Why Potential Living Kidney Donors Do Not Proceed for Donation: A Single-Center Experience.

BACKGROUND: Living donor kidney transplantation is the best type of renal replacement therapy. However, large numbers of potential living kidney donors (LKDs) are declined because of various reasons. The aim of this study is to define and quantify the reasons for declining potential LKDs. METHODS: All potential LKDs evaluated at our center between September 2008 and December 2016 were reviewed. Data were collected from the electronic database. RESULTS: A total of 2090 potential LKDs were evaluated, with an average age of 32 years (range, 18-67 years) and men constituting 72.6%. A total of 675 (32.3%) were accepted for donor nephrectomy. Living kidney donation did not proceed in 830 (39.7%): 661 (79.6%) because of donor-related reasons and 169 (20.4%) because of recipient-related reasons. Donor-related reasons included medical contraindications (61.7%), immunological barriers (23.1%), surgical contraindications (7.9%), and psychosocial reasons (7.3%). A total of 585 (28.0%) potential LKDs voluntarily withdrew themselves at variable time points during the evaluation process, even after being accepted for donation. Male and young (18-35 years) potential LKDs were more likely to withdraw compared with female and older (>35 years) potential LKDs (34.3% vs 11.4%, P < .005 and 29.6% vs 24.5%, P = .02, respectively). CONCLUSIONS: Despite the large number of potential LKDs, medically complex donors are increasing, and a significant proportion decided to withdraw at some point during the evaluation process. The latter highlights the need to increase public awareness about living donation, to perform more careful initial screening and targeted educational programs, and to provide continuous support for potential LKDs.

Manifestations oto-rhino-laryngologiques des maladies systémiques

Les atteintes oto-rhino-laryngologiques sont parmi les plus fréquentes des manifestations observées dans les maladies systémiques et rhumatologiques. Une grande variété de pathologies a été décrite telles que la polychondrite atrophiante, certaines granulomatoses et connectivites ou la sarcoïdose. Dans d'autres cas, l'atteinte ORL est plus rare mais peut, parfois, révéler la maladie et poser des difficultés diagnostiques. Une étroite collaboration entre spécialistes ORL, rhumatologues et internistes est indispensable pour améliorer l'approche diagnostique et thérapeutique chez ces patients

Tuberculose lymphonodale cervicale chez les enfants vaccines par le BCG

La tuberculose ganglionnaire cervicale est une localisation extrapulmonaire relativement frequente chez l'enfant. Elle pose essentiellement des difficultes de prevention. L'objectif de ce travail est d'etudier les particularites diagnostiques et therapeutiques chez des enfants vaccines par le BCG. Materiel et methodes: Notre etude retrospective porte sur 23 cas de tuberculose ganglionnaire chez des enfants vaccines; colliges sur une periode de 10 ans allant de 2002 a 2011. Resultats : La moyenne d'age des enfants etait de 8 ans. Le delai de consultation etait en moyenne de 1 mois. Seize enfants presentaient une polyadenopathie cervicale bilaterale. L'echographie cervicale a objective une necrose intra ganglionnaire dans 17 cas. Le diagnostic de tuberculose ganglionnaire a ete confirme par l'examen anatomopathologique d'une piece d'adenectomie dans tous les cas. Aucun des enfants n'a presente de forme grave ou compliquee. Un traitement antituberculeux selon le schema national a ete instaure dans tous les cas. L'evolution a ete favorable dans tous les cas. Conclusion : Malgre tous les efforts deployes par notre pays pour la lutte contre la tuberculose; cette derniere sevit toujours a l'etat endemique. La vaccination par le BCG a permis de diminuer considerablement le nombre des formes graves mais ne protege pas parfaitement contre cette maladie

[Ear nose sarcoma. Report of 3 cases]. / Les Sarcomes à localisation ORL. (A propos de 3 Observations).

BACKGROUND: Head and neck sarcoma are very rare malignant tumors which can occur on any different ENT localization. AIM: The authors report tree different variety of ENT sarcoma diagnosed and treated at the oto-rhino-laryngological department of military hospital of Tunis. We intend to remind of clinical and histological particularities, therapeutic modalities and finally to evaluate the follow-up. METHODS: From 2001 to 2007, three cases of head and neck sarcomas were diagnosed in ENT department of military hospital of Tunis. RESULT: the study concerned a women (22 years old) and two men 36 and 76 years old. It deals with an orbital rhabdomyosarcoma, a carcinosarcoma of submandibular gland and a maxillary chondrosarcoma. In each case, diagnosis was validated by the immunohistochemistry. All patients had surgical removal of their tumor. External irradiation or/and chemotherapy was also indicated for all cases. CONCLUSION: ENT sarcomas are aggressive neoplasm. Long-term survival is bad with high potentialities of local recurrence and distant metastases.

[MR imaging of coronary arteries: noncontrast free-breathing whole heart acquisition with ultrafast 3D balanced gradient-echo technique]. / Imagerie par résonance magnétique des artères coronaires: acquisition "coeur entier", en respiration libre, sans injection d'agent de contraste et utilisant la séquence 3D en écho de gradient balancé ultrarapide.

The 3D balanced gradient-echo technique is described along with th eimaging protocol for MR imaging of th ecoronary arteries. A 3D volume with spatial resolution of 0.6 x 0.6 x 0.75 mm composed of 140 slices covering the whole heart is acquired over 10 minutes. The main advantage of this whole heart technique is the possibility to image the coronary arteries along their entire course in a single acquisition. Selection of the navigator positions, timing of image acquisition and its duration through the R-R interval are the main factors requiring optimization.

[Contrast enhanced MR angiography: evolving towards whole-body real time acquisitions]. / Angiographie par résonance magnétique avec injection de produit de contraste: évolution vers le corps entier et le temps réel.

MRA includes all techniques used to depict vessels with MR. Gadolinium contrast injection combined with gradient echo sequences is the technique of choice for vascular imaging. Technical advances now allow faster acquisitions. The purpose of this article is to present two main advances with MRA: whole-body MRA and dynamic 3D MRA. Technical considerations, acquisition techniques, advantages and pitfalls based on our experience with a 1.5T MR unit will be discussed in order to promote their use in routine clinical practice.

L'aspergillose naso-sinusienne dans sa forme pseudo-tumorale: a propos d'un cas

Les rhinosinusites aspergillaires sont; actuellement; en nette augmentation. La forme invasive de la maladie est essentiellement decrite chez les sujets a immunite compromise. Cette forme peut eroder l'os et / ou mener a des complications cranio-cerebrales. La presentation clinique est peu specifique et le diagnostic est assez souvent suspecte a l'imagerie. Le traitement medico- chirurgical est dans la majorite des cas curatif. Nous rapportons les aspects cliniques; radiologiques et therapeutiques d'un patient atteint d'une rhinosinusite aspergillaire

Les cellulites cervico-faciales d'origine dentaire : a propos de 150 cas

Les cellulites cervico-faciales d'origine dentaire sont des infections des tissus cellulo-adipeux; de la face et du cou; ayant des potentialites extensives pouvant parfois etre graves et engager le pronostic vital. Le but de ce travail est d'etudier le profil epidemioclinique et paraclinique de nos patients; d'evaluer leur prise en charge therapeutique et leur evolution. Notre etude est retrospective et a porte sur 150 cas de cellulites cervico-faciales d'origine dentaire colliges sur 10 ans entre 1997 et 2006. La prise en charge therapeutique etait medico-chirurgicale. Les cellulites cervico-faciales d'origine dentaire sont une pathologie potentiellement grave dont la prise en charge est couteuse et les repercussions socio-professionnelles et economiques sont lourdes d'ou l'interet d'une politique de prevention efficace et ciblee visant a reduire la morbidite liee a ces infec-tions

Les tumeurs parotidiennes : a propos de 43 cas

Les tumeurs des glandes salivaires sont rares; dominees en frequence par les tumeurs parotidiennes. Elles sont caracterisees par une grande heterogeneite morpho-histologique. Cliniquement; elles se manifestent le plus souvent par une masse parotidienne non specifique. A l'examen histologique; les formes benignes sont les plus frequentes dominees par l'adenome pleomorphe. Le traitement de ces tumeurs demeure chirurgical en premier lieu. Neanmoins; la complication majeure de cette chirurgie reste la paralysie faciale pouvant etre transitoire ou permanente. Le but de cet article est d'analyser chez 43 patients suivis et traites d'une tumeur parotidienne les differents aspects epidemio cliniques; radiologiques et histologiques de ces tumeurs

[Sudden onset of hemoptysis during (coil) embolization of a Swan-Ganz catheter induced pseudoaneurysm of the pulmonary artery]. / Survenue d'une hémorragie bronchique lors de l'embolisation d'un pseudo-anévrysme pulmonaire consécutif a un cathétérisme par Swan-Ganz.

We report the embolization of a pulmonary artery pseudoaneurysm consecutive to Swan-Ganz catheterization. Embolization was successful despite an iatrogenic rupture and a massive hemoptysis.

[Thyroid surgery (356 cases): risks and complications]. / Chirurgie thyroïdienne (356 cas): risques et complications.

The purpose of this study was to evaluate the risks and complication rate of thyroid surgery. The authors present a retrospective study of 356 patients surgically treated for thyroid nodules, between 1987 and 1998, at the military hospital of Tunis. The patients were categorised into 3 groups: group I: 238 solitary thyroid nodules (66.8%); group II: 92 multinodular goitres (25.8%) included 12 retrosternal goitres (3.37%) and group III: 26 cases of Basedow's disease (7.4%). Patients benefitted from unilateral surgery in 72% of cases and from bilateral surgery (total or subtotal thyroidectomy) in the remaining 28% of cases. Malignancy was found in 34 cases (9.5%). The complications observed were haemorrhage (0.56% of cases), unilateral post operative recurrent laryngeal palsy (1.12% of cases), and permanent hypoparathyroidism in 0.81% of cases. Experienced surgeons and the use of a meticulous surgical technique can reduce the incidence of post operative complications in thyroid surgery.