Prevention of fluid effusion in kidney transplantation with the use of hemostatic biomaterials

BACKGROUND

Fluid effusion (blood, lymph, or urine) in kidney transplantation may give rise to several complications, directly, such as hematoma, seroma, lymphocele, and/or urinoma, or consequently, such as increased infection risk, longer hospital stay, graft compression--with or without functional impairment--and necessity of further hospitalizations. The aim of this study was to evaluate effectiveness of hemostatic biomaterials in prevention of fluid effusions, especially lymphocele in kidney transplant patients.

METHODS

We selected 40 patients who underwent kidney transplantation from 2009 to 2012 in which we used hemostatic biomaterials, and compared their results with those of other transplant patients from our center in which we did not used these biomaterials. Evaluated parameters were: fluid effusion, graft function, quality and quantity of drainage, blood count, and operative time.

RESULTS

There was no difference in operative time. The incidence of complications on which biomaterials can have a role decreased; particularly, we observed a reduction from 24.21% to 7.5% of fluid effusions (lymphocele). There was no evidence of complications due to biomaterials.

CONCLUSIONS

Hemostasis is important in surgery, and in kidney transplantations lymphostasis also has a significant role. In addition to the traditional hemostatic methods, recently some biomaterials, with the purpose of providing atraumatic hemostasis, were added. In our experience they are easy to use, and their use has proved to be effective for both hemostasis and lymphostasis with consequent reduction of fluid effusions.

Transcranial magnetic stimulation shows impaired transcallosal inhibition in Marchiafava-Bignami syndrome

A case of Marchiafava-Bignami (MB) syndrome with selective callosal involvement was evaluated by clinical examination and magnetic resonance imaging (MRI) in the acute phase and 6 months after the onset of symptoms; at the same time, the corticospinally and transcallosally mediated effects elicited by transcranial magnetic stimulation (TMS) were investigated. The first MRI study showed the presence of extensive abnormal signal intensity throughout the entire corpus callosum. After high-dose corticosteroid administration her symptoms rapidly resolved, in parallel with the reversion of MRI changes, except for severe cognitive impairment. Follow-up TMS examination revealed persistent transcallosal inhibition (TI) abnormalities. This report indicates that the measurement of TI during the course of MB syndrome is useful for evaluating functional changes to the corpus callosum, including their evaluation with time and after treatment and for elucidating the pathophysiology of MB syndrome.

Changes in motor cortex excitability during muscle fatigue in amyotrophic lateral sclerosis

To further investigate the pathophysiology of amyotrophic lateral sclerosis (ALS), the silent period (SP) evoked by transcranial magnetic stimulation during a fatiguing muscle contraction was evaluated in 15 patients and in 15 healthy subjects. Physiological lengthening of the SP duration was not observed in patients with disease duration of > or = 2 years. Decreased intracortical inhibition, probably secondary to dysfunction of the inhibitory interneurons that modulate the corticomotoneuronal firing, appears in later stages of disease. Normal motor cortex adaptation is impaired and cortical hyperexcitability might be unmasked during fatigue in ALS patients with longer disease duration.

Prenatal ultrasound diagnosis of a femur-fibula-ulna complex during the first half of pregnancy

A case of fetal femur-fibula-ulna (FFU) complex diagnosed by ultrasound is presented. Ultrasonographic features of a fetus displaying bilateral femoral hypoplasia, aplasia of the right forearm and the right hand, ray defects of the left hand are described. The importance of an early diagnosis of this malformation is emphasized with respect to parental counselling concerning prognosis and further prenatal management.

[Hemicrania and photosensitive epilepsy in pediatric age]

OBJECTIVE

Photosensitive epilepsy is joined to headache. Aim of the present study was the follow up of children suffering from headaches in order to verify if headache can be the only symptom of epileptic photosensitivity.

PATIENTS AND METHODS

Thirteen children affected by headache were examined. They were screened on the basis of photosensitivity showed on the EEG. During following 6 patients had seizures.

RESULTS

Antiepileptic drugs (VPA, CBZ, CZM) improved seizures and headache. In the others patients migraine therapy improved epileptic photosensitivity on the EEG.

CONCLUSIONS

Headache can be the only symptom of epileptic photosensitivity. Migraine and photosensitive epilepsy in childhood are of particular interest because of growing features of occipital lobe. This has therapeutic significance.

Reference resistance indices of the umbilical, fetal middle cerebral and uterine arteries at 24-42 weeks of gestation

The objective of this cross-sectional study was to construct new reference ranges for Doppler flow velocity waveform resistance indices for the fetal umbilical artery, middle cerebral artery, placental and non-placental uterine arteries and the placentocerebral ratio in a large and minimally selected population attending a single clinic. Study design and data analysis adhered to a number of stringent and validated methodological recommendations derived both from the recent literature and from a review of earlier publications in this field. The final database comprised initial routine Doppler velocimetry at 24-42 weeks' gestation in 1675 pregnancies. Separate regression models were fitted to estimate the mean and standard deviation at each gestational age for each vessel. New charts, centile tables and regression equations are presented for the resistance indices of the fetal umbilical artery, middle cerebral artery, placental and non-placental uterine arteries and the mean of both uterine arteries and for the placentocerebral ratio.

[An annual decrement in the spirometric parameters of those employed in producing refractory materials. A longitudinal study]

Results of a longitudinal study on the yearly decline of two pulmonary parameters are reported. All subjects were workers in a refractory material factory and exposed to dust with low silica content. The study brought about an annual measurement of two spirometric parameters (VC and FEV1) during a 13 year period of follow up on 113 subjects. 56% and 57.5% of them showed annual decreases of VC and FEV1 statistically significant. The trend of the two functional parameters over time was studied both in the whole group of workers and in subgroups obtained from occupational exposure levels, smoking habit, age. The most affected volumetric index was the VC. The 3 risk indicators considered (occupational exposure, smoking habit and age) all negatively influence the VC decrease; however, the effect is statistically significant only for smoking habit. The FEV1 changes with reference to the above mentioned risk indicators are less clear. From the whole group a number of 15 losers were selected.

[Traditional causes of home accidents]

The author reviews the common causes of domestic accidents, falls are examined in particular. The author concludes by indicating various safety measures designed to prevent domestic accidents or at least minimize the consequences.

[First aid]

Particular safety measures are suggested that a victim alone at home can practice self-applied first aid without provoking further injury. Mild wound injuries necessitate medical advice in order to determine the necessity of a tetanus shot. A physician should also inspect if the bandaging and medication was properly applied. If only one rescurer is available, there are general criteria which indicate that first aid be given in certain cases while other emergency situations necessitate urgent care. Various examples of emergency situations are illustrated which differentiate between life-threatening situation and less critical emergencies. An immediate evaluation of the severity of the victim's condition with corresponding type of treatment can save the victim's life. Drugs and medications should always be kept in a fixed place which is easily accessible to family members and eventually to medical personnel. We include a list of all necessary first aid materials, and their possible substitution in case they are not available. Fundamental regulations regarding gas leak-related accidents are listed. We advise not ringing the doorbell, electric lights should not be used, the windows and doors should be opened wide and the victim should be dragged away as far as possible. General indications are given in order to slow or decrease external bleeding.