Search

The use of elderly deceased donors requires refining criteria for both the donor and the recipient. This report attempted to identify parameters susceptible to further improvement. This retrospective multicenter study analyzed the outcomes of kidney recipients from 15 consecutive elderly deceased donors in the south French region (IR9). Donors were 65 to 74 years old. Mean creatinine clearance was 80 mL/min/1.73 m(2). The donor risk factors for allograft dysfunction were stroke, hypertension, cardiovascular disease, cardiac death, smoking, arrhythmia, and diabetes. The recipients were 35 to 70 years old. The median cold ischemia time was 24 hours. Four patients (16%) suffered delayed graft function (DGF). Three recipients (12%) died within the first 2 months after transplantation. The postoperative complications (29%) were 2 renal artery thromboses, 4 renal artery stenoses, and 1 toe ischemia. Two years after transplantation, their mean serum creatinine was 157 micromol/L. The patient and graft survivals were 88% and 70%, respectively. These results seemed worse than those reported in the literature, but it was a small cohort and a new experience. DGF is probably linked to improvable management to reduce cold ischemia time. The elevated rate of surgical complications might be related to a lack of experience in donor and recipient evaluations. Kidney transplantation from elderly donors requires an efficient organization and an accurate evaluation of both donor renal function and recipient cardiovascular state.

In some HER2-positive breast tumors, cell surface overexpression of HER2 is not associated with gene amplification but may instead rest in altered gene transcription, half-life, or recycling of the oncoprotein. Here, we show that HER2 overexpression in HER2 2+ carcinomas is associated with neither an increase in gene transcription nor a deregulation in the ubiquitin-dependent pathways, but instead seems to be regulated by protein kinase Calpha (PKCalpha) activity. The stimulation of PKCalpha up-regulated HER2 expression, whereas PKCalpha inhibition by pharmacologic treatments and PKCalpha-specific small interfering RNA led to a dramatic down-regulation of HER2 levels only in breast cancer cells HER2 2+. Consistent with the in vitro data, our biochemical analysis of HER2 2+ human primary breast specimens revealed significantly higher levels of phosphorylated PKCalpha compared with HER2-negative tumors. Inhibition of HER2 activation by the tyrosine kinase inhibitor lapatinib led to decreased levels of PKCalpha phosphorylation, clearly indicating a cross-talk between PKCalpha and HER2 molecules. These data suggest that HER2 overexpression in HER2 2+ carcinomas is due to an accumulation of the recycled oncoprotein to the cell surface induced by activated PKCalpha.

The authors present an environmental microbiological monitoring programme carried out over a period of 15 months in 16 operating theatres performing specific types of surgery. The levels of microbial contamination of the air and of four of the most representative surfaces of the clean area were determined at 3 different times for each theatre, both before and during surgery. For the air assessment, the results obtained with three different samplers, Sed-3 Unit, SAS and RCS, were compared. The results were on the whole acceptable, but some poor conditions were detected during the theatres in use, especially in general surgery theatres; in some of these the floors showed levels of contamination consistently exceeding the reference limits. As the monitoring programme proceeded, the microbiological quality of the air and of the surfaces in the theatres notably improved. The three air samplers showed different conditions expressed with units of measure not always readily comparable. For active samplers, the bacterial load determined by RCS, although less variable, were always higher (even 2-3 fold) than those obtained with the SAS. Passive sampling takes longer but determines the real risk of infection for the patients; contemporary determination of the fall-out and the CFU/m3 helps to identify the occupational risks. Since the limit values established by the ISPESL guidelines for the operating theatres have been defined only for active samplers, there is urgent need for more exhaustive national guidelines to define similar values also for passive sampling. The Authors conclude stressing the importance of promoting continuing information-education programmes to heighten the awareness of all those involved in operating theatre activities.

Background: Controversy exists about the effects of calcineurin inhibitors on bone metabolism. We decided to compare the effects of CyA vs FK506 on bone metabolism of kidney recipients., Patients and Methods: From 94 patients grafted at the University Hospital of Nice between 1996 and 1999 treated either by CyA (N=49) or by FK506 (N=45), we selected 14 pairs (18 M, 10F), matched for gender, BMI, time lapsed since transplantation and gonadal status in females. Patients with>1 transplantation or>1 rejection episode were excluded. Cumulative dose of steroids was recorded. Bone mineral density (BMD) was mesured at heel and forearm, as well as serum concentration of calcium, phosphate, parathyroid hormone (PTH), vitamin D metabolites, C-telopeptide (CTX), creatinine, estradiol as well as Bone Alkaline Phosphatase (BAP) activity., Results: Despite the matching, time on hemodialysis was longer in FK506 group. Cumulative dose of steroids was similar between groups. There was no difference between groups in BMD and biochemical parameters except for estradiol serum levels which were dramatically lower in FK506 than in CsA (P=0,02) and for a trend (p=0,08) for BAP and CTX to be higher in FK506 than in CsA., Conclusions: BMD is not lower in FK506- than in CsA-treated patients although exposure to hyperparathyroidism was longer and estradiol levels were lower in the FK506 than in the CsA group. These data suggest that FK506 may have a favorable bone effect to compensate for these deleterious factors. This hypothesis remains to be tested in longitudinal studies.

We report a case of bone insufficiency fracture of the cuboid in a 33-year-old female patient with many risk factors of bone insufficiency: long term steroid treatment for lupus erythematosus, renal failure, hemodialysis since 3 years and severe secondary hyperparathyroidism. Early diagnosis was established using magnetic resonance imaging (MRI), and confirmed 4 months later on radiography, showing typical line of sclerosis perpendicular to bone trabeculae. Literature review shows only few detailed cuboid stress fracture case reports: four cases in young athletes, one case complicating plantar fascia disruption and one case after plantar fasciotomy. Insufficiency fracture of the foot bones involves mainly the metatarsals, the calcaneus, the talus, whereas cuboid location seems exceedingly rare. Physiopathological characteristics of this uncommon fracture are mentioned.

We report a case of a fracture of the inferior angle of the scapula related to prolonged cough, without triggering trauma, sport, or occupational activity. Bone insufficiency was present in this patient. Stress fractures of the scapula are rare; the fatigue type is the most frequent, associated with sports or occupational activity. We do not find any published case report about scapula stress fracture related to cough, until rib fractures are frequent in this situation. Repetitive muscular activity of the serratus anterior and major rhomboid on the inferior angle of the scapula during cough may explain this avulsion fracture.

Renal transplantation began in 1951 with a living donor. With advances in cadaveric transplantation, living donor transplantation became marginalised. Because of recent progresses in the field of transplantation, the scarcity of cadaveric kidneys and the attractivity of laparoscopic nephrectomy this therapeutic modality is regaining interest. The indications and standards of practice are well codified in Europe. Living donor laparoscopic nephrectomy, however, bears some morbidity as well as mortality.

We report two renal transplant patients who experienced onset of severe bilateral knee pain 1 and 3 months after transplantation, respectively, while on tacrolimus therapy. Tacrolimus, like cyclosporine A, is an immunosuppressive agent that inactivates the enzyme calcineurin phosphatase. A bone pain syndrome was reported in 1989 in organ transplant recipients treated with cyclosporine A. Our cases suggest that tacrolimus may induce the same syndrome. Technetium 99m bone scanning shows increased uptake in the affected areas, and magnetic resonance imaging changes are consistent with bone marrow edema. The tacrolimus dosage need not be reduced unless trough levels are too high. The symptoms resolve completely within a few months. Imaging studies should be done to rule out avascular necrosis. The pathophysiology of this syndrome is discussed. Since tacrolimus was introduced recently, similar cases should be published.

We report a case of lipoma arborescens treated with an arthroscopic procedure. Lipoma arborescens is an uncommon pseudo-tumoral synovial lesion usually located in the suprapatellar pouch of the knee. This diagnosis should be considered, particularly in patients with chronic joint effusion. Magnetic resonance imaging confirms the lipomatous nature of the synovial proliferation. When limited to the anterior compartment of the knee, lipoma arborescens can be treated by arthroscopic synovectomy.

The authors intend to draw the attention on the issue of tetanus infections in adult patients whose history is often unknown or incomplete. For these people, current regulations (Presidential Decree 7th Nov 2001 no. 464) provides for more extended vaccination coverage. The input data were drawn by different sources (ISS; MS; National Statistics Institute; Campania Epidemiological Observatory) and allowed for the tetanus infections having occurred in Italy and Campania in the last ten years.

We report a case of longitudinal tibial fracture as the first manifestation of bone insufficiency in a 50-year-old patient who had received a renal transplant 12 years earlier. The epidemiological, clinical, and imaging features of these fractures are reviewed. Bone loss occurs in the long term in about half of renal transplant recipients. The main causes are preexisting renal osteodystrophy; glucocorticoid therapy; and hyperparathyroidism, whether residual or secondary to imperfect graft function. The effects of cyclosporine therapy on bone metabolism remain unclear. Identification of patients at very high risk of fracture and available options for early prophylaxis are discussed.

A case of severe hyperparathyroidism (HPT), secondary to chronic renal failure, with massive distal phalangeal osteolysis is reported. After parathyroidectomy, brachydactyly and osteosclerosis of the distal phalanges were observed; the phalanx of the thumbs healed with shortened and sclerotic beaked appearance. These radiographic findings are actually uncommon because of more efficient treatment of renal osteodystrophy. Pathophysiology of this bone sclerotic lesion is discussed, and other causes of distal phalangeal osteosclerosis are mentioned.

We report the 6-year radiographic follow-up of a phalangeal brown tumor in a patient with severe hyperparathyroidism secondary to chronic renal failure treated with hemodialysis. The phalangeal lesion increased in size during the first 3 years, until the patient finally accepted to undergo parathyroidectomy. The initial radiographic change was a small intracortical lytic area. Two years later, an expansile cystic lesion was visible in the phalanx, and computed tomography showed a cortical defect. Ossification of the lesion occurred over the 2.5 years following parathyroidectomy. The epidemiology, radiographic changes and post-treatment evolution of brown tumor in dialysed patients is reviewed. Surgical parathyroidectomy is the standard treatment for brown tumor complicating secondary hyperparathyroidism. The usefulness and limitations of treatment with vitamin D analogs, recently reported in a few case reports, are discussed.

Prenatal exposure to misoprostol has been associated with Moebius and limb defects. Vascular disruption has been proposed as the mechanism for these teratogenic effects. The present study is a multicenter, case-control study that was designed to compare the frequency of prenatal misoprostol use between mothers of Brazilian children diagnosed with vascular disruption defects and matched control mothers of children diagnosed with other types of defects. A total of 93 cases and 279 controls were recruited in eight participating centers. Prenatal exposure was identified in 32 infants diagnosed with vascular disruption defects (34.4%) compared with only 12 (4.3%) in the control group (P<0.0000001). Our data suggest that prenatal exposure to misoprostol is associated to the occurrence of vascular disruption defects in the newborns.

A time series study was carried out to assess the relationship between the air pollutants measured by the air quality monitoring network and daily mortality in Turin, Italy. We used TSP, SO2, NO2, O3, and CO concentrations measured from 1-1-1991 to 31-12-1996 at three stations of the city network, chosen to represent different, typical circumstances of exposure to air pollution in the town. The analysis was performed by robust Poisson regression model including loss smoothing functions to allow for long-time trend, seasons, temperature and relative humidity. Dummy variables for the days of the week and holidays were also included. The relative risk of death for a unit increase in the pollutant concentration either during the same day (lag 0) in the previous ones (lag up to 5) was computed. The unit increase was 50 micrograms/m3 for TSP, SO2, NO2, O3, and 2 mg/m3 for CO. The average daily number of deaths for natural causes was 21. The relative risks for total mortality were 1.04 for TSP (lag 1), 1.10 for SO2 (lag 2), 1.06 for NO2 (lag 1), 1.01 for O3 (lag 0), 1.03 for CO (lag 1). The relative risks were 1.05 for TSP (lag 0), 1.12 for SO2 (lag 2), 1.07 for NO2 (lag 1), 1.03 for O3 (lag 0), 1.03 for CO (lag 1) for cardiovascular mortality, and 1.08 for TSP (lag 2), 1.20 for SO2 (lag 2), 1.12 for NO2 (lag 2), 1.03 for O3 (lag 2), 1.05 for CO (lag 2) for respiratory mortality.