10 research outputs found
Shortening a Carrel Patch in a Graft With Multiple Arteries: A Step-By-Step Technical Analysis0
Objectives: Multiple renal arteries in donor kidneys are not a rare
entity. Whenever encountered, they pose a surgical challenge in renal
transplant because they require a more complicated back table vascular
reconstruction and implant technique. We devel-oped a unique
step-by-step in vivo illustration of the application of shortening a
Carrel (aortic) patch to address multiple arteries in deceased-donor
renal transplant.
Materials and Methods: Case report.
Results: We present the case of a 63-year-old man who received a left
kidney from a deceased donor with 2 arteries on a Carrel patch that were
anastomosed in a neopatch model.
Conclusions: A donor kidney with multiple arteries is a challenge before
arterial anastomosis. Various anastomotic patterns have been described
for this situation. Treatment of multiple arteries depends mainly on the
donor source (living or deceased), the characteristics of multiple
arteries, and the transplant surgeon's preference. When the length of
the aortic patch of a deceased donor is > 2.5 cm, the surgeon may
shorten it and form a neopatch to facilitate a single arterial
anastomosis to the recipient
An uncommon cause of acutely altered mental status in a renal transplant recipient
Introduction. Neurological complications are quite frequent in patients
after solid organ transplantation presenting with focal or generalized
neurologic symptoms as well as altered mental status. Posterior
reversible encephalopathy syndrome is a rare cliniconeuroradiological
entity characterized by headache, altered mental status, cortical
blindness, seizures, and other focal neurological signs and a diagnostic
magnetic resonance imaging.
Case report. We present a case of a 57-year-old woman with one episode
of seizures and sudden onset of altered mental status (time and person
perception) accompanied with headache at the thirtieth postoperative day
after renal transplantation.
Conclusion. Posterior reversible encephalopathy syndrome, although an
uncommon post-renal transplantation complication, should be considered
in these patients, as several factors surrounding the setting of
transplantation have been implicated in its development. Thus,
physicians should be aware of this condition in order to establish the
diagnosis and offer appropriate treatment
Apoptosis, Inflammatory Bowel Disease and Carcinogenesis: Overview of International and Greek Experience
Apoptosis is critical for organ development, tissue homeostasis, the elimination of abnormal cells and the maintenance of immune homeostasis by variable regulatory mechanisms. The death of T lymphocytes following their activation involves a series of proteases (caspases), which comprise the central executioners of apoptosis. Abnormal regulation of apoptosis results in disease. T-cell resistance against apoptosis contributes to inappropriate T-cell accumulation and the perpetuation of the chronic inflammatory process in inflammatory bowel disease with potential tumourigenic effect. The use of antitumour necrosis factor-alpha, anti-interleukin-6R and anti-interleukin-12 antibodies suppresses colitis activity by induction of T-cell apoptosis, thereby having important implications for the design of effective therapeutic strategies in inflammatory bowel diseases. Contrary to international data, the incidence of cancer in Greek patients with inflammatory bowel disease appears to be low. A balance between cell proliferation (Ki-67 overexpression) and apoptosis (Bax protein overexpression) may partly explain the low incidence of cancer development in Greek inflammatory bowel disease patients
Renal Transplant Lithiasis: Analysis of Our Series and Review of the Literature
Background and Purpose: Renal transplant lithiasis represents a rather
uncommon complication. Even rare, it can result in significant morbidity
and a devastating loss of renal function if obstruction occurs. We
present our experience with graft lithiasis in our series of renal
transplantations and review the literature regarding the epidemiology,
pathophysiology, and current therapeutic strategies in the management of
renal transplant lithiasis.
Patients and Methods: In a retrospective analysis of a consecutive
series of 1525 renal transplantations that were performed between
January 1983 and March 2007, 7 patients were found to have allograft
lithiasis. In five cases, the calculi were localized in the renal unit,
and in two cases, in the ureter. A review in the English language was
also performed of the Medline and PubMed databases using the keywords
renal transplant lithiasis, donor-gifted lithiasis, and urological
complications after kidney transplantation. Several retrospective
studies regarding the incidence, etiology, as well as predisposing
factors for graft lithiasis were reviewed. Data regarding the current
therapeutic strategies for graft lithiasis were also evaluated, and
outcomes were compared with the results of our series.
Results: Most studies report a renal transplant lithiasis incidence of
0.4% to 1%. In our series, incidence of graft lithiasis was 0.46% (n
= 7). Of the seven patients, three were treated via percutaneous
nephrolithotripsy (PCNL); in three patients, shockwave lithotripsy (SWL)
was performed; and in a single case, spontaneous passage of a urinary
calculus was observed. All patients are currently stone free but still
remain under close urologic surveillance.
Conclusion: Renal transplant lithiasis requires vigilance, a high index
of suspicion, prompt recognition, and management. Treatment protocols
should mimic those for solitary kidneys. Minimally invasive techniques
are available to remove graft calculi. Long-term follow-up is essential
to determine the outcome, as well as to prevent recurrence
Endoclipping treatment of life-threatening rectal bleeding after prostate biopsy
Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound (TRUS)-guided multiple biopsy of the prostate, but is usually mild and stops spontaneously. We report what is believed to be the first case of life-threatening rectal bleeding following this procedure, which was successfully treated by endoscopic intervention through placement of three clips on the sites of bleeding. This case emphasizes endoscopic intervention associated with endoclipping as a safe and effective method to achieve hemostasis in massive rectal bleeding after prostate biopsy. Additionally, current data on the complications of the TRUS-guided multiple biopsy of the prostate and the options for treating fulminant rectal bleeding, a consequence of this procedure, are described