Rupture of allograft kidney: a salvageable condition.
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Biomedical subjects
Publications and source records attributed to L Burrows.
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Living-related kidney transplants continue to yield the best results. The two primary approaches for living-related donor nephrectomy are the intraperitoneal and extraperitoneal operations. We herein describe a series of 8 cases in which an eleventh rib intraperitoneal extrapleural incision was used for living-related donor nephrectomy. The advantages of the operation in terms of improved ability to manage vascular anomalies is described. No complication has been encountered.
The transfusion-induced immune suppression that prolongs kidney graft survival for transplant patients may be detrimental to patients with malignancies. We studied the relationship of blood transfusion to the disease-free survival of 169 patients with operable breast cancer who had undergone mastectomy with axillary dissection at Mount Sinai Hospital between 1964 and 1972. The cumulative 5-year disease-free survival rate for patients who had received transfusions was 51% compared with 65% for patients who had not received blood (p = 0.0210). The two groups of patients were comparable in age, stage, discharge hemoglobin values, proportion of radical mastectomies, and duration of follow-up. Admission hemoglobin values were lower and operative blood loss was higher among patients who had received transfusions, and significant survival differences were noted in relation to operative blood loss: 69% of women with estimated blood loss less than the mean of 370 ml were free of disease at 5 years compared with 50% of women with higher intraoperative losses (p = 0.0279). However, the first year after operation the association of survival with transfusion was highly significant (77% for those who had received transfusions, 94% for those who had not, p = 0.0096), whereas survival rates in relation to operative blood loss differed by only 7% during the same interval (p = 0.1182). These results indicate that perioperative blood transfusion may be a significant prognostic factor for patients undergoing mastectomy for operable breast cancer.
Recent studies suggest that pretransplant blood transfusions prolong kidney graft survival by nonspecific immune suppression. Since immune suppression in patients with cancer is associated with early recurrence and poor prognosis, we studied the relationship of perioperative blood transfusion to recurrence of Stage I (subset N0) lung cancer. Technique-related variables were minimized by limiting the study to one surgeon (P. A. K.). Life-table and Cox proportional hazards analysis of age, sex, tumor size, histopathology, admission and discharge hematocrit values, estimated operative blood loss, duration of operation, extent of resection, anesthetic agents, and blood transfusion revealed two statistically significant prognostic factors: extent of resection (p = 0.0056) and use or non-use of transfusions (p = 0.0283). The cumulative 5 year disease-free survival rate of the 15 patients undergoing pneumonectomy was 42% compared to 75% for 150 patients undergoing lobectomy and lesser procedures. Transfused patients had lower disease-free rates within 5 years than nontransfused patients (62% versus 76%, p = 0.0132). Survival advantage was also noted in nontransfused patients after deleting patients subjected to pneumonectomy. These results indicate that perioperative transfusion in patients with lung cancer undergoing resection accelerates the appearance of recurrent or metastatic cancer. This supports the findings of previous studies of breast and colon cancer that blood transfusion is detrimental to the patient with cancer.
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A series of HL-A defined, nonrelated blood transfusions given in small aliquots from the same donor to prospective cadaveric and living-related donor recipients has been presented. The results to date show 100% kidney survival in this small series over a relatively short period of time. The rejections noted have been very mild, and easily reversed. Nonspecific antibodies appear to be produced by the recipients in response to the blood, and these antibodies seem to have no negative effect upon kidney survival. This method of small aliquot transfusion to produce the desired effect is cheaper, wastes less blood, is less likely to lead to a CMV or HAA infestation in the transfusion recipient, and appears to be a highly efficient method of producing the desired effect.
Three case reports of direction extension of pancreatic pseudocysts into the spleen are presented. This unusual complication can occur in both emergent and nonemergent settings. The most useful diagnostic procedures to assess whether there is an intrasplenic pseudocyst are sonograms, CAT scans, splenic scan, and occasionally angiography. The best treatment for this condition is a prompt distal pancreatectomy.
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A 46-year-old man with diabetes mellitus and cadaveric kidney transplant, maintained on a regimen of prednisone and azathioprine, developed a necrotizing pneumonia. The abscess cavity became secondarily infected with Rhizopus and was cured by surgical resection. Secondary invasion of an abscess cavity by Rhizopus and the successful surgical treatment of pulmonary phycomycosis in an immunosuppressed patient have not previously been reported.
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Allyl chloride (3-chloroprene) is mutagenic for Salmonella typhimurium and it induces gene conversions in Saccharomyces cerevisiae. It also displays DNA-modifying activity for E. coli. This is in contrast to a recent study which reported its lack of genetic activity for Salmonella typhimurium.
Lymphocele is a known complication of renal transplantation. The diagnosis is easily made by sonographic technics. Although one may perform percutaneous aspiration or drainage or both, we found that peritonealization of the lymphocele may be more advantageous.
To evaluate the extent of injury in short- and long-term renal allografts, the urinary excretion of IgG, IgA, and IgM was observed during acute rejection crisis. In reversible rejection, treatment resulted in prompt correction of immunoglobulinuria, whereas in irreversible crisis urinary immunoglobulin levels continuously increased in spite of the same antirejection treatment. A good prognosis in long-term allografts was shown by low levels of immunoglobulinuria; unstable graft function had higher levels. Immunoglobulinuria can be used as an additional test to evaluate the reversibility of acute rejection, and also has significance in the long-term situation.
The laboratory rat has been widely used as a preclinical model of renal transplantation. Surgical anastomosis of the small lumenal structures encountered requires strict adherence to basic principles of microsurgical technique. Nonfatal technical errors may adversely affect renal allograft function and influence experimental results. Experience obtained from a series of more than 600 rat renal transplants is discussed.