Renal transplant surgery may be associated with important perioperative complications. In this scenario, the anesthetic technique should provide optimal conditions for the surgical team, guarantee hemodynamic stability and kidney perfusion, and adequate analgesia. Preoperative evaluation should always be performed. In the intraoperative period, standard monitoring is sufficient in most cases. General balanced anesthesia, alone or in combination with spinal anesthesia or peripheral block, is the technique of choice. Management of blood pressure during the surgery is crucial. Before reperfusion, a mean arterial blood pressure of 65 mmHg is recommended, increasing to 80–90 mmHg when reperfusion is imminent until the end of surgery. Vasopressors, such as ephedrine, may be necessary to achieve blood pressure targets. Mannitol and furosemide are commonly used to increase urine output. In the postoperative period, analgesia should be ensured.
Background: Many patients with myotonic dystrophy type 1 (DM1) develop muscular atrophy and weakness accompanied with myotonia in their adulthood. Some patients with DM1 have cataracts and heart problems without muscular weakness. CTG expansion in 3' untranslated region of DMPK gene causes DM1. The detection of this mutation has been done using Southern blotting or PCR-Southern blotting. But these methods need many procedures. Recently, the triplet repeat primed PCR (TP-PCR) was developed to detect some nucleotides repeat expansions. Objective: We tried to apply this TP-PCR methods to detect the Japanese DM1 patients and aimed to evaluate the efficacy for screening DM1. Patients and methods: We took peripheral blood from 10 Japanese patients in our hospital with informed consent. Three of them had cataracts and abnormal ECG findings without muscular weakness. We designed primers and an anchor-primer according to the previous reports about TP-PCR for SCA36 and C9ORF72. We examined the TP-PCR and fragment analysis each with fluorescent-labeled primers by autosequencer, and did PCR-Southern blotting analysis. Results: The PCR-fragment analysis revealed mild expansion within 100 repeats in three patients without muscular weakness. Seven other patients had smear-like abnormal band in the PCR-Southern blotting. TP-PCR showed smear-like-peaks in all 10 patients including three mild ones. Conclusion: This method could detect all abnormal expansions. But above 100 repeats, all patients showed almost the same pattern and could not show the difference of the size of repeats. The triplet repeat primed PCR is a convenient and useful method for screening DM1.
Results: Dural Arteriovenous fistulas were found in patients at age ranging from 32-74 years old. They are mostly found at cavernous sinus (40%), transverse-sigmoid sinus (35%) respectively. At these locations patients usually present with headache, exophthalmos and opthalmoparesis (70%, 65%, and 38% respectively) which are resemble with other common neurological diseases. CT brain, MRI or MRA brain were selected to examine in every patients. Average delayed time before definite diagnosis is 1.5 months. Factors involved in delayed diagnosis are unrecognizing symptoms mimicking common neurological diseases (60%), choosing improper neuroimaging (60%) and overlooking subtle abnormalities in those neuroimaging (45%). Conclusions: Keeping in mind that headache, exophthalmos and opthalmoparesis can be presentation of dural arteriovenous fistulas particularly in middle-age to elderly patients and selecting proper initial neuroimaging as well as meticulous interpreting would help to achieve correct diagnosis and be able to start treatment in timely fashion.
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