The finding of vascular and urinary anomalies in the harvested kidney for transplantation.

INTRODUCTION: In kidney transplantation, anatomical vascular and excretory anomalies may represent causes of failure. Today's surgical techniques have made the most of the organs with anatomic anomalies and iatrogenic injury successfully used for transplantation. MATERIALS AND METHODS: From January 2000 to June 2006, we harvested 230 kidneys, of including 88 kidneys (20%) with vascular, urinary, or vascular-urinary anomalies; 64 kidneys were implanted and 15 were sent to other transplantation centers. Only 9 kidneys were not appropriate for transplantation. RESULTS: All patients who received kidneys with the above-mentioned anomalies were carefully examined after the transplantation and short-term and long-term complications were evaluated with respect to controls without anomalies. DISCUSSION: Renal anatomic anomalies are frequently observed during kidney transplantation and may produce postsurgical complications. However, the presence of these anomalies does not necessarily imply the impossibility of using the kidney for a transplant, especially because of improved surgical techniques. Our experience in transplantation procedures showed that even if kidneys present the above-mentioned anomalies they can still be considered appropriate for transplantation when we perform a correct harvesting/back-table transplant surgery. So vascular and urinary anomalies have to be considered always an incentive to research new surgical solutions and to perform a careful surgical technique

Transplantation and young surgeons in italy

The relation between young surgeons and transplantation has always been a "love and hate" one. Until a few years ago this branch of surgery was seen as pioneering, with extreme and and extensive training, and was reserved to few elected members. Nowadays things are different. In this article we try to understand the true reasons that young Italian surgeons avoid transplantation surgery

Measuring proliferation in breast cancer: practicalities and applications

Various methods are available for the measurement of proliferation rates in tumours, including mitotic counts, estimation of the fraction of cells in S-phase of the cell cycle and immunohistochemistry of proliferation-associated antigens. The evidence, advantages and disadvantages for each of these methods along with other novel approaches is reviewed in relation to breast cancer. The potential clinical applications of proliferative indices are discussed, including their use as prognostic indicators and predictors of response to systemic therapy

Immunohistochemical evidence of abnormal expression of the antioncogene-encoded p53 phosphoprotein in Hodgkin's disease and CD30+ anaplastic lymphomas

The gene encoding p53 phosphoprotein, originally believed to be an oncogene, recently has been proposed as a candidate antioncogene (tumor-suppressor gene). Abnormalities of the p53 gene expression have been demonstrated in different human malignancies including carcinomas and sarcomas, but little information concerning p53 immunoreactivity in human lymphomas is so far available. In this study immunohistochemical staining for p53-protein was performed on frozen- and paraffin-embedded samples from patients with Hodgkin's (HD) and non-Hodgkin's lymphomas (NHL). No p53 immunoreactivity could be demonstrated in any cell type in nonneoplastic lymphoid samples, including germinal center cells in reactive lymph nodes and cortical thymocytes. On the other hand, a significant proportion of p53+ neoplastic cells was observed in 23 of 31 cases of HD and 17 of 68 cases of NHL. All positive lymphoma cases were diagnosed as high-grade or CD30+ anaplastic NHL. The demonstration of abnormal expression of p53 protein in these diseases can contribute to addressing unresolved issues regarding the origin and pathogenesis of HD and CD30+ anaplastic lymphomas

The usefulness of lateral internal sphincterotomy combined with hemorrhoidectomy in the treatment of hemorrhoids: a randomized prospective study

The aim of this prospective randomized study was to investigate anorectal manometric findings in hemorrhoid patients and to evaluate the clinical benefits and physiological consequences of additioning a lateral internal sphincterotomy (LIS) to haemorrhoidectomy. Anorectal manometry was preoperatively performed in forty-eight consecutive patients with prolapsed piles; resting and squeeze pressures, sphincter length and rectoanal inhibitory reflex were recorded. Ten healthy volunteers served as controls. Six patients were excluded because no raised and pressures were found. Forty-two patients were randomised: Group 1 (n = 22) patients underwent haemorrhoidectomy plus LIS; Group 2 (n = 20) patients underwent haemorrhoidectomy alone. Postoperative course was carefully evaluated; all patients were questioned about continence and anorectal manometry was repeated twice. Sphincter anomalies were found in 87.5% of patients. Haemorrhoidectomy alone did not affect anal pressures, which returned into the normal ranges after sphincterotomy. Postoperative course was better in LIS group. Anal stricture was seen in four patients without sphincterotomy; no patients with LIS experienced and incontinence. This study shows that high and pressures are very frequent in hemorrhoid patients; they are not due to hypertensive and cushions and might have a pathogenetic role. Anorectal manometry is very useful to identify patients with raised anal pressures; in these cases additioning a lateral internal sphincterotomy to haemorrhoidectomy seems justified; it significantly improves postoperative course and can be safely performed

Construction of age-related reference limits for 24-hour blood pressure pattern.

Blood pressure (BP) is recursively variable during the day-night cycle because of a physiological circadian rhythm. The aim of this study is, therefore, to show how to construct the population reference limits (desms) for BP in its time varying 24-h pattern, starting from a small sample, in order to facilitate their use in a local context. The sample for standardization comprised 427 clinically healthy subjects (211 males and 216 females), ranging in age from 16 to 100 years, attending their routine activities. The procedure begins with the statistical biometry related to the sample, and proceeds with the computation of the BP desms related to (1) the time-qualified discrete values; (2) the parameters of circadian rhythm; (3) the daily pressure load. The pertaining rules are explained step by stop, allowing each one to prepare the proper local desms for BP 24-h pattern. These standards may be useful for validating the individual BP monitoring according to the upper limits of the circadian physiological variability in the diagnostic procedure for identifying hypertensive subjects

Age-related changes in blood pressure twenty-four-hour pattern in normotensive subjects of two populations

OBJECTIVES: This study investigates the systolic (S) and diastolic (D) blood pressure (BP) 24-h pattern in normotensive healthy subjects belonging to two populations characterized respectively by a "non-salt culture" (Italian subjects) and a "salt culture" (Japanese subjects) in their dietary salt intake (4-6 g/day in Italians vs 10-12 g/day in Japanese). The comparison was performed by taking into consideration the within-day variability (WDV) and circadian rhythmicity (CR) of BP with respect to age. MATERIALS AND METHODS: Subjects investigated were 862 normotensive healthy subjects (308 Italians and 554 Japanese), stratified by age from 16 to 75 years, who volunteered for a noninvasive BP monitoring in an ordinary day of their life. The SBP and DBP time series were analyzed via conventional parametric statistics as well as chronobiological procedures. RESULTS: The biometric estimates demonstrate that BP changes in its WDV and CR as a function of age in both populations. Despite the difference in their habitual salt intake, the age-related changes in BP WDV and CR result to be almost comparable at the cross-sectional contrasts, giving origin to age-related trends for SBP and DBP which are significantly parallel. CONCLUSIONS: The comparability of BP WDV and CR in the two populations with a substantial difference in salt intake suggests that the normotensive status in human races is realized despite the difference in their habitual salt intake. This implies the ancestral development of mechanism(s) of adaptation to the possible "sodium luxus consumption". Although the adaptive mechanisms which provide a normotensive regimen under different conditions of sodium intake are almost unexplored, the racial adaptation to dietary salt constitutes, however, the initial condition for the cause-effect nexus between dietary salt intake and hypertension in human populations

Gallstone ileus: Literature review and report of a case treated with minilapa-rotomy

Material and methods: A gallstone ileus report, diagnosed by integrated radiological approach, treated by minilaparotomy plus enterolithotomy and followed up for two years. Results: Traditional radiologic findings, idtrasonography and computed tomography showed both the stone in the bowel lumen and the cholecystoduodenal fistula with air in the biliary tract. The enterolithotomy alone worked out the obstruction and no complication was observed. Discussion: Integrated radiologic examinations are indicated in defining nature, site and seriousness of gallstone ileus. In most cases surgical treatment is mandatory to work out both the bowel occlusion and bilioenteric illness even though it is often wiser to perform an operation of enterolithotomy alone owing to the general and local conditions of the patient. After this surgical approach, bilioenteric fistula disappears in most cases with no residual lithiasis; in the cases in which fistula and/or lithiasis persist, a decisive surgical operation can be performed in a second step. © 2000 GEM s.r.l

Suboptimal kidney: the experience of a single transplant unit

Not all kidneys are suitable for transplantation. In 2001 in Italy, only 1530 of 1748 organs were transplanted. This difference (-12.5%) not only represents organs harvested from marginal donors considered not suitable, but also kidneys that, although collected from standard donors, had a vascular, parenchymal, or urologic anomaly that made them unsuitable for transplantation. In our center, we established a procedure that defined the characteristics of suboptimal kidneys and allowed us to specifically select the appropriate recipient. We considered as suboptimal all organs with complex arterial anomalies (more than 2 arteries although on a single patch or separated such as to need a double anastomosis or a bench reconstruction); organs with noticeable parenchymal damage (macroscopic sclerosis areas or sutured polar branches accidentally damaged during removal), and organs with complex anomalies of the excretory tract (complete double district). The organs were not considered as suboptimal if they had venous anomalies revised on the bench or if they had a double artery with a single patch <2.5 cm. Such organs were transplanted to recipients who were between 55 and 60 years of age with a body weight of at least 20% less than the donor, and female