RESUMO
Between January 1985 and September 1987, we performed a prospective comparative study between segmental-pancreas transplantation with duct obstruction by neoprene (n = 17) and pancreaticoduodenal transplantation with enteric diversion to a Roux-en-Y intestinal loop (n = 14). All recipients had insulin-dependent diabetes. The immunosuppressive protocol consisted of low doses of the steroids cyclosporin A and azathioprine. Mean follow-up was 16.5 mo for the enteric-diversion group and 13.5 mo for duct-obstructed groups. Two-year patient and pancreas- and kidney-graft actuarial survival rates were 92.9, 75.5, and 74.2%, respectively, in the former group and 92.3, 58.4, and 63.7%, respectively, in the latter group (NS). Five whole-organ grafts were lost (3 vascular thromboses, 1 pancreatitis, 1 rejection), and four segmental grafts were lost (2 vascular thromboses, 1 bleeding, 1 patient's death with functional graft). More surgical complications occurred in the recipients of whole-organ grafts and were often related to the intestinal anastomosis. A satisfactory blood glucose control was observed at 3 mo and 1 yr in both groups. Provocative tests showed higher and prompter insulin secretion in patients with whole-organ grafts. In patients with segmental grafts, the response was lower and delayed with a general tendency to impaired glucose tolerance. A marked hyperinsulinemia after meals was observed in whole-organ graft recipients. Slight nocturnal hyperinsulinemia was observed in both groups. At 1 yr, glycosylated hemoglobin was normal in both groups. The absence of a significant difference between the two groups, in terms of survival and graft function, and the lower surgical complication rate seen with segmental grafts have made us return to neoprene-injected segmental grafts.
Assuntos
Duodeno , Transplante de Pâncreas , Ritmo Circadiano , Diabetes Mellitus Tipo 1/cirurgia , Sobrevivência de Enxerto , Humanos , Terapia de Imunossupressão , Insulina/sangue , Transplante de Rim , Ductos Pancreáticos/cirurgia , Estudos ProspectivosRESUMO
Since November 1975, 103 pancreas transplantations have been performed in 97 insulin-dependent diabetic patients. Pancreas and kidney were grafted simultaneously in 84 patients (plus 1 double retransplantation). Eighty-nine pancreas grafts were prepared by duct obstruction with neoprene, and 14 were pancreaticoduodenal grafts with enteric diversion in a Roux-en-Y loop. Five immunosuppressive protocols were subsequently used. With the latest protocols, patient and pancreas survival improved to 93 and 72% at 1 yr, respectively. The improvement in graft survival appeared to be particularly related to the reduction of the number of pancreas grafts lost in rejection. The patients treated with the last protocols, including cyclosporin A (CsA) and only low doses of steroids, showed a better glucose tolerance after provocative tests. Pancreas-graft function did not appear to be influenced by CsA treatment.
Assuntos
Terapia de Imunossupressão , Transplante de Pâncreas , Soro Antilinfocitário/uso terapêutico , Azatioprina/uso terapêutico , Ciclosporinas/uso terapêutico , Duodeno/patologia , Teste de Tolerância a Glucose , Sobrevivência de Enxerto , Humanos , Transplante de Rim , NeoprenoRESUMO
Patient and kidney survival rates were compared between 69 diabetic patients undergoing simultaneous kidney-pancreas transplantation (group 1) and 723 nondiabetic patients undergoing kidney transplantation (group 2). The patients were treated with different immunosuppressive regimens over the years: steroids plus antilymphocyte globulin (ALG) plus azathioprine (Aza); cyclosporin A (CsA) plus ALG; steroids plus ALG plus Aza, replacing Aza 1 mo posttransplantation; or low doses of steroids plus CsA plus Aza. One-year kidney survival rates with the different regimens were 50, 42, 54, and 76%, respectively, in group 1 and 71, 74, 78, and 84%, respectively, in group 2. Patient survival was 60, 57, 71, and 86%, respectively, in group 1 and 93, 95, 94, and 96%, respectively, in group 2. Differences between the two groups were statistically significant for the first three protocols but not for the one used in this study. In group 1, 38 patients (55%) had a functioning kidney graft, whereas 15 (21%) lost their kidney to rejection. Between these two patient categories, there was no significant difference in age, sex, duration of diabetes, time on dialysis, blood transfusion number, HLA immunization, or HLA matching. Thus, since 1984, kidney-graft survival has not been inferior in diabetic patients. This improvement is mainly due to a decreased mortality related to better patient preparation and improvement in immunosuppression.
Assuntos
Sobrevivência de Enxerto , Transplante de Rim , Transplante de Pâncreas , Humanos , Terapia de ImunossupressãoRESUMO
Surgery plays an important role in the treatment of renovascular Hypertension (RVHT). 123 RVHT carrier patients were treated by means of 101 single autotransplants (11 double autotransplants) and 34 autotransplants preceded by extracorporeal replacement of the branches of the renal artery (1 bilateral case). Taken all round, the patients improved either totally or partly (93.5%). In lesions involving multiple branches of the renal artery, replacement of these by a hypogastric autologous arterial transplant is regularly the only technique possible to save the kidney.
Assuntos
Hipertensão Renovascular/cirurgia , Transplante de Rim , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Hipertensão Renovascular/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Transplante AutólogoRESUMO
Six patients carrying bulky renal cysts located in the kidney lower pole were treated by percutaneous resection of the cystic wall. No complications were observed during the peri and postoperational period. In all cases disappearance of symptoms was observed, and the total success rate (absence of residual cavity) recorded was 4/6, two cases presenting persistence of a small residual cavity which originated one case of relapse. The paper presents the technique used, and the indications and possible therapeutic actions for the treatment of simple kidney cysts are discussed.
Assuntos
Doenças Renais Císticas/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Operatórios/métodosAssuntos
Terapia de Imunossupressão/métodos , Transplante de Pâncreas , Soro Antilinfocitário/uso terapêutico , Azatioprina/uso terapêutico , Ciclosporinas/uso terapêutico , Esquema de Medicação , Quimioterapia Combinada , Sobrevivência de Enxerto , Humanos , Pâncreas/imunologia , Pâncreas/fisiologia , Prednisona/uso terapêuticoAssuntos
Imunossupressores/uso terapêutico , Transplante de Rim , Transplante de Pâncreas , Análise Atuarial , Creatinina/sangue , Infecções por Citomegalovirus/etiologia , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/tratamento farmacológico , Nefropatias Diabéticas/cirurgia , Rejeição de Enxerto/efeitos dos fármacos , Humanos , Insulina/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Estudos RetrospectivosAssuntos
Adenocarcinoma/diagnóstico , Neoplasias da Próstata/diagnóstico , Fosfatase Ácida/sangue , Adenocarcinoma/patologia , Idoso , Antígenos de Neoplasias/análise , Cálculos/diagnóstico , Ensaios Enzimáticos Clínicos , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Próstata/enzimologia , Antígeno Prostático Específico , Hiperplasia Prostática/diagnóstico , Neoplasias da Próstata/patologia , Fatores de TempoRESUMO
Two patients in end-stage renal failure and with neurogenic bladders due to spina bifida complicated by myelomeningocele were considered for renal transplantation. One patient had had a right nephrectomy and urinary diversion via an ileal conduit; the other, after various external drainage procedures (cystostomy, bilateral nephrostomy), had had a tubular ileocystoplasty. Both underwent 2 surgical procedures prior to renal transplantation: in case 1 we performed a left nephrectomy and then ileal conduit removal + Kock pouch; in case 2 a bilateral nephrectomy was performed via 2 posterior incisions and then we removed the ileocystoplasty and formed the pouch. The continent ileostomy was formed according to the original technique with slight modifications. The patients have been followed up for 12 and 15 months after transplantation.
Assuntos
Transplante de Rim , Cuidados Pré-Operatórios , Derivação Urinária , Injúria Renal Aguda/cirurgia , Adulto , Feminino , Humanos , Ileostomia , Íleo/cirurgia , Masculino , Meningomielocele/complicações , Espinha Bífida Oculta/complicações , Bexiga Urinaria Neurogênica/etiologiaRESUMO
Combined liver and pancreas harvesting in the same donor is nowadays a routine procedure in our institution. In terms of sharing of the vascular pedicule the priority is given in the majority of cases to the liver graft. Thus vascular reconstruction of the pancreatic graft is often required before transplantation. From February 1987 to June 1990 we transplanted 62 pancreases coming from a donor where also a liver graft had been harvested; 46 were segmental grafts prepared by duct injection with neoprene, 14 were pancreatico-duodenal grafts with bladder diversion of the exocrine secretion, and 2 were whole pancreas scheduled for bladder diversion and secondarily reconverted to duct injection (1 whole and 1 segmental graft) for poor duodenal blood supply. Among the 47 segmental grafts (46 + 1 reconverted from whole to segmental), in only 10 cases was the celiac axis with an aortic patch possible; conversely in 37 cases the splenic artery had been divided at its origin during the harvesting; bench surgery for vascular reconstruction was realized in 33 cases. Among the 14 pancreatico-duodenal grafts with bladder diversion and the whole pancreas with duct obstruction, in 5 cases the celiac axis and the superior mesenteric artery were harvested on the same aortic patch; in 10 cases the splenic artery was divided at its origin during the harvesting, requiring bench surgery for reconstruction.
Assuntos
Diabetes Mellitus Tipo 1/cirurgia , Artéria Hepática/cirurgia , Transplante de Pâncreas/métodos , Pâncreas/irrigação sanguínea , Artéria Esplênica/cirurgia , Cadáver , Duodeno/irrigação sanguínea , Duodeno/transplante , Humanos , Fígado/irrigação sanguínea , Transplante de Fígado , Obtenção de Tecidos e ÓrgãosRESUMO
The rationale behind pancreatic transplantation is to provide a self-regulated, endogenous source of insulin and other islet hormones, thus restoring normal metabolism with the ultimate goals of prevention, stabilization or reversal of secondary degenerative complications. We report clinical and metabolic data of 8 patients submitted to simultaneous kidney and pancreas transplantation in our institute, who had a pancreatic graft function for 4 (1 case) and 5 (7 cases) years. To assess the impact of transplanted pancreatic mass on long-term function, we also included 10 patients from a comparative study between segmental pancreas transplantation (group A, 5 pts) and whole pancreas with enteric diversion transplantation (group B, 5 pts), who had pancreatic function for 2 and 3 yr. All patients are alive. Seven of these patients are off insulin, while one patient lost pancreatic function during an operation performed to correct an arterial stenosis of the graft. HbAlc levels were normal during the entire follow-up period (5.2+/-0.14% at 4 yr; 5.1+/-0.6% at 5 yr). In 24-hour metabolic profiles we observed near normal blood glucose levels, with good insulin release at 4 yr and a mild hyperglycemia at 5 yr (BG at 9 p.m.: 8.8+/-1.3 mmol/l). OGTT performed in 5 patients, 4 yr after pancreas transplantation, showed an impaired glucose tolerance, while the same test performed at 5 yr, showed higher values (BG 120 minutes: 14.7+/-0.2 mmol/l). Group A and group B patients are all alive, with good renal and pancreatic function.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Diabetes Mellitus Tipo 1/cirurgia , Duodeno/transplante , Transplante de Pâncreas , Adulto , Diabetes Mellitus Tipo 1/complicações , Neuropatias Diabéticas/prevenção & controle , Neuropatias Diabéticas/terapia , Retinopatia Diabética/prevenção & controle , Retinopatia Diabética/terapia , Seguimentos , Humanos , Transplante de Rim/métodos , Transplante de Pâncreas/métodos , Ductos Pancreáticos/cirurgiaRESUMO
From September 1984 to March 1986, 70 patients with upper ureteral stones were treated in our institution. 43 patients underwent endoscopic procedures including retrograde ureterorenoscopy, antegrade ureterorenoscopy and percutaneous surgery. A second group of 27 patients was treated by extracorporeal shock wave lithotripsy (ESWL). The overall success rate was 74.5 and 85% for the endoscopic and the ESWL groups, respectively. Obstruction and dilatation of the renal collecting system seemed to play a major role in the failure of either endoscopic or ESWL treatment.
Assuntos
Cálculos Ureterais/terapia , Adulto , Dilatação/métodos , Endoscopia , Feminino , Humanos , Litotripsia , Masculino , Fatores Sexuais , Cálculos Ureterais/cirurgiaRESUMO
Thirteen patients with a benign tumor or pseudotumor of the upper urinary tract underwent endourological treatment on 17 occasions. These patients were divided into two groups according to the anatomopathological findings. Five patients comprised group I. Mean patient age, 57.3 years. These patients had a tumor in the excretory cavity. Endoscopic work up revealed 3 papillary necroses, 1 inflammatory polyp, 1 Von Brun islet. One ureterorenoscopy (biopsy + laser) and four percutaneous (tumor resection) procedures were performed. Eight patients comprised group II. Mean patient age, 59 years. Six patients had pyelocaliceal tumors and two patients had ureteric tumors. Histologic analyses revealed a noninvasive low grade tumor on six occasions and two fibroepithelial polyps. Two ureteric tumors and 1 pelvic tumor were treated by retrograde ureterorenoscopy (2 resections and 1 Nd/Yag laser photocoagulation). Five patients were treated percutaneously (resection alone or combined with Nd/Yag laser). Four patients received local chemotherapy. Patient follow-up ranged from 1 to 3 years. Tumor recurrence was observed in 3 patients treated by percutaneous resection.
Assuntos
Endoscopia , Neoplasias Renais/cirurgia , Neoplasias Ureterais/cirurgia , Idoso , Antineoplásicos/uso terapêutico , Terapia Combinada , Feminino , Humanos , Neoplasias Renais/tratamento farmacológico , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Ureterais/tratamento farmacológicoRESUMO
The percutaneous treatment of benign renal cysts has been proposed in alternative to conventional surgery. It minimizes the complication rate and assures good clinical results. In our Department, 15 patients with 16 symptomatic benign renal cysts underwent either percutaneous cyst aspiration + sclerosis (10 cases) or percutaneous resection of the cyst wall (6 cases). In the first group, all patients were relieved from symptoms, and 70% had no residual cavity. Two patients presented a secondary infection of the cyst, treated with systemic antibiotics and percutaneous drainage (1 case). In the second group, we did not observe any complication, all patients were relieved from symptoms, and only 1 cyst recurred, probably due to incomplete resection.