Restrospective correlation of clinical and histologic findings of 189 exchanged kidneys.

Tissues samples from 189 unsuccessful renal allografts, 47 recovered at autopsy and the others removed surgically, were examined histologically by light microscopy. Tissues samples were obtained from cadaver kidneys that had been exchanged regionally for transplantation. Each allograft tissue sample was rated as to extent of pathologic changes denoting rejection and was classified accordingly. Surgical and autopsy reports, as well as clinical data, were then obtained and these were compared with the retrospective pathologic findings of this study. Our pathologic findings agreed with the original pathologic diagnosis as to presence or absence of rejection changes in 180 cases, but disagreed with the clinical diagnosis of rejection in 28 of the 63 cases with minimal or no histologic evidence of rejection. There was less disagreement with the clinical diagnosis for the 87 cases with histologic evidence of rejection which had been judged as sufficient to cause allograft loss, 70 having been clinically diagnosed as rejected. Disagreement occurred most often where the allograft had never functioned or had been lost within 3 months. Retrospective analysis did not disclose any association between rejection histology and preformed antibodies or length of kidney perfusion time. Sufficient allografts appeared to have been lost for reasons other than rejection to cast doubt on the validity of interpreting renal allograft data only by graft survival statistics.     

Computed tomographic findings in renal angiomyolipoma: an histologic correlation

Accurate preoperative diagnosis of renal angiomyolipomas is essential if conservative resection or angiographic embolization is to be used. Computed tomographic (CT) scanning failed to diagnose angiomyolipoma preoperatively in 2 patients, and this led to a retrospective review of 6 patients to define the limits of CT scanning in preoperative diagnosis. The CT findings were correlated with the histology of the tumors. Two tumors with positive attenuation coefficients suggestive of renal adenocarcinoma had significant amounts of immature "fetal" fat, and one of these had a virtual absence of mature fat. The relative inability of CT scanning to identify immature "fetal" fat, especially in the presence of abundant vessel and muscle elements, is a limitation to its use in the preoperative diagnosis of angiomyolipoma. A negative attenuation coefficient is highly characteristic of renal angiomyolipoma with mature fat elements. A positive attenuation coefficient, although suggestive of renal cell carcinoma, may be found in angiomyolipomas with paucity of mature fat or high proportions of immature fat.     

Thoracic complications of urologic laparoscopy: correlation between radiographic findings and clinical manifestations

BACKGROUND AND PURPOSE: The usefulness of plain film chest radiography (CXR) in evaluation for thoracic complications after laparoscopic urologic procedures is uncertain. Our objectives were to examine the association between radiographic findings and clinical manifestations of thoracic complications after laparoscopic urologic procedures and to determine the prevalence of postoperative CXR at our institution. PATIENTS AND METHODS: We performed a retrospective review of 195 patients who underwent laparoscopic renal/adrenal urologic procedures at our institution from 1998 to 2005. Chi-square analysis was used to compare the rate of radiographic abnormalities and thoracic complications between different types of laparoscopic procedures. RESULTS: A total of 96 patients (96/195, 49%) had postoperative CXR, and abnormalities were noted in 75 (75/96, 78%). The abnormalities seen on CXR included atelectasis, pleural effusions, pneumomediastinum, pneumothorax, subcutaneous emphysema, and pneumonia. Retroperitoneal laparoscopy had significantly more incidental subclinical pneumothoraces (P = 0.000469) and subcutaneous emphysema (P = 0.043) identified by CXR than either transperitoneal, hand-assisted, or cryosurgery. Overall, eight patients (8.3%) had clinical manifestations of a thoracic complication but only five (5.2%) were clinically significant complications detected by CXR. Thus, while 75 CXRs were noted as abnormal, 70 (93%) documented incidental findings that did not affect patient care. CONCLUSIONS: Thoracic complications after laparoscopic urologic procedures are uncommon events. Although the majority of CXRs after such procedures do contain abnormalities, most abnormalities are subclinical and do not affect postoperative management. Patients with significant radiographic findings demonstrated significant clinical symptoms. Thus, routine CXR after urologic laparoscopy does not appear to be necessary to identify thoracic complications and may be overused.     

The clinical spectrum of renal osteodystrophy in 57 chronic hemodialysis patients: a correlation between biochemical parameters and bone pathology findings

Fifty-nine chronic hemodialysis patients who had been on dialysis for an average of 77 months underwent bone biopsies and the pathologic findings were correlated with biochemical and demographic data. All but two had evidence of renal osteodystrophy, 23 with osteitis fibrosa (OF), 19 with osteomalacia and/or adynamic disease (OM/AD), and 15 with mixed osteodystrophy (MOD). Patients in each group were similar with regard to age, sex distribution, duration of dialysis, unstimulated serum aluminum, calcium and phosphorus. Patients with osteitis fibrosa (OF) had statistically higher DFO stimulated aluminum, alkaline phosphatase and PTHC levels than the other two groups although there was marked individual variation. The bone biopsies were also evaluated for the amount of aluminum deposited in the osteoid seam. All 23 of the patients with OF and 11 of the 15 patients with MOD had no, mild, or minimal aluminum deposition but 12 of the 19 patients with OM/AD had moderate to marked aluminum deposition. Patients with minimal to mild aluminum deposition were similar in age, duration of dialysis, sex distribution, unstimulated and DFO stimulated aluminum levels, calcium, phosphorus, alkaline phosphatase to those with moderate to marked deposition but had significantly higher parathormone levels. All patients had been treated in a similar fashion regarding diet, oral phosphate binders and vitamin D; therefore, the observed differences in bone pathology were not readily explicable. However, patients who were found to have osteitis fibrosa and those with minimal to mild aluminum deposition had significantly higher parathormone levels when compared with patients in the other groups at the inception of dialysis.     

Wrist injuries: correlation of clinical and arthroscopic findings

Wrist arthroscopy was done for one hundred nine patients with chronic wrist pain, averaging 22.8 months in duration. History regarding mechanism of injury, painful crepitus, pain with activity or at rest, localization of tenderness, visible swelling, and instability with examination was compared with arthroscopic findings of ligament damage, articular cartilage damage, and synovitis. Both pain at rest and swelling correlated significantly with synovitis. Tenderness did not correlate with specific ligament injury. Wrist ligament injuries and/or cartilage damage were noted in 96.3% of these wrists. Ligament injuries were frequently multiple, averaging 2.6 ligament injuries per wrist. No significant association was found between the presence of chondromalacia, synovitis, or specific ligament tears and the mechanism of injury, duration of symptoms, presence of clicking, or pain with activity.     

Biopsy of marginal donor kidneys: correlation of histologic findings with graft dysfunction

BACKGROUND: Kidney biopsies are being used to evaluate marginal donors, but rigorous statistical validation of this practice with multivariate analysis has not been performed. METHODS: To analyze histologic parameters in 78 donor biopsies for their ability to predict graft dysfunction, we used a proportional odds model that included both donor and recipient factors. Glomerulosclerosis was categorized into grades 0, 1, 2, and 3, corresponding to 0, 1-10%, 11-20%, and 21-30% global sclerosis, respectively. The degrees of interstitial fibrosis, tubular atrophy, arteriosclerosis, and arteriolar hyalinosis were graded from 0 to 3+, using definitions suggested by the Banff Schema of allograft pathology. RESULTS: Increasing donor age was associated with higher glomerulosclerosis, tubular atrophy, and arteriosclerosis. Kidneys with any degree of interstitial fibrosis were 2.6 times [odds ratio (OR)] more likely to experience a worse outcome at 6 months (P = 0.02). This association held up after correction for acute rejection (OR 2.5, P = 0.03) and high panel-reactive antibody (OR 3.4, P = 0.006), However, the OR was reduced to 1.9 (P = 0.15) after controlling for recipient age. With each increment in the grade of glomerulosclerosis, the odds for a worse outcome at 12 months increased to 2.3 (P = 0.005). The value for OR became 2.0 (P = 0.03) when controlling for recipient age (P = 0.01), 2.4 (P = 0.005), when controlling for acute rejection, and 2.3 (P = 0.006) when controlling for high panel-reactive antibody. CONCLUSIONS: Histopathological parameters present in donor biopsies can independently predict post-transplant graft function. Implications for the pool of donor organs available for transplantation are discussed.     

Short segment Hirschsprung's disease as a cause of discrepancy between histologic, histochemical, and clinical features

Diagnostic difficulty may be encountered in Hirschsprung's disease when discrepancy is noted between the histochemical pattern, the presence or absence of ganglion cells, and clinical features. This is mainly a problem in neonates, and the cause of the discrepancy is probably due to biopsy specimens being taken above a short aganglionic segment. When short segment Hirschsprung's disease is suspected, a low suction biopsy should be taken for the demonstration of acetylcholinesterase activity.     

脊髓型颈椎病电生理检测特点及临床评估相关性分析

目的　探讨皮层体感诱发电位 (CSEP)检测结果与脊髓型颈椎病 (CSM)临床表现、后路“单开门”椎板成形(ODLP)手术疗效间的相关性。方法　选择并随访 31例行ODLP的病例 ,按照CSEP检测波形分类 ,并根据手术前后JOA分值进行病情分度、计算临床改善率 ,进而将各因素相关数据进行统计处理 ,分析彼此间的相关性。结果　CSM患者术前JOA分值为 8.4 2± 2 .94 ,术后为 11.4 6± 2 .85 ,随访时为 12 .13± 3.2 0 ,术后及随访JOA分值明显增加 (P<0 .0 5 ) ,临床改善率为 4 7.80 %± 2 3.4 2 %。CSEP检测Ⅰ型波 3例 ,Ⅱ型波 6例 ,Ⅲ型波 14例 ,Ⅳ型波 8例 ;临床症状严重者 2例 ,重度者 11例 ,中度者 16例 ,轻度者 2例 ;手术疗效优良者 15例 ,一般者 16例。CSEP检测结果与临床病情间进行相关性分析 (Hc=14 .4 8,P <0 .0 1) ,CSEP检测结果与临床改善率间进行相关性分析 (Uc =3.995 ,P <0 .0 5 )。结论　ODLP是治疗CSM一种成熟的外科术式 ,疗效肯定。CSM患者CSEP检测结果与病变程度、临床改善率间存在显著相关性 ,CSEP电生理检测有助于更准确地了解脊髓受损程度 ,预测手术效果 ,为临床提供客观、有价值的信息。     

Perigraft seroma: clinical, histologic, and serologic correlates

A 14 year retrospective study of perigraft seroma, defined as an enlarging sterile fluid collection at the site of a prosthetic graft, revealed well-documented cases in 5 of 118 extraanatomical bypasses (4.2 percent), 3 of 248 aortic reconstructive procedures (1.2 percent), and 1 of 395 femoropopliteal bypasses (0.3 percent). These nine cases involved four polytetrafluoroethylene and five Dacron grafts. There were five graft thromboses, one instance of limb loss, two graft infections, two deaths, and 13 separate surgical procedures related to the perigraft seroma. Histologic studies revealed a fibrous pseudomembrane lining the perigraft seroma wall and immature fibroblasts lining the graft. Sera from three patients with perigraft seroma, five patients with well-incorporated prosthetic grafts, and three healthy volunteer subjects were tested for in vitro evidence of fibroblast inhibition against fibroblast tissue cultures derived from the pseudomembrane of a perigraft seroma. Control fetal calf serum, sera from all three healthy subjects, and sera from all five patients with well-incorporated grafts allowed fibroblast proliferation. In contrast, sera from all three patients with perigraft seroma inhibited fibroblast growth. Furthermore, sera collected 1, 2, and 3 months after graft removal from one patient and serum collected 3 months after spontaneous resolution of a perigraft seroma from another patient failed to inhibit fibroblasts. We have concluded that patients with perigraft seroma have a high rate of graft and limb loss and require multiple reoperations. The pathogenesis of perigraft seroma appears to involve a humoral fibroblast inhibitor which prevents maturation and proliferation of perigraft fibroblasts, leading to poor graft incorporation. The decrease of inhibition below detectable levels after graft removal or spontaneous resolution of the perigraft seroma suggests that the graft may induce host production of the inhibitor. Effective therapy of perigraft seroma may include fibroblast modulation, removal of the inciting graft, or both.     

Adrenal myelolipoma: clinical, radiologic, and histologic features

The adrenal myelolipoma is a benign, endocrinologically inactive tumor whose histologic structure consists of mature adipose tissue with foci of hematopoietic cells. A case is presented of a seventy-one-year-old woman in whom the diagnosis was established preoperatively by means of sonography, computerized tomography, and magnetic resonance tomography. In a review of the literature, the radiologic profile is discussed, and based on the analysis of 59 surgically treated cases a therapy recommendation is given.     

Pseudodiverticula of ureter: radiologic and histologic findings

A 70-year-old man with previous history of TUR-BT presented positive urinary cytology at one year follow-up. Cystoscopy with bladder mapping was negative, and IVP revealed multiple outpouchings of the right upper ureter without hydronephrosis. Ureteroscopy failed because of an underlying stricture. Surgical excision of the strictured segment and of 2.5 cm of cranial ureter was performed. Histopathology demonstrated focal hyperplasia of the urothelium with outpouchings involving only the mucosa, compatible with the diagnosis of pseudodiverticula.     

The correlation between magnetic resonance imaging and the operative and clinical findings after lumbar microdiscectomy

Fifty-four consecutive patients were studied prospectively with magnetic resonance imaging before microdiscectomy, and the findings correlated with clinical symptoms before and after operation. A sequestrated fragment was found in 59% of cases, a subligamentous disc sequestration in 25% and a disc protrusion in 16%. The levels operated on were L4/5 – 36%, L5/S1 – 62.5%, and one at L3/4; 71% were laterally placed, 10% lay intraforaminal and 10% medial. The diameter of the protrusion was 4 mm to 13 mm for the craniocaudal extension, and 5 mm to 18 mm for the anteroposterior extension. No correlation could be found between a neurological deficit and the size of the prolapse. A positive correlation was present between the increasing degree of canal obstruction and the degree of disc degeneration determined by imaging for extrusions, subligamentous disc sequestrations and free sequestrations. Nerve root inflammation and enlargement was seen in 36% of the images, corresponding to an operative finding of 32%. Magnetic resonance imaging is a helpful preoperative diagnostic investigation which shows structural changes in the disc and the correct localisation and size of the disc sequestration, but there was no correlation between the imaging findings and the clinical symptoms.

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Résumé. Dans une étude prospective 54 patients d’un age moyen de 41 ans ont été examinés avant une microdiscectomie au moyen d’un protocole IRM standardisé. Les résultats de l’IRM ont été mis en corrélation avec les symptomes cliniques avant et après chirurgie et les constatations operatoires. 59% des patients avaient un fragment libre, 25% un séquestre sous-ligamentaire du disque et 16% une protrusion du disque au niveau L4/5 (36%) ou L5/S1 (62%) et aussi une au niveau L3/4. 71% de celles ci étaient situées médiolatéralement, 10% latéralement ou intraforaminal et 10% seulement avaient une localisation médiale. Les diamètres de la protrusion discale variaient de 4 à 13 mm pour l’extension craniocaudale et de 5 à 18 mm pour l’extension antério-postérieure. Aucune corrélation entre un déficit neurologique et la taille du prolapse discal ont été trouvée. Une corrélation existe entre le degré d’augmentation de l’obstruction du canal et le degré de la dégénération du disque déterminéà l’aide du l’IRM pour les extrusions, les séquestres sous-ligamentaires et les séquestres libres. L’inflammation et l’agrandissement de la racine du nerf se montraient dans 36% des IRM correspondant à 32% intra-opèra- toires. Le IRM est une technique diagnostique importante préoperative pour permettre la localisation correcte, et pour une prévision de la grandeur de la séquestration disquaire. Il n’existe pas de corrélation entre le IRM et les symptomes cliniques.

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Accepted: 5 September 1997     

Parathyroid sonography in secondary hyperparathyroidism: correlation with clinical findings

We present the results of ultrasonic neck examination in 72 patients (47 males, 25 females) on chronic haemodialysis, with clinical and biochemical signs of increased function of the parathyroid glands. The findings of the ultrasonic examination performed using linear transducers of 5 and 7.5 MHz for the surface tissue are compared with the duration of haemodialysis treatment, biochemical parameters (calcium, phosphate, parathormone, alkaline phosphatase) and skeleton X-ray findings. In 18 patients parathyroid glands were not visible, in 30 patients there were one or two enlarged (i.e. abnormal) parathyroid glands, and in the remaining 24 patients three or four of the glands were enlarged. Abnormal parathyroid glands were more often found in patients who had been dialysed for a longer period of time, as well as in those with a higher parathormone level in the blood. It is concluded that ultrasonic examination of the neck is very useful in the diagnosis of enlarged parathyroid glands, and helpful in the management of patients on chronic haemodialysis.     

Intravascular ultrasonic imaging: histologic and echographic correlation

The feasibility of assessing arterial wall characteristics with an intravascular 40 MHz ultrasonic imaging device was determined in vitro. Ten autopsy specimens of human arteries, with and without atherosclerosis, were studied. A close relationship was observed between the histologic section and the corresponding ultrasonic cross-section with regard to the location, maximum plaque thickness and extent of the atherosclerotic lesion along the circumference of the vessel wall. Based on echogenicity of the atherosclerotic lesion, ultrasound could distinguish four basic types of atherosclerotic plaque components: 1. hypoechoic: a reflection of lipid deposits; 2. soft echoes: reflective of fibromuscular tissue; 3. bright echoes: representative of fibrous tissue; 4. bright echoes with shadowing behind the lesion: representative of calcium deposits. It is anticipated that development of such a catheter-tip imaging system combined with recanalisation methods will be of immense benefit for the precise localisation and identification of vessel wall pathology, precise positioning of a recanalisation instrument (laser device, atherectomy catheter) and subsequent use of this recanalisation procedure and for assessing the effect of recanalisation.     

Bone histologic response to deferoxamine in aluminum-related bone disease

We have examined the changes in bone histology in 28 uremic patients after long-term treatment with the aluminum chelator, deferoxamine. Marked declines in stainable bone-surface aluminum were associated with increases in bone formation rate and osteoblastic osteoid following deferoxamine. The increased bone formation resulted from increases in bone apposition and length of double-tetracycline labels, the latter being highly correlated with the increase in osteoblastic osteoid (r = 0.85). While bone surface aluminum was highly correlated with bone formation rate (r = .69, p less than .001), bone aluminum content did not correlate with bone formation (r = 0.13) and was often elevated after treatment despite an improvement in bone histology. Patients who had undergone prior parathyroidectomy were less likely to have improved bone histology than those with intact parathyroid glands. We conclude that aluminum chelation therapy with deferoxamine is effective in ameliorating the bone histology of patients with chronic renal failure and bone aluminum accumulation, and that the change in stainable bone-surface aluminum is a more sensitive indicator than the change in bone aluminum content in assessing adequacy of chelation therapy. Patients who need deferoxamine treatment but have undergone a prior parathyroidectomy will probably require a more intensive treatment schedule than those who have intact parathyroid glands.     

OSAS in children: correlation between endoscopic and polysomnographic findings.

OBJECTIVES: To correlate polysomnographic findings with clinical history of apnea, the degree of obstruction caused by tonsillar hypertrophy, and to age group. STUDY DESIGN AND SETTING: 267 children with a clinical diagnosis of obstructive sleep apnea (OSAS) were evaluated. Patients were divided into preschool- and school-age categories, and subdivided in 3 additional groups, according to tonsillar hypertrophy. Polysomnographic findings were compared within groups. RESULTS: 34% of children had history of OSAS and normal polysomnographic findings. Tonsillar hypertrophy was correlated to more severe apnea among preschool-age children, but not among school-age children. Among children with tonsillar hypertrophy, more severe apnea was observed in preschool-age children than in school-age children. CONCLUSIONS: There is little correlation between polysomnographic and clinical findings in children with OSAS. SIGNIFICANCE: Adenotonsillar hypertrophy leads to more severe polysomnographic patterns in preschool-age children. More severe apnea is observed in younger children with adenotonsillar hypertrophy than in older ones.