Management of Large Retroperitoneal Lipoma in a 12-Year-Old Patient

Retroperitoneal lipomas are rare tumors. The etiology of their proliferation is uncertain. Metabolic and genetic causes have been reported. We present the case of a 12-year-old patient with a large pelvic lipoma causing dysuria and pelvic pain. Magnetic resonance imaging revealed the existence of a large retroperitoneal fat tumor. Ultrasound-guided fine needle biopsy was performed to exclude malignancy. The biopsy specimen revealed tissue consistent with a benign lipoma tumor. Exploratory laparotomy revealed a solid lipoma of the retroperitoneal space 8 × 6 cm and weighing 300 g. The patient had a good postoperative performance status. Lipomas should be considered in the differential diagnosis of a solid tumor in the retroperitoneal space. © 2009 Elsevier Inc. All rights reserved

Long-term prognosis of acute kidney injury after first acute stroke

Background and objectives: Acute kidney injury (AKI) has been associated with increased mortality in a variety of clinical settings. We studied the incidence, predictors, and effect of AKI on long-term overall mortality and cardiovascular events after stroke. Design, setting, participants, & measurements: This was a prospective outcome study of 2155 patients who sustained an acute first-ever stroke and were followed for 10 yr. Patients were divided in two groups: (1) Those with an acute increase (over 48 h) in serum creatinine ≥0.3 mg/dl or a percentage increase of ≥50% and (2) those with a change <0.3 mg/dl, no change at all, or even a reduction. Results: Twenty-seven percent of patients developed AKI after acute stroke. Stroke severity, baseline estimated GFR, heart failure, and stroke subtype predict the occurrence of AKI. The probability of 10-yr mortality for patients with AKI was 75.9 and 57.7 in the patients without AKI (log rank test 45.0; P = 0.001). When patients with AKI were subdivided into three groups according to AKI severity, the probability of 10-yr mortality increased: 73.7, 86.5, and 89.2 in stages 1, 2, and 3, respectively. In Cox proportional hazard analysis, AKI was an independent predictor of 10-yr mortality (P < 0.01) and for the occurrence of new composite cardiovascular events (P < 0.05) after adjustment for available confounding variables. Conclusions: AKI after stroke is a powerful and independent predictor of 10-yr mortality and new composite cardiovascular events. Copyright © 2009 by the American Society of Nephrology

Renal dysfunction in acute stroke: An independent predictor of long-term all combined vascular events and overall mortality

Background. Acute stroke is the third leading cause of death in western societies after ischemic heart disease and cancer. Although it is an emergency disease sharing the same atherosclerotic risk factors with ischemic heart disease, the association of renal function and stroke is poorly investigated. The present study aims at assessing renal function status in patients with acute stroke and investigate any prognostic significance on the outcome. Methods. This is a prospective study of hospitalized first-ever stroke patients over 10 years. The study population comprised 1350 patients admitted within 24 h from stroke onset and followed up for 1 to 120 months or until death. Patients were divided in 3 groups on the basis of the estimated Glomerular Filtration Rate (eGFR) that was calculated from the abbreviated equation of the Modification Diet for Renal Disease in ml/min/1.73m2 of body surface area: Group-A comprised patients who had eGFR > 60, group-B those with 30 ≤ eGFR ≤ 60 and group-C patients with eGFR < 30. Patients with Acute Kidney Injury (AKI) were excluded from the study. The main outcome measures were overall mortality and the composite new cardiovascular events (myocardial infarction, recurrent stroke, vascular death) among the 3 groups during the follow-up period. Results. Almost 1/3 (28.08%) of our acute stroke patients presented with moderate (group B) or severe (group C) renal dysfunction as estimated by eGFR. After adjusting for basic demographic, stroke risk factors and stroke severity on admission, eGFR was an independent predictor of stroke mortality at 10 years. Patients in groups B and C had an increased probability of death during follow-up: Hazard ratio = 1.21 with 95% CI 1.01-1.46, p < 0.05 and Hazard ratio = 1.76 with 95% CI 1.14-2.73, p < 0.05 respectively, compared to patients belonging to group A. The probability of death from any cause was significantly different among groups (log rank test 55.4, p = 0.001) during the follow-up period: in group-A patients it was 62.8 (95% CI 57.6-68.1), in group-B 77.3 (95% CI 68.5-86.1) and in group-C 89.2 (95% CI 75.1-100). During the follow-up period 336 new cardiovascular events occurred. The probability to have a new composite cardiovascular event was also significantly different among the 3 groups (log rank test 21.1, p = 0.001): in group-A patients it was 45.2 (95% CI 38.7-51.7), in group-B 67.4 (95% CI 56.2-78.6) and in group-C 77.6 (95% CI 53.5-100). Conclusion. Renal function on admission appears to be a significant independent prognostic factor for long term mortality and new cardiovascular morbidity over a 10-year period. © The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved