[Retroperitoneal complications after lumbar disk prolapse surgery]. / Retroperitoneale komplikationer ved operation for lumbal discusprolaps.

Injury to retroperitoneal vascular structures secondary to lumbar disc surgery is a rare but serious complication. In some cases early recognition and surgical intervention is of vital importance. Vascular injuries may be classified in in the following manner. 1. Laceration of one artery or a vein only. 2. Laceration of a artery and a vein leading to formation of arteriovenous fistula. 3. False aneurysm. Based on a review of the literature and three case reports, the anatomy is reviewed. The diagnosis, clinical pictures and the vascular reconstruction are discussed.

Hypertension is not a complication in cyclosporine-A monotherapy.

The course of blood pressure and antihypertensive treatment (AHT) was studied in 27 renal transplant recipients immunosuppressed with cyclosporine-A (CyA) as monotherapy. At the time of transplantation 13 patients received AHT and 14 were normotensive. The final outcome of transplantation and CyA immunosuppression was 19 patients without AHT, 4 with reduced AHT and 3 with unchanged doses of AHT, while in 1 case a de novo mild hypertension necessitated diuretic treatment.

Bacterial urinary tract infection in cyclosporine-A immunosuppressed renal transplant recipients.

Urinary tract infection and rejection in 48 renal transplant patients immunosuppressed with cyclosporine-A monotherapy were analysed. Urinary tract infection was diagnosed in 52% of the cases with Escherichia coli dominating. Urinary tract infection took a mild and relatively uncomplicated course as only one case of graft pyelonephritis caused graft nephrectomy and no influence on graft survival was observed (p greater than 0.05) in the infected cases in contrast to rejection episodes which caused a significantly reduced graft survival (p less than 0.01).

Graft failure and graft nephrectomy without severe complications.

The courses of 34 graft failures leading to graft nephrectomy in 19 patients were examined retrospectively. Cyclosporin (CsA) was the sole immunosuppressive in 70% of the cases, and azathioprine-prednisolone in 30%. Having diagnosed graft failure, the immunosuppressive treatment was continued for about 2-3 months and then tapered slowly. No deaths related to graft failure were recorded. In three cases a delay in graft nephrectomy caused complications such as sepsis and coagulopathy. We conclude that continuing immunosuppression a few months after having diagnosed graft failure may postpone or avoid graft nephrectomy while steroid withdrawal symptoms do not complicate the course at the time of graft failure.

The outcome of 48 renal transplantations immunosuppressed with cyclosporine-A as monotherapy.

The course of 48 consecutive cadaveric renal transplantations immunosuppressed with Cyclosporine-A (CyA) as monotherapy in 3 different doses was retrospectively analysed. CyA doses were based on clinical observations. Overall one-year graft survival was 52% and for grafts immediate diuresing 82%. A dosage schedule of 12 mg CyA/kg/day seemed to secure graft function without any side effects to the patient.

Ruptured abdominal aortic aneurysm with fistula into the inferior vena cava.

Aortocaval fistula is an unusual complication of ruptured abdominal aortic aneurysm. A case of coincident rupture of an abdominal aortic aneurysm into both the retroperitoneum and the inferior vena cava is presented. The symptoms and the treatment are discussed.

Indications for and timing of removal of non-functioning kidney transplant.

The clinical indications for and the timing of removal of non-functioning cadaver kidney transplants were studied in 49 of 58 kidneys which had never functioned or which ceased to function in the period 1979-1982. The reason for graftectomy was rejection in 32 cases, rejection and graft infection in eight, surgical complications in eight cases and infection in one case. Nine of the 58 failed kidney grafts were not removed. Graftectomy was performed within a week after diagnosis of graft failure in 24 of the 49 cases. The clinical indications for graftectomy were compared with the morphologic observations in the grafts. Discrepancy was greatest in regard to diagnosis of rejection and primary renal artery thrombosis. Severe complications related to graft failure aggravated the condition in 17 patients and resulted in eight deaths. Based on the findings, a management schedule is proposed. It facilitates postponement or avoidance of graftectomy and minimizes the risk of complications relating to failure of graft function.

Pretransplant status of grafts and recipients. Treatment with dialysis and renal transplantation in diabetic nephropathy. Experiences through 11 years. Survival curves and causes of death.

An 11 year study is presented comprising 74 diabetic patients with terminal uraemia treated with dialysis and transplantation. The cumulative patient survival rate after one year is 45%. No difference is found between the survival rates of transplanted and dialysed patients. Sixty-six percent of the patients died from cardiovascular-, and 21% from infectious causes.