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1.
Ann Vasc Surg ; 83: 240-250, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34933108

RESUMO

BACKGROUND: For surgical treatment of primary aortic infection and aortic graft infection, in situ reconstruction with autologous vein(s) has the lowest rates of re-infection and of graft thrombosis. In this study, we have assessed the outcome after autologous femoral vein reconstruction in patients with aortic (graft) infection and we provide insights into the specific technical surgical considerations of the procedure. METHODS: In this retrospective single-center study, all patients who underwent autologous femoral vein reconstruction because of primary aortic infection or aortic graft infection between January 2012 and January 2020 were included. The primary outcome parameter was 30-day mortality. RESULTS: Twenty-nine patients with autologous femoral vein reconstruction for a primary aortic infection (n = 3) or aortic graft infection (n = 26) were included. An aorto-enteral fistula was detected in 13 patients (49%). Venous reconstruction of the aorta was performed with a single femoral vein in 17 patients (59%), and two femoral veins in 12 patients (41%). Thirty-day mortality was 17%. Relapse of infection occurred in two patients (7%) and no amputations were needed. One year after surgery, only three patients (10%) still needed stockings and after 2 years none of the patients used stockings. CONCLUSIONS: Central aortic reconstruction with femoral veins is a durable solution for primary aortic and aortoiliac graft infections with a low incidence of reinfections, amputations, and venous hypertension.


Assuntos
Implante de Prótese Vascular , Infecções Relacionadas à Prótese , Aorta/diagnóstico por imagem , Aorta/cirurgia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Veia Femoral/cirurgia , Veia Femoral/transplante , Humanos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
2.
Paediatr Anaesth ; 31(11): 1150-1160, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34379843

RESUMO

Living-donor kidney transplantation is the first choice therapy for children with end-stage renal disease and shows good long-term outcome. Etiology of renal failure, co-morbidities, and hemodynamic effects, due to donor-recipient size mismatch, differs significantly from those in adult patients. Despite the complexities related to both patient and surgery, there is a lack of evidence-based anesthesia guidelines for pediatric kidney transplantation. This educational review summarizes the pathophysiological changes to consider and suggests recommendations for perioperative anesthesia care, based on recent research papers.


Assuntos
Anestesia , Falência Renal Crônica , Transplante de Rim , Criança , Humanos , Rim , Doadores Vivos , Assistência Perioperatória
4.
World J Surg ; 40(2): 471-8, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26319261

RESUMO

BACKGROUND: The lengths of right renal veins are shorter when compared to their left counterparts. Since the implantation of kidneys with short renal veins is considered more challenging, many surgeons prefer left kidneys for transplantation. Therefore, our hypothesis is that the implantation of right kidneys from living and deceased donors is associated with more technical graft failures as compared to left kidneys. METHODS: Two consecutive cohorts of adult renal allograft recipients of living (n = 4.372) and deceased (n = 5.346) donor kidneys between January 1, 2000 and January 1, 2013 were analyzed. Data were obtained from the prospectively maintained electronic database of the Dutch Organ Transplant Registry. Technical graft failure was defined as failure of the renal allograft within 10 days after renal transplantation without signs of acute rejection. RESULTS: In the living donor kidney transplantation cohort, the implantation of right donor kidneys was associated with a higher incidence of technical graft failure (multivariate analysis p = 0.03). For recipients of deceased donor kidneys, the implantation of right kidneys was not significantly associated with technique-related graft failure (multivariate analysis p = 0.16). CONCLUSIONS: Our data show that the implantation of right kidneys from living donors is associated with a higher incidence of technique-related graft failure as compared to left kidneys.


Assuntos
Sobrevivência de Enxerto , Transplante de Rim/métodos , Rim/cirurgia , Veias Renais/anatomia & histologia , Sítio Doador de Transplante/anatomia & histologia , Adulto , Feminino , Humanos , Rim/irrigação sanguínea , Transplante de Rim/efeitos adversos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Países Baixos , Tamanho do Órgão , Sistema de Registros
5.
World J Urol ; 34(7): 955-61, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26369548

RESUMO

PURPOSE: To minimize cold ischemia time, transplantations with kidneys from deceased donors are frequently performed during the night. However, sleep deprivation of those who perform the transplantation may have adverse effects on cognitive and psychomotor performance and may cause reduced cognitive flexibility. We hypothesize that renal transplantations performed during the night are associated with an increased incidence of pure technical graft failure. METHODS: A retrospective analysis of data of the Dutch Organ Transplant Registry concerning all transplants from deceased donors between 2000 and 2013 was performed. Nighttime surgery was defined as the start of the procedure between 8 p.m. and 8 a.m. The primary outcome measure was technical graft failure, defined as graft loss within 10 days after surgery without signs of (hyper)acute rejection. RESULTS: Of 4.519 renal transplantations in adult recipients, 1.480 were performed during the night. The incidence of pure technical graft failure was 1.0 % for procedures started during the night versus 2.6 % for daytime surgery (p = .001). In a multivariable model, correcting for relevant donor, recipient and graft factors, daytime surgery was an independent predictor of pure technical graft failure (p < .001). CONCLUSIONS: Limitation of this study is mainly to its retrospective design, and the influence of some relevant variables, such as the experience level of the surgeon, could not be assessed. We conclude that nighttime surgery is associated with less pure technical graft failures. Further research is required to explore factors that may positively influence the performance of the surgical team during the night.


Assuntos
Plantão Médico/normas , Rejeição de Enxerto/etiologia , Transplante de Rim/métodos , Complicações Pós-Operatórias/etiologia , Feminino , Rejeição de Enxerto/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Falha de Tratamento
6.
J Surg Oncol ; 101(3): 259-69, 2010 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-20039272

RESUMO

Metalloproteinases (MPs) such as the matrix metalloproteinases (MMPs) and adamalysins (ADAMs and ADAMTS) are expressed in various stages of colorectal cancer (CRC), and some correlate with survival and prognosis. The MPs are regulated by various factors including EMMPRIN, TIMPs, and RECK. In addition, micro-RNAs are found to be relevant for both MP expression levels and CRC prognostication. Both MPs and their regulators could be potential targets for intervention and therapy in CRC.


Assuntos
Neoplasias Colorretais/enzimologia , Metaloproteases/fisiologia , Neoplasias Colorretais/etiologia , Ativação Enzimática , Proteínas Ligadas por GPI , Humanos , Glicoproteínas de Membrana/fisiologia , Metaloendopeptidases/fisiologia , Metaloproteases/genética , MicroRNAs/fisiologia , Inibidores Teciduais de Metaloproteinases/fisiologia
8.
Cancer Lett ; 237(2): 289-97, 2006 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-16046057

RESUMO

mRNA, and latent and active levels MMP-2 and -9 were higher in tumor tissue compared to normal tissue from 63 patients with colorectal cancer, whereas RECK and EMMPRIN levels were lower. Correlations between mRNA, latent, and active MMP were particular high for MMP-2 in tumor tissue (R(s)=0.6-0.8, P<0.001). For active MMP-2, but not for MMP-9, a significant negative partial correlation (R(p)=-0.440, P<0.001) for RECK was found in tumor tissue, which was confirmed by linear regression analysis. In exploratory survival analyses we found that in patients with localized disease the RECK level in normal or tumor tissue had a significant (P=0.017) association with overall survival.


Assuntos
Basigina/biossíntese , Neoplasias Colorretais/enzimologia , Metaloproteinase 2 da Matriz/biossíntese , Metaloproteinase 9 da Matriz/biossíntese , Glicoproteínas de Membrana/biossíntese , Sobrevivência Celular , Neoplasias Colorretais/metabolismo , Progressão da Doença , Feminino , Proteínas Ligadas por GPI , Predisposição Genética para Doença , Humanos , Masculino , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Prognóstico , RNA Mensageiro/metabolismo , Fatores de Tempo , Resultado do Tratamento
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