Effect of Age on Native Kidney Function after Adult Intestinal Transplants on Long-Term Follow-up

Background

Kidney function usually deteriorates after intestinal transplant, with prevalence of renal failure almost 20% after 5 years. We report our results on adults from single institution over >10 years.

Methods

Forty-six patients were transplanted with 22 survivors; we divided them in 2 groups: Group 1, recipients with creatinine >1.2 mg/dL (normal, 0.50–1.2) and Group 2, normal creatinine. Group 1 included 12 patients (9 males) with a mean age of 42.8 years; all lived at home, with normal creatinine at transplant (apart from 1 patient with a creatinine of 1.6 mg/dL), and were mainly transplanted for short bowel syndrome. One underwent retransplantation. Immunosuppression was based on alemtuzumab (8 recipients) plus tacrolimus (FK). Group 2 included 10 patients (6 males) with a mean age of 34.7 years; all lived at home, had normal creatinine at transplantation, and were mainly transplanted for short bowel syndrome. Immunosuppression was mainly based on alemtuzumab (8 recipients) plus FK.

Results

There were no relevant differences between the 2 groups regarding number of recipients, sex, baseline creatinine at transplant, reason for transplantation, retransplantation, immunosuppression, antifungal or antiviral therapy, hospitalization, total parenteral nutrition (or fluids), or stoma. The only relevant difference was age (P = .04); patients with deteriorated kidney function or altered creatinine were found to be older.     

Piggy-back versus conventional technique in liver transplantation: report of a randomized trial

Liver transplantation with preservation of the recipient vena cava (the “piggy-back” technique) has been proposed as an alternative to the traditional method. We performed a randomized study on 39 cirrhotic patients, 20 who underwent the piggy-back technique (group 1) and 19 the traditional method using venovenous bypass (group 2) to evaluate the feasibility and true advantages of the piggy-back technique compared to the traditional method. Two patients were switched to the conventional technique due to the presence of a caudate lobe embracing the vena cava in one patient and a caval lesion in the other. Statistically significant differences between the two groups were only found for the warm ischemia time (48.5 ± 13 min for piggy-back vs 60 ± 12 min for the conventional method) and for renal failure (zero cases in group 1 vs four cases in group 2). We therefore believe that liver transplantation with the piggy-back technique can easily be performed in almost all cases, and that only a few, specific situations, such as a very enlarged caudate lobe, do not justify its routine use. Received: 30 May 1996 Received after revision: 7 October 1996 Accepted: 28 October 1996     

Bilateral median and ulnar neuropathy at the wrist in a parquet floorer.

Many cases of work related compression neuropathy of the ulnar and median nerves at the wrist have been described. This report presents a case of bilateral distal neuropathy of the median and ulnar nerves in a parquet floorer, who laid wooden block flooring by hand and used the palms and volar surface of both hands to hit the blocks into place. He also used an electric sander and polisher. Bilateral numbness and paraesthesias in all fingers had been present for about one year. Clinical examination was normal; the neurological assessment indicated slight impairment in response to tactile, heat, and pain stimuli in all 10 fingers. Electroneurography showed increased distal motor latencies of median and ulnar nerves at both wrists, although the lower limbs were normal. The results of blood, urine, and instrumental tests excluded systemic disease or local factors that could cause compression neuropathy. After stopping work for three months, the clinical picture and electroneurographic results improved. These data support the hypothesis that the damage to the median and ulnar nerves had been caused by the patient's way of working, which provoked repeated bilateral microtrauma to his wrists. To diagnose work related multiple neuropathy can be difficult and an accurate work history is necessary. Preventive measures and diligent health care are required for this category of worker.     

Expression of connective tissue growth factor is a prognostic marker for patients with intrahepatic cholangiocarcinoma

BACKGROUND AND AIMS: Connective tissue growth factor is a member of the 'CCN' protein family. Consistent with its profibrotic properties, it is over-expressed in several human epithelial malignancies. PATIENTS AND METHODS: We have retrospectively evaluated by immunohistochemistry the presence of connective tissue growth factor in archival tissues from 55 resected intrahepatic cholangiocarcinomas and compared its expression to the main pathological parameters, disease free and overall survival. RESULTS: Tumours were scored as high and low/absent expressers (> or =50%, 0-50% cells, respectively). Thirty-three of 55 cholangiocarcinomas (60%) were high and 22 (40%) low expressers. No significant correlation was found between connective tissue growth factor and tumour grade, tumour location, vascular and perineural invasion. Eighteen of 22 (82%) low/absent expressers and 12/33 (36%) high expressers had recurrence of disease (P=0.001). Low/absent expressers showed a poor disease free and overall survival compared with the higher expressers (P<0.001). Vascular invasion was related to tumour recurrence (P=0.025) and to decreased disease free survival (P<0.05). During proportional hazard regression analysis, only connective tissue growth factor was found to influence disease free survival (P=0.01). CONCLUSIONS: Expression of connective tissue growth factor is an independent prognostic indicator of both tumour recurrence and overall survival for intrahepatic cholangiocarcinoma patients regardless of tumour location, tumour grade, vascular and perineural invasion.     

Clinico-radiological observations on pulmonary manifestations of leptospirosis during the Montefeltro epidemic

During the summer of 1984, in the Montefeltro area an epidemic of leptospirosis took place from a common source. In 15% of the people affected, the disease involved the lungs. In 3 patients the disease had a deadly course; one decrease was due to ARDS. The clinical, anatomopathological, and radiological features are described of the patients who presented with lung involvement. Such an outcome proved to be more likely than we thought. X-ray pattern of the chest was a polymorphous appearance, in spite of the same anatomopathological substratum, characterized by lung edema and endoalveolar hemorrhages.     

MRI of the hand in psoriatic and rheumatical arthritis

Magnetic resonance imaging (MRI) of the hand in patients with psoriatic arthritis (PA) was evaluated and compared with MRI of the hand in patients with rheumatoid arthritis (RA). Both MRI and X-ray examinations of the hands were performed in 28 PA patients and 18 RA patients.The MRI showed a PA pattern characterized by a more pronounced soft tissue swelling as compared with RA patients. Diffuse and pronounced periarticular oedema that spread to the subcutis was evident in 24 (85.7 %) PA patients. Subchondral changes were characteristic of PA patients, and were observed in 12 of 28 PA patients (42.8 %). In these cases, conventional X-ray examination failed to show any bone change. These two changes were not seen in RA patients. Our preliminary results indicate that MRI might play a role in differential diagnosis between PA and RA especially in the early phase of the disease in which conventional radiological examination is negative.     

Tunicamycin blocks the emergence and maintenance of insulin receptors on mitogen-activated human T lymphocytes

Treatment of phytohemagglutinin (PHA) activated human T lymphocytes with tunicamycin, an antibiotic that specifically inhibits asparagine-linked N-glycosylation of proteins, totally blocked the normal emergence of insulin receptors on these lymphocytes and their cellular proliferation during culture in a dose-dependent manner. Carbohydrate incorporation into protein was inhibited 82% by 0.5 μg/mL while leucine incorporation was unaffected. Tunicamycin exposure of activated T lymphocytes, which had acquired insulin receptors during culture, reduced cellular insulin binding by 35% to 84% and reduced PHA binding to 40% of control levels within 24 hours. Scatchard analysis revealed decreases in insulin binding capacity but not affinity. Similar treatment with cycloheximide only decreased insulin binding by 12%. These findings suggest N-glycosylation of proteins is a necessary biochemical event (1) for the emergence and maintenance of insulin receptors on mitogen activated T lymphocytes, and (2) for mitogen activated T lymphocytes to undergo cell division.     

Aneurysm of the superior mesenteric vein]

Aneurysms originating in the superior mesenteric vein are extremely rare: 4 cases have been reported in the international literature. The authors describe a case of a female patient admitted to hospital for vague abdominal pain. The CT findings revealed a cyst-like neoformation. By means of angiography it was then identified as a dilatation of the superior mesenteric vein. The causes of such dilatations are not altogether clear. Current interpretations refer to possible congenital and acquired factors, as well as trauma. The accompanying symptoms are abdominal pain, icterus, gastrointestinal haemorrhage or portal hypertension, but occasionally patients may present no symptoms whatsoever.     

Renal oncocytoma. A diagnostic and therapeutic problem

Renal oncocytoma is a more common entity as one may believe. Five cases and their sonographic features observed in six months are reported; in none of these cases was possible a secure diagnosis before the operation.