Advantage of eradication therapy for Helicobacter pylori before kidney transplantation in uremic patients.

ABSTRACT From January 1999 to February 2007, 61 end-stage renal disease (ESRD) candidates for kidney transplantation underwent an esophagogastroduodenoscopy (EGDS) to detect Helicobacter pylori (HP). We correlated treatment for HP before transplantation and upper digestive tract hemorrhagic complications and possible recurrence of peptic disease posttransplantation. The 32 (52.4%) HP-Positive cases were divided into 2 groups: (1) 17 patients who underwent treatment for the eradication of the infection with 40 mg/d omeprazole for 4 weeks, 500 mg claritromycin twice daily for 7 days, and 2 g/d amoxicillin for 7 days; and (2) 15 untreated patients. No significant differences were found in the …

TRATTAMENTO MULTIDISCIPLINARE DELLA GANGRENA DI FOURNIER. CASE REPORT

Introduzione:Fournier ha descritto per la prima volta una fascite necrotizzante dei genitali e/o del perineo che può evolvere rapidamente in shock settico con mortalità fino al 67%1. Caso Clinico: Pz. maschio 50 a.a. con turbe psichiche e diabete mellito II sottoposto ad emorroidectomia. A 24 ore dolore distrettuale, iperpiressia, edema dello scroto, crepitio inguinale sottocutaneo bilaterale. Veniva effettuato drenaggio chirurgico urgente della regione inguinale bilateralmente e recentazione scrotale; nel post-operatorio NPT e terapia antibiotica e.v.(ertapenem sodico 1 gr/die e linezolidd 600 mg x 2/die). Doppia medicazione/die e curettage dei reliquati necrotici seguiti da lavaggi con be…

Role and clinical importance of Helicobacter pylori infection in hemodialysis patients

Dyspepsia is an extrarenal symptom frequently found in hemodialysed patients; it is due to chronic renal failure, and uremic gastritis is a specific associated condition in chronic renal failure (CRF). On the other hand, in the general population, Helicobacter pylori infection is an important dyspepsia-related risk factor; its close connections with gastro-duodenal pathology are already known, above all the peptic disease in a really exclusive way. By observation of a dyalitic group of patients, opportunely matched with a no CRF group, we evaluated CRF-associated uremia and Helicobacter pylori infection which could eventually interact causing symptoms and lesions. A statistical analysis of …

Endoscopic screening of the upper and lower digestive tract of the patients with chronic renal failure on waiting list for renal transplantation

Iniziali esperienze sull'impiego di un dispositivo per l'anastomosi vascolare meccanica per le fistolle arterovenose per l'emodialisi.

INTRODUZIONE ED OBIETTIVI Nella costruzione delle fistole artero-venose, il confezionamento manuale dell’anastomosi è il gold standard.Generalmente questa è realizzata con una o due suture a sopraggitto in continua o talora a punti staccati. La tecnica è abbastanza standardizzata,anche se può richiedere una significativa spesa di tempo, specie in presenza di vasi di piccolo calibro, e una curva di apprendimento anche lunga. Riportiamo la nostra esperienza sull’uso di un dispositivo che permette di rendere l’esecuzione di quest’intervento più rapida, precisa e senza il clampaggio preventivo dell’arteria. MATERIALI E METODI Abbiamo impiegato la suturatrice meccanica per il confezionamento di …

Terminal ligature of inferior thyroid arterhy branches during total thyroidectomy for multinodular goiter is associated with higher postoperative calcium and PTH levels

Purpose: To evaluate the impact of truncal versus terminal branch ligature of the inferior thyroid artery (ITA) on postoperative calcium and PTH plasma levels in patients undergoing total thyroidectomy for multinodular goiter. Methods: A prospective randomized study was performed comparing a group of patients that underwent either truncal ligature of the ITA (group 1) or terminal ligature of ITA branches (group 2). Results: A series of 126 consecutive patients with non-toxic euthyroid multinodular goiter underwent total thyroidectomy. Truncal ligature of the ITA was performed in 63 patients (group 1) and terminal branch ITA ligature in 63 patients (group 2). Postoperative ionized serum calc…

Il trattamento medico e chirurgico nei pazienti affetti da iperparatiroidismo secondario e terziario. Revisione della letteratura

Introduzione: L’iperparatiroidismo è un’alterazione fisiopatologica della secrezione di paratormone dovuta o da un rilascio autonomo e anomalo (iperparatiroidismo primario o terziario) da parte delle paratiroidi o da un’alterazione dell’omeostasi del calcio che stimola l’eccessiva produzione di paratormone (iperparatiroidismo secondario). Obiettivi: Il trattamento clinico dell’iperparatiroidismo secondario o terziario non è univoco. Sorge pertanto la necessità di una revisione delle attuali metodiche diagnostico-terapeutiche. Discussione: Nell’iperparatiroidismo secondario (2HPT) si ha una progressiva iperplasia delle paratiroidi e un incremento della produzione di paratormone. Tra le cause…

TRATTAMENTO ENDOSCOPICO DEI POLIPI DEL COLON-RETTO IN UN AMBULATORIO DI ENDOSCOPIA DIGESTIVA:NOSTRA ESPERIENZA

The aim of this report was to evaluate the effectiveness of the endoscopic treatment of colonic polyps to allow secondary prophylaxis in order to prevent the onset of cancer arising from adenomas. From October 2002 to January 2004 we performed 487 colonoscopies on a patient group with the following indications: screening prior to kidney transplant; screening for colorectal cancer (patients positive at faecal occult blood testing); follow-up of patients who had undergone colonic resections for colorectal cancer; patients with other diseases. Colorectal polyps were diagnosed in 15 males and 15 females, with a mean age of 63 years. All the neoplasms were resected during colonoscopy and specime…

Ultrasound (US) guided central venous catheterization of internal jugular vein on over 65-year-old patients versus blind technique.

Background and Objectives Performing a central venous catheterization (CVC) on older patients for long-term central intravenous therapy could be a very important procedure. It could be associated with a high incidence of related complications, especially on over 65-year-old, high risk, selected patients. Methods The authors analyzed the results of 72 central venous CVC of internal jugular vein performed on over 65-year-old patients with ultrasound (US) guide from January 1998 to April 2003. Results The average performing time was 4 min, with 98.7% of success, 0% of major complications, and 4.1% of minor complications (one mild vagal hypotension and two catheter dislocation). Conclusions The…

Use of monitoring intraoperative parathyroid hormone during parathyroidectomy in patients on waiting list for renal transplantation.

This report describes the use of intraoperative parathyroid hormone (ioPTH) assay during parathyroidectomy for patients with secondary hyperparathyroidism on the waiting list for renal transplantation. The levels of ioPTH were determined among waiting list patients undergoing subtotal parathyroidectomy and tertiary hyperparathyroidism patients undergoing procedures. The levels of ioPTH were significantly reduced at 10 minutes by 59.7,3% among with secondary hyperparathyroidism and 68.9% among tertiary hyperparathyroidism. A 15 minutes it was 85% in secondary hyperparathyroidism and 89.7% in tertiary hyperparathyroidism. A decrement of 50% in basal values at 10 minutes and 85% decrement or m…

3D CT scan for perioperative identification of anatomical variations of lungs.

Aim: The aim of this study is to investigate anatomical lung variations and vascular patterns using volumetric 3D computed tomography (CT) representations. Methods & results: We considered 24 major thoracic surgery performed in our ward. In these, we discovered some interesting anatomical variations of the main pulmonary fissures. These findings were not visible on the plain x-ray or during routine examination of a preoperative CT scan. After re-examination of 3D CT scan reconstruction the anatomical variations were detected. Discussion: General thoracic surgeons must familiarize themselves with anatomical variations in lungs. 3D images may aid the general thoracic surgeon in performin…

Sphincter-like motion following machanical dilation of the internal inguinal ring during indirect inguinal hernia procedure

INTRODUCTION: Even today, there is still great speculation as to the underlying pathogenesis of inguinal hernia. As a result, it could be extrapolated that the vast majority of repairs are based upon conjecture. Most current repairs are founded upon the principle of "closing the defect" in the anatomy, either by suturing closed under tension, covering with a mesh or obliterating the defect with a plug. Many variants of each method are refined to achieve better clinical outcomes. Yet few, if any, strive to understand a fundamental question: "What has gone wrong with the normal physiological and anatomical mechanisms that prevent abdominal structures protruding through the abdominal wall?" We…

La ligature terminale des branches de l’artère thyroïdienne inférieure diminue la morbidité parathyroïdienne après thyroïdectomie totale pour goitre

Resume But de l’etude Le but de cette etude etait d’evaluer l’impact de la ligature proximale de l’artere thyroidienne inferieure sur le taux postoperatoire de calcium et de parathormone chez les patients operes d’une thyroidectomie totale pour goitre. Patients et methodes Une etude randomisee a compare un groupe de patients operes par ligature proximale tronculaire de l’artere thyroidienne inferieure (groupe 1) a un deuxieme groupe de patients operes par ligature distale des branches de l’artere thyroidienne inferieure au contact de la capsule thyroidienne. Cent vingt-six patients consecutifs operes d’une thyroidectomie totale pour goitre multiheteronodulaire euthyroidien ont ete inclus. S…

Mediastinal syndrome from plasmablastic lymphoma in human immunodeficiency virus and human herpes virus 8 negative patient with polycythemia vera: a case report

Background: Plasmoblastic lymphoma is a rare and aggressive subtype of diffuse large B cell lymphoma, which occurs usually in the jaw of immunocompromised subjects. Case presentation: We describe the occurrence of plasmoblastic lymphoma in the mediastinum and chest wall skin of an human immunodeficiency virus-negative 63-year-old Caucasian man who had had polycytemia vera 7 years before. At admission, the patient showed a superior vena cava syndrome, with persistent dyspnoea, cough, and distension of the jugular veins. Imaging findings showed a 9.7 × 8 × 5.7 cm mediastinal mass. A chest wall neoformation biopsy and ultrasound-guided fine-needle aspiration biopsy of the mediastinal mass allo…

Informed consent in high-risk renal transplant recipients.

Abstract Before performing a clinical, diagnostic, and/or therapeutic action, the doctor is required to provide the patient with a bulk of information defined as informed consent. This expression was used for the first time in 1957 during a court case in California and the two words— informed and consent —are used together to underline the fact that the patient cannot give his or her true consent without first receiving correct information concerning the medical act in question. With regard to the medicolegal aspects governing organ transplants, despite the bulk of detailed work performed by health service workers involved in this surgical field with the aim of preparing adequate informed c…

Trattamento chirurgico di un caso di fibroistiocitoma maligno del mesocolon trasverso

INTRODUZIONE: I fibroistiocitomi (MFH) sono dei sarcomi che originano dai tessuti molli, solitamente si localizzano nelle estremità dell’organismo nel tronco e nel retroperitoneo; la localizzazione dei MFH primitivi a livello addominale e/o intestinale è molto rara, infatti non più di 40 casi sono stati descritti a tutt’oggi in letteratura. CASO CLINICO: Paziente donna di anni 80 nella quale è stata osservata una tumefazione localizzata a livello della regione epigastrica e dell’ipocondrio di destra, di consistenza teso elastica, ricoperta da cute integra e associata a sintomatologia dispeptica. Gli esami di laboratorio erano nella norma eccetto l’Emoglobina di 8,2 gr/dl, i Globuli Rossi di…

USO DEL BISTURI AD ULTRASUONI IN UN CASO DI DISSEZIONE "DIFFICILE" DEI VASI ILIACI IN CORSO DI TRAPIANTO DI RENE

Introduzione: La preparazione “difficile” dei vasi iliaci nel ricevente causata da uno stato di fibrosi serrata periavventiziale con linfoadenomegalia satellite a volte è gravata da complicanze nel post trapianto ( linfocele, sieroma ed ematoma). Le aderenze tra l’asse vascolare iliaco e soprattutto la linfoadenomegalia sono spesso dovute al cateterismo femorale. Materiali e metodi: Il caso clinico riguarda una paziente di 60 anni, da circa 4 anni in dialisi per insufficienza renale cronica di n.d.d. con fibrosi periavventiziale dell’asse iliaco e linfoadenomegalia satellite da cateterismo femorale bilaterale. In corso di trapianto di rene la preparazione dei vasi iliaci è stata effettuata …