[Renal transplantation in Bologna]. / Il trapianto renale a Bologna.

From october '76 to march '79 at the Clinica Chirurgica I of the University of Bologna 50 renal graft have been performed with living donor in 8 cases and with cadaver donor in 42. In the living donor group there was one death for rejection and sepsis. The remaining 7 patients are all alive with normal renal function. Among the 42 patients with cadaver donor 6 died: 3 early (one for gastric hemorrage, one for necrosis of the ascending colon, and one for rejection) and 3 late (two following many rejection episodes and one for miocardial infarction). 6 more patients underwent transplantectomy (4 for acute and 2 for chronic rejection). The 27 remaining patients have normal renal function. The only early important surgical problem was one urinary fistula in the 15th postoperative day successfully reoperated. The major late surgical complication was a renal artery stenosis distal from the arterial anastomosis followed by difficult but effective surgical correction. The authors regret not having been able to use more than half of the possible cadaver donors for refusal of the relatives.

[Clinico-statistical analysis of the problem of the cadaver donor in renal transplantation (clinical experience from 1945 to the present time)]. / Analisi clinico-statistica del problema del donatore cadavere in funzione del trapianto di rene (esperienza clinica dal 1975 ad oggi).

The series of cadaver donors in Bologna hospitals from 1975 to today is reviewed. All possible donors were compared with those actually utilized and the reasons that led to renunciation in a large percentage of cases are analysed. The examination shows that among the factors limiting the number of donors utilized particularly important were the criteria adopted for establishment of donor suitability, family consent and the results of support therapy of the donor's vital functions.

Alterations in the enzyme profile in intensive care patients undergoing total parenteral nutrition.

Total parenteral nutrition (TPN) has been demonstrated to be an effective therapeutic means in improving the clinical course of the critically ill patients. Various metabolic complications are described; the cause of some of these remain unclear. The changes in some plasma enzyme indices (GOT, GPT, GIDH, LDH, HBDH, CPK, ChE, AP, gamma-GT) in two groups of critically ill patients undergoing TPN (group with more marked enzyme alterations and group with less marked alteration) were examined. Two types of alterations were found: (1) early increase of some enzymes (GOT, GPT, GIDH); (2) constant increase of plasma enzyme level during TPN (AP, gamma GT). These two evolutionary patterns were more evident in the complicated group and the enzyme changes were statistically significant for GOT and GPT (P = 0.05) and not significant for initial values of G1DH, ap and gamma-GT. Both groups presented constant elevated plasma values of LDH, HBDH, CPK and depressed constant ChE value during treatment; the difference was not significant in both groups for the same enzymes. The data were interpreted from a functional point of view; that is they were related to both the metabolic post-aggressive state and TPN. A relationship between the rate of protein catabolism and the inductive increase of some enzymes (GOT, GPT, G1DH) was found. Whereas a final induction in the energy metabolism is suggested for other enzymes (LDH, HBDH), the alteration of CPK, AP, gamma-GT and ChE was interpreted as dependent on: (1) direct muscular trauma (CPK); (2) functional increase in relation to the duration of TPN (AP and gamma-GT); (3) possible depressed malnutritive synthesis (ChE). The improvement of the enzymatic patterns with the early use of TPN and with the improvement of clinical and nutritional conditions was emphasized.

RNA-synthesis in rat kidneys after fluorinated anesthetics or inorganic fluoride administration.

RNA-synthesis in rat kidneys is affected by the administration of 0.5% methoxyflurane and 1% enflurane; also fluoride, a product of fluorinated anesthetics metabolism, hinders renal RNA-synthesis in rats.

Metabolic changes during prolonged total parenteral nutrition in intensive care.

Intensive care patients receiving prolonged total parenteral nutrition (TPN) developed alterations of liver function tests, seen in the activity of certain serum enzymes. Hepatomegaly and jaundice sometimes appeared. The changes in chemical pathology were in serum transaminases activity (GOT, GPT, GDH); alkaline phosphatase and gamma-glutamyltranspeptidase as indices of cholestasis; lactate dehydrogenase, hydroxybutyrate dehydrogenase and creatine phosphokinase, as enzymes related to energy metabolism; pseudocholinesterase, as a protein metabolism-related enzyme. The possible causes of these alterations in critically ill patients undergoing TPN are considered and a functional final metabolic interpretation is proposed.

[Thoracic injuries and resuscitation. Case reports and critical review]. / Traumi del torace in rianimazione. Contributo casistico e revisione critica

A series of 68 chest injuries treated at the Resuscitation and Intensive Care Unit. S. Orsola Policlinic, Bologna, between May 1967 and December 1973 is presented. Treatment was given by the staff of the anaesthesia and resuscitation service and the chest surgery section, 2nd Surgical Clinic, University of Bologna. The types of case observed and the treatment methods employed are bierfly explained, together with the clinical and statistical data. Emphasis is laid on the relation between clinical course and blood gas values. The value of tracheostomy and protracted intubation is discussed, together with the utility of antalgic and psychosedative management. The increased frequency of bronchopneumonic complications is noted. Encouraging results obtained by surgical stabilisation of movable flaps by means of Kirschner wires are reported. While this method admittedly requires thoracotomy, this in itself has the advantage of enabling existing pleural and pulmonary lesions to be repaired.