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Biomedical subjects

R S Filo

Publications and source records attributed to R S Filo.

At least 55 records · Page 3Linked to original sources
PubMed1991

Apparent avascular necrosis of the hip: appearance and spontaneous resolution of MR findings in renal allograft recipients.

The sensitivity of magnetic resonance (MR) imaging in the detection of avascular necrosis (AVN) of the hip and natural history of the MR findings were determined prospectively in renal allograft recipients, a group at risk for development of the disease. One hundred four patients were studied up to 24 months after transplantation. In 25 hips in 14 patients, MR findings were consistent with AVN. Pain developed in seven hips in four patients; in each hip, the MR images showed abnormality before the onset of symptoms. Plain radiographs showed abnormality in all hips that became painful; however, the plain radiographs of 17 of 18 asymptomatic hips in which MR imaging showed evidence of AVN showed no abnormality over a mean follow-up period of 16 months. All MR lesions in the symptomatic hips were larger than those in the asymptomatic cohort. MR lesions in seven hips (in five asymptomatic patients) regressed in size; in six hips, the MR images returned to normal. The findings suggest that some patients with MR evidence of AVN of the hip have spontaneous improvement.

Adolescent↗
PubMed1991

Transient porphyrinemia in a liver transplant recipient.

We report a case of acquired porphyrinemia in a liver transplant recipient. Thrombosis of the portal vein and hepatic artery led to massive necrosis of the patient's first donor liver, necessitating its removal. After an 18-hour anhepatic period, a second donor liver was transplanted. During this interval, the patient was warmed with an infrared heat lamp that emitted bright visible light. Following the anhepatic period, a photodistributed cutaneous erythema was noted. The level of total serum porphyrins during the anhepatic period was significantly elevated at 1.548 mumol/L (normal, less than 0.018 mumol/L). Fractionation showed that the levels of the hydrophobic porphyrins, coproporphyrin and protoporphyrin, were elevated, while the levels of the hydrophilic porphyrins remained normal. Following the successful second liver transplantation, the patient's porphyrin levels declined. This is the first reported case of acquired porphyrinemia in a liver transplant recipient.

Child↗
PubMed1990

The use of internalised ureteric stents in renal transplant recipients.

Since 1982, we have used internal indwelling ureteric stents for the management and prevention of ureteric reconstruction complications in 28 renal allograft recipients. A total of 30 stents were placed in 18 patients either diagnostically or therapeutically in the management of allograft ureteric obstruction. In 16 patients internal stents were placed at the time of reconstruction for primary ureteropyelostomy (3), secondary ureteropyelostomy (8), repeat reimplant (3) and repair of ureteric or pelviureteric junction injury (2). Complications included 3 episodes of transplant pyelonephritis, proximal stent migration (1), persistent bacteriuria (1) and prolonged healing of a ureteropyelostomy (1). Internalised ureteric stenting is a safe and effective means of managing or preventing ureteric reconstruction complications in renal transplant recipients.

Humans↗
PubMed1990

Needle biopsy of renal allografts: comparison of two techniques.

Two techniques for renal allograft biopsy were retrospectively evaluated to compare relative safety and efficacy. After ultrasound (US) localization of the kidney and biopsy with a hand-held 14-gauge cutting needle, an adequate specimen was obtained in 74 of 77 cases (96%). Major complications occurred in six of these 77 cases (8%). One hundred four biopsies were performed by using a smaller 18-gauge cutting needle with a spring-loaded biopsy "gun" and real-time US guidance. With this newer technique, specimens adequate for diagnosis were obtained in 99 biopsies (95%). There was a single major complication with this technique (1%). The 18-gauge needle with real-time US guidance yields comparably adequate specimens with a lower frequency of complications.

Biopsy, Needle↗
PubMed1989

Renal transplantation into the reconstructed bladder.

In our experience with 821 renal transplants performed between 1974 and October 1987 we used the native or reconstructed bladder of the patient in all but 2 instances. Seven patients have undergone enterocystoplasty and subsequent renal transplantation, while 1 underwent bladder augmentation after transplantation. Of these 8 patients 4 have functioning grafts 6 months to 7 years after transplant or reconstruction. Renal transplantation coupled with enterocystoplasty in properly selected patients has acceptable morbidity and should be considered as an alternative to other forms of urinary diversion in allograft recipients.

Adolescent↗
PubMed1989

Duplex Doppler US of renal allografts: causes of elevated resistive index.

The authors retrospectively investigated the utility of the resistive index (RI) in evaluating the major causes of renal allograft dysfunction. Three hundred fourteen duplex US studies in 162 patients with 150 episodes of renal allograft dysfunction within a 17-month period were reviewed. Histologic findings were available in 69 cases. Three patients had hyperacute rejection with a mean RI of 0.85 +/- 0.049. There were 37 episodes of acute rejection (mean RI, 0.76 +/- 0.054) and 22 instances of chronic rejection (mean RI, 0.71 +/- 0.065). Ureteral obstruction (nine cases; mean RI, 0.72 +/- 0.026) was the only cause of allograft dysfunction other than rejection with a mean RI greater than 0.70. Mean RI values associated with rejection were significantly elevated above those in the 88 cases of dysfunction without rejection (mean, 0.64 +/- 0.064) and in baseline examinations (mean, 0.63 +/- 0.066). The results identified two causes of increased RI values in addition to acute rejection: chronic rejection and ureteral obstruction.

Cyclosporins↗
PubMed1989

Secondary hyperparathyroidism. The role of surgery.

A retrospective analysis was undertaken to better define the clinical presentation and therapy of patients with secondary hyperparathyroidism and the timing of surgical removal of the parathyroid glands in secondary hyperparathyroidism. Sixty-eight patients with end-stage renal disease (ESRD) underwent 74 parathyroid procedures over a 10-year period. There were 38 per cent women and 62 per cent men in this population--the same proportion of men and women with ESRD. These proportions are reversed when compared with patients with primary hyperparathyroidism. The mean time between initiation of dialytic therapy and parathyroidectomy was 5.4 years. Preoperative mean serum calcium and phosphorus levels were 10.1 +/- 0.2 and 6.1 +/- 0.2 mg/dl, respectively. All patients were symptomatic and 60 per cent of the patients had at least two symptoms before surgery. Renal osteodystrophy was the most common symptom (74%), whereas pruritus was noted in 65 per cent of this population. Patients underwent either subtotal (88%) or total (12%) parathyroidectomy with autotransplantation. Six patients required reoperation: five for recurrent disease (2 to 5 years after the initial surgery) and one for persistent disease. All patients were symptomatically improved after the surgery. Complications included the following: transient hoarseness (7%), hypocalcemia requiring calcium, and/or vitamin D therapy (32%) for 6 months after surgery. This analysis demonstrates that although the initial therapy of secondary hyperparathyroidism is medical, surgical therapy should be instituted before multiple symptoms develop in the ESRD population.

Adult↗
PubMed1988

Renal transplantation in a patient with an artificial urinary sphincter device.

Use of the artificial urinary sphincter device has become widespread. We describe the successful transplantation of a renal allograft into a recipient with an artificial urinary sphincter. Pretransplant placement of a sphincter, intraoperative avoidance of the prosthetic device and proper urinary drainage perioperatively make the artificial urinary sphincter device a feasible means to provide continence in a renal transplant recipient.

Adult↗
PubMed1987

Thrombofibrinous sheath occlusion of peritoneovenous shunts.

Thrombofibrinous sheath occlusion of peritoneovenous shunts is described in two case presentations. In reviewing the literature, we found only 17 other such cases mentioned. Most patients were seen initially with recurrence of ascites and only one with superior vena cava syndrome. A shuntogram documented a characteristic sheath in 17 patients, and relocation was the preferred treatment. Relocation was successful in eight of 11 attempts, but long-term follow-up data were not available. Histologic examination of the sheath in our first case study revealed recent and organized thrombus. This would help explain why only one of three patients was successfully treated with fibrinolytic agents.

Catheterization↗
PubMed1985

Abdominal wall and inguinal hernias in continuous ambulatory peritoneal dialysis patients.

This retrospective analysis of 140 continuous ambulatory peritoneal dialysis patients followed during a 4 year period revealed a 5 percent incidence of abdominal wall hernias. Inguinal hernias were frequently manifested as unilateral scrotal swelling. Hernias too small to be appreciated by physical examination were easily demonstrable with intraperitoneal instillation of technetium 99m sulfur colloid through the continuous ambulatory peritoneal dialysis catheter. This procedure was also useful when differentiating dialysate leaks from inguinal hernia in the early and late postoperative periods. Recurrences developed in 27 percent of the herniorrhaphies. Factors contributing to the development of abdominal wall hernias in continuous ambulatory peritoneal dialysis patients include uremia, obesity, anemia, and chronically elevated intraperitoneal pressures.

Adolescent↗
PubMed1985

The manifestation and management of late urological complications in renal transplant recipients: use of the urological armamentarium.

The incidence of urological complications in renal transplant patients is well documented. The majority of these complications occur in the early postoperative period; late occurrences (more than 3 months) are much less common. We have had experience with 7 patients who presented with late complications 3 months to 7 years after transplantation: ureteral obstruction occurred in 4 patients, ureteral disruption or laceration in 2 and neurogenic bladder with hydronephrosis in 1. Management of these patients has been varied and has included cystoscopic stent placement, Boari flap, ureteropyelostomy, ureteroneocystostomy, bladder augmentation and urinary undiversion. Grafts have been salvaged in 6 of 7 patients. Transplant patients who present with late urological complications can be challenging. However, the potential for intervention and graft salvage is excellent.

Female↗
PubMed1985

Time course of glomerular endothelial injury related to pulsatile perfusion preservation.

To elucidate the time course of glomerular and arterial endothelial injury resulting from pulsatile perfusion preservation of human kidneys, we examined two kidneys, one at 16 and the other at 42 hr, for which no suitable recipient could be found. The scanning electron microscope revealed subtle changes at 16 hr in the filtration barrier. These included mild endothelial swelling with an increase in the appearance of bulbous processes, and elongated fenestrae. The visceral epithelial surface was normal as was the arterial endothelial surface. By 42 hr the glomerular endothelial surface displayed very prominent cytoplasmic ridges and clearly distorted fenestrae. The arterial endothelium exhibited a tendency to separate from the vessel wall. The proximal tubular epithelium revealed scattered loss of microvilli. These changes are similar in kind to, albeit less severe than, those described after 60 hr of perfusion. They may represent cell swelling following ischemia, or be the result of altered cell permeability engendered by low temperature. The possibility remains that such changes could be minimized by modifying the perfusate. Scanning electron microscopy provides a versatile tool in the study of vascular and other surfaces of tissues stored with perfusion preservation.

Endothelium↗
PubMed1984

Surgical considerations of continuous ambulatory peritoneal dialysis.

The surgical considerations pertaining to 173 continuous ambulatory peritoneal dialysis catheters were reviewed in 140 patients from 1979 through 1983. All catheters were inserted in the operating suite by an open technique. Local anesthesia was used in the majority of patients (59%). Catheter peritonitis was the most frequent complication, 228 episodes/2407 patient months. Twenty-three percent of the patients accounted for 51% of catheter-related peritonitis. Sixteen catheters were removed because of an inability to clear the infection. Intra-abdominal catastrophes were noted in four patients and differentiation from continuous ambulatory peritoneal dialysis peritonitis was based on serial examinations, bacteriologic cultures, and/or a progressive increase in free abdominal air. Surgically-related catheter complications were designated either early (less than 1 month) or late (greater than 1 month) in relation to catheter placement. Frequent early complications were mechanical flow problems and dialysate leaks. Five of 11 mechanical flow difficulties required catheter replacement while none of the dialysate leaks required surgical intervention, and all healed spontaneously. Common late complications included 35 tunnel infections, 23 of which were associated with peritonitis. Nine of these catheters (25%) were removed. Cuff extrusion was also associated with a high incidence (83%) of catheter attrition. Thirty-six patients underwent renal transplantation and in no instance did the catheter increase patient or renal allograft morbidity rates.

Abdomen, Acute↗
PubMed1984

Cadaver donor renal transplantation by centers of the South-Eastern Organ Procurement Foundation. The prospective study after 6.5 years and 3811 allografts.

After 6.5 years, the SEOPF prospective study of 3811 cadaver grafts is summarized. The prime variables of transfusions, homologous leucocytic antibodies (HLA)-A and B typing and anti-lymphocyte serum treatment, continue to beneficially affect survival, but trends in the data suggest that they either have small or short-term effects. Apparently the determinants of true long-term survival are still not uncovered. Any erythrocyte preparation provides the transfusion effect if administered more than 10 days and less than 365 days before transplantation. Dialysis in the first week after transplantation adversely affects graft survival. Splenectomy may improve graft survival, but increases patient mortality. Thus, we believe it is unwarranted as a routine measure. We continue to collect long-term data on this group of patients, which will probably stand as a benchmark study of precyclosporin renal transplantation.

Antilymphocyte Serum↗