Usefulness of ultrasound fusion technology for hepatocellular carcinoma localisation, pre- and post-thermal ablation.

Introduction: Percutaneous thermal ablation of inconspicuous lesions can be challenging. Fusion ultrasound (FUS) allows the use of previously performed diagnostic imaging like computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET-CT) to localise hepatocellular carcinoma (HCC) for treatment. This paper illustrates FUS case studies of pre-, intra- and post-ablation imaging of inconspicuous HCC, supplemented by use of contrast-enhanced ultrasound (CEUS). Method: Four prospective cases during September 2014 to October 2018, with HCC amenable to ablation, which were poorly identified on ultrasound, underwent FUS. FUS pre-screening was scheduled within three months of the previous CT or MRI, and between one to four weeks prior to the scheduled ablation date. Post-ablation imaging with FUS was performed between four to six weeks to coincide with their routine follow-up CT or MRI. Findings: There were potential benefits observed in the cases with combined techniques of FUS and CEUS for limiting circumstances such as heat sink effect, multiple lesions targeting, inconspicuous lesion detection and pre-ablation technical feasibility assessment. Discussion: The combined use of FUS and CEUS improves tumour visibility, increases operator imaging confidence and reduces heat sink effect during percutaneous thermal ablation. Conclusion: FUS imaging is helpful in targeting poor conspicuity lesions that cannot be detected on grey-scale ultrasound. It facilitates in ensuring optimal treatment of hepatic lesions for improvement of patient prognosis and follow-up imaging.

Treatment and renal outcome of lupus nephritis: single center experience.

Systemic Lupus Erythematosus (SLE) is a multisystemic autoimmune disease with renal involvement being one of the most frequent and serious manifestations of the disease. The aim of the study is to analyze the treatment and renal outcome of patients with lupus nephritis (LN) WHO class III and IV on cyclophosphamide (CYC). We retrospectively identified 41 patients with biopsy proven LN who was given either oral or intravenous CYC. The male: female ratio was 4:37; with a mean age of 31.7 +/- 9.8 years at presentation. 36 patients (87.8%) had LN class IV and only five patients (12.2%) with LN class III. The mean serum creatinine at presentation was 87.4 +/- 37.2 micromol/L with mean follow-up of 84 +/- 78 months. A total of 30 patients (73.2%) completed 12 courses of IV CYC and one patient (2.4%) completed three months of oral CYC. 71.0% (n = 22) had complete response (CR), 25.8% (n = 8) had partial response and 3.2% (n = 1) had no response (NR). Of the remaining 11 patients, two patients (4.9%) died during the treatment, three patients (7.3%) defaulted treatment and five patients (12.2%) are still receiving ongoing treatment. Presence of hypertension (p < 0.003) and evidence of chronicity on renal biopsy (p < 0.016) were significantly correlated with the progressive deterioration of renal function in our population. In conclusion, hypertension and evidence of chronicity on renal biopsy, proved to be risk factors for progressive renal impairment in our study population. The achieved global outcome can be considered good.

Comparison of patient survival between various subgroups among renal transplant patients: a single center experience.

OBJECTIVES: To compare patient graft survival between various subgroups among renal transplant patients. PATIENTS AND METHODS: A retrospective analysis of all renal transplant patients from January 1, 1993, to June 1, 2003, was performed using follow-up records and data submitted to the National Renal Registry. RESULTS: A total of 91 renal transplant patients were followed, with a male-to-female ratio of 57:34 (62.6%:37.4%) and mean age at transplant 35.6 +/- 12.1 years (range 10.1-64.4 years) with 38 (41.8%) cases transplanted locally and 53 (58.2%) cases transplanted overseas, of which 36 (39.6%) were from live donors and the remaining 55 (60.4%) from cadavers. As of June 1, 2003, 50 transplant patients are on regular follow-up, with 41 patients lost due to 12 (29.3%) deaths, 16 (39.0%) graft failures, 11 (26.8%) transfers, and 2 (4.9%) lost to follow-up. Overall patient and graft survival rates at 2, 5, and 10 years were 93.1%, 77.4%, and 49.2%, respectively. Survival rates for male transplant patients were 91.4%, 71.9%, and 46.7% compared to 96.1%, 86.9%, and 53.6% for females. Survival rates for Malay race patients were 92.0%, 59.5%, and 28.6%; Chinese rates were 96.0%, 81.6%, and 54.8%, and Indian rates were 81.0%, 81.0%, and 46.3%, respectively. The survivals for transplants from living donors were 96.9%, 85.6%, and 62.3% compared to cadaveric kidney transplants namely 89.9%, 71.3%, and 35.0%. The local transplant survival rates were 96.9%, 82.3%, and 60.8% compared to overseas transplants, with survival rates of 89.9%, 73.5%, and 35.7%. Finally, living-related donor transplantation survival rates were 96.8%, 84.9%, and 62.2% compared to nonrelated donors-90.1%, 71.3%, and 35.0%-at 2 years, 5 years, and 10 years, respectively. CONCLUSION: Overall survival has been good. The survival rates were better among female gender, Chinese race, local transplantation, and kidneys from living-related donors.

Pregnancy in patients with renal transplants in Malaysia.

There were 72 pregnancies in 46 renal transplants (RTs) between 1984 and 2001, 89% from living donors, 11% cadaveric. Mean age at RT was 26.9 +/- 4.3 years and at pregnancy 30.7 +/- 4.7 years. Mean time to pregnancy after RT was 4.5 +/- 3.1 years. 54% were unplanned. 45 (63%) resulted in surviving infants, 37% delivered by Caesarean section. 35% were premature. Mean birth weight was 2.38 +/- 0.57 kg. 64% were on cyclosporine. No patient had an acute rejection during pregnancy; 38% had pre-existing hypertension. Complications include urinary infection (13%), proteinuria (15%) and preeclampsia (15%). Mean serum creatinine before pregnancy was 112.7 +/- 32.6 umol/l, 1 year post-pregnancy it was 119.4 +/- 38.7. The mean time of follow up of mothers is 4.9 +/- 3.5 years. 10 year graft survival was 83% and patient survival 94%.

Peritoneal implantation of ureter in a cadaveric kidney transplant recipient.

We report here a case of a kidney transplant recipient in whom the ureter was initially implanted into the peritoneum. Excessive ultrafiltration volume and reversal of serum vs dialysate creatinine ratio when the patient was recommenced on continuous ambulatory peritoneal dialysis first suggested the diagnosis which was subsequently confirmed by a plain abdominal x-ray demonstrating placement of ureteric stent in the peritoneum. This rare complication was successfully corrected with surgical re-implantation of ureter into the bladder and 5 years later, the patient remains well with good graft function.