Bariatric Surgery to Target Obesity in the Renal Transplant Population: Preliminary Experience in a Single Center.

During the last century, obesity has become a global epidemic. The effect of obesity on renal transplantation may occur in perioperative complications and impairment of organ function. Obese patients have metabolic derangements that can be exacerbated after transplantation and obesity directly impacts most transplantation outcomes. These recipients are more likely to develop adverse graft events, such as delayed graft function and early graft loss. Furthermore, obesity is synergic to some immunosuppressive agents in triggering diabetes and hypertension. As behavioral weight loss programs show disappointing results in these patients, bariatric surgery has been considered as a means to achieve rapid and long-term weight loss. Up-to-date literature shows laparoscopic bariatric surgery is feasible and safe in transplantation candidates and increases the rate of transplantation eligibility in obese patients with end-stage organ disease. There is no evidence that restrictive procedures modify the absorption of immunosuppressive medications. From 2013 to 2016 we performed six bariatric procedures (sleeve gastrectomy) on obese patients with renal transplantation; mean preoperative body mass index (BMI) was 39.8 kg/m2. No postoperative complication was observed and no change in the immunosuppressive medications regimen was needed. Mean observed estimated weight loss was 27.6%, 44.1%, 74.2%, and 75.9% at 1, 3, 6, and 12 months follow-up, respectively. Our recommendation is to consider patients with BMI >30 kg/m2 as temporarily ineligible for transplantation and as candidates to bariatric surgery if BMI >35 kg/m2. We consider laparoscopic sleeve gastrectomy as a feasible, first-choice procedure in this specific population.

[Epidemiological Surveillance of Cholera in Russia During the Period of the Seventh Pandemic].

In this work basic stages of formation of the epidemiological surveillance of cholera in Russia are described. In 1990-s for the first time zoning by epidemic manifestations of cholera was carried out at the level of subjects forming parts of Russia and other Republics of the Soviet Union with the introduction of differential tactics of epidemiological surveillance. Improvement of epidemiological surveillance of cholera was aimed at harmonization with the IHR (2005), integration of epidemiological surveillance of cholera and social-hygienic monitoring of water objects of I and II categories. Characterization of isolated Vibrio cholerae strains (1990-2014) on the genomic basis determined the emergence of new VNTR-genotypes of V. cholerae O1 ctxAB+ tcpA+, responsible for outbreaks, simultaneously with isolation of V. cholerae 01 ctxAB-tcpA-strains during monitoring of environmental objectsfor cholera. A viewpoint is considered of the beginning of the eighth cholera pandemic in the context of emergence of V. cholerae El Tor strains with CTXφ prophage carrying ctxB gene of cholera toxin of classical biovar. Main directions offurther enhancement ofepidemiological surveillance include the study of basic data structures used in the epidemiological surveillance system, the use of zoning of municipal units offederal subjects with corresponding surveillance tactics and expected economic effect.

[Neutral alpha-glucosidase activity in the urine in congenital hydronephrosis in children]. / Aktivnost' neitral'noi al'fa-gliukozidazy v moche pri vrozhdennom gidronefroze u detei.

Enzymuria was studied in children who had undergone surgery for congenital hydronephrosis. A total of 109 patients were operated on according to Andersen-Hynes-Kucher with ureteral intubation and pelvic drainage. The course of renal tissue tubular function recovery upon elimination of the obstruction in the pyeloureteral segment was followed up by urine activity of neutral alpha-glucosidase as was the enzyme activity dynamics in dysplastic congenital hydronephrosis. The latter evidences reduced, but satisfactory functional capacity of the operated on organs.

[The choice of the method of urinary diversion in bladder exstrophy in children]. / K vyboru metoda derivatsii mochi pri ékstrofii mochevogo puzyria u detei.

Transplantation of the ureters into the sigmoid colon by Tikhov-Coffey in the authors' modification has been carried out in 10 children. The ureters were placed into the channel made by supramucosal dissection. Good response was achieved in 9 patients. One case of transplantation of the only ureter of heminephrectomized kidney was fatal.

[Surgical treatment in different variants of the duplicated kidney in children]. / Operativnoe lechenie razlichnykh variantov udvoennoi pochki u detei.

The paper details various surgical treatment of double kidney variants. A total of 49 children have been treated, of whom in 3 cases the subdivision was incomplete. The causes and characteristics of the kidney lesions varied. They had arisen most frequently due to tissue embryonal inferiority. The method of operative correction requires a careful approach to parenchymal affection form and degree, to the examination policy and is predetermined by timely and thorough diagnosis.

[The morphofunctional status of the contralateral kidney in hydronephrosis as the criterion of the efficacy of surgical treatment in the past]. / Morfofunktsional'noe sostoianie kontralateral'noi pochki pri gipernefroze kak kriterii éffektivnosti operativnogo lecheniia v otdelennom periode.

An x-ray examination has been performed for 109 patients operated on for unilateral hydronephrosis since 1980. All the children underwent surgery according to Andersen-Hines-Kucher. Long-term follow-up excretory urography determined the coefficient of surface area for the contralateral and operated on kidney. The coefficient served a criterion of the kidney morphology and function. The paper provides follow-up morphological parameters for both kidneys in relation of the obstruction degree, postoperative period, age of the child at the moment of the surgery. In hydronephrosis of the 1 degree morphological changes in the kidney did not occur, 2-degree hydronephrosis abnormalities in the kidney disappeared after the surgery by the 3 postoperative year. In severe disease morphological recovery was observed to the end of postoperative year 6, whereas intensive growth of the parenchyma owing to immature renal structures lasted for 3 postoperative years. In similar obstruction, more serious changes in the renal tissue occurred in younger children which may be due to more pronounced shifts in renal tissue differentiation.

[Radioisotope renography in the assessment of kidney function and urodynamics in children following the surgical treatment of hydronephrosis]. / Radioizotopnaia renografiia v otsenke funktsional'nogo sostoianiia i urodinamiki pochek u detei posle operativnogo lecheniia gidronefroza.

The paper provides radionuclide findings in children surgically treated for hydronephrosis. Altogether 109 children were operated on according to the technique by Andersen-Hines-Kucher with ureteral intubation and pelvic drainage. The radionuclide investigation allows determination of the time needed for functional recovery of the operated on kidney as well as visualization of changes in the contralateral follow-up period. Preoperative age-related changes in recovery of secretory and excretory functions of the operated on kidney were investigated.