Lymphocele following renal transplantation may be associated with ureteral obstruction, venous obstruction, venous thrombosis, infection and pain. Drainage of lymphocele is indicated when these complications arise or if the patient is symptomatic from the size and pressure of the lymphocele. Less invasive methods for the treatment of lymphocele, including simple needle aspiration, external drainage and sclerotherapy, are associated with an unacceptably high incidence of recurrence and complications. Internal drainage is the treatment of choice either via the retroperitoneal transplant incision or transperitoneally through abdominal incision. We now report a case of posttransplanted lymphocele that was successfully drained into the peritoneal cavity using laparoscopy. We believe this is an effective alternative route to provide internal drainage for lymphoceles.

Adult↗

PubMed1993

Transmission of hepatitis C virus by renal transplantation.

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Cadaver↗

PubMed1993

Monitoring of cyclosporin A levels with radioimmunoassay in renal transplant recipients: comparison of monospecific and nonspecific assays.

Patients receiving cyclosporin A (CsA) therapy should be monitored carefully in order to avoid side effects and maintain immunosuppression. Radioimmunoassay is one of the most commonly used methods of monitoring CsA levels. The decision to use whole blood vs plasma or monospecific vs nonspecific monoclonal antibodies for the measurement of CsA levels has been a controversial issue. In this study, CsA levels in the whole blood and plasma were measured simultaneously with INCSTAR specific monoclonal antibodies in 20 renal transplant recipients (group A). There was a significant correlation between the CsA levels in the whole blood and plasma (R2 = 0.7379, p < 0.00001). However, at the therapeutic limit, the correlation was not good. The whole blood/plasma CsA concentration ratios were not correlated with the hematocrits of the patients. In another group of 20 renal transplant recipients (group B), CsA levels in whole blood and plasma were measured simultaneously with INCSTAR nonspecific monoclonal antibodies. There was a significant correlation between the CsA levels in whole blood and plasma (R2 = 0.6714, p < 0.00001). The whole blood/plasma ratios were significantly correlated with the hematocrits (R2 = 0.5457, p = 0.0002). The later finding could be due to the extensive cross-reactivity of nonspecific monoclonal antibodies with CsA metabolites, which are almost exclusively bound to the erythrocytes. The hematocrits in renal transplant recipients usually show significant change over a period of time. The plasma level may be more stable in such cases. However, measurement of whole blood levels also has several advantages, mainly from a technical aspect.(ABSTRACT TRUNCATED AT 250 WORDS)

Cyclosporine↗

PubMed1993

[Pheochromocytoma nuclear pattern analysis by flow cytometry].

Flow cytometric nuclear DNA analyses were performed on paraffin-embedded tissue samples taken from 39 patients with pheochromocytoma treated between 1981 and 1992. The Hedley technique was used for measurement of nuclear DNA contents. Only 30 cases out of the 39 tumors were available for the determination of DNA ploidy analyses. Ten cases (33.3%) showed a diploidy pattern, 8-cases (27%) showed an aneuploidy pattern and 12 cases (40%) revealed a tetraploidy pattern. Four cases of malignant pheochromocytoma with regional or distal metastasis had been noted during a mean follow-up period of 4.75 years. All these four cases showed tetraploidy nuclear pattern with vascular invasion on pathological examination, which was statistically significant (p < 0.001) in differentiation between benign and malignant pheochromocytoma. About one third of patients with tetraploidy appeared to have malignant tendencies and this was statistically significant (p < 0.05). None of the patients with either diploidy or aneuploidy pattern had disease progression. The location of the tumor (adrenal vs. extra-adrenal) and 24 hours urine total vanillylmandelic acid (VMA) amounts were not significantly different from the diploid, aneuploid or tetraploid groups. These results suggested that nuclear DNA ploidy pattern is an important independent, and useful prognostic factor for patients with pheochromocytoma.

Adrenal Gland Neoplasms↗

PubMed1993

Seminal vesicle cyst: an unusual cause of hematospermia--a case report.

Seminal vesicle cyst is a rare disease. The traditional diagnostic method is the vasoseminal vesiculography. We present one case detected by transrectal ultrasonography during examination for hematospermia. He was treated with transperineal aspiration and sclerotherapy under guidance of ultrasonography. The patient had an uneventful clinical course after treatment, but long term follow up is necessary. Literature about seminal vesicle cyst and hematospermia will be reviewed.

Adult↗

PubMed1992

Xanthogranulomatous pyelonephritis: experience in 36 cases.

A retrospective study of 36 patients with xanthogranulomatous pyelonephritis who underwent nephrectomy at our hospital was performed. The disease occurred most frequently in middle-aged women with a history of recurrent urinary tract disorder. There were 2 cases of focal xanthogranulomatous pyelonephritis, 2 associated with emphysematous pyelonephritis, 2 that manifested as fistula formation between the colon or skin, and 1 with deep sinus formation into the hip joint that presented as septic arthritis. Flank pain and fever were the most frequent complaints. Escherichia coli (67%) and Proteus mirabilis (26%) were the most common organisms isolated from the voided urine, kidney and blood stream. Cephalothin plus gentamicin or tobramycin were the drugs of choice before surgical intervention.

Adult↗

PubMed1992

The clinical outcome of hepatitis C virus antibody-positive renal allograft recipients.

In order to investigate the prevalence of antibody to hepatitis C virus (anti-HCV) in renal transplant patients, the evolution of anti-HCV status, and clinical outcome in anti-HCV-positive renal allograft recipients, we tested the sera from 120 renal transplant patients for anti-HCV. Thirty-eight patients were hepatitis B surface antigen (HBsAg)-positive. Two patients were anti-delta-positive. A total of 79 patients (65.8%) had at least one serum positive for anti-HCV. Anti-HCV positivity decreased after transplantation for more than 5 years (65.5% at transplantation versus 37.9%, 78.3 +/- 13.4 months later). Among those with positive anti-HCV, the HBsAg-positive group had significantly higher incidence of chronic hepatitis (50% vs. 25.5%, P = 0.026) and liver cirrhosis (21.4% vs. 0%, P = 0.001) than HBsAg-negative group. Among the 82 HBsAg-negative patients, the prevalence of anti-HCV was significantly higher in those with chronic hepatitis than in those without (86.7% vs. 56.7%, P = 0.027). We conclude from this study: (1) anti-HCV positivity is quite prevalent in renal transplant patients; (2) coinfection of hepatitis B virus (HBV) and hepatitis C virus (HCV) may lead to aggressive liver disease and cirrhosis; HCV infection alone has a more benign clinical outcome; and (3) HCV infection is an important cause of posttransplant chronic hepatitis in HBsAg-negative patients.

Adult↗

PubMed1992

Subcapsular hematoma of spleen--a complication following extracorporeal shock wave lithotripsy for ureteral calculus.

Splenic trauma with hematoma following extracorporeal shock wave lithotripsy (ESWL) is very rare. We reported a case of subcapsular hematoma of spleen with impending rupture following ESWL for ureteral calculus. This case was noted to have liver cirrhosis and splenomegaly, and received a total of 2000 shock waves under 18 kilovoltage. The subcapsular hematoma occurred 2 months later. Splenectomy was undertaken for a symptomatic huge subcapsular hematoma and thrombocytopenia. We reviewed the literature and concluded that portal hypertension with severe coagulopathy are contraindications for ESWL, even in case with ureteral calculus.

Female↗

PubMed1992

Malignancy in renal transplant recipients.

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Carcinoma, Hepatocellular↗

PubMed1992

Clinical analysis of 206 cases of kidney transplantation.

From July 1981 to May 1991, 206 kidney transplantations were performed at the Chang Gung Memorial Hospital. There were 762 patients on our waiting list for transplantation at that time. Patient follow-up care was undertaken, alternately, by urologists and nephrologists. The average follow-up period was 4.0 +/- 2.8 years. Patient data were registered in the UCLA (University of California at Los Angeles) International Kidney Transplant Registry. Eighty patients received living-related transplants, 126 received cadaveric transplants. Twenty-four per cent of transplant recipients were carriers of HBsAg. Their survival rates were equal to those of non-carriers up to five years postoperatively, although they were prone to episodes of hepatitis. Nineteen kidneys were from HBsAg carriers with recipient survival rates, five years postoperatively, not significantly different from those who received kidneys from non-carriers. However, there was one case of seroconversion from HBsAg negative to HBsAg positive status. There were 19 deaths among the recipients, the major cause of death being infection (57.9%). Eight grafts were lost due to medical noncompliance. Malignant lymphomas were noted in three cases who are now alive and well. Three cases of hepatomas were noted, but unfortunately none of them survived. The transplant recipients were found to enjoy a better quality of life after undergoing psychiatric evaluation. The one-year patient survival rate was 97.4% and 96.2% for living-related and cadaveric transplants, respectively. The one-year graft survival rate was 96.0% and 88.5% for living-related and cadaveric transplants, respectively. Kidney transplantation is a well-accepted method of treatment for end-stage renal disease.

Adult↗