Anogenital distance is associated with genital measures and seminal parameters but not anthropometrics in a large cohort of young adult men.

STUDY QUESTION: Is the anogenital distance (AGD) correlated to anthropometric, genital and sperm parameters in young adult men? SUMMARY ANSWER: We observed that reduced AGD is strongly associated with altered semen parameters and reduced testicular volume. WHAT IS KNOWN ALREADY: Abnormalities in the foetal development of the testis have been suggested as causative of common male reproductive disorders, such as cryptorchidism, hypospadias, reduced semen quality and testicular germ cell tumour, collectively defined as 'testicular dysgenesis syndrome'. In human epidemiological studies, alterations in AGD have been frequently associated with clinically relevant outcomes of reproductive health, suggesting AGD as a marker of foetal testicular development. STUDY DESIGN, SIZE, DURATION: This study was performed within the annual screening protocol to evaluate male reproductive health in the high schools of Padua and surroundings (Veneto Region, the North-East of Italy). Here we report the findings of 794 subjects who completed the study protocol between October 2016 and May 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS: We evaluated 794 students aged 18-19 years recording the following parameters: height, weight, BMI, waist circumference, arm span, pubis-to-floor and crown-to-pubis length, penile length and circumference, testicular volumes, semen parameters and AGD (measured from the posterior base of the scrotum to the centre of the anus). MAIN RESULTS AND THE ROLE OF CHANCE: Of the subjects, 49% had an abnormal arm span-height difference (>3 cm) and 63.4% had an altered ratio of crown-to-pubis/pubis-to-floor length (≤0.92). The rate of subjects with reduced testicular volume was 23%. Median sperm concentration was 51.0× 106/ml and total sperm count was 122.5 × 106. AGD showed a direct positive relation with testicular volume and penile length and circumference (R = 0.265, 0.176 and 0.095, respectively, all P < 0.05). No significant relation was observed between AGD and anthropometric parameters. Sperm concentration, total sperm count, progressive motility and normal morphology showed a significant and positive correlation with AGD (R = 0.205, 0.210, 0.216 and 0.117, respectively, all P < 0.05). LIMITATIONS, REASONS FOR CAUTION: Our cohort of young adults is not representative of the general population. Hormonal evaluation was missing. WIDER IMPLICATIONS OF THE FINDINGS: Our findings show that AGD is associated with testicular volumes, penile measures and seminal parameters in young adult men. Because AGD is hormonally determined during foetal life, the reported high incidence of reduced semen quality and reduced testicular volume could be related to a reduced androgenic exposure in utero. AGD could represent a simple and useful method to evaluate testicular and penile development in adult men. STUDY FUNDING/COMPETING INTEREST(S): The authors have no potential conflict of interest to declare. No external funding was obtained for this study. TRIAL REGISTRATION NUMBER: N/A.

Giant mid-esophageal diverticulum. Conservative treatment of postoperative leakage.

Mid-esophageal diverticula are rare entities. Only symptomatic patients usually receive surgical treatment. Esophageal leakage is one of the most common complications after these procedures. Though in literature, operative management is the preferred treatment for esophageal fistula, conservative approach is described in case of small leaks. We report a case of an operated giant mid-esophageal diverticulum complicated with an esophageal fistula. The patient underwent a surgical treatment and recovered completely.

Penile doppler ultrasound predicts cardiovascular events in men with erectile dysfunction.

BACKGROUND: Traditional risk factors used to assess cardiovascular risk miss a significant population who are indeed at risk for future cardiac events. Erectile dysfunction (ED) is an emerging marker for future cardiovascular disease (CVD) and major adverse cardiovascular events (MACE), especially in young and middle-aged men with vasculogenic ED. Cavernous arteries morphological alterations at penile colour doppler ultrasound (P-CDU) are used to find a vasculogenic ED. OBJECTIVES: We investigated the possible relationship between cavernous arteries morphological alterations at P-CDU assessment and future MACE. MATERIALS AND METHODS: We conducted a retrospective cohort study involving 300 ED patients, aged 35-65 years (mean age 54.1 ± 7.1), with a follow-up period of 10 years. Patients underwent vascular evaluation including P-CDU, colour doppler ultrasound of the carotid and lower limbs arteries. At baseline data for glucose metabolism, lipid profile, hypertension and hormonal status were collected. During the follow-up period, the occurrence of MACE was evaluated. RESULTS: We found a strong association between cavernous arteries morphological alterations and CVD with a threefold increased risk of future MACE in comparison to patients with healthy cavernous arteries (RR 3.2, 95% CI 1.17-8.78). This association remained statistically significant after adjustment for CV risk factors (age, glycaemia, total cholesterol, hypertension and smoke). CONCLUSIONS: Morphological alterations of cavernous arteries are independently associated with an increased risk of future MACE. These data contribute to the formulation of the hypothesis that cavernous artery pathology at P-CDU is related to MACE.

Evaluation of research products released during a national project funded by the Italian Ministry of Health.

Evaluation of research products released during activities that have received public funds should be a mandatory practice. In this study, we evaluated the research products released during the research program "Innovative Strategies to Expand Cadaveric Donor Pool for Liver Transplantation" (SITF Project), funded by the Italian Ministry of Health. The SITF Project prefigured the participation of Italian transplantation centers with more advanced experience in the field of liver transplantation. The research products released during the SITF Project were evaluated according to Guidelines for Research Evaluation of the Committee for Evaluation of Research (CIVR) from the Italian Ministry of Education, University and Research. Thus, we considered as the research products released during the SITF Project the number of articles published in English language in peer-reviewed scientific journals by each operative unit (OU), as returned by PubMed. The articles were included on the basis of relationship with the research lines of the SITF Project and availability of the impact factor (IF) calculated by Thomson Scientific for each journal. Following these criteria, 62 research products were released during the executive phase of the SITF Project (January 1, 2004-December 31, 2005). All research products were original articles, with no reviews or letters. The articles were published in 10 different scientific journals (mean IF, 2.64+/-1.74). Spearman's rank test found a weak negative correlation between journal IF and number of published articles (r= -.2919; P= .413). Although the OU involved in the coordination of the SITF Project released a relatively high number of articles (n=8; IF, 0.923+/-0.352), several other OUs obtained better results for number of articles (9-11) and/or IF (3.071+/-2.248 or 2.959+/-1.779). In projects that benefit from public funds, the potential negative impact of coordination activities to scientific production should be adequately considered.

Evaluation of an information system for kidney transplantation in adult and pediatric recipients using the RAND/UCLA Appropriateness Method.

In the mid-1980s, RAND Corporation and University of California Los Angeles (UCLA) developed the RAND/UCLA Appropriateness Method (RAM) to evaluate the correctness of medical and surgical procedures. In this study, the RAND/UCLA Appropriateness Method was used to evaluate the appropriateness of a dataset concerning kidney transplantation in adult and pediatric recipients for an information system funded by the Italian Ministry of Health. The original dataset was obtained using an interdisciplinary pool of regional experts (n=60). This dataset held 514 items about kidney transplantation in adult (n=268) and pediatric (n=246) recipients. The items were stratified as 3 main groups: pretransplantation items (adult, n=141; pediatric, n=122), transplantation items (adult, n=49; pediatric, n=45), and early posttransplantation and follow-up items (adult, n=78; pediatric, n=79). In the second round, the dataset was subjected to an extraregional panel of independent experts (n=9) to assess each item using a score ranging from 1 to 9 based on increasing appropriateness. The expert-opinion process returned for adult and pediatric kidney recipient items whole mean scores of 8.52+/-0.32 and 8.65+/-0.32, respectively. Overall agreement, uncertainty, and disagreement between experts about item appropriateness concerning adult kidney recipients were 94.6%, 5.4%, and 0%, respectively. For pediatric kidney recipients, overall agreement, uncertainty, and disagreement between experts about item appropriateness were 96.9%, 2.35%, and 0.07%, respectively. This study supported the use of a structured expert-opinion process as an effective strategy to evaluate the appropriateness of large datasets for kidney transplantation in both adult and pediatric recipients.

Application of the RAND/UCLA Appropriateness Method to evaluate an information system for kidney/pancreas transplantation in adult recipients.

With the aim to evaluate the correctness of medical and surgical procedures, RAND Corporation and University of California Los Angeles (UCLA) developed the RAND/UCLA Appropriateness Method (RAM). In this study, the RAM was applied to evaluate the appropriateness of a dataset concerning kidney/pancreas transplantation in adult recipients for an information system funded by the Italian Ministry of Health. The original dataset was obtained using an interdisciplinary pool of experts (n=60) involved in kidney/pancreas transplantation activity in the Liguria Region. This dataset held 291 items, stratified as pretransplantation items (n=158), transplantation items (n=49), and early posttransplantation and follow-up items (n=84). In the second round, the dataset was subjected to an extraregional panel of independent experts (n=9) to assess each item using a score ranging from 1 to 9 based on increasing appropriateness. The expert-opinion process returned a whole mean score of 8.47+/-0.43 (95% confidence interval [CI] 8.30-8.63). Overall agreement, uncertainty, and disagreement between experts about item appropriateness were 98.5%, 1.49%, and 0%, respectively. Agreement/uncertainty for pretransplantation, transplantation, and posttransplantation items were 99.87%/0.12%, 100%/0%, and 96.37%/3.62%, respectively. This study supported the utility of a structured expert-opinion process as an effective strategy to evaluate the appropriateness of large datasets for kidney/pancreas transplantation in adult recipients.

Model for End-Stage Liver Disease (MELD) score and organ allocation from cadaveric donors for 198 liver transplantation procedures performed in a single center.

Since February 2002, the United Network for Organ Sharing (UNOS) proposed to adopt a modified version of the Model for End-Stage Liver Disease (MELD) to assign priority on the waiting list for orthotopic liver transplantation (OLT). In this study, we evaluated the impact of MELD score on liver allocation in a single center series of 198 liver recipients (mean age of patients, 52.21+/-8.92 years), considering the relationship between clinical urgency derived from MELD score (overall MELD, 18.7+/-6.83; MELD <15 in 69 patients, MELD >or=15 in 129 patients) and geographical distribution of cadaveric donors (inside/outside Liguria Region, 125/73). The waiting time for OLT was 230+/-248 days, whereas the 3-month and 1-year patient survivals were 87.37% and 79.79%, respectively. No difference was observed for MELD score retrospectively calculated for patients who underwent OLT before February 2002 (n=71) compared with MELD score calculated for patients who received a liver thereafter (18.26+/-6.68 vs 18.94+/-6.92; P= .504). No significant difference was found in waiting time before and after adoption of MELD score (213+/-183 vs 238+/-278 days; P= .500), or by stratifying patients for MELD <15/>or=15 (225+/-234 vs 232+/-256 days; P= .851). Using the geographical distribution of donors as a grouping variable (outside vs inside Liguria Region), no significance occurred for MELD score (19.68+/-7.42 vs 18.17+/-6.42; P= .135) or waiting time (211+/-226 vs 242+/-261 days; P= .394). In our series, more OLTs were performed among sicker patients and no differences were found in the management of livers procured from cadaveric donors outside or inside Liguria Region. However, further efforts are needed to reduce the waiting time among patients with higher MELD scores.

Sirolimus therapy in liver transplant patients: an initial experience at a single center.

Sirolimus (SRL) is an mTOR inhibitor that has been shown, in contrast to calcineurin inhibitors (CNI), to inhibit cancers in experimental models. Since February 2005, we introduced SRL in liver transplant patients in group a, in whom the primary disease was hepatocellular carcinoma (HCC) associated with hepatitis B virus (HBV), hepatitis C virus (HCV), alcoholic or autoimmune liver cirrhosis, and group b, HCC-negative patients who developed posttransplantation cancers de novo. Of 18 patients in group a, 11 received SRL ab initio (subgroup a1), starting for 10 patients at 66.1+/-29.2 days after surgical healing and after 10 days in 1 case; the remaining 7 patients (subgroup a2) received SRL at 31.2+/-24.2 months. Three patients in group b, included 1 with Kaposi's sarcoma, 1 with bladder cancer, and 1 with thyroid cancer. In this group, SRL was introduced at 80.8+/-40.4 months. In all patients but one, who received a single 5 mg loading dose, SRL was started at 2 mg/d and adjusted to 6 to 8 ng/mL blood levels. CNI drugs, present as primary therapy, were gradually tapered to low levels and eventually stopped. The following observations were drawn from this initial experience: (1) 4/21 (19.0%) patients had to discontinue SRL because of early and late side effects: thrombocytopenia (n=2) and headache with leukopenia and leg edema associated with knee joint arthralgia (n=2); (2) 14 patients (11 in group a and 3 in group b) are still on SRL monotherapy; (3) 1 HCC recurrence and 1 de novo pancreatic adenocarcinoma were observed at 14 and 16 months, respectively (at the time of transplantation, both patients were beyond the MIlan HCC criteria), and (4) 1 patient, from subgroup a1, died after 99 days due to pneumonitis and possible relation to SRL lung toxicity. In conclusion, SRL appeared to be an effective immunosuppressant that could be used as monotherapy in liver transplant patients. Any conclusion on SRL anticancer effects can only come from randomized large studies after long follow-up.

Preliminary results of liver transplantation for hepatocellular carcinoma among allocation organ policy strategies, neoadjuvant treatments, and intention-to-treat analysis.

We retrospectively evaluated the impact of our strategy for patients with hepatocellular carcinoma (HCC) according to an intention-to-treat analysis and drop-out probability. We evaluated only patients within the Milan criteria. We analyzed the outcomes of neoadjuvant strategies for HCC, organ allocation policy, and systematic application of strategies to increase the deceased donor pool as the current tendency to expand transplantability criteria for those patients. Kaplan-Meier survival probability rates at 1, 3, and 5 years according to an intention-to-treat analysis were 87.02%, 74.53%, and 65.93% for transplanted patients (n=108), and 50%, 14.29%, and 14.29% for the excluded or waiting list group (n=13), respectively (P< .0001). Drop-out risk at 3, 6, and 12 months was 2.40%, 8.59%, and 16.54%, respectively. During the same period, the mortality probability rates at 3, 6, and 12 months among patients without HCC awaiting orthotopic liver transplantation (OLT) were 3.60%, 9.50%, and 18.34%, respectively. Drop-out rate was lower among patients treated before OLT (P< .0001). On the basis of the neoadjuvant treatment results to reduce drop-out risk, we suggest avoiding the high priority for the HCC cohort, particularly within the first 6 months from entrance on the waiting list, because this approach can reduce the chances of patients with end-stage liver disease (ESLD) alone.

Renal transplant compartment syndrome: a case report.

An unusual case of early double kidney transplant dysfunction due to abdominal compartment syndrome is herein reported. A 62-year-old woman on peritoneal dialysis underwent dual kidney transplantation. The grafts were positioned extraperitoneally in both iliac possae using standard techniques. Surgical procedures and immediate postoperative period were uneventful. The urine output was immediate and the creatinine decreased, but in a few days she developed severe ascites with reduced urine output, increased creatinine, and progressive changes on Doppler ultrasound. The patient underwent paracentesis: the kidney function recovered as well as the Doppler ultrasound. Kidney biopsy was negative for rejection or renal pathology. Graft dysfunction was related to the presence of ascites. A catheter inserted in the abdomen measured intra-abdominal pressure (IAP) of 14 mm Hg. IAP correlated with renal function showing that IAP probably explained renal flow modifications.

Application of an artificial neural network model to predict delayed decrease of serum creatinine in pediatric patients after kidney transplantation.

Artificial neural network, a computer-based technology that uses nonlinear statistics to recognize the relationship between input variables and an output variable, has been previously applied to outcome prediction in adult kidney recipients. In this study, we evaluated the effectiveness of a neural network model to predict a delayed decrease of serum creatinine in pediatric kidney recipients. The neural network was constructed with a training set of pediatric kidney recipients (n = 107) by using 20 input variables and assuming for the output variable, the time after 3 days to reach a serum creatinine level 50% below that before kidney transplantation. In the final model, the following input variables showing higher predictive values were retained: serum creatinine on day 1 post transplant, urine volume in the first 24 hours, diagnostic category, pretransplant dialysis mode, patient sex, donor sex, body weight on day 1 posttransplant, and patient age. The model was validated in a second set of patients (n = 41) by blinding the network for the output variable. The overall accuracies of the neural network for the training set, the validation set, and the whole patient cohort were 89.1%, 76.92%, and 87.14%, respectively. A comparative logistic regression analysis revealed only serum creatinine on day 1 posttransplant to be an independent predictor for the output variable (overall accuracy: 79.05%). The neural network showed sensitivity and specificity for the whole patient cohort to be 0.875 and 0.87, respectively, whereas using logistic regression sensitivity and specificity yields 0.37 and 0.94, respectively. This study proposes a neural network model that seemed to predict a delayed decrease in serum creatinine among pediatric kidney recipients. The availability of the source code may allow development of stand-alone neural networks to validate our model in prospective studies.

Application of a Bayesian simulation model to a database for split liver transplantation on two adult recipients in the environment of WinBUGS (Bayesian Inference Using Gibbs Sampling).

A Bayesian simulation model has been applied to a database developed for split liver transplantation on two adult recipients (SLT A/A) in the context of a macroregional project funded by the Italian Ministry of Health. The model was entered within Bayesian inference Using Gibbs Sampling (WinBUGS), a free software for Bayesian analysis of complex statistical models using Markov chain Monte Carlo techniques developed by the MRC Biostatistics Unit Cambridge jointly with the Imperial College School of Medicine at St Mary's, London. The model was built by using data entry performed from January 1, 2005 to August 5, 2005. In that period, 20 potential donors suitable for the SLT A/A procedure were entered into the database. We only selected the continuous and dichotomous donor-related variables (DRV, n = 62) for which almost one data entry procedure. The model assumed that a database user learned during data entry procedures for each donor, and that the probability of a successful input may depend on the number of previous errors and corrections. After binary transformation of the DRV (value 0 for each input record, value 1 for each no input record), we calculated an overall value of 0.28 +/- 0.27 (median: 0.3; 95% confidence interval: from 0.18 to 0.629). The transformed DRV were entered within the WinBUGS environment after model specification, assuming as success (y = 1) each procedure of input record, and as failure (y = 0) each procedure of no input record. A unequivocal convergence was obtained after 10,000 iterations, and a simulation run was launched for a further 10,000 updates. We obtained a negligible Monte Carlo error and a fine profile in the kernel density plot. This study supported the application of simulation models to databases concerning liver transplantation as a useful strategy to identify a critical state in the data entry process.

A preliminary data entry analysis on a multicentric informative system for split liver transplantation in two adult recipients.

In the context of the national research program "Innovative Strategies to Expand Cadaveric Donor Pool for Liver Transplantation" (SITF project), funded by the Italian Ministry of Health, an experimental and multicentric Web-based information system was developed to automate theoretical matching between a potential donor and two adult recipients for in situ split liver transplantation (SLT A/A). Data entry in the SITF database was performed in addition to activities formally required for patient and donor management by national legislation and guidelines. Data entry carried out within the SITF database from January 1, 2005 to August 8, 2005 was processed by stratifying original variables as donor- and patient-related. Only records required for donor-recipients matching had a mandatory data entry. The donor subset showed data entry procedures in 62 variables for 20 potential donors, whereas in the patient subset, we found 28 variables for 100 potential liver recipients. In the donor subset, 1004 records were filled, for a raw completeness of 77.08%. After adjustment for appropriateness, there were 935 remaining records with an adjusted completeness of 76.64% (P = .823). In the patient subset, 2653 records were filled, for a raw completeness of 98.69%. No difference in patient subset records was found after rechecking for appropriateness. A significant difference occurred for adjusted completeness between the donor versus the patient subsets (P < .0001). The results of this study suggested that only the presence of mandatory donor records may produce a consistent database suitable for SLT A/A.

Application of the RAND/UCLA appropriateness method to evaluate an informative system for liver transplantation in adult and pediatric recipients.

The Delphi Method (DM) is the most frequently used technique to acquire structured expert-opinion elicitation (EOE). It has been increasingly applied to construct guidelines in medicine and to evaluate the appropriateness of clinical procedures. In this study, the RAND/UCLA appropriateness method was used as a structured EOE process to evaluate the appropriateness of a dataset concerning liver transplantation in adult and pediatric recipients for an information system funded by the Italian Ministry of Health. The original dataset was obtained using an interdisciplinary pool of regional experts (n = 60). This dataset held 280 items stratified into three groups: I. pretransplant items (n = 123); II. transplant items (n = 65); III. early posttransplant and follow-up items (n = 92). In the second DM round, the dataset was subjected to an extraregional panel of independent experts (n = 9) to assess a score ranging from 1 to 9 on each item based on increasing appropriateness, according to the RAND/UCLA Appropriateness Method. Overall agreement, uncertainty, and disagreement between experts was 95.89%, 3.12%, and 0.99%, respectively. For each group, agreement-uncertainty-disagreement were 99.35%/0.65%/0% (group I), 91.53%/5.30%/3.17% (group II), and 96.87%/3.13%/0% (group III), respectively. This study supported the use of a structured EOE process to evaluate the appropriateness of a large dataset for liver transplantation activity.

Split liver network: a collaborative internet-based scenario to expand the organ pool.

BACKGROUND: Split liver transplantation (SLT) has become a crucial option to maximize the liver pool, while organ procurement organizations (OPOs) usually allocate whole livers to single centers. In 2003, Italian Ministry of Health funded the Innovative Strategies to Expand Cadaveric Donor Pool for Liver Transplantation project with the goal to establish sharing criteria for SLT for two adults (SLT A/A), involving Italian transplantation centers, the North Italy Transplant OPO, and the Italian National Transplant Center. METHODS: SITF group defined donor/recipient inclusion criteria, setting minimum graft/recipient weight ratio (GRWR) at 1.2%. Donors and recipients on waiting list were shared on an Internet secured Web-based application (Split Liver Network [SLN]). SLN performs real-time matches between the registered donor and all patients on the bases of GRWR, displaying a size-based list of matched donor/patients, figuring hemiliver allocation once the whole organ is referred to a specific center. RESULTS: In the 2005 period, 47 donors and 124 patients were entered by nine centers, and six hemiliver allocations for three SLT A/A procedures were performed. By retrospective simulation of 32 donors and 613 recipients in the Nord Italia Transplant area, matchable recipients were available for all donors, while blood group frequency seemed a determining factor, more than donor body weight. COMMENTS: SLN hemiliver allocation might increase matching possibilities, offering a timely transplant for recipients of rare group, small-size, or in need of short wait. Our experience suggests that such an environment may be helpful to share a macroregional pool of liver recipients and to optimize SLT.

Medical report type in liver transplantation as a quality system document: new prospects for computerization.

The usage of a computerized system to organize data and ease the activity procedures of liver transplantation is useful in clinical transplantation. Preliminary cognitive research on systems of clinical transplantation database concerning medical reports was performed to verify their development level. The survey highlighted that, so far, there has been no experimentation that can be applied to a medical report type devoted to liver transplantation. Regulations in force substantially point out that the medical report ought to contain all items that have to be taken into account in handling the patient from pretransplantation to follow-up. The Department of Transplantation of Genoa chose its medical report model for liver transplantation. The medical report model included the following items: personal data; case history; diagnosis; initial examination for prelisting; fitness for transplantation; assistance context; clinical data including subjective, objective, and instrumental parameters; pharmacological therapies; informed consent, evaluation of fitness; nursing data; counseling and clinical evaluations according to protocols and guidelines of the national transplantation centers. If the computing is well trained, it is supposed to help maintain a whole data view provided it is supplied information in an adequate way. Immediate clinical procedural advantages and useful scientific observations may be obtained from a high-quality database. In fact, all functions have to be applied to specific clinical, administrative needs to be remotely shared and conveniently integrated with each other to make the liver transplantation medical report an easy and handy instrument for inputting and handling data. It must be a precise, complete instrument that may be accessible in real time from any site connected with the intranet network, be unchangeable, and be protected to ensure certification and forensic medicine value.

Split liver transplantation for acute Wilson's disease: new option for urgent recipient?

Wilson's disease is a rare metabolic disorder that may lead to fulminant hepatitis and subsequent liver failure. Herein, we present a case of split liver transplantation performed on a patient with acute Wilson's disease. A 27-year-old female with acute presentation of Wilson's disease and advanced neurological impairment, received a Right Split liver Graft (Segments: IV, V, VI, VII and VIII) transplant. The graft was obtained by an in situ splitting technique. The graft implantation was performed in a standard fashion. No acute rejection episodes of the organ occurred. The postoperative course was uneventful. The graft function, ceruloplasmine level and copper levels progressively normalized. The patient totally recovered from neurological symptoms and the Kayser-Fleischer rings disappeared within one month. At 13 months of follow-up, the patient presented with no symptoms and in good condition. The current literature reports high preoperative mortality rate in patients that underwent partial liver graft for acute hepatic failure. However, our experience indicates that in situ split technique of liver may be a feasible and effective alternative to whole graft transplantation in urgent cases. Moreover, to our knowledge, this is the first successfully case of in situ split liver transplantation for acute Wilson's disease described in literature.

Laparoscopic splenectomy for hematologic diseases: a preliminary analysis performed on the Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS).

BACKGROUND: The Italian Registry of Laparoscopic Surgery of the Spleen (IRLSS) was developed to provide at the national level an informative tool useful for performing multicenter studies in the field of spleen laparoscopic surgery. In this first study analyzing the IRLSS data, a cohort of patients with hematologic diseases was retrospectively investigated for potential predictive parameters that could affect the outcome of laparoscopic splenectomy. METHODS: A total of 309 patients who underwent laparoscopic splenectomy for hematologic diseases in 17 Italian centers (between February 1, 1993, and September 30, 2004) were entered in the IRLSS. Their records were analyzed retrospectively by the Student's t-test, chi-square, and logistic regression. RESULTS: The mean operative time was 141 min (range, 30-420 min). Conversion was necessary in 21 cases (7%), and approximately 1 accessory spleen in 25 patients (9%) was found. The mean spleen weight was 1191 g (range, 85-4,500 g). Perioperative death occurred in two cases (0.6%). No complications were experienced by 253 patients (81.9%), who had a mean hospital stay of 5.4 days (range, 2-30 days). Overall morbidity occurred in 56 patients (18.1%), mainly associated with transient fever (n = 22), pleural effusion (n = 13), and actual or suspected hemorrhage (n = 12), requiring a reintervention for 7 patients. Multivariate analysis found that body mass index (p = 0.024) and clinical indication (p = 0.004) were independent predictors for surgical conversion. The clinical indication was almost significant as an independent predictor for the occurrence of postoperative complication (p = 0.05). CONCLUSIONS: This first study analyzing the IRLSS data shows that laparoscopic splenectomy may represent the gold standard treatment for hematologic diseases with normal-size spleen. The low morbidity and mortality rate suggests that laparoscopic splenectomy can be successfully proposed also for splenomegaly in hematologic malignancies.

Innovative strategies to expand cadaveric donor pool for liver transplantation (SITF project): a network between Italian transplantation centers supported by the Ministry of Health.

In 2002, the Italian Ministry of Health (IMH) launched a formal call for health research programs within the Research and Development (R&D) Policy. In this context, the research program "Innovative Strategies to Expand Cadaveric Donor Pool for Liver Transplantation" (SITF Project) has been proposed. The SITF Project has been formally approved by IMH as a 2-year research program included in the R&D Policy. The main goals of the SITF Project are to improve matching criteria for split liver transplantation (SLT) in both pediatric and adult recipients, to promote an increase of the SLT/full- size liver transplantation ratio at the national level, and, especially, to establish shared criteria for SLT in 2 adult recipients. The original executive plan of the SITF Project prefigured the participation of both the Italian transplantation centers with more advanced experience in the field of SLT, and institutional partnership, such as Nord Italia Transplant (NITp) and Italian National Transplant Center. A first Web public area concerning the SITF Project has been activated, as well as a reserved Web area with the aim to share cadaveric donors and patients in the waiting lists between Operative Units involved in the research program. For this objective, the first version Oracle-based database able to perform an automatic matching between a single cadaveric donor and 2 potential adult recipients has been released at the beginning of 2005. The SITF Project represents a new approach in the management of SLT for 2 adult recipients in Italy and a model for a functional network between Italian transplantation centers.

Impact of different cadaveric donor age cut-offs on adult recipient survival after liver transplantation: a single-center analysis.

The increase in the number of patients awaiting liver transplantation (OLT) has forced the use of cadaveric donors (CD) with suboptimal characteristics. Of these, donor age is perhaps the most investigated parameter. Although excellent outcomes were observed for OLT using CD aged over 60 years, the European Liver Transplant Registry (ELTR) Group found an increased risk by using CD of more than 55 years. The Italian National Transplant Center has recently assumed that CD age more than 60 years is a potential risk factor for OLT. In this study, a single-center analysis was performed by stratifying CD by three age cut-offs (< or =55 or >55, < or =60 or >60, and < or =65 or >65 years) to evaluate effects on OLT outcome. Although no significant difference in 6-month and 1-year patient or graft survival occurred after stratification for each donor age cut-off, a better survival was observed with OLT performed using livers procured from CD >55 years. A significant increase in cold ischemia time (CIT) was observed among OLT performed with grafts procured from CD < or =55 and < or =65 years (P = .007), and there was an inverse correlation between overall CIT and donor age (R = -0.300; P = .0022). However, no impact on 1-year patient survival was observed by introducing CIT in univariate logistic regression models as well as donor age, recipient age, donor/recipient age ratio, donor/recipient sex mismatch, ELTR diagnostic categories, and UNOS status. The results of this study suggest the suitability of CD of more than 55 years for OLT and the need to further investigate the cut-off value for CIT-related risk.