ABSTRACT
OBJECTIVE: Our aim was a retrospective evaluation of technical procedures, clinical success, and follow-up of renal transplant patients with stenosis in the transplant renal artery (TRAS) after endovascular treatment. METHODS: From January 1981 to September 2009, 2,150 allograft renal transplants included 62 patients who underwent endovascular procedures for TRAS >75%. Parameters included technical success, arterial blood pressure, antihypertensive drugs, and creatinine level before and after the intervention. RESULTS: Percutaneous transluminal angioplasty (PTA)/stent placement success was 90.3%. Seventy-nine PTAs with 11 stents were primary interventions with 6 PTAs and 4 stent procedures subsequently performed due to restenosis (mean time to event, 1.5 months). The median follow-up was 39 months (range, 1-236). The mean preprocedure creatinine level was 2.8 ± 1.7 mg/dL, and the 1-month postprocedure value was decreased to 2.1 ± 1.2 mg/dL (P < .001). Systolic arterial blood pressure fell from 147.2 ± 18.7 mm Hg to 131.6 ± 14.2 mm Hg (P < .001) and diastolic blood pressure from 84.4 ± 9.8 mm Hg to 76 ± 9.4 mm Hg (P < .001). Postprocedure number of antihypertensive drugs was reduced from 2.3 ± 1.1 to 1.6 ± 1 (P < .0001). The patency rates were: 95 ± 2.8% at 1 month, 87.9 ± 4.3% at 3 months, and 85 ± 4.7% at 12 months. Secondary patency was 100% with no restenosis on follow-up. Allograft survival after primary and secondary PTA/stenting was 97% at 1, 93% at 3.89% at 5, and 85% at 10 years. The complication included 2 renal artery thromboses, a dissection treated with stents, and a late arterial graft pseudoaneurysm. CONCLUSIONS: TRAS, a problem after kidney transplantation, is detected to be a significant stenosis through the use of Doppler ultrasound. Revascularization is recommended to improve hypertension and graft function. PTA should be primarily planned with stenting for patients with a restenosis or after a lack of response to PTA.
Subject(s)
Angioplasty, Balloon/instrumentation , Kidney Transplantation/adverse effects , Renal Artery Obstruction/therapy , Stents , Angioplasty, Balloon/adverse effects , Antihypertensive Agents/therapeutic use , Biomarkers/blood , Blood Pressure , Chi-Square Distribution , Creatinine/blood , Humans , Kaplan-Meier Estimate , Renal Artery Obstruction/blood , Renal Artery Obstruction/diagnostic imaging , Renal Artery Obstruction/etiology , Renal Artery Obstruction/physiopathology , Retrospective Studies , Risk Assessment , Risk Factors , Spain , Time Factors , Treatment Outcome , Ultrasonography, Doppler , Vascular PatencyABSTRACT
Los plasmocitomas extramedulares son neoplasias malignas de células plasmáticas con origen en los tejidos blandos. El plasmocitoma pulmonar primario es la forma más rara de plasmocitoma extramedular. Los hallazgos radiológicos son inespecíficos y el diagnóstico es histológico. La tomografía computarizada (TC) torácica es útil para confirmar su localización y planificar la cirugía.Se presenta un caso de plasmocitoma endobronquial primario en un paciente adulto, cuyo diagnóstico se realizó por anatomía patológica. Se describen los hallazgos en la radiografía de tórax y en la TC y se analiza la utilidad de las reconstrucciones tridimensionales para planificar la cirugía (AU)
Extramedullary plasmacytomas are malignant neoplasms of the plasmatic cells of the soft tissues. Primary pulmonary plasmacytoma is the rarest type of extramedullary plasmacytoma. The radiologic findings are unspecific and the diagnosis is histologic. Chest CT is useful for confirming its location and planning surgery.We present a case of primary endobronchial plasmacytoma in an adult diagnosed at histology. We describe the findings at plain-film chest X-ray and at CT, and we analyze the usefulness of 3D reconstructions for planning surgery (AU)
Subject(s)
Humans , Male , Middle Aged , Plasmacytoma , /trends , Radiography, Thoracic , Radiography, Thoracic/trends , Thorax/pathology , Thorax , Bronchoscopy , ImmunohistochemistryABSTRACT
Extramedullary plasmacytomas are malignant neoplasms of the plasmatic cells of the soft tissues. Primary pulmonary plasmacytoma is the rarest type of extramedullary plasmacytoma. The radiologic findings are unspecific and the diagnosis is histologic. Chest CT is useful for confirming its location and planning surgery. We present a case of primary endobronchial plasmacytoma in an adult diagnosed at histology. We describe the findings at plain-film chest X-ray and at CT, and we analyze the usefulness of 3D reconstructions for planning surgery.
Subject(s)
Bronchial Neoplasms/diagnostic imaging , Plasmacytoma/diagnostic imaging , Tomography, X-Ray Computed , Humans , Male , Middle AgedABSTRACT
The investigation of a chronic hemolytic anemia in a white girl reveals the presence of Hb SS (sickle cell anemia in its classic form), that carries out the same unsuspected diagnosis in her sister and the realization of both parents as carriers of the sickle cell anemia trait. Some remarks about its epidemiology and scarcity in the white race era done. We consider the essential for the diagnosis.
