Extracorporeal membrane oxygenation as a bridge to organ donation: a case report.

Hemodynamic instability is a frequent complication in potential organ donors. Despite maximal medical therapy, it can lead to cardiac arrest with consequent loss of organs. In this study we present the use of extracorporeal membrane oxygenation circulation (ECMO) as a bridge to organ procurement in a potential donor with hemodynamic instability. A 14-year-old girl who drowned in a pool experienced cardiorespiratory arrest with prolonged resuscitation. In the intensive care unit (ICU), she displayed hemodynamic instability requiring high doses of inotropis agents. After 60 hours for ICU admission clinical diagnosis of brain death, was established and consent for organ donation obtained. During the observation period, the hemodynamic instability worsened, requiring ECMO which was continued during transport to the operating room and during organ retrieval, totaling 3 hours. We retrieved liver, kidneys, heart valves and cornea. Liver and kidney transplantations were successfully performed in 3 recipients, all of whom displayed appropriate organ functions after 15 months. In conclusion, ECMO support of potential donors can be used to prevent cardiac arrest, preserve organs, and thus increase the number of potential donors.

Type I autoimmune hepatitis: clinical course and outcome in an Italian multicentre study.

BACKGROUND: Many reports of autoimmune hepatitis (AIH) were written in the 'pre-Hepatitis C era' and data on the natural history are still incomplete. AIM: To evaluate the clinical presentation and the natural history of type I AIH. METHODS: Seventy-three consecutive patients with a regular follow-up of at least 2 years were prospectively included in the study. The mean follow-up was 91 +/- 61 months. RESULTS: Patients with 'acute' onset at presentation were significantly older than patients with 'chronic' onset (P < 0.05) and had significantly higher serum levels of transaminase, gamma-glutamyltransferase and bilirubin; Prothrombin time was significantly lower in the said group compared with AIH patients with 'chronic' onset. In 4 of 63 (6.3%) female patients, AIH had the onset during pregnancy; in all of them the outcome of pregnancy was favourable. The major events during the follow-up included oesophageal varices (n = 9) and ascites (n = 4), and 60 patients remained in remission while receiving immunosuppression. None of the patients died during the follow-up, but seven patients were transplanted. The cumulative transplant-free probability of survival was 73.5% at 280 months. CONCLUSIONS: Elderly patients have more frequently an acute onset at presentation. Survival in AIH is apparently good; with early diagnosis, and improved medical therapy, liver transplantation for AIH will become a rare event in future.

[The Gemeprost test in the screening of endometrial pathology]. / Il Gemeprost nello screening della patologia endometriale.

A randomized clinical trial has been performed to evaluate the efficacy of intravaginal 1 mg Gemeprost for pre-operative cervical dilatation prior to vacuum aspiration and curettage for endometrial biopsy. Eighty-nine patients were evaluated, 51 treated with Gemeprost and 38 with placebo: in the first group biopsy was possible in 94% of cases vs 86% in the second group. Pain was significantly reduced with Gemeprost improving the success rate and the patient compliance.

Pelvic and para-aortic lymph nodal positivity in the ovarian carcinoma: its prognostic significance.

Our study is based on 29 patients with ovarian carcinoma in early stage (IA-IIB) having undergone total abdominal hysterectomy, with bilateral salpingo-oophorectomy, omentectomy, appendectomy and pelvic and paraaortic lymphadenectomy selective and bioptic. Out of the 29 patients 11 were classified I stage and 18 II stage. Within 3 years, out of 10 patients with node metastases, 1 is alive and free of disease, 6 deceased from the tumor and 3 are alive with residual tumor at various stages of invasion. Out of the 19 patients without nodes metastases 14 are alive and free of disease, 4 deceased from the tumor and 1 is alive with residual carcinoma. Survival related to histological type shows no statistically significant differences. Grading III has a survival of 27.6%, while the other two grades have a survival of 70% without significant differences. We can affirm that lymph nodes metastases represent the most reliable marker of high risk patients among the 3 risk factors (grading, histotype and nodes metastases) even if considered on a limited number of patients on the basis of preliminary data so obtained.

Surgical strategy management following lymph nodal positivity at the three levels (a retrospective and perspective study).

The purpose of this study is to evaluate the type of distribution, regular or irregular, of metastases in lymph nodes of I, II and III level. We inted also to establish if the levels of lymph nodal areas represent an evaluation index of prognostic risk more effective than other ones. The results evidenced that in 19.2% of all the classes N+ metastases were not increasing regularly from the level I to the level III. The influence of seven factors on disease free survival has been evaluated: pT, pN, number of metastatic nodes, ER+ or ER-, PgR+ or PgR-, grading, metastatic level at axillary lymph nodes. The present report points out that only the extent of tumor and lymph nodal level have a statistically significant influence on disease free survival. Comparison among disease free survival curves stage N0 with N+ at I level and with N+ at II level revealed that there is no significant difference of survival among these classes, while the comparison between the first 3 classes and N+ at III level is statistically significant.

Two cases of clinical Ib stage cervix carcinoma with exclusive metastases to presacral lymph-nodes.

There is regular progression of metastases through different stations of pelvic lymph nodes as far as para-aortic lymph-nodes in 81.1% of the cases examined of cervix carcinoma. In this paper we report two cases of squamous carcinoma of the cervix with metastases limited to one presacral lymph node, while other pelvic and para-aortic lymph nodes were free. These cases are two examples of irregularity of invasion of metastases from cervix carcinoma. It is extremely rare that presacral station is single and first invaded without extension of lower lymph nodal level. Our technique of pre-sacral lamina excision in connection with the inferior bridge of para-aortic and para-caval connective tissue during para-aortic lymphadenectomy is confirmed. The fatal outcome of the first patient's case is related to such risk factors lymph nodes metastases, deep infiltration of the cervix and involvement of lower section of the uterus. The second patient was free of disease within four months from surgery.

Primary choriocarcinoma of the fallopian tube: report of a case.

A case of the relatively rare condition of a choriocarcinoma in the fallopian tube is presented. The patient apparently recovered completely and quantitative beta hCG assay demonstrated negative results after TAHBSO and adjuvant chemotherapy. This brings the total cases reported to 77.