Legionella pneumonia presenting with rhabdomyolysis and acute renal failure: a case report

Legionella pneumophila infection is a recognized but rare cause of rhabdomyolysis. While the mechanism of rhabdomyolysis associated with Legionella is unknown, theories include direct invasion of Legionella into the muscle itself, or the release of its endotoxin into the circulation with subsequent muscle injury. In this case report, we describe a case of Legionella pneumonia presenting as altered mental status, high fever, and rhabdomyolysis with acute renal failure. We review the epidemiology, clinical and laboratory findings, and treatment of the disease.     

Residual contrast medium in the cortex of the kidney around an infected renal cyst on CT: case report

We present a case of a patient with an infected renal cyst. Delayed computed tomography showed residual contrast medium in the cortex of the kidney around it. Delayed computed tomography might be useful to identify an infected renal cyst.     

Spontaneous rupture of the renal pelvis caused by calculus: a case report

Rupture of the urinary collecting system associated with peripelvic extravasation of the urine is an unusual condition and commonly associated with obstructing calculus. We report a patient, recently given chemotherapy due to lymphoma, with acute abdomen symptoms. He had a renal pelvis rupture with perirenal extravasation of urine, an uncommon condition due to a stone in the ureter. Diagnosis was suspected on serial ultrasonography, and confirmed by computed tomograhy. Diagnosis, follow-up, and therapeutic approach are discussed.     

Isolated interrupted aortic arch in 42‐year‐old adult—case report

Interrupted aortic arch (IAA) is a rare congenital anomaly characterized by a complete luminal and anatomical interruption between the ascending and descending thoracic aorta. It is usually detected in the perinatal period or during infancy, but a very few cases have been reported in adults. Here, we present the case of a 42‐year‐old man who visited our hospital for arterial hypertension and in whom IAA was diagnosed with echocardiography and confirmed by computed tomography angiography. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 41:521–523, 2013;     

Acute renal failure in a Caucasian traveler with severe malaria: a case report

Acute renal failure (ARF) secondary to severe malaria is uncommon. We report a case of a patient visiting Africa for the first time presenting with malaria and ARF. There was complete recovery after hemodialysis. Early initiation of hemodialysis proves to be useful in restoration of renal function.     

急性肾功能衰竭患儿透析疗法的近期疗效分析

对２０例急性肾功能衰竭患儿分别采用腹膜透析（腹透组）与血液透析（血透组）治疗，观察其近期疗效。结果表明，两种透析方法无论在改善肾功能和无机盐代谢以及纠正二氧化碳结合力（ＣＯ２ＣＰ）等方面的近期疗效均无显著差异（Ｐ＞０．０５）；血透组在改善肾功能、无机盐代谢和ＣＯ２ＣＰ等平均时间明显短于腹透组（Ｐ＜０．０５）；而腹透组的并发症明显低于血透组。作者认为腹膜透析方法简便易行，设备简单，并发症少，具有广阔的应用前景     

Obstructive uropathy and acute renal failure due to ureteral calculus in renal graft: a case report

Introduction

Obstructive uropathy caused by kidney stones is quite rare in transplant kidneys.

Clinical case

The authors report the case of a patient, previously gastrectomized for gastric carcinoma. He underwent renal transplantation using uretero-ureterostomy, and presented an episode of acute renal failure 7 years after surgery. Ultrasound (US) examination showed no sign of rejection but allowed detection of moderate hydronephrosis in the transplant kidney. Subsequent computed tomography (CT) revealed a kidney stone in the middle ureter at the crossing of the iliac vessels. The patient therefore urgently underwent percutaneous nephrostomy of the graft and recovered diuresis and renal function. The patient was transferred to the Transplant Center where he underwent ureterotomy with removal of the stone and subsequent ureteropyelostomy. Also transureteral resection of the prostate (TURP) was performed due to urinary retention of prostatic origin. Histological examination showed prostate carcinoma, Gleason stage 3, which was treated conservatively using radiotherapy without suspension of the administered low dose of immunotherapy.

Discussion

Calculosis is one of the least common causes of obstructive uropathy in transplant kidneys. In the described case, US examination performed after onset of renal insufficiency led to subsequent radiological investigation and resulting interventional procedures (nephrostomy and surgical removal of the stone) with complete recovery of pre-existing renal function.     

1例门静脉及右肾静脉积气CT表现北大核心CSCD

患者女,81岁,乏力、嗜睡3天,寒战、呼吸困难1 h;慢性阻塞性肺病、支气管哮喘30年,房间隔缺损20年,腔隙性脑梗死10年,心功能不全4年。查体:嗜睡状,血压102/56 mmHg。实验室检查:C反应蛋白298.38 mg/L。3天后患者突发意识丧失、血压下降;双侧中下肺野呼吸音增粗,闻及明显湿啰音,腹部膨隆,腹肌紧张,肠鸣音消失,移动性浊音阳性;实验室检查:血液pH 7.38,血CO 2分压58.70 mmHg,血O 2分压86.50 mmHg。     

Cavernous haemangioma of the duodenum with acute massive bleeding in the ascending portion: a case report

Duodenal cavernous haemangiomas are rare, benign disorders, and massive gastrointestinal (GI) bleeding is a rare clinical condition. The present case report describes a 50-year-old male patient who presented with severe, ongoing haematochezia. A peripheral blood smear at the time of admission showed significant anaemia, and haemoglobin level was 52 g/l (normal range, 120–175 g/l). Albumin level was also low at 28 g/l (normal range, 40–55 g/l). Standard computed tomography (CT) showed mural thickening and relative lumen stenosis in the ascending (fourth) portion of the duodenum. Contrast-enhanced CT using hypotonic solution revealed the lesions to be hypervascular haemangiomas. Laparotomy and segmental duodenum resection were performed, and the first jejunal limb was anastomosed using a side-to-end technique. Histopathological examination confirmed the diagnosis of cavernous haemangioma. The patient showed marked improvement during follow-up. The present case findings emphasize that duodenal haemangioma is possible without a history of chronic anaemia, and should remain a consideration in differential diagnosis for patients presenting with massive GI bleeding. CT is useful for preoperative diagnosis of massive bleeding, and surgery with segmental resection is usually curative.     

连续性肾脏替代治疗急性肾衰的疗效及护理方法

目的探讨连续性肾脏替代治疗急性肾衰的临床疗效及护理体会。方法选取本院102例急性肾衰患者,均给予连续性肾脏替代治疗,根据随机数字法,将其分为对照组(常规护理)和观察组(护理干预),各51例,比较治疗前后2组肾功能、治疗效果及并发症发生情况。结果与对照组相比,观察组治疗后血肌酐、尿素氮水平显著降低,KT/V值显著增高(P0.05);与对照组相比,观察组治疗后APACHEⅡ评分及尿量恢复600 m L/d均显著降低(P0.05);与对照组相比,观察组低血压、心律失常等并发症发生率降低(P0.05)。结论连续性肾脏替代治疗急性肾衰期间,护理干预能够明显改善患者肾功能,提高治疗的临床疗效,降低并发症发生率。     

Acute right‐sided colonic diverticulitis mimicking appendicitis: A report of two cases

We describe two right‐sided diverticulitis cases that presented with marked right iliac fossa tenderness with guarding and rebound and laboratory parameters resembling acute appendicitis. The imaging findings suggested diverticulitis in both cases. One of the patients underwent surgery and the other one was followed up with medical treatment. Awareness of these imaging findings may aid in the diagnosis of right‐sided diverticulitis, which is frequently misdiagnosed and mistreated. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2013     

SDH‐deficient renal cell carcinoma: A case report associated with a novel germline mutation

The highly syndromic nature of succinate dehydrogenase‐deficient RCCs constitutes their active surveillance and molecular profiling the alpha and omega.     

Improvement of refractory pruritus after lipoprotein‐apheresis in arthrogryposis‐renal failure‐cholestasis syndrome

Accumulation of bile acids can lead to invalidating pruritus in cholestatic patients. Few reports exist on the influence of lipoprotein‐apheresis (LA) on plasma level of total bile acids (tBA). We report of significant decrease in tBA levels and drastic improvement of pruritus in a 5‐year‐old girl with arthrogryposis‐renal failure‐cholestasis syndrome. We present LA as a suitable rescue treatment option in therapy‐refractory cholestasis‐associated pruritus, at least as bridge until a long‐term solution such as entero‐biliary anastomosis or transplantation is possible.     

Embolectomy of acute embolic stroke associated with ipsilateral carotid web: a case report and literature review

A carotid web is a thin intraluminal protrusion located in the posterolateral wall of the carotid bulb, which might be a risk factor for cryptogenic stroke. The mechanism of ischemic stroke caused by carotid web is still unclear, but it might be related to hemodynamic changes distal to the web, resulting in flow forces and remote embolization of fibrin-based clots. The diagnosis of a carotid web mainly depends on carotid artery imaging examinations. The main therapeutic strategies include medical treatment with oral antiplatelet agents and anticoagulants, and operative treatment, such as carotid endarterectomy and carotid artery stenting. Few cases of acute large-vessel occlusion undergoing mechanical thrombectomy in the setting of carotid web as the etiology have been reported. We report here a case of a 37-year-old woman who underwent stent retriever embolectomy after acute ischemic stroke. Carotid artery imaging examinations, including digital subtraction angiography and magnetic resonance imaging, and pathology showed that a carotid web was located at the proximal right internal carotid artery. We also discuss the clinical pathophysiological and imaging features, and the treatment of carotid web as described in the currently available literature.     

Patlak plot analysis CT‐GFR for the determination of renal function: comparison of normal dogs with autologous kidney transplant dogs

Glomerular filtration rate (GFR) can be determined using Patlak plot analysis with single‐slice dynamic computed tomography (CT). Acute autologous graft failure has several causes, all of which induce a measurable decrease in glomerular filtration rate. This study demonstrated in an experimental model of canine autologous renal transplant that CT‐derived renal plasma clearance was significantly lower (p = 0.002) in dogs having undergone transplant (0.077 ± 0.058 ml min^?1 ml renal tissue^?1) compared with control dogs (0.396 ± 0.139 ml min^?1 ml renal tissue^?1). A significant negative curvilinear relationship was seen between serum creatinine and total renal plasma clearance (R² = 0.84, p = 0.0001). Alterations in renal time attenuation curve shape in dogs having undergone transplant may have been related to increased renal vascular resistance related to tubular necrosis. CT‐GFR may be a useful experimental tool in the evaluation of renal dysfunction in transplant models. Copyright © 2010 John Wiley & Sons, Ltd.