Endovenous Iliocaval Revascularization for Transplant Kidney Salvage

Purpose: We report the case of a venous iliocaval recanalization to preserve a transplant kidney. Case Report: A young patient with a nephrotic syndrome caused by focal segmental glomerulosclerosis (FSGS) underwent a robot-assisted living-donor kidney transplant. The postoperative course was uneventful; serum creatinine at discharge was 1.51 mg/dL (normal range = 0.72-1.17 mg/dL). In the course of the following months, the patient was readmitted repeatedly due to acute kidney failure not related to rejection, recurrent FSGS, or anastomotic stenosis. All episodes started after prolonged standing and renal function improved after bed rest. Several hospital admissions and investigations later, phlebography revealed an occlusion of the inferior vena cava (IVC) and both common iliac veins with large collateral vessels through the azygos system. An endovenous recanalization of the iliocaval tract was performed, with subsequent normalization of transplant kidney function. Conclusion: Vascular complications after renal transplantation are an important cause of graft loss. We present an endovenous treatment option for a chronic occlusion of the IVC and common iliac vein with intermittent venous congestion as a cause of transplant failure

Keratinocytes in the treatment of severe burn injury: an update

Burns are among the most life-threatening physical injuries, in which fast wound closure is crucial. The surgical burn care has evolved considerably throughout the past decennia resulting in a shift of therapeutic goals. Therapies aiming to provide coverage of the burn have been replaced by treatments that have both functional as aesthetic outcomes. The standard in treating severe burns is still early excision followed by skin grafting. The use of cultured keratinocytes to cover extensive burn wounds appeared very promising at first, but the technique still has several limitations of which the long time to culture, the major costs, the risk of infection and the need for an adequate dermal layer limit clinical application. The introduction of dermal substitutes, composite grafts, tissue engineering based on stem cell application have been advocated. The aim of this review is to assess the use of cultured keratinocytes in terms of technical aspects, clinical application, limitations and future perspectives. Cultured keratinocytes are expected to keep playing a role in wound healing, especially in the field of chronic wounds. In severe burns, despite its limitations, keratinocytes can be beneficial if implemented as one of the elements in a broader wound management

10-years' experience of aortic valve replacement with the Mitroflow bioprosthesis

Objective: Recent reports raised concerns on the durability of the Mitroflow aortic bioprosthesis, especially for the LXA-model without anticalcification treatment. This study reflects a single-center experience with the Mitroflow for aortic valve replacement (AVR). Method: From June 2003 to December 2014, 634 patients underwent AVR with the Mitroflow prosthesis. The study focused on 510 consecutive patients that received the LXA-prosthesis (2003-2012), by addressing the end-points survival and prosthesis durability, with structural valve degeneration (SVD) defined by a mean transprosthetic gradient > 30 mmHg at echocardiography and/or need for reoperation. Results: The mean patient age was 76±6 years, with 14% 80 y. Valve sizes 23 and 25 were used in 70%, and 19 and 21 in only 18%, avoiding patient-prosthesis mismatch (PPM) in 91%. The mean follow-up time was 5.0±3.2 years, cumulating a total of 2152 patient-years (max 11.6 y). The 1-, 5-, and 8-year patient survival was 86±2%, 67±3%, and 47±3 % respectively. Freedom from SVD was 99±1% and 88±3 % at 5 and 8 years. Reoperation for SVD was performed in 3.3%, including redo-AVR (9) or TAVI (6) for cusp rupture (6) and stenotic calcified degeneration (9). Prosthetic explantation for endocarditis was done in 3 patients. No specific patient- nor prosthesis-related factors significantly affected valve durability. SVD was not observed with the more recent Mitroflow model-DLA with phospholipid reduction therapy (used since May 2012), within a maximal follow-up time of 2.8 y. Conclusion: Despite lacking anticalcification treatment, the LXA-generation Mitroflow bioprosthesis offered a reliable aortic valve substitute in patients older than 70 years. The low occurrence of PPM, enhanced by its specific design and a consistent supra-annular implantation technique, might have improved the valve durability. Further results with the Mitroflow model-DLA have to be awaited

Ten-year results of aortic valve replacement with first-generation Mitroflow bioprosthesis : is early degeneration a structural or a technical issue?

OBJECTIVES: Concerns have been raised about the durability of the first-generation Mitroflow aortic bioprosthesis (model 12 A-LX) due to the lack of anticalcification treatment. This study reflects a 10-year experience with this prosthesis for aortic valve replacement. METHODS: From June 2003 to May 2012, the Mitroflow prosthesis was used for aortic valve replacement in 510 patients, of whom only 467 with complete clinical follow-up were included for analysis. Study end-points were survival and incidence of structural valve degeneration (SVD). Analysis of SVD was based on cumulative incidence function and competing-risk Cox regression. RESULTS: The mean patient age was 76.4 +/- 6.1 years. Valve sizes from 23 to 25 were used in 70.4%, whereas sizes from 19 to 21 were used in only 19.2%, thereby avoiding patient-prosthesis mismatch in 89.1%. Within a median follow-up time of 6.6 years (interquartile range 4.4), a cumulative 2375 patient-years, the survival rate was 86.2%, 67.3% and 33.3% at 1, 5 and 10 years, respectively. The cumulative incidence of SVD, with death as a competing risk, was 0%, 0.7% and 6.2% at 1, 5 and 10 years, respectively. Only age <75 years tended to affect the late hazard of SVD (hazard ratio 0.50, 95% confidence interval 0.23-1.08, P = 0.08), regardless of valve-specific issues. CONCLUSIONS: The data do not support the concerns about early accelerated structural degeneration of the first-generation Mitroflow bioprosthesis used for aortic valve replacement in patients older than 75 years. We postulate that limiting the number of small prostheses using a proper implantation technique has enhanced the reduction in risk of significant patient-prosthesis mismatch as the main determinant of early SVD

Onderzoek en dienstverlening via het expertisecentrum Onderwijsinnovatie: Projectmatig wetenschappelijk onderzoek 2016-2019

Onderzoek en dienstverlening via het expertisecentrum 'onderwijsinnovatie' in de periode 2016-2019 werden volgende onderzoeksprojecten uitgevoerd: - High impact learning: opleiden in flexibele en uitdagende leeromgevingen - Innovatieve en differentiërende houding - Blend - Diverse leraarskamer - Quid Pro Quo: naar een kwaliteitsvolle lerarenopleiding voor M/V met talent - Didactische taalondersteuning voor zaakvakleerkrachten met ex-OKAN-leerlingen in de klas - Context is the key - op weg naar een taalsterk vrijetijdsaanbod voor anderstalige lagereschoolkinderen - Design@school: STEM-didactiek en STEM-effectiviteit in de overgang van basis- naar secundair onderwijs - Wiskunde & computationeel denken via een STEM aanpakstatus: publishe