Salvage of an Octogenarian Liver Graft Using Normothermic Perfusion: A Case Report.

Liver transplantation with very old donors is safe, but is associated with an increased incidence of ischemic-type biliary lesions and delayed graft function. Normothermic machine perfusion (NMP) is a novel technique for preservation of liver grafts and has the potential to reduce ischemia-reperfusion injury. A case is reported here of a liver transplantation (LT) with a graft from an 83-year-old brain-dead donor. Procurement was with dual perfusion and en bloc, modified fast technique. Donor kidneys were not transplanted due to severe atherosclerosis and poor perfusion. The liver was shipped to the transplantation center and underwent NMP with a blood-based perfusate. During machine perfusion lactates decreased, vascular flow was stable, and bile production restored, and the graft was considered suitable for transplantation. The postoperative course was uneventful and 4 months after surgery the patient is in good clinical condition with normal liver function. To date, few LTs have been performed with NMP in humans, but its preliminary results are promising. NMP allows functional evaluation of the graft and possibly reduction of post-transplantation complications when extended-criteria donor grafts are used.

The impact of everolimus on renal function in maintenance liver transplantation.

We retrospectively investigated the impact on renal function (RF) of conversion from calcineurin inhibitors (CNI) to everolimus (EVL) monotherapy in orthotopic liver transplant (OLT) recipients. Between January 2006 and July 2007, 70 deceased donor OLT recipients including 51 men and 19 women of overall mean age of 55.9 +/- 11 years were enrolled into a program of conversion to EVL monotherapy at a mean interval of 45 +/- 35.9 months from transplantation (range, 7-192 months). The indication for conversion was deteriorating RF in 64 (91.4%). Efficacy failure was defined as the persistence of CNI, EVL discontinuation, death, graft loss, loss to follow-up, or need for dialysis at 12 months. Twelve months after switching, 53 patients (75.7%) were on EVL monotherapy. Their mean change in creatinine clearance (CrCl) from baseline (day 1 before EVL introduction) to endpoint (12 months) was 5.8 +/- 13.1 mL/min. On univariate and multivariate analyses, the clinical variable correlated with the greatest probability of improvement was the baseline CrCl (P < .0001). Conversion from CNI to EVL monotherapy was successful in 75.7% of cases with improvement in RF correlated with baseline CrCl. These data supported preemptive minimization of CNI in the posttransplant course, seeking to delay the decline in RF.

Role of color Doppler sonography in post-transplant surveillance of vascular complications involving pancreatic allografts().

PURPOSE: To evaluate the role of color Doppler ultrasonography in the postoperative surveillance of the vascular complications involving pancreas allografts. METHODS: A retrospective analysis of a consecutive series of 223 pancreas transplantations was performed. All recipients received antithrombotic prophylaxis, which was tailored to the individual's estimated risk of thrombosis. All patients were monitored with daily color Doppler ultrasonography during the first post-transplant week and thereafter whenever clinically indicated. Vascular complications were defined as all thrombotic events requiring: increased anticoagulant therapy, angiography with fibrinolytic therapy, or repeat surgery. RESULTS: The overall patient survival rates at one, three, and five years after transplantation were 94.7%, 93.3%, and 91%, respectively. The overall graft survival rates at the same time points were 87.4%, 79.6%, and 75.6%, respectively. In 28 of the 223 cases (12.5%) graft thromboses were diagnosed with Doppler ultrasound within the first 10 days after transplantation. In 3 cases, graft pancreatectomies were performed because of a complete loss of blood flow in the parenchyma. An attempt to rescue the graft was made in 18 patients. Fourteen of these grafts were saved and are still functioning (77.7%); and 4 rescue attempts failed and the grafts were subsequently explanted (32.3%). CONCLUSION: Color Doppler ultrasound is a suitable tool for postoperative surveillance of pancreas transplant recipients. Its use can lead to early diagnosis and timely treatment of vascular complications.

Liver adenomatosis: clinical, histopathologic, and imaging findings in 15 patients.

PURPOSE: To report and correlate the clinical, histopathologic, and imaging findings in 15 patients with liver adenomatosis. MATERIALS AND METHODS: Fifteen adult patients had more than 10 hepatic adenomas each and no history of glycogen storage disease or anabolic steroid use. Ten of them underwent bolus-enhanced dynamic computed tomography (CT) with or without magnetic resonance (MR) imaging, ultrasonography, and/or angiography. RESULTS: Clinical abnormalities included abdominal pain in 11 (73%) and hepatomegaly in 10 (67%) patients, and abnormal liver function in 10 (91%) of 11 patients. The number of adenomas in each patient was 10-50 at imaging, but many more lesions were found in the resected specimens. Hemorrhage was commonly found within adenomas at histopathologic analysis, but only four patients had clinical and imaging evidence of substantial hemorrhage. In all patients, the adenomas increased over time, and two patients developed hepatocellular carcinoma. CT and MR features of the adenomas included evidence of hypervascularity (63%), intratumoral fat (50% of patients at CT, 80% at MR), and decreased conspicuity at portal venous and delayed-phase imaging. Fifty percent of patients had congenital or acquired hepatic vascular abnormalities. CONCLUSION: The imaging and histopathologic features of individual adenomatous lesions are similar to those reported in young women who are taking oral contraceptives. However, the lesions in liver adenomatosis are not steroid dependent but rather multiple, progressive, and symptomatic, and they are more likely to lead to impaired liver function, hemorrhage, and perhaps malignant degeneration.

17-alpha-Hydroxyprogesterone caproate and natural progesterone in assisted reproduction: a comparative study.

The use of luteal phase support has been demonstrated in patients undergoing an IVF/ET procedure. This study was designed to compare the absorption and the efficacy of two different luteal supports: 17-alpha-hydroxyprogesterone caproate (Lentogest, AMSA, Italy) and natural Progesterone (Prontogest, AMSA, Italy). A total of 80 patients received luteal supplementation with 50 mg of natural P/day intramuscularly, until beta-hCG evaluation. Then, in case of positive beta-hCG, patients were randomly divided into two groups (A and B) in order to compare two different protocols: Group A, 17-OHPc (341 mg once a week) and Group B, natural P (50 mg/day) both intramuscularly and extended for 10-12 weeks. Our study showed that the treatment with 17-OHPc results in a higher percentage of pregnancy rate compared to natural P, but the differences are not statistically significant. Thus, we emphasize that 17-OHPc preparation for better acceptance appears to be the most suitable and comfortable method for luteal phase support.

Intramuscular versus vaginal progesterone in assisted reproduction: a comparative study.

The effectiveness and the absorption of two progesterone (P) presentations have been compared for luteal phase support of patients aged < or = 37 years undergoing an in vitro fertilization (IVF) procedure for the first time, who were stimulated after pituitary desensitization with gonadotrophin releasing hormone agonists (GnRHa). All of them had two ovaries, normal ovarian functions and normal endometrial morphology: the indication for the assisted reproductive technique was the tubal factor. Two hundred and fifty patients were randomly allocated to two groups in order to compare two treatment protocols: Group A: natural i.m. P (50 mg/day, Prontogest, AMSA, Italy); Group B: micronized vaginal P (200 mg/day Esolut, Angelini, Italy). We were able to show that the i.m. P resulted in a higher percentage of pregnancies than the vaginal preparation, with statistically significant differences. We recommend the use of injectable P, and suggest reserving intravaginal P as a second choice for patients who cannot tolerate intramuscular administration.

[Blood sugar response to administration of bran or guar added to pasta in children with type I diabetes]. / Risposta glicemica dopo somministrazione di pasta di semola e di pasta al guar in bambini affetti da diabete tipo I.

Blood sugar profiles after administration of pasta with (PG) and without (P) guar have been evaluated in 30 young type I diabetic children. Maximum increase of blood sugar was observed at 30' (mean = 21 mg/dl) after P and at 90' (mean = 6 mg/dl) after PG. Maximum decrease in blood sugar levels was reached at 180' in both groups (50 mg/dl after P and 25 mg/dl after PG). Blood sugar level was significantly different only at 180'. No significant difference was observed analyzing rates of increase.

Early diagnosis of subclinical complications in insulin dependent diabetic children and adolescents.

212 insulin dependent young diabetics with mean age of 16 yr and mean diabetes duration of 9 yr, have been examined for prevalence of subclinical signs of microvascular disease. Prevalence of retinopathy is increased in subjects of older age when matched for diabetes duration. Subclinical abnormalities of peripheral nervous system, identified by neurophysiological techniques, are present in about 20% of patients. These abnormalities are mainly related to metabolic control as evaluated by HbA1c determination. Albumin excretion rate over 10 mcg/min is observed in about 40% of subjects and is related to increased blood pressure values and poor metabolic control.

The interstitial lung disease associated with rheumatoid arthritis: evidence for imbalance of helper T-lymphocyte subpopulations at sites of disease activity.

Rheumatoid arthritis (RA) is a generalized disorder characterized by chronic inflammation of peripheral joints and by involvement of many organs, including the lung parenchyma. The inflammatory infiltrates of the rheumatoid synovial membranes are associated with increased numbers of T-lymphocytes, with increased proportions of helper (OKT4 positive) T-cells and decreased percentages of suppressor/cytotoxic (OKT8 positive) T-cells, and since patients with interstitial lung disease associated with RA often have increased numbers of lymphocytes in the alveolar structures, it seemed possible that rheumatoid lung disease could also be associated with an imbalance of T-lymphocyte subpopulations. To test this hypothesis, patients with chronic interstitial lung disease and RA were evaluated by lung biopsy, gallium-67 scanning and bronchoalveolar lavage to assess the activity of the lung disorder and the T-lymphocyte subpopulations were identified with the OKT4, OKT8 and Tec T-5.9 monoclonal antibodies. The Tec T-5.9 is a recently described monoclonal antibody which recognizes a small T-cell fraction of the OKT4 positive T-lymphocytes, responsible for many helper T-cell functions, including the response to allogenic antigens and help in immunoglobulin production by B-cells. Histologic evaluation of the biopsies demonstrated active lung inflammation in all patients and gallium-67 scans showed an increased lung uptake in five of the six patients studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Fibronectin concentrations in pleural effusions of patients with malignant and non-malignant diseases.

We have determined the amount of fibronectin in pleural fluids and plasma of 131 patients suffering from pleurisy of malignant and non-malignant etiology. We observed a significantly higher concentration of fibronectin in pleural fluids of a few patients with mesothelioma as compared with that found in pleural fluids of patients with pleurisies of different etiology. In these patients the pleural fluid fibronectin concentration was higher than that measured in plasma, suggesting local synthesis of fibronectin.