1/84. Use of hemiacidrin in management of infection stones.Unless all fragments are removed at the time of surgery for struvite stones a high incidence of recurrent infection and stone formation is likely. To reduce the recurrence rate of such stones the renal pelvis is irrigated postoperatively with 10 per cent hemiacidrin solution for at least 48 hours or until all fragments have been dissolved. We have managed successfully 35 patients (36 kidneys) without enxountering any complications. Included in our most recent series are 2 patients with solitary kidneys who had successful dissolution of stone fragments. Absolute contraindications to the use of hemiacidrin are infected urine, fever or flank discomfort. Although we have found hemiacidrin dissolution of renal stones to be safe and effective it is essential that the clinician be aware of the proper technique and its possible complications.- - - - - - - - - - ranking = 1keywords = discomfort (Clic here for more details about this article) |
2/84. ceftriaxone-associated nephrolithiasis and biliary pseudolithiasis.Biliary pseudolithiasis has been reported in patients who received ceftriaxone therapy. In addition to biliary sludge formation occasional reports of ceftriaxone-induced nephrolithiasis have been published. In general, these adverse effects will develop after seven to ten days of treatment. We report on a seven-year-old boy with ceftriaxone-associated biliary pseudolithiasis and nephrolithiasis four days after initiation of treatment. patients receiving a high dose of ceftriaxone and developing colicky abdominal pain should be considered for ultrasound and a change in antibiotic therapy if appropriate.- - - - - - - - - - ranking = 0.65759970706402keywords = abdominal pain (Clic here for more details about this article) |
3/84. Thymic carcinoid and parathyroid hyperplasia detection with 99mTc-MIBI men type 1.We report a case of a 35-year-old male, with a history of diarrhea, renal lithiasis with frequent expulsions of calculus and hypercalcemia during the last 2 years. The patient was studied and diagnosed with a multiple endocrine neoplasia type I (MEN I), familiar (mother with MEN I). A scintigraphic study with 99mTc-MIBI was performed in order to localize hyperfunctioning parathyroid glands because of biochemical diagnosis of primary hyperparathyroidism. Double phase 99mTc-MIBI scan detected one hyperfunctioning parathyroid gland and a large anterior mediastinal mass. Subsequent, plain radiograph and CT of the chest showed a soft-tissue mass in that localization. Punch biopsy of the lesion guided by CT revealed malignant cells of neuroendocrine tumor. The tumor was removed and histologically confirmed as a carcinoid within a thymus in a MEN type I syndrome. MEN I patients can benefit from the examination with this agent which can potentially localize not only parathyroid endocrine pathology but also unknown associated tumors.- - - - - - - - - - ranking = 0.0097555937318949keywords = chest (Clic here for more details about this article) |
4/84. Acute pancreatitis caused by extracorporeal shock wave lithotripsy for bilateral renal pelvic calculi.An elderly woman with a history of cholecystectomy and a re-operation for postoperative peritonitis underwent extracorporeal shock wave lithotripsy (ESWL) for right and left renal pelvic calculi, 11 x 6 and 12 x 5 mm in size, to which 2400 and 1400 shots at 20 kV were given, respectively, on the same day. During the evening after the operation, the patient started to complain of upper abdominal pain. Laboratory examination on the next day revealed elevations in blood and urine amylase levels and a diagnosis of pancreatitis was made. Conservative treatment, including administration of protease inhibitor, did not improve her symptoms; abdominal distension became marked and she underwent laparotomy. Necrosection and indwelling of several drain tubes in abdomen were performed with an operative diagnosis of acute necrotic pancreatitis. With daily irrigation of drain tubes and treatment for methicillin-resistant Staphyloococcus aureus infection of the lungs and abdominal cavity, septicemia and duodenal fistula, the patient gradually recovered and was discharged on postoperative day 151. It was suggested that ESWL was responsible for the acute pancreatitis. Either an obstruction of the pancreatic duct by fragments of common duct stone, or mechanical injury of the pancreas due to adhesion between the pancreas and surrounding tissue caused by the lapalotomy, was considered as a possible cause of pancreatitis. To our knowledge, there has been no previous report of severe acute pancreatitis and the present case suggests that ESWL may cause severe pancreatic even in cases without stone shadow in the bile, common duct or pancreatic duct.- - - - - - - - - - ranking = 0.95204977376246keywords = abdominal pain, upper (Clic here for more details about this article) |
5/84. radiology of abdominal pain.radiology plays an integral role in the evaluation of patients with significant abdominal pain. The cross-sectional modalities (computed tomography, ultrasound, and magnetic resonance imaging) are widely used, but there is sometimes confusion about how to use each test appropriately. We review how each test is done, consider the strengths and weaknesses of each modality, and discuss how to use them in an intelligent, cost-effective manner.- - - - - - - - - - ranking = 3.2879985353201keywords = abdominal pain (Clic here for more details about this article) |
6/84. Localized dissection and delayed rupture of the abdominal aorta after extracorporeal shock wave lithotripsy.Extracorporeal shock wave lithotripsy (ESWL) represents the preferred treatment for most upper ureteric and renal calculi. Complication rates associated with ESWL are low, justifying the enthusiasm and acceptance of this treatment modality. As the technique has become more widely available, some deleterious effects on the kidneys and the surrounding tissues are increasingly recognized. We report on the rupture of a severely calcified abdominal aorta in a 65-year-old man who underwent 3 months of ESWL treatment earlier for renal calculi. The patient was seen with an acute recrudescence of a long-standing abdominal and left flank pain, which began immediately after the last of the three sessions of ESWL and was associated with an episode of hypotension that occurred an hour before admission. Patient history and chronologic course of events strongly suggest the role of ESWL in the genesis of abdominal aorta rupture.- - - - - - - - - - ranking = 0.29445006669844keywords = upper (Clic here for more details about this article) |
7/84. milk of calcium in the inferior calyx of a hydronephrotic kidney in a tetraplegic patient - a diagnosis to be made before scheduling for extracorporeal shock wave lithotripsy.STUDY DESIGN: A Case Report of renal milk of calcium in a tetraplegic subject. OBJECTIVES: To increase the awareness of renal milk of calcium in spinal cord injury (SCI) physicians. Renal milk of calcium contains a colloidal suspension of calcium crystals. Since upright views of the kidneys are not performed in tetraplegic subjects, the renal milk of calcium may be misinterpreted as renal lithiasis by routine radiography taken in supine position. SETTING: Regional spinal injuries Centre, Southport, england. METHOD: In a 41-year-old male with traumatic tetraplegia, X-ray of abdomen in supine position showed multiple opacities in the region of the left kidney. These radio opaque shadows were interpreted as renal calculi. Subsequently, computed tomography (CT) of the kidneys was performed. RESULTS: CT confirmed the presence of calculi in the mid-polar calyx. However, the density situated in the inferior calyx of the hydronephrotic left kidney exhibited a horizontal upper edge. This specific radiological finding as observed in the CT of kidneys, provided the clue to the presence of milk of calcium in the inferior calyx of the hydronephrotic left kidney. CONCLUSION: As plain film of the abdomen in standing position is not performed in SCI patients, physicians caring for SCI patients should have a high index of suspicion for renal milk of calcium. Prompt diagnosis of renal milk of calcium will help to avoid unnecessary surgery, or extracorporeal shock wave lithotripsy.- - - - - - - - - - ranking = 0.29445006669844keywords = upper (Clic here for more details about this article) |
8/84. Patterns of sulfadiazine acute nephrotoxicity.sulfadiazine acute nephrotoxicity is reviving specially because of its use in toxoplasmosis in hiv-positive patients. We report 4 cases, one of them in a previously healthy person. Under treatment with sulfadiazine they developed oliguria, abdominal pain, renal failure and showed multiple radiolucent renal calculi in echography. All patients recovered their previous normal renal function after adequate hydration and alcalinization. A nephrostomy tube had to be placed in one of the patients for ureteral lithiasis in a single functional kidney. None of them needed dialysis or a renal biopsy because of a typical benign course. Treatment with sulfadiazine requires exquisite control of renal function, an increase in water ingestion and possibly the alcalinization of the urine. We communicate a case in a previously healthy person, a fact not found in the recent literature. Probably many more cases are not detected. We think that a prospective study would be useful.- - - - - - - - - - ranking = 0.65759970706402keywords = abdominal pain (Clic here for more details about this article) |
9/84. Silent hydronephrosis/pyonephrosis due to upper urinary tract calculi in spinal cord injury patients.STUDY DESIGN: A study of four patients with spinal cord injury (SCI) in whom a diagnosis of hydronephrosis or pyonephrosis was delayed since these patients did not manifest the traditional signs and symptoms. OBJECTIVES: To learn from these cases as to what steps should be taken to prevent any delay in the diagnosis and treatment of hydronephrosis/pyonephrosis in SCI patients. SETTING: Regional spinal injuries Centre, Southport, UK. methods: A retrospective review of cases of hydronephrosis or pyonephrosis due to renal/ ureteric calculus in SCI patients between 1994 and 1999, in whom there was a delay in diagnosis. RESULTS: A T-5 paraplegic patient had two episodes of urinary tract infection (UTI) which were successfully treated with antibiotics. When he developed UTI again, an intravenous urography (IVU) was performed. The IVU revealed a non-visualised kidney and a renal pelvic calculus. In a T-6 paraplegic patient, the classical symptom of flank pain was absent, and the symptoms of sweating and increased spasms were attributed to a syrinx. A routine IVU showed non-visualisation of the left kidney with a stone impacted in the pelviureteric junction. In two tetraplegic patients, an obstructed kidney became infected, and there was a delay in the diagnosis of pyonephrosis. The clinician's attention was focused on a co-existent, serious, infective pathology elsewhere. The primary focus of sepsis was chest infection in one patient and a deep pressure sore in the other. The former patient succumbed to chest infection and autopsy revealed pyonephrosis with an abscess between the left kidney and left hemidiaphragm and xanthogranulomatous inflammation of perinephric fatty tissue. In the latter patient, an abdominal X-ray did not reveal any calculus but computerised axial tomography showed the presence of renal and ureteric calculi. CONCLUSIONS: The symptoms of hydronephrosis may be bizarre and non-specific in SCI patients. The symptoms include feeling unwell, abdominal discomfort, increased spasms, and autonomic dysreflexia. physicians should be aware of the serious import of these symptoms in SCI patients.- - - - - - - - - - ranking = 2.1973114542575keywords = discomfort, upper, chest (Clic here for more details about this article) |
10/84. Double infundibular obliteration with abscess formation after percutaneous nephrolithotomy.A case of an unusual complication after percutaneous nephrolithotomy. After removal of an infectious staghorn calculus followed by SWL, the patient developed a double infundibular stricture leaving the kidney divided into three separate compartments. In spite of the absence of clinical symptoms of infection, this was further complicated by abscess formation and finally, function loss of the upper part of the kidney. Combined retro- and anterograde endoscopic surgery failed to re-establish the complete continuity of the uretero-caliceal system and the patient had to undergo partial nephrectomy. Possible etiologies, contributing factors and means of prevention for this rare complication are discussed.- - - - - - - - - - ranking = 0.29445006669844keywords = upper (Clic here for more details about this article) |
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