Search

We describe the case of a patient with chronic renal failure under hemodialysis for five years who, after renal transplantation, developed acute renal failure and hypertension refractory to medical therapy. Given the clinical and imaging (renal ultrasound and computed tomography) suspicion of renal artery graft thrombosis, invasive angiography was performed, which confirmed the diagnosis. The therapeutic approach consisted of percutaneous thrombus aspiration and subsequent balloon angioplasty of the entire artery, followed by stent implantation in a second procedure. The clinical course was uneventful with improvement of renal function and normalization of blood pressure. The case highlights the importance of percutaneous intervention in the management of patients with vascular complications after transplantation, with successful application of a procedure normally used in the setting of acute myocardial infarction - percutaneous thrombus aspiration and implantation of a drug-eluting vascular stent., (Copyright © 2011 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.)

We report the case of a 18-year-old girl having a solid pseudopapillary pancreatic tumor. The patient underwent local enucleation of the tumor located on pancreatic head and remained free of recurrence on the 5th year of follow up. Surgical management is discussed.

Splenic metastasis is rare, and is usually associated with disseminated malignancy. The primary tumours more frequently related with splenic metastasis are lung, breast, gynaecologic, specially ovary tumours, colon, rectum and melanoma. Isolated secondary splenic disease is rare, but it is described, often associated to ovary cancer. We report a 55 years old women with parenchymal splenic metastases of serous ovary cystadenocarcinoma in the 5th follow up year. This patient had positive peritoneal washings chytology but not macroscopic disease. We discuss the secondary splenic involvement of ovary cancer, dissemination route, prognosis and role of splenectomy as treatment modality in this unusual recurrence site in ovary cancers.

We describe a retrospective analysis of 105 patients who underwent day-case laparoscopic cholecystectomy to evaluate the safety of this procedure. Selection criteria included surgical indications and admission/exclusion criteria for day-case surgery. We analysed: causes of overnight stay and readmission, need of medical or nursing care after discharge, degree of patient satisfaction and insatisfaction reasons. This study has demonstrated a low rate of overnight stay and readmission and a high degree of patient satisfaction for this procedure. We concluded that in selected patients, laparoscopic cholecystectomy as a day-case surgery is a safe procedure.

Eighteen hemodialysis patients with the diagnosis of mesenteric ischemia (MI), admitted to the Renal Service in the last 5 years, were retrospectively reviewed. All patients, 10 males and 8 females, average age 66.3 +/- 8.6 years, were complaining of acute abdominal pain without other specific clinical or laboratorial findings, had their diagnosis confirmed during laparatomy, with ischemic involvement of the ileocecal/ascendant colon area in 14 cases and the small bowel in 4. Noteworthy was the high incidence of previous dialysis-induced hypotensive episodes (10/18), the presence of leukocytosis (13/18), the high average hemoglobin level of 9.4 gr/dl, and the constant finding of non-occlusive MI. Average time in-hospital was 15.4 days (2 to 30) and the mortality--88% (16 patients). The growing incidence of MI mostly of the non-occlusive type, and its grim prognosis, calls for an early diagnosis of functional ischemic colitis, and the adoption of preventive action to avoid bowel infarction.