BackgroundAbdominoplasty is a common surgical procedure where excess abdominal skin and fat is reduced to improve body contouring. Fibrin sealant has been proposed to reduce post-surgical bleeding and exudation. In this study we evaluated if there was a significant statistical difference between the use or not of fibrin glue in abdominoplasty surgery in reducing bleeding and exudation by the amount of surgical drain output.Material and methodsA retrospective chart review on 68 post-bariatric abdominoplasty patients (fifty-eight females, ten males) was performed. We divided the patients in group A (30 cases, 44%), in which we used fibrin sealant, and in group B (38 cases, 56%), in which we did not use fibrin glue. We calculated total amount of liquid in suction drainages until the day of its removal. Statistical analysis included the independent T-test with a Significance Level of .05.ResultsThe average drainage output in group A was 620.0±375.0 mL, in group B was 500.0±290.0 mL. Results indicate an insignificant correlation between the use of fibrin glue and the amount of liquid in the surgical drains, t= 1.52, p= 0.13. The result is not significant at p <.05 with Independent T-Test.ConclusionSurely the use of fibrin sealant has a high value in all surgical branches to reduce postoperative complications, but in our study we did not notice advantages in its use in reducing the surgical drain output.

BACKGROUND:The management of patients suffering from Amanita Phalloides poisoning (APP) may be very challenging. Furthermore, the treatment often includes depurative techniques and Orthotopic Liver Transplantation (OLTx) must be started timely to be effective. We report our experience in severe APP treatment.PATIENTS AND METHODS:We retrospectively evaluated five patients suffering from APP and hospitalized within our Intensive Care Unit, assessing different kinds of treatment: two different dialytic techniques, namely Continuous Renal Replacement Therapy (CRRT), and Charcoal Plasmaperfusion (CRRT+CPP), and OLTx.RESULTS:Two patients treated with CRRT+CPP, one patient treated with CRRT only and the patient treated by OLTx recovered. One patient, undergoing CRRT only, died after 14 days of treatment. During the CRRT+CPP treatment no relevant complication occurred. The transplanted patient received dialytic treatment for 7 days after transplantation in order to support renal function impairment and to enhance liver function recovery.CONCLUSIONS:Clinical management of patients suffering from APP requires multi-disciplinary intervention; therefore it is recommended to treat these patients in an Intensive Care Unit with specialized nephrological and toxicological consultancy, in collaboration with an organ transplantation team. In the near future we wish to associate dialytic treatment with a bioartificial liver device, which could bridge the time gap to liver transplantation.

Acute renal failure is the most common complication of rhabdomyolysis, with an 8-20% reported incidence. In particular, rhabdomyolysis associated with acute renal failure is frequently observed in critically ill patients, with a 6-16% reported incidence in Intensive Care Units. Dialytic treatment is necessary to correct hydroelectrolytic imbalance and renal function alterations and it may be a pathogenetic therapy by myoglobin removal. In the present study we evaluated our experience on patients suffering from rhabdomyolysis and acute renal failure subjected to dialytic treatment. We retrospectively studied 28 patients, 17 admitted in our Intensive Care Unit (ICU-patients) and treated by continuous renal replacement therapy (particularly by continuous venovenous hemofiltration, continuous venovenous hemodialysis and continuous venovenous hemodiafiltration) and 11 admitted in our Nephrology Department (NICU-patients) and treated by high-efficiency daily hemodialysis. We excluded one ICU-patient from the study because she was affected with lung end-stage neoplasia and it would have been difficult to evaluate the effects of the dialytic treatment on RML biochemical index and on her final outcome. ICU-patients were older, with a mean age of 64 +/- 10 yrs, and were suffering from MODS and typical elderly diseases, such as cardiac and respiratory chronic failure, except from 3 patients with acute liver failure resulting from poisoning, who were relatively younger. In NICU-patients, instead, the mean age was 36 +/- 16 yrs and the causes of RML were narcotic drugs abuse, repetitive seizures and vigorous exercise, more frequently observed in young people. In three relatively older NICU-patients RML was due to lipid lowering drugs assumption. Before starting the dialytic treatment, in ICU-patients CPK plasma level was 2615 +/- 3586, while K+ was 5.10 +/- 1.08 and sCr was 5.69 +/- 4.06 In NICU-patients, on the other hand, CPK was 14273 +/- 9266, while K+ was 5.75 +/- 0.92 and sCr was 5.9 +/- 0.4. ICU-patients mortality rate was 50% (8/16 patients) in spite of the good recovery of renal function and the biochemical RML indexes improvement. In NICU-patients, instead, only one patient died for septic complications (he was a heroin-addict and suffered from overdose syndrome). Early dialytic treatment of RML allows not only to avoid life-threatening complications (first of all the acute renal failure) but moreover it's a pathogenetic treatment because it removes great amount of myoglobin from the plasma. Beside this, continuous renal replacement therapy allows a successful management of critically ill patients with severe hemodynamic conditions. Nevertheless, the final outcome may be very different between ICU- and NICU-patients, with a higher mortality rate in ICU-patients, suffering from MODS.

Continuous Renal Replacement Therapy (CRRT) indication is still discussed. We report our experience on 98 patients affected with Multiple Organ System Failure (MOSF) and renal failure (acute or chronic) requiring dialysis and timely treated by CRRT. Mortality after 5 days of ICU permanence was 60.2%; the remaining 39 patients were discharged within 21 days and received CRRT treatment for 6.36 +/- 5.59 days. APACHE II score was not able to predict the outcome of patients suffering from acute renal failure (ARF). On the contrary, Systemic Inflammatory Response Syndrome (SIRS) incidence was significantly higher in deceased patients compared to recovered patients.In conclusion, it is important to start dialytic treatment immediately when patients affected with MOSF show renal function damage, even if at an initial stage, in order to improve patients' survival. Moreover a multidisciplinary approach is preferable in ICU patients treatment for not underestimating the management of metabolic and infective complications, the nursing care, and nutritional support.

This multicenter phase 1/2 trial investigated the combination of bendamustine, lenalidomide, and dexamethasone in repeating 4-week cycles as treatment for relapsed refractory multiple myeloma (MM). Phase 1 established maximum tolerated dose (MTD). Phase 2 assessed overall response rate at the MTD. Secondary endpoints included progression-free survival (PFS) and overall survival (OS). A total of 29 evaluable patients were enrolled. Median age was 63 years (range, 38-80 years). Median number of prior therapies was 3 (range, 1-6). MTD was bendamustine 75 mg/m2 (days 1 and 2), lenalidomide 10 mg (days 1-21), and dexamethasone 40 mg (weekly) of a 28-day cycle. Partial response rate was 52%, with very good partial response achieved in 24%, and minimal response in an additional 24% of patients. Median follow-up was 13 months; median OS has not been reached. One-year OS is 93% (95% confidence interval [CI], 59%-99%). Median PFS is 6.1 months (95% CI, 3.7-9.4 months) with one-year PFS of 20% (95% CI, 6%-41%). Grade 3/4 adverse events included neutropenia, thrombocytopenia, anemia, hyperglycemia, and fatigue. This first phase 1/2 trial testing bendamustine, lenalidomide, and dexamethasone as treatment of relapsed refractory MM was feasible and highly active. This study is registered at www.clinicaltrials.gov as #NCT01042704.

We studied the activity of some enzymes directly involved in the endogenous antioxidative defense system: glutathione-peroxidase (GPX), glutathione s-transferase (GST) and superoxide dismutase (SOD). We have investigated the effects of selenium and vitamin E diet supplementation, in form of selenium-vitamin E enriched yeast, in Wistar rats that were undergone to surgical right nephrectomy and 30 minutes of hypoxia. Blood samples were tested for several parameters as glucose, cholesterol, etc. to assess the general health conditions. The protocol consisted of 3 groups of 25 Wistar rats: a control group, a pre-fed group and a post-fed group. The results showed a significative difference in the behaviour of azotemia, proteins and cholesterol. In the control group the activity rapidly increased, then the values decreased slowly and differently for each substance. The pre and post-fed group showed a pronounced increase after 48 h but the normal values are reached more rapidly. We observed an increase in the activity of the GPX and GST after surgical operation and ischemia, but the GPX in pre-fed group reached the normal value before the other groups.

Mazzarella, V.*; Splendiani, G.; Tozzo, C.; Manni, M.°; R-Colombo, °; Severini, G.9; Caiola, S.*; Fortnnato, L.; Zazzaro, D.; Casciani, C. U. Author Information

To determine whether pregnancy has an adverse influence on survival or graft function, a retrospective study was conducted. A total of 321 renal transplant(rTx) patients were followed on a day hospital basis of Tor Vergata University of Rome between January 1981 and April 1996. Out of 90 female subjects, 74 of childbearing age (less than 45 years) underwent the study. Six women had 7 pregnancies which resulted in 5 live births and two first trimester abortions. In one case the pregnancy occurred at 4 months after rTx: spontaneous abortion and acute rejection with graft loss occurred, for the four successful pregnancies the preconception serum creatinine (sCr) was 1.34 mg/dl (range: 1.3–1.4) and remained stable at the end of follow-up. The woman with two successful pregnancies had a sCr increase after second pregnancy, but it has remained stable at 4 yrs after rTx. The pt receiving rTx at 1981 with successful pregnancy after two yrs, reached ESRD 7 yrs after delivery because chronic rejection. Our data are consistent with other studies demonstrating no contraindication to pregnancy in women with stable renal transplant and controlled blood pressure. However, careful interdisciplinary monitoring is needed to reduce maternal and fetal risks.

Nontraumatic rhabdomyolysis may be associated with severe metabolic disturbances. In particular previous literature has described a 8-20% incidence of acute renal failure in rhabdomyolysis. The aim of this study was to evaluate our experience on 11 patients with acute renal failure treated by high efficiency daily hemodialysis.

Dr. Valentina Mazzarella, Ospedale S. Eugenio, Clinica Chirurgica II Università, Piazzale dell’Umanesimo 10, I-00144 Roma (Italia) Dear Sir, Erythropoietin (EPO) has been shown to be an excellent drug to reverse anemia in uremia with few adverse effects. We describe 1 case of leukemia developing during EPO treatment in a uremic patient. In July 1995, we observed a 74-year-old man affected by end-stage renal failure following nephroangiosclerosis on maintenance hemodialysis since January 1993. The patient had a good clinical status except for a persistent anemia: hemoglobin was 7.1 g/dl, hematocrit 20.9%, white blood cell count 6.1 × lOVμl, platelet count 221.0 × 103/μl. EPO treatment (4,000 IU s.c. twice weekly) was started. The hemoglobin value improved after 18 days and became stable, at 8.2 g/dl. Seven weeks after EPO therapy, the patient complained of fever, dyspnea, weakness and leukocytosis. Subsequent laboratory and clinical features showed a picture of acute lymphocytic leukemia (ALL). One month later the patient died during chemotherapy. Campistrus et al. [1] observed acute non-lymphocytic leukemia (ANLL) in a uremic patient in hemodialysis treated with EPO. Uyttebroeck et al. [2] described a transformation to acute myelomonocytic leukemia in a child affected by 5q-syndrome after EPO treatment. Both authors did not exclude that extramedullary hematopoiesis with secondary transformation to leukemia stimulated by EPO occurred. Furthermore the development of acute leukemia was observed in 3/14 patients with myelodysplastic syndromes while on EPO therapy [3]. There is evidence that EPO in vitro can stimulate ANLL blast cells [4]. At present, EPO is employed in anemia associated with all hematologic malignancies and solid tumors except acute myeloid leukemia. An interesting study suggests that in both murine and human systems genetic alterations of the EPO receptor gene are not rare events and could be involved in the occurrence of the erythroleukemic process [5]. We observed 1 case of ALL in a uremic patient and no references have been found on ALL after EPO treatment. It is possible that the anemia was a symptom of a preleu-kemic state. Further investigations are needed in order to clarify whether EPO increases the potential risk of transformation to acute leukemia. Careful use of EPO is important in particular in uremic patients, because the anemia is not always a renal symptom.

probably reflect vascular maternal adptation mechanisms. Raynaud' s phenomenon can be present during systemic disease flare-up as well as an isolated symptom in otherwise asymptomatic patient. On the other hand, the presence of autoantibodies in the absence of clinical signs of connective tissue desease classified the patients as affected with pre-connective tissue disease. With these considerations in mind, we evaluated 101 selested patients with recurrent miscarriage on immunological basis divided in four groups: primary antiphospholipid antibodies syndrome (aPL) (n=28), subclinic autoimmune thyroid syndrome (TG) (n=40), alloimmune (n=20) and controls (12 women with two or more miscarriages without immunological causes). Initial modifications of periungueal capillaroscopy were present in all study groups. Local abnormality in the digital arteries were present in 19/28 (67,8%) of the aPL women; 23/40 (57.5%) in TG group; 16/21 (76.1 %) in alloimmune; 6/12 (50%) in controls. The main capillary microscopy feature were microhemmorrhage, microaneurysm, teleangectasias and oedema. Patients with microscopically impaired capillaries have higher reactivity to ischemic stress, probably due to vasocostriction, These data suggest that immunologic RSA may have a vasospastic tendency and endothelial damage that may be due to immune complex and/or to complement activation, and that this examination can be predictive for arterial uterine blood during pregnancy.

Splendiani, G.; Mazzarella, V.; Zazzaro, D.; Tozzo, C.; Casciani, C. U. Author Information