肾穿刺活检石蜡组织切片DNA的提取和PCR扩增

目的建立从肾穿刺活检石蜡组织切片提取DNA并进行PCR扩增的方法。方法肾脏病理诊断为乙肝病毒相关性肾小球肾炎、原发性IgA肾病和膜性肾病各2例的肾活检组织蜡块，包埋时间1个月-5年。提取方法包括清洁切片、融蜡、消化及DNA的提取。紫外分光光度计测定DNA浓度。应用聚合酶链反应（PCR）扩增血管紧张素转换酶（ACE）和乙型肝炎病毒核心抗原（HBcAg）基因片段。结果2张2Ixm厚石蜡切片获取的DNA总量为10-30μg。ACE基因的PCR扩增结果显示，6例标本均在490bp和（或）190bp处显示清晰条带。HBcAg的PCR扩增结果显示，2例乙肝病毒相关性肾小球肾炎标本在132bp处显示清晰条带，其余4例阴性。结论本方法可以从肾穿刺活检石蜡切片中获取足够高质量DNA并进行PCR扩增，方法简便，结果稳定，不受包埋时间长短的限制，为肾脏疾病的辅助诊断、肾活检组织的大宗遗传学分析提供了可能。     

Saphenous vein interposition as a salvage technique for complex vascular situations during renal transplantation

The shortage of donor organs for renal transplantation leads to the necessity of accepting organs with vascular disadvantages, such as venous difficulties (eg, shortness, disrupted vein after explantation) or arterial problems (eg, iatrogenic vascular accidents, arterial plaques, hemodynamically relevant polar arteries) and horseshoe kidneys. Consequently, such organs may not be considered for transplantation. Surgeons still have the ability to use such organs by saphenous vein interposition. This study focused on the frequency of vascular difficulties in 100 randomly selected kidney transplantations and their outcomes after arterial or venous saphenous vein interposition.     

Intraoperative renal duplex sonography: a valuable method for evaluating renal artery reconstructions.

OBJECTIVES: to determine the ability of duplex sonography to intraoperatively detect technical problems with renal artery reconstructions. DESIGN: retrospective evaluation of a standard protocol. PATIENTS AND METHODS: the outcome of intraoperative duplex was compared with postoperative angiography, surface duplex, MRA, echo or direct inspection in case of re-exploration in 77 renal artery reconstructions in 62 patients. These included six extracorporeal reconstructions, eight and 17 reconstructions with an artery and autogenous vein respectively, 10 renal artery re-implantations in the aorta (prosthesis), 32 endarterectomies and four reconstructions of kidney transplant vessels. RESULTS: intraoperative duplex was normal in 67/73 reconstructions with sufficient data. In six cases technical problems were revealed by intraoperative duplex and the reconstruction was re-explored. After re-exploration intraoperative duplex was normal in all cases. Confirmatory studies demonstrated normal results in 61/64 reconstructions with normal intraoperative duplex and abnormal results in 6/6 reconstructions with technical problems revealed by intraoperative duplex. Three reconstructions with normal intraoperative duplex occluded as demonstrated by angiography less than 2 weeks after surgery. CONCLUSIONS: renal duplex sonography is a valuable method available for intraoperative detection of technical problems. Haemodynamic duplex data were less important than B-mode imaging in discriminating between normal and abnormal reconstruction.     

Techniques for percutaneous renal biopsies

The technique of renal biopsy includes the preparation of the patient, the localization of the kidneys, the biopsy itself and the postbiopsy care of the patient. A review of the literature and a survey of pediatric nephrologists practicing in the New York metropolitan area and in Philadelphia was used to determine what those techniques were. In preparation for biopsy, bleeding disorders are excluded and corrected if present. In units that localize the kidney by anatomical landmarks, a sonogram is performed at some earlier time to determine that the patient has two kidneys in the usual location. After sedation, patients are placed in the prone position, with a bolster under the abdomen. Sonography is the most commonly used localization method. This is followed by probing to confirm localization and depth. The Tru-Cut needle and the Franklin Vim Silverman needles are the two most commonly used. All nephrologists in the New York area then have the specimen examined to ensure adequacy of sampling. Postbiopsy care includes observation of vital signs, bed rest overnight and some limitation of activity for 2 days to 2 weeks subsequently. In the biopsy of renal allografts, palpation achieves adequate localization. The technique is otherwise the same as for the biopsy of native kidneys.     

Wrist arthrodesis by intramedullary rod fixation: a valuable technique

Arthrodesis of the wrist with intramedullary rod fixation is a simple technique that provides the opportunity for performing concomitant procedures. Iliac bone graft usually is not required with this technique, as the intramedullary rod is a load-sharing construct that allows compression at the fusion site and facilitates union. Rod removal usually is optional, and the long intramedullary beam effect of the rod can function as an internal splint if fibrous or hypoplastic union occurs. Early mobilization is possible, sometimes with only minimal splinting. The results with use of this technique over a ten year period of time in ten wrists (nine patients) with endstage radiocarpal joint instability are reported.     

Intraoperative cell salvage during radical prostatectomy: a safe technique for Jehovah's Witnesses

Radical retropubic prostatectomy (RRP) is an operation historically associated with the potential for significant blood loss. Patients who refuse a blood transfusion, such as Jehovah's witnesses, may be only offered radiation therapy as potentially curative treatment for prostate cancer because of the potential for a transfusion. Intraoperative cell salvage (IOCS) is an effective blood management strategy for patients who are not willing to accept predonated autologous or allergenic blood. We present our management for Jehovah's Witness patients with clinically localized prostate cancer, emphasizing our blood management approach. This is the first such report.     

Thiel embalming technique: a valuable method for microvascular exercise and teaching of flap raising

Because of its high requirements on dexterity and microsurgical skills and the need of complete understanding of flap anatomy, microvascular free flap transfer belongs to the most demanding surgical procedures. Therefore, courses for flap raising and microvascular exercise are considered a prerequisite to prepare for clinical practise. To achieve teaching conditions as realistic as possible we used a novel cadaver embalming method enabling tissue dissection comparable to the living body. Thirty cadavers which were offered to us by the Institute of Anatomy for the purpose of running flap raising courses were embalmed in the technique described by Thiel. On each cadaver, nine free flaps were dissected according to a structured protocol by each course participant and afterwards used for microvascular exercise. The conservation of fine vascular structures and the suitability of the embalmed tissue for microvascular suturing were observed and photographically documented. The Thiel embalming technique provided flap raising procedures to be performed under realistic conditions similar to the living body. Vessels and nerves could be exposed and dissected up to a diameter of 1 mm and allowed for microvascular suturing even after weeks like fresh specimens. The Thiel embalming method is a unique technique and ideally suited to teach flap raising and microvascular suturing on human material.     

Alternative renal biopsies: past and present

Renal biopsy techniques have been used commonly worldwide for more than 70 years. They play an important role in the diagnosis, treatment, and prognosis of various renal diseases. Percutaneous renal biopsy (PRB) is currently the most important and widely used renal biopsy method. Although >90% of renal biopsies are PRBs, in certain settings, alternative renal biopsy techniques must be used, such as open, laparoscopic, transjugular, and transurethral renal biopsies. This review describes the history, advantages, and disadvantages of the various renal biopsy methods and discusses their current and future uses.     

Henoch-Schoenlein syndrome: a clinical and morphological study of renal biopsies

In 36 patients with incipient and advanced renal failure (CCr 80--30 ml/min X 1.73 m2), serum chemistry including ionized Ca, serum PTH and fractional intestinal absorption of Ca (whole body counter; two-dose-technique; 47Ca p.o. and i.v. to correct for urinary and endogenous fecal loss were measured. Quantitative bone histology after in vivo tetracycline double labeling was evaluated from undecalcified sections before and 18 months after therapy with vitamin D3 or 5,6-trans-25-OH-CC in a dose sufficient to raise intestinal absorption and/or urinary excretion of Ca. Intestinal absorption of Ca was impaired in some patients at a GFR of 60 ml/min/1.73 m2. After up to 10000 U/d 5,6-trans-25-OH-CC and 8000 IU/d vitamin D3, respectively, fractional intestinal absorption of Ca rose and was normalized in all patients. There was a concomitant rise in urinary Ca. Serum PTH fell, but did not always return into the normal range. Ionized Ca rose in all patients. Bone histology was evaluated in 17 of these 36 patients after informed consent was obtained. The mass of mineralized bone (Vv) rose in 7/17 patients, pointing to a positive calcium balance. Volumetric density of osteoid (Vvos) and surface density of osteoid (Svos) fell in 10/17 patients concomitant with an increase in the fraction of mineralizing seams and a decrease in the number of lamellae in osteoid seams. Osteoclastic resorption (OCl) fell as did the fraction of woven osteoid seams. However, woven osteoid failed to disappear completely and osteoclastic resorption stayed elevated in some patients. 5,6-trans-25-OH-CC and vitamin D3, in doses that normalized intestinal absorption of Ca, failed to restore completely bone histology to normal although mineralization and collagen texture of osteoid were consistently improved. The dose response characteristics to vitamin D of different abnormalities of Ca metabolism appear to be non-uniform.     

Changing trends in pediatric renal biopsies: analysis of pediatric renal biopsies in national nephrology registry data

Renal biopsy is the gold standard method for determining the diagnosis, treatment, and prognosis in children with renal disease. This study aims to evaluate the histopathological features of pediatric renal biopsies obtained from the national nephrology registry in the last two decades. Data recorded in the Turkish Society of Nephrology Registry System (TSNRS) in 1991 as well as in between 2001 and 2010 were analyzed. A total of 3892 biopsies were recorded; with the least number in 1991 (total 103 biopsies from 17 centers) and the highest number in 2008 (total 654 biopsies from 23 centers). Glomerular diseases constituted the main group in the registry (62.64%), followed by systemic diseases (20.06%). Focal and segmental glomerulosclerosis (FSGS) and Henoch–Schönlein purpura (HSP) nephritis (IgA vasculitis) were the most common glomerular and systemic diseases, respectively. Overall prevalence of renal amyloidosis and membranous nephropathy (MN) was quite low (1.87% and 1.56%, respectively) in all periods. Compared to 1991, there was an increasing trend in the frequencies of certain disorders including hemolytic uremic syndrome (HUS), IgA nephropathy, and HSP nephritis; and there was a decrease in acute proliferative glomerulonephritis (GN) in 2008. As well as demonstrating the etiologies of renal diseases which can only be identified by renal biopsies, this study provides important information regarding the changing patterns of histopathological findings due to better management of pediatric renal diseases over the years in Turkey.     

Recipient ureterocalycostomy in a renal allograft: case report of a transplant salvage

The use of a recipient ureter ureterocalycostomy in the management of ureteral obstruction in a renal transplant recipient is presented. This technique can be used when primary modes of reconstruction are unavailable and nephrectomy is the only alternative.     

Minimally invasive salvage therapy for transplanted renal allografts

Abstract

Purpose: To evaluate the effectiveness of interventional therapy for complications of transplanted renal allografts. Materials and methods: Between January 2009 and March 2014, 14 patients underwent interventional therapy for complications of renal allografts. Complications included transplant renal artery stenosis (TRAS), TRAS combined with pseudoaneurysms, transplant renal venous kinking and ureteral obstruction (UO). Serum creatinine (S.Cr) levels were evaluated before and after procedure. The characteristics and procedure outcomes of these patients with vascular and nonvascular complications were also analyzed. Results: All primary procedures were successfully performed, which included percutaneous transluminal angioplasty (PTA) for TRAS (n?=?4), stenting and coil embolization for TRAS combined with pseudoaneurysms (n?=?1), stenting for renal vein kinking (n?=?2), and percutaneous nephrostomy (PCN) for UO (n?=?7) and secondary antegrade stent placement in six UO patients after 1 week of PCN. No major procedure related complications occurred. S.Cr level subsequently improved from 6.0?±?3.6 to 2.6?±?2.1?mg/dL (p?<?0.001), as well as patients’ clinical features within 1 week after procedure. In our study, the onset time of vascular complications was earlier (<6 months) than nonvascular complications with significant difference (p?<?0.001). During follow-up, the patient with TRAS and pseudoaneurysms suffered acute rejection 1 month after treatment and received transplant renal artery embolization. One patient with TRAS showed restenosis 4 months after procedure, and was retreated successfully with stenting. Thirteen cases reserved their transplanted renal allografts. Conclusion: Interventional therapy could be prior considered for transplanted renal allograft complications as its effectiveness and minimal invasiveness in saving the transplanted renal grafts.