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D Montanaro

Publications and source records attributed to D Montanaro.

At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

Effects of successful renal transplantation on left ventricular mass.

Left ventricular hypertrophy is an independent cardiovascular risk factor in the general population and in patients with chronic renal failure. Relatively little is known about the effects of renal transplantation on left ventricular hypertrophy. The aim of this study was to determine the changes in left ventricular mass after successful renal transplantation and to evaluate the importance of some clinical, laboratory, and echocardiographic variables on the trend to left ventricular hypertrophy. Twenty-three patients with end-stage renal disease were studied by ambulatory blood pressure monitoring and echocardiography before and 2 years following renal transplantation. After 24 months of follow-up, all transplant recipients had adequate renal function (serum creatinine <2 mg/dL). At the end of the study, we observed a significant decrease in left ventricular mass and left ventricular mass index compared to the pretransplantation period. In renal transplant recipients, the prevalence of left ventricular hypertrophy significantly decreased (78% versus 44%, P < .03) after 2 years of follow-up. Systolic 24-hour blood pressure was the only predictor of left ventricular mass and of left ventricular mass index at 2 years after transplantation. In conclusion, successful renal transplantation produces a regression of left ventricular hypertrophy. This beneficial effect depends on a decrease in systolic pressure levels.

Adult↗
PubMedDate not supplied

Long-term results of in situ split-liver transplantation.

BACKGROUND: Split-liver transplantation (SLT) offers immediate expansion of the cadaver donor pool. The principal beneficiaries have been adult and pediatric recipients with excellent outcomes. This study analyzed a single-center experience of adult to adult in situ SLT in adult recipients. PATIENTS AND METHODS: Fourteen consecutive adult-to-adult in situ SLT have been performed at our institution since 1998. The extended right lobe comprising segment 1 was transplanted in to adult patients, the left lateral segment, for pediatric transplants. RESULTS: Donors of SLT were significantly younger (P = .03) than those of whole liver transplants. Survival rates of patients receiving a split liver were 83%, 73%, and 73% at 1, 3, and 5 years after the transplant respectively and grafts of 73%, 73%, and 73% for SLT and 76%, 70%, and 66% for whole liver transplants (P = .44). The rate of biliary complication after SLT was 21%, which was comparable to that after whole organ transplantation (17%). The incidence of hepatic artery thrombosis and primary nonfunction was not significantly different between split liver and whole organ transplantation performed during the same time period (7% versus 4.6% P = .67 and 7% versus 2.6% P = .32, respectively). CONCLUSION: This limited single-center experience confirmed that both early and long-term results of SLT are comparable to those of traditional whole liver organ transplantation.

Adult↗
PubMedDate not supplied

A single-center experience of late retransplantation of the liver.

Liver retransplantation is considered to carry a higher risk than primary transplantation. However, there are an increasing number of retransplant candidates, especially owing to late graft failure. The aim of this study was to analyze a single-center experience in late liver retransplantation. The overall rate of primary retransplantation was 11.4% (28 re-OLT out of 245 primary OLT); the 14 (52%) who underwent retransplantation at more than 3 months after the first transplant were analyzed by a medical record review. Causes of primary graft failure leading to retransplantation were chronic hepatic artery thombosis in five cases (36%); recurrent HCV cirrhosis in four cases (29%); chronic rejection in two cases (14%); veno-occlusive disease; hepatic vein thrombosis or idiopathic graft failure in one case each (7%). UNOS status at re-OLT was always 2A, all patients were hospitalized; three were intensive care unit bound. ICU and total hospital stay had been 7 +/- 5 and 28 +/- 16 days, respectively. One- and 2-year patient and graft survivals were 84% and 62% and 67% and 67%, respectively. Death occurred in four patients. Two out of the three recovered in ICU at the time of retransplantation, at a median interval of 15 +/- 9 days after retransplantation. The survival rate after late retransplantation is improving, and this option should be considered to be a efficient way to save lives, especially by defining the optimal timing for retransplantation.

Adult↗
PubMedDate not supplied

[Clinicopathologic correlations in acute renal graft rejection].

Although the diagnostic and therapeutic outcome of renal transplantation has successfully improved during the last decades, acute graft rejection (AGR) is still an ongoing cause of concern being often associated with irreversible graft dysfunction. Renal biopsy remains a valuable tool in the initial assessment of the potential graft malfunction especially during the early post-transplant period. It is an accurate and sensitive means for detecting prognostically relevant microscopic abnormalities, and assisting in subsequent patient management. For long time, the histopathologic evaluation of AGR has suffered from an irreducible bias with poor interobserver rates. Nowadays, the classification schemes of AGR include the BANFF approach and the National Institute of Heath Collaborative Clinical Trials in Transplantation (NIH-CCTT) system: both have been originally designed in order to improve the diagnostic reproducibility of AGR among pathologists. Arteritis and tubulitis, along to clinical information, constitute the cardinal features of the BANFF classification. Distinguishing features of the traditional NIH-CCTT system includes microscopic criteria such as assessment of interstitial hemorrhage, extent and quality of inflammatory infiltrate, and acute glomerulitis, in addition to tubulitis and arteritis. The BANFF classification has apparently gained more popularity than the time-honored NIH-CCTT system since, if used in the appropriate clinical context, it allows a more accurate assessment of AGR, provides prognostically relevant information, and has a better reproducibility rate among pathologists. Nevertheless, the accuracy trend has not significantly improved during the last few years.

Acute Disease↗
PubMedDate not supplied

[Surgical complications after kidney transplantation].

Chronic renal failure needs substitutive treatment such as haemodialysis and peritoneal dialysis for the patient to survive. Kidney transplantation (KTx) improves survival of the patient with chronic renal failure. Since the first KTx, performed by Merrill in Boston in 1959, advances in medical therapy, immunosuppressive therapy and refinements in surgical technique have improved the quality of life of the transplant patient. We present a review of the incidence, diagnosis and therapy of surgical complications after KTx reported in the literature and a retrospective analysis of 297 consecutive cadaveric donor kidney transplants done in our institution from September 1993 to September 2002. Vascular complications represent 5-10% of postoperative complications. Our experience showed an incidence of 1.7% renal artery thrombosis, 1.4% renal vein thrombosis, 1.7% renal artery stenosis, 1.4% arterial rupture due to fungal arteritis, 0.7% spontaneous graft ruptures and 12% lymphoceles. Urological complications account for 10-15% of postoperative complications. In our series we found an incidence of 7.4% urinary leakage, 2.7% urinary obstruction and 3% urinary reflux. Gastrointestinal complications represent 16% of postoperative complications. Our series showed 1% pancreatitis with an overall mortality of 33% and an incidence of 1.7% intestinal perforations. Surgical complications still represent a challenge that increments morbidity and mortality among kidney transplant recipients. Data shown may offer some guidance on how to deal with early and late post-transplant surgical complications.

Arteritis↗
PubMedDate not supplied

[Cardiovascular disease after renal transplantation].

Cardiovascular disease is the leading cause of morbidity and mortality following renal transplantation. Because many renal transplant recipients die with functioning grafts, deaths resulting from cardiovascular disease have became an increasingly important cause of graft loss, particularly after the first post-transplantation year. Moreover, a contribution of some cardiovascular risk factors to renal allograft dysfunction has been demonstrated. A number of observational studies suggest that cardiovascular disease is more common in renal transplant patients than in the general population. The excessive risk for cardiovascular disease is related to a high prevalence and accumulation of atherogenic risk factors before and after transplantation. Hypertension, post-transplantation diabetes and hyperlipidemia are well-recognized risk factors for the development of cardiovascular events after renal transplantation and are strongly associated with immunosuppressive therapy. Progressive renal dysfunction may also influence the risk of cardiovascular complications after renal transplantation. The elevated risk may also be caused by non- traditional risk factors such as anaemia, adhesion molecules, hyperhomocysteinemia, microinflammatory state, abnormal coagulation and oxidative stress. To prevent post-transplantation cardiovascular disease it is crucial to define the etiological risk factors. Some risk factors can be modified, and for some of these, there is strong evidence from studies in the general population that intervention improves survival. Given the significant morbidity and mortality of cardiovascular disease in renal transplant recipients, aggressive treatment intervention for potentially modifiable factors are strongly advocated after transplantation. In addition to treatment intervention, risk management should also involve tailoring the immunosuppressive regimen to minimize both direct and indirect cardiovascular risks. In this article we attempted to review and quantify the post-transplant risk factors for cardiovascular disease as well as offer suggestions on optimizing the therapy or treatment strategies to minimize the risk of cardiovascular complications in renal transplant patients. Reduction of cardiovascular morbidity and mortality can improve not only the life expectancy and quality of life of the transplant recipients but also their graft function and survival.

Anemia↗
PubMedDate not supplied

[Renal transplantation in the North Italy Transplant program (NITp): Organ allocation and results].

Renal transplantation is an effective therapeutic tool for patients with end-stage renal diseases (ESRDs). Data reported in this article summarize the results obtained from 30 years' activity in the North Italy Transplant program (NITp), the first transplant organization in Italy that implemented a donor procurement and organ transplantation network. In the NITp kidney allocation is governed by a computerized algorithm, NITK3, put in place in 1997, aimed at ensuring equity, transparency and traceability during the stages of the allocation decision-making process. The NITp working group has recognized the NITK3 criteria and they are periodically reviewed following the results of the analysis of patients' transplantation odds. The results obtained with the use of the NITK3 algorithm have been very satisfactory: after 6 yrs, a significantly higher percentage of patients at immunological risk (sensitized or waiting for re-transplant), of patients waiting for >3 yrs and of patients with 0-1 HLA A,B,DR mismatches have been transplanted. Moreover, a higher percentage of kidneys were used locally (in a hospital within the procurement area), and this is known to stimulate donor procurement. Finally, we performed a preliminary statistical analysis of transplants carried out from 1998-2002 in 5/16 centers of the NITp area, demonstrating the quality of the NITp program in terms of patient and graft survival, and that donor and recipient age are the variables significantly impacting on transplant results.

Adolescent↗
PubMedDate not supplied

[Evaluation of the effectiveness of disinfectants used in several Neapolitan hospitals].

Among the various and complex aspects concerning the etiology of nosocomial infections, a relevant role is played by the indiscriminate and incorrect use of disinfectants: they may change paradoxically from devices used for nosocomial infection prevention into carriers of infections. Critical situations are: a) inadequate cleaning of the container; b) inaccurate concentrations set up; c) use of unsterilized water as a diluent; d) introduction of gauze or cotton flocks into the container; e) disinfectant contact with inactivating substances such as soaps, detergents, and organic substances; f) solution stability; etc.. Therefore, in the light of the experience we acquired in the field of nosocomial infections, we believed interesting to carry out a study in order to detect contamination of disinfectants used in various hospitals in Naples as well as their usage. In the period from January to May 1988, 243 disinfecting solutions routinely used in surgical departments of the 2nd School of Medicine and of three large neapolitan hospitals were tested for microbiological contamination. The analysis was carried out according to Kelsey and Maurer. 13 disinfectants were contaminated. The bacterial count exceeded the value of 5000 col/ml in 6 cases, while for he other disinfectants there were levels between 2500 and 4500 col/ml. 64% of the microorganisms isolated belonged to Pseudomonas spp. (cepacia, aeruginosa, fluorescens, maltophilia), while Acinetobacter calcoaceticus and Staphylococcus epidermidis were found in 21% and 15% of specimens respectively. A major consideration arising out from our study is the little attention played to health problems related to disinfection by hospital staff, together with a lack of knowledge about the proper way of using disinfectants.(ABSTRACT TRUNCATED AT 250 WORDS)

Disinfectants↗
PubMedDate not supplied

[Levels of anti-Legionella antibodies in a healthy Neapolitan population].

Legionella pneumophila was firstly recognized as the causative agent of a serious pneumonia about a decade ago. Since then a number of studies was carried out in order to define the epidemiological and clinical features of the microorganism. So far a high variability of the geographic distribution of the infection has been reported, with prevalences up to 50% of healthy populations. Therefore, a seroepidemiological survey was carried out on prevalence of Legionella pneumophila infections among healthy people in Naples. 562 serum specimens were randomly collected and examined by the indirect fluorescent antibody technique for antibodies against serogroups 1 to 6 of Legionella pneumophila, using 1:256 as the cut off titer. An overall prevalence of 23% was observed among the 562 persons tested. 24.5% among males and 21.9% among females had antibodies against Legionella pneumophila. There were no significant differences associated with sex and age, even though an apparent increase with age was observed. The highest prevalence was found for antibodies against serogroup 3 (9.4%). This finding was confirmed in all the age-sex groups, but among males aging between 21 and 40 years and among elderly people, 12.1% of persons tested had antibodies against only one serogroup of Legionella pneumophila, whilst 5.3%, 3.4% and 2.1% of subjects had antibodies against 2, 3 and 4 serogroups respectively. No serologic cross reactivity of Legionella pneumophila groups was found among seropositivities to different serogroups.

Adolescent↗
PubMedDate not supplied

Beta-2-microglobulin in synovial fluid of rheumatoid arthritis.

The concentration of beta-2-microglobulin was determined by radioimmunoassay in the synovial fluid of 12 patients affected with rheumatoid arthritis and in 10 with other arthropathies. The white cell count, total protein concentration, total hemolytic activity of complement and acid phosphatase activity were also determined. Only beta-2-microglobulin was found to be significantly higher in rheumatoids compared to non-rheumatoid cases. In contrast, the other parameters showed no significant differences between the 2 groups of patients. These preliminary observations suggest that the measurement of beta-2-microglobulin concentrations in synovial fluid may be of diagnostic value.

Adult↗