Anti-DFS70 antibodies detected by specific methods in patients with thrombosis or recurrent pregnancy loss: no evidence of an association.

A dense fine speckled pattern (DFS) caused by antibodies to the DFS70 kDa nuclear protein is a relatively common finding while testing for anti-nuclear antibodies (ANA) by indirect immunofluorescence (IIF) on HEp-2 cells. However, despite many efforts and numerous studies, the clinical significance of anti-DFS70 antibodies is still unknown as they can be found in patients with various disorders and even in healthy subjects. In this study we aimed at verifying whether these antibodies are associated with thrombotic events or with unexplained recurrent pregnancy loss (RPL). We studied 443 patients with venous or arterial thrombosis or RPL and 244 controls by IIF on HEp-2 cells and by a DFS70-specific chemiluminescent immunoassay (CIA). The DFS pattern was observed in IIF in 31/443 (7.0%) patients and in 6/244 (2.5%) controls (p = 0.01) while anti-DFS70 specific antibodies were detected by CIA in 11 (2.5%) patients and in one (0.4%) control (p = 0.06). Positive samples, either by IIF or by CIA, were then assayed by a second DFS70-specific line-immunoassay (LIA) method: 83.3% of the CIA positive samples were confirmed DFS70 positive versus only 29.7% of the IIF positive samples. These findings show that IIF overestimates anti-DFS70 antibody frequency and that results obtained by specific CIA and LIA assays do not indicate that venous or arterial thrombosis or RPL are linked to a higher prevalence of anti-DFS70 antibodies.

Gastrointestinal bleeding from enterically drained transplanted pancreas.

Gastrointestinal bleeding has been described as related complication of pancreas transplantation. Of 166 simultaneous pancreas kidney transplantations, 61 were enteric-drained pancreas transplants (eight done with and 53 without Roux-en-Y loop). The patients were divided into two groups according to Roux (group I, n = 8) or no Roux (group II, n = 53) technique. Seven patients experienced anastomotic hemorrhage between the jejunum and duodenal stump (11%), five cases in group I and two in group II (P < 0.001). No relationships between gastrointestinal bleeding duodenal stump and recipient jejunum blood flow, mean pancreatic cold ischemia time, platelet count, and prothrombin time were observed. Donor age over 40 years and abnormal activated partial thromboplastin time constituted risk factors for hemorrhage from the duodenojejunal anastomosis. There were no significant differences in pancreas graft and patient survival rates between the two groups. Anastomotic hemorrhage did not influence patient and graft survival.

A case of rapid intrahepatic dissemination of hepatocellular carcinoma after radiofrequency thermal ablation.

BACKGROUND: Radiofrequency ablation (RFA) is a novel technique for the treatment of liver malignancies that is becoming increasingly more popular because of its feasibility, effectivity, repeatability, and safety. However, an increased number of complications after RFA has been reported in literature. The aim of this paper is to discuss the possible role of RFA in rapid intrahepatic spreading of hepatocellular carcinoma (HCC). PATIENTS AND METHODS: We treated a 66-year-old woman who had a 3.5-cm HCC with two courses of percutaneous RFA using a modified needle with seven hooks. The effectiveness of the treatment was assessed 1 month later by enhanced computed tomography. RESULTS: Two courses of treatment were needed owing to the nodule position (close to the inferior vena cava). Computed tomography scan performed 1 month after the second RFA showed an intrahepatic arteriovenous fistula. Angiography performed after 1 month showed a rapid intrahepatic spreading of HCC. CONCLUSIONS: Radiofrequency ablation can create an arteriovenous fistula that can facilitate migration of tumoral cells from the nodule to the hepatic portal system and rapid intrahepatic dissemination of HCC.

A report of six cases of familial papillary thyroid cancer.

AIMS: Familial occurrence of papillary thyroid cancer is uncommon. The purpose of this study was review our own experience in a series of 267 papillary thyroid cancers. METHODS: We analysed the clinical records of 267 consecutive patients operated on for papillary thyroid cancer (PTC) in our hospital between June 1980-March 2000. RESULTS: We identified a family history in three families (6 patients), which results in a 2.25% familial papillary thyroid carcinoma (FPTC) rate. Pathology findings revealed that the tumour was multifocal and bilateral in 2 patients. Lymph-node metastases were found in 4 patients. They are all alive with a mean time of follow-up of 74.3 months (range 2-120). CONCLUSIONS: We recommend that patients with familial disease should be treated according to the disease stage and other risk factors, similar to those with sporadic differentiated papillary thyroid cancer. We encourage the further reporting and pedigree analysis to identify patients affected by FPTC.

Successful surgical salvage of pancreas allograft.

BACKGROUND: Early and late complications related to the pancreas after simultaneous kidney-pancreas transplantation (SKPT) frequently result in graft loss. The authors describe a surgical rescue technique that allows salvage of the pancreatic graft when surgical complications appear after the transplant. METHODS: Of 158 patients who underwent SKPT, 7 were identified with posttransplant complications that required surgical salvage of the pancreas allograft. The surgical salvage technique consisted of the following: pancreatoduodenectomy with conversion from whole-pancreas transplant with bladder or enteric diversion to segmental graft with duct injection (three cases) and conversion from whole-pancreas transplant with duct injection (four cases). RESULTS: Five of seven pancreas allografts are still functioning, with a mean follow-up of 28 months (range, 6-42 months). CONCLUSION: The described surgical treatment may be useful for surgical salvage of the pancreatic allograft, without major impairment of endocrine function.

Advantages and disadvantages of enteric versus bladder diversion in simultaneous kidney-pancreas transplantation.

Simultaneous kidney-pancreas transplantation is universally accepted as being the first-choice treatment for insulin-dependent diabetes mellitus in young patients with end stage renal disease. One hundred and fifty-six simultaneous kidney-pancreas transplantations were evaluated, namely, 33 segmental pancreas transplants with duct occlusion using neoprene (group I), 73 whole pancreas transplants with bladder diversion (group II) and 46 whole pancreas transplants with enteric diversion (group III) (37 with systemic venous drainage and 9 with portal diversion). Patient actuarial survival rates at 1, 5 and 10 years were 85%, 78% and 49%, respectively, in group I and 95%, 78% and 65% in group II. In group III the rates were 87% and 72% at 1 and 3 years, respectively. Kidney survival rates at 1, 5 and 10 years were 83%, 72% and 36% in group I and 89%, 78% and 59% in group II. In group III the survival rates were 85% and 72% at 1 and 3 years. Pancreas survival rates at 1, 5 and 10 years were 66%, 37% and 15% in group I and 73%, 67% and 65% in group II. In group III the rates were 87% and 68% at 1 and 3 years. Developments in the fields of organ retrieval technology, clinical immunosuppression and surgical technique have enabled us to improve our success rates, both in terms of organ survival and the quality of life of kidney-pancreas transplant recipients.

Urological complications after simultaneous renal and pancreatic transplantation.

OBJECTIVE: To report the urological complications after simultaneous renal and pancreatic transplantation. DESIGN: Retrospective study. SETTING: Teaching hospital, Italy. SUBJECTS: 143 consecutive patients having simultaneous renal and pancreatic transplantation by one of three techniques. 33 segmental pancreas with duct occlusion, 77 whole pancreas with bladder diversion, and 33 enteric diversion with systemic (n = 26) or portal venous drainage (n = 7). Urological complications were related to the pancreatic transplant, to the renal transplant, or unrelated to the transplant. MAIN OUTCOME MEASURES: Morbidity. RESULTS: After occlusion of the duct and enteric diversion, there were no urological complications related to the pancreatic transplant. On the other hand, among the 77 patients with pancreatic drainage into the bladder, urological complications were common (56/77; 73%). Complications related to the renal transplant were recorded in 6/33 (18%), 26/77 (34%) and 12/33 (36%), respectively. Complications unrelated to the transplant occurred in 6/77 patients (8%) in the bladder drainage group. Five patients after bladder drainage required cystoenteric conversion. CONCLUSIONS: Enteric diversion is a safe alternative to bladder diversion and results in significantly fewer urological complications.