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Biomedical subjects

F K Merkel

Publications and source records attributed to F K Merkel.

18 recordsLinked to original sources
PubMed1992

Percutaneous transluminal angioplasty for transplant renal artery stenosis.

A recent report has challenged the efficacy and safety of percutaneous transluminal angioplasty (PTA) for the treatment of transplant renal artery stenosis (TRAS). From January 1983 to December 1990, 24 PTA procedures were performed for TRAS in 18 patients. The stenoses were anastomotic in two cases, in the main renal artery in 14, and segmental in eight. After PTA, the residual stenosis was less than 20% in 14 (58%), 20%-50% in four (17%), and greater than 50% in six (25%). The mean diastolic blood pressure decreased from 106 mm Hg 1 day prior to PTA to 82 mm Hg 1 day after PTA. Long-term follow-up mean diastolic blood pressure (at 2-32 months) was 93 mm Hg (P less than .01). Eleven of the 18 patients (63%) had a 10% or greater reduction in diastolic blood pressure on long-term follow-up. Major complications occurred in two patients; one groin hematoma required surgical evacuation, and one polar infarct led to hypertension that was difficult to control. No surgical revisions of the transplant renal artery were necessary. The authors' data indicate that PTA should remain the treatment of choice for nonanastomotic TRAS.

Adult↗
PubMed1990

Percutaneous treatment of urine leaks in renal transplantation patients.

The data on post-renal transplantation urine leaks in 23 patients were retrospectively reviewed to assess the role of percutaneous urine-diverting procedures in their treatment. The leaks were confirmed by means of antegrade pyelography, and either a nephrostomy catheter or a nephroureteral stent was placed. Nephrostography was performed frequently to evaluate leak closure. Urinary diversion was continued for an average of 68 days. Leak closure was documented in 20 of 23 (87%) cases. In four patients, concomitant infection or multiorgan failure precluded adequate therapy. One patient developed a ureteral stricture after the urine-diverting procedure and required surgical correction. The results suggest that percutaneous urine-diverting procedures are a definitive treatment for post-renal transplantation urine leaks.

Adult↗
PubMed1990

Organ donation.

Explore the source record for details and available documents.

Humans↗
PubMed1977

The application of ileal conduits in pediatric renal transplantation.

Our experience with the use of ileal conduits as receptors of renal homografts in 5 of 41 transplant recipients during the preceding 4 years is described. These 5 chronic renal failure patients were between 6 months and 17 years old, and had unsalvageable bladders that required an ileal conduit at an elective time before transplantation. The causes of renal failure in these children included dysplasia and chronic urinary tract infection. In an attempt to retard the rate of renal insufficiency all patients underwent multiple operative procedures on the lower urinary tract. Two cadaveric and 3 kidneys from living relatives were transplanted. One infant (6 months old) died of severe fluid and electrolyte imbalance 5 days post-transplantation. Of the remaining patients 3 are now 2 to 3 1/2 years post-transplantation and exhibit normal homograft function, and 1 died recently of chronic rejection. All conduits functioned well without evidence of ureteroileal obstruction, significant infection or stomal stenosis.

Adolescent↗
PubMed1977

Return of function in the thrombosed kidney after transplantation.

The incidence of intraglomerular thrombi in renal allografts and factors regulating their resolution were studied. A case report is presented in which resolution of intraglomerular thrombi is documented. In addition, 17 transplanted patients with renal biopsies were serially studied. Intraglomerular thrombi were found in 4 of 8 specimens taken 1 h after reanastamosis, all from donors with a terminal course involving prolonged hypotension. Glomerular fibrinolytic activity was markedly diminished in 4 of 11 patients' subsequent biopsy specimens; all taken during acute rejection. Resolution of thrombi was documented when signs of rejection were absent.

Adult↗
PubMed1977

The effect of length of preservation on renal transplant survival.

Pulsatile preservation of cadaver kidneys for periods of 36 to 67 hours does not adversely affect the success rate following transplantation. Immediate urine output correlated well with an increased chance for short and long term transplant kidney function. No kidneys should be discarded because of perfusion periods as long as 36 to 67 hours if the ground rules for organ retrieval and preservation have been followed.

Cadaver↗
PubMed1976

Microvascular techniques for polar artery reconstruction in kidney transplants.

The complications of ureteral ischemia make revascularization of polar vessels attractive in cadaver and live-related transplants. Thirty-two patients underwent reconstruction of polar vessels of 1.2 to 2.5 mm, in diameter after revascularization of the major vessels as follows: (1) inferior epigastric artery to polar artery, ten patients - six cadaver transplants, four living-related transplants (The vessels are spatulated and sutured precisely by microvascular techniques with Nos. 7-0 or 8-0 Tevdek); (2) polar vessel with a patch of aorta to iliac artery, one patient - living relative donor; (3) polar artery to the main renal artery or branch, 17 patients - 14 cadaver transplants, three living-related transplants [A Waters "MOX"-100 machine is used with cryoprecipitated plasma (800 mg. of SoluMedrol and 80 U. of insulin added) for preservation.]; (4) autogenous saphenous vein graft, two patients - one child receiving on adult live-related kidney and one cadaver transplant with three arteries and a stenosis of the inferior polar vessel; (5) polar artery to vein patch in iliac artery, two patients - cadaver transplants. Follow-up was done by arteriography (18 patients), direct observation (two patients), and by use of ultrasound (one patient). The remaining 11 patients have exhibited no evidence of occlusion. Twenty of 21 patients exhibited patent vessels; one thrombosed at the time of the transplant operation. Long-term patency in those patients studied was 95%. We advocate small-vessel reconstruction in human renal transplantation, either during ex vivo preservation (workbench surgery) or at the time of transplantation.

Arteriovenous Shunt, Surgical↗
PubMed1975

An intraluminal technique for arterial occlusion during renal transplantation.

A simple technique was developed for occlusion of atherosclerotic vessels in patients undergoing renal transplantation. Fogarty catheters were placed within the iliac arteries via a stab wound and the balloons inflated to provide safe and gentle occlusion of atherosclerotic vessels during the transplant operation.

Arteriosclerosis↗