Travails of self-manipulation of a catheter.

A large number of patients suffer from Stage 5 chronic kidney disease (CKD). One of the treatment options used in these patients is continuous ambulatory peritoneal dialysis (PD), which is known to improve patient quality of life. 15-50% of Stage 5 chronic kidney disease patients are on PD in the USA. The PD catheter maybe inserted into the abdominal cavity by a surgeon, an interventional radiologist or a nephrologist. We report the most unusual case of an adult patient who reinserted the slipped PD catheter himself leading to an "unseen before" complication.

Percutaneous ultrasound-guided renal biopsy: A Libyan experience.

This study was done to assess the safety and efficacy of ultrasound-guided percutaneous renal biopsy (PRB), to ascertain the risk factors for complications and determine the optimal period of observation. The radiologist (A.M.) at the National Organ Transplant Centre, Central Hospital, Tripoli, Libya, performed 86 PRBs between February 1, 2006, and January 31, 2008, using an automated biopsy gun with 16-gauge needle. Coagulation profile was done in all the patients. All patients were kept on strict bed rest for six hours post-procedure. Eighty six renal biopsies were performed on 78 patients referred from rheumatology department and eight post-kidney transplant recipients; 23 were males with age range 15 - 56 years and 63 females with age range 16 - 66 years. A mean of 17.5 glomeruli were present in each specimen. A glomerular yield of less than five glomeruli was seen in four biopsies. Class I lupus nephritis (LN) was seen in 1 patient, class II lupus nephritis in 7 patients, class III LN in 13 patients and class IV LN in 29 patients. All the eight renal allografts were diagnosed as acute tubular necrosis or acute interstitial rejection. The risk of post-biopsy bleeding was higher in women, older patients and higher PTT. The overall complication rate was 5.8%. Three complications were observed within six hours of biopsy. No late complication was seen. PRB under real-time ultrasound-guidance is a safe and efficacious procedure to establish the histological diagnosis and should be done as out-patient procedure. Observation time of six hours post-biopsy is optimal.

Reasons for Unwillingness of Libyans to Donate Organs after Death

Introduction: Organ transplantation in Libya depends exclusively on donations from live relatives. This limitation increases mortality and prolongs the patients' suffering and waiting time. Objectives: The aims of this study were to explore willingness to donate organs after death and to identify the reasons for refusal. Methods: A population-based cross-sectional study was conducted from April to July 2008 on a cluster sample of 1652 persons (58males and 42females). The questionnaire included demographic information and mainly enquired about willingness to donate organs after death and the reasons for refusal when applicable. Results: About one-third (29.7) of participants were in favor of donating their organs after death; 60.1refused and 10.2were undecided. Willingness was significantly associated with being male; younger age; having a college or graduate degree; and being single (P 0.05 for all). Lack of adequate knowledge about the importance of deceased organ donation and uncertainty about its religious implications were the most predominant reasons for refusal (43.8and 39.5; respectively). Other reasons included ethical concerns about retrieving organs from dead bodies (37.9); preference for being buried intact (28); and uneasiness about the idea of cadaver manipulation (33). Conclusion: There were a considerable resistance to deceased organ donation; especially among females; those of older age; married people; and those with a low education level. The barriers to cadaveric donations were lack of adequate knowledge; unease about body manipulation; and concerns about religious implications. Public educational campaigns should be coordinated with religious leadership

Living related kidney transplantation in Libya: a single center experience.

OBJECTIVE: The aim of this study was to establish a successful living related kidney transplantation program in Libya and to bring down health care costs in management of patients with end-stage renal disease. PATIENTS AND METHODS: Since the transplantation program was launched on August 17, 2004, 135 patients have been transplanted up to August 17, 2007. The donors and recipients were screened prior to transplantation. Our immunosuppressive protocol was cyclosporine-based. Both donors and recipients were followed in the transplant outpatient clinic. RESULTS: Among 135 accepted pairs, 133 cases (98.5%) were genetically related donors and recipients and 2 cases were emotionally related. Mean donor age was 37 +/- 9.5 years (range, 18-56 years). Recipient age was significantly lower, namely, 37 +/- 13.6 years (range, 7-67 years). Among the recipients, 95 (70.4%) were males and 40 (29.6%) females, while among the donors, 102 (75.6%) were males and 33 (24.4%) females. The most common donor-recipient relationship was brother-to-brother. There was no early or late surgical mortality among donors. Delayed graft function was observed in 3 patients (2.2%), acute rejection in 6 (4.4%), and posttransplantation infections in 8 (5.9%). Urinary tract infections were diagnosed in 6 patients (4.4%) and pneumonia in 3 (2.2%). Postsurgical complications included ureteric kink in 2 patients (1.5%) and an anastomotic urine leak in 4 (3.0%). At 36 months, graft survival was observed in 130 patients (96.3%) and patient survival in 126 (93.3%). CONCLUSION: The Libyan National Organ Transplant Program has been successful with results comparable to international levels.

Multiple visceral aneurysms in antiphospholipid antibody syndrome - an unusual presentation.

Visceral artery aneurysms are an uncommon form of abdominal vascular disease and represent a rare clinical entity; however, 10-20% will rupture, which is associated with a significant mortality rate of 20-70% depending on the location of the aneurysm. Antiphospholipid antibody syndrome (APS) was originally described in patients with systemic lupus erythematosus and usually presents with deep venous thrombosis, recurrent abortion and stroke. The development of vasoocclusive disease in APS has been well documented, but the presence of concurrent aneurysms in some patients may cause diagnostic and therapeutic confusion. We report on a patient with primary APS who presented unusually with multiple visceral large aneurysms.

The reverse of intestinal segments for the treatment of ileostomy diarrhea.

Ileostomy diarrhea still represents a real problem; for further understanding of it's management using Anti-Peristaltic Segments we have undertaken an experimental study where 12 mongrel dogs were used. Permanent ileostomy was done after which segments of small intestine of different lengths 5-55 cm long were divided 35 cm proximal to the ileostomy and rotated on their vascular pedicle through 180 degrees, and continuity of the small intestine was restored. Quality, quality of the stool, intestinal transit time, body weight loss, and survival of the experimental animals were studied to observe the effect of Anti-Peristaltic Intestinal Segments, the length of the Anti-Peristaltic segments needed for better control of ileostomy diarrhea, and the Critical length of the Anti-Peristaltic segments. We have observed that dogs cannot tolerate ileostomy. Anti-Peristaltic Intestinal Segments regulate the quality and quantity of stools, delay the intestinal transit, allow for the greater absorption and decrease the weight loss, but only to certain limits. Anti-Peristaltic intestinal segments of 20-30 cm. long give better control of ileostomy diarrhea. The critical Anti-Peristaltic intestinal segment is 50 cm long.