Erwin T. Jacob

Alleviation of Experimental Ischemic Acute Renal Failure by Dimethyl Sulfoxide

Acute, ischemic renal failure was induced in rats by clamping of the renal vessels for 1 h. Following the termination of the ischemic period 5 g/kg of dimethyl sulfoxide (DMSO) were administered intravenously as a 20% solution in saline. Control animals received normal saline. There were not deaths among the DMSO-treated animals. Urine flow began within 15 min of DMSO infusion. 24 h after the experiment the mean blood urea was 73 +/- (SEM) 14 mg/100 ml (n = 29). All the control rats died during the week following the experiment. The mean blood urea at 24 h was 276 +/- 18 mg/100 ml (n = 20). In 10 additional animals perfusion of the kidney with DMSO prior to the closure of renal vessels protected the organ from ischemic damage. These experiments have a bearing on the therapeutic approach to ischemic renal failure in man, and on preservation methods of donor kidneys for transplantation.

Hepatic infarction and gallbladder necrosis complicating arterial embolization for bleeding duodenal ulcer

SummaryA case of severe duodenal hemorrhage in a septic renal allograft recipient is presented in which successful occlusion of the gastroduodenal artery by Gelfoam emboli also resulted in severe hepatic infarction and gallbladder necrosis. These complications were caused by reflux of emboli from the gastroduodenal artery into the distal branches of the hepatic artery.

Renal Transplantation in the Amyloidosis of Familial Mediterranean Fever: Experience in Ten Cases

Ten patients with familial Mediterranean fever (FMF) and histologically confirmed amyloidosis received cadaver kidney transplants for treatment of terminal renal disease. Colchicine, 1 mg daily, was included in the routine postoperative regimen from 1974 for amyloidotic patients. Graft and patient survival were compared with ten nonamyloidotic recipients of renal grafts matched for age, sex, type of allograft, and HLA compatibility. In the FMF group, five of ten grafts have survived from 20 to 64 months; in the control group, six of ten. While only recipients with functioning grafts survived in the FMF group, patient survival in the control group is eight of ten after one year. In all five FMF survivors, graft function is satisfactory, proteinuria is absent, and blood creatinine levels are normal. Amyloid involvement of an allograft was documented 16 months after transplantation in the only patient whose maintenance colchicine dosage had been reduced to 0.5 mg daily.

Calculus in 16-Year-Old Cadaveric Kidney Transplant: A Unique Case and Literature Review

Calculi are rare in transplanted kidneys with an incidence of 0.1-0.2% of all urological complications. The clinical presentation of an obstructing stone is different from that seen in nontransplant patients and can be easily mistaken for rejection. Ultrasonography and renogram may fail to detect it. Steroid therapy, the treatment of choice for acute rejection, may improve renal functions albeit obstruction. An obstruction ureteral stone in a 16-year-old cadaveric kidney transplant was mistaken for acute rejection. Steroid therapy improved renal function for a short time, but then anuria recurred. Failing treatment, the kidney was considered lost and hemodialysis was started. Spontaneous passage of a stone and improved renal functions clarified the picture. The literature regarding kidney transplant stones is reviewed.

Angiotensin-converting enzyme inhibitor (SQ 20881) in the diagnosis of renovascular hypertension.

SQ 20881, an angiotensin-converting enzyme inhibitor, was given to 12 patients with renovascular hypertension and to 1 patient with unilateral pa renchymatous renal disease in order to evaluate the role of renin-angiotensin systems in their hypertension. Plasma renin activity (PRA) and aldosterone were assayed in systemic blood before and after the injection of SQ 20881. In 5 patients PRA was also measured separately in each renal vein. Blood pressure decreased, PRA increased, and aldosterone level decreased in the 12 renin- dependant patients. When PRA was sampled separately from each renal vein, the increase was larger on the side of the affected kidney. Four patients with a positive test underwent corrective surgery, and in all blood pressure became normal. SQ 20881 is a useful agent in evaluating the contribution of renin in patients with hypertension.

Food as a cause of small intestinal obstruction. A report of five cases without previous gastric surgery.

The clinical and roentgenographic findings in five patients with small intestinal obstruction caused by food impaction are presented. None had undergone previous gastric surgery. While the clinical features are those of small intestinal obstruction, an upper gastrointestinal study may demonstrate the exact site and nature of the obstruction.

Dacron arterio-venous interposition graft: an access to circulation in patients on chronic hemodialysis.

In a small percentage of cases, conventional a-v fistulae of the Brescia- Cimino type fail to provide long-term access facilities for chronic hemo dialysis. When homologous venous interposition grafts are not available, the surgeon is forced to seek foreign interposition material. In three instances woven dacron arterio-venous interposition grafts were success fully constructed in the thigh, and uneventful hemodialysis was accom plished in all 3 patients.

Decompensated Ureteropelvic Junction Obstruction in Renal Allograft

We report a case of complete obstruction at the ureteropelvic junction in a renal allograft 6 months after related kidney transplantation. Surgical treatment consisted of a Foley nondismembered Y-V pyeloplasty. Although the donor harbored undetected bilateral, mild, ureteropelvic junction stenosis, as established by review of the excretory urogram that was performed before nephrectomy, the remaining kidney functioned well, as confirmed by renal function and morphological appearance on a repeat excretory urogram. The possible mechanisms of ureteropelvic junction decompensation, the most crucial of which appears to be autonomic denervation of the allograft, are discussed.

Ileostomy with the Eeatm stapler

The EEATMinstrument was used to perform ileostomy in three patients. Two female patients with complications of Crohns colitis underwent total colectomy and proctocolectomy, respectively. The first patient was operated upon because of toxic megacolon and the second patient for severe perianal disease. A third male patient underwent total colectomy for severe ulcerative colitis that failed to respond to medical therapy. In all patients, ileocutaneous anastomosis was performed with the EEA stapler (ILS, Ethicon). No serious complications were observed except for slight retraction of the ileostomy in one patient after he had gained 22 pounds.