Renal transplant compartment syndrome: a case report.

An unusual case of early double kidney transplant dysfunction due to abdominal compartment syndrome is herein reported. A 62-year-old woman on peritoneal dialysis underwent dual kidney transplantation. The grafts were positioned extraperitoneally in both iliac possae using standard techniques. Surgical procedures and immediate postoperative period were uneventful. The urine output was immediate and the creatinine decreased, but in a few days she developed severe ascites with reduced urine output, increased creatinine, and progressive changes on Doppler ultrasound. The patient underwent paracentesis: the kidney function recovered as well as the Doppler ultrasound. Kidney biopsy was negative for rejection or renal pathology. Graft dysfunction was related to the presence of ascites. A catheter inserted in the abdomen measured intra-abdominal pressure (IAP) of 14 mm Hg. IAP correlated with renal function showing that IAP probably explained renal flow modifications.

Pyramidal tract side effects induced by deep brain stimulation of the subthalamic nucleus.

OBJECTIVE: To study the pyramidal tract side effects (PTSEs) induced by the spread of current from the subthalamic nucleus (STN) to the pyramidal tract (PT), in patients with parkinsonism undergoing STN stimulation. METHODS: 14 patients bilaterally implanted with tetrapolar electrodes were assessed. For each side separately, the threshold of adverse effects induced by monopolar stimulation delivered by the chronically used contact was detected. The voltage was progressively increased until the patient experienced discomfort. All the PTSEs induced at 130 Hz (high-frequency stimulation (HFS)) and 2 or 3 Hz (low-frequency stimulation (LFS)) were videotaped. By superimposing the preoperative and postoperative MR images, the minimum distance (R) from the centre of the used contact to the medial border of the PT were measured. RESULTS: The progressive increase in voltage at HFS induced tonic motor contractions, mainly located in the face, in 27/28 electrodes. LFS induced synchronous rhythmic myoclonus in the same territory. PTSEs induced at threshold voltage by HFS were observed in the upper face at 13/28 electrodes (bilaterally in six cases) and in the contralateral lower face at five electrodes. A positive correlation was found between the stimulus intensity capable of eliciting motor contractions at HFS and R. CONCLUSIONS: HFS of the STN preferentially activates the corticobulbar tract over the corticospinal tract. Therefore, cranial motor contractions need to be looked for during electrical parameter setting. The positive correlation between the electrical intensity threshold for PTSEs and R reflects the need for millimetre accuracy in electrode positioning.

[Cystic lymphangioma of the adult: our experience and review of literature]. / Linfangioma cistico dell'adulto: nostra esperienza e revisione della letteratura.

Cystic lymphangioma is an uncommon benign pathology, usually reported in children, rarely in adult. Its embryopathogenesis is still controversial: it seems to arise from the lymphatic vessels, mainly in the cervico-cranial district. It is macroscopically characterised by multiple cystic non-communicating concamerations. Definitive diagnosis used to be intraoperative and was usually an unexpected finding. Nowadays, with modern imaging technologies, CT and MRI, diagnosis can be assumed before intervention even though certain diagnosis can still be reached only with histological examination. Imaging techniques can help for a precise mapping of the lesion and definition of its limits with the other structures, improving therapeutic success. Various therapeutical options are reported in literature, but complete surgical excision is still considered the best approach and the most successful. The Authors report their experience and review the literature on cystic lymphangioma in adult.

Reactivity of ubiquinones and ubiquinols with free radicals.

The reactivity of quinones 1-4 and of the corresponding quinols 5-8 towards carbon- and oxygen-centred radicals were studied. All quinones bearing at least one nuclear position free, readily react with alkyl and phenyl radicals to afford the alkylated quinones 12-24; however, quinones 1 and 3 reacted with 2-cyano-2-propyl radical to yield products (the mono- and di-ethers 9-11) derived from the attack on the carbonylic oxygen. The reactions carried out on quinones with the benzoyloxy radical led to no reaction products and in the case of Q10, the isoprenic chain also remained unchanged. Quinols 5-8 reacted only with oxygen-centred radicals (benzoyloxy and 2-cyano-2-propyl-peroxy radicals) to give the corresponding quinones. The isoprenic chain of Q10 did not undergo attack even with peroxy radicals. Carbon-centred radicals resulted unable to abstract hydrogen from the studied quinols.

[Deep venous thrombosis after leg amputation. Review of the argument]. / La trombosi venosa profonda dopo amputazione degli arti inferiori. Review sull'argomento.

Patients undergoing lower extremity amputation are perceived to be at high risk for deep vein thrombosis (DVT). DVT can cause micro or macro pulmonary embolism and often the post-thrombophlebitic syndrome. The chronic condition can affect patient quality of life and his residual working capacity. Usually the echo-Doppler or the color-Doppler is used as a prevention and diagnostic method, identifying patients at high risk. Following the Authors examine and report the Literature opinion about the topics.

[Angioneurosis due to vibrating tools with special reference to plethysmographic and Doppler vascular diagnosis]. / L'angioneurosi da strumenti vibranti, con particolare riferimento alla diagnostica vascolare pletismografica e Doppler.

Angioneurosis, together with bones and joints disorders, represents the most frequent clinical syndrome due to vibrating instruments. The authors report a general presentation of the disease, particularly focused on indications, usefulness and methods of plethysmography and Doppler C.W., as noninvasive diagnostic procedures.

[Jejunal adenocarcinoma: case report and review of the literature]. / Adenocarcinoma isolato del digiuno: considerazioni su un caso e revisione della letteratura.

Adenocarcinoma of the jejunum is a rare tumor. The diagnosis is often difficult and not early. The Authors report a case recently observed in their clinical practice and successfully operated, reporting also what's in the literature about.

[Abdominal tuberculous lymphadenitis simulating pancreatis cancer]. / Linfoadenite tubercolare addominale simulante un carcinoma pancreatico.

The Authors report the case of a patient symptomatic for fever, weight loss and abdominal pain submitted to abdominal sonography and CT which identified a mass of the pancreatic head. The patient underwent laparotomy plus biopsy; the istologic and bacteriological diagnosis demonstrated a tuberculous lymphoadenitis in spite of a normal cutaneous tuberculin test. Abdominal localization of TBC infection therefore is increasing in epidemiological studies, and thus it must be included in the differential diagnosis of subdiaphragmatic disease.

[Vascular bench surgery in renal transplant]. / Chirurgia di banco vascolare nel trapianto di rene.

The development in the number of patients for renal transplants has not been matched to the kidneys supplied. On this subject the authors think that this chronic deficit could be improved by making use of all the organs by using a series of technical means during bench surgery; which enable optimisation of use of kidneys with vascular abnormalities or those injured upon removal. The authors report their experience of 450 renal transplants operated between January 1981 and December 1985 and of the evolution vascular bench surgical techniques which enable use of a considerable number of kidneys which would otherwise have been discarded. Moreover, it helped the implant, shortened surgery time without prolonging hot ischemia, and did not increase the number of complications.

[Renal transplantation in patients over 60 years of age. An increasing clinical reality]. / Il trapianto renale nei pazienti ultrasessantenni. Una realtà clinica in aumento.

The elevation of the uremic population age, the longer survival of dialysis, the increasing number of elderly donors, together with the safer surgical, anesthesiological and immunological procedures have led all over the word to an improvement of over 60s patients transplantation program, with very good results. The authors present their own experience of renal transplantation in elderly recipients and a review of what is reported in the literature on the question.

[Retrorectal hamartomatous cysts or "tail gut syndrome": a case report and review of the literature]. / Cisti amartomatosa retrorettale o "tail gut syndrome": caso clinico e revisione della letteratura.

Retrorectal cyst hamartomas or so called tail gut syndrome are dystopic lesions, rarely reported in Literature, characterized by the presence of cysts lined by mucous-producing ciliated epithelium. The Authors report a case, recently observed and surgically treated, in a 55 year old male, hospitalized because of an abscess and fistula in the right buttock diagnosed to be a cyst hamartoma. The Literature is reviewed as well.

[Pregnancy in women undergoing a kidney transplant. Our experience and a review of the literature]. / Gravidanza in donne sottoposte a trapianto renale. Nostra esperienza e review della letteratura.

The chances of pregnancy for uremic women are usually very low, because of hormonal balance changes which determine a strong reduction in fertility. Epidemiological studies reveal that pregnancy in hemodialyzed women in fertile patients 4.6-6 months after a well functioning kidney transplant, one fertile transplanted woman over 50 can become pregnant. In the first transplant era, pregnancy after kidney transplant was considered "a big hazard", especially because of the possible side-effects of immunosuppression drugs on foetus development, and the risk of a worsening in the mother's renal function. Therefore, women were strongly recommended to avoid pregnancy. More recently, several reported papers have shown that pregnancy can be safely carried on also by transplanted women, under careful criteria and monitoring. Our experience too, even if limited in number (4 patients) reported in this article confirms this conviction.

Differential effect of alpha-tocopherol and ascorbate on oxidative injury induced in immune cells by thermal stress.

As immune cells are often subjected to hyperthermia that can easily occur either after intense and/or prolonged exercise or during defense against pathogens, in this paper we analysed whether superoxide anion production occurred in lymphocytes exposed to high temperature and, consequently, if antioxidants could exert any protective function. The results demonstrated that an increase of superoxide anion was induced in rabbit lymphocytes exposed to 42 degrees C for 1h, although cell viability was no affected. However, suppression of either Pokeweed mitogen (PWM)-driven cell proliferation, or immunoglobulin production or IL-2 synthesis was observed. To evaluate the capacity of antioxidants to restore the immune suppressed responses, two vitamins, alpha-tocopherol and ascorbic acid, were added to PWM-stimulated cultures following heat treatment. The data demonstrated that alpha-tocopherol was able to totally abrogate the inhibitory effects mediated by thermal stress, while ascorbic acid did not give any protective results.

[Technique of vascular reconstructive bench surgery in pancreas transplantation]. / Tecnica di chirurgia ricostruttiva "su banco" degli assi vascolari nel trapianto di pancreas.

Vascular reconstructive bench surgery has become a basic step in pancreas transplantation, in order to prevent vascular thrombosis. The Authors describe their experience, also reporting literature results.

[Interstitial radiotherapy with 125I in non-resectable pancreatic carcinoma]. / Radioterapia interstiziale con 125I nel carcinoma pancreatico non resecabile.

The authors analyze results of 220 patients suffering from pancreatic cancer treated in their department from 1982 to 1992. Among these patients 24 of them underwent surgical operation for positioning of radioactive pills. The discussion is on indication and results of this technique, considering also what's reported in scientific literature on the argument.

[Malignant neoplasms arising "de novo" after a kidney transplant. Our experience and a review of the literature]. / Neoplasie maligne "de novo" insorgenti dopo trapianto renale. Nostra esperienza e revisione della letteratura.

The incidence of "de novo" cancers in kidney transplanted patients, especially because of immunosuppressive treatment, seems to be increased. The authors analyse their experience and review the literature.