Comparison of Polyvinyl Alcohol Versus Combination of Lipiodol-Bleomycin Emulsion and NBCA-Lipiodol Emulsion for Renal Angiomyolipoma Embolization: A Prospective Randomized Study.

BACKGROUND. Consensus is lacking regarding optimal embolic agents for transcatheter arterial embolization (TAE) of renal angiomyolipomas (AMLs). OBJECTIVE. The purpose of our study was to compare the safety and efficacy of TAE with polyvinyl alcohol (PVA) and TAE with a combination of ethiodized oil (Lipiodol)-bleomycin emulsion and N-butyl cyanoacrylate (NBCA)-Lipiodol emulsion for the treatment of patients with large or symptomatic AMLs. METHODS. This prospective study enrolled patients referred for TAE of a large (> 4 cm) or symptomatic renal AML from July 2007 to December 2018. Patients were randomized to undergo TAE using PVA particles or a combination of Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion. Patients underwent serial clinical follow-up visits and follow-up CT or MRI examinations after TAE. Outcomes were compared between groups. RESULTS. Seventy-eight patients were enrolled. After exclusions, the analysis included 72 patients (15 men, 57 women; mean age, 35.0 years; 51 patients with hematuria, 66 patients with flank pain): 35 patients were randomized to treatment by PVA and 37 were randomized to treatment by a combination of Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion. Complete occlusion of all angiographically visible arterial supply was achieved in all patients. No major adverse event occurred in any patient. The mean follow-up after TAE was 77 ± 45 (SD) months (range, 37-180 months). The frequency of resolution of hematuria after initial TAE without recurrence was greater after treatment by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than by PVA (100.0% vs 80.0%, respectively; p = .03). At 12-month follow-up, the frequency of complete resolution of flank pain was higher after treatment by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than by PVA (100.0% vs 75.0%, p = .03). Mean reduction in AML volume at 36 months or longer after TAE versus at baseline was greater in patients treated by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than in those treated by PVA (98.0% vs 85.7%, respectively; p = .04). The frequency of complete response by modified RECIST (mRECIST) criteria at 36 months or longer after TAE was greater in patients treated by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than by PVA (94.6% vs 74.3%, p = .04). The rate of repeat TAE was higher among patients treated by PVA than among those treated by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion (25.7% vs 8.1%, p = .04). CONCLUSION. Superior outcomes after TAE of AML were achieved using Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than using PVA. CLINICAL IMPACT. TAE using a combination of Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion is a safe and effective treatment option for large or symptomatic AMLs. TRIAL REGISTRATION. Chinese Clinical Trial Registry ChiCTR2100053296.

Treatment and Management of Loin Pain Hematuria Syndrome.

PURPOSE OF REVIEW: Loin pain hematuria syndrome (LPHS) is rare and seldom diagnosed, yet it has a particularly significant impact on those affected. This is a review of the latest and seminal evidence of the pathophysiology and diagnosis of LPHS and presents the typical clinical presentation and treatment options available. RECENT FINDINGS: LPHS is typically found in young women with characteristic symptoms, including severe recurrent flank pain and gross or microscopic hematuria. The majority of patients will experience crippling pain for many years without effective therapy, often requiring frequent use of narcotic medication. However, the lack of conclusive pathophysiology, in conjunction with the rarity of LPHS, has prohibited the development and trial of definitive treatment options. Nevertheless, in order to combat this rare but severe disease, management strategies have continued to evolve, ranging from conservative measures to invasive procedures. This review presents an overview of the current hypotheses on the pathophysiology of LPHS in addition to summarizing the management strategies that have been utilized. Only 30% of LPHS patients will experience spontaneous resolution, whereas the majority will continue to face chronic, crippling pain. Several methods of treatment, including invasive and non-invasive, may provide an improved outcome to these patients. Treatment should be individually tailored and multi-disciplinary in nature. Further research is required to further elucidate the pathophysiology and develop new, specific, treatment options.

Latrodectus Facies After Latrodectus Hesperus Envenomation in a Pediatric Patient.

BACKGROUND: Black widow spider (Latrodectus spp) envenomation represents the most medically significant spider envenomation in the United States, prompting more than 2500 calls to poison centers annually. The female spider, which is responsible for symptomatic envenomations, is classically described as a shiny black spider with a red hourglass-shaped marking on the ventral abdomen. Clinical features of envenomation include painful muscle cramping, abdominal pain, and autonomic disturbances, such as tachycardia, hypertension, and diaphoresis. "Latrodectus facies" or "facies latrodectismica" is an additional distinctive but rarely described clinical finding characterized by periorbital edema, lacrimation, and blepharospasm. CASE REPORT: A 6-year-old female developed the typical clinical features of Latrodectus envenomation after being found in bed with a Western black widow spider (Latrodectus hesperus) with no ventral marking. She initially improved with opioid analgesia, but 6 h later her symptoms worsened again, and concurrent with this worsening she developed Latrodectus facies. She received additional opioid analgesia and all her symptoms resolved within 24 h. Her mother provided informed and written consent for the acquisition and publication of the facial photographs presented. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: A high degree of clinical suspicion is necessary to correctly diagnose Latrodectus envenomation, especially when the spider escapes unnoticed or in young children in whom the bite is not witnessed. To our knowledge, Latrodectus facies has not been reported previously in a young child, and recognition of this finding will aid clinicians in limiting unnecessary interventions and administering appropriate therapy.

Chinese herbal medicine to treat urolithiasis in a patient with right flank pain and hematuria: A case report.

OBJECTIVE: Urolithiasis is a common medical condition affecting the urinary tract. Typical symptoms reported by patients include colic pain and hematuria. Some patients may undergo surgical intervention or lithotripsy to remove the stones. In this case, we demonstrated that Chinese herbal medicine (CHM) was an effective modality to remove stones in a patient with urolithiasis. CLINICAL FEATURES AND OUTCOME: A 47-year-old man suffered from right flank pain and hematuria for three months and was diagnosed with an upper third ureteral stone obstruction with right hydronephrosis. He had received extracorporeal shock wave lithotripsy (ESWL) three times before his first CHM visit, but it was unsuccessful. Therefore, he sought CHM for further intervention. His symptoms subsided, and the image study showed complete removal of the ureteral stone after regular therapy with Zhi Bai Di Huang Wan () combined with Lygodii spora (), Curcumae radix (), Endothelium Corneum Gigeriae Galli (), Lysimachiae herba (), Orthosiphon stamineus () for approximately four months. Neither complications nor side-effects were noted during the CHM treatment. CONCLUSIONS: In this case, we concluded that CHM may be an effective alternative therapy for the treatment of ureteral stones, and furthermore, may also be applied as an option to salvage failed ESWL procedures.

Failure of Ciprofloxacin Therapy in the Treatment of Community-Acquired Acute Pyelonephritis caused by In-Vitro Susceptible Escherichia coli Strain Producing CTX-Type Extended-Spectrum β-Lactamase / 감염과화학요법

While carbapenems are the drug of choice to treat extended-spectrum-β-lactamase (ESBL)-producing strains, some alternative carbapenem-sparing regimens are suggested for antibiotic stewardship. We experienced a case of ciprofloxacin treatment failure for acute pyelonephritis caused by an apparently susceptible Escherichia coli. A 71-year-old woman presented the emergency department with fever for 7 days and bilateral flank pain for 2 days. The laboratory results and abdominopelvic computed tomography finding were compatible with acute pyelonephritis. During 3-day ciprofloxacin therapy, the patient remained febrile with persistent bacteremia. After the change in antibiotics to ertapenem, the patient’s clinical course started to improve. ESBL-producing E. coli isolates were identified in all three consecutive blood samples. Pulsed-field gel electrophoresis (PFGE) patterns, serotypes, and sequence types showed the three isolates were derived from the identical strain. The isolates produced CTX-M-14 type ESBL belonging to the ST69 clonal group. Despite in vitro susceptibility, the failure was attributed to a gyrA point mutation encoding Ser83Leu within quinolone resistance-determining regions. This case suggests that ciprofloxacin should be used cautiously in the treatment of serious infections caused by ciprofloxacin-susceptible, ESBL-producing E. coli, even in acute pyelonephritis because in-vitro susceptibility tests could fail to detect certain genetic mutations.

Failure of Ciprofloxacin Therapy in the Treatment of Community-Acquired Acute Pyelonephritis caused by In-Vitro Susceptible Escherichia coli Strain Producing CTX-Type Extended-Spectrum β-Lactamase / 감염과화학요법

While carbapenems are the drug of choice to treat extended-spectrum-β-lactamase (ESBL)-producing strains, some alternative carbapenem-sparing regimens are suggested for antibiotic stewardship. We experienced a case of ciprofloxacin treatment failure for acute pyelonephritis caused by an apparently susceptible Escherichia coli. A 71-year-old woman presented the emergency department with fever for 7 days and bilateral flank pain for 2 days. The laboratory results and abdominopelvic computed tomography finding were compatible with acute pyelonephritis. During 3-day ciprofloxacin therapy, the patient remained febrile with persistent bacteremia. After the change in antibiotics to ertapenem, the patient’s clinical course started to improve. ESBL-producing E. coli isolates were identified in all three consecutive blood samples. Pulsed-field gel electrophoresis (PFGE) patterns, serotypes, and sequence types showed the three isolates were derived from the identical strain. The isolates produced CTX-M-14 type ESBL belonging to the ST69 clonal group. Despite in vitro susceptibility, the failure was attributed to a gyrA point mutation encoding Ser83Leu within quinolone resistance-determining regions. This case suggests that ciprofloxacin should be used cautiously in the treatment of serious infections caused by ciprofloxacin-susceptible, ESBL-producing E. coli, even in acute pyelonephritis because in-vitro susceptibility tests could fail to detect certain genetic mutations.

Lateral Cutaneous Nerve Entrapment Syndrome (LACNES): A previously unrecognized cause of intractable flank pain.

BACKGROUND AND AIMS: Chronic abdominal pain may occasionally be due to terminal endings of intercostal nerves (ACNES, abdominal cutaneous nerve entrapment syndrome) that are entrapped in the abdominal wall. Spontaneous neuropathic flank pain may also be caused by involvement of branches of these intercostal nerves. Aim is to describe a series of patients with flank pain due to nerve entrapment and to increase awareness for an unknown condition coined Lateral Cutaneous Nerve Entrapment Syndrome (LACNES). METHODS: Patients possibly having LACNES (constant area of flank tenderness, small point of maximal pain with neuropathic characteristics, locoregional altered skin sensation) presenting between January 2007 and May 2016 received a diagnostic 5-10mL 1% lidocaine injection. Pain levels were recorded using a numerical rating scale (0, no pain to 10, worst possible). A >50% pain reduction was defined as success. Long term effect of injections and alternative therapies were determined using a satisfaction scale (1, very satisfied, no pain - 5, pain worse). RESULTS: 30 patients (21 women, median age 52, range 13-78) were diagnosed with LACNES. Pain following one injection dropped from 6.9±1.4 to 2.4±1.9 (mean, p<0.001) leading to an 83% immediate success rate. Repeated injection therapy was successful in 16 (pain free n=7, pain acceptable, n=9; median 42 months follow-up). The remaining 14 patients received (minimally invasive) surgery (n=5) or other treatments (medication, manual therapy or pulsed radiofrequency, n=9). Overall treatment satisfaction (scale 1 or 2) was attained in 79%. CONCLUSIONS AND IMPLICATIONS: LACNES should be considered in patients with chronic flank pain. Injection therapy is long term effective in more than half of the population.

An Evidence-Based Model for the Successful Treatment of Flank and Lateral Abdominal Wall Hernias.

BACKGROUND: Lateral abdominal wall defects are a significant contributor to patient morbidity and mortality in the United States. Reconstruction involving flank hernias and bulges is relatively scarce in the literature despite its serious consequences. The authors aim to identify an objective approach for the evaluation and successful repair of defects of the lateral abdominal wall. METHODS: A retrospective analysis was carried out on patients presenting for open repair of a lateral wall defect performed by a single surgeon. Over a 5-year period, there were 29 consecutive patients with a mean follow-up period of 21.2 months. Patient demographics including body mass index, number of hernia defects, number of previous repairs/abdominal operations, defect size, operative time, blood loss, and complications (e.g., recurrence/bulge, seroma, hematoma, wound infection, persistent pain, skin breakdown, and fascial dehiscence) were collected. RESULTS: Patients who underwent flank hernia repairs using an inlay/underlay nonbridged technique with the use of acellular dermal matrix had low recurrence and overall complication rates. Only one patient (3.4 percent) had a recurrence at follow-up, and another patient (3.4 percent) had developed a bulge. CONCLUSIONS: The authors' data indicate successful results when their technique is applied. Proper patient selection is essential, along with a thorough understanding of anatomy and techniques for successful reconstruction. The authors recommend using an inlay (preferred) or underlay repair with acellular dermal matrix to reinforce the surrounding musculofascial closure. This technique, in conjunction with the authors' holistic abdominal wall reconstruction protocol, has optimized outcomes and identified a successful multidisciplinary strategy for the reconstruction of lateral wall defects. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Page kidney after botulinum toxin injection during chiropractic care / 영남의대학술지

Page kidney refers to the phenomenon of hypertension secondary to long-standing compression of renal parenchyma caused by renal subcapsular collection. The most common cause of renal subcapsular collection is a hematoma which usually occurs after a history of blunt trauma. A 42-year-old female patient who received botulinum toxin injection in her back during chiropractic care was admitted to the emergency room with sudden bilateral flank pain and hypertension. The computed tomography (CT) images demonstrated the presence of bilateral subcapsular renal hematoma. The patient was treated conservatively and recovered well. The follow up CT images showed markedly resolved bilateral hematoma.

Transperitoneal laparoscopic renal denervation for the management of loin pain haematuria syndrome.

OBJECTIVES: To assess the role of laparoscopic renal denervation as a surgical option in loin pain-haematuria syndrome (LPHS), refractory to conservative treatment. MATERIAL AND METHODS: Nine patients between 2000 and 2010 with a diagnosis of LPHS following extensive investigations. The data collection from medical records and electronic databases included demographic details, details of surgical procedures, perioperative outcomes, pain recurrences and ongoing analgesia requirements. A telephone follow-up was conducted after at least one year after the procedure for each patient using the Pain Impact Questionnaire (PIQ-6TM) to assess impact of pain on their quality of life. RESULTS: Nine patients (nine women; median age 37 years) underwent 11 laparoscopic denervations. The median follow-up was 28 months. The median operative time was 150 min. There were no significant postoperative complications. In four patients (44%) laparoscopic denervation procedures were curative (median follow-up 70.5 months). The analgesic requirement was significantly reduced in 22% of patients. Telephone follow-up confirmed that 66.66% of the patients had better quality of life after the procedure. CONCLUSIONS: Laparoscopic renal denervation is a feasible and safe alternative to open procedures in patients with refractory LPHS, producing good outcomes in terms of pain-free rates and quality of life impact.

Hypnotherapy intervention for loin pain hematuria: a case study.

Loin pain hematuria is characterized by chronic loin pain, hematuria, and dysuria. There are no known effective treatments for loin pain hematuria and longer term use of analgesics and surgical options are often ineffective or associated with negative side effects. This article reports on a 17-year-old female patient diagnosed with loin pain hematuria who presented with unilateral, uncontrolled loin pain following numerous unsuccessful attempts at controlling her symptoms with traditional medical interventions, including antibiotics, opioids, and renal denervation. The patient received 8 sessions of hypnotherapy. Baseline, endpoint, and follow-up measures administered included the General Health Questionnaire, Hospital Anxiety and Depression Scale, McGill Pain Questionnaire, Pain Discomfort Scale, and visual analogue measures of pain, academic interference, and social interference. At follow-up, results indicated clinically significant decreases in pain, anxiety, and depression with nearly complete remission of presenting symptoms.

A Case of Ulcerative Colitis Patient with Colonic Stenosis and Enterocutaneous Fistula

Ulcerative colitis (UC) is one of the chronic inflammatory bowel diseases (IBD), characterized by a diffuse mucosal inflammation limited to the colon. Complications of UC include stricture, colorectal cancer, and toxic colitis. UC patients rarely present with a stenosis or fistula, and strictures develop in less than 5% of patients with UC. We present a patient with UC, accompanied by unusual complications that involved not only a stricture but also a fistula and abscess. A 49-year-old female was presented with a left flank pain and fever that had begun two weeks before admission. She had received a diagnosis of UC 20 years ago and had it treated for 2 years in a local hospital. However, she arbitrarily stopped visiting the hospital and relied on home remedies. An abdominopelvic CT scan revealed luminal narrowing and extra-peritoneal fistula formation in the descending colon. Fistula was connected with a subcutaneous abscess in the left flank. She had undergone total colectomy and ileo-anal anastomosis. On the pathologic exam, the long standing UC with severe stenosis was observed without malignant change. It cannot be emphasized enough that a correct therapeutic approach and an appropriate follow-up schedule are very important for patients with UC.

Comparison of an Indwelling Period Following Ureteroscopic Removal of Stones between Double-J Stents and Open-Ended Catheters: A Prospective, Pilot, Randomized, Multicenter Study

PURPOSE: The aim of this study was to evaluate whether long-term, postoperative ureteral stenting is necessary after ureteroscopic removal of stones (URS) during an uncomplicated surgical procedure. MATERIALS AND METHODS: We prospectively examined 54 patients who underwent URS for lower ureteral stones from February 2010 to October 2010. Inclusion criteria were a stone less than 10 mm in diameter, absence of ureteral stricture, and absence of ureteral injury during surgery. We randomly placed 5 Fr. open-tip ureteral catheters in 26 patients and removed the Foley catheter at postoperative day 1. The remaining 28 patients received double-J stents that were removed at postoperative day 14 by cystoscopy under local anesthesia. All patients provided visual analogue scale (VAS) pain scores at postoperative days 1, 7, and 14 and completed the storage categories of the International Prostate Symptom Score (IPSS) at postoperative day 7. RESULTS: The VAS scores were not significantly different on postoperative day 1 but were significantly smaller in the 1-day ureteral catheter group at postoperative days 7 and 14 (p<0.01). All of the storage categories of the IPSS were significantly lower in the 1-day ureteral stent group (p<0.01). The ratio of patients who needed intravenous analgesics because of severe postoperative flank pain was not significantly different between the two groups (p=0.81). No patients experienced severe flank pain after postoperative day 2, and no patients in either group had any other complications. CONCLUSIONS: One-day ureteral catheter placement after URS can reduce postoperative pain and did not cause specific complications compared with conventional double-J stent placement.

Renal colic in adults: NSAIDs and morphine are effective for pain relief.

(1) Renal colic is an acute syndrome involving unilateral flank pain, linked to an obstruction in the upper urinary tract. The pain is often intense. After having considered other diagnoses and checked for signs of complication (fever, oligoanuria), the first step is to control the pain; (2) Which non-invasive treatments have a positive risk-benefit balance in relieving this type of pain? To answer this question, we reviewed the available evidence, based on the standard Prescrire methodology; (3) According to a meta-analysis of 20 trials, nonsteroidal antiinflammatory drugs (NSAIDs) and strong opioid analgesics have comparable efficacy. The most widely studied NSAID is diclofenac, given intramuscularly at a dose of 50 mg or 75 mg. Pethidine is the best-assessed strong opioid, given intramuscularly at a dose of 50 mg to 100 mg, which corresponds to about 5 mg to 10 mg of morphine. Morphine is given intravenously; subcutaneous administration is an alternative although it has not been evaluated in renal colic; (4) In clinical trials, NSAIDs were associated with fewer adverse effects than opioids, which cause vomiting in about 20% of patients (versus about 6% with an NSAID); (5) NSAIDs expose patients to a risk of functional renal impairment, especially in patients with heart failure, renal artery stenosis, dehydration, renal impairment or ongoing treatment with a nephrotoxic drug, and the very elderly. NSAIDs should never be used during pregnancy; (6) According to one trial in 130 patients, the analgesic effect of the morphine and NSAID combination was greater than either agent used alone, in about 10% of patients; (7) Paracetamol has not been evaluated in comparative trials of renal colic, even for moderate pain; (8) Scopolamine is the only antispasmodic to have been evaluated in a comparative trial. Adding scopolamine to morphine did not seem to provide additional efficacy; (9) Other drugs, which have not been adequately tested as of early 2009, have no documented benefit in the treatment of the pain associated with renal colic; tamsulosin, nifedipine, desmopressin; (10) Among the non-drug measures tested, local active warming, taking care to avoid burns, was effective against pain according to one trial; pain was reduced by at least 50% using a device delivering 42 degrees C to the abdomen or lower back; (11) In pregnant women, morphine carries a lower risk of adverse effects than NSAIDs; (12) In practice, the treatment of renal colic is mainly based on taking an NSAID, or morphine when the NSAID does not adequately control the pain or when it is better to avoid using NSAIDs.

A case of Klebsiella psoas abscess due to diverticulitis and intestinal tuberculosis / 대한내과학회지

A 38-year-old male-to-female transgender patient who had undergone a transsexual operation 20 years earlier presented with right flank pain and chills. Abdominal CT scan and gastrografin colon enema revealed a right psoas abscess and an abnormal communication between the large bowel and this psoas abscess. She underwent a right hemicolectomy and was finally diagnosed as having a Klebsiella psoas abscess due to perforated diverticulitis and intestinal tuberculosis. Additional antibiotics and antituberculous medication were required. A secondary psoas abscess due to diverticulitis is rare, and to our knowledge, no case combined with intestinal tuberculosis has previously been reported. We present the case with a brief review of related reports.

A case of Klebsiella psoas abscess due to diverticulitis and intestinal tuberculosis / 대한내과학회지

A 38-year-old male-to-female transgender patient who had undergone a transsexual operation 20 years earlier presented with right flank pain and chills. Abdominal CT scan and gastrografin colon enema revealed a right psoas abscess and an abnormal communication between the large bowel and this psoas abscess. She underwent a right hemicolectomy and was finally diagnosed as having a Klebsiella psoas abscess due to perforated diverticulitis and intestinal tuberculosis. Additional antibiotics and antituberculous medication were required. A secondary psoas abscess due to diverticulitis is rare, and to our knowledge, no case combined with intestinal tuberculosis has previously been reported. We present the case with a brief review of related reports.

An adrenal gland abscess after N-butyl-2-cyanoacrylate (Histoacryl(R)) injection therapy for gastric varices bleeding / 대한내과학회지

N-butyl-2-cyanoacrylate (Histoacryl(R)) is used to obtain hemostasis in gastric variceal bleeding. Known complications of Histoacryl(R) injection therapy include bleeding, perforation, stenosis, and embolism. We report a case of adrenal abscess as a very rare complication of Histoacryl(R) injection. A 40-year-old male with liver cirrhosis was admitted with acute gastric variceal bleeding. Sclerotherapy using Histoacryl(R) mixed with lipiodol (3 mL) was successful. Twenty-seven months later, he was readmitted complaining of left flank pain and a fever of 39degreesC. Abdominal computed tomography (CT) showed a heterogeneous enhancing solid and cystic mass (6.1x3.0 cm) at the left adrenal gland. A left adrenalectomy was performed and the pathological examination confirmed a Histoacryl(R)-related adrenal abscess. We present this case along with a brief review of the literature

Sclerotherapy of Renal Cysts in Korean ADPKD Patients / 대한신장학회잡지

BACKGROUND: Autosomal dominant polycystic kidney disease(ADPKD) is the most common hereditary renal disease in adults, and its major complaints include pain and abdominal fullness due to cyst expansion. So far, for the control of these symptoms, cyst ablation with ethanol or tetracycline, laparoscopic manipulations and surgical marsupialization have been used. METHODS: We used conventional ethanol(n=9) or n-butyl cyanoacrylate(NBCA) plus lipiodol solution (n=18) or both(n=3) for separate cysts as the sclerosing agent in 24 adult Korean ADPKD patients. And their clinical courses after treatment were evaluated. RESULTS: The male to female ratio was 8 : 16 and the mean age at the treatment was 50 yrs(S.D. 13.1). Causes for aspiration were pain in 14 and abdominal fullness in 7 patients and the range for the cyst diameters aspirated were 5-16 cm. Flank pain or discomfort were decreased subjectively in most cases except two. Mean arterial pressures(S.D.) (mmHg) before and after procedure were as follows 112(11.1)(basal), 96(9.6)(1 month) and 98(9.7)(6 month)(p < 0.05, paired-t test). Blood urea nitrogen levels(mg/dL) were not changed 6 month later[24 (12.1) vs. 22(14.6)]. There was no major complication such as bleeding or infection and no death and associated with procedure. There was no difference of therapeutic effect according to sclerosing agent. CONCLUSION: NBCA was as effective as conventional ethanol for sclerotherapy in ADPKD and cyst ablation therapy showed a BP-lowering effect in short-term period.

Percutaneous Aspiration and Instillation of Ethanol for the Simple Renal Cysts / 대한비뇨기과학회지

Recently the percutaneous aspiration and instillation with 95% ethanol, for the sclerosing therapy of the renal simple cyst, was widely used because of high recurrence rate in simple needle aspiration. Ten patients were instillated with ethanol after aspiration. Ages of patients were between 37 to 77 years old. Chief complaints were flank pain, gross hematuria, indigestion, epigastric discomfort and hypertension. After local anesthesia, the cysts were punctured with a trocar needle and inserted 8.3 Fr. single J-catheter with guide wire in turn, under ultrasonic guidance. After complete aspiration of the fluid, 95% ethanol was instillated as much as 20-30% of the cystic volume, and kept for 20-30 minutes. The pigtail catheter was removed after one day. The aspirated volume was 166 ml in average and nearly identical to transudate. There was no bacteria or malignant cells. Follow-up period was 7+/-2 months in average. Five cases were completely cured, four cases recurred but the cyst was smaller(< 50% of the original size) and one recurred as its original size. The complications were transient flank pain and facial flushing. In conclusion, aspiration and instillation with ethanol was very easy, safe, fast and effective treatment for the simple renal cyst.

Superselective Embolization of Renal Angiomyolipoma

PURPOSE: Authors retrospectively evaluated the efficacy of superselective renal arterial emboliation in 5 patients with symptomatic renal angiomyolipoma. MATERIALS AND METHODS: Five Patients with renal angiomyolipoma who had been treated with superselective renal arterial embolization were analysed retrospectively. Two patients who had multiple bilateral lesions were associated with tuberous sclerosis. The mbolic materials used were absolute alcohol in 6 sessions, absolute alcohol mixed with lipiodol in one session, and polyvinyl alcohol in one session. RESULTS: We could observe devascularization of the tumor on the post-embolization arteriograms. The symptoms such as flank pain were improved in all patients during the follow-up period of 3 months to 3years. CONCLUSION: Superselective renal arterial embolization is an effective and safe procedure in the management of renal angiomyolipomas.