Bilateral perirenal urinoma with mediastinal extension

We report a unique case of adult-type polycystic kidney disease (PKD) having bilateral chronic perirenal fluid collection with unusual extension. Fluid collections at both sides are connected across the midline anterior to the abdominal aorta and inferior vena cava. In addition, supradiaphragmatic extension through aortic hiatus was well demonstrated by computed tomography (CT). Anatomical boundaries and relations between two perirenal spaces are evaluated.     

Staging Systems for Newly Diagnosed Myeloma Patients Undergoing Autologous Hematopoietic Cell Transplantation: The Revised International Staging System Shows the Most Differentiation between Groups

The Revised International Staging System (R-ISS) and the International Myeloma Working Group 2014 (IMWG 2014) are newer staging systems used to prognosticate multiple myeloma (MM) outcomes. We hypothesized that these would provide better prognostic differentiation for newly diagnosed multiple myeloma (MM) compared with ISS. We analyzed the Center for International Blood and Marrow Transplant Research database from 2008 to 2014 to compare the 3 systems (N?=?628) among newly diagnosed MM patients undergoing upfront autologous hematopoietic cell transplantation (AHCT). The median follow-up of survivors was 48 (range, 3 to 99) months. The R-ISS provided the greatest differentiation between survival curves for each stage (for overall survival [OS], the differentiation was 1.74 using the R-ISS, 1.58 using ISS, and 1.60 using the IMWG 2014) . Univariate analyses at 3 years for OS showed R-ISS I at 88% (95% confidence interval [CI], 83% to 93%), II at 75% (95% CI, 70% to 80%), and III at 56% (95% CI, 3% to 69%; P < .001). An integrated Brier score function demonstrated the R-ISS had the best prediction for PFS, though all systems had similar prediction for OS. Among available systems, the R-ISS is the most optimal among available prognostic tools for newly diagnosed MM undergoing AHCT. We recommend that serum lactate dehydrogenase and cytogenetic data be performed on every MM patient at diagnosis to allow accurate prognostication.     

Individual surgeon practice is the most important factor influencing diverting loop ileostomy creation for patients undergoing sigmoid colectomy for diverticulitis

Background

To identify factors associated with diverting ileostomy creation (DLI) in patients undergoing sigmoid colectomy for diverticular disease in a high volume colorectal unit and to obtain information for better preoperative patient counseling.

Management of the colorectal polyp referred for resection: A case-matched comparison of advanced endoscopic surgery and laparoscopic colectomy

Background

Colonoscopy is the gold standard for colorectal screening and surveillance. Advanced endoscopic polypectomy techniques such as endoscopic submucosal dissection (ESD) have been introduced to remove large colorectal polyps. Our aim was to compare the outcomes of patients who underwent ESD with those of who underwent laparoscopic colectomy for benign colorectal polyps.

Management of knee rheumatoid arthritis and tibia nonunion with one-stage total knee arthroplasty and intramedullary nailing: A report of two cases

Total knee arthroplasty (TKA) is a surgical procedure which is widely used in the treatment of gonarthrosis secondary to rheumatoid arthritis (RA). The incidence of stress fractures in tibia in the patients with RA is higher compared to normal patients. In this study, we report two cases of TKA and intramedullary nailing in RA patients with severe knee arthritis and tibial nonunion. Both patients had a satisfactory clinical outcome with radiological healing of the tibial fracture.     

Rosai-Dorfman disease with epidural and spinal bone marrow involvement: magnetic resonance imaging and diffusion-weighted imaging features

Sinus histiocytosis with massive lymphadenopathy (SHML), or Rosai-Dorfman disease, is a rare histiocytic disorder that typically presents with chronic, self-limiting cervical lymphadenopathy. Although this disease mainly affects histiocytes, there are a few reports of bone marrow infiltration. Diffusion-weighted imaging (DWI) is a promising technology in differentiating between various bone marrow pathologies. We here present conventional magnetic resonance imaging and DWI features of a patient with SHML and bone marrow involvement.     

Fluid resuscitation of acute hemorrhage in uninephrectomized rabbits--effects on the early function of the remnant kidney

The aim of this study was to determine the effects of fluid resuscitation of acute hemorrhage on the early function and histopathology of the remnant kidney in uninephrectomized rabbits. Thirty-nine adult rabbits were studied in four groups. Group 1 (n = 8) included healthy controls; Group 2 (n = 10) healthy, bled animals; Group 3 (n = 10) uninephrectomized, non-bled animals; and Group 4 (n = 11) uninephrectomized, bled animals. In the hemorrhage groups, 8 mL kg(-1) of blood was drawn, and replaced with lactated Ringer's solution three times the volume of shed blood. Urine and blood samples were collected after 120-minutes of observation. None of the animals experienced hypotension during the study period. Serum and urinary electrolytes were similar between the Groups (p > 0.05). Urine output was lower in Groups 3 and 4 than in Group 1 (p = 0.001, both). Urinary microalbumin, NAG, fractional sodium excretion and creatinine clearance were similar in all four Groups. Light microscopic evaluation revealed only slight enlargement of the proximal tubule lumen in the renal medulla of the rabbits that were both uninephrectomized and bled. We observed no deleterious effects of well resuscitated hemorrhage on early function and histopathology of the remnant kidney in uninephrectomized rabbits.     

The midterm results of cardiac transplantation patients

OBJECTIVE: Cardiac transplantation is an important treatment option that increases the survival and decreases the limitations in effort capacity among patients with end-stage heart disease. In this study we have presented the midterm results of 13 patients who underwent cardiac transplantation between 2003 and 2007. PATIENTS AND METHODS: There were 10 male and three female patients of mean age of 32 +/- 13.27 years (12 to 54). In one patient, we performed combined cardiac and renal transplantation. Ischemic cardiac disease was present in six patients and cardiomyopathy in seven patients. The mean age of the donors was 23.3 +/- 11.8 years (12 to 46). Corticosteroids, cyclosporine, and mycophenolate mofetil were used for immunosuppression. Sirolimus was employed in five cases due to impaired renal function. Patients were followed by echocardiography, endomyocardial biopsy, and dobutamine stress echocardiography. RESULTS: The mean follow-up was 18.6 +/- 13.4 (1 to 38) months. In four patients, there was grade IIIA (II-R) rejection. In five patients, tacrolimus or cyclosporine was replaced with sirolimus due to elevated creatinine levels. Dobutamine stress echocardiography was positive in one patient, who displayed a severe left main coronary artery lesion. There was no operative mortality. There was only one hospital mortality (7.6%). Two patients died in the midterm. The overall mortality on follow-up was 3 (23.1%). The survival rates in the first, second, and third years were 92%, 88%, and 75%, respectively. Ejection fraction were more than 50%; all of posttransplant survivors showed good effort capacity. CONCLUSION: Cardiac transplantation is a definitive, safe, and effective treatment for patients with end-stage heart failure.