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Biomedical subjects

S B Streem

Publications and source records attributed to S B Streem.

At least 73 records · Page 4Linked to original sources
PubMed1994

Long-term results of renal transplantation into the valve bladder.

Between 1970 and 1990 renal transplantation was performed in 16 patients with a history of posterior urethral valves. While 10 patients had undergone supravesical urinary diversion before the development of end stage renal disease, all but 1 transplant were drained to the unaugmented native bladder. The 2 and 5-year graft survival rates were 70% and 59%, respectively. Of the 15 surviving patients 11 have allografts that are functioning at a mean of 86 months after transplantation with a mean serum creatinine of 2.0 mg./dl. Urological complications occurred in 19% of the transplants. No detrimental effect of the valve bladder on long-term allograft survival or function was apparent. With appropriate treatment of vesical dysfunction, these patients can be expected to have graft function comparable to the general transplant population despite use of the unaugmented native bladder.

Adolescent↗
PubMed1994

Percutaneous management of upper tract foreign bodies.

Although percutaneous management of calculi has become less frequent, the techniques developed for that purpose are being used to manage patients with more complex upper tract problems. Percutaneous techniques analogous to those used for stone disease were applied in four patients with upper tract foreign bodies (silk suture, balloon catheter or stent fragments) inaccessible to definitive ureteroscopic management. Three patients had associated calculi. In each case, the intraoperative course was uneventful, the postoperative stay was only 4 to 5 days, and the result was an uninfected, unobstructed renal unit. Percutaneous techniques can be successful in the management of the increasingly frequent problem of upper tract foreign bodies and will often represent the treatment of choice.

Adolescent↗
PubMed1994

Living unrelated donor renal transplantation.

The organ shortage remains a major barrier to renal transplantation in the United States. Living unrelated kidney donors help to alleviate this problem. The current literature supports the use of living unrelated donors for kidney transplantation. This approach helps to reduce the cadaveric graft shortage and may improve results. A uremic patient should not be obligated to wait for a cadaveric kidney when a willing motivated living unrelated donor exists.

Graft Survival↗
PubMed1993

Can citrate therapy prevent nephrolithiasis?

This prospective study was done to help determine whether or not oral citrate therapy can elevate urinary citrate levels and reduce the incidence of recurrent calcium stones in patients with hypocitraturia (urinary citrate less than 320 mg/24 hr). The treatment group (Group I) consisted of 10 patients treated with oral citrate and hydration. The control group (Group II) was treated with hydration alone. In Group I, the new stone formation rate (stones per patient year) fell from 1.17 +/- 0.26 to 0.45 +/- 0.32 (p = 0.07) and the twenty-four-hour urinary citrate excretion rose from 69 +/- 14 mg to 473 +/- 96 mg (p = 0.002). In Group II, the new stone formation rate fell from 0.9 +/- 0.25 to 0.27 +/- 0.13 (p = 0.03). The twenty-four-hour urinary citrate excretion increased, though not significantly, from 166 +/- 21 mg to 326 +/- 77 mg (p = 0.06). We conclude that oral citrate therapy can significantly increase urinary citrate levels in patients with recurrent stones associated with hypocitraturia but that oral citrate therapy and hydration were no better than hydration alone in reducing the incidence of recurrent stones.

Calcium Oxalate↗
PubMed1993

Simplified infusion method for 10% hemiacidrin irrigation of renal pelvis.

A variable pressure volumetric pump was used for 10% hemiacidrin irrigation of the renal pelvis in 7 renal units (6 patients) with struvite calculi after initial percutaneous debulking and extracorporeal shock-wave lithotripsy (ESWL). The pump provided a constant display of intrapelvic infusion pressure, and an alarm which signaled if a preset maximum infusion pressure was exceeded. Compared with standard open manometer monitoring of intrapelvic pressure, this closed system of irrigation eliminates the problems associated with time-consuming assembly and maintenance, irrigant spillage, and system contamination. At the completion of therapy, 5 renal units were completely stone-free while 2 had only minimal residual caliceal "dust." Complications were minor and few in number. We conclude that a variable pressure volumetric pump provides excellent clinical results and safely simplifies irrigation for percutaneous chemolysis of struvite calculi.

Citrates↗
PubMed1993

Management of renal cell carcinoma with coexistent renal artery disease.

Coexistence of renal cell carcinoma and renal artery disease is an unusual and challenging problem. From 1969 to 1991, 34 patients presented with localized renal cell carcinoma and renal artery disease affecting all of the functioning renal parenchyma. These patients represented 4 categories: 1) a solitary kidney with renal cell carcinoma and renal artery disease (5), 2) bilateral renal cell carcinoma and coexistent renal artery disease (5), 3) unilateral renal cell carcinoma and contralateral renal artery disease (13), and 4) unilateral renal cell carcinoma and bilateral renal artery disease (11). Atherosclerosis was the most common cause of renal artery disease (30), followed by medial fibroplasia (2), renal artery aneurysm (1) and arteriovenous malformation (1). A total of 23 patients (68%) presented with azotemia (serum creatinine 1.5 mg./dl. or more) and 11 (32%) presented with hypertension. All patients underwent complete surgical excision of renal cell carcinoma. A nephron sparing operation was performed preferentially (30 patients) and bilateral renal cancer operations were staged. Eight patients underwent simultaneous partial (6) or radical (2) nephrectomy and surgical renal revascularization. There were no operative deaths. Postoperatively, preservation of renal function was achieved in 33 patients and 1 required chronic dialysis. At mean followup of 47 months 23 patients (68%) were alive with no evidence of malignancy and 2 were alive with recurrent renal cell carcinoma. Three patients died of metastatic renal cell carcinoma, while 6 died of unrelated causes. All of the latter 6 patients were free of renal cell carcinoma at death. Nephron sparing surgery combined occasionally with renal arterial reconstruction can yield gratifying results in this complex patient population.

Adult↗
PubMed1993

Percutaneous management of transplant ureteral fistulas: patient selection and long-term results.

Of 24 renal allograft recipients with urinary extravasation 14 (58%) with ureteral fistulas were selected for percutaneous management in an attempt to obviate secondary operative intervention. The initial procedure in all cases was placement of a percutaneous nephrostomy tube with subsequent internal or internal/external stenting. With a mean followup of 47 months, the percutaneous management proved definitive in 5 patients (36%) and palliative in 1 (7%). The other 8 patients (57%) subsequently required open operative intervention. With this study, we conclude that percutaneous techniques can provide long-term definitive management for at least some transplant ureteral fistulas. However, even in a highly selected group of patients success rates will be limited.

Follow-Up Studies↗
PubMed1993

Renal oncocytoma: clinical and biological correlates.

We treated 31 patients with renal oncocytoma. Renal cell carcinoma was found existing separately within the same or contralateral kidney in 10 patients (32%). Followup of 29 patients revealed 24 alive with no evidence of disease and 1 alive with recurrent oncocytoma, while 1 with coexistent tumors died of progressive renal cell carcinoma and 3 tumor-free patients died of unrelated diseases. Quantitative deoxyribonucleic acid analysis was performed on cell suspensions of fresh tumor by flow cytometry or by image cytometry on touch preparations from frozen tissue in 16 patients with renal oncocytoma. Ploidy analysis revealed all oncocytomas to be diploid. Frozen tissue immunohistology was performed using murine monoclonal antibody against human HLA-A, B and C (class I) antigens with the avidin-biotin peroxidase technique in 11 patients with renal oncocytoma. Ten oncocytomas did not express these self-recognition antigens and 1 was only weakly positive for antigen expression. In contrast, renal cell carcinomas strongly expressed HLA class I antigens. The high incidence of coexistence of renal oncocytoma and renal cell carcinoma has important clinical implications. Loss of HLA class I antigen expression by renal oncocytomas may provide an additional method for differentiating this lesion from renal cell carcinoma.

Adenoma, Oxyphilic↗
PubMed1993

Preoperative hospitalization to hydrate living kidney donors can be omitted without sacrificing graft function.

This prospective study was done to determine whether preoperative hospitalization for hydration of living kidney donors could be omitted without sacrificing graft function in the recipient. The study group consisted of 36 consecutive kidney donors who underwent donation on a "to come in" basis. Fluid management consisted of 1 l. lactated ringer's solution per hour beginning 2 hours preoperatively. The control group was hospitalized preoperatively for intravenous hydration of an equivalent amount of saline solution given for 12 to 16 hours. No recipient of the study group donors experienced delayed graft function. Furthermore, in that group immediate and longer term graft function, as defined by immediate graft output, serum creatinine on postoperative day 1 and nadir serum creatinine levels, was equivalent to or better than that in the control group. We conclude that a rapid infusion of saline solution in the immediate preoperative period can replace overnight intravenous hydration of living kidney donors, and that the result will be a significant reduction in overall hospital stay for the donor without compromise in graft function for the recipient.

Adult↗
PubMed1993

Combination therapy for staghorn calculi in solitary kidneys: functional results with long-term followup.

A total of 10 patients with staghorn calculi in a solitary kidney was managed with endourological sandwich therapy consisting of primary percutaneous debulking followed by extracorporeal shock wave lithotripsy (ESWL*) of residual inaccessible stones. Secondary percutaneous procedures, ESWL and chemical dissolution were used as necessary in a vigorous attempt to render each patient stone-free. As such, these 10 renal units underwent 21 percutaneous procedures through 13 tracts, 17 ESWL treatments and 3 courses of hemiacidrin. No patient required open operative intervention or dialytic support. With 4 to 57 months (mean 31.6) of followup, renal function for the group as a whole improved as evidenced by a decrease in mean serum creatinine levels from 3.1 mg./dl. before treatment to 2.2 mg./dl. at latest followup. More importantly, renal function has remained stable or improved in 9 of the 10 patients individually. We conclude that an aggressive, combined endourological approach to the management of staghorn calculi provides long-term preservation of function in the affected kidney.

Adult↗
PubMed1993

Improved success of living unrelated renal transplantation with cyclosporine immunosuppression.

Kidney transplantation with a living unrelated donor was performed in 13 patients. The donors comprised 10 spouses, 2 brothers-in-law and 1 stranger. All donor-recipient pairs were red blood cell compatible with a negative T cell crossmatch. Five patients underwent transplantation before 1984 without cyclosporine immunosuppression; the 1-year patient and graft survival rates in this group were 40% and 20%, respectively. Eight patients have undergone transplantation since 1985 with cyclosporine immunosuppression. The 1-year patient and graft survival rates in this group were 100% and 88%, respectively (p = 0.03). Currently, 6 patients in the latter group have a well functioning graft with serum creatinine levels of 1.2 to 2.0 mg./dl. (mean 1.5 mg./dl.) and with followup of 1 to 6 years (mean 2.9 years). Excellent graft survival results can now be achieved with living unrelated donors and their expanded use can provide an important additional source of organs for transplantation.

Cyclosporine↗
PubMed1992

Extracorporeal shock wave lithotripsy for patients with calcified ipsilateral renal arterial or abdominal aortic aneurysms.

A total of 4 patients with renal or upper ureteral calculi associated with ipsilateral calcified renal arterial or abdominal aortic aneurysms underwent extracorporeal shock wave lithotripsy. One patient with a renal artery aneurysm had a solitary kidney. Linear distance from the calcified aneurysm to the stone, calculated by computerized and plain tomography, ranged between 4.6 and 6.5 cm. (mean 5.3). Treatment was accomplished on an unmodified Dornier HM3 lithotriptor using 900 to 2,400 shock waves (mean 1,575) at 18 kv. There were no complications of treatment and all 4 patients were discharged from the hospital within 24 hours, at which time radiographic examination revealed excellent stone comminution without change in the calcified aneurysm. With followup as long as 30 months, no adverse effects of therapy have become evident. We conclude that the presence of an ipsilateral calcified aneurysm may not necessarily preclude treatment of renal or upper ureteral calculi with extracorporeal shock wave lithotripsy, although further studies are required to help define the potential limits of such therapy in this setting.

Aged↗
PubMed1992

Treatment of caliceal diverticular calculi with extracorporeal shock wave lithotripsy: patient selection and extended followup.

We treated 19 selected patients with calculi in 21 caliceal diverticula with extracorporeal shock wave lithotripsy (ESWL). By limiting this treatment to patients with relatively small (less than 1.5 cm.) calculi associated with a radiographically patent diverticular neck, a stone-free state was initially achieved in 11 patients (58%). Of 14 patients with flank pain before ESWL 12 (86%) were rendered symptom-free or markedly improved, often independent of a stone-free state. Extended followup in 13 patients for 12 to 49 months (mean 23.8 months) after ESWL revealed recurrent stones or stone growth in only 1. Although pain relief has remained constant for those initially rendered symptom-free, recurrent infection has been documented in 6 (67%) of 9 patients with infection before ESWL. We conclude that ESWL for selected patients with calculi in caliceal diverticula can achieve a relatively high initial stone-free rate and that recurrent stones may not be inevitable. Treatment in this setting also may provide long-term symptomatic relief that is often independent of a stone-free state. However, recurrent infection is not unusual, especially when associated with residual calculi. Considering the relatively noninvasive nature of this approach, ESWL should be considered an acceptable form of primary management for selected patients with calculi in caliceal diverticula.

Adult↗
PubMed1992

Long-term efficacy of combination therapy for struvite staghorn calculi.

A total of 28 patients with extensive struvite staghorn calculi underwent endourological sandwich therapy consisting of primary percutaneous debulking followed by extracorporeal shock wave lithotripsy (ESWL*) of residual stone fragments. Secondary percutaneous procedures, ESWL treatments and 10% hemiacidrin irrigations were used as necessary specifically to achieve a stone-free renal unit. With 12 to 55 months (mean 31 months) of followup, during which time regular surveillance was done and antibiotic prophylaxis was used routinely, renal function remained stable or improved in 93% of the patients, including 4 with a solitary kidney. Infection has recurred or persisted in 30% of the patients, while stones recurred in 22%. We conclude that an aggressive, combined endourological approach to the management of struvite staghorn calculi can achieve long-term results comparable to standard operative intervention.

Combined Modality Therapy↗