Emphysematous pyelonephritis in a transplant kidney.

Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the kidney and its surrounding tissues. It is characterized by the production of gas within the kidney and perinephric structures. EPN often affects diabetic women but can also occur in nondiabetic patients who have ureteral obstruction and in immunocompromised patients. Herein, we report EPN in a 23-year-old woman who had a renal transplantation.

Radiofrequency ablation of the spleen in patients with thalassemia intermedia: a pilot study.

OBJECTIVE: We investigated the efficacy and safety of radiofrequency ablation on the hematologic parameters in patients with thalassemia intermedia (TI). MATERIALS AND METHODS: Radiofrequency ablation of the spleen was performed in 15 children with TI under general anesthesia using a cool-tip radiofrequency probe. These patients were regarded as the radiofrequency ablation group. Nine patients with TI who underwent partial splenectomy during the past 3 years and another 14 patients with TI who underwent total splenectomy were also enrolled in this study as the first and second control groups (CG1 and CG2). RESULTS: In the radiofrequency ablation group, two (13%) patients showed a significant increase in the mean hemoglobin level compared with the year before (1.5 and 1.8 g/dL). In addition, three (20%) other patients became transfusion-free in the year after radiofrequency ablation. In CG1, one (11%) patient showed a significant increase in hemoglobin the year after partial splenectomy, and another two (22%) patients became transfusion-free. In CG2, six (43%) patients revealed a significant increase in hemoglobin in the year after total splenectomy, and another four (29%) revealed a significant decrease in the need for transfusions. The mean increase in hemoglobin and platelet count was more significant in CG2 than in the radiofrequency ablation group and CG1. The mean hospital stay was significantly shorter in the radiofrequency ablation group (1.7 days vs 7.5 and 8.2 days in CG1 and CG2, respectively). CONCLUSION: We believe that radiofrequency ablation of the spleen can be a safe procedure in patients with TI and is at least as effective as partial splenectomy, having only minor self-limiting complications.

Hypoparathyroidism and intracerebral calcification in patients with beta-thalassemia major.

BACKGROUND: Hypoparathyroidism is one of the most important endocrine complications of thalassemia major. This study was conducted to evaluate the prevalence of intracerebral calcifications in patients with thalassemia with and without hypoparathyroidism. METHODS: 47 beta-thalassemia patients with hypoparathyroidism underwent a brain CT scan to investigate the presence and extent of intracerebral calcification. 30 age- and sex-matched beta-thalassemic patients with normal parathyroid function who had undergone brain CT for headache, or some other minor neurologic problems were also enrolled in the study serving as controls. The amount of intracerebral calcification, hematologic parameters, and some clinical findings were compared between both groups. RESULTS: Intracerebral calcification was present in 54.2% of beta-thalassemia patients with hypoparathyroidism. The most frequent sites of calcification were basal ganglia, and frontoparietal areas of the brain. Thalami, internal capsule, cerebellum and posterior fossa were other less frequently calcified regions of the brain. In contrast, there was no evidence of intracerebral calcifications in the 30 thalassemic patients with normal parathyroid function. There was not a statistically significant difference between serum ferritin concentrations in thalassemia patient with hypoparathyroidism and those with normal parathyroid function (2781 vs. 2178, P>0.05). CONCLUSION: Intracranial calcification is a common finding in thalassemia patients with hypoparathyroidism, it can be extensive and involves most regions of the brain.

Percutaneous transhepatic venous angioplasty and stenting in a 9-month-old patient with hepatic vein obstruction after partial liver transplantation.

Hepatic venous outflow obstruction is a rare but serious complication after liver transplantation. We report ultrasound-guided percutaneous transhepatic stent placement in a 9-month-old infant with a left lateral split liver transplantation with near-complete hepatic vein obstruction.

Transplantation of a cadaveric liver allograft with right lobe cavernous hemangioma, without back-table resection: a case report.

UNLABELLED: The use of extended criteria liver donors has become a necessity in an era of organ scarcity for transplantation. We present here a case report of orthotopic liver transplantation using a liver with a giant right lobe hemangioma without backtable resection. CASE REPORT: There were no data regarding the liver mass before organ procurement. The donor liver function tests and electrolyte profile were normal. During donor exploration a hemangioma was identified in segments V-VI, occupying approximately 20% of the total liver volume. It was prepared for transplantation on a sterile backtable without performing backtable hemangioma resection. A standard orthotropic liver transplant procedure was performed uneventfully, without veno-veno bypass. There was no bleeding from the hemangioma. The ischemic time was 9 hours and 20 minutes. Postoperative course was uneventful and the patient was discharged at 19 days after the operation. The hemangiomas showed evolution with some decrease in size upon later follow-ups. No clinically important complication was observed. CONCLUSION: Our case and other previous reports show that even large hemangiomas should not be considered to be a contraindication to organ procurement. These benign lesions either could be left in situ and observed or resected.

Early hepatic artery thrombosis after liver transplantation: diagnosis and treatment.

BACKGROUND: Hepatic artery thrombosis (HAT) occurs in 3% to 9% of all liver transplantations with acute graft failure as a possible sequel. METHODS: Eleven episodes of HAT were identified among 256 orthotropic liver transplantations (whole, LDCT, split) performed on 253 patients between April 1993 and July 2006. HAT was suspected clinically and confirmed by Doppler ultrasonography, magnetic resonance angiography, angiography, or reexploration. One patient was excluded due to poor follow-up. Treatment options included exploration with HA thrombectomy plus thrombolysis, retransplantation, or conservative treatment of hepatic and biliary complications. RESULTS: Among 11 patients of mean age 29.98 +/- 17.14 years (range, 10 months to 56 years). 2 had split right lobe liver transplantations and 9 received whole organs. None of LDLTs were identified to have HAT. The causes of liver cirrhosis among HAT patients were autoimmune hepatitis (n=3), cryptogenic (n=3), Wilson (n=1), PBC (n=1), biliary atresia (n=1), and HBs (n=1). HAT was diagnosed at 5.9 +/- 4.43 (range, 2 to 16) days after operation. Most patients developed right upper quadrant (RUQ) pain at presentation. Two patients developed acidosis, fever, or SIRS and underwent retransplantation. Four underwent exploration of HA and 1 was treated conservatively. Three cases expired due to HAT complications. CONCLUSION: We found RUQ pain to be the presenting sign of early HAT in majority of cases. RUQ pain has been reported to occur in late HAT. Whenever HAT is confirmed, liver transplanted patients should be revascularized or even retransplanted. Intra-arterial thrombolysis and thrombolytic therapy for HAT should be done cautiously due to the potential risk of hemorrhage.

Methanol poisoning: acute MR and CT findings in nine patients.

INTRODUCTION: Methanol poisoning is an uncommon but potent central nervous system toxin. We describe here the CT and MR findings in nine patients following an outbreak of methanol poisoning. METHODS: Five patients with a typical clinical presentation and elevated anion and osmolar gaps underwent conventional brain MRI with a 1.5-T Gyroscan Interna scanner. In addition nonenhanced CT was performed in another three patients with more severe toxicity. RESULTS: Bilateral hemorrhagic or nonhemorrhagic necrosis of the putamina, diffuse white matter necrosis, and subarachnoid hemorrhage were among the radiological findings. Various patterns of enhancement of basal ganglial lesions were found including no enhancement, strong enhancement and rim enhancement. CONCLUSION: A good knowledge of the radiological findings in methanol poisoning seems to be necessary for radiologists. The present study is unique in that it enables us to include in a single report most of the radiological findings that have been reported previously.

Urethral reconstruction using autologous and everted vein graft: an experimental study.

Urethral reconstruction is one of the problematic issues in pediatric surgery. To evaluate the efficacy of vein graft for urethral reconstruction in rabbits, about 3 cm of distal urethra was excised under microscopic magnification. In groups A, B, and D, the urethra was replaced with the internal jugular vein. In group B, before performing anastomosis, vein grafts were everted. In group C (control group) after removing the urethra, a catheter was inserted without substituting the urethra and then fixed. Groups A, B, and C were kept for 3 months. Group D was divided into five subgroups each consists of two rabbits, which were killed at days 7, 10, 14, 22, and 30 for evolutionary histopathological studies. Gross evaluation, retrograde urethrography, and histopathological studies were also performed in other groups. Retrograde urethrography and gross evaluation revealed no sign of stricture and fistula formation in six and eight rabbits in groups A and B, respectively. However, those complications were observed in all the rabbits in group C. The grafted part of the neourethra was epithelialized with uroepithelium in all rabbits in group A (vein graft) and group B (everted vein graft) but only partial epithelialization was observed in three rabbits of group C. Severe fibrosis with stricture formation was developed in six rabbits in the control group. In group D, epithelialization gradually replaced necrosis and inflammation, within 1 month. This study showed that vein, everted or not, can be used as a substitute for urethra. It also suggests that new epithelialization might be formed from ingrowing of the uroepithelium from the proximal part.

Efficiency of premarital screening of beta-thalassemia trait using MCH rather than MCV in the population of Fars Province, Iran.

Iran is a country with high prevalence of about 5-10% of beta-thalassemia trait. The prevalence of Cooly's anemia has declined from 11.6 in 10000 population to 7.2 in 10000 in a five-year period due to screening program of beta-thalassemia trait before marriage. This study was conducted to compare the sensitivity of mean corpuscular hemoglobin (MCH) < 27 pg and mean corpuscular volume (MCV) < 80 fl as a screening test in first step of screening of beta-thalassemia trait. From 2449 couples (4898 cases) participating in the premarital screening to our clinic, 902 cases with either MCH < 27 pg, MCV < 80 fl, anemia, pallor or family history of beta-thalassemia were enrolled in the study. MCV, MCH as well as Hb A2 were measured in all cases. MCH and MCV had sensitivities of 98.5% and 97.6% for the diagnosis of beta-thalassemia trait, respectively. A false negative value of MCH is about 1% lower than that of MCV. MCH is a more sensitive screening test for detecting beta-thalassemia minor before marriage.