StatSensor-i point-of-care creatinine analyzer may identify patients at high-risk of contrast-induced nephropathy.

The current study assessed the accuracy of the StatSensor-i (STA) point-of-care creatinine analyzer prior to and following adjustment (offset correction) by linear regression scatter plots produced by the reference samples from patients and volunteers for detecting high risk of contrast-induced nephropathy in patients with an estimated glomerular filtration rate <45 ml/min/1.73 m2. Blood samples were obtained from 233 consecutive outpatients scheduled for contrast-enhanced CT studies. Of the 233 patients, 123 patient samples were evaluated prior to adjustment and the other 110 following adjustment. Serum creatinine levels and estimated glomerular filtration rate were measured using the analyzer and compared with the values returned by laboratory tests. Analysis was with the paired t-test, the Pearson correlation coefficient and Bland-Altman plotting. The sensitivity, specificity, positive and negative predictive values (PPV, NPV), and accuracy for detecting patients with an estimated glomerular filtration rate <45 ml/min/1.73 m2 were subsequently calculated. Mean serum creatinine levels measured with the analyzer were significantly higher than those returned by laboratory tests before (P<0.0001) and after adjustment (P<0.01). Following adjustment, the difference in serum creatinine values obtained with the STA analyzer and by laboratory methods did not exceed 0.3 mg/dl. Prior to adjustment, 9.7% of the samples were overdiagnosed as having an estimated glomerular filtration rate of <45 ml/min/1.73 m2; following adjustment, the overdiagnosis rate was 2.7%. The sensitivity, specificity, PPV, NPV and accuracy were 100, 89, 50, 100 and 90.2% before and 100, 96.3, 33.3, 100 and 96.4% after adjustment, respectively. With the adjusted point-of-care creatinine analyzer, estimated glomerular filtration rate may be reliably evaluated in the radiology suite.

[Clinical Study of Percutaneous Radiofrequency Ablation for Small Renal Tumor].

Percutaneous radiofrequency ablation (PRFA) has been applied as an option of minimally invasive treatment for small renal tumor. We retrospectively evaluated 5 patients with small renal tumor for whom PRFA was performed at our hospital. The average age was 69.6 years (range 45-86), average tumor diameter 20.0 mm (8-34), average preoperative glomerular filtration rate (eGFR) 66.8 ml/min/1.73m2 (42. 1-93.2), and follow-up period was 23.4 months (8-34). There were two minor complications (grade 1), including perirenal hematoma and pain at the probe insertion site in each patient. One patient had local recurrence 22 months after PRFA and the additional PRFA will be performed. PRFA could be a feasible, safe and effective therapy for small renal tumor.

[Several treatments with endovascular stent graft for ureteroarterial fistula after construction of cutaneous ureterostomy : report of a case].

A 78-year-old man underwent a radical cystectomy and the construction of a cutaneous ureterostomy for bladder cancer. He had an 8 Fr single-J ureteral catheterindwelt for stomal stenosis caused by parastomal hernia. Thirty-one months after the operation, the patient was admitted with gross hematuria. Contrast-enhanced computed tomography showed a highly suspicious left uretero-iliac artery fistula (UIAF), which was finally diagnosed by angiography. A covered endovascular stent graft was placed in the left iliac artery, and the gross hematuria was resolved. Six months after the endovascular stenting, he had recurrent gross hematuria and underwent additional treatment with placement of a secondary stent graft. Two months later, a pseudoaneurysm developed in the left iliac artery, and emergency angiography was performed to treat an impending rupture of the aneurysm. During the angiography, a thrombus formed in the left iliac artery, and he died due to multiple organ failure caused by an infective thrombus and sepsis. Endovascular stent graft placement is a safe and effective treatment to manage the acute phase of ureteroarterial fistula. However, the long-term effectiveness of this treatment remains to be established.