Cardiovascular reflexes in the neurological evaluation of impotence.

Testing of the autonomic cardiovascular reflexes (single breath beat-to-beat variation and orthostatic blood pressure change) was performed in 542 patients with erectile dysfunction who were grouped according to aetiological factors and their response to visual sexual stimulation and the papaverine test. Age-related normal values for autonomic tests were determined in the group of 124 patients with psychogenic impotence. Abnormal cardiovascular reflexes were associated with ageing and organic impotence, indicating autonomic dysfunction as a major contribution to impotence. Single breath beat-to-beat variation, as a simple non-invasive test, is useful in the clinical evaluation of impotence, especially in patients with diabetes and a history of alcohol abuse.

Intracavernous self-injection for erectile failure.

Thirty-three patients with erectile failure were taught to self-inject papaverine intracavernosally. The dose was from 15 to 80 mg. Phentolamine was added if 80 mg was not sufficient. The patients kept a diary on the effects of the regimen, and also filled out a questionnaire after a follow-up of 4-16 months. The results showed that 55% were satisfied with the method. However, technical difficulties were common. Sexual stimulation turned out to be very important resulting in varying erections on consecutive occasions with the same papaverine dose. Prolonged erection occurred once in 5 patients and was easily handled conservatively in all. Fibrous plaques developed in 2 patients. Twelve patients (36%) stopped the injections for various reasons. When failure occurred the disappointment was usually severe. Thus, the selection of patients for self-injection is important.

The value of basic investigations in the diagnosis of impotence.

172 patients with impotence symptoms were investigated by SBBBV-test, orthostatic blood pressure, Doppler examination of the superficial and deep penile arteries, penile-brachial index, visual sexual stimulation, papaverin test, and measurement of bulbocavernous reflex latency time. Visual sexual stimulation and papaverin test correlated well with each other, and so did papaverin test and PBI in cases of arterial insufficiency. SBBBV was simple to perform and useful in detecting autonomic neuropathy. There were characteristic differences in the pattern of erectile failure between young and old patients. The differentiation to organic or psychogenic erectile failure was easier in the young age groups, whereas the old patients more often had a combination of vascular and psychogenic aetiology.

Living donor nephrectomy: surgical aspects.

A series of 143 living donor nephrectomies during a 14 year period is presented. The overall complication rate was 16 per cent. The incidence of wound complications was 4.2 per cent and of lower urinary tract infections 9.8 per cent. To date no donor has had known significant problem related to the nephrectomy or to the solitary kidney status.

Comparison of two different immunosuppressive dosages of methylprednisolone in clinical renal transplantation.

In order to study the immunosuppressive effect of methylprednisolone, thirty cadaver kidney recipients where randomly allocated into two groups: the low dose control group and the high dose experimental group. In 12 patients in the control group a clinical rejection episode occurred within two weeks of the transplantation, 3 rejections were irreversible, whereas 7 patients rejected in the experimental group, there were no irreversible rejections. In the low dose group the clinical rejection occurred significantly earlier. Fine needle aspiration biopsies of the grafts showed that the number of macrophages infiltrating the graft was significantly lower in the experimental group. Increasing the dose of methylprednisolone given prophylactically can modify the number and severity of rejection episodes early after renal transplantation.

Kidney transplantation in patients over 60 years of age.

Between 1972 and the end of 1978 kidney transplantation was performed on 39 patients over 60 years of age. In one case a kidney from a live donor was used. The other patients received cadaver kidneys. Patient and graft survival in this group of patients did not differ from the results obtained with younger age groups. 14 patients have died. The chief reasons for death were cardiac infarction and infection. The mortality rate was no higher among patients over 60 years than among younger groups. The results show that kidney transplantation can be performed successfully on patients of relatively advanced age.

Diagnostic evaluation of the in situ inflammatory response of renal allograft rejection.

Transplant aspiration cytology (TAC) may be performed daily from human renal allografts without risk to the graft or to the graft recipient. With TAC it is possible to accurately quantitate the onset, type, degree and duration of the inflammatory response of rejection, predict the course of rejection, and on certain occasions also visualise the rejection prior to the appearance of clinical signs. The method also provides a quantitative tool for the assessment of the effects of immunosuppressive and anti-inflammatory drugs on the composition of the in situ inflammatory infiltrate.

Renal transplantation in amyloidosis.

During a three-year period renal transplantation was performed in 12 patients with amyloidosis. This disease was primary (or the cause unknown) in two cases and secondary in ten. In the latter cases the primary disease was rheumatoid arthritis in six, ankylosing spondylitis in one, osteomyelitis in two and tuberculosis in one. Five of the 12 patients were alive one year after transplantation. Two years after transplantation four out of seven were alive. Graft survival was the same. At the end of the three-year period five patients were alive. In two of these cases renal biopsy showed amyloid deposits in the transplant two and three years, respectively, after the transplantation.

Spontaneously thrombosing congenital crural arteriovenous fistulas. Report of a case.

A report of spontaneously thrombosing arteriovenous fistulas in the popliteal and crural region jeopardizing the peripheral circulation is presented. A favourable effect was achieved with a femoral-posterior tibial bypass utilising a great saphenous graft.

Surgical complications in 500 kidney transplantations.

The surgical complications in a series of 500 transplantations done by a single transplantation unit with over ten years' experience in the field are reported. The complications are divided into vascular, urological and gastrointestinal. In addition, renal rupture, primary wound infections and operative deaths are reported. Most of the losses of transplants caused by surgical complications are due to renal rupture and vascular complications, accounting for 3.6 and 2 percent of losses respectively out of the 500 kidney transplants. The urological complications caused a loss of the remaining 1.2% of a total of 6.8%. tthe overall mortality was highest in gastrointestinal complications with 6% of the total of 10% deaths following surgical complications. The mortality rate in the group of patients with gastrointestinal bleeding and perforations and with acute pancreatitis was extremely high. More accurate screening for potential candidates for gastroduodenal ulceration and better prophylactic treatment is needed. More active treatment of acute pancreatitis is suggested.

Peptic ulceration in kidney transplantation.

Gastroduodenal ulceration occurred in 45 patients during the post-transplantation period in a series of 500 transplantations of 434 patients. The mortality rate of this complication was high, 42%. Bleeding and perforation were the main problems. These complications occurred frequently during treatment for acute rejection. Present day prophylaxis, which is based on the use of antacids, seems to be inadequate for controlling these complications. Other possibilities for reducing the incidence of gastroduodenal ulceration in transplant patients are discussed. Since increased serum gastrin concentrations are often observed in these patients, prophylactic treatment should be based on preoperative evaluation of gastric secretion and serum gastrin determinations. The new histamine (H2) blocking agents should be evaluated in these patients.