The Assessment of the Risk of Acute Kidney Injury in Patients Undergoing an Urgent Endovascular Treatment Due to Severe Renal Bleeding.

INTRODUCTION: This study was designed to assess the clinical factors associated with the development of acute kidney injury (AKI) in patients undergoing endovascular treatment during the course of severe renal bleeding. METHODS: A retrospective analysis was performed of 36 consecutive patients who were treated endovascularly between January 2006 and December 2016 for anemia caused by iatrogenic (26 pts) or posttraumatic (10 pts) renal bleeding. Typical patient data, baseline, and postprocedural blood parameters were evaluated. As a predictor of AKI occurrence, SCr0 > 1.5 mg/dL, eGFR < 60 ml/min/1.73 m2, and Mehran score were evaluated. RESULTS: Fourteen patients (39%) developed AKI after CM injection. Time of hospitalization (p = 0.02), hypotension (p = 0.005), dialysis (p = 0.05), blood transfusions (p = 0.028), amount of blood received (p = 0.003), red blood units > 3 (RBU) (p = 0.032), and CM > 150 ml (p = 0.014) were related to AKI occurrence. The Mehran score may be used as a predictor of AKI occurrence (p = 0.022). The SCr > 1.5 mg/dL and eGFR < 60 ml/min/1.73 m2 were not statistically significant. Selective renal embolization (mean 34% loss of renal tissue) does not lead to AKI. CONCLUSIONS: Hypotension, anemia requiring blood transfusion, and administration of CM exceeding 150 ml poses higher risk of AKI development, which leads to longer hospital stay and need of dialysis. The Mehran score may be used as predictor of AKI occurrence. Up to one third of the kidney was embolized with no AKI linked to the procedure. The concern of AKI occurrence should not be a cause of delay of endovascular treatment.

Use of a calcium sulfate-based bone graft substitute for benign bone lesions.

Twenty-three patients with a benign bone lesion grafted with calcium sulfate, with and without demineralized bone matrix, were reviewed. At a minimum of 1 year postoperatively, 21 patients had achieved between 76% and 100% bone repair based on anteroposterior and lateral radiographs. Overall, the mean Enneking Functional Evaluation System score was 98%. Calcium sulfate is a well-tolerated, biodegradable, osteoconductive bone graft substitute. It is a reasonable alternative to autogenous bone graft for benign bone lesions.

Nursing care of the patient with metastatic bone disease.

The incidence of metastatic bone disease is great. Half of the million cancers diagnosed yearly spread to bone. The nursing management of the patient involves assessment and psychologic support during the diagnosis. Patient education for prophylactic or stabilization surgery, radiation, hypercalcemia, and other treatments is given. Ongoing assessment of pain relief as well as the patient's mobility makes nursing care complex.

"Benign" metastasizing pleomorphic adenoma. A case report and review of literature.

A case of a 34-year-old man with a pathologic fracture through a lytic lesion in the left glenoid is presented. The results of a needle biopsy of the lesion showed a benign pleomorphic adenoma. Sixteen years previously, the patient had a pleomorphic adenoma of the parotid gland. Histology of the initial tissue and the needle biopsy specimen were identical. The patient developed metastasis without any local recurrence of the initial tumor. When evaluating a patient with a lytic lesion of bone with a history of a benign pleomorphic adenoma of the salivary gland, a metastasis should be considered.

Allograft prosthetic composite reconstruction for limb salvage and severe deficiency of bone at the knee or hip.

We reviewed the clinical, radiographic, and where applicable, oncologic results of 112 consecutive allograft prosthetic composite reconstructions performed at Rush Presbyterian St Luke's Medical Center. The source of the bone defects included resection of a tumor, failure of a prior arthroplasty, and periprosthetic fracture. The patients having reconstruction after tumor resection achieved an average Enneking functional score of 28.3. Satisfactory clinical and radiographic results were obtained in 70% to 93%, depending on the group. Based on our experience, we have established a set of principles that should maximize functional results and minimize problems with allograft prosthetic composite arthroplasty.

Intralesional excision compared with en bloc resection for giant-cell tumors of bone.

We reviewed the results for forty consecutively seen patients, each of whom had been managed by one surgeon for a giant-cell tumor of bone in an extremity between 1976 and 1990. Twenty patients had been managed with an en bloc resection and twenty, with an intralesional excision of the tumor with adjunctive local insertion of methylmethacrylate or phenol. All patients had been followed for a minimum of two years. Both en bloc resection and intralesional excision were found to be excellent oncological procedures. There were fewer complications and better functional results after the intralesional procedure than following the en bloc resection.

Update in orthopaedic oncology.

Orthopaedic oncology is a growing field with unanswered questions. Improvements in imaging have led to increases in limb salvage surgery. Chemotherapy is indicated in most bone sarcomas but varied agents are used. Newer surgical procedures such as an internal hemipelvectomy and resection using an expandable prothesis are currently being evaluated. Further research in all areas is indicated.

Allograft prosthetic composite arthroplasty for osteosarcoma and other aggressive bone tumors.

Allograft prosthetic composite arthroplasty is a reconstruction alternative after limb salvage for aggressive bone tumors. It combines an off-the-shelf implant with a fresh-frozen allograft and has several potential advantages over conventional techniques. Good clinical results can be achieved with acceptable morbidity. The procedure can be performed successfully even in patients receiving chemotherapy. Nonunion was the most common complication encountered but was amenable to autogenous iliac bone graft. The procedure can be customized to meet the needs of the patient, making custom implant manufacturing delay and expense unnecessary.

The nursing role in limb salvage surgery.

Limb salvage surgery has proven itself as a valuable option for sarcoma patients. The reconstruction options are vast and include metallic implants, allografts, and a combination of both. The nursing implications for these patients are unlimited. The patient needs to be educated and assessed closely for complications such as infections, nonunion of the allograft, and limited mobility. Although the nursing care is more complicated, the rewards with working with these patients are great.

Complications associated with limb salvage for extremity sarcomas and their management.

A retrospective clinical review of 100 consecutive patients with extremity sarcomas managed by limb salvage operations was performed to evaluate local tumor control and morbidity. The mean follow-up period was 45.1 months. Overall survival was 86%. There were local recurrences in 3% of patients, and 26 complications in 22 patients. Wound necrosis was the most frequent complication. Failure of allogeneic bone graft operations occurred in 25 patients. Most of the complications were salvageable without loss of limb. Limb salvage is an acceptable surgical treatment of extremity sarcomas based on adequate local control and minimal morbidity.

The use of large allografts for tumor reconstruction and salvage of the failed total hip arthroplasty.

Large bone defects have become a more common orthopedic problem in recent year. This is due to the increased enthusiasm for limb salvage surgery as a technique to manage patients with primary bone tumors and for patients who have had multiple joint arthroplasties with subsequent bone loss. One technique that has proven successful for this difficult problem is the use of fresh frozen allografts to reconstruct these skeletal defects. From January 1981 until January 1987, 60 large fragment fresh frozen allografts were used for skeletal reconstruction. These grafts were divided into three basic groups: intercalary, 15; osteoarticular, 16; and allograft-prosthetic composite, 29. The diagnoses included 43 bone tumors, 16 failed total hip arthroplasties, and one traumatic bone loss. The average patient age was 39.7 years and had an average follow-up period of 24 months. The average length of allograft was 12.4 cm. Using the Enneking Functional Evaluation System, the final functional analysis revealed excellent or good results in 86% of the patients and fair or poor results in 14% of the patients. Roentgenological union at the allograft-host bone junction was achieved in 90% of the patients in a mean time of 5.8 months after surgery. An additional three patients obtained union after autogeneic bone grafting. At the time of follow-up evaluation, 92.3% of the patients were free of tumor; they had no local recurrences. The use of fresh frozen allografts represents an acceptable alternative for the reconstruction of large skeletal defects. One can expect good or excellent function for the majority of patients. The best functional results were obtained with the intercalary allografts and the allograft-prosthetic composites.