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Biomedical subjects

T Ben Abdallah

Publications and source records attributed to T Ben Abdallah.

At least 19 recordsLinked to original sources
PubMed1997

[Urinary fistula after transplantation: eleven cases].

OBJECTIVES: To specify the anatomical features of urinary fistulas and to evaluate the results of percutaneous and surgical treatment of post-transplantation urinary fistulas. PATIENTS AND METHODS: 11 urinary fistulas were observed after 160 renal transplantations, corresponding to an incidence of this complication of 6.8%. Urinary fistulas were treated percutaneously in three cases and surgically in eight cases. THE FOLLOWING COMPLICATIONS WERE OBSERVED DURING SURGICAL TREATMENT: extensive necrosis of the urethra in four cases, rupture of the sutures in two cases, a punctate pelvic fistula in one case. RESULTS: The incidence of fistula was 5.8% for Leadbetter reimplantation and 8.1% for Lich-Gregoir extravesical reimplantation. We obtained one success in three patients treated percutaneously and one death and seven successes out of eight patients treated surgically. We performed ureteropelvic anastomosis with the native ureter in the case of extensive necrosis of the ureter (4 cases), a new reimplantation in three cases and suture of the pelvic fistula in one case. CONCLUSION: More than one half of post-transplantation urinary fistulas observed in our department are secondary to ischaemic necrosis of the ureter. We emphasize the value of preservation of the ureteric blood supply during organ harvesting. Post-transplantation urinary fistulas must be treated surgically, as soon as possible, to avoid infectious complications.

Follow-Up Studies↗
PubMed1995

[Ureteral stenoses and fistulas after kidney transplantation].

We report a retrospective study of 100 renal transplants, the majority using kidneys from related live donors. We saw 6 ureteric stenoses and four fistulas. Three relatively small stenoses and two limited fistulas were treated percutaneously, all of them successfully. The transplant had to be removed in two patients with a ureteric fistula. Four stenoses and one fistula were treated successfully by open surgery. Actuarial survival of grafts with a urological complication was significantly shorter than that of transplants free of such lesions.

Actuarial Analysis↗
PubMed1995

[Renal transplantation from related live donors. Results and survival].

We report a retrospective study of 91 renal transplants from related live donors carried out at the Charles Nicolle Hospital, Tunis, between 1986 and 1993. There were 27 HLA-identical and 64 semi-identical. Classical immunosuppression based upon corticosteroids and azathioprine was used in the majority of cases. Surgical complications occurred in 15.4% of cases. 56% of patients had at least one acute rejection attack. There were 4 deaths, 3 related to infection and one to septic arterial rupture. Return to hemodialysis was related to chronic rejection in 5 cases and to recurrence of the initial nephropathy in one case. 5-year actuarial survival was 94% for recipients and 81% for grafts. In this series, acute rejection had no negative influence on graft survival and the difference between graft survival between HLA-identical and semi-identical patients was not statistically significant.

Actuarial Analysis↗
PubMed1995

[Methicillin resistant Staphylococcus aureus. Decrease of incidence in a medical resuscitation unit at CHU Charles-Nicolle in Tunis].

Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen in hospitals. Between 1985 to 1988, there has been an increase in the number of MRSA (92 %) caused by an epidemic emergency in medical care unit of our hospital. Infections control measures allowed to stop these outbreaks (20 % MRSA in 1990). But incidence of MRSA persist to decrease without supplement control measures and in 1994, only 7 % of Staphylococcus aureus strains are MRSA.

Cross Infection↗
PubMed1992

[Staphylococcus aureus nosocomial infections in an intensive care milieu (1985-1989) in Tunis].

221 strains of Staphylococcus aureus oxacillin resistant (MetiR) caused nosocomial infections were isolated from 1985 to 1989 in a medical intensive care unit. The survey of susceptibility to antibiotics was established according to the computerized data of disk susceptibility test. The resistance phenotypes to beta-lactams, aminoglycosides and macrolides were established for epidemiological study. S. aureus infections were mainly bacteraemia (31%) and peritonitis (12%). These isolates were resistant to oxacillin with a high level (mean MIC 386 micrograms/ml). Their resistance phenotypes were MLSBc (constitutive resistance to macrolides, lincosamine and streptogramines B) in 53% and S + KGT (resistance to streptomycin, kanamycin, gentamicin and tobramycin) in 61%. All the isolates were susceptible to pristinamycin and vancomycin (MIC 0.1 and 2 micrograms/ml). These phenotypes related to the spread of multiply drug resistant strains were responsible of nosocomial outbreaks. Strains with the same pattern of resistance were isolated among the medical staff and in the environment. Infection control measures allowed to stop these outbreaks.

Cross Infection↗
PubMed1991

[Fistulas and ureteral strictures after kidney transplantation. Diagnosis and treatment].

We report our experience of 4 urine fistulas and 4 ureteral strictures after renal transplantation. Percutaneous nephrostomy was performed on all patients. The diagnosis was established by antegrade pyelography. Nephrectomy was performed on 2 patients because of failure of drainage and formation of an infected urine collection due to an extended ureteral necrosis. Abstention was elected in one case as renal function did not improve due to associated chronic rejection. In 5 cases, renal function quickly improved with drainage: 2 were operated on immediately, and one after failure of endo-urological treatment of a urine fistula. Antegrade dilatation has been used successfully in one stenosis. In the last case, a double pigtail stent allowed a urine fistula to close. Percutaneous nephrostomy seems to be best method of drainage when ureteral obstruction or fistula is suspected in renal transplant patients, and permits diagnosis by antegrade pyelography. Percutaneous management may be a satisfactory way of treatment for limited stenosis or fistulas.

Humans↗
PubMed1990

[Continuous ambulatory peritoneal dialysis in Tunisia].

CAPD covers about 4% of renal replacement therapy patients in Tunisia. From February 1983 to 1988, 47 patients, 21 males and 26 females whose mean age was 36, 14 +/- 15 were treated. Their socio-cultural level was variable. The mean duration of therapy was 14.5 months/patient/year. The five years patient survival rate was 46% and the technique survival rate 21%. Most patients had a good general condition and were professionally rehabilitated. Peritonitis was the main complication: its incidence was 1.8 episodes/patient/year. Yeasts peritonitis were relatively frequent, specially in patients who had previously been treated with antibiotics. Peritonitis was often cured with a local and general treatment. Yearly CAPD cost was 1/3 lower than center hemodialysis and a better management allowed to decrease the expenses due to laboratory and X ray investigations and to hospitalization. On the basis of this clinical experience, we believe that CAPD is an efficient and valid therapeutic modality, less expensive than hemodialysis. It is probably a suitable renal replacement therapy in other centers in Tunisia and in other developing countries.

Humans↗
PubMed1990

[The first thirty months of kidney transplantation in Tunisia].

Kidney transplantation is actually the best replacement therapy for the end stage renal failure. It sets free the hemodialysed patient from the hemodialysis restraint and contributes to solve the socio-economic problems risen by chronic hemodialysis. The authors report the results of this technic during the first 30 months of kidney transplantation in the "Hôpital Charles Nicolle" of Tunis. They describe the first steps which led to kidney transplantation, the therapeutic regimens, the medico-legal problems and the specific complications observed during this start period.

Costs and Cost Analysis↗