Renal and obstetric outcomes in pregnancy after kidney transplantation: Twelve-year experience in a Singapore transplant center.

AIM: Renal and obstetric outcomes in pregnancy after kidney transplantation in Singapore were last studied in 2002. A review of these outcomes in Singapore is now timely following advances in transplant and obstetric medicine. The aim was to evaluate the renal and obstetric outcomes in pregnancy after kidney transplantation in a Singapore tertiary center. METHODS: Kidney transplant recipients who underwent pregnancy after transplantation at Singapore General Hospital between January 2001 and December 2012 were identified. Data on demographics, comorbidities and clinical outcomes were collected. RESULTS: There were 10 pregnancies identified in nine recipients. The median age of recipient at childbearing was 34.6 years (IQR, 32.8-36.8) and the median interval from transplantation to conception was 69 months (IQR, 38-97). There was no difference between the median pre-pregnancy estimated glomerular filtration rate (eGFR) (47.9 mL/min/1.73 m(2); IQR, 38.4-56.8) and median eGFR at time of last post-partum follow up (43.9 mL/min/1.73 m(2); IQR, 34.5-48.7, P = 0.549). Borderline allograft rejection occurred in one recipient (10.0%) 36 days after birth due to non-adherence to immunosuppressive medication, with subsequent allograft loss 37 months after birth. No mortalities were recorded during the study period. All the 10 pregnancies (100%) ended in singleton live births. Pre-eclampsia occurred in five pregnancies (50.0%), and there were seven (70.0%) preterm deliveries. The median gestational age was 35.4 weeks (IQR, 32.6-38.2) and the median birthweight was 2353 g (IQR, 1811-2648). CONCLUSION: Post-transplantation pregnancies ended successfully with no significant worsening of allograft function, but they were associated with risks to both recipients and newborns.

Experience with the Use of Splint Caps for the Management of Fingertip Amputation Injuries.

Background: Fingertip amputation injuries are common hand injuries amongst all ages. If occurring as a result of workplace accidents, these injuries has the potential to lead to significant socioeconomic costs. Non-surgical techniques can treat these injuries with the potential to alleviate the burden of these socioeconomic costs. The aim of our study is to describe an alternative, cost-effective device to manage fingertip amputation injuries, and to present our short-term outcomes with this treatment modality. Methods: A retrospective study of patients with isolated fingertip amputation injuries who received treatment with semi-occlusive dressing and splint cap from 1 February 2018-21 December 2018 was conducted. The semi-occlusive dressing used was UrgoTul. The splint cap is a 3-dimensional thermoplastic splint to cover the semi-occlusive dressing of the injured finger. Results: There were 28 patients and 31 digits. The average age was 39.9 ± 12.7 years. 89.3% were male, 75% were foreign workers, 96.4% were blue-collared workers, 40% had dominant hand injuries and 25.8% had nailbed involvement. The average duration of follow-up was 66 ± 37.4 days and the average duration of hospital leave was 6.5 ± 4 weeks. The splint cap was applied for an average of 18.1 ± 6.2 days. The total time for tissue regrowth was 27.5 ± 8.8 days. 14.8% had residual nail deformities and return of sensation took 31.5 ± 11 days. Grip strength was 82.5% of unaffected hand. The mean range of motion at the distal interphalangeal, proximal interphalangeal and metacarpophalangeal joint was 58.8 ± 21.3°, 86.9 ± 15.5°, 81.4 ± 6.0° respectively, and 63.9 ± 23.6° and 66.3 ± 17.3° at the interphalangeal and metacarpophalangeal joint of the thumb respectively. Cost analysis will be further elaborated in the paper. Conclusions: Fingertip amputation injuries have a potential for regeneration through healing by secondary intention under semi-occlusive dressing conditions. The splint cap provides an easy to fashion, cost-efficient and comfortable addition to semi-occlusive dressings for fingertip injuries.

A case of mesenteric panniculitis associated with metastatic poorly differentiated cancer of unknown primary site.

Mesenteric panniculitis is the inflammation of intestinal mesentery. It may be associated with malignancy. We present a case of mesenteric panniculitis that manifested as unresolved fever which subsequently was found to be due to poorly differentiated metastatic carcinoma.

A case of Lemierre-like Syndrome: internal jugular vein thrombosis secondary to Staphylococcus aureus sternoclavicular joint septic arthritis.

Lemierre syndrome is the internal jugular vein (IJV) suppurative thrombophlebitis, usually secondary to oropharyngeal infection. Staphylococcus aureus is an emerging responsible pathogen. We report a unique case of IJV thrombosis secondary to methicillin-susceptible S. aureus sternoclavicular joint septic arthritis. We review the existing literature on Lemierre syndrome: its various manifestations, causative pathogens, treatment and management.