RESUMEN
BACKGROUND: The transposed autologous basilic vein to brachial artery arteriovenous fistula provides vascular access in the absence of adequate superficial vein. The long-term patency and complication rates of this conduit are largely unreported. PATIENTS AND METHODS: Seventy-four brachiobasilic fistulas were performed in 65 patients. This was a secondary or tertiary access procedure in 84 per cent of patients. RESULTS: Of the 74 fistulas performed, 50 were successfully used for dialysis (68 per cent) and 24 (32 per cent) were never used, including 13 fistulas that failed without being used for dialysis. Of the 74 fistulas, 46 per cent failed (n = 34), 10 patients died with a functioning fistula (n = 10) and five were transplanted. The 30-day secondary patency was 73 per cent at 1 year, 53 per cent at 2 years and 43 per cent at 3 years rate was 96 per cent. Cumulative secondary patency was 73 per cent at 1 year, 53 per cent at 2 years and 43 per cent at 3 years. Nineteen (26 per cent) fistulas underwent a further 19 operative procedures. Fifty-one (69 per cent) fistulas developed complications. The most common complications were arm oedema (24 per cent), thrombosis (22 per cent) and bleeding (18 per cent). CONCLUSION: In high-risk patients the autologous transposed brachiobasilic fistula has equivalent patency and lower complication rates than those reported for polytetrafluoroethylene interposition grafts.
Asunto(s)
Derivación Arteriovenosa Quirúrgica/métodos , Catéteres de Permanencia , Adulto , Anciano , Anciano de 80 o más Años , Catéteres de Permanencia/efectos adversos , Edema/etiología , Femenino , Supervivencia de Injerto , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana Edad , Diálisis Renal , Infección de la Herida Quirúrgica/etiología , Trombosis/etiología , Trasplante Autólogo , Grado de Desobstrucción VascularRESUMEN
In September 1998, a 48 year old male underwent bilateral renal transplantation from a 51 year old non-heart beating donor (NHBD) with ischemic heart disease. The grafts exhibited delayed graft function, otherwise short term results have been good, with a three month serum creatinine of 80 mumol/l, three month GFR of 79 ml/min per 1.73 m2 BSA, and no episodes of acute rejection. We advocate dual transplantation when sub-optimal NHBD kidneys are otherwise in danger of being discarded.
Asunto(s)
Trasplante de Riñón , Donantes de Tejidos , Cadáver , Supervivencia de Injerto , Paro Cardíaco , Humanos , Hipertensión/complicaciones , Fallo Renal Crónico/etiología , Fallo Renal Crónico/cirugía , Masculino , Persona de Mediana Edad , Infarto del MiocardioRESUMEN
A boy investigated for neonatal jaundice was noted to have lipaemic serum and was subsequently shown to have type V hyperlipoproteinaemia. Dietary treatment was maintained for five years and he followed a typical clinical course. Circumstantial evidence suggested an autosomal recessive inheritance pattern.
Asunto(s)
Hiperlipoproteinemias/genética , Humanos , Hiperlipoproteinemias/dietoterapia , Recién Nacido , Lípidos/sangre , MasculinoRESUMEN
Examination of eight Atlantic species of the genus Littorina by starch gel electrophoresis of purine nucleoside phosphorylase revealed extensive polymorphism within the L. saxatilis complex. In this group, four alleles have been identified. Heterozygotes are four banded, and thus, as in vertebrates, the enzyme is likely to be a trimer. Breeding experiments confirmed the genetic interpretation of the phenotype patterns. Where species of the saxatilis complex [L. saxatilis (=L. rudis), L. arcana, L. nigrolineata, L. neglecta] are sympatric, there are sometimes significant allele frequency differences between them. A fifth allele was present at a high frequency in L. obtusata and L. mariae, and L. littorea and L. neritoides each possessed unique alleles. A total of eight alleles was identified. Densitometric scanning of heterozygote patterns pointed to activity differences between alleles and also showed that, while the heterotrimeric bands were never less intense than the homotrimeric bands, the heterotrimeric bands were sometimes less intense than expected. It is not clear whether this represents nonrandom association of subunits, decreased stability of heterotrimers, or simply an artifact of the staining and quantifying process.