John E. Payne

Successful Renal Transplantation in Patients Positive for Hepatitis B Antigen

Abstract We examined the effect of hepatitis B antigenemia on the outcome of renal allografts. Sixteen of 116 renal-allograft recipients were hepatitis antigen (HBs Ag) positive before transplantation. These HBs AG-positive patients had a graft survival of 60.3 and 30.2 per cent at one and two years. The mortality in the positive group was 18.9 per cent, and that in the negative patients was 19.8 per cent. The results of post-transplant hepatic tests in the two groups were similar. In seven other patients HBs Ag positivity was detected after transplantation. They did not differ from other patients with transplants in either hepatic or graft function. The mean period of post-transplant HBs Ag positivity was 16.5 months in this group of 23 patients. HBs Ag antigenemia acquired before transplantation or in the post-transplant period could not be correlated with hepatic dysfunction or poor graft survival. (N Engl J Med 291:62–65, 1974)

Outcome of treatment of 686 gunshot wounds of the trunk at Los Angeles County-USC Medical Center: Implications for the community

The Los Angeles County-University of Southern California (LAC-USC) Medical Center, a level I trauma center, has experienced a rapidly increasing incidence of gunshot wounds (GSWs). We sought to enumerate the annual monetary costs and medical consequences of thoracoabdominal gunshot wounds in the epicenter of urban violence. A consecutive series of patients admitted from September 1, 1989 to August 31, 1990 was studied. Their records were coded by trauma nurse reviewers and held in the Trauma Emergency Medical Information System (TEMIS) and Automated Medical Record Abstracting and Reporting System (AMRARS). Diagnoses, procedures, and complications were verified by chart review. An estimate of disability 3 months after discharge was made from the record and reported on a functional activity scale. The total number of patients with GSWs admitted to all of the level I Los Angeles County trauma centers was 2771 during the study period. The total number of patients with major gunshot injuries admitted to LAC-USC Medical Center was 1007. Thoracoabdominal wounds without any head wound component occurred in 686 gunshot patients. Three quarters of the injured patients with truncal gunshot injuries were Hispanic. Total length of stay at the LAC-USC Medical Center for those with truncal wounds was 4666 hospital bed days including 432 ICU bed days, representing a minimum estimated total medical cost of

Vascular access for chronic hemodialysis using modified bovine arterial graft arteriovenous fistula

5,441,334. Annual medical cost of all admissions including rehabilitation, however, could be as great as

Renal transplantation. In adult patients with end stage polycystic kidney disease.

12 million for the Medical Center and

Selective splenectomy in chronic renal failure.

53 million for the County of Los Angeles. Thirty percent of patients had MediCal insurance. Payment could not be recovered from another 57% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Observed differences in postoperative lymphocyte transformation are explained by patient and population variations

Abstract Modified bovine arterial graft arteriovenous fistulas were used for access to the circulation for hemodialysis in thirty-six patients whose forearm vessels were unsuitable for Brescia-Cimino fistulas. Twenty-seven of thirty-one thigh fistulas and three of five forearm fistulas are still functioning well. Most of the complications were minor and may be preventable. Thigh heterografts provided excellent blood flow for dialysis and have been the most successful alternative for patients who have repeated shunt or fistula failures.

Management of multiple renal arteries in renal transplantation

Seventeen adult patients with end stage polycystic kidney disease underwent renal transplantation. Two groups were identified: (1) those transplanted with retained polycystic kidneys, (2) those prepared with preliminary bilateral nephrectomy. Although there was a shockingly higher incidence in the mortality rate in the non-nephrectomized group, no specific cause could be identified. The results do indicate, however, that bilateral nephrectomy is essential in all patients with a history of pyelonephritis or gross hematuria. Substantial benefit from retained kidneys was noted only during the initial period of hemodialysis.

A Review of the Current Methods Used for Access to the Circulation for Hemodialysis

Hypersplenism occurred in about 10 per cent of our patienrs with chronic renal failure. Sptenectomy corrected the hematologic abnormalities. Hypersplenic patients have critically impaired azathioprine tolerance. Because there are no significant detrimental effects of splenectomy in patients with allografts, evidence of hypersplenism should be sought and if detected the spleen should be removed prior to renal transprantation.

Epidemiology of Cytomegalovirus Infection after Transplantation and Immunosuppression

In the present study, the kinetics of the lymphocyte response to phytohemagglutinin were examined by harvesting lymphocytes at 24 hour intervals in four nonoperated control subjects, preoperatively and postoperatively in six men who underwent herniorrhaphy, and in four people who had colectomy for adenocarcinoma. Nonorthogonal analysis after logarithmic transformation and adjustment for individual and population variations showed no differences in preoperative and postoperative transformation. No age effects were seen. The previous evidence that surgery inhibits transformation to phytohemagglutinin was explained by wide kinetic variations in both patient and control populations.

Use of Androgenic Anabolic Steroids by Athletes

Abstract Over a three-year period, 23 kidneys with multiple renal arteries were transplanted. Four types of vascular anastomoses were used: Carrel aortic patches; accessory artery to main renal artery anastomoses; double renal artery anastomoses to the external iliac artery; and anastomoses of the conjoined arteries to the external iliac artery. The results in this series compared favorably with a similar group of single artery transplants. The indications and hemodynamic justification for each procedure are presented.