Devin E. Eckhoff

Urological complications in 210 consecutive simultaneous pancreas-kidney transplants with bladder drainage.

ObjectiveThe urological complications of 210 patients who underwent simultaneous pancreas-kidney (SPK) transplantation over a 7-year period were reviewed. Summary Background DataWorldwide, bladder drainage has become the accepted method of exocrine drainage after pancreas transplantation. With the increasing use of bladder drainage, the surgical post-transplant complications have shifted from intra-abdominal complications to urological complications. MethodsTwo hundred ten diabetic patients received SPK transplants with bladder drainage. A retrospective review was conducted to analyze the incidence, type, and management of urological complications. ResultsThe most frequent urological complications were hematuria, leak from the duodenal segment, recurrent urinary tract infections, urethritis, and ureteral stricture and disruption. Complications related to the renal transplant included ureteral stricture and leaks, as well as lymphoceles. ConclusionsDespite the high incidence of urological complications, 5-year actuarial patient and graft survival are excellent. Only one graft and one patient were lost secondary to urological complications.

100 consecutive liver transplants in infants and children: an 8-year experience.

Orthotopic liver transplantation has become the treatment of choice for most children and infants with end-stage liver disease. The purpose of this retrospective study was to examine the results of 100 consecutive liver transplants performed in infants and children at a single institution. During an 8-year study period (July 1984 to December 1992), 100 pediatric liver transplants were performed in 76 patients. Thirty-four patients (44.7%) were infants (mean age, 7.0 months; mean weight, 6.1 kg), and 42 (55.3%) were children (mean age, 8.2 years; mean weight, 30.6 kg). There were 36 reduced-size liver transplants (RLT) and 64 whole-size transplants (WLT). Eight infants (23.5%) and 10 children (20.7%) required retransplantation. After transplantation, 71% of the patients had one or more rejection episodes, 66% had one or more infections, 17.1% had biliary complications, and 39.4% required one or more reoperations. There were 17 deaths. The actuarial 8-year survival rate for the patients with biliary atresia was 82.3%; for all infants in this series, it was 77.6%. No difference in patient survival was noted when RLT was compared with WLT. The overall 8-year actuarial patient survival rate for infants and children was 77.3%.

Immunohistochemical evaluations of ultrashort-segment Hirschsprung's disease

PURPOSE: Unlike classic Hirschsprungs disease, short-segment and ultrashort-segment varieties are usually found to be latent and milder. Ultrashort-segment Hirschsprungs disease may present as intractable chronic constipation in children over one year of age, adolescents, and adults. Anorectal myectomy has been shown in many instances to provide effective long-term treatment for certain patients with ultrashort-segment Hirschsprungs disease. Histologically, the affected segment in Hirschsprungs disease has been shown to have increased cholinergic nerves, lack of nitric oxide synthase-containing neuronal elements, and show moderate to severe loss of myenteric neurons. METHODS: Here, we report three cases that showed clinical and manometric evidence of ultrashort-segment Hirschsprungs disease. Two of the three patients responded well to myectomy. RESULTS: Detailed histologic and immunohistochemical evaluation of the internal anal sphincter and a comparison with three normal controls revealed absence of nitric oxide synthase-containing neurons in both cases that responded well to surgery and continued presence of these neurons in the patient who did not respond. A review of the current literature on various treatment modalities is included. CONCLUSIONS: Anorectal myectomy provides long-term relief of this chronic problem in a subgroup of patients with ultrashort-segment Hirschsprungs disease who lack nitrinergic neurons at the internal anal sphincter.

Proctocolectomy and quadruple-limb W pouch reconstruction for the management of pediatric ulcerative colitis and familial polyposis

Proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the procedure of choice for many children with ulcerative colitis and familial polyposis. The modified quadruple-limb (W) IPAA was designed to increase reservoir compliance and capacity, and to improve functional results by decreasing stool frequency. However, only limited information has been reported concerning the technical considerations and functional outcomes from W IPAA modification and utilization in the pediatric population. Additionally, pediatric IPAA physiological adaptation, expressed as IPAA volume/pressure relationships, for any type of IPAA design has not been described. In this report, the authors analyze their functional and physiological results with W IPAA in 19 children undergoing colectomy for ulcerative colitis and familial polyposis. Since 1986, 19 children (5 girls, 14 boys; mean age, 15.3 years [range, 11 to 18 years]) have undergone proctocolectomy with W IPAA for ulcerative colitis (n = 9) and familial polyposis (n = 10). IPAA pressure and volume profiles were measured in 10 patients at 2 and 12 months postileostomy takedown, and in five patients at 3 years. W IPAA compliance was calculated as the change in volume over change in pressure (delta V/delta P). There were no deaths, anastomotic leaks, or pelvic sepsis. The 24-hour stool frequency (mean +/- SEM) decreased significantly (P < or = .05) from 4.6 +/- 0.6 at 2 months to 3.3 +/- 0.1 at 12 months. No nighttime evacuation occurred after 12 months. W IPAA evacuation volume significantly increased (P < or = .05) from 238 +/- 22.9 mL at 2 months to 346 +/- 26.5 mL at 12 months and remained stable thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)

Pancreatic and component transplantation for type I diabetes

Abstract In the last several years, pancreas transplantation has developed into a highly successful surgical modality of treating selected patients for type I diabetes. The bladder technique is a simple, safe, and reliable technical surgical procedure that is now available. Long-term follow-up studies are demonstrating the beneficial effects of pancreatic grafts on secondary complications. New advances in molecular genetics may one day allow the transplantation of islets or genetically engineered cells, thus supplanting the need for transplantation of the whole pancreas.