Impact of a preoperative evaluation on the outcomes of an arteriovenous fistula

PURPOSE: The aim of this study was to determine the possible predictors of primary arteriovenous fistula (AVF) failure and examine the impact of a preoperative evaluation on AVF outcomes. METHODS: A total of 539 patients who underwent assessment for a suitable site for AVF creation by physical examination alone or additional duplex ultrasound were included in this study. Demographics, patient characteristics, and AVF outcomes were analyzed retrospectively. RESULTS: AVF creation was proposed in 469 patients (87.0%) according to physical examination alone (351 patients) or additional duplex ultrasound (118 patients); a prosthetic arteriovenous graft was initially placed in the remaining 70 patients (13.0%). Although the primary failure rate was significantly higher in patients assessed by duplex ultrasound (P = 0.001), ultrasound information changed the clinical plan, increasing AVF use for dialysis, in 92 of the 188 patients (48.9%) with an insufficient physical examination. Female sex and diabetes mellitus were risk factors significantly associated with primary AVF failure. Because of different inclusion criteria and a lack of adjustment for baseline differences, Kaplan-Meier survival analysis showed better AVF outcomes in patients assessed by physical examination alone; an insufficient physical examination was the only risk factor significantly associated with AVF outcomes. CONCLUSION: Routine use of duplex ultrasound is not necessary in chronic kidney disease patients with a satisfactory physical examination. Given that female gender and diabetes mellitus are significantly associated with primary AVF failure, duplex ultrasound could be of particular benefit in these subtypes of patients without a sufficient physical examination.

Comparison of Hematopoietic Stem Cell Activity in Normal Bone Marrow, in vivo G-CSF Stimulated Bone Marrow, and G-CSF-Mobilized Peripheral Blood / 대한수혈학회지

BACKGROUND: Classically, bone marrow (BM) has been the sole source of hematopoietic stem cell transplantation, but limitations of conventional bone marrow transplantation have stimulated a search for alternative sources of stem cells. METHODS: We compared hematopoietic stem cell activity of normal bone marrow (BM), in vivo G-CSF-stimulated bone marrow (G-CSF BM), and G-CSF-mobilized peripheral blood (G-CSF PB) by immunophenotyping, clonogeneicity, and long-term culture-initiating cell (LTC-IC) analysis. RESLUTS: The average numbers of CD34+/HLA-DR- cells after CD34+ cells isolation from each stem cell source were 59.64 +/- 8.70%, 91.39 +/- 1.98%, and 95.75 +/- 2.08% in normal BM, G-CSF BM, and G-CSF PB, respectively (normal BM vs. G-CSF BM, normal BM vs. G-CSF PB, p<0.0001). And the average numbers of CD34+/CD38- cells were 66.23 +/- 9.33%, 95.08+/- 2.09%, and 91.76 +/- 4.59% in normal BM, G-CSF BM, and G-CSF PB, respectively (normal BM vs. G-CSF BM, normal BM vs. G-CSF PB, p<0.0001). The numbers of CFU-GM was significantly higher in G-CSF PB (53.2 +/- 4.05) and G-CSF BM (52.5 +/- 3.63) than that of normal BM (31.3+/- 5.50) (p<0.0001). Also the numbers of CFU-GEMM and CFU-Mk were also significantly higher in G-CSF PB (110.3 +/- 8.79 and 13.3 +/- 1.49) and G-CSF BM (109.7 +/- 10.78 and 11.2 +/- 1.69) than that of normal BM (48.8 +/- 1.48 and 8.5 +/- 1.72) (p<0.05). Comparison of LTC-IC in the three sources of stem cells showed that G-CSF PB and G-CSF BM were superior to normal BM at five weeks of culture (p<0.05). CONCLUSIONS: These data suggest that the amount of both early progenitor cells and late progenitor cells in G-CSF PB and G-CSF BM are higher than that of normal BM. And our results further support that the higher stem cell transplantation using G-CSF-mobilized PB and in vivo G-CSF-stimulated BM can lead to more rapid and sustained engraftment even in cases of high risk of rejection.

A Case of Prenatally Detected Trisomy 9 Associated with Dandy Walker Syndrome / 대한산부인과학회잡지

Complete trisomy 9 is a rare chromosomal aneuploidy in live born infants. The majority of cases of trisomy 9 end in spontaneous abortion in the first trimester. Clinical finding of co-mplete trisomy 9 demonstrate multiple organ abnormalities in the craniofacial, cardiovascular, skeletal, genitouronary systems. We report a fetus with Dandy Walker syndrome which was diagnosed prenatally and was subsequently found to have a complete trisomy 9.