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201.
Smets YF; van der Pijl JW; van Dissel JT; Ringers J; de Fijter JW; Lemkes HH 《Nephrology, dialysis, transplantation》1997,12(4):764-771
BACKGROUND: Although technical success rate of simultaneous pancreas kidney
(SPK) transplantation in insulin-dependent diabetes mellitus (IDDM)
patients with diabetic nephropathy has improved, morbidity remains high due
to infection and rejection. The purpose of this study was to analyse
infections encountered in our series of SPK transplants, using a
restrictive antibiotic prophylaxis policy. METHODS: We reviewed all
infectious diseases after 66 consecutive bladder-drained SPK
transplantations in 64 IDDM patients with end-stage renal disease due to
diabetic nephropathy. During follow-up, the perioperative antibiotic
regimen was altered (from 5 days preemptive therapy with multiple drugs to
1 day prophylaxis with cefamandole), and long-term viral prophylaxis
(high-dose aciclovir) was introduced. For post-operative urinary tract or
opportunistic infection, no prophylaxis was given. RESULTS: Overall mean
infection rate was 2.9 infections/ patient/year after a mean follow-up of
2.3 years. Surgical site infections (SSI) were seen in 30% of the patients,
with Enterococci present in 47%. Logistic regression showed one day
cefamandole prophylaxis to be associated with SSI, but there was no
significant influence of SSI on either graft or patient survival.
Forty-eight percent of all infections were lower urinary tract infections
(UTI). There were 59 first UTIs (89%), probably related to long-term Foley
catheter use, and 47 second UTIs (71%). Subsequent UTIs were not
microbiologically related to first UTIs. Cytomegalovirus (10 patients) and
other opportunistic agents did not cause mortality or graft loss. Five
grafts were lost due to infection (SSI three times, post-transplant
lymphoproliferative disease twice). Only one patient died because of
infection (2%). CONCLUSIONS: Infectious diseases after SPK transplantation
caused significant morbidity but did not influence either patient or graft
survival. A change in prophylactic policy for both SSI as well as recurrent
UTI, combined with earlier Foley removal, may lower incidences of these
infections.
相似文献
202.
JW BALFE 《Nephrology (Carlton, Vic.)》1996,2(S1):s225-s229
Summary: An overview is presented of the current management of children with end-stage renal disease (ESRD), focusing on specific therapies such as haemodialysis, peritoneal dialysis and renal transplantation. Also discussed is the overall management of such children, with attention directed at growth, nutrition and development. 相似文献
203.
Complications of automatic implantable cardioverter defibrillators: radiographic, CT, and echocardiographic evaluation 总被引:1,自引:0,他引:1
Goodman LR; Almassi GH; Troup PJ; Gurney JW; Veseth-Rogers J; Chapman PD; Wetherbee JN 《Radiology》1989,170(2):447-452
Automatic implantable cardioverter defibrillators (AICDs) were studied in three groups: (a) Serial radiographs were reviewed in 51 clinic patients. Twenty of 96 (21%) AICD patches distorted with time. (b) Thirty-six postoperative computed tomographic (CT) scans of asymptomatic patients revealed that pericardial fluid collections were frequent during the month after surgery but rare beyond that. Echocardiography was insensitive for these collections. CT also demonstrated dense fibrosis around some distorted patches, months after surgery. (c) Five other patients with pericardial infection had distorted patches, and the four studied with CT had fluid beneath their patches. (d) A case of constrictive pericarditis had distorted patches but was not diagnosed with CT. The authors conclude that distorted patches may indicate postoperative complications and that CT is the imaging modality of choice. 相似文献
204.
Doppman JL; Dedrick RL; Shook DR; Lutz RJ; Goldstein SR; Blacklock JB; Boretos JW; Paul RH; Austin HA d; Bowman RL 《Radiology》1986,159(2):477-483
Techniques have been developed for isolated perfusion of chemotherapeutic agents in patients with glioblastoma. Three catheters that facilitate crossing the carotid siphon have been developed; two are based on an everting or toposcopic principle, and one uses microjets for deflectability and improved mixing. Blood from the ipsilateral jugular vein is aspirated at high volumes (300 ml/min) for extracorporeal circulation through an adsorption column (for recovery of carmustine) or dialysers (for recovery of cisplatin). Preliminary experience in 10 patients suggests that high doses of chemotherapeutic agent can be administered using these catheters, with reduced retinal and systemic toxicity. 相似文献
205.
A 64 year old caucasian male with known alcoholic liver disease presented with rectal bleeding. The patient bled repeatedly despite resuscitation. A sigmoid colectomy was performed following an angiogram. Large colonic, rectal and mesenteric variceal vessels were noted at surgery. Further bleeding postoperatively was rapidly controlled with octreotide infusion. Octreotide may be as useful in the control of colonic variceal bleeding as it is in the control of oesophageal variceal bleeding. 相似文献
206.
JW Nicol MB ChB MPJ Yardley FRCS PD Bull FRCS 《International journal of clinical practice》1994,48(5):278-279
SUMMARY A case is presented of a patient who required endotracheal intubation followed by tracheostomy and who consequently developed an adhesion between the vocal processes, which was identified and divided at direct laryngoscopy. 相似文献
207.
The clinical assessment of a transplanted kidney is often difficult, especially in the immediate postoperative period. The biochemical parameters used to monitor renal function change slowly and can take several days to reflect the actual renal status. We have modified a technique for determining the glomerular filtration rate (GFR) from a Tc-99m DTPA renal scan and have found that it correlates with the actual GFR throughout the postoperative course. In addition, we describe a method for changing dose calibrator measurements into administered counts. This technique for determining the GFR provides a quick and accurate assessment of renal function and is useful to guide therapeutic decisions. 相似文献
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