Biomedical subjects
Publications and source records attributed to J Konnak.
A soft tissue mass causing ureteral obstruction should be considered malignant until proved otherwise. We report a case of retrograde ureteral intussusception that caused obstruction. To our knowledge, this condition has not been described in the recent literature.
The bioCarbon ureterostomy device is a stomal prosthesis for upper tract urinary diversion that has had preliminary successes in animal and human trials in Europe and Peru. Implantation of a pure carbon stomal prosthesis offers the potential advantages of high biocompatibility, lack of encrustation, and elimination of stomal stenosis which is frequently associated with cutaneous ureterostomy. Nine bioCarbon ureterostomy devices were implanted from August, 1984 through July, 1985. Although successful implantation was achieved in 2 patients, the complication rate was high. The bioCarbon ureterostomy device has potential as an alternative form of urinary diversion. However, significant problems need to be remedied before it can be recommended for routine clinical application.
Creation of a continent low pressure urinary reservoir was attempted in 33 patients: 11 with a supravesical diversion, 6 with a vesicostomy, 9 treated by catheter drainage and 7 with end stage bladder disease. The common problems were poor urine storage associated with bladder fibrosis, defunctionalization and decentralization or spinal cord injury coupled with a poorly functional urethral continence mechanism. The over-all outcome at a mean of 21 months (range 4 months to 11 years) was excellent in terms of upper tract function, reservoir capability and continence.
Experience with 35 second grafts included in a total number of 310 renal transplants was analyzed to identify factors associated with success. The 2 year life-table renal survival rate of sequential cadaveric grafts is 42 percent compared in 54 percent for primary cadaveric grafts. The 2 year life-table patient survival rate for the same group is 68 percent compared to 72 percent for single cadaveric homotransplants. Twenty-one of 30 patients tested in the interval between grafts developed cytotoxic antibodies to greater than 5 percent of a random panel of cells; 43 percent of these kidneys functioned at least one year; 65 percent functioned for one year or more if the cytotoxicity was 5 percent or less. If the first graft functioned greater than 3 months, the second had a 67 percent chance of functioning for one year; if less than 3 months, the second had a 45 percent one year function rate. Removal of the first transplant at time of second transplantation resulted in an 88 percent one year life-table survival rate of the second kidney in nine patients. Removal prior to second transplantation resulted in a 25 percent one year survival rate in 23 patients. To further evaluate this significant finding, data was obtained through the American College of Surgeons/National Institutes of Health (ACS/NIH) Organ Transplant Registry from five major transplant centers. Thirty-two patients had their first graft removed at time of second transplantation with a 52 percent one year life-table kidney survival rate vs. 29 percent if the first were removed more than 90 days prior to second grafting. Statistical analysis shows this to be significant at the 95 percent confidence level.
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