Successful ex vivo renal artery reconstruction and renal autotransplantation.

BACKGROUND: The increasing experience with renal allotransplantation has led to continuing development in vascular surgical techniques. These improvements have enabled complex ex vivo renal artery surgery and renal autotransplantation to be performed. The aims of the present study were to describe the results achieved with renal autotransplantation and ex vivo renal artery reconstruction (RAR) at the Newcastle Transplant Unit, John Hunter Hospital, and to review the current indications for such surgery. METHODS: A retrospective review was performed of patients who required renal autotransplantation with or without RAR at John Hunter Hospital, between 1991 and 1999. Data were obtained from the Newcastle Transplant Unit and the Medical Record Department of John Hunter Hospital. RESULTS: Two patients required ex vivo RAR and renal autotransplantation for severe fibromuscular dysplasia (FMD) complicated by stenoses and renal artery branch aneurysms. The third patient required autotransplantation for bilateral retroperitoneal fibrosis. There was one postoperative complication of pelviureteric junction obstruction that was treated successfully with a temporary ureteric stent. All patients demonstrated normal graft function and were normotensive on follow up, which ranged from 2.5 to 5 years. CONCLUSION: The present review confirms the long-term benefits of ex vivo RAR and renal autotransplantation that have been demonstrated by previous studies. In transplant units experienced with this surgery it has been shown to be a successful and durable technique for the treatment of a variety of vascular, urologic and other diseases.

Topical mitomycin C therapy for carcinoma in situ of the bladder: a followup.

We studied 15 patients with histologically proved multifocal carcinoma in situ of the bladder who were in remission at a mean followup of 21 months after induction intravesical chemotherapy with mitomycin C. These patients have been followed for a further 28 months, for a total mean duration of 49 months. Of the 15 patients 4 suffered new areas of carcinoma in situ, including 3 who subsequently required cystectomy (2 after unsuccessful intravesical bacillus Calmette-Guerin therapy and 1 with a simultaneous invasive tumor). One patient underwent transurethral resection of the prostate for carcinoma in situ of the prostatic urethra, which subsequently was shown to be limited to mucosa and not involving the deeper ducts nor the stroma. Of the remaining 11 patients 1 died of unrelated disease and 2 suffered recurrent papillary transitional cell carcinoma treated successfully with a combination of intravesical bacillus Calmette-Guerin therapy and resection. The other 8 patients have remained free of tumor. None of the 15 patients had metastatic cancer. We believe that these results support the durability of response after induction mitomycin C therapy. We stress the necessity for prolonged close followup to detect recurrent tumor and to avoid metastatic disease.

Dealing with a student grievance.

How do faculty deal with a student grievance? When a student fails clinically and appeals that failure, how can faculty respond? The author presents a case history of a student grievance and describes statutory and case law, which underlie the practice of nurse educators.

Xanthogranulomatous pyelonephritis in a renal allograft: a case report.

We report a case of xanthogranulomatous pyelonephritis in a renal allograft. The kidney was not removed and there was an initial response to antibiotic therapy, with amelioration of toxicity and improvement in renal function. However, the kidney failed 10 months later in association with histological changes of chronic rejection.

Relative value of antibiotics and catheter care in the prevention of urinary tract infection after transurethral prostatic resection.

One hundred patients were prospectively randomised into two groups to receive either a single dose of 1 g ampicillin and 80 mg gentamicin pre-operatively or no antibiotic prophylaxis. The incidence of breakage in the continuity of the closed drainage system was documented. All patients with urinary tract infection (UTI), catheterisation, clinical prostatic carcinoma, neurogenic bladder and bladder tumours were excluded. UTIs, bacteraemia and fever were noted. There were 7 late exclusions. The incidence of UTI in the control and antibiotic groups was 16 and 17% respectively. No blood cultures were positive. There were no significant differences in the incidence of fever between the two groups. A break in the closed drainage system occurred in 13 patients. Fifteen of the 93 developed UTI. A break in the closed drainage system occurred in 7 of the 15 patients (40%) with UTI. Of the 78 patients without UTI, 8 had a break (10%). This difference was highly significant. We recommend that less emphasis be placed on prophylactic antibiotics and more on avoiding breakage of the closed system in the prevention of UTI after transurethral resection of the prostate (TURP) in the low risk situation.

Topical mitomycin C therapy for carcinoma of the bladder.

We studied 19 consecutive patients with biopsy proved carcinoma in situ of the bladder who had received 8 weekly doses of 30 mg. intravesical mitomycin C. Followup with cystoendoscopy, biopsy and cytology studies every 3 months ranged from 6 to 48 months, with an average of 21 months. A complete initial response was achieved in 15 patients, 11 of whom have remained free of tumor with no further therapy. The 4 patients who failed to respond to initial therapy subsequently were free of tumor after further intravesical mitomycin C (2), excision (1) or doxorubicin (1). Three patients died of unrelated diseases. Only 1 patient has had metastatic transitional cell carcinoma. No patient had undergone cystectomy or radiotherapy. These data indicate that mitomycin C achieves a high initial response in patients with carcinoma in situ of the bladder and maintains this control in many patients for months or years.

Solitary metastasis of squamous cell carcinoma of the bladder to the myocardium.

We report a case of an isolated cardiac metastasis from squamous cell carcinoma of the bladder. The incidence and difficulty in the diagnosis of myocardial deposits from bladder tumors are discussed.

Levels of selenium in blood and tissues associated with some selenium deficiency diseases in New Zealand sheep.

Whole bloods from weaned lambs with severe selenium responsive unthriftiness usually contain <5 ng Se/ml. Mildly or moderately affected lambs have blood levels of 5-10 ng/ml. Selenium responsive infertility in ewes appears to be associated with whole blood selenium levels below 10 ng/ml.

Selenium in New Zealand pastures.

In grasses and clovers the highest concentrations of selenium were found in the leaves. The selenium content of different species in spring pastures on the same soil type did not vary widely although the slower growing and more deeply rooting species contained higher levels. The concentration of selenium in a pasture varied with time of the year, the lower levels being usually associated with conditions that stimulated rapid growth of the herbage, although factors other than growth rate were also involved. Lucerne appeared to be unusual in that in some areas it accumulated much higher levels of selenium than was found in other associated species. A very wide variation in levels of selenium in pastures growing on different soils has been observed 3-1500 ng/g). Selenium-responsive unthriftiness in grazing lambs occurred where the selenium content of spring pastures was <20 ng/g. Pastures containing >30 ng/g were apparently adequate while intermediate levels were probably marginally deficient.

Meckel stone ileus: a case report.

Calculus formation is a rare complication of a Meckel's diverticulum. These calculi may cause a mechanical small-bowel obstruction--Meckel stone ileus--an extremely rare mode of presentation of a Meckel's diverticulum. A case in which this has occurred is reported--only the fifth such occasion that this has happened.