Perirenal space blocking restores gastrointestinal function in patients with severe acute pancreatitis

AIM:To investigate effects of perirenal space blocking(PSB)on gastrointestinal function in patients with severe acute pancreatitis(SAP).METHODS:Forty patients with SAP were randomly allocated to receive PSB or no PSB(NPSB).All the SAP patients received specialized medical therapy(SMT).Patients in the PSB group received PSB+SMT when hospitalized and after diagnosis,whereas patients in the NPSB group only received SMT.A modifed gastrointestinal failure(GIF)scoring system was used to assess the gastrointestinal function in SAP patients after admission.Pain severity(visual analog scale,0 to100)was monitored every 24 h for 72 h.RESULTS:Modified GIF score decreased in both groups during the 10-d study period.The median score decrease was initially significantly greater in the PSB group than in the NPSB group after PSB was per-formed.During the 72-h study period,pain intensity decreased in both groups.The median pain decrease was significantly greater in the PSB group than in the NPSB group at single time points.Patients in the PSB group had significantly lower incidences of hospital mortality,multiple organ dysfunction syndrome,systemic inflammatory response syndrome,and pancreatic infection,and stayed in the intensive care unit for a shorter duration.However,no difference in terms of operation incidence was found between the two groups.CONCLUSION:PSB could ameliorate gastrointestinal dysfunction or failure during the early stage of SAP.Moreover,PSB administration could improve prognosis and decrease the mortality of SAP patients.

Perirenal extra-adrenal myelolipoma

Myelolipomas are rare tumors consisting of both adipose and hematopoietic tissue and are typically found within the adrenal gland. Extra-adrenal involvement is rare, especially those tumors involving the perirenal space and collecting system. We report a case of a patient with an incidentally discovered perirenal mass that was initially concerning for a retroperitoneal liposarcoma. Following surgical resection and pathological analysis, the lesion was found to be an extra-adrenal myelolipoma. This case report and review of the literature demonstrates the importance of the proper workup and management of perirenal lipoma variants while addressing the issues of tissue biopsy, surgical intervention, and pre- and post-operative surveillance.

Telmisartan prevents high-fat diet-induced hypertension and decreases perirenal fat in rats

We sought to investigate the effects of telmisartan on high-fat diet-induced hypertension and to explore the possible underlying mechanisms. Rats receiving high-fat diet were randomly divided into two groups, the tel- misartan group （n = 9） and the high-fat diet group （n = 10）. The control group consisted of age-matched rats on a regular diet （n = 10）. At the end of the treatment, the body weight, blood pressure, insulin sensitivity and serum adiponectin levels of all rats were examined, and their visceral fat was extracted and weighed. Our results showed that telmisartan improved insulin resistance and dyslipidemia and increased serum adiponectin levels. Telmisar- tan also lowered both systolic blood pressure and diastolic blood pressure, and decreased the accumulation of perirenal fat associated with high-fat diet. Furthermore, telmisartan increased adiponectin mRNA expression in the perirenal fat. Correlation analysis showed that both systolic blood pressure and diastolic blood pressure were positively correlated with perirenal fat. These effects of telmisartan may be mediated through decreases in perirenal fat and contributed to the improvement of perirenal fat function. Our findings suggested a strong link between perirenal fat and high-fat diet-induced hypertension, and identified telmisartan as a potential drug for the treatment of obesity-related hypertension.

The effect of perirenal fat stranding on infectious complications after ureterorenoscopy in patients with ureteral calculi

Objective:Perirenal fat stranding(PFS)is linear areas of soft-tissue attenuation in the perirenal space on non-contrast computed tomography.The present study aimed to investigate whether PFS is associated with infectious complications after ureterorenoscopy(URS)in patients with ureteral calculi in any location.Methods:The data of 602 patients with ureteral stones who underwent URS were analyzed retrospectively.The patients were divided into two groups as Group 1(PFS not detected)and Group 2(PFS detected).Gender,and age of patients,size,side,and location of the stone,operation time,double-J stent insertion status,perioperative ureter injury,postoperative infection after URS and related complications,and duration of hospital stay were compared.Results:While PFS was not detected in 530 patients,PFS was detected in 72 patients.The mean age,male/female ratio,side and localization of the stones,operation time,and perioperative insertion of the double-J after lithotripsy were statistically similar(p>0.05).The median stone diameter was smaller in Group 2(9 mm vs.8 mm)(p=0.033).Fever was observed in 30 and 38 patients in Group 1 and Group 2,respectively(p=0.0001).Urinary tract infection was detected in 24 and 27 patients in Group 1 and Group 2,respectively(p=0.0001).The urosepsis did not occur in any patients in Group 1,whereas 8(11.1%)patients in Group 2 experienced urosepsis(p=0.0001).Conclusion:According to the results of the present study,patients with ureteral stones accompanied by PFS are much more prone to ureteral injuries and infectious complications such as urinary tract infection,fever,and sepsis after URS.

Immunoglobulin G4-related kidney disease involving the renal pelvis and perirenal fat:A case report

BACKGROUND Immunoglobulin(Ig)G4-related disease(Ig G4-RD)is an autoimmune disease associated with chronic and progressive inflammation and fibrosis.It is difficult to differentiate Ig G4-RD involving the kidney from infectious diseases and malignancy on imaging.CASE SUMMARY We report the case of a 51-year-old Chinese man whose abdominal computed tomography scan showed diffuse bilateral enlargement of the kidneys and perirenal fat,thickening of the renal pelvic walls,and hydronephrosis of the right kidney.Relevant laboratory test results showed a serum creatinine level of 464μmol/L.The patient was diagnosed with acute renal failure and was started on intermittent hemodialysis.Further tests revealed high serum Ig G4 levels(20.8 g/L)and an enlarged right submaxillary lymph node.Biopsy and histopathological examination of the enlarged node led to the diagnosis of Ig G4-RD.After corticosteroid therapy,his serum creatinine level quickly decreased to near normal levels.CONCLUSION Ig G4-RD affecting the renal pelvis or perirenal fat is rare,with atypical imaging features.Multidisciplinary consultation is critical for accurate diagnosis and treatment of this disease.Suspected cases should undergo biopsy to avoid misdiagnosis.

Pleural effusion and ascites in extrarenal lymphangiectasia causedby post-biopsy hematoma: A case report

BACKGROUNDThe renal system has a specific pleural effusion associated with it in the form of“urothorax”, a condition where obstructive uropathy or occlusion of thelymphatic ducts leads to extravasated fluids (urine or lymph) crossing thediaphragm via innate perforations or lymphatic channels. As a rare disorder thatmay cause pleural effusion, renal lymphangiectasia is a congenital or acquiredabnormality of the lymphatic system of the kidneys. As vaguely mentioned in areport from the American Journal of Kidney Diseases, this disorder can be causedby extrinsic compression of the kidney secondary to hemorrhage.CASE SUMMARYA 54-year-old man with biopsy-proven acute tubulointerstitial nephropathyexperienced bleeding 3 d post hoc, which, upon clinical detection, manifested as amassive perirenal hematoma on computed tomography (CT) scan withoutconcurrent pleural effusion. His situation was eventually stabilized byexpeditious management, including selective renal arterial embolization. Despite good hemodialysis adequacy and stringent volume control, a CT scan 1 mo laterfound further enlargement of the perirenal hematoma with heterogeneoushypodense fluid, left side pleural effusion and a small amount of ascites. Thesefluid collections showed a CT density of 3 Hounsfield units, and drained fluid ofthe pleural effusion revealed a dubiously light-colored transudate withlymphocytic predominance (> 80%). Similar results were found 3 mo later, duringwhich time the patient was free of pulmonary infection, cardiac dysfunction andovert hypoalbuminemia. After careful consideration and exclusion of otherpossible causative etiologies, we believed that the pleural effusion was due to theocclusion of renal lymphatic ducts by the compression of kidney parenchymaand, in the absence of typical dilation of the related ducts, considered our case asextrarenal lymphangiectasia in a broad sense.CONCLUSIONAs such, our case highlighted a morbific passage between the kidney and thoraxunder an extraordinarily rare condition. Given the paucity of pertinentknowledge, it may further broaden our understanding of this rare disorder.

Comparison of fatty acid profile of three adipose tissues in Ningxiang pigs

The present study is conducted to determinate fatty acids(FA) composition in 3 adipose tissues. Subcutaneous and perirenal adipose tissues were prepared from 24 Ningxiang castrated boars and 24 castrated gilts fattened by a traditional diet for 56 d, respectively. The results showed that the FA profile in the 3 adipose tissues(dorsal subcutaneous adipose [DSA], abdominal subcutaneous adipose [ASA], and perirenal adipose [PA]) differed greatly. In boars, the proportions of oleic acid(c18:1 n9 c)(P < 0.05), cis-11-20 c acid(c20:1)(P < 0.05), and a-linolenic acid(c18:3 n3)(P < 0.05) in DSA were the highest among 3 adipose tissues, whereas palmitic acid(c16:0)(P < 0.05) and stearic acid(c18:0)(P < 0.05) in DSA had the lowest proportion. In gilts, cis-11-20 c acid(c20:1)(P < 0.05) in DSA was the highest, while stearic acid(c18:0)(P < 0.05) in subcutaneous adipose was the lowest among these deposits. Overall, the results indicate that from external to inner carcass of boars, the sum of saturated fatty acids(SFA) increase, but the sum of monounsaturated fatty acids(MUFA) decrease, while ASA of gilts have the greatest proportion of MUFA and the lowest SFA. Sex and adipose locations as significant effects on the FA profile are interaction.