Long-term outcome of early steroid withdrawal in pediatric renal transplantation.

BACKGROUND: Steroid use in renal transplant is related to multiple adverse effects. Long-term effects of early withdrawal steroids in pediatric renal transplant were assessed. METHODS: Renal transplant children with low immunological risk treated on basiliximab, tacrolimus, and mycophenolate with steroid withdrawal or steroid control were evaluated between 2003 and 2019. Clinical variables, treatment adherence, acute rejection, graft loss, and death were analyzed through hazard ratios, and Kaplan-Meier and multivariate analyses. RESULTS: The study included 152 patients, 71.1% steroid withdrawal, mean follow-up 8.5 years, 64.5% structural abnormalities, and 81.6% deceased donor. At 12 years of transplant, event-free survival analysis for graft loss or death showed no significant difference between steroid withdrawal and control steroid treatment (85.9% vs. 80.4%, p = .36) nor in acute rejection at 10 years (18.5% vs. 20.5%, p = .78) or in donor-specific antibody appearance (19.6% vs. 21.4%, p = .98). Delta height Z-score was increased in the steroid withdrawal group (p < .01). The main predictor of graft loss or death was non-adherence to treatment (p = .001; OR: 17.5 [3.3-90.9]). CONCLUSIONS: Steroid withdrawal therapy was effective and safe for low-risk pediatric renal transplant in long-term evaluation. Non-adherence was the main predictor of graft loss or death.

Kidney transplant in pediatric patients with severe bladder pathology.

The aim of the current study was to compare results in pediatric renal transplantation of patients with and without SBP. Between 2001 and 2013, a total of 168 kidney transplants were performed at our center. A retrospective analysis was performed and recipients were divided into two groups: NB and SBP. Incidence of surgical complications after procedure, and graft and patient survival were evaluated. A total of 155 recipients (92%) with complete data were analyzed, and 13 recipients that had had previous bladder surgeries were excluded (11 with VUR surgery and two with previous kidney transplants), of the 155 recipients: 123 (79%) patients had NB, and 32 (21%) patients had SBP, with a median follow-up of 60 (1-137) and 52 (1-144) months, respectively. Among post-transplant complications, UTI (68.8% vs. 23%, p < 0.0001) and symptomatic VUR to the graft (40.6% vs. 7.3%, p < 0.0001) were significantly higher in the SBP group. There was no significant difference in overall graft and patient survival between groups. Renal transplantation is safe in pediatric recipients with SBP; however, urologic complications such as UTI and VUR were significantly higher in this group. Graft and patient survival was similar in SBP and NB groups.

Case Report: Kommerell's diverticulum and left aberrant subclavian artery stenosis hybrid treatment with branched aortic stent-graft.

Kommerell's diverticulum in association with left or right aberrant subclavian arteries is a rare finding and is challenging to treat. Contemporary surgical and endovascular techniques provide a broad arsenal of possible treatments. Imaging techniques and modeling technology allow a more personalized strategy for each patient. In this case, we present a symptomatic patient with a Kommerell's diverticulum and a left aberrant subclavian artery complicated by proximal stenosis and poststenotic aneurysm. A hybrid technique using a single-branched thoracic stent-graft (Castor, MicroPort Medical, Shanghai, China) in combination with a surgical left subclavian-carotid bypass and endovascular occlusion of the poststenotic aneurysm using a vascular plug device (Amplatzer Vascular Plug, Abbott, Chicago, United States) was performed. This approach was planned and facilitated by the use of a 3D model. Alternative treatment options and the strengths of this approach are briefly reviewed and discussed.

Luxación congénita de rodillas: presentación de un caso / Congenital Dislocation of the Knee: A Case Report

Se presenta el caso de una recién nacida con diagnóstico de luxación congénita de rodilla bilateral sin patologías asociadas, con adecuada evolución tras la instauración de tratamiento ortopédico. La luxación congénita de rodillas es una patología infrecuente (1 en 100.000 nacidos), 80 veces menos frecuente que la displasia en el desarrollo de las caderas y, por ende, con pocos casos en la literatura mundial y ningún caso en la literatura nacional. Se caracteriza por hiperextensión de la rodilla y marcada limitación para la flexión. El diagnóstico y el tratamiento tempranos se asocian a un buen pronóstico

We present a case of a newborn diagnosed with Bilateral Congenital Knee Dislocation, without associated pathologies and with a proper progression after orthopedic treatment. Bilateral Congenital Knee Dislocation is uncommon; with an incident of 1 in 100,000 births, which is 80 times less frequent than hip dysplasia. Therefore, fewer cases have been reported in global literature and no cases have been reported in national literature. Bilateral Congenital Knee Dislocation is characterized by knee hyperextension and a strong limitation in flexion. Early diagnosis and treatment are associated with a good prognosis.

Sarcoma vesical primario durante el embarazo, el primer caso publicado / Primary bladder sarcoma in pregnancy: the first case report

Los sarcomas vesicales primarios son tumores extremadamente raros, constituyendo menos del 1 por ciento de todos los tumores primarios de vejiga, con casos reportados esporádicamente. El embarazo trae consigo un problema complejo a cualquier patología urológica, especialmente oncológicas. Presentamos el primer caso publicado de sarcoma de vejiga en una mujer embarazada chilena de 28 años de edad, que dio a luz un recién nacido sano, además de una revisión de la literatura al respecto.

Primary bladder sarcomas are extremely rare tumors, representing less than 1 percent of the primary tumorsof bladder, being reported sporadically. Urologic problems become more complex to treat during pregnancy, especially oncologics diseases. We present the first known case of bladder sarcoma diagnosed in a pregnant 28 years old Chilean. Areview of literature was performed.