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

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 plane and dangerous for the underlying presence of the graft. MATERIALS AND METHODS: A case of incisional hernia in a kidney transplant recipient was repaired by laparoscopic mesh technique. The polypropylene-polyglycolic acid composite mesh was fastened with a mixed technique of absorbable tacks for medial margin of the defect and fibrin sealant for the lateral side in contiguity with graft surface. RESULTS: The patient was discharged after 4 days. The 6-month follow-up did not show mesh displacement or recurrence of hernia. CONCLUSIONS: The laparoscopic mesh repair may become the criterion standard for kidney transplant patients affected by incisional hernia. The difficulties of mesh fixation close to the graft can be overcome by the combination of fibrin sealant glue and absorbable tacks at different margins of the wall defect. This technique may offer advantages for this population of patients.

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

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 tubular scaffold to create a biliary-digestive anastomosis as well. For the above evaluation, 5 animals were used and killed after 15 days and 5 animals after 3 months. At 15-day and 3-month follow-ups, the fibrillar structure was not digested by lytic action bile. The fibers of the scaffold were organized despite being in contact with bile action. A new epithelial tissue appeared on the scaffold surface suggesting the suitability of this scaffold for future studies of the repair of biliary tract injuries with the use of resorbable copolymer on biliary injuries.

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

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,ß-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 with the use of the external iliac vessels. The flow was assessed by means of Doppler ultrasound examination weekly, and 1 month after the implantation we removed the scaffold for histopathologic evaluation. RESULTS: The implants showed a perfect leak-proof seal and adequate elastic tension to blood pressure. About ∼3 weeks after the implantation, Doppler examination revealed thrombosis of the graft, so we proceeded to its removal. Histologic examination showed chronic inflammation, with the presence of foreign body cells and marked neovascularization. The material had been largely absorbed, leaving some isolated spot residues. CONCLUSIONS: The biocompatibility of PHEA-PLA/PCL and its physical properties make it suitable for the replacement of vessels. In the future, the possibility of functionalizing the material with a variety of molecules, to modulate the inflammatory and coagulative responses, will allow obtaining devices suitable for the replacement of native vessels.

The medical and surgical treatment in secondary and tertiary hyperparathyroidism. Review.

INTRODUCTION: Hyperparathyroidism is an alteration of the pathophysiological parathyroid hormone (PTH) secretion due or an independent and abnormal release (primary or tertiary hyperparathyroidism) by the parathyroid or an alteration of calcium homeostasis that stimulates the excessive production of parathyroid hormone (secondary hyperparathyroidism). AIMS: There is not a standard, clinical or surgical, treatment for hyperparathyroidism. We review current diagnostic and therapeutic methods. DISCUSSION: In secondary hyperparathyroidism (2HPT) there is a progressive hyperplasia of the parathyroid glands and an increased production of parathyroid hormone. Several causes are proposed: chronic renal insufficiency, vitamin D deficiency, malabsorption syndrome. The tertiary hyperparathyroidism (3HPT) is considered a state of excessive autonomous secretion of PTH due to long-standing 2HPT and it's usually the result of a lack of suppression in the production of PTH. The pathophysiological implications are both skeletal and extraskeletal: it damages the cardiovascular system, nervous system, immune, hematopoietic and endocrine system. The introduction of new drugs has improved the survival of these patients, allowing the inhibition of the synthesis of PTH. Indication for surgical treatment is unresponsive medical therapy. CONCLUSIONS: There are no large prospective studies that comparing the medical and surgical treatment. The choice is not unique and we have to consider the singolar case and the clinical condition of the patient.

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

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 samples were collected before surgery at anesthesia induction for PTH testing intraoperative (rapid assay) and central laboratory, and 10 minutes after the removal of each gland. The times from collection-processing to communication to the surgeon of the results were compared for both the methods. It was considered successful the abatement of PTH of ≥70% at rapid intraoperative testing and consequently surgical intervention stopped before communication of central laboratory PTH testing. RESULTS: The average time of reporting the test results of the central laboratory was 41.5 minutes (SD ± 9), whereas with the rapid intraoperative PTH (ioPTH) testing the average time was 9.9 minutes (SD ± 2.02). An average of 33.6 minutes of the duration per intervention (SD ± 10.27) were virtually saved with the use of ioPTH testing. The 2 values of the Pearson correlation (ρ) of 0.99 obtained (for baseline) and 0.975 (for the 10-minute) lead us to conclude that there is an excellent correlation between the series of data. CONCLUSIONS: Rapid ioPTH testing, owing to its accuracy, permits a dramatic reduction of operating time for patients with secondary hyperparathyroidism that need to be treated before inclusion on the waiting list.

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 to evaluate the graft function in the immediate postoperative period and in the following days. The onset of RACS involves a surgical decompression of the graft and the subsequent closure of the abdominal wall with tension-free technique. Several authors agree that only the immediate surgical decompression following an early diagnosis can ensure a recovery of the graft. Early detection of the RACS is the key to preventing the loss of the graft. It is desirable to prevent this syndrome by reducing the discrepancy in weight between donor and recipient by 17%. However the shortage of organs makes such a selection not easy; therefore, in cases at risk for RACS, a close instrumental and clinical monitoring of the patient during post-transplantation recovery is recommended, so a prompt surgical decompression can be performed if RACS is suspected.

Bimodal regulation of p21(waf1) protein as function of DNA damage levels.

Human p21(Waf1) protein is well known for being transcriptionally induced by p53 and activating the cell cycle checkpoint arrest in response to DNA breaks. Here we report that p21(Waf1) protein undergoes a bimodal regulation, being upregulated in response to low doses of DNA damage but rapidly and transiently degraded in response to high doses of DNA lesions. Responsible for this degradation is the checkpoint kinase Chk1, which phosphorylates p21(Waf1) on T145 and S146 residues and induces its proteasome-dependent proteolysis. The initial p21(Waf1) degradation is then counteracted by the ATM-Chk2 pathway, which promotes the p53-dependent accumulation of p21(Waf1) at any dose of damage. We also found that p21(Waf1) ablation favors the activation of an apoptotic program to eliminate otherwise irreparable cells. These findings support a model in which in human cells a balance between ATM-Chk2-p53 and the ATR-Chk1 pathways modulates p21(Waf1) protein levels in relation to cytostatic and cytotoxic doses of DNA damage.

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/storage. In addition to histologic analysis of collected pancreata, we analyzed the number of CK19(+) cells and their viability using chi-square tests with values P < .05 considered to be significant. Rat pancreas histology showed as University of Wisconsin in situ perfusion and preservation by the two-layer method to be more effective to maintain the morphologic integrity of both exocrine and endocrine tissues. There were a larger number of CK19(+) cells with good viability. Moreover, the effects of oxygenation were visible in pancreas biopsies preserved after exsanguination. In situ University of Wisconsin perfusion and preservation for 240 minutes with the two-layer method yielded greater numbers and viability of CK19(+) cells even after 8 weeks of cryopreservation.

A case report of a difficult dissection of the iliac vessels conducted by means of the harmonic scalpel during a kidney transplantation.

BACKGROUND: The "difficult" preparation of iliac vessels in the kidney transplant recipient caused by a perivascular fibrosis with satellite lymphadenopathy is sometimes burdened by post-transplant complications (lymphocele, seroma and hematoma). Both iliac vascular adhesions and satellite lymphoadenopaty are often due to reiterate femoral cannulation aimed to hemodialysis. PATIENTS AND METHODS: The case report concerns a 60 years old female uremic patient, on dialysis for about 4 years with perivascular fibrosis and pelvic lymphadenopathy caused by bilateral femoral artery catheterization. In the course of kidney transplant, preparation of the iliac vessels was performed by ultrasonic scalpel. In the case we handled there was no incidence of immediate, medium and long term post operative complications, with a considerable reduction of the operative time in the vascular dissection performed without ligation. Often the long dialytic period, the same nephropathy, reiterative femoral catheterization determine perivascular fibrosis and/or consensual lymphadenopathy. In these cases, in light of initial experience, the use of ultrasonic scalpel enables easy dissection by the coagulative synthesis not only of vascular compartment but also of the lymphatic duct whose leakage, particularly in these cases, creates a favourable condition to hematoma and/or lymphocele formation. These complications, although rarely jeopardize patient's life, however, may affect the outcome of transplantation in terms of morbidity and survival of the organ. The use of ultrasonic scalpel ensures total control of vascular and lymphatic compartment coagulation, alongside a reduction in the time of surgical dissection.

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 differentiation process at -196 °C for 8 weeks before culture in the same medium. The results revealed that TLM was better than UW as a preservation solution in terms of beta-cell viability and insulin secretion. We suggest that the use of TLM solution allows one to obtain less damaged cells for research purposes.

Double endocrine neoplasia in a renal transplant recipient: case report and review of the literature.

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 a young woman who underwent renal transplantation. CASE REPORT: A 37-year-old woman with end-stage renal disease for 18 years underwent transplantation when she was 30 years old with a 17-year-old standard cadaveric donor receiving immunosuppressive therapy with mycophenolate mofetil, cyclosporine, and steroids. Follow-up demonstrated good indices of renal function with negative tumor pathology at 79 months when, at an annual ultrasound monitoring, we found a lesion in the right lobe of the thyroid and left adrenal neoplasm of dubious interpretation. The cytology for the thyroid was highly suspicious of papillary carcinoma, whereas the histological examination after surgery diagnosed a thyroid multifocal papillary microcarcinoma (mpT1NxMx) and an oxyphil cell adrenocortical carcinoma (pT2, N0). RESULTS: Six months after total thyroidectomy with central lymphadenectomy and left kidney and adrenal gland removal the patient showed no evidence of recurrent lesions and stable graft function. CONCLUSIONS: The rare occurrence of solid tumors after transplantation has no known etiopathogenetic relation. Despite the young age of the patient and the double neoplasm that could have produced an unfavorable outcome for the patient and the graft, careful follow-up for tumor pathologies and multidisciplinary management achieved an early diagnosis of both tumors with a surgical eradication without adjuvant therapy, preserving the life of the patient and the function of the graft.

[Differentiated microcarcinoma of the thyroid gland]. / Il microcarcinoma differenziato della tiroide.

BACKGROUND: The thyroid microcarcinoma is a tumor with maximum diameter of 10 mm (WHO). For the most part is not clinically palpable and not evident by imaging investigations. The papillary microcarcinoma is the most common form of thyroid cancer, followed by follicular microcarcinoma. The aim of our study is to assess the frequency of microcarcinoma, the association of benign thyroid disease himself and the controversial surgery. PATIENTS AND METHODS: We analyzed 391 patients (321 F and 70 M) who underwent total thyroidectomy from 2004 to 2009 at a Unit of General Surgery, Uremic and Organ Transplant, Hospital of Palermo. RESULTS: 42 carcinomas were detected, of which 24 PTMC and 1 follicular microcarcinoma. The PTMC was associated with cancer in only 2 cases (papillary carcinoma and parathyroid carcinoma) in the remaining thyroid tissue was suffering from benign disease (20 goiters, 3 Hashimoto thyroiditis, a trabecular adenoma). TALK: Controversial is still the type of surgery to be performed in case of differentiated thyroid microcarcinomas, as well as the indication is still debated to lymphadenectomy. CONCLUSIONS: Papillary microcarcinoma of the thyroid in our series, represents 57% of all thyroid cancers. Microcarcinoma and benign thyroid disease association (76.92% of cases) was high. The therapeutic attitude adopted by us was total thyroidectomy associated with conservative lymphadenectomy in the presence of palpable lymph nodes, instead to abstaining in the absence of clinical evidence of nodal metastases.

Primary malignant fibrous histiocytoma of the mesocolon transversum.

Primary malignant fibrous histiocytoma (MFH) is a rare and biologically aggressive tumor. Differential diagnosis must include cystic neoplasms of the pancreas (mucinous and serous cystoadenoma or cystocarcinoma), cystic lymphangioma or mesothelioma and retroperitoneal haematoma. Making the right diagnosis preoperatively may be often difficult, but MFH may be suspected when a huge retroperitoneal mass is found at imaging in elderly patients. We report a case of a primary abdominal MFH originating from the mesocolon transversum.

Informed consent in high-risk renal transplant recipients.

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 consent models, this has not yet been accompanied by the necessary legislative development. The informed consent model to be presented to the kidney transplant candidate should include a detailed description of the recipient's comorbidity and should aim at reducing the number of medicolegal actions, which have become more and more frequent in the last few years due to the ever increasing number of patients considered as suitable for transplantation. Informed consent, therefore, should not be a mere bureaucratic formality to be obtained casually, but should be carefully stipulated together with the patient by the transplant surgeon. It is, in fact, an indispensable condition for transforming a potentially illegal action, that is, the violation of an individual's psychophysical integrity, into a legal one.

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 and a stepwise regression, with posttransplant intact parathyroid hormone (iPTH) as the dependent variable and other variables as regressors. A statistically significant correlation was observed between PYD and alkaline phosphatase (ALP; P = .0026, r = .41); PYD and DPD (P = .015, r = .34); pre- and posttransplant iPTH (P = .024, r = .31); and creatinine and ALP (P = .024, r = .31). Taking the groups separately, there were significant correlations between PYD and ALP (P = .0076, r = .42); PYD and DPD (P = .017, r = .38); ALP and posttransplant iPTH (P = .038, r = .33); osteocalcin (OC) and posttransplant iPTH (P = .048, r = .32); and pre- and posttransplant iPTH (P = .019, r = .37) among subjects in the first group, whereas subjects in the second group showed a correlation between posttransplant iPTH and age at transplantation (P = .032, r = .61). In conclusion, we showed that urinary cross-links may be helpful to reveal bone resorption in kidney recipients when usual bone metabolism parameters do not demonstrate hyperparathyroidism.

Isolation and culture 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-like structures. These cells were stained for the pancreatic ductal cell marker cytokeratin-19 (CK-19) and the pancreatic endocrine markers insulin and glucagon. After the second week, 90% of cells were positive for CK-19. Up to 20.1% of the cells in pancreatic 3-dimensional structures induced by 17.8 mmol/L glucose were positive for insulin, and <3.2%, for glucagon. The positive ratio of immunoreactive staining was dependent on the glucose concentration; 17.8 mmol/L glucose effectively stimulated insulin- and glucagon-secreting cells. We concluded that porcine Wirsung duct cells were capable of proliferation with the potential to differentiate toward beta cells upon glucose induction in vitro.

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 distal graft ureter had caused a giant urinoma. The patient was reexplored on day 2 posttransplantation with a primary fascial approximation. Thirty days after transplantation we discovered a large incisional hernia and performed a repair. No drain was used. The patient continued immunosuppressive therapy (cyclosporine, mycophenolate mofetil, prednisolone) and was discharged on postoperative day 4 with no complications. An ultrasonographic follow-up at 1 year revealed the prosthesis to be correctly positioned. Incisional hernia is not rare after renal transplantation but the real incidence is unknown. Immunosuppressive therapy, prolonged pretransplantation dialysis, obesity, and diabetes are probably the major causes of incisional hernias in these patients. Surgical complications of renal transplantation surgery, such as wound hematoma, urinoma, and lymphocele, are the most important predisposing factors for an incisional hernia. The use of intraperitoneal ePTFE dual-mesh is feasible, safe, and easy to repair a large incisional hernia in a kidney transplant patient.

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

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 hemorrhagic erosive gastritis of patients with regard to the treated HP-Positive and nontreated HP-Positive patients (2 vs 3) and between the HP-negative patients and the nontreated HP-Positive patients (2 vs 3). The presence of gastric or duodenal ulcers was significantly higher in the nontreated patient than in the treated HP-positive patients (5 vs 1; P=.05) and significantly higher in the nontreated HP-Positive patients than in the HP-negative patients (5 vs 0; P=.05). We concluded that HP-positive patients should therefore be treated for the infection to avoid a long-term significant increase of gastric and/or duodenal peptic disease subsequent to renal transplantation in these immunodepressed subjects.

[The role of colonoscopy in patient follow-up after surgery for colorectal cancer. A retrospective study and review of the literature]. / L'utilità della colonscopia nel follow-up dei pazienti operati per cancro del colon-retto. Analisi retrospettiva e revisione della letteratura.

To improve survival rate after colon or rectum resection for cancer patients should be strictly followed up in order to identify possible local disease relapse or metachronous neoplasia. From October 2002 to January 2006, 864 patients had undergone colonoscopy and 68 were treated surgically for colorectal adenocarcinoma. Of these, 36 were men and 32 women, with a mean age of 63 years. Nineteen of the patients underwent a left colectomy, 28 an anterior resection, 18 a right colectomy and 3 a resection of the transverse colon. For all these patients follow-up program include a colonoscopy performed annually for the first two years, and subsequently, if the results were negative, after a further three and then five years. Out of 68 patients, 2 showed suspect anastomotic recurrence, which proved to be granulomas at the histological examination. In addition, in 11 cases, there were 3 right colon adenomatous polyps, 2 transverse colon polyps (one villous and the other tubular), 5 descending colon polyps (three tubular and two villous) and 1 tubulo-villous polyp of the rectum. No metachronous neoplasias were observed. An examination of the data resulting from our own 68 cases shows that, in spite of the fact that no local disease relapse or metachronous neoplasia was observed, the identification of 11 polyps would suggest that the use of colonoscopy in such patients might be the gold standard for early diagnosis of recurrences and new polyps.

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 more at 15 minutes was predictive for the success of abnormal parathyroid gland removal. The application of this technique during subtotal parathyroidectomy results was useful to predict a correct excision of abnormal parathyroid glands among patients with secondary hyperparathyroidism on the waiting list and for tertiary hyperparathyroidism patients.