Francisco Javier Burgos Revilla

Utilidad de la ecografía y el Eco-Doppler en el transplante renal

OBJECTIVES The aim of the study is to analyze the usefulness of ultrasound and Doppler ultrasound for the evaluation of transplant donors and recipients, for renal transplant follow-up and for the resolution of surgical complications after renal transplant. METHODS Abdominal ultrasound was performed in donors and recipients of renal grafts. In the recipients with vascular risk factors a Doppler ultrasound of the iliac and lower limb arteries was systematically done. Doppler ultrasound was performed in the first and seventh day after renal transplant, as well as for graft dysfunction at any moment. RESULTS Recipient ultrasound informs about the existence of acquired renal cystic disease and Doppler ultrasound allows evaluating the vascular state of high risk recipients. In the immediate post-transplant period ultrasound studies are useful for detection of vascular complications, graft obstruction and to control the evolution of acute rejection and acute tubular necrosis. Finally, ultrasound is the technique of choice in the endourological management of surgical complications after renal transplant. CONCLUSION Ultrasound under urologic control is essential in the evaluation of the kidney transplant recipient, post-transplant follow-up and in the resolution of surgical complications.

Presentación clínica del carcinoma de células renales en el trasplante renal

OBJECTIVES To analyze the clinical presentation and therapeutic response of renal cell carcinoma (RCC) of the renal graft. METHODS Analysis of the cases described in our centre and review of current literature. RESULTS RCC has a higher incidence in transplant patients, affecting the graft in less than 10% of the cases. Detection is usually a casual event during follow-up due to the absence of innervation, although its presentation may be as an acute abdomen in case of breakage of the graft. Conventional treatment consists of transplant nephrectomy, but partial nephrectomy has been performed in recent years with good results. The modification of immunosuppression is a routine measure after treatment. CONCLUSIONS The incidence of RCC after renal transplants in our series is 0.7%, of which 22% are originated in the graft. The clinical presentation of the primitive RCC of the graft is variable. Partial nephrectomy is technically feasible and oncologically safe in the treatment of RCC of the renal graft.

The Usefulness of Contrast-Enhanced Ultrasound in the Assessment of Early Kidney Transplant Function and Complications

Objectives: The routine diagnostic method for assessment of renal graft dysfunction is Doppler ultrasound. However, contrast-enhanced ultrasound (CEUS) may provide more information about parenchymal flow and vascular status of kidney allografts. The aim of the study was to assess the effectiveness of CEUS in the immediate post-transplant period, focusing on acute vascular complications. A brief review of available literature and a report of our initial experience is made. Material and methods: 15 kidney transplant (KT) cases with clinical suspicion of acute surgical complication were assessed with CEUS and conventional Doppler ultrasound (US). In addition, bibliographic review was conducted through PubMed, Embase, and ClinicalKey databases. Results: 10% of KT underwent CEUS, useful for detecting vascular complication or cortical necrosis in 4 (26%) and exclude them in 74%. Grafts with acute vascular complications have a delayed contrast-enhancement with peak intensity lower than normal kidneys. Perfusion defects can be clearly observed and the imaging of cortical necrosis is pathognomonic. Conclusions: CEUS is a useful tool in the characterization of renal graft dysfunction with special interest on acute vascular complications after renal transplant. It is a feasible technique for quantitative analysis of kidney perfusion, which provides information on renal tissue microcirculation and regional parenchymal flow. Exploration could be done by a urologist at the patient’s bedside while avoiding iodinated contrast.

Rentabilidad de la biopsia ampliada con 10 muestras prostáticas: Estudio prospectivo sobre 222 pacientes

Resumen es: Objetivo: Actualmente no esta establecido ni el numero de muestras ni de biopsias para el correcto diagnostico del cancer prostatico. Presentamos nuestra...

TOLERANCIA Y COMPLICACIONES DE LA BIOPSIA TRANSRECTAL ECODIRIGIDA PROSTÁTICA AMPLIADA A DIEZ CILINDROS. PAPEL DEL BLOQUEO DE HACES NEUROVASCULARES CON LIDOCAÍNA

OBJECTIVES The growing interest on increasing the number of biopsy samples during ultrasound guided prostatic biopsies moved us to evaluate the tolerability and complications of the extensive biopsy with/without blockage of neurovascular bundles. METHODS A group of 222 patients underwent prostatic biopsy with the aim to obtain 10 cores on each. After evaluation of the first 50 cases performed without anesthesia, decision was taken to proceed with neurovascular blockage with 2% lidocaine, comparatively evaluating both groups for results on tolerability, complications and global adverse events. RESULTS The aimed number of cores could not be completed in 16% of the patients without anesthesia in comparison with 2.33% with anesthesia (p < 0.002); the biopsy was qualified as painful or very painful by 10.9% and 1.9% respectively (p < 0.0002). The results of the visual analogical scale for pain were 2.46 +/- 1.67 and 4.5 +/- 2.11 for the anesthesia/without anesthesia groups respectively, with mild-moderate vagal reactions in 28% of these latter in comparison with 7.7% in patients receiving lidocaine. Rectal bleeding was the most worrying complication, being moderate-severe in 4.7% of the patients, with 2% hospital admission. CONCLUSIONS The increase in the number of ultrasound guided prostatic biopsy samples may be associated with a higher frequency of complications, mainly bleeding, and requires the application of local anesthesia due to worse tolerance. Neurovascular bundle blockage with lidocaine is very effective to diminish biopsy associated pain.Resumen es: OBJETIVO: El creciente interes por ampliar el numero de muestras obtenidas durante la biopsia transrectal ecodirigida prostatica nos ha hecho evaluar la ...

Inmunosupresión y complicaciones quirúrgicas post-trasplante renal

Resumen es: Objetivo: Los nuevos inmunosupresores disminuyen las tasas de rechazo agudo en el transplante renal y mejoran la supervivencia del injerto, aunque modifi...

RESULTADOS DE UNA SERIE DE 6000 PACIENTES CON BIOPSIA TRANSRECTAL ECODIRIGIDA DE PRÓSTATA. PARTE I: ANATOMÍA PATOLÓGICA, TACTO RECTAL, ECOGRAFÍA TRANSRECTAL Y PSA.

Resumen es: OBJETIVOS: Analizar los resultados de la Biopsia Transrectal Ecodirigida (BTE) prostatica realizadas en 6000 pacientes asi como su relacion con los difer...

Results of a series of transrectal ultrasound guided biopsy of the prostate in 6000 patients: Part II: PSA derived parameters

Resumen es: OBJETIVO: En esta serie se revisan los resultados de 6000 pacientes biopsiados en una o mas ocasiones por sospecha de CP, analizando el papel que puedan ...

Recurrent vulvar melanoma invading urethra. Clinical case and literature review

Recurrent vulvar melanoma is a rare entity and literature regarding its management is scarce. Mucosal melanomas comprise less than 1% of all melanomas and vulvovaginal melanoma is the second least frequent of them (18%) after those in the urinary tract (3%). It is the second most common histological type of vulvar cancer, representing 7–10% of all malignant vulvar neoplasms. Initial symptoms are nonspecific and complete excision of the lesion is indicated in cases of suspected diagnosis. Prognosis of patients with these neoplasms is poor and remains unchanged despite the treatment approach. Hemivulvectomy with lymph node dissection is the current procedure of choice, whether combined with adjuvant therapies or not. When affecting the urethra, its behavior is especially aggressive, half of them, presenting with metastasis and with a very short life expectancy. We describe a case of recurrent vulvar melanoma invading distal urethra and its management.

Experience with Hypothermic Machine Perfusion in Extended Criteria Donors. Functional Outcomes

Introduction Preservation of Extended Criteria Donors (ECD) with Hypothermic Machine Perfusion (HMP) decreases delayed graft function (DGF) (26 vs 38% with cold storage-CS) and improves 1-year graft survival (1yS). Time of HMP preservation could decrease DGF. Flow (F) and renal resistance (RR) are prognostic factors to assess graft viability. Objectives To compare local and imported donors and receptors characteristics, F, RR and functional outcomes. Materials and Methods Prospective cohort of fist-graft receptors from 2012, with ≥ 1 year of follow-up. Local ECD were preserved with HMP after kidney recovery. Imported ECD were preserved with CS and HMP (once they arrived at our institution). Vascular thrombosis, acute rejection (AR), DGF and 1yS were assessed. Results 119 imported and 74 local grafts. Median age was higher in imported grafts: 76.9 vs 69.2 y.o. No differences in sex, hypertension, BMI, DM and terminal creatinine levels were observed. Cold ischemia time was longer in ECD: 18.4 vs 16.3 h. Relative time of PHM was longer in local ECD: 0.92 vs 0.41. (Table 1) Median age of imported ECD receptors was higher: 63.2 56.1 y.o. No differences in sex, hypertension, BMI, DM, peripheral vascular and heart disease, kind and time in dialysis were observed. (Table 2) F increased and RR decreased in both groups at the end of PHM preservation. No differences between groups were observed. (Table 3) DGF incidence was higher in imported ECD(28.0 vs 18.1%), 1yS was lower in imported ECD (80.3 vs 91.9%). No differences in vascular thrombosis (5.9 vs 5.4), AR (12.3 vs 9.8%) and creatinine clearance at 6 and 12 months (39.4 vs 39.1 ml/m; 41.2 vs 40.5 ml/m) were observed. (Table 4) Conclusions PHM reduces the risk of DGF in both groups, compared with DGF rates with CS. DGF reduction is higher in local grafts, with HMP immediately after organ recovery. Shorter cold ischemia time could be another protective factor. Table. No title available. Table. No title available. Table. No title available. Table. No title available.