Long-Term Follow-up Results of Renal Transplantation in Pediatric Patients With Focal Segmental Glomerulosclerosis: A Single-Center Experience.

INTRODUCTION AND AIM: Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage renal disease in children. We analyzed the long-term outcome of pediatric patients with FSGS undergoing renal transplantation. The objective of the study is to report the experience of a single center and determine the incidence of recurrence, rejection, graft loss, and related risk factors. MATERIALS AND METHOD: This retrospective cohort study was performed between 1991 and 2018. Thirty patients with a pathologic diagnosis of primary FSGS were included in the study. The patients were diagnosed with FSGS according to histologic features in biopsies. RESULTS: Twenty-one of the donors were deceased (70%) and 9 were alive (30%). FSGS recurred in only 2 patients. Graft loss occurred in 6 patients (20%). The causes of graft loss were chronic rejection in 4 patients and acute rejection in 2. Our graft survival rate was 100% at 1 year, 91% at 5 years, 80% at 10 years, 70% at 15 years, and 42% at 20 years. Five- and 10-year graft survival rates were 83% and 83% in living donors and 94% and 79% in deceased donors, respectively. According to Kaplan-Meier analysis, there was no statistically significant difference in terms of graft survival between living and deceased donors. CONCLUSION: This study, with its contribution to literature in terms of long follow-up of FSGS patients from childhood to adulthood, is important. However, further studies are required.

Corona mortis: an anatomic study in seven cadavers and an endoscopic study in 28 patients.

BACKGROUND: The corona mortis is defined as the vascular connections between the obturator and external iliac systems. While detailed information on the arterial anastomoses in corona mortis is available, a complete description of the venous system is lacking. Although the tiny anastomoses behind the pubic symphysis between the obturator and external iliac arteries have been described in classical anatomy textbooks, these texts neglect to mention that these anastomoses can be life threatening. Attention needs to be paid to these anastomoses between the arterial and the venous system located over the superior pubic ramus during laparoscopic procedures. METHODS: Fifty retroinguinal regions were dissected in seven cadavers and 28 patients. RESULTS: During the dissections, a venous anastomosis on the superior pubic ramus was a consistent finding in 96% of cases. This vein coursed vertically to the inferior border of the superior pubic ramus and connected to the obturator vein. Accessory branches of the obturator artery were observed in only 8% of the dissections. The tiny connections between the obturator and external iliac arteries are less important, since their diameter is <1 mm. CONCLUSIONS: We have termed the venous connection between the external iliac and obturator veins over the superior pubic ramus "the communicating vein". This structure forms the corona mortis. Surgeons dealing with direct, indirect, femoral, or obturator hernias need to be aware of these anastomoses and their close proximity to the femoral ring. In classical anatomy textbooks, a description of the veins that form corona mortis is found less often than descriptions of the arteries. Since a venous connection is more probable than an arterial one, its importance must be appreciated by surgeons in order to avoid venous bleeding.

Gasless vs gaseous laparoscopy in the treatment of hepatic hydatid disease.

BACKGROUND: Despite the reduced rate of occurrence, the hydatidosis of the liver is still taking an important place in surgical practice in Asia Minor and the Middle East. Traditional techniques for performing liver cyst surgery seem to be comparatively traumatic. In this clinical study, we present our experience with laparoscopic treatment of hydatid cyst of the liver and discuss the validity of the gasless technique as a solution to carbon dioxide (CO(2)) ensufflation problems. METHODS: All patients were prepared by administering albendazole for 21 days preoperatively. Surgery was performed on 87 patients under general anesthesia. Working space was obtained in 51 operations by using an abdominal wall lifting device, Laparolift (Origin Med Systems, Menlo Park, California, USA) (group 1). In 36 patients, the abdominal cavity was insufflated with CO(2) gas (group 2). In all cases, hydatid cysts were identified, and gauze soaked in germicide solution were placed around them. The cysts were punctured and aspirated. Then germisid solution was injected into the cysts. The cysts walls were opened, and germinative membranes were evacuated. RESULTS: The median operation time was 50.49 +/- 10.9 min (range, 30-75 min) in group 1 and 70.8 +/- 16 min (ranges 40-120 min) in group 2. The difference in the operative times of the two groups was significant (p < 0.01). There was no significant difference between the minor complications of the two groups. There were no deaths and no major complications or conversions to open surgery in any of the groups. There were no recurrences during follow-up time. CONCLUSIONS: The use of gasless technique for the laparoscopic treatment of liver cyst is a safe, time-saving, and promising procedure that can be applied in selected cases.