Browsing by Subject "GRAFT"

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  • Choque-Velasquez, Joham; Colasanti , Roberto; Rezai Jahromi, Behnam; Hernesniemi, Juha (2017)
    OBJECTIVE: The preservation of normal peri/intralesional bridging veins is extremely important in every micro-neurosurgical operation. The purpose of our study was to describe the "squeeze maneuver"assisted by indocyanine green videoangiography (ICGV), a simple technique to "resuscitate" partially occluded bridging veins during microneurosurgical operations. METHODS: When a bridging vein is inadvertently stretched up to its collapse during microneurosurgical procedures, a precise identification of the partially occluded zone is carried out under high magnification (10-153), as well as with the aid of the ICGV. If a continuous irrigation with isotonic saline solution does not allow one to reestablish the venous flow, the "squeeze maneuver" is carried out. This consists of squeezing and sliding with the bipolar forceps the occluded vessel along the normal venous flow direction. This procedure is repeated several times, while a continuous saline irriga-tion is applied. The ICGV is performed to confirm an adequate patency of the vein. RESULTS: This maneuver permits to restore the normal diameter of the vein and blood flow inside it. CONCLUSION: The "squeeze maneuver"assisted by ICGV represents a safe, clean, fast, and even cheap method for restoring the flow of partially occluded bridging veins during microneurosurgical operations.
  • Tantiyavarong, Pichaya; Kramer, Anneke; Heaf, James G.; Finne, Patrik; Asberg, Anders; Cases, Aleix; Caskey, Fergus J.; Massy, Ziad A.; Jager, Kitty J.; Noordzij, Marlies (2020)
    Background. Kidney transplantation should improve abnormalities that are common during dialysis treatment, like anaemia and mineral and bone disorder. However, its impact is incompletely understood. We therefore aimed to assess changes in clinical indicators after the transition from chronic dialysis to kidney transplantation. Methods. We used European Renal Association-European Dialysis and Transplant Association Registry data and included adult dialysis patients for whom data on clinical indicators before and after transplantation (2005-15) were available. Linear mixed models were used to quantify the effect of transplantation and of time after transplantation for each indicator. Results. In total, 16 312 patients were included. The mean age at transplantation was 50.1 (standard deviation 14.2) years, 62.9% were male and 70.2% were on haemodialysis before transplantation. Total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol and triglycerides increased right after transplantation but decreased thereafter. All other indicators normalized or approached the target range soon after transplantation and these improvements were sustained for the first 4 years of follow-up. In patients with higher estimated glomerular filtration rate (eGFR) levels (30-60 and >60 mL/min/1.73 m(2)), the improvement of haemoglobin, ferritin, ionized calcium, phosphate, parathyroid hormone, HDL cholesterol, triglycerides, albumin and C-reactive protein levels was more pronounced than in patients with a lower eGFR ( Conclusions. Except for total cholesterol, LDL cholesterol and triglycerides, all clinical indicators improved after transplantation. These improvements were related to eGFR. Nevertheless, values remained out of range in a considerable proportion of patients and anaemia and hyperparathyroidism were still common problems. Further research is needed to understand the complex relationship between eGFR and the different clinical indicators.
  • Giebel, Sebastian; Labopin, Myriam; Czerw, Tomasz; Socie, Gerard; Blaise, Didier; Ghavamzadeh, Ardeshir; Passweg, Jacob; Ljungman, Per; Poire, Xavier; Chevallier, Patrice; Remenyi, Peter; Rambaldi, Alessandro; Anafasyev, Boris; Fegueux, Nathalie; Rovira, Montserrat; Itälä-Remes, Maija; Bornhaeuser, Martin; Mohty, Mohamad; Nagler, Arnon (2019)
    Background: Anti-thymocyte globulin (ATG) is widely used to prevent graft-versus-host disease (GVHD) after allogeneic peripheral blood stem cell transplantation (alloPBSCT). The goal of this study was to retrospectively assess the effect of ATG on outcomes in the setting of Philadelphia chromosome-positive acute lymphoblastic leukaemia (Ph+ ALL). Methods: In the analysis, 1170 adult patients undergoing alloPBSCT from human leucocyte antigen-matched sibling or unrelated donors in the first complete remission between 2007 and 2016 were included. ATG was used in 429/575 (75%) and 121/595 (20%) patients transplanted from unrelated or sibling donors, respectively. Results: The incidence of chronic GVHD was 35% for patients treated with ATG compared with 52% in those not receiving ATG (p <0.001), while the rate of extensive chronic GVHD was 16% and 36%, respectively (p <0.001). The probability of survival free from GVHD and relapse (GRFS) was 42% and 32%, respectively (p = 0.002). In a multivariate model, the use of ATG was associated with reduced risk of overall chronic GVHD (hazard ratio [HR] = 0.52, p <0.001) and extensive chronic GVHD (HR = 0.46, p <0.001). It was also associated with better GRFS (HR = 0.77, p = 0.007), despite increased risk of relapse (HR = 1.41, p = 0.02). No significant effect was found with regard to the risk of non-relapse mortality and overall mortality. Conclusions: The use of ATG for patients with Ph+ ALL undergoing alloPBSCT is associated with reduced risk of chronic GVHD without impact on survival and therefore, could be considered. However, increased risk of relapse suggests the need for strict monitoring of minimal residual diseases and appropriate interventions after transplantation. (C) 2018 Elsevier Ltd. All rights reserved.
  • Giebel, Sebastian; Labopin, Myriam; Socie, Gerard; Beelen, Dietrich; Browne, Paul; Volin, Liisa; Kyrcz-Krzemien, Slawomira; Yakoub-Agha, Ibrahim; Aljurf, Mahmoud; Wu, Depei; Michallet, Mauricette; Arnold, Renate; Mohty, Mohamad; Nagler, Arnon (2016)
    Allogeneic hematopoietic cell transplantation is widely used to treat adults with high-risk acute lymphoblastic leukemia. The aim of this study was to analyze whether the results changed over time and to identify prognostic factors. Adult patients treated between 1993 and 2012 with myeloablative allogeneic hematopoietic cell transplantation from HLA matched sibling (n=2681) or unrelated (n=2178) donors in first complete remission were included. For transplantations from sibling donors performed between 2008 and 2012, 2-year probabilities of overall survival were: 76% (18-25 years old), 69% (26-35 and 36-45 years old) and 60% (46-55 years old). Among recipients of transplantations from unrelated donors, the respective survival rates were 66%, 70%, 61%, and 62%. In comparison with the 1993-2007 period, significant improvements were observed for all age groups except for the 26-35-year old patients. In a multivariate model, transplantations performed between 2008 and 2012, when compared to 1993-2007, were associated with significantly reduced risks of non-relapse mortality (Hazard Ratio 0.77, P=0.00006), relapse (Hazard Ratio 0.85, P=0.007), treatment failure (Hazard Ratio 0.81, P
  • Homsy, Pauliina; Blomqvist, Carl; Heiskanen, Ilkka; Vikatmaa, Leena; Tukiainen, Erkki; Numminen, Kirsti; Sampo, Mika; Leppäniemi, Ari; Albäck, Anders; Kantonen, Ilkka; Vikatmaa, Pirkka (2020)
    Objective: Radical excision of retroperitoneal or intra-abdominal soft tissue sarcomas may necessitate vessel resection and reconstruction. The aim of this study was to assess surgical results of retroperitoneal or intra-abdominal sarcomas involving major blood vessels. Methods: This was a retrospective single centre cohort study and a comprehensive review of literature. Patients with retroperitoneal or intra-abdominal sarcomas treated by the oncovascular team in Helsinki University Hospital from 2010 to 2018 were reviewed for vascular and oncological outcomes. A comprehensive literature review of vascular reconstructions in patients with retroperitoneal sarcoma was performed. Results: Vascular reconstruction was performed in 17 patients, 11 of whom required arterial reconstructions. Sixteen of the operations were sarcoma resections; the post-operative diagnosis for one patient was thrombosis instead of the presumed recurrent leiomyosarcoma. Early graft thrombosis occurred in two venous and one arterial reconstruction. Late thrombosis was detected in three (18%). The median follow up was 27 (range 0-82) months. Of the patients with sarcoma resections 5 (31%) died of sarcoma and further 4 (25%) developed local recurrence or new distant metastases. The comprehensive review of literature identified 37 articles with 110 patients, 89 of whom had inferior vena cava reconstruction only. Eight arterial reconstructions were described. Late graft thrombosis occurred in 14%. The follow up was 0-181 months, during which 57% remained disease free and 7% died of sarcoma. Conclusion: Vascular reconstructions enable radical resection of retroperitoneal and intra-abdominal sarcomas in patients with advanced disease. The complex operations are associated with an acceptable rate of serious perioperative complications and symptomatic thrombosis of the repaired vessel is rare. However, further studies are needed to assess the performance of the vascular reconstructions in the long term.