Biomedical subjects

Yacine Hammoudi

Publications and source records attributed to Yacine Hammoudi.

6 recordsLinked to original sources

PubMed2006

Consequences of iliac arterial atheroma on renal transplantation.

PURPOSE: Because recipient age has significantly increased in the last 15 years, surgeons must sometimes deal with atherosclerotic lesions of the iliac arterial system. Arterial restoration during renal transplantation should now be less frequent due to better preoperative screening and the prevention of arteriosclerosis in patients on renal transplantation waiting lists but in some patients EIA atheroma may require an additional surgical vascular procedure during renal transplantation. We describe the role of iliac artery atherosclerosis and the technical aspects of arterial restoration performed in patients who have undergone renal transplantation since 1985. MATERIALS AND METHODS: In a series of 1,110 cadaveric renal transplantations performed between 1985 and 2000, 38 patients required endarterectomy during renal transplantation and 69 were considered not to require any special procedure. RESULTS: In the 38 patients requiring endarterectomy a total of 12 end-to-end arterial anastomoses were performed and 6 ASs (50%) were observed, while 26 side-to-end arterial anastomoses were performed with only 1 AS (4%). Patient and graft survival curves showed a significant negative correlation with the severity of atherosclerosis. CONCLUSIONS: Preoperative assessment of the EIA is mandatory before renal transplantation. Renal transplantation can be performed in patients with an atheromatous EIA if the artery can be clamped for endarterectomy. In our experience side-to-end anastomosis using a donor patch onto the EIA provides better results by avoiding AS after endarterectomy. However, despite vascular repair graft survival is significantly lower in patients with atheromatous lesions requiring endarterectomy.

Adult↗

PubMed2004

'Burned-out' primary testicular cancer.

OBJECTIVE: To report the natural history of 'burned-out' testicular tumour (a testicular tumour that has regressed spontaneously with no treatment and that generally presents at the stage of metastases). PATIENTS AND METHODS: We report five cases of burned-out testicular tumours to illustrate the clinical, radiological and histopathological features, and discuss the hypothesis of natural history of these neoplasms. RESULTS: The findings in the five patients tended to indicate that metastatic progression appears to induce spontaneous regression of the previous tumour site. Patients explored for extragonadal germ cell tumour present with various clinical features depending on the site of the metastases. CONCLUSION: Despite the controversial hypotheses of the origin of these tumours, extragonadal germ cell tumours should be considered to be metastases of a 'burned-out' primary testicular tumour that must be investigated. When a primary testicular tumour is detected, the testis must be removed, and standard chemotherapy yields good long-term results. The hypothesis of an immunological reaction against the tumour inducing the spontaneous necrosis of the primary tumour and possibly the metastases should be considered. Immunological screening should be proposed in patients to investigate this interesting model of spontaneous tumour regression.

Adolescent↗

PubMed2004

[Scrotal angiofibroblastoma].

Angiomyofibroblastoma of the scrotum is a rare and benign tumour which affect old patient. It's treatment is surgical. A case of angiomyofibroblastoma of the scrotum is reported in a 34 years old man. The literature is reviewed with special reference to the ethiopathogenesis, clinical features and treatment of this tumour entity.

Adult↗

PubMed2003

Long-term results of renal transplantation using kidneys harvested from non-heartbeating donors: a 15-year experience.

PURPOSE: To expand the pool of suitable organ donors we developed an organ procurement program of non-heartbeating donors during the last 15 years. We compare graft survival in patients receiving renal transplants procured from non-heartbeating with recipients of kidneys from heartbeating donors. MATERIALS AND METHODS: From 1986 to 1999, 60 renal transplantations were performed with kidneys harvested from non-heartbeating donors (Mastrich category IV). Kidneys were procured using a double balloon triple lumen catheter inserted into the femoral artery. The 60 kidneys were selected from 70 non-heartbeating donors based on age younger than 50 years, warm ischemia less than 30 minutes, creatinine less than 200 micromol./l., and no hypertension or major histological lesions. Long-term results of graft survival and complications were compared with a series of 1,065 renal transplantations performed during the same period with kidneys procured from heartbeating donors. RESULTS: Mean age of the recipients was statistically different as non-heartbeating donors were older. However, the 10-year graft survival rates were similar in both groups (50% versus 53%). Incidence of ureteral stenosis and fistula, arterial stenosis and thrombosis was not statistically different in both groups. On the other hand, delay graft function was more frequent in non-heartbeating donors (60% versus 40%, p = 0.01). CONCLUSIONS: Despite a high rate of acute tubular necrosis, kidneys harvested from non-heartbeating donors had the same graft survival rates as those procured from heartbeating donors. Surgical complications were not different. Transplantation of selected kidneys procured from non-heartbeating donors should be promoted as a response to organ shortage.

Adult↗

PubMed2003

Urodynamic testing predicts long-term urological complications following simultaneous pancreas-kidney transplantation.

INTRODUCTION: Combined pancreas-kidney transplantation is the treatment of choice for patients with type I diabetes mellitus associated with chronic renal failure. The introduction of the bladder drainage technique constituted a marked improvement of the surgical technique with a reduction of life-threatening complications. However, drainage of pancreatic secretions via the urinary bladder causes urological complications leading, in some cases, to cystoenteric conversion. We retrospectively analysed whether pre-operative urodynamic findings may predict the subsequent development of urological complications and influence the choice of exocrine secretion drainage. PATIENTS AND METHODS: From 1987 to 1997, 39 bladder-drained simultaneous pancreas-kidney transplantations were performed in 16 men and 23 women with a mean age of 38.5 yr. All patients underwent a complete urological assessment prior to surgery, including medical history, physical examination, urethrocystography and urodynamic assessment. RESULTS: Twenty-eight patients are alive with a mean follow-up of 62 +/- 8 months. In 60% of cases, both kidney and pancreas remain functional. Seven patients experienced recurrent lower urinary tract infections. Six patients suffered from chemical urethritis (four men and two women) and six suffered from recurrent haematuria (blood transfusions were required in two patients). One patient had incrusted stones at the site of duodenal staples. Urological complications were mostly observed in the 22 patients (79%) with abnormal urodynamic characteristics (Relative risk: 5.1). Intravenous Somatostatin failed to definitively cure these complications in most cases. Seven patients (17%) (five with urethritis, two with haematuria) required cystoenteric conversion. Two patients developed post-operative ileal fistula, one cutaneous and one into the bladder. All urinary symptoms resolved in these seven patients. CONCLUSION: The frequency of specific urinary complications is high (28%) in bladder-drained simultaneous pancreas-kidney transplantation patients. These complications are statistically more frequent in the case of an abnormal pre-transplant urodynamic assessment.

Adult↗

PubMed2003

[Prospective study of harvest-to-transplant time: proposed organization].

INTRODUCTION: The cold ischaemia time of a kidney before transplantation has a negative impact on the risk of acute tubular necrosis and graft survival. This cold ischaemia time can be reduced by a different organization of harvesting, organ distribution and transplantation. MATERIAL AND METHODS: Seventy nine organ donor case files from the same hospital were reviewed from reception of the donor until transplantation. 135 renal transplantations, including 60 kidneys and 14 kidney-pancreas transplants were performed on site with organs harvested from these donors. The various phases of harvesting were studied: reception and resuscitation of the patient took 30 hours, and the diagnosis of brain death, information of the families and transfer of the donor to the operating room for harvesting took 11 hours. RESULTS: The mean cold ischaemia time was 6 hours when kidney-pancreas transplantation was performed and 22 hours 30 minutes for isolated local renal transplantation. The decisive factor is the time required to obtain HLA typing, which is only performed during organ harvesting for isolated renal transplantation. HLA typing and lymph node sampling in the intensive care unit would save 7 hours. CONCLUSION: The authors recommend that HLA typing and lymph node sampling for cross matches be performed in the intensive care unit in order to reduce the cold ischaemia time.

Adult↗