Percutaneous decompression: treatment for respiratory distress secondary to multicystic dysplastic kidney

Multicystic dysplastic kidney is a common renal anomaly in the newborn. Long-term problems, such as pain, infection, hypertension and neoplasm, although infrequent, have been reported. Acute, life-threatening complications resulting from the size of the affected kidney are rare and emergency nephrectomy has been the only reported effective therapy. We present a case of ultrasound-guided percutaneous cyst decompression used as definitive treatment of respiratory failure associated with multicystic dysplastic kidney.     

Long-term survival in an infant with urethral atresia

Complete urethral atresia is an anomaly that previously was incompatible with life. We report on a surviving infant with this anomaly. As a fetus urinary decompression was accomplished with a vesicoamniotic shunt. Peritoneal dialysis was initiated shortly after birth and at 9 months supramembranous scrotal inlay urethroplasty was performed to provide for egress of urine from the bladder. A maternal renal allograft was performed when he was 12 months old. When the patient was 3 1/2 years old he had normal renal function and emptied the bladder to completion through the reconstructed urethra. Although mildly delayed, he continues to progress with all developmental milestones.     

A giant renal artery aneurysm diagnosed post partum

We report a case of a 5.8 cm. right renal artery aneurysm diagnosed intact 8 weeks post partum. Rupture of a renal arterial aneurysm during pregnancy is a rare but well described catastrophic event. There are no previous reports of an intact renal artery aneurysm diagnosed either ante partum or post partum. To our knowledge, this also represents the largest reported renal artery aneurysm. The aneurysm was repaired successfully with kidney salvage and closure of the fistulous connection to the renal vein.     

Selection criteria for the evaluation of living related renal donors

The documented long-term health of the living related renal donor is a tribute to careful preoperative selection and surgical technique. At our medical center 187 prospective donors were evaluated during a 6-year period and 91 underwent donor nephrectomy. Hypertension, renal artery anomalies and donor indecision were the most common reasons for donor rejection. Recipient health and/or death, or a positive crossmatch after pre-transplant donor specific transfusion were other post-arteriogram reasons not to proceed with transplantation. Women were more likely to undergo nephrectomy than men, and older or heavier donors were more likely to be rejected. Using the transcostal, extrapleural surgical approach for nephrectomy there were no deaths or major complications, and the mean postoperative length of stay was 6.4 days. The average postoperative increase in serum creatinine was 0.33 mg./dl. with an average creatinine at discharge of the patient from the hospital of 1.2 mg./dl. The latter creatinine values varied concordantly with donor age. Only 56% of fully evaluated donors (91 of 159) actually underwent donor nephrectomy. The minimal morbidity sustained by these patients re-emphasizes the importance of careful donor selection.     

Venous disease: investigation and treatment,fact or fiction?

This review looks at some clinical and experimental methods and treatments used in venous disease, and attempts to dispel some myths which have been associated with it. Over the last century numerous techniques have been introduced to aid the understanding of the physiology of normal legs and the pathophysiology of those with venous disease. Tourniquet testing along with clinical examination remains the only method of venous assessment in most hospitals. Venous ulceration in the past has been associated with deep vein incompetence, but the newer, non-invasive techniques of Doppler ultrasound and duplex examination are now identifying patients with leg ulceration who have superficial venous insufficiency and therefore a surgically correctable condition. Perforating veins and their possible role in the aetiology of venous ulceration along with invasive and non-invasive methods for their detection is reviewed. Some of the conservative compression treatments and dressings available for the treatment of venous ulceration are discussed. It is concluded that adherence to sound surgical principles remains the mainstay of the successful management of patients with venous disease.     

Knee joint hemarthrosis--differential diagnostic considerations for planning an operation

From 1980 to the end of 1988, arthroscopy has been performed on 620 patients with acute hemarthrosis of the knee joint. Of all the intraarticular lesions, 89.4% required surgery. Arthroscopy has changed in the last decade from diagnostic screening to invasive instrumentation for exact operative planing and alternative operative techniques. Hemarthrosis in stable knee joints was caused by minor lesions (7.84%) that did not require surgical procedures. Seventy-three patients had traumatic patellar dislocations--in 33 cases associated with chondral or osteochondral fractures. In 54.8% of the isolated medial retinacular ruptures, simple suture was performed in 14 cases--3 times arthroscopically and 11 times open, combined with lateral retinacular release without redislocation following. Associated chondral fracture indicated surgery in all cases. Isolated meniscus pathology (12.48%) was treated by arthroscopy alone, and refixation of the medial meniscus was carried out using the inside-out technique in 27 cases. Arthroscopic elevation of lateral tibia plateau fracture--indicated by type II fracture according to the AO classification--was performed in 3 cases with excellent results, and was associated with screw fixation and image intensification in 2 patients. Intercondylar eminence fracture is an excellent indication for arthroscopic refixation in the presence of the mono- or two-fragment type of fracture. ACL rupture is the main intra-articular pathology (64.8%) for hemarthrosis of the knee joint, which was diagnosed as an acute injury within the 1st week following trauma (51.04%). Anterior instability can be detected clinically if a careful examination with the Lachman test, combined with the missing end-point and pivot-shift test, is performed.(ABSTRACT TRUNCATED AT 250 WORDS)     

The cytoskeleton of cultured skin fibroblasts from patients with Huntington's chorea

Cultured skin fibroblasts from patients with Huntington's chorea were prepared for indirect immunofluorescence using monospecific antibodies to tubulin, actin, and fibronectin. The fibroblasts were also visualized by transmission electron microscopy. The fibroblasts were observed after 3 hours of plating and treatment with various concentrations of colcemid and cytochalasin B to test the reaction of the microfibrillar network to stressful conditions. Disorders were not apparent in the cytoskeletal system (microtubules, microfilaments, and intermediate filaments) when compared with normal controls. Fibronectin was arranged in a fibrillar pattern similar to that seen with actin immunofluorescence. This colinear arrangement was not disturbed in Huntington's chorea cells. Microtubules, microfilaments, and 10-nm intermediate filaments became more parallel as the incubation period increased from 3 to 24 hours. This study showed that the cytoskeleton and the attachment of one surface protein (fibronectin) are not affected in Huntington's chorea.