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Biomedical subjects

M Dawahra

Publications and source records attributed to M Dawahra.

At least 37 records · Page 2Linked to original sources
PubMed1999

The use of long-term defunctionalized bladder in renal transplantation: is it safe?

OBJECTIVE: Evaluation of the use of defunctionalized bladder in renal transplantation, concerning surgical complications. METHODS: In order to assess the complication rate of ureteral reimplantation in long-term defunctionalized bladder, we compared 20 patients on haemodialysis for more than 15 years (group I) with another 20 patients on haemodialysis for less than 5 years (group II). None of these patients had renal failure due to urological causes or neurogenic bladder. Non-stented extravesical ureteroneocystostomy was done routinely in all patients except 1 in group II who underwent Politano-Leadbetter ureteroneocystostomy and 7 patients in group I who underwent Politano-Leadbetter (3 patients) and pyelo-ureteral anastomosis using the recipient's native ureter (4 patients). The amount of residual urine was insignificant (<100 cm(3)) in both groups. RESULTS: The mean postoperative bladder catheterization period was 7.8 days in group I and 4.2 days in group II. Postoperative urinary tract infections were observed in 9 cases of group I and in 4 cases of group II. No surgical complications occurred in patients of group II, while there were 6 patients with surgical complications in group I: stenosis after a pyelo-ureteral anastomosis (1 case), stenosis after a ureterovesical anastomosis with Politano-Leadbetter technique (1 case), urinary fistulae (3 cases; 1 with Politano-Leadbetter ureteroneocystostomy and 2 cases with pyelo-ureteral anastomosis), and vesico-ureteral reflux (1 case with Politano-Leadbetter ureteroneocystostomy). These 6 cases had the lowest bladder capacity (30-150 cm(3)) among our 40 patients. Graft losses were comparable between the two groups and were not due to surgical complications. CONCLUSION: Small defunctionalized bladders can be used in kidney transplantation, but it may represent an increased surgical risk due to difficulty in performing ureteral reimplantation.

Adult↗
PubMed1998

[Graft function following renal transplantation in children].

BACKGROUND: Since renal transplantation is known to be the best choice for the growing child with end-stage renal failure, we prospectively evaluated early and late graft function in transplanted children. POPULATION AND METHODS: The study included 78 children (32 girls, 46 boys) 10.4 +/- 0.6 years at the time of transplantation. Renal investigations were performed at 3, 6 and 12 months post-transplantation and yearly thereafter. Inulin clearance was used to evaluate the glomerular filtration rate (GFR), and the reabsorption rates of Na, P and Ca were measured concomitantly. RESULTS: The overall adjusted GFR was approximately 70 mL/min/1.73 m2 and remained unchanged during the first 5 years post-transplantation. In the mean time the absolute GFR increased significantly, suggesting a remaining capacity for compensatory hypertrophy of the transplanted kidney. Renal function was significantly influenced by the number of rejection episodes during the first 2 years post-transplantation but no correlation was found between GFR and the number of HLA mismatches or the use of preemptive transplantation.

Child↗
PubMed1998

Role of the donor in post-transplant renal function.

BACKGROUND: The donor, i.e. adult or paediatric, might influence the outcome of the graft function. METHODS: The glomerular filtration rate (GFR) of 120 transplanted children (47 girls) aged 10.4+/-4.6 years (0.7-17.2) was prospectively assessed over a 5-year period. The patients were divided into two groups according to the age of donor: adult (donor age > 18 years; n=33) and paediatric (donor age < 18 years; n=87). GFR was assessed by inulin clearance at 3, 6 and 12 months and yearly thereafter. RESULTS: The average GFR was stable in the range of 70 ml/min/1.73 m2 for the whole follow-up period. The adjusted GFR in adult graft recipients was significantly higher at 3 months post-transplantation: 80.6+/-36.9 vs 65.1+/-22.0, P=0.02. However, from the second year post-transplantation, the adjusted GFR in paediatric graft recipients became significantly higher than that of adult graft recipients. Such results could be due to an improvement in the absolute GFR (ml/min) of paediatric graft recipients with time (P=0.0001) whereas that of the adult graft recipients remained stable despite the children's growth. CONCLUSIONS: The adjusted GFR of adult graft recipients was significantly higher than that of paediatric graft recipients in the early post-transplant period. In the long-term, a progressive decrease in adjusted GFR was noted in adult graft recipients. On the one hand, this may be due to a functional adaptation and/or inadequate compensatory growth of the graft. On the other hand, the absolute GFR of paediatric graft recipients increased, suggesting an ongoing capacity for growth and/or compensatory hypertrophy after child-to-child renal transplantation.

Adaptation, Physiological↗
PubMed1998

[Laparoscopic surgical treatment of simple cysts of the kidney].

OBJECTIVE: To demonstrate the efficacy of laparoscopic treatment of symptomatic renal cysts or cysts suspicious of malignancy. MATERIAL AND METHODS: 10 patients (mean age: 58 years) were operated by laparoscopy either for compressive or symptomatic cysts (7 cases), or for cysts suspicious of malignancy (3 cases). The mean cyst diameter was 7.8 cm. All patients were evaluated by preoperative CT scan. There were 8 Bosniak type I and 3 Bosniak type II cysts. RESULTS: The procedure was performed via an intraperitoneal approach (8 cases) or via a retroperitoneal approach (2 cases). The mean operating time was 92 min and the mean hospital stay was 5.4 days. One patient was operated (conversion to lumbotomy) for uncontrolled haemorrhage of the base of the cyst. The 10 cysts were found to be benign histologically. All 10 patients are asymptomatic (mean follow-up: 8.3 months) with disappearance of the cyst on the follow-up CT scan. CONCLUSION: Laparoscopic treatment of renal cysts is feasible and effective. However, this treatment must be reserved for Bosniak type I and II cysts, associated with a low risk of malignancy.

Adult↗
PubMed1998

[Hazards of lumbar ureteroscopy: apropos of 4 cases of avulsion of the ureter].

Ureteroscopy is frequently indicated in the treatment of stones of the pelvic ureter. Access to the lumbar ureter is associated with a higher complication rate: wounds, ureteric rupture, haemorrhage, or more serious lesions such as avulsions of the ureter. We present 4 cases of avulsion of the ureter seen in our department, corresponding to 4 men with stones of the lumbar ureter treated by ureteroscopy, 2 of them after failure of in situ extracorporeal lithotripsy (ESWL) and an attempt to "flush" the stone and the other two because ESWL was not available. The ureteric lesion was related to a Dormia catheter in 2 cases and the ureteroscope in 2 cases. The lesion was diagnosed and treated immediately in 2 patients and after a delay in the other 2 cases. Repair consisted of ureteric reimplantation on a Boari flap (1 case), implantation onto a psoas bladder (1 case), ureteroileoplasty (1 case) and autologous transplantation (1 case). Ureteric lesions prevented uretero-ureterostomy. Ureteric reimplantation on psoas bladder and/or Boari flap appears to be the simplest method, but it cannot always be performed. In the case of avulsion of the ureteropelvic junction with a large defect, autologous transplantation is a method of choice in young subjects. Ureteroileoplasty appears to be reserved for elderly patients.

Adult↗
PubMed1998

Pancreas transplantation: results and indications.

Pancreatic transplantation is the best method of replacing the endocrine function of the gland in Type 1 insulin-dependent diabetic patients. At the end of 1996, 9,000 pancreas transplants had been reported to the international Pancreas Transplant Registry. For 1994-1996, one-year pancreas survival rates were 81% for simultaneous pancreas and kidney transplantation (n = 1,516), 71% for pancreas after kidney (n = 141) and 64% for pancreas alone (n = 64). In patients with a functional graft, glycosylated haemoglobin, fasting blood sugar, and 24-h metabolic profiles are normal. The effect of pancreatic transplantation on secondary complications often appears after several years of normal pancreatic function. Successful transplantation is associated with an improvement in different aspects of the quality of life. The decision to perform pancreatic transplantation depends on the balance between the risks of transplantation, mainly surgical or related to immunosuppression, and those of diabetes development. The advantages and drawbacks of pancreatic transplantation and insulin therapy need to be honestly and carefully analysed for specific populations of diabetic patients as well as for each individual. At present, simultaneous pancreaticorenal transplantation is the best treatment for diabetic patients with chronic renal failure. Transplantation of the pancreas alone in non-uraemic patients may also be considered in carefully selected subjects.

Diabetes Mellitus, Type 1↗
PubMed1997

Outcome of preemptive renal transplantation and pretransplantation dialysis in children.

The present study compares the outcome of 40 children (39%) transplanted without prior dialysis, i.e., preemptive transplantation (PET), with 63 children (61%) transplanted after a variable duration of dialysis, i.e., pretransplantation dialysis (PTD). The two groups were matched for recipient and donor age and for immunological risk factors. There was no statistical difference in the time to first acute rejection episode nor in the number of acute rejection episodes during the 1st year after renal transplantation. In the PET group, 78% of the recipients received blood transfusion versus 92.5% in the PTD group (P < 0.05), and the average number of blood units per patient was 3.2 and 7.8, respectively (P < 0.05). Arterial hypertension was found in 55% of the patients in the PET group versus 73% in the PTD group (P < 0.05). The number of functioning grafts at the end of the study period was 87.5% in the PET group and 73% in the PTD group (NS). The major cause of graft failure was vascular thrombosis in the PET group (3/5) and chronic allograft rejection in the PTD group (10/17). In the PET group, the actuarial graft survival rate was 100%, 84%, 81%, and 76% at 1, 3, 5, and 7 years, which was not statistically different from the PTD group at 1, 3, and 5 years (98%, 91%, and 73%, respectively) but there was a significantly lower graft survival (59%) after 7 years in the PTD (P < 0.05). The 7-year actuarial patient survival rate was 97% in the PET group and 90% in the PTD group (NS). In the PTD group, children on dialysis for less than 1 year (group 1, n = 25) were compared with those on dialysis for more than 1 year (group 2, n = 38). Arterial hypertension was noted in 40% of patients from group 1 and 65% from group 2 (P < 0.05); there was no significant difference in graft loss rate. In conclusion, these results confirm PET as the preferred approach rather than PTD in children who need renal replacement therapy.

Child↗
PubMed1997

Endopyelotomy with the Acucise cutting balloon device. Early clinical experience.

OBJECTIVES: To evaluate the efficacy of the Acucise balloon cutting device in the treatment of ureteropelvic junction (UPJ) stenosis. METHODS: Forty-four patients with primary (21) or secondary (23) UPJ stenosis underwent Acucise endopyelotomy between July 1992 and February 1995. RESULTS: The average operating time was 53 min and the average hospital stay was 6 +/- 4 days. The follow-up schedule included a symptom questionnaire, intravenous urography and diuretic renal scan. Of the 44 patients, 38 have been followed for a minimum of 3 months postoperatively (mean: 12 months, range: 3-39 months). Overall success was achieved in 29 (76%). The procedure was successful in 16 out of 19 cases (84%) with secondary strictures. When the technique was used for the treatment of primary UPJ strictures, the success rate was only 68% (13 out 19). The presence of a large periureteric urinoma was identified as the cause of failure in 2 cases of primary strictures. CONCLUSION: We recommend the use of the Acucise device as the first-line therapy for treatment of secondary UPJ stenosis (except in the presence of large enclosed stones). We do not approve the use of the Acucise device for treatment of primary UPJ strictures. In primary hydronephrosis, the negative role of periureteric extravasation probably explains the low success rate of 68% (as opposed to 85% for a large series of percutaneous endopyelotomies.

Adolescent↗
PubMed1996

Ureteropelvic invagination procedure for endopyelotomy (Gelet technique): review of 51 consecutive cases.

Between 1990 and 1995, we performed 51 endopyelotomies on 38 cases of primary and 13 of secondary obstruction of the ureteropelvic junction (UPJ) using the ureteropelvic invagination technique. Of the 51 patients in the series, 49 have been followed for a minimum of 3 months postoperatively (mean follow-up 16 months). Overall, success was achieved in 38 (77.5%). Endoscopic endopyelotomy was successful in 11 of 13 cases (84.5%) with secondary strictures. When the technique was used for the treatment of primary UPJ stricture, the success rate was only 75% (27 of 36). The presence of a crossing vessel was identified as the cause of failure in five cases of primary strictures; hence, we advocate the use of angiography to identify crossing vessels preoperatively. We recommend the use of the ureteropelvic invagination technique as the first-line therapy for primary hydronephrosis in adults in the absence of a crossing vessel.

Adolescent↗
PubMed1996

[Role of celioscopy in the treatment of lymphocele after transplantation].

Lymphoceles can be observed after renal transplantation. Sometimes lymphoceles can cause symptoms (renal insufficiency, pain). In these cases they require surgical treatment. From january 92 to december 1993 seven patients with complicated lymphoceles were treated. Simple drainage with injections of polyvidone iodine was used in 4 cases without effect. Surgical drainage was performed in 5 cases with complete disappearance of the pouch (on open surgical procedure, four celioscopic procedures). Celioscopic marsupialization of lymphoceles after transplantation is a method of choice and is preferred to open surgery for lymphoceles which develop internally.

Adult↗
PubMed1996

[Quality of life and skin urinary diversions. Results of a questionnaire completed by 73 patients].

UNLABELLED: The objective of this study was to evaluate the quality of life of patients with a cutaneous urinary diversion. MATERIAL AND METHODS: A 25-item self-administered questionnaire was sent to 73 patients with a cutaneous urinary diversion, either non-continent (NCD), such as a transileal cutaneous ureterostomy, or continent (CD), such as a Mainz or Kock reservoir. RESULTS: 66 patients answered the questionnaire: 34 NCD and 32 CD. The mean follow-up was 69.2 years for NCD and 58 years for CD. No significant difference was demonstrated between the two samples in terms of the interference of their diversion with their everyday life. Most patients declared that their sex life was now "severely disturbed". However, 3 patients regained a sexual activity after their diversion. Patients with an ideal conduit presented a higher incidence of stoma problems. Overall, 90% of patients with an NCD and 97% of those with a CD were satisfied or very satisfied with their diversion. CONCLUSION: Regardless of the type of diversion, patients were satisfied with their operation. When a cutaneous diversion is necessary, the choice of a continent or non-continent diversion cannot be solely based on the argument of "continence". The best possible choice, as a function of surgical limitations and the patient's desires, can only be determined on the basis of a dialogue between the surgeon and the patient.

Dermatologic Surgical Procedures↗
PubMed1996

[Treatment of lymphocele after kidney transplantation].

Lymphocele is a possible postoperative complication of renal transplantation and its treatment is still controversial. Over a 3-year period (January 1992 to December 1993), 7 patients with a complicated lymphocele were treated by various modalities. Puncture-drainage was used in 7 cases, Povidone sclerotherapy was performed in 4 cases and internal drainage was performed by surgical marsupialization in one case and by laparoscopy in 4 cases. The results of external drainage and sclerotherapy were disappointing, with 1 good result out of 7 and 1 moderate result out of 4, respectively. On the other hand, internal drainage was effective in every case, whether it was performed by surgical or laparoscopic marsupialization. The latter technique avoids the disadvantages of open surgery in high-risk patients. Laparoscopy appears to be the treatment of choice for post-renal transplantation lymphoceles, as it is simple, rapid and effective.

Adult↗
PubMed1996

[Renal and adrenal involvement in von Hippel-Lindau disease: clinical features and therapeutic strategies].

OBJECTIVES: We report our experience of renal and/or adrenal manifestations of von Hippel-Lindau disease and propose a practical approach. METHODS: Eight patients (mean age: 43 years) presented with predominant renal and adrenal lesions in 6 cases and 2 cases, respectively. RESULTS: All patients are alive with a mean follow-up of 8.1 years. A local recurrence after partial nephrectomy was observed in two cases. Two patients are in renal failure and are treated by dialysis and two patients require hormone replacement therapy for adrenal insufficiency. CONCLUSIONS: The predegenerative nature of simple renal was not observed. Conservative renal surgery is adapted to small renal tumours, with a low cytological grade and without any distant lesions in the same kidney. Radical nephrectomy is reserved for large lesions (greater than 5 cm) with a high cytological grade. The presence of pheochromocytoma must be systematically excluded. Preservation of the adrenal gland in the case of homolateral renal surgery for cancer is recommended. The reliability of the genetic test allows early diagnosis of this disease.

Adrenal Gland Diseases↗