Biomedical subjects
D D Oakes
Publications and source records attributed to D D Oakes.
Transplantation in patients with a history of renal cell carcinoma: long-term results and clinical considerations.
We report four cases of renal transplantation after prior incidental removal of renal cell carcinomas. Follow-up periods ranged from 21 months to 8 years. Our experience provides the first long-term follow-up of such cases and indicates that the overall prognosis is favorable when asymptomatic renal adenocarcinomas are removed prior to renal transplantation. The period between nephrectomy and renal transplantation ranged from 8 hours to 30 months. Three patients had prolonged tumor-free survival, and one died from a widely disseminated second adenocarcinoma 21 months after transplantation.
Lye ingestion. Clinical patterns and therapeutic implications.
Conventional treatment of caustic esophagitis consists of early endoscopy to the first site of injury followed by antibiotic and steroid therapy, with early mechanical dilatation to prevent stricture formation. The failure of this approach in two recent patients led us to review our overall experience with the management of patients who had ingested lye or other caustic substances. Of 42 patients treated at the Santa Clara Valley Medical Center between 1970 and 1980, seven sustained severe esophageal burns. All had intractable strictures despite steroids, antibiotics, and, in three cases, attempts at dilatation. We conclude that patient survival should not be jeopardized by overly aggressive attempts to salvage an extensively damaged esophagus. Such attempts will probably prove both futile and dangerous, and effective re-establishment of oral-intestinal continuity is now possible by a variety of techniques.
Arterial injury during perfusion preservation: a possible cause of posttransplantation renal artery stenosis.
To evaluate the effect of perfusion preservation upon renal arteries, 10 sets of porcine kidneys were removed en bloc and flushed in iced Sacks' solution via an aortic cannula. Preservation at 4 degrees C was by ice storage without perfusion (10 kidneys), perfusion with cannulation of the aortic segment (five kidneys), or perfusion with direct cannulation of the renal artery (five kidneys). After 48 to 72 hours the renal arteries and their primary branches were examined histologically. No intimal changes were evident by light microscopy. By scanning electron microscopy the endothelium of all renal arteries preserved by ice storage or aortic perfusion remained intact with only occasional deposits of particulate matter. By contrast, three distinct lesions appeared in all arteries subjected to direct cannulation: (1) full-thickness crushing at the site of the securing ligature, (2) intimal flattening at the site of contact with the cannula, and (3) marked disruption of intimal architecture extending several millimeters beyond the cannula tip. The latter injury, presumably caused by turbulent flow, is not apparent to the unaided eye. If this abnormal intima is not adequately excised at the time of transplantation, fibrin and platelet deposition may lead to fibrosis and localized arterial stenosis. The injury can be avoided by ice storage or by indirect perfusion via an aortic cannula.
Renovascular hypertension after transplantation of a kidney perfused via multiple renal arteries.
A case presented in which a kidney with multiple (four) renal arteries was perfused by cannulating the two larger vessels. In spite of precautions to minimize damage at the sites of cannulation, stenosis developed at the orifices of the two principal vessels. This resulted in renovascular hypertension and led eventually to transplant nephrectomy. A technique has subsequently been developed to permit perfusion preservation without direct cannulation of the renal arteries. This completely eliminates cannula-related injury as a cause of renal artery stenosis.
Changing concepts in the management of splenic trauma.
Overwhelming sepsis may occur, even years later, in asplenic children or adults who are otherwise healthy. The injured spleen can be successfully repaired in almost all patients. Repair should not be attempted if the survival of the patient would be jeopardized by continuing or delayed hemorrhage. If splenectomy is unavoidable, the patient must be informed of his vulnerable state and be protected as much as possible by vaccines and by early aggressive treatment of all infections.
Effect of hepatectomy on mitotic activity in the rat spleen.
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Neurogenic respiratory failure: a 5-year experience using implantable phrenic nerve stimulators.
During the past 5 years, 20 phrenic nerve stimulators have been implanted in 11 patients who were ventilator dependent because of neurogenic respiratory failure. Ten patients had traumatic spinal cord lesions; the remaining patient suffered from a progressive demyelinating disease. There was no operative mortality. Complications included 1 stimulator malfunction and 1 pneumothorax. In spite of adjacent tracheostomies, there were no infections or wound complications. Of the 20 stimulators implanted, 13 initially produced good diaphragmatic function, 2 had fair function, and 5 had little or not function. Three patients became completely independent of their ventilators; 6 became partially independent, thus simplifying nursing care. There were no late complications. As of December, 1979, 7 patients had benefited or were continuing to benefit from phrenic nerve stimulation.
Reactivation of ocular malignant melanoma after renal transplantation.
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Cannulas for kidney preservation.
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Renal artery stenosis after machine preservation and transplantation of cadaver kidneys.
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Renal perfusion preservation without cannulation. Prevention of posttransplantation renal artery stenosis.
Cadaver kidneys were preserved by a technique that uses hypothermic pulsatile perfusion without cannulation of the renal arteries. This avoids the mechanical trauma that is inevitably associated with cannulation and preserves a maximum of untraumatized arterial tissue. Cannulation injury is thus eliminated as a potential cause of renal artery stenosis. Revascularization is simplified, especially when multiple renal arteries are attached to a cuff of aorta.
Acute hepatocellular damage following intraportal transplantation of pancreatic islets in rats.
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A three year experience using modified bovine arterial heterografts for vascular access in patients requiring hemodialysis.
Between January 1974 and December 1976 28 arteriovenous fistulae were created in 25 uremic patients using modified bovine arterial heterografts. Bovine grafts were inserted only if the patient's own vessels were deemed inadequate to permit the development of a useable Brescia fistula. Graft patency by the life-table method was 92% at three months and 75% at one year. Complications leading to graft failure included late thrombosis, inadequate healing of skin flaps, and graft disruption secondary to faulty cannulation. Ten patients died; none of the deaths were graft-related. At the end of the period of observation all patients requiring hemodialysis had functioning bovine grafts. It is felt that for this purpose the modified bovine arterial heterograft is superior to any other currently available vascular conduit. The location of these grafts should be planned so as to make maximal use of distal vasculature and allow multiple sequential access procedures in the same extremity. An idealized approach which encompasses these principles is presented.
Topical steroids for uremic pericardial effusions.
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Successful renal vein reconstruction with bovine arterial heterografts.
Extensive damage to a short right renal vein complicated transplant surgery in two patients. The use of a segment of modified bovine arterial heterograft permitted successful transplantation in both cases. These results are in contrast to the reported inability of bovine arterial heterografts to remain patent elsewhere in the systemic venous system.
Comparison of long-term kidney survival following cold storage or pulsatile preservation.
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