9 research outputs found
Glucose tolerance after portacaval shunt in liver cirrhosis
The liver plays a key role in glucose homeostasis and insulin metabolism. Altered glucose and insulin levels in peripheral blood are common findings in chronic liver disease. The aim of the present study was to investigate the effect of surgical portosystemic shunt on plasma glucose and insulin responses to glucose administration in a group of cirrhotic patients. For this purpose 10 cirrhotic subjects (8 males and 2 females) aged 42 to 65 years underwent an oral glucose tolerance test (OGTT, 75 g), and an intravenous glucose tolerance test (IVGTT, 0.33 g/kg) before and after undergoing a side-to side portocaval anastomosis (PCS). 6 noncirrhotic, nondiabetic patients matched for sex, age and body weight who underwent abdominal vascular surgery served as controls. In cirrhotic subjects, the PCS resulted in: increased plasma glucose and insulin levels during OGTT; decreased C-peptide level during OGTT; unmodified plasma glucose and insulin concentrations during IVGTT. In control subjects the abdominal surgery did not affect plasma glucose and insulin responses to oral or intravenous glucose loads. These results suggest that in cirrhotic subjects surgical portocaval shunt results in: deterioration of oral but not intravenous glucose tolerance, due to an escape of ingested glucose from the liver; increased peripheral insulin response to oral glucose administration as a consequence of reduction in hepatic removal of the hormone; and decreased pancreatic response to oral glucose due possibly to a greater feed back inhibition of beta-cell. These events seem to be a consequence of the shunt per se and not of a deterioration of hepatocellular function
Endourological management of ureteral stenosis and vesicoureteral reflux after renal transplantation
INTRODUCTION AND OBJECTIVES. Ureteral stenosis and vesicocoureteral reflux after renal
transplantation represent a key concern because of their incidence and the associated
morbidity. Prompt diagnosis and minimally invasive treatment are mandatory in immunosuppressed
patients with single kidney. The aim of this study is to evaluate the success rate
of the endourological techniques in the management of such complications.
MATERIALS AND METHODS. Between January 1996 and December 2006, 647 kidney transplants
were performed. Urinary tract continuity was re-established by ureteroneocystostomy according
to Gregoir-Lich technique. We observed 13 cases of ureteral stenosis (2%) and 11
cases of symptomatic vesicoureteric reflux (1.7%). The endourogical procedure was performed
in 13 patients: 5 cases of II-III grade vesicoureteric reflux, 4 early ureteral stenosis
and 4 late ureteral stenosis. Patients with vesicoureteric reflux underwent endoscopic injection
of macroplastique in 4 cases and Durasphere in 1. Early ureteral stenoses were treated
using balloon dilation in 2 cases, balloon dilation and laser endoureterotomy in 3, ureteral
stent placement in the other. Recipients with late stenosis underwent laser incision and
balloon dilation in 2 cases, balloon dilation in 1 and a laser incision only in the last case.
Combined antegrade and retrograde endoscopic approach was performed in 7 patients,
whereas retrograde access in 1.
RESULTS. Endourologic treatment was successful in 9 cases (69.2%); 2 patients required
open reconstructive surgery due to endourological technique failure (early ureteropelvic
junction stricture, late ureterovesical anastomotic stricture).
Vesicoureteric reflux was corrected in 3 patients (60%), 2 patients underwent uretero-ureterostomy
for recurrent reflux. No technique-related morbidity was observed. With a mean follow-
up of 81.6 months, 8 patients show normal renal function, 5 patients have returned to
haemodialysis (4 for chronic rejection, 1 for carcinoma in the graft).
CONCLUSIONS. Considering their low morbidity and the satisfactory success rate, we claim
that endourological procedures should be considered the preferred treatment for ureteral
stenosis and vesicoureteric reflux in selected patients
Are there any relations among transplant centre volume, surgical technique and anatomy for donor graft selection? Ten-year multicentric Italian experience on mini-invasive living donor nephrectomy
Selection of the right or left living donor kidney for transplantation is influenced by many variables. In the present multi centric study including 21 Italian transplant centres, we evaluated whether centre volume or surgical technique may influence the selection process
[Surgical overview on kidney and pancreas transplantation]
The main purpose of this paper, written by a group of Italian expert transplant surgeons, is to provide clinical support and to help through the decision-making process over pre-transplant surgical procedures in potential kidney recipients, as well as selection of pancreas transplant candidates and perioperative management of kidney recipient. Current topics such as different approaches in minimally invasive donor nephrectomy, methods of graft preservation and treatment of failed allograft were addressed
[Surgical overview on kidney and pancreas transplantation]
The main purpose of this paper, written by a group of Italian expert transplant surgeons, is to provide clinical support and to help through the decision-making process over pre-transplant surgical procedures in potential kidney recipients, as well as selection of pancreas transplant candidates and perioperative management of kidney recipient. Current topics such as different approaches in minimally invasive donor nephrectomy, methods of graft preservation and treatment of failed allograft were addressed