Complications relating to the urinary tract associated with bladder-drained pancreatic transplantation.

OBJECTIVE: To evaluate the incidence and management of the urological complications after bladder-drained pancreatic transplantation. PATIENTS AND METHODS: A retrospective study was carried out on 24 consecutive bladder-drained pancreatic transplants in 24 patients with type I insulin-dependent diabetes mellitus, 22 with simultaneous kidney transplants and two of pancreas alone, over a period of 53 months. RESULTS: All 24 patients were alive within a mean follow-up of 26.7 months: 22 patients have functioning pancreatic grafts and are insulin-independent. The overall incidence of urological complications was 83% (20 of 24 patients) and 14 patients had more than one complication. The major non-infective complication was haematuria (eleven), which was treated conservatively, with only two patients requiring enteric conversion. One patient developed a duodeno-vesical fistula and lost the functioning pancreatic graft as a consequence. Other non-infective complications were urethritis (one) and urethral stricture (one), which were managed with catheter drainage and internal urethrotomy, respectively, and vulval ulcers (one) and reflux pancreatitis (one) treated conservatively. The main infective complications were recurrent lower urinary tract infection (nine), asymptomatic persistent bacteriuria (nine), prostatitis and epididymitis (one), and pyelonephritis (one), all managed with appropriate antibiotics. Three patients developed septicaemia from urosepsis and were treated successfully with antibiotics. Two patients developed genital warts and were treated with laser vaporization. CONCLUSION: Although bladder drainage has significantly contributed to the increasing success of pancreatic transplantation, urological complications are frequent and can be serious and life-threatening. As more of these procedures are performed urologists need to be able to recognize and treat these problems.

Donor sepsis is not a contraindication to cadaveric organ donation.

Systemic donor infection is regarded as being an absolute contraindication to cadaveric organ donation for transplantation. This is largely due to fear of transmitting pathogenic organisms to the immunosuppressed recipient. However, due to the current shortage of organs available for transplantation, clinicians are faced with the option of using organs from 'non-ideal' donors, such as those patients with documented evidence of infection. We report the successful outcome of six orthotopic liver transplants, 11 renal transplants, one combined heart lung transplant and one simultaneous kidney and pancreas transplant with organs from eight donors in whom bacterial meningitis (n = 7) and acute bacterial epiglottitis (n = 1) were the antecedent causes of death.

Graduate follow-up in the University of Wisconsin family practice residency programs.

Between June 30, 1973, and June 30, 1980, 100 family physicians completed their family practice residency training at the University of Wisconsin Medical School. Ninety-seven graduates completed an extensive 13-page mail survey. The primary purposes of the study were to measure the adequacy of the graduate's residency training program and to determine how well the graduates have done as family physicians. A majority of respondents considered themselves adequately prepared in most areas listed with a few noticeable exceptions. For example, 50 percent or more felt underprepared in fracture care, emergency surgery, and applying forceps for vaginal deliveries. For selected administrative and financial aspects of a practice, more than 60 percent felt underprepared. In general, the graduates were satisfied with the potential for practice growth as well as their current level of income. Regarding hospital privileges, between 85 and 93 percent of the graduates were very satisfied with the availability and extent of their privileges. Finally, all 100 graduates are board certified in family practice and at this writing none have changed into another specialty or intend to do so in the foreseeable future.