Biomedical subjects
Publications and source records attributed to O Lindfors.
A series of 143 living donor nephrectomies during a 14 year period is presented. The overall complication rate was 16 per cent. The incidence of wound complications was 4.2 per cent and of lower urinary tract infections 9.8 per cent. To date no donor has had known significant problem related to the nephrectomy or to the solitary kidney status.
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Over a 4-year period, 32 patients, 11 females and 21 males between 18 to 62 years of age (mean age 39 years) were operated on because of renovascular hypertension. Three patients were operated on bilaterally. The most common type of arterial reconstruction was aortorenal venous bypass. Early nephrectomy was performed in two patients, and secondary nephrectomy due to graft occlusion in four patients. There was no operative mortality. Seven patients died during follow-up, five of them of cardiovascular causes. The proportion of patients who were cured or improved by surgery throughout a follow-up of two to 72 months (mean 24 months) exceeded 87%. Nine of these 28 patients were normotensive, the other 19 were improved with less need of drugs following surgery. Four patients were failures. Lateralizing renal venous renin activity was found to be the best single criterion for prediction of improvement following surgery. In the majority of the patients who were cured after surgery, there was no preoperative heart hypertrophy and fundoscopic findings were normal or mildly pathological. A higher incidence of hypertensive changes in the target organs was observed preoperatively in the improved patients than in the cured ones.
Between 1972 and the end of 1978 kidney transplantation was performed on 39 patients over 60 years of age. In one case a kidney from a live donor was used. The other patients received cadaver kidneys. Patient and graft survival in this group of patients did not differ from the results obtained with younger age groups. 14 patients have died. The chief reasons for death were cardiac infarction and infection. The mortality rate was no higher among patients over 60 years than among younger groups. The results show that kidney transplantation can be performed successfully on patients of relatively advanced age.
Nine autogenous vein grafts (AVG) have been used in nine patients to create arteriovenous fistulae for haemodialysis. All the patients lacked vessels for construction of a regular arteriovenous fistula. Three of the AVG failed during dialysis treatment 3, 10 and 14 months respectively following construction. Another AVG thrombosed but function was restored by thromboectomy. The same graft was later complicated by a false aneurysm and rupture but was then reconstructed with a vein patch. One AVG with a false aneurysm in the proximal anastomosis was repaired within six weeks.
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Reconstruction of a stenotic renal artery was done on 5 hypertensive renal transplant recipients, all of whom had deterioration of renal function when the stenosis was detected. After reconstruction renal function improved in 4 of the patients. The blood pressure was easier to control in all 5 patients, with 3 becoming normotensive. A high preoperative plasma renin activity returned to normal postoperatively in 4 patients. No recurrences were observed after a followup of more than a year.
Gastroduodenal ulceration occurred in 45 patients during the post-transplantation period in a series of 500 transplantations of 434 patients. The mortality rate of this complication was high, 42%. Bleeding and perforation were the main problems. These complications occurred frequently during treatment for acute rejection. Present day prophylaxis, which is based on the use of antacids, seems to be inadequate for controlling these complications. Other possibilities for reducing the incidence of gastroduodenal ulceration in transplant patients are discussed. Since increased serum gastrin concentrations are often observed in these patients, prophylactic treatment should be based on preoperative evaluation of gastric secretion and serum gastrin determinations. The new histamine (H2) blocking agents should be evaluated in these patients.
Twenty-three subcutaneous arteriovenous fistulas were created for hemodialysis in 18 patients with terminal renal failure due to juvenile diabetes. Seventeen patients received well-functioning fistulas. Four patients needed reoperations due to late failure and the reoperations were successful in three. Venous hypertension syndrome developed in two patients because of thrombosis of the vein proximally to the anastomosis. In one patient extensive arteriosclerotic disease was the cause of late failure of two fistulas. Sepsis with low flow state was the cause of failure in one patient. None of the patients developed clinical signs of arterial insufficiency in the operated limb.
The surgical complications in a series of 500 transplantations done by a single transplantation unit with over ten years' experience in the field are reported. The complications are divided into vascular, urological and gastrointestinal. In addition, renal rupture, primary wound infections and operative deaths are reported. Most of the losses of transplants caused by surgical complications are due to renal rupture and vascular complications, accounting for 3.6 and 2 percent of losses respectively out of the 500 kidney transplants. The urological complications caused a loss of the remaining 1.2% of a total of 6.8%. tthe overall mortality was highest in gastrointestinal complications with 6% of the total of 10% deaths following surgical complications. The mortality rate in the group of patients with gastrointestinal bleeding and perforations and with acute pancreatitis was extremely high. More accurate screening for potential candidates for gastroduodenal ulceration and better prophylactic treatment is needed. More active treatment of acute pancreatitis is suggested.
Renal transplantations were performed over a period of three years to twenty patients with end-stage diabetic nephropathy. Two of the patients were transplanted with kidneys from living donors, others with cadaver kidneys. One year after the transplantation 6 patients out of 12 were alive, after two years one out of four. Graft survival after one year was 4 out of 12, and after two years one out of four patients. Eight patients had died, the primary causes of death having been infection or infarction. Late complications in the form of gangrene occurred in four patients with a functioning transplant. The issue of priority, criteria for selection, and the use of living donors are discussed.
Stenosis of the renal artery of the transplant (RAT), is reported with a frequency of 5-10% (Nerstrøm, Ladefoged & Lund 1972, Nilsson, Henriksson & Thoren 1976, Beachley, Pierce, Boykin & Lee 1976). The stenosis is significant if it deteriorates the renal function or elevates the arterial blood pressure. The angiographic impression of a stenosis depends on the projection and it is difficult to correlate the radiological findings with the blood flow. Moreover both renal failure and hypertension might depend on other factors than stenosis of the RAT. The aim of this study was to establish how often a reconstruction of a RAT suspected of being stenotic would benefit the patient.
During the period Feb. 1967--Aug. 1976 94 first renal transplantations were performed using living related donors and histocompatibility tests. Eight transplantations were performed on children under 15 years old and four on patients over 50 years old. The rest of the patients were between 15 and 50 years old. No exclusions were performed. 22 patients expired, seven of these with a well functioning graft. The patient survival (P.S.) was 90% at 1 year, 87% at 2 years and 77% at 5 years, the graft survival (G.S.) was 81% at 1 year, 80% at 2 years and 68% at 5 years. The clinical results showed a fairly good correlation with the histocompatibility degree. In the A-B-match groups the 1, 2 resp. 5 years P.S. was 95, 96 resp. 89% and G.S. 90, 90 resp. 89%. In 43% of the patients rejection of variable degree developed. The rejection led to graft loss in 12%.
Hypertension was found in four patients after unilateral renal-artery thrombosis following blunt abdominal trauma. In one patient, who was followed up from the time of injury, renin hypersecretion and secondary aldosteronism developed within a few days, and hypertension was present 12 weeks later. Increasing haemoglobin and raised blood-erythropoietin concentrations were also found. In the three other patients, hypertension was found casually within 3 years of trauma. In all patients, unilateral renin production by the affected kidney was significantly increased. Nephrectomy of the diseased kidney corrected hypertension and endocrine abnormalities in all patients. The delayed onset of hypertension despite early activation of the renin/angiotensin/aldosterone axis accords with the course of events observed in experimentally induced hypertension in rats, and suggests that several weeks or even months are required for hypertension to develop after sudden renal-artery occlusion in man. Slowly acting mechanisms, probably initiated by hypersecretion of renin, may be responsible for the hypertension.
Experiences with 45 uremic patients with arteriovenous fistulas for dialysis are described. The operation is easy and successful if the vessels of the patient are intact. Varicose syndromes of the hand may occur but can be managed. Complications from cannulations, such as large hematomas, are rare but may obstruct otherwise good fistulas. The fistula should be constructed in good time before a definite need for dialysis arises.
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Explore the source record for details and available documents.