Biomedical subjects
Publications and source records attributed to S P Pastershank.
Nineteen urologic complications developed in 161 renal transplant patients, 14 of whom developed cutaneous fistulae. The majority of complications occurred at the ureterovesical and ureteropelvic areas. Pelvic and vesical abnormalities were uncommon. Twelve patients with cutaneous fistulae were treated conservatively. The mortality rate in our series was 47%.
Angiography revealed persistence of the primitive sciatic artery in two cases. In one, the artery supplied a large arteriovenous malformation, and the profunda femoris artery was absent. In the other, there were associated findings of neurofibromatosis, decreased left lower limb lymphatic vessels, a left subinguinal lymphocele, and absent external iliac and femoral arteries.
Early acute rejection occurs between two and ten days after renal homotransplantation and has been recognized in eight of 156 renal transplants. Four of the eight patients developed spontaneous renal rupture unrelated to biopsies. Pathologically, there was acute passive congestion with areas of tubular necrosis, venous thrombi and perivenous lymphoplasia. Glomerular and arterial immunogenic injury was slight. Radiologically, the kidneys were enlarged with stretching of the interlobar and segmental arteries, decreased peripheral filling and a homogeneous nephrogram. Renal vein filling defects were a frequent feature.
Twenty-five patients with rheumatoid arthritis presented with knee joint bursal abnormalities. Nineteen patients presented with symptoms simulating thrombophlebitis. Sixteen had a rupture of the posterior joint capsule without a communicating semimembranosus-gastrocnemius bursa (S-G), with extension ventrally between the soleus and gastrocnemius muscles or between the skin and muscle. Nine had an enlarged S-G bursa with or without rupture. Two patients had additional cephalad ruptures: one from the posterior compartment and the other one from the suprapatellar bursa.
In three cases of intrarenal arterial collateral circulation the collateral channels developed between interlobar arteries in diseased kidneys. Probably these originated in hypertrophied spiral vessels that had arisen from the interlobar arteries in the area of the minor calyces. This form of collateral circulation will undoubtedly be recognized more frequently with the increased use of magnification radiography.
Two patients are presented who sustained common hepatic artery injuries secondary to blunt trauma. One patient had a laceration and thrombosis of the proximal hepatic artery while the second patient developed a false aneurysm with dissection which necessitated ligation of the hepatic artery.