Gerardo Mendez-Picon

Prejejunal transposition of colon to prevent the development of short bowel syndrome in puppies with 90 per cent small intestine resection

Abstract Resection of 90% of the small intestine in beagle pupplies produced consistent morbidity and frquetly mortality. Transposition of an isoperistaltic colon segment proximal to the remaining small intestine reduced the morbidity, eliminated the mortality, and allowed almost normal growth and development. The colon segments slows transit time without producing active obstruction.

Surgical Complications in Renal Transplant Recipients

This article reviews complications in the kidney transplant patient related to other surgical procedures and related to organ transplantation, with emphasis on the surgical aspects.

Nonpenetrating vascular injury to the subclavian artery

Blunt subclavian artery injury has been uncommonly reported in the literature. Recent encounter with three such injuries prompted us to review our experience over the past 10 years uncovering only one additional case. These four cases and a review of pertinent literature form the basis for this article. Key clinical issues include a high index of suspicion in patients sustaining major blunt deceleration and rotational or direct injuries to the neck, thorax, and/or upper extremities. Prompt diagnosis remains obscured by the presence of severe associated injuries, the treatment of which requires prioritization. Arteriography is invaluable to elucidate injury because prompt vascular control is dictated by various approaches depending on the location. Expeditious surgical repair is indicated to prevent complications of hemorrhage, pseudoaneurysm, thromboembolism, and/or arteriovenous fistula. Long-term results appear to be good with major morbidity related to associated neurologic, soft tissue, and bony injuries.

The effect of tracheostomy incisions on tracheal growth

Abstract Respiration through an endotracheal tube often provides very adequate ventilation for infants and children with respiratory distress. Nevertheless, there are pediatric patients for whom tracheostomy is indicated. A technical point of contention concerns the tracheal incision. Excision of tracheal tissue or multiple incisions, which meet or cross have been abandoned in the pediatric age group. The choice today is a vertical incision dividing several cartilages 1–3 versus a transverse incision between tracheal rings. 4,5 This experiment was designed to compare the effect of longitudinal and transverse incisions on tracheal growth and development in the immature growing animal.

Wound Infections in Renal Transplant Patients

During a 33-month interval 106 consecutive renal transplants were performed. Prophylactic parenteral antibiotics, local wound irrigation with antibiotic solutions and drains were used. The over-all incidence of wound infection was 11.3 per cent. The true incidence in primary wounds was 8.4 per cent and in reopened wounds it was 21.7 per cent. Graft loss owing to infection was 33.3 per cent. Sepsis occurred in 25 per cent and death in 16.6 per cent of the patients with wound infection. The incidence of infections in hematomas was 27.5 per cent. The use of prophylactic measures contributed to a lower incidence of wound infection, while the use of drains and the occurrence of hematomas increased the incidence of infections.

Long-term study of tracheal growth after segmental resection in puppies

Abstract Techniques in neonatal respiratory care have improved dramatically. Infants are now surviving after prolonged periods of endotracheal intubation. This improvement in survival has produced an increased incidence of acquired tracheal stenosis 1–4 in a very young age group. A concern regarding growth and development may affect the decision to excise the stenosis. This experiment was designed to study some aspects of the long-term fate of the puppy trachea after resection and end-to-end anastomosis.

Use of the greenfield filter in adolescents for deep vein thrombosis and pulmonary embolism

Serious venous thromboembolic disease is now recognized more frequently in the pediatric age group. Caval interruption is indicated most commonly for prophylaxis against life-threatening or recurrent pulmonary embolism (PE) when anticoagulation is ineffective or contraindicated. Greenfield vena caval filters have been utilized locally in 415 adult patients with 97% long-term patency and 5% recurrent embolization. Its application in adolescents is reported herein. Standard adult (30-mm) vena caval filters were placed in ten patients, ages 13 to 18. Four filters were required following PE, six were used for deep venous thrombosis (DVT) when anticoagulation was contraindicated, and one was inserted prophylactically. In eight patients, filter insertion was accomplished with local anesthesia, while two underwent filter placement under general anesthesia administered for other procedures. One filter was misplaced into the right renal vein, requiring a second filter insertion. All patients have been followed from 1 to 11 years with yearly vascular duplex imaging and radionuclide venograms documenting caval patency without clinical embolic sequelae. This duplicates the adult experience in safety and efficacy. As recognition of venous thromboembolism becomes more frequent in the pediatric age group, safe caval interruption may be necessary for those excluded from or not responsive to anticoagulation. This technique may be extended to smaller patients with miniaturization of both filter and carrier.

Synthesis of transcobalamin II in totally hepatectomized dogs

Abstract Transcobalamin II is the protein found in mammals serum which will bind vitamin B 12 and transport it into cells. Other workers have suggested that this protein is made in the liver. We have found that rates of synthesis of this proteinin dogs (as shown by cycloheximide sensitivity) are uneffected by total removal of the liver implying that the liver is not the only organ responsible for synthesis of this protein.

Why Do Secondary Cadaver Renal Transplants Succeed? Results of the South-eastern Organ Procurement Foundation Prospective Study, 1977-1982

We report the selective and therapeutic factors affecting multiple kidney transplant success from a prospective multicenter study of the South-Eastern Organ Procurement Foundation. From June 1977 to March 1982, 3,215 cadaver kidney transplants were performed at 39 institutions. There were 2,535 first, 564 second, 103 third and 13 fourth grafts. The actuarial graft survival rates at 1 and 2 years were 52 plus or minus 1 and 45 plus or minus 1 per cent, respectively, for first grafts, 44 plus or minus 2 and 40 plus or minus 3 per cent for second grafts, and 42 plus or minus 5 and 31 plus or minus 6 per cent for third grafts. Graft survival rates were significantly lower for second and third than for first transplants (p less than 0.003). There was no difference in patient survival rates. The data were analyzed to determine which selective and therapeutic variables governed success of primary and secondary grafts. Pre-transplant blood transfusions were associated with a significant increase in graft survival rates in primary (p less than 0.00005) and secondary transplants (p less than 0.01), and did not affect patient survival rates. The administration of antilymphocyte serum also improved graft survival rates significantly in primary (p less than 0.00005) and secondary grafts (p less than 0.00002), without alteration of patient survival rates. HLA compatibility improved primary graft survival rates (p less than or equal to 0.022) but this did not reach statistical significance in secondary graft survival rates. Second transplant graft survival rates were best when the primary graft functioned for more than 12 months (Breslow p less than or equal to 0.02) but were not related to the reason for loss of the first graft. Pre-transplant bilateral nephrectomy improved graft survival rates significantly but this phenomenon was linked to other treatment factors. No beneficial effect on graft survival rate could be shown after pre-transplant splenectomy in patients with primary or secondary grafts and this procedure was associated with reduced patient survival rates in both groups.

Lack of association of human renal allograft rejection and circulating K-cell, NK-cell, or total T-cell levels

Abstract Thirty-three recipients of cadaveric renal allografts and four living-related allografts were serially monitored at weekly intervals for natural killer (NK)-cell, effector-cell (K) activity in antibody-dependent cellular cytotoxicity (ADCC) and daily total circulating T-lymphocyte (TCTC) levels. Rabbit anti-human thymocyte globulin (ATG) was shown to have a dramatic suppressive effect on all three immune parameters in most of the patients (>90%) studied. Patients experiencing rejection episodes during the first 60 days post-transplant did not express increased levels of any parameter compared to seven non-rejecting patients when measured pretransplant or after 2 and 4 weeks post-transplant. Furthermore, increased early levels were not associated with an increased frequency of rejection episodes. Values of each of these parameters measured during clinical rejection were shown not to be significantly elevated when compared to values determined at identical times post-transplant in recipients who experienced no rejection episodes during the initial 60 days following grafting. Similar comparisons made 3, 2, and 1 week prior to rejection episodes also failed to reveal a significant elevation of any parameter in advance of rejection. Thus, NK-cell, K-cell, and TCTC levels do not appear to be associated with rejection phenomena and are of limited clinical usefulness in monitoring renal allograft recipients.