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One Institution (one + institution)
Selected AbstractsSacral nerve stimulation for voiding dysfunction: One institution's 11-year experience,NEUROUROLOGY AND URODYNAMICS, Issue 1 2007Suzette E. Sutherland Abstract Aim The purpose of this study was to review our institution's 11-year experience with SNS for the treatment of refractory voiding dysfunction. Dating back to 1993, it covers a span of time which describes the evolution of SNS as it includes PNE trials, non-tined (bone-anchored or fascial-anchored) leads, percutaneous tined leads with two-staged procedures, and even percutaneous pudendal trials. Methods A retrospective review was performed on SNS patients who received an implantable pulse generator (IPG) in our practice from 12/1993 to 12/2004. After Institutional Review Board approval, consents for chart review were obtained from 104 patients, representing 44% of this neuromodulatory patient population. Results Of our population, 87% were female and 13% were male. Average age at implant was 50 years,±,13.4 years. Duration of symptoms before implantation was 116 months (range 9,600 months). Eighty percent were implanted for a predominant complaint of urinary urgency and frequency (U/F). Overall, 22% had U/F only, 38% had concomitant urge incontinence (UI), and 20% had concomitant mixed incontinence (MI). Twenty percent were treated for non-obstructive urinary retention (UR), with half of these associated with a neurogenic etiology. Additionally, 46.2% had pelvic pain, 58.6% had bowel complaints, and 51% reported sexual dysfunction. In patients with U/F, mean voiding parameters as described by pre-implant voiding diaries revealed the following: 12.4 (±5.1) voids per 24 hr; 2.3 (±1.8) voids per night; 5.0 (±4.7) leaks per 24 hr; and 2.3 (±2.6) pads per 24 hr. Statistically significant improvements post-implantation were noted with mean decreases in the following: 4.3 voids per 24 hr; 1.0 void per night; 4.4 leaks per 24 hr; and 2.3 pads per 24 hr (all P,<,0.05). In the UR group a statistically significant improvement post-implantation was noted only in voids per night, with a mean decrease of 0.8 (P,<,0.05). With a mean follow up of 22 months (range 3,162 months), sustained subjective improvement was >50%, >80%, and >90% in 69%, 50%, and 35% of patients, respectively. By quality of life survey, 60.5% of patients were satisfied and 16.1% were dissatisfied with current urinary symptoms. Only 13% (14 patients) abandoned therapy, making up a significant portion of those dissatisfied with current urinary symptoms. Good overall lead durability was seen (mean 22 months, range 1,121 months), with the first successful lead proving to be the most durable (mean 28 months, range 1.4,120 months). Lead durability decreased progressively with subsequent trials. Overall, 53% of patients experienced at least one reportable event (RE) attributable to either lead or IPG. A total of 126 REs were noted, with 97% mild-to-moderate in severity. REs included lack of efficacy, loss of efficacy, infection, hematoma/seroma, migration, pain, undesirable change in sensation, and device malfunction. In this population, 47.1% of leads were tined while 52.9% were non-tined. Tined leads had an overall lower RE rate as compared to non-tined leads: 28% and 73%, respectively. Conclusions SNS is an effective method for treating certain types of voiding dysfunction. Although 53% of patients experienced at least one RE, 97% were mild-to-moderate and did not appear to affect the continued use of this therapy. With improved technology, such as percutaneous tined leads, the RE rate is decreasing. Further analyses of subsets of this population are currently underway. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] The impact of the 2005 International Society of Urological Pathology (ISUP) consensus on Gleason grading in contemporary practiceHISTOPATHOLOGY, Issue 4 2009Piotr Zareba Aims:, To investigate the impact of the 2005 International Society of Urological Pathology (ISUP) Gleason grading consensus in contemporary practice. Methods and results:, The Gleason scores (GS) were compared in two consecutive patient cohorts with matched biopsies and prostatectomies: (i) 908 patients evaluated before the ISUP consensus (July 2000,June 2004) and (ii) 423 patients evaluated after the ISUP consensus (October 2005,June 2007). All biopsies and prostatectomies were performed and scored in one institution and were sampled and processed identically. There was a higher percentage of biopsy and prostatectomy specimens with GS , 7 after the ISUP consensus (GS , 7 on biopsy in 32% before ISUP versus 46% after ISUP; GS , 7 on prostatectomy in 53% before ISUP versus 68% after ISUP; P < 0.001). No significant difference in the complete and ±1 unit Gleason agreement was found before and after the ISUP consensus. There was a trend towards better complete agreement for GS , 7 after the ISUP consensus. Conclusions:, There was a shift towards higher GS on biopsy and prostatectomy in our practice after the ISUP consensus, although , there was no significant impact on the biopsy,prostatectomy Gleason agreement. The significance of this shift for patient management and prognosis is uncertain. [source] Measurement error in computed tomography pelvimetryJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 2 2005N Anderson SUMMARY Computed tomography pelvimetry is still used in clinical practice. We wished to quantify observer error in order to assess the level of confidence with which pelvic measurements can be described as adequate or inadequate. Anteroposterior inlet, anteroposterior outlet, transverse inlet and interspinous distances were measured from 11 CT pelvimetry examinations by five observers at one institution. Three CT pelvimetries were measured by five observers at a second institution. Intraobserver and interobserver variation was assessed using analysis of variance. Reliability of measurements was assessed using intraclass correlation coefficient. Combined error was calculated to determine 95% confidence limits for published minimum recommended pelvic measurements. The standard error of measurement, combining all sources, for measurement of the bony dimensions of the pelvis were: for anteroposterior inlet, 2.0 mm; anteroposterior outlet, 6.9 mm; transverse inlet, 1.3 mm; and interspinous distance, 2.1 mm. The 95% confidence interval around the recommended anteroposterior outlet of 100 mm was 88.5,111.3 mm. Observer variation in measurement of anteroposterior outlet is so large as to make the measurement of doubtful clinical utility. [source] Identifying risk for recurrent hepatocellular carcinoma after liver transplantation: Implications for surveillance studies and new adjuvant therapiesLIVER TRANSPLANTATION, Issue 7 2008Edie Y. Chan The recurrence of hepatocellular carcinoma (HCC) is a major cause of mortality for patients transplanted with HCC. There currently exists no standard method for identifying those patients with a high risk for recurrence. Identification of factors leading to recurrence is necessary to develop an efficient surveillance protocol and address new potential adjuvant therapies. We conducted a retrospective review of 834 consecutive liver transplants from 1/1/1996 to 12/31/2005 (mean follow-up 1303 ± 1069 days) at one institution and 352 consecutive transplants from 1/2/2002 to 12/31/2005 (mean follow-up 836 ± 402 days) at a second institution. The test cohort comprised patients identified with HCC in their explanted livers from 1/1/2001 to 12/31/2005 at the first institution. Explant pathology and donor and recipient characteristics were reviewed to determine factors associated with HCC recurrence. These predictors were validated in the remaining liver transplant recipients. The test cohort had 116 patients with findings of HCC in their explanted livers. Twelve patients developed recurrent HCC. Stepwise logistic regression identified 4 independent significant explant factors predictive of recurrence. Size of one tumor (>4.5 cm), macroinvasion, and bilobar tumor were positive predictors of recurrence, whereas the presence of only well-differentiated HCC was a negative predictor. Designating each significant factor with points in relation to its odds ratio, a Predicting Cancer Recurrence Score (PCRS) with results ranging from ,3 to 6 was developed that accurately determined risk of recurrence. These findings were then applied to the two validation cohorts, which confirmed the high predictive value of this model. In conclusion, patients transplanted for HCC with a PCRS of ,0 have a low risk of recurrence. Patients with a PCRS of 1 or 2 have a moderate risk of recurrence, and those with a PCRS of ,3 have a high risk for recurrence. Liver Transpl 14:956,965, 2008. © 2008 AASLD. [source] Changes in pediatric diabetes care throughout a 30-yr period at one institution for pediatric diabetology in GermanyPEDIATRIC DIABETES, Issue 2 2002Thomas M. Kapellen Abstract: Aims: The objective of the present study was to investigate putative changes in pediatric diabetes care at one institution between 1969 and 1998. Methods: A structured questionnaire was used to analyze all medical records from the Hospital for Children and Adolescents of the University of Leipzig, Germany, from 1969 to 1998, in order to review the number of cases of type 1 diabetes mellitus and the length of hospital stay of children with diabetes during the 30-yr period. Results: Between 1969 and 1998, 441 children and adolescents (211 boys and 230 girls) with newly diagnosed diabetes mellitus type 1 were treated at the Hospital for Children and Adolescents in Leipzig. The number of patients newly diagnosed increased from 55 between 1969 and 1973 to 105 between 1994 and 1998 (p <,0.0003). The initial therapy and diabetes education were carried out in an in-patient setting. The average duration of hospital stay was 36 d in the years 1969,73, and 17 d in the years 1994,98 (p <,0.0002). This reduction of time spent in hospital was achieved by establishing structured training courses and exact planning of treatment in relation to the degree of illness at presentation. Conclusion: The number of patients with type 1 diabetes mellitus receiving care in this single institution between the years 1969 and 1998 has increased continuously. With the help of quality-assured structured training courses in a clinic for pediatric diabetes care, a dramatic reduction of the duration of hospital stay was achieved. [source] Eine Lanze für den Sachverständigenrat?PERSPEKTIVEN DER WIRTSCHAFTSPOLITIK, Issue 4 2007Plädoyer für eine differenziertere Analyse wirtschaftswissenschaftlicher Beratungsinstitutionen On a closer look, these conclusions are disputable. Therefore, in this contribution we analyse both institutions with respect to different functions of scientific advice such as: (1) operative advice, (2) conception, (3) information of the public, (4) legitimization, and (5) filter. Our approach shows that the simultaneous treatment of all functions by one institution is impossible. Finally, the institutionalization of the German Council is quite appropriate with respect to some functions of scientific advice. [source] Routine testing for mismatch repair deficiency in sporadic colorectal cancer is justifiedTHE JOURNAL OF PATHOLOGY, Issue 4 2005Robyn Lynne Ward Abstract This study prospectively examines the accuracy of immunohistochemical staining in the identification of mismatch repair defective (MMRD) colorectal cancer in routine clinical practice. The potential impact of this information on decisions regarding adjuvant treatment and germline testing were quantified. A consecutive series of fresh tissue (836 cancers) was obtained from 786 individuals undergoing curative surgery for colorectal cancer at one institution. As part of normal practice, each tumour was screened for the expression of MLH1 and MSH2 by immunohistochemical staining (IHC) and relevant clinicopathological details were documented. Microsatellite instability (MSI) was assessed using standard markers. Overall, 108 (13%) tumours showed loss of staining for either MLH1 (92 tumours) or MSH2 (16 tumours). The positive predictive value of mismatch repair IHC when used alone in the detection of MSI tumours was 88%, and the negative predictive value was 97%. Specificity and positive predictive value were improved by correlation with microsatellite status. Tumour stage (HR 3.5, 95% CI 2.0,6.0), vascular space invasion (HR 1.9, 95% CI 1.2,3.0) and mismatch repair deficiency (HR 0.2, 95% CI 0.05,0.87) were independent prognostic factors in stages II and III disease. Screening by mismatch repair IHC could reasonably have been expected to prevent ineffective treatment in 3.6% of stage II and 7.6% of stage III patients. The frequency of germline mismatch repair mutations was 0.8%, representing six unsuspected hereditary non-polyposis colorectal cancer (HNPCC) cases. Routine screening of colorectal cancers by mismatch repair IHC identifies individuals at low risk of relapse, and can prevent unnecessary adjuvant treatments in a significant number of individuals. Abnormal immunohistochemistry should be confirmed by microsatellite testing to ensure that false-positive results do not adversely impact on treatment decisions. Copyright © 2005 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [source] Long-term outcome of tension-free vaginal tape for treating stress incontinence in women with neuropathic bladdersBJU INTERNATIONAL, Issue 6 2010Ahmad Abdul-Rahman Study Type , Therapy (case series) Level of Evidence 4 OBJECTIVE To evaluate the long-term safety and efficacy of the tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with neuropathic bladder dysfunction. PATIENTS AND METHODS Twelve women (mean age 53.3 years, range 41,80) with neuropathic bladder dysfunction and SUI confirmed by video-cystometrography (VCMG) were treated with a TVT in one institution by an expert neuro-urologist between November 1997 and December 2000. The patient's notes, clinical annual follow-up and VCMG after the procedure, and the incontinence impact questionnaire (IIQ) forms (Urinary Distress Inventory, and IIQ-7) were assessed during the long-term clinical follow-up for SUI, in addition to a health-related quality of life assessment. The cure of SUI was defined as no loss of urine on physical exercise, confirmed VCMG after the procedure, and by clinical assessment. RESULTS The mean (range) follow-up was 10 (8.5,12) years. Nine patients were using clean intermittent self-catheterization before the insertion of TVT and continued to do so afterward. At 10 years of follow-up, one patient had died (with failed TVT initially), and two were lost to follow-up at 5 years after surgery, but up to 5 years they did not complain of UI and VCMG did not show SUI. The remaining seven of the nine patients were completely dry, and two improved and were satisfied with using one or two pads/day. Two patients showed neurogenic detrusor overactivity confirmed on VCMG, with no evidence of SUI. One patient needed a transient urethral catheter for urinary retention after surgery, one had a bladder injury that required leaving the catheter for 5 days, but no urethral erosions were reported during the follow-up. CONCLUSIONS In women with neuropathic bladder dysfunction secondary to a variety of spinal cord pathologies, and who have SUI necessitating a definitive intervention, insertion of TVT should be considered a desirable treatment, with very good long-term outcomes. [source] Stage migration in localized prostate cancer has no effect on the post-radical prostatectomy Kattan nomogramBJU INTERNATIONAL, Issue 5 2010Ruban Thanigasalam Study Type , Prognosis (case series) Level of Evidence 4 OBJECTIVE To investigate the effect of prostate-specific antigen (PSA) testing on stage migration in an Australian population, and its consequences on the prognostic accuracy of the post-radical prostatectomy (RP) Kattan nomogram, as in North America widespread PSA testing has resulted in prostate cancer stage migration, questioning the utility of prognostic nomograms in this setting. PATIENTS AND METHODS The study comprised 1008 men who had consecutive RP for localized prostate cancer between 1991 and 2001 at one institution. Two groups were assessed, i.e. those treated in 1991,96 (group 1, the early PSA era), and 1997,2001 (group 2, the contemporary PSA era). Differences in clinicopathological features between the groups were analysed by chi-squared testing and survival modelling. Individual patient data were entered into the post-RP Kattan nomogram and the efficacy assessed by receiver- operating characteristic curve analysis. RESULTS Patients in group 2 had lower pathological stage disease (P = 0.01) and fewer cancers with Gleason score ,8 (P < 0.001) than group 1. Multivariate analysis identified preoperative serum PSA level (P < 0.01) and Gleason score (P < 0.01) as strong predictors of biochemical relapse in both groups. In group 2 pathological stage was not significant, but margin involvement became highly significant (P = 0.004). There was no difference in the predictive accuracy of the Kattan nomogram between the groups (P = 0.253). CONCLUSIONS These findings show a downward stage migration towards organ-confined disease after the introduction of widespread PSA testing in an Australian cohort. Despite this, the Kattan nomogram remains a robust prognostic tool in clinical practice. [source] Salvage robotic-assisted radical prostatectomy: initial results and early report of outcomesBJU INTERNATIONAL, Issue 7 2009Ronald S. Boris OBJECTIVE To evaluate the initial results of salvage robotic-assisted radical prostatectomy (SRARP) after recurrence following primary radiotherapy (RT) for localized prostate cancer. PATIENTS AND METHODS Between December 2002 and January 2008, 11 patients had SRARP with pelvic lymph node dissection by one surgeon from one institution. Six patients had brachytherapy, three had external beam RT (EBRT), one intensity-modulated RT, and one received brachytherapy with an EBRT boost. All patients had prostate cancer on biopsy after RT, with negative computed tomography and bone scan. The mean (range) follow-up was 20.5 (1,77) months. RESULTS The mean interval from RT to SRARP was 53.2 months; the mean preoperative prostate-specific antigen (PSA) level was 5.2 ng/mL, the operative duration 183 min and the estimated blood loss 113 mL. One patient had prolonged lymphatic drainage, one had an anastomotic leak, and one had an anastomotic stricture requiring direct vision internal urethrotomy at 3 months. The mean duration of catheterization was 10.4 days and the hospital stay 1.4 days. Three patients had a biochemical recurrence, at 1, 2 and 43 months. In one of two patients with node-positive carcinoma of the prostate the PSA level failed to reach a nadir of zero after surgery. In patients with a minimum follow-up of 2 months, eight of 10 are continent (defined as zero to one pad per day) and two have erections adequate for intercourse with the use of phosphodiesterase-5 inhibitors. CONCLUSION SRARP after RT-resistant disease recurrence is feasible with minimal perioperative morbidity. Early functional outcomes appear to be at least equivalent with historical salvage RP series. Robotic extended pelvic lymph node dissection is safe and can improve the accuracy of surgical staging. A longer follow-up is necessary to better assess the functional and oncological outcomes. [source] Impact of tumour volume on surgical and pathological outcomes after robot-assisted radical cystectomyBJU INTERNATIONAL, Issue 7 2008Bertram Yuh OBJECTIVE To report on the influence that bladder tumour volume has on operative and pathological outcomes after robotic-assisted radical cystectomy (RARC, a minimally invasive alternative to open cystectomy for treating bladder cancer), as with the lack of tactile feedback in RARC tumour volume might compromise the outcome. PATIENTS AND METHODS Between 2005 and 2007, 54 consecutive patients had RARC at one institution. CT urograms were obtained in all patients for staging purposes and to evaluate hydronephrosis. Patients were separated into two groups based on pathological tumour dimensions. Once selected into two-dimensional (2D, flat) or 3D (bulky) tumour groups the patients were compared for operative and pathological variables. RESULTS The mean age of all patients was 67 years; 19 had tumours classified as 2D and 35 as 3D. There were no statistical differences in age, sex, body mass index, American Society of Anesthesiologists score, previous surgery, mean hospital stay, or estimated blood loss between the groups. The difference in operative duration for bladder removal was almost statistically significant (P = 0.077). Intraoperative transfusion was more common in the 3D group (P = 0.044); 43% of patients in the 3D group had hydronephrosis, vs only 16% in the 2D group. 3D tumours were more likely to be higher stage (P = 0.051). All positive margins in the patient were in the 3D group (P = 0.04); no patients with ,T2 disease had a positive surgical margin. CONCLUSIONS Bulky tumours removed with RARC might be associated with an increased rate of intraoperative transfusion, higher stage disease, and higher rate of margin positivity. In patients with large-volume tumours on preoperative assessment, wider dissection of perivesical tissue might decrease the margin-positive rates. [source] Comparison of the clinical outcome after hormonal therapy for prostate cancer between Japanese and Caucasian menBJU INTERNATIONAL, Issue 6 2006TAKASHI FUKAGAI OBJECTIVE To investigate the impact of race on the effectiveness of hormonal therapy in patients with prostate cancer, by comparing the outcomes of Caucasian men (CM) and Japanese-American men (JAM) treated with hormonal therapy at one institution. PATIENTS AND METHODS Fifty-nine CM and 105 JAM with prostate cancer were treated with hormonal therapy at The Queen's Medical Center in Honolulu. Age, stage, Gleason score, race, and pretreatment PSA levels were abstracted. The Kaplan,Meier method was used to construct overall and cause-specific survival curves, which were compared using log-rank statistics. These factors were assessed as to their interdependence and correlation with the clinical course using a Cox proportional hazards regression model. RESULTS Although there were no statistical differences in patient background, JAM who had received hormonal treatment had a better outcome than CM for overall and cause-specific survival rate (P = 0.001 and 0.036, respectively). Race was one of the significant prognostic factors in the multivariate analysis (P = 0.03). The findings suggest a difference in the effectiveness of hormonal therapy for prostate cancer in JAM living in Hawaii compared to CM. CONCLUSIONS There were marked racial differences in clinical outcome after hormonal therapy between JAM and CM. A prospective study with more patients might be necessary to elucidate the differential effectiveness of hormonal therapy for prostate cancer in different races, especially between Japanese and Caucasians. [source] A comparison of the pathology of transitional cell carcinoma of the bladder and upper urinary tractBJU INTERNATIONAL, Issue 6 2005Grant D. Stewart OBJECTIVE To clarify the histopathological patterns of upper and lower urinary tract transitional cell carcinomas (TCCs), as previous reports suggest that upper urinary tract TCCs have a greater tendency towards high-grade disease than bladder TCCs, of which most are low-grade and low-stage tumours. PATIENTS AND METHODS All patients presenting with TCC of bladder or upper urinary tract between February 1991 and December 2001 at one institution were identified. Further patient information was obtained from the hospital database and case-note review. RESULTS In all, 164 patients with upper urinary tract TCC and 2197 with bladder TCC were identified. There was a correlation between grade and stage of both upper urinary tract and bladder TCCs. 35% of the upper tract TCCs were classified as grade 2 and 44% as grade 3, while for bladder TCCs, 31% of lesions were classified as grade 2 and 35% as grade 3 (P = 0.003). Of the upper urinary tract lesions 33% were stage pT2,T4, compared with only 20% of bladder TCCs (P = 0.001). CONCLUSIONS Upper urinary tract TCC is a higher grade and stage disease than bladder cancer, a finding that emphasizes the need for aggressive treatment of upper urinary tract TCC. If endourological management of upper urinary tract TCC is considered, histopathological determination of tumour grade before treatment is essential. [source] Managing varicoceles in children: results with microsurgical varicocelectomyBJU INTERNATIONAL, Issue 3 2005Jonathan Schiff Authors from New York present their experience of elective varicocelectomy, using microsurgical techniques, in a large series of children. They found the procedure to be safe and effective, and gave a much lower complication rate than the published rate in open varicocelectomy. The results of urethroplasty in post-traumatic paediatric urethral strictures are presented by authors from Mansoura. They found the overall success of one-stage perineal anastomotic repair of such strictures to be excellent, with very little morbidity. OBJECTIVE To report our experience of microsurgical subinguinal varicocelectomy in boys aged ,,18 years. PATIENTS AND METHODS Boys aged ,,18 years treated with microsurgical varicocelectomy between 1996 and 2000 at one institution were retrospectively reviewed. Indications for surgery included ipsilateral testicular atrophy, large varicocele or pain. Microsurgery was assisted by an operating microscope (×10,25) allowing preservation of the lymphatics, and the testicular and cremasteric arteries. Patient age, varicocele grade, complications and follow-up interval were recorded. RESULTS In all there were 97 microsurgical subinguinal varicocelectomies (23 bilateral) in 74 boys (mean age 14.7 years). Left-sided varicoceles were significantly larger (mean grade 2.9) than right-sided (mean grade 1.4) varicoceles. The mean follow-up was 9.6 months. There were four complications: two hydroceles, of which one resolved spontaneously after 4 months; one patient had persistent orchialgia that resolved after 8 months; and one developed hypertrophic scarring at the inguinal incision site. There were no infections, haematomas or intraoperative injuries to the vas deferens or testicular arteries. All boys were discharged home on the day of surgery. CONCLUSIONS Microsurgical subinguinal varicocelectomy in boys is a safe, minimally invasive and effective means of treating varicoceles. Compared with published results of the retroperitoneal mass ligation technique, which has a 15% overall complication rate and a 7,9% hydrocele occurrence rate, the microsurgical subinguinal approach appears to offer less morbidity, with a 1% hydrocele rate. We consider that microsurgical subinguinal varicocelectomy offers the best results with lower morbidity than other techniques. [source] Incomplete cellular depopulation may explain the high failure rate of bovine ureteric graftsBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2008J. I. Spark Background: The aim was to assess the results of a decellularized bovine ureter graft (SynerGraft®) for complex venous access. Methods: Bovine ureter conduits were implanted in patients with a failed fistula or access graft in whom native vessels were unsuitable as conduits. Graft histories were obtained from all patients who had undergone this procedure at one institution. Failed grafts were explanted and subjected to histological examination. A sample of fresh bovine ureter was immunostained for galactose (,1 , 3) galactose (,-Gal). Results: Nine patients with a median age of 46 (range 25,70) years underwent complex venous access surgery between August 2004 and November 2006 using a SynerGraft®. Graft types included loop superficial femoral artery to stump of long saphenous vein (four patients), loop brachial artery to vein (two), brachial artery to axillary vein (two) and left axillary artery to innominate vein (one). Three grafts developed aneurysmal dilatation and two thrombosed. Histological assessment of the explanted bovine ureters revealed acute and chronic transmural inflammation. Immunostaining of fresh bovine ureter suggested residual cells and the xenoantigen ,-Gal. Conclusion: Graft failure with aneurysmal dilatation and thrombosis in complex arteriovenous conduits using bovine ureter may be due to residual xenoantigens. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] | ||||||||||