Sample records for reliable preoperative renal

  1. eGFR is a reliable preoperative renal function parameter in patients with gastric cancer

    Takayuki; Kosuge; Tokihiko; Sawada; Yoshimi; Iwasaki; Junji; Kita; Mitsugi; Shimoda; Nobumi; Tagaya; Keiichi; Kubota


    AIM: To evaluate the validity of the estimated glomerular filtration rate (eGFR) as a preoperative renal function parameter in patients with gastric cancer. METHODS: A retrospective study was conducted in 147 patients with gastric cancer. Preoperative creatinine clearance (Ccr), eGFR, and preand postoperative serum creatinine (sCr) data were examined. Preoperative Ccr and eGFR were then compared for their reliability in predicting postoperative renal dysfunction. RESULTS: Among 110 patients with normal preo...

  2. Perioperative renal outcome in cardiac surgical patients with preoperative renal dysfunction: aprotinin versus epsilon aminocaproic acid.

    Maslow, Andrew D; Chaudrey, Alyas; Bert, Arthur; Schwartz, Carl; Singh, Arun


    The administration of aprotinin to patients with pre-existing renal dysfunction who are undergoing cardiac surgery is controversial. Therefore, the authors present their experience with the use of aprotinin for patients with preoperative renal dysfunction who underwent elective cardiac surgery requiring cardiopulmonary bypass (CPB). Retrospective analysis. University hospital. Consecutive cardiac surgical patients with preoperative serum creatinine (SCr) > or =1.8 mg/dL undergoing nonemergent cardiac surgery requiring CPB. None. One hundred twenty-three patients either received epsilon aminocaproic acid (EACA, n = 82) or aprotinin (n = 41) as decided by the attending anesthesiologist and surgeon. Data were collected from the Society of Thoracic Surgeons database and from automated intraoperative anesthesia records. Renal function was assessed from measured serum creatinine (SCr) and calculated creatinine clearances (CrCls). Acute perioperative renal dysfunction was defined as a worsening of perioperative renal function by > or =25% and/or the need for hemodialysis (HD). Data were recorded as mean and standard deviation or percentage of population depending on whether the data were continuous or not. Data were compared by using an analysis of variance, chi-square analysis, Student paired and unpaired t tests, Fisher exact test, Wilcoxon rank sum test, and Mann-Whitney U test. A p value or =3 months after surgery was significantly lower in the aprotinin group compared with the EACA group (1.8 v 2.2 mg/dL, p < 0.05). Acute perioperative renal dysfunction was associated with worse patient outcome and longer CPB and AoXCl times. Demographic and surgical variables indicated that the sicker patients undergoing more complex surgeries were more likely to be treated with aprotinin. Although aprotinin patients had a higher renal risk score, the administration of aprotinin did not negatively impact renal outcome.

  3. Preoperative diagnosis of renal oncocytoma: case report and literature review

    Wang Linhui; Wang Zhixiang; Sun Yinghao


    To differentiate renal oncocytoma from renal carcinoma, the clinical data of four patients with incidentally found renal oncocytomas were studied in this report. And additional Immunohistochemistry examinations were done to confirm diagnosis. Renal oncocytomas were found incidentally in four patients during medical examination. No characteristic changes were found in laboratory tests. Radiology examination provided the location and possibility of renal oncocytoma. History, laboratory test and radiology exanimation indicated the diagnosis of renal oncocytoma, but the final identify of renal oncocytoma need pathology examination.

  4. Accurate perioperative flow measurement of the portal vein and hepatic and renal artery: A role for preoperative MRI?

    Vermeulen, Mechteld A.R., E-mail: [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Ligthart-Melis, Gerdien C., E-mail: [Department of Internal Medicine, Dietetics and Nutritional Sciences, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Buijsman, René, E-mail: [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Siroen, Michiel P.C., E-mail: [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Poll, Marcel C.G. van de, E-mail: [Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht (Netherlands); Boelens, Petra G., E-mail: [Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht (Netherlands); Dejong, Cornelis H.C., E-mail: [Department of Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht (Netherlands); Schaik, Cors van, E-mail: [Department of Radiology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Hofman, Mark B.M., E-mail: [Department of Physics and Medical Technology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands); Leeuwen, Paul A.M. van, E-mail: [Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam (Netherlands)


    Background: Quantification of abdominal blood flow is essential for a variety of gastrointestinal and hepatic topics such as liver transplantation or metabolic flux measurement, but those need to be performed during surgery. It is not clear whether Duplex Doppler Ultrasound during surgery or MRI before surgery is the tool to choose. Objective: To examine whether preoperative evaluation of abdominal blood flow using MRI could prove to be a useful and reliable alternative for the perioperative sonographic approach. Methods: In this study portal and renal venous flow and hepatic arterial flow were sequentially quantified by preoperative MRI, preoperative and perioperative Duplex Doppler Ultrasound (DDUS). 55 Patients scheduled for major abdominal surgery were studied and methods and settings were compared. Additionally, average patient population values were compared. Results: Mean (±SD) plasmaflow measured by perioperative DDUS, preoperative DDUS and MRI, respectively was 433 ± 200/423 ± 162/507 ± 96 ml/min (portal vein); 96 ± 70/74 ± 41/108 ± 91 ml/min (hepatic artery); 248 ± 139/201 ± 118/219 ± 69 ml/min (renal vein). No differences between the different settings of DDUS measurement were detected. Equality of mean was observed for all measurements. Bland Altman Plots showed widespread margins. Hepatic arterial flow measurements correlated with each other, but portal and renal venous flow correlations were absent. Conclusions: Surgery and method (DDUS vs. MRI) do not affect mean flow values. Individual comparison is restricted due to wide range in measurements. Since MRI proves to be more reliable with respect to inter-observer variability, we recommend using mean MRI results in experimental setups.

  5. The Amsterdam preoperative anxiety and information scale provides a simple and reliable measure of preoperative anxiety.

    Boker, Abdulaziz; Brownell, Laurence; Donen, Neil


    To compare three anxiety scales; the anxiety visual analogue scale (VAS), the anxiety component of the Amsterdam preoperative anxiety and information scale (APAIS), and the state portion of the Spielburger state-trait anxiety inventory (STAI), for assessment of preoperative anxiety levels in same day admission patients. Patients completed the three anxiety assessment scales both before and after seeing the anesthesiologist preoperatively. The scales used were the STAI, the six-question APAIS, and the VAS. APAIS was further subdivided to assess anxiety about anesthesia (sum A), anxiety about surgery (sum S) and a combined anxiety total (i.e., sum C = sum A + sum S). These scales were compared to one another. Pearson's correlation (pair-wise deletion) was used for validity testing. Cronbach's alpha analysis was used to test internal validity of the various components of the APAIS scale. A correlation co-efficient (r) > or = 0.6 and P scale sets were completed by 197 patients. There was significant and positive correlation between VAS and STAI r = 0.64, P anxiety components of the APAIS (sum C) and desire for information were 0.84 and 0.77 respectively. In addition to VAS, the anxiety component of APAIS (sum C) is a promising new practical tool to assess preoperative patient anxiety levels.

  6. Resection of a giant renal angiomyolipoma in a solitary kidney with preoperative arterial embolization

    SHEN Wen-hao; PAN Jin-hong; YAN Ju-nan; CHEN Zhi-wen; ZHOU Zhan-song; LU Gen-sheng; LI Wei-bing


    Renal angiomyolipoma is a type of benign tumor that occurs sporadically in addition to being associated with tuberous sclerosis. Preoperative embolization of large tumors is important to avoid excessive blood loss during surgery. We reported a patient with a 5505-g giant renal angiomyolipoma in a solitary kidney. The patient was treated with preoperative embolization and radical nephrectomy without complications. This type of treatment for an enormous angiomyolipoma can reduce the risk of uncontrolled hemorrhage caused by rupture of the tumor during the operation and should be considered for the treatment of similar tumors.

  7. Reliability and validity of Korean version of modified: Yale preoperative anxiety scale

    Jung, Kyuwhan; Im, Mi-Hyang; Hwang, Jeong-Min; Oh, Ah-Young; Park, Moon Seok; Jeong, Woo-Jin; Kim, Seong-Chan; Jung, Sun-Woo; Sohn, Hyejin; Yoon, Mi-Ok; Jang, Mi-Suk; Moon, Suk-Bae


    Purpose The modified Yale Preoperative Anxiety Scale (mYPAS) was developed for evaluating the level of preoperative anxiety in children. The purpose of this study was to develop a Korean version of the mYPAS (K-mYPAS) and to establish its validity and reliability based on the Korean preoperative pediatric patients. Methods K-mYPAS was made through stringent back-translation procedure. Total enrolled 102 patients answered questionnaires of Korean version of State-Trait Anxiety Inventory for Ch...

  8. Validity and Reliability of the Czech Version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS).

    Zeleníková, Renáta; Homzová, Pavlína; Homza, Miroslav; Bužgová, Radka


    The purpose of this study was to validate the Czech version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in adult patients undergoing elective surgery. A cross-sectional study. Data were collected from July 2012 to January 2013. For reliability and validity testing, two instruments measuring preoperative anxiety were administered to the participants on the same occasion, (APAIS and the Spielberg State Anxiety Inventory (STAI-S)). The sample consisted of 344 patients undergoing elective surgery. Reliability of APAIS anxiety subscale measured by Cronbach's alpha was 0.91. Reliability of APAIS information subscale measured by Cronbach's alpha was 0.78. The APAIS anxiety subscale correlated significantly with the STAI-S (0.69). Women scored significantly higher on anxiety scales than men. APAIS may be a useful tool to measure preoperative anxiety in Czech patients undergoing elective surgery. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  9. Reliability and validity of the Spanish version of the modified Yale Preoperative Anxiety Scale.

    Jerez, C; Ullán, A M; Lázaro, J J


    To minimise preoperative stress and increase child cooperation during induction of anaesthesia is one of the most important perioperative objectives. The modified Yale Preoperative Anxiety Scale was developed to evaluate anxiety. The aim of this study was to translate into Spanish, and validate the psychometric properties of the Spanish version of this scale. The Spanish translation of the scale was performed following the World Health Organisation guidelines. During induction of anaesthesia, 81 children aged 2 to 12 years were recorded. Two observers evaluated the recordings independently. Content validity index of modified Yale Preoperative Anxiety Scale Spanish version was assessed. Weighted Kappa was calculated to measure interobserver agreement, and the Pearson correlation between the Induction Compliance Checklist and the modified Yale Preoperative Anxiety Scale was determined. The Spanish version obtained high content validity (0.91 to 0.98). Reliability analysis using weighted Kappa statistics revealed that interobserver agreement ranged from 0.54 to 0.75. Concurrent validity was high (r=0.94; P<.001). Validated assessment tools are needed to evaluate interventions to reduce child preoperative anxiety. The Spanish version of the modified Yale Preoperative Anxiety Scale evaluated in this study has shown good psychometric properties of reliability and validity. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Impact of preoperative chronic renal failure on liver transplantation: a population-based cohort study

    Chung PC


    Full Text Available Peter Chi-Ho Chung,1,2 Hsiu-Pin Chen,1,2 Jr-Rung Lin,3,4 Fu-Chao Liu,1,2 Huang-Ping Yu1,2 1Department of Anesthesiology, Chang Gung Memorial Hospital, 2College of Medicine, 3Clinical Informatics and Medical Statistics Research Center, 4Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan Purpose: The purpose of this study was to assess whether preoperative chronic renal failure (CRF affects the rates of postoperative complications and survival after liver transplantation. Methods: This population-based retrospective cohort study included 2,931 recipients of liver transplantation performed between 1998 and 2012, enrolled from the Taiwan National Health Insurance Research Database. Patients were divided into two groups, based on the presence or absence of preoperative CRF. Results: The overall estimated survival rate of liver transplantation recipients (LTRs with preoperative CRF was significantly lower than that of patients without preoperative CRF (P=0.0085. There was no significant difference between the groups in terms of duration of intensive care unit stay, total hospital stay, bacteremia, postoperative bleeding, and pneumonia during hospitalization. Long-term adverse effects, including cerebrovascular disease and coronary heart disease, were not different between patients with versus without CRF. Conclusion: These findings suggest that LTRs with preoperative CRF have a higher rate of mortality. Keywords: chronic renal failure, cohort study, survival rate, liver transplantation, population-based study

  11. Preoperative Leucocytosis, Thrombocytosis and Anemia as Potential Prognostic Factors in Non-metastatic Renal Cell Carcinoma.

    Hutterer, Georg C; Krieger, Daniel; Mrsic, Edvin; Pohlmann, Kristof; Bezan, Angelika; Stojakovic, Tatjana; Pummer, Karl; Zigeuner, Richard; Pichler, Martin


    To validate the potential prognostic significance of preoperatively assessed inflammatory parameters leucocytosis, thrombocytosis and anemia in patients with non-metastatic renal cell carcinoma (RCC). We retrospectively evaluated a cohort comprising 736 consecutive patients with non-metastatic RCC, operated on between 2004 and 2012 with curative radical or partial nephrectomy at a single tertiary academic centre. Laboratory parameters were assessed within one week before surgical intervention. Patients were categorized using laboratory parameter cut-off values according to receiver operating characteristics (ROC) analyses. Cancer-specific survival (CSS) was assessed using the Kaplan-Meier method. To evaluate the potential prognostic significance of the preoperative laboratory parameters, multivariate Cox regression models were applied. Multivariable analysis identified preoperative thrombocytosis (≥285,000/μl) as an independent prognostic factor for CSS (Hazard ratio=2.28, 95% confidence interval=1.24-4.20, p=0.008). Regarding CSS, an elevated preoperative platelet count represented an independent prognostic factor of poor survival. Our findings strengthen the potential prognostic significance of preoperative thrombocytosis in patients with non-metastatic RCC. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  12. Pre-operative renal arterial embolisation does not provide survival benefit in patients with radical nephrectomy for renal cell carcinoma.

    May, M; Brookman-Amissah, S; Pflanz, S; Roigas, J; Hoschke, B; Kendel, F


    Currently, there is no widespread use of percutaneous renal artery embolisation (PRAE) as a pre-operative treatment in the management of renal cell carcinoma (RCC). There is also a scarcity of studies concerning the potential benefits of this procedure. All patients with RCC who underwent pre-operative PRAE before nephrectomy (n = 227) and all patients solely undergoing surgery (n = 607) at our institution from 1992 to 2006 were included. Information on techniques used, perioperative transfusion requirements, pathological and clinical variables, acute toxicity and complications were obtained from a retrospective review of medical records. Propensity modelling techniques were used to compare cancer-specific survival (CSS) and overall survival (OS) in both groups. Propensity scores were calculated from a logistic matching model including age, gender, clinical tumour size, grading, pN stage, cM stage, pT stage, histology and microvascular invasion. This resulted in 189 matches. The mean follow-up of the entire group of matched patients was 81 months. The 5-year actuarial CSS and OS for the total group of matched patients was 80.8% and 73.9%, respectively. CSS and OS did not show any significant differences between the matched treatment groups. There were no statistical differences in surgical complications between all patients treated with pre-operative PRAE (n = 227) and all patients without PRAE (n = 607), except for blood transfusion (61% vs 24%; ppost-embolization syndrome, including lumbar pain, fever, nausea, hypertension and macroscopic haematuria, were reported by 202 patients (89%), in most cases being mild and self-limited. There is no conclusive evidence that pre-operative PRAE provides survival benefits in the management of surgically resected RCC.

  13. Evaluation of pre-operative staging of renal cell cancer with cine MR imaging

    Uematsu, Hidemasa; Inoue, Hiroshi; Hayashi, Koji; Kitagawa, Akane; Yamamori, Sanae; Ishitoya, Satoshi; Ogura, Keiji [Rakuwakai Otowa Hospital, Kyoto (Japan); Yamada, Hiroki; Ishii, Yasushi


    To assess the utility of single section cine MR images in evaluation of extrarenal invasion of renal cell cancer. Six patients who subsequently underwent definitive surgery were examined. Sequential twenty FLASH images were acquired in coronal and parasagittal single section during one respiratory cycle. These images were evaluated in cine-loop mode to assess tumoral movement with adjacent structures. Cine MR images showed that the tumor in one patient were fixed to the spleen and the tumors in five patients showed free movement. At pathologic examination, cine MR findings were proved correct in all patients. Cine MR images may be useful for pre-operative evaluation of extrarenal invasion. (author).

  14. Preoperative Proteinuria Predicts Adverse Renal Outcomes after Coronary Artery Bypass Grafting

    Huang, Tao-Min; Wu, Vin-Cent; Young, Guang-Huar; Lin, Yu-Feng; Shiao, Chih-Chung; Wu, Pei-Chen; Li, Wen-Yi; Yu, Hsi-Yu; Hu, Fu-Chang; Lin, Jou-Wei; Chen, Yih-Sharng; Lin, Yen-Hung; Wang, Shoei-Shen; Hsu, Ron-Bin; Chang, Fan-Chi; Chou, Nai-Kuan; Chu, Tzong-Shinn; Yeh, Yu-Chang; Tsai, Pi-Ru; Huang, Jenq-Wen; Lin, Shuei-Liong; Chen, Yung-Ming


    Whether preoperative proteinuria associates with adverse renal outcomes after cardiac surgery is unknown. Here, we performed a secondary analysis of a prospectively enrolled cohort of adult patients undergoing coronary artery bypass grafting (CABG) at a medical center and its two affiliate hospitals between 2003 and 2007. We excluded patients with stage 5 CKD or those who received dialysis previously. We defined proteinuria, measured with a dipstick, as mild (trace to 1+) or heavy (2+ to 4+). Among a total of 1052 patients, cardiac surgery–associated acute kidney injury (CSA-AKI) developed in 183 (17.4%) patients and required renal replacement therapy (RRT) in 50 (4.8%) patients. In a multiple logistic regression model, mild and heavy proteinuria each associated with an increased odds of CSA-AKI, independent of CKD stage and the presence of diabetes mellitus (mild: OR 1.66, 95% CI 1.09 to 2.52; heavy: OR 2.30, 95% CI 1.35 to 3.90). Heavy proteinuria also associated with increased odds of postoperative RRT (OR 7.29, 95% CI 3.00 to 17.73). In summary, these data suggest that preoperative proteinuria is a predictor of CSA-AKI among patients undergoing CABG. PMID:21115618

  15. Preoperative Erythrocyte Sedimentation Rate Independently Predicts Overall Survival in Localized Renal Cell Carcinoma following Radical Nephrectomy

    Brian W. Cross


    Full Text Available Objectives. To determine the relationship between preoperative erythrocyte sedimentation rate (ESR and overall survival in localized renal cell carcinoma (RCC following nephrectomy. Methods. 167 patients undergoing nephrectomy for localized RCC had ESR levels measured preoperatively. Receiver Operating Characteristics curves were used to determine Area Under the Curve and relative sensitivity and specificity of preoperative ESR in predicting overall survival. Cut-offs for low (0.0–20.0 mm/hr, intermediate (20.1–50.0 mm/hr, and high risk (>50.0 mm/hr groups were created. Kaplan-Meier analysis was conducted to assess the univariate impact of these ESR-based groups on overall survival. Univariate and multivariate Cox regression analysis was conducted to assess the potential of these groups to predict overall survival, adjusting for other patient and tumor characteristics. Results. Overall, 55.2% were low risk, while 27.0% and 17.8% were intermediate and high risk, respectively. Median (95% CI survival was 44.1 (42.6–45.5 months, 35.5 (32.3–38.8 months, and 32.1 (25.5–38.6 months, respectively. After controlling for other patient and tumor characteristics, intermediate and high risk groups experienced a 4.5-fold (HR: 4.509, 95% CI: 0.735–27.649 and 18.5-fold (HR: 18.531, 95% CI: 2.117–162.228 increased risk of overall mortality, respectively. Conclusion. Preoperative ESR values represent a robust predictor of overall survival following nephrectomy in localized RCC.

  16. Pre-operative renal artery embolization and suprarenal IVC filter placement for prevention of fat embolization in renal angiomyolipoma with venous extension.

    Cornman-Homonoff, Joshua; Li, David; Schiffman, Marc


    Though generally considered benign, angiomyolipomas can invade through the renal vein into the inferior vena cava, putting patients at risk of catastrophic pulmonary fat embolization. Venous invasion is thus an indication for surgical resection but is thought to increase the risk of adverse operative outcomes including intraoperative hemorrhage and embolization of fat and/or tumor thrombus. We report a novel approach to mitigating these complications illustrated in the case of a 43-year-old woman with IVC-invasive renal AML who underwent successful radical nephrectomy after concurrent pre-operative renal artery embolization and placement of a retrievable suprarenal IVC filter.

  17. Reliability of a CT reconstruction for preoperative surgical planning in the arthroscopic Latarjet procedure.

    Hardy, Alexandre; Loriaut, Philippe; Granger, Benjamin; Neffati, Ahmed; Massein, Audrey; Casabianca, Laurent; Pascal-Moussellard, Hugues; Gerometta, Antoine


    The arthroscopic Latarjet procedure has provided reliable results in the treatment of anterior shoulder instability. However, this procedure remains technically challenging and is related to several complications. The morphology of the coracoid and the glenoid are inconsistent. Inadequate coracoid and glenoid preparing may lead to mismatching between their surfaces. Inadequate screws lengthening and orientation are a major concern. Too long screws can lead to suprascapular nerve injuries or hardware irritation, whereas too short screws can lead to nonunions, fibrous unions or migration of the bone block. The purpose of the study was to investigate the application of virtual surgical planning and digital technology in preoperative assessment and planning of the Latarjet procedure. Twelve patients planned for an arthroscopic Latarjet had a CT scan evaluation with multi-two-dimensional reconstruction performed before surgery. Interobserver and intraobserver reliability were evaluated. The shape of the anterior rim of the glenoid and the undersurface of the coracoid were classified. Coracoid height was measured, respectively, at 5 mm (C1) and 10 mm (C2) from the tip of the coracoid process, corresponding to the drilling zone. Measurements of the glenoid width were then taken in the axial view at 25 % (G1) and 50 % (G2) of the glenoid height with various α angles (5°, 10°, 15°, 20°, 25°, 30°) 7 mm from the anterior glenoid rim. Shapes of the undersurface of the coracoid and the anterior rim of the glenoid were noted during the surgical procedure. Post-operative measurements included the α angle. Concerning coracoid height measurements, there was an almost perfect to substantial intra- and inter-reliability, with values ranging from ICC = 0.75-0.97. For the shape of the coracoid, concordances were, respectively, perfect (ICC = 1) and almost perfect (0.87 [0.33; 1]) for the intra- and interobserver reliabilities. Concerning the glenoid, concordance was

  18. Correlation of Preoperative Renal Insufficiency With Mortality and Morbidity After Aortic Valve Replacement: A Propensity Score Matching Analysis

    Lin, Chun-Yu; Tsai, Feng-Chun; Chen, Yung-Chang; Lee, Hsiu-An; Chen, Shao-Wei; Liu, Kuo-Sheng; Lin, Pyng-Jing


    Abstract Preoperative end-stage renal disease carries a high mortality and morbidity risk after aortic valve replacement (AVR), but the effect of renal insufficiency remains to be clarified. Through propensity score analysis, we compared the preoperative demographics, perioperative profiles, and outcomes between patients with and without renal insufficiency. From August 2005 to November 2014, 770 adult patients underwent AVR in a single institution. Patients were classified according to their estimated glomerular infiltration rate (eGFR) as renal insufficiency (eGFR: 30–89 mL/min/1.73 m2) or normal (eGFR, ≥90 mL/min/1.73 m2). Propensity scoring was performed with a 1:1 ratio, resulting in a matched cohort of 88 patients per group. Demographics, comorbidities, and surgical procedures were well balanced between the 2 groups, except for diabetes mellitus and eGFR. Patients with renal insufficiency had higher in-hospital mortality (19.3% versus 3.4%, P 72 hour; 25% versus 9.1%, P = .008), intensive care unit stays (8.9 ± 9.9 versus 4.9 ± 7.5 days, P = .046), and hospital stays (35.3 ± 31.7 versus 24.1 ± 20.3 days, P = .008), compared with those with normal renal function. Multivariate analysis confirmed that preoperative renal insufficiency was an in-hospital mortality predictor (odds ratio, 2.33; 95% confidence interval, 1.343–4.043; P = .003), as were prolonged cardiopulmonary bypass time, intraaortic balloon pump support, and postoperative hemodialysis. The 1-year survival significantly differed between the 2 groups including (normal 87.5% versus renal insufficiency 67.9%, P < .001) or excluding in-hospital mortality (normal 90.7% versus renal insufficiency 82.1%, P = .05). Patients with preoperative renal insufficiency who underwent AVR had higher in-hospital mortality rates and increased morbidities, especially those associated with hemodynamic instabilities requiring intraaortic balloon pump support or

  19. Face validity and inter-rater reliability of the Danish version of the modified-Yale Preoperative Anxiety Scale

    Skovby, Pernille; Rask, Charlotte Ulrikka; Dall, Rolf


    Introduction Preoperative anxiety is common in young children and associated with adverse outcomes after sur-gery. The modified Yale Preoperative Anxiety Scale (m-YPAS) has been developed to assess pre-operative anxiety in children. The purpose of this study was to translate and adapt the m......-YPAS to Danish cultural and linguistic conditions and to test face validity and inter-reliability in a clinical setting. Materials and methods The translation was performed in accordance with WHO guidelines. Face validity as well as linguistic difficulties of the Danish version was tested and solved in a focus...... material for the validation process. However, development of systematic training of future raters is necessary and further validation of the Danish version of m-YPAS is called for....

  20. Optimising renal cancer patients for nephron-sparing surgery: a review of pre-operative considerations and peri-operative techniques for partial nephrectomy.

    Ertemi, Hani; Khetrapal, Pramit; Pavithran, Nevil M; Mumtaz, Faiz


    Nonmodifiable factors including pre-operative renal function and amount of healthy renal tissue preserved are the most important predictive factors that determine renal function after partial nephrectomy. Ischaemia time is an important modifiable risk factor and cold ischaemia time should be used if longer ischaemia time is anticipated. New techniques may have a role in maximising postoperative kidney function, but more robust studies are required to understand their potential benefits and risks.

  1. Preoperative single-bolus high-dose antithymocyte globulin as induction therapy in sensitized renal transplant recipients

    WANG Dong; WU Wei-zhen; YANG Shun-liang; CHEN Jin-hua; TAN Jian-ming


    Background Immunological sensitization remains a major problem following renal transplantation. There is no consensus for the management of sensitized renal allograft recipients. The patients become tethered to dialysis while waiting for compatible donors. This study was designed to evaluate the efficacy and safety of preoperative single- bolus high-dose antithymocyte globulin (ATG) as induction therapy in sensitized renal transplant recipients.Methods A total of 56 patients were divided into two groups according to the level of panel reactive antibody(PRA): non-sensitized group (PRA<10%, n=30) and sensitized group (PRA≥ 10%, n=26). The characteristics of the recipients and donors were comparable between the two groups. Mycophenolate mofetil (MMF, 1 g) or ATG(iv. 9 mg/kg) were given preoperatively in the two groups as induction therapy. After the transplantation, the patients were treated with standard triple therapy regimen consisting of tacrolimus (FK-506) or cyclosporine A,MMF, and prednisolone. Acute rejection (AR) and infection episodes were recorded and renal function was monitored during a 12-month follow-up. X2 test and t test were used to analyze the data.Results During the follow-up, 6 patients (20.0%) suffered AR episodes in the non-sensitized group and 4(15.4%) in the sensitized group (P=0.737); 8 patients (26.7%) experienced 11 infection episodes (average, 1.4episodes per infected patient) in the non-sensitized group, and 6 (23.1%) experienced 10 infection episodes (average, 1.7 episodes per infected patient) in the sensitized group (P=0.757, 0.890). The safety of the drugs,which was assessed by the occurrence of side effects, was comparable between the two groups. The hospital stay was 13-25 days (mean, 16.7±3.3) in the nonsensitized group and 14-29 days (mean, 16.2±3.1) in the sensitized group, respectively (P=0.563). No delayed graft function (DGF) was observed in all the patients. Both the 12-month actuarial patient and graft survival rates

  2. Mild preoperative renal dysfunction as a predictor of long-term clinical outcome after coronary bypass surgery.

    van de Wal, Ruud M A; van Brussel, Ben L; Voors, Adriaan A; Smilde, Tom D J; Kelder, Johannes C; van Swieten, Henry A; van Gilst, Wiek H; van Veldhuisen, Dirk Jan; Plokker, H W Thijs


    Renal dysfunction is a prognostic marker in patients with cardiovascular disease. However, no long-term follow-up studies on the influence of mild renal dysfunction on mortality in patients undergoing coronary bypass grafting have been reported. Therefore, we aimed to identify the significance of preoperative (mild) renal dysfunction as a long-term predictor of clinical outcome after coronary bypass surgery. In 358 patients who underwent isolated saphenous vein aorta-coronary artery bypass grafting, estimated glomerular filtration rates were calculated with the Cockroft-Gault equation (GFRc). Patients were categorized into 2 groups (group 1, GFRc >71.1 mL x min (-1) x 1.73 m (-2) ; group 2, GFRc <71.1 mL x min (-1) x 1.73 m (-2) ). Multivariate Cox proportional hazard analyses were performed to determine the independent prognostic value of GFRc. During a median follow-up of 18.2 years, 233 patients (65.1%) died. Patients who died had lower GFRc and were older. Multivariate analysis demonstrated that total mortality in patients with lower GFRc was significantly increased (lower GFRc group vs normal GFRc group: hazard ratio, 1.44; P = .019). Lower GFRc was also an independent predictor of cardiac mortality (hazard ratio, 1.51; P = .032). No significant differences were observed between groups in the occurrence of myocardial infarction and the need for reintervention. Our study demonstrates that after long-term follow-up, preoperative mild renal dysfunction is an independent predictor of long-term (cardiac) mortality in patients who undergo coronary artery bypass grafting.

  3. Single minimum incision endoscopic radical nephrectomy for renal tumors with preoperative virtual navigation using 3D-CT volume-rendering

    Shioyama Yasukazu


    Full Text Available Abstract Background Single minimum incision endoscopic surgery (MIES involves the use of a flexible high-definition laparoscope to facilitate open surgery. We reviewed our method of radical nephrectomy for renal tumors, which is single MIES combined with preoperative virtual surgery employing three-dimensional CT images reconstructed by the volume rendering method (3D-CT images in order to safely and appropriately approach the renal hilar vessels. We also assessed the usefulness of 3D-CT images. Methods Radical nephrectomy was done by single MIES via the translumbar approach in 80 consecutive patients. We performed the initial 20 MIES nephrectomies without preoperative 3D-CT images and the subsequent 60 MIES nephrectomies with preoperative 3D-CT images for evaluation of the renal hilar vessels and the relation of each tumor to the surrounding structures. On the basis of the 3D information, preoperative virtual surgery was performed with a computer. Results Single MIES nephrectomy was successful in all patients. In the 60 patients who underwent 3D-CT, the number of renal arteries and veins corresponded exactly with the preoperative 3D-CT data (100% sensitivity and 100% specificity. These 60 nephrectomies were completed with a shorter operating time and smaller blood loss than the initial 20 nephrectomies. Conclusions Single MIES radical nephrectomy combined with 3D-CT and virtual surgery achieved a shorter operating time and less blood loss, possibly due to safer and easier handling of the renal hilar vessels.

  4. Sentinel node detection after preoperative short-course radiotherapy in rectal carcinoma is not reliable

    Braat, AE; Moll, FCP; de Vries, JE; Wiggers, T


    Background: Seninel node (SN) detection may be used in patients with colonic carcinoma. However, its use in patients with rectal carcinoma may be unreliable. To address this, SN detection was evaluated in patients with rectal carcinoma after short-course preoperative radiotherapy. Methods: Patent Bl

  5. End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline.

    Capitanio, Umberto; Larcher, Alessandro; Terrone, Carlo; Antonelli, Alessandro; Volpe, Alessandro; Fiori, Cristian; Furlan, Maria; Dehò, Federico; Minervini, Andrea; Serni, Sergio; Porpiglia, Francesco; Trevisani, Francesco; Salonia, Andrea; Carini, Marco; Simeone, Claudio; Montorsi, Francesco; Bertini, Roberto


    Although nephron-sparing surgery (NSS) has demonstrated benefit in terms of renal function preservation, it is unclear whether NSS might also decrease the risk of end-stage renal disease (ESRD) relative to radical nephrectomy (RN). In the current paper, we aimed to report the rate and the predictors of ESRD after surgery, accounting for detailed individual baseline characteristics and comorbidities. A multi-institutional collaboration among five European tertiary care centers allowed study of 2027 patients with normal preoperative renal function and a clinically localized T1abN0M0 renal mass. Cox regression analyses were used to predict the risk of ESRD (defined as the onset of a postoperative estimated glomerular filtration rate <15ml/min per 1.73 m(2)) after adjusting for the individual baseline risk of developing chronic kidney disease. Univariable ESRD rates at 5 and 10 yr of follow-up were virtually equivalent for patients who underwent NSS (1.5% and 2.5%, respectively) versus RN (1.9% and 2.7%, respectively; hazard ratio [HR]: 0.8; 95% confidence interval [CI], 0.4-1.6). However, diabetes, smoking, uncontrolled hypertension, and other comorbidities were consistently more frequent in the NSS group relative to their RN counterparts. After adjusting for detailed baseline individual characteristics, NSS was shown to have an independent protective effect relative to RN (HR: 0.4; 95% CI, 0.2-0.8; p=0.02) at multivariable analyses.

  6. Mild preoperative renal dysfunction as a predictor of longterm clinical outcome after coronary bypass surgery

    van de Wal, RMA; van Brussel, BL; Voors, AA; Smilde, TDJ; van Swieten, HA; van Gilst, WH; van Veldhuisen, DJ; Plokker, HWT


    Renal dysfunction is a prognostic marker in patients with cardiovascular disease. However, no long-term follow-up studies on the influence of mild renal dysfunction on mortality in patients undergoing coronary bypass grafting have been reported. Therefore, we aimed to identify the significance of pr

  7. Preoperative Plasma Fibrinogen Level as a Significant Prognostic Factor in Patients With Localized Renal Cell Carcinoma After Surgical Treatment.

    Lee, Hakmin; Lee, Sang Eun; Byun, Seok-Soo; Kim, Hyeon Hoe; Kwak, Cheol; Hong, Sung Kyu


    We sought to investigate the association of preoperative fibrinogen levels with clinicopathologic outcomes after surgical treatment of nonmetastatic renal cell carcinoma. We reviewed the records of 1511 patients who had their fibrinogen levels measured preceding surgery. The associations between preoperative fibrinogen level and risk of adverse clinicopathologic outcomes were tested using the multivariate logistic regression and multiple Cox-proportional hazards model, respectively. Based on plasma fibrinogen levels, we stratified the patients into 2 groups with a cut-off value of 328  mg/dL. Kaplan-Meier analysis showed significantly inferior survival outcomes in progression-free (P fibrinogen level (≥328  mg/dL) was significantly related to a higher Fuhrman grade (hazard ratio [HR] 1.374, P = 0.006) and a larger tumor size (≥7  cm) (HR 2.364, P fibrinogen level is a significant predictor for poor disease progression (HR 1.857, P fibrinogen levels were significantly associated with poor pathological features and worse survival outcomes in patients with nonmetastatic renal cell carcinoma after surgical treatment. Further evaluations such as prospective randomized trials are needed to understand the underlying mechanism for these associations.

  8. Noncontrast-Enhanced Magnetic Resonance Versus Computed Tomography Angiography in Preoperative Evaluation of Potential Living Renal Donors.

    Blankholm, Anne Dorte; Pedersen, Bodil G; Østrat, Ernst Ø; Andersen, Gratien; Stausbøl-Grøn, Brian; Laustsen, Susse; Ringgaard, Steffen


    Living renal donors undergo an extensive examination program. These examinations should be as safe, gentle, and patient friendly as possible. To compare computed tomography angiography (CTA) and an extensive magnetic resonance imaging (MRI) protocol without contrast agents to observations from nephrectomy in living renal donors and to evaluate whether noncontrast-enhanced MRI can replace CTA for vessel assessment in living renal donors. CTA and MRI results were compared to observations from nephrectomy, which served as the reference standard. Fifty-one potential kidney donors underwent imaging, and 31 donated a kidney. Comparisons in sensitivity, specificity, and accuracy were made with respect to the number of arteries, early branching, and the number of veins. Agreement was assessed using Cohen's kappa. The exact McNemar's test was used to test for statistically significant differences. In the assessment of more than one renal artery, the sensitivity and specificity of MRI and CTA were high and in perfect agreement compared to observations from surgery. The results for both MRI and CTA were as follows: (sensitivity 100%/specificity100%/accuracy 100%/Kappa = 1/P = 1). When comparing the ability to test for early branching we found, MRI: (sensitivity 33%/specificity 100%/accuracy 87%/Kappa = 0.45/P = 1) and CTA: (sensitivity 50%/specificity 100%/accuracy 90%/Kappa = 0.62/P = 1). When used to depict supernumerary veins, we found MRI: (sensitivity60%/specifivity100%/accuracy 93%/Kappa = 0.72/P = 1), whereas CTA showed: (sensitivity 40%/specificity 96%/accuracy 87% Kappa = 0.43/P = 1). In conclusion, an optimized MRI protocol that includes noncontrast-enhanced magnetic resonance angiography can be substituted for CTA for preoperative assessment of the renal vessels before living donor nephrectomy. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

  9. Preoperative fasting protects against renal ischemia-reperfusion injury in aged and overweight mice

    Jongbloed, Franny; De Bruin, Ron W F; Pennings, Jeroen L A; Payán-Gómez, César; Van Den Engel, Sandra; Van Oostrom, Conny T.; De Bruin, Alain; Hoeijmakers, Jan H J; Van Steeg, Harry; IJzermans, Jan N M; Dollé, Martijn E T


    Ischemia-reperfusion injury (IRI) is inevitable during kidney transplantation leading to oxidative stress and inflammation. We previously reported that preoperative fasting in young-lean male mice protects against IRI. Since patients are generally of older age with morbidities possibly leading to a

  10. Preoperative fasting protects against renal ischemia-reperfusion injury in aged and overweight mice

    F. Jongbloed (Franny); R.W.F. de Bruin (Ron); J.L.A. Pennings (Jeroen); C. Payan-Gomez; S. van den Engel (Sandra); C.T.M. van Oostrom (Conny); A. de Bruin (Alain); J.H.J. Hoeijmakers (Jan); H. van Steeg (Harry); J.N.M. IJzermans (Jan); M.E.T. Dollé (Martijn)


    textabstractIschemia-reperfusion injury (IRI) is inevitable during kidney transplantation leading to oxidative stress and inflammation. We previously reported that preoperative fasting in young-lean male mice protects against IRI. Since patients are generally of older age with morbidities possibly

  11. Preoperative fasting protects against renal ischemia-reperfusion injury in aged and overweight mice

    Jongbloed, Franny; De Bruin, Ron W F; Pennings, Jeroen L A; Payán-Gómez, César; Van Den Engel, Sandra; Van Oostrom, Conny T.; De Bruin, Alain; Hoeijmakers, Jan H J; Van Steeg, Harry; IJzermans, Jan N M; Dollé, Martijn E T


    Ischemia-reperfusion injury (IRI) is inevitable during kidney transplantation leading to oxidative stress and inflammation. We previously reported that preoperative fasting in young-lean male mice protects against IRI. Since patients are generally of older age with morbidities possibly leading to a

  12. Preoperative fasting protects against renal ischemia-reperfusion injury in aged and overweight mice

    F. Jongbloed (Franny); R.W.F. de Bruin (Ron); J.L.A. Pennings (Jeroen); C. Payan-Gomez; S. van den Engel (Sandra); C.T.M. van Oostrom (Conny); A. de Bruin (Alain); J.H.J. Hoeijmakers (Jan); H. van Steeg (Harry); J.N.M. IJzermans (Jan); M.E.T. Dollé (Martijn)


    textabstractIschemia-reperfusion injury (IRI) is inevitable during kidney transplantation leading to oxidative stress and inflammation. We previously reported that preoperative fasting in young-lean male mice protects against IRI. Since patients are generally of older age with morbidities possibly l

  13. Can contrast-enhanced renal MR angiography replace conventional angiography in preoperative evaluation of living renal donors?

    Abdelhady Taha Emam


    Full Text Available The aim of the study was to detect if gadolinium-enhanced renal magnetic reso-nance angiography (MRA can replace conventional angiography in imaging vascular anatomy in potential living renal donors and compare with surgical findings. MR imaging (MRI and breath-hold three-dimensional gadolinium-enhanced MRA of kidneys were done for 60 conse-cutive patients for whom successful nephrectomy was done. MRA findings were compared with the findings of nephrectomy. MRI and MRA identified 28 out of 60 patients with normal arterial and venous anatomy, and concordance was found at surgery in 27 of these patients. Vascular anomalies were depicted on MRI in 32 patients, with concordance at surgery in 27 patients. Re-garding arterial anomalies, the MRA had a sensitivity of 89.3%, a specificity of 94.0% and an accuracy of 90.8%. For venous anomalies, the sensitivity was 98.5%, specificity was 100% and accuracy was 98.6%. In conclusion, gadolinium-enhanced MRA of the kidneys can replace con-ventional angiography as a safe and accurate modality for the assessment of potential living renal donors.

  14. Preoperative and palliative embolization of renal cell carcinomas. Follow-up of 49 patients; Praeoperative und palliative Embolisation des Nierenzellkarzinoms. Nachsorge von 49 Patienten

    Hallscheidt, P.; Besharati, S.; Noeldge, G.; Lopez, R.; Kauffmann, G.W. [Universitaetsklinikum Heidelberg (Germany). Abteilung Radiodiagnostik; Haferkamp, A. [Universitaetsklinikum Heidelberg (Germany). Urologische Klinik und Poliklinik


    Purpose: To evaluate the influence of preoperative and palliative embolization of renal cell carcinomas on survival, intra- and post-operative procedures, and symptom control for palliative and preoperative indications. Materials and Methods: 56 patients who underwent renal cell carcinoma embolization from 1981 to 1999 were included in this retrospective study. Results: 24 women and 32 men were included (mean age 59.4 years). Complete follow-up data was available for 49 patients. 42 patients underwent preoperative embolization at different tumor stages (pT1: 1 patient, pT2: 6, pT3 a: 4, pT3 b: 19, pT3 c: 2, pT4: 5). 14 patients underwent palliative embolization (T1: 0 patients, T2: 5, T3: 4, T4: 4). Indications for preoperative embolization were bleeding of the renal tumor in 6 cases - non-recurrent bleeding reported, flank pain in 4 patients - 3 of 4 patients had no further symptoms, recurrent tumor embolization in 1 patient, and 2 patients who wanted to be treated without symptoms. The mean survival time of preoperative embolized patients was 3.1{+-}5.11 years with a 5-year survival rate of 50%. The mean survival time of palliative embolized patients was 0.67{+-}0.76 years with initial metastases (n=7) and 2.33{+-}2.40 without metastases (n=6). Conclusion: Palliative embolization of renal cell carcinomas is a safe therapeutic method to treat advanced renal cell carcinomas allowing control of symptoms such as hematuria and flank pain in more than 90% of our cases. Preoperative embolization yields a patient survival time comparable to that of patients at earlier tumor stages and is dependent on the metastases. (orig.)

  15. Intraobserver and intermethod reliability for using two different computer programs in preoperative lower limb alignment analysis

    Mohamed Kenawey


    Conclusion: Computer assisted lower limb alignment analysis is reliable whether using graphics editing program or specialized planning software. However slight higher variability for angles away from the knee joint can be expected.

  16. Anatomic and Quantitative Temporal Bone CT for Preoperative Assessment of Branchio-Oto-Renal Syndrome.

    Ginat, D T; Ferro, L; Gluth, M B


    We describe the temporal bone computed tomography (CT) findings of an unusual case of branchio-oto-renal syndrome with ectopic ossicles that are partially located in the middle cranial fossa. We also describe quantitative temporal bone CT assessment pertaining to cochlear implantation in the setting of anomalous cochlear anatomy associated with this syndrome.

  17. Visual Analogue Scale for Anxiety and Amsterdam Preoperative Anxiety Scale Provide a Simple and Reliable Measurement of Preoperative Anxiety in Patients Undergoing Cardiac Surgery

    Joaquín Hernández-Palazón


    Full Text Available Background: Anxiety is an emotional state characterized by apprehension and fear resulting from anticipation of a threatening event. Objectives: The present study aimed to analyze the incidence and level of preoperative anxiety in the patients scheduled for cardiac surgery by using a Visual Analogue Scale for Anxiety (VAS-A and Amsterdam Preoperative Anxiety and Information Scale (APAIS and to identify the influencing clinical factors. Patients and Methods: This prospective, longitudinal study was performed on 300 cardiac surgery patients in a single university hospital. The patients were assessed regarding their preoperative anxiety level using VAS-A, APAIS, and a set of specific anxiety-related questions. Their demographic features as well as their anesthetic and surgical characteristics (ASA physical status, EuroSCORE, preoperative Length of Stay (LoS, and surgical history were recorded, as well. Then, one-way ANOVA and t-test were applied along with odds ratio for risk assessment. Results: According to the results, 94% of the patients presented preoperative anxiety, with 37% developing high anxiety (VAS-A ≥ 7. Preoperative LoS > 2 days was the only significant risk factor for preoperative anxiety (odds ratio = 2.5, CI 95%, 1.3 - 5.1, P = 0.009. Besides, a positive correlation was found between anxiety level (APAISa and requirement of knowledge (APAISk. APAISa and APAISk scores were greater for surgery than for anesthesia. Moreover, the results showed that the most common anxieties resulted from the operation, waiting for surgery, not knowing what is happening, postoperative pain, awareness during anesthesia, and not awakening from anesthesia. Conclusions: APAIS and VAS-A provided a quantitative assessment of anxiety and a specific qualitative questionnaire for preoperative anxiety in cardiac surgery. According to the results, preoperative LoS > 2 days and lack of information related to surgery were the risk factors for high anxiety levels.

  18. Partial nephroureterectomy in duplex renal system: preoperative 3D virtual rendering and retroperitoneal laparoscopic approach in children

    Molinaro F.


    Full Text Available Introduction: the aim of this study is to presents the results of our preliminary series of 8 partial nephroureterectomy performed by retroperitoneoscopy using harmonic scalpel with a preoperative 3D virtual reconstruction of bidimensional magnetic resonance images in children affected by duplication of the renal system. Materials and methods: We perform a retrospective study in our Pediatric Surgery Unit from January 2007 to January 2012 of all children affected by duplication of the renal system treated by retroperitoneal laparoscopic approach. Images collected were reconstructed using IRCAD VR render software. Data include: sex, age at surgery, clinical and radiological features, surgical procedure, follow-up and complications. Results: retroperitoneal laparoscopic partial nephroureterectomy was performed in 8 children (6 males and 2 females. All patients had a non-functioning moiety of a duplex kidney and in addition recurrent urinary tract infections. Two cases were associated with ureterocele; of them in one case we performed a previous endoscopic incision of the obstructing ureterocele. All patients underwent radiological evaluation prior to surgery, by ultrasound, voididng cystourethrography, renal scintigraphy and contrast-enhanced MRI evaluations. Images collected were reconstructed using IRCAD VR render software. Patients were treated by a 3-4 trocars technique and parenchymal section was performed using harmonic scalpel. The mean operative time was 180 minutes; no cases required open conversion. The mean hospital stay was 5 days. The mean follow-up was 38 months. No cases of secondary atrophy of the lower pole were observed. Discussion: Volume rendering gives high anatomical resolution and it can be useful to guide the surgical procedure. Laparoscopic retroperitoneal partial nephrectomy is a safe and feasible procedure in children for experienced pediatric laparoscopic surgeons.

  19. Visual Analogue Scale for Anxiety and Amsterdam Preoperative Anxiety Scale Provide a Simple and Reliable Measurement of Preoperative Anxiety in Patients Undergoing Cardiac Surgery

    Joaquín Hernández-Palazón; Diego Fuentes-García; Luis Falcón-Araña; Antonio Rodríguez-Ribó; Carlos García-Palenciano; María José Roca-Calvo


    Background: Anxiety is an emotional state characterized by apprehension and fear resulting from anticipation of a threatening event. Objectives: The present study aimed to analyze the incidence and level of preoperative anxiety in the patients scheduled for cardiac surgery by using a Visual Analogue Scale for Anxiety (VAS-A) and Amsterdam Preoperative Anxiety and Information Scale (APAIS) and to identify the influencing clinical factors. Patients and Methods: This prospective, longitu...

  20. Reliability of whole slide images as a diagnostic modality for renal allograft biopsies.

    Jen, Kuang-Yu; Olson, Jean L; Brodsky, Sergey; Zhou, Xin J; Nadasdy, Tibor; Laszik, Zoltan G


    The use of digital whole slide images (WSI) in the field of pathology has become feasible for routine diagnostic purposes and has become more prevalent in recent years. This type of technology offers many advantages but must show the same degree of diagnostic reliability as conventional glass slides. Several studies have examined this issue in various settings and indicate that WSI are a reliable method for diagnostic pathology. Since transplant pathology is a highly specialized field that requires not only accurate but rapid diagnostic evaluation of biopsy materials, this field may greatly benefit from the use of WSI. In this study, we assessed the reliability of using WSI compared to conventional glass slides in renal allograft biopsies. We examined morphologic features and diagnostic categories defined by the Banff 07 Classification of Renal Allograft Pathology as well as additional morphologic features not included in this classification scheme. We found that intraobserver scores, when comparing the use of glass slides versus WSI, showed substantial agreement for both morphologic features (κ = 0.68) and acute rejection diagnostic categories (κ = 0.74). Furthermore, interobserver reliability was comparable for morphologic features (κ = 0.44 [glass] vs 0.42 [WSI]) and acute rejection diagnostic categories (κ = 0.49 [glass] vs 0.51 [WSI]). These data indicate that WSI are as reliable as glass slides for the evaluation of renal allograft biopsies.

  1. External validation of a preoperative renal stone grading system: reproducibility and inter-rater concordance of the Guy's stone score using preoperative computed tomography and rigorous postoperative stone-free criteria.

    Ingimarsson, Johann P; Dagrosa, Lawrence M; Hyams, Elias S; Pais, Vernon M


    To validate the Guy's stone score (GSS) using preoperative computed tomography (CT) and to assess its inter-rater concordance and association with rigorous definitions of stone clearance. The preoperative CT scans of 166 consecutive percutaneous nephrolithotomy (PCNL) patients treated by a single surgeon were independently reviewed by 2 urology residents and graded according to GSS. Concordance was calculated using Cohen's kappa score. Residual fragments (RFs) were evaluated on CT or plain radiography on postoperative day 1. GSS was correlated with 3 different outcomes; RFs II and III and 20 of 36 cases (56%) pertained to unclear definitions of "partial staghorn stone" and "abnormal anatomy." The GSS is a straightforward grading system of the complexity of renal stones. When applied to preoperative CT scans, it offers good inter-rater concordance and is associated with rigorous endpoints of stone clearance. The inter-rater concordance could be further improved by explicit definitions of abnormal anatomy, partial vs complete staghorn stones, and the size of a calculus that constitutes a separate stone. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Renal length discrepancy by ultrasound is a reliable predictor of an abnormal DMSA scan in children.

    Khazaei, Mahmood R; Mackie, Fiona; Rosenberg, Andrew R; Kainer, Gad


    A renal length discrepancy (RLD) of more than 10 mm by ultrasound (US) is accepted as a potential indicator of an underlying renal pathology; however, there are few supporting data for this in children. Our objective was to determine a cutoff at which RLD on US is a reliable predictor of dimercaptosuccinate acid (DMSA) scan abnormality. We present data from 90 patients who had both renal US and a DMSA scan, as well as DMSA scan results compared with bipolar RLD by US. Positive (PPV) and negative (NPV) predictive values were calculated for renal RLD from 6 to >10 mm. The left kidney was longer in 56%, whereas the right kidney was longer in 37%; their lengths were equal in 8%. For children at all ages, a left kidney longer than the right by >or=10 mm or a right kidney longer than the left by >or=7 mm gave a PPV for DMSA abnormality of 79% and 100%, respectively. In children older than 4 years, if the right kidney was longer by >or=7 mm or if the left kidney was longer by >or=10 mm, the PPVs for DMSA abnormality were 100% and 63%, respectively. In children younger than 4 years, when the right kidney was longer by >or=6 mm or the left was kidney longer by >or=10 mm, the PPV were 86% and 100%, respectively. Thus, children with a right kidney longer than the left by even DMSA scan.

  3. Efficiency and Reliability of Laparoscopic Partial Nephrectomy for Renal Tumors Larger than 4 cm

    Faruk Özgör


    Full Text Available Aim: To evaluate safety and efficiency of laparoscopic partial nephrectomy for renal tumors larger than 4 cm. Methods: We retrospectivelly evaluated the medical records of 65 patients who underwent laparascopic partial nephrectomy between May 2009 and June 2013 in our clinic. The patients were divided into two groups according to tumor size. Patients with a tumor 4 cm were included in group 1 (n=45 and group 2 (n=20, respectively. Demographic, perioperative and postoperative parameters were compared between the groups. Histopathological examination and surgical margin status were also evaluated. Results: The mean age of the patients was 59.2±10.9 (range: 26- 81 years. The mean tumor size and the mean RENAL nephrometry score were significantly higher in group 2 than in group 1. The mean operation time and warm ischemia time were similar between groups but estimated blood loss and transfusion requirement were significantly higher in group 2. Convertion to open surgery was seen two patients in group 2 and one patient in group 1. Only one patient underwent radical nephrectomy for uncontrolled bleeding in group 2. There was no difference in preoperative and 3-month postoperative serum creatinine levels between the groups. The incidence of positive surgical margin was 0% and 5% in group 1 and group 2, respectively. Conclusion: Laparoscopic partial nephrectomy for renal tumors is an effective and feasible procedure with acceptable oncologic results. However, tranfusion rate and requiremet of pelvicaliceal system repair were more common in patients with tumor >4 cm. (The Medical Bulletin of Haseki 2015; 53:30-5

  4. Reliability of preoperative planning of an image-guided system for oral implant placement based on 3-dimensional images: an in vivo study.

    Fortin, Thomas; Bosson, Jean Luc; Coudert, Jean Loup; Isidori, Michel


    The purpose of this study was to assess the reliability of the planning software of an image-guided implant placement system based on a mechanical device coupled with a template stabilized on soft tissue during surgery. Thirty consecutive partially or completely edentulous patients were treated with the image-guided system. For each patient, a study prosthesis was fabricated and duplicated in acrylic resin and served as a scanning template. Axial images were obtained from a computerized tomographic scan and transferred to planning software that provides real 3-dimensional information to plan implant position. Once the final position of the implant was defined, preoperative data such as the size of implants and anatomic complications were recorded using the planning software. The scanning template was then drilled in that exact position by a drilling machine. During surgery, the drilled template was used as a drill guide. After implant placement, intraoperative data were recorded and statistically compared with the preoperative data using the Kendall correlation coefficient for qualitative data and the Kappa concordance coefficient for quantitative data. Agreement between the preoperative and intraoperative data was high for both implant size and anatomic complications. The Kendall correlation coefficient was 0.8 for the diameter and 0.82 for the length. The Kappa concordance coefficient was 0.87 for both dehiscence and bone graft, 0.88 for osteotomy, and 1.0 for fenestration. In the few instances where planning was not perfect, implant placement was completed in a clinically acceptable manner. The results suggest that the image-guided system presented is reliable for the preoperative assessment of implant size and anatomic complications. It may also be reliable for flapless surgery.

  5. The effect of preoperative renal dysfunction with or without dialysis on early postoperative outcome following cardiac surgery.

    Al-Sarraf, Nael


    Although previous studies have shown increased mortality in renal dysfunction patients undergoing cardiac surgery, there is lack of data on the pattern of postoperative complications that occur in such patients and their distribution among dialysis and non-dialysis dependent renal dysfunction.

  6. Can EGFR mutation status be reliably determined in pre-operative needle biopsies from adenocarcinomas of the lung?

    Lindahl, Kim Hein; Sørensen, Flemming Brandt; Jonstrup, Søren Peter


    The identification of EGFR mutations in non-small-cell lung cancer is important for selecting patients, who may benefit from treatment with EGFR tyrosine kinase inhibitors. The analysis is usually performed on cytological aspirates and/or histological needle biopsies, representing a small fraction......-operative biopsies (131 histological and 70 cytological) and on the surgical specimens, using PCR. Samples with low tumour cell fraction were assigned to laser micro-dissection (LMD). We found nine (4.5%) patients with EGFR mutation in the lung tumour resections, but failed to identify mutation in one...... of the corresponding pre-operative, cytological specimens. Several (18.4%) analyses of the pre-operative biopsies were inconclusive, especially in case of biopsies undergoing LMD and regarding exon 21 analysis. Discrepancy of mutation status in one patient may reflect intra-tumoural heterogeneity or technical issues...

  7. Predictive capacity of pre-donation GFR and renal reserve capacity for donor renal function after living kidney donation

    Rook, M; Hofker, HS; van Son, WJ; van der Heide, JJH; Ploeg, RJ; Navis, GJ


    Kidney transplantation from living donors is important to reduce organ shortage. Reliable pre-operative estimation of post-donation renal function is essential. We evaluated the predictive potential of pre-donation glomerular filtration rate (GFR) (iothalamate) and renal reserve capacity for post-do

  8. Noncontrast-Enhanced Magnetic Resonance Versus Computed Tomography Angiography in Preoperative Evaluation of Potential Living Renal Donors

    Blankholm, Anne Dorte; Pedersen, Bodil G; Østrat, Ernst Ø


    RATIONALE AND OBJECTIVES: Living renal donors undergo an extensive examination program. These examinations should be as safe, gentle, and patient friendly as possible. To compare computed tomography angiography (CTA) and an extensive magnetic resonance imaging (MRI) protocol without contrast agents...... to observations from nephrectomy in living renal donors and to evaluate whether noncontrast-enhanced MRI can replace CTA for vessel assessment in living renal donors. MATERIAL AND METHODS: CTA and MRI results were compared to observations from nephrectomy, which served as the reference standard. Fifty......-one potential kidney donors underwent imaging, and 31 donated a kidney. Comparisons in sensitivity, specificity, and accuracy were made with respect to the number of arteries, early branching, and the number of veins. Agreement was assessed using Cohen's kappa. The exact McNemar's test was used to test...

  9. Preoperative preparation of high-risk, specifically hyperimmunized canine renal allograft recipients with total-lymphoid irradiation and cyclosporine

    Rapaport, F.T.; Meek, A.G.; Arnold, A.N.; Miura, S.; Hayashi, R.; Strober, S.


    Hyperimmunized subjects are a particularly high-risk and rapidly growing group in the patient population awaiting renal transplantation. In a search for methods designed to ameliorate the prognosis in such cases, dogs of defined DLA genotype were sensitized with DLA incompatible skin allografts and injections of buffy coat. Each recipient was challenged with a renal allograft bearing the same DLA incompatibilities. Five dogs received kidney transplants, without any other treatment, and rejected their transplants at 2.5, 4, 5, 6, and 6.5 days, respectively. Another four dogs were given a 9-11-week course (1760 +/- 35 cGy) of total-lymphoid irradiation (TLI), followed by rabbit antithymocyte globulin (ATG); these animals rejected their renal allografts at 7, 8, 14, and 17 days, respectively. Five other dogs were treated with TLI and received cyclosporine (CsA) and methylprednisolone (MPd) daily until graft rejection. Their renal allografts survived for 7.5, 8.5, 20, 62, and 227 days, respectively. Renal allografts placed in normal recipients under the same conditions of donor-recipient DLA incompatibility had a mean survival time of 12.4 days (range: 10-18 days). At the time of transplantation, the specific anti-DLA antibody titers in the recipients were 81 to 243 in the untreated dogs; 27 to 81 in the TLI-ATG-treated group, and 3 to 243 in the TLI-CsA/MPd-treated group. The titers fell within 24-48 hr after renal transplantation, to 3 to 81 in the untreated sensitized dogs; they were 3 to 9 in the TLI-ATG-treated group, and were 9 to 243 in the TLI-CsA/MPd treated group. The cytotoxic antibody titers reached postoperative peaks of 6500 to 200,000 in the untreated dogs; 729 to 6500 in the TLI-ATG-treated dogs, and 243 to 6500 in the TLI-CsA/MPd-treated recipients.

  10. Face validity and inter-rater reliability of the Danish version of the modified-Yale Preoperative Anxiety Scale

    Skovby, Pernille; Rask, Charlotte Ulrikka; Dall, Rolf


    -YPAS to Danish cultural and linguistic conditions and to test face validity and inter-reliability in a clinical setting. Materials and methods The translation was performed in accordance with WHO guidelines. Face validity as well as linguistic difficulties of the Danish version was tested and solved in a focus...

  11. Relation between preoperative renal dysfunction and cardiovascular events (stroke, myocardial infarction, or heart failure or death) within three months of isolated coronary artery bypass grafting.

    Holzmann, Martin J; Sartipy, Ulrik


    Renal dysfunction is related to long-term mortality and myocardial infarction after coronary artery bypass grafting (CABG). We aimed to investigate the association between preoperative renal dysfunction and early risk of stroke, myocardial infarction, or heart failure after CABG. From the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry, we included all 36,284 patients who underwent primary isolated CABG from 2000 to 2008 in Sweden. The Swedish National Inpatient Registry was used to obtain the primary end point, which was rehospitalization for stroke, myocardial infarction, or heart failure ≤90 days after CABG. Logistic regression models were used to estimate the risk for the primary outcome and the secondary outcome of death from any cause, while adjusting for confounders. During 90 days of follow-up, there were 2,462 cardiovascular events and 617 deaths. In total, 17% of patients developed acute kidney injury postoperatively. Odds ratios with 95% confidence intervals for cardiovascular events after adjustment for age, gender, atrial fibrillation, left ventricular ejection fraction, diabetes mellitus, peripheral vascular disease, and history of myocardial infarction, heart failure, or stroke was 1.24 (1.06 to 1.45) in patients with an estimated glomerular filtration rate of 15 to 45 ml/min/1.73 m(2) but became nonsignificant after acute kidney injury was introduced into the statistical model. The risk of death was significantly increased in patients with estimated glomerular filtration rate of 15 to 45 ml/min/1.73 m(2) (odds ratio 1.76, 95% confidence interval 1.38 to 2.25) even after adjustment for all confounders. Renal dysfunction was associated with all-cause mortality but not with cardiovascular events during the first 3 postoperative months after primary isolated CABG.

  12. Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase

    Guerrero-Orriach, José Luis; Ariza-Villanueva, Daniel; Florez-Vela, Ana; Garrido-Sánchez, Lourdes; Moreno-Cortés, María Isabel; Galán-Ortega, Manuel; Ramírez-Fernández, Alicia; Alcaide Torres, Juan; Fernandez, Concepción Santiago; Navarro Arce, Isabel; Melero-Tejedor, José María; Rubio-Navarro, Manuel; Cruz-Mañas, José


    Purpose To evaluate if the preoperative administration of levosimendan in patients with right ventricular (RV) dysfunction, pulmonary hypertension, and high perioperative risk would improve cardiac function and would also have a protective effect on renal and neurological functions, assessed using two biomarkers neutrophil gelatinase-associated lipocalin (N-GAL) and neuronal enolase. Methods This is an observational study. Twenty-seven high-risk cardiac patients with RV dysfunction and pulmonary hypertension, scheduled for cardiac valve surgery, were prospectively followed after preoperative administration of levosimendan. Levosimendan was administered preoperatively on the day before surgery. All patients were considered high risk of cardiac and perioperative renal complications. Cardiac function was assessed by echocardiography, renal function by urinary N-GAL levels, and the acute kidney injury scale. Neuronal damage was assessed by neuron-specific enolase levels. Results After surgery, no significant variations were found in mean and SE levels of N-GAL (14.31 [28.34] ng/mL vs 13.41 [38.24] ng/mL), neuron-specific enolase (5.40 [0.41] ng/mL vs 4.32 [0.61] ng/mL), or mean ± SD creatinine (1.06±0.24 mg/dL vs 1.25±0.37 mg/dL at 48 hours). RV dilatation decreased from 4.23±0.7 mm to 3.45±0.6 mm and pulmonary artery pressure from 58±18 mmHg to 42±19 mmHg at 48 hours. Conclusion Preoperative administration of levosimendan has shown a protective role against cardiac, renal, and neurological damage in patients with a high risk of multiple organ dysfunctions undergoing cardiac surgery. PMID:27143905

  13. Carcinoma de células renales: estadificación prequirúrgica por tomografía computada y su analogía con la anatomía patológica Renal cell carcinoma: preoperative staging by computed tomography and its analogy to pathology

    María Cinthya Ortega Hrescak


    Full Text Available Objetivo. Evaluar la correlación entre la estadificación preoperatoria de los carcinomas de células renales usando tomografía computada y los resultados anatomopatológicos de la pieza operatoria. Materiales y Métodos. Se llevó a cabo un estudio retrospectivo entre los años 2005 y 2011, tomando un total de 40 pacientes con diagnóstico presuntivo de carcinoma de células renales (CCR del Servicio de Urología, que habían sido sometidos a nefrectomía total o parcial. Se compararon diferentes parámetros del estudio imagenológico (tomografía computada y anatomopatológico de cada paciente y se evaluó qué reciprocidad existía entre la estadificación pre y posoperatoria según el TNM. Resultados. Los datos obtenidos mediante el estudio anatomopatológico de la pieza operatoria mostraron 28 lesiones limitadas al riñón (estadios T1 y T2, 3 lesiones con extensión perirrenal y a la vena renal (estadio T3a, 7 lesiones con compromiso de la vena cava (estadio T3b y 2 lesiones con extensión más allá de la fascia de Gerota (estadio T4. Se encontró una fuerza de concordancia casi perfecta entre la estadificación tomográfica y anatomopatológica (kappa = 0,87 con respecto al criterio T del TNM. Sólo 2 T1b (por estudio anatomopatológico fueron sobrediagnosticados como T2 (según tomografía computada y 2 T3b (según estudio anatomopatológico se subdiagnosticaron como T3a (según tomografía computada. Conclusión. La tomografía computada proporciona una buena delimitación y caracterización del carcinoma de células renales. El nivel de concordancia con el patrón de referencia más fiable (anatomía patológica resultó casi perfecto (k = 0,87 para la estadificación del estadio T.Objective. To evaluate the correlation between the preoperative staging of renal cell carcinoma by computed tomography (CT and histopathologic results of the surgical specimen. Materials and Methods. A retrospective study has been carried out in a total

  14. Fatores de risco pré-operatórios para o desenvolvimento de Insuficiência Renal Aguda em cirurgia cardíaca Preoperative risk factors for the development of Acute Renal Failure in cardiac surgery

    Ana Claudia Kochi


    Full Text Available OBJETIVO:Avaliar os fatores de risco clínicos pré-cirurgicos para o desenvolvimento de Insuficiência Renal Aguda (IRA em pacientes submetidos à cirurgia cardíaca. MÉTODO: Foram estudados, de modo prospectivo, 150 pacientes submetidos à cirurgia cardíaca, durante 21 meses consecutivos, havendo um leve predomínio de homens (57%, idade média de 56 ± 15 anos, sendo que 66% apresentavam insuficiência coronariana como principal diagnóstico e 34% valvulopatias. A mediana da creatinina sérica no período pré-operatório foi de 1,1 mg/dl. IRA foi definida como elevação de 30% da creatinina sérica basal. O protocolo de variáveis clínicas teve seu preenchimento iniciado 48 horas antes do procedimento cirúrgico e encerrado 48 horas após o mesmo, incluindo variáveis cardiológicas e não-cardiológicas, além de resultados laboratoriais. RESULTADOS: A IRA esteve presente em 34% dos casos. Após análise multivariada, presença de doença vascular periférica foi fator pré-operatório identificado. CONCLUSÃO: Os resultados obtidos nesse estudo permitiram sinalizar alguns fatores contributivos para o desenvolvimento de IRA em cirurgia cardíaca, o que pode possibilitar condutas clínicas simples para evitar a disfunção renal nestas situações e, conseqüentemente, redução da taxa de mortalidade. No presente trabalho, o tamanho da amostra talvez tenha impedido a identificação de outros fatores de risco significativos.OBJECTIVE: To evaluate clinical risk factors for the development of Acute Renal Failure (ARF in patients who undergo cardiac surgery. METHOD: Over a period of 21 consecutive months, one hundred and fifty patients who underwent cardiac surgery were studied. There was a slight prevalence of men (57% and the average age was 56 ± 14.8 years. Sixty-six percent presented with coronary artery disease as the main diagnosis and 34% valvular heart disease. The median preoperative serum creatinine was 1.1 mg/dL. ARF was

  15. Urine collection in the freely moving rat : Reliability for measurement of short-term renal effects

    Haas, M; Kluppel, A.C A; Moolenaar, Frits; Meijer, D.K F; de Jong, P.E; de Zeeuw, D


    Studies on short-term renal responses to (pharmacological) intervention require accurate and multiple collection of urine samples. Several invasive techniques have been described for frequent urine collection of the conscious rat, each having their own limitations. No data are available about the fe

  16. Heterogeneity and renal mass biopsy:a review of its role and reliability

    Jeffrey JTomaszewski; Robert GUzzo; Marc CSmaldone


    Increased abdominal imaging has led to an increase in the detection of the incidental small renal mass (SRM). With increasing recognition that the malignant potential of SRMs is heterogeneous, ranging from benign (15%-20%) to aggressive (20%), enthusiasm for more conservative management strategies in the elderly and infirmed, such as active surveillance (AS), have grown considerably. As the management of the SRM evolves to incorporate ablative techniques and AS for low risk disease, the role of renal mass biopsy (RMB) to help guide individualized therapy is evolving. Historically, the role of RMB was limited to the evaluation of suspected metastatic disease, renal abscess, or lymphoma. However, in the contemporary era, the role of biopsy has grown, most notably to identify patients who harbor benign lesions and for whom treatment, particularly the elderly or frail, may be avoided. When performing a RMB to guide initial clinical decision making for small, localized tumors, the most relevant questions are otfen relegated to proof of malignancy and documentation (if possible) of grade. However, signiifcant intratumoral heterogeneity has been identiifed in clear cell renal cell carcinoma (ccRCC) that may lead to an underestimation of the genetic complexity of a tumor when single-biopsy procedures are used. Heterogeneous genomic landscapes and branched parallel evolution of ccRCCs with spatially separated subclones creates an illusion of clonal dominance when assessed by single biopsies and raises important questions regarding how tumors can be optimally sampled and whether future evolutionary tumor branches might be predictable and ultimately targetable. hTis work raises profound questions concerning the genetic landscape of cancer and how tumor heterogeneity may affect, and possibly confound, targeted diagnostic and therapeutic interventions. In this review, we discuss the current role of RMB, the implications of tumor heterogeneity on diagnostic accuracy, and

  17. Antenatal Ultrasonographic Anteroposterior Renal Pelvis Diameter Measurement: Is It a Reliable Way of Defining Fetal Hydronephrosis?

    Alamanda Kfoury Pereira


    Full Text Available Purpose. It was to quantify the intraobserver and interobserver variability of the sonographic measurements of renal pelvis and classify hydronephrosis severity. Methods. Two ultrasonographers evaluated 17 fetuses from 23 to 39 weeks of gestation. Renal pelvis APD were taken in 50 renal units. For intraobserver error, one of them performed three sequential measurements. The mean and standard deviation from the absolute and percentage differences between measurements were calculated. Bland-Altman plots were used to visually assess the relationship between the precision of repeated measurements. Hydronephrosis was classified as mild (5.0 to 9.9 mm, moderate (10.0 to 14.9 mm, or severe (≥15.0 mm. Interrater agreement were obtained using the Kappa index. Results. Absolute intraobserver variation in APD measurements was 5.2±3.5%. Interobserver variation of ultrasonographers was 9.3±9.7%. Neither intraobserver or interobserver error increased with increasing APD size. The overall percentage of agreement with the antenatal hydronephrosis diagnosis was 64%. Cohen's Kappa to hydronephrosis severity was 0.51 (95% CI, 0.33 to 0.69. Conclusion. Inter and intraobserver APD measurement errors were low in these group, but the agreement to hydronephrosis diagnosis and classification was fair. We suggest that standard and serial APD measurement can better define and evaluate fetal hydronephrosis.

  18. Reliability of DMSA for the diagnosis of renal parenchymal abnormality in children

    Craig, J.C. [Centre for Kidney Research, New Children' s Hospital, Sydney (Australia); Dept. of Public Health and Community Medicine, Univ. of Sydney (Australia); Dept. of Paediatrics and Child Health, University of Sydney, Sydney (Australia); Irwig, L. [Centre for Kidney Research, New Children' s Hospital, Sydney (Australia); Dept. of Public Health and Community Medicine, Univ. of Sydney (Australia); Ford, M.; Uren, R.F. [Dept. of Nuclear Medicine, New Children' s Hospital, Sydney (Australia); Willis, N.S. [Centre for Kidney Research, New Children' s Hospital, Sydney (Australia); Howman-Giles, R.B. [Dept. of Nuclear Medicine, New Children' s Hospital, Sydney (Australia); Rossleigh, M.A. [Dept. of Nuclear Medicine, Sydney Children' s Hospital, Sydney (Australia); Grunewald, S. [Dept. of Nuclear Medicine and Diagnostic Ultrasound, Westmead Hospital, Sydney (Australia)


    The objective of this study was to evaluate the variability of technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy interpretation by four nuclear medicine physicians for the diagnosis of renal parenchymal abnormality in children, and to compare variability among three different DMSA methods in clinical use: planar alone, single-photon emission tomography (SPET) alone, and planar with SPET. One hundred consecutive DMSA studies were independently interpreted 3 times by four participating nuclear medicine specialists from different departments and in random order. All scans were classified by the presence or absence of renal parenchymal abnormality using the modified four-level grading system of Goldraich. Indices of agreement were the percentage of agreement and the kappa statistic. Disagreement was analysed using children, kidneys and kidney zones (three zones per kidney). Using patients as the unit of analysis, agreement for planar and planar with SPET methods was 87%-88% (kappa 0.74) for the normal-abnormal scan classification. The corresponding agreement value for the SPET alone method was 78% (kappa 0.56). Similarly, substantial disagreement (disagreement {>=}2 categories) occurred in 2.5% and 1.3% of comparisons between observers for planar alone and planar with SPET, respectively, but in 5.2% of comparisons for SPET alone. These results did not vary appreciably whether interpretation of patients, kidneys or kidney zones was compared. It is concluded that the four experienced nuclear medicine physicians showed substantial agreement in the interpretation of planar alone and planar with SPET DMSA scintigraphic images. Interpretation of SPET DMSA images, without planar images, was significantly more variable than interpretation using the two other methods, disagreement occurring in more than 20% of comparisons. SPET DMSA scintigraphy, when used without planar images, does not provide a firm basis for clinical decision making in the care of children who may

  19. Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase

    Guerrero-Orriach JL


    Full Text Available José Luis Guerrero-Orriach,1 Daniel Ariza-Villanueva,1 Ana Florez-Vela,1 Lourdes Garrido-Sánchez,2,3 María Isabel Moreno-Cortés,1 Manuel Galán-Ortega,1 Alicia Ramírez-Fernández,1 Juan Alcaide Torres,3 Concepción Santiago Fernandez,3 Isabel Navarro Arce,1 José María Melero-Tejedor,4 Manuel Rubio-Navarro,1 José Cruz-Mañas1 1Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain; 2CIBER Fisiología de la Obesidad y Nutrición (CIBEROBN, Instituto de Salud Carlos III, Málaga, Spain; 3Department of Nutrition and Endocrinology, Instituto de Investigaciones Biomédicas de Málaga (IBIMA, University Hospital Virgen de la Victoria, Málaga, Spain; 4Department of Cardiovascular Surgery, University Hospital Virgen de la Victoria, Málaga, Spain Purpose: To evaluate if the preoperative administration of levosimendan in patients with right ventricular (RV dysfunction, pulmonary hypertension, and high perioperative risk would improve cardiac function and would also have a protective effect on renal and neurological functions, assessed using two biomarkers neutrophil gelatinase-associated lipocalin (N-GAL and neuronal enolase. Methods: This is an observational study. Twenty-seven high-risk cardiac patients with RV dysfunction and pulmonary hypertension, scheduled for cardiac valve surgery, were prospectively followed after preoperative administration of levosimendan. Levosimendan was administered preoperatively on the day before surgery. All patients were considered high risk of cardiac and perioperative renal complications. Cardiac function was assessed by echocardiography, renal function by urinary N-GAL levels, and the acute kidney injury scale. Neuronal damage was assessed by neuron-specific enolase levels. Results: After surgery, no significant variations were found in mean and SE levels of N-GAL (14.31 [28.34] ng/mL vs 13.41 [38.24] ng/mL, neuron-specific enolase (5.40 [0.41] ng/mL vs 4.32 [0.61] ng

  20. Preoperative Proteinuria and Reduced Glomerular Filtration Rate Predicts Renal Replacement Therapy in Patients Supported With Continuous-Flow Left Ventricular Assist Devices.

    Topkara, Veli K; Coromilas, Ellie J; Garan, Arthur Reshad; Li, Randall C; Castagna, Francesco; Jennings, Douglas L; Yuzefpolskaya, Melana; Takeda, Koji; Takayama, Hiroo; Sladen, Robert N; Mancini, Donna M; Naka, Yoshifumi; Radhakrishnan, Jai; Colombo, Paolo C


    Renal failure requiring renal replacement therapy (RRT) has detrimental effects on quality of life and survival of patients with continuous-flow left ventricular assist devices (CF-LVADs). Current guidelines do not offer a decision-making algorithm for CF-LVAD candidates with poor baseline renal function. Objective of this study was to identify risk factors associated with RRT after CF-LVAD implantation. Three hundred and eighty-nine consecutive patients underwent contemporary CF-LVAD implantation at the Columbia University Medical Center between January 2004 and August 2015. Baseline demographics, comorbid conditions, clinical risk scores, and renal function were analyzed in patients with or without RRT after CF-LVAD implantation. Time-dependent receiver-operating characteristic curve analysis was performed to define optimal cutoffs for continuous risk factors. Forty-four patients (11.6%) required RRT during a median follow-up of 9.9 months. Patients requiring RRT had significantly worse renal function, lower hemoglobin, and increased proteinuria at baseline. Low estimated glomerular filtration rate (proteinuria (urine protein to creatinine ratio ≥0.55 mg/mg) were significant predictors of RRT after CF-LVAD support. Dipstick proteinuria was also a significant predictor of RRT after CF-LVAD implantation. Patients with both low estimated glomerular filtration rate and proteinuria had highest risk of RRT (63.6%) compared with those with either low estimated glomerular filtration rate or proteinuria (18.7%) and those with neither of these risk factors (2.7%) at 1-year follow-up (log-rank Pproteinuria are predictors RRT after CF-LVAD implantation and should be routinely assessed in CF-LVAD candidates to guide decision making. © 2016 American Heart Association, Inc.

  1. Preoperative planning of renal transplantation: a comparison of non-contrast-enhanced ultrasonography, computed tomography, and magnetic resonance angiography with observations from surgery.

    Blankholm, Anne Dorte; Pedersen, Bodil G; Stausbøl-Grøn, Brian; Andersen, Gratien; Hørlyck, Arne; Østrat, Ernst Ø; Laustsen, Sussie; Ringgaard, Steffen


    Many candidates for kidney transplantation need to undergo vessel examination before the transplantation procedure. To identify the optimal preoperative modality for the examination of vessel status without the use of contrast agents in kidney transplant candidates. Fifty-three consecutive patients were examined and 31 patients were transplanted. Ultrasonography (US), non-contrast-enhanced computed tomography (NCCT), and non-contrast-enhanced magnetic resonance angiography (NCMRA) were compared using inspection during kidney transplantation (TX) as a reference standard. The sensitivity and specificity to severe arteriosclerotic changes and the accuracy were calculated. Kappa statistics were used to assess the agreement between TX and the different examination modalities, and McNemar's test was used to test for significant differences. US had higher sensitivity (1.0) and better agreement with observations from surgery (k = 0.89) than both NCCT (sensitivity = 0.60; k = 0.72) and NCMRA (sensitivity = 0.20; k = 0.30). No significant difference was found between TX and US (P = 0.3173) or TX and NCCT (P = 0.1573), but there was a significant difference between TX and NCMRA (P = 0.0455). US was inconclusive in 20% of cases, and the internal iliac artery could not be visualized in 69% of cases. Either US or NCCT can be used as the preferred preoperative imaging modality to examine vessel status before kidney transplantation, but a combination of the two is preferable. NCMRA should not be used as the sole imaging modality for preoperative imaging before kidney transplantation because of its low sensitivity in detecting severe arteriosclerotic disease without the presence of stenosis. © The Foundation Acta Radiologica 2014.

  2. Small renal Oncocytomas: Differentiation with multiphase CT

    Gakis, Georgios, E-mail: [Department of Urology, University Hospital Tuebingen, Eberhard-Karls University, Hoppe-Seyler Strasse 3, Tuebingen (Germany); Kramer, Ulrich [Department of Radiology, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen (Germany); Schilling, David; Kruck, Stephan; Stenzl, Arnulf [Department of Urology, University Hospital Tuebingen, Eberhard-Karls University, Hoppe-Seyler Strasse 3, Tuebingen (Germany); Schlemmer, Hans-Peter [Department of Radiology, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen (Germany)


    Objectives: To evaluate characteristic imaging findings of tumor attenuation in multiphase computed tomography (CT) between renal oncocytomas and clear-cell renal cell carcinoma (ccRCC) of small tumor size ({<=}5 cm). Methods: We retrospectively identified 20 patients with complete four-phase CT with either histologically confirmed small renal oncocytoma (N = 10) or ccRCC (N = 10) who underwent subsequent total or partial nephrectomy. Exclusion criteria for RCC were non-clear-cell components in histology and a tumor diameter >5 cm. The relative attenuation of solid renal lesions and normal renal cortex was determined in the unenhanced, corticomedullary, nephrographic and excretory phase. Statistical comparison was carried out by Wilcoxon Rank Sum Test. Results: Mean tumor size of renal oncocytomas was 2.8 {+-} 0.4 cm (1.2-5) and of ccRCC 2.5 {+-} 0.2 cm (1.7-4.4; p = 0.57). All lesions were homogenous without extended areas of necroses. In the nephrographic phase, the difference of attenuation between renal cortex and tumor lesion was highest in both entities (oncocytoma, 48.1 {+-} 5.2 HU; ccRCC, 67.5 {+-} 12.1) but not between entities (p = 0.30). In the corticomedullary phase, renal oncocytomas showed greater isodensity to the normal renal cortex (13.9 {+-} 4.3 HU) compared to clear-cell RCC (51.5 {+-} 5.0 HU; p = 0.003). No further significant differences were found for the unenhanced and excretory phase. Conclusions: In this study, the maximum tumor-to-kidney contrast coincided with the nephrographic phase which was thus the most reliable for the detection of a renal lesion <5 cm. For lesion characterization, the corticomedullary phase was most useful for differentiating both entities. This finding is particularly important for the preoperative planning of a partial nephrectomy.

  3. 3D FIESTA pulse sequence for assessing renal artery stenosis: is it a reliable application in unenhanced magnetic resonance angiography?

    Gaudiano, Caterina; Busato, Fiorenza; Ferramosca, Emiliana; Cecchelli, Carlo; Corcioni, Beniamino; De Sanctis, Lucia Barbara; Santoro, Antonio; Golfieri, Rita


    To assess the capability of the three-dimensional (3D) Fast Imaging Employing Steady-State Acquisition (FIESTA) sequence in evaluating renal artery stenosis (RAS). We retrospectively analysed 79 patients referred for suspected RAS, examined by 3D FIESTA and contrast-enhanced magnetic resonance angiography (CE-MRA), using a 1.5T whole-body scanner. Image quality was assessed as well as the presence and grade of RAS. Patients with RAS ≥ 50% were evaluated for possible digital subtraction angiography (DSA). Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of 3D FIESTA were calculated with ROC analysis using CE-MRA and DSA as the standard of reference. A total of 186 renal arteries were assessed; 36 had RAS ≥ 50 % demonstrated by CE-MRA. Ten patients underwent DSA, for a total evaluation of 22 arteries. Sensitivity, specificity, NPV, PPV, and accuracy of 3D FIESTA were 91.7%, 100%, 98%, 100%, and 98%, respectively, as compared to CE-MRA, and 88.2%, 100%, 71.4%, 100%, and 91%, respectively, as compared to DSA. The area under the ROC curve (AUC) of 3D FIESTA as compared to CE-MRA and DSA was 0.958 and 0.941, respectively. Our study demonstrated the capability of the 3D FIESTA sequence in evaluating RAS, with high-quality images and good diagnostic accuracy. The 3D FIESTA sequence provides a robust evaluation of RAS. The 3D FIESTA sequence allows non-invasive evaluation of the renal arteries. The 3D FIESTA sequence could be a useful tool in evaluating RAS.

  4. Is proBNP a Reliable Marker for the Evaluation of Fluid Load in Patients Undergoing Continuous Renal Replacement Therapy?

    Seher Erdogan


    Full Text Available Aim: Pro-B type natriuretic peptide (proBNP has been defined as a volume marker in hemodialysis patients. In the present study we aimed to evaluate the role of serum proBNP levels to indicate fluid load in patients undergoing continuous renal replacement therapy (CRRT due to overhydration. Material and Method: Patients who were admitted to a tertiary 7-bed pediatric intensive care unit and underwent CRRT due to overhydration were included in the study. Results: The study was conducted with 15 girls (53.6% and 13 boys (46.4%. The mean age was 61.46±56.13 months (range, 2-183 months; the mean CRRT administration time was 20.8±14.9 hours (range, 5-60 hours; and the mean percentage of fluid extracted from the body was 8.43 ± 4.51% (range, 2.5-20%. CRRT was administered to 12 patients because of fluid overload (42.9% and to 12 (57.1% because of fluid load accompanied by uremia.. There was a statistically significant difference between body weight, urea, and creatinine levels of patients before and after treatment (p= 0.001. The mean proBNP level was 23.306 ± 13.943 pg/mL immediately before CRRT and the mean proBNP after CRRT was 22.178 ± 15.473 pg/mL. There was no statistically significant difference between the initial and final proBNP levels (p= 0.756. With the exception of serum sodium levels, there was no correlation between the final proBNP levels and body weight, urea, and creatinine (p>0.05. Similarly, there was also no correlation between initial proBNP levels and fluid load (p= 0.602 or between the percentage of extracted fluid and final proBNP levels (p= 0.155. Discussion: There was no significant correlation between the fluid load and initial proBNP levels or with the extracted fluid percentage and final proBNP levels in patients undergoing CRRT because of fluid overload.In conclusion, no appropriate marker was determined to evaluate cumulative fluid load and the extracted liquid volume.

  5. 42 CFR 414.320 - Determination of reasonable charges for physician renal transplantation services.


    ... renal transplantation services. 414.320 Section 414.320 Public Health CENTERS FOR MEDICARE & MEDICAID... Determination of reasonable charges for physician renal transplantation services. (a) Comprehensive payment for... a renal transplantation, including the usual preoperative and postoperative care, and...

  6. Relationship of postoperative systemic inflammatory response syndrome and preoperative midway through the urine and perioperative renal pelvis urine of percutaneous nephrostolithotomy%术后系统性炎症反应综合征与经皮肾镜碎石术前中段尿及术中肾盂尿的相关研究

    许承斌; 鲁可权; 曹希亮; 于文朝; 刘永亮; 巩加存


    Objective To explore the relationship of postoperative systemic inflammatory response syndrome (SIRS) and preoperative midway through the urine and perioperative renal pelvis urine of percutaneous nephrostolithotomy (PCNL).Methods Participants included 450 patients with urinary calculus who underwent PCNL,preoperative midway through the urine and perioperative renal pelvis urine of PCNL was collected.Results Of 450 cases,preoperative midway through the urine germiculture positive 100 cases (22.2%,100/450 ),perioperative renal pelvis urine germiculture positive 85 cases (18.9%,85/450),46 cases ( 10.2%,46/450) occurred SIRS after PCNL.Decompression of perioperative renal pelvis urine germiculture positive 20 cases (23.5%,20/85) preoperative midway through the urine germiculture positive,perioperative renal pelvis urine the bacteria cultures negative 80 cases (21.9%,80/365 ) preoperative midway through the urine germiculture positive (P >0.05),preoperative midway through the urine germiculture positive 15 cases ( 15.0%,15/100) in SIRS,preoperative midway through the urine the bacteria cultures negative 31 cases ( 8.9%,31 /350) in SIRS (P > 0.05 ).Decompression of perioperative renal pelvis urine germiculture positive 18 cases (21.2%,18/85) in SIRS,perioperative renal pelvis urine the bacteria cultures negative 28 cases (7.7%,28/365) in SIRS (P < 0.05 ).Conclusion Preoperative midway through the urine has no correlation with the occurrence of SIRS,perioperative renal pelvis urine germiculture positive can predict the occurrence of SIRS,giving corresponding antibiotic treatment can improve the security of PCNL.%目的 探讨术后系统性炎症反应综合征(SIRS)与经皮肾镜碎石术(PCNL)术前中段尿及术中肾盂尿的相关性.方法 共纳入450例行PCNL的尿路结石患者,均于PCNL术前留取中段尿,并于术中留取肾盂尿.结果 450例患者中,术前中段尿细菌培养阳性100例(22.2%,100/450),术

  7. Preoperative assessment and optimization in periampullary and pancreatic cancer

    S Myatra


    Full Text Available Perioperative management of pancreatic and periampullary cancer poses a considerable challenge to the pancreatic surgeon, anesthesiologist, and the intensive care team. The preoperative surgical evaluation of a pancreatic lesion aims to define the nature of the lesion (malignant or benign, stage the tumor, and to determine resectability or other non-surgical treatment options. Patients are often elderly and may have significant comorbidities and malnutrition. Obstructive jaundice may lead to coagulopathy, infection, renal dysfunction, and adverse outcomes. Routine preoperative biliary drainage can result in higher complication rates, and metal stents may be preferred over plastic stents in selected patients with resectable disease. Judicious use of antibiotics and maintaining fluid volume preoperatively can reduce the incidence of infection and renal dysfunction, respectively. Perioperative fluid therapy with hemodynamic optimization using minimally invasive monitoring may help improve outcomes. Careful patient selection, appropriate preoperative evaluation and optimization can greatly contribute to a favorable outcome after major pancreatic resections.

  8. Preoperative urinary tract obstruction in scoliosis patients.

    Suzuki, Shigeru; Kotani, Toshiaki; Mori, Kazuetsu; Kawamura, Ken; Ohtake, Akira


    While the association between scoliosis and cardiac and respiratory function impairments has been well characterized in clinical practice and research, the potential effect of scoliosis on urinary tract structure and renal function has received little attention. Therefore, the purpose of this study was to evaluate the preoperative clinical characteristics of urinary tract structure and renal function in pediatric patients with idiopathic scoliosis, using a combination of blood tests, urinalysis, and imaging. Preoperative measures of urinary tract structure and renal function were obtained for 16 patients, 13-17 years old, scheduled for corrective surgery for idiopathic scoliosis. Preoperative assessment included blood test and urinalysis, combined with structural imaging on ultrasound (US), magnetic resonance imaging (MRI), magnetic resonance urography (MRU), and radioisotope tracing (RI), using technetium-99 m mercaptoacetyltriglycine ((99m) Tc-MAG3). Differences in blood and urine tests between patients with and without urinary tract obstruction (UTO) were evaluated for significance using Mann-Whitney U test. For all 16 patients, blood tests and MRU were within normal limits. Dilatation of the renal pelvis was identified on US in eight patients (50.0%). UTO was identified on RI in six patients (37.5%). UTO was associated with elevated β2-microglobulin concentration. Urinary β2-microglobulin concentration >0.7 μg/mg Cr differentiated patients with UTO from those without UTO, with a sensitivity of 100% and specificity of 70%. β2-Microglobulin concentration may be a useful marker to screen for asymptomatic UTO in patients with idiopathic scoliosis. © 2016 Japan Pediatric Society.

  9. Preoperative prediction of severe postoperative pain.

    Kalkman, C J; Visser, K; Moen, J; Bonsel, G J; Grobbee, D E; Moons, K G M


    We developed and validated a prediction rule for the occurrence of early postoperative severe pain in surgical inpatients, using predictors that can be easily documented in a preoperative setting. A cohort of surgical inpatients (n=1416) undergoing various procedures except cardiac surgery and intracranial neurosurgery in a University Hospital were studied. Preoperatively the following predictors were collected: age, gender, type of scheduled surgery, expected incision size, blood pressure, heart rate, Quetelet index, the presence and severity of preoperative pain, health-related quality of life the (SF-36), Spielberger's State-Trait Anxiety Inventory (STAI) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The outcome was the presence of severe postoperative pain (defined as Numeric Rating Scale > or =8) within the first hour postoperatively. Multivariate logistic regression in combination with bootstrapping techniques (as a method for internal validation) was used to derive a stable prediction model. Independent predictors of severe postoperative pain were younger age, female gender, level of preoperative pain, incision size and type of surgery. The area under the receiver operator characteristic (ROC) curve was 0.71 (95% CI: 0.68-0.74). Adding APAIS scores (measures of preoperative anxiety and need for information), but not STAI, provided a slightly better model (ROC area 0.73). The reliability of this extended model was good (Hosmer and Lemeshow test p-value 0.78). We have demonstrated that severe postoperative pain early after awakening from general anesthesia can be predicted with a scoring rule, using a small set of variables that can be easily obtained from all patients at the preoperative visit. Before this internally validated preoperative prediction rule can be applied in clinical practice to support anticipatory pain management, external validation in other clinical settings is necessary.

  10. Preoperative preparation of children

    Priya Reshma Aranha


    Full Text Available Surgery is a stressful and anxiety provoking experience for children. Millions of children undergo surgery every year. The majority of children experience significant preoperative anxiety which intern can affect their recovery. Preoperative anxiety may bring about physical and physiological changes in children, which can be particularly evident in terms of increased heart rate and blood pressure. To identify various strategies used to minimize the preoperative anxiety of children and update their clinical effectiveness among children undergoing surgery, the authors searched PubMed, MEDLINE, CINAHL, ScienceDirect, Google Scholar, Scopus, and Cochrane Library for identifying the relevant studies and retrieved available literature. It is concluded that utilization of the strategies available to reduce the preoperative anxiety of children will be a promising intervention to reduce anxiety, to promote relaxation, satisfaction, and speedy recovery. Many of these techniques are simple, cost-effective and can be easily carried out by nurses. It is essential to use the age appropriate and individualized methods in preparing children for surgery. Further research is required to strengthen the evidence.

  11. Interventions for preoperative smoking cessation

    Møller, A; Villebro, N


    Smokers have a substantially increased risk of intra- and postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence. The preoperative period may be a well chosen time to offer smoking cessation interventions due to increased patient motivation....

  12. Impact of magnetic resonance urography on preoperative diagnostic workup in children affected by hydronephrosis: should IVU be replaced?

    Leppert, A; Nadalin, S; Schirg, E; Petersen, C; Kardorff, R; Galanski, M; Fuchs, J


    The aim of this study was to determine the role of magnetic resonance urography (MRU) in preoperative diagnostic workup of children with hydronephrosis in a prospective clinical study with comparison of MRU, standard diagnostic investigations, and intraoperative findings. Thirty-one children with hydronephrosis secondary to different causes underwent ultrasound scan (US), intravenous urography (IVU), micturation cysto-urethrography (MCU), isotope nephrography (ING) and MRU. For MRU the authors performed sagittal and coronal halve-Fourier SSFSE scans in a 1.5 Tesla MR system. T1- and T2-weighted sequences were used in axial orientation to improve morphologic information. In 24 patients, preoperative data were compared with intraoperative findings. Comparison of the different imaging modalities proved MRU to be able to provide more detailed information about the correct localization of stenoses along the urinary tract and the morphology of renal parenchyma. MRU showed the highest concordance of all imaging modalities with intraoperative findings. As a reliable investigation, MRU has the potentials to replace IVU in preoperative diagnostic workup of hydronephrosis in childhood. Copyright 2002, Elsevier Science (USA). All rights reserved.

  13. Tc-99 m diethylenetriamine-pentaacetic acid (DTPA): is it reliable for assessment of methotrexate-induced cumulative effect on renal filtration in rheumatoid arthritis patients?

    Amin, Amr; Effat, Dina; Goher, Nabila; Ramadan, Basma


    Methotrexate (MTX) is commonly employed as the initial DMARD used for the treatment of rheumatoid arthritis (RA). We aimed to contribute to the safety profile of MTX by assessing its cumulative effect on renal filtration. A total of 52 RA adult female patients with normal baseline serum creatinine and GFR at the initial diagnosis of the disease were included. Group 1 (G1) included 30 patients (mean age 40.4 ± 4.4 years) on MTX and NSAIDS, while 22 RA patients (mean age 38.5 ± 8.2 years) who received NSAIDs only served as control group (G2). Renal function was assessed by GFR measurement using technetium diethylenetriamine-pentaacetic acid (Tc-99 m DTPA) at a point of the study time corresponding to disease duration. Twenty-one out of thirty (70 %) in G1 showed reduced GFR compared to 6/22 (27.3 %) in G2 (P = 0.007), with 3.3 ± 0.5 % annual reduction in GFR. Reduced GFR in G1 showed significant negative correlation with age (r = -0.396, P = 0.005), MTX cumulative dose (r = -0.263, P = 0.049), MTX-intake duration (r = -0.293, P = 0.031) and NSAIDs-intake duration (r = -0.344, P = 0.014). Low-dose MTX has a slow cumulative effect on renal filtration manifested by GFR reduction overtime that could be monitored by Tc-99 m DTPA.

  14. Pre-operative anaemia.

    Clevenger, B; Richards, T


    Pre-operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri-operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non-cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre-operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of 'functional' iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre-operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated.

  15. 阿姆斯特丹术前焦虑与信息量表中文版的信效度研究%Reliability and validity of the Chinese version of the Amsterdam preoperative anxiety and informa-tion scale

    吴昊; 刘延军; 马正良; 顾小萍


    Objective To determine the reliability and validity of the Chinese edition of the Amster-dam preoperative anxiety and information scale ( APAIS) for the assessment of preoperative anxiety of Chi-nese patients.Methods The APAIS was translated into Chinese version.One hundred and thirty patients undergoing elective surgery were enrolled to complete the APAIS,STAI-S,VAS-A at the day before surgery, and thirty subjects received a re-test of APAIS at the day of surgery.Results The average score of Chinese version of APAIS anxiety scale and information scale were (7.37±3.51) and (3.67±1.94),respectively. Cronbachαfor the anxiety scale was 0.84 and information scale was 0.78,respectively.Test-retest reliability were r=0.746(P<0.01) and r=0.655(P<0.01) ,respectively.Factor analysis showed anxiety and the desire for information were found,which explained 73.82%of variance.The anxiety scale of APAIS significantly corre-lated with STAI-S and VAS-A,Correlation Coefficient were r=0.720(P<0.01) and r=0.641(P<0.01) ,respec-tively.Conclusion The Chinese version of the APAIS has good reliability and validity to quick measure the preoperative anxiety and desire for information of patients.%目的:评价阿姆斯特丹术前焦虑与信息量表( the Amsterdam preoperative anxiety and in-formation scale,APAIS)中文版本用于评估中国患者术前焦虑程度的信效度。方法将APAIS译为中文,术前1 d对130例患者进行APAIS量表、状态特质焦虑量表( state-trait anxiety inventory,STAI-S)、焦虑视觉模拟量表( visual analog scales-anxiety,VAS-A)评测,手术当日30例患者复测APAIS量表。结果中文版APAIS焦虑分量表平均得分(7.37±3.51)分,信息需要分量表平均得分(3.67±1.94)分。信度分析显示,焦虑量表和信息需要量表的Cronbach α系数分别为0.840和0.782,重测信度分别为( r=0.746, P<0.01)和( r=0.655, P<0.01)。因

  16. Renal artery aneurysm mimicking renal calculus with hydronephrosis.

    Chen, Shanwen; Meng, Hongzhou; Cao, Min; Shen, Baihua


    A 51-year-old woman was found to have a left renal calculus with hydronephrosis. She underwent unsuccessful extracorporeal shock wave lithotripsy, leading to the recommendation that percutaneous lithotomy was necessary to remove the renal calculus. In view of the unusual shape of the calculus and absence of abnormalities in urine sediment, preoperative computed tomography and renal angiography were performed, which instead showed a calcified left renal artery aneurysm. Subsequent efforts to perform an aneurysmectomy also failed, eventually necessitating left nephrectomy. This case illustrates the pitfalls in the diagnosis of a renal artery aneurysm, which is a relatively common condition that may have unusual presentations. Hence, it is suggested that the possibility of a renal artery aneurysm be considered in the differential diagnosis when one detects a renal calculus with an unusual appearance. In addition, we propose that 3-dimensional reconstruction computed tomography be performed before considering surgical options for such renal calculi to rule out the possibility of a renal artery aneurysm.

  17. Trauma renal Renal trauma

    Gerson Alves Pereira Júnior


    Full Text Available Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration

  18. Preoperative anxiety in neurosurgical patients.

    Perks, Anna; Chakravarti, Sucharita; Manninen, Pirjo


    Anxiety is common in surgical patients, with an incidence of 60% to 92%. There is little information on the incidence and severity of preoperative anxiety in patients scheduled for neurosurgery. The aim of this study was to measure the level of preoperative anxiety in neurosurgical patients and to assess any influencing factors. After the Institutional Review Board approval and informed written consent, 100 patients booked for neurosurgery were interviewed preoperatively. Each patient was asked to grade their preoperative anxiety level on a verbal analog scale, Amsterdam Preoperative Anxiety and Information Scale, and a set of specific anxiety-related questions. The anxiety scores and the responses to the questions were compared between the sex, age, weight, diagnosis, and history of previous surgery. The mean age (+/-SD) was 50+/-13 years. The preoperative diagnosis was tumor (n=64), aneurysm (n=14), and other (n=22). Overall verbal analog scale was 5.2+/-2.7; the score was higher for female (5.8+/-2.8) than male patients (4.6+/-2.5) (PAmsterdam Preoperative Anxiety and Information Scale anxiety and knowledge scores were greater for surgery than for anesthesia. Questionnaire results showed that the most common anxieties were waiting for surgery, physical/mental harm, and results of the operation. In conclusion, our study showed that neurosurgical patients have high levels of anxiety, with a higher incidence in females. There was a moderately high need for information, particularly in patients with a high level of preoperative anxiety.

  19. Renal arteriography

    ... Read More Acute arterial occlusion - kidney Acute kidney failure Aneurysm Atheroembolic renal disease Blood clots Renal cell carcinoma Renal venogram X-ray Review Date 1/5/2016 Updated by: Jason Levy, ...

  20. Validation of the Spanish version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS)

    Vergara-Romero, Manuel; Morales-Asencio, Jos? Miguel; Morales-Fern?ndez, Angelines; Canca-Sanchez, Jose Carlos; Rivas-Ruiz, Francisco; Reinaldo-Lapuerta, Jose Antonio


    Background Preoperative anxiety is a frequent and challenging problem with deleterious effects on the development of surgical procedures and postoperative outcomes. To prevent and treat preoperative anxiety effectively, the level of anxiety of patients needs to be assessed through valid and reliable measuring instruments. One such measurement tool is the Amsterdam Preoperative Anxiety and Information Scale (APAIS), of which a Spanish version has not been validated yet. Objective To perform a ...

  1. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) - the first trial of a German version

    Berth, H; Petrowski, K; Balck, F


    Objective: Preoperative anxiety influences the result of the treatment in patients. To assess preoperative anxiety the Amsterdam Preoperative Anxiety and Information Scale (APAIS) was developed. The APAIS measures anxiety and the need-for-information with 6 items, with good reliability and validity. This article presents the first test of the German version of this screening instrument.Methods: The German version of the APAIS was tested on 68 patients questioned before surgery on the lower...

  2. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) - the first trial of a German version

    Berth, Hendrik; Petrowski, Katja; Balck, Friedrich


    Objective: Preoperative anxiety influences the result of the treatment in patients. To assess preoperative anxiety the Amsterdam Preoperative Anxiety and Information Scale (APAIS) [1] was developed. The APAIS measures anxiety and the need-for-information with 6 items, with good reliability and validity. This article presents the first test of the German version of this screening instrument. Methods: The German version of the APAIS was tested on 68 patients questioned before surgery on the low...

  3. Reference Genes for Gene Expression Analysis by Real-time Reverse Transcription Polymerase Chain Reaction of Renal Cell Carcinoma

    Bjerregaard, Henriette; Pedersen, Shona; Kristensen, Søren Risom


    Differentiation between malignant renal cell carcinoma and benign oncocytoma is of great importance to choose the optimal treatment. Accurate preoperative diagnosis of renal tumor is therefore crucial; however, existing imaging techniques and histologic examinations are incapable of providing...

  4. Vascular Variations and Anastomosis Techniques in Renal Transplant Donors

    ilker Murat Arer


    Conclusion: Preoperative evaluation of renal vasculature of transplant donors is an important issue in means of decreasing peroperative vascular complications and decision for nephrectomy site. [Cukurova Med J 2015; 40(3.000: 542-546

  5. [Renal angiomyolipoma complicated by retroperitoneal hematoma].

    Rabii, R; Fekak, H; Moufid, K; Joual, A; Benjelloun, S; Khaleq, K; Idali, B; Harti, A; Barrou, L


    Renal angiomyolipoma (AML) is a benign tumor, they are generally asymptomatic or can manifested by abdominal pain, palpable mass or hematuria. We report an uncommoun case of 65 years old women who consulted for retroperitoneal hemorrhage by spontaneous rupture of renal AML with palpable mass. The ultrasound and CT abdominopelvic scan were performed in the preoperative diagnosis and showed a typical right renal AML with retroperitoneal hematoma. The right nephrectomy by transperitoneal approach was performed with a good follow-up. The histological examination confirmed the diagnosis for renal AML. About this case, the authors discuses the diagnosis and the management for AML with retroperitoneal hemorrhage.

  6. Ureteropelvic junction obstruction: the effect of pyeloplasty on renal function

    Dowling, K.J.; Harmon, E.P.; Ortenberg, J.; Polanco, E.; Evans, B.B.


    We studied preoperatively and postoperatively 41 children who underwent pyeloplasty for correction of unilateral ureteropelvic junction obstruction. Conventional radiological studies and quantitative radioiodine hippurate renal scans were obtained to assess the effect of pyeloplasty on the appearance of the kidney and its function. Analysis of the data suggests that the degree of improvement in renal function is related primarily to the age at which the surgical correction is accomplished and whether infection has occurred preoperatively.

  7. Preoperative Planning of Orthopedic Procedures using Digitalized Software Systems.

    Steinberg, Ely L; Segev, Eitan; Drexler, Michael; Ben-Tov, Tomer; Nimrod, Snir


    The progression from standard celluloid films to digitalized technology led to the development of new software programs to fulfill the needs of preoperative planning. We describe here preoperative digitalized programs and the variety of conditions for which those programs can be used to facilitate preparation for surgery. A PubMed search using the keywords "digitalized software programs," "preoperative planning" and "total joint arthroplasty" was performed for all studies regarding preoperative planning of orthopedic procedures that were published from 1989 to 2014 in English. Digitalized software programs are enabled to import and export all picture archiving communication system (PACS) files (i.e., X-rays, computerized tomograms, magnetic resonance images) from either the local working station or from any remote PACS. Two-dimension (2D) and 3D CT scans were found to be reliable tools with a high preoperative predicting accuracy for implants. The short learning curve, user-friendly features, accurate prediction of implant size, decreased implant stocks and low-cost maintenance makes digitalized software programs an attractive tool in preoperative planning of total joint replacement, fracture fixation, limb deformity repair and pediatric skeletal disorders.

  8. Preoperative alcoholism and postoperative morbidity

    Tonnesen, H; Kehlet, H


    BACKGROUND: Preoperative risk assessment has become part of daily clinical practice, but preoperative alcohol abuse has not received much attention. METHODS: A Medline search was carried out to identify original papers published from 1967 to 1998. Relevant articles on postoperative morbidity...... in alcohol abusers were used to evaluate the evidence. RESULTS: Prospective and retrospective studies demonstrate a twofold to threefold increase in postoperative morbidity in alcohol abusers, the most frequent complications being infections, bleeding and cardiopulmonary insufficiency. Wound complications...... to postoperative morbidity. CONCLUSION: Alcohol consumption should be included in the preoperative assessment of likely postoperative outcome. Reduction of postoperative morbidity in alcohol abusers may include preoperative alcohol abstinence to improve organ function, or perioperative alcohol administration...

  9. Reliability of CT in preoperative evaluation of bladder carcinoma

    Nurmi, M.; Puntala, P. (Univ. of Turku (Finland). Dept. of Surgery); Katevuo, K. (Univ. of Turku (Finland). Dept. of Radiology)


    Sixty patients with bladder carcinoma were examined by CT prior to radical cystectomy. CT indicated perivesical tumor growth or extension to neighboring organs correctly in 60 % of the cases. Overstaging was observed in 23% and understaging in 8 % of the cases. Most of the difficulties concerned assessment of tumors in the anterior bladder wall and identification of the plane between the bladder and the seminal vesicle. In most instances CT provided no supplementary information to clinical staging, but was useful when obesity or previous irradiation impeded clinical staging. (authors).

  10. Perioperative acute renal failure.

    Mahon, Padraig


    PURPOSE OF REVIEW: Recent biochemical evidence increasingly implicates inflammatory mechanisms as precipitants of acute renal failure. In this review, we detail some of these pathways together with potential new therapeutic targets. RECENT FINDINGS: Neutrophil gelatinase-associated lipocalin appears to be a sensitive, specific and reliable biomarker of renal injury, which may be predictive of renal outcome in the perioperative setting. For estimation of glomerular filtration rate, cystatin C is superior to creatinine. No drug is definitively effective at preventing postoperative renal failure. Clinical trials of fenoldopam and atrial natriuretic peptide are, at best, equivocal. As with pharmacological preconditioning of the heart, volatile anaesthetic agents appear to offer a protective effect to the subsequently ischaemic kidney. SUMMARY: Although a greatly improved understanding of the pathophysiology of acute renal failure has offered even more therapeutic targets, the maintenance of intravascular euvolaemia and perfusion pressure is most effective at preventing new postoperative acute renal failure. In the future, strategies targeting renal regeneration after injury will use bone marrow-derived stem cells and growth factors such as insulin-like growth factor-1.

  11. 纽曼系统护理模式对 B 超引导下肾穿刺活检术患者术前焦虑及术后并发症的影响%Influence of the Neuman nursing model on preoperative anxiety and postoperative complications in patients undergoing ;ultrasound guided renal biopsy puncture

    尹华; 欧阳涵; 王赟


    目的:探讨纽曼系统护理模式对B超引导下肾穿刺活检术(PRB)患者术前焦虑及术后并发症的影响。方法将100例B超引导下PRB患者采用随机数字表法分为干预组(49例)及对照组(51例),对照组患者采用常规护理模式,干预组患者护理方法采用纽曼系统护理模式,观察两组患者Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)评分的变化及并发症发生情况。结果干预组SAS、SDS评分较治疗前明显降低,且明显低于对照组;干预组血尿、发热、肾周血肿、腰背疼痛、24 h内排尿困难及穿刺失败的发生例数均明显少于对照组。结论纽曼系统护理模式可较好地缓解肾穿刺患者术前焦虑情况,并有效降低术后并发症发生率。%Objective To investigate the influence of the Neuman nursing model on the preoperative anxiety and the postoperative complications in the patients with ultrasound guided renal biopsy puncture .Methods Totals of 100 cases of patients with renal biopsy puncture by ultrasound guided were randolIlly divided into intervention group and control group ,there are 49 patients in intervention group and 51 patients in control group .ontrol group received the usual care measulres ,while intervention group received Neuman systems model for care .After the intervention , we observe the variation of the Self‐Rating Anxiety Scale (SAS) and Self‐ratingdepressionscale (SDS) .Results The SAS and SDS score of intervention group was lower than the before ,and it was also significantly lower than the sanle time of control group ,the difference was statistically significant .The incidence of complications in intervention group such as the hematuria ,fever ,kidney hematoma ,lower back pain ,24 h of difficulty urinating and puncture failure were significantly less than that in control group .Conclusion The Newman system care model can effectively control anxi‐ety efect and the

  12. The Role of Adrenalectomy in Renal Cancer.

    Weight, Christopher J; Mulders, Peter F; Pantuck, Allan J; Thompson, R Houston


    Since the 1960s, routine ipsilateral adrenalectomy (IA) has been considered an integral step in the removal of renal tumors as a part of a radical nephrectomy. However, recent data from the past decade have narrowed the indications for adrenalectomy and called into question the need for adrenalectomy at all in the treatment of renal cell carcinoma (RCC). We sought to identify the role of adrenalectomy in the treatment of RCC. Specifically, we wanted to answer the following questions: What is the incidence of ipsilateral adrenal involvement by cancer? How reliable is preoperative imaging? What is the rate of ipsilateral and contralateral metachronous recurrence? And finally, what are the potential noncancer sequelae from unnecessary removal of the adrenal gland? A systematic literature search of Embase, PubMed, Cochrane, and Ovid Medline was performed to identify studies evaluating the role of adrenalectomy during RCC surgery. Only articles published in English from the years 2000-2015 were included. Case reports, articles about primary adrenal tumors, letters to the editor, and surgical technique papers were excluded. We found little evidence to suggest that routine IA is associated with a higher risk of short-term surgical or medical complications. We did not find evidence that IA is associated with improved cancer control. Tomographic preoperative imaging of the adrenal gland demonstrating no cancer involvement is rarely wrong (<1% of the time), and the few adrenal lesions missed on imaging can often be identified intraoperatively. Some evidence indicates that IA may be associated with worse long-term survival. Adrenalectomy rates have been decreasing in recent years, reflecting a changing practice pattern. IA at the time of kidney surgery for a renal mass should be performed only if radiographic or intraoperative evidence indicates adrenal gland involvement. We sought to define the role of adrenalectomy in patients with kidney cancer. Although there are not high

  13. Current and novel renal biomarkers in heart failure

    Damman, Kevin; Voors, Adriaan A.; Navis, Gerjan; van Veldhuisen, Dirk J.; Hillege, Hans L.


    Renal function is the most important predictor of clinical outcome in heart failure (HF). It is therefore essential to have accurate and reliable measurement of renal function and early specific markers of renal impairment in patients with HF. Several renal functional entities exist, including glome

  14. Translation and validation of the Amsterdam preoperative anxiety and information scale (APAIS) for use in Japan.

    Nishimori, Mina; Moerman, Nelly; Fukuhara, Shunichi; van Dam, F S A M; Muller, M J; Hanaoka, Kazuo; Yamada, Yoshitsugu


    Preoperative anxiety is a very common phenomenon that adversely affects a patient's physical and psychological outcome. To evaluate subjective complaints such as anxiety, use of a validated psychological instrument is essential. In this study, we translated, culturally adapted and validated the Amsterdam preoperative anxiety and information scale (APAIS) for use in Japan. One hundred and twenty-six preoperative patients participated in this cross-sectional study. The psychometric properties of the APAIS evaluated by factor analysis, correlation with the state-trait anxiety inventory (STAI) and Cronbach's alpha were very similar to those of the original Dutch and English versions. Female gender and a high information requirement were associated with high preoperative anxiety. In conclusion, the Japanese version of the APAIS is a valid and reliable instrument for screening Japanese patients for preoperative anxiety and information requirements. Female gender and high information requirement may be associated with high preoperative anxiety.

  15. Renal Osteodystrophy

    Aynur Metin Terzibaşoğlu


    Full Text Available Chronic renal insufficiency is a functional definition which is characterized by irreversible and progressive decreasing in renal functions. This impairment is in collaboration with glomeruler filtration rate and serum creatinine levels. Besides this, different grades of bone metabolism disorders develop in chronic renal insufficiency. Pathologic changes in bone tissue due to loss of renal paranchyme is interrelated with calcium, phosphorus vitamine-D and parathyroid hormone. Clinically we can see high turnover bone disease, low turnover bone disease, osteomalacia, osteosclerosis and osteoporosis in renal osteodystropy. In this article we aimed to review pathology of bone metabolism disorders due to chronic renal insufficiency, clinic aspects and treatment approaches briefly.

  16. Outcomes following cardiac surgery in patients with preoperative renal dialysis.

    Vohra, Hunaid A; Armstrong, Lesley A; Modi, Amit; Barlow, Clifford W


    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was that whether patients who are dependent on chronic dialysis have higher morbidity and mortality rates than the general population when undergoing cardiac surgery. These patients often require surgery in view of their heightened risk of cardiac disease. Altogether 278 relevant papers were identified using the below mentioned search, 16 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. Dialysis-dependent (DD) patients undergoing coronary artery bypass grafting (CABG) or valve replacement have higher morbidity but acceptable outcomes. There is some evidence to show that outcomes after off-pump coronary artery bypass grafting (OPCAB) are better than after on-pump coronary artery bypass grafting (ONCAB) and that results are worse in DD patients with diabetic nephropathy. Patients undergoing combined procedures have a higher mortality.

  17. Interventions for preoperative smoking cessation

    Thomsen, Thordis; Villebro, Nete; Møller, Ann Merete


    : Randomized controlled trials that recruited people who smoked prior to surgery, offered a smoking cessation intervention, and measured preoperative and long-term abstinence from smoking or the incidence of postoperative complications or both outcomes. DATA COLLECTION AND ANALYSIS: The review authors......BACKGROUND: Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. OBJECTIVES: The objectives of this review...... are to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively, and on the incidence of postoperative complications. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group Specialized Register in January 2014. SELECTION CRITERIA...

  18. Preoperative staging of rectal cancer.

    Smith, Neil; Brown, Gina


    Detailed preoperative staging using high resolution magnetic resonance imaging (MRI) enables the selection of patients that require preoperative therapy for tumour regression. This information can be used to instigate neoadjuvant therapy in those patients with poor prognostic features prior to disturbing the tumour bed and potentially disseminating disease. The design of trials incorporating MR assessment of prognostic factors prior to therapy has been found to be of value in assessing treatment modalities and outcomes that are targeted to these preoperative prognostic subgroups and in providing a quantifiable assessment of the efficacy of particular chemoradiation treatment protocols by comparing pre-treatment MR staging with post therapy histology assessment. At present, we are focused on achieving clear surgical margins of excision (CRM) to avoid local recurrence. We recommend that all patients with rectal cancer should undergo pre-operative MRI staging. Of these, about half will have good prognosis features (T1-T3b, N0, EMVI negative, CRM clear) and may safely undergo primary total mesorectal excision. Of the remainder, those with threatened or involved margins will certainly benefit from pre-operative chemoradiotherapy with the aim of downstaging to permit safe surgical excision. In the future, our ability to recognise features predicting distant failure, such as extramural vascular invasion (EMVI) may be used to stratify patients for neo-adjuvant systemic chemotherapy in an effort to prevent distant relapse. The optimal pre-operative treatment regimes for these patients (radiotherapy alone, systemic chemotherapy alone or combination chemo-radiotherapy) is the subject of current and future trials.

  19. Preoperative CT-Angiography Predicts Ex Vivo Vein Length for Right Kidneys After Laparoscopic Donor Nephrectomy

    Özdemir-van Brunschot, D.M.D.; Rottier, S.J.; Ouden, J.E. den; Jagt, M.F.P. van der; D'Ancona, F.C.H.; Kloke, H.J.; Vliet, D. van der; Schultze Kool, L.J.; Warle, M.C.


    BACKGROUND Implantation of a kidney with a short renal vein is technically more challenging and therefore prone for technique-related complications. It remains unclear whether pre-operative computed tomography angiography (CTA), to assess vascular anatomy of the donor kidney, can be used to predict

  20. Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review

    Møller, Morten Hylander; Adamsen, Sven; Thomsen, Reimar Wernich


    metabolic acidosis, tachycardia, acute renal failure, low serum albumin level, high American Society of Anaesthesiologists score, and preoperative delay >24 h were associated with poor prognosis. Conclusions. In patients with PPU, a number of negative prognostic factors can be identified prior to surgery......, and many of these seem to be related to presence of the sepsis syndrome...

  1. Preoperative calculation of risk for prolonged intensive care unit stay following coronary artery bypass grafting

    Dihmis Walid C


    Full Text Available Abstract Objective Patients who have prolonged stay in intensive care unit (ICU are associated with adverse outcomes. Such patients have cost implications and can lead to shortage of ICU beds. We aimed to develop a preoperative risk prediction tool for prolonged ICU stay following coronary artery surgery (CABG. Methods 5,186 patients who underwent CABG between 1st April 1997 and 31st March 2002 were analysed in a development dataset. Logistic regression was used with forward stepwise technique to identify preoperative risk factors for prolonged ICU stay; defined as patients staying longer than 3 days on ICU. Variables examined included presentation history, co-morbidities, catheter and demographic details. The use of cardiopulmonary bypass (CPB was also recorded. The prediction tool was tested on validation dataset (1197 CABG patients between 1st April 2003 and 31st March 2004. The area under the receiver operating characteristic (ROC curve was calculated to assess the performance of the prediction tool. Results 475(9.2% patients had a prolonged ICU stay in the development dataset. Variables identified as risk factors for a prolonged ICU stay included renal dysfunction, unstable angina, poor ejection fraction, peripheral vascular disease, obesity, increasing age, smoking, diabetes, priority, hypercholesterolaemia, hypertension, and use of CPB. In the validation dataset, 8.1% patients had a prolonged ICU stay compared to 8.7% expected. The ROC curve for the development and validation datasets was 0.72 and 0.74 respectively. Conclusion A prediction tool has been developed which is reliable and valid. The tool is being piloted at our institution to aid resource management.

  2. Renal transplantation in a child with thrombosed inferior vena cava

    Surjeet Kumar


    Full Text Available The external iliac vein is commonly used in renal transplantation for vascular anastomosis of the allograft renal vein. However, there are rare instances when the transplant surgeon may encounter thrombosis of the ilio-caval vein during surgery, making renal transplantation a challenge. Often, these patients are considered unsuitable for renal transplantation. We report a case of thrombosis of the inferior vena cava in an asymptomatic pediatric patient in whom the splenic vein was used, at transplantation, for venous drainage. This case highlights that pre-operative Doppler screening should be performed in all potential renal transplant recipients.

  3. Impact of mild renal impairment on early postoperative mortality after open cardiac surgery

    Ghani A


    Full Text Available Preoperative severe renal impairment is included in the risk scores to predict out-come after open cardiac surgery. The purpose of this study was to assess the impact of pre-operative mild renal impairment on the early postoperative mortality after open heart surgery. Data of all cases of open cardiac surgery performed from January 2005 to June 2006 were collec-ted. Cases with preoperative creatinine clearance below 60 mL/min were excluded from the study. Data were retrospectively analyzed to find the impact of renal impairment on short-term outcome. Of the 500 cases studied, 47 had preoperative creatinine clearance between 89-60 mL/min. The overall mortality in the study cases was 6.8%. The mortality was 28.7% in those who developed postoperative ARF, 33.3% in those who required dialysis and 40.8% in those with preoperative mild renal impairment. Binary logistic regression analysis showed that female gender (P = 0.01, preoperative mild renal impairment (P = 0.007 as well as occurrence of multi organ failure (P < 0.001 were the only independent variables determining the early postoperative mortality after cardiac surgeries. Among them, preoperative mild renal impairment was the most significant and the best predictor for early postoperative mortality after cardiac surgery. Our study suggests that renal impairment remains a strong predictor of early mortality even after adjustment for several confounders.

  4. Non-contrast magnetic resonance angiography in renal transplantation and renal donation

    Blankholm, Anne Dorte


    examination of living kidney donors. We compared CTA to an extensive MRI protocol without the use of contrast agents, including NCMRA, and to observations from living donor nephrectomy, which served as the reference standard. We concluded that an optimised MRI protocol without contrast agents could...... be substituted for CTA for preoperative vessel assessment in living kidney donors.......Renal transplantation is the treatment of choice in cases of severe renal disease. The majority of candidates for kidney transplantation have arteriosclerosis to some extent; thus, preoperative imaging of the vessels is needed. Different imaging modalities are available and are used...

  5. Renal perfusion scintiscan

    Renal perfusion scintigraphy; Radionuclide renal perfusion scan; Perfusion scintiscan - renal; Scintiscan - renal perfusion ... supply the kidneys. This is a condition called renal artery stenosis. Significant renal artery stenosis may be ...

  6. Anxiety in preoperative anesthetic procedures.

    Valenzuela Millán, Jaquelyn; Barrera Serrano, José René; Ornelas Aguirre, José Manuel


    Preoperative anxiety is a common and poorly evaluated condition in patients who will undergo an anesthetic and surgical intervention. The objective of this study was to determine the prevalence of anxiety in a group of patients undergoing elective surgery, as assessed by the Amsterdam Anxiety Preoperative and Information (AAPI) scale. We studied 135 patients scheduled for elective surgery applying the AAPI scale 24 h before the surgical procedure to evaluate the presence of anxiety and patient characteristics. A descriptive analysis with mean +/- standard deviation for categorical variables was done. For intragroup differences, chi(2) test was used. Pearson correlation for the association between anxiety and postoperative complications was carried out. A value of p =0.05 was considered significant. One hundred six patients were surgically treated, 88% were female (average age 44 +/- 12 years). Some degree of preoperative anxiety was present in 72 patients (76%; p = 0.001) with a grade point average on the AAPI scale equal to 17 +/- 7 points, of which 95 (70%, OR = 5.08; p = 0.002) were females. Results of this study suggest the presence of high levels of preoperative anxiety in patients scheduled for elective surgery. The origin of the anxiety appears to be related to many factors that can be evaluated in pre-anesthetic consultation. Further study is needed to prevent the presence of this disorder.

  7. Primary renal primitive neuroectodermal tumor.

    Goel, V; Talwar, V; Dodagoudar, C; Singh, S; Sharma, A; Patnaik, N


    Primitive Neuroectodermal Tumor of the kidney is a rare entity. Very few cases of primary renal PNET have been reported to date. Most literature about rPNET is isolated case reports. We report a case of rPNET in a 39-year-old male with a pre-operative diagnosis of renal cell carcinoma with renal vein thrombosis. The patient underwent radical nephrectomy with thrombolectomy, and histopathological examination revealed a highly aggressive tumor composed of monotonous sheets of round cells. Tumor cells were positive for CD 99 and FLI-1, hence confirming the diagnosis of Primitive Neuroectodermal Tumor. Post-surgery, patient was given VAC/IE-based adjuvant chemotherapy. In view of highly aggressive nature of this tumor, prompt diagnosis and imparting effective chemotherapy regimen to the patient is required, and it is important to differentiate PNET from other small round-cell tumors because of different therapeutic approach.

  8. Renal Function Recovery after Nephrectomy or Nephron-Sparing Surgery in Children with Unilateral Renal Tumor.

    Cozzi, Denis A; Ceccanti, Silvia; Cozzi, Francesco


    Introduction Children with unilateral renal tumor (URT) and preoperative renal dysfunction (PRD) may benefit from nephron-sparing surgery (NSS). To test this hypothesis, we studied the outcome of baseline renal function after nephrectomy or NSS among children with URT. Materials and Methods Retrospective records review of children with URT who underwent nephrectomy (25 children) or NSS (11 children) at our institution. We analyzed the estimated glomerular filtration rate (eGFR) changes over time among patients, stratified by both preoperative renal function (with or without PRD) and surgical extent (NSS vs. nephrectomy). The primary end point was evaluation of compensatory recovery of preoperative eGFR after surgery. Only children older than 2 years at surgery were included in the study. Renal dysfunction was defined as an eGFR  100 mL/min/1.73 m(2), respectively, achieved or maintained two-kidney eGFR values (T-KEV) (p = 0.01). After NSS, four adolescent patients with PRD and seven without PRD achieved or maintained T-KEV. Conclusion The majority of children with URT and low baseline eGFR present with an impaired renal function recovery after nephrectomy and may benefit from NSS. Collaborative studies are needed to support present findings. Georg Thieme Verlag KG Stuttgart · New York.

  9. Preoperative anxiety in surgical patients - experience of a single unit.

    Matthias, Anne Thushara; Samarasekera, Dharmanbandhu Nandadeva


    Preoperative anxiety has a significant effect on the outcome of anesthesia and surgery. At present, there is no published data on the preoperative anxiety levels in Sri Lankan patients. In the West, several validated questionnaires such as The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and State Trait Anxiety Inventory (STAI) are used. To measure the preoperative anxiety levels in patients using APAIS and to analyze the factors affecting anxiety and the role played by the anesthetist in allaying anxiety. One hundred patients scheduled for elective surgery were prospectively studied using the APAIS. The internal consistency was checked using Cronbach's alpha. The ages varied 25 to 72 years (mean=48.7 years, SD=13.6). Reliability of the APAIS was high; Cronbach's alpha=0.864 in the overall component and 0.84, 0.73 and 0.97 in the anxiety related to surgery, anesthesia and in the information desire components, respectively. Females were more anxious than males (p=0.02) and those who had never sustained surgery were more anxious than those who previously had surgery (p=0.05). An anesthetist's visit and premedication reduced total anxiety scores (Z=-3.07, p=0.002) and anesthesia related anxiety scores (Z=-3.45, p=0.001). The prevalence of anxiety is high among Sri Lankan patients. Females are more anxious than males and those who have never had surgery are more anxious than those who have had surgery. The anesthetist's visit could reduce anxiety. Sinhala version of the APAIS is highly reliable in assessing the preoperative anxiety levels. Copyright © 2012. Published by Elsevier B.V.

  10. An analysis of preoperative localization of parathyroid glands in hyperparathyroidism associated with thyroid diseases

    Komatsu, Makoto; Inoue, Kazuaki [Fujimi-kogen Hospital, Nagano (Japan); Itoh, Atsuko


    Recently hyperparathyroidism associated with some thyroid diseases, especially nonmedually thyroid carcinoma has been payed attention to. In this study we analyzed 12 cases of hyperparathyroidism (6 cases independent of thyroid diseases and 6 cases associated with thyroid diseases) and estimated the affect of association with thyroid diseases on the preoperative localization of the parathyroid glands. The results of preoperative localization of the parathyroid glands in cases independent of thyroid diseases were relatively satisfactory. On the other hand, the preoperative localization in cases associated with thyroid diseases came to false result in about half of them. It was far from satisfactory. Association of thyroid diseases strongly affected the preoperative localization of the parathyroid glands in hyperparathyroidism. Conventional imaging such as ultrasonography, CT, MRI and {sup 201}Tl-{sup 99m}TC subtraction scintigraphy alone were not satisfactory. Now {sup 99m}Tc-MIBI scintigraphy is expected to be one of reliable imaging methods for progress in the preoperative localization. (author)

  11. [Preoperative fasting guidelines: an update].

    López Muñoz, A C; Busto Aguirreurreta, N; Tomás Braulio, J


    Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Interventions for preoperative smoking cessation

    Thomsen, Thordis; Villebro, Nete; Møller, Ann Merete


    and keywords (surgery) or (operation) or (anaesthesia) or (anesthesia). MEDLINE, EMBASE and CINAHL were also searched, combining tobacco- and surgery-related terms. Most recent search April 2010. Selection criteria Randomized controlled trials that recruited people who smoked prior to surgery, offered......Background Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. Objectives The objective of this review...... was to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively and on the incidence of postoperative complications. Search strategy The specialized register of the Cochrane Tobacco Addiction Group was searched using the free text...

  13. Interventions for preoperative smoking cessation

    Thomsen, Thordis; Villebro, N.; Møller, Ann Merete;


    Background Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. Objectives The objective of this review...... was to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively and on the incidence of postoperative complications. Search strategy The specialized register of the Cochrane Tobacco Addiction Group was searched using the free text......; pooled RR 10.76 (95% confidence interval (CI) 4.55 to 25.46, two trials) and RR 1.41 (95% CI 1.22 to 1.63, five trials) respectively. Four trials evaluating the effect on long-term smoking cessation found a significant effect; pooled RR 1.61 (95% CI 1.12 to 2.33). However, when pooling intensive...


    A. V. Govorov


    Full Text Available Renal cryoablation is an alternative minimally-invasive method of treatment for localized renal cell carcinoma. The main advantages of this methodology include visualization of the tumor and the forming of "ice ball" in real time, fewer complications compared with other methods of treatment of renal cell carcinoma, as well as the possibility of conducting cryotherapy in patients with concomitant pathology. Compared with other ablative technologies cryoablation has a low rate of repeat sessions and good intermediate oncological results. The studies of long-term oncological and functional results of renal cryoablation are presently under way.

  15. Renal angiomyolipoma

    Holm-Nielsen, P; Sørensen, Flemming Brandt


    lesion. Three cases of renal angiomyolipoma, 2 of which underwent perfusion-fixation, were studied by electron microscopy to clarify the cellular composition of this lesion. In the smooth muscle cells abundant accumulation of glycogen was found, whereas the lipocytes disclosed normal ultrastructural......-specific vesicular structures. These findings suggest a secondary vascular damage, i.e. the thickened vessels may not be a primary, integral part of renal angiomyolipoma. Evidence of a common precursor cell of renal angiomyolipoma was not disclosed. It is concluded that renal angiomyolipoma is a hamartoma composed...

  16. Renal Function Recovery with Total Artificial Heart Support.

    Quader, Mohammed A; Goodreau, Adam M; Shah, Keyur B; Katlaps, Gundars; Cooke, Richard; Smallfield, Melissa C; Tchoukina, Inna F; Wolfe, Luke G; Kasirajan, Vigneshwar


    Heart failure patients requiring total artificial heart (TAH) support often have concomitant renal insufficiency (RI). We sought to quantify renal function recovery in patients supported with TAH at our institution. Renal function data at 30, 90, and 180 days after TAH implantation were analyzed for patients with RI, defined as hemodialysis supported or an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m. Between January 2008 and December 2013, 20 of the 46 (43.5%) TAH recipients (age 51 ± 9 years, 85% men) had RI, mean preoperative eGFR of 48 ± 7 ml/min/1.73 m. Renal function recovery was noted at each follow-up interval: increment in eGFR (ml/min/1.73 m) at 30, 90, and 180 days was 21 ± 35 (p = 0.1), 16.5 ± 18 (p = 0.05), and 10 ± 9 (p = 0.1), respectively. Six patients (30%) required preoperative dialysis. Of these, four recovered renal function, one remained on dialysis, and one died. Six patients (30%) required new-onset dialysis. Of these, three recovered renal function and three died. Overall, 75% (15 of 20) of patients' renal function improved with TAH support. Total artificial heart support improved renal function in 75% of patients with pre-existing significant RI, including those who required preoperative dialysis.

  17. MEMS reliability

    Hartzell, Allyson L; Shea, Herbert R


    This book focuses on the reliability and manufacturability of MEMS at a fundamental level. It demonstrates how to design MEMs for reliability and provides detailed information on the different types of failure modes and how to avoid them.

  18. Preoperative embolization of a giant neurofibroma of the chest in a patient with neurofibromatosis type II: A case report

    Bae, Suk Hyun [Dept. of Radiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang (Korea, Republic of); Shin, Jong Soo [Dept. of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul (Korea, Republic of)


    Giant plexiform neurofibromas, which are rare in patients with neurofibromatosis type II (NFII), are difficult to manage surgically, as they are extensively infiltrative and highly vascularized. Preoperative embolization is performed to reduce intraoperative blood loss and operative time, increase resectability of lesions, and improve visualization of the operative field during surgery of hypervascular tumors such as renal cell carcinoma and intracranial meningioma. Preoperative intravascular embolization of a giant chest wall neurofibroma has not been reported in the English literature. We report successful treatment of a giant chest wall neurofibroma in a 45-year-old male with NFII by preoperative intravascular embolization followed by surgical resection.

  19. The Amsterdam Preoperative Anxiety and Information Scale (APAIS)

    Moerman, N; van Dam, F S; Muller, M J; Oosting, H


    The purpose of the present study was to assess patients' anxiety level and information requirement in the preoperative phase. During routine preoperative screening, 320 patients were asked to assess their anxiety and information requirement on a six-item questionnaire, the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Two hundred patients also completed Spielberger's State-Trait Anxiety Inventory (STAI-State). Patients were able to complete the questionnaire in less than 2 min. On factor analysis, two factors emerged clearly: anxiety and the need for information. The anxiety scale correlated highly (0.74) with the STAI-State. It emerged that 32% of the patients could be considered as "anxiety cases" and over 80% of patients have a positive attitude toward receiving information. Moreover, results demonstrated that 1) women were more anxious that men; 2) patients with a high information requirement also had a high level of anxiety; 3) patients who had never undergone an operation had a higher information requirement than those who had. The APAIS can provide anesthesiologists with a valid, reliable, and easily applicable instrument for assessing the level of patients' preoperative anxiety and the need for information.

  20. Estimating glomerular filtration rate preoperatively for patients undergoing hepatectomy

    Yoshimi Iwasaki; Tokihiko Sawada; Shozo Mori; Yukihiro Iso; Masato Katoh; Kyu Rokkaku; Junji Kita; Mitsugi Shimoda; Keiichi Kubota


    AIM: To compare creatinine clearance (Ccr) with estimated glomerular filtration rate (eGFR) in preoperative renal function tests in patients undergoing hepatectomy. METHODS: The records of 197 patients undergoing hepatectomy between August 2006 and August 2008 were studied, and preoperative Ccr, a three-variable equation for eGFR (eGFR3) and a five-variable equation for eGFR (eGFR5) were calculated. Abnormal values were defined as Ccr < 50 mL/min, eGFR3 and eGFR5 < 60 mL/min per 1.73 m2. The maximum increases in the postoperative serum creatinine (post Cr) level and postoperative rate of increase in the serum Cr level (post Cr rate) were compared. RESULTS: There were 37 patients (18.8%) withabnormal Ccr, 31 (15.7%) with abnormal eGFR3, and 40 (20.3%) with abnormal eGFR5. Although there were no significant differences in the post Cr rate between patients with normal and abnormal Ccr, eGFR3 and eGFR5 values, the post Cr level was significantly higher in patients with eGFR3 and eGFR5 abnormality than in normal patients ( P < 0.0001). Post Cr level tended to be higher in patients with Ccr abnormality ( P = 0.0936 and P = 0.0875, respectively). CONCLUSION: eGFR5 and the simpler eGFR3, rather than Ccr, are recommended as a preoperative renal function test in patients undergoing hepatectomy.

  1. Glomerular Filtration Rate Estimation in Renal and Non-Renal Solid Organ Transplantation

    Hornum, Mads; Feldt-Rasmussen, Bo


    Following transplantation (TX) of both renal and non-renal organs, a large proportion of patients have renal dysfunction. There are multiple causes for this. Chronic nephrotoxicity and high doses of calcineurin inhibitors are important factors. Preoperative and perioperative factors like...... hypertension, hypotension, drugs and infections may play a causative role as well. Organ-specific causes include hepatorenal syndrome, cirrhosis, low cardiac function, low respiratory function and diabetes developed both before and after TX. It is important to be able to perform precise and valid measurements...

  2. Evaluation of Renal Histopathological Changes, as a Predictor of Recoverability of Renal Function Following Pyeloplasty for Ureteropelvic Junction Obstruction



    Full Text Available Background Pyeloplasty is a widely accepted treatment for ureteropelvic junction obstruction (UPJO. However, the renal function recoverability after pyeloplasty is still a matter of debate. Different parameters have been used to predict renal functional recoverability after corrective surgery, with conflicting results. Objectives In this study, renal biopsy was carried on a series of cases of UPJO, during pyeloplasty, to study the extent of histological alterations in renal parenchyma, as a result of obstruction, and its predictive value in renal function recoverability after pyeloplasty. Patients and Methods We retrospectively analyzed the renal biopsy obtained during pyeloplasty in 53 adult patients. Histopathological changes were graded on a scale of 1 to 3, according to their severity, and compared with the differential renal function (DRF revealed on the preoperative and postoperative follow up diethylene triamine pentaacetic acid (DTPA renal scan. A Fischer’s t test was used to evaluate statistical differences between values. Results This study showed a linear relationship between the severity of histological changes and renal function recovery, after pyeloplasty. Out of 24 obstructed renal units (ORU, with minimal histopathological changes (grade I, 21 ORU (87.5%, with > 35% DRF preoperatively, showed significant improvement in renal function after 12 months of pyeloplasty (P 0.05. Renal function deterioration after pyeloplasty was not observed in any of the cases. Conclusions The severity of pathological changes in renal parenchyma, due to UPJO, is a good predictor of renal function recoverability, after pyeloplasty. The ORUs, with DRF > 35%, usually have normal (grade I renal biopsy and might be expected to present better functional recoverability after pyeloplasty.

  3. Cytological Punctures in the Diagnosis of Renal Tumours: A Study on Accuracy and Reproducibility

    Kümmerlin, Intan P E D; Smedts, Frank; ten Kate, Fiebo J W;


    BACKGROUND: Fine needle aspiration (FNA) cytology is under consideration as an auxiliary preoperative diagnostic technique in the diagnosis of renal masses. However, reports for FNA are contradictory with regard to diagnostic accuracy and applicability. OBJECTIVE: To evaluate the diagnostic accur...

  4. Do psychological interventions reduce preoperative anxiety?

    Renouf, Tessa; Leary, Alison; Wiseman, Theresa

    The systematic review investigates whether, during preoperative assessments, nurse-delivered psychological interventions reduce anxiety levels preoperatively for patients undergoing elective surgery. Seventeen studies met the inclusion criteria for data extraction and in-depth critiquing. Of these, two were discarded due to lack of validity, while the remaining studies were organised thematically in a narrative synthesis, generating two principal results: patients' preoperative anxieties were lowered by nurse-delivered general preoperative psychological interventions; and patients valued individualised preoperative interventions delivered by nurses. However, the single oncology study in the review showed an elevation in preoperative anxiety, regardless of intervention, and highlights the need for more research in this under-reviewed area. In the meantime, the authors believe that service improvements should be implemented to ensure that, where possible, psychological preoperative interventions are individualised.

  5. Renal cancer

    Corgna, Enrichetta; Betti, Maura; Gatta, Gemma; Roila, Fausto; De Mulder, Pieter H. M.


    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all acknowle

  6. Renal fallure


    920705 Endothelin and acute renal failure:study on their relationship and possiblemechanisms. LIN Shanyan(林善锬), et al.Renal Res Lab, Huashan Hosp, Shanghai MedUniv, Shanghai, 200040. Natl Med J China 1992;72(4): 201-205. In order to investigate the role of endothelin

  7. Renal cancer.

    Corgna, E.; Betti, M.; Gatta, G.; Roila, F.; Mulder, P.H.M. de


    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  8. Renal cancer

    Corgna, Enrichetta; Betti, Maura; Gatta, Gemma; Roila, Fausto; De Mulder, Pieter H. M.


    In Europe, renal cancer (that is neoplasia of the kidney, renal pelvis or ureter (ICD-9 189 and ICD-10 C64-C66)) ranks as the seventh most common malignancy in men amongst whom there are 29,600 new cases each year (3.5% of all cancers). Tobacco, obesity and a diet poor in vegetables are all

  9. Software reliability

    Bendell, A


    Software Reliability reviews some fundamental issues of software reliability as well as the techniques, models, and metrics used to predict the reliability of software. Topics covered include fault avoidance, fault removal, and fault tolerance, along with statistical methods for the objective assessment of predictive accuracy. Development cost models and life-cycle cost models are also discussed. This book is divided into eight sections and begins with a chapter on adaptive modeling used to predict software reliability, followed by a discussion on failure rate in software reliability growth mo

  10. Interventional radiological treatment of renal transplant complications: A pictorial review

    Lezzi, Roberto; La, Torre Michele fabio; Santoro, Marco; Dattesi, Robrta; Nestola, Massimiliano; Posa, Alessandro; Romagnoli, Jacopo; CItterio, Franco; Bonomo, Lorenzo [' A. Gemelli' Hospital - Catholic University, Rome (Italy)


    Renal transplantation is the treatment of choice for patients with chronic renal failure, which produces a dramatic improvement in the quality of life and survival rates, in comparison to long-term dialysis. Nowadays, new imaging modalities allow early diagnosis of complications, and thanks to the recent developments of interventional techniques, surgery may be avoided in most cases. Knowledge in the types of renal transplant complications is fundamental for a correct pre-operative planning. In this article, we described the most common or clinically relevant renal transplant complications and explained their interventional management.

  11. Emergency Transcatheter Arterial Embolization for Acute Renal Hemorrhage.

    Wang, Hong Liang; Xu, Chun Yang; Wang, Hong Hui; Xu, Wei


    The aims of this study were to identify arteriographic manifestations of acute renal hemorrhage and to evaluate the efficacy of emergency embolization. Emergency renal artery angiography was performed on 83 patients with acute renal hemorrhage. As soon as bleeding arteries were identified, emergency embolization was performed using gelatin sponge, polyvinyl alcohol particles, and coils. The arteriographic presentation and the effect of the treatment for acute renal hemorrhage were analyzed retrospectively. Contrast extravasation was observed in 41 patients. Renal arteriovenous fistulas were found in 12 of the 41 patients. In all, 8 other patients had a renal pseudoaneurysm, 5 had pseudoaneurysm rupture complicated by a renal arteriovenous fistula, and 1 had pseudoaneurysm rupture complicated by a renal artery-calyceal fistula. Another 16 patients had tumor vasculature seen on arteriography. Before the procedure, 35 patients underwent renal artery computed tomography angiography (CTA). Following emergency embolization, complete hemostasis was achieved in 80 patients, although persistent hematuria was present in 3 renal trauma patients and 1 patient who had undergone percutaneous nephrolithotomy (justifying surgical removal of the ipsilateral kidney in this patient). Two-year follow-up revealed an overall effective rate of 95.18 % (79/83) for emergency embolization. There were no serious complications. Emergency embolization is a safe, effective, minimally invasive treatment for renal hemorrhage. Because of the diversified arteriographic presentation of acute renal hemorrhage, proper selection of the embolic agent is a key to successful hemostasis. Preoperative renal CTA plays an important role in diagnosing and localizing the bleeding artery.

  12. Clinical study of preoperative selective arterial embolization combined with laparoscopic enucleation of tumor in treatment of renal hamartoma%术前选择性动脉栓塞联合腹腔镜肿瘤剜除术治疗肾错构瘤

    林明恩; 洪英楷; 何学军; 张炜


    s:Objective To study the clinical effect of preoperative selective arterial embolization(SAE)and laparoscopic enucleation of tumor surgery on renal angiomyolipoma(RAML).Methods The clinical data of 52 patients with RAML hospitalized from January 2014 to January 2016 in our hospital were respectively analyzed,of which 22 cases were treated by retroperitoneal laparoscopic enucleation 24 hours after SAE(group SAE),30 cases received laparoscopic enucleation of tumor treatment(non SAE group).The clinical effect of patients be-tween two groups were compared.Results The success rate of tumor enucleating of SAE group was 100%(22/22),which was higher than 66.67%(20/30)of non SAE group,and the difference had statistical significance(P0.05),the Scr of SAE group was significantly lower than that of non SAE group,the difference was significant(P0.05).All of 52 patietns were followed up from 6 months to 24 months,no tumor recurrence after surgery was found.Conclusion SAE combined with laparoscopic enucleation in treatment of RAML can reduce the surgical trauma,improve postoperative rehabilitation and protect renal function,which was safe application.%目的:探讨肾错构瘤(RAML)采用术前选择性动脉栓塞术(SAE)与腹腔镜肿瘤剜除术治疗的临床效果。方法回顾分析2014年1月至2016年1月我院收治的52例RAML患者的临床资料,其中22例患者术前行SAE后24 h内腹腔镜肿瘤剜除术(SAE组),30例患者未行SAE直接行腹腔镜肿瘤剜除术治疗(非SAE组),对比2组的临床效果。结果 SAE组的肿瘤剜除术成功率为100%(22/22),高于非SAE组的66.67%(20/30),差异有统计学意义(P<0.05)。SAE组的术中出血量、手术时间、肾动脉阻断时间、胃肠功能恢复时间均少于非SAE组,差异具有统计学意义(P<0.05),住院时间明显长于非SAE组,差异有统计学意义(P<0.05)。术后3个月,2组eGFR比较

  13. Preoperative localization in primary hyperparathyroidism

    Han, Sanson; Kitamura, Hiroyuki; Takagita, Shin-ichi; Maetani, Toshiki; Iwahashi, Yuka; Miyazaki, Masakazu; Yamamoto, Norio [Tenri Hospital, Nara (Japan)


    Between 1992 and 1996, 31 cases (8 men and 23 women) with primary hyperparathyroidism (PHPT) were treated in our department. In this study, we compared which of the preoperative localization methods was most useful in the detection of PHPT. The sensitivity for detection of abnormal parathyroid glands was 88.6% on ultrasonography (US), 76.9% on magnetic resonance imaging (MRI), 74.3% on Tl-Tc subtraction scintigraphy and 68.8% on computed tomography. We concluded that US should be performed first, with MRI as a supplementary method, for the detection of abnormal parathyroid glands and the evaluation of invasion within the body. (author)

  14. Preoperative Evaluation for Noncardiac Surgery.

    Cohn, Steven L


    This issue provides a clinical overview of preoperative evaluation for noncardiac surgery, focusing on risk factors, elements of evaluation, medication management, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  15. Confiabilidade da previsão da acuidade visual pós-operatória de catarata mediante medição da acuidade visual pré-operatória utilizando o retinômetro Heine Lambda 100 Reliability of predictable postoperative visual acuity of cataracts as measured by Heine Lambda 100 retinometer preoperatively

    Guilherme Novoa Colombo-Barboza


    , from April to July, 2009. In the preoperative period, Heine retinometer test was performed under mydriasis and its results were compared to postoperative best corrected visual acuity three months after surgery and correlated with the morphological classification of cataracts, being considered a satisfactory result those who did not vary more than two lines in Snellen chart. Results: The satisfactory cases found in our study were 86.78%, with results of visual acuity with Heine retinometer equal to the postoperative visual acuity in 34.7% of the cases. Predominant nuclear opacity N1+ has a higher reliability than N2+ and N3+ (50%, 31.3% and 26.7%, respectively. Regarding all studied eyes, statistical significance was noted (p<0.0001. Conclusion: In most cases Heine retinometer underestimated or maintained best corrected visual acuity 3 months postoperatively in patients who underwent cataract surgery. With respect to the morphological classification of cataracts, the higher the opacity of the nuclear lens, the greater the visual acuity underestimation.

  16. Preoperative fasting time in children.

    Adeel, S


    The aim of preoperative fasting is to prevent regurgitation and pulmonary aspiration while limiting potential problems of thirst, dehydration and hypoglycaemia. The American Society of Anaesthesiologists (ASA) has suggested guidelines for preoperative fasting for children undergoing elective surgery. We did a postal survey to determine the current practice regarding these guidelines amongst all specialist registrars in anaesthesia in Ireland. A questionnaire was sent to all specialist registrars in anaesthesia (90 in total), 60 (67%) were returned and analysed. The question asked was how long children should be kept fasting before elective surgery. The results of our survey suggest that most of the respondents are following the ASA guidelines for clear fluids and solids however there were differing opinion regarding the duration of fasting for formula milk and breast milk. In conclusion, we would recommend greater awareness and collaboration between anaesthetists, nurses and surgeons to ensure that fasting instructions are consistent with the ASA guidelines and that patient and their parents understand these directives as well.

  17. Renal teratogens.

    Morgan, Thomas M; Jones, Deborah P; Cooper, William O


    In utero exposure to certain drugs early in pregnancy may adversely affect nephrogenesis. Exposure to drugs later in pregnancy may affect the renin-angiotensin system, which could have an impact on fetal or neonatal renal function. Reduction in nephron number and renal function could have adverse consequences for the child several years later. Data are limited on the information needed to guide decisions for patients and providers regarding the use of certain drugs in pregnancy. The study of drug nephroteratogenicity has not been systematized, a large, standardized, global approach is needed to evaluate the renal risks of in utero drug exposures.

  18. Renal parenchymal histopathology predicts life-threatening chronic kidney disease as a result of radical nephrectomy.

    Sejima, Takehiro; Honda, Masashi; Takenaka, Atsushi


    The preoperative prediction of post-radical nephrectomy renal insufficiency plays an important role in the decision-making process regarding renal surgery options. Furthermore, the prediction of both postoperative renal insufficiency and postoperative cardiovascular disease occurrence, which is suggested to be an adverse consequence caused by renal insufficiency, contributes to the preoperative policy decision as well as the precise informed consent for a renal cell carcinoma patient. Preoperative nomograms for the prediction of post-radical nephrectomy renal insufficiency, calculated using patient backgrounds, are advocated. The use of these nomograms together with other types of nomograms predicting oncological outcome is beneficial. Post-radical nephrectomy attending physicians can predict renal insufficiency based on the normal renal parenchymal pathology in addition to preoperative patient characteristics. It is suggested that a high level of global glomerulosclerosis in nephrectomized normal renal parenchyma is closely associated with severe renal insufficiency. Some studies showed that post-radical nephrectomy severe renal insufficiency might have an association with increased mortality as a result of cardiovascular disease. Therefore, such pathophysiology should be recognized as life-threatening, surgically-related chronic kidney disease. On the contrary, the investigation of the prediction of mild post-radical nephrectomy renal insufficiency, which is not related to adverse consequences in the postoperative long-term period, is also promising because the prediction of mild renal insufficiency might be the basis for the substitution of radical nephrectomy for nephron-sparing surgery in technically difficult or compromised cases. The deterioration of quality of life caused by post-radical nephrectomy renal insufficiency should be investigated in conjunction with life-threatening matters.

  19. Sarcoidose renal



    Full Text Available Em uma mulher de 62 anos, branca, em avaliação pré-operatória de facectomia, foram detectadas alterações urinárias, tendo sido firmados os diagnósticos de calculose renal esquerda e exclusão renal homolateral. No pré-operatório da nefrectomia foram evidenciados processo pulmonar intersticial bilateral e adenopatia torácica, cuja investigação foi adiada para após a cirurgia. No rim retirado foram detectados granulomas epitelióides não necrotizantes, o mesmo ocorrendo posteriormente em biópsia transbrônquica. A paciente foi tratada com metilprednisolona, com discreta melhora pulmonar, o que não ocorreu com a função renal. O diagnóstico final foi de sarcoidose com envolvimento pulmonar, ganglionar torácico e renal.

  20. Renal failure


    930150 Epidermal growth factor and its recep-tor in the renal tissue of patients with acute re-nal failure and normal persons.LIU Zhihong(刘志红),et al.Jinling Hosp,Nanjing,210002.Natl Med J China 1992;72(10):593-595.Epidermal growth factor(EGF)and its receptor(EGF-R)were identified by immunohis-tochemical method(4 layer PAP)in the renaltissue specimens obtained from 11 normal kid-neys and 17 cases of acute renal failure(ARF).The quantitative EGF and EGF-R in the tissuewere expressed as positive tubules per mm~2.The amount of EGF and EGF-R in renal tissue

  1. Preoperative information management system using wireless PDAs.

    Sawa, Tomohiro; Okahara, Masaharu; Santo, Masayuki; Schmidt, Ulrich; Nakata, Yoshinori; Morita, Shigeho; Ohno-Machado, Lucila


    Personal Digital Assistant (PDA) and wireless communication are currently available in clinical settings. We developed wireless PDA software that assists anesthesiologists in pre-operative patient assessment. The device communicates with the hospital information system through a wireless LAN and is equipped with pre-programmed data entry templates for pre-operative assessment. As a preliminary test of the device, we randomly assigned residents in preoperative assessment to an intervention and a control arm and compared the results.

  2. Renal failure


    2005234 Association between serum fetuin-A and clinical outcome in end-stage renal disease patients. WANG Kai(王开), Dept Renal Dis, Renji Hosp Shanghai, 2nd Med Univ, Shanghai 200001. Chin J Nephrol, 2005;21(2):72-75. Objective: To investigate the change of serum fetuin-A level before and after dialysis, and the association of serum fetuin-A level with clinical parameters

  3. Renal failure


    950351 Serum erythropoietin levels in chronic renalinsufficiency.ZHAI Depei(翟德佩),et al.DeptNephrol.General Hosp,Tianjin Med Univ,Tianjin,300000.Tianjin Med J 1995;23(1):19-21.Patients with chronic renal insufficiency(CRI) areoften associated with anemia.The deficiency of EPOproduction in the kidney is thought to be a key factorin the pathogenesis of renal anemia.Serum erythropoi-

  4. Renal failure


    2008463 Protective effect of recombination rat augmenter of liver regeneration on kidney in acute renal failure rats. TANG Xiaopeng(唐晓鹏), et al. Dept Nephrol, 2nd Affili Hosp Chongqing Med Univ, Chongqing 400010.Chin J Nephrol 2008;24(6):417-421. Objective To investigate the protective effects of recombination rat augmenter of liver regeneration (rrALR) on tubular cell injury and renal dysfunction

  5. Renal Hemangiopericytoma

    İbrahim Halil Bozkurt


    Full Text Available Hemangiopericytoma is an uncommon perivascular tumor originating from pericytes in the pelvis, head and tneck, and the meninges; extremely rarely in the urinary system. We report a case of incidentally detected renal mass in which radiologic evaluation was suggestive of renal cell carcinoma. First, we performed partial nephrectomy, and then, radical nephrectomy because of positive surgical margins and the pathological examination of the surgical specimen that revealed a hemangiopericytoma. No additional treatment was administered.

  6. Italian validation of the Amsterdam Preoperative Anxiety and Information Scale.

    Buonanno, Pasquale; Laiola, Anna; Palumbo, Chiara; Spinelli, Gianmario; Terminiello, Virginia; Servillo, Giuseppe


    Preoperative anxiety is usually experienced by patients awaiting surgical procedures and it can negatively impact patient's outcome. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a questionnaire created to identify anxious patients and their need for information: it has been translated and validated in many languages because of its reliability and ease of completion. To date, no Italian version of the APAIS has been produced; our aim was to translate and validate the APAIS in Italian. We produced an Italian version of the APAIS and we administered it to 110 patients undergoing elective surgery; we explored its structure by factor analysis and its reliability by Cronbach's alpha. We analyzed its external validity by confronting it to the Spielberg's State-Trait Anxiety Inventory (STAI). Sensitivity, specificity, and positive and negative predictive values of the Italian version of the APAIS were determined. The Italian version of the APAIS confirmed the original structure of the questionnaire and its internal consistency; it well correlated with the STAI-Y1, the subscale of the STAI which explore the anxiety "state." An APAIS score of 14 was found as best cutoff to distinguish anxious and non-anxious patients. The Italian translation of the APAIS showed psychometric properties similar to the original version. Its reliability and its efficiency make it a powerful tool even in Italian population to detect anxiety and need for information.

  7. Preoperative evaluation of oesophageal adenocarcinoma.

    Khanna, Lauren G; Gress, Frank G


    The preoperative evaluation of oesophageal adenocarcinoma involves endoscopic ultrasound (EUS), computed tomography (CT), and positron emission tomography (PET). With routine Barrett's oesophagus surveillance, superficial cancers are often identified. EUS, CT and PET have a limited role in the staging of superficial tumours. Standard EUS has limited accuracy, but high frequency ultrasound miniprobes are valuable for assessing tumour stage in superficial tumours. However, the best method for determining depth of invasion, and thereby stage of disease, is endoscopic mucosal resection. In contrast, in advanced oesophageal cancers, a multi-modality approach is crucial. Accurate tumour staging is very important since the treatment of advanced cancers involves a combination of chemotherapy, radiation, and surgery. EUS is very useful for staging of the tumour and nodes. High frequency ultrasound miniprobes provide the ability to perform staging when the lesion is obstructing the oesophageal lumen. CT and PET provide valuable information regarding node and metastasis staging.

  8. Reliability Engineering

    Lazzaroni, Massimo


    This book gives a practical guide for designers and users in Information and Communication Technology context. In particular, in the first Section, the definition of the fundamental terms according to the international standards are given. Then, some theoretical concepts and reliability models are presented in Chapters 2 and 3: the aim is to evaluate performance for components and systems and reliability growth. Chapter 4, by introducing the laboratory tests, puts in evidence the reliability concept from the experimental point of view. In ICT context, the failure rate for a given system can be

  9. Renal denervation:history, today and tomorrow

    BAO Ruo-tai; CHEN Zhong; MA Gen-shan


    Renal denervation is a new technique approved effective for resistant-hypertension treatment .The common renal denervation system consists of a generator and a flexible catheter .During this minimally invasive procedure , the interventionalist uses a steerable catheter with a radio frequency ( RF) energy electrode tip .The RF energy is delivered to the renal artery via standard femoral artery access .A series of 2-minute ablation are delivered in each renal artery to distroy the nerves system .The procedure does not involve a permanent device implant .By deactivating the renal nerves , and therefore reducing sympathetic nerve transmission , a significant and reliable reduction in blood pressure could be achieved .In this review, potential complications and future sights of renal denervation are also discussed .

  10. Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery

    Bydon, Mohamad; Abt, Nicholas B.; Macki, Mohamed; Brem, Henry; Huang, Judy; Bydon, Ali; Tamargo, Rafael J.


    Background: Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify elective cranial neurosurgical cases (2006-2012). Morbidity was defined as wound infection, systemic infection, cardiac, respiratory, renal, neurologic, and thromboembolic events, and unplanned returns to the operating room. For 30-day postoperative mortality and morbidity, adjusted odds ratios (ORs) were estimated with multivariable logistic regression. Results: Of 8015 patients who underwent elective cranial neurosurgery, 1710 patients (21.4%) were anemic. Anemic patients had an increased 30-day mortality of 4.1% versus 1.3% in non-anemic patients (P neurosurgery was independently associated with an increased risk of 30-day postoperative mortality and morbidity when compared to non-anemic patients. A hematocrit level below 33% (Hgb 11 g/dl) was associated with a significant increase in postoperative morbidity. PMID:25422784

  11. Preoperative Smoking Status and Postoperative Complications

    Grønkjær, Marie; Eliasen, Marie; Skov-Ettrup, Lise Skrubbeltrang;


    To systematically review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type.......To systematically review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type....

  12. Rex shunt preoperative imaging: diagnostic capability of imaging modalities.

    Sharon W Kwan

    Full Text Available The purpose of this study was to evaluate the diagnostic capability of imaging modalities used for preoperative mesenteric-left portal bypass ("Rex shunt" planning. Twenty patients with extrahepatic portal vein thrombosis underwent 57 preoperative planning abdominal imaging studies. Two readers retrospectively reviewed these studies for an ability to confidently determine left portal vein (PV patency, superior mesenteric vein (SMV patency, and intrahepatic left and right PV contiguity. In this study, computed tomographic arterial portography allowed for confident characterization of left PV patency, SMV patency and left and right PV continuity in 100% of the examinations. Single phase contrast-enhanced CT, multi-phase contrast-enhanced CT, multiphase contrast-enhanced MRI, and transarterial portography answered all key diagnostic questions in 33%, 30%, 0% and 8% of the examinations, respectively. In conclusion, of the variety of imaging modalities that have been employed for Rex shunt preoperative planning, computed tomographic arterial portography most reliably allows for assessment of left PV patency, SMV patency, and left and right PV contiguity in a single study.

  13. Parameters from preoperative overnight oximetry predict postoperative adverse events.

    Chung, F; Zhou, L; Liao, P


    Continuous home monitoring of oxygen saturation has become a reliable and feasible practice. The objective of this study was to investigate the role of preoperative overnight oximetry in predicting postoperative adverse events. Following research ethics board approval, consented patients underwent a preoperative overnight monitoring of oxygen saturation with a portable oximeter. Parameters from the oximetry data were extracted and their predictive performance for postoperative adverse events was evaluated. A total of 573 patients were studied with age: 60±12 years and 45% male. Oxygen desaturation index (ODI), cumulative time percentage with SpO2 3.0 events/h, >9.2 events/h and > 28.5 events/h; CT90: >0.1%, >1.1% and >7.2%; mean SpO2: rate of postoperative adverse events. For ODI >28.5 vs. ODI ⋝28.5 events/h, the odds ratio adjusted with age, gender, body mass index and American Society of Anesthesiologists physical status was 2.2 (95% CI: 1.3-3.9). Patients with mean preoperative overnight SpO2 28.5 events/h or CT90 >7.2% are at higher risk for postoperative adverse events. Overnight oximetry could be a useful tool to stratify patients for the risk of postoperative adverse events.

  14. Evaluation of renal function in children with moderate or severe hydronephrosis after operation

    杨屹; 吉士俊; 赵国贵


    Objective To evaluate postoperative renal function in children with congenital moderate or severe hydronephrosis. Methods 99m Tc-labeled diethylenetriaminepenta-acetic acid scintigraphy was performed in 50 children with unilateral moderate or severe hydronephrosis to determine postoperative renal function. We also analyzed the factors influencing renal function recovery. Results Average postoperative renal function in 50 cases was 40.62%±10.09%. Among them, 32% of patients had nearly normal renal function and differentiated renal function reached up to 45%. Average preoperative and postoperative renal function in 25 cases was 23.89%±11.65% and 39.33%±8.59% respectively and the increase of renal function was about 15.44%±11.18% (P=0.0003). Renal parenchyma thickness was negatively correlated with postoperative renal function (r=-0.62, P=0.0009). The follow-up period was positively correlated with postoperative renal function (r=0.58, P=0.0026). The patients'age had no correlation with renal function recovery (r=-0.05, P=0.80). Recovery of renal function in hydronephrosis with extrarenal pelvis was greater than that in hydronephrosis with intrarenal pelvis (P=0.016). Conclusions Postoperative renal function in children with moderate or severe hydronephrosis can recover to normal. Recovery of renal function was more obvious in hydronephrosis with thinner renal parenchyma, longer follow-up period and extrarenal pelvis.

  15. [The role of magnetic resonance imaging to select patients for preoperative treatment in rectal cancer].

    Rödel, Claus; Sauer, Rolf; Fietkau, Rainer


    Traditionally, the decision to apply preoperative treatment for rectal cancer patients has been based on the T- and N-category. Recently, the radial distance of the tumor to the circumferential resection margin (CRM) has been identified as an important risk factor for local failure. By magnetic resonance imaging (MRI) this distance can be measured preoperatively with high reliability. Thus, selected groups have started to limit the indication for preoperative therapy to tumors extending to - or growing within 1 mm from - the mesorectal fascia (CRM+). Pros and cons of this selected approach for preoperative treatment and first clinical results are presented. Prerequisites are the availability of modern high-resolution thin-section MRI technology as well as strict quality control of MRI and surgical quality of total mesorectal excision (TME). By selecting patients with CRM-positive tumors on MRI for preoperative therapy, only approximately 35% patients will require preoperative radiotherapy (RT) or radiochemotherapy (RCT). However, with histopathologic work-up of the resected specimen after primary surgery, the indication for postoperative RCT is given for a rather large percentage of patients, i.e., for pCRM+ (5-10%), intramesorectal or intramural excision (30-40%), pN+ (30-40%). Postoperative RCT, however, is significantly less effective and more toxic than preoperative RCT. A further point of concern is the assertion that patients, in whom a CRM-negative status is achieved by surgery alone, do not benefit from additional RT. Data of the Dutch TME trial and the British MRC (Medical Research Council) CR07 trial, however, suggest the reverse. To omit preoperative RT/RCT for CRM-negative tumors on MRI needs to be further investigated in prospective clinical trials. The German guidelines for the treatment of colorectal cancer 2008 continue to indicate preoperative RT/RCT based on the T- and N-category.

  16. [Preoperative fasting 2008: medical behaviour between empiricism and science].

    Weiss, G; Jacob, M


    Preoperative fasting aims at minimizing the risk of pulmonary aspiration. However, perioperative safety does not directly increase with the duration of total abstinence from food and liquids. The traditional principle "nil per os from midnight on", is based on insufficient data, overinterpretation and expert opinion. In fact, the total perioperative risk of a clinically relevant regurgitation of gastric content is low. Clear liquids are not stored within the stomach for a long time and in the healthy, a fasting period of 6 h allows the total passage of solid food. Identifying those patients with an increased risk of perioperative aspiration is still difficult. In particular, the impact of pregnancy, adipositas and diabetes, trauma, smoking, opioids and renal insufficiency has not been clarified. This lack of knowledge is reflected by national and international guidelines concerning preoperative fasting, which mention the "patient at risk" without defining it exactly. Abstention from clear liquids 2 h before and of solids 6 h before induction of anesthesia, is becoming increasingly more accepted. Feeding babies with breast milk appears to be tolerated 4 h before anesthesiological procedures.

  17. Renal Cell Carcinoma in A Patient with Kartagener Syndrome: First Case Report in English Language

    Erkin Sağlam


    Full Text Available Cardiac and pulmonary anomalies are common among patients with situs inversus totalis. Renal anomalies, including renal agenesis, dysplasia, hypoplasia, ectopia, polycystic kidney, and horseshoe kidney have been reported. We report a case of renal cell carcinoma in a patient with situs inversus totalis (SIT. Our case represents the fourth case report of renal cell carcinoma in a patient with situs inversus totalis and to the best of our knowledge this is the first report in English language. Due to the higher frequency of cardiac, pulmonary, renal, and vascular anomalies the management of patients with situs inversus and urologic disease requires careful preoperative evaluation.

  18. The relationship between preoperative creatinine clearance and outcomes for patients undergoing liver transplantation: a retrospective observational study

    Wenger Urs


    Full Text Available Abstract Background Renal failure with following continuous renal replacement therapy is a major clinical problem in liver transplant recipients, with reported incidences of 3% to 20%. Little is known about the significance of postoperative acute renal failure or acute-on-chronic renal failure to postoperative outcome in liver transplant recipients. Methods In this post hoc analysis we compared the mortality rates of 135 consecutive liver transplant recipients over 6 years in our center subject to their renal baseline conditions and postoperative RRT. We classified the patients into 4 groups, according to their preoperative calculated Cockcroft formula and the incidence of postoperative renal replacement therapy. Data then were analyzed in regard to mortality rates and in addition to pre- and peritransplant risk factors. Results There was a significant difference in ICU mortality (p=.008, hospital mortality (p=.002 and cumulative survival (p Conclusion This study shows that in liver transplant recipient’s acute renal failure with postoperative RRT is associated with mortality and the mortality rate is higher than in patients with acute-on-chronic renal failure and postoperative renal replacement therapy.

  19. Renal Cysts

    ... as “simple” cysts, meaning they have a thin wall and contain water-like fluid. Renal cysts are fairly common in ... simple kidney cysts, meaning they have a thin wall and only water-like fluid inside. They are fairly common in ...

  20. Renal failure


    970363 Effect on serum PTH and 1, 25(OH)2 D3levels of rapid correction of metabolic acidosis in CRFpatients with secondary hyperparathyroidism. YUANQunsheng(袁群生), et al. Renal Div, PUMC Hosp,Beijing, 100730. Chin J Nephrol 1996; 12(6): 328-331.

  1. Drug-induced renal injury

    Drugs can cause acute renal failure by causing pre-renal, intrinsic or post-renal toxicity. Pre-renal ... incidence of drug dose adjustment in renal impairment in the SAMJ. ... Fever, haemolytic anaemia, thrombocytopenia, renal impairment and.

  2. A comparison between patient recall and concurrent measurement of preoperative quality of life outcome in total hip arthroplasty.

    Howell, Jonathan; Xu, Min; Duncan, Clive P; Masri, Bassam A; Garbuz, Donald S


    The objective is to evaluate the reliability of patients' recall of preoperative pain and function during the immediate postoperation period after total hip arthroplasty. A prospective cohort of 104 patients completed a survey about their quality of life before operation, and recalled preoperative status at 3 days, 6 weeks, and 12 weeks after operation. Quality of life was measured by the Western Ontario and McMaster University Osteoarthritis Index, the Oxford-12 hip score, and the 12-item Short-Form score. The intraclass correlation coefficient and Spearman correlation coefficient were used to compare preoperative quality of life scores to the scores recalled. The reliability of recall remained high up to 3 months postoperation. Patients are able to accurately recall their preoperative function for up to 3 months after total hip arthroplasty.

  3. Low-grade leiomyosarcoma of renal vein: A case report

    Nalan NEŞE


    Full Text Available Leiomyosarcomas originating from renal vein are quite rare malignant tumors since only 30 cases have been reported in the literature. Clinical symptoms which are due to a renal mass along with radiological findings, usually mislead to a preoperative diagnosis of renal cell carcinoma. The correct diagnosis is frequently made on nephrectomy specimens. Low-grade leiomyosarcomas need to be differentiated from leiomyomas. Increased mitotic activity and necrosis are known to be gold standards for differential diagnosis. In this report, we present a case of a 62 year old woman whose tumor in the left kidney diagnosed as low-grade leiomyosarcoma together with a brief review of the literature.

  4. Emergency intervention therapy for renal vascular injury

    LIU Feng-yong; WANG Mao-qiang; FAN Qing-sheng; WANG Zhi-jun; DUAN Feng; SONG Peng


    Objective: To evaluate the efficacy and safety of the interventional techniques in the treatment of renal vascular injury.Methods: A total of 16 patients with renal vascular injuries were treated by superselective arterial embolization.The renal injuries resulted from renal biopsy in 7 patients,endovascular intervention in 2.percutaneous puncture and pyelostomy in 2.local resection of renal tumor in 1 and trauma in 4.With regards to clinical manifestations,there was hemorrhagic shock in 8 patients,severe flank pain in 14,and hematuria in 14.CT and ultrasonography confmued that 15 Patients had perirenal hematoma.The embolization was performed with microcoils in 13 and standard stainless steel coils in 3 patients,associated with polyvinyl alcohol particles (PVA) in 9,and gelfoam particles in 6 cases.Results: Renal angiogram revealed arteriovenous fistula in renal parenchyma in 9 cases,pseudoaneurysm in 3 and extravasation of contrast media in 4.The arterial embolization was successful in all 16 cases in a single session.The angiography at the end of therapy showed that abnormal vessels had disappeared without other major intrarenal arterial branch occlusion.In 13 patients with hemodynamical compromise,blood loss-related symptoms were immediately relieved after blood transfusion.In 14 patients with severe flank pain,the pain was progressively relieved.Hematuda ceased in 14 patients 2-14 days after the embolization procedures.The renal function was impaired after the procedure in 6 cases,in which preoperative renal insufficiency was exacerbated in 3 and developed new renal dysfunction in 3.2 of whom received hemodialysis.The ultrasonography showed that perirenal hematoma was gradually absorbed within 2.6 mortths after the procedure.A11 patients were followed up in 6-78 months (mean,48 months).Six patients died of primary diseases (5 cases of renal failure and multiple organ failure and 1 case of malignant tumor).Ten patients survived without bleeding and further

  5. Detection of acute renal allograft rejection by analysis of renal tissue proteomics in rat models of renal transplantation

    Dai Yong


    Full Text Available At present, the diagnosis of renal allograft rejection requires a renal biopsy. Clinical management of renal transplant patients would be improved if rapid, noninvasive and reliable biomarkers of rejection were available. This study is designed to determine whether such protein biomarkers can be found in renal-graft tissue proteomic approach. Orthotopic kidney transplantations were performed using Fisher (F344 or Lewis rats as donors and Lewis rats as recipients. Hence, there were two groups of renal transplant models: one is allograft (from F344 to Lewis rats; another is syngrafts (from Lewis to Lewis rats serving as control. Renal tissues were collected 3, 7 and 14 days after transplantation. As many as 18 samples were analyzed by 2-D Electrophoresis and mass spectrometry (MALDI-TOF-TOF-MS. Eleven differentially expressed proteins were identified between groups. In conclusion, proteomic technology can detect renal tissue proteins associated with acute renal allograft rejection. Identification of these proteins as diagnostic markers for rejection in patients′ urine or sera may be useful and non-invasive, and these proteins might serve as novel therapeutic targets that also help to improve the understanding of mechanism of renal rejection.

  6. Renal failure (chronic)

    Clase, Catherine


    Chronic renal failure is characterised by a gradual and sustained decline in renal clearance or glomerular filtration rate (GFR). Continued progression of renal failure will lead to renal function too low to sustain healthy life. In developed countries, such people will be offered renal replacement therapy in the form of dialysis or renal transplantation. Requirement for dialysis or transplantation is termed end-stage renal disease (ESRD).Diabetes, glomerulonephritis, hypertension, pyelone...

  7. A fresh look at preoperative body washing

    Tanner, Judith; Gould, Dinah; Jenkins, Philip; Hilliam, Rachel; Mistry, Neetesh; Walsh, Susannah


    National guidelines do not support preoperative body washing to reduce surgical site infections, instead recommending bathing or showering with soap. Yet preoperative body washing continues to be widely used in many hospitals across Europe. This paper suggests that existing trials of preoperative body washing, upon which guidelines are based, are dated and proposes a new investigation of preoperative body washing using modern definitions of surgical site infection with standardised patient follow up, modern surgical techniques and well designed trials. This paper provides a critique of existing guidelines and describes a randomised trial with 60 participants to compare the effect of soap and two antiseptic washing products on colony forming units (CFUs) for up to six hours. Chlorhexidine gluconate and octenidine were significantly more effective than soap in reducing CFUs in the underarm, and chlorhexidine was significantly more effective than soap in reducing CFUs in the groin. PMID:22448182

  8. Preoperative steroid in abdominal wall reconstruction

    Jensen, Kristian Kiim; Brøndum, Tina Lee; Belhage, Bo


    INTRODUCTION: Preoperative administration of high-dose glucocorticoid leads to improved recovery and decreased length of stay after abdominal surgery. Even so, studies on administration of glucocorticoids for patients undergoing abdominal wall reconstruction (AWR) for giant ventral hernia repair ...

  9. Preoperative alcohol cessation prior to elective surgery

    Oppedal, Kristian; Møller, Ann Merete; Pedersen, Bolette


    Hazardous drinking has been associated with an increased postoperative complication rate after surgery. Common complications include postoperative infections, cardiopulmonary complications, and bleeding episodes. Preoperative abstinence may to some degree reverse alcohol-induced pathophysiological...

  10. Preoperative steroid in abdominal wall reconstruction

    Jensen, Kristian Kiim; Brøndum, Tina Lee; Belhage, Bo;


    INTRODUCTION: Preoperative administration of high-dose glucocorticoid leads to improved recovery and decreased length of stay after abdominal surgery. Even so, studies on administration of glucocorticoids for patients undergoing abdominal wall reconstruction (AWR) for giant ventral hernia repair ...

  11. Renal posttransplant's vascular complications

    Bašić Dragoslav


    present study demonstrate that the rate of this complication in LD group was low, only 0.3%, but significantly higher in CD group - 11.8%. Many factors should be considered in order to understand for such significant difference among these groups. First of all, cadaveric transplant activity in our country is very low. In our series, median waiting period for renal transplantation was 2.8 years in LD group vs. 4.8 years in CD group (p<0.01. Also, vascular damages because of long term hemodialysis are contributing factors. Mean age of CD recipients was 7.4 years bigger vs. LD recipients. Primary cadaveric graft damage by accident and further manipulations during cadaveric donor nephrectomy, preservation and per-fusion are additional factors compromising the quality of cadaveric renal transplant outcome. Also, preoperative evaluation of cadaveric grafts is not as exact as in cases of LD grafts (excretory urography arteriography, etc. In the available transplant literature it is almost impossible to find data about vascular complications by different donor types. Mostly, authors offer experiences related to all transplants and most of them agree that in the present time better results are obtained using living donors [17].

  12. Renal Primitive Neuroectodermal Tumor: A Case Report.

    Yang, Cheng; Xu, Hanjiang; Zhou, Jun; Hao, Zongyao; Wang, Jianzhong; Lin, Changmin; Zhang, Li; Zhu, Xia; Liang, Chaozhao


    Primitive neuroectodermal tumor (PNET) is a malignant small round cell tumor and typically arises from bone or soft tissue in adolescents and young adults. Renal PNET is extraordinarily rare and exhibits highly aggressive biological behavior with poor prognosis.We present here a new case of renal PNET in a 31-year-old female. The patients were referred to our hospital because of left flank pain with nausea and vomiting for 1 week. A computed tomography scan revealed a 14.7 × 12.7 cm well-defined, unevenly mass lesion with both solid and cystic components and the tumor was not enhanced uniformly.A preoperative diagnosis of cystic renal cell carcinoma and urinary tract infection was made. The patient undergone anti-inflammatory therapy followed by a left radical nephrectomy. Taken with morphological pattern and immunohistochemical markers, a diagnosis of renal PNET was made. Two cycles of combined chemotherapy were executed. At the 14-month follow-up, no evidence of metastasis or recurrence was indicated.This case reminds clinicians that for adolescents and young adults with a suspicious renal mass, a diagnosis of renal PNET should be always considered. An initial surgery followed by radiotherapy and chemotherapy is suggested for the therapeutic management.

  13. Preoperative education for lumbar surgery for radiculopathy

    Louw, A; Louw, Q; L. Crous


    To date no studies have been published on preoperative education forpatients who had lumbar surgery. The aim of this study was to determine if there is a demand for preoperative education for patients who had lumbar surgery for radiculopathy. A convenience sample of 47 patients who had lumbar surgery and a random sample of 141 physiotherapists involved in treating patients who had lumbar surgery completed a newly developed spinal surgery questionnaire. The data were analyzed using descriptive...

  14. Can dimercaptosuccinic acid renal scintigraphy be used to assess global renal function?

    Durand, E.; Prigent, A. [Service de Biophysique et de Medecine Nucleaire, Hopital de Bicetre, Paris (France)


    Use of dimercaptosuccinic acid (DMSA) has been proposed for the assessment of both relative and absolute renal function. Our aim was to test whether the renal absolute DMSA uptake (ADU) can reflect the absolute renal function from a theoretical point of view. A simple model was used to compute the ADU in the case of injury to one kidney. It was found that the assumption that ADU correctly reflects the absolute renal function may lead to a more than 50% overestimation of the function of both the normal and the impaired kidney. The later the measurement is made and the more impaired is the kidney, the more important is the error. Although DMSA can reliably quantify the relative renal function, it should not be used to assess absolute renal function lest major overestimation should occur. (orig.)

  15. Microelectronics Reliability


    convey any rights or permission to manufacture, use, or sell any patented invention that may relate to them. This report was cleared for public release...testing for reliability prediction of devices exhibiting multiple failure mechanisms. Also presented was an integrated accelerating and measuring ...13  Table 2  T, V, F and matrix versus  measured  FIT

  16. Renale Osteopathie

    Horn S


    Die renale Osteopathie umfaßt Erkrankungen des Knochens, die bei Patienten mit chronischen Nierenerkrankungen auftreten, wie den sekundären bzw. tertiären Hyperparathyreoidismus, die adynamische Knochenerkrankung und die Osteopathie nach Nierentransplantation. Durch die Identifikation des Kalzium-Sensing-Rezeptors bzw. des Vitamin D-Rezeptors hat sich unser Verständnis der Zusammenhänge in den letzten Jahren erheblich verbessert. Neue Medikamente versprechen effizientere Prophylaxe- und Thera...

  17. Renale Knochenerkrankungen

    Mayer G


    Full Text Available Störungen des Mineral- und Knochenstoffwechsels sind bei fast allen Patienten mit chronischen Nierenerkrankungen anzutreffen. Pathogenetisch spielt eine Neigung zur Phosphatretention bei einer Reduktion der glomerulären Filtrationsrate die zentrale Rolle. Neben typischen, aber sehr variablen Veränderungen der Knochenstruktur (renale Osteopathie besteht auch eine sehr enge Assoziation zwischen diesen Störungen und dem massiv erhöhten kardiovaskulären Risiko der Patienten.

  18. Obesity and renal hemodynamics

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.


    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile

  19. Obesity and renal hemodynamics

    Bosma, R. J.; Krikken, J. A.; van der Heide, J. J. Homan; de Jong, P. E.; Navis, G. J.


    Obesity is a risk factor for renal damage in native kidney disease and in renal transplant recipients. Obesity is associated with several renal risk factors such as hypertension and diabetes that may convey renal risk, but obesity is also associated with an unfavorable renal hemodynamic profile inde

  20. The normal renal size of Korean children. Radiologic estimation

    Ko, Young Tae; Hyun, Jae Suk; Kim, Young Sun; Kim, Kyung Do [Chungang University College of Medicine, Chinju (Korea, Republic of)


    A nephropathy following urinary tract infection is usually referred to as renal scarring. The main radiologic features are an overall reduction in the size of the kidney, with coarse scar, deformity of calyxes and indentation of the surface. If adequately treated, the progressive renal scarring by urinary tract infection could be prevented. Therefore, the early radiologic detection of renal damage following urinary tract infection or vesicoureteral reflux is great importance for the evaluation of the pathogenesis of renal scarring and for the planning of the therapy. To evaluate the renal damage, we must have the normal data of the kidneys. Many reports discussed the renal size in normal children, but there are no reports in the Korean children. We estimate the renal length, width, several focal parenchymal thicknesses for renal size evaluation and segmental lumbar vertebral length at the intravenous paleography in the normal Korean children. And the linear equations are obtained by the regression analysis between the various renal parameters and segmental vertebral length. Thereafter we make out the nomogram by the obtained equations. The renal length and width are highly correlated to the segmental lumbar vertebral length than various renal parenchymal thicknesses. These results suggest that the renal length and width are reliable parameters for normal renal size evaluation in growing kidney. And then the obtained equations and nomograms might be useful in the diagnosis of parenchymal loss in early scarring and follow-up. (author)

  1. Bilateral Renal Mass-Renal Disorder: Tuberculosis

    Ozlem Tiryaki


    Full Text Available A 30-year-old woman has presented complaining of weakness and fatigue to her primary care physician. The renal sonography is a routine step in the evaluation of new onset renal failure. When the renal masses have been discovered by sonography in this setting, the functional imaging may be critical. We reported a case about bilateral renal masses in a young female patient with tuberculosis and renal insufficiency. Magnetic resonance (MR has revealed the bilateral renal masses in patient, and this patient has been referred to our hospital for further management. The patient’s past medical and surgical history was unremarkable.

  2. Fine Needle Aspiration Using Improved Agar Microbiopsy is Highly Concordant With Renal Mass Final Diagnosis and Subclassification

    Schieven, Louise W.; Smedts, Frank; Hopman, Anton H.; van der Wijk, Jan; Nijman, Rien J.; de Jong, Igle J.


    Purpose: Computerized tomography and ultrasound are usually sufficient for preoperative evaluation of renal masses greater than 5 cm. For renal masses less than 5 cm additional histological evaluation could improve diagnosis and treatment decisions. We investigated the concordance between an improve

  3. Renal cavernous hemangioma: robot-assisted partial nephrectomy with selective warm ischemia. Case report and review of the literature



    Renal hemangioma is a relatively rare benign tumor with a wide range of clinical and radiological presentation, not easy to differentiate preoperatively from a renal cancer. Due to its benign nature complete surgical resection is the recommended therapy and is considered curative.

  4. Fine Needle Aspiration Using Improved Agar Microbiopsy is Highly Concordant With Renal Mass Final Diagnosis and Subclassification

    Schieven, Louise W.; Smedts, Frank; Hopman, Anton H.; van der Wijk, Jan; Nijman, Rien J.; de Jong, Igle J.


    Purpose: Computerized tomography and ultrasound are usually sufficient for preoperative evaluation of renal masses greater than 5 cm. For renal masses less than 5 cm additional histological evaluation could improve diagnosis and treatment decisions. We investigated the concordance between an improve

  5. Distal renal tubular acidosis

    Renal tubular acidosis - distal; Renal tubular acidosis type I; Type I RTA; RTA - distal; Classical RTA ... excreting it into the urine. Distal renal tubular acidosis (Type I RTA) is caused by a defect ...

  6. Proximal renal tubular acidosis

    Renal tubular acidosis - proximal; Type II RTA; RTA - proximal; Renal tubular acidosis type II ... by alkaline substances, mainly bicarbonate. Proximal renal tubular acidosis (Type II RTA) occurs when bicarbonate is not ...

  7. Proposal for classification of the circumaortic renal collar's morphology.

    Natsis, Konstantinos; Tsitouridis, Ioannis; Totlis, Trifon; Levva, Sofia; Tsikaras, Prokopios; Skandalakis, Panagiotis


    In the present study, we propose a classification of the different forms of the circumaortic renal collar based on the findings of 319 patients and on a literature review. The patients underwent a CT angiography scan of the abdomen for various diagnostic reasons. The different forms in which the circumaortic renal collar may appear were categorized. The renal collar was observed in eight of the 319 (2.5%) patients. The classification we propose is the following: Type I, one left renal vein splitting into two branches, a preaortic and a retroaortic, draining into the inferior vena cava; Type II, two different left renal veins, the one preaortic and the other retroaortic, draining into the inferior vena cava; and Type III, either anastomoses between the preaortic and retroaortic vein, being multiple or not, or multiple preaortic or retroaortic renal veins without anastomoses. Although the circumaortic renal collar is usually asymptomatic, the knowledge of this variation is useful, mainly before abdominal aortic aneurysm surgery and renal transplantation. Failure to recognize the collar's retroaortic component may lead to hemorrhage and death during retroperitoneal surgery. We believe that our classification contributes to recognize the circumaortic renal collar's morphology both preoperatively and intraoperatively.

  8. Preoperative education for lumbar surgery for radiculopathy

    A. Louw


    Full Text Available To date no studies have been published on preoperative education forpatients who had lumbar surgery. The aim of this study was to determine if there is a demand for preoperative education for patients who had lumbar surgery for radiculopathy. A convenience sample of 47 patients who had lumbar surgery and a random sample of 141 physiotherapists involved in treating patients who had lumbar surgery completed a newly developed spinal surgery questionnaire. The data were analyzed using descriptiveand inferential statistical tests. Results showed that 100% of the patients and 99% of therapists view preoperative education to be an important component for lumbar surgery for radiculopathy. The most important factors identifiedfor inclusion in preoperative educational programs were reason for surgery, risks associated with surgery, limitations following surgery and more education regarding pain. The preferred method of education delivery was verbal one-on-one education. This study demonstrates that there is a demand for preoperative education for patients who had lumbar surgery.

  9. [Preoperative assessment of lung disease patients.].

    Ramos, Gilson; Ramos Filho, José; Pereira, Edísio; Junqueira, Marcos; Assis, Carlos Henrique C


    Lung complications are the most frequent causes of postoperative morbidity-mortality, especially in lung disease patients. So, those patients should be preoperatively carefully evaluated and prepared, both clinically and laboratorially. This review aimed at determining surgical risk and at establishing preoperative procedures to minimize peri and postoperative morbidity-mortality in lung disease patients. Major anesthetic-surgical repercussions in lung function have already been described. Similarly, we tried to select higher-risk patients, submitted or not to lung resection. To that end, clinical and laboratorial propedeutics were used. Finally, a proposal of a preoperative algorithm was presented for procedures with lung resection. Lung disease patients, especially those with chronic evolution, need to be preoperatively thoroughly evaluated. ASA physical status and Goldmans cardiac index are important risk forecasting factors for lung disease patients not candidates for lung resection. Adding to these criteria, estimated postoperative max VO2, FEV1 and diffusion capacity are mandatory for some patients submitted to lung resection. beta2-agonists and steroids should be considered in the preoperative period of these patients.

  10. Analysis of renal cyst of high density containing proteinaceous fluid: report of 6 cases

    Jin Wen; Han zhong Li; He Xiao


    Objective:To investigate clinical features and imageology of renal cysts of high density, containing proteinaceous fluid and increase the diagnosis and treatment level of this special type renal cyst. Methods:Six cases were proven to be renal cysts of high density(pathologically) from 2002 to 2007 were reviewed. Among 6 cases, 1 was in the upper pole of kidney, 4 were medial and 1 was located in the anus perineum. All were 2-5 cm in size. Ultrasonography(US) excretory unognaphy, multiphase CT and renal angiography DSA imaging was performed for preoperative diagnosis. The preoperative diagnosis found renal neoplasms in 4 and renal cysts in 2. All of them were operated by partial nephrectomy. Results:All of the 6 renal high density renal masses were reseoted surgically, which were proved pathologically to be renal cysts; high density present. All of them contained proteinaceous fluid with benign cyst walls on histologic examination. No recurrence was seen in any of these cases during a long follow-up. Conclusion:CT and B-US have a higher diagnostic value, which can show the internal shape and character better. B-US or CT guided puncturing biopsy can be better applied to atypical renal cysts. Once the correct diagnosis is acquired, laparoscopic surgical treatment should be carried out.

  11. Renal tuberculosis

    Džamić Zoran


    Full Text Available Tuberculosis is still a significant health problem in the world, mostly in developing countries. The special significance lies in immunocompromised patients, particularly those suffering from the HIV. Urogenital tuberculosis is one of the most common forms of extrapulmonary tuberculosis, while the most commonly involved organ is the kidney. Renal tuberculosis occurs by hematogenous dissemination of mycobacterium tuberculosis from a primary tuberculosis foci in the body. Tuberculosis is characterized by the formation of pathognomonic lesions in the tissues - granulomata. These granulomata may heal spontaneously or remain stable for years. In certain circumstances in the body associated with immunosuppression, the disease may be activated. Central caseous necrosis occurs within tuberculoma, leading to formation of cavities that destroy renal parenchyma. The process may gain access to the collecting system, forming the caverns. In this way, infection can be spread distally to renal pelvis, ureter and bladder. Scaring of tissue by tuberculosis process may lead to development of strictures of the urinary tract. The clinical manifestations are presented by nonspecific symptoms and signs, so tuberculosis can often be overlooked. Sterile pyuria is characteristic for urinary tuberculosis. Dysuric complaints, flank pain or hematuria may be presented in patients. Constitutional symptoms of fever, weight loss and night sweats are presented in some severe cases. Diagnosis is made by isolation of mycobacterium tuberculosis in urine samples, by cultures carried out on standard solid media optimized for mycobacterial growth. Different imaging studies are used in diagnostics - IVU, CT and NMR are the most important. Medical therapy is the main modality of tuberculosis treatment. The first line anti-tuberculosis drugs include isoniazid, rifampicin, pyrazinamide and ethambutol. Surgical treatment is required in some cases, to remove severely damaged kidney, if

  12. Effects of Cardiopulmonary Bypass on Renal Perfusion, Filtration, and Oxygenation in Patients Undergoing Cardiac Surgery.

    Lannemyr, Lukas; Bragadottir, Gudrun; Krumbholz, Vitus; Redfors, Bengt; Sellgren, Johan; Ricksten, Sven-Erik


    Acute kidney injury is a common complication after cardiac surgery with cardiopulmonary bypass. The authors evaluated the effects of normothermic cardiopulmonary bypass on renal blood flow, glomerular filtration rate, renal oxygen consumption, and renal oxygen supply/demand relationship, i.e., renal oxygenation (primary outcome) in patients undergoing cardiac surgery. Eighteen patients with a normal preoperative serum creatinine undergoing cardiac surgery procedures with normothermic cardiopulmonary bypass (2.5 l · min · m) were included after informed consent. Systemic and renal hemodynamic variables were measured by pulmonary artery and renal vein catheters before, during, and after cardiopulmonary bypass. Arterial and renal vein blood samples were taken for measurements of renal oxygen delivery and consumption. Renal oxygenation was estimated from the renal oxygen extraction. Urinary N-acetyl-β-D-glucosaminidase was measured before, during, and after cardiopulmonary bypass. Cardiopulmonary bypass induced a renal vasoconstriction and redistribution of blood flow away from the kidneys, which in combination with hemodilution decreased renal oxygen delivery by 20%, while glomerular filtration rate and renal oxygen consumption were unchanged. Thus, renal oxygen extraction increased by 39 to 45%, indicating a renal oxygen supply/demand mismatch during cardiopulmonary bypass. After weaning from cardiopulmonary bypass, renal oxygenation was further impaired due to hemodilution and an increase in renal oxygen consumption, accompanied by a seven-fold increase in the urinary N-acetyl-β-D-glucosaminidase/creatinine ratio. Cardiopulmonary bypass impairs renal oxygenation due to renal vasoconstriction and hemodilution during and after cardiopulmonary bypass, accompanied by increased release of a tubular injury marker.

  13. Renale Osteopathie

    Horn S


    Full Text Available Die renale Osteopathie umfaßt Erkrankungen des Knochens, die bei Patienten mit chronischen Nierenerkrankungen auftreten, wie den sekundären bzw. tertiären Hyperparathyreoidismus, die adynamische Knochenerkrankung und die Osteopathie nach Nierentransplantation. Durch die Identifikation des Kalzium-Sensing-Rezeptors bzw. des Vitamin D-Rezeptors hat sich unser Verständnis der Zusammenhänge in den letzten Jahren erheblich verbessert. Neue Medikamente versprechen effizientere Prophylaxe- und Therapiemöglichkeiten. Wir beeinflussen dadurch nicht nur die Morbidität und Lebensqualität, sondern auch die Mortalität unserer Patienten.

  14. Renal disease in pregnancy.

    Thorsen, Martha S; Poole, Judith H


    Anatomic and physiologic adaptations within the renal system during pregnancy are significant. Alterations are seen in renal blood flow and glomerular filtration, resulting in changes in normal renal laboratory values. When these normal renal adaptations are coupled with pregnancy-induced complications or preexisting renal dysfunction, the woman may demonstrate a reduction of renal function leading to an increased risk of perinatal morbidity and mortality. This article will review normal pregnancy adaptations of the renal system and discuss common pregnancy-related renal complications.

  15. The internist and the renal resistive index: truths and doubts.

    Boddi, Maria; Natucci, Fabrizia; Ciani, Elisa


    The renal resistive index (RRI) is measured by Doppler sonography in an intrarenal artery, and is the difference between the peak systolic and end-diastolic blood velocities divided by the peak systolic velocity. The RRI is used for the study of vascular and renal parenchymal renal abnormalities, but growing evidence indicates that it is also a dynamic marker of systemic vascular properties. Renal vascular resistance is only one of several renal (vascular compliance, interstitial and venous pressure), and extrarenal (heart rate, aortic stiffness, pulse pressure) determinants that combine to determine the RRI values, and not the most important one. RRI cannot always be considered a specific marker of renal disease. To summarize from the literature: (1) hydronephrosis, abdominal hypertension, renal vein thrombosis and acute kidney injury are all associated with an acute increase in interstitial and venous pressure that determine RRI values. In all these conditions, RRI is a reliable marker of the severity of renal damage. (2) The hemodynamic impact of renal artery stenosis can be assayed by the RRI decrease in the homolateral kidney by virtue of decreasing pulse pressure. However, renal diseases that often coexist, increase renal vascular stiffness and hide the hemodynamic effect of renal stenosis. (3) In transplant kidney and in chronic renal disease, high RRI values (>0.80) can independently predict renal and clinical outcomes, but systemic (pulse pressure) rather than renal hemodynamic determinants sustain the predictive role of RRI. (4) Higher RRI detects target renal organ damage in hypertension and diabetes when renal function is still preserved, as a marker of systemic atherosclerotic burden. Is this the fact? We attempt to answer.

  16. Chronic depression: development and evaluation of the luebeck questionnaire for recording preoperational thinking (LQPT

    Kühnen Tanja


    Full Text Available Abstract Background A standardized instrument for recording the specific cognitive psychopathology of chronically depressed patients has not yet been developed. Up until now, preoperational thinking of chronically depressed patients has only been described in case studies, or through the external observations of therapists. The aim of this study was to develop and evaluate a standardized self-assessment instrument for measuring preoperational thinking that sufficiently conforms to the quality criteria for test theory. Methods The "Luebeck Questionnaire for Recording Preoperational Thinking (LQPT" was developed and evaluated using a german sample consisting of 30 episodically depressed, 30 chronically depressed and 30 healthy volunteers. As an initial step the questionnaire was subjected to an item analysis and a final test form was compiled. In a second step, reliability and validity tests were performed. Results Overall, the results of this study showed that the LQPT is a useful, reliable and valid instrument. The reliability (split-half reliability 0.885; internal consistency 0.901 and the correlations with other instruments for measuring related constructs (control beliefs, interpersonal problems, stress management proved to be satisfactory. Chronically depressed patients, episodically depressed patients and healthy volunteers could be distinguished from one another in a statistically significant manner (p Conclusion The questionnaire fulfilled the classical test quality criteria. With the LQPT there is an opportunity to test the theory underlying the CBASP model.

  17. Validation of measures of parents' preoperative anxiety and anesthesia knowledge.

    Miller, K M; Wysocki, T; Cassady, J F; Cancel, D; Izenberg, N


    Parents' anxiety about their children's anesthesia may adversely affect the children's outcomes and compromise the quality of informed consent. Studies of these issues have been limited by the lack of validated measures of parental anxiety and knowledge surrounding anesthesia. In the present study, we evaluated psychometric properties of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the Standard Anesthesia Learning Test (SALT) among 85 parents who participated in an evaluation of the effects of a videotape about pediatric anesthesia. The results supported the internal consistency, test-retest reliability, and concurrent validity of both instruments and documented the equivalence of two forms of the SALT. Factor analysis supported the previously demonstrated factor structure of the APAIS, further confirming its construct validity. We conclude that the APAIS and SALT are reliable and valid measures of parental anxiety and knowledge of pediatric anesthesia that can be used for clinical and research purposes. This study verified the reliability and validity of two questionnaires for measuring parents' knowledge and anxiety about pediatric anesthesia. These questionnaires can be used in further research on factors affecting parental anxiety and knowledge before their children's surgery.

  18. Renal calculus

    Pyrah, Leslie N


    Stone in the urinary tract has fascinated the medical profession from the earliest times and has played an important part in the development of surgery. The earliest major planned operations were for the removal of vesical calculus; renal and ureteric calculi provided the first stimulus for the radiological investigation of the viscera, and the biochemical investigation of the causes of calculus formation has been the training ground for surgeons interested in metabolic disorders. It is therefore no surprise that stone has been the subject of a number of monographs by eminent urologists, but the rapid development of knowledge has made it possible for each one of these authors to produce something new. There is still a technical challenge to the surgeon in the removal of renal calculi, and on this topic we are always glad to have the advice of a master craftsman; but inevitably much of the interest centres on the elucidation of the causes of stone formation and its prevention. Professor Pyrah has had a long an...

  19. Concurrent Multilocular Cystic Renal Cell Carcinoma and Leiomyoma in the Same Kidney: Previously Unreported Association

    Min Su Cheong


    Full Text Available We present an unusual case of concurrent occurrence of a multilocular cystic renal cell carcinoma and a leiomyoma in the same kidney of a patient with no evident clinical symptoms. A 38-year-old man was found incidentally to have a cystic right renal mass on computed tomography. Laparoscopic radical nephrectomy was performed under a preoperative diagnosis of cystic renal cell carcinoma. Histology revealed a multilocular cystic renal cell carcinoma and a leiomyoma. This is the first report of this kind of presentation.

  20. Pre-operative fasting guidelines: an update

    Søreide, E; Eriksson, L I; Hirlekar, G


    Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children......Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children...

  1. Use of preoperative embolization prior to Transplant nephrectomy

    Carrie Yeast


    Full Text Available ABSTRACT Introduction After a failed transplant, management of a non-functional graft with pain or recurrent infections can be challenging. Transplant nephrectomy (TN can be a morbid procedure with the potential for significant blood loss. Embolization of the renal artery alone has been proposed as a method of reducing complications from an in vivo failed kidney transplant. While this does yield less morbidity, it may not address an infected graft or refractory hematuria or rejection. We elected to begin preoperative embolization to assess if this would help decrease the blood loss and transfusion rate associated with TN. Materials and Methods We performed a retrospective analysis of all patients who underwent non-emergent TN at our institution. Patients who had functioning grafts that later failed were included in analysis. TN was performed for recurrent infections, pain or hematuria. We evaluated for blood loss (EBL during TN, transfusion rate and length of hospital stay. Results A total of 16 patients were identified. Nine had preoperative embolization or no blood flow to the graft prior to TN. The remaining 7 did not have preoperative embolization. The shortest time from transplant to TN was 8 months and the longest 18 years with an average of 6.3 years. Average EBL for the embolized patients (ETN was 143.9cc compared to 621.4cc in the non-embolized (NETN group (p=0.041. Average number of units of blood transfused was 0.44 in the ETN with only 3/9 patients requiring transfusion. The NETN patients had average of 1.29 units transfused with 5/7 requiring transfusion. The length of stay was longer for the ETN (5.4 days compared to 3.9 in the NETN. No intraoperative complications were seen in either group and only one patient had a postoperative ileus in the NETN. Conclusion Embolization prior to TN significantly decreases the EBL but does not significantly decrease transfusion rate. However, patients do require a significantly longer

  2. Validation of the Spanish version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS).

    Vergara-Romero, Manuel; Morales-Asencio, José Miguel; Morales-Fernández, Angelines; Canca-Sanchez, Jose Carlos; Rivas-Ruiz, Francisco; Reinaldo-Lapuerta, Jose Antonio


    Preoperative anxiety is a frequent and challenging problem with deleterious effects on the development of surgical procedures and postoperative outcomes. To prevent and treat preoperative anxiety effectively, the level of anxiety of patients needs to be assessed through valid and reliable measuring instruments. One such measurement tool is the Amsterdam Preoperative Anxiety and Information Scale (APAIS), of which a Spanish version has not been validated yet. To perform a Spanish cultural adaptation and empirical validation of the APAIS for assessing preoperative anxiety in the Spanish population. A two-step forward/back translation of the APAIS scale was performed to ensure a reliable Spanish cultural adaptation. The final Spanish version of the APAIS questionnaire was administered to 529 patients between the ages of 18 to 70 undergoing elective surgery at hospitals of the Agencia Sanitaria Costa del Sol (Spain). Cronbach's alpha, homogeneity index, intra-class correlation coefficient, and confirmatory factor analysis were calculated to assess internal consistency and criteria and construct validity. Confirmatory factor analysis showed that a one-factor model was better fitted than a two-factor model, with good fitting patterns (root mean square error of approximation: 0.05, normed-fit index: 0.99, goodness-of-fit statistic: 0.99). The questionnaire showed high internal consistency (Cronbach's alpha: 0.84) and a good correlation with the Goldberg Anxiety Scale (CCI: 0.62 (95% CI: 0.55 to 0.68). The Spanish version of the APAIS is a valid and reliable preoperative anxiety measurement tool and shows psychometric properties similar to those obtained by similar previous studies.

  3. Predictors and in-hospital outcomes of preoperative acute kidney injury in patients with type A acute aortic dissection

    Wang, Xiao; Ren, Hong-Mei; Hu, Chun-Yan; Que, Bin; Ai, Hui; Wang, Chun-Mei; Sun, Li-Zhong; Nie, Shao-Ping


    Background Acute kidney injury (AKI) is common after surgery for acute aortic dissection (AAD) and increases in-hospital and long-term mortality. However, few data exist on the clinical and prognostic relevance of early preoperative AKI in patients with type A AAD. We aimed to determine the incidence and predictors of preoperative AKI and the impact of AKI on in-hospital outcomes in patients with type A AAD. Methods From May 2009 to June 2014, we retrospectively enrolled 178 patients admitted to our hospital within 48 h from symptom onset and receiving open surgery for type A AAD. The patients were divided into no AKI and AKI groups and staged with AKI severity according to the KDIGO criteria before surgery. Results AKI occurred in 41 patients (23.0%). The incidence of in-hospital complications was significantly higher in patients with preoperative AKI compared to no AKI (41.5% vs. 9.5%, P < 0.001), including renal infarction (7.3% vs. 0, P = 0.012), and it increased with AKI severity (Ptrend < 0.001). Patients with AKI had higher in-hospital mortality compared with patients without AKI, although no significant difference was found (14.6% vs. 5.1%, P = 0.079). Multivariate analysis indicated that male gender, diastolic blood pressure on admission and bilateral renal artery involvement were independent predictors of preoperative AKI in patients with type A AAD. Conclusions Early AKI before surgery was common in patients with type A AAD, and was associated with increased in-hospital complications. Male gender, diastolic blood pressure on admission and bilateral renal artery involvement were major predictors for preoperative AKI. PMID:27781058

  4. Validation of the Malay version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS).

    Mohd Fahmi, Z; Lai, L L; Loh, P S


    Preoperative anxiety is a significant problem worldwide that may affect patients' surgical outcome. By using a simple and reliable tool such as the Amsterdam Preoperative Anxiety and Information Scale (APAIS), anaesthesiologists would be able to assess preoperative anxiety adequately and accurately. The purpose of this study was to develop and validate the Malay version of APAIS (Malay-APAIS), and assess the factors associated with higher anxiety scores. The authors performed forward and backward translation of APAIS into Malay and then tested on 200 patients in the anaesthetic clinic of University Malaya Medical Centre. Psychometric analysis was performed with factor analysis, internal consistency and correlation with Spielberger's State-Trait Anxiety Inventory (STAI-state). A good correlation was shown with STAI-state (r = 0.59). Anxiety and need for information both emerged with high internal consistency (Cronbach's alpha 0.93 and 0.90 respectively). Female gender, surgery with a higher risk and need for information were found to be associated with higher anxiety scores. On the other hand, previous experience with surgery had lower need for information. The Malay-APAIS is a valid and reliable tool for the assessment of patients' preoperative anxiety and their need for information. By understanding and measuring patient's concerns objectively, the perioperative management will improve to a much higher standard of care.

  5. Significance of preoperative neutrophil–lymphocyte count ratio on predicting postoperative sepsis after percutaneous nephrolithotomy

    Volkan Sen


    Full Text Available We evaluated the usefulness of preoperative neutrophil–lymphocyte count ratio (NLCR in predicting postoperative sepsis after percutaneous nephrolithotomy (PCNL. In total, 487 patients who underwent PCNL for renal stones were included in the present retrospective study. The stone burden, number of tracts and location, operation time, fluoroscopy time, presence of residual stones, and blood transfusion rates were postoperatively recorded in all patients. All patients were followed up for signs of systemic inflammatory response syndrome (SIRS and sepsis. The association of sepsis/SIRS with the risk factors of infectious complications, including NLCR, was evaluated. SIRS was detected in 91 (18.7% patients, 25 (5.1% of whom were diagnosed with sepsis. Stone burden, operation time, irrigation rate, previous surgery, nephrostomy time, access number, blood transfusion, residual stone, postoperative urinary culture, renal pelvis urinary culture, and stone culture were found to be predictive factors for SIRS and sepsis development. Receiver operating characteristic curve analysis revealed an NLCR cutoff of 2.50 for predicting the occurrence of SIRS/sepsis. We found that the incidence of sepsis was significantly higher in patients with NLCR ≥ 2.50 than in patients with NLCR < 2.50 (p = 0.006. Preoperative and postoperative urine culture positivity were associated with high NLCR (p = 0.039 and p = 0.003, respectively. We believe that preoperative NLCR may be a promising additive predictor of bacteremia and postoperative sepsis in patients who undergo PCNL for renal stones. This marker is simple, easily measured, and easy to use in daily practice without extra costs.

  6. Analysis of 64-row multidetector CT images for preoperative angiographic evaluation of potential living kidney donors; Analyse der mehrphasigen 64-Zeilen-Multidetektor-Computertomographie zur praeoperativen angiographischen Evaluation potenzieller Lebendnierenspender

    Blondin, D.; Andersen, K.; Kroepil, P.; Cohnen, M.; Moedder, U.; Jung, G. [Universitaetsklinikum Duesseldorf, Institut fuer Diagnostische Radiologie, Duesseldorf (Germany); Sandmann, W. [Universitaetsklinikum Duesseldorf, Klinik fuer Gefaesschirurgie und Nierentransplantation, Duesseldorf (Germany); Ivens, K. [Universitaetsklinikum Duesseldorf, Klinik fuer Nephrologie, Duesseldorf (Germany)


    Anatomical imaging and the ascertainment of any anomalies in the renal vessels and the ureters are essential in the planning of a kidney donation. The aim of the present study was to assess the value of 64-row multidetector CT in noninvasive examination of the renal vessels and ureters of potential living kidney donors. The evaluation embraced 63 living renal donors (LNS) who underwent preoperative CT examination from December 2004 to January 2007. The examinations were all carried out using a Somatom Sensation -Cardiac 64 (Siemens Medical Solutions, Germany). As well as CT angiography (CTA), a venous phase of the abdomen and a late phase after 15 min using low-dose technique were performed for CT urography (CTU). The radiological findings were compared with the surgical results, or with the angiograms in 2 cases. Sensitivity, specificity and both negative and positive predictive value were calculated. In the 63 (31 female, 32 male) donors CTA had a sensitivity of 100% in examination of the main and accessory renal arteries and of 98.3% when the venous and ureteric anatomy were assessed. The sensitivity of low-dose CTU was also 100%. The findings recorded in this study indicate that noninvasive preoperative planning with 64-row multidetector CTA and CTU is a reliable 'one-stop shopping' method of examination for potential living kidney donors. (orig.) [German] Die anatomische Darstellung und Erfassung moeglicher Anomalien der Nierengefaesse und Ureteren ist fuer die Planung einer Lebendnierenspende von essenzieller Bedeutung. Die vorliegende Untersuchung soll die Wertigkeit der nichtinvasiven Evaluation mit der 64-Zeilen-Multidetektor-CT untersuchen. In die Auswertung wurden 63 Lebendnierenspender (LNS) eingeschlossen, die im Zeitraum 12.2004 bis 01.2007 mit der CT praeoperativ untersucht wurden. Die Untersuchungen erfolgten mit einem Somatom-Sensation-Cardiac-64 (Siemens Medical Solutions, Deutschland). Neben einer CT-Angiographie (CTA) wurden eine

  7. A simple and accurate grading system for orthoiodohippurate renal scans in the assessment of post-transplant renal function

    Zaki, S.K.; Bretan, P.N.; Go, R.T.; Rehm, P.K.; Streem, S.B.; Novick, A.C. (Cleveland Clinic Foundation, OH (USA))


    Orthoiodohippurate renal scanning has proved to be a reliable, noninvasive method for the evaluation and followup of renal allograft function. However, a standardized system for grading renal function with this test is not available. We propose a simple grading system to distinguish the different functional phases of hippurate scanning in renal transplant recipients. This grading system was studied in 138 patients who were evaluated 1 week after renal transplantation. There was a significant correlation between the isotope renographic functional grade and clinical correlates of allograft function such as the serum creatinine level (p = 0.0001), blood urea nitrogen level (p = 0.0001), urine output (p = 0.005) and need for hemodialysis (p = 0.007). We recommend this grading system as a simple and accurate method to interpret orthoiodohippurate renal scans in the evaluation and followup of renal allograft recipients.

  8. Pregnancy tests with end-stage renal disease.

    Fahy, Brenda G; Gouzd, Valerie A; Atallah, Joseph N


    Tests to ascertain pregnancy status are often obtained during preoperative evaluation, especially when there is a history of uncertain pregnancy or suggestion of current pregnancy. A serum pregnancy test, a beta-human chorionic gonadotropin (beta-HCG) level, was preoperatively obtained from a woman of childbearing age with end-stage renal disease (ESRD) with an unreliable history of irregular menstruation coupled with unprotected sexual activity. The beta-HCG was elevated in the range indicating pregnancy. Further work-up showed that this hormonal elevation was secondary to ESRD without pregnancy.

  9. Grid reliability

    Saiz, P; Rocha, R; Andreeva, J


    We are offering a system to track the efficiency of different components of the GRID. We can study the performance of both the WMS and the data transfers At the moment, we have set different parts of the system for ALICE, ATLAS, CMS and LHCb. None of the components that we have developed are VO specific, therefore it would be very easy to deploy them for any other VO. Our main goal is basically to improve the reliability of the GRID. The main idea is to discover as soon as possible the different problems that have happened, and inform the responsible. Since we study the jobs and transfers issued by real users, we see the same problems that users see. As a matter of fact, we see even more problems than the end user does, since we are also interested in following up the errors that GRID components can overcome by themselves (like for instance, in case of a job failure, resubmitting the job to a different site). This kind of information is very useful to site and VO administrators. They can find out the efficien...

  10. Renal actinomycosis with concomitant renal vein thrombosis.

    Chang, Dong-Suk; Jang, Won Ik; Jung, Ji Yoon; Chung, Sarah; Choi, Dae Eun; Na, Ki-Ryang; Lee, Kang Wook; Shin, Yong-Tai


    Renal actinomycosis is a rare infection caused by fungi of the genus Actinomyces. A 74-year-old male was admitted to our hospital because of gross hematuria with urinary symptoms and intermittent chills. Computed tomography of the abdomen showed thrombosis in the left renal vein and diffuse, heterogeneous enlargement of the left kidney. After nephrectomy, sulfur granules with chronic suppurative inflammation were seen microscopically, and the histopathological diagnosis was renal actinomycosis. Our case is the first report of renal actinomycosis with renal vein thrombosis.


    Soraia Geraldo Rozza Lopes


    Full Text Available El objetivo del estudio fue comprender el significado de espera del trasplante renal para las mujeres en hemodiálisis. Se trata de un estudio cualitativo-interpretativo, realizado con 12 mujeres en hemodiálisis en Florianópolis. Los datos fueron recolectados a través de entrevistas en profundidad en el domicilio. Fue utilizado el software Etnografh 6.0 para la pre-codificación y posterior al análisis interpretativo emergieron dos categorías: “las sombras del momento actual”, que mostró que las dificultades iniciales de la enfermedad están presentes, pero las mujeres pueden hacer frente mejor a la enfermedad y el tratamiento. La segunda categoría, “la luz del trasplante renal”, muestra la esperanza impulsada por la entrada en la lista de espera para un trasplante.

  12. Renal failure


    930564 Dwell times affect the local host de-fence mechanism of peritoneal dialysis patients.WANG Tao(汪涛),et al.Renal Instit,SunYatsen Med Univ,Guangzhou,510080.Chin JNephrol 1993;9(2):75—77.The effect of different intraperitoneal awelltimes on the local host defence in 6 peritonealdialysis patients was studied.A significant de-crease in the number of peritoneal cells,IgG con-centration and the phagoeytosis and bactericidalactivity of macrophages was determined when thedwell time decreased from 12 to 4 hs or form 4 to0.5hs,but the peroxidase activity in macrophagesincreased significantly.All variables,except theperoxidase activity in macrophages,showed nosignificant difference between patients of high or

  13. Traumatismo renal

    Rocha, Sofia Rosa Moura Gomes da


    Introdução: A realização deste trabalho visa a elaboração de uma revisão sistematizada subordinada à temática da traumatologia renal. Objectivos: Os principais objectivos deste trabalho são: apurar a etiologia, definir a classificação, analisar o diagnóstico e expôr o tratamento e as complicações. Desenvolvimento: Os traumatismos são a principal causa de morte antes dos 40 anos. O rim é o órgão do aparelho génito-urinário mais frequentemente atingido. Os traumatismos renais são mais fre...


    A. L. Goncharov


    Full Text Available The identification of small colon lesions is one of the major problems in laparoscopic colonic resection.Research objective: to develop a technique of visualization of small tumors of a colon by preoperative endoscopic marking of a tumor.Materials and methods. In one day prior to operation to the patient after bowel preparation the colonoscopy is carried out. In the planned point near tumor on antimesentery edge the submucous infiltration of marking solution (Micky Sharpz blue tattoo pigment, UK is made. The volume of entered solution of 1–3 ml. In only 5 months of use of a technique preoperative marking to 14 patients with small (the size of 1–3 cm malignant tumors of the left colon is performed.Results. The tattoo mark was well visualized by during operation at 13 of 14 patients. In all cases we recorded no complications. Time of operation with preoperative marking averaged 108 min, that is significantly less in comparison with average time of operation with an intra-operative colonoscopy – 155 min (р < 0.001.Conclusions. The first experience of preoperative endoscopic marking of non palpable small tumors of a colon is encouraging. Performance of a technique wasn't accompanied by complications and allowed to reduce significantly time of operation and to simplify conditions of performance of operation.

  15. Preoperative exercise training to improve postoperative outcomes

    Valkenet, K.


    It is common knowledge that better preoperative physical fitness is associated with better postoperative outcomes. However, as a result of aging of the population and improved surgical and anaesthesia techniques, the proportion of frail patients with decreased physical fitness levels undergoing majo

  16. Preoperational test report, primary ventilation system

    Clifton, F.T.


    This represents a preoperational test report for Primary Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space filtered venting of tanks AY101, AY102, AZ101, AZ102. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  17. Preoperative evaluation : risk management and implementation aspects

    Klei, W.A. van


    In preoperative risk management the anesthesiologist uses diagnostic information to estimate the probability of outcomes and to decide on the anesthetic strategy in a particular patient. The aim of this thesis was explore to what extent simple patient characteristics, particularly obtained from

  18. Pre-operative fasting guidelines: an update

    Søreide, E; Eriksson, L I; Hirlekar, G


    Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children...

  19. Preoperational test report, vent building ventilation system

    Clifton, F.T.


    This represents a preoperational test report for Vent Building Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides Heating, Ventilation, and Air Conditioning (HVAC) for the W-030 Ventilation Building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  20. Preoperative and intraoperative continuous use of ...


    Sep 13, 2016 ... in clinics to improve patient safety and effectiveness with. Introduction ... and control group according to different use of drugs. The two ... Key words: Anesthesia, dexmedetomidine, effect, intervention, preoperative, recovery, remifentanil .... will lead to postoperative pain in patients and severe agitation after ...

  1. Preoperational test, vent building ventilation system

    Clifton, F.T., Westinghouse Hanford


    Preoperational Test Procedure for Vent Building Ventilation System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The Vent Building ventilation system provides ventilation, heating, cooling, and zone confinement control for the W-030 Project Vent Building. The tests verify correct System operation and correct indications displayed by the central Monitor and Control system.

  2. Preoperative evaluation : risk management and implementation aspects

    Klei, W.A. van


    In preoperative risk management the anesthesiologist uses diagnostic information to estimate the probability of outcomes and to decide on the anesthetic strategy in a particular patient. The aim of this thesis was explore to what extent simple patient characteristics, particularly obtained from preo

  3. Volumetry may predict early renal function after nephron sparing surgery in solitary kidney patients.

    Kuru, Timur H; Zhu, Jie; Popeneciu, Ionel V; Rudhardt, Nora S; Hadaschik, Boris A; Teber, Dogu; Roethke, Matthias; Hohenfellner, Markus; Zeier, Martin; Pahernik, Sascha A


    We investigate the impact of the residual kidney volume measured by tumor volumetry on preoperative imaging in predicting post-operative renal function. Nephron sparing surgery (NSS) in renal cell carcinoma (RCC) is the standard treatment for T1 kidney tumors. Resection of kidney tumors in solidary kidneys needs precise preoperative counseling of patients regarding post-operative renal function. Patients planned for renal tumor surgery who underwent prior nephrectomy on the contralateral side were included. We identified 35 patients in our database that underwent NSS in solitary kidneys and met the inclusion criteria. Tumor volumetry was performed on computer tomography (CT) or magnetic resonance imaging (MRI) with the Medical Imaging Interaction Toolkit (MITK). Clinical and pathological data were assessed. Follow-up data included renal function over 3 years. Mean age was 64 ± 8.1 years. Mean tumor volume on imaging was 27.5 ± 48.6 cc. Mean kidney volume was 195.2 ± 62.8 cc and mean residual kidney volume was 173.4 ± 65.3 cc. We found a correlation between renal function (MDRD) and residual kidney volume on imaging 1-week post-surgery (p = 0.038). Mid- and long-term renal function was not associated with residual kidney volume. In conclusion, renal volumetry may predict early renal function after NSS.

  4. A renal registry for Africa: first steps.

    Davids, M Razeen; Eastwood, John B; Selwood, Neville H; Arogundade, Fatiu A; Ashuntantang, Gloria; Benghanem Gharbi, Mohammed; Jarraya, Faiçal; MacPhee, Iain A M; McCulloch, Mignon; Plange-Rhule, Jacob; Swanepoel, Charles R; Adu, Dwomoa


    There is a dearth of data on end-stage renal disease (ESRD) in Africa. Several national renal registries have been established but have not been sustainable because of resource limitations. The African Association of Nephrology (AFRAN) and the African Paediatric Nephrology Association (AFPNA) recognize the importance of good registry data and plan to establish an African Renal Registry. This article reviews the elements needed for a successful renal registry and gives an overview of renal registries in developed and developing countries, with the emphasis on Africa. It then discusses the proposed African Renal Registry and the first steps towards its implementation. A registry requires a clear purpose, and agreement on inclusion and exclusion criteria, the dataset and the data dictionary. Ethical issues, data ownership and access, the dissemination of findings and funding must all be considered. Well-documented processes should guide data collection and ensure data quality. The ERA-EDTA Registry is the world's oldest renal registry. In Africa, registry data have been published mainly by North African countries, starting with Egypt and Tunisia in 1975. However, in recent years no African country has regularly reported national registry data. A shared renal registry would provide participating countries with a reliable technology platform and a common data dictionary to facilitate joint analyses and comparisons. In March 2015, AFRAN organized a registry workshop for African nephrologists and then took the decision to establish, for the first time, an African Renal Registry. In conclusion, African nephrologists have decided to establish a continental renal registry. This initiative could make a substantial impact on the practice of nephrology and the provision of services for adults and children with ESRD in many African countries.

  5. Utility of Ultraportable Echocardiography in the Preoperative Evaluation of Noncardiac Surgery

    Costa, Jean Allan; Almeida, Maria Lucia Pereira; Estrada, Tereza Cristina Duque; Werneck,Guilherme Lobosco; Rocha, Alexandre Marins; Rosa,Maria Luiza Garcia; Ribeiro, Mario Luiz; Mesquita, Claudio Tinoco


    Background The ultraportable echocardiogram machine, with relevant portability and easiness in performing diagnoses, when in experienced hands, may contribute to the reliability of preoperative evaluation in noncardiac surgeries. Objectives To assess cardiac function parameters in patients aged older than 60 years, candidates of elective noncardiac surgeries, classified as ASA1 or ASA 2 according to surgical risk. Methods A total of 211 patients referred for elective surgeries, without suspic...

  6. Imaging spectrum of primary malignant renal neoplasms in children

    Rama Anand


    Full Text Available Wilms′ tumor (WT is the most common abdominal tumor in children. Many pediatric renal tumors in the past were categorized as WT; however, in recent years, several specific renal tumors have been recognized as distinct pathological entities. The age and clinical presentation of the child and distinctive imaging features may help in reaching a specific diagnosis in most cases. This is important as it has implications on the pre-operative diagnostic work-up and prognosis of the child. However, it is often not possible to differentiate one from the other pediatric renal tumor on the basis of imaging alone, and the final diagnosis is often made at histological examination of the surgical specimen. This article reviews the imaging features of primary malignant renal neoplasms in children along with their clinical presentation and pathological features.

  7. Renal protection in cardiovascular surgery [version 1; referees: 2 approved

    Nora Di Tomasso


    Full Text Available Acute kidney injury (AKI is one of the most relevant complications after major surgery and is a predictor of mortality. In Western countries, patients at risk of developing AKI are mainly those undergoing cardiovascular surgical procedures. In this category of patients, AKI depends on a multifactorial etiology, including low ejection fraction, use of contrast media, hemodynamic instability, cardiopulmonary bypass, and bleeding. Despite a growing body of literature, the treatment of renal failure remains mainly supportive (e.g. hemodynamic stability, fluid management, and avoidance of further damage; therefore, the management of patients at risk of AKI should aim at prevention of renal damage. Thus, the present narrative review analyzes the pathophysiology underlying AKI (specifically in high-risk patients, the preoperative risk factors that predispose to renal damage, early biomarkers related to AKI, and the strategies employed for perioperative renal protection. The most recent scientific evidence has been considered, and whenever conflicting data were encountered possible suggestions are provided.

  8. Renal Cell Carcinoma Mimicking Adrenal Tumor

    Mohammad Kazem Moslemi


    Full Text Available There are a variety of causes of adrenal pseudotumors on computerized tomography (CT scan, including upper-pole renal mass, gastric diverticulum, prominent splenic lobulation, pancreatic mass, hepatic mass, and periadrenal varices. We present a case of a large subhepatic mass that discrimination of its origin from neighborhood organs was difficult preoperatively. Our patient was a 58 years old man, that three months after an unsuccessful operation in another center for a pseudoadrenal mass underwent a very difficult subcapsular tumorectomy in our center.

  9. Percutaneous renal puncture: requirements and preliminary results

    Leroy, A; Payan, Y; Richard, F; Chartier-Kastler, E; Troccaz, J; Leroy, Antoine; Mozer, Pierre; Payan, Yohan; Chartier-Kastler, Emmanuel; Troccaz, Jocelyne


    This paper introduces the principles of computer assisted percutaneous renal puncture, that would provide the surgeon with an accurate pre-operative 3D planning on CT images and, after a rigid registration with space-localized echographic data, would help him to perform the puncture through an intuitive 2D/3D interface. The whole development stage relied on both CT and US images of a healthy subject. We carried out millimetric registrations on real data, then guidance experiments on a kidney phantom showed encouraging results.

  10. Renal anomalies in patients with turner syndrome: Is scintigraphy superior to ultrasound?

    Hamza, Rasha T; Shalaby, Mennatallah H; Hamed, Laith S; Abdulla, Dunya B A; Elfekky, Sahar M; Sultan, Omar M


    Renal anomalies are present in up to 30% of patients with Turner syndrome (TS). Renal ultrasound (U/S) detects anatomical renal anomalies only while renal scintigraphy detects anomalies, detects early renal malfunction, and estimates glomerular filtration rate (GFR). Thus, we aimed to assess frequency of renal abnormalities detected by scintigraphy in comparison to renal U/S in TS patients. Ninety TS patients were subjected to auxological assessment, measurement of serum creatinine; and renal U/S and scintigraphy. Renal U/S detected renal anomalies in 22.22% of patients versus 17.78 % detected by scintigraphy (P = 0.035). Scintigraphy detected renal functional abnormalities in 44.44% of patients in the form of subnormal total GFR, abnormal renogram curve pattern, improper tracer handling and perfusion; and difference in split renal function >10% between both kidneys. Patients with a 45,X karyotype had more renal functional abnormalities (56%) than those with mosaic karyotype (33.33%), P = 0.04. In conclusion, renal scintigraphy is not superior to U/S in detection of renal anomalies but is a reliable method for early detection of renal malfunction in TS patients especially those with 45,X to ensure early management to offer a better quality of life.

  11. Preoperative staging of perforated diverticulitis by computed tomography scanning

    M.P.M. Gielens; I.M. Mulder (Irene); E. van der Harst (Erwin); M.P. Gosselink (Martijn Pieter); K.J. Kraal; H.T. Teng; J.F. Lange (Johan); J. Vermeulen (Jefrey)


    textabstractBackground: Treatment of perforated diverticulitis depends on disease severity classified according to Hinchey's preoperative classification. This study assessed the accuracy of preoperative staging of perforated diverticulitis by computerized tomography (CT) scanning. Methods: All patie

  12. The Amsterdam Preoperative Anxiety and Information Scale (APAIS)

    Moerman, N; Dam, van, F.S.A.M; Muller, M.J; Oosting, H


    ... phase.During routine preoperative screening, 320 patients were asked to assess their anxiety and information requirement on a six-item questionnaire, the Amsterdam Preoperative Anxiety and Information Scale (APAIS...

  13. Retroperitoneal Gastrointestinal Type Schwannoma Presenting as a Renal Mass

    Susan J. Hall


    Full Text Available Retroperitoneal schwannomas are extremely rare, and unreported in Urology. Often thought to be malignant from imaging the diagnosis is often delayed until Histology. We report a case of retroperitoneal schwanoma thought to be a malignant renal mass. Seventy three year old lady presented with abdominal pain. Imaging showed a mass attached to the renal pelvis thus she underwent a radical nephrectomy. Histology reported retroperitoneal schwannoma. Malignant forms are rare however treatment for these is surgical excision. Awareness of the existence of these tumors may help in avoiding unnecessary radical surgeries by opting for biopsy preoperatively.

  14. Frontiers of reliability

    Basu, Asit P; Basu, Sujit K


    This volume presents recent results in reliability theory by leading experts in the world. It will prove valuable for researchers, and users of reliability theory. It consists of refereed invited papers on a broad spectrum of topics in reliability. The subjects covered include Bayesian reliability, Bayesian reliability modeling, confounding in a series system, DF tests, Edgeworth approximation to reliability, estimation under random censoring, fault tree reduction for reliability, inference about changes in hazard rates, information theory and reliability, mixture experiment, mixture of Weibul

  15. [Preoperative assessment of patients with diabetes mellitus].

    Takeda, Kiyoshi


    The perioperative morbidity of diabetic patients is related to preoperative end-organ damage. Due to the microvascular pathology, autonomic neuropathy is common and cardiovascular abnormalities such as hypertension, painless myocardial ischemia, and orthostatic hypotension may predispose patients to perioperative cardiovascular instability. Autonomic dysfunction also contributes to delayed gastric emptying, and preoperative administration of a histamine antagonist and a gastric emptying agent is needed. Chronic hyperglycemia leads to glycosylation of tissue proteins and the accumulation of abnormal collagen can cause stiff joint syndrome resulting in difficult tracheal intubation. The primary goal of pre and intraoperative blood glucose control is to avoid hypoglycemia and ketosis. Moreover, the tight glycemic control has been reported to improve survival in critically ill patients who were treated in the intensive care unit.

  16. Preoperatively diagnosed mucocele of the appendix.

    Rojnoveanu, Gh; Ghidirim, Gh; Mishin, I; Vozian, M; Mishina, A


    Mucocele of the appendix is an infrequent entity, characterized by distension of the lumen due to accumulation of mucoid substance and is rarely diagnosed preoperatively. If untreated, mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The type of surgical treatment is related to the dimensions and the histology of the mucocele. Appendectomy is used for simple mucocele or for cystadenoma. Right hemi-colectomy is recommended for cystadeno carcinoma. In this paper, we report a case of an asymptomatic 37-year-old woman in whom mucocele was found on a routine ultrasound examination and preoperative computed tomography scan. Surgery revealed a big appendix measuring 84 mm in length and 40 mm in diameter. The final pathologic diagnosis was simple mucocele. Celsius.

  17. Preoperative Alcohol Consumption and Postoperative Complications

    Eliasen, Marie; Grønkjær, Marie; Skov-Ettrup, Lise Skrubbeltrang


    .30-2.49), prolonged stay at the hospital (RR = 1.24; 95% CI: 1.18-1.31), and admission to intensive care unit (RR = 1.29; 95% CI: 1.03-1.61). Clearly defined high alcohol consumption was associated with increased risk of postoperative mortality (RR = 2.68; 95% CI: 1.50-4.78). Low to moderate preoperative alcohol...... complications, prolonged stay at the hospital, and admission to intensive care unit....

  18. Renal Papillary Necrosis: Role of Radiology

    Pandya, Vaidehi K.


    Renal Papillary Necrosis (RPN) is idefined as Ischemic necrobiosis of the papilla in the medulla of the kidneys. Variety of etiological factors are recognized which cause papillary necrosis, such as analgesic nephropathy, diabetes mellitus, urinary obstruction and sickle cell haemoglobinopathy. The early diagnosis of RPN is important to improve prognosis and reduce morbidity. Radiological Imaging offers early diagnosis and can guide prompt treatment of papillary necrosis and can minimize a decline in renal function. Here we report three cases of RPN with typical imaging findings. One of them was diabetic and hypertensive female with recurrent Urinary tract Infections and other was a male with no known co-morbidity. Both of them were diagnosed to have renal papillary necrosis on CT scan and were managed operatively and conservatively, respectively. Third case was a healthy female being investigated to be renal donor for her son. Here RPN was an incidental finding and was treated conservatively. Thus CT scan could detect it pre-operatively and complications due to transplantation of a kidney with papillary necrosis were avoided. So, we want to emphasize the importance of Radiology, particularly CT scanning in detection of RPN and to guide early and prompt treatment. PMID:26894147

  19. Preoperative Arterial Interventional Chemotherapy on Cervical Cancer

    WANG Hui; LING HU-Hua; TANG Liang-dan; ZHANG Xing-hua


    Objective:To discuss the therapeutic effect of preoperative interventional chemotherapy on cervical cancer.Methods:Preoperative interventional chemotherapy by femoral intubation was performed in 25 patients with bulky cervical cancer.The patients received bleomycin 45 mg and cisplatin or oxaliplatin 80 mg/m2.Results:25 cases(including 8 cases with stage Ⅰ and 17 cases with stage Ⅱ)received one or two courses of preoperative interventional chemotherapy.The size of the focal lesions was decreased greatly and radical hysterectomy and lymphadenectomy were performed successfully in all the patients.All of the specimens were sent for pathological examination.Lymphocyte infiltration was found more obvious in the cancer tissues as compared with their counterpart before treatment.As a result,relevant vaginal bleeding was stopped completely shortly after the treatment.Conclusion:Arterial interventional chemotherapy was proved to reduce the local size of cervical cancer and thus control the hemorrhage efficiently.The patients with cervical cancer can receive radical hysterectomy therapy after the interventional chemotherapy.

  20. Citrus aurantium blossom and preoperative anxiety.

    Akhlaghi, Mahmood; Shabanian, Gholamreza; Rafieian-Kopaei, Mahmoud; Parvin, Neda; Saadat, Mitra; Akhlaghi, Mohsen


    Reducing anxiety is very important before operation. Preoperative visit and use of premedication are popular methods to achieve this goal, but the role of anxiolytic premedication remains unclear and postoperative side-effects may result from routine premedication. Citrus aurantium is used as an alternative medicine in some countries to treat anxiety, and recently the anxiolytic role of this medicinal plant was established in an animal model study. The aim of this study was to assess the anxiolytic effect of Citrus aurantium blossomon preoperative anxiety. We studied 60 ASA I patients undergoing minor operation. In a randomized double-blind design, two groups of 30 patients received one of the following oral premedication two hours before induction of anesthesia: 1) Citrus aurantium blossom distillate (C-group); 2) Saline solution as placebo (P-group). Anxiety was measured before and after premedication using the Spielberger state-trait anxiety inventory (STAI-state) and the Amsterdam preoperative anxiety and information scale (APAIS) before operation. After premedication, both the STAI-state and the APAIS scales were decreased in C-group (ppreoperative anxiety before minor operation. Copyright © 2011 Elsevier Editora Ltda. All rights reserved.

  1. Preoperative imaging diagnosis of carotid body tumors.

    Pacheco-Ojeda, Luis A; Martínez-Viteri, Miguel A


    Carotid body tumors (CBTs) are relatively frequent lesions encountered at high altitudes, such in as the Andean Mountains. A correct preoperative diagnosis is essential for surgical planning and performance. For this reason, we have reviewed the evolution of our experience in the imaging diagnosis of these tumors. Between 1980 and June 2008, 160 CBTs were diagnosed. A total of 138 tumors were operated on, 4 are waiting for surgery, and 18 were not operated on because of age, medical conditions, or patient refusal. We have reviewed retrospectively the modalities of imaging diagnosis in our patients who underwent operation. Among the 138 tumors operated on, a correct preoperative diagnosis was done in 127 cases (92%). The preoperative diagnosis of the remaining 11 patients was unspecified benign tumor for 6 patients and neck lymph node for 5 patients. The imaging methods performed by different radiologists were conventional ultrasound, color Doppler ultrasound, carotid conventional angiography (CA), axial tomography, magnetic resonance and magnetic resonance angiography, and computed tomographic angiography (CTA). Most patients had more than one image study. Review of radiologist reports revealed a correct diagnosis in all carotid CA, magnetic resonance studies, and CTA. Additionally, CTA appeared to be a valuable method to predict the Shamblin group. Clinical suspicion and current image techniques permit a correct diagnosis in practically all cases of CBT.

  2. Implications of preoperative hypoalbuminemia in colorectal surgery

    Adam Truong; Mark H Hanna; Zhobin Moghadamyeghaneh; Michael J Stamos


    Serum albumin has traditionally been used as a quantitative measure of a patient’s nutritional status because of its availability and low cost. While malnutrition has a clear definition within both the American and European Societies for Parenteral and Enteral Nutrition clinical guidelines, individual surgeons often determine nutritional status anecdotally. Preoperative albumin level has been shown to be the best predictor of mortality after colorectal cancer surgery. Specifically in colorectal surgical patients, hypoalbuminemia significantly increases the length of hospital stay, rates of surgical site infections, enterocutaneous fistula risk, and deep vein thrombosis formation. The delay of surgical procedures to allow for preoperative correction of albumin levels in hypoalbuminemic patients has been shown to improve the morbidity and mortality in patients with severe nutritional risk. The importance of preoperative albumin levels and the patient’s chronic inflammatory state on the postoperative morbidity and mortality has led to the development of a variety of surgical scoring systems to predict outcomes efficiently. This review attempts to provide a systematic overview of albumin and its role and implications in colorectal surgery.

  3. Renal blood flow and metabolism after cold ischaemia: peroperative measurements in patients with calculi

    Petersen, H K; Henriksen, Jens Henrik Sahl


    correlated inversely to arterial-renal venous O2-difference (r = -0.74, P less than 0.05, n = 9) and directly to the preoperatively estimated unilateral glomerular filtration rate (r = 0.76, P less than 0.05, n = 8). After hypothermic ischaemia RBF decreased on the average by 42% (P less than 0.......01) immediately after re-established perfusion and 36% (P less than 0.02) 30 min later. In one additional patient, who had a short warm ischaemia (8 min), the flow pattern was the same. As arterial pressure remained constant, the reduced RBF signifies an increased renal vascular resistance. Renal O2-uptake...... and renal venous L/P ratio were almost constant, indicating no significant anaerobic processes being involved in the flow response. None of the patients showed any signs of reactive hyperaemia. It is concluded that hypothermic renal ischaemia may be followed by an increased renal vascular resistance even...

  4. Renal Cell Carcinoma Metastasis from Biopsy Associated Hematoma Disruption during Robotic Partial Nephrectomy

    Christopher Caputo


    Full Text Available We describe a case in which a patient with a past medical history of ovarian cancer received a diagnostic renal biopsy for an incidentally discovered renal mass. During left robotic partial nephrectomy (RPN, a perinephric hematoma was encountered. The hematoma was not present on preoperative imaging and was likely a result of the renal biopsy. The renal cell carcinoma (RCC and the associated hematoma were widely excised with negative surgical margins. On follow-up imaging at five months postoperatively, a recurrent renal mass at the surgical resection bed and several new nodules in the omentum were detected. During completion left robotic total nephrectomy and omental excision, intraoperative frozen sections confirmed metastatic RCC. We believe that a hematoma seeded with RCC formed as a result of the renal biopsy, and subsequent disruption of the hematoma during RPN caused contamination of RCC into the surrounding structures.

  5. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) - the first trial of a German version.

    Berth, Hendrik; Petrowski, Katja; Balck, Friedrich


    Preoperative anxiety influences the result of the treatment in patients. To assess preoperative anxiety the Amsterdam Preoperative Anxiety and Information Scale (APAIS) [1] was developed. The APAIS measures anxiety and the need-for-information with 6 items, with good reliability and validity. This article presents the first test of the German version of this screening instrument. The German version of the APAIS was tested on 68 patients questioned before surgery on the lower extremities in the Orthopaedic Department of a University Hospital. From 68 patients, 47 (69%) were female and the average age was 55 years. Besides the APAIS, several additional questionnaires with similar or divergent content were administered for testing the convergent and discriminant validity of the APAIS (HADS, SCL-9-K, KASA, COSS, STOA). The two scales anxiety and need-for-information could be replicated by a factor analysis and had high reliability (anxiety: Cronbachs Alpha = 0.92; need-for-information: Cronbachs Alpha = 0.86). As expected the scales of the APAIS correlated highly with different standard questionnaires which measure anxiety (KASA, STOA) and low with questionnaires of divergent contents (HADS depression, COSS). The APAIS-scales are independent of sex, age or previous surgeries. Patients with a higher need-for-information show higher anxiety (r=0.59) prior to surgery. During its first trial the German version of the APAIS proved to be a reliable and valid instrument. Furthermore, it is a good screening instrument to assess preoperative anxiety and need-for-information in clinical practice, especially due to its brevity. In further studies the predictive validity has to be examined in large heterogeneous samples.

  6. Persistent renal hyperparathyroidism caused by intrathyroidal parathyroid glands.

    Chen, Chin-Li; Lin, Shih-Hua; Yu, Jyh-Cherng; Shih, Ming-Lang


    Renal hyperparathyroidism usually occurs in chronic renal failure patients on regular dialysis. However, renal hyperparathyroidism resulting from intrathyroidal parathyroid glands is an uncommon condition. We herein present the case of a 35-year-old woman who has been on hemodialysis for 20 years. She had renal hyperparathyroidism with generalized weakness and bone pain for 2 years. The patient initially underwent parathyroidectomy at a local institution, during which two large parathyroid glands were resected from the right side (no parathyroid glands were found on the left side); however, the surgical procedure was unsuccessful, and the patient had persistent renal hyperparathyroidism after the operation. She was then transferred to our hospital and ectopic intrathyroidal parathyroid glands were localized by neck ultrasonography and technetium-99m sestamibi scans with single-photon emission computed tomography imaging preoperatively. A left thyroid lobectomy was performed and two intrathyroidal parathyroid glands were found. The patient recovered uneventfully and her symptoms resolved. Therefore, clinicians should be aware of the possibility of renal hyperparathyroidism resulting from intrathyroidal parathyroid glands in cases where the renal hyperparathyroidism persists after parathyroidectomy.

  7. Prevalence and association of post-renal transplant anemia

    Hesham Elsayed


    Full Text Available In some renal allograft recipients, anemia persists or develops following transplantation. Anemia is associated with pre-operative blood loss and allograft dysfunction, including delayed graft function, acute rejection and chronic allograft dysfunction. To study the prevalence and association of post-renal transplant anemia, we studied 200 renal transplant recipients; 131 (65.5% patients were males and 69 (34.5% patients were females, and age ranged from 17 to 67 years, with a mean of 37.7 ± 10.8 years. All patients were receiving cyclosporine, prednisolone and mycophenolate mofetil (MMF. Complete blood count was done at two times: three and six months post-renal transplant. There were 74% anemic patients three months after renal transplantation and 45% anemic patients six months after renal transplantation. High creatinine value, female gender, delayed graft function, episodes of acute rejection, perioperative blood loss and infections were the only significant independent risk factors for prevalence of anemia post-renal transplant. In our study, we did not find an association between MMF and cyclosporine nor angiotensin-converting enzyme inhibitors (ACEIs or angiotensin receptors blocker (ARBs with anemia. This study demonstrates that anemia is a common complication during the first six months after kidney transplantation, with several risk factors precipitating this complication.

  8. Efficacy of preoperative biliary tract decompression in patients with obstructive jaundice.

    Gundry, S R; Strodel, W E; Knol, J A; Eckhauser, F E; Thompson, N W


    Fifty consecutive matched patients with benign or malignant biliary tract obstruction were compared to determine the efficacy of preoperative percutaneous biliary drainage (PBD). Twenty-five patients underwent PBD for an average of nine days before operation; 25 patients underwent percutaneous transhepatic cholangiography ( PTHC ) followed immediately by operation. Serum bilirubin levels before PTHC were 16.5 +/- 7.6 mg/dL and 14.9 +/- 7.6 mg/dL in PBD and non-PBD groups, respectively. Serum bilirubin levels decreased to 6.5 +/- 6.2 mg/dL preoperatively in patients having PBD. One week after operation, bilirubin levels were 4.2 +/- 4.3 mg/dL and 9.0 +/- 5.2 mg/dL in the PBD and non-PBD groups, respectively. Major morbidity (sepsis, abscess, renal failure, or bleeding) occurred in two patients (8%) having PBD and in 13 patients (52%) without PBD. One patient (4%) with PBD, and five patients (20%) without PBD, died. The mean hospital stay was shorter for the PBD group. Preoperative PBD reduces operative mortality and morbidity and results in a more rapid resolution of hyperbilirubinemia during the postoperative period.

  9. Emergency Off-Pump Coronary Artery Bypass Graft Surgery for Patients on Preoperative Intraaortic Balloon Pump.

    Ito, Hisato; Mizumoto, Toru; Tempaku, Hironori; Fujinaga, Kazuya; Sawada, Yasuhiro; Teranishi, Satoshi; Shimpo, Hideto


    The aim of this study was to investigate early and long-term outcomes of patients with acute coronary syndrome preoperatively requiring intraaortic balloon pump support who underwent emergency off-pump coronary artery bypass graft surgery. One hundred and fifteen patients on preoperative intraaortic balloon pump receiving emergency off-pump coronary artery bypass graft surgery over an 11-year period were evaluated. The median age was 71 years (range, 33 to 87). Acute myocardial infarction and unstable angina were present in 54 patients (47.0%) and 61 patients (53.0%), respectively. Left main disease and triple-vessel disease without left main involvement were present in 74 patients (64.3%) and 33 patients (28.7%), respectively. There were 3 perioperative deaths. Complete surgical revascularization was accomplished in 82 patients (71.3%), and in situ internal thoracic artery graft was used in 96 (83.5%). Late survival, freedom from major adverse cardiac and cerebrovascular events, and freedom from repeat revascularization rates at 5 years were 83.3%, 73.5%, and 84.2%, respectively. The Cox multivariate prognostic predictors of total mortality were preoperative renal impairment (hazard ratio [HR] 7.90; 95% confidence interval [CI]: 3.06 to 20.4) and low ejection fraction (HR 0.94, 95% CI: 0.88 to 0.99). The multivariate risk predictors of major adverse cardiac and cerebrovascular events were preoperative renal impairment (HR 2.68, 95% CI: 1.00 to 7.19) and peripheral vascular disease (HR 2.81, 95% CI: 1.05 to 7.51), and complete revascularization was protective (HR 0.39, 95% CI: 0.19 to 0.81). The multivariate risk factor of repeat revascularization was previous percutaneous coronary intervention (HR 3.26, 95% CI: 1.14 to 9.33), and complete surgical revascularization was also protective (HR 0.30, 95% CI: 0.11 to 0.85). Off-pump coronary artery bypass graft surgery is a feasible option for patients requiring preoperative intraaortic balloon pump support. Copyright

  10. Iron therapy for pre-operative anaemia.

    Ng, Oliver; Keeler, Barrie D; Mishra, Amitabh; Simpson, Alastair; Neal, Keith; Brookes, Matthew J; Acheson, Austin G


    Pre-operative anaemia is common and occurs in up to 76% of patients. It is associated with increased peri-operative allogeneic blood transfusions, longer hospital lengths of stay and increased morbidity and mortality. Iron deficiency is one of the most common causes of this anaemia. Oral iron therapy has traditionally been used to treat anaemia but newer, safer parenteral iron preparations have been shown to be more effective in other conditions such as inflammatory bowel disease, chronic heart failure and post-partum haemorrhage. A limited number of studies look at iron therapy for the treatment of pre-operative anaemia. The aim of this Cochrane review is to summarise the evidence for use of iron supplementation, both enteral and parenteral, for the management of pre-operative anaemia. The objective of this review is to evaluate the effects of pre-operative iron therapy (enteral or parenteral) in reducing the need for allogeneic blood transfusions in anaemic patients undergoing surgery. We ran the search on 25 March 2015. We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), EMBASE Classic and EMBASE (Ovid), CINAHL Plus (EBSCO), PubMed, clinical trials registries, conference abstracts, and we screened reference lists. We included all randomised controlled trials (RCTs) which compared pre-operative iron monotherapy to placebo, no treatment, standard of care or another form of iron therapy for anaemic adults undergoing surgery. Anaemia was defined by haemoglobin values less than 13 g/dL for males and 12 g/dL for non-pregnant females. Data were collected by two authors on the proportion of patients who receive a blood transfusion, amount of blood transfused per patient (units) and haemoglobin measured as continuous variables at pre-determined time-points: pre

  11. Preoperative Embolization of Hypervascular Thoracic, Lumbar, and Sacral Spinal Column Tumors: Technique and Outcomes from a Single Center

    Nair, Sreejit; Gobin, Y. Pierre; Leng, Lewis Z.; Marcus, Joshua D.; Bilsky, Mark; Laufer, Ilya; Patsalides, Athos


    Summary The existing literature on preoperative spine tumor embolization is limited in size of patient cohorts and diversity of tumor histologies. This report presents our experience with preoperative embolization of hypervascular thoracic, lumbar, and sacral spinal column tumors in the largest series to date. We conducted a retrospective review of 228 angiograms and 188 pre-operative embolizations for tumors involving thoracic, lumbar and sacral spinal column. Tumor vascularity was evaluated with conventional spinal angiography and was graded from 0 (same as normal adjacent vertebral body) to 3 (severe tumor blush with arteriovenous shunting). Embolic materials included poly vinyl alcohol (PVA) particles and detachable platinum coils and rarely, liquid embolics. The degree of embolization was graded as complete, near-complete, or partial. Anesthesia records were reviewed to document blood loss during surgery. Renal cell carcinoma (44.2%), thyroid carcinoma (9.2%), and leiomyosarcoma (6.6%) were the most common tumors out of a total of 40 tumor histologies. Hemangiopericytoma had the highest mean vascularity (2.6) of all tumor types with at least five representative cases followed by renal cell carcinoma (2.0) and thyroid carcinoma (2.0). PVA particles were used in 100% of cases. Detachable platinum coils were used in 51.6% of cases. Complete, near-complete, and partial embolizations were achieved in 86.1%, 12.7%, and 1.2% of all cases, respectively. There were no new post-procedure neurologic deficits or other complications with long-term morbidity. The mean intra-operative blood loss for the hypervascular tumors treated with pre-operative embolization was 1745 cc. Preoperative embolization of hypervascular thoracic, lumbar, and sacral spine tumors can be performed with high success rates and a high degree of safety at high volume centers. PMID:24070089

  12. Development of preoperative planning software for transforaminal endoscopic surgery and the guidance for clinical applications.

    Chen, Xiaojun; Cheng, Jun; Gu, Xin; Sun, Yi; Politis, Constantinus


    Preoperative planning is of great importance for transforaminal endoscopic techniques applied in percutaneous endoscopic lumbar discectomy. In this study, a modular preoperative planning software for transforaminal endoscopic surgery was developed and demonstrated. The path searching method is based on collision detection, and the oriented bounding box was constructed for the anatomical models. Then, image reformatting algorithms were developed for multiplanar reconstruction which provides detailed anatomical information surrounding the virtual planned path. Finally, multithread technique was implemented to realize the steady-state condition of the software. A preoperative planning software for transforaminal endoscopic surgery (TE-Guider) was developed; seven cases of patients with symptomatic lumbar disc herniations were planned preoperatively using TE-Guider. The distances to the midlines and the direction of the optimal paths were exported, and each result was in line with the empirical value. TE-Guider provides an efficient and cost-effective way to search the ideal path and entry point for the puncture. However, more clinical cases will be conducted to demonstrate its feasibility and reliability.

  13. Kidney (Renal) Failure

    ... How is kidney failure treated? What is kidney (renal) failure? The kidneys are designed to maintain proper fluid ... marrow and strengthen the bones. The term kidney (renal) failure describes a situation in which the kidneys have ...

  14. Renal arteries (image)

    A renal angiogram is a test used to examine the blood vessels of the kidneys. The test is performed ... main vessel of the pelvis, up to the renal artery that leads into the kidney. Contrast medium ...

  15. Delta-Reliability

    Eugster, P.; Guerraoui, R.; Kouznetsov, P.


    This paper presents a new, non-binary measure of the reliability of broadcast algorithms, called Delta-Reliability. This measure quantifies the reliability of practical broadcast algorithms that, on the one hand, were devised with some form of reliability in mind, but, on the other hand, are not considered reliable according to the ``traditional'' notion of broadcast reliability [HT94]. Our specification of Delta-Reliability suggests a further step towards bridging the gap between theory and...


    N Safai


    Full Text Available "nAcute renal failure (ARF following cardiac surgery occurs in 1 to 10% of patients. Patients who develop ARF have higher rates of mortality. This study was undertaken to estimate the role of perioperative variables in predicting of post cardiac surgery ARF. We studied a cohort of 398 adult patients who underwent cardiac surgery at our institution from February 2004 to February 2006. Adult patients who were scheduled for cardiac valvular surgery, coronary artery bypass grafting (CABG or both, with or without cardiopulmonary bypass (CPB were included. Exclusion criteria were death within two days of operation (n= 8, incomplete patient data, and preexisting renal dysfunction and dialysis requirement or a baseline serum creatinine > 4 mg/dl. Age, sex, left ventricular ejection fraction, diabetes, preoperative, presence of proteinuria (on dipstick, type of surgery, use of CPB and duration of surgery were recorded. A logistic regression analysis was performed to assess independent contribution of variables in the risk of ARF. A binary logistic regression revealed age was an independent predictor of ARF (P < 0.05. When both all variables were included in a multinominal logistic regression model, preoperative proteinuria independently predicted ARF (Odds ratio= 3.91, 95% CI: 1.55-9.91, P = 0.004. Our results revealed that special considerations should be given to elderly and patients with proteinuria when managing post cardiac surgery ARF.

  17. Reliability computation from reliability block diagrams

    Chelson, P. O.; Eckstein, E. Y.


    Computer program computes system reliability for very general class of reliability block diagrams. Four factors are considered in calculating probability of system success: active block redundancy, standby block redundancy, partial redundancy, and presence of equivalent blocks in the diagram.

  18. [Renal leiomyoma. Case report].

    Joual, A; Guessous, H; Rabii, R; Benjelloun, M; Benlemlih, A; Skali, K; el Mrini, M; Benjelloun, S


    The authors report a case of renal leiomyoma observed in a 56-year-old man. This cyst presented in the from of loin pain. Computed tomography revealed a homogeneous renal tumor. Treatment consisted of radical nephrectomy. Histological examination of the specimen showed benign renal leiomyoma.

  19. Renal inflammatory myofibroblastic tumor

    Heerwagen, S T; Jensen, C; Bagi, P


    Renal inflammatory myofibroblastic tumor (IMT) is a rare soft-tissue tumor of controversial etiology with a potential for local recurrence after incomplete surgical resection. The radiological findings in renal IMT are not well described. We report two cases in adults with a renal mass treated...

  20. Comparison of analgesic efficacy of preoperative or postoperative carprofen with or without preincisional mepivacaine epidural anesthesia in canine pelvic or femoral fracture repair.

    Bergmann, Hannes M; Nolte, Ingo; Kramer, Sabine


    To compare analgesic efficacy of preoperative versus postoperative administration of carprofen and to determine, if preincisional mepivacaine epidural anesthesia improves postoperative analgesia in dogs treated with carprofen. Blind, randomized clinical study. Dogs with femoral (n=18) or pelvic (27) fractures. Dogs were grouped by restricted randomization into 4 groups: group 1 = carprofen (4 mg/kg subcutaneously) immediately before induction of anesthesia, no epidural anesthesia; group 2 = carprofen immediately after extubation, no epidural anesthesia; group 3 = carprofen immediately before induction, mepivacaine epidural block 15 minutes before surgical incision; and group 4 = mepivacaine epidural block 15 minutes before surgical incision, carprofen after extubation. All dogs were administered carprofen (4 mg/kg, subcutaneously, once daily) for 4 days after surgery. Physiologic variables, nociceptive threshold, lameness score, pain, and sedation (numerical rating scale [NRS], visual analog scale [VAS]), plasma glucose and cortisol concentration, renal function, and hemostatic variables were measured preoperatively and at various times after surgery. Dogs with VAS pain scores >30 were administered rescue analgesia. Group 3 and 4 dogs had significantly lower pain scores and amount of rescue analgesia compared with groups 1 and 2. VAS and NRS pain scores were not significantly different among groups 1 and 2 or among groups 3 and 4. There was no treatment effect on renal function and hemostatic variables. Preoperative carprofen combined with mepivacaine epidural anesthesia had superior postoperative analgesia compared with preoperative carprofen alone. When preoperative epidural anesthesia was performed, preoperative administration of carprofen did not improve postoperative analgesia compared with postoperative administration of carprofen. Preoperative administration of systemic opioid agonists in combination with regional anesthesia and postoperative administration

  1. Preoperative Evaluation: Estimation of Pulmonary Risk.

    Lakshminarasimhachar, Anand; Smetana, Gerald W


    Postoperative pulmonary complications (PPCs) are common after major non-thoracic surgery and associated with significant morbidity and high cost of care. A number of risk factors are strong predictors of PPCs. The overall goal of the preoperative pulmonary evaluation is to identify these potential, patient and procedure-related risks and optimize the health of the patients before surgery. A thorough clinical examination supported by appropriate laboratory tests will help guide the clinician to provide optimal perioperative care. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. A preoperative checklist in esthetic plastic surgery

    Anger,Jaime; Letizio,Nelson; Orel,Maurício; Souza Junior,José Leão de; Santos,Márcio Martines dos


    The authors present a checklist to be used at the last stage of a preoperative visit for esthetic plastic surgery composed of 29 yes/no questions, four blank spaces for entering data, and one question for ranking the level of risk of deep vein thrombosis. The criteria are divided into three tables relating to three areas: anesthesia, psychological aspects, and clinical risk factors. The answers are framed in four colors that identify the level of risk and suggest the degree of attention warra...

  3. Preoperational test report, recirculation ventilation systems

    Clifton, F.T.


    This represents a preoperational test report for Recirculation Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102 and supports the ability to exhaust air from each tank. Each system consists of a valved piping loop, a fan, condenser, and moisture separator; equipment is located inside each respective tank farm in its own hardened building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  4. Preoperational test report, raw water system

    Clifton, F.T.


    This represents the preoperational test report for the Raw Water System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system supplies makeup water to the W-030 recirculation evaporative cooling towers for tanks AY1O1, AY102, AZ1O1, AZ102. The Raw Water pipe riser and associated strainer and valving is located in the W-030 diesel generator building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  5. Preoperative irradiation and cystectomy for bladder cancer.

    Smith, J A; Batata, M; Grabstald, H; Sogani, P C; Herr, H; Whitmore, W F


    Between 1971 and 1974, 101 patients at Memorial Sloan-Kettering Cancer Center underwent planned integrated treatment for bladder cancer with 2000 rads by megavoltage delivered to the whole pelvis over five consecutive days followed by radical cystectomy within a week. The overall five-year survival rate was 39%; the hospital mortality rate was 2%. In the pelvis alone tumor recurred in 9% of the patients. These results support other studies demonstrating the efficacy of this and other regimens of preoperative irradiation and cystectomy.

  6. Living renal donors: optimizing the imaging strategy--decision- and cost-effectiveness analysis

    Y.S. Liem (Ylian Serina); M.C.J.M. Kock (Marc); W. Weimar (Willem); K. Visser (Karen); M.G.M. Hunink (Myriam); J.N.M. IJzermans (Jan)


    textabstractPURPOSE: To determine the most cost-effective strategy for preoperative imaging performed in potential living renal donors. MATERIALS AND METHODS: In a decision-analytic model, the societal cost-effectiveness of digital subtraction angiography (DSA), gadolinium-enhanced

  7. Role of R.E.N.A.L. Nephrometry Score in Laparoscopic Partial Nephrectomy

    Hai-Jiang Zhou


    Conclusions: The RNS is a valuable tool for evaluating the complexity of renal tumor anatomy. It can aid surgeons in preoperative decision-making concerning management therapy. Future multicenter, large sample size studies are warranted for evaluating its predicting performance of perioperative outcomes.

  8. Dual-energy computed tomography angiography for evaluating the renal vascular variants

    TAO Xiao-feng; ZHU Jing-qi; WU Ying-wei; TANG Guang-yu; SHI Yu-zhen; ZHANG Lei; LIN Yi


    Background Recognizing renal vascular variants preoperatively is important in order to avoid vascular complications during surgery.This study aimed to investigate the renal vascular variants with dual-energy computed tomography (DECT) angiography to provide valuable information for surgery.Methods A total of 378 patients underwent DECT.The number,size,course and relationships of the renal vessels were retrospectively observed from the scans.Anomalies of renal arteries and veins were recorded and classified.Multiplanar reformations (MPR),maximum intensity projections (MIP),and volume renderings (VR) were used for analysis.Results In 378 patients (756 kidneys),renal artery variations were discovered and recorded in 123 kidneys (16.3%,123/756) of 106 patients (28.0%,106/378).Type IB (early branches of the only one main renal artery) and IC (accessory renal artery with only one main renal artery) were found most frequently with an incidence of 11.4% (43/378) and 14.5%(55/378).The incidence of renal artery variations in the left kidney was not statistically different than in the right kidney (12.4% vs.11.1%).The incidence of renal vein variations was detected in 104 patients (27.5%,104/378).The incidence of venous variants in the right kidney was higher than in the left kidney (20.1% vs.7.4%),but left renal vein variations were more complex.Variants of the left renal vein were detected in 28 patients including type 1 (circumaortic left renal vein) in eight cases,type 2 (retroaortic left renal vein) in seven cases,type 3 (abnormal reflux) in six cases,type 4 (late venous confluence of left renal vein) in five cases,and type 5 (rare type) in two cases.The frequency of left renal vein variation associated with the left renal accessory artery was significantly higher than with early branches of the left renal artery (P=0.037).Conclusions The renal vascular variants are rather common and complex.DECT angiography can demonstrate the precise anatomy of the

  9. Postpartum renal vein thrombosis.

    Rubens, D; Sterns, R H; Segal, A J


    Renal vein thrombosis in adults is usually a complication of the nephrotic syndrome. Rarely, it has been reported in nonnephrotic women postpartum. The thrombosis may be a complication of the hypercoagulable state associated with both the nephrotic syndrome and pregnancy. Two postpartum patients with renal vein thrombosis and no prior history of renal disease are reported here. Neither patient had heavy proteinuria. In both cases, pyelonephritis was suspected clinically and the diagnosis of renal vein thrombosis was first suggested and confirmed by radiologic examination. Renal vein thrombosis should be considered in women presenting postpartum with flank pain.

  10. Renal infarction resulting from traumatic renal artery dissection.

    Kang, Kyung Pyo; Lee, Sik; Kim, Won; Jin, Gong Yong; Na, Ki Ryang; Yun, Il Yong; Park, Sung Kwang


    Renal artery dissection may be caused by iatrogenic injury, trauma, underlying arterial diseases such as fibromuscular disease, atherosclerotic disease, or connective tissue disease. Radiological imaging may be helpful in detecting renal artery pathology, such as renal artery dissection. For patients with acute, isolated renal artery dissection, surgical treatment, endovascular management, or medical treatment have been considered effective measures to preserve renal function. We report a case of renal infarction that came about as a consequence of renal artery dissection.

  11. Efficacy of preoperative US vascular mapping for arteriovenous fistula in patients with hemodialysis

    Lee, Min Sun; Hwang, Ji Young; Kang, Byung Chul; Baek, Seung Yon [College of Medicine, Ewha Womans University, Seoul (Korea, Republic of)


    The purpose of this study is to assess the efficacy of preoperative US vascular mapping to predict postoperative patency of the arteriovenous fistula for hemodialysis. Sixty-six patients who underwent hemodialysis for end-stage renal failure (M:F = 34:32, mean age, 58.8 years) were observed prospectively from January 2001 to April 2003. The patients were divided into two groups: the vascular mapping group and the control group. A comparative analysis of the re-operation rate between the two groups was determined by use of the chi-square rest, efficacy of preoperative US vascular mapping according to the type of surgery. A comparative analysis of the secondary patency after percutaneous transluminal angioplasty was determined by the use of Fischer exact test, and a comparative analysis of the diminution of patency during the follow-up periods was determined by the use of the Logrank test. In the mapping group, the diameters of intraoperatively selected vessels were investigated and compared with the recommended diameter on preoperative US vascular mapping determined statistically by the use of Fisher's exact test. The preoperative US vascular mapping group had relatively lower re-operation rates (11.8%) than the control group (28.1%) ({rho} = 0.09). The preventive role of US vascular mapping in more effective in decreasing the re-operation rate for a native arteriovenous fistula (7.4%) than for a synthetic arteriovenous graft (25.9%) ({rho} = 0.06). For patients than had an interventional procedure, the failure rate to obtain a secondary patency was smaller than in the mapping group (33.3%), compared with the control group (46.3%) ({rho} = 0.37). Patients in the mapping group had a higher patency than the control group patients for a native arteriovenous fistula (92.0%) and a synthetic arteriovenous graft (71.4%) at one year following surgery ({rho} = 0.10, {rho} = 0.79). The arteriovenous fistulas in the mapping group had a higher patency for both a native

  12. VLSI Reliability in Europe

    Verweij, Jan F.


    Several issue's regarding VLSI reliability research in Europe are discussed. Organizations involved in stimulating the activities on reliability by exchanging information or supporting research programs are described. Within one such program, ESPRIT, a technical interest group on IC reliability was

  13. Analysis of effects of fixation type on renal function after endovascular aneurysm repair.

    Kouvelos, George N; Boletis, Ioannis; Papa, Nektario; Kallinteri, Amalia; Peroulis, Michalis; Matsagkas, Miltiadis I


    To report a prospective nonrandomized study comparing the effects of suprarenal (SR) vs. infrarenal (IR) stent-graft fixation on renal function in patients undergoing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Patients with AAA undergoing elective EVAR between June 2008 and June 2010 were eligible for the comparative study of fixation method on renal function. Patients with impaired renal function [estimated creatinine clearance (eCrCl) history of renal impairment were not eligible. Renal function was assessed by measuring serum creatinine (SCr) and total proteins and microalbumin in the urine preoperatively, on postoperative day 1, and at 1, 6, and 12 months. The eCrCl was calculated using the Cockcroft-Gault formula. A standard preoperative hydration protocol was followed in all patients, and stent-graft choice was at the operator's discretion. Of 116 patients undergoing elective EVAR in the study period, 16 were ineligible, leaving 100 patients (95 men; median age 74 years) enrolled in the study (49 SR and 51 IR). There was no statistically significant difference between the groups in the prevalence of any risk factor, the baseline SCr and eCrCl values, contrast usage, or procedure duration. At the postoperative measurement, there was no significant deterioration of renal function in either group, although total urinary proteins increased significantly in both groups (IR p=0.01, SR p20% decrease in eCrCl was not significantly different between the groups. No patient had an adverse renal event. Deterioration in renal function was observed 12 months after EVAR in patients receiving a stent-graft with suprarenal fixation, even though this did not seem to increase the likelihood of postoperative renal impairment. Furthermore, suprarenal fixation may be responsible for progressively significant proteinuria. Further studies are needed to determine the long-term impact of suprarenal fixation on renal function and investigate the potential

  14. Preoperative functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS)

    Hartwigsen, G.; Siebner, Hartwig R.; Stippich, C.


    motor as well as higher cognitive functions (i.e. language). Pre-operative fMRI can be used to identify the brain regions that are activated during specific sensorimotor or language tasks. TMS is able to disrupt neuronal processing in the targeted brain area which in turn may affect task performance......Neurosurgical resection of brain lesions aims to maximize excision while minimizing the risk of permanent injury to the surrounding intact brain tissue and resulting neurological deficits. While direct electrical cortical stimulation at the time of surgery allows the precise identification......MRI is well established although the number of studies on presurgical language fMRI is still limited. In contrast, the reliability and accuracy of preoperative TMS remains to be determined....

  15. Results of a selective policy for preoperative radiotherapy in rectal cancer surgery.

    Gandy; O'Leary; Falk; Roe


    Preoperative radiotherapy (pRT) for rectal cancer may reduce local recurrence and improve survival. This study was undertaken to assess a selective policy of pRT in rectal cancer. The aim was to determine whether patients likely to have involved circumferential margins (CRM) could be reliably selected for pRT using clinical criteria. We have used CRM and delay in surgery as outcome measures. Seventy-nine patients with rectal cancer were assessed for preoperative radiotherapy using clinical criteria. Twelve of 26 (46%) pRT patients had positive CRM compared with three of 53 (5.6%) who did not receive pRT (P benefit from radiotherapy and has avoided excessive delays prior to surgery. However, almost half of the pRT patients did not have involved CRM. With improved imaging techniques we may be able to refine our selection criteria further.

  16. Unforeseen Intra-operative Hyperkalemia in a well Dialyzed Patient during Renal Transplantation

    Gautam P


    Full Text Available Renal excretion and cellular uptake of potassium play key roles in the body′s defense mechanism against hyperkalemia. Intra-operative hyperkalemia is an uncommon life-threatening complication during elective renal transplant surgery. We report herewith a non-insulin dependent diabetic kidney transplant recipient with prolonged pre-operative fasting, in whom, despite pre-operative hemodialysis, unforeseen high serum potassium level suddenly presented as wide-complex bradycardia during the surgery. The patient responded well to medical therapy of the hyperkalemia and the surgery was completed uneventfully. It is difficult to single out the exact cause of hyperkalemia in our patient. Prolonged pre-operative fasting for about nine hours, associated with insulinopenia and hyperglycemia, in the presence of β-blockade and metabolic acidosis, have probably collectively resulted in efflux of potassium from intra-cellular stores. This potentially catastrophic complication should be remembered in diabetic patients undergoing any type of surgery.

  17. Oncological and functional outcomes of salvage renal surgery following failed primary intervention for renal cell carcinoma

    Fernando G. Abarzua-Cabezas


    Full Text Available Purpose To assess the oncologic and functional outcomes of salvage renal surgery following failed primary intervention for RCC. Materials and Methods We performed a retrospective review of patients who underwent surgery for suspected RCC during 2004-2012. We identified 839 patients, 13 of whom required salvage renal surgery. Demographic data was collected for all patients. Intraoperative and postoperative data included ischemic duration, blood loss and perioperative complications. Preoperative and postoperative assessments included abdominal CT or magnetic resonance imaging, chest CT and routine laboratory work. Estimated glomerular filtration rate (eGFR was calculated according to the Modification of Diet in Renal Disease equation. Results The majority (85% of the patients were male, with an average age of 64 years. Ten patients underwent salvage partial nephrectomy while 3 underwent salvage radical nephrectomy. Cryotherapy was the predominant primary failed treatment modality, with 31% of patients undergoing primary open surgery. Pre-operatively, three patients were projected to require permanent post-operative dialysis. In the remaining 10 patients, mean pre- and postoperative serum creatinine and eGFR levels were 1.35 mg/dL and 53.8 mL/min/1.73 m2 compared to 1.43 mg/dL and 46.6 mL/min/1.73 m2, respectively. Mean warm ischemia time in 10 patients was 17.4 min and for all patients, the mean blood loss was 647 mL. The predominant pathological stage was pT1a (8/13; 62%. Negative surgical margins were achieved in all cases. The mean follow-up was 32.9 months (3.5-88 months. Conclusion While salvage renal surgery can be challenging, it is feasible and has adequate surgical, functional and oncological outcomes.

  18. Update on three-dimensional image reconstruction for preoperative simulation in thoracic surgery

    Chen-Yoshikawa, Toyofumi F.


    Background Three-dimensional computed tomography (3D-CT) technologies have been developed and refined over time. Recently, high-speed and high-quality 3D-CT technologies have also been introduced to the field of thoracic surgery. The purpose of this manuscript is to demonstrate several examples of these 3D-CT technologies in various scenarios in thoracic surgery. Methods A newly-developed high-speed and high-quality 3D image analysis software system was used in Kyoto University Hospital. Simulation and/or navigation were performed using this 3D-CT technology in various thoracic surgeries. Results Preoperative 3D-CT simulation was performed in most patients undergoing video-assisted thoracoscopic surgery (VATS). Anatomical variation was frequently detected preoperatively, which was useful in performing VATS procedures when using only a monitor for vision. In sublobar resection, 3D-CT simulation was more helpful. In small lung lesions, which were supposedly neither visible nor palpable, preoperative marking of the lesions was performed using 3D-CT simulation, and wedge resection or segmentectomy was successfully performed with confidence. This technique also enabled virtual-reality endobronchial ultrasonography (EBUS), which made the procedure more safe and reliable. Furthermore, in living-donor lobar lung transplantation (LDLLT), surgical procedures for donor lobectomy were simulated preoperatively by 3D-CT angiography, which also affected surgical procedures for recipient surgery. New surgical techniques such as right and left inverted LDLLT were also established using 3D models created with this technique. Conclusions After the introduction of 3D-CT technology to the field of thoracic surgery, preoperative simulation has been developed for various thoracic procedures. In the near future, this technique will become more common in thoracic surgery, and frequent use by thoracic surgeons will be seen in worldwide daily practice. PMID:27014477

  19. Religiousness and preoperative anxiety: a correlational study

    Karimollahi Mansoureh


    Full Text Available Abstract Background Major life changes are among factors that cause anxiety, and one of these changes is surgery. Emotional reactions to surgery have specific effects on the intensity and velocity as well as the process of physical disease. In addition, they can cause delay in patients recovery. This study is aimed at determining the relationship between religious beliefs and preoperative anxiety. Methods This survey is a correlational study to assess the relationship between religious beliefs and preoperative anxiety of patients undergoing abdominal, orthopaedic, and gynaecologic surgery in educational hospitals. We used the convenience sampling method. The data collection instruments included a questionnaire containing the Spielberger State-Trait Anxiety Inventory (STAI, and another questionnaire formulated by the researcher with queries on religious beliefs and demographic characteristics as well as disease-related information. Analysis of the data was carried out with SPSS software using descriptive and inferential statistics. Results were arranged in three tables. Results The findings showed that almost all the subjects had high level of religiosity and moderate level of anxiety. In addition, there was an inverse relationship between religiosity and intensity of anxiety, though this was not statistically significant. Conclusion The results of this study can be used as evidence for presenting religious counselling and spiritual interventions for individuals undergoing stress. Finally, based on the results of this study, the researcher suggested some recommendations for applying results and conducting further research.

  20. Preoperative chemoradiotherapy for locally advanced gastric cancer

    Pepek Joseph M


    Full Text Available Abstract Background To examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT for gastric cancer. Methods Patients with gastroesophageal (GE junction (Siewert type II and III or gastric adenocarcinoma who underwent neoadjuvant CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Overall survival (OS, local control (LC and disease-free survival (DFS were estimated using the Kaplan-Meier method. Toxicity was graded according to the Common Toxicity Criteria for Adverse Events version 4.0. Results Forty-eight patients were included. Most (73% had proximal (GE junction, cardia and fundus tumors. Median radiation therapy dose was 45 Gy. All patients received concurrent chemotherapy. Thirty-six patients (75% underwent surgery. Pathologic complete response and R0 resection rates were 19% and 86%, respectively. Thirty-day surgical mortality was 6%. At 42 months median follow-up, 3-year actuarial OS was 40%. For patients undergoing surgery, 3-year OS, LC and DFS were 50%, 73% and 41%, respectively. Conclusions Preoperative CRT for gastric cancer is well tolerated with acceptable rates of perioperative morbidity and mortality. In this patient cohort with primarily advanced disease, OS, LC and DFS rates in resected patients are comparable to similarly staged, adjuvantly treated patients in randomized trials. Further study comparing neoadjuvant CRT to standard treatment approaches for gastric cancer is indicated.

  1. Preoperative evaluation for lung cancer resection

    Spyratos, Dionysios; Porpodis, Konstantinos; Angelis, Nikolaos; Papaiwannou, Antonios; Kioumis, Ioannis; Pitsiou, Georgia; Pataka, Athanasia; Tsakiridis, Kosmas; Mpakas, Andreas; Arikas, Stamatis; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Tsiouda, Theodora; Machairiotis, Nikolaos; Siminelakis, Stavros; Argyriou, Michael; Kotsakou, Maria; Kessis, George; Kolettas, Alexander; Beleveslis, Thomas; Zarogoulidis, Konstantinos


    During the last decades lung cancer is the leading cause of death worldwide for both sexes. Even though cigarette smoking has been proved to be the main causative factor, many other agents (e.g., occupational exposure to asbestos or heavy metals, indoor exposure to radon gas radiation, particulate air pollution) have been associated with its development. Recently screening programs proved to reduce mortality among heavy-smokers although establishment of such strategies in everyday clinical practice is much more difficult and unknown if it is cost effective compared to other neoplasms (e.g., breast or prostate cancer). Adding severe comorbidities (coronary heart disease, COPD) to the above reasons as cigarette smoking is a common causative factor, we could explain the low surgical resection rates (approximately 20-30%) for lung cancer patients. Three clinical guidelines reports of different associations have been published (American College of Chest Physisians, British Thoracic Society and European Respiratory Society/European Society of Thoracic Surgery) providing detailed algorithms for preoperative assessment. In the current mini review, we will comment on the preoperative evaluation of lung cancer patients. PMID:24672690

  2. Primary renal primitive neuroectodermal tumor: A rare presentation

    V Goel


    Full Text Available Primitive Neuroectodermal Tumor of the kidney is a rare entity. Very few cases of primary renal PNET have been reported to date. Most literature about rPNET is isolated case reports. We report a case of rPNET in a 39-year-old male with a pre-operative diagnosis of renal cell carcinoma with renal vein thrombosis. The patient underwent radical nephrectomy with thrombolectomy, and histopathological examination revealed a highly aggressive tumor composed of monotonous sheets of round cells. Tumor cells were positive for CD 99 and FLI-1, hence confirming the diagnosis of Primitive Neuroectodermal Tumor. Post-surgery, patient was given VAC/IE-based adjuvant chemotherapy. In view of highly aggressive nature of this tumor, prompt diagnosis and imparting effective chemotherapy regimen to the patient is required, and it is important to differentiate PNET from other small round-cell tumors because of different therapeutic approach.

  3. Evaluation of Renal Function Under Controlled Hypotension in Zero Ischemia Robotic Assisted Partial Nephrectomy

    Ester Forastiere


    Full Text Available Background/Aims: In partial nephrectomy with hilar clamping every minute of ischemia can impair renal function, thus great importance is having the controlled hypotension as a part of zero ischemia technique. The aim of the study is to evaluate the effects of hypotensive anesthesia on renal function, in patients undergoing robotic assisted partial nephrectomy (RAPN , during surgery and at 3 months follow up. Methods: This is a prospective study of 100 patients, ASA 1-2, who underwent zero ischemia RAPN under controlled hypotension (CH from December 2011 through to May 2013. Serum creatinine, BUN, estimated glomerular filtration rates (eGFR, fractional excretion of sodium (FSE and technetium Tc 99m mercaptoacetyltriglycine (99mTC-MAG-3, renal scintigraphy with effective renal plasma flow (ERPF were evaluated. Results: Mean duration of CH was 50±4 minutes. Acute renal failure wasn't observed in any of the patients. A significant variation of eGFR during the procedure and 24 hours after surgery was observed. No significant variation of BUN and FSE was detected. Comparing preoperative ERPF of the operated kidney with ERPF 3 months after surgery, it decreased by 2%. Conclusion: In patients with normal preoperative renal function CH didn't show any detrimental impact on renal function during and after robotic assisted partial nephrectomy.

  4. Evaluation of renal function under controlled hypotension in zero ischemia robotic assisted partial nephrectomy.

    Forastiere, Ester; Claroni, Claudia; Sofra, Maria; Torregiani, Giulia; Covotta, Marco; Marchione, Maria Grazia; Giannarelli, Diana; Papalia, Rocco


    In partial nephrectomy with hilar clamping every minute of ischemia can impair renal function, thus great importance is having the controlled hypotension as a part of zero ischemia technique. The aim of the study is to evaluate the effects of hypotensive anesthesia on renal function, in patients undergoing robotic assisted partial nephrectomy (RAPN) , during surgery and at 3 months follow up. This is a prospective study of 100 patients, ASA 1-2, who underwent zero ischemia RAPN under controlled hypotension (CH) from December 2011 through to May 2013. Serum creatinine, BUN, estimated glomerular filtration rates (eGFR), fractional excretion of sodium (FSE) and technetium Tc 99m mercaptoacetyltriglycine (99mTC-MAG-3), renal scintigraphy with effective renal plasma flow (ERPF) were evaluated. Mean duration of CH was 50 ± 4 minutes. Acute renal failure wasn't observed in any of the patients. A significant variation of eGFR during the procedure and 24 hours after surgery was observed. No significant variation of BUN and FSE was detected. Comparing preoperative ERPF of the operated kidney with ERPF 3 months after surgery, it decreased by 2%. In patients with normal preoperative renal function CH didn't show any detrimental impact on renal function during and after robotic assisted partial nephrectomy.

  5. Measuring preoperative anxiety in patients with intracranial tumors: the Amsterdam preoperative anxiety and information scale.

    Goebel, Simone; Kaup, Lea; Mehdorn, Hubertus Maximilian


    Preoperative anxiety is a major problem in patients with brain tumors and is of high clinical relevance. However, to date no instruments have been validated for the assessment of preoperative anxiety for this patient group. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) has shown promising results for the assessment of preoperative anxiety. The aim of this study was to determine its psychometric properties and the optimal cutoff score for patients with intracranial tumors to make it applicable in the neurosurgical setting. The sample totaled 180 neurosurgical patients with intracranial tumors. Patients were administered the APAIS along with the Hospital Anxiety and Depression Scale as the gold standard against which the APAIS was compared. Patients scoring 11 or above in the anxiety subscale of the Hospital Anxiety and Depression Scale were defined as clinical cases having anxiety. The psychometric properties of the APAIS were evaluated for a postulated 2-factor structure, Cronbach α, and correlations. The postulated 2-factor structure could not be replicated. Instead, we found a 3-factor solution (anxiety about the operation, anxiety about the anesthesia, information requirement). The area under the receiver operating characteristics curve ranged from ≥0.65 to ≥0.77. Optimal cutoff scores were calculated. The cutoff score for the anxiety scale was ≥10 for the whole sample and men only, and was ≥11 for women only. Analysis of the psychometric properties yielded satisfactory results (eg. Cronbach α for the anxiety scale >0.84). Despite its brevity, the APAIS is valid and recommendable for the assessment of preoperative anxiety in patients with intracranial tumors. As this is the first validation study focusing on patients with severe diseases and major surgeries, we recommend the application of our cutoff scores also for patients similar to our study population with regard to disease and surgery severity.

  6. Efficacy of Magnetic Resonance urography in detecting crossing renal vessels in children with ureteropelvic junction obstruction.

    Pavicevic, Polina K; Saranovic, Djordjije Z; Mandic, Marija J; Vukadinovic, Vojkan M; Djordjevic, Miroslav Lj; Radojicic, Zoran I; Petronic, Ivana; Cirovic, Dragana; Nikolic, Dejan


    An aberrant or accessory crossing renal vessel (CV) leading to the lower pole of the kidney is the most common extrinsic cause of uretero pelvic obstruction(UPJ) obstruction in a child and young adolescent.There is still controversy regarding there functional significance in obstruction Preoperative identification of such vessels may influence surgical management. First aim is to determine the value of magnetic resonance (MR) urography in detecting crossing vessels in children with UPJ obstruction,comparing the data with postoperative findings and the second one is to evaluate morphologic and functional parameters in these hydronephrotic kidneys. Between June 2009 and December 2012 we retrospectively reviewed MR urography records of one hundred and nine children with unilateral hydronephrosis at the University Children's Hospital. 68 (62.4%) were male and 41 (37.6%) were female,median age was 6.5 ± 5.7. Of the total number of patients, 30 (27%) underwent pyeloplasty, while 79 (72.5%) did not. The age at surgery ranged from 0.3 to 18 years (median 6.6 years). The indication for surgery was based on standard criteria (obstructed renal transit time with or without altered renal function of vDRF MRU, there was no crossing vessel in 21 kidneys, confirmed at surgery in 18. A crossing vessel was detected with MRU in 9 kidneys and confirmed at surgery in 6. Thus, the sensitivity of MRU was 66.7%, the specificity was 85.7%, the positive predictive value was 66.7%, the negative predictive value was 85.7% and the accuracy was 80%. There was no statistically significant difference in the detection of crossing vessels between MR urography and surgery (p = 0.004 and p MRU and surgery showed good agreement (κ = 0.524). Based on our results we suggest that MR urography is a reliable and safe diagnostic tool to determine crossing vessels in selected children with UPJ obstruction. Thus, MRU can substitute for other imaging modalities and provide detailed information about the

  7. The effect of preoperative smoking cessation or preoperative pulmonary rehabilitation on outcomes after lung cancer surgery: a systematic review.

    Schmidt-Hansen, Mia; Page, Richard; Hasler, Elise


    The preferred treatment for lung cancer is surgery if the disease is considered resectable and the patient is considered surgically fit. Preoperative smoking cessation and/or preoperative pulmonary rehabilitation might improve postoperative outcomes after lung cancer surgery. The objectives of this systematic review were to determine the effectiveness of (1) preoperative smoking cessation and (2) preoperative pulmonary rehabilitation on peri- and postoperative outcomes in patients who undergo resection for lung cancer. We searched MEDLINE, PreMedline, Embase, Cochrane Library, Cinahl, BNI, Psychinfo, Amed, Web of Science (SCI and SSCI), and Biomed Central. Original studies published in English investigating the effect of preoperative smoking cessation or preoperative pulmonary rehabilitation on operative and longer-term outcomes in ≥ 50 patients who received surgery with curative intent for lung cancer were included. Of the 7 included studies that examined the effect of preoperative smoking cessation (n = 6) and preoperative pulmonary rehabilitation (n = 1) on outcomes after lung cancer surgery, none were randomized controlled trials and only 1 was prospective. The studies used different smoking classifications, the baseline characteristics differed between the study groups in some of the studies, and most had small sample sizes. No formal data synthesis was therefore possible. The included studies were marked by methodological limitations. On the basis of the reported bodies of evidence, it is not possible to make any firm conclusions about the effect of preoperative smoking cessation or of preoperative pulmonary rehabilitation on operative outcomes in patients undergoing surgery for lung cancer.

  8. [Use of preoperative glucocorticoid to risk reduction of complications after esophagectomy by esophagus carcinoma: meta-analysis].

    Raimondi, Antônio Marcos


    Preoperative glucocorticoid administration has been proposed for reducing postoperative morbidity. This is not widely used before esophageal resection because of incomplete knowledge regarding its effectiveness. The aim here was to assess the effects of preoperative glucocorticoid administration in adults undergoing esophageal resection for esophageal carcinoma. Studies were identified by searching the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CancerLit, SCIELO and Cochrane Library, and by manual searching from relevant articles. The last search for clinical trials for this systematic review was performed in December 2005. This review included randomized studies of patients with potentially resectable carcinomas of the esophagus that compared preoperative glucocorticoid administration with placebo. Data were extracted by the reviewer, and the trial quality was assessed using Jadad scoring. Odds ratio with 95% confidence limits and bayesian relative risk were used to assess the significance of the difference between the treatment arms. Four randomized trials involving 169 patients were found. There were no differences in postoperative mortality, anastomotic leakage, hepatic and renal failure between the glucocorticoid and placebo groups. There were fewer postoperative respiratory complications (95% CI = 0.09-0.46), sepsis (95% CI = 0.10-0.81), and total postoperative complications (95% CI = 0.06-0.23) with preoperative glucocorticoid administration. Prophylactic administration of glucocorticoids is associated with decreased postoperative complications.

  9. Preoperative Ultrasonography as a Predictor of Difficult ...

    bowel, iliac vessels, and so on; high conversion rate in acute cholecystitis, and ... can reliably predict the chances of conversion to the open procedure and the ..... Source of Support: Nil, Conflicts of Interest: None declared. [Downloaded free ...

  10. Refractory anemia leading to renal hemosiderosis and renal failure

    Sujatha Siddappa; K M Mythri; Kowsalya, R.; Ashish Parekh


    Renal hemosiderosis is a rare cause of renal failure and, as a result, may not be diagnosed unless a detailed history, careful interpretation of blood parameters and renal biopsy with special staining is done. Here, we present a rare case of renal hemosiderosis presenting with renal failure.

  11. Refractory anemia leading to renal hemosiderosis and renal failure

    Sujatha Siddappa


    Full Text Available Renal hemosiderosis is a rare cause of renal failure and, as a result, may not be diagnosed unless a detailed history, careful interpretation of blood parameters and renal biopsy with special staining is done. Here, we present a rare case of renal hemosiderosis presenting with renal failure.

  12. Renal replacement therapy for acute renal failure.

    Macedo, E; Bouchard, J; Mehta, R L


    Renal replacement therapy became a common clinical tool to treat patients with severe acute kidney injury (AKI) since the 1960s. During this time dialytic options have expanded considerably; biocompatible membranes, bicarbonate dialysate and dialysis machines with volumetric ultrafiltration control have improved the treatment for acute kidney injury. Along with advances in methods of intermittent hemodialysis, continuous renal replacement therapies have gained widespread acceptance in the treatment of dialysis-requiring AKI. However, many of the fundamental aspects of the renal replacement treatment such as indication, timing of dialytic intervention, and choice of dialysis modality are still controversial and may influence AKI patient's outcomes. This review outlines current concepts in the use of dialysis techniques for AKI and suggests an approach for selecting the optimal method of renal replacement therapy.

  13. Pre-operative pain and sensory function in groin hernia

    Aasvang, Eske K; Hansen, Jeanette B; Kehlet, Henrik


    mechanism. AIMS: To investigate the correlation between pre-operative pain intensity and sensory functions in the groin hernia area. METHODS: Patients with unilateral groin hernia were examined preoperatively by quantitative sensory testing (thermal, mechanical, and pressure [detection and pain thresholds...... pain is not related to findings of hyperalgesia or other changes in sensory function that may support pain-induced pre-operative neuroplasticity as a pathogenic mechanism for the development of persistent postherniotomy pain....

  14. Renal function after renal artery stenting

    George S. Hanzel; Mark Downes; Peter A. McCullough


    @@ Atherosclerotic renal artery stenosis (ARAS), a common clinical finding, is increasing in prevalence as the population ages. ARAS is seen in ~ 7% of persons over 65 years of age1 and in ~ 20% of patients at the time of coronary angiography.2 It is an important cause of chronic kidney disease and may result in 11-14% of cases of end stage renal disease.3

  15. Magnetic resonance angiography in potential live renal donors: a joint radiological and surgical evaluation

    Subramaniam, M.; Mizzi, A.; Roditi, G. E-mail:


    AIM: To assess the impact of a joint surgical and radiological audit on the accuracy of contrast-enhanced magnetic resonance angiography (MRA) reports in the evaluation of potential renal donors. MATERIALS AND METHODS: We analysed the records of live renal donors who underwent gadolinium-enhanced MRA as part of the pre-operative evaluation to assess renal vasculature between August 1999 and July 2002 when feedback from surgical findings to radiology had been available. In cases of discrepancy between MRA reports and surgical findings, studies were retrieved from the magnetic resonance imaging (MRI) workstation and subjected to detailed joint clinical and radiological review. Scan quality was assessed and sources of discrepancy were identified. RESULTS: There were 45 donors, 23 men and 22 women with a mean age of 41 years. Reported MRA findings were fully confirmed at surgery in 38 of 45 cases. These images were not analysed further. In seven donors the findings at surgery were discrepant with the radiological reports: there were four cases of 'missed' early branches and three cases of 'missed' accessory arteries. In the first year of the audit there were four discrepant cases out of 18 (22%), all of which were radiological reporting errors. The number of discrepant cases in the second year was two out of 19 cases (11%). Neither of these was a radiological reporting error. There was one 'missed' early renal artery branch in the third year of audit, which was identified on MRA review. CONCLUSION: The study highlights the importance of detecting and clearly reporting not only accessory renal arteries, but also early renal arterial branches in the pre-operative evaluation of renal donors. The accuracy of pre-operative MRA in potential renal donors is high, but radiological reporting of MRA examinations is improved through careful clinical feedback, audit and interdisciplinary co-operation.

  16. Are surgical scrubbing and pre-operative disinfection of the skin in orthopaedic surgery reliable?

    Salvi, M; Chelo, C; Caputo, F; Conte, M; Fontana, C; Peddis, G; Velluti, C


    This study attempts to establish the actual effectiveness of pre-surgical disinfection of the patient and surgeon's hands. We evaluated bacterial density and composition on the skin of 15 patients undergoing knee arthroscopy and the left hand of two surgeons after standard disinfection with povidone-iodine. Three samples were taken after the first 6-min scrub in the first surgical operation from the periungual space of the 1 degrees finger, from the interdigital space between the 2 degrees and 3 degrees fingers and from the transverse palmar crest of the left hand of two surgeons for seven consecutive surgical sessions, for a total of 42 samples, and two samples from the pre-patellar skin and from the popliteal skin of 15 patients undergoing knee arthroscopy, for a total of 30 samples. Pre-surgical handwashing and disinfection procedures were identical in each case. Pre-surgical disinfection of the patient's skin with povidone-iodine was shown to be completely effective, with 100% of samples negative. Samples taken from the interdigital space and the palmar crest (100% of samples negative) demonstrated the efficacy of disinfection of the surgeon's hands with povidone-iodine, while the periungual space was contaminated in 50% of the samples. The bacterial strains isolated belong to the staphylococcus genus in 100% of the cases, with pathogenic strains in 29.6% of the cases. Standard pre-surgical disinfection of skin in areas easily accessible to the disinfectant is sufficient in itself to guarantee thorough sanitization. Standard scrubbing of the surgeon's hands is insufficient in eliminating bacterial contamination, including pathogenic germs, in the periungual space, where it is probably difficult for the disinfectant to come into contact with the skin.

  17. Reliability Generalization: "Lapsus Linguae"

    Smith, Julie M.


    This study examines the proposed Reliability Generalization (RG) method for studying reliability. RG employs the application of meta-analytic techniques similar to those used in validity generalization studies to examine reliability coefficients. This study explains why RG does not provide a proper research method for the study of reliability,…

  18. Preoperational test report, recirculation condenser cooling systems

    Clifton, F.T.


    This represents a preoperational test report for Recirculation Condenser Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The four system provide condenser cooling water for vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102. Each system consists of a valved piping loop, a pair of redundant recirculation pumps, a closed-loop evaporative cooling tower, and supporting instrumentation; equipment is located outside the farm on concrete slabs. Piping is routed to the each ventilation condenser inside the farm via below-grade concrete trenches. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  19. Pre-operative antiseptic skin preparation.

    Murkin, Claire Elizabeth

    Theatre nurses use antiseptic skin preparation products every day, but little thought seems to be given as to why a surgeon has a particular preference for one antiseptic skin preparation over another - whether it is for its efficacy, safety or application properties. Woodhead et al (2004) states that nurses still work in a ritualistic environment. Rituals are 'any action performed according to custom, without understanding the reasons why it is being practised'. Nursing practice should be evidence-based; nurses should understand the rationale behind the choice of a particular antiseptic, and be knowledgable about the clinical effectiveness of antiseptic's use pre-operatively, to achieve optimum results. This article focuses on the main types of antiseptic skin preparation while highlighting each product's activity and the relevant considerations for choosing the appropriate product for each patient. Theatre staff need to emphasize the importance of skin preparation and the correct application techniques, while educating the scrub team and surgeons with respect to skin preparation.

  20. Preoperational test report, recirculation condenser cooling systems

    Clifton, F.T.


    This represents a preoperational test report for Recirculation Condenser Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The four system provide condenser cooling water for vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102. Each system consists of a valved piping loop, a pair of redundant recirculation pumps, a closed-loop evaporative cooling tower, and supporting instrumentation; equipment is located outside the farm on concrete slabs. Piping is routed to the each ventilation condenser inside the farm via below-grade concrete trenches. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  1. Predictors of preoperative anxiety in children.

    Wollin, S R; Plummer, J L; Owen, H; Hawkins, R M F; Materazzo, F


    This study aimed to identify factors contributing to anxiety at induction of anaesthesia in children. One hundred and twenty children aged five to twelve years and scheduled for surgery requiring general anaesthesia were included. Children were interviewed and assessed prior to surgery. Parents completed anxiety measures prior to surgery and were interviewed after the induction of anaesthesia. The level of children's anxiety was determined at the time of induction of anaesthesia by the modified Yale Preoperative Anxiety Scale. Factors associated with increased levels of anxiety in the children included increased number of people in the room at induction of anaesthesia; longer waiting time between admission at the hospital and induction of anaesthesia; negative memories of previous hospital experiences; and having a mother who does not practise a religion. Suggestions for implementation of the findings and for future research are provided.

  2. Preoperative information needs of children undergoing tonsillectomy.

    Buckley, Aoife


    AIMS AND OBJECTIVES: To identify the information needs of children undergoing tonsillectomy with reference to content of information, method of delivery, information providers and timing of information provision. BACKGROUND: Tonsillectomy can be anxiety provoking for children and preoperative preparation programmes are long recognised to reduce anxiety. However, few have been designed from the perspectives of children and to date little is known about how best to prepare children in terms of what to tell them, how to convey information to them, who can best provide information and what is the best timing for information provision. DESIGN: A qualitative descriptive study. METHOD: Data were collected from nine children (aged 6-9) using interviews supported by a write and draw technique. Data were coded and categorised into themes reflecting content, method, providers and timing of information. RESULTS: Children openly communicated their information needs especially on what to tell them to expect when facing a tonsillectomy. Their principal concerns were about operation procedures, experiencing \\'soreness\\' and discomfort postoperatively and parental presence. Mothers were viewed as best situated to provide them with information. Children were uncertain about what method of information and timing would be most helpful to them. CONCLUSION: Preoperative educational interventions need to take account of children\\'s information needs so that they are prepared for surgery in ways that are meaningful and relevant to them. Future research is needed in this area. RELEVANCE TO CLINICAL PRACTICE: Practical steps towards informing children about having a tonsillectomy include asking them what they need to know and addressing their queries accordingly. Child-centred information leaflets using a question and answer format could also be helpful to children.

  3. Imaging of renal osteodystrophy

    Jevtic, V. E-mail:


    Chronic renal insufficiency, hemodialysis, peritoneal dialysis, renal transplantation and administration of different medications provoke complex biochemical disturbances of the calcium-phosphate metabolism with wide spectrum of bone and soft tissue abnormalities termed renal osteodystrophy. Clinically most important manifestation of renal bone disease includes secondary hyperparathyroidism, osteomalacia/rickets, osteoporosis, adynamic bone disease and soft tissue calcification. As a complication of long-term hemodialysis and renal transplantation amyloid deposition, destructive spondyloarthropathy, osteonecrosis, and musculoskeletal infections may occur. Due to more sophisticated diagnostic methods and more efficient treatment classical radiographic features of secondary hyperparathyroidism and osteomalacia/rickets are now less frequently seen. Radiological investigations play an important role in early diagnosis and follow-up of the renal bone disease. Although numerous new imaging modalities have been introduced in clinical practice (scintigraphy, CT, MRI, quantitative imaging), plain film radiography, especially fine quality hand radiograph, still represents most widely used examination.

  4. Determination of representative renal depth for accurate attenuation corred in measurement of glomerular filtration rate in transplanted kidney

    Oh, Soon Nam; Kim, Sung Hoon; Rha, Sung Eun; Chung, Yong An; Yoo, Ie Ryung; Sohn, Hyung Sun; Lee, Sung Young; Chung, Soo Kyo [The Catholic Univ. of Korea, Seoul (Korea, Republic of)


    To measure reliable glomerular filtration rate by using the representative values of transplanted renal depths, which are measured with ultrasonography. We included 54 patients (26 men, 28 women), with having both renal scintigraphy and ultrasonography after renal transplantation. We measured DFR with Gates' method using the renal depth measured by ultrasonography, and median and mean ones in each patient. We compared GFR derived from ultrasonography-measured renal depth with GFR derived from median and mean renal depths. The correlation coefficients were obtained among GFR derived from ultrasonography-measured renal depths, median and mean renal depth under linear regression analysis. We determined whether GFR derived from median or mean renal depth could substitute GFR derived from ultrasonography-measured renal depth with Bland-Altman method. We analyze the expected errors of the GFR using representative renal depth in terms of age, sex, weight, height, creatinine value, and body surface. The transplanted renal depths range from 3.20 cm to 5.96 cm. The mean value and standard deviation of renal depths measured by ultrasonography are 4.09{+-}0.65 cm in men, and 4.24{+-}0.78 cm in women. The median value of renal depths measured by ultrasonography is 4.36 cm in men and 4.14 cm in women. The GFR derived from median renal depth is more consistent with GFR derived from ultrasonography-measured renal depth than GFR derived from mean renal depth. Differences of GFR derived from median and ultrasonography-measured renal depth are not significantly different in the groups classified with creatinine value, age, sex, height, weight and body surface. When median value is adapted as a representative renal depth, we could obtain reliable GFR in transplanted kidney simply.

  5. Comparing Heparin-Coated and Non-Coated Oxygenators on Renal Functions in Coronary Artery Bypass Surgery

    Bektaş Battaloğlu


    Full Text Available Background: Renal damage and subsequent acute renal failure is one of the most important complications in patients who had cardiac surgery. Multicenter studies with thousands of patients which exposed the risk factors for acute renal failure has been published especially in the last decade. This study is designed for evaluation of heparin-coated and non-coated oxygenators on the renal functions. Methods: This study has been performed prospectively with 50 patients who had undergone coronary bypass surgery in our clinic from March 2006 to September 2006. The patients have been divided into two groups as non-coated oxygenators (n = 25, Group 1 used and heparin-coated oxygenators (n = 25, Group 2 used. Blood samples were collected at the preoperative, and at 1st, 24th and 96th postoperative hours. The demographic data were similar in two groups. Results: There was no early mortality in both groups. Operative and postoperative parameters were similar in both groups. There were no statistical differences between the evaluated parameters like BUN, creatinine, sodium, potassium, calcium, chloride, phosphorus, urine protein, creatinine clearence, urine sodium, urine calcium and urine chloride tests at preoperative period in both groups. We did not detect renal dysfunction in any patients. There are no statistical differences in the creatinine clearance in preoperative and postoperative periods in both groups. In group one, creatinin levels were lower than group two at 24 hours after surgery and these differences were statistically important in two groups. We found no significant difference between two groups regarding the other parameters for renal function during the postoperative period. Conclusion: In this study, there were not any significant difference between coated and non-coated oxygenators’ effects over renal functions of patients whose renal functions were normal preoperatively.

  6. Incidental renal neoplasms

    Rabjerg, Maj; Mikkelsen, Minne Nedergaard; Walter, Steen;


    On the basis of associations between tumor size, pathological stage, histological subtype and tumor grade in incidentally detected renal cell carcinoma vs symptomatic renal cell carcinoma, we discussed the need for a screening program of renal cell carcinoma in Denmark. We analyzed a consecutive...... series of 204 patients with renal tumors in 2011 and 2012. The tumors were classified according to detection mode: symptomatic and incidental and compared to pathological parameters. Eighty-nine patients (44%) were symptomatic, 113 (55%) were incidental. Information was not available in two patients...

  7. Insuficiencia renal aguda.

    Carlos Hernán Mejía


    Acute renal failure (ARF) is a clinic syndrome characterized by decline in renal function occurring over a short time period. Is a relatively common complication in hospitalized critically ill patients and is associated with high morbidity and mortality. ARF has often a multi-factorial etiology syndrome usually approached diagnostically as pre-renal, post-renal, or intrinsic ARF. Most intrinsic ARF is caused by ischemia or nephrotoxins and is classically associated with acute tubular necrosis...

  8. Super-selective renal artery embolization for the treatment of acute renal hemorrhage%超选择性动脉栓塞治疗急性肾出血



    目的 探讨超选择性肾动脉栓塞治疗急性肾出血的价值.方法 采用4 F导管或(和)2.7 F微导管注入钢圈或(和)微钢圈、聚乙烯醇颗粒超选择性肾动脉栓塞治疗17例严重肾出血患者.5例患者于术前行多层螺旋CT血管造影(CTA)检查,9例患者于术后4 d~54个月行CT平扫、增强扫描与CTA检查.结果 17例患者均一次性介入治疗成功.术前CT增强扫描和CTA可见出血灶、动静脉畸形、动脉瘤等异常征象.术后CT可见栓塞动脉所支配的肾组织出现不同程度的梗死、萎缩,肾边缘收缩、凹陷.4例可见对侧正常肾代偿性增大.术后CTA见异常血管消失,弹簧钢圈无移位.结论 超选择性肾动脉栓塞治疗急性肾出血安全、可靠.CTA对发现术前出血部位及术后疗效评估有重要意义.%Objective To evaluate super-selective renal artery embolization in treating acute renal hemorrhage. Methods A total of 17 patients with massive renal bleeding were enrolled in this study. After super-selective renal artery catheterization with 4 F and/or 2.7 F catheter was accomplished, renal artery embolization with microcoils, coils and/or PVA particles was carried out. Preoperative CTA was performed in five patients. Plain CT scanning and contrast-enhanced CTA were employed in nine patients at 4 days to 54 months after treatment. Results Technical success was achieved in all of the 17 cases. Pre-interventional CT scan showed abnormal signs of hemorrhage, arteriovenous malformation, aneurysm, etc. Post-interventional CT scan showed different degrees of renal infarction, renal atrophy, peripheral contraction and depression of the kidney which were located in the areas originally supplied by embolized artery. Compensatory hypertrophy of the contralateral normal kidney occurred in four cases. Abnormal blood vessels disappeared in postinterventional CTA. No coil displacement was seen. Conclusion For the treatment of acute renal hemorrhage super

  9. Preoperative Evaluation of Thyroid Epithelial Lesions by DNA Ploidy and Galectin-3 Expression in FNAC

    Sonia L. Elsharkawy


    CONCLUSIONS: From the results of this study we can consider that DNA ploidy and Galectin-3 could refine the FNA results and  increase its sensitivity as a screening test from sensitivity(60% to reach sensitivity (93.3%, thus decreasing the false negative cases. From this study, it is concluded that the application of ancillary techniques as galectin-3 immunocytochemical markers may become a reliable indicator for surgical intervention, DNA ploidy measurements on the other hand may be of value in galectin-3 negative cases to determine the behavior of the lesion in such cases & refine the preoperative assessment by out ruling false negative cases.

  10. Paraganglioma of the heart. The value of magnetic resonance imaging in the preoperative evaluation.

    Conti, V R; Saydjari, R; Amparo, E G


    Although the 131I-metaiodobenzylguanidine scan has proven reliable in identifying mediastinal paragangliomas, further localization has usually required dynamic computerized tomographic scanning which requires rapid bolus injection of contrast material. In the case presented herein, magnetic resonance imaging provided accurate preoperative localization and added important anatomic detail that was not appreciated with dynamic computerized tomograms or with other studies. Magnetic resonance imaging can accurately localize cardiac paragangliomas without injection of contrast material and may provide more detailed information for better guidance for surgical excision.

  11. Characterization of acute renal allograft rejection by proteomic analysis of renal tissue in rat.

    Chen, Gang; Huang, Jing-Bin; Mi, Jie; He, Yun-Feng; Wu, Xiao-Hou; Luo, Chun-Li; Liang, Si-Min; Li, Jia-Bing; Tang, Ya-Xiong; Li, Jie


    Rapid and reliable biomarkers of renal allograft rejection have not been available. This study aimed to investigate biomarkers in renal allograft tissue using proteomic analysis. Orthotopic kidney transplantations were performed using Fisher (F344) or Lewis rats as donors and Lewis rats as recipients. Syngenic control group (Group I) constituted F344-to-F344 orthotopic kidney allo-transplantations (n = 8); and allogenic group (Group II) consisted of F344-to-Lewis orthotopic kidney allo-transplantations (n = 8). Renal tissues were harvested 7 days after transplantation. Samples were analyzed using 2-D electrophoresis and matrix assisted laser desorption ionization-time of flight mass spectrometry. 6 differentially expressed proteins were identified between allogenic group and syngenic control group. A rat model of acute renal allograft rejection was successfully set up. Differentially expressed proteins in renal allograft tissue of rat were detected using proteomic analysis and might serve as novel diagnostic and therapeutic targets in human. Quantitative proteomics, using MALDL-TOF-MS methodology has the potential to provide a profiling and a deeper understanding of acute renal rejection.

  12. Renal Graft Fibrosis and Inflammation Quantification by an Automated Fourier-Transform Infrared Imaging Technique.

    Vuiblet, Vincent; Fere, Michael; Gobinet, Cyril; Birembaut, Philippe; Piot, Olivier; Rieu, Philippe


    Renal interstitial fibrosis and interstitial active inflammation are the main histologic features of renal allograft biopsy specimens. Fibrosis is currently assessed by semiquantitative subjective analysis, and color image analysis has been developed to improve the reliability and repeatability of this evaluation. However, these techniques fail to distinguish fibrosis from constitutive collagen or active inflammation. We developed an automatic, reproducible Fourier-transform infrared (FTIR) imaging-based technique for simultaneous quantification of fibrosis and inflammation in renal allograft biopsy specimens. We generated and validated a classification model using 49 renal biopsy specimens and subsequently tested the robustness of this classification algorithm on 166 renal grafts. Finally, we explored the clinical relevance of fibrosis quantification using FTIR imaging by comparing results with renal function at 3 months after transplantation (M3) and the variation of renal function between M3 and M12. We showed excellent robustness for fibrosis and inflammation classification, with >90% of renal biopsy specimens adequately classified by FTIR imaging. Finally, fibrosis quantification by FTIR imaging correlated with renal function at M3, and the variation in fibrosis between M3 and M12 correlated well with the variation in renal function over the same period. This study shows that FTIR-based analysis of renal graft biopsy specimens is a reproducible and reliable label-free technique for quantifying fibrosis and active inflammation. This technique seems to be more relevant than digital image analysis and promising for both research studies and routine clinical practice.

  13. Renal cavernous hemangioma: robot-assisted partial nephrectomy with selective warm ischemia. Case report and review of the literature.

    Ceccarelli, G; Codacci Pisanelli, M; Patriti, A; Biancafarina, A


    Renal hemangioma is a relatively rare benign tumor with a wide range of clinical and radiological presentation, not easy to differentiate preoperatively from a renal cancer. Due to its benign nature complete surgical resection is the recommended therapy and is considered curative. A 73-year old male patient followed-up for a lung carcinoma and a chronic renal failure underwent a CT scan showing a 35-mm mass of the inferior pole of the left kidney. The patient underwent robot-assisted partial nephrectomy with left inferior pole selective warm ischemia. The outcome was favorable and no repercussions on the renal reserve were observed postoperatively. Histopathological characteristics of the surgical specimen were consistent with renal cavernous hemangioma. A robot-assisted operation allows the fine dissection required to carry out a bloodless nephron-sparing surgery without a complete warm ischemia. The use of robot could be noteworthy for nephron-sparing surgery in cases of concomitant chronic renal failure.

  14. Urinary KIM-1 and AQP-1 in patients with clear renal cell carcinoma: Potential noninvasive biomarkers

    Mijušković Mirjana


    Full Text Available Background/Aim. Kidney injury molecule-1 (KIM-1 and aquaporin-1 (AQP-1 are potential early urinary biomarkers of clear renal cell carcinoma (cRCC. The aim of this study was to ascertain relationship between the urine concentrations KIM-1 and AQP-1 with tumor size, grade, pT stage and type of operation (radical or partial nephrectomy in patients with cRCC. Methods. Urinary concentrations of urinary KIM-1 (uKIM-1 and urinary AQP-1 (uAQP-1 were determined by commercially available ELISA kits. The analysis included 40 patients undergoing partial or radical nephrectomy for cRCC and 40 age- and sex-matched healthy adult volunteers. Results. The median preoperative concentrations of KIM-1 in the cRCC group [0.724 ± 1.120 ng/mg urinary creatinine (Ucr] were significantly greater compared with controls (healthy volunteers (0.210 ± 0.082 ng/mgUcr (p = 0.0227. Postoperatively, uKIM-1 concentration decreased significantly to control values (0.177 ± 0.099 ng/mgUcr vs 0.210 ± 0.082 ng/mgUcr, respectively. The size, grade and stage of tumor were correlated positively with preoperative uKIM-1 concentrations. Contrary to these results, concentrations of uAQP-1 in the cRCC group were significantly lower (0.111 ± 0.092 ng/mgUcr compared with the control group (0.202 ± 0.078 ng/mgUcr (p = 0.0014. Postoperatively, the concentrations of uAQP-1 increased progressively up to control values, approximately. We find no significant correlation between preoperative uAQP-1 concentrations and tumor size, grade and stage. Conclusion. uKIM-1 was found to be a reliable diagnostic marker of cRCC, based on its significantly increased values before and decreased values after the nephrectomy. [Projekat Ministarstva nauke Republike Srbije, br. III41018

  15. Isolated Renal Hydatidosis Presenting as Renal Mass: A Diagnostic Dilemma

    Datteswar Hota


    Full Text Available Hydatid disease is a parasitic infestation by larval form of Echinococcus granulosus. Isolated renal involvement is extremely rare. There are no specific signs and symptoms of renal hydatidosis. However it may present as palpable mass, flank pain, hematuria, malaise, fever, and hydatiduria or as a complication of it such as infection, abscess, hemorrhage, necrosis and pelviureteric junction obstruction, renal failure etc. Except hydatiduria, none are pathognomonic for renal hydatidosis. There is no literature on renal hydatidosis presenting as renal mass we report 2 cases of isolated renal hydatidosis, which mimicked a renal mass on imaging study.

  16. Distal renal tubular acidosis in recurrent renal stone formers

    Osther, P J; Hansen, A B; Røhl, H F


    (1.1%) had complete distal renal tubular acidosis and 14 (15.5%) incomplete distal renal tubular acidosis. Our results confirm that distal renal tubular acidification defects are associated with a more severe form of stone disease and make distal renal tubular acidosis one of the most frequent...... metabolic disturbances in renal stone formers. Distal renal tubular acidosis (dRTA) was relatively more common in female stone formers and most often found in patients with bilateral stone disease (36%). Since prophylactic treatment in renal stone formers with renal acidification defects is available...

  17. Renal pelvis or ureter cancer

    Transitional cell cancer of the renal pelvis or ureter; Kidney cancer - renal pelvis; Ureter cancer ... Cancer can grow in the urine collection system, but it is uncommon. Renal pelvis and ureter cancers ...

  18. Surgery in elderly people: preoperative, operative and postoperative care to assist healing.

    Hughes, Sarah; Leary, Antonella; Zweizig, Susan; Cain, Joanna


    Surgery for elderly women is likely to increase steadily as the population of elderly people increases globally. Although increasing age increases perioperative morbidity and mortality, the functional age and physiologic reserve rather than chronological age is more important in preventing complications. Preparation for surgery, with special attention to functional capacity and activity, mental status, and existing comorbid conditions, can improve outcomes. Perioperative management must be tailored to physiologic changes of ageing, which affect respiratory, cardiac and renal function, as well as guidelines for preventing infection and thrombotic events. Of particular note is the enhanced effect of narcotic medications in elderly people, which affects intraoperative and postoperative management of pain. Prevention of postoperative delirium is accomplished through preoperative and postoperative planning. Discharge planning, particularly for frail elderly people, must start before surgery. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. [Preoperative information for paediatric patients. The anaesthesiologist's point of view].

    Orliaguet, G


    Medical information is mandatory before any medical procedure, including pediatric anesthesia. Preoperative information covers many aspects, including medico-psychologic and judicial aspects. When the patient is a child, information must be delivered to the parents in priority. However, the French law has given a particular attention to the opinion of the child. In 70% of the cases, preoperative anxiety of the parents is more related to anesthesia than to the surgical procedure itself. We have to explain the most frequent adverse effects, as well as the more severe and well known complications to the parents, even though they are very infrequent. The only cases where preoperative information is not required are: emergency cases and refusal of the patient or the parents to be informed. While information is necessarily oral, it may be completed using a written document. The quality of the preoperative information directly influences the quality of the psychological preoperative preparation of the parents, and thereafter of the child. Preoperative preparation programs have been developed, but controversial results have been observed. The great majority of the studies on preoperative programs were performed in the USA, where the demand for preoperative information is very important. It is far from sure that the results of all these studies may be extrapolated to French parents, and French studies are needed.

  20. The role of anxiolytic premedication in reducing preoperative anxiety.

    Carroll, Jennifer K


    Prevention of preoperative anxiety with anxiolytic premedication is associated with improved preoperative outcomes in surgical patients. The objective of the authors\\' study was to evaluate the percentage of surgical patients that are prescribed premedication for preoperative anxiety before their anticipated surgical procedure. A prospective study was carried out by theatre nursing staff in the theatre reception bay of a university teaching hospital. A questionnaire was designed to record the number of patients that described symptoms consistent with preoperative anxiety. The number of patients that had been offered anxiolytic premedication for preoperative anxiety was also recorded. Consent was obtained from 115 consecutive surgical patients (male, n=52; female, n=63). Of these, 66% (n=76) reported anxiety before their surgical procedure (male: n=27, female: n=49). Premedication with a low-dose benzodiazepine was prescribed by an anaesthetist in 4% of cases (n=5). Patients that received premedication preoperatively reported effective relief of their anxiety symptoms This study demonstrates that preoperative patient anxiety is highly prevalent. The authors\\' findings suggest that premedication with anxiolytic pharmacological therapy may be an underused therapeutic resource for managing preoperative patient anxiety.

  1. Preoperative distress predicts persistent pain after breast cancer treatment

    Mejdahl, Mathias Kvist; Mertz, Birgitte Goldschmidt; Bidstrup, Pernille Envold Hansen;


    at the Department of Breast Surgery, Rigshospitalet, Denmark, were invited to participate in the study. Patients filled out a questionnaire preoperatively, and 4 and 8 months after surgery. Preoperative distress was measured with the Distress Thermometer (DT; 11-point scale, 0-10). We examined the association...

  2. Long-term effects of a preoperative smoking cessation programme

    Villebro, Nete Munk; Pedersen, Tom; Møller, Ann M;


    Preoperative smoking intervention programmes reduce post-operative complications in smokers. Little is known about the long-term effect upon smoking cessation.......Preoperative smoking intervention programmes reduce post-operative complications in smokers. Little is known about the long-term effect upon smoking cessation....

  3. Interpreting pre-operative mastoid computed tomography images: comparison between operating surgeon, radiologist and operative findings.

    Badran, K; Ansari, S; Al Sam, R; Al Husami, Y; Iyer, A


    This study aimed to compare the interpretations of temporal bone computed tomography scans by an otologist and a radiologist with a special interest in temporal bone imaging. It also aimed to determine the usefulness of this imaging modality. A head and neck radiologist and an otologist separately reported pre-operative computed tomography images using a structured proforma. The reports were then compared with operative findings to determine their accuracy and differences in interpretations. Forty-eight patients who underwent pre-operative computed tomography scans in a 30-month period were identified. Six patients were excluded because complete operative findings had not been recorded. Positive and negative predictive values and accuracy of the anatomical and pathological findings were calculated for 42 patients by both reporters. The accuracy was found to be less than 80 per cent, except for identification of the tegmen and lateral semicircular canal erosion. Overall, there was no significant difference in interpretations of computed tomography scans between reporters. There was a slight difference in interpretation for tympanic membrane retraction, facial canal erosion and lateral semicircular canal fistula and/or erosion. Pre-operative computed tomography scanning of the temporal bone is useful for predicting anatomy for surgical planning in patients with chronic otitis media, but its reliability remains questionable.

  4. Impact of preoperative defecation pattern on postoperative constipation for patients undergoing cardiac surgery.

    Iyigun, Emine; Ayhan, Hatice; Demircapar, Aslı; Tastan, Sevinc


    To analyse the impact of preoperative defecation pattern on postoperative defecation pattern for patients undergoing cardiac surgery. Constipation is a neglected problem that occurs frequently after cardiac surgery. Descriptive study. The study sample comprised 102 patients who underwent cardiac surgery. A Descriptive Information Form, Rome III Diagnostic Criteria, Constipation Severity Instrument, Postoperative Defecation Pattern Evaluation Form and Bristol Stool Form Scale were used for data collection and analysis. The Constipation Severity Instrument scores of just over one-third (37·2%) of the patients who were constipated prior to surgery were higher compared to those who were not constipated. Following cardiac surgery, 39·2% of patients developed constipation and 80% of these patients were constipated prior to cardiac surgery. The findings indicate a significantly high relationship between preoperative and postoperative defecation pattern (r = 0·71, p cardiac surgery. During the preoperative period, clinical nurses may evaluate the patients' defecation patterns using valid and reliable scales and follow the defecation of the patients, especially patients with defecation problems, during the postoperative period. © 2016 John Wiley & Sons Ltd.

  5. Assuring reliability program effectiveness.

    Ball, L. W.


    An attempt is made to provide simple identification and description of techniques that have proved to be most useful either in developing a new product or in improving reliability of an established product. The first reliability task is obtaining and organizing parts failure rate data. Other tasks are parts screening, tabulation of general failure rates, preventive maintenance, prediction of new product reliability, and statistical demonstration of achieved reliability. Five principal tasks for improving reliability involve the physics of failure research, derating of internal stresses, control of external stresses, functional redundancy, and failure effects control. A final task is the training and motivation of reliability specialist engineers.

  6. The Accelerator Reliability Forum

    Lüdeke, Andreas; Giachino, R


    A high reliability is a very important goal for most particle accelerators. The biennial Accelerator Reliability Workshop covers topics related to the design and operation of particle accelerators with a high reliability. In order to optimize the over-all reliability of an accelerator one needs to gather information on the reliability of many different subsystems. While a biennial workshop can serve as a platform for the exchange of such information, the authors aimed to provide a further channel to allow for a more timely communication: the Particle Accelerator Reliability Forum [1]. This contribution will describe the forum and advertise it’s usage in the community.

  7. Effect of acupressure on preoperative anxiety: a clinical trial.

    Valiee, Sina; Bassampour, Shiva Sadat; Nasrabadi, Alireza Nikbakht; Pouresmaeil, Zahra; Mehran, Abbas


    Preoperative anxiety, as an emotional reaction, is common among patients undergoing surgery. The purpose of this study was to examine the effect of acupressure on preoperative anxiety before abdominal surgery. The 70 subjects of this clinical trial were randomly assigned into the acupressure group (n=35), which received acupressure at the true points, or the placebo group (n=35), which received acupressure at sham (false) points. Preoperative anxiety and vital signs before and after the intervention were measured in both groups. The findings demonstrated a reduction in the level of preoperative anxiety for both groups (Pacupressure group (Pacupressure at true points (third eye and Shen men) can reduce higher preoperative anxiety of patients before abdominal surgery and that it has had a more clinically beneficial effect than sham points.

  8. Enlightenment on Computer Network Reliability From Transportation Network Reliability

    Hu Wenjun; Zhou Xizhao


    Referring to transportation network reliability problem, five new computer network reliability definitions are proposed and discussed. They are computer network connectivity reliability, computer network time reliability, computer network capacity reliability, computer network behavior reliability and computer network potential reliability. Finally strategies are suggested to enhance network reliability.

  9. Influence of Preoperative Musculotendinous Junction Position on Rotator Cuff Healing After Double-Row Repair.

    Tashjian, Robert Z; Erickson, Gregory A; Robins, Richard J; Zhang, Yue; Burks, Robert T; Greis, Patrick E


    The primary purpose of this study was to determine the effect of the preoperative position of the musculotendinous junction (MTJ) on rotator cuff healing after double-row arthroscopic rotator cuff repair. A secondary purpose was to evaluate how tendon length and MTJ position change when the rotator cuff heals. Preoperative and postoperative magnetic resonance imaging (MRI) scans of 42 patients undergoing arthroscopic double-row rotator cuff repair were reviewed. Patients undergoing repairs with other constructs or receiving augmented repairs (platelet-rich fibrin matrix) who had postoperative MRI scans were excluded. Preoperative MRI scans were evaluated for anteroposterior tear size, tendon retraction, tendon length, muscle quality, and MTJ position with respect to the glenoid in the coronal plane. The position of the MTJ was referenced off the glenoid face as either lateral or medial. Postoperative MRI scans were evaluated for healing, tendon length, and MTJ position. Of 42 tears, 36 (86%) healed, with 27 of 31 small to medium tears (87%) and 9 of 11 large to massive tears (82%) healing. Healing occurred in 94% of tears that had a preoperative MTJ lateral to the face of the glenoid but only 56% of tears that had a preoperative MTJ medial to the glenoid face (P = .0135). The measured tendon length increased an average of 14.4 mm in patients whose tears healed compared with shortening by 6.4 mm in patients with tears that did not heal (P MTJ lateralized an average of 6.1 mm in patients whose tears healed compared with medializing 1.9 mm in patients whose tears did not heal (P = .026). The overall follow-up period of the study was from April 2005 to September 2014 (113 months). The preoperative MTJ position is predictive of postoperative healing after double-row rotator cuff repair. The position of the MTJ with respect to the glenoid face is a reliable, identifiable marker on MRI scans that can be predictive of healing. Level IV, retrospective review of case

  10. [Hemorrhagic bilateral renal angiomyolipoma].

    Benjelloun, Mohamed; Rabii, Redouane; Mezzour, Mohamed Hicham; Joual, Abdenbi; Bennani, Saâd; el Mrini, Mohamed


    Renal angiomyolipoma is a rare benign tumour, often associated with congenital diseases especially de Bourneville's tuberous sclerosis. Bilateral angiomyolipoma is exceptional. The authors report a case of bilateral renal angiomyolipoma in a 33-year-old patient presenting with haemorrhagic shock. In the light of this case and a review of the literature, the authors discuss the diagnostic and therapeutic aspects of this disease.


    Musso CG


    Full Text Available Renal physiology plays a key role in the pharmacokinetics of many drugs. Knowledge of the particularities of each nephron function (filtration, secretion, reabsorption and excretion and each of renal tubular transport mechanisms (simple diffusion, facilitated diffusion, facilitated transport, active transport, endocytosis and pinocytosis is fundamental to achieve better management of drug prescriptions.

  12. Renal Dysfunction after Off-Pump Coronary Artery Bypass Surgery- Risk Factors and Preventive Strategies

    Gaurab Maitra


    Full Text Available Postoperative renal dysfunction is a relatively common and one of the serious complications of cardiac surgery. Though off-pump coronary artery bypass surgery technique avoids cardiopulmonary bypass circuit induced adverse effects on renal function, multiple other factors cause postoperative renal dysfunction in these groups of patients. Acute kidney injury is generally defined as an abrupt and sustained decrease in kidney function. There is no consen-sus on the amount of dysfunction that defines acute kidney injury, with more than 30 definitions in use in the literature today. Although serum creatinine is widely used as a marker for changes in glomerular filtration rate, the criteria used to define renal dysfunction and acute renal failure is highly variable. The variety of definitions used in clinical studies may be partly responsible for the large variations in the reported incidence. Indeed, the lack of a uniform definition for acute kidney injury is believed to be a major impediment to research in the field. To establish a uniform definition for acute kidney injury, the Acute Dialysis Quality Initiative formulated the Risk, Injury, Failure, Loss, and End-stage Kidney (RIFLE classification. RIFLE , defines three grades of increasing severity of acute kidney injury -risk (class R, injury (class I and failure (class F - and two outcome classes (loss and end-stage kidney disease. Various perioperative risk factors for postoperative renal dysfunction and failure have been identified. Among the important preoperative factors are advanced age, reduced left ventricular function, emergency surgery, preoperative use of intraaortic balloon pump, elevated preoperative serum glucose and creatinine. Most important intraoperative risk factor is the intraoperative haemodynamic instability and all the causes of postoperative low output syndrome com-prise the postoperative risk factors. The most important preventive strategies are the identification of the

  13. Renal transplant improves pulmonary hypertension in patients with end stage renal disease

    Bozbas Serife


    Full Text Available Abstract Background Pulmonary hypertension (PH is present in a significant proportion of patients with end stage renal disease (ESRD and is of prognostic importance. Data on the effect of renal transplant on PH is very limited. In this study, the aim was to examine the effect of renal transplant on systolic pulmonary artery pressure (SPAP determined by Doppler echocardiography. Methods Analysis was performed on the records of 500 consecutive patients who underwent renal transplant at our center between the years 1999 to 2008. The prevalence of PH in the preoperative assessment period was established. Patients were diagnosed as having PH when measured SPAP values were > 35 mm Hg. Results Pulmonary hypertension was detected in 85 of the 500 (17% patients under pre-transplant evaluation. At post-transplant follow up Doppler echocardiographic examination was performed on 50 of the 85 patients. After exclusion of 8 cases (1 due to massive pulmonary thromboemboli; 7 due to graft failure requiring dialysis therapy analyses were performed on 42 patients who had undergone both pre- and post-transplant echocardiographic examination. Mean SPAP at pre-transplant evaluation was 45.9 ± 8.8 mm Hg and in 6 (14.3% cases SPAP was above 50 mm Hg. Compared to pre-transplant values, a significant decrease was observed in mean SPAP values in an average of 53 months of postoperative follow up (41.8 ± 7.4 mm Hg vs. 45.9 ± 8.8 mm Hg, p Conclusion These findings indicate that patients with ESRD accompanied by PH may benefit from renal transplant. Further research is required for more concrete conclusions to be drawn on this subject.

  14. Images in plastic surgery: digital thermographic photography ("thermal imaging") for preoperative perforator mapping.

    Chubb, Daniel; Rozen, Warren M; Whitaker, Iain S; Ashton, Mark W


    Preoperative imaging to identify the location of individual perforators has been shown to improve operative outcomes, and while computed tomographic angiography (CTA) and magnetic resonance angiography are currently the most widely used modalities, these have substantial limitations. Such limitations include the need for intravenous access, the need for iodinated contrast media, radiation exposure with CTA, and long scanning times with magnetic resonance angiography. Complications from the use of contrast media are also noteworthy, and can include anaphylactoid reactions and renal toxicity. In a move to avoid these problems, we have recently introduced a technique that is readily available and easy to implement for preoperative imaging, and may show an accuracy that matches the more advanced imaging modalities. Thermal imaging is a readily performed technique, and can be undertaken by the reconstructive surgeon themselves at the initial consultation, enabling prompt operative planning, and avoiding the need for delays in imaging, confusion in the interpretation of a radiologist report, and the need for an intermediary radiologist altogether. In our experience thus far, the technique matches the accuracy for location of CTA, and a larger clinical trial of the technique is underway.

  15. Human Reliability Program Overview

    Bodin, Michael


    This presentation covers the high points of the Human Reliability Program, including certification/decertification, critical positions, due process, organizational structure, program components, personnel security, an overview of the US DOE reliability program, retirees and academia, and security program integration.

  16. Power electronics reliability analysis.

    Smith, Mark A.; Atcitty, Stanley


    This report provides the DOE and industry with a general process for analyzing power electronics reliability. The analysis can help with understanding the main causes of failures, downtime, and cost and how to reduce them. One approach is to collect field maintenance data and use it directly to calculate reliability metrics related to each cause. Another approach is to model the functional structure of the equipment using a fault tree to derive system reliability from component reliability. Analysis of a fictitious device demonstrates the latter process. Optimization can use the resulting baseline model to decide how to improve reliability and/or lower costs. It is recommended that both electric utilities and equipment manufacturers make provisions to collect and share data in order to lay the groundwork for improving reliability into the future. Reliability analysis helps guide reliability improvements in hardware and software technology including condition monitoring and prognostics and health management.

  17. Reliability of pre- and intraoperative tests for biliary lithiasis

    Escallon, A. Jr.; Rosales, W.; Aldrete, J.S.


    The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable.

  18. Reliability of pre- and intraoperative tests for biliary lithiasis.

    Escallon, A; Rosales, W; Aldrete, J S


    The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable. PMID:3888131

  19. Primary renal hydatidosis

    Johnsy Merla Joel


    Full Text Available Echinococcosis or hydatidosis caused by the tapeworm, Echinococcus granulosus, has the highest prevalence in endemic regions and sheep farming areas. The most common organ involved is the liver (50–75% followed by the lungs (15–20% and other organs (10–20%. Primary involvement of the kidney without the involvement of the liver and lungs, i.e., isolated renal hydatid disease is extremely rare even in endemic areas. The incidence of renal echinococcosis is 2–4%. Renal hydatid cysts usually remain asymptomatic for many years and are multiloculated. A 63-year-old male presented with left loin pain. Computed tomography scan abdomen revealed a presumptive diagnosis of renal hydatid disease. The nephrectomy specimen received in histopathology confirmed the diagnosis. We describe a rare case of primary renal hydatidosis.

  20. Reliable Design Versus Trust

    Berg, Melanie; LaBel, Kenneth A.


    This presentation focuses on reliability and trust for the users portion of the FPGA design flow. It is assumed that the manufacturer prior to hand-off to the user tests FPGA internal components. The objective is to present the challenges of creating reliable and trusted designs. The following will be addressed: What makes a design vulnerable to functional flaws (reliability) or attackers (trust)? What are the challenges for verifying a reliable design versus a trusted design?

  1. Renal cell carcinoma: histological classification and correlation with imaging findings

    Muglia, Valdair F., E-mail: [Universidade de Sao Paulo (CCIFM/FMRP/USP), Ribeirao Preto, SP (Brazil). Centro de Ciencias das Imagens e Fisica Medica. Faculdade de Medicina; Prando, Adilson [Universidade Estadual de Campinas (UNICAMP), SP (Brazil); Hospital Vera Cruz, Campinas, SP (Brazil). Dept. de Imaginologia


    Renal cell carcinoma (RCC) is the seventh most common histological type of cancer in the Western world and has shown a sustained increase in its prevalence. The histological classification of RCCs is of utmost importance, considering the significant prognostic and therapeutic implications of its histological subtypes. Imaging methods play an outstanding role in the diagnosis, staging and follow-up of RCC. Clear cell, papillary and chromophobe are the most common histological subtypes of RCC, and their preoperative radiological characterization, either followed or not by confirmatory percutaneous biopsy, may be particularly useful in cases of poor surgical condition, metastatic disease, central mass in a solitary kidney, and in patients eligible for molecular targeted therapy. New strategies recently developed for treating renal cancer, such as cryo and radiofrequency ablation, molecularly targeted therapy and active surveillance also require appropriate preoperative characterization of renal masses. Less common histological types, although sharing nonspecific imaging features, may be suspected on the basis of clinical and epidemiological data. The present study is aimed at reviewing the main clinical and imaging findings of histological RCC subtypes. (author)

  2. Renal vein thrombosis mimicking urinary calculus: a dilemma of diagnosis.

    Wang, Yimin; Chen, Shanwen; Wang, Wei; Liu, Jianyong; Jin, Baiye


    Renal vein thrombosis (RVT) with flank pain, and hematuria, is often mistaken with renal colic originating from ureteric or renal calculus. Especially in young and otherwise healthy patients, clinicians are easily misled by clinical presentation and calcified RVT. A 38-year-old woman presented with flank pain and hematuria suggestive of renal calculus on ultrasound. She underwent extracorporeal shock wave lithotripsy that failed, leading to the recommendation that percutaneous lithotomy was necessary to remove the renal calculus. In preoperative view of the unusual shape of the calculus without hydronephrosis, noncontrast computed tomography was taken and demonstrated left ureteric calculus. However computed tomography angiography revealed, to our surprise, a calcified RVT that was initially thought to be a urinary calculus. This case shows that a calcified RVT might mimic a urinary calculus on conventional ultrasonography and ureteric calculus on noncontrast computed tomography. Subsequent computed tomography angiography disclosed that a calcified RVT caused the imaging findings, thus creating a potentially dangerous clinical pitfall. Hence, it is suggested that the possibility of a RVT needs to be considered in the differential diagnosis whenever one detects an uncommon shape for a urinary calculus.

  3. New strategies for preoperative skin antisepsis.

    Ulmer, Miriam; Lademann, Juergen; Patzelt, Alexa; Knorr, Fanny; Kramer, Axel; Koburger, Torsten; Assadian, Ojan; Daeschlein, Georg; Lange-Asschenfeldt, Bernhard


    During the past decades, encouraging progress has been made in the prevention of surgical site infections (SSI). However, as SSI still occur today, strategic prevention measures such as standardized skin antisepsis must be implemented and rigorously promoted. Recent discoveries in skin physiology necessitate the development of novel antiseptic agents and procedures in order to ameliorate their efficacy. In particular, alternate target structures in the skin need to be taken into consideration for the development of the next generation of antiseptics. Recent investigations have shown that a high number of microorganisms are located within and in the close vicinity of the hair follicles. This suggests that these structures are an important reservoir of bacterial growth and activity in human skin. To date, it has not been fully elucidated to what extent conventional liquid antiseptics sufficiently target the hair follicle-related microbial population. Modern technologies such as tissue-tolerable plasma (TTP) have been tested for their potential antiseptic efficiency by reducing the bacterial load in the skin and in the hair follicles. First experiments using liposomes to deliver antiseptics into the hair follicles have been evaluated for their potential clinical application. The present review evaluates these two innovative methods for their efficacy and applicability in preoperative skin antiseptics.

  4. Preoperative optimization of the vascular surgery patient

    Zhan HT


    Full Text Available Henry T Zhan,1 Seth T Purcell,1,2 Ruth L Bush1 1Texas A&M Health Science Center College of Medicine, Bryan, 2Baylor Scott and White, Temple, TX, USA Abstract: It is well known that patients who suffer from peripheral (noncardiac vascular disease often have coexisting atherosclerotic diseases of the heart. This may leave the patients susceptible to major adverse cardiac events, including death, myocardial infarction, unstable angina, and pulmonary edema, during the perioperative time period, in addition to the many other complications they may sustain as they undergo vascular surgery procedures, regardless of whether the procedure is performed as an open or endovascular modality. As these patients are at particularly high risk, up to 16% in published studies, for postoperative cardiac complications, many proposals and algorithms for perioperative optimization have been suggested and studied in the literature. Moreover, in patients with recent coronary stents, the risk of noncardiac surgery on adverse cardiac events is incremental in the first 6 months following stent implantation. Just as postoperative management of patients is vital to the outcome of a patient, preoperative assessment and optimization may reduce, and possibly completely alleviate, the risks of major postoperative complications, as well as assist in the decision-making process regarding the appropriate surgical and anesthetic management. This review article addresses several tools and therapies that treating physicians may employ to medically optimize a patient before they undergo noncardiac vascular surgery. Keywords: perioperative care, intraoperative care, medical management, risk evaluation/stratification, medical treatment

  5. Demonstration by radionuclide imaging of possible vascular steal from a renal transplant. [I-131, Tc-99

    Bloss, R.S.; McConnell, R.W.; McConnell, B.G.; Floyd, M.; Conner, W.T.; Henry, R.G.; Kahan, B.D.


    Radionuclide studies in a renal-transplant patient with congestive heart failure suggested vascular steal from the renal allograft by a contralateral femoral arteriovenous fistula. These reliable, noninvasive diagnostic procedures have potential use in similar settings to evaluate allograft perfusion and function. Correction by removal of the fistula was demonstrated.

  6. Digital correction of magnification in pelvic x rays for preoperative planning of hip joint replacements : Theoretical development and clinical results of a new protocol

    The, B; Diercks, RL; Stewart, RE; van Ooijen, PMA; van Horn, [No Value; van Horn, J.R.


    The introduction of digital radiological facilities leads to the necessity of digital preoperative planning, which is an essential part of joint, replacement surgery. To avoid errors in the preparation and execution of hip surgery, reliable correction of the Magnification of the projected hip is a p

  7. Viking Lander reliability program

    Pilny, M. J.


    The Viking Lander reliability program is reviewed with attention given to the development of the reliability program requirements, reliability program management, documents evaluation, failure modes evaluation, production variation control, failure reporting and correction, and the parts program. Lander hardware failures which have occurred during the mission are listed.

  8. Comparison of intravenous urography and magnetic resonance urography in preoperative evaluation of pelvi-ureteric junction obstruction in children.

    Sharma, Alok; Sodhi, Kushaljit Singh; Saxena, Akshay Kumar; Bhatia, Anmol; Menon, Prema; Rao, Katragadda L N; Khandelwal, Niranjan


    To compare intravenous urography (IVU) and magnetic resonance urography (MRU) in the preoperative evaluation of pelvi-ureteric junction obstruction (PUJO) in children. A total of 35 children up to 10 years of age in whom unilateral or bilateral PUJO were suspected on ultrasonography were enrolled in this prospective study. All children underwent IVU and MRU, and the findings were compared. Of the 70 kidneys evaluated, 14 (20%) were not visualized on IVU because of nonexcretion of contrast, whereas all the 70 (100%) kidneys were visualized on MRU. On IVU, nephrogram was not visualized in 66 (94.2%) of the 70 kidneys, whereas MRU showed prompt and homogeneous nephrogram in 68 (97.1%) of the 70 kidneys. No evidence of PUJO was seen in 31 (44.2%) kidneys on both IVU and MRU. IVU showed PUJO in 26 (37.1%) kidneys, whereas MRU showed it in 38 (54.2%) kidneys. MRU detected two duplex systems that were missed on IVU. A focal renal lesion and two incidental extra renal abnormalities were detected on MRU, which were not visualized on IVU. MRU is better than IVU, especially in case of poorly functioning kidneys which are not visualized on IVU. MRU also provides anatomic details of the ureter and vessels with better evaluation of renal parenchyma. It also has an additional advantage of detecting incidental extra renal abnormalities, if present.

  9. Renal Cortical Lactate Dehydrogenase: A Useful, Accurate, Quantitative Marker of In Vivo Tubular Injury and Acute Renal Failure.

    Richard A Zager

    Full Text Available Studies of experimental acute kidney injury (AKI are critically dependent on having precise methods for assessing the extent of tubular cell death. However, the most widely used techniques either provide indirect assessments (e.g., BUN, creatinine, suffer from the need for semi-quantitative grading (renal histology, or reflect the status of residual viable, not the number of lost, renal tubular cells (e.g., NGAL content. Lactate dehydrogenase (LDH release is a highly reliable test for assessing degrees of in vitro cell death. However, its utility as an in vivo AKI marker has not been defined. Towards this end, CD-1 mice were subjected to graded renal ischemia (0, 15, 22, 30, 40, or 60 min or to nephrotoxic (glycerol; maleate AKI. Sham operated mice, or mice with AKI in the absence of acute tubular necrosis (ureteral obstruction; endotoxemia, served as negative controls. Renal cortical LDH or NGAL levels were assayed 2 or 24 hrs later. Ischemic, glycerol, and maleate-induced AKI were each associated with striking, steep, inverse correlations (r, -0.89 between renal injury severity and renal LDH content. With severe AKI, >65% LDH declines were observed. Corresponding prompt plasma and urinary LDH increases were observed. These observations, coupled with the maintenance of normal cortical LDH mRNA levels, indicated the renal LDH efflux, not decreased LDH synthesis, caused the falling cortical LDH levels. Renal LDH content was well maintained with sham surgery, ureteral obstruction or endotoxemic AKI. In contrast to LDH, renal cortical NGAL levels did not correlate with AKI severity. In sum, the above results indicate that renal cortical LDH assay is a highly accurate quantitative technique for gauging the extent of experimental acute ischemic and toxic renal injury. That it avoids the limitations of more traditional AKI markers implies great potential utility in experimental studies that require precise quantitation of tubule cell death.

  10. Renal replacement therapy after cardiac surgery; renal function recovers

    Steinthorsdottir, Kristin Julia; Kandler, Kristian; Agerlin Windeløv, Nis


    To assess renal outcome in patients discharged from hospital following cardiac surgery-associated acute kidney injury (CSA-AKI) with need for renal replacement therapy.......To assess renal outcome in patients discharged from hospital following cardiac surgery-associated acute kidney injury (CSA-AKI) with need for renal replacement therapy....

  11. A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy

    Klatte, Tobias; Ficarra, Vincenzo; Gratzke, Christian; Kaouk, Jihad; Kutikov, Alexander; Macchi, Veronica; Mottrie, Alexandre; Porpiglia, Francesco; Porter, James; Rogers, Craig G.; Russo, Paul; Thompson, R. Houston; Uzzo, Robert G.; Wood, Christopher G.; Gill, Inderbir S.


    Context A detailed understanding of renal surgical anatomy is necessary to optimize preoperative planning and operative technique and provide a basis for improved outcomes. Objective To evaluate the literature regarding pertinent surgical anatomy of the kidney and related structures, nephrometry scoring systems, and current surgical strategies for partial nephrectomy (PN). Evidence acquisition A literature review was conducted. Evidence synthesis Surgical renal anatomy fundamentally impacts PN surgery. The renal artery divides into anterior and posterior divisions, from which approximately five segmental terminal arteries originate. The renal veins are not terminal. Variations in the vascular and lymphatic channels are common; thus, concurrent lymphadenectomy is not routinely indicated during PN for cT1 renal masses in the setting of clinically negative lymph nodes. Renal-protocol contrast-enhanced computed tomography or magnetic resonance imaging is used for standard imaging. Anatomy-based nephrometry scoring systems allow standardized academic reporting of tumor characteristics and predict PN outcomes (complications, remnant function, possibly histology). Anatomy-based novel surgical approaches may reduce ischemic time during PN; these include early unclamping, segmental clamping, tumor-specific clamping (zero ischemia), and unclamped PN. Cancer cure after PN relies on complete resection, which can be achieved by thin margins. Post-PN renal function is impacted by kidney quality, remnant quantity, and ischemia type and duration. Conclusions Surgical renal anatomy underpins imaging, nephrometry scoring systems, and vascular control techniques that reduce global renal ischemia and may impact post-PN function. A contemporary ideal PN excises the tumor with a thin negative margin, delicately secures the tumor bed to maximize vascularized remnant parenchyma, and minimizes global ischemia to the renal remnant with minimal complications. Patient summary In this report

  12. A signature of renal stress resistance induced by short-Term dietary restriction, fasting, and protein restriction

    F. Jongbloed (Franny); T.C. Saat (Tanja); M. Verweij (Marcel); C. Payan-Gomez; J.H.J. Hoeijmakers; S. van den Engel (Sandra); C.T.M. van Oostrom (Conny); Ambagtsheer, G.; S. Imholz (Sandra); J.L.A. Pennings (Jeroen L.A.); H. van Steeg (Harry); Ijzermans, J.N.M.; M. Dollé (MartijnE.T.); R.W.F. de Bruin (Ron)


    textabstractDuring kidney transplantation, ischemia-reperfusion injury (IRI) induces oxidative stress. Short-Term preoperative 30% dietary restriction (DR) and 3-day fasting protect against renal IRI. We investigated the contribution of macronutrients to this protection on both phenotypical and

  13. Renal neuroendocrine tumors

    Brian R Lane


    Full Text Available Objectives: Neuroendocrine tumors (NETs are uncommon tumors that exhibit a wide range of neuroendocrine differentiation and biological behavior. Primary NETs of the kidney, including carcinoid tumor, small cell carcinoma (SCC, and large cell neuroendocrine carcinoma (LCNEC are exceedingly rare. Materials and Methods: The clinicopathologic features of renal NETs diagnosed at a single institution were reviewed along with all reported cases in the worldwide literature. Results: Eighty renal NETs have been described, including nine from our institution. Differentiation between renal NETs and the more common renal neoplasms (renal cell carcinoma, transitional cell carcinoma can be difficult since clinical, radiographic, and histopathologic features overlap. Immunohistochemical staining for neuroendocrine markers, such as synaptophysin and chromogranin, can be particularly helpful in this regard. Renal carcinoids are typically slow-growing, may secrete hormones, and pursue a variable clinical course. In contrast, SCC and LCNEC often present with locally advanced or metastatic disease and carry a poor prognosis. Nephrectomy can be curative for clinically localized NETs, but multimodality treatment is indicated for advanced disease. Conclusions: A spectrum of NETs can rarely occur in the kidney. Renal carcinoids have a variable clinical course; SCC and LCNEC are associated with poor clinical outcomes. Diagnosis of NETs, especially LCNEC, requires awareness of their rare occurrence and prudent use of immunohistochemical neuroendocrine markers.

  14. Pregnancy and renal transplantation.

    Başaran, O; Emiroğlu, R; Seçme, S; Moray, G; Haberal, M


    Ovarian dysfunction, anovulatory vaginal bleeding, amenorrhea, high prolactin levels, and loss of libido are the causes of infertility in women with chronic renal failure. After renal transplantation, endocrine function generally improves after recovery of renal function. In this study we retrospectively evaluated the prepregnancy and postdelivery renal function, outcome of gestation, as well as maternal and fetal complications for eight pregnancies in eight renal transplant recipients between November 1975 and March 2003 of 1095 among 1425. Eight planned pregnancies occurred at a mean of 3.6 years posttransplant. Spontaneous abortion occured in the first trimester in one case. One intrauterine growth retardation was observed with a full-term pregnancy; one intrauterine growth retardation and preterm delivery; one preeclampsia with preterm delivery and urinary tract infection; and one preeclampsia with preterm delivery and oligohydramnios. The mean gestation period was 35.5 +/- 3.0 weeks (31.2 to 38.0). Pregnancy had no negative impact on renal function during a 2-year follow-up. No significant proteinuria or acute rejection episodes were observed. Among the seven deliveries, no congenital anomaly was documented and no postpartum problems for the child and the mother were observed. Our study suggests that successful pregnancy is possible in renal transplant recipients. In cases with good graft function and absence of severe proteinuria or hypertension, pregnancy does not affect graft function or patient survival; however, fetal problems are encountered such as intrauterine growth retardation, low birth weight, and preeclampsia.

  15. Renal autotransplantation: current perspectives.

    Stewart, B H; Banowsky, L H; Hewitt, C B; Straffon, R A


    Autotransplantation, with or without an extracorporeal renal operation, has been done 39 times in 37 patients. Indications for the procedure included severe ureteral injury in 4 patients, failed supravesical diversion in 2, renal carcinoma in a solitary kidney in 1, renovascular hypertension in 1 and donor arterial reconstruction before renal transplantation in 29. Success was obtained in all but 2 procedures, both of which involved previously operated kidneys with severe inflammation and adhesions involving the renal pelvis and pedicle. Based on our experience and a review of currently available literature we believe that renal autotransplantation and extracorporeal reconstruction can provide the best solution for patients with severe renovascular and ureteral disease not correctable by conventional operative techniques. The technique can be of particular value in removing centrally located tumors in solitary kidneys and in preparing donor kidneys with abnormal arteries for renal transplantation. The role of autotransplantation in the management of advanced renal trauma and calculus disease is less clear. A long-term comparison of patients treated by extracorporeal nephrolithotomy versus conventional lithotomy techniques will be necessary before a conclusion is reached in these disease categories.

  16. Recognition and management of preoperative risk.

    Nierman, E; Zakrzewski, K


    Internists are frequently asked to do preoperative consultations and to manage perioperative complications. Realistic goals are to identify patient factors that increase the risk of surgery, to quantify this risk in order to make decisions about the appropriateness of and timing of the surgery, to provide recommendations on how to minimize the risk, to identify and manage coexisting medical conditions and their associated medication requirements, to monitor the patient for perioperative problems, and to make recommendations to deal with these problems when they occur. With few exceptions, nonselective imaging and laboratory screening tests have repeatedly been shown to be of little value when the history and physical do not suggest a problem. The risk associated with the planned surgery can be estimated, with the most common serious complications being cardiac events. Updated versions of Goldman's risk indices are particularly helpful for this. Clinical variables are optimally combined with selective stress testing to discern which patients will benefit from preoperative revascularization. This has been studied best in the setting of vascular surgery. A critical guiding principle is that the value of revascularization must be judged in terms of long term gains rather than just immediate perioperative benefit. Other interventions include the selective use of beta blockers, adequate analgesia for all, control of hypertension, and appropriate volume management, especially in the settings of preexisting CHF or valvular disease. It must also be recognized that perioperative ischemia and CHF often present atypically. An approach that combines aspects of both the ACC/AHA and the ACP guidelines seems optimal. A variety of noncardiac issues must also be addressed. Postoperative pulmonary complications are common, especially with preexisting pulmonary disease, thoracic and upper abdominal surgery, and obesity. PFTs and ABGs are indicated in selected patients. Stopping

  17. Anterior mediastinal paraganglioma: A case for preoperative embolization

    Shakir Murtaza


    Full Text Available Abstract Background Paraganglioma is a rare but highly vascular tumor of the anterior mediastinum. Surgical resection is a challenge owing to the close proximity to vital structures including the heart, trachea and great vessels. Preoperative embolization has been reported once to facilitate surgical treatment. Case presentation We report a case of anterior mediastinal paraganglioma that was embolized preoperatively, and was resected without the need for cardiopulmonary bypass and without major bleeding complications. Conclusion We make a case to further the role of preoperative embolization in the treatment of mediastinal paragangliomas.

  18. Pre-operative investigations: yield and conformity to national guidelines.

    Juliana, H; Lim, T A; Inbasegaran, K


    Routine ordering of pre-operative investigations yields a low true positive rate and is not cost effective. In this study, case notes of 251 adults who underwent elective surgery were reviewed. Pre-operative investigations were classified as 'indicated' or 'not indicated', based on the national guidelines. Only 56% of all tests done were indicated. The overall rates of expected and unexpected abnormal values from pre-operative blood investigations were 51.1% and 34.4% respectively. This study found that selective testing based on guidelines was beneficial. However, the results also suggest that the local guidelines need to be reviewed.

  19. Midterm renal functions following acute renal infarction

    Sakir Ongun


    Full Text Available The aim of this study was to explore clinical features of renal infarction (RI that may have a role in diagnosis and treatment in our patient cohort and provide data on midterm renal functions. Medical records of patients with diagnosis of acute RI, established by contrast enhanced computed tomography (CT and at least 1 year follow-up data, who were hospitalized in our clinic between 1998 and 2012 were retrospectively reviewed; including descriptive data, clinical signs and symptoms, etiologic factors, laboratory findings, and prescribed treatments. Patients with solitary infarct were treated with acetylsalicylic acid (ASA only, whereas patients with atrial fibrillation (AF or multiple or global infarct were treated with anticoagulants. Estimated Glomerular Filtration Rate (eGFR referring to renal functions was determined by the Modification of Diet in Renal Disease (MDRD formula. Twenty-seven renal units of 23 patients with acute RI were identified. The mean age was 59.7 ± 15.7 years. Fourteen patients (60.8% with RI had atrial fibrillation (AF as an etiologic factor of which four had concomitant mesenteric ischemia at diagnosis. At presentation, 20 patients (86.9% had elevated serum lactate dehydrogenase (LDH, 18 patients (78.2% had leukocytosis, and 16 patients (69.5% had microscopic hematuria. Two patients with concomitant mesenteric ischemia and AF passed away during follow up. Mean eGFR was 70.8 ± 23.2 mL/min/1.73 m2 at admission and increased to 82.3 ± 23.4 mL/min/1.73 m2 at 1 year follow up. RI should be considered in patients with persistent flank or abdominal pain, particularly if they are at high risk of thromboembolism. Antiplatelet and/or anticoagulant drugs are both effective treatment options according to the amplitude of the infarct for preserving kidney functions.

  20. Midterm renal functions following acute renal infarction.

    Ongun, Sakir; Bozkurt, Ozan; Demir, Omer; Cimen, Sertac; Aslan, Guven


    The aim of this study was to explore clinical features of renal infarction (RI) that may have a role in diagnosis and treatment in our patient cohort and provide data on midterm renal functions. Medical records of patients with diagnosis of acute RI, established by contrast enhanced computed tomography (CT) and at least 1 year follow-up data, who were hospitalized in our clinic between 1998 and 2012 were retrospectively reviewed; including descriptive data, clinical signs and symptoms, etiologic factors, laboratory findings, and prescribed treatments. Patients with solitary infarct were treated with acetylsalicylic acid (ASA) only, whereas patients with atrial fibrillation (AF) or multiple or global infarct were treated with anticoagulants. Estimated Glomerular Filtration Rate (eGFR) referring to renal functions was determined by the Modification of Diet in Renal Disease (MDRD) formula. Twenty-seven renal units of 23 patients with acute RI were identified. The mean age was 59.7 ± 15.7 years. Fourteen patients (60.8%) with RI had atrial fibrillation (AF) as an etiologic factor of which four had concomitant mesenteric ischemia at diagnosis. At presentation, 20 patients (86.9%) had elevated serum lactate dehydrogenase (LDH), 18 patients (78.2%) had leukocytosis, and 16 patients (69.5%) had microscopic hematuria. Two patients with concomitant mesenteric ischemia and AF passed away during follow up. Mean eGFR was 70.8 ± 23.2 mL/min/1.73 m(2) at admission and increased to 82.3 ± 23.4 mL/min/1.73 m(2) at 1 year follow up. RI should be considered in patients with persistent flank or abdominal pain, particularly if they are at high risk of thromboembolism. Antiplatelet and/or anticoagulant drugs are both effective treatment options according to the amplitude of the infarct for preserving kidney functions.

  1. Preoperative factors influencing success in pterygium surgery

    Torres-Gimeno Ana


    Full Text Available Abstract Background To identify preoperative, perioperative and postoperative risk factors that influence the success of pterygium surgery. Methods This is a prospective study of thirty-six patients with primary or recurrent pterygia. A detailed anamnesis and an ophthalmological examination were performed looking for the following factors: age, race, latitude and altitude of the main place of residence, hours of exposure to the sun, use of protective measures against UV-radiation, classification of pterygium, width of the pterygium at limbus, surgical technique (conjunctival autograft plus suturing versus tissue glue, graft alterations (misapposition, granuloma, haemorrhage, oedema, retraction or necrosis, and postoperative symptoms (foreign-body sensation, pain. The examinations were performed 2 and 7 days and 2, 6 and 12 months after surgery. In addition, recurrence was defined as any growth of conjunctiva into the cornea. Results A logistic regression and a survival analysis have been used to perform data analysis. A total number of 36 patients completed a one year follow-up. A total of 13 patients were born and lived in Spain, and 26 came from other countries, mostly Latin America. A total number of 8 males (no women presented a recurrence, mainly between 2 and 6 months. The hours of sun exposure through their life was independently related to surgical success. Pterygia of less than 5 mm of base width showed a weak positive correlation with recurrence. None of the other factors considered were significantly related to recurrence. Conclusions Male gender and high sun exposure are strongly and independently related to surgical success after the removal of pterygia.

  2. [Spectrum and susceptibility of preoperative conjunctival bacteria].

    Fernández-Rubio, M E; Cuesta-Rodríguez, T; Urcelay-Segura, J L; Cortés-Valdés, C


    To describe the conjunctival bacterial spectrum of our patients undergoing intraocular surgery and their antibiotic sensitivity during the study period. A retrospective study of preoperative conjunctival culture of patients consecutively scheduled for intraocular surgery from 21 February 2011 to 1 April 2013. Specimens were directly seeded onto blood-agar and MacConkey-agar (aerobiosis incubation, 2 days), and on chocolate-agar (6% CO2 incubation, 7 days). The identified bacteria were divided into 3 groups according to their origin; the bacteria susceptibility tests were performed on those more pathogenic and on some of the less pathogenic when more than 5 colonies were isolated. The sensitivity of the exigent growing bacteria was obtained with disk diffusion technique, and for of the non-exigent bacteria by determining their minimum inhibitory concentration. The Epidat 3.1 program was used for statistical calculations. A total of 13,203 bacteria were identified in 6,051 cultures, with 88.7% being typical colonizers of conjunctiva (group 1), 8.8% typical of airways (group 2), and the remaining 2.5% of undetermined origin (group 3). 530 cultures (8.8%) were sterile. The sensitivity of group 1 was: 99% vancomycin, 95% rifampicin, 87% chloramphenicol, 76% tetracycline. Levels of co-trimoxazole, aminoglycosides, quinolones, β-lactams and macrolides decreased since 2007. The group 2 was very sensitive to chloramphenicol, cefuroxime, rifampicin, ciprofloxacin and amoxicillin/clavulanate. In group 3, to levofloxacin 93%, ciprofloxacin 89%, tobramycin 76%, but ceftazidime 53% and cefuroxime 29% decreased. None of the tested antibiotics could eradicate all possible conjunctival bacteria. Bacteria living permanently on the conjunctiva (group 1) have achieved higher resistance than the eventual colonizers. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  3. Lactulose and renal failure.

    Vogt, B; Frey, F J


    The introduction of lactulose as a new therapeutic agent for treatment of hepatic encephalopathy was a major breakthrough in this field. It was hypothesized that lactulose might prevent postoperative renal impairment after biliary surgery in patients with obstructive jaundice. The presumable mechanism purported was the diminished endotoxinemia by lactulose. Unfortunately, such a reno-protective effect has not been shown conclusively until now in clinical studies. In chronic renal failure lactulose is known to promote fecal excretion of water, sodium, potassium, amonium, urea, creatinine and protons. Thus, lactulose could be useful for the treatment of chronic renal failure. However, compliance to the therapy represents a major problem.

  4. Renal tubule cell repair following acute renal injury.

    Humes, H D; Lake, E W; Liu, S


    Experimental data suggests the recovery of renal function after ischemic or nephrotoxic acute renal failure is due to a replicative repair process dependent upon predominantly paracrine release of growth factors. These growth factors promote renal proximal tubule cell proliferation and a differentiation phase dependent on the interaction between tubule cells and basement membrane. These insights identify the molecular basis of renal repair and ischemic and nephrotoxic acute renal failure, and may lead to potential therapeutic modalities that accelerate renal repair and lessen the morbidity and mortality associated with these renal disease processes. In this regard, there is a prominent vasoconstrictor response of the renal vasculature during the postischemic period of developing acute renal failure. The intravenous administration of pharmacologic doses of atrial natriuretic factor (ANF) in the postischemic period have proven efficacious by altering renal vascular resistance, so that renal blood flow and glomerular filtration rate improve. ANF also appears to protect renal tubular epithelial integrity and holds significant promise as a therapeutic agent in acute renal failure. Of equal or greater promise are the therapeutic interventions targeting the proliferative reparative zone during the postischemic period. The exogenous administration of epidermal growth factor or insulin-like growth factor-1 in the postischemic period have effectively decreased the degree of renal insufficiency as measured by the peak serum creatinine and has hastened renal recovery as measured by the duration of time required to return the baseline serum creatinine values. A similarly efficacious role for hepatocyte growth factor has also been recently demonstrated.

  5. Unilateral occlusion of duplicated uterus with ipsilateral renal anomaly in young girls: a study with MRI

    Li, Y.W. [Dept. of Medical Imaging, National Taiwan Univ. Hospital, Taipei (Taiwan, Province of China); Shieh, C.P. [Dept. of Pediatric Nephrology, Taipei Municipal Women and Children`s Hospital (Taiwan, Province of China); Chen, W.J. [Dept. of Surgery, National Taiwan Univ. Hospital, Taipei (Taiwan, Province of China)


    Twenty-four young girls (mean age 13.0 years) with unilateral occlusion of a duplicated uterus and ipsilateral renal agenesis, dysplasia or hypoplasia were studied with magnetic resonance imaging (MRI) following ultrasound examination. Hydrocolpos (n=4), hydrometrocolpos (n=2), hematocolpos (n=11), hematometrocolpos (n=5), hematocolpometra, hematosalpinx (n=3) and hematometra, hematosalpinx (n=1) were noted (two of these patients had presented with hydrocolpos and hematocolpos before and after the menarche). Twenty-two of these girls presented with ipsilateral renal agenesis (right 11, left 11) with ectopic ureters to Gartner`s dust cysts (GDC) in two, in one renal hypoplasia and in one renal dysplasia with ectopic ureters to GDC. MRI offered specific images of the genital tract, showing the exact type of muellerian duct anomaly and providing high diagnostic accuracy. Such preoperative identification of a uterine anomaly, complemented with appropriate surgical intervention, can assist young girls in achieving normal fertility in the future. (orig.)

  6. Renal scintigraphy in veterinary medicine.

    Tyson, Reid; Daniel, Gregory B


    Renal scintigraphy is performed commonly in dogs and cats and has been used in a variety of other species. In a 2012 survey of the members of the Society of Veterinary Nuclear Medicine, 95% of the respondents indicated they perform renal scintigraphy in their practice. Renal scintigraphy is primarily used to assess renal function and to evaluate postrenal obstruction. This article reviews how renal scintigraphy is used in veterinary medicine and describes the methods of analysis. Species variation is also discussed.

  7. Predicting ease of perinephric fat dissection at time of open partial nephrectomy using preoperative fat density characteristics.

    Zheng, Yin; Espiritu, Patrick; Hakky, Tariq; Jutras, Kristin; Spiess, Philippe E


    To predict the ease of perinephric fat surgical dissection at the time of open partial nephrectomy (OPN) using perinepheric fat density characteristics as measured on preoperative computed tomography (CT). In all, 41 consecutive OPN patients with available preoperative imaging and prospectively collected dissection difficulty assessment were identified. Using a scoring system that was adopted for the purposes of this study, the genitourinary surgeon quantified the difficulty of the perinephric fat dissection on the surface of the renal capsule at the time of surgery. On axial CT slice centred on the renal hilum, we measured the quantity and density of perinephric fat whose absorption coefficient was between -190 to -30 Hounsfield units. Correlation between perinephric fat surface density (PnFSD) as noted on preoperative imaging and as observed by the surgeon at time of surgery were correlated in a completely 'double-blinded' fashion. Density comparisons between fat dissection difficulties were made using an anova. Associations between covariates and perinephric fat density were evaluated by univariate and multivariate logistic regression analyses. Receiver-operating characteristic (ROC) curves for six different predictive models were created to visualise the predictive enhancement of PnFSD. PnFSD was positively correlated with total surgical duration (Pearson's correlation coefficient 0.314, P = 0.04). PnFSD significantly correlated with gender (P = 0.001) and difficulty of perinephric fat surgical dissection (P dissection that was not difficult (n = 19) was 5598.32 (1367.77) surface density pixel unit (SDPU), and for a difficult dissection (n = 22) was 10272.23 (3804.67) SDPU. Univariate analysis showed gender (P = 0.002), and PnFSD were predictive of the presence of 'sticky' perinephric fat. A multivariate analysis model showed that PnFSD was the only variable that remained an independent predictor of perinephric fat dissection difficulty (P = 0.01). Of the six

  8. Current MR imaging of renal cell carcinoma

    Oh, Sae Lin; Sung, Seuk Jae [Dept. of Radiology, Anam Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)


    Renal cell carcinoma (RCC) consists of approximately 85-90% of renal masses, and its incidence is increasing due to widespread use of modern imaging modalities such as ultrasonography or computed tomography. Computed tomography has served an important role in the diagnosis and staging of RCC; however, recent advances in magnetic resonance imaging (MRI) techniques have considerably improved our ability to predict tumor biology beyond the morphologic assessment. Multiparametric MRI protocols include standard sequences tailored for the morphologic evaluation and acquisitions that provide information about the tumor microenvironment such as diffusion-weighted imaging and dynamic contrast-enhanced MRI. The role of multiparametric MRI in the evaluation of RCC now extends to preoperative characterization of RCC subtypes, histologic grade, and quantitative assessment of tumor response to targeted therapies in patients with metastatic disease. Herein, the clinical applications and recent advances in MRI applied to RCC are reviewed along with its merits and demerits. We aimed to review MRI techniques and image analysis that can improve the management of patients with RCC. Familiarity with the advanced MRI techniques and various imaging findings of RCC would also facilitate optimal clinical recommendations for patients.

  9. Preoperative physical therapy for elective cardiac surgery patients

    Hulzebos, E.H.J.; Smit, Y.; Helders, P.P.J.M.; Meeteren, N.L.U. van


    BACKGROUND: After cardiac surgery, physical therapy is a routine procedure delivered with the aim of preventing postoperative pulmonary complications. OBJECTIVES: To determine if preoperative physical therapy with an exercise component can prevent postoperative pulmonary complications in cardiac sur

  10. An audit of documented preoperative evaluation of surgery patients ...

    Southern African Journal of Anaesthesia and Analgesia 2015; 21(4):23-28 ... The information obtained from the standardised PAR form in each patient's file was audited using a ... inadequate preoperative assessment and management were.

  11. Preoperative preparation of patients with pituitary gland disorders

    Malenković, Vesna; Gvozdenović, Ljiljana; Milaković, Branko; Sabljak, Vera; Ladjević, Nebojsa; Zivaljević, Vladan


    This paper presents the most common disorders of pituitary function: acromegaly, hypopituitarism, diabetes insipidus and syndrome similar to diabetes insipidus, in terms of their importance in preoperative preparation of patients...

  12. Primary renal synovial sarcoma

    Girish D. Bakhshi


    Full Text Available Primary Renal Sarcoma is rare tumor comprising only 1% of all renal tumours. Synovial sarcomas are generally deep-seated tumors arising in the proximity of large joints of adolescents and young adults and account for 5-10% of all soft tissue tumours. Primary synovial sarcoma of kidney is rare and has poor prognosis. It can only be diagnosed by immunohistochemistry. It should be considered as a differential in sarcomatoid and spindle cell tumours. We present a case of 33-year-old female, who underwent left sided radical nephrectomy for renal tumour. Histopathology and genetic analysis diagnosed it to be primary renal synovial sarcoma. Patient underwent radiation therapy and 2 years follow up is uneventful. A brief case report with review of literature is presented.

  13. Renal protection in diabetes

    Parving, H H; Tarnow, L; Rossing, P


    BACKGROUND: The combination of diabetes and hypertension increases the chances of progressive renal disorder and, ultimately, renal failure. Roughly 40% of all diabetics, whether insulin-dependent or not, develop diabetic nephropathy. Diabetic nephropathy is the single most important cause of end......-stage renal disease in the Western world and accounts for more than a quarter of all end-stage renal diseases. Diabetic nephropathy is a major cause of increased morbidity and mortality in diabetic patients. Increased arterial blood pressure is an early and common phenomenon in incipient and overt diabetic...... nephropathy. The relationship between arterial blood pressure and diabetic nephropathy is a complex one, with diabetic nephropathy increasing blood pressure and blood pressure accelerating the course of nephropathy. OVERVIEW: Calcium antagonists antagonize preglomerular vasoconstriction. Additional putative...

  14. Renal primitive neuroectodermal tumors.

    Bartholow, Tanner; Parwani, Anil


    Primitive neuroectodermal tumors exist as a part of the Ewing sarcoma/primitive neuroectodermal tumor family. These tumors most commonly arise in the chest wall and paraspinal regions; cases with a renal origin are rare entities, but have become increasingly reported in recent years. Although such cases occur across a wide age distribution, the average age for a patient with a renal primitive neuroectodermal tumor is the mid- to late 20s, with both males and females susceptible. Histologically, these tumors are characterized by pseudorosettes. Immunohistochemically, CD99 is an important diagnostic marker. Clinically, these are aggressive tumors, with an average 5-year disease-free survival rate of only 45% to 55%. Given that renal primitive neuroectodermal tumor bears many similarities to other renal tumors, it is important to review the histologic features, immunostaining profile, and genetic abnormalities that can be used for its correct diagnosis.

  15. Renal vein thrombosis

    ... Saunders; 2012:chap 34. Read More Acute kidney failure Arteriogram Blood clots Dehydration Nephrotic syndrome Pulmonary embolus Renal Tumor Review Date 5/19/2015 Updated by: Charles Silberberg, ...

  16. Eligibility for renal denervation

    Persu, Alexandre; Jin, Yu; Baelen, Marie;


    -resistant hypertension (ENCOReD). The analysis included 731 patients. Age averaged 61.6 years, office blood pressure at screening was 177/96 mm Hg, and the number of blood pressure-lowering drugs taken was 4.1. Specialists referred 75.6% of patients. The proportion of patients eligible for renal denervation according......Based on the SYMPLICITY studies and CE (Conformité Européenne) certification, renal denervation is currently applied as a novel treatment of resistant hypertension in Europe. However, information on the proportion of patients with resistant hypertension qualifying for renal denervation after...... undetected secondary causes of hypertension (11.1%). In conclusion, after careful screening and treatment adjustment at hypertension expert centers, only ≈40% of patients referred for renal denervation, mostly by specialists, were eligible for the procedure. The most frequent cause of ineligibility...

  17. Reliability and safety engineering

    Verma, Ajit Kumar; Karanki, Durga Rao


    Reliability and safety are core issues that must be addressed throughout the life cycle of engineering systems. Reliability and Safety Engineering presents an overview of the basic concepts, together with simple and practical illustrations. The authors present reliability terminology in various engineering fields, viz.,electronics engineering, software engineering, mechanical engineering, structural engineering and power systems engineering. The book describes the latest applications in the area of probabilistic safety assessment, such as technical specification optimization, risk monitoring and risk informed in-service inspection. Reliability and safety studies must, inevitably, deal with uncertainty, so the book includes uncertainty propagation methods: Monte Carlo simulation, fuzzy arithmetic, Dempster-Shafer theory and probability bounds. Reliability and Safety Engineering also highlights advances in system reliability and safety assessment including dynamic system modeling and uncertainty management. Cas...

  18. Association of Preoperative Anemia With Postoperative Mortality in Neonates.

    Goobie, Susan M; Faraoni, David; Zurakowski, David; DiNardo, James A


    Neonates undergoing noncardiac surgery are at risk for adverse outcomes. Preoperative anemia is a strong independent risk factor for postoperative mortality in adults. To our knowledge, this association has not been investigated in the neonatal population. To assess the association between preoperative anemia and postoperative mortality in neonates undergoing noncardiac surgery in a large sample of US hospitals. Using data from the 2012 and 2013 pediatric databases of the American College of Surgeons National Surgical Quality Improvement Program, we conducted a retrospective study of neonates undergoing noncardiac surgery. Analysis of the data took place between June 2015 and December 2015. All neonates (0-30 days old) with a recorded preoperative hematocrit value were included. Anemia defined as hematocrit level of less than 40%. Receiver operating characteristics analysis was used to assess the association between preoperative hematocrit and mortality, and the Youden J Index was used to determine the specific hematocrit cutoff point to define anemia in the neonatal population. Demographic and postoperative outcomes variables were compared between anemic and nonanemic neonates. Univariate and multivariable logistic regression analyses were used to determine factors associated with postoperative neonatal mortality. An external validation was performed using the 2014 American College of Surgeons National Surgical Quality Improvement Program database. Neonates accounted for 2764 children (6%) in the 2012-2013 American College of Surgeons National Surgical Quality Improvement Program databases. Neonates inlcuded in the study were predominately male (64.5%), white (66.3%), and term (69.9% greater than 36 weeks' gestation) and weighed more than 2 kg (85.0%). Postoperative in-hospital mortality was 3.4% in neonates and 0.6% in all age groups (0-18 years). A preoperative hematocrit level of less than 40% was the optimal cutoff (Youden) to predict in-hospital mortality

  19. Complete renal recovery from severe acute renal failure after thrombolysis of bilateral renal vein thrombosis.

    Ramadoss, Suresh; Jones, Robert G; Foggensteiner, Lukas; Willis, Andrew P; Duddy, Martin J


    A previously healthy young man presented with acute renal failure due to extensive spontaneous deep vein thrombosis, including the inferior vena cava (IVC) and both renal veins. The patient was treated with selectively delivered thrombolytic therapy over a 7-day-period, which resulted in renal vein patency and complete recovery of renal function. A stent was placed over a segment stenosis of the IVC. No thrombophilic factors were identified. Bilateral renal vein thrombosis in young fit individuals is an unusual cause of acute renal failure. Thrombolytic therapy, even with delay, can completely restore renal function.




    Full Text Available Renal failure in obstetrics is rare but important complication, associated with significant mortality and long term morbidity.1,2 It includes acute renal failure due to obstetrical complications or due to deterioration of existing renal disease. AIMS AND OBJECTIVES: To evaluate the etiology and outcome of renal failure in obstetric patients. METHODS: We prospectively analyzed 30 pregnant and puerperal women with acute renal failure or pre-existing renal disease developing renal failure during pregnancy between November 2007 to sep-2009. Patients who presented/developed ARF during the hospital stay were included in this study. RESULTS: Among 30 patients, mean age was 23 years and 33 years age group. 12 cases (40% patients were primigravidae and 9(30% patients were multigravidae and 9 cases (30% presented in post-partum period. Eighteen cases (60% with ARF were seen in third trimester, followed by in postpartum period 9 cases (30%. Most common contributing factors to ARF were Pre-eclampsia, eclampsia and HELLP syndrome 60%, sepsis 56.6%, post abortal ARF 10%. DIC 40%. Haemorrhage as the aetiology for ARF was present 46%, APH in 20% and PPH in 26.6%. The type of ARF was renal in (63% and prerenal (36%; Oliguric seen in 10 patients (33% and high mortality (30%. Among the 20 pregnant patients with ARF, The average period of gestation was 33±2 weeks (30 -36 weeks, 5 cases (25% presented with intrauterine fetal demise and 18 cases (66% had preterm vaginal delivery and 2 cases (10% had induced abortion. And the average birth weight was 2±0.5 kg (1.5 kg. Eight cases (26% required dialysis. 80% of patients recovered completely of renal functions. 63% patients recovered without renal replacement therapy whereas 17% required dialysis. the maternal mortality was 20%, the main reason for mortality was septic shock and multi organ dysfunction (66%. CONCLUSION: ARF related pregnancy was seen commonly in the primigravidae and in the third trimester, the most

  1. A randomized trial of preoperative oral carbohydrates in abdominal surgery

    Sada, Fatos; Krasniqi, Avdyl; Hamza, Astrit; Gecaj-Gashi, Agreta; Bicaj, Besnik; Kavaja, Floren


    Background Carbohydrate-rich liquid drinks (CRLDs) have been recommended to attenuate insulin resistance by shortening the preoperative fasting interval. The aim of our study the effect of preoperative oral administration of CRLDs on the well-being and clinical status of patients. Methods A randomized, double blind, prospective study of patients undergoing open colorectal operations (CR) and open cholecyctectomy (CH) was conducted. Patients were divided into three groups: study, placebo, and ...

  2. Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones

    Borly, L; Anderson, I B; Bardram, Linda


    BACKGROUND: After cholecystectomy for symptomatic gallstone disease 20%-30% of the patients continue to have abdominal pain. The aim of this study was to investigate whether preoperative variables could predict the symptomatic outcome after cholecystectomy. METHODS: One hundred and two patients...... and sonography evaluated gallbladder motility, gallstones, and gallbladder volume. Preoperative variables in patients with or without postcholecystectomy pain were compared statistically, and significant variables were combined in a logistic regression model to predict the postoperative outcome. RESULTS: Eighty...

  3. Preoperative Nutritional Status of the Surgical Patients in Jeju

    Moon, Myung-Sang; Kim, Sung-Soo; Lee, Sang-Yup; Jeon, Dal-Jae; Yoon, Min-Geun; Kim, Sung-Sim; Moon, Hanlim


    Background To assess the preoperative nutritional status of patients with various disorders and to provide data for pre- and postoperative patient management plans, particularly in the elderly. There is no published information on age-matched and disease-matched preoperative nutritional/immunologic status for orthopedic patients, especially in the elderly, in Jeju. Methods In total, 331 patients with four categories of orthopedic conditions were assessed: 92 elective surgery patients, 59 arth...

  4. [Value of preoperative planning in total hip arthroplasty].

    De Thomasson, E; Mazel, C; Guingand, O; Terracher, R


    Preoperative planning enables an assessment of the size of the implants needed before total hip replacement. Eggli and Müller demonstrated the reproduciblity of preoperative planning but did not evaluate its contribution to reducing limb length discrepancy. As femur lateralization and the position of the prosthetic center of rotation affect joint mechanics, it would be useful to assess their contribution to the efficacy of preoperative planning. We reviewed the files of 57 patients who underwent total hip arthroplasty for primary joint degeneration or necrosis limited to one hip. The healthy hip served as a control. The surgical plan was elaborated from the preoperative pelvis x-rays (AP and lateral views) and anatomic measurements on films obtained three months postoperatively. In 49 cases, preoperative planning predicted a restoration of the normal anatomy of the operated hip (center of rotation, femur lateralization, length of the operated limb). This objective was achieved in only 22.5% of the cases. Femur lateralization was the most difficult objective to achieve (59.2%). Equal limb length and good position of the center of rotation was achieved in 70% of the cases. For eight patients (14%) preoperative planning was not satisfactory, the implant offset not being adapted to the patient's anatomy. There are limits to preoperative planning, particularly for restitution of adequate femur lateralization. This difficulty appears to be related to three factors: inadequate adaptation of the implant to hip anatomy (14% of the cases in our experience), stiff rotation in degenerative hips inhibiting proper assessment of the length of the femoral neck, and relative imprecision of operative evaluation of femoral anteversion affecting femur lateralization and the level of the femoral cut. Although imperfect, preoperative planning is, in our opinion, essential before total hip arthroplasty in order to avoid major positioning errors and operative difficulties.

  5. Essential elements of the preoperative breast reconstruction evaluation

    Cheng, Angela; Losken, Albert


    A plethora of options exist for breast reconstruction and preoperative evaluation must be thorough to lead to a successful outcome. We review multiple components of the preoperative assessment including the patient’s history, goals, imaging, and key elements of the physical exam. Consideration for tumor biology, staging, need or response to chemotherapy or radiation therapy is important in deciding on immediate versus delayed reconstruction. It is also important to consider the patient’s anat...

  6. Preoperative PET/CT in early-stage breast cancer

    Bernsdorf, M; Berthelsen, A K; Wielenga, V T;


    The aim of this study was to assess the diagnostic and therapeutic impact of preoperative positron emission tomography and computed tomography (PET/CT) in the initial staging of patients with early-stage breast cancer.......The aim of this study was to assess the diagnostic and therapeutic impact of preoperative positron emission tomography and computed tomography (PET/CT) in the initial staging of patients with early-stage breast cancer....

  7. Renal papillary necrosis

    Stephen A. Geller


    Full Text Available In 1877, Dr. Nikolaus Friedreich (1825-1882; student of Virchow who became Professor of Pathology at Heidelberg and who also described Friedreich’s ataxia first described renal papillary necrosis (RPN in patients with prostatic hypertrophy and secondary hydronephrosis. Thereafter in 1937, Froboese and Günther emphasized the association of this entity with diabetes mellitus. These authors also observed renal papillary necrosis in cases of urinary tract obstruction even in the absence of diabetes mellitus.

  8. [Hyperuricemia and renal risk].

    Viazzi, Francesca; Bonino, Barbara; Ratto, Elena; Desideri, Giovambattista; Pontremoli, Roberto


    Recent studies have revealed an association between elevated levels of uric acid and conditions correlated to chronic kidney diseases such as hypertension, cardiovascular and cerebral disease, insulin resistance. Several pathogenetic mechanisms at cellular and tissue levels could justify a direct correlation between serum uric acid levels and renal damage. Growing evidence indicating a correlation between urate lowering therapy and renal morbidity could encourage the use of urate lowering therapy in primary or secondary prevention in chronic kidney disease.

  9. Review of ACR renal criteria in systemic lupus erythematosus.

    Dooley, M A; Aranow, C; Ginzler, E M


    The American College of Rheumatology renal criteria require re-evaluation to incorporate recent advances in the classification of glomerulonephritidies. Renal biopsy is now common and safely performed by experienced nephrologists in community as well as academic settings. The optimal criterion is renal histopathology findings of an immune complex mediated glomerulonephritis as interpreted by an experienced pathologist employing accepted criteria. Renal biopsies should be analysed by routine histopathology, immunofluorescent and electron microscopy. Rating of activity and chronicity should be noted. Secondary criteria for patients unable to undergo renal biopsy includes a combination of findings. These include proteinuria, hypocomplementemia, elevated anti-dsDNA antibodies and an active urine sediment. Proteinuria is a nonspecific finding and, most importantly, can be associated with a number of comorbidities including diabetes, hypertension and atherosclerotic disease. Persistent proteinuria > 0.5 g per day or a spot protein to creatine ratio of > 0.5 should be accompanied by an additional feature supporting active lupus such as positive serologies (hypocomplementemia and/or elevated anti-dsDNA antibodies) and/or active urinary sediment. Similarly, active urinary sediment should be accompanied by the additional criterion of proteinuria to meet renal criteria. Decline in renal function is not a reliable criterion given the numerous medications, comorbidities and other clinical circumstances which may result in this feature.

  10. Preoperative Chemoradiotheraph for Inflammatory Breast Cancer

    Hongbo Ren; Qi Wang; Yaoxiong Yan; Shaolin Li; Biyou Huang


    OBJECTIVE To observe the effect of preoperative chemoradiotherapy for inflammatory breast cancer.METHODS From December 1996 to December 2000, we received and treated 21 patients with inflammatory breast carcinoma with a combinedmodality treatment. The chemotherapy protocol consisted of cyclophosphamide (CTX), pirarubicin (THP-ADM) and 5-fluorouracil (5-FU) or CTX, 5-Fu and methotrexate (MTX). The same infusion scheme was repeated on day 21. After 3~4 cycles the patients were treated with radiotherapy. When the radiation dose reached 40 Gy, the patients who were unable or unwilling to under go an operation received continued radiotherapy. When the radiation dose to the supra clavicular fossa and internal mammary lymph nodes reached 60 Gy and 50 Gy respectively, the radiotherapy was stopped. Chemotherapy was then continued with the original scheme. Patients who had indications for surgery and were willing to under go an operation received no treatment for 2 weeks, after which a total mastectomy was performed. Chemotherapy and radiotherapy was resumed with the original scheme after the operations. When the radiation dose reached 50 Gy, radiotherapy was stopped.RESULTS All patients were followed-up for more than 5 years with a follow-up rate of 100%. The overall 3 and 5-year survival rates of these patients were 42.9%, and 23.8% respectively. For patients in Stage ⅢB the 3 and 5-year survival rates were 50.0% and 27.8% respectively, and for patients in Stage Ⅳ, the 3 and 5-year survival rates were both 0.0%.There was a significant difference between the 2 stage groups (P<0.05,X2=11.60). For patients who received an operation, the 3 and 5-year survival rates were 80.0% and 33.3% respectively, For patients who were not treated with an operation, the 3 and 5-year survival rates were both0.0%, There was a significant difference between the operated and nonoperated groups (P<0.05, X2=11.64).CONCLUSION The prognosis of inflammatory breast carcinoma is poor

  11. Association of Urine Dipstick Proteinuria and Postoperative Renal Function Following Robotic Partial Nephrectomy.

    Krane, Louis S; Heavner, Matthew G; Peyton, Charles; Rague, James T; Hemal, Ashok K


    In patients with normal estimated renal function before robot-assisted partial nephrectomy (RPN), there is still a risk for de Novo chronic kidney disease (CKD). We assessed the role of dipstick spot proteinuria in risk stratifying patients for CKD progression. From our prospectively maintained, institutional review board-approved database of patients undergoing RPN, we queried those with estimated glomerular filtration rate (eGFR) >60 and bilateral functional units. We assessed proteinuria through dipstick (trace or above) on voided urine in preoperative urologic appointment 60 preoperatively, of whom 57 (21%) had proteinuria preoperatively. In univariate analysis, these patients were more likely to be diabetic (p = 0.023) and to be on an angiotensin converting enzyme inhibitor or angiotensin receptor blocker (p = 0.001) but had similar age (p = 0.13), body mass index (p = 0.09), and tumor size (p = 0.56) with similar rates of hypertension (p = 0.07). At a median 16 months, controlling for confounding variables, preoperative proteinuria on urinary dipstick was associated with a 2.3× (95% confidence interval 1.03-4.95) increased risk of de Novo CKD stage III progression. Patients with proteinuria preoperatively, despite a normal eGFR, likely have intrinsic medicorenal disease. These patients should be counseled preoperatively that they have a higher risk of CKD progression following RPN.

  12. Measurement System Reliability Assessment

    Kłos Ryszard


    Full Text Available Decision-making in problem situations is based on up-to-date and reliable information. A great deal of information is subject to rapid changes, hence it may be outdated or manipulated and enforce erroneous decisions. It is crucial to have the possibility to assess the obtained information. In order to ensure its reliability it is best to obtain it with an own measurement process. In such a case, conducting assessment of measurement system reliability seems to be crucial. The article describes general approach to assessing reliability of measurement systems.

  13. Reliable knowledge discovery

    Dai, Honghua; Smirnov, Evgueni


    Reliable Knowledge Discovery focuses on theory, methods, and techniques for RKDD, a new sub-field of KDD. It studies the theory and methods to assure the reliability and trustworthiness of discovered knowledge and to maintain the stability and consistency of knowledge discovery processes. RKDD has a broad spectrum of applications, especially in critical domains like medicine, finance, and military. Reliable Knowledge Discovery also presents methods and techniques for designing robust knowledge-discovery processes. Approaches to assessing the reliability of the discovered knowledge are introduc

  14. Reliability of fluid systems

    Kopáček Jaroslav


    Full Text Available This paper focuses on the importance of detection reliability, especially in complex fluid systems for demanding production technology. The initial criterion for assessing the reliability is the failure of object (element, which is seen as a random variable and their data (values can be processed using by the mathematical methods of theory probability and statistics. They are defined the basic indicators of reliability and their applications in calculations of serial, parallel and backed-up systems. For illustration, there are calculation examples of indicators of reliability for various elements of the system and for the selected pneumatic circuit.

  15. Circuit design for reliability

    Cao, Yu; Wirth, Gilson


    This book presents physical understanding, modeling and simulation, on-chip characterization, layout solutions, and design techniques that are effective to enhance the reliability of various circuit units.  The authors provide readers with techniques for state of the art and future technologies, ranging from technology modeling, fault detection and analysis, circuit hardening, and reliability management. Provides comprehensive review on various reliability mechanisms at sub-45nm nodes; Describes practical modeling and characterization techniques for reliability; Includes thorough presentation of robust design techniques for major VLSI design units; Promotes physical understanding with first-principle simulations.

  16. Laparoscopic Renal Cryoablation

    Schiffman, Marc; Moshfegh, Amiel; Talenfeld, Adam; Del Pizzo, Joseph J.


    In light of evidence linking radical nephrectomy and consequent suboptimal renal function to adverse cardiovascular events and increased mortality, research into nephron-sparing techniques for renal masses widely expanded in the past two decades. The American Urological Association (AUA) guidelines now explicitly list partial nephrectomy as the standard of care for the management of T1a renal tumors. Because of the increasing utilization of cross-sectional imaging, up to 70% of newly detected renal masses are stage T1a, making them more amenable to minimally invasive nephron-sparing therapies including laparoscopic and robotic partial nephrectomy and ablative therapies. Cryosurgery has emerged as a leading option for renal ablation, and compared with surgical techniques it offers benefits in preserving renal function with fewer complications, shorter hospitalization times, and allows for quicker convalescence. A mature dataset exists at this time, with intermediate and long-term follow-up data available. Cryosurgical recommendations as a first-line therapy are made at this time in limited populations, including elderly patients, patients with multiple comorbidities, and those with a solitary kidney. As more data emerge on oncologic efficacy, and technical experience and the technology continue to improve, the application of this modality will likely be extended in future treatment guidelines. PMID:24596441

  17. Neonatal renal vein thrombosis.

    Brandão, Leonardo R; Simpson, Ewurabena A; Lau, Keith K


    Neonatal renal vein thrombosis (RVT) continues to pose significant challenges for pediatric hematologists and nephrologists. The precise mechanism for the onset and propagation of renal thrombosis within the neonatal population is unclear, but there is suggestion that acquired and/or inherited thrombophilia traits may increase the risk for renal thromboembolic disease during the newborn period. This review summarizes the most recent studies of neonatal RVT, examining its most common features, the prevalence of acquired and inherited prothrombotic risk factors among these patients, and evaluates their short and long term renal and thrombotic outcomes as they may relate to these risk factors. Although there is some consensus regarding the management of neonatal RVT, the most recent antithrombotic therapy guidelines for the management of childhood thrombosis do not provide a risk-based algorithm for the acute management of RVT among newborns with hereditary prothrombotic disorders. Whereas neonatal RVT is not a condition associated with a high mortality rate, it is associated with significant morbidity due to renal impairment. Recent evidence to evaluate the effects of heparin-based anticoagulation and thrombolytic therapy on the long term renal function of these patients has yielded conflicting results. Long term cohort studies and randomized trials may be helpful to clarify the impact of acute versus prolonged antithrombotic therapy for reducing the morbidity that is associated with neonatal RVT.

  18. The importance of preoperative diagnosis of blister aneurysms.

    Russin, Jonathan J; Kramer, Daniel R; Thomas, Debi; Hasson, Denise; Liu, Charles Y; Amar, Arun P; Mack, William J; Giannotta, Steven L


    We describe a series of 14 surgical blister aneurysm (BA) patients and compare outcomes in those with known cerebral BA to those lacking preoperative BA diagnosis/recognition. BA are broad, fragile, pathologic dilatations of the intracranial arteries. They have a low prevalence but are associated with substantially higher surgical morbidity and mortality rates than saccular aneurysms. A confirmed, preoperative BA diagnosis can alter operative management and technique. We performed a retrospective review of prospectively collected data on aneurysm patients undergoing surgery at a major academic institution. All patients from 1990 to 2011 with a postoperative BA diagnosis were included. Chart reviews were performed to identify patients with preoperative BA diagnoses and collect descriptive data. We identified 14 patients, 12 of whom presented with subarachnoid hemorrhage. The age of the cohort (mean ± standard deviation: 41.8 ± 13.9 years) was lower than that generally reported for saccular aneurysm populations. Preoperatively diagnosed BA had an intraoperative rupture (IOR) rate of 28.6% (2/7) compared to a 57.1% (4/7) rate in the undiagnosed patients. The mortality rate in the preoperatively diagnosed cohort was 14.3% (1/7) while that of the undiagnosed group was 42.8% (3/7). BA remain a diagnostic and treatment challenge with morbidity and mortality rates exceeding those of saccular aneurysms. Preoperative BA diagnosis may decrease IOR and mortality rates and improve patient outcomes.

  19. Evaluating the effects of preoperative fasting and fluid limitation.

    Tosun, Betül; Yava, Ayla; Açıkel, Cengizhan


    The aim of the study was to evaluate the effects of preoperative fasting and fluid limitation in patients undergoing laparoscopic cholecystectomy. Although traditional long-term fasting is not recommended in current preoperative guidelines, this is still a common intervention. Visual analogue scale was used to assess hunger, thirst, sleepiness, exhaustion, nausea and pain; State and Trait Anxiety Inventory was used to assess the preoperative anxiety of 99 patients undergoing elective laparoscopic cholecystectomy. Mean time of preoperative fasting and fluid limitation were, respectively, 14.70 ± 3.14 and 11.25 ± 3.74 h. Preoperatively, 58.60% of the patients experienced moderate anxiety. Patients fasting 12 h or longer had higher hunger, thirst, nausea and pain scores. The mean trait anxiety score of patients fasting 12 h or longer was statistically significantly higher. Receiving nothing by mouth after midnight preoperatively is a persisted intervention and results in discomfort of patients. Clinical protocols should be revised and nurses should be trained in current fasting protocols. © 2014 Wiley Publishing Asia Pty Ltd.

  20. Targeting Strategies for Renal Cell Carcinoma: From Renal Cancer Cells to Renal Cancer Stem Cells

    Zhi-xiang Yuan; Jingxin Mo; Guixian Zhao; Gang Shu; Hua-lin Fu; Wei Zhao


    Renal cell carcinoma (RCC) is a common form of urologic tumor that originates from the highly heterogeneous epithelium of renal tubules. Over the last decade, targeting therapies to renal cancer cells have transformed clinical care for RCC. Recently, it was proposed that renal cancer stem cells (CSCs) isolated from renal carcinomas were responsible for driving tumor growth and resistance to conventional chemotherapy and radiotherapy, according to the theory of CSCs; this has provided the rati...


    Elisangela Giachini


    Full Text Available The aim of this study is to evaluate the incidence and prevalence of malignant kidney tumors, to contribute to identifying factors which the diagnosis of renal cell carcinomas. Through this study, we understand that kidney disease over the years had higher incidence rates, especially in adults in the sixth decade of life. The renal cell carcinoma (RCC is the third most common malignancy of the genitourinary tract, affecting 2% to 3% of the population. There are numerous ways of diagnosis; however, the most important are ultrasonography, magnetic resonance imaging and computed tomography. In general most of the patients affected by the CCR, have a good prognosis when diagnosed early and subjected to an effective treatment. This study conducted a literature review about the CCR, through this it was possible to understand the development needs of the imaging methods used for precise diagnosis and classification of RCC through the TNM system.

  2. Acute renal failure and outcome of children with solitary kidney undergoing cardiac surgery.

    Abou El-Ella, Raja S; Najm, Hani K; Godman, Michael; Kabbani, Mohamed S


    The aim of this study was to investigate the risk of acute renal failure (ARF), the need for renal replacement therapy, and the outcome of children with a solitary functioning kidney undergoing open heart surgery. The study was performed retrospectively on all children diagnosed with solitary functioning kidney and who required open heart surgery between January 2003 and January 2007. Demographic, perioperative renal function and intensive care course data were documented. Eight patients (six females) fulfilled the study criteria and were included in the study. Their median age and weight were 4.5 months and 3.6 kg, respectively. Their mean +/- standard deviation (SD) preoperative blood urea nitrogen (BUN) and creatinine levels were 3.7 +/- 1.6 mmol/L and 55 +/- 10 micromol/L, respectively. Postoperatively, the mean BUN and creatinine levels peaked on the first postoperative day to reach 7.8 +/- 2.6 mmol/L and 76 +/- 22 micromol/L, respectively, before starting to return to their preoperative values. Two out of eight patients (25%) developed ARF after surgery, but only one of them (12.5%) required renal replacement therapy. Open heart surgery on bypass can be performed safely for children with solitary functioning kidney with a good outcome. ARF requiring renal replacement therapy might occur temporarily after bypass surgery in a minority of cases.

  3. Re-establishment of erythropoietin responsiveness in end-stage renal failure following renal transplantation.

    Jeffrey, R F; Kendall, R G; Prabhu, P; Norfolk, D R; Will, E J; Davison, A M


    Re-establishment of erythropoietin (EPO) secretion following renal transplantation is poorly understood. The development of sensitive EPO radioimmunoassay has enabled further study of this phenomenon. Forty-one adult patients were studied during the first 16 weeks following renal transplantation. Twenty six received cyclosporin monotherapy and 15 also received prednisolone and azathioprine. Serum creatinine, haemoglobin (Hb), ferritin and EPO were assayed pre-operatively, daily for 1 week, weekly for 1 month, and fortnightly to 16 weeks. An expected EPO value, for any Hb level, was derived by linear regression analysis in 144 patients with iron deficiency anemia. An observed to expected ratio (O/E) was calculated, a value of 1.0 implying appropriate responsiveness. Hb increased from 8.6 +/- 2.0 (SD) to 12.3 +/- 2.1 g/dl (p weeks, an increase unaffected by ferritin status. Mean EPO concentration increased during the first week with a peak at day 4 (22.1 +/- 13.3 to 44.6 +/- 40.0 mu/ml, p week 16 (r = -0.404, p weeks (p weeks when mean serum creatinine was 142 +/- 48 mumol/l. Patients with poor ongoing renal function (9 cases, serum creatinine > 250 mumol/l at 16 weeks) had impaired Hb recovery (10.1 +/- 1.6 vs 12.7 +/- 2.0 g/dl at 16 weeks, p < 0.05). EPO values were not different in those patients but median O/E ratios were significantly depressed (p < 0.05) throughout, the maximum O/E ratio being 0.75. Recovery of renal function is accompanied by a beneficial Hb response driven by EPO synthesis in the transplant. The O/E ratio provides a useful index to assess EPO responsiveness. Appropriate secretion was achieved during the first 4 months and optimized by immediate and satisfactory graft function.

  4. Renal graft biopsy assists diagnosis and treatment of renal allograft dysfunction after kidney transplantation: a report of 106 cases.

    Han, Yong; Guo, Hui; Cai, Ming; Xiao, Li; Wang, Qiang; Xu, Xiaoguang; Huang, Haiyan; Shi, Bingyi


    Acute antibody mediated rejection (AMR) is one of the most important complications after kidney transplantation. Renal graft biopsy is safe and reliable without adverse effects on the patients and transplanted kidneys, which was of great instructive significance in diagnosis and treatment of renal allograft dysfunction after renal transplantation. This paper reported a case series of 106 patients underwent renal allograft biopsies. All biopsies were evaluated according to the Banff 2007 schema. 52 examples were obtained within 1 month after transplantation, and there were another 20 examples in one to two months and other 34 examples in two to three months. Appropriate therapy was applied and clinical outcomes were observed. All patients received renal biopsies and anti-inflammatory and hemostasis treatment without complications. There were 2 cases of hyperacute rejection, and 15 cases of acute AMR. All Paraffin-embedded samples were stained by HE, periodic acid-Schiff (PAS), Masson, and immunohistochemistry (C4d, cd20, cd45RO, SV40). All samples were found C4d immunohistochemical staining positive. Patients with acute AMR were managed by steroid intravenous pulse therapy, Rabbit anti-thymocyte globulin intravenous pulse therapy, anti CD20 monoclonal antibody intravenous therapy and so on. Two cases of hyperacute rejection had renal failure, and received kidney excision; 12 cases in 15 cases of AMR recovered, another 2 cases did not recover with high-level creatine, and other 2 cases of renal allograft received excision.

  5. Mini-flank supra-12th rib incision for open partial nephrectomy for renal tumor with RENAL nephrometry score ≥10: an innovation of traditional open surgery.

    Wang, Hang; Sun, Li-an; Wang, Yiwei; Xiang, Zhuoyi; Zhou, Lin; Guo, Jianming; Wang, Guomin


    The skill of supra-12th rib mini-flank approach for open partial nephrectomy (MI-OPN) provides an advanced operative method for renal tumor. Compared with laparoscopic and robotic surgery, it may be a feasible selection for the complex renal tumors. We describe our techniques and results of MI-OPN in complex renal tumors with high RENAL nephrometry score (RENAL nephrometry score ≥10). Fifty-five patients diagnosed with renal tumors between January 2009 and July 2013 were included in this study. Eligibility criteria comprised of patients with complex renal tumor (RENAL score ≥10) being candidates for partial nephrectomy (PN). All patients received MI-OPN and all surgeries were performed by a single urologist. The preoperative workup comprised of medical history, physical examination, and routine laboratory tests. Serum creatinine was recorded preoperatively and 2 to 3 months after operation. Operative time, ischemia time, blood loss, operative and postoperative complications, renal function, and pathology parameters were recorded. MI-OPN was successfully performed in all cases. Mean tumor size was 4.7 cm (range: 2.5-8.1). Mean warm ischemia time was 28.1 minutes (range: 21-39), mean operative time was 105 minutes (range: 70-150) and mean estimated blood loss was 68 mL (range: 10-400). Mean postoperative hospital stay was 6.5 days (range: 5-12). Postoperative complications were found in 3 patients (5.5%). The mean pre- and postoperative serum creatinine levels were 76.2 μmol/L (range: 47-132) and 87.1 μmol/L (range: 61-189) with significant difference (P = 0.004). The mean pre- and postoperative estimated glomerular filtration rate (eGFR) were 91.5 (range: 34-133) and 82.5 (range: 22-126.5), respectively with significant difference (P = 0.024). In an average follow-up of 19.9 months (range: 8-50), no local recurrence or systemic progression occurred. In conclusion, MI-OPN can combine the benefits of both minimal invasive and traditional open

  6. Trisacryl Gelatin Microembolism and Metastases in the Lung after Renal Artery Embolization and Nephrectomy for Renal Cell Carcinoma

    Andres Borja Alvarez


    Full Text Available This is the first report, to our knowledge, of widespread, histologically confirmed trisacryl gelatin pulmonary microembolism after renal artery embolization (RAE. In addition, this is the first report of lung involvement by both metastatic renal cell carcinoma (RCC and an embolic agent used for RAE. The patient was a 63-year-old woman who recently presented with both dyspnea on exertion and productive cough. Her past medical history included clear cell RCC, which was treated with preoperative trisacryl gelatin microsphere RAE and right nephrectomy 9 years earlier. Computed tomography of the chest showed multiple lung nodules, a mass-like density in the left lower lobe, and mediastinal and hilar lymphadenopathy. Wedge resections of the lung showed multiple foci of metastatic RCC and extensive involvement of the muscular pulmonary arteries by trisacryl gelatin microspheres.


    Ekrem Akdeniz


    Full Text Available Objective:In this study, we aimed to investigate the impact of percutaneous nephrolitotomy on kidney functions in stage III or higher chronic renal failure patients using glomerular filtration rate and serum creatinine level. Material and Method:Between 2010 and 2014, percutaneous nephrolithotomy was applied to patients who had glomerular filtration rate below 60 mL/min/1.73m2. Pre-operative demographic features, stone burden and localization, urine analysis and microbial test, serum creatinine level, direct urinary system graphy, and spiral non-enhanced computerized tomography were obtained. Intraoperative renal unit counts, anesthesia and surgery time, and X-ray exposure time were calculated. Early and late post-operative complications, hospitalization time, stone-free rate, and glomerular function rate were evaluated, retrospectively. Findings:Pre-operatively, mean creatinine value was 2,42±0.76 mg/dL, mean glomerular filtration rate was 45.3±13mL/min/1.73m2, mean stone burden was 393±40 mm², mean intervention time was 79±34 min and 12 patients were stone free (70.5%. Decrease of hemoglobin 1,6 g/dL and transfusion was done only two patients (11.8% due to excessive bleeding. In early and long term follow-up, mean creatinine values and glomerular filtration rate were 1.98±0.72mg/dL, 2.16±0.78mL/dL and 54.1±14 mL/min/1.73m2and 51.8±15 mL/min/1.73m2, respectively. Comparison of pre-operative and post-operative creatinine and glomerular filtration rates revealed significant decrease in creatinine level and increase in glomerular filtration rate. Results:Percutaneous nephrolithotomy which eliminates urinary obstruction is safely used in the treatment of kidney stones with minimal damage on kidney functions. Stage III or higher renal failure patients who have obstructive kidney stones or recurrent urinary tract infections can effectively be treated and this may help patients to prevent progression to end-stage renal failure.

  8. LED system reliability

    Driel, W.D. van; Yuan, C.A.; Koh, S.; Zhang, G.Q.


    This paper presents our effort to predict the system reliability of Solid State Lighting (SSL) applications. A SSL system is composed of a LED engine with micro-electronic driver(s) that supplies power to the optic design. Knowledge of system level reliability is not only a challenging scientific ex

  9. Principles of Bridge Reliability

    Thoft-Christensen, Palle; Nowak, Andrzej S.

    The paper gives a brief introduction to the basic principles of structural reliability theory and its application to bridge engineering. Fundamental concepts like failure probability and reliability index are introduced. Ultimate as well as serviceability limit states for bridges are formulated...

  10. Improving machinery reliability

    Bloch, Heinz P


    This totally revised, updated and expanded edition provides proven techniques and procedures that extend machinery life, reduce maintenance costs, and achieve optimum machinery reliability. This essential text clearly describes the reliability improvement and failure avoidance steps practiced by best-of-class process plants in the U.S. and Europe.

  11. Hawaii Electric System Reliability

    Loose, Verne William [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Silva Monroy, Cesar Augusto [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)


    This report addresses Hawaii electric system reliability issues; greater emphasis is placed on short-term reliability but resource adequacy is reviewed in reference to electric consumers’ views of reliability “worth” and the reserve capacity required to deliver that value. The report begins with a description of the Hawaii electric system to the extent permitted by publicly available data. Electrical engineering literature in the area of electric reliability is researched and briefly reviewed. North American Electric Reliability Corporation standards and measures for generation and transmission are reviewed and identified as to their appropriateness for various portions of the electric grid and for application in Hawaii. Analysis of frequency data supplied by the State of Hawaii Public Utilities Commission is presented together with comparison and contrast of performance of each of the systems for two years, 2010 and 2011. Literature tracing the development of reliability economics is reviewed and referenced. A method is explained for integrating system cost with outage cost to determine the optimal resource adequacy given customers’ views of the value contributed by reliable electric supply. The report concludes with findings and recommendations for reliability in the State of Hawaii.

  12. Hawaii electric system reliability.

    Silva Monroy, Cesar Augusto; Loose, Verne William


    This report addresses Hawaii electric system reliability issues; greater emphasis is placed on short-term reliability but resource adequacy is reviewed in reference to electric consumers' views of reliability %E2%80%9Cworth%E2%80%9D and the reserve capacity required to deliver that value. The report begins with a description of the Hawaii electric system to the extent permitted by publicly available data. Electrical engineering literature in the area of electric reliability is researched and briefly reviewed. North American Electric Reliability Corporation standards and measures for generation and transmission are reviewed and identified as to their appropriateness for various portions of the electric grid and for application in Hawaii. Analysis of frequency data supplied by the State of Hawaii Public Utilities Commission is presented together with comparison and contrast of performance of each of the systems for two years, 2010 and 2011. Literature tracing the development of reliability economics is reviewed and referenced. A method is explained for integrating system cost with outage cost to determine the optimal resource adequacy given customers' views of the value contributed by reliable electric supply. The report concludes with findings and recommendations for reliability in the State of Hawaii.

  13. An anaesthetic pre-operative assessment clinic reduces pre-operative inpatient stay in patients requiring major vascular surgery.

    O'Connor, D B


    BACKGROUND: Patients undergoing major vascular surgery (MVS) require extensive anaesthetic assessment. This can require extended pre-operative stays. AIMS: We investigated whether a newly established anaesthetic pre-operative assessment clinic (PAC) would reduce the pre-operative inpatient stay, avoid unnecessary investigations and facilitate day before surgery (DBS) admissions for patients undergoing MVS. PATIENT AND METHODS: One year following and preceding the establishment of the PAC the records of patients undergoing open or endovascular aortic aneurysm repair, carotid endarterectomy and infra-inguinal bypass were reviewed to measure pre-operative length of stay (LoS). RESULTS: Pre-operative LoS was significantly reduced in the study period (1.85 vs. 4.2 days, respectively, P < 0.0001). Only 12 out of 61 patients in 2007 were admitted on the DBS and this increased to 33 out of 63 patients (P = 0.0002). No procedure was cancelled for medical reasons. CONCLUSION: The PAC has facilitated accurate outpatient anaesthetic assessment for patients requiring MVS. The pre-operative in-patient stay has been significantly reduced.

  14. Chapter 9: Reliability

    Algora, Carlos; Espinet-Gonzalez, Pilar; Vazquez, Manuel; Bosco, Nick; Miller, David; Kurtz, Sarah; Rubio, Francisca; McConnell,Robert


    This chapter describes the accumulated knowledge on CPV reliability with its fundamentals and qualification. It explains the reliability of solar cells, modules (including optics) and plants. The chapter discusses the statistical distributions, namely exponential, normal and Weibull. The reliability of solar cells includes: namely the issues in accelerated aging tests in CPV solar cells, types of failure and failures in real time operation. The chapter explores the accelerated life tests, namely qualitative life tests (mainly HALT) and quantitative accelerated life tests (QALT). It examines other well proven and experienced PV cells and/or semiconductor devices, which share similar semiconductor materials, manufacturing techniques or operating conditions, namely, III-V space solar cells and light emitting diodes (LEDs). It addresses each of the identified reliability issues and presents the current state of the art knowledge for their testing and evaluation. Finally, the chapter summarizes the CPV qualification and reliability standards.

  15. Synchronous Bilateral Adrenal Metastases from Papillary Renal Cell Carcinoma

    Kaan Gokcen


    Full Text Available We report a case of synchronous bilateral adrenal metastasis of renal cell carcinoma. The contralateral metastatic adrenal mass was treated by the laparoscopic transperitoneal approach. The renal mass and its huge ipsilateral metastatic adrenal gland were removed en bloc with open procedure. A 54-year-old man presented to our clinic with left-sid renal cell carcinoma synchronously bilateral adrenal metastases. The primary tumor was localized in the upper-mid pole of the kidney. The diagnosis was established preoperatively by computed tomography. The size of the contralateral adrenal mass was 65 x 45 mm, but the ipsilateral metastatic adrenal mass was huge (140 x 65 mm. After all analysis and other scannings for any metastasis, a contralateral lapararoscopic transperitoneal adrenalectomy and a left open nephroadrenalectomy were performed simultaneously. Synchronous bilateral adrenal metastases from primary renal cell carcinoma without another metastasis is very rare. The optimal surgical procedure should be selected according to the metastatic adrenal masses size and the patient%u2019s status.

  16. Renal inflammatory myofibroblastic tumor - a new case report.

    Petrescu, Amelia; Berdan, Gabriela; Hulea, Ionela; Gaitanidis, Raluca; Ambert, V; Jinga, V; Popescu, M; Andrei, F; Niculescu, L


    Renal inflammatory pseudotumor is uncommon, benign tumor that has been classified into separate group but there is a risk that this lesion could be misdiagnosed. The aim of this work is to report a new case of 57-years-old man presented in our hospital with hematuria, minimal grade fever and right flank pain. Magnetic resonance imaging (MRI) and sonography revealed a tumor of the right mediorenal parenchyma, 2.5 cm in diameter. The patient underwent right nephroureterectomy under the diagnosis of renal cell carcinoma. Macroscopically examination carried out on the removed kidney showed a 2/2/1.5 cm yellowish, gelatinous, well circumscribed, mediorenal and pericaliceal mass. Fragments of the tumor were fixed in 10% formaldehyde, included in paraffin, and the sections were stained with HE, VG and immunohistochemically with vimentin (VIM), MNF116, SyN, smooth muscle actin (ACT), desmin, CD68, S100, HMB45, and CD117. The histological examination revealed a compact spindle cell proliferation, a hypocellular fibrous area in an edematous myxoid background infiltrated by small lymphocytes, histiocytes, some plasma cells and small bone area. The spindle cells were diffuse positive for VIM, ACT, CD68 and negative for desmin, MNF116, SyN, S100, HMB45, and CD117. The pathologic diagnosis was renal inflammatory pseudotumor, raising the problem of differential diagnosis, as the clinical and imagistic aspects are similar to those of a renal carcinoma and the problem in establishing a preoperative correct diagnosis.

  17. Malignant renal tumors in children

    Justin Scott Lee


    Full Text Available Renal malignancies are common in children. While the majority of malignant renal masses are secondary to Wilms tumor, it can be challenging to distinguish from more aggressive renal masses. For suspicious renal lesions, it is crucial to ensure prompt diagnosis in order to select the appropriate surgical procedure and treatment. This review article will discuss the common differential diagnosis that can be encountered when evaluating a suspicious renal mass in the pediatric population. This includes clear cell sarcoma of the kidney, malignant rhabdoid tumor, renal medullary carcinoma and lymphoma. 

  18. Prognostic significance of preoperative fibrinogen in patients with colon cancer.

    Sun, Zhen-Qiang; Han, Xiao-Na; Wang, Hai-Jiang; Tang, Yong; Zhao, Ze-Liang; Qu, Yan-Li; Xu, Rui-Wei; Liu, Yan-Yan; Yu, Xian-Bo


    To investigate the prognostic significance of preoperative fibrinogen levels in colon cancer patients. A total of 255 colon cancer patients treated at the Affiliated Tumor Hospital of Xinjiang Medical University from June 1(st) 2005 to June 1(st) 2008 were enrolled in the study. All patients received radical surgery as their primary treatment method. Preoperative fibrinogen was detected by the Clauss method, and all patients were followed up after surgery. Preoperative fibrinogen measurements were correlated with a number of clinicopathological parameters using the Student t test and analysis of variance. Survival analyses were performed by the Kaplan-Meier method and Cox regression modeling to measure 5-year disease-free survival (DFS) and overall survival (OS). The mean preoperative fibrinogen concentration of all colon cancer patients was 3.17 ± 0.88 g/L. Statistically significant differences were found between preoperative fibrinogen levels and the clinicopathological parameters of age, smoking status, tumor size, tumor location, tumor-node-metastasis (TNM) stage, modified Glasgow prognostic scores (mGPS), white blood cell (WBC) count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and carcinoembryonic antigen (CEA) levels. Univariate survival analysis showed that TNM stage, tumor cell differentiation grade, vascular invasion, mGPS score, preoperative fibrinogen, WBC, NLR, PLR and CEA all correlated with both OS and DFS. Alpha-fetoprotein (AFP) and body mass index correlated only with OS. Kaplan-Meier analysis revealed that both OS and DFS of the total cohort, as well as of the stage II and III patients, were higher in the hypofibrinogen group compared to the hyperfibrinogen group (all P TNM stage, mGPS score, CEA, and AFP levels correlated with both OS and DFS. Preoperative fibrinogen levels can serve as an independent prognostic marker to evaluate patient response to colon cancer treatment.

  19. Preoperative psychological testing--another form of prejudice.

    Ashton, David; Favretti, Franco; Segato, Gianni


    Preoperative psychological screening of bariatric surgery candidates has become routine, and a significant proportion of patients have their surgery deferred as a consequence. If psychological testing is being used as a form of preoperative triage, both patients and surgeons are entitled to know whether there is sufficient evidence to justify its use in this way. We define the argument for psychological screening as consisting of four premises (p1-p4) and a conclusion (C) as follows: (p1) A significant minority of obese patients will not be successful in losing weight following bariatric surgery-the "failure" group; (p2) A significant minority of patients will exhibit abnormal psychological profiles during preoperative testing; (p3) The majority of individuals referred to in (p2) will be found in group (p1) i.e., abnormal psychological profiles identified preoperatively predict less favorable weight loss outcomes postoperatively; (p4) Identifying patients with adverse psychological profiles preoperatively would allow either exclusion of those at high risk of failure or provide a more secure rationale for targeted pre- and postoperative support; (C) Psychological screening should be part of the routine preoperative assessment for patients undergoing obesity surgery. We reviewed the literature to find evidence to support the premises and show that (p1) can be justified but that (p2) is problematic and can only be accepted in a heavily qualified version. We find no evidence for (p3) and since (p4) and (C) are predicated on (p3), the argument clearly fails. There is no evidence to suggest that preoperative psychological screening can predict postoperative outcomes and no justification for using such testing as a means of discriminating between candidates presenting themselves for bariatric surgery.

  20. Preoperative functional MRI localization of language areas in Chinese patients with brain tumors Validation with intraoperative electrocortical mapping

    Hechun Xia; Wei Huang; Liang Wu; Hui Ma; Xiaodong Wang; Xuexin Chen; Shengyu Sun; Xiaoxiong Jia


    Ten Chinese patients with brain tumors involving language regions were selected. Preoperative functional MRI was performed to locate Broca's or Wernicke's area, and the cortex that was essential for language function was determined by electrocortical mapping. A site-by-site comparison between functional MRI and electrocortical mapping was performed with the aid of a neuronavigation device. Results showed that the sensitivity and specificity of preoperative functional MRI were 80.0% and 85.0% in Broca's area and 66.6% and 85.2% in Wernicke's area, respectively. These experimental findings indicate that functional MRI is an accurate, reliable technique with which to identify the location of Wernicke's area or Broca's area in patients with brain tumors.

  1. Detection of renal ischemia by in situ microdialysis - an experimental study

    Keller, Anna Krarup

    Purpose: Acute vascular thrombosis of the renal artery or vein is a feared and devastating complication after renal operations, especially transplantation. The aim of the present study was to evaluate microdialysis as a possible new tool for fast and reliable detection of renal ischemia...... was placed outside, on the renal capsule. The contra lateral kidney was removed. After two hours of baseline measurements, ischemia was introduced by clamping the renal artery or vein in the first two groups. Microdialysis samples were taken every thirty minutes during baseline and the following five hours...... in a porcine model. Material and methods: Twenty healthy anesthetized pigs were randomized to experiments on left or right kidney and into three groups: arterial ischemia (n=8); venous ischemia (n=8) and controls (n=4). One microdialysis catheter was inserted superficially in the renal cortex and one...

  2. Laparoscopic sleeve gastrectomy prevents the deterioration of renal function in morbidly obese patients over 40 years.

    Ruiz-Tovar, Jaime; Giner, Lorena; Sarro-Sobrin, Felipe; Alsina, Maria Engracia; Marco, María Paz; Craver, Lourdes


    Chronic kidney disease (CKD) risk has been associated with elevated body mass index (BMI), especially in morbidly obese subjects. Aging and obesity can play a synergic effect on accelerating the renal function deterioration. Bariatric surgery (mainly gastric bypass or biliopancreatic diversion) has demonstrated an improvement on renal function, but little is known about the potential effect of sleeve gastrectomy on renal function. A prospective observational study was performed. Between 2009 and 2013, 50 morbidly obese patients over 40 years underwent a laparoscopic sleeve gastrectomy (LSG) at our institution. Renal function was evaluated by serum creatinine, urea, and estimated glomerular filtration rate (eGFR), calculated using the MDRD-4 formula. All the variables were obtained at three times: on the first visit to the surgeon's office (baseline), the day before surgery (preoperative), and 12 months after surgery. Fifty patients underwent a LSG, 44 females (88%) and 6 males (12%), with a mean age 49.2 ± 6.4 years and mean BMI of 48.4 ± 7.7 kg/m(2). MDRD-4 values presented a significant reduction (69.4 ml/min/m(2) at baseline vs 62.5 ml/min/m(2) preoperatively; CI95% (2.2-11.3 ml/min/m(2)); p = 0.01). Comparing pre- and postoperative values, a significant reduction could be determined in creatinine (0.89 mg/dl preoperatively vs 0.71 mg/dl postoperatively; p = 0.01), urea (36.1 mg/dl preoperatively vs 29.8 mg/dl postoperatively; p = 0.023), and a significant increase in MDRD-4 (62.5 ml/min/m(2) preoperatively vs 77.6 ml/min/m(2) postoperatively; p < 0.001). In patients over 40 years, renal function is going to deteriorate as long as the excess of weight persists. Laparoscopic sleeve gastrectomy has shown to improve the renal function 12 months after surgery.

  3. Percutaneous renal tumour biopsy.

    Delahunt, Brett; Samaratunga, Hemamali; Martignoni, Guido; Srigley, John R; Evans, Andrew J; Brunelli, Matteo


    The use of percutaneous renal tumour biopsy (RTB) as a diagnostic tool for the histological characterization of renal masses has increased dramatically within the last 30 years. This increased utilization has paralleled advances in imaging techniques and an evolving knowledge of the clinical value of nephron sparing surgery. Improved biopsy techniques using image guidance, coupled with the use of smaller gauge needles has led to a decrease in complication rates. Reports from series containing a large number of cases have shown the non-diagnostic rate of RTB to range from 4% to 21%. Re-biopsy has been shown to reduce this rate, while the use of molecular markers further improves diagnostic sensitivity. In parallel with refinements of the biopsy procedure, there has been a rapid expansion in our understanding of the complexity of renal cell neoplasia. The 2013 Vancouver Classification is the current classification for renal tumours, and contains five additional entities recognized as novel forms of renal malignancy. The diagnosis of tumour morphotype on RTB is usually achievable on routine histology; however, immunohistochemical studies may be of assistance in difficult cases. The morphology of the main tumour subtypes, based upon the Vancouver Classification, is described and differentiating features are discussed.

  4. Effect of percutaneous renal sympathetic nerve radiofrequency ablation in patients with severe heart failure.

    Dai, Qiming; Lu, Jing; Wang, Benwen; Ma, Genshan


    This study aimed to investigate the clinical feasibility and effects of percutaneous renal sympathetic nerve radiofrequency ablation in patients with heart failure. A total of 20 patients with heart failure were enrolled, aged from 47 to 75 years (63±10 years). They were divided into the standard therapy (n = 10), and renal nerve radiofrequency ablation groups (n = 10). There were 15 males and 5 female patients, including 8 ischemic cardiomyopathy, 8 dilated cardiomyopathy, and 8 hypertensive cardiopathy. All of the patients met the criteria of New York Heart Association classes III-IV cardiac function. Patients with diabetes and renal failure were excluded. Percutaneous renal sympathetic nerve radiofrequency ablation was performed on the renal artery wall under X-ray guidance. Serum electrolytes, neurohormones, and 24 h urine volume were recorded 24 h before and after the operation. Echocardiograms were performed to obtain left ventricular ejection fraction at baseline and 6 months. Heart rate, blood pressure, symptoms of dyspnea and edema were also monitored. After renal nerve ablation, 24 h urine volume was increased, while neurohormone levels were decreased compared with those of pre-operation and standard therapy. No obvious change in heart rate or blood pressure was recorded. Symptoms of heart failure were improved in patients after the operation. No complications were recorded in the study. Percutaneous renal sympathetic nerve radiofrequency ablation may be a feasible, safe, and effective treatment for the patients with severe congestive heart failure.

  5. Can renal infarction occur after renal cyst aspiration? Case report.

    Emre, Habib; Soyoral, Yasemin Usul; Tanik, Serhat; Gecit, Ilhan; Begenik, Huseyin; Pirincci, Necip; Erkoc, Reha


    Renal infarction (RI) is a rarely seen disorder, and the diagnosis is often missed. The two major causes of RI are thromboemboli originhating from a thrombus in the heart or aorta, and in-situ thrombosis of a renal artery. We report a case of RI that developed due to renal artery and vein thrombosis, as confirmed by pathological evaluation of the nephrectomy material, three weeks after renal cyst aspiration.

  6. Coronary Heart Disease Preoperative Gesture Interactive Diagnostic System Based on Augmented Reality.

    Zou, Yi-Bo; Chen, Yi-Min; Gao, Ming-Ke; Liu, Quan; Jiang, Si-Yu; Lu, Jia-Hui; Huang, Chen; Li, Ze-Yu; Zhang, Dian-Hua


    Coronary heart disease preoperative diagnosis plays an important role in the treatment of vascular interventional surgery. Actually, most doctors are used to diagnosing the position of the vascular stenosis and then empirically estimating vascular stenosis by selective coronary angiography images instead of using mouse, keyboard and computer during preoperative diagnosis. The invasive diagnostic modality is short of intuitive and natural interaction and the results are not accurate enough. Aiming at above problems, the coronary heart disease preoperative gesture interactive diagnostic system based on Augmented Reality is proposed. The system uses Leap Motion Controller to capture hand gesture video sequences and extract the features which that are the position and orientation vector of the gesture motion trajectory and the change of the hand shape. The training planet is determined by K-means algorithm and then the effect of gesture training is improved by multi-features and multi-observation sequences for gesture training. The reusability of gesture is improved by establishing the state transition model. The algorithm efficiency is improved by gesture prejudgment which is used by threshold discriminating before recognition. The integrity of the trajectory is preserved and the gesture motion space is extended by employing space rotation transformation of gesture manipulation plane. Ultimately, the gesture recognition based on SRT-HMM is realized. The diagnosis and measurement of the vascular stenosis are intuitively and naturally realized by operating and measuring the coronary artery model with augmented reality and gesture interaction techniques. All of the gesture recognition experiments show the distinguish ability and generalization ability of the algorithm and gesture interaction experiments prove the availability and reliability of the system.

  7. Preoperative White Matter Lesions Are Independent Predictors of Long-Term Survival after Internal Carotid Endarterectomy

    Niku Oksala


    Full Text Available Background: Cerebral white matter lesions (WMLs predict long-term survival of conservatively treated acute stroke patients with etiology other than carotid stenosis. In carotid endarterectomy patients, WMLs are associated with severe carotid stenosis and unstable plaques, with the risk of perioperative complications and with increased 30-day perioperative risk of death. However, no data exist on their effect on postoperative long-term survival, a factor important when considering the net benefit from carotid endarterectomy. Whether this effect is independent of classical risk factors and indications for surgery is not known either. We hypothesized that WMLs could be evaluated from preoperative routine computed tomography (CT scans and are predictors of postoperative survival, independent of classical cardiovascular risk factors, indication category and degree of carotid stenosis. Methods: A total of 353 of 481 (73.4% consecutive patients subjected to carotid endarterectomy due to different indications, i.e. asymptomatic stenosis (n = 28, 7.9%, amaurosis fugax (n = 52, 14.7%, transient ischemic attack (n = 135, 38.2% or ischemic stroke (n = 138, 39.1%, from prospective vascular registries during the years 2001-2010 with digital preoperative CT scans, were included in the study. WMLs were rated by a radiologist (Wahlund criteria in a blinded fashion. Internal carotid artery (ICA stenoses were angiographically graded (Results: WML severity could be assessed with a substantial intraobserver agreement (Spearman's rho 0.843, p Conclusions: WMLs in a preoperative CT scan provide a substantially reliable estimate of postoperative long-term survival of carotid endarterectomy patients independent of currently used criteria, i.e. cardiovascular risk factors, indication category and degree of ipsilateral ICA stenosis.

  8. Multidetector spiral CT renal angiography in the diagnosis of renal artery fibromuscular dysplasia

    Sabharwal, Rohan [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia)]. E-mail:; Vladica, Philip [Department of Radiology, Westmead Hospital, Sydney, NSW (Australia); Coleman, Patrick [Department of Renal Medicine, Westmead Hospital, Sydney, NSW (Australia)


    Objective: The aim of this study was to evaluate the role and detection rate of multidetector spiral CT renal angiography (CTA) as compared with conventional angiography (CA), the commonly accepted gold standard, in the diagnosis of renal artery fibromuscular dysplasia (FMD). In addition, the role of CTA reconstructions (multiplanar reformatted images (MPR), maximum intensity projections (MIP) and shaded-surface display (SSD)) in the detection of FMD was also evaluated. Materials and methods: CTA results were retrospectively reviewed in 21 hypertensive patients with CA-proven FMD. Clinical indications for referral included resistant hypertension (requiring greater than three antihypertensive medications), labile hypertension, hypertension in combination with renal impairment and the presence of abdominal bruits in the context of systemic hypertension. In some cases, these clinical indications were supplemented by positive results in other tests, including plasma renin assay, captopril scintigraphy and/or Doppler ultrasound. The findings of CA in these 21 patients were compared to CTA. Results: Mean patient age was 62.33 + 14.32 years (range 24-85 years). CTA identified all 42 main renal arteries (100%) and all 10 accessory renal arteries (100%) visualized on CA. In the diagnosis of FMD, CTA detected all 40 (100%) lesions detected by CA. No single CTA reconstruction technique was able to detect all lesions noted on corresponding CA, however, upon review of all CTA reconstructions (MPR, MIP and SSD) in each case, every lesion was correctly identified by CTA. Conclusion: Our experience suggests that CTA is a non-invasive, reliable and accurate method for the diagnosis of renal artery fibromuscular dysplasia. Moreover, in our experience CTA has many advantages as a diagnostic screening tool over CA, including accessibility, speed, lower complication profile, versatility and cost-effectiveness. CTA shows great potential as a guiding tool for directing subsequent

  9. Comparison of renal function after donor and radical nephrectomy.

    Gazel, Eymen; Biçer, Sait; Ölçücüoğlu, Erkan; Yığman, Metin; Taştemur, Sedat; Çamtosun, Ahmet; Ceylan, Cavit; Ateş, Can


    Glomerular filtration rate (GFR) is directly proportionate to nephron reserves. In this respect, it is known that the patients who underwent radical nephrectomy due to renal tumor are under high risk of chronic kidney disease (CKD) in the long term. In this study, it was aimed to compare post-operative renal functions of patients who underwent radical nephrectomy due to renal malignancy and who underwent donor nephrectomy as renal donors, to observe whether renal failure process develops or not, and to determine the factors that affect post-operative renal functions. 70 patients who underwent donor nephrectomy as renal donors and 130 patients who underwent radical nephrectomy due to renal tumor were studied. When we divided the groups as those with a GFR of below 60 mL/min/1.73 m(2) and those with a GFR of above 60 mL/min/1.73 m(2), we observed that GFR values of patients who underwent radical nephrectomy had a significantly stronger tendency to stay below 60 mL/min/1.73 m(2) compared to patients who underwent donor nephrectomy (p < 0.001). When we divided the groups as those with a GFR of below 30 mL/min/1.73 m(2) and those with a GFR of above 30 mL/min/1.73 m(2), we observed that there were no patients in donor nephrectomy group whose GFR values dropped below 30 mL/min/1.73 m(2) and there was not a statistically significant difference between the groups (p = 0.099). If possible, nephron sparing methods should be preferred for patients to undergo nephrectomy because of the tumor without ignoring oncologic results and it should be remembered that patient's age and pre-operative renal functions may affect post-operative results in donor selection.

  10. WE-D-204-07: Development of An ImageJ Plugin for Renal Function Quantification: RenalQuant

    Marques da Silva, A; Narciso, L [PUCRS, Porto Alegre, RS (Brazil)


    Purpose: Commercial workstations usually have their own software to calculate dynamic renal functions. However, usually they have low flexibility and subjectivity on delimiting kidney and background areas. The aim of this paper is to present a public domain software, called RenalQuant, capable to semi-automatically draw regions of interest on dynamic renal scintigraphies, extracting data and generating renal function quantification parameters. Methods: The software was developed in Java and written as an ImageJ-based plugin. The preprocessing and segmentation steps include the user’s selection of one time frame with higher activity in kidney’s region, compared with background, and low activity in the liver. Next, the chosen time frame is smoothed using a Gaussian low pass spatial filter (σ = 3) for noise reduction and better delimitation of kidneys. The maximum entropy thresholding method is used for segmentation. A background area is automatically placed below each kidney, and the user confirms if these regions are correctly segmented and positioned. Quantitative data are extracted and each renogram and relative renal function (RRF) value is calculated and displayed. Results: RenalQuant plugin was validated using retrospective 20 patients’ 99mTc-DTPA exams, and compared with results produced by commercial workstation software, referred as reference. The renograms intraclass correlation coefficients (ICC) were calculated and false-negative and false-positive RRF values were analyzed. The results showed that ICC values between RenalQuant plugin and reference software for both kidneys’ renograms were higher than 0.75, showing excellent reliability. Conclusion: Our results indicated RenalQuant plugin can be trustingly used to generate renograms, using DICOM dynamic renal scintigraphy exams as input. It is user friendly and user’s interaction occurs at a minimum level. Further studies have to investigate how to increase RRF accuracy and explore how to solve

  11. Photovoltaic system reliability

    Maish, A.B.; Atcitty, C. [Sandia National Labs., NM (United States); Greenberg, D. [Ascension Technology, Inc., Lincoln Center, MA (United States)] [and others


    This paper discusses the reliability of several photovoltaic projects including SMUD`s PV Pioneer project, various projects monitored by Ascension Technology, and the Colorado Parks project. System times-to-failure range from 1 to 16 years, and maintenance costs range from 1 to 16 cents per kilowatt-hour. Factors contributing to the reliability of these systems are discussed, and practices are recommended that can be applied to future projects. This paper also discusses the methodology used to collect and analyze PV system reliability data.

  12. Structural Reliability Methods

    Ditlevsen, Ove Dalager; Madsen, H. O.

    of structural reliability, including the theoretical basis for these methods. Partial safety factor codes under current practice are briefly introduced and discussed. A probabilistic code format for obtaining a formal reliability evaluation system that catches the most essential features of the nature......The structural reliability methods quantitatively treat the uncertainty of predicting the behaviour and properties of a structure given the uncertain properties of its geometry, materials, and the actions it is supposed to withstand. This book addresses the probabilistic methods for evaluation...

  13. Preoperative cryotherapy use in anterior cruciate ligament reconstruction.

    Koyonos, Loukas; Owsley, Kevin; Vollmer, Emily; Limpisvasti, Orr; Gambardella, Ralph


    Unrelieved postoperative pain may impair rehabilitation, compromise functional outcomes, and lead to patient dissatisfaction. Preemptive multimodal analgesic techniques may improve outcomes after surgery. We hypothesized that patients using preoperative cryotherapy plus a standardized postoperative treatment plan will have lower pain scores and require less pain medication compared with patients receiving a standardized postoperative treatment plan alone after arthroscopically assisted anterior cruciate ligament reconstruction (ACLR). A total of 53 consecutive patients undergoing arthroscopically assisted ACLR performed by one of seven surgeons were randomly assigned to one of two groups. Group 1 received no preoperative cryotherapy and group 2 received 30 to 90 minutes of preoperative cryotherapy to the operative leg using a commercial noncompressive cryotherapy unit. Visual analog scale pain scores and narcotic use were recorded for the first 4 days postoperatively. Total hours of cold therapy and continuous passive motion (CPM) use and highest degree of flexion achieved were recorded as well. Group 1 consisted of 26 patients (15 allograft Achilles tendon and 11 autograft bone patellar tendon bone [BPTB]), and group 2 consisted of 27 patients (16 allograft Achilles tendon and 11 autograft BPTB). Group 2 patients reported less pain (average 1.3 units, p cryotherapy, hours of CPM use, or maximum knee flexion achieved. Complications did not occur in either group. This is the first report we are aware of showing the postoperative effects of preoperative cryotherapy. Our results support the safety and efficacy of preoperative cryotherapy in a multimodal pain regimen for patients undergoing ACL reconstruction.

  14. Preoperative thrombocytosis predicts poor survival in patients with glioblastoma

    Brockmann, Marc A.; Giese, Alf; Mueller, Kathrin; Kaba, Finjap Janvier; Lohr, Frank; Weiss, Christel; Gottschalk, Stefan; Nolte, Ingo; Leppert, Jan; Tuettenberg, Jochen; Groden, Christoph


    Thrombocytosis, which is defined as a platelet count greater than 400 platelets/nl, has been found to be an independent predictor of shorter survival in various tumors. Release of growth factors from tumors has been proposed to increase platelet counts. Preoperative platelet counts and other clinical and hematological parameters were reviewed from the records of 153 patients diagnosed between 1999 and 2004 with histologically confirmed glioblastoma in order to evaluate the prognostic significance of preoperative thrombocytosis in these patients. The relationship between thrombocytosis and survival was initially analyzed in all patients regardless of further therapy. Univariate log-rank tests showed that the median survival time of 29 patients with preoperative thrombocytosis (19%) was significantly shorter (4 months; 95% confidence interval [95% CI], 3–6 months) compared to 124 patients with normal platelet counts (11 months; 95% CI, 8–13 months; p = 0.0006). Multivariate analysis (Cox proportional hazards model) confirmed preoperative platelet count, age, prothrombin time, and activated partial thromboplastin time to be prognostic factors of survival (all p thrombocytosis was diagnosed (6 months; 95% CI, 4–12 months) compared to patients with normal platelet count (13 months; 95% CI, 11–15 months; p = 0.0359). In multivariate analysis, age, platelet count, preoperative prothrombin time, and degree of tumor resection retained significance as prognostic factors of survival (all p thrombocytosis to be a prognostic factor associated with shorter survival time in patients with glioblastoma. PMID:17504931

  15. Significance of preoperative thrombocytosis in epithelial ovarian cancer

    Crasta Julian


    Full Text Available Background: Reactive thrombocytosis is reported in a variety of solid tumors. A few studies have documented preoperative thrombocytosis in ovarian cancer and identified it as a marker of aggressive tumor biology. Aim: To study the incidence of preoperative thrombocytosis (platelets greater than 400x10 in epithelial ovarian cancer and its association with other clinicopathologic factors. Materials and Methods: Sixty-five patients with invasive ovarian epithelial cancer were retrospectively reviewed and analyzed for the association preoperative thrombocytosis with other clinical and histopathological prognostic factors. Means were analyzed by Student′s t test; proportions were determined by Chi-square analysis. Results: Twenty of 65 (37.5% patients had thrombocytosis at primary diagnosis. Patients with preoperative thrombocytosis were found to have lower hemoglobin (P < 0.0002, more advanced stage disease (P < 0.05 and higher grade tumors (P < 0.02. Patients with thrombocytosis had greater likelihood of subpotimal cytoreduction. Conclusions: Preoperative thrombocytosis is a frequent finding in ovarian carcinomas and their association with advanced stage disease and higher grade denotes that platelets play a role in the tumor growth and progression.

  16. Imaging chronic renal disease and renal transplant in children

    Carmichael, Jim; Easty, Marina [Great Ormond Street Hospital, Radiology Department, London (United Kingdom)


    At Great Ormond Street Hospital we have the highest number of paediatric renal transplant patients in Europe, taking cases from across the United Kingdom and abroad. Our caseload includes many children with rare complicating medical problems and chronic renal failure related morbidity. This review aims to provide an overview of our experience of imaging children with chronic renal failure and transplants. (orig.)

  17. Renal sympathetic denervation: MDCT evaluation of the renal arteries.

    Hutchinson, Barry D


    Percutaneous transluminal renal sympathetic denervation is a new treatment of refractory systemic hypertension. The purpose of this study was to assess the clinical utility of MDCT to evaluate the anatomic configuration of the renal arteries in the context of renal sympathetic denervation.

  18. Screening renal stone formers for distal renal tubular acidosis

    Osther, P J; Hansen, A B; Røhl, H F


    A group of 110 consecutive renal stone formers were screened for distal renal tubular acidosis (RTA) using morning fasting urinary pH (mfUpH) levels followed by a short ammonium chloride loading test in patients with levels above 6.0. In 14 patients (12.7%) a renal acidification defect was noted...

  19. A double-blind, randomized, placebo-controlled study of nifedipine on early renal allograft function.

    Wilkie, M E; Beer, J C; Evans, S J; Raftery, M J; Lord, R H; Moore, R; Marsh, F P


    A double-blind, randomized, placebo-controlled study was conducted to determine the effect of nifedipine on early renal allograft function when added to a triple therapy immunosuppression regime comprising low-dose cyclosporin (CsA), prednisolone and azathioprine. Fifty adult cadaveric renal allograft recipients were randomized to placebo (group P n = 17), nifedipine 10 mg preoperatively and 20 mg b.d. postoperatively for 48 h, followed by matching placebo for 3 months (group NS n = 16) or nifedipine 10 mg preoperatively and 20 mg b.d. postoperatively for 3 months (group NL n = 17). Donor and recipient exclusion criteria included recent calcium antagonist treatment. At 3 months after transplantation mean GFR adjusted for graft loss was significantly higher in group NL than in NS (mean +/- SD 61 +/- 28 versus 34 +/- 25 ml/min/1.73 m2; P nifedipine commenced preoperatively and continued for 3 months following transplantation has beneficial effects on early renal allograft function when incorporated as part of an immunotherapy regimen based on cyclosporin.

  20. Renal Tumor Biopsy Technique

    Lei Zhang; Xue-Song Li; Li-Qun Zhou


    Objective:To review hot issues and future direction of renal tumor biopsy (RTB) technique.Data Sources:The literature concerning or including RTB technique in English was collected from PubMed published from 1990 to 2015.Study Selection:We included all the relevant articles on RTB technique in English,with no limitation of study design.Results:Computed tomography and ultrasound were usually used for guiding RTB with respective advantages.Core biopsy is more preferred over fine needle aspiration because of superior accuracy.A minimum of two good-quality cores for a single renal tumor is generally accepted.The use of coaxial guide is recommended.For biopsy location,sampling different regions including central and peripheral biopsies are recommended.Conclusion:In spite of some limitations,RTB technique is relatively mature to help optimize the treatment of renal tumors.

  1. Dyslipoproteinemia in renal transplantation.

    Gunjotikar R


    Full Text Available Twenty-seven live related donor renal allograft recipients were evaluated for dyslipoproteinemia. Twenty-two patients received dual immunosuppression with prednisolone and azathioprine. Five patients received cyclosporin as well. Total cholesterol (Tch, triglycerides (TG, HDL cholesterol (HDLch, LDL cholesterol (LDLch and VLDL cholesterol (VLDLch levels were estimated. Fifteen (56% patients showed significant lipoprotein abnormalities. Renal allograft recipients showed significantly lower levels of Tch (p < 0.05 and LDLch (p < 0.05 and higher levels of TG (p < 0.005 and HDLch (p < 0.05. Diet and beta blockers did not influence lipoprotein levels. A significant negative correlation was noted between post-transplant duration and Tch, TG and VLDLch levels. Increased TG levels were associated with increase in weight and higher daily prednisolone dosage at the time of evaluation. The study confirms the existence of dyslipoproteinemia in renal allograft recipients.

  2. Renal (Kidney) Manifestations in TSC

    ... International TSC Research Conference Text Size Get Involved RENAL (KIDNEY) MANIFESTATIONS IN TSC Download a PDF of ... sclerosis complex (TSC) will develop some form of renal (kidney) disease during their lifetime. There are three ...

  3. Renal involvement in antiphospholipid syndrome.

    Pons-Estel, Guillermo J; Cervera, Ricard


    Renal involvement can be a serious problem for patients with antiphospholipid syndrome (APS). However, this complication has been poorly recognized and studied. It can be present in patients who have either primary or systemic lupus erythematosus-associated APS. Clinical and laboratory features of renal involvement in APS include hypertension, hematuria, acute renal failure, and progressive chronic renal insufficiency with mild levels of proteinuria that can progress to nephrotic-range proteinuria. The main lesions are renal artery stenosis, venous renal thrombosis, and glomerular lesions (APS nephropathy) that may be acute (thrombotic microangiopathy) and/or chronic (arteriosclerosis, arterial fibrous intimal hyperplasia, tubular thyroidization, arteriolar occlusions, and focal cortical atrophy). APS can also cause end-stage renal disease and allograft vascular thrombosis. This article reviews the range of renal abnormalities associated with APS, and their diagnosis and treatment options.

  4. [Renal transplantation and urinary lithiasis].

    Lechevallier, E; Saussine, C; Traxer, O


    Renal lithiasis in renal donors is rare. A renal stone in a donor, or in a renal transplant, is not a contraindication for harvesting nor transplantation. If possible, the stone must be removed at the time of the transplantation. The risk of lithiasis is increased in the renal transplant recipient, with a frequency of 2-6%. Metabolic abnormalities for lithiasis are frequent and can be induced by the immunosuppressive treatment, anticalcineurins. Lithiasis can have a poor prognosis in the renal recipient with a risk for infection or renal dysfunction. Small (renal transplant can be followed-up. Stones of 0.5-1.5cm need an extracorporeal lithotripsy with a previous safety JJ stent. Stones greater than 1.5cm can be treated by ureteroscopy or percutaneous surgery.

  5. Remote Digital Preoperative Assessments for Cleft Lip and Palate May Improve Clinical and Economic Impact in Global Plastic Surgery.

    Hughes, Christopher; Campbell, Jacob; Mukhopadhyay, Swagoto; McCormack, Susan; Silverman, Richard; Lalikos, Janice; Babigian, Alan; Castiglione, Charles


    Reconstructive surgical care can play a vital role in the resource-poor settings of low- and middle-income countries. Telemedicine platforms can improve the efficiency and effectiveness of surgical care. The purpose of this study is to determine whether remote digital video evaluations are reliable in the context of a short-term plastic surgical intervention. The setting for this study was a district hospital located in Latacunga, Ecuador. Participants were 27 consecutive patients who presented for operative repair of cleft lip and palate. We calculated kappa coefficients for reliability between in-person and remote digital video assessments for the classification of cleft lip and palate between two separate craniofacial surgeons. We hypothesized that the technology would be a reliable method of preoperative assessment for cleft disease. Of the 27 (81.4%) participants, 22 received operative treatment for their cleft disorder. Mean age was 11.1 ± 8.3 years. Patients presented with a spectrum of disorders, including cleft lip (24 of 27, 88.9%), cleft palate (19 of 27, 70.4%), and alveolar cleft (19 of 27, 70.4%). We found a 95.7% agreement between observers for cleft lip with substantial reliability (κ = .78, P cleft palate, with a moderate interrater reliability (κ = .55, P = .01). We found only a 47.8% agreement between observers for alveolar cleft with a nonsignificant, weak kappa agreement (κ = .06, P = .74). Remote digital assessments are a reliable way to preoperatively diagnose cleft lip and palate in the context of short-term plastic surgical interventions in low- and middle-income countries. Future work will evaluate the potential for real-time, telemedicine assessments to reduce cost and improve clinical effectiveness in global plastic surgery.

  6. Renal denervation and hypertension.

    Schlaich, Markus P; Krum, Henry; Sobotka, Paul A; Esler, Murray D


    Essential hypertension remains one of the biggest challenges in medicine with an enormous impact on both individual and society levels. With the exception of relatively rare monogenetic forms of hypertension, there is now general agreement that the condition is multifactorial in nature and hence requires therapeutic approaches targeting several aspects of the underlying pathophysiology. Accordingly, all major guidelines promote a combination of lifestyle interventions and combination pharmacotherapy to reach target blood pressure (BP) levels in order to reduce overall cardiovascular risk in affected patients. Although this approach works for many, it fails in a considerable number of patients for various reasons including drug-intolerance, noncompliance, physician inertia, and others, leaving them at unacceptably high cardiovascular risk. The quest for additional therapeutic approaches to safely and effectively manage hypertension continues and expands to the reappraisal of older concepts such as renal denervation. Based on the robust preclinical and clinical data surrounding the role of renal sympathetic nerves in various aspects of BP control very recent efforts have led to the development of a novel catheter-based approach using radiofrequency (RF) energy to selectively target and disrupt the renal nerves. The available evidence from the limited number of uncontrolled hypertensive patients in whom renal denervation has been performed are auspicious and indicate that the procedure has a favorable safety profile and is associated with a substantial and presumably sustained BP reduction. Although promising, a myriad of questions are far from being conclusively answered and require our concerted research efforts to explore the full potential and possible risks of this approach. Here we briefly review the science surrounding renal denervation, summarize the current data on safety and efficacy of renal nerve ablation, and discuss some of the open questions that need

  7. Renal Artery Stent Outcomes

    Murphy, Timothy P.; Cooper, Christopher J.; Matsumoto, Alan H.; Cutlip, Donald E.; Pencina, Karol M.; Jamerson, Kenneth; Tuttle, Katherine R.; Shapiro, Joseph I.; D’Agostino, Ralph; Massaro, Joseph; Henrich, William; Dworkin, Lance D.


    BACKGROUND Multiple randomized clinical trials comparing renal artery stent placement plus medical therapy with medical therapy alone have not shown any benefit of stent placement. However, debate continues whether patients with extreme pressure gradients, stenosis severity, or baseline blood pressure benefit from stent revascularization. OBJECTIVES The study sought to test the hypothesis that pressure gradients, stenosis severity, and/or baseline blood pressure affects outcomes after renal artery stent placement. METHODS Using data from 947 patients with a history of hypertension or chronic kidney disease from the largest randomized trial of renal artery stent placement, the CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) study, we performed exploratory analyses to determine if subsets of patients experienced better outcomes after stent placement than the overall cohort. We examined baseline stenosis severity, systolic blood pressure, and translesion pressure gradient (peak systolic and mean) and performed interaction tests and Cox proportional hazards analyses for the occurrence of the primary endpoint through all follow-up, to examine the effect of these variables on outcomes by treatment group. RESULTS There were no statistically significant differences in outcomes based on the examined variables nor were there any consistent nonsignificant trends. CONCLUSIONS Based on data from the CORAL randomized trial, there is no evidence of a significant treatment effect of the renal artery stent procedure compared with medical therapy alone based on stenosis severity, level of systolic blood pressure elevation, or according to the magnitude of the transstenotic pressure gradient. (Benefits of Medical Therapy Plus Stenting for Renal Atherosclerotic Lesions [CORAL]; NCT00081731) PMID:26653621

  8. Preoperative parathyroid gland localization with technetium-99m sestamibi in secondary hyperparathyroidism

    Pons, F.; Vidal-Sicart, S.; Fuster, D.; Herranz, R. [Department of Nuclear Medicine, Hospital Clinic, University of Barcelona (Spain); Torregrosa, J.V. [Unit of Renal Transplant, Hospital Clinic, Barcelona (Spain); Sabater, L.; Fernandez-Cruz, L. [Department of Surgery, Hospital Clinic, Barcelona (Spain)


    Technetium-99m sestamibi scintigraphy has become a valuable tool in locating parathyroid glands in patients with primary hyperparathyroidism. The aim of this study was to evaluate its usefulness in secondary hyperparathyroidism. Twenty patients were injected intravenously with 740 MBq of {sup 99m}Tc-sestamibi and images were obtained at 15 min and 2 h post injection. All patients underwent parathyroid ultrasonography (US) as well as bilateral surgical neck exploration and 64 parathyroid glands were removed. US revealed at least one enlarged gland in 15/20 patients (75%), while {sup 99m}Tc-sestamibi scintigraphy showed focal areas of increased uptake in at least one gland in 17/20 patients (85%). When imaging results for all glands were evaluated according to surgical results, sensitivity was 54% for parathyroid scintigraphy and 41% for US, and specificity was 89% for both imaging techniques. There was a discrepancy between the two imaging modalities in 28 glands (35%). The mean surgical weight of US-positive glands (1492{+-}1436 mg) was significantly higher than that of US-negative glands (775{+-}703 mg) (P<0.05). However, there were no significant differences in weight between sestamibi-positive and sestamibi-negative glands. When only sestamibi-positive glands were considered, a positive correlation between uptake and weight was found (r=0.4, P<0.05). In conclusion, parathyroid US and {sup 99m}Tc-sestamibi scintigraphy are complementary imaging techniques in the preoperative localization of abnormal parathyroid glands in patients with secondary hyperparathyroidism. The limited sensitivity of the techniques means that patients will still require bilateral neck exploration; therefore routine preoperative parathyroid scanning in renal patients is not justified. (orig.) With 3 figs., 2 tabs., 22 refs.

  9. Reliable Electronic Equipment

    N. A. Nayak


    Full Text Available The reliability aspect of electronic equipment's is discussed. To obtain optimum results, close cooperation between the components engineer, the design engineer and the production engineer is suggested.

  10. Reliability prediction techniques

    Whittaker, B.; Worthington, B.; Lord, J.F.; Pinkard, D.


    The paper demonstrates the feasibility of applying reliability assessment techniques to mining equipment. A number of techniques are identified and described and examples of their use in assessing mining equipment are given. These techniques include: reliability prediction; failure analysis; design audit; maintainability; availability and the life cycle costing. Specific conclusions regarding the usefulness of each technique are outlined. The choice of techniques depends upon both the type of equipment being assessed and its stage of development, with numerical prediction best suited for electronic equipment and fault analysis and design audit suited to mechanical equipment. Reliability assessments involve much detailed and time consuming work but it has been demonstrated that the resulting reliability improvements lead to savings in service costs which more than offset the cost of the evaluation.

  11. Randomised controlled trial comparing oral and intravenous paracetamol (acetaminophen) plasma levels when given as preoperative analgesia.

    van der Westhuizen, J; Kuo, P Y; Reed, P W; Holder, K


    Gastric absorption of oral paracetamol (acetaminophen) may be unreliable perioperatively in the starved and stressed patient. We compared plasma concentrations of parenteral paracetamol given preoperatively and oral paracetamol when given as premedication. Patients scheduled for elective ear; nose and throat surgery or orthopaedic surgery were randomised to receive either oral or intravenous paracetamol as preoperative medication. The oral dose was given 30 minutes before induction of anaesthesia and the intravenous dose given pre-induction. All patients were given a standardised anaesthetic by the same specialist anaesthetist who took blood for paracetamol concentrations 30 minutes after the first dose and then at 30 minute intervals for 240 minutes. Therapeutic concentrations of paracetamol were reached in 96% of patients who had received the drug parenterally, and 67% of patients who had received it orally. Maximum median plasma concentrations were 19 mg.l(-1) (interquartile range 15 to 23 mg.l(-1)) and 13 mg.l(-1) (interquartile range 0 to 18 mg.l(-1)) for the intravenous and oral group respectively. The difference between intravenous and oral groups was less marked after 150 minutes but the intravenous preparation gave higher plasma concentrations throughout the study period. It can be concluded that paracetamol gives more reliable therapeutic plasma concentrations when given intravenously.

  12. Image-guided preoperative prediction of pyramidal tract side effect in deep brain stimulation

    Baumgarten, C.; Zhao, Y.; Sauleau, P.; Malrain, C.; Jannin, P.; Haegelen, C.


    Deep brain stimulation of the medial globus pallidus is a surgical procedure for treating patients suffering from Parkinson's disease. Its therapeutic effect may be limited by the presence of pyramidal tract side effect (PTSE). PTSE is a contraction time-locked to the stimulation when the current spreading reaches the motor fibers of the pyramidal tract within the internal capsule. The lack of side-effect predictive model leads the neurologist to secure an optimal electrode placement by iterating clinical testing on an awake patient during the surgical procedure. The objective of the study was to propose a preoperative predictive model of PTSE. A machine learning based method called PyMAN (for Pyramidal tract side effect Model based on Artificial Neural network) that accounted for the current of the stimulation, the 3D electrode coordinates and the angle of the trajectory, was designed to predict the occurrence of PTSE. Ten patients implanted in the medial globus pallidus have been tested by a clinician to create a labeled dataset of the stimulation parameters that trigger PTSE. The kappa index value between the data predicted by PyMAN and the labeled data was .78. Further evaluation studies are desirable to confirm whether PyMAN could be a reliable tool for assisting the surgeon to prevent PTSE during the preoperative planning.

  13. [The preoperative staging of rectal neoplasms: the clinical exam and diagnostic imaging].

    Grande, M; Danza, F M


    The management of rectal cancer remains an important clinical problem. Although there was been great progress in surgical management, the survival of patients with locally advanced disease has not improved significantly during the past decades. Preoperative staging and evaluation of the risk of recurrence may help in the choice of operation. It is difficult for clinicians to quantify reliably with digital examination the degree of fixation of the tumor, and they usually cannot distinguish nodal metastases except in advanced cases. The more frequent overstaging of small tumors within one quadrant of the rectum is a major drawback of digital examination. Computed tomography and magnetic resonance seems to underestimate the extension of rectal tumors, but both can be helpful in selecting patients with advanced tumors for whom preoperative adjuvant treatment is being considered. Endoluminal ultrasound is superior in staging tumors confined to the rectal wall, but is not the ideal tool for staging: the results are examiner dependent, the field of vision in depth is limited, and stricturing tumors cannot be passed by the ultrasound transducer. Imaging diagnostic attendibility confirms the preeminent role of intraoperative exploration in the assessment of neoplastic diffusion in order to plan a correct surgical treatment.

  14. Renal Failure in Pregnancy.

    Balofsky, Ari; Fedarau, Maksim


    Renal failure during pregnancy affects both mother and fetus, and may be related to preexisting disease or develop secondary to diseases of pregnancy. Causes include hypovolemia, sepsis, shock, preeclampsia, thrombotic microangiopathies, and renal obstruction. Treatment focuses on supportive measures, while pharmacologic treatment is viewed as second-line therapy, and is more useful in mitigating harmful effects than treating the underlying cause. When supportive measures and pharmacotherapy prove inadequate, dialysis may be required, with the goal being to prolong pregnancy until delivery is feasible. Outcomes and recommendations depend primarily on the underlying cause.

  15. Renal lithiasis and nutrition.

    Grases, Felix; Costa-Bauza, Antonia; Prieto, Rafel M


    Renal lithiasis is a multifactorial disease. An important number of etiologic factors can be adequately modified through diet, since it must be considered that the urine composition is directly related to diet. In fact, the change of inappropriate habitual diet patterns should be the main measure to prevent kidney stones. In this paper, the relation between different dietary factors (liquid intake, pH, calcium, phosphate, oxalate, citrate, phytate, urate and vitamins) and each type of renal stone (calcium oxalate monohydrate papillary, calcium oxalate monohydrate unattached, calcium oxalate dihydrate, calcium oxalate dihydrate/hydroxyapatite, hydroxyapatite, struvite infectious, brushite, uric acid, calcium oxalate/uric acid and cystine) is discussed.

  16. Pediatric Renal Neoplasms.

    Ranganathan, Sarangarajan


    Renal tumors in childhood consist of a diverse group of tumors ranging from the most common Wilms' tumor, to the uncommon and often fatal rhabdoid tumor. Diagnosis is based on morphologic features and aided by ancillary techniques such as immunohistochemistry and cytogenetics. Molecular techniques have helped identify a group of pediatric renal cell carcinomas that have specific translocations, called translocation-associated carcinomas. Differential diagnosis of the various tumors is discussed. Pathogenesis and nephroblastomatosis, the precursor lesions of Wilms tumor, also are discussed briefly, as are the handling of these tumor specimens and prognostic factors. Copyright © 2009 Elsevier Inc. All rights reserved.

  17. Gravidez e transplante renal

    Andrade, Joana Rita Ferreira


    Enquadramento: A gravidez é rara em mulheres com Doença Renal Crónica, sobretudo em estadio avançado, em virtude de várias condicionantes como a disfunção ovárica, hemorragias vaginais anovulatórias e amenorreia. Contudo, após transplante renal é possível alimentar o sonho de constituir família, mas é preciso considerar os riscos aumentados para o enxerto e a maior susceptibilidade para complicações da gravidez. Objectivo: Avaliar os riscos e identificar as variáveis que influenciam o suce...

  18. Renal lithiasis and nutrition

    Prieto Rafel M


    Full Text Available Abstract Renal lithiasis is a multifactorial disease. An important number of etiologic factors can be adequately modified trough diet, since it must be considered that the urine composition is directly related to diet. In fact, the change of inappropriate habitual diet patterns should be the main measure to prevent kidney stones. In this paper, the relation between different dietary factors (liquid intake, pH, calcium, phosphate, oxalate, citrate, phytate, urate and vitamins and each type of renal stone (calcium oxalate monohydrate papillary, calcium oxalate monohydrate unattached, calcium oxalate dihydrate, calcium oxalate dihydrate/hydroxyapatite, hydroxyapatite, struvite infectious, brushite, uric acid, calcium oxalate/uric acid and cystine is discussed.

  19. The rating reliability calculator

    Solomon David J


    Full Text Available Abstract Background Rating scales form an important means of gathering evaluation data. Since important decisions are often based on these evaluations, determining the reliability of rating data can be critical. Most commonly used methods of estimating reliability require a complete set of ratings i.e. every subject being rated must be rated by each judge. Over fifty years ago Ebel described an algorithm for estimating the reliability of ratings based on incomplete data. While his article has been widely cited over the years, software based on the algorithm is not readily available. This paper describes an easy-to-use Web-based utility for estimating the reliability of ratings based on incomplete data using Ebel's algorithm. Methods The program is available public use on our server and the source code is freely available under GNU General Public License. The utility is written in PHP, a common open source imbedded scripting language. The rating data can be entered in a convenient format on the user's personal computer that the program will upload to the server for calculating the reliability and other statistics describing the ratings. Results When the program is run it displays the reliability, number of subject rated, harmonic mean number of judges rating each subject, the mean and standard deviation of the averaged ratings per subject. The program also displays the mean, standard deviation and number of ratings for each subject rated. Additionally the program will estimate the reliability of an average of a number of ratings for each subject via the Spearman-Brown prophecy formula. Conclusion This simple web-based program provides a convenient means of estimating the reliability of rating data without the need to conduct special studies in order to provide complete rating data. I would welcome other researchers revising and enhancing the program.

  20. Reliability of power connections

    BRAUNOVIC Milenko


    Despite the use of various preventive maintenance measures, there are still a number of problem areas that can adversely affect system reliability. Also, economical constraints have pushed the designs of power connections closer to the limits allowed by the existing standards. The major parameters influencing the reliability and life of Al-Al and Al-Cu connections are identified. The effectiveness of various palliative measures is determined and the misconceptions about their effectiveness are dealt in detail.

  1. Effect of preoperative biliary drainage on outcome of classical pancreaticoduodenectomy

    Chandra Shekhar Bhati; Chandrashekhar Kubal; Pankaj Kumar Sihag; Ankur Atal Gupta; Raj Kamal Jenav; Nicholas G Inston; Jagdish M Mehta


    AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticodu odenectomy.METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted.RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable.CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy.

  2. Upper airway imaging and its role in preoperative airway evaluation

    Jagadish G Sutagatti


    Full Text Available Ultrasonography (USG is well-known as a fast, safe, and noninvasive technique. Its application for imaging of the airway is now gaining momentum. The upper airway has a complex anatomy, and its assessment forms a vital part of every preanesthetic evaluation. Ultrasound (US imaging can help in upper airway assessment in the preoperative period. There are various approaches to upper airway USG. The technique has its own advantages, disadvantages, and limitations. This simple yet challenging imaging technique is all set to become an important part of routine preoperative airway evaluation. This article reviews the various approaches to upper airway US imaging, interpretation of the images, limitations, and disadvantages of the technique and its varied clinical applications in the preoperative period. The scientific material presented here was hand searched from textbooks and journals, electronically from PubMed, and Google scholar using text words.

  3. Pancreatic Somatostatinoma Diagnosed Preoperatively: Report of a Case

    Yasuhisa Mori


    Full Text Available Context Somatostatinoma is a rare neoplasm of the pancreas. Preoperative diagnosis is often difficult. Case report We report a 72-year-old woman with a pancreatic head tumor measuring 37 mm in diameter, and enlargement of the lymphnodes on the anterior surface of the pancreatic head and the posterior surface of the horizontal part of the duodenum.Laboratory data showed an elevated plasma somatostatin concentration. Examination of a biopsy specimen of thepancreatic head mass obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA showedhistopathological features of a neuroendocrine tumor. Immunohistochemical staining showed that the tumor cells werepositive for somatostatin, leading to a preoperative diagnosis of pancreatic somatostatinoma. The patient underwentpylorus-preserving pancreaticoduodenectomy. The plasma somatostatin concentration decreased progressively aftersurgery. Conclusions A rare case of pancreatic somatostatinoma with lymph node metastases was presented.Immunohistochemical analysis of a biopsy specimen obtained by EUS-FNA was useful for preoperative diagnosis.


    Gao Jiechun; Dong Kuiran; Jing Baixiang


    Objective: To study the significance of preoperative chemotherapy for the treatment of neurogenic tumor in children. Methods: VMA, MYCN gene and DNA content of 21 cases of neuroblastoma treated with preoperative chemotherapy were studied with a control group. Results: Resection rate was 95.5%. Mean survival time was 28.1±10.2 months, which was significantly higher than the control group (8.8±6.8 months, P<0.01).Post chemotherapeutic VMA was lower. DNA index was also reduced and the percentage of cells in G0+G1 phases was elevated. The MYCN expression was suppressed.Conclusion: Preoperative chemotherapy can induce the apoptosis of neurogenic tumor cells and inhibit its proliferative activity.

  5. Indications of laparoscopic cholecystectomy based on preoperative imaging findings

    Wakizaka, Yoshitaka; Sano, Syuichi; Nakanishi, Yoshimi; Koike, Yoshinobu; Ozaki, Susumu; Iwanaga, Rikizo (Sapporo City General Hospital (Japan)); Uchino, Junichi


    We studied the indications for laparoscopic cholecystectomy (LC) and values of preoperative imaging findings in 82 patients who underwent preoperative imaging diagnostic tests (abdominal echogram, abdominal CAT scan, ERCP). We analyzed mainly patients who were considered to be indicated for LC but whose gallbladders could be removed by open laparotomy, or whose gallbladders were removed by open laparotomy but were considered indicated for LC from retrospective study. We found the following results. LC could be easily performed in patients with a history of severe acute cholecystitis if they had no findings of a thickened wall or negative gallbladder signs. Abdominal echogram and CAT scan were the best preoperative imaging tests for determining the gallbladder's state, especially for obstruction of the cystic duct. These results are important today when the operative indications of LC are extremely indefinite because of the accumulation of operative experience and technological improvements. (author).

  6. Multidisciplinary System Reliability Analysis

    Mahadevan, Sankaran; Han, Song; Chamis, Christos C. (Technical Monitor)


    The objective of this study is to develop a new methodology for estimating the reliability of engineering systems that encompass multiple disciplines. The methodology is formulated in the context of the NESSUS probabilistic structural analysis code, developed under the leadership of NASA Glenn Research Center. The NESSUS code has been successfully applied to the reliability estimation of a variety of structural engineering systems. This study examines whether the features of NESSUS could be used to investigate the reliability of systems in other disciplines such as heat transfer, fluid mechanics, electrical circuits etc., without considerable programming effort specific to each discipline. In this study, the mechanical equivalence between system behavior models in different disciplines are investigated to achieve this objective. A new methodology is presented for the analysis of heat transfer, fluid flow, and electrical circuit problems using the structural analysis routines within NESSUS, by utilizing the equivalence between the computational quantities in different disciplines. This technique is integrated with the fast probability integration and system reliability techniques within the NESSUS code, to successfully compute the system reliability of multidisciplinary systems. Traditional as well as progressive failure analysis methods for system reliability estimation are demonstrated, through a numerical example of a heat exchanger system involving failure modes in structural, heat transfer and fluid flow disciplines.

  7. Sensitivity Analysis of Component Reliability



    In a system, Every component has its unique position within system and its unique failure characteristics. When a component's reliability is changed, its effect on system reliability is not equal. Component reliability sensitivity is a measure of effect on system reliability while a component's reliability is changed. In this paper, the definition and relative matrix of component reliability sensitivity is proposed, and some of their characteristics are analyzed. All these will help us to analyse or improve the system reliability.

  8. Branchio-oto-renal syndrome.

    Jalil, Jawad; Basheer, Faisal; Shafique, Mobeen


    The association of branchial arch anomalies (branchial cysts, branchial fistulas), hearing loss and renal anomalies constitutes the branchio-oto-renal (BOR) syndrome also known as Melnick Fraser syndrome. We present a case of this rare disorder in a girl child who presented with profound deafness, preauricular pits, branchial sinuses and renal hypoplasia.

  9. Drug-induced renal disease.

    Curtis, J R


    The clinical manifestations of drug-induced renal disease may include all the manifestations attributed to natural or spontaneous renal diseases such as acute renal failure, chronic renal failure, acute nephritic syndrome, renal colic, haematuria, selective tubular defects, obstructive nephropathy, etc. It is therefore vital in any patient with renal disease whatever the clinical manifestations might be, to obtain a meticulous drug and toxin inventory. Withdrawal of the offending drug may result in amelioration or cure of the renal disorder although in the case of severe renal failure it may be necessary to utilise haemodialysis or peritoneal dialysis to tide the patient over the period of acute renal failure. Analgesic nephropathy is an important cause of terminal chronic renal failure and it is therefore vital to make the diagnosis as early as possible. The pathogenesis of some drug-induced renal disorders appears to be immunologically mediated. There are many other pathogenetic mechanisms involved in drug-induced renal disorders and some drugs may under appropriate circumstances be responsible for a variety of different nephrotoxic effects. For example, the sulphonamides have been incriminated in examples of crystalluria, acute interstitial nephritis, acute tubular necrosis, generalised hypersensitivity reactions, polyarteritis nodosa and drug-induced lupus erythematosus.

  10. Management of chronic renal failure.

    de Zeeuw, D.; Apperloo, AJ; de Jong, P.


    There is growing evidence that treatment of patients with renal function impairment will undergo a major shift within the next few years. Along with more or less successful attempts to alleviate the signs and symptoms of reduced renal function, new insights into renal pathophysiology as well as new

  11. Creatinine-based estimation of rate of long term renal function loss in lung transplant recipients. Which method is preferable?

    Broekroelofs, J; Stegeman, CA; Navis, GJ; de Haan, J; van der Bij, W; de Zeeuw, D; de Jong, PE


    Background: Progressive renal function loss during long-term follow up is common after lung transplantation and close monitoring is warranted, Since changes in creatinine generation and excretion may occur after lung transplantation, the reliability of creatinine-based methods of renal function asse

  12. [Renal replacement therapy by hemodialysis in Constantine (Algeria)].

    Bouhabel, Abdelouahab; Laib, Zoheir; Hannache, Kamel; Aberkane, Abdelhamid


    End-stage renal failure is considered a public heath problem that constitutes a heavy cost on communities worldwide. To be able to plan the treatment of this pathology, we must have reliable and updated information through health network which represents the best mean for planning and reflexion locally and nationwide. The aim of our study was to answer to this need through a local registry of renal replacement therapy and nephrology network that we have for the first time an inventory of this pathology in an Algerian town (Constantine), and in this article we present the first results concerning patients under chronic hemodialysis.

  13. Preoperative predictors of weight loss following bariatric surgery: systematic review.

    Livhits, Masha; Mercado, Cheryl; Yermilov, Irina; Parikh, Janak A; Dutson, Erik; Mehran, Amir; Ko, Clifford Y; Gibbons, Melinda Maggard


    Obesity affects 32% of adults in the USA. Surgery generates substantial weight loss, but 20-30% fails to achieve successful weight loss. Our objective was to identify preoperative psychosocial factors associated with weight loss following bariatric surgery. We performed a literature search of PubMed® and the Cochrane Database of Reviews of Effectiveness between 1988 and April 2010. Articles were screened for bariatric surgery and weight loss if they included a preoperative predictor of weight loss: body mass index (BMI), preoperative weight loss, eating disorders, or psychiatric disorder/substance abuse. One thousand seven titles were reviewed, 534 articles screened, and 115 included in the review. Factors that may be positively associated with weight loss after surgery include mandatory preoperative weight loss (7 of 14 studies with positive association). Factors that may be negatively associated with weight loss include preoperative BMI (37 out of 62 studies with negative association), super-obesity (24 out of 33 studies), and personality disorders (7 out of 14 studies). Meta-analysis revealed a decrease of 10.1% excess weight loss (EWL) for super-obese patients (95% confidence interval (CI) [3.7-16.5%]), though there was significant heterogeneity in the meta-analysis, and an increase of 5.9% EWL for patients with binge eating at 12 months after surgery (95% CI [1.9-9.8%]). Further studies are necessary to investigate whether preoperative factors can predict a clinically meaningful difference in weight loss after bariatric surgery. The identification of predictive factors may improve patient selection and help develop interventions targeting specific needs of patients.

  14. Preoperative antibiotics for septic arthritis in children: delay in diagnosis.

    MacLean, Simon B M; Timmis, Christopher; Evans, Scott; Lawniczak, Dominik; Nijran, Amit; Bache, Edward


    To review the records of 50 children who underwent open joint washout for septic arthritis with (n=25) or without (n=25) preoperative antibiotics. Records of 50 children who underwent open joint washout for presumed septic arthritis with (n=25) or without (n=25) preoperative antibiotics were reviewed. 17 boys and 8 girls aged 3 weeks to 16 years (median, 1.5 years) who were prescribed preoperative antibiotics before joint washout were compared with 12 boys and 13 girls aged one month to 14 years (median, 2 years) who were not. Following arthrotomy and washout, all patients were commenced on high-dose intravenous antibiotics. Patients were followed up for 6 to 18 months until asymptomatic. Patients who were referred from places other than our emergency department were twice as likely to have been prescribed preoperative antibiotics (p=0.0032). Patients prescribed preoperative antibiotics had a longer median (range) time from symptom onset to joint washout (8 [2-23] vs. 4 [1-29] days, p=0.05) and a higher mean erythrocyte sedimentation rate (93.1 vs. 54.3 mm/h, p=0.023) at presentation. Nonetheless, the 2 groups were comparable for weight bearing status, fever, and positive culture, as well as the mean (range) duration of antibiotic treatment (4.9 [4-7] vs. 4.7 [1-8] weeks, p=0.586). Preoperative antibiotics should be avoided in the management of septic arthritis in children. Their prescription delays diagnosis and definitive surgery, and leads to additional washouts and complications. A high index of suspicion and expedite referral to a specialist paediatric orthopaedic unit is needed if septic arthritis is suspected.

  15. Assessment of patient satisfaction with the preoperative anesthetic evaluation

    Gebremedhn EG


    Full Text Available Endale Gebreegziabher Gebremedhn, Vidhya Nagaratnam Department of Anesthesia, School of Medicine, Gondar College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Background: The evaluation of patient satisfaction is a core aspect of the continuous quality improvement in anesthesia service that can be affected by the preoperative anesthetist visit. This visit enables the anesthetist to know about the patient's general health status and the nature of surgery, to choose the type of anesthesia, and to discuss perioperative complications and their management with the patient. Patients have sometimes complained about the information given during the preoperative anesthetic evaluation in the University of Gondar teaching and referral hospital. The aim of this study was to determine the level of patient satisfaction with the preoperative anesthetist visit. Methods: A cross-sectional study was conducted from February 15 to April 15, 2013. All consecutive elective patients who were operated upon under anesthesia during the study period were interviewed 24 hours after operation. A pretested questionnaire and checklists, which were developed based on the hospital's anesthetic evaluation sheet, were used for data collection. Results: A total of 116 elective patients were operated upon under anesthesia during the study period. Of these, 102 patients were included in our study, with a response rate of 87.9%. Anesthetists introduced themselves to ~24% patients; provided information about anesthesia to ~32%, postoperative complications to ~21%, postoperative analgesia to ~18, and postoperative nausea and vomiting to ~21%; and spent adequate time with ~74%. Patients' questions were answered by the anesthetist in ~65% of cases, and ~65% of patients had reduced anxiety after the anesthetist visit. The patients' overall satisfaction with the preoperative anesthetist visit was ~65%. Conclusion and recommendation: Patient satisfaction with the

  16. Analysis of estrogen and progesterone receptors on preoperative fine-needle aspirates.

    Frigo, B; Pilotti, S; Zurrida, S; Ermellino, L; Manzari, A; Rilke, F


    For 56 cases of carcinoma of the breast, results of the immunocytochemical assay for estrogen and progesterone receptors performed on preoperative fine-needle aspirates were compared with those obtained on scraping material from the same tumors. The value and usefulness of this last analysis was demonstrated in a previous study. The level of agreement between the two cytological techniques was assessed by the k statistic. A high level of agreement was found, with k values of 0.909 and 0.889 for estrogen and progesterone receptors, respectively. The results reported here revealed the reliability of steroid receptor determination on fine-needle aspiration biopsies, provided that sufficient cellularity was available. This technique can replace the open biopsy procedure, in as much as it represents a rapid, almost painless, and easily repeated method for the assessment of the receptor status, and is useful for treatment decisions at any time during the course of the disease.

  17. Preoperative evaluation of synchronous colorectal cancer using MR colonography

    Achiam, Michael P; Andersen, Lars Peter Holst; Klein, Mads


    it is noninvasive, and most of the colon can be evaluated. Furthermore, it has higher patient acceptance, and no sedation or radiation is used. The purpose of this study was to determine the feasibility of performing MRC preoperatively in an everyday clinical situation in a group of patients who were not offered......RATIONALE AND OBJECTIVES: It is well known that synchronous cancers (incidence, 2%-11%) and polyps (incidence, 12%-58%) occur in patients with colorectal cancer. Magnetic resonance colonography (MRC) seems like the obvious choice as a diagnostic tool in preoperative evaluation, because...

  18. [Importance of preoperative and intraoperative imaging for operative strategies].

    Nitschke, P; Bork, U; Plodeck, V; Podlesek, D; Sobottka, S B; Schackert, G; Weitz, J; Kirsch, M


    Recent advances in preoperative and postoperative imaging have an increasing influence on surgical decision-making and make more complex surgical interventions possible. This improves the possibilities for frequently occurring challenges and promoting improved functional and oncological outcome. This manuscript reviews the role of preoperative and intraoperative imaging in surgery. Various techniques are explained based on examples from hepatobiliary surgery and neurosurgery, in particular real-time procedures, such as the online use of augmented reality and in vivo fluorescence, as well as new and promising optical techniques including imaging of intrinsic signals and vibrational spectroscopy.

  19. [Hypertension and renal disease

    Kamper, A.L.; Pedersen, E.B.; Strandgaard, S.


    hypertension. Mild degrees of chronic kidney disease (CKD) can be detected in around 10% of the population, and detection is important as CKD is an important risk factor for atherosclerotic cardiovascular disease. Conversely, heart failure may cause an impairment of renal function. In chronic progressive...

  20. Insuficiencia renal aguda.

    Carlos Hernán Mejía


    Full Text Available La insuficiencia renal aguda se diagnostica aproximadamente en 5% de los pacientes hospitalizados. Sus principales causas se relacionan con la alteración del flujo sanguíneo renal, sea por depleción de volumen, baja perfusión renal o por distribución intrarrenal inadecuada y obstrucción del árbol urinario. El diagnóstico parte de la historia clínica y un buen examen físico que corrobore el estado de volemia del paciente y se complementa con el uso adecuado de los índices urinarios (excreción de sodio y osmolaridad, el uroanálisis y la ecografía renal. Su tratamiento consiste en una adecuada recuperación del volumen, manejo de los diuréticos, soporte nutricional, conservación del equilibrio hidroelectrolítico y brindar terapia de diálisis si hay toxicidad urémica, hipercaliemia severa (>6.5 mEq/l, acidosis metabólica o sobrecarga severa de volumen.

  1. Management of Renal Cysts

    Nalbant, Ismail; Can Sener, Nevzat; Firat, Hacer; Yeşil, Süleyman; Zengin, Kürşad; Yalcınkaya, Fatih; Imamoglu, Abdurrahim


    Background and Objectives: Renal cysts have a high prevalence in the general population, and their estimated incidence increases with age. Renal cyst aspiration (usually with sclerotherapy) or open/laparoscopic decortication is a generally effective and safe method in the treatment of symptomatic simple renal cysts. The success rates of laparoscopic decortication and percutaneous aspiration-sclerotherapy were compared to assist in the decision making for the procedure. Methods: A total of 184 patients with symptomatic simple renal cysts were treated with either laparoscopic decortication in 149 cases or percutaneous aspiration-sclerotherapy in 35 cases. The follow-up period was approximately 35 months, and the symptomatic and radiologic success rates of the 2 techniques were compared retrospectively. Results: Laparoscopic decortication was found to have high success rates, a low recurrence rate, and minimal morbidity. Percutaneous aspiration-sclerotherapy is an outpatient procedure with a minimally higher recurrence rate. Conclusion: When a symptomatic cyst is encountered and treatment of the cyst is indicated, laparoscopic decortication is a more efficient method that offers better results than percutaneous aspiration-sclerotherapy. PMID:25848184

  2. Rupture of Renal Transplant

    Shona Baker


    Full Text Available Background. Rupture of renal allograft is a rare and serious complication of transplantation that is usually attributed to acute rejection, acute tubular necrosis, or renal vein thrombosis. Case Presentation. LD, a 26-year-old male with established renal failure, underwent deceased donor transplantation using kidney from a 50-year-old donor with acute kidney injury (Cr 430 mmol/L. LD had a stormy posttransplant recovery and required exploration immediately for significant bleeding. On day three after transplant, he developed pain/graft swelling and another significant haemorrhage with cardiovascular compromise which did not respond to aggressive resuscitation. At reexploration, the renal allograft was found to have a longitudinal rupture and was removed. Histology showed features of type IIa Banff 97 acute vascular rejection, moderate arteriosclerosis, and acute tubular necrosis. Conclusion. Possible ways of avoiding allograft rupture include use of well-matched, good quality kidneys; reducing or managing risk factors that would predispose to delayed graft function; ensuring a technically satisfactory transplant procedure with short cold and warm ischemia times; and avoiding large donor-recipient age gradients.

  3. Primary renal graft thrombosis

    Bakir, N; Sluiter, WJ; Ploeg, RJ; van Son, WJ; Tegzess, Adam


    Background. Renal allograft thrombosis is a serious complication of kidney transplantation that ultimately leads to graft loss. Its association with acute and hyperacute rejection is well documented; however, in a large proportion of patients the precise cause remains obscure. The exact incidence an


    Тамаргазін, О. А.; Національний авіаційний університет; Власенко, П. О.; Національний авіаційний університет


    Airline's operational structure for Reliability program implementation — engineering division, reliability  division, reliability control division, aircraft maintenance division, quality assurance division — was considered. Airline's Reliability program structure is shown. Using of Reliability program for reducing costs on aircraft maintenance is proposed. Рассмотрена организационная структура авиакомпании по выполнению Программы надежности - инженерный отдел, отделы по надежности авиацио...

  5. Ultra reliability at NASA

    Shapiro, Andrew A.


    Ultra reliable systems are critical to NASA particularly as consideration is being given to extended lunar missions and manned missions to Mars. NASA has formulated a program designed to improve the reliability of NASA systems. The long term goal for the NASA ultra reliability is to ultimately improve NASA systems by an order of magnitude. The approach outlined in this presentation involves the steps used in developing a strategic plan to achieve the long term objective of ultra reliability. Consideration is given to: complex systems, hardware (including aircraft, aerospace craft and launch vehicles), software, human interactions, long life missions, infrastructure development, and cross cutting technologies. Several NASA-wide workshops have been held, identifying issues for reliability improvement and providing mitigation strategies for these issues. In addition to representation from all of the NASA centers, experts from government (NASA and non-NASA), universities and industry participated. Highlights of a strategic plan, which is being developed using the results from these workshops, will be presented.

  6. Photovoltaic module reliability workshop

    Mrig, L. (ed.)


    The paper and presentations compiled in this volume form the Proceedings of the fourth in a series of Workshops sponsored by Solar Energy Research Institute (SERI/DOE) under the general theme of photovoltaic module reliability during the period 1986--1990. The reliability Photo Voltaic (PV) modules/systems is exceedingly important along with the initial cost and efficiency of modules if the PV technology has to make a major impact in the power generation market, and for it to compete with the conventional electricity producing technologies. The reliability of photovoltaic modules has progressed significantly in the last few years as evidenced by warranties available on commercial modules of as long as 12 years. However, there is still need for substantial research and testing required to improve module field reliability to levels of 30 years or more. Several small groups of researchers are involved in this research, development, and monitoring activity around the world. In the US, PV manufacturers, DOE laboratories, electric utilities and others are engaged in the photovoltaic reliability research and testing. This group of researchers and others interested in this field were brought together under SERI/DOE sponsorship to exchange the technical knowledge and field experience as related to current information in this important field. The papers presented here reflect this effort.

  7. ``Aggressive`` renal angiomyolipoma

    Cittadini, G. Jr. [Univ. of Genoa (Italy). Dept. of Radiology; Pozzi Mucelli, F. [Univ. of Trieste (Italy). Dept. of Radiology; Danza, F.M. [Catholic Sacro Cuore Univ., Rome (Italy). Dept. of Radiology; Derchi, L.E. [Univ. of Genoa (Italy). Dept. of Radiology; Pozzi Mucelli, R.S. [Univ. of Trieste (Italy). Dept. of Radiology


    We describe the US and CT examinations of 4 patients with renal angiomyolipoma with an `aggressive` appearance, and review the literature. The imaging findings in 4 patients with benign renal angiomyolipomas associated with thrombosis of the renal vein and/or inferior vena cava are presented. CT demonstrated fat densities within both tumor and thrombus. In one patient, small lymph nodes with low density internal areas were detected in the para-aortic region. When considering our patients together with those reported in the literature, we found that most angiomyolipomas with venous invasion were large and centrally located within the kidney. Venous thrombosis was observed in 9 lesions of the right kidney, and in only 4 of the left one. One patient only had symptoms due to the thrombus; 10 had problems due to the tumor; and 3 were asymptomatic. Only 4 patients with pararenal enlarged lymph nodes have been reported on in the imaging literature. Fat-containing nodes were detected by CT in one case only; the others had enlarged nodes of soft-tissue density. In one patient the diagnosis of hamartomatous lymph node invasion was established by angiography. In patients with renal angiomyolipoma, demonstration of both fatty thrombus and the fatty infiltration of lymph nodes of the renal hilum cannot be regarded as an indication of malignancy, but only of local aggessive behavior. Conservative treatment seems possible. Detection of enlarged lymph nodes of soft tissue density may cause difficult diagnostic problems, with the diagnosis addressed only by the presence of associated lesions. (orig./MG).

  8. American Society of Anesthesiologists Classification Versus ARISCAT Risk Index: Predicting Pulmonary Complications Following Renal Transplant.

    Kupeli, Elif; Er Dedekarginoglu, Balam; Ulubay, Gaye; Oner Eyuboglu, Fusun; Haberal, Mehmet


    Patients with chronic renal failure are prone to pulmonary complications. Renal transplant recipients should undergo complete preoperative evaluation to determine risk of postoperative pulmonary complications. The American Society of Anesthesiologists classification and the Assess Respiratory Risk in Surgical Patients in Catalonia risk index correlate well with incidence of postoperative pulmonary complications. Here, we compared their accuracy in predicting pulmonary complications following renal transplant. We retrospectively reviewed medical records of renal transplant recipients between years 2004 and 2015. We collected patient data on Assess Respiratory Risk in Surgical Patients in Catalonia risk index, including demographics, smoking history, comorbidities, preoperative pulmonary risk score, laboratory results, surgery information, history of lower respiratory tract infection 1 month pretransplant, urgency of surgery, American Society of Anesthesiologists classification, and pulmonary complications within 1 month posttransplant. Of 172 patients (123 males; mean age 38.82 y), 22 (12.8%) developed pulmonary complication during the first month posttransplant, including effusion (9 patients), pneumonia (10 patients), respiratory inefficiency (2 patients), and pulmonary embolism (1 patient). Atelectasis was observed in 95.4% of patients with complications. A positive correlation was observed between age and development of complications (r = 0.171; P = .025). Regarding risk score, 75% of patients at high risk and 19.5% at intermediate risk developed pulmonary complications. Patients with low-risk scores had significantly lower complications than intermediate- and high-risk groups (P Catalonia risk index.

  9. Bariatric Surgery as a Bridge to Renal Transplantation in Patients with End-Stage Renal Disease.

    Al-Bahri, Shadi; Fakhry, Tannous K; Gonzalvo, John Paul; Murr, Michel M


    Obesity is a relative contraindication to organ transplantation. Preliminary reports suggest that bariatric surgery may be used as a bridge to transplantation in patients who are not eligible for transplantation because of morbid obesity. The Bariatric Center at Tampa General Hospital, University of South Florida, Tampa, Florida. We reviewed the outcomes of 16 consecutive patients on hemodialysis for end-stage renal disease (ESRD) who underwent bariatric surgery from 1998 to 2016. Demographics, comorbidities, weight loss, as well as transplant status were reported. Data is mean ± SD. Six men and ten women aged 43-66 years (median = 54 years) underwent laparoscopic Roux-en-Y gastric bypass (LRYGB, n = 12), laparoscopic adjustable gastric banding (LAGB, n = 3), or laparoscopic sleeve gastrectomy (LSG, n = 1). Preoperative BMI was 48 ± 8 kg/m(2). Follow-up to date was 1-10 years (median = 2.8 years); postoperative BMI was 31 ± 7 kg/m(2); %EBWL was 62 ± 24. Four patients underwent renal transplantation (25%) between 2.5-5 years after bariatric surgery. Five patients are currently listed for transplantation. Five patients were not listed for transplantation due to persistent comorbidities; two of these patients died as a consequence of their comorbidities (12.5%) more than 1 year after bariatric surgery. Two patients were lost to follow-up (12.5%). Bariatric surgery is effective in patients with ESRD and improves access to renal transplantation. Bariatric surgery offers a safe approach to weight loss and improvement in comorbidities in the majority of patients. Referrals of transplant candidates with obesity for bariatric surgery should be considered early in the course of ESRD.

  10. Laparoscopic partial nephrectomy for T1a renal tumors is safe and feasible

    WANG Hui; GAO Zhen-li; LIN Chun-hua; WU Ji-tao; WANG Lin; WANG Jian-ming; SUN De-kang; WANG Ke; YU Qing-xia


    Background Some patients with exophytic renal masses less than 4 cm and suboptimal renal function, or a solitary kidney and bilateral renal tumors are considered for laparoscopic partial nephrectomy (LPN), which is feasible for early-stage renal tumors, although it is still considered technically difficult and time consuming. Shortening the time of the operation and renal warm ischemia are required urgently. In this study, we report our initial experiences of LPN,especially with some improved surgical techniques. Methods Between July 2005 and October 2009, 74 patients with T1a renal tumor were treated by LPN, 39 using transperitoneal approach and 35 using retroperitoneal approach. In all cases, the tumor was removed with a margin of 0.5 cm. We compared glomerular filtration rate (GFR) preoperatively and postoperatively, and renal warm ischemia time between traditional ligature and Hem-o-lok methods. Results All operations were completed successfully, and there was no conversion to open surgery. Mean operation time was 76 minutes (range, 68-120), mean time of renal warm ischemia was 23 minutes (range, 15-32), and mean blood loss was 65 ml (range, 40-300). No hemorrhage or urine leak was observed in two cases with the collecting system sewn. Thirteen cases used Hem-o-lok to clamp the suture instead of traditional ligature, and mean time of renal warm ischemia was (16.5±2.3) minutes (range, 12-18). Mean postoperative hospital stay was 6.3 days (range, 5-12).Sixty-seven cases had renal clear cell carcinoma, six papillary renal cell carcinoma, and one renal collecting duct carcinoma. All the tumor margin specimens were negative. The mean follow-up was 30.6 months (range, 3-51), and no recurrence or metastasis was observed. Conclusions LPN for pT1 stage renal tumor was safe and feasible. Hem-o-lok instead of traditional ligature to clamp the suture when sewing the renal wound could shorten the warm ischemia time.

  11. Preoperative assessment of the cancellous bone mineral density of the proximal humerus using CT data

    Krappinger, Dietmar; Roth, Tobias; Gschwentner, Martin; Suckert, Armin; Blauth, Michael; Hengg, Clemens; Kralinger, Franz [Innsbruck Medical University, Department of Trauma Surgery and Sports Medicine, Innsbruck (Austria)


    Osteoporotic fractures of the proximal humerus show an increasing incidence. Osteoporosis not only influences the fracture risk after low-energy trauma, but also affects the mechanical stability of internal fixation. Preoperative assessment of the local bone quality may be useful in the surgical treatment of patients sustaining these injuries. The aim of the present study was to present a method for the preoperative assessment of the local cancellous bone mineral density (BMD) of the proximal humerus using CT data. In the first part of the study, CT scans of 30 patients with unilateral fractures of the proximal humerus after low-energy trauma were used. The local BMD was assessed on the contralateral uninjured side. All 30 patients additionally underwent dual-emission X-ray absorptiometry (DXA) of the lumbar spine, proximal femur, and forearm of the side of the uninjured proximal humerus within 6 weeks after trauma. Three independent trauma surgeons performed measurements on the uninjured proximal humerus twice with a time interval of 4 weeks in order to assess the inter- and intraobserver reliability of the method. In the second part of the study, the local BMD of 507 patients with either proximal humerus fractures or chronic shoulder instability was assessed by a single trauma surgeon. In both parts, the average HU values in standardized ROIs of the humeral head were automatically calculated after correcting for HU values below the water equivalent. A linear calibration equation was computed for the calculation from HU to BMD using a calibration device (EFP). The intra- and interobserver reliability was high (ICC > 0.95). Correlation coefficients between the local BMD of the proximal humerus and other anatomical sites were between 0.35 (lumbar spine) and 0.64 (forearm). We found a high correlation between the local BMD and age. The BMD in the fracture group was significantly lower than in the instability group. These patients were significantly older and more

  12. Validation of the French version of the Amsterdam preoperative anxiety and information scale (APAIS).

    Maurice-Szamburski, Axel; Loundou, Anderson; Capdevila, Xavier; Bruder, Nicolas; Auquier, Pascal


    Most patients are anxious before surgery. The level of preoperative anxiety depends on several factors and merits an objective evaluation. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a self-report questionnaire comprising six questions that have been developed and validated to evaluate the preoperative anxiety of patients. This global index assesses three separate areas: anxiety about anaesthesia, anxiety about surgery, and the desire for information. The purpose of this study was to translate the APAIS into French and to evaluate the psychometric properties of the French version of the APAIS. The process consisted of two steps. The first step involved the production of a French version of the APAIS that was semantically equivalent to the original version. In the second step, we evaluated the psychometric properties of the French version, including the internal consistency and reliability, the differential item functioning, and the external validity. Participants older than 18, undergoing elective surgery (except obstetric), able to understand and read French, and able to complete a self-report questionnaire were eligible for inclusion in the study. A forward-backward translation was performed. The psychometric evaluation covered three domains: internal validity, external validity, and acceptability. Within 4-48 h after surgery, the patients were asked to complete the "Evaluation du Vécu de l'ANesthésie" questionnaire" (EVAN) questionnaire, which is a validated, multi-dimensional questionnaire that assesses the patient's experiences in the perioperative period. A database with 175 patients was created. The principal component factor analysis revealed the same three-dimensional structure as the original scale. The confirmatory factor analysis showed a strong fit with a root mean square error of approximation of 0.069 and a comparative fit index of 1.00. The amount of differential item functioning (DIF) between the subgroups of patients (i

  13. Radiological classification of renal angiomyolipomas based on 127 tumors

    Prando Adilson


    Full Text Available PURPOSE: Demonstrate radiological findings of 127 angiomyolipomas (AMLs and propose a classification based on the radiological evidence of fat. MATERIALS AND METHODS: The imaging findings of 85 consecutive patients with AMLs: isolated (n = 73, multiple without tuberous sclerosis (TS (n = 4 and multiple with TS (n = 8, were retrospectively reviewed. Eighteen AMLs (14% presented with hemorrhage. All patients were submitted to a dedicated helical CT or magnetic resonance studies. All hemorrhagic and non-hemorrhagic lesions were grouped together since our objective was to analyze the presence of detectable fat. Out of 85 patients, 53 were monitored and 32 were treated surgically due to large perirenal component (n = 13, hemorrhage (n = 11 and impossibility of an adequate preoperative characterization (n = 8. There was not a case of renal cell carcinoma (RCC with fat component in this group of patients. RESULTS: Based on the presence and amount of detectable fat within the lesion, AMLs were classified in 4 distinct radiological patterns: Pattern-I, predominantly fatty (usually less than 2 cm in diameter and intrarenal: 54%; Pattern-II, partially fatty (intrarenal or exophytic: 29%; Pattern-III, minimally fatty (most exophytic and perirenal: 11%; and Pattern-IV, without fat (most exophytic and perirenal: 6%. CONCLUSIONS: This proposed classification might be useful to understand the imaging manifestations of AMLs, their differential diagnosis and determine when further radiological evaluation would be necessary. Small (< 1.5 cm, pattern-I AMLs tend to be intra-renal, homogeneous and predominantly fatty. As they grow they tend to be partially or completely exophytic and heterogeneous (patterns II and III. The rare pattern-IV AMLs, however, can be small or large, intra-renal or exophytic but are always homogeneous and hyperdense mass. Since no renal cell carcinoma was found in our series, from an evidence-based practice, all renal mass with detectable

  14. Reliability Centered Maintenance - Methodologies

    Kammerer, Catherine C.


    Journal article about Reliability Centered Maintenance (RCM) methodologies used by United Space Alliance, LLC (USA) in support of the Space Shuttle Program at Kennedy Space Center. The USA Reliability Centered Maintenance program differs from traditional RCM programs because various methodologies are utilized to take advantage of their respective strengths for each application. Based on operational experience, USA has customized the traditional RCM methodology into a streamlined lean logic path and has implemented the use of statistical tools to drive the process. USA RCM has integrated many of the L6S tools into both RCM methodologies. The tools utilized in the Measure, Analyze, and Improve phases of a Lean Six Sigma project lend themselves to application in the RCM process. All USA RCM methodologies meet the requirements defined in SAE JA 1011, Evaluation Criteria for Reliability-Centered Maintenance (RCM) Processes. The proposed article explores these methodologies.

  15. Urinary l-type fatty acid-binding protein is a predictor of early renal function after partial nephrectomy.

    Yanishi, Masaaki; Kinoshita, Hidefumi; Mishima, Takao; Taniguchi, Hisanori; Yoshida, Kenji; Komai, Yoshihiro; Yasuda, Kaneki; Watanabe, Masato; Sugi, Motohiko; Matsuda, Tadashi


    Urinary biomarkers of renal injury urinary may identify loss of renal function following nephron-sparing surgery (NSS). This study was designed to evaluate whether urinary l-type fatty acid-binding protein (l-FABP) is an early biomarker of loss of renal function after NSS. Specifically, the kinetics of urinary l-FABP level after NSS and its correlation with factors related to ischemic renal injury were analyzed. This study prospectively evaluated 18 patients who underwent NSS between July and December 2014, including 12 who underwent laparoscopic and six who underwent robot-assisted partial nephrectomy. Urinary l-FABP concentrations were measured preoperatively and 1, 2, 3, 6, 12, 24, 48, and 72 h after renal artery declamping. Loss of renal function loss was calculated by comparing the effective renal plasma flow, as determined by (99m)Tc-mercaptoacetyltriglycine (MAG3) clearance, on the operated and normal sides. The decrease in estimated glomerular filtration rate from before surgery to six months after surgery was also measured. Urinary l-FABP concentration peaked within 2 h of declamping, which may quantify nephron damage caused by ischemia. The decrease in MAG3 reduction ratio correlated with both the ischemia time and peak urinary l-FABP concentration. Peak urinary l-FABP concentration showed a significant correlation with MAG3 reduction ratio. l-FABP is a suitable urinary biomarker for predicting the extent of ischemic renal injury.

  16. Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones

    Borly, L; Anderson, I B; Bardram, L


    patients completed all questionnaires. Twenty-one patients continued to have abdominal pain after the operation. Patients with pain 1 year after cholecystectomy were characterized by the preoperative presence of a high dyspepsia score, 'irritating' abdominal pain, and an introverted personality...

  17. [The 'paper-based' preoperative evaluation: sometimes, a suitable alternative].

    Bucx, M.J.L.; Wolff, A.P.; Scheffer, G.J.


    In the Netherlands, the majority of elective-surgery patients are evaluated by the anaesthesiologist at the preoperative assessment clinic. We believe that this visit can be omitted in selected patients as it has only minimal benefit, whereas its disadvantages can be substantial. Alternatively, the

  18. Accuracy of diagnostic imaging in nephroblastoma before preoperative chemotherapy

    Rieden, K. [Radiologische Klinik, Abt. Klinische Radiologie, Heidelberg (Germany); Weirich, A. [Kinderklinik, Univ. of Heidelberg (Germany); Troeger, J. [Radiologische Klinik, Abt. Paediatrische Radiologie, Univ. of Heidelberg (Germany); Gamroth, A.H. [Deutsches Krebsforschungszentrum, Heidelberg (Germany); Raschke, K. [Radiologische Klinik, Abt. Paediatrische Radiologie, Univ. of Heidelberg (Germany); Ludwig, R. [Kinderklinik, Univ. of Heidelberg (Germany)


    From July 1988 to February 1991, 130 children with the tentative diagnosis of nephroblastoma were treated preoperatively. The initial diagnostic images (excretory urography, ultrasound, CT, MRI) have been analysed both prospectively and retrospectively and the findings correlated with the intraoperative and histological results. Of the preoperatively treated patients 93.8% had a Wilms` tumour or one of its variants. Five patients had a different malignant tumour and 3 patients, i.e. 2.3% of those preoperatively treated or 1.6% of all registered patients, had benign tumours of the kidney. Wilms` tumour generally presented as a well-defined mass with an inhomogeneous morphology on CT. On ultrasound only 24% of the tumours were homogeneous. Intratumoral haemorrhage and cystic areas occurred frequently; calcifications were rare (8%). With regard to caval involvement only ultrasound and MRI enabled the correct diagnosis, while CT could not differentiate compressions from invasion. The pretherapeutic diagnostic imaging was of sufficient accuracy to start preoperative chemotherapy without diagnostic biopsy. (orig.)

  19. Ranitidine improves postoperative suppression of antibody response to preoperative vaccination

    Nielsen, Hans Jørgen; Hammer, J H; Moesgaard, F;


    The effect of the histamine-2 receptor antagonist ranitidine (100 mg intravenously every 12 hours for 72 hours) on postoperative serum antibody responses to preoperative immunization with six limit of flocculation tetanus toxoid and six limit of flocculation diphtheria toxoid was assessed...

  20. Preoperative subtyping of meningiomas by perfusion MR imaging

    Zhang, Hao; Roediger, Lars A.; Shen, Tianzhen; Miao, Jingtao; Oudkerk, Matthijs


    Introduction This paper aims to evaluate the value of perfusion magnetic resonance (MR) imaging in the preoperative subtyping of meningiomas by analyzing the relative cerebral blood volume (rCBV) of three benign subtypes and anaplastic meningiomas separately. Materials and methods Thirty-seven menin