ABSTRACT
BACKGROUND: Pulmonary hypertension in the setting of renal transplantation has been associated with early allograft dysfunction and increased mortality, but this relationship has not been extensively studied. METHODS: We performed a retrospective cohort study of adult patients who underwent their first renal transplantation in the years 2003-2009 and had pre-transplantation echocardiograms. Pulmonary hypertension was defined as right ventricular systolic pressure ≥40 mm Hg in the absence of left-sided valvular disease and/or left ventricular ejection fraction ≤50%. Eighty-two of 205 patients (40%) met the inclusion criteria. The relationship between pulmonary hypertension and death-censored allograft failure (hemodialysis dependence or retransplantation) and serum creatinine was assessed with the use of Cox hazard regression and generalized mixed models. RESULTS: The presence of pulmonary hypertension was associated with a 3-fold increase in the risk of death-censored allograft failure (95% confidence interval, 1.20-7.32; P = .02). Failure rates were 19% at 24 months and 51% at 96 months for those with pulmonary hypertension versus 7% at 24 months and 20% at 86 months for those without pulmonary hypertension (P = .01). Among those without graft failure, there was an increase in creatinine levels after transplantation (P = .01). Effect estimates were unchanged by adjustment for multiple covariates and when pulmonary hypertension was defined as right ventricular systolic pressure ≥36 mm Hg. CONCLUSIONS: Pulmonary hypertension before renal transplantation carries a 3-fold increased risk of death-censored allograft failure. The relationship between the pulmonary circulation and renal allograft failure warrants further study.
Subject(s)
Echocardiography , Hypertension, Pulmonary/complications , Kidney Transplantation/adverse effects , Primary Graft Dysfunction/etiology , Adult , Female , Humans , Hypertension, Pulmonary/diagnostic imaging , Hypertension, Pulmonary/physiopathology , Male , Middle Aged , Preoperative Period , Proportional Hazards Models , Retrospective StudiesABSTRACT
Two patients with massive prostate adenocarcinoma were evaluated by several imaging modalities. Computed tomography provided excellent anatomic delineation of the tumors. In one patient, computed tomography demonstrated significant tumor regression following orchiectomy. Giant prostate carcinoma should be considered in the differential diagnosis of a large, inhomogeneous pelvic mass.
Subject(s)
Adenocarcinoma/diagnostic imaging , Prostatic Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Adenocarcinoma/pathology , Adenocarcinoma/surgery , Aged , Diagnosis, Differential , Humans , Male , Middle Aged , Orchiectomy , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgeryABSTRACT
Giant pseudopolyp formation is an uncommon but well-recognized complication of Crohn's disease. The computed tomography manifestations are described for the first time. Correlation with air-contrast barium enema, as well as colonoscopy, is presented. Computed tomography can be a useful adjunct in the diagnosis as well as management of this disease entity.
