[Percutaneous nephrostomy complications in obstructive renal failure]. / Complicatiile nefrostomiei percutanate in tratamentul insuficientei renale obstructive.

OBJECTIVES: The study aimed to identify the complications recorded at the patients with obstructive renal failure treated with percutaneous nephrostomy (PCN). MATERIAL AND METHOD: The retrospective study investigated the data of 244 patients admitted in our department and treated with percutaneous nephrostomy for obstructive renal failure during January 2005 - December 2007. Demographical data, investigation, indication, complications and hospital stay were recorded. RESULTS: Median preoperative/discharge haematological values were hematocrit 27.4% comparing to 25.8% and haemoglobin 9.9g% comparing to 9.3g%. An anaemic syndrome was noted at admission time in 161 (65.9%) patients and at discharge time 202 (82.8%). 126 (51.6%) patients were treated with blood transfusion with an average dose of 2.47 red blood cell units per patient. In 25 (10.1%) patients the nefrostomy tube was clamped in order to control the postoperative bleeding. The median hospitalization time was 8.7 days with a median ICU stay of 3.3 days. The recorded mortality was 3.2% (8 patients) with an average time of 5.8 days between the operatory time and exitus time. CONCLUSIONS: The most frequent causes of obstructive renal failure necessiting percutaneous nephrostomy are malignancies. Preoperative anaemic syndrome is aggravated in the postoperative period and frequently need red blood cell administration. In experienced hands, PCN catheter placement is safe and usually successful.

[Five years of kidney transplantation in Iasi]. / Cinci ani de transplant renal în centrul universitar Iasi.

The activity of Renal Transplant Center Iasi started in November 2000, when we realized the first renal transplant from a live donor. Since then, 46 renal transplants were successfully realized in our center, to patients aged between 13-47 years (medium age = 30 +/- 5), M/F=27/19, 25 (56.8%) of them selected from HD, 17 (39.9%) from CAPD and 4 (8.7%) pre-emptive. Medium age of donors was 49.1 years (30-64), M/F=29/17. The donors were, in 78.3% of cases, first-degree relatives (parents, siblings). In 10 cases (21.7%) the grafts were donated by "emotionally related"donors (in most cases, spouses). An urologist-cardiovascular surgeon team, performed the transplant operations. There were no important complications during operation. We had one major vascular complication (graft artery thrombosis) in a 13 years recipient, successfully resolved after thrombectomy and stenting. Immunosuppressive therapy associated induction with monoclonal antibodies anti-Tac, cyclosporine, MMF and prednisone. Eight patients from 46 (17.39%) presented acute rejection episodes and all responded at corticosteroids. Medium values of serum creatinine were: 1.54 mg% at 1 month, 1.42 mg% at 6 months, 1.44 mg% at 1 year, 1.21 mg% at 2 years, 1.38 mg% at 3 years, 1.4 mg% at 4 years and 1.2 at 5 years. The survival of patients and donors is 100% and the survival of renal graft--97.1% (one case of chronic allograft nephropathy with lost of renal function). We also present the satisfactory evolution of the 51 renal transplanted patients addressed to our center from different other renal transplantation centers in Romania for management follow-up.

[Our experience in diagnostic and treatment of the upper urothelial tract tumours]. / Experienta noastra în diagnosticul si tratamentul tumorilor uroteliale înalte.

UNLABELLED: The aim of the study was to analyse methods of diagnostic and treatment used in our clinic in patients with upper urothelial tract tumors in recent years. MATERIAL AND METHODS: We studied retrospectively 117 files of patients diagnosed with upper tract tumors between 1996-2002. RESULTS AND DISCUSSIONS: The diagnostic was based in 99 cases by urography, retrograde pyelography or both, in 10 cases by cystoscopy (for intramural ureteral tumors), in 8 cases by ureteroscopy and one case was diagnosed by antegrade pyelography. Ultrasound didn't diagnosed solely any tumor. Computerized tomography was also be helpful for staging. Radical treatment was realised in 73 patients (total nephroureterectomy), in 4 patients ureterectomy of the ileo-pelvic segment were realised by stripping. In 20 patients, we performed subtotal nephroureterectomy, in 9 patients transurethral resection, in 2 cases terminal ureterectomy, and in one case we done endoscopic electrocauterization after cold biopsy. CONCLUSION: The most important paraclinical investigation in diagnostic of upper urothelial tract tumors are radiological investigations, urography and retrograde pyelography. Best way to cure such tumors are total nephroureterectomy. In select cases we can perform terminal ureterectomy and transurethral electroresections.

[The surgical problems of continuous ambulatory peritoneal dialysis: 3 years of experience]. / Problemele chirurgicale ale dializei peritoneale continua ambulatorie; experienta primilor 3 ani.

PURPOSE: This study presents the surgical problems of CAPD catheter insertion and mechanical complications in 37 cases (39 peritoneal dialysis catheters inserted for CAPD), being our experience along a time period of 3 years. MATERIALS AND METHODS: The catheters were of Tenckhoff-type, with double Dacron cuff (Fresenius Medicale Care). We used an open-type surgical procedure with spinal anaesthesia. RESULTS: In all the 8 cases with previous abdominal interventions the catheters were functional. We found an early catheter obstruction only in two cases, by means of a "greater omentum fimbriae". In the third case a partial omentectomy was performed. In 1 patient with parietal granuloma and frequent peritonitis a new peritoneal catheter was inserted (with a new tegumentary outlet). Hernia was found in 1 patient and was successfully cured by means of surgical intervention. This patient continued the CAPD treatment. In 2 cases we interrupted the CAPD treatment (one renal transplant; one converted to hemodialysis). 25 patients had no catheter-related complications. CONCLUSION: We wish to state that catheter occlusion and hernia must not lead to an abandon of CAPD treatment.

[Is partial cystectomy a justified intervention in the treatment of bladder tumors?]. / Este cistectomia partiala o interventie justificata în tratamentul tumorilor vezicale?

The authors present their experience of 122 partial cystectomy cases made on a number of 288 vesical tumors in our clinic, during 5 years (1986-1991) from which 23 are superficial tumors and 99 are infiltrative ones. The treatment of vesical tumors can be done in many ways; this partial cystectomy must be completed with an other therapeutic method: irradiation on chemotherapy in conformity with the anatomo-pathological form, the steady and tumoral grading.

[Tumors of the upper urinary tract. Apropos 35 cases]. / Tumorile cailor urinare superioare. Consideratii pe marginea a 35 cazuri.

Thirty-five cases of upper urinary tract tumors treated by the authors in an interval of 10 years (1979-1988) are presented. After a detailed analysis of the cases some general considerations on the anatomopathologic forms of upper urinary tract tumors, stage classification, symptoms and clinical and laboratory diagnosis, therapeutical indications are made.