[Immune response during laparoscopic and open living donor nephrectomy. An experimental pig model]. / Respuesta inmunohumoral durante la nefrectomía abierta y laparoscópica de donante vivo. Modelo porcino experimental.

INTRODUCTION: It's been demonstrated laparoscopic access determines a lower surgical stress, by measurement of several markers as different interleuquines (IL) or C-reactive protein (CRP). Endothelin 1 (ET-1) is a powerful vasoconstrictor produced in renal endothelium scarcely studied in laparoscopy. The objective of this study is to analyze immune response during laparoscopic and open donor nephrectomy, in a porcine experimental model by means of measuring IL-2, 10, tumoral necrosis factor alpha (TNFalpha), CRP and ET-1. METHODS: Twenty pigs underwent left nephrectomy, 10 by laparoscopy and 10 by open approach in an experimental model. Both groups were monitorized IL-2, 10, TNF alpha, ET-1 at basal, immediately post surgery, first, third, fifth and seventh days after procedure. RESULTS: The comparative analysis between groups demonstrated a significant increase in levels of CRP (1.44+/-0.88 vs 1.32+/-0.14 mg/dl, p=0.046), TNF alpha (131.14+/-41.37 vs 57.19+/-23.71 pg/ml, p>0.001) and ET-1 (0.91+/-0.49 vs 0.56+/-0.5 fmol/ml, p=0.001) of open nephrectomy group, as a higher levels of IL-2 in laparoscopic group. CONCLUSIONS: Open donor nephrectomy determines a higher immune response than laparoscopic approach. The importance of this fact over the ischemia-reperfusion syndrome or the immediate function of graft is not clearly established.

[Experimental models for research and training in renal transplant]. / Modelos experimentales para la investigación y el entrenamiento en trasplante renal.

An update on aspects and use of different experimental models applied in kidney transplant research is presented . This paper includes qualities, as long as similarities between most frequently used animal models and human clinical standards. Contributions of those models based on microsurgical or laparoscopic techniques are revised. The physiological consequences (hemodynamic, immunologic) of surgical technique (laparoscopy), applied in experimental models as long as non-heart beating organ donor models and organ preservation methods are also reviewed. Finally, an update of those models applied in research in prothocols of either immunosupression or xenotransplant is done.

[Experimental pancreatic islet transplant into the genito-urinary tract simultaneous to kidney transplant]. / Trasplante experimental de islotes de pancreas en el tracto genitourinario asociado al trasplante renal.

INTRODUCTION AND OBJECTIVES: Simultaneous kidney and pancreas transplant is a good treatment for both renal and pancreas insufficiency. Experimental apply of genitourinary tract for pancreas implantation is reported in this work. MATERIAL AND METHOD: Twenty animals aged as average 5.5 monts (SD 1.1) and an average weight of 53 kgr were submitted to this protocol. In the day 1 a left nephrectomy is completed and the graft is perfused with University of Wisconsin solution. A partial pancreatectomy is completed at following, isolation of pancreatic islets by colagenase enzymatic digestion. Islets are dryed with Ditizone and culptured for 24 hours at 37 degrees C and 5% CO2. Day-2 a right nephrectomy is performed and orthotopic renal autotransplant using the left kidney is completed. Pancreatic islets are transplanted in 4 different locations of the genitourinary tract: renal subcapsular space, bladder submucosae, testis parenchyma and vas deferens. Day-7, all the animals were sacrifized to complete pathological study. RESULTS AND CONCLUSIONS: Viable islets were isolated in bladder submucosae and testis after transdeferential injection.

[Comparative analysis of renal graft function after open vs. laparoscopic nephrectomy: experimental model]. / Análisis comparativo de la función del injerto renal de donante vivo tras nefrectomía abierta y laparoscópica: modelo experimental.

INTRODUCTION: Living donor renal transplant reports a higher patient and graft survival in comparison to cadaver donor and represents a good alternative facing the current lack of organs for transplant. GOALS: To analyze comparatively in an experimental model (pig) the influence of ischemia-reperfusion and functional outcome of renal graft retrieved by open Vs laparoscopic nephrectomy. MATERIAL AND METHODS: 30 lab pigs were nephrectomized (left kidney): 15 by laparoscopy and 15 by open surgery, as living donors, in a model of renal autotransplant. Renal blood flow (RBF) was measured by means of an electromagnetic probe and creatinine levels during the first week after the implant. RESULTS: Comparative analysis of RBF during the immediate 60 min after unclamping showed a significant reduction of average RBF in laparoscopic group in comparison to open group (p < 0.001), with a more evident reduction of RBF in the laparoscopic group during the 5-min period after unclamping (p < 0.001) and a progressive recuperation of RBF during the 1st hour, slowest in laparoscopic group. Creatinine levels in the first week after the transplant decreased progressively from 1.3 to 0.8 mgrs/dl in the open group and from 2 to 1.1 mg/dl in laparoscopic group (p < 0.001). CONCLUSIONS: Renal grafts retrieved by laparoscopy presents a more evident ischemia-reperfusion syndrome shown by a lower average RBF after unclamping and a significant deterioration of renal function during the first week after transplant.

Respuesta inmunohumoral durante la nefrectomía abierta y laparoscópica de donante vivo. Modelo porcino experimental / Immune response during laparoscopic and open living donor nephrectomy. An experimental pig model

Introducción: Se ha demostrado la menor agresividad quirúrgica provocada por el abordaje laparoscópico, en base a la medición de diversos marcadores de estrés postquirúrgico, entre los que se encuentran distintas interleuquinas (IL) y la proteína C reactiva (PCR). La endotelina 1 (ET-1) es un vasoconstrictor potente producido en el endotelio renal escasamente analizado en el curso de la cirugía laparoscópica. El objetivo del trabajo es analizar comparativamente la respuesta inmunohumoral inducida por las nefrectomías laparoscópica y abierta en un modelo experimental porcino, en base a la cuantificación de la PCR, las IL-2, 10, el factor de necrosis tumoral alfa (TNF alfa), y la ET-1.Material y métodos: Se analizan comparativamente dos grupos de cerdos de 25-40 Kg, un grupo CONTROL (N=10) y grupo LAPAROSCÓPICO (N=10), a los que se les realiza una nefrectomía abierta o laparoscópica respectivamente. Se determinó en sangre venosa periférica los niveles de PCR, IL-2, IL-10, TNF α y ET-1. Las determinaciones analíticas se realizaron en los momentos: basal, postcirugía, 1, 3, 5, y 7 días postquirúrgico. Resultados: El análisis comparativo de ambos grupos demuestra un aumento estadísticamente significativo de la PCR(1,44+ 0,88 vs 1,32 + 0,14 mg/dl, p=0,046), TNF α (131,14 + 41,37 vs 57,19 + 23,71 pg/ml, p>0,001) y ET-1 (0,91 + 0,49vs 0,56 + 0,5 fmol/ml, p=0,001) del grupo abierto en comparación con el grupo control, así como una elevación de la IL-2 en el grupo laparoscópico. Conclusiones: La respuesta inmunohumoral inducida por la nefrectomía abierta es superior a la de la nefrectomía laparoscópica en el curso de la donación. La importancia de este hecho en el síndrome isquemia reperfusión o la función inmediata del injerto no está claramente establecida (AU)

Introduction: It’s been demonstrated laparoscopic access determines a lower surgical stress, by measurement of several markers as different interleuquines (IL) or C- reactive protein (CRP). Endothelin 1 (ET-1) is a powerful vasoconstrictor produced in renal endothelium scarcely studied in laparoscopy. The objective of this study is to analyze immune response during laparoscopic and open donor nephrectomy, in a porcine experimental model by means of measuring IL-2,10, tumoral necrosis factor α (TNFα), CRP and ET-1.Methods: Twenty pigs underwent left nephrectomy, 10 by laparoscopy and 10 by open approach in an experimental model. Both groups were monitorized IL-2, 10, TNF α, ET-1 at basal, immediately post surgery, first, third, fifth and seventh days after procedure. Results: The comparative analysis between groups demonstrated a significant increase in levels of CRP (1,44 + 0,88vs 1,32 + 0,14 mg/dl, p=0,046), TNF α (131,14 + 41,37 vs 57,19 + 23,71 pg/ml, p>0,001) and ET-1 (0,91 + 0,49 vs 0,56+ 0,5 fmol/ml, p=0,001) of open nephrectomy group, as a higher levels of IL-2 in laparoscopic group. Conclusions: Open donor nephrectomy determines a higher immune response than laparoscopic approach. The importance of this fact over the ischemia-reperfusion syndrome or the immediate function of graft is not clearly established (AU)

Modelos experimentales para la investigación y el entrenamiento en trasplante renal / Experimental models for research and training in renal transplant

Introducción y objetivos: Se presenta una revisión sobre las diferentes características y el uso de los distintos modelos experimentales utilizados para el trasplante renal (TR). Esta revisión incluye las cualidades, así como sus semejanzas a los humanos, de las especies más frecuentemente utilizadas. Se revisan las aportaciones de los diferentes modelos al entrenamiento de las diferentes técnicas quirúrgicas como la laparoscopia o la microcirugía. Se repasan sus contribuciones al estudio y la investigación en campos como los efectos hemodinámicos o inmunológicos del neumoperitoneo, las técnicas de donante a corazón parado o las diferentes formas de preservación de los injertos. Por último, se realiza una revisión de los diferentes modelos utilizados para la investigación de los distintos protocolos de inmunosupresión así como el xenotrasplante

Introduction and objetives: An update on aspects and use of different experimental models applied in kidney transplant research is presented . This paper includes qualities, as long as similarities between most frequently used animal models and human clinical standards. Contributions of those models based on microsurgical or laparoscopic techniques are revised. The physiological consequences (hemodynamic, immunologic) of surgical technique (laparoscopy), applied in experimental models as long as non-heart beating organ donor models and organ preservation methods are also reviewed. Finally, an update of those models applied in research in prothocols of either immunosupression or xenotransplant is done

Trasplante experimental de islotes de páncreas en el tracto genitourinario asociado al trasplante renal / Experimental pancreatic islet transplant into the genito-urinary tract simultaneous to kidney transplant

Conceptualmente el trasplante de páncreas (TP) asociado al trasplante renal (TR) puede resolver la insuficiencia renal crónica (IRC) y la diabetes (DM). Aunque el lugar de implantación más frecuentemente utilizado es la vena porta, el tracto genitourinario puede ser adecuado desde un punto de vista técnico durante el TR. 20 animales con una edad media de 5,5 (SD 1,1) meses y una mediana de peso de 53 (30,102) kg se sometieron al siguiente protocolo experimental. El primer día, se lleva a cabo la nefrectomía izquierda y el injerto es perfundido con solución de Wisconsin, lo que se sigue de una pancreatectomía distal y el aislamiento de islotes por medio de la digestión enzimática con Colagenasa. Los islotes son teñidos con el colorante vital Ditizona (DTZ) y cultivados durante 24 horas a 37º y 5% de Co2. El día 2 se realiza la nefrectomía derecha y un TR ortotópico del injerto renal izquierdo preservado. Los islotes son trasplantados en 4 localizaciones diferentes en el tracto genitourinario: el espacio subcapsular del injerto renal, en la submucosa de vejiga, en el parénquima testicular y por vía deferencial. El día 7, los animales son sacrificados para estudio histopatológico. Se demostraron islotes viables en la submucosa vesical y en el testículo tras infusión por vía deferencial

Introduction and objectives: Simultaneous kidney and pancreas transplant is a good treatment for both renal and pancreas insufficiency. Experimental apply of genitourinary tract for pancreas implantation is reported in this work. Material and method. Twenty animals aged as average 5.5 monts (SD 1.1) and an average weight of 53 kgr were submitted to this protocol. In the day 1 a left nephrectomy is completed and the graft is perfused with University of Wisconsin solution. A partial pancreatectomy is completed at following, isolation of pancreatic islets by colagenase enzymatic digestion. Islets are dryed with Ditizone and culptured for 24 hours at 37ºC and 5% CO2. Day-2 a right nephrectomy is performed and orthotopic renal autotransplant using the left kidney is completed. Pancreatic islets are transplanted in 4 different locations of the genitourinary tract: renal subcapsular space, bladder submucosae, testis parenchyma and vas deferens. Day-7, all the animals were sacrifized to complete pathological study. Results and conclusions: Viable islets were isolated in bladder submucosae and testis after transdeferential injection

Análisis comparativo de la función del injerto renal de donante vivo tras nefrectomía abierta y laparoscópica: modelo experimental / Comparative analysis of renal graft fuction after open vs laparoscopic nephrectomy: experimental model

Introducción: El trasplante renal (TR) de donante vivo presenta una supervivencia del injerto y del paciente superior al TR procedente de cadáver y representa una alternativa eficaz frente al problema de la escasez de órganos. Objetivo: Analizar comparativamente en un modelo experimental en cerdo, la influencia del síndrome de isquemia repercusión y la evolución funcional del injerto renal extraído mediante nefrectomía abierta y laparoscópica. Material y métodos: 30 cerdos fueron sometidos a nefrectomía izquierda: 15 por laparoscopia y 15 por vía abierta, como donantes vivos en un modelo de autotrasplante renal. Se midió el flujo sanguíneo renal (FSR) postdesclampaje mediante sonda electromagnética y los niveles de creatinina (Cr) durante la primera semana postrasplante. Resultados: El análisis comparativo del FSR en la 1ª hora postTR objetivó: una disminución significativa del FSR medio en el grupo de laparoscopia frente al abierto (p<0,001), con una reducción del FSR en los primeros 5 minutos más acusado en el grupo laparoscópico (p<0,001), y una recuperación progresiva del FSR durante la 1ª hora, que es más lenta para el grupo laparoscópico. Los niveles de Cr en la primera semana postrasplante descendieron progresivamente desde 1,3 a 0,8 mg/dl en el grupo abierto, y de 2 a 1,1 mg/dl en el grupo laparoscópico (p<0,001). Conclusiones: Los injertos renales extraídos vía laparoscópica presentan una acentuación del síndrome de isquemiareperfusión manifestado por un FSR postdesclampaje inferior al FSR prenefrectomía y un deterioro significativo de la función renal durante la primera semana postrasplante

Introduction: Living donor renal transplant reports a higher patient and graft survival in comparison to cadaver donor and represents a good alternative facing the current lack of organs for transplant. Goals: To analyze comparatively in an experimental model (pig) the influence of ischemia-reperfusion and functional outcome of renal graft retrieved by open Vs laparoscopic nephrectomy. Material and methods: 30 lab pigs were nephrectomized (left kidney): 15 by laparoscopy and 15 by open surgery, as living donors, in a model of renal autotransplant. Renal blood flow (RBF) was measured by means of an electromagnetic probe and creatinine levels during the first week after the implant. Results: Comparative analysis of RBF during the immediate 60 min after unclamping showed a significant reduction of average RBF in laparoscopic group in comparison to open group (p<0.001), with a more evident reduction of RBF in the laparoscopic group during the 5-min period after unclamping (p<0.001) and a progressive recuperation of RBF during the 1st hour, slowest in laparoscopic group. Creatinine levels in the first week after the transplant decreased progressively from 1.3 to 0.8 mgrs/dl in the open group and from 2 to 1.1 mg/dl in laparoscopic group (p<0.001). Conclusions: Renal grafts retrieved by laparoscopy presents a more evident ischemia-reperfusion syndrome shown by a lower average RBF after unclamping and a significant deterioration of renal function during the first week after transplant

[Modification of the hemodynamic parameters and peripheral vascular flow in a porcine experimental of model of laparoscopic nephrectomy]. / Modificaciones de los parámetros hemodinámicos y de los distintos flujos vasculares periféricos en modelo experimental porcino de nefrectomía laparoscópica.

OBJECTIVES: It has been demonstrated that abdominal high-pressure and the use of CO2 pneumoperitoneum induce changes of the cardiovascular and respiratory systems, attributable to two factors: changes of the cardiac output (CO) and hypercarbia. Other modifications derived from these facts include changes of the systemic vascular resistances (SVR), blood pressure (BP), central venous pressure (CVP), vascular changes like modifications of the renal blood flow (RBF), carotid flow (CF), portal flow, and hepatic artery flow (HAF). Our objective is to analyze the hemodynamic modifications induced by pneumoperitoneum on renal blood flow, carotid flow, portal flow and hepatic artery flow in a porcine experimental model. METHODS: We compared two groups of pigs: CONTROL group (n = 10) and LAPAROSCOPIC group (n = 10), undergoing open or laparoscopic nephrectomy respectively. In every case, catheters were inserted into the right external jugular vein and femoral artery and cardiac output, CVP, blood pressure and systemic vascular resistances (calculated as RVS = (BP/CVP)x 80/CO); these measurements were taken at the following times: baseline, 5, 30, 60 min. and postoperatively. Renal blood flow, carotid flow, portal flow and hepatic artery flow were registered by means of an electromagnetic probe around the vessel 30 minutes after the start of surgery. RESULTS: Comparative analysis shows: an increase of cardiac output in the laparoscopic group, the difference which was maximal at 30 minutes (4.33 + 0.73 vs. 8 .54 + 1.26 l/min., p < 0.,001); a descent of the systemic vascular resistances (1118.81 + 302.52 vs. 663.37 + 81.45 dynes .s.cm5, p < 0.001) and an increase of blood pressure (66.5 + 11.52 vs. 80.25 + 2.49 mm Hg in the laparoscopic group. Flow analysis showed an increase of the carotid artery flow (125.73 + 41.69 vs. 291.7 + 51.52 ml/min., p < 0.001) and a decrease of portal flow (973.67 + 131.70 vs. 546.83 + 217.53 ml/min., p = 0.001) and hepatic artery flow (278.00 + 94.71 vs. 133.33 + 112.32 ml/min., p = 0.03) in the laparoscopic group. There were no significant differences in renal blood flow with the volume expansion used. CONCLUSIONS: Laparoscopic nephrectomy conditions an increase of carotid flow, probably secondary to the increase of cardiac output, and also a diminishment of hepatic perfusion, both arterial and portal. Nevertheless, volume expansion and the limitation of intra-abdominal pressure to 12 mm Hg enable to maintain similar renal blood flow in both groups.

[Comparative analysis about hemodynamic and renal blood flow effects during open versus laparoscopic nephrectomy. An experimental study]. / Análisis comparativo de las modificaciones hemodinámicas y del flujo sanguineo renal (FSR) durante la nefrectomía abierta y laparoscópica. Modelo experimental.

BACKGROUND: The increase of intraabdominal pressure to 10 mmHg provokes a decrease of renal blood flow (RBF). Pneumoperitoneum during laparoscopic techniques with intra-abdominal pressure (IAP) to 15 mmHg, results in a decrease in RBF, urine output and glomerular filtration rate (GFR). PURPOSE: Analyze the changes in RBF, urine output an GFR in a porcine experimental model during open vs laparoscopic nephrectomy. MATERIALS AND METHODS: 30 pigs (medium weigh= 22.6+3.2 Kg) were divided into two groups: Laparoscopic nephrectomy was performed using 15 pigs and open nephrectomy in 15 pigs, following a living donor nephrectomy autotransplantation model. Study parameters were urine volume and GFR baseline values, 30 and 60 minutes during nephrectomy. RBF was measured using an electromagnetic flow catheter around the main renal artery during the initial 60 minutes of nephrectomy. RESULTS: The laparoscopic technique was associated with a significant reduction of RBF (80+2.7 vs 262+3 ml/min) (p<0.005), diuresis (42%) and GFR (38%), vs the open group. CONCLUSIONS: Laparoscopic nephrectomy involves a significant reduction of RBF, GFR and diuresis, which is potentially transcendent in living donor nephrectomy and kidney transplantation.

Modificaciones de los parámetros hemodinámicos y de los distintos flujos vasculares periféricos en modelo experimental porcino de nefrectomía laparoscópica / Modification of the hemodynamic parameters and peripheral vascular flow in a porcine experimental of model of laparoscopic nephrectomy

Objetivo: Se ha demostrado que la hiperpresión abdominal y la utilización del neumoperitoneo con CO2, provocan cambios en los aparatos cardiovascular y respiratorio, atribuibles a dos factores: alteraciones en el gasto cardiaco (GC) e hipercarbia. Otras alteraciones derivadas de estos hechos son los cambios en las resistencias vasculares sistémicas (RVS), la tensión arterial (TA), la presión venosa central (PVC), cambios vasculares como las alteraciones en el flujo sanguíneo renal (FSR), flujo carotídeo (FAC), flujo portal (FP) y flujo de la arteria hepática (FAH). Nuestro objetivo es analizar las modificaciones hemodinámicas producidas por el neumoperitoneo sobre los FSR, FC, FP y FAH en modelo experimental porcino. Métodos: Se analizan comparativamente dos grupos de cerdos, un grupo CONTROL (N=10) y grupo LAPAROSCÓPICO (N=10), a los que se les realiza una nefrectomía abierta o laparoscópica respectivamente. En ambos grupos se canaliza la vena yugular externa derecha y la arteria femoral y se monitoriza el GC, la PVC, la TA, las RVS (calculada mediante la fórmula RVS=(TA-PVC)*80/GC); estas determinaciones se realizan en los momentos: basal, 5, 30, 60 minutos y postcirugía. Mediante sonda electromagnética alrededor del vaso, se registran los FSR, FC, FP y FAH a los 30 minutos de iniciada la intervención quirúrgica. Resultados: El análisis comparativo de ambos grupos demuestra un aumento del GC en el grupo laparoscópico, cuya diferencia fue máxima a los 30 minutos (4,33 + 0,73 vs 8,54 + 1,26 l/min, p< 0,001); un descenso de las RVS (1118,81 + 302,52 vs 663,37 + 81,45 dinas x s x cm-5 p< 0,001) y un aumento de la TA del grupo laparoscópico (66,5 + 11,52 vs 80,25 + 2,49 mm Hg, p= 0,004). El análisis de los flujos demostró un aumento del FAC (125,73 + 41,69 vs 291,70 + 51,52 ml/min, p<0,001) y una disminución del FP (973,67+ 131,70 vs 546,83+ 217,53 ml/min, p= 0,001) y del FAH (278,00 + 94,71 vs 133,33+112,32 ml/min, p=0,03) en el grupo laparoscópico. No existieron diferencias significativas en el FSR con la expansión de la volemia utilizada. Conclusiones: La nefrectomia laparoscópica condiciona un aumento del FC, posiblemente secundario al aumento del gasto cardiaco, así como un descenso de la perfusión hepática, tanto arterial como portal. Sin embargo, la expansión de la volemia y la reducción de la PIA a 12 mmHg permiten mantener el FSR semejante en ambos grupos (AU)

Objectives: It has been demonstrated that abdominal high-pressure and the use of C02 pneumoperitoneum induce changes of the cardiovascular and respiratory systems, attributable to two factors: changes of the cardiac output(CO) and hypercarbia. Other modifications derived from these facts include changes of the systemic vascular resistances (SVR), blood pressure (BP), central venous pressure (CVP), vascular changes like modifications of the renal blood flow (RBF), carotid flow (CF), portal flow, and hepatic artery flow (HAF). Our objective is to analyze the hemodynamic modifications induced by pneumoperitoneum on renal blood flow, carotid flow, portal flow and hepatic artery flow in a porcine experimental model. Methods: We compared two groups of pigs: CONTROL group (n = 10) and LAPAROSCOPIC group (n = 10), undergoing open or laparoscopic nephrectomy respectively. In every case, catheters were inserted into the right external jugular vein and femoral artery and cardiac output, CVP, blood pressure and systemic vascular resistances (calculated as RVS = (BP/CVP)x 80/CO); these measurements were taken at the following times: baseline, 5, 30, 60 min. and postoperatively. Renal blood flow, carotid flow, portal flow and hepatic artery flow were registered by means of an electromagnetic probe around the vessel 30 minutes after the start of surgery. Results: Comparative analysis shows: an increase of cardiac output in the laparoscopic group, the difference which was maximal at 30 minutes (4.33 + 0.73 vs. 8 .54+ 1.26 l/min., p < 0,001); a descent of the systemic vascular resistances (1118.81+ 302.52 vs. 663.37+ 81.45 dynes .s.cm5, p < 0.001) and an increase of blood pressure (66.5+ 11.52 vs. 80.25+ 2.49 mm Hg in the laparoscopic group. Flow analysis showed an increase of the carotid artery flow (125.73+ 41.69 vs. 291.7+ 51.52 ml/min., p < 0.001) and a decrease of portal flow (973.67+ 131.70 vs. 546.83+ 217.53 ml/min., p = 0.001) and hepatic artery flow (278.00+ 94.71 vs. 133.33+ 112.32 ml/min., p = 0.03) in the laparoscopic group. There were no significant differences in renal blood flow with the volume expansion used. Conclusions: Laparoscopic nephrectomy conditions an increase of carotid flow, probably secondary to the increase of cardiac output, and also a diminishment of hepatic perfusion, both arterial and portal. Nevertheless, volume expansion and the limitation of intra-abdominal pressure to 12 mm Hg enable to maintain similar renal blood flow in both groups (AU)

Análisis comparativo de las modificaciones hemodinámicas y del flujo sanguíneo renal (FSR) durante la nefrectomía abierta y laparoscópica. Modelo experimental / Comparative analysis about hemodynamic and renal blood flow effects during open versus laparoscopic nephrectomy. An experimental study

Introducción: El aumento de la presión intraabdominal (PIA) por encima de 10 mmHg conlleva una reducción del flujo sanguíneo renal (FSR). El neumoperitoneo inducido durante las técnicas laparoscópicas, condiciona presiones intraabdominales (PIA) próximas a 15 mmHg, circunstancia que reduce el FSR, la diuresis y el filtrado glomerular (FG). Objetivo: Analizar comparativamente en un modelo experimental en cerdo, las modificaciones del FSR, la diuresis y el FG inducidas por las nefrectomías abierta y laparoscópica. Material y métodos: Un total de 30 cerdos (peso medio = 22,6+3,2 Kg) han sido sometidos a nefrectomía izquierda: 15 por laparoscopia y 15 por vía abierta, como donantes vivos en un modelo de autotrasplante renal. Se midió la diuresis y el FG basales y a los 30 y 60 min del inicio de la nefrectomía. El FSR medio se determinó mediante sonda electromagnética en la arteria renal principal durante la primera hora de la cirugía. Resultados: Se objetivó una reducción significativa del FSR (80+2,7 vs 262+3 ml/min) (p<0,005) durante la nefrectomía laparoscópica frente a la abierta. También se demostró una disminución significativa de la diuresis (42%) y del FG (38%) del grupo laparoscópico frente al abierto. Conclusiones: La nefrectomía laparoscópica conlleva una disminución significativa del FSR, circunstancia potencialmente trascendente en el TR con donante vivo, así como del FG y de la diuresis

Background: The increase of intraabdominal pressure to 10 mmHg provokes a decrease of renal blood flow (RBF). Pneumoperitoneum during laparoscopic techniques with intra-abdominal pressure (IAP) to 15 mmHg, results in a decrease in RBF, urine output and glomerular filtration rate (GFR). PURPOSE: Analyze the changes in RBF, urine output an GFR in a porcine experimental model during open vs laparoscopic nephrectomy. Materials and methods: 30 pigs (medium weigh= 22.6+3.2 Kg) were divided into two groups: Laparoscopic nephrectomy was performed using 15 pigs and open nephrectomy in 15 pigs, following a living donor nephrectomy autotransplantation model. Study parameters were urine volume and GFR baseline values, 30 and 60 minutes during nephrectomy. RBF was measured using an electromagnetic flow catheter around the main renal artery during the initial 60 minutes of nephrectomy. Results: The laparoscopic technique was associated with a significant reduction of RBF (80+2.7 vs 262+3 ml/min) (p<0.005), diuresis (42%) and GFR (38%), vs the open group. Conclusions: Laparoscopic nephrectomy involves a significant reduction of RBF, GFR and diuresis, which is potentially transcendent in living donor nephrectomy and kidney transplantation

[Extra-anatomic urinary diversion by subcutaneous catheter]. / Derivación urinaria extra-anatómica mediante catéter subcutáneo.

Percutaneous nephrostomy has been one of most used palliative method of urinary diversion to treat cronic renal failure in neoplasic patients. Psychological and social factors meke this measure to be rejected by some patients even sin situations where this is the only action that would make their survival longer. The utilization of ureteral stents provides benefits to a certain percentage of patients, not being possible its usage in all the occassions. Urinary subcutaneous diversion can be a simple and well tolerated alternative for the patient. The following clinic case describes and approach implementing a subcutaneous stent in a 60-y-old male with a severe ureteric obstruction after failed management by endoscopy or open surgery.

[Celsior's kidney preservation in renal transplantation. Our experience]. / Preservación con Celsior en trasplante renal. Nuestra experiencia.

BACKGROUND: The goal of this research is to make a comparative analysis of acute tubular necrosis (NTA) incidence in function of preservation solution used: Wisconsin vs Celsior. METHODS: From January 1994 to December 2002, 229 kidney transplantation procedures were executed; 190 of them were perfused with Wisconsin (82.9%) and 39 with Celsior (17.1%). After checking the statistical homogeneity of both groups, we analysis comparatively the incidence of NTA and the evolution of serum creatinine in function of preservation solution utilized. RESULTS: There was not statistical significant difference in NTA incidence between Celsior (23%) and Wisconsin group (36%). We assessed that each group were comparable with regard to NTA incidence of subgroups with cold ischemia times longer 12 hours. Creatinine serum in Celsior group tended to be lower than Wisconsin group at 1, 3, 6 and 12 months posttransplantation (statistically significant difference, p<0.05) CONCLUSIONS: Kidney preservation in Celsior solution provides similar results to the ones obtained in Wisconsin solution in relation with NTA incidence and kidney function with the added advantage of a lower cost.

Preservación con Celsior en trasplante renal. Nuestra experiencia / Celsior's kidney preservation in renal transplantation. Our experience

OBJETIVOS: Analizar comparativamente la incidencia de necrosis tubular aguda (NTA) y función del injerto renal según el líquido de preservación empleado. Wisconsin vs Celsior. MATERIAL Y MÉTODOS: Desde enero de 1994 a diciembre de 2002 se implantaron 229 injertos renales, 190 de ellos preservados con Wisconsin (82,9 por ciento) y 39 con Celsior (17,1 por ciento). En este trabajo, tras comprobar la homogeneidad estadística de ambos grupos, se analiza comparativamente la incidencia de NTA y la evolución de la creatinina sérica en función del líquido de preservación empleado. RESULTADOS: No hay diferencia significativa en la incidencia de NTA entre los grupos Celsior (23 por ciento) y Winsconsin (36 por ciento). Se obtiene resultado similar en proporción de NTA en el subgrupo de injertos con periodos de isquemia fría superior a 12 h, con independencia del líquido de preservación empleado. El grupo Celsior presenta menores niveles de creatinina sérica a 1, 3, 6 y 12 meses postransplante renal, con una diferencia estadística significativa (p<0,05). CONCLUSIONES: La preservación renal con Celsior proporciona resultados equivalentes a Wisconsin en relación a incidencia de NTA y función renal, con la ventaja de un menor coste (AU)

[Ureteral stenosis after kidney transplantation: treatment with a self-expanding metal prosthesis]. / Estenosis ureteral post-transplante renal: tratamiento con prótesis metálica autoexpandible.

OBJECTIVE: To determinate the efficacy in the treatment of ureteral estenoses after renal transplantation with metallic self-expandable stent. MATERIALS AND METHODS: From october of 1995 to april of 2002, 8 ureteral obstruction post renal transplantation have treated by means of implants of a metallic self-expandable stent (6 men and 2 women). The average time of pursuit was of 30 months (rank 2-53 months). In this work the severity and location of the estenosis are analysed, the method of implant of the stent, the permeability of the same one, the levels of creatinine pre and postimplant and the complications derived from the same one. RESULTS: The treatment was effective in the 100% of the patients (8/8), with an average reduction of the creatinine of 36% (rank 13.6%-59.6%). The complications were minimum and the hospital stay was short. CONCLUSIONS: In the patients with: chronic deterioration of the graft with short functional expectation, patient with high surgical risk and reestenosis after ureteral reimplantation by previous ureteral estenosis, the use of a metallic self-expandable stent, constitutes technique of election given its efficacy and low associate morbidity.

Estenosis ureteral post-trasplante renal: tratamiento con prótesis metálica autoexpandible / Ureteral obstruction after renal transplantation: treatment with metallic self-expandable

OBJETIVO: Determinar la eficacia del empleo de prótesis metálicas autoexpandibles en el tratamiento de las estenosis ureterales post-trasplante renal. MATERIAL Y MÉTODOS: Desde octubre de 1995 a abril de 2002, se han tratado 8 estenosis ureterales postTR mediante el implante de una prótesis metálica autoexpandible (6 hombres y 2 mujeres). El tiempo medio de seguimiento fue de 30 meses (rango 2-53 meses). En este trabajo se analizan la severidad y localización de la estenosis, el método de implante de la prótesis, la permeabilidad de la misma, los niveles de creatinina pre y postimplante y las complicaciones derivadas del mismo. RESULTADOS: El tratamiento fue efectivo en el 100 por ciento de los pacientes (8/8), con un descenso medio de la creatinina del 36 por ciento (rango 13,6 por ciento-59,6 por ciento). Las complicaciones fueron mínimas y la estancia hospitalaria fue corta. CONCLUSIONES: En los pacientes con: deterioro crónico del injerto con expectativa funcional corta, pacientes con alto riesgo quirúrgico y reestenosis tras reimplantación ureterovesical por estenosis ureteral previa, el empleo de una prótesis metálica autoexpandible constituye la técnica de elección dada su eficacia y baja morbilidad asociada (AU)

OBJECTIVE: To determinate the efficacy in the treatment of ureteral estenoses after renal transplantation with metallic self-expandable stent. MATERIALS AND METHODS: From october of 1995 to april of 2002, 8 ureteral obstruction post renal transplantation have treated by means of implants of a metallic self-expandable stent (6 men and 2 women). The average time of pursuit was of 30 months (rank 2-53 months). In this work the severity and location of the estenosis are analysed, the method of implant of the stent, the permeability of the same one, the levels of creatinine pre and postimplant and the complications derived from the same one. RESULTS: The treatment was effective in the 100% of the patients (8/8), with an average reduction of the creatinine of 36% (rank 13,6%-59,6%). The complications were minimun and the hospital stay was short. CONCLUSIONS: In the patients with: chronic deterioration of the graft with short functional expectation, patient with high surgical risk and reestenosis after ureteral reimplantation by previous ureteral estenosis, the use of a metallic self-expandable stent, constitutes technique of election given its efficacy and low associate morbidity (AU)

[Comparative study of ureteral anastomosis with or without double-J catheterization in renal transplantation]. / Estudio comparativo entre anastomosis ureteral con o sin cateterización con doble j en trasplante renal.

OBJECTIVE: To analyze the impact of the use of the routine double-J stent in the incidence of urological complications, like fistula, stenosis, ureteral obstruction and urinary tract infection. METHODS: A retrospective study was conducted on two groups of patients: 28 without double-J stent and 28 with it. We reviewed urological complications: stenosis, fistula and obstruction. We paid special attention to urinary tract infection and other inherents complications to the use of double-J stents. RESULTS: A patient from the double-J stended group (3.6%) developed a urinary fistula and there were no obstructions. 13 patients (46.6%) had a positive urinary culture in the first month post RT. Two urinary fistulas and 4 obstructions were developed in the non-stended group. Six major complications of the urinary tract. 14 patients (50%) had a positive urinary culture in the first month post RT. CONCLUSIONS: The use of double-J stent across uterovesical anastomosis decreases the post-RT ureteral complications. Stent placement does not increase the risk of urinary tract infection in the early post-RT.

Estudio comparativo entre anastomosis ureteral con o sin cateterización con doble J en trasplante renal / Comparative study about the use of double-J stent across ureteral anastomosis in renal transplantation

OBJETIVO: Analizar la influencia de la cateterización de la reimplantación ureterovesical del trasplante renal (TR) con catéter tipo doble J (DJ) en la incidencia de complicaciones urológicas tipo fístula, estenosis, obstrucción e infecciones del tracto urinario. MÉTODO: De manera retrospectiva se comparan dos grupos homogéneos de pacientes: 28 sin catéter tipo doble J (DJ) y 28 con él. En el periodo de seguimiento se estudia la incidencia de fístulas urinarias, estenosis y procesos obstructivos de la vía urinaria. Se presta especial atención a los procesos infectivos de la vía urinaria como a las complicaciones inherentes de la cateterización ureteral. RESULTADOS: En el grupo con DJ se evidenció una fístula urinaria (3,6 por ciento) y ningún proceso obstructivo. Trece pacientes (46,4 por ciento) presentaron cultivos de orina positivos en el primer mes pos-TR. En el grupo sin DJ se evidenciaron dos fístulas urinarias (7,1 por ciento) y cuatro episodios obstructivos (14,3 por ciento), existiendo un total de 6 complicaciones mayores de la vía urinaria. Catorce pacientes (50 por ciento) presentaron cultivos de orina positivos en el primer mes post-TR.CONCLUSIONES: La cateterización de la ureteroneocistostomía en el TR disminuye la incidencia de fístulas urinarias y de fenómenos obstructivos ureterales. No aumenta la incidencia de infecciones urinarias en el postrasplante inmediato (AU)

Sepsis y fracaso renal agudo en paciente portador de marcapasos / Sepsis and acute kidney failure in a pacemaker-wearing patient

La glomerulonefritis aguda es un cuadro cada vez menos frecuente con el desarrollo de tratamientos antibióticos adecuados. Sin embargo, en los últimos años encontramos casos más graves, en pacientes con peor pronóstico y más comprometidos. Suele asociarse a infecciones de distinto origen, pero la glomerulonefritis secundaria a la infección de los cables de un marcapasos permanente es muy infrecuente y en la literatura sólo hemos encontrado dos casos previos (AU)