Secondary Vascular Access Procedures for Hemodialysis After Primary Snuff-Box Arteriovenous Fistula

Aim: To investigate the secondary arteriovenous fistulas constructed after a snuff-box fistula. Material and Method: We reviewed data on 95 arteriovenous fistulas that were created as a secondary vascular access between January 2007 and December 2015. Of those 95 fistulas, 37 (39%) were ipsilateral elbow brachial-cephalic arteriovenous fistulas and 58 (61%) were ipsilateral wrist radial-cephalic arteriovenous fistulas; all were created after a primary snuff-box fistula. Results: All arteriovenous fistulas had matured. The primary patency rates for elbow brachial-cephalic arteriovenous fistulas and radial-cephalic arteriovenous fistulas were as follows: 1-year rate, 88% to 87% and 4-year rate, 70% to 61%. The secondary patency rates for were as follows: 1-year rate, 91% to 93%; 4-year rate, 72% to 63%. No early failure occurred. There were 15 late failures. The most common causes of failure were stenosis within the vein (n=8 patients), aneurysm (n=5 patients), and central vein stenosis (n=2 patients). Discussion: These data suggest that before a radial-cephalic or brachial-cephalic arteriovenous fistula is created, the construction of a snuff-box fistula enable the vascular structures to dilate, and may so fascilitate the success rate of seconder AVFs. For this reason a radial-cephalic arteriovenous fistula or an elbow brachial-cephalic arteriovenous fistula should be the second choice

Perivascular epithelioid cell tumor outgrowth from the liver

INTRODUCTION: Perivascular epithelioid celltumor (PEComa) is a rare mesenchymal neoplasia and can be found in various body sites. On the other hand, hepatic PEComa is very rare, with only a few studies having reported hepatic malignant PEComa. There is no gold standard regarding the use of diagnostic imaging studies. The diagnosis of hepatic PEComa is made by a positive immunohistochemical staining for HMB45 and Melan A. Herein, we discussed the therapeutic and follow-up process of a symptomatic hepatic PEComa case. PRESENTATION OF CASE: A 22-year-old woman presented with a palpable mass in abdomen. A computerized tomographic examination showed a giant hepatic mass of left lobe origin, which was excised surgically. The pathology result was reported as a PEComa. DISCUSSION: The diagnostic approach, treatment modalities, and follow-up procedures are not standard. The main treatment modality for PEComa is surgical excision with adequate surgical margin. CONCLUSION: A longer follow-up is required for patients with hepatic PEComa because the nature of the disease is not entirely clear. (C) 2018 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd

Use of soluble complement receptor type 1 to prevent local and distant organ injury in a rat intestinal ischemia reperfusion model

Introduction: In this experimental study we aimed to examine the in vivo effect of soluble complement receptor type 1 (sCR1) in preventing local and distant organ injury in an ischemia reperfusion model via the superior mesenteric artery (SMA). Using these data, it may be possible to determine the clinical usage of sCR1. Material and Methods: 24 male rats, weighing between 200 and 250 g, were classified into four groups. In group 1, the SMA was clamped for 60 minutes. In group 2, intravenous (IV) sCR1 was given after laparotomy. In group 3, the SMA was clamped for 60 min, at the 60th minute IV sCR1 was administered, and then 1 min later reperfusion was carried out. Group 4 was the laparotomy group. To investigate organ injury, liver function tests (serum AST and ALT levels) and kidney function tests (serum BUN and creatinine levels) were carried out. To evaluate the systemic and local effects of inflammation, total serum levels of protein, albumin, tumour necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were tested. In tissue samples, glutathione (GSH), malondialdehyde (MDA), and myeloperoxidase (MPO) positive neutrophil counts were identified. Results: According to the statistical analysis, sCR1 was shown to reduce the ischemia-reperfusion injury and have antiinflammatory effects. In addition, distant organ injury due to reperfusion was prevented by sCR1. Conclusion: sCR1 was verified to decrease both mortality and morbidity. [Arch Clin Exp Surg 2017; 6(3.000): 126-131

Role of preoperative C-reactive protein value and neutrophil ratio in the determination of conversion from laparoscopic appendectomy to open appendectomy

BACKGROUND: In this study, we aimed to investigate the factors causing conversion from laparoscopic appendectomy (LA) to open appendectomy (OA) in patients with acute appendicitis and to investigate the role of preoperative C reactive protein (CRP) and neutrophil ratio in this conversion and determine a cut-off point for these parameters. METHODS: Records of patients who underwent LA due to acute appendicitis at our general surgery department between January 2011 and January 2017 were retrospectively evaluated. The preoperative American Society of Anesthesiology (ASA) scores, Alvarado scores, white blood cell count, C-reactive protein level, and neutrophil ratio were evaluated. RESULTS: LA was performed in 394 patients with an initial diagnosis of acute appendicitis. A conversion to OA (cOA) was performed in 17 patients (4.31%). A CRP value of >= 108.5 mg/L and a neutrophil ratio of >= 81.5% were found to be statistically significant for the cOA (p<0.001). CONCLUSION: Our study results showed that male gender, age, elevated neutrophil ratio, and CRP value were the main risk factors for cOA in patients who were scheduled for LA due to acute appendicitis

Effect of static magnetic field on experimental dermal wound strength

Context: An animal model. Aim: We sought to evaluate the effect of static magnetic fields on cutaneous wound healing. Materials and Methods: Male Wistar rats were used. Wounds were created on the backs of all rats. Forty of these animals (M group) had NeFeB magnets placed in contact with the incisions, either parallel (Pa) and perpendicular (Pr) to the incision. The other 40 animals (sham [S] group) had nonmagnetized NeFeB bars placed in the same directions as the implanted animals. Half of the animals in each group were killed and assessed for healing on postoperative day 7 and the other half on postoperative day 14. The following assessments were done: gross healing, mechanical strength, and histopathology. Statistical Analysis Used: Intergroup differences were compared by using the Mann-Whitney U or t test. Values for P less than 0.05 were accepted as significant. Results and Conclusions: There were no differences between the magnetic and sham animals with respect to gross healing parameters. The mechanical strength was different between groups. On postoperative day 14, the MPr14 had significantly higher scores than the other groups. When static, high-power, magnetic fields are placed perpendicular to the wound, increased wound healing occurs in the skin of the experimental model

Deceased-donor transplantation activities at Baskent University.

Int Soc Organ Donat & Procuremen