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Biomedical subjects

J C West

Publications and source records attributed to J C West.

At least 73 records · Page 4Linked to original sources
PubMed1984

Intestinal evisceration resulting from a motor vehicle accident.

Presented is the case of a motor vehicle accident (MVA) victim with hypotension and evisceration of small intestine. Vigorous resuscitation in the emergency department was required, after which a portion of small bowel was resected at laparotomy. Evisceration secondary to trauma in an MVA is a rare injury. Significant blood loss occurs. Although abdominal sepsis did not occur in our case, this is a complication for which the patient must be monitored closely.

Abdominal Muscles↗
PubMed1980

Effect of timing of administration and quantity of blood transfusion on cadaver renal transplant survival.

Graft and patient survival rates were analyzed in 239 consecutive first cadaver renal transplants as a function of time of administration of blood transfusion and the number of units given. There was no statistically significant difference in patient survival in comparing patients who were never transfused, patients not previously transfused who received blood peroperatively, those who received blood before transplantation only, and those who were transfused before transplantation and peroperatively. In fact, the best survival rates were achieved in patients who were not transfused previously. Graft survival rates were significantly better in the prior transfused groups compared to either the never transfused group or the larger no prior transfused group which included the peroperatively transfused patients. Graft survival of the peroperatively transfused patients was intermediate between the never transfused and the prior transfused patients. There was no statistically significant difference between graft survival rates of patients who received more than 6 units of blood with those receiving less than 6 units. Also, the time interval from the last transfusion to transplantation appeared to have no effect on graft survival. Since an intentional transfusion protocol carries the real risk of sensitization and delay or elimination of the transplantation option, a prospective study comparing peroperative with preoperative transfusions is suggested. Such a study would answer the questions of the risk of sensitization with prior transfusion and the value of peroperative transfusions.

Blood Transfusion↗
PubMed1980

Surgical management of complications of vascular access for hemodialysis.

Infection involving the vascular suture line of the graft to the host artery resulting in either fistula or false aneurysm was the most serious type of surgical complication in a series of vascular access procedures. Excision of the aneurysm and foreign material followed by vein bypass graft was the preferred treatment. Other complications included arterial or venous insufficiency of the hand distal to forearm fistulas, the gradual development of stenosis at the graft suture line and thromboses of fistulas and shunts. Careful management of these complications is important both in preserving the access site, when possible, and in avoiding unnecessary sequelae related to vascular insufficiency of an extremity.

Aneurysm↗
PubMed1979

Should the ruptured renal allograft be removed?

During a 16-month period when 93 renal transplants were performed, eight kidney graft ruptures were detected within 18 days of transplantation, without evidence of venous obstruction. Six grafts were removed at the time of an exploratory operation for rupture and only one showed signs of probable irreversible rejection when examined by microscopy. Two graft ruptures were repaired and one of these grafts has had good long-term function 22 months later. These observations suggest that if bleeding at the site of grafts has had good long-term function 22 months later. These observations suggest that if bleeding at the site of graft rupture can be securely controlled and if the conditions of the patient and of the graft are favorable except for the rupture, it may be possible to save more than one of eight grafts.

Adolescent↗
PubMed1979

Improving graft and patient survival rates in renal transplantation.

This report illustrates the improving trend in patient survival of recipients of cadaver and living-related kidneys. Mortality has been less than 3% for living-related recipients and less than 8% at one year for recipients of cadaver kidneys excluding diabetic patients. Although mortality of the diabetic recipient group receiving cadaver kidneys remains a problem, it has decreased in the last year such that overall mortality of the entire diabetic group is 20% at one year. The various factors leading to improved graft function rate are also emphasized.

Actuarial Analysis↗
PubMed1978

Colon perforation after kidney transplantation.

Between 1962 and 1977 approximately 2% of Denver kidney transplant patients developed colon perforation. The single commonest cause was diverticulitis of the left colon (6/13 cases). In spite of drastic reduction or discontinuation of immunosuppression, only 5/13 patients survived for more than 90 days after operation. Analysis of this experience suggests that the high mortality rate associated with this complication can be reduced by early operation which removes the perforation from the peritoneal cavity (either exteriorization or resection) without primary intestinal reanastomosis. We believe that candidates for kidney transplantation with a history of previously symptomatic diverticulosis coli should have elective colon resection prior to transplantation. Any kidney transplant patient with lower abdominal signs should be investigated and treated aggressively.

Adolescent↗
PubMed1978

Pediatric cadaver kidneys for transplantation.

A group of 24 kidneys from donors ranging in age from 1 1/2 to 10 years were transplanted singly into adults and were compared to a group of 44 adult cadaveric kidneys transplanted into adults. There were no vascular complications in either group. There were two urological complications in the 24 pediatric donor cases and none with the adult donor cases. During the first month after transplantation, the mean creatinine clearance was lower in the pediatric donor group; later the function of the pediatric donor kidneys was at least as good as the function of the adult donor grafts. In the group of pediatric donor kidneys, the outcome using kidneys from donors younger than 3 years of age was less satisfactory than for donors 3 to 10 years of age. These data suggest that transplantation of a single pediatric kidney into an adult, particularly if the pediatric donor is at least 3 years of age, will provide satisfactory renal function.

Adult↗
PubMed1977

Acute bacteremia in asplenic renal transplant patients.

Four cases of overwhelming bacteremia were observed in asplenic renal transplant patients 12 to 20 months after transplantation. The bacteriologic findings and presentation of these infections are characteristic of post-splenectomy sepsis reported in nontransplant patients. It is suggested that the absence of the spleen, more than immunosuppression with azathioprine and prednisone, predisposes to these late, uncommon infections after transplantation.

Acute Disease↗
PubMed1977

Pediatric kidney transplantation for cystinosis.

In an experience of more than 700 kidney transplants, three recipients are known to have had congenital cystinosis. A cadaver kidney transplant in a 10 yr old child with nephropathic cystinosis functioned well for 7 1/2 yr before it was rejected and the graft was free of recurrent cystinosis after that interval. This prolongation of life was associated with marked accumulation of cystine in the patient's thyroid gland, presenting as a mass in the neck. If additional longevity is achieved in this patient, abnormal intracellular cystine accumulation may be expected in other host tissues. Retransplantation was carried out with the father as donor, accepting the possibility of increased cystine levels in the retransplant. This patient's age of 18 yr identifies him as one of the longest known survivors of infantile nephropathic cystinosis.

Adolescent↗