The prevalence of hypertension in patients with end-stage renal disease ranges between 10 and 100%^[1]. It occurs in renal transplant recipients in 40 – 75%^[3],[4]. Factors contributing to post-transplant hypertension include immunosuppressive therapy: corticosteroids and calcineurin inhibitors; causes related to the graft: chronic graft dysfunction, genetic, renal artery stenosis, recurrence of the original disease and factors related to the native kidneys. Investigation of post-transplant hypertension should be directed to these possible underlying factors. Treatment considerations will depend on the presence or absence of underlying factors and should observe interaction between hypotensive medications and immunosuppressive drugs.

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Two patients with renal cell carcinoma that extended into the inferior vena cava (IVC) to the level of the hepatic veins and also had coronary artery disease are presented. Both patients underwent a onestage combined coronary revascularization and extended right nephrectomy with the use of cardiopulmonary bypass, deep hypothermia and circulatory arrest. When pre-operative angioplasty is not feasible, a one-stage combined operation for ischaemic heart disease and advanced renal carcinoma with IVC extension can be performed safely.

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Progress in cardiac imaging techniques allowed earlier diagnosis of malignant cardiac tumors. Between January 1978 and June 1999, 75 cases of primary heart tumours were surgically excised, 8 of them (10.67%) were malignant. They came from 4 males and 4 females, and with age ranging from 3 weeks to 70 years (mean 29); 3 tumours came from 3 infants (<1 year); the others developed in adult patients. All patients survived the surgical excision but died during the follow-up period. The histotypes were: 3 rhabdomyosarcomas (RMS), 2 malignant fibrous histiocytomas (MFH), 1 immature malignant intrapericardial teratoma, 1 fibrosarcoma and 1 mesothelioma. Among the 3 RMS, 2 were pleomorphic RMS (in the adult patients), located respectively in both atria and in the left ventricle and infiltrating the anterior papillary muscle; one (in a newborn) was an embryonal RMS of the anterior left ventricular wall spreading in the pericardium. MFH recurred twice in both patients; one patient died of post-operative complications after the second recurrence while the other patient died of heart failure 84 months after the first surgery. Also immature malignant intrapericardial teratoma recurred 2 months after the surgery; the newborn died of post-operative complications such as the newborn with fibrosarcoma. The mesothelioma occurred in an adult patient who died 5 months after the surgery. Despite complete surgical resection, which is initially successful, recurrence of tumor occurs and late mortality is still very high (100%). Our experience over a ten-year period confirms: a) the difficult differential diagnosis between primary sarcomas of the heart with other masses including secondary tumours and b) the relatively low incidence of heart malignancies in adults (10.95%) versus a higher incidence in childhood (37.5%).

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Transplantation of organs is the great adventure of this century. Alexis Carrel developed methods of joining blood vessels, which made the transplantation of organs feasible. Demikhov performed the first intra-thoracic canine lung and heart transplantation in the 1940s. In the early 1950s, Metras demonstrated that canine lung transplantation is technical feasible. In 1963, the first human lung transplant was performed and during the subsequent 15 years, about 40 clinical lung transplants were performed around the world. Successful lung transplant was achieved in 1982. The discovery of cyclosporine and its use as an immunosuppressant drug permitted prolonged survival in all transplanted organs especially in lung transplants. At present, lung transplantation is successfully used worldwide The remarkable progress and improved results in lung transplantation is due to superior immunosuppression strategies, improved donor and recipient selection, new antibiotics, improved strategies of preservation using prostaglandine E1 have decreased reperfusion injury, and prevention of post-operative sepsis due to bacterial, fungal, viral and parasitic infections, especially in cystic fibrosis. Heart-lung transplant is indicated for patients with pulmonary vascular disease, congenital heart disease and cystic fibrosis. These represent 72% of indications. Double lung transplant is reserved for bilateral lung anomalies without consequences on cardiac function: infectious diseases, bronchiectasies, cystic fibrosis, lymphangioleiomyomatosis, bronchioloalveolar carcininoma, and emphysema. Single lung transplant is reserved for patients who have no infection of their native lungs such as primary pulmonary hypertension without cardiac insufficiency, idiopathic fibrosis, histiocytosis X and emphysema without distension. The operative mortality rate is in the range of 10%. The five-year survival rate is about 60%. Despite advances in treatment of complications such as infection and chronic rejection, they are still responsible for half of the deaths after transplantation. However, in young patients with end-stage lung disease, lung transplantation is the sole treatment.

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