Evaluation of Persistent Lymphatic Fluid Leakage Using a Strategy of Placing a Drain After Kidney Transplantation: A Statistical Analysis to Assess Its Origin.

OBJECTIVES: Using a strategy of placing a surgical drain after kidney transplantation, the duration of a lymphatic fluid leakage and prevalence of a symptomatic lymphocele were retrospectively analyzed. The risk factors for persistent lymphatic fluid leakage or asymptomatic lymphocele were evaluated using multivariate analysis to estimate the origin of the lymphatic fluid leakage. MATERIALS AND METHODS: Patients with persistent lymphatic fluid leakage and symptomatic lymphocele were defined as those with lymphatic fluid drainage >50 mL for more than 15 days and those who required a percutaneous drainage of the lymphocele, respectively. RESULTS: Persistent lymphatic fluid leakage and symptomatic lymphocele were observed in 40 (16.4%) and 10 (4.1%) of a total of 244 patients, respectively. The maximum durations of lymphatic fluid drainage from the initial drain tube and the second drainage of the symptomatic lymphocele were 48 and 28 days, respectively. Anastomosis of the graft artery to the external iliac artery was an independent risk factor to predict persistent lymphatic fluid leakage or symptomatic lymphocele after kidney transplantation (odds = 2.597, P = .008). CONCLUSION: The findings of the study suggest that the lymphatic fluid originates from the recipient's iliac lymph trunk rather than from the graft kidney.

[Progression from adenocarcinoma to small cell carcinoma of the prostate during endocrinotherapy: a case report].

A 72-year-old man had undergone surgical castration for metastatic prostate cancer (stage D2, the PSA value was 4,300 ng/ml) in September, 1997. He was well clinically for 16 months with undetected level of PSA. However, he presented with general malaise and gross hematuria in May, 1999. After admission to our hospital his condition rapidly deteriorated and he died one week later with respiratory failure. Autopsy revealed extensive involvement of the prostate and bladder by solid tumor with multiple metastases in lungs, liver, spleen, kidneys and bone. Histological examination revealed pure small cell carcinoma of the prostate.

Three decades of corneal transplantation: indications and patient characteristics.

PURPOSE: To review the indications and patient characteristics for penetrating keratoplasty (PKP). METHODS: Retrospective review of records at the Pathology Service, Department of Ophthalmology, University of Toronto from 1964 to 1997. RESULTS: The 6,222 records were reviewed. The leading indications for PKP were regraft, keratoconus (KC), pseudophakic bullous keratopathy (PBK), Fuchs' dystrophy, viral infections, and trauma, in that order. During the second half of the 1980s, PBK replaced KC as the leading indication for transplantation. The average age of patients increased from 49 (+/-19) years during the second half of the 1960s to 63 (+/-20) years at the first half of the 1990s. Gender differences (M/F ratio) were significant for KC, viral keratopathy, trauma, PBK, aphakic bullous keratopathy (ABK), edema of unspecified etiology, interstitial keratitis, rheumatoid arthritis, and Fuchs' dystrophy. Diagnostic category differences between all patients for PKPs and regrafts were significant for autoimmune keratolysis, congenital opacities, PBK, ABK, edema of unspecified etiology, scarring, Fuchs' dystrophy, and KC. CONCLUSION: Indications are in accordance with the literature with the exception of regraft, which was higher. An increase in the average age of patients corresponded with the PBK epidemic. The high male-to-female ratio among patients with KC was different from that previously reported for the prevalence of this condition. Sex distribution among patients with PBK and ABK showed a female predominance. Differences in the underlying disease distributions between regrafted patients and the rest of the series coincide with prognostic classifications for PKP.