[Urological problems in kidney transplantation].
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Biomedical subjects
Publications and source records attributed to A Sidi.
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Hereditary factor XI deficiency may remain undiagnosed until severe bleeding is observed after an operation or trauma. Two such cases were encountered and, therefore, a regular screening test for coagulation disorders among urological patients was initiated. During 2 years (1975 and 1976) 10 additional cases of factor XI deficiency were detected: 5 severe and 5 partial. All patients were Ashkenazic Jews of Eastern European origin. The 5 patients with severe factor XI deficiency underwent an operation without any complications. They were transfused with 5 to 20 ml./kg./day of fresh frozen plasma from the day before the operation until 10 to 14 days postoperatively. Of the 5 patients with partial XI deficiency 4 underwent an operation. In 1 of 3 patients who did not receive transfusions postoperative bleeding was observed. A minimal level of 0.3 U./ml. (30 per cent) factor XI was found necessary to ensure good hemostasis during and after an operation. In view of a recent finding of relatively high gene frequency of factor XI deficiency in Ashkenazic Jews it seems warranted to do a partial thromboplastin time in such patients who need an operation.
A case of solitary crossed renal ectopia with concomitant, severe vesicoureteral reflux and a rudimentary ipsilateral ectopic ureter draining into the vas deferens is presented. In addition to these anomalies the patient had complete urethral duplication and right cryptorchidism, as well as right congenital dislocation of the hip. To our knowledge this is the first such case to be documented in the medical literature.
Intravenous (IV) anesthesia titrated to continuous computer-processed electroencephalograms (EEGs) was studied in 32 consecutive patients undergoing cardiac surgery. Anesthesia was induced with fentanyl 50 micrograms/kg with no EEG monitoring (n = 16) or 25 to 50 micrograms depending on changes in EEG (n = 16). EEG, oxygen saturation by pulse oximeter, intra-arterial blood pressure (BP), central venous pressure (CVP), and pulmonary artery pressure (PAP) (n = 18) were monitored continuously. Cardiac output (CO), CVP, PAP, spectral-edge frequency for each hemisphere, and BP were recorded before induction, immediately before intubation, and 1 and 5 minutes after intubation. With EEG monitoring, intubation was performed when spectral-edge frequency decreased to 10 Hz or less. Recall and pain were investigated 2 to 12 weeks postoperatively. With EEG, the amount of fentanyl used before intubation was significantly lower (39.7 +/- 2 micrograms/kg; p less than 0.005) than without EEG (50 micrograms/kg). The decrease in BP (% change) was less with than without EEG; mean changes in BP between preinduction and preintubation were -7.4% +/- 3.8% and -16.5% +/- 3.1% and between preinduction and 1 minute after intubation 0.3% +/- 3.4% and -12.5% +/- 3.5%, respectively. Percent changes in mean BP between intubation and 1 minute after were 9.6% +/- 4.0% with EEG and 5.2% +/- 3.0% without EEG. No patient in either group had recall. The authors conclude that using EEG monitoring to estimate depth of anesthesia during induction and laryngoscopy may increase safety in high-risk patients undergoing cardiac surgery.
We present three patients with successful surgical repair of abdominal aortic aneurysms with signs of imminent rupture in octogenarians. The patients presented with evidence of severe left ventricular dysfunction and reduced compliance either before or during surgery. Extremely cautious delivery of fluids and of after-load reducing agents was employed under the guidance of measurements of cardiac output and filling pressures from a pulmonary arterial catheter inserted prior to surgery.
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