RESUMEN
Patients with intractably diminished bladder storage function are encountered frequently by neurourologists, occasionally requiring reconstructive surgery for appropriate resolution. Although sacral neuromodulation is a recognized effective therapeutic modality, present techniques are technically demanding, invasive, and expensive. This study investigated the effect of non-invasive third sacral nerve (S3) stimulation on bladder activity during filling cystometry. One hundred forty-six patients underwent standard urodynamic filling cystometry that was then immediately repeated. Patients in the study group (n = 74) received antidromic transcutaneous sacral neurostimulation during the second fill and the control group (n = 72) underwent a second fill without neurostimulation. A statistically significant increase in bladder storage capacity without a corresponding rise in detrusor pressure was observed in the neurostimulated patients. This improvement in functional capacity is an encouraging finding that further supports the use of this non-invasive treatment modality in clinical practice.
Asunto(s)
Terapia por Estimulación Eléctrica , Plexo Lumbosacro/fisiopatología , Vejiga Urinaria/fisiopatología , Incontinencia Urinaria/terapia , Adolescente , Adulto , Anciano , Estudios Cruzados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Presión , Incontinencia Urinaria/fisiopatología , UrodinámicaAsunto(s)
Trasplante de Riñón , Obtención de Tejidos y Órganos , Cadáver , Humanos , Factores de TiempoRESUMEN
This paper describes the results of renal transplants carried out in a single center more than 10 years ago. One hundred fifty-five recipients received 170 grafts; 164 from cadavers and 6 from living-related donors. All patients received the same immunosuppressive therapy with azathioprine and low-dose steroid. 1. The total actual patient survival was 67.1% at 10 years; 104 patients survived and 51 died. 2. The actual first cadaver graft survival was 54.7% at 10 years; 82 grafts survived and 68 were lost. Death with a functioning graft was the commonest cause of graft loss. 3. Ninety-seven patients and 70 first cadaver grafts survived in the 12th year. Two patients survived with first cadaver grafts into the 21st year. 4. Tissue match grade was not related to cadaver graft survival at 10 years. 5. Five of the 6 recipients of living-related donor kidneys survived but only 3 of their grafts were functioning after 10 years.
Asunto(s)
Azatioprina/uso terapéutico , Trasplante de Riñón/métodos , Prednisolona/uso terapéutico , Adolescente , Adulto , Niño , Supervivencia de Injerto , Antígenos HLA , Humanos , Terapia de Inmunosupresión , Trasplante de Riñón/inmunología , Persona de Mediana Edad , Prednisolona/administración & dosificaciónRESUMEN
93 patients received 102 renal transplants between 1968 and 1977. 99 grafts were from cadavers and 3 were from live donors; 93 were first grafts, 7 were second, and 2 were third. At 10 years total actual patient survival was 66.6%. 50 (55.5%) of 90 first cadaver grafts, and 52.2% of all cadaver grafts, survived at 10 years. Cardiovascular disease was the commonest cause of death, being responsible for 18 of 31 deaths (58%).
Asunto(s)
Azatioprina/uso terapéutico , Trasplante de Riñón , Prednisolona/uso terapéutico , Adolescente , Adulto , Cadáver , Causas de Muerte , Supervivencia de Injerto , Humanos , Terapia de Inmunosupresión , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
A new urodynamic investigation system, based on a microprocessor, is described. The design principles, versatility and advantages of the equipment are discussed. It is concluded that this system offers significant benefits to the urodynamic unit for both routine and research work.
Asunto(s)
Computadores , Microcomputadores , Urodinámica , Adulto , Femenino , Humanos , Masculino , Reología , Vejiga Urinaria/fisiopatología , Micción , Trastornos Urinarios/fisiopatologíaRESUMEN
We have used a low dose of steroid (20 mg of prednisolone), commencing the day after transplantation, for 151 consecutive renal transplants in 141 patients. Five patients received grafts from living related donors, 146 received cadaver grafts. All patients received azathioprine for routine immunosuppression and the first 47 received a single dose of actinomycin C i.v. for treatment of rejection. No other immunosuppressive drugs were used. This treatment provided satisfactory immunosuppression as 109 of 151 grafts continue to function for periods of 3 months to 10 years and, of 42 grafts lost, only 17 failed from rejection. The cumulative survival of first cadaver grafts at 1 and 2 years in recipients of all ages (7 to 55 years) was 77.9 and 76.0%, respectively; in recipients 15 to 34 years old, 90.9 and 86.1%, respectively. Twenty-three patients died, no patient died from infection during the admission for transplantation, and infection played a part in the deaths of only four patients. The incidence of other complications was low; seven patients developed gastrointestinal complications, one died, four patients developed diabetes, all survived; only one patient developed avascular necrosis of bone.
Asunto(s)
Trasplante de Riñón , Prednisolona/administración & dosificación , Administración Oral , Adolescente , Adulto , Azatioprina/farmacología , Cadáver , Niño , Diabetes Mellitus/inducido químicamente , Enfermedades Gastrointestinales/inducido químicamente , Supervivencia de Injerto/efectos de los fármacos , Humanos , Hidrocortisona/farmacología , Persona de Mediana Edad , Osteonecrosis/inducido químicamente , Prednisolona/efectos adversos , Prednisolona/farmacología , Trasplante HomólogoRESUMEN
One hundred and nine patients undergoing 119 transplants have been followed up from 8 months to 9 years. Urological complications occurred in 16 transplants, an incidence of 13.4%. Ureteroneocystostomy was performed primarily in all cases; in 98 by the conventional Politano-Leadbetter technique with 9 (9.2%) urological complications and in 32 by an extravesical technique with 7 (21.8%) urological complications. One patient died as a result of ureteric obstruction, without operation. In 3 patients with lower ureteric obstruction, transurethral ureteric meatotomy was successful in 2 cases and resulted in no change in renal function in the third. Two patients with urinary fistulae were managed successfully by continuous drainage with indwelling urethral catheters. The remaining 10 patients required 12 open surgical procedures for relief of ureteric obstruction, with improvement in function in 7 patients.
Asunto(s)
Trasplante de Riñón , Trasplante Homólogo/efectos adversos , Estudios de Seguimiento , Humanos , Métodos , Complicaciones Posoperatorias , Enfermedades Ureterales/etiología , Enfermedades Ureterales/cirugía , Obstrucción Ureteral/etiología , Obstrucción Ureteral/cirugía , Cateterismo Urinario , Fístula Urinaria/etiología , Fístula Urinaria/cirugía , UrografíaRESUMEN
Azathioprine combined with a low dose of steroid (20mg of prednisolone) commencing the day following transplantation has been used for immunosuppression for 151 consecutive renal transplants in 141 patients (146 cadaver grafts, 5 living related donor grafts). Immunosuppression was satisfactory as 109 grafts function from 6 months to 10 years, 17 of 42 grafts lost failed from rejection. No patient died from infection before 90 days, 4 died later from infection, 2 associated with anti-rejection therapy. Seven patients developed gastrointestinal complications, 1 died; 4 developed diabetes, all survived; only 1 patient developed avascular necrosis of bone.
Asunto(s)
Trasplante de Riñón , Prednisolona/uso terapéutico , Adolescente , Adulto , Anciano , Azatioprina/uso terapéutico , Enfermedades del Sistema Nervioso Central/mortalidad , Niño , Neoplasias del Colon/mortalidad , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Enfermedades Gastrointestinales/mortalidad , Rechazo de Injerto , Cardiopatías/mortalidad , Articulación de la Cadera/fisiopatología , Humanos , Hidrocortisona/uso terapéutico , Inmunosupresores , Persona de Mediana Edad , Embolia Pulmonar/mortalidad , Factores de TiempoRESUMEN
100 kidney transplants have been carried out on 91 patients (7 had 2 transplants and 2 had 3 transplants). 4 transplants were from living related donors and 96 from cadavers. 76 patients survive, all but one with functioning kidneys. The cumulative survival of patients was 82% at 2 years and 80-7% at 5 years. 8 patients died with functioning grafts, and 2 of the other deaths took place more than 3 months after removal of a rejected kidney and resumption of haemodialysis. There were no deaths from sepsis in the first 60 days after transplantation. The cumulative survival of all grafts was 82-1% at 2 and 5 years. The cumulative survival of first grafts was 82-5% at 2 and 5 years.