The ileocecal segment. An antirefluxing colonic conduit form of urinary diversion.
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Biomedical subjects
Publications and source records attributed to L Zinman.
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The hypercoagulable state associated with select cases of glomerulonephritis is difficult to diagnose by standard laboratory techniques but is clinically manifested by recurrent shunt and fistula thrombosis which may be refractory to anticoagulant therapy. Bilateral nephrectomy reversed this hypercoagulable state. After renal allograft, however, the patient experienced hyperacute rejection, and transplant nephrectomy was required to cure the recurrent hypercoagulable state. The mechanism of this previously unreported phenomenon and its implications with regard to renal transplantation are discussed.
The ileocecal intestinal segment has been used as a diverting conduit with a satisfactory colonic stoma in 6 patients with potentially reversible bladder disorders. Followup has been from 1 to 5 years. The ileocecal valve has been modified successfully by a fundoplication procedure similar to the Nissen esophagogastric junction operation to prevent ileocecal and ureteral reflux. IVP and renal function studies revealed resolution of pre-existing hydronephrosis and preservation of previously normal upper urinary tracts. One patient has undergone reversal of the diversion by cecocystoplasty and simultaneous bladder augmentation, and has been followed for 5 years with sterile urine and normal IVPs. The anatomic and functional advantages of a conduit with an antireflux mechanism that is applicable to the hydronephrotic collecting system are discussed.
The natural history, presenting signs and symptoms, and radiologic evaluation of patients with hypernephroma are reviewed. Radical nephrectomy is the treatment of choice in patients free of metastatic disease. Patients who have evidence of metastatic disease should not be subjected to nephrectomy unless hemorrhage, pain, or some other severe local problem warrants it. Radiotherapy and chemotherapy may be useful as adjunctive therapy in a patient with metastatic disease.
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