the cases. VA improvement more than 2 Snellen lines at 36 weeks occurred in 37%, 25%, and 14.8% of patients in the IVB, IVB/IVT and MPC groups, respectively. Intravitreal bevacizumab injection in patients with DME yielded a better visual outcome at 24 weeks compared with macular photocoagulation. After 6 weeks changes in CMT and VA were not compatible. No adjunctive effect of IVT was demonstrated

effect of simvastatin on lowering panel reactive antibody titer in sensitized dialysis patients: a randomized placebo controlled clinical trial

Patients with panel reactive antibodies [PRA] have many difficulties to find a crossmatch-nega- tive kidney for transplantation and are at a higher risk of post-transplantation rejection. To evaluate the effect of simvastatin on PRA and post-transplant outcome of these sensitized pa- tients. 82 patients with end-stage renal disease [ESRD] with a PRA >/= 25% were evaluated. In a one-year follow-up, the patients were treated with simvastatin. These patients were compared with 82 matched con- trols receiving placebo tablets. At the end of the second and 12th month, PRA was rechecked in all patients. Those patients who underwent transplantation continued to take simvastatin six months after transplanta- tion. Serum creatinine levels were checked at monthly intervals post-operation. The mean +/- SD PRA level at the end of the second month was 36.63% +/- 31.14% and 45.34% +/- 24.36% in cases and controls, respectively [P=0.012]. Seven patients in the case group and 10 in the control group were lost to follow-up. The remaining patients continued to take simvastatin for 12 month. The mean +/- SD PRA level at the end of the 12[th] month was 24.02% +/- 31.04% in cases and 43.15% +/- 26.56% in controls [P=0.001]. 25 patients underwent renal transplantation and continued to receive simvastatin 6 months after transplantation. These patients were matched with 25 controls treating with placebo. The mean +/- SD creatinine level 6 months after kidney transplantation was 2.05 +/- 1.14 mg/dL and 3.15 +/- 1.09 mg/ dL in cases and controls consecutively [P=0.02]. Simvastatin can be safely used to lower PRA and improve post-transplantation outcomes

Emphysematous pyelonephritis in a transplant kidney

Emphysematous pyelonephritis [EPN] is a severe necrotizing infection of the kidney and its surrounding tis- sues. It is characterized by the production of gas within the kidney and perinephric structures. EPN often affects diabetic women but can also occur in nondiabetic patients who have ureteral obstruction and in im- munocompromised patients. Herein, we report EPN in a 23-year-old woman who had a renal transplantation

Successful replantation of amputated penile shaft following industrial injury

Penile amputation is an uncommon urological emergency. Although rare, traumatic amputation of penis is a challenging injury to treat. However, modern microsurgical reconstruction techniques have improved success rate of penile replantation and become the procedure of choice for managing these patients. Herein, we report on a case of penile amputation following an industrial accident

nutcracker syndrome: an underdiagnosed cause for high grade varicocele

The nutcracker syndrome represents a clinical condition caused by compression of the left renal vein [LRV] between the superior mesenteric artery [SMA] and the aorta. One of its manifestations is left-sided varicocele. The aim of this study is to determine the prevalence of nutcracker syndrome in patients with primary and recurrent high grade left-sided varicocele. Fifty patients with primary and recurrent high grade left-sided varicocele were enrolled in this study. Color Doppler ultra-sonography [US] of renal vessels was done and diameter of LRV and peak systolic velocity [PSV] were measured in renal hilum and in site of compression of LRV be-tween SMA and the aorta and then magnetic resonance angiography [MRA] of renal vessels was done. Thirty six patients [72%] had primary high grade varicocele and 14 patients [28%] had recurrent high grade varicocele. Twelve patients [33%] with primary high grade varicocele and seven patients [50%] with recurrent varicocele had evidences of NCS in color Doppler US and MRA. The differences of LRV diameter in NCS group and in patients without NCS were statistically significant [P<0.001]. The differences of PSV in the LRV at the hilar portion in the NCS group and in the patients without NCS were not statistically significant. The differences of PSV in the LRV at the aortomesenteric portion in the NCS group and in the patients without NCS were statistically significant [P< 0.001]. In all patients with NCS, MRA showed dilatation and compression of LRV at site of passage between aorta and SMA. NCS should be suspected in patients with high grade primary and recurrent varicocele

Risk factors and laboratory diagnostics for post renal transplant tuberculosis: a case-controlled, country-wide study on definitive cases

Tuberculosis [TB] is a common cause of morbidity and mortality in renal transplant recipients. It is usually misdiagnosed because of lack of medical awareness and its infrequency in renal transplant recipients. 44 cases [0.3%] with post-transplant TB out of 12820 patients who had renal transplants performed between 1984 to 2003 were found from the hospital records of 12 major kidney transplantation centers in Iran. These cases were compared with 184 healthy transplant subjects whose transplants were performed by the same surgical team as the controls. The mean age of cases and controls was 37.7 [13-63] and 35.6 [8-67] years [p=0.3], respectively. The mean duration of pre-transplantation hemodialysis was 30.3 [3-168] months in cases and 18.2[1-180] months in controls [p=0.03]. A past history of tuberculosis was detected in 2 cases and 1 control [p=0.3]. The mean doses of initial and maintenance immunosuppressive drugs in cases and controls were not significantly different. A total of 25 cases [56.8%] and 60[32.6%] controls had rejection prior to diagnosis of TB [p=0.004; OR=2.7, CI95%: 1. 3-5.6]. To our knowledge, this is the first study that demonstrated increasing risk of post-transplant TB by extending the duration of pre-transplant hemodialysis and the number of post-transplant rejection episodes. Further study is needed to clarify our new findings specifically in respect of different immunosuppressive regimens

LASIK after Sclera! buckling surgery

To compare the safety, efficacy, and visual results of laser in situ keratomileusis [LASIK] in eyes with and without previous scleral buckling surgery in the same individuals.In a prospective clinical trial, 14 eyes of 7 patients with myopic refractive error and history of sclera] buckling in one eye, underwent LASIK surgery in both eyes according to a standard surgical protocol. Uncorrected visual acuity [UCVA], best corrected visual acuity [BCVA], refraction, Orbscan topography, and pachymetry were recorded 1, 3, 6, and 12 months after LASIK. Eyes with previous scleral buckling were named RD group and the fellow eyes without any previous ocular surgery were named non-RD group. LASIK was performed without any complication. No patient developed a new RD or significant vitreoretinal changes during one year of follow-up. There was no decrease in BCVA in any of the eyes. In the RD group, mean spherical equivalent [MSE] before LASIK was -7.67 D and '.4.-as reduced to -0.17, -0.87, -1.37, and -1.89 D at 1, 3, 6, and 12 months after LASIK, respectively. In the non-RD group, MSE before LASIK was -5.25 D which was reduced to +0.05, -0_17. -0_37. and -0.57 D - at 1. 3, 6, and 12 months after LASIK, respectively. Differences between the two eroups were statistically significant at 3, 6, and, 12 months after operation. Myopic regression between 1 and 12 months after LASIK in the RD group [-1.71 D] was greater than the non-RD group [-0.62 D]. [P=0.019] Mean increase in central corneal thickness during this period had no significant difference between the two groups. Corneal power increase in the RD group [2.44 D] was more than the non-RD group [1.01 D]. [P=0.00I] LASIK may be considered for treatment of myopia in eyes with previous RD surgery. Although it seems to be safe in these eyes, it is not as effective as LASIK in eyes without previous RD surgery. Myopic regression seems to be more pronounced in these eyes