No abstract

The diagnosis of sclerosing mesenteritis has increased with the more frequent use of MDCT and the popularization of the DICOM viewer. Defined hallmarks on MDCT can be helpful for differentiating sclerosing mesenteritis from other pathologies.

In order to evaluate potential long-term kidney damage of childhood leukemia and risk factors affecting renal damage, we studied 116 children treated for acute lymphoblastic leukemia (ALL) using the St. Jude Total XI and XIII protocols in 1991-1998. The median follow-up period after the completion of treatment was 35 months. The following parameters were examined: urinalysis, urinary creatinine (Cr), calcium (Ca), phosphorus, b 2 -microglobulin, glomerular filtration rate (GFR), tubular phosphorus reabsorption (TPR), and renal function tests. Radiological evaluation included renal ultrasonography (US), and renal scans with DMSA or MAG-3 were performed. Blood chemistry and renal US patients were normal in all patients except two. GFR, TPR, urinary Ca/Cr, b 2 -microglobulin, and renal scan were abnormal in 19.0%, 16.4%, 13.8%, 6.0%, and 40.5% of patients, respectively. The abnormality rate in GFR was significantly higher in patients<2 years of age. TPR abnormality was found to be significantly higher in patients who did not have G-CSF. An abnormal renal scan was associated with Hb< 10 g/dL, kidney infiltration, or hypertension at presentation and also occurred patients who underwent methotrexate treatment with frequent intervals during the follow-up period. Patients should be followed-up after cessation of therapy with the conventional tests mentioned above. In case of any abnormality, further detailed tests should be performed; renal scan seems to be more predictive for renal damage. Am.

The objective of this study was to determine the frequency of electrolyte perturbations and their relationship with leukemic status before and after chemotherapy in patients with acute lymphocytic leukemia. Blood biochemistry, liver and renal function tests, and renal sonograms were examined at diagnosis and during induction therapy in 334 patients. Renal and electrolyte disturbances were then studied in 116 patients between 3 and 110 months after cessation of the St. Jude chemotherapy treatment protocol. Glomerular filtration rate, electrolyte, protein, and beta-2-microglobulin levels were determined in fresh urine samples, and serum electrolyte levels were examined in blood samples. Renal sonographic examinations and scintigraphic examinations were performed with DMSA and MAG-3. Renal leukemic involvement was detected by sonographic examination in 32 patients who had also presented with hyperphosphatemia or hyperuricemia. Patients with electrolyte disorders at diagnosis were less likely to have tumor lysis syndrome during induction chemotherapy. This may be explained by correction of their electrolyte disorders at the time of diagnosis, which may protect them from tumor lysis syndrome. Hypocalcemia and hyponatremia at the time of diagnosis were found to be significant initial risk factors for renal scan abnormalities and microproteinuria, respectively, during the late therapy period (P < 0.05). Electrolyte abnormalities and renal changes were commonly observed before and after therapy for leukemia. Patients presenting with hypocalcemia and hyponatremia should be examined for microproteinuria and should undergo renal scanning during the late therapy period.

The RI is insensitive for detection of obstruction in patients with acute renal colic, and its value in routine practice seems quite controversial.

No abstract

No abstract

A rteriovenous fistulas in the portal circulation not only may produce the classicchangesof increased cardiacoutputandcongestive heartfailurebut also, more frequently, may result in portal hy pertension with its sequelae of variceal bleed ing and ascites. The overall mortality rate with an untreated arteriovenous fistula in the me senteric circulation has been reported to be approximately25% [1]. Suchfistulasusually involve either the hepatic or the splenic artery [I]. Arteriovenous fistulas involving the supe rior mesenteric artery are uncommon and have usually been observed in patients who have undergone abdominal surgery or have sustainedpenetratingtrauma [I, 2].We present a case of superiormesenteric ar teriovenous fistula that was a complication of an aortobifemoral bypass operation, and we dis cuss the management of endovascular therapy. Case ReportA 53-year-old man underwent aortobifemo ml bypass grafting for treatment of an abdomi nal aortic aneurysm and diffuse atherosclerotic involvement of the iliac arteries. Development of an abdominal bruit was first noted on the third postoperative day. The flow spectrum from abdominal Doppler examination showed arterialization of the superior mesenteric vein (Figs. lB and IC). Because the fistula was diagnosed early, the patient had no signs of portal hypertension and his liver func tion was normal.Careful review ofthe preoper ative aortogram showed no evidence of the fistula, thus confirming that the fistula was caused by thesurgical trauma.We discussed alternatives for immediate treatment and decided that a transvenous ap proach to occlude the single draining vein of the fistulawould be useful.Transarterial em bolization was not considered feasible because the arterial feeders of the fistula were multiple, small in caliber, and difficult to catheterize and because of the risk of mesenteric ischemia.A 5-French cobra catheter was placed into thesuperior mesenteric arteryusinga rightfem oral approach. An infusion of contrast material into the superior mesenteric artery showed the portal vein, into which a 6-French introducing To our knowledge,ours is the first reported caseof superior mesenteric arteriovenousfis tula after aortic bypass surgery and the first re ported description of endovascular treatment.Delay in diagnosis of artenoportal fistulas may cause significant morbidity and mortality associatedwith the portal hypertensionand se quelae such as ascites, variceal bleeding, and progressive liver failure. Such fistulas may take monthsorevenyearsto becomeclinicallyman ifest [I , 3]. Although surgery has traditionally been the method of choice for treating arterio venous fistulas involving the portal circulation, endovascular techniqueshavebeenincreasingly