1/53. L4-5 disk lesion resulting in back pain with bowel, bladder and sexual dysfunction without paraparesis.This is a case report of a patient with bowel, bladder and sexual dysfunction associated with low back pain. This patient had an essentially normal neurological examination. There was radiological evidence of a disk lesion, and urodynamic findings consistent with lower motor neuron bladder dysfunction. His symptoms are attributed to a L4-5 disk herniation resulting in a partial cauda equina syndrome. The relevant anatomy is reviewed, and the differential diagnosis is discussed.- - - - - - - - - - ranking = 1keywords = back pain, back (Clic here for more details about this article) |
2/53. Ureterocystoplasty in a patient with a single kidney.Ureterocystoplasty (UCP) has now been widely used for bladder augmentation, with and without unilateral nephrectomy. Many techniques have been described to incorporate portions of the upper renal tract, but none have yet described UCP in a child with unilateral renal agenesis.- - - - - - - - - - ranking = 0.004259111802578keywords = upper (Clic here for more details about this article) |
3/53. The role of 99mtechnetium dimercapto-succinic acid renal scans in the evaluation of occult ectopic ureters in girls with paradoxical incontinence.PURPOSE: We describe the use of 99mtechnetium (Tc) dimercapto-succinic acid (DMSA) renal scintigraphy to document poorly functioning and/or ectopic renal units associated with occult ectopic ureters. MATERIALS AND methods: During the last 8 years 6 toilet-trained girls were referred for lifelong continuous urinary dribbling. Initial radiological evaluation included renal and bladder sonography in 6, excretory urography in 4, a mercaptoacetyltriglycine-3 renal scan in 1 and cystovaginoscopy in 2. Ultimately a 99mTc-DMSA renal scan was performed in all 6 girls before surgical intervention. RESULTS: Sonography failed to establish the diagnosis of ureteral ectopia in all cases, and revealed a normal solitary kidney in 3, normal kidneys in 1, an apparently uncomplicated unilateral duplication without hydroureteronephrosis in 1 and a contralateral uncomplicated duplication in 1. Excretory urography in 4 cases was inconclusive and showed a solitary kidney in 1, ipsilateral duplication without a normal appearing upper pole collecting system in 1, contralateral uncomplicated duplication in 1 and normal kidneys in 1. A mercaptoacetyltriglycine-3 renal scan in another girl with a solitary kidney on sonography failed to demonstrate a contralateral small ectopic kidney. Cystovaginoscopy performed in 2 patients by other pediatric urologists was nondiagnostic. 99mTc-DMSA renal scintigraphy was diagnostic in all 6 cases, and revealed a small poorly functioning ectopic kidney in 3 and a poorly functioning dysplastic upper pole moiety in 3, which were consistent with a diagnosis of ureteral ectopia. An ectopic ureter was confirmed by cystoscopic and surgical findings in all girls. CONCLUSIONS: 99mTc-DMSA renal scintigraphy reliably detects and localizes hypoplastic ectopic kidneys and poorly functioning upper pole moieties associated with occult ectopic ureters in girls with continuous urinary leakage.- - - - - - - - - - ranking = 0.012777335407734keywords = upper (Clic here for more details about this article) |
4/53. Successful immunosuppressant therapy of severe progressive cerebellar degeneration and sensory neuropathy: a case report.A 56 year old woman had a 19 month history of a severe subacute progressive cerebellar degeneration, peripheral sensory neuropathy, and urinary incontinence. She was confined to a wheelchair, needed assistance with eating, and her speech was almost unintelligible. No underlying cancer was found despite repeated investigations, and no autoantibodies were demonstrated. She received a 3-month course of intensive immunosuppressant therapy with intravenous immunoglobulin 400 mg/kg per day for 5 days every month, oral cyclophosphamide 50 mg twice or three times a day to maintain the total lymphocyte count between 500 and 750/mm(3), and prednisone 60 mg per day. She experienced dramatic subjective and objective improvement. The dysarthria and the upper extremity dysmetria disappeared, and she regained the ability to write and cook. The lower extremity ataxia improved and she became able to walk with a cane. urinary incontinence disappeared. A trial of intensive immunosuppressant treatment is worth considering in a patient with a clinical syndrome resembling paraneoplastic disorders, even if an underlying neoplasm and autoantibodies are not demonstrated.- - - - - - - - - - ranking = 0.004259111802578keywords = upper (Clic here for more details about this article) |
5/53. Recurrent abdominal and flank pain in children with idiopathic hypercalciuria.OBJECTIVE: To evaluate the role of idiopathic hypercalciuria (IH) as a cause of recurrent abdominal pain (RAP) in children. patients AND methods: We retrospectively reviewed the medical records of 124 children referred for various complaints who had 24-h urine calcium excretion greater than 2 mg/kg/d or random urine calcium-creatinine ratio greater than 0.18 mg/mg. RESULTS: Fifty-two children with various clinical complaints had RAP or flank pain. These comprised of 22 males and 30 females, 9 mo to 15.9 y of age, mean 6.7 /- 3.5 y. A family history of urolithiasis was present in 50% of all the children. Only 6 of the 52 children with abdominal pain had renal stones. In addition to abdominal pain, 27 children had hematuria and 10 had urinary incontinence. Mild metabolic acidosis was present in three children, parathyroid hormone activity elevated in two and serum vitamin d activity was increased in nine. All children were treated with increased fluid intake and a reduction in dietary sodium and oxalate and some required treatment with thiazide and antispasmodics. Forty-five cases responded to treatment, 5 failed to improve from therapy, and 2, which were not followed up as patients, were not available. CONCLUSION: We describe 52 children with RAP or back pain due to IH and recommend that IH be considered in the differential diagnosis of RAP in childhood.- - - - - - - - - - ranking = 0.23563673058567keywords = back pain, back, abdominal pain (Clic here for more details about this article) |
6/53. Complete microsurgical excision of cervical extramedullary and intramedullary vascular malformations.Eleven patients with vascular malformations of the cervical spinal cord have been operated upon at the University of Zurich. Total microsurgical excision was achieved in all. One patient had a lesion which was entirely intramedullary. Nine patients had combined lesions, intramedullary and extramedullary. Only one patient had a lesion which was entirely extramedullary. There was one operative death from meningitis. Another patient improved slightly postoperatively, but eventually died of urological complications. One patient had the operation immediately following his only subarachnoid hemorrhage, and has thus been protected from neurological damage. One patient has had postoperative reversal of his progressive neurological deterioration and severe pain. Six patients severely impaired preoperatively improved dramatically. One patient who was quadriplegic preoperatively has regained function in her upper extremities. The treatment of choice in lesions such as these is complete microsurgical excision.- - - - - - - - - - ranking = 0.004259111802578keywords = upper (Clic here for more details about this article) |
7/53. An unusual cause of incontinence.BACKGROUND: Incontinence is the most common urological symptom of tethered cord syndrome and may present as the earliest sign of this condition. The presence of unexplained incontinence with spinal anomalies, low back and leg symptoms, should raise the suspicion of tethered cord syndrome and lead to a lumbar MRI study, even though only subtle neurological abnormalities are found. OBJECTIVE: This case acts as a timely reminder of the need to be familiar with adult tethered cord syndrome so that an appropriate diagnosis is made promptly. DISCUSSION: The two groups of tethered cord syndrome, group 1 and group 2, are briefly defined; this paper discusses the presenting history of a patient in the first group.- - - - - - - - - - ranking = 0.012850230003595keywords = back (Clic here for more details about this article) |
8/53. Infantile spinal cord tumor: diagnostic difficulties. A case report.We report an infant with a thoracic intradural extramedullary tumor to illustrate the presentation of an infantile spinal cord tumor and the difficulty in establishing a diagnosis. An infant presented with edema of the legs, motor loss in the lower extremities, and anuria at 3 months of age. magnetic resonance imaging of the lumbar region did not reveal any abnormalities. At 1 year of age, the patient underwent surgery to correct urinary incontinence of unknown etiology. The patient developed gait disturbance and had abdominal pain at 17 months of age. magnetic resonance imaging of the thoracic spine revealed an intradural extramedullary tumor at T2-T5. The spinal cord tumor was completely resected and pathologic findings indicated an endodermal cyst. All symptoms improved after the operation. Infants who present with weakness of the lower legs, urinary incontinence and unknown abdominal pain should be evaluated for a spinal cord tumor.- - - - - - - - - - ranking = 0.023757820390446keywords = abdominal pain (Clic here for more details about this article) |
9/53. Unusual arachnoid cyst of the quadrigeminal cistern in an adult presenting with apneic spells and normal pressure hydrocephalus--case report.A 67-year-old woman was admitted to our clinic with symptoms of normal pressure hydrocephalus, lower cranial nerve pareses, and pyramidal and cerebellar signs associated with respiratory disturbances. Computed tomography (CT) and magnetic resonance imaging revealed a 4.7 x 5.4 cm quadrigeminal arachnoid cyst causing severe compression of the tectum and entire brain stem, aqueduct, and cerebellum, associated with moderate dilation of the third and lateral ventricles. Emergency surgery was undertaken due to sudden loss of consciousness and impaired breathing. The cyst was totally removed by midline suboccipital craniotomy in the prone position. Postoperatively, her symptoms improved except for the ataxia and impaired breathing. She was monitored cautiously for over 15 days. CT at discharge on the 18th postoperative day revealed decreased cyst size to 3.9 x 4.1 cm. Histological examination confirmed the diagnosis of the arachnoid cyst of the quadrigeminal cistern. The patient died of respiratory problems on the 5th day after discharge. Quadrigeminal arachnoid cysts may compress the brain stem and cause severe respiratory disturbances, which can be fatal due to apneic spells. patients should be monitored continuously in the preoperative and postoperative period until the restoration of autonomous ventilation is achieved.- - - - - - - - - - ranking = 0.14004924951112keywords = breathing (Clic here for more details about this article) |
10/53. urinary incontinence due to duplication of ureter--a case report.A seventeen years old female student from Nakla, Sherpur was admitted in the surgical unit I of Mymensingh Medical College Hospital (MMCH) on 28th October 2000 with the one and only complain of continuous dribbling of urine since her birth. Besides her urinary incontinence she used to have urge for micturition and normal voiding pattern as well. She has a good physique but a very depressed mental state. IVU suggested about the duplication of the right ureter but not clearly. Voiding cystourethrogram excluded any degree of vesicoureteral reflux. During examination under anesthesia (EUA) a tiny orifice was noted in the urethro-vaginal septum just below the external urethral orifice through the orifice delineated whole of the ecotopic ureter. Right heminephrectomy was done including excision of the pelvis and proximal part of the upper ureter that was draining directly to the exterior. Postoperative recovery was uneventful and the patient got rid of the ever-disgusting problem.- - - - - - - - - - ranking = 0.004259111802578keywords = upper (Clic here for more details about this article) |
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