Reliability of individual acceleration-speed profile in-situ in elite youth soccer players.

The aims of this study were to describe differences in the acceleration-speed (A-S) profile in-situ and to assess the week-to-week reliability of the A-S profile in-situ over a given training cycle of elite youth soccer players, in relation to the number of sessions included and analyse the effect of the inclusion or not of a specific sprint session. In this retrospective study, 18 male elite U19 football players (179.4 ± 7.1 cm; 69.0 ± 9.5 kg) participated. GPS data collected from three consecutive typical training weeks were used to calculate different combinations of A-S profile in-situ variables (theoretical maximal acceleration [A0], theoretical maximal speed [S0] and the slope of the acceleration-speed [ASslope]). The number (and content) of sessions affected mainly S0 while A0 remained similar with or without a sprint session. The reliability of the A-S profile in-situ is more related to the spread of points rather than a specific number of sessions (and thus points) and was improved when a high percentage of maximum speed (i.e. ≥ 95%) was reached. The present study showed low week-to-week variability for A0, S0 and ASslope. However, practitioners need to make sure that the values cover a sufficient range of raw data [20-95% of maximum speed] to build a clear and consistent linear regression, and in turn extrapolate meaningful A-S profile values.

A sudden bilateral hearing loss caused by inner ear hemorrhage.

INTRODUCTION: Labyrinthine hemorrhage is a rare cause of sudden deafness and generally concerns only on one side. CASE SUMMARY: An 84-year-old man with a past medical history of myelomonocytic chronic leukemia (CMML) suffered from sudden bilateral hearing loss associated with vertigo. The audiogram revealed a left cophosis and a right profound deafness. Videonystagmography showed a left vestibular deficit. The MRI showed a spontaneous strong T1 weighted signal in the left and right labyrinths, corresponding to a bilateral inner ear hemorrhage (IEH). Dizziness resolved rapidly following vestibular physiotherapy, in contrast to hearing which did not improve at all and let the patient isolated in his environment. The patient successfully underwent cochlear implantation so that he could communicate. DISCUSSION: Most IEHs are unilateral and due to anticoagulants treatments and hematological diseases. Only rare cases have described bilateral labyrinth hemorrhage. This is the first case reported of bilateral labyrinth hemorrhage due to CMML.

Influence of Carotid Siphon Anatomy on Brain Aneurysm Presentation.

BACKGROUND AND PURPOSE: Intracranial aneurysm is a devastating disease of complex etiology that is not fully understood. The purpose of this study was to assess the implications of carotid siphon anatomy for the formation and development of intracranial aneurysms. MATERIALS AND METHODS: Between January 2007 and May 2015, lateral view digital subtraction angiographic images of 692 consecutive patients with intracranial aneurysms treated in our department of interventional neuroradiology were reviewed and had their angles measured. Data on the location, presentation, and size of the lesions were collected and evaluated by multivariate analysis in relation to the measured angles. RESULTS: Of 692 aneurysms, 225 (32.51%) ruptured and 467 (67.49%) unruptured, 218 (31.50%) were in the carotid siphon and 474 (68.50%) were distal to the siphon, and the mean aneurysm size was 7.99 ± 6.95 mm. Multivariate analysis showed an association between angles of >15.40° and rupture (P = .005), postsiphon location (P = .034), and aneurysm size of >1.001 mm (P = .015). Multivariate analysis also showed that every 1-year increase in patient age produced an increase of 1.002 mm in aneurysm size (P = .015). CONCLUSIONS: There was a significant independent direct relation of greater anterior knee angle with intracranial aneurysms located distal to the carotid siphon, larger aneurysms, and greater risk of rupture. These findings may be associated with the hemodynamic interactions of blood flow and the curvature of the carotid siphon.

[Tumoral calcinosis at an unusual site in a haemodialysis patient]. / Calcinose pseudotumorale de localisation inhabituelle chez un patient hémodialysé.

BACKGROUND: Tumour-like calcinosis is a rare cause of tissue calcification in patients on maintenance haemodialysis for chronic renal failure. Its estimated incidence is between 0.5 and 7% of haemodialysis patients. PATIENTS AND METHODS: A 29-year-old male patient was referred to our department with a large cervical mass lesion increasing in size for two months. The patient had been on maintenance haemodialysis for one year for chronic renal failure during which time he reported multiple episodes of cervical trauma. Cervical MRI demonstrated a 11 x 9 cm calcified tumoral mass extending to the cervical muscles and the lower cervical spine (C6, C7, T1), accompanied by C6 osteolysis. Laboratory studies revealed secondary hyperparathyroidism with elevated calcium-phosphorus product. The patient underwent parathyroidectomy and several weeks later, there was a dramatic regression of the tumoral calcinosis. Renal transplantation was performed secondarily with no recurrence of the tumoral calcification after six years of follow-up. DISCUSSION: Tumour-like calcinosis of the lower cervical spine with osteolysis of the cervical vertebrae is very rare. The principal contributing factors are hyperparathyroidism, elevation of calcium-phosphorus product and local trauma. Optimal treatment of these calcifications remains controversial. While surgical resection of the mass is commonly recommended, in our case report, despite the initial aggressiveness of the lesion, surgery was not performed and treatment of hyperparathyroidism alone was sufficient to ensure dramatic improvement with complete resolution of the calcinosis within few weeks.

[Current management of arteriovenous malformations. Retrospective study of 31 cases and literature review]. / Manejo actual de las malformaciones arteriovenosas. Estudio retrospectivo de 31 casos y revisión de la literatura.

OBJECTIVE: To establish some therapeutic criteria about the treatment of AVMs of III, IV and V grade of Spetzler and Martin and to analyse the results in the subgroup of preoperative embolization plus surgery. METHODS: We perform a retrospective analysis of a group of 31 patients with arteriovenous malformations (AVMs) treated in our center between 1999 and 2004. There were 19 women and 12 men, with a mean age of 31.6 years old (range, 1-62a). Their symptoms upon admission were intracranial hemorrhage in 77.4%, seizures in 12.9%, headache, ischemic event and incidental finding in 3.2% each group. Diagnostic angiography was performed in 29 cases and anatomopathologic diagnostic in 2 cases. The malformations were classified with Spetzler and Martin Grading Scale, in 10.3% grade I, 24.1% grade II, 37.9% grade III, 24.1% grade IV and 3.4% grade V. Patients were classified in 6 subgroups of treatment (surgery, embolization, radiosurgery, embolization plus surgery, embolization plus radiosurgery and conservative treatment). RESULTS: AVMs grade III, IV and V (19 patients) were treated with surgery (6 cases), embolization plus surgery (5 cases), but also other kind of treatments (embolization alone, radiosurgery and conservative) were used. Functional results in these groups of patients were 36.8% (7 cases) with no symptoms or slights symptoms (modified Rankin 0-1), 52.6% (10 cases) minor disability (mRankin 2), 5.3% (1 case) moderate disability and 5.3% (1 case) mortality. We observe a high rate of postembolization hemorrhage in the group of patients in which the combination of preoperative embolization plus surgery was used. In these cases, early surgery was performed with a good functional recovery. There was one case of postoperative mortality. CONCLUSION: We should consider some factors like the natural history, clinical presentation (hemorrhage), angiographic features (deep arterial supply, aneurisms), Spetzler and Martin Grading and the clinical condition of the patient before treating a cerebral AVM. In the subgroup of treatment with embolization plus surgery, we recommend to achieve a subtotal preoperative embolization > 50%, not to obliterate more than 50% in one session, to perform staged embolization waiting from 4 to 6 weeks between procedures, and from 1 to 3 weeks between the last embolization and surgery.

Manejo actual de las malformaciones arteriovenosas. Estudio retrospectivo de 31 casos y revisión de la literatura / Actual Management of arteriovenous malformations. Retrospective study of 31 cases and literature review

Objetivos. Establecer unos criterios terapéuticos en las malformaciones arterio venosas (MAVs) grados III,IV y V de Spetzler y Martin y análisis de resultados en el subgrupo de tratamiento con embolización más cirugía. Material y métodos. Estudio retrospectivo de 31pacientes con MAVs cerebrales tratados en nuestro servicio entre 1999 y 2004. Se trata de 19 mujeres y 12 hombres, con una edad media de 31,6 años (rango de 1 a 62a).La forma de presentación fue en un 77,4% hemorragiaintracraneal, en un 12,9% crisis comicial y en un 3,2%cefalea, infarto isquémico y hallazgo casual en cada uno de ellos. En 29 casos se realizó arteriografía diagnóstica y en 2 casos el diagnóstico fue anatomo-patológico. Según la clasificación de Spetzler y Martin, 10,3%fueron de Grado I, 24,1% de Grado II, 37,9% de GradoIll, 24,1% de Grado IV y 3,4% de Grado V. Se clasificaron en 6 grupos según el tratamiento realizado (cirugía, embolización, radiocirugía, embolización más cirugía, embolización más radiocirugía y tratamiento conservador).Resultados. Las MAVs grado III, IV y V (19 pacientes)fueron tratadas en su mayoría por cirugía (6 casos) y embolización más cirugía (5 casos) pero también se utilizaron otras modalidades de tratamiento (embolización, radiocirugía y conservador). Los resultados funcionales de estos 3 subgrupos muestra un 36,8% (7 casos) de asintomáticos o con mínimos síntomas (Rankin m 0-1),un 52,6% (10 casos) de discapacidad leve pero independientes(Rankin m=2), un 5,3% (1 caso) de moderada discapacidad (Rankin m=3), y un 5,3% (1 caso)de mortalidad. En el manejo combinado embolización más cirugía de malformaciones complejas, se observa un alto porcentaje de sangrado postembolización que motivó cirugía precoz con buen resultado funcional. Hubo un caso de mortalidad postquirúrgica. Conclusiones. En el tratamiento de las MAVs cerebralesse debe tener en cuenta factores como la historia natural, la forma de presentación (hemorragia), las características angioestructurales (presencia de aporte arterial profundo, aneurismas), la escala de Spetzler y Martin y el estado clínico del paciente. En el tratamiento con embolización más cirugía es recomendable obtener una embolización prequirúrgica subtotal > 50%, no ocluir más del 50% por sesión, mantener un intervalo entre sesiones de embolización entre4 y 6 semanas y un intervalo entre última embolización y cirugía entre 1 y 3 semanas

Objective. To stablish some therapeutic criteria about the treatment of AVMs of III, IV and V grade of Spetzler and Martin and to analyse the results in the subgroup of preoperative embolization plus surgery. Methods. We perform a retrospective analysis of a group of 31 patients with arteriovenous malformations(AVMs) treated in our center between 1999 and 2004.There were 19 women and 12 men, with a mean age of 31,6 years old (range, 1-62a). Their symptoms upon admission were intracranial hemorrhage in 77,4%, seizures in 12,9%, headache, ischemic event and incidental finding in 3,2% each group. Diagnostic angiography was performed in 29 cases and anatomopathologic diagnosticin 2 cases. The malformations were classified with Spetzler and Martin Grading Scale, in 10,3% grade I,24,1% grade II, 37,9% grade III, 24,1% grade IV and3,4% grade V. Patients were classified in 6 subgroups of treatment (surgery, embolization, radiosurgery, embolizationplus surgery, embolization plus radiosurgery and conservative treatment).Results. AVMs grade III, IV and V (19 patients) were treated with surgery (6 cases), embolization plus surgery(5 cases), but also other kind of treatments (embolization alone, radiosurgery and conservative) were used. Functional results in these groups of patients were36,8% (7 cases) with no symptoms or slights symptoms(modified Rankin 0-1), 52,6% (10 cases) minor disability(mRankin 2), 5,3% (1 case) moderate disability and 5,3% (1 case) mortality. We observe a high rate of postembolization hemorrhage in the group of patients in which the combination of preoperative embolization plus surgery was used. In these cases, early surgery was performed with a good functional recovery. There was one case of postoperative mortality. Conclusion. We should considerer some factors likethe natural history, clinical presentation (hemorrhage),angiographic features (deep arterial supply, aneurisms), Spetzler and Martin Grading and the clinical condition of the patient before treating a cerebral AVM. In the subgroup of treatment with embolization plus surgery, we recommend to achieve a subtotal preoperative embolization > 50%, not to obliterate more than50% in one session, to perform staged embolization waiting from 4 to 6 weeks between procedures, and from 1 to 3 weeks between the last embolization and surgery

Kinin-dependent hypersensitivity reactions in hemodialysis: metabolic and genetic factors.

Although the association of angiotensin I-converting enzyme inhibitors (ACEis) with a negatively charged membrane is thought to be responsible for hypersensitivity reactions (HSRs) during hemodialysis, we hypothesize that these complications are due to changes in plasma aminopeptidase P (APP) activity and genotype. To test this hypothesis, we measured plasma APP activity in 14 patients who suffered HSR (HSR+) while dialyzed with an AN69 membrane and simultaneously treated with an ACEi. APP activity was also studied in a control group (n=39) dialyzed under the same conditions, but who did not suffer any side effect (HSR-). We found significantly decreased plasma APP activity (P=0.013) in HSR+ subjects as well as altered degradation of endogenous des-Arginine(9)-bradykinin, with a significantly lower beta value (P<0.001). The same analytical approach was taken in 171 relatives of HSR+ patients. Variance component analysis suggested that genetic differences may explain 61% of the phenotypic variability of plasma APP activity (P<0.001) and the kinetic parameters that characterized kinin degradation. We also showed that the C-2399A single-nucleotide polymorphism at the XPNPEP2 locus was a significant predictor of APP activity in the 39 HSR- controls (P=0.029). Furthermore, a recessive genetic model for the A allele disclosed a significant difference in mean APP activity by genotype (P<0.001). Finally, our study defined the nonspecific inhibition of recombinant APP by some ACEis. In conclusion, this paper highlights the complexity of HSR in hemodialysis, suggesting, as with angioedema, that these rare, but life-threatening adverse events are governed by several metabolic and genetic factors.

[Intraoperative neurophysiological monitoring of brain stem in a case of cavernoma in the pons]. / Monitorización neurofisiológica intraoperatoria del tronco del encéfalo en un caso de cavernoma en protuberancia.

Neurophysiological monitoring during surgery to avoid damaging of eloquent brain areas is a useful tool. We are performing intraoperative neurophysiological test to locate motor, sensitive and speech areas with cortical stimulation and cranial nerves during cerebellopontine cranial base surgery. Neurophysiological monitoring during brain stem surgery has been less described. Brain stem surgery implies a careful selection of patients for surgery given the high risk of morbidity and mortality. For this reason, conservative treatment is usually indicated when an asymptomatic cavernoma is incidentally found. Instead, when bleeding or neurological deficit appear, operative treatment may be indicated and then the goal of surgery is to avoid the disability linked to the natural history. We present the case of a 29 year old woman with diagnosis of multiple cavernomas. She was admitted at our hospital because she presented weakness and sensitive disturbance of left limbs and dizziness. The CT scan and MRI showed a pontine haemorrhage caused by a cavernous hemangioma. We operated her on using neurophysiological monitoring of VII, VIII, X and XII cranial nerves with electromyographic recordings. Postoperative disability could be reduced with a better knowledge of entry zone into the brain stem and early physiotherapy.

Monitorización neurofisiológica intraoperatoria del tronco del encéfalo en un caso de cavernoma en protuberancia / Intraoperative neurophysiological monitoring of brain stem in a case of cavernoma in the pons

La introducción del control neurofisiológico intraoperatorio ha conseguido minimizar el riesgo funcional quirúrgico en lesiones localizadas en áreas cerebrales funcionales. En la actualidad realizamos control neurofisiológico intraoperatorio para localizar el área motora o sensitiva y el área del lenguaje mediante estimulación cortical, así como de los pares craneales en cirugía del ángulo ponto cerebeloso. La monitorización neurofisiológica durante cirugía del tronco del encéfalo y fosa romboidea está menos instaurada. La cirugía del tronco del encéfalo implica una cuidadosa selección de los pacientes, dado el alto riesgo de morbilidad y mortalidad asociadas. Por esta razón, los cavernomas de esta región suelen ser tratados de manera conservadora cuando se trata de un hallazgo casual o no son sintomáticos. Sin embargo, la presencia de un sangrado o afectación neurológica inducen a tomar una decisión quirúrgica, dada la mala evolución natural. Presentamos el caso de una mujer de 29 años, diagnosticada de cavernomas múltiples, que ingresó por cuadro de debilidad motora y déficit sensitivo en hemicuerpo izquierdo. Se realizó TC craneal y RM que mostraba hemorragia protuberancial y se practicó una craniectomía infratentorial y resección de la lesión vascular por línea media, con control neurofisiológico intraoperatorio del VII, VIII, X y XII pares craneales con lectura electromiográfica. El control neurofisiológico ayudó a decidir el punto de acceso a la lesión que no afloraba a la superficie, minimizar las secuelas postoperatorias y pronosticar precozmente los déficits asociados con el fin de iniciar una rehabilitación precoz

Neurophysiological monitoring during surgery to avoid damaging of eloquent brain areas is a useful tool. We are performing intraoperative neurophysiological test to locate motor, sensitive and speech areas with cortical stimulation and cranial nerves during cerebellopontine cranial base surgery. Neurophysiological monitoring during brain stem surgery has been less described. Brain stem surgery implies a careful seleccion of patients for surgery given the high risk of morbidity and mortality. For this reason, conservative treatment is usually indicated when an asymptomatic cavernoma is incidentally found. Instead, when bleeding or neurological deficit appear, operative treatment may be indicated and then the goal of surgery is to avoid the disability linked to the natural history. We present the case of a 29 years old woman with diagnosis of multiple cavernomas. She was admitted at our hospital because she presented weakness and sensitive disturbance of left limbs and dizziness. The CT scan and MRI showed a pontine haemorrhage caused by a cavernous hemangioma. We operated her on using neurophysiological monitoring of VII, VIII, X and XII cranial nerves with electromyographic recordings. Postoperative disability could be reduced with a better knowledge of entry zone into the brain stem and early physiotherapy

Use of midodrine (Gutron) to treat permanent hypotension in a chronic hemodialysis patient.

Chronic hypotension, infrequent though possible in chronic renal failure patients on hemodialysis, has harmful consequences on their physical state and hence general well-being. These patients often experience acute intradialytic manifestations while non-pharmacologic interventions as pharmacologic agents are sometimes insufficient to improve symptoms. Well tolerated, midodrine appears to be a suitable and effective agent as it raises blood pressure significantly via its effect on peripheral alpha-adrenergic receptors. The authors describe their use of midodrine in a dialysis patient for the longest period of time reported up to now, documented by a pharmacokinetic study, confirming long-term both clinical efficacy and safety of the drug.

Tratamiento quirúrgico de las metástasis cerebrales / The surgical treatment of cerebral metastases

Introducción. Hasta un 40 por ciento de los pacientes con cáncer presentan metástasis cerebrales, de manera que la incidencia de éstas en la población general llega hasta el 0,15 por ciento. Se han descrito diferentes tratamientos de las metástasis. La mayoría persiguen la erradicación de una o de varias metástasis, con lo que se consigue mejorar la calidad y la expectativa de vida de los pacientes. Desarrollo. Los principales factores que determinan el pronóstico y la indicación quirúrgica son la edad, el estado funcional y la extensión de la enfermedad neoplásica. La existencia de más de una metástasis no contraindica la cirugía. Conclusiones. El desarrollo de nuevas técnica quirúrgicas en las últimas dos décadas ha conseguido disminuir la morbilidad y la mortalidad operatorias. La cirugía seguida de radioterapia holocraneal continúa siendo el método de elección en el tratamiento de las metástasis. En casos en los que no esté indicado el tratamiento quirúrgico puede llevarse a cabo radiocirugía (AU)

[Severe chronic renal failure subsequent to acute pyelonephritis in alcoholic patients]. / Insuffisance rénale chronique sévère, séquelle de pyélonéphrite aiguë chez l'éthylique.

BACKGROUND: Chronic alcoholism and malnutrition are uncommon causes of complicated acute pyelonephritis (APN). CASE REPORTS: Since 1997, we have seen 5 patients with chronic alcoholism (3 women and 2 men, mean age 53.4 +/- 13 years) without cirrhosis, diabetes or renal failure who developed severe APN in a state of malnutrition (albumin 22 +/- 3 g/l, total cholesterol 0.86 +/- 0.2 g/l). Diagnosis was made 14.6 +/- 9 days after onset of atypical symptoms which the patients neglected. There was a major bacterial inoculum: Escherichia coli 10(6.2 +/- 2) (3 multisusceptible and 2 amoxicillin-resistant strains); positive blood cultures in 3 cases. The imaging study showed bilateral diffuse lesions with focal swelling and kidney enlargement, without obstacle, abscess, or papillary necrosis. All patients had severe acute renal failure (maximum serum creatinine: 582 +/- 210 mumol/l; 3 patients underwent dialysis). Mean duration of antibiotic therapy was 40 +/- 7 days (i.v.: 22 +/- 3 d). Renal scarring occurred since creatinine clearance was 33 +/- 22 ml/min 2 months after the initial episode. One patient progressed to end-stage renal failure. CONCLUSION: In malnourished alcoholic patients, APN may be unusually severe due to late diagnosis leading to the risk of irreversible renal damage and severe chronic renal failure.

[Midodrine (Gutron) treatment of permanent arterial hypotension in a chronic hemodialysis patient]. / Traitement par midodrine (Gutron) de l'hypotension artérielle permanente d'un patient hémodialysé chronique.

Chronic hypotension, although unfrequent in uremic patients on hemodialysis, accentuates the deterioration of patients physical state and thus, their general well-being. These patients often experience acute intradialytic symptoms and respond very poorly to conventional therapies. Well tolerated, midodrine is a suitable and effective choice as it raises blood pressure significantly through its effect on peripheral alpha-adrenergic receptors. The authors report observing the use of midodrine by a dialysis patient during the longest time period published to date, documented by a pharmacokinetic study, and that confirms the excellent results and proves long term tolerance for that drug.

[Surgical treatment of brain metastases]. / Tratamiento quirúrgico de las metástasis cerebrales.

INTRODUCTION: Up to 40% of the patients with cancer have cerebral metastases, so that their incidence in the general population reaches 0.15%. Different treatments for metastases have been described. Most aim to eradicate one or several metastases so as to improve the quality of life and life expectancy of the patients. DEVELOPMENT: The main factors determining the prognosis and indication for surgery are age, functional state and extent of the neoplastic disease. The presence of more than one metastasis does not contraindicate surgery. CONCLUSIONS: The development of new surgical techniques over the past twenty years has led to a reduction in operative morbidity and mortality. Surgery followed by holocranial radiotherapy is still the method of choice for the treatment of metastases. In cases in which surgical treatment is not indicated, radiosurgery may be done.

Indwelling silicone femoral catheters: experience of three haemodialysis centres.

The aim of this study is to describe the experience of three haemodialysis centres using indwelling femoral silicone catheter (model SSL 1220M, Medcomp, USA) in 55 patients, three with acute renal failure, one requiring plasmapheresis, and 51 with chronic renal failure but no other available vascular access. Sixty-four catheters were in place for a mean duration of 41.5 +/- 30 days. The rate of catheter-related complications, including mechanical problems, thromboses, and infections was low and they were never life-threatening. The results of the study suggest that femoral cannulation with modern flexible devices can be considered as a reliable temporary access, even for extended periods, with advantages exceeding those for subclavian and jugular routes.

Occipital neuralgia secondary to exuberant callus formation. Case report.

The authors report the case of a 78-year-old woman suffering from right occipital neuralgia in whom computerized tomography and magnetic resonance images demonstrated an irregular bone mass in the C-2 vertebral body. This "bone tumor" happened to be an exuberant callus formation that arose as a result of a previous axis body fracture. The patient's occipital pain was immediately relieved after she underwent C2-3 root release.

[Femoral indwelling silicone catheter: experience of three hemodialysis centers]. / Cathéter fémoral siliconé à demeure: expérience de trois centres d'hémodialyse.

The use of femoral vein for temporary access in hemodialysis patients is still considered as a slightly desirable route. However recent technical improvements have made this approach more reliable because the new femoral catheters can be left in place for a long time and used for ambulatory treatment. We describe the experience of three hemodialysis centres with temporary indwelling femoral catheter made of silicone (SSL 1220 M, Medcomp) in 55 patients: 3 patients with acute renal failure, 1 requiring plasmapheresis and 51 with chronic renal failure but no other available vascular access. Sixty four catheters were implanted and left in place for a mean of 41.5 +/- 30 days. Complications (mechanical, thrombotic and infectious) were infrequent and never life-threatening. These results suggest that the femoral route can be used reliably for temporary access, and provides advantages over subclavian and jugular routes in certain circumstances.

[Value of renal scintigraphy in the diagnosis of vascular complications of renal transplantation]. / Intérêt de la scintigraphie rénale dans le diagnostic des complications vasculaires de la transplantation rénale.

Nuclear medicine can make an efficient contribution to the diagnosis and monitoring of renal disease and to the assessment of therapeutic interventions in the field of renal transplantation. The new radio pharmaceutical MAG 3 labelled with 99mTc provides renal imaging of quality in patients with impaired renal function and enables quantitative evaluation of renal function. We report on radionuclide evaluation, with special emphasis on the analysis of the vascular component of the scintigram, in the different clinical situations (i.e. renal failure) that may compromise the outcome of a successful renal transplant.

Aesthetic units in skin grafting of the face.

In patients with difficult facial reconstructions, one of the most important requirements is to plan well, before beginning treatment. It is known that it is important to consider the aesthetic unit of the face. Each cutaneous area is to be reconstructed by a single, separate graft or flap. We present 4 patients illustrating difficult situations. Special attention has been drawn to the choices for each separate graft or flap. This study was made possible with the aid of a medical illustrator who prepared a real dissection of our final reconstruction. In fact, after these difficult operations, we often forget exactly what was previously done and we believe that a good catamnesis of our surgical adventure can be useful to share with other surgeons who deal with the same difficult procedures.