Search PubMed⌕ Search

Biomedical subjects

L E Ratner

Publications and source records attributed to L E Ratner.

At least 73 records · Page 4Linked to original sources
PubMed1995

Laparoscopic live donor nephrectomy.

A laparoscopic live-donor nephrectomy was performed on a 40-year-old man. The kidney was removed intact via a 9-cm infraumbilical midline incision. Warm ischemia was limited to less than 5 min. Immediately upon revascularization, the allograft produced urine. By the second postoperative day, the recipient's serum creatinine had decreased to 0.7 mg/dl. The donor's postoperative course was uneventful. He experienced minimal discomfort and was discharged home on the first postoperative day. We conclude that laparoscopic donor nephrectomy is feasible. It can be performed without apparent deleterious effects to either the donor or the recipient. The limited discomfort and rapid convalescence enjoyed by our patient indicate that this technique may prove to be advantageous.

Adult↗
PubMed1995

Cholecystectomy in the peritoneal dialysis patient. Unique advantages to the laparoscopic approach.

Laparoscopic cholecystectomy has proven to be a safe and effective treatment for symptomatic gallstone disease. Several subsets of patients, however, may not be candidates for the laparoscopic approach, including patients with morbid obesity, acute cholecystitis, and previous abdominal surgery. Because of peritoneal thickening and abdominal adhesions secondary to peritoneal dialysis, the applicability of laparoscopic cholecystectomy in patients maintained on chronic peritoneal dialysis is also unclear. We performed laparoscopic cholecystectomy on three peritoneal dialysis patients without intraoperative complications. We have noted several unique advantages to laparoscopic surgery in this patient population and advocate this approach in peritoneal dialysis patients requiring cholecystectomy.

Adult↗
PubMed1995

Acute abdomen in the hemodialysis patient population.

BACKGROUND: The cause and frequency of the acute abdomen in patients undergoing hemodialysis are not well reported. Previous studies associate bowel infarction with hemodialysis, but dialysis generally is not implicated as a risk factor for mesenteric ischemia. METHODS: The records of 567 patients undergoing long-term hemodialysis during the period from July 1988 to June 1993 were retrospectively reviewed. RESULTS: Twelve patients (2.1% of the hemodialysis population) were admitted with acute abdominal pain or sepsis. They were demographically no different than their counterparts who did not have an acute abdomen. The final diagnoses were bowel infarction in 11 patients and acute pancreatitis in one. Principal areas of involvement were equally divided between large and small intestine and were due to nonocclusive mesenteric ischemia in all cases. Six patients had an occluded hemodialysis fistula on admission, suggesting hypotension and/or hypovolemia as a possible etiologic factor. Overall, mortality and major morbidity rates were 50% and 25%, respectively. CONCLUSIONS: An acute abdomen is a relatively uncommon problem in the hemodialysis population but is associated with a high mortality. Mesenteric infarction is the most common cause and should be the presumptive diagnosis until proven otherwise.

Abdomen, Acute↗
PubMed1994

Angiosarcoma of the small intestine: a case report and literature review.

A case of primary intestinal angiosarcoma in a 59-yr-old man is reported. The patient had recurrent gastrointestinal bleeding with normal upper and lower gastrointestinal endoscopies, technetium-99m-labeled erythrocyte scan, and angiography. Barium small bowel series and abdominal computerized tomography showed an ileal mass. Pathological examination was consistent with hemangiosarcoma with both solid and vasoformative patterns. Metastatic disease was also identified in the small bowel mesentery, liver, spleen, lungs, and brain. No identifiable underlying or epidemiologic factors have previously been reported to be associated with this rare type of tumor of the gastrointestinal tract. The pertinent literature on gastrointestinal angiosarcoma also is reviewed.

Hemangiosarcoma↗
PubMed1993

Strategies for the successful transplantation of the horseshoe kidney.

Horseshoe kidney is probably the most common renal fusion anomaly. Horseshoe kidneys have been successfully transplanted en bloc into a single recipient or, alternatively, they have been divided and implanted into 2 patients. Despite these facts the use of horseshoe kidney allografts for transplantation is rare. We report a case of the successful transplantation of an en bloc horseshoe kidney into a single recipient. The evaluation of fused kidneys for transplantation, technical considerations and previously reported cases are discussed.

Adult↗
PubMed1993

Intraoperative fluid management.

The surgeon should be cognizant of both the intraoperative and postoperative consequences of intraoperative fluid administration. Optimal fluid management should take into consideration the patient's overall condition and should not be based solely on the cardiovascular response to volume loading. The selection of a particular fluid for resuscitation solution should be tailored to the patient's individual situation. No single fluid preparation will be appropriate for all clinical situations. Crystalloids, colloids, and hypertonic saline solutions have all been shown to be effective in restoring intravascular volume. Each has its own relative advantages and disadvantages and will be appropriate in differing situations. Colloid preparations should not be avoided for fear of inducing pulmonary edema, and the use of hypertonic solutions should not be precluded by fear of potential metabolic complications. The judicious use of both hypertonic solutions and colloids is safe. For the vast majority of routine surgical cases, where the patient is hemodynamically stable and postoperative fluid overloading is not a significant problem, isotonic crystalloids such as lactated Ringer's are both sufficient and cost effective.

Colloids↗
PubMed1993

Probable antibody-mediated failure of two sequential ABO-compatible hepatic allografts in a single recipient.

Two sequential ABO-compatible orthotopic liver allografts failed, despite excellent initial posttransplant function, in a patient with preformed donor-specific alloantibodies. There was no evidence of cell-mediated rejection. Retrospective crossmatching of recipient serum, obtained immediately prior to the first transplant, revealed the presence of lymphocytotoxic antibodies directed against donor class I HLA B17, at a titer of greater than 1:32,768. Similarly, lymphocytotoxic antibodies directed against the second donor's class I HLA A2 phenotype were detected on retrospective crossmatching utilizing both the three-wash Amos technique (TWA-CDC), and the anti-human immunoglobulin augmented technique (AHG-CDC), at a titer of greater than 1:32,768. Anti-class I specific alloantibodies were eluted from both failed liver grafts at titers of 1:256. The hepatic necrosis in zones 3 and 2 that were observed on histologic examination, and the profound refractory consumptive thrombocytopenia subsequent to each transplant may have been the result of antibody-mediated rejection by preformed lymphocytotoxic antibodies. Despite the liver's remarkable capacity to withstand antibody-mediated injury, primary humoral rejection following ABO compatible liver transplantation may occur if extremely high titers of performed allospecific lymphocytotoxic antibodies are present.

ABO Blood-Group System↗
PubMed1991

Is colonoscopy safe in the early postcolectomy period?

Colonoscopy was performed preoperatively and 1, 2, 3 and 7 days following a left hemicolectomy with a primary anastomosis in 11 dogs. The remaining colon and anastomosis were adequately visualized. Maximal intraluminal pressures achieved were from 15 to 35 mmHg. No leakage of air or intra-abdominal abscesses were present. In ten patients undergoing colonoscopy for lower gastrointestinal symptoms, the pressures were similarly measured. Although pressures were slightly higher in patients, averaging 30 mmHg, the results suggest that colonoscopy can be safely performed during the early postcolectomy period.

Air↗
PubMed1991

Immunology of renal allograft rejection.

Allograft rejection remains the critical problem of renal transplantation. The immunologic mechanisms that underlie renal allograft rejection are heterogeneous and involve the humoral and cellular limbs of the immune response. Antibody-mediated hyperacute rejection is now rare owing to improved prospective cross-matching. Chronic rejection, characterized by intrarenal arterial fibrosis, is still poorly understood. Knowledge of the afferent and efferent processes involved in rejection has led to effective therapeutic and experimental strategies that employ monoclonal antibodies and other pharmacologic agents to reverse, or prevent, acute allograft rejection. In addition, allospecific tolerance has been achieved experimentally and clinically in a variety of manners. Preliminary studies on the mechanism of allograft tolerance induced by donor-specific blood transfusions before transplantation suggest a role for an immunoregulatory cell population that specifically down regulates cytotoxic lymphocyte responses to donor antigens in some recipients. A role for noninherited maternal antigens and anti-idiotypic antibodies in down regulating immune responses to allografts have also been reported by several studies. An improved understanding of allograft rejection and tolerance may identify approaches to prolong allograft survival without the morbidity and mortality associated with present-day immunosuppression.

Animals↗
PubMed1989

Safety of endoscopy in the immediate postoperative period following gastric anastomosis.

The safety of gastrointestinal endoscopy in the immediate postoperative period following partial gastrectomy was assessed in ten dogs. Endoscopy was performed preoperatively and at 1, 2, 3, and 7 days postoperatively. The mean pressures required to perform an adequate endoscopy varied from 17 to 20 mm Hg. Following partial gastrectomy, the abdominal wall was closed with a zipper to facilitate inspection of the gastric anastomosis. No leakage of air or intra-abdominal abscesses were seen following endoscopy. The results of this study suggest that endoscopy can be safely performed in the immediate postgastrectomy period.

Animals↗
PubMedDate not supplied

Left adrenal vein localization by 3D real-time volume-rendering CTA before laparoscopic nephrectomy in living renal donors.

BACKGROUND: We investigated whether the left adrenal vein could be consistently localized on three-dimensional (3D) real-time volume-rendering computed tomographic angiographic (CTA) mapping in a group of living renal donors before laparoscopic nephrectomy. METHODS: Sixty-six consecutive potential renal donors were referred for CTA vascular mapping before laparoscopic donor nephrectomy. Thirty-three patients were examined on a single-detector helical CT scanner and the other 33 were examined on a multidetector unit. In each patient, arterial phase and venous phase volumetric data sets were acquired after the intravenous injection of 150 cc of non-ionic contrast material. Three radiologists reviewed the data sets at a free-standing workstation after the application of 3D volume-rendering software and reached a consensus on whether the left adrenal vein was visualized and, when seen, its position relative to the abdominal aorta. RESULTS: The left adrenal vein was found in 92.5% of the 66 donors (91% in the single-detector group and 94% in the multidetector group). The junction of the left adrenal vein and left renal vein averaged 5.2 mm (range = 0-13 mm) from the left lateral wall of the abdominal aorta. CONCLUSION: Three-dimensional real-time volume-rendering CTA with single-detector and multidetector scanners permits consistent localization of the left adrenal vein in more than 90 % of prospective living renal donors.

Adrenal Glands↗