Kidney transplantation in children: results of 383 grafts performed at Enfants Malades Hospital from 1973 to 1984.
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Adolescent↗
Biomedical subjects
D Beurton
Publications and source records attributed to D Beurton.
Post-surgical deterioration of renal function in primary hyperoxaluria.
Primary hyperoxaluria leading to calcium oxalate urinary stones and renal deposits occurs rarely in adults. We report three cases in whom end-stage renal failure was precipitated by urological surgery. In contrast, in one case renal stones were destroyed by extracorporeal shock-wave lithotripsy and renal function was not significantly altered. This emphasises the need for early diagnosis. This may not be easy in adult patients: urolithiasis may not be severe, radiological nephrocalcinosis may be lacking, and renal failure may develop late in life.
Adult↗
[Surgical complications of renal transplantation in children. Retrospective study of 372 cases].
On the basis of a personal series of 372 cases of renal transplantation performed in children, half of whom presented congenital urinary tract malformations, the authors report 110 complications (29.6%). The most frequent complications were urological (14.2%), consisting essentially of fistulae (8.9%) and stenoses (3%). These were followed by vascular complications (6.4%) generally in the form of stenoses (4.8%) and rarely thromboses (1.1%). The authors also report the various local complications which were infectious (wall abscess, suppuration of the renal compartment), haemorrhagic (haematomas) or stones (stones forming on non-resorbable sutures) as well as 5 cases of lymphocele. The prophylaxis of these complications depends on the care taken in collection of the graft (en bloc removal of both kidneys), the restoration of the continuity of the urinary tract (as much as possible Lich-Gregoire extravesical uretero-vesical reimplantation), the vascular anastomoses (vascular dissection limited to a strict minimum), the choice of suture material (resorbable synthetic suture material) and the prevention of infection by systematic pre-, intra- and post-operative antibiotic therapy.
Child↗
[Urinary diversions and intestinal grafts in renal transplantation in children. Report of 8 cases].
In a series of 400 transplantations, 8 children presented a severe lesion of the lower urinary tract requiring an intestinal graft to divert the urine or to replace the useless bladder: 4 cases of posterior urethral valves and 4 cases of neurogenic bladder. Four permanent urinary diversions and 4 bladder enlargements, including 3 temporary diversions, were performed. The sigmoid colon was used in 5 cases and the ileum was used in 3 cases. The preparation of the intestinal graft was always performed prior to the transplantation. The uretero-intestinal anastomosis included an antireflux device in 3 of the 8 cases. There were no deaths in this series. Three occlusions and 2 lymphoceles occurred in the immediate post-transplantation period, but were corrected by re-operation. Two cases of calculi occurred in the long term, one of which required operation. Moderate stenosis of the renal artery in one case resulted in systemic hypertension which was well controlled by medical treatment. An episode of acute pyelonephritis resolved rapidly with antibiotic treatment. Two cases of acidosis were corrected by salt supplementation. There was one case of early graft rejection on the 15th day and a delayed rejection after 18 months, leading to removal of the transplant. At the present time, 6 renal grafts function normally (75%) with a follow-up of 1 to 8 years.
Adolescent↗
[Ureterosigmoidostomy with antireflux in children. Apropos of a short series].
Ureterosigmoidostomy with anti-reflux technique (Petit-Leadbetter procedure) was performed in 12 children, mainly after failure to repair an exstrophy. After a mean follow up of 45 months, results were assessed as good from clinical and urographic points of view, although there were 3 possible cases of reflux, one of anastomotic stenosis (operated upon with success) and one of moderate continence only. An anastomotic tumor was not detected, but follow up is of moderate duration only. This operation should be reserved for a limited number of cases: those with irreparable exstrophy and those in whom a skin bypass is unacceptable.
Adolescent↗
[Use of the intestinal graft in renal transplantation in children and adults].
Intestinal grafts as a means to external shunting of urine during renal transplant operation were described by W.D. Kelly as early as 1966. Since then 80 cases have been reported in the Anglo-Saxon literature. A total of 68 well-documented cases showed functional kidneys in 52%, complications in 42% and a 13% mortality rate. Between 1973 and 1985, of 400 renal transplant operations in children, an intestinal graft was used in 8 cases (2%) to provide 4 definitive external diversions and 4 enlargements or replacements of bladder. Indications for use were neurological bladder and posterior urethra valves. In all cases the graft was prepared before transplant operation. Enlargement of bladder requires good cervico-urethral function determined by previous study of a generally nonfunctioning bladder distal to an cutaneous ureterostomy. To avoid post-transplant urological effects the graft for enlargement or replacement is opened temporarily on to skin and closed several months after grafting. Follow up for 2 to 8 years showed 6 kidneys functioning normally, and 3 enlarged or replaced bladders out of 4 currently closed functioning satisfactorily. The 2 lost kidneys were rejected 2 weeks and 2 years respectively after the graft operation. There was no mortality or urological complication. The only surgical complications related to the intestinal graft were 3 early-onset occlusions treated successfully. Calculi formed in 2 cases, one being eliminated spontaneously at an early stage and the other, of late onset, requiring two operations. Metabolic or infectious complications were benign.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Study of a homogeneous series of 27 total cystectomies for cancer].
A homogeneous series of 27 cases of cystoprostatectomy performed for cancer was analysed from two points of view: surgical and carcinological. Surgical treatment in a group of relatively young patients in good general health resulted in low mortality (3.7%) and morbidity (26%) with a mean hospital stay of 23.9 days. In this series, cystectomy was followed by cutaneous ureterostomy (5 cases), Coffey ureterostomy (4 cases), Bricker ureterostomy (8 cases) and 10 replacements. The techniques are described. In 8 cases of replacement, sub-total prostatectomy was performed and, in one half of patients, sexual potency was preserved. There was only one case of superficial recurrence in the graft-urethra junction which was resected without further recurrence after 6 years. Twenty-three patients were treated by radiotherapy and 9 received cis-platinum based chemotherapy. The 5 year survival rate was 22%. The overall survival for N+ tumours, which were the most common in this series, did not exceed 2 years. In contrast, all N- patients are alive after a period of 7 years. At the present time, no decisive role can be attributed to either radiotherapy or chemotherapy. Radical surgery, performed early in the course of the disease, remains the only effective treatment. Furthermore, replacement with preservation of the sphincter decreases the mutilating aspect of cystoprostatectomy.
Adult↗
[Nuclear magnetic resonance study of the thyroid tissue according to its histology].
To date, T1 and T2 proton relaxation times in Nuclear Magnetic Resonance have not been widely studied in thyroid disorders. In an earlier study, we compared 99mTc and histological data with T1 and T2 relaxation times. We found that nodules heterogeneity affect NMR results. This should therefore be taken into account when interpreting magnetic resonance images. The purpose of the present study was to compare T1 and T2 in thyroid tissues according to the diagnosis and the different histological components which had been quantitative defined by histomorphometric methods. 71 samples from 43 patients were examines: 35 euthyroid multiheteronodular goitres, 5 hot nodules, 2 papillary carcinomas, 1 Basedow's disease. The results show that image interpretation according to histology is difficult.
Carcinoma, Papillary↗
Diminution of circulating polymorphonuclear leucocytes by administration of a monoclonal antibody reacting with granulocytes and monocytes.
The monoclonal antibody 3A35 which binds mouse polymorphonuclear leucocytes (PMN) and monocytes was injected intravenously (i.v.) into normal mice. A great diminution of circulating PMN was observed. The percentage of PMN passed through a minimum (2.5%) 20 min after antibody injection and returned to normal value (18.3%) within 24 h. After repeated daily injections, the ability of the antibody to induce granulopenia attenuated. Moreover, mice bearing the 3A35-producing hybridoma as an ascitic tumor had a normal percentage of blood PMN and a normal granulopoiesis as judged from bone marrow cytological examination. Thus, the monoclonal antibody produced a transitory diminution of PMN but could not induce a lasting granulopenia.
Animals↗
[Malignant chemodectoma of the intrapetrous facial nerve].
A 30 year old man presented with a tumor of the intrapetrous portion of the facial nerve, found to be a malignant chemodectoma on investigation. Possible relations with tumors of the APUD system, as well as pathogenic and therapeutic aspects are discussed.
Adult↗
[Vesico-ureteral reflux in adults. Apropos of 103 cases].
Case reports of 103 adult patients operated upon for vesicorenal reflux are reviewed. The majority of the patients (94%) were women, and clinical signs appeared initially after puberty in half of these, mainly as fever, abdominal pains and pyuria. Twelve of the 25 women known to have children had had serious septic accidents during pregnancy. Only 11% had two normal kidneys, 50% having bilateral and 39% unilateral kidney lesions. Of the total studied, 70% of kidneys had corticopapillary lesions, while 35% were smaller than normal. The average length of the submucous trajectory of a refluxing ureter was 3.5 mm, 95.5% of kidneys with corticopapillary lesions having a ureter ending in a short submucous trajectory (average: 3.7 mm). Of the 156 ureters operated upon by antireflux advancement, stenosis developed in 2 and residual reflux in 9, 7 of these latter corresponding to exclusively transvesical ureteral dissections. Global efficacy was 73% for this type of surgery, with 7.5% poor and 19.5% doubtful results. Conclusions drawn from this analysis were: the adverse effects of reflux during pregnancy (one out of 2 cases), the frequency of renal lesions in adults (35% of small kidneys and 70.4% of kidneys with corticopapillary lesions), the short submucous portion of these ureters--its length did not exceed that found in children with reflux--perhaps there had not been intramural ureteral growth, and the efficacy of the antireflux operation if a wide extravesical dissection is performed before the antireflux advancement procedure itself.
Adolescent↗
[Results of 310 cadaver kidney transplants in children and adolescents].
This study reports the results of 310 cadaver kidney transplantations in 295 children and adolescents performed from 1973 to 1983. The actuarial survival of patients was 97% at one year and 92% at 5 years; that of grafts was 79% at 1 year and 65% at 5 years, these rates having improved during the last years. Results were similar and even better for the 18 second transplantations. Among the causes of failure, rejection comes first (65%), then thromboses of renal artery (13%) and relapses of oxalosis or steroid resistant nephrosis (12%). Patients with cytotoxic antibodies have a less good survival of grafts, especially after 5 years. HLA A and B compatibility is a factor of success. Among complications hypertension is frequent, 53% of patients receiving antihypertensive treatment after 1 year. It is sometimes severe and was responsible for death in 5 cases. Growth was variable after transplantation: 25% of children before puberty had a catch-up curve, 25% had an unchanged growth and 50% an increased retardation. The average standard deviation was near zero but it was -0.49 SD/year in patients with creatinine level greater than or equal to 150 mumol and +0.24 SD in children under alternate day steroid therapy. Rehabilitation was excellent, less than 3% of patients not being engaged in any activity 1 year after transplantation.
Adolescent↗
[Adjuvant chemotherapy of infiltrating bladder cancer. A feasibility trial].
From January 1981 until December 1983, 51 patients have been submitted to total cystectomy for infiltrative bladder cancer, stages B2 C and D1 of the Marshall classification. They have be proposed in a trial of feasibility with adjuvant chemotherapy using Adriamycin and Cis Platinum. 24 patients have been excluded, 17 because medical contraindications, 5 because they were foreigners, 3 because they refused the therapy. 27 patients have received the chemotherapy. In 5 patients the treatment has been interrupted before the completion of 6 cycles. The results show the feasibility of a trial with adjuvant chemotherapy. The theorical rationale and the methodology are discussed.
Adult↗
[Renal cancers with venous extension: surgical problems].
Renal cell carcinoma with a thrombus limited to the trunk of the renal vein is quite different from renal cell carcinoma extending into the inferior vena cava. In the first case, the operative mortality is low, and the five year survival rate is about 53%. In the second case, surgery is difficult and the mortality is high; the gravity is directly related to the level of tumour thrombus involvement in the inferior vena cava; the proportion of cases with metastatic dissemination at the time of surgery is higher; the two year survival rate is 38.5% only. However, the long term survival rate of patients without metastasis and alive after surgical management, is equal in the two groups, about 60%. The prognosis of surgical treatment of renal cell carcinoma with massive extension high in the inferior vena cava would be improved by the optimal patient selection (patients without metastasis) and by the use of cardio-vascular surgical procedures (CEC).
Carcinoma, Renal Cell↗
Bladder tumours in children.
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Adolescent↗
[Perisinusoidal hepatic deposits. Symptomatology and identification].
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Amyloid↗
[A further case of painful ophthalmoplegia or Tolosa-Hunt syndrome].
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Aged↗
[Mortality and morbidity after total cystectomy for cancer].
The authors review mortality and morbidity in 100 consecutive patients who during a six year period underwent total cystectomy for carcinoma of the bladder. The postoperative mortality was 15 (15%), essentially as a result of septic and respiratory complications. In relation to the type of diversion: 6 deaths in 46 cases of cutaneous ureterostomy, 4 deaths amongst 19 cases of trans-intestinal cutaneous ureterostomy, 3 deaths amongst 24 cases of uretero-colic implantation and 2 deaths amongst 11 cases of replacement enterocystoplasty . Amongst factors involved in the cause of postoperative mortality, three appeared to be of essential importance: a very high anaesthetic class (class IV), defective drainage of dissected areas, sources of deep abscesses , and use of the intestine in the method of completing total cystectomy. In the last 40 cases, the use of cutaneous ureterostomy in 82.5% of cases and careful attention to drainage of the operative site led to a reduction in mortality to 5% (2/40) whilst in the first 60 cystectomies of the series, 68.3% of which were completed by ureterocolic implantation, mortality was 21.7% (13/60). Early and late complications were also much more frequent in diversion procedures using the intestine than after direct cutaneous ureterostomy. But after replacement enterocystoplasty , late complications were virtually nonexistent. The authors indicate the following guidelines as conclusions: - in patients who accept a cutaneous implant, direct cutaneous ureterostomy is the best bypass procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗