J. Hartwell Harrison

Successful Homotransplantation of the Human Kidney Between Identical Twins

○ A patient whose illness had begun with edema and hypertension was found to have suffered extreme atrophy of both kidneys. Because of the steady worsening of the condition and the appearance of uremia with other unfavorable prognostic signs, transplantation of one kidney from the patients healthy identical twin brother was undertaken. Preparations included collection of evidence of monozygosity and experimental transplantation of a skin graft from the twin. During the transfer of the healthy kidney it was totally ischemic for 82 minutes. Evidence of functional activity in the transplanted kidney was obtained. The hypertension persisted until the patients diseased kidneys were both removed. The homograft has survived for 11 months, and the marked clinical improvement in the patient has included disappearance of the signs of malignant hypertension.

Kidney transplantation between seven pairs of identical twins.

Kidney Transplantation Between Seven Pairs of Identical Twins JOSEPH MURRAY;JOHN MERRILL;J. HARRISON; Annals of Surgery

Kidney Transplantation in Modified Recipients

Kidney Transplantation in Modified Recipients Joseph Murray;John Merrill;Gustave Dammin;James Dealy;Guy Alexandre;J. Harrison; Annals of Surgery

Evaluation of the positive urine culture; an approach to the differentiation of significant bacteria from contaminants.

Abstract 1.1. A method for quantitative bacterial counts, using the agar pour plate technic as a part of the procedure for urine cultures, is described. This procedure offers advantages in the rational management of infections of the urinary tract. It also permits a more reliable evaluation of therapy. 2.2. A degree of bacteriuria approximating 1,000 viable organisms/ml. of urine is required for the certain diagnosis of infection. Extraluminal infections or subsiding urogenital infections may be associated with a lower urinary concentration of bacteria. 3.3. Quantitative studies have shown that the presence of a moderate number of bacteria on a stained smear is highly suggestive of significant bacteriuria. Pyuria during infection is variable and fails to correlate closely with clinically significant bacteriuria.

Surgical management of fifty patients with kidney transplants including eighteen pairs of twins.

Abstract Surgical experience with fifty patients with kidney transplant has been discussed. The selection of the potential recipient and donor, the consideration of the donor, the preparation of the recipient, operative technics, postoperative management, complications and results have been presented.

Renal cell carcinoma: natural history and chemotherapeutic experience.

Eght-four patients with renal cell carcinoma were analyzed retrospectively in order to 1) determine the effectiveness of systemic chemotherapy-hormonal and non-hormmonal, 2) identify the clinical features of renal cell carcinoma that may be important in prognosis and 3) characterize the paraneoplastic features of renal cell carcinoma. Metastatic disease was present at diagnosis in 57 per cent of the cases and developed within 1 year in an additional 19 per cent of the cases were paradoxically associated with a longer survival (20 months median) compared to single-organ metastasis (5 to 11 months median). Paraneoplastic syndromes occurred in up to 40 per cent of patients with variable survival. Metastatic disease was unresponsive objectively to either primary nephrectomy or to a variety of chemotherapy trials.

Renal vein renin activity in the prognosis of surgery for renovascular hypertension

Abstract Twenty-four hypertensive patients underwent corrective surgery for renal hypertension. The postoperative follow-up period was one year or more in all. In twelve patients the results were classified as excellent (five patients) or good (seven patients). Type of surgery (nephrectomy, thirteen patients; vascular repair, eleven patients) was not a factor in the clinical results. Renal vein renin activity ratio and absolute renal vein renin activity from the involved kidney provided the most accurate means of predicting surgical results. The ratio correctly predicted the surgical result in eleven of fourteen patients, and the absolute level correlated correctly in all but one of fourteen patients. Divided ureteral function tests did not distinguish between patients whose condition was and was not improved by surgery, and the intravenous pyelogram, although adequate for screening for the presence of functional renovascular disease, included a high proportion of false-positive tests. Aortography, although revealing the arterial stenosis in all instances, emphasized the need for confirmation of the functional significance of the lesion since half the patients with stenosis did not respond to surgery. On the basis of our experience, renal vein renin determinations appear to be a highly reliable means of selecting patients for corrective renal surgery.

Total adrenalectomy for reactivated carcinoma of the prostate.

AN effective new approach to the treatment of neoplastic disease was provided by Huggins and Hodges1 when they demonstrated the control of cancer of the prostate by orchiectomy and the administrati...

Tumors of the adrenal cortex

Extensive advances in surgery of the adrenal cortex have occurred in the last 23 years. The significant historical events are outlined herein. The demonstration 22 years ago that man can survive after bilateral total adrenalectomy, with adequate substitution therapy, has given a great impetus to surgery of tumors of the adrenal. The pathology, the pathologic physiology, and important steps in preoperative evaluation and diagnosis are given in detail. The intraoperative and postoperative management are described, including the details of effective chemotherapy. Emphasis is appropriately placed on the importance of the team approach to the problem of neoplasm of the adrenal cortex, for nowhere is there a greater necessity for the combined efforts of internists, radiologists, chemotherapists, and surgeons.

CLINICAL STUDIES ON BILATERAL COMPLETE ADRENALECTOMY IN PATIENTS WITH SEVERE HYPERTENSIVE VASCULAR DISEASE

Excerpt INTRODUCTION The aggravation of hypertensive cardiovascular disease which follows ACTH administration1, 2lends support to the concept that amelioration of the vascular disease might follow ...