Renal transplants: can acute rejection and acute tubular necrosis be differentiated with MR imaging?

Article Abstract:

Kidney (renal) transplants are frequently performed in the United States. As with any organ transplant, rejection of the transplanted kidney is a major problem. Early detection of rejection or other problems is very important in providing effective treatment. It is often difficult to differentiate between the problems of acute rejection of the transplant and acute tubular necrosis (ATN, or death of tubular tissue). Some research has suggested that corticomedullary differentiation (CMD; between the inner and outer layer of the kidney) is lost in rejection, but maintained in ATN. This study examined the use of magnetic resonance (MR) imaging to detect the loss of CMD, and differentiate between ATN and rejection of a transplanted kidney. MR examinations were performed in 40 renal transplant patients soon after surgery. In addition, 37 follow-up MR imaging procedures were performed in 29 patients, 10 of whom having had no renal problems and the other 19 having had various problems. Initial MR examinations found good or fair CMD in 22 patients with initially normal renal function. ATN developed in 16 patients; MR imaging revealed poor CMD in 11 of these patients, fair CMD in 3, and good CMD in 2. One patient with acute rejection had poor CMD and one with both ATN and rejection had fair CMD. Follow-up MR examinations found poor CMD in 12 of 17 cases of ATN (71 percent), in 8 of 11 cases (73 percent) of acute rejection, and in 6 of 7 cases (86 percent) involving a combination of ATN, acute rejection, and other renal problems. Follow-up imaging showed that CMD improved in five patients whose post-transplant renal problems resolved. These results indicate that although decreased CMD is indicative of renal problems, it is occurs with both ATN and rejection, as well as other problems, and is not a useful factor in differentiating between ATN and rejection of a transplanted kidney. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Measurement, Complications and side effects, Graft rejection, Kidneys, Kidney transplantation, Magnetic resonance imaging, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation, Kidney, Kidney diseases

---

Fluoroscopically guided nasoenteric feeding tube placement: results of a 1-year study

Article Abstract:

Chronically ill patients must have adequate nutrition to successfully overcome their diseases, but they are often unable to take in enough food and liquids on their own. These patients often require a feeding tube to ensure that they receive the nutrients they need. Nasoenteric feeding tubes have been in use for just over a decade. They are placed through the nose and advanced into the intestines for direct feeding into the intestines. Complications arising from using these tubes are often caused by improper positioning of the tubes during placement. This study examined the use of a fluoroscope (an X-ray imaging device) to guide placement of the tubes in order to prevent complications caused by improper positioning. The study examined success and complication rates in placing 882 nasoenteric feeding tubes with a fluoroscope in 448 patients during a one-year period. There were 764 successful placements (86.6 percent), 43 partially successful placements (4.9 percent), and 65 unsuccessful placements (7.4 percent). Failures were mainly caused by inability to pass the tube through the pyloric channel (outlet of the stomach) or the hypopharynx (back of the throat). Tube repositioning was required in 654 patients, with 503 of these caused by dislodgement from the jejunum (a section of the small intestine). Major complications occurred in four (0.4 percent) of the patients during or immediately after placement, with only one of these being caused by malpositioning of the tube. Six patients (1 percent) experienced diarrhea and 27 patients (6 percent) developed aspiration pneumonia (caused by the feeding mixture entering the lungs). Two-thirds of the patients with aspiration pneumonia had tubes found not in their original positions. These results indicate that placement of a nasoenteric feeding tube using a fluoroscope as a guide is safe and effective. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Enteral feeding, Enteral nutrition, Artificial feeding, Feeding methods, Tube feeding, Fluoroscopy

---

Biliary carcinoma: CT evaluation of extrahepatic spread

Article Abstract:

The use of computed tomography (CT), an X-ray procedure which allows the radiologist to produce images of the abdomen and liver which appear as if the patient was serially sectioned, was applied to an evaluation of the spread of cancer (metastasis) of the bile duct system outside of the liver (extrahepatic spread). The confirmation of a primary cancer of the bile duct system spreading outside of the liver is a poor prognostic factor and may serve as an indication of the futility of the application of an aggressive surgical procedure. Fifty-six patients with proven biliary cancer and 75 patients with no evidence of such cancer were involved in the study with the CT. Of those with biliary disease, 20 patients had cancer of the gall bladder. In 14 cases there was evidence of metastasis to lymph nodes outside of the liver and, in nine, to the peritoneum (the lining of the abdominal cavity). These findings were established by CT. Twenty-two patients had a diagnosis of cancer of the bile duct close to the liver, and 73 percent of these patients had metastatic involvement when first seen; four patients later developed lymph node involvement and five had involvement of the peritoneum. The spread of biliary cancer to lymph nodes distant to the liver is an important factor in staging and in the prognosis of this disease. A highly significant number of patients develop metastases even following what was hoped to be curative surgery.

Metastasis, Cancer metastasis, PET imaging, Positron emission tomography, Liver cancer, Pelvic cancer, Lymphatic metastasis, Biliary tract diseases, Gallbladder cancer

Similar abstracts:

• Abstracts: Exogenous reinfection with multidrug-resistant Mycobacterium tuberculosis in patients with advanced HIV infection
• Abstracts: The Marlboro Grand Prix: circumvention of the television ban on tobacco advertising. The Master Settlement Agreement with the tobacco industry and cigarette advertising in magazines
• Abstracts: A model of intrauterine infection and preterm delivery in mice. A high-throughput study of gene expression in preterm labor with a subtractive microarray approach
• Abstracts: Synthetic enamel repairs early carious lesion. Should a dental explorer be used to probe suspected carious lesions?
• Abstracts: Identification of high-risk and low-risk subgroups of patients with mitral-valve prolapse. Echocardiographic detection of left atrial extension of bronchial carcinoma

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.