PARAMETERS OF MICTURITION: CLINICAL STUDY.
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Biomedical subjects
Publications and source records attributed to K J MACKINNON.
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Four renal homotransplants were carried out between cadaver donors and four recipients, all of whom were in terminal chronic renal failure. Immune suppression was attempted with azathioprine (Imuran), actinomycin C and prednisone; no radiation was used, nor were the recipient's kidneys, spleen or thymus removed. One patient died with disseminated histoplasmosis at two weeks; another with irreversible homograft rejection at 30 days; a third patient died of septicemia after 9(1/2) weeks with stable renal function. The fourth patient, whose transplant had been ischemic for 190 minutes and had not functioned for 2(1/2) weeks thereafter, eventually achieved good function which remained unchanged to 7(1/2) months. Changes in urinary enzyme excretion and in the I(131) renogram and meralluride scan were of value in assessing homograft rejection.
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Usefulness of intestinal perfusion in the treatment of uremia is limited by (a) low clearances, (b) atrophy of the perfused mucous membrane, and (c) poor toleration by the patient. A method of intestinal perfusion has been devised which uses most of the small bowel without exclusion from the fecal stream. Two Roux-en-Y anastomoses are made, the proximal 12'' below the ligament of Treitz, the distal 18'' above the ileocecal valve. Perfusion is carried out between the proximal jejunostomy and distal ileostomy, daily. Six litres of fluid are perfused in four hours. The bowel is used for digestion during the remaining 20 hours of the day. Patients have solid bowel movements daily, prior to perfusion. Reflux of intestinal contents, between perfusions, is slight. The method allows maximal diffusion, may prevent bowel atrophy and is well tolerated by the patient. The method is being used, in conjunction with hemodialysis, in treatment of chronic uremia.
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