[Pregnancy after kidney transplantation. Case load of the Transplantation Center of Vicenza]. / Gravidanza dopo trapianto di rene: casistica del Centro Trapianti dell'Azienda Ospedaliera di Vicenza.

BACKGROUND: Pregnancy after kidney transplant has become possible thanks to recent surgical and pharmacological breakthroughs. MATERIALS AND METHODS: We performed a retrospective study including all pregnant women transplanted in our center after 1997. The following variables were analyzed. The type of nephropathy, patient age when dialysis began, patient age at trans-plantation, the time between dialysis and transplantation and the time between transplantation and childbirth. Immunosuppressive therapy, type of delivery, baby's weight and Apgar score were also considered. RESULTS: We followed four pregnancies in three patients who were, respectively, diagnosed with chronic pyelonephritis, post-partum cortical necrosis and immunoglobulin A (IgA) glomerulonephritis (GN). We observed complications in three cases and two pre-term births. In one case, the baby's weight at birth was lower when compared to the gestation age. We did not observe any significant disease in the baby's follow-up. CONCLUSIONS: We concluded that our data were in agreement with those in the literature confirming that pregnancy after kidney transplant, although possible, carries an elevated risk; and therefore, patients have to be referred to highly specialized centers.

Role of antigenemia assay in the early diagnosis and treatment of CMV infection in renal transplant patients.

AIM: CMV antigenemia by direct pp65 antigen detection and quantification was monitored on a weekly basis during the first 3 months after kidney transplantation. SUBJECTS AND METHODS: Preemptive therapy with ganciclovir was started according to the following criteria: any positive antigemia in CMV-NEG subjects, a single determination > or = 30 cell or a two fold increase of positive cells in two consecutive specimens in CMV-POS and continued until pp65 was cleared. Overall, 109 patients were monitored. RESULTS: Among the 24 CMV-NEG patients, 13 (54%) developed a pp65 positive assay without symptoms and were treated. Ten patients remained CMV-infection free and one patient developed late onset (7 months) CMV disease (hepatitis). Among the 85 POS patients 15 (17%) developed a pp65 positive assay and were treated. Two of them developed CMV disease within 7 days of the onset of positive antigenemia and 13 were asymptomatic. The other 70 patients remained CMV-infection free. The interval between transplant and the onset of CMV infection was 39 +/- 13 days in the CMV-NEG group and 64 +/- 20 days in the CMV-POS group (p < 0.001). The peak antigenemia level was 193 +/- 175 cells in the CMV-NEG group and 55+/- 78 cells in the CMV-POS group (p < 0.001). The duration of treatment did not differ in the two groups (22 +/- 7days). A second course of therapy, due to a relapse of asymptomatic infection was performed in 11/13 (85%) treated CMV-NEG patients and in 2/15 (13%) treated CMV-POS patients. CONCLUSIONS: Among the total 28 treated patients, we observed only 6 episodes of mild creatinine increase and 9 episodes of mild neutropenia. In the overall population, we observed 8 systemic infections not related to CMV.

[Surgical anatomy, diagnosis and treatment of spigelian hernia]. / Anatomia chirurgica, diagnosi e trattamento dell'ernia di Spigelio.

In reporting 11 cases of Spigelian hernia observed, the Authors describe pathological findings of this rare disease. Aetiopathogenesis as well as indication for surgery and surgical technique are stressed.

[Hematomas of the abdominal rectus muscle]. / Ematomi del muscolo retto dell'addome.

The authors report their experience in relation to a series of 12 cases of hematoma of the rectus abdominis (ER) observed over the course of 13 years at the 2nd Division of General Surgery at Vicenza Hospital: 7 were spontaneous, 2 post-traumatic, 1 occurred during anti-coagulant treatment, 1 in a patient with altered coagulation levels due to liver cirrhosis, and 1 was post-operative. Clinical symptoms were sub-acute in 8 cases and were characterised by abdominal pain in all cases, the appearance of an abdominal mass in 4 cases and by ecchymosis in 3 cases. Symptoms were acute in 4 cases with signs of impaired general conditions and anemia. Echography made a decisive contribution to the diagnosis in this pathology and, based on the author's experience, when it was used it prevented the use of surgery. Computerised axial tomography, although it contributed a few precise findings to the diagnosis of ER, was rarely useful. Eight patients were operated: 2 due to collapse and anemia, 4 due to failure to identify the disease, 1 due to persistence of the parietal mass, and 1 due to infection of the hematoma. In the 4 cases which were not operated, the course of the disease was more favourable. The sole death was an elderly cardiopathic patient due to postoperative complications following general surgery. The most suitable therapeutic approach, in those cases where an accurate diagnosis of ER has been made, is to refrain from any form of treatment and to monitor symptoms until they resolve, which will occur spontaneously after 20-30 days.(ABSTRACT TRUNCATED AT 250 WORDS)

[Primary adenocarcinoma of the duodenum: a clinical case and review of the literature]. / L'adenocarcinoma primitivo del duodeno: caso clinico e revisione della letteratura.

A case of primary duodenal adenocarcinoma recently observed gives the Authors the chance to review the literature. Diagnosis is often delayed because symptomatology is usually vague and non specific, a fact that is even more in contrast with diagnostic techniques, which, on the contrary, are handy and easily performed (endoscopy, duodenography). Surgical resection is the only proposable treatment while no local and distant diffusion has yet showed, otherwise the operation is limited to a digestive and/or biliary derivation. Anyhow, prognosis remains severe.

[Rectal cancer in the elderly patient: the results of surgical therapy]. / II cancro del retto nel paziente anziano: risultati della terapia chirurgica.

The study was carried out on 100 patients over 70 suffering from rectal cancer. The operative death-rate resulted higher in wider resections than in more limited ones, though the former showed a lower incidence of relapse and higher survival rates. Operative death-rate was more strictly related to the presence of cardiorespiratory alterations than to age per se. As a consequence, in Authors' opinion, surgical therapy is not to be completely rejected in old-aged patients; on the contrary it should be discussed according to the patient status. With the increase of the population mean age rectal cancer diagnosis in old patients has become more frequent; nowadays, improvements in anaesthesia and reanimation practice allow a considerable decrease in surgical risks with a corresponding increased possibility of a radical surgical therapy.