Swallowed nasal pack: a rare but serious complication of the management of epistaxis.

Packing of the nose with a suitable material remains a popular method of treating epistaxis. The authors report a serious complication of a new design of nasal pack; Rapid Rhino, which was swallowed during the treatment of a patient with epistaxis, resulting in bowel perforation.

The significance of vascular anomalies in human renal transplantation.

In a review of 250 consecutive human cadaveric kidney transplants the primary failure rate of donor kidneys with an anatomically abnormal blood supply was 36.7% as compared with 16.2% for kidneys with a single artery and vein (P less than 0.001). The incidence of primary failure due to renal vascular thrombosis in the abnormal group was 24.2%, compared with 4.1% in the normal group (P greater than 0.001). A significantly greater incidence of anastomotic haemorrhage and urinary leak was also associated with an abnormal blood supply in the donor kidney.

Results of 250 consecutive cadaver kidney transplants.

The results of 250 cadaver kidney transplants performed at this hospital between May 1968 and December 1974 were analysed. A functioning transplant was defined strictly as one that maintained the recipient in good health with a serum creatinine below 442 mumol/1 (5 mg/100 ml) without any need for dialysis. The proportions of kidneys functioning after one, two, and three years were 40-4%, 33-9%, and 31-1% respectively, the corresponding survival rates of patients being 62-6%, 57-4%, and 43-8%. The primary failure rate overall was 21-6%, while the failure rates for first, second, and third transplants were 18-1%, 39-9%, and 66-7% respectively. Half of the primary failures were attributed to the use of cadaver kidneys with abnormal vasculature or long ischaemic times or originating from non-ventilated donors. Of the initially successful transplants 49% were subsequently lost due to rejection (53%) or death of the patient with a functioning transplant (46%), and of the secondary losses 58% occurred within three months of transplantation. HLA matching of donor and recipient for two or more antigens was associated with a significant increase in transplant survival--46% at three years as opposed to 9-5% at three years for kidneys with poorer matches.

The clinical problems of dosage and the route of administration of antilymphocyte globulin.

The production and quality control of ALG are outlined. The advantages and disadvantages of the various routes of administration of ALG are discussed. We tend to use a short duration high dose course of ALG in renal transplantation, myasthenia gravis and polyarteritis nodosa.

A randomized prospective clinical trial of antilymphocyte globulin in 100 cadaveric renal transplants.

In controlled randomized study of antilymphocyte globulin (ALG) in 100 cadaveric renal transplants, 15 patients receiving a second transplant were excluded. Ofthe first transplants, 42 were in the control and 43 in the ALG group. The two groups were similar. The ALG used was either prodduced in our laboratories or obtained from a commerical source. It was observed that ALG produced a significant lymphopenia, that the oliguric phase of the ALG group was half that of the controls, and that the ALG group although less likely to suffer rejection episodes responded significantly better when treated than did those in the control group.

Agonal phase, ischaemic times, and renal vascular abnormalities and outcome of cadaver kidney transplants.

A retrospective study of 250 cadaver kidney transplants was carried out to determine the effects of the agonal period, the warm and cold ischaemic times, and the use of kidneys with vascular anomalies on the primary success and failure and the subsequent level of function of the transplants. Kidneys with vascular anomalies or from non-ventilated donors had a primary failure rate of over 30%, whereas those with normal vasculature or from ventilated donors had a rate of 17%. An initial warm ischaemic time of more than 60 minutes was associated with a primary failure rate of 57% and a cold ischaemic time of over 550 minutes with a primary failure rate of 47%. The interrelationship between the warm and cold ischaemic times in the primary success or failure of the transplants was examined and criteria defined for selecting potentially viable cadaver kidneys for transplantation, as follows: (1) The donor should be (a) ventilated, (b) aged 6-50 years, and (c) have normal ante-mortem renal function and have secreted more than 1-5 1 of urine in the 24 hours before death (or an equivalent volume if the urinary output was recorded for less than 24 hours before death); (2) the kidney should have normal renal vasculature enabling single arterial and venous anastomoses to be performed; (3) kidneys with I.W.I.T.s of longer than 60 minutes should not be used; (4) for kidneys with I.W.I.T.s of less than 20 minutes the C.I.T. is not critical but should not exceed 12 hours; (5) for kidneys with I.W.I.T.s of 20-60 minutes the C.I.T. should not exceed 450 minutes.