Paradise, for the skeptic Mohammed Afifi, was just four steps down from his porch into a sunny garden. There he would sit, morning and evening, in the shadow of Tamaara, his beloved tamarhinna tree, ...soaking up the sights, sounds, and smells of his precious corner of the natural world. From an old yellow straw chair, Afifi would train his perceptive gaze on that garden in all its detail. Flora and fauna blessed him with honorary membership in their enchanted realm. Only the rare downpours of winter and the dust storms of spring could banish him indoors. Yet, whether inspired at the side of the heater, purring black cat on his lap, or next to the pansy bed, with ecstatic flocks of bee-eaters overhead, Afifi's intimate, whimsical musings radiate a profound and unique sense of place.
Lisa J. White's nuanced translation of Taramiim fii Dhill Taraara captures Afifi's impish, ironic sense of humor and his unsparing honesty. She handles Afifi's parting gift to the world with great care and honor. Mohammed Afifi died in 1981, in winter, just after completing this fictionalized memoir. Majestic and melancholy, mysterious and magical-the essence of his world, Afifi's extraordinary garden, is here revealed to the English-speaking world.
Thrombotic microangiopathy is a well-known problem in patients following renal transplantation. In postrenal transplantation, thrombotic microangiopathy is often a reflection of hemolytic uremic ...syndrome. We aimed to determine the causes of thrombotic microangiopathy in a population of renal transplantation recipients and discuss the literature.
We investigated the causes of thrombotic microangiopathy during a 1-year period, from June 2003 to June 2004, at the King Fahad National Guard Hospital in Riyadh, Saudi Arabia, by reviewing the slides of all transplant biopsies (n=25) performed during this interval. Pre- and posttransplant crossmatching was done when possible.
Five cases of thrombotic microangiopathy were found. Three of these cases were from the 25 transplantations performed at King Fahad National Guard Hospital, while the other 2 transplantations had been performed abroad and were referred to us for follow-up. Three cases were related to cyclosporine, and 1 case was secondary to both cyclosporine and tacrolimus. The fifth case had features of thrombotic microangiopathy related to an antiphospholipid syndrome in a patient with systemic lupus erythematosus.
In the literature, the most-frequent cause of hemolytic uremic syndrome in patients following renal transplantation is recurrence of the hemolytic uremic syndrome. Other causes include drug-related (cyclosporine, tacrolimus) toxicity, procoagulant status, and antibody-mediated rejection. We found that the most-frequent cause of thrombotic microangiopathy was drug related, secondary mainly to cyclosporine. In the current study, the frequency of thrombotic microangiopathy was similar to the percentage reported in the literature (20%).
BACKGROUNDDiagnosing cerebral sinus venous thrombosis (CSVT) manifested as a spontaneous subdural hematoma (SDH) is challenging due to variability of its clinical features. The neuroradiological ...investigation is crucial to confirm the diagnosis. The management of SDH secondary to CVST is controversial and not well established. CASE DESCRIPTIONWe present a case of an adult man with Down's syndrome who underwent a left-sided craniotomy and evacuation of spontaneous subdural hematoma. Post-surgery magnetic resonance venography (MRV) revealed venous sinus thrombosis in the right transverse sinus with loss of flow signal. He was started on Apixaban two weeks post-surgery. Three months later, the patient re-presented with recurrence of the SDH. His anticoagulation was discontinued, and he underwent craniotomy reopening and evacuation of the recurrent hematoma. The patient returned to his baseline following this procedure. The patient was followed up in the out-patient clinic regularly. Interval brain MRI and MRV performed at six months showed further resolution of the thrombosis of the right sigmoid sinus with restoration of the venous flow. CONCLUSIONThe management of SDH complicating CVST remains controversial due to the rarity of its presentation and the hazards associated with the use of anticoagulation.
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