Pharmarcomechanical thrombectomy combined with transluminal balloon angioplasty for treating transplant renal vein thrombosis.

Renal vein thrombosis (RVT) is a rare vascular complication that occurs after renal transplantation and usually results in irreversible kidney damage and graft loss. We report the case of a patient who underwent right iliac fossa allogeneic kidney transplantation and developed RVT combined with ipsilateral thrombosis from the popliteal to the femoral veins, with extension to the common iliac veins, 4 months after transplantation. Under unfractionated heparin anticoagulation, an Aegisy (Life Tech Scientific Co., Ltd., Shenzhen, China) vena cava filter was placed to prevent pulmonary embolism. Percutaneous mechanical thrombectomy combined with balloon angioplasty was performed to aspirate the thrombus and successfully dilate the narrow venous lumen. The patient's renal function was restored postoperatively. Ultrasonography showed the allograft and ipsilateral lower extremity deep veins to be fluent and patent. To conclude, in patients with RVT after renal transplantation, percutaneous mechanical thrombectomy in conjunction with balloon angioplasty can be performed with desirable outcomes and no severe adverse effects. This method reduces the risk of bleeding from exposure to systemic intravenous thrombolysis and avoids surgery-associated trauma.

Renal papillary necrosis with urinary tract obstruction: A case report.

BACKGROUND: Renal papillary necrosis (RPN) is a rare disease. It is difficult to distinguish RPN with urinary tract obstruction from upper urinary tract occupying lesions. We reported a case of RPN and made a definite diagnosis largely based upon its endoscopic characteristics. CASE SUMMARY: A 75-year-old woman presented with right flank pain, visible hematuria and a body temperature greater than 39 ℃. Laboratory investigations revealed leukocytosis with 12.7 × 10/L white blood cells and 93.6% neutrophils. Blood creatinine was 333 umol/L. Ultrasonography showed hydronephrosis of the right kidney and a right distal ureteric lesion. After urgent placement of right ureteral double J stent and treatment with antibiotics, the patient's symptoms and the blood abnormalities improved rapidly. Computed tomography urography showed the presence of multiple occupying lesions in the right pelvis. The endoscopic ureteroscopy revealed that renal papillary necrosis and the subsequent migration of sloughed papillae into the upper ureter and calyces. The sloughed papillae appeared like "cottons", which were whitish, soft, and irregularly-shaped without blood supply. In addition, the necrotic and sloughed renal papillae were removed by flexible ureteroscopy to prevent further obstruction. Pathological examination found that infarcted renal papillae were associated with inflammatory exudation. Three months after discharge, follow-up computed tomography urography showed no obvious lesions in the renal pelvis. CONCLUSION: This case revealed the endoscopic features of RPN. In addition, flexible ureteroscopy proves to be vital in diagnosis and treatment of RPN.

Individualized minimally invasive treatment for adult testicular hydrocele: A pilot study.

BACKGROUND: Hydrocelectomy is the gold standard for the treatment of hydrocele, but it often causes complications after surgery, including hematoma, infection, persistent swelling, hydrocele recurrence, and chronic pain. In recent years, several methods for minimally invasive treatment of hydrocele have been introduced, but they all have limitations. Herein, we introduce a new method of individualized minimally invasive treatment for hydrocele. AIM: To present a new method for the treatment of adult testicular hydrocele. METHODS: Fifty-two adult patients with idiopathic testicular hydrocele were included. The key point of this procedure was that the scope of the resection of the sheath of the tunica vaginalis was determined according to the maximum diameter (d) of the effusion measured by ultrasound and the maximum diameter of the portion of the sheath pulled out of the scrotum was approximately πd/2. The surgical procedure consisted of a 2-cm incision in the anterior wall of the scrotum, drainage of the effusion, and dissection of part of the sheath of the tunica vaginalis. After the sheath was peeled away to the predetermined target extent, the pulled-out sheath was removed. The intraoperative findings and postoperative complications were analyzed. RESULTS: All patients were successfully treated with a median operation time of 18 min. The median maximum diameter of the effusion on ultrasound was 3.5 cm, and the median maximum diameter of the resected sheath was 5.5 cm. Complications occurred in four (7.7%) patients: two (3.8%) cases of mild scrotal edema, one (1.9%) case of scrotal hematoma, and one (1.9%) case of wound infection. All of the complications were grade I-II. Recurrent hydrocele, chronic scrotal pain, and testicular atrophy were not observed during a median follow-up of 12 mo. CONCLUSION: We report a new technique for individualized treatment of testicular hydrocele, which is quantitative and minimally invasive and yields good outcomes. Further study is warranted to verify its potential value in clinical practice.

Clinical significance of soluble major histocompatibility complex class I chain-related a in renal cell carcinoma patients.

OBJECTIVE: Major histocompatibility complex class I chain-related A (MICA) is a stress-inducible glycoprotein that can be shed as a soluble protein. This study was conducted to determine the expression of MICA in renal cell carcinoma (RCC) and examine the clinical relevance of soluble MICA (sMICA) in this disease. METHODS: Immunohistochemistry and real-time PCR analyses were performed to assess the expression of MICA in 48 pairs of RCC and adjacent normal renal tissues. Serum levels of sMICA were measured in 48 RCC patients, 12 patients with benign renal tumors, and 20 healthy individuals. The correlations between sMICA levels and clinicopathological parameters were analyzed and the diagnostic performance of sMICA in RCC was evaluated. RESULTS: RCCs exhibited elevated expression of MICA compared to adjacent normal tissues. Serum concentrations of sMICA were significantly greater in RCC patients (348.5 ± 32.5 pg/ml) than those with benign disease (289.3 ± 30.4 pg/ml) and healthy controls (168.4 ± 43.2 pg/ml) and significantly correlated with advanced tumor stage, lymph node metastasis, distant metastasis, vascular invasion, and higher histological grade. Using a cut-off point of 250 pg/ml, sMICA demonstrated a specificity and sensitivity of 63.2% and 75.6%, respectively, in distinguishing between RCC and benign renal tumors. CONCLUSION: MICA expression is upregulated in RCC and increased serum sMICA levels predict aggressive tumor behavior. However, the applicability of sMICA alone is limited in distinguishing RCC from benign renal tumors.

Two-year observation of a randomized trial on tacrolimus-based therapy with withdrawal of steroids or mycophenolate mofetil after renal transplantation.

OBJECTIVE: To evaluate the safety and feasibility of steroid or mycophenolate mofetil (MMF) withdrawal from tacrolimus-based immunosuppressant regimen in renal allograft recipients. METHODS: A cohort of 45 patients following cadaveric renal allograft transplantation were randomly divided into 3 groups based on the regimen of combination of tacrolimus, steroid, and MMF: triple therapy group, steroid withdrawal group, and MMF withdrawal group. During 2 years, survival of patients and allografts, clinical acute rejection, adverse events, hepatic and renal allograft function, and blood lipids were monitored to evaluate the safety and feasibility of steroid or MMF withdrawal after renal transplantation. RESULTS: During two-year observation, steroid or MMF was successfully withdrawn from immunosuppressant regimen based on tacrolimus without any clinical acute rejection. Patient and graft survival rates were 100% and all the renal allografts kept excellent function. Some adverse events occurred and there were no significant differences among groups. CONCLUSION: Withdrawal of steroid or MMF in low-immunological-risk renal allografts treated with tacrolimus-based immunosuppressant regimen can be achieved with no increased risk of acute rejection.

Renal pedicle lymphatic disconnection for chyluria via retroperitoneoscopy and open surgery: report of 53 cases with followup.

PURPOSE: We present our experience with retroperitoneoscopic renal pedicle lymphatic disconnection. We compared the clinical efficacy of this treatment for chyluria with that of open surgery. MATERIALS AND METHODS: From January 1998 to June 2004, 53 patients (55 renal units) with chyluria underwent renal pedicle lymphatic disconnection via the retroperitoneoscopic and conventional open approaches. The diagnosis of chyluria was confirmed by the ether test and the side of chylous reflux was determined by cystoscopy. Operative time, intraoperative blood loss, postoperative intestinal recovery and hospital stay were evaluated. Increases in hemoglobin and serum albumin were compared before and after surgery during followup. RESULTS: Retroperitoneoscopic renal pedicle lymphatic disconnection or open surgery was performed successfully in all patients. In terms of operative time, intraoperative blood loss, postoperative intestinal recovery and hospital stay retroperitoneoscopy was superior to conventional open surgery. During retroperitoneoscopy the inferior vena cava was injured in 1 case but repaired successfully by laparoscopy without conversion to open surgery. Postoperative gross hematuria in 1 case disappeared 4 days later. In the open surgery group the renal segmental artery was inadvertently injured in 1 case and anastomosis was performed successfully. Wound healing was delayed in 1 case due to hypoalbuminemia. Recurrence developed in 2 patients during the 6 to 84-month followup. CONCLUSIONS: Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria has the advantages of minimal invasion and rapid recovery compared with open surgery.

Association between a C/A single nucleotide polymorphism of the E-cadherin gene promoter and transitional cell carcinoma of the bladder.

PURPOSE: We investigated whether a C/A single nucleotide polymorphism at position -160 from the transcription start site of the E-cadherin gene promoter is associated with transitional cell carcinoma of the bladder (TCCB). MATERIALS AND METHODS: A hospital based case-control study was performed in 50 patients with TCCB, including 38 men and 12 women 33 to 72 years old (mean age 53.8 +/- 12.3), and 50 normal controls, including 31 men and 19 women 22 to 69 years old (mean age 48.9 +/- 13.1). Genomic DNA was extracted from subject blood samples. Genotypes were determined using polymerase chain reaction based restriction fragment length polymorphism technique. RESULTS: A allele frequencies at the -160 position of the E-cadherin gene promoter were significantly higher in TCCB than in normal controls (p <0.01). A allele carriers were at higher relative risk for TCCB than C only carriers (OR 4.16, 95% CI 1.74 to 9.93). AC and AA genotypes were associated with an increased risk of TCCB compared with CC genotypes (OR 3.48, 95% CI 1.26 to 9.63 and OR 4.91, 95% CI 1.79 to 13.45, respectively). A allele frequencies at the same position were also significantly higher in invasive TCCB than in superficial carcinoma (p <0.05). However, there was no statistical difference in A allele frequency between high and low TCCB pathological grades (p >0.05). CONCLUSIONS: The -160 C/A single nucleotide polymorphism of the E-cadherin gene promoter is associated with TCCB. This single nucleotide polymorphism may serve as a prognostic marker of TCCB.

Comparison of open surgery versus retroperitoneoscopic approach to chyluria.

PURPOSE: We compared the clinical effectiveness of renal pedicle lymphatic disconnection for chyluria performed by retroperitoneoscopy and by open surgery. MATERIALS AND METHODS: Three male and 4 female patients 33 to 68 years old (mean age 49) with chyluria underwent retroperitoneoscopic renal pedicle lymphatic disconnection. Chyluria was on the left side in 5 cases and on the right side in 2. Open renal pedicle lymphatic disconnection was performed in 4 men and 2 women 33 to 61 years old (mean age 45.8). Chyluria was on the left and right sides in 3 cases each. Mean operative time, intraoperative blood loss, postoperative intestinal function recovery time, intraoperative and postoperative complications, postoperative hospital delay and operative outcome were compared in these 2 groups. RESULTS: Compared with the open surgery group results in the retroperitoneoscopic group were superior in terms of operative time (42 to 90 minutes, mean +/- SD 65.0 +/- 18.8 versus 120 to 220, mean 156.7 +/- 38.8), intraoperative blood loss (20 to 50 ml., mean 29.3 +/- 10.2 versus 60 to 250, mean 171.7 +/- 76.5), postoperative intestinal function recovery time (24 to 48 hours, mean 36.0 +/- 6.9 versus 24 to 72, mean 54.0 +/- 21.1), intraoperative and postoperative complications, and postoperative hospital stay (3 to 6 days, mean 4.7 +/- 0.7 versus 7 to 9 days, mean 7.8 +/- 1.0). In the open surgery group primary anastomosis was performed in 1 case due to injury to a renal artery branch during the operation. Chyluria resolved the day after surgery in the 2 groups. No obvious complications developed postoperatively. The followup of 2 to 12 months (mean 6.7 +/- 4.0) showed no recurrence of chyluria. CONCLUSIONS: Retroperitoneoscopic renal pedicle lymphatic disconnection completely ligates the lymphatic vessels with minimal invasion, less blood loss, rapid recovery and a good short-term outcome.