1/6. ARF after retrograde pyelography: a case report and literature review.Acute renal failure (ARF) occasionally occurs after intravenous injection of contrast medium, but complications are rare after retrograde pyelography. After reviewing the reports in the English-language literature, the authors found very few on those complications after retrograde pyelography. The authors present a patient who had ARF after the technique. The patient had a history of hypopharyngeal cancer with underlying serum creatinine level at the high end of the normal limits. Bilateral flank pain and decreased urine amount were noted soon after the procedure of retrograde pyelography. Subsequently, blood urea nitrogen and creatinine levels both elevated, and hemodialysis was needed. Several days later, diuretic phase took place. Thereafter, the symptoms subsided gradually. Pyelorenal extravasation of contrast medium was remarkable during the procedure. There was no evidence of hydronephrosis during the course of ARF. Early awareness and management may prevent the complications of ARF such as acute lung edema and hyperkalemia. Therefore, clinical physicians should be aware of the occurrence of ARF and its clinical presentation after performing retrograde pyelography.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. A unique extra-anatomic urinary diversion!The ureter is often involved in pelvic malignancy, leading to obstruction, hydronephrosis, and deterioration of renal function. decompression is provided either by retrograde stenting or by nephrostomy followed by antegrade stent insertion. We present an interesting case where an iatrogenic accident during antegrade stenting led to the placement of the lower end of the stent in the rectal stump. Although this led to a favorable outcome, in that it provided internal continent drainage, it cannot be recommended for emulation. However, it does show that a physician should not only have conventional wisdom but also a good measure of innovation and pragmatism.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. Obstructive uropathy associated with endometriosis.Although endometriosis involving the urinary tract is uncommon, it is responsible for considerable morbidity. A review of eight cases at two Ottawa teaching hospitals from 1979 to 1983 revealed obstructive uropathy in seven patients. There was permanent loss of kidney function in two, ovarian remnant syndrome in two, and patient and family history of renal disease in three. The diagnosis of endometriosis was not made before operation in four patients. endometriosis was localized in four patients and generalized in the remaining four, while four patients had significant uterosacral nodularity. The conclusion reached after study of this small but important population is that physicians should have a heightened awareness of this uncommon but serious manifestation of the disease. Earlier diagnosis might be achieved on the basis of a high index of suspicion and careful physical and pelvic examination. The liberal use of intravenous pyelography even in cases of minimal endometriosis is urged. Intensive and prolonged follow-up of all patients with the diagnosis of endometriosis is recommended until the menopause has been reached. Treatment of obstructive uropathy requires meticulous surgical intervention and we recommend ovarian ablation with adjuvant hormonal therapy in most circumstances.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Stenosing ureteritis in Henoch-Schonlein purpura.We report on a boy with Henoch-Schonlein purpura in whom flank pain and gross hematuria developed during the early phase of the disease. Urologic investigations revealed hydronephrosis and ureteral stenosis. Pyeloplasty was done to relieve ureteropelvic junction obstruction. Severe hemorrhagic ureteritis and vasculitis were noted on the ureteral biopsy. Recovery was slow and residual hydronephrosis persisted. Although abdominal pain usually accompanies Henoch-Schonlein purpura, colicky flank pain associated with hematuria should alert the physician to the presence of ureteritis. Recognition and early surgical treatment of this urologic complication of Henoch-Schonlein purpura may prevent a potentially serious outcome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. barium and fecal impaction: an unusual case of bilateral hydronephrosis.We present an interesting case report of the second adult female reported to suffer from bilateral ureteral hydronephrosis, secondary to a fecal impaction, and the first caused by complications from residual barium. This elderly patient suffers from many associated neurologic, bowel, and urinary tract problems; this case report demonstrates their close proximal relationship. Through ureteral stent placement and manual disimpaction of the barium fecaloma, the patient was able to recover her normal renal and bowel functions. Aided by the use of excellent figures, it is our intent to inform physicians that they should consider fecal impaction as a cause for bilateral ureteral hydronephrosis in predisposed patients, and also the necessity of purging the GI tract of residual barium following radiologic studies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. Intrinsic ureteric involvement by endometriosis: a case report.endometriosis occasionally involves the urinary tract, and a ureteral obstruction from this order constitutes a rare variant with serious consequences. Intrinsic ureteric involvement by endometriosis is an exceedingly rare event. This case report describes intrinsic ureteric involvement by endometriosis. The case involved 47-year-old woman, gravida 4, para 2, who had a 4-year history of dysmenorrhea and hypermenorrhea. An intravenous pyelogram showed a right hydronephrosis. She underwent a total abdominal hysterectomy and a right ureteroureterostomy. A pathologic examination revealed complete obstruction of the right ureter by intrinsic intramural endometriosis. We conclude that because ureteral endometriosis, especially intrinsic endometriosis, is usually silent and results in a high rate of renal loss before recognition, physicians should have a hightened awareness of this uncommon but serious manifestation of endometriosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |