Conservative approach to lower urinary tract abnormalities in cadaveric renal transplantation.
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Adolescent↗
Biomedical subjects
A Yussim
Publications and source records attributed to A Yussim.
Rhinocerebral mucormycosis in renal transplant recipients: report of three cases and review of the literature.
Mucormycosis is an opportunistic infection caused by fungi of the order Mucorales. The commonest clinical form is rhinocerebral mucormycosis, which has been described as characteristically complicating diabetes mellitus and leukemia. Three patients with rhinocerebral mucormycosis complicating renal transplantation are described, and 11 additional cases recorded in the English-language medical literature are reviewed. The mean age of the 14 patients was 36 years, and the ratio of males to females was 1.8:1. Diabetes mellitus was present in only five patients, and polycystic kidney was the most common underlying renal disease. Most kidney grafts were obtained from cadavers. Eight patients had evidence of graft rejection, and the majority had been receiving corticosteroids and azathioprine. The initial manifestations of infections became evident two days to four years after transplantation (median, two months). Facial swelling, tissue necrosis, and cranial nerve involvement were common. Seven of 14 cases occurred in Israel, a finding suggesting the intervention of local factors. Despite antifungal and/or surgical therapy, nine patients died as a consequence of the infection days to months after diagnosis. Although a rare complication, rhinocerebral mucormycosis remains a serious threat to the kidney transplant recipient.
Adult↗
Pancreas transplantation.
Although intensified insulin therapy regimens enable normalization of blood glucose levels and related metabolic parameters, these regimens are associated with an increased incidence of hypoglycemic episodes. Pancreas transplantation has achieved the goal of providing insulin independence with stable and continuous normoglycemia. But because of the associated morbidity and mortality and the need for life-long immunosuppression after transplant, it is difficult to justify pancreas transplantation in diabetic patients at a pre-uremic stage. Pancreas transplantation is therefore performed in conjugation with renal transplantation. The majority of renal transplant centers, however, have been reluctant to perform simultaneous kidney-pancreas transplantation in insulin-dependent uremic patients because of the additional risks associated with pancreas transplantation. More recently, refinements in surgical technique, introduction of new immunosuppressive agents, and better selection of transplant candidates have contributed to improved survival. Today, combined pancreas-kidney transplantation is an accepted treatment for carefully selected patients with insulin dependent diabetes and end-stage renal disease and in a small group of patients with uncontrolled severe metabolic problems. The effect of a euglycemic state after pancreas transplantation on the progression of micro- and macroangiopathy remains to be proved, although recently there is evidence to suggest that some end-organ lesions may be halted or even ameliorated. Further improvement in anti-rejection strategies may achieve better long-term graft survival and provide the incentive to perform pancreas transplantation at an earlier stage, before severe secondary complications of diabetes develop.
Adult↗