Low-dose Spinal Block With Continuous Epidural Infusion for Renal Transplantation in a Patient With Alport Syndrome: A Case Report.

OBJECTIVE: We aim to describe management of a patient receiving renal transplantation for chronic renal failure due to Alport syndrome with low dose of intrathecal bupivacaine and continuous epidural infusion of local anesthetic. CASE REPORT: A 38-years-old man with chronic renal failure secondary to Alport syndrome underwent kidney transplantation. Because of a high risk of respiratory and cardiovascular complications related to the patient's baseline lung disease and abnormalities in heart conduction, we selected combined spinal-epidural anesthesia. The block was ultrasound-guided and performed at the T12-L1 interspace with 4.5 mg of 0.5% intrathecal hyperbaric bupivacaine followed by a continuous epidural infusion of 0.5% levobupivacaine mixed with 25 µg of Fentanyl at the initial rate of 8 mL/h. Sensory block to T5-T6 was obtained within 10 minutes. The patient then received mild sedation with Propofol and Remifentanil. Methylprednisolone and diuretics were administered before vascular unclamping according to our internal protocol. Surgery lasted 3 hours with no clinical or procedural complication. CONCLUSIONS: Although renal transplantation is usually performed under general anesthesia, in a particularly complex patient with chronic renal failure, chronic obstructive pulmonary disease and a worsened respiratory mechanics, we applied a combined approach with a low dose of intrathecal bupivacaine and continuous epidural infusion of local anesthetic. The technique did not affect hemodynamics while having a positive impact on recovery of function of the transplanted organ with rapid improvement of urine output, serum creatinine, and blood urea nitrogen levels.

Donor and recipient postoperative complications in living related kidney transplantation. A multicentric study.

BACKGROUND: Living related kidney transplantation is considered a gold standard of renal transplantation in order to overcome end-stage renal disease within the same family members. Living donation, albeit decreasing cadaveric donor shortage, exposes donors to the risk of surgical complications. METHODS: In order to assess the postoperative complication rate in donors and recipients, we reviewed retrospectively 90 consecutive living related kidney transplants in a multicentric study. All nephrectomies were performed extraperitoneally through a left flank incision. RESULTS: Major perioperative complications (first 3 weeks after surgery) occurred in 12 subjects: these included bleeding (2.2%), symptomatic pneumothorax (1.1%), iliac thrombophlebitis (3.3%), iliac artery dissection (1.1%), laparotomic dehiscence (2.2%), perirenal hematoma (1.1%), renal artery stenosis (1.1%), urinary fistula (1.1%). Minor perioperative complications took place in 8 cases. One recipient died. Donor postoperative major complications occurred in 2 subjects. CONCLUSIONS: On the basis of these results we conclude that living related kidney transplantation is an important treatment of end stage renal disease, due to the associated low major complication rate and the high feasibility of this methodology.

[Arterial complications of renal transplantation. Experience with 360 cases]. / Sulle complicanze arteriose dei trapianti di rene. Esperienza su 360 casi.

The Authors report the arterial complications observed in a 360 kidney transplantations experience. They analyze the etiological, diagnostic and therapeutic features.

[Considerations on 12 cases of mesenteric embolism treated surgically]. / Considerazioni su 12 casi di embolia mesenterica trattati chirurgicamente.

Twelve cases of mesenteric artery embolism surgically treated with a surviving rate of 66% are reported. The Authors point out the diagnostic features and the various factors affecting the surgical result.

[An aneurysm of the inferior pancreaticoduodenal artery: a surgically treated case]. / Aneurisma dell'arteria pancreatico duodenale inferiore: su un caso sottoposto ad intervento chirurgico.

Aneurysms of the lower duodenal pancreatic artery are an extremely rare dilatative arterial pathology. Diagnosis is often difficult and rupture is a frequent clinical evolution; surgical therapy, especially when rupture has already occurred, entails a high risk of operative mortality. A case is described of aneurysm of the lower duodenal pancreatic artery which was treated by elective surgery with good results.

[Extra-anatomical bypasses: axillofemoral and femorofemoral. Indications and results]. / I by-pass extra-anatomici: "axillofemorali e femorofemorali". Indicazioni e risultati.

Indications for a unilateral or bilateral axillofemoral and femorofemoral bypass, are presented. Our experience in 48 patients with axillofemoral and femorofemoral form the basis of this report. Indications for these extended bypasses included suppurative growing infection and obliterated common and profunda femoris arteries. These procedures were rapidly performed in critically ill patients. One patient died of recurrent artoduodenal hemorrhage three days following successful axillofemoral bypass. The other patients enjoyed patent grafts for variable periods, although some of them successfully underwent a declotting procedure.

Popliteal artery entrapment syndrome (report on seven cases).

In connection with 7 cases of the popliteal artery entrapment syndrome observed, the Authors discuss certain anatomical, clinical, diagnostic and therapeutic aspects of the cases.

[An unusual case of aneurysm of the artery of the quadriceps]. / Un caso insolito di aneurisma dell'arteria del quadricipite.

A case of gastrocnemia artery aneurysm observed before the appearance of clinical complications is reported. This localization is up to date unreported. The clinical behaviour and the angiographic investigation did not allow to identify the site of the arteriopatic lesion. This was possible only with surgical treatment.