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Biomedical subjects

G Ciancio

Publications and source records attributed to G Ciancio.

At least 91 records · Page 5Linked to original sources
PubMed1996

Destructive allograft fungal arteritis following simultaneous pancreas-kidney transplantation.

Fungal arteritis of the Y graft used to revascularize the whole pancreas graft developed in 2 recipients of simultaneous pancreas-kidney transplant that were performed within 36 hr of each other. The vascular infection became manifest 6-7 days following transplantation. In both patients, the vasculitis culminated in an arterial rupture that required immediate operative intervention. This compromise of the Y grafts contributed to loss of both pancreatic grafts and necessitated vascular reconstruction to reperfuse the lower extremity. To date, both patients continue to experience normal kidney transplant function.

Adult↗
PubMed1996

Association of interleukin-10 with rejection-sparing effect in septic kidney transplant recipients.

Certain cytokines, particularly gamma-interferon (IFN) and interleukin (IL)-2 associated with TH1 cell function, have been shown to play a role in allograft rejection. One paradigm for long-term allograft acceptance involves TH2 cytokine predominance (IL-4 and IL-10). We describe two renal allograft recipients for whom immunosuppression was discontinued due to serious sepsis and who maintained stable renal function over 2-6 months without immunosuppression. During this time, there were higher levels of both IFN-gamma and IL-10 in the peripheral blood than in stable control kidney transplant recipients on immunosuppression. In one of the patients, levels of IL-10 fell, while those of IFN-gamma remained persistently elevated. This was associated with biopsy-proven rejection. Although peripheral blood cytokine levels may not reflect intragraft events, these data are consistent with an allograft protective role for IL-10 offsetting that of IFN-gamma in both patients off immunosuppression.

Adult↗
PubMed1996

A prospective study of hepatitis C virus infection in renal allograft recipients.

Hepatitis C virus (HCV) is the predominant cause of posttransplant non-A, non-B hepatitis among renal allograft recipients. Prior studies evaluating the impact of HCV in kidney transplantation have been retrospective in design and based largely on changes in serum transaminases. We studied a group of HCV-infected end-stage renal disease patients prospectively with pretransplant liver biopsies and close virologic and biochemical follow-up posttransplant. Fourteen patients have been followed a mean of 11.6 +/- 5.6 months posttransplant (range, 5-21 months). Six had changes of chronic hepatitis on pretransplant liver biopsy while 8 showed only mild histologic abnormalities. Circulating viral titers increased several-fold over baseline levels during posttransplant follow-up. Viral replication was particularly enhanced immediately following a course of antilymphocyte therapy. Although all patients showed a 2-3 fold increase in alanine aminotransferase (ALT) following transplantation, there were no association noted between pretransplant liver histology, the use of FK506 and/or cyclosporine-based immunosuppression, and the magnitude of ALT change posttransplant. The only clinical outcome found to differ significantly was a higher incidence of cytomegalovirus infection among patients with chronic hepatitis. All patients are alive with functioning grafts. There have been no episodes of fulmiinant or subfulminant liver failure. We conclude that HCV-infected patients can be safely transplanted with excellent short-term follow-up. Continued monitoring with sequential liver biopsies will be needed to define the long-term course of HCV infection in an immuno-suppressed population.

Adult↗
PubMed1996

Twelve years' experience with non-heart-beating cadaveric donors.

From 1983 to August 1995, the University of Miami Organ Procurement Organization evaluated 41 candidates for non-heart-beating cadaveric donation and determined that 34 patients met the criteria. All patients had irreversible brain injury incompatible with survival. All families gave permission for withdrawal of life support and for tissue and organ donation after cardiac arrest. Thirteen donors died in the operating room, and 9 died in the ICU or emergency department. Four of the 9 patients who died in the ICU had undergone femoral cannulation. The remaining 12 donors were brain-dead but had an unpredicted cardiac arrest before laparotomy. All kidneys were preserved by using machine pulsatile perfusion, and 21 kidneys were transported to other centers. Of the 35 transplanted kidneys, 26 (74%) had immediate function, 6 (17%) had delayed graft function, and 3 (9%) were not used for other reasons. Five of the six transplanted livers had immediate function.

Adolescent↗
PubMed1996

Urethritis/dysuria after simultaneous pancreas-kidney transplantation.

We evaluated the role of conservative treatment for urethritis and its complications after simultaneous pancreas-kidney (SPK) transplant. Twenty-six type I diabetic recipients with end-stage renal disease underwent SPK transplants with bladder exocrine drainage. Urethritis/ dysuria occurred in 4/26 (16%) of the patients. All cases resolved with conservative treatment that included Foley catheter and/or suprapubic cystostomy. Despite the frequency of this urological complication, none of the patients needed diversion of the exocrine drainage from the bladder to the intestine.

Adult↗
PubMed1995

Prostate cancer after heart transplantation.

Prostate cancer has an unpredictable natural history if left untreated, particularly if the neoplasm is discovered when it is apparently organ confined. To our knowledge we report the first case of organ confined adenocarcinoma of the prostate in a cardiac transplant recipient. The therapeutic decision is complicated by the uncertainty of the impact of continued immunosuppression on tumor growth. Although the effect of immunosuppression on the growth of prostate cancer is unknown, our patient was treated within the accepted guidelines for similarly affected nonimmunosuppressed individuals. Improvements in long-term survival rates of patients undergoing cardiac transplantation warranted radical surgical ablation as treatment for this man with clinically organ confined prostate cancer.

Adenocarcinoma↗
PubMed1995

Flow-cytometric DNA analysis of paraffin-embedded renal cell carcinoma tissue from patients treated by parenchymal-sparing surgery.

OBJECTIVE: To determine the utility of deoxyribonucleic acid (DNA) ploidy pattern, detected by flow cytometry, in predicting the outcome of renal cell carcinoma (RCC). PATIENTS AND METHODS: DNA content was retrospectively assessed by flow cytometry in 28 primary paraffin-embedded RCCs from 24 patients (16 men and eight women, mean age 61.9 years, range 40-89) who had undergone renal parenchymal-sparing surgery. RESULTS: Tumour recurred locally in three patients, two with diploid tumours and one with aneuploid tumour. Two patients with diploid tumours had metastatic disease 11-58 months after surgery. Only one patient with aneuploid tumour developed metastatic disease. There was no difference in local recurrence or metastases with the type of renal parenchymal-sparing surgery used (enucleation or partial nephrectomy) nor any significant difference in overall survival (P = 0.11). CONCLUSION: While DNA content might be of considerable predictive value for patients with RCC, these results showed that there was no difference in mortality rate, recurrence rate, or type of renal parenchymal-sparing surgery used between aneuploid and diploid tumours.

Adult↗
PubMed1995

Conservative surgical treatment of renal cell carcinoma. The University of Miami experience.

Thirty-four patients with renal cell carcinoma underwent renal parenchymal-sparing surgery; 10 enucleation (Group A), 15 partial nephrectomy (Group B), and nine a combination of procedures (Group C). Conservative surgery was performed in the presence of normal contralateral unit in four patients (11.7%). Local recurrence (group A = 1, group B = 2, group C = 2) developed in five patients. Metastases appeared in six patients (17.6%) from 12 to 58 months postoperatively. Adequate renal function was obtained in 32 of the 34 patients. Mean follow-up for all patients was 64.6 months overall, 75.6 months from group A, 64.1 months for group B and 53.4 months for group C. The three and five year probabilities of survival for all patients were 77.8% and 69.5% respectively, 80% for group A, 80% for group B and 85% and 57.1% for group C. Enucleation and partial nephrectomy are both viable options in the management of solitary or bilateral renal cell carcinoma. There is no decline ineffective tumor control and prognosis.

Actuarial Analysis↗