From our point of view, the consequence of the mercury intoxication (mercury chloride) [author’s remark: in those times, mercury chloride was a common disinfectant] is imitating this condition and thereby leading to a ‘blockade of the reticulo-endothelial system’ with a simultaneous acute renal failure. Therefore, in this clinical situation with the above-mentioned constellation, the absolute indication for kidney transplantation is given because of the lack of renal function. Mercury chloride, which is known to be a salt of a heavy metal, causes localized lesions and after resorption, it causes damage to parenchymatoseous organs, particularly of the intestine and the kidneys. Obviously caused by the negative molecular charge and the binding to blood proteins, it results in a selective dysfunction of the reticulo-endothelial system. The histopathological analysis of the organs which were damaged by the mercury chloride (spleen, lymph-nodes, liver, heart, adrenal glands, etc.) showed that particularly the organs which are rich in reticulo-endothelial-system had degenerations, although they retained their ability to regenerate. Furthermore, the mercury elimination from the organism is prolonged because of a relative high blood level. So, in our case, the blood-concentration of mercury on the fourth day after the ingestion of 4.0 g of mercury chloride with suicidal intention was 1.5 mg%, and it was reduced by 10-fold on the next day, which was the first day after transplantation. Therefore, at a state of moderate intensity and in an early stage of the mercury chloride poisoning, after a complete degeneration of the parenchymatous organs did not already occur, the time window of the ‘blockade of the reticulo-endothelial system’ in a state of potential regeneration of the parenchymatous organs can be identified. In such a situation, the kidney transplantation performs the task of elimination of the poison from the organism as long as the endogenous kidneys have regenerated fairly. In summary, it can be concluded that after the question of sense and purpose of a kidney transplantation after mercury chloride poisoning was explained, we had to find an adequate organ, as we know the attempts of xenotransplantation (for example, from monkeys or domestic animals like pigs or goats) were disappointing. Particularly, in some of these experiments, a continuous anaphylaxis of the recipient animal after reperfusion of the organ which was anastomosed by vessel suture could be observed, which had a lethal result for the recipient animal. Against the background of these facts, a human cadaver seems to be the best option as a donor transplant organ because a healthy human can under no circumstances be deliberately injured by the organ removal, even if the removed organ is for transplantation. It is proven that cadaveric organs keep their sterility for some time. Furthermore, it is known from the physiology that cadaveric kidneys keep their function for some time after reperfusion with ringer-solution. Under consideration of these assessments, different groups of scientists have tried to transplant skin, joints and parathyreoideal glands from a human body to another human. The description of a kidney transplantation from a traumatic body to another human with the revascularization by vessel anastomosis is not yet known. So we report here about a kidney transplantation which was approved by Professor A. Belz.
The objective of this study was to assess the cost-utility of renal transplantation compared with dialysis. To accomplish this, a prospective cohort of pre-transplant patients were followed for up to two years after renal transplantation at three University-based Canadian hospitals. A total of 168 patients were followed for an average of 19.5 months after transplantation. Health-related quality of life was assessed using a hemodialysis questionnaire, a transplant questionnaire, the Sickness Impact Profile, and the Time Trade-Off Technique. Fully allocated costs were determined by prospectively recording resource use in all patients. A societal perspective was taken. By six months after transplantation, the mean health-related quality of life scores of almost all measures had improved compared to pre-transplantation, and they stayed improved throughout the two years of follow up. The mean time trade-off score was 0.57 pre-transplant and 0.70 two years after transplantation. The proportion of individuals employed increased from 30% before transplantation to 45% two years after transplantation. Employment prior to transplantation [relative risk (RR) = 23], graft function (RR 10) and age (RR 1.6 for every decrease in age by one decade), independently predicted employment status after transplantation. The cost of pre-transplant care (66,290) were similar. Transplantation was considerably less expensive during the second year after transplantation ($27,875). Over the two years, transplantation was both more effective and less costly than dialysis. This was true for all subgroups of patients examined, including patients older than 60 and diabetics. We conclude that renal transplantation was more effective and less costly than dialysis in all subgroups of patients examined.
For many years, there was controversy over whether stents should be used after ureteral surgery. The argument was nowhere more evident than in discussions of pyeloplasty or repair of ureteral injury because the results were often poor whether or not a stent was used. The early stents were standard ureteral catheters or, in some cases, small urethral catheters with only two holes in the distal end, and these did not provide adequate urine drainage. The smooth muscles of the calyces and renal pelvis push a bolus of urine into the upper ureter with a rather strong peristaltic contractions, and small-caliber ureteral catheters cannot drain this sudden increase in volume. Thus, in the case of a pyeloplasty, some urine was forced out of the ureteropelvic anastomosis. In the case of injury farther down the ureter, once the bolus of urine had passed the ureteropelvic junction, it had no way of reentering the catheter lumen and so was carried under pressure along the outside of the stent to the site of the injury, where, again, leakage occurred. In either case, the leakage of urine into the periureteral tissues caused fibrosis, contracture, and stricture. Also, these stents were rarely left indwelling and therefore served as an avenue for infection. Further, because these stents drained to the outside and so required external collection devices, patients were eager to have them removed on the earliest possible date. Most urologists arbitrarily removed the stents after only 10 days, long before healing was complete.
Temel ve Sistemik Cerrahi
Jan 2005
647-711
H Gulay
Gulay H. Temel ve Sistemik Cerrahi. İzmir Güven Kitapevi.
2005; 1.cilt, 647-711.