Polyomavirus Nephropathy: Ten-Year Experience.

BACKGROUND: Polyomavirus nephropathy (BKVN) is an important cause of chronic allograft dysfunction (CAD). Recipient determinants (male sex, white race, and older age), deceased donation, high-dose immunosuppression, diabetes, delayed graft function (DGF), cytomegalovirus infection, and acute rejection (AR) are risk factors. Reducing immunosuppression is the best strategy in BKVN. The objective of our study was to evaluate CAD progression after therapeutic strategies in BKVN and risk factors for graft loss (GL). METHODS: Retrospective analysis of 23 biopsies, from patients with CAD and histological evidence of BKVN, conducted over a period of 10 years. Glomerular filtration rate was <30 mL/min in 16 patients at the time of the BKVN diagnosis. RESULTS: BKVN was histologically diagnosed in 23 recipients (19 men, 4 women). All patients were white, with age of 51.2 ± 12.1 years (6 patients, age >60 years), and 22 had a deceased donor. Diabetes affected 4 patients, DGF occurred in 3, cytomegalovirus infection in 2, and AR in 15. All patients were medicated with calcineurin inhibitors (CNI) (95.7% tacrolimus) and corticoids, and 16 also received an antimetabolite. One year after antimetabolite reduction/discontinuation and/or CNI reduction/switching and/or antiviral agents, graft function was decreased in 11 patients, increased/stabilized in 10, and unknown in 2. GL occurred in 9 patients. Older age (hazard ratio, 1.76; 95% confidence interval, 0.94-3.28) and DGF (hazard ratio, 2.60; 95% confidence interval, 0.54-12.64) were the main risk factors for GL. The lower GFR at the time of the BKVN diagnosis was associated with an increased risk of initiation of dialysis. CONCLUSIONS: GL occurred in 39.1% of patients with BKVN and DGF; older age and lower GFR at the time of diagnosis were important risk factors. Early diagnosis of BKVN is essential to prevent GL.

[Suppurative complications of acute pancreatitis]. / Complicatiile supurative ale pancreatitei acute.

BACKGROUND/AIMS: This retrospective study investigated the management of the suppurative complication of acute pancreatitis in our clinic. MATERIALS AND METHODS: A retrospective study was made in the Surgery no. 1 Clinic of Timisoara during the period of 6 years (1996-2001) and on the subject of the acute pancreatitis with suppurative complications. RESULTS: As a result the study found a number of 16 cases of suppurative complications out of a total number of 224 acute pancreatitis (7.14%). The acute pancreatitis with suppurative complications was most frequent of biliary etiology (56.2%). All suppurations have occurred on serious necrotizing hemorrhagic acute pancreatitis background. The major elements that contributed to determining the diagnosis were: systemic toxicity, the permanent sepsis, the association of multiple organ failure, but the element that provided certainty in the diagnosis was the computed tomography (CT scan). The surgical mortality was 18.7%. CONCLUSIONS: The acute pancreatitis that evolves unfavorable under medical treatment must be operated. Necrotic tissues and purulent collections must be evacuated and drained efficiently. Open drainage through laparotomy lowered postoperative mortality. The early surgical intervention had a favorable effect on the prognostic.

[The indications for surgical treatment in venous malformations of the lower extremities]. / Indicatiile tratamentului chirurgical în malformatiile venoase ale membrelor inferioare.

The venous congenital anomalies are diseases with a low frequency to compare with the great number of the acquired venous diseases, but that present interest specially through their disabled evolution and through the insufficient standardisation and limited treatment. The paper present the experience of the First Surgical Clinic of Timisoara, with 76 venous congenital abnormalities of the lower limbs. We studied 48 patients with syndrome Klippel-Trénaunay, 12 with syndrome Parkes Weber and 16 venous hemangiomas. The surgical treatment was performed to 6 patients with syndrome Klippel-Trénaunay; in 3 cases we have do phlebolysis. The operation realized in syndrome Parkes Weber was in 1 patient the Malan operation and in another one an embolisation. 13 patients with venous hemangioma were operated on (81%) performing in 12 cases the complete excision and in 1 case the transcutaneous ligature followed by sclerotherapy. The indications of the surgical treatment in the venous congenital abnormalities require a good judgment, a precise lesion diagnosis and a competent evaluation of the therapeutics venous.