Role of multi-detector computed tomography (MDCT) in management of post percutaneous nephrolithotomy (PCNL) bleeding

Objective: To evaluate the role of multidetector computerized tomography (MDCT) angiography in post percutaneous nephrolithotomy (PCNL) bleed and compare findings with conventional angiography (CA).Material and methods: We conducted a retrospective analysis of patients who had post PCNL bleeding and subsequently underwent a MDCT angiography followed by CA. We reviewed eight patients, who presented between January 2009 and January 2013. We performed a MDCT angiography on a 16 slice GE bright speed CT scanner. All angiographies were done by using the Digital Subtraction Angiography Suite. The angioembolisation, if required, was conducted by an interventional nephrologist, specializing in therapeutic embolisation.Results: The mean age of the patients was 42±17 years. Mean time of post PCNL bleed presentation was 10.06±7.9 days. Five patients presented with aneurysm and three presented with an AV fistula with pseudoaneurysm. The right renal unit was involved in six cases and the left in two cases. The lower polar segmental artery was involved in six cases and the upper polar artery in two cases. The CA and MDCT findings matched in all cases and the MDCT helped the clinician to assess and embolise the appropriate arterial tree.Conclusion: MDCT is rapid, reproducible and noninvasive. MDCT angiography performed in the setting of post PCNL bleeding provides an accurate assessment of the site and nature of bleeding. The MDCT angiography matched the CA findings in all patients in the present study.

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The Role of Tranexamic Acid in Controlling Bloodloss During PCNL for Staghorn Calculi

Revista de Chimie ◽

10.37358/rc.18.12.6833 ◽

2019 ◽

Vol 69 (12) ◽

pp. 3745-3748

Author(s):

Raluca Costina Barbilian ◽

Victor Cauni ◽

Bogdan Mihai ◽

Ioana Buraga ◽

Mihai Dragutescu ◽

...

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Percutaneous Nephrolithotomy ◽

Kidney Stones ◽

Postoperative Bleeding ◽

Invasive Technique ◽

Transfusion Rate ◽

Staghorn Calculi ◽

Type Of Surgery

The aim of this paper is to assess the efficiency and safety of the tranexamic acid in reducing blood loss and the need for transfusion in patients diagnosed with staghorn calculi treated by percutaneous nephrolithotomy. Percutaneous nephrolithotomy (PCNL) is a minimally invasive technique used for large kidney stones. Hemorrhagic complications and urinary sepsis are serious complications associated with this type of surgery. Tranexamic acid is an antifibrinolytic drug that has the property of reducing intra or postoperative bleeding. The experience with tranexamic acid in preventing blood loss during percutaneous nephrolithotomy for is limited. The use tranexamic acid in percutaneous nephrolithotomy for staghorn type stones is safe and is associated with reduced blood loss and a lower transfusion rate.

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Percutaneous Superselective Coil-Embolization of Intrarenal Arteriovenous Fistulas

Acta Radiologica ◽

10.1177/02841851960373p222 ◽

1996 ◽

Vol 37 (3P2) ◽

pp. 539-541 ◽

Cited By ~ 4

Author(s):

H. Husstedt ◽

A. Chavan ◽

F. Ghadban ◽

A. Leppert ◽

M. Galanski

Keyword(s):

Coil Embolization ◽

Av Fistula ◽

Arteriovenous Fistulas ◽

Percutaneous Catheter ◽

Coil Occlusion ◽

Av Fistulas ◽

Small Parts

Purpose: To evaluate the role of percutaneous transcatheter coil-occlusion in the management of uncontrollable postoperative hematuria due to iatrogenic arteriovenous (AV) fistula. Material and Methods: In 2 patients, AV fistulas were occluded with percutaneous catheter-guided superselective coil embolization. Results: In both cases, occlusion of the AV fistulas was successful. Only small parts (less than 10%) of the parenchyma had to be sacrificed. No hypertension occurred. Conclusion: Percutaneous coil embolization is a useful alternative to surgery in cases of postoperative AV fistulas. Hematuria can be effectively controlled without resulting hypertension.

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The Role of Virtual Autopsy and Use of a CT Scanner in Medico-Legal Death Investigations

Multidisciplinary Medico-Legal Death Investigation ◽

10.1016/b978-0-12-813818-2.00004-1 ◽

2018 ◽

pp. 69-73 ◽

Cited By ~ 1

Author(s):

Odey Ukpo ◽

Donald Boger

Keyword(s):

Ct Scanner ◽

Virtual Autopsy

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Human arterial responses to isometric exercise: the role of the muscle metaboreflex

Clinical Science ◽

10.1042/cs20060276 ◽

2007 ◽

Vol 112 (8) ◽

pp. 441-447 ◽

Cited By ~ 17

Author(s):

Tom S. Davies ◽

Michael P. Frenneaux ◽

Ross I. Campbell ◽

Michael J. White

Keyword(s):

Plantar Flexion ◽

Isometric Exercise ◽

Arterial Tree ◽

Contralateral Limb ◽

Post Exercise ◽

Muscle Metaboreflex ◽

Calf Exercise ◽

Exercise Induced ◽

Arterial Responses

The effects of exercise on the distensibility of large and medium-sized arteries are poorly understood, but can be attributed to a combination of local vasodilator effects of exercise opposed by sympathetic vasoconstrictor tone. We sought to examine this relationship at the conduit artery level, with particular reference to the role of the sympatho-excitatory muscle metaboreflex. The effect of maintained muscle metaboreflex activation on a previously passive or exercised limb femoral artery was investigated. A total of ten healthy volunteers performed 2 min of isometric ankle plantar-flexion at 40% MVC (maximal voluntary force), in conjunction with 2 min of either non-ischaemic isometric HG (handgrip; control condition) or IHG (ischaemic HG) at 40% MVC. IHG was followed by 2 min of PECO (post-exercise circulatory occlusion) to maintain muscle metaboreflex activation. FTPWV [femoral–tibial PWV (pulse wave velocity)] was measured in the exercised or contralateral limb at baseline and immediately following calf exercise. BP (blood pressure) and HR (heart rate) were measured continuously throughout. In the HG condition, BP and HR returned promptly to baseline post-exercise, whereas exercised leg FTPWV was decreased (less stiff) by 0.6 m/s (P<0.05) and the non-exercised leg PWV was not changed from baseline. PECO caused a sustained increase in BP, but not HR, in the IHG condition. Contralateral leg PWV increased (stiffened) during PECO by 0.9 m/s (P<0.05), whereas exercised limb FTPWV was not changed from baseline. In conclusion, muscle metaboreflex activation causes a systemic stiffening of the arterial tree, which can overcome local exercise-induced decreases in arterial PWV.

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Abstract W MP20: Automation and Quantification of the Angiographic Capillary Blush in Patients with Acute Ischemic Stroke undergoing Endovascular Intervention

Stroke ◽

10.1161/str.46.suppl_1.wmp20 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Jason Tarpley ◽

Fabien Scalzo ◽

Jeffry R Alger ◽

Amin Aghaebrahim ◽

Conrad Liang ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cerebral Blood Volume ◽

Spatial Information ◽

Endovascular Intervention ◽

Ordinal Scale ◽

Conventional Angiography ◽

Non Invasive ◽

Angiography Suite ◽

Scale Properties

Background: In acute ischemic stroke, non-invasive perfusion imaging can guide the decision to perform endovascular intervention. A subset of these patients who are ineligible for IV TPA or for whom it has failed may benefit by going directly to endovascular intervention without delays imposed by non-invasive imaging. In these patients, an angiographic biomarker of viable brain tissue such as the capillary blush described by the Capillary Index Score (CIS) will be important for decision making in the angiography suite. Indeed, a favorable CIS score is associated with good outcomes when recanalization is achieved. However, any ordinal angiographic scale is observer dependent and limited by scale properties. Methods: Here we used our novel perfusion angiography software (PerfAngio) to extract cerebral blood volume (CBV) maps from conventional angiograms acquired during endovascular intervention at either UPMC or UCLA. Areas of angiographic blush were selected manually from a subset of the angiograms. These blush areas trained a machine learning model to identify features of angiographic blush from CBV maps to produce blush maps. Results: In the figure, we show PerfAngio’s blush map in a patient with acute proximal MCA occlusion prior to endovascular recanalization. At each pixel cool colors represent low likelihood of capillary blush and hotter colors represent higher likelihood of blush. These color maps allow for spatial characterization of the blush and quantifies it as a continuous variable rather than according to an ordinal scale. Conclusions: PerfAngio blush maps allow for automation and quantification of the blush seen during conventional angiography. These maps render data that does not depend on observer interpretation and provide spatial information about the capillary blush that is not captured by the CIS. Since PerfAngio blush maps can be acquired in real time, they are amenable for use in the angiography suite to inform the decision to recanalize or not.

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Abstract 4688: The Impact of Marfan Syndrome on Arterial Stiffness and Endothelial Function: The Role of Matrix Metalloproteinases

Circulation ◽

10.1161/circ.118.suppl_18.s_930-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Stella Brilli ◽

Dimitris Tousoulis ◽

Charalambos Antoniades ◽

George Hatzis ◽

Nikos Ioakeimidis ◽

...

Keyword(s):

Matrix Metalloproteinases ◽

Arterial Stiffness ◽

Endothelial Function ◽

Marfan Syndrome ◽

Augmentation Index ◽

Flow Mediated Dilation ◽

Arterial Tree ◽

Augmentation Pressure ◽

The Impact

Background: Marfan syndrome is characterised by high risk of aortic dissections and increased cardiovascular risk. However, the impact of Marfan syndrome on endothelial function and arterial stiffness is unclear, while the role of matrix metalloproteinases is unknown. We examined the impact of Marfan syndrome on the elastic properties of the arterial tree, and vascular endothelial function, and we evaluated the potential role of matrix metalloproteinases in these effects. Methods: The study population consisted of 17 subjects with Marfan syndrome, aged 26.6±2.3 years old, with BMI 20.5±1.03Kg/m2 and 22 healthy individuals matched for gender, age (26.4±0.78 years old, p=NS) and BMI (22.4±0.86 Kg/m2). Arterial stiffness was evaluated by measuring carotid-femoral pulse wave velocity (PWV), while augmentation pressure and augmentation index (AIx) were also determined, as measures of arterial wave reflections. Endothelial function was evaluated by determining flow mediated dilation (FMD) in the brachial artery while matrix metalloproteinase 9 (MMP-9) levels were determined by ELISA. Results: Patients with Marfan syndrome had significantly lower pulse pressure in the radial artery (41.0±1.07mmHg) compared to controls (51.3±4.4mmHg). In addition, patients had higher AIx (17.6±2.4%) and augmentation pressure (5.44±0.65mmHg) compared to controls (7.72±3.43% and 2.41±1.14mmHg respectively, p<0.05 for both). However, the difference in PWV between patients and controls did not reach statistical significance (6.33±0.33 vs 5.96±0.23m/s respectively, p=NS). Patients with Marfan syndrome had lower FMD (2.05±1.13%) and higher plasma MMP-9 (827±70ng/ml) compared to controls (6.8±2.3% p<0.05 and 326±50ng/ml, p<0.01). Conclusions: Marfan syndrome is associated with increased MMP-9 levels, as well as with elevated augmentation index and augmentation pressure compared to healthy individuals, matched for age, gender and body mass index. Moreover, flow-mediated dilation is also impaired in these subjects. These findings suggest that Marfan syndrome directly affects the elastic properties and endothelial function of the arterial tree, with matrix metalloproteinases being important mediators in the pathophysiology of this syndrome.

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Abstract 256: Rbp-j Controls the Fate of the Kidney Vasculature

Hypertension ◽

10.1161/hyp.60.suppl_1.a256 ◽

2012 ◽

Vol 60 (suppl_1) ◽

Author(s):

Eugene Lin ◽

Maria Luisa S Sequeira Lopez ◽

Roberto A Gomez

Keyword(s):

Stromal Cells ◽

Mesangial Cells ◽

Notch Signaling Pathway ◽

Renal Vasculature ◽

Arterial Tree ◽

Mural Cells ◽

Vascular Markers ◽

Renal Abnormalities ◽

Glomerular Tuft

Proper assembly of the renal vasculature is essential for post-natal life, and alterations to the renal vasculature are at the root of many types of cardiovascular disease. However, the mechanisms underlying the establishment, assembly and maintenance of the renal blood vessels are poorly understood. We have identified a population of renal stromal cells (marked by their expression of the transcription factor Foxd1) that differentiate to form the mural cells of the kidney arterial tree (excluding endothelial cells) and the glomerular mesangium. We previously demonstrated that RBP-J, the final transcriptional effector of the Notch signaling pathway, controls the phenotype of renin cells which are also derived from the Foxd1 lineage. We therefore hypothesized that RBP-J regulates the differentiation of stromal cells into the mural cells of the kidney arterioles. To answer this question, we deleted RBP-J in the metanephric stromal precursor cells, and found that mutant mice displayed striking kidney abnormalities in early life. Staining for vascular markers showed a significant decrease in the number of arteries and arterioles. Vessel walls were thinner due to a decrease in both the size and number of smooth muscle cells. We also noted a near absence of renin cells, supporting our earlier findings regarding the key role of RBP-J in establishing the differentiated renin cell endowment. These findings were accompanied by delayed nephrogenesis and other renal abnormalities including tubular dilation. In addition, mutant kidneys lacked Foxd1-lineage cells within the glomeruli, resulting in a depletion of mesangial cells and glomerular aneurysms. Thus, we conclude that RBP-J in Foxd1+ stromal cells plays a key role in the development of the kidney vasculature, and regulates the fate of cells that compose the arterial tree and the glomerular tuft.

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Punctures versus shocks: a comparison of renal functional and structural changes after percutaneous nephrolithotomy and shockwave lithotripsy for solitary renal stone

Journal of Clinical Urology ◽

10.1177/2051415819888083 ◽

2019 ◽

Vol 13 (4) ◽

pp. 254-260

Author(s):

Nitin Shrivastava ◽

Brusabhanu Nayak ◽

Prabhjot Singh ◽

Prem N Dogra ◽

Rakesh Kumar ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Percutaneous Nephrolithotomy ◽

Filtration Rate ◽

Structural Changes ◽

Renal Stone ◽

Dimercaptosuccinic Acid ◽

Shockwave Lithotripsy ◽

Renal Unit ◽

Number Of Patients

Objective: To evaluate renal functional and structural changes following percutaneous nephrolithotomy and shockwave lithotripsy for solitary non-obstructing non-staghorn renal stone. Materials and methods: Patients with solitary unilateral non-staghorn renal stones who were planned for percutaneous nephrolithotomy (20 patients) and shockwave lithotripsy (20 patients) were prospectively evaluated for renal functional and structural changes 60 days after the procedure and complete clearance of stones. Tc99-dimercaptosuccinic acid was used to assess cortical scarring and Tc99-diethylenetriamine pentaacetic acid and Tc99-levo levo ethylecysteine were used for glomerular filtration rate calculations, respectively. Results: The mean stone size was 24.4 mm and 13.7 mm in the percutaneous nephrolithotomy group and the shockwave lithotripsy group, respectively. No new cortical scars developed in either of the groups on Tc99-dimercaptosuccinic acid scan. Both the treated and untreated kidneys showed an overall insignificant fall in glomerular filtration rate in both the groups. The number of patients showing significant deterioration in the individual glomerular filtration rate in both the treated and untreated renal unit was more in the shockwave lithotripsy group. Conclusion: Both percutaneous nephrolithotomy and shockwave lithotripsy are comparable in terms of adverse effects on renal parenchyma and renal function. Level of evidence: Not applicable for this multicentre audit.

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