Simultaneous pancreas-kidney transplantation is becoming an accepted procedure for the treatment of Type I diabetic patients with end-stage renal disease. Its value in Type II diabetic patient remains to be evaluated. With the improvements in technical skills and immunosuppression medications, the procedure has become safer than those performed in the previous decade. However, the diabetic host is a high-risk individual. Careful evaluation and selection is prudent to keep excellent results with this scarce organ. As we have seen in this series, death is the number one cause of graft loss and better preoperative evaluation will continue to be of significant value to lower the mortality rate of SPK transplantation. We are moving to the use of marginal donors and marginal recipients very carefully and more data is needed to prove its safety and cost effectiveness. At our center, long-term patient and graft survival have been acceptable (86% and 73%, respectively, at 5 years). We will continue to use SPK transplantation as the procedure of choice for excellent candidates. We may need to change our philosophy to use living-related kidney transplants followed by a sequential pancreas transplant to overcome some of the shortage of pancreatic organs. The issue of primary enteric drainage has not been addressed in this report due to our success with bladder drainage. Despite the lower threshold for enteric conversion, about 10% of our patients are converted.

Adolescent↗

PubMed1998

Long-term follow-up of 102 living kidney donors.

This study evaluated 102 randomly selected living-related kidney donors who were operated between November 1975 and December 1996 after a mean follow-up period of 10.2 years (range 8 months to 22 years). The donor male:female ratio was 45:57, and mean age was 41.0 years (range 21 to 65 years). The average preoperative and last follow-up blood creatinine levels were 73.37 micromol/l (range 44.2-106.8 micromol/l) and 78.67 micromol/l (range 8.84-318.2 micromol/l), respectively (p:NS), and the corresponding average creatinine clearance values were 108.4 ml/min (range 100-130 ml/min) and 96.8 ml/min (range 27 to 125 ml/min) (p: NS). Four donors had 24-hour urine protein excretion above 0.1 gram (2 G, 0.7 G, 0.2 G, and 0.14 G, specifically). The donors' mean systolic blood pressures before, and after the operation on the last follow-up were 131.7 +/- 21.2 mmHg and 139.6 +/- 20.9 mmHg, respectively (p:NS). Nine donors (8.8%) developed hypertension which required anti-hypertensive treatment. The mean age of the hypertensive group was 48.0 years (range 30 to 65 years), whereas that for the nonhypertensive group was 39.4 years (range 18 to 76 years) (p <0.02). Only one donor (0.9%), a 41 year-old female, was diagnosed with chronic renal disease related to pyelonephritis. These results support the utilization of living donors for kidney transplantation, an option which helps broaden a limited donor pool.

Adolescent↗

PubMed1995

Musculoskeletal problems after kidney transplantation.

Explore the source record for details and available documents.

Adolescent↗

PubMed1993

Changes in gastric mucosal histamine and prostaglandin E2-like activities in relation to portal somatostatin following small bowel resection in guinea-pigs.

The effects of 85% intestinal resection on the portal somatostatin (SLI) gastric mucosal histamine (HA) and prostaglandin E2 (PGE2)-like activities were studied in guinea-pigs. A considerable increase in gastric mucosal HA-like activity of guinea-pigs subjected to small bowel resection (189.9 +/- 15.0 ng/g tissue) was measured in comparison to control values (42.9 +/- 6.3 ng/g tissue) (p < 0.001). The mean tissue PGE2-like activity in the sham operated group was 1636.9 +/- 128.8 ng/g tissue, whereas in the test group it was 650.5 +/- 59.3 ng/g tissue. After 85% small bowel resection a significant fall in portal and systemic venous SLI values was observed (T = 0, p < 0.05). Thus, the small bowel seems to be a major source of the increase of gastric mucosal HA-like activity and the decrease in PGE2-like activity.

Animals↗

PubMed1990

Acute appendicitis associated with pneumoperitoneum.

Spontaneous pneumoperitoneum is infrequently encountered as a radiographic finding in association with a perforated appendicitis. This may lead to diagnostic errors, of which every radiologist and surgeon should be aware. We report a case of perforated appendicitis associated with free intraperitoneal gas.

Acute Disease↗