Percutaneous renal artery embolization has been introduced as an alternative to nephrectomy for patients with a nonfunctioning allograft and Graft Intolerance Syndrome. The symptoms resulting from this syndrome include fever, local pain, hypertension, and hematuria. From April 2003 to October 2003, 5 patients were treated with this technique. The intraparenchymal renal arteries were embolized by injection of calibrated tris-acryl gelatin microspheres of increasing size (from 100-330 to 700-900 microm) and completed with the insertion of 5-mm-8-mm steel coils in the renal artery. The procedure was well tolerated in all cases; no major complications occurred. In 3 patients, the symptoms disappeared immediately. In 1 patient, it was necessary to perform a second embolization due to collateral circulation developing from a lumbar artery; this further procedure resolved the symptoms. In the last case, the patient underwent nephrectomy because of septic fever. In conclusion, patients with this syndrome refractory to medical treatment may be treated by the effective and minimally invasive procedures of percutaneous allograft artery embolization with no significant short-term or late complications.

Balloon Occlusion↗

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Acute diverticulitis with colon perforation in renal transplantation.

INTRODUCTION: Acute diverticulitis with colon perforation is a serious condition in transplant recipients. The aim of this study was to analyze our experience with colon perforations among 875 renal transplant recipients between January 1986 and September 2004. METHODS: Patients were analyzed by age, gender, steroid dosage, time interval from the transplantation, delay between symptoms and surgery, clinical presentation, surgical procedure, graft and patient outcomes. RESULTS: We identified 8 patients with colon perforation. The incidence of perforation was 0.9%. Mean age at the the time of perforation was 58.5 years. Fever, abdominal pain, localized or diffuse signs of peritonitis, and leukocytosis were present in 7 patients (87.5%). Three patients (37.5%) were on steroid-free immunosuppression, whereas in 2 cases (25%) the steroid dosage was >20 mg/d. The mean interval between transplantation and perforation was 4.1 years. Two episodes (25%) occurred within 1 month following transplantation and the other 6 (75%) between 1 and 15 years. The interval between the onset of symptoms and surgery was longer than 48 hours in 1 patient (12.5%). In 5 cases (62.5%), a Hartmann procedure was performed; in 2 patients (25%), a resection with primary anastomosis was preferred. The last patient had a direct suture of the colon. Mortality rate was 12.5%. At a median follow-up of 6.1 years, 6 patients (75%) are alive with 5 functioning grafts. CONCLUSIONS: Colon perforations in renal transplant recipients remain a challenging surgical problem. An aggressive diagnostic attitude and an immediate surgical treatment may contribute to significantly decrease the incidence and the mortality of this complication.

Colonic Diseases↗

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[Significance of esophagogastroduodenoscopy before cholecystectomy].

The aim of the study was to assess the significance of oesophagogastro-duodenoscopy (EGDS) before cholecystectomy. Over the period from 1988 to 1999 EGDS was performed in 384 patients before surgery out of a total of 1439 cholecystectomies. 42.8% presented no lesions, whereas pathological findings were detected in 57.2%. The lesions observed were divided into major and minor. EGDS performed prior to cholecystectomy detected major lesions in elderly patients and in patients with atypical biliary symptoms.

Adult↗

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Primary breast carcinoma: immunocytochemical and immunohistochemical evaluation of biological parameters.

Fine needle aspiration biopsy is an effective procedure for the diagnosis and biological characterization of carcinoma of the breast. The authors compared the immunocytochemical expression of oestrogen receptor and progesterone receptor, Ki67 antigen and p53 protein, evaluated in pre-surgical fine needle aspirates, with the immunohistochemical results observed in the corresponding histological sections. Fine needle aspirates and paraffin embedded sections obtained from 37 patients with primary carcinoma of the breast were studied by immunocytochemistry and immunohistochemistry, respectively. Percentage agreement between values obtained with cytology and histology was 89.6% for oestrogen receptor, 76.9% for progesterone receptor, 91.3% for Ki67 and 77.7% for p53. The data reported here suggest that the evaluation of biological parameters by fine needle aspiration biopsy may be useful to decide the best medical and surgical treatment for primary breast carcinoma.

Adult↗

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[Secondary hyperparathyroidism].

We reviewed the results of twenty-four years' experience of parathyroidectomy for secondary hyperparathyroidism. Over the period from 1976 to 2000, we performed 171 parathyroidectomies for secondary hyperparathyroidism (91 males, 80 females; median age: 57.4). Autotransplantation was performed in 45. Of the 171 patients undergoing parathyroidectomy, 14 (8.1%) were treated for relapse. Twenty-four of the 45 patients treated with autotransplantation (53.3%) were followed up for 82 +/- 37 months. Hypoparathyroidism was observed in 33.3% of these (worse after 6 months in 21% and stable in 46%). Five patients (11.1%) experienced a relapse of hyperparathyroidism. We believe that the treatment of choice for secondary hyperparathyroidism is subtotal parathyroidectomy, the indications for autotransplantation in parathyroid surgery are rare.

Female↗

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[Colonic perforation in patients undergoing colonoscopy].

Colonic perforations associated with colonoscopy are uncommon. We determined the incidence, clinical presentation, and medical and surgical treatments of iatrogenic colon perforations. We present the medical records of 8 patients with iatrogenic colorectal perforations seen over a period of 17 years. The median age 68.3 years. Emergency laparotomy was performed in 7 patients. One case was treated with a medical approach. One postoperative death occurred. In the absence of significant contamination primary repair is the best treatment. Non-operative management is indicated in patients without peritoneal irritation.

Aged↗

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[Dunbar's syndrome and aorto-mesenteric compression. A casual association?].

Celiac artery compression syndrome and superior mesenteric artery syndrome are two rare diseases, extensively documented in the literature, with a pathogenesis which is still controversial. Their association never been carefully studied and only one such case has been reported. For this reason we reviewed our experience from january 1974 to december 2000, including 57 patients diagnosed with coeliac artery compression syndrome and 27 patients with superior mesenteric artery syndrome. We found the presence of both syndromes in 6 patients. All 6 were submitted successfully to a duodeno-jejunal bypass and decompression of the coeliac artery. In this paper we analyse the pathogenesis, clinical presentation, diagnosis and treatment of these syndromes emphasising their common aspects. The association of the coeliac artery compression syndrome and superior mesenteric artery syndrome has never been thoroughly studied because of their rarity. The lack of recognition of this association may, in some cases, justify the controversial results reported in the surgical treatment of these syndromes.

Adolescent↗

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[Early enteral nutrition in patients treated with major surgery of the abdomen and the pelvis].

Hypercatabolism after operations has a negative influence on nutritional status, the healing process, infective complications and hospital stay. Moreover, the immune status of the patient has been shown to be equally important for septic morbidity and mortality. It is extensively accepted that in critical situations, an adequate nutritional support (enteral or parenteral) is absolutely necessary, but subjects such as the best way of feeding, the kind of nutrients to be used and the administration time are still debatable issues. Our aim was to evaluate the effectiveness (nutritional and immunological features) and clinical outcomes (septic morbidity and mortality) of total parenteral nutrition (TPN), early enteral nutrition and early enteral immunonutrition (EEN, EEIN) in 171 patients undergoing major abdominal and urological surgery for neoplastic pathology. Our prospective, randomised study showed no significant differences among the 3 nutritional supports (TPN, EEN, EEIN) with regard to restoration of normal nitrogen balance during the acute phase of surgical stress. No correlations were found in the 3 groups with immunoglobulin percentage, lymphocyte subpopulations and their functional patterns as studied by specific immunological tests. The skin test, on the other hand, seems to be more representative of the immune condition of the patients, demonstrating a faster improvement in immunological status in the EEIN group as compared to the control group. A smaller percentage of septic morbidity and mortality was found in both enteral nutritional groups (EEN and EEIN), although there was a statistically significant difference only between the TPN and EEIN groups. The hospital stay was 3.5 days shorter in enteral feeding patients (EEN, EEIN). Finally, EEN was less expensive than the other nutritional conditions, this result depending on the cost of the different materials used (infusion sets, linear filters, prepacked diets, etc.).

Abdomen↗

PubMedDate not supplied

Hyperthyroidism with concurrent thyroid cancer.

The occurrence of thyroid malignancy is considered a rare event in hyperthyroid patients. With the aim of assessing the clinical relevance of this association, we have analyzed the incidence of thyroid cancer in hyperthyroid patients treated by surgery. The incidence of thyroid cancer was retrospectively evaluated in 202 hyperthyroid patients who underwent thyroidectomy during a twenty-year period. A thyroid cancer was diagnosed in 12 cases (5.9 per cent). Histologic examination revealed the presence of papillary carcinoma in 9 cases, follicular carcinoma in 1 case and Hürthle cell carcinoma in 2 cases. The association between thyroid cancer and hyperthyroidism was more frequent in toxic adenomas (17.8 per cent) than in toxic diffuse (5.3 per cent) or multinodular goiters (1.7 per cent). In 8 patients they presented as an occult carcinoma (maximum diameter below 1 cm), but unfavourable histologic features, such as local invasiveness and multifocality, were found in 5 of them. Follow-up data indicate that all 12 patients are currently alive and apparently free of disease. Hyperthyroid patients, particularly those affected by toxic adenomas, should be carefully evaluated to exclude the presence of concurrent malignancy. A special attention should be made moreover to the presence of "occult" lesions that, in our study was characterized in a higher proportion (62.5 per cent) of cases, by unfavourable histologic features.

Adult↗

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[Clinically non-palpable lesions of the breast: radiologic features, biologic factors, and surgical strategy].

The use of mammography for early detection of breast cancer showed an increased detection of non-palpable breast-lesions (NPBL). The authors evaluate the radiologic findings, the biological factors and the surgical approach, trough the personal experience and the literature, for a correct treatment of these lesions.

Adult↗

PubMedDate not supplied

[Are small-size depressed-type colorectal neoplasias really the expression of a early stage of colorectal cancer. Apropos of a clinical case].

A route of colorectal cancer development other than the adenoma-carcinoma sequence has recently become an issue due to the discovery of the depressed-type early colorectal cancers. Despite the protruding shapes of depressed-type early colorectal cancers, they probably have biological characteristics which differ from those of the usual polyp lesions. They show more aggressive behavior than the polypoid type and can arise de novo. Depressed-type lesions, in contrast to flat-type or protruded-type lesions, tend to invade the submucosa rapidly, so it is better treat them surgically from the outset. We report a case of a small depressed-type colorectal cancer involving the caecum of a 79-year-old male patient.

Adenocarcinoma↗

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[Parathyroid carcinoma: clinical aspects and therapy].

Parathyroid carcinoma is a rare entity with an 0,5-1% of incidence on primary hyperparathyroidism (HPP) in literature. The very high values of calcium and parathormone (PTH) and the clinical aspects of hypercalcemia are the characteristics findings in these patients. We present our experience on 6 pts on 153 cases with HPP treated (3,9%). The clinical and diagnostic suspects are frequently intraoperative findings and the decision making for the surgeon is not always easy (parathyroidectomy with or without hemithyroidectomy, lymphadenectomy, surgical resection of other tissues). The mortality rate is high and we have registered three deaths at 8,14 and 64 months.

Aged↗