P. De Rosa

Intrarectal ultrasound and computed tomography in the pre- and postoperative assessment of patients with rectal cancer

The ability of intrarectal ultrasound to recognize the local extent of disease was investigated in 23 patients with histologically proven adenocarcinoma of the lower two-thirds of the rectum before operation. Two probes, 12 cm long, working at a frequency of 3·5 and 7·5 MHz, were used. The results were compared with those of pre-operative computed tomography (CT) and with the pathological report of the resected specimens. Sonography correctly staged 20 of 23 tumours with two false negatives and one false positive, while CT correctly staged 19 of 23 tumours with two false negatives and two false positives. The results of ultrasound were found to be as accurate as those of CT; the low cost and simple use of ultrasound makes it preferable in the pre-operative assessment of the depth of invasion of rectal cancer. In addition, intrarectal ultrasound was routinely performed in 42 patients, operated on for rectal cancer by means of sphincter-saving procedures, at variable intervals in the first 2 years postoperatively. Eight local recurrences were recognized and confirmed by CT. Based on the low cost, reliability and simple use, intrarectal ultrasound is proposed as first examination for local recurrence detection in the follow-up of patients with low anterior resection for rectal cancer.

Postexplant Residual Cavity Hemostasis with a TachoSil Patch

Intracapsular nephrectomy as the standard explant technique for a unfunctional graft is associated with intra- and postoperative complications due mainly to hemorrhage, fluid collections, effusions from damaged tissues and the residual cavity. We have reported herein a positive experience with the use of a collagen medical sponge patch into the surgical site for hemostasis. Use of this device produced a reduction in postoperative bleeding and collections with shortened time of drainage, reduced infection risk, and earlier discharge.

Posttransplant renal monitoring with B-flow ultrasonography.

B-flow ultrasonography (BFU) is a new technology to detect blood circulation. It has been developed by using digitally encoded sonography, showing higher spatial and temporal resolution than Doppler imaging because of the clearer definition of the vessel lumen. Our study was performed on 55 patients, including 37 men (67.3%) and 18 women (32.7%), of overall mean age of 45.8 years (range = 16-60 who underwent kidney transplantation from deceased donors. The patients underwent an ultrasonography check postoperatively with successive daily controls to compare evaluations with both techniques: the combination of color and power Doppler versus BFU. In 25 patients (45.5%), visualization of cortical blood flow was clearer than with the standard techniques. The parameters of intrarenal circulation were easy to measure. In conclusion, BFU was effective to visualize hemodynamic flow and to detect stenotic lesions in the renal artery. Combined with the conventional B-mode technique, BFU seems to be useful in the evaluation of renal anasthamotic stenosis, especially among patients with vascular diseases.

O43 A common LH polymorphism is associated with higher FSH consumption during ovarian stimulation for IVF/ICSI cycles

Material and Methods: This is a retrospective study of patients delivered in the maternity department in TMC over 12 years from 1996 to 2008. Information was taken from the delivery suit registration book and department registration files. Results: The number of HIV infected mothers giving birth in Tripoli Medical Centre is steadily increasing since the hospital opened in September 1996. In 1997 HIV infected mothers constituted 2.5/10 000 of deliveries, this increased to 40/10 000 deliveries in 2008, which is higher than incidence of HIV in Tripoli (0.3%), Overall we have 221 cases of HIV infected mothers giving birth in TMC, /4 of these were in the last 4 years. We only have details on 150 of these patients. We are aware of only one mortality in these patients. Age of patients ranged from 17 to 43 and their nationality varied from 100% non Libyan (mainly African origin) in 1996 up to nearly 96% Libyan in the last couple of years. Regarding the mode of delivery all patients were delivered normally between 1996–2002, since then more patients are being delivered by elective cesarean section. Babies of HIV mothers have a higher rate of being still birth or admitted to neonatal intensive care than the average hospital rate. Conclusion:With the increasing incidence of HIV among our Libyan mothers, doctors and midwifes need to be trained in dealing with these patients with the aim to reduce neonatal infection.

Saccular Aneurysm of Graft Renal Artery: Case Report

Repair of anatomic anomalies in a donor kidneys vascular structures requires prompt recognition of the aberrant condition and an appropriate repair technique that does not compromise transplant success. Our report describes a case of a saccular aneurysm of the donor kidney, renal artery, which was identified during harvesting and repaired on the back-table using a prosthetic patch derived from the excised lesion to cover the breach. The long-term results were good.

Low Limb and Allograft Rescue With Iliofemoral Graft for External Iliac Artery Dissection: Case Report

The technical difficulties in performing a transplantation can often be joined by an accident that demands an urgent solutions, putting the life of the patient in serious risk. In our case we were forced to perform an iliofemoral PTFE graft substitution to save the vascularization of the right lower limb. The cause was constituted by a dissection in the external iliac artery wall immediately after upstream declamping. Fortunately quick understanding of the complication made us stop the lesion downstream before it involved the femoral district. In addition the renal artery was already not declamped and the organ not perfused. Successively we anastomosed the renal artery to the PTFE graft with an end-to side anastomosis. Our first target was obviously to preserve the low limb vascularization but, with this solution we managed also to save the allograft. Actually renal function is conserved and with an optimal state of the vascular graft.

Multiorgan Retrieval and Horseshoe Kidney: Case Report

Horseshoe kidney, a congenital anatomic condition with fusion of the kidney poles, causes the organ to be placed around the aorta usually below the origin of the mesenteric artery. This congenital disorder affects about 1 in 400 people. Retrieval for multiorgan transplantation dissects and canulates major abdominal vessels, aorta and vena cava, below the renal vessels to infuse refrigerated preservation solution. The presence of a horseshoe kidney could be a hazard for the retrieval team when cannulating when following standard techniques. We have described herein a surgical maneuver exposing the anterior surface of the aorta for canulation. We transected the horseshoe kidney in the midline with the use of a linear cutter stapler GIA 60 mm (Ethicon), after previously ligating both kidney pedicles. This technique was safely performed without the need for cannulation through the iliac vessels.

OP03.02: Ultrasonographic findings related to insulin resistance in patients with polycystic ovarian syndrome

Objectives: To identify, appraise and summarise the evidence regarding the effect of using time-lapse embryo incubation and/or selection for improving the reproductive outcomes. Methods: We searched for randomised controlled trials (RCT) on PubMed, Scopus, and ClinicalTrials.gov on 30-Mar-2017. Two review authors independently performed study selection, data extraction, and assessment of the risk of bias. Disagreements were solved by consensus. We corresponded with study investigators in order to resolve any queries, as required. Data were analysed trying to respect the intention-to-treat principle. The assessed outcomes were live birth/ongoing pregnancy (LB/OP); clinical pregnancy (CP), and miscarriages. We estimated the relative risks (RR) with their 95% confidence interval (CI) using a random effects model; heterogeneity was evaluated by I2 statistics. Results: The electronic searches retrieved 1,000 records: 7 studies including 1,776 women were included. We identified low quality evidence of no effect for LB/CP (RR=1.02; 95%CI=0.85-1.22; I2=55; 6 RCTs; 1,745 women; downgraded because of limitations of the included studies and inconsistency); moderate quality evidence of no effect for CP (RR=1.05; 95%CI=0.91-1.21; I2=27%; 6 RCTs; 828 women; downgraded because of limitations of the included studies); and very low quality evidence of no effect on miscarriage (RR=1.51; 95%CI=0.73-3.14; I2=0%; 363 clinical pregnancies; downgraded two levels because of serious imprecision and one level because of limitations of the included studies. Conclusions: The available evidence doesn’t support the use of time-lapse embryo incubation and/or selection for improving the reproductive outcomes of couples undergoing in vitro fertilisation.

Echo Doppler Sonography of the Renal Allograft Acute Rejection

Echo Doppler sonography has attracted much interest for the diagnosis, by a non invasive procedure, of renal allograft acute rejection ([1]).