Hyperbaric oxygen therapy in wound healing in mice / [Oxigenoterapia hiperbárica na cicatrização de feridas em camundongos]

We investigated the local and systemic effects of hyperbaric oxygen therapy in BALB/C mice, exposed to two different exposure times, under 2.4 atmosphere (ATM). Fifteen animals were divided into three groups (GI, GII and Control) and underwent a surgical excision of a skin fragment of approximately one square centimeter of the dorsal region. The wounds were treated and monitored for 21 days. In the control group, the wound was cleaned once a day with sterile 0.9% NaCl solution. GI and GII mice were submitted to daily hyperbaric oxygen therapy of 30 or 60minutes sessions, respectively. The wounds were photographed every three days and their surfaces were analyzed by an image analyzer. At 21 days, all animals were euthanatized for histopathological analysis of the skin, lungs and liver in order to identify eventual alterations in wound healing or in the analyzed organs. Animals belonging to GI showed a faster skin wound healing in comparison to the other groups. Animals from GII, however, showed a delayed wound healing process and exhibited lung and microcirculatory alterations. These findings allow us to conclude that the exposure time to the oxygen in hyperbaric environment is crucial and can help or disturb skin wound healing or even be deleterious to other organs.(AU)

Investigaram-se os efeitos locais e sistêmicos da oxigenoterapia hiperbárica em camundongos BALB / C, submetidos a dois tempos de exposição diferentes, sob atmosfera 2,4 (ATM). Quinze animais foram divididos em três grupos (GI, GII e controle) e submetidos à excisão cirúrgica de fragmento de pele de aproximadamente um centímetro quadrado da região dorsal. As feridas foram tratadas e acompanhadas por 21 dias. No grupo controle, a ferida foi limpa uma vez ao dia, com solução estéril de NaCl 0,9%. Camundongos GI e GII foram submetidos à oxigenoterapia hiperbárica diária de 30 ou 60 minutos de sessões, respectivamente. As feridas foram fotografadas a cada três dias, e suas superfícies analisadas por um analisador de imagens. Aos 21 dias, todos os animais foram submetidos à eutanásia para análise histopatológica da pele, do pulmão e do fígado, em busca de eventuais alterações na cicatrização da ferida ou nos órgãos analisados. Animais pertencentes ao GI apresentaram cicatrização mais rápida de feridas cutâneas em comparação aos outros grupos. Já os animais do GII apresentaram retardo na cicatrização da ferida e alterações pulmonares e microcirculatórias. Esses achados permitem concluir que o tempo de exposição ao oxigênio em ambiente hiperbárico é fundamental e pode auxiliar ou atrapalhar a cicatrização de feridas cutâneas ou mesmo ser deletério para outros órgãos.(AU)

The relationship between interferon-γ gene polymorphism and acute kidney allograft rejection.

Cytokine gene polymorphisms have been associated with modified gene expression and cytokine production. Gamma interferon (IFN-γ) plays an important role in the pathogenesis of kidney transplant rejection. This study evaluated the association between IFN-γ gene polymorphisms and the history of acute allograft rejection in 53 adult first-transplant recipients receiving cadaveric kidney grafts. They were followed up in a single centre until 2006, for a median time of 4 years after transplantation (1-22 years). IFN-γ gene polymorphisms +874 T/A (rs2430561) were determined by polymerase chain reaction (PCR). T/T high IFN-γ genotype was found in 12, intermediate T/A in 29 and low A/A in 12 patients. Twenty-six acute kidney rejection episodes were evidenced in 20 patients, of which none occurred in the 12 patients with low IFN-γ genotype A/A. Age, gender, number of HLA (human leukocyte antigen) mismatches, ABO blood groups, HLA, time after transplantation, creatinine clearance and immunosuppressive regimens were excluded as confounding factors associated with IFN-γ genotype distribution between rejectors and non-rejectors. IFN-γ gene polymorphisms could be an important risk factor for acute kidney transplant rejection, whereas the low A/A IFN-γ genotype could be protective against rejection.

Influence of long-term dialysis treatment on operative complications after renal transplantation.

BACKGROUND: We sought to assess the influence of long-term dialysis treatment on operative complications after kidney transplantation. METHODS: We identified and prospectively followed 2 groups of patients who underwent renal transplantation: group I were on dialysis <5 years and group II, >15 years. We compared the groups regarding mismatches, residual diuresis, operative and medical complications, as well as duration of hospitalization after transplantation. RESULTS: Groups I and II included 36 and 24 patients with 33.3% and 45.8% female of mean ages at transplantation of 49 (range, 9-73) and 45 (range, 27-56) years, respectively. Group I contained 9 seniors and 4 subjects <18 years. There were no significant differences in mean donor age, number of marginal donors, mismatches, postoperative bleeding, wound infections, urine leakage, or duration of hospitalization. However, the number of postoperative lymphoceles was significantly higher in group II: 5 (20.8%) versus 1 (2.7%) (P = .01). Graftectomy was performed in 2 group II patients including 1 primary graft nonfunction, and another for recurrent focal segmental glomerulosclerosis. CONCLUSION: Our results suggested that the duration of dialysis treatment was not a significant factor for postoperative complications and prolonged hospital stay, except for an increased risk of lymphocele formation.

Appendiceal carcinoid and mucinous cystadenoma in renal transplant recipients: case reports.

There is an increased incidence of tumors among renal transplant patients, which are associated with immunosuppression. Carcinoids are rare neuroendocrine tumors that arise from the enterochromaffin cells. Although appendiceal carcinoid tumors are the commonest malignant neoplasms affecting the appendix, and mucinous cystadenoma is the commonest benign appendiceal neoplasm, they have not been reported in immunosuppressed patients. We present two renal transplant recipients who developed combined appendiceal carcinoid and mucinous cystadenoma.

Posttransplant lymphoproliferative disorder in the wall of a lymphocele: a case report.

Posttransplant lymphoproliferative disorder (PTLD) is a well-known complication of renal transplantation with increased incidence after introduction of more powerful immunosuppressive drugs. Presenting symptoms are nonspecific; some patients may be entirely asymptomatic. Herein we have reported a case of PTLD arising in the lymphocele wall presenting with B-symptoms and deterioration of graft function. A 62-year-old-female with end-stage renal disease secondary to Balkan endemic nephropathy and positive Epstein-Barr virus (EBV) serology before transplantation received a renal transplant from a deceased donor. Six months after transplantation she was admitted to the hospital with a 1-week history of malaise, weight loss, anorexia, night sweats, and febrile episodes. Multisliced computed tomography demonstrated a cystic structure at the renal hilus. Graft function deteriorated, so the patient underwent puncture of the lymphocele. Urgent graftectomy was necessary to stop the bleeding. Pathohistology demonstrated EBV-positive, CD20-positive PTLD. The patient received 6 cycles of chemotherapy and continued on hemodialysis. We concluded that a high index of suspicion for PTLD should be maintained when evaluating lymphoceles arising in the later posttransplantation period. Irrespective of their imaging features, biopsy should be performed to exclude PTLD.

Clinical features of Kaposi's sarcoma in Croatian renal transplant recipients.

AIM: To investigate the prevalence, clinical manifestations and outcome of Kaposi's sarcoma in Croatian renal transplant recipients. METHODS: The Department database was retrospectively analysed according to clinical presentation, immunosuppressive protocol, treatment, and outcome of patients with Kaposi's sarcoma. RESULTS: Kaposi's sarcoma occurred in four male patients (0.67% of all renal transplant recipients), with the onset of clinical presentation at 4 to 18 months of transplantation. HLA-B35 was present in all patients, whereas HLA-A2, -DR3 and -DR5 were present in three patients each. In all patients, the disease manifested with purple or bluish papules on the skin, without visceral organ or lymph node involvement. Immunosuppression was rapidly reduced in the first patient who rejected the graft. Three patients achieved complete remission upon reduction of immunosuppressive therapy and local irradiation, with preserved renal function. CONCLUSION: Kaposi's sarcoma is rare in Croatian renal transplant recipients. It tends to occur in male patients, soon after transplantation and is associated with HLA-B35. Reduction of immunosuppression is recommended as the first choice method in patients with skin-limited disease, accompanied by radiotherapy in resistant cases.

Outcome after renal transplantation in a "senior" program: the Croatian experience.

BACKGROUND: The Eurotransplant "senior" program allocates kidneys from elderly donors to patients >65 years old. It aims to increase the number of renal transplantations. Kidneys are allocated locally without human leukocyte antigen (HLA) matching to decrease the cold ischemia time. Croatia has introduced its own "senior" program based on HLA matching. We compared results with those from Eurotransplant. METHODS: We identified and prospectively followed all patients aged of >or=65 years who underwent a first renal transplantation. We recorded their HLA matching, cold ischemia time, renal function, surgical and medical complications, and duration of hospitalization. RESULTS: Through October 2007, 22 elderly patients received an allograft from donors who were >65 years old. There were 8 female and 14 male patients of mean age at transplantation of 67.4 years. Mean donor age was 66 years. The number of HLA mismatches ranged from 1 to 5, and cold ischemia time from 7 to 15 hours. One-year patient survival was 95.4%, and graft survival was 81.8%. Delayed graft function, defined as the need for dialysis for >7 days after transplantation, occurred in 63.6% of patients. Older recipients required prolonged hospitalization after transplantation (45 days; range, 16-131). Frequent posttransplant complications included posttransplant diabetes mellitus in 1 patient, delayed wound healing in 5 patients, and lymphocoel in 2 patients. Maligancies occurred in 3 patients, neoplasm of the native kidney, posttransplant lymphoproliferative disease, and skin cancer. One patient experienced acute rejection that was successfully treated with steroids. Seventeen patients experienced 20 viral infections. There was only 1 serious infection (pulmonary tuberculosis). The major problems were cardiovascular complications which occurred in 40.9% of patients.

Extracorporeal shock wave lithotripsy of impacted radiolucent stone at the right pyeloureteric junction and oral dissolution therapy in a patient with transplanted liver: a case report.

Extracorporeal shock wave lithotripsy (ESWL) is a safe, effective method to treat urinary lithiasis. The success rate in ESWL depends on stone location, size, number, and fragility as well as calceal anatomy and patency of the urinary tract. An association of calcineurin inhibitors and uric acid urolithiasis has been reported in renal allograft recipients, but the mechanism remains unknown. Herein we have reported the case of 68-year-old male patient who developed cryptogenic cirrhosis and underwent liver transplantation. Seven years after transplantation, the patient was admitted to the hospital with right renal colic. An 8.9-mm radiolucent stone at the pyeloureteric junction was associated with moderate consecutive hydronephrosis. The second stone was located in a lower renal calyx. After a failed attempt at retrograde ureteral stenting, we performed a percutaneous nephrostomy. Antegrade pyelography with following ESWL treatment resulted in disintegration of the obstructive stone at the pyeloureteric junction. Afterward, we performed antegrade placement of a double-J stent. Residual stones in the lower renal calyx were successfully treated with a 3-month course of oral intake of a dissolution agent-potassium sodium hydrogen citrate. In this case, we have discussed ESWL and oral dissolution therapy of radiolucent stones in a hydronephrotic right kidney, which resulted in stone-free disease after 3 months of combined therapy. There was neither clinical nor biochemical damage to the transplanted liver.

Anderson-Fabry disease in kidneys from deceased donor.

Anderson-Fabry disease (AFD) is a rare, X-linked lysosomal storage disease that leads to progressive intracellular accumulation of globotriaosylceramide in visceral organs and the vascular endothelium. We report two patients with end-stage renal disease who received renal allograft from deceased female donor who died from heart failure. A 62-year-old women received a renal allograft in July 2006. Except for low-range proteinuria, renal function was normal until 6 months after transplantation when serum creatinine increased from 120 to 150 micromol/L. A renal biopsy was performed. Based on the specific pathological finding, AFD in donor was suspected. In order to prove the diagnosis, the other recipient also underwent renal biopsy 3 months later. This was 45-year-old female with stable graft function and nonnephrotic proteinuria. Light microscopic findings included a 'foamy' appearance of affected cells with swelling and vacuolization of podocytes. Electron microscopic finding show mesangial cells and podocytes filled with dense lysosomal granules appearing as myelin figures and 'zebra bodies'. Changes were less intensive than in the biopsy of the first recipient. The donor was 54-year-old Italian women who died on the Adriatic coast after heart attack. This is the first case of AFD found in a kidney allograft from deceased donor.

Renal transplantation in patients with Balkan endemic nephropathy.

BACKGROUND: Balkan endemic nephropathy (BEN) is a chronic tubulointerstitial disease prevalent in Croatia, Romania, Bulgaria, Bosnia and Herzegovina, and Serbia. In addition to renal disease, an increased incidence of upper urothelial carcinomas (UUCs) has been observed in the foci of BEN. Carcinoma may occur alone or in combination with BEN. Immunosuppression is associated with an increased risk for development of different malignancies. There are no data in the literature about the outcome of patients with BEN after transplantation. METHODS: We performed a retrospective evaluation of the database and review of the charts and pathology reports of 601 renal transplant recipients treated at our institution. RESULTS: From January 1995 to December 2004, kidney transplantations were performed in nine patients with BEN. One-year graft survival was 100%. A man, who was transplanted in 1997 died 2 years after transplantation with a functioning graft due to disseminated cancer from the pelvis of his own kidney. A female patient developed UCC 2 years after transplantation. They were both treated with a bolus of methylprednisolone before transplantation, because of four HLA-mismatches. A male patient developed UCC in the native and transplanted kidneys. He underwent a native nephroureterectomy with partial nephroureterectomy of transplanted kidney. His graft function was preserved with decreased immunosuppression. Three years later a urinary bladder carcinoma was discovered on a regularly performed multislice computed tomography. One patient developed a skin malignancy. Other patients have had uneventful posttransplantation courses with excellent graft function. Thus, 33.3% of patients with BEN developed UUC, compared with a 0.67% prevalence of urinary tract tumors among transplanted patients with other causes of end-stage renal disease. CONCLUSION: Patients with BEN are at increased risk for the development of UCC after transplantation. Regular screening for early detection of malignancy is mandatory. Longer follow-up and results from other transplant centers are needed to further investigate the relationship between BEN and UCC after renal transplantation.

Conservative surgical treatment of low-grade urothelial carcinoma in the renal allograft recipient: a case report.

Development of urothelial carcinoma in a renal allograft is rare. We report the case of 52-year-old male patient who developed chronic renal failure secondary to Balkan endemic nephropathy and underwent renal allotransplantation. The patient who developed low-grade pTa urothelial carcinoma in the left contracted kidney at 3 years after transplantation and underwent nephroureterectomy. Three years later, the same neoplastic process was observed in the renal allograft. Preoperative estimation for allograft tumor recurrence and progression included percutaneous tumor biopsy followed by cytopathological, histological, and cytogenetic analysis. Cytopathology revealed well-differentiated urothelial tumor cells. Histopathologic analysis showed low-grade urothelial carcinoma. Cytogenetic examination demonstrated that the tumor originated from the recipient suggesting a low malignant potential of carcinoma. Based on these findings, we decided to perform a right-side nephroureterectomy and graft-sparing procedure, which resulted in preservation of allograft function. In this report we discussed the prognostic factors, which are the basis for rational therapeutic approaches in these patients.

[Rupture of the spleen and acute pancreatitis after ESWL therapy: a rare complication]. / Milzruptur und akute Pankreatitis nach ESWL-Therapie: eine seltene Komplikation.

INTRODUCTION: ESWL is a safe and efficient method in the therapy of urolithiasis which, however, is not free of complications. CASE REPORT: ESWL was performed in a 54-year-old patient with a stone of 18 mm in size located in one of the upper calyces of the left kidney. Several hours after the ambulatory ESWL treatment the patient was admitted to the emergency room with strong pain in the left lumbar region and the upper abdomen. During examination low blood pressure, tachycardia and low Hb levels were found. Ultrasound and CAT scans revealed a subcapsular rupture of the spleen. Surgery was indicated, and a laparotomy with splenectomy was performed. Ten days after surgery the patient developed acute pancreatitis which was treated conservatively with success. CONCLUSIONS: Although ESWL is a safe method in the treatment of urinary stones with a relatively small number of complications, rare complications like ruptures of the spleen have to be considered. Special attention should be given to patients with kidney stones in the left upper calyces, pathological growth of the spleen, and accompanying diseases such as chronic heart failure or hypertension. In such patients ESWL should not be performed on an outpatient basis.

Does mycophenolate mofetil increase the incidence of cytomegalovirus disease compared with azathioprine after cadaveric kidney transplantation?

Although most of the published papers had not found increase in the incidence of CMV disease in kidney transplant recipients treated with mycophenolate mofetil (MMF), we had feeling from everyday practice that after its introduction number of patients with CMV disease has increased. To test this hypothesis, we performed retrospective analysis of our database, comparing the incidence of CMV disease in patients treated with azathioprine (AZA) and patients treated with MMF. CMV disease was defined as CMV antigenemia (positive CMV pp65 determined by ELISA test) plus any of the following: decrease leucocytes or platelets, increased transaminases, increase in serum creatinine. The azathioprine treated group (AZA group) included 280 patients (132 female) treated for 17,672 months with AZA + Cyclosporine A (CyA) + steroid, or AZA + steroid, while the MMF group included 219 patients (112 female) treated for 5079 months with MMF + CyA + steroid, or MMF + steroid. There was no difference in acute rejection episodes between the AZA and the MMF group. The AZA group had 51 CMV disease episodes (1 episode per 346.5 treatment months), and the MMF group experienced 43 episodes (1 per 118.1 months) (P < .01). Mean onset of CMV disease was 32.65 +/- 47.69 (SD) months after transplantation in the AZA group, and 3.72 +/- 4.43 in the MMF group. There was no difference between two treatment groups regarding the donor-recipient CMV status mismatch. Despite having the increased incidence of CMV disease, MMF group had less severe disease compared to AZA group with decrease in leukocyte count in 11.6% vs 15.7% of episodes, decrease in platelet count in 20.9% vs 21.6%, elevation of transaminases in 18.6% vs 29.4% respectively, and finally increase in serum creatinine greater than 20% in 51.2% in MMF vs 74.5% in AZA group. Five patients from the AZA group experienced CMV pneumonitis with the mortality rate of 80%. Only one patient from the MMF group had CMV pneumonitis, and he survived. According to our results, patients treated with MMF have increased risk for development of CMV disease. However, the disease course is less severe, and less frequently accompanied with deterioration of renal function in comparison to the AZA group.

The elements of draping.

We consider the gravity-induced draping of a 3D object with a naturally flat, isotropic elastic sheet. As the size of the sheet increases, we observe the appearance of new folded structures of increasing complexity that arise because of the competition between elasticity and gravity. We analyze some of the simpler 3D structures by determining their shape and analyzing their response and stability and show that these structures can easily switch between a number of metastable configurations. For more complex draperies, we derive scaling laws for the appearance and disappearance of new length scales. Our results are consistent with commonplace observations of drapes and complement large-scale computations of draping by providing benchmarks. They also yield a qualitative guide to fashion design and virtual reality animation.

Clustering and fluidization in a one-dimensional granular system: molecular dynamics and direct-simulation Monte Carlo method.

We study a one-dimensional granular gas of pointlike particles not subject to gravity between two walls at temperatures T(left) and T(right). The system exhibits two distinct regimes, depending on the normalized temperature difference Delta=(T(right)-T(left))/(T(right)+T(left)): one completely fluidized and one in which a cluster coexists with the fluidized gas. When Delta is above a certain threshold, cluster formation is fully inhibited, obtaining a completely fluidized state. The mechanism that produces these two phases is explained. In the fluidized state the velocity distribution function exhibits peculiar non-Gaussian features. For this state, comparison between integration of the Boltzmann equation using the direct-simulation Monte Carlo method and results stemming from microscopic Newtonian molecular dynamics gives good coincidence, establishing that the non-Gaussian features observed do not arise from the onset of correlations.

Kaposi's sarcoma after renal transplantation. Case reports.

Immunodeficiency in transplant recipients with chronic immunosuppressive treatment may have influence to developing of virus infection diseases. This publication shows a case report kidney transplant recipient which develops Kaposi's Sarcoma correlated with HLA typing.

Urinary tract infection in acute appendicitis.

The effect of acute appendicitis (AA) on aerobic urinary tract infection was investigated. Abnormal urinalysis and urinary tract infection in patients with AA have seldom been reported previously. Appendectomy was performed in 84 patients with no previous urogenital, retroperitoneal, or pelvic disease, trauma or operation and AA was pathologically confirmed in 66 of them. Aerobic cultures of appendiceal tissue and mesenteriolum were done. Control groups included 25 patients with inguinal hernioplasty and 40 patients with varicocele repair. Urinalysis and urine culture were done prior to operation, and on days 1, 3, and 6 postoperatively. The "O" serogrouping identification of Escherichia coli (E. coli) was performed in the appendix, mesenteriolum and urine. Abnormal urinalysis was found in 48% of patients with AA before appendectomy, and in 12% on day 6 postoperatively (P < 0.05). Aerobes were isolated from urine in 32% of patients before appendectomy and in 24% on day 6 following surgery. E. coli was more often found in the appendix than in the mesenteriolum (P < 0.05). In seven out of 66 patients (11%) bacteriuria of more than 10(5) was found. All of them had identical aerobic strain isolated from the appendix, mesenteriolum and urine (E. coli in 4, Streptococcus faecalis in 2 and Corynebacterium species in one patient) according to antimicrobial susceptibility testing and "O" serogrouping of E. coli. Lower urinary tract infection was clinically manifested on day 3 postoperatively in 4 of them and in none from the control groups. Bacteria spreading from the appendix to the retroperitoneal space may invade the urinary tract and cause either symptomatic or asymptomatic urinary tract infection in patients with AA.

Urinalysis, ultrasound analysis, and renal dynamic scintigraphy in acute appendicitis.

OBJECTIVES: The influence of acute appendicitis (AA) on the right kidney and urinalysis was investigated. Permanent damage of the urinary tract and abnormal urinalysis have been previously reported in AA. METHODS: Appendectomy was performed in 84 patients with no previous urogenital, retroperitoneal, or pelvic disease, trauma, or operation. AA was confirmed in 66 of them. Control groups were the remaining 18 patients and 40 patients with varicocele repair. Renal sonography and urinalyses were done prior to operation, on days 1, 3, and 6 postoperatively. Pentetic acid renal scintigraphy was done on postoperative day 1 in patients with abnormal urinalysis. An obstructive radiographic curve indicated furosemide renography. RESULTS: Abnormal urinalysis was found in 48% of patients with AA before appendectomy and in 12% on day 6 postoperatively. Sonography showed pyelocaliceal dilation of the right kidney in 38% of patients with AA prior to appendectomy and in none on day 6 postoperatively. Patients with AA had pyelocaliceal dilation of the right kidney more frequently than those in the control groups (P < 0.001). It was more frequent in patients having abnormal urinalysis (P < 0.01). Scintigraphy confirmed pyelocaliceal dilation of the right kidney in 38% of patients with abnormal urinalysis. Furosemide renography excluded an obstruction in all of them. CONCLUSIONS: Inflammation is the major cause of abnormal urinalysis and transitory pyelocaliceal dilation in some patients with AA. Erythrocyturia, pyuria, proteinuria, and pyelocaliceal dilation detected by sonography or scintigraphy can frequently be found in patients with AA, but should not mislead the surgeon in the diagnosis of AA.

[Unusual localization of an echinococcal cyst]. / Neobicna lokalizacija ehinokokne ciste.

Hardly ever one can find a hydatid cyst in other parts of the organism except in the liver and lungs. The localization in the retroperitoneum is very rare. We have shown an unusually located hydatid cyst in the retroperitoneum. The cyst was firmly integrated with the structure of m. psoas and the muscle resection was necessary.