Laparoscopic versus open donor nephrectomy.
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Humans↗
Biomedical subjects
Mirza M Idu
Publications and source records attributed to Mirza M Idu.
Systematic review of preservation methods and clinical outcome of infrainguinal vascular allografts.
OBJECTIVE: We systematically reviewed clinical studies on the use of venous and arterial allografts for infrainguinal revascularization. We attempted to find evidence for the best infrainguinal vascular allograft by a systematic review of the available literature. METHODS: An electronic search of the MEDLINE, EMBASE, and Cochrane databases was used to determine key articles from studies on the different types of vascular allografts used in infrainguinal reconstruction from 1966 to 2004. Articles were independently reviewed by using previously defined inclusion and exclusion criteria. Study results were gathered with cumulative primary patency as the primary end point. Secondary end points were major complications, graft disintegration, and major limb loss. Quantitative analysis was performed on the prospective randomized trials, and linear regression analysis was performed on cumulative primary patency. Fontaine's classification system was applied. RESULTS: No systematic review of randomized controlled trials was found. Five randomized controlled trials, 3 prospective cohort or case series, and 15 retrospective case series with 3,837 vascular allografts were found. Methods of allograft preservation were cryopreservation (5 studies), cold storage (3 studies), and glutaraldehyde preservation of human umbilical veins (15 studies). One-year cumulative primary patency rates were 13% to 79% for cryopreservation, 63% to 80% for cold storage, and 40% to 91% for glutaraldehyde. The weighted mean 1-year cumulative primary graft patency rate was 41% for cryopreservation, 71% for cold storage, and 70% for glutaraldehyde allografts. Four randomized trials on femoropopliteal bypasses demonstrated higher patency rates of glutaraldehyde-preserved human umbilical veins than polytetrafluoroethylene grafts. Statistical heterogeneity between studies (I(2) = 91.4%) was too high to perform a formal meta-analysis. The rate of major limb loss was 20% to 58% for cryopreservation, 10% to 69% for cold storage, and 0% to 65% for glutaraldehyde, and the percentage of graft disintegration was 2% to 6% for cryopreservation, 4% to 15% for cold storage, and 0% to 11% for glutaraldehyde. CONCLUSIONS: A firm conclusion could not be made because there were no studies available in which direct comparison was performed between different preservation methods of vascular allografts. In addition, heterogeneity of the individual studies hampered direct comparison of different types of vascular allografts. However, the overall graft performance of glutaraldehyde-preserved human umbilical vein allografts may be superior to that of other vascular allografts.
Arterial Occlusive Diseases↗
Is a selective splinted ureterocystostomy protocol feasible in renal transplantation? An analysis of 475 renal transplantations.
Routine splinting of the ureterocystostomy during renal transplantation lowers the urological complication rate but increases patient's morbidity. The number needed to treat to prevent one urological complication is high. The aim of this study was to identify risk factors, which can be used in the implementation of a selective splinting ureterocystostomy protocol. Retrospective analysis of 475 consecutive renal transplantations performed between January 1999 and December 2004. Donor, surgical-technical and recipient factors were assessed. Urological complications occurred in 62 (13%) patients. In 29 of these 62 patients (6.1%), only a temporary percutaneous nephrostomy catheter was necessary and in 33 (6.9%) surgical revision was required. Episodes of acute rejection and delayed graft function were identified as the only independent risk factors for a urological complication: odds ratio 2.62 [95% confidence interval: (CI) 1.38-4.97] and 2.22 (95% CI: 1.14-4.33), respectively. None of the risk factors for urological complications after renal transplantation that are known at the time of performing the ureterocystostomy are useful for the implementation of a selective splinting protocol.
Adolescent↗
Epstein Barr virus specific T-cells generated from unstable human atherosclerotic lesions: Implications for plaque inflammation.
OBJECTIVE: T-cell activation is an essential feature of atherosclerotic plaque inflammation, which eventually may lead to plaque rupture. In this study, we investigated if EBV, a common herpes virus, is capable of stimulating atherosclerotic plaque derived T-cells and thus could contribute to atherosclerotic plaque inflammation. METHODS: Plaque derived T-cell cultures were established from symptomatic carotid atherosclerotic plaques of 19 patients. B-cells from the same patients were transformed with EBV to form lymphoblastoid cell lines (B-LCL) that served as antigen presenting cells. The proliferation of T-cells in the presence of autologous B-LCL was analyzed using 3H-thymidine incorporation. The presence of EBV in atherosclerotic material was analyzed by PCR. RESULTS: Of the 19 cell obtained T-cell cultures, 11 responded to EBV (58%, mean stimulation index: 10.1+/-3.1). PCR analysis showed that EBV DNA was present in 15 of the tissue samples (79%). All the specimens that contained EBV responding T-cells also contained EBV. EBV specific T-cells secreted granzymes, as indication of functional cytotoxic potential. CONCLUSIONS: EBV-specific cytotoxic T-cells and EBV DNA can be frequently observed in human atherosclerotic plaques. This suggests that a T-cell response against EBV could contribute to plaque inflammation, and thus to the onset of acute clinical symptoms.
Atherosclerosis↗
Collapse of a stent-graft following treatment of a traumatic thoracic aortic rupture.
PURPOSE: To report a collapsed stent-graft used to treat a traumatic aortic rupture. CASE REPORT: A Gore TAG stent-graft was placed in a 20-year-old man with multiple injuries. Postimplantation computed tomographic angiography (CTA) demonstrated no contrast extravasation and total exclusion of the traumatic rupture. Routine CTA 3 months after implantation revealed a collapsed stent-graft located in the outer curve of the distal aortic arch. A Talent stent-graft was placed successfully within the collapsed prosthesis. Postimplantation CTA demonstrated no contrast extravasation and good apposition of the endograft to the aortic wall. At 6 months, the repair remains secure; there is no sign of graft collapse or endoleak. CONCLUSIONS: Collapse of stent-grafts can occur after treatment for traumatic aortic ruptures; endovascular methods can be used to restore a satisfactory luminal contour.
Accidents, Traffic↗
The fate of unrevised stenoses in infrainguinal autologous vein grafts as detected by intraoperative duplex scanning.
Intraoperative infrainguinal autologous vein graft stenoses are common, and some authors advise revision of these stenoses. But the natural history of these lesions is not clear. This study was undertaken to determine the natural history of duplex-detected intraoperative stenoses with a nonrevision policy. Intraoperative duplex scanning was performed in 46 infrainguinal autologous vein bypasses. The surgeon was blinded for the results of the intraoperative duplex scan and no intraoperative graft revision or modification of the routine postoperative protocol was performed after the duplex scan. Intraoperative duplex parameters and patient and bypass characteristics were correlated with the occurrence of an early graft event (occlusion or revision of a patent graft within 6 weeks postoperatively), which was the study's primary endpoint. Early graft event rate was 37% (17/46). PSV ratio and PSV-max were the only parameters with a significant correlation with the occurrence of an early graft event. An intraoperatively measured PSV ratio of > or =3.0 was the best predictor of an early graft failure with a sensitivity of 71% (95% CI: 50-83%) and a specificity of 90% (95% CI: 78-97%). In 12 of the 15 (80%) grafts matching this criterion an early graft event occurred, while only 5 (16%) early graft events occurred in the remaining 31 grafts (ie, a negative predictive value of 84%). When a PSV ratio of > or =3.0 was used as a cutoff value to predict early postoperative graft events, the likelihood ratios for a positive and negative test result were respectively 6.82 (95% CI: 2.23-20.8) and 0.33 (95% CI: 0.16-0.69). Unrevised intraoperative duplex-detected stenoses in infrainguinal autologous vein graft stenoses are a serious threat to early graft patency. The presence of an intraoperatively detected graft stenosis with a PSV ratio > or =3.0 is a strong predictor of early graft failure.
Constriction, Pathologic↗