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Biomedical subjects

D G Wombolt

Publications and source records attributed to D G Wombolt.

31 records · Page 2Linked to original sources
PubMed1982

Unusual vascular findings in transplanted kidneys.

Of 189 unsuccessful renal transplant cases, eight were selected for retrospective analysis because they had been classified histologically as "chronic rejection with marked vascular changes" even though they had been removed less than 60 days after transplantation. Review of these cases revealed that only one of the eight transplants had postoperative function and that this transplant had only marginal functions. All eight kidneys had intimal damage that was unlike the usual lesions of rejection. Five kidneys showed evidence of thrombosis with recanalization, and five had what appeared to be a double layer of the intima. The findings in eight cases suggest that severe intimal damage occurred within 60 days of implantation and may not represent the usual rejection processes; it may reflect, in part, damage to the intima prior to or during implantation.

Adult↗
PubMed1982

Radiation therapy for renal transplant rejection reactions.

Forty-four renal transplant patients were given radiation therapy for severe rejection phenomena. The 29 patients who had only one course of irradiation had a 52.3% successful function rate. Fifteen patients received from two to four courses of irradiation with an ultimate 60% rate of sustained function. Fifty patients who received only steroid and other medical management but no irradiation had a 60% rate of successful renal function. In the irradiation group, no patient whose creatinine level did not respond to radiation therapy maintained a functioning kidney. The data indicate that the overall successful function rate is maintained by radiation therapy in patients who show severe allograft rejection phenomena.

Adolescent↗
PubMed1982

Intrarenal arterial stenosis. Saralasin acetate infusion test as an aid to diagnosis.

This report documents a case of hypertension caused by an intrarenal arterial stenosis in a ten-year-old girl. The renovascular origin of her hypertension was suggested by a positive saralasin acetate infusion test, and the lesion was identified by use of the subtraction technique in renal arteriography. Partial nephrectomy resulted in resolution of the patient's hypertension with good function in the remaining portion of the kidney.

Angiography↗
PubMed1981

Experience with subclavian vein for vascular access.

We report our experience with the subclavian vein as a route for temporary vascular access. By modifying the technique described by Uldall one can place these catheters at the bedside without the need of a separate exit tunnel. They are easily maintained in place and allow for early discharge home while awaiting permanent vascular access maturation. The results of approximately 600 dialysis treatments showed adequate clearence with a mean postdialysis drop in creatinine of 5.0mg./dl. and BUN of 46mg./dl. Complication rates were minimal with no hemo or pneumothorax. The rate of complications between bedside and operating room placement was not different. We feel the low complication rate, the ease of insertion, and the patency at home makes this an attractive alternative to other means of temporary dialysis such as: peritoneal dialysis, repeat femoral vein catheterization or arteriovenous shunts.

Catheterization↗
PubMed1981

Results of hemodialysis & hemoperfusion in the treatment of acute arsenic ingestion.

Hemodialysis and charcoal hemoperfusion have been used in the last few years for the treatment of acute toxin ingestion. We used these methods to treat a patient with a known ingestion of 1.3 grams of arsenic trioxide. We measured blood and urine levels of arsenic prior to and after dialytic therapy in addition to before and after conventional chelation therapy. The blood and urine levels showed no significant change with any therapy and clinically he lapsed into prolonged coma. In view of the lack of laboratory and clinical response, we feel that hemodialysis and hemoperfusion may not be indicated in acute massive ingestion. Supportive care to maintain blood pressure and urinary output may be all there is to offer. In recent years both hemodialysis and hemoperfusion have been introduced as treatment of accidental or deliberate drug or toxin ingestion. (1-4) There have been previous reports on the supposedly successful treatment of arsenic ingestion with hemodialysis. (5-6) We report our experience with a massive ingestion of arsenic trioxide. This patient received treatment with conventional chelating agents, standard hemodialysis, as well as hemoperfusion, without evidence of significant removal of arsenic or clinical benefit.

Adult↗
PubMed1979

Restrospective correlation of clinical and histologic findings of 189 exchanged kidneys.

Tissues samples from 189 unsuccessful renal allografts, 47 recovered at autopsy and the others removed surgically, were examined histologically by light microscopy. Tissues samples were obtained from cadaver kidneys that had been exchanged regionally for transplantation. Each allograft tissue sample was rated as to extent of pathologic changes denoting rejection and was classified accordingly. Surgical and autopsy reports, as well as clinical data, were then obtained and these were compared with the retrospective pathologic findings of this study. Our pathologic findings agreed with the original pathologic diagnosis as to presence or absence of rejection changes in 180 cases, but disagreed with the clinical diagnosis of rejection in 28 of the 63 cases with minimal or no histologic evidence of rejection. There was less disagreement with the clinical diagnosis for the 87 cases with histologic evidence of rejection which had been judged as sufficient to cause allograft loss, 70 having been clinically diagnosed as rejected. Disagreement occurred most often where the allograft had never functioned or had been lost within 3 months. Retrospective analysis did not disclose any association between rejection histology and preformed antibodies or length of kidney perfusion time. Sufficient allografts appeared to have been lost for reasons other than rejection to cast doubt on the validity of interpreting renal allograft data only by graft survival statistics.

Diagnosis, Differential↗
PubMed1978

Analysis of tonic muscle activity and muscle cramps during hemodialysis.

A problem associated with some patients undergoing hemodialysis is the presence of muscle cramps. As the etiology of these cramps is still unknown, the purpose of this study was to evaluate tonic muscle activity and muscle cramps during hemodialysis. Forty-six complete dialysis treatment sessions were studied. Electromyographic (EMG) activity was recorded from a leg muscle in patients who cramped and control patients who did not cramp. EMG was analyzed via a minicomputer for each minute of recording time. Results indicated the mean muscle cramp latency from start of dialysis was 248 minutes. Average muscle cramp was 10 minutes in duration and took three minutes to develop and seven minutes to fully dissipate. Tonic EMG activity in patients with muscle cramps showed a continued increase throughout the latter part of dialysis whereas the control patients showed a continual decline. The results suggest that the latent increase in EMG activity may be causally related to muscle cramps and may be a useful predictor as to the onset of muscle cramps during hemodialysis.

Electromyography↗
PubMed1975

Progressive renal artery stenosis. An experimental model.

A method of inducing slow gradual constriction of a renal artery is described. A metal constrictor is partially filled with ameroid, a hydroscopic material. Over a period of weeks, the ameroid expands, causing increasing obstruction to the renal artery. Data revealed a progressive decrease in function as measured by p-aminohippurate, inulin, and creatinine clearance on the affected side with an increase in function in the contralateral side.

Animals↗