Of 240 adults with sickle cell anemia seen over 11 years, 12 had the nephrotic syndrome. In 9 (75%) the glomerular lesion, sickle glomerulopathy, consisted of mesangial expansion and basement membrane duplication. Six patients had type IV renal tubular acidosis. Four of the 9 Patients died within 24 months (17 ± 5; mean ± SD), while 5 survived 36 months or longer (80 ± 49); no significant differences were seen between the former and the latter in age, admission serum creatinine and C3 levels, urinary protein excretion, or the frequency of renal tubular acidosis. Chronic azotemia developed in 3 and acute renal shutdown in another 2. Of 22 patients with sickle glomerulopathy (our 9 added to 13 from the literature) 11 died within 2 years. Ten of these (91 %) had developed renal failure, compared to only 5 of the 11 (45%) who survived longer than 2 years (p < 0.05). The 5-year mortality in the general population of sickle cell anemia is 3.75%, and 75% of patients aged 15 years or older survive 18 years or longer. The nephrotic syndrome, most often caused by sickle glomerulopathy, occurs in 4% of patients with sickle cell anemia, leading to renal failure in two-thirds and death in 2 years in half the patients. The development of chronic azotemia correlates strongly with early mortality. The prognosis is much worse than that in the general population of sickle cell anemia.
Anterior cervical discectomy with or without fusion has been commonly used for cervical disc disease since the description by Smith and Robinson in 1958. In this report, surgical technique, advantages, and disadvantages of the posterior approach, known as the posterior keyhole laminotomy-foraminotomy, are reviewed and motion versus fusion surgery discussed. Between 1996 and 2004, the keyhole laminotomy-foraminotomy was performed on 84 patients suffering from lateral cervical soft disc herniation or osteophytes. All the procedures were performed under the surgical microscope. A high-speed drill was used for drilling the bone. In 49 patients (58%), soft disc herniation was removed, while in 35 patients (42%) there were osteophytes. Successful relief of radiculopathy symptoms was achieved in 80 patients (96%). In 4 patients the symptoms recurred. One patient (1.2%) developed kyphosis. The only complication observed intraoperatively was a partial root injury in one patient (1.2%). Mean hospitalization time was 48 hours. The posterior approach is particularly appropriate in patients whose root compression is located posterolaterally. Advantages of this surgery are minimal lamina resection, good visualization of the nerve root, postoperative early mobilization and minimal hospitalization. Microsurgery enables us to both preserve the motion of operated segment and avoid cervical instability.
Arteriovenous fistulae and pseudoaneurysms are not rare after renal biopsy. The majority of these lesions (80%) are asymptomatic or show only transient symptoms. We present here a patient who developed life-threatening hematuria following an open renal biopsy. Arteriovenous fistula and pseudoaneurysm were detected in the biopsied kidney by color-coded Doppler sonography, confirmed by angiography, and the fistula was sealed by superselective arterial embolization with metallic coils. Color-coded Doppler sonography successfully detects the majority of arteriovenous fistulae after renal biopsy, and selective arterial embolization obviates the need for surgical intervention in most cases.
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