1/55. Renal involvement of thrombotic thrombocytopenic purpura: special reference to the glomeruloid structures.We report the case of a 9-year-old girl with biopsy-proven renal thrombotic microangiopathy in thrombotic thrombocytopenic purpura (TTP), with particular reference to the glomeruloid structures. The renal biopsy sample from this TTP patient revealed platelet thrombus deposition, a glomeruloid structure and aneurysm with relative sparing of the glomeruli. The glomeruloid structure displayed a proliferation of mainly capillary-sized channels lined by factor viii-related, antigen-positive plump endothelial cells embedded in the edematous connective tissue. These glomeruloid vessels communicated with the aneurysmal segment at the end portion of the arteriolar branch. We believe that the glomeruloid structures in TTP represent not merely organization or recanalization of thrombus but rather active angiogenesis through aneurysmal dilation in the arteriolized vessel, probably initiated by platelet agglutination.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
2/55. systemic vasculitis with bilateral perirenal haemorrhage in chronic myelomonocytic leukaemia.The cases of two patients with chronic myelomonocytic leukaemia associated with periarteritis nodosa-like, antineutrophil cytoplasmic antibody negative, systemic vasculitis, are reported. A 61 year old man was admitted with fever, diffuse myalgia, and abdominal pain. blood and bone marrow examination showed chronic myelomonocytic leukaemia. Vasculitis of the gall bladder was responsible for acalculous cholecystitis. A massive spontaneous bilateral perirenal haemorrhage occurred. A 73 year old woman with chronic myelomonocytic leukaemia had been followed up for one year when unexplained fever occurred. Two months after the onset of fever, sudden abdominal pain was ascribed to spontaneous bilateral renal haematoma related to bilateral renal arterial aneurysms. Neuromuscular biopsy showed non-necrotising periarteriolar inflammation. To our knowledge, systemic vasculitis has never been reported in chronic myelomonocytic leukaemia. In our two cases a non-random association is suggested because (a) chronic myelomonocytic leukaemia is a rare myelodysplastic syndrome, (b) spontaneous bilateral perirenal haematoma is not a usual feature of periarteritis nodosa.- - - - - - - - - - ranking = 0.33333333333333keywords = aneurysm (Clic here for more details about this article) |
3/55. Infrarenal mycotic pseudoaneurysm. A late complication of coronary bypass surgery with proximal aortic dissection.A 62-year-old man developed a mycotic infrarenal pseudoaneurysm at the re-entry site of a previous aortic dissection. The aortic dissection had occurred one year earlier while he was undergoing coronary bypass surgery. The patient was successfully treated with a Dacron bifurcation graft after the mycotic aneurysm had been sterilized. Causes and relationships of the mycotic pseudoaneurysm to aortic dissection and aortic balloon support are discussed.- - - - - - - - - - ranking = 2.3333333333333keywords = aneurysm (Clic here for more details about this article) |
4/55. A case report of nonresective staple exclusion of abdominal aortic aneurysm associated with horseshoe kidney.A 55 year old male with a history of intermittent claudication presented with an abdominal mass, and was diagnosed by abdominal computed tomography (CT) with an abdominal aortic aneurysm accompanying horseshoe kidney. The horseshoe kidney configuration and governing vessels, urinary duct course, and right common iliac arterial stenosis were shown by methods such as angiogram, spiral CT, and intravenous pyelogram before operation. At the operation, the abdomen was opened by a median incision and, using a staple exclusion technique, the abnormal renal artery was reconstructed using 189 mm knitted Y shaped dacron graft replacement and the great saphenous vein. The isthmus was not resected. There were no post operative complications, nor was there any large decrease in renal function. Good results were obtained, and we herein report our results together with a discussion of the literature.- - - - - - - - - - ranking = 11.609204337017keywords = aortic aneurysm, aneurysm (Clic here for more details about this article) |
5/55. Mycotic abdominal aortic aneurysm: a fatal sequel to concomitant prostatic and renal aspergillosis. Case report and review of the literature.We report the first case of aspergillus mycotic aneurysm as a sequel to concomitant prostatic and renal aspergillosis. The patient had undergone left nephrectomy and transurethral resection of prostate for aspergillus infection one year ago. He again presented with LUTS and backache and clinical examination showed visible pulsations in the epigastrium. CT-scan abdomen showed a pseudoaneurysm of the abdominal aorta. The aneurysm was repaired in situ with homografting and omental wrap. However, the patient succumbed to septicemia on the tenth postoperative day. Adjunctive surgery is usually essential as medical management alone has been unsatisfactory. It is imperative that these cases should be followed closely to detect the disease recurrence and complications at the earliest.- - - - - - - - - - ranking = 10.287363469614keywords = aortic aneurysm, aneurysm (Clic here for more details about this article) |
6/55. Severe renal impairment in the case of classic polyarteritis nodosa.A 14-year-old boy with classic polyarteritis nodosa (cPAN) and a clinical picture resembling rapidly progressive glomerulonephritis (RPGN) is described. He had severe hypertension, malaise, weight loss, fever, myalgia, and rapid deterioration of renal function. Renal biopsy revealed acute necrotizing vasculitis. angiography showed small saccular aneurysmatic dilatations in the intrarenal branches of the right renal artery and the intrahepatic branches of the hepatic artery. cPAN was diagnosed and pulse methylprednisolone (MP), pulse cyclophosphamide (CYC) and subsequently oral prednisolone were given. Clinical and laboratory findings improved dramatically and remission was attained rapidly. The patient has remained in remission for the last 11 months. cPAN should be considered in patients who present with severe systemic symptoms and hypertension. Progressive renal insufficiency can occur during the acute course of cPAN due to renal vascular involvement without glomerulonephritis. Prompt and aggressive corticosteroid and cytotoxic therapy is essential to suppress disease activity and to maintain remission.- - - - - - - - - - ranking = 0.33333333333333keywords = aneurysm (Clic here for more details about this article) |
7/55. Massive hematuria due to right renal artery mycotic pseudoaneurysm in a patient with subacute bacterial endocarditis.A 40-year-old woman with recently diagnosed bacterial endocarditis was admitted to the hospital with gross hematuria and anemia. Computed tomography revealed a large right upper pole renal artery pseudoaneurysm, a wedge-shaped hypoperfused region of the left kidney, and a splenic abscess. Radiographic embolization of the right renal artery was performed to stabilize the bleeding. The splenic abscess was drained. Subsequent right nephrectomy and splenectomy were performed for persistent leukocytosis. This unusual presentation of a septic embolus and its management are discussed.- - - - - - - - - - ranking = 1.6666666666667keywords = aneurysm (Clic here for more details about this article) |
8/55. Renal Behcet's disease: a cumulative analysis.OBJECTIVE: To analyze cumulated data about renal involvement in Behcet's disease (BD) and to report on 6 patients with BD and renal problems. methods: We found reports of 159 patients (including our patients) with BD and specific renal disease (amyloidosis 69, glomerulonephritis [GN] 51, renal vascular disease 35, and interstitial nephritis 4) in our survey. RESULTS: The frequency of renal problems among BD patients has been reported to vary between 0% to 55%. male gender is a risk factor for all types of renal BD. nephrotic syndrome was present in 83% of patients with amyloidosis, and renal failure was common at the time of diagnosis. The mean interval between the initial manifestation of BD and diagnosis of amyloidosis was shorter in men than in women (P =.02). AA-type amyloid fibrils were shown in all cases studied. Vascular involvement was common in the patients with amyloidosis (60%). The renal findings in GN show a wide spectrum, from asymptomatic hematuria and/or proteinuria to rapidly progressive GN. Several types of glomerular lesions ranging from minor glomerular changes to crescentic glomerulonephritis are observed in BD. The common types of glomerular lesions among the reported cases are crescentic GN, proliferative GN, and immunoglobulin a (IgA) nephritis. Aneurysms may be located throughout the renal artery, from the orifice of the main artery to intrarenal microaneurysms. Another type of renal disease (amyloidosis or GN) and other major vascular involvement were present in all cases with renal vein thrombosis. hypertension is common among patients with renal artery aneurysm or stenosis. Microscopic vascular disease was described in 4 patients. CONCLUSIONS: Based on data in the literature, we suggest that renal involvement in BD is more frequent than has been recognized, although it is most often mild in nature. amyloidosis is one of the prognostic factors affecting survival. patients with vascular involvement carry high risk for amyloidosis, and administration of colchicine to these patients may be beneficial. More evidence is needed to accept interstitial nephritis as a manifestation of BD. In spite of some difficulties, hemodialysis and renal transplantation are safe treatment options in BD-related uremia.- - - - - - - - - - ranking = 0.66666666666667keywords = aneurysm (Clic here for more details about this article) |
9/55. Spontaneous bilateral perirenal hematoma as a complication of polyarteritis nodosa in a patient with human immunodeficiency virus infection.We present a 29-year-old man with polyarteritis nodosa (PAN) having human immunodeficiency virus (hiv) infection. This patient fulfilled the American College of rheumatology (ACR) 1990 criteria for PAN, and the diagnosis was confirmed by typical arteriographic findings, including microaneurysms. Due to the rupture of microaneurysms, perirenal hematomas occurred in both kidneys. Unilateral nephrectomy was performed, and renal histology confirmed that aneurysm rupture was the etiology of the perirenal hematoma. The occurrence of renal hematomas is a usual complication of PAN. However, bilateral renal hematoma during the course of hiv-associated PAN is quite rare, and to our knowledge, this would be the second case reported in the literature. When compared with other viral agents, the association of hiv with PAN may be considered rare. However, as suggested by various reports in the literature, hiv infection should always be kept in mind while evaluating patients with PAN.- - - - - - - - - - ranking = 1keywords = aneurysm (Clic here for more details about this article) |
10/55. Pyelocalyceal diverticulum: an unusual cause of acute renal colic.The differential diagnosis of acute flank pain includes kidney stones, urinary tract infection, dissecting abdominal aortic aneurysm (AAA), arterial or venous compromise of the kidney, renal abscess, renal carcinoma, and papillary necrosis. This is a report of an unusual cause of renal colic: pyelocalyceal diverticulum. Stasis of urine within a diverticulum promotes both calculus formation and urinary tract infection, either of which can lead to colic. Several radiographic findings may suggest a calyceal diverticulum, including, on plain X-ray, a very peripheral or mobile renal calculus, or on intravenous pyelogram, an early filling-defect and delayed or retained filing of a circular or ovoid mass.- - - - - - - - - - ranking = 2.3218408674034keywords = aortic aneurysm, aneurysm (Clic here for more details about this article) |
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