Outcomes in obese kidney transplant recipients.

BACKGROUND: Kidney transplantation (KT) in obese patients is controversial. The present study aimed to evaluate patient and graft survival and post-transplantation complications between obese and nonobese recipients. METHODS: Patients (n = 3,054) receiving a KT from 1998 to 2008 were divided according to body mass index (BMI) into 3 groups for analysis: group I: BMI <30 kg/m(2) (nonobese); group II: ≥30-34.9 kg/m(2) (class I obese); and group III: ≥35 kg/m(2) (class II and III obese). RESULTS: Mean BMIs were: group I (n = 2,822): 22.6 ± 3.3 kg/m(2); group II (n = 185): 31.9 ± 1.3 kg/m(2); and group III (n = 47): 36.8 ± 1.7 kg/m(2). There were no differences among the 3 groups in patient demographic variables regarding race, sex, or organ source. One-year (I, 98%; II, 98%; III, 95%) and 5-year (I, 90%; II, 92%; III, 89%) patient survival rates were similar among groups. Graft survival rates at 1 year were 96% for groups I and II and 91.5% for group III. Five-year graft survivals were: I, 81%; II, 96%; and III, 79%. The most common cause of graft loss was death, and the main cause of death was infection in all groups. Obese patients were more likely to experience wound dehiscence (I, 1.9%; II, 7.6%; III, 19.1%; P < .001), develop new-onset diabetes after transplantation (NODAT; I, 16.2%; II, 27%; III, 36%; P < .001), and have a prolonged length of hospital stay (I, 11.3 ± 11.4 d; II, 14.5 ± 14.3 d; III, 15.9 ± 16.7 d; P < .001). CONCLUSIONS: Obese recipients demonstrated outcomes similar to nonobese patients regarding patient and graft survival. However, they had higher rates of prolonged length of hospital stay, wound dehiscence, and NODAT.

Epilepsia partialis continua (Koshevnikov): a preliminary case report.

We report on the preliminary clinical and electrophysiological aspects of an in-patient possibly presenting epilepsia partialis continua (Koshevnikov). We discuss the different etiologies and emphasize on the possible idiopathic form in this case.

Spinal cord injury: patients who had an accident, walked but became spinal paralysed.

Out of 1410 patients admitted to the spinal cord injury unit (SARAH) for rehabilitation during a 10-year period (1981-90) 10 had a missed spinal trauma lesion and became paralysed after having overcome the initial injuries and being allowed to walk. Patients were admitted to hospital with a history of being able to walk after an accident and subsequently developing a neurological deficit. Seven patients had radiological findings compatible with instability of the spine. Four had a head injury with coma and an undetected spinal fracture at the first evaluation in the emergency room. Other associated factors were: spinal stenosis, prolapsed disc, infection, foreign bodies, procedures for reduction and stabilization of the fractured spine. We emphasize the need for very careful clinical study and investigation for the diagnosis of multiinjured patients, especially when there is a concurrent brain injury.

Pyrexia in hospitalised spinal cord injury patients.

To discover the frequency of pyrexia in spinal cord injury (SCI) patients in the Hospital for Medicine of the Locomotor System (HMLS/SARAH), a review study was undertaken. For a period of 3 months, all new episodes of fever were recorded. During the study 221.3 patients/month were observed. The age ranged from 14 to 60 years and time of lesion from 1 to 6,264 days: 85 patients were paraplegia or paraparetic, and 44 tetraplegic or tetraparetic. At the beginning of the study 10.8% of the patients had fever. During follow up, we observed a rate of 33.9 new incidences per 100 patients/month. In 77.3% only one cause was identified, and in 8% no cause could be defined. The commonest causes were urinary tract infection (UTI) (44.3%), and soft tissue infections (11.4%). Frequent causes of fever in the acute stage other than UTI were complications related to the initial trauma and thromboembolic disease (p < 0.05). These results demonstrate the high incidence of fever in patients with SCI, in addition to providing a useful approach for diagnosis and management.