Outcomes of kidney transplant recipients exposed to Chagas disease under Benznidazole prophylaxis. A single center 10-year experience.

BACKGROUND: Chagas disease (ChD) is endemic in many parts of the world and can be transmitted through organ transplantation or reactivated by immunosuppression. Organs from infected donors are occasionally used for transplantation, and the best way of managing the recipients remains a subject of debate. METHODS: We present a single-center cohort study describing a 10-year experience of kidney transplantation in patients at risk of donor-derived ChD and or reactivation. Patients received prophylactic treatment with Benznidazole and were monitored for transmission or reactivation. Monitoring included assessing direct parasitemia, serology, and polymerase chain reaction (PCR). RESULTS: Fifty-seven kidney transplant recipients (KTRs) were enrolled in the study. Forty-four patients (77.2%) were at risk of primary ChD infection, nine patients (15.8%) were at risk of disease reactivation, and four patients (7.0%) were at risk of both. All patients received Benznidazole prophylaxis, starting on the first day after transplantation. Parasitemia was assessed in 51 patients (89.5%), serology also in 51 patients (89.5%), and PCR in 40 patients (70.2%). None of the patients exhibited clinically or laboratory-detectable signs of disease. A single patient experienced a significant side effect, a cutaneous rash with intense pruritus. At 1-year post-transplantation, the patient and graft survival rates were 96.5% and 93%, respectively. CONCLUSION: In this study, no donor-derived or reactivation of Trypanosoma cruzi infection occurred in KTRs receiving Benznidazole prophylaxis.

Assessing the impact of positive cultures in preservation fluid on renal transplant outcomes: a scoping review.

BACKGROUND: Infection following kidney transplantation is a significant risk factor for adverse outcomes. While the donor may be a source of infection, microbiological assessment of the preservation fluid (PF) can mitigate potential recipient contamination and help curb unnecessary antibiotic use. This scoping review aimed to describe the available literature on the association between culture-positive preservation fluid, its clinically relevant outcomes, and management. METHODS: Following the Joanna Briggs Institute's scoping review recommendations, a comprehensive search in databases (EMBASE, MEDLINE, and gray literature) was conducted, with data independently extracted by two researchers from selected studies. RESULTS: We analysed 24 articles involving 12,052 samples, predominantly published post-2000, 91% of which retrospective. The prevalence of culture-positive preservation fluid varied from 0.86 to 77.8%. Coagulase-negative staphylococci emerged as the most frequently isolated pathogen in 14 studies. The presence of ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species), observed in two studies involving 1074 donors, was significantly associated with an increased risk of probable donor-derived infections (p-DDI). Of the reviewed articles, 14 reported on probable donor-derived infections, while 19 addressed the topic of preemptive antibiotic therapy. CONCLUSIONS: Routine culturing of preservation fluid is crucial for the identification of pathogenic organisms, facilitates targeted treatment and prevents probable donor-derived infections. Furthermore, this approach helps avoid the treatment of low-virulence contaminants, thereby reducing unnecessary antimicrobial use and the risk of antibiotic resistance. In cases where ESKAPE or Candida species are detected, preemptive therapy appears to be an important strategy. Given that the current evidence primarily stems from retrospective studies, there is a pressing need for large-scale, prospective trials to corroborate these recommendations. This scoping review currently represents the most thorough compilation of evidence on how contamination of preservation fluids affects kidney transplant management.

Single-dose antithymocyte globulin in standard immunological risk kidney transplant recipients: efficacy and kinetics of peripheral blood CD3+ T lymphocyte modulation.

BACKGROUND: Polyclonal anti-T cell antibodies (ATG or thymoglobulin®) are used as induction therapy in kidney transplant recipients. This study evaluates the safety, efficacy, and CD3+ T lymphocyte modulation of two ATG regimens. METHODS: The trial included two cohorts of kidney transplant recipients that were followed for one year. The study group, including standard immunological risk recipients, received one 3 mg/kg dose of ATG. The comparator group, including standard and high immunological risk kidney transplant recipients, received a fractionated dose regimen (up to four 1.5 mg/kg doses). Patient and graft outcomes and the kinetics of CD3+ T lymphocyte modulation in the peripheral blood were evaluated. RESULTS: One hundred kidney transplant recipients were included in each group. The one-year incidence of treated acute rejection, and patient and graft survival did not differ between groups. Bacterial infections were significantly more frequent in fractionated-dose group patients (66% versus 5%; P = 0.0001). At one-year follow-up, there was no difference in the incidence of cytomegalovirus infection (P = 0.152) or malignancies (P = 0.312). CD3+ T lymphocyte immunomodulation in the single-dose group was more effective in the first two days after transplantation. After the third post-transplant day, CD3+ T lymphocyte modulation was more efficient in the fractionated dose group. CONCLUSION: Both regimens resulted in low rejection rates and equivalent survival. The single and reduced dose regimen protects from the occurrence of bacterial infections. CD3+ T lymphocyte modulation occurred with different kinetics, although it did not result in distinct outcomes.

Laparoscopic subtotal colectomy with cecorectal anastomosis for slow-transit constipation.

Subtotal colectomy with cecorectal anastomosis represents an interesting alternative to total colectomy with ileorectal anastomosis. Several technical variants to the methods for performing the anastomosis between the cecum and the rectal stump after subtotal colectomy have been reported. The mechanical, antiperistaltic, end-to-end cecorectal anastomosis is safe and easy to perform. The authors aimed to assess the safety and feasibility of this technique performed laparoscopically in a series of four patients. All the procedures were completed laparoscopically. The mean time for surgery was 200 min (range, 180-220 min). There was no mortality and no postoperative complications. The mean hospital stay was 4 days (range, 3-5 days). This technique can be performed laparoscopically with all the advantages inherent to the minimally invasive approach.

Gangrene of the perineum.

Fournier's gangrene, an anaerobic necrotizing cellulitis of the infradiaphragmatic soft tissues, is a serious pathologic entity with an unpredictable course. From 1978 to 1991, a total of 24 men (mean age, 57 years; range 27 to 90) were treated for this entity at our institution. Diagnosis prompted immediate institution of multimodal treatment combining triple antibiotics, surgical dissection, debridement, and repeated surgical drainage. Fecal diversion (16 patients), hyperbaric oxygenation, and standard intensive care procedures were widely indicated and performed quasi-systematically. The mean interval between initial symptoms and diagnosis was 7.4 days. Lesions were limited to the perineum in 11 patients but extended to the abdomen, thighs, or loins in the remaining 13. The pathogens were identified in 19 patients, and hemoculture results were positive in 5. A coloproctologic origin was identified in 12 patients and a urogenital origin in 4. In 2 patients, perineal gangrene occurred postoperatively, and no etiology was determined for 6. Six patients died, and 18 patients recovered, without any sequelae. The prognosis is better when the patient is young (less than 60 years old), has clinically localized disease, without systemic involvement, and sterile hemocultures and is managed with colostomy. A thorough workup is mandatory to determine the etiology (locoregional lesion, malignancy, hemopathy, arteritis).

Small bowel volvulus resulting from a congenital band treated laparoscopically.

In recent years, laparoscopy has dramatically changed the approach to the patient with acute abdominal pain. We report the case of a patient with small bowel volvulus caused by a congenital band binding the greater omentum to the mesentery, which was promptly diagnosed and treated using laparoscopy. Early intervention averted irreversible ischemic lesions of the intestine and the need for bowel resection. With the routine use of laparoscopy in the setting of acute abdominal pain, rare affections can be easily diagnosed and effectively treated.

Inferior vena cava hypoplasia with intrahepatic venous continuation: sonographic, angiographic and MR features including MR angiography.

In cases of inborn or acquired obstacles on the inferior vena cava (IVC), the derived blood flow usually goes through collaterals in the azygos or the hemiazygos venous systems. Exceptionally, a collateral pathway through the portal system or through an anastomosis in between hepatic veins, shunting the IVC interruption, is encountered. In the present paper, the authors describe the fortuitous discovery of a IVC hypoplasia in its retrohepatic segment. MR venography, correlated with fluoroscopic angiography, clearly depicted an intrahepatic collateral circulation consisting of a double aneurysmal communication between an inferior right hepatic vein and the main right hepatic vein.

[After the 2001 European Society of Cardiology Guidelines: is it possible to reduce the number of patients with syncope to be hospitalized?]. / Dopo le Linee Guida 2001 della Società Europea di Cardiologia: è possibile ridurre il numero di pazienti con sincope da ospedalizzare?

AIM: The aim of this paper was to evaluate how many patients with syncope should be hospitalized according to the 2001 European Society of Cardiology (ESC) Guidelines on the management of syncope. METHODS: Starting from August 2002 we prompted a Syncope Unit (SU), as a multi-disciplinary functional structure including the Emergency Department. One of the main objectives of the SU was the implementation of the 2001 ESC Guidelines on Syncope and of the relevant criteria for hospitalization. All the clinical data concerning the patients presenting with syncope were prospectively collected and stored in a dedicated database. RESULTS: Between September 1, 2002 and April 30, 2003, 402 patients were observed for a syncope. Out of these, 19 had a cardiogenic syncope, 3 focal neurologic disorders, 25 a severe trauma, 4 severe orthostatic hypotension and 5 carotid syncope. Therefore, 56 patients out of 402 were found to have indication to therapeutical hospitalization. Among the remaining 346 patients, 83 patients were found to have a structural heart disease and/or an abnormal ECG, 1 had syncope during exercise, 3 presented a familial history of sudden death. Thirty-three were found to have severe comorbidities and further 14 had occasional indication to hospitalization. Thus, 190 out of the 402 patients with syncope (47.3%) presented at least 1 criterion for hospitalization according to the ESC Guidelines. CONCLUSION: The implementation of the ESC Guidelines on Syncope is technically feasible. Nevertheless, even when the Guidelines are strictly observed, a high percentage of patients with syncope has still to be hospitalized. Our data suggest that new criteria should be established for a safe Emergency Department discharge of the patients with syncope, particularly of those with structural heart disease or abnormal ECG.

[Recurrence of virus B hepatitis after liver transplantation]. / Récidive du virus de l'hépatite B après transplantation hépatique.

Thirty-three HBs antigen positive patients without signs of viral replication underwent orthotopic liver transplantation and received long term passive immunoprophylaxis with anti-HBs immunoglobulins at high doses perioperatively and then at a dose of 10,000 IU every month. All patients became negative during the first 6 months following surgery. At 34 months the survival rate was 67 percent and the actuarial recurrence rate of serum HBs antigen was 7.1 percent. Reappearance of HBs antigen was associated with evidence of HBV replication and histological alterations of the graft. In our experience, long term passive immunoprophylaxis reduces HBV reinfection of the grafted liver.

[Leiomyosarcoma of the liver: a case treated by transplantation]. / Léiomyosarcome du foie: un cas traité par transplantation.

A 68 year old woman with primary hepatic leiomyosarcoma, impairement of general status and right upper quadrant pain was diagnosed with liver tumor by sonography, CT scan and nuclear magnetic resonance imaging. Angiograms showed a hypervascular tumor. The patient was treated by hepatic transplantation but died 15 days after operation. The diagnosis of leiomyosarcoma was established by immunohistochemical and ultrastructural studies; the primary nature was confirmed by necropsy. Diagnostic and therapeutic features of primary hepatic leiomyosarcoma--the 19th case reported in the literature--are discussed.

[Primary neuroendocrine tumor in the intrahepatic bile ducts: a rare finding in an asymptomatic patient]. / Tumeur neuro-endocrine primitive des voies biliaires intrahépatiques: une découverte exceptionnelle chez un malade asymptomatique.

Neuroendocrine tumors of the biliary tree are rare. In all cases except one, diagnosis was made in symptomatic patients. We report a case of an asymptomatic intrahepatic bile duct neuroendocrine tumor in a 74-year old man. To our knowledge, this is the second reported case of an asymptomatic intrahepatic bile duct neuroendocrine tumor. Diagnosis was only made by anatomopathological examination of the tumor after resection. Systemic and immunohistochemical hormonal screening was negative. Twenty months after surgery, the patient was asymptomatic and there was no recurrence.

A new device for objective assessment of skin type in Caucasians by violet light reflectance.

In the present study, we tested a new device called skin phototype diagnosis (SPD) built for the purpose of objectively determining skin phototype. We compared its performance with that of phototype determinations according to Fitzpatrick method and on tristimulus colorimetry (Minolta CR-200). Our population consisted of 100 subjects of Caucasian race (60 female, 40 male; mean age 33 years). Skin colour was measured with both devices (SPD and Minolta CR-200) on the medial surface of the arm (constitutional skin colour). Our study showed that the SPD gave a better representation of Fitzpatrick phototype, showing 89% concordance (evaluated by classification matrix) as against the 71% concordance of the L(*)a(*)b(*) and Yxy colorimetric systems. The present results are important because evaluation of phototype with the SPD device is easy, fast, objective and reliable. Moreover, this instrument has potential applications in cosmetology and in photodermatology.

[Biliary complications after a liver transplant]. / Complicanze biliari dopo trapianto epatico.

Biliary tract complications are still an important source of morbidity and mortality after liver transplantation. Between March 1988 and September 1991 we performed 111 liver transplants in 109 patients (84 men and 25 women, mean age 44.5 +/- 1.1 year). Biliary tract reconstruction was via a choledocho-choledochostomy (n = 107) or via a Roux limb choledochojejunostomy (n = 4). Ten biliary complications (11.9%) occurred (6 biliary leakage, 3 biliary strictures, 1 biliary cast syndrome). Five patients (5.9%) necessitated operative repair (Roux limb choledochojejunostomy). No death was related to biliary tract complication.

[Orthotopic liver transplantation and hepatocellular carcinoma]. / Trapianto ortotopico di fegato e carcinoma epatocellulare.

Nineteen orthotopic liver transplantations (OLT) were performed in patients with hepatocellular carcinoma, between March 1988 and December 1990, in our Department. Thirteen patients (68.4%), 10 men and 3 women, mean age 48.2 +/- 2.8 years, were clear cut neoplastic disease, six patients (31.6%), 4 men and 2 women, mean age 48.6 +/- 4.2 years, were incidental tumors. Three years survival rate was 20% in clear cut neoplastic diseases (4 patients died for neoplastic recurrence) and 66% in incidental tumors. Our results demonstrate that liver transplantation for hepatobiliary malignancy is still justified, patient selection is important in predicting outcome.

Gallbladder torsion. A case report.

Gallbladder torsion is a rare condition causing acalculus cholecystitis. Its preoperative identification is difficult with current radiological means and it is generally diagnosed at surgery. A case of gallbladder torsion due to an extremely rare anomaly consisting of partial fixation of the fundus to a fore-shortened liver bed is reported. The etiology, diagnosis and treatment of this condition are discussed.

[Automated measurement of elastase activity and elastase inhibitory capacity of serum]. / Dosage automatique de l'activité élastasique et de la capacité d'inhibition élastasique du sérum.

A technic of autoanalysis of the elastase activity and the capacity of elastase inhibition of the serum is described. This estimation depends on the hydrolysis by elastase of N-ter-butoxycarbonyl-L-nitrophenyl ester with liberates p.nitrophenol the colour of which is read at 405 nm. The means of this sample estimation are reported in a few cases of respiratory, dermatological and pancreatic disease.

[Assay of acenocoumarol (Sintrom) in the plasma by liquid chromatography]. / Dosage de l'acénocoumarol (Sintrom) dans le plasma par chromatographie en phase liquide.

Reversed-phase liquid chromatography was performed on C18 column using a pH 4 buffered water-methanol 45:55 (v/v) mobile phase and ultraviolet detection (307 nm). Warfarin was used as internal standard and dichloro-1,2 ethane as extraction solvent. The analytical recovery was greater than 98 p. cent. The within-day coefficient of variation (CV) was 5 p. cent, while the between day CV was 6.4 p. cent. The limit of detection was 0.02 mg/l.

[Peripheral neuropathies in essential mixed cryoglobulinemia: influence of positive serology for hepatitis C virus]. / Neuropathies périphériques des cryoglobulinémies mixtes essentielles: influence d'une sérologie positive pour le virus de l'hépatite C.

Among 15 patients suffering from peripheral neuropathy, 67% had anti-HCV antibodies. The anti-HCV antibodies positive patients had more severe multiple mono- and poly-neuropathies and more frequent inflammatory neuromuscular infiltrates. In some VHC positive cases, the peripheral neuropathy was efficiently treated by interferon alpha.

[Surgical treatment of anterior rectoceles in women. The transanal approach]. / Traitement chirurgical de la rectocèle antérieure de la femme. La voie transanale.

Anterior rectocele is a herniation of the anterior rectal wall into the vagina, which may be either isolated or associated with other pelvic floor disorders. Rectocele could result in outlet obstruction with dyschezia, manual extraction of faeces and/or false incontinence. Rectocele is diagnosed clinically, and can be confirmed by defecography. Other tests may demonstrate associated causes of constipation. Symptomatic rectoceles can be treated via a transrectal route, with two or three layers of plication of the rectal wall and excision of the redundant mucosal flap. The results of transrectal repair are good: short hospital stay, no mortality, morbidity less than 5%, good short- and mid-term results in approximately 80% of cases. Selection criteria in favour of the transrectal approach have not been clearly identified.

[Laparoscopic treatment of appendiceal peritonitis in adults]. / Traitement par voie coelioscopique des péritonites appendiculaires chez l'adulte.

UNLABELLED: The aim of this study was to evaluate the results of laparoscopic treatment of appendicular peritonitis. PATIENTS AND METHODS: From January 1991 to December 1994, 32 patients (16 men and 16 women with a mean age of 43 years) underwent emergency laparoscopy for a clinical diagnosis of localized or generalized appendicular peritonitis. All patients had double antibiotic therapy for at least 7 days. The laparoscopic appendectomy technique consisted of:insufflation to 12 mmHg, introduction of 3 trocars, first peritoneal lavage, coagulation of the mesoappendix, ligature of the base of the appendix, no drainage. RESULTS: There were 4 conversions (12.5%). Nine of the 28 cases treated completely by laparoscopy, presented generalized peritonitis and 19 presented localized peritonitis (including 8 abscesses). The operations were performed by 7 surgeons and the mean operating time was 86 minutes. There were no deaths. The postoperative morbidity was 10.7%. The mean duration of postoperative ileus was 2.8 days. The mean hospital stay was 6.8 days. Histological examination concluded on acute suppurative appendicitis 96.4% of cases. There were no bowel obstructions or incisional hernias with a mean followup of 28.5 months. CONCLUSIONS: The laparoscopic treatment of appendicular peritonitis is possible, simple and reproducible, effective, without any specific complications. The advantages of laparoscopic techniques over the traditional large incisions are the absence of parietal complications, the quality of exploration and peritoneal lavage, and improvement of postoperative comfort.