Kidney transplant complications and obesity

Objective

To determine the rate of graft failure and complications secondary to morbid obesity in kidney transplant patients at our institution.

Methods

A retrospective study involving recipients renal transplants from 2002 to 2007. Patients were divided into 3 groups: group 1, body mass index (BMI) >35 underwent a diet plan and gained weight posttransplant; group 2, BMI >35 underwent successful diet modifications posttransplant; and group 3, BMI <35 did not undergo a diet regimen.

Results

Sixty-six patients were studied. Group 1 patients, (n = 21, BMI >35) had higher postoperative complications, longer operative time, and longer hospital stay when compared with their obese counterparts group 3 (n = 23, BMI <35). We saw no significant change in postoperative complications between group 2 and group 3 (n = 22, BMI > 35).

Conclusions

Worse graft function and complications were seen with patients who gained weight post operatively. Conversely, a good outcome was seen with those patients that lost weight pre and post operatively. The results of this study may open the field for pretransplant weight loss procedures to improve quality of life, nutrition, and overall health of transplant candidates.     

Intra-arterial Autologous Bone Marrow Cell Transplantation in a Patient with Upper-extremity Critical Limb Ischemia

Induction of therapeutic angiogenesis by autologous bone marrow mononuclear cell transplantation has been identified as a potential new option in patients with advanced lower-limb ischemia. There is little evidence of the benefit of intra-arterial cell application in upper-limb critical ischemia. We describe a patient with upper-extremity critical limb ischemia with digital gangrene resulting from hypothenar hammer syndrome successfully treated by intra-arterial autologous bone marrow mononuclear cell transplantation.     

Komplexverletzungen des Fußes

Complex injuries of the foot are often overlooked, especially in the multiple injured patient, and they then lead to major loss of function. When the mechanism of injury suggests involvement of the foot, a clinical examination of the lower extremities should be included in the primary diagnostic procedures implemented in the multiply injured patient, followed by radiological examination once the patient's condition is stable. The condition of the soft tissues is of decisive importance in the prognosis of complex foot injuries, regardless of whether the damage to the foot is one component of a polytrauma or an isolated injury, which can also be life threatening. The diagnostic examinations selected should be adapted to the severity of the injuries in the particular multiply injured patient. Successful therapy involves stable internal fixation of injuries to bones and joints, though the external fixation options should be considered in the first instance, and carefully selected methods of temporary and definitive soft tissue reconstruction. The aim of treatment is the best possible reconstruction of the foot as a functional weight-bearing unit with intact soft tissue cover and a natural form. Good results can be achieved when there is close interdisciplinary cooperation between trauma (orthopedic) and plastic surgeons. Patient with severe injuries of this kind should be transferred to a trauma center as the first step toward this end.     

Granular-cell tumor: a rare variant of mammary tumor

BACKGROUND: Granular cell tumor (GCT) is a rare variant of mammary tumor beset with diagnostic dilemmas that may be resolved by using numerous, very complex, enzymohistochemical and immunohistochemical methods. CASE REPORTS: We reported three female patients 16, 21 and 65 years old, operated on for mammary tumor at the Surgical Clinic of the School of Medicine in Nis, over the period of thirty years, 1977 to 2007. During this period 14.022 mammary tumors were diagnosed, including these three cases. These tumors had benign characteristics, without associated tumors in other localizations. A typical histological feature of GCT was a granular cytoplasm in large ovoid cells, organized like nests or like a trabecular arrangement. The tumors were analyzed by sets of histochemical, enzymohistochemical, immunohistochemical methods as well as ultrastructural examination. Protein, S-100 neuron-specific enolase and vimentin expressed a diffuse and intensive immunohistochemical activity, while expression of estrogen and progesterone receptors, as well as HER-2 oncoprotein was negative. The ultrastructural analysis confirmed that the tumor cells were enriched by lysosomes and consequential disorganization of cytoplasm. CONCLUSION: The reported enzymo- and immunohistochemical combined methods provide a precise diagnosis and confirm the GCT's neural origin, which has been disputed for years.     

The influence of oxygen therapy on the hypercapnia in patients with chronic obstructive pulmonary disease

BACKGROUND/AIM: Oxygen therapy is a necessary therapeutic method in treatment of severe chronic respiratory failure (CRF), especially in phases of acute worsening. Risks which are to be taken into consideration during this therapy are: unpredictable increase of carbon dioxide in blood, carbonarcosis, respiratory acidosis and coma. The aim of this study was to show the influence of oxygen therapy on changes of arterial blood carbon dioxide partial pressure. METHODS: The study included 93 patients in 104 admittances to the hospital due to acute exacerbation of CFR. The majority of the patients (89.4%) had chronic obstructive pulmonary disease (COPD), while other causes of respiratory failure were less common. The effect of oxygenation was controlled through measurement of PaO2 and PaCO2 in arterial blood samples. To analyse the influence of oxygen therapy on levels of carbon dioxide, greatest values of change of PaO2 and PaCO2 values from these measurements, including corresponding PaO2 values from the same blood analysis were taken. RESULTS: The obtained results show that oxygen therapy led to the increase of PaO2 but also to the increase of PaCO2. The average increase of PaO2 for the whole group of patients was 2.42 kPa, and the average increase of PaCO2 was 1.69 kPa. There was no correlation between the initial values of PaO2 and PaCO2 and changes of PaCO2 during the oxygen therapy. Also, no correlation between the produced increase in PaO2 and change in PaCO2 during this therapy was found. CONCLUSION: Controlled oxygen therapy in patients with severe respiratory failure greately reduces the risk of unwanted increase of PaCO2, but does not exclude it completely. The initial values of PaO2 and PaCO2 are not reliable parameters which could predict the response to oxygen therapy.     

Outcomes of Percutaneous Mechanical Thrombectomy of Arteriovenous Fistulas in Hemodialysis Patients

Thrombosis of arteriovenous fistulas is usually superimposed on underlying stenosis in the arterial anastomosis, draining vein, or central vein. Restoring the patency of thrombosed fistulas requires mechanical thrombectomy, in conjunction with angioplasty of the underlying lesion. We evaluated the success rate of percutaneous thrombectomy of fistulas at our medical center. We retrospectively queried a prospective, computerized vascular access database to identify 41 patients with thrombosed fistulas treated percutaneously. Technical success was defined as the ability to use the fistula for at least one dialysis session. Primary patency was defined as time to the next intervention, and secondary failure as the time to permanent fistula failure. Of the 41 thrombosed fistulas, 21 were in the forearm and 20 in the upper arm. Percutaneous thrombectomy was technically successful in 31 of 41 patients (76%). The technical success rate was similar for upper arm and forearm fistulas (85% vs. 66%, p = 0.43). An underlying stenotic lesion was present at the arterial anastomosis in 13 patients (31%), in the draining vein in 37 (90%), and in the central vein in 3 patients (7%). Twelve patients (29%) had concurrent stenoses at two locations. At 6 months, the primary patency was 20%, and the secondary patency was 54%. In conclusion, percutaneous treatment of thrombosed fistulas can restore fistula patency about three‐fourths of patients. However, the primary fistula patency is fairly short‐lived, and the fistulas require repeated interventions to achieve long‐term survival.     

Interventional management of critical limb ischemia in renal patients

Critical limb ischemia (CLI) represents the most severe clinical manifestation of peripheral arterial disease (PAD), defined as the presence of chronic ischemic rest pain, ulcers, or gangrene attributable to objectively proven arterial occlusive disease. The occurrence of CLI in patients with kidney insufficiency portends a strikingly high rate of subsequent morbidity and mortality. Generally, the primary therapy for CLI is revascularization of the affected limb. However, patients with CLI and kidney insufficiency represent a unique and challenging patient subset, and data from surgical series suggest reduced rates of limb salvage and higher medium and long-term mortality rates for patients with kidney insufficiency compared with those with normal kidney function. In contemporary practice, endovascular techniques are fast replacing surgical bypass as the first-line revascularization strategy for CLI, based on high technical success rates and low rates of procedure-related morbidity and mortality. However, a large series on endovascular outcomes for the treatment of CLI in patients with kidney insufficiency is lacking. Based on the severely reduced long-term survival rates of patients with CLI and kidney insufficiency, future efforts should focus on early detection of PAD in patients with kidney insufficiency and institution of aggressive medical therapy to prevent progression in the global burden of atherosclerosis in this patient population.     

Procalcitonin in preoperative diagnosis of abdominal sepsis

Background and aims The present study attempted to identify the diagnostic significance of procalcitonin (PCT) in acute abdominal conditions as well as the range of concentrations relating to diagnosis of abdominal sepsis. Materials and methods This was prospective clinical study. The study included 98 consecutive patients with acute abdominal conditions, divided in sepsis and systemic inflammatory response syndrome (SIRS) group. Results PCT concentrations on admission were significantly higher in the sepsis group than in the SIRS group (median [interquartile range] 2.32 [7.41] vs 0.45 ng/ml [2.62]). A cutoff value of 1.1 ng/ml yielded 72.4% sensitivity and 62.5% specificity. In a group of patients with abdominal symptoms lasting for more than 24 h, a cut-off value of 1.1 ng/ml yielded higher sensitivity (82.9%) and higher specificity (77.3%). Conclusion Our results suggest that PCT measurements may be useful for early, preoperative diagnosis of abdominal sepsis.     

Frakturen des Processus coronoideus ulnae

Trauma und Berufskrankheit - Zusammenfassung Der Processus coronoideus ist der wichtigste knöcherne Stabilisator des Ellbogengelenks, der vordere Anteil des Lig. collaterale ulnae, welcher am...