Misdiagnosing esophageal perforation as esophageal atresia.

We report a case of traumatic perforation of esophagus misdiagnosed as esophageal atresia in a 1.7 kg preterm (28 weeks) twin. Initial resistance to the passage of orogastric tube and failure of passage of contrast material down the esophagus prompted the diagnosis of esophageal atresia. Subsequently, the passage of orogastric tube as well as radiological findings at the age of 7 days made us change the diagnosis to traumatic perforation of esophagus. The baby was managed conservatively and discharged in good health at the age of 2 months. Literature is reviewed and the attention of pediatricians is drawn to this problem.

Urological complications of Cadaveric Renal Transplantation.

Urological complications in 211 consecutive primary and secondary cadaveric renal transplants, performed t our institution between March 1993 and December 1996, were encountered in 13 patients (6.2%). The complications included urine leakage in four cases (1.9%)., obstruction of the upper urinary tract in seven (3.3%), urethral strictures in two (1%) and stone formation in one. Successfully treated complications amounted to 86%. Associated infection and urinary leak resulted in the loss of two grafts.

Experience with living related donor nephrectomy: Evaluation of 200 cases.

Over a ten year period (1979 to 1989), 200 patients have undergone live donor nephrectomy through a flank extraperitoneal approach without rib resection. The average hospital stay was short and the major complications were negligible. Early graft function was seen in 97% of the cases. Delayed function due to acute tubular necrosis developed in 3%. Urinary leak was seen in 3%. Two kidneys were lost due to infection related to urinary fistulate. In 70 donors, 37 +/- 13 month's follow-up was available. Hypertension developed in two patients three and three and one-half years post donation. Significant proteinuria (>300 mg/day) was noted in one patient. No significant renal functional abnormalities were observed. Creatinine clearance was about 70% of the initial measurement at the observation time. We conclude that extraperitoneal flank live donor nephrectomy is generally safe and associated with minimal perioperative and long-term morbidity. Moreover, the procedure provides an excellent allograft function.

Urolithiasis in Saudi Arabia.

In a retrospective study, 760 Saudi patients with urolithiasis were epidemiologically and metabolically studied (41% were from the Central region, 32% South, 14% West, 9% North, and 1% East; the remaining 3% were Saudi but of unknown region). The male to female ratio was 5:1; 87 percent of the patients were aged thirty to sixty years and 11 patients were under age fourteen. There was no clear relation of stone formation to occupation. Sixty-nine percent of calculi were renal, 29 percent ureteric, and only 3 percent were bladder calculi. Two hundred seventy-eight operative procedures were done (36.5% of all patients), including pyelolithotomy, nephrolithotomy, ureterolithotomy, ESWL, cystolithotomy, and extractions by basket. Infection was a rarity (6%) and urinary schistosomiasis was found in 33 patients (4.3%), 24 of whom were from a schistosoma-infested region. Raised serum calcium was found in only 5.7 percent and raised serum urate in 13 percent. Increased urinary excretion of urate was found in 60 percent and hypercalciuria in 9 percent. Seventy-six percent of stones analyzed (239) were calcium oxalate, 20.5 percent urate, and 3.3 percent phosphate.

Ocular side effects of systemic steroid therapy in renal transplant patients.

Sixty-one renal transplant patients were studied for ocular complications of steroid therapy. Twenty patients (32.8%) were found to have posterior subcapsular cataract. Three patients (4.9%) had ocular hypertension. There was no significant correlation between cataract formation and the total dose of steroids, number of rejection episodes, or the period of hemodialysis. HLA-A9 was present in noncataract patients to a greater extent, a statistically significant (P less than .05) finding not reported before to our knowledge.

Extracorporeal shock-wave lithotripsy (ESWL)-induced erosions in upper gastrointestinal tract. Prospective study in 40 patients.

In a prospective study in 40 patients receiving ESWL treatment, gastric and/or duodenal erosions occurred in 32 patients (80%); in 24 (60%) the erosions were in the proximal part of the stomach. There was no direct relation between the patients' weight and the development of erosions. In some patients more erosions developed in relation to the number of shock waves received and the intensity of energy given. In most patients early onset of hematuria indicated development of more erosions. To our knowledge this is the first report in the literature on ESWL-induced erosions in the upper gastrointestinal tract.

Survival of sub-optimal cadaver renal grafts with prolonged cold ischaemic times using cyclosporin.

Between September 1983 and December 1985, 33 cadaver kidneys with prolonged ischaemic times (mean 47.3 +/- 11.0 h), and frequently in problematic conditions, were received from Europe and transplanted into adults (16 male, 12 female, mean age 34 +/- 11 years) and children (2 male, 3 female, mean age 8.8 +/- 4.0 years), using cyclosporin (CsA) and steroid immunosuppression. Six patients have died (three with functioning grafts) and 12 grafts have been lost. Eighteen grafts remain functioning, with a mean survival of 27 months. The 1 year actuarial patient and graft survivals were 82% and 69% respectively. The mean time to cessation of haemodialysis was 17 +/- 10 days, and to stable graft function was 28 +/- 11 days. At 3 months (27 patients) mean serum creatinine was 191 +/- 88 mumol/l (2.16 +/- 1.0 mg/dl), with a mean CsA dose of 6.7 +/- 2.2 mg/kg per day. There was an association between the immediate post-transplant renographic perfusion index and the serum creatinine at 3 months (r = 0.52, P less than 0.01). At no stage did the serum creatinine correlate with CsA dose or length of ischaemic time. These results demonstrate that despite suboptimal conditions, prolonged cold ischaemic times, and periods of oliguria, cadaver kidney transplants may be managed successfully with CsA and low-dose steroids.

Brucellosis in a farming community in Saudi Arabia.

This communication describes a study of the prevalence of brucellosis in a farming community of Saudi Arabia. Standard agglutination tests of sera from 21 patients were tested for Brucella abortus and Brucella melitensis. The results show that 8 (38%) were positive with titres of 160 or over 20 480 and with titre of complement fixation tests ranging from 8 to 64. Agglutination titres of 20 to 40 were present in only 3 cases. Those patients with positive agglutination titre of 160 or higher admitted histories of consumption of raw milk. All 8 patients presented typical symptoms of brucellosis and responded to appropriate antibiotic therapy. This study suggests that farm workers and those who drink raw milk are more likely to contract brucellosis than are the general population.