Conservative management of penetrating and blunt Type III renal injuries.

OBJECTIVE: To determine the optimal management, conservative or surgical, of patients with penetrating or blunt Type III renal injuries. PATIENTS AND METHODS: This retrospective study comprised 122 patients with blunt abdominal or penetrating trauma with suspected significant renal injuries. Forty-five patients (32 penetrating and 13 blunt trauma) with Type III injury were identified. Of these patients, 28 (17 penetrating and 11 blunt trauma) had their renal injuries treated conservatively while 14 patients, all with penetrating injuries, underwent immediate surgical repair. Three patients died from multiple trauma shortly after arrival in the emergency room. RESULTS: In the 42 surviving patients with Type III renal injuries, four required delayed intervention. These included two of those managed conservatively and two of the 14 who underwent initial surgical intervention. Three renal units were lost, all of which were in those treated surgically. Thus, of the 42 surviving patients with Type III renal trauma, 28 (67%) were successfully managed conservatively without renal loss. CONCLUSION: This study suggests that Type III penetrating trauma may be successfully managed conservatively with a similar outcome to those patients with Type III blunt injuries. Initial surgical intervention may only be necessary in those with associated intra-abdominal injuries or haemodynamic instability.

Ex vivo activated memory T-lymphocytes as adoptive cellular therapy of human renal cell tumour targets with potentiation by cis-diamminedichloroplatinum(II).

OBJECTIVE: To determine if cis-diamminedichloroplatinum(II) (CDDP) enhances, by immunomodulation, ex vivo anti-tumour cytotoxicity of autolymphocyte therapy (ALT) against a chemotherapy-resistant tumour, and if lysis is mediated through T-cells, NK-cells, or both. MATERIALS AND METHODS: Human renal cell carcinoma (RCC) target cells were derived from surgical specimens and incubated in complete medium (CM) with CDDP, or in CM alone (control group). ALT-cells were prepared from autologous whole peripheral blood mononuclear cells (PBMC) or NK-cell (CD56)-depleted PBMC obtained before surgery. Tumour cells from each group were labelled with chromium-51(51Cr) and used as targets for ALT-cells and PBMC in a standard (4 h) and delayed (18 h) 51Cr-release assay at varying effector/target ratios (E:T). RESULTS: Tumour cells incubated in CDDP showed enhanced lysis, as measured by the 51Cr-release assay, at all E:T tested. This lysis was significantly greater during the 18 h assay and when ALT-cells were used as the effector cells rather than PBMC. Depletion of CD45RO+ (memory) T-cells from the ALT cell population precluded both the 4 and 18 h tumour cell lysis. Depletion of NK-cells (CD56+) diminished the ex vivo lysis of autologous targets during the 4 but not the 18 h assay. ALT-cells derived from two patients demonstrated ex vivo tumour-specificity against autologous and allogeneic RCC. CONCLUSIONS: These data suggest that: (i) ex vivo activated memory T-cells are the principal component demonstrating significant tumour-specific cytotoxicity of ALT-cells against RCC tumour targets; (ii) CDDP may alter the physical properties of tumour cells rendering them susceptible to immune-mediated attack; (iii) the combination of ALT and CDDP may lead to increased therapeutic efficacy in patients with metastatic RCC.

Renal angiomyolipoma associated with neurofibromatosis and primary carcinoid of mesentery.

A patient with von Recklinghausen's disease manifested by dermal neurofibromatosis and cafe-au-lait spots presented with complaints of malaise, weight loss, lower extremity weakness, and a palpable left lower abdominal quadrant mass. Evaluation revealed a lumbar neurofibroma, a localized primary carcinoid tumor of the mesentery, and a left renal angiomyolipoma. Although an association between neurofibromatosis and carcinoid has been previously reported, we believe this is the first report documenting the association of all three entities.

Splenic abscess as complication of perinephric abscess.

Retroperitoneal extension of perinephric abscess with fistulization to intra-abdominal and intrathoracic structures has been well documented in the literature. Intraperitoneal rupture is much less common, and exceptionally may not present as an acute abdominal condition. We describe herein 1 such case involving the spleen. Since the extent of the disease may not be apparent radiologically, and often is only ascertained at the time of surgery, we recommend an aggressive approach to renal calculi as the most effective means of preventing complicated perinephritis.

Rhabdomyolysis and acute renal failure as a complication of urethral surgery.

Acute renal failure secondary to rhabdomyolysis is a well-known entity. A case of rhabdomyolysis with renal failure secondary to positioning during urethral surgery is presented.