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Treatment with FTY720 reduced IRI and prevented unrecoverable acute renal failure after significant ischemic injury. This study suggests that FTY720 may help improve the quality of grafts from NHBD and marginal donors by abrogating the IRI insult.

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was a small caecal carcinoma with a 4 cm metastatic deposit in the right lobe of the liver. DISCUSSION Gas gangrene is a condition of rapidly developing and spreading infection mediated by toxins released by the bacteria Clostridium spp. It is most often associated with traumatic injuries. C. perfringens is the commonest species, followed by C. novyi. C. septicum is relatively uncommon, and it is estimated to be the cause of only 1.3% of all clostridial infections. 1-3 C. septicum represents a novel subtype among clostridial species, with several notable differences. It is able to cause devastating tissue necrosis in the absence of prior trauma, 1 3-6 and is able to present distant from the presumed portal of entry resulting in metastatic myonecrosis. 4 5 Clostridial infections are believed to have a greater prevalence among individuals who have malignant disease. 1 4-6 Larson et al, in a series of 241 patients with clostridial infection, found 10% had an associated malignancy. 5 However, when C. septicum infections were considered alone the incidence of associated malignancy was 52.6%. 6 In a further study of patients with C. septicum infection, conducted between 1966 and 1993, 50% had a primary malignancy, 75% of which were colonic, of these 40% were caecal. 5 Few patients presenting with C. septicum infection have a history of prior trauma. 1 4-6 Several papers have suggested that mucosal ulceration of the tumour surface and haematogenous invasion allow a portal of entry for the bacteria, thus explaining the low incidence of antecedent trauma. 7-9 The theory of mucosal ulceration as the portal of entry is supported by the case reported by Abella et al in which a patient with radiation colitis had spontaneous C. septicum gas gangrene. 1 Our case illustrates the fulminant nature of gas gangrene and although it is an uncommon diagnosis, it is essential that the management be initiated early. This should include aggressive resuscitation, early antibiotics, hyperbaric oxygen therapy (although this has never been subjected to a controlled trial and unless it is readily available it would seem to present a potentially fatal delay), and radical surgical debridement.

The intracompartmental pressure monitor provides accurate, rapid, and direct measurement of intraabdominal pressure, and may be a useful tool for continuous intraabdominal pressure measurement among patients at risk of abdominal compartment syndrome.