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renal protection in major surgery

Merja Kokki, Marja Heikkinen, Pyry Välitalo, Heidi Hautajärvi, Juho Hokkanen, Hanna Pitkänen, Ulla Sankilampi, Veli-Pekka Ranta, Hannu Kokki
BACKGROUND AND OBJECTIVES: This study aimed to characterize the pharmacokinetics of oxycodone and its major metabolites in infants and covered the age range between extremely preterm neonates and 2-year old infants. METHODS: Seventy-nine infants (gestational age 23-42 weeks; postnatal age 0-650 days) received intravenous oxycodone hydrochloride trihydrate at a dose of 0.1 mg/kg during or after surgery. Three to seven blood samples were taken from each infant, and plasma concentrations of oxycodone, noroxycodone, oxymorphone, and noroxymorphone were quantified...
October 25, 2016: British Journal of Clinical Pharmacology
Bulent Ergin, Michal Heger, Asli Kandil, Cihan Demirci-Tansel, Can Ince
Ischemia/reperfusion (I/R) is one of the main causes of acute kidney injury (AKI), which is characterized by sterile inflammation and oxidative stress. Immune cell activation can provoke overproduction of inflammatory mediators and reactive oxygen species (ROS), leading to perturbation of the microcirculation and tissue oxygenation associated with local and remote tissue injury. This study investigated whether the clinically employed immunosuppressant mycophenolate mofetil (MMF) was able to reduce I/R-induced renal oxygenation defects and oxidative stress by preventing sterile inflammation...
October 25, 2016: Clinical and Experimental Pharmacology & Physiology
Guillaume Passot, Delphine Vaudoyer, Laurent Villeneuve, Florent Wallet, Annie-Claude Beaujard, Gilles Boschetti, Pascal Rousset, Naoual Bakrin, Eddy Cotte, Olivier Glehen
OBJECTIVE: To determine whether a perioperative, standardized clinical pathway could impact the failure-to-rescue rate after cytoreductive surgery (CRS) for peritoneal carcinomatosis (PC) in a tertiary center. SUMMARY OF BACKGROUND DATA: Morbidity and mortality remain significant after CRS for PC. Clinical pathways have been associated with better outcomes after surgery. The failure-to-rescue rate is a useful metric for evaluating quality in surgery. MATERIALS AND METHODS: This study included 666 patients that received CRS for PC between 2009 and 2014...
April 11, 2016: Annals of Surgery
Peter Onody, Peter Aranyi, Zsolt Turoczi, Rita Stangl, Andras Fulop, Emese Dudas, Gabor Lotz, Attila Szijarto
AIMS AND OBJECTIVES: Acute renal failure is a severe complication of lower extremity major arterial reconstructions, which could even be fatal. Levosimendan is a dual-acting positive inotropic and vasodilatory agent, which is suspected to have protective effects against cardiac ischemia. However, there is no data available on lower limb or remote organ ischemic injuries therefore the aim of the study was to investigate the effect of levosimendan on lower limb ischemia-reperfusion injury and the corollary renal dysfunction...
2016: PloS One
Xiaobin Tang, Whitney Annie Long, Chang Hu, Feng Tang, Qian Wang, Lei Li
BACKGROUND: Open surgery and the retrograde endovascular approach via the distal left common carotid artery (LCCA) have some limitations in LCCA ostial stenosis treatment. The 'no touch' technique used in the renal artery was modified for this situation. METHODS: Fifteen selective LCCA stenosis patients were treated by the modified 'no touch' technique in the antegrade endovascular approach from March 2013 to March 2016. Thirteen underwent the transfemoral approach and the other two had the transbrachial approach due to a 'bovine aortic arch'...
August 19, 2016: Journal of Neurointerventional Surgery
Yucel Gonul, Senem Kazandı, Ahmet Kocak, Ahmet Ahsen, Ahmet Bal, Afra Karavelioglu, Omer Hazman, Ozan Turamanlar, Serdar Kokulu, Seref Yuksel
OBJECTIVE: Acute kidney injury (AKI) is a serious condition that can be induced by liver transplantation, major hepatic resection or prolonged portal vein occlusion. AKI can increase the frequency of postoperative complications. In the current study, we aimed to investigate whether interleukin-18 binding protein (IL-18BP) pretreatment has a protective effect against possible kidney injury following liver ischemia-reperfusion (IR) achieved by Pringle maneuver in an experimental rat model...
August 2016: American Journal of the Medical Sciences
Bo Tao Jiang, Qing Zhi Chen, Zong Hua Guo, Wei Zou, Xiong Chen, Wen Liang Zha
BACKGROUND: Ischemia/reperfusion (I/R) injury, which is commonly seen in the field of renal surgery or transplantation, is a major cause of acute renal failure (ARF). The ischemic ARF in diabetic rats is much more severe than that in the normal rats exposed to as same ischemic time. Ischemic post-conditioning (IPO) is a phenomenon by which intermittent interruptions of blood flow in the early phase of reperfusion can protect organs from I/R injury. To determine whether the renal protection effect of IPO mediates by toll-like receptor 4 (TLR4) signaling pathway in diabetic rats...
August 5, 2016: Renal Failure
Daniel Ramirez, Matthew J Maurice, Peter A Caputo, Ryan J Nelson, Onder Kara, Ercan Malkoc, Jihad H Kaouk
OBJECTIVES: Contemporary guidelines for treatment of localized renal masses suggest nephron-sparing surgery (NSS) as an option for T1a tumors in appropriate patients. Large comparative series assessing the risk of complications between open and robotic approaches for partial nephrectomy are lacking. Our objective is to assess differences in complications following robotic (RPN) and open partial nephrectomy (OPN) among experienced surgeons. PATIENTS AND METHODS: We identified patients in our IRB-approved, prospectively maintained database who underwent OPN or RPN for management of unifocal, T1a renal tumors at our institution between January 2011 and August 2015...
July 13, 2016: BJU International
Christine Selton-Suty, François Delahaye, Pierre Tattevin, Claire Federspiel, Vincent Le Moing, Catherine Chirouze, Pierre Nazeyrollas, Véronique Vernet-Garnier, Yvette Bernard, Sidney Chocron, Jean-François Obadia, François Alla, Bruno Hoen, Xavier Duval
OBJECTIVES: Symptomatic neurological complications (NC) are a major cause of mortality in infective endocarditis (IE) but the impact of asymptomatic complications is unknown. We aimed to assess the impact of asymptomatic NC (AsNC) on the management and prognosis of IE. METHODS: From the database of cases collected for a population-based study on IE, we selected 283 patients with definite left-sided IE who had undergone at least one neuroimaging procedure (cerebral CT scan and/or MRI) performed as part of initial evaluation...
2016: PloS One
Romain Boissier, Eugenie Di Crocco, Alice Faure, Geraldine Hery, Véronique Delaporte, Eric Lechevallier, Pierre D E Mouriquand, Jean-Michel Guys, Gilles Karsenty
OBJECTIVE: To document the long-term outcomes of paediatric augmentation gastrocystoplasty (AGC) in terms of preservation of renal function and maintenance of dryness, and to analyse the rate of complications. PATIENTS AND METHODS: The medical records of children who had undergone AGC between 1992 and 2000 (minimum time interval of 15 years) were reviewed retrospectively. The following data were collected: age at surgery, the cause of bladder dysfunction, functioning of the AGC, any complications, and the long-term outcome of the patients...
June 20, 2016: BJU International
B J Orandi, B E Lonze, A Jackson, S Terezakis, E S Kraus, N Alachkar, S M Bagnasco, D L Segev, J B Orens, R A Montgomery
Patients requiring desensitization prior to renal transplantation are at risk for developing severe antibody-mediated rejection (AMR) refractory to treatment with plasmapheresis and intravenous immunoglobulin (PP/IVIg). We have previously reported success at graft salvage, long-term graft survival and protection against transplant glomerulopathy with the use of eculizumab and splenectomy in addition to PP/IVIg. Splenectomy may be an important component of this combination therapy and is itself associated with a marked reduction in donor-specific antibody (DSA) production...
May 23, 2016: American Journal of Transplantation
Frédérique Hovaguimian, Paul S Myles
BACKGROUND: Blood transfusions are associated with morbidity and mortality. However, restrictive thresholds could harm patients less able to tolerate anemia. Using a context-specific approach (according to patient characteristics and clinical settings), the authors conducted a systematic review to quantify the effects of transfusion strategies. METHODS: The authors searched MEDLINE, EMBASE, CENTRAL, and grey literature sources to November 2015 for randomized controlled trials comparing restrictive versus liberal transfusion strategies applied more than 24 h in adult surgical or critically ill patients...
July 2016: Anesthesiology
Yudai Nagata, Mitsuaki Fujimoto, Kimihiko Nakamura, Naohito Isoyama, Masafumi Matsumura, Koki Fujikawa, Koichi Uchiyama, Eiichi Takaki, Ryosuke Takii, Akira Nakai, Hideyasu Matsuyama
BACKGROUND: Renal ischemia-reperfusion (I/R) injury is associated with delayed graft function and results in poor long-term graft survival. We previously showed that splenectomy (SPLN) protects the kidney from I/R injury and reduces serum TNF-α levels. Herein, we further investigated the effects of SPLN on inflammatory responses and tissue injury in renal I/R by examining the expression of major inflammatory cytokines and heat shock protein 70 (HSP70). Because it was shown previously that the anti-TNF-α agent infliximab (IFX) attenuated renal I/R injury, we also investigated whether IFX administration mimics the effects of SPLN...
August 2016: Transplantation
Hisato Ito, Toru Mizumoto, Hironori Tempaku, Kazuya Fujinaga, Yasuhiro Sawada, Satoshi Teranishi, Hideto Shimpo
BACKGROUND: The aim of this study was to investigate early and long-term outcomes of patients with acute coronary syndrome preoperatively requiring intraaortic balloon pump support who underwent emergency off-pump coronary artery bypass graft surgery. METHODS: One hundred and fifteen patients on preoperative intraaortic balloon pump receiving emergency off-pump coronary artery bypass graft surgery over an 11-year period were evaluated. The median age was 71 years (range, 33 to 87)...
September 2016: Annals of Thoracic Surgery
Nora Di Tomasso, Fabrizio Monaco, Giovanni Landoni
Acute kidney injury (AKI) is one of the most relevant complications after major surgery and is a predictor of mortality. In Western countries, patients at risk of developing AKI are mainly those undergoing cardiovascular surgical procedures. In this category of patients, AKI depends on a multifactorial etiology, including low ejection fraction, use of contrast media, hemodynamic instability, cardiopulmonary bypass, and bleeding. Despite a growing body of literature, the treatment of renal failure remains mainly supportive (e...
2016: F1000Research
Francesco Onorati, Andrea Perrotti, Daniel Reichart, Giovanni Mariscalco, Ester Della Ratta, Giuseppe Santarpino, Antonio Salsano, Antonio Rubino, Fausto Biancari, Giuseppe Gatti, Cesare Beghi, Marisa De Feo, Carmelo Mignosa, Aniello Pappalardo, Theodor Fischlein, Sidney Chocron, Christian Detter, Francesco Santini, Giuseppe Faggian
OBJECTIVES: Several single-centre experiences have reported significant operative mortality and morbidity after mitral valve surgery in redo scenarios (ReMVS). Several preoperative risk factors outlining 'high-risk' categories have been reported, but scanty data on the impact of different operative techniques for these major challenging procedures have been analysed to date. The aim of the study is to investigate those intraoperative factors and postoperative events affecting early survival after redo mitral procedures...
May 2016: European Journal of Cardio-thoracic Surgery
Armando E De Gracia-Nieto, Oriol Angerri, Jordi Bover, Daniel Salas, Juan Manuel Villamizar, Humberto Villavicencio
OBJECTIVE: The aim of this study was to determine the incidence of acute renal failure secondary to rhabdomyolysis (ARFSR) as a complication of major urological surgery (MUS), as well as to describe the clinical characteristics and identify possible risk and protective factors. SUBJECTS AND METHODS: Cases of ARFSR due to MUS between January 1997 and August 2011 were identified using the institutional database. The incidence was estimated and the clinical characteristics were analyzed using simple scatterplot graphs to identify possible risk and protective factors...
2016: Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre
Henry Whalen, Paul Shiels, Marc Littlejohn, Marc Clancy
Renal ischemia reperfusion injury (IRI) is a major problem, currently without treatments in clinical use. This reflects the failure of animal models to mimic the severity of IRI observed in clinical practice. Most described models lack both the ability to inflict a permanent reduction in renal function and the sensitivity to demonstrate the protective efficacy of different therapies in vivo. To test novel cell-based therapies, we have developed a model of renal IRI in Fisher 344 rats. Animals were subjected to 120 min of unilateral warm ischemia, during which they underwent an intra-renal artery infusion of therapeutic agents or vehicle...
February 18, 2016: Renal Failure
Takahiro Moriyama, Yuichi Kanmura, Sten G E Lindahl
BACKGROUND: Ischemia-reperfusion (I/R) injury is one of the most important pathologic processes causing acute kidney injury. Human atrial natriuretic peptide (hANP) has various effects, including renal protection. The purpose of the present work was to study the effects of intrarenal angiotensin II (Ang II) and investigate the potential of hANP to prevent kidney injury. MATERIALS AND METHODS: Male Sprague-Dawley rats were divided into three groups as follows: (1) sham; (2) I/R (30 min of bilateral renal ischemia followed by 6 h reperfusion); and (3) I/R + hANP (I/R injury + continuous intravenous infusion of hANP at 0...
March 2016: Journal of Surgical Research
Sophie Becker, Jakob Müller, Geraldine de Heer, Stephan Braune, Valentin Fuhrmann, Stefan Kluge
BACKGROUND: Since the overall prognosis of very elderly patients is generally limited, admissions to intensive care in these patients are often restricted. Therefore, only very few information is available on the prognosis of nonagenarians after intensive care treatment. The aim of this study was to analyze the clinical characteristics and outcomes of very elderly patients (≥90 years) admitted to an intensive care unit (ICU). METHODS: Monocentric, retrospective observational study of all patients aged ≥90 years admitted to the Department of Intensive Care Medicine with a total capacity of 132 ICU beds at the University Medical Center Hamburg in Germany between January 2008 and June 2013...
December 2015: Annals of Intensive Care
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