The superficial femoral vein: a valuable conduit for a short renal vein in kidney transplantation.

A variety of techniques have been developed to improve the problem with a short renal vein in kidney transplantation. Those techniques range from thorough mobilization of the recipient common and external iliac veins (iliac vein transposition) to donor vein elongation with a saphenous or gonadal vein or a polytetrafluoroethylene graft. Right renal vein extension using the inferior vena cava represents an excellent option for cadaveric kidney transplantation; however, for kidneys from living donors, that is not a suitable alternative. We present two cases where the superficial femoral vein was used as a conduit with good results; there was no additional morbidity for the patient. Although uncommon, renal vein extensions are sometimes needed in kidney transplantation. The superficial femoral vein comes close to representing the ideal conduit for a short renal vein when compared with a synthetic or an autologous graft due to its diameter and harvesting technique.

The durability of endoscopic saphenous vein grafts: a 5-year observational study.

BACKGROUND: Endoscopic saphenous vein harvest has been explored as a minimally invasive alternative to a long continuous leg incision for removal of the greater saphenous vein. The endoscopic technique uses limited incisions (2-4) with extended "skin bridges" and videoscopic equipment for the dissection and removal of the greater saphenous vein. This study was undertaken to evaluate the long-term durability of saphenous vein grafts harvested by an endoscopic technique and used for lower extremity arterial revascularization. METHODS: All patients who underwent endoscopic saphenous vein harvesting for lower extremity arterial bypass grafting were prospectively followed for graft patency and risk factors. Grafts were surveyed with serial duplex scans at 3- to 6-month intervals over this 5-year study. Life-table methods were used to assess graft survival. A computerized registry and medical records were reviewed to determine graft patency and patient survival. RESULTS: From September 1994 to August 2000, 164 lower extremity arterial saphenous vein grafts harvested by an endoscopic technique were used for lower extremity arterial bypass grafting in 150 patients. The patient population included 111 males (75%) and 112 smokers (75%), but also included a high-risk cohort of 65 diabetic patients (43%) and 15 patients undergoing dialysis/renal transplant (10%). Twenty-eight patients (19%) died within the study period. With life-table methods, 1-, 3-, and 5-year secondary patency rates were 85% (+/- 3.2%), 74% (+/- 5.7%), and 68% (+/- 11.6%). Of the 30 failed grafts, 7 (4%) failed in the first month related to inadequate runoff (4), cardiac instability (2), and an additional surgical procedure (1). Twenty-three grafts (14%) failed between 1 and 42 months. Twenty-two (16%) of these 134 patent grafts underwent a second procedure to maintain patency (13 as primary-assisted patency and 9 as secondary patency). CONCLUSIONS: Endoscopic saphenous vein harvest for lower extremity arterial reconstruction provides a satisfactory conduit for lower extremity bypass grafting. Although increased manipulation from this limited access technique may incite an injury response in the vein, these vein grafts can maintain an adequate patency for lower extremity bypass grafting.

[Antibiotic therapy in secondary peritonitis: towards a definition of its optimal duration]. / Antibioticoterapia en peritonitis secundaria: hacia una definición de su duración óptima.

BACKGROUND: The optimal time period of antibiotic treatment in secondary peritonitis is still unknown. AIM: To prospectively evaluate: 1) The preferred time period of antibiotic treatment in secondary peritonitis by means of a survey applied to a sample of surgeons, and 2) The outcome of a series of patients with secondary peritonitis in whom the length of antibiotic treatment was based on clinical and laboratory indicators. PATIENTS AND METHODS: A survey presenting the case of a patient with acute appendicitis and secondary peritonitis was applied to 100 Mexican surgeons. The optimal length of antibiotic treatment in that particular patient was asked. Results were tabulated and analyzed. Subsequently, 35 patients with secondary peritonitis were prospectively evaluated. Antibiotics were discontinued when fever relapsed and the white blood count normalized. Clinical characteristics, diagnosis, surgical treatment and outcome were analyzed. Recurrence of sepsis was investigated as the main outcome variable. RESULTS: The survey revealed that 96% surgeons recommended antibiotic treatment for a period longer than one week. In our study group median age was 33 years, 21 were male and 14 female. All patients had a surgical abdominal condition associated to secondary peritonitis. Median period of antibiotic treatment was 3 days. In a follow-up of one month there was no persistent or recurrent sepsis in any patient. CONCLUSIONS: This information may impact in determining the total length of antibiotic therapy if our results are reproduced in studies with more patients.

Mutual exclusion of apoptosis and hsp70 in human vein intimal hyperplasia in vitro.

BACKGROUND: Apoptosis of vascular smooth muscle cells (VSMC) plays a role in physiological vascular remodeling, as well as in disease states such as atherosclerosis and restenosis after angioplasty. Heat shock protein 70 (hsp70) may protect the cell against apoptosis and/or necrosis. In this study, we examined hsp70 expression and its temporal relationship to cell survival or death in a model of intimal vein hyperplasia in vitro. METHODS: Segments of human saphenous veins were placed into culture. At different days vein segments were serum-starved or exposed to heat shock. Apoptosis and hsp70 expression were analyzed by Western blot, immunohistochemistry, and TUNEL assay. RESULTS: A marked intimal vein hyperplasia developed after 14 days of culture when compared with baseline. hsp70 was present at baseline and disappeared during culture. Heating during culture could not up-regulate hsp70. The apoptotic markers were absent at baseline and present during normal culture. Conversely, serum starvation stimulated strong hsp70 expression coincidental with the disappearance of apoptotic markers. CONCLUSIONS: Stimulation of veins during culture with serum resulted in hyperplasia, apoptosis, and inhibition of hsp70 expression. Down-regulation of hsp70 may permit apoptosis and vessel wall remodeling in this model.

Maintenance of Acanthamoeba culbertsoni by cryopreservation.

In order to determine the viability of trophozoites of Acanthamoeba culbertsoni under cryopreservation conditions, cultures in serum-casein-glucose-yeast extract medium were subject to 5%, 7.5%, and 10% concentrations of dimethylsulfoxide (DMSO). With the methodology followed, the percentages of recovery varied between 75.6% and 86.6% with DMSO at 10%, between 54.5% and 73.5% with DMSO at 7.5%, and between 43.6% and 68.5% with DMSO at 5%. The amebae were kept in liquid nitrogen for 30-210 days. The highest viability of trophozoites was founded when DMSO was used at a final concentration of 10% and an equilibrium temperature of 4 C. Gross cultural or morphological changes were not noted in trophozoites thawed from frozen suspensions.

Effect of three immunostimulants on the resistance against Trichinella spiralis infection in mice. (preliminary report).

Twenty eight NIH mice were divided into four groups of seven animals each. Mice in groups were injected intraperitoneally with Freund's complete adjuvant (FCA), Concanavalin A (Con A), Equimune (EI) and phosphate buffered saline (PBS), respectively, 7 days before infection with 300 Trichinella spiralis infective larvae per animal. Forty two days after infection all mice were sacrificed and processed by artificial digestion to determine the number of larvae per gram (LPG) of muscle tissue. The mean +/- SD of LPG obtained were 59.8 +/- 13.1, 17 +/- 8.5, 3.3 +/- 6.2 and 71 +/- 11.5 for groups FCA, Con A, EI, and PBS, respectively. Significant reductions in larvae worm numbers, compared with non-treated controls, were 76% and 95.3% in groups Con A and EI, respectively.