Long term effects of kidney donation on blood pressure and kidney function of donors

Kidney transplantation from a live donor has many advantages, but the donor should undergo a major surgery and accept potential morbidity and mortality. In this study, we evaluated the long term effects of nephrecetomy on renal function and blood pressure of kidney donors. In this cross-sectinal study, we assessed 195 kidney donors. The controls were 100 healthy individuals with two kidneys. The variables were age, sex, systolic blood pressure [SBP], diastolic blood pressure [DBP], serum creatinine, creatinine clearance and proteinuria [all before and after kidney donation] and time interval between donation and study. Data analysis was accomplished using SPSS software, and paired t-test and Pearson correlation coefficient were used for data analysis. Although serum creatinine was elevated at the time of study, but this rise was not significant. SBP at the time of study was significantly greater than the time of donation [P<0.001]. Creatinine clearance at the time of study was significantly lower than the time of donation [P<0.001]. There was no correlation between serum creatinine, creatinine clearance, SBP, DBP and age at the time of kidney donation in men. Age at the time of kidney donation was correlated with SBP and DBP and creatinine changes in women [P=0.001 and P=0.002, respectively]. This study showed that nephrectomy does not impair renal function in donor and does not lead to a progressive rise in blood pressure or urine protein excretion up to 6.5 years after nephrectomy. Nevertheless, we suggest that kidney donors should be selected after exact screening for potential risk factors of renal disease

[Complication rates of carotid endarterectomy in Taleghani and lranmehr hospitals, Tehran, Iran]

Previous studies demonstrated the efficacy of carotid endarterectomy [CEA] in reducing the risk of strokes and deaths in selected patients afflicted with carotid artery stenosis. Selection of patients for CEA depends on degree of stenosis, whether patient is symptomatic or asymptomatic and complication rate of CEA; so, it has been recommended that surgical departments publish their complication rates. As there were no data regarding complication rates of CEA in Iran, this study was performed. We performed a retrospective study of all CEAs performed in Taleghani and Iranmehr hospitals till March 2001.In-hospital mortality or strokes were determined by review of patients' files. Telephone interview of patients or their families achieved additional follow-up for complications occurring within 30 days of CEA. The cohort consisted of 246 consecutive cases of CEA. There were 12 [6.4%] strokes and 4[2.1%] deaths in Iranmehr and 2[3.4%] strokes and 3[5.2%] deaths in Taleghani hospitals. Overall complication rate was 8.5%. Risk factors for stroke or death were history of diabetes mellitus and, unexpectedly, history of previous CEA on contra lateral side. According to the results of this study, CEA is appropriate for symptomatic patients with stenosis greater than 70% and not recommended for asymptomatic patients. Determining complication rates of CEA in other centers will help the selection of appropriate patients for CEA

Surgical treatment of A-V fistulas: a new technique

The isolation and control of the peripheral and distal portions of the involved artery and vein of an A-V fistula prior to repair is a needless complication often resulting in increased trauma and clot formation. In the repair of 93 cases of A-V fistulas a simplified technique was successfully used in the last 32 cases with excellent results. In this technique the dissection of the venous limbs is completely omitted and only the involved artery is freed proximal and distal to the lesion. The artery is then divided above and below the fistula and the free ends ligated. Arterial continuity is established by vein graft interposition. The advantages of this technique and the results of clinical follow-up are discussed