USE OF INTRAPERITONEAL PTFE DUAL-MESH IN A GIANT INCISIONAL HERNIA AFTER RENAL TRANSPLANTATION: A CASE REPORT

Objectives: We evaluated the incidence of incisional hernia after kidney transplantation, predisposing factors and the results of surgical repair of a giant incisional hernia by intraperitoneal PTFE dual mesh. Patients and methods: We report our experience about an incisional hernia in a 55 years male after renal transplantation treated with an intraperitoneal dual mesh prosthesis. The cause of incisional hernia was probably due to an urinoma for a total necrosis of distal graft ureter that needed to reopen in 2sd day post transplant with primary fascial approximation. Thirty days after transplantation we discovered a large incisional hernia that rapidly became monstrous with migration of o…

Tyroid surgery with “ligasure

PTFE mesh in renal allograft compartment sindrome

Video-assisted two-stage basilic vein transposition for creation of brachio-basilic arteriovenous fistulae

We report our experience in a mixed minimally-in- vasive technique for the two-stage transposition of basilic vein on a small series of eight patients. The operative tech- nique consisted of a modified endoscopic (1) approach for the two-stage transposition (2). The intervention was performed under Brachial Plexus Block (3).

Cell Therapy in Type 1 Diabetes

The incidence of diabetes mellitus has grown exponentially in the last few years. Etiopathogenesis of diabetes implies a ?-cells damage in the islet of Langerhans, either through an autoimmune reaction present in type 1 diabetic patients or through altered function within these cells that affect their ability to secrete a properly functioning insulin hormone, in patients suffering from type 2 diabetes. Exogenous insulin supply is, at the moment, the therapy of choice of the disease but it does not allow tight control of glucose regulation, leading to long-term complications. Over the past few decades, pancreas or pancreas-kidney organ transplantation has been the most effective treatment fo…

Trattamento laparoscopico del Mielolipoma surrenalico: caso clinico e revisione della letteratura.

Adrenal myelolipoma is a rare benign, non-functioning tumor consisting of fat and hematopoietic tissues. In January 2005 we had observed an adrenal myelolipoma in 70 year old man. During the follow-up for bladder urothelioma, an abdominal CT revaled a well delineated 4x4 cm homogeneous fatty mass in the right suprarenal area with negative attenuation values. The functional study of adrenal gland was normal. The patient underwent videolaparoscopic right adrenalectomy (Gagner technique). Postoperative course was uneventful. The istological diagnosis showed adrenal myelolipoma. We conclude that videolaparoscopic adrenalectomy should be considered the gold standard treatment for benign adrenal …

La colecistectomia laparoscopica nel paziente uremico

The aim of this study was to evaluate the effectiveness of the laparoscopic cholecystectomy performed in two uremic patients with gallstones. From January to July 2004, 15 patients with gallstones underwent to laparoscopic cholecystectomy (LC). Two patients had chronic renal failure on haemodyalisis: a symptomatic fourty-two old woman, which had primitive hyperparathyroidism and primitive hyperaldosteronism, and asymptomatic transplant candidate fifty-five old man. No minor and major complications occurred and both patients were discharged 4 days after LC. Even in uremic patients the L.C. must be the gold standard for the treatment of gallstones both symptomatic and asymptomatic.

A complex case of fatal calciphylaxis in a female patient with hyperparathyroidism secondary to end stage renal disease of graft and coexistence of haemolytic uremic syndrome.

Background: Calciphylaxis is a potentially fatal complication of persistent secondary hyperparathyroidism; its cause is still not clear. Unfortunately there is no close relation in severity of clinical picture, serological and pathological alteration. For this reason the prognosis is difficult to establish. Administration of sodium thiosulphate may reduce the precipitation of calcium crystals and improve the general clinical conditions before surgical parathyroidectomy, which seems the only therapeutic approach able to reduce the mortality risk in these patients. Methods and Results: A 60 year old female patient suffering from End Renal Stage Disease, on haemodialysis from 2001 due to the o…

Intraoperative Parathyroid Hormone Monitoring During Parathyroidectomy for Hyperparathyroidism in Waiting List and Kidney Transplant Patients

This report describes the use of the intraoperative parathyroid hormone (ioPTH) assay during parathyroidectomy in waiting list and transplanted patients. ioPTH levels were determined in 40 patients on the waiting list for kidney transplantation with secondary hyperparathyroidism who underwent subtotal parathyroidectomy and 9 transplanted patients with tertiary hyperparathyroidism who underwent removal of hyperplasic glands. Rapid PTH levels decreased significantly at each time period; the percentage decrease in rapid PTH levels was 61.3% among patients with IPT II and 70.2% in patients with IPT III at 10 minutes and 86.5% in patients with IPT II and 91% in patients with IPT III at 15 minute…

Trattamento endoscopico dei polipi del colon-retto

Thyroidectimy using the Harmonic scalpel. Retrospective analisis of 188 consecutive cases

Barrett's esophagus incidence in a sicilian population of refluxing patients undergoing EGDS

A Good Breath of Oxygen for Beta-Like Cells Obtained From Porcine Exocrine Pancreatic Tissue

Ischemia is the most important factor that affects organ survival during harvesting. The two-layer method (TLM) is one of several cold storage solutions that seeks to preserve organs and cells avoiding in vivo and in vitro ischemia. We compared the retrieval of beta-like elements from exocrine pancreatic cells using TLM versus University of Wisconsin (UW) solutions. For this purpose pancreata laparoscopically harvested from 20 female pigs were preserved in UW solution or TLM before digestion. The resulting exocrine cells were divided into 2 groups: the first was cultured in a designed medium to allow differentiation into beta-like cells and the second was cryopreserved before the differenti…

Il trattamento chirurgico delle lesioni nodulari tiroidee: nostra esperienza. Analisi di 462 casi.

Nodular thyroid lesions are the most frequent endocrine diseases in the general population. The surgical procedure is indicated for nodular thyroid tissue degeneration, or when the suppressive pharmacologic therapy is less efficient, even if sometimes both factors are associated. In Authors' study 462 patients were observed who underwent surgical procedures for thyroid diseases between January 1997-April 2003. In the thyroid pathology, either uninodular or multinodular, the surgical therapy adopted is total thyroidectomy, according to other Authors. The aim of total thyroidectomy is to avoid recurrence and simplify long term pharmacologic treatment. Although the question about the surgical …

Videolaparoadrenalectomy, our experience

Reoperation for persistent or recurrent secondary hyperparathyroidism. Surgical treatment of renal hyperparathyroidism

Background: Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. Its pathophysiology is mainly due to hyperphosphatemia and vitamin D deficiency and resistance. When medical treatment fails, subtotal and total parathyroidectomy with autotransplantation are the standard procedures, although both are associated with high recurrence rates. Methods and Results: 4 patients experienced persistence and 9 relapse. The first 4 were subjected to reoperation after 6 months for the persistence of symptoms due to the finding of a supernumerary adenomatous gland while the remaining patients at the reoperation showed in 5 cases 2 more glands in over thymic position, a…

S.I.L.C.indicazione e limiti: Risultati preliminari

L'evoluzione della tecnica laparoscopica associata all'innovazione tecnologica ha permesso di aprire nuovi orizzonti all'approccio alla colecistectomia. Gli Autori presentano la loro iniziale esperienza (9 casi) sulla S.I.L.C. (single incision laparoscopic cholecystectomy). Gli stessi, nel presente lavoro, ne descrivono la tecnica. Lo studio, senza enfatizzare i risultati, ne propone indicazioni elimiti.Da questa iniziale esperienza gli Autori traggono degli spunti di affinamento tecnico e miglioramento tecnologico.Gli Autori concludono che la S.I.L.C. non può sostituire la colecistectomia laparoscopica, attuale "gold standard", ma costituisce una tecnica più convincente della N.O.T.E.S.

Is secondary hyperparathyroidism-related myelofibrosis a negative prognostic factor for kidney transplant outcome?

Secondary hyperparathyroidism (HP) presenting with hypocalcemia and subsequent increased parathormone (PTH), is mainly identified in patients with chronic renal failure, which has been associated with variable degrees of bone marrow fibrosis. For suitable patients with end-stage renal disease (ESRD), kidney transplantation is recognized as the therapy of choice, being superior to dialysis in terms of quality of life and long-term mortality risk; in this regard interesting data show that increased time on dialysis prior to kidney transplantation is associated with decreased graft and patient survival. In our opinion an important and until now underestimated determinant of graft survival is t…

PTFE mesh in renal allograft compartment syndrome.

We report a case of anuria in a 42-year-old female kidney transplant patient that occurred secondary to extrinsic compression from a large kidney being placed extraperitoneally in a small iliac fossa. Prompt reexploration in the immediate postoperative period resulted in salvage of the graft with restoration of kidney function. The abdominal wall was reconstructed using prosthetic mesh, which decreased the compartment pressure within the iliac fossa sufficiently to allow the renal vein patency and the kidney perfusion. We think that this tension-free surgical technique should be applied in those cases in which the retroperitoneal space is less than the size of the kidney to avoid renal allo…

Gangrena dei genitali di Fournier

Fournier’s disease in an acute pathologic process of cellulitis and necrotising fascitis involving the male genitals with a mortalità of 30-50 %. The main causes are periurethral and perirectal infections, immunodepressive syndromes, diabetes mellitus and traumas. Mixed types of infections involve aerobic and anaerobic germs, the latter being responsible for necrosis of the subcutaneous tissue. Therapy is synergic and multi-disciplinary, antibiotic with radical and reconstructive surgery. The Authors report a case of Fournier’s gangrene. The discuss about various type of necroting diseases; the different etiological agents. Spreading ways of infectionthrough extermal genitalia,anatomical st…

SURRENALECTOMIA LAPAROSCOPICA DESTRA PER MIELOLIPOMA, CASE REPORT

Use of tacrolimus and mycophenolate mofetil as induction and maintenance in simultaneous pancreas-kidney transplantation

Clinical trials using quadruple immunosuppression that include the combination of tacrolimus and mycophenolate mofetil have been shown to reduce the incidence of acute rejection episodes in simultaneous pancreas-kidney (SPK) transplantation. In an attempt to obtain a low rejection rate without antibody induction therapy, we undertook a prospective study of combined tacrolimus and mycophenolate mofetil and steroids as primary immunosuppression for SPK transplantation. In this study, we analyzed 17 patients who received low-dose intravenous tacrolimus as induction therapy. This was combined with oral tacrolimus, mycophenolate mofetil, and steroids as the primary immunosuppression regimen. The…

La colecistectomia laparoscopica nel paziente uremico

Aspetti psicologici nel trapianto renale

Use of Intraperitoneal ePTFE Gore Dual-Mesh Plus in a Giant Incisional Hernia After Kidney Transplantation: A Case Report

We evaluated the incidence of and predisposing factors for an incisional hernia after kidney transplantation. Numerous techniques have been used to repair postoperative fascial dehiscences or simple incisional hernias, but no clear treatment exists for giant hernias. Our aim was to obtain (1) a safe procedure to repair a large abdominal defect and reinforce the surrounding, fragile zones and (2) a simple, rapid technique to reduce the operative time. Herein we have described the surgical repair of a giant incisional hernia using intraperitoneal Gore ePTFE dual-mesh plus (Gore-Tex; W. L. Gore, Flagstaff, Ariz, USA) in a 55-year-old man status-post renal transplantation. Total necrosis of dis…

Eppure,sembrava una neoplasia...Anomala localizzazione laringea di tiroide ectopica

Abnormal expansion of segmented filamentous bacteria in the gut

Human intestinal microbiota create a complex polymicrobial ecology characterized by high population density, wide diversity, and complexity of interactions. Any imbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequences including an increase in the number and/or alteration in the type of bacteria in the upper gastrointestinal tract, which is referred to as small intestinal bacterial overgrowth (SIBO) syndrome. SIBO is frequently found in persons fulfilling criteria for irritable bowel syndrome (IBS), and the large overlapping of symptoms of these two pathological conditions led some authors to believe that IBS is secondary to S…

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 …

EPPURE SEMBRAVA UNA NEOPLASIA...ANOMALA LOCALIZZAZIONE DI TIROIDE ECTOPICA

Ruolo della Colonscopia nella sorveglianza dei pazienti operati di cancro del colon rettale.

A Misunderstood intestinal perforation believed acute pancreatitis: A case report

Acute pancreatitis represents one, possible but rare, of the several complications of laparoscopic cholecystectomy. In the case reported, a 31-year-old female patient complained of abdominal pain after laparoscopic cholecystectomy. The clinical picture, the high values of serum amylase, lipase and white blood cell count and the subsequent abdominal computed tomography (CT) led to diagnose an acute biliary pancreatitis. This was pharmacologically treated, but the patient worsened in a few days. A contrastenhanced CT showed the presence of free air and effusion into the peritoneal cavity. The patient was submitted to another intervention, which revealed a 1-cm jejunal perforation. The injured…

Thyroid Surgery with "Ligasure"

Tecniche agronomiche, aspetti varietali e caratterizzazione del melone d'inverno.

tecniche agronomiche

SUCCESSFUL ARTERO VENOUS FISTULA USING CARDICA C-PORT xA SYSTEM IN AN ELDERLY UREMIC PATIENT. A CASE REPORT.

INTRODUCTION AND AIMS: In artero venous fistula (AVF) hand-sewn anastomoses are considered the gold standard. These are performed generally with a double running suture. These suturing techniques yeld excellent results, despite being time-consuming, difficult to perform with small vessels, and associated with a significant learning curve. These device are intented to enable rapid, precise and reliable anastomoses in AVF without artery cross-clamping. METHODS: We report the case of a male 65 years old uremic patient with serious atherosclerosis that, in local anesthesia, underwent proximal AVF by mechanical anastomosis between cephalic vein and radial artery without arterious cross-clamping.…

Il gozzo nel paziente uremico cronico, Analisi della nostra esperienza nell'ambulatorio dei pazienti in lista d'attesa per trapianto renale

Rottura di rene trapiantato.Analisi di due casi

Tecniche di allungamento della vena renale destra in corso di chirurgia di banco nel trapianto di rene da donatore cadavere

Use of Marginal Donors in Kidney Transplantation: Our Experience

The use of elderly donors has been advocated to expand the organ donor pool because of increased needs and the organ shortage. The aim of this study was to analyze whether the use of elderly donors and marginal kidneys affected the outcome of renal transplantations. Herein we presented data on 126 kidney transplantations performed from January 1996 to September 2003 using 32 marginal donors (group A) and 94 ideal donors (group B). We analyzed the medical and surgical complications and the graft survivals at a median follow-up of 18 months. Medical and surgical complications occurred in 22% and 5% versus 7% and 4% in groups A and B, respectively. The mean cold ischemia time and the mean age …

Videolaparosurrenectomia: nostra esperienza preliminare

INTRODUCTION: In 1992, Gagner described the first laparoscopic adrenalectomy. Since then this technique has been more and more widely employed and several studies confirmed its advantages, comparing to the traditional approach, in terms of reduction of mean hospital stay and therefore of the health expense. PATIENTS AND METHODS: The Authors' preliminary experience spreads from March to November 2003 when 4 patients were studied and thus underwent a transperitoneal laparoscopic adrenalectomy: 2 of them were affected by Cushing syndrome, 1 by pheochromocytoma in MEN and 1 by an incidentaloma. The transabdominal access in lateral decubitus with 4 trocars was performed. RESULTS: No complication…

TWO STAGE TRANSPOSITION OF BRACHIO-BASILIC ARTERO-VENOUS FISTULA (BBAVF)BY ULTRACISION

TRATTAMENTO ENDOSCOPICO DEL CARCINOIDE GASTRICO. A PROPOSITO DI UN CASO CLINICO

"Pure" large cell neuroendocrine carcinoma of the gallbladder. Report of a case and review of the literature

Primary Neuroendocrine Tumours (NETs) of the gallbladder are rare. Among all NETs of the gallbladder, large cell neuroendocrine carcinoma (LCNEC) is exceedingly rare. In most of the cases LCNECs are combined with other histological components. We reviewed clinical presentation and management of all patients with "pure" LCNEC from published literature since the first case was published in 2000, as well as one patient from our experience. Only 7 cases of "pure" LCNEC has been described in the last 15 years, our case is the eighth. The diagnosis of gallbladder NETs is rarely made preoperatively since the presentation generally consists of non-specific symptoms including upper abdominal pain, d…

Secondary Hyperparathyroidism and renal transplantation.

Videofluorografia digitale ed acalasia esofagea: dalla diagnosi al follow-up postoperatorio

Intraoperative measurement of parathyroid hormone: A Copernican revolution in the surgical treatment of hyperparathyroidism

Intraoperative parathyroid hormone (PTH) monitoring in the setting of the operating room represents a valuable example of the rationale use of the laboratory diagnostic in a patient-oriented approach. Rapid intraoperative PTH (ioPTH) assay is a valid tool for an accurate evaluation of the success of parathyroid surgery. The reliability of the user-friendly portable systems as well as the collaboration between operators and surgical staff allow the one-site monitoring of the ioPTH decrements on the course of the surgical management of hyperparathyroidism. The rapid answer provided by an effective decrement of PTH during parathyroidectomy contributes dramatically to the efficacy of parathyroi…

MANAGEMENT OF LEIOMYOMA OF THE TRANSVERSE COLON: CASE REPORT

Colonic leiomyoma is a mesenchymal tumor that arises from the muscularis mucosae or muscularis propria and is composed of well-differentiated smooth muscle cells with no atypia. It is often incidentally found since its growth affects the submucosal layer and the lesion is covered with normal epithelium. Endoscopic ultrasonography is recommended to define the grade of infiltration of the tumor and eventually lymph node involvement. Histological examination is critical to establish the nature of the tumor and its behaviour. In the case of a voluminous tumor surgical treatment is needed. we report case of a patient that underwent colonoscopy showing the presence of a neoformation at 70 cm from…

Sequele nella chirurgia dell’iperparatiroidismo.

Insufficienza renale acuta e dialisi

Barrett's Oesophagus incidence in a sicilian population of refluxing patients undergoing EGDS

Histologic effects of university of wisconsin two-layer method preservation of rat pancreas.

Marginal donors represent a poorly utilized source of organs for transplantation despite their availability. The key is to reduce the ischemic damage in the effort to improve organ quality. This study investigated the histologic effects after in situ perfusion of preservation with a two-layer method compared with the classic University of Wisconsin preservation in term of tissue integrity and number of viable exocrine cells in the rat pancreas both after exsanguination and at 8 weeks of cryopreservation. Pancreata harvested from 60 rats were collected using 3 methods: two-layer method following University of Wisconsin perfusion; exsanguination; and classic University of Wisconsin perfusion/…

Bone Resorption in Kidney Transplant Recipients

Early diagnosis of persistent hyperparathyroidism (HP) following kidney transplantation may prevent worsening of osteodystrophy and potential damage to the graft. We evaluated the utility of collagen pyridinoline (PYD) and deoxypyridinoline (DPD) urinary cross-links beyond the common HP markers to evaluate 70 selected stable recipients between 1997 and 2006 who were divided into 2 group depending on the immunosuppressive protocol. All patients showed elevated levels of urinary cross-links even though calcemia and phosphoremia values were normal. Their mean creatinine level was slightly increased. Data were assessed as mean values +/- SD. All variables underwent a correlation matrix analysis…

Electrospun PHEA-PLA/PCL Scaffold for Vascular Regeneration: A Preliminary in Vivo Evaluation

Abstract Background There is increasing interest in the development of vessel substitutes, and many studies are currently focusing on the development of biodegradable scaffolds capable of fostering vascular regeneration. We tested a new biocompatible and biodegradable material with mechanical properties similar to those of blood vessels. Methods The material used comprises a mixture of α,β-poly(N-2-hydroxyethyl)- d,l -aspartamide (PHEA) and polylactic acid (PLA), combined with polycaprolactone (PCL) by means of electrospinning technique. Low-molecular-weight heparin was also linked to the copolymer. A tubular PHEA-PLA/PCL sample was used to create an arteriovenous fistula in a pig model wit…

Ligasure haemorrhoidectomy: our experencie on fifty patients

The role of colonscopy in patient follow-up after surgery for colorectal cancer

The role of colonscopy in patient follow-up after surgery for colorectal cancer. A retrospective study and review of the literature

Eight-point compass rose underlay technique in 72 consecutive elderly patients with large incisional hernia

Summary Background Repair of incisional hernia (IH) in the elderly is a challenge for the surgeon. Primary closure is preferable but is not always possible because of high recurrence rates of IH repaired without a prosthesis and/or possible respiratory and cardiovascular complications due to extreme tension of the margins. We report our experience with underlay mesh placement in elderly patients with large IH. Methods A total of 72 patients from January 2003 to December 2009 underwent IH repair involving placement of an intraperitoneal Gore® DualMesh® prosthesis. The prosthesis was first anchored at eight points in a compass rose pattern using a Gore® suture passer and then firmly secured t…

Renal Allograft Compartment Syndrome: Is It Possible to Prevent?

Renal allograft compartment syndrome (RACS) is a complication characterized by increased pressure over 15 to 20 mm Hg of the iliac fossa site of transplanted kidney that can lead to a reduction of the blood supply to the graft, resulting in organ ischemia. This study aims to evaluate, through a review of the literature, the incidence, detection, treatment, and possible prevention of RACS. The incidence of this complication, which appears generally in the immediate post-transplantation period, is currently approximately 1% to 2% and is underestimated because of poor nosography for the presence of symptoms common to other post-transplantation complications. Doppler ultrasound is indispensable…

Isolation & culture of b-like cells from porcine Wirsung duct

Urinary collagen cross-links to evaluate hyperparathyroidism in kidney transplant patients

INTRODUCTION AND AIMS: One of most common complication following kidney transplantation is reappearance of hyperparathyroidism (HP) some months after normal serum levels. An early diagnosis represents the best prophylaxis measures to prevent worsening of osteodystrophy and potential damage to the graft and vascular tissue.The aim to our study was to evaluate, beyond the common HP markers, if the urinary cross-links of the collagen PYD (pyridinoline) and DPD (Deoxypyridinoline) are useful markers able to show increasing levels of parathormone. METHODS: We evaluated 50 stable kidney transplanted patients divided into 2 group (A: 38 pts and B: 12 pts) dependent on the type of their immunosuppr…

A case of renal carcinoma metastasis simulating a thyroid goiter

Background: Although the thyroid is a highly vascularized gland, it is not a common target of metastasis from extrathyroidal cancer. Clear-cell renal carcinoma (cRCC) frequently metastasizes to the thyroid, representing 2-3% of all adult tumors, and more than 40% of patients present with metastases at diagnosis. The presence of cRCC thyroidal metastases makes the differential diagnosis from thyroid clearcell carcinoma extremely difficult. Patients and Methods: A 70-year-old woman presented with a mild compressive symptomatology due to a recent multinodular thyroid goiter with a ‘simple’ multinodular ultrasound pattern, in the absence of signs of malignancy and with normal findings for hormo…

Laparoscopic Repair of Boundary Incisional Hernia in a Kidney Transplant Patient: A Safe Tacks-Fibrin Glue Combined Mesh Fixation Technique.

Abstract Background Incisional hernia in renal transplant patients is a complication that negatively affects the global outcome of transplant and quality of life. The repair of this condition was classically made by open repair with mesh. Increasing evidence suggests that laparoscopic repair could be advocated as the technique of choice in these patients with optimal results. However, the fixation of mesh should be performed by a mixed combination of fibrin sealant (lateral margin of wall defect) and tacks (medial margin). The tacks fixation of the mesh along the lateral margin of the wall defect, close to the graft, is generally difficult for the small size of the remaining aponeurotic pla…

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

Il reintervento per l'iperparatiroidismo renale persistente o recidivo

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 …

The use of marginal donors in kidney transplantatio: our experience

Dissecting the different biological effects of oncogenic Ras isoforms in cancer cell lines: Could stimulation of oxidative stress be the one more weapon of H-Ras?

Abstract Ras proteins are small GTPase functioning as molecular switches that, in response to particular extracellular signalling, as growth factors, activate a diverse array of intracellular effector cascades regulating cell proliferation, differentiation and apoptosis. Human tumours frequently express Ras proteins (Ha-, Ki-, N-Ras) activated by point mutations which contribute to malignant phenotype, including invasiveness and angiogenesis. Despite the common signalling pathways leading to similar cellular responses, studies clearly demonstrate unique roles of the Ras family members in normal and pathological conditions and the lack of functional redundancy seems to be explainable, at lea…

Comparison between local and regional anesthesia in arteriovenous fistula creation.

Purpose Assessment of the effectiveness of Brachial Plexus Block (BPB) via axillary approach compared to regional anesthesia for arteriovenous fistula surgery in patients affected by end-stage renal disease. Methods We compared forty patients randomly divided into two groups. Group A underwent BPB procedure with 15 mL ropivacaine 1% and 10 mL of saline (0.9% NaCl) via axillary approach. Group B received local anesthesia with lidocaine 2%. The forearm blood vessels were assessed by Doppler ultrasonography before and after the intervention. Results BPB performed on Group A was associated with a considerable venous dilation and a significant decrease (48.7%, P<.05) in pulsatility index (PI)…

The role of coloscopy in patient follow-up after surgery for colorectal cancer.

Mesh fixation in hernia repair suture versus human glue fibrin.

Ileus following spontaneous jejunum intramural hematoma: case report and review of the literature.

Anticoagulant therapy may cause the onset of a spontaneous intramural hema- toma of the small bowel, in the jejunum, ileum or duodenum. A 53-year-old woman on therapy with heparin for previous pulmonary embolism was admitted for abdominal pain and vomit. Computed tomography scan visualized an intramural hematoma of the jejunum causing subtotal obstruction of the intestinal lumen. The patient underwent resection of a part of the jejunum, securing intestinal continuity by a mechanical side-to-side anastomosis. The postoperative course was regular, but the initial anticoagulant therapy was reduced to prevent recurrence. In conclusion, spontaneous hema- toma of small bowel can occur as a compli…

L'utilità della colonscopia nel follow-up dei pazienti operati per cancro del colon-retto. Analisi retrospettiva e revisione della letteratura

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…

Is It Possible to Create a “Mechanical” Arteriovenous Fistula in Hemodialysis Patients?

Manual suturing still remains the best technique for the creation of vascular anastomoses on uremic patients with excellent results, despite being time consuming, difficult to perform with small vessels, and associated with a significant learning curve. We created a full mechanical arteriovenous fistula on a 65-year-old uremic patient with a new device already used in cardiac bypass surgery. The fistula was created automatically and rapidly, without the need for temporary occlusion of the artery, reducing the risk of blood clotting. We believe that mechanical devices may be useful to produce precise and fast anastomoses requiring minimal training for the surgeon.

Intraoperative Parathyroid hormone monitoring during parathyroidectomy for renal hyperparathyroidism

La chirurgia laparoscopica nel paziente uremico

POLYETHYLENE AND BIODEGRADABLE STARCH-BASED MULCHING FILMS FOR USE IN MELON PRODUCTION IN THE WESTERN COAST OF SICILY

Plastic mulching is currently used in many areas of the world for growing warm-season crops such as tomatoes, peppers, melons and water melons. The winter melon is widely grown in Sicily on about 6000 hectares. Plants are grown in the open field during the spring-summer months. In the last decades, mulching plastic films have enhanced winter melon early and total yields in Sicily. However, the disadvantage of polyethylene plastic mulches is that they have to be removed and disposed of after use. The aim of this study was to compare the effects of polyethylene (PE) and biodegradable mulching films on yield, fruit size and quality of several winter melon genotypes. Sicilian landraces (‘Cartuc…

Renal Transplantation by Automatic Anastomotic Device in a Porcine Model

Automatic vascular staplers for vascular anastomoses in kidney transplantation may dramatically reduce the operative time and, in particular, warm ischemia time, thus increasing the outcome of transplantation. Ten pigs underwent kidney auto-transplantation by automatic anastomotic device. Kidneys were collected by laparotomy with selective ligations at the renal hilum and perfused with cold storage solution. To overcome the shortage in length of renal hilum, a tract of the internal jugular vein was harvested to increase the length of the vessels. The anastomoses were totally performed by the use of the anastomotic device. On 10 kidney transplants, nine were successful and no complications o…

The sentinel node biopsy is not contraindicated in multifocal breast carcinoma

Aim. Following the availability of the results ofvalidation studies, the sentinel lymph node biopsy(SLNB) has replaced routine axillary dissection(AD) as the new standard of care in early unifocal breast cancers.Multifocal (MF) and multicentric (MC) tumours have been considered as a contraindication for this technique due to the possible incidence of a higher false-negative rate. In this retrospective study we try to demonstrate the usefulness of SLNB in MF/MC breast carcinoma. Patients and Methods. Eight hundreds and fiftyeightpatients with breast carcinoma underwent a conservative surgery and sentinel node excision. Ninety-four out of 858 patients had histological diagnosis of multifocal …

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…

Videolaparosurrenectomia.nostra esperienza

La chirurgia delle lesioni nodulari tiroidee: analisi di 592 casi

Comparison between Rapid Intraoperative and Central Laboratory Parathormone Dosage in 12 Kidney Transplant Candidates

Abstract Background The rapid intraoperative parathormone (PTH) and at central laboratory PTH dosage gives similar results. The central laboratory provides results in longer times and higher costs. Intraoperative measurement can reduce time and costs during parathyroidectomy. Methods Twelve patients undergoing parathyroidectomy for hyperparathyroidism renal transplant candidates were included. Diagnosis was made by laboratory tests (serum calcium, PTH) and imaging techniques (ultrasonography and scintigraphy). All patients presented PTH levels of >400 pg/mL (the limit value to be maintained in list for kidney transplantation) and resistant to medical therapy. For each patient, 2 blood sampl…

Struma ovarii. Case report and revision of the literature

Struma ovarii is a rare form of ovarian neoplasm, entirely or predominantly composed of thyroid tissue. This tumour generally has a benign biological behavior, although some cases of malignant transformation have been reported (5-10%). The tumour usually presents as an asymptomatic mature mass that may measure as much as 10 cm in diameter. The presence of ascites is possible (15-20%), and in a few cases the association of ascites and hydrothorax has been recorded (Pseudo-Meigs Syndrome); a close relationship between ascites and high levels of Ca-125, that may wrongly induce to a diagnosis of ovarian carcinoma is present. Other possible clinical consequences are compressive symptoms on adjac…

INTRAPERITONEAL MESH IN ELDERLY PATIENTS WITH LARGE INCISIONAL HERNIAS. A RAPID AND SIMPLE SURGICAL TREATMENT

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…

Risposta del melone invernale alla pacciamatura con film organico.

Thyroid surgery with the system Ligasure.

Isolation and colture of beta-like cells from porcine Wirsung duct

We sought to develop a protocol to isolate and culture porcine Wirsung duct cells in order to determine their potency to differentiate into insulin-expressing beta-like cells. The porcine Wirsung duct isolated by a surgical microdissection was digested with collagenase P and trypsin to dissociate ductal cells. These elements were cultured in serum-free supplemented media: for 2 weeks. Thereafter the cells were exposed to varying concentrations of glucose (0, 5.6, 17.8, and 25 mmol/L) to induce a beta-like phenotype, as identified by immunohistochemical staining. Cell growth proceeded slowly for the first 2 weeks of culture. After glucose induction for 2 weeks, they formed pancreatic islet-l…

GIANT INCISIONAL HERNIA IN THE ELDERLY PATIENT. A RAPID AND SIMPLE SURGICAL TREATMENT

Intraoperative parathyroid hormone monitorino durino parathyroidectomy for renal hyperparathyroidism

Suppressor of cytokine signaling 3 sensitizes anaplastic thyroid cancer to standard chemotherapy

We previously showed that cancer cells from papillary, follicular, and anaplastic thyroid carcinomas produce interleukin-4 and interleukin-10, which counteract the cytotoxic activity of conventional chemotherapy through the up-regulation of antiapoptotic molecules. Here, we identify Janus kinase/signal transducers and activators of transcription (STAT) and phosphatidyl inositol 3-kinase (PI3K)/AKT as the down-stream pathways through which these cytokines confer resistance to cell death in thyroid cancer. We found that the absence of suppressors of cytokine signaling (SOCS) molecules allows the propagation of the survival signaling. Exogenous expression of SOCS1, SOCS3, and SOCS5 in the high…

TWO STAGE TRASPOSITION OF BRACHIO-BASILIC ARTERO-VENOUS FISTULA (BBAVF)BY ULTRACISION.

Double Endocrine Neoplasia in a Renal Transplant Recipient: Case Report and Review of the Literature

Abstract Introduction The incidence of cancer compared for age groups is 3–4 times higher in transplant recipients than the general population. The increased risk is related to immunosuppressive therapy as well as the use of increasingly older donors and recipients. Although cardiovascular disease with a functioning transplant is the leading cause of death (47%), cancer mortality is significant especially among older patients. However, the most frequent posttransplantation cancers relate to hemolymphopoietic organs and skin, whereas the occurrence of solid tumors elsewhere is rare. Herein we have described a rare case of synchronous double malignancy of endocrine organs (thyroid-adrenal) in…

Incidentaloma Surrenalico. Caso di Sindrome di Cushing subclinica.

The authors describe a case of adrenal incidentaloma that was the cause of subclinical Cushing's syndrome and take the opportunity to weigh up some of the clinical, diagnostic and therapeutic aspects. Besides the particular expression of the symptoms which were difficult to interpret before reaching a diagnosis, the authors describe the diagnostic work-up adopted, aimed at precisely identifying the type of tumour and the surgical procedure implemented laparoscopically, the outstanding validity of which is confirmed compared to traditional adrenalectomy techniques.

Struma ovarii:revisione della letteratura, considerazioni su un caso clinico

Sistemic calciphylaxis and thrombotic microangiopathy in a kidney transplant patient: Two mixing fatal syndromes?

Abstract Abnormalities in calcium and phosphorus metabolism are common and metabolic bone diseases develop often in patients with chronic renal failure (CRF). Effective clinical management includes measures to control phosphorus retention and prevent hyperphosphataemia, to maintain serum calcium concentrations within the normal range and to prevent excess parathyroid hormone (PTH) secretion by the judicious use of vitamin D sterols. Certain of these interventions, however, appear to increase the risk of soft tissue and vascular calcification in patients with End Stage Renal Disease (ESRD), so current therapeutic approaches are thus being re-evaluated in an effort to limit these risks. Patie…

Electrospun Polyhydroxyethyl-Aspartamide-Polylactic Acid Scaffold for Biliary Duct Repair: A Preliminary In Vivo Evaluation

Abstract Tissue engineering has emerged as a new approach with the potential to overcome the limitations of traditional therapies. The objective of this study was to test whether our polymeric scaffold is able to resist the corrosive action of bile and to support a cell's infiltration and neoangiogenesis with the aim of using it as a biodegradable tissue substitute for serious bile duct injuries. In particular, a resorbable electrospun polyhydroxyethyl-aspartamide–polylactic acid (90 mol% PHEA, 10 mol% PLA)/polycaprolactone (50:50 w/w) plate scaffold was implanted into rabbit gallbladder to assess the in vivo effects of the lytic action of the bile on the scaffold structure and then as a tu…

Localization of sentinel lymph node in breast cancer. A prospective study

Abstract Introduction Sentinel Lymph Node Biopsy (SLNB) is the standard of care for staging axillary lymph nodes in women with breast cancer and clinically negative nodes. It is associated with reduced arm morbidity, moderated or severe lymphoedema, and a better quality of life in comparison with standard axillary treatment. Unfortunately, skip metastases makes all minimally invasive approaches, such as axillary sampling, unreliable. The aim of the present clinical prospective study is to evaluate the position of SLN in an important number of cases and establish the real incidence of skip metastases in clinically node-negative patients. Patients and methods A cohort of 898 female patients w…

I trapianti in rapporto ai mass media: dal trionfalismo alla ricerca esasperata della malpractice

“Magnifying glass” for difficult radiocephalic arteriovenous fistulas

Background: Some uremic patients suffering from diabetes, atherosclerosis or simple by absent or exhausted peripheral vascular bed require bigger effort in creating arteriovenous fistula. Although it is possible to use prosthetic graft for difficult cases, the use of native vessels falls always in the respect of patient’s quality of life. A help for these cases comes from the use of a microsurgical technique for creating vascular access. Patient and Methods: For this study we evaluated the 72 patients underwent microsurgical radiocephalic fistula comparing them to a homogeneous group of 72 patients underwent traditional surgery. The patients were followed up at 1, 2 months and 1 year. Resul…

I TUMORI DEL RENE: INQUADRAMENTO NOSOLOGICO, STAGING E FATTORI PROGNOSTICI

RECURRENT RENAL CARCINOMA MIMICKING A GOITRE: A CASE REPORT

Although the thyroid is a high vascularised gland, it is not common terget of metastases from extraglandular cancer. We reported a case of a 70 year-old woman who underwnt total thyroidectomy for multinodular goitre. In the patient's clinical hystory a nephrectomy was carried out 2 years before due to unspecified causes. The histopathological examination of the thyiroid showed a pattern compatible with clear cell renal carcinoma metastasis. The patient's relatives revealed, when questioned again, that the nephrectomy was due to the presence of a clear renal cell carcinoma keep concealed to the patients. Thanks to a timely intervention, the mass was removed and a better survival was guarante…

Use of intraoperative parathyroid hormone in waiting list and kidney transplant patients

Vantaggi e limiti dell'approccio laparoscopico nell'addome acuto

INTRODUZIONE ED OBIETTIVI Le condizioni patologiche che possono insorgere con un quadro di addome acuto sono molto numerose ed il loro riconoscimento, nonostante l’affinamento delle procedure diagnostiche, rappresenta sempre una difficile prova anche per il chirurgo più esperto. Grazie alla standardizzazione delle procedure e all’impiego dell’alta tecnologia la laparoscopia trova oggi sempre maggiori indicazioni per risolvere dubbi diagnostici, anche in urgenza. MATERIALI E METODI Viene riportata la nostra esperienza di approccio laparoscopico su 147 pazienti, tutti emodinamicamente stabili, ricoverati con una diagnosi di ingresso di addome acuto. RISULTATI Nel 59% dei casi il trattamento l…

Endoscopic treatment of colonic polyps into digestive endoscopy ambulatory

Electrospun biodegradable materials for vascular regenerative medicine

Objectives: There is a rising interest for the development of small-sized blood vessels substitutes. Several studies have been focused on the development of a biodegradable graft temporarily able to substitute the blood vessels and allow their complete regeneration after a certain time. We tried to develop a biodegradable material, with optimal mechanical characteristics and the capacity to allow cells adhesion, differentiation and proliferation by electrospinning to obtain a nano-fibrillar scaffold starting from a polymeric solution. Methods: We report the in vivo application on rats of two new electrospun biodegradable materials, specifically designed to create tubular structures. Both bi…

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…

Ileus Following Spontaneous Jejunum Intramural Hematoma: Case Report and Review of the Literature

Anticoagulant therapy may cause the onset of a spontaneous intramural hematoma of the small bowel, in the jejunum, ileum or duodenum. A 53-year-old woman on therapy with heparin for previous pulmonary embolism was admitted for abdominal pain and vomit. Computed tomography scan visualized an intramural hematoma of the jejunum causing subtotal obstruction of the intestinal lumen. The patient underwent resection of a part of the jejunum, securing intestinal continuity by a mechanical side-to-side anastomosis. The postoperative course was regular, but the initial anticoagulant therapy was reduced to prevent recurrence. In conclusion, spontaneous hematoma of small bowel can occur as a complicati…

VALUTAZIONE ECO-COLOR-DOPPLER DEL RENE TRAPIANTATO. REVIEW DELLA CASISTICA E VALUTAZIONE CRITICA

Un caso complesso di calcificassi associata ad iperparatiroidismo secondario (IPTII) con coesistenza di sindrome emolitico uremica SEU) in paziente già sottoposta a trapianto di rene

Introduzione La calcificassi è l’estrema complicanza potenzialmente letale dell’iperparatiroidismo IPT spesso di tipo II. La sua patogenesi è dubbia in quanto concorrono variabili di tipo individuale legate ad una complessa reazione di ipersensibilità in presenza di PTH, vitamina D ed ipercalcemia.Una non sempre correlazione tra gravità dei segni clinici ed alterazioni laboratoristiche ed anatomo-patologiche rende difficile la prognosi. Il sodio tiosolfato e.v. può ridurre la precipitazione di calcio e disostruire le arterie migliorando il quadro clinico rappresentando oltre alla paratiroidectomia (PTX) l’unica terapia capace di ridurre l’elevato rischio di mortalità Materiali e metodi: Il …

Post-transplant renal lymphocele treated by percutaneous ultrasono graphy guide aspiration and instillation of povidone-iodine

MONITORAGGIO ECO-COLORDOPPLER DEL RENE TRAPIANTATO.NOSTRA ESPERIENZA

Introduzione: La metodica ultrasonografica, come è noto, scevra da complicanze, ripetibile, non invasiva ed altamente tollerata dal paziente, consente un attento monitoraggio sia delle caratteristiche anatomomorfologiche del graft (ATN,rigetto,intossicazione da farmaci,infarto),sia l’immediata diagnosi di complicanze post-operatorie (raccolte fluide perirenali, idronefrosi,trombosi vascolari).L’integrazione con power-colordoppler consente altresì il corretto monitoraggio delle condizioni di perfusione d’organo, desunte dai dati connessi alla valutazione seriata delle resistenze parenchimali. Materiali e metodi: La casistica è limitata agli ultimi tre anni di attività su un gruppo di 22 pazi…

INQUADRAMENTO ED ASPETTI FISIOPATOLOGICI DELL'ITTERO OSTRUTTIVO

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

ENDOTRACHEAL STENT IN A CASE OF SEVERE TRACHEAL STENOSIS FROM RELAPSING GOITER

Objectives:The surgical approach for tracheal complications in thyroidectomy sometimes requires tracheotomy in urgency for supporting the airways flow (especially in presence of giant goiter). Nevertheless, tracheotomy, even if necessary to guarantee the restoration of respiratory function, it can not be considered as definitive therapy in presence of alterations of trachea (i.e. stenosis) susceptible to heal. An useful help in clinical management comes by tracheal prosthesis as we showed in a case of a giant relapsing multinodular goiter. Materials and methods: A 72 yr old woman, affected by giant relapsing goiter rapidly growing, came to our observation with severe orthopnea, due to steno…

A NEW KIND OF DISPOSABLE AUTOSTATIC SURGICAL RETRACTOR IN INGUINAL HERNIA REPAIR

Objectives: The aim of this study is to demonstrate the effectiveness of a new kind of disposable autostatic surgical retractor in hernias procedures in order to achieve an easier, faster, and safer surgical intervention. Material and Methods: Between January and March 2008, 42 inguinal hernioplasty procedures have been performed using the 3PAWS model of ReeTrakt™ a self-retaining, low profile retractor. Equivalent patients samples, in which operations were performed using conventional retraction devices, were considered for comparison of the intra and postoperative results. Results: In all of the 42 inguinal hernioplasty procedures performed, the ReeTrakt™ system has simplified the perform…

Uso del dosaggio del paratormone intraoperatorio nei pazienti sottoposti a paratiroidectomia in lista d'attesa per trapianto renale

SUCCESFULLY TREATED HEMOLITIC UREMIC SYNDROME (HUS) BY PLASMA APHERESIS AFTER KIDNEY TRANSPLANTATION

Objectives: The HUS is a rare disease; it exists a kind related to acute toxicity by Cyclosporine on the short time following kidney transplantation. Although the causes of this syndrome are still unclear, data from the literature show that patients with high levels of Reactive Antibodies (PRA test), Alport syndrome (as primitive renal disease), or which have history of HUS present a higher risk of HUS after renal transplantation. Materials and Methods: We report a case of a 58 yr old woman whose cause of uremia we did not know dependent on an episode of HUS. The patients underwent renal transplantation from deceased donor and treated with Cyclosporine, Mycophenolate Mofetil and steroids as…

Intraoperative parathyroid hormone monitoring during parathyroidectomy for hyperparathyroidism in waiting list and kidney tranplant patients

UTILIZZO DI RENI MARGINALI: NOSTRA ESPERIENZA

Introduzione La scarsa disponibilità di organi e l’incremento del numero dei pazienti trapiantabili ha condotto all’utilizzo di graft provenienti da donatori anziani o marginali. Lo scopo del presente studio è quello di analizzare i risultati di pazienti sottoposti a trapianto renale da donatori anziani o marginali. Metodi Tra gennaio 1996 e settembre 2007 abbiamo eseguito 137 trapianti renali. 39 da donatori marginali (gruppo A) e 98 da donatori ideali (gruppo B). Dopo un follow-up di 18 mesi abbiamo analizzato i risultati ottenuti in termini di complicanze mediche e chirurgiche e di sopravvivenza dell’organo. Risultati L’analisi dei dati ha dimostrato nel gruppo A un tasso di complicanze …

L’INDICE DI RESISTENZA (IR) QUALE FATTORE PROGNOSTICO NELL’OUTCOME DEL TRAPIANTO DI RENE

Introduzione Il valore diagnostico dell’’indice di resistenza renale (IR) nel post trapianto è ormai indiscusso. Nel seguente lavoro ci si propone di correlare i valori medi di indice di resistenza renale a carico dei tratti distali delle arterie interlobulari alla funzionalità renale, quale fattore prognostico nella valutazione della sopravvivenza del graft. Metodi La popolazione sottoposta a studio comprende 100 pazienti trapiantati dal gennaio 2001 al dicembre 2008, durante un follow-up medio di 12 mesi, mediante una valutazione ecodoppler del graft e del tratto distale delle arterie interlobulari.Tali dati sono stati messi a confronto con alcuni parametri di funzionalità renale quali il…

Linfocele post-trapianto:esperienza del nostro centro

USE OF HARMONIC SCALPEL FOR BRACHIO-BASILIC VEIN TRANSPOSITION IN AUTOGENOUS PROXIMAL ARTERIOVENOUS FISTULA

Objectives: This study evaluates the effectiveness and helpfulness of ultrasonic surgical device for atraumatic surgical dissection and hemostasis in brachio-basilic vein transposition. Since prosthetic grafts have been reached poor results and high costs, the primary use of autogenous AVF is recommended. Materials and Methods: From March 2004 to March 2009 67 cases (61 F ; 6 M; mean age 52 years) of brachio-basilic arteriovenous fistulae (BBAVF) were fashioned; in second stage, after vein maturation (about 30 days), we performed a superficial transposition of arterialized basilic vein by harmonic scalpel (UltracisionTM).. Results : On 67 cases of transposition of BBAVF 2 cases failed after…

Giant incisional hernia in the ederly patient. A Rapid and simple surgical technique

Objectives The aim is to obtain a) a safe procedure to repair the large abdominal defect and reinforce the fragile zones around; b) a simple and rapid technique to reduce the operation time. Materials And Methods Retrospective review of medical records of 72 elderly patients in whom intraperitoneal mesh placement was used between January 1988 and June 2005. Results No intraoperative complication occurred. In the postoperative stage 7 seromas, 4 haematomas, 2 infections occurred, all solved with conservative treatment. Conclusion The incidence of incisional hernia (IH) vary between 1% and 15 %, with increasing risk of recurrence in relation to the age of patients, wound infection, obesity an…

FUNZIONALITA' RENALE E INDICE DI RESISTENZA (IR)

INTRODUZIONE La valutazione dell’indice di resistenza renale (IR) nel post trapianto è stata largamente dibattuta e nonostante mostri valori differenti nei vasi iterlobulari rispetto a quelli interlobari il suo valore diagnostico è ormai indiscusso. Nel seguente lavoro i risultati dei valori medi di IR renale valutati nei tratti distali delle arterie interlobulari sono stati correlati alla funzionalità renale. METODI Da gennaio 2001 a maggio 2007 in 55 pazienti sottoposti a trapianto renale abbiamo eseguito, durante un follow-up medio di 6 mesi, una valutazione ecodoppler del graft e del tratto distale delle arterie interlobulari. Tutti gli esami sono stati condotti dallo stesso esaminatore…

Secondary Hyperparathyroidism and renal transplantation

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…

Trattamento minilaparotomico dei linfoceli post trapianto renale

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 …

Rottura di rene trapiantato : analisi di due casi

KIDNEY TRANSPLANTATION IN ELDERLY PATIENTS: OUR EXPERIENCE

Funzionalità renale e indice di resistenza(IR)

USO DELLA PROTESI INTRAPERITONEALE IN PTFE IN UN GRANDE LAPAROCELE DOPO TRAPIANTO RENALE : CASE REPORT

Introduzione Il caso riguarda il trattamento chirurgico con l’utilizzo di protesi intraperitoneale dual mash PTFE di un laparocele in un paziente di 55 aa sottoposto a precedente trapianto di rene. Tale complicanza derivava da un urinoma per la necrosi massiva dell’uretrere distale del graft; per cui il pz. è stato sottoposto a reintervento in 2 giornata post trapianto con ricostruzione del piano del muscolo aponeurotico. A circa un mese dal trapianto comparsa di tumefazione in sede incisionale, che rapidamente si è evoluta fino a raggiungere le caratteristiche del grande laparocele.Gli esami strumentali evidenziavano la presenza dell’omento e del piccolo intestino nel sacco erniario. Mater…