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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Black J, Cox M, Chung W, Lowe M, Barber J, Dennison AR, Bagul A, Yang B. O083 A proof of principle study of cell targeted delivery of sirna guided by innate repair receptor epor/βcr highly expressed by injured tubular epithelial cells in porcine kidneys subjected to extended cold ischaemia times. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Introduction
Small interfering RNA (siRNA) has been used in biological models for disease modification. Whilst challenges remain with targeted cell delivery, caspase-3, an executing enzyme of apoptosis and inflammation, plays a crucial role in acute kidney injury. Using caspase-3 siRNA or erythropoietin derived peptide CHBP, we have demonstrated renoprotection against ischaemia-reperfusion injury in isolated kidney preservation, and further applied the conjugate of both.
Methods
Porcine kidneys (n = 3) subjected to 10 minutes of warm ischemia were retrieved and perfused with 500 mL hyperosmolar citrate. In comparison with the control (Kidney 1) caspase-3 siRNAHBSP (Kidney 2) or CHBP (Kidney 3) conjugate was administered into the kidney and autologous blood and stored for 22 hours in ice. Organs were then preserved by normothermic perfusion (NP) for 3 hours using clinical-grade cardiopulmonary bypass. Functional parameters were recorded, and kidney biopsies were taken at time zero (pre-perfusion) and hourly intervals following NP.
Results
Preliminary findings showed increased arterial flow rate and urine output together with neutralised perfusate pH in the kidneys (2 and 3) receiving both conjugates compared to the control.
Conclusion
Improved physiological outcomes in kidneys subjected to the novel agent treatment suggest protective effects against ischaemia. We hypothesise outcomes should be transferrable to human kidneys, which may facilitate the use of marginal kidneys following prolonged ischaemia, otherwise deemed unsuitable for transplantation. Renal histological and molecular studies of the effect of the agent are underway.
Take-home message
Despite a small sample, this pilot proof of principle study suggests that caspase-3 inhibitors may have a role in limiting the detrimental effects of ischaemia on renal tissues subjected to prolonged cold ischaemic times. It is hoped that this may be beneficial if replicated in the human kidney model at increasing the deceased donor organ pool by enabling use of marginal kidneys subjected to prolonged ischaemic times.
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Affiliation(s)
- J Black
- Leicester General Hospital, University Hospitals of Leicester , UK
| | - M Cox
- Leicester General Hospital, University Hospitals of Leicester , UK
| | - W Chung
- Leicester General Hospital, University Hospitals of Leicester , UK
| | - M Lowe
- Leicester General Hospital, University Hospitals of Leicester , UK
| | - J Barber
- Leicester General Hospital, University Hospitals of Leicester , UK
| | - AR Dennison
- Leicester General Hospital, University Hospitals of Leicester , UK
| | - A Bagul
- Leicester General Hospital, University Hospitals of Leicester , UK
| | - B Yang
- Leicester General Hospital, University Hospitals of Leicester , UK
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Perston Y, Bagul A. Small bowel ileal conduit antegrade continence enema in adults with constipation. Ann R Coll Surg Engl 2022; 104:1-2. [DOI: 10.1308/rcsann.2021.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Y Perston
- QE University Hospital, Birmingham, UK
| | - A Bagul
- QE University Hospital, Birmingham, UK
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Ponnuswamy A, Thiyagarajan U, Bagul A, Gupta A. An Unusual Case of Resistant Hypokalaemia in a Patient With Large Bowel Obstruction Secondary to Neuroendocrine Carcinoma of the Prostate. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mathuram Thiyagarajan U, Ponnuswamy A, Bagul A, Gupta A. An Unusual Case of Resistant Hypokalaemia in a Patient with Large Bowel Obstruction Secondary to Neuroendocrine Carcinoma of the Prostate. Case Rep Surg 2017; 2017:2394365. [PMID: 28386507 PMCID: PMC5366774 DOI: 10.1155/2017/2394365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 02/14/2017] [Accepted: 02/20/2017] [Indexed: 11/25/2022] Open
Abstract
Neuroendocrine Carcinoma of the Prostate (NECP) is rare and only few cases have been reported, constituting less than 0.5% of prostatic malignancies. We report a rare case of large bowel obstruction from NECP posing a further challenge in management due to resistant hypokalaemia. A 70-year-old man presented with clinical signs of large bowel obstruction who was known to have prostatic carcinoma three years ago, treated initially with hormone therapy then chemoradiation. The blood profile showed a severe hypokalaemia and CT scan revealed liver and lung metastases apart from confirming large bowel obstruction from local invasion of NECP. Severe hypokalaemia was believed to be caused by paraneoplastic syndrome from tumor burden or by recent administration of Etoposide. Intensive potassium correction through a central venous access in maximal doses of 150 mmol/24 hours under cardiac monitoring finally raised serum potassium to 3.8 mmol/L. This safe period allowed us to perform a trephine colostomy at the left iliac fossa. The postoperative period was relatively uneventful. This first case report is presenting a rare cause of large bowel obstruction from a neuroendocrine carcinoma of prostate and highlights the importance of an early, intensive correction of electrolytes in patients with large tumor burden from NECP.
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Affiliation(s)
| | - A. Ponnuswamy
- Department of Paediatrics, Eastbourne District General Hospital, Eastbourne BN21 2UD, UK
| | - A. Bagul
- Department of Transplantation, Leicester General Hospital, Leicester LE5 4PW, UK
| | - A. Gupta
- Department of General Surgery, St Helier Hospital, Carshalton SM5 1AA, UK
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West H, Singh R, Bagul A, Doughman T, Rizzello A. Renal transplantation using donor grafts with complete ureteral duplication. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bagul A, McNicol F, Carter P. Quantifying quality of life (QOL) of patients treated with botox for chronic anal fissure. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Soliman M, Morsy M, Bagul A. Modification of the parachute technique to simplify vascular anastomosis in kidney transplantation. Ann R Coll Surg Engl 2014; 97:79. [PMID: 25519281 DOI: 10.1308/rcsann.2015.97.1.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- M Soliman
- St George's Healthcare NHS Trust, UK
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Abstract
BACKGROUND Preoperative imaging in patients undergoing surgery for primary hyperparathyroidism (PHPT) is used primarily to facilitate targeted parathyroidectomy. Failure of preoperative localisation mandates a bilateral exploration. It is thought that the results of imaging may also predict the success of surgery. The aims of this study were to assess whether the findings on preoperative localisation influenced outcomes following parathyroidectomy for PHPT and to explore factors underlying failure to cure at surgery. METHODS We analysed outcomes of all patients who underwent first-time surgery for PHPT in two centres over a 5-year period to determine an association with demographic characteristics and findings on preoperative imaging. Records of patients not cured by initial surgery were reviewed to explore factors underlying failure to cure. RESULTS The failure rate (persistent disease) in the entire cohort was 5 % (25/541) (bilateral neck explorations, 5 %; unilateral exploration, 7 %; targeted approach, 4 %), while two patients developed recurrent disease. In patients who had undergone dual imaging with an ultrasound scan and (99m)Tc-sestamibi scintigraphy, failure rates with "lateralised and concordant" imaging, "nonconcordant" imaging, and "dual-negative" imaging were 2, 9, and 11 %, respectively (p = 0.01). Of the 25 patients with persistent disease, multigland disease (MGD) was present in 52 % (13/25) and ectopic adenoma in 24 % (6/12). CONCLUSIONS Patients with PHPT who do not have lateralised and concordant dual imaging are at higher risk of persistent disease. A significant proportion of failures are due to the inability to recognise the presence and/or extent of MGD.
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Affiliation(s)
- A Bagul
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK,
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Bagul A, Patel HP, Chadwick D, Harrision BJ, Balasubramanian SP. Authors reply to letter to editor: primary hyperparathyroidism: an analysis of failure of parathyroidectomy. World J Surg 2014; 38:2483. [PMID: 24798027 DOI: 10.1007/s00268-014-2603-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Bagul
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2RX, UK,
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Hossain MA, Bagul A. Normothermic perfusion of extended criteria donor kidneys utilizing an ex vivo machine. Am J Transplant 2013; 13:2501-2. [PMID: 23915115 DOI: 10.1111/ajt.12376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 01/25/2023]
Affiliation(s)
- M A Hossain
- Department of Renal Transplantation, St. Georges Hospital NHS Trust, London, UK
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Bagul A, Clarke A. T-shaped mesh improvisation for laparoscopic ventral mesh rectopexy: a novel technique. Ann R Coll Surg Engl 2013. [PMID: 23317740 PMCID: PMC3964650 DOI: 10.1308/003588413x13511609957056f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Bagul
- Poole Hospital NHS Foundation Trust, UK.
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Affiliation(s)
- A Bagul
- Poole Hospital NHS Foundation Trust, UK
| | - A Clarke
- Poole Hospital NHS Foundation Trust, UK
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Bagul A, Koay Y, Jack S, Shrotri M. 486. Does Incentive Spirometry Influence Lung Functions in Patients Awaiting Major Oesophageal/gastric Surgery? Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
The internal iliac artery is less commonly used in renal transplantation in comparison to the external iliac artery due to its size and the risk of compromising distal vascular supply to the pelvis. We report a cadaveric renal transplant in which we performed a side-to-end anastomosis using the internal iliac artery. This technique can provide adequate perfusion to the transplant kidney without the associated risks and complications in the patient whose internal iliac artery is of a good diameter and quality.
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Affiliation(s)
- I H Mohamed
- Department of Transplant Surgery, Leicester General Hospital, UK.
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Thiyagarajan UM, Bagul A, Frost J, Horsburgh T, Nicholson M. Role of Human Leukocyte Antigen, Donor-Specific Antibodies, and Their Impact in Renal Transplantation. Transplant Proc 2012; 44:1231-5. [DOI: 10.1016/j.transproceed.2011.10.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 10/27/2011] [Indexed: 10/28/2022]
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Bagul A, Firmin LC, Thiyagarajan UM, Nicholson ML. Laparoscopic reinsertion/exchanges of peritoneal dialysis catheters using the modified Y-TEC(®) system. Ann R Coll Surg Engl 2011. [PMID: 21944805 DOI: 10.1308/003588411x570909c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Bagul
- Leicester General Hospital, UK.
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Bagul A, Jones S, Dundas S, Aly EH. Endometriosis in the canal of Nuck hydrocele: An unusual presentation. Int J Surg Case Rep 2011; 2:288-9. [PMID: 22096756 PMCID: PMC3215261 DOI: 10.1016/j.ijscr.2011.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 03/01/2011] [Accepted: 03/29/2011] [Indexed: 10/17/2022] Open
Abstract
The authors describe an unusual rare presentation of endometriosis in a hydrocoele of the canal of Nuck. A 43-year-old lady presented with a swelling in her right groin associated with mild discomfort. Examination revealed a cystic swelling in the groin for which she underwent an exploration and excision of the swelling. Surgery revealed a hydrocele of the canal of Nuck which was confirmed histologically. The unusual presentation of endometriosis in the sac was confirmed immunocytochemically.
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Affiliation(s)
- A. Bagul
- Colorectal Surgical Unit, Aberdeen Royal Infirmary, Aberdeen AB25 2ZD, United Kingdom
| | - S. Jones
- Colorectal Surgical Unit, Aberdeen Royal Infirmary, Aberdeen AB25 2ZD, United Kingdom
| | - S. Dundas
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZD, United Kingdom
| | - Emad H. Aly
- Colorectal Surgical Unit, Aberdeen Royal Infirmary, Aberdeen AB25 2ZD, United Kingdom
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Thiyagarajan UM, Bagul A, Mohamed I, Nicholson ML. Post-biopsy renal allograft compartment syndrome: Addressing the problem, illustrated with a case report. Int J Surg Case Rep 2011; 2:188-90. [PMID: 22096723 DOI: 10.1016/j.ijscr.2011.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Accepted: 06/13/2011] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Renal allograft compartment syndrome (RACS) has recently been coined to describe early allograft dysfunction secondary to raised pressure in the retroperitoneal space. This may be caused by direct compression of the renal vessels or by a diffuse renal parenchymal compression. Herein, we report a renal allograft compartment syndrome secondary to a needle core transplant biopsy and discuss the management strategies in line with an updated literature review. PRESENTATION OF CASE A retrospective case-note review was carried out where a 45-year-old male had a transplant renal biopsy at 4-weeks after transplant for raising creatinine. Following biopsy patient developed abdominal discomfort and had haematuria. DISCUSSION Doppler ultrasound scanning of graft demonstrated good perfusion but a small haematoma (2 × 2 × 2 cm) in the upper pole of the kidney at the site of the biopsy. Patient was thereafter assessed conservatively with serial ultrasound monitoring. After 24 h, significant deterioration of graft function was observed. The third scan, demonstrated reversed flow in diastole in the upper pole of the kidney with a resistive index of 1.0 in the main renal vessel. With the above findings the kidney transplant was explored immediately and the transplant released from a 300 ml of liquefied haematoma, which was under considerable pressure. In the next 24-h, the patient showed an immediate return of graft function. CONCLUSION We recommend sequential ultrasound Doppler scanning as an invaluable tool to help identify early RACS. The surgical exploration and adequate heamostasis with surgical glue should be sought out in all RACS.
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Affiliation(s)
- U Mathuram Thiyagarajan
- Department of Infection, Immunity & Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom
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Bagul A, Firmin LC, Thiyagarajan UM, Nicholson ML. Laparoscopic reinsertion/exchanges of peritoneal dialysis catheters using the modified Y-TEC® system. Ann R Coll Surg Engl 2011; 93:322-3. [DOI: 10.1308/rcsann.2011.93.4.322b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Bagul
- Leicester General Hospital Leicester, UK
| | - LC Firmin
- Leicester General Hospital Leicester, UK
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Hosgood SA, Mohamed IH, Bagul A, Nicholson ML. Hypothermic machine perfusion after static cold storage does not improve the preservation condition in an experimental porcine kidney model. Br J Surg 2011; 98:943-50. [DOI: 10.1002/bjs.7481] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2011] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Combining hypothermic techniques, as a more practical approach to preservation, may enhance the condition of kidneys donated after cardiac death.
Methods
Porcine kidneys were retrieved after 10 min in situ warm ischaemia, then preserved by either 18 h static cold storage (CS), hypothermic machine perfusion for 18 h (HMP) or 14 h static CS followed by 4 h HMP (4HMP). Kidneys were reperfused for 3 h with oxygenated autologous blood on an isolated organ perfusion system to assess renal function and injury.
Results
Intrarenal resistance was significantly higher in the 4HMP group than in the CS and HMP groups: mean(s.d.) area under the curve (AUC) 8·48(2·97), 3·41(1·80) and 3·78(1·68) mmHg/min.h respectively (P = 0·011). Creatinine clearance was lower after 4HMP and CS: AUC 2·3(0·6) and 2·2(1·7) ml per min per 100g.h respectively versus 9·8(7·3) ml per min per 100g.h in the HMP group (P = 0·022). Levels of endothelin 1 were higher in the 4HMP and CS groups: mean(s.d.) 21·6(4·0) and 24·2(2·3) pg/ml respectively versus 11·4(4·6) pg/ml in the HMP group (P = 0·002). Morphological damage was increased in the 4HMP group.
Conclusion
This porcine kidney study demonstrated no advantage to the addition of 4 h of HMP after CS.
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Affiliation(s)
- S A Hosgood
- Department of Infection, Immunity and Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - I H Mohamed
- Department of Infection, Immunity and Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - A Bagul
- Department of Infection, Immunity and Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - M L Nicholson
- Department of Infection, Immunity and Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
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Bagul A, Jones S, Usmani C. Control of postoperative bleeding following a procedure for prolapse and haemorrhoids: a novel technique. Ann R Coll Surg Engl 2011. [PMID: 21477454 DOI: 10.1308/003588411x12851639107395j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Bagul
- Department of Colorectal Surgery, Dorset County Hospital, Dorchester, UK.
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Bagul A, Jones S, Usmani C. Control of postoperative bleeding following a procedure for prolapse and haemorrhoids: a novel technique. Ann R Coll Surg Engl 2011; 93:263. [DOI: 10.1308/rcsann.2011.93.3.263a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Bagul
- Department of Colorectal Surgery, Dorset County Hospital Dorchester, UK
| | - S Jones
- Department of Colorectal Surgery, Dorset County Hospital Dorchester, UK
| | - C Usmani
- Department of Colorectal Surgery, Dorset County Hospital Dorchester, UK
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Nicholson ML, Kaushik M, Lewis GRR, Brook NR, Bagul A, Kay MD, Harper SJ, Elwell R, Veitch PS. Randomized clinical trial of laparoscopic versus open donor nephrectomy. Br J Surg 2009; 97:21-8. [DOI: 10.1002/bjs.6803] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
This randomized controlled trial was designed to determine the safety and efficacy of laparoscopic donor nephrectomy (LDN) in comparison with short-incision open donor nephrectomy (ODN).
Methods
Eighty-four live kidney donors were randomized in a 2 : 1 ratio to LDN (56 patients) or short-incision ODN without rib resection (28). Primary endpoints were pain relief and duration of inpatient stay.
Results
There was no donor death or allograft thrombosis in either group. The first warm ischaemic time median (range) 4 (2–7) versus 2 (1–5) min; P = 0·001) and the duration of operation (160 (110–250) versus 150 (90–200); P = 0·004) were longer for LDN. LDN led to a reduction in parenteral morphine requirement 59 (6–136) versus 90 (35–312) mg; P = 0·001) and hospital stay (4 (2–6) versus 6 (2–9) days; P = 0·001), and earlier return to employment (42 (14–84) versus 66·5 (14–112) days; P = 0·004). Postoperative respiratory function was improved after LDN. There were more postoperative complications per donor in the ODN group (0·6(0·7) versus 0·3(0·5); P = 0·033). At a median follow-up of 74 months, there were no differences in renal function or allograft survival between the groups.
Conclusion
LDN removes some of the disincentives to live donation without compromising the outcome of the recipient transplant.
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Affiliation(s)
- M L Nicholson
- Transplant Surgery Group, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - M Kaushik
- Transplant Surgery Group, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - G R R Lewis
- Transplant Surgery Group, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - N R Brook
- Transplant Surgery Group, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - A Bagul
- Transplant Surgery Group, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - M D Kay
- Transplant Surgery Group, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - S J Harper
- Transplant Surgery Group, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - R Elwell
- Transplant Surgery Group, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - P S Veitch
- Transplant Surgery Group, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
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25
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Kay MD, Hosgood SA, Bagul A, Nicholson ML. Comparison of preservation solutions in an experimental model of organ cooling in kidney transplantation. Br J Surg 2009; 96:1215-21. [DOI: 10.1002/bjs.6681] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Viscous preservation solutions such as University of Wisconsin solution (UW) may be less effective at rapid removal of blood from an organ so that cooling takes longer. This study assessed the temperature changes of kidneys flushed with UW and hyperosmolar citrate (HOC).
Methods
Porcine kidneys were retrieved and flushed with 500 ml UW or HOC at 4 °C while monitoring kidney temperature at depths of 5 and 20 mm. Renal function was measured on an isolated organ preservation system.
Results
The mean(s.d.) rate of temperature fall was slower with UW (at 20 mm: 0·64(0·11) versus 1·01(0·56) °C per min per 100 g; P = 0·016). The perfusion flow rate required to reduce the temperature to less than 10 °C at a depth of 20 mm was lower in the UW group (P = 0·002). Kidneys flushed with HOC gained more weight than those flushed with UW (mean(s.d.) 50(8) versus 7(13) per cent; P = 0·002). Flushing with UW was associated with less histological injury but there were no significant differences in renal function parameters between the groups.
Conclusion
UW cooled kidneys more slowly than HOC, but with no adverse effect on renal function. UW resulted in less oedema and histological injury than HOC.
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Affiliation(s)
- M D Kay
- Transplant Group, Department of Infection, Immunity and Inflammation University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - S A Hosgood
- Transplant Group, Department of Infection, Immunity and Inflammation University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - A Bagul
- Transplant Group, Department of Infection, Immunity and Inflammation University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - M L Nicholson
- Transplant Group, Department of Infection, Immunity and Inflammation University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
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26
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Yates PJ, Bagul A, Doughman T, Nicholson ML. Non-ligation of the distal cephalic vein maintains patency of median cubital vein arteriovenous fistulae. Ann R Coll Surg Engl 2009; 91:84-5. [PMID: 19148973 DOI: 10.1308/rcsann.2009.91.1.84b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- P J Yates
- Department of Transplant Surgery, Leicester General Hospital, Leicester, UK.
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27
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Hosgood SA, Bagul A, Kaushik M, Rimoldi J, Gadepalli RS, Nicholson ML. Application of nitric oxide and carbon monoxide in a model of renal preservation. Br J Surg 2008; 95:1060-7. [DOI: 10.1002/bjs.6174] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract
Background
Nitric oxide and carbon monoxide exert vasodilatory effects that minimize ischaemia–reperfusion injury. An isolated porcine kidney model was used to assess the effects of administering the nitric oxide donor sodium nitroprusside (SNP) and carbon monoxide-releasing molecule (CORM) 3 during a period of warm preservation followed by reperfusion.
Methods
Kidneys were perfused under warm preservation conditions after 10 min of warm ischaemia and 16 h of cold storage in four groups: SNP, control, CORM-3 and inactive CORM-3 (inactive control). Renal function and viability were assessed.
Results
SNP and CORM-3 increased renal blood flow (RBF) during warm preservation (P = 0·014). After reperfusion, RBF was significantly improved in the CORM-3 group compared with the control group (P = 0·019). The reduction in creatinine clearance was significantly less in the CORM-3 group than in the inactive CORM-3 group (P = 0·021), and serum creatinine levels were significantly lower (P = 0·029). There was a negative correlation between RBF during warm preservation and functional parameters during reperfusion (creatinine concentration: rs = − 0·722, P < 0·001; sodium excretion: rs = − 0·912, P < 0·001).
Conclusion
The beneficial vasodilatory effects of CORM-3 during warm preservation improved renal function during reperfusion; SNP exerted similar, although less pronounced, effects.
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Affiliation(s)
- S A Hosgood
- Department of Transplant Surgery, University Hospitals of Leicester, Leicester, UK
| | - A Bagul
- Department of Transplant Surgery, University Hospitals of Leicester, Leicester, UK
| | - M Kaushik
- Department of Transplant Surgery, University Hospitals of Leicester, Leicester, UK
| | - J Rimoldi
- Department of Medicinal Chemistry, University of Mississippi, 331 Faser Hall, University, MS 38677, USA
| | - R S Gadepalli
- Department of Transplant Surgery, University Hospitals of Leicester, Leicester, UK
| | - M L Nicholson
- Department of Transplant Surgery, University Hospitals of Leicester, Leicester, UK
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28
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Bagul A, Hosgood SA, Kaushik M, Kay MD, Waller HL, Nicholson ML. Experimental renal preservation by normothermic resuscitation perfusion with autologous blood. Br J Surg 2008; 95:111-8. [PMID: 17696214 DOI: 10.1002/bjs.5909] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Normothermic perfusion (NP) has the potential to improve metabolic support and maintain the viability of ischaemically damaged organs. This study investigated the effects of NP compared with current methods of organ preservation in a model of controlled non-heart-beating donor (NHBD) kidneys. METHODS Porcine kidneys (n = 6 in each group) were subjected to 10 min warm ischaemia and then preserved as follows: 2 h cold storage (CS) in ice (CS2 group), 18 h CS (CS18 group), 18 h cold machine perfusion (CP group) or 16 h CS + 2 h NP (NP group). Renal haemodynamics and function were measured during 3 h reperfusion with autologous blood using an isolated organ perfusion system. RESULTS Increasing CS from 2 to 18 h reduced renal blood flow (mean(s.d.) area under the curve (AUC) 444(57) versus 325(70) ml per 100 g; P = 0.004), but this was restored by NP (563(119) ml per 100 g; P = 0.035 versus CS18). Renal function was also better in CS2, CP and NP groups than in the CS18 group (mean(s.d.) serum creatinine fall 92(6), 79(9) and 64(17) versus 44(13) per cent respectively; P = 0.001). The AUC for serum creatinine was significantly lower with CS for 2 h than for 18 h (mean(s.d.) 1102(2600) versus 2156(401) micromol/l.h; P = 0.001), although values in CP and NP groups were not significantly different from those in the CS2 group (1354(300) and 1756(280) micromol/l.h respectively). Two hours of NP increased the adenosine 3'-triphosphate : adenosine 3'-diphosphate ratio to a significantly higher level than the preperfusion values in all other groups (P = 0.046). CONCLUSION NP with oxygenated blood was able to restore depleted ATP levels and reverse some of the deleterious effects of CS.
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Affiliation(s)
- A Bagul
- Department of Transplant Surgery, University Hospitals of Leicester, Leicester, UK
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29
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Bagul A, Brook NR, Kaushik M, Nicholson ML. Tunnelled Catheters for the Haemodialysis Patient. Eur J Vasc Endovasc Surg 2007; 33:105-12. [PMID: 17067828 DOI: 10.1016/j.ejvs.2006.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Accepted: 08/25/2006] [Indexed: 11/21/2022]
Abstract
Haemodialysis depends upon the establishment of a durable means of vascular access. Although the creation of a successful arterio-venous Fistulae (AVF) is the ideal, this is not always possible or practical. Tunnelled catheters play an important role as an interim/bridge technique for emergency access or while an AVF matures, but may be associated with significant morbidity. The aim of this review is to highlight recent evidence based developments in tunnelled catheters, including methods of placement, complications and possible management strategies.
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Affiliation(s)
- A Bagul
- Transplant Department, Leicester General Hospital, Leicester, UK.
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30
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Kaushik M, Bagul A, Yates PJ, Elwell R, Nicholson ML. Comparison of Techniques of Vascular Control in Laparoscopic Donor Nephrectomy: The Leicester Experience. Transplant Proc 2006; 38:3406-8. [PMID: 17175287 DOI: 10.1016/j.transproceed.2006.10.142] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objective of this study was to compare the safety and efficacy of three different methods to secure the renal vessels during laparoscopic donor nephrectomy (LDN). METHODS Vessel lengths and intraoperative vascular complications were compared in a prospective series of 106 LDNs in which the vessels had been secured using a stapling device, metal clips, or polymer clips. RESULTS One hundred six patients underwent LDN (right = 25, left = 81). Renal vein lengths were not significantly different after stapling or using polymer clips (36 +/- 10 vs 37 +/- 9 mm; P = .463). Renal arterial length was shorter after stapling (30 +/- 7 mm) compared with both endoclips (34 +/- 10 mm; P = .030) and polymer clips (34 +/- 8 mm; P = .030). There was one major arterial bleed in the endoclip group, one episode of stapler malfunction, but no adverse events with polymer clips. CONCLUSION Polymer clips are safe and yield greater vessel lengths during LDN.
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Affiliation(s)
- M Kaushik
- Department of Cardiovascular Sciences, Transplant Group, University Hospitals of Leicester, Leicester General Hospital, Leicester, LE5 4PW, United Kingdom
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31
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Abstract
OBJECTIVE Mycophenolate Mofetil (MMF) is a key component of available immunosuppressant regimens for transplantation. Traditionally a dose of 2 g/d is utilized, with the incidence of side effects, most notably gastrointestinal, being well known to transplant teams. The aim of this study was to assess the incidence of side effects and rejection rates with reduced doses compared to standard regimens of MMF. METHODS Case notes of 117 renal transplants performed from 2002 to 2004 were reviewed retrospectively for the incidence of side effects and rejection rates for MMF doses of 1 g twice a day (n = 86) versus 500 mg twice a day (n = 27). RESULTS All patients received MMF, steroids, and a calcineurin inhibitor or sirolimus. The incidence of side effects was higher at 1 g twice a day. Seventy-nine percent of the patients required dose reductions due to side effects. The incidence of acute rejection episodes was similar in both groups. CONCLUSION The balance between adequate immunosuppression, side effects, and the risk of rejection is a constant dilemma faced by transplant surgeons. This study showed a reduced side effect profile with similar rejection rates when using a lower-dose regimen of MMF. This may have implications for future immunosuppressive protocols.
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Affiliation(s)
- M Kaushik
- Division of Transplant Surgery, University of Leicester, Leicester, UK.
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32
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Bagul A, Doughman T, Yates PJ, Nicholson ML. Internal jugular tunnelled dialysis catheters: a method permitting repeated surgical insertions. Ann R Coll Surg Engl 2006; 88:503. [PMID: 17014031 PMCID: PMC1964693 DOI: 10.1308/rcsann.2006.88.5.503b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Bagul
- Department of Transplant Surgery, Leicester General Hospital, Leicester, UK.
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33
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Reddy VM, Bagul A, Qureshi AA, Nicholson ML. A Simple Technique to Control a Bleeding Arteriovenous Fistula. Ann R Coll Surg Engl 2006. [DOI: 10.1308/rcsann.2006.88.6.592c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- VM Reddy
- Department of Transplant Surgery, Leicester General Hospital Leicester, UK
| | - A Bagul
- Department of Transplant Surgery, Leicester General Hospital Leicester, UK
| | - AA Qureshi
- Department of Transplant Surgery, Leicester General Hospital Leicester, UK
| | - ML Nicholson
- Department of Transplant Surgery, Leicester General Hospital Leicester, UK
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34
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Affiliation(s)
- A Bagul
- Department of Transplant Surgery, Leicester General Hospital, Leicester, UK.
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35
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Hosgood S, Harper S, Kay M, Bagul A, Waller H, Nicholson ML. Effects of arterial pressure in an experimental isolated haemoperfused porcine kidney preservation system. Br J Surg 2006; 93:879-84. [PMID: 16673356 DOI: 10.1002/bjs.5381] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Normothermic preservation provides metabolic support to an ischaemically damaged organ before use as a kidney transplant. Optimal conditions for ex vivo preservation have not yet been established. This study examined the effects of arterial pressure on renal preservation using isolated haemoperfused kidneys.
Methods
An isolated organ preservation system, developed using cardiopulmonary bypass technology, was used to perfuse porcine kidneys with normothermic oxygenated blood. Groups of kidneys (n = 6) were perfused at a mean arterial pressure of 95, 75 or 55 mmHg.
Results
Kidneys perfused at the higher mean arterial pressures of 95 and 75 mmHg demonstrated improved renal function: mean(s.d.) area under the curve (AUC) for creatinine clearance 71(19) and 55(30) respectively versus 14(12) in the 55-mmHg group, P = 0·002; AUC for serum creatinine 938(140) and 1290(394) versus 2404(595), P = 0·003. The higher perfusion pressures were also associated with better acid–base homeostasis and improved renal haemodynamics.
Conclusion
Mean arterial pressures of either 95 or 75 mmHg were capable of sustaining physiological renal function, but kidneys in the 95-mmHg group demonstrated superior renal function overall.
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Affiliation(s)
- S Hosgood
- Department of Cardiovascular Sciences, Transplant Group, University of Leicester, Leicester General Hospital, Leicester, UK
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36
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Bagul A, Brook NR, Harper SJF, Nicholson ML. Vascular clamping of calcified vessels: the peanut technique. Ann R Coll Surg Engl 2006; 88:77. [PMID: 16468141 PMCID: PMC1963617 DOI: 10.1308/rcsann.2006.88.1.77a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Bagul
- Department of Transplant Surgery, Leicester General Hospital, Leicester, UK.
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37
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Bagul A, Taha R, Metcalfe MS, Brook NR, Nicholson ML. Pre-incision infiltration of local anesthetic reduces postoperative pain with no effects on bruising and wound cosmesis after thyroid surgery. Thyroid 2005; 15:1245-8. [PMID: 16356087 DOI: 10.1089/thy.2005.15.1245] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Optimizing postoperative pain control is an important aspect in perioperative patient care. The aim of this study was to investigate the efficacy of preincision local anesthetic infiltration in postoperative pain management for thyroid surgery and its relationship to bruising and wound cosmesis. In a randomized single-blinded study, 39 consecutive patients listed for thyroid surgery were assigned into two groups. Group I (n = 19) received subcuticular preincision infiltration with 10 ml of bupivacaine (0.5%) and Group II (n = 20) received no infiltration. Postoperatively, the pain experienced was evaluated by two methods: verbal response scores and linear analogue scores (0-100 mm) at different time intervals following surgery. Bruising and cosmetic effects resulting from surgery were assessed using a linear analogue score at discharge. The two groups were well matched for confounding variables. Pain scores were significantly different at 6 hours post operatively (p = 0.0341) with mean scores Group I = 33 and Group II = 50, but this difference disappeared at 24 hours. No patients (0%) received IV morphine in Group I compared to 5 patients (25%) in Group II. There was no significant difference in the mean bruising scores (p = 0.8864) and mean cosmetic scores (p = 0.3339) at discharge. Preincision infiltration with bupivacaine provides easy and better analgesic control postoperatively in patients following thyroid surgery with no effects on bruising or wound cosmesis.
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Affiliation(s)
- A Bagul
- Department of Transplant and Endocrine Surgery, Leicester General Hospital, UK.
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38
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Brook NR, Harper SJ, Bagul A, Elwell R, Nicholson ML. Laparoscopic Donor Nephrectomy Yields Kidneys With Structure and Function Equivalent to Those Retrieved by Open Surgery. Transplant Proc 2005; 37:625-6. [PMID: 15848478 DOI: 10.1016/j.transproceed.2004.12.292] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The technical challenges of laparosopcic transperitoneal donor nephrectomy (LapDN) have raised concerns over the quality of the procured allografts. This study reports the anatomical and functional outcomes of kidneys retrieved from 60 live donors entered into a randomized controlled trial of open versus laparoscopic procurement. Open and laparoscopic donors were well matched for age (P = .18) and body mass index (P = .49). Operating time (P = .0001) and first warm ischaemic time (P < .001) were longer for the laparoscopic donors but total warm time was not different (P = .52). Left renal vein length (P = .14) and left renal artery length (P = .38) were similar. No differences in right vessel length were observed. Rates of acute rejection did not differ, and recipient renal function was similar in the two groups. This study demonstrates that LapDN yields kidneys that are structurally and functionally equivalent to those acquired by the open operation. This data may go some way towards allaying concerns over the effect of laparoscopic procurement on live donor kidneys.
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Affiliation(s)
- N R Brook
- University of Leicester, Leicester, UK.
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39
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Agaba AE, Bagul A, Adenugba JB, Kenogbon JI. Audit of patient's waiting time to see their family doctor prior to referral to a fast-access breast clinic in the era of a guaranteed 2-week wait. Breast 2002; 11:430-3. [PMID: 14965707 DOI: 10.1054/brst.2002.0449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2002] [Revised: 04/11/2002] [Accepted: 04/24/2002] [Indexed: 11/18/2022] Open
Abstract
PURPOSE A prospective study aimed at assessing the effect of introduction of a fast-tract referral system for patients with suspected breast cancer and the quality of GP referrals in Barnsley. METHODS Between February and April 2001, 70 consecutive patients with symptomatic breast disorders were seen in the fast-access breast clinic. Mean age=46 years (range 18-84). Ten non-urgent referrals seen in the study period were included in the analysis to determine the appropriateness of such referrals. Three screening criteria were used to select high-risk patients and data were recorded prospectively. Patients were classified as urgent, soon or routine based on symptomatology. RESULTS Of the 70 patients seen, 20 were considered as urgent, 20 as soon and 30 as routine. Forty patients were seen within the '2-week wait' period. Twelve were classified on clinical grounds as malignant. Mean waiting time to see the GP was 2.2 days. Mean waiting time to see the specialist breast surgeon was 6.6 days. CONCLUSION A fast-track system for suspected breast cancer has led to a significant reduction in the time to diagnosis and initiation of a definitive treatment, with most made within 2 weeks. Fast-track referrals is not appropriate in all cases.
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Affiliation(s)
- A E Agaba
- Breast Unit, Barnsley District General Hospital, Barnsley, South Yorkshire, UK.
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