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BACKGROUND:Arteriovenous internal fistula is the first choice for hemodialysis. In the process of hemodialysis, many patients suffer from venous outflow stenosis. The methods including thrombolysis, intervention, surgical repair and fistula reconstruction al have their disadvantages. OBJECTIVE:To compare the midterm effects of polytetrafluoroethylene segment implantation and exclusively surgical repair in arteriovenous internal fistula with outflow tract obstruction. METHODS:Eighty patients with venous outflow stenosis, aged 22-80 years, were divided into test group (n=50;polytetrafluoroethylene segment implantation) and control group (n=30;simple surgical repair). The post-operative infection rate, postoperative time til recurrence of fistula dysfunction, and accumulate survival rate were compared between the two groups. RESULTS AND CONCLUSION:During the fol ow-up period of 10-28 months in the test group, there were nine patients with vascular access dysfunction, and the accumulate survival rate was 100%for 6 postoperative months, 92%for 12 months, and 82%for 18 months. In the control group, there were seven cases of vascular access dysfunction at 8-28 months of fol ow-up, and the accumulate survival rate was 93%for 6 postoperative months, 87%for 12 months, and 77%for 18 months. No statistical y significant difference in the postoperative infection rate was observed between the two groups. The Kaplan-Meier survival curves showed that the accumulate survival rate was slightly higher in the test group than the control group, but there was no significant difference based on log-rank test (P=0.44). These findings indicate that polytetrafluoroethylene segment implantation for arteriovenous internal fistula with outflow tract obstruction has the similar effects as the surgical repair if it does not alter the autologous behavior of the initial access and maximal y reserve the vessels for puncture.
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Objective To evaluate the effect of pregnancy and delivery after renal transplantation (RT)on recipients,graft and offspring.Methods Clinical data of 6 pregnancies in 5 recipients were retrospectively studied and literature was reviewed.Results Among them,6 pregnancies and 4 deliveries occurred in 5 female RT recipients.The mean age at pregnancy was 31.1 years,with a mean interval between RT and pregnancy being 3.6 years.Preeclampsia developed in two pregnancies and hyperlipemia in one pregnancy.One RT recipient who discontinued immunosuppressant following pregnancy on her own exhibited subsequent renal failure.She underwent a second RT and delivered a healthy baby two years following the second RT.One RT recipient decreased the immunosuppressant dose to half after the pregnancy on her own and developed renal failure thereafter.Four patients underwent a Cesarean section at 38 th,35 th,35 th,and 38 th week,respectively.The mean birth weight was 3262.5 g with all Apgar scores of 10.Conclusion Our data coupled with prior reports suggest that for the recipients with normal renal function,successful pregnancy is achievable if immunosuppressant was taken correctly,but the pregnancy is at high risk,and careful monitoring is needed.
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ObJective To discuss the causes,diagnosis,treatment and outcomes of renal artery aneurysm(RAA). Methods Duriog August 1998 and December 2004,1251 patients underwent rehal transplantation,and 5 men(mean age,43)who received end-to-end anastomose from renal graft artery to the internal iliac artery were found to develop RAA.The main complains included aggravated renal function,sudden oliguria or anuria,hypertension and allograft pain.Color Doppler flow and digital subtraction angiography were used to confirm aneurysm.Size of the RAA were 1.8 cm×2.0 cm×2.0 am to 4.0 cm×4.0 cm×5.0 cm. Results Two aneurysms were located at the anastomotic stoma.One patient who lost renal function 1 month after the aneurysm was diagnosed received nephrectomy,regular hemodialysis,and another renal transplantation 1 year later.The other patient successfully underwent cadaver transplantation without removing the original renal allograft after the renal dysfunction occurred.The renal function remained normal during 2 years'follow-up.Two renal artery aneurysm cases also accompanied with proximate renal artery stenosis.One patient was treated with balloon dilatation and stent implantation,and normal renal function was observed during 1 years followup. Another patient had graft removed and underwent retransplantation.The renal function was excellent during 3 years'follow-up.Atherosclerotic plaque within internal iliac artery anastomotic stoma,which lead to artery stenosis and aneurysm,was found in 1 patient.Two days after the renal allograft was removed,this patient died of brainstem embolism. Conclusions End-to-end anastomose from renal graft artery to the internal iliac artery seems to be related with postoperative complications.Patients with confirmed RAA should be cautiously managed.Retransplantation and interventional thera PY may be the choice.
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Objective To evaluate the impact of the different organ preservation solutions on the outcome of islet transplantation, and possibility of using hypertonic citric potassium solution as the organ preservation solution. Methods Adult human pancreata was selected and hypertonic citric potassium solution and UW solutions were used as organ preservation solutions respectively to isolate and purify human islets. Islet number and IEQ as well as the functions of the two groups were compared. Results There was no significant difference in the islet number after isolation ( P values were 0.671 and 0.716 respectively), and there was no significant difference in the islet number after purification ( P values were 0.684 and 0.767 respectively) between the two groups. After purification, there was no significant difference in the concentration of insulin secreted by islets between the two groups both under the stimulation of high concentration and low concentration glucose ( P values were 0.275 and 0.546 respectively), and no significant difference in C pep secretion ( P values were 0.126 and 0.657 respectively). Survival rate of the islets in the two groups was over 85 % . Conclusion In pancreas transplantation, hypertonic citric potassium solution could be used as pancreas preservation solution.
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<p><b>OBJECTIVE</b>To evaluate magnetic resonance urography (MRU) in the diagnosis of urinary tract obstruction after renal transplantation.</p><p><b>METHODS</b>A total of 31 patients with suspected urinary tract obstruction after renal transplantation were examined, and the results were compared with those from surgery and B-ultrasound examination.</p><p><b>RESULTS</b>The urinary tract after renal transplantation was clearly shown using MRU, and all patients were clearly diagnosed by MRU. Imaging results were consistent with those from surgery.</p><p><b>CONCLUSIONS</b>MRU is suitable for detecting urinary tract obstruction after renal transplantation. It is a alternative method for IVP and CT in patients with renal function impairment and uremia.</p>
Subject(s)
Humans , Kidney Transplantation , Magnetic Resonance Imaging , Methods , Ureteral Obstruction , Diagnosis , Urinary Tract , Pathology , Urography , MethodsABSTRACT
<p><b>OBJECTIVE</b>To study pathogeny, diagnosis and treatment of ureter fistula after renal transplantation.</p><p><b>METHODS</b>The clinical data from 30 cases after renal transplantations were analyzed.</p><p><b>RESULTS</b>Four patients received conservative treatment, and 2 repairment of the fistula. Eleven patients had resection of the ureter or adjustment of the kidney, followed by the anastomosis of the ureter and bladder again. After the turning of the bladder's lamella, 13 patients were given 20 - 24 Foley's tube connecting the pelvis and bladder and nine of them were not subjected to re-anastomosis waiting for the pelvis crawling to the bladder as a tunnel. The one-year survival rates for 30 cases and kidneys was 96.7% (29/30) and 86.7% (26/30) respectively.</p><p><b>CONCLUSIONS</b>There a lot of causes for ureter which are fistula, running related to every aspect of transplantation. Early diagnosis and treatment is important to prognosis. Most patients need reanastomosis. According to the blood stream, edema, length of the ureter, operative procedures are selected to ensure free of strain.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Kidney Transplantation , Postoperative Complications , Urinary Fistula , Diagnosis , TherapeuticsABSTRACT
Objective To present 3 cases of MFH of the urinary system. Methods Two cases of renal MFH and one case of bladder MFH were retrospectively analysed. Results The diagnosis was established on pathological examination and immunohistochemistry. Two patients died 4～7 months affer operation , while the other patient has been well for 30 months. Conclusions It is difficult to differentiate it from primary renal and bladder neoplasm.Immunohistochemistry is helpful to distinguish it from carcinoma,renal sarcoma and renal parental cell carcinoma.