1/8. light chain amyloidosis of the urinary bladder. A site restricted deposition of an externally produced immunoglobulin.AIMS:To identify the amyloid protein in a patient with amyloidosis localised to the urinary bladder, and to see whether subtyping of the protein by sequence analysis increases the understanding of the selection of the urinary bladder as the site of amyloid deposition. methods:A patient with gross haematuria and a congophilic mass in his urinary bladder was evaluated further. Characterisation of the amyloid protein was performed using conventional histological and immunohistochemical methods. Determination of the N-terminal amino acid sequence of the amyloid protein was performed using protein sequencers. RESULTS:The patient's history, physical examination, and laboratory evaluation excluded the involvement of other organs, justifying a diagnosis of amyloidosis localised to the urinary bladder. Histological and immunological studies showed that the amyloid protein deposited in the urinary bladder of the patient was probably of the amyloid light chain type. No plasma cells or lymphocytes were seen in sections of the urinary bladder and lower ureter adjacent to the amyloid deposits. Molecular analysis showed the sequence NFMLTQPHSISGSPG, which assigned the amyloid protein to either the Vlambda(I) or the Vlambda(VI) immunoglobulin (Ig) light chain families. CONCLUSIONS:The findings suggest that the amyloid protein in this patient originated outside the urinary bladder. The heterogeneity of the Ig proteins in known cases of amyloidosis of the lower urinary tract suggests that the amino acid residues, which determine the Vlambda subtyping, have no major role in restricting the deposited protein to the urinary bladder.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/8. A rare case of painless gross hematuria: primary localized AA-type amyloidosis of the urinary bladder.A 60-year-old Asian woman presented with a 1-year history of painless gross hematuria. She had no prior urologic history and no other medical problems. Her physical examination, urine cytology, and computed tomography scan were normal. cystoscopy demonstrated several punctate areas of erythema within the bladder. Biopsies revealed amyloidosis, and immunohistochemical staining of the specimens defined the process as amyloid AA (often called secondary amyloidosis). The workup for systemic conditions associated with amyloid AA was negative. This represents an unusual case of primary localized AA-type amyloidosis of the bladder.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/8. Giant diverticulum of the bladder simulating ovarian cyst.A patient was admitted for investigation of a giant ovarian cyst, confirmed by physical examination. At laparotomy the genital organs appeared normal. Ultrasonic reexamination affirmed the preliminary findings of a pelvic cystic mass. A urinary bladder diverticulum was suspected and confirmed by cystography and found to be nonobstructive in nature. Although extremely rare, bladder diverticulum should be considered in the differential diagnosis of a cystic pelvic mass.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/8. Primary localized AA type amyloidosis of urinary bladder: case report of rare cause of episodic painless hematuria.A 45-year-old diabetic man presented with an episodic history of painless gross hematuria. He had had no previous urinary symptoms or any other medical problems. His physical examination, urine cytology, and computed tomography scan findings were normal. cystoscopy demonstrated two nodular masses in the urinary bladder with a hemorrhagic mucosal surface. Biopsies revealed amyloidosis, and immunohistochemical staining of the specimens defined the process as amyloid AA (mostly seen in secondary amyloidosis). The workup for systemic conditions associated with amyloid AA was negative. This represents an unusual case of primary localized AA-type amyloidosis of the bladder.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/8. Undetected genito-urinary dysfunction in vertebral fractures.Five of fourteen patients admitted with fractures of the thoracic and lumbar vertebrae who had normal rectal tone and sacral sensation were subsequently found to have genito-urinary dysfunction. Four patients had a hypotonic bladder documented by cystometrograms. The other patient was impotent from the time of fracture. Since the genito-urinary dysfunction was not detectable by physical examination, thorough urological evaluations are recommended for all patients with fractures of the lower thoracic and upper lumbar vertebrae, even when rectal tone and sacral sensation are normal.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/8. Emergent exploratory laparotomy for a patient with recent Guillain-Barre recurrence: a case report.A case study is presented of a 20-year-old male with a recent exacerbation of guillain-barre syndrome who had an emergent exploratory laparotomy under general endotracheal anesthesia. His preoperative history and physical examination indicated complicating factors, including blunt abdominal trauma, ethanol ingestion, and a full stomach. The management of patients with guillain-barre syndrome and their special needs are discussed.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/8. Nongynecologic causes of unexplained lower abdominal pain in adolescent girls.Unexplained lower abdominal pain in young women can present a challenge for even the most experienced clinicians. Although the cause is usually benign and self-limited, occasionally a serious underlying disorder exists. Clinicians should have an organized approach for diagnosis and management in an effort to avoid any unnecessary tests or referrals. The most important elements of the evaluation are thorough history, careful physical, and sequential follow-up as needed. Selective use of the laboratory and radiographic studies should be considered on an individual basis. This paper describes four disorders in adolescent girls that may present with pain in the lower abdominal region and closely resemble pathologic conditions within the gynecologic tract. Practitioners who provide services to young women should be aware of these entities so that the correct diagnosis is established as soon as possible and appropriate therapy initiated in a timely fashion.- - - - - - - - - - ranking = 0.043418336230542keywords = physical (Clic here for more details about this article) |
8/8. Inguinal cystoceles: a previously overlooked etiology of prostatism in men without bladder outlet obstruction.PURPOSE: We determine whether inguinal cystoceles, a type of extraperitoneal herniation of the bladder, are responsible for symptoms consistent with prostatism in men without bladder outlet obstruction. MATERIALS AND methods: From January 1996 to February 1997 inguinal cystoceles were treated with surgical repair of the floor of the inguinal canal in 8 men with a relatively long history of symptoms consistent with prostatism. The diagnosis of inguinal cystoceles was based on the filling phase of video urodynamic studies done with the patient standing. The clinical outcome of surgery was assessed using the International prostate Symptom Score and urodynamic findings. RESULTS: All inguinal cystoceles studied were physically occult but clearly detected as wide-mouthed, mild protrusions of the bladder wall in the inguinal region on cystograms obtained with the patient standing. Although clear cystoceles were present on radiography on the right side in 1 case, the left side in 2 and bilaterally in 5, apparent bilateral weakness in Hesselbach's triangle was noted in all at surgery. High detrusor opening pressure and a relatively long opening time were regarded as urodynamic parameters characteristic of this condition. These parameters and subjective symptoms dramatically improved after bilateral surgical repair of the floor of the inguinal canal. CONCLUSIONS: Inguinal cystoceles negatively affect voiding dynamics by increasing opening pressure and opening time, indicating that they should be considered in the differential diagnosis of men with symptoms consistent with prostatism. Video urodynamics is mandatory to detect this condition, which to our knowledge has been previously overlooked on radiography and urodynamics.- - - - - - - - - - ranking = 0.043418336230542keywords = physical (Clic here for more details about this article) |