Preemptive kidney transplantation in systemic lupus erythematosus.

Preemptive kidney transplantation is associated with superior outcomes. Patients who have kidney failure due to systemic lupus erythematosus (SLE) may not receive a preemptive kidney transplant because of the concern for risk of disease recurrence with shortened graft and patient survival. We identified 8001 patients in the United Network for Organ Sharing dataset who underwent kidney transplantation between October 1987 and February 2009 with kidney failure due to SLE. Seven hundred thirty patients received a preemptive kidney transplant with 7271 patients who were on dialysis before transplantation; their mean ages were 40.0±11.6 years and 36.9±11.7 years, respectively, (P<.01). Women constituted 82.5% of preemptive and 81.4% of non-preemptive groups (P=.47). Preemptive transplant recipients were more likely to receive a living donor kidney transplant (odds ratio [OR]=3.6; 95% confidence interval [CI]=3.3-4.5; P<.01). In unadjusted analyses, preemptive transplantation was associated with lower risk of recipient death (hazard ratio [HR]=0.52; 95% CI=0.38-0.70; P<.01). The difference remained significant after adjustment fr covariates (HR=0.55; 95% CI=0.36-0.84; P<.01). Graft survival was also superior among preemptive kidney transplant recipients in both unadjusted (HR=0.56; 95% CI=0.49-0.68; P<.01), and adjustment analyses (HR=0.69; 95% CI=0.55-0.86; P<.01). We concluded that preemptive kidney transplantation among patients with SLE was associated with superior patient and graft outcomes and should be considered when feasible.

Pyoderma Gangrenosum in Crohn's Disease: Unusual Presentation and Management.

Pyoderma gangrenosum is an uncommon, destructive, cutaneous ulceration which presents as ulcerative, pustular, bulluous and vegetative forms, the ulcerative forms being more common. We present the case of 41-year-old woman with Crohn's disease who presented with a rather unusual form of pyoderma gangrenosum, aseptic cutaneous abscess. It was initially misdiagnosed as a fistulous tract in the abdominal wall, but later prompt diagnosis of pyoderma gangrenosum led to a very satisfactory outcome.

Photodynamic therapy (PDT) for oesophageal dysplasia and early carcinoma with mTHPC (m-tetrahydroxyphenyl chlorin): a preliminary study.

Barrett's oesophagus is a premalignant condition in which stratified squamous type mucosa of the normal oesophagus is replaced by specialised intestinal type columnar mucosa. Oesophageal resection was previously considered to be the treatment of choice for high-grade dysplasia or superficial carcinoma arising in this columnar-lined mucosa. We treated four patients with Barrett's oesophagus and high-grade dysplasia, and one patient with superficial oesophageal carcinoma with photodynamic therapy (PDT) using an argon-pumped dye laser light (652 nm). PDT was also delivered using a xenon arc lamp (Paterson lamp, light 652 nm +/- 15 nm) in two patients with Barrett's oesophagus and high-grade dysplasia. mTHPC (m-tetrahydroxyphenyl chlorin) 0.15 mg/kg was used as a photosensitiser in all the patients. We have been able to demonstrate the elimination of columnar-lined oesophageal mucosa, reduction in the length of the Barrett's segment or downgrading of the dysplasia in all of the patients. There is no evidence of recurrence in the patient who had oesophageal carcinoma, at 27 months follow-up. We conclude that mTHPC is useful as a photosensitiser for PDT in the management of Barrett's oesophagus with high-grade dysplasia or superficial carcinoma and the Paterson lamp is a potential alternative light source for PDT.