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https://www.readbyqxmd.com/read/28224376/a-case-of-atypical-hemolytic-uremic-syndrome-in-a-second-renal-transplant
#1
Nicholas A Zwang, Bing Ho, Yashpal S Kanwar, Brad Lewis, Matthew Cusick, John J Friedewald, Lorenzo Gallon
Atypical hemolytic uremic syndrome (aHUS) has gained increased visibility over several years as an important cause of renal failure. Unfortunately, diagnosis is often difficult because individual courses can be highly variable depending the causative genetic mutations. Here we present the case of a patient with a failed renal allograft and acute failure of a second allograft who was ultimately diagnosed with aHUS. Interestingly, he developed early de novo donor specific antibodies (DSA) after the second renal transplant in context of likely recurrent aHUS...
February 21, 2017: Journal of Nephrology
https://www.readbyqxmd.com/read/28217390/management-of-aneurysmal-subarachnoid-hemorrhage-state-of-the-art-and-future-perspectives
#2
REVIEW
Giovanni Grasso, Concetta Alafaci, R Loch Macdonald
BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) accounts for 5% of strokes and carries a poor prognosis. It affects around 6 cases per 100,000 patient years occurring at a relatively young age. METHODS: Common risk factors are the same as for stroke, and only in a minority of the cases, genetic factors can be found. The overall mortality ranges from 32% to 67%, with 10-20% of patients with long-term dependence due to brain damage. An explosive headache is the most common reported symptom, although a wide spectrum of clinical disturbances can be the presenting symptoms...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28216350/application-of-color-coded-quantitative-digital-subtraction-angiography-in-predicting-the-outcomes-of-immediate-type-i-and-type-iii-endoleaks
#3
Min Zhou, Zijie Su, Zhenyu Shi, Weiguo Fu, Xiangdong Meng, Yonggang Wang, Baolei Guo, Kaiyi Huang
OBJECTIVE: Immediate type I and type III endoleaks after endovascular aneurysm repair (EVAR) could be persistent or temporary. Reintervention is necessary for persistent ones. Color-coded quantitative digital subtraction angiography (CQDSA) could provide a quantitative evaluation of the endoleak hemodynamics. We aimed to use CQDSA to quantify immediate type I and type III endoleaks after EVAR and to find a practical way to predict their outcomes. METHODS: Between January 2012 and December 2014, 485 consecutive patients with abdominal aortic aneurysms underwent EVAR at our institution...
February 16, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28216345/role-of-intravascular-ultrasound-imaging-during-endovascular-interventions-of-failing-hemodialysis-access-grafts
#4
John R Ross, Dion L Franga, Michael Gallichio, Ankur J Patel, Kenneth Ouriel
BACKGROUND: Arteriovenous (AV) access graft complications represent a serious complication in patients undergoing hemodialysis. Angiography is one method of visualizing them. However, angiography is not always an effective means of detecting lesions that occur in this context. Intravascular ultrasound (IVUS) is an adjunct modality used to identify stenoses responsible for failing access by identifying multiple stenoses, including those that are most severe. The purpose of this study was to define the value of IVUS in patients with failing AV access grafts by comparing digital subtraction angiography (DSA) alone with DSA followed by IVUS...
February 16, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28210801/patient-radiation-doses-and-reference-levels-in-pediatric-interventional-radiology
#5
Bouchra Habib Geryes, Adeline Bak, Julie Lachaux, Augustin Ozanne, Nathalie Boddaert, Francis Brunelle, Olivier Naggara, Guillaume Saliou
OBJECTIVES: To describe, in a multicentric paediatric population, reference levels (RLs) for three interventional radiological procedures. METHODS: From January 2012 to March 2015, children scheduled for an interventional radiological procedure in two French tertiary centres were retrospectively included and divided into four groups according to age: children younger than 2 years (A1), aged 2-7 years (A5), 8-12 years (A10) and 13-18 years (A15). Three procedures were identified: cerebral digital subtraction angiography (DSA), brain arteriovenous malformation (bAVM) embolization, and head and neck superficial vascular malformation (SVM) percutaneous sclerotherapy...
February 16, 2017: European Radiology
https://www.readbyqxmd.com/read/28210507/super-selective-mesenteric-embolization-provides-effective-control-of-lower-gi-bleeding
#6
Toan Pham, Bob Anh Tran, Kevin Ooi, Marcus Mykytowycz, Stephen McLaughlin, Matthew Croxford, Iain Skinner, Ian Faragher
Introduction. We aimed to assess the efficacy and safety of digital subtraction angiography (DSA) and super-selective mesenteric artery embolization (SMAE) in managing lower GI bleeding (LGIB). Method. A retrospective case series of patients with LGIB treated with SMAE in our health service. Patients with confirmed active LGIB, on either radionuclide scintigraphy (RS) or contrast-enhanced multidetector CT angiography (CE-MDCT), were referred for DSA +/- SMAE. Data collected included patient characteristics, screening modality, bleeding territory, embolization technique, technical and clinical success, short-term to medium-term complications, 30-day mortality, and progression to surgery related to procedural failure or complications...
2017: Radiology Research and Practice
https://www.readbyqxmd.com/read/28210263/a-paradigm-shift-on-the-question-of-b-cells-in-transplantation-recent-insights-on-regulating-the-alloresponse
#7
REVIEW
Daniel J Firl, Gilles Benichou, James I Kim, Heidi Yeh
B lymphocytes contribute to acute and chronic allograft rejection through their production of donor-specific antibodies (DSAs). In addition, B cells present allopeptides bound to self-MHC class II molecules and provide costimulation signals to T cells, which are essential to their activation and differentiation into memory T cells. On the other hand, both in laboratory rodents and patients, the concept of effector T cell regulation by B cells is gaining traction in the field of transplantation. Specifically, clinical trials using anti-CD20 monoclonal antibodies to deplete B cells and reverse DSA had a deleterious effect on rates of acute cellular rejection; a peculiar finding that calls into question a central paradigm in transplantation...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/28207638/association-of-local-intrapulmonary-production-of-antibodies-specific-to-donor-major-histocompatibility-complex-class-i-with-the-progression-of-chronic-rejection-of-lung-allografts
#8
Ei Miyamoto, Hideki Motoyama, Masaaki Sato, Akihiro Aoyama, Toshi Menju, Kei Shikuma, Terumasa Sowa, Akihiko Yoshizawa, Masao Saito, Akihiro Takahagi, Satona Tanaka, Mamoru Takahashi, Keiji Ohata, Takeshi Kondo, Kyoko Hijiya, Toyofumi F Chen-Yoshikawa, Hiroshi Date
BACKGROUND: Antibody-mediated rejection may lead to chronic lung allograft dysfunction, but antibody-mediated rejection may develop in the absence of detectable donor-specific antibody (DSA) in recipient serum. This study investigated whether humoral immune responses develop not only systemically but locally within rejected lung allografts, resulting in local production of DSA. METHODS: Lewis rats received orthotopic left lung transplantation from Lewis (syngeneic control) or Brown-Norway (major histocompatibility complex-mismatched allogeneic) donor rats...
February 15, 2017: Transplantation
https://www.readbyqxmd.com/read/28207630/clinical-trials-for-immunosuppression-in-transplantation-the-case-for-reform-and-change-in-direction
#9
Philip J O'Connell, Dirk Kuypers, Roslyn R Mannon, Michael Abecassis, Stephen Chadban, John S Gill, Barbara Murphy, Peter W Nickerson, Jesse D Schold, Peter Stock, Daniel Seron, Rita Alloway, Jonathan Bromberg, Klemens Budde, Stanley Jordan, Christophe Legendre, Carmen Lefaucheur, Minnie Sarwall, Dorry Segev, Mark D Stegall, Stefan G Tullius, Germaine Wong, E Steve Woodle, Nancy Ascher, Randall E Morris
Currently trials of immunosuppression in transplantation are in decline because their objectives remain focused on improving acute rejection rates and graft survival in the first 12 months. With 1 year renal graft survival rates of greater than 90% the best that can be hoped for is noninferiority trial outcomes compared to current standard of care. Current trial design is not leading to novel therapies improving long term outcomes and safety, and hence important unmet clinical needs in transplantation remain unanswered...
February 15, 2017: Transplantation
https://www.readbyqxmd.com/read/28207524/in-stent-stenosis-in-the-patient-with-internal-carotid-aneurysm-after-treated-by-the-willis-covered-stent-two-case-reports-and-literature-review
#10
Lun-Xin Liu, Meng-Yuan Song, Xiao-Dong Xie
: In-stent stenosis after treated by Willis covered stent-case reports. BACKGROUND: Advancements in minimally invasive technology have allowed endovascular reconstruction of internal carotid aneurysm. However, in-stent stenosis is an important and well-characterized complication of stenting after the treatment of internal carotid aneurysm. CASE DESCRIPTION: We would present 2 patients who were diagnosed with in-stent stenosis after the treatment of Willis covered stent...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28199785/assessment-of-tocilizumab-anti-il-6-receptor-monoclonal-as-a-potential-treatment-for-chronic-antibody-mediated-rejection-and-transplant-glomerulopathy-in-hla-sensitized-renal-allograft-recipients
#11
Jua Choi, Olivier Aubert, Ashley Vo, Alexandre Loupy, Mark Haas, Dechu Puliyanda, Irene Kim, Sabrina Louie, Alexis Kang, Alice Peng, Joe Kahwaji, Nancy Reinsmoen, Mieko Toyoda, Stanley C Jordan
Extending the functional integrity of renal allografts is the primary goal of transplant medicine. Development of donor-specific antibodies (DSAs) post-transplant leads to chronic active antibody-mediated rejection (cABMR) and transplant glomerulopathy (TG), resulting in the majority of graft losses in the U.S. This reduces the quality & length of life for patients and increases cost. There are no approved treatments for cABMR. Evidence suggests the pro-inflammatory cytokine interleukin 6 (IL-6) may play an important role in DSA generation and cABMR...
February 15, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28197790/surgical-treatment-of-anterior-cranial-fossa-dural-arterio-venous-fistulas-davfs-a-two-centre-experience
#12
Pietro Meneghelli, Alberto Pasqualin, Luigi Andrea Lanterna, Claudio Bernucci, Roberto Spinelli, Gianluigi Dorelli, Piergiuseppe Zampieri
BACKGROUND: Anterior cranial fossa dural arterio-venous fistulas (DAVFs) represent 6% of all intracranial DAVFs; characteristically they show an aggressive behaviour with high risk of intracranial haemorrhage. Peculiar anatomical features, such as feeding by the ethmoidal arteries and the pattern of venous drainage (frequently with varices that mimic aneurysmal dilatation), can be evaluated in detail only by digital subtraction angiography (DSA), which represents the "gold standard" in the diagnosis of such cranial fistulas...
February 14, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28197712/outflow-angle-measurement-a-simple-approach-for-the-differential-diagnosis-of-intracranial-protrusion-with-a-branch-artery-arising-from-its-top
#13
Mo Chen, Hong-Mei Song, Ming-Hua Li, Wu Wang, Yong-Dong Li
PURPOSE: Magnetic resonance angiography (MRA) is an important diagnosis method for the detection of intracranial aneurysms (IAs), but it is not useful for differentiating between IA and infundibular dilatation (ID) in patients in whom imaging shows an intracranial protrusion with a branch artery at its top. The objective of this study was to introduce a new approach-measurement of the outflow angle (OA)-for differentiating between IA and ID in such cases. METHODS: The study included 7 patients with a total of 9 protrusions...
February 14, 2017: Surgical and Radiologic Anatomy: SRA
https://www.readbyqxmd.com/read/28191005/significance-of-anti-hla-antibodies-on-adult-and-pediatric-heart-allograft-outcomes
#14
REVIEW
Massimo Mangiola, Marilyn Marrari, Brian Feingold, Adriana Zeevi
As methods for human leukocyte antigens (HLA) antibody detection have evolved and newer solid phase assays are much more sensitive, the last 15 years has seen a renewed focus on the importance of HLA antibodies in solid organ transplant rejection. However, there is still much controversy regarding the clinical significance of antibody level as depicted by the mean fluorescence intensity of a patient's neat serum. Emerging techniques, including those that identify antibody level and function, show promise for the detection of individuals at risk of allograft rejection, determination of the effectiveness of desensitization prior to transplant, and for monitoring treatment of rejection...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/28187014/delayed-donor-bone-marrow-infusion-induces-liver-transplant-tolerance
#15
Yan Xie, Yang Wu, Kang Xin, Jiao-Jing Wang, Hong Xu, Suzanne T Ildstad, Joseph Leventhal, Guang-Yu Yang, Zheng Zhang, Josh Levitsky
BACKGROUND: Nonmyeloablative conditioning followed by donor bone marrow infusion (BMI) to induce tolerance has not been robustly tested in liver transplantation (LT) and may be unsafe at the time of LT. We hypothesized T cell depleted BMI is effective in inducing tolerance when delayed after LT, resulting in potentially safer future clinical applications. METHODS: Nonimmunosuppressed syngeneic (Lewis to Lewis) and allogeneic (ACI to Lewis) rat LT transplants were initially performed as controls...
February 10, 2017: Transplantation
https://www.readbyqxmd.com/read/28183839/mr-imaging-of-individual-perfusion-reorganization-using-superselective-pseudocontinuous-arterial-spin-labeling-in-patients-with-complex-extracranial-steno-occlusive-disease
#16
V Richter, M Helle, M J P van Osch, T Lindner, A S Gersing, P Tsantilas, H-H Eckstein, C Preibisch, C Zimmer
BACKGROUND AND PURPOSE: Patients with multiple stenoses or occlusions of the extracranial arteries require an individualized diagnostic approach. We evaluated the feasibility and clinical utility of a novel MR imaging technique for regional perfusion imaging in this patient group. MATERIALS AND METHODS: Superselective pseudocontinuous arterial spin-labeling with a circular labeling spot enabling selective vessel labeling was added to routine imaging in a prospective pilot study in 50 patients (10 women, 70...
February 9, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28182088/renal-transplant-patients-biopsied-for-cause-and-tested-for-c4d-dsa-and-igg-subclasses-and-c1q-which-humoral-markers-improve-diagnosis-and-outcomes
#17
James C Cicciarelli, Nathan A Lemp, Youngil Chang, Michael Koss, Katrin Hacke, Noriyuki Kasahara, Kevin M Burns, David I Min, Robert Naraghi, Tariq Shah
The association between donor specific antibodies (DSA) and renal transplant rejection has been generally established, but there are cases when a DSA is present without rejection. We examined 73 renal transplant recipients biopsied for transplant dysfunction with DSA test results available: 23 patients diffusely positive for C4d (C4d+), 25 patients focally positive for C4d, and 25 patients negative for C4d (C4d-). We performed C1q and IgG subclass testing in our DSA+ and C4d+ patient group. Graft outcomes were determined for the C4d+ group...
2017: Journal of Immunology Research
https://www.readbyqxmd.com/read/28173620/proteasome-inhibitor-carfilzomib-based-therapy-for-antibody-mediated-rejection-of-the-pulmonary-allograft-use-and-short-term-findings
#18
Christopher R Ensor, Samuel A Yousem, Marilyn Marrari, Matthew R Morrell, Massimo Mangiola, Joseph M Pilewski, Jonathan D'Cunha, Stephen R Wisniewski, Raman Venkataramanan, Adriana Zeevi, John F McDyer
We present this observational study of lung transplant recipients (LTR) treated with Carfilzomib (CFZ)-based therapy for antibody-mediated rejection (AMR) of the lung. Patients were considered responders to CFZ if C1q-fixing ability of their immunodominant (ID) DSA was suppressed after treatment. Treatment consisted of CFZ plus plasma exchange and immunoglobulins. Fourteen LTRs underwent CFZ for 20 ID DSA AMR. Ten (71.4%) of LTRs responded to CFZ. DSA IgG MFI fell from 7664 (IQR 3230-11874) to 1878 (653-7791) after therapy (p=0...
February 7, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28166393/donor-specific-antibodies-c1q-binding-improvement-in-kidney-graft-management
#19
Sylvie Ferrari-Lacraz
The diagnosis of acute antibody mediated rejection (ABMR) after kidney transplantation is based on three parameters: 1) decreased renal function, 2) histopathological signs of rejection, 3) presence of Donor Specific Antibody (DSA) [1]. Patient survival, as well as graft survival have improved since 5 to 10 years [2], thanks to several factors, including better management of patients, better immunosuppressive regimens, detection and avoidance of DSA. Although anti-HLA antibodies follow-up have improved ABMR management, its treatment remains challenging, and outcome may be worsened because of a delay in the diagnosis...
February 6, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/28163172/endovascular-management-of-para-prosthetic-aortocaval-fistula-case-report-and-systematic-review-of-the-literature
#20
Claudio Bianchini Massoni, Giulia Rossi, Tiziano Tecchio, Paolo Perini, Antonio Freyrie
The aim of this article is to report a case of asymptomatic para-anastomotic aortocaval fistula (ACF) treated by endovascular aortic repair, and to review data of the literature on arteriovenous fistulae (AVF) secondary to abdominal aortic surgery. A 78-year-old male complained of worsening pain in the right lower limb since 2 months. He presented a history of right femoro-popliteal bypass for peripheral arterial occlusive disease and elective surgical treatment for a non-ruptured infrarenal aortic aneurysm (Dacron tube graft)...
February 2, 2017: Annals of Vascular Surgery
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