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Biomedical subjects

S M Flechner

Publications and source records attributed to S M Flechner.

At least 91 records · Page 5Linked to original sources
PubMed1984

Percutaneous transluminal dilatation. A realistic appraisal in patients with stenosing lesions of the renal artery.

The application of percutaneous transluminal dilatation in the management of patients with renal artery stenosis remains controversial today. Both advocates and detractors of this therapeutic maneuver can acknowledge reports of technical success with short-term follow-up and several instances of significant major complications. Very few firm conclusions can be drawn from the literature on percutaneous transluminal dilatation at the current time. To answer the many questions about this procedure, it is appropriate to encourage that carefully designed randomized protocols comparing surgical revascularization and percutaneous transluminal dilatation in patients with similar clinical and epidemiologic criteria be developed.

Aged↗
PubMed1983

Screening for transplant renal artery stenosis in hypertensive recipients using digital subtraction angiography.

Digital subtraction angiography was used in 10 renal allograft recipients with sustained hypertension after transplantation to detect transplant renal artery stenosis. Recipients with end-to-end vascular anastomoses were visualized adequately in the anteroposterior projection. Two cases of transplant renal artery stenosis were identified by digital subtraction angiography and then verified by catheter angiography. Patients with end-to-side vascular anastomoses may require additional oblique projections. Digital subtraction angiography is a safe, noninvasive and cost-effective screening procedure to diagnose transplant renal artery stenosis in most recipients. Catheter angiography can be applied more selectively to those recipients with stenosis observed by digital subtraction angiography or when more detailed imaging is required.

Adolescent↗
PubMed1983

Intermittent clean catheterization: an alternative to diversion in continent transplant recipients with lower urinary tract dysfunction.

A total of 3 renal transplant recipients who were candidates for urinary diversion underwent successful transplantation using a planned program of intermittent clean catheterization. The urinary tract dysfunction was caused by a lower motor neuron neurogenic bladder, prune belly syndrome and myelodysplasia. The patients remain dry between catheterizations and maintain serum creatinine levels of 1.1, 0.8 and 0.5 mg. per cent, respectively, with a followup of 6 to 25 months. There has been only 1 urinary tract infection during 42 patient-months at risk while on self-catheterization. Pre-transplant urologic evaluation and patient education are mandatory. The ideal candidate for intermittent clean catheterization is a patient with a low pressure bladder that fails to empty and who is continent between catheterizations. Intermittent clean catheterization is a safe and effective alternative to diversion in continent transplant recipients with lower urinary tract dysfunction.

Adult↗
PubMed1983

Simultaneous structural and functional imaging of the transplant kidney using digital subtraction angiography.

We herein describe our preliminary experience with digital subtraction angiography in the noninvasive evaluation of renal transplant structure and function. A single digital subtraction angiography study was obtained in 38 patients with transplant kidneys and various levels of renal function. The main renal artery was demonstrated well in all studies. Stored digital information was used to generate appearance and clearance rates of contrast medium to produce a functional renal image. There was good correlation between the functional image pattern on digital subtraction angiography and the known degree of renal functional impairment. No adverse effects resulted from the small dose of intravenous contrast material used for angiography. This initial study suggests that digital subtraction angiography is a rapid, safe and noninvasive method for visualization of the transplant kidney, and can afford clinically relevant structural and functional information.

Adult↗
PubMed1983

Functional capacity and rehabilitation of recipients with a functioning renal allograft for ten years or more.

Forty-nine renal transplant recipients who had a single functioning allograft for ten or more years are reviewed. There were 17 cadaver recipients and 32 living-related recipients. Most patients have enjoyed excellent long-term renal function with stable mean daily dosages of azathioprine and prednisone. Fifty-three percent of patients never experienced a rejection episode, and 24% of patients experienced only one rejection episode. Five recipients (10%) developed malignancy following transplantation. Based on the Karnofsky activity scale, 80% of patients enjoyed unrestricted activity at ten years posttransplant. The two major factors contributing to declining activity were progression of systemic diseases such as atherosclerosis or diabetes, and declining allograft function. Following transplantation, all patients developed renewed interest in sexual activity, all men were potent, and all women experienced regular menses. Nine men achieved fatherhood and five women underwent successful pregnancy. Currently, 46 recipients are alive with a functioning allograft. These data confirm the ability of recipients with a long-term functioning renal allograft to return to the work force, participate in preillness levels of activity, and enjoy sexual activity and parenthood.

Activities of Daily Living↗
PubMed1983

The effect of cyclosporine on early graft function in human renal transplantation.

The effect of cyclosporine and steroids on early renal allograft function and eventual graft outcome was analyzed in 100 recipients; 33 recipients of living related donor (LRD) and 67 recipients of cadaveric donor (CAD) allografts were studied. A concurrent population of 47 CAD recipients treated with azathioprine and steroids was used for comparison. Recipients received oral cyclosporine (14 mg/kg) 48 hours (LRD) or 6-12 hours (CAD) pretransplant. No cases of acute tubular necrosis (ATN) were observed in the LRD recipients. The incidence of posttransplant ATN was similar in the cyclosporine-treated (41%) and in the azathioprine-treated (45%) CAD recipients (P = ns). Cyclosporine-treated CAD kidneys preserved less than 24 hr experienced a lower rate of ATN (P less than .01) using simple cold storage (31%), as compared with hypothermic pulsatile perfusion (57%). One-month creatinine nadirs were higher in cyclosporine-treated than in azathioprine-treated recipients, using median values for each group. One-year actuarial patient survival for cyclosporine-treated LRD recipients was 97%; CAD recipients, 94%, and azathioprine-treated CAD recipients, 91%. Graft survival rates in the same groups were 91%, 76%, and 55%, respectively. The major causes of graft loss in cyclosporine-treated patients were nonimmunologic. It is concluded that cyclosporine and prednisone are a safe, efficacious combination for LRD and CAD renal transplantation. The possibility of nephrotoxicity leading to impaired graft function in the early posttransplant period should not preclude the administration of cyclosporine prior to alloantigen presentation.

Acute Kidney Injury↗
PubMed1983

Cyclosporine: a new and promising immunosuppressive agent.

Cyclosporine is an exciting new agent that has been heralded as a major advance in chemical immunosuppression for organ transplantation. The drug is a potent, reversible suppressant of both humoral and cellular immunity and does not cause myelosuppression. Its mechanism of action appears to be selective for lymphocytes and may interrupt the necessary cellular signals required for proliferation of alloreactive T-cells. In early clinical trials cyclosporine has been shown to ameliorate renal allograft survival. A major concern about its widespread clinical use has been the observed nephrotoxicity and possible development of lymphomas in treated patients. Adverse side effects may be minimized by pharmacologic monitoring of drug levels. Future questions include the ideal dosage schedule, necessity for additional immunosuppressive agents, distinction between nephrotoxicity and rejection, and the precise mode of absorption, accumulation, and metabolism of the drug. Cyclosporine may be considered the prototype of a new generation of immunosuppressive agents that open up new perspectives in the field of immunoregulation. The ability to synthesize the compound may permit future biochemical manipulations to increase the immunobiologic specificity and decrease the toxicity of the drug.

Adult↗
PubMed1982

Continuous flow and conventional resectoscope methods in transurethral prostatectomy: comparative study.

The continuous flow resectoscope is claimed to be superior to the conventional resectoscope with respect to blood loss, resection time and rate, and irrigant absorption. These purported advantages were tested by a study of the results of transurethral resection of the prostate in 36 patients assigned randomly to 2 groups: 1) 20 patients operated on with the continuous flow resectoscope and 2) 16 operated on with the conventional resectoscope. No statistically significant differences for blood loss, resection rate or irrigant absorption were found between the 2 groups. We concluded that the preference of the surgeon continues to be the most important determinant in instrument choice.

Body Weight↗
PubMed1982

Improved cadaver allograft survival in transfused recipients who remain serologically negative for cytomegalovirus.

Between April 1976 and October 1979, 100 consecutive cadaver renal transplants were done. Before transplantation 48 recipients were seronegative and 52 were seropositive for cytomegalovirus. After transplantation there were 20 primary and 38 secondary cytomegalovirus infections. The development of post-transplant cytomegalovirus infection, with or without overt symptoms, had no effect on graft survival. The 1-year graft survival was significantly better (p less than 0.05) in high transfused (more than 5 units) recipients (70 per cent) compared to nontransfused recipients (36 per cent). The beneficial effect of transfusions was not diminished in patients with positive post-transplant cytomegalovirus serology. Of the transfused recipients those who remained serologically negative for cytomegalovirus pre-transplant had significantly better 1-year graft survival (78 per cent) than those who were cytomegalovirus positive before transplantation (58 per cent) (p less than 0.05). The improved graft survival in patients who remain cytomegalovirus seronegative after multiple blood transfusions may be a manifestation of unresponsiveness to immunologic as well as virogenetic stimulation.

Adult↗
PubMed1982

Determinants of allograft survival in 100 consecutive cadaver kidney transplants.

We reviewed 100 consecutive cadaver renal transplants done at our clinic between April 1976 and October 1979. A minimum 1-year followup was available on all patients. The actual 1-year graft survival rate was 64 per cent and the actual 1-year patient survival rate was 91 per cent. Criteria that had no significant effect on 1-year allograft survival were performance of pre-transplant nephrectomy and/or splenectomy, red blood cell group or the level of pre-formed antibody. A major determinant of graft survival was the number of blood transfusions received before transplantation. The 1-year graft survival rate was 36 per cent with no pre-transplant transfusions, 64 per cent with 1 to 5 transfusions and 70 per cent with more than 5 transfusions (p less than 0.005). The 1-year graft survival rate was not influenced by the use of kidneys imported from other states, the use of pediatric cadaver donors 1 to 15 years old or extended renal preservation times. Our experience supports continued regional and national sharing of adult and pediatric cadaver donor kidneys with extended preservation times.

Adolescent↗
PubMed1982

Pretransplant donor specific blood transfusions for one haplotype stimulatory mixed lymphocyte culture living related donor transplants.

Three donor specific blood transfusions were given at 2-wk intervals pretransplantation, to those donor-recipient pairs who were one haplotype identical, but had stimulatory MLC. Two of 10 recipients who received donor specific blood transfusions developed T cell cytotoxic antibodies against their donor and were not transplanted. Eight recipients were successfully transplanted with no evidence of hyperacute rejection. All eight grafts are functioning from 2 to 15 mo post-transplant. Serum creatinines range from 1.0--3.9 mg%. There have been five patients who developed acute rejection episodes during the first 5 days post-transplant, and there have been a mean of 2.4 rejection episodes per patient. These results compare favorably to historical controls at the same institution who had a 40% incidence of graft success. The long-term graft survival remains to be elucidated.

Blood Donors↗
PubMed1981

Aspergillosis of the urinary tract: ascending route of infection and evolving patterns of disease.

Aspergillosis limited to the urinary tract is a rare disease, seen most often in patients with altered immunity, especially diabetics. The disease has 3 patterns, 2 of which have been described previously. We report the first case documenting the ascending route of infection. Multiple urine cultures may be required for proper identification. Histopathology and culture of sloughed tissue and fungus balls shed per urethram are the essential means of reliable diagnosis. successful treatment of this disease localized to the urinary tract require a high index of suspicion in certain clinical settings, prompt diagnosis, a combination of systemic and local antifungal chemotherapy, and surgical drainage when necessary.

Amphotericin B↗
PubMed1980

Role of nephrectomy in the treatment of non-functioning or very poorly functioning unilateral tuberculous kidney.

We reviewed 300 consecutive cases of genitourinary tuberculosis at Wrightington Hospital from 1961 to 1978. There were 73 patients with non-functioning or poorly functioning kidneys who underwent nephrectomy after at least 6 weeks of intensive chemotherapy with 3 antituberculous drugs. Three of 4 patients with unilateral non-functioning kidneys who did not have a primary nephrectomy had delayed complications. Late complications of in situ non-functioning tuberculous kidneys included draining flank sinuses, abscesses and hypertension. These complications can occur years after completion of chemotherapy, even in sterile organs. The incidence of hypertension in this series was 11.3 per cent. The incidence of hypertension in patients with unilateral non-functioning or poorly functioning tuberculous kidneys was 23.2 per cent (p less than 0.005). Two-thirds of the hypertensive patients with severe unilateral tuberculous nephropathy benefited by a decrease in blood pressure after nephrectomy. Removal of these kidneys does not cause a significant loss of renal function. The perioperative morbidity and mortality of the procedure should be minimal in a generally younger population. It is concluded that primary nephrectomy is an important adjunct in the comprehensive management of the unilateral non-functioning kidney.

Adolescent↗