Glomerular disease and acute kidney injury in Sudan: Demographics, histological diagnosis and outcome.

BACKGROUND: Acute kidney injury (AKI) is a relatively common clinical condition, associated with high rates of mortality. Although there is extensive literature on the nature and consequence of AKI in the developed world, much less is known in the developing world and more specifically in sub-Saharan Africa (SSA). OBJECTIVES: To describe the demographics, histological diagnosis and clinical course of patients presenting with AKI to a single centre in Sudan. METHODS: Retrospective data were collected on 100 consecutive patients with AKI and an active urinary sediment, who underwent diagnostic native percutaneous renal biopsy. RESULTS: The mean (standard deviation) age of those biopsied was 33.6 (14.1) years of age, with a preponderance (58%) of females. The most common clinical indications for biopsy were AKI associated with haematuria and proteinuria (72%), AKI and proteinuria (22.5%) or AKI and haematuria (5%). The frequencies of the most common primary glomerulonephritides (GN) were focal segmental GN (15%) and mesangiocapillary GN (8%). Lupus nephritis was the most frequent secondary GN associated with AKI (31%) and the most common overall histological diagnosis. Peak creatinine, but not oliguria, at presentation predicted likelihood of remaining dialysis-dependent. Age at presentation but not baseline renal function by estimated glomerular filtration rate (eGFR), was associated with the likelihood of having residual chronic kidney disease following an episode of AKI. CONCLUSIONS: The data suggested differences in the pattern of intrinsic renal/glomerular disease leading to AKI to those published and mainly derived from the developed world and patients in SSA.

Consensus Document on Intermittent Claudication from the Central European Vascular Forum (C.E.V.F.)-3rd revision (2013) with the sharing of the Mediterranean League of Angiology and Vascular Surgery, and the North Africa and Middle East Chapter of International Union of Angiology.

This paper is the review of the Consensus Document on Intermittent Claudication of the Central European Vascular Forum (CEVF), published in 2008, and and shared with the North Africa and Middle East Chapter of International Union of Angiology and the Mediterranean League of Angiology and Vascular Surgery. The Document presents suggestions for general practitioners and vascular specialists for more precise and appropriate management of PAD, particularly of intermittent claudication, and underlines the investigations that should be required by GPs and what the GP should expect from the vascular specialist (angiologist, vascular surgeon). The idea of the Faculty is to produce a short document, which is an easy reference in daily clinical practice, both for the GPs and vascular specialists.

Endovascular graft bail-out post reconstruction of popliteal artery injury. First case report.

A male patient who sustained a blunt trauma to the right knee and chest resulting in posterior dislocation of the knee joint and avulsion injury to the right popliteal artery (segments II and III) had a vascular repair by interposition saphenous vein graft. Postoperatively an episode of hypotension resulted in thrombotic occlusion of the graft and acute limb ischemia. Graft and distal thrombectomy, though successful, resulted in a stenotic segment with two perforations. To shorten the operating time this was managed by Viabahn Endoprothesis stent-graft through both native popliteal artery and vein graft. Immediate regain of pedal pulses was achieved, and at 6 months follow up Viabahn endograft is still patent, foot well perfused with normal pedal pulses and patient fully active. In complicated popliteal artery injuries, with complex time consuming revascularization procedures, an endovascular graft as a back up or bail-out technique might be a valid option in some selected cases with high anesthetic risk, to shorten operating time. In this context Viabahn endoprosthesis seems to be both efficient and durable on the short term.

Factors affecting platelet yield and their impact on the platelet increment of patients receiving single donor PLT transfusion.

The aim of this study was to analyze the impact of various donor and machine parameters on PLT yield in 127 PLT apheresis procedures, to optimize PLT yield achieving clinical and economic advantages. One hundred and twenty-seven apheresis procedures were analyzed. Age, gender, volume processed, Hb, and PLT precounts were included as donor predicting variables. AC infusion rate, processing time, and plasma volume collected with PLTs were assessed as machine parameters. We evaluated the post-transfusion effectiveness in 23 patients with thrombocytopenia, studying the effect of PLT dose, ABO group, and PLT storage time. Females gave higher yields, compared to males, P<0.01. PLT yield correlated positively with PLT precount (r=0.512), and TBV (r=0.404), and negatively with donor preapheresis Hb (r=-0.306). Processing time and AC infusion rate had a positive impact on PLT yield. Post-apheresis decrease in PLT count was 53.6+/-26.3x10(11). Donors with Hb>or=12 g/dl, donated safely. Most of the complications were citrate related (13.4% of all procedures). PLT increments in transfused patients correlated positively with the number of units transfused (r=0.41), and negatively with PLT storage days (r=-0.342). PLT increments in patients receiving ABO-compatible PLTs were 75% higher, compared to the increments in patients receiving incompatible PLTs. PLT count and volume processed were the main predictors of PLT yield. Increasing the processing time, the AC infusion rate, or the volume of plasma obtained with PLTs can increase PLT yields. High PLT dose, short storage time, as well as ABO compatibility should be considered during PLT transfusion.

Penile implants in the treatment of organic impotence.

OBJECTIVE: To evaluate the reliability and safety of penile implants in the treatment of organic impotence at the Saudi Aramco - Dhahran Health Center. METHODS: A series of 108 cases of organic impotence that underwent 125 penile implantation procedures between 1988 and 1997 was reviewed. The follow-up period ranged between 6 months and 10 years. The mean age was 57.9 years (range 26-76). The prostheses used were AMS (American Medical System) inflatable (92 cases) and malleable (16 cases). RESULTS: There were no complications in 86 patients, (80%) who had functioning prostheses all through the follow-up period. Revision of the implants was required in 13 patients (14%). The causes of revision were severe infection, intolerable pain from an oversized malleable prosthesis, and dysfunction of the inflatable prostheses. Removal of the implant was necessary in severe infection, intolerable pain, and extrusion of the prosthesis. All 9 patients (8%) had inflatable prostheses and refused a second implant. There was no single mortality among our series. The overall procedure complications involved 26 out of 125 procedures (21%). It was shown that malleable penile prostheses have significantly lower procedure complications than the inflatable ones (p<0.05). CONCLUSION: Penile implants are reliable and safe modality of treatment for organic impotence with acceptable morbidity.

Discontinous splenogonadal fusion mimicking testicular tumor.

Full text is available as a scanned copy of the original print version.

Laparoscopic varicocelectomy for infertility. An initial report from Saudi Arabia.

OBJECTIVE: To evaluate laparoscopic varicocelectomy for the treatment of infertility in Saudi males. METHODS: Between January 1992 and July 1994, laparoscopic varicocele repair was performed at Saudi Aramco Dhahran Health Center, in 48 patients, 8 for pain and 40 for infertility. RESULTS: The 8 patients with pain improved postoperatively. As for those with infertility, 63% had an improved sperm count and 66% showed increased sperm motility. Thirty percent had no change in motility or count. CONCLUSION: Laparoscopic varicocelectomy is a simple and safe technique with good results and can be performed as day surgery with early return to normal activity.

Transaxillary first rib resection for thoracic outlet syndrome: follow-up of 9 cases.

Nine cases of Thoracic Outlet Syndrome (TOS) were treated by transaxillary 1st rib resection over a three year period. Mean follow-up was 26 +/- 4 months. Patients were recalled every 3 months post-operatively for surveillance. Parameters for evaluation included physical examination, return of patient to (full-range or partial range) pre-illness activity, nerve conduction velocities, somato-sensory evoked potentials, Duplex imaging and venography or arteriography if the latter two were indicated. Neurogenic involvement with or without vascular compression was present in 7 cases (78%) and satisfactory results of surgery were recorded in 6 patients (67%). The clinical settings and detailed results are reviewed and variable factors that might alter the outcome are analyzed in this series. Neither duration of symptoms, sex differences nor associated bony anomalies had any effect on operative results. The single factor that seemingly had a negative impact on the outcome after surgery was the patient's need to return to strenuous and repetitive arm and/or hand movements.

Intra-arterial streptokinase as adjuvant therapy for complicated Buerger's disease: early trials.

Selective low-dose intra-arterial streptokinase was used in 11 long standing, complicated cases of Buerger's disease of the lower limbs suffering from acute exacerbations or thrombotic episodes with resulting variable degrees of gangrene or pre-gangrene of toes or feet, often despite previous lumbar sympathectomy. They had no other possible therapeutic options but wait for major amputation. The overall success rate (with amputation avoided or altered) was 58.3% and bleeding complications occurred in 16.6% of the total limbs at risk included. Favorable factors influencing the therapeutic outcome of thrombolytic therapy were a shorter presentation time, previous sympathectomy and nicotine abstinence. Even with necessary precautions, the technique does not seem to be totally safe. However it can be rewarded in some properly selected cases.