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Pseudoaneurysms ( PAs) developing at the site of vascular anastomosis after organ transplantation are a rare but serious complication. We report a series of 3 cases of PA observed in a single center over a period of 18 years. The mode of presentation was acute bleeding in 2 cases. In the third patient, who underwent combined kidney and pancreas transplantation, the PA on the renal graft was discovered by chance. Graft removal associated with iliac artery ligation and extra-anatomic femoro-femoral bypass represents the standard treatment. However, interposition of a venous homograft may allow preservation of inferior limb perfusion and possibly graft salvage. [ABSTRACT FROM AUTHOR]

Abstract: Background: Invasive fungal infection (IFI) is a severe complication of liver transplantation burdened by high mortality. Guidelines recommend targeted rather than universal antifungal prophylaxis based on tiers of risk. Methods: We aimed to evaluate IFI incidence, risk factors, and outcome after implementation of a simplified two‐tiered targeted prophylaxis regimen based on a single broad‐spectrum antifungal drug (amphotericin B). Patients presenting 1 or more risk factors according to literature were administered prophylaxis. Prospectively collected data on all adult patients transplanted in Turin from January 2011 to December 2015 were reviewed. Results: Patients re‐transplanted before postoperative day 7 were considered once, yielding a study cohort of 581 cases. Prophylaxis was administered to 299 (51.4%) patients; adherence to protocol was 94.1%. Sixteen patients developed 18 IFIs for an overall rate of 2.8%. All IFI cases were in targeted prophylaxis group; none of the non‐prophylaxis group developed IFI. Most cases (81.3%) presented within 30 days after transplantation during prophylaxis; predominant pathogens were molds (94.4%). Only 1 case of candidemia was observed. One‐year mortality in IFI patients was 33.3% vs 6.4% in patients without IFI (P = .001); IFI attributable mortality was 6.3%. At multivariate analysis, significant risk factors for IFI were renal replacement therapy (OR = 8.1) and re‐operation (OR = 5.2). Conclusions: The implementation of a simplified targeted prophylaxis regimen appeared to be safe and applicable and was associated with low IFI incidence and mortality. Association of IFI with re‐operation and renal replacement therapy calls for further studies to identify optimal prophylaxis in this subset of patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: Liver transplantation (OLT) is the gold standard therapy for patients with cirrhosis complicated by hepatocellular carcinoma (HCC) within Milan Criteria (MC). We evaluated the impact of the etiology of the underlying liver disease on long-term outcomes of patients undergoing OLT for HCC within MC having a Model for End-stage Liver Disease (MELD) score < 15. Methods: From November 2002 to December 2009, we performed 203 primary OLTs from brain-dead donors in recipients with HCC and cirrhosis with biochemical MELD scores below 15. We excluded 31 patients outside MC on the explant pathology of the native liver. The remaining 172 were divided into 3 groups according to the etiology of the underlying cirrhosis: hepatitis C virus-positive (HCV+; n = 78; 45%), hepatitis B virus-positive (HBV+; n = 65; 38%) and other indications (n = 29; 17%). The groups were compared for donor and recipient features, donor-recipient match, and transplant variables. The study endpoint was long-term patient survival. Results: The groups were similar, except for a greater prevalence of hepatitis B core antibody-positive grafts in the HBV+ group and less frequent HCC bridging procedures in the other indications group. After a median follow-up of 72 months, HCC recurrence was observed in 8 (4.7%) patients (6 HCV+, 2 other indications), 5 of whom died. Overall 5-year patient survival of 82%, revealed significant differences among groups: 98.3% in HBV+, 67.1% in HCV+, and 85.8% in other indications (HBV+ vs other indications: P = .01; HBV+ vs HCV+: P = .0001; HCV+ vs other indications: P = NS). In the HCV+ group, recurrent HCV hepatitis was the most frequent cause of death. Upon multivariate analysis, HBV positivity in the recipient was an independent predictor of better patient survival (hazard ratio = 0.10, 95% confidence interval 0.02–0.64, P = .013). Conclusions: Etiology of the underlying cirrhosis significantly influenced the long-term survival after OLT of patients with HCC within MC and MELD < 15. It should be taken into account in estimation of survival benefit. [Copyright &y& Elsevier]

A “Point-Of-Care-Testing” (POCT) system relies on portable and simply operated self-standing analytical devices. To fulfill diagnostic requirements, the POCT system should provide highly sensitive simultaneous detection of several biomarkers of the pathology of interest (multiplexing) in a short assay time. One of the main unsolved issues in POCT device development is the integration of pre-analytical sample preparation procedures in the miniaturized device. In this work, an integrated POCT system based on gravitational field-flow fractionation (GrFFF) and chemiluminescence (CL) detection is presented for the on-line sample pre-analytical treatment and/or clean-up and analysis of biological fluids. As a proof of principle for the new GrFFF-CL POCT system, the automatic on-line analysis of plasma alkaline phosphatase activity, a biomarker of obstructive liver diseases and bone disorders, starting from whole blood samples was developed. The GrFFF-CL POCT system was able to give quantitative results on blood samples from control and patients with low sample volume (0.5 μL) and reagent consumption, short analysis time (10 minutes), high reproducibility and with a linear range of 50–1400 IU L−1. The system can be easily applied to on-line prepare plasma from whole blood for other clinical biomarkers and for other assay formats, based on immunoassay or DNA hybridization. [ABSTRACT FROM AUTHOR]

In a modern hospital biochemical laboratory, the efficiency and quality of the analysis result production process are fundamental. With respect to quality, an important step in the process is validation. In this step, laboratory physicians, who are physicians specialized in laboratory work, check the analysis result reports in order to verify that no error has occurred during their production. The application described in this paper is an expert system named DNSev. DNSev has been developed in order to improve the quality of the validation process performed by a specific laboratory information system (LIS), called ITALAB C/S, a system used in about thirty percent of Italian hospital laboratories. Objectives achieved by DNSev are: analysis result validation support (medical laboratory expertise in the process is translated into rules and automatically applied by DNSev), help for laboratory automation (checks that are usually manually executed are now automatically executed), clarity (reasoning performed by DNSev in issuing alarms is documented in order to explain it to laboratory physicians), flexibility (new types of reasoning can be easily added to the system by simply upgrading its knowledge base), reliability (checks may be tailored, based on patient characteristics) and time saving and cost reduction. During the development of DNSev, the knowledge acquisition and elicitation task was performed by interviewing laboratory physicians, and also by using available documents and laboratory guidelines. In order to conduct a significant trial test, we installed DNSev in the centralized biochemical laboratory of ‘Sant''Orsola-Malpighi’ Hospital in Bologna (Italy). This is one of the largest Italian biochemical laboratories, managed entirely by ITALAB C/S LIS. During this test we achieve a time saving of around 63% for each analysis request and a reduction on the overall number of analysis requests to be manually examined by laboratory physicians by around 20–25%. About performance of DNSev checks we achieved good accuracy and sensibility levels and a very low false normal level. These results demonstrate that an expert system may be a valid solution for improving quality and efficiency of well-defined medical tasks. [Copyright &y& Elsevier]