Browsing by Author "Hakim, Nadey S."

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A Fast and Safe Living-Donor "Finger-Assisted" Nephrectomy Technique: Results of 225 Cases
(Başkent Üniversitesi, 2008-12) Hakim, Nadey S.; Canelo, Ruben; Papalois, Vassilios
Renal transplant remains the treatment of choice for end-stage renal disease. It improves both the quality of life and the quantity of life in recipients. We present a living-donor nephrectomy technique that is less invasive than the conventional open flank incision. This technique involves only 1 incision and is smaller than the one used in the laparoscopic technique. We have successfully introduced this new technique at our center. The procedure may be done safely and is applicable in all potential donors regardless of the body mass index of the donor or the size of the surgeon’s hands. It provides excellent grafts and has allowed us to expand our living-donor program.
End-Stage Vascular Access: Direct Intra-atrial Insertion of a Dialysis Catheter
(Başkent Üniversitesi, 2008-06) Wales, Lucy; Hakim, Nadey S.; Dosani, Tariq; Power, Albert; Anderson, Jon R.
Central venous occlusions are a frequent problem in hemodialysis patients. We describe the case of a patient with end-stage vascular access in whom we successfully inserted a direct intra-atrial dialysis line during coronary artery bypass grafting. This technique could be a significant contribution to patients in whom alternative vascular access options are exhausted.
Justifying a Third Pancreas Transplant: a Case Report
(Başkent Üniversitesi, 2008-03) Wales, Lucy; Hakim, Nadey S.; Mustafa, Nazar; Dosani, Tariq; Canelo, Ruben
Early pancreas graft failure after simultaneous pancreas-kidney transplant can occur in up to 20% of recipients. Results after pancreas retransplant continue to improve, with results comparable to primary pancreas transplants. We describe an unusual case of a third pancreas transplant in which a remnant of a previous arterial Y-graft was used for the arterial anastomosis, and we discuss the factors used to justify the decision to do a third pancreas transplant.
Principles of Research
(Başkent Üniversitesi, 2007-12) Hakim, Nadey S.
Quiescent Interplay Between Inducible Nitric Oxide Synthase and Tumor Necrosis Factor-α: Influence on Transplant Graft Vasculopathy in Renal Allograft Dysfunction
(Başkent Üniversitesi, 2006-06) Elahi, Maqsood M.; Matata, Bashir M.; Hakim, Nadey S.
A healthy endothelium is essential for vascular homeostasis, and preservation of endothelial cell function is critical for maintaining transplant allograft function. Damage to the microvascular endothelial cells is now regarded as a characteristic feature of acute vascular rejection, an important predictor of graft loss. It is also linked with transplant vasculopathy, often associated with chronic allograft nephropathy. Large bursts of nitric oxide in infiltrating monocytes/macrophages modulated by inducible nitric oxide synthase are considered pivotal in driving this mechanism. Indeed, it has been shown recently that increased circulating levels of tumor necrosis factor-α in the rejecting kidneys are largely responsible for triggering inducible nitric oxide synthase expression. This in turn suggests that several structural and functional features of graft rejection could be mediated by tumor necrosis factor-α. Despite the large body of evidence that supports immunologic involvement, knowledge concerning the cellular and biochemical mechanisms for nephritic cell dysfunction and death is incomplete. The role of tumor necrosis factor-α in mediating pathophysiological activity of inducible nitric oxide synthase during transplant vasculopathy remains contentious. Here, we discuss the effect of inducible nitric oxide synthase and tumor necrosis factor-α interaction on progressive damage to glomerular and vascular structures during renal allograft rejection. Selective inhibition of inducible nitrous oxide synthase and tumor necrosis factor-a as a potential therapy for ameliorating endothelial dysfunction and transplant graft vasculopathy is also discussed.
Recent Developments and Future Prospects in Pancreatic Transplantation
(Başkent Üniversitesi, 2003-06) Hakim, Nadey S.
Pancreas transplantation is not a life-saving procedure, so the benefits should be sufficient in terms of quality of life to outweigh the risks. Successful transplants give patients more positive health perceptions, improved social interaction, more satisfaction with diet and increased vitality. Studies are unanimous in finding that patients with successful transplants rate their lives better after transplantation than before. The effect of a double transplant in uraemic diabetic patients can be dramatic; patients rate their quality of life higher than diabetics who receive a kidney transplant alone.
Use of ETS-FLEX Endoscopic Linear Vascular Cutter in Donor Nephrectomy and Transplantation Surgery: A Single Institution’s Experience
(Başkent Üniversitesi, 2004-12) Hakim, Nadey S.; Dosani, Muhammad Tariq; Papalois, Vassilios
Objectives: We describe our experience with the use of ETS-FLEX endoscopic linear vascular cutter from January 2000 to October 2004 in live-donor nephrectomy and pancreatic bench work. Materials and Methods: In live-donor nephrectomy, ETS-FLEX endoscopic linear vascular cutter (ELVC) is used for the stapling and division of renal vessels and ureter. When positioned on a vessel, the vascular cutter applies 3 staple lines proximally and 3 distally, and the vessel in between them is divided. In pancreatic graft bench work, ELVC is applied in 3 steps: the splenectomy, ligation of the mesenteric root, and the ligation of any peripancreatic lymphatic tissue or small vessels. Results: From October 2000 to October 2004, we performed 80 living-donor nephrectomies in 56 men and 24 women (mean age, 39 years; range, 24-63 years). Thirty-one grafts were with multiple vessels. Mean warm ischemia time was 60 ± 5 seconds. Mean operative time was 60 ± 10 minutes. In all cases, there was no need for further hemostasis after removal of the kidney. There were no operative complications. All grafts were successfully revascularized with 100% graft survival (range of follow-up, 1-48 months). Patients’ length of stay in hospital was 3 ± 1 days. We have used the ETS-FLEX ELVC in 30 pancreatic graft preparations since January 2000. Mean time taken for the bench work preparation including Y-graft anastomosis was 45 ± 10 minutes. Following revascularization, there was excellent perfusion with minimal and easily controllable bleeding that did not require blood transfusion. Conclusions: We believe that our use of the laparoscopic instrument, ETS-FLEX ELVC, with a mini-incision technique in live-donor nephrectomy and pancreatic graft preparation makes these complex and time-consuming procedures simple and fast, minimizing the chances of postoperative complications and resulting in excellent patient and graft survival.