Hipertensión arterial vasculorrenal en varón joven / Vasculo-renal arterial hypertension in a young male patient

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Transanal self-expanding metal stents as an alternative to palliative colostomy in selected patients with malignant obstruction of the left colon.

BACKGROUND: Palliative colostomy is still unavoidable in many patients with malignant obstruction of the left colon. This report describes an initial experience and follow-up in a small series of patients with left-sided colon obstruction in whom transanal self-expanding metal stent (SEMS) placement was attempted for palliative purposes. METHODS: Palliative transanal SEMS placement was attempted in 11 patients with malignant obstruction of the rectosigmoid region. The selection criteria included patients with advanced pelvic disease, peritoneal carcinomatosis and/or multiple parenchymatous metastatic disease. Wallstent oesophageal endoprostheses were used, and the technique was carried out by interventional radiologists. RESULTS: The technique succeeded in relieving the obstruction in seven patients, and surgical intervention was prevented in six. Five of these six patients died with an unobstructed colon from 26 days to 7 months after SEMS placement. The technique failed in four patients, three of whom underwent emergency colostomy. CONCLUSION: Transanal SEMS placement is an appealing method for the relief of obstruction in selected patients, obviating the need for palliative colostomy.

[Aneurysms of the splenic artery in patients with liver transplantation]. / Aneurismas de la arteria esplénica en pacientes con trasplante hepático.

Splenic artery aneurysms (SAA) are not uncommon in patients with hepatic transplant (HT). Three in 150 transplanted patients in our institutions were diagnosed with SAA and two of them had a spontaneous rupture. In two patients embolization with interventionist radiology was performed with excellent results. SAA should be investigated before and after HT and be treated with embolization as soon as possible because of the high risk of rupture.

[Embolism in renal artery]. / Embolia sobre la arteria renal.

OBJECTIVE: To describe a useful algorithm when acute non-traumatic renal artery occlusion is suspected. METHODS: The diagnostic and therapeutic aspects of this uncommon disease are analyzed through two cases that had been managed differently. RESULTS: Early clinical suspicion is based upon a non-colic sudden flank pain in patients with a history of cardiac embolic events, increased serum LDH, ALAT and ASAT, proteinuria, non-lithiasic, non-functioning kidney on IVP and a normal sized non-dilated kidney on ultrasound. The next step is diagnostic angiography and fibrinolysis when indicated. CONCLUSIONS: Intra-arterial fibrinolysis is the treatment of choice in renal artery embolism when functional recovery by angiographic and clinical criteria is present, and will be further enhanced the earlier the diagnosis is made.

[Initial treatment of pyonephrosis using percutaneous nephrostomy. Value of the technique]. / Tratamiento inicial de la pionefrosis mediante nefrostomía percutánea. Valor de la técnica.

Until early in the eighties, the initial treatment of choice for pyonephrosis was by emergency surgical excision, which carried a high intraoperative and early postoperative morbidity and mortality. The introduction of percutaneous nephrostomy, a technique with a low complication rate that permits easy access in dilated excretory tracts and is highly effective, as shown by the clinical and analytical course of the patients with pyonephrotic kidney and by the number of nephrectomies performed, represented a substantial change in the initial therapeutic approach. The present article reports our experience of 123 percutaneous nephrostomies performed in 118 pyonephrotic kidneys over a period of 10 years, which constitutes one of the largest series reported in the literature. The clinical features and the findings disclosed by imaging techniques that permit making the diagnosis are presented. We describe the PCN procedure and its advantages, with special reference to the reduced morbidity and mortality, particularly in those cases complicated by septic shock. The procedure also permits evaluation of the underlying obstructive uropathy and function of the compromised kidney, therefore more renal units can be preserved, nephrectomy can be avoided and morbidity is minimal. For all the foregoing reasons, PCN guided by an imaging technique is currently the most effective initial treatment of pyonephrosis.

[Transcatheter arterial embolization in the hemorrhagic complications of kidney trauma]. / Embolización arterial transcatéter en las complicaciones hemorrágicas del trauma renal.

Transcatheter arterial embolization is a nonsurgical alternative for the complications arising from biopsy, surgery and blunt or penetrating renal trauma. Fourteen transcatheter embolization procedures were performed in 13 patients for hemorrhage following biopsy of the native kidney (3 cases) biopsy of the transplanted kidney graft (3 cases), stone surgery (3 cases), blunt abdominal trauma (2 cases), a stab wound (1 case) and an A-V fistula (1 case). The bleeding was effectively controlled in all cases. Nephrectomy was required in 3 cases (21.4%) whose kidneys were not viable and cannot be ascribed to a complication of the embolization procedure. The diagnostic aspects of hemorrhage arising from renal trauma, the embolization technique and its indications are discussed. In our view, transcatheter arterial embolization is the technique of choice for the hemorrhagic complications of blunt or penetrating renal trauma or those caused by biopsy or surgery.