Biomedical subjects
Publications and source records attributed to A Muolo.
The authors, starting from a case of desmoid tumour of abdominal wall, they had the opportunity to observe, discuss its possible etiopathogenetic factors, and confirm the validity of operation as the only therapy.
The spontaneous breakage of a kidney is a rare complication which may occur in the first weeks after a transplantation. The cause which can determine it is not yet cleared up, although the Authors think the greatest responsibility for this can be ascribed to rejection. In this work the authors report the experience and casuistry of the Transplantation Centre of Verona.
The Authors study again the problems of lymphocele in kidney transplantation by showing an interesting clinical case: a lymphocele with smallest size, developing an intensively compressive action on iliac vein. In the light of the experience of 354 transplantations, they discuss the etiopathology and clinics thereof. They particularly emphasize the diagnostical role of echography. Whereas the asymptomatic lymphoceles require no treatments for their trend to be reabsorbed, the symptomatic ones need a quick solution of the compressive effect. Then they consider the therapeutical solutions suggested as an alternative to the interperitoneal marsupialization, which remains the most widely used method.
The urological complications after a renal transplantation still represent an event anything but rare, ranging, according to the different statistics, from 0.9% up to 23%, with a mortality between 0 and 25%. In this work done by the Verona Centre the experience on 274 transplantations is reported. The urological complications weighed with 6.2% and absence of mortality among the patients. The importance of the prevention and precocious diagnosis is confirmed.
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Biopsies collected from gastroduodenal mucosa during endoscopic examination of 20 patients having undergone renal transplantation and subsequent immunosuppressive therapy showed cytomegalovirus (CMV) inclusion bodies in nine cases. CMV antibody titres were tested in all patients before and after the transplant procedure. Not all patients exhibited viraemia-related symptoms at the time of endoscopy. No correlation was found between the presence of CMV-type cells within the gastroduodenal mucosa, endoscopic and histological findings, the duration of the transplant, and the dosage of immunosuppressive drugs. The duodenum seems to be the elective site of CMV. The involvement of gastric mucosa seems to represents a worsening of the illness. Eight of nine patients with positive biopsies for CMV inclusion had negative pretransplant antibody titres to CMV. All nine patients were seropositive after transplantation and showed seroconversion. Five of 11 recipients with negative biopsies for CMV inclusion bodies, were seronegative before transplantation. Seroconversion occurred in five patients after the transplant; the other six had no rise in antibody titres. The lack of pre-transplant CMV antibody titre and its subsequent increase after transplantation identifies a greater risk of developing post-transplant CMV infection.
Renal transplant recipients can develop hepatic function abnormalities or severe leucopenia after transplantation. Generally it is thought to be due to azathioprine intolerance and patients are treated by curtailment of immunosuppressive therapy, being subsequently at risk to lose their allograft because of rejection. Evidence of Cytomegalovirus (CMV) infection is also common after renal transplantation. It is generally thought that the majority of these infections are asymptomatic, but they can be accompanied by leucopenia and/or hepatic function abnormalities. Sixty-nine renal transplant recipients have been studied for at least three months in order to investigate the relationship between CMV and azathioprine intolerance after transplantation. Twenty-five out of 58 patients who underwent seroconversion to CMV (a fourfold or greater rise in titer of CMV antibodies) after transplantation or who had a high CMV titer (greater than or equal to 1 : 16) prior to transplant, developed azathioprine intolerance. None of 11 patients who before renal transplantation had low CMV titers and who did'nt underwent seroconversion did not tolerate azathioprine. Therefore the Authors advance the hypothesis that azathioprine intolerance following renal transplantation can be often due to an asymptomatic and unknown CMV infection.
Seventy-two patients were typed for HLA-A and HLA-B. Kidney-graft survival, reversibility and time of appearance of reject episodes were comparated with matching level. Matching level had double classification: NIT and Verona; the validity of tissue-typing as prediction of the best result of transplantation and major reversibility of reject episodes.
Of 165 renal transplanted patients, three (1.8%) developed a pelvic lymphocele. Decreased renal function, leg edema, a lower quadrant abdominal mass and fluid retention represented suspicion as the possibility of lymph collection in the perirenal space. Excretory urography associated with pelvic tomography, Computerized Tomography and B scan ultrasound confirmed diagnosis and were helpful in the post-operative follow-up. Drainage procedure restored normal renal function and morphology. External drainage and marsupialization into the peritoneum have been used successfully.
Of 165 renal Transplantated patients, 12 developed aseptic bone necrosis in the femoral head (6 patients), in the femoral condyle (5 patients), in the astragalus (1 patient). The onset of symptoms was 6 to 23 months after transplantation. 99mTc-O4-MDP bone scintigraphy and radiological examination associated with clinical signs confirmed the diagnosis. Unresolved hyperparathyroidism, phosforus depletion, ponderal increase, total i.v. prednisolone-boluses and trauma represented conditions which might predispose to the development of lesion. 8 patients were managed with conservative treatment. 4 patients required a total of 8 operations: head replacement arthroplasty and articular cartilage reimplant in two patients with disease involving femoral head; articular cartilage reimplant and condyle replacement arthroplasty in two patients with disease involving femoral condyle.
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An assessment was made of the anterior cubital region as a vascular approach for primary and alternative dialysis. Reference is made to 36 fistulae in this area within 44 months' survival in the drawing of various conclusions with regard to surgical technique. End anastomosis of the median, cephalic or basilic vein laterally on the brachial or radial artery is recommended as a means of preventing or cutting down the more common complications associated with internal arteriovenous fitulae. The anastomosis should not exceed 6 mm in diameter. Complications led to loss of fistula function. In many cases, however, they did not prevent employment of the region for alternative approaches, such as superficialisation of the basilic vein or prosthesis.
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Forty rejection episodes were noted in a series of 35 renal transplants. 72.5% were reversible with i.v. 1 g "boluses" of 6-methylprednisolone. Four subjects died during the post-operative period, 10 were subjected to explantation and 21 were discharged with a functioning kidney; of these, mean blood creatinine was 1.02 +/- 0.31 mg in 19. Factors other than rejection influence the results of transplantation. Gastrointestinal, metabolic and bone complications typical of protracted steroid management are examined.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.