grossesse gemellaire et la transplantation renale. A propos d'une premiere observation Tunisienne

Women with end-stage renal disease or on regular dialysis have low fertility. Renal transplantation restores not only normal renal and endocrine functions but also the reproductive function as well and so conception becomes possible. Pregnancy in transplanted women is at higher risk and necessitates a multidisciplinary follow up. We report the course and out come of two successful pregnancies, the second was the first case of twin pregnancy in Tunisia in a transplanted woman. Our patient is 35 years old had a chronic renal insufficiency, secondary to interstitial nephropathy. After six years of hemodialysis, she had received a renal graft from a living donor [her brother]. A double drug immunosuppression was given [Prednisolone - Azathioprine]. Two years later, she became pregnant and delivered a normal baby at term, and one year later she had a twin pregnancy that ended successfully and delivered by caesarian section two babies with different sex. Pregnancy after renal transplantion must be considered as a risk factor for any subsequent pregnancy, and the risk increases in case of twin pregnancy

[Mechanical ventilation in intensive care units: indications, modalities and complications. A prospective multicentric survey in Tunisia]

The survey was perfomed during the month of march 1998 and concerned 9 ICUs located in teraching hospitals. Tp be included each ICU had to MV for more than 12 hours were included in the study and had a 28 day follow-up in the ICU or until hospital discharge. Collected parameters were indications of MV, modalities of MV and of weaning, complication and outcome at ospoital discharge. Assist-control ventilation was the most used ventilation modality [69,8%]. Weaning of MV was performed in 63% of the study patients and was based on a once-a-day attempt of spontaneous breathing through a T-piece [59,5%] and a combination of intermittent mandatory ventilation with pressure support [IMV-PS: 27%] or pressure support alone [11,2%]. Mean lenght of hospital stay was 19,7 +/- 15,9 days of which 11,6 days were spent in the ICU. Fifty nine pateints [54%] were alive at discharge form the ICU of whom 4 ultimately died during their hospital stay. MV pratice as well as ICU facilities are not homogenous in Tunisia. Recommendations and guidelines should be buil in order to standardize MV practice in Tunisia