Cases reported "Acute Disease"

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21/197. Recovery of renal function after right nephrectomy, cavectomy and left renal vein ligation.

    Right nephrectomy and ligation of the left renal vein often lead to acute renal failure, but not obligatorily to renal infarction and chronic uremia, thanks to the peculiar venous supply of the left kidney. A man underwent right nephrectomy, inferior cavectomy and ligation of the left renal vein and became anuric. Hemodialysis was necessary for some days, but he partially recovered his renal function. proteinuria occurred a few days after the operation and decreased but had not disappeared after ten months. Eventually the patient died of brain metastases. There are a few reports of similar operations, some successful, others not, but very few papers report an adequate follow-up of subsequent changes in renal function. Nephrologists could be involved in the postoperative care of these cases. They should be aware of the possible recovery of renal function and should try all possible strategies to help the left kidney recover its function.
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22/197. Acutely exaggerated hepatitis B induced by the withdrawal of immunosuppressants in a seroconverted renal transplant recipient: report of a case.

    The long-term reciprocal impact of renal transplantation on infection by hepatitis b virus (HBV) is still a matter of intense debate, and the topic remains controversial. We herein report the case of a 50-year-old male asymptomatic HBV carrier who had seroconverted to positive anti-HBe antibody (Ab) and received a kidney transplantation from a cadaver donor (HB surface(s) antigen (Ag)-negative). Nine months later, his kidney function deteriorated due to chronic rejection, and hemodialysis was temporarily required. Triple drug therapy (cyclosporine, prednisolone, azathioprine) for immunosuppression was changed to two-drug therapy (cyclosporine and prednisolone) at a reduced dosage because of this episode. After that episode, severe hepatitis with HBV antigenemia developed without any change in the serological state. The levels of dna polymerase in a potential recipient from a cadaveric donor should be checked before transplantation to predict the occurrence of hepatitis when the recipient is an asymptomatic carrier of HBV, especially in cases of serologically HBeAg-negative, and anti-HBeAb-positive carriers.
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23/197. Treatment of acute renal failure caused by renal artery occlusion with renal artery angioplasty.

    BACKGROUND: Renovascular disease is a common cause of renal impairment and hypertension, particularly in the older population. Oligoanuric acute renal failure secondary to renal artery occlusion is not well recognized; however, it is potentially reversible if identified and treated. methods: Five patients presented to our institution with oligoanuric acute renal failure. Each had evidence of vascular disease, and a prerenal insult was identified. They were investigated with renal artery Doppler ultrasound or nuclear imaging before proceeding to percutaneous angioplasty and stent placement. RESULTS: The targeted kidney had relatively well-preserved renal size, and potential viability of the renal tissue was determined by nuclear scanning with parenchymal uptake of tracer. Percutaneous angioplasty and stent placement resulted in brisk reperfusion of the kidney and an immediate diuresis with improvement of renal function, avoiding supportive dialysis after the procedure. Contrast nephrotoxicity was identified in two of the five cases. CONCLUSION: renal artery occlusion should be considered as a cause of oliguric acute renal failure, particularly in patients at high risk who present with a sudden deterioration of renal function, with nuclear imaging showing potentially viable renal tissue with relatively well-preserved renal size. Percutaneous revascularization should be considered in this group.
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24/197. Two unusual cases of adult intussusception.

    adult intussusception is very rare. We report 2 unusual cases, a 58-year-old man with a transverse colo-colonic intussusception caused by a malignant sessile polyp that also had an asymptomatic synchronous neoplasm of the kidney, and an 18-year-old female with an ileocecolic intussusception caused by acute appendicitis. This report stresses the point that intussusception in adults may represent an underlying malignancy. The age of the patient and the anatomic location of the intussusception provide significant input as to the etiology and hence the most appropriate surgical procedure.
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25/197. Acute focal bacterial nephritis: report of four cases.

    Focal acute bacterial nephritis is a localized bacterial infection of the kidney presenting as an inflammatory mass not containing drainable pus. The further distinction between acute focal bacterial nephritis and other renal masses is aided by the appropriate use of renal sonography and computed tomography. We report 4 cases with this entity.
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26/197. renal artery dissection after blunt abdominal trauma: a rare cause of acute cortical necrosis.

    renal artery injury is an uncommon complication of blunt abdominal trauma. We present a case of a 19-year-old man who developed acute cortical necrosis in a congenital single kidney after a motorcycle accident. On initial presentation, he had signs of splenic injury and required immediate laparotomy and splenectomy. His renal function deteriorated, and he became dialysis dependent. Computed tomography followed by percutaneous angiography showed a dissection of a single renal artery causing the formation of a large pseudoaneurysm. A second angiogram showed an increase in the size of the pseudoaneurysm. We performed a laparotomy and attempted in situ vein graft repair of the renal artery. A wedge biopsy specimen taken at laparotomy revealed acute cortical necrosis, and plain radiographs showed cortical calcification. renal artery dissection and pseudoaneurysm formation are rare events after blunt trauma. Iatrogenic damage is the most common cause of pseudoaneurysm. Traumatic pseudoaneurysms have a poor prognosis without prompt surgical intervention. Renal arterial damage may occur after blunt trauma, and early imaging and intervention are essential to salvage renal function.
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27/197. Acute respiratory failure caused by an incarcerated right-sided adult bochdalek hernia: report of a case.

    We herein report the case of a 63-year-old woman with a right-sided Bochdalek hernia. She was admitted to our hospital as an emergency patient with dyspnea and abdominal pain. A blood gas analysis showed hypoxia. A chest X-ray and computed tomography revealed a remarkable right diaphragm elevation caused by a herniation of the colon and right kidney. Under a thoracolaparotomy, a herniation of the strangulated colon and right kidney was recognized in the site of the foramen of Bochdalek, and a direct closure of the hernia opening was thus performed after repairing the location of the colon and right kidney. A right-sided Bochdalek hernia in adults is a rare clinical entity and there have been fewer than ten such cases so far reported in the world literature. This case highlights the need for a prompt diagnosis and appropriate surgical intervention.
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28/197. Epstein-Barr virus-associated acute interstitial nephritis: infection or immunologic phenomenon?

    Epstein-Barr virus (EBV) dna in renal tissue in acute interstitial nephritis (IN) has not been previously reported. An 18-year-old male presented with a sore throat, fever, cervical lymphadenopathy, and oliguric renal failure. The rapid slide test for heterophile antibodies associated with infectious mononucleosis was positive, and a renal biopsy showed an acute interstitial nephritis. A polymerase chain reaction (PCR) assay identified EBV dna in the renal biopsy. In situ hybridization (ISH) for EBV rna and immunohistochemistry for latent membrane protein 1 of EBV were negative. Hemodialysis and prednisone 60 mg PO OD were administered and the s-creatinine dropped from 1,224 to 75 micromol/l over 9 days. The identification of EBV dna in the kidney raises the possibility that direct infection plays a role in acute IN associated with EBV.
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29/197. mars procedure as a bridge to combined liver-kidney transplantation in severe chromium-copper acute intoxication: a paediatric case report.

    We describe a case of multi-organ failure (liver-kidney insufficiency and brain oedema) caused by accidental, acute intoxication with a chromium and copper-containing substance, as an example of the introduction of the new extracorporeal procedure mars (molecular adsorbents recirculating system) in a girl 3.5 years old.
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30/197. Acute lumbago and sciatica as first symptoms of focal xanthogranulomatous pyelonephritis.

    Xanthogranulomatous pyelonephritis (XGP) is a rare inflammatory disease of the kidney, presenting in a diffuse or focal form. The preoperative diagnosis of XGP is made only in 10% of the cases because neither the clinical nor the radiological presentation are specific and could be confused with renal tumors, thus deserving the name of 'great imitator'. We report a case of focal XGP in a middle-aged man presenting with acute lumbago and sciatica, an unusual clinical presentation.
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