Successful Elongation of a Short Graft Renal Artery by a Gonadal Vein.

OBJECTIVES: The objective of this presentation is to share our experiences with a successful reconstruction of a short graft renal artery using a gonadal vein, which occurred during a difficult laparoscopic donor nephrectomy. CASE REPORT: A 27-year-old man was referred to our clinic for a living-related renal transplant with a diagnosis of end-stage renal disease. The donor was with his mother. At last, a laparoscopic donor nephrectomy was planned. Massive intra-abdominal hemorrhage occurred during the dissection of renal artery. Urgent intervention was performed to maintain the patency of renal allograft and to stabilize the donor. Hemorrhage was brought under control. Donor nephrectomy was completed with a short remaining segment of renal artery. We decided to use the elongation of the graft renal artery using the gonadal vein of the same side was decided. End-to-end anastomosis was performed. After elongation of graft renal artery, anastomosis to internal iliac artery was performed. The trans-plant procedure was completed successfully. The kidney functioned immediately. Doppler ultrasound revealed that perfusion of the kidney was normal. The postoperative creatinine levels of recipient were in the normal ranges. Daily urine output was normal. There are not enough publications about elongation of graft renal artery using gonadal vein. CONCLUSIONS: Elongation of a short remaining graft renal artery by using gonadal vein seems to be a simple, safe, and reliable method. This technique provides an alternative approach for the reconstruction of short renal arteries in living-donor kidney transplants.

Protective effects of zinc, pentoxifylline, and N-acetylcysteine in an animal model of laparoscopy-induced ischemia/reperfusion injury of the small intestine.

BACKGROUND: Pneumoperitoneum induced to facilitate laparoscopy is associated with splanchnic hypoperfusion, ischemia/reperfusion (I/R) injury, and oxidative stress. AIM: This study investigated the effects of pre- and postlaparoscopic conditioning, zinc, pentoxifylline, and N-acetylcysteine on markers of I/R injury of the small intestine in an animal model. METHODS: Male Sprague-Dawley rats (n=56) were randomized to 1 of 7 treatment groups. Except for group 7 (control group that underwent sham surgery without pneumoperitoneum), pneumoperitoneum was induced in all by use of carbondioxide insufflation under a pressure of 15 mmHg. Group 1 (laparoscopic I/R) was subjected to 60 minutes of pneumoperitoneum. Group 2 (laparoscopic preconditioning plus laparoscopy) was subjected to 5 minutes of insufflation and 5 minutes of desufflation followed by 60 minutes of pneumoperitoneum. Group 3 (laparoscopy plus laparoscopic postconditioning) was subjected to 60 minutes of pneumoperitoneum and 60 minutes of desufflation followed by 5 minutes of insufflation and 5 minutes of desufflation. Group 4 (zinc), group 5 (pentoxifylline), and group 6 (N-acetylcysteine) received a single intraperitoneal injection of zinc (50 mg/kg), pentoxifylline (50 mg/kg), or N-acetylcysteine (150 mg/kg), respectively, 5 minutes before the desufflation period. Animals were killed at the end of the experiments, and small intestine samples were tested for malondialdehyde (MDA), catalase (CAT), glutathione peroxidase (GPX), and superoxide dismutase (SOD). RESULTS: There was no significant difference for MDA levels between each other in the groups 1, 2, and 3. But MDA levels were higher significantly in groups 1, 2, and 3 than those of groups 4, 5, 6, and 7. SOD and GPX levels of group 3 were significantly higher than those of groups 1, 2, 4 through 7. According to the SOD levels, there was no significant difference between each other in those of groups 1, 2, 4 through 7. GPX levels of group 3 were significantly higher than those of groups 1, 2, 4 through 7. GPX levels of group 1 were significantly lower than those of groups 5 and 7. The mean CAT level of groups 1 and 2 was significantly lower than that of groups 3, 6, and 7. The mean CAT level of group 3 was significantly higher than that of groups 1, 2, 4 through 7. CONCLUSIONS: In this animal model of small intestine I/R injury, laparoscopy caused small intestine ischemia as evidenced by elevated markers of tissue I/R injury. This effect was significantly attenuated by zinc, pentoxifylline, and N-acetylcysteine, but not by prelaparoscopy conditioning and postlaparoscopy conditioning.

Re-protective effects of pre- and post-laparoscopy conditioning, zinc, pentoxifylline, and N-acetylcysteine in an animal model of laparoscopy-induced ischemia/reperfusion injury of the kidney.

BACKGROUND: Pneumoperitoneum (P) created to facilitate laparoscopy (L) is associated with splanchnic hypoperfusion, ischemia/reperfusion (I/R) injury, and oxidative stress. AIM: This study investigated the effects of pre- and post-laparoscopic conditioning, zinc, pentoxifylline (PTX), and N-acetylcysteine (NAC) on markers of I/R injury in an animal model. METHODS: Sprague-Dawley male rats (n = 56, weight range 300-350 g) were randomly placed in one of seven treatment groups. Except for group C (control group who underwent a sham operation without pneumoperitoneum), pneumoperitoneum was created in all using CO(2) insufflation under a pressure of 15 mmHg. Group L (laparoscopy) was subjected to 60 min of pneumoperitoneum. Group Lpre (laparoscopic preconditioning plus laparoscopy) was subjected to 5 min of insufflation and 5 min of desufflation followed by 60 min of pneumoperitoneum. Group Lpost (laparoscopy plus laparoscopic post-conditioning) was subjected to 60 min of pneumoperitoneum and 60 min of desufflation followed by 5 min of insufflation and 5 min of desufflation. The laparoscopy plus zinc (LZ), PTX (LP), and NAC (LNAC) groups received a single intraperitoneal injection of zinc (50 mg/kg), pentoxifylline (50 mg/kg), or N-acetylcysteine (150 mg/kg) 5 min before the desufflation period. Animals were sacrificed at the end of the experiments, and kidney samples were tested for malondialdehyde (MDA), catalase (CAT), glutathione peroxidase (GPX), and superoxide dismutase (SOD). RESULTS: MDA levels, as an indicator of oxidative stress in kidney tissue samples, were significantly higher in all pneumoperitoneum groups compared to Group C, except for Group Lpre. The pattern of change in tissue levels of SOD, GPX, and catalase was variable in the different treatment groups. CONCLUSIONS: In this animal model of renal ischemia/reperfusion injury, laparoscopy caused renal ischemia as evidenced by elevated markers of tissue ischemia-reperfusion injury. This effect was significantly attenuated by post-laparoscopy conditioning, zinc, pentoxifylline, and N-acetylcysteine, but not by pre-laparoscopy conditioning.

The efficacy and immunogenicity of Pneumo-23 and ACT-HIB in patients undergoing splenectomy.

BACKGROUND: The objective of this prospective study is to validate the efficiency of Streptococcus pneumoniae and Haemophilus influenzae vaccines in splenectomized patients via the demonstration of seroconversion and uninterrupted ability for opsonization. METHODS: Thirty-two adult patients (18 males, 14 females; mean age 46.1 years; range 18 to 79 years) who underwent elective or urgent splenectomy for various benign and malignant hematological disorders, splenic trauma and splenic masses were reviewed. Pneumo-23 and Act-HIB were administered to all patients on routine basis. In order to demonstrate the ongoing opsonizing capacity of the immune system and the seroconversion of immunoglobulins after vaccination, antibody titers of IgG and IgM and plasma C3 and C4 levels were quantitatively measured. RESULTS: The operative morbidity was 9% and overall mortality was 16%, with no early postoperative death in this series. Five patients with various malignant disorders died due to dissemination of their primary tumor. None of the patients with benign hematological disorders or those with splenic trauma died during the mean follow-up of 427 days. Furthermore, death from overwhelming postsplenectomy infection was nil in our clinical survey. All of the patients including those with malignancy had normal IgG (mean: 1383.1 mg/dL) and IgM levels (mean: 80.9 mg/dL) during discharge and at the last follow-up. Among the patients with benign hematological disorders, splenic trauma and splenic masses necessitating splenectomy, C3 and C4 levels were entirely within normal limits with a mean of 108.8 mg/dL and 21.4 mg/dL, respectively. CONCLUSION: This preliminary study reveals adequate seroconversion of immunoglobulins in all patients and normal C3 and C4 levels in patients with benign hematological disorders and splenic trauma. Moreover, none of the patients in the latter group had S. pneumoniae or H. influenzae infection nor did they expire due to overwhelming sepsis during the follow-up period. Long-term follow-up is required to determine the continuation of this immunologic response and the necessity of repeated vaccination.