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Aim: To evaluate possible adverse consequences and complications following the procedure of Mason-McLeans Vertical Banded Gastroplasty (VBG), and in those cases the possibility to be related to a surgical mistake., Personal Experience: It is based on a casuistic of more than 180 patients, submitted to this restrictive bariatric surgery in the same institution since 2001. Controls of the prescribed postop follow up revealed a very low rate of complications, as only in three cases, all of them with spontaneous presentation, there was a complication related to the banding., Results: All the observed complications were related to a late postoperative inadequate alimentation for excess of meals, after the immediate orthodox behaviour of the first months., Discussion: From the comparative evaluation of all the patients submitted to the Mason-McLean procedure it seems of the utmost evidence the importance of a correct alimentation, mainly to the low bulk of the single meal, to avoid complications and obtain the best EWL%., Conclusions: Adherence to the guidelines for the post op alimentation in such patients is the key to obtain the best results from the operation avoiding the side effects and complications here described.

VGP represents the single more diffuse bariatric operation among the others restrictive ones, proposed and used from Mason since 1970. Other restrictive operations followed, introduced in the surgical armamentarium, but the Mason-like procedure remained the reference one, although with variations introduced by the single surgeon. On a basis of a personal experience of 163 patients operated with VGP, the Authors report the personal modifications of the procedure, in search of safety and better results.

In the post human genome era, several ''omics'' fields are emerging. Proteomics has experienced a rapid growth in the recent past and has great potential for the future. Proteomic technologies are used with increasing frequency also in nephrology. The aim of this review is to examine the recent application of emerging proteomic technologies to the study of renal physiology and pathophysiology. We highlight the use in renal research of a number of available techniques including 2-dimensional gel electrophoresis, liquid chromatography/mass spectrometry, surface-enhanced laser desorption/ionization, and capillary electrophoresis/mass spectrometry. We examine the role, efficacy and diagnostic potential of the different proteomic approaches, focusing on current difficulties and potential solutions. The integrating role of bioinformatics and the need for standardized procedures for sample preservation and analysis and reporting of results are also discussed. Although the field is still in an embryonic stage, the knowledge gained up to now is important not only for a better understanding of renal physiology and pathophysiology, but also for the identification of disease markers and the development and follow-up of new therapies. This review gives an overview of proteomics, providing background information, outlining the scopes, highlighting the applications in nephrology, and reporting advantages and limitations.

Bariatric surgery is still in search of a general agreement among surgeons for the more advisable technical procedure, and the various solutions actually overall performed are almost only on empirical basis. The main wanted result of such variety, of procedures is represented by the possibility to restore the body weight to physiological values without adverse effects. The Authors' experience is referred to 94 consecutive surgical procedures to treat obese patients and is completely homogenous, with all the patients treated by vertical gastroplasty, and the most of them are almost completely controlled till 24 months for clinical, biological, psychological and weight parameters. The complete absence of complications and the relevant compliance of all patients, without biological derangement from the normal values, correction of those preoperatively altered, and with the restoration of the body weight to the mean normal values of BMI, encourage the Authors to sustain the great advisability of the chosen technique.

Bariatric surgery for the treatment of morbid obesity or overweight refractory to medical therapy was born at the beginning of second half of the twentieth century, and its first steps were uncertain and with a not jet well definite purpose. In fact the main result to be pursued seemed to be simply the reduction of body weight, and any change of anatomy of the digestive tract able to reduce the absorbtion of nutrients was judged adequate. But very early the adverse consequences of malabsorption so obtained became evident, and other operations possibly free from those complications were devised and clinically tested. So aside the by-pass operations many other surgical procedures found their room, all of them aiming to fight the ever more diffuse obesity of the people. This historical review of the various surgical procedures attempted in these last sixty years for morbid obesity is very interesting for a better understanding of the problem and to have a solid basis for future rational choices.

Repairing a parietal defect of a large incisional hernia should not be limited to the closure of the breach by means of the modern biocompatible prosthetic sheets, but must also be able to restore a correct intra abdominal pressure, otherwise the derangement from the normal respiratory dynamics and the circulatory stasis in the abdominal veins and in those of the lower limbs remain unaltered. Over-correcting the parietal abdominal tension on the contrary can cause a dangerous compartmental syndrome. The attempts of an intraoperative measurement of the correct intra abdominal pressure restoration has been generally hampered from the condition of curarization of the patient during the operation. Using the automatic mechanical ventilator fixed at volume and not at pressure priority, as usual, can offer the possibility to calibrate, following objective parameters, the propriety of the surgical repair still during the final phases of the reparative operation. The simplicity and ingenuity of the here proposed method and the normal availability in every operative theatre of the necessary means for this measurements described, requires attention among the surgeons and a large diffusions of its simple use.

Cardiovascular disease after renal transplantation is often the expression of a disease process that first started with the onset of renal dysfunction many years before, and its prevention starts with the early predialysis phase of chronic renal failure and with the aggressive treatment of hypertension and dyslipidemia. The evidence that dialysis treatment itself accelerates arterial damage is poor. After transplantation, however, many patients are restored to a state not of normal renal function but of chronic renal impairment and have drug-induced hypertension and dyslipidemia, resulting in a vastly increased risk of atherosclerosis. Further research is required on optimal strategies to prevent or ameliorate cardiovascular disease, to establish the roles of lipid-lowering and antihypertensive therapies after transplantation and to define immunosuppressive ad hoc treatments for each kind of patient.

The Argon Beam Coagulator has gained his space in surgery thanks to its operative characteristics, that are very useful in sealing the bleeding parenchymal tissue with minimal injury to the surroundings. The aim of the present study is that of evaluate the physical properties of the instrument in its coagulation action. The experimental study with the Birtcher 6000 Argon Beam Coagulator has been designed to measure the top temperature that develops right where the Argon beam meets the tissue, while operating. Using a laser guided telethermometer, the searching of that temperature was uneasy right on the operatory field because of the unwilling movements of the operator hand and those of the patient himself. Therefore a similar protocol was made on a piece of meat coming from the butcher. At the longest application of the beam coagulation on the same point the developed temperature was never higher than 100 degrees C whilst a complete coagulation effects. The advantage of the Argon Beam coagulation are therefore to seal the diffuse bleeding without injury to this adjacent tissues, never exposed to a temperature higher than that of boiling water. The advantages are also evident in comparison with the more usual spray electrosurgery that is instead characterized by a wide carbonisation also with this spray option.

The development and progression or recurrent and de novo renal disease does not seem to have been influenced by the use of newer immunosuppressive agents. The rate of development of recurrent and de novo renal disease has been variable and is perhaps related to pre-existing immunological and/or haematological factors. The diagnosis of recurrent glomerulonephritis requires an accurate diagnosis of both primary renal disease and subsequent disease in the transplant kidney. Published data suggest that recurrent glomerulonephritis occurs in 6 to 19.4% of all renal transplant recipients, and causes the loss of 1.1 to 4.4% of all renal allografts. However, the propensity for glomerulonephritis to recur seems to be time dependent. Consequently, as grafts survival increases, so, too, does the likelihood of disease recurrence. In conclusion, currently available data on recurrence patterns of the less common nephropathies are unfortunately inadequate and our practice is therefore guided by small series, case reports, and local experience. It is to be hoped for that this deficit be addressed in the near future through the use of powerful database and registries, some of which are prospectively collecting data on specific disorders. Prospective studies on the treatment of recurrent glomerulonephritis are lacking. As grafts last longer and recurrent glomerulonephritis becomes a more significant entity, affecting greater numbers of patients, the opportunity to study management prospectively will be possible. This will probably require a cooperative, multicentre approach but it is clearly the only way forward, remembering that renal transplantation is a treatment, not a cure.

Background: In transplanted patients undergoing immunossuppressive therapy the incidence of malignant neoplasia is 3-4 times higher than in the general population. Aim of the present study was to evaluate the prevalence of different tumours and the links between modulation of immunosuppressive therapy and patient and graft survival., Patients: We evaluated 2029 kidney-transplanted patients from four Transplant Centres (Bari, Bologna, Modena, Novara) belonging to the Associazione InterRegionale Trapianti (AIRT)., Results: The incidence of neoplastic disease after transplantation was 3.9% in our population with a median time between transplantation and clinical onset of 23 months. We demonstrated a significant difference in the geographical distribution of different tumours. We did not observe any correlation with specific immunosuppressive drugs. Finally, dramatic reduction of the immunosuppression levels did not modify either the patients' or the graft's survival., Conclusions: Several factors can influence the post-transplant onset of neoplastic diseases with immunosuppressive therapy playing a pivotal role. The implementation of a National Registry would be the first step in an attempt to optimise immunosuppression in this particular group of patient's.

Background: The number of patients on the waiting list for renal transplantation has progressively increased in the last decade, while the number of potential donors have remained the same. The expansion of the donor pool using marginal donors may represent a possible, although partial solution to this problem. Thus, the aim of the present analysis was to evaluate the graft survival of double renal transplant from marginal donors performed within the Associazione InterRegionale Trapianti (AIRT) and to assess whether this procedure is characterized by an increase in surgical complications., Patients: 79 double renal transplants were performed from January 1st 1999 to December 31st 2002 in three AIRT transplant centers (Bari, Bologna, Torino). Immunosuppressive therapy for all patients included anti-IL-2 receptor antibodies, corticosteroids, tacrolimus and mofetil micophenolate., Results: Graft survival was 90% at 36 months. Acute rejection incidence was 6.4%, while the incidence of surgical complications was 16.6%., Conclusions: The present study opens new perspectives to overcome the actual shortage of donor kidneys. Indeed, the use of marginal organs for double renal transplantation not suitable for single transplantation may create an additional pool of potential donors and significantly increase the number of kidney transplants.

Background: HCV infection in hemodialysis is still a matter of debate from an epidemiological and clinical point of view. Evaluation criteria for HCV-infected patients as transplant candidates are still not adequately standardized. Aims of the present study were to investigate: 1. the percentage of HCV positive patients on the waiting list of three Italian regions belonging to the Associazione InterRegionale Trapianti (AIRT); 2. to analyze the clinical approach in the evaluation of these patients in the attempt to define national guidelines for their pre- and post-transplant management., Patients: We evaluated 2045 uremic patients on the waiting lists of four transplant centers (Bari, Bologna, Modena, Novara) belonging to AIRT at 31/12/2002., Results: The overall prevalence of HCV positive patients was 14.2%, with a peak in the Puglia waiting list. The most common screening tests were AST and ALT serum levels and viral load (HCV RNA). Although there is a clear evidence that histological parameters are the main diagnostic and prognostic markers, a liver biopsy was performed in only 9.5% of patients. An even smaller percentage of HCV-infected patients underwent anti-viral therapy., Conclusions: Our retrospective analysis evidenced the need to improve common clinical strategies in approaching HCV-infected canditates to renal transplantation in the attempt to improve their post-transplant outcome.

Background: Proteinuria is associated with an increased risk of renal failure. In chronic kidney transplant failure it is associated with poorer graft outcome., Materials and Methods: In our Unit 405 renal transplants were performed between April 1992 and December 2001. We analysed 1) the main causes of post-transplant proteinuria and 2) the prognostic significance for graft outcome in patients with a minimum follow-up of 6 months., Results: Early proteinuria was associated with a higher incidence of chronic allograft nephropathy (CAN) and de novo/recurrent nephropathies. Graft outcome was poorer in patients with early persistent proteinuria., Conclusions: Proteinuria after renal transplantation increases the risk of graft failure. We can, therefore, hypothesize that a graft biopsy is the best way to reveal the causes of proteinuria so that therapeutic interventions, which have been shown to reduce proteinuria, can be applied immediately.

Over the last few years emerging evidence indicate the involvement of herpes viruses in the pathogenesis of several medical complications in transplanted patients. Herpes viruses are transmitted via inter-human contact and cause a primary infection, which commonly fails to give clinical signs and may persist even for years in a latent state in healthy subjects. In transplanted patients, herpes viruses may be transmitted through the transplanted organ or may be reactivated because of the use of powerful immunosuppressive drugs. Moreover, the persistence of immunosuppression greatly favours the clinical expression and severity of virus infection. Thus, herpes viruses seem to be involved in both acute and chronic deterioration of graft function, in the pathogenesis of post-transplant lymphoproliferative disorders and Kaposi sarcoma, and even in vessel atherosclerosis. This review will focus on relevant clinical aspects of herpes-virus infection, namely cytomegalovirus, EBV, herpes simplex 1 and 2, varicella zoster virus, HHV-6, HHV-7 and HHV-8, in kidney transplanted patients.