Sang Seob Yun

Predictors of Postoperative Mortality of Ruptured Abdominal Aortic Aneurysm: A Retrospective Clinical Study

Purpose Despite significant improvements in surgery, anesthesia, and postoperative critical care, the postoperative mortality rate of ruptured abdominal aortic aneurysm (RAAA) has remained at 40% to 50% for several decades. Therefore, we evaluated factors associated with the postoperative mortality of RAAA. Materials and Methods From January 1999 to December 2008, a retrospective study was performed with 34 patients who underwent open repair of RAAA. The preoperative factors included age, sex, smoking, comorbidities, serum creatinine, hemoglobin, shock, pulse rate, and time from emergency room to operation room. The intraoperative factors included blood loss, transfusion, aortic clamping site and time, aneurysmal characteristics, rupture type, graft type, hourly urine output (HUO), and operative time. The postoperative factors included inotropic support, renal replacement therapy (RRT), reoperation, bowel ischemia, multiple organ failure (MOF), and intensive care unit stay. The 2-day and the 30-day mortality rates were analyzed separately. Results The 2-day and the 30-day mortality rates were 14.7% and 41.2%, respectively. On univariate analysis, shock, transfusion, HUO, inotropic support and MOF for the 2-day mortality and serum creatinine, transfusion, aortic clamping site, HUO, inotropic support, RRT and MOF for the 30-day mortality were statistically significant. On multivariate analysis, shock, inotropic support and MOF for the 2-day mortality and aortic clamping site, RRT and MOF for the 30-day mortality were statistically significant. Conclusion To decrease the postoperative mortality rate of RAAA, prevention of massive hemorrhage and acute renal failure with infrarenal aortic clamping, as well as prompt operative control of bleeding and maintenance of systemic perfusion are important.

Different Effects of Orbital Shear Stress on Vascular Endothelial Cells: Comparison with the Results of In Vivo Study with Rats

Purpose: An attempt was made to characterize the orbital shear stress by comparing the effects of orbital shear stress on vascular endothelial cells (ECs) with the results of animal experiments. Materials and Methods: In the laboratory study, cultured ECs of well were distinguished by center and periphery then exposed to orbital shear stress using an orbital shaker. In the animal study, arteriovenous (AV) fistulas were made at the right femoral arteries of Sprague-Dawley rats to increase the effect of the laminar flow. The condition of the stenosis was given on the left femoral arteries. The protein expression of inducible nitric oxide synthase (iNOS) and Akt phosphorylation were observed and compared. Results: Under orbital shear stress, ECs showed an increase in iNOS protein expression and phosphorylation of Akt but most of the protein expressions derived from the periphery. When compared to the animal study, the increased expression of iNOS protein and phosphorylation of Akt were observed in the sample of AV fistula conditions and the iNOS protein expression was decreased in the stenosis conditions. Conclusion: Orbital shear stress did not show the characteristics of a pure turbulent shear force. By comparing the observation with the morphological changes of vascular ECs and site-specific protein expression on the results of animal experiments, uniform directional lamina shear stress forces were expressed at the periphery.

Kidney Transplantation from Living Donor Allograft with Small Renal Cell Cancer after Laparoscopic Partial Nephrectomy: A Case Report

Purpose The allograft shortage extended the limit of traditional criteria used for transplantation. Also to meet the eligible immunologic living donor, it seems suitable to use kidneys with a small renal cancer excised for transplant under the circumstance of scarce deceased donors. Possible risk for malignancy recurrences is still a controversial issue, though kidneys with satisfactory function can be transplanted as far as the recipients comprehend the benefits. The aim of this article is to present a case of living-donor transplantation following laparoscopic partial nephrectomy of small renal cell cancer. Methods A 48-year-old woman recipient with end-stage renal disease was carried on hemodialysis for more than 13 years. Her brother aged 42 was verified with small renal cell cancer (0.7cm) after donor preoperative renal CT scan was done. However, the donor’s renal function was excellent for renal transplantation and showed optimal HLA cross matching result, in contrast with recipients’ other relatives. The recipient and her family consented to have transplantation in a fully informed situation about the possible risk of post-transplant cancer recurrence. Results The graft partial nephrectomy was performed successfully via laparoscopic procedure without renal artery and vein clamping and then laparoscopic donor nephrectomy was carried out. Tumor mass was sent for pathologic analysis and verified normal margin before transplantation. Dual renal arteries were seen and anastomosed to the right external iliac artery end-to-side manner. After the operation, both donor and recipient are physically healthy and the creatinine level (range: 1.05-1.24) of recipient is stable and normal. Recipient is receiving maintenance immunosuppressant following our regimen and no other complications were noted. Conclusion To best of our acknowledgement, this was the first practice of laparoscopic in vivo partial nephrectomy before kidney transplantation. It would be beneficial to proceed with donor partial nephrectomy of renal cell cancer before kidney transplantation in the presence of wide disparity between donor and recipient, and for the best, long term follow-up is essential. Figure. No caption available. Figure. No caption available. Figure. No caption available.

Kidney transplantation using expanded criteria deceased donors with terminal acute kidney injury: a single center experience in Korea

Purpose We investigated the clinical outcomes of deceased donor kidney transplantation (KT) using kidneys with terminal acute kidney injury (AKI). Methods Between February 2000 and December 2013, we performed 202 deceased donor renal transplants from 159 brain dead donors. According to the expanded criteria donor (ECD) and AKI network criteria, we divided 202 recipients into 4 groups: Group I: Non-AKI & standard criteria donor (SCD) (n = 97); group II: Non-AKI & ECD (n = 15); group III: AKI & SCD (n = 52); and group IV: AKI & ECD (n = 38). Results The incidence of delayed graft function (DFG) was significantly higher in patients with AKI than it was in the non-AKI group (P = 0.008). There were no significant differences among the 4 groups in graft survival (P = 0.074) or patient survival (P = 0.090). However, the long-term allograft survival rate was significantly lower in group IV than it was in other groups (P = 0.024). Conclusion Allografts from deceased donors with terminal AKI had a higher incidence of DGF than did those from donors without AKI. However, there is no significant difference in graft and patient survival rates among the groups. So, the utilization of renal grafts from ECDs with terminal AKI is a feasible approach to address the critical organ shortage.