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

Trapianto di insule di Langerhans

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…

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…

Towards an ideal source of mesenchymal stem cell isolation for possible therapeutic application in regenerative medicine.

Background. The possibility of obtaining mesenchymal stem cells (MSCs) from fetal tissue such as amniotic fluid, chorionic villi and placenta is well-known and a comparison between MSCs originating in different sources such as fetal tissue and those from bone marrow in terms of yield and function is a topical issue. The mesenchymal stem cells isolated from bone marrow are well-characterized. Unfortunately the low quantitative yield during isolation is a major problem. For this reason, other tissue sources for MSCs are of paramount importance. Conclusion. In this review, starting from a description of the molecular and cellular biology of MSCs, we describe alternative sources of isolation ot…

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

HUMAN FIBRIN GLUE SEALING VERSUS SUTURE POLYPROPYLENE FIXATION IN LICHTENSTEIN INGUINAL HERNIORRAPHY: A PROSPECTIVE OBSERVATIONAL STUDY.

Background: Patients who underwent primary inguinal hernia repair still report a high rate of postoperative pain after operation due to effect of mesh fixation by suture. An alternative is the use of human fibrin glue. We compared the two techniques. Methods: 468 patients randomly underwent primary inguinal hernia Lichtenstein repair fixing the mesh by suture or by human fibrin glue (HFG); in both cases themesh was fixed to the posterior wall of the inguinal canal and to the inguinal legament. results: No significant differences were recorded between the two groups in terms of complications, while the sutureless technique reduces the operative time and the postoperative pain. Conclusions: A…

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…

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…

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…

An old method for good new cells

The aim of this work was to demonstrate a greater number of viable cells using a micro-surgical in-situ perfusion to collect rat pancreata compared with the pancreas after exsanguination. We used 3 groups of 20 rats. Perfusion was performed by selective cannulation of the left common iliac artery with administration of UW solution at 4 degrees C. Collected pancreata were digested and cells separated by Ficoll gradient were placed in culture to permit adhesion to dishes. Cells were characterized and tested for viability. We observed a gain of about 14% in the number of viable cells compared with those obtained after exsanguination (P < .001 by chi-square).

Pancreatic islets from non-heart beating donor pig: Two-layer preservation method in an in vitro porcine model

Purpose Pancreata from non-heart beating donors could represent an unlimited source of islets if their cell viability can be efficiently preserved during the time necessary to process the organs by the use of a better solution of preservation compared to the classic University of Wisconsin solution. The aim of this study was to determine whether it is possible to obtain functioning “alive islets” from non-heart-beating donors by comparing, on a porcine model, the classic “UW ice-store” method with a two-layer cold storage method (TLM) using oxygenated Perfluorocarbons (PFC) and UW. Methods Whole pancreata were harvested from 20 NHBDs female pigs with similar characteristics and preserved fo…

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…

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…

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…

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…

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.…

OBTAINING MESENCHYMAL STEM CELLS FROM ADIPOSE TISSUE OR MURIN ORIGIN: EXPERIMENTAL STUDY.

The aim of this study was to isolate and characterize rat adipose Derived Mesenchymal Stem Cells (AD-MSCs) in order to evaluate their proliferative potential and their ability to different cell types. AD-MSCs and Derived Mesenchymal Stem Cells (BM-MSCs) have the same characteristic in terms of plasticity. The advantage of adipose tissue is that it is an easier accessible source and it offers a large amount of MSCs by less invasive surgical tecniques. MSCs were obtained from subcutaneous adipose tissue of Wistar rats. first of all microbiological controls were made to exclude the presence of bacteria of fungi in then tissue. Adipose tissue was mechanically and enzimatically fragmented and st…

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 …

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

Obtaining Mesenchymal Stem Cells From Adipose Tissue Of Murin Origin: Experimental Study

Secondary Hyperparathyroidism and renal transplantation.

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…

Electrophoresis of proteins and DNA on horizontal sodium dodecyl sulfate polycrylamide gels

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…

Iperparatiroidismo terziario

Successful treatment of gastrointestinal bleeding with recombinant factor VIIa after kidney transplantation in patients with pancytopenia.

Abstract Hemostatic disorders can often complicate transplantation procedures. Moreover, antihemmorhagic drugs may not efficiently control bleeding that occurs in such cases. We report on a patient who underwent kidney transplantation complicated by bone marrow aplasia and gastric bleeding who was succesfully treated with recombinant activated FVII (Novoseven). In May 2005, a 53-year-old man affected by chronic renal insufficiency underwent kidney transplantation. At the beginning of June, laboratory tests showed progressive reduction in the blood cell count with anemia, granulocytopenia, and thrombocytopenia related to the development of marrow insufficiency. We commenced transfusion thera…

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…

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…

From gut microflora imbalance to mycobacteria infection: is there a relationship with chronic intestinal inflammatory diseases?

The gut of a healthy adult harbours a myriad of different microbial species. It is estimated that approximately 10 14 are present in total bacterial colony forming units (CFU). Each colony colonizes a specific intestinal tract. In healthy adult, the main control of intestinal bacterial colonization occurs through gastric acidity but also other factors can influence the intestinal microenvironment such as pH, temperature, competition among different bacterial strains, peristalsis, drugs, radiotherapy and much more. Impaired microbial homeostasis leads to an alteration of the permeability of tissue, together with the activation of the intestinal immune system MALT (mucosal associated lymphoid…

Il reintervento per l'iperparatiroidismo renale persistente o recidivo

Using Polymeric Scaffolds for Vascular Tissue Engineering

With the high occurrence of cardiovascular disease and increasing numbers of patients requiring vascular access, there is a significant need for small-diameter (&lt;6 mm inner diameter) vascular graft that can provide long-term patency. Despite the technological improvements, restenosis and graft thrombosis continue to hamper the success of the implants. Vascular tissue engineering is a new field that has undergone enormous growth over the last decade and has proposed valid solutions for blood vessels repair. The goal of vascular tissue engineering is to produce neovessels and neoorgan tissue from autologous cells using a biodegradable polymer as a scaffold. The most important advantage of …

POSSIBLE RELATION BETWEEN GUT MICROFLORA COMPOSITION AND ONCOGENIC RISK: IS STIMULATION OF INFLAMMATION THE ONE RING OF CONNECTION?

Human intestinalmicrobiotais characterizedby highpopulationdensity, wide diversity and complexity of interactions. Dysbiosis, both qualitative and quantitative, might have serious health consequences including an increase in the number and/or alteration of bacteria colonizing the gastrointestinal tract, which could be referred as gut microflora imbalance (GMI). GMI is frequently found in patients suffering from irritable bowel syndrome; this is the reason why some authors believe that IBS is secondary to GMI. Interestingly, GMI is also found in about 25% of Crohn’s disease patients. Stimulation of inflammation by the ‘dangerous bacteria’, through specific activation of the intestinal immune…

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…

Beyond islet trasplantation in diabetes cell terapy:from embryonic stem cells to transdifferentation of adult cells

Exogenous insulin is, at the moment, the therapy of choice of diabetes, but does not allow tight regulation of glucose leading to long-term complications. Recently, pancreatic islet transplantation to reconstitute insulin-producing cells, has emerged as an alternative promising therapeutic approach. Unfortunately, the number of donor islets is too low compared with the high number of patients needing a transplantation leading to a search for renewable sources of high-quality -cells. This review, summarizes more recent promising approaches to the generation of new -cells from embryonic stem cells for transdifferentiation of adult cells, particularly a critical examination of the seminal work…

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&lt;.05) in pulsatility index (PI)…

Mesh fixation in hernia repair suture versus human glue fibrin.

Intraoperative Parathyroid hormone monitoring during parathyroidectomy for renal hyperparathyroidism

Surgical vascular access in the porcine model for long-term repeatedblood sampling

A simple technique for implanting a long-term jugular catheter in piglets under general anesthesia is described. We report our experience in 10 young female pigs with a body weight of 20-30 Kg. The surgical procedure involves implantation of a jugular central venous catheter (11Fr polyurethane) tunneled in the subcutaneous fat layer of the neck. This procedure may be performed in about 15 minutes. The maintenance of the catheter is described which allows several daily blood samples to be taken. This procedure reduces both the stress in piglets and the chance of catheter dislodgement due to the animals scratching or rubbing. Blood sampling can be easily performed with a low incidence of infe…

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…

Histological findings of the internal inguinal ring in patients having indirect inguinal hernia

BACKGROUND: Aiming to deepen the understanding of the factors involved in the genesis of groin hernia, this study is focused on identifying the histological changes within the muscle fibers of the internal inguinal ring in patients having indirect inguinal hernia. METHODS: In eight patients with primary or recurrent bilateral indirect inguinal hernia who underwent a Stoppa open posterior inguinal hernia repair, a tissue specimen from the edge of the internal inguinal ring was biopsied and histologically examined. RESULTS: In all of the tissue samples, remarkable degenerative changes such as fibrohyaline degeneration of the muscle fibers, vascular congestion, and phlogistic infiltration thro…

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

Organismi geneticamente modificati: definizioni e finalità.

Article 2 of the European Directive 2011/18/EC defines a genetically modified organism (GMO) a san organism in which the genetic material has been altered in a way that does not occuirr naturally by inserting DNA fragments from one organism's gene into the chromosomes of another, changing its genetic expression. In the field of animal and plants biotechnology there are different application areas of genetic engineering such as improving the quantity and quality of argicultural production, pharmaceutical production in more sustainable ways or applications in environmental field.

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…

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…

“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…

The use of a new kind of low profile retractor for arteriovenous fistula procedure simplifies and speeds up the intervention

Purpose The aim of this study was to demonstrate the effectiveness of a new kind of disposable surgical retractor in arteriovenous fistula (AVF) procedures in order to achieve an easier, faster and safer surgical intervention. Methods Between January and June 2008, 22 AVF procedures were performed using the 3PAWS ReeTrakttrade; (Insightra Inc. - Irvine, Ca., USA) a self-retaining, low profile retractor. An equivalent patient sample, in which an AVF was performed using conventional retraction devices, was considered for comparison of the intra- and post-operative results. Results In all of the 22 AVF procedures performed, the ReeTrakt™ system has simplified the performance of the surgical te…

Post-transplantation tertiary hyperparathyroidism.

Tertiary hyperparathyroidism is intended as a state of excessive autonomous excretion of parathyroid hormone after longstanding secondary hyperparathyroidism. It is a condition of a severe hyperparathyroidism that persists in the renal recipient despite a successful transplantation. The high levels of parathyroid hormone lead to a worsening of graft function accompanied by systemic symptoms. This article reviews the main aspects related to tertiary hyperparathyroidism from mechanism of pathogenesis to prevention and treatment, suggesting some indications about the best management of patients on a waiting list for kidney transplant.

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

APPROCCIO MULTIDISCIPLINARE AL GOZZO RECIDIVO CON GRAVE STENOSI TRACHEALE: UN CASO CLINICO

INTRODUZIONE Il reintervento per patologia a carico della ghiandola tiroidea è raro, ma risulta spesso indicato nelle ricomparsa di patologia nodulare dopo interventi parziali. La ricorrenza della patologia multinodulare si aggira infatti intorno al 12% di tutti gli interventi sulla tiroide. Questi interventi di totalizzazione possono talvolta richiedere la collaborazione di equipe chirurgiche con diverse specialità in successivi steps temporali. MATERIALI E METODI Il caso clinico riguarda una donna di 72 anni sottoposta 40 anni prima ad intervento di tiroidectomia parziale che riferisce la comparsa di voluminosa tumefazione in sede sottojoidea nell’arco di 2 mesi accompagnata da crisi resp…

Secondary Hyperparathyroidism and renal tranplantation

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

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…

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 …

Il trapianto di rene nell'anziano: quali sono i limiti? Aspetti etici e valutazione del paziente

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 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…