INTRODUCTION: Renal vein thrombosis (RVT) has an incidence of 0.55% to 3.4% and accounts for as many as one-third of early allograft losses. Rarely, RVT may be a consequence of an extension of ipsilateral iliac vein thrombosis. We present a rare case of iliocaval thrombosis as a consequence of inferior vena cava compression by a large-for-size kidney transplant. CASE REPORT: A 20-year-old woman with spina bifida and kidney failure received a living donor kidney from her 52-year-old father. On postoperative day 8, the patient had right lower quadrant abdominal pain associated with oliguria. Graft duplex ultrasonography examination revealed venous thrombosis arising in the right femoral vein and extending to the iliac vein. An urgent second laparotomy was performed, and the kidney was finally placed in the peritoneal cavity. CONCLUSIONS: The eventuality of an inferior vena cava compression by a transplanted kidney should be considered in any recipient with sudden leg swelling and acute graft dysfunction. An early diagnosis and prompt intervention may reduce the progression to RVT and subsequent graft nephrectomy. When planning a kidney transplantation with a supposed size discrepancy between donor and recipient, positioning the kidney on the left side or in the peritoneal cavity may be preferred.

INTRODUCTION: Development of cancer after transplantation has rapidly became one of the leading causes of death in kidney transplant recipients with functioning grafts. Anogenital malignant neoplasms may occur with a 14-fold increased incidence, and human papilloma virus (HPV) infection has been recently identified as the leading cause of cervical carcinoma. We report the preliminary findings of a prospective study that evaluated the incidence of HPV infection and cervical carcinoma in a population of kidney transplant recipients. PATIENTS AND METHODS: The study included 35 female recipients of a deceased donor kidney with at least 6 months of follow-up. All patients underwent a cervicovaginal brushing, an HPV DNA test, and a Papanicolaou test. RESULTS: Twenty-two patients (62.8%) were positive for HPV DNA. Thirteen of 22 HPV DNA-positive recipients (59%) demonstrated a high-risk HPV genotype. No cytologic anomalies were detected in Papanicolaou smears. CONCLUSIONS: These preliminary data demonstrated a high incidence of HPV infection in renal transplant recipients. Most of our recipients exhibited a high-risk HPV genotype, which suggests higher aggressiveness of such infection in immunosuppressed patients. The HPV test is useful to monitor patients at higher risk of anogenital malignant neoplasms by identifying the cytologic anomalies at an earlier stage. This ongoing study will investigate the rate of progression of HPV infection and the clinical patterns of HPV-positive cytologic anomalies in renal transplant recipients.

INTRODUCTION: While deaths with a functioning graft have occurred more frequently in recent years, other nonimmunologic factors may have an important role in late allograft loss. These variables include socioeconomic and cultural status as risk factors for posttransplantation noncompliance with therapy. We examined the effect of socioeconomic and cultural status on graft and patient survival in a population of kidney transplant recipients. PATIENTS AND METHODS: This retrospective study included 223 kidney transplantations performed between September 2000 and December 2006. RESULTS: A significant improvement in graft and recipient survival was observed with increased educational achievement level. Subjects with a high school diploma or college degree demonstrated significantly better outcome. Recipients who had attended intermediate or technical schools were also significantly more likely to have a better outcome than the lowest educational group. Using the lowest socioeconomic class as a reference, a proportional hazard model demonstrated statistically significant benefit for better outcome in patients with skilled occupations. CONCLUSIONS: Results of the present study showed a significant difference in kidney transplantation outcome between different socioeconomic and educational classes. These results could help physicians to educate patients with end-stage renal disease to better understand long-term recovery after transplantation.

INTRODUCTION: Diagnosis of thyroid disease is fundamental in the evaluation of patients awaiting kidney transplantation. We analyzed the incidence of thyroid disease in patients with end-stage renal disease (ESRD) and evaluated its evolution before and after kidney transplantation. PATIENTS AND METHODS: Between January 2000 and May 2008, we evaluated 323 candidates for kidney transplantation. In all patients, serum concentrations of free triiodothyronine, free thyroxine, and thyroid-stimulating hormone were determined and a ultrasonography of the neck was performed. Patients with thyroid cancer were considered eligible for kidney transplantation after at least 2 years since treatment. RESULTS: One-hundred-four patients with ESRD (44%) had functional or morphologic changes in the thyroid gland. Forty-one patients (17.4%) underwent fine-needle aspiration cytology; 3 demonstrated showed papillary carcinoma; 3, follicular adenomas; 8, uncertain cytologic lesions; and 27, a nodular goiter. Seventeen patients underwent surgery. Six of 11 patients with thyroid cancer underwent transplantation: two patients underwent laterocervical lymph node dissection because of local recurrence within 2 years after successful transplantation; the other 4 patients are alive with a functioning graft. Of the 184 transplant recipients, 10 underwent surgery to treat thyroid disease: 8 with multinodular goiter, 1 with micropapillary carcinoma, and 1 with follicular adenoma. All 10 patients are alive with a well-functioning graft and no signs of disease recurrence. CONCLUSIONS: Thyroid diseases are common in patients with ESRD. Early diagnosis and treatment significantly decreased morbidity and mortality in patients awaiting transplantation.

A new species of spirochete which we have called Spirochaeta hebdomadis has been described as the specific etiological agent of seven day fever, a disease prevailing in the autumn in Fukuoka and other parts of Japan. This spirochete is distinguishable from Spirochaeta icterohaemorrhagiae to which it presents certain similarities. Young guinea pigs are susceptible to inoculation with the blood of patients and to pure cultures of the spirochete, and those developing infection exhibit definite symptoms suggestive of those of seven day fever in man. The blood serum of convalescents from seven day fever contains specific immune bodies acting spirochetolytically and spirocheticidally against the specific spirochetes, but not against Spirochaeta icterohaemorrhagiae. The field mouse (Microtus montebelli) is the normal host of the spirochetes, which have been detected in the kidneys and urine of 3.3 per cent of the animals examined. The endemic area of prevalence of seven day fever corresponds with the region in which field mice abound.

Pure cultures of the spirochaetal causative agent of the disease known as Weil's disease, or febrile icterus, in Japan, have been obtained by us in a solid, a semisolid, and a fluid medium. The spirochaeta thus isolated remains pathogenic for guinea pigs for many generations. Up to the present time we have succeeded through the courtesy of Professor Nagayo, Dr. Konuma, and Dr. Ishihara, in cultivating three different strains. The spirochaeta is a facultative anaerobe. The solid and semisolid culture media possess one disadvantage, in that they are opaque on account of the addition of red blood corpuscles; but it is hoped that this drawback may soon be overcome by further studies. We shall report later the results of investigations regarding various questions in immunity as well as further details regarding the biological properties of the spirochaeta.

1. A method for the pure cultivation of Spirochoeta duttoni, Spirochoeta kochi, Spirochoeta obermeieri, and Spirochoeta novyi is described in this paper. In vitro these strains reach their maximum growth after seven, eight, or nine days at 37 degrees C. For their multiplication they require the presence of a piece of fresh sterile tissue and a body fluid capable of forming a loose fibrin with the tissue. The presence of some oxygen seems indispensable for their growth, since they fail to grow in an atmosphere of hydrogen or in vacuo. No growth was obtained at room temperature. 2. From cultures that show a good growth subcultures can be made and the growth can be kept up in this way for many passages. 3. The pathogenicity of these organisms is not lost by cultivation, although there is a tendency for the virulence to become attenuated after growth in vitro has continued for a long time. 4. Longitudinal division has been observed and was followed under the dark-field microscope in fresh preparations from cultures. It occurs in all the species irrespective of the length of the organism. Transverse division seems also to occur, but I have not yet observed the entire process.