Biomedical subjects
Publications and source records attributed to S Avramov.
The authors review their results of five year follow up of renal transplantation. They summarised the results of treatment with three immunosuppressive regimens. There is an analysis of rejection episodes, recurrent glomerulonephritis, infections, surgical complications, a median graft as well as patient survival and other patterns of complications of renal transplantation.
Between 1982 and 1991 we performed eight operations on seven patients with carotid artery aneurysms. Their mean age was 52.8 years (range: 20-67 years). Five aneurysms were atherosclerotic, one was associated with Marfan's syndrome, and two were pseudoaneurysms, one occurring after Dacron patch angioplasty and the other due to tuberculosis. Seven aneurysms were treated electively; one patient underwent an emergency surgical procedure. In one case, the internal carotid artery was ligated. Seven operations were reconstructive. No intraluminal shunt was used. No perioperative deaths occurred. Regressive hemiparesis and ipsilateral Horner's syndrome developed in one patient. The follow-up period ranged from six months to nine and a half years. One patient died of myocardial infarction three months after surgery.
The interdisciplinary transplant team on Medical faculty--Novi Sad is formed at the beginning of the 1986, and first successfully cadaver binephrectomy was performed in April 1986, and kidneys was transported in Transplant Centre in Belgrade. The first human renal transplantation with cadaveric kidney was performed 20, May 1986, and result was excellent. The first human renal transplantation with living related kidney was performed 27, Sept 1986, and result also was excellent. During the last three years our transplant team performed 32 renal transplantations. cadaveric kidney transplantations - 25 living-related kidney transplantation - 6 kidney autotransplantation - 1 Our Concept and organisation of interdisciplinary transplant team in Medical Faculty--Novi Sad is the very efficacy model of organisation and at the same time the cheapest solution. In this paper we discuss our organization of human renal transplantation, and technique of donor-neprectomy (cadaveric and living-related) and cold perfusion of kidney with Collins solution. Our rules for implantation are shown as the Algorythm. At the end of this paper we present our results, based on three year's experience and list of the members of our interdisciplinary transplant team.
From 1983 to 1988 on the Department for Experimental Surgery 20 preservations of the liver has been done, with ice cold Euro- Collins and Ringer solutions, either with in situ or with on banch technique after fast expantation. On five dogs standard 55% left hepatectomy has been done and the right side preserved in situ. Partial heterotopic liver transplantation to the right iliac fossa was performed on five dogs. Total vascular exclusion of the liver and extracorporal inierior vena cava and jugular vein by pass with assisted circulation was performed on one dog, without assistance on four dogs. Total orthotopic liver transplantation was performed on two dogs. The surgical team practiced the technique of liver transplantation in experiment and liver resection with in situ technique and on banch technique.
Organ transplantation is predominantly vascular surgical procedure. Vascular aspects of renal transplantation are important in all surgical phases of this procedure: --donor-nephrectomy (living-related or cadaver nephrectomy)--include nephrectomy undamaged kidneys, each with good length of renal artery (with or without aortic patch), renal vein (with or without caval patch) and ureter --organ-ex situ-surgery (bench surgery) sometimes is necessary after cold perfusion with Collins solution --implant surgical procedure, which include--dissection of recipient vessels (localisation.) --venous anastomosis (type and technique) --arterial anastomosis (type and technique) --use of vascular grafts (autografts or alografts) for kidney revascularisation during implantation (???) In the period 1987-1988, in our Experimental Surgery Unit a total of 20 dogs were operated (experimental kidney autotransplantation) under the same surgical team. The aims of those experimental autotransplantations were: training of the surgical team for routine human renal transplantations and usefulness of vascular grafts (autografts or allografts) for kidney revascularisation. We divided animals into the three groups: The first group (5 dogs)--revascularisation using AUTOVENOUS grafts The second group (5 dogs)--revascularisation using ALLOGRAFTS (Dacron or e-PTFE-Goretex grafts) The third group (10 dogs)--direct revascularisation without vascular grafts (control group) The best results were in the third group (no early vascular thrombosis) especially with end-to-end arterial anastomosis (we prefer it) and end-to-side venous anastomosis. Unfortunately in the second group, results were bad (vascular anastomotic thrombosis in the all cases during the first 48 hours).(ABSTRACT TRUNCATED AT 250 WORDS)
The variations of arterial and venous hillar blood vessels in human kidneys are numerous and surgical transplant teams have to know them. It is very important during doner-nephrectomy for transplantation. Sometimes, after doner, nephrectomy and kidney cold perfusion with Collins, there is a need for vascular repair of kidney hillar blood vessels, using microvascular surgical technique. The aim of this repair is: to have a kidney with main renal artery of good length and size and with main renal vein of good length and size. This procedure is called: extracorporeal "ex-situ" vascular repair of kidney hillar blood vessels. In the period 1987-1988, in our Experimental Surgery Unit a total of 20 dogs were operated on (kidney autotransplantation) and only in four (4) dogs we found variations in numbers of kidneys arterial and venous hillar blood vessels (20%) and repaired those vessels after cold perfusion of kidney. One dog had kidney with double renal arteries and double renal veins, and we had to make fusion the both arteries into the main renal artery of good size (5 mm) and the both veins into the renal vein of good size (12 mm). Three dogs had kidneys with main trunk of renal artery and one important separate polar renal artery, and we had to make implantation of separate polar renal artery into the main trunk of renal artery (end-te-side vascular anastomosis). For those vascular reconstructions we used polipropilene 6-o or -o as suturae material and binocular (magnification 2.5 x). The hemodynamically results of those reconstructions immediately after kidney implantation were very satisfactory.
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