Acute Kidney Injury Secondary to Hypercalcemia in a Kidney Transplant Patient With Pneumocystis jirovecii Pneumonia: A Case Report.

BACKGROUND: Persistent hyperparathyroidism is one of the main causes of hypercalcemia following kidney transplantation; differential diagnosis is required. CASE PRESENTATION: We report the case of a 61-year-old kidney transplant recipient who underwent transplant in September 2016. She was admitted in March 2017 presenting with a 3-week history of asthenia, hypotension, and cough. Laboratory analysis showed acute kidney injury with hypercalcemia and elevation of inflammatory markers. She was initially treated with hydration therapy. A few days after admission she developed respiratory failure: chest computed tomography showed a ground-glass pattern. A diagnosis of Pneumocystis jirovecii was made on bronchoalveolar lavage. A subsequent graft biopsy was performed that revealed intratubular calcium deposition without signs of rejection. The patient was given trimethoprim/sulfamethoxazole, with improvement in pulmonary and renal function as well as improvement in hypercalcemia. CONCLUSIONS: P jirovecii infection can trigger activation of intra-alveolar macrophages that leads to extrarenal vitamin D production with subsequent hypercalcemia. This rare event should be considered in renal transplant patients with pulmonary infection accompanied by hypercalcemia. In our case, hypercalcemia also provoked acute kidney injury.

Successful Treatment of Focal Segmental Glomerulosclerosis Recurrence in a Second Kidney Transplant Patient: A Case Report.

BACKGROUND: Recurrence of focal segmental glomerulosclerosis (FSGS) in renal allograft recipients after first transplant occurs in the second graft in virtually all patients. There is little evidence regarding optimal treatment. CASE PRESENTATION: A 55-year-old man with primary FSGS and disease recurrence in both the first and the second kidney grafts is presented. In 1999, the patient developed FSGS 3 years after transplant, which was treated with plasmapheresis and cyclophosphamide. Hemodialysis was started at 8 years from the onset of relapse. In February 2014, the patient received a second kidney transplant, and after 2 weeks laboratory analysis showed nephrotic proteinuria (5.9 g/d) with increased serum creatinine. Biopsy results revealed recurrence of FSGS. At that time, he was treated with steroids and plasmapheresis with partial efficacy, achieving a serum creatinine level of 1.1 mg/dL with decreased proteinuria (1 g/d). After 4 months, creatinine worsened (1.6 mg/dL) with new evidence of proteinuria. Second biopsy results showed evidence of FSGS progression. The patient then received plasmapheresis and 2 doses of rituximab. Follow-up was characterized by progressive remission up to complete resolution. The patient is currently free from relapses after 3 years with good renal function and almost no proteinuria. CONCLUSIONS: More evidence and prospective studies are needed to better understand the role of rituximab in FSGS in order to obtain an optimized therapeutic protocol for recurrence of FSGS in renal transplant recipients.

Implantable cardioverter defibrillator in sport participation.

Although athletic participation lowers cardiovascular risk and improves quality of life, it may represent a hazard in high-risk group athletes such as those with cardiac abnormalities receiving an implantable cardioverter defibrillator (ICD). ICD sports participants are exposed to the potential risk of inappropriate shocks due to sinus tachycardia and other supraventricular arrhythmias during exertion as well as device injury. The safety of athletic participation of ICD-patients is not completely defined and ICD efficacy in interrupting malignant arrhythmias during intense exercise is partly unknown. This explains difficulties in current recommendations made by physicians, given the associated potentially ischemic, autonomic and metabolic conditions. The scope of this review is to underline specific considerations including potential risks and recommendations for athletic participation in this patient-group.

Atrial fibrillation in athletes.

Many studies have shown a relationship between long-term endurance sport practice and atrial fibrillation. Inflammation, anatomic remodelling, alterations in the autonomic system and neurohormonal activation are all possible explanations for the increased prevalence of this arrhythmia in athletes. Atrial fibrillation may determine disabling symptoms like palpitations and impaired physical performance, compromising eligibility for competitive activities, but exclusion from sport is not necessary for all athletes. Limited data are available on drug therapy and recently ablation resulted to be a particularly attractive option for young athletes with paroxysmal atrial fibrillation. The purpose of this review is to discuss mechanisms, clinical features, management of atrial fibrillation in competitive athletes, including criteria for eligibility and disqualification in sport practice.

Neuropeptide Y in the brain and retina of the adult teleost gilthead seabream (Sparus aurata L.).

The presence of neuropeptide Y (NPY) in the brain and retina of gilthead seabream (Sparus aurata L.) was investigated for the first time. For this investigation we employed an immunoperoxidase technique and the western immunoblot analysis using an antiserum raised against porcine NPY. The results showed that NPY-immunoreactivity was widely distributed in the brain of S. aurata. In particular, we have found NPY-immunoreactive (ir) neurons in the area ventralis telencephali pars centralis and pars lateralis, in the area dorsali telencephali pars centralis subdivision two and in nucleus intermedius thalami. An intense NPY-ir was detected in the telencephalon, in the optic tectum, in the thalamus, hypothalamus and in the vagal lobes. Scarce positive fibres were seen in the olfactory bulbs. NPY-ir amacrine cells were observed in the retina. The western immunoblot analysis revealed a protein band with a mobility corresponding to that of synthetic NPY. Our findings are, in general, in agreement with those obtained in other teleosts. The extensive distribution of NPY indicates for this peptide a key role in basic physiological actions, including visual and gustatory inputs processing.

Peripheral benzodiazepine receptors on platelets of fibromyalgic patients.

OBJECTIVE: The aim of the present study was to analyze if alterations of peripheral-type benzodiazepine receptor (PBR) characteristics occurred in platelet membranes of patients affected by primary fibromyalgia (FM). DESIGN AND METHODS: Platelets were obtained from 30 patients with FM. Evaluation of kinetic parameters of PBR was performed using [(3)H] PK11195 as specific radioligand compared with 16 healthy volunteers. RESULTS: The results showed a significant increase of PBR binding sites value in platelet membranes from FM patients (B(max) was 5366+/-188 fmol/mg vs. controls, 4193+/-341 fmol/mg, mean+/-SEM) (**p<0.01) but not for affinity value (K(d) was 4.90+/-0.39 nM vs. controls, 4.74+/-0.39 nM, mean+/-SEM) (p>0.05). Symptom severity scores (pain and tiredness) were positively correlated with B(max). CONCLUSIONS: Our results showed an up-regulation of PBR in platelets of FM patients, and this seems to be related to the severity of fibromyalgic symptoms.

Autoradiographic distribution of peripheral benzodiazepine receptors in the retina of the albino rabbit, Lepus cunicula.

The distribution of peripheral benzodiazepine receptors (PBRs) in the retina of the albino rabbit, Lepus cunicula, was studied by autoradiography using [3H]-PK11195, a isoquinoline carboxamide, as a tracer. Autoradiograms obtained by directly placing the slides containing the retina sections on tritium-sensitive film provide evidence for the presence of PBRs in rabbit retina. Furthermore, the dark field examination of photomicrographs taken from autoradiograms showed two dense horizontal bands corresponding to the outer and inner photoreceptor segments, and to the inner plexiform layer. The retinal regions where [3H]-PK11195 binding was more dense are rich in mitochondria, suggesting that as in other neuronal tissues, retinal PBRs are involved in the mitochondrial activity.

One-year experience with a new expanded polytetrafluoroethylene vascular graft for hemodialysis.

Hemodialysis access achieved through a prosthetic vascular graft has become more popular, especially in diabetic and older patients and those who have had several unsuccessful surgical accesses. From January to December 1996, we implanted a newly available expanded polytetrafluoroethylene (ePTFE) graft (DIASTAT Vascular Access Graft) that allows early cannulation in 18 patients (11 men and 7 women; mean age +/- SD, 63.7 +/- 11 years). Thirteen of these patients had at least one failed vascular access. All grafts were cannulated for dialysis within 7 days of implantation, with flow rates > or = 300 ml/min. The time to hemostasis after the first cannulation ranged from 2 to 4 min. The primary patency rate at one year was 56%. Four grafts developed thrombosis requiring surgical intervention; three were salvaged and one was removed. The one-year assisted or cumulative patency rate was 72%. One patient had persistent bleeding requiring graft revision immediately after surgery. The bleeding stopped and its origin was not determined. There were no graft infections or hematomas. Because of the early cannulation possible with the DIASTAT graft, as well as the lesser time to hemostasis than that generally achieved with standard ePTFE grafts, this prosthesis is a good alternative to autogenous access construction.

Relationships between neuropsychological and psychopathological dimensions in male alcoholics.

A study was conducted of the relationships between psychopathology and neuropsychological deficit in chronic alcoholic patients who had received the Minnesota Multiphasic Personality Inventory (MMPI), the Halstead-Reitan Neuropsychological Test Battery, and the Wechsler Adult Intelligence Scale (WAIS). Classification of the MMPIs by code type resulted in the formation of groups of 10 subjects with normal MMPIs, 19 subjects with MMPI profiles suggestive of depression, and 10 subjects with profiles suggestive of psychosis. Analysis of covariance was performed for various Halstead-Reitan scores; the only significant findings emerged for several of the verbal subtests of the WAIS. The group with psychotic MMPIs did substantially more poorly on these measures than the other groups. It was concluded that depressed alcoholics do not show greater neuropsychological deficit than do individuals with no significant psychopathology other than alcoholism. However, alcoholics with MMPI profiles that suggest psychosis differ from the other groups studied with regard to certain verbal abilities.

[Malignant gastric lymphomas]. / Linfomi gastrici maligni.

Primary malignant lymphomas of the stomach are the most frequent non-epithelial neoplasms of this organ (3%). Their onset and their development are insidious and a proved diagnosis is established only by laparatomy and biopsy specimens. In the absence of proved distant spread, surgical treatment in conjunction with radiation therapy and chemotherapy, gives very good results, with a five years survival rate of 50-70%, even in the presence of regional metastases, and sometimes a final cure is observed.

[Unusual case of pericecal internal hernia of the retrocecal fossa]. / Raro caso di ernia interna pericecale della fossa retrocecale.

Prompted by actual observation of one case, the authors call attention to this rare form of pericecal hernia. After a brief recall of pertinent anatomical features, they emphasize the rarity of this of hernia and the difficulty of diagnosing it preoperatively on the basis of clinical semiotics and radiological findings. In the last part of their paper the authors review the possible complications of this disorders and discuss therapeutic methods for its correction.