A complication of percutaneous transluminal angioplasty in the transplanted kidney

The following case report illustrates a complication that can occur as a consequence of implementing percutaneous transluminal angioplasty for correction of renal artery stenosis in a transplanted kidney. Immediately following the procedure, there was severe spasm of upper and lower branches of the renal artery and thrombosis of the arterial supply to the middle portion of the kidney.     

Abscess-fistula association: radiologic recognition and percutaneous management

Thirty-five patients with postoperative enteric and/or biliary fistulae were diagnosed and treated by percutaneous catheter drainage. All were initially considered to have postoperative abdominal abscesses, and the enteric or biliary communications were unrecognized before radiologic intervention. In addition, at the time of initial catheter insertion, only six of the 35 abscesses were recognized as being associated with an underlying fistula. In the other 29 patients the fistulae were found either by clinical follow-up or contrast sinogram after 24-72 hr of catheter drainage. Percutaneous catheter drainage was the definitive treatment in 28 (80%) of the 35 patients. The seven failures were either from inadequate catheter positioning or inability to treat the primary cause of the fistula (e.g., radiation enteritis, perforated cancer). These data suggest that even abscesses with underlying fistulae, traditionally an indication for surgical intervention, may be successfully managed by percutaneous methods.     

Obstructed hepatic duct bifurcation: decompression via single percutaneous tract

A technique for the percutaneous decompression of the obstructed right and left hepatic ducts using a single percutaneous tract was performed successfully on eight patients with bilateral ductal obstruction of various etiologies. Eliminating a second percutaneous drainage procedure when bilobar biliary decompression is indicated results in decreased morbidity, increased patient acceptance, and effective palliation of centrally obstructing lesions of the biliary tract.     

应用介入技术治疗肾脏移植并发症

近年来随着医学技术的不断进步,各种器官的移植愈来愈多,尤其是肾脏移植己基本成熟,肾移植的数量也明显增多,但随之而来肾移植并发症患者的数量也明显增加。特别是移植肾动脉,肾静脉和输尿管狭窄的患者,因此探索一种安全有效损伤小的技术愈显重要,作者通过自己的工作结合文献复习,认为介入技术为治疗肾移植后并发症最好方法之一,优于外科手术。自1954年Merril为首的移植小组成功地完成了同卵双生子之间的肾移植,并使移植肾得到长期存活以来,肾移植得到了迅猛发展,到2001年底,全球共实施同种异体肾移植50万例,我国共实施肾移植4万余例。但随…     

Polar infarct in a transplanted kidney: Cause of a pseudomass

Ultrasonography has become fairly standard for assessing common complications of renal transplantation such as hydronephrosis, urinomas, and lymphoceles. Infarctions are a less common complication that may occur in the setting of transplant rejection. We report a case in which an apparent solid mass on sonography proved to represent normal residual renal parenchyma in a kidney with a small shrunken lower pole due to infarction.     

Polar infarct in a transplanted kidney: cause of a pseudomass

Ultrasonography has become fairly standard for assessing common complications of renal transplantation such as hydronephrosis, urinomas, and lymphoceles. Infarctions are a less common complication that may occur in the setting of transplant rejection. We report a case in which an apparent solid mass on sonography proved to represent normal residual renal parenchyma in a kidney with a small shrunken lower pole due to infarction.     

Aortic dissection: percutaneous management with a separating stent-graft--preliminary results

PURPOSE: To determine the test performance and longitudinal evolution of air trapping for diagnosing bronchiolitis obliterans syndrome (BOS). MATERIALS AND METHODS: Over 7 years, 111 combined inspiratory and expiratory computed tomographic examinations were performed in eight healthy control subjects and 38 heart-lung transplant recipients. Functional impairment was assessed with the BOS classification. Receiver operating characteristic (ROC) analysis was performed to determine the optimal threshold of air trapping to distinguish between patients with and those without BOS and to compute sensitivity and specificity for diagnosing BOS. RESULTS: The extent of air trapping increased with BOS severity (P =.001). A threshold of 32% of air trapping is optimal for distinguishing between patients with and those without BOS and provides a sensitivity of 83%, a specificity of 89%, and an accuracy of 88%. The prevalence of BOS and positive predictive value of air trapping increased with postoperative time, but the negative predictive value of air trapping remained high throughout the study. Patients without BOS who had air trapping exceeding 32% of the parenchyma were at significantly increased risk of developing BOS (P =.004). CONCLUSION: At the threshold of 32%, air trapping is sensitive, specific, and accurate for diagnosing BOS. Patients with air trapping below 32% are unlikely to have BOS. Air trapping exceeding 32% may be an early indicator of future BOS.     

Use of mycophenolate mofetil in patients with a transplanted kidney and cyclosporin nephrotoxicity

Cyclosporine (CsA) nephrotoxicity is an important problem in renal transplant recipients, which can influence long-term graft survival. The safety of conversion from CsA to azathioprine (AZA) remains controversial and can result in higher incidence of acute rejection. Mycophenolate mofetil (MMF) is a new immunosuppressive agent superior to AZA in the prevention of acute rejection. Five patients with cyclosporine nephrotoxicity were converted from CsA/AZA/prednisolon to MMF/prednisolon protocol. All patients had low immunological risk and 4 out of 5 patients received antithymocyte globulin before conversion as the induction therapy or as the treatment for acute rejection. Mean follow-up after conversion was 16.8 months (range 4-32 months). No patient experienced acute rejection during follow-up period. The mean serum creatinine concentration decreased from 219 +/- 44.18 (range 168-280) to 122.6 +/- 48.02 mumol/l (range 72-187 mumol/l) (p = 0.002). Arterial hypertension improved after CsA withdrawal in 20% of patients. We have concluded that, in selected patients with cyclosporine nephrotoxicity, CsA withdrawal with concomitant use of MMF is safe and effective in the improvement of graft function and arterial hypertension.     

Intravascular gas in the transplanted kidney: a sign of extensive graft necrosis

We encountered a case of transplanted kidney necrosis, with computed tomography (CT) demonstrating multiple areas of intravascular gas within the allograft. The intravascular gas represented air emboli from gas liberated from fermentation by gas-forming organisms in a perinephric abscess. Arterial bleeding accelerated by the wound infection and the resultant large perinephric hematoma caused renal infarction. Gas-forming infection of transplanted organs is associated with a poor graft outcome, which can present as a fulminant clinical course. Intravascular gas should be distinguished from collecting system gas because the former could represent extensive necrosis of the transplanted kidney.     

Exercise renal scintigraphy shows renal ischemia in a transplanted kidney

Exercise renography is essentially a research method to investigate hypertension and has very limited clinical application. Captopril renography has long been used to study renal artery stenosis causing hypertension with good results. The authors describe a patient with a transplanted kidney supplied by reversal of flow via the external iliac artery. A "steal phenomenon" of the kidney related to ambulation was considered likely. Ischemia of the transplanted kidney was revealed by exercise renography, which showed parenchymal trapping of radiotracer as a result of exercise.     

Magnetic resonance imaging, with surface coil, of a transplanted kidney

MR appearance of the kidney transplant is evaluated on a series of 80 examinations performed on a supraconductive unit operating at 0.5 T. Normal function kidneys displayed a clearly delineated corticomedullary differentiation (CMD); the ratio between the thickness of cortex and medulla didn't exceed 0.6. The same appearance was observed in non complicated acute tubular necrosis. Complete loss of CMD was the major finding in acute rejection (74% of the cases), but it was not specific as it was also observed in chronic rejection and in acute glomerulonephritis. Cortex thickening was helpful for the detection of rejected transplants with visible CMD. The sensitivity of MR in the detection of acute rejection was 94%. Specificity of MR findings for acute rejection depended on the transplant age: it varied from 100% for examinations performed during the first 3 months after transplantation, to less than 50% for examinations of the second year.     

移植肾穿刺活检患者护理

肾移植术后移植肾功能延迟恢复（DGF）是一种常见的并发症，其发生率占尸体肾移植20％～50％，活体肾移植4％～10％^[1,2]。移植肾活检是准确评估移植肾状态及制订治疗方案不可或缺的手段^[3]，一旦出现ATN及DGF应及早行移植肾穿刺活检^[4]。我院1997年1月-2007年1月79例DGF患者接受移植肾穿刺活检，现将护理体会报告如下：     

Impassable ureteral strictures: management with percutaneous ureteroneocystostomy

Sixteen of 227 patients referred for percutaneous placement of a ureteral stent had impassable stenoses. Stenoses were benign (n = 8) or attributed to malignant retroperitoneal neoplasm (n = 8). Electrocautery was used to create a neotract between the stenosed ureter and the bladder or ileal loop. A double-J stent was placed after dilation of the tract by use of angioplasty. Neotracts were established and stents were placed in all patients. Complications (digestive tract fistulas) developed in two patients. This technique is safe if the electrode is placed close to the bladder or ileal loop. The procedure can be used as an alternative to surgery or permanent nephrostomy or in initial treatment of benign anastomotic stenosis.     

Unusual renal pseudotumor (cloison) in a young woman with chronic rejection of a transplanted kidney

Localized nontumorous conditions may simulate renal neoplasms. A case is described in which a cloison was observed in conjunction with chronic rejection of a renal transplant.     

Unusual renal pseudotumor (cloison) in a young woman with chronic rejection of a transplanted kidney

Localized nontumorous conditions may simulate renal neoplasms. A case is described in which a cloison was observed in conjunction with chronic rejection of a renal transplant.