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.
Diagnostic Imaging ; Female ; Humans ; Kidney Failure, Chronic/*surgery ; Kidney Transplantation/*adverse effects ; Male ; Middle Aged ; Postoperative Complications/diagnosis/*radiography ; Quality of Life ; Survival Rate

OBJECTIVETo investigate the clinical characteristics and treatment of negative pressure pulmonary edema (NPPE) with upper airway obstruction (UAO) in children.

METHODData of 3 cases with NPPE and UAO in pediatric intensive care unit (PICU) from Mar, 2007 to May, 2013 were analyzed.

RESULT(1) Two cases were male and 1 was female with age respectively 6, 16 and 30 months.One had airway foreign body , 1 laryngitis , and 1 retropharyngeal abscess. The onset of NPPE varied from 5 to 40 minutes following relief of obstruction. (2) NPPE presented with acute respiratory distress with signs of tachypnea, tachycardia, 2 of the 3 with pink frothy pulmonary secretions, progressively decreased oxygen saturation, rales on chest auscultation and wheezing. (3) NPPE chest radiograph showed diffuse interstitial and alveolar infiltrates, images confirmed pulmonary edema. (4) All these patients received these therapeutic measures including mechanical ventilation, retaining high PEEP, diuretics, limiting the fluid input volume to 80-90 ml/ (kg×d) on the basis of circulation stability. The rales on chest auscultation disappeared after 10, 6, 12 hours. The ventilators of 2 patients were removed within 24 hours, in another case it was removed 50 hours later because of secondary infection. All patients were cured and discharged without complication.

CONCLUSIONNPPE progresses very fast, characterized by rapid onset of symptoms of respiratory distress after UAO, with pulmonary edema on chest radiograph. The symptoms resolve rapidly if early support of breath and diuretics are applied properly.

Acute Disease ; Airway Obstruction ; complications ; Child, Preschool ; Diuretics ; therapeutic use ; Female ; Foreign Bodies ; complications ; Humans ; Infant ; Laryngismus ; complications ; Male ; Positive-Pressure Respiration ; Postoperative Complications ; etiology ; physiopathology ; therapy ; Pulmonary Edema ; diagnosis ; etiology ; physiopathology ; therapy ; Radiography, Thoracic ; Retrospective Studies

BACKGROUND/AIMS: A stercoral perforation of the colon (SPC) is a rare, life-threatening disease. The aim of this study was to represent the definition of SPC and help the diagnosis and treatment of this condition. METHODS: We reviewed 92 medical records of patients who underwent operation due to colonic perforation from January 2000 to February 2009 retrospectively. Maurer's diagnostic criteria were used for the diagnosis of SPC. RESULTS: Eight patients (8.7%) were diagnosed as SPC. The age of the patients ranged from 59 to 85 years old. All of the patients were female and had a history of long-standing constipation. Only two patients (25%) were diagnosed as SPC preoperatively. The site of perforation of all patients was sigmoid colon. The methods of operation were Hartmann's procedure (7 cases), and primary repair with sigmoid loop colostomy (1 case). There were one recurrence and two deaths (25%) due to sepsis and multiple organ failure. CONCLUSIONS: SPC should be considered in chronically constipated, and bedridden patients who present with acute abdomen. Hartmann's procedure is the treatment of choice in most situations. Mortality is high but can be minimized with early definitive surgery.
Aged ; Aged, 80 and over ; Colon, Sigmoid/pathology ; Colonic Diseases/*diagnosis/radiography/surgery ; Female ; Humans ; Intestinal Perforation/*diagnosis/radiography/surgery ; Middle Aged ; Postoperative Complications ; Respiratory Distress Syndrome, Adult/etiology ; Retrospective Studies ; Sepsis/etiology ; Tomography, X-Ray Computed

Few studies have been conducted to explain the pain patterns resulting from osteoporotic vertebral compression fractures (OVCF). We analyzed pain patterns to elucidate the pain mechanism and to provide initial guide for the management of OVCFs. Sixty-four patients underwent percutaneous vertebroplasty (N=55) or kyphoplasty (N=9). Three pain patterns were formulized to classify pains due to OVCFs: midline paravertebral (Type A), diffuse paravertebral (Type B), and remote lumbosacral pains (Type C). The degree of compression was measured using scale of deformity index, kyphosis rate, and kyphosis angle. Numerical rating scores were serially measured to determine the postoperative outcomes. As vertebral body height (VBH) decreased, paravertebral pain became more enlarged and extended anteriorly (p<0.05). Type A and B patterns significantly showed the reverse relationship with deformity index (p<0.05), yet Type C pattern was not affected by deformity index. Postoperative pain severity was significantly improved (p<0.05), and patients with a limited pain distribution showed a more favorable outcome (p<0.05). The improvement was closely related with the restoration of VBH, but not with kyphosis rate or angle. Thus, pain pattern study is useful not only as a guide in decision making for the management of patients with OVCF, but also in predicting the treatment outcome.
Aged ; Aged, 80 and over ; Female ; Fracture Fixation, Internal/methods ; Fractures, Compression/etiology/radiography/*surgery ; Humans ; Kyphosis/therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Osteoporosis/*complications/diagnosis ; Pain/etiology/*surgery ; Pain Measurement ; Pain, Postoperative/etiology ; Polymethyl Methacrylate/administration & dosage/therapeutic use ; Questionnaires ; Sickness Impact Profile ; Spinal Fractures/radiography/*surgery ; Tomography, X-Ray Computed ; Treatment Outcome

We experienced one fatal case of biliary cast syndrome after cadaveric liver transplantation involving both intrahepatic ducts. A 58-year-old man underwent cadaveric liver transplantation because of hepatitis B virus related liver cirrhosis and concomitant hepatocellular carcinoma. Five weeks after the liver transplantation, postoperative course was complicated by development of acute cholangitis. Subsequent endoscopic retrograde cholangiography revealed diffuse intrahepatic bile duct strictures without filling defects. Percutaneous liver biopsy, which was done to exclude rejection, revealed biliary cast. Successful endoscopic removal was precluded due to its diffuse involvement. Because of the deterioration of patient's condition by refractory biliary obstruction and cholangitis, retransplantation from cadaveric donor was performed. Debridement of the biliary tree after graft removal yielded a near-complete cast of the intrahepatic ductal system. Biliary cast syndrome should be suspected when jaundice or cholangitis is associated with dilated ducts on abdominal imaging studies in cadaveric liver transplantation recipients. Initial therapeutic options include removal of biliary cast after endoscopic or percutaneous cholangiography. Although endoscopic retrieval of biliary cast by endoscopic retrograde cholangiopancreatography could be employed as a first-line management, other modalities such as endoscopic nasobiliary drainage, percutaneous transhepatic drainage, or retransplantation should be considered when complete removal is not feasible and the condition of the recipient deteriorates.
Bile Duct Diseases/*diagnosis/etiology/pathology ; Bile Ducts, Extrahepatic/pathology ; Bile Ducts, Intrahepatic/pathology ; Cholangiopancreatography, Endoscopic Retrograde ; Fatal Outcome ; Humans ; Jaundice, Obstructive/etiology ; *Liver Transplantation ; Male ; Middle Aged ; Postoperative Complications/*diagnosis/pathology/radiography ; Tomography, X-Ray Computed

OBJECTIVE: We wanted to determine the technical and clinical efficacy of using a PTFE-covered self-expandable nitinol stent for the palliative treatment of malignant biliary obstruction. MATERIALS AND METHODS: Thirty-seven patients with common bile duct strictures caused by malignant disease were treated by placing a total of 37 nitinol PTFE stents. These stents were covered with PTFE with the exception of the last 5 mm at each end; the stent had an unconstrained diameter of 10 mm and a total length of 50-80 mm. The patient survival rate and stent patency rate were calculated by performing Kaplan-Meier survival analysis. The bilirubin, serum amylase and lipase levels before and after stent placement were measured and then compared using a Wilcoxon signed-rank test. The average follow-up duration was 27.9 weeks (range: 2-81 weeks). RESULTS: Placement was successful in all cases. Seventy-six percent of the patients (28/37) experienced adequate palliative drainage for the remainder of their lives. There were no immediate complications. Three patients demonstrated stent sludge occlusion that required PTBD (percutaneous transhepatic biliary drainage) irrigation. Two patients experienced delayed stent migration with stone formation at 7 and 27 weeks of follow-up, respectively. Stent insertion resulted in acute elevations of the amylase and lipase levels one day after stent insertion in 11 patients in spite of performing endoscopic sphincterotomy (4/6). The bilirubin levels were significantly reduced one week after stent insertion (p < 0.01). The 30-day mortality rate was 8% (3/37), and the survival rates were 49% and 27% at 20 and 50 weeks, respectively. The primary stent patency rates were 85%, and 78% at 20 and 50 weeks, respectively. CONCLUSION: The PTFE-covered self-expandable nitinol stent is safe to use with acceptable complication rates. This study is similar to the previous studies with regard to comparing the patency rates and survival rates.
Adenocarcinoma/*complications ; Aged ; Aged, 80 and over ; Alloys/adverse effects/*therapeutic use ; Cholestasis, Extrahepatic/etiology/*surgery ; Coated Materials, Biocompatible/*therapeutic use ; Common Bile Duct/radiography/surgery ; Digestive System Neoplasms/*complications ; Equipment Design ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Palliative Care/methods ; Pilot Projects ; Polytetrafluoroethylene/adverse effects/*therapeutic use ; Postoperative Complications/diagnosis/epidemiology ; Prospective Studies ; *Stents/adverse effects ; Survival Analysis ; Treatment Outcome

Foreign bodies, such as surgical sponges or drains, are sometimes retained after surgical procedures.1 Retention of a drain in the breast tissue postoperatively is an unusual complication. This report describes two cases of characteristic sonographic findings related to retained silastic drains following breast surgery.
*Ultrasonography, Mammary ; Silicones ; Postoperative Complications/*diagnosis/radiography/ultrasonography ; *Mammography ; Humans ; Foreign Bodies/*diagnosis/radiography/ultrasonography ; Female ; Drainage/*instrumentation ; Dimethylpolysiloxanes ; Adult

Occult bladder injury may sometimes go unrecognized during tension-free vaginal tape (TVT) procedures. We report a case of occult intraperitoneal bladder injury that occurred during a TVT procedure. There was no sign of bladder perforation on the initial cystoscopy, which was performed just after the insertion of the trocar. Signs of general peritonitis appeared after the patient started to void the next day. A postoperative cystogram and cystoscopy showed an intraperitoneal bladder injury and a pinhead-sized ulcerative lesion in the right lateral wall of the bladder. We suspect that at the time of initial cystoscopy, the trocar passed through the submucosal area without violating the bladder mucosa. The occult bladder injury may have been caused after the initial cystoscopy by advancing the rough edge of the prolene tape during the extraction of the trocar. This report is the first description of such an occult bladder injury during a TVT procedure.
Vagina/surgery ; Urologic Surgical Procedures/adverse effects ; Urinary Incontinence, Stress/*surgery ; Urinary Bladder/*injuries/radiography ; *Postoperative Complications ; Peritonitis/diagnosis/etiology ; Humans ; Female ; Cystoscopy ; Adult

BACKGROUND: Pulmonary aspergilloma is relatively common in korea. It arises from the colonization proliferation of Aspergillus in preexisting lung parenchymal cavities, in particular tuberculosis. The most common s ymptom in this disorder is hemoptysis, which may or may not be massive and life threatening. A routine chest radiography and computed tomography (CT) are the most important diagnostic procedures. A surgical resection of the aspergilloma has recently been recommended, because of the relatively low incidence of postoperative complications than in the past. A more concentrated sample of patients with aspergilloma, who either underwent a thoracotomy or tested positive for aspergillus antibodies, were reviewed. METHOD: The medical records of twenty-two patients with aspergilloma, who had a proven thoracotomy (9 cases), or who tested positive for the diagnostic procedure and/or aspergillus antibodies (13 cases) from January 1995 to December 2000, were reviewed retrospectively. RESULTS: The most common underlying lung disease was a current or old healed tuberculosis, and 3 patients had cultures of mycobacterium other than tuberculosis (MOTT). The mean time until the aspergilloma was detected 5.91 years in the healed tuerculosis cases. The others cases involved a lung abscess, bronchiectasis and without lung disease. The extrapulmonary disease was alcoholism and diabetes. Hemoptysis was most common in 72.7%. A computed tomography (CT) is useful for diagnosis. The right upper lobe, especially the posterior segment, is the most common location. Bronchial artery embolization is ineffective for a long term follow-up. A lobectomy is most common in a thoracotomy, and intra-operative and post-operative complications are rare. During follow-up, the mortality rate, not from the aspergilloma but from respiratory failure, was 13.6%. CONCLUSION: Aspergilloma is a common cavitary lung disease, It mainly arises from tuberculosis, either current or healed, but extra-pulmonary disease including alcoholism or diabetes are other possible risk factors. Their most common problem in aspergilloma is hemoptysis. Surgery has a low risk of post-operative complications and is recommended in relatively preserved lung function or healthy patients. Medical maneuvers including embolization, and the local insertion of certain materials needs to be studied more closely.
Alcoholism ; Antibodies ; Aspergillus ; Bronchial Arteries ; Bronchiectasis ; Colon ; Diagnosis ; Follow-Up Studies ; Hemoptysis ; Humans ; Incidence ; Korea ; Lung ; Lung Abscess ; Lung Diseases ; Medical Records ; Mortality ; Mycobacterium ; Postoperative Complications ; Radiography ; Respiratory Insufficiency ; Retrospective Studies ; Risk Factors ; Thoracotomy ; Thorax ; Tuberculosis

PURPOSE: Intussusception is a very common pediatric problem and needs early management. This study evaluated the risk factors of intussusception in infants and children for early diagnosis and treatment. METHODS: 216 cases of pediatric intussusception occurring between 1993 and 1999 in Mokpo Catholic Hospital were investigated retrospectively. 164 patients treated with barium reduction comprised the barium reduction (BR) group and 52 patients treated with manual reduction or bowel resection was operation (OP) group. RESULTS: The age incidence under 1 year old was 108 patients (65.9%) in BR group, 45 patients (86.5%) in OP group. Male to female ratio was 1.8:1 in BR and 1.7:1 in OP, respectively. In the seasonal distribution spring was more common in both group (34.1%, 34.6%). 60.4% in BR group, 76.9% in OP group were revealed leukocytosis above 10.000/mm3 in serum. Previous combined diseases were upper respiratory infection (31.7%, 42.3%), acute gastroenteritis (1.2%, 1.9%) and multiple familial polyposis (0.5% in BR group). The frequent symptoms and signs were bloody stool (86.0%,92.3%), abdominal pain and irritability (86.6%, 82.7%), vomiting (76.9%, 67.3%), and abdominal mass (56.7%, 76.9%). Tachycardia was 12.2% in BR and 44.2% in OP. In plain abdominal radiography, intestinal obstructive pattern was present in 5.5% of BR group and 53.8% of OP group. Success rate of barium reduction within 24 hours after symptom appearance was 82.3%. Within 24-48 hours was 61.1%, above 48 hours was 25%. There was a statistically significant difference between BR group and OP group of patients under 1 year old, with tachycardia, symptoms for longer than 48 hours and obstructive pattern on plain abdominal radiography (p<0.05). Of surgical cases, 84.6% were idiopathic. The common anatomical type was ileo-colic type (53.9%). The methods of operation were manual reduction (94.2%) and bowel resection (5.8%). Postoperative complications occurred in 4 cases; 3 cases of wound infection and 1 case of pulmonary complication. Recurrence rate was 12.8% in BR group. CONCLUSION: Risk factors of high incidence such as under 1 year old, severe obstructive pattern on the plain abdominal radiograph, symptoms for longer than 48 hours, and tachycardia, were related with a low success rate of barium reduction. Therefore, a gentle barium enema is recommended in high risk patients for diagnosis and prompt surgical intervention.
Abdominal Pain ; Barium ; Child* ; Diagnosis ; Early Diagnosis ; Enema ; Female ; Gastroenteritis ; Humans ; Incidence ; Infant* ; Intussusception* ; Jeollanam-do ; Leukocytosis ; Male ; Postoperative Complications ; Radiography, Abdominal ; Recurrence ; Retrospective Studies ; Risk Factors ; Seasons ; Tachycardia ; Vomiting ; Wound Infection