Simultaneous pediatric kidney transplantation and ureterocystoplasty in a 20-month-old boy.

Kidney transplantation (KT) in children with end-stage renal disease and an abnormal bladder poses a complex management challenge. Ureterocystoplasty (UC) has been previously reported in older children with non-compliant bladders, but the timing and technique of repair are controversial. This case reports the youngest patient, a 20-month-old boy to undergo successful single-stage UC and living-related KT. UC was performed because of a fibrotic, non-compliant bladder. A temporary vesicostomy was placed to provide adequate drainage in the presence of urethral stenosis. The patient developed a single episode of pyelonephritis within the first six months post-operatively, but there were no other urologic complications. At 13 months, the renal function is excellent with a mean glomerular filtration rate of 100 mL/min/1.73 m(2) and no clinical evidence of rejection. This case demonstrates that simultaneous UC and KT can be safely performed even in infants with non-compliant bladders and renal failure.

Successful living related kidney transplantation across an anti-donor HLA antibody.

In preconditioning highly sensitized kidney transplant candidates, renal allograft outcomes have been better when the serum titer for class I anti-HLA donor-specific antibody (DSA) is low in the recipient at the time of transplantation. However, the ideal level to which the titer should be lowered is still controversial. We report a primary living related kidney transplant in a 34-year-old highly sensitized woman (pretransplant panel-reactive antibody=70%) with end-stage renal disease secondary to chronic glomerulonephritis. We sought to desensitize by lowering the DSA titer specifically to 1:4 pretransplant. A standard complement-dependent cytotoxicity cross-match with her donor (sister) was repeatedly negative, although she was positive for class I antibody against her mismatched HLA antigen (A*2402) at a titer up to 1:16 by the single-antigen flowbead assay. The target DSA titer of 1:4 before transplant was achieved by 12 sessions of plasmapheresis (PP) over 7 weeks, plus two intravenous immune globulin infusions (IVIG) (500 mg/kg/infusion). The patient outcome was excellent. Neither IVIG nor PP was needed posttransplant. The serum creatinine ranged between 0.5 mg/dL and 1.2 mg/dL, and no rejection episode was documented at 28 weeks posttransplant. Therefore, we encourage the use of IVIG and PP to lower the DSA titer to at least 1:4 before kidney transplantation in highly sensitized patients. Large prospective trials are needed to establish a consensus for pretransplant risk assignment and to evaluate the need for desensitization.

Intrapyloric injection of botulinum toxin a for the treatment of persistent gastroparesis following successful pancreas transplantation.

Intrapyloric injection of botulinum toxin A (BoTx) successfully improved symptoms in idiopathic and diabetic gastroparesis (DGP) refractory to medical treatment. Therefore, we used it in three pancreas transplant patients done in our institution during the last 18 months. They had severe, persistent DGP despite successful pancreas transplantation. They received 100 units of BoTx during the first injection. The clinical effect became evident within 2 weeks after the treatment, and lasted for an average of 29 weeks (range 14-44 weeks). The patients' subjective evaluation showed improvement of their symptoms and quality of life following BoTx. Patients 2 and 3 had recurrent symptoms at 44 and 24 weeks, respectively, after the first injection; they required a second dose of 90 and 80 units, respectively. They are doing well at 3 months follow-up. Intrapyloric injection of BoTx is safe and efficient. It should be considered for treating residual DGP following successful pancreas transplantation.

[Invasive carcinoma of the cervix in young women in Tunisia]. / Le cancer invasif du col utérin chez la femme jeune en Tunisie.

A series of 133 patients, 35 years or less in age (mean: 31.8) presenting with a carcinoma of the cervix and treated at Salah Azaiz Institute from 1969 to 1989 was analysed and compared to a control group of patients older than 35 years (mean: 54). Neither clinical nor epidemiological particularities were found in the younger patients group, except an early sexual life and a high proportion of early stage tumours (33% versus 15.9% in the older women group). Overall survival of the younger women was dramatically worse than that of the older women: 40% and 50% at 5 years, 20% and 40% at 10 years, and 14% and 30% at 15 years, respectively. This difference is statistically significant in stage I-II patients. Young age, non-sterilization of the tumour after brachytherapy, and anemia, are associated with a poor prognosis.

[Cancer of the cervix uteri in Tunisia. Clinical presentation and development over a 10-year period]. / Le cancer du col utérin en Tunisie. Présentation clinique et évolution au cours d'une période de 10 ans.

Carcinoma of the cervix is still common in Tunisia, where it occupies second place among malignant diseases in women. Accounting for 17% of the female population of the National Cancer Institute of Tunis, it is preceded only by breast cancer (27%). Study of the factors concurrent with the origin of carcinoma of the uterine cervix seems to indicate that its decrease is secondary to the lowered average age at marriage, to the fall in the reproduction rate among the population at large, and to improved socio-economic conditions among the poorer classes. Study of clinical features observed during two separate periods of 10 years shows a modification in the physiognomy of this cancer, with, notably, a larger frequence of lower stages (45% of stage II in 1984 vs 20% in 1974) and a slight tendancy towards the discovery of smaller non - or early - infiltrating tumors (4% in 1984 vs 0% in 1974). Efforts must continue to be made in the domaine of early detection, especially among the "high risk" population.