ABSTRACT
BACKGROUND: The determinants for recurrence of Crohn's disease remain controversial. Eight factors that might predict recurrence were studied in 130 patients operated on for Crohn's disease over a 24-year period. METHODS: Separate survival curves were estimated for each variable. A multivariate analysis was then carried out in which several selected explanatory variables were included simultaneously in a proportional hazards regression model. RESULTS: Operation for recurrent disease was necessary in 36 patients. Univariate analysis revealed a highly significant relationship between the presence of granulomas and subsequent recurrence (P = 0.003). There was a trend towards increased recurrence in patients with ileocolonic disease and segmental colectomy (P = 0.11 and P = 0.1 respectively). Age, sex, length of history, indication for operation and affected lines of transection were not associated with recurrence. After multivariate analysis, the association of granulomas with recurrence remained significant (P = 0.03). This association persisted when death was regarded as a treatment failure (P = 0.02). CONCLUSION: The presence of granulomas in patients with Crohn's disease is significantly associated with recurrence.
Subject(s)
Crohn Disease/surgery , Granuloma/complications , Adolescent , Adult , Age Distribution , Aged , Colectomy , Female , Follow-Up Studies , Humans , Ileal Diseases/surgery , Male , Middle Aged , Multivariate Analysis , Recurrence , Risk Factors , Survival Analysis , Treatment OutcomeABSTRACT
A retrospective cohort study was undertaken to evaluate the diagnostic value of the renal medulla in acute renal allograft rejection (ARAR). One hundred and ninety-five biopsies from 98 patients were randomly selected out of 565 transplant biopsies. Biopsies were graded blindly from Grade 0 (no rejection) to Grade 3 (severe rejection) using standard criteria; ARAR was confirmed by a fall in all cases of mean serum creatinine concentration from 0.331 +/- 0.182 to 0.184 +/- 0.079 mmol/l, with anti-rejection therapy. In the 43 biopsies which contained both cortex and medulla, the ARAR grades and the intensities of mononuclear cell, plasma cell, polymorphonuclear cell and eosinophil infiltrates, and of interstitial oedema and haemorrhage, were similar in cortex and medulla (Spearman's Rank Correlation r = 0.55-0.81, P < 0.001). The sensitivity, specificity and overall accuracy of medullary changes in predicting ARAR changes in the cortex were 77%, 100% and 38%, respectively. Acute vascular rejection changes could not be compared between renal cortex and renal medulla because of the anatomical differences between cortex and medulla. Further evaluation of ARAR in the all 195 biopsies, of which 188 had cortical tissue and 50 had medullary tissue, showed no significant differences in histological features (P > 0.05), except for more cortical biopsies with plasma cells (29%) than medullary biopsies with plasma cells (10%; P < 0.02). It is concluded that: (1) ARAR histological changes are similar in cortex and medulla; (2) the predictive value of ARAR medullary changes for cortical rejection changes has low sensitivity (77%) and high specificity (100%).(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Graft Rejection/pathology , Kidney Cortex/pathology , Kidney Medulla/pathology , Kidney Transplantation/immunology , Acute Disease , Adolescent , Adult , Aged , Biopsy , Child , Cohort Studies , Female , Humans , Kidney Transplantation/pathology , Male , Middle Aged , Random Allocation , Retrospective Studies , Transplantation, Homologous/pathologyABSTRACT
OBJECTIVE: To report a case of isolated renal mucormycosis in a previously healthy man, and to briefly review the literature relating to this rare condition. CLINICAL FEATURES: An 18-year-old man presented with a two-month history of fevers followed by two weeks of severe left loin pain. Initial treatment with antibiotics failed and abdominal computed tomography and renal perfusion scans were requested, demonstrating a non-functioning left kidney. INTERVENTION AND OUTCOME: Nephrectomy was performed, the histology of which was consistent with mucormycosis. Amphotericin B was administered for one month. The patient made a complete recovery and no underlying disorder was found. CONCLUSIONS: This man is believed to be the first reported Australian with isolated renal mucormycosis, and only the second person worldwide in whom an identifiable underlying disorder was absent.
Subject(s)
Kidney Diseases/diagnosis , Mucormycosis/diagnosis , Adolescent , Amphotericin B/therapeutic use , Biopsy , Combined Modality Therapy , Humans , Kidney Diseases/microbiology , Kidney Diseases/therapy , Male , Mucormycosis/microbiology , Mucormycosis/therapy , Nephrectomy , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Renal oncocytoma is an uncommon tumour which is being diagnosed with increasing frequency in recent years. Traditionally, these renal tumours were considered to be histological variants of renal adenocarcinomas, with no prognostic significance of their own. Several recent retrospective studies have demonstrated that they are a separate benign entity; therefore, differentiation and identification of these tumours are of the utmost importance.
Subject(s)
Adenoma/pathology , Kidney Neoplasms/pathology , Adenoma/diagnosis , Adenoma/surgery , Adult , Aged , Female , Humans , Kidney/pathology , Kidney Neoplasms/diagnosis , Kidney Neoplasms/surgerySubject(s)
Wiskott-Aldrich Syndrome/epidemiology , China/ethnology , Humans , Infant , Infant, Newborn , Malaysia , Male , Wiskott-Aldrich Syndrome/pathologyABSTRACT
The first living patient with a Schistosoma japonicum-type infection who presented with the nephrotic syndrome is reported in detail. It is not clear whether the nephrotic syndrome was due to the schistosome infection or to the deposition of hepatitis B antigen and antibody complexes. This is the tenth case of schistosomiasis reported from aborigines in Malaysia and a sylvatic source of infection is suggested.
