Ethical Issues in the Use of Suboptimal Kidneys for Transplants: An Italian Point of View.

The shortage of organs leads to the need for utilizing suboptimal kidneys for transplantation. The distinction between optimal, marginal, and suboptimal kidneys leads surgeons to face not only technical problems but also ethical and legal issues related to clinical advantages offered by the transplant of a nonstandard kidney and the acquisition of consent. Between 1999 and 2015, we performed 658 transplants, 49 (7.5%) using suboptimal kidneys. All patients were alive and with vital graft throughout follow-up. We did not encounter any major surgical complications. From a technical point of view, our experience and literature review confirm that transplant of suboptimal kidney leads to good clinical results but exposes patients to a increased risks of surgical complications. Therefore, these interventions must take place in hospitals fully prepared for this type of surgery and performed by experienced transplant surgeons with proper matching between organ and recipient. Considering the insufficient resources available, from an ethical and legal point of view, doctors play an essential role in optimizing the use of these kidneys by avoiding wastage of organs, ensuring that transplants are done in suitable patients, and that patients are fully informed and aware of the risks and benefits associated with the specific suboptimal kidney being transplanted. We believe that, in highly specialized centers, the number of suboptimal kidney transplants should be increased, as their use has shown good clinical results and carries fewer ethical issues compared with marginal kidneys. Further, suboptimal kidneys may also be proposed for use in young patients with end-stage renal disease.

Intraoperative radiochromoguided mapping of sentinel lymph node in colon cancer.

AIMS AND BACKGROUND: The aim of our study was to assess the feasibility of sentinel lymph node (SLN) detection in colon cancer using a radiochromoguided technique. The regional lymph node status is crucial for colorectal cancer staging and the stage of disease at the time of diagnosis is the main factor influencing therapeutic decision-making and patient survival. METHODS AND STUDY DESIGN: Between April and June 2001 eight patients with colon cancer were studied by radiochromoguided sentinel lymph node mapping. At the time of surgery 2 ml of patent blue dye was injected around the tumor, followed after 10 minutes by 2 ml of 99mTc-labeled albumin. After 30 minutes the SLN was identified by a gamma probe. Surgery was completed by standard resection. The SLN was processed for permanent hematoxylin and eosin staining and for immunohistochemical examination with anti-CEA and anti-cytokeratin antibodies. RESULTS: SLNs were identified in six patients; two were negative for metastasis by hematoxylin-eosin and immunohistochemical examination, two were positive for metastasis by both methods, and two were negative for metastasis by hematoxylin-eosin but positive by immunohistochemical examination. There were no false negative SLNs and no complications occurred. CONCLUSION: The actual utility of SLN detection for prognostic purposes is still unknown, but intraoperative radiochromoguided SLN mapping is technically feasible in colon cancer, although it is associated with more technical difficulties than in breast cancer and malignant melanoma.

[Desmoid tumors of the abdominal wall]. / Tumori desmoidi della parete addominale.

The authors report their experience in the management of desmoid tumors, rare benign neoplasias, locally aggressive and potentially recurrent after surgery. Etiopathogenetic, diagnostic, and therapeutic features of these tumors are analysed and the value of surgery as well as chemo- or radiotherapy is considered.