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F R Bentley

Publications and source records attributed to F R Bentley.

At least 37 records · Page 2Linked to original sources
PubMed1991

There is an answer to the shortage of organ donors.

From a retrospective review of 32,562 deaths that occurred in 1988 in the service area of Kentucky Organ Donor Affiliates, an area with a population of 3.4 million, 173 potential solid organ donors were identified for a rate of 50.8 donors per million population base. There were only 38 actual solid organ donors from this potential pool. The physician failed to recognize the potential for donation in 29 instances and in 92, the family refused consent for donation. In the second phase of the study, we analyzed 155 consecutive medically suitable organ donor referrals for one year. A specific focus on the process and timing of the request for donation was made in this review. In 143 of these instances (92 per cent), a clear temporal separation of the explanation of death or the certainty of family acceptance of death before the request for donation yielded a donor success in 53 of 82 instances. In contrast, only 11 of 61 instances resulted in a consent when the discussion of death and donation were combined into one discussion with the family (p less than 0.05). From this study, there seemed to be adequate numbers of organs available to provide for the current pool of recipients within the state of Kentucky. Educational assistance and an ongoing individual patient review of each death improved the donor rate during the time frame of this study. It is essential to allow a temporal separation between the explanation of death and the request for organ donation to maximize actual organ donation.

Adolescent↗
PubMed1989

Terminal loop cutaneous ureterostomy in cadaveric kidney transplantation.

The presence of a nonfunctional bladder is a common finding in some patients with end-stage renal disease in whom transplantation is a proposed option. Over the last 20 years, we have performed six terminal loop cutaneous ureterostomies for urinary drainage during kidney transplantation. Neurogenic bladder in five patients and exstrophy in one patient prohibited use of the bladder. Four long-term graft survivors (19 months and 4, 10, and 20 years) experienced no short-term problems with the procedure, but two episodes of pyelonephritis have occurred. In our patients no graft dysfunction or loss could be attributed to infection, and no stomal stenosis or revision has occurred. We conclude that terminal loop cutaneous ureterostomy is feasible using normal-caliber ureters, and is a safe, effective means of urinary drainage during kidney transplantation when the bladder is not available. It also eliminates the necessity of preparatory bowel surgery that has its attendant risk of contamination in an immunocompromised patient.

Adult↗
PubMed1985

Accidental administration of hepatitis B immune globulin to a patient positive for hepatitis B surface antigen.

Approximately 24 hours after receiving hepatitis B immune globulin (HBIG), a renal transplant surgeon developed localized urticaria at the site of injection followed by generalized urticaria and angioedema, which resolved after administration of corticosteroids but recurred ten days later. Blood drawn from the surgeon prior to his receiving the HBIG injection was positive for hepatitis B surface antigen (HBsAg). We believe that the adverse reaction may have been caused by HBsAg-HBIG immune complexes. This case illustrates the necessity for knowing the results of hepatitis serology before injection of HBIG is given in high risk individuals. It also re-emphasizes the value of periodic screening for hepatitis B in such persons and the need for hepatitis B vaccine.

Angioedema↗
PubMed1984

Long-term effect of splenectomy versus no splenectomy in renal transplant patients. Reanalysis of a randomized prospective study.

In 1980 we determined the patient and renal allograft survival in 299 kidney transplants recipients who, between 1976 and 1979, were randomized to splenectomy (n = 146) versus nonsplenectomy (n = 152), and who were treated with antilymphocyte globulin-azathioprine-prednisone for immunosuppression. The preliminary analysis showed significantly (P less than .05) better (10% overall, 12% for cadaver, 14% for nonidentical-related) graft survival rates at two years in splenectomized recipients. The splenectomized patients had higher white blood counts and received more azathioprine and less prednisone. We concluded that splenectomy had a beneficial effect for at least the first two years posttransplant without a detrimental effect on patient survival. Splenectomy, however, remains controversial. Thus, we reanalyzed the original cohort 7 years after the study began and 4 years after the last patient was entered. The reanalysis showed that the differences in graft survival rates between splenectomized and nonsplenectomized recipients were no longer significant. There were more late deaths from sepsis in the splenectomized group, although the overall patient survival rates were similar in splenectomized and nonsplenectomized recipients. Splenectomy modestly improved graft survival for the first few years, but the eventual fate of the graft was determined by other factors. The dominant influence on graft survival rates was the source of the kidney (at 6 years in splenectomized recipients the functional survival rate of grafts from HLA-identical siblings was 24% higher than that of grafts from HLA-mismatched relatives, which in turn was 24% higher than that of grafts from cadaver donors; in nonsplenectomized recipients the difference in 6-year function rates between HLA-identical and mismatched related grafts was 34%, and between mismatched related and cadaver grafts was 16%. Between 1979 and 1983, we performed pretransplant splenectomies in all recipients of renal allografts from HLA-mismatched related or cadaver donors. Two-year graft survival rates were 81% and 68%, respectively, in azathioprine-treated recipients, 7% and 12% higher than in the splenectomized patients in the randomized trial. (ABSTRACT TRUNCATED AT 400 WORDS)

Azathioprine↗
PubMed1984

Similar renal allograft functional survival rates for kidneys from sibling donors matched for zero-versus-one haplotype with the recipient.

From January 1968 to December 1983, 536 primary renal transplants from siblings donors were performed at a single institution; of the donor-recipient pairs, 246 were matched for two, 205 for one, and 43 for zero HLA haplotypes. Renal allograft functional survival rates at two years were 93%, 75%, and 83% for the 2, 1, and 0-haplotype matched pairs. Corresponding patient survival rates were 95%, 85%, and 93%. The functional survival rate of grafts from the HLA-identical sibling donors was significantly better than the rates in both mismatched donor groups (P = .004), but the difference between the one-haplotype and the zero-haplotype matched pairs was not significant. Most transplant units do not perform transplants between siblings mismatched for both haplotypes because it is assumed that the graft survival rates will be inferior to what can be achieved with a one-haplotype match, and that the outcome will be no better than with cadaveric transplantation. Our results do not support that presumption. Although HLA-identical siblings are the best donors, a sibling should not be excluded as a donor simply because he or she is a complete mismatch. The graft survival rate (83%) is still superior to that achieved with cadaveric transplants (64% at two years, n = 618), and is at least as good as that achieved with transplants from siblings matched for one HLA haplotype. The advent of donor-specific blood transfusion has resulted in liberalization of criteria for acceptance of related donors, but the results of our analysis suggest that a liberal policy, at least in regard to haplotype matching, has always been justified--and certainly at this time the recipient with a willing living donor, regardless of match, should not be relegated to receive a cadaver graft (a scarce resource) that could otherwise be transplanted to someone else who does not have a related donor.

Graft Survival↗
PubMed1984

Pancreatic cancer.

Cancer of the pancreas remains a disease for which there is no satisfactory treatment. A specific population at risk and etiologic factors have not been clearly defined. The increased incidence in industralized countries over the past 30 to 40 years is not understood. Technological advances have permitted more frequent diagnosis at an early stage, but this has not influenced survival statistics. Clearly, there is a need for a reliable tumor marker that will allow diagnosis to be made even earlier. Radical surgery appears to have reached a plateau in terms of improving survival. Morbidity and mortality have decreased since pancreatoduodenectomy began to be widely used. This decrease is probably due to better pre- and postoperative surgical management than to major improvements in technique. More radical procedures have failed to demonstrate clearcut improvements in survival. Radiotherapy and chemotherapy are in the early stages of systematic exploration in treating pancreatic cancer. Most reports deal only with palliating advanced, nonresectable disease. The utility of radiotherapy and chemotherapy as adjuncts to surgery have not been defined.

Combined Modality Therapy↗
PubMed1982

Axilloaxillary bypass for subclavian and innominate artery revascularization.

From 1975 to 1977, ten patients have undergone axilloaxillary bypass grafting from the Vascular Surgery Services at Charity Hospital and the Veterans Administration Hospital in New Orleans, Louisiana. Eight of the patients had lesions in the subclavian artery, and two patients had innominate artery lesions. All patients were relieved of both central nervous system and upper extremity symptoms. Early graft patency has been good. There have been no operative complications. Two patients developed late graft thrombosis. This was easily remedied by simple graft thrombectomy. Axilloaxillary artery bypass is an effective procedure for revascularization of the subclavian and innominate arteries. The authors feel that it is the procedure of choice for most innominate artery lesions, and is also useful in subclavian artery revascularization in selected elderly high-risk patients, where it may be performed under local anesthesia.

Adult↗
PubMedDate not supplied

Laparoscopic cholecystectomy in transplant patients.

Acute cholecystitis is a serious condition in transplant patients and elective cholecystectomy is generally recommended when gallstones are found. We reviewed the results of laparoscopic cholecystectomy (LC) in 10 immunosuppressed transplant patients (6 heart, 4 kidney) and compared them to the results of open cholecystectomy performed in 26 transplant patients (14 heart, 11 kidney, 1 kidney/pancreas). The LC group had a 20% incidence of minor complication with no major complications and no deaths. The open-cholecystectomy group experienced 19% minor complications, 23% major complications, and 15% deaths. The average postoperative length of stay for the LC patients was 4.6 days (2 days for the 5 straightforward cases) as compared to 9.1 days after open cholecystectomy (4 days for the 13 straightforward open cases). Oral immunosuppression was stopped prior to operation but could be restarted within 29 hours after operation in the LC patients and 68 h in the open cases. The findings at LC were helpful in assessing whether acute cholecystitis and/or choledocholithiasis was the source of fever, liver-function abnormalities, or pancreatitis in these immunosuppressed transplant patients. We conclude that LC can be performed safely in transplant patients, but that in 10-20% of patients, the operation will be converted to an open procedure. The advantages of LC in these patients are a shorter hospitalization and less delay to resumption of preoperative oral immunotherapy than after open cholecystectomy.

Adult↗