Two Cases of Micro-Arteriovenous Fistula in the Lower Extremity with Misdiagnosis of Refractory Cellulitis.

We report our experience of two cases of refractory cellulitis caused by peripheral micro-arteriovenous fistulas (AVFs) in the lower extremity. The micro-AVFs were so small that they could not be located accurately; further, the patients' symptoms differed markedly from those previously reported for AVF. AVF is known to cause ischemic symptoms. In contrast, micro-AVF causes congestive symptoms and remains undetected in the majority of patients. Identification of this pathology is crucial to enable effective treatment by the ligation of the incompetent perforator vein that increases venous hypertension, leading to congestive symptoms.

Right versus left retroperitoneoscopic living-donor nephrectomy.

PURPOSE: To compare the safety and efficacy of right-side and left-side retroperitoneoscopic donor nephrectomy (RDN) using our hybrid technique. METHODS: We retrospectively reviewed the data obtained from 151 consecutive patients who underwent RDN between May 2005 and July 2013. Right and left nephrectomies were performed in 87 and 64 patients, respectively. We compared these two groups with respect to donors' intraoperative parameters, postoperative outcomes, and recipients' outcomes. RESULTS: There were no significant differences between the two groups regarding donor blood loss, warm ischemia time, donor postoperative creatinine levels, donor postoperative length of hospital stay, recipient creatinine levels at 1 year after transplantation, and 1-year graft survival rate after transplantation. The time required for graft extraction and overall operative time were significantly shorter in the right RDN group than in the left RDN group (152 vs. 168 min, P = 0.016; 175 vs. 195 min, P = 0.0059). Only one case in the right nephrectomy group required open conversion because of uncontrollable bleeding from the inferior vena cava. CONCLUSION: Although larger sample sizes would be required to evaluate postoperative complication rate, these results indicate that both the right and left RDN could be performed with similar donor and recipient outcomes.

A novel resting strategy for improving islet engraftment in the liver.

BACKGROUND: Several studies have revealed that posttransplant insulin treatment is beneficial to rest the islet grafts. However, insulin infusion per se is not enough to completely suppress the heavy workload arising caused by postprandial hyperglycemia. Therefore, the present study examined whether short-term fasting combined with insulin treatment could effectively prevent graft exhaustion after intraportal islet transplantation. METHODS: A marginal dose of syngeneic rat islet grafts were transplanted intraportally into the control, insulin-treated, and insulin+rest groups of streptozotocin-induced diabetic rats. The control group fed freely without insulin treatment, and the other groups were continuously treated with an optimal amount of insulin to maintain normoglycemia. In addition, the insulin+rest group fasted and received total parenteral nutrition during the 2 weeks after transplantation. RESULTS: The curative rate was significantly higher in both the insulin and insulin+rest groups than the control group (P<0.0001). The glucose tolerance, residual graft mass, and graft function were significantly ameliorated in the insulin+rest group, but not in the insulin group, compared to the control group (P<0.01, P=0.03, P=0.001). CONCLUSIONS: These data suggest that short-term fasting combined with insulin treatment, especially during the avascular period of the grafts, could therefore be a promising regimen for improving pancreatic islet engraftment in the liver.