1/179. carboplatin-related hematuria and acute renal failure.cisplatin is a potent tubular toxin with a high incidence of nephrotoxicity. carboplatin is considered less nephrotoxic but can still cause tubular injury and interstitial nephritis in patients who have been previously treated with cisplatin. The affected individuals usually have nonoliguric renal failure with a urine output of more than a liter per day. We present a 57-year-old white woman with no history of renal disease who underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for stage IC ovarian carcinoma. One month later, she received chemotherapy with paclitaxel (Taxol) and carboplatin. On the following day, she developed frank hematuria and flank pain associated with a diminished urine output. Intravenous pyelogram (IVP) showed bilateral hydronephrosis with a total blockage of dye flow at the level of intraureteral lucencies consistent with bilateral blood clots. Her coagulation profile and uric acid was normal. Her acute renal failure (ARF) spontaneously resolved in the following 24 hours, with a brisk diuresis presumably due to clot lysis. The follow-up IVP showed a resolution of obstructive changes. A review of the literature shows a previous case in which high doses of carboplatin were implicated as the cause of hemorrhagic cystitis, presumably by toxicity to transitional epithelium of the bladder. We believe that the current case represents carboplatin-induced damage to the transitional epithelium in the renal pelvi and ureters causing gross hematuria and blood clots, resulting in bilateral ureteral obstruction and hydronephrosis.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/179. Renal auto-transplantation with interposed PTFE arterial graft: not necessarily a cure for loin pain/haematuria syndrome.A case report of a 23 year old man is described who was diagnosed with loin pain/haematuria syndrome. Despite auto-transplantation with interposed polytetrafluoroethylene (PTFE)-prosthesis in the arterial anastomosis the symptoms recurred. A possible mechanism for the recurrent pain is proposed.- - - - - - - - - - ranking = 6keywords = pain (Clic here for more details about this article) |
3/179. hematuria from arteriovesical fistula: unusual presentation of ruptured iliac artery aneurysm.iliac artery aneurysm rupture can be rapidly fatal if not diagnosed immediately. These aneurysms usually present in patients with other aneurysmal diseases of the aortoiliac arterial system. If not diagnosed and surgically repaired, iliac artery aneurysms can proceed to expand and ultimately rupture, usually presenting with back, flank, or abdominal pain and, possibly, signs of systemic shock. We present an unusual case report of a common iliac artery aneurysm rupture presenting as gross hematuria due to an arteriovesical fistula. Only three other cases of arteriovesical fistulae have been reported previously. Unlike the case presented, all three of these cases involved trauma or surgical instrumentation or manipulation of the bladder.- - - - - - - - - - ranking = 1.798711619002keywords = pain, abdominal pain (Clic here for more details about this article) |
4/179. hematuria: an unusual presentation for mucocele of the appendix. Case report and review of the literature.mucocele of the appendix is a nonspecific term that is used to describe an appendix abnormally distended with mucus. This may be the result of either neoplastic or non-neopleastic causes and may present like most appendiceal pathology with either mild abdominal pain or life-threatening peritonitis. Urologic manifestations of mucocele of the appendix have rarely been reported. laparoscopy can be used as a diagnostic tool in equivocal cases. Conversion to laparotomy may be indicated if there is a special concern for the ability to remove the appendix intact or if more extensive resection is warranted, as in malignancy. We here report our experience with a woman presenting with hematuria whose ultimate diagnosis was mucocele of the appendix, and we review the appropriate literature. This case highlights the mucocele as a consideration in the differential diagnosis of appendiceal pathology and serves to remind the surgeon of the importance for careful intact removal of the diseased appendix.- - - - - - - - - - ranking = 1.798711619002keywords = pain, abdominal pain (Clic here for more details about this article) |
5/179. A case of pelvic arteriovenous malformation in a male.BACKGROUND: Congenital pelvic arteriovenous malformation (AVM) is rare especially in males. We present a case of pelvic AVM in a 38-year-old male. He was admitted to our hospital with left flank abdominal pain and painless gross hematuria. methods/DISCUSSION: Pelvic computed tomography demonstrated a homogeneous contrast-enhanced mass, 6 cm in diameter. For diagnosis, non-invasive magnetic resonance imaging (MRI) and color Doppler ultrasonography were very useful in our case. Though the treatment is controversial, we decided to monitor his clinical course.- - - - - - - - - - ranking = 2.798711619002keywords = pain, abdominal pain (Clic here for more details about this article) |
6/179. Acute renal infarction. Clinical characteristics of 17 patients.We analyzed the medical records of patients with an established diagnosis of acute renal infarction to identify predictive parameters of this rare disease. Seventeen patients (8 male) who were admitted to our emergency department between May 1994 and January 1998 were diagnosed by contrast-enhanced computed tomography (CT) as having acute renal infarction (0.007% of all patients). We screened the records of the 17 patients for a history with increased risk for thromboembolism, clinical symptoms, and urine and blood laboratory results known to be associated with acute renal infarction. A history with increased risk for thromboembolism with 1 or more risk factors was found in 14 of 17 patients (82%); risk factors were atrial fibrillation (n = 11), previous embolism (n = 6), mitral stenosis (n = 6), hypertension (n = 9), and ischemic cardiac disease (n = 7). All patients reported persisting pain predominantly from the flank (n = 11), abdomen (n = 4), and lower back (n = 2). On admission, elevated serum lactate dehydrogenase was found in 16 (94%) patients, and hematuria was found in 12 (71%) of 17 patients. After 24 hours all patients showed an elevated serum lactate dehydrogenase, and 14 (82%) had a positive test for hematuria. Our findings suggest that in all patients presenting with the triad--high risk of a thromboembolic event, persisting flank/abdominal/lower back pain, elevated serum levels of lactate dehydrogenase and/or hematuria within 24 hours after pain onset--contrast-enhanced CT should be performed as soon as possible to rule out or to prove acute renal infarction.- - - - - - - - - - ranking = 3keywords = pain (Clic here for more details about this article) |
7/179. Abdominal aortic aneurysm with aorta-left renal vein fistula with left varicocele.Abdominal aortic aneurysm with spontaneous aorto-left renal vein fistula is a rare but well-described clinical entity usually with abdominal pain, hematuria, and a nonfunctioning left kidney. This report describes a 44-year-old man with left-sided groin pain and varicocele who was treated with conservative measures only. The diagnosis was eventually made when he returned with microscopic hematuria, elevated serum creatinine level, and nonfunction of the left kidney; computed tomography scan demonstrated a 6-cm abdominal aortic aneurysm, a retroaortic left renal vein, and an enlargement of the left kidney. This patient represents the youngest to be reported with aorto-left renal vein fistula and the second case with a left-sided varicocele.- - - - - - - - - - ranking = 2.798711619002keywords = pain, abdominal pain (Clic here for more details about this article) |
8/179. Chronic painless hematuria and urethral bleeding as the presenting manifestations of Osler-Weber-Rendu disease.A case of a young man with profound iron deficiency anemia, chronic painless hematuria and urethral bleeding is presented. He had the typical cutaneous findings of Osler-Weber-Rendu disease (hereditary hemorrhagic telangiectasia). Appropriate urological studies demonstrated bladder and urethral telangiectases, with no other explanation for the bleeding. Osler-Weber-Rendu disease should be considered in the differential diagnosis of chronic painless hematuria.- - - - - - - - - - ranking = 6keywords = pain (Clic here for more details about this article) |
9/179. radiation-induced pseudocarcinomatous proliferations of the urinary bladder: a report of 4 cases.Four cases of radiation cystitis that caused diagnostic difficulty because of an epithelial proliferation with architectural complexity and reactive cytologic atypia are described. The patients, 2 male, 2 female, were from 43 to 77 years of age. Two presented with hematuria. cystoscopy disclosed abnormalities in 3 patients. Microscopic examination showed irregularly shaped and arranged aggregates of epithelial cells in the upper and mid zones of the lamina propria. The cells, which typically showed at least mild, and sometimes severe, pleomorphism, were usually transitional, but squamous differentiation was seen focally in 3 cases. Ulceration of the overlying epithelium was present in all cases and was prominent and associated with conspicuous fibrin and hemorrhage in one of them. edema of the lamina propria was present in 3 cases, whereas lamina propria fibrosis and chronic inflammation were present in all cases. The presence in all 4 cases of vascular ectasia and other changes characteristic of radiation injury, such as atypical fibroblasts, prompted investigation of the clinical history in 2 cases in which the pathologist was unaware that the patient had received radiation. Pseudocarcinomatous proliferations in the bladder caused by radiation injury have received limited attention in the literature. Our cases illustrate the potential diagnostic errors with which these lesions may be associated.- - - - - - - - - - ranking = 0.053835100749003keywords = upper (Clic here for more details about this article) |
10/179. Inverted papilloma as a cause of high-grade ureteral obstruction.Inverted papilloma of the urinary tract is a rare benign lesion. We report, to our knowledge, the first case of high-grade ureteral obstruction caused by an inverted papilloma with coexistent carcinomatous elements. Our patient was referred for evaluation of painless, gross hematuria. Imaging studies demonstrated a left proximal ureteral filling defect causing severe left-sided hydroureteronephrosis. ureteroscopy demonstrated a 1-cm papillary lesion on the medial aspect of the proximal ureteral wall. Pathologic examination documented a lesion with elements of inverted papilloma and a small focus of well-differentiated transitional cell carcinoma. We discuss the management and significance of this rare urothelial lesion.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
| | Next -> |