Hypertension is an independent predictor of mean platelet volume in patients with acute ischaemic stroke.

INTRODUCTION: Mean platelet volume (MPV) was shown to be significantly increased in patients with acute ischaemic stroke, especially in non-lacunar strokes. Moreover, some studies concluded that increased MPV is related to poor functional outcome after ischaemic stroke, although this association is still controversial. However, the determinants of MPV in patients with acute ischaemic stroke have never been investigated. SUBJECTS AND METHODS: We recorded the main demographic, clinical and laboratory data of consecutive patients with acute (admitted within 24 h after stroke onset) ischaemic stroke admitted in our Neurology Service between January 2003 and December 2008. MPV was generated at admission by the Sysmex XE-2100 automated cell counter (Sysmex Corporation, Kobe, Japan) from ethylenediaminetetraacetic acid blood samples stored at room temperature until measurement. The association of these parameters with MPV was investigated in univariate and multivariate analysis. RESULTS: A total of 636 patients was included in our study. The median MPV was 10.4 ± 0.82 fL. In univariate analysis, glucose (ß= 0.03, P= 0.05), serum creatinine (ß= 0.002, P= 0.02), haemoglobin (ß= 0.009, P < 0.001), platelet count (ß=-0.002, P < 0.001) and history of arterial hypertension (ß= 0.21, P= 0.005) were found to be significantly associated with MPV. In multivariate robust regression analysis, only hypertension and platelet count remained as independent determinants of MPV. CONCLUSIONS: In patients with acute ischaemic stroke, platelet count and history of hypertension are the only determinants of MPV.

Successful Elongation of a Short Graft Renal Artery by a Gonadal Vein.

OBJECTIVES: The objective of this presentation is to share our experiences with a successful reconstruction of a short graft renal artery using a gonadal vein, which occurred during a difficult laparoscopic donor nephrectomy. CASE REPORT: A 27-year-old man was referred to our clinic for a living-related renal transplant with a diagnosis of end-stage renal disease. The donor was with his mother. At last, a laparoscopic donor nephrectomy was planned. Massive intra-abdominal hemorrhage occurred during the dissection of renal artery. Urgent intervention was performed to maintain the patency of renal allograft and to stabilize the donor. Hemorrhage was brought under control. Donor nephrectomy was completed with a short remaining segment of renal artery. We decided to use the elongation of the graft renal artery using the gonadal vein of the same side was decided. End-to-end anastomosis was performed. After elongation of graft renal artery, anastomosis to internal iliac artery was performed. The trans-plant procedure was completed successfully. The kidney functioned immediately. Doppler ultrasound revealed that perfusion of the kidney was normal. The postoperative creatinine levels of recipient were in the normal ranges. Daily urine output was normal. There are not enough publications about elongation of graft renal artery using gonadal vein. CONCLUSIONS: Elongation of a short remaining graft renal artery by using gonadal vein seems to be a simple, safe, and reliable method. This technique provides an alternative approach for the reconstruction of short renal arteries in living-donor kidney transplants.

Increase in Body Mass Index After Renal Transplantation.

The aim of this study was to determine the changes in body mass index (BMI) of patients after renal transplantation regarding causes like steroid use, lower necessity for dietary restrictions, and changes in eating habits. Ninety-seven patients were enrolled in this retrospective study; they had undergone cadaver or living donor renal transplantation between 2011 and 2013. Demographic features of patients, height, weight, and BMI were evaluated before and 6 and 12 months after surgery. The patients were grouped as malnutritioned, normal, overweight, and obese. Statistical analyses were performed using the SPSS 11.0 statistics program. Mean age of patients was 39.1 ± 10.7 years. Twenty-six (26.8%) were female and 71 (73.1%) were male. Mean BMI before surgery was 22.52 ± 3.97 kg/m(2). Six months post-transplantation the mean BMI was 24.40 ± 4.1 kg/m(2) and after 12 months it was 25.56 ± 4.14 kg/m(2) (P < .05). Also, 68% of patients showed improvement 12 months after surgery; they were in the preoperative malnutrition group. There is a significant increase in the BMI of patients in the first year who undergo renal transplantation, and the reason is multifactorial. BMI is relevant to diabetes, hypertension, and allograft nephropathy. BMI should be carefully considered in the follow-up of patients who have undergone renal transplantation, and early nutritional changes with dietary and exercise programs should be performed in overweight cases.

Evaluation of renal transplantations performed in the Transplantation Center at Sanko University Medical School.

INTRODUCTION: Renal transplantation is the optimum treatment to improve the quality and length of life in end-stage renal disease. The aim of this study is to evaluate patients who underwent renal transplantation in our transplantation center and to present our clinical experience. METHODS: Living donor and cadaveric renal transplants performed in the Transplantation Center of Sanko University Medical School between 2011 and 2014 were evaluated retrospectively. In our study, important parameters, such as delayed graft function, early and late phase infections and urologic complications after the operation, results of renal transplants with marginal donors with high creatinine levels, and increase in posttransplant body mass index were evaluated regarding to the living donor and cadaveric renal transplants performed in our transplantation center. RESULTS: We included 136 patients were (92 males [68%] and 44 females [32%]), with an average age of 38.9 ± 9.8 years (range, 17-67). There were 63 living donor renal transplantations (43%) and 73 cadaveric renal transplantations (57%). The youngest cadaveric donor was 3 years old, and the oldest was 86. Fifteen of the cadaveric donors had blood creatinine levels around 1.5 g/dL. The highest level of creatinine from cadaveric donors was 5.1 g/dL. CONCLUSIONS: Living donor renal transplantations have higher success rate than cadaveric renal transplantations. Ureteroneocystostomy and native ureteropyelostomy seem to be safe and efficient treatment methods for ureteral complications. High creatinine levels in marginal donors do not affect graft function in early stages.