Intestinal complications of endometriosis

Five patients with intestinal endometriosis are presented. Two patients had appendiceal involvement, and 3 with sigmoid colon involvement presented with clinical features indistinguishable from carcinoma of the colon. It is important for surgeons to be aware of the possibility of intestinal endometriosis when treating patients with polypoidal colonic masses, strictures of the pelvic colon and atypical rectal bleeding

Exchange of cadaveric kidneys for transplantation in Australia and New Zealand

Summary: In the period from March 1970 to April 1978, 176 kidneys from 137 cadaver donors were exchanged, on the basis of HLA matching, between transplant centres throughout Australia and New Zealand. The kidneys were preserved by simple ice storage or machine perfusion, and transported by air in chipped ice. Total ischaemia times ranged from 3·5 to 28·6 hours and immediate function occurred in 52% of cases. Graft survival was 62% at one year, 51% at three years and 47% at five years, the corresponding patient survival rates being 86%, 74% and 71%. An average of 1·4 antigens mismatched was achieved, and 59% of recipients received kidneys with zero or one antigen mismatched. These kidneys survived better than those with two or more antigens mismatched, the difference being 12% at one year, and rising to more than 20% at five years. The results confirm the practicability and potential value of the Organ Sharing Scheme, and indicate that effective sharing of kidneys on the basis of zero HLA mismatches could substantially improve the current success rate of clinical cadaveric renal transplantation

Regulation of rat liver microsomal cholesterol 7α-hydroxylase by MgATP: Effect of pH

Cholesterol 7α-hydroxylase when assayed under conditions that favour phosphorylation can be activated or inactivated by MgATP, depending on ATP concentration and the pH of the incubation medium. Maximum stimulation of 7α-hydroxylase was obtained with 0.5 mM ATP in both acidic and alkaline pH. At a pH lower than 7.4, 7α-hydroxylase was inactivated by 2.0 and 3.0 mM MgATP. The inactivation by 3 mM MgATP was significantly greater at pH 6.7 than pH 7.4. Protein kinases enhanced these effects, suggesting covalent modification of the enzyme by phosphorylation. These findings are consistent with a protein kinase catalyzed phosphorylation, and suggest that MgATP may have a dual role in the activation and inactivation of 7α-hydroxylase in vivo

Vascular changes following hypothermic preservation

This study identifies ultrastructural changes in the endothelium due to hypothermic HP-5 perfusion. These changes appear to be reversible and a manifestation of hypothermic hypoxia. This data provides a basis for improving perfusion techniques in both hypothermic preservation and cryoprotectant introduction and removal for cryopreservation

In vitro analysis of the cation content of solutions for kidney storage

An in vitro kidney preservation model, based on the measurement of cortical slice oxygen consumption, was used to analyse the influence of the cationic composition of perfusates on hypothermic kidney storage. It was found that, while changes in the potassium concentration of storage solutions had little influence on subsequent cortical slice respiration, increasing sodium concentration produced progressive depression of this respiration. It was concluded that flush perfusates for kidney storage should contain only a low concentration of sodium ions

The ureter in renal transplantation: results of a simple technique of uretero vesical anastomosis

An extravesical ureteral implantation with the routine use of an internal stent was performed in 358 transplants (351 cadaveric and 7 living related). The 1-year patient and graft survival was 93% and 87%, respectively, with a minimum followup of 2 years. Ureteral complications developed in 9 patients (2.6%), with 3 fistulas, 2 of which resolved spontaneously, and 6 stenoses following stent removal. Nephrostomy drainage and antegrade stenting were initially attempted in all cases of stenosis, and were successful in 4. Revision of the ureteral anastomosis was required in 1 case of fistula and 2 cases of stenosis (0.9%). Extrinsic compression resulted in ureteral obstruction in 3 cases (2 lymphoceles and 1 hematoma), which resolved following drainage. Stent related complications occurred in 8 patients (2.2%), including obstruction due to the stent in 2 cases, breakage during removal in 3 leaving fragments in the upper urinary tract, proximal migration of 2 stents that were retrieved via percutaneous nephrostomy and calculus formation on 1 stent in a patient with hyperparathyroidism, necessitating extracorporeal shock wave lithotripsy for stent removal. In the cases with ureteral or stent related complications 1-year patient and graft survival was 100%. These results suggest that ureteral stents used routinely in renal transplantation are associated with a low incidence of urinary leaks, early postoperative obstruction and subsequent surgery for urological complications. However, a small number of unique problems related to stent use or malfunction may occur. Minimally invasive strategies using percutaneous nephrostomy and antegrade stenting are effective in managing the majority of complications that occur following ureteral stenting in renal transplant recipients

A simplified kidney preservation system: Further development and results of extended perfusion

Preliminary results with a greatly simplified continuous perfusion system indicated that satisfactory preservations of canine kidneys could be achieved in a small circuit from which much of the complexity required for pH, temperature, and pulse pressure control in conventional systems had been eliminated. Further development has been undertaken to simplify the pump control unit and to compare materials suitable for construction of the definitive circuit. Reliability of mechanical components and of preservation quality have been studied in a series of 48 hour perfusions of canine kidneys, with the use of both cryoprecipitated plasma and a five percent albumin solution as perfusates. Perfusions were carried out at both very low (0.5 °C.) and low (5 °C.) temperatures, since the operating temperature of the circuit, when immersed in chipped ice for simplified temperature control, depended on the material used in its construction. A total of 2,424 hours of perfusion was carried out, and no mechanical failure occurred; all components functioned efficiently and reliably. Plasma proved to be unsuitable at these low temperatures; only two of six dogs survived after 48 hours perfusion at 0.5 °C. and six of nine survived at 5 °C. All kidneys perfused with albumin at both temperatures survived, with maximum serum creatinines of 6.3 and 4.9 mg. percent, respectively, demonstrating that this solution is the more satisfactory of the two perfusates for this system