Management of Grade IV Renal Graft Trauma Secondary to Oncological Surgery: A Case Report.

BACKGROUND: Renal graft injury is a challenging condition that can endanger function or become a life-threatening event. Although the most common cause of renal graft injury is trauma, some cases of injuries associated with surgical procedures have been described. Here, we present a case of a transplant patient who experienced a grade IV renal graft injury after an open oophorectomy. CLINICAL CASE: A 31-year-old woman received a renal transplant from a cadaveric donor. During her follow-up, a multilocular cyst with a solid mural nodule tumor of the left ovary was documented, with an 84% risk for malignancy as determined by the International Ovarian Tumour Analysis score. Therefore, an open unilateral (left) oophorectomy was scheduled. RESULTS: The patient was readmitted 2 days after surgery and was hemodynamically stable despite intense pain in the right iliac fossa, sudden creatinine elevation, and hematuria. Tomography revealed a peri-graft hematoma with a mass effect. An exploratory laparotomy was performed, and 2 lacerations with an exposed collecting system and without urinary leakage were identified. These were repaired with absorbable barbed sutures reinforced with Teflon patches on the edges, with cellulose hemostatic mesh and fibrin adhesive on top of these patches. In the postoperative period, creatinine decreased to its baseline levels, but a urinary leak was noted, which was corrected by ureteral stent placement. CONCLUSION: The management of renal graft trauma requires closer monitoring and stricter criteria for reaching a definitive therapeutic decision to prevent the deterioration of the graft and the patient.

Renal transplantation recipient patients survival.

INTRODUCTION: The Bajío High Specialty Regional Hospital started operating in 2007 to tackle the health demands of 5.8 million inhabitants. It has 184 beds and a transplant unit with 26 beds. In 2008, the renal transplant program launched activities. OBJECTIVE: To describe the survival of kidney transplant receptor patients and of the grafted kidney at the Bajío High Specialty Regional Hospital. METHODS: Retrospective cohort study, where consecutive transplants carried out between 2008 and 2016 were included. Statistical analysis was performed using the Kaplan-Meier method. RESULTS: A total of 837 transplants were analyzed. Graft survival censored for death, with a functional graft at 1 and 5 years, was 94.6% and 78.9%. Patient survival at 1 and 5 years was 95.4% and 88.1%. CONCLUSIONS: The renal transplant program is one of the the best programs established in Mexico, both for the number of deceased-donor kidney transplants performed and for the patient and graft survival achieved. These data indicate that the renal transplant program has had a sustained development.

INTRODUCCIÓN: El Hospital Regional de Alta Especialidad del Bajío inició sus funciones en 2007 para atender la demanda de salud de 5.8 millones de habitantes, cuenta con 184 camas y una unidad de trasplantes con 26 camas. En 2008 inició actividades el programa de trasplante renal. OBJETIVO: Presentar la supervivencia de los pacientes receptores de trasplante renal y del riñón injertado en el Hospital Regional de Alta Especialidad del Bajío, Guanajuato, México. MÉTODO: Estudio de cohorte retrospectivo en el que se incluyeron los trasplantes consecutivos realizados entre 2008 y 2016. El análisis estadístico se efectuó con el método de Kaplan-Meier. RESULTADOS: Se analizaron 837 trasplantes. La supervivencia del injerto censurada para muerte con injerto funcional a uno y cinco años fue de 94.6 y 78.9 %. La supervivencia del paciente a uno y cinco años fue de 95.4 y 88.1 %. CONCLUSIONES: El programa de trasplante renal constituye uno de los mejor establecidos en México, tanto por el número de trasplantes renales de donante fallecido realizados como por la supervivencia obtenida de paciente e injerto. Los datos indican que el programa de trasplante renal ha tenido un desarrollo sostenido.

Supervivencia de los pacientes receptores de trasplante renal / Renal transplantation recipient patients survival

Resumen Introducción: El Hospital Regional de Alta Especialidad del Bajío inició sus funciones en 2007 para atender la demanda de salud de 5.8 millones de habitantes, cuenta con 184 camas y una unidad de trasplantes con 26 camas. En 2008 inició actividades el programa de trasplante renal. Objetivo: Presentar la supervivencia de los pacientes receptores de trasplante renal y del riñón injertado en el Hospital Regional de Alta Especialidad del Bajío, Guanajuato, México. Método: Estudio de cohorte retrospectivo en el que se incluyeron los trasplantes consecutivos realizados entre 2008 y 2016. El análisis estadístico se efectuó con el método de Kaplan-Meier. Resultados: Se analizaron 837 trasplantes. La supervivencia del injerto censurada para muerte con injerto funcional a uno y cinco años fue de 94.6 y 78.9 %. La supervivencia del paciente a uno y cinco años fue de 95.4 y 88.1 %. Conclusiones: El programa de trasplante renal constituye uno de los mejor establecidos en México, tanto por el número de trasplantes renales de donante fallecido realizados como por la supervivencia obtenida de paciente e injerto. Los datos indican que el programa de trasplante renal ha tenido un desarrollo sostenido.

Abstract Introduction: The Bajío High Specialty Regional Hospital started operating in 2007 to tackle the health demands of 5.8 million inhabitants. It has 184 beds and a transplant unit with 26 beds. In 2008, the renal transplant program launched activities. Objective: To describe the survival of kidney transplant receptor patients and of the grafted kidney at the Bajío High Specialty Regional Hospital. Methods: Retrospective cohort study, where consecutive transplants carried out between 2008 and 2016 were included. Statistical analysis was performed using the Kaplan-Meier method. Results: A total of 837 transplants were analyzed. Graft survival censored for death, with a functional graft at 1 and 5 years, was 94.6% and 78.9%. Patient survival at 1 and 5 years was 95.4% and 88.1%. Conclusions: The renal transplant program is one of the the best programs established in Mexico, both for the number of deceased-donor kidney transplants performed and for the patient and graft survival achieved. These data indicate that the renal transplant program has had a sustained development.

Fibrinogen and thrombin concentrations are critical for fibrin glue adherence in rat high-risk colon anastomoses.

OBJECTIVE: Fibrin glues have not been consistently successful in preventing the dehiscence of high-risk colonic anastomoses. Fibrinogen and thrombin concentrations in glues determine their ability to function as sealants, healers, and/or adhesives. The objective of the current study was to compare the effects of different concentrations of fibrinogen and thrombin on bursting pressure, leaks, dehiscence, and morphology of high-risk ischemic colonic anastomoses using fibrin glue in rats. METHODS: Colonic anastomoses in adult female Sprague-Dawley rats (weight, 250-350 g) treated with fibrin glue containing different concentrations of fibrinogen and thrombin were evaluated at post-operative day 5. The interventions were low-risk (normal) or high-risk (ischemic) end-to-end colonic anastomoses using polypropylene sutures and topical application of fibrinogen at high (120 mg/mL) or low (40 mg/mL) concentrations and thrombin at high (1000 IU/mL) or low (500 IU/mL) concentrations. RESULTS: Ischemia alone, anastomosis alone, or both together reduced the bursting pressure. Glues containing a low fibrinogen concentration improved this parameter in all cases. High thrombin in combination with low fibrinogen also improved adherence exclusively in low-risk anastomoses. No differences were detected with respect to macroscopic parameters, histopathology, or hydroxyproline content at 5 days post-anastomosis. CONCLUSIONS: Fibrin glue with a low fibrinogen content normalizes the bursting pressure of high-risk ischemic left-colon anastomoses in rats at day 5 after surgery.

Fibrinogen and thrombin concentrations are critical for fibrin glue adherence in rat high-risk colon anastomoses

OBJECTIVE: Fibrin glues have not been consistently successful in preventing the dehiscence of high-risk colonic anastomoses. Fibrinogen and thrombin concentrations in glues determine their ability to function as sealants, healers, and/or adhesives. The objective of the current study was to compare the effects of different concentrations of fibrinogen and thrombin on bursting pressure, leaks, dehiscence, and morphology of high-risk ischemic colonic anastomoses using fibrin glue in rats. METHODS: Colonic anastomoses in adult female Sprague-Dawley rats (weight, 250-350 g) treated with fibrin glue containing different concentrations of fibrinogen and thrombin were evaluated at post-operative day 5. The interventions were low-risk (normal) or high-risk (ischemic) end-to-end colonic anastomoses using polypropylene sutures and topical application of fibrinogen at high (120 mg/mL) or low (40 mg/mL) concentrations and thrombin at high (1000 IU/mL) or low (500 IU/mL) concentrations. RESULTS: Ischemia alone, anastomosis alone, or both together reduced the bursting pressure. Glues containing a low fibrinogen concentration improved this parameter in all cases. High thrombin in combination with low fibrinogen also improved adherence exclusively in low-risk anastomoses. No differences were detected with respect to macroscopic parameters, histopathology, or hydroxyproline content at 5 days post-anastomosis. CONCLUSIONS: Fibrin glue with a low fibrinogen content normalizes the bursting pressure of high-risk ischemic left-colon anastomoses in rats at day 5 after surgery. .

Reduction of the closure time of postoperative enterocutaneous fistulas with fibrin sealant.

AIM: To assess whether the use of fibrin sealant shortens the closure time of postoperative enterocutaneous fistulas (ECFs). METHODS: The prospective case-control study included 70 patients with postoperative ECFs with an output of < 500 mL/d, a fistulous tract of > 2 cm and without any local complication. They were divided into study (n = 23) and control groups (n = 47). Esophageal, gastric and colocutaneous fistulas were monitored under endoscopic visualization, which also allowed fibrin glue application directly through the external hole. Outcome variables included closure time, time to resume oral feeding and morbidity related to nutritional support. RESULTS: There were no differences in mean age, fistula output, and follow-up. Closure-time for all patients of the study group was 12.5 +/- 14.2 d and 32.5 +/- 17.9 d for the control group (P < 0.001), and morbidity related to nutritional support was 8.6% and 42.5%, respectively (P < 0.01). In patients with colonic fistulas, complete closure occurred 23.5 +/- 19.5 d after the first application of fibrin glue, and spontaneous closure was observed after 36.2 +/- 22.8 d in the control group (P = 0.36). Recurrences were observed in 2 patients because of residual disease. One patient of each group died during follow-up as a consequence of septic complications related to parenteral nutrition. CONCLUSION: Closure time was significantly reduced with the use of fibrin sealant, and oral feeding was resumed faster. We suggest the use of fibrin sealant for the management of stable enterocutaneous fistulas.

[Bursting pressure in normal and ischemic colonic anastomoses in rats; using biological and synthetic adhesives]. / Presión de estallamiento en anastomosis de colon normal e isquémico en ratas, con adhesivos tisulares biológicos y sintéticos.

OBJECTIVE: We wanted to determine bursting pressure in normal and ischemic colonic anastomoses in rats as well as the frequency and type of complications with the use of biological and synthetic adhesives. MATERIAL AND METHODS: We designed an experimental study using 80 Sprague-Dawley rats, weighing between 200 and 250 g, divided into four groups: one control group and three study groups. Anastomoses were realized using one layer of interrupted 6-0 polypropylene sutures. Each group was divided into two categories: normal colon (n = 10) and ischemic colon, induced by dividing mesenteric blood vessels (n = 10). Group 2 used octyl-cyanoacrylate, group 3 used N-2-butyl-cyanoacrylate, and group 4 used 40 mg/ml fibrinogen with 1000 u/ml of thrombin. Bursting pressure was measured with a manometer creating pressure in the anastomotic bowel using an infusion pump at 1 ml/min of NaCl 0.9%. Statistical analysis was performed with Student's t test, one-way ANOVA, chi square test or Fisher's exact test. RESULTS: Group 1: (control) normal 127.8 +/- 16.21 versus 109 +/- 17 with ischemia (p < 0.05); group 2: normal 145.5 +/- 89 versus ischemic colon 97.6 +/- 40 (p = 0.136); group 3: normal 145.7 +/- 34 versus 130.8 +/- 15.33 with ischemia (p = 0.22); group 4: normal 239 +/- 26.4 versus 196.5 +/- 14.3 with ischemia (0.000). Bursting pressure was statistically significant in group 4, showing greater pressures (p < 0.001). Bursting segment was shown to be higher outside the anastomoses. Complications such as adhesions and intestinal obstruction were seen more frequently in both cyanoacrylate groups. CONCLUSIONS: An increased bursting pressure was shown in the fibrinogen groups, having a greater tensile strength of the anastomoses. Pressures similar when anastomoses were treated with any of the other two synthetic adhesives.

Operación de Hartmann: experiencia institucional de 92 casos consecutivos / Hartmann's procedure: institutional experience of 92 consecutive cases

Antecedentes: desde su descripción en 1923, el procedimiento de Hartmann es ampliamente utilizado en el tratamiento quirúrgico de complicaciones agudas del colon izquierdo, cuando no es posible realizar lavado mecánico preoperatorio y/o cuando Objetivo: analizar los resultados de la operación de Hartmann en el tratamiento quirúrgico de pacientes consecutivos en una misma institución, durante un intervalo de 30 meses.existe alta posibilidad de dehiscencia anastomótica.Tipo de estudio: prospectivo, no al azar y longitudinal.Material y métodos: pacientes tratados mediante procedimiento de Hartmann entre marzo de 1995 y septiembre de 1998. Se realizó análisis de indicación del procedimiento, hallazgos transoperatorios, morbilidad y mortalidad, así como la frecuencia de reversión con reinstalación de la continuidad intestinal y su morbimortalidad.Resultados: se sometieron al procedimiento de Hartmann 92 pacientes. La edad promedio de los pacientes fue de 60 + 25 años (margen de 21 a 88 años) y 60 por ciento superaba los 65 años de edad. El procedimiento fue de urgencia en 91 por ciento de los casos. Los pacientes presentaban en su mayoría sepsis intraabdominal (56 por ciento) y patología colónica benigna (83 por ciento). Se detectó morbilidad de 34 por ciento y mortalidad de 19 por ciento. Durante el seguimiento se restauró la continuidad intestinal en 32 por ciento de los casos sin ocurrir fatalidades.Conclusiones: el procedimiento de Hartmann es buena opción para el tratamiento quirúrgico no electivo de patología rectosigmoidea complicada. La morbilidad y la mortalidad de la operación depende en gran medida del grado de sepsis preoperatoria y de la condición preexiste del paciente. La baja tasa de restauración en la continuidad intestinal probablemente se debe a un corto tiempo de seguimiento

Complicaciones abdominales consecutivas a derivación cardiopulmonar / Abdominal complications resulting from cardiopulmonary derivation

Objetivo. Conocer la frecuencia de complicaciones intraabdominales y su impacto en la supervivencia de pacientes sujetos a DCP para procedimientos quirúrgicos comunes a corazón abierto. Antecedentes. Las complicaciones gastrointestinales después de cirugía cardiaca con derivación cardiopulmonar, tienen incidencia del 0.3 al 3 por ciento, pero la mortalidad puede sobrepasar 60 por ciento. Pese a las mejorías en el cuidado pre, trans, y posoperatorio, la impresión general ha sido que las complicaciones abdominales permanecen como un problema significativo. Tipo de Estudio. Retrospectivo de casos y controles. Material y métodos. Pacientes consecutivos sometidos a cirugía cardiaca con derivación cardiopulmonar, entre marzo de 1995 y marzo de 1997. Se identificó cualquier complicación abdominal, su diagnóstico, manejo médico o quirúrgico y mortalidad. Resultados. Se estudiaron 1,352 pacientes de los cuales 516 fueron operados por revascularización coronaria (38 por ciento), 502 (37 por ciento) por reemplazo valvular, 68 (5.2 por ciento) una combinación de reemplazo valvular y revascularización, 144 (10.6 por ciento) corrección de defectos congénitos, y 122 (9.6 por ciento) tratados por padecimientos diversos. Desarrollaron complicaciones 44 pacientes (3.3 por ciento) y éstas fueron íleo intestinal posoperatorio en 14 casos (32 por ciento), la mitad de ellos tuvo hiperamilasemia. Las complicaciones hepatobiliares representaron 29.5 por ciento (13 casos). Diez pacientes (22.7 por ciento) tuvieron enfermedad ulceropéptica complicada con hemorragia o perforación. La pandreatitis aguda grave se observó en 4.5 por ciento de los casos al igual en dos pacientes con necrosis intestinal. Tres casos presentaron complicaciones quirúrgicas no relacionadas con DCP y fueron traumatismo hepático grado I, apendicitis aguda y colitis amibiana. La mortalidad fue de 11/44 (25 por ciento). Como grupo control, se analizaron 73 pacientes operados el día o alrededor de los días como los del grupo de estudio y que no desarrollaron complicaciones gastrointestinales. La mortalidad en este grupo fue de 5/73 (6.8 por ciento). ...