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At least 343 records · Page 19Linked to original sources
PubMed2000

Local thrombolytic treatment for renal arterial embolism.

OBJECTIVE: To determine the utility of local thrombolysis in the treatment of acute renal arterial occlusion. METHODS: We used local thrombolytic treatment in a female patient, aged 76, with 72 h of anuria, right lumbar and flank pain. She had a 3-year history of ischemic heart disease and atrial fibrillation controlled with digital treatment. Also, she was nephrectomized on the left side 33 years ago for lithiasic pyonephrosis. A normal right urinary tract was demonstrated with ultrasound examination, KUB radiography and retrograde pyelography. The next step was diagnostic abdominal angiography and local thrombolytic treatment with streptokinase. RESULT: Thrombolysis with streptokinase was successful following 72 h of renal artery occlusion. After 24 months the patient is doing well. CONCLUSION: Local intra-arterial thrombolysis is the treatment of choice in renal artery occlusion.

Acute Disease↗
PubMed2006

Sarcomatous dedifferentiated renal cell carcinoma mimicking a severe purulent kidney infection.

Sarcomatous renal cell carcinomas (SRCCs) originate from a dedifferentiation of renal cell carcinoma (RCC). They are characterized by an aggressive course and very poor prognosis. Less known is their ability to imitate inflammatory diseases of the kidney. The aim of the study was to outline the less usual symptoms of SRCCs in a retrospective analysis of 180 patients operated for RCC in 1997-2001. In 11 (6.1%) patients (8 men and 3 women, age 40-76 years, mean age 60 years) SRCC was present. The pTNM classification, results of histological examination, the stage of RCC dedifferentiation and survival after the operation are presented. In almost every patient SRCC was diagnosed at a late stage with combined histological variants of RCC. Survival of the patients after the operation ranged from 1 to 19 (average 8.8) months. In 2 patients an atypical clinical picture imitated abscess of the kidney and calculous pyonephrosis. The authors warn that in spite of the clinical signs of inflammatory disease of the kidneys, a tumorous origin should be excluded. In doubtful cases a quick peroperative biopsy and histology should be performed. Sometimes only a definitive histological examination can reveal the tumorous origin of the disease.

Abscess↗
PubMed1984

Retroperitoneal fibrosis. A follow-up study.

13 patients with retroperitoneal fibrosis (RPF) were reviewed. 10 patients had idiopathic disease and in 3 patients the disease was secondary to temporal arteritis, aortic aneurysm and ergotamine ingestion. Ureterolysis was performed in all patients. 4 patients were reoperated due to problems arising from RPF progression. A total of 24 ureters were lysed. 23 of these functioned in the early postoperative period. 22 ureters were available for follow-up 4 months to 20 years later. 19 kidneys had a free outflow, 2 kidneys were removed and 1 left in situ without function. A review is presented on the etiology, pathogenesis and treatment of this disease. Percutaneous nephrostomy is recommended when the patient presents with severely elevated plasma creatinine, pyonephrosis or urosepsis.

Adult↗
PubMed1987

Cytoplasmic creatine kinase in normal and pathological human kidney tissue.

Cytoplasmic creatine kinase (CK) activity was measured in 39 renal cortex samples from various kidney diseases. The highest CK values were observed in normal tissues (507 +/- 71). The mean values of CK enzymatic activity in the other groups decreased in the following order: chronic pyelonephritis (273 +/- 98), hydronephrosis (233 +/- 102), renal tuberculosis (133 +/- 34), pyonephrosis (96 +/- 46), and hypernephroma (45 +/- 33). The decrease in CK activity in kidney tissue paralleled tissue damage, and affects cellular functionality in relation with the processes that use adenosine 5'-triphosphate, such as the ionic pumps.

Carcinoma, Renal Cell↗
PubMed1979

Paranephric abscess: a changing concept.

The aetiology of the paranephric abscess has been greatly modified since the introductiion of antibiotics. Its frequency has decreased but its prognosis has not been improved. 20 cases of paranephric abscess have been studied retrospectively. Its main cause is no longer the haematogenic staphylococcus infection but primary kidney infection. The disease is difficult to diagnose as the evolution is slow and the symptoms unspecific. The main symptoms are: abdominal pain, feeling of physical prostation, subfebrility, acute pain in the flank and significant increase in blood sedimentation rate. The infection is due in most cases to a silent kidney or a kidney stone with pyonephrosis. Accompaying diabetes mellitus was often observed.

Abscess↗
PubMed1989

Phase II trial of ifosfamide and mesna in advanced ovarian carcinoma: a Gynecologic Oncology Group Study.

Ifosfamide (isophosphamide) and mesna (2-mercaptoethane sodium sulfonate) were administered intravenously at monthly intervals to 46 patients with advanced epithelial ovarian carcinoma refractory to or recurrent after cisplatin-containing combination chemotherapy. Initially, ifosfamide was given as 1.5 g/m2/d x 5 days and mesna as 300 mg/m2 every 4 hours for three doses following ifosfamide, but the initial dose of ifosfamide was reduced to 1.2 g/m2 because of toxicity. Four of the patients initially entered were found to be ineligible: two who had had more than one prior chemotherapy regimen and two who did not have ovarian primaries. One patient received an inadequate trial and four patients had discontinuation of therapy because of toxicity, leaving 41 evaluable for response. Three patients (7.0%) had complete responses and five (13.0%) had partial responses for an overall response rate of 20.0%. Response duration ranged from 2.1 to 20.3 + months with a median of 6.9 + months. Two patients died of renal failure, one of whom had no known renal disease and received 1.5 g/m2/d x 5 days ifosfamide. The second patient received the 1.2 g/m2 dose and was found to have chronic pyelonephritis and pyonephrosis at autopsy. Gynecologic Oncology Group (GOG) grade 3 or 4 granulocytopenia was seen in eight (19.5%), grade 3 or 4 thrombocytopenia in four (9.8%), and grade 3 or 4 neurotoxicity in six (14.6%) of the 41 patients evaluable for toxicity. Ifosfamide/mesna is active in epithelial ovarian cancer. GOG trials in untreated patients are being initiated and toxicity is being evaluated.

Carcinoma↗
PubMed2004

Diffusion-weighted MRI in the evaluation of renal lesions: preliminary results.

The purpose of this study was to evaluate the capability and the reliability of diffusion-weighted MRI in the evaluation of normal kidney and different renal lesions. 39 patients (10 normal volunteers and 29 patients with known renal lesions) underwent MRI of the kidneys by using a 1.5 T superconducting magnet. Axial fat suppressed turbo spin echo (TSE) T(2) and coronal fast field echo (FFE) T(1) or TSE T(1) weighted images were acquired for each patient. Diffusion-weighted (DW) images were obtained in the axial plane during breath-hold (17 s) with a spin-echo echo planar imaging (SE EPI) single shot sequence (repetition time (TR)=2883 ms, echo time (TE)=61 ms, flip angle=90 degrees ), with b value of 500 s mm(-2). 16 slices were produced with slice thickness of 7 mm and interslice gap of 1 mm. An apparent diffusion coefficient (ADC) map was obtained at each slice position. The ADC was measured in an approximately 1 cm region of interest (ROI) within the normal renal parenchyma, the detected renal lesions and the collecting system if dilated. ADC values in normal renal parenchyma ranged from 1.72 x 10(-3) mm(2) s(-1) to 2.65 x 10(-3) mm(2) s(-1), while ADC values in simple cysts (n=13) were higher (2.87 x 10(-3) mm(2) s(-1) to 4.00 x 10(-3) mm(2) s(-1)). In hydronephrotic kidneys (n=6) the ADC values of renal pelvis ranged from 3.39 x 10(-3) mm(2) s(-1) to 4.00 x 10(-3) mm(2) s(-1). In cases of pyonephrosis (n=3) ADC values of the renal pelvis were found to be lower than those of renal pelvis of hydronephrotic kidneys (0.77 x 10(-3) mm(2) s(-1) to 1.07 x 10(-3) mm(2) s(-1)). Solid benign and malignant renal tumours (n=7) showed ADC values ranging between 1.28 x 10(-3) mm(2) s(-1) and 1.83 x 10(-3) mm(2) s(-1). In conclusion diffusion-weighted MR imaging of the kidney seems to be a reliable way to differentiate normal renal parenchyma and different renal diseases. Clinical experience with this method is still preliminary and further studies are required.

Adult↗
PubMedDate not supplied

Postnephrectomy arteriovenous fistula.

The development of the postnephrectomy arteriovenous fistula (PNAVF) between the renal vessels stumps is rare. Here we present a case report of PNAVF, and review the diagnosis, treatment and prevention. The most common clinical features include a loud murmur over the previous nephrectomy scar, and heart failure resistant to common medical treatment. A 58-year-old white woman was admitted to the hospital for a complete evaluation of an unexplained congestive heart failure with no response to common medical treatment. She had had a right nephrectomy for pyonephrosis 13 years before. The diagnosis of PNAVF was suspected because over the right lumbar region a definite trill was palpated, and on auscultation a harsh, machinery-like murmur was heard. The diagnosis was confirmed by aortogram and selective renal arteriography. In May 1989, the right arteriovenous was excised through a right subcostal transperitoneal approach. The renal vessel stumps were individually ligated and sutured separately close to aorta and vena cava. The patient's postoperative course was entirely uneventful in the following seven years. We conclude that during nephrectomy, the renal vessels should be ligated separately, and the transfixation in mass of the stumps avoided to prevent arteriovenous fistula.

Arteriovenous Fistula↗
PubMedDate not supplied

Laparoscopic nephrectomy in inflammatory renal disease: proposal for a staged approach.

INTRODUCTION: The present study shows and discusses the preliminary experience of customized and staged approach in the minimally invasive treatment of inflammatory renal diseases, using either pure laparoscopic surgery or the hand-assisted technique. MATERIALS AND METHODS: We prospectively assessed 17 patients with inflammatory renal diseases operated by laparoscopic approach. Mean age was 41 years and the surgical indication was repeated pyelonephritis in 8 cases, pyonephrosis in 4 cases and renal exclusion due to staghorn stone in 5 cases. The staged laparoscopic approach was chosen based on kidney size and on the presence or not of tomographic findings showing significant perirenal infiltration. Thus, retroperitoneal access was chosen in cases where the kidney was smaller than 12 cm or in the absence of signs of significant perirenal infiltration on the computerized tomography. For the remainder, transperitoneal access was employed. RESULTS: Of the 17 patients, 11 underwent laparoscopic nephrectomy by retroperitoneal access, and all cases were successful. Mean surgical time was 160 minutes. In 6 cases where the nephrectomy was performed by laparoscopic transperitoneal access, the use of hand assistance was required. Four surgeries were successfully completed with mean time of 190 minutes and 2 were converted to open surgery with mean time of 220 minutes. CONCLUSION: The laparoscopic nephrectomy for inflammatory renal disease is feasible, but presents a high degree of complexity, requiring a customized approach. The use of hand assistance is an attractive option when the inflammatory process is intense, and can avoid conversions, maintaining the advantages of minimally invasive treatments.

Adult↗
PubMedDate not supplied

Ultrasound guided percutaneous nephrostomy for obstructive uropathy in benign and malignant diseases.

OBJECTIVE: Analyze the success rate, complications and overall benefit of ultrasound guided percutaneous nephrostomy (PCN) for the relief of obstructive uropathy in benign and malignant diseases. MATERIALS AND METHODS: PCN was performed in 50 kidneys of 32 patients. It was performed in emergency rooms totally under ultrasound guidance by general surgeons. Seldinger technique was used in all cases. Changes in renal function after the procedure were analyzed using paired t-test. RESULTS: The procedure was successfully completed in 42 out of 50 kidneys (84%). There has been no major complication and 28% minor complications. The renal function improved significantly when PCN was performed for benign conditions (mean creatinine 3.52 mg/dL before and 2.18 mg/dL after PCN), however in malignancy there has been no significant improvement in renal function (before PCN mean creatinine 6.39 mg/dL and after PCN 5.41 mg/dL). CONCLUSION: We conclude that PCN can be effectively performed under ultrasound guidance and should be the initial procedure in acutely obstructed kidneys with pyonephrosis and poor renal function. In malignant cases, however, improvement in renal function is possible only if the procedure is carried out at an early stage.

Adolescent↗
PubMed1976

Sonographic-radiographic correlations of renal and perirenal infections.

Sonograms of 43 patients with intrinsic and perirenal infectious processes are reviewed. Fourteen had acute pyelonephritis; three, suppurative pyelonephritis; two, focal pyelonephritis; six, renal abscesses; three, infected cysts; six, perinephric abscesses; six, pyonephrosis; and three, chronic pyelonephritis. Sonography had little diagnostic value except for the patients with perinephric abscess. However, it proved valuable as a guide for a percutaneous approach to obtain cells for histologic diagnosis, to obtain fluid to determine chemotherapy, and to perform antegrade pyelography and percutaneous nephrostomy.

Abscess↗
PubMed1984

Imaging in inflammatory disease of the kidney.

The evaluation and management of patients with severe persistent urinary tract infection after appropriate antibiotic therapy can be difficult. The first radiologic examination is usually excretory urography, but the findings often are nonspecific. A group of 40 patients was studied to assess the contribution of cross-sectional imaging and included patients with diffuse and focal pyelonephritis, renal abscess, pyonephrosis, and pararenal abscess. Indications for cross-sectional imaging include persistent symptoms despite antibiotics, predisposing "risk factors," suspicion of flank mass on other imaging methods, and no excretion on urography. Percutaneous aspiration and/or drainage for diagnosis and/or treatment can be guided by the cross-sectional imaging methods.

Abscess↗
PubMed1991

Nephrobronchial fistula. Case report.

A 26-year-old woman presented with a six-year history of right staghorn calculus and pyonephrosis. Intravenous pyelography showed a non-functioning right kidney and chest radiography, an elevated right hemidiaphragm and fluid in the right costaphrenic space. At operation a nephrobronchial fistula was found, and nephrectomy and subdiaphragmatic drainage of the lung abscess was carried out. Culture of the pus grew Proteus mirabilis. The patient made an uneventful recovery and was discharged on the sixteenth day after operation.

Adult↗
PubMed2005

[Pancreatic fistula after left nephrectomy].

OBJECTIVES: To report our experience with pancreatic fistula after left nephrectomy to point out this unfrequent complication. METHODS: We perform a chart review of 3 cases of pancreatic fistula after left nephrectomy experienced in our institution between 1983-2004. RESULTS: All patients were males, with an average age of 51 years. Indications for nephrectomy were renal cell carcinoma, renal abscess and pyonephrosis. Classic Israel incision was the surgical approach in all three cases, with accidental opening of the peritoneum. Wound inflammatory signs appeared on third postoperative day, drainage of pancreatic juice on postoperative day 4. Treatment consisted on NPO 7 days, and intravenous hydration, atropin and wide spectrum antibiotics. Mean duration of pancreatic juice drainage was 8 days. CONCLUSIONS: Pancreatic tail injury is a possible complication of left nephrectomy due to the close anatomical vicinity of both organs, that may be altered by tumoral or inflammatory disease of the kidney. If not recognized, it may lead to a pancreatic fistula, the diagnosis and treatment of which should be known by the urologist.

Adult↗
PubMed2006

[Single trocar laparoscopic nephrectomy].

OBJECTIVES: The usual laparoscopic hand assisted nephrectomy procedure requires either two or three trocars and a small incision to extract the organ. Our experience reveals that surgical invasion is significantly less when we use only one trocar and a retroperitoneal approach. METHODS: We start with a small low oblique incision close to the pubis and insert a trocar over the iliac crest. When the kidney is free we grasp the undissected vascular pedicle between thumb and middle finger and without moving the inserted hand, we remove the telescope and introduce the stapler. The index finger is used blind to check that the stapler is correctly positioned before triggering. Finally, we divide the ureter in the same way We have carried out 74 nephrectomies with this procedure. RESULTS: The mean operative time was 67.12 minutes. A retroperitoneal haematoma occurred in one patient and was drained by the same approach without further incident. One patient had an intestinal occlusion that in the reoperation was found to be caused by a loop of intestine trapped in a peritoneal tear: the postoperative was satisfactory. We lost one patient: an 89-year-old lady with a pyonephrosis and a retroperitoneal abscess. The operation was uneventful, but the patient died after five days; possibly because of septic shock. The other patients had no significant complications. CONCLUSIONS: The use of only one trocar markedly reduced operative invasion. The blind division en-bloc of the pedicle saves valuable time and does not offer any additional risk. The possibility of an arterio-venous fistula is remote because the stapler leaves the artery close to the vein, but separated from it. Cost is minimal because the surgeon only needs one trocar and a stapler. Consequently, we believe that this procedure with only one trocar could also be safely adopted for living donor nephrectomy

Equipment Design↗
PubMed2002

[Treatment of 2019 cases with upper urinary tract calculi using a piezoelectric lithotriptor ESL-500A].

PURPOSE: We evaluated the results of extracorporeal shock wave lithotripsy (ESWL) in a large number of cases with upper urinary tract calculi, and reported the strategy how to improve the efficacy and safety of ESWL. PATIENTS AND METHOD: Eight hundred fifteen patients with renal calculi and 1,204 patients with ureteral calculi were treated using a piezoelectric ultrasound-guided lithotriptor, Toshiba ESL-500A. Auxiliary measures were needed in 51 cases (2.5%) and 1,968 cases (97.5%) were treated by in situ procedures. ESWL was performed with the optimal positioning of the patient and under the continuous monitoring by ultrasound system. The visibility of stones was improved by removal of abdominal gas and administration of diuretic agent to dilate the ureter. Cases with urinary tract infection were medicated by antibiotics and the obstruction of the urinary tract was cleared away as soon as possible. RESULTS: Including the cases with residual fragments less than 4 mm, the success rates at one month after the treatment were 97.7% and 98.7% for the renal and ureteral calculi, respectively. The mean numbers of sessions were 1.49 for renal calculi and 1.16 for ureteral calculi. Multiple sessions were required in 24.2% of renal calculi and 12.0% of ureteral calculi. No serious complication has been observed except for three cases, which were sepsis after ESWL, anuria in a solitary kidney, and pyonephrosis caused by Steinstrasse with urinary infection, respectively. CONCLUSION: ESWL using ESL-500A is an efficient treatment of upper urinary tract calculi which has higher pulverization rate and fewer complications in the adequate procedure.

Adolescent↗
PubMed1997

[The conservative surgery of renal carcinoma].

In the period 1986-1997, 387 cases of renal carcinoma were operated upon, at the Department of Urology, Parma General Hospital (Italy). Among these, thirty patients (all together 31 operations, 26 men and 5 women, mean age 58 +/- 11.3 years) have had conservative, nephron-sparing surgery; in 8 patients, conservative procedure was mandatory, due to previous contralateral nephrectomy or renal unreliability (4 RCC, 1 TCC, 1 severe injury, 1 pyonephrosis, 1 end stage insufficiency); in 23 patients, with normal contralateral kidney, the tumor was less than 4 cm in diameter and unique. Preoperatively, all cases had been staged by abdominal TC, chest X-ray, bone scan, renal angiography. 23 of 30 cases showed pathological stages I-II (pT1-T2), while 8 patients had stage III (pT3) tumors. After dismissal we recommended: abdominal echography after three months; again US and TC, chest X-ray after further three months. Then US and/or TC every six months, should the former results suggest a relapse, either locally and/or at a distance. Mean follow-up was 40 months. 6/30 patients (19.3%) died of metastatic disease (mean survival time: 27 months). 25 patients are alive and tumor free after a mean follow-up of 43.1 months. Immediate postoperative complications were 2 cases of urinary fistula treated by ureteral stenting.

Adult↗
PubMed1999

[A case of spontaneous pyeloduodenal fistula].

A 61-year-old woman visited our hospital complaining of right flank pain and fever. The radiograph demonstrated multiple renal calculi. Radio renography showed no uptake in the right kidney. Therefore, we diagnosed her with pyonephrosis, and recommended open nephrectomy. However, she selected the conservative treatment with extra corporeal shockwave lithotripsy (ESWL). In spite of disappearance of multiple calculi, pyuria continued for 3 months after ESWL. Retrograde pyelography showed a fistula from the right pelvis into the duodenum. The patient was successfully treated by nephrectomy and duodeno-fistelectomy.

Duodenal Diseases↗