Renal transplantation outcomes in obese patients: a French cohort-based study.

BACKGROUND: Whilst there are a number of publications comparing the relationship between body mass index (BMI) of kidney transplant recipients and graft/patient survival, no study has assessed this for a French patient cohort. METHODS: In this study, cause-specific Cox models were used to study patient and graft survival and several other time-to-event measures. Logistic regressions were performed to study surgical complications at 30 days post-transplantation as well as delayed graft function. RESULTS: Among the 4691 included patients, 747 patients were considered obese with a BMI level greater than 30 kg/m2. We observed a higher mortality for obese recipients (HR = 1.37, p = 0.0086) and higher risks of serious bacterial infections (HR = 1.24, p = 0.0006) and cardiac complications (HR = 1.45, p < 0.0001). We observed a trend towards death censored graft survival (HR = 1.22, p = 0.0666) and no significant increased risk of early surgical complications. CONCLUSIONS: We showed that obesity increased the risk of death and serious bacterial infections and cardiac complications in obese French kidney transplant recipients. Further epidemiologic studies aiming to compare obese recipients versus obese candidates remaining on dialysis are needed to improve the guidelines for obese patient transplant allocation.

[Torsion of Riedel's lobe. Two cases (author's transl)]. / Torsion du lobe de Riedel. Deux observations.

The authors report two cases of torsion of Riedel's lobe. The first case resembled acute cholecystitis. Resection was followed by a cure. The second case presented in the form of a complicated abdomino-pelvic tumor. Its removal did not prevent a fatal issue due to fibrinolysis probably related to advanced ischemic infarction of Riedel's lobe of the liver. It seems that these complications are exceptional.

[Acute pancreatitis and cholelithiasis. A study of thirty cases (author's transl)]. / Pancréatite aiguë et lithiase biliaire. Analyse d'une série de trente cas.

The authors report a series of 30 cases of acute pancreatitis associated with cholelithiasis. There were 9 cases of necrotizing pancreatitis and the latter group included the 4 deaths observed in this series. Clinical, radiological and laboratory data were in favor of this association in 24 out of the 30 cases. Cholelithiasis appeared to be directly responsible for initiating the pancreatitis in 1/3 of cases. In another 1/3 of cases the mecanism was thought to be related to scarring of the sphincter of Oddi. In the remaining 1/3 of cases no direct relationship could be found. On the basis of these findings, the authors recommend that emergency surgery be reserved for these cases in which cholelithiasis appears to be the etiology. (The biliary syndrome overshadowing the pancreatic syndrome) and to postpone treatment of pancreatic lesions. In all other cases, the authors suggest to keep elective surgery, for after a period of initial conservative treatment with the hope of then treating together biliary and pancreatic lesions.

Congenital hepatic fibrosis (asymptomatic and latent form) and multiple gastric ulcers.

Congenital hepatic fibrosis (asymptomatic and latent form) was diagnosed in a 67-year-old male during laparotomy for a gastric ulcer. The gastrectomy specimen revealed multiple chronic ulcers with healing in the form of villous mucosal hyperplasia. The pathological diagnosis of congenital hepatic fibrosis and similar hamartomatous lesions is discussed. A possible relationship between congenital hepatic fibrosis and gastroduodenal ulceration is envisaged.

[Closure of the vagina after colpohysterectomy using an automatic suture forceps (author's transl)]. / La fermeture du vagin après colpo-hystérectomie par pince à suture automatique.

Closure of the lower third of the vagina using a TA 55 automatic suture forceps is an easy procedure which offers the best guarantee from a septic and haemostatic standpoint during the peroperative phase. We have used the technique on 50 occasions. In all cases, it gave a linear vaginal scar without granuloma. Used in association with sub-peritoneal suction drainage it brings about a reduction in the number of lymphoceles and their complications.