Clotting problems with the Teflon-Silastic arteriovenous shunt in patients on regular haemodialysis.

Episodes of clotting that occurred in 22 patients on regular haemodialysis were studied over a six-month period. The venous pressure during dialysis and the radiology of the Teflon-Silastic arteriovenous shunt were found to be satisfactory guides for the management of the shunt. The failure of the shunt during the early stage was mainly due to technical reasons. Histological study of the excised vessels in removed long-term shunts showed that these had failed because of rigidity and thickening of the vessel wall due to calcium and iron deposits or chronic inflammation, or both.

Renal carcinoma in patients undergoing nephrectomy: analysis of survival and prognostic factors.

A series of 155 patients who underwent nephrectomy for renal carcinoma between 1965 and 1985 at Manchester Royal Infirmary were analysed for survival in relationship to presenting features, surgical staging and histopathology. Univariate and multivariate analyses were carried out. Five-year survival estimates for stage 1 disease were 81%, for stage 2 disease 65%, for stage 3 disease 39% and for stage 4 disease 6%. An erythrocyte sedimentation rate (ESR) greater than 30 mm/h was associated with worse survival and a history of hypertension was associated with better survival. Renal vein invasion alone was related to worse survival. Perinephric fat invasion was also associated with worse survival and this association in the multivariate analysis was more significant than expected, suggesting that the principles of radical surgery should be observed. The presence of granular cells as opposed to clear cells worsened survival. Patients with papillary tumours had a better survival than those with solid tumours.

Bile acid malabsorption: a complication of conduit surgery.

We examined the possibility that use of a section of the terminal ileum for ileal conduit construction may impair bile acid absorption and cause choloretic diarrhoea. Nineteen normal subjects (mean age 41 years) and 16 patients with conduits (mean age 47 years) were investigated using the SeHCAT retention test. Conduit patients showed significant impairment of SeHCAT retention compared with normal subjects; 82% of patients had a retention below the lower limit of normal. The mean bowel frequency of patients during the test was 3 motions/day this being significantly different from their pre-operative bowel habit. It was concluded that the use of the terminal ileum in conduit construction may impair bile acid absorption, as measured by the SeHCAT retention test, and may cause an increase in bowel frequency.

Modified method of diuresis renography for the assessment of equivocal pelviureteric junction obstruction.

Thirty-five hydronephrotic kidneys, in which diuresis renography showed either an equivocal (13) or non-obstructive (22) response pattern, were studied by a modified method in which intravenous frusemide was given 15 min before the start of the renogram so as to assess elimination during the period of maximum diuresis. Thirteen kidneys were identified as obstructed, including three in which the standard diuretic renogram appeared to exclude obstruction. These results indicate that the modified method increases the specificity of diuresis renography when used to assess patients with equivocal pelviureteric junction obstruction.

Response to influenza vaccine by renal transplant patients.

Twenty-five renal transplant patients and 17 controls were vaccinated with influenza vaccine. Antibody titres were estimated before and one, three, and 12 months after vaccination. On the basis of antibody titre measurements the transplant group showed a similar qualitative and quantitative response to that of the controls. No rejection episodes occurred among the transplant patients as a result of vaccination and nobody in the trial developed influenza. We conclude that it is safe to vaccinate transplant patients with an inactivated influenza vaccine and that protection (haemagglutination-inhibiting antibody) can be induced.

Diuresis renography and the results of pyeloplasty for idiopathic hydronephrosis.

Eighty-six kidneys in 82 patients have been assessed by diuresis renography after pyeloplasty. A non-obstructed diuresis renogram was found in 64% of kidneys. Ninety per cent of patients were clinically improved by surgery and 51% of cases studied had improved urographic features. Thirty kidneys (29 patients) were assessed both before and after pyeloplasty. An improvement in the diuresis renogram was found in 89% of cases postoperatively. Standard renography demonstrated improved drainage in only 33% of kidneys. These findings are discussed in relation to the value of diuresis renography after pyeloplasty.

Dynamic scintigraphy in clinical urology.

The technique of isotope renal scintigraphy using Technetium-99m labelled agents and a gamma camera system on-line to a digital computer is described. Its value in diagnosing renal space-occupying disease and renovascular abnormalities is emphasised. A method of measuring individual renal haemodynamics and the possible potential of such techniques are discussed. Radio-isotope studies are rapid, simple, non-invasive and non-toxic. They give information complementary to that from urography.

Regional renography in segmental renal disease.

Twenty-nine patients with symptomatic segmental renal disorders were studied by regional renography. Twenty-three patients had duplex kidneys and 6 had other segmental disease. Abnormal gamma camera findings included ureteroureteric reflux, vesicoureteric reflux, impaired function, obstruction and non-obstructive dilatation. Comparison between renography and radiology in duplex kidneys showed agreement in 10 cases. In 7 kidneys the gamma camera provided additional information and in 6 cases the X-rays alone were abnormal. It is concluded that regional renography should be performed wherever possible to complement conventional radiology in the functional and urodynamic evaluation of segmental renal disease.

The dilated non-obstructed renal pelvis.

This paper discusses 28 patients with renal pelvic dilatation in whom obstruction was excluded by excretion urography and diuresis renography. The clinical presentation and progress of the patients over a follow-up period of 1 to 5 years are presented. One patient required pyeloplasty, one developed 2 asymptomatic pelvic calculi and one showed some deterioration in function on the affected side. The remaining 25 patients remain well and their follow-up renograms show satisfactory renal function and excretion. Before the advent of objective means of assessing renal function and urodynamics, these patients would probably have been subjected to pyeloplasty. The present study confirms that the correct management of the dilated non-obstructed renal pelvis is conservative.