RESUMO
OBJECTIVE: The aim of this paper is to identify the variables that could be of interest in the outcome of a series of cadaveric kidney transplantation performed at the University Hospital, Navarra School of Medicine, by means of multifactorial and multivariate statistical analyses. METHOD: We analyzed 307 cadaveric kidney transplantation performed since 1976 at the University Hospital, School of Medicine, University of Navarra. Two series are included: the historical and the actual. The former did not include cyclosporine A in the immunosuppressor protocol. RESULTS: The first step was to compare survival in both series. The cyclosporine A series had a better survival, which was statistically significant (p < 0.0001). The prognostic factors in both series were also analyzed. The influence of the different variables were studied in the survival distribution. The worse prognostic variables of the historical group on allograft survival were donor's age (particularly between 20 and 50 years old), delayed graft function, serum creatinine level greater than 2.5 mg/dl at the first month following transplantation, general surgical complications, and vascular and other complications. In the actual group, the allografts with the worst survival were in those that received 4-10 pre-transplant blood transfusions, those with more that 2 HLA-DR mismatches, the hyperimmunized receptors with a level of pre-formed cytotoxic antibodies greater than 50%, those who rejected the allograft in the initial post-transplant period, those with a serum creatinine level greater than 2.5 mg/dl and those who presented surgical complications in general and urinary and vascular complications in particular. CONCLUSIONS: The multivariate analysis reveals that the prognostic factors of the historical group were delayed graft function, surgical complications, HLA A+B mismatches and the donor's age. In the actual group, the factors were receptor's age, surgical complications, large ischemia time, peak reactive antibody and number of rejections.
Assuntos
Sobrevivência de Enxerto , Transplante de Rim , Análise Atuarial , Humanos , Análise Multivariada , PrognósticoRESUMO
We analyzed 307 cadaver kidney transplantations performed since 1976 at the University Hospital of the University of Navarra. Two series, the historical and the current one, are presented. In the former, cyclosporine A was not included in the immunosuppressor protocol. The surgical complications were evaluated in both series and their influence on the survival of the allograft. The current series showed a significant decrease in surgical complications. Allograft survival in the historical series was influenced by surgical complications in general, and vascular and other complications in particular. The current series was influenced by surgical complications in general, and urinary and vascular complications in particular. The multivariate analysis showed that surgical complications were one of the most important prognostic factor in both series.
Assuntos
Transplante de Rim , Complicações Pós-Operatórias , Ciclosporina/uso terapêutico , Sobrevivência de Enxerto , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Análise Multivariada , Fatores de TempoRESUMO
We report a case of squamous cell carcinoma of the ureter with periureteral infiltration. Three years following radical surgery, no evidence of tumor progression has been observed. Only 1% to 1.6% of urothelial tumors of the upper urinary tract are purely squamous cell tumors. This tumor type carries a poor prognosis. Currently, the best results can be achieved by early diagnosis and radical surgery.
Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Ureterais/patologia , Carcinoma de Células Escamosas/cirurgia , Humanos , Masculino , Metaplasia , Pessoa de Meia-Idade , Neoplasias Ureterais/cirurgiaRESUMO
Between July 1976 and June 1990, 244 transplantations were performed. Of the 237 patients monitored, 13 (5.4%) had vascular complications: 10 (77%) renal artery stenosis, 1 (7.7%) primitive iliac artery stenosis, 1(7.7%) renal artery thrombosis, 1 (7.7%) renal vein thrombosis. Six patients underwent surgery (Angioplasty was performed in three patients, re-anastomosis to the common iliac artery in one, by-pass of saphenous vein in another one, while in the last one it was tried a release of the vascular pediculus). Management with drugs was possible in one case. At present, 11 of the 13 patients are still alive and three of the grafts remain functional after a mean follow-up time of 83 months. According to a univariate study, the influential factors in the development of vascular complications are, the identity of Locus A, the type of extraction in Locus B, the length of cold ischaemia, the type of vascular anastomosis and the number of previous rejections. The factors with maximal influence in the development of complications are the type of vascular suture (with or without patch) and the number of previous rejections (according to a study of log regression models). The study demonstrates the significant influence vascular complications have on the graft's durability (p = 0.005).
Assuntos
Artéria Ilíaca , Transplante de Rim/efeitos adversos , Artéria Renal , Veias Renais , Cadáver , Sobrevivência de Enxerto , Humanos , Doenças Vasculares/epidemiologia , Doenças Vasculares/etiologiaRESUMO
One case of paratesticular embryonal rhabdomyosarcoma (RMS), affected during its evolution by a tumoral thrombus in the inferior vena cava. This unusual association forced the use of a cardiopulmonary by-pass, profound hypothermia and circulatory arrest, in order to carry out complete exeresis of the damage. Also, revision of the literature emphasizing that today's therapeutical approach for RMS should essentially be multidisciplinary.
Assuntos
Neoplasias dos Genitais Masculinos , Células Neoplásicas Circulantes , Rabdomiossarcoma , Escroto , Veia Cava Inferior , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada , Dactinomicina/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Neoplasias dos Genitais Masculinos/patologia , Neoplasias dos Genitais Masculinos/terapia , Humanos , Ifosfamida/administração & dosagem , Excisão de Linfonodo , Masculino , Orquiectomia , Radioterapia de Alta Energia , Rabdomiossarcoma/patologia , Rabdomiossarcoma/terapia , Veia Cava Inferior/cirurgia , Vincristina/administração & dosagemRESUMO
We report a case of hyperammonemia and transient blindness following transurethral prostatic resectin. Glicine and ammonia metabolism are reviewed. Water intoxication may not account for these symptoms.
Assuntos
Amônia/sangue , Cegueira/etiologia , Prostatectomia/efeitos adversos , Idoso , Glicina/sangue , Humanos , Masculino , Prostatectomia/métodosRESUMO
We report a case of right common iliac artery fistula to the left ureter in a patient affected by an invasive bladder tumour treated with radical surgery, radiotherapy and neo-adjuvant chemotherapy. At the time of manifestation, our patient had indwelling catheters and presented an urinary tract infection. Diagnosis was established during autopsy. We feel that the cause of this complication is multifactorial.
Assuntos
Fístula , Artéria Ilíaca , Doenças Ureterais , Fístula Urinária , Doenças Vasculares , Idoso , Fístula/etiologia , Humanos , Masculino , Doenças Ureterais/etiologia , Fístula Urinária/etiologia , Doenças Vasculares/etiologiaRESUMO
A case is presented on the use of extracorporeal lithotrity by shock waves to treat vesical lithiasis, using the desk module of a Lithostar-PlusR (Siemens) lithotripter. This is an effective method without morbidity an adequate for ambulatory use, specially valuable in patients where the use of more invasive methods, or surgery can be contraindicated or when the patient refuses such methods.