Complications of automated spring fired biopsy gun technique. A retrospective analysis of 230 cases.

BACKGROUND: Renal biopsy (RB) is a procedure which allows obtaining kidney tissue for a morphological diagnosis. As an invasive procedure, RB could lead to some complications. The aim of the study was to assess the incidence and the severity of various complications of renal biopsy(RB) performed by automated spring fired biopsy gun with needles 16 and 18G. MATERIAL AND METHODS: A total number of 230 RB obtained from patients over 18 years of age, within the period from January 2009 to July 2013, were analyzed retrospectively. All RB were performed by a standartized technique using an automated spring fired biopsy gun, with 16, and 18 G disposable needle. The average age of the patients was 45.5 ± 22.3 years, 119 male and 111 female. As many as 170 biopsies were performed with 16 G needle and 60 with 18G. The assessment of the early post-biopsy complications was done by renal ultrasound (US). RESULTS: Of all RB, 92.7% were successfully performed. In 60% of the failed RB 18 G needle was used. No post-biopsy complications were noted in 93.4%. Hematomas were observed in 15 out of 230 cases (6.6%). Of those, 80% were assessed as minor hematomas (12/15) with an average size of 20.4mm ± 11mm and they appeared to be asymptomatic.While 8 cases (66%) of all 12 minor hematomas were obtained by two passes (66%), only 4 cases (34%) of hematoma were observed after one pass <0.01. The cases of hematomas obtained with 16 G needle were significantly higher than those in the group with 18G (8 to 4, p<0,05). However, when the number of hematomas in both groups referred to the number of all biopsies in the corresponding group, no significant difference of this complication was observed, p > 0.05. The incidence of major complications was 1.3%. CONCLUSION: The optimal period for US examination of the kidneys for early diagnosis of complications is up to 24 hours after RB. The experience of the physician performing the procedure is of great importance for reducing the risk of complications as well as the RB technique used. An automated spring fired biopsy gun with needle 16G is recommended.

[A multicenter comparative observation on the effectiveness and the rapidness of the effect of Cystostop Rapid versus antibiotic therapy in patients with uncomplicated cystitis].

UNLABELLED: The currently available treatment for uncomplicated urinary tract infections includes only antibiotics and chemotherapeutic agents. Experience in the management of acute uncomplicated infections using non-antibiotic products is very limited. The aim of this observation was to study to what extent the response to Cystostop Rapid would be more rapid and more effective compared to antibiotic therapy in patients with acute uncomplicated urinary bladder infections. The secondary objective was to determine the time to improvement of cystitis symptoms following the start of treatment, as well as the duration of patients' disablement. A total of 158 female subjects were included, assessed microbiologically, and evaluated for incidence and severity of symptoms, before the start of treatment and after completion of treatment. A visual analogue scale was used for patient self-assessment of the severity of symptoms, the improvement of symptoms, as well as the time to improvement of symptoms. RESULTS: 158 females, eligible according to the inclusion criteria of the study, were allocated to one of the two groups according to time of enrollment: Group A included 86 subjects: assigned to Cystostop Rapid for 3 days and administered according to the manufacturer's recommended regimen; and Group B included 72 women: assigned to ciprofloxacin 500 mg twice daily for 3 days according to the Product Registration File with the BDA. The clinical and microbiological effectiveness of Cystostop Rapid was comparable to that of ciprofloxacin, providing a two-fold more rapid improvement of cystitis symptoms, at a mean time to improvement of 24 hours (p < 0.02) versus 46 hours for ciprofloxacin. Clinical improvement within 48 hours of Cystostop Rapid regimen occurred in 97% (p < 0.02) of patients, vs. 65.3% of patients on ciprofloxacin. Improvement of symptoms within 12 hours was reported in 36% of patients on Cystostop Rapid vs. 5.5% of patients in the ciprofloxacin group (p < 0.02). No adverse events or intolerability to the therapy were reported throughout the course of the study.

Biopsy of subcutaneus fatty tissue for diagnosis of systemic amyloidosis.

BACKGROUND: The diagnosis of systemic amyloidosis is determined through histological material from biopsy of different parenchymal organs, which have high diagnostic and informative value, but hide a high risk of bleeding because of the accumulation of amyloid in the vessels' wall. The main methods are kidney, liver, gastro-intestinal tract biopsy and aspiration of subcutaneous fatty tissue. The sensitivity of trans-dermal core kidney biopsy (KB) is close to 100%. The rectal biopsy is positive in 73% of cases, the biopsy of bone marrow in bout 50% and the one of gingival mucosa in 40-46 % of cases. The biopsy of subcutaneous fatty tissue (BSFT) is a new, highly sensitive method with sensitivity 73% and specificity 90%, so that it can be used as a screening test in patients without any clinical symptom or organ dysfunction. PATIENTS AND METHODS: One hundred fifteen patients, 59 male and 56 female with an average age 49.7+/-15.93 years were included in the study divided in two groups. The first group consisted of patients with kidney biopsy proved amyloidosis compared to biopsy findings from other parenchymal organs. The second group consisted of patients suspected having amyloidosis who underwent biopsies from various tissues or organs except kidney biopsy because there was contraindication. RESULTS: One hundred fifteen biopsies of subcutaneous fatty tissue (SFT) were performed for the diagnosis of systemic amyloidosis. In order to compare the data from the BSFT to the other known and practiced till the moment methods BSFT was performed in 54 patients with proved amyloidosis by KB. In 51/54 the positive result for amyloid was confirmed. A comparison of the data in a sample of 20 patients, 11 female and 9 male, in 18/20 patients the result from BSFT is positive (90%). In coloring with Congo red are typed with KMnO4 19/54 patients, 12 female and 7 male, with average age 48.12 (SD +/-13.21). In 14/19 the amyloidosis was typed as AA (74.2%) and 5/19 non-AA, probably AL (25.8%). To reveal the meaning of so called screening-biopsy of subcutaneous fatty tissue for excluding accompanying amyloidosis in patients with significant proteinuria and/or uremia, dysglobulinemia, laboratory constellations for nephritic syndrome in immune nephropathies and chronic infections (Chronic Obstructive Lung Disease, purulent infections) with contraindications for kidney biopsy 61 screening BSFT were performed, accumulation of amyloid was defined in 37. In all of the patients the result was verified also by biopsies of rectal, gingival and stomach mucosa. CONCLUSION: The purposeful searching and proving of amyloid in subcutaneous fatty tissue of the abdominal wall is a new, highly sensitive method. The receiving of richer material from SFT in the method "biopsy" in stead of "aspiration", makes it more reliable for proving amyloid in the case that it exists. The method is enough informative for proving not only amyloidosis AL, but also for amyloidosis AA, in treating with KMnO4. The biopsy of SFT in combination with biopsies from other mucosa can prove the accumulation of amyloid in contraindications for performing KB.

Diagnostic value of the Conventional and Doppler ultrasound in pregnancy complicated with preeclampsia.

BACKGROUND: Preeclampsia (PE) is a pregnancy complication usually of the third trimester. The clinical manifestations are hypertension and proteinuria with or without edema. Its pathogenesis is characterized by generalized vasoconstriction and endothelial dysfunction. The aim of this study was to evaluate the diagnostic value of the Doppler ultrasound examination of the renal interlobar vessels in pregnancy complicated with preeclampsia in the context of the theory about the increased vessel resistance in this pregnancy disorder. METHODS: Fifty two women aged 16-38, (mean age 23+/-9.54) streamed into three groups were examined by abdominal ultrasound in Triplex regime. The first group included 18 pregnant with PE, the second 21 women in the third trimester of normal pregnancy, and the third group 13 non-pregnant women. In all 3 groups the renal volume (RV) and parenchyma volume (PV) were determined by conventional ultrasound (CU). The doppler waveform analysis (DWA) of the interlobar renal arteries (IRA) gave the following indices: resistance index (RI), pulsatility index (PI), peak systolic velocity (Vmax) and end diastolic velocity (Vmin). RESULTS. RV and PV in the PE group were significantly higher then those of the healthy pregnant women: RV: 231.4+/-58 to 187+/-45, p<0.05 and for PV: 200+/-11 to 130+/-6.78, p<0.05. Such a difference was not found out for the healthy pregnant women compared to the non-pregnant ones. No significant differences of the examined doppler indices were found in the three groups. CONCLUSION: Although the arteriolar vasoconstriction and the tissue hypoxia are leading in the PE pathogenesis, the DWA of the IRA in PE pregnancy does not differ from those of the healthy pregnant and nonpregnant women. As one of the most frequently used imaging technique Doppler Ultrasound (DU) of the renal IRA and DWA of these vessels shows no diagnostic advantage as compared to the renal CU in pregnancy complicated with PE.

[Secondary systemic amyloidosis A combined with primary glomerulonephritis and systemic diseases]. / Vtorichna sistemna amiloidoza A v suchetanie s purvichni glomerulonefriti i sistemni zaboliavaniia.

Amyloidosis is characterized by organic dysfunction as a result of deposition of amyloid substance in the walls of the small blood vessels and extracellularly in different organs. The involvement of the kidneys in systemic amyloidoses AL and AA has irreversible evolution to renal failure. The object of the study was to determine the prevalence of the secondary (reactive) systemic amyloidosis AA in combination with primary glomerulonephritis (PGN) and lupus nephropathy (SLE) and to create diagnostic approach for its early detection. The prevalence of amyloidosis among the renal biopsies in the Department of Nephrology by the Chair of Internal Diseases for the period 1981-1988, retrospectively, is 4% (in 11 out of 268 biopsies). For the period 1989-1996, prospectively, by directed quest, amyloid was found in 35 out of 269 renal biopsies (11%). For differentiation of AA preliminary treatment of the histologic material with KMnO4 was used. In 20 cases amyloidosis appeared as independent finding in the renal tissue, while in 15 it was combined with histologic picture of immune nephropathies: in 11 with primary glomerulonephritis (7% out of 155 PGN) and in 4 with systemic lupus erythematodes (11% out of 31 SLE). The combination of PGN with AA was almost always associated with chronic infections. It was most often observed in diffuse membranous GN or FSGSH. Our studies demonstrate increased prevalence of amyloidosis among the renal biopsies during the last years, which could be due to directed quest, but it could be a real fact, too. We suggest staining for amyloid in all renal biopsies, as well as its directed quest in mucosae of the gastro-intestinal tract and by aspiration of the abdominal subcutaneous fatty tissue in the patients with primary GN or systemic diseases.