Comparison of standard immunosuppression with adjuvant antilymphoblast globulin in primary cadaver kidney transplant survival

Adjuvant, prophylactic, antilymphoblast globulin and standard immunosuppression have produced comparable long-term cadaver kidney graft survivals at separate institutions. A comparison was made of 35 primary cadaver kidney grafts into recipients treated with prophylactic, adjuvant antilymphoblast globulin to 55 recipients of primary cadaver kidney grafts treated with standard immunosuppression. Antilymphoblast globulin delayed early rejection episodes (P under 0.05), making early post-transplant management simpler. There were no significant differences between the two groups with respect to graft losses due to rejection at any interval beyond one month.

Effect of donor surgeon on first cadaver kidney transplant function

Community urologists and general surgeons were recruited into a cadaver kidney program in 1976. This study from 1 center compares 41 primary cadaver kidney grafts retrieved by community hospital retrieval teams to 60 primary cadaver kidney grafts retrieved by a center-based transplant team. Of the kidneys 100 were preserved with Collins' C2 flushing followed by simple cold storage and 1 was preserved with pulsatile machine perfusion. Cold storage time ranged from 9 to 44.5 hours in the community hospital kidney group and from 11 to 44 hours in the university hospital group. There was no significant difference between the 2 kidney retrieval teams with respect to 1) incidence of acute tubular necrosis, 2) 1-month serum creatinine nadir of surviving grafts, 3) 1 and 2-year serum creatinine levels and 4) actuarial graft survivals up to 5 years. Community hospital retrieval teams can provide kidneys as satisfactory for transplantation as a center-based transplant team and are a valuable resource for cadaver kidney transplant programs.

Human kidney preservation by intracellular electrolyte flush followed by cold storage for over 24 hours

Many transplant teams are reluctant to accept kidneys preserved with intracellular electrolyte flushing followed by simple cold storage when preservation time exceeds 24 hr. This study from one center is a comparison of 63 primary cadaver kidney grafts preserved with Collins 2 solution flush followed by cold storage for 9 to 23 1/2 hr to 42 primary cadaver kidney grafts preserved by the same method for 24 to 44 1/2 hr. Kidneys cold-stored for over 24 hr had a significantly increased requirement for dialysis in the first week following transplantation (55% versus 30%). One-month serum creatinine nadirs and actuarial graft survivals were not significantly different. Cadaver donor methylprednisolone (30 to 60 mg/kg) 2 to 9 hr prior to kidney removal reduced the requirement for first-week hemodialysis in the kidneys cold-stored for over 24 hr (23% versus 69%, P under 0.05). A human kidney preserved by the same method and cold-stored for 61 hr was successfully transplanted into a 38-year-old myelodysplastic. Satisfactory human kidney preservation can occur with intracellular electrolyte flush solutions followed by cold storage for over 24 hr when the warm ischemia time is very short.

Uroepithelial carcinoma in association with cyclophosphamide ingestion

The association of daily oral cyclophosphamide with the development of transitional cell carcinoma or squamous cell carcinoma of the bladder had been documented. We report the first 2 cases of transitional cell carcinoma of the renal pelvis and an additional 4 cases of transitional cell carcinoma of the bladder following cyclophosphamide ingestion. Patients who have been taking daily oral cyclophosphamide for a prolonged period should have excretory urography, cystoscopy and bladder mucosal biopsies performed as part of a cancer surveillance protocol.

Initial experience with the Rosen incontinence device

During a 25-month period, beginning in May 1977, 19 patients had Rosen incontinence devices implanted. During the 9 to 34 months of followup 26 additional operations were required for urethral compression balloon leakage, urethral compression balloon aneurysm, tubing kinks, reservoir malfunction and urethral erosion. Currently, 7 devices are in place, 6 of which are functioning and 3 of which have aneurysms of the urethral compression balloon. The 6-month failure rate of the first device was 44 per cent. During the 247 months that the devices were in place the patients were dry for 89 months, and required pad protection for 118 months and condom or an external urethral clamp for 40 months.

A simple method for freezing lymphocytes in microtest plates

Freezing lymphocytes in microtest plates instead of vials for the purpose of screening sera for HLA or other cytotoxic antibodies offers the same technical advantages as freezing sera in microtest plates for tissue typing. Plate-loading errors and cell wastage are minimized, and time required for serum screening is greatly reduced. A method for freezing lymphocytes in large numbers of microtest plates for use in serum screening that is simple, reproducible, and inexpensive is described. Cryoprotected lymphocytes dispensed into microtest plates are placed on a metal table that is lowered onto a tray containing 1 cm of liquid nitrogen in a Styrofoam box. The amount of liquid nitrogen in the tray and the height of the metal table above the tray determine the freezing rate of the lymphocytes. Over 100 microtest plates can be frozen per cycle with total cooling uniformity. The materials required for this freezing device can be assembled for less than $400. Commercial freezing units typically cost over $4,000.

Herpes simplex type 1 hepatitis in renal transplantation

Herpes simplex is a rare but usually fatal cause of acute hepatitis in adults. Most previously reported cases have occurred in debilitated or immunosuppressed patients. We report two additional fatal cases that occurred in renal transplant recipients. In case 1, there is evidence that the allograft may have been the initial nidus of infection. In case 2, dissemination from a genital infection occurred and failed to respond to vidarabine therapy that was started early in the clinical course. We also review the literature concerning previously reported cases of herpes hepatitis.

An analysis of 100 primary cadaver kidney transplants

A multifactorial analysis of 100 consecutive first cadaver kidney transplants was done to document the current status of this treatment for end stage renal disease and to determine the influence of the following variables on kidney losses owing to rejection: splenectomy, pre-transplant transfusions, transfusion at the transplantation, recipient sex, pre-transplant nephrectomy, donor and recipient A, B or O blood group, human leukocyte A and B antigen mismatches, kidney preservation method, donor treatment with methylprednisolone and cyclophosphamide, recipient treatment with antilymphocyte serum or antilymphoblast globulin and a low dose of steroid treatment for rejection. Pre-transplant splenectomy for leukopenia, 5 or more pre-transplant blood transfusions and pre-transplant transfusions without development of circulating cytotoxic antibodies significantly reduced kidney losses owing to rejection (p less than 0.05)., A low dose of steroid treatment for rejection resulted in a trend towards improved patient survival without sacrificing kidney graft survival. Clinical studies demonstrating decreases in kidney graft rejection should be controlled for pre-transplant blood transfusions and, possibly, for pre-transplant splenectomy for hypersplenism.

Human leukocyte A and B antigens in patients with prostatic adenocarcinoma

An increasing number of diseases has been associated with specific human leukocyte antigens. A total of 100 white men with adenocarcinoma of the prostate was serotyped for 32 A and B antigens. Compared to a control population of 169 white subjects relative risks of 2 or more were associated with the antigens A11 and A29. Relative risks of 0.20 or less were associated with the antigens AW23, BW21 and BW22. None of these relative risks was significant statistically. We were unable to demonstrate a significant human leukocyte A or B antigen association with adenocarcinoma of the prostate.

Chronic tubulointerstitial nephritis from infectious mononucleosis

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Transureteroureterostomy: 25-year experience with 100 patients

During the last 25 years 100 patients have been subjected to transureteroureterostomy. In 2 cases postoperative death was attributable to other pathologic processes. We treated 94 donor units successfully in this manner. An additional 2 units, normal for several years after transureteroureterostomy, had periureteral fibrosis and stricture owing to the inferior mesenteric artery syndrome and required another definitive surgical procedure. Ninety-seven recipient kidneys remained normal after the procedure.

Percutaneous aspiration biopsy of renal allografts using ultrasound localization

Percutaneous aspiration of renal allografts was done employing ultrasound localization and the Jamshidi renal biopsy needle-syringe. Adequate tissue for pathologic assessment was obtained in 19 of 20 biopsy attempts. There were no complications. Ultrasound provides a convenient, nonradiologic means of renal localization for allograft biopsy. The aspiration needle-syringe is well suited for percutaneous transplant biopsy.

Stress hematuria: athletic pseudonephritis in marathoners

Hematuria and proteinuria have been noted in athletes after heavy exercise. Evaluation of 383 marathoners after a 26-mile, 385-yard run revealed hematuria in 17 per cent and proteinuria in 30 per cent. These abnormalities were not related to sex. The condition is transient and appears to be benign. A diagnostic approach to avoid missing significant renal or urologic disease is outlined.

Management of postoperative pelvic lymphoceles

Lymphoceles following pelvic surgery are not rare events. The management of this postoperative complication in 18 patients included needle aspiration, external drainage, and intraperitoneal marsupialization. The following diagnostic and therapeutic approach is recommended: ultrasonographic definition of the lymphocele; excretory urography to assess upper urinary tract obstruction; observation of small, nonobstructing, asymptomatic lymphoceles; needle aspiration for diagnosis confirmation; intraperitoneal marsupialization for noninfected, large lymphoceles that are obstructing the upper urinary tract or are symptomatic; and incision and drainage of small or infected lymphoceles.

Nocturnal penile tumescence monitoring with stamps

A stamp technique was developed to detect complete nocturnal erections for the evaluation of impotence. The test correctly detected complete nocturnal erections in 22 potent men and absence of complete nocturnal erections in 11 impotent men (P value under 0.001). This is a simple, useful screening test for organic impotence.

Clinical experience with hinged silicone penile implants for impotence

Herein is discussed 25 men between 26 and 66 years old who underwent implantation of paired hinged silicone penile prostheses for importance. Subtraction of 20 mm. from the maximum symphysis to the mid glans length obtained in the outpatient setting provided an accurate estimate of the rigid shaft length of the implanted prostheses. The prosthesis, itself, was a satisfactory corporeal dilator in 84 per cent of the patients. In 1 case the prosthesis had to be removed because of infection and 4 patients would have benefited from a narrower shaft diameter prosthesis. After implantation of the new prosthesis 96 per cent of the patients had satisfactory intercourse.

Comparison of intracellular flushing and cold storage to machine perfusion for human kidney preservation

Transplant teams have been reluctant to accept kidneys preserved with intracellular electrolyte flushing followed by simple cold storage, especially when retrieved by non-transplant surgeons or when preservation time exceeds 24 hours. This study from 1 center is a comparison of 40 primary cadaver kidney grafts preserved with Collins' C2 flushing followed by simple cold storage to 37 primary cadaver kidney grafts preserved with cryoprecipitated plasma on the MOX-100 machine. Cold storage time was 10 to 44.5 hours in the C2 group and 3.5 to 39 hours in the machine-perfused group, with a mean of 23 hours in each group. There was no significant difference between the 2 preservation methods no matter who removed the kidney with respect to 1) the incidence of acute tubular necrosis, 2) the 1-month serum creatinine nadir of surviving grafts and 3) the actuarial graft survivals up to 2 years. Among the 40 C2-preserved kidneys 17 were retrieved by community surgeons and 23 were retrieved by transplant surgeons. Human kidneys removed from beating-heart cadaver donors can be preserved satisfactorily with either Collins' 2 flushing followed by simple cold storage or pulsatile machine perfusion, even when preservation times exceed 24 hours.

Color photography in open urological surgery

The quality of intraoperative color slide photography can be improved by 1) orienting the viewer with landmark outline and constant camera position during the procedure, 2) brown gloves to avoid contrast within the operative field, 3) blue sponges to absorb blood, 4) contrasting stay sutures or tapes and 5) taking multiple pictures at different exposures. These points are illustrated with the photographic record of the repair of multiple renal artery aneurysms to provide the urologist with helpful hints in the recording of his interesting or challenging operative procedures.

Hemangiopericytomas in male pelvis

All cases of hemangiopericytomas involving the male pelvis which have been reported in the English literature with clinical data have been reviewed. Their clinical features, roentgenographic findings, pathologic features, and treatment are presented with an illustrative case. The tumor is an aggressive neoplasm which characteristically produces late local recurrences or metastases. Since the clinical behavior cannot be reliably predicted from its histologic appearance, all must be regarded as malignant. Primary treatment should be en bloc excision since a high recurrence rate results when simple enucleation or excision is performed. Long-term follow-up is mandatory, and local recurrences or metastases should be resected whenever feasible. Radiation and chemotherapy may convert a nonresectable lesion into a resectable one and provide significant palliation.