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Biomedical subjects

S Sterioff

Publications and source records attributed to S Sterioff.

At least 91 records · Page 5Linked to original sources
PubMed1980

Open-lung biopsy in the renal transplant recipient.

In 22 renal transplant recipients, 23 open-lung biopsy procedures were performed. There were two (8.7%) biopsy-related complications (hemorrhage and pneumothorax) and five deaths (22.7%), although the deaths could not be definitely related to the biopsy procedure itself. Seventeen biopsy specimens yielded specific diagnoses, and six were nonspecific. The mortality rate for the patients with specific diagnoses was not significantly different from that of patients with nonspecific diagnoses (25% vs. 16.7%). Other factors analyzed, such as age, diabetes, hypoxia, leukopenia, and donor source, did not affect the result of biopsy. We conclude that the patient's underlying disease and added immunosuppressive therapy are the factors most responsible for the clinical outcome. We suggest that without early treatment of the infectious agents, the mortality rate of the group with specific diagnoses would likely have been higher.

Adult↗
PubMed1979

Iliac artery ligation: the relative paucity of ischemic sequelae in renal transplant patients.

In order to assess the effect of iliac artery ligation on the distal extremity, the ten year experience of the Johns Hopkins renal transplantation program was reviewed. Among 467 transplant procedures in 390 patients there were six cases in which the common and/or external iliac artery had been ligated for control of untoward hemorrhage from an infected arteriotomy site. These six cases were studied in detail with particular attention to ischemic sequelae in the involved leg. There were no immediate or causally-related deaths. No patient lost a leg or required an immediate reconstructive procedure for limb salvage. Four of the six recovered ambulatory status, and only two of these required a later, elective reconstruction for claudication. The combination of these six with eight other similar patients previously reported provides a total of 14 cases of iliac artery ligation in renal transplant patients. No patient suffered actual limb loss, and only three underwent subsequent elective reconstruction for claudication. It is concluded that common and/or external iliac artery ligation without immediate revascularization may be performed for control of hemorrhage with little danger of limb loss in renal transplant patients.

Adult↗
PubMed1979

Severe infection due to Streptococcus pneumoniae in asplenic renal transplant patients.

The medical records of 293 patients who underwent renal transplantation were analyzed for the occurrence of Streptococcus pneumoniae and Haemophilus influenzae infections in relation to splenectomy. Splenectomy was done in 236 (81%) graft recipients before or concomitant with transplantation. Bacteremia developed in five and fulminant sepsis in two from 3 to 32 months after splenectomy. No serious infections with these organisms occurred in the nonsplenectomy group. These results suggest that asplenia may be an additional factor predisposing transplant patients to serious infection. Prevention of these serious pneumococcal infections may be possible with polyvalent pneumococcal vaccine.

Adult↗
PubMed1979

Renal transplantation in patients with diabetes mellitus--revisited.

Sixty-one patients with end-stage renal failure due to diabetic nephropathy received 68 renal allografts from June 1970 to February 1978. Patient and graft survival results equaled those for nondiabetic patients, as reported by the Human Renal Transplant Registry (HRTR). Renal allografts from siblings or pretreated cadaver donors had a significantly longer survival time than did allografts from nonpretreated cadaver donors. It is concluded that renal transplantation with living related and pretreated cadaver donor kidneys continues to be the treatment of choice and is superior to other forms of treatment in the insulin-dependent diabetic patient with end-stage renal disease.

Adult↗
PubMed1978

Painful crises following renal transplantation in sickle cell anemia.

A 34 year old woman with sickle cell (SS) anemia and chronic renal failure of unknown etiology was maintained on dialysis for 11 months before she received a cadaveric renal transplant. After 24 months, transplant function is excellent although a mild urinary concentrating defect (Umax = 532 mOsm/liter) is present. Renal biopsies five and 11 months after transplant revealed mild focal interstitial infiltrates and mesangial thickening. A major complication has been the reemergence of numerous severe painful crises, inferred to be caused by an increased blood viscosity consequent to a rising hematocrit value, after a hiatus of many years. The succession of crises was stopped with a prophylactic partial exchange transfusion program, reemerged when the program was discontinued, and was stopped again when the transfusion program was reinstituted. We conclude that renal transplantation may be successfully performed in patients with sickle cell disease. Complications of the hemoglobinopathy may develop, but painful crises can be successfully managed with judicious transfusion therapy.

Adult↗
PubMed1977

The surgical approach to urological complications in renal allotransplant recipients.

Urinary extravasation or ureteral obstruction occurred in 22 patients who received 30 transplants in a series of 290 renal transplants. This incidence represent 10.3 per cent of the entire transplant experience at The Johns Hopkins Hospital and Baltimore City Hospitals from 1968 to the present time. Ureteroneocystostomy was used as the primary form of urinary tract reconstruction in all but 1 patient who had urinary complications. These 22 patients received 30 renal transplants: 6 from living related donors and 24 from cadaver sources. There were 15 instances of urinary extravasation and 14 instances of obstruction. All but 2 fistulas were diagnosed within 30 days of the original transplant. Obstruction occurred later, with 4 cases of ureterovesical obstruction being diagnosed 3 to 5 years after the transplant procedure. The ureterovesical junction or bladder was the site of complication in 17 of the 29 instances. Surgical management in these cases was highly individualized, with successful outcomes more commonly attained in those cases characterized by obstruction. Ureteral stents were used in all but 1 secondary procedure involving the ureter and these stents were not associated with an increased incidence of urinary tract infection. Death directly related to the urological complications occurred in 2 cases, 5 patients underwent transplant nephrectomy and 2 patients died of rejection and infection more than 6 months after the urinary fistulas were successfully managed. From the original series, there are 15 of the 22 patients who have stable renal function after secondary or tertiary urological procedures on the transplanted kidney. Four patients underwent surgical correction of hydronephrosis associated with infection or diminishing renal function more than 3 years after the transplantation and 3 of these had good results.

Adolescent↗
PubMed1977

Temporary vascular bypass for perfusion of a renal transplant during abdominal aneurysmectomy.

A temporary vascular bypass was utilized to maintain perfusion of a renal transplant during abdominal aortic aneurysmectomy. The shunt, of polyvinyl tubing, was placed between the upper abdominal aorta and the common iliac artery, where the perfusion pressure was only 15 mm Hg less than systemic pressure. The transplanted kidney fuctioned normally during 71 minutes of aortic cross clamping, and there was no evidence of postoperative renal failure.

Aorta, Abdominal↗
PubMed1977

Delayed cutaneous hypersensitivity and human renal allotransplantation.

A group of 154 patients on chronic dialysis has been evaluated by DNCB reactivity. Viewed as a group, these patients exhibit a highly significant decrease in immunologic responsiveness in comparison to normal individuals. However, 19% of patients had an immunologic response to DNCB and 12% an irritant response. This pretransplant DNCB responsiveness correlated significantly with subsequent allograft rejection in 71 renal allotransplant recipients. For example, at 1 year after transplantation graft survival was strikingly different: DNCB- patients, 78%; DNCB+ patients, 29%; and DNCB-IR patients; 20%. Pretransplant recall-antigen testing results in 32 patients did not correlate significantly with subsequent transplant results. Serial posttransplant delayed cutaneous hypersensitivity responses in patients with a positive response to a skin test antigen in the pretransplant period suggest possible usefulness of this technique for detecting rejection in the posttransplant period. DNCB skin testing should be performed in all transplant candidates to evaluate host responsiveness and should aid in future patient management.

Adolescent↗
PubMed1977

Mycotic aneurysm with recurrent sepsis complicating post-transplant nephrectomy.

A hypertensive 37-year-old man underwent renal transplantation. The transplanted kidney was removed 5 days later, 21 months before his death. He was maintained after transplantation by hemodialysis. His postoperative course was complicated by recurrent pseudomonal infection with bacteremia. He presented with symptoms of acute peritoneal irritation and hypovolemia followed by sudden death. Postmortem examination revealed that a saccular mycotic aneurysm of the left common iliac artery, which was the site of post-transplant nephrectomy, had ruptured into the peritoneal cavity. The case exemplifies postoperative mycotic aneurysm, the frequently obscure clinical findings of iliac artery aneurysms, and the need for a high index of suspicion of mycotic aneurysm in patients undergoing renal transplantation.

Adult↗
PubMed1976

Perfusion nephropathy in human transplants.

To determine whether perfusion preservation affected the structure and survival of kidney transplants, we correlated clinical and histologic data in 77 kidneys biopsied one hour after transplantation. Twenty-one of 36 perfusion-preserved kidneys had a glomerular capillary lesion suggestive of intravascular coagulation. None of 41 kidneys preserved by hypothermia alone had this lesion. Presence of the lesion did not correlate with donor or recipient characteristics, warm or cold ischemia time, HLA match, percentage of preformed lymphocytotoxic antibody titers or perfusion characteristics. Of 21 transplants with the lesion, nine required nephrectomy by one month, and one-month serum creatinine was less than 2.0 mg per deciliter in only three of the remaining 12 transplants. We conclude that perfusion preservation may cause pathologic changes that may adversely affect kidney-transplant function. The causes of the pathologic process remain unclear.

Cadaver↗
PubMed1976

Surgical treatment of acute diverticulitis by staged procedures.

A retrospective 10-year experience with the traditional three-stage plan (diverting colostomy, resection, colostomy closure) for perforated diverticulitis of the colon in four urban hospitals was reviewed to accurately assess the mortality rate. Only patients who were admitted in a non-elective manner with signs of an acute abdomen or who were already hospitalized with another illness and developed an acute abdomen were considered. Fecal or generalized purulent peritonitis, or pelvic peritonitis with abscess were observed at laparotomy in all instances. Two hundred and eight patients representing 211 episodes met the above stated criteria for inclusion in the study. A transverse colostomy was performed in 203 instances associated with 16 deaths, and 8 sigmoid colostomies were associated with two deaths. The overall mortality after the first stage was 8.5%. A loop colostomy was constructed most frequently and a completely divided colostomy performed in only 31 of 211 (15%) instances. Of 147 instances in which the diseased sigmoid colon was resected, 44 (30%) had the colostomy ablated at the same operation, resulting in only one death (0.7% mortality). Colostomy closure as a separate procedure in 103 instances resulted in 4 deaths (3.9% mortality). The highest mortality rate occurred in patients in the in the eighth decade. Staged procedures for perforated colonic diverticula can be carried out with a mortality rate of 11%.

Abdomen, Acute↗
PubMed1976

Arteriovenous fistulas for dialysis using modified bovine arteries.

Arteriovenous fistulas were created on 21 occasions in 18 patients using an interposed segment of processed bovine carotid artery. In 18 fistulas, there were loops in the femoral region, and in three, they were created in the forearm. Seventeen of 21 fistulas developed a useful patency, with useful patency being achieved in 16 of the 18 patients. This patency is impressive, since it provided life-saving vascular access in these patients who previously had had failure of multiple standard shunts or fistulas. However, there was a high incidence of complications, with 17 of 21 fistulas developing some complication. Ten fistulas spontaneously occluded, but flow was restored in six. Seven significant infections occurred in fistulas of the thigh, with one patient eventually dying from complications. In two patients, major hematomas developed, and in six patients, false aneurysms developed, four of these false aneurysms being clearly associated with infection. Venograms were useful in the arm for demonstrating patency of the vein to be used for the arteriovenous fistula. The bovine interposed segment is a useful alternative in patients with difficult vascular access problems for hemodialysis but should be reserved only for such patients.

Animals↗