Complications of percutaneous nephrostomy, percutaneous insertion of ureteral endoprosthesis, and replacement procedures.

PURPOSE: The aim of the present study was to record and identify the frequency of complications following percutaneous nephrostomy, replacement of nephrostomy drains and percutaneous insertion of ureteral endoprostheses. METHODS: During a 10-year period 341 patients were referred to our department with indications for percutaneous nephrostomy and/or percutaneous insertion of a ureteral endoprosthesis, and a total of 1036 interventional procedures were performed (nephrostomy, catheter change, stenting). RESULTS: There were three major complications (0.29%): two patients died during the first 30 days after the procedure, due to aggravation of their condition caused by the procedure, and one patient had retroperitoneal bleeding requiring surgery. There were 76 complications of intermediate severity (7.33%): catheter or stent displacement (n = 37, 3.57%) catheter occlusion (n = 18, 1.73%), hematuria (n = 12, 1.16%), and urinary tract infection (n = 9, 0.87%). The 55 minor complications (5.3%) comprised inflammation of the skin at the site of insertion of the percutaneous catheter. CONCLUSION: The small number of complications observed during acts of interventional uroradiology prove transcutaneous manipulations to be safe medical procedures.

Long-term follow-up in patients with malignant biliary obstruction after percutaneous placement of uncovered wallstent endoprostheses.

PURPOSE: Evaluation of the treatment of malignant obstructive jaundice by percutaneous insertion of uncovered stents. MATERIAL AND METHODS: 51 patients (35 men, 16 women) with inoperable malignant biliary obstruction underwent percutaneous placement of uncovered Wallstent biliary endoprostheses. A total of 65 endoprostheses were inserted. RESULTS: The technical success rate was 98%, and the procedure-related complications rate was 10%. Early complications rate within the first 30 days was 2%. The clinical success rate within the first 30 days was 98% and the 30-day mortality rate was 2%. The late complications rate was 16%. The overall stent occlusion rate was 18% at a mean of 288.4 days. Mean survival time of the 50 patients was 214 days, and the mean total duration of hospital stay was 9.8 days. CONCLUSIONS: The advantages of uncovered Wallstent endoprostheses justify their placement in patients with inoperable malignant obstructive jaundice since patients' quality of life is markedly improved. Stent insertion is associated with a low complication rate, most stents remain patent longer than the patients' survival time and patients' hospital stay is relatively short.

Mini-review: Islet transplantation to create a bioartificial pancreas.

Donor scarcity precludes the use of pancreatic transplantation to treat type I diabetes. Xenogeneic islet transplantation offers the possibility of overcoming this problem; however, it entails the use of immunoisolation devices to prevent immune rejection of the transplanted islets. These devices consist of a semipermeable membrane, which surrounds the islets and isolates them from the host's immune system, while allowing the passage of insulin and essential nutrients, including glucose. Problems associated with proposed device designs include diffusion limitations, biocompatibility, device retrieval in the event of failure, and mechanical integrity. Microencapsulation appears to be the most promising system of immunoisolation, however, the design of a device suitable for human clinical use remains a challenge. (c) 1994 John Wiley & Sons, Inc.