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D E Engen

Publications and source records attributed to D E Engen.

34 records · Page 2Linked to original sources
PubMed1987

The clinical spectrum of granulomatous prostatitis: a report of 200 cases.

Granulomatous prostatitis, reviewed in 200 tissue-diagnosed cases, occurred in 0.8 per cent of the benign inflammatory prostatic specimens. Often the disease followed a recent urinary tract infection (71 per cent) and was suspicious clinically for prostatic cancer (59 per cent). The diagnosis usually was made by needle biopsy or at transurethral prostatectomy (94 per cent). Most cases of granulomatous prostatitis were classified as nonspecific. The recently identified entity of post-transurethral resection granulomatous prostatitis was found in 49 patients. A proposed new category of granulomatous prostatitis that is secondary to systemic granulomatous diseases was documented in 6 patients. Most cases of granulomatous prostatitis resolved spontaneously and required no specific therapy.

Adult↗
PubMed1987

Prostatic involvement in Wegener's granulomatosis.

Wegener's granulomatosis involving the prostate gland is unusual. We report 3 cases of this condition in which typical necrotizing granulomas with vasculitis were seen histologically. These lesions may cause gross hematuria or obstructive voiding, including urinary retention. Management includes prostatectomy when the symptoms are severe but an initial trial of aggressive medical therapy may be successful. Treatment requires a knowledge of the natural history of Wegener's granulomatosis and its usual response to medical therapy.

Aged↗
PubMed1987

Renal transplantation in patients with indwelling continuous ambulatory peritoneal dialysis catheters.

Controversy exists regarding management of the continuous ambulatory peritoneal dialysis catheter in patients undergoing renal transplantation. We performed 30 transplants (23 cadaveric and 7 living related) in 27 patients with indwelling continuous ambulatory peritoneal dialysis catheters. Dialysis was necessary in the immediate post-transplantation period in 9 of 30 patients (30 per cent). Of these 9 patients 3 had temporary hemodialysis and 6 resumed continuous ambulatory peritoneal dialysis with the indwelling catheter. Two postoperative complications clearly were related to the continuous ambulatory peritoneal dialysis catheter: 1 patient required abdominal exploration for control of bleeding related to disruption of peritoneal adhesions at the time the continuous ambulatory peritoneal dialysis catheter was removed and 1 suffered an abscess at the catheter site 1 month after the catheter was removed. No patient experienced peritonitis during immunosuppression after transplantation. We support leaving the continuous ambulatory peritoneal dialysis catheter during and after transplantation to simplify pre-transplantation patient care and to avoid the possible need for temporary post-transplantation hemodialysis in many patients.

Abscess↗
PubMed1986

Current status of renal transplantation--1986.

During the course of 3 decades, and particularly during the past 5 years, clinical renal transplantation has improved to become a safe mode of therapy for end-stage renal disease. Currently, more than 95% 1-year survival can be expected, both in patients who receive allografts from living-related donors and in those who receive cadaver kidneys. One-year living-related donor graft survival is 98%, and 1-year cadaver graft survival is 87%. Cyclosporine has been an important adjunctive immunosuppressive agent not only because of improved results but also because it has shortened hospitalization time.

Antilymphocyte Serum↗
PubMed1985

Adaptation of existing cutaneous ureterostomy for urinary drainage after renal transplantation.

We adapted existing cutaneous ureterostomies for urinary drainage in 3 patients who underwent renal transplantation. Careful preoperative radiological evaluation of the ureteral anatomy and appropriate preoperative planning are necessary for such patients. The concentration of serum creatinine was 0.9, 1.3 and 1.5 mg. per dl. at 2 months, 3 years and 10 years, respectively, after transplantation. All 3 patients have had bacteriuria that necessitated therapy with chronic suppressive antibiotics but clinical pyelonephritis has not occurred.

Adolescent↗
PubMed1985

Treatment of renal cell carcinoma by in situ partial nephrectomy and extracorporeal operation with autotransplantation.

During a 10-year period, 33 patients underwent in situ enucleation, in situ partial nephrectomy, or an extracorporeal operation for low-grade (1 or 2), low-stage (I or II), bilateral or solitary renal cell carcinoma. Only one patient (3%) (who had undergone in situ partial nephrectomy) had local recurrence; the projected 5-year rates of nonprogression of disease and survival from death due to cancer only were 76% and 87%, respectively. A group of patients who were closely matched for grade and stage of renal cell cancer underwent traditional transabdominal radical nephrectomy during the same time interval and had rates of nonprogression and survival similar to those of the conservative surgical group. Thus, in selected patients with low-grade, low-stage renal cell cancer, conservative surgical treatment (that is, renal parenchyma-saving procedures) can produce favorable results without the side effects (such as renal failure) associated with ablative renal operations.

Adult↗
PubMed1985

Use of radiographically abnormal kidneys in living-related donor renal transplantation.

A retrospective study was undertaken to evaluate the significance of anatomic variants in living-related donor kidneys, when used in renal transplantation. 301 arteriograms were performed in the evaluation of such potential living donors over an 8-year period. 51 (16.9%) were found to have one or more radiographic abnormalities. 20 of the 51 patients (39%) were judged as not suitable for transplantation because of radiographic abnormalities. 7 of 31 patients who were accepted as organ donors declined for personal reasons. The remaining 24 patients underwent donor nephrectomy with the abnormal kidney utilized as the donor organ. In follow-up, none of the kidneys were lost because of their primary radiographic abnormality, and allograft survival of abnormal kidneys was the same as for normal kidneys transplanted under parallel circumstances. We conclude, in properly selected living donors, kidneys with anatomic variants without pathological significance can be used safely in renal allotransplantation. We do not recommend, however, transplanting kidneys with the potential for the development of progressive disease.

Adult↗
PubMed1984

Improving results in primary diabetic renal transplantation.

One hundred seventeen patients with renal failure resulting from insulin-dependent diabetes mellitus received primary renal allografts from June 1970 to April 1983. Factors significantly associated with improved graft and patient survival were LRD sources (in particular, HLA-identical) and splenectomy. Variables such as transfusions, age, sex, and the administration of ALG were not significantly associated with transplant outcome. However, survival of patients and grafts has improved in recent years and continues to compare favorably with hemodialysis results. Although splenectomy might be the most important variable responsible for the improvement of our recent results, the use of ALG for rejection episodes might have contributed substantially to the improvement. Early transplantation, not analyzed in this study, might prove to be the most significant variable in the outcome of transplantation in patients with diabetic renal failure.

Adult↗
PubMed1983

Primary and secondary renal transplantation in diabetic patients.

A total of 117 (101 primary and 16 secondary) renal transplants were performed on 101 diabetic patients. The mean duration of diabetes mellitus to the onset of end-stage renal disease was 17.5 years. After primary transplantation, overall one- and five-year patient survival was 77% and 55%, respectively; for grafts, it was 58% and 45%, respectively. One- and five-year living-related donor graft survival was 66% and 53%, respectively; for cadaveric kidneys, it was 45% and 33, respectively. One- and five-year graft survival for 20 HLA-identical living-related donor kidneys was 85% and 77%, respectively. Among the 16 recipients of secondary grafts, patient survival at one and five years was 65% and 29%, respectively; graft survival at one year was 24%. Acceptable patient and graft survival continues with primary renal transplantation. In view of the poor results with secondary transplantation in the diabetic patient, however, its continued application should be questioned.

Adult↗
PubMed1983

Splenectomy in high-risk primary renal transplant recipients.

One hundred sixty-five high-risk patients who were either 50 years of age or older or had diabetes mellitus, or both underwent primary renal transplantation. One hundred eight had splenectomy and 57 did not. Graft and patient survival were analyzed in regard to whether splenectomy had been performed at all and whether it had been performed 30 days or more before transplantation, less than 30 days before, or at the time of transplantation. Also, the influence of age, diabetes, blood transfusions, blood type, donor type, HLA mismatch, pretransplantation dialysis, and percentage of performed antibodies were analyzed, as were complications and causes of death. Differences in patient survival were not significant in any one of these categories, although survival in the splenectomized group was generally better. The incidence of infection and sepsis was comparable in both groups and was responsible for death in 34 percent of the patients who underwent splenectomy compared with 22 percent of those who did not (no significant difference). Splenectomy improved cadaver donor renal allograft survival (p = 0.001) in the diabetic patients (p = 0.015) and in those 50 years of age or older (p = 0.026) but it did not improve survival in those who received living related donor kidneys. No significant differences were detectable in regard to the timing of splenectomy. The effect of splenectomy was significant in the patients who had not received transfusions (p = 0.003). It also improved survival in the transfused patients. Splenectomy in high-risk diabetic patients and patients 50 years of age or older does not seem to be associated with increased mortality.

Adult↗
PubMed1983

Acute dissecting aneurysm of the aorta after renal transplantation.

We report on a man with a long history of systemic lupus erythematosus, who had signs and symptoms of a dissecting aortic aneurysm 25 days after receiving a living related donor transplant. The aneurysm was repaired successfully while the patient was on immunosuppression. However, the patient died 3 weeks later of cytomegalovirus pneumonia.

Adult↗
PubMed1982

The management of acquired rectourinary fistula.

Rectourinary fistula is an uncommon entity with many causes for which the optimal management remains unclear. To clarify this, a 50-year experience with acquired rectourinary fistula at the Mayo Clinic was reviewed. In the management of 57 patients, 34 patients underwent repair of rectourinary fistula, the success rate being 88 per cent and the morbidity 29 per cent. Based on this experience, a simple plan of management emphasizing etiologic and prognostic factors is presented. Repair of rectourinary fistulas can be undertaken with a high degree of success and acceptable morbidity for patients with fistulas of benign cause and for those with fistulas of malignant cause who have no gross evidence of malignancy, minimal induration from irradiation, and anticipated long-term survival. Colostomy as an adjunctive procedure is usually unnecessary in the repair of fistulas associated with benign conditions.

Adult↗
PubMed1979

Hemosiderosis of urinary bladder.

We believe this is the first case of proved hemosiderosis of the bladder to be reported. The clinical presentation, radiographic findings, and cystoscopic appearance suggested a primary bladder neoplasm.

Cystoscopy↗
PubMed1979

Malignancy in uremia: dialysis versus transplantation.

The incidence of cancer was compared in 499 dialysis patients and 121 renal transplant recipients. De novo malignancy developed in 15 patients on chronic dialysis (3 per cent) and in 6 transplant recipients (4.9 per cent), a significant increase over the expected number in the age-matched general population. There was no difference in the incidence of cancer in uremic patients on dialysis or after transplantation. A total of 10 dialysis patients (67 per cent) and 1 transplant patient (16 per cent) died of cancer. Neoplasms in the dialysis patients were the common types of mesenchymal tumors, while superficial skin cancers were seen more frequently in the transplant recipients. The differences in tumor types accounted for the higher mortality rate from cancer in the dialysis patients and may reflect different patterns of immunosuppression in these 2 patient populations.

Aged↗
PubMedDate not supplied

Renal artery graft-to-duodenum fistula: unusual presentation of a recurrent flank abscess.

Perhaps the most devastating complication of a prosthetic vascular graft is the formation of an aortoenteric fistula. Most reports have dealt with fistulas between the aortic graft and the duodenum, although any revascularized vessel with prosthetic material can be the site of an enteric fistula. We report an unusual case in which a renal artery previously revascularized with a silk prosthetic graft developed a fistula to the duodenum 16 years later. Whether the prosthetic graft is in the aortic position or to a visceral vessel, when a fistula develops the only acceptable treatment is complete removal of the graft and revascularization with autogenous tissues, if necessary.

Adult↗