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Biomedical subjects

R Munda

Publications and source records attributed to R Munda.

At least 91 records · Page 5Linked to original sources
PubMed1981

Hazard of percutaneous transluminal dilation in renal transplant arterial stenosis.

Percutaneous transluminal dilation of a transplant renal artery was attempted in a patient. The renal artery was perforated by the balloon catheter during the procedure. Despite prompt surgical intervention, the kidney was lost because of irreversible ischemia. This experience is a warning that irreversible ischemia can occur with a transplant kidney if an occlusive complication occurs after percutaneous transluminal dilation. Since the warm ischemic time can exceed the surgical approach and repair, the renal transplant can be lost, and treatment of the patient will resume with long-term hemodialysis. Surgical correlation is a more predictable method, which still must be considered as the treatment of a renal allograft artery stenosis.

Angioplasty, Balloon↗
PubMed1980

Failure of saralasin in preventing renal failure in ischemic transplanted kidneys.

Many potential cadaveric kidney donors have been exposed to shock or hypotension before or during organ donation. Renin-mediated vasoconstriction has been implied in the pathogenesis of acute renal failure. High renin levels have been associated with poor graft survival under hypothermic pulsatile perfusion. An attempt was made to block renin effect with Saralasin (1-Sar-8-ala-angiotensin II), a competitive blocker. Eight conditioned mongrel dogs had their renal arteries exposed, and Saralasin, 100 microgram, was injected intra-arterially. Warm ischemia was then induced for 30 min. Thereafter, the kidney was removed and placed under hypothermic pulsatile perfusion for 24 hours, during which time Saralasin was given continuously at a rate of 1 microgram/min. The kidneys were reimplanted in the same animal on the contralateral iliac fossa, Saralasin, 100 microgram, was given intraarterially after implantation, and a contralateral nephrectomy was performed. Four control animals were given saline solution instead of Saralasin. No significant differences were noted in perfusion characteristics and postoperative creatinine values between treated and control groups. This apparent lack of protective effect of angiotensin II competitive blocker suggests that in the pathophysiology of acute renal failure other factors could be involved besides renin release.

Acute Kidney Injury↗
PubMed1978

Pulmonary infections in renal transplant recipients.

Forty-six episodes of pulmonary infection occurred in 41 patients during a seven year period in which 187 renal transplants were performed in 168 patients. Thirty-seven episodes followed 152 cadaveric transplants (24.39%), and four episodes followed 35 living related donor transplants (11.4%). Five patients had two episodes of pulmonary infection. Twenty-four patients recovered, and 17 died (41.5%). Pulmonary infections appeared from two days to three years after transplantation, but predominated in the first four months (32/46). They were caused primarily by bacterial agents (74%) with protozoa, fungi, and viruses appearing less frequently. In 35 episodes, a single etiologic agent was found, but 11 were caused by two or more agents. When compared with noninfected recipients, there was no significant difference with regard to number of rejection crises, maintenance prednisone dosage, or blood glucose. However, subnormal renal function was significantly associated with the development of infection. Azathioprine dosages were actually higher for the noninfected patients, reflecting a tendency to lower the dose of azathioprine in the presence of decreased renal function. Fever was the most common presenting symptom. Transtracheal aspiration with Gram stain and direct sensitivity plating routinely provided early and accurate identification of the organism and a guide for therapy in bacterial infections. Pulmonary infection in renal transplant recipients is associated with a high mortality rate. Early diagnosis and specific treatment are essential to successful management.

Bacterial Infections↗
PubMed1978

Hypothermic pulsatile perfusion and transplantation of pediatric cadaveric kidneys into adults.

Twenty-seven adults received en block or single renal allografts from pediatric donors less than 12 years of age. Hypothermic pulsatile perfusion of these small kidneys presented no technical difficulties. Flow rates ranged between 0.8-1.2 ml/min/gm. Single pediatric kidneys from donors as young as three years were able to produce a creatinine clearance of 50 ml/min in adults by one month posttransplant. No differences in renal function were noted between en bloc or single kidneys. En bloc transplants were associated with an increased incidence of renal arterial thromboses (3/8 cases). Because of this, pediatric cadaver kidneys were transplanted as single units, and an additional advantage was that they could provide donor kidneys for two recipients. In our series, one year pediatric graft survival is less than a comparable group of adult cadaveric kidney recipients.

Adult↗
PubMed1977

Renal allograft artery stenosis.

Thirteen renal artery stenoses occurred in 127 renal allograft transplantations performed at the University of Cincinnati Medical Center over a four year period. The most common symptoms were hypertension and decreasing renal function occurring from three days to three years post transplantation. Eight lesions occurred in patients with a single artery and five when double arteries had been joined together prior to anastomosis rather than implanted separately. The most common causes of renal artery stenosis was intimal hyperplasia of the donor vessel distal to the anastomosis (8 patients), atheromatous plaques (2), technical failure (2), and external compression (1). Surgical correction was facilitated by a midline incision. Resection of the stenotic segment and reanastomosis was the preferred procedure. Surgical failure and recurrence of hypertension were associated with involvement of small arteries or distal arteriolar level. When kidneys with multiple arteries are available, Carrel patches should be used when possible; if not, they should be implanted separately rather than joined together prior to anastomosis, thus decreasing the possibility of creating turbulent blood flow.

Blood Vessel Prosthesis↗
PubMed1976

Traumatic pseudoaneurysms: a review of 32 cases.

The management of 23 patients with traumatic pseudoaneurysms is presented. A pulsatile mass associated with pain was the usual presentation. Hypertension and hypovolemic shock from rupture are uncommon presentations but potential hazards of this lesion. Twenty-one pseudoaaeurysms were treated surgically. Resection with end-to-end anastomosis (eight patients), with graft replacement (one patient), with lateral repair (seven patients) was done. Hypothermia with circulatory arrest and external Dacron shunt were used to prevent visceral ischemia during high aortic occlusion. There were no mortalities or significant postoperative complications.

Adolescent↗