Azathioprine Associated with Intrahepatic Cholestasis in a Patient with Twin Pregnancy after a Second Kidney Transplant.

Introduction: Most pregnancies in women after a kidney transplant result in a live birth, but kidney functions should be stable for one year before conception. For immunosuppression modification occurring before pregnancy, azathioprine is used because it is considered safe for major congenital malformations during pregnancy. However, there may be an association between exposure to azathioprine during pregnancy and the onset of an unusual, early and severe form of intrahepatic cholestasis. Case description: A young patient with a twin pregnancy after a second kidney transplant experienced intrahepatic cholestasis. There was a wide range of differential diagnosis. A battery of tests was requested including autoimmune markers, virology, and imaging. The conclusion that azathioprine was contributing to intrahepatic cholestasis with pregnancy was reached after exclusion of all other differentials. Conclusions: Complications of pregnancy after a kidney transplant include hypertension, pre-eclampsia, deterioration of graft function up to rejection, but also unusual side effects of immunosuppression medication. LEARNING POINTS: A twin pregnancy after a second kidney transplant is rare.In addition to bone marrow suppression and elevation of liver enzymes, azathioprine can contribute to intrahepatic cholestasis of pregnancy.Complications of pregnancy after kidney transplant include hypertension, pre-eclampsia, deterioration of graft function up to rejection, but also unusual side effects of immunosuppression medication.

Nongrafted sinus floor elevation with a space-maintaining titanium mesh: case-series study on four patients.

PURPOSE: Numerous materials and techniques have been introduced to augment the maxillary sinus floor for future dental implant placement. Schneiderian membrane tenting above simultaneously placed implants proved to be a successful technique. The present study investigated the use of a titanium micromesh for lateral-window sinus floor elevation without bone grafting. MATERIAL AND METHODS: Four patients indicated for two-stage sinus lifting were included. Through a lateral window, a titanium micromesh was tailored and placed into the sinus to maintain the elevated membrane in place. Immediate and 6-month postoperative cone beam computed tomography (CBCT) was performed to measure the gained bone height. During implant placement, bone core biopsies were retrieved for histomorphometry. RESULTS: The average residual ridge height among the eight sinuses was 3.6 mm ± 1.6 mm. Six months postoperatively, it reached 9.63 mm ± 1.47 mm. Histomorphometry revealed that the average bone volume of the native bone was 30.3% ± 9.1%, while that of the newly formed bone was 55.3% ± 11.4%. CONCLUSION: Within the limitations of this study due to the small sample size, the use of the titanium micromesh as a space-maintaining device after schneiderian membrane elevation is a reliable technique to elevate the floor of the sinus without grafting.

The validity of different display monitors in the assessment of dental implant site dimensions in cone beam computed tomography images.

OBJECTIVE: To determine if the differing contrast resolution of various LCD monitors affects the reliability or accuracy of measurements of proposed implant sites. MATERIALS AND METHODS: Edentulous areas of human dry skulls were marked with radiopaque markers in order to standardize the plane of the transverse cross-sections of the ridges and path of measurements. The skulls were imaged by a CBCT device and the images stored in proprietary format on the workstation. The data sets were then transferred, with the proprietary reformatting software, to two different laptops using CDs. Transverse cross-sectional images of the ridges were reformatted on all three computers and ridge dimensions were recorded using the linear measurement tool of the proprietary software. Ridge dimensions were recorded directly from the three different monitors by two observers and compared to measurements recorded directly from the bone. The measurement errors and intra- and inter-examiner reliability were calculated for each monitor and compared with each other. RESULTS: Intra- and inter-examiner reliability scores for the measurements recorded from all three devices were very high and ranged between 0.993-0.999. The mean of the absolute errors was 0.55 mm for the workstation, 0.61 mm for laptop 1 and 0.68 mm for laptop 2. The absolute errors were statistically significant for all three monitors (p-value < 0.001), but there was no statistically significant difference between the absolute errors obtained from the three monitors. CONCLUSIONS: No differences in the reliability or accuracy of measurements of implant site dimensions were obtained using color LCD monitors with different contrast resolution capabilities.