ABSTRACT
BACKGROUND: Renal pelvic dilatation (RPD) is a frequent finding in fetal ultrasound. The aim of the study is to correlate the prenatally detected moderate and severe pyelectasis with the postnatal outcome. METHODS: A retrospective analysis involving 90 cases of prenatally detected moderate and severe RPD referred to our prenatal diagnosis centre with 18 months of urological follow-up. Prenatal ultrasound was correlated with postnatal renal function, assessed by plasmatic creatinine and/or renal scintigraphy performed before surgery. RESULTS: Cases were divided between two groups according to postnatal management: group A including 35 newborns (38.9%) that needed surgical treatment and group B with 55 patients (61.1%) who were managed conservatively. The group A presented higher median RPD (18âmm, IQR 12-25âmm) compared to the group B (11âmm, IQR 10-14âmm). The most common anomaly detected within group A was pelvi-ureteric junction (PUI) obstruction (43%). Within group B 32 cases (58%) showed spontaneous resolution of hydronephrosis during postnatal follow up. In case of moderate pyelectasis the risk of postnatal surgery was 25% and raised to 60% for severe RPD. In our study, 29 newborns showed pathologic scintigraphies: 25 required surgery while 4 did not find indication for surgery due to ipsilateral renal function irreversible damage. 6 patients had high creatinine level (>0.6âmg/dl). 35 cases out of 90 (39%) developed monolateral irreversible renal function impairment. CONCLUSION: Moderate and severe RPD are often correlated with postnatal renal damage, therefore a close multidisciplinary follow-up is required. Prenatal scanning is highly predictive of postnatal outcome and can address properly the prenatal counseling.
Subject(s)
Conservative Treatment , Hydronephrosis/therapy , Pyelectasis/therapy , Ureteral Obstruction/surgery , Urologic Surgical Procedures , Vesico-Ureteral Reflux/therapy , Creatinine/metabolism , Female , Humans , Hydronephrosis/complications , Hydronephrosis/congenital , Hydronephrosis/diagnostic imaging , Infant, Newborn , Kidney Pelvis/surgery , Male , Pregnancy , Pyelectasis/diagnostic imaging , Pyelectasis/metabolism , Radionuclide Imaging , Remission, Spontaneous , Renal Insufficiency/congenital , Renal Insufficiency/etiology , Renal Insufficiency/metabolism , Retrospective Studies , Severity of Illness Index , Solitary Kidney , Ultrasonography, Prenatal , Ureter/surgery , Ureteral Obstruction/congenital , Ureteral Obstruction/diagnostic imaging , Urethral Stricture/diagnostic imaging , Urethral Stricture/metabolism , Urethral Stricture/therapy , Urogenital Abnormalities/diagnostic imaging , Urogenital Abnormalities/metabolism , Urogenital Abnormalities/therapy , Vesico-Ureteral Reflux/diagnostic imaging , Vesico-Ureteral Reflux/metabolismABSTRACT
Introduction. To evaluate the role of hyperthermic isolated limb perfusion (HILP) in arterial thrombosis following melanoma-soft tissue sarcoma chemotherapy. Report. Here is presented one case of iliac-common femoral artery subacute thrombosis and a review of the appropriate literature performed using a MEDLINE search. Acute/subacute arterial occlusion is one of the most feared vascular complications of HILP, located nearly always in the external iliac-femoral artery axis, being those vessels cannulated for perfusion. Conclusions. The small number of reported cases indicates either the rarity of this complication or unawareness of its existence. The true incidence of this complication is probably underreported.
