Biomedical subjects

Naeem Haider

Publications and source records attributed to Naeem Haider.

3 recordsLinked to original sources

PubMed2004

Cold ischemia and the reduced long-term survival of cadaveric renal allografts.

BACKGROUND: Prolonged cold ischemia time (CIT) is accompanied by delayed cadaveric renal allograft function and early allograft loss, but the effect of CIT on long-term allograft survival is less certain and has not been studied in detail. METHODS: Using data from the United Network for Organ Sharing, we identified 6465 patients who received a kidney-only transplant of cadaveric origin for the first time in 1995. We examined the effect of CIT on the 6-year survival of these kidneys using Cox proportional hazard analysis. RESULTS: The mean CIT of the kidney was 21 +/- 7 hours (mean +/- SD) and correlated with the serum creatinine on discharge (R= 0.20, P < 0.001) and the distance traveled by the kidneys (R= 0.30, P < 0.001). CIT had a significant effect on the 6-year allograft survival (a 10-hour increase in CIT was associated with a hazard risk ratio (RR) of 1.20 for graft failure (P < 0.001) that persisted (RR = 1.40, P= 0.021) after adjusting for donor age, recipient age and race, human leukocyte antigen (HLA) mismatch, panel reactive antibodies, and first 6 months' rejection treatments. Similarly, compared to CIT category of 0 to 10 hours, the 6-year graft survival was progressively worse for 11 to 20 hours (RR = 1.03), 21 to 30 hours (RR = 1.12), and, significantly so, for >30 hours (RR = 1.32; P= 0.011). The gain in HLA match with increasing CIT was not uniform; for instance, HLA match in >30 hours was lower than for 21 to 30 hours (2.4 +/- 1.5 vs. 2.7 +/- 1.6; P < 0.001). CONCLUSION: (1) Cadaveric kidneys continue to undergo prolonged periods of cold ischemia; (2) prolonged cold storage is associated with longer distance traveled by the kidneys, but is not associated with any significant gain in tissue matching; and (3) prolonged cold ischemia is a significant predictor of long-term graft loss. Reducing prolonged cold ischemia by regional distribution of organs and less stringent tissue matching may reduce the persistent high rate of long-term loss of cadaveric renal allografts.

Adult↗

PubMed2003

An indication for continuous cervical paravertebral block (posterior approach to the interscalene space).

We present a patient who required perioperative analgesia with continuous nerve block for shoulder disarticulation, for whom the only approach possible to the brachial plexus was from posterior. A 51-yr-old woman was suffering from intractable upper extremity pain and dysfunction as a result of severe lymphedema after metastatic spread of breast cancer to the axilla. Her pain was poorly controlled despite aggressive treatment with oral, systemic, and intrathecal opiates. She presented for amputation of her arm as a last resort for management of pain. In order to provide optimal postoperative analgesia, continuous peripheral nerve block was selected in consultation with the patient, and due to anatomic disfigurement and tumor invasion, a continuous cervical paravertebral block was placed preoperatively and shoulder disarticulation was performed using a combined regional/general anesthesia technique. The patient had an uneventful recovery without pain for the 6 postoperative days that the catheter was in place and 0.25% bupivacaine was infused at 5 mL/h. Because of anatomic considerations, which precluded the use of all other approaches to the brachial plexus, the posterior cervical paravertebral approach provided an effective means of pain control in this difficult clinical situation.

Anesthesia, General↗

PubMedDate not supplied

Epidural spread after continuous cervical paravertebral block: a case report.

BACKGROUND AND OBJECTIVE: This report illustrates epidural spread after continuous cervical paravertebral block (CCPVB). By fluoroscopy, it also explains the mechanism of the complication. CASE REPORT: A healthy 22-year-old male developed bilateral upper-extremity motor weakness immediately after placement of a continuous cervical paravertebral block for postoperative pain control after shoulder stabilization surgery. The tip of the stimulating catheter was demonstrated in the C7 neuroforamen. Contrast injected through the catheter demonstrated epidural spread. The contralateral block resolved after 4 hours and the patient suffered no respiratory embarrassment or other untoward sequelae. CONCLUSION: Continuous cervical paravertebral block is a relatively new, but generally well-accepted, modality for postoperative pain control after major surgery to the upper limb. Epidural spread is recognized as a complication. In this particular case, medial placement of the catheter was possibly caused by unintentional medial direction of the bevel of the Tuohy needle. Meticulous attention to the direction of the needle bevel and early recognition and management of adverse events are mandatory. The same principles may apply for continuous thoracic, lumbar, and sacral paravertebral blocks.

Adult↗