Epidemic varicella zoster virus reactivation in renal transplant recipients: a case report.

Immunosuppression after transplantation renders the transplant recipient susceptible to a broad array of viral pathogens. Of 31 patients transplanted during 2012 in our center, 6 (19.3%) experienced varicella zoster virus (VZV) reactivation. The median time from transplantation to reactivation was 6.2 months. Immunosuppression consisted of antithymocyte globulin in 5 patients and basiliximab in 1, followed by tacrolimus, mycophenolic acid, and prednisolone. Two patients had T-cell-mediated rejection and were treated with pulse doses of corticosteroids. All patients received valganciclovir as prophylaxis of CMV infection. In 3 patients a disseminated vesicular skin rash was the sole manifestation of VZV reactivation. Two were successfully treated with acyclovir and 1 with ganciclovir. Ramsay Hunt syndrome complicated herpes zoster in the fourth patient, whereas the remaining 2 patients had visceral involvement, pneumonitis, and encephalitis, and died in spite of full doses of antiviral therapy. This was the first case of "epidemic" VZV reactivation in the 35-year history of our transplant center. VZV-specific cellular immunity pretransplantation is not sufficient to protect kidney transplant recipients from herpes zoster episodes. Considering the potentially devastating consequences of VZV reactivation, additional treatment options and universal prophylaxis should be contemplated.

[Tumors of the upper urinary tract: results of conservative surgery]. / Tumeurs de la voie excrétrice supérieure: résultats de la chirurgie conservatrice.

OBJECTIVE: To determine the results of conservative surgery for upper urinary tract urothelial tumours. PATIENTS AND METHODS: From 1986 to 1997, 352 patients were treated in the Belgrade urology clinic for upper urinary tract urothelial tumour. 54 patients (15.3%) were treated by conservative surgery. The sex ratio was 1.3 men for 1 woman. The mean age was 63 years. In most cases, the tumour was situated in the ureter. Conservative surgery was performed on principle in 60% of patients for a small isolated lesion (solitary low-stage, low-grade tumour). In contrast, in about 40% of cases, conservative surgery was performed by necessity due to the presence of bilateral tumours, a solitary kidney or renal failure related to Balkan nephropathy. The median follow-up was 67.3 months (range: 6 months-14 years). RESULTS: 15.8% of patients developed a local recurrence during the follow-up period. The risk of recurrence was higher when conservative surgery was performed for indications of necessity than when it was performed on principle (21.7% versus 11.8%), but the difference was not statistically significant (c2 test, t test). The stage and grade of differentiation were identified as the most significant predictive factors for the risk of local recurrence. The overall 5-year survival rate was 67% with more favourable results in the case of conservative surgery performed on principle compared conservative surgery by necessity (72% versus 60%). The difference between these results was not statistically significant, but a statistically significant difference was observed for tumour stage and grade (grade III versus grade I and II, pT3 versus pT1, pT2). The 5-year survival probability was 68.5%. Recurrence was most likely to occur during the early postoperative course, as 81.56% occurred during the first 18 months. CONCLUSION: Urothelial tumours can be managed conservatively. However, the risk of recurrence is directly correlated with the tumour stage and grade, with a high level of statistical significance, and with the type of indication for conservative surgery performed, but with no statistically significant difference.

Combined general and epidural anaesthesia versus general anaesthesia for radical cystectomy.

The basic objective of the study is to present the effects of two types of anesthesia, general and combined general and epidural, on intraoperative bleeding and to present the effect of epidural analgesia during the postoperative period in radical cystecomy. Subjects who received general and epidural anesthesia had on the average 28.5% less bleeding than those who only had general anesthesia. Patients who received postoperative epidural analgesia had statistically significantly better analgesia during the postoperative period than those who were administered Tramadol intramuscularly.

[Surgical treatment and quality of life in patients with carcinoma of the penis]. / Hirurski tretman i kvalitet zivota bolesnika sa karcinomom penisa.

Penile carcinoma is a rare disease with the annual incidence of 1-2 cases per 100,000 men. About 95% of all penile malignancies are squamous cell carcinoma. At the Clinic of Urology in the period 1988-1998 we treated 58 patients with penile carcinoma. Nine of these (15.5%) were subjected to total penectomy due to the extent of the lesion, while partial amputation of the penis was performed in 84.5% (49 cases). The aim of the therapy was to completely remove the primary lesion with adequate margins. Postoperative follow-up comprised, among other things, evaluation of the quality of life as reflected in pain, sexuality and emotional distress. Quality of life of patients subjected to partial penectomy where no cases of relapse were recorded, was satisfactory, while in cases of total penectomy about 24% (14 patients) suffered marked emotional distress induced by the loss of the mark of male sexuality and sexual impotence. In the light of the prominent problems related to the quality of life induced by severe psychological influence of penis amputation, local excision, Mohs's operation and laser therapy are increasingly used in the treatment of penile carcinoma.

[Quality of life in patients with a modified Mainz-pouch II urinary diversion]. / Kvalitet zivota bolesnika sa modifikovanom Mainz-pouch II derivacijom urina.

The type of urinary derivation after radical cystectomy due to urinary bladder carcinoma does not influence survival substantially, but it may influence the quality of life of the patients very much. One of modifications of classical ureterosigmoidostomy that has been focused by urologist in recent years in the sigma rectum pouch (Mainy pouch II), for its substantially improved aspects of quality of life and earlier occupational rehabilitation of these patients. In the period August 1994 through March 1998 we made Meinz pouch II (the modification implies fixation of the pouch to the parietal peritoneum and implantation of the ureter into the pouch as suggested by Camey-Le-Duc). This surgical technique is associated with lots of advantages as the continent form of urinary derivation, and as a fairly simple surgical technique it is an improvement in this type of surgery. Intactness of the abdominal wall (no urostoma), frequency of defecation/urination in 3-4 hr intervals during the day and 4-5 hours during the night, absolutely volitonal control of these functions, rapid postoperative recovery with stabilization of renal function parameters, low percentage of ascending infections, higher degree of occupational rehabilitation, i.e. lower incidence of disability and good psychosocial status are all advantages of this method in the light of the quality of life of these otherwise very difficult patients.