ABSTRACT
AIM: To evaluate the morbidity and mortality of carotid endarterectomy at Wellington Hospital. METHOD: A retrospective study of all patients undergoing carotid endarterectomy at Wellington Hospital in the four year period from June 1987 to June 1991 was performed. Data was collected from chart review. A general practitioner questionnaire was sent to assess posthospitalisation outcome. RESULTS: One hundred and one carotid endarterectomies were performed in 89 patients. The overall combined 30 day mortality and disabling stroke rate in symptomatic patients was 5.1%. CONCLUSIONS: Carotid endarterectomy is performed at Wellington Hospital with an acceptable 30 day mortality and disabling stroke rate.
Subject(s)
Endarterectomy, Carotid/adverse effects , Endarterectomy, Carotid/mortality , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/mortality , Endarterectomy, Carotid/statistics & numerical data , Female , Hospitals , Humans , Male , New Zealand , Retrospective StudiesABSTRACT
Femoral neuropathy is an uncommon complication that can occur subsequent to a number of abdominal and/or pelvic procedures. The neuropathy is usually evident immediately after the operation, but there may be some delay in diagnosis of the clinical problem. The neuropathy generally resolves completely after a period of time, but in some instances there may be a residual deficit. Four cases of femoral neuropathy are described which developed after operation for renal transplantation.
Subject(s)
Femoral Nerve , Kidney Transplantation/adverse effects , Adult , Female , Humans , Kidney Transplantation/instrumentation , Kidney Transplantation/methods , Male , Middle Aged , Peripheral Nervous System Diseases/diagnosis , Peripheral Nervous System Diseases/etiology , Peripheral Nervous System Diseases/prevention & control , PrognosisABSTRACT
Over a five and one half year period, four of nine patients with endstage renal failure due to polycystic kidney disease managed by continuous ambulatory peritoneal dialysis (CAPD) developed peritonitis following intestinal perforation. Two patients had colonic perforation associated with diverticular disease, one necrosis of the terminal ileum, and one acute appendicitis. Two of the patients died subsequent to these complications. The survivors had early transfer to haemodialysis. In contrast, over the same period, only two of 125 patients with renal failure due to other causes and managed by CAPD had acute intestinal perforation. In both cases this was associated with acute appendicitis. Both patients survived. All episodes of peritonitis in CAPD patients with polycystic kidneys demand very close monitoring, cessation of CAPD, and early surgical intervention. CAPD is relatively contraindicated in such patients.
Subject(s)
Kidney Failure, Chronic/etiology , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Polycystic Kidney Diseases/therapy , Female , Humans , Intestinal Perforation/etiology , Kidney Failure, Chronic/therapy , Male , Middle Aged , Peritonitis/etiology , Renal DialysisABSTRACT
Peritonitis in patients on continuous ambulatory peritoneal dialysis while usually due to contamination of the dialysis line by skin organisms may also be due to intra-abdominal pathology. Three cases are described in whom peritonitis was due to acute appendicitis. The recognition of an intra-abdominal source of infection in patients on CAPD is discussed, and surgical management stressed.
Subject(s)
Appendicitis/complications , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis/etiology , Acute Disease , Adolescent , Appendicitis/diagnosis , Appendicitis/surgery , Diagnosis, Differential , Female , Humans , Kidney Failure, Chronic/therapy , Male , Middle Aged , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Peritonitis/diagnosisABSTRACT
Living-related renal transplantation as treatment for end-stage renal failure has not been used widely in Australasia. The results of such treatment in 31 patients at Wellington Hospital are described. The five year graft survival of 80.2% encourages us to continue with an active policy of living related transplantation.
Subject(s)
Kidney Transplantation , Tissue Donors , Adult , Aged , Child , Family , Female , Graft Rejection , Graft Survival , Humans , Male , Middle Aged , New Zealand , ReoperationABSTRACT
Thomas shunts have been utilized 24 times in 20 patients to provide secondary vascular access in an often poor-risk group of patients, including children. Twenty of the shunts were on the iliac vessels. Five shunts are in current use, the longest having been in situ for 83 months. Another 13 shunts provided access until renal transplantation or death of the patient. Six shunts developed deep infection which usually extended to the Dacron-arterial anastomosis; the management of these infected iliac shunts was difficult and hazardous. No definite advantage for the iliac placement of shunts has been established, and its use at this site cannot be recommended. Although the Thomas shunt can provide good long-term access, our experience suggests that its use should be limited to that of a "shunt of last resort".
Subject(s)
Arteriovenous Shunt, Surgical , Iliac Vein/surgery , Adolescent , Adult , Arteriovenous Shunt, Surgical/adverse effects , Child , Female , Humans , Infections , Male , Middle Aged , Polyethylene Terephthalates/adverse effects , Renal DialysisABSTRACT
Gastrointestinal complications occurred in 19 of 290 recipients (6.6%) of the 325 cadaveric renal allografts undertaken between September 1969 and December 1978. The mortality was 42.1%. Upper gastrointestinal complications, principally haemorrhage, occurred in 12 patients (4.1%), 11 of whom were males, usually within four months of transplantation, and often associated with acute rejection and its treatment. Surgery was required in five patients. The overall mortality was 16.7%. Colonic complications occurred in five patients (1.7%), four of whom died, the absence of specific signs having led to a significant delay in diagnosis. One patient died from abdominal vascular disease, and one from carcinoma of the gallbladder. To decrease the high morbidity and mortality, both medical and appropriate surgical prophylaxis for peptic ulceration and diverticular disease are necessary, as is an awareness of the transplant recipient's propensity to develop a gastrointestinal complication at any time, up to years after transplantation. Early recognition and treatment of such complications are essential.
Subject(s)
Gastrointestinal Diseases/etiology , Kidney Transplantation , Cholestasis, Extrahepatic/etiology , Colonic Diseases/etiology , Duodenal Ulcer/etiology , Gastrointestinal Hemorrhage/etiology , Graft Rejection , Mesenteric Vascular Occlusion/etiologyABSTRACT
Review of the results of the use of an external ureterovesical anastomosis in 266 renal transplantations showed that urinary fistulae occurred in 34 patients (12.8%), and ureteric obstruction in six (2.3%). The fistulae were due to technical failure of the anastomosis in 13 patients, to distal ureteric necrosis in 13, to total ureteric necrosis in six, and to other causes in two. Fistula management was successful in 26 cases (76.5%), but multiple operations were often necessary and wound complications frequent (41.2%). The continuing high incidence of urological complications following ureterovesical anastomosis has resulted in increasing use of ureteroneocystostomy as the primary form of urinary reconstruction after transplantation in this unit.
Subject(s)
Kidney Transplantation , Ureter/surgery , Ureteral Diseases/etiology , Urinary Bladder/surgery , Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Transplantation, Homologous , Ureteral Obstruction/etiology , Urinary Fistula/etiology , Vesico-Ureteral Reflux/etiologyABSTRACT
The clinical records of 386 patients undergoing surgery for peripheral arterial disease during the period 1958 to 1974 were examined for patterns of wound infection. The incidence of infection in arterial reconstructive procedures was 7.4%, of which infections 2.2% were major. A high incidence of minor wound infection was found not to be of significance with regard to patient morbidity. The greater risk of wound infection occurring when there was an ischaemic skin lesion present distally in the limb was confirmed. An incision in the groin was not clearly identified as a significant factor in the development of wound infection. The prophylactic use of antibiotics has not resulted in a lower incidence of infection, when compared with those results reported from centres where antibiotic prophylaxis has not been routine. Analysis by year has demonstrated a lower incidence of infection in the more recent years 1969 to 1974.