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Biomedical subjects

M A Ghoneim

Publications and source records attributed to M A Ghoneim.

At least 109 records · Page 6Linked to original sources
PubMed1994

Postrenal transplant urethral Kock pouch.

We report on a man with schistosomal bladder who developed stage T3N0M0, grade II transitional cell carcinoma of the bladder 9 years following successful renal transplantation. Radical cystoprostatectomy was performed and urethral Kock pouch was implanted in the same setting. The patient was continent and the graft function was maintained without reflux or obstruction at a follow-up period of 2 years. No complications due to poor intestinal healing or intraabdominal sepsis were observed despite immunosuppression and electrolyte disorders were minor.

Adult↗
PubMed1993

Optimization of uretero-intestinal anastomosis in urinary diversion: an experimental study in dogs. I. Evaluation of the Le Duc technique.

Experimental evaluation of uretero-ileal reimplantation was carried out in 10 adult mongrel dogs. One half of the ureters (10) were implanted into ileal reservoirs using the classic Le Duc technique. In the other half, the implanted ureters were covered by ileal mucous membrane. Following the classic Le Duc technique, 40% of the reimplanted ureters showed evidence of either reflux and/or stenosis resulting from shortening and fibrosis of the tunnel. The remaining 60% were perfect due to spontaneous nipple formation at the implantation sites rather than to creeping of the intestinal mucosa. In contrast, none of the ureters examined was either refluxing or stenotic. This study outlines the critical importance of covering the implanted ureters with mucosa to avoid the ureteric adventitia being exposed to the irritative effects of urine with subsequent scarring.

Animals↗
PubMed1993

Optimization of uretero-intestinal anastomosis in urinary diversion: an experimental study in dogs. II. Influence of exposure to urine on the healing of the ureter and ileum.

The influence of exposure to urine on the ureteric adventitia and the ileal mucous membrane was studied in 10 mongrel dogs. When the ureter was implanted freely into the lumen of the bladder its adventitia became the seat of granulation tissue formation. This is later covered by creeping of transitional epithelium lining the ureter, forming what is in effect a ureteral nipple. Final healing is associated with an unpredictable amount of scarring. Furthermore, it was noted that healing and creeping of the ileal mucous membrane are impeded in the presence of urine. The sum of these effects is that ureters implanted in an open sulcus of the small intestine are not covered by intestinal epithelium, they tend to form spontaneous nipples and their healing is associated with either stenosis or reflux in some 30% of cases.

Animals↗
PubMed1993

Optimization of uretero-intestinal anastomosis in urinary diversion: an experimental study in dogs. III. A new antireflux technique for uretero-ileal anastomosis: a serous-lined extramural tunnel.

A new antireflux uretero-ileal reimplantation technique suitable for use with bladder substitutes is presented. This procedure entails creation of a serous-lined extramural tunnel. Following detubularization of the bowel segment, the adjacent flaps are approximated by continuous 4/0 non-absorbable sutures 1.5 cm from the cut edges. The ureters are laid in the trough thus fashioned. "Button-holes" are created in the bowel flaps and a mucosa-to-mucosa uretero-ileal anastomosis is carried out. The mucosal edges of the flaps are then approximated by one layer of continuous 4/0 (PGA) suture resulting in closure of this artificial tunnel. The feasibility and functional outcome of this technique were experimentally investigated in 8 dogs. Follow-up was carried out up to 30 weeks. Assessment by intravenous urography and ascending studies showed that the procedure is an efficient method of providing an unobstructed unidirectional flow of urine.

Animals↗
PubMed1993

Percutaneous treatment of lymphocele in renal transplant recipients.

Of 700 consecutive live-donor kidney transplants, 37 patients (5%) developed a symptomatic lymphocele. Two of ten patients were treated successfully by a single percutaneous needle aspiration. Percutaneous catheters were inserted in 30 patients, either primarily of after failure of other treatments. Of these 30 patients, tetracycline sclerotherapy was used in 21. The overall success rate of percutaneous catheter drainage was 93% (28/30). Surgical marsupialization was successful in 7 of 8 patients (88%). We conclude that percutaneous needle aspiration is ineffective in the treatment of symptomatic lymphocele, while percutaneous catheter drainage with tetracycline sclerotherapy is safe and effective. Should catheter drainage fail, surgical marsupialization will usually be effective.

Adult↗
PubMed1993

Endourologic management of ureteric complications after live-donor kidney transplantation.

Among 620 consecutive live-donor kidney transplants, 40 patients (6.5%) developed ureteric complications in the form of fistula (N = 16) or obstruction (N = 24). Patients with these complications were stratified into two consecutive groups according to the use of graft percutaneous nephrostomy (PCN) in their initial management. Group A was comprised of 17 patients (8 fistulas and 9 obstructions) treated by conventional open surgery without graft PCN. In Group B, 23 patients (8 fistulas and 15 obstructions) were initially treated by graft PCN until resolution of azotemia and control of infection, then treated definitively by endourologic procedures or open surgery. Patients of Group B demonstrated significantly better graft function 2 weeks after treatment, better 1-year graft survival, a shorter hospital stay, and a lower incidence of secondary post-treatment complications. Moreover, in this group of patients, endourologic procedures provided definitive management in 3 of 8 patients with ureteric fistula and in 9 of 15 patients with ureteric obstruction. These data supplement the growing evidence that endourologic techniques are good adjuncts to or substitutes for open surgery in renal allograft recipients with ureteric complications.

Adult↗
PubMed1993

Cyclosporin in primary haploidentical live-donor kidney transplantation: is it worthwhile?

Two consecutive prospective randomized trials were performed to study three immunosuppressive protocols in 195 kidney transplant recipients. Only adult primary renal transplant recipients with one haplotype HLA mismatch were included. All patients received kidneys from living related donors and had previous donor non-specific blood transfusions. Study I included 112 recipients who were randomly assigned to receive either azathioprine (Aza) and prednisolone (P) (n = 54) or cyclosporin (CsA) and P (n = 58). Patients in this study were followed up for 3-6 years (mean 50 +/- 8 months). Study II included 83 recipients who were randomly assigned to receive either triple therapy of Aza-CsA-P (n = 41) or conventional therapy of Aza-P (n = 42). Patients in this study were followed up for a period of 32 +/- 10 (range 26-43) months. Analysis of data in the two studies demonstrated the absence of statistically significant differences in graft or patient survival rates over short- and long-term follow-up periods among recipients of the conventional immunotherapy and those receiving the CsA-P or the triple therapy. The overall frequency of acute rejection episodes was not significantly different between the two treatment groups of each study. Serum creatinine was significantly higher in the CsA-P group while the incidence of infection was significantly lower in the triple group. When switching from one regimen to another is considered, at least 75% of the one-haplotype HLA mismatched live-related donor renal transplants could be maintained on conventional immunotherapy with comparable degree of success to those treated with the CsA-P or the triple therapy. However, in at least 15% of patients with conventional immunotherapy, CsA could reverse ongoing rejections and can therefore be considered as a rescue treatment.

Adult↗
PubMed1993

Endothelium localization of ETB receptor revealed by immunohistochemistry.

The ETB receptor has been found to be predominantly expressed in the vascular endothelium of various bovine tissues by immunostaining with a highly specific antiserum that does not cross-react with ETA. The tissues examined include the lung, trachea, kidney, adrenal gland, pituitary gland, and cerebellum. The wide-spread localization of ETB in the endothelial lining suggests that there is an ETB-mediated autocrine system of endothelin, which plays an important role in regulation of the functions of endothelial cells.

Animals↗
PubMed1993

Prospective randomized study of azathioprine versus cyclosporin in live-donor kidney transplantation.

A total of 112 recipients of haploidentical live-related donor kidney transplants were assigned randomly prior to transplantation to two groups of immunosuppressive treatment. The first group (54 patients) received the conventional immunotherapy of azathioprine (AZA) and prednisolone (P; AZA-P group). In the second group, 58 patients were given cyclosporin (Cs) and P (Cs-P group). All patients had previous third-party blood transfusions. The follow-up period ranged from 3 to 6 years (mean 50 +/- 8 months) during which 13 patients (24%) in the AZA-P group and 6 (10%) in the Cs-P group were switched to the alternate immunotherapy (p > 0.05). Analysis of patient and graft survival along the follow-up period did not disclose significant differences between patients of the two groups. While the overall frequency of acute rejection episodes was not significantly different between the two treatment groups, the number of patients who had 2 or more rejection episodes was higher in the AZA-P group (p < 0.04). The mean serum creatinine levels were significantly higher in the Cs-P group than corresponding levels in the AZA-P group at 1, 12 and 24 months after transplantation. We have concluded that at least 75% of the haploidentical human lymphocyte antigen mismatched live-related donor renal transplants can be maintained on AZA-P immunotherapy with a comparable degree of success to those treated with Cs-P. However, in at least 15% of patients with conventional immunotherapy, Cs could reverse ongoing rejections, and therefore, it can be considered as a rescue treatment in AZA-treated patients with steroid-resistant or ongoing rejections.

Adult↗
PubMed1993

Study of asymptomatic microscopic hematuria in potential living related kidney donors.

Thirty potential living related kidney donors with asymptomatic microscopic hematuria of nonsurgical causes were entered in this study. They underwent thorough history taking, medical and ENT examination, laboratory and radiologic assessment and pure-tone audiometry. Family members were also subjected to urine analysis and audiometry. Moreover, the 30 donors were subjected to kidney biopsies which were examined by light microscopy, direct and indirect immunofluorescent microscopy, and electron microscopy. Hereditary nephritis (with or without sensorineural deafness) was found to be the most common cause of asymptomatic microscopic hematuria (25/30), followed by isolated C3 deposits disease (3/30), IgA nephropathy (1/30) and IgM nephropathy (1/30). Since these disease conditions are of a progressive nature, we have concluded that relatives of uremic patients with asymptomatic microscopic hematuria should not be considered for kidney donation even if they are strongly motivated.

Adult↗
PubMed1993

Salvage of difficult transplant urinary fistulae by ileal substitution of the ureter.

We report our experience with 4 cases of ileal substitution of the ureter after live-donor kidney transplantation and review the literature. The indications were recurrent ureteric fistula and obstruction in 3 cases and extensive necrosis of the ureter and renal pelvis in one case. Nephrostomy tube drainage was a useful adjunct to diagnosis and treatment of the 4 cases. No mortalities or graft losses were encountered and satisfactory graft function was maintained 2-14 years after ileal substitution of the ureter. Moreover, no electrolyte or acid-base disturbances were observed. One patient developed recurrent vesical stones 2 and 4 years after ileoureteral replacement secondary to bladder neck obstruction. Ileal substitution of the ureter seems a feasible operation to salvage difficult and recurrent transplant urinary fistulae in exceptional situations when it is impossible to restore urinary continuity using urinary tract tissues.

Adolescent↗