ABSTRACT
Current practice guidelines recommend that 'low-risk' outpatients undergoing percutaneous native renal biopsy (PRB) are observed for 6-8 h to identify post-biopsy complications. We performed a retrospective review of 225 PRB procedures in low-risk outpatients who were observed for a 4-h period to determine the safety with regard to complication rate and timing. PRB was performed using a standardised protocol and under ultrasound guidance with a 16- or 18-gauge needle. Bleeding complications occurred in 7% (16/225) of patients, of which 88% (14/16) were detected within a 4-h period. The two undetected complications presented more than 72 h after the procedure. This suggests that a 4-h observation period may be safe and adequate in identifying the majority of patients who will experience significant complications in the first 24 h, with a potential saving of time and resources.
Subject(s)
Kidney , Outpatients , Biopsy/adverse effects , Biopsy/methods , Biopsy, Needle/adverse effects , Biopsy, Needle/methods , Humans , Kidney/diagnostic imaging , Kidney/pathology , UltrasonographyABSTRACT
Angioinvasive complications of Scedosporium infections are rare. We report two cases of mycotic aneurysm, following apparent localized infection, due to Scedosporium apiospermum and Pseudallescheria boydii. The thoracoabdominal aorta was affected in one patient, and cerebral vessels were affected in the other. Despite voriconazole therapy and surgical resection, the patients died. Previously reported cases are reviewed.
Subject(s)
Aneurysm, Infected/diagnosis , Aneurysm, Infected/microbiology , Mycetoma/complications , Mycetoma/diagnosis , Pseudallescheria/isolation & purification , Scedosporium/isolation & purification , Aneurysm, Infected/pathology , Aneurysm, Infected/therapy , Antifungal Agents/administration & dosage , Aorta/pathology , Cerebral Arteries/pathology , Fatal Outcome , Humans , Male , Middle Aged , Mycetoma/microbiology , Mycetoma/therapy , Pyrimidines/administration & dosage , Triazoles/administration & dosage , Vascular Surgical Procedures/methods , VoriconazoleABSTRACT
Following renal transplantation, hypercalcaemia is frequently caused by persisting hyperparathyroidism. Unregulated extrarenal 1,25-dihydroxyvitamin D (1,25(OH)(2)D) synthesis, which is well recognized as a cause of hypercalcaemia in granulomatous diseases, may also occur after kidney transplantation. This mechanism is also likely to be responsible for hypercalcaemia reported during treatment of cytomegalovirus and associated with acute symptomatic pneumocystis jivorecii pneumonia (PCP). Hypercalcaemia as a prodromal feature of indolent PCP has not been described. We report a renal transplant recipient who developed hypercalcaemia 30 months post-transplant due to extrarenal production of 1,25(OH)(2)D. Two months later, PCP was diagnosed and hypercalcaemia resolved after initiation of treatment.
Subject(s)
Hypercalcemia/etiology , Kidney Transplantation/adverse effects , Pneumonia, Pneumocystis/etiology , Diagnosis, Differential , Humans , Hypercalcemia/diagnosis , Hypercalcemia/therapy , Male , Middle Aged , Pneumonia, Pneumocystis/diagnostic imaging , Pneumonia, Pneumocystis/drug therapy , Prognosis , Radiography , Vitamin D/analogs & derivatives , Vitamin D/bloodABSTRACT
A 39 year old female presented with rapidly enlarging goitre, minimal obstructive symptoms and no constitutional symptoms. Clinical examination revealed diffusely enlarged, firm, non-tender thyroid gland. Biochemical investigations showed subclinical hypothyroidism, positive thyroid antibodies and unremarkable inflammatory markers. Ultrasound examination and CT scan of the neck were suspicious of Riedels thyroiditis. The patient was referred for a FDG PET scan to evaluate for systemic fibro-inflammatory process or lymphoma. Subsequent core biopsy of the thyroid gland demonstrated a chronic inflammatory process with fibrosis consistent with Riedels thyroiditis. A FDG PET/CT study showed diffuse FDG uptake in the thyroid gland and no abnormal retroperitoneal FDG uptake elsewhere to suggest active retroperitoneal fibrosis. The goitre reduced in size with thyroid hormone replacement and steroids, however the patient was lost to follow up.