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Biomedical subjects

S Sterioff

Publications and source records attributed to S Sterioff.

At least 73 records · Page 4Linked to original sources
PubMed1984

Results of treatment of center hemodialysis patients.

Four hundred eighty-three patients were maintained by hemodialysis in an outpatient hemodialysis center at the Mayo Clinic between 1963 and 1977. Although only 18 patients had experienced a myocardial infarction and 6 had had a cerebral infarction before beginning dialysis, 30 subsequently had acute myocardial infarction and 45 had a stroke. These two complications accounted for 48 of the 98 deaths that occurred during maintenance dialysis. Despite such complications, 183 patients were employed, 124 remained active at home or at school, and 115 were totally disabled. Survival of patients maintained solely by dialysis was 52% at 5 years. For the group as a whole, including patients who received their first allograft, the survival rate at 5 years was 65%.

Adolescent↗
PubMed1984

Survival rates of 2,728 patients with end-stage renal disease.

This multicenter regional study analyzes survival of a large group of patients who began chronic dialysis or received their first renal transplant during the 5 1/2-year period that ended in June 1983. Survival was determined from the onset of renal replacement therapy, irrespective of changes in treatment modality. Univariate life-table analysis was used to examine more than 35 risk factors. Age of patients at entry into the therapeutic program significantly affected survival. General survival rates were lower for patients with diabetes than for nondiabetics, irrespective of treatment modality, with the exception of those older than 60 years of age. Five-year graft survival was lower for diabetics than for nondiabetics in all age groups, irrespective of source. Patients with systemic lupus erythematosus, focal glomerulosclerosis, or glomerulonephritis had the highest survival rates, whereas those with primary renal malignant lesions, primary hypertensive disease, or diabetes mellitus as the cause of renal failure had the lowest. Concurrent morbid conditions that adversely affected survival included arteriosclerotic heart disease, peripheral vascular disease, noncutaneous malignant lesions, chronic pulmonary disease, and multiple coexisting morbid conditions. Although the objective of this study was to analyze survival for single patient characteristics, irrespective of treatment modality, analyses of survival rates by treatment modality for a control group indicated that minimal differences were evident by the third year among the four treatment groups: in-center hemodialysis, home hemodialysis, living related donor transplantation, and cadaver transplantation; however, recipients of cadaver grafts had lower survival rates than all other groups, even those maintained by in-center hemodialysis (P = 0.025).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Transfusion-induced alloimmunization in patients awaiting renal allografts.

Lymphocytotoxic antibodies can be induced by the immunologic stimulus of pregnancy, blood transfusion, or tissue allograft. The presence of such antibodies can delay or prevent renal transplantation. However, a history of prior transfusion exposure has been strongly associated with excellent renal allograft survival. The problem of ensuring this 'transfusion effect' while minimizing the risk of alloimmunization is real for patients awaiting renal allografts. We examined the influence of pregnancy, allograft rejection, and transfusions on the levels of lymphocytotoxic antibodies in the sera of patients awaiting renal transplantation. The results indicate that transfusions alone have a minimal effect on alloimmunization in men and in nulliparous women. The influence of transfusions alone was seen in 77% of men and 86% of women showing less than 10% panel reactivity. Deliberate transfusion policies for patients awaiting renal allografts should be designed to minimize transfusion exposure to parous patients or those who have previously rejected a renal graft.

Antilymphocyte Serum↗
PubMed1984

Improving results in primary diabetic renal transplantation.

One hundred seventeen patients with renal failure resulting from insulin-dependent diabetes mellitus received primary renal allografts from June 1970 to April 1983. Factors significantly associated with improved graft and patient survival were LRD sources (in particular, HLA-identical) and splenectomy. Variables such as transfusions, age, sex, and the administration of ALG were not significantly associated with transplant outcome. However, survival of patients and grafts has improved in recent years and continues to compare favorably with hemodialysis results. Although splenectomy might be the most important variable responsible for the improvement of our recent results, the use of ALG for rejection episodes might have contributed substantially to the improvement. Early transplantation, not analyzed in this study, might prove to be the most significant variable in the outcome of transplantation in patients with diabetic renal failure.

Adult↗
PubMed1983

Splenectomy in high-risk primary renal transplant recipients.

One hundred sixty-five high-risk patients who were either 50 years of age or older or had diabetes mellitus, or both underwent primary renal transplantation. One hundred eight had splenectomy and 57 did not. Graft and patient survival were analyzed in regard to whether splenectomy had been performed at all and whether it had been performed 30 days or more before transplantation, less than 30 days before, or at the time of transplantation. Also, the influence of age, diabetes, blood transfusions, blood type, donor type, HLA mismatch, pretransplantation dialysis, and percentage of performed antibodies were analyzed, as were complications and causes of death. Differences in patient survival were not significant in any one of these categories, although survival in the splenectomized group was generally better. The incidence of infection and sepsis was comparable in both groups and was responsible for death in 34 percent of the patients who underwent splenectomy compared with 22 percent of those who did not (no significant difference). Splenectomy improved cadaver donor renal allograft survival (p = 0.001) in the diabetic patients (p = 0.015) and in those 50 years of age or older (p = 0.026) but it did not improve survival in those who received living related donor kidneys. No significant differences were detectable in regard to the timing of splenectomy. The effect of splenectomy was significant in the patients who had not received transfusions (p = 0.003). It also improved survival in the transfused patients. Splenectomy in high-risk diabetic patients and patients 50 years of age or older does not seem to be associated with increased mortality.

Adult↗
PubMed1983

Acute dissecting aneurysm of the aorta after renal transplantation.

We report on a man with a long history of systemic lupus erythematosus, who had signs and symptoms of a dissecting aortic aneurysm 25 days after receiving a living related donor transplant. The aneurysm was repaired successfully while the patient was on immunosuppression. However, the patient died 3 weeks later of cytomegalovirus pneumonia.

Adult↗
PubMed1982

Postsplenectomy sepsis and mortality in adults.

From 1955 to 1979, in Rochester, Minn, 193 residents with a mean age of 46 years underwent splenectomy. Only two cases of fulminant sepsis were documented during the 1,090 person-years of follow-up (0.18 cases per 100 person-years) in this unselected population. The incidence of any type of serious infection subsequent to splenectomy was estimated at 7.16 infections per 100 persons-years of follow-up (78 cases). The incidence of infections was significantly increased among patients undergoing incidental splenectomy in conjunction with abdominal operations for malignant neoplasms or other conditions. Immunosuppression, radiation, and chemotherapy also significantly increased the risk of subsequent infection. The low risk of fulminant sepsis after splenectomy in the general adult population justifies a policy of individualization of each case as to the relative merits of splenectomy v splenic preservation.

Adolescent↗
PubMed1982

Total colectomy and the cancer family syndrome: report of a case.

A case is reported of a 47-year-old man with a family history consistent with Cancer Family Syndrome (CFS), who manifested proximal colon carcinoma. On the authors' recommendation, with the knowledge that the colon in CFS shows an inordinate lifelong susceptibility to malignant neoplastic transformation, a total abdominal colectomy was performed. The resected colon was found to contain an additional occult carcinoma distal to the primary lesions. Knowledge of this phenomena is critical to the management of CFS.

Adenocarcinoma↗
PubMed1982

Malignant nonfunctioning paraganglioma of the retroperitoneum producing renovascular hypertension.

Malignant nonchromaffin paraganglioma (chemodectoma) is an unusual tumor arising from chemoreceptor cells derived from the neural crest. Although these tumors generally occur in the head and neck, where the term "carotid body tumor" applies, more than 20 cases of retroperitoneal origin have been described. This case report presents the clinical, radiographic, and pathologic features of a chemodectoma arising in the retroperitoneal area that produced severe hypertension by unilateral real vascular compression. The patient underwent exploratory laparotomy, and a left nephrectomy was done. Follow-up examination 1 year after surgery disclosed no clinical evidence of disease, and he had normal blood pressures without medication.

Adult↗
PubMed1981

Factors influencing outcome of kidney allografts from pretreated cadaveric donors.

A five-year retrospective analysis of patient and graft survival after initial cadaveric kidney transplantation showed that recipients of kidneys from cadaveric donors pretreated with cyclophosphamide (Cytoxan) and methylprednisolone (Medrol) had better graft survival than those patients who received nonpretreated kidneys. In patients not receiving transfusions, transplantation of a pretreated kidney improved the chances of success, with graft survival equivalent to that for patients receiving transfusions. Splenectomy was beneficial for graft survival and did not affect overall patient survival. The effect of splenectomy could not be clearly separated fro the effect of donor pretreatment.

Adolescent↗
PubMed1981

Renal transplantation after failure of a first graft.

Renal transplantation in the nondiabetic patient can be achieved with a graft survival comparable with the over-all survival of the cadaveric first graft. The utilization of immunologic donor pretreatment in second cadaveric renal transplantation was of no benefit to graft survival. The second graft survived significantly longer than the first graft when the survival in the same patients was evaluated in a paired fashion. In our experience, retransplantation in the patient with juvenile-onset diabetes using a cadaveric graft gives disastrous results. Of pretreatment, splenectomy, transfusion, preformed antibodies, antigens mismatched, course and time of first-graft loss, diabetes, age and donor source analyzed in this study, only diabetes was found to have a significant effect upon the survival of the second graft.

Adult↗
PubMed1981

Skin autografts to cover exposed renal allografts.

Exteriorized renal allografts that protrude abnormally after dehiscence of transplant wounds pose a rare but formidable surgical problem. If good renal allograft function is present and wound sepsis is controlled, the renal allograft need not be removed even if the wound cannot be approximated. The exposed kidney behaves like other body soft tissues, and resurfacing the renal cortex with skin autografts can be performed successfully. We present four cases demonstrating that split-thickness autografts can be successfully utilized to cover an exposed renal allograft with salvage of allograft function. The incidence of this situation was 0.62% in a series of 641 consecutive renal transplants. We also observed, incidentally, that there was no apparent linkage between the HL-A complex and the tendency for keloid formation.

Adult↗
PubMed1980

Oral cholecystography in assessment of acute abdominal pain.

During one year, 77 patients had oral cholecystography within five days of the onset of acute upper abdominal symptoms. These patients were not severely ill, as evidenced by the fact that only 18 were hospitalized. The patients were unselected and the results were reviewed in retrospect. Accordingly, the data cannot be critically analyzed. Nonetheless, diagnostically useful information was obtained in 57 of these cases. In 44 patients, a normal gallbladder was visualized, and in 13 patients gallstones were seen. Three conclusions are derived from this study. First, oral cholecystography can be performed within five days of the onset of acute upper abdominal symptoms with a reasonable expectation of obtaining diagnostically useful information. Second, the usually recommended delay of four to six weeks is unnecessary. Finally, this diagnostic study should be performed in the acute situation when it is not precluded by nausea, vomiting, or a severely ill patient.

Abdomen, Acute↗
PubMed1980

Renal transplantation: its use in a patient with systemic lupus erythematosus and complete occlusion of inferior vena cava.

A 22-year-old woman with systemic lupus erythematosus and complete occlusion of the inferior vena cava underwent a living related donor renal transplantation, with the kidney placed in the standard pelvic extraperitoneal position. If adequate collateral circulation bypassing the impedance of vena caval obstruction can be demonstrated, there is no need for orthotopic renal transplantation.

Adult↗
PubMed1980

Urinary tract reconstruction in renal transplantation. Mayo Clinic experience and review of literature.

Althrough rejection remains the most frequent cause of renal allograft failure, technical problems have contributed and continue to contribute to graft loss. Urologic complications may be caused by technical errors in the donor nephrectomy or in urinary tract reconstruction. During the past decade, however, with advances in medical and surgical management, the reported incidence of urologic complications in renal transplantation has declined steadily. This may be due to (1) more extensive donor and recipient preparation and evaluation for surgery, (2) improvement of surgical technique with increasing experience in donor and recipient, and (3) more refined diagnosis and treatment of urologic and infectious complications.

Adolescent↗
PubMed1980

In vitro alteration of canine renal allograft immunogenicity.

Significant prolongation of renal allograft survival was demonstrated in a controlled canine model with the host suboptimally immunosuppressed when grafts were perfused for 24 hr with cryoprecipitated plasma (CPP) that had been obtained from plasma of dogs "pretreated" with i.v. cyclophosphamide (80 mg/kg for 5 1/2 hr) and i.v. methylprednisolone (60 mg/kg for 2 1/2 hr). The active metabolites of these drugs within the pretreated plasma may have modified the graft immunogenicity in vitro. However, the use of pretreated kidneys in combination with 24 hr of perfusion with CPP did not result in prolonged graft survival. Furthermore, 24-hr perfusion of pretreated kidneys with their own pretreated CPP did not improve graft survival. This suggests that the pretreated canine kidney does not tolerate pulsatile preservation with CPP; this is in contrast to the human experience and may be attributable to a species difference.

Animals↗