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Luis Fernando Z. Funchal Diego Costa Astur Rafael Ortiz Moises Cohen 《Arthroscopy》2019,35(3):930-937
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Background
Hyperparathyroidism is a common complication in chronic kidney disease and might persist in up to 25% of patients after transplantation. In this setting, vitamin D analogues further aggravate persistent hypercalcemia and cinacalcet has not been approved for these patients, some of whom will require parathyroidectomy to correct post-transplantation hyperparathyroidism.Objectives
In this single-center, retrospective study we aimed to analyze the long-term effect of parathyroidectomy on calcium, phosphorus, and parathyroid hormone (PTH) levels and its effect on allograft function in kidney transplantation patients submitted to parathyroidectomy.Patients and Methods
Fifteen patients underwent parathyroidectomy between January 2005 and January 2015; median age 54 years old; 8 (53.3%) were receiving cinacalcet at the time of surgery. Pre-parathyroidectomy median values of intact PTH, calcium, and phosphorus were, respectively, 262 pg/mL, 10.8 mg/dL, and 2.4 mg/dL. Surgery consisted of uniglandular parathyroidectomy in 5 (33.3%) patients, biglandular in 4 (26.7%), and subtotal in 6 (40%). There was no surgery-related mortality.Results
Compared with baseline, there was a decrease of PTH (262 pg/mL vs. 106 pg/mL, P = .001), calcium, and phosphorus levels (10.8 mg/dL vs. 10.4 mg/dL, P = .3; 2.4 vs. 2.9 mg/dL, P = .05) 1 year after surgery; with normalization of serum calcium at the end of follow-up (10.8 mg/dL vs. 9.4 mg/dL, P = .04). A decrease in estimated glomerular filtration rate occurred 1 month post-surgery (62.7 mL/m vs. 49.7 mL/m, P = .006) but returned to baseline 1 year after surgery (62.7 mL/m vs. 60.8 mL/m, P = .73).Conclusion
Parathyroidectomy appears to be a safe procedure and should be considered in kidney transplantation patients with persistent post-transplantation hyperparathyroidism. Although there was an acute estimated glomerular filtration rate decrease, we observed no long-term deterioration in allograft function. 相似文献4.
Introduction
Noninfective pneumonitis is a class-related effect within mammalian target of rapamycin (mTOR) inhibitors, including everolimus, and can occasionally be severe.Case Report
A 62-year-old man, medicated with everolimus due to a heart transplantation 17 years previously and with chronic kidney disease, was admitted to the intensive care unit (ICU) with acute respiratory failure, cardiovascular shock, and impaired renal function requiring dialysis. Computed tomography (CT) scan revealed right upper lobe consolidation. Extensive microbiological workup, autoimmune testing, and cytology were negative and echocardiography showed preserved heart function. Everolimus levels were normal (5.7–6.1 ng/mL) and the drug was suspended at day 9. The patient was difficult to ventilate and responded poorly to broad-spectrum antibiotic and antifungal therapy. On day 25, CT scan and bronchoscopy revealed left-sided alveolar hemorrhage, and corticosteroid pulses were performed. The patient gradually improved. After discharge and 6 months of follow-up, clinical recovery was complete and chest imaging substantially improved.Discussion
Pneumonitis occurs in up to 4.3% of transplant recipients using everolimus for immunosuppression. Despite usually presenting as a mild and self-limited disease, severe cases have been described. Alveolar hemorrhage can occur and is associated with poor outcome. Everolimus levels do not seem to accurately predict toxicity. Corticosteroid therapy has been used with success in severe disease. We review the pathophysiological, clinical, and management-related aspects of this entity with emphasis on its potential severity.Conclusion
Our case was a rare occurrence of severe life-threatening pulmonary disease related to everolimus. Awareness of the potential severity of this entity is important for the management of patients using mTOR inhibitors. 相似文献5.
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T.N. de Almeida J.P. Victorino J. Bistafa Liu D. Tófoli Queiroz Campos C. Graf M.C. Jordani L.A. Carneiro d&#x;Albuquerque K.D.S. Mendes O. Castro-e-Silva 《Transplantation proceedings》2018,50(3):841-847
Background
The liver may be injured in situations where it is submitted to ischemia, such as partial hepatectomy and liver transplantation. In all cases, ischemia is followed by reperfusion and, although it is essential for the reestablishment of tissue function, reperfusion may cause greater damage than ischemia, an injury characterized as ischemia-reperfusion (I/R) damage. The aim of this work was to analyze the effect of ischemic preconditioning with the use of methylene blue (MB; 15 mg/kg) 5 or 15 minutes before I/R (IRMB5′ and IRMB15′, respectively) on the hepatic injury occurring after I/R.Methods
Twenty-eight male Wistar rats were used, and liver samples submitted to partial ischemia (IR) or not (NI) were obtained from the same animal. The samples were divided into 7 groups. Data were analyzed statistically by means of the nonparametric Mann-Whitney test and Wilcoxon Matched test, with the level of significance set at 5% (P < .05).Results
The rate of oxygen consumption by state 3 mitochondria was inhibited in all ischemic groups compared with the sham group (SH vs IR: P = .0052; SH vs IRMB5′: P = .0006; SH vs IRMB15′: P = .0048), which did not occur in the nonischemic contralateral portion of the same liver (SH vs NI: P = .7652; SH vs NIMB5′: P = .059; SH vs NIMB15′: P = .3153). The inhibition of the rate of oxygen consumption by state 3 mitochondria was maintained in the presence of MB (IR vs IRMB5′: P = .4563; IR vs IRMB15′: P = .9021). The respiratory control ratio was reduced in all ischemic groups compared with the sham group, owing to the inhibition of oxygen consumption in state 3 (SH vs IR: P = .0151; SH vs IRMB5′: P = .005; SH vs IRMB15′: P = .0007).Conclusions
Methylene blue had no effect on the mitochondrial respiratory parameters studied, but was able to reduce lipid peroxidation, preventing the production of reactive oxygen species (SH vs IRMB15′: P = .0210). 相似文献11.
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João Egidio Romão Junior Rolf Passos Lopes Maria Regina Teixeira Araújo Hugo Abensur 《Transplantation proceedings》2019,51(6):1845-1847
BackgroundThere are numerous reports of successful pregnancies following kidney transplantation. However, little information is available regarding the management and evolution of multiple pregnancies in a kidney-transplanted woman.Case reportWe report the case of successful consecutive spontaneous triplet and twin pregnancies in a woman who had undergone kidney transplantation at 30 years of age, 12 years before the first pregnancy, as a result of end-stage renal disease secondary to chronic glomerulonephritis due to diffuse proliferative lupus nephritis. An integrated multidisciplinary team closely followed progress during the pregnancies. Maternal complications during the pregnancies included light proteinuria, controlled hypertension, and anemia. No graft rejection episodes or deterioration of renal function was noted during the pregnancies or after the deliveries.ConclusionCurrently, more than 2 years after her last pregnancy, the mother and all 5 babies are healthy and the mother’s renal transplant function is normal. 相似文献
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P.S. Lima A.S.d. Campos C.S. Corrêa C.J.M. Dias C.T. Mostarda C.E.N. Amorim A.M.C. Garcia 《Transplantation proceedings》2018,50(3):746-749
Background
The incidence of anemia in kidney transplantation patients (KTPs) is very common and seems to be associated with the reduction in both renal function and physical exercise tolerance. The purpose of the present study was to compare biochemical markers of anemia and renal function of physically active and sedentary KTPs.Method
Serum hemoglobin (Hb), hematocrit (Hct), and serum creatinine (used to derive estimated glomerular filtration rate [eGFR]) were obtained from the medical records of 18 KTPs assisted at the Center for Prevention of Kidney Diseases of the Federal University of Maranhao Hospital. The physically active transplant patients (group 1) included 7 men and 2 women, aged 49 ± 14 years who participated for at least 6 months on a supervised physical exercise program (SPEP) (2 to 3 times a week, 90-minute sessions) and the sedentary counterparts (group 2) of 2 men and 7 women, aged 37 ± 15 years.Results
Group 1 presented higher values of Hb (14.2 ± 2.6 vs 10.7 ± 0.6 g/dL; P = .003), Hct (41.6% ± 7.0% vs 32.3% ± 1.4%; P = .004), and eGFR (64.4 ± 19.4 vs 39.3 ± 19.7 mL/min/1.73 m2; P = .015) when compared with group 2. There was a positive and significant correlation between Hb and eGFR (r = 0.528; P = .024), and between Hct and eGFR (r = .509; P = .031).Conclusions
Our results suggest that regular physical activity seems to improve the biochemical markers of anemia and also the renal function of KTPs, and these patients should be advised to participate in SPEP. 相似文献14.
Laura Andrade Rocha Carlos Eli Piccinato Mauricio Serra Ribiero Christiane Becari Renata Dellalibera Joviliano Edwaldo Edner Joviliano 《Journal of vascular surgery》2017,65(1):119-127
Objective
The purpose of this study was to investigate the roles of the kallikrein-kinin system and matrix metalloproteinases (MMPs) in the development of arterial restenosis attributable to intimal hyperplasia in the femoropopliteal arteries.Methods
This report describes a single-center prospective study of 27 patients with peripheral artery disease who required percutaneous transluminal angioplasty and stenting of the femoropopliteal segment using covered stent grafts. The blood concentrations of total and kininogen fractions were evaluated using immunoenzymatic methods. Plasma kallikrein was evaluated by the colorimetric method. Tissue kallikrein was evaluated by the spectrophotometric method. The activity of kininase II was measured by fluorometric analysis. Quantification of MMPs was performed by zymography, and tissue inhibitors of metalloproteinases were measured by enzyme-linked immunosorbent assay.Results
Four (15%) of the treated patients developed restenosis at the 6-month follow-up evaluation. These patients had significantly lower levels of high-molecular-weight kininogens (24 hours; P < .05) and low-molecular-weight kininogens (before, P < .05; 24 hours, P < .01; 6 months, P < .05) and lower levels of tissue inhibitor of metalloproteinases-2 (6 months; P < .05) than the patients without restenosis. The activity levels of plasma and tissue kallikrein, kininase II, and MMPs did not differ significantly between the patients with and without restenosis.Conclusions
This study demonstrates an involvement of the kallikrein-kinin system in in-stent restenosis, although we could not confirm the participation of metalloproteinases in the restenosis process. 相似文献15.
Albert A. Sader 《American journal of surgery》1983,145(3):420-423
A laterally rotating surgical device attached to a conventional operating table is described. It allows rapid and safe changes of the patient's position from the supine to the right or left lateral decubitus and vice versa. It has proved to be useful whenever both thoracic and abdominal approaches are necessary for one-stage surgical procedures such as esophageal and thoracoabdominal aortic aneurysm resections. 相似文献
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Albert A. Sader 《American journal of surgery》1975,130(1):102
A new way to stabilize nasogastric tubes is presented, aimed at preventing decubitus ulcerations of the mucosa of the nose and pharynx. 相似文献
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J.S. Toledo E.F.K. Ribeiro M.M. Correia P.C.M. de Souza R.R. Coutinho D.F.M. Torres 《Transplantation proceedings》2018,50(10):2946-2949
Introduction
Organ transplantation is often the only possible treatment to save the lives of patients with end-stage organ failure. Limiting factors include failure to notify in cases of patients with brain death, the inefficient procurement and distribution of organs, the lack of specific educational policies for health care professionals, lack of knowledge on the organ transplantation process, and family refusal for organ donation.Objective
To evaluate the knowledge of students enrolled in different undergraduate university courses in Rio de Janeiro on the regulations and strategies governing transplant organ donation in Brazil.Methods
This qualitative, observational study used a 10-item questionnaire aimed at obtaining data on respondents' general knowledge regarding organ donation and transplantation. The questionnaire was applied using either a printed or an electronic version developed on Google Forms and was completed anonymously.Results
Overall, 587 questionnaires were completed. The participants were divided into 3 groups according to their field of study: 256 (43.6%) from courses related to arts and humanities, 159 (27.1%) from science and technology-related courses, and 172 (29.3%) from the biomedical field. Most respondents (396; 67.5%) were unaware of the criteria required to be an organ transplant donor.Conclusion
There is a significant lack of knowledge among university students on issues related to the organ donation and transplantation process in Brazil. 相似文献20.
D. Nunes-Carneiro A. Marques-Pinto C. Veiga I. Braga J.F. Cabral M. Almeida V. Cavadas A. Castro-Henriques R. Almeida A. Fraga M. Silva-Ramos 《Transplantation proceedings》2019,51(5):1559-1562
IntroductionThe current approach in living-donor kidney transplant is to preserve the best kidney for the donor and harvest the contralateral one. Due to a shorter renal vein and a greater incidence of venous thrombosis, left kidneys are more frequently elected. Notwithstanding, arterial anatomy may be complex and thus render the transplantation procedure more difficult and prone to complications.ObjectivesTo analyze the outcomes after multiple-artery left kidney nephrectomy (MALKN) and right kidney nephrectomy (RKN).ResultsSeventy-three cases were performed from 1999 to 2017 in our institution: 34 MALKN and 39 RKN. The mean operative time was significantly longer in MALKN. Warm ischemia time, donor and receptor hospital stay, and postoperative complications did not differ between groups.There was a positive correlation between renal arteries' ostia distance in MALKN and the duration of warm ischemia period.There was no significant difference in the incidence of acute tubular necrosis, first-year variations in serum creatinine, and glomerular filtration rate between groups. Long-term graft survival did not significantly differ between groups. Three cases of vein thrombosis after RKN were reported with graft loss.ConclusionThe safety and efficacy of MALKN does not differ from RKN, although there appears to be a higher incidence of vein thrombosis after right kidney transplantation. Despite being technically more demanding, particularly in cases with distant artery ostia, MALKN could be a better option than RKN for living donation, expanding the available donor pool, although more studies are needed to affirm this conclusion. 相似文献