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PubMed1997

Epidural anaesthesia for ureteral reimplantation in an infant with congenital tracheal stenosis.

PURPOSE: We report a case of an infant with severe congenital tracheal stenosis who underwent ureteral reimplantation using lumbar epidural anaesthesia combined with light general anaesthesia. CLINICAL FEATURES: A six-month-old girl with symptomatic tracheal stenosis, demonstrated by computed tomography, was scheduled for ureteral reimplantation. She received continuous lumbar epidural anaesthesia with bupivacaine 0.25% through a 21 gauge catheter positioned at L3-4 interspace. Nitrous oxide/oxygen 50% and sevoflurane 1.5-2% were administered through a face mask and spontaneous breathing was preserved. Anaesthesia and surgery were uneventful. Postoperative epidural analgesia with bupivacaine 0.2% was excellent. The epidural catheter was withdrawn 48 hr postoperatively and she was discharged from the hospital five days later. CONCLUSION: Airway management is a major anaesthetic consideration in an infant with tracheal stenoses requiring abdominal surgery. We have demonstrated that regional anaesthesia combined with light general anaesthesia via face mask is an acceptable option, providing good analgesia during and after surgery. The technique preserves spontaneous ventilation and avoids tracheal manipulation.

Anesthesia, Epidural↗
PubMed2002

Modified extravesical ureteral reimplantation and routine stenting in kidney transplantation.

In the past, extravesical ureteroneocystostomy has been technically modified several times, with varying results. In this study, we evaluate our experience with modified extravesical re-implantation and routine stenting. From January 1988 to September 2001, 411 consecutive renal transplantations (220 LRD/LUD, 191 CAD) were performed at our institutions. Of 220 kidneys utilized for living related transplantation, 39 were retrieved laparoscopically and 181 were retrieved by open nephrectomy. The ureteroneocystostomy performed was a modified Lich-Gregoir re-implantation with routine stenting, using the upper transplant ureter. A double ureter was encountered in 11 patients and was managed with a conjoint ureteral ostium-to-mucosa anastomosis, using two stents. In two patients with graft ureteropelvic junction (UPJ) stenosis, a double ipsilateral drainage was performed, applying modified extravesical reimplantation with concomitant ureteroneocystostomy. There were no ureteral leaks. Five (1.22%) patients developed temporary ureterovesical junction (UVJ) obstruction/edema following stent removal, which necessitated re-stenting for 4-6 weeks. Two patients (0.49%) developed delayed stenosis and were successfully treated with retrograde balloon dilatation.(One at the UPJ of a pediatric kidney, and one at UVJ). All patients with functioning grafts in this series are currently stent-free. We conclude that the modified extravesical reimplantation with routine stenting is an effective and safe technique in renal transplantation, associated with almost no complications.

Cystostomy↗
PubMed1997

Reimplantation of autoclaved tumour bone in limb salvage surgery.

This is a prospective clinical study of 7 patients with malignant bone tumours who were treated by resection of the tumour, followed with reconstruction by reimplantation of the resected autoclaved tumour bone. There were 3 male and 4 female patients between 10 and 36 years of age. All the tumours were Stage IIB. Five of the 7 were in the region of the knee joint. Histologically, 5 were osteosarcomas, 1 a recurrent chondrosarcoma and 1 a recurrent Ewing's sarcoma. All the patients were treated by en bloc resection of the tumour with wide margins. The resected length ranged from 13 cm to 28 cm. After removal of soft tissue and cartilage, the resected bone segment was autoclaved for 5 min at 132 degrees C and 29 pounds per square inch pressure (0.2 mega Pascal). This autoclaved segment of bone was then reimplanted and fixed with an appropriate implant. The average follow-up was 20 months with a range of 14 to 27 months. None of the tumours recurred and, at the most recent follow-up, all the patients were alive, 6 with no evidence of disease and one with a lung metastasis. Six of the 7 patients were available for radiological assessment. Solid bone union was seen in 4 patients, delayed union in 1 and nonunion in 1. This method of reconstruction using an autoclaved tumour bone graft is useful in countries where facilities for allograft or tumour prostheses are not available owing to financial, technical or sociocultural reasons.

Adolescent↗
PubMed2005

The use of refluxing ureter in the creation of a Mitrofanoff channel in children undergoing bladder augmentation: is a formal reimplantation necessary?

To study the fate of a refluxing ureteral stump used as a Mitrofanoff channel (MC) for clean intermittent catheterization (CIC), without reimplantation in augmented bladders. Ten boys and seven girls, 1-14 years old (mean 6.5 years) seen in period 1998-2005, underwent creation of MC using refluxing or potentially refluxing ureters. Concomitant bladder augmentation (BA) was performed for various abnormalities of lower urinary tract, including exstrophy epispadias complex, neurogenic bladder cloaca and posterior urethral valve. The uretero-vesical junction was maintained intact during creation of the MC. Follow-up period ranged from 2-72 months (mean 32.5 months). Satisfactory CIC was possible in 14 children while in two children the stoma became obstructed due to non-usage. Urinary leak via the ureteric MC was seen in only one patient who partially responded to anticholinergic therapy and a shortened CIC interval but this needed to be formally closed subsequently. A refluxing ureter can be used in the creation of a MC without formal reimplantation in the majority of children undergoing BA.

Adolescent↗
PubMed1990

Decreased vascular compliance after reimplantation of the left lower lobe in young pigs.

The effects of chronic denervation on pulmonary vasculature are not well understood. Three groups of young pigs were prepared: (1) those receiving sham thoracotomy, (2) those having left upper lobectomy alone (innervated left lower lobe), and (3) those receiving left pneumonectomy followed by reimplantation of the left lower lobe (denervated left lower lobe). At 10 weeks after operation, animals were anesthetized and instrumented for study. No changes in baseline pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output, or pulmonary vascular resistance were observed. With diversion of the entire cardiac output to the left lung or lobe, however, the group with reimplanted lobes had a significantly higher pulmonary artery pressure and pulmonary vascular resistance than the other groups. This may result from chronic denervation of the pulmonary vasculature and receptor upregulation.

Animals↗
PubMed1993

The distribution and morphological characteristics of axons innervating the periodontal ligament of reimplanted teeth in cats.

Twelve weeks after reimplanting lower canines the distribution and characteristics of myelinated and non-myelinated axons within the periodontal ligament were investigated by light and electron microscopy. The ligament was examined at 2-mm intervals along the length of the root of four reimplanted teeth and of the contralateral canines, which served as controls. In each case the periodontal ligament was reinnervated. In two of the teeth, which showed extensive apical resorption, the innervation was much less than in control teeth. In two teeth showing minimal or no apical resorption the degree of innervation at the most apical level did not differ significantly from controls.

Animals↗
PubMed1991

Reoperative ureteral reimplantation: strategies for management.

Ureteral reimplantation is a procedure commonly performed by both urologists and pediatric surgeons. Although the vast majority are successful, there are some patients in whom technical considerations or bladder/ureteral abnormalities militate against success. We review our experience in 19 patients with multiple failed reimplants. The reasons for their failure, the investigations required to document such, and the management of these difficult problems will be discussed. In our hands, 95% of these patients ultimately became reflux-free and nonobstructed.

Adolescent↗
PubMed1990

Immunorestorative effects of reimplanted splenic tissue and splenosis.

Different immune functions were analysed in detail in 41 patients who had been splenectomized after a traumatic rupture of the spleen within four years after surgical intervention. Patients were assigned to one of the following groups as judged by liver/spleen scintigraphy: (1) patients with reimplanted splenic tissue, (2) patients with splenosis, and (3) patients without splenic tissue. Leukocytosis and an increased number of total lymphocytes as well as B-cells were observed in patients of all groups. In addition, the number of circulating T-suppressor cells was significantly increased in patients with no detectable splenic tissue. In contrast, serum concentrations of immunoglobulins and complement components were in the normal range; similarly, phagocytosis-associated functions of the patients' neutrophils and monocytes were found to be unimpaired (chemiluminescence and particle uptake). However, in all groups of splenectomized patients a deficiency in specific serum opsonic activity against a strain of Escherichia coli (O:102, H:6) could be detected. We conclude that neither splenosis nor autologous reimplantation of splenic tissue restores opsonic deficiency caused by splenectomy.

Adolescent↗
PubMed1979

Aortorenal reimplantation in treatment of renovascular hypertension.

From 1964 to 1977, 33 patients underwent aortorenal reimplantation as surgical treatment for renovascular hypertension. Over-all results were 13 patients cured (39 per cent), 15 patients improved (46 per cent), and there were 5 failures (15 per cent). The results were equally satisfactory in patients with atherosclerotic or fibrous renal artery disease. Postoperative arterial stenosis or occlusion occurred in 5 patients (15 per cent). Aortorenal reimplantation is an effective method of renal revascularization in properly selected patients, and long-term results are comparable with those of aortorenal bypass.

Adolescent↗
PubMed1990

Artificial urinary sphincter cuff erosion. Experience with reimplantation in 38 patients.

Artificial urinary sphincter cuff erosion has become rare but remains a dreaded consequence of sphincter implantation. Our experience indicates that with rational and systematic management of this problem, sphincter reimplantation can restore continence in many of these patients. During a ten-year period, 412 artificial sphincters were implanted at the Mayo Clinic. Bladder neck or urethral erosion occurred in 64 patients (15.5%). Ultimately, 38 patients had reimplantation, and the outcome was successful in 32 (84%). After the advent of delayed activation, the incidence of cuff erosion decreased greatly--from a peak of 18 percent (12 of 66 cases) in 1977 to 1.3 percent (1 of 79 cases) in 1985.

Female↗
PubMed1982

A two-stage procedure for reimplantation of autogenous freeze-treated mandibular bone.

A one-stage procedure for reimplantation of autogenous freeze-treated unaugmented mandibular bone is at risk of infection and slow union from dehiscence of intraoral incisions. A two-stage method is described, which attempts to overcome these problems. Reimplantation of bone is delayed until intraoral healing has taken place. The bone segment is augmented with autogenous cancellous bone chips to improve its reactivity and potential for union. In addition, nerve reanastomosis is undertaken. Two clinical cases with successful outcomes are described.

Adult↗
PubMed2004

Separate grafts or en bloc anastomosis for arch vessels reimplantation to the aortic arch.

BACKGROUND: This study compares the results of the separated graft technique and the en bloc technique as a method of arch vessels reimplantation during surgery of the aortic arch and determines the predictive risk factors associated with hospital mortality and adverse neurologic outcome during aortic arch repair. METHODS: Between October 1995 and March 2002, 352 patients (mean age 64.9 +/- 11.3 years; urgent status: 49/352 [13.9%]) underwent surgery of the aortic arch using the separated graft technique (group A: n = 230 [65.3%]) and the en bloc technique (group B: n = 122 [34.7%]) to reimplant the arch vessels. An aortic arch replacement was performed in 32 patients (9.1%), an ascending aorta and arch replacement in 222 patients (53.1%), an aortic arch and descending aorta replacement in 16 patients (4.5%), and a complete replacement of the thoracic aorta in 82 patients (23.3%). Brain protection was achieved by means of antegrade selective cerebral perfusion in all patients. The mean cardiopulmonary bypass time was 204.8 +/- 61.9 minutes (group A: 199.7 +/- 57.0 minutes; group B: 214.5 +/- 69.4 minutes; p = 0.033), the mean myocardial ischemic time was 121.5 +/- 43.2 minutes (group A: 116.7 +/- 38.9 minutes; group B: 130.80 +/- 49.4 minutes; p = 0.003), and the mean antegrade selective cerebral perfusion time was 84.5 +/- 36.4 (group A: separated graft technique 91.3 +/- 36.3 minutes; group B: 70.6 +/- 32.7 minutes; p = 0.000). RESULTS: Overall hospital mortality was 6.8% (group A: 6.5%; group B: 7.4%; p = not significant [NS]). The permanent neurologic dysfunction rate was 3.5% (group A: 4.0%; group B: 2.5%; p = NS). The transient neurologic dysfunction rate was 5.4% (group A: 5.5%; group B: 5.2%, p = NS). Postoperative systemic morbidity was similar in the two groups. A logistic regression analysis revealed preoperative cardiac tamponade (p = 0.011; odds ratio [OR] = 5.9) and cardiopulmonary bypass time (p = 0.010; OR = 1.01/min) to be independent predictors of hospital mortality. None of the analyzed preoperative variables were associated with an increased risk of permanent neurologic dysfunction. Age more than 70 years old (p = 0.029, OR = 5.7), myocardial revascularization (p = 0.001, OR = 2.9), and pump time (p = 0.013, OR = 1.01/min) were indicated as independent predictors of transient neurologic dysfunction by logistic regression. CONCLUSIONS: Antegrade selective cerebral perfusion was confirmed to be a safe method of cerebral protection allowing complex aortic arch operations to be performed with acceptable results in terms of hospital mortality and neurologic outcome. The separated graft technique had no adverse impact on hospital mortality and morbidity.

Adult↗
PubMed2004

Results of aortic valve-sparing operations: experience with remodeling and reimplantation procedures in 65 patients.

BACKGROUND: Valve-sparing operations for aortic root aneurysms are increasing in frequency, but techniques and results are still in evolution. We reviewed our experience with 65 patients (adults and children) who had this operation at our institution to determine early and late outcomes. METHODS: A retrospective clinical review was undertaken using hospital records, clinical and echocardiographic, computed tomography, magnetic resonance imaging data, and telephone interviews with patients and their physicians. RESULTS: Between July 1994 and December 2002, 65 patients (46 adults and 19 children) underwent a valve-sparing operation for aortic root aneurysm. Forty-four of the patients had the Marfan syndrome; the remaining 21 had either a nonspecific connective tissue disorder (14 patients) or a miscellaneous disease process such as Ehlers-Danlos syndrome (7 patients). Fifty-eight (89%) had a David II (remodeling) procedure and 7 had a David I (reimplantation) procedure. The DePaulis "Valsalva graft" was used in six of the David I patients. There were no operative or hospital deaths; only one late death occurred in an adult due to salmonella meningitis. Overall, survival was 100% at one year and 98% at 3 and 5 years. Ten patients (7 adults and 3 children) developed significant late aortic insufficiency (AI). Nine of these patients had a David II procedure and in 8 of these cases, AI was secondary to significant late annular dilatation. One of the 10 patients developed late AI 8.2 years after a David I procedure; his AI was secondary to aortic leaflet extension and prolapse. Six of the 10 patients who developed significant late AI required aortic valve replacement (4 adults and 2 children). Freedom from late aortic valve replacement (AVR) in this series of 65 patients was 91% at 3 and 84% at 5 years. At the close of this study, 58 patients were New York Heart Association (NYHA) class I and 6 were NYHA class II; no patients were class III or IV. There were no episodes of endocarditis or clinically significant thromboembolism. CONCLUSIONS: Valve-sparing operations provide satisfactory results for many patients with an aortic root aneurysm, but the David II remodeling procedure has a greater risk of late annular dilatation and AI. The David I reimplantation procedure utilizing the DePaulis Valsalva graft may obviate this problem.

Adolescent↗
PubMed2006

Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study.

BACKGROUND: This study evaluates the midterm clinical results of valve-preserving aortic root reconstruction by means of a modified conduit incorporating sinuses of Valsalva. METHODS: During a 5-year period, 151 patients with aneurysm of the aortic root underwent a reimplantation type of valve-sparing procedure using the Gelweave Valsalva prosthesis that incorporates sinuses of Valsalva. There were 121 males (80.1%), and the mean age was 56.4 +/- 14.4 years (range, 14 to 83). Fourteen percent of the patients had Marfan syndrome and 8.6% had bicuspid aortic valve. Seven patients (4.6%) suffered from acute aortic dissection. Aortic replacement was extended to the arch in 14 patients (9.3%). Sixteen patients (10.6%) had associated cusp repair. RESULTS: In-hospital mortality was 3.3%, and it was significantly higher among patients operated on for acute dissection (p = 0.001) and in symptomatic patients (III-IV New York Heart Association class; p = 0.021). Follow-up (mean, 18 months; range, 1 to 60) was 100% complete. There were 2 late deaths. Ten patients (6.8%) had 3 to 4+ aortic regurgitation, and 8 of these required late aortic valve replacement. Cusp repair was associated with a high incidence of late aortic valve replacement (p = 0.005). At 5 years, freedom from aortic valve replacement and freedom from grade 3 to 4 aortic insufficiency was 90.8% +/- 3.3% and 88.7% +/- 3.6%, respectively. CONCLUSIONS: The reimplantation valve-sparing procedure with the Gelweave Valsalva prosthesis provides satisfactory results for patients with aortic root aneurysm. Aortic cusp repair may lead to late aortic insufficiency. Proper leaflet evaluation is of paramount importance in preventing residual valve regurgitation.

Adolescent↗
PubMed2006

At-level neuropathic pain is induced by lumbosacral ventral root avulsion injury and ameliorated by root reimplantation into the spinal cord.

Neuropathic pain is common after traumatic injuries to the cauda equina/conus medullaris and brachial plexus. Clinically, this pain is difficult to treat and its mechanisms are not well understood. Lesions to the ventral roots are common in these injuries, but are rarely considered as potential contributors to pain. We examined whether a unilateral L6-S1 ventral root avulsion (VRA) injury in adult female rats might elicit pain within the dermatome projecting to the adjacent, uninjured L5 spinal segment. Additionally, a subset of subjects had the avulsed L6-S1 ventral roots reimplanted (VRA+Imp) into the lateral funiculus post-avulsion to determine whether this neural repair strategy elicits or ameliorates pain. Behavioral tests for mechanical allodynia and hyperalgesia were performed weekly over 7 weeks post-injury at the hindpaw plantar surface. Allodynia developed early and persisted post-VRA, whereas VRA+Imp rats exhibited allodynia only at 1 week post-operatively. Hyperalgesia was not observed at any time in any experimental group. Quantitative immunohistochemistry showed increased levels of inflammatory markers in laminae III-V and in the dorsal funiculus of the L5 spinal cord of VRA, but not VRA+Imp rats, specific to areas that receive projections from mechanoreceptive, but not nociceptive, primary afferents. These data suggest that sustained at-level neuropathic pain can develop following a pure motor lesion, whereas the pain may be ameliorated by acute root reimplantation. We believe that our findings are of translational research interest, as root implantation surgery is emerging as a potentially useful strategy for the repair of cauda equina/conus medullaris injuries.

Animals↗
PubMed2005

Laparoscopic ureteral reimplantation: a simplified dome advancement technique.

Laparoscopic Boari flap reimplantation has been used to treat long distal ureteral strictures. This technique requires extensive bladder mobilization and complex intracorporeal suturing. This demonstrates a novel laparoscopic bladder dome advancement approach for ureteral reimplantation. This technique obviates the need for bladder pedicle dissection and simplifies the required suturing.

Humans↗