Distal transplant pancreatectomy during SPK: successful clinical outcome.

Simultaneous pancreas and kidney transplantation (SPK) is considered an extremely effective and well-established therapeutic option for selected patients with end-stage renal disease (ESRD), secondary to type 1 diabetes. Vascular complications in pancreas transplantation are more common than in any other solid organ transplant. Thrombosis is the most frequently observed surgical complication of pancreatic transplantation. We report a case of a successful management regarding the thrombosed distal pancreatic segment during SPK transplantation.

Graft pancreatitis: literature review.

Graft pancreatitis is an inflammatory disease leading to autodigestion of the gland. The failure of the pancreatic graft can be attributed to immunological or nonimmunological causes. It consists of a premature activation of pancreatic proenzymes. When complications such as bleeding or leaks have already occurred, surgical correction should be considered. The aim of this review is to draw the attention of surgeons to the complications that can easily be avoided.

Tesio-Caths provide effective and safe long-term vascular access.

BACKGROUND: Vascular access is judged on its ability to provide good dialysis adequacy, its durability and complication rates. Formation of a functional arteriovenous fistula is desirable but difficult to achieve in a significant proportion of patients. We report the large-scale use of Tesio-Caths, a twin-line single-lumen central venous catheter, to maximize dialysis adequacy where formation of an arteriovenous fistula was not possible. METHODS: All patients who had Tesio-Caths inserted between 1 January 1999 and 1 October 2002 were studied. RESULTS: Six hundred and twenty-three Tesio-Caths were inserted from 1 January 1999 to 1 October 2002 in 435 patients, generating 7464 patient months of follow-up. Five hundred and ninety-four out of 623 (95.3%) Tesio-Caths were immediately functional. Mean dialysis adequacy measured by single-pool Kt/V was 1.5+/-0.3 for all Tesio-Caths for the entire period of study, with 68% of Tesio-Caths delivering a Kt/V >1.4. Cumulative functional Tesio-Cath survival to final failure was 77.8 and 44% at 1 and 3 years, respectively. Cumulative patient survival was 84.7, 71.4 and 63% at 1, 2 and 3 years, respectively. Access-related infection accounted for 0.28 admissions/1000 catheter days, and the death rate from access-related sepsis was 9.6 deaths/1000 patient years at risk. The admission rate for access dysfunction was 0.33/1000 patient years at risk. CONCLUSION: Tesio-Caths provide good dialysis adequacy for patients in whom an arteriovenous fistula cannot be formed. Patient and functional access survival for this group was comparable with current European data irrespective of vascular access type. Complication rates were acceptably low.

Ethical issues in non-heart-beating donation.

A shortage of organ donors and the large number of patients desperately waiting for kidney transplant have led to the search for new sources of transplantable organs. The waiting list has grown at an alarming rate resulting in increased waiting times and deaths. The introduction of non heart beating (NHB) donation programmes generates a lot of ethical issues. How should death of a patient be defined in the case of NHB donation? Is there a strict separation of responsibilities of the medical teams in the different phases of the procedure (patient treatment and actual donation)? How should consent be obtained? Is sufficient respect and care given to the patient and his family? How is the viability of the organs assessed and how should the organs be allocated? We believe that it is very important to debate these issues and to try to outline an ethical framework for NHB donation that can enjoy the widest possible community support.

Renal artery aneurysm: ex vivo repair and autotransplantation: case report and review of the literature.

The incidence of renal artery aneurysm is unknown, its natural history is unclear and unpredictable, and the clinical symptoms are of little or no value in diagnosis. The risk of rupture is high in pregnant women, as in splenic artery aneurysms and in aneurysms greater than 2 cm in size. Digital subtraction angiography is the best diagnostic test. When an aneurysm is identified, surgery is the best treatment option to avoid hypertension or rupture of the aneurysm. Because of advances in organ preservation, nephrectomy, ex vivo repair, and autotransplantation is a safe and successful procedure. We report the case of a 2-cm-wide neck aneurysm that was treated by nephrectomy, ex vivo repair, and auto-transplantation.

Posttraumatic cyst of the spleen: a case report and review of the literature.

Splenic cysts are rare lesions. They are mainly divided into primary or genuine cysts and secondary or false cysts according to their etiology and pathophysiology. Primary cysts have a cellular lining that can be caused by either congenital events or parasitic infestations (Echinococcus). Secondary cysts have no cellular lining and may be of hemorrhagic, serous, inflammatory, or degenerative origin. It is important for surgeons to assess each individual case and decide on the most suitable treatment, taking into account the features of the cyst, the time of onset, and the age of the patient, to avoid possible complications. We report a case of posttraumatic pseudocyst treated successfully by splenectomy and we review the literature.

Mirizzi syndrome: a case report and review of the literature.

The Mirizzi syndrome is a rare benign cause of obstructive jaundice. The syndrome is a result of the impaction of a large stone, or several smaller ones, in either the Hartmann's pouch or the cystic duct, causing obstruction to the common hepatic duct. It is particularly interesting to surgeons because the surgery has to be carefully planned to avoid unnecessary damage to the common bile duct. Furthermore, it poses a differential diagnosis dilemma for surgeons as well as radiologists because there are no diagnostic procedures or clinical features that have a 100% specificity and sensitivity. As a result, the Mirizzi syndrome often has been mistaken for carcinoma of the gallbladder. We report one case of Mirizzi syndrome to draw attention to the importance of this syndrome and to describe the clinical, diagnostic, and therapeutic aspects of the disease.

Perisplenitis as a cause of acute abdomen: a case report.

Splenitis can complicate blood-borne sepsis in hemodialysis patients. Symptoms include left upper quadrant pain and tenderness in addition to generalized systemic manifestation of infection. Clinical diagnosis is difficult and there is no specific investigation to confirm it. Computed tomography scan of the spleen can help in identifying a splenic abscess, rupture, or infarction. A splenectomy is the treatment of choice in splenic abscess, in splenitis to avoid spontaneous rupture, and in recurrent perisplenitis.