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Biomedical subjects

M F Mozes

Publications and source records attributed to M F Mozes.

At least 55 records · Page 3Linked to original sources
PubMed1986

Anatomic abnormalities of cadaver kidneys procured for purposes of transplantation.

Over a 7-year period the authors studied the vascular and ureteric anomalies of kidneys procured from brain dead, heart-beating cadavers for the purposes of transplantation. Four hundred donors had a bilateral nephroureterectomy performed using an en-bloc technique, followed by fine anatomical dissection in cold saline slush solution. Thus, 800 kidneys were available for study. Single renal arteries were found in 72 per cent of the kidneys, with multiple arteries occurring in 28 per cent. The renal veins showed a more uniform anatomical pattern and were single in 92 per cent of instances. There were nine ureteral anomalies, all duplications, being just 1 per cent of the total number studied. Sex, race, and blood group of the donor did not significantly influence the number of anomalies seen. In sum, anatomical variants were noted in 197 (49.3%) donors, 69 (17.3%) with bilateral anomalies and 128 (32.0%) with unilateral anomalies. A knowledge of these anatomical variants will allow surgeons responsible for organ procurement to proceed with caution and so prevent wastage of cadaver kidneys due to technical misadventures.

Adolescent↗
PubMed1985

The spectrum of peritonitis in renal transplant recipients.

Peritonitis in immunosuppressed renal transplant recipients continues to be associated with a high mortality. Twenty-four patients with intraperitoneal infections were identified in 542 consecutive renal transplant recipients over a period of 15 years (4.4%). Sixteen of the 24 (66.6%) died as a result of these infections. Transplant wound sepsis and the complications and surgery of gastrointestinal diseases accounted for the majority of instances. During the period 1980-1983 only four cases occurred with no episodes being due to wound complications. Symptoms and signs were vague and nonspecific, and in three patients the diagnosis was made only at autopsy. Surgery aimed to eliminate the septic focus with the drainage of abscesses and the avoidance of large bowel anastomoses. In 22 patients, a polymicrobial flora was obtained from the contaminated peritoneal cavity, with an average of 2.25 organisms per patient. These data suggest that the prohibitive mortality of peritonitis in renal transplant recipients may be lowered by prophylactic gastrointestinal surgery prior to transplantation, as well as by measures designed to lower the incidence of transplant wound sepsis. Peritoneal lavage, computed tomography, and laparotomy in the face of an undiagnosed source for sepsis may be warranted in these high-risk patients.

Adolescent↗
PubMed1985

Parathyroid allotransplantation in the treatment of complicated idiopathic primary hypoparathyroidism.

Parathyroid allotransplantation was performed in a 25-year-old woman with idiopathic hypoparathyroidism that had been diagnosed at age 4 years. Long-term medical management of the primary condition with vitamin D and oral calcium supplementation was complicated by multiorgan calcinosis and renal failure. At the age of 21 years she received a successful cadaver renal allograft. Four years later she developed calcinosis cutis with widespread skin necrosis. Medical control of calcium and phosphate metabolism was unsatisfactory and the skin necrosis became progressive and life threatening. A parathyroid allograft that was performed with tissue from a parathyroid adenoma resulted in normalization of the serum calcium and phosphorus levels with arrest and subsequent healing of the skin necrosis. Later failure of the parathyroid allograft was followed by successful retransplantation of normal parathyroid tissue from a cadaver organ donor.

Adult↗
PubMed1984

Partial splenic embolization, an alternative to splenectomy--results of a prospective, randomized study.

UNLABELLED: We conducted a prospective, randomized study comparing transcatheter partial splenic embolization (PSE) with splenectomy (SX) in 53 renal transplant candidates. An additional 112 PSE procedures were performed for various indications in 101 patients. STUDY RESULTS: A mean +/- SD of 65% +/- 16% of splenic mass was ablated in the PSE group. The early postoperative morbidity rate was similar in the two study groups, as was the duration of hospital stay. Abscess or rupture of the spleen were not encountered. Severe pancreatitis occurred only in the SX group. Renal transplantation was carried out in equivalent numbers in both groups, with a similar long-term (2.5 to 4.0 years) graft survival (60% versus 66%). No difference in long-term patient mortality was noted. Splenic "regeneration" occurred frequently after PSE. PSE experience exclusive of study: Embolization attempts failed in nine patients. Repeat PSE was performed in 11 of the 101 patients. Where hypersplenism was the primary indication, PSE resulted in significant improvement in the hematologic parameters. The incidence of serious complications was acceptably low. There were two late procedure-related deaths. Our conclusion from the study and the total experience of 137 PSE procedures is that PSE offers an acceptably safe alternative to SX in selected high-risk patients in whom both the surgical intervention and the resulting asplenic state carry a prohibitive risk.

Adolescent↗
PubMed1983

Heart and spleen "twin grafts" in rats: IV. Influence of donor spleen cell mass on allograft survival.

Heart and spleen twin grafts from LEW to ACI rats may survive permanently, whereas those grafted from ACI to LEW rats do not. This strain difference in graft acceptance was analyzed quantitatively by transplanting one to three ACI spleens into LEW rats in order to compensate for the relatively small size of ACI spleens (Fig. 1). Under these conditions permanent graft survival was not observed in LEW recipients. However, during host splenectomy 3 days after transplantation, a nonimmunological factor was observed. The transplanted ACI spleens showed congestion and infarctions, while in the LEW to ACI transplant model the LEW spleens did not. This observation could be explained by the size of the vascular pedicle in ACI spleens. Although no problem was encountered immediately after completing the anastomoses, allogeneic spleens react by increasing in size, to such an extent that their size exceeds the capacity of the smaller vascular pedicle in ACI rats and results in congestion. Hence, the concept is formulated that early compromise of hemodynamics on a nonimmunological base may determine the fate of ACI spleen graft before immunological factors have a chance to become effective.

Animals↗
PubMed1981

[Peritonitis following kidney transplantation].

Twenty of 322 renal allograft recipients developed intraperitoneal infections. The mortality was 70% and responsible for 20% of all transplant deaths. Wound infections were the source of the peritonitis in over 50% of the patients, 40% were on high-dose immunosuppression. In contradistinction to the patients who died, the clinical picture of the survivors was characterized by: (1) localized peritonitis, (2) no high-dose immunosuppression, (3) absence of uncommon pathogens like C. albicans and S. marcescens, (4) radical peritoneal debridement with irrigation of the abdominal cavity at the time of surgery.

Humans↗
PubMed1981

The pathogenesis of hyperchloremic metabolic acidosis associated with kidney transplantation.

The mechanism of persistent hyperchloremic metabolic acidosis developing after kidney transplantation was investigated in six patients. In five patients in whom acidosis failed to lower the urine pH below 5.5, an infusion of sodium sulfate also failed to lower the urine pH. Neutral phosphate infusion failed to increase the urine minus blood (U-B) carbon dioxide tension (pCO2) difference normally in these patients. This abnormal response to both maneuvers indicates the presence of a tubular defect for distal hydrogen ion secretion. In the remaining patient, spontaneous acidosis lowered the urine pH below 5.5 and increased the U-B pCO2 normally with the administration of phosphate, demonstrating that this patient's distal capacity for hydrogen secretion was intact. The plasma aldosterone level was low in this patient, and thus he had the acidification defect characteristic of aldosterone deficiency. Hyperkalemia developed in two patients; both were aldosterone-deficient, and they had a low fractional potassium excretion ion response to stimulation with sodium sulfate or acetazolamide. In all but one patient, who lost his kidney to accelerated rejection, chronic rejection developed. Homogeneous deposition of complement (C3) along the tubular basement membrane was found in three patients. Our data suggest that a secretory type of distal renal tubular acidosis can be an early sign of the immunologic process that leads to chronic rejection.

Acidosis, Renal Tubular↗
PubMed1981

Massive subcutaneous emphysema: an unusual presentation of jejunal perforation.

Massive diffuse subcutaneous emphysema resulting from perforation of the proximal jejunum is presented. Seventy-nine reported instances of subcutaneous emphysema of gastrointestinal origin were reviewed. Emphysema originating from the jejunum has not been previously reported. The colon (26 patients) and rectum (16 patients) were the more common sites of perforation. Perforations of the stomach and duodenum were found in 14 patients. The most common site for presentation of the subcutaneous air was the lower abdominal wall and thigh, and the more common causes were carcinoma of the colon and rectum and diverticulitis. The pathogenesis of emphysema in the patient described, as well as in the great majority of other patients, is from intraluminal gas rather than from gas-forming organisms. The air spreads along neurovascular bundles and other anatomic planes and may rapidly reach areas distant from the perforation. The recognition of these phenomena in the diagnosis of gastrointestinal perforation is important.

Clostridium Infections↗
PubMed1980

Total parathyroidectomy and autotransplantation in secondary hyperparathyroidism.

Sixteen patients with chronic renal failure and symptomatic secondary hyperparathyroidism underwent total parathyroidectomy. Sixteen to 25 fragments of parathyroid tissue measuring 1 cu mm were autotransplanted into the brachioradial muscle. Evidence of "take" of the autotransplant was present in all patients, although four patients still have hypocalcemia and require calcium and vitamin D supplementation. Three patients have experienced late diminution of autotransplant function. Symptomatic improvement occurred promptly in 15 of the 16 patients. Two patients with persistently elevated parathormone levels were treated by partial excision of the implant, and one patient whose autograft functioned inadequately was successfully treated by implantation of cryopreserved autologous parathyroid tissue. Total parathyroidectomy with autotransplantation of parathyroid fragments to the forearm is the preferred surgical procedure for secondary hyperparathyroidism.

Adolescent↗
PubMed1980

Splenic embolization.

While transcatheter embolization of the spleen has shown promise in the treatment of a wide spectrum of disorders, the incidence of serious complications with this technique has limited its use as an alternative to operative splenectomy. In our institution 41 patients were treated with a modified technique involving partial splenic embolization, careful antibiotic prophylaxis, and adequate pain control. There was no mortality and only few instances of clinically significant complications: a splenic abscess in one patient, pancreatitis in one patient, severe pleural effusions in two patients, and pneumonia in five patients.

Adolescent↗
PubMed1979

Hepatic dysfunction during isoniazid chemoprophylaxis in renal allograft recipients.

Hepatitis is a frequent complication of dialysis and renal transplantation; therefore, the occurrence of drug hepatotoxicity is an additional important consideration in renal allograft recipients. Azathioprine, needed for immunosuppression, and isoniazid, used for antituberculous chemoprophylaxis, are both potentially hepatotoxic. A retrospective study of 119 patients who received 126 renal allografts was done to estimate the probable incidence of isoniazid-related hepatic dysfunction. All patients in this series were administered isoniazid chemoprophylaxis. Posttransplantation hepatitis developed in 13 patients. Circumstantial evidence supported a presumptive diagnosis of isoniazid hepatotoxicity in three recipients. We concluded that routine isoniazid chemoprophylaxis is not justified in renal allograft recipients based on the probability of hepatotoxicity as contrasted to the infrequent occurrence of tuberculosis.

Adolescent↗
PubMed1978

Jaundice after renal allotransplantation.

Of 567 patients receiving renal transplantation at the University of Minnesota between October 1967 and October 1975, 22 developed clinical jaundice. Of these 22, nine died with their initial episode of hepatitis, six died within three months of causes associated with liver malfunction, four developed evidence of chronic hepatic failure and only three totally recovered from their illness. Five had clear evidence of Australia antigen positive hepatitis B, four of cytomegalovirus hepatitis, two of herpes hominis hepatitis, one of varicella zoster hepatitis and three of hepatic failure associated with systemic bacterial and/or fungal sepsis. Two of the 22 patients were thought likely to have cytomegalovirus hepatitis though definite proof was absent and in five patients a clear-cut etiology could not be made. In many of these patients the diagnosis was confounded by the previous presence of HB(s)Ag antigen and the frequent occurrence of a previous or concurrent infection with cytomegalovirus. The role of various drugs including azathioprine, sulfisoxazole, chlorpromazine, acetominophen, etc., could not be established but major roles for these agents in the face of the many viral and bacterial infections present in these patients is doubted. No clear-cut therapy could be established although it appears safe to discontinue azathioprine for longer or shorter periods of time with or without substitution of cyclophosphamide without serious deterioration of renal function. The problem of hepatic failure in transplant patients is still unsolved and will require a prospective study of etiologic agents and sub-clinical hepatic dysfunction in order to establish even the first principles of clinical-pathological correlation.

Adult↗