Defining hepatocellular chimerism in a liver failure patient bridged with hepatocyte infusion.

BACKGROUND: A practical method of monitoring engraftment by transplanted hepatocytes for the purpose of bridging human liver failure to native regeneration is described. METHODS: A previously healthy 37-year-old female with a 2-week history of a febrile illness presented with fulminant liver failure. Findings on admission included the following: illicit drug use, serum hepatitis B surface antigen positive, grade 1 encephalopathy, prothrombin time (pt) >100 sec, F7<1%, NH3 150 micromol/L, alanine aminotransferase 4079 U/L, total bilirubin level 11.4 mg/dl, and glucose 70 mg/dl (on IV D10). With immunosuppression, 8.8x10(8), 96% viable human hepatocytes were intraportally infused. Clinical chemistries, total sHLA class I, and ELISA to measure donor-specific sHLA-A1 and -B8 were recorded. Serial transjugular liver biopsies were performed and pooled for histological examination, DNA extraction, and HLA DNA typing. RESULTS: The patient fully recovered. At months 3 and 4 with donor biopsy specimen class I HLA DNA no longer detectable, immunosuppression was tapered off. The patient is clinically normal, serum hepatitis B surface antigen negative at 10 months of follow-up. CONCLUSIONS: Bridging liver failure with donor hepatocytes with HLA class I antigen disparate from recipients is clinically feasible, and allows for a marker, combined with serial graft histology, to safely wean immunosuppression when native liver regeneration succeeds.

Persistent sciatic artery. Report of three cases and literature review.

Persistence of the sciatic artery (SA) is a rare vascular anomaly, resulting from lack of regression of an embryonal artery to the lower extremity. Forty-nine cases have been published in the world literature since 1832. The persistent sciatic artery (PSA) is particularly prone to undergo aneurysm formation or atherosclerosis. It originates from the internal iliac artery, courses in close proximity to the sciatic nerve, and provides the main supply to the popliteal artery because a hypoplastic superficial femoral artery (SFA), contributing only collaterals to the knees, is usually associated with a PSA. This anomaly should be kept in mind in the clinical assessment of a pulsatile gluteal mass. It also presents a potential hazard during hip and renal transplant surgery.

Fibrodysplasia of the popliteal arteries.

Fibrodysplasia is a generalized arterial dysplasia of unknown etiology. We report a case involving both popliteal arteries. The patient presented with microemboli of the toes of both feet originating in the dysplastic popliteal arteries. The clinical significance of popliteal artery fibrodysplasia is briefly discussed.

Perforation and hemorrhage of a non-Meckelian ileal diverticulum: preoperative angiographic diagnosis.

A 54-year-old male with infective bacterial endocarditis experienced right lower quadrant pain and gastrointestinal hemorrhage. The clinical impression of hemorrhagic diverticulitis was supported by the preoperative angiographic findings of a collection of extravasated contrast material in the right lower quadrant of the abdomen originating from a branch of the ileocolic artery. Exploratory laparotomy and pathologic examination of the resected specimen confirmed an ileal diverticulum which had perforated and was the source of hemorrhage.

Renal ablation with the Gianturco stainless steel coil for control of massive proteinuria.

We describe a patient with membranoproliferative glomerulonephritis, renal failure, hypoalbuminemia and massive proteinuria. Attempts to reduce the protein loss with corticosteroids, indomethacin and mercurial diuretics were unsuccessful. Renal artery occlusion via Gianturco stainless steel coils was accomplished with the sole major complication of an ileus, probably caused by narcotics given for analgesia. The coils provide a convenient means of terminating renal function without resort to nephrectomy.

The impact of continuity of nursing care personnel on patient satisfaction.

Although continuity in nursing care is valued highly by nurses, there is little research that demonstrates its value to patients. In this study, the relationship of nursing care continuity to patient satisfaction was examined. Overall patient satisfaction was not related to continuity of nursing care, but nursing continuity on specific shifts was related to satisfaction with discrete aspects of care, such as involvement of patients and families in care.

Transcatheter embolization of traumatic renal arteriovenous fistula.

An iatrogenic renal arteriovenous fistula was treated by transcatheter embolization with particles of absorbable gelatin sponge. Recurrent massive hematuria was successfully controlled. The procedure was easily accomplished with minimal loss of renal parenchyma. Surgery, which usually requires partial or total nephrectomy, was avoided.

An alternate technique for lower extremity venography.

An alternate technique of performing lower extremity venography is described for use in patients in whom injection into a superficial vein of the foot is not possible.

Weismann-Netter-Stuhl syndrome: toxopachyostéose diaphysaire tibio-péronière.

Three cases of Weismann-Netter-Stuhl syndrome in nonrelated patients are reported. The classic feature of the syndrome is a congenital anterior bowing of the middiaphyseal part of both tibiae and fibulae. The authors' experience and review of 37 cases reported since its original description in 1954 has revealed a definite association of diaphyseal bowing of other long bones and squaring of the pelvis. The association of mental retardation, goiter, and anemia previously described are felt to be coincidental. At present, this syndrome seems to be some sort of diaphyseal dysplasia, which may be familial or sporadic. The radiographic findings are quite specific and allow easy differentiation of this entity from other disease states: knowledge of this syndrome by the radiologist should prevent unnecessary diagnostic evaluation by the clinician.

Renal artery embolization to control urinary cutaneous fistula after partial resection of a horseshoe kidney.

We describe a patient with a chronic urinary cutaneous fistula following partial nephrectomy of a previously separated horseshoe kidney, who was treated successfully by stainless steel coil embolization of the renal artery. Thus, a major reoperation was avoided.

Transcatheter embolization of the dorsal pancreatic artery to control massive postoperative bleeding.

We report a severely traumatized patient who developed massive bleeding through surgical drains in the postoperative period. Superselective dorsal pancreatic arteriography demonstrated extravasation of contrast material in the pancreatic bed. Embolization with Gel-foam particles successfully controlled this severe bleeding. Transcatheter embolization is the procedure of choice for controlling pancreatic bleeding in acutely traumatized patients.

Percutaneous transluminal angioplasty following endarterectomy.

Prior to the introduction of percutaneous transluminal angioplasty (PTA), bypass grafting or endarterectomy was the treatment of choice for aortoiliofemoral atherosclerotic occlusive disease. Currently, PTA is a well-established procedure for the treatment of aortoiliofemoral atherosclerotic occlusive disease. PTA is as effective as, and safer than, surgery in these cases. Percutaneous transluminal angioplasty and endarterectomy cause similar trauma to the arterial wall, i.e., intimal denudation, plaque disruption and splitting, and medial disruption, splitting, and overstretching. Both PTA and endarterectomy heal in a similar manner, i.e., neointima formation and scarring. Both PTA and endarterectomy can be repeated. Therefore, PTA can be performed after endarterectomy or vice versa. Several patients with recurrent occlusive disease after endarterectomy have been safely treated with PTA. Our results obtained with PTA in patients who had a prior endarterectomy are comparable to the results obtained in patients who did not have a prior endarterectomy. No complications have been encountered. A previous endarterectomy does not preclude a subsequent PTA, or vice versa, in patients with recurrent occlusive disease.

Septic arthritis of the hip: a rare complication of angiography.

Local infection at the puncture site following percutaneous angiography has been reported as exceedingly rare. We describe the first patient with documented septic arthritis of the hip following percutaneous transfemoral arteriography. Radiologists should be aware of this potentially serious complication.

Percutaneous retrieval of a broken Lunderquist guidewire from the pelvicalyceal system.

The stiff Lunderquist guidewire may occasionally be needed during percutaneous insertion of a nephrostomy catheter, especially in patients with a large amount of subcutaneous fat or with a hard renal capsule. This wire may fracture at the junction of its stiff portion with the flexible tip. We have reported such an occurrence, in which an operative procedure was avoided by successful percutaneous retrieval of the broken wire tip, using the loop-snare technique.

Treatment of peripheral arterial obstruction with streptokinase: results in arterial vs graft occlusions.

A retrospective study of the efficacy of local low-dose intraarterial streptokinase for the treatment of peripheral arterial occlusion was performed in 60 cases. The results of treatment of occlusion of native arterial and arterial graft occlusions were compared. Twenty-two (73%) of 30 cases of arterial occlusion showed complete or partial angiographic resolution, compared with 16 (53%) of 30 cases of arterial graft occlusion. Ten (71%) of 14 patients with venous arterial grafts were successfully treated vs only six (38%) of 16 patients with prosthetic arterial grafts. These results suggest that streptokinase is an effective fibrinolytic agent for the treatment of arterial occlusion and arterial graft occlusion. Its effectiveness in arterial graft obstruction is comparatively low, although patients with venous grafts respond much more favorably than those with synthetic conduits.

Transcatheter embolization of an arteriovenous malformation of the scrotum.

There are several vascular abnormalities that could affect the scrotum. The commonest is a varicocele, and differentiation between this and other lesions is possible using Doppler ultrasound and pelvic angiography. A patient with a scrotal arteriovenous malformation (AVM) is presented in whom transcatheter embolization was possible.

A simple technique to straighten the curved tip of a "J" guidewire.

We describe a simple technique to straighten the curved tip of a "J" guidewire when the plastic introducer is not readily available. This technique may expedite angiographic procedures.