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Biomedical subjects

H Koolpe

Publications and source records attributed to H Koolpe.

8 recordsLinked to original sources
PubMed1994

Management of ureteral stenosis after renal transplantation.

BACKGROUND: Ureteral stenosis is the most common urologic complication of renal transplantation. Preferred management options for this complication vary among centers. Ureteral stenosis occurred in 24 (3.4 percent) of 692 consecutive renal transplants. The diagnosis was confirmed by antegrade pyelography after ultrasonography in all instances. An attempt was made to treat all patients by percutaneous stenting, usually with dilatation of the ureter, which was possible in 21 patients. In three patients, a wire could not be passed across the stricture and these patients were treated surgically. STUDY DESIGN: The patients were divided into two groups. Patients in group 1 (14 patients) presented within three months from the date of transplantation and patients in group 2 (seven patients) presented after three months. RESULTS: The site of stenosis was the ureterovesical junction in 80 percent of the patients and the uretero-pelvic junction in 20 percent. Urinary tract infection occurred in 70 percent of the patients in group 1 and 100 percent of patients in group 2. The success rate of percutaneous stenting was 71 percent (ten of 14 patients) in group 1, but only 29 percent (two of seven patients) in group 2. The failures were treated by repeated stenting (one patient in each group) or by operation. One allograft (7 percent) was lost in group 1 and two (28 percent) were lost in group 2. The average follow-up period was 38 months in group 1 and 56 months in group 2. There was no mortality in this series. CONCLUSIONS: Ureteral stenosis in the early postrenal transplant period can be safely and effectively treated by percutaneous dilatation and stenting, with few side effects and long-term success. This method is specially efficacious in patients who present within three months from the time of their transplant. In patients who have ureteric strictures developing after three months from transplantation, percutaneous stenting is of limited value and most patients require surgical correction.

Adult↗
PubMed1990

Traumatic occlusion of two radiocephalic fistulas: case reports and their management.

The number of ambulatory dialysis patients is increasing each year with a concomitant rise in extremity access fistulas and grafts. The anatomic location of these fistulas makes them particularly susceptible to traumatic occurrences. Management of traumatic occlusion of these fistulas becomes a critical issue in allowing continuing dialysis in these patients. Management of two such patients is presented.

Adolescent↗
PubMed1987

Risk of pulmonary embolus with inferior vena cava thrombosis.

The authors have evaluated the risk of pulmonary embolism both as a primary event or as a secondary embolus despite adequate anticoagulation in 39 patients with phlebographically documented inferior vena caval (IVC) thrombosis. Twenty-six of these patients had thrombi characterized as free floating, and 13 had thrombi that were adherent to the IVC wall without a free-floating component. The incidence of initial pulmonary embolism confirmed by either pulmonary arteriography or high probability ventilation-perfusion lung scanning was 50 per cent (13/26) in those patients with free-floating IVC thrombi, but 15 per cent (2/13) in those with closely adherent mural thrombi (P less than 0.05). Pulmonary embolism despite adequate anticoagulation occurred in 27 per cent (7/26) of patients with free-floating clots, but in only 17 per cent (1/8) of cases with adherent thrombi (P greater than 0.05). These data strongly suggest that patients with documented free-floating inferior vena caval thrombi are at a significant risk for pulmonary embolism as an initial event and perhaps also as a recurrent embolus, even in the presence of adequate anticoagulation. When such thrombi are identified, the overall incidence of pulmonary embolus is high and conventional anticoagulant treatment with heparin may not be sufficient.

Heparin↗
PubMed1985

Pain control: comparison of percutaneous and operative nephrolithotomy.

Percutaneous removal of renal calculi is an effective form of therapy with less morbidity than some other operative procedures. The narcotic requirements of 21 patients treated percutaneously were compared with a comparable group of patients treated by open nephrolithotomy. Patients treated percutaneously stayed in the hospital for 8.9 days and required 6.5 doses of narcotics. Patients treated by open surgical lithotomy remained in the hospital for 11.0 days and required 21 doses of narcotics. When compared on a daily basis, patients in the open operative group required 2.7 times more doses of narcotics than patients treated percutaneously. Percutaneous nephrolithotomy appears to be significantly less painful than operative nephrolithotomy utilizing a standard flank incision as indicated by narcotic analgesic usage.

Adolescent↗
PubMed1981

Percutaneous nephrostomy: comparison of sonographic and fluoroscopic guidance.

Both sonography and fluoroscopy have been recommended for renal localization and needle guidance for percutaneous nephrostomy. The respective efficacies of both methods have been compared in a prospective study of 88 patients undergoing percutaneous nephrostomy by the catheter over guide wire technique. Fifty-five patients had initial puncture using either an A-mode (42 patients) or real time (13 patients) sonographic aspiration transducer, while 33 patients had a single plane vertical beam fluoroscopy for puncture guidance. The use of either sonographic method for the initial needle puncture significantly reduced the number of puncture attempts (p = 0.000004) and potential iatrogenic risk, eliminated the need for intravenous administration of contrast material, allowed initial safe introduction of a large caliber needle, and decreased the length of time needed to perform the procedure.

Drainage↗
PubMed1980

Wedged pressure recording and injection of contrast medium into the hepatic veins: a study performed on the livers of cadavers to explain clinical findings.

Portal and hepatic veins were injected with Microfil in the normal and cirrhotic livers of cadavers. Based on pathologic and anatomic studies previously reported and on the present investigation, the authors explain the background of wedged hepatic pressure recording and the findings when contrast medium is injected into a catheter wedged in a hepatic vein.

Catheterization↗
PubMed1980

Percutaneous brush biopsy and internal drainage of biliary tree through endoprosthesis.

Percutaneous insertion of a permanent internal prosthesis for biliary tract decompression was successful in 15 patients with obstructive jaundice. Percutaneous brush biopsy of the obstructing lesion that preceded stent placement in six patients was successful in obtaining diagnostic tissue in four. Both techniques are described in detail with illustrative cases.

Adult↗