scholarly journals Post-Traumatic Intraparenchymal Renal Hemorrhages: Correlation between CT and DSA Vascular Findings for Superselective Embolization Procedures

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1256
Author(s):  
Francesco Giurazza ◽  
Andrea Contegiacomo ◽  
Fabio Corvino ◽  
Alberto Rebonato ◽  
Davide Castiglione ◽  
...  
Keyword(s):  
Renal Function ◽  
Diagnostic Accuracy ◽  
Clinical Success ◽  
Vascular Lesion ◽  
Endovascular Embolization ◽  
Technical Success Rate ◽  
Contrast Enhanced Ct ◽  
Superselective Embolization ◽  
Before And After ◽  
Post Traumatic

Background: This study aims to investigate the correlation between computed tomography (CT) and digital subtraction angiography (DSA) findings in patients affected by acute post-traumatic intraparenchymal renal hemorrhages and evaluate their conservative management with superselective embolization. Methods: This retrospective multicenter analysis focuses on patients affected by renal bleedings detected by contrast-enhanced CT and treated with superselective endovascular embolization. CT findings were compared to DSA. Embolization procedural data were analyzed and renal function was evaluated before and after the intervention. Results: Twenty-seven patients were retrospectively evaluated in one year. Compared to DSA, CT showed 96.3% diagnostic accuracy in terms of hemorrhage recognition; concerning the type of vascular lesion, there was discrepancy between CT and DSA in five cases. The technical success rate of embolization was 100%, while primary clinical success was 88.9%. The inferior parenchymal third was the most frequent site of renal injury. Microcoils were the most adopted embolics. Renal function did not change significantly before and after embolization. Conclusions: CT has elevated diagnostic accuracy in detecting post-traumatic intraparenchymal renal hemorrhages; in a small percentage, the type of vascular lesion may differ from the findings observed at DSA. In this scenario, superselective embolization presents high clinical success with a low complication rate.

scholarly journals PERCUTANEOUS NEPHROSTOMY FOR RELIEF OBSTRUCTIVE UROPATHY: BENIGN VERSUS MALIGNANT DISEASE

2017 ◽  
Vol 24 (1) ◽  
Author(s):  
Prahara Yuri ◽  
Sungsang Rochadi
Keyword(s):  
Renal Function ◽  
Obstructive Uropathy ◽  
Percutaneous Nephrostomy ◽  
T Test ◽  
Technical Success Rate ◽  
Significant Difference ◽  
Before And After ◽  
Benign Process ◽  
The Mean ◽  
Ultrasound Guided Puncture

Objective: This study aimed to find out the effectiveness of percutaneous nephrostomy (PCN) as palliative decompression of the obstructed urinary system. Materials & Methods: A case control study was performed with 118 patients (69 female and 49 male) with obstructive uropathy who were undergoing PCN during 2009 until 2012, retrospectively. The mean of age was 50.03 years. The PCN technique involves an ultrasound-guided puncture of the dilated collecting system with nephrostomy trocar than insert an 8 Fr nasogastric tube as nephrostomy catheter. Differences of renal function between benign and malignancy were assessed using Independent t-test. Changes in renal function after procedure were expressed as mean ± SD and analyzed using Pair t-test.  Results: There was no procedure-related mortality. The most cause of malignancy was cervix cancer (36.4%) while the result of a benign process was 28.8% of urinary tract stones. Dialysis before procedure were performed in 43 (36.4%) consisting of 42 malignancies and 1 benign process. Improvement in renal function were statistically significant both benign and malignant groups seen in the levels of creatinine and blood urea nitrogen (BUN) before and after procedure (p<0.001). The mean differences were also statistically significant at the preoperative creatinine values between benign and malignant processes (p=0.019) but BUN levels before and after as well as postoperative creatinine levels showed no significant difference. Conclusion: PCN is a widely used technique, with a high technical success rate and low rate of complications. Obstructive uropathy due to benign processes had a better prognosis than malignancy after PCN treatment. Hemodialysis was mainly performed in patients with malignancy prior to PCN.

scholarly journals Endovascular Therapy of Severe Non-Variceal Gastrointestinal Bleeding – One Decade Experience.

2021 ◽  
Author(s):  
Martin Vorčák ◽  
Ján Sýkora ◽  
Martin Ďuriček ◽  
Peter Bánovčin ◽  
Marian Grendár ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Transcatheter Arterial Embolization ◽  
Clinical Success ◽  
Arterial Embolization ◽  
Endovascular Embolization ◽  
Favorable Outcome ◽  
Recurrent Bleeding ◽  
Clinical Effects ◽  
Technical Success ◽  
Technical Success Rate

Abstract Introduction Severe non-variceal gastrointestinal bleeding is a life-threatening condition with complicated treatment if endoscopic rescue fails. In that case, transcatheter arterial embolization is recommended to stop the bleeding. The technical and clinical effects of this technique were analyzed in this group of patients, as well as its complication rate and 30-day mortality.Method Patient data of the one-decade period (from 2010 to 2019) were analyzed retrospectively. Twenty-seven patients (18 men and nine women, median age 61 years) treated by endovascular embolization in our institution with clinically significant gastrointestinal hemorrhage after unsuccessful or impossible endoscopic treatment were identified.Results The source of bleeding was found in 88% of patients, but embolization was performed in 96% of them. The technical success rate in the sample was 100%, and the clinical favorable outcome rate was 88.5%. The bleeding recurrence occurred in eight cases, five of whom had technically successful re-embolization in four cases. The incidence of recurrent bleeding was significantly higher in patients with two or more comorbidities with (p = 0.043). There was one serious complication (4%) in the group and minor difficulties occurred in 18% of patients; 30-day mortality reached 22%. Mortality was significantly higher in the group of patients with re-bleeding (p = 0.044).Discussion Our documented results in common are in the established rank of previously published results, which range from 62-100% for technical success, 52-94% for the clinical favorable outcome, 9-66% for re-bleeding and 4-46% for 30-day mortality.Conclusion Transcatheter arterial embolization is a safe mini-invasive method with high technical and clinical success in patients with endoscopically untreatable gastrointestinal bleeding. It is also suitable for high-risk cases. Mortality (to a significant extent) typically depends on the re-bleeding presence and the patient's comorbidity.

scholarly journals The Clinical and Technical Effectiveness of Endovascular Embolization in Patients with Nonvariceal Gastrointestinal Bleeding

2017 ◽  
Vol 01 (01) ◽  
pp. 005-012
Author(s):  
Azadeh Elmi ◽  
T. Walker ◽  
Suvranu Ganguli ◽  
Sanjeeva Kalva
Keyword(s):  
Multivariate Analysis ◽  
Gastrointestinal Bleeding ◽  
Clinical Success ◽  
Mortality Rates ◽  
Therapeutic Endoscopy ◽  
Endovascular Embolization ◽  
Technical Success ◽  
Selective Embolization ◽  
Technical Success Rate ◽  
Clinical Records

Background and Aim Endovascular embolization is a well-established option in the management of acute gastrointestinal bleeding (GIB) after failed therapeutic endoscopy; however, questions remain concerning the outcomes and the various predictors of clinical and technical success of this therapy. The authors aimed to assess the effectiveness of endovascular embolization in patients with nonvariceal GIB. Method Clinical records of 88 patients (mean age: 67.8 years) who underwent endovascular embolization for GIB were reviewed. Patient demographics, history, angiographic findings, treatment, and outcomes were recorded. The technical success of embolization, and the 24-hour and 30-day rebleeding and mortality rates were calculated. Multivariate analysis was performed to assess the factors associated with 24-hour and 30-day rebleeding. Results Angiography demonstrated signs of bleeding in 63 (71.6%) patients and all underwent selective embolization of the abnormal artery. Empiric embolization was performed in 25 patients. Embolization was performed with coils (n = 45), Gelfoam (n = 12), microparticles (n = 14), glue (n = 2), or a combination of these (n = 15). The technical success rate was 96.6%. The 24-hour and 30-day rebleeding occurred in 13 (14.7%) and 16 (18.2%) patients, respectively. The 24-hour and 30-day mortality rates were 9.1 and 11.3%, respectively. Ischemic complications following embolization were seen in three patients, of which two required surgery. Based on the multivariate analysis, the need for continued transfusion after embolization and prior GIB were independent variables associated with 24-hour and 30-day rebleeding, respectively. Conclusions Endovascular embolization has a high technical and clinical success in patients presenting with nonvariceal GIB.

Renal function in 29 healthy adults before and after nephrectomy

JAMA ◽  
1966 ◽  
Vol 196 (4) ◽  
pp. 322-324 ◽  
Author(s):  
A. G. Krohn
Keyword(s):  
Renal Function ◽  
Healthy Adults ◽  
Before And After

RENAL FUNCTION AND KIDNEY SIZE FOLLOWING HYPOPHYSECTOMY IN MAN

1965 ◽  
Vol 48 (3) ◽  
pp. 348-354 ◽  
Author(s):  
Thomas Falkheden ◽  
Ingmar Wickbom
Keyword(s):  
Renal Function ◽  
Diabetic Retinopathy ◽  
Glomerular Filtration Rate ◽  
Plasma Flow ◽  
Mammary Carcinoma ◽  
Filtration Rate ◽  
Renal Plasma Flow ◽  
Kidney Weight ◽  
Kidney Size ◽  
Before And After

ABSTRACT Measurements of glomerular filtration rate (GFR) and renal plasma flow (RPF) were performed in close connection with roentgenographic estimation of kidney size, before and after hypophysectomy, in 10 patients (four cases of metastatic mammary carcinoma, five cases of diabetic retinopathy and one case of acromegaly). Hypophysectomy was regularly followed by a decrease in GFR and RPF. In most cases, a reduction in the roentgenographic kidney size was also observed. However, the changes in the roentgenographic kidney size and calculated kidney weight after hypophysectomy were smaller and occurred at a slower rate than the alterations in GFR and RPF. The results favour the view that, primarily, the decrease in GFR and RPF following hypophysectomy is essentially functional rather than due to a reduced kidney mass.

scholarly journals Comparison of different techniques for the management of venous steno-occlusive lesions during placement of peripherally inserted central catheter

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Woo Jin Yang ◽  
Danbee Kang ◽  
Ji Hoon Shin ◽  
Eun Ho Jang ◽  
Seung Yeon Noh ◽  
...  
Keyword(s):  
Clinical Success ◽  
Alternative Pathway ◽  
Transluminal Angioplasty ◽  
Second Line ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Success Rates ◽  
Initial Attempt ◽  
Technical Success Rate ◽  
Occlusive Lesion

AbstractThe purpose of this study is to investigate strategies for peripherally inserted central catheter (PICC) placement in patients with venous steno-occlusive lesion (VSOL). We performed a retrospective cohort study in adults with central or peripheral VSOL who underwent PICC placement procedures from January 2015 to December 2018. Four different strategies [selecting alternative pathway/over the wire (SAP/OTW), percutaneous transluminal angioplasty (PTA), re-puncture in ipsilateral arm (RIA), and catheter placement in the contralateral arm (CICA)] were analyzed and we compared the clinical outcomes by strategy and compared the strategy between central and peripheral VSOLs. During 4 years, 258 PICC procedures performed in patients with VSOLs, 100 PICC were included in the analysis. The overall technical success rate of initial attempt with SAP/OTW was 32.2%. As a second-line technique, PTA was most frequently used in both central (100%) and peripheral (68.2%) VSOL groups. The clinical success rates within 2 months of SAP/OTW, PTA, RIA, CICA were 55.2%, 43.2%, 14.3%, and 33.3%, respectively (P = 0.24). In conclusion, when the SAP/OTW failed, the PTA can be preferred as a second-line technique for both central and peripheral VSOLs. When guidewire passage fails, the operator could adopt the RIA or CICA technique as an alternative method.

scholarly journals CT diagnosis of ilioinguinal lymph node metastases in melanoma using radiological characteristics beyond size and asymmetry

BJS Open ◽  
2021 ◽  
Vol 5 (1) ◽  
Author(s):  
M J Wilkinson ◽  
H Snow ◽  
K Downey ◽  
K Thomas ◽  
A Riddell ◽  
...  
Keyword(s):  
Lymph Node ◽  
Diagnostic Accuracy ◽  
Multivariable Analysis ◽  
Ct Scans ◽  
Non Invasive ◽  
Poor Predictor ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Node Metastases

Abstract Background Diagnosis of lymph node (LN) metastasis in melanoma with non-invasive methods is challenging. The aim of this study was to evaluate the diagnostic accuracy of six LN characteristics on CT in detecting melanoma-positive ilioinguinal LN metastases, and to determine whether inguinal LN characteristics can predict pelvic LN involvement. Methods This was a single-centre retrospective study of patients with melanoma LN metastases at a tertiary cancer centre between 2008 and 2016. Patients who had preoperative contrast-enhanced CT assessment and ilioinguinal LN dissection were included. CT scans containing significant artefacts obscuring the pelvis were excluded. CT scans were reanalysed for six LN characteristics (extracapsular spread (ECS), minimum axis (MA), absence of fatty hilum (FH), asymmetrical cortical nodule (CAN), abnormal contrast enhancement (ACE) and rounded morphology (RM)) and compared with postoperative histopathological findings. Results A total of 90 patients were included. Median age was 58 (range 23–85) years. Eighty-eight patients (98 per cent) had pathology-positive inguinal disease and, of these, 45 (51 per cent) had concurrent pelvic disease. The most common CT characteristics found in pathology-positive inguinal LNs were MA greater than 10 mm (97 per cent), ACE (80 per cent), ECS (38 per cent) and absence of RM (38 per cent). In multivariable analysis, inguinal LN characteristics on CT indicative of pelvic disease were RM (odds ratio (OR) 3.3, 95 per cent c.i. 1.2 to 8.7) and ECS (OR 4.2, 1.6 to 11.3). Cloquet’s node is known to be a poor predictor of pelvic spread. Pelvic LN disease was present in 50 per cent patients, but only 7 per cent had a pathology-positive Cloquet’s node. Conclusion Additional CT radiological characteristics, especially ECS and RM, may improve diagnostic accuracy and aid clinical decisions regarding the need for inguinal or ilioinguinal dissection.

scholarly journals The Inverse Spacer—A Novel, Safe, and Cost-Effective Approach in Routine Procedures for Revision Knee Arthroplasty

2021 ◽  
Vol 10 (5) ◽  
pp. 971
Author(s):  
Kristoff Hammerich ◽  
Jens Pollack ◽  
Alexander F. Hasse ◽  
André El Saman ◽  
René Huber ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Clinical Success ◽  
Cost Effective ◽  
Revision Total Knee Arthroplasty ◽  
Rotational Stability ◽  
X Rays ◽  
Free Interval ◽  
Major Disadvantage ◽  
Cost Effective Approach ◽  
Before And After

Background: A major disadvantage of current spacers for two-stage revision total knee arthroplasty (R-TKA) is the risk of (sub-) luxation during mobilization in the prosthesis-free interval, limiting their clinical success with detrimental consequences for the patient. The present study introduces a novel inverse spacer, which prevents major complications, such as spacer (sub-) luxations and/or fractures of spacer or bone. Methods: The hand-made inverse spacer consisted of convex tibial and concave femoral components of polymethylmethacrylate bone cement and was intra-operatively molded under maximum longitudinal tension in 5° flexion and 5° valgus position. Both components were equipped with a stem for rotational stability. This spacer was implanted during an R-TKA in 110 knees with diagnosed or suspected periprosthetic infection. Postoperative therapy included a straight leg brace and physiotherapist-guided, crutch-supported mobilization with full sole contact. X-rays were taken before and after prosthesis removal and re-implantation. Results: None of the patients experienced (sub-) luxations/fractures of the spacer, periprosthetic fractures, or soft tissue compromise requiring reoperation. All patients were successfully re-implanted after a prosthesis-free interval of 8 weeks, except for three patients requiring an early exchange of the spacer due to persisting infection. In these cases, the prosthetic-free interval was prolonged for one week. Conclusion: The inverse spacer in conjunction with our routine procedure is a safe and cost-effective alternative to other articulating or static spacers, and allows crutch-supported sole contact mobilization without major post-operative complications. Maximum longitudinal intra-operative tension in 5° flexion and 5° valgus position appears crucial for the success of surgery.

Predictors for Clinical Success at One Year following Renal Artery Stent Placement

2002 ◽  
Vol 9 (4) ◽  
pp. 495-502 ◽  
Author(s):  
Trude C. Gill-Leertouwer ◽  
Elma J. Gussenhoven ◽  
Johanna L. Bosch ◽  
Jaap Deinum ◽  
Hans van Overhagen ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Stent Placement ◽  
Clinical Success ◽  
Artery Stenosis ◽  
Renal Function Impairment ◽  
Function Impairment ◽  
Renal Artery Stent

Purpose: To determine pretreatment variables that may predict 1-year clinical outcome of stent placement for renal artery stenosis. Methods: In a prospective study, 40 consecutive patients (29 men; mean age 60 ± 9.1 years) with angiographically proven atherosclerotic renal artery stenosis were treated with stent placement because of drug resistant hypertension (n=14), renal function impairment (n=14), or both (n=12). Clinical success at 1 year was defined as a decrease of diastolic blood pressure ≥10 mmHg or a decrease in serum creatinine ≥20%, depending on the indication for treatment. Regression analysis was performed using anatomical parameters from angiography and intravascular ultrasound, estimates of renal blood flow from renal scintigraphy, and single-kidney renal function measurements. Results: Patients treated for hypertension had better outcome than those treated for renal function impairment, with clinical success rates of 85% and 35%, respectively. Preserved renal function, with low serum creatinine and high 2-kidney glomerular filtration rate at baseline, was associated with clinical success in the entire patient group at follow-up (p=0.02 and p=0.03, respectively). An elevated vein-to-artery renin ratio on the affected side was borderline predictive (p=0.06). In patients treated for renal impairment, lateralization to the affected kidney (affected kidney—to–2-kidney count ratio ≤0.45) on the scintigram emerged as a significant predictor for clinical success, with an odds ratio of 15 (p=0.048). Conclusions: Clinical success of renal artery stent placement is better for the treatment of hypertension than for preserving renal function. In patients with renal function impairment, lateralization to the affected kidney on the scintigram appears to be a predictor of clinical success.

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