1/12. Reconstructive renal surgery using a water jet.PURPOSE: We describe the successful application of a water jet to reconstructive renal surgery. MATERIALS AND methods: Two consecutive patients underwent reconstructive renal surgery using a waterjet apparatus for a 4.0x6.5 cm. well encapsulated tumor of the lower pole of the left kidney and a 4.5x2.5 cm. staghorn calculus of the left kidney, respectively. The water jet apparatus (Parenchimotom 01) consists of a pressure generating pump and a flexible hose connected to the hand piece, and a nozzle with a pinhole opening of 0.3 mm. RESULTS: Both patients underwent surgery through a left lumbar incision. Partial nephrectomy was performed in 1 patient and anatrophic nephrotomy for stone removal in the other. dissection time was 25 and 12 minutes, with blood loss of 150 and 100 ml., respectively. No temporary vascular clamping or local hypothermia was necessary. Both patients were discharged home 10 days after surgery and at followup no negative sequelae were attributable to the procedure. CONCLUSIONS: The operative procedures proved easy, fast and effective. No temporary vessel clamping or hypothermia was required. Using a water jet is a novel approach that is helpful in renal surgery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/12. A case of late-onset primary hyperoxaluria type 1.Primary hyperoxaluria type 1 (PH1) is an inherited metabolic disorder characterized by recurrent urolithiasis and nephrocalcinosis frequently leading to progressive renal insufficiency during the second decade of life. Systemic organ involvement as a result of the accumulation of calcium oxalate crystal deposits in vessel walls often is observed. We report a case of a 56-year-old woman with late-onset of PH1 who developed rapidly progressive renal failure and severe systemic oxalosis with skin and eye involvement despite intensified hemodialytic therapy during the waiting period for combined liver and kidney transplantation. This case illustrates the difficulties in treatment of PH1-induced end-stage renal disease. Combined liver and kidney transplantation should be offered to these patients as soon as possible to reverse the underlying metabolic defect and to restore renal function.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/12. Laparoscopic assisted percutaneous nephrolithotomy (PCNL) in ectopic kidneys: two different techniques.Two patients presented with calculi in ectopic kidneys. Complete clearance of calculi was achieved by laparoscopic assisted percutaneous nephrolithotomy (PCNL), by different but related techniques. In one patient with prior history of open pyelolithotomy, the anterior surface of the kidney was exposed by mobilizing the overlying sigmoid colon laparoscopically and the percutaneous tract was established into the desired calyx under combined laparoscopic and fluoroscopic control. In the second patient, the tract was established between the major mesenteric vessels without any mobilization of the bowel. Herein, we outline the nuances of these two related techniques, and the indications and contraindications for their use for laparoscopic assisted PCNL in ectopic kidneys.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/12. Haemorrhage due to rupture of the kidney with intraparenchymal calculi, chronic pyelonephritis and acute obstructive uropathy. A case report.Massive left perirenal haemorrhage due to rupture of the kidney with intrarenal calculi has not been previously described and in this case is thought to have been due to erosion of small vessels by intraparenchymal calculi aggravated by oedema and ischaemia caused by associated acute obstructive uropathy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/12. The etiology and treatment of delayed bleeding following percutaneous lithotripsy.In 1,032 percutaneous stone manipulations the incidence of significant, documented or presumed vascular injuries was 0.9 per cent. Seven cases of pseudoaneurysm, arteriovenous fistula or vascular lacerations were found, all of which were diagnosed angiographically. The patients were treated successfully with transcatheter embolization techniques. Two additional patients experienced delayed bleeding, presumably from vascular injuries, which resolved spontaneously with conservative therapy. Arteriography should be performed in these patients with serious postoperative bleeding. Embolization of the peripheral vessel is preferable to flank exploration.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/12. Reno-cerebral oxalosis induced by xylitol.A 20-year-old man suffering from Crohn's disease developed coma and generalized seizures following ileocecal resection. During postoperative parenteral feeding he received xylitol in an unusually high concentration. CT examinations a few days before death showed intense hypodensity and swelling of brainstem and basal ganglia and increasing triventricular dilatation. autopsy revealed, mainly in the brainstem and cerebellum, a destruction of intracerebral, intracerebellar and leptomeningeal vessel walls by birefringent crystals (probably calcium oxalate), an early inflammatory reaction and severe brain edema with final tonsillar herniation. The same crystalloid deposits were found in the kidneys.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/12. Transcatheter embolization with autologous clot in the treatment of renal bleeding.Six cases of renal bleeding which were successfully treated by transcatheter embolization with autologous clot are described and illustrated. The problems of clot lysis and consequent vessel recanalization are discussed both from an experimental and clinical point of view. It is concluded that clot embolization is suitable treatment for renal bleeding and, in selected cases, is preferable to open surgery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/12. cholesteatoma of the renal pelvis treated by extracorporeal surgery and autotransplantation with pyelocystostomy.We report on a patient who had had recurrent renal stones on the right side for 37 years. At the sixth lithotomy the diagnosis of cholesteatoma of the renal pelvis was discussed. After another recurrence of stones and a pelvic lesion nephrectomy was considered. However, the kidney still had 60 per cent of total renal function and the other kidney also harbored stones. Therefore, extracorporeal exploration was performed. The stones and keratin masses were removed from the pelvis and frozen section showed no malignant changes. The kidney was reimplanted in the ipsilateral iliac fossa with end-to-side anastomosis to the external iliac vessels and a wide direct anastomosis between the pelvis and the bladder. At followup 2 months postoperatively the patient was well. Autotransplantation with pyelocystostomy facilitates free passage of recurrent stones and keratin fragments, and allows for future transurethral control of the renal pelvis. Thus, the procedure is well suited for the treatment of cholesteatoma of the renal pelvis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/12. Control of postoperative renal hemorrhage by embolization with a Gianturco coil.A 35-year-old woman underwent a left pyelonephrolithotomy for removal of a staghorn calculus. blood loss was minimal for 5 days. Then there was profuse bleeding from the left kidney that did not respond to conservative management. Angiographic examination demonstrated extravasation of contrast medium from a minor intrarenal artery in the lower pole of the kidney directly into the pelvicalyceal system. An attempt was made to embolize the bleeding vessel with Gelfoam particles but this failed because the Gelfoam passed directly into the collecting system. A Gianturco coil, however, occluded the vessel and immediately the hemorrhage ceased; the patient had no further complications. The authors emphasize that the introduction of a steel coil to control bleeding is advocated only when the use of temporary occlusive agents is unsuccessful.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
10/12. Successful management of postoperative hemorrhage of the kidney by selective transcatheter embolization.A case is reported where postoperative hemorrhage from the kidney was successfully managed by selective transcatheter embolization of the bleeding vessel. A review of the literature reveals that only three papers have been published dealing with selective embolization for controlling hemorrhage from the kidney. Our case is another illustration of the possibilities and usefulness of this method of treatment in the management of persistent postoperative hemorrhage.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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