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Biomedical subjects

R J Corry

Publications and source records attributed to R J Corry.

At least 145 records · Page 8Linked to original sources
PubMed1982

Gastrointestinal bleeding and mycotic superior mesenteric aneurysm.

This is a case report of management of a delayed mycotic superior mesenteric artery aneurysm occurring in a patient 2 years after aortic valve replacement for endocarditis. A chronic ulcer history, anticoagulation therapy, episodic gastrointestinal bleeding associated with negative gastrointestinal series, and gastritis seen at endoscopy delayed the ultimate diagnosis. An episode of massive hemorrhage precipitated angiography with subsequent surgical confirmation of the diagnosis. Management included debridement and extirpation of the major part of the aneurysm, Doppler assessment of the inadequacy of collateral mesenteric arterial blood flow, and restoration of flow with a bypassing saphenous vein graft segment. Although this technique of reconstruction has been suggested, we can find no other report of such a similar case among the few reported surgical successes with superior mesenteric artery mycotic aneurysm.

Aneurysm, Infected↗
PubMed1981

Pretibial rash in Legionella pneumophila pneumonia.

Legionella pneumophila pneumonia developed in a 46-year-old man, 23 days after receiving a cadaveric renal homograft. A painful, nonpruritic, macular, erythematous rash limited to the pretibial surfaces of both legs appeared on the fifth day of illness. Fever, pneumonia, and rash resolved in association with erythromycin lactobionate therapy.

Erythema Nodosum↗
PubMed1981

A 2-year trial of prospective HLA-DR matching: effects on renal allograft survival and rate of transplantation.

In a 2-year trial at a single center, prospective HLA-DR matching for cadaver renal transplantation exerted a stronger effect than either HLA-A and B matching or blood transfusion. One-year cumulative graft survivals for two-DR-matched organs was 92%. Grafts matched for one DR antigen had a cumulative 1-year graft survival of 65% whereas grafts matched for zero DR antigens had a cumulative 1-year survival of 41%. When all cadavers with less than two identifiable DR antigens were excluded from this analysis, however, the graft survivals of the groups known to be mismatched for one or two DR antigens were similar (61% versus 59%). Grafts matched for three or four HLA-A and B antigens did somewhat better than those matched for only zero, one, or two HLA A and B antigens (74% versus 59%, 1-year survival). This effect was only demonstrable in the zero- and one-DR-matched group. Similarly, prior blood transfusion exerted a modest effect (transfused versus nontransfused, 71% versus 56% 1-year graft survival) that was also most evident in the zero- and one-DR-matched groups. The institution of this trial was also associated with a 35% annual increase in the rate of transplantation and a 50% reduction in median patient waiting time. DR typing of cadaveric donors is feasible and highly desirable. Multicenter pooling of DR-typed donors is thus predicted to lead to optimal matching for a high proportion of renal transplant candidates.

Graft Survival↗
PubMed1980

Transfusion and renal allograft survival: beneficial effect of transfusions given on day of transplantation.

To determine if the beneficial effect of blood transfusion on renal allograft survival can be obtained without risk of presensitization, we examined the effect of transfusions given on the day of transplant surgery in a series of 180 primary cadaveric renal allografts. Three-month graft survival of those transfused only on the day of transplant was significantly better than the graft survival of those never transfused, and was not significantly different from graft survival of those transfused during the dialysis waiting period. Maximal beneficial effect was achieved by administration of as few as two to three units. We conclude that the benefits of transfusion can be obtained while minimizing the risks of presensitization if transfusion is minimized during the dialysis waiting period and patients are electively transfused at the time of transplant.

Adolescent↗
PubMed1980

Experience with live donor nephrectomy.

We studied 100 patients undergoing nephrectomy for living related renal transplantation. after completion of tissue typing preoperative studies included urinalysis and culture, creatinine clearance determination, excretory urography and renal arteriography. Patient characteristics, preoperative test, surgical approach, complications, long-term followup and cost factors were reviewed. There was no mortality and morbidity was minimal except for wound complications. Renal function generally remained normal. Donor nephrectomy is a worthwhile and safe procedure with an acceptably low incidence of postoperative complications.

Adolescent↗
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

Cytomegalovirus as a cause of cecal ulcer with massive hemorrhage in a renal transplant recipient.

Although cytomegalovirus disease following renal transplantation occurs frequently, ulcerative lesions of the gastrointestinal tract are not common. This report describes a patient with a single large cecal ulcer, with cytomegalovirus inclusion bodies located in the ulcer bed. The patient presented with massive rectal bleeding necessitating a right hemicolectomy. No other manifestations of systemic cytomegalovirus disease were present in this patient.

Cecal Diseases↗
PubMed1980

Hemosiderosis without cirrhosis: an unusual case of portal hypertension.

A renal transplant recipient presented with bleeding esophageal varices. Needle biopsy, later confirmed by operative wedge biopsy, showed slight periportal fibrosis but no cirrhosis or hepatitis. No etiology for his liver disease could be determined and he could not be differentiated from other reported patients with idiopathic noncirrhotic portal hypertension (IPH). His liver biopsy did show massive hepatic iron deposition. He had received about 115 units of blood while on hemodialysis and had taken oral iron supplementation for 8 years. IPH has been associated with toxin exposure, especially arsenic and vinyl chloride. This case suggests that excessive iron deposition may also lead to IPH and the indiscriminate use of iron supplementation in hemodialysis or renal transplant patients should be avoided.

Adult↗
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

Management of surgical gastrointestinal complications in renal transplant recipients.

Gastrointestinal (GI) complications developed in 19 (7.2%) of 265 patients after renal transplantation, and 3 (16%) patients died. Complications included colon perforations, colonic bleeding, small-bowel infarction, pancreatitis, subphrenic abscess, and upper GI tract bleeding. Ulcers located in the second portion of the duodenum developed in six patients; four of them required operation for massive hemorrhage, which occurred during or immediately after the administration of high-dose methylprednisolone for rejection. However, the association of methylprednisolone and colon perforation was not clear from this report. Early diagnosis and prompt operation for surgical-type GI complications in transplant recipients contribute to a low mortality.

Adult↗