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Perioperative renal protection

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https://www.readbyqxmd.com/read/28718983/multimodality-image-guided-cryoablation-for-inoperable-tumor-induced-osteomalacia
#1
Sri Harsha Tella, Hayet Amalou, Bradford J Wood, Richard Chang, Clara C Chen, Cemre Robinson, Michelle Millwood, Guthrie Lori, Sheng Xu, Elliot Levy, Venkatesh Krishnasamy, Rachel I Gafni, Michael T Collins
Tumor-induced osteomalacia (TIO) is a debilitating paraneoplastic condition caused by small phosphaturic mesenchymal tumors (PMTs) that secrete large amounts of the phosphate- and vitamin D-regulating hormone, FGF23. Tumor removal results in cure. However, due to high perioperative comorbidity, either from tumor location or host factors, surgery is sometimes not an option. Tumor destruction via cryoablation may be an effective option for inoperable PMTs. Three subjects with a confirmed diagnosis of TIO were studied...
July 18, 2017: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
https://www.readbyqxmd.com/read/28711369/predicting-failure-to-rescue-after-abdominal-aortic-aneurysm-repair-in-elderly-patients
#2
Caitlin W Hicks, Anna O'Kelly, Tammam Obeid, Satinderjit Locham, Mahmoud B Malas
BACKGROUND: We aim to describe trends in failure to rescue (FTR) among elderly patients undergoing elective open aortic aneurysm repair (OAR) and endovascular aortic aneurysm repair (EVAR). MATERIALS AND METHODS: All patients aged ≥80 y recorded in the Vascular Quality Initiative database (2002-2014) undergoing nonruptured infrarenal AAA repair were included. Primary outcome was FTR, defined as percentage of deaths in patients who had a complication within 30 d of surgery...
July 12, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28710786/comparison-of-perioperative-and-functional-outcomes-of-robotic-partial-nephrectomy-for-ct1a-versus-ct1b-renal-masses
#3
Christopher R Reynolds, Joan C Delto, David Paulucci, Corey Weinstein, Ketan Badani, Daniel Eun, Ronney Abaza, James Porter, Akshay Bhandari, Ashok Hemal
OBJECTIVES: To compare perioperative and functional outcomes of patients with cT1a or cT1b renal masses undergoing robotic partial nephrectomy in a large multi-institutional study. PATIENTS AND METHODS: The present retrospective IRB approved multi-institutional study utilized a prospectively maintained database to identify patients undergoing robotic partial nephrectomy by 6 surgeons for a solitary cT1a (n=1307) or cT1b (n=377) renal mass from 2006 to 2016. Perioperative and renal function outcomes at discharge and median follow-up of 12...
July 15, 2017: BJU International
https://www.readbyqxmd.com/read/28709662/neonatal-aortic-arch-reconstruction-with-direct-splanchnic-perfusion-avoids-deep-hypothermia
#4
Muhammad Aanish Raees, Clinton D Morgan, Venessa L Pinto, Ashly C Westrick, Chevis N Shannon, Karla G Christian, Bret A Mettler, David P Bichell
BACKGROUND: Neonatal aortic arch reconstruction, typically performed with deep hypothermia and selective cerebral perfusion, leaves splanchnic organ protection dependent on hypothermia alone. A simplified method of direct in-field descending aortic perfusion during neonatal arch reconstruction permits the avoidance of deep hypothermia. We hypothesize that direct splanchnic perfusion at mild hypothermia provides improved or equivalent safety compared with deep hypothermia and may contribute to postoperative extracardiac organ recovery...
July 11, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28708967/investigation-of-the-effect-of-milrinone-on-renal-damage-in-an-experimental-non-heart-beating-donor-model
#5
Erdal Uysal, Mehmet Dokur, Serdar Altınay, Eyup İlker Saygılı, Kadir Batcıoglu, Mehmet S Ceylan, Hatem Kazımoglu, Burcin A Uyumlu, Mehmet Karadag
PURPOSE: In our study, it was aimed to investigate the preventive effect of milrinone on renal damage in experimental controlled non-heart-beating donors (NHBDs) model. MATERIALS AND METHODS: Sixteen rats randomly divided into 2 groups, 8 rats in each were used. Group 1 was control, group 2 was milrinone group. Group 1 rats received 1.25 ml 0.09% NaCl intraperitoneally equivalent to the milrinone diluted volume. Group 2 rats were administered intraperitoneally with 0...
July 14, 2017: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
https://www.readbyqxmd.com/read/28700489/the-effect-of-intraoperative-dexmedetomidine-on-acute-kidney-injury-after-pediatric-congenital-heart-surgery-a-prospective-randomized-trial
#6
Youn Yi Jo, Ji Young Kim, Ji Yeon Lee, Chang Hu Choi, Young Jin Chang, Hyun Jeong Kwak
BACKGROUND: Dexmedetomidine has been reported to have a renal protective effect after adult open heart surgery. The authors hypothesized that intraoperative infusion of dexmedetomidine would attenuate the decrease in renal function after pediatric open heart surgery. METHODS: Twenty-nine pediatric patients (1-6 years) scheduled for atrial or ventricular septal defect repair were randomly assigned to receive either continuous infusion of normal saline (control group, n = 14) or dexmedetomidine (a bolus dose of 0...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28620307/peri-and-postoperative-treatment-with-the-interleukin-1-receptor-antagonist-anakinra-is-safe-in-patients-undergoing-renal-transplantation-case-series-and-review-of-the-literature
#7
Catharina M Mulders-Manders, Marije C Baas, Femke M Molenaar, Anna Simon
In patients undergoing solid organ transplantation, the presence of an interleukin-1 (IL-1) driven disease may require the addition of IL-1 inhibiting drugs to the standard immunosuppressive regimen to protect against inflammation and negative graft outcome. Three patients undergoing renal transplantation were treated perioperatively with the interleukin-1 receptor antagonist anakinra. Kidney function increased rapidly in all three and the only complications seen were minor infections. In vitro studies report associations between serum and urinary levels of IL-1β and IL-1 receptor antagonist and negative graft outcome, and studies in animals and two small human trials illustrate a possible protective effect of anti-IL-1 therapy after solid organ transplantation...
2017: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/28556989/weight-based-dosing-of-alemtuzumab-an-ounce-of-prevention
#8
Joshua J Augustine
Alemtuzumab is a lymphocyte-depleting humanized monoclonal antibody that targets CD52 and binds to T and B lymphocytes, macrophages, monocytes and natural killer cells.(1) It was approved decades ago for the treatment of B-cell chronic lymphocytic leukemia (CLL), and the use of alemtuzumab in kidney transplantation was first described in the late 1990s as a drug that could promote tolerance and allow for maintenance drug minimization.(2) Although there has been variability in dosing in renal transplantation(3-5) , alemtuzumab is typically administered at a dosage of 30 mg intravenously once or twice in the perioperative transplant period, which is a fraction the cumulative dosage used for CLL...
May 30, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/28556519/lessons-learned-early-termination-of-a-randomized-trial-of-calcineurin-inhibitor-and-corticosteroid-avoidance-using-belatacept
#9
Kenneth A Newell, Aneesh K Mehta, Christian P Larsen, Peter G Stock, A Bradley Farris, Shikha G Mehta, David Ikle, Brian Armstrong, Yvonne Morrison, Nancy Bridges, Mark Robien, Roslyn B Mannon
The intent of this NIH-sponsored study was to compare a belatacept-based immunosuppressive regimen with a maintenance regimen of tacrolimus and mycophenolate (MMF). Nineteen primary, EBV-immune renal transplant recipients with a negative cross-match were randomized to one of three groups. All patient groups received perioperative steroids and maintenance MMF. Patients in groups 1 and 2 were induced with alemtuzumab and maintained on tacrolimus or belatacept, respectively. Patients in group 3 were induced with basiliximab, received 3 months of tacrolimus, and maintained on belatacept...
May 28, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28530620/-laparoscopic-ureteral-reimplantation
#10
Iván González Rodríguez, Rodrigo Gil Ugarteburu, Sergio Fernández-Pello Montes, Begoña Díaz Méndez, Rebeca Blanco Fernández, Javier Mosquera Madera
Although the laparoscopic ureteral reimplantation (LUR) has a history of over 20 years, its presence in the literature is relatively sparse, almost always in the form of small case series with low statistical power, which has prevented consistent results. It has proven to be a safe and effective technique, improving the safety profile and perioperative complications compared to open ureteral reimplantation (OUR). The few long-term results suggest a similar success rate between the open and laparoscopic approaches...
May 2017: Archivos Españoles de Urología
https://www.readbyqxmd.com/read/28464554/does-training-of-fellows-affect-peri-operative-outcomes-of-robot-assisted-partial-nephrectomy
#11
Zine-Eddine Khene, Benoit Peyronnet, Elise Bosquet, Benjamin Pradère, Corentin Robert, Tarek Fardoun, Solène-Florence Kammerer-Jacquet, Grégory Verhoest, Nathalie Rioux-Leclercq, Romain Mathieu, Karim Bensalah
OBJECTIVE: To evaluate the impact of fellows' involvement on the peri-operative outcomes of robot-assisted partial nephrectomy (RAPN). MATERIALS AND METHODS: We analysed 216 patients who underwent RAPN for a small renal tumour. We stratified our cohort into two groups according to the involvement of a fellow surgeon during the procedure: expert surgeon operating alone (expert group) and fellow operating under the supervision of the expert surgeon (fellow group)...
May 2, 2017: BJU International
https://www.readbyqxmd.com/read/28437021/optimal-outcome-achievement-in-partial-nephrectomy-for-t1-renal-masses-a-contemporary-analysis-of-open-and-robotic-cases
#12
Matthew J Maurice, Daniel Ramirez, Önder Kara, Ercan Malkoç, Ryan J Nelson, Khaled Fareed, Robert J Stein, Amr F Fergany, Jihad H Kaouk
OBJECTIVES: To compare optimal outcome achievement between open and robotic partial nephrectomy. PATIENTS AND METHODS: Using our institutional partial nephrectomy database, we reviewed 605 cases performed for unifocal clinical T1 renal masses in non-solitary kidneys from 2011-2015. Tetrafecta, which was defined as negative surgical margins, freedom from perioperative complications, ≥80% renal functional preservation, and no chronic kidney disease upstaging, was chosen as the composite optimal outcome...
April 24, 2017: BJU International
https://www.readbyqxmd.com/read/28342285/development-of-a-human-cadaver-model-for-training-in-laparoscopic-donor-nephrectomy
#13
Erica R H Sutton, Adrian Billeter, Devin Druen, Henry Roberts, Jonathan Rice
BACKGROUND: The organ procurement network recommends a surgeon record 15 cases as surgeon or assistant for laparoscopic donor nephrectomies (LDN) prior to independent practice. The literature suggests that the learning curve for improved perioperative and patient outcomes is closer to 35 cases. In this article, we describe our development of a model utilizing fresh tissue and objective, quantifiable endpoints to document surgical progress, and efficiency in each of the major steps involved in LDN...
March 25, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28340819/influence-of-proton-pump-inhibitors-on-mycophenolic-acid-pharmacokinetics-in-patients-with-renal-transplantation-and-the-relationship-with-cytochrome-2c19-gene-polymorphism
#14
H S Ciftci, M S Karadeniz, T Tefik, Y Caliskan, H Yazıcı, E Demir, A Turkmen, I Nane, F S Oguz, F Aydin
BACKGROUND: Most patients have serious digestive complications after renal transplantation. Therefore, it is important to protect gastrointestinal function to improve the survival rate of transplant patients. Proton pump inhibitors (PPIs) such as lansoprazole and rabeprazole are widely administered to renal transplant patients with mycophenolic acid (MPA) in the perioperative period. PPIs are metabolized by cytochrome (CYP) 2C19 enzymes. Mycophenolate sodium (MYF) and mycophenolate mofetil (MMF) have been used in immunosuppression...
April 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28331287/does-remifentanil-attenuate-renal-ischemia-reperfusion-injury-better-than-dexmedetomidine-in-rat-kidney
#15
E Erkılıç, E Kesimci, F Alaybeyoğlu, I Kılınç, R Tural, A Yazgan, T Gümüş, A Sepici Dinçel, E G Dumlu, O Kanbak
BACKGROUND: Ischemia-reperfusion (I/R) injury is a common cause of patient morbidity and mortality in the perioperative period. Patients undergoing long-lasting, abdominal, and urogenital surgeries with risk factors such as advanced age, peripheral artery disease, diabetes mellitus, renovascular disease, and congestive heart failure are candidates for acute kidney injury (AKI) due to impaired renal perfusion and decreased functional renal reserve. Pharmacological agents with multiple functions and anti-oxidative and anti-inflammation properties may be promising preventative strategies for AKI...
2017: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/28274751/predictors-of-early-aortic-neck-dilatation-after-endovascular-aneurysm-repair-with-endoanchors
#16
MULTICENTER STUDY
Apostolos K Tassiopoulos, Spyridon Monastiriotis, William D Jordan, Bart E Muhs, Kenneth Ouriel, Jean Paul De Vries
OBJECTIVE: Dilatation of the aorta within the proximal neck after endovascular aneurysm repair (EVAR) can be associated with late endoleaks and migration. This study was designed to identify predictors of early neck dilation in patients undergoing EVAR with Heli-FX EndoAnchors (Medtronic, Santa Rosa, Calif) measured perioperatively to 1 year at different longitudinal levels of neck length. METHODS: The study group of Aneurysm Treatment Using the Heli-FX Aortic Securement System (ANCHOR) comprises 257 consecutive patients prospectively enrolled between April 2012 and September 2014 undergoing EVAR with Heli-FX EndoAnchor implantation at 38 investigational sites...
July 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28240954/effect-of-cold-storage-on-immediate-graft-function-in-an-experimental-model-of-renal-transplantation-in-cats
#17
Rebecca A Csomos, Robert J Hardie, Chad W Schmiedt, Fern A Delaney, Jonathan F McAnulty
OBJECTIVE To assess the effect of cold storage (CS) on immediate posttransplantation function of renal autografts in cats. ANIMALS 15 healthy 1-year-old cats. PROCEDURES Cats were assigned to 2 groups and underwent autotransplantation of the left kidney followed by nephrectomy of the right kidney. The left kidney was autotransplanted either immediately (IT group; n = 6) or after being flushed with a cold sucrose phosphate solution and stored on ice while the implant site was prepared (CS group; 9). Serum creatinine and BUN concentrations were monitored daily and autografts were ultrasonographically examined intermittently for 14 days after surgery...
March 2017: American Journal of Veterinary Research
https://www.readbyqxmd.com/read/28224201/dexmedetomidine-protects-against-cisplatin-induced-acute-kidney-injury-in-mice-through-regulating-apoptosis-and-inflammation
#18
H Liang, H-Z Liu, H-B Wang, J-Y Zhong, C-X Yang, B Zhang
OBJECTIVE AND DESIGN: Cisplatin-based chemotherapy has been widely used in the perioperative period of cancer surgery, which exacerbates the risk of renal injury. In this study, we examined whether dexmedetomidine (DEX), a commonly used anesthetic adjuvant, shows a protective effect against cisplatin-induced acute kidney injury. MATERIALS: Acute kidney injury in mice was induced by cisplatin. TREATMENTS: Mice were administered with DEX 25 μg/kg or atipamezole 250 μg/kg (once a day, for 3 days) after cisplatin treatment...
May 2017: Inflammation Research: Official Journal of the European Histamine Research Society ... [et Al.]
https://www.readbyqxmd.com/read/28154270/reassessment-of-acute-kidney-injury-after-cardiac-surgery-a-retrospective-study
#19
Xiangcheng Xie, Xin Wan, Xiaobing Ji, Xin Chen, Jian Liu, Wen Chen, Changchun Cao
Objective To evaluate the incidence, risk, or protective factors of acute kidney injury (AKI) in patients after cardiac surgery based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Methods A retrospective analysis of 2,575 patients undergoing their first documented cardiac surgery with cardiopulmonary bypass (CPB) was conducted. Perioperative variables were collected and analyzed. Univariate and multiple logistic regression models were used for determining the association between the development of AKI and risk factors...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28117559/anatomical-study-of-renal-arterial-vasculature-and-its-potential-impact-on-partial-nephrectomy
#20
Veronica Macchi, Alessandro Crestani, Andrea Porzionato, Maria Martina Sfriso, Aldo Morra, Marta Rossanese, Giacomo Novara, Raffaele De Caro, Vincenzo Ficarra
OBJECTIVES: To validate Graves' classification of the intrarenal arteries and to verify the absence of collateral arterial blood supply between different renal segments, in order to maximize peri-operative and functional outcomes of partial nephrectomy. MATERIALS AND METHODS: The study was performed on 15 normal kidneys sampled from eight unembalmed cadavers. Kidneys with the surrounding perirenal fat tissue were removed en bloc with the abdominal segment of the aorta...
January 24, 2017: BJU International
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