共查询到20条相似文献，搜索用时 15 毫秒
1.
G. Peluso P. Incollingo N. Carlomagno V. D&#x;Alessandro V. Tammaro M. Caggiano M.L. Sandoval Sotelo N. Rupealta M. Candida G. Mazzoni S. Campanile G. Chiacchio A. Scotti M.L. Santangelo 《Transplantation proceedings》2019,51(1):160-163
Background
Patients on peritoneal dialysis treatment represent 15% of the global dialysis population. The major complication of peritoneal dialysis is catheter and peritoneal infection. Peritoneal dialysis patients who receive kidney transplants are at increased risk of infection because of immunosuppressive therapy.Aim
The purpose of this study is to show our ideal timing to remove peritoneal catheter after kidney transplant, which gives adequate security on renal function recovery and reduction of septic risk.Method of Study
We analyzed the outcomes of 65 patients on peritoneal dialysis who underwent kidney transplant between 2000 and 2016.Results
In 61 cases there was an immediate graft functional recovery. In 4 cases there was a delayed graft function (DGF), and we performed a hemodialysis with temporary placement of a venous catheter. In all patients we removed peritoneal dialysis catheter 30 to 45 days after transplant. There has been 1 case of catheter infection, which was treated with antibiotic therapy.Discussion
Our average time to remove the peritoneal dialysis catheter was shorter than times in previous studies, between the 30th and 45th postoperative day. In the 4 cases in which there has been a DGF, we performed hemodialysis treatment to avoid, in the immediate postoperative period, direct insults to the peritoneum by local dialysis procedures.Conclusion
Our experience show that the 30th to 45th postoperative day is a good time frame, better yet a good watershed between the safe removal of peritoneal catheter when patients have a stabilized renal function and the possibility of leaving it in situ, to resume peritoneal dialysis in case of persistent DGF. 相似文献2.
A simple device created to prevent the entanglement of sutures with the struts of a bioprosthesis in the mitral position is presented. The technique appears to be effective, safe for the valve cusps, and easy to employ. 相似文献
3.
Eugenia Bruzzese Valeria Raia Eliana Ruberto Riccardo Scotto Antonietta Giannattasio Dario Bruzzese Maria Cristina Cavicchi Michela Francalanci Carla Colombo Nadia Faelli Valeria Daccò Giuseppe Magazzù Stefano Costa Vincenzina Lucidi Fabio Majo Alfredo Guarino 《Journal of cystic fibrosis》2018,17(3):375-382
Background
Intestinal dysbiosis has been described in Cystic Fibrosis (CF) and probiotics have been proposed to restore microbial composition. Aim of the study was to investigate the effects of Lactobacillus rhamnosus GG (LGG) on clinical outcomes in children with cystic fibrosis (CF).Methods
A multicentre, randomised double-blind, clinical trial was conducted in children with CF. After 6 months of baseline assessment, enrolled children (2 to 16 years of age) received Lactobacillus GG (6 × 109 CFU/day) or placebo for 12 months. Primary outcomes were proportion of subjects with at least one pulmonary exacerbation and hospitalisation over 12 months. Secondary endpoints were total number of exacerbations and hospitalisations, pulmonary function, and nutritional status.Results
Ninety-five patients were enrolled (51/95 female; median age of 103 ± 50 months). In a multivariate GEE logistic analysis, the odds of experiencing at least one exacerbation was not significantly different between the two groups, also after adjusting for the presence of different microbial organisms and for the number of pulmonary exacerbations within 6 months before randomisation (OR 0.83; 95% CI 0.38 to 1.82, p = 0.643). Similarly, LGG supplementation did not significantly affect the odds of hospitalisations (OR 1.67; 95% CI 0.75 to 3.72, p = 0.211). No significant difference was found for body mass index and FEV1.Conclusions
LGG supplementation had no effect on respiratory and nutritional outcomes in this large study population of children with CF under stringent randomised clinical trial conditions. Whether earlier interventions, larger doses, or different strains of probiotics may be effective is unknown. 相似文献4.
5.
N. Spampinato P. Stassano C. Gagliardi R. Tufano D. Iorio 《The Annals of thoracic surgery》1981,32(6):602-603
Two patients experienced an episode of massive air embolism during extracorporeal circulation. Several emergency measures were taken. (1) The roller pump was reversed to take out air from the aorta. (2) The circuit was disconnected and recirculated to eliminate air bubbles. (3) Perfusion was restarted and the patient cooled to 24°C for 40 minutes. (4) Pentothal (thiopental), steroids, and assisted ventilation were administered. The outcome was favorable in both patients, and there were no neurological sequelae. Immediate cooling and prolonged circulation seem to be a satisfactory approach to this problem. 相似文献
6.
Mario Musella Vincenzo Bruni Francesco Greco Marco Raffaelli Marcello Lucchese Antonio Susa Maurizio De Luca Giuseppe Vuolo Emilio Manno Antonio Vitiello Nunzio Velotti Rossella D’Alessio Enrico Facchiano Andrea Tirone Giuseppe Iovino Gastone Veroux Luigi Piazza 《Surgery for obesity and related diseases》2019,15(8):1332-1339
BackgroundLaparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure, while laparoscopic adjustable gastric banding (LAGB) has been for a decade one of the most popular interventions for weight loss. After LSG and LAGB, some patients may require a second surgery due to weight regain or late complications. One anastomosis gastric bypass (OAGB) is a promising bariatric procedure, which provides effective long-term weight loss and has a favorable effect on type 2 diabetes.ObjectivesTo retrospectively analyze data from 10 Italian centers on conversion from LAGB and LSG to OAGB.SettingHigh-volume centers for bariatric surgery.MethodsProspectively collected data from 10 high-volume centers were retrospectively reviewed. Body mass index (BMI), percentage of excess BMI loss, reasons for redo, remission from co-morbidities (hypertension, diabetes, gastroesophageal reflux, and dyslipidemia), and major complications were recorded.ResultsThree hundred patients were included in the study; 196 patients underwent conversion from LAGB to OAGB and 104 were converted from LSG. BMI was 45.1 ± 7 kg/m2 at the time of first intervention, 41.8 ± 6.3 kg/m2 at redo time, and 30.5 ± 5.5 kg/m2 at last follow-up appointment. Mean percentage of excess BMI loss was 13.2 ± 28.2 at conversion and 73.4 ± 27.5 after OAGB. Remission rates from hypertension, diabetes, gastroesophageal reflux, and dyslipidemia were 40%, 62.5%, 58.7% and 52%, respectively. Mean follow-up was 20.8 (range, 6–156) months and overall complications rate was 8.6%.ConclusionOur data show that OAGB is a safe and effective revisional procedure after failed restrictive bariatric surgery. 相似文献
7.
A. Giacomoni L. Centonze S. Di Sandro A. Lauterio A.L. Ciravegna V. Buscemi F. Ferla M. Tripepi G. Concone R. De Carlis G. Colussi M. Gregorini L. De Carlis 《Transplantation proceedings》2017,49(4):632-637
Introduction
Robot-assisted kidney harvesting from living donors is feasible and safe. We report the results of a mono-centric experience relative to 98 consecutive robotic nephrectomies with emphasis on global donor complications.Materials and Methods
This is a retrospective cohort study. Donors underwent robot-assisted kidney harvesting. The preferred kidney was the left one even in the presence of vascular anomalies. In the first cases we used a robotic hand–assisted technique, then the totally robotic technique, and finally the modified totally robot-assisted technique. Postoperative complications were ranked according to the five-grade Clavien-Dindo classification.Results
Between November 2009 and November 2016, 98 living donors underwent nephrectomy. We experienced 14 complications. The 3 intraoperative ones (3.06%) were 1 pneumothorax and 2 acute bleedings, 1 of them requiring transfusion. The 11 postoperative complications (11.22%) were as follows: 5 wound seromas, 1 rhabdomyolisis (Clavien I), 1 paretic ileum, 1 anemia requiring transfusion, 1 hypertensive crisis (Clavien II), and 2 chylus collections drained by interventional radiologists (Clavien III). Transfusion rate was 2.1%; conversions, reoperations, and mortality were nil. No statistically significant difference was observed between the patients with complications and without in terms of gender, age, anatomical anomalies, body mass index (BMI), and learning curve. We observed a longer global operation length of time in patients with complications.Conclusion
Robotic assistance results in shorter and simpler learning curves for the harvesting of kidneys from living donors. It enables an easier and more efficient management of possible intraoperative complications. The rate of postoperative complications is comparable with the rate of complications encountered in traditional laparoscopic series with high numbers of harvestings. 相似文献8.
Luigi Di Tommaso Ettorino Di Tommaso Raffaele Giordano Emanuele Pilato Gabriele Iannelli 《The Annals of thoracic surgery》2021,111(4):1325-1330
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9.
10.
P.G. Gazzetta M. Bissolati A. Saibene C.G.A. Ghidini G. Guarneri F. Giannone O. Adamenko A. Secchi R. Rosati C. Socci 《Transplantation proceedings》2017,49(4):646-649
During the last century, obesity has become a global epidemic. The effect of obesity on renal transplantation may occur in perioperative complications and impairment of organ function. Obese patients have metabolic derangements that can be exacerbated after transplantation and obesity directly impacts most transplantation outcomes. These recipients are more likely to develop adverse graft events, such as delayed graft function and early graft loss. Furthermore, obesity is synergic to some immunosuppressive agents in triggering diabetes and hypertension. As behavioral weight loss programs show disappointing results in these patients, bariatric surgery has been considered as a means to achieve rapid and long-term weight loss.Up-to-date literature shows laparoscopic bariatric surgery is feasible and safe in transplantation candidates and increases the rate of transplantation eligibility in obese patients with end-stage organ disease. There is no evidence that restrictive procedures modify the absorption of immunosuppressive medications. From 2013 to 2016 we performed six bariatric procedures (sleeve gastrectomy) on obese patients with renal transplantation; mean preoperative body mass index (BMI) was 39.8 kg/m2. No postoperative complication was observed and no change in the immunosuppressive medications regimen was needed. Mean observed estimated weight loss was 27.6%, 44.1%, 74.2%, and 75.9% at 1, 3, 6, and 12 months follow-up, respectively. Our recommendation is to consider patients with BMI >30 kg/m2 as temporarily ineligible for transplantation and as candidates to bariatric surgery if BMI >35 kg/m2. We consider laparoscopic sleeve gastrectomy as a feasible, first-choice procedure in this specific population. 相似文献
11.
D. Dondossola C. Lonati A. Zanella M. Maggioni B. Antonelli P. Reggiani S. Gatti G. Rossi 《Transplantation proceedings》2019,51(1):111-116
Background
Machine perfusion is increasingly utilized in liver transplantation to face the detrimental consequences of the use of extended-criteria donors. Hypothermic oxygenated machine perfusion (HOPE) appears to be more protective relative to static cold storage. Conversely, normothermic machine perfusion (NMP) allows a better graft evaluation. We describe a pilot prospective study on machine perfusion in selected grafts.Methods
HOPE was executed for all the grafts procured from donors after cardiac death (DCDs) and for livers from donors after brain death (DBDs) requiring prolonged preservation time. NMP was used when a more precise evaluation was needed. Both HOPE and NMP were performed through the portal vein and hepatic artery.Results
From July 2016 to November 2017, we performed 7 HOPE procedures: 5 for DCD and 2 for DBD grafts. Two livers presented with macrovesicular steatosis >30% (1 DCD and 1 DBD). HOPE lasted 240 minutes (180–320 min) with a total ischemia time of 575 minutes (410–810 min). Six grafts were successfully transplanted. One DCD graft required additional evaluation using NMP. The graft was then discarded due to extensive hepatocellular necrosis. In the post-transplant course, acute and chronic renal failure were the main complications affecting 3 and 2 recipients, respectively. In our series, steatosis was the main risk factor for kidney injury. Patient and graft survival rate was 100% and no ischemic cholangiopathies were observed after 270 days (106–582 days).Conclusions
Our study confirms HOPE safety and efficacy for DCD and DBD grafts. These data are particularly significant for DCD management in the Italian setting where the mandatory 20-minute hands-off interval before death declaration further prolongs warm ischemia time. 相似文献12.
A.A. Rahnemai-Azar J.D. Perkins N. Leca C.D. Blosser C.K. Johnson S.D. Morrison R. Bakthavatsalam A.P. Limaye L. Sibulesky 《Transplantation proceedings》2018,50(1):14-19
Background
The new kidney allocation system (KAS) intends to allocate the top 20% of kidneys to younger recipients with longer life expectancy. We hypothesized that the new KAS would lead to greater allocation of Public Health Service (PHS) increased-risk donor organs to younger recipients.Methods
Analyses of the Organ Procurement and Transplantation Network data of patients who underwent primary deceased kidney transplantation were performed in pre- and post-KAS periods.Results
The allocation of PHS increased-risk kidney allografts in various age groups changed significantly after implementation of the new KAS, with an increased proportion of younger individuals receiving increased-risk kidneys (7% vs 10% in age group 20–29 y and 13% vs 18% in age group 30–39 y before and after KAS, respectively; P < .0001). This trend was reversed in recipients 50–59 years old, with 31% in the pre-KAS period compared with 26% after KAS (P < .0001).Conclusions
The new KAS resulted in a substantial increase in allocation of PHS increased-risk kidneys to candidates in younger age groups. Because increased-risk kidneys are generally underutilized, future efforts to optimize the utilization of these organs should target younger recipients and their providers. 相似文献13.
Rossella Gioco Daniela Corona Antonella Agodi Francesca Privitera Martina Barchitta Alessia Giaquinta Ilari Alba Sara D’Errico Flavia Pinto Concetta De Pasquale Maria Luisa Pistorio Pierfrancesco Veroux Massimiliano Veroux 《Transplantation proceedings》2019,51(9):2927-2930
BackgroundMalignancy is an important cause of mortality in renal transplants recipients. The aim of this study was to evaluate the incidence, prognosis, and survival of patients developing a de novo post-transplant cancer.MethodsUsing a retrospective cohort design, we evaluated the incidence of de novo cancers among kidney transplants patients in our hospital from January 2000 to December 2012. We also evaluated the patient survival after tumor diagnosis.ResultsWe included 535 kidney transplants recipients with a mean follow-up of 7.8 years; among them, 39 (7.2%) developed malignancies. Median time from transplant to cancer diagnosis was 3 years, with a median age at diagnosis of 60 years. Male patients were significantly older at time of cancer diagnosis (68.5 years) compared with women (38 years, P < .05), and cancer diagnosis occurred significantly earlier in men (3.5 years since transplantation) than in women (8.5 years, P < .05). Among 39 patients affected by a de novo post-transplant cancer, 18 patients (46.2%) died, with an average age at death of 58.5 years. The average time from cancer diagnosis to death was 1.5 years. Among the group of patients who did not develop a post-transplant cancer, 83 patients (16.7%) died, with a median age at time of death of 54.5 years (P < .05).ConclusionsKidney transplant recipients are at higher risk of developing a post-transplant cancer. Prognosis after cancer diagnosis is poor, probably as a consequence of a more aggressive behavior of cancer in transplant recipients. Intensive screening protocols could allow for an earlier diagnosis thereby improving the long-term outcome of these patients. 相似文献
14.
E. Favi R. Santangelo S. Iesari M. Morandi G.E. Marcovecchio E.M. Trecarichi M.P. Salerno M. Ferraresso F. Citterio J. Romagnoli 《Transplantation proceedings》2017,49(8):1766-1772
Background
Cytomegalovirus (CMV) disease represents a major cause of post-transplantation morbidity and mortality. To estimate the risk of infection and monitor response to antiviral therapy, current guidelines suggest combination of viral load monitoring with direct assessment of CMV-specific immune response. We used enzyme-linked immunospot (ELISpot) for the evaluation of CMV-specific T-cell response in kidney transplant recipients with CMV viremia and investigated how information gained could help manage CMV infection.Methods
Seventeen patients on pre-emptive antiviral therapy and CMV quantitative polymerase chain reaction (qPCR) ≥500 copies/mL (first episode after transplantation) were assessed using ELISpot and divided into Weak (9 patients with baseline ELISpot <25 spot-forming colonies [SFCs]/200,000 peripheral blood mononuclear cells [PBMCs]) and Strong Responders (8 patients with baseline ELISpot ≥25 SFCs/200,000 PBMCs). CMV-specific T-cell response, infection severity, viral load, and antiviral therapy were prospectively recorded and compared between groups at 1, 2, and 24 months of follow-up.Results
Demographic and transplant characteristics of Weak and Strong Responders were similar. No episodes of CMV disease were observed. Weak Responders were more likely to experience CMV syndrome (56% vs 36.5%) and late virus reactivation (56% vs 25%) than Strong Responders. Weak Responders showed higher baseline median viral loads (19,700 vs 9265 copies/mL) and needed antiviral therapy for longer (179 vs 59.5 days). T-cell response showed 2 main patterns: early and delayed.Conclusions
ELISpot provides prognostic information about infection severity, risk of late reactivation, and response to therapy. Randomized trials, evaluating the need for antiviral therapy in kidney transplant recipients with asymptomatic infection and effective virus-specific T-cell immune response, are warranted. 相似文献15.
C. Caletti P. Manuel Ferraro A. Corvo G. Tessari S. Sandrini I. Capelli E. Minetti L. Gesualdo G. Girolomoni L. Boschiero A. Lupo G. Zaza 《Transplantation proceedings》2019,51(1):136-139
Background
Although optimization of immunosuppressive schemes in renal transplantation have minimized acute posttransplant complications, long-term outcomes are still not optimal and most of the chronic graft damage is drug-related. Therefore, to define the best long-term maintenance immunosuppressive regimen is of major importance in renal transplantation. To assess this objective, we undertook a large, multicenter cohort study in Italy.Methods
We retrospectively analyzed data of 5635 patients (enrolled from 1983 to 2012) and we assessed the impact of 3 major immunosuppressive regimens (calcineurin inhibitors+antimetabolites+corticosteroids [CNI+ANT+CS] vs CNI+mammalian target-of-rapamycin (mTOR) inhibitors+CS [CNI+mTOR-I+CS] vs CNI+CS) on long-term clinical outcomes by employing several statistical algorithms.Results
The overall difference in the incidence of outcome over time was not statistically different within the first 5 years of follow-up (P = .13); however, it became significant at 10 years and 20 years (P < .01), with the CNI+CS group showing the lowest cumulative incidence of outcome. Compared with the CNI+ANT+CS group, the CNI+mTOR-I+CS group patients had a significantly higher risk of outcome (hazard ratio [HR], 1.30; P = .024); the difference remained significant and even increased in magnitude after adjustment for potential confounders (HR, 1.38; P = .006). Similarly, patients in the CNI+CS group had a significantly higher risk of the outcome (HR, 1.64; P < .001).Conclusion
Our data confirm that CNI+ANT+CS is the “gold standard” therapy in renal transplantation, but, whenever required, the introduction of mTOR-Is instead of ANT may not dramatically modify major clinical outcomes. The use of mTOR-I could be a valuable pharmacologic tool to minimize CNI complications and insure adequate immunosuppression. 相似文献16.
Salvatore Tolone Mario Musella Edoardo Savarino Stefano Cristiano Ludovico Docimo Mervyn Deitel 《Surgery for obesity and related diseases》2019,15(4):567-574
BackgroundMinigastric bypass (MGB) is being performed widely with effective weight loss and improvement in co-morbidities. Because of similarity to Billroth II (BII), there are concerns about bile reflux.ObjectivesTo assess the esophagogastric junction (EGJ) function, esophageal peristalsis, and reflux exposure after MGB and BII.SettingUniversity Hospital, Italy; Public Hospital, Italy.MethodsObese patients underwent symptom questioning, endoscopy, high-resolution impedance manometry, and impedance-pH monitoring, before and 1 year after MGB. Esophageal motor function, EGJ, EGJ–contractile integral, intragastric pressure (IGP), and gastroesophageal pressure gradient were determined. Acid exposure time, number of refluxes, and symptom-association probability were assessed. A group of patients who underwent BII were studied with the same protocol and served as controls.ResultsTwenty-two MGB and 20 BII patients were studied. After surgery, none of the patients reported de novo heartburn or regurgitation. At endoscopic follow-up, esophagitis and bile findings were absent in all. High-resolution impedance manometry features did not vary significantly after MGB, whereas IGP and gastroesophageal pressure gradient statistically diminished (P < .01). BII patients had significantly lower values in IGP, sphincter pressure, and EGJ–contractile integral. In MGB patients, a marked decrease in number of refluxes (from median 41 to 7, P < .01) was observed, whereas BII patients had statistically significant higher acid exposure and number of refluxes (57, P < .001).ConclusionsIn contrast to BII, MGB does not increase any kind of reflux. Also, the differences in IGP and gastroesophageal pressure gradient suggest that bile reflux occurs more readily after BII than after MGB, and that these 2 operations share more differences than similarities. 相似文献
17.
Ester De Marco Daniela Corona Flavio Origlio Giuseppe Giuffrida Rossella Gioco Chiara Palermo Francesca Privitera Alessia Giaquinta Alba Ilari Sara D’Errico Flavia Pinto Fausto Carbone Anna Carbonaro Pierfrancesco Veroux Massimiliano Veroux 《Transplantation proceedings》2019,51(9):2906-2909
BackgroundA careful assessment of a living donor is mandatory to minimize the short- and long-term risk related to kidney donation. In this study, we evaluated the incidence of incidental findings (IFs) in a large population of potential living kidney donors. Moreover, this study evaluated if the presence of IFs could influence the chance of living kidney donation and post-transplant outcomes.MethodsOne hundred and sixty consecutive potential prospective living kidney transplant donors, who underwent a multidetector computed tomography angiography (MDCTA), were included in the study. An IF was defined as an incidentally discovered mass or lesion, detected by computed tomography angiography during the imaging evaluation of potential living donors. Clinical outcomes of living donors with IF were compared with those without IF.ResultsIn 10 patients (6.2%) an incidental finding was detected at MDCTA assessment. Among the 10 patients presenting with an IF, 7 patients (4.3%) were excluded from the living donation: 2 patients with an adrenal lesion, 3 patients with cancer, and 2 patients with a large (>8 cm) renal cyst. Graft and patient survival of kidney transplant recipients of donors with IFs were not significantly different to those receiving a kidney from living donors without IFs.ConclusionsIncidental findings are frequently discovered during living kidney donor evaluation. Whereas most are asymptomatic or not clinically relevant, predonation screening could identify potentially life-threatening diseases at an earlier stage, allowing for a more radical treatment. 相似文献
18.
The surgical treatment of 87 hepatic cysts from Echinococcus granulosus in 42 patients has been presented. The importance of determining the features of the cysts in each patient (age, number, location, and relation with vasculobiliary structures) in order to carry out the most appropriate treatment was stressed. Radical surgery was preferred because marsupialization, a conservative technique still widely used, has a high complication rate (60 percent in this study) and a prolonged recovery time. Arguments for and against cystopericystectomy and hepatic resections have been discussed. It is noteworthy that excellent results have been observed after hepatic resection when it was performed in selected patients. 相似文献
19.
D. Pezzati D. Ghinolfi E. Balzano P. De Simone L. Coletti N. Roffi E. Rreka L. Meacci D. Campani A. Mazzoni A. Paolicchi L. Caponi P. Marchetti L. Marselli F. Filipponi 《Transplantation proceedings》2017,49(4):726-728
Liver transplantation with very old donors is safe, but is associated with an increased incidence of ischemic-type biliary lesions and delayed graft function. Normothermic machine perfusion (NMP) is a novel technique for preservation of liver grafts and has the potential to reduce ischemia-reperfusion injury. A case is reported here of a liver transplantation (LT) with a graft from an 83-year-old brain-dead donor. Procurement was with dual perfusion and en bloc, modified fast technique. Donor kidneys were not transplanted due to severe atherosclerosis and poor perfusion. The liver was shipped to the transplantation center and underwent NMP with a blood-based perfusate. During machine perfusion lactates decreased, vascular flow was stable, and bile production restored, and the graft was considered suitable for transplantation. The postoperative course was uneventful and 4 months after surgery the patient is in good clinical condition with normal liver function. To date, few LTs have been performed with NMP in humans, but its preliminary results are promising. NMP allows functional evaluation of the graft and possibly reduction of post-transplantation complications when extended-criteria donor grafts are used. 相似文献
20.
Giovanni Pratesi Gabriele Piffaretti Fabio Verzini Giovanni De Blasis Patrizio Castelli Carlo Pratesi 《Journal of vascular surgery》2018,67(3):740-746