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Afshar Zomorrodi,1 Farzad Kakaei,2 Sahar Zomorrodi,3 Amin Bagheri1 1Department of Urology and Kidney Transplantation, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran; 2Department of Surgery, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran; 3TabrizUniversity of Medical Sciences, Tabriz, Iran Introduction: Three modalities for treating chronic kidney failure are peritoneal dialysis, hemodialysis, and kidney transplantation. Among them kidney transplantation is cost-efficient and leads to a somewhat normal quality of life. In this approach, most often the external iliac artery is selected for anastomosis, but this could be disastrous if anastomosis leads to a complication. The traditional end-to-end approach for anastomosis of the kidney artery to the internal iliac artery leads to pelvic organ ischemia. However, if the end-to-end anastomosis is replaced by an end-to-side approach, it is safer. This report discusses some cases of end-to-side anastomosis using the internal iliac artery. Method: In ten cases of chronic kidney failure, we anastomosed the kidney artery to the internal iliac artery with an end-to-side approach. Results: After vessels were unclamped, all patients had diuresis. Their creatinine was in normal range and was blood flow in the internal iliac artery, based on color Doppler ultrasound. Conclusion: End-to-side anastomosis can be done in some chronic kidney failure patients if their internal iliac arteries are large enough. This approach is safer than anastomosis using the external iliac artery. Keywords: kidney transplant, internal iliac artery, anastomosis

Shahryar Hashemzadeh1, Khosrow Hashemzadeh2, Farzad Kakaei3, Raheleh Aligholipour4, Kamyar Ghabili51Tuberculosis and Lung Disease Research Center, 2Department of Cardiovascular Surgery, Shahid Madani Hospital, 3Department of General Surgery, 4Students Research Committee, 5Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, IranBackground: Postintubation tracheal stenosis remains the most common indication for tracheal surgery. In the event of a rapid and progressive course of the disease after extubation, surgical approaches such as primary resection and anastomosis or various methods of tracheoplasty should be selected. We report our experience with surgical management of moderate to severe postintubation tracheal stenosis. We also compared intraoperative variables in postintubation tracheal stenosis between those with and without previous tracheostomy.Methods: Over a 5-year period from June 2005 to July 2010, 50 patients aged 14–64 years with moderate (50%–70% of the lumen) to severe (>70%) postintubation tracheal stenosis underwent resection and primary anastomosis. Patients were followed up to assess the surgical outcome. To study the effect of previous tracheostomy on treatment, surgical variables were compared between patients with previous tracheostomy (group A, n = 27) and those without previous tracheostomy (group B, n = 23).Results: Resection and primary anastomosis was performed via either cervical incision (45 patients) or right thoracotomy (five patients). In two patients with subglottic stenosis, complete resection of the tracheal lesion and anterior portion of cricoid cartilage was performed, and the remaining trachea was anastomosed to the thyroid cartilage using a Montgomery T-tube. There was only one perioperative death in a patient with a tracheo-innominate fistula. The length of the resected segment, number of resected rings, and subsequent duration of surgery were significantly greater in group A compared with group B (P < 0.05). Six months after surgery, the outcome was satisfactory to excellent in 47 (95.9%) patients.Conclusion: This surgical approach leads to highly successful results in the treatment of moderate to severe postintubation tracheal stenosis. In addition, previous tracheostomy might prolong the duration of surgery and increase the need for postoperative interventions due to an increase in the length and number of resected tracheal segments. Therefore, in the event of emergency tracheostomy in postintubation tracheal stenosis, insertion of the tracheostomy tube close to the stenotic segment is recommended.Keywords: trachea, tracheostomy, tracheal stenosis, intubation, tracheal resection

The development of malignancies after solid organ transplants is a well-known complication. Cancer is associated with significant consequences for the organ transplant patient. It is expected that cancer will surpass cardiovascular complications as the leading cause of death in transplant patients within the next few years. We report on a 36-year-old male patient who developed mixed germ-cell testicular tumor seven years after liver transplantation for alcoholic cirrhosis. He was treated with orchiectomy, retroperitoneal lymph node dissection and post-operative chemotherapy.