Our Timing to Remove Peritoneal Catheter Dialysis After Kidney Transplant.

BACKGROUND: Patients on peritoneal dialysis treatment represent 15% of the global dialysis population. The major complication of peritoneal dialysis is catheter and peritoneal infection. Peritoneal dialysis patients who receive kidney transplants are at increased risk of infection because of immunosuppressive therapy. AIM: The purpose of this study is to show our ideal timing to remove peritoneal catheter after kidney transplant, which gives adequate security on renal function recovery and reduction of septic risk. METHOD OF STUDY: We analyzed the outcomes of 65 patients on peritoneal dialysis who underwent kidney transplant between 2000 and 2016. RESULTS: In 61 cases there was an immediate graft functional recovery. In 4 cases there was a delayed graft function (DGF), and we performed a hemodialysis with temporary placement of a venous catheter. In all patients we removed peritoneal dialysis catheter 30 to 45 days after transplant. There has been 1 case of catheter infection, which was treated with antibiotic therapy. DISCUSSION: Our average time to remove the peritoneal dialysis catheter was shorter than times in previous studies, between the 30th and 45th postoperative day. In the 4 cases in which there has been a DGF, we performed hemodialysis treatment to avoid, in the immediate postoperative period, direct insults to the peritoneum by local dialysis procedures. CONCLUSION: Our experience show that the 30th to 45th postoperative day is a good time frame, better yet a good watershed between the safe removal of peritoneal catheter when patients have a stabilized renal function and the possibility of leaving it in situ, to resume peritoneal dialysis in case of persistent DGF.

Synthetic cyanoacrylic glue in the prevention of post-operative lymphocele after pelvic lymphadenectomy in patients with uterine malignancies: A prospective, single-blind, preliminary study.

OBJECTIVES: Lymphoceles are among the most common post-operative complications of pelvic lymphadenectomy, with a reported incidence of 1% to 29% in gynecology oncology. Several studies evaluated the effectiveness of biological glues on reducing lymphoceles, but no data on gynecological patients are available. We evaluated the effectiveness of cyanoacrylic glues (n-butyl cyanoacrylate) (Glubran 2 - GEM s.r.l., Italy) in preventing lymphocele on 30 patients who underwent pelvic lymphadenectomy for endometrial or cervical cancer. METHODS: Single-blind prospective randomized study. Patients were divided into 2 groups: pelvic lymphadenectomy plus n-butyl cyanoacrylate (treatment group: 44 patients) and pelvic lymphadenectomy without n-butyl cyanoacrylate (control group: 44 patients). Primary endpoint was incidence of pelvic lymphocele in the two groups 30 days after surgery, and evaluated with pelvic ultrasound and RMI examination. Secondary endpoints evaluated drainage volume of lymphorrhea 36, 48, 72 and 96 h after surgery. RESULTS: 15% in the treatment group and 36.6% in the control group had lymphocele 1month after the procedure (p<0.03; RR 0.4 [95% CI 0.152-0.999]). Concerning the secondary outcome in group A the amount of lymphorrhea presented a constant significant decrease during evaluation; on the contrary, in group B, after an initial decrease at 48 h, the amount of lymphorrhea remained unchanged; at all considered times the amount of lymphorrhea resulted significantly greater in controls. CONCLUSION: Intraoperative application of n-butyl cyanoacrylate seems to reduce lymph production after pelvic lymphadenectomy, providing a useful additional treatment option for reducing drainage volume and preventing lymphocele development after pelvic lymphadenectomy.

Laparoscopic findings and hormonal patterns in the treatment of endometriosis by danazol.

The authors have studied, in 120 women with sterility, the incidence of endometriosis in the laparoscopic diagnostics, the development of pathology after the treatment by Danazol alone (600 mg/daily/6 months) or preoperative Danazol and subsequent conservative surgery, the sera RIA levels of FSH, LH, PRL, 17 beta-oestradiol and progesterone during therapy, the pelvic findings in the laparoscopic second look and the pregnancy rates after the treatment. On the findings of the obtained results, which agree with the most recent studies, the authors point out the significance of laparoscopy in the diagnosis and staging of endometriosis; the correlation between staging and different therapies; the peculiarity of the laparoscopic second look in monitoring endometriosis evolution after therapy and at last the deep correlations, not yet well explained, among the mild endometriosis and alterations as the luteal phase defect and the anovulatory both in the acute fitness of the pathology and after treatment by Danazol alone or preoperative Danazol with subsequent conservative surgery as shown by persistence of sterility or of infertility, although without other well-known reasons which could explain the subsequent pregnancy failures.

Hysterosalpingography and laparoscopy in the study of infertile women.

The Authors confront the data obtained from HSG and laparoscopy carried out in women with sterility problems to evaluate the diagnostic validity of each one of these investigations. There is agreement between the results of both methods in 74.19% of the patients. They think that, for a conclusive evaluation of the tubal factor in infertility, laparoscopy is most useful.

Ultrasound placental study and fetal lung maturity.

This study was undertaken to ascertain the usefulness of placental development ultrasound study in prediction of RDS. We examined 96 women near term of pregnancy; the accuracy of placental maturity grades in predicting fetal lung maturity was compared with lecithin/sphingomyelin ratio and with clinical development of RDS in the infants. We observed good correlation among ultrasound placental grades and fetal maturity.