Postexplant residual cavity hemostasis with a TachoSil patch.

Intracapsular nephrectomy as the standard explant technique for a unfunctional graft is associated with intra- and postoperative complications due mainly to hemorrhage, fluid collections, effusions from damaged tissues and the residual cavity. We have reported herein a positive experience with the use of a collagen medical sponge patch into the surgical site for hemostasis. Use of this device produced a reduction in postoperative bleeding and collections with shortened time of drainage, reduced infection risk, and earlier discharge.

Saccular aneurysm of graft renal artery: case report.

Repair of anatomic anomalies in a donor kidney's vascular structures requires prompt recognition of the aberrant condition and an appropriate repair technique that does not compromise transplant success. Our report describes a case of a saccular aneurysm of the donor kidney, renal artery, which was identified during harvesting and repaired on the back-table using a prosthetic patch derived from the excised lesion to cover the breach. The long-term results were good.

Bench surgery in right kidney transplantation.

The problems deriving from the anatomic differences between the two harvested kidneys make the bench surgery necessary to solve some technical difficulties in transplantation. This condition is particularly real in the case of right kidney transplantation, especially in presence of arterial anomalies. In this study, we focused our attention on venous reconstruction in cases of short renal right veins. In 3 years, we performed 55 consecutive cadaveric renal transplants in patients with an end-stage chronic renal insufficiency. The right kidney was used in 30 patients, eight of whom had two or more arteries attached to a single aortic patch, and 22 had a single artery. In these right transplanted kidneys, the elongation of renal vein was performed end-to-side to the external iliac vein, reconstructing a "T-patch" (angular reconstruction) in 28 patients and a "linear" one in two cases. The vascular anastomoses had no thrombotic problems. We have followed the progress of the patients for more than 2 years; no one has lost the graft due to chronic rejection or other complications. In conclusion, elongation of the right renal vein with a T-patch constitutes a feasible, physiological procedure without vascular complications or apparent reverberations for graft blood flow.

Posttransplant renal monitoring with B-flow ultrasonography.

B-flow ultrasonography (BFU) is a new technology to detect blood circulation. It has been developed by using digitally encoded sonography, showing higher spatial and temporal resolution than Doppler imaging because of the clearer definition of the vessel lumen. Our study was performed on 55 patients, including 37 men (67.3%) and 18 women (32.7%), of overall mean age of 45.8 years (range = 16-60 who underwent kidney transplantation from deceased donors. The patients underwent an ultrasonography check postoperatively with successive daily controls to compare evaluations with both techniques: the combination of color and power Doppler versus BFU. In 25 patients (45.5%), visualization of cortical blood flow was clearer than with the standard techniques. The parameters of intrarenal circulation were easy to measure. In conclusion, BFU was effective to visualize hemodynamic flow and to detect stenotic lesions in the renal artery. Combined with the conventional B-mode technique, BFU seems to be useful in the evaluation of renal anasthamotic stenosis, especially among patients with vascular diseases.

Low limb and allograft rescue with iliofemoral graft for external iliac artery dissection: case report.

The technical difficulties in performing a transplantation can often be joined by an accident that demands an urgent solutions, putting the life of the patient in serious risk. In our case we were forced to perform an iliofemoral PTFE graft substitution to save the vascularization of the right lower limb. The cause was constituted by a dissection in the external iliac artery wall immediately after upstream declamping. Fortunately quick understanding of the complication made us stop the lesion downstream before it involved the femoral district. In addition the renal artery was already not declamped and the organ not perfused. Successively we anastomosed the renal artery to the PTFE graft with an end-to side anastomosis. Our first target was obviously to preserve the low limb vascularization but, with this solution we managed also to save the allograft. Actually renal function is conserved and with an optimal state of the vascular graft.

[Treatment of recto-urethral fistulas in Crohn's disease]. / Trattamento delle fistole retto-uretrali nel morbo di Crohn.

We report the thirteenth case of a rectourethral fistula in Crohn's disease. The patient, a 37 year-old-white male, had a 20 year history of intestinal Crohn's disease and had undergone numerous bowel resections. His symptoms were fecaluria, urorrhea and passing of urine from an orifice just outside the base of the scrotum. He had urinary infection and severe ileocolitis. He underwent a diagnostic evaluation that revealed a fistula comprising the membranous urethra, the rectum, the perineum and the scrotum. We performed medical therapy with metronidazole (20 mg/kg/day/12 months). We present in this article a review of the literature on the management of rectourethral fistulas in Crohn's disease. Surgeons have successfully used several approaches in the repair of this disorder, but no single procedure had proved to be best or even universally applicable. We emphasize, as the literature suggests, that management must be individualized. Medical therapy with metronidazole has an important role in a patient with rectourethral fistula and concomitant proctitis, ileocolitis, urinary sepsis and multiple previous surgeries.

[Future of immunologic therapy of bronchogenic carcinoma]. / Un futuro alla terapia immunologica del ca broncogeno.

The AA. report their experience as to the treatment applied to patients suffering from unremovable bronchial cancers. They can therefore stress the results obtained by chemotherapeutic treatment associated to thymopentin as well as interferon-thymopentin treatment. Elderly patients were subjected to interferon-thymopentin therapy, which helped in improving their life standard and survival.

[Pulmonary tuberculosis today. The findings over a 5-year period in a ward for women]. / La tubercolosi polmonare oggi. Rilievi su di un quinquennio in una divisione femminile.

The authors studied the cases of pulmonary tuberculosis they had the opportunity to observe during a five-year period from 1985 to 1989 carrying out the phenomenon. As a result they pointed out that the worst affected subjects belonged to the age bands included between the second and the third decade, followed by the fifth decade and over. They concluded that the 234 cases they examined do not represent the real number of affected subjects and that elderly patients to the most serious cases.