ABSTRACT
Aorto-enteric fistula, i.e. communication between the aorta and the digestive tract, is a clinical condition that usually appears in patients who have already been submitted to aneurismectomy. Primary fistula, in patients not submitted to surgical treatment, is uncommon. The authors describe a case of primary aorto-enteric fistula which was diagnosed and operated on early, with a favourable outcome. The critical analysis of the authors' experience and the literature data stress that an early diagnosis and suitable therapy can reduce mortality.
Subject(s)
Aortic Diseases/diagnosis , Duodenal Diseases/diagnosis , Intestinal Fistula/diagnosis , Vascular Fistula/diagnosis , Aged , Aorta, Abdominal , Humans , MaleABSTRACT
BACKGROUND AND AIMS: The scarce availability of organs and the excellent results obtained using living donors, due to the improved degree of compatibility between donor and recipient, the short period of organ storage and the possibility of choosing the ideal surgical "timing", in the authors' opinion justify the use of living donors from a clinical and ethical-moral point of view. METHODS: Between April 1986 and December 1996 a 406 renal transplants were performed; of these, 10 patients received grafts from living donors. Preliminary screening consisted in a careful clinical and immunological evaluation to evaluate the operating risk, good compatibility with the recipient and the perfect bilateral function of the kidney. RESULTS: The 10 donors had no postoperative mortality or morbidity, no alterations of renal function, and no onset of hypertension and/or proteinuria in the immediate post-operative period or at a distance. The organ and patient survival rate (including a follow-up of between 2 and 54 months, mean 25 months) was 100%. CONCLUSIONS: The authors suggest that living donors represent a valid alternative in uremic patients. This therapeutic act must be carried out in complete respect for ethical, moral and legislative principles and must be based on a careful clinical selection to minimise the risks of donation and to guarantee the maximum benefit for the recipient. It is to be hoped that further improvements are made in immunodepressive treatment, and above all an appropriate increase in transplants from cadaveric donors, making the use of living donors superfluous since this practice maims a perfectly healthy individual.
Subject(s)
Kidney Failure, Chronic/surgery , Kidney Transplantation/methods , Tissue Donors , Animals , Humans , Uremia/surgeryABSTRACT
Due to their uremic state and altered host response induced by immunodepressive therapy, renal transplant recipients are particularly susceptible to infectious complications with high morbidity and mortality. We here report the results of a prospective study with 170 renal transplant patients, undertaken to evaluate the efficacy of ceftriaxone in the prevention of wound and early urinary tract infection. No wound infection was observed, however, 12 patients (7.1%) developed urinary tract infections. On the basis of these data, we recommend ceftriaxone prophylaxis as a safe and effective measure to prevent transplant wound infection and to reduce the incidence of postoperative urinary tract infection.
Subject(s)
Bacterial Infections/prevention & control , Ceftriaxone/therapeutic use , Kidney Transplantation , Surgical Wound Infection/prevention & control , Urinary Tract Infections/prevention & control , Adult , Female , Humans , Male , Prospective StudiesABSTRACT
Pulmonary hamartochondromas are tumor-like malformations, often presenting as asymptomatic, noncharacteristic masses that sometimes cannot be differentiated from lung carcinomas and metastases, preoperatively. Eleven patients (6 females and 5 males) with hamartochondroma of the lung were treated at this Institute over a 10 years period. Definitive diagnosis was established at thoracotomy, and treatment of choice was wedge resection. Two patients had pleural postoperative complications while the others made an excellent recovery. All patients are still alive (median survival: 56 months) and no recurrences occurred. Several studies showed that CT and transthoracic needle-aspiration biopsy are reliable methods to achieve the diagnosis in such benign lesions and their use allows a conservative approach. Since none of our cases could be diagnosed with certainty by the above procedures we always performed diagnostic and therapeutic thoracotomy with excellent results.