Role of resistive index measurement in diagnosis of acute rejection episodes following successful kidney transplantation.

OBJECTIVE: This study was performed to evaluate the role of resistive index (RI) in the diagnosis of rejection episodes following successful kidney transplantation. MATERIALS AND METHODS: One hundred and one unrelated living first kidney allograft adult recipients (75 males and 26 females) of overall mean age of 39 years were enrolled and prospectively followed for 6 months. The measurement of RI by Doppler ultrasonography was performed in all patients on days 3 and 7 as well as at months 1, 3, and 6 in addition to when there was graft dysfunction. We determined serum creatinine and cyclosporine levels. RESULTS: Twenty-seven patients (26.7%) experienced 33 acute rejection episodes during the follow-up. There were significant differences between mean RI among patients with normal function vs rejection: 0.606 +/- 0.065 vs 0.866 +/- 0.083 (P < .05), respectively. Overall, elevated levels of cyclosporine, ischemic acute tubular necrosis (ATN), and renal artery thrombosis were observed in 8, 5, and 3 patients, respectively. No association was observed between these factors and RI. CONCLUSIONS: RI was significantly higher in patients with acute rejection episodes. It had no association with ATN or cyclosporine toxicity. Hence, RI may be useful to diagnose acute renal allograft rejection following renal transplantation.

A comparison between clinical and pathologic staging in patients with bladder cancer.

PURPOSE: To determine the accuracy of clinical staging methods of bladder cancer and TURBT results in estimating the pathologic stage of tumor. MATERIALS AND METHODS: Thirty two patients who had undergone radical cystectomy were studied in this retrospective survey. The results of bimanual examination, cystoscopy, TURBT pathology report and the tumor contour in CT scan, (size, infiltrative deepness, pelvic lymph nodes involvement and hydronephrosis) were recorded. The type of surgery and pathologic report of cystectomy sample were analyzed as well. Then the results of bimanual examination, tumor size, hydronephrosis and CT scan findings including tumor infiltrative deepness, pelvic lymph adenopathy and TURBT findings were compared to pathologic results of cystectomy sample. RESULTS: Seven patients were females and 25 were males. Their mean age was 62 (range 36 to 80) years. Gross hematuria and irritative urinary symptoms were the most common complaints. The duration between symptom manifestation and patient's referral was 5 days to 72 months (mean 12 months). Bimanual examination in estimating the extravesical involvement of tumor had a specificity of 82%, sensitivity of 46%, positive predictive value of 70% and negative predictive value of 63%. The size of tumor in determining extravesical involvement had a specificity of 41%, sensitivity of 93%, and positive predictive value of 58% and negative predictive value of 87%. Hydronephrosis was present in 15 patients of whom, 14(93%) had bladder muscle involvement. CT scan specificity was 70%, and sensitivity was 46% regarding pelvic lymph adenopathy and perivesical fat involvement. In TURBT report no muscle sample was observed in 11 cases, so that the interpretations of results were impossible. The reported grade of tumor was lower than pathologic sample of cystectomy in 4 patients. CONCLUSION: Clinical staging in invasive bladder cancers has not high accuracy regarding the involvement of bladder surrounding fats and pelvic adenopathies. A tumor sized more than 5 cm could be sensitive in estimating extravesical involvement. Positive predictive value of hydronephrosis is considerable regarding bladder muscle involvement. Tumor understaging by TURBT is happened in high percentage of patients with invasive bladder cancer.

Endoscopic renal cyst ablation.

INTRODUCTION: Our aim was to evaluate the result of simple renal cyst ablation by endoscope and compare the results with other techniques of renal cyst treatment. MATERIALS AND METHODS: A prospective study was performed at Shaheed Faghihi hospital from January 2001 to January 2003. Ten patients with symptomatic simple renal cyst were selected for this study. The exclusion criteria were history of previous renal surgery, parapelvic cyst, and cyst size less than 50 mm. Urinalysis, urine culture, serum electrolytes, ultrasonography, and CT scan were done before operation. The patients underwent endoscopic renal cyst ablation and cytology of cyst fluid and histopathological examination of cysts' walls were done in all patients. The patients were followed with ultrasonography after two weeks and 2, 6, and 12 months postoperatively. Disappearance of the cyst or decreasing its size to less than 50% of its primary size was considered as improvement. RESULTS: All the patients were female with a mean age of 55 (range 22 to 75) years. The operation was successful in 9 patients with no major complications. Perinephric hematoma and excessive leakage were seen in two patients. The operative time was 38+/-10.8 minutes and hospital stay was 3+/-1.3 days. Mean size of cyst before operation was 75+/-19.7 mm and changed to 12.7+/-15.3 mm after operation (p<0.001). Flank pain subsided in 88.8% (p<0.008). CONCLUSION: Cyst ablation can be used for the treatment of simple renal cysts not responding to aspiration and sclerosing therapy, and if there is no laparoscopic facility. More studies are needed to confirm these results.

Thrombocytopenia in HIV-infected patients, Islamic Republic of Iran.

Thrombocytopenia is a blood dyscrasia common in AIDS patients that may result from increased viral load and diminished CD4 T lymphocytes. We evaluated the rate of thrombocytopenia (platelet count < 100 000/microL) in 170 HIV-infected patients (161 males and 9 females) from May 2000-April 2001 in Kermanshah, Islamic Republic of Iran. All except 7 females were injecting drug users. While 34 patients had thrombocytopenia, 3 had severe thrombocytopenia (platelet count < 20 000/microL). Although prevalence was similar in various stages of HIV infection (18.5%-22.5%), severe thrombocytopenia was in patients with CD4 T cell count < 200 cells/microL. There were no other associated conditions. Mild thrombocytopenia is common in HIV-infected patients in our region.

Thrombocytopenia in HIV-infected patients, Islamic Republic of Iran

Thrombocytopenia is a blood dyscrasia common in AIDS patients that may result from increased viral load and diminished CD4 T lymphocytes. We evaluated the rate of thrombocytopenia [platelet count < 100 000/microL] in 170 HIV-infected patients [161 males and 9 females] from May 2000-April 2001 in Kermanshah, Islamic Republic of Iran. All except 7 females were injecting drug users. While 34 patients had thrombocytopenia, 3 had severe thrombocytopenia [platelet count < 20 000/microL]. Although prevalence was similar in various stages of HIV infection [18.5%-22.5%], severe thrombocytopenia was in patients with CD4 T cell count < 200 cells/microL. There were no other associated conditions. Mild thrombocytopenia is common in HIV-infected patients in our region

[Brucellosis of the pubic symphysis. Apropos of a case. Review of the literature]. / Infection mélitoccocique de la symphyse pubienne. A propos d'un cas, revue de la littérature.

The authors report a case of symphysis pubis osteomyelitis due to Brucella. Such localisation seems not to have been reported before. Despite an initially bad observance of antibiotic treatment, evolution has finally been favourable. At two year follow-up, no functional or radiological sequellae was observed.