Antenatal renal pelvic dilatation; the long-term outlook

Energy Technology Data Exchange (ETDEWEB)

Duncan, K.A. [Royal Aberdeen Children' s Hospital and Aberdeen Maternity Hospital, Foresterhill, Aberdeen (United Kingdom)]. E-mail: k.duncan@nhs.net

2007-02-15

Aim: The purpose of this study was twofold: first to provide data for more accurate counselling of parents with regard to prognosis, and second, to ensure that by following a policy of selective micturating cystourethography (MCUG), significant pathology is not missed, in particular vesicoureteric reflux (VUR). (MCUG is only undertaken if the renal pelvic diameter (RPD) is {>=} 10 mm or if there is calyceal or ureteric dilatation.) Material and methods: Data were collected prospectively over a 6-year period. Pre and postnatal imaging findings were collected for all infants in whom a RPD of {>=} 5 mm was identified at any gestational age. The imaging records of all patients were reviewed in 2005 for evidence of pathology detected after re-presentation with symptoms. The age range at review varied from 2-8 years. Results: Complete data were available in 527 infants. The risk of significant pathology was related to the degree of antenatal renal pelvic dilatation varying from 6% for a RPD of 5 mm at 20 weeks gestation to 38% at 10mm. At 28-33 weeks gestation the risk varied from 5% at 5 mm to 15% at 10 mm. Subsequent imaging record review revealed only one patient with grade II VUR in the study population not picked up by our selective MCUG policy. Conclusion: The present study provides prognostic information that can be given to parents both antenatally and postnatally, and reassurance that a selective MCUG policy is appropriate.

Antenatal renal pelvic dilatation; the long-term outlook

International Nuclear Information System (INIS)

Duncan, K.A.

2007-01-01

Aim: The purpose of this study was twofold: first to provide data for more accurate counselling of parents with regard to prognosis, and second, to ensure that by following a policy of selective micturating cystourethography (MCUG), significant pathology is not missed, in particular vesicoureteric reflux (VUR). (MCUG is only undertaken if the renal pelvic diameter (RPD) is ≥ 10 mm or if there is calyceal or ureteric dilatation.) Material and methods: Data were collected prospectively over a 6-year period. Pre and postnatal imaging findings were collected for all infants in whom a RPD of ≥ 5 mm was identified at any gestational age. The imaging records of all patients were reviewed in 2005 for evidence of pathology detected after re-presentation with symptoms. The age range at review varied from 2-8 years. Results: Complete data were available in 527 infants. The risk of significant pathology was related to the degree of antenatal renal pelvic dilatation varying from 6% for a RPD of 5 mm at 20 weeks gestation to 38% at 10mm. At 28-33 weeks gestation the risk varied from 5% at 5 mm to 15% at 10 mm. Subsequent imaging record review revealed only one patient with grade II VUR in the study population not picked up by our selective MCUG policy. Conclusion: The present study provides prognostic information that can be given to parents both antenatally and postnatally, and reassurance that a selective MCUG policy is appropriate

Retroperitoneal laparoscopic pyelolithotomy in renal pelvic stone versus open surgery - a comparative study.

Science.gov (United States)

Singal, Rikki; Dhar, Siddharth

2018-01-01

The introduction of endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy have led to a revolution in the the management of urinary stone disease. The indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. To study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy in retroperitoneal renal stone. We compared the results of laparoscopic and open surgery in terms of easy accessibility, operative period, renal injuries, and early recovery. This prospective study was conducted on renal pelvic stone cases from January 2009 to February 2016 in Suchkhand Hospital, Agra, India. The study included a total of 1700 cases with the diagnosis of solitary renal pelvic stones. In group A - 850 cases - retroperitoneal laparoscopic pyelolithotomy was performed, while group B - 850 cases - underwent open pyelolithotomy. The mean operative time was less in group B than group A (74.83 min vs. 94.43 min) which was significant (p<0.001). The blood loss was less in the laparoscopic group than in the open group (63 mL vs. 103mL). There were statistically significant differences in the post-operative pain scores, and postoperative complications compared to group B (p<0.001). The mean hospital stay was less in group A (p<0.03), which was significant. Laparoscopic surgery reduces analgesic requirements, hospital stay, and blood loss. The disadvantages include the reduced working space, the cost of equipment and the availability of a trained surgeon.

CNS sites activated by renal pelvic epithelial sodium channels (ENaCs) in response to hypertonic saline in awake rats.

Science.gov (United States)

Goodwill, Vanessa S; Terrill, Christopher; Hopewood, Ian; Loewy, Arthur D; Knuepfer, Mark M

2017-05-01

In some patients, renal nerve denervation has been reported to be an effective treatment for essential hypertension. Considerable evidence suggests that afferent renal nerves (ARN) and sodium balance play important roles in the development and maintenance of high blood pressure. ARN are sensitive to sodium concentrations in the renal pelvis. To better understand the role of ARN, we infused isotonic or hypertonic NaCl (308 or 500mOsm) into the left renal pelvis of conscious rats for two 2hours while recording arterial pressure and heart rate. Subsequently, brain tissue was analyzed for immunohistochemical detection of the protein Fos, a marker for neuronal activation. Fos-immunoreactive neurons were identified in numerous sites in the forebrain and brainstem. These areas included the nucleus tractus solitarius (NTS), the lateral parabrachial nucleus, the paraventricular nucleus of the hypothalamus (PVH) and the supraoptic nucleus (SON). The most effective stimulus was 500mOsm NaCl. Activation of these sites was attenuated or prevented by administration of benzamil (1μM) or amiloride (10μM) into the renal pelvis concomitantly with hypertonic saline. In anesthetized rats, infusion of hypertonic saline but not isotonic saline into the renal pelvis elevated ARN activity and this increase was attenuated by simultaneous infusion of benzamil or amiloride. We propose that renal pelvic epithelial sodium channels (ENaCs) play a role in activation of ARN and, via central visceral afferent circuits, this system modulates fluid volume and peripheral blood pressure. These pathways may contribute to the development of hypertension. Copyright © 2016 Elsevier B.V. All rights reserved.

Has the pelvic renal stone position inside the upper loop of JJ stent any influence on the extracorporeal shock wave lithotripsy results?

Science.gov (United States)

Pricop, Catalin; Serban, Dragomir N; Serban, Ionela Lacramioara; Cumpanas, Alin-Adrian; Gingu, Constantin-Virgil

2016-01-01

JJ stents are often encountered in patients with pelvic renal stones referred for shock wave lithotripsy, most of them being placed either for obstructive renal pelvic stones or for ureteric stones mobilized retrograde during the JJ stent insertion. The aim of the study was to determine whether the relative stone position in the upper loop of the JJ stent during extracorporeal shock wave lithotripsy (SWL) influences the efficiency of the procedure. The study was designed as a prospective cohort study on 162 patients addressing the same urological department, with single renal pelvic stone (primary or mobilized to the renal pelvis during the insertion of JJ stent), smaller than 15 mm, with JJ stent, treated by SWL using a second generation spark gap lithotripter, 18 kV, 3000 waves/session. Patients were divided in three groups according to the relative position of the stone to the upper loop of the JJ stent as appears on plain X-ray: stone-inside-loop, loop-crossing-stone and stone-outside the loop. The SWL success rate was the primary outcome of the study. p Value, Chi square and Kruskal-Wallis tests were used for statistical analysis. For stone-inside-loop cases, SWL efficiency was 22.7 versus 42 % for all the other cases (p = 0.002). Other factors for decreased SWL success rate were: higher stone radio-opacity, larger JJ of stent and obese patients. Study limitation is represented by the relative small study group and by the evaluation of stone density using plain X-ray instead of computer tomography. For pelvic renal stones having the same density characteristics studied by plain X-ray, the SWL efficiency is lower in stone-inside-loop cases comparing with the other positions. The overall stone free rate for renal pelvic stones could be explained by the second generation lithotripter used for all procedures.

Significance of lower-pole pelvicaliceal anatomy on stone clearance after shockwave lithotripsy in nonobstructive isolated renal pelvic stones.

Science.gov (United States)

Sozen, Sinan; Kupeli, Bora; Acar, Cenk; Gurocak, Serhat; Karaoglan, Ustunol; Bozkirli, Ibrahim

2008-05-01

To investigate the probable effect of lower-pole pelvicaliceal anatomy on stone clearance after shockwave lithotripsy (SWL) in patients with nonobstructive renal pelvic stones. The clinical records of patients with isolated renal pelvic stones who underwent SWL between 1996 and 2005 were reviewed. After excluding patients with obstruction leading to dilatation, major anatomic abnormalities, noncalcium stones, metabolic abnormalities, history of recurrent stone disease, multiple stones, and previous renal surgery, 153 patients were enrolled in the study. Lower pole infundibulopelvic angle (IPA) and infundibular length and width were measured from intravenous urography. Patients were classified into three groups according to stone burden (group 1, renal pelvis, and both in 50 (32.6%), 29 (18.9%), and 8 (5.2%) patients, respectively. There was no statistically significant difference in pelvicaliceal anatomic features except narrower IPA (P=0.02) in group 1 patients with residual stones. The falling of stone fragments to the lower calix in spite of the ureter whether clinically significant or not after SWL of pelvic stones initially seems to be related to stone burden rather than lower caliceal anatomy. However, existence of a more narrow IPA in group 1 patients with residual fragments led us to believe that lower-pole IPA can play a role in stone clearance, especially for smaller stones, probably because of smaller residual fragment size or the more mobile nature of the primary stone.

Right ovarian vein drainage variant: Is there a relationship with pelvic varices?

International Nuclear Information System (INIS)

Koc, Zafer; Ulusan, Serife; Oguzkurt, Levent

2006-01-01

Objective: To correlate right ovarian vein (ROV) variations that drain into the right renal vein (RRV) with the presence of pelvic varices. Materials and methods: Routine abdominal multidetector-row computed tomography scans of 324 women were analyzed for the presence and type of ROV variations in this retrospective study. The subjects were divided into 2 groups: those with ROV variations and those without such variations. The diameters of the subjects' ROV, left ovarian vein (LOV), and parauterine veins were measured. Pelvic varices and the presence and degree of ovarian vein reflux were noted and compared between the 2 groups. The χ 2 -test and the Pearson correlation test were used for statistical analysis. Results: Thirty-two (9.9%) of 324 women studied exhibited ROV variant that drained into the right renal vein, and the remaining subjects (90.1%) exhibited a normal pattern of ROV drainage that flowed directly into the inferior vena cava. Pelvic varices were identified in 59 (18%) of the subjects. Reflux was not observed in any patient without pelvic varices. Fifty-seven of 59 women exhibited ovarian vein reflux. In 56 of those 57 individuals, reflux occurred only in the LOV, and in 1 subject, reflux was noted predominantly in the ROV. No significant relationship between the presence of an ROV that drained into the right renal vein and pelvic varices was noted. Conclusion: Although right-sided pelvic varices associated with right ovarian vein drainage variations are rare, anatomic variations of the right ovarian vein are not. This study did not find an association between the presence of right ovarian vein and pelvic varices

Right ovarian vein drainage variant: Is there a relationship with pelvic varices?

Energy Technology Data Exchange (ETDEWEB)

Koc, Zafer [Baskent Universitesi, Adana Hastanesi, Radyoloji Boeluemue, Serin Evler 39, Sok. No. 6 Yueregir, Adana (Turkey)]. E-mail: koczafer@gmail.com; Ulusan, Serife [Baskent Universitesi, Adana Hastanesi, Radyoloji Boeluemue, Serin Evler 39, Sok. No. 6 Yueregir, Adana (Turkey); Oguzkurt, Levent [Baskent Universitesi, Adana Hastanesi, Radyoloji Boeluemue, Serin Evler 39, Sok. No. 6 Yueregir, Adana (Turkey)

2006-09-15

Objective: To correlate right ovarian vein (ROV) variations that drain into the right renal vein (RRV) with the presence of pelvic varices. Materials and methods: Routine abdominal multidetector-row computed tomography scans of 324 women were analyzed for the presence and type of ROV variations in this retrospective study. The subjects were divided into 2 groups: those with ROV variations and those without such variations. The diameters of the subjects' ROV, left ovarian vein (LOV), and parauterine veins were measured. Pelvic varices and the presence and degree of ovarian vein reflux were noted and compared between the 2 groups. The {chi}{sup 2}-test and the Pearson correlation test were used for statistical analysis. Results: Thirty-two (9.9%) of 324 women studied exhibited ROV variant that drained into the right renal vein, and the remaining subjects (90.1%) exhibited a normal pattern of ROV drainage that flowed directly into the inferior vena cava. Pelvic varices were identified in 59 (18%) of the subjects. Reflux was not observed in any patient without pelvic varices. Fifty-seven of 59 women exhibited ovarian vein reflux. In 56 of those 57 individuals, reflux occurred only in the LOV, and in 1 subject, reflux was noted predominantly in the ROV. No significant relationship between the presence of an ROV that drained into the right renal vein and pelvic varices was noted. Conclusion: Although right-sided pelvic varices associated with right ovarian vein drainage variations are rare, anatomic variations of the right ovarian vein are not. This study did not find an association between the presence of right ovarian vein and pelvic varices.

A Case of Squamous Cell Carcinoma of the Renal Pelvis in association with Schistosoma hematobium

Directory of Open Access Journals (Sweden)

Muhammad A. A. Khan

2012-01-01

Full Text Available A 72-year-old man presented with painless frank haematuria. Investigations included intravenous urogram and abdominal/pelvic CT which revealed a marked focal thickening of the wall of the inferior aspect of the left renal pelvis extending into the lower pole calyx and into the pelviureteric junction resulting in left hydronephrosis. Urine cytology demonstrated clusters of malignant keratinised squamous cells and schistosome ova. He underwent left laparoscopic radical nephroureterectomy and histology revealed moderately differentiated keratinising squamous cell carcinoma in the renal pelvis.

Bilateral Malrotation and a Congenital Pelvic Kidney with Varied Vasculature and Altered Hilar Anatomy

OpenAIRE

Singh, J.; Singh, N.; Kapoor, K.; Sharma, M.

2015-01-01

Variations of structure and position of the kidney along with variations of renal vessels are most frequently reported. Rotational variations form a rare entity that are not cited in most embryology textbooks. During an educational cadaveric dissection of a 42-year-old male, a complex picture of bilateral anatomical variants was encountered. Malrotation of both kidneys and a left lobulated ectopic kidney along with open hilum was observed. The left kidney showed a pelvic position in front of...

Endourological Evaluation and Management of Leukoplakia of the Renal Pelvis

Directory of Open Access Journals (Sweden)

Hidehiro Kakizaki

1996-01-01

Full Text Available Since August 1989, we have seen 4 patients with leukoplakia of the renal pelvis associated with a longstanding renal stone. In 2 of them, excretory or retrograde pyelography revealed multiple filling defects in the left renal pelvis as well as a renal stone, although urine cytological examination was negative. One of the other 2 patients underwent extracorporeal shock wave lithotripsy (ESWL for the renal stone, but this was not followed by the passage of stone fragments. The renal stone in the remaining patient was associated with staghorn calculi. For stone extraction as well as endoscopic evaluation of the intrapelvic lesion, percutaneous nephroscopy was performed. A small to large amount of tissue-like white debris in sheets characteristic of leukoplakia was found in the renal pelvis with stones embedded in it and was removed directly by forceps or suction and then by irrigating with saline. We propose that 1 the endourological approach should be recommended for patients with renal pelvic lesions associated with longstanding renal stones or for patients who show difficulty in passing stone fragments after ESWL and 2 this entity of leukoplakia should be kept in mind for the differential diagnosis of renal pelvic lesions associated with renal stones.

The comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy in the treatment of solitary large renal pelvic stones

NARCIS (Netherlands)

Tefekli, Ahmet; Tepeler, Abdulkadir; Akman, Tolga; Akçay, Muzaffer; Baykal, Murat; Karadağ, Mert Ali; Muslumanoglu, Ahmet Y.; de la Rosette, Jean

2012-01-01

The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could find a place in the management of large renal pelvic stones which are generally considered as excellent indications for percutaneous nephrolithotomy (PNL). Between 2006 and 2009, 26 consecutive patients with large

Left ventricular hypertrophy in renal failure review | Arodiwe ...

African Journals Online (AJOL)

Renal failure is becoming increasingly common in our enironment. Advances in management like availability of dialysis and transplantation is prolonging the live of patients. As a consequence complication are increasingly being encountered. Cardiovascular complication is one of the commonest; and left ventricular ...

Left ventricular diastolic dysfunction in chronic renal failure patients on chronic hemodialysis in Dr. Cipto-Mangunkusumo Hospital : the association with left ventricular mass

Directory of Open Access Journals (Sweden)

Idrus Alwi

2006-06-01

Full Text Available Fourty three patients with chronic renal failure undergoing chronic hemodialysis in Division of Nephrology and Hypertension, Faculty of Medicine, University of Indonesia/Cipto-Mangunkusumo Hospital, Jakarta, since October 2003 until February 2004, were examined for echocardiography (2-D, M-mode, Doppler imaging.Diastolic dysfunction was found in 58.1 % of chronic renal failure patients on hemodialysis. There was no significant difference between left ventricular mass in the group with or without left ventricular diastolic dysfunction. (Med J Indones 2006; 15:105-8Keywords: Left ventricular mass, diastolic function, chronic renal failure, hemodyalisis

A Rare Case of Atypical Renal Arteries Arrangement with Ectopic Kidneys in a Guinea Pig

Directory of Open Access Journals (Sweden)

Maženský D.

2016-12-01

Full Text Available We recorded a very rare case of atypical renal arteries arrangement in a guinea pig using the corrosion technique in the study of the arterial system. The right renal artery originated from the ventral wall of the abdominal aorta at the level of the caudal aspect of the 5th lumbar vertebra. The left renal artery originated from the left common iliac artery approximately 12 mm caudally to the aortic bifurcation. The right kidney was located ventral to the aortic bifurcation and the left kidney inside the pelvic cavity between the common iliac arteries. According to the vascular pattern, we determined that the ectopic kidneys in this guinea pig were unusual. This is the first case describing bilateral ectopic kidneys in a guinea pig.

Endovascular management of recurrent stenosis following left renal vein transposition for the treatment of Nutcracker syndrome.

Science.gov (United States)

Baril, Donald T; Polanco, Patricio; Makaroun, Michel S; Chaer, Rabih A

2011-04-01

Nutcracker syndrome is an entity resulting from left renal vein compression by the superior mesenteric artery and the aorta, leading to symptoms of left flank pain and hematuria. Conventional treatment has been surgical, commonly through transposition of the left renal vein to a more caudal location on the inferior vena cava. Additionally, endovascular approaches, primarily via renal vein stenting, have been described for treatment of this syndrome. We report the case of a patient with Nutcracker syndrome who underwent successful left renal vein transposition but then developed recurrent symptoms 10 months postoperatively and was successfully treated with angioplasty and stenting. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

An Unusual Course of Segmental Renal Artery Displays a Rare Case of Hilar Nutcracker Phenomenon

Directory of Open Access Journals (Sweden)

Devendra A. Sawant

2015-01-01

Full Text Available Nutcracker phenomenon or renal vein entrapment is classically seen as a compression of renal vein in between abdominal aorta and superior mesenteric artery with patients being asymptomatic or clinically manifested in the form of nutcracker syndrome as proteinuria, hematuria, flank pain, pelvic congestion in women, and varicocele in men. In this report, we are presenting a case of rare variant of nutcracker phenomenon along with brief review of anatomy, pathophysiology, public health, and clinical significance of nutcracker syndrome. On a routine dissection of an adult male cadaver, we noticed an unusual arrangement of the structures at the hilum of the left kidney showing entrapment of renal vein between left anterior inferior and posterior segmental renal arteries. The variation in the course of left anterior inferior segmental renal artery leads to compression of left renal vein at renal hilum. Therefore, we have named this rare abnormal anatomical entity as hilar nutcracker phenomenon. The structures in the right renal hilum are normal. The objective of this paper is to report an unusual but important variant of nutcracker phenomenon and also give collective knowledge of such anatomical variations in renal vasculature that will help in diagnosing and treating such rare renal disorder.

Bicornuate unicollis uterus with left renal agenesis | Adeyinka ...

African Journals Online (AJOL)

This is a case report of a 30 year old lady with 8 years history of 2 Infertility. Radiological findings by Hystero-salpingography (HSG) revealed a Bicornuate Unicolis uterus. This was further confirmed by Ultrasound, which also demonstrated a Left Renal agenesis inclusive. Radiological features, clinical presentation and ...

Leiomyosarcoma of inferior vena cava involving bilateral renal veins: Surgical challenges and reconstruction with upfront saphenous vein interposition graft for left renal vein outflow

Directory of Open Access Journals (Sweden)

Rishi Nayyar

2010-01-01

Full Text Available Leiomyosarcoma of inferior vena cava (IVC involving bilateral renal veins presents a surgical challenge. Herein, we report the successful management of two such cases using restoration of left renal venous outflow by saphenous vein interposition graft as first step of surgery. Then radical resection of tumor and right kidney was done. IVC was lastly reconstructed using Gore-Tex graft. This report highlights the surgical challenges to ensure radical resection. Furthermore, the importance of restoring left renal outflow in presence of concomitant right nephrectomy is discussed. Both the patients were disease free at six months with no loss of left renal glomerular filtration rate.

LEFT RENAL TUMOR: A RARE CADAVERIC FINDINGS

Directory of Open Access Journals (Sweden)

Siva Prasad

2015-08-01

Full Text Available A benign tumour is a non - cancerous growth that does not spread (metastasize to other parts of the body and is not usually life - threatening. Many researchers believe that most of the following types of kidney tumours are benign. However, others feel that some of these tumours have the potential to develop into renal cell carcinoma. There are no diagnostic tests that can confirm if a benign tumour has the potential to become cancerous. Benign tumours are sometimes found along with renal cell carcinoma when a removed kidney is examined by a pathologist. For these reasons, benign kidney tumours are treated like malignant tumours. In this case we have observed a male cadaver with a large tumour in the left kidney during our routine dissections of undergraduates .

A Case of Left Renal Vein Ligation in a Patient with Solitary Left Kidney Undergoing Liver Transplantation to Control Splenorenal Shunt and Improve Portal Venous Flow.

Science.gov (United States)

Martino, Rodrigo B; Júnior, Eserval Rocha; Manuel, Valdano; Rocha-Santos, Vinicius; D'Albuquerque, Luis Augusto C; Andraus, Wellington

2017-10-11

BACKGROUND Adequate portal venous flow is required for successful liver transplantation. Reduced venous flow and blood flow 'steal' by collateral vessels are a concern, and when there is a prominent splenorenal shunt present, ligation of the left renal vein has been recommended to improve portal venous blood flow. CASE REPORT A 51-year-old man who had undergone right nephrectomy in childhood required liver transplantation for liver cirrhosis and hepatocellular carcinoma due to hepatitis C virus (HCV) infection. The patient had no other comorbidity and no history of hepatorenal syndrome. At transplantation surgery, portal venous flow was poor and did not improve with ligation of shunt veins, but ligation of the left renal vein improved portal venous flow. On the first and fifth postoperative days, the patient was treated with basiliximab, a chimeric monoclonal antibody to the IL-2 receptor, and methylprednisolone. The calcineurin inhibitor, tacrolimus, was introduced on the fifth postoperative day. On the sixteenth postoperative day, renal color Doppler ultrasound showed normal left renal parenchyma; hepatic Doppler ultrasound showed good portal vein flow and preserved hepatic parenchyma in the liver transplant. CONCLUSIONS This case report has shown that in a patient with a single left kidney, left renal vein ligation is feasible and safe in a patient with no other risk factors for renal impairment following liver transplantation. Modification of postoperative immunosuppression to avoid calcineurin inhibitors in the very early postoperative phase may be important in promoting good recovery of renal function and to avoid the need for postoperative renal dialysis.

Comparing the difference of measured GFR of ectopic pelvic kidney between anterior and posterior imaging processing in renal dynamic imaging

International Nuclear Information System (INIS)

Li Baojun; Zhao Deshan

2014-01-01

Objective: To compare and analyze the difference of measured glomerular filtration rate (GFR) of ectopic pelvic kidney between anterior and posterior imaging processing in renal dynamic imaging. Methods: There were 10 patients collected retrospectively, with ectopic kidneys in pelvic cavity confirmed by ultrasound, CT, renal dynamic imaging and other imaging modalities. All images of ectopic kidneys in renal dynamic imaging were processed by anterior and posterior methods respectively. The ectopic kidney was only processed in anterior imaging, ectopic kidney and contralateral normal kidney were processed in posterior imaging. Total GFR equalled the sum of GFR of normal kidney in posterior imaging and GFR of ectopic kidney in anterior imaging, was compared with total GFR of two kidneys in posterior imaging and GFR in two-sample method. All correlation analysis were completed between GFRs from three methods and all patients were followed up. Statistically paired t-test and bivariate correlation analysis test were used. Results: The mean GFR of ectopic kidney in anterior imaging equal to (27.48±12.24) ml/(min · 1.73 m 2 ). It was more than GFR [(10.71 ±4.74) ml/ (min · 1.73 m 2 )] in posterior imaging above 46% (t=5.481, P<0.01). There was no significant difference (t=-2.238, P>0.05), but better correlation (r=0.704, P<0.05) between total GFR in anterior imaging and GFR in two-sample method. There was significant difference (t=4.629, P<0.01)and worse correlation (r=0.576, P>0.05) between total GFR in posterior imaging and GFR in two-sample method. Conclusion: Comparing with GFR in posterior imaging, GFR in anterior imaging can more truly reflect function condition of ectopic pelvic kidney in renal dynamic imaging. (authors)

Renal pelvic calculi and neoplasm. New indication for treatment of asymptomatic renal pelvic calculi?

DEFF Research Database (Denmark)

Vibitis, H; Jørgensen, J B

1990-01-01

Metaplasia of the renal pelvis caused by chronic irritation, calculi, infection is a reversible pre-malignant condition. The application of ESWL on renal calculi as a safe treatment in relation to metaplasia is discussed and a case history is presented.......Metaplasia of the renal pelvis caused by chronic irritation, calculi, infection is a reversible pre-malignant condition. The application of ESWL on renal calculi as a safe treatment in relation to metaplasia is discussed and a case history is presented....

Absence of Middle Hepatic Vein Combined with Retro-Aortic Left Renal Vein: a Very Rare Case Report

Directory of Open Access Journals (Sweden)

Sezer Akçer

2012-06-01

Full Text Available The hepatic and renal veins drain into the inferior vena cava. The upper group of hepatic veins consists of three veins which extend to the posterior face of the liver to join the inferior cava. The left renal vein passes anterior to the aorta just below the origin of the superior mesenteric artery. We detected a variation in the hepatic and renal veins in a multislice CT angiogram of a nine-year-old male patient in the Radiology Department of Afyon Kocatepe University Medical School. The upper group hepatic veins normally drains into the inferior vena cava as three separate trunks, namely the right, left and middle. In our case, we found that only the right and left hepatic veins existed and the middle hepatic vein was absent. Furthermore, the left renal vein, which normally passes anterior to the abdominal aorta, was retro-aortic. Left renal vein variations are of great importance in planning retroperitoneal surgery and vascular interventions. Knowledge of a patient’s hepatic vein and renovascular anatomy and determining their variations and anomalies are of critical importance to abdominal operations, transplantations and preoperative evaluation of endovascular interventions.

Deep Vein Thrombosis of the Left Leg: A Case of May-Thurner Syndrome

Directory of Open Access Journals (Sweden)

Jiten Desai

2018-02-01

Full Text Available A 56-year-old woman presented with gradually worsening shortness of breath associated with dull left leg pain over 5 days. She denied any recent travel, recent surgeries or immobilization. CT pulmonary angiography and CT venography revealed multiple bilateral pulmonary emboli and extensive left pelvic and left lower extremity deep vein thromboses. Contrast-enhanced CT showed that the right common iliac artery crossed the left common iliac vein and compressed it externally, indicative of May–Thurner syndrome. Catheter-directed thrombolysis of the left lower extremity was performed and heparin infusion was started. The patient also underwent left iliac vein balloon angioplasty with stenting and infra-renal inferior vena cava filter placement via the jugular approach to prevent further embolization.

Retro-aortic, left inferior renal capsular vein

Directory of Open Access Journals (Sweden)

Umberto G Rossi

2015-01-01

Full Text Available In our case report, abdominal multi-detector computed tomography was used for the pre-operative anatomy evaluation in a living kidney donor. The early phase of the test revealed normal kidneys in the donor. The vascular phase detected a venous variant on the left side: An inferior renal capsular vein, which had a loop and a retro-aortic course. This preoperative knowledge was crucial for the laparoscopic nephrectomy as a surgical procedure for harvesting kidney from the living donor.

Retro-aortic left renal vein--an anatomic variation description and review of literature.

Science.gov (United States)

Suma, H Yekappa; Roopa, Kulkarni

2011-01-01

This study reports the presence of a retro-aortic renal vein on the left side draining into the inferior vena cava. This variation was observed during routine dissection in a female cadaver aged about 55 years. This variation is of importance because of its implications in renal transplantation, renal surgery, vascular surgery, uroradiology and gonadal surgeries. The knowledge of such variations can help the clinicians for its recognition and protection.

Collateral veins in left renal vein stenosis demonstrated via CT

Energy Technology Data Exchange (ETDEWEB)

Lien, H.H.; Lund, G.; Talle, K.

1983-02-01

Twelve patients with left renal vein stenosis from tumor compression were studied with CT. All had distended collateral veins in the perirenal space which either formed a radiating or a cobweb pattern or appeared as marked longitudinal veins. Inferior phrenic vein branches were seen in seven patients and were considerably enlarged in two. Other major veins possibly taking part in collateral circulation could not be recognized due to obliteration of fat planes. The renal fascia was thickened in eleven patients, probably due to edema. A close study of the perirenal space with CT may give valuable information about collateral development.

Collateral veins in left renal vein stenosis demonstrated via CT

International Nuclear Information System (INIS)

Lien, H.H.; Lund, G.; Talle, K.

1983-01-01

Twelve patients with left renal vein stenosis from tumor compression were studied with CT. All had distended collateral veins in the perirenal space which either formed a radiating or a cobweb pattern or appeared as marked longitudinal veins. Inferior phrenic vein branches were seen in seven patients and were considerably enlarged in two. Other major veins possibly taking part in collateral circulation could not be recognized due to obliteration of fat planes. The renal fascia was thickened in eleven patients, probably due to edema. A close study of the perirenal space with CT may give valuable information about collateral development. (orig.)

Degree of Left Renal Vein Compression Predicts Nutcracker Syndrome

Directory of Open Access Journals (Sweden)

Patrick T. Hangge

2018-05-01

Full Text Available Nutcracker syndrome (NS refers to symptomatic compression of the left renal vein (LRV between the abdominal aorta and superior mesenteric artery with potential symptoms including hematuria, proteinuria, left flank pain, and renal venous hypertension. No consensus diagnostic criteria exist to guide endovascular treatment. We aimed to evaluate the specificity of LRV compression to NS symptoms through a retrospective study including 33 NS and 103 control patients. The size of the patent lumen at point of compression and normal portions of the LRV were measured for all patients. Multiple logistic regression analyses (MLR assessing impact of compression, body mass index (BMI, age, and gender on the likelihood of each symptom with NS were obtained. NS patients presented most commonly with abdominal pain (72.7%, followed by hematuria (57.6%, proteinuria (39.4%, and left flank pain (30.3%. These symptoms were more commonly seen than in the control group at 10.6, 11.7, 6.8, and 1.9%, respectively. The degree of LRV compression for NS was 74.5% and 25.2% for controls (p < 0.0001. Higher compression led to more hematuria (p < 0.0013, abdominal pain (p < 0.006, and more proteinuria (p < 0.002. Furthermore, the average BMI of NS patients was 21.4 and 27.2 for controls (p < 0.001 and a low BMI led to more abdominal pain (p < 0.005. These results demonstrate a strong correlation between the degree of LRV compression on imaging in diagnosing NS.

Individual renal function study using dynamic computed tomography

International Nuclear Information System (INIS)

Fukuda, Yutaka; Kiya, Keiichi; Suzuki, Yoshiharu

1990-01-01

Dynamic CT scans of individual kindneys were obtained after an intravenous bolus injection of contrast agent. Time-density curves measured from the renal cortex, medulla and pelvis revealed the changes in density produced by the contrast agent reflecting the differential phase of renal function. Renal cortical density increased rapidly after bolus administration and then renal medullary and pelvic density increased continuously. In analyzing time-density curve, the cortico-medullary junction time, which is the time when the cortical and medullary curves cross was 57±8 seconds in patients with normal renal function. The cortico-medullary junction time was delayed in patient with decreased glomerular filtration rate. The cortico-pelvic junction time, which is the time when the cortical and pelvic curves cross was 104±33 seconds in patients with normal renal function. The cortico-pelvic junction time was delayed in patients with declined urinary concentrating capacity. In patients with unilateral renal agenesis and patients who were treated surgically by ureteral sprits, the relationship between individual renal functions and these junction times was examined. As a result of study there were inversely significant correlations between C-M junction time and unilateral GFR and between C-P junction time and urinary concentrating capacity. These studies indicate that dynamic CT scanning is an effective way that individual renal function can be monitored and evaluated. (author)

The outcome of extracorporeal shockwave lithotripsy for renal pelvic stone with and without JJ stent--a comparative study.

Science.gov (United States)

Mohayuddin, Nazim; Malik, Hamad Afzal; Hussain, Manzoor; Tipu, Salman Ahmed; Shehzad, Asad; Hashmi, Altaf; Naqvi, Syed Ali Anwar; Rizvi, Syed Adibul Hasan

2009-03-01

To compare the outcome of Extra corporeal shockwave lithotripsy for a renal pelvic stone with and without JJ stent. A comparative cross sectional study was carried out at Sindh Institute of Urology and Transplantation from January 2007 to January 2008. Eighty patients with renal pelvic stone measuring 2cm +/- 2mm were selected for treatment with Extra Corporeal Shockwave Lithotripsy (ESWL). All of these patients were adults with normal renal function and had unilateral renal stones with negative urine cultures. Patients with renal failure and children were excluded. They were divided into two groups of 40 each. Group A patients underwent ESWL without a JJ stent and in Group B a JJ stent was placed before ESWL. SLX F2 electromagnetic ESWL machine was used to impart shock waves. 3000 shockwaves were given in a session. Both the groups were compared for renal colic, steinstrasse, fever, lower urinary tract symptoms (LUTS) emergency room visits and hospital admissions, stone clearance, number of ESWL sessions, auxilliary procedures, (percutaneous nephrostomy or ureterorenoscopy) and cost. Ureteric colic occurred in 13 (32.5%) patients in group A and in 3 (7.5%) patient in group B. Steinstrasse developed in 4 (10%) patients with out JJ stent and in 3 (7.5%) patients with JJ stent. Fever was encountered in 1 (2.5%) patient in group A and in 3 (7.5%) patient in group B. Mean emergency room visits were 2.1 per patient in group A and 0.7 per patient in group B. Stone clearance occurred in 33 (82.5%) patients in group A and 31 (77.5%) in group B. In group B lower urinary tract symptoms were found in 50% versus 20% in group A. Auxillary procedure was performed in one (2.5%) patient each in both groups. Pre ESWL JJ stenting for a 2 cm +/- 2 mm renal stone was not beneficial in terms of steinstrasse, fever, stone clearance and number of ESWL sessions. However ureteric colic was significantly less in the stented group. Lower urinary tract symptoms (LUTS) was also significantly

Pelvic congestion syndrome masquerading as osteoarthritis of the hip

Directory of Open Access Journals (Sweden)

Scott J Dos Santos

2016-12-01

Full Text Available Objectives: Pelvic congestion syndrome (PCS is associated with pelvic vein reflux (PVR, occasionally secondary to venous compression. Its symptoms, usually intra-pelvic, are alleviated following the abolition of this reflux by pelvic vein embolisation (PVE. The objective of this report is to present two cases of left hip pain, erroneously diagnosed as osteoarthritis, which disappeared after successful PVE and abolition of PVR. Methods: Two females presented with lower limb varicose veins, and also had a history of left-sided hip pain. Both had previously been investigated for the hip pain and diagnosed as osteoarthritis despite minimal arthritic changes on pelvic X-rays. During investigation for lower limb varicose veins, both showed a pelvic origin for their leg veins and hence underwent transvaginal duplex ultrasound. This revealed PVR, and PVE was planned in both patients. Results: Both patients underwent PVE and reported ‘miraculous’ resolution of left hip pain and also PCS symptoms including pelvic pain, irritable bowel issues and the disappearance of pelvic dragging, with almost immediate disappearance of vulval and vaginal varicosities. One patient also noted reduced clitoral sensitivity. Conclusion: Manifestations of PCS may vary in terms of intra- or extra-pelvic signs. PCS and PVR should be considered in the differential diagnosis of patients with arthritic symptoms in the hip without evident radiographic evidence.

Application of 80-kVp scan and raw data-based iterative reconstruction for reduced iodine load abdominal-pelvic CT in patients at risk of contrast-induced nephropathy referred for oncological assessment: effects on radiation dose, image quality and renal function.

Science.gov (United States)

Nagayama, Yasunori; Tanoue, Shota; Tsuji, Akinori; Urata, Joji; Furusawa, Mitsuhiro; Oda, Seitaro; Nakaura, Takeshi; Utsunomiya, Daisuke; Yoshida, Eri; Yoshida, Morikatsu; Kidoh, Masafumi; Tateishi, Machiko; Yamashita, Yasuyuki

2018-05-01

To evaluate the image quality, radiation dose, and renal safety of contrast medium (CM)-reduced abdominal-pelvic CT combining 80-kVp and sinogram-affirmed iterative reconstruction (SAFIRE) in patients with renal dysfunction for oncological assessment. We included 45 patients with renal dysfunction (estimated glomerular filtration rate  60 ml per lmin per 1.73 m 2 ) who underwent standard oncological abdominal-pelvic CT (600 mgI kg -1 , 120-kVp, filtered-back projection) were included as controls. CT attenuation, image noise, and contrast-to-noise ratio (CNR) were compared. Two observers performed subjective image analysis on a 4-point scale. Size-specific dose estimate and renal function 1-3 months after CT were measured. The size-specific dose estimate and iodine load of 80-kVp protocol were 32 and 41%,, respectively, lower than of 120-kVp protocol (p 0.05). No significant kidney injury associated with CM administration was observed. 80-kVp abdominal-pelvic CT with SAFIRE yields diagnostic image quality in oncology patients with renal dysfunction under substantially reduced iodine and radiation dose without renal safety concerns. Advances in knowledge: Using 80-kVp and SAFIRE allows for 40% iodine load and 32% radiation dose reduction for abdominal-pelvic CT without compromising image quality and renal function in oncology patients at risk of contrast-induced nephropathy.

Case report: Varicosity of the communicating vein between the left renal vein and the left ascending lumbar vein mimicking a renal artery aneurysm: Report of an unusual site of varicose veins and a novel hypothesis to explain its association with abdominal pain

Directory of Open Access Journals (Sweden)

Sandeep G Jakhere

2011-01-01

Full Text Available A communicating vein between the left renal vein and the left ascending lumbar vein has only rarely been reported in the imaging literature. There are very few reports of varicosity of this communicating vein. Nonetheless, awareness about this communicating vein is of utmost importance for surgeons performing aortoiliac surgeries and nephrectomies as it may pose technical difficulties during surgery or cause life-threatening retroperitoneal hemorrhage. Varicosity of this venous channel may be mistaken for paraaortic lymphadenopathy, adrenal pseudo-mass, or renal artery aneurysm. We report a case of a patient with varicosity of this communicating vein, which mimicked a left renal artery aneurysm. A novel hypothesis is also proposed to explain the relationship with abdominal pain.

Long-term safety of left renal vein division and ligation to expedite complex abdominal aortic surgery.

Science.gov (United States)

Samson, Russell H; Lepore, Michael R; Showalter, David P; Nair, Deepak G; Lanoue, Julien B

2009-09-01

Left renal vein division and ligation (LRVDAL) is performed to facilitate complex abdominal aortic surgery. Surgeons restore continuity of the vein due to concern that ligation could cause renal compromise or hematuria. However, we report the short and long-term safety of left renal vein division and ligation. Between 1992 and 2007, we divided the left renal vein in 56 patients (40 males, 16 females) ages 57 to 84 (average 74-years-old) who were treated for aortic occlusive disease (9) or abdominal aortic aneurysm (47). Patients requiring concomitant renal artery reconstruction were excluded from this review. Suprarenal cross-clamp was used in 51 patients with temporary vessel-loop control of the renal arteries. Creatinine (Cr) and glomerular filtration rates (eGFR) were measured pre-, post-, and long-term after surgery. Outpatient records of all patients that had survived more than 12 months were also reviewed in order to evaluate the late effects on renal function or symptoms possibly related to LRVDAL. Median procedure duration was 157 (61-375) minutes. Median cross-clamp time was 16 (10-45) minutes. Median intensive care unit (ICU) and hospital length of stays were 2 (1-11) days and 7 (4-58) days, respectively. There were no deaths. There were no complications directly related to renal vein ligation. Hematuria, seen in 2 patients, was a result of traumatic insertion of a Foley catheter. Median pre-op and discharge Cr levels were 1.1 mg/dL (0.7-2.4 mg/dL) and 1.1 mg/dL (0.6-2.1 mg/dL), respectively (P 2.0 mg/dL remained unchanged post-op. Only 2 patients with a Cr of 2.0 mg/dL and both returned to normal by day 3 post-op. Thirty-six patients have been followed for more than a year (median 34.5 months, maximum 144 months) and Cr has remained stable in all but 2 patients. These 2 patients, both with a pre-op Cr of 1.5 mg/dL, subsequently developed Cr levels of 2.1 mg/dL and 2.4 mg/dL but maintained baseline Cr levels for 25 and 34 months, respectively, before

Congenital seminal vesicle cyst accompanying with ipsilateral renal agenesis in an adolescent patient: A pediatric radiologist approach to Zinner’s syndrome

Directory of Open Access Journals (Sweden)

Mehmet Burak Özkan

2015-12-01

Full Text Available A fifteen-year-old boy who had complaints of left sided pelvic pain with known ipsilateral left renal agenesia was referred to pediatric radiology department. Incidentally, his sonography examination revealed a dilated tubular structure located in the retro-vesicular region from cephalic to prostate. Contrast enhanced pelvic MRI showed a huge seminal vesicle cyst which is over 6 cm without a mass effect near the aspect border of the prostate and bladder. The patient was diagnosed with Zinner syndrome. The patient doesn’t have new complaint with no definite increase in the diameter of the cyst. In this case presentation we are discussing the Zinner syndrome’s imaging findings from a pediatric radiologist approach with a brief review of the literature.

Incidental Anatomic Finding of Celiacomesenteric Trunk Associated with 'Nutcracker Phenomenon,' or Compression of the Left Renal Vein.

Science.gov (United States)

Peterson, Joshua; Hage, Anthony N; Diljak, Stephan; Long, Benjamin D; Marcusa, Daniel P; Stribley, John M; Brzezinski, David W; Eliason, Jonathan

2017-12-15

BACKGROUND Celiacomesenteric trunk (CMT) is a very rare anatomic finding in which the celiac artery and the superior mesenteric artery (SMA) originate from the abdominal aorta through a common trunk. Clinical associations with CMT include arterial aneurysm, thrombosis, and celiac artery compression. However, an association between CMT and abdominal venous congestion caused by left renal vein compression, or 'nutcracker phenomenon,' has not been previously reported. CASE REPORT A 91-year-old woman, who died from a cerebrovascular accident (CVA), underwent a cadaveric examination at our medical school. On examination of the abdomen, there was an incidental finding of CMT. The arterial and venous diameters were measured, and vascular histopathology was undertaken. The vascular anatomy was consistent with CMT type 1-b. Nutcracker phenomenon (NCP) (left renal vein compression) was seen anatomically as dilatation and engorgement of the left renal vein, relative to the right renal vein (10.77±0.13 mm vs. 4.49±0.56 mm, respectively), and dilatation and engorgement of the left ovarian vein, relative to the right ovarian vein (4.37±0.15 mm vs. 1.06±0.09 mm, respectively) with left ovarian varicocele. The aortoceliac angle (ACA) and the aortomesenteric angle (AMA) approached zero degrees. CONCLUSIONS We have described a rare anatomic finding of CMT that created an acute AMA and NCP. Awareness of this rare association between CMT and NCP by clinicians, vascular surgeons, and radiologists may be of value in the future evaluation and surgical management of patients who present clinically with 'nutcracker syndrome.'

Extraperitoneal pelvic leiomyosarcoma

International Nuclear Information System (INIS)

Santamarina, Mario G.; Baltazar, Alberto D.; Arce, Patricia; Dettano, Veronica; Lopez, Jessica

2003-01-01

Extraperitoneal pelvic leiomyosarcoma is a very uncommon neoplasic process. It is a highly aggressive tumor with unfavorable prognosis. Clinical findings are nonspecific; diagnosis is generally made in an advanced stage of the disease. We present a case of a 34 years old female patient with pelvic leiomyosarcoma located at the recto vaginal septum who referred vulvar tumor and disability of the left lower limb. This case report describes the results obtained by ultrasound, Computed Tomography, Magnetic Resonance Imaging and pathology. (author)

Posterior Nutcracker Syndrome Associated with Interrupted Left Inferior Vena Cava with Azygos Continuation and Retroaortic Right Renal Vein

Energy Technology Data Exchange (ETDEWEB)

Luo, Xiao Li; Zhou, Xiao Dong [Xijing Hospital, Fourth Military Medical University, Shaanxi (China); Qian, Gen Nian; Xiao, Hui; Zhao, Chun Lei [Fuzhou General Hospital, Fujian (China)

2012-06-15

Various anatomic anomalies have been considered the causes of nutcracker syndrome (NCS). Posterior NCS refers to the condition, in which vascular narrowing was secondary to the compression of the retroaortic left renal vein while it is crossing between the aorta and the vertebral column. Here, we report an unusual case of posterior NCS associated with a complicated malformation of the interrupted left inferior vena cava with azygos continuation and retroaortic right renal vein, diagnosed by both color Doppler ultrasonography and CT angiography.

Posterior Nutcracker Syndrome Associated with Interrupted Left Inferior Vena Cava with Azygos Continuation and Retroaortic Right Renal Vein

International Nuclear Information System (INIS)

Luo, Xiao Li; Zhou, Xiao Dong; Qian, Gen Nian; Xiao, Hui; Zhao, Chun Lei

2012-01-01

Various anatomic anomalies have been considered the causes of nutcracker syndrome (NCS). Posterior NCS refers to the condition, in which vascular narrowing was secondary to the compression of the retroaortic left renal vein while it is crossing between the aorta and the vertebral column. Here, we report an unusual case of posterior NCS associated with a complicated malformation of the interrupted left inferior vena cava with azygos continuation and retroaortic right renal vein, diagnosed by both color Doppler ultrasonography and CT angiography.

Reference ranges and reliability of transabdominal ultrasonographic renal dimensions in thoroughbred horses.

Science.gov (United States)

Draper, Alexandra C E; Bowen, I Mark; Hallowell, Gayle D

2012-01-01

The aims of this study were to establish a normal reference range (mean ± 2 SD) and assess reliability of renal dimensions obtained using transabdominal ultrasonography in Thoroughbred horses (n = 7). A minimum of three ultrasonographic cineloops were obtained from each intercostal space and the left paralumbar fossa by two observers daily for three consecutive days. Renal length, width, and thickness and cortex, medulla, and pelvic dimensions were obtained. Measurements were undertaken by both observers, who were unaware of prior measurements, to assess reproducibility and measured on three separate occasions to evaluate short-term measurement repeatability. Measurements from images obtained by both operators were compared to evaluate image repeatability. The left kidney was consistently identified in the left 15th-17th intercostal space and the paralumbar fossa with maximal length in the 16th intercostal space (12.7 ± 2.0 cm) and maximal width in the paralumbar fossa (7.9 ± 1.1 cm). The right kidney was consistently identified in the right 15th-17th intercostal space with maximal length and maximal width in the 15th intercostal space (16.0 ± 0.7 cm and 7.9 ± 1.0 cm). Reproducibility, image repeatability, measurement repeatability were good to excellent, although were less good for the smaller structures. There were no differences in renal dimensions between horses. Overall renal ultrasonography was reliable and a normal reference range for Thoroughbred horses was established. Renal dimensions vary between rib spaces. As repeatability and reproducibility were excellent for renal length and width, it may be prudent to use those measurements in rib spaces where parameters were maximal. © 2011 Veterinary Radiology & Ultrasound.

Sonographic findings of renal tuberculosis

International Nuclear Information System (INIS)

Yoon, Chong Hyun; Lee, Chang Joon; Kim, Seung Hyun

1990-01-01

In order to determine sonographic characteristic of renal tuberculosis, we retrospectively collected 27 cases during a 5 year period. Infected kidneys showed large size (52%) and lobulating contour (76%). In 19 cases of increased parenchymal echogenicity, most of them (16 cases) showed decreased parenchymal thickness. We divided hydronephrotic patterns into 4 categories; predominant calyceal dilatation with mild or no pelvic dilatation (67%), focal calyectasis without pelvic dilation (15%), parenchymal cavitation without hydronephrosis (11%) and proportional hydronephrosis with calyceal deformity (7%). Our findings suggest that disproportional hydronephrosis would be the characteristic finding of renal tuberculosis

[Orthotopic renal transplant: our experience].

Science.gov (United States)

De Gracia, R; Jiménez, C; Gil, F; Escuin, F; Tabernero, A; Sanz, A; Hidalgo, L

2007-01-01

Orthotopic renal transplant (ORT) is useful in cases of severe atherosclerosis, heterotopic bilateral transplant, unsuitable pelvic vessels and in aortic thrombosis, but it is not available in all the institutions and it is only realized of exceptional form. To review the indication, surgical technique and outcome of the ORT at our hospital. The studied included five cases between January 1990 and December 2005. We analyzed several variables: demographic characteristics, characteristics of the donor, ischemia times, evolution of renal function and morbi-mortality associated. Left ORT was performed in three men and two women. Mean patient age was 52+/-5 years, all the patients received kidneys from cadaveric donors. Mean creatinine and urea one month postoperative were 2.2+/-0.72 mg/dl and 103+/-17.2 mg/dl and at 6 months postoperative were 1.8+/-0.59 mg/dl and 78+/-14 mg/dl respectively. Immediately all patients received prophylaxis with low molecular weight heparin but it was indicated antiaggregation to two patients when they left the hospital, anticoagulation to two patients and to one of them was decided to anticoagulation nor antiagregation for history of bled digestive. A patient died for bleeding episode at level of the renal graft six months after the transplant, she was in treatment with dicumarinics, they were indicated by venous deep thrombosis in right leg. The survival a year is 80 % of the graft and the patient. Only two patients returned to hospital later, one of them for presenting an episode of diverticulitis and the other one for renal obstructive failure that needed laying of catheter pig-tail. Four patients presented stenosis of renal native vassels detected in control magnetic nuclear resonance, not symptomatic. There are two patients who take more than three years transplanted with renal stable function (creatinina 1.3 mg/dl and 1.4 mg/dl respectively). ORT is an excellent option in patients with co-morbidity increased for atherosclerosis and

Scleroderma Renal Crisis: A Reversible Cause of Left Ventricular Dysfunction.

Science.gov (United States)

Martínez-Milla, Juan; Gaebelt, Hans Paul; Sánchez-Pernaute, Olga; Kallmeyer, Andrea; Romero, José; Farré, Jerónimo

2018-05-02

We report a case of acute left ventricular dysfunction due to myocarditis, in the setting of a scleroderma renal crisis. The case is particularly intriguing for the favorable outcome of both symptoms and heart function following immunosuppressive therapy. We also highlight the changes observed over time with image techniques as well as in electrocardiograms. Copyright © 2018 Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. Publicado por Elsevier España, S.L.U. All rights reserved.

Abdominal and pelvic ultrasound study of the maned wolf (Chrysocyon brachyurus

Directory of Open Access Journals (Sweden)

Luciana D. Guimarães

2013-02-01

Full Text Available The aim of the present study was the ultrasound characterization of the abdominal and pelvic regions of five maned wolves kept in captivity at the Triage Center of Wild Animals of the Federal University of Viçosa (Centro de Triagem de Animais Silvestres, Universidade Federal de Viçosa. This characterization included descriptions of ultrasonographic aspects and measurements of various structures using B-mode ultrasound. Biometric data were collected to assess the existence of significant linear correlations between these measurements and the measurements obtained by ultrasound. Additionally, hematological and serum biochemistry evaluations of the animals were performed. The ultrasound findings were similar to those available in the literature on domestic dogs, which were used for comparison as a result of the lack of published data regarding maned wolves. The latter species showed characteristics closely resembling those of the former, differing in the spleen and left renal cortex echogenicities, in the appearance of the prostatic and testicular regions and in the hepatic portal vein morphology. In the current study, the biometric values were similar to those previously published; however, no data regarding thoracic perimeter, modified crown-rump length or thoracic depth were found in the literature for this Canidae species. Statistical analysis showed the existence of a strong negative correlation between the modified crown-rump length and left renal length, between the modified crown-rump length and the right renal volume, between the thoracic perimeter and the height at the cranial pole of the left adrenal gland and between the thoracic perimeter and the height at the caudal pole of the left adrenal gland. Laboratory findings, including segmented neutrophil, eosinophil, monocyte and lymphocyte counts and the serum levels of glucose, ALT, alkaline phosphatase, urea, total protein, globulin, creatine phosphokinase, triglyceride, sodium

Contribution of 99mTc-DTPA dynamic renal scintigraphy with furosemide test in the exploration of low grade urethra-pelvic junction syndrome. Report of 17 cases

International Nuclear Information System (INIS)

Ghfir, I.; Ben Rais, N.

2009-01-01

Introduction The renal scintigraphy using 99m Tc-DTPA with furosemide test constitutes a noninvasive and functional method that is of appreciable interest in the exploration of the upper urinary tract and in the evaluation of the separate renal function. It distinguishes the functional character of dilation from organic obstruction needing surgery or endoscopic treatment. Material and methods We report, through this work, the observations of 17 patients with a low grade urethra-pelvic junction syndrome detect by intravenous urography (I.V.U.). 99m Tc-DTPA renal scintigraphy with furosemide test was carried out among all our patients by means of a gamma-camera with large field equipped with a low energy high-resolution parallel collimator. The evaluation of images obtained consisted of analysis of urethra-pelvic permeability taking into account the semiquantitative parameters of time-activity curve or isotopic nephrogram (I.N.) obtained after digital reconstruction of sequential images. Results On the 17 studied cases, the sex-ratio was equal to 1.83; the average age was 18.92 years with extremes spanning from 4 years to 70 years. Renal scintigraphy categorized four patients groups. Group I: two patients (11.76%) with normal aspect of I.N.; group II; seven patients (41.17% of cases) with functional dilation; group III: five patients (29.41%) with organic obstruction and a group IV: three patients (17.64%) with intermediate response. Discussion 99m Tc-DTPA renal scintigraphy with furosemide test allowed, through our study, to obviate the limits of IVU and manometric explorations to distinguish functional dilation of organic obstruction. It permits the improvement of treatment with a favourable dosimetry. (authors)

Severe Renal Hemorrhage in a Pregnant Woman Complicated with Antiphospholipid Syndrome: A Case Report

Directory of Open Access Journals (Sweden)

Shohei Kawaguchi

2011-01-01

Full Text Available Antiphospholipid syndrome is a systemic autoimmune disease with thrombotic tendency. Consensus guidelines for pregnancy with antiphospholipid syndrome recommend low-dose aspirin combined with unfractionated or low-molecular-weight heparin because antiphospholipid syndrome causes habitual abortion. We report a 36-year-old pregnant woman diagnosed with antiphospholipid syndrome receiving anticoagulation treatment. The patient developed left abdominal pain and gross hematuria at week 20 of pregnancy. An initial diagnosis of left ureteral calculus was made. Subsequently abdominal-pelvic computed tomography was required for diagnosis because of the appearance of severe contralateral pain. Computed tomography revealed serious renal hemorrhage, and ureteral stent placement and pain control by patient-controlled analgesia were required. After treatment, continuance of pregnancy was possible and vaginal delivery was performed safely. This is the first case report of serious renal hemorrhage in a pregnant woman with antiphospholipid syndrome receiving anticoagulation treatment and is an instructive case for urological and obstetrical practitioners.

Relationship Between Adult Renal Dimensions and Biometric ...

African Journals Online (AJOL)

We measured renal dimensions sonographically and correlated the values obtained with some anthropometric parameters in order to identify the best estimate of renal size in a clinical setting. The renal dimensions of 200 adult subjects referred for abdomino-pelvic scan at University of Nigeria Teaching Hospital, Enugu ...

[Multiple non-responding ESWL lithiasis in ectopic pelvic kidney: laparotomic surgical management].

Science.gov (United States)

Abed El Rahman, D; Zanetti, G; Cozzi, G; Cozzi, L A; Abed El Rahman, S; Maggioni, A; Rocco, F

2010-01-01

A 34 year-old male with multiple lithiasis of ectopic pelvic left kidney, which for 5 years had been causing pain in the left iliac region irradiating to ipsilateral inguinal region and testis. 4 ESWL treatments were unsuccessful. The diagnostic imaging (Angio-CT + Uro-CT) showed ectopic pelvic left kidney with abnormal vascularisation, characterised by multiple lithiasis extending in total area of 4x2 cm with shorter ureter. Right kidney was in normal position. A left pyelocalicolithotomy after DJ stent positioning was performed.

Unusual case of left iliac vein compression secondary to May-Thurner syndrome and crossed fused renal ectopia

International Nuclear Information System (INIS)

Elsharawy, Mohamed A.; Moghazy, Kahled M.; Alsaif, Hind S.; Al-Asiri, Mosad M.

2008-01-01

External compression of the left iliac vein against the fifth lumbar vertebra by the right iliac artery (May and Thurner Syndrome) is a well known anatomic variant. We identified a rare case of May-Thurner syndrome associated with crossed fused renal ectopia on the left side. The patient presented with complete thrombosis of the left common iliac vein down to the popliteal vein. He was treated with catheter directed thrombolysis followed by anticoagulant therapy. (author)

Renal streaky artifact during contrast-enhanced abdominal and pelvic CT: Comparison of high versus low osmolality contrast media

International Nuclear Information System (INIS)

Kim, Dae Hong; Kim, Jong Chul; Lee, Chung Keun; Shin, Kyoung Suk

1994-01-01

Introduction of low osmolality contrast agent(LOCA) has allowed safer, more comfortable contrast-enhanced CT examination, but there has been significant increase in image degradation when evaluating the kidneys due to streaky artifact. The authors reviewed findings of contrast- enhanced abdominal and pelvic computed tomography(CT) to know the difference of renal streaky artifact between a high osmolality contrast agent (HOCA) and LOCA. This study included two hundred contrast-enhanced CT in 200 patients, 100 performed with HOCA(meglumine ioglicate, 150 ml) and 100 performed with LOCA (iopromide,150 ml). The severity of renal streaky artifact was compared between HOCA and LOCA groups. Of the scans performed with HOCA, 40 had no artifact, 52 had grade I artifact, 6 had grade II artifact, and 2 had grade III artifact. Of the scans preformed with LOCA, 23 had no artifact, 44 had grade I artifact, 29 had grade II artifact, and 4 had grade III artifact. There was significant difference in the degree of the streaky artifact depending upon the osmolality of the contrast media used(by χ 2 -test, P=.0001). The results of this study revealed a statistically significant increased incidence of artifacts and distortions of renal image with LOCA when compared with HOCA

Lower pole renal cut injury due to the iliac wing fracture: A rare case report

Directory of Open Access Journals (Sweden)

Çaglar Yildirim

2015-07-01

Full Text Available The most frequent causes of blunt genitourinary injuries are falls from heights, motor vehicle accidents and sports injuries. Firearm injuries and penetrating stab wounds are also frequently encountered. Skeletal system traumas in the vicinity of the urogenital system can cause urological organ injuries. Though rarely, renal traumas can be dependent on the kinetic energy of the trauma and the retroperitoneal movement capacity of the kidneys and cannot be explained with the proximity of the kidney to the skeletal system. In cases with high-energy decelerations, renal pedicle and ureteropelvic junction traumas are more frequently observed. Herein, we presented a grade 3 left kidney lower pole injury developed secondary to A2 type pelvic fracture following a high energy deceleration trauma. It should not be forgotten that especially in this type of fractures, injuries of the lower renal pole can occur.

Incidental Anatomic Finding of Celiacomesenteric Trunk Associated with ‘Nutcracker Phenomenon,’ or Compression of the Left Renal Vein

Science.gov (United States)

Peterson, Joshua; Hage, Anthony N.; Diljak, Stephan; Long, Benjamin D.; Marcusa, Daniel P.; Brzezinski, David W.; Eliason, Jonathan

2017-01-01

Patient: Female, 91 Final Diagnosis: Nutcracker syndrome • celiacomesenteric trunk Symptoms: Dyspepsia • dysphagia Medication: — Clinical Procedure: — Specialty: Surgery Objective: Congenital defects/diseases Background: Celiacomesenteric trunk (CMT) is a very rare anatomic finding in which the celiac artery and the superior mesenteric artery (SMA) originate from the abdominal aorta through a common trunk. Clinical associations with CMT include arterial aneurysm, thrombosis, and celiac artery compression. However, an association between CMT and abdominal venous congestion caused by left renal vein compression, or ‘nutcracker phenomenon,’ has not been previously reported. Case Report: A 91-year-old woman, who died from a cerebrovascular accident (CVA), underwent a cadaveric examination at our medical school. On examination of the abdomen, there was an incidental finding of CMT. The arterial and venous diameters were measured, and vascular histopathology was undertaken. The vascular anatomy was consistent with CMT type 1-b. Nutcracker phenomenon (NCP) (left renal vein compression) was seen anatomically as dilatation and engorgement of the left renal vein, relative to the right renal vein (10.77±0.13 mm vs. 4.49±0.56 mm, respectively), and dilatation and engorgement of the left ovarian vein, relative to the right ovarian vein (4.37±0.15 mm vs. 1.06±0.09 mm, respectively) with left ovarian varicocele. The aortoceliac angle (ACA) and the aortomesenteric angle (AMA) approached zero degrees. Conclusions: We have described a rare anatomic finding of CMT that created an acute AMA and NCP. Awareness of this rare association between CMT and NCP by clinicians, vascular surgeons, and radiologists may be of value in the future evaluation and surgical management of patients who present clinically with ‘nutcracker syndrome.’ PMID:29242494

Albumin uptake by renal lymphatics with and without obstruction of the renal vein

International Nuclear Information System (INIS)

Threefoot, S.A.; Pearson, J.E. Jr.; Georgiardis, A.

1989-01-01

Experiments involving injection of radio-iodinated albumin into the left renal arteries or left ureters of dogs indicate that the renal lymphatics are capable of a major contribution in returning to the circulation albumin (or other large molecules) escaping from renal capillaries. I-131-albumin was injected into the jugular vein of controls or into the left renal artery or in retrograde manner into the left ureter of female dogs. Experimental groups included those with no obstruction, occlusion of left renal veins or left renal lymphatics, or both. Collections were made from the right femoral artery, both renal veins, thoracic duct and both ureters at frequent intervals for 2 to 4 hours. Data analysis included I-131 concentration, specific activity, rate of recovery and selected ratios. After renal arterial injection, the percentage of I131 recovered in thoracic duct lymph of dogs without renal venous obstruction was 5 to 10 times that recovered in those that received injections into the jugular vein. In dogs with renal venous obstruction, recovery from the thoracic duct was 10 to 1,000 times that in control dogs. Most of the differences occurred during the first hour, after which time as recirculation and redistribution occurred the rates of appearance in thoracic duct lymph in each group were similar. The differences in the ratios of concentration in thoracic duct lymph to concentration in femoral arterial blood were also much greater when the renal vein was obstructed than in dogs with no obstruction. The greater return of albumin through the thoracic duct in those with impeded renal venous outflow was probably related to both sequestered concentration and increased intrarenal pressure

Large cell non-Hodgkin's lymphoma masquerading as renal carcinoma with inferior vena cava thrombosis: a case report

Directory of Open Access Journals (Sweden)

Weissman Alan

2011-06-01

Full Text Available Abstract Introduction Many cancers are associated with inferior vena cava (IVC obstruction, but very few cancers have the ability to propagate within the lumen of the renal vein or the IVC. Renal cell carcinoma is the most common of these cancers. Renal cancer with IVC extension has a high rate of recurrence and a low five year survival rate. Case presentation A 62-year-old Caucasian woman previously in good health developed the sudden onset of severe reflux symptoms and right-sided abdominal pain that radiated around the right flank. A subsequent ultrasound and CT scan revealed a right upper pole renal mass with invasion of the right adrenal gland, liver, left renal vein and IVC. This appeared to be consistent with stage III renal cancer with IVC extension. Metastatic nodules were believed to be present in the right pericardial region; the superficial anterior abdominal wall; the left perirenal, abdominal and pelvic regions; and the left adrenal gland. The pattern of these metastases, as well as the invasion of the liver by the tumor, was thought to be atypical of renal cancer. A needle biopsy of a superficial abdominal wall mass revealed a surprising finding: The malignant cells were diagnostic of large-cell, B-cell non-Hodgkin's lymphoma. The lymphoma responded dramatically to systemic chemotherapy, which avoided the need for nephrectomy. Conclusion Lymphomas only rarely progress via intraluminal vascular extension. We have been able to identify only one other case report of renal lymphoma with renal vein and IVC extension. While renal cancer would have been treated with radical nephrectomy and tumor embolectomy, large-cell B-cell lymphomas are treated primarily with chemotherapy, and nephrectomy would have been detrimental. It is important to remember that, rarely, other types of cancer arise from the kidney which are not derived from the renal tubular epithelium. These may be suspected if an atypical pattern of metastases or unusual

Skull metastasis revealing a renal tumor: A case report and review of the literature

Directory of Open Access Journals (Sweden)

Mohamed Badri

Full Text Available Background: Renal cell carcinomas represent 85% of malignant renal tumors. Typically, the tumor remains asymptomatic a long time before the appearance of urologic clinical signs. In some cases, metastasis can precede the manifestations of the primary tumor. Different sites are potential metastatic localizations for renal tumors, including skull metastases who represent a very rare location. Case description: We report the case of a 65-year-old man presented after the appearance of a skull mass. This tumefaction developed and had progressively grown up during 9 months. Neurological examination was normal. Brain imaging showed a soft tissue lesion in the left parietal bone with marked osteolysis. Peroperative was found a huge oval-shape hemorrhagic and firm mass associated with scalp invasion and bone destruction that was totally resected. Histopathology revealed renal cell carcinoma (RCC. Pelvic and abdominal CT scan was performed, revealing a large mass on the left kidney with irregular contours and poor definition. The patient was then transferred to urology where he underwent nephrectomy. The patient went then through adjuvant chemotherapy. Clinical and radiological follow up of 12 months did not bring to light tumor recurrence. Conclusions: Although metastases to the head and neck occur infrequently, they should be considered when evaluating any unusual subcutaneous mass in the head and neck. RCC should not be discounted when sites as unlikely as the calvaria are evaluated. Treatment of metastatic renal cell carcinoma is complex, and the optimal regimen for achieving a lasting response without severe toxicity has not yet been defined. Keywords: Renal tumor, Skull metastasis, Neurosurgery

[Obstructed hemivagina and ipsilateral renal anomaly: unusual cause of piocolpos. Report a case and review of literature ].

Science.gov (United States)

Cortés-Contreras, Diana Karen; Juárez-Cruz, Patricio Manuel; Vázquez-Flores, José; Vázquez-Flores, Al David

2014-10-01

OHVIRA (Obstructed hemivagina and ipsilateral renal anomaly) by acronym and abbreviations in English or Herlyn Werner Wunderlich syndrome is a rare congenital malformation caused by an alteration in the Mullerian ducts and Wolffian Ducts. Which is characterized by a triad: uterus didelphys, obstructed and ipsilateral renal agenesis hemivagina still uncertain etiology. Patients are usually asymptomatic until menarche where the most common clinical presentation is pelvic pain, followed by a vaginal or abdominal mass, normal menstrual periods, infertility, and vaginal discharge rarely appears. The case of a female patient of 15 years, nubile with chronic fetid vaginal discharge, initially diagnosed and treated as pelvic inflammatory disease occurs, however because it is an exceptional condition with the background of the patient, by complementary studies were conducted where pelvic ultrasound revealed pyocolpos and absence of left kidney, uterus didelphys, blind hemivagina by other imaging studies, where we could integrate Herlyn-Werner-Wunderlich syndrome. In conclusion, abnormalities in the development of the Miillerian ducts are difficult to diagnose early, so you must have the embryological knowledge, conduct thorough clinical assessment and detailed picture in whom the coridition is suspected to identify malformations coexisting urinary tract and vaginal defects with the importance of preserving reproductive success through appropriate planning of surgical approach, given that the fertility rate in these patients is comparable to the average.

Conservative management of a grade V injury to an ectopic pelvic kidney following blunt trauma to the lower abdomen: a case report

Directory of Open Access Journals (Sweden)

Becker Adam M

2010-07-01

Full Text Available Abstract Introduction Ectopic pelvic kidneys represent an anatomic variant that remains clinically asymptomatic in most patients. While there is some literature to suggest that ectopic kidneys may be more predisposed to blunt trauma injuries, there are few examples to guide the management of these injuries. To our knowledge, we present the first case of a grade V renal injury to an ectopic pelvic kidney managed successfully with conservative measures. Case Presentation We present a case of grade V renal injury to an ectopic pelvic kidney in a 21 year-old African-American male. The clinical and radiographic findings are presented, along with the patient's conservative hospital course. Conclusion We suggest that management of grade V renal injuries to ectopic pelvic kidneys can be treated similarly to that of kidneys in normal anatomic position. Conservative measures may be considered in properly selected patients.

Posterior Nutcracker Syndrome with Left Renal Vein Duplication: A Rare Cause of Haematuria in a 12-Year-Old Boy

Directory of Open Access Journals (Sweden)

J. Preza Fernandes

2012-01-01

Full Text Available The nutcracker syndrome (NCS is a rare cause of haematuria. It embraces an extended nonpathognomonic spectrum of symptoms that imply a difficult diagnosis. Ultimately it may be associated with substantial morbidity and even life-threatening events. We report a rare cause if a 12-year-old boy who presented with a history of frequent intermittent episodes of painless constant haematuria. The cystoscopy showed a bloody urine ejaculate from the left ureter meatus. The Doppler ultrasonography showed turbulent pattern of venous blood flow of the posterior renal vein branch behind the aorta. The abdominopelvic computer tomography (apCT revealed left renal vein (LRV duplication with a dilated retroaortic branch, entrapped between the aorta and the vertebral column, promoting the renal nutcracker syndrome. The patient was initially hospitalized and managed with oral iron supplements and continuous saline bladder irrigation, not requiring additional treatment. The child is currently asymptomatic, with haemoglobin value returning to normal and therefore proposed to conservative management with close followup. The authors present a case report of episodic haematuria caused by a rare entity—posterior nutcracker syndrome with renal vein duplication.

CT of anomalies of the inferior vena cava and left renal vein

International Nuclear Information System (INIS)

Kokubo, Takashi; Oyama, Kazuyuki; Ohtomo, Kuni; Yashiro, Naobumi; Itai, Yuji; Iio, Masahiro; Masuyama, Shigeyoshi.

1988-01-01

Incidence of anomalies of the inferior vena cava (IVC) and left renal vein (LRV) was examined with post-contrast abdominal CT studies in the last five years and seven months retrospectively. Of the total 1100 cases, right retrocaval ureter was noted in two cases (0.2 %), left IVC was two (0.2 %) and bilateral IVC was twelve (1.1 %) about anomalies of the IVC. As to anomalies of the LRV, retroaortic LRV was four (0.4 %) and circumaortic LRV was six (0.5 %). These results did not always agree with those of previous reports on dissection cases. Particularly, incidence of anomalies of the LRV on CT was much lower than that on dissection. We speculated that racial difference was one of its causes. Clinical usefulness of CT for evaluation of anomalies of the IVC and LRV was stressed. (author)

Percutaneous Fixation of Anterior Column Acetabular Fracture in a Renal Transplant Recipient

Directory of Open Access Journals (Sweden)

Halil Ceylan

2013-01-01

Full Text Available Renal transplantation, performed per million population, ranges from 30 to 60 in developed countries. The transplanted kidney is generally placed in iliac fossa; therefore the treatment procedure of the pelvic trauma in these patients should be selected carefully. The gold standard technique for the treatment of displaced acetabulum fractures is open reduction and internal fixation. Our patient had received a living-related-donor renal transplant due to chronic renal failure. In the second year of transplantation, she had been injured in a motor-vehicle accident, and radiographs showed a right acetabular anterior column fracture and left pubic rami fractures. The patient was treated with percutaneous fixation techniques and at one year of postoperative period there was no evidence of degenerative signs and the clinical outcome was good. Beside having the advantage of avoiding dissection through the iliac fossa by the standard ilioinguinal approach, percutaneous techniques, with shorter surgical time, decreasing soft tissue disruption, and the potential for early discharge from hospital might be ideal for a renal transplant recipient carrying a higher risk of infection. Percutaneous fixation of selected acetabular fractures in a renal transplant recipient would presumably have the potential to decrease the morbidity associated with traditional open surgical procedures.

Pelvic Vein Embolisation in the Management of Varicose Veins

International Nuclear Information System (INIS)

Ratnam, Lakshmi A.; Marsh, Petra; Holdstock, Judy M.; Harrison, Charmaine S.; Hussain, Fuad F.; Whiteley, Mark S.; Lopez, Anthony

2008-01-01

Pelvic vein incompetence is common in patients with atypical varicose veins, contributing to their recurrence after surgery. Therefore, refluxing pelvic veins should be identified and treated. We present our experience with pelvic vein embolisation in patients presenting with varicose veins. Patients presenting with varicose veins with a duplex-proven contribution from perivulval veins undergo transvaginal duplex sonography (TVUS) to identify refluxing pelvic veins. Those with positive scans undergo embolisation before surgical treatment of their lower limb varicose veins. A total of 218 women (mean age of 46.3 years) were treated. Parity was documented in the first 60 patients, of whom 47 (78.3%) were multiparous, 11 (18.3%) had had one previous pregnancy, and 2 (3.3%) were nulliparous. The left ovarian vein was embolised in 78%, the right internal iliac in 64.7%, the left internal iliac in 56.4%, and the right ovarian vein in 42.2% of patients. At follow-up TVUS, mild reflux only was seen in 16, marked persistent reflux in 6, and new reflux in 3 patients. These 9 women underwent successful repeat embolisation. Two patients experienced pulmonary embolisation of the coils, of whom 1 was asymptomatic and 1 was successfully retrieved; 1 patient had a misplaced coil protruding into the common femoral vein; and 1 patient had perineal thrombophlebitis. The results of our study showed that pelvic venous embolisation by way of a transjugular approach is a safe and effective technique in the treatment of pelvic vein reflux.

Ectopia renal cruzada con fusión, reflujo vesicoureteral y riñón ectópico afuncional:: informe de un caso Crossed renal ectopia with fusion, vesicoureteral reflux and dysfunctional ectopic kidney:: A case report

Directory of Open Access Journals (Sweden)

Sandalio Durán Álvarez

2010-03-01

due to the no-obstructive pelvic dilation or right kidney, crossed renal ectopia with fusion of dysfunctional left kidney and II degree bilateral vesicoureteral reflux from right kidney and of V degree from the crossed ectopic left kidney. At eleven months life he undergoes a lumbotomy and the hydronephrosis big sac was fused with lower pole of the right kidney. This big sac was resected and a low ureter ligature was carried out.

Anatomic Patterns of Renal Arterial Sympathetic Innervation: New Aspects for Renal Denervation.

Science.gov (United States)

Imnadze, Guram; Balzer, Stefan; Meyer, Baerbel; Neumann, Joerg; Krech, Rainer Horst; Thale, Joachim; Franz, Norbert; Warnecke, Henning; Awad, Khaled; Hayek, Salim S; Devireddy, Chandan

2016-12-01

Initial studies of catheter-based renal arterial sympathetic denervation to lower blood pressure in resistant hypertensive patients renewed interest in the sympathetic nervous system's role in the pathogenesis of hypertension. However, the SYMPLICITY HTN-3 study failed to meet its prespecified blood pressure lowering efficacy endpoint. To date, only a limited number of studies have described the microanatomy of renal nerves, of which, only two involve humans. Renal arteries were harvested from 15 cadavers from the Klinikum Osnabruck and Schuchtermann Klinik, Bad Rothenfelde. Each artery was divided longitudinally in equal thirds (proximal, middle, and distal), with each section then divided into equal superior, inferior, anterior, and posterior quadrants, which were then stained. Segments containing no renal nerves were given a score value = 0, 1-2 nerves with diameter 4 nerves or nerve diameter ≥600 µm a score = 3. A total of 22 renal arteries (9 right-sided, 13 left-sided) were suitable for examination. Overall, 691 sections of 5 mm thickness were prepared. Right renal arteries had significantly higher mean innervation grade (1.56 ± 0.85) compared to left renal arteries (1.09 ± 0.87) (P renal artery has significantly higher innervation scores than the left. The anterior and superior quadrants of the renal arteries scored higher in innervation than the posterior and inferior quadrants did. The distal third of the renal arteries are more innervated than the more proximal segments. These findings warrant further evaluation of the spatial innervation patterns of the renal artery in order to understand how it may enhance catheter-based renal arterial denervation procedural strategy and outcomes. The SYMPLICITY HTN-3 study dealt a blow to the idea of the catheter-based renal arterial sympathetic denervation. We investigated the location and patterns of periarterial renal nerves in cadaveric human renal arteries. To quantify the density of the

Impaired left ventricular systolic function and increased brachial-ankle pulse-wave velocity are independently associated with rapid renal function progression.

Science.gov (United States)

Chen, Szu-Chia; Lin, Tsung-Hsien; Hsu, Po-Chao; Chang, Jer-Ming; Lee, Chee-Siong; Tsai, Wei-Chung; Su, Ho-Ming; Voon, Wen-Chol; Chen, Hung-Chun

2011-09-01

Heart failure and increased arterial stiffness are associated with declining renal function. Few studies have evaluated the association between left ventricular ejection fraction (LVEF) and brachial-ankle pulse-wave velocity (baPWV) and renal function progression. The aim of this study was to assess whether LVEFfunction was estimated by eGFR slope. The renal end point was defined as ≥25% decline in eGFR. Clinical and echocardiographic parameters were compared and analyzed. After a multivariate analysis, serum hematocrit was positively associated with eGFR slope, and diabetes mellitus, baPWV (P=0.031) and LVEFfunction decline and progression to the renal end point.

Diagnosis of nutcracker syndrome of the left renal vein. Value of the corticomedullary phase of helical CT

International Nuclear Information System (INIS)

Igari, Hidenori

2001-01-01

The clinical significance of the corticomedullary phase of helical CT in the diagnosis of nutcracker syndrome of the left renal vein (LRV) was evaluated. A total of 38 patients with hematuria of unknown origin (12 men and 26 women, mean age 24 years [range: 18-32 years]) were examined by helical CT of the kidneys, retrograde left renal venography, and measurement of renocaval pressure gradients. The sensitivity and specificity of the corticomedullary and nephrographic phases of helical CT for detecting the nutcracker syndrome were determined. The nutcracker syndrome was diagnosed on the basis of the renography findings combined with pressure measurements in 19 patients: 12 with LRV hypertension and collateral veins, 1 with hypertension and no collateral veins, and 6 with collateral veins and normal pressure gradients or borderline hypertension. Both the corticomedullary- and nephrographic-phase images revealed distended LRVs in 26 (68%) of the 38 patients. The LRV mean attenuation values in the corticomedullary phase (164±22 Hounsfield units [H], range: 138-209 H) was significantly greater (p<0.001) than in the nephrographic phase (80±14 H, range: 62-100 H). During the corticomedullary phase, opacified blood from the renal vein was mixed with unopacified blood in the IVC. In the nephrographic phase, however, the IVC was enhanced homogeneously, but only slightly. Corticomedullary-phase imaging detected collateral veins that exhibited early enhancement, indicating retrograde flow from the LRVs in 15 out of 18 patients (83% of those with collateral veins), while the nephrographic-phase imaging revealed collateral veins in 8 patients (44% of those with collateral veins). The sensitivity and specificity of the corticomedullary-phase scan for detecting the nutcracker syndrome were 79% and 100%, respectively, as opposed to 42% and 100%, respectively, for the nephrographic phase. Retrograde flow from the LRV into the collateral veins in the corticomedullary phase is a

Effect of Pelvic Tilt and Rotation on Cup Orientation in Both Supine and Standing Positions.

Science.gov (United States)

Yun, Hohyun; Murphy, William S; Ward, Daniel M; Zheng, Guoyan; Hayden, Brett L; Murphy, Stephen B

2018-05-01

The purpose of this study is to analyze the effect of pelvic tilt and rotation on radiographic measurement of cup orientation. A total of 68 patients (79 hips) were included in this study. The patients had a computed tomography study and approximately 3 months of postoperative standing anteroposterior pelvic radiographs in both supine and standing positions. We used 2-dimensional (2D)/3-dimensional (3D) matching to measure pelvic tilt and rotation, and cup orientation. There was a wide range of pelvic tilt between individuals in both supine and standing positions. Supine pelvic tilt was different from standing pelvic tilt (P cup anteversion before and after 2D/3D matching in both supine and standing positions (P cup anteversion before and after 2D/3D matching. When all 79 hips were separated into right and left side, pelvic rotation inversely correlated with the pelvic tilt-adjusted difference in anteversion before and after 2D/3D matching of the right side but directly correlated with that of the left side in both supine and standing positions. This study demonstrated that the measurement of cup anteversion on anteroposterior radiographs is significantly affected by both pelvic tilt and pelvic rotation (depending on the side). Improved understanding of pelvic orientation and improved ability to measure pelvic orientation may eventually allow for desired cup positioning to potentially protect against complications associated with malposition of the cup. Copyright © 2017 Elsevier Inc. All rights reserved.

Adrenocortical carcinoma presenting as varicocele and renal vein thrombosis: a case report

Directory of Open Access Journals (Sweden)

Horne John M

2011-08-01

Full Text Available Abstract Introduction Adrenocortical carcinomas are rare aggressive tumors. Their annual incidence is approximately one to two per million among the population of the United States of America. Patients with active endocrine tumors often present with Cushing's syndrome accompanied by virilizing features. Conversely, patients with non-functioning tumors may present with symptoms related to a mass-occupying lesion, such as abdominal pain and flank pain. Although varicoceles and acute kidney injuries are common problems in medicine, they are uncommon presentations of these rare tumors and easy to miss. We report a case of a large adrenocortical carcinoma that presented as testicular pain, varicocele, and acute kidney injury secondary to renal vein thrombosis. Case presentation A 54-year-old Caucasian man with a left-sided varicocele presented to our emergency department with lower abdominal pain and a decrease in urination. Four months previously, he had noticed pain and swelling in his left groin and had been diagnosed with left-sided varicocele. For one week, he began developing left-sided abdominal pain and decreased urination frequency, so he came to our emergency department for evaluation. His physical examination revealed a hard mass occupying the entire left side of his abdomen, crossing the midline, and extending to the pelvic brim. His blood tests showed acute kidney injury and mild anemia. Computed tomography of his abdomen showed a large retroperitoneal mass on the left side, displacing the left kidney inferiorly and the spleen superiorly with thoracic epidural compression. Thrombus was also identified in his left renal vein and inferior vena cava. Computed tomography of his chest showed bilateral pulmonary nodules. A computed tomography-guided abdominal mass biopsy was performed, and the diagnosis of adrenocortical carcinoma was made on the basis of pathology and immunohistochemistry. His hormonal evaluations were normal. His kidney

Treatment of Pelvic Venous Spur (May-Thurner Syndrome) with Self-Expanding Metallic Endoprostheses

International Nuclear Information System (INIS)

Binkert, Christoph A.; Schoch, Eric; Stuckmann, Gerd; Largiader, Jon; Wigger, Pius; Schoepke, Wolfdietrich; Zollikofer, Christoph L.

1998-01-01

Purpose: The application of self-expanding metallic endoprostheses (stents) to treat symptomatic pelvic venous spurs as an alternative to surgery. Methods: Wallstents with a diameter from 14 to 16 mm and one Cragg stent were placed in the left common iliac vein of eight patients (seven women, one man; mean age 42 years) with a symptomatic pelvic venous spur (left deep venous thrombosis or post-thrombotic leg swelling). Four patients had surgical thrombectomy prior to stent placement. Results: Technical success with immediate reduction of left leg circumference was achieved in all eight patients. A primary patency rate of 100% was observed during an average follow-up of 3 years (range 10-121 months). There were no procedural or stent-related complications. Conclusion: The percutaneous transfemoral placement of self-expanding metallic stents is an effective minimally invasive alternative to surgery in the treatment of symptomatic pelvic venous spur

Leiomyosarcoma of the renal pelvis

Directory of Open Access Journals (Sweden)

Dhamne Sagar

2009-10-01

Full Text Available Leiomyosarcomas are rare malignant tumors of the kidney. They may arise from the renal capsule, renal vein, renal pelvic musculature or renal parenchyma. Renal pelvis is an uncommon site of occurrence, with around 10 cases reported in the literature so far. Here we present a 60-year-old male who presented with increased urinary frequency, lower limb weakness, anorexia and weight loss. Imaging showed a right renal mass. A renal cell carcinoma was suspected clinically. A right nephrectomy was performed, which showed a large circumscribed mass in the hilar region. Histology revealed a tumor mass arising from the renal pelvis. The tumor was composed of spindle cells arranged in fascicles. Immunohistochemistry showed tumor cells to be positive for smooth muscle actin (SMA and desmin (Des and negative for cytokeratin (CK, HMB 45, CD117 (C-kit, and CD34. That confirmed the diagnosis of leiomyosarcoma.

Renal dysplasia with the ipsilateral ectopic ureter mimicking abscess of the prostate

Directory of Open Access Journals (Sweden)

Grbić Dragan

2014-01-01

Full Text Available Introduction. In males the ectopic ureter usualy drains into the prostate (50%. During ureteric developement a thin membrane (Chawalla’s membrane separates the lumen of the ureter and the urogenital sinus at the point where the ureter joins the urogenital sinus. This membrane ruptures allowing urin to drain from the ureter to the urogenital sinus. The authors reported a case of renal dysplasia associated with ipsilateral uretral ectopia mimicking prostatic abscess. Case report. A subfebrile (37.3°C, 23-year-old patient, otherwise healthy, presented with persistent ascending perineal pain non-responsive to antibiotics and analgetics. Digitorectal examination (DRE showed asymmetric prostate with a soft, tender, buldging left lobe suggestive of prostatic abscess. The diagnosis was suspected using transrectal ultrasonography (TRUS, but the picture of the anechoic tubular structure in the left lobe of the prostate with a proximal undefined extraprostatic extension and a caudal intraprostatic blind end was incoclusive for the definitive diagnosis of prostatic abscess. Magnetic resonance imaging (MRI was ordered and definitive diagnosis of renal dysplasia associated with the ipsilateral ectopic ureter filled with inflamed content mimicking prostatic abscess was made. Transurethral incision/minimal resection of the distal, blindly closed end of left ectopic ureter was done. Endoscopic surgical treatment was sufficient for relief of clinical symptoms. The patient’s recovery was uneventful. Conclusion. To the best of our knowledge, a case of renal dysplasia with the ipsilateral ectopic ureter mimicking prostate abscess has not been reported so far. Cystic pelvic malformations in males may result from too craniall sprouting of the ureteral bud, with delayed absorption and ectopic opening of the distal end of the ureter.

The grade of vesicoureteral reflux in voiding cystourethrography: comparison with ultrasonography and Tc99m-DMSA renal scintigraphy

International Nuclear Information System (INIS)

1998-01-01

To evaluate the prevalence of abnormalities seen on sonography and renal scintigraphy, according to the grade of vesicoureteral reflux (VUR) on in voiding cystourethrography(VCUG). One hundred and forty-nine patients (age range: 1 months-10 years) with urinary tract infection underwent sonography, VCUG, and renal scans, and 32 showed VUR on VCUG. We retrospectively evaluated the frequency and characteristic findings of sonographic abnormalities according to the grade of VUR, and also the frequency of cortical defects seen on renal scans of 32 patients with VUR. The remaining 117 patients without VUR were also evaluated for the frequency of abnormal findings seen on sonography and renal scans. Among 32 patients (49 kidneys) with VUR, abnormal findings were not detected in 17 (29 kidneys) on sonography; thus, findings were abnormal in 15 (20 kidneys, 41%). Among these 20 kidneys, renal calyceal and/or pelvic dilatation and dilatation of distal ureter were seen in 11, all of which were grade 4-5 VUR. Renal pelvic dilatation only was noted in eight kidneys; two were grade 1-3 and six were grade 4-5 VUR. Nineteen patients (24 kidneys, 49%) showed focal cortical defects on renal scintigraphy. Six kidneys were grade 1-3, and 18 kidneys were grade 4-5 VUR. Of 117 patients without VUR, 34 patients (29%) showed renal pelvic dilatation on sonography and in 14 patients (12%), cortical defects were seen on renal scintigraphy. Among 32 patients with VUR, 41% showed abnormal sonographic findings and in 49%, cortical defects were seen on renal scintigraphy. With a higher grade of VUR, the prevalence of abnormalities increased on both sonography and renal scintigraphy. Sonographic demonstration of renal caliceal and/or pelvic dilatation associated with ipsilateral distal ureteric dilatation was the characteristic finding in high grade VUR.=20

Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance

Energy Technology Data Exchange (ETDEWEB)

Cuellar i Calabria, Hug; Quiroga Gomez, Sergi; Sebastia Cerqueda, Carmen; Boye de la Presa, Rosa; Miranda, Americo; Alvarez-Castells, Agusti [Hospitals Universitaris Vall D' Hebron, Institut de Diagnostic Per La Imatge, Servei De Radiodiagnostic, Barcelona (Spain)

2005-08-01

The use of multidetector computed tomography (MDCT) in routine abdominal explorations has increased the detection of the nutcracker phenomenon, defined as left renal vein (LRV) compression by adjacent anatomic structures. The embryology and anatomy of the nutcracker phenomenon are relevant as a background for the nutcracker syndrome, a rare cause of hematuria as well as other symptoms. MDCT examples of collateral renal vein circulation (gonadal, ureteric, azygous, lumbar, capsular) and aortomesenteric (anterior) and retroaortic (posterior) nutcracker phenomena in patients with no urologic complaint are shown as well as studies performed on patients with gross hematuria of uncertain origin. Incidental observation of collateral veins draining the LRV in abdominal MDCT explorations of asymptomatic patients may be a sign of a compensating nutcracker phenomenon. Imbalance between LRV compression and development of collateral circulation may lead to symptomatic nutcracker syndrome. (orig.)

Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance

International Nuclear Information System (INIS)

Cuellar i Calabria, Hug; Quiroga Gomez, Sergi; Sebastia Cerqueda, Carmen; Boye de la Presa, Rosa; Miranda, Americo; Alvarez-Castells, Agusti

2005-01-01

The use of multidetector computed tomography (MDCT) in routine abdominal explorations has increased the detection of the nutcracker phenomenon, defined as left renal vein (LRV) compression by adjacent anatomic structures. The embryology and anatomy of the nutcracker phenomenon are relevant as a background for the nutcracker syndrome, a rare cause of hematuria as well as other symptoms. MDCT examples of collateral renal vein circulation (gonadal, ureteric, azygous, lumbar, capsular) and aortomesenteric (anterior) and retroaortic (posterior) nutcracker phenomena in patients with no urologic complaint are shown as well as studies performed on patients with gross hematuria of uncertain origin. Incidental observation of collateral veins draining the LRV in abdominal MDCT explorations of asymptomatic patients may be a sign of a compensating nutcracker phenomenon. Imbalance between LRV compression and development of collateral circulation may lead to symptomatic nutcracker syndrome. (orig.)

Pelvic Venous Variations in Patients with Congenital Inferior Vena Cava Anomalies: Classification with Computed Tomography

International Nuclear Information System (INIS)

Morita, S.; Higuchi, M.; Saito, N.; Mitsuhashi, N.

2007-01-01

Background: Pelvic venous variations of congenital inferior vena cava (IVC) anomalies that have the potential to cause problems during related surgery and interventional radiology are not fully appreciated. Purpose: To classify pelvic venous variations of congenital IVC anomalies using computed tomography (CT). Material and Methods: CT images for 36 patients with congenital IVC anomalies were retrospectively reviewed. Pelvic venous variations were classified with regard to the relationship with the iliac veins and the presence of interiliac communication. Results: Pelvic venous variations were classified into eight types. One azygous continuation displayed normal connection with the bilateral common iliac veins (CIV) (type 1). Of 28 double IVCs, 11 (39.3%) displayed no interiliac communication (type 2a), five (17.9%) displayed interiliac communication from the left CIV (type 2b), one (3.6%) had communication from the right CIV (type 2c), six (21.4%) had communication from the left internal iliac vein (IIV) (type 2d), and five (17.9%) had communication from the right IIV (type 2e). Six left IVCs displayed symmetrical-to-normal connection with the bilateral CIV (type 3). One absence of infrarenal IVC displayed no connection with the CIV (type 4). Conclusion: Eight types of pelvic venous variations of congenital IVC anomalies were classified using CT

Renal cell carcinoma in patient with crossed fused renal ectopia

Directory of Open Access Journals (Sweden)

Ozgur Cakmak

2016-01-01

Full Text Available Primary renal cell carcinomas have rarely been reported in patients with crossed fused renal ectopia. We presented a patient with right to left crossed fused kidney harbouring renal tumor. The most frequent tumor encountered in crossed fused renal ectopia is renal cell carcinoma. In this case, partial nephrectomy was performed which pave way to preservation of the uninvolved both renal units. Due to unpredictable anatomy, careful preoperative planning and meticulous delineation of renal vasculature is essential for preservation of the uninvolved renal units.

Idiopathic renal hematuria in a dog; the usefulness of a method of partial occlusion of the renal artery.

Science.gov (United States)

Mishina, M; Watanabe, T; Yugeta, N; Maeda, H; Fujii, K; Wakao, Y; Takahashi, M; Yamamura, H

1997-04-01

Exploratory laparotomy was performed on a dog suspected of having idiopathic renal hematuria. Two catheters were inserted into the bilateral ureters, and hematuria from the left kidney was confirmed. The blood flow was occluded in the ventral and dorsal rami of the left renal artery in order to localize the site of hemorrhage. As hematuria disappeared when the dorsal ramus was occluded, the site of renal hematuria was localized to the area dominated by the dorsal ramus of the renal artery. As a result of ligating the dorsal ramus of the left renal artery in this dog, renal hematuria subsided, and the dog has shown a favorable course, to date, one year after surgery.

Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy

Directory of Open Access Journals (Sweden)

Robert Marcovich

2003-06-01

Full Text Available Introduction of minimally invasive techniques has revolutionized the surgical management of renal calculi. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are now both well-established procedures. Each modality has advantages and disadvantages, and the application of each should be based on well-defined factors. These variables include stone factors such as number, size, and composition; factors related to the stone's environment, including the stone's location, spatial anatomy of the renal collecting system, presence of hydronephrosis, and other anatomic variables, such as the presence of calyceal diverticula and renal anomalies; and clinical or patient factors like morbid obesity, the presence of a solitary kidney, and renal insufficiency. The morbidity of each procedure in relation to its efficacy should be taken in to account. This article will review current knowledge and suggest an algorithm for the rational management of renal calculi with shock wave lithotripsy and percutaneous nephrolithotomy.

Anatomical variants of the internal spermatic vein discovered during the percutaneous embolization of left varicoceles in a pediatric population

International Nuclear Information System (INIS)

Garel, L.; Dubois, J.; Rypens, F.; Ouimet, A.; Yazbeck, S.

2004-01-01

To report on the high incidence of anatomical variants of the origin and course of the internal spermatic vein (ISV) discovered at the time of percutaneous embolization of left varicoceles in a pediatric population. We reviewed retrospectively the 65 cases of left varicocele treated by percutaneous embolization (grade II and III) in our institution between 1990 and 2000. The course of the left renal vein (LRV), the origin of the ISV, and the number of ISVs and their pathway were recorded in all cases, according to the B ren classification. In 37/65 (57%), the ISV was single and arose from a normal LRV (type I).The following variants were encountered: type V - circumaortic LRV 9/65 (14%); type IVb - intrarenal origin of ISV 8/65 (12%); type II - multiple ISV 5/65 (8%); and pelvic collaterals 6/65 (9%). Venous anatomical variants are frequently encountered (43%) at the time of left varicocele embolization in children. Such variants often impose some adjustments to the technique of embolization and, at times, hamper the procedure. (author)

Association between left ventricular dysfunction, anemia, and chronic renal failure. Analysis of the Heart Failure Prevalence and Predictors in Turkey (HAPPY) cohort.

Science.gov (United States)

Kepez, A; Mutlu, B; Degertekin, M; Erol, C

2015-06-01

Anemia and chronic renal failure (CRF) are frequent comorbidities in patients with heart failure (HF), and they have been reported to be associated with increased mortality and hospitalization rates. HF, anemia, and CRF have been reported to interact with each other forming a vicious cycle termed cardio-renal-anemia syndrome. The aim of the present study was to evaluate the association of HF, anemia, and CRF using data from the large-scale"Heart Failure Prevalence and Predictors in Turkey (HAPPY)" study. Among the HAPPY cohort, 3,369 subjects who had either left ventricular dysfunction (LVD) or normal left ventricular function on echocardiography or normal serum NT-proBNP levels were included in this analysis. The prevalence of anemia and CRF was significantly higher in patients with LVD compared with subjects with normal ventricular function (20.7 % vs. 4.0 % and 19.0 % vs. 3.7 %, respectively; p renal-anemia syndrome and the necessity of treating these comorbidities in patients with HF.

Retroperitoneoscopic pyelolithotomy: a good alternative treatment for renal pelvic calculi in children.

Science.gov (United States)

Cezarino, Bruno Nicolino; Park, Rubens; Moscardi, Paulo Renato Marcelo; Lopes, Roberto Iglesias; Denes, Francisco T; Srougi, Miguel

2016-01-01

Nephrolitiasis, once considered an adult disease, has become increasingly prevalent in children, with na increase from 6% to 10 % annually in past 25 years. Kidney stones in pediatric population can result from metabolic diseases in up to 50% of children affected. Other factors associated with litiasis are infection, dietary factors, and anatomic malformations of urinary tract. Standard treatment procedures for pediatric population are similar to adult population. Extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), percutaneous nepfrolithotomy (PCNL), as well as laparoscopic and retroperitoneoscopic approaches can be indicated in selected cases. The advantages of laparoscopic or retroperitoneoscopic approaches are shorter mean operation time, no trauma of renal parenchyma, lower bleeding risk, and higher stone-free rates, especially in pelvic calculi with extrarenal pelvis, where the stone is removed intact. A 10 year-old girl presented with right abdominal flank pain, macroscopic hematuria,with previous history of urinary infections.. Further investigation showed an 1,5 centimeter calculi in right kidney pelvis. A previous ureterorenoscopy was tried with no success, and a double J catheter was placed. After discussing options, a retroperitoneoscopic pielolithotomy was performed. The procedure occurred with no complications, and the calculi was completely removed. The foley catheter was removed in first postoperative day and she was discharged 2 days after surgery. Double J stent was removed after 2 weeks. Retroperitoneoscopic pielolithotomy is a feasible and safe procedure in children, with same outcomes of the procedure for adult population. Copyright® by the International Brazilian Journal of Urology.

Laparoscopic assisted percutaneous nephrolithotomy in chronic kidney disease patients with ectopic pelvic kidney

Directory of Open Access Journals (Sweden)

Sujata K Patwardhan

2017-01-01

Conclusion: Although laparoscopic assisted PCNL is an option in the management of patients with stone disease in ectopic pelvic kidney, prolonged time for healing of tract may increase postoperative morbidity in these patients with impaired renal function.

Infra-renal angles, entry into inferior vena cava and vertebral levels of renal veins.

Science.gov (United States)

Satyapal, K S

1999-10-01

Current norms for renal vasculature hold true in only half the population. Standard textbooks perpetuate old misconceptions regarding renal venous anatomy. This study is aimed to determine left and right infra-renal angles (L-IRA, R-IRA); entry level of renal veins into the inferior vena cava (IVC), and height of IVC under renal vein influence; and their vertebral level. One hundred morphologically normal en-bloc renal specimens randomly selected from post-mortem examinations were dissected and resin casted. IRA were also measured from venograms of 32 adult and 11 foetal cadavers, as were vertebral entry levels. IRA measurements (degrees) were as follows: left, 55 degrees +/- 16 degrees (20 degrees -102 degrees ); right, 60 degrees +/- 17 degrees (10 degrees -93 degrees ). Left vein entered IVC higher than right 54%, lower 36%, and opposite each other 10%. Vertical distance between lower borders of veins was 1.0 +/- 0.9 cm. Vertical distance of IVC under renal vein influence was 2.3 +/- 1.0 cm. Vertebral level of veins in adults lies between TI2-L2. In foetuses, IRA was as follows: left, 65 degrees +/- 12 degrees (45 degrees -90 degrees ); right, 58 degrees +/- 7 degrees (40 degrees -70 degrees ); vertebral level between T12 and L3. Similar IRA values from literature noted on right, 51 degrees (26 degrees -100 degrees ); differences on left, 77 degrees (43 degrees -94 degrees ), clearly differing from Williams et al. (Gray's Anatomy, 37(th) ed, 1989) statement that renal veins "open into the inferior vena cava almost at right angles." Large variations of IRA are not surprising since kidneys are considered normally "floating viscera," varying position with posture and respiratory movement as well as in live vs. cadaveric subjects. The entry level into the IVC also differs from Williams et al. This study uniquely quantitated actual height difference between lower borders of left and right veins. The data presented appears to be the first documentation of vertebral

[Ultrasonography in acute pelvic pain].

Science.gov (United States)

Kupesić, Sanja; Aksamija, Alenka; Vucić, Niksa; Tripalo, Ana; Kurjak, Asim

2002-01-01

Acute pelvic pain may be the manifestation of various gynecologic and non-gynecologic disorders from less alarming rupture of the follicular cyst to life threatening conditions such as rupture of ectopic pregnancy or perforation of inflamed appendix. In order to construct an algorithm for differential diagnosis we divide acute pelvic pain into gynecologic and non-gynecologic etiology, which is than subdivided into gastrointestinal and urinary causes. Appendicitis is the most common surgical emergency and should always be considered in differential diagnosis if appendix has not been removed. Apart of clinical examination and laboratory tests, an ultrasound examination is sensitive up to 90% and specific up to 95% if graded compression technique is used. Still it is user-depended and requires considerable experience in order to perform it reliably. Meckel's diverticulitis, acute terminal ileitis, mesenteric lymphadenitis and functional bowel disease are conditions that should be differentiated from other causes of low abdominal pain by clinical presentation, laboratory and imaging tests. Dilatation of renal pelvis and ureter are typical signs of obstructive uropathy and may be efficiently detected by ultrasound. Additional thinning of renal parenchyma suggests long-term obstructive uropathy. Ruptured ectopic pregnancy, salpingitis and hemorrhagic ovarian cysts are three most commonly diagnosed gynecologic conditions presenting as an acute abdomen. Degenerating leiomyomas and adnexal torsion occur less frequently. For better systematization, gynecologic causes of acute pelvic pain could be divided into conditions with negative pregnancy test and conditions with positive pregnancy test. Pelvic inflammatory disease may be ultrasonically presented with numerous signs such as thickening of the tubal wall, incomplete septa within the dilated tube, demonstration of hyperechoic mural nodules, free fluid in the "cul-de-sac" etc. Color Doppler ultrasound contributes to more

Multiple vascular anomalies involving renal, testicular and suprarenal arteries

Directory of Open Access Journals (Sweden)

Suresh Rao

2015-09-01

Full Text Available Knowledge of variations of blood vessels of the abdomen is important during operative, diagnostic and endovascular pro- cedures. During routine dissection of the abdominal cavity, we came across multiple vascular anomalies involving renal, suprarenal and testicular arteries. The left kidney was supplied by two renal arteries originating together from the abdomi- nal aorta, and the right kidney was supplied by two accessory renal arteries, one of which was arising from the right renal artery and the other one from the aorta (about 2 inches below the origin of the renal artery. Accessory renal veins were present on both sides. The right testicular artery was arising from the lower accessory renal artery. The left testicular artery was looping around the inferior tributary of the left renal vein, whereby forming a sharp kink. The left middle suprarenal artery was diving into three small branches; the upper two branches were supplying the left suprarenal gland, whereas the lower branch was supplying the left kidney. Furthermore, detailed literature and the clinical and surgical importance of the case are discussed. [Arch Clin Exp Surg 2015; 4(3.000: 168-171

[Anatomy character of renal artery and treatment of living-donor renal transplantation].

Science.gov (United States)

Zhang, Lei; Fei, Ji-guang; Chen, Li-zhong; Wang, Chang-xi; Deng, Su-xiong; Qiu, Jiang; Li, Jun; Chen, Guo-dong; Huang, Gang

2009-12-15

To study the anatomy characters of renal artery and the treatment of multiple arteries in living donor renal grafts. Records of 142 living donors were analyzed in our center. We analyzed the anatomic structure of renal arteries by DSA and CTA pre-transplantation. Thirty-one kidneys with multiple arteries were transplanted after reconstruction. Then clinical effects were compared between multiple-renal-arteries group (n=31) and single-renal-artery group (n=111). The incidence of multiple renal artery was 30.99%, and there was no difference between both sides (left kidney 22.54%, right kidney 22.13%). If the multiple artery occurred in left or right kidney, the incidence of the multiple artery occurred in the other side was 56.25% and 60.00%, respectively. The diameter of left main renal artery was more magnanimous (P=0.001) and the first branch was more closed to abdominal aorta (P=0.004). Operation time and warm/cool ischemia time were longer in the multiple-renal-arteries group. However, estimated blood loss, delayed graft function, acute rejection and flow rate of arcuate artery were similar in both groups, the same as serum creatinine and serum creatinine clearance rate on day 7, 1 month and 3 month post-operation. It was shown by repeated measures ANOVA that graft with multiple arteries didn't affect the tendency of renal function at early time post-operation. Comprehending the character of renal artery and accurate treatment of multiple artery anastomosis are critical for the effect of the living kidney transplantation.

Iliac renal ectopia explored by {sup 99m}Tc-DTPA and {sup 99m}Tc-DMSA scintigraphy. Report of one case; Ectopie renale iliaque exploree par scintigraphie au {sup 99m}Tc-DTPA et au {sup 99m}Tc-DMSA. A propos d'un cas

Energy Technology Data Exchange (ETDEWEB)

Ghfir, I.; Ben Rais, N. [Hopital Ibn Sina, CHU de Rabat, Service de Medecine Nucleaire de Rabat (Morocco)

2008-11-15

Introduction Renal ectopia is a malposition by anomaly of migration during the embryonic development. It can be high, low or crossed. Association with an obstructive malformation is rather frequent. The objective of this work is to highlight the interest of {sup 99m}Tc-DTPA and {sup 99m}Tc-DMSA scintigraphy in the exploration of this type of malformation through the observation of a patient presenting an iliac right renal ectopia associated with an ureteral-pelvic junction syndrome. Observation A 38-year-old patient with an ureteral-pelvic junction syndrome on a right iliac renal ectopia revealed by intravenous urography. The dynamic renal scintigraphy using {sup 99m}Tc-DTPA with furosemide test evidenced an organic obstruction in the right urinary tract with a right renal function estimated at 40% on the {sup 99m}Tc-DMSA scintigraphy. A right pyelo-plasty was carried out. The evolution was marked by the disappearance of pain and a remarkable improvement of the permeability of the right urinary tract on the follow-up scintigraphy. Discussion Renal ectopia is not an unfrequent urinary malformation. It is generally low, pelvic or iliac. Association with an ureteral-pelvic junction obstruction is rather frequent. In this purpose, renal scintigraphy intervenes as a means of functional exploration, with low ionizing radiation and non-invasive to assess the permeability of the urinary tracts of the ectopic kidney and to appreciate the relative renal function. This contributes to the orientation of diagnosis and the improvement of therapeutic strategy.

A case of Klippel-Feil syndrome with renal agenesis

Directory of Open Access Journals (Sweden)

Mehmet Karakoç

2010-05-01

Full Text Available Klippel-Feil syndrome (KFS is is a rare syndrome that characterized by fusion of at least two congenital vertebrae in the cervical region. The most common characteristics of KFS are short neck, low nuchal hair line and restricted joint mobility of the cervical region.Addititonal features are scoliosis, sipina bifida, cervical rib, Sprengel deformity and facial asymmetry, and renal and cardiac anomalies. In this report a 10 years old girl was admitted with complaints of short stature and abnormal neck curvature. Physical examination of the patient revealed short neck, low nuchal hair line, and Sprengel’s deformity, height hard palate, facial asymmetry and torticollis. Cervical paravertebral muscle spasm was found on the left as (+ / right (+ +. Muscle tone, muscle strength, reflexes and sensory examination were found to be normal. Radiological examination of the C4-5 and C6-7 cervical region revealed the loss of inteverebral disc spaces and block vertebra. Also there was hemivertebra anomaly and aplasia of odontoid process. Abdominal and pelvic ultrasound examination revelaed absence of right kidney. Echocardiographical examination gave no abnormality. The case was presented in order to draw attention to KFS with renal agenesia in the light of current literature.

Menstruation. A hazard in radionuclide renal transplant evaluation

International Nuclear Information System (INIS)

Orzel, J.A.; Jaffers, G.J.

1986-01-01

Serial Tc-99m DTPA studies were performed to evaluate renal transplant blood flow and function in a 34-year-old woman. A hypervascular pelvic mass with increased blood pool activity was intermittently identified. This hypervascular lesion suggested a pathologic condition of the pelvis, and its blood pool simulated bladder activity, confusing interpretation of renal function. This perplexing vascular lesion was the uterus, with varying degrees of blood flow and blood pool activity depending on the timing of the renal study in relation to the menstrual cycle

Menstruation. A hazard in radionuclide renal transplant evaluation

Energy Technology Data Exchange (ETDEWEB)

Orzel, J.A.; Jaffers, G.J.

1986-06-01

Serial Tc-99m DTPA studies were performed to evaluate renal transplant blood flow and function in a 34-year-old woman. A hypervascular pelvic mass with increased blood pool activity was intermittently identified. This hypervascular lesion suggested a pathologic condition of the pelvis, and its blood pool simulated bladder activity, confusing interpretation of renal function. This perplexing vascular lesion was the uterus, with varying degrees of blood flow and blood pool activity depending on the timing of the renal study in relation to the menstrual cycle.

Effect of the Individual Strengthening Exercises for Posterior Pelvic Tilt Muscles on Back Pain, Pelvic Angle, and Lumbar ROM of a LBP Patient with Excessive Lordosis: A Case Study.

Science.gov (United States)

Yoo, Won-Gyu

2014-02-01

[Purpose] The purpose of this study was to document the effect of individual strengthening exercises for posterior pelvic tilt muscles on back pain, pelvic tilt angle, and lumbar ROM of a low back pain (LBP) patient with excessive lordosis. [Subjects] The subject was a 28 year-old male with excessive lordosis who complained of severe LBP at the L3 level. [Methods] He performed individual strengthening exercises for the posterior pelvic tilt muscles (rectus abdominis, gluteus maximus, hamstring). [Results] Pelvic tilt angles on the right and left sides recovered to his normal ranges. Limited lumbar ROM increased, and low back pain decreased. [Conclusion] We suggest that an approach of individual resistance exercises is necessary for the effective and fast strengthening of the pelvic posterior tilt muscles in case of LBP with excessive lordosis.

Comparison of two-dimensional MR angiography and microsphere measurement of renal blood flow for detection of renal artery stenosis

International Nuclear Information System (INIS)

Powers, T.A.; Lorenz, C.H.; Shetty, A.N.; Holburn, G.E.; Price, R.R.

1990-01-01

This paper compares depiction of the renal arteries by MR angiography to renal blood flow as determined with microspheres in a dog model of renal artery stenosis. A left renal artery stenosis was created by placement of a silk ligature. Nb-95-labeled microspheres were injected into the left ventricle and a reference blood sample was drawn. The dog was imaged in the 1.5-T MR imager with two-dimensional MR angiography sequences. The kidneys were excised, weighted, divided into sections, and counted. Two dogs were studied to date. In dog 1, left renal blood flow (RBF) was 42 mL/min/100 g and right RBF was 337 mL/min/100 g. In dog 2 left RBF was 44 mL/min/100 g and right RBF was 608 mL/min/100 g

Ultrasonographically determined renal values and comparisons to serum biochemistry renal variables in aged semi-captive cheetahs (Acinonyx jubatus).

Science.gov (United States)

Kirberger, Robert M; Tordiffe, Adrian S W

2017-11-06

Cheetahs in captivity have a high prevalence of chronic renal diseases. We ultrasonographically evaluated the renal volumes, a variety of renal dimensions, interarcuate artery resistive indices (RI) as well as aortic diameters and the length of the ventral aspect of the 6th lumbar vertebrae in 27 aged semi-captive anesthetized cheetahs. Renal size, dimensions and ratios were compared to urine specific gravity, serum creatinine and urea values. There were minimal differences for all values between left and right kidneys. Mean kidney length was 65.1 mm (range 55.2-76.9) with left kidney length ratios to L6 length being 1.60 (range 1.27-2.06) and to the aortic diameter 7.69 (range 4.54-10.72). Significant correlations between left renal length as well as length:L6 ratio to creatinine values were found ((r - 0.66) and (r - 0.60) respectively). The mean RI values of the different sedation/anesthetic protocols ranged from 0.46-0.55. Left renal length and L6 ventral vertebral body length as well as left kidney RI values should be routinely measured in all cheetah abdominal ultrasound examinations. These measurements, together with serum creatinine, urea and urine specific gravity values may be relatively sensitive indicators of early renal pathology in the absence of gross ultrasonographic changes.

Digital subtraction angiography in 105 living renal transplant donors

International Nuclear Information System (INIS)

Suh, Ho Jong; Oh, Kyung Seung; Kim, So Sun; Huh, Jin Do; Kim, Ho Joon; Chun, Byung Hee; Joh, Young Duck

1989-01-01

In order to analyze the number and length of the renal arteries and to evaluate abnormalities of the renal parenchyma and vessel, digital subtraction angiogram images of 105 potential renal donors (45 men and 60 women aged 17-66 years) were studied retrospectively. For the entire series, 31 donors had multiple renal arteries on one side (15 on the left, 11 on the right) and 5 donors on the both sides. 89 donors were family related either parents or siblings of recipients. The estimation of the length of the renal artery was based on the mean height of the second lumbar vertebral body (L2). The right renal artery is significant longer than on the left and measured more than the height of L2 vertebral body in 84 cases on the right and 60 cases on the left. Twenty two donors underwent right nephrectomy due to presence of multiple renal arteries on the left (N=14), proximal bifurcation of left main renal artery (N=3), and young females in reproductive age (N=5). Unexpected abnormalities found with angiogram were seen in 7 cases and they include renal artery stenosis (N=2), renal cysts (N=4) and focal infarction (N=1). In cases of the renal cysts and focal infarction, there were no serious complications related to the abnormalities. It is conclude that intra-arterial digital subtraction angiography is safe and efficient method to image renal anatomy of the potential renal donors

Bilateral renal artery variation

OpenAIRE

Üçerler, Hülya; Üzüm, Yusuf; İkiz, Z. Aslı Aktan

2014-01-01

Each kidney is supplied by a single renal artery, although renal artery variations are common. Variations of the renal arteryhave become important with the increasing number of renal transplantations. Numerous studies describe variations in renalartery anatomy. Especially the left renal artery is among the most critical arterial variations, because it is the referred side forresecting the donor kidney. During routine dissection in a formalin fixed male cadaver, we have found a bilateral renal...

Late solitary pelvic metastasis of hepatocellular carcinoma mimicking alpha-fetoprotein-producing gynaecologic tumour

Directory of Open Access Journals (Sweden)

Ji He Kim

2018-01-01

Full Text Available Extrahepatic spread of hepatocellular carcinoma (HCC is uncommon; and, pelvic metastasis, in particular, is extremely rare. A 71-year-old woman was admitted for evaluation of pelvic solitary solid mass. She had undergone a left lobectomy 28 years previously. Magnetic resonance imaging of the abdomen and pelvis demonstrated a heterogeneous mass in the right pelvic cavity, whereas no space-occupying lesions or ascites were detected in the liver. CA 125 levels were within normal limits; however, serum alpha-fetoprotein levels were markedly elevated. She underwent laparoscopic pelvic mass excision, total hysterectomy, and bilateral salpingo-oophorectomy. Histopathologic findings and immunochemical staining results indicated metastatic HCC. Herein, we report an unusual case of a patient with solitary recurrence in the pelvic cavity 28 years after initial diagnosis and treatment.

Aneurisma da Artéria Renal: caso clínico Renal Artery Aneurysm

Directory of Open Access Journals (Sweden)

Joana Moreira

2011-12-01

Full Text Available Apresenta-se o caso clínico de um doente com volumoso aneurisma da artéria renal esquerda. Do sexo masculino, de 22 anos de idade, com lombalgia à esquerda com algumas semanas de evolução. Recorreu ao médico assistente que solicitou estudo imagiológico por ecografia abdominal. Detectada imagem sugestiva de aneurisma da aorta abdominal. Este achado motivou a transferência para o nosso Hospital onde foi admitido consciente e orientado, hemodinamicamente estável, apresentando uma massa pulsátil epigástrica, com frémito e sopro sistólico à auscultação. Angio-TC revelou um aneurisma da artéria renal esquerda com 16 cm de diâmetro. Dada a estabilidade clínica e topografia lesional optou-se por tentar embolizar, sem sucesso, o tronco da artéria renal esquerda antes da abordagem cirúrgica. O doente foi então submetido a Nefrectomia total esquerda por via toraco-abdominal. Pós-operatório sem complicações, locais ou sistémicas. Alta ao 8ºdia, mantendo boa função renal e com níveis normais de hemoglobina. Diagnóstico de aneurisma da artéria renal confirmado por estudo anátomo-patológico da peça operatória.One case of a large left renal artery aneurysm in a young patient 22 years old is presented. He appealed to his assistant physician a few weeks after development of left back pain. Abdominal ultrasound imaging study has been requested. Suggestive abdominal aortic aneurysm was detected. This finding led to the transfer to our hospital where he was admitted conscious and hemodynamically stable. A pulsatile epigastric mass with a systolic murmur on auscultation and thrill were detected. Angio-CT scan revealed a left renal artery aneurysm, 16 cm in diameter. Given the clinical stability and lesional topography we decide a previous embolization of left renal artery, unsuccessfully. The patient underwent then left total nephrectomy, through thoraco-abdominal incision. No local or systemic complications in the postoperative

BILATERAL DUPLICATION OF RENAL ARTERIES

OpenAIRE

Prajkta A Thete; Mehera Bhoir; M.V.Ambiye

2014-01-01

Routine dissection of a male cadaver revealed the presence of bilateral double renal arteries. On the right side the accessory renal artery originated from the abdominal aorta just above the main renal artery. On the left side the accessory renal artery originated from the abdominal aorta about 1 cm above the main renal artery. Knowledge of the variations of renal vascular anatomy has importance in exploration and treatment of renal trauma, renal transplantation, renal artery embolization, su...

Spine lateral flexion strength development differences between exercises with pelvic stabilization and without pelvic stabilization

Science.gov (United States)

Straton, Alexandru; Gidu, Diana Victoria; Micu, Alexandru

2015-02-01

Poor lateral flexor muscle strength can be an important source of lumbar/thoracic back pain in women. The purpose of this study was to evaluate pelvic stabilization (PS) and no pelvic stabilization (NoPS) lateral flexion strength exercise training on the development of isolated right and left lateral flexion strength. Isometric torque of the isolated right and left lateral flexion muscles was measured at two positions (0° and 30° opposed angle range of motion) on 42 healthy women before and after 8 weeks of PS and NoPS lateral flexion strength exercise training. Subjects were assigned in three groups, the first (n=14) trained 3 times/week with PS lateral flexion strength exercise, the second (n=14) trained 3 times/week with NoPS lateral flexion strength exercise and the third (control, n=14) did not train. Post training isometric strength values describing PS and NoPS lateral flexion strength improved in greater extent for the PS lateral flexion strength exercise group and in lesser extent for the NoPS lateral flexion strength exercise group, in both angles (pstrength exercises; NoPS lateral flexion strength exercises can be an effective way of training for the spine lateral flexion muscles, if there is no access to PS lateral flexion strength training machines.

Ultrasonography assessment of renal size and its correlation with body mass index in adults without known renal disease

International Nuclear Information System (INIS)

Raza, M.; Hameed, A.; Khan, M.I.

2012-01-01

Many conditions affect renal size. To evaluate abnormalities in renal size, knowledge of standardised values for normal renal dimensions is essential as it shows variability in the values of normal renal size depending on body size, age and ethnicity. Ultrasound, being an easily available, non-invasive, safe and less expensive modality, is widely used for evaluation of renal dimensions and repeated follow-ups. The objectives of this study were to determine renal size by ultrasound in adults without any known renal disease, and to determine the relationship of renal size with body mass index. Methods: Study was conducted in the Department of Diagnostic Radiology, Shifa International Hospital and PIMS Islamabad. Renal size was assessed by ultrasound in 4,035 adult subjects with normal serum creatinine and without any known renal disease, between November 2002 and December 2010. Renal length, width, thickness and volume were obtained and mean renal length and volume were correlated with body mass index and other factors like age, side, gender, weight and height of the subjects. Results: Mean renal length on right side was 101.6+-8.9 mm, renal width 42.7+-7.1 mm, and parenchymal thickness 14.4+-2.9 mm. On left side, mean renal length was 102.7+-9.2 mm, width 47.6+-7.0 mm, and parenchymal thickness 15.1+-3.1 mm. Mean renal volume on right was 99.8+-37.2 cm/sup 3/ and on left was 124.4+-41.3 cm/sup 3/. Left renal size was significantly larger than right in both genders. Relationship of mean renal length was significant when correlated with age, side, gender, height and weight, and body mass index. Renal volumes also showed a similar relationship with side, gender, height and weight, and body mass index; but with age such a relationship was seen only for left kidney. Conclusion: Pakistani population has mean renal size smaller than reference values available in international literature. Renal length and volume have a direct relationship with body mass index. Mean renal

Reversal of end-stage renal disease after aortic dissection using renal artery stent: a case report

Directory of Open Access Journals (Sweden)

Parikh Chirag R

2004-05-01

Full Text Available Abstract Background Medical management is the conventional treatment for Stanford Type B aortic dissections as surgery is associated with significant morbidity and mortality. The advent of endovascular interventional techniques has revived interest in treating end-organ complications of Type B aortic dissection. We describe a patient who benefited from endovascular repair of renal artery stenosis caused by a dissection flap, which resulted in reversal of his end-stage renal disease (ESRD. Case presentation A 69 y/o male with a Type B aortic dissection diagnosed two months earlier was found to have a serum creatinine of 15.2 mg/dL (1343.7 μmol/L on routine visit to his primary care physician. An MRA demonstrated a rightward spiraling aortic dissection flap involving the origins of the celiac artery, superior mesenteric artery, and both renal arteries. The right renal artery arose from the false lumen with lack of blood flow to the right kidney. The left renal artery arose from the true lumen, but an intimal dissection flap appeared to be causing an intermittent stenosis of the left renal artery with compromised blood flow to the left kidney. Endovascular reconstruction with of the left renal artery with stent placement was performed. Hemodialysis was successfully discontinued six weeks after stent placement. Conclusion Percutaneous intervention provides a promising alternative for patients with Type B aortic dissections when medical treatment will not improve the likelihood of meaningful recovery and surgery entails too great a risk. Nephrologists should therefore be aggressive in the workup of ischemic renal failure associated with aortic dissection as percutaneous intervention may reverse the effects of renal failure in this population.

Evaluation of magnetization transfer ratio in ascites and pelvic cystic masses

Energy Technology Data Exchange (ETDEWEB)

Okada, Susumu [Nippon Medical School, Inba, Chiba (Japan). Chiba-Hokuso Hospital; Kato, Tomoyasu; Yamashita, Takashi [and others

1997-12-01

To investigate the feasibility of magnetization transfer contrast (MTC) in characterization of pelvic cystic masses and ascites, in vitro studies were performed. Cystic fluids were taken from operative specimens of ten ovarian cystic masses (five mucinous cystadenomas, one cystadenocarcinoma, two serous cystadenocarcinomas, two clear cell carcinomas) and three non-ovarian pelvic cysts (one paraovarian cyst, one pseudomyxoma peritonei, one pelvic abscess). Samples of ascitic flied were drawn by peritoneal puncture in twenty patients (thirteen with peritonitis carcinomatosa, five with liver dysfunction, two with renal dysfunction). Total protein content in ascitic fluids was measured. Magnetization transfer ratio (MTR) was calculated by the signal intensities under the gradient echo sequence with and without the application of off-resonance pulses. The relative signal intensities (RSI) relative to water in T{sub 1} and T{sub 2} weighted images were obtained using spin echo sequence. There was no correlation between histological type of pelvic mass and MTR and RSI. Good correlation (R{sup 2}=0.761) was obtained between MTR and protein content in ascitic fluids, whereas no correlation was noted between RSI and protein content in ascitic fluids. These results suggest that MTC is not useful in the characterization of pelvic masses but is applicable in the differentiation between exudative ascites and transudative ascites. (author)

Non-contrast magnetic resonance angiography in renal transplantation and renal donation

DEFF Research Database (Denmark)

Blankholm, Anne Dorte

2015-01-01

for this purpose, including US, CTA and CEMRA. CTA is based on x-ray technology, and the applied iodine-based contrast agent can cause nephropathy and, in rare cases, severe allergic reactions. Allergic reactions to Gd used in CEMRA are extremely rare. Thus, CEMRA was often used for preoperative examination before...... renal transplantation. In 2006, it was realised that the Gd used in CEMRA could cause NSF, which prompted the Danish National Board of Health to produce guidelines for the use of contrast agents in patients with severe renal disease. This thesis discusses different preoperative imaging methods without...... contrast agents before kidney transplantation and kidney donation. Study I is a review of NCMRA techniques and clinical applications. In study II, we searched for an NCMRA method with consistently good image quality for the examination of the pelvic vessels in patients with severe renal disease. Five...

The Role of Non-Steroidal Anti-Inflammatory Drugs in Renal Colic

Directory of Open Access Journals (Sweden)

Elizabeth Waine

2010-04-01

Full Text Available NSAIDs provide optimal analgesia in renal colic due to the reduction in glomerular filtration and renal pelvic pressure, ureteric peristalsis and ureteric oedema. Prevention of glomerular afferent arteriolar vasodilatation renders these patients at risk of renal impairment. NSAIDs have the additional benefit of reducing the number of new colic episodes and preventing subsequent readmission to hospital. Despite recent work promoting the use of pharmacological agents to improve stone passage rates, NSAIDs do not appear to reduce the time to stone passage or increase the likelihood of stone passage in renal colic.

Association of renal biochemical parameters with left ventricular diastolic dysfunction in a community-based elderly population in China: a cross-sectional study.

Directory of Open Access Journals (Sweden)

Jingmin Zhou

Full Text Available BACKGROUND: Relationship of left ventricular diastolic dysfunction (LVDD with parameters that could provide more information than hemodynamic renal indexes has not been clarified. We aimed to explore the association of comprehensive renal parameters with LVDD in a community-based elderly population. METHODS: 1,166 community residents (aged ≥ 65 years, 694 females participating in the Shanghai Heart Health Study with complete data of renal parameters were investigated. Echocardiography was used to evaluate diastolic function with conventional and tissue Doppler imaging techniques. Serum urea, creatinine, urea-to-creatinine ratio, estimated glomerular filtration rate (eGFR and urinary albumin-to-creatinine ratio (UACR were analyzed on their associations with LVDD. RESULTS: The prevalence of LVDD increased in proportion to increasing serum urea, urea-to-creatinine ratio and UACR. These three renal parameters were found negatively correlated to peak early (E to late (A diastolic velocities ratio (E/A, and positively to left atrial volume index; UACR also positively correlated with E to peak early (E' diastolic mitral annular velocity ratio (E/E'. Serum urea, urea-to-creatinine ratio and UACR correlated with LVDD in logistic univariate regression analysis, and urea-to-creatinine ratio remained independently correlated to LVDD [Odds ratio (OR 2.82, 95% confidence interval (CI 1.34-5.95] after adjustment. Serum urea (OR 1.18, 95%CI 1.03-1.34, creatinine (OR 6.53, 95%CI 1.70- -25.02, eGFR (OR 0.22, 95%CI 0.07-0.65 and UACR (OR 2.15, 95%CI 1.42-3.24 were revealed independent correlates of advanced (moderate and severe LVDD. CONCLUSIONS: Biochemical parameters of renal function were closely linked with LVDD. This finding described new cardio-renal relationship in the elderly population.

Ligation of the left renal vein in epm1-wistar rats: functional and morphologic alterations in the kidneys, testes and suprarenal glands

Directory of Open Access Journals (Sweden)

José Carlos Costa Baptista-Silva

Full Text Available OBJECTIVE: The ligation of the left renal vein (LLVR in man is a contraversial procedure in view of the risks of lesion to the renal parenchyma. With the objective of studying the morphologic and functional alterations caused by these lesions, we conducted experimental research with rats. MATERIAL AND METHODS: 64 male adult EPM1-WISTAR rats were used, divided into 8 groups - 4 for LLRV and four for control. Each LLRV group and corresponding control group were sacrificed progressively on the 7th, 15th, 30th and 60th day after the initial surgery. RESULTS: We found morphofunctional alterations only in animals that underwent LLRV in the four periods of sacrifice.The proteinuria creatinine in serum, testosterone in serum and serum corticosterone in serum showed practically no alteration in relation to the normal values for rats. Statistically significant severe histological lesions were found in the kidneys and testes of the LLRV groups. Lesions in the suprarenal glands were also present in these groups, but no sufficient to demonstrate statistical significance CONCLUSION: Based on these results we can conclude that the ligation of the left renal vein is a procedure of high risk in these animals.

Renal and perirenal non-Hodgkin's lymphoma: CT findings

International Nuclear Information System (INIS)

Lee, Seon Kyu; Kim, Seung Hyup; Lee, Goo; Choi, Byeung In; Han, Man Chung

1992-01-01

CT findings of 19 kidneys in 12 patients with renal and perirenal non-Hodgkin's lymphoma were retrospectively reviewed to determine distinguishing characteristic and specific findings. CT manifestation of the renal and perirenal lymphoma included multiple nodules in five kidneys(26.3%), trans-capsular infiltration in three kidneys(15.8%), trans-sinus infiltration in nine kidneys(47.4%) and diffuse infiltration in two kidneys(10.5%). Perirenal changes were thickening of the renal fascia in ten kidneys(52.6%) and crescent lesion of low attenuation in the subcapsular area in five kidneys(26.3%) Retroperitoneal lymphadenopathy was evident in eleven patient(57.9%). Renal calyceal dilatation without renal pelvic dilatation(selective calycelal dilatation) was noted in three kidneys. Familiarity with these CT findings of renal and perirenal lymphoma may be helpful in the diagnosis and management of patient with non-Hodgkin's lymphoma

Converting to increased Tc-99m DTPA renal flow from slight decrease in renal flow following angioplastic procedures in a patient with unequal renal artery stenoses

International Nuclear Information System (INIS)

Shih Weijen; Mitchell, B.L.

1990-01-01

The use of Tc-99m DTPA renal flow imaging has increased in importance since the introduction of catheter angioplasty. The high diagnostic accuracy and non-invasive technique as compared to digital subtraction angiography have done much to enhance its usage in the evaluation of renal functional status. This paper reports Tc-99m DTPA renal flow imaging findings before and after angioplasty in a patient with bilateral renal artery stenosis. The slight decrease in Tc-99m DTPA renal flow on the kidney before angioplasty converted to an increase in flow on the right kidney after angioplasty. Post procedural blood flow was much higher on the right, where stenosis was previously more severe. It is hypothesized that the right kidney was protected from elevated aterial pressure by its 90% arterial stenosis while the left kidney was exposed to elevated systemic blood pressure. Because of vascular damage to the unprotected left kidney, post-angioplasty blood flow was less in the left kidney than in the ischemic but protected right kidney. (orig.) [de

Massive postpartum right renal hemorrhage.

Science.gov (United States)

Kiracofe, H L; Peterson, N

1975-06-01

All reported cases of massive postpartum right renal hemorrhage have involved healthy young primigravidas and blacks have predominated (4 of 7 women). Coagulopathies and underlying renal disease have been absent. Hematuria was painless in 5 of 8 cases. Hemorrhage began within 24 hours in 1 case, within 48 hours in 4 cases and 4 days post partum in 3 cases. Our first case is the only report in which hemorrhage has occurred in a primipara. Failure of closure or reopening of pyelovenous channels is suggested as the pathogenesis. The hemorrhage has been self-limiting, requiring no more than 1,500 cc whole blood replacement. Bleeding should stop spontaneously, and rapid renal pelvic clot lysis should follow with maintenance of adequate urine output and Foley catheter bladder decompression. To date surgical intervention has not been necessary.

Prospective study comparing three-dimensional computed tomography and magnetic resonance imaging for evaluating the renal vascular anatomy in potential living renal donors.

Science.gov (United States)

Bhatti, Aftab A; Chugtai, Aamir; Haslam, Philip; Talbot, David; Rix, David A; Soomro, Naeem A

2005-11-01

To prospectively compare the accuracy of multislice spiral computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) in evaluating the renal vascular anatomy in potential living renal donors. Thirty-one donors underwent multislice spiral CTA and gadolinium-enhanced MRA. In addition to axial images, multiplanar reconstruction and maximum intensity projections were used to display the renal vascular anatomy. Twenty-four donors had a left laparoscopic donor nephrectomy (LDN), whereas seven had right open donor nephrectomy (ODN); LDN was only considered if the renal vascular anatomy was favourable on the left. CTA and MRA images were analysed by two radiologists independently. The radiological and surgical findings were correlated after the surgery. CTA showed 33 arteries and 32 veins (100% sensitivity) whereas MRA showed 32 arteries and 31 veins (97% sensitivity). CTA detected all five accessory renal arteries whereas MRA only detected one. CTA also identified all three accessory renal veins whereas MRA identified two. CTA had a sensitivity of 97% and 47% for left lumbar and left gonadal veins, whereas MRA had a sensitivity of 74% and 46%, respectively. Multislice spiral CTA with three-dimensional reconstruction was more accurate than MRA for both renal arterial and venous anatomy.

What is the best option for 10-20mm renal pelvic stones undergoing ESWL in the pediatric population: stenting, alpha blockers or conservative follow-up?

Science.gov (United States)

Telli, Onur; Gokce, Mehmet Ilker; Ozturk, Erdem; Suer, Evren; Mermerkaya, Murat; Afandiyev, Faraj; Ozcan, Cihat; Guclu, Adil Gucal; Soygur, Tarkan; Burgu, Berk

2015-09-01

In this study we aimed to identify the effect of three different modalities (stenting, doxazosin and conservative follow-up) on stone free rates and complication rates for 10-20mm renal pelvic stones in pediatric patients who underwent shock wave lithotripsy. In this study data from 241 renal units (RUs) of 195 consecutive patients with 10-20mm renal pelvis stones were analyzed retrospectively. There were 3 groups in the study; 56 (23.2%) RUs with ureteral stenting were categorized as group 1, and 39 (16.2%) RUs that received doxazosin were categorized as group 2. The remaining 146 (60.6%) RUs without history of ureteral stenting or alpha-blockers usage were categorized as group 3. Patient demographics, stone characteristics, stone free rates (SFRs), time to stone expulsion and complications were documented and compared in each group. Mean age of the population was 6.6 years and mean stone size was 13.8 ± 2.9 mm. Demographic characteristics of the 3 groups were not significantly different. SFRs of the three groups were 89.2%, 87.1% and 82.1% (p = 0.275). Mean time to stone expulsion for groups 1 and 2 were 17.4 and 21.8 days respectively and significantly lower than that in group 3 (31.3 days). Ureteral stenting or doxazosin for shockwave lithotripsy (SWL) is not superior to watchful waiting in terms of SFR and complications however both modalities shorten the stone expulsion time for 10-20mm renal pelvis stones in the pediatric population. Copyright © 2015 Elsevier Inc. All rights reserved.

Preterm Delivery in the Setting of Left Calyceal Rupture

Directory of Open Access Journals (Sweden)

Brent Hanson

2015-01-01

Full Text Available Spontaneous rupture of the renal collecting system is a rare but serious complication of pregnancy. We report a case of nontraumatic left renal calyceal rupture in a pregnancy which ultimately progressed to preterm delivery. A 29-year-old primigravida with a remote history of urolithiasis presented with left flank pain, suprapubic pain, and signs of preterm labor at 33 weeks of gestation. The patient was believed to have urolithiasis, although initial renal ultrasound failed to demonstrate definitive calculi. After a temporary improvement in flank pain with medication, the patient experienced acute worsening of her left flank pain. Urology was consulted and further imaging was obtained. Magnetic resonance imaging (MRI was consistent with bilateral hydronephrosis and rupture of the left renal calyx. Given the patient’s worsening pain in the setting of left calyceal rupture, the urology team planned for placement of a left ureteral stent. However, before the patient could receive her stent, she progressed to active labor and delivered a viable female infant vaginally. Following delivery, the patient’s flank pain resolved rapidly and spontaneously, so no surgical intervention was performed. A summary of the literature and the details of this specific clinical situation are provided.

Breast cancer metastatic to the kidney with renal vein involvement.

Science.gov (United States)

Nasu, Hatsuko; Miura, Katsutoshi; Baba, Megumi; Nagata, Masao; Yoshida, Masayuki; Ogura, Hiroyuki; Takehara, Yasuo; Sakahara, Harumi

2015-02-01

The common sites of breast cancer metastases include bones, lung, brain, and liver. Renal metastasis from the breast is rare. We report a case of breast cancer metastatic to the kidney with extension into the renal vein. A 40-year-old woman had undergone left mastectomy for breast cancer at the age of 38. A gastric tumor, which was later proved to be metastasis from breast cancer, was detected by endoscopy. Computed tomography performed for further examination of the gastric tumor revealed a large left renal tumor with extension into the left renal vein. It mimicked a primary renal tumor. Percutaneous biopsy of the renal tumor confirmed metastasis from breast cancer. Surgical intervention of the stomach and the kidney was avoided, and she was treated with systemic chemotherapy. Breast cancer metastatic to the kidney may present a solitary renal mass with extension into the renal vein, which mimics a primary renal tumor.

Characterization of normal feline renal vascular anatomy with dual-phase CT angiography.

Science.gov (United States)

Cáceres, Ana V; Zwingenberger, Allison L; Aronson, Lillian R; Mai, Wilfried

2008-01-01

Helical computed tomography angiography was used to evaluate the renal vascular anatomy of potential feline renal donors. One hundred and fourteen computed tomography angiograms were reviewed. The vessels were characterized as single without bifurcation, single with bifurcation, double, or triple. Multiplicity was most commonly seen for the right renal vein (45/114 vs. 3/114 multiple left renal veins, 0/114 multiple right renal arteries, and 8/114 multiple left renal arteries). The right kidney was 13.3 times more likely than the left to have multiple renal veins. Additional vascular variants included double caudal vena cava and an accessory renal artery. For the left kidney, surgery and computed tomography angiography findings were in agreement in 92% of 74 cats. For the right kidney, surgery and computed tomography angiography findings were in agreement in 6/6 cats. Our findings of renal vascular anatomy variations in cats were similar to previous reports in humans. Identifying and recognizing the pattern of distribution of these vessels is important when performing renal transplantation.

Contribution of {sup 99m}Tc-DTPA dynamic renal scintigraphy with furosemide test in the exploration of low grade urethra-pelvic junction syndrome. Report of 17 cases; Apport de la scintigraphie renale dynamique au {sup 99m}Tc-DTPA avec epreuve au furosemide dans l'exploration du syndrome de la jonction pyelo-uretrale a minima. A propos de 17 cas

Energy Technology Data Exchange (ETDEWEB)

Ghfir, I.; Ben Rais, N. [Hopital Ibn Sina, CHU de Rabat, Service de Medecine Nucleaire, Rabat (Morocco)

2009-10-15

Introduction The renal scintigraphy using {sup 99m}Tc-DTPA with furosemide test constitutes a noninvasive and functional method that is of appreciable interest in the exploration of the upper urinary tract and in the evaluation of the separate renal function. It distinguishes the functional character of dilation from organic obstruction needing surgery or endoscopic treatment. Material and methods We report, through this work, the observations of 17 patients with a low grade urethra-pelvic junction syndrome detect by intravenous urography (I.V.U.). {sup 99m}Tc-DTPA renal scintigraphy with furosemide test was carried out among all our patients by means of a gamma-camera with large field equipped with a low energy high-resolution parallel collimator. The evaluation of images obtained consisted of analysis of urethra-pelvic permeability taking into account the semiquantitative parameters of time-activity curve or isotopic nephrogram (I.N.) obtained after digital reconstruction of sequential images. Results On the 17 studied cases, the sex-ratio was equal to 1.83; the average age was 18.92 years with extremes spanning from 4 years to 70 years. Renal scintigraphy categorized four patients groups. Group I: two patients (11.76%) with normal aspect of I.N.; group II; seven patients (41.17% of cases) with functional dilation; group III: five patients (29.41%) with organic obstruction and a group IV: three patients (17.64%) with intermediate response. Discussion {sup 99m}Tc-DTPA renal scintigraphy with furosemide test allowed, through our study, to obviate the limits of IVU and manometric explorations to distinguish functional dilation of organic obstruction. It permits the improvement of treatment with a favourable dosimetry. (authors)

Evaluation of the renal venous system on late arterial and venous phase images with MDCT angiography in potential living laparoscopic renal donors

International Nuclear Information System (INIS)

Kawamoto, S.; Lawler, L.P.; Fishman, E.K.

2005-01-01

Objective: The objective of our study was to assess whether both renal arteries and renal veins can be evaluated using single-phase MDCT data sets alone to eliminate the need for both arterial and venous phase data sets. Materials and methods: One hundred consecutive potential living renal donors who underwent 4- MDCT were evaluated. CT was performed with 120 mL of IV contrast material at an injection rate of 3 mL/sec. Both late arterial and venous phase acquisitions were obtained at 25 and 55 sec from the start of IV contrast injection, respectively. The number of the right and left renal veins and its anatomic variations were assessed by two reviewers. Late arterial phase images were evaluated initially, and then venous phase images were analyzed to assess opacification of the renal vein and to see whether venous phase data sets changed or added information about the venous anatomy as seen on late arterial phase images. Results: The retroaortic left renal vein was found in two subjects, and the circumaortic left renal vein was detected in three subjects. The renal veins were adequately opacified on late arterial phase images in all subjects. There were six subjects who had a normal left renal vein with a small posterior branch coursing posterior to the aorta and draining into the inferior vena cava, which were difficult to differentiate from the lumbar vein or ascending lumbar vein; in three of these six subjects, the small posterior branch was opacified only on venous phase images. Conclusion: Late arterial phase images obtained at 25 sec after the start of contrast injection can reveal the renal vein anatomy except for a small posterior branch of the left renal vein difficult to differentiate from the lumbar or ascending lumbar vein, as seen in three subjects. The data suggest that venous phase imaging is not necessary for the evaluation of renal vein anatomy. (author)

Evaluation of the renal venous system on late arterial and venous phase images with MDCT angiography in potential living laparoscopic renal donors

Energy Technology Data Exchange (ETDEWEB)

Kawamoto, S.; Lawler, L.P.; Fishman, E.K. [Johns Hopkins Hospital, Baltimore, MD (United States). The Russell H. Morgan Department of Radiology and Radiological Science

2005-03-15

Objective: The objective of our study was to assess whether both renal arteries and renal veins can be evaluated using single-phase MDCT data sets alone to eliminate the need for both arterial and venous phase data sets. Materials and methods: One hundred consecutive potential living renal donors who underwent 4- MDCT were evaluated. CT was performed with 120 mL of IV contrast material at an injection rate of 3 mL/sec. Both late arterial and venous phase acquisitions were obtained at 25 and 55 sec from the start of IV contrast injection, respectively. The number of the right and left renal veins and its anatomic variations were assessed by two reviewers. Late arterial phase images were evaluated initially, and then venous phase images were analyzed to assess opacification of the renal vein and to see whether venous phase data sets changed or added information about the venous anatomy as seen on late arterial phase images. Results: The retroaortic left renal vein was found in two subjects, and the circumaortic left renal vein was detected in three subjects. The renal veins were adequately opacified on late arterial phase images in all subjects. There were six subjects who had a normal left renal vein with a small posterior branch coursing posterior to the aorta and draining into the inferior vena cava, which were difficult to differentiate from the lumbar vein or ascending lumbar vein; in three of these six subjects, the small posterior branch was opacified only on venous phase images. Conclusion: Late arterial phase images obtained at 25 sec after the start of contrast injection can reveal the renal vein anatomy except for a small posterior branch of the left renal vein difficult to differentiate from the lumbar or ascending lumbar vein, as seen in three subjects. The data suggest that venous phase imaging is not necessary for the evaluation of renal vein anatomy. (author)

MR imaging findings of extraovarian endocervical mucinous borderline tumors arising from pelvic endometriosis

International Nuclear Information System (INIS)

Yeo, Dong Myung; Rha, Sung Eun; Byun, Jae Young; Lee, Ahwon; Kim, Mee Ran

2013-01-01

We report MR imaging findings of a rare case of endocervical mucinous borderline tumor (MBT) involving the cul-de-sac and left fallopian tube arising from extensive pelvic endometriosis with pathologic correlation in a 35-year-old woman presented with vague pelvic pain. Endocervical MBT is a type of endometriosis-associated carcinoma. Imaging findings of endocervical MBT are unilocular or oligolocular cystic lesions with enhancing mural nodules, which are different from those of the more common intestinal type MBT.

MR imaging findings of extraovarian endocervical mucinous borderline tumors arising from pelvic endometriosis

Energy Technology Data Exchange (ETDEWEB)

Yeo, Dong Myung; Rha, Sung Eun; Byun, Jae Young; Lee, Ahwon; Kim, Mee Ran [Seoul St. Mary' s Hospital, The Catholic University of Korea, Seoul (Korea, Republic of)

2013-12-15

We report MR imaging findings of a rare case of endocervical mucinous borderline tumor (MBT) involving the cul-de-sac and left fallopian tube arising from extensive pelvic endometriosis with pathologic correlation in a 35-year-old woman presented with vague pelvic pain. Endocervical MBT is a type of endometriosis-associated carcinoma. Imaging findings of endocervical MBT are unilocular or oligolocular cystic lesions with enhancing mural nodules, which are different from those of the more common intestinal type MBT.

[Case report of rare co-occurrence of renal cell carcinoma and crossed renal dystopia (L-shaped kidney)].

Science.gov (United States)

Bakov, V N; Los, M S

2017-10-01

L-shaped kidney refers to a rare anomaly of the relative kidney positioning. Due to low prevalence, the literature on the co-occurrence of this anomaly with malignancy is lacking. And, if the diagnosis of a renal anomaly does not present difficulties, if a tumor is detected in such a kidney, even MSCT does not always help differentiate a pelvic tumor from a tumor of the renal parenchyma spreading to the pelvicalyceal system. This has important implications for choosing an appropriate surgical strategy. A feature of the presented clinical observation is the co-occurrence of the rare anomaly of kidney position and locally advanced renal cell carcinoma spreading to the renal pelvis. Due to the massive spread of the tumor, an organ-sparing surgery was not feasible. Due to the suspicion of tumor spread to the renal pelvis, the patient underwent nephrureterectomy of the L-shaped kidney. Introduction to renoprival state with transfer to chronic hemodialysis became the only option to maintain homeostasis and extend the patients life. Histological examination revealed clear cell renal cell carcinoma with invasion of the pelvis and renal capsule, with no clear demarcation between the fused kidneys.

Evaluation of set-of errors in pelvic irradiation with electronic portal imaging device

International Nuclear Information System (INIS)

Wu Xiaoying; Zhang Zhen; Wang Wenchao; Ren Jun; Guo Xiaomei; Lu Huizhong

2007-01-01

Objective: Evaluate the systematic and random set-up error in the pelvic irradiation u- sing electronic portal imaging device(EPID) to provide institution-specific margin for PTV design in pelvic cancer treatment planning with 3D conformal therapy and/or IMRT. Methods: From May to August 2005, twelve patients who received pelvic irradiation, were involved in this study. CT simulations were performed and DRRs were generated as the reference images. Ant-post and lateral portal images were taken daily, and total of 244 sets of EPID images were collected for the whole group. The translational shifts along right-left, superior-inferior and anterior-posterior directions were calculated with aligning the pelvic bony structures on the DRRs and electronic portal images. The systematic and random setup errors were evaluated based on the 244 sets of data. PTV margin was assessed assuming target rotation was negligible. Results: In the right- left (R-L), superior-inferior (S-I) and anterior-posterior (A-P) directions, the maximum shifts were 9.9, 14.0 and 21.1 mm and the systematic setup errors were 0.5, 0.2 and 2.3 mm respectively. For all 244 sets of data in this study, the frequency of the shift larger than 10 mm were 0% (R-L), 1% (S-I) and 3% (A -P); and in R-L and S-I direction, 92% and 91% of the times the shift was smaller than 5 mm. However, only 79% of the times the A-P shift was less than 5 mm. Conclusions: It is suggested in this study that in order to achieve a target coverage of better than 95% of the times throughout the pelvic irradiation in our institution, a 5 mm PTV margin in right-left and superior-inferior directions is required, however, the anterior-posterior margin needs to be increased to at least 10 mm. One needs to be cautious though when applying the PTV margin derived from small sample of patient population to individual patient. (authors)

Anatomic variations of the renal vessels: focus on the precaval right renal artery.

Science.gov (United States)

Bouali, Ourdia; Labarre, David; Molinier, François; Lopez, Raphaël; Benouaich, Vincent; Lauwers, Frédéric; Moscovici, Jacques

2012-07-01

The aim of this study was to determine the prevalence of precaval right renal artery and to investigate the distribution of renal arteries and veins. We discuss a theory of development of renal vascular variants. We retrospectively reviewed 120 arterial phase contrast material-enhanced spiral computerized tomography scans of the abdomen (1- to 2-mm section thickness) performed during a two-month period. Forty percent of the study group (48 patients) had one artery and one vein on each side, with typical course. There was a 9.17% prevalence of precaval right renal artery: 10 patients had a lower pole accessory artery in precaval position and one patient had the main and the accessory arteries that pass anterior to the inferior vena cava. In these cases, associated variations of renal vessels were higher than in the patients without precaval artery variant. There were multiple arteries in 28.3% of the right kidneys and in 26.7% of the left ones. Variants of the right renal vein consisted in multiple veins in 20% (24 cases). We detected no case of multiple left renal veins, but we described variations of its course (circum- or retroaortic vein) in 9.17% (11 cases). Twenty-six patients (21.7%) had associated variations of the renal pedicle. The current technical support allows for a minimally invasive study of vessels anatomy. In our study the prevalence of a precaval right renal artery appears to be higher than previously reported (9.17%). Knowledge on anatomical variations of right renal artery and associated renal vessels variations has major clinical implications.

EFFECTIVENESS AND SAFETY OF EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY FOR UNCOMPLICATED PELVIC CONCREMENTS

Directory of Open Access Journals (Sweden)

A. V. Khasigov

2017-01-01

Full Text Available Introduction. Extracorporeal shockwave lithotripsy (ESWL allowed to improve the treatment results for patients suffering from the kidney stone disease (KSD, decrease the number of complications, optimize the nearest and distant therapy results; however, its success depends on the initial size and shape of the stone. Purpose of the study. Тo examine the clinical effectiveness and safety of electromagnetic ESWL used on simple renal calculi taking their sizes into account. Materials and methods. The survey included 110 patients with simple renal calculi who passed electromagnetic ESWL procedures. The first group consisted of 75 patients with calculi ≤ 15 mm in diameter, the second group included 35 patients with stones > 15 mm. Results. Complete disintegration of stones ≤ 15 mm was accomplished in 74,7% of cases in 1-2 lithotripsy sessions, and after 3 months residual fragments were found in 4% of cases only. Elimination of stones > 15 mm from the renal collecting system takes considerably longer, all patients require more than 1 lithotripsy session. In 3 months following the ESWL residual stones were found in 17,2% of analysed cases. Stone sizes had no bearing on the pain syndrome frequency and severity as well as activation of urinary infection. Macrohematuria, renal haematomas, and an increase of blood creatinine level compared with the original value were more frequent in patients with stones > 15 mm. Conclusions. Electromagnetic ESWL is an efficient and safe method for monotherapy of patients with uncomplicated pelvic concrements. Clinical ESWL effectiveness for stones ≤15 mm by the 3rd month of monitoring reaches 96,0%, for stones > 15 mm it is 82,8% (р<0,05. The level and severity of complications is higher in case of pelvic stones >15 mm compared with the stones < 15 mm in diameter (р<0,05.

[In vivo anatomical study of inferior attachment of renal fascia in adult with acute pancreatitis as shown on multidetector computed tomography].

Science.gov (United States)

Qi, Rui; Zhou, Xiangping; Yu, Jianqun; Li, Zhenlin

2014-04-01

This study aims to explore the inferior adhesion of the renal fascia (RF), and the inferior connectivity of the perirenal spaces (PS) with multidetector computed tomography (MDCT), and to investigate the diagnostic value of CT for showing this anatomy. From May to July 2012, eighty-two patients with acute pancreatitis presented in our hospital were enrolled into this study and underwent contrast-enhanced CT scans. All the image data were used to perform three dimensional reconstruction to show the inferior attachment of RF and the inferior connectivity of PS. The fusion of anterior renal fascia (ARF) and posterior renal fascia (PRF) next to the plane of iliac fossa were found on the left in 71.95% (59/82) cases, and on the right in 75.61% (62/82). In these cases, bilateral perirenal spaces, and anterior and posterior pararenal spaces were not found to be connected with each other. No fusion of ARF and PRF below the level of bilateral kidneys occurred on the left side in 28.05% (23/82) cases and on the right side in 24.39% (20/82). In these patients, the PS extended to the extraperitoneal space of the pelvic cavity and further to the inguinal region, and bilateral anterior and posterior pararenal spaces were not found to be connected with each other. Three-dimensional reconstruction on contrast-enhanced MDCT could be a valuable procedure for depicting inferior attachment of RF, and the inferior connectivity of PS.

Multidetector row CT angiography of living related renal donors: Is there a need for venous phase imaging?

Energy Technology Data Exchange (ETDEWEB)

Namasivayam, Saravanan [Department of Radiology, Division of Abdominal Imaging, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322 (United States); Kalra, Mannudeep K. [Department of Radiology, Division of Abdominal Imaging, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322 (United States); Waldrop, Sandra M. [Department of Radiology, Division of Abdominal Imaging, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322 (United States); Mittal, Pardeep K. [Department of Radiology, Division of Abdominal Imaging, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322 (United States); Small, William C. [Department of Radiology, Division of Abdominal Imaging, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322 (United States)]. E-mail: wsmall@emory.edu

2006-09-15

Objective: To prospectively evaluate whether renal venous anatomy can be detected from arterial phase images of multidetector row CT (MDCT) of renal donors. Material and methods: Institutional review board approved our study protocol with waiver of consent. Forty-eight consecutive renal donors (age range, 21-56 years; M:F, 20:28) referred for MDCT evaluation were included. Two sub-specialty radiologists performed an independent and separate evaluation of renal venous anatomy in arterial and venous phase images. Opacification of renal venous structures was scored on a five-point scale (1-not seen; 3-minimal opacification; 5-excellent opacification). Arterial and venous phase opacification scores were compared by Wilcoxon signed rank test. Results: Both readers detected all renal venous anomalies in arterial as well as venous phase images. Each reader detected accessory right renal veins (n = 14), retroaortic left renal vein (n = 2), circumaortic left renal vein (n = 1), and left renal hilar arteriovenous malformation (n = 1) in arterial phase images. Retroaortic left renal venous branch was difficult to differentiate from lumbar vein (reader-1, n = 1; reader-2, n = 2) in both arterial and venous phase images. Sensitivity of detection of renal veins, left adrenal, gonadal and lumbar veins in arterial phase images was 100, 83-88, 100, and 85-90%, respectively. As expected, venous phase images showed significantly greater opacification of renal veins, left gonadal, adrenal and lumbar veins (p < .05). However, this did not substantially limit the evaluation of renal venous anatomy in arterial phase images. Both readers had substantial interobserver agreement (kappa coefficient, 0.7; p < 0.05). Conclusions: Arterial phase MDCT images alone can be used to detect renal venous anomalies, and to identify small left renal venous branches namely, the left gonadal, adrenal and lumbar veins in renal donors. Venous phase MDCT acquisition is not necessary for evaluation of renal

Multidetector row CT angiography of living related renal donors: Is there a need for venous phase imaging?

International Nuclear Information System (INIS)

Namasivayam, Saravanan; Kalra, Mannudeep K.; Waldrop, Sandra M.; Mittal, Pardeep K.; Small, William C.

2006-01-01

Objective: To prospectively evaluate whether renal venous anatomy can be detected from arterial phase images of multidetector row CT (MDCT) of renal donors. Material and methods: Institutional review board approved our study protocol with waiver of consent. Forty-eight consecutive renal donors (age range, 21-56 years; M:F, 20:28) referred for MDCT evaluation were included. Two sub-specialty radiologists performed an independent and separate evaluation of renal venous anatomy in arterial and venous phase images. Opacification of renal venous structures was scored on a five-point scale (1-not seen; 3-minimal opacification; 5-excellent opacification). Arterial and venous phase opacification scores were compared by Wilcoxon signed rank test. Results: Both readers detected all renal venous anomalies in arterial as well as venous phase images. Each reader detected accessory right renal veins (n = 14), retroaortic left renal vein (n = 2), circumaortic left renal vein (n = 1), and left renal hilar arteriovenous malformation (n = 1) in arterial phase images. Retroaortic left renal venous branch was difficult to differentiate from lumbar vein (reader-1, n = 1; reader-2, n = 2) in both arterial and venous phase images. Sensitivity of detection of renal veins, left adrenal, gonadal and lumbar veins in arterial phase images was 100, 83-88, 100, and 85-90%, respectively. As expected, venous phase images showed significantly greater opacification of renal veins, left gonadal, adrenal and lumbar veins (p < .05). However, this did not substantially limit the evaluation of renal venous anatomy in arterial phase images. Both readers had substantial interobserver agreement (kappa coefficient, 0.7; p < 0.05). Conclusions: Arterial phase MDCT images alone can be used to detect renal venous anomalies, and to identify small left renal venous branches namely, the left gonadal, adrenal and lumbar veins in renal donors. Venous phase MDCT acquisition is not necessary for evaluation of renal

Treatment outcomes of open pelvic fractures associated with extensive perineal injuries.

Science.gov (United States)

Hasankhani, Ebrahim Ghayem; Omidi-Kashani, Farzad

2013-12-01

The main causes of death in patients with open pelviperineal injuries are uncontrollable bleeding and pelvic sepsis. The aim of this study was to evaluate the management outcomes of open pelvic fractures associated with extensive perineal injuries. We retrospectively studied 15 cases with open pelvic fractures associated with extensive perineal injuries (urethral and anal canal laceration) admitted between August 2006 and September 2010. Mechanism of injury, Injury Severity Score, associated injuries, hemodynamic status on arrival, resuscitation and transfusion requirements, operative techniques, intra- and postoperative complications, length of intensive care unit and hospital stay, and mortality were recorded in a computerised database for further evaluation and analysis. The male to female ratio was 12:3 with an average age of 38.6 years (ranged, 11 to 65 years). The average packed red blood cell units used were 8 units (ranged, 4 to 21 units). All patients were initially transferred to the operating room for colostomy, radical debridement and fixation of the pelvic fracture by an external fixator. One patient had acute renal failure, which improved with medical treatment and 2 patients (13.3%) died, one with type III anteroposterior compression fracture due to hemorrhagic shock and the other due to septicemia. Open pelvic fractures with extensive perineal injuries are associated with high mortality rates. Early diagnosis and appropriate treatment, including reanimation, colostomy, cystostomy, vigorous and repeated irrigation and debridement, and fixation by an external fixator can improve the outcomes and reduce the mortality rate.

Pelvic Incidence: A Predictive Factor for Three-Dimensional Acetabular Orientation—A Preliminary Study

Directory of Open Access Journals (Sweden)

Christophe Boulay

2014-01-01

Full Text Available Acetabular cup orientation (inclination and anteversion is a fundamental topic in orthopaedics and depends on pelvis tilt (positional parameter emphasising the notion of a safe range of pelvis tilt. The hypothesis was that pelvic incidence (morphologic parameter could yield a more accurate and reliable assessment than pelvis tilt. The aim was to find out a predictive equation of acetabular 3D orientation parameters which were determined by pelvic incidence to include in the model. The second aim was to consider the asymmetry between the right and left acetabulae. Twelve pelvic anatomic specimens were measured with an electromagnetic Fastrak system (Polhemus Society providing 3D position of anatomical landmarks to allow measurement of acetabular and pelvic parameters. Acetabulum and pelvis data were correlated by a Spearman matrix. A robust linear regression analysis provided prediction of acetabulum axes. The orientation of each acetabulum could be predicted by the incidence. The incidence is correlated with the morphology of acetabula. The asymmetry of the acetabular roof was correlated with pelvic incidence. This study allowed analysis of relationships of acetabular orientation and pelvic incidence. Pelvic incidence (morphologic parameter could determine the safe range of pelvis tilt (positional parameter for an individual and not a group.

Hepatic and renal function with successful long-term support on a continuous flow left ventricular assist device.

Science.gov (United States)

Deo, Salil V; Sharma, Vikas; Altarabsheh, Salah E; Hasin, Tal; Dillon, John; Shah, Ishan K; Durham, Lucian A; Stulak, John M; Daly, Richard C; Joyce, Lyle D; Park, Soon J

2014-03-01

Data regarding the long-term clinical effects of a continuous flow left ventricular assist device (CF-LVAD) on hepato-renal function is limited. Hence our aim was to assess changes in hepato-renal function over a one-year period in patients supported on a CF-LVAD. During the study period 126 patients underwent CF-LVAD implant. Changes in hepato-renal laboratory parameters were studied in 61/126 patients successfully supported on a CF-LVAD for period of one year. A separate cohort of a high-risk group (HCrB) of patients (56/126) with a serum creat>1.9 mg/dL (168 μmol/L) (75th percentile) or a serum bil>1.5 mg/dL (25.65 μmol/L) (75th percentile) was created. Changes in serum creatinine and bilirubin were analysed at regular intervals for this group along with the need for renal replacement therapy. Baseline creatinine and blood urea nitrogen (BUN) for the entire cohort was 1.4[1.2,1.9 mg/dL] [123.7(106,168) μmol/L) and 27[20,39.5 mg/dL] [9.6(7.1,14.1) mmol/L] respectively. After an initial reduction at the end of one month [1(0.8,1.2) mg/dL; 88(70,105) μmol/L] (passist device support for one year. High-risk patients demonstrate a higher 30-day mortality and temporary need for renal replacement therapy. Yet even in this cohort, improvement is present over a period of one year on the device, with a minimal need for permanent haemodialysis. Copyright © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Giant kidney worms in a patient with renal cell carcinoma.

Science.gov (United States)

Kuehn, Jemima; Lombardo, Lindsay; Janda, William M; Hollowell, Courtney M P

2016-03-07

Dioctophyma renale (D. renale), or giant kidney worms, are the largest nematodes that infect mammals. Approximately 20 cases of human infection have been reported. We present a case of a 71-year-old man with a recent history of unintentional weight loss and painless haematuria, passing elongated erythematous tissue via his urethra. CT revealed a left renal mass with pulmonary nodules and hepatic lesions. On microscopy, the erythematous tissue passed was identified as D. renale. On subsequent renal biopsy, pathology was consistent with renal cell carcinoma. This is the first reported case of concomitant D. renale infection and renal cell carcinoma, and the second reported case of D. renale infection of the left kidney alone. 2016 BMJ Publishing Group Ltd.

Is Tamsulosin Effective after Shock Wave Lithotripsy for Pediatric Renal Stones? A Randomized, Controlled Study.

Science.gov (United States)

Shahat, Ahmed; Elderwy, Ahmad; Safwat, Ahmed S; Abdelkawi, Islam F; Reda, Ahmed; Abdelsalam, Yasser; Sayed, Mohamed; Hammouda, Hisham

2016-04-01

We assessed the effect of tamsulosin as an adjunctive therapy after shock wave lithotripsy for pediatric single renal pelvic stones. A total of 120 children with a unilateral single renal pelvic stone were included in a prospective randomized, controlled study. All children were randomized to 2 equal groups. Group 1 received tamsulosin (0.01 mg/kg once daily) as adjunctive therapy after shock wave lithotripsy in addition to paracetamol while group 2 received paracetamol only. Stone clearance was defined as no renal stone fragments or fragments less than 3 mm and no pelvicalyceal system dilatation. Our study included 69 boys and 51 girls with a median age of 3.5 years and a median stone size of 1.2 cm. There was no statistically significant difference between groups 1 and 2 in stone or patient criteria. Of the children 99 (82.5%) achieved stone clearance after the first session, including 50 in group 1 and 49 in group 2. All children in each group were cleared of stones after the second session. The overall complication rate was 14.2%. There was no statistically significant difference between single session stone clearance rates (p = 0.81) and complications rates (p = 0.432) in either group. On multivariate analysis using logistic regression smaller stone size (p = 0.016) and radiopaque stones (p = 0.019) were the only predictors of stone clearance at a single shock wave lithotripsy session. Tamsulosin therapy did not affect stone clearance (p = 0.649). Tamsulosin does not seem to improve renal stone clearance. Smaller and radiopaque renal stones have more chance of clearance after shock wave lithotripsy for pediatric single renal pelvic stones. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

A case report of a rare presentation of follicular thyroid carcinoma with pelvic and kidney metastases: Emphasis on multidisciplinary and multimodality management approach

Directory of Open Access Journals (Sweden)

Muhammad Adib Abdul Onny

2017-12-01

Full Text Available Introduction: Follicular thyroid carcinoma (FTC is the second most common type of thyroid cancer, after papillary thyroid carcinoma (PTC, accounting for approximately 10% of all malignant thyroid tumours with higher predilection for women. FTC demonstrates capsular and/or vascular invasion and often presents with distant metastasis in 20%–30% of cases via the haematogenous spread. FTC tends to commonly metastasize to the lung and bone although other sites have been identified. Kidney metastasis from a primary FTC however is rare and has not been widely reported. We report a case of FTC with metastatic to the kidney in a patient presenting with a large left pelvic mass. Case presentation: A 54-year-old, Malay, lady with underlying hypertension and dyslipidaemia presented with chronic left pelvic pain since 1 year ago, following a fall during a recent vacation trip. She also experienced significant unintentional weight loss for the past few months. Clinical examination noted an ill-defined palpable firm mass over the left inner thigh. Pelvic radiograph showed a solitary ill-defined osteolytic lesion at the left superior and inferior pubic rami with cortical destruction. MRI of the pelvis showed a large lobulated enhancing expansile mass originating from the left pubic bone measuring 10.0(AP × 6.0(W × 8.5(CC cm, hypointense signal on T1W and hyperintense signal on T2W. The mass infiltrated adjacent bony structures and muscles. Patient subsequently undergone core biopsy of the left pelvic mass and histopathological examination (HPE noted metastatic follicular thyroid carcinoma. An ultrasound examination of the thyroid showed a multinodular goitre with suspicious nodule in the left thyroid gland. Pre-operative contrast-enhanced computed tomography (CECT showed primary thyroid carcinoma with nodal, lung and bone metastases with possible left kidney involvement. Total thyroidectomy was ensued and follicular thyroid carcinoma was confirmed based on

Direct pelvic access percutaneous nephrolithotomy in management of ectopic kidney stone: a case report and literature review.

Science.gov (United States)

Mehmet, Rifaioglu Murat; Rustu, Yalcinkaya Fatih; Hanefi, Bayarogullari; Mursel, Davarci; Fusun, Aydogan; Mehmet, Inci

2013-01-01

Percutaneous nephrolithotomy (PNL) is an effective procedure for the treatment of patients with large or complex stones. PNL is challenging in anomalous kidneys, certain patients, such as those with renal ectopia. It is unable to undergo PNL in conventional technique safely in these cases. We presented a case report of laparoscopic-assisted PNL via direct pelvic puncture in a pelvic kidney stone and discussed previous published literature. A 49-year-old man presented with right lower quadrant pain and hematuria. Intravenous pyelography and three-dimensional computerized tomography revealed an opaque 2.7 × 1.7 cm pelvis renalis stone in a right side ectopic pelvic kidney with grade III hydronephrosis. Laparoscopic-assisted tubeless PNL was performed to remove the calculus. Laparoscopic-assisted PNL as a minimally invasive therapy in ectopic kidney has many advantages. Our case showed that, in pelvic ectopic kidney with pelvic stones greater than 1.5 cm in size, laparoscopic-assisted PNL via direct pelvis puncture is a safe and effective technique.

Renal artery anatomy assessed by quantitative analysis of selective renal angiography in 1,000 patients with hypertension.

Science.gov (United States)

Lauder, Lucas; Ewen, Sebastian; Tzafriri, Abraham Rami; Edelman, Elazer Reuven; Lüscher, Thomas Felix; Blankenstijn, Peter J; Dörr, Oliver; Schlaich, Markus; Sharif, Faisal; Voskuil, Michiel; Zeller, Thomas; Ukena, Christian; Scheller, Bruno; Böhm, Michael; Mahfoud, Felix

2018-05-20

With increasing attention to renovascular causes and targets for hypertension there arises a critical need for more detailed knowledge of renal arterial anatomy. However, a standardised nomenclature is lacking. The present study sought to develop a standardised nomenclature for renal anatomy considering the complexity and variation of the renal arterial tree and to assess the applicability of the nomenclature. One thousand hypertensive patients underwent invasive selective renal artery angiography in nine centres. Further, renovasography was performed in 249 healthy swine as a surrogate for normotensive anatomy. Anatomical parameters were assessed by quantitative vascular analysis. Patients' mean blood pressure was 168/90±26/17 mmHg. The right main renal artery was longer than the left (41±15 mm vs. 35±13 mm, prenal arteries and renal artery disease were documented in 22% and 9% of the patients, respectively. Other than exhibiting a longer left main renal artery in uncontrolled hypertensives (+2.7 mm, p=0.034) there was no anatomical difference between patients with controlled and uncontrolled hypertension. Main renal artery mean diameter was smaller in patients with impaired kidney function (GFR Renal arterial anatomy differs between sides but shows no difference between patients with and without blood pressure control. Impaired GFR was associated with small main renal artery diameter.

The feasibility of measuring renal blood flow using transesophageal echocardiography in patients undergoing cardiac surgery.

Science.gov (United States)

Yang, Ping-Liang; Wong, David T; Dai, Shuang-Bo; Song, Hai-Bo; Ye, Ling; Liu, Jin; Liu, Bin

2009-05-01

There is no reliable method to monitor renal blood flow intraoperatively. In this study, we evaluated the feasibility and reproducibility of left renal blood flow measurements using transesophageal echocardiography during cardiac surgery. In this prospective noninterventional study, left renal blood flow was measured with transesophageal echocardiography during three time points (pre-, intra-, and postcardiopulmonary bypass) in 60 patients undergoing cardiac surgery. Sonograms from 6 subjects were interpreted by 2 blinded independent assessors at the time of acquisition and 6 mo later. Interobserver and intraobserver reproducibility were quantified by calculating variability and intraclass correlation coefficients. Patients with Doppler angles of >30 degrees (20 of 60 subjects) were eliminated from renal blood flow measurements. Left renal blood flow was successfully measured and analyzed in 36 of 60 (60%) subjects. Both interobserver and intraobserver variability were renal blood flow measurements were good to excellent (intraclass correlation coefficients 0.604-0.999). Left renal arterial luminal diameter for the pre, intra, and postcardiopulmonary bypass phases, ranged from 3.8 to 4.1 mm, renal arterial velocity from 25 to 35 cm/s, and left renal blood flow from 192 to 299 mL/min. In patients undergoing cardiac surgery, it was feasible in 60% of the subjects to measure left renal blood flow using intraoperative transesophageal echocardiography. The interobserver and intraobserver reproducibility of renal blood flow measurements was good to excellent.

Biomechanical comparison of supraacetabular external fixation and anterior pelvic bridge plating.

Science.gov (United States)

Çavuşoğlu, Ali Turgay; Erbay, Fatma Kübra; Özsoy, Mehmet Hakan; Demir, Teyfik

2017-10-01

Unstable pelvic ring injuries are complex and risky injuries due to high morbidity and mortality. Although anterior pelvic external fixator is a suitable method for rapid stabilization of an injured pelvic ring, due to some disadvantages such as high complication rate, nerve damage, and difficulties of patient's mobility and comfort, there has recently been increased searching for alternative methods for stabilization of the pelvic ring. Pubic symphysis zone freely moves in pelvic models. This study aims to evaluate the biomechanical stability of anterior pelvic bridge plating and compare it with supraacetabular external fixators in an untreated unstable pelvic fracture model. Samples were loaded statically with 2-mm/min loading rate in single leg standing position. Maximum load was 2.3 kN. When loading the samples, photographs were taken continuously. Stiffness values were calculated from the load displacement curves. Some reference parameters were described and were measured from unloaded and 2.3-kN-loaded photographs of the test. The mean stiffness values were 491.14 ± 52.22, 478.55 ± 41.44, and 470.25 ± 44.51 N/mm for anterior pelvic bridge plating group, supraacetabular external fixator group, and Control group, respectively. According to the measured parameters from photographs, the mean displacement at the pubic symphysis was 4.7 ± 0.32, 15.8 ± 2.01, and 18.2 ± 0.47 mm for anterior pelvic bridge plating, supraacetabular external fixator, and Control group, respectively. The highest displacement in the pubic symphysis was found in Control group, and minimum displacement was observed in anterior pelvic bridge plating group. When the perpendicular distance between the right and left lower end of ischium was examined, it was observed that displacement was minimum in anterior pelvic bridge plating group compared to other two groups, regarding to the high stability of pubic symphysis. In conclusion, this study revealed

COMPARATIVE STUDY OF CULTURE AND SENSITIVITY PATTERNS OF PRE OPERATIVE MID STREAM URINE WITH RENAL PELVIC URINE AND STONE TO PREDICT UROSEPSIS FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY: A PROSPECTIVE CLINICAL STUDY

Directory of Open Access Journals (Sweden)

Bhargava Vardhana Reddy

2015-11-01

Full Text Available INTRODUCTION : Percutaneous nephrolithotomy (PCNL is the most frequently performed surgery for stone disease at our institution. Nearly 100 PCNL procedures are being performed in a year at our institution. Septicemia following PCNL can be catastrophic despite sterile preoperative urine and prophylactic antibiotics. Infected stones, obstructed kidneys , and comorbidit y have been held responsible. In this study we analyzed various culture specimens, namely Mid - stream urine (MSU, renal pelvic urine and crushed stones. MATERIALS AND METHODS : We performed a prospective clinical study in all our patients undergoing PCNL b etween January 2013 and December 2014. MSU was sent for culture and sensitivity testing (C&S one day prior to surgery. Percutaneous access into the ipsilateral pelvicaliceal system is achieved under image intensification using a fine, 14 gauge Kellet need le. Urine from the pelvicaliceal system is first aspirated and sent as pelvic urine C&S. Stone fragments are collected to be proces0sed for C&S. The data collected were divided into 3 main groups, that is MSU C&S, pelvic urine C&S and stone C&S. RESULTS : A total of 83 patients were included in the study, of this MSU C&S was positive in 9/83 (10.8% patients, Pelvic C&S in 10 /73 (13.7% patients and Stone C&S in 25/83 (30.1% patients. Out of 25 cases of stone culture positive patients 17 patients develope d Systemic Inflammatory Response Syndrome (SIRS but only 2 patients developed SIRS in MSU C & S positive patients. CONCLUSIONS: The results of our study suggest that positive stone C&S is the better predictor of potential urosepsis than MSU. Stone cultur e is available only after surgery but appears to be the best guide for antibiotic therapy in case of sepsis. So the routine collection of stone for C&S will be beneficial

Uterus bicornis bicollis, imperforate hemivagina and ipsilateral renal agenesis: case report and literature review.

Science.gov (United States)

DaCosta, V; Christie, L; Wynter, S; Harriott, J; Frederick, J

2009-09-01

We present a case of a patient with Uterus bicornis bicollis, imperforate hemivagina and ipsilateral renal agenesis. This group of congenital malformations is often asymptomatic until puberty, when it presents as cyclic dysmenorrhoea, leucorrhoea or a pelvic mass. Magnetic resonance imaging is becoming the preferred modality for delineation of uterine malformations. When congenital abnormalities of the reproductive tract are encountered, a search should also be made for renal anomalies. Patients with Uterus bicornis bicollis and unilateral imperforate vagina are often seen with pain severe enough to mimic an acute abdomen. It is important to keep this unusual congenital malformation in mind in the differential diagnosis of vaginal discharge, pelvic mass and/or abdominopelvic pain in young women so as to avoid inappropriate surgical procedures.

Pelvic splenosis. Clinical case presentation and literature review

International Nuclear Information System (INIS)

Schalch Ponce de Leon, J.M.; Rivera B, B.; Garcia O, R.

2005-01-01

A feminine patient of 31 years primigravidas with pregnancy of 6 weeks of gestation by FUM. Splenoctomy antecedent 20 years ago by splenic traumatic rupture. It enters to the service of Gynecology for sudden and intense pelvic pain in iliac left fossa and scarce trans vaginal bled. Ultrasound reports uterine cavity without gestational sack, mass of 3.5x1.4 cm in right annex. She is carried out to laparoscopy with pre surgical diagnosis of 'right ectopic pregnancy'. During the surgery its are found data that indicate probable splenosis in bottom of right sack. It was carried out at simple and contrasted TAC that show vascularized solid tumoration accustomed in bottom of right sack. The hepatosplenic scintillography with colloidal sulfide labelled with 99m Tc corroborate the diagnostic of pelvic and abdominal splenosis. (Author)

Metanephric Adenofibroma associated with Papillary Renal CeU Carcinoma

International Nuclear Information System (INIS)

Roa, Carmen Lucia B; Navarrete, Maria Constanza

2008-01-01

Metanephric adenofibroma is an infrequent biphasic epithelial-stromal renal tumor, occasionally associated with papillary renal cell carcinoma. We describe a case of a girl with a four year clinical history of intermittent hematuria; she was diagnosed, using a left-side tru-cut renal biopsy, with a Wilms' tumor with stromal and epithelial component, with no sign of anaplasia. Later, through the product of the left-side nephrectomy that was performed at the National Cancer institute of Colombia, she was diagnosed with metanephric adenofibroma associated with papillary renal cell carcinoma

Fulminant Staphylococcus lugdunensis septicaemia following a pelvic varicella-zoster virus infection in an immune-deficient patient: a case report

Directory of Open Access Journals (Sweden)

Woznowski M

2010-09-01

Full Text Available Abstract Introduction The deadly threat of systemic infections with coagulase negative Staphylococcus lugdunensis despite an appropriate antibiotic therapy has only recently been recognized. The predominant infectious focus observed so far is left-sided native heart valve endocarditis, but bone and soft tissue infections, septicaemia and vascular catheter-related bloodstream infections have also been reported. We present a patient with a fatal Staphylococcus lugdunensis septicaemia following zoster bacterial superinfection of the pelvic region. Case presentation A 71-year old male diagnosed with IgG kappa plasmocytoma presented with a conspicuous weight loss, a hypercalcaemic crisis and acute renal failure. After initiation of haemodialysis treatment his condition improved rapidly. However, he developed a varicella-zoster virus infection of the twelfth thoracic dermatome requiring intravenous acyclovir treatment. Four days later the patient presented with a fulminant septicaemia. Despite an early intravenous antibiotic therapy with ciprofloxacin, piperacillin/combactam and vancomycin the patient died within 48 hours, shortly before the infective isolate was identified as Staphylococcus lugdunensis by polymerase chain reaction. Conclusion Despite S. lugdunensis belonging to the family of coagulase-negative staphylococci with an usually low virulence, infections with S. lugdunensis may be associated with an aggressive course and high mortality. This is the first report on a Staphylococcus lugdunensis septicaemia following a zoster bacterial superinfection of the pelvic region.

Development of chronic heart failure in a young woman with hypertension associated with renal artery stenosis with preserved renal function

DEFF Research Database (Denmark)

Byrne, Christina; Abdulla, Jawdat

2014-01-01

A 33-year-old woman with presumed essential hypertension and symptoms equivalent to New York Heart Association class II was suspected of heart failure and referred to echocardiography. The patient's ECG showed a left bundle branch block. Electrolytes, serum creatinine and estimated-glomerular fil......A 33-year-old woman with presumed essential hypertension and symptoms equivalent to New York Heart Association class II was suspected of heart failure and referred to echocardiography. The patient's ECG showed a left bundle branch block. Electrolytes, serum creatinine and estimated......-glomerular filtration rate as well as urine test for protein were all normal. The patient had no peripheral oedema. The transthoracic echocardiography confirmed systolic and diastolic dysfunction and an ejection fraction of 25% and left ventricular hypertrophy. Ultrasound of renal arteries and renal CT angiography...... (renal CTA) revealed a significant stenosis and an aneurysm corresponding to the right renal artery with challenges to traditional interventions....

Trigeminal perineural spread of renal cell carcinoma

International Nuclear Information System (INIS)

Hornik, Alejandro; Rosenblum, Jordan; Biller, Jose

2012-01-01

A 55-year-old man had a five-day history of “pins and needles” sensation on the left chin. Examination showed decreased pinprick sensation on the territory of the left mandibular branch of the trigeminal nerve. Brain magnetic resonance imaging (MRI) with gadolinium showed enhancement involving the left mandibular branch. Computed tomography (CT) of the chest, abdomen, and pelvis showed a left kidney mass diagnosed as renal carcinoma following nephrectomy. The “numb-chin” syndrome heralds or accompanies systemic malignancies. Trigeminal perineural spread has been well-documented in head and neck neoplasms, however, to our knowledge, it has not been reported in renal neoplasms. (author)

Experimental research on local renal injury of dog with microwave ablation guided by DSA

International Nuclear Information System (INIS)

Lin Jianping; Xian Zhengyuan; Shi Rongshu; Zhang Gaofeng; Li Xianlang

2008-01-01

Objective: To explore the efficiency, complications and probability of preserving part renal function by local renal microwave ablation. Methods: The fresh pig renal pelvis full filled with 30% diatrizoate meglumine and the dogs kidney taken arterial pyelography were both ablated with microwave. Dogs were divided into three groups: measuring temperature after ablation group, single point ablation both on the two kidneys group and double points ablation on unilateral kidney group. In measuring temperature after ablation group, DSA and pathology were performed immediately after ablation. In the other groups, DSA with blood and urine samplings were taken for routine tests including renal function right after the ablation and 10 days later. Results: Experiment in vitro showed conspicuous renal pelvic contraction and convolution. The group under power rate of 70, 3 min produced urine leak easily. Preliminary test in vivo with DSA showed the disappearance of local kidney blood supply. The residual renal function was related to areas of necrosis. Acute stage pathology revealed acute renal cortex medulla and pelvic cells injury. DSA of chronic stage showed no change in size of the area of ablation. The blood supply of necrotic areas was not restored. The residual kidney possessed the excretion contrast medium with no urine leaks. Upper pole of right kidney adhered with adjacent tissue, together with thickened covering. Pathology revealed fibrous proliferation around the coagulative necrosis. Conclusion: Microwave ablation can inactivate the local renal tissue, and, effectively preserve the big blood vessels and function of residual kidney. No urine leaks occurred in chronic stage but easily to produce adhesions with adjacent tissue. (authors)

Test-re-test reliability and inter-rater reliability of a digital pelvic inclinometer in young, healthy males and females.

Science.gov (United States)

Beardsley, Chris; Egerton, Tim; Skinner, Brendon

2016-01-01

Objective. The purpose of this study was to investigate the reliability of a digital pelvic inclinometer (DPI) for measuring sagittal plane pelvic tilt in 18 young, healthy males and females. Method. The inter-rater reliability and test-re-test reliabilities of the DPI for measuring pelvic tilt in standing on both the right and left sides of the pelvis were measured by two raters carrying out two rating sessions of the same subjects, three weeks apart. Results. For measuring pelvic tilt, inter-rater reliability was designated as good on both sides (ICC = 0.81-0.88), test-re-test reliability within a single rating session was designated as good on both sides (ICC = 0.88-0.95), and test-re-test reliability between two rating sessions was designated as moderate on the left side (ICC = 0.65) and good on the right side (ICC = 0.85). Conclusion. Inter-rater reliability and test-re-test reliability within a single rating session of the DPI in measuring pelvic tilt were both good, while test-re-test reliability between rating sessions was moderate-to-good. Caution is required regarding the interpretation of the test-re-test reliability within a single rating session, as the raters were not blinded. Further research is required to establish validity.

Cerebral and Renal Oxygen Saturation Are Not Compromised in the Presence of Retrograde Blood Flow in either the Ascending or Descending Aorta in Term or Near-Term Infants with Left-Sided Obstructive Lesions

NARCIS (Netherlands)

van der Laan, Michelle E.; Mebius, Mirthe J.; Roofthooft, Marcus T. R.; Bos, Arend F.; Berger, Rolf M. F.; Kooi, Elisabeth M. W.

2017-01-01

Background: In infants with left-sided obstructive lesions (LSOL), the presence of retrograde blood flow in either the ascending or descending aorta may lead to diminished cerebral and renal blood flow, respectively. Objectives: Our aim was to compare cerebral and renal tissue oxygen saturation

Test–re-test reliability and inter-rater reliability of a digital pelvic inclinometer in young, healthy males and females

OpenAIRE

Chris Beardsley; Tim Egerton; Brendon Skinner

2016-01-01

Objective. The purpose of this study was to investigate the reliability of a digital pelvic inclinometer (DPI) for measuring sagittal plane pelvic tilt in 18 young, healthy males and females.\\ud \\ud Method. The inter-rater reliability and test–re-test reliabilities of the DPI for measuring pelvic tilt in standing on both the right and left sides of the pelvis were measured by two raters carrying out two rating sessions of the same subjects, three weeks apart.\\ud \\ud Results. For measuring pel...

Head and pelvic movement asymmetry during lungeing in horses with symmetrical movement on the straight.

Science.gov (United States)

Rhodin, M; Roepstorff, L; French, A; Keegan, K G; Pfau, T; Egenvall, A

2016-05-01

Lungeing is commonly used as part of standard lameness examinations in horses. Knowledge of how lungeing influences motion symmetry in sound horses is needed. The aim of this study was to objectively evaluate the symmetry of vertical head and pelvic motion during lungeing in a large number of horses with symmetric motion during straight line evaluation. Cross-sectional prospective study. A pool of 201 riding horses, all functioning well and considered sound by their owners, were evaluated in trot on a straight line and during lungeing to the left and right. From this pool, horses with symmetric vertical head and pelvic movement during the straight line trot (n = 94) were retained for analysis. Vertical head and pelvic movements were measured with body mounted uniaxial accelerometers. Differences between vertical maximum and minimum head (HDmax, HDmin) and pelvic (PDmax, PDmin) heights between left and right forelimb and hindlimb stances were compared between straight line trot and lungeing in either direction. Vertical head and pelvic movements during lungeing were more asymmetric than during trot on a straight line. Common asymmetric patterns seen in the head were more upward movement during push-off of the outside forelimb and less downward movement during impact of the inside limb. Common asymmetric patterns seen in the pelvis were less upward movement during push-off of the outside hindlimb and less downward movement of the pelvis during impact of the inside hindlimb. Asymmetric patterns in one lunge direction were frequently not the same as in the opposite direction. Lungeing induces systematic asymmetries in vertical head and pelvic motion patterns in horses that may not be the same in both directions. These asymmetries may mask or mimic fore- or hindlimb lameness. © 2015 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.

Rare case of left adrenal cortical carcinoma with level 3 inferior vena ...

African Journals Online (AJOL)

Observation: A 21-year-old male, incidentally detected with left supra renal tumor invading the left renal vein and the thrombus extending into the supra diaphragmatic IVC, underwent laparotomy with simultaneous median sternotomy on total cardiac bypass for removal of IVC tumor thrombus and radical excision of the ...

Renal denervation in a patient with Alport syndrome and rejected renal allograft

OpenAIRE

Raju, Narayana; Lloyd, Vincent; Yalagudri, Sachin; Das, Bharati; Ravikishore, A.G.

2015-01-01

Renal denervation is a new intervention to treat resistant hypertension. By applying radiofrequency (RF) to renal arteries, sympathetic nerves in adventitia layer of vascular wall can be denervated. Sympathetic hyperactivity is an important contributory factor in hypertension of hemodialysis patients. Hyperactive sympathetic nervous system aggravates hypertension and it can cause complications like left ventricular hypertrophy, heart failure, arrhythmias and atherogenesis. Our report illustra...

Bilateral triple renal arteries

International Nuclear Information System (INIS)

Pestemalci, Turan; Yildiz, Yusuf Zeki; Yildirim, Mehmet; Mavi, Ayfer; Gumusburun, Erdem

2009-01-01

Knowledge of the variations of the renal artery has grown in importance with increasing numbers of renal transplants, vascular reconstructions and various surgical and radio logic techniques being performed in recent years. We report the presence of bilateral triple renal arteries, discovered on routine dissection of a male cadaver. On the right side, one additional renal artery originated from the abdominal aorta (distributed to superior pole of the kidney) and one other originated from the right common iliac artery (distributed to lower pole of the kidney). On the left side, both additional renal arteries originated from the abdominal aorta. Our observation has been compared with variations described in the literature and their clinical importance has been emphasized. (author)

Evaluation of Renal Function in Children by Tc-99m DTPA Scintigraphy

Directory of Open Access Journals (Sweden)

Sevin Ayaz

2016-09-01

Full Text Available Aim: Dynamic renal scintigraphy can demonstrate both structural and functional renal pathologies. Our aim was to evaluate renal functions in children by technetium-99m diethylenetriaminepentaacetic acid (Tc-99m DTPA dynamic renal scintigraphy, and todetermine the frequency of scintigraphically detectable atrophic kidneys. Material and Method: Dynamic renal scintigraphy studies of 17 children (12 males, five females with urinary system complaints, having a mean age of 6.15 ± 4.41 years, were included in this retrospective study. Images were obtained with a dual-head gamma camera after intravenous (IV injection of Tc-99m DTPA. Results: The functions of 34 kidneys were evaluated. Decreased perfusion of the left and right kidneys was detected in 35.3% (n=6/17 and 11.8% (n=2/17 of cases, respectively. Prolongation in Tmax of the left and right kidneys was shown in 52.9% (n=9/17 and 29.4% (n=5/17 of the cases, respectively. Glomerular filtration rate of the left and right kidneys was normal in 64.7% (n=11/17 and 88.2% (n=15/17 of cases, respectively. Delayed excretion of the left and right kidneys wasdetected in 29.4% (n=5/17 and 11.8% (n=2/17 of cases, respectively. Stasis of urine in the left and right kidneys which responded to IV diuretics wasdemonstrated in 58.8% (n=10/17 and 70.6% (n=12/17 of cases, respectively. Dynamic renal scintigraphy findings in favour of left and right renal atrophy were obtained in 17.6% (n=3/17 and 5.9% (n=1/17 of cases, respectively. Discussion: Dynamic renal scintigraphy with Tc-99m DTPA was found to be useful in the evaluation of renal functions of children and in determining the frequency of atrophic kidneys.

Swine as a model in renal physiology and nephrology: an overview

International Nuclear Information System (INIS)

Terris, J.M.

1986-01-01

Swine have become an important animal model in many areas of biomedical research for a variety of reasons. They are suited for studies in nephrology and renal physiology because they are the only mammal, with the exception of the dwarf water buffalo, which has been shown to have kidneys morphologically similar to the human. Maturational characteristics of fetal and neonatal kidney are similar to those of the newborn human infant. Therefore, studies to evaluate the pyeloureteral dynamics of human like multipapillary kidneys or developmental studies related to the newborn human cannot be conducted adequately in any other mammal. The following overview addresses the morphology and pelvic and ureteral dynamics of swine and human kidneys, maturation of renal hemodynamics in the neonate, renal function and the effects of anesthesia and diruetics on renal function in the pig. Additionally, the use of swine in other areas of interest to the nephrologist and renal physiologist are considered, eg, renal response to exercise, irradiation therapy, kidney preservation and renal transplantation

Pelvic floor muscle function in women with pelvic floor dysfunction

DEFF Research Database (Denmark)

Tibaek, Sigrid; Dehlendorff, Christian

2014-01-01

The objectives of this study were to investigate the level of pelvic floor muscle (PFM) function in women with pelvic floor dysfunction (PFD) referred by gynaecologists and urologists for in-hospital pelvic floor muscle training (PFMT), and to identity associated factors for a low level of PFM...

99mTc-DMSA renal uptake in urological diseases measured from renal tomographic images using single photon emission computed tomography (SPECT)

International Nuclear Information System (INIS)

Oishi, Yukihiko; Tashiro, Kazuya; Kishimoto, Koichi; Wada, Tetsuro; Torii, Shinichiro; Yoshigoe, Fukuo; Machida, Toyohei; Yamada, Hideo; Toyama, Hinako.

1987-01-01

To determine renal function, 99m Tc-DMSA renal uptake was measured from renal tomographic images obtained by single photon emission computed tomography (SPECT). A total of 77 tests was conducted on 73 patients with various diseases in the kidneys and urinary tract to determine renal uptake. The correlation coefficient(r) between total renal volume and total renal uptake was 0.3509 and that between renal volume and uptake of 143 kidneys was 0.5433. In 62 patients whose creatinine clearance could be measured, the correlation coefficient between creatinine clearance and total renal volume was 0.2352, and that between creatinine clearance and total renal uptake was 0.8854, that is, creatinine clearance correlated well with renal uptake. Renal volume and uptake determined in 10 normal male and 10 normal female adults were 220 ml and 26.8 % for the right kidney and 239 ml and 27.6 % for the left kidney for the males and 206 ml and 26.4 % (right) and 237 ml and 27.9 % (left) for the females. This method, which requires no blood or urine collection, is very useful as an individual kidney function test to evaluate individual kidney function and to understand kidney function before and after operation in patients with renal and urinary diseases. (author)

Paraparesis secondary to erratic migration of Dioctophyma renale in a dog

Directory of Open Access Journals (Sweden)

Fernando Swiech Bach

2016-05-01

Full Text Available ABSTRACT: A 4 years old mongrel stray bitch, weighing 16kg was submitted to physical examination to demonstrated inability of locomotion with the pelvic limbs. Extradural spinal cord compression was observed in myelotomography of the thoracolumbar segment. The patient was submitted to exploratory hemilaminectomy of T13-L1 and L1-L2, in an attempt to decompress the medullar segments. During the surgery was observed one adult parasite, identified as Dioctophyma renale , located in the extradural space and causing spinal cord compression. The patient was submitted to postoperative physical therapy, presenting clinical improvement 15 days after surgery, remaining on prone position and able to move the pelvic limbs, but not yet able to walk unassisted. It started walking naturally 60 days after the surgery. With the present clinical report, the erratic migration of the parasite Dioctophyma renale should be added to the list of differential diagnoses for patients with paraparesis and extramedullary lesion pattern, especially in endemic areas.

A case study presentation: The MAG3 captopril renal scan, which side are you on ?

International Nuclear Information System (INIS)

Richards, A.

1998-01-01

Full text: A 68-year-old woman with widespread vascular disease presented to the Nuclear Medicine Department with severe hypertension, (a blood pressure of 200/160 supine), a known small right kidney, and a large abdominal aortic aneurysm. A baseline renal scan was performed with IV administration of 300 MBq of 99m Tc-labelled MAG3. A normal left kidney was demonstrated, with a Grade 0 renogram pattern. The right kidney was non visualised and non functioning. The patient was then administered orally with 25 mg of A.C.E. inhibitor captopril and her blood pressure fell by greater than 100 mm Hg. A second MAG3 Renal Scan was performed. The finding conflicted with results of a Renal Artery Angiogram and Renal Artery Doppler Ultrasound, both demonstrating a normal left renal artery. A repeat MAG3 Renal scan with captopril challenge was performed. Differential diagnosis included: 1.Left sided microvascular disease; 2. A functioning though very ischaemic right kidney that was producing renin, suggested by contrast opacification of the right renal cortex on CT; or 3. A false negative renal artery angiogram, with non-visualisation of an arterial stenosis caused by thrombus or compression of the left renal artery by the abdominal aortic aneurysm. Subsequent Renal Vein Renin Sampling measured left renal vein renin activity at 4.50,μg/L/h, (compared with 4.80μg/L/h in the IVC). Right renal vein renin activity was 13.20μg/L/h. This lateralization of renin secretion to the right side with suppression of left sided secretion suggested that the renovascular hypertension was caused by the right kidney. This was a very unusual result, as the MAG3 captopril renal scan had incorrectly and strongly suggested a left sided origin to the renovascular hypertension. In addition, the right kidney not seen to accumulate MAG3 was in fact functioning sufficiently to produce renin. It is hypothesized that the left kidney had adjusted to allow normal function only at very high circulating

Pelvic Muscle Rehabilitation: A Standardized Protocol for Pelvic Floor Dysfunction

Directory of Open Access Journals (Sweden)

Rodrigo Pedraza

2014-01-01

Full Text Available Introduction. Pelvic floor dysfunction syndromes present with voiding, sexual, and anorectal disturbances, which may be associated with one another, resulting in complex presentation. Thus, an integrated diagnosis and management approach may be required. Pelvic muscle rehabilitation (PMR is a noninvasive modality involving cognitive reeducation, modification, and retraining of the pelvic floor and associated musculature. We describe our standardized PMR protocol for the management of pelvic floor dysfunction syndromes. Pelvic Muscle Rehabilitation Program. The diagnostic assessment includes electromyography and manometry analyzed in 4 phases: (1 initial baseline phase; (2 rapid contraction phase; (3 tonic contraction and endurance phase; and (4 late baseline phase. This evaluation is performed at the onset of every session. PMR management consists of 6 possible therapeutic modalities, employed depending on the diagnostic evaluation: (1 down-training; (2 accessory muscle isolation; (3 discrimination training; (4 muscle strengthening; (5 endurance training; and (6 electrical stimulation. Eight to ten sessions are performed at one-week intervals with integration of home exercises and lifestyle modifications. Conclusions. The PMR protocol offers a standardized approach to diagnose and manage pelvic floor dysfunction syndromes with potential advantages over traditional biofeedback, involving additional interventions and a continuous pelvic floor assessment with management modifications over the clinical course.

The Role of Pelvic Floor Muscles in Male Sexual Dysfunction and Pelvic Pain.

Science.gov (United States)

Cohen, Deborah; Gonzalez, Joshua; Goldstein, Irwin

2016-01-01

Sexual function is essential to good health and well-being in men. The relationship between male sexual function, pelvic floor function, and pelvic pain is complex and only beginning to be appreciated. The objectives of the current review are to examine these complex relationships, and to demonstrate how pelvic floor physical therapy can potentially improve the treatment of various male sexual dysfunctions, including erectile dysfunction and dysfunction of ejaculation and orgasm. Contemporary data on pelvic floor anatomy and function as they relate to the treatment of various male sexual dysfunctions were reviewed. Examination of evidence supporting the association between the male pelvic floor and erectile dysfunction, ejaculatory/orgasmic dysfunction, and chronic prostatitis/chronic pelvic pain syndrome, respectively. Evidence suggests a close relationship between the pelvic floor and male sexual dysfunction and a potential therapeutic benefit from pelvic floor therapy for men who suffer from these conditions. Pelvic floor physical therapy is a necessary tool in a more comprehensive bio-neuromusculoskeletal-psychosocial approach to the treatment of male sexual dysfunction and pelvic pain. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Test–re-test reliability and inter-rater reliability of a digital pelvic inclinometer in young, healthy males and females

Directory of Open Access Journals (Sweden)

Chris Beardsley

2016-03-01

Full Text Available Objective. The purpose of this study was to investigate the reliability of a digital pelvic inclinometer (DPI for measuring sagittal plane pelvic tilt in 18 young, healthy males and females. Method. The inter-rater reliability and test–re-test reliabilities of the DPI for measuring pelvic tilt in standing on both the right and left sides of the pelvis were measured by two raters carrying out two rating sessions of the same subjects, three weeks apart. Results. For measuring pelvic tilt, inter-rater reliability was designated as good on both sides (ICC = 0.81–0.88, test–re-test reliability within a single rating session was designated as good on both sides (ICC = 0.88–0.95, and test–re-test reliability between two rating sessions was designated as moderate on the left side (ICC = 0.65 and good on the right side (ICC = 0.85. Conclusion. Inter-rater reliability and test–re-test reliability within a single rating session of the DPI in measuring pelvic tilt were both good, while test–re-test reliability between rating sessions was moderate-to-good. Caution is required regarding the interpretation of the test–re-test reliability within a single rating session, as the raters were not blinded. Further research is required to establish validity.

Late unıon of the renal veıns wıth the ınterposed left renal artery

OpenAIRE

Çavdar, Safiye; Şehirli, Ümit; Malcic-Gürbüz, Jasna; Gümüşçü, Burak; Akalın, Aytül

2003-01-01

The complicated embryological development of the renal vein shows extensive variability in its anatomy. In this study, the rare bilateral late union of the renal veins with the interposed renal artery was observed during dissection for educational purposes. Its significance in different clinical conditions has been discussed.

Renal artery origins: best angiographic projection angles.

Science.gov (United States)

Verschuyl, E J; Kaatee, R; Beek, F J; Patel, N H; Fontaine, A B; Daly, C P; Coldwell, D M; Bush, W H; Mali, W P

1997-10-01

To determine the best projection angles for imaging the renal artery origins in profile. A mathematical model of the anatomy at the renal artery origins in the transverse plane was used to analyze the amount of aortic lumen that projects over the renal artery origins at various projection angles. Computed tomographic (CT) angiographic data about the location of 400 renal artery origins in 200 patients were statistically analyzed. In patients with an abdominal aortic diameter no larger than 3.0 cm, approximately 0.5 mm of the proximal part of the renal artery and origin may be hidden from view if there is a projection error of +/-10 degrees from the ideal image. A combination of anteroposterior and 20 degrees and 40 degrees left anterior oblique projections resulted in a 92% yield of images that adequately profiled the renal artery origins. Right anterior oblique projections resulted in the least useful images. An error in projection angle of +/-10 degrees is acceptable for angiographic imaging of the renal artery origins. Patients sex, site of interest (left or right artery), and local diameter of the abdominal aorta are important factors to consider.

Anatomical variants of the internal spermatic vein discovered during the percutaneous embolization of left varicoceles in a pediatric population; Variantes anatomiques de la veine spermatique lors du traitement endovasculaire des varicoc es gauches : une serie pediatrique

Energy Technology Data Exchange (ETDEWEB)

Garel, L.; Dubois, J.; Rypens, F.; Ouimet, A.; Yazbeck, S. [Univ. of Montreal, Sainte-Justine Hospital, Montreal, Quebec (Canada)]. E-mail: laurent_garel@ssss.gouv.qc.ca

2004-02-01

To report on the high incidence of anatomical variants of the origin and course of the internal spermatic vein (ISV) discovered at the time of percutaneous embolization of left varicoceles in a pediatric population. We reviewed retrospectively the 65 cases of left varicocele treated by percutaneous embolization (grade II and III) in our institution between 1990 and 2000. The course of the left renal vein (LRV), the origin of the ISV, and the number of ISVs and their pathway were recorded in all cases, according to the B ren classification. In 37/65 (57%), the ISV was single and arose from a normal LRV (type I).The following variants were encountered: type V - circumaortic LRV 9/65 (14%); type IVb - intrarenal origin of ISV 8/65 (12%); type II - multiple ISV 5/65 (8%); and pelvic collaterals 6/65 (9%). Venous anatomical variants are frequently encountered (43%) at the time of left varicocele embolization in children. Such variants often impose some adjustments to the technique of embolization and, at times, hamper the procedure. (author)

Contribution of pelvic floor muscles to stiffness of the pelvic ring

NARCIS (Netherlands)

Pool-Goudzwaard, A.L.; Hoek van Dijke, G; van Gurp, M; Mulder, P; Snijders, C.J.; Stoeckart, R.

2004-01-01

STUDY DESIGN: A biomechanical study in embalmed specimens, on the relation between applied tension in the pelvic floor muscles, stiffness of the pelvic ring and generation of movement in the sacroiliac joints. OBJECTIVE: To gain insight into the effect of tension in the pelvic floor muscles on

Application of single-incision transvaginal mesh in a woman undergoing peritoneal dialysis and suffering from refractory advanced stage pelvic organ prolapse

OpenAIRE

Sun, Yi-Hung; Kan, Wei-Chih; Wu, Ming-Ping

2016-01-01

Objective: We would like to provide an option of minimal invasive surgical intervention for a patient with end-stage renal disease undergoing continuous ambulatory peritoneal dialysis, who was at the advanced-stage pelvic organ prolapse (POP) and who also failed to be treated conservatively. Materials and method: We present a case of uterine prolapse stage IV in a woman who underwent continuous ambulatory peritoneal dialysis due to end-stage renal disease. Her severity of POP had only limi...

Renal myxoma: a case report

Directory of Open Access Journals (Sweden)

Carlos Henrique C Souza

2015-04-01

Full Text Available Myxomas are rare tumors that can appear in many anatomical locations. There are only 14 cases of renal involvement documented in the literature. This article reports a case of renal myxoma in an elderly woman with recurrent cystitis. After five years of follow-up, the computed tomography (CT revealed a large solid tumor mass in the left kidney. Tumor resection was performed preserving the affected kidney with histopathological diagnosis of renal myxoma. The objective of this study is to report a rare case of renal myxoma, emphasizing the importance of the differential diagnosis from other benign and malignant mesenchymal tumors.

Pelvic floor muscle problems mediate sexual problems in young adult rape victims.

Science.gov (United States)

Postma, Riemke; Bicanic, Iva; van der Vaart, Huub; Laan, Ellen

2013-08-01

Prior studies have addressed sexual abuse and sexual function in adult women. No studies have focused on the effect of adolescence rape on sexual functioning. To investigate the effect of rape on sexual problems and on pelvic floor problems, as well as the mediating role of pelvic floor problems on sexual problems, in a homogenous group of victims of adolescence rape without a history of childhood sexual, physical, and/or emotional abuse. Sexual functioning and pelvic floor functioning were assessed using self-report questionnaires. In this cross-sectional study, a group of 89 young women aged 18-25 years who were victimized by rape in adolescence was compared with a group of 114 nonvictimized controls. The rape victims were treated for posttraumatic stress disorder (PTSD) 3 years prior to participation in the study. Three years posttreatment, rape victims were 2.4 times more likely to have a sexual dysfunction (lubrication problems and pain) and 2.7 times more likely to have pelvic floor dysfunction (symptoms of provoked vulvodynia, general stress, lower urinary tract, and irritable bowel syndrome) than nonvictimized controls. The relationship between rape and sexual problems was partially mediated by the presence of pelvic floor problems. Rape victims and controls did not differ with regard to sexual activities. Rape victims suffer significantly more from sexual dysfunction and pelvic floor dysfunction when compared with nontraumatized controls, despite the provision of treatment for PTSD. Possibly, physical manifestations of PTSD have been left unaddressed in treatment. Future treatment protocols should consider incorporating (physical or psychological) treatment strategies for sexual dysfunction and/or pelvic floor dysfunction into trauma exposure treatments. © 2013 International Society for Sexual Medicine.

The use of pelvic fins for benthic locomotion during foraging behavior in Potamotrygon motoro (Chondrichthyes: Potamotrygonidae

Directory of Open Access Journals (Sweden)

Akemi Shibuya

2015-06-01

Full Text Available Synchronized bipedal movements of the pelvic fins provide propulsion (punting during displacement on the substrate in batoids with benthic locomotion. In skates (Rajidae this mechanism is mainly generated by the crural cartilages. Although lacking these anatomical structures, some stingray species show modifications of their pelvic fins to aid in benthic locomotion. This study describes the use of the pelvic fins for locomotory performance and body re-orientation in the freshwater stingray Potamotrygon motoro (Müller & Henle, 1841 during foraging. Pelvic fin movements of juvenile individuals of P. motoro were recorded in ventral view by a high-speed camera at 250-500 fields/s-1. Potamotrygon motoro presented synchronous, alternating and unilateral movements of the pelvic fins, similar to those reported in skates. Synchronous movements were employed during straightforward motion for pushing the body off the substrate as well as for strike feeding, whereas unilateral movements were used to maneuver the body to the right or left during both locomotion and prey capture. Alternating movements of the pelvic fins are similar to bipedal movements in terrestrial and semi-aquatic tetrapods. The pelvic fins showed coordinated movements during feeding even when stationary, indicating that they have an important function in maintaining body posture (station holding during prey capture and manipulation. The use of pelvic fins during prey stalking may be advantageous because it results in less substrate disturbance when compared to movements generated by pectoral fin undulation. The range of pelvic fin movements indicates more complex control and coordination of the pelvic radial muscles.

Renal function and urological complications after radical hysterectomy with postoperative radiotherapy and platinum-based chemotherapy for cervical cancer.

Science.gov (United States)

Okadome, Masao; Saito, Toshiaki; Kitade, Shoko; Ariyoshi, Kazuya; Shimamoto, Kumi; Kawano, Hiroyuki; Minami, Kazuhito; Nakamura, Motonobu; Shimokawa, Mototsugu; Okushima, Kazuhiro; Kubo, Yuichiro; Kunitake, Naonobu

2018-02-01

We aimed to clarify renal functional changes long term and serious urological complications in women with cervical cancer who undergo radical hysterectomy followed by pelvic radiotherapy and/or platinum-based chemotherapy to treat the initial disease. Data on 380 women who underwent radical hysterectomy at the National Kyushu Cancer Center from January 1997 to December 2013 were reviewed. Main outcome measures were the estimated glomerular filtration rate (eGFR) and monitored abnormal urological findings. Postoperative eGFR was significantly lower than preoperative eGFR in 179 women with surgery alone and in 201 women with additional pelvic radiotherapy and/or chemotherapy (both P types of univariate analyses for eGFR reduction in women after treatment showed that older age, advanced stage, pelvic radiotherapy, and platinum-based chemotherapy were significant variables on both analyses. Two types of multivariate analyses showed that platinum-based chemotherapy or pelvic radiotherapy were associated with impaired renal function (odds ratio 1.96, 95% confidence interval 1.08-3.54 and odds ratio 2.85, 95% confidence interval 1.12-7.24, for the respective analyses). There was a higher rate of bladder wall thickening in women with pelvic radiotherapy had than those without it (17.4% vs. 2.7%, P chemotherapy and/or postoperative pelvic radiotherapy. Serious and life-threatening urological complications are rare, but surgeons should be aware of the possibility during the long follow-up. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Limb ischemia, an alarm signal to a thromboembolic cascade - renal infarction and nephrectomy followed by surgical suppression of the left atrial appendage.

Science.gov (United States)

Caraşca, Cosmin; Borda, Angela; Incze, Alexandru; Caraşca, Emilian; Frigy, Attila; Suciu, HoraŢiu

2016-01-01

We present the case of a 55-year-old male with mild hypertension and brief episodes of paroxysmal self-limiting atrial fibrillation (AF) since 2010. Despite a small cardioembolic risk score, CHA2DS2-Vasc=1 (Congestive heart failure, Hypertension, Age=75, Diabetes melitus, prior Stroke), the patient is effectively anticoagulated using acenocumarol. In December 2014, he showed signs of plantar transitory ischemia, for which he did not address the doctor. In early January 2015, he urgently presented at the hospital with left renal pain, caused by a renal infarction, diagnosed by computed tomography (CT) angiography. Left nephrectomy was performed with pathological confirmation. He was discharged with effective anticoagulation treatment. Within the next two weeks, he suffered a transitory ischemic event and a stroke, associated with right sided hemiparesis. On admission, AF was found and converted to sinus rhythm with effective anticoagulation - international normalized ratio (INR) of 2.12. Transthoracic echocardiography detected no pathological findings. Transesophageal echocardiography showed an expended left atrial appendage (LAA) with a slow blood flow (0.2 m÷s) and spontaneous echocontrast. Considering these clinical circumstances, surgical LAA suppression was decided on as a last therapeutic resort. Postoperative evolution was favorable; the patient is still free of ischemic events, one year post-intervention. Some morphological and hemodynamic characteristics of LAA may add additional thromboembolic risk factors, not included in scores. Removing them by surgical LAA suppression may decrease the risk of cardioembolic events. Intraoperative presence of thrombus makes it an indisputable proof.

Transvaginal Drainage of Pelvic Abscesses and Collections Using Transabdominal Ultrasound Guidance.

Science.gov (United States)

Ching, Kevin C; Sumkin, Jules H

2015-01-01

Objectives. To evaluate clinical outcomes following transvaginal catheter placement using transabdominal ultrasound guidance for management of pelvic fluid collections. Methods. A retrospective review was performed for all patients who underwent transvaginal catheter drainage of pelvic fluid collections utilizing transabdominal ultrasound guidance between July 2008 and July 2013. 24 consecutive patients were identified and 24 catheters were placed. Results. The mean age of patients was 48.1 years (range = 27-76 y). 88% of collections were postoperative (n = 21), 8% were from pelvic inflammatory disease (n = 2), and 4% were idiopathic (n = 1). Of the 24 patients, 83% of patients (n = 20) had previously undergone a hysterectomy and 1 patient (4%) was pregnant at the time of drainage. The mean volume of initial drainage was 108 mL (range = 5 to 570). Catheters were left in place for an average of 4.3 days (range = 1-17 d). Microbial sampling was performed in all patients with 71% (n = 17) returning a positive culture. All collections were successfully managed percutaneously. There were no technical complications. Conclusions. Transvaginal catheter drainage of pelvic fluid collections using transabdominal ultrasound guidance is a safe and clinically effective procedure. Appropriate percutaneous management can avoid the need for surgery.

Intra-pelvic pressure changes after pelvic fracture: A cadaveric study quantifying the effect of a pelvic binder and limb bandaging over a bolster.

Science.gov (United States)

Morris, Rhys; Loftus, Andrew; Friedmann, Yasmin; Parker, Paul; Pallister, Ian

2017-04-01

Unstable pelvic fractures can be life-threatening due to catastrophic haemorrhage. Non-invasive methods of reducing and stabilising these injuries include pelvic binder application and also lower limb bandaging over a knee-flexion bolster. Both of these methods help close the pelvic ring and should tamponade bleeding. This study aimed to quantify the intra-pelvic pressure changes that occurred with 3 different manoeuvres: lower limb bandaging over a bolster; a Trauma Pelvic Orthotic Device (T-POD) pelvic binder, and a combination of both. Following a pilot study with 2 soft embalmed cadavers, a formal study with 6 unembalmed cadavers was performed. For each specimen an unstable pelvic injury was created (OA/OTA 61-C1) by dividing the pelvic ring anteriorly and posteriorly. A 3-4cm manometric water-filled balloon was placed in the retropubic space and connected to a 50ml syringe and water manometer via a 3-way tap. A baseline pressure of 8cmH 2 O (equating to the average central venous pressure) was used for each cadaver. Steady intra-pelvic pressures (more reliably reflecting the pressures achieved following an intervention) were used in the subsequent statistical analysis, using R statistical language and Rstudio. Paired t-test or Wilcoxon's rank sum test were used (depending on the normality of the dataset) to determine the impact of each intervention on the intra-pelvic pressure. The mean steady intra-pelvic pressures were significantly greater than the baseline pressure for each intervention. The binder and limb bandaging over a bolster alone increased the mean steady pelvic pressures significantly to 24 (SE=5) (plower limb bandaging over a bolster and pelvic binder application significantly increased intra-pelvic pressure above the baseline pressure. This was further increased through combining these interventions, which could be useful clinically to augment haemorrhage control in these fractures. Lower-limb bandaging over a bolster, and pelvic binder

The effect of anatomic differences on the relationship between renal artery and diaphragmatic crus.

Science.gov (United States)

Esen, K; Tok, S; Balci, Yuksel; Apaydin, F D; Kara, E; Uzmansel, D

2018-01-01

The aim of this study is to investigate the effect of anatomic differences on the relationship between renal artery and diaphragmatic crus via the touch of two structures. The study included dynamic computed tomography (CT) scans of 308 patients performed mainly for characterisation of liver and renal masses. Anatomic differences including the thickness of the diaphragmatic crus, the localisation of renal artery ostium at the wall of aorta, the level of renal artery origin with respect to superior mesenteric artery were evaluated. Statistical relationships between renal artery-diaphragmatic crus contact and the anatomic differences were assessed. Thickness of the diaphragmatic crus at the level of renal artery origin exhibited a statistically significant relationship to renal artery-diaphragmatic crus contact at the left (p renal artery origin and renal artery- -diaphragmatic crus contact at the left (p renal artery ostium at the wall of aorta (right side, p = 0.436, left side, p = 0.681) did not demonstrate a relationship to renal artery-diaphragmatic crus contact. Thickness of the diaphragmatic crus and high renal artery origin with respect to superior mesenteric artery are crucial anatomic differences determining the relationship of renal artery and diaphragmatic crus. (Folia Morphol 2018; 77, 1: 22-28).

Value of renal scintigraphy with captopril test in the exploration of renovascular hypertension: Case report

International Nuclear Information System (INIS)

Ghfir, I.; Berehou, F.Z.; Ben Rais, N.

2007-01-01

Introduction Dynamic renal scintigraphy with 99m Tc-DTPA and captopril test is a non-invasive functional method for the diagnosis of renovascular hypertension. It allows differentiating between hypertension induced by renal arterial stenosis from primary arterial hypertension with an incidental stenosis. Case report A 14-year-old girl, without previous medical history, developed a severe arterial hypertension with cephalalgia and ears buzzing. Auscultation revealed a murmur in the left lumbar pit. Renal angiography objectified a stenosis of the infra renal aorta due to a circumferential parietal thickening associated to renal arteries stenosis more marked in the left side. Dynamic renal scintigraphy after administration of captopril highlighted a marked collapse of the rate of tracer uptake exceeding 40% on the left side with an increase in the time of collecting on the right side testifying a frankly positive test prevailing on the left. A transluminal angioplasty of the left renal artery and a revascularization surgery on the right side were carried out. The evolution was marked by an improvement of blood pressure figures. Discussion Dynamic renal scintigraphy using 99m Tc-DTPA with captopril test constitutes a non-invasive process with a low dosimetry for the patients. Its principal goal is to affirm the role of renovascular stenosis in the origin of arterial hypertension and to determine which hypertensive patients with renal arterial stenosis can be treated successfully by surgical or endoscopic revascularization of the kidney. (authors)

Renal phlebographic findings in painless macrohematuria

International Nuclear Information System (INIS)

Seidel, K.; Federschmidt, K.

1982-01-01

After extensive review of literature concerning renal varices including suburothelial phlebectasia three cases of painless macrohematuria are recommended with unusual phlebographic findings: 1. a large renoiliac anastomosis combined with associated varices of the ureter, 2. a wide renohemazygal anastomosis draining nearly totally left renal venous blood into the vena cava superior, simultaneous existing varices of renal pelvis and ureter and 3. a persisting circumaortal ring. It is discussed whether phlebographic revealed renal varicosity is origin of bleeding in any case or bleeding may be caused eventually by associated suburothelial phlebectasia. (orig.) [de

Retrospective study of renal images on whole bone scanning

International Nuclear Information System (INIS)

Yanagisawa, Munetoshi; Machida, Toyohei; Miki, Makoto; Ohishi, Yukihiko; Ueda, Masataka

1978-01-01

One hundred and twenty-seven cases were surveyed by sup(99m)Tc-pyrophosphate at Jikei hospital. Renal images on whole-bone scanning were observed in all cases; 75% of all renal images were normal and 25% were abnormal. Thirteen percent of these abnormal images were symmetric and 87% were asymmetric. Four of the symmetric renal images were bilaterally bad. Three of the four bilaterally bad renal images involved prostate carcinomas with general metastases and the last involved serious bilateral hydronephrosis. The reason for the high percentage of asymmetric renal images was that the materials involved many urogenital cases. Asymmetric renal images other than the urogenital cases, were recognised in 8% of all cases. This percentage is consistent with Hattner's report. Unilateral abnormal renal images involved 8 hydronephrosis cases, 2 unilateral nonfunctioning kidneys and one malrotation kidney. Among the hydronephrosis cases, serious cases gave low uptake and mild cases gave high uptake. The reason for this phenomenon was, presumably, that there were differences in renal uptake, renal excretion and renal pelvic accumulation. In nine cases, one kidney was not visualized on whole-bone scanning, 8 of them involved nephrectomy and the remainining one unilateral nonfunctioning kidney. Six cases presented locally abnormal renal images on whole-bone scanning, three of them suffered renal cell carcinomas and the rest renal solitary cyst. Eighty-eight percent of the abnormal renal images agreed with IVP findings. The renal images of whole-bone scanning faithfully reflected the original renal lesion. Two cases of renal carcinoma and renal solitary cyst recognized on whole-bone scanning are presented, to indicate the usefulness of renal images on whole-bone scanning. (auth.)

An Unexpected Cause of Pelvic Pain in a Pubertal Case: Herlyn-Werner-Wunderlich Syndrome

Directory of Open Access Journals (Sweden)

Yasemin Kayadibi

2014-03-01

Full Text Available Uterovaginal duplication with imperforated hemivagina is a rare type of Mullerian anomaly. If ipsilateral renal agenesis is associated with this complex genital malformation, it is called Herlyn-Werner-Wunderlich syndrome. Clinical presentations of this syndrome include pelvic pain and mass effect due to obstructed hemivagina in pubertal adolescents and adults. Hematocolpos, even after menstruation period, leads to misdiagnosis. Laparotomy is the gold standard for the diagnosis, however, magnetic resonance imaging has an accuracy upto 100% in evaluating uterovajinal anatomy. In this article, we aimed to present ultrasonographic and magnetic resonance imaging findings in a patient with Herlyn-Werner-Wun derlich syndrome who presented with cyclic pelvic pain. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 60-3

CT differentiation of periappendiceal inflammation with appendicitis and pelvic inflammatory disease in woman with right lower quadrant pain

International Nuclear Information System (INIS)

Wang, Hyun Hye; Kim, Mi Young; Kim, Jung Eun; Kim, Youn Jeong; Suh, Chang Hae

2006-01-01

We wanted to determine the usefulness of the computed tomography (CT) findings for making the diagnosis between periappendiceal inflammation (PAI) with appendicitis and pelvic inflammatory disease (PID) for the women presenting with right lower quadrant pain. We retrospectively analyzed the CT findings of 83 women with right lower quadrant pain: PAI in 36 and PID in 47 patients. We reviewed the CT images, including the appendiceal diameter and the enhancing wall thickening, the cecal thickening, the location of the appendix, thickening of the right anterior renal fascia, abscess, mesenteric fatty infiltration, ascites, heterogeneous uterine enhancement and paralytic ileus. Statistical analysis was performed by using the t-test for the diameter of appendix, and the x 2 test or Fisher's exact test for the CT findings. The mean diameter of the appendix was 11.0 ± 3.4 mm for the PAI subjects and it was 6.7 ± 2.0 mm for the PID subjects (ρ < 0.0001). Wall thickening of the appendix was more commonly detected in PAI (25 subjects, 69%) than in PID (15 subjects, 32%) (ρ = 0.0007). Thickening of the right anterior renal fascia was more commonly detected in PAI (18 subjects, 50%) than in PID (7 subjects, 15%). Cecal thickening, ascitis, heterogeneous uterine enhancement and paralytic ileus were not significantly different between PAI and PID. Abscess and mesenteric fatty infiltration were more frequently detected in the RLQ and in the abdomen or pelvic cavity in PAI and PID, respectively (ρ < 0.05). There was no significant difference in the distribution of ascites between the diseases. The CT findings of the appendiceal diameter, enhancing wall thickening and thickening of the right anterior renal fascia are useful for making the diagnosis of PAI. The abdominal and pelvic distributions of abscess and mesenteric fatty infiltration are highly suggestive findings of PID

A Rare Renal Epithelial Tumor: Mucinous Cystadenocarcinoma Case Report and Review of the Literature

Directory of Open Access Journals (Sweden)

Abdulkadir Tepeler

2011-01-01

Full Text Available Primary renal mucinous cystadenocarcinoma is a very rare lesion of kidney which originates from the metaplasia of the renal pelvic uroepithelium. Only one case with primary mucinous cystadenocarcinoma has been reported in the English literature. We report second case of mucinous cystadenocarcinoma which was radiologically classified as type-IIF Bosniak cyst in peripheral localization. We aimed to present this extreme and unusual entity with its radiological, surgical, and pathologic aspects under the light of literature.

Lesions in mink (Mustela vison) infected with giant kidney worm (Dioctophyma renale).

Science.gov (United States)

Mace, T F

1976-01-01

Adult Dioctophyma renale occupied the enlarged renal pelvis of the right kidney of naturally infected mink. Lesions in the kidney parenchyma consisted of connective tissue proliferation in the interstitial tissue, tubular atrophy and fibrosis, and periglomerular fibrosis. The luminal surface of the renal pelvis wall was formed of numerous papillae covered with transitional epithelium. The nematodes in the lumen were bathed in an albuminous fluid containing red blood cells, epithelial cells and D. renale eggs. The left (uninfected) kidney was 60% larger than the left kidney of normal mink.

Renal Metastasis from Primary Cervical Cancer: A Case Report

International Nuclear Information System (INIS)

Jeon, Seong Woo; Kim, See Hyung; Kwon, Sun Young

2013-01-01

Metastasis of malignant tumors to the kidney is clinically rare and often discovered by autopsy. Primary lymphoma and lung cancer are known that can metastasize to the kidney. Other malignant tumor metastasis to the kidney is very unusual. Primary cervical cancer metastasis to adjacent pelvic organs and lymph nodes are well known followed by abdominal solid organs such as the liver and adrenal glands. However, reported primary cervical cancer metastasis to the kidney is extremely rare and mostly appeared as bilateral multiple renal masses. We report here on a rare case of unilateral single renal metastasis from primary cervical cancer after concur- rent chemoradiotherapy.

Multiple variations of the renal and testicular vessels: possible embryological basis and clinical importance.

Science.gov (United States)

Mazengenya, Pedzisai

2016-08-01

During routine dissection of the abdominal cavity of a 55-year-old African male cadaver, multiple anomalies including renal and testicular vessels were encountered. The right kidney was supplied by three right hilar renal arteries arising from the abdominal aorta at different vertebral levels whereas only one left renal artery supplied the left kidney. On the right three renal veins drained the kidney into the inferior vena cava. In contrast, the left kidney was drained by a single renal vein which received a large primary posterior tributary. The primary posterior tributary had three tributaries from the posterior lumbar region. The right testis had two sources of arterial supply; one from the subcostal artery and another from the abdominal aorta. The left testis was supplied normally by a single testicular artery. The right testis was drained by four testicular veins as follows: one drained into the subcostal vein, the other two drained separately for a longer course and joined shortly before draining into the right main renal vein, the fourth one drained into the anterior aspect of the inferior vena cava at the level of the second lumbar vertebra. On the left, the testicle was drained by two testicular veins which travelled separately from the deep inguinal ring and joined shortly before they drain into the left renal vein. This variation may represent an immature form of complicated development of kidneys and testes. Additionally, emphasis must be put on preoperative vascular examination to avoid surgical complications from variant vessels in this region.

Computed tomography angiogram. Accuracy in renal surgery

International Nuclear Information System (INIS)

Rabah, Danny M.; Al-Hathal, Naif; Al-Fuhaid, Turki; Raza, Sayed; Al-Yami, Fahad; Al-Taweel, Waleed; Alomar, Mohamed; Al-Nagshabandi, Nizar

2009-01-01

The objective of this study was to determine the sensitivity and specificity of computed tomography angiogram (CTA) in detecting number and location of renal arteries and veins as well as crossing vessels causing uretero-pelvic junction obstruction (UPJO), and to determine if this can be used in decision-making algorithms for treatment of UPJO. A prospective study was carried out in patients undergoing open, laparoscopic and robotic renal surgery from April 2005 until October 2006. All patients were imaged using CTA with 1.25 collimation of arterial and venous phases. Each multi-detector CTA was then read by one radiologist and his results were compared prospectively with the actual intra-operative findings. Overall, 118 patients were included. CTA had 93% sensitivity, 77% specificity and 90% overall accuracy for detecting a single renal artery, and 76% sensitivity, 92% specificity and 90% overall accuracy for detecting two or more renal arteries (Pearson χ 2 =0.001). There was 95% sensitivity, 84% specificity and 85% overall accuracy for detecting the number of renal veins. CTA had 100% overall accuracy in detecting early dividing renal artery (defined as less than 1.5 cm branching from origin), and 83.3% sensitivity, specificity and overall accuracy in detecting crossing vessels at UPJ. The percentage of surgeons stating CTA to be helpful as pre-operative diagnostic tool was 85%. Computed tomography angiogram is simple, quick and can provide an accurate pre-operative renal vascular anatomy in terms of number and location of renal vessels, early dividing renal arteries and crossing vessels at UPJ. (author)

Anatomic variation in the origin of the main renal arteries: spiral CTA evaluation

Energy Technology Data Exchange (ETDEWEB)

Beregi, J.P.; Willoteaux, S.; Remy-Jardin, M. [Department of Vascular Radiology, Hopital Cardiologique, 59 - Lille (France); Mauroy, B.; Francke, J.P. [Laboratoire d`Anatomie, Univ. de Lille (France); Mounier-Vehier, C. [Department of Hypertension and Internal Medicine, Hopital Cardiologique, Lille (France)

1999-09-01

The aim of this study was to provide quantitative data on the origin and trajectory of the main renal arteries using spiral CT angiography and arteriography. Normal renal artery anatomy was assessed on spiral CT angiography (axial transverse sections and shaded-surface-display reconstructions) in 100 patients referred for renal arteriography who had no significant renal artery stenosis. Two hundred major renal arteries were studied. The vast majority of right (88 %) and left (87 %) renal arteries originated between the lower third of the first lumbar vertebra and the lower border of the second lumbar vertebra. In 50 patients both ostia were at the same level; in the remaining 50 patients, the right ostium was located above the left in 37 patients. On the right, the angle of origin varied from -10 to + 55 (mean + 24 ). On the left, the angle of origin varied from + 30 to -55 (mean -11 ). Spiral CT angiography provides additional anatomic data, notably regarding the angle of origin of the renal arteries, that is potentially useful for planning interventional procedures. (orig.) With 4 figs., 19 refs.

Anatomic variation in the origin of the main renal arteries: spiral CTA evaluation

International Nuclear Information System (INIS)

Beregi, J.P.; Willoteaux, S.; Remy-Jardin, M.; Mauroy, B.; Francke, J.P.; Mounier-Vehier, C.

1999-01-01

The aim of this study was to provide quantitative data on the origin and trajectory of the main renal arteries using spiral CT angiography and arteriography. Normal renal artery anatomy was assessed on spiral CT angiography (axial transverse sections and shaded-surface-display reconstructions) in 100 patients referred for renal arteriography who had no significant renal artery stenosis. Two hundred major renal arteries were studied. The vast majority of right (88 %) and left (87 %) renal arteries originated between the lower third of the first lumbar vertebra and the lower border of the second lumbar vertebra. In 50 patients both ostia were at the same level; in the remaining 50 patients, the right ostium was located above the left in 37 patients. On the right, the angle of origin varied from -10 to + 55 (mean + 24 ). On the left, the angle of origin varied from + 30 to -55 (mean -11 ). Spiral CT angiography provides additional anatomic data, notably regarding the angle of origin of the renal arteries, that is potentially useful for planning interventional procedures. (orig.)

Low-energy shock wave preconditioning reduces renal ischemic reperfusion injury caused by renal artery occlusion.

Science.gov (United States)

Xue, Yuquan; Xu, Zhibin; Chen, Haiwen; Gan, Weimin; Chong, Tie

2017-07-01

To evaluate whether low energy shock wave preconditioning could reduce renal ischemic reperfusion injury caused by renal artery occlusion. The right kidneys of 64 male Sprague Dawley rats were removed to establish an isolated kidney model. The rats were then divided into four treatment groups: Group 1 was the sham treatment group; Group 2, received only low-energy (12 kv, 1 Hz, 200 times) shock wave preconditioning; Group 3 received the same low-energy shock wave preconditioning as Group 2, and then the left renal artery was occluded for 45 minutes; and Group 4 had the left renal artery occluded for 45 minutes. At 24 hours and one-week time points after reperfusion, serum inducible nitric oxide synthase (iNOS), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), creatinine (Cr), and cystatin C (Cys C) levels were measured, malondialdehyde (MDA) in kidney tissue was detected, and changes in nephric morphology were evaluated by light and electron microscopy. Twenty-four hours after reperfusion, serum iNOS, NGAL, Cr, Cys C, and MDA levels in Group 3 were significantly lower than those in Group 4; light and electron microscopy showed that the renal tissue injury in Group 3 was significantly lighter than that in Group 4. One week after reperfusion, serum NGAL, KIM-1, and Cys C levels in Group 3 were significantly lower than those in Group 4. Low-energy shock wave preconditioning can reduce renal ischemic reperfusion injury caused by renal artery occlusion in an isolated kidney rat model.

Effect of pelvic floor rehabilitation technique in preventing the postpartum pelvic floor dysfunction

Directory of Open Access Journals (Sweden)

Shi-Qiong Li

2017-04-01

Full Text Available Objective: To explore the effect of pelvic floor rehabilitation technique in preventing the postpartum pelvic floor dysfunction and on the sexual life quality. Methods: A total of 286 puerpera with pelvic floor dysfunction who were admitted in our hospital from May, 2014 to May, 2015 42 d after delivery were included in the study, and randomized into the treatment group and the control group with 143 cases in each group. After guidance, the puerpera in the control group were given pelvic floor muscle training by themselves at home. On this basis, the puerpera in the treatment group were treated by the pelvic floor rehabilitation apparatus. The puerpera in the two groups were treated for 4 weeks. The pelvic floor function before treatment, 6 months and 1 year after delivery was detected. The color Doppler ultrasound apparatus was used to detect BSD, PUVA, UVJ-M, and BND 3 months after delivery. Results: BND, PUVA-R, PUVA-S, and UVJ-M 3 months after delivery in the treatment groups were significantly lower than those in the control group, while BSD-S was significantly higher than that in the control group. The improvement of type I and II muscle fiber fatigue (%, POP-Q degree, AP indication point (cm, and vaginal dynamic pressure (cmH2O was significantly superior to that in the control group. The comparison of pelvic floor muscle strength classification before treatment between the two groups was not statistically significant. After treatment, the pelvic floor muscle in the two groups was significantly strengthened, and the proportion of V grade patients was significantly increased when compared with before treatment. Conclusions: The postpartum early pelvic floor rehabilitation technique can effectively enhance the pelvic floor function, and prevent the postpartum pelvic floor dysfunction, with an accurate efficacy; therefore, it deserves to be widely recommended in the clinic.

Primary renal synovial sarcoma

Directory of Open Access Journals (Sweden)

Girish D. Bakhshi

2012-03-01

Full Text Available Primary Renal Sarcoma is rare tumor comprising only 1% of all renal tumours. Synovial sarcomas are generally deep-seated tumors arising in the proximity of large joints of adolescents and young adults and account for 5-10% of all soft tissue tumours. Primary synovial sarcoma of kidney is rare and has poor prognosis. It can only be diagnosed by immunohistochemistry. It should be considered as a differential in sarcomatoid and spindle cell tumours. We present a case of 33-year-old female, who underwent left sided radical nephrectomy for renal tumour. Histopathology and genetic analysis diagnosed it to be primary renal synovial sarcoma. Patient underwent radiation therapy and 2 years follow up is uneventful. A brief case report with review of literature is presented.

Chronic pelvic pain.

Science.gov (United States)

Stein, Sharon L

2013-12-01

Chronic pelvic pain is pain lasting longer than 6 months and is estimated to occur in 15% of women. Causes of pelvic pain include disorders of gynecologic, urologic, gastroenterologic, and musculoskeletal systems. The multidisciplinary nature of chronic pelvic pain may complicate diagnosis and treatment. Treatments vary by cause but may include medicinal, neuroablative, and surgical treatments. Copyright © 2013 Elsevier Inc. All rights reserved.

Pelvic Actinomycosis

Directory of Open Access Journals (Sweden)

Alejandra García-García

2017-01-01

Full Text Available Introduction. Actinomycosis is a chronic bacterial infection caused by Actinomyces, Gram-positive anaerobic bacteria. Its symptomatology imitates some malignant pelvic tumours, tuberculosis, or nocardiosis, causing abscesses and fistulas. Actinomycoses are opportunistic infections and require normal mucous barriers to be altered. No epidemiological studies have been conducted to determine prevalence or incidence of such infections. Objective. To analyse the clinical cases of pelvic actinomycosis reported worldwide, to update the information about the disease. Methods. A systematic review of worldwide pelvic actinomycosis cases between 1980 and 2014 was performed, utilising the PubMed, Scopus, and Google Scholar databases. The following information was analysed: year, country, type of study, number of cases, use of intrauterine device (IUD, final and initial diagnosis, and method of diagnosis. Results. 63 articles met the search criteria, of which 55 reported clinical cases and 8 reported cross-sectional studies. Conclusions. Pelvic actinomycosis is confusing to diagnose and should be considered in the differential diagnosis of pelvic chronic inflammatory lesions. It is commonly diagnosed through a histological report, obtained after a surgery subsequent to an erroneous initial diagnosis. A bacterial culture in anaerobic medium could be useful for the diagnosis but requires a controlled technique and should be performed using specialised equipment.

Validation of the Pelvic Floor Distress Inventory-20 and the Pelvic Floor Impact Questionnaire-7 in Danish women with pelvic organ prolapse

DEFF Research Database (Denmark)

Due, Ulla; Brostrøm, Søren; Lose, Gunnar

2013-01-01

To translate the Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) and to evaluate their psychometric properties in Danish women with symptomatic pelvic organ prolapse....

Pelvic and acetabular fractures

International Nuclear Information System (INIS)

Mears, D.C.; Rubash, H.E.

1986-01-01

This treatise focuses primarily on the clinical aspects of diagnosis and treatments of pelvic and acetabular fractures. However, considerable attention is also paid to the radiographic diagnosis of trauma and postoperative effects. The book begins with a succinct review of pelvic and acetabular anatomy and pelvic biomechanics. It continues with a radiographic classification of pelvic injury, which will represent the major source of the book's interest for radiologists. The remainder of the book is concerned with clinical management of pelvic and acetabular trauma, including preoperative planning, surgical approaches, techniques of reduction, internal fixation, eternal fixation, post-operative care, and late problems. Even throughout this later portion of the book there are extensive illustrations, including plain radiographs, computed tomographic (CT) scans, reconstructed three-dimensional CT scans, and schematic diagrams of diverse pelvic and acetabular fractures and the elementary surgical techniques for their repair

A large unilateral renal artery aneurysm in a young child

International Nuclear Information System (INIS)

Robitaille, P.; Lord, H.; Dubois, J.; Rypens, F.; Oligny, L.L.

2004-01-01

The case of a 13-month-old boy with fibromuscular dysplasia (FMD) presenting with a large saccular aneurysm of the left renal artery and renovascular hypertension is reported. Renal and intrarenal arteries showed numerous small aneurysms alternating with stenoses. All arterial lesions were localized to the left kidney. After left nephrectomy, the patient's blood pressure normalized. Histopathologic examination of the arteries disclosed changes typical of medial fibroplasias, the most frequently described form of FMD in children. This diagnosis is rewarding as it represents a surgically curable cause of severe hypertension. (orig.)

Sacroiliac pain in a dialysis patient

Science.gov (United States)

Tristano, Antonio G

2009-01-01

The case is reported of a 47-year-old man with a history of chronic renal failure, treated with peritoneal dialysis, who presented with acute sacroiliac joint pain secondary to a pelvic abscess. Initially a diagnosis of infectious sacroiliitis of the left sacroiliac joint was suspected, but following investigation a pain referable to the sacroiliac joint was suspected. The patient recovered with a combination of antibiotics for the pelvic abscess and non-steroidal anti-inflammatory drugs. PMID:21994518

An IGRT margin concept for pelvic lymph nodes in high-risk prostate cancer

International Nuclear Information System (INIS)

Groher, M.; Kopp, P.; Deutschmann, H.; Sedlmayer, F.; Wolf, Frank; Drerup, M.

2017-01-01

Gold-marker-based image-guided radiation therapy (IGRT) of the prostate allows to correct for inter- and intrafraction motion and therefore to safely reduce margins for the prostate planning target volume (PTV). However, pelvic PTVs, when coadministered in a single plan (registered to gold markers [GM]), require reassessment of the margin concept since prostate movement is independent from the pelvic bony anatomy to which the lymphatics are usually referenced to. We have therefore revisited prostate translational movement relative to the bony anatomy to obtain adequate margins for the pelvic PTVs compensating mismatch resulting from referencing pelvic target volumes to GMs in the prostate. Prostate movement was analyzed in a set of 28 patients (25 fractions each, totaling in 684 fractions) and the required margins calculated for the pelvic PTVs according to Van Herk's margin formula M = 2.5 Σ + 1.64 (σ ' -σ p ). The overall mean prostate movement relative to bony anatomy was 0.9 ± 3.1, 0.6 ± 3.4, and 0.0 ± 0.7 mm in anterior/posterior (A/P), inferior/superior (I/S) and left/right (L/R) direction, respectively. Calculated margins to compensate for the resulting mismatch to bony anatomy were 9/9/2 mm in A/P, I/S, and L/R direction and 10/11/6 mm if an additional residual error of 2 mm was assumed. GM-based IGRT for pelvic PTVs is feasible if margins are adapted accordingly. Margins could be reduced further if systematic errors which are introduced during the planning CT were eliminated. (orig.) [de

Adhesive small bowel obstruction due to pelvic inflammatory disease: A case report

Directory of Open Access Journals (Sweden)

Razan A Al-Ghassab

2018-01-01

Full Text Available We report a rare case of a 32-year-old woman with adhesive small bowel obstruction due to pelvic inflammatory disease. She had no history of abdominal surgery, gynecological complaints or constitutional symptoms of chronic illness. The diagnosis was based on the laparoscopic findings of small bowel adhesions, free peritoneal fluid, “violin string” adhesions of Fitz-Hugh–Curtis syndrome and left hydrosalpinx. Laparoscopic adhesiolysis was performed successfully, and the patient had an uneventful postoperative course. The authors conclude that pelvic inflammatory disease should be included as a cause of adhesive small bowel obstruction in sexually active young women with no history of abdominal surgery or constitutional symptoms of chronic disease. When performed by experienced surgeons, laparoscopy in such patients is feasible and safe.

Renal denervation in a patient with Alport syndrome and rejected renal allograft

Directory of Open Access Journals (Sweden)

Narayana Raju

2015-12-01

Full Text Available Renal denervation is a new intervention to treat resistant hypertension. By applying radiofrequency (RF to renal arteries, sympathetic nerves in adventitia layer of vascular wall can be denervated. Sympathetic hyperactivity is an important contributory factor in hypertension of hemodialysis patients. Hyperactive sympathetic nervous system aggravates hypertension and it can cause complications like left ventricular hypertrophy, heart failure, arrhythmias and atherogenesis. Our report illustrates the use of renal denervation using conventional RF catheter for uncontrolled hypertension in a patient with Alport syndrome and rejected renal allograft. Progressive and sustained reduction of blood pressure was obtained post-procedure and at 24 months follow-up with antihypertensives decreased from 6 to 2 per day, thereby demonstrating the safety, feasibility, and efficacy of the procedure. There are some reports available on the usefulness of this technique in hemodialysis patients; however, there are no studies of renal denervation in patients with Alport syndrome and failed allograft situation.

Renal denervation in a patient with Alport syndrome and rejected renal allograft.

Science.gov (United States)

Raju, Narayana; Lloyd, Vincent; Yalagudri, Sachin; Das, Bharati; Ravikishore, A G

2015-12-01

Renal denervation is a new intervention to treat resistant hypertension. By applying radiofrequency (RF) to renal arteries, sympathetic nerves in adventitia layer of vascular wall can be denervated. Sympathetic hyperactivity is an important contributory factor in hypertension of hemodialysis patients. Hyperactive sympathetic nervous system aggravates hypertension and it can cause complications like left ventricular hypertrophy, heart failure, arrhythmias and atherogenesis. Our report illustrates the use of renal denervation using conventional RF catheter for uncontrolled hypertension in a patient with Alport syndrome and rejected renal allograft. Progressive and sustained reduction of blood pressure was obtained post-procedure and at 24 months follow-up with antihypertensives decreased from 6 to 2 per day, thereby demonstrating the safety, feasibility, and efficacy of the procedure. There are some reports available on the usefulness of this technique in hemodialysis patients; however, there are no studies of renal denervation in patients with Alport syndrome and failed allograft situation. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Risk factors related to interfractional variation in whole pelvic irradiation for locally advanced pelvic malignancies

International Nuclear Information System (INIS)

Yoon, W.S.; Yang, D.S.; Lee, J.A.; Lee, S.; Park, Y.J.; Kim, C.Y.

2012-01-01

Purpose: The goal of the present study was to demonstrate risk factors affecting the interfractional variation in whole pelvic irradiation. Patients and methods: Daily image acquisitions of 101 patients with locally advanced pelvic malignancy were undertaken using a kilo-voltage orthogonal on-board imager. The baseline deviation (the shift between the initial treatment and each fraction; Value Base ) and day-to-day variation (the shift between the previous treatment and each fraction; Value DD ) were measured. The standard deviations (SD) along the x- (right-left), y- (cranial-caudal), and z- (anterior-posterior) axes (SD[x], SD[y], and SD[z], respectively), the 3D vector of the SD (SD[3D]), and the mean of 3D shift (mean[3D]) were calculated in each patient. Various clinical factors, lumbar pelvic balance and rotation, and the shift of 5 consecutive fractions from the initial treatment (Value 5Fx ) were investigated as risk factors. Results: The prone set-up showed a larger mean Base [3D] than in the supine position (p =0.063). A body mass index (BMI) ≥ 30 kg/m 2 resulted in the largest mean DD [3D] (p = 0.078) and SD DD [3D] (p = 0.058). All the SD 5Fx along the x-, y-, and z-axes had moderate linear relationships with SD Base and SD DD (p 5Fx [3D] also had a moderate linear relationship with the mean Base [3D], mean DD [3D], SD Base [3D], and SD DD [3D] (p 5Fx had the same significant relationship with SD Base and SD DD (p 2 was associated with the largest SD DD [x] (p = 0.003). Conclusion: Close surveillance through high-quality and frequent image guidance is recommended for patients with extensive variations of the initial five consecutive fractions or obesity. (orig.)

Prevalence of myofascial chronic pelvic pain and the effectiveness of pelvic floor physical therapy.

Science.gov (United States)

Bedaiwy, Mohamed A; Patterson, Betsy; Mahajan, Sangeeta

2013-01-01

To determine the prevalence of myofascial pain and the outcome of transvaginal pelvic floor physical therapy for the treatment of chronic pelvic pain caused by myofascial pelvic pain in a tertiary care facility. A retrospective chart review was performed on all women who presented to our facility between January 2005 and December 2007. Those diagnosed with myofascial pelvic pain and referred for transvaginal pelvic floor physical therapy over this 3-year period were evaluated. Participants with an initial pain score of > or = 4, myofascial pelvic pain on examination, and who attended 2 or more physician visits were included in the analysis. Patient physical examination findings, symptoms, and verbal pain ratings were reviewed. In all, 146 (13.2%) of 1,106 initially screened patients were diagnosed with myofascial pain. Seventy-five (51%) of the 146 patients who were referred for physical therapy were included, and 75% had an initial pain score of > or = 7. Pain scores significantly improved proportional to the number of physical therapy visits completed, with 63% of patients reporting significant pain improvement. Transvaginal physical therapy is an effective treatment for chronic pelvic pain resulting from myofascial pelvic pain.

Progressive paralyzing sciatica revealing a pelvic pseudoaneurysm a year after hip surgery in a 12yo boy.

Science.gov (United States)

Boulouis, Grégoire; Shotar, Eimad; Dangouloff-Ros, Volodia; Janklevicz, Pierre-Henri; Boddaert, Nathalie; Naggara, Olivier; Brunelle, Francis

2016-01-01

Identifying extra spinal causes of a lumbar radiculopathy or polyneuropathy can be a tricky diagnosis challenge, especially in children. Among them, traumatic or iatrogenic pseudoaneurysms of iliac arteries have been seldom reported, in adults' series. The authors report an unusual case of progressive paralyzing left sciatica and lumbar plexopathy in a 12 years old boy, 12 months after a pelvic osteotomy for bilateral hip luxation secondary to osteochondritis dissecans. Spine MRI and pelvic CT angiography revealed a giant internal iliac artery pseudoaneurysm, enclosed in a chronic hematoma. The patient was successfully treated with endovascular coil embolization, and subsequent surgical hematoma evacuation. However, three months after treatment, neurological recovery was incomplete. This case highlights the importance of a rapid and extensive diagnosis work up of all causes of lower limb radiculopathies in children, including pelvic arteries lesions especially after pelvic surgery to avoid therapeutic delays that may jeopardize the chances of neurological recovery. Copyright © 2015 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

on uterus didelphys: a case report

Directory of Open Access Journals (Sweden)

Abel Cordoba

2017-01-01

Full Text Available In November 2013, a woman with Herlyn-Werner-Wunderlich (HWW syndrome was diagnosed with a locally advanced left cervical adenocarcinoma. The patient’s malformation consisted of two uteri with two cervixes, a obstructed vagina, and a left renal agenesis. Classification FIGO: stage IIIa because of infiltration of the inferior third of the vagina wall. Locoregional management comprised an infrarenal lateral aortic lymphadenectomy followed by concomitant radio-chemotherapy to the pelvic (inguinal, pelvic, and infrarenal para aortic nodes volumes. A total of 50.4 Gy were delivered (1.8 Gy/fraction/day to the node (inguinal, pelvic, and aortic infrarenal and pelvic volume; a concomitant boost to the primary cervical tumor and macroscopic nodes to 59.92 Gy (2.14 Gy/fraction/day was performed. 20 Gy were delivered with intracavitary brachytherapy boost with mold technique and a pulsed-dose-rate technique due to the rarity of this uterine malformation. After 30 months of follow-up, there was no evidence of locoregional or distant recurrence.

Renal transitional cell carcinoma: a sonographic and radiological correlation

International Nuclear Information System (INIS)

Prando, A.; Marins, J.L.C.; Prando, D.; Pereira, R.M.

1984-01-01

A sonographic study was performed on nine patients with renal transitional cell carcinoma and the findings correlated with those of excretory urography, retrograde and/or antegrade pyelography. In six patients the correct diagnosis was considered mainly by the radiological features. In the remaining three patients, due to its unusual manifestations, this diagnosis was accomplished only by sonography. A small echogenic mass at the peryphery of a chronic hydronephrotic kidney, a huge complex mass due to a multiple arborescent papilary tumor and a demonstration of a mass in a presumptive renal pelvic inflammatory disease, respectively, represented these uncommon aspects. The spectrum of features of this entity and the related differential diagnosis are also presented. (Author) [pt

Ischiogluteal bursitis mimicking soft-tissue metastasis from a renal cell carcinoma

International Nuclear Information System (INIS)

Voelk, M.; Gmeinwieser, J.; Manke, C.; Strotzer, M.; Hanika, H.

1998-01-01

We report a case of ischiogluteal bursitis mimicking a soft-tissue metastasis from a renal cell carcinoma. A 66-year-old woman suffered from pain over the left buttock 6 months after she was operated on for renal cell carcinoma of the left kidney. CT of the abdomen and pelvis revealed a tumor-like lesion adjacent to the left os ischii, which was suspected to be a soft-tissue metastasis. Percutaneous biopsy revealed no evidence of malignancy, but the histopathological diagnosis of chronic bursitis. (orig.)

Renal Artery Stenosis (RAS) Case study

International Nuclear Information System (INIS)

Zaater, M.K.

2012-01-01

Renal Artery Stenosis (RAS), is one of the causes of secondary hypertension; there are many causes of renal artery stenosis, as atherosclerosis of the renal artery which account for 90% of cases of RAS; fibromuscular dysplasia accounts for 10% of RAS. Various causes of thrombophilia either due congenital causes or acquired causes and can lead to RAS. Our patient was presented by acute attack of epistaxis and hypertension. Angiography of the Renal Arteries,are showed no sign of renal artery stenosis. However, the right kidney showed upper pole infarction, and the left kidney showed evidence of functional lower pole renal artery stenosis, although there is no anatomical stenosis detected in angiography. Work up for the cause of thrombophilia did not help in the diagnosis, which may be due to an undiscovered cause of thrombophilia

Renal Denervation Findings on Cardiac and Renal Fibrosis in Rats with Isoproterenol Induced Cardiomyopathy

Science.gov (United States)

Liu, Qian; Zhang, Qi; Wang, Kai; Wang, Shengchan; Lu, Dasheng; Li, Zhenzhen; Geng, Jie; Fang, Ping; Wang, Ying; Shan, Qijun

2015-12-01

Cardio-renal fibrosis plays key roles in heart failure and chronic kidney disease. We sought to determine the effects of renal denervation (RDN) on cardiac and renal fibrosis in rats with isoproterenol induced cardiomyopathy. Sixty male Sprague Dawley rats were randomly assigned to Control (n = 10) and isoproterenol (ISO)-induced cardiomyopathy group (n = 50). At week 5, 31 survival ISO-induced cardiomyopathy rats were randomized to RDN (n = 15) and Sham group (n = 16). Compared with Control group, ejection fraction was decreased, diastolic interventricular septal thickness and left atrial dimension were increased in ISO-induced cardiomyopathy group at 5 week. After 10 weeks, cardio-renal pathophysiologic results demonstrated that the collagen volume fraction of left atrio-ventricular and kidney tissues reduced significantly in RDN group compared with Sham group. Moreover the pro-fibrosis factors (TGF-β1, MMP2 and Collagen I), inflammatory cytokines (CRP and TNF-α), and collagen synthesis biomarkers (PICP, PINP and PIIINP) concentration significantly decreased in RDN group. Compared with Sham group, RDN group showed that release of noradrenaline and aldosterone were reduced, angiotensin-converting enzyme (ACE)/angiotensin II (Ang II)/angiotensin II type-1 receptor (AT1R) axis was downregulated. Meanwhile, angiotensin-converting enzyme 2 (ACE2)/angiotensin-1-7 (Ang-(1-7))/mas receptor (Mas-R) axis was upregulated. RDN inhibits cardio-renal fibrogenesis through multiple pathways, including reducing SNS over-activity, rebalancing RAAS axis.

False iliac artery aneurysm following renal transplantation

DEFF Research Database (Denmark)

Levi, N; Sønksen, Jens Otto Reimers; Schroeder, T V

1999-01-01

We report a very rare case of a false iliac artery aneurysm following renal transplantation. The patient was a 51-year-old women who presented with a painful 10 x 10 cm pulsating mass in her left iliac fossa. The patient had received a second cadaveric renal transplantation 5 years previously....... The graft never functioned and transplant nephrectomy was performed 2 weeks later. A CT-scanning showed a 10 x 10 cm large aneurysm arising from the left external iliac artery. At operation a large false aneurysm was identified arising from the original transplant anastomotic site. Due to the extent...

Chronic female pelvic pain

Directory of Open Access Journals (Sweden)

Gaurab Maitra

2013-01-01

Full Text Available Chronic pelvic pain (CPP is defined as nonmalignant pain perceived in the structures related to the pelvis that has been present for more than 6 months or a non acute pain mechanism of shorter duration. Pain in the pelvic region can arise from musculoskeletal, gynaecological, urologic, gastrointestinal and or neurologic conditions. Key gynaecological conditions that contribute to CPP include pelvic inflammatory disease (PID, endometriosis, adnexa pathologies (ovarian cysts, ovarian remnant syndrome, uterine pathologies (leiomyoma, adenomyosis and pelvic girdle pain associated with pregnancy. Several major and minor sexually transmitted diseases (STD can cause pelvic and vulvar pain. A common painful condition of the urinary system is Interstitial cystitis(IC. A second urologic condition that can lead to development of CPP is urethral syndrome. Irritable bowel syndrome (IBS is associated with dysmenorrhoea in 60% of cases. Other bowel conditions contributing to pelvic pain include diverticular disease,Crohn′s disease ulcerative colitis and chronic appendicitis. Musculoskeletal pathologies that can cause pelvic pain include sacroiliac joint (SIJ dysfunction, symphysis pubis and sacro-coccygeal joint dysfunction, coccyx injury or malposition and neuropathic structures in the lower thoracic, lumbar and sacral plexus. Prolonged pelvic girdle pain, lasting more than 6 months postpartum is estimated in 3% to 30% of women. Nerve irritation or entrapment as a cause of pelvic pain can be related to injury of the upper lumbar segments giving rise to irritation of the sensory nerves to the ventral trunk or from direct trauma from abdominal incisions or retractors used during abdominal surgical procedures. Afflictions of the iliohypogastric, ilioinguinal, genitofemoral, pudendal and obturator nerves are of greatest concern in patients with pelvic pain. Patient education about the disease and treatment involved is paramount. A knowledge of the differential

Didelphic uterus with imperforate unilateral vagina and ipsilateral renal agenesis: Magnetic resonance

International Nuclear Information System (INIS)

Rodrigo, R.M.; Saez, F.; Astigarraga, E.; Rodriguez, O.

1993-01-01

We present two cases of didelphic uterus with the clinical appearance of a pelvic mass produced by the hematometra-hematocolpos retained by an imperforate unilateral hemivagina. In both cases, this anomaly was accompanied by ipsilateral renal agenesis. We basically review the diagnosis of this disorder, focusing on magnetic resonance as the technique of choice. (Author) 10 refs

Value of renal scintigraphy with captopril test in the exploration of renovascular hypertension: Case report; Apport de la scintigraphie renale avec test au captopril dans l'exploration de l'hypertension arterielle renovasculaire: a propos d'un cas

Energy Technology Data Exchange (ETDEWEB)

Ghfir, I.; Berehou, F.Z.; Ben Rais, N. [Centre Hospitalier Universitaire de Rabat, Hopital Ibn-Sina, Service de Medecine Nucleaire (Morocco)

2007-08-15

Introduction Dynamic renal scintigraphy with {sup 99m}Tc-DTPA and captopril test is a non-invasive functional method for the diagnosis of renovascular hypertension. It allows differentiating between hypertension induced by renal arterial stenosis from primary arterial hypertension with an incidental stenosis. Case report A 14-year-old girl, without previous medical history, developed a severe arterial hypertension with cephalalgia and ears buzzing. Auscultation revealed a murmur in the left lumbar pit. Renal angiography objectified a stenosis of the infra renal aorta due to a circumferential parietal thickening associated to renal arteries stenosis more marked in the left side. Dynamic renal scintigraphy after administration of captopril highlighted a marked collapse of the rate of tracer uptake exceeding 40% on the left side with an increase in the time of collecting on the right side testifying a frankly positive test prevailing on the left. A transluminal angioplasty of the left renal artery and a revascularization surgery on the right side were carried out. The evolution was marked by an improvement of blood pressure figures. Discussion Dynamic renal scintigraphy using {sup 99m}Tc-DTPA with captopril test constitutes a non-invasive process with a low dosimetry for the patients. Its principal goal is to affirm the role of renovascular stenosis in the origin of arterial hypertension and to determine which hypertensive patients with renal arterial stenosis can be treated successfully by surgical or endoscopic revascularization of the kidney. (authors)

Bilateral multiple cystic kidney disease and renal cortical abscess in a Boerboel

Directory of Open Access Journals (Sweden)

A. M. Kitshoffa

2011-04-01

Full Text Available Cystic renal disease is rare in dogs and although infected renal cysts have been reported in humans, no report could be found in dogs. A 58 kg, 5-year-old, castrated, male Boerboel presented with weight loss, pyrexia, lethargy and vomiting, 20 months after an incident of haematuria was reported. The initial ultrasonographic diagnosis was bilateral multiple renal cysts of unknown aetiology. The cysts had significantly increased in size over the 20-month period and some contained echogenic specks which could be related to infection, normal cellular debris or haemorrhage. In both kidneys the renal contours were distorted (the left more than the right. The abnormal shape of the left kidney was largely due to multiple cysts and a large crescent-shaped septate mass on the cranial pole of the kidney. Aspirates of the septate mass were performed (left kidney and the cytology and culture were indicative of an abscess. It is suggested that the previous incident of haematuria provided a portal of entry for bacteria into the cysts resulting in renal cortical abscess formation.

Ischiogluteal bursitis mimicking soft-tissue metastasis from a renal cell carcinoma

Energy Technology Data Exchange (ETDEWEB)

Voelk, M.; Gmeinwieser, J.; Manke, C.; Strotzer, M. [Department of Radiology, University Hospital, Regensburg (Germany); Hanika, H. [Department of Urology, St. Josef Hospital, Regensburg (Germany)

1998-09-01

We report a case of ischiogluteal bursitis mimicking a soft-tissue metastasis from a renal cell carcinoma. A 66-year-old woman suffered from pain over the left buttock 6 months after she was operated on for renal cell carcinoma of the left kidney. CT of the abdomen and pelvis revealed a tumor-like lesion adjacent to the left os ischii, which was suspected to be a soft-tissue metastasis. Percutaneous biopsy revealed no evidence of malignancy, but the histopathological diagnosis of chronic bursitis. (orig.) With 2 figs., 8 refs.

Open heart surgery after renal transplantation.

Science.gov (United States)

Yamamura, Mitsuhiro; Miyamoto, Yuji; Mitsuno, Masataka; Tanaka, Hiroe; Ryomoto, Masaaki; Fukui, Shinya; Tsujiya, Noriko; Kajiyama, Tetsuya; Nojima, Michio

2014-09-01

to evaluate the strategy for open heart surgery after renal transplantation performed in a single institution in Japan. we reviewed 6 open heart surgeries after renal transplantation in 5 patients, performed between January 1992 and December 2012. The patients were 3 men and 2 women with a mean age of 60 ± 11 years (range 46-68 years). They had old myocardial infarction and unstable angina, aortic and mitral stenosis, left arterial myxoma, aortic stenosis, and native valve endocarditis followed by prosthetic valve endocarditis. Operative procedures included coronary artery bypass grafting, double-valve replacement, resection of left arterial myxoma, 2 aortic valve replacements, and a double-valve replacement. Renal protection consisted of steroid cover (hydrocortisone 100-500 mg or methylprednisolone 1000 mg) and intravenous immunosuppressant infusion (cyclosporine 30-40 mg day(-1) or tacrolimus 1.0 mg day(-1)). 5 cases were uneventful and good renal graft function was maintained at discharge (serum creatinine 2.1 ± 0.5 mg dL(-1)). There was one operative death after emergency double-valve replacement for methicillin-resistant Staphylococcus aureus-associated prosthetic valve endocarditis. Although the endocarditis improved after valve replacement, the patient died of postoperative pneumonia on postoperative day 45. careful perioperative management can allow successful open heart surgery after renal transplantation. However, severe complications, especially methicillin-resistant Staphylococcus aureus infection, may cause renal graft loss. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Testicular artery arising from an aberrant right renal artery | Suluba ...

African Journals Online (AJOL)

This case report we discovered the rare variation of the origin of the right testicular artery arising from the right aberrant renal artery with double renal artery irrigating both left and right kidneys. These variations in the testicular arteries and renal arteries have implication to surgical procedures such as orchidopexy repair for ...

Correction of Pelvic Tilt and Pelvic Rotation in Cup Measurement after THA - An Experimental Study.

Science.gov (United States)

Schwarz, Timo Julian; Weber, Markus; Dornia, Christian; Worlicek, Michael; Renkawitz, Tobias; Grifka, Joachim; Craiovan, Benjamin

2017-09-01

Purpose  Accurate assessment of cup orientation on postoperative pelvic radiographs is essential for evaluating outcome after THA. Here, we present a novel method for correcting measurement inaccuracies due to pelvic tilt and rotation. Method  In an experimental setting, a cup was implanted into a dummy pelvis, and its final position was verified via CT. To show the effect of pelvic tilt and rotation on cup position, the dummy was fixed to a rack to achieve a tilt between + 15° anterior and -15° posterior and 0° to 20° rotation to the contralateral side. According to Murray's definitions of anteversion and inclination, we created a novel corrective procedure to measure cup position in the pelvic reference frame (anterior pelvic plane) to compensate measurement errors due to pelvic tilt and rotation. Results  The cup anteversion measured on CT was 23.3°; on AP pelvic radiographs, however, variations in pelvic tilt (± 15°) resulted in anteversion angles between 11.0° and 36.2° (mean error 8.3°± 3.9°). The cup inclination was 34.1° on CT and ranged between 31.0° and 38.7° (m. e. 2.3°± 1.5°) on radiographs. Pelvic rotation between 0° and 20° showed high variation in radiographic anteversion (21.2°-31.2°, m. e. 6.0°± 3.1°) and inclination (34.1°-27.2°, m. e. 3.4°± 2.5°). Our novel correction algorithm for pelvic tilt reduced the mean error in anteversion measurements to 0.6°± 0.2° and in inclination measurements to 0.7° (SD± 0.2). Similarly, the mean error due to pelvic rotation was reduced to 0.4°± 0.4° for anteversion and to 1.3°± 0.8 for inclination. Conclusion  Pelvic tilt and pelvic rotation may lead to misinterpretation of cup position on anteroposterior pelvic radiographs. Mathematical correction concepts have the potential to significantly reduce these errors, and could be implemented in future radiological software tools. Key Points   · Pelvic tilt and rotation influence cup

Assessment of a semiautomated pelvic floor measurement model for evaluating pelvic organ prolapse on MRI.

Science.gov (United States)

Onal, S; Lai-Yuen, S; Bao, P; Weitzenfeld, A; Greene, K; Kedar, R; Hart, S

2014-06-01

The objective of this study was to assess the performance of a semiautomated pelvic floor measurement algorithmic model on dynamic magnetic resonance imaging (MRI) images compared with manual pelvic floor measurements for pelvic organ prolapse (POP) evaluation. We examined 15 MRIs along the midsagittal view. Five reference points used for pelvic floor measurements were identified both manually and using our semiautomated measurement model. The two processes were compared in terms of accuracy and precision. The semiautomated pelvic floor measurement model provided highly consistent and accurate locations for all reference points on MRI. Results also showed that the model can identify the reference points faster than the manual-point identification process. The semiautomated pelvic floor measurement model can be used to facilitate and improve the process of pelvic floor measurements on MRI. This will enable high throughput analysis of MRI data to improve the correlation analysis with clinical outcomes and potentially improve POP assessment.

Post-radiation nephritis. Study of the renal consequences of splenic irradiation for lymphoma

International Nuclear Information System (INIS)

Le Bourgeois, J.P.; Godefroy, D.; Di Paolo, M.; Parmentier, C.; Tubiana, M.

1975-01-01

The left kidney consequences of splenic irradiation in 40 patients with lymphomas were studied. The renal work-up performed before irradiation and every six months afterwards includes: blood pressure, biological tests, IV P and 179 Hg neohydrine renal scan. Computer scan data processing showed a partial disfunction of left kidney in 16 patients with 18 month-follow up. Renal disfunction appeared within 8 to 10 months following spleen irradiation. During that period no clinical or radiological abnormalities were observed [fr

Measurement of renal index on X-CT

International Nuclear Information System (INIS)

Iguchi, Takashi

1991-01-01

Morphological measurements of the kidney were made using X-CT images. Anteroposterior (AP) width of the kidney as well as the renal sinus on both right and left sides and the transverse width of the first lumbar vertebral body were measured from CT images. Changes according to age in AP width of the kidney and the transverse width of the lumbar vertebral body were investigated. As to the ratio of the AP width of the kidney (both right and left) to the transverse width of the lumbar vertebral body, and the ratio of the AP width of the kidney to the AP width of the renal sinus, the changes due to aging and the differences between male and female were studied. The average AP width of the right kidney was 47 mm, while that of the left kidney was 49 mm. The left kidney was slightly larger than the right kidney with statistical significance. In subjects up to 19 years of age, both the AP width of the kidney and the transverse width of the lumbar vertebral body showed correlation with age, while after the age of 20, there was no age-related correlation. The average ratio of the AP width of the kidney to the transverse width of the lumbar vertebral body was 1.13 for the right kidney and 1.19 for the left kidney. The difference between those two items was statistically significant and the changes due to aging were slight. During the age between 4 and 64 years, they were constant and no significant change was noticed. No difference between male and female was found. From the age of 65 years, a decreasing tendency was noticed. The ratios of AP width of the kidney to the AP width of renal sinus for both kidneys in males and females were found to be inversely correlated with age. They were similar to the changes due to aging in renal functions of the cortex system. On CT images, the ratio of AP width could be the index of both the size of the kidney and the thickness of the renal parenchyma respectively. (author)

Complex left profunda femoris vein to renal vein bypass for the management of progressive chronic iliofemoral occlusion.

Science.gov (United States)

Anaya-Ayala, Javier E; Adams, Matthew K; Telich-Tarriba, Jose E; Dresser, Kelly L; Ismail, Nyla; Peden, Eric K

2013-01-01

Chronic occlusions of the inferior vena cava (IVC) and iliofemoral veins are long-term sequelae of deep venous thrombosis (DVT) that can lead to postthrombotic syndrome (PTS). Patients may present with a wide spectrum of signs and symptoms, ranging from mild discomfort and swelling to severe venous hypertension and ulcerations. We report a 68-year-old man who had a history of left lower extremity DVT after a laminectomy and who developed PTS with nonhealing ulcers. The patient underwent a cross-pubic femorofemoral venous bypass that failed to improve his clinical status. After unsuccessful endovascular attempts for recanalization of the iliofemoral segment, a profunda femoris to IVC bypass was performed. The symptoms recurred 2 years later. Venography revealed restenosis at the caval anastomosis that did not resolve by endovascular means. A surgical revision was performed, and given the quality of the IVC, a jump bypass was created to the left renal vein. The swelling improved and the ulcers healed completely. Twenty-eight months after the complex reconstructions, he remains ulcer-free with mild edema controlled with stockings. Venous reconstructions remain a viable option for patients with symptomatic and recalcitrant nonmalignant obstruction of the large veins. Copyright © 2013 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

Pelvic exenteration for locally advanced primary and recurrent pelvic neoplasm: a series of 54 resectable cases

Directory of Open Access Journals (Sweden)

Sergio Renato Pais Costa

2008-09-01

Full Text Available Objective: To report on a series of 54 patients with pelvic neoplasms submitted to curative pelvic exenteration at a tertiary hospital and describe the results (morbidity, mortality, and long-term survival. Methods: The complete data of 54 patients submitted to pelvic exenteration between 1999 and 2007 were evaluated. Sixteen men and 38 women with a mean age of 65 years and median age of 66 years (36 to 77 were studied. Surgical procedures included total pelvic exenteration (n = 26, anterior pelvic exenteration(n = 5, and posterior pelvic exenteration (n = 23. Rresults: The mean operative time was 402 minutes (280 to 585. The average volume of intraoperative bleeding was 2,013 ml (300 to 5,800. Postoperative mortality was 5% (n = 3. The overall morbidity rate was 46%(n = 25. Histological evaluation demonstrated that 47 resections were R0 (87% while seven were R1 (13%. The overall survival rate in five years was 23.5% (n = 12. Cconclusions: Despite its aggressive nature and high morbidity, pelvic exenteration is still justified in locally advanced pelvic neoplasms or even in isolated pelvic recurrence, since it affords a greater long-term control of the neoplasm.

Are Radiation Therapy Oncology Group Para-aortic Contouring Guidelines for Pancreatic Neoplasm Applicable to Other Malignancies—Assessment of Nodal Distribution in Gynecological Malignancies

Energy Technology Data Exchange (ETDEWEB)

Kabolizadeh, Peyman; Fulay, Suyash; Beriwal, Sushil, E-mail: beriwals@upmc.edu

2013-09-01

Purpose: Intensity modulated radiation therapy is used to reduce dose to adjacent critical structures while maintaining adequate target coverage, but it requires precise target localization. We report the 3-dimensional distribution of para-aortic (PA) lymph nodes (LN) in pelvic malignancies. We propose a guideline to accurately define the PA LN by anatomic landmarks and compare our data with published guidelines for pancreatic cancer. Methods and Materials: A retrospective analysis was performed on 46 patients with pelvic malignancies and positive PA LNs. Positive LNs were defined based on size and morphology or fluorodeoxyglucose avidity. All PA LNs were characterized into 3 groups based on location: left PA (between aorta and left psoas muscle), aortocaval (between aorta and inferior vena cava), and right paracaval (between inferior vena cava and right psoas muscle). Patients with retrocrural LNs were also analyzed. Results: One hundred thirty-three positive PA LNs were evaluated. The majority of the PA LNs were in the left PA (59%) and aortocaval (35) regions, and only 8% were in the right paracaval region. All patients with positive right paracaval LNs also had involved left PA LNs, with only 1 exception. The highest PA LN involvement was at the level of the renal vessels and was seen in 28% of patients. Of these patients with disease extending to renal vessels, 38% had retrocrural LN involvement. Conclusions: The nodal contouring for the PA region should not be defined by a fixed circumferential margin around the vessels. The left PA and aortocaval spaces should be covered adequately because these are common locations of PA LNs. For microscopic disease superiorly, contouring should extend up to renal vessels rather than a fixed bony landmark. For patients who have nodal involvement at renal vessels, one can consider including retrocrural LNs. Radiation Therapy Oncology Group Para-aortic Contouring Guidelines for Pancreatic Neoplasm are not applicable to

Are Radiation Therapy Oncology Group Para-aortic Contouring Guidelines for Pancreatic Neoplasm Applicable to Other Malignancies—Assessment of Nodal Distribution in Gynecological Malignancies

International Nuclear Information System (INIS)

Kabolizadeh, Peyman; Fulay, Suyash; Beriwal, Sushil

2013-01-01

Purpose: Intensity modulated radiation therapy is used to reduce dose to adjacent critical structures while maintaining adequate target coverage, but it requires precise target localization. We report the 3-dimensional distribution of para-aortic (PA) lymph nodes (LN) in pelvic malignancies. We propose a guideline to accurately define the PA LN by anatomic landmarks and compare our data with published guidelines for pancreatic cancer. Methods and Materials: A retrospective analysis was performed on 46 patients with pelvic malignancies and positive PA LNs. Positive LNs were defined based on size and morphology or fluorodeoxyglucose avidity. All PA LNs were characterized into 3 groups based on location: left PA (between aorta and left psoas muscle), aortocaval (between aorta and inferior vena cava), and right paracaval (between inferior vena cava and right psoas muscle). Patients with retrocrural LNs were also analyzed. Results: One hundred thirty-three positive PA LNs were evaluated. The majority of the PA LNs were in the left PA (59%) and aortocaval (35) regions, and only 8% were in the right paracaval region. All patients with positive right paracaval LNs also had involved left PA LNs, with only 1 exception. The highest PA LN involvement was at the level of the renal vessels and was seen in 28% of patients. Of these patients with disease extending to renal vessels, 38% had retrocrural LN involvement. Conclusions: The nodal contouring for the PA region should not be defined by a fixed circumferential margin around the vessels. The left PA and aortocaval spaces should be covered adequately because these are common locations of PA LNs. For microscopic disease superiorly, contouring should extend up to renal vessels rather than a fixed bony landmark. For patients who have nodal involvement at renal vessels, one can consider including retrocrural LNs. Radiation Therapy Oncology Group Para-aortic Contouring Guidelines for Pancreatic Neoplasm are not applicable to

[Functional aspects of pelvic floor surgery].

Science.gov (United States)

Wagenlehner, F M E; Gunnemann, A; Liedl, B; Weidner, W

2009-11-01

Pelvic floor dysfunctions are frequently seen in females. The human pelvic floor is a complex structure and heavily stressed throughout female life. Recent findings in the functional anatomy of the pelvic floor have led to a much better understand-ing, on the basis of which enormous improvements in the therapeutic options have arisen. The pelvic floor activity is regulated by three main muscular forces that are responsible for vaginal tension and suspension of the pelvic floor -organs, bladder and rectum. For different reasons laxity in the vagina or its supporting ligaments as a result of altered connective tissue can distort this functional anatomy. A variety of symptoms can derive from these pelvic floor dysfunctions, such as urinary urge and stress incontinence, abnormal bladder emptying, faecal incontinence, obstructive bowel disease syndrome and pelvic pain. Pelvic floor reconstruction is nowadays driven by the concept that in the case of pelvic floor symptoms restoration of the anatomy will translate into restoration of the physiology and ultimately improve the patients' symptoms. The exact surgical reconstruction of the anatomy is there-fore almost exclusively focused on the restoration of the lax pelvic floor ligaments. An exact identification of the anatomic lesions preoperatively is eminently necessary, to allow for an exact anatomic reconstruction with respect to the muscular forces of the pelvic floor. Georg Thieme Verlag Stuttgart * New York.

An unusual localization of seven months delayed pelvic lymphocele following radical retropubic prostatectomy: Case report and literature review

Directory of Open Access Journals (Sweden)

Berk Hazır

Full Text Available Introduction: A pelvic lymphocele is a collection of lymphatic fluid that develops after extensive lymphadenectomies in surgeries such as urological malignancies or renal transplantation. Pelvic lymphoceles may cause complications such as fever, abdominal pain, leg swelling, genital swelling and flank pain. This report summarizes the management of a pelvic lymphocele after open radical retropubic prostatectomy with bilateral lymphadenectomy. Presentation of case: Herein, we present a case in which a pelvic lymphocele developed seven months post-radical open retropubic prostatectomy and through this patient we discussed the lymphocele following radical prostatectomy. The pelvic lymphocele occurred along the sciatic nerve from the sciatica foramen to the intergluteal muscles. The patient was treated with three drainage catheters. This localization is an atypical and unusual for lymphocele after radical retropubic prostatectomy. Discussion: Lymphocele formation that leads to major complications after radical prostatectomy is rare. Lymphocele formation is most commonly seen in the early postoperative period, but it should be considered in patients with fever, abdominal pain or leg swelling during the late postoperative period. Lymphocele formation was the most common cause of hospital readmission after radical prostatectomy. Conclusion: Lymphocele formation can be seen in atypical regions and can lead to unexpected complications after radical prostatectomy. Therefore, it should be brought to mind when complaints such as fever and lower extremity swelling occurred in patients underwent extensive lymph node dissection. Surgical treatment options are available, but percutaneous interventions can also be used. Keywords: Radical retropubic prostatectomy, Pelvic lymphocele, Percutaneous drainage, Prostate cancer, Case-report

Pelvic denervation procedures for dysmenorrhea.

Science.gov (United States)

Ramirez, Christina; Donnellan, Nicole

2017-08-01

Chronic pelvic pain and dysmenorrhea are common conditions affecting reproductive-age women. Surgical pelvic denervation procedures may be a treatment option for women with midline dysmenorrhea, in which medical management is declined by the patient, ineffective at managing symptoms, or medically contraindicated. This review describes the surgical techniques and complications associated with pelvic denervation procedures as well as the current evidence for these procedures in women with primary dysmenorrhea and dysmenorrhea secondary to endometriosis. Presacral neurectomy is the preferred pelvic denervation procedure in patients with primary dysmenorrhea and midline chronic pelvic pain associated with endometriosis. In patients with endometriosis presacral neurectomy is a useful adjunct to excision or ablation of all endometrial lesions to improve postoperative pain relief. There is no additional patient benefit of performing combined presacral neurectomy and uterine nerve ablation procedures. Pelvic denervation procedures can be performed safely and quickly with a low risk of complication if the surgeon is knowledgeable and skilled in operating in the presacral space. Patients should be adequately counseled on expected success rates and potential complications associated with pelvic denervation procedures.

Clinical Significance of Renal Pelvic Dilatation less than 10 mm in Neonates: Correlation with Urinary Tract Infection and Vesicoureteral Reflux

Energy Technology Data Exchange (ETDEWEB)

Lee, Woong Hee; Kim, Young Tong; Jo, Sung Sik; Kim, Sang Won; Shin, Hyung Cheol; Kim, Il Young [Cheonan Hospital, Soonchunhyang University, Cheonan (Korea, Republic of)

2009-12-15

We wanted to evaluate the correlation of mild renal pelvic dilatation (RPD) that is observed to be less than 10 mm on ultrasound (US) with urinary tract infection (UTI) and vesicoureteral reflux (VUR) in neonates. We reviewed 137 kidneys of 107 neonates who had RPD less than 10 mm on US. All the kidneys were divided into two groups: Group I (RPD <= 5.0 mm) and Group II (RPD > 5.0 mm), and we statistically analyzed the RPD change according to UTI and VUR. Seven neonates had VUR (5.1%), and there was no statistical significance between Group I (6 neonates, 5.6%) and Group II (1 neonate, 3.3%). Thirty seven cases (27%) had UTI and there was no statistical significance between Group I (30 cases, 28.0%) and Group II (7 cases, 23.3%). The RPD did not change in 81.8% of the cases, it increased in 4.4% of the cases and it decreased in 13.9% of the cases on follow up US. The incidence of VUR and UTI were not different according to the change of RPD. There were no statistical differences between the changes of RPD and the incidences of UTI and VUR in neonates with mild RPD less than 10 mm. Most of RPD did not change on the follow up US

Clinical Significance of Renal Pelvic Dilatation less than 10 mm in Neonates: Correlation with Urinary Tract Infection and Vesicoureteral Reflux

International Nuclear Information System (INIS)

Lee, Woong Hee; Kim, Young Tong; Jo, Sung Sik; Kim, Sang Won; Shin, Hyung Cheol; Kim, Il Young

2009-01-01

We wanted to evaluate the correlation of mild renal pelvic dilatation (RPD) that is observed to be less than 10 mm on ultrasound (US) with urinary tract infection (UTI) and vesicoureteral reflux (VUR) in neonates. We reviewed 137 kidneys of 107 neonates who had RPD less than 10 mm on US. All the kidneys were divided into two groups: Group I (RPD ≤ 5.0 mm) and Group II (RPD > 5.0 mm), and we statistically analyzed the RPD change according to UTI and VUR. Seven neonates had VUR (5.1%), and there was no statistical significance between Group I (6 neonates, 5.6%) and Group II (1 neonate, 3.3%). Thirty seven cases (27%) had UTI and there was no statistical significance between Group I (30 cases, 28.0%) and Group II (7 cases, 23.3%). The RPD did not change in 81.8% of the cases, it increased in 4.4% of the cases and it decreased in 13.9% of the cases on follow up US. The incidence of VUR and UTI were not different according to the change of RPD. There were no statistical differences between the changes of RPD and the incidences of UTI and VUR in neonates with mild RPD less than 10 mm. Most of RPD did not change on the follow up US

Interobserver Variation of the Renal Length Measurement on Ultrasonography

International Nuclear Information System (INIS)

Jeong, Yoong Ki; Chung, Hye Weon; Kim, Tae Sung; Ryoo, Jae Wook; Kim, Tae Kyoung; Kim, Seung Hyup

1995-01-01

We assessed interobserver variation in the measurement of the renal length on ultrasonography. Ultrasonographic examinations were performed in randomly selected 50 patients. The maximallenhths of both kidneys were measured with calipers during the scanning from frozen images by three observers in a blinded fashion. There was a relatively constant tendency of an observer to measure a renal length either longer or shorter than the other observer(Kendall coefficient>0.05). Average interobserver variations were 0.51 cm (±0.42 cm) in right kidney and 0.53 cm (±0.41 cm) in left kidney and were within 1 cm in 91% right and 89% of left kidney. Interobserver variation about 1cm should be considered in the measurement of the renal length on ultrasonography

Tumoral calcinosis in a dog with chronic renal failure

International Nuclear Information System (INIS)

Spotswood, T.C.

2003-01-01

A 2-year-old male German shepherd dog in poor bodily condition was evaluated for thoracic limb lameness due to a large, firm mass medial to the left cranial scapula. Radiography revealed several large cauliflower-like mineralized masses in the craniomedial left scapula musculature, pectoral region and bilaterally in the biceps tendon sheaths. Urinalysis, haematology and serum biochemistry showed that the dog was severely anaemic, hyperphosphataemic and in chronic renal failure. The dog was euthanased and a full post mortem performed. A diagnosis of chronic renal failure with secondary hyperparathyroidism was confirmed. The mineralised masses were grossly and histopathologically consistent with a diagnosis of tumoral calcinosis. Tumoral calcinosis associated with chronic renal failure that does not involve the foot pads is rarely seen

In vivo estimation of renal volume using a rotating gamma camera for sup(99m)Tc-dimercaptosuccinic acid renal imaging

Energy Technology Data Exchange (ETDEWEB)

Kawamura, J; Itoh, H; Yoshida, O; Fujita, T; Torizuka, K

1984-03-01

The in vivo renal volume was determined using SPECT for sup(99m)Tc-DMSA renal imaging. The total renal volume was derived by summing the DMSA distribution volumes of the transaxial slices in the whole kidney. In 20 healthy subjects the renal volume in the right kidney was 220 ml for men and 195.2 ml for women, while that in the left kidney was 213 ml for men and 193.7 ml for women. Differences in those values were not statistically significant. A good correlation was found between renal volumes in both kidneys and body surface area. In 106 kidneys including solitary and pathological kidneys, individual renal volume correlated well with individual DMSA renal uptake rate which demonstrates cortical functioning mass, depending on the cortical blood flow. Thus, SPECT enables an accurate noninvasive means of estimating in vivo functioning renal volume.

Normal renal arterial anatomy assessed by multidetector CT angiography: are there differences between men and women?

Science.gov (United States)

Turba, Ulku Cenk; Uflacker, Renan; Bozlar, Ugur; Hagspiel, Klaus D

2009-03-01

The purpose of this study was to determine renal arterial anatomy and gender differences in adults without renovascular disease using multidetector computed tomography angiography (MDCTA). MDCTA datasets of 399 patients were retrospectively reviewed. Measurements of the aortorenal diameters, the angulation of the renal ostia and pedicles as well as the distance between the origins of the renal arteries were measured. Differences in measurements between genders were tested for statistical significance using analysis of variance (ANOVA) and Pearson's Chi-Square tests. A total of 798 renal arteries were available for analysis in 207 female (mean age = 52.91 years) and 192 male patients (mean age = 53.04 years). Female patients were found to have smaller aortae (at the level of the right renal ostium) and bilateral renal arteries than males (mean aortic diameter M/F = 18.33/15.89 mm, mean right renal artery ostial diameter M/F = 5.06/4.59 mm, mean left ostial renal diameter M/F = 5.14/4.66 mm) (p renal ostia level in relation to the vertebrae and the majority of renal arteries originated at the L1 and L2 levels. The longitudinal distance between right and left renal artery ostia ranged from 0 to 32 mm (mean = 4,6 mm, median = 5mm). The mean anteroposterior orientation of the right renal ostia was M/F = 29.45 degrees/28.20 degrees , and M/F = -7.96 degrees/-11.14 degrees for left renal artery ostia. The mean anteroposterior orientation of the right renal pedicle was M/F = 41.37 degrees/44.34 degrees and M/F = 42.31 degrees/43.95 degrees for the left pedicle. There are some differences in normal renal arterial anatomy between genders. Normal renal arterial information is useful not only for planning and performing of endovascular and laparoscopic urologic procedures, but also for medical device development. Copyright 2009 Wiley-Liss, Inc.

Tuberculosis of the genitourinary system-Urinary tract tuberculosis: Renal tuberculosis-Part II

International Nuclear Information System (INIS)

Merchant, Suleman; Bharati, Alpa; Merchant, Neesha

2013-01-01

This article reviews the computed tomography and magnetic resonance imaging (MRI) features of renal tuberculosis (TB), including TB in transplant recipients and immunocompromised patients. Multi detector computed tomography (MDCT) forms the mainstay of cross-sectional imaging in renal TB. It can easily identify calcification, renal scars, mass lesions, and urothelial thickening. The combination of uneven caliectasis, with urothelial thickening and lack of pelvic dilatation, can also be demonstrated on MDCT. MRI is a sensitive modality for demonstration of features of renal TB, including tissue edema, asymmetric perinephric fat stranding, and thickening of Gerota's fascia, all of which may be clues to focal pyelonephritis of tuberculous origin. Diffusion-weighted MR imaging with apparent diffusion coefficient (ADC) values may help in differentiating hydronephrosis from pyonephrosis. ADC values also have the potential to serve as a sensitive non-invasive biomarker of renal fibrosis. Immunocompromised patients are at increased risk of renal TB. In transplant patients, renal TB, including tuberculous interstitial nephritis, is an important cause of graft dysfunction. Renal TB in patients with HIV more often shows greater parenchymal affection, with poorly formed granulomas and relatively less frequent findings of caseation and stenosis. Atypical mycobacterial infections are also more common in immunocompromised patients

Essure Surgical Removal and Subsequent Resolution of Chronic Pelvic Pain: A Case Report and Review of the Literature.

Science.gov (United States)

Lora Alcantara, Isamarie; Rezai, Shadi; Kirby, Catherine; Chadee, Annika; Henderson, Cassandra E; Elmadjian, Malvina

2016-01-01

Background. Hysteroscopic tubal sterilization (Essure) is a minimally invasive option for permanent contraception with high reported rates of patient satisfaction. A small percentage of these women subsequently choose to have the tubal inserts removed due to regret or perceived side effects such as late-onset pelvic pain secondary to placement of the Essure device. Case. A twenty-nine-year-old woman G4P4014 presented with a two-year complaint of chronic pelvic pain and dyspareunia after the hysteroscopic placement of an Essure device for sterilization. On reviewing the images of the HSG, it was noted that although tubal occlusion was confirmed, the left Essure coil appeared curved on itself in an elliptical fashion and did not seem to follow the expected anatomic trajectory of the fallopian tube. The patient reported resolution of chronic pelvic pain following laparoscopic removal of Essure device. Conclusion. A misplaced Essure device should be considered in the differential diagnosis of chronic pelvic pain in women who had difficult placement of the device. In addition to demonstrating tubal occlusion, careful examination of the configuration of the Essure microinserts on HSG examination provides valuable information in patients with pelvic pain after Essure placement.

Pelvic floor physical therapy in urogynecologic disorders.

Science.gov (United States)

Kotarinos, Rhonda K

2003-08-01

Physical therapists are uniquely qualified to treat pelvic floor dysfunction with conservative management techniques. Techniques associated with incontinence and support functions of the pelvic floor include bladder training and pelvic floor rehabilitation: pelvic floor exercises, biofeedback therapy, and pelvic floor electrical stimulation. Pain associated with mechanical pelvic floor dysfunction can be treated by physical therapists utilizing various manual techniques and modalities. Research documents that conservative management is effective in treating many conditions associated with pelvic floor dysfunction. Research should be conducted to determine if addressing diastasis recti and contracture of the pelvic floor musculature should be a component of the standard physical therapy protocol.

Extreme premature with persistent left superior vena cava.

Science.gov (United States)

Aboitiz-Rivera, Carlos Manuel; Blachman-Braun, Ruben; Parra-Pérez, Mariana Yazmin

2017-10-01

Persistent left superior vena cava (PLSVC) is a congenital anomaly, that results when there is an absence of the normal regression of the left common precardinal vein during embryogenesis. Usually, this anomaly remains asymptomatic, however, when the PLSVC drains into the left atrium this could lead to a right-to-left shunt. Additionally, this can result in inadvertent delivery of air or thrombus into the systemic circulation with potential neurologic, cardiac and renal complications. In this article, we present a case of an extreme premature Mexican newborn in which the diagnosis was made after placement of a percutaneous central venues catheter.

Awareness and timing of pelvic floor muscle contraction, pelvic exercises and rehabilitation of pelvic floor in lifelong premature ejaculation: 5 years experience

Directory of Open Access Journals (Sweden)

Giuseppe La Pera

2014-06-01

Full Text Available Objectives: To assess the cure rate of patients with premature ejaculation who underwent a treatment involving: 1 awareness of the pelvic floor muscles 2 learning the timing of execution and maintenance of contraction of the pelvic floor muscles during the sensation of the pre-orgasmic phase 3 pelvic floor rehabilitation (bio feed back, pelvic exercises and electrostimulation. Materials and methods: We recruited 78 patients with lifelong premature ejaculation who completed the training. The patients were informed of the role of the pelvic floor. They were taught to carry out the execution and maintenance of contraction of the pelvic floor muscles during the sensation of the pre-orgasmic phase to control the ejaculatory reflex. In order to improve the awareness, the tone and the endurance of the pelvic floor muscles, patients were treated with the rehabilitation of pelvic floor (RPF consisting mainly in biofeedback, pelvic exercises and in some cases also in electro-stimulation (ES. The training was carried out for a period of about 2-6 months with an average of 2-5 visits per cycle. Results: 54% of patients who completed the training were cured of premature ejaculation and learned over time to be able to postpone the ejaculation reflex. In a subgroup of 26 patients was also measured the IELT which on the average increased from < 2 minutes to >10 minutes. The best results occurred mainly in patients aged less than 35 where the cure rate was 65%. There were no side effects. Conclusions: In this study, approximately half of patients with premature ejaculation were cured after applying the above treatment.This therapy, necessitates a fairly long period of time (2-6 months and a great commitment on the part of the patient, nevertheless it can be a valid and effective treatment for patients with premature ejaculation. This treatment makes the patient independent in that he is not bound to specific times for taking medication. Furthermore there are no

Renal Function and Outcomes With Use of Left Ventricular Assist Device Implantation and Inotropes in End-Stage Heart Failure: A Retrospective Single Center Study.

Science.gov (United States)

Verma, Sean; Bassily, Emmanuel; Leighton, Shane; Mhaskar, Rahul; Sunjic, Igor; Martin, Angel; Rihana, Nancy; Jarmi, Tambi; Bassil, Claude

2017-07-01

Left ventricular assist device (LVAD) and inotrope therapy serve as a bridge to transplant (BTT) or as destination therapy in patients who are not heart transplant candidates. End-stage heart failure patients often have impaired renal function, and renal outcomes after LVAD therapy versus inotrope therapy have not been evaluated. In this study, 169 patients with continuous flow LVAD therapy and 20 patients with continuous intravenous inotrope therapy were analyzed. The two groups were evaluated at baseline and at 3 and 6 months after LVAD or inotrope therapy was started. The incidence of acute kidney injury (AKI), need for renal replacement therapy (RRT), BTT rate, and mortality for 6 months following LVAD or inotrope therapy were studied. Results between the groups were compared using Mann-Whitney U test and Chi-square with continuity correction or Fischer's exact at the significance level of 0.05. Mean glomerular filtration rate (GFR) was not statistically different between the two groups, with P = 0.471, 0.429, and 0.847 at baseline, 3 and 6 months, respectively. The incidence of AKI, RRT, and BTT was not statistically different. Mortality was less in the inotrope group (P < 0.001). Intravenous inotrope therapy in end-stage heart failure patients is non-inferior for mortality, incidence of AKI, need for RRT, and renal function for 6-month follow-up when compared to LVAD therapy. Further studies are needed to compare the effectiveness of inotropes versus LVAD implantation on renal function and outcomes over a longer time period.

Variations in Branching Pattern of Renal Artery in Kidney Donors Using CT Angiography.

Science.gov (United States)

Munnusamy, Kumaresan; Kasirajan, Sankaran Ponnusamy; Gurusamy, Karthikeyan; Raghunath, Gunapriya; Bolshetty, Shilpakala Leshappa; Chakrabarti, Sudakshina; Annadurai, Priyadarshini; Miyajan, Zareena Begum

2016-03-01

Each kidney is supplied by a single renal artery originating from abdominal aorta. Since there are lots of renal surgeries happening now-a-days, it becomes mandatory for the surgeons to understand the abnormality and variations in the renal vasculature. To study the variations in the branching pattern of renal artery for the presence of early division and accessory renal artery in Indian kidney donors using CT angiography. The CT angiogram images of 100 normal individuals willing for kidney donation were analysed for early divisions and occurrence of accessory renal artery. A 51% of kidney donors showed variation in the renal artery. Out of 51% variations 38 individuals had accessory renal artery and 13 individuals had early division of renal artery. The distribution of accessory renal artery was equal on both sides (13% on right and left) and 12% of individuals had accessory renal artery on both sides. Out of 13% earlier divisions, 5% was on right side, 7% was on left side and 1% was on both sides. This study concludes that 51% of kidney donors had renal artery variations. Hence, awareness of variations by evaluating the donors is a must before renal transplantation, urological procedures and angiographic interventions.

Anorectal and Pelvic Pain.

Science.gov (United States)

Bharucha, Adil E; Lee, Tae Hee

2016-10-01

Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacological, behavioral, and physical therapy. Opioids should be avoided, and surgical treatment has a limited role, primarily in refractory interstitial cystitis. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Early release of neonatal ureteral obstruction preserves renal function

DEFF Research Database (Denmark)

Shi, Yimin; Pedersen, Michael; Li, Chunling

2004-01-01

was left in place or released after 1 or 4 wk. Renal blood flow (RBF) and kidney size were measured sequentially over 24 wk using MRI. In rats in which the obstruction was left in place, RBF of the obstructed kidney was progressively reduced to 0.92 ± 0.17 vs. 1.79 ± 0.12 ml·min−1·100 g body wt−1 (P ...The incidence of congenital hydronephrosis is ∼1% and is often associated with renal insufficiency. It is unknown whether early release is essential to prevent deterioration of renal function. Rats were subjected to partial unilateral ureteral obstruction (PUUO) on postnatal day 2. The obstruction...... downregulation of Na-K-ATPase to 62 ± 7%, aquaporin-1 to 53 ± 3%, and aquaporin-3 to 53 ± 7% of sham levels. Release after 1 wk completely prevented development of hydronephrosis, reduction in RBF and glomerular filtration rate, and downregulation of renal transport proteins, whereas release after 4 wk had...

Rare calcium oxalate monohydrate calculus attached to the wall of the renal pelvis.

Science.gov (United States)

Grases, Felix; Costa-Bauza, Antonia; Prieto, Rafael M; Saus, Carlos; Servera, Antonio; García-Miralles, Reyes; Benejam, Joan

2011-04-01

Most renal calculi can be classified using well-established criteria in a manner that reflects both composition and fine structure under specific pathophysiological conditions. However, when a large patient population is considered, rare renal calculi invariably appear, some of which have never been classified; careful study is required to establish stone etiology in such cases. The patient in the present case report formed two types of calculi. One was attached on the wall of the renal pelvis near the ureter and part of the calculus was embedded inside pelvic renal tissue. The calculus developed on an ossified calcification located in the pelvis tissue. Current knowledge on the development of calcification in soft tissues suggests a pre-existing injury as an inducer of its development. A mechanism of calculus formation is proposed. The second stone was a typical jack-stone calculus. © 2011 The Japanese Urological Association.

Experimental studies of renal blood flow by digitized functional angiography

International Nuclear Information System (INIS)

Buersch, J.H.; Ochs, C.; Hahne, H.J.; Heintzen, P.H.

1985-01-01

New techniques of digital image processing have been experimentally tested for the assessment of renal blood flow. The underlying principle in functional angiography is the extraction of flow parameters. Basically, density-time variations of the contrast medium are analayzed from to each picture element of a 256x256 matrix. The real-time acquisition rate of images was 25/sec. For the calculation of angiographic flow a PDP 11/40 computer was used to interactively perform a time dependent segmentation of the renal arteries and the aorta. Subsequently, volume flow was calculated in relative units for the specific vascular segments under study. 15 control angiograms were made in 5 animals with cardiac output ranging between 0.8 to 2.2l/min. Unilateral renal blood flow was calculated as 24+-3.4% of pre-renal aortic flow without systematic side differences. Reproducibility from repeated flow measurements showed an SD of +-1.8% of the individual pre-renal aortic flow. Renal flow was also measured in 3 animals with an experimentally created 50% flow reduction of the left kidney. Angiographic flow in the left renal artery dropped to 12+-2% of pre-renal flow. The present experimental data suggest that digital angiography has sufficient diagnostic capabilities for the detection of abnormal renal blood flow. The technique may serve as a useful diagnostic adjunct to conventional angiography and has the potential of assisting in the evaluation of renal vascular hypertension. (orig.) [de

FDG-PET of patients with suspected renal failure. Standardized uptake values in normal tissues

International Nuclear Information System (INIS)

Minamimoto, Ryogo; Takahashi, Nobukazu; Inoue, Tomio

2007-01-01

This study aims to clarify the effect of renal function on 2-[ 18 F] fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) imaging and determine the clinical significance of renal function in this setting. We compared FDG distribution between normal volunteers and patients with suspected renal failure. Twenty healthy volunteers and 20 patients with suspected renal failure who underwent FDG-PET between November 2002 and May 2005 were selected for this study. We define ''patients with suspected renal failure'' as having a blood serum creatinine level in excess of 1.1 mg/dl. The serum creatinine level was examined once in 2 weeks of the FDG-PET study. Regions of interest were placed over 15 regions for semi-quantitative analysis: the white matter, cortex, both upper lung fields, both middle lung fields, both lower lung fields, mediastinum, myocardium of the left ventricle, the left atrium as a cardiac blood pool, central region of the right lobe of the liver, left kidney, and both femoris muscles. The mean standardized uptake values (SUVs) of brain cortex and white matter were higher in healthy volunteers than in renal patients. The mean SUVs of the mediastinum at the level of the aortic arch and left atrium as a cardiac blood pool were lower in healthy volunteers than in patients with suspected renal failure. These regions differed between healthy volunteers and patients with suspected renal failure (P<0.05). We found decreasing brain accumulation and increasing blood pool accumulation of FDG in patients with high plasma creatinine. Although the difference is small, this phenomenon will not have a huge effect on the assessment of FDG-PET imaging in patients with suspected renal failure. (author)

A comparison between stabilization exercises and pelvic floor muscle training in women with pelvic organ prolapse

Directory of Open Access Journals (Sweden)

Nuriye Özengin

2015-03-01

Full Text Available Objective: This study aimed to compare the effectiveness of stabilization exercises and pelvic floor muscle training in women with stage 1 and 2 pelvic organ prolapse. Materials and Methods: In a total 38 women with pelvic organ prolapse whose average age was 45.60 years, pelvic floor muscles were evaluated with electromyography, and prolapse with pelvic organ prolapse quantification system, and the quality of life with prolapse quality of life questionnaire. Afterwards, the subjects were divided into two groups; stabilization exercise group (n=19 and pelvic floor muscle training group (n=19. Stabilization exercise group were given training for 8 weeks, 3 times a week. Pelvic floor muscle training group were given eight-week home exercises. Each group was assessed before training and after eight weeks. Results: An increase was found in the pelvic muscle activation response in the 2 groups (p≤0.05. There was no difference in EMG activity values between the groups (p>0.05. A difference was found in the values Aa, Ba and C in subjects of each group (p≤0.05, and the TVL, Ap, Bp and D values of subjects in pelvic floor muscle training group (p≤0.05 in the before and after pelvic organ prolapse quantification system assessment, however, no difference was found between the groups (p≤0.05. A positive difference was found in the effect of prolapse sub parameter in each of the two groups, and in general health perception sub parameter in subjects of stabilization exercise group (p<0.05 in the prolapse quality of life questionnaire. Conclusions: It was concluded that both training programs increased the pelvic floor muscle strength, provided a decline in prolapse stages. Stabilization exercise has increased general health perception unlike home training, thus, these exercises can be added to the treatment of women with prolapse.

Distal renal tubular acidosis as a cause of osteomalacia in a patient with primary Sjögren's syndrome

Directory of Open Access Journals (Sweden)

Jovelić Aleksandra

2005-01-01

Full Text Available Background. One half of the patients with primary Sjögren’s syndrome has extraglandular manifestations, including renal involvement. The most frequent renal lesion is tubulo-interstitial nephritis, which manifests clinically as distal tubular acidosis and may result in the development of osteomalacia. Case report. In a 29 - year-old female patient, with bilateral nephrolithiasis, the diagnosis of primary Sjögren’s syndrome, tubulo-interstitial nephritis, distal renal tubular acidosis, and hypokalemia were established. She was treated for hypokalemia. Two years later she developed bone pains and muscle weakness, she wasn’t able to walk, her proximal muscles and pelvic bones were painful, with radiological signs of pelvic bones osteopenia and pubic bones fractures. The diagnosis of osteomalacia was established and the treatment started with Schol’s solution, vitamin D and calcium. In the following two months, acidosis was corrected, and the patient started walking. Conclusion. In our patient with primary Sjögren’s syndrome and interstitial nephritis, osteomalacia was a result of the long time decompensate acidosis, so the correction of acidosis, and the supplementation of vitamin D and calcium were the integral part of the therapy.

Frequency and factors effecting non clearance of lower pole renal stones

International Nuclear Information System (INIS)

Ullah, A.; Zubair, M.; Khan, N.; Malik, A.

2015-01-01

Renal stone disease is a major health hazard in Pakistan and extra-corporeal shockwave lithotripsy is one of comprehensive method used to treat these stones. The aim of this study is to determine the frequency of factors affecting the non-clearance of stone fragments of lower pole renal stone after extra corporeal shockwave lithotripsy. The study was done with the objective to determine the frequency the spatial anatomical factors which can influence the non-clearance of lower pole stone fragments after ESWL. Methods: One and nineteen (119) patients with lower pole renal stone less than 10 mm were subjected to maximum 3 sessions of extracorporeal shock wave lithotripsy. KUB radiographs, ultrasonography and intravenous urography were used as investigative tools for lower pole renal calyceal anatomy. X ray KUB and ultrasound were done after a week for clearance. Data was analysed with the help of SPSS version 10.0 and presented in the forms of tables and graphs. Results: There were 77 (64.71%) males and 42 (35.29%) females. Infundibulo-pelvic angle (IPA)>40 degree was present in 93 (78.15%), Infundibular length (IL) <22 mm in 107 (89.92%) and Infundibular width (IW) >4 mm was present in 100 (84.03%) patients. The frequency of stone non clearance was noted in 31 (26.05%). Infundibulo-pelvic angle (IPA)>40 degree (p=0.000), Infundibular length (IL)<22 mm (p=0.001) and Infundibular width (IW)>4 mm (p=0.046) were significant variables affecting stone clearance. Conclusion: The frequency of non-clearance of lower calyx of kidney stone is 26.05%. The clearance of fragments of the lower calyx kidney stones is affected by three spatial anatomical factors, i.e., Infundibulopelvic angle, Infundibular width and infundibular length. (author)

Giant kidney worms in a patient with renal cell carcinoma

OpenAIRE

Kuehn, Jemima; Lombardo, Lindsay; Janda, William M; Hollowell, Courtney M P

2016-01-01

Dioctophyma renale (D. renale), or giant kidney worms, are the largest nematodes that infect mammals. Approximately 20 cases of human infection have been reported. We present a case of a 71-year-old man with a recent history of unintentional weight loss and painless haematuria, passing elongated erythematous tissue via his urethra. CT revealed a left renal mass with pulmonary nodules and hepatic lesions. On microscopy, the erythematous tissue passed was identified as D. renale. On subsequent ...

Percutaneous nephrolithotomy of bilateral staghorn renal calculi in pediatric patients: 12 years experience in a tertiary care centre.

Science.gov (United States)

Purkait, Bimalesh; Kumar, Manoj; Sokhal, Ashok Kumar; Bansal, Ankur; Sankhwar, Satya Narayan; Gupta, Ashok Kumar

2017-08-01

To assess the outcomes of percutaneous nephrolithotomy (PCNL) in bilateral staghorn calculi in pediatric patients, we have performed a retrospective analysis. Staghorn calculus is defined as stone that fills a greater part of the pelvic-caliceal system. Still, in developing countries, patients may present with staghorn calculus. PCNL is the preferred treatment modality for staghorn calculus both in adult and children. Our study included fifty-one pediatric patients (calculus in children needs expertise. PCNL in B/L staghorn renal calculus in children is safe and effective. B/L staghorn renal calculi with compromised renal function have higher chance of complications including bleeding.

Pelvic Insufficiency Fracture After Pelvic Radiotherapy for Cervical Cancer: Analysis of Risk Factors

International Nuclear Information System (INIS)

Oh, Dongryul; Huh, Seung Jae; Nam, Heerim; Park, Won; Han, Youngyih; Lim, Do Hoon; Ahn, Yong Chan; Lee, Jeong Won; Kim, Byoung Gie; Bae, Duk Soo; Lee, Je Ho

2008-01-01

Purpose: To investigate the incidence, clinical characteristics, and risk factors of pelvic insufficiency fracture (PIF) after pelvic radiotherapy (RT) in cervical cancer. Methods and Materials: Medical records and imaging studies, including bone scintigraphy, CT, and MRI of 557 patients with cervical cancer who received whole-pelvic RT between January 1998 and August 2005 were reviewed. Results: Eighty-three patients were diagnosed as having PIF after pelvic RT. The 5-year cumulative incidence of PIF was 19.7%. The most commonly involved site was the sacroiliac joint. Pelvic pain developed in 48 patients (57.8%) at diagnosis. Eleven patients (13.3%) needed admission or narcotics because of severe pain, and others had good relief of symptoms with conservative management. In univariate analysis, age ≥55 years (p < 0.001), anteroposterior/posteroanterior parallel opposing technique (p = 0.001), curative treatment (p < 0.001), and radiation dose ≥50.4 Gy (p = 0.005) were the predisposing factors for development of PIF. Concurrent chemotherapy (p = 0.78) was not significant. Multivariate analysis showed that age ≥55 years (p < 0.001), body weight <55 kg (p = 0.02), curative treatment (p = 0.03), and radiation dose ≥50.4 Gy (p = 0.04) were significant predisposing factors for development of PIF. Conclusion: The development of PIF is not rare after pelvic RT. The use of multibeam arrangements to reduce the volume and dose of irradiated pelvic bone can be helpful to minimize the risk of fracture, especially in elderly women with low body weight

Post Pelvic Radiotherapy Bony Changes

Energy Technology Data Exchange (ETDEWEB)

Huh, Seung Jae [Samsung Medical Center, Seoul (Korea, Republic of)

2009-03-15

There has been recent interest in radiation-induced bone injury in clinical conditions, especially for pelvic insufficiency fracture (PIF). A PIF is caused by the effect of normal or physiological stress on bone with demineralization and decreased elastic resistance. Pelvic radiotherapy (RT) can also contribute to the development of a PIF. A PIF has been regarded as a rare complication with the use of megavoltage equipment. However, recent studies have reported the incidence of PIFs as 8.2{approx}20% after pelvic RT in gynecological patients, an incidence that was higher than previously believed. The importance of understanding a PIF lies in the potential for misdiagnosis as a bony metastasis. If patients complain of pelvic pain after whole-pelvis radiation therapy, the presence of a PIF must be considered in the differential diagnosis. The use of multibeam arrangements and conformal RT to reduce the volume and dose of irradiated pelvic bone can be helpful to minimize the risk of fracture. In addition to a PIF, osteonecrosis and avascular necrosis of the femoral head can develop after radiation therapy. Osteoradionecrosis of the pelvic bone is a clinical diagnostic challenge that must be differentiated from an osseous metastasis. A post-radiation bone sarcoma can result as a long-term sequela of pelvic irradiation for uterine cervical cancer.

Analysis of intimal extent and predictors of renal atrophy in patients with aortic dissection

Energy Technology Data Exchange (ETDEWEB)

Chan, Wen-Hui; Huang, Yu-Chieh; Wan, Yung-Liang [Dept. of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Coll. of Medicine, Chang Gung Univ., Taoyuan, Taiwan (China)], e-mail: ylw0518@adm.cgmh.org.tw; Weng, Hsu-Huei [Dept. of Diagnostic Radiology, Chang Gung Memorial Hospital at Chia-Yi, Coll. of Medicine, Chang Gung Univ., Taoyuan, Taiwan (China); Ko, Sheung-Fat [Dept. of Diagnostic Radiology, Chang Gung Memorial Hospital at Kaohsiung, Coll. of Medicine, Chang Gung Univ., Taoyuan, Taiwan (China); Chu, Jaw-Ji; Lin, Pyng-Jing [Dept. of Cardiac Surgery, Chang Gung Memorial Hospital at Linkou, Coll. of Medicine, Chang Gung Univ., Taoyuan, Taiwan (China)

2012-09-15

Background: The intimal flap of aortic dissection may extend to the abdominal branches and probably lead to malperfusion syndrome. Renal malperfusion and renal atrophy are significantly related to patient outcomes. Purpose: To study the extent of the intimal flap and predisposing factors for renal atrophy in patients with aortic dissection. Material and Methods: From January 2001 to June 2008, 176 (137 men, aged 21-86 years, mean 51.9 years) of 225 subjects with aortic dissection and computed tomography (CT) met the inclusion criteria for this study. Of these 176 patients, 35 (19.9%) developed unilateral renal atrophy. A review of the CT was conducted to classify aortic branch vessel perfusion into three types: type 1, in which the branch vessels are perfused exclusively from the true lumen; type 2, in which the branches are perfused from both the true and false lumens; and type 3, in which the branches are perfused exclusively from the false lumen. Variables including age, gender, type of aortic dissection, type of perfusion of the abdominal branches, and the presence of thrombi in the false lumen were analyzed to determine whether these factors were related to the left or right side and global or focal renal atrophy. Results: Of 880 abdominal branches in 176 patients, 622 (70.7%) were classed as perfusion type 1, 50 (5.7%) as type 2, and 208 (23.6%) as type 3. Type 3 perfusion was most commonly observed in the left renal artery, at a frequency of 31.7% (66/208). Partial thrombosis in the false lumen above the level of the renal arteries was seen in 68.8% of patients; such thrombi and type 3 perfusion of the renal artery were significantly related to renal atrophy. The laterality (left or right) and extent (global or focal) of renal atrophy were not related to age, gender, type of aortic dissection, or perfusion type. Conclusion: Type 3 perfusion is most frequent in the left renal artery, and such perfusion and partial thrombi in the false lumen above the renal

Analysis of intimal extent and predictors of renal atrophy in patients with aortic dissection

International Nuclear Information System (INIS)

Chan, Wen-Hui; Huang, Yu-Chieh; Wan, Yung-Liang; Weng, Hsu-Huei; Ko, Sheung-Fat; Chu, Jaw-Ji; Lin, Pyng-Jing

2012-01-01

Background: The intimal flap of aortic dissection may extend to the abdominal branches and probably lead to malperfusion syndrome. Renal malperfusion and renal atrophy are significantly related to patient outcomes. Purpose: To study the extent of the intimal flap and predisposing factors for renal atrophy in patients with aortic dissection. Material and Methods: From January 2001 to June 2008, 176 (137 men, aged 21-86 years, mean 51.9 years) of 225 subjects with aortic dissection and computed tomography (CT) met the inclusion criteria for this study. Of these 176 patients, 35 (19.9%) developed unilateral renal atrophy. A review of the CT was conducted to classify aortic branch vessel perfusion into three types: type 1, in which the branch vessels are perfused exclusively from the true lumen; type 2, in which the branches are perfused from both the true and false lumens; and type 3, in which the branches are perfused exclusively from the false lumen. Variables including age, gender, type of aortic dissection, type of perfusion of the abdominal branches, and the presence of thrombi in the false lumen were analyzed to determine whether these factors were related to the left or right side and global or focal renal atrophy. Results: Of 880 abdominal branches in 176 patients, 622 (70.7%) were classed as perfusion type 1, 50 (5.7%) as type 2, and 208 (23.6%) as type 3. Type 3 perfusion was most commonly observed in the left renal artery, at a frequency of 31.7% (66/208). Partial thrombosis in the false lumen above the level of the renal arteries was seen in 68.8% of patients; such thrombi and type 3 perfusion of the renal artery were significantly related to renal atrophy. The laterality (left or right) and extent (global or focal) of renal atrophy were not related to age, gender, type of aortic dissection, or perfusion type. Conclusion: Type 3 perfusion is most frequent in the left renal artery, and such perfusion and partial thrombi in the false lumen above the renal

Medical infrared imaging and orthostatic analysis to determine lameness in the pelvic limbs of dogs

Directory of Open Access Journals (Sweden)

Erika Fernanda V. Garcia

2017-12-01

Full Text Available Subtle lameness makes it difficult to ascertain which is the affected limb. A study was conducted to investigate a change in the thermal pattern and temperature of the thermal image of the paw print in a lame pelvic limb compared to a non-lame pelvic limb of dogs confirmed by orthostatic analysis. Fourteen client owned dogs with a unilateral pelvic limb lameness and 14 healthy employee dogs were examined and the pelvic limbs radiographed. Thermal images of the paw print were taken after each dog was kept in a static position on a foam mat for 30 seconds. Average temperatures and thermographic patterns were analyzed. Analysis was performed in a static position. The asymmetry index for each stance variable and optimal cutoff point for the peak vertical force and thermal image temperatures were calculated. Image pattern analysis revealed 88% success in differentiating the lame group, and 100% in identifying the same thermal pattern in the healthy group. The mean of the peak vertical force revealed a 10.0% difference between the left and right pelvic limb in healthy dogs and a 72.4% between the lame and non-lame limb in the lame dog group. Asymmetry index analysis revealed 5% in the healthy group and 36.2% in the lame group. The optimal cutoff point for the peak vertical force to determine lameness was 41.77% (AUC = 0.93 and for MII 0.943% (AUC = 0.72. The results of this study highlight the change in the thermal pattern of the paw print in the lame pelvic limb compared to a non-lame pelvic limb in the lame group and the healthy group. Medical infrared imaging of the paw prints can be utilized to screen for the lame limb in dogs.

Retrospective morphometric study of the suitability of renal arteries for renal denervation according to the Symplicity HTN2 trial criteria

Science.gov (United States)

Schönherr, Elisabeth; Rehwald, Rafael; Nasseri, Parinaz; Luger, Anna K; Grams, Astrid E; Kerschbaum, Julia; Rehder, Peter; Petersen, Johannes; Glodny, Bernhard

2016-01-01

Objective The aim of this study was to describe the renal arteries of humans in vivo, as precisely as possible, and to formulate an expected value for the exclusion of renal denervation due to the anatomical situation based on the criteria of the Symplicity HTN trials. Design and setting In a retrospective cohort study, the renal arteries of 126 patients (57 women, 69 men, mean age 60±17.2 years (CI 57.7 to 63.6)) were segmented semiautomatically from high-contrast CT angiographies. Results Among the 300 renal arteries, there were three arteries with fibromuscular dysplasia and one with ostial renal artery stenosis. The first left renal artery was shorter than the right (34±11.4 mm (CI 32 to 36) vs 45.9±15 mm (CI 43.2 to 48.6); p0.05). The first left renal arteries were 1.1±0.4 mm (CI 0.9 to 1.3), and the first right renal arteries were 0.3±0.6 mm (CI 0.1 to 0.5) thinner in women than in men (p4 mm. Some 46% of the patients, or 58.7% when variants and diseases were taken into consideration, were theoretically not suitable for denervation. Conclusions Based on these precise measurements, the anatomical situation as a reason for ruling out denervation appears to be significantly more common than previously suspected. Since this can be the cause of the failure of treatment in some cases, further development of catheters or direct percutaneous approaches may improve success rates. PMID:26729385

A fascia lata free flap in pelvic exenteration for Fournier gangrene due to advanced rectal cancer: a case report.

Science.gov (United States)

Sawayama, Hiroshi; Miyanari, Nobutomo; Sugihara, Hidetaka; Iwagami, Shiro; Mizumoto, Takao; Kubota, Tatsuo; Haga, Yoshio; Baba, Hideo

2017-12-01

Fournier gangrene due to advanced rectal cancer is a rapidly progressive gangrene of the perineum and buttocks. Emergency surgical debridement of necrotic tissue is crucial, and secondary surgery to resect tumors is necessary for wound healing. However, pelvic exenteration damages the pelvic floor, increasing the likelihood of herniation of internal organs into the infectious wound. The management of pelvic exenteration for rectal cancer with Fournier gangrene has not yet been established. We herein describe the use of a fascia lata free flap in pelvic exenteration for rectal cancer with Fournier gangrene. A 66-year-old male who had undergone colostomy for large bowel obstruction due to advanced rectal cancer and continued chemotherapy was referred to our hospital for Fournier gangrene resulting from chemotherapy. Emergency surgical debridement was performed, and the infectious wound around the rectal cancer was treated with intravenous antibiotic agents postoperatively. However, the tumor was exposed by the wound, and exudate persisted. Pelvic exenteration was performed due to tumor infiltration into the bladder and prostate. Tumor resection resulted in a defect in the pelvic floor. A fascia lata free flap (15 × 9 cm) obtained from the left thigh was fixed to the edge of the peritoneum and ileal conduit to close the defect in the pelvic floor and prevent small bowel herniation into the resected space. There was no intraabdominal inflammation or bowel obstruction postoperatively, and outpatient chemotherapy was continued. Surgical repair with a fascia lata free flap to close the defect in the pelvic floor led to a good clinical outcome for pelvic exenteration in a patient with Fournier gangrene due to advanced rectal cancer.

Gradient field echo imaging and Gd-DTPA for the assessment of renal function in humans

International Nuclear Information System (INIS)

Von Schulthess, G.K.; Kikinis, R.; Durr, R.; Bino, M.; Jager, P.; Kubler, O.

1986-01-01

To evaluate renal parenchymal function, 1.5 T gradient field echo imaging using a sequence of repetitive 10-second scans was performed in apneic patients after injection of Gd-DTPA (0.1 mmol/kg body weight). During the 10-second pauses the patients were allowed to breathe. Angled coronal images (TR=40 msec, TE =20 msec, flip angle = 40 0 ) were obtained in four volunteers and four patients with hydronephrosis. Image quality was excellent, suggesting unprecedented spatial resolution for renal function studies. Initially, cortical perfusion was observed. Then the papilae became isointense; after 70 seconds they became hypointense; and finally the renal pelvic signal dropped. No papillary signal drop was seen in hydronephrosis, as confirmed by region-of-interest analysis. These results strongly suggest that in MR renal ''function'' studies with Gd-DTPA, T1 and T2 paramagnetic effects are operative

Mature Cystic Renal Teratoma

International Nuclear Information System (INIS)

Yavuz, Alpaslan; Ceken, Kagan; Alimoglu, Emel; Akkaya, Bahar

2014-01-01

Teratomas are rare germline tumors that originate from one or more embryonic germ cell layers. Teratoma of the kidney is extremely rare, and less than 30 cases of primary intrarenal teratomas have been published to date. We report the main radiologic features of an unusual case of mature cystic teratoma arising from the left kidney in a two-year-old boy. A left-sided abdominal mass was detected on physical examination and B-Mod Ultrasound (US) examination revealed a heterogeneous mass with central cystic component. Computed tomography (CT) demonstrated a lobulated, heterogeneous, hypodense mass extending craniocaudally from the splenic hilum to the level of the left iliac fossa. Nephrectomy was performed and a large, fatty mass arising from the left kidney was excised. The final pathologic diagnosis was confirmed as cystic renal teratoma

Effect of complete hilar versus only renal artery clamping on renal histomorphology following ischemia/reperfusion injury in an experimental model.

Science.gov (United States)

Umul, M; Cal, A C; Turna, B; Oktem, G; Aydın, H H

2016-01-01

To evaluate the effect of temporary complete hilar versus only renal artery clamping with different duration of warm ischemia on renal functions, and possibly identify a "safe" clamping type and duration of renal ischemia. Fifty male rabbits have been incorporated to study. Rabbits were subjected to ischemia/reperfusion injury by temporary vascular clamping. Reagents were randomized to 3 experimental groups (only renal artery clamping, complete hilar clamping, sham surgery) and sub-groups were determined according to different clamping times (30 and 60 minutes). Median laparotomy and left renal hilus dissection were performed to sham group. Only artery or complete hilar clamping was performed for 30 or 60 minutes by microvascular bulldog clamps to other reagents. Rabbits were sacrificed 10 days after primary surgery and left nephrectomy performed. Nephrectomy materials were evaluated for the level of nitric-oxide synthase (NOS) immunoreactivity, malondialdehyde (MDA) level and superoxide dismutase (SOD) activity and an electron microscopic examination was performed. NOS immunoreactivity was correlated with the temporary clamping time. We also observed that complete hilar vascular clamping entails an increase on NOS immunoreactivity. MDA levels were similar for all experimental surgery groups (p = 0.42). The SOD activity was decreased among all subgroups compared with sham surgery. But the significant decrease occurred in 30 minutes only artery and 30 minutes complete hilar clamping groups in proportion to sham surgery (p = 0.026 and p = 0.019, respectively). This current study suggested that only renal artery clamping under 30 minutes is more appropriate during renal surgical procedures requiring temporary vascular clamping.

Complex pelvic ring injuries associated with floating knee in a poly-trauma patient: A case report.

Science.gov (United States)

Zhou, Yuebin; Guo, Honggang; Cai, Zhiwei; Zhang, Yuan

2017-12-01

Complex pelvic ring fracture associated with floating knee is comparatively rare which usually results from high-energy trauma including vehicle-related accidence, falls from height, and earthquake-related injury. To our knowledge, few literatures have documented such injuries in the individual patient. Management of both injuries present challenges for surgical management and postoperative care. The purpose of this study is to prove the feasibility and benefits of damage control orthopedics (DCO). Our case involved a 45-year-old lady who was hit by a dilapidated building. The patient was anxious, pale and hemodynamically stable at the initial examination. The pelvis was unstable and there were obvious deformities in the left lower extremities. Significant degloved injuries in the left leg were noted. Her radiographs and physical examination verified the above signs. Unstable pelvic fractures, multiple fractures of bilateral lower limbs with floating knee injury, multiple pelvic and rib fractures and multiple degloving injuries and soft tissue contusion formed the characteristics of the multiple-injury. The algorithm of DCO was determined as the treatment. Early simplified procedures such as wound debridement, pelvis fixation, closed reduction and EF of the right shoulder joint, and chest wall fixation were conducted as soon as possible. After a period of time, internal fixations were applied to the fracture sites. The subsequent functional exercise was also conducted in accordance with this algorithm. This patient got recovery after the treatments which were guided by the criterion of DCO. The restoration of limb functional and the quality of life greatly improved. The DCO plays a decisive role in the first aid and follow-up treatment of this patient. The guidelines of management of complex pelvic ring injuries and floating knee should be established by authorities.

Essure Surgical Removal and Subsequent Resolution of Chronic Pelvic Pain: A Case Report and Review of the Literature

Directory of Open Access Journals (Sweden)

Isamarie Lora Alcantara

2016-01-01

Full Text Available Background. Hysteroscopic tubal sterilization (Essure is a minimally invasive option for permanent contraception with high reported rates of patient satisfaction. A small percentage of these women subsequently choose to have the tubal inserts removed due to regret or perceived side effects such as late-onset pelvic pain secondary to placement of the Essure device. Case. A twenty-nine-year-old woman G4P4014 presented with a two-year complaint of chronic pelvic pain and dyspareunia after the hysteroscopic placement of an Essure device for sterilization. On reviewing the images of the HSG, it was noted that although tubal occlusion was confirmed, the left Essure coil appeared curved on itself in an elliptical fashion and did not seem to follow the expected anatomic trajectory of the fallopian tube. The patient reported resolution of chronic pelvic pain following laparoscopic removal of Essure device. Conclusion. A misplaced Essure device should be considered in the differential diagnosis of chronic pelvic pain in women who had difficult placement of the device. In addition to demonstrating tubal occlusion, careful examination of the configuration of the Essure microinserts on HSG examination provides valuable information in patients with pelvic pain after Essure placement.

Carcinoma of the renal pelvis and ureter

Directory of Open Access Journals (Sweden)

Fernando Korkes

2006-12-01

Full Text Available OBJECTIVE: To assess the occurrence of upper urinary tract urothelial tumors (UUTT in Brazil. MATERIALS AND METHODS: We performed a clinical and histopathologic study of 33 patients who were diagnosed with a malignant neoplasm in the renal pelvis or ureter in the period of 1994 to 2004, in a single institution. RESULTS: Among the patients with upper urinary tract carcinoma, 70% were males and 30% females, with mean age of 65 ± 16 years (ranging from 31 to 91 years. Nineteen patients presented renal pelvis tumor (58%, 9 ureteral tumor (27% and 5 synchronic pelvic and ureteral tumors (15%. Renal pelvis tumors represented 2.8% of all the urothelial neoplasms, and 11.4% of all renal neoplasms treated in the same period. Ureteral tumors represented 1.6% of all the urothelial malignancies surgically managed in these 11 years. Tobacco smoking was the most common risk factor, and analgesic abuse was not reported by those patients. Most carcinomas were high-grade and muscle-invasive. Mean time to diagnosis was 7 months, being hematuria the most common symptom. CONCLUSIONS: A high association was also found between UUTT and bladder urothelial carcinoma. UUTT were mostly seen in men in their seventies and related to a high overall and cancer-related mortality rate. The overall disease-specific survival was 40%, much lower than found in most of the reported series.

Right-Sided Intrarenal Splenosis Mimicking a Renal Carcinoma

Directory of Open Access Journals (Sweden)

Jay B. Page

2006-01-01

Full Text Available We describe a patient who underwent nephrectomy for an enhancing right renal mass that was subsequently pathologically confirmed as right renal splenosis. Since renal splenosis is quite rare and has previously been reported only in the left kidney, we did not consider splenosis in our differential diagnosis during the evaluation of the renal mass. Magnetic resonance imaging, as well as radionucleotide scan using 99mTc-labelled red blood cells, has been utilized for identifying ectopic splenic tissue. An elevated index of suspicion must be present in patients with a history of splenectomy or traumatic splenic rupture to avoid undue nephrectomy.

Patients with Pelvic Floor Muscle Spasm Have a Superior Response to Pelvic Floor Physical Therapy at Specialized Centers.

Science.gov (United States)

Polackwich, Alan Scott; Li, Jianbo; Shoskes, Daniel A

2015-10-01

Chronic prostatitis/chronic pelvic pain syndrome is a common condition that often requires multimodal therapy. Patients with chronic pelvic pain syndrome have a high incidence of pelvic floor spasm, which can be treated with pelvic floor physical therapy. However, this is a specialized skill. We compared outcomes of pelvic floor physical therapy as part of multimodal therapy in patients with chronic pelvic pain syndrome between those treated at our institution and elsewhere. We identified patients from our chronic pelvic pain syndrome registry with pelvic floor spasm who were seen between 2010 and 2014 for more than 1 visit. Patient phenotype was assessed with the UPOINT system and symptom severity was determined by the National Institutes of Health CPSI. A 6-point decrease in CPSI was used to define patient improvement. A total of 82 patients fit the study criteria. Mean age was 41.6 years (range 19 to 75) and median symptom duration was 24 months (range 3 to 240). Mean CPSI was 26.8 (range 10 to 41), the median number of positive UPOINT domains was 3 (range 1 to 6) and 27 patients (32.9%) were treated locally. At followup 9 patients had refused pelvic floor physical therapy, and 24 and 48 had undergone pelvic floor physical therapy elsewhere and at CCF, respectively. The mean change in CPSI was 1.11 ± 4.1 in patients who refused, -3.46 ± 6.7 in those treated elsewhere and -11.3 ± 7.0 in those treated at CCF (p physical therapy at CCF (OR 4.23, p = 0.002) and symptom duration (OR 0.52, p = 0.03) predicted improvement. Pelvic floor physical therapy can be effective for chronic pelvic pain syndrome in patients with pelvic floor spasm. However, the outcome depends on specialty training and experience of therapists. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Multidetector row computed tomography evaluation of the micropig kidney as a potential renal donor.

Science.gov (United States)

Yoon, Woong; Lee, Min Young; Ryu, Jung Min; Moon, Yong Ju; Lee, Sang Hun; Park, Jae Hong; Yun, Seung Pil; Jang, Min Woo; Park, Sung Su; Han, Ho Jae

2010-03-01

Multidetector row computed tomography (MDCT) provides anatomical information about the kidney and other internal organs. Presently, the suitability of 64-channel MDCT to assess the kidney of healthy micropigs was evaluated. Morphological evaluations of the kidney and the major renal vessels of six healthy micropigs were carried out using MDCT, recording kidney volume and the diameter and length of renal arteries and veins. The mean diameters and lengths of the renal artery were 0.44 +/- 0.05 and 4.51 +/- 0.55 cm on the right side and 0.46 +/- 0.06 and 3.36 +/- 0.27 cm on the left side, respectively. The mean diameters and lengths of the renal vein were 1.44 +/- 0.52 and 4.22 +/- 1.29 cm on the right side and 1.38 +/- 0.17 and 5.15 +/- 0.87 cm on the left side, respectively. The mean volume of the right kidney was 79.3 +/- 14.5 mL and of the left kidney was 78.0 +/- 13.9 mL. The data presented in this study suggest that the MDCT offers a noninvasive, rapid, and accurate method for the evaluation of the renal anatomy in living kidney donors. It also provides sufficient information about extra-renal anatomy important for donor surgery and determination of organ suitability.

Spontaneous rupture of renal pelvis secondary to ureteral obstruction by urothelial tumor

Energy Technology Data Exchange (ETDEWEB)

Fernandes, Daniel Alvarenga; Palma, Ana Laura Gatti; Kido, Ricardo Yoshio Zanetti; Barros, Ricardo Hoelz de Oliveira; Martins, Daniel Lahan; Penachim, Thiago Jose; Caserta, Nelson Marcio Gomes, E-mail: daniel_alvafer@yahoo.com.br, E-mail: daniel_alvafer@icloud.com [Universidade Estadual de Campinas (UNICAMP), SP (Brazil). Fac. de Medicina. Dept. de Radiologia

2014-09-15

Partial spontaneous rupture of the upper urinary tract is rare and usually associated with nephrolithiasis. Other reported causes, apart from instrumentation and trauma, involve obstructive ureteral tumor in the pelvic cavity, retroperitoneal fibrosis, fluid overload, and pregnancy. We report a case of spontaneous rupture of renal pelvis secondary to ureteral obstruction caused by urothelial tumor, clinically suspected and evaluated by CT scans and MRIs, discussing the relevant findings for diagnosis.(author)

Multispecialty retrospective review of the clinical utility of pelvic magnetic resonance imaging in the setting of pelvic pain.

Science.gov (United States)

Moore, John R; Pathak, Ram A; Snowden, Caroline; Bolan, Candice W; Young, Paul R; Broderick, Gregory A

2017-12-01

Pelvic pain is a common complaint, and management of it is often difficult. We sought to evaluate the utility of magnetic resonance imaging (MRI) in the diagnosis of male pelvic pain. Though MRIs are commonly ordered to evaluate pelvic pain, there are very few studies obtaining the efficacy of pelvic MRI in determining a definitive diagnosis. The primary aim of our study was to evaluate the clinical utility of pelvic MRI for a diagnosis code that included pain. After receiving institutional review board approval, a retrospective study was performed of all pelvic MRIs completed at our institution from January 2, 2010 to December 31, 2014. These were further delineated into ordering providers by specialty and urology-specific International Classification of Diseases, Ninth Revision (ICD-9) code diagnoses (male pelvic pain, prostatitis, groin pain, scrotal pain, testicular pain, and penile pain). Clinical utility was defined as positive if MRI findings resulted in a change in management. Subanalysis was performed on patients with an ICD-9 co-diagnosis of previous oncologic concern. A total of 2,643 pelvic MRIs were ordered at our institution over a 5-year period. Of these, 597 pelvic MRIs (23%) were ordered for a diagnosis code that included pain (hip pain, rectal pain, joint pain, penile pain, scrotal pain, male pelvic pain and orchitis). Total utility for MRIs to find anatomic abnormalities potentially responsible for the present pain was 34% (205/597). When ordered by urologic providers, utility was 23%. Oncologists represented the highest positivity rate at 57%. Chronic pelvic pain is a multispecialty complaint that is difficult to treat. We were surprised to find the large number of both specialists and generalists invested in the management of pelvic pain. The increasing availability of MRI technology makes it a likely candidate to test for a clinically significant anatomic reason for pain. Though MRI is a test with minimal adverse effect and no increased risk

Spleen injury following left extracorporeal shockwave lithotripsy (ESWL).

Science.gov (United States)

Marinkovic, Serge P; Marinkovic, Christina M; Xie, Donghua

2015-02-18

A splenic rupture associated with extracorporeal shockwave lithotripsy (ESWL) is exceedingly rare. We report a case of stage 3 splenic laceration, hemoperitoneum and subsequent splenic rupture following an ESWL for a left mid polar renal calculus. During the ESWL, although the patient's pain was controlled the gentleman was very nervous and had to be repositioned eight individual times. Approximately 6 hours after the ESWL, the patient phoned the urologist complaining of severe left flank pain unlike any previous episode of renal colic. A computerized tomography (CT) scan demonstrated a stage 3 splenic injury with hemoperitoneum. The patient decompensated and an emergent splenectomy was then performed and the patient experienced an uneventful recovery. Splenic injury likely results from unintentional movement during the sound wave administration for the stone fragmentation procedure. Utilizing noise cancelling headphones during ESWL may preclude the potential pitfalls of patient nervousness.

Pelvic belt effects on sacroiliac joint ligaments: a computational approach to understand therapeutic effects of pelvic belts.

Science.gov (United States)

Sichting, Freddy; Rossol, Jerome; Soisson, Odette; Klima, Stefan; Milani, Thomas; Hammer, Niels

2014-01-01

The sacroiliac joint is a widely described source of low back pain. Therapeutic approaches to relieve pain include the application of pelvic belts. However, the effects of pelvic belts on sacroiliac joint ligaments as potential pain generators are mostly unknown. The aim of our study was to analyze the influence of pelvic belts on ligament load by means of a computer model. Experimental computer study using a finite element method. A computer model of the human pelvis was created, comprising bones, ligaments, and cartilage. Detailed geometries, material properties of ligaments, and in-vivo pressure distribution patterns of a pelvic belt were implemented. The effects of pelvic belts on ligament strain were computed in the double-leg stance. Pelvic belts increase sacroiliac joint motion around the sagittal axis but decrease motion around the transverse axis. With pelvic belt application, most of the strained sacroiliac joint ligaments were relieved, especially the sacrospinous, sacrotuberous, and the interosseous sacroiliac ligaments. Sacroiliac joint motion and ligament strains were minute. These results agree with validation data from other studies. Assigning homogenous and linear material properties and excluding muscle forces are clear simplifications of the complex reality. Pelvic belts alter sacroiliac joint motion and provide partial relief of ligament strain that is subjectively marked, although minimal in absolute terms. These findings confirm theories that besides being mechanical stabilizers, the sacroiliac joint ligaments are likely involved in neuromuscular feedback mechanisms. The results from our computer model help with unraveling the therapeutic mechanisms of pelvic belts.

Infusion dynamic ureteroscintigraphy in assessment of ureteral and pelvic contractivity in renal tuberculosis and chronic pyelonephritis

International Nuclear Information System (INIS)

Savin, I.B.; Tovstykh, A.M.; Morozov, N.V.

1995-01-01

A novel radionuclide method: infusion dynamic ureterscintigraphy was used in examinations of 42 patients with the initial forms of nephrotuberculosis, 18 patients with chronic nonspecific pyelonephritis, and 51 healthy controls. The new method was shown to be highly sensitive in assessment of ureteral and pelvic contractility in specific and nonspecific involvement of the kidneys. 16 refs.; 3 figs

A huge renal capsular leiomyoma mimicking retroperitoneal sarcoma

Directory of Open Access Journals (Sweden)

Lal Anupam

2009-01-01

Full Text Available A huge left renal capsular leiomyoma mimicking retroperitoneal sarcoma presented in a patient as an abdominal mass. Computed tomography displayed a large heterogeneous retro-peritoneal mass in the left side of the abdomen with inferior and medial displacement as well as loss of fat plane with the left kidney. Surgical exploration revealed a capsulated mass that was tightly adherent to the left kidney; therefore, total tumor resection with radical left nephrectomy was performed. Histopathology ultimately confirmed the benign nature of the mass. This is the largest leiomyoma reported in literature to the best of our knowledge.

Choroid plexus metastasis of renal-cell carcinoma. A case report

Energy Technology Data Exchange (ETDEWEB)

Shigemori, Minoru; Shimamoto, Houtetsu; Noguchi, Shinji; Yoshitake, Yasuhiro; Sugita, Yasuo; Kuramoto, Shinken

1987-10-01

A rare case of the choroid plexus metastasis of renal-cell carcinoma is reported. A 58-year-old man was admitted on March 3, 1982, with complaints of mild headache and a transient attack of muscle weakness of the left upper extremity. He had undergone a left nephrectomy because of renal-cell carcinoma 2 years before this admission. A CT scan revealed a small mass in the right lateral ventricle that was markedly enhanced by the contrast medium. A carotid angiogram was normal, but a left vertebral angiogram showed a round tumor stain in the distal portion of the right posterior choroidal artery. To determine the nature of the tumor, it was successfully removed via the right frontal transventricular approach. The immediate recovery from the operation was uneventful, but the patient became semicomatose 6 hours later because of a large subdural hematoma over the left hemisphere. An emergency operation for clot removal and external decompression failed to improve the patient's status, and he died on the 3rd postoperative day. An histological examination of the tumor determined the diagnosis of clear-cell-type renal-cell carcinoma. The CT demonstration of choroid plexus metastasis is quite rare. To our knowledge, only two cases have been described.

Chronic pelvic floor dysfunction.

Science.gov (United States)

Hartmann, Dee; Sarton, Julie

2014-10-01

The successful treatment of women with vestibulodynia and its associated chronic pelvic floor dysfunctions requires interventions that address a broad field of possible pain contributors. Pelvic floor muscle hypertonicity was implicated in the mid-1990s as a trigger of major chronic vulvar pain. Painful bladder syndrome, irritable bowel syndrome, fibromyalgia, and temporomandibular jaw disorder are known common comorbidities that can cause a host of associated muscular, visceral, bony, and fascial dysfunctions. It appears that normalizing all of those disorders plays a pivotal role in reducing complaints of chronic vulvar pain and sexual dysfunction. Though the studies have yet to prove a specific protocol, physical therapists trained in pelvic dysfunction are reporting success with restoring tissue normalcy and reducing vulvar and sexual pain. A review of pelvic anatomy and common findings are presented along with suggested physical therapy management. Copyright © 2014 Elsevier Ltd. All rights reserved.

Accidental Coverage of Both Renal Arteries during Infrarenal Aortic Stent-Graft Implantation: Cause and Treatment

Directory of Open Access Journals (Sweden)

Umberto Marcello Bracale

2014-01-01

Full Text Available The purpose of this paper is to report a salvage maneuver for accidental coverage of both renal arteries during endovascular aneurysm repair (EVAR of an infrarenal abdominal aortic aneurysm (AAA. A 72-year-old female with a 6 cm infrarenal abdominal aortic aneurysm was treated by endovascular means with a standard bifurcated graft. Upon completing an angiogram, both renal arteries were found to be accidentally occluded. Through a left percutaneous brachial approach, the right renal artery was catheterized and a chimney stent was deployed; however this was not possible for the left renal artery. A retroperitoneal surgical approach was therefore carried out with a retrograde chimney stent implanted to restore blood flow. After three months, both renal arteries were patent and renal function was not different from the baseline. Both endovascular with percutaneous access via the brachial artery and open retroperitoneal approaches with retrograde catheterization are feasible rescue techniques to recanalize the accidentally occluded renal arteries during EVAR.

Radiographic cup anteversion measurement corrected from pelvic tilt.

Science.gov (United States)

Wang, Liao; Thoreson, Andrew R; Trousdale, Robert T; Morrey, Bernard F; Dai, Kerong; An, Kai-Nan

2017-11-01

The purpose of this study was to develop a novel technique to improve the accuracy of radiographic cup anteversion measurement by correcting the influence of pelvic tilt. Ninety virtual total hip arthroplasties were simulated from computed tomography data of 6 patients with 15 predetermined cup orientations. For each simulated implantation, anteroposterior (AP) virtual pelvic radiographs were generated for 11 predetermined pelvic tilts. A linear regression model was created to capture the relationship between radiographic cup anteversion angle error measured on AP pelvic radiographs and pelvic tilt. Overall, nine hundred and ninety virtual AP pelvic radiographs were measured, and 90 linear regression models were created. Pearson's correlation analyses confirmed a strong correlation between the errors of conventional radiographic cup anteversion angle measured on AP pelvic radiographs and the magnitude of pelvic tilt (P cup anteversion angle from the influence of pelvic tilt. The current method proposes to measure the pelvic tilt on a lateral radiograph, and to use it as a correction for the radiographic cup anteversion measurement on an AP pelvic radiograph. Thus, both AP and lateral pelvic radiographs are required for the measurement of pelvic posture-integrated cup anteversion. Compared with conventional radiographic cup anteversion, the errors of pelvic posture-integrated radiographic cup anteversion were reduced from 10.03 (SD = 5.13) degrees to 2.53 (SD = 1.33) degrees. Pelvic posture-integrated cup anteversion measurement improves the accuracy of radiographic cup anteversion measurement, which shows the potential of further clarifying the etiology of postoperative instability based on planar radiographs. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

Recent Advances in Understanding Pelvic-Floor Tissue of Women With and Without Pelvic Organ Prolapse: Considerations for Physical Therapists.

Science.gov (United States)

Saunders, Kimberly

2017-04-01

Pelvic organ prolapse is a fairly common condition that imposes significant symptoms, diminished quality of life, social burden, financial expense, and surgical risk on women. As evidence supporting the benefit of pelvic-floor muscle training in nonsurgical management of pelvic organ prolapse grows, physical therapists are becoming a provider of choice interacting with women affected by pelvic organ prolapse. This perspective article will review recent research on tissue characteristics of 3 key components of pelvic organ support: skeletal muscle, ligament, and vaginal wall. This information will be summarized as implications for physical therapists. An improved understanding of pelvic-floor tissue in women with and without pelvic organ prolapse will provide a more comprehensive appreciation of the interaction of multiple systems in the disorder. © 2017 American Physical Therapy Association.

Tumoral calcinosis in a dog with chronic renal failure : clinical communication

Directory of Open Access Journals (Sweden)

T.C. Spotswood

2003-06-01

Full Text Available A 2-year-old male German shepherd dog in poor bodily condition was evaluated for thoracic limb lameness due to a large, firm mass medial to the left cranial scapula. Radiography revealed several large cauliflower-like mineralized masses in the craniomedial left scapula musculature, pectoral region and bilaterally in the biceps tendon sheaths. Urinalysis, haematology and serum biochemistry showed that the dog was severely anaemic, hyperphosphataemic and in chronic renal failure. The dog was euthanased and a full post mortem performed. A diagnosis of chronic renal failure with secondary hyperparathyroidism was confirmed. The mineralized masses were grossly and histopathologically consistent with a diagnosis of tumoral calcinosis. Tumoral calcinosis associated with chronic renal failure that does not involve the foot pads is rarely seen.

Evaluation of Effectiveness of Embolization in Pelvic Congestion Syndrome with the New Vascular Occlusion Device (ArtVentive EOS™): Preliminary Results

International Nuclear Information System (INIS)

Pyra, Krzysztof; Woźniak, Sławomir; Drelich-Zbroja, Anna; Wolski, Andrzej; Jargiełło, Tomasz

2016-01-01

PurposeThis study aimed to collect confirmatory data in support of the safety and efficiency of the ArtVentive EOS™ for the treatment of the pelvic congestion syndrome (PCS). This study was based on the OCCLUDE 1 Study Protocol approved by the Local Ethics Committee.Materials and MethodsA prospective study carried out in June and July 2014 included 12 women aged 21–48 years (mean 31 years) scheduled for PCS embolization using the ArtVentive EOS™. The inclusion criteria were clinical symptoms of PCS documented by transvaginal Doppler ultrasound and pelvic MRI. The pelvic pain was assessed by VAS score from 0 to 10 (0 represents lack of pain and 10 unbearable pain). A decrease in pelvic pain intensity based on the VAS was considered a clinical success.ResultsSuccessful embolization procedures with ArtVentive EOS™ were performed in 11 out of 12 patients. Nine patients underwent unilateral embolization of the left ovarian vein, and two had bilateral embolization of the ovarian veins. Complete ovarian vein occlusion confirmed by post deployment venography was achieved in all 11 patients. Procedures lasted from 19 to 45 min (average 28 min). Pain intensity decrease was observed in all 11 patients—a decrease of 5.6 points—from 7.3 pre-procedure to 1.6 post-embolization (standard deviation: 0.67). In one case, the left ovarian vein was injured by guide wire manipulation with contrast extravasation—not clinically significant.ConclusionsThe use of ArtVentive EOS™ for occlusion of the ovarian veins in PCS patients is safe and effective.

Evaluation of Effectiveness of Embolization in Pelvic Congestion Syndrome with the New Vascular Occlusion Device (ArtVentive EOS™): Preliminary Results

Energy Technology Data Exchange (ETDEWEB)

Pyra, Krzysztof, E-mail: k.pyra@poczta.fm [Medical University of Lublin, Department of Interventional Radiology and Neuroradiology (Poland); Woźniak, Sławomir, E-mail: slavwo7572@gmail.com [Medical University of Lublin, III Gynecology Clinic (Poland); Drelich-Zbroja, Anna, E-mail: zbroanna@interia.pl; Wolski, Andrzej, E-mail: andrzej.s.wolski@gmail.com; Jargiełło, Tomasz, E-mail: tojarg@interia.pl [Medical University of Lublin, Department of Interventional Radiology and Neuroradiology (Poland)

2016-08-15

PurposeThis study aimed to collect confirmatory data in support of the safety and efficiency of the ArtVentive EOS™ for the treatment of the pelvic congestion syndrome (PCS). This study was based on the OCCLUDE 1 Study Protocol approved by the Local Ethics Committee.Materials and MethodsA prospective study carried out in June and July 2014 included 12 women aged 21–48 years (mean 31 years) scheduled for PCS embolization using the ArtVentive EOS™. The inclusion criteria were clinical symptoms of PCS documented by transvaginal Doppler ultrasound and pelvic MRI. The pelvic pain was assessed by VAS score from 0 to 10 (0 represents lack of pain and 10 unbearable pain). A decrease in pelvic pain intensity based on the VAS was considered a clinical success.ResultsSuccessful embolization procedures with ArtVentive EOS™ were performed in 11 out of 12 patients. Nine patients underwent unilateral embolization of the left ovarian vein, and two had bilateral embolization of the ovarian veins. Complete ovarian vein occlusion confirmed by post deployment venography was achieved in all 11 patients. Procedures lasted from 19 to 45 min (average 28 min). Pain intensity decrease was observed in all 11 patients—a decrease of 5.6 points—from 7.3 pre-procedure to 1.6 post-embolization (standard deviation: 0.67). In one case, the left ovarian vein was injured by guide wire manipulation with contrast extravasation—not clinically significant.ConclusionsThe use of ArtVentive EOS™ for occlusion of the ovarian veins in PCS patients is safe and effective.

Synchronous colon and renal cancer - case report

International Nuclear Information System (INIS)

Luczynska, E.; Pawlik, T.; Aniol, J.; Chwalibog, A.

2008-01-01

Primary cancer may occur synchronously in two different organs. We present an example of pathologically proven, coexistent renal and colony double malignant tumors. A 59 year old man, was admitted to the Institute of Oncology due to left renal lesion, discovered during a routine abdominal ultrasound examination. The CT exam was performed before surgery. The CT scans reveled a second abnormality, presenting irregular shaped and thickened to 20 mm intestinal wall within a patient's large bowel. As a next diagnostic step a CT-colonoscopy was undertaken, which confirmed the presence of an exophytic sigmoid lesion, eccentrically affecting the colonic wall and protruding into the lumen moderately narrowing it, placed about 50 cm from the external rectal sphincter. Patient underwent simultaneous radical left nephrectomy and sigmoidectomy. Both tumors were confirmed in pathologic evaluation, reveling renal clear cell carcinoma (Fuhrman G II) and colonic adenocarcinoma (Astler-Coller B2). Preoperative careful imaging studies reveled neoplastic tumors in two different organs, allowing for radical resection at the same surgical procedure. (author)

CT staging of renal pelvis tumor

International Nuclear Information System (INIS)

Yoon, Soo Woong; Cho, Kyoung Sik; Lee, Jong Hwa; Ham, Su Yeon; Won, Yeong Cheol; Ji, Eun Kyung; Choi, Seong Hun; Shin, Byung Suck

1999-01-01

To assess the value of computed tomography (CT) in the preoperative staging of transitional cell carcinoma (TCC) of the renal pelvis. We retrospectively evaluated the CT TNM staging of 38 patients with TCC of the renal pelvis who had undergone preoperative abdominal CT examination between January 1990 and January 1998. In CT staging for differentiation between early-stage (T0-2) and advanced-stage disease (T3-T4), three criteria were used, namely the presence or obliteration of the renal sinus fat layer, the smoothness or irregularity of margin between the tumor and renal parenchyma, and the presence or absence of hydronephrosis proximal to the tumor. CT staging was performed by two genitourinary radiologists blinded to the pathologic results, and was compared with pathologic staging. Pathologic results revealed 19 cases of early stage disease (T0=8, T1=9, T2=2) and 19 of advanced stage (T3=12, T4=7). Overall CT staging accuracy was 82%(31/38) ; four cases were overstaged and three were understaged. In early-stage disease, sensitivity and specificity were 79%, and 84%, and in advanced stage disease were 83% and 80%. Three of four overstaged cases showed hydronephrosis proximal to the tumor. In the second CT staging, using proximal hydronephrosis of the tumor as a criterion for early-stage disease, the sensitivity and specificity of early-stage disease were 95% and 75%, respectively, and the specificity of advanced-stage disease was 95%. When hydronephrosis proximal to a tumor was considered to be a sign of early stage disease, the CT staging of renal pelvic TCC was highly accurate

Lifestyle advice with or without pelvic floor muscle training for pelvic organ prolapse

DEFF Research Database (Denmark)

Due, Ulla; Brostrøm, Søren; Lose, Gunnar

2016-01-01

INTRODUCTION AND HYPOTHESIS: We evaluated the effect of adding pelvic floor muscle training (PFMT) to a structured lifestyle advice program. METHODS: This was a single-blinded randomized trial of women with symptomatic pelvic organ prolapse (POP) stage ≥ II. Participants were randomized...

Bilateral Vascular Variations at the Renal Hilum: A Case Report

Directory of Open Access Journals (Sweden)

Naveen Kumar

2012-01-01

Full Text Available Imaging technology with its advancement in the field of urology is the boon for the patients who require minimally invasive approaches for various kidney disorders. These approaches require a precise knowledge of the normal and variant anatomy of vascular structures at the hilum of the kidney in terms of their pattern of arrangement and division. The present paper describes a bilateral anomalous arrangement of the structures at the renal hilum as well as their peculiar branching pattern which is of clinical and surgical relevance. Multiple branching of the renal vessels was observed in both kidneys due to which the hila were congested. The right renal artery immediately after its origin divided into 2 branches. The upper branch represented an aberrant artery whereas the lower branch gave 5 divisions. The left renal artery also divided into 2 branches much before the hilum as anterior and posterior divisions. The anterior branch took an arched course and gave 6 branches. The posterior branch gave 3 terminal branches before entering the renal substance. In addition to anomalous hilar structures, normal architecture of both kidneys was altered and the hilum of the left kidney was found on its anterior surface.

Minimally invasive anterior pelvic internal fixation: An anatomic study comparing Pelvic Bridge to INFIX.

Science.gov (United States)

Reichel, Lee M; MacCormick, Lauren M; Dugarte, Anthony J; Rizkala, Amir R; Graves, Sara C; Cole, Peter A

2018-02-01

Anterior external fixation for pelvic ring fractures has shown to effectively improve stability and reduce mortality. However, these fixators can be associated with substantial morbidity such as pin tract infection, premature loss of fixation, and decreased quality of life in patients. Recently, two new methods of subcutaneous anterior pelvic internal fixation have been developed; the INFIX and the Pelvic Bridge. These methods have the purported advantages of lower wound complications, less surgical site pain, and improved quality of life. We sought to investigate the measured distances to critical anatomic structures, as well as the qualitative and topographic differences notable during implantation of both devices in the same cadaveric specimen. The Pelvic Bridge and INFIX were implanted in eleven fresh cadavers. Distances were then measured to: the superficial inguinal ring, round ligament, spermatic cord, lateral femoral cutaneous nerve (LFCN), femoral nerve, femoral artery, and femoral vein. Observations regarding implantation and topography were also recorded. The INFIX had greater measured distances from all structures except for the LFCN, in which its proximity placed this structure at risk. Neither device appears to put other critical structures at risk in the supine position. Significant implantation and topographic differences exist between the devices. The INFIX application lacked "safety margins" concerning the LFCN in 10/11 (90.9%) specimens, while Pelvic Bridge placement lacked "safety margins" with regard to the right superficial ring (1/11, 9%) and the right spermatic cord (1/11, 9%). Both the Pelvic Bridge and INFIX lie at safe distances from most critical pelvic structures in the supine position, though INFIX application places the LFCN at risk. Copyright © 2017 Elsevier Ltd. All rights reserved.

Pelvic floor and sexual male dysfunction

Directory of Open Access Journals (Sweden)

Antonella Pischedda

2013-04-01

Full Text Available The pelvic floor is a complex multifunctional structure that corresponds to the genito- urinary-anal area and consists of muscle and connective tissue. It supports the urinary, fecal, sexual and reproductive functions and pelvic statics. The symptoms caused by pelvic floor dysfunction often affect the quality of life of those who are afflicted, worsening significantly more aspects of daily life. In fact, in addition to providing support to the pelvic organs, the deep floor muscles support urinary continence and intestinal emptying whereas the superficial floor muscles are involved in the mechanism of erection and ejaculation. So, conditions of muscle hypotonia or hypertonicity may affect the efficiency of the pelvic floor, altering both the functionality of the deep and superficial floor muscles. In this evolution of knowledge it is possible imagine how the rehabilitation techniques of pelvic floor muscles, if altered and able to support a voiding or evacuative or sexual dysfunction, may have a role in improving the health and the quality of life.

Retroperitoneoscopic pyelolithotomy: A minimally invasive alternative for the management of large renal pelvic stone

Directory of Open Access Journals (Sweden)

Saurabh Sudhir Chipde

2014-01-01

Full Text Available Introduction: Large stones in renal pelvis can be treated with percutaneous nephrolithotomy (PCNL or pyelolithotomy (either by open or laparoscopic techniques. PCNL is difficult in undilated system. For pyelolithotomy, laparoscopy is more preferable over the open surgery. Surgeons are more familiar with the tansperitoneoscopic anatomy than retroperitoneoscopic one, but retroperitoneoscopic approach can be attempted if we anticipate the problems in the transperitoneal route. Case: A fifty years old gentleman presented to us with the complaint of dull aching right flank pain. On ultrasonographic examination, he was found to have a large stone in renal pelvis with minimal hydronephrosis and thickened omentum on right side. Xray KUB showed a large radio-opaque shadow in renal area. We did the CECT-Urogram of the patient to know the detailed anatomy, which showed a stone of 5.3 x 3.7 cm in right extra-rena pelvis without hydronephrosis and a large focal area of marked fat stranding in omentum on the right side in mid and lower abdomen with swirling of fat stranding on the superior aspect suggestive of omental infarction and torsion. Due to undilated caliceal system, we preferred laparoscopic surgery over the PCNL in this patient. As whole of the omental tissue was stuck on right side we decided to proceed with transperitoneoscopic route instead of retroperitoneoscopic one. The DJ stent was inserted preoperatively.The surgery was performed in the flank position with three ports, one 10mm port just antero-inferior to tip of 12th rib for camera and two 5mm working ports, one at anterior axillary line and other at renal angle. We created the retroperitoneal space with the customized balloon, made with the glove-fingure. Results: The operative time was 1 hour 40 minutes, and there were no intra or post-operative complications. The stone was removed in toto. Patient was orally allowed on first postoperative day and foleys was removed on second day. patient

Juxtarenal Aortic Pseudoaneurysm – Right Renal Vein Fistula with Circumaortic Renal Collar-Delayed Manifestation of a Gunshot Injury – an Uncommon Entity Diagnosed with CT Angiography

International Nuclear Information System (INIS)

Garg, Lalit; Jain, Neeraj; Agrawal, Sachin; Chauhan, Udit; Goel, Vandana; Puri, Sunil Kumar

2016-01-01

Delayed presentation of post-traumatic aortic pseudoaneurysm and its fistulous communication with the right renal vein is a very rare entity. Most of the cases described in literature are due to abdominal aortic aneurysm (AAA) rupture into the left renal vein. To the best of our knowledge, communication with the right renal vein has not been described in published literature. Our patient also had a circumaortic renal collar, which is a rare renal vein anomaly. Aortic pseudoaneurysm, its fistulous communication with the right renal vein and circumaortic renal collar in a single patient is of extremely rare occurrence. A 29-year-old male presented to the cardiology department with complaints of breathlessness, abdominal pain and hematuria for the last 6 months. On clinical examination there was evidence of audible bruit over the abdomen. He had a past history of a gunshot injury around two years back. CT angiography revealed a large partially calcified pseudoaneurysm arising from the right lateral wall of the abdominal aorta with the neck of the pseudoaneurysm at juxtarenal location with a fistula between the anterior wall of the pseudoaneurysm and the posterior wall of the right renal vein. There was an associated incidental finding of circumaortic left renal vein with gross aneurysmal dilatation of both pre- and retro-aortic part of the renal vein. Delayed presentation of aortic pseudoaneurysm with its fistulous communication with the right renal vein is a rare entity. CT angiography is a non-invasive modality for diagnosis of the exact site of communication, length of aneurysm, proximal and distal extent of the affected segment and its relationship with surrounding structures

Mode of delivery and Pelvic floor disorder

International Nuclear Information System (INIS)

Noor, R.; Neelam, H.; Bashir, M.S.

2017-01-01

Objective: To compare pelvic floor dysfunction in non pregnant women who had delivered vaginally versus those with cesarean delivery. Methodology: The prevalence of pelvic floor disorders among non pregnant women was assesses by using a standardized tool pelvic floor distress inventory short form (PFDI-20). Data was collected from Jinnah Hospital Lahore, Pakistan. Results: Total numbers of participants were 278. 47.12% subjects had moderate, 36.69% miner and 16.19% had severe pelvic floor dysfunction. The symptoms of pelvic organ prolapse were more prevalent (mean value is 59.1876) than Urinary Distress (mean value is 40.5426), while the Colorectal-Anal Distress (mean value is 35.9150) were least prevalent. Conclusion: Pelvic floor disorders are very common among females and are strongly associated with mode of delivery. Although spontaneous vaginal birth was extensively associated with pelvic floor disorders the instrumental delivery affects most. (author)

Measurements of the Exerted Pressure by Pelvic Circumferential Compression Devices

Science.gov (United States)

Knops, Simon P; van Riel, Marcel P.J.M; Goossens, Richard H.M; van Lieshout, Esther M.M; Patka, Peter; Schipper, Inger B

2010-01-01

Background: Data on the efficacy and safety of non-invasive Pelvic Circumferential Compression Devices (PCCDs) is limited. Tissue damage may occur if a continuous pressure on the skin exceeding 9.3 kPa is sustained for more than two or three hours. The aim of this study was to gain insight into the pressure build-up at the interface, by measuring the PCCD-induced pressure when applying pulling forces to three different PCCDs (Pelvic Binder® , SAM-Sling ® and T-POD® ) in a simplified model. Methods: The resulting exerted pressures were measured at four ‘anatomical’ locations (right, left, posterior and anterior) in a model using a pressure measurement system consisting of pressure cuffs. Results: The exerted pressure varied substantially between the locations as well as between the PCCDs. Maximum pressures ranged from 18.9-23.3 kPa and from 19.2-27.5 kPa at the right location and left location, respectively. Pressures at the posterior location stayed below 18 kPa. At the anterior location pressures varied markedly between the different PCCDs. Conclusion: The circumferential compression by the different PCCDs showed high pressures measured at the four locations using a simplified model. Difference in design and functional characteristics of the PCCDs resulted in different pressure build-up at the four locations. When following the manufacturer’s instructions, the exerted pressure of all three PCCDs tested exceeded the tissue damaging level (9.3 kPa). In case of prolonged use in a clinical situation this might put patients at risk for developing tissue damage. PMID:20361001

Clinical evaluation of renal function study using I-123 orthoiodohippurate (I-123 OIH) in patients with obstructive uropathy

International Nuclear Information System (INIS)

Okada, Junichi; Uchiyama, Guio; Katsurai, Hiroshi; Uno, Koichi; Uematsu, Sadao.

1984-01-01

Functional images and regional renograms using I-123 OIH were evaluated by comparing with patients' clinical courses, intravenous pyelographies and Creatinine clearances. Twenty-one patients with obstructive uropathy were studied. Functional images were processed in three parameters of Tmax, T 1/2 and ERBF (effective renal blood flow). ERBF images were composed of regional counts in early blood flow phase of renograms. Regional renograms were produced on renal parenchyma and pelvis. ERBF images represented the functioning distributions of renal tissue after the surgery and the recoveries in the renal parenchyma. Tmax and T 1/2 images and pelvic regional renograms showed the good correlations with IVP findings which presented the dilatation of pelvis and the delay of excretion. Parenchymal regional renograms showed the poor correlations with Creatinine clearances and caused sometimes errors in ROI settings. The evaluation of renal function only by the parenchymal regional renogram seemed to be inappropriated. (author)

Paraparesis secondary to erratic migration of Dioctophyma renale in a dog

OpenAIRE

Bach, Fernando Swiech; Klaumann, Paulo Roberto; Montiani-Ferreira, Fabiano

2016-01-01

ABSTRACT: A 4 years old mongrel stray bitch, weighing 16kg was submitted to physical examination to demonstrated inability of locomotion with the pelvic limbs. Extradural spinal cord compression was observed in myelotomography of the thoracolumbar segment. The patient was submitted to exploratory hemilaminectomy of T13-L1 and L1-L2, in an attempt to decompress the medullar segments. During the surgery was observed one adult parasite, identified as Dioctophyma renale , located in the extradura...

Biomechanics of the pelvic floor musculature

NARCIS (Netherlands)

Janda, S.

2006-01-01

The present thesis was motivated by two main goals. The first research goal of the thesis was to understand the complex biomechanical behaviour of the pelvic floor muscles. The second goal was to study the mechanism of the pelvic organ prolapse (genital prolapse). The pelvic floor in humans is a

Renal contrast-enhanced MR angiography: timing errors and accurate depiction of renal artery origins.

Science.gov (United States)

Schmidt, Maria A; Morgan, Robert

2008-10-01

To investigate bolus timing artifacts that impair depiction of renal arteries at contrast material-enhanced magnetic resonance (MR) angiography and to determine the effect of contrast agent infusion rates on artifact generation. Renal contrast-enhanced MR angiography was simulated for a variety of infusion schemes, assuming both correct and incorrect timing between data acquisition and contrast agent injection. In addition, the ethics committee approved the retrospective evaluation of clinical breath-hold renal contrast-enhanced MR angiographic studies obtained with automated detection of contrast agent arrival. Twenty-two studies were evaluated for their ability to depict the origin of renal arteries in patent vessels and for any signs of timing errors. Simulations showed that a completely artifactual stenosis or an artifactual overestimation of an existing stenosis at the renal artery origin can be caused by timing errors of the order of 5 seconds in examinations performed with contrast agent infusion rates compatible with or higher than those of hand injections. Lower infusion rates make the studies more likely to accurately depict the origin of the renal arteries. In approximately one-third of all clinical examinations, different contrast agent uptake rates were detected on the left and right sides of the body, and thus allowed us to confirm that it is often impossible to optimize depiction of both renal arteries. In three renal arteries, a signal void was found at the origin in a patent vessel, and delayed contrast agent arrival was confirmed. Computer simulations and clinical examinations showed that timing errors impair the accurate depiction of renal artery origins. (c) RSNA, 2008.

Evaluation of renal vascular in living donors before transplantation using dynamic contrast enhanced MR angiography

International Nuclear Information System (INIS)

Wang Hong; Mu Xuetao; Zhong Xin; Dong Yuru; Dong Yue; Ma Yi; Wu Chunnan

2010-01-01

Objective: To explore whether dynamic contrast-enhanced MRA (DCE MRA) can provide an effective assessment of renal vascular in living donors before transplantation. Methods: Thirty five healthy living renal donor candidates were scanned on MR system before transplantation. After injection of Gd-DTPA 1 ml in vein, a test-bolus scan was used to get the time delay of Gd-DTPA reaching renal artery. Then, a 3D T 1 -weighted fast low-angle shot sequence (3D FLASH) was performed in the coronal plane. The 3D FLASH scan would repeat four times with an inter-phase of 10 seconds. Thus, the imaging of the renal arterial, venous and collecting systems were got. Two radiologists observed renal arteries and veins on original imaging and MIP reconstmcted imaging. The quality of MR angiography was evaluated on a five- point scale and the vascular anatomy or variations of the arterial and venous systems were recorded, using intraoperative findings as a standard of reference. Results: The quality for all MRA was good or very good for the most of living renal donors. Among 70 renals, several variations of vascular were found, including 5 left accessory artery, 9 right accessory artery, 3 left proximal arterial branch and 6 right proximal arterial branch. Among 70 renal veins, 1 right accessory veins and 2 left varicocele were observed. One small accessory artery of right kidney was missed with DCE MRA, but identified by operation. Conclusion: DCE MRA was noninvasive tool for evaluation of the renal vasculature and variations with high accuracy. It would be a good modality in preoperative evaluation of living renal donors. (authors)

Computed tomography of renal cell carcinoma in patients with terminal renal impairment

International Nuclear Information System (INIS)

Ferda, Jiri; Hora, Milan; Hes, Ondrej; Reischig, Tomas; Kreuzberg, Boris; Mirka, Hynek; Ferdova, Eva; Ohlidalova, Kristyna; Baxa, Jan; Urge, Tomas

2007-01-01

Purpose: An increased incidence of renal tumors has been observed in patients with end-stage-renal-disease (ESRD). The very strong association with acquired renal cystic disease (ACRD) and increased incidence of the renal tumors (conventional renal cell carcinoma (CRCC), papillary renal cell carcinoma (PRCC) or papillary renal cell adenoma (PRCA)) was reported. This study discusses the role of computed tomography (CT) in detecting renal tumors in patients with renal impairment: pre-dialysis, those receiving dialysis or with renal allograft transplants. Materials and methods: Ten patients (nine male, one female) with renal cell tumors were enrolled into a retrospective study; two were new dialysis patients, three on long-term dialysis, and five were renal transplant recipients with history of dialysis. All patients underwent helical CT, a total of 11 procedures were performed. Sixteen-row detector system was used five times, and a 64-row detector system for the six examinations. All patients underwent nephrectomy of kidney with suspected tumor, 15 nephrectomies were performed, and 1 kidney was assessed during autopsy. CT findings were compared with macroscopic and microscopic assessments of the kidney specimen in 16 cases. Results: Very advanced renal parenchyma atrophy with small cysts corresponding to ESRD was found in nine patients, chronic pyelonephritis in remained one. A spontaneously ruptured tumor was detected incidentally in one case, patient died 2 years later. In the present study, 6.25% (1/16) were multiple PRCA, 12.5% (2/16) were solitary PRCC, 12.5% tumors (2/16) were solitary conventional renal cell carcinomas (CRCC's), 12.5% tumors (2/16) were multiple conventional renal cell carcinomas (CRCC's), 25% (4/16) were CRCC's combined with multiple papillary renal cell carcinomas with adenomas (PRCC's and PRCA's), and 25% (4/16) of the tumors were multiple PRCC's combined with PRCA's without coexisting CRCC's. Bilateral renal tumors were found in our study

Relative Renal Blood Flow Measurements With Rb-82 and a Hybrid Gamma Camera Using a Pig Model

Science.gov (United States)

Pretorius, P. H.; Fung, L. C. T.; Schell, C. P.; King, M. A.

2005-02-01

We have successfully demonstrated with chronically implanted blood flow probes in a pig model that renal uptake of Rb-82 is indeed sensitive to acute renal blood flow changes. Two flow probes were placed around the left and right renal arteries in a surgical procedure nine weeks before the first Rb-82 measurements. Together with the flow probes, a flow restrictor was implanted around the left renal artery. Single bolus infusions of 6 mCi Rb-82 were used to study the uptake in the kidneys approximately 7 minutes apart in hybrid-image limited-angle acquisitions (stationary camera heads posterior and anterior of the pig) while changing the flow to the left kidney between acquisitions. The acquired data were reconstructed into 7.5-s frames using a maximum likelihood (ML) list-mode reconstruction algorithm exploiting timing signals inserted into the list every 0.25 s. Reconstructed data were orientated to coronal views before regions of interest (ROIs) were drawn over both kidneys with a separate background region for each. The data represented are noisy due to the reconstructed 7.5-s frames, and the total imaging time of 5 min (or 4 Rb-82 half-lives). We were able to show a steady decline in uptake of Rb-82 in the left kidney that correlates with the reduction in renal blood flow. The reduced blood flow to the left kidney affects the Rb-82 uptake to the right kidney slightly, while blood flow decreased up to 33%. Comparing the baseline renal blood flow of the left kidney obtained before and after the intervention indicates that some ischemia persists after blood flow was restored. Attenuation compensation better described the contour of the kidney but only scales the time activity curve without changing its shape.

Postoperative low-pelvic irradiation for stage I-IIA cervical cancer patients with risk factors other than pelvic lymph node metastasis

International Nuclear Information System (INIS)

Hong, J.-H.; Tsai, C.-S.; Lai, C.-H.; Chang, T.-C.; Wang, C.-C.; Lee, Steve P.; Tseng, C.-J.; Hsueh, Swei

2002-01-01

Purpose: To retrospectively investigate whether postoperative low-pelvic radiotherapy (RT) is an appropriate treatment for node-negative, high-risk Stage I-IIA cervical cancer patients. Methods and Materials: A total of 228 Stage I-IIA cervical cancer patients treated by radical surgery and postoperative RT were included in this study. All patients had histopathologically negative pelvic node metastasis, but at least one of the following risk factors: parametrial involvement, positive or close resection margins, invasion depth two-thirds or greater cervical stromal thickness. Seventy-nine patients (35%) received 30-50 Gy (median 44) to whole pelvis and a boost dose to the low pelvis (whole-pelvic RT group); the other 149 patients (65%) received low-pelvic RT only (low-pelvic RT group). For both groups, the total external RT dose to the low pelvis ranged from 40 to 60 Gy (median 50). The potential factors associated with survival, small bowel (gastrointestinal) complications, and leg lymphedema were analyzed, and patients who had a relapse in the upper pelvis were identified. Results: The 5-year overall and disease-specific survival rate was 84% and 86%, respectively. After multivariate analysis, only bulky tumor (≥4 cm) and non-squamous cell carcinoma were significantly associated with survival. Parametrial involvement, lymph-vascular invasion, ≤50.4 Gy to the low pelvis, positive or close margins, and low-pelvic RT alone did not significantly affect survival. Grade I-V small bowel complications occurred in 33 patients (15%). Whole pelvic RT and >50.4 Gy to the low pelvis, but not old age and treatment technique (AP-PA vs. box), were significantly associated with gastrointestinal complications. Three patients (2%) in the low-pelvic RT group and 6 patients (8%) in the whole-pelvic RT group were found to have Grade III or higher small bowel complications (p=0.023). Thirty-one percent of patients developed lymphedema of the leg. A dose to the low pelvis >50.4 Gy

The screening pelvic radiograph in pediatric trauma

International Nuclear Information System (INIS)

Rees, M.J.; Aickin, R.; Kolbe, A.; Teele, R.L.

2001-01-01

Background. Pelvic radiographs are routinely obtained in adult trauma to optimise early management. In adults, pelvic fractures are associated with high early transfusion requirement, high injury severity scores and an increased incidence of other abdominal and thoracic injuries. It is unclear whether this holds true in children. Objective. To determine whether the screening pelvic radiograph is necessary in paediatric trauma. Materials and methods. The notes of all patients who presented after trauma to the Starship Children's Hospital and were triaged to the resuscitation room during 1997 were reviewed. Results of initial radiography were obtained and correlated with later imaging. Results. Our review of 444 injured children seen over a period of 1 year revealed that of 347 children who had screening pelvic radiographs, only 1 had a pelvic fracture. The fracture in this child was clinically apparent and required no specific treatment. Conclusions. The presence of a pelvic fracture is rare in injured children. By omitting screening pelvic radiographs there are potential benefits, including reduced radiation exposure to children and cost savings. Uninterpretable or abnormal clinical examination or haematuria requires further investigation, but routine screening for pelvic fracture is unnecessary. (orig.)

Simple technique for measuring relative renal blood flow

International Nuclear Information System (INIS)

Shames, D.M.; Korobkin, M.

1976-01-01

To determine whether externally monitored early renal uptake of 131 I-hippurate is proportional to renal blood flow, the renal uptake of 131 -hippurate at 1 to 2 min after injection was compared with the renal accumulation of radioactive carbonized microspheres in dogs. A renal artery catheter equipped with a balloon was used to decrease renal blood flow unilaterally. One minute after the intravenous injection of 100 μCi of 131 I-hippurate, about 1 μCi of either 85 Sr- or 95 Nb-labeled carbon microspheres was injected into the left ventricle. Radioactivity was measured over both kidneys. The total radioactivity within each kidney region of interest was corrected for background and integrated over the 1 to 2 min interval after injection. Thirteen measurements of relative renal blood flow were made for seven dogs. The dogs were then killed and both kidneys were excised and counted for the radioactivity of the microspheres. The 1 to 2-min relative renal uptake of 131 I-hippurate correlated well with relative microsphere uptake, suggesting that relative renal blood flow can be simply determined from the external measurements of renal uptake of 131 I-hippurate

The Role of Vaginal Mesh Procedures in Pelvic Organ Prolapse Surgery in View of Complication Risk

Directory of Open Access Journals (Sweden)

David R. Ellington

2013-01-01

Full Text Available Synthetic transvaginal mesh has been employed in the treatment of pelvic organ prolapse for more than a decade. As the use of these devices increased during this period so did adverse event reporting. In 2008, the Food and Drug Administration (FDA Public Health Notification informed physicians and patients of rising concerns with the use of synthetic transvaginal mesh. Shortly thereafter and in parallel to marked increases in adverse event reporting within the Manufacturer and User Device Experience (MAUDE, the FDA released a Safety Communication regarding urogynecologic surgical mesh use. Following this report and in the wake of increased medical industry product withdrawal, growing medicolegal concerns, patient safety, and clinical practice controversy, many gynecologists and pelvic reconstructive surgeons are left with limited long-term data, clinical guidance, and growing uncertainty regarding the role of synthetic transvaginal mesh use in pelvic organ prolapse. This paper reviews the reported complications of synthetic transvaginal mesh with an evidence-based approach as well as providing suggested guidance for the future role of its use amidst the controversy.

The Role of Vaginal Mesh Procedures in Pelvic Organ Prolapse Surgery in View of Complication Risk

Science.gov (United States)

Ellington, David R.; Richter, Holly E.

2013-01-01

Synthetic transvaginal mesh has been employed in the treatment of pelvic organ prolapse for more than a decade. As the use of these devices increased during this period so did adverse event reporting. In 2008, the Food and Drug Administration (FDA) Public Health Notification informed physicians and patients of rising concerns with the use of synthetic transvaginal mesh. Shortly thereafter and in parallel to marked increases in adverse event reporting within the Manufacturer and User Device Experience (MAUDE), the FDA released a Safety Communication regarding urogynecologic surgical mesh use. Following this report and in the wake of increased medical industry product withdrawal, growing medicolegal concerns, patient safety, and clinical practice controversy, many gynecologists and pelvic reconstructive surgeons are left with limited long-term data, clinical guidance, and growing uncertainty regarding the role of synthetic transvaginal mesh use in pelvic organ prolapse. This paper reviews the reported complications of synthetic transvaginal mesh with an evidence-based approach as well as providing suggested guidance for the future role of its use amidst the controversy. PMID:24069035

Risk factors related to interfractional variation in whole pelvic irradiation for locally advanced pelvic malignancies

Energy Technology Data Exchange (ETDEWEB)

Yoon, W.S.; Yang, D.S.; Lee, J.A.; Lee, S.; Park, Y.J.; Kim, C.Y. [Korea Univ. Medical Center, Seoul (Korea, Republic of). Dept. of Radiation Oncology

2012-05-15

Purpose: The goal of the present study was to demonstrate risk factors affecting the interfractional variation in whole pelvic irradiation. Patients and methods: Daily image acquisitions of 101 patients with locally advanced pelvic malignancy were undertaken using a kilo-voltage orthogonal on-board imager. The baseline deviation (the shift between the initial treatment and each fraction; Value{sub Base}) and day-to-day variation (the shift between the previous treatment and each fraction; Value{sub DD}) were measured. The standard deviations (SD) along the x- (right-left), y- (cranial-caudal), and z- (anterior-posterior) axes (SD[x], SD[y], and SD[z], respectively), the 3D vector of the SD (SD[3D]), and the mean of 3D shift (mean[3D]) were calculated in each patient. Various clinical factors, lumbar pelvic balance and rotation, and the shift of 5 consecutive fractions from the initial treatment (Value{sub 5Fx}) were investigated as risk factors. Results: The prone set-up showed a larger mean{sub Base}[3D] than in the supine position (p =0.063). A body mass index (BMI) {>=} 30 kg/m{sup 2} resulted in the largest mean{sub DD}[3D] (p = 0.078) and SD{sub DD}[3D] (p = 0.058). All the SD{sub 5Fx} along the x-, y-, and z-axes had moderate linear relationships with SD{sub Base} and SD{sub DD} (p < 0.001). The SD{sub 5Fx}[3D] also had a moderate linear relationship with the mean{sub Base}[3D], mean{sub DD}[3D], SD{sub Base}[3D], and SD{sub DD}[3D] (p < 0.001). In multivariate analysis, the SD{sub 5Fx} had the same significant relationship with SD{sub Base} and SD{sub DD} (p < 0.001). A BMI {>=} 30 kg/m{sup 2} was associated with the largest SD{sub DD}[x] (p = 0.003). Conclusion: Close surveillance through high-quality and frequent image guidance is recommended for patients with extensive variations of the initial five consecutive fractions or obesity. (orig.)

Growth speed in patients with chronic renal failure undergoing to renal transplantation between 2000 and 2009 in the Hospital Nacional de Ninos: research protocol

International Nuclear Information System (INIS)

Arroyo Molina, Ana Victoria

2013-01-01

The growth speed was investigated in children with chronic renal failure after renal transplantation, in the Hospital Nacional de Ninos during the study period January 2000-December 2009. Factors that have influenced are analyzed: age of onset of renal disease, etiology of renal disease, metabolic acidosis, anemia, renal osteodystrophy, episodes of infection and rejection. Besides, on the growth rate and expected family size, to intervene or prevent them in future cases. Also, the use that has given in the hospital to growth hormone, before and after renal transplantation is determined to eventually use parallel therapies to the transplantation. An echocardiographic study is recommended to perform as part of the treatment of chronic renal failure to identify the existence of left ventricular hypertrophy and heart failure, which may occur as a result of complications of the failure [es

Double uterus with obstructed hemivagina and ipsilateral renal agenesis: pelvic anatomic variants in 87 cases.

Science.gov (United States)

Fedele, L; Motta, F; Frontino, G; Restelli, E; Bianchi, S

2013-06-01

What are the anatomic variants (and their frequencies) of double uterus, obstructed hemivagina and ipsilateral renal agenesis? Most cases examined (72.4%) were of the classic anatomic variant of the Herlyn-Werner-Wunderlich syndrome (with didelphys uterus, obstructed hemivagina and ipsilateral renal agenesis) but the 27.6% of cases are of a rare variant of the syndrome (with uterus septum or cervical agenesis), showing relevant clinical and surgical implications. The extreme variability of anatomic structures involved in this syndrome (both uterus, cervico-vaginal and renal anomalies) is well known, even if a complete and uniform analysis of all its heterogeneous presentations in a large series is lacking. This is a retrospective study with 87 patients referred to our third level referral center between 1981 and 2011. We analyzed the laparoscopic and chart records of 87 women, who referred to our institute with double uterus, unilateral cervico-vaginal obstruction and ipsilateral renal anomalies. Sixty-three of 87 patients had the more classic variant of didelphys uterus with obstructed hemivagina; 10/87 patients had septate bicollis uterus with obstructed hemivagina; 9/87 patients had bicornuate bicollis uterus with obstructed hemivagina; 4/87 patients had didelphys uterus with unilateral cervical atresia; 1/87 patients had bicornuate uterus with one septate cervix and unilateral obstructed hemivagina. This is a retrospective study with a long enrolling period (30 years). New insights in the anatomic variants of this rare syndrome with their relevant surgical implications.

Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction

OpenAIRE

Faubion, Stephanie S.; Shuster, Lynne T.; Bharucha, Adil E.

2012-01-01

Nonrelaxing pelvic floor dysfunction is not widely recognized. Unlike in pelvic floor disorders caused by relaxed muscles (eg, pelvic organ prolapse or urinary incontinence, both of which often are identified readily), women affected by nonrelaxing pelvic floor dysfunction may present with a broad range of nonspecific symptoms. These may include pain and problems with defecation, urination, and sexual function, which require relaxation and coordination of pelvic floor muscles and urinary and ...

Suprarenal fixation barbs can induce renal artery occlusion in endovascular aortic aneurysm repair.

Science.gov (United States)

Subedi, Shree K; Lee, Andy M; Landis, Gregg S

2010-01-01

Renal artery occlusion following endovascular abdominal aortic aneurysm repair with suprarenal fixation is uncommon. We report one patient who was found to develop renal artery occlusion and parenchymal infarction 6 months after repair using an endovascular graft with suprarenal fixation. Our patient underwent emergent endovascular repair of a symptomatic 6 cm abdominal aortic aneurysm. The covered portion of the endograft was inadvertently deployed well below the renal artery orifices. At the completion of the procedure both renal arteries were confirmed to be patent. One month postoperatively, a computed tomographic (CT) scan showed exclusion of the aortic sac and normal enhancement of both kidneys. At 6 months, the patient was found to have elevated serum creatinine levels despite having no clinical symptoms. CT scanning revealed a nonenhancing left kidney, and angiography demonstrated an occlusion of the left renal artery. A barb welded to the bare metal stent appeared to be impinging on the renal artery. We believe that renal artery occlusion after endovascular repair can occur due to repetitive injury to the renal artery orifice from barbs welded to the bare metal stent. To our knowledge, this is the first reported case of renal artery occlusion caused by repetitive injury from transrenal fixation systems. Copyright 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

Power doppler ultrasound findings of renal infarct after experimental renal artery occlusion: comparison with spiral CT

International Nuclear Information System (INIS)

Jung, Seung Eun; Shinn, Kyung Sub; Kim, Hak Hee; Mun, Seok Hwan; Lee, Young Joon; Lee, Bae Young; Choi, Byung Gil; Lee, Jae Mun; Lee, Hee Jeong

1999-01-01

To evaluate the efficacy of power Doppler ultrasonography (PDUS) in depicting renal infarction in rabbits during experimental renal segmental arterial occlusion, and to compare the results with those of CT scanning. In 28 rabbits weighing 2.5 4kg, the segmental renal artery was occluded through the left main renal artery by embolization with Ivalon (Nycomed, Paris, France). Power Doppler ultrasonography and spiral CT scanning were performed before and at 2, 5, 8, 15, and 24 hours, and 3 and 7 days after occlusion of the segmental renal artery. The location of infarcted areas and collaterals, as seen on PDUS and CT scans, was evaluated by two radiologists. In all cases, as seen on power Doppler ultrasonography, infarcted areas-when compared with normal parenchyma, clearly demonstrated wedge-shaped perfusion defects in the kidney. The location of the lesion closely corresponded to the location seen during CT scanning. After renal arterial occlusion, transiently congested capsular arteries, which were named 'capsular sign', were seen in 63% of rabbits in the two and five-hour groups. No significant cortical rim sign was demonstrated on power Doppler ultrasonography, though it was noted on spiral CT at 15 and 24 hours, and 3 and 7 days after renal arterial occlusion. Power Doppler ultrasonography was useful for the diagnosis of renal infarction. Congested capsular artery seen in the early stage of renal infarction might be a characteristic finding of this condition, as seen on power Doppler ultrasonography

Partial Renal Embolization for Pediatric Renovascular Hypertension Secondary to Fibromuscular Dysplasia

International Nuclear Information System (INIS)

Ishijima, Hideyuki; Ishizaka, Hiroshi; Sakurai, Minako; Ito, Kazuto; Endo, Keigo

1997-01-01

We report a 7-year-old boy with renovascular hypertension showing multiple stenoses and microaneurysms of the dorsal branch of the left renal artery caused by fibromuscular dysplasia. Hypertension was successfully treated with transcatheter alcohol and gelatin sponge embolization of the dorsal branch and its distribution. The vertebral branch remained intact. No severe complication was encountered. Loss of renal function by renal scintigraphy was minimal. The patient remains asymptomatic at 1 year

Renal morphology of Bradypus torquatus

Directory of Open Access Journals (Sweden)

Pedro Kastein Faria da Cunha Bianchi

2012-11-01

Full Text Available Among the Xenarthras, sloths present a hydric ingestion restricted to water from leaves, fruits, and vegetables. As a first approach to verify whether these animals have some morphophysiological difference which could justify or compensate this low hydric ingestion, the renal anatomy of these animals was investigated, particularly that of maned sloth (Bradypus torquatus. Kidneys from these animals were macroscopically analyzed, through light microscopy and scanning electron microscopy. The Bradypus torquatus kidneys are bean-shaped paired organs, located dorso-cranially to the pelvic girdle, between the peritoneum and the posterior abdominal wall. The use of histological techniques allowed us to identify, in the cortical region, the renal corpuscles and tubules, and, in the medullary region, a significant amount of interstitial tissue with a collecting duct. The results of this study showed that, although Bradypus torquatus doesn’t drink water directly, its kidneys doesn’t differ from that of most mammals, presenting the same anatomical structure, suggesting that these animals fully reach their hydric needs, basically by consuming leaves, fruits, and sprouts. Nevertheless, in order to confirm this hypothesis, studies on the effectiveness of water reabsorption, such as the renin-angiotensin-aldosterone system, must be carried out.

[Study of anatomy of the lateral attachment of the renal fascia in adult with multidetector computed tomography].

Science.gov (United States)

Qi, Rui; Zhou, Xianping; Yu, Jianqun; Chen, Weixia; Li, Zhenlin; Zhang, Chunle

2012-08-01

The present paper is aimed to observe the lateral attachment of the renal fascia (RF) in vivo with multidetector computed tomography (MDCT) scanning, and to discuss its diagnostic value. 121 healthy adults were adopted into this experiment. All images were obtained with MDCT and double phase enhancement scanning. Then we observed the lateral attachment of RF. In addition, we mad a fresh body specimen as anatomical basis. The study found that above the renal hilar plane (RHP), the anterior renal fascia laterally fused with the peritoneum of the liver on the right and the peritoneum of the spleen on the left,and the posterior renal fascia fused with the subdiaphragmatic fascia. The lateral attachment of the RF at the RHP and the lower renal pole(LRP)is divided into three types. The RF in Type I is about 47.9% (58/121) at the left RHP, while about 33.9% (41/121) at the right RHP. At the LRP of the kidney is about 55.3% (67/121) on the left, and about 42.1% (51/121) on the right. The RF in Type I is about 38.8% (47/121) on the left side at the RHP, about 26.4% (32/121) on the right side. At the LRP, left side about 27.3% (33/121), right side about 13.3%(16/121). The RF in Type III at the RHP is 13.3% (16/121) on the left side, and on the right side is about 39.7% (48/121). At the LRP, it is about 17.4% (21/121) on the left side, and about 44.6% (54/121) on the right side. MDCT can display the lateral attachment of the RF better as well as the outside connection of the retroperitoneal space.

MR imaging in female pelvic organs prolapse

International Nuclear Information System (INIS)

Capiel, Carlos A. h; Bouzas, Carlos A.

2003-01-01

Pelvic floor weakness and consequent organ prolapse may result in a variety of symptoms, including pain, urinary or fecal incontinence and constipation. Diagnosis is made primary on the basis of findings at physical pelvic examination. Imaging is useful in patients in whom findings at physical examination are equivocal. Different imaging techniques (fluoroscopy, ultrasonography), can be useful in evaluating pelvic organs prolapse. MR imaging is a new noninvasive technique that provides a multiplanar global evaluation of the pelvic contents and demonstrates pelvic organs prolapse. Reference points are the pubococcygeal line and puborectalis muscle sling. This pictorial assay illustrates different grades of cystourethrocele, recto-sigmoidocele and hysteroptosis (uterine prolapse) on MR imaging. (author)

An unusual case of Y-shaped right renal vein.

Science.gov (United States)

Lavy, M; Martin, L; Eouzan, D; Turco, C; Heyd, B; Mantion, G; Parratte, B; Tatu, L

2015-01-01

Vascular renal anomalies are frequent, multiple and well described and result from errors in vessel embryogenesis between the 6th and 10th week of gestation. Historically, variations are described in anatomic dissection and currently mostly in image interpretation. We report an anatomic variation concerning the right renal vein which, to our knowledge, has never been described in the literature either by dissection or by radiological examination. This variation was discovered during the routine dissection of an embalmed male body. It consists of a Y-shaped right renal vein and is associated with multiple retroperitoneal variations: a bilateral accessory renal artery, a trident ending of the right renal artery and a left testicular vein variation. Venous and arterial renal anatomy and its variations are fundamentally important in renal surgery, especially concerning living donor renal grafts. These variations may be diagnosed thanks to injected tomodensitometry which has a good sensitivity and specificity for anomalies. Preoperative diagnosis of an anatomic vascular renal variation may reduce morbidity during surgery, which is why precise examination of injected tomography should be mandatory.

Quantitative analysis of MR perfusion/diffusion images in a dog model of renal artery stenosis with microsphere correlation

International Nuclear Information System (INIS)

Lorens, C.H.; Powers, T.A.; Holburn, G.E.; Price, R.R.

1990-01-01

This paper compares MR perfusion/diffusion-derived parameters with microsphere determination of asymmetry of renal perfusion in a dog model of renal artery stenosis. A left renal artery stenosis was created by placement of a silk ligature. Nb-95-labeled microspheres were injected into the left ventricle, and a reference blood sample was drawn. The dog was imaged in a 1.5-T MR imager with both spin-echo and turbo-FLASH perfusion/diffusion-sensitive pulse sequences. The kidneys were excised, weighted, divided into sections, and counted. Two dogs have been studied to date. In dog 1, left renal blood flow (RBF) was 42 mL/min/100g and right RBF was 337 mL/min/100g. In dog 2 left RBF was 444 mL/min/100g and right RBF was 608 mL/min/100g. The apparent diffusion coefficients (ADC) reflected the asymmetry of flow in dog 1 for both spin-echo and turbo-FLASH sequences (RADC/LADC = 1.7) and showed essentially equal flow in dog 2(RADC/LADC = 0.7)

Frequency and clinical predictors of coronary artery disease in chronic renal failure renal transplant candidates.

Science.gov (United States)

de Albuquerque Seixas, Emerson; Carmello, Beatriz Leone; Kojima, Christiane Akemi; Contti, Mariana Moraes; Modeli de Andrade, Luiz Gustavo; Maiello, José Roberto; Almeida, Fernando Antonio; Martin, Luis Cuadrado

2015-05-01

Cardiovascular diseases are major causes of mortality in chronic renal failure patients before and after renal transplantation. Among them, coronary disease presents a particular risk; however, risk predictors have been used to diagnose coronary heart disease. This study evaluated the frequency and importance of clinical predictors of coronary artery disease in chronic renal failure patients undergoing dialysis who were renal transplant candidates, and assessed a previously developed scoring system. Coronary angiographies conducted between March 2008 and April 2013 from 99 candidates for renal transplantation from two transplant centers in São Paulo state were analyzed for associations between significant coronary artery diseases (≥70% stenosis in one or more epicardial coronary arteries or ≥50% in the left main coronary artery) and clinical parameters. Univariate logistic regression analysis identified diabetes, angina, and/or previous infarction, clinical peripheral arterial disease and dyslipidemia as predictors of coronary artery disease. Multiple logistic regression analysis identified only diabetes and angina and/or previous infarction as independent predictors. The results corroborate previous studies demonstrating the importance of these factors when selecting patients for coronary angiography in clinical pretransplant evaluation.

Morbidity and outcome of pelvic exenteration in locally advanced pelvic malignancies.

Science.gov (United States)

Ramamurthy, Rajaraman; Duraipandian, Amudhan

2012-09-01

Pelvic exenteration is a technically demanding surgical procedure performed for locally advanced cancers in the pelvis. Aim of the present study was to analyze morbidity, failure pattern and survival after pelvic exenteration during a period of 15 years in a dedicated cancer centre in South India. Retrospective analysis of case records of 50 patients who underwent pelvic exenteration from 1996 to 2011 in the Department of Surgical Oncology, Government Royapettah Hospital Chennai. Forty-six patients were females and 4 were males with a mean age of 48.3 years (range 21-72). Twenty six patients had cervical cancer,14 had rectal cancer, 3 had bladder cancer,2 had endometrial cancer, 2 had vaginal cancer, 1 had uterine sarcoma, 1 had anal cancer and 1 had ovarian cancer. The postoperative morbidity was 50%. 7 patients (14%) developed recurrence of which 5 had local and 2 had distant recurrence. The estimated 5 year overall survival for all patients in our series was 53.5% and for the patients with Ca rectum and Ca cervix was 60.6% and 40.1% respectively. Adjacent organ invasion had a significant impact over survival. Pelvic exenteration provides a curative form of treatment for carefully selected locally advanced cancer in the pelvis and it can be done safely with acceptable complications in centers experienced in multivisceral resections.

A Case of Atrial Tachycardia Circulating around a Left Atrial Roof Scar with Diabetes Mellitus and Renal Failure on Hemodialysis

Directory of Open Access Journals (Sweden)

Naoko Hijioka

2016-01-01

Full Text Available Introduction. Little is known about the effects of volume change by hemodialysis (HD and mechanical stress caused by an anatomical structure being in contact with the left atrium on the progression of atrial remodeling. We experienced a case of atrial tachycardia (AT in a patient who had left atrial (LA scarring at the LA roof and a low-voltage area with slow conduction around the LA scar as components of AT circuit. Here, we present the conceivable hypothesis of the LA scar and the low-voltage area formation. Our concept can be useful in developing a strategy for ablation in a patient with chronic renal failure (CRF on HD. Case Report. A 65-year-old man with CRF on HD was referred for AT ablation. Three-dimensional electroanatomical mapping revealed that the AT conducted around an LA scar in a counterclockwise fashion. There was a slow conduction area at the superior side of the LA scar, where the AT was terminated during the ablation. Computed tomography indicated a close relationship between the LA and the anatomical structures (ascending aorta and pulmonary artery. Conclusion. Volume change by HD and close contact of anatomical structures to the LA can promote atrial remodeling, resulting in AT occurrence.

Reconstruction of Complex Post-Traumatic Perineal/Pelvic Defects ...

African Journals Online (AJOL)

of the pelvic diaphragm). A composite pedicled. ALT flap was considered adequate for the initial reconstruction and stabilization, with the option of using a free fibular flap later, should the pelvic ring remain unstable. The fascia was used to complete the pelvic ring. It also provided anterior support to the pelvic diaphragm.

Sonographic determination of spleen to left kidney ratio among Igbo ...

African Journals Online (AJOL)

The weight and height of the subjects were obtained with the participants wearing light ... Results: Measurement of spleen and left kidney lengths were reliable within and between .... obtained in the coronal plane passing through the renal.

Renal angioplasty for atherosclerotic renal artery stenosis: Cardiologist′s perspective

Directory of Open Access Journals (Sweden)

A S Gulati

2013-01-01

Full Text Available Atherosclerotic renal artery stenosis (ARAS is frequently associated with concomitant coronary and peripheral arterial disease with a significant impact on cardiovascular morbidity and mortality. Renal angioplasty of ARAS is more challenging because of increased incidence of technical failures, complications, and restenosis; while there is barely perceptible control of hypertension and only marginal improvement in renal function. This is because most of the patient population in recent randomized trials had unmanifested or clinically silent renovascular disease. Manifestations of RAS should be looked for and incorporated in the management plan particularly before deciding for revascularization. In the absence of clinical manifestation like renovascular hypertension, ischemic nephropathy, left ventricular failure, or unstable coronary syndromes; mere presence of RAS is analogous to presence of concomitant peripheral arterial disease which increases risk of adverse coronary events. Dormant-RAS in the absence of any manifestations can be managed with masterly inactivity. Chronological sequence of events and clinical condition of the patient help in decision making by identifying progressive renovascular disease. Selecting patients for renal artery stenting who actually will benefit from revascularization shall also decrease the unnecessary complications inherent with any interventional procedure. The present review is an attempt to analyze the current view on the diagnostic and management issues more specifically about the need and rationale behind angioplasty.

Pelvic floor dysfunction, and effects of pregnancy and mode of delivery on pelvic floor

Directory of Open Access Journals (Sweden)

Murat Bozkurt

2014-12-01

Full Text Available Pelvic floor dysfunction (PFD, although seems to be simple, is a complex process that develops secondary to multifactorial factors. The incidence of PFD is increasing with increasing life expectancy. PFD is a term that refers to a broad range of clinical scenarios, including lower urinary tract excretory and defecation disorders, such as urinary and anal incontinence, overactive bladder, and pelvic organ prolapse, as well as sexual disorders. It is a financial burden on the health care system and disrupts women's quality of life. Strategies applied to decrease PFD are focused on the course of pregnancy, mode and management of delivery, and pelvic exercise methods. Many studies in the literature define traumatic birth, usage of forceps, length of the second stage of delivery, and sphincter damage as modifiable risk factors for PFD. Maternal age, fetal position, and fetal head circumference are nonmodifiable risk factors. Although numerous studies show that vaginal delivery affects pelvic floor structures and their functions in a negative way, there is not enough scientific evidence to recommend elective cesarean delivery in order to prevent development of PFD. PFD is a heterogeneous pathological condition, and the effects of pregnancy, vaginal delivery, cesarean delivery, and possible risk factors of PFD may be different from each other. Observational studies have identified certain obstetrical exposures as risk factors for pelvic floor disorders. These factors often coexist; therefore, the isolated effects of these variables on the pelvic floor are difficult to study. The routine use of episiotomy for many years in order to prevent PFD is not recommended anymore; episiotomy should be used in selected cases, and the mediolateral procedures should be used if needed.

Iliac vein stenosis is an underdiagnosed cause of pelvic venous insufficiency.

Science.gov (United States)

Santoshi, Ratnam K N; Lakhanpal, Sanjiv; Satwah, Vinay; Lakhanpal, Gaurav; Malone, Michael; Pappas, Peter J

2018-03-01

Reflux in the ovarian veins, with or without an obstructive venous outflow component, is reported to be the primary cause of pelvic venous insufficiency (PVI). The degree to which venous outflow obstruction plays a role in PVI is currently ill-defined. We retrospectively reviewed the charts of 227 women with PVI who presented to the Center for Vascular Medicine from January 2012 to September 2015. Assessments and interventions consisted of an evaluation for other causes of chronic pelvic pain by a gynecologist; preintervention and postintervention visual analog scale (VAS) pain score; complete venous duplex ultrasound examination; and Clinical, Etiology, Anatomy, and Pathophysiology classification. All patients underwent diagnostic venography of their pelvic and left ovarian veins as well as intravascular ultrasound of their iliac veins. Patients were treated in one of six ways: ovarian vein embolization (OVE) alone (chemical ± coils), OVE with staged iliac vein stenting, OVE with simultaneous iliac vein stenting, iliac vein stenting alone, OVE with venoplasty, and venoplasty alone. Of the 227 women treated, the average age and number of pregnancies was 46.4 ± 10.4 years and 3.36 ± 1.99, respectively. Treatment distribution was the following: OVE, n = 39; OVE with staged stenting, n = 94; OVE with simultaneous stenting, n = 33; stenting alone, n = 50; OVE with venoplasty, n = 8; and venoplasty alone, n = 3. Seven patients in the OVE and stenting groups (staged) and one patient in the OVE + venoplasty group required a second embolization of the left ovarian vein. Eighty percent (181/227) of patients demonstrated an iliac stenosis >50% by intravascular ultrasound. Average VAS scores for the entire cohort before and after intervention were 8.45 ± 1.11 and 1.86 ± 1.61 (P ≤ .001). In the staged group, only 9 of 94 patients reported a decrease in the VAS score with OVE alone. VAS score decreased from 8.6 ± 0.89 before OVE to 7.97 ± 2.10 after OVE

Transvaginal duplex ultrasonography appears to be the gold standard investigation for the haemodynamic evaluation of pelvic venous reflux in the ovarian and internal iliac veins in women.

Science.gov (United States)

Whiteley, M S; Dos Santos, S J; Harrison, C C; Holdstock, J M; Lopez, A J

2015-12-01

To assess the suitability of transvaginal duplex ultrasonography to identify pathological reflux in the ovarian and internal iliac veins in women. A retrospective study of patients treated in 2011 and 2012 was performed in a specialised vein clinic. Diagnostic transvaginal duplex ultrasonography in women presenting with symptoms or signs of pelvic vein reflux were compared with the outcomes of treatment from pelvic vein embolisation. A repeat transvaginal duplex ultrasonography was performed 6 weeks later by a blinded observer and any residual reflux was identified. Results from 100 sequential patients were analysed. Mean age 44.2 years (32-69) with mode average parity of 3 (0-5 deliveries). Pre-treatment, 289/400 veins were refluxing (ovarian - 29 right, 81 left; internal iliac - 93 right, 86 left). Coil embolisation was successful in 86/100 patients and failed partially in 14/100 - 5 due to failure to cannulate the target vein. One false-positive diagnosis was made. Currently there is no accepted gold standard for pelvic vein incompetence. Comparing transvaginal duplex ultrasonography with the outcome from selectively treating the veins identified as having pathological reflux with coil embolisation, there were no false-negative diagnoses and only one false-positive. This study suggests that transvaginal duplex ultrasonography could be the gold standard in assessing pelvic vein reflux. © The Author(s) 2014.

Simultaneous occurrence of a severe Morel-Lavallée lesion and gluteal muscle necrosis as a sequela of transcatheter angiographic embolization following pelvic fracture: a case report.

Science.gov (United States)

Shimizu, Takayoshi; Matsuda, Shuichi; Sakuragi, Atsushi; Tsukie, Tomio; Kawanabe, Keiichi

2015-03-26

Morel-Lavallée lesions are posttraumatic hemolymphatic collections caused by disruption of the interfascial planes between the subcutaneous soft tissue and muscle. Severe peripelvic Morel-Lavallée lesions have rarely been reported in the literature. By contrast, a number of cases of gluteal muscle necrosis following transcatheter angiographic embolization for pelvic fracture have been reported. Each entity can result in severe infection and sepsis, and the mortality rate in such cases is quite high. However, to date, no previous reports have described a case in which these life-threatening entities occurred simultaneously. A 32-year-old Asian man simultaneously developed severe peripelvic Morel-Lavallée lesions and gluteal muscle necrosis with sepsis following transcatheter angiographic embolization after an unstable pelvic fracture. Extremely large skin and soft tissue defects, which were untreatable with any commonly used flaps, were generated after repeated debridement. In addition, a deep-bone infection was suspected in his left fractured iliac bone, while motor function was almost completely lost in his left leg, possibly as a sequela of transcatheter angiographic embolization. As a result of his condition, a left hemipelvectomy was unavoidable. A pedicled fillet flap from his sacrificed left limb was used for the treatment of the defects and to provide a durable base for a prosthesis. Our patient survived and returned to his previous job 24 months after the surgery wearing a prosthetic left leg. As illustrated by the present case, severe peripelvic Morel-Lavallée lesions and gluteal muscle necrosis following transcatheter angiographic embolization can occur simultaneously after unstable pelvic fractures. Physicians should recognize that these entities can result in life-threatening sepsis and, therefore, should attempt to detect them as early as possible. When hemipelvectomy is unavoidable, a pedicled upper and lower leg in-continuity fillet flap may

Association between circulating fibroblast growth factor 23, α-Klotho, and the left ventricular ejection fraction and left ventricular mass in cardiology inpatients.

Directory of Open Access Journals (Sweden)

Kensaku Shibata

Full Text Available BACKGROUND: Fibroblast growth factor 23 (FGF23, with its co-receptor Klotho, plays a crucial role in phosphate metabolism. Several recent studies suggested that circulating FGF23 and α-Klotho concentrations might be related to cardiovascular abnormalities in patients with advanced renal failure. PURPOSE: Using data from 100 cardiology inpatients who were not undergoing chronic hemodialysis, the association of circulating levels of FGF23, α-Klotho, and other calcium-phosphate metabolism-related parameters with the left ventricular ejection fraction (LVEF and left ventricular mass (LVM was analyzed. METHODS AND RESULTS: LVEF was measured using the modified Simpson method for apical 4-chamber LV images and the LVM index (LVMI was calculated by dividing the LVM by body surface area. Univariate analysis showed that log transformed FGF23, but not that of α-Klotho, was significantly associated with LVEF and LVMI with a standardized beta of -0.35 (P<0.001 and 0.26 (P<0.05, respectively. After adjusting for age, sex, estimated glomerular filtration rate, and serum concentrations of intact parathyroid hormone, and 25-hydroxyvitamin D as covariates into the statistical model, log-transformed FGF23 was found to be a statistically positive predictor for decreased left ventricular function and left ventricular hypertrophy. CONCLUSIONS: In cardiology department inpatients, circulating FGF23 concentrations were found to be associated with the left ventricular mass and LVEF independent of renal function and other calcium-phosphate metabolism-related parameters. Whether modulation of circulating FGF23 levels would improve cardiac outcome in such a high risk population awaits further investigation.

Functional anatomy of pelvic floor

Directory of Open Access Journals (Sweden)

Salvatore Rocca Rossetti

2016-03-01

Full Text Available Generally, descriptions of the pelvic floor are discordant, since its complex structures and the complexity of pathological disorders of such structures; commonly the descriptions are sectorial, concerning muscles, fascial developments, ligaments and so on. On the contrary to understand completely nature and function of the pelvic floor it is necessary to study it in the most unitary view and in the most global aspect, considering embriology, philogenesy, anthropologic development and its multiple activities others than urological, gynaecological and intestinal ones. Recent acquirements succeeded in clarifying many aspects of pelvic floor activity, whose musculature has been investigated through electromyography, sonography, magnetic resonance, histology, histochemistry, molecular research. Utilizing recent research concerning not only urinary and gynecologic aspects but also those regarding statics and dynamics of pelvis and its floor, it is now possible to study this important body part as a unit; that means to consider it in the whole body economy to which maintaining upright position, walking and behavior or physical conduct do not share less than urinary, genital, and intestinal functions. It is today possible to consider the pelvic floor as a musclefascial unit with synergic and antagonistic activity of muscular bundles, among them more or less interlaced, with multiple functions and not only the function of pelvic cup closure.

Pelvic belt effects on pelvic morphometry, muscle activity and body balance in patients with sacroiliac joint dysfunction.

Directory of Open Access Journals (Sweden)

Odette Soisson

Full Text Available The sacroiliac joint (SIJ is frequently involved in low back and pelvic girdle pain. However, morphometrical and functional characteristics related to SIJ pain are poorly defined. Pelvic belts represent one treatment option, but evidence still lacks as to their pain-reducing effects and the mechanisms involved. Addressing these two issues, this case-controlled study compares morphometric, functional and clinical data in SIJ patients and healthy controls and evaluates the effects of short-term pelvic belt application.Morphometric and functional data pertaining to pelvic belt effects were compared in 17 SIJ patients and 17 controls. Lumbar spine and pelvis morphometries were obtained from 3T magnetic resonance imaging. Functional electromyography data of pelvis and leg muscles and center of pressure excursions were measured in one-leg stance. The numerical rating scale was used to evaluate immediate pain-reducing effects.Pelvic morphometry was largely unaltered in SIJ patients and also by pelvic belt application. The angle of lumbar lateral flexion was significantly larger in SIJ patients without belt application. Muscle activity and center of pressure were unaffected by SIJ pain or by belt application in one-leg stance. Nine of 17 patients reported decreased pain intensities under moderate belt application, four reported no change and four reported increased pain intensity. For the entire population investigated here, this qualitative description was not confirmed on a statistical significant level.Minute changes were observed in the alignment of the lumbar spine in the frontal plane in SIJ patients. The potential pain-decreasing effects of pelvic belts could not be attributed to altered muscle activity, pelvic morphometry or body balance in a static short-term application. Long-term belt effects will therefore be of prospective interest.

Pelvic Belt Effects on Pelvic Morphometry, Muscle Activity and Body Balance in Patients with Sacroiliac Joint Dysfunction

Science.gov (United States)

Soisson, Odette; Lube, Juliane; Germano, Andresa; Hammer, Karl-Heinz; Josten, Christoph; Sichting, Freddy; Winkler, Dirk; Milani, Thomas L.; Hammer, Niels

2015-01-01

Introduction The sacroiliac joint (SIJ) is frequently involved in low back and pelvic girdle pain. However, morphometrical and functional characteristics related to SIJ pain are poorly defined. Pelvic belts represent one treatment option, but evidence still lacks as to their pain-reducing effects and the mechanisms involved. Addressing these two issues, this case-controlled study compares morphometric, functional and clinical data in SIJ patients and healthy controls and evaluates the effects of short-term pelvic belt application. Methods Morphometric and functional data pertaining to pelvic belt effects were compared in 17 SIJ patients and 17 controls. Lumbar spine and pelvis morphometries were obtained from 3T magnetic resonance imaging. Functional electromyography data of pelvis and leg muscles and center of pressure excursions were measured in one-leg stance. The numerical rating scale was used to evaluate immediate pain-reducing effects. Results Pelvic morphometry was largely unaltered in SIJ patients and also by pelvic belt application. The angle of lumbar lateral flexion was significantly larger in SIJ patients without belt application. Muscle activity and center of pressure were unaffected by SIJ pain or by belt application in one-leg stance. Nine of 17 patients reported decreased pain intensities under moderate belt application, four reported no change and four reported increased pain intensity. For the entire population investigated here, this qualitative description was not confirmed on a statistical significant level. Discussion Minute changes were observed in the alignment of the lumbar spine in the frontal plane in SIJ patients. The potential pain-decreasing effects of pelvic belts could not be attributed to altered muscle activity, pelvic morphometry or body balance in a static short-term application. Long-term belt effects will therefore be of prospective interest. PMID:25781325

Pelvic belt effects on pelvic morphometry, muscle activity and body balance in patients with sacroiliac joint dysfunction.

Science.gov (United States)

Soisson, Odette; Lube, Juliane; Germano, Andresa; Hammer, Karl-Heinz; Josten, Christoph; Sichting, Freddy; Winkler, Dirk; Milani, Thomas L; Hammer, Niels

2015-01-01

The sacroiliac joint (SIJ) is frequently involved in low back and pelvic girdle pain. However, morphometrical and functional characteristics related to SIJ pain are poorly defined. Pelvic belts represent one treatment option, but evidence still lacks as to their pain-reducing effects and the mechanisms involved. Addressing these two issues, this case-controlled study compares morphometric, functional and clinical data in SIJ patients and healthy controls and evaluates the effects of short-term pelvic belt application. Morphometric and functional data pertaining to pelvic belt effects were compared in 17 SIJ patients and 17 controls. Lumbar spine and pelvis morphometries were obtained from 3T magnetic resonance imaging. Functional electromyography data of pelvis and leg muscles and center of pressure excursions were measured in one-leg stance. The numerical rating scale was used to evaluate immediate pain-reducing effects. Pelvic morphometry was largely unaltered in SIJ patients and also by pelvic belt application. The angle of lumbar lateral flexion was significantly larger in SIJ patients without belt application. Muscle activity and center of pressure were unaffected by SIJ pain or by belt application in one-leg stance. Nine of 17 patients reported decreased pain intensities under moderate belt application, four reported no change and four reported increased pain intensity. For the entire population investigated here, this qualitative description was not confirmed on a statistical significant level. Minute changes were observed in the alignment of the lumbar spine in the frontal plane in SIJ patients. The potential pain-decreasing effects of pelvic belts could not be attributed to altered muscle activity, pelvic morphometry or body balance in a static short-term application. Long-term belt effects will therefore be of prospective interest.

[The Life Impacts and Symptom Distress in Women With Pelvic Organ Prolapse Syndrome Before Pelvic Reconstruction Surgery].

Science.gov (United States)

Ko, I-Chen; Lo, Tsia-Shu; Lu, Yu-Ying; Tsao, Lee-Ing

2017-02-01

The decision whether or not to undergo pelvic reconstructive surgery is difficult for women suffering from pelvic organ prolapse. However, little research has examined the symptom distress and life impacts that these women face prior to this surgery. Thus, it is crucial that gynecology nurses learn about these life impacts and symptom distresses in order to help these women make the best decisions with regard to surgery. To explore the life impacts and degree of symptom distress in pre-surgery women with pelvic organ prolapse; to explore the relationships between demographic data and the variables of life impact and degree of symptom distress; and to identify the factors that relate to the explainable variance in the life impacts of these women. A cross-sectional and correlational research design was used and a total of 110 women with pelvic organ prolapse who had not yet undergone pelvic reconstruction surgery were recruited in the gynecological clinics of one medical center in Taiwan. Daytime urination frequency was the most prevalent urinary tract symptom noted by the participants; vaginal protrusion was the most prevalent pelvis-related symptom noted; and depression and anxiety were the most prevalent life impacts noted. Moreover, greater lower-urinary-tract symptom distress was associated with greater pelvic-symptom distress. Furthermore, greater lower urinary tract and pelvic symptom distresses were associated with a greater negative impact on life. Education background and pelvis-related symptoms were the explained variances in pre-surgery life impacts. Women with pelvic organ prolapse should pay particular attention to symptoms that include: daytime urinary frequency, vaginal protrusion, and emotional problems including depression and anxiety. Education background and level of symptom distress should be taken into consideration when caring for the life impacts of this vulnerable group of women.

A case report of bicornis bicollis uterus with unilateral cervical atresia: an unusual aetiology of chronic debilitating pelvic pain in a Cameroonian teenager.

Science.gov (United States)

Dohbit, Julius Sama; Meka, Esther; Tochie, Joel Noutakdie; Kamla, Igor; Mwadjie, Darolles; Foumane, Pascal

2017-06-02

Congenital uterine anomalies like bicornis or bicornuate uterus are relatively rare in sub-Saharan Africa. They are associated with an increased rate of spontaneous abortion, preterm delivery, and infertility. The occurrence of bicornis bicollis uterus with unilateral cervical atresia is exceptional and its management is controversial. We hereby report a rare cause of chronic pelvic pain in a Cameroonian teenager due to unilateral obstructive hematometra and hematosalpinx in the non-communicating horn of a bicornis bicollis uterus. A 13-year-old premenarchal non-virgin female presented with chronic and severe cyclical crampy pelvic pain. On clinical examination, she had a perforated hymen, a single vagina, and one uterine cervix. A two-dimensional pelvic ultrasonography revealed hematometra but missed out the underlying anomaly. Failure to drain the hematometra by serial cervical dilatations prompted an exploratory laparotomy which revealed: bicornis bicollis uterus with a right rudimentary uterine horn communicating with the vagina and a left non-communicating uterine horn distended by hematometra due to a homolateral cervical atresia. She underwent utero-vaginal canalization and a left hemi-hysterotomy with drainage of the hematometra. The postoperative period was uneventful. Regular cyclic menses occurred thereafter beginning at the first postoperative month. She had complete resolution of symptoms without recurrence after six months. Due to the risk of compromised fertility from bicornis uterus and the diagnostic challenges akin to resource-limited settings, we highlight the need for a high index of suspicion by healthcare providers when faced with chronic pelvic pain in premenarchal adolescents.

Early development of the human pelvic diaphragm

NARCIS (Netherlands)

Koch, Wijnandus Franciscus Robertus Maria

2006-01-01

The last decade an increasing interest in the pelvic floor can be observed in medical sciences. The lack of data on the development of the human pelvic floor is striking. The early development of the human pelvic diaphragm was studied. Materials and methodsUse was made of 38 human embryos and

[Revascularization surgery of an anuric solitary kidney using the left colic artery as a free graft].

Science.gov (United States)

da Gama, A Dinis; Nunes, J Silva; Cunha e Sá, Diogo; Pedro, Luís Mendes

2003-01-01

The thrombotic occlusion of one renal artery may become completely asymptomatic, due to the functionality of the contralateral kidney. However, in rare circumstances, such is the case of individuals with a solitary kidney, a situation of anuria and acute renal failure may constitute the main presentation of the condition. The authors report the clinical case of a 43 year old male patient, with the previous diagnosis of an infrarenal aortic occlusion and a single left kidney, who developed a thrombotic occlusion of the renal artery, with anuria and acute renal failure. The patient underwent an emergency revascularization procedure, consisting in the implantation of a prosthetic bypass graft from the superceliac aorta to the renal artery, with immediate recovery of the diuresis and renal function. Seventeen months later as a consequence of an anastomotic hyperplasia, an occlusion of the bypass graft occurred, again with anuria and acute renal failure. The patient was reoperated on and due to the inadequacy of both saphenous veins to be used as the material of choice for the revascularization procedure, a redundant segment of the left colic artery (Riolan's arcade) was removed and used as an interposition graft, from the middle colic artery to the renal artery, followed by an immediate restoration of diuresis and renal function. The singular and recurrent character of this clinical condition and the utilization of an original, eventually unique and well succeeded revascularization procedure, prompted its presentation and divulgation.

[Continuous improvement of portable domestic pelvic floor neuromuscular electrical stimulation on the pelvic floor function of patients with urinary incontinence].

Science.gov (United States)

Sun, Zhijing; Zhu, Lan; Lang, Jinghe; Wang, Wei; Shi, Honghui; Pang, Hongxia; Shi, Xinwen

2015-12-01

To evaluate continuous improvement of portable domestic pelvic floor neuromuscular electrical stimulation on the pelvic floor function of patients with stress urinary incontinence after short-term pelvic floor electrophysiological treatment in hospital. Totally 60 women with stress urinary incontinence were recruited for this randomized controlled trial. The control group including a total of 30 patients, only received 4 weeks pelvic floor electrophysiological treatment in the hospital. Family consolidation treatment group (experimental group) including 30 patients, after 4-week treatment in hospital, received 12-week of pelvic floor neuromuscular electrical stimulation using portable electrical stimulator at home under the guidance of doctors. In post-treatment 6 months and 9 months, 1-hour pad test was measured for urine leakage, pelvic floor electrical physiological parameters were assessed, and subjective improvement of symptoms of urinary incontinence were evaluated. All these data were analysed to compare the effect of the two groups. In 9 months after treatment, average change of urine leakage, the control group and experiment group were (75±24)% versus (99±3)%, the difference was statistically significant (Pcontinuous improvement of pelvic floor function.

Magnetic resonance imaging of pelvic floor dysfunction.

Science.gov (United States)

Lalwani, Neeraj; Moshiri, Mariam; Lee, Jean H; Bhargava, Puneet; Dighe, Manjiri K

2013-11-01

Pelvic floor dysfunction is largely a complex problem of multiparous and postmenopausal women and is associated with pelvic floor or organ descent. Physical examination can underestimate the extent of the dysfunction and misdiagnose the disorders. Functional magnetic resonance (MR) imaging is emerging as a promising tool to evaluate the dynamics of the pelvic floor and use for surgical triage and operative planning. This article reviews the anatomy and pathology of pelvic floor dysfunction, typical imaging findings, and the current role of functional MR imaging. Copyright © 2013 Elsevier Inc. All rights reserved.

Proof in nuclear medicine of venous flow impairments in the area of the legs and the pelvic

International Nuclear Information System (INIS)

Mostbeck, A.; Lofferer, O.; Partsch, H.

1976-01-01

Based upon experience with 563 patients, the 131I fibrinogen test has proven a reliable method for the diagnosis of acute leg vein thrombosis. Investigations correlated by means of roentgenological phlebography performed by routine technique in 83 patients showed similar results in 77% of the cases. Analyzing the negative results of 23%, we consider 19% of the discrepancies to be due to faulty phlebographic and 4% to faulty fibrinogen results. Phlebography may reveal false positive results in recurrent thrombosis of the lower legs. The fibrinogen test may reveal false positive results after trauma, fractures, and in cases of superficial phlebitis and arthritis. Pelvic venous occlusions are detectable by radionuclid venography. This method is non-invasive (injection of 99m Tc albumin particles or microspheres in less than 1 ml, by means of a very thin needle into a dorsal foot vein). A lung scan is obtained in every examination. The results conformed in 89% of 250 patients with those obtained from Doppler ultrasonic investigations. Two thirds of all pelvic vein thromboses were located on the left side. Perfusion defects of the lungs were probably caused by pulmonary embolism (lung scanning) and were found in an average of 54% of all leg and pelvic vein thromboses (in thrombosis of the lower legs in 35%, of the thigh in 57% and of the pelvic vein in 70%). These figures are in good conformity with pathological-anatomical data concerning the frequency of pulmonary emboli and infarctions in leg and pelvic vein thrombosis. (Author)

Knowledge of the pelvic floor in nulliparous women

OpenAIRE

Neels, Hedwig; Wyndaele, Jean-Jacques; Tjalma, Wiebren A. A.; De Wachter, Stefan; Wyndaele, Michel; Vermandel, Alexandra

2016-01-01

[Purpose] Proper pelvic floor function is important to avoid serious dysfunctions including incontinence, prolapse, and sexual problems. The current study evaluated the knowledge of young nulliparous women about their pelvic floor and identified what additional information they wanted. [Subjects and Methods] In this cross-sectional survey, a validated, 36 item questionnaire was distributed to 212 nulliparous women. The questionnaire addressed demography, pelvic floor muscles, pelvic floor dys...

Imaging findings in idiopathic pelvic fibrosis

International Nuclear Information System (INIS)

Wiesner, W.; Bongartz, G.; Stoffel, F.

2001-01-01

Two patients presented with ureteric obstruction, and voiding symptoms and constipation, respectively, and were examined by means of intravenous urography and computed tomography. One patient was additionally examined by means of MR tomography. After CT (performed in both patients) and MRT (performed in one patient) had shown a diffuse, contrast-enhancing, infiltrating process in the small pelvis with infiltration of adjacent organs and vessels, surgical biopsy proved the diagnosis of idopathic pelvic fibrosis. Extension of retroperitoneal fibrosis below the pelvic rim is very rare. Clinical symptoms of pelvic fibrosis are variable and imaging findings may lead to a broad list of differential diagnoses. We present two patients with idiopathic pelvic fibrosis and discuss radiological findings and differential diagnoses of this rare disease. (orig.)

Imaging findings in idiopathic pelvic fibrosis

Energy Technology Data Exchange (ETDEWEB)

Wiesner, W.; Bongartz, G. [Inst. of Diagnostic Radiology University Hospital Basel (Switzerland); Stoffel, F. [Inst. of Urology, University Hospital Basel (Switzerland)

2001-04-01

Two patients presented with ureteric obstruction, and voiding symptoms and constipation, respectively, and were examined by means of intravenous urography and computed tomography. One patient was additionally examined by means of MR tomography. After CT (performed in both patients) and MRT (performed in one patient) had shown a diffuse, contrast-enhancing, infiltrating process in the small pelvis with infiltration of adjacent organs and vessels, surgical biopsy proved the diagnosis of idopathic pelvic fibrosis. Extension of retroperitoneal fibrosis below the pelvic rim is very rare. Clinical symptoms of pelvic fibrosis are variable and imaging findings may lead to a broad list of differential diagnoses. We present two patients with idiopathic pelvic fibrosis and discuss radiological findings and differential diagnoses of this rare disease. (orig.)

Physical activity and the pelvic floor.

Science.gov (United States)

Nygaard, Ingrid E; Shaw, Janet M

2016-02-01

Pelvic floor disorders are common, with 1 in 4 US women reporting moderate to severe symptoms of urinary incontinence, pelvic organ prolapse, or fecal incontinence. Given the high societal burden of these disorders, identifying potentially modifiable risk factors is crucial. Physical activity is one such potentially modifiable risk factor; the large number of girls and women participating in sport and strenuous training regimens increases the need to understand associated risks and benefits of these exposures. The aim of this review was to summarize studies reporting the association between physical activity and pelvic floor disorders. Most studies are cross-sectional and most include small numbers of participants. The primary findings of this review include that urinary incontinence during exercise is common and is more prevalent in women during high-impact sports. Mild to moderate physical activity, such as brisk walking, decreases both the odds of having and the risk of developing urinary incontinence. In older women, mild to moderate activity also decreases the odds of having fecal incontinence; however, young women participating in high-intensity activity are more likely to report anal incontinence than less active women. Scant data suggest that in middle-aged women, lifetime physical activity increases the odds of stress urinary incontinence slightly and does not increase the odds of pelvic organ prolapse. Women undergoing surgery for pelvic organ prolapse are more likely to report a history of heavy work than controls; however, women recruited from the community with pelvic organ prolapse on examination report similar lifetime levels of strenuous activity as women without this examination finding. Data are insufficient to determine whether strenuous activity while young predisposes to pelvic floor disorders later in life. The existing literature suggests that most physical activity does not harm the pelvic floor and does provide numerous health benefits for

Intra-abdominal gout mimicking pelvic abscess

International Nuclear Information System (INIS)

Chen, Chia-Hui; Chen, Clement Kuen-Huang; Yeh, Lee-Ren; Pan, Huay-Ban; Yang, Chien-Fang

2005-01-01

Gout is the most common crystal-induced arthritis. Gouty tophi typically deposit in the extremities, especially toes and fingers. We present an unusual case of intrapelvic tophaceous gout in a patient suffering from chronic gouty arthritis. CT and MRI of the abdomen and pelvic cavity disclosed calcified gouty tophi around both hips, and a cystic lesion with peripheral enhancement in the pelvic cavity along the course of the iliopsoas muscle. The intra-abdominal tophus mimicked pelvic abscess. (orig.)

Intra-abdominal gout mimicking pelvic abscess

Energy Technology Data Exchange (ETDEWEB)

Chen, Chia-Hui; Chen, Clement Kuen-Huang [Kaohsiung Veterans General Hospital, Department of Radiology, Kaohsiung (Taiwan); National Yang-Ming University, School of Medicine, Taipei (Taiwan); Yeh, Lee-Ren; Pan, Huay-Ban; Yang, Chien-Fang [Kaohsiung Veterans General Hospital, Department of Radiology, Kaohsiung (Taiwan)

2005-04-01

Gout is the most common crystal-induced arthritis. Gouty tophi typically deposit in the extremities, especially toes and fingers. We present an unusual case of intrapelvic tophaceous gout in a patient suffering from chronic gouty arthritis. CT and MRI of the abdomen and pelvic cavity disclosed calcified gouty tophi around both hips, and a cystic lesion with peripheral enhancement in the pelvic cavity along the course of the iliopsoas muscle. The intra-abdominal tophus mimicked pelvic abscess. (orig.)

Gynecological pelvic pain as emergency pathology.

Science.gov (United States)

Rivera Domínguez, A; Mora Jurado, A; García de la Oliva, A; de Araujo Martins-Romeo, D; Cueto Álvarez, L

Acute pelvic pain is a common condition in emergency. The sources of acute pelvic pain are multifactorial, so it is important to be familiar with this type of pathologies. The purpose of this article is review the main causes of gynecological acute pelvic pain and their radiologic appearances to be able to make an accurate diagnosis and provide objective criteria for patient management. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

An Atraumatic Symphysiolysis with a Unilateral Injured Sacroiliac Joint in a Patient with Cushing’s Disease: A Loss of Pelvic Stability Related to Ligamentous Insufficiency?

Directory of Open Access Journals (Sweden)

Andreas Höch

2016-01-01

Full Text Available Glucocorticoids are well known for altering bone structure and elevating fracture risk. Nevertheless, there are very few reports on pelvic ring fractures, compared to other bones, especially with a predominantly ligamentous insufficiency, resulting in a rotationally unstable pelvic girdle. We report a 39-year-old premenopausal woman suffering from an atraumatic symphysiolysis and disruption of the left sacroiliac joint. She presented with external rotational pelvic instability and immobilization. Prior to the injury, she received high-dose glucocorticoids for a tentative diagnosis of rheumatoid arthritis over two months. This diagnosis was not confirmed. Other causes leading to the unstable pelvic girdle were excluded by several laboratory and radiological examinations. Elevated basal cortisol and adrenocorticotropic hormone levels were measured and subsequent corticotropin-releasing hormone stimulation, dexamethasone suppression test, and petrosal sinus sampling verified the diagnosis of adrenocorticotropic hormone-dependent Cushing’s disease. The combination of adrenocorticotropic hormone-dependent Cushing’s disease and the additional application of exogenous glucocorticoids is the most probable cause of a rare atraumatic rotational pelvic instability in a premenopausal patient. To the authors’ knowledge, this case presents the first description of a rotationally unstable pelvic ring fracture involving a predominantly ligamentous insufficiency in the context of combined exogenous and endogenous glucocorticoid elevation.

Triple pelvic ring fixation in patients with severe pregnancy-related low back and pelvic pain.

NARCIS (Netherlands)

Zwienen, C.M. van; Bosch, E.W. van den; Snijders, C.J.; Vugt, A.B. van

2004-01-01

STUDY DESIGN: Single-group prospective follow-up study. OBJECTIVES: To assess the functional outcome of internal fixation of the pelvic ring in patients with severe pregnancy-related low back and pelvic pain (PLBP) in whom all other treatments failed. BACKGROUND DATA: More than half of all pregnant

Sciatica due to pelvic hematoma: case report

Directory of Open Access Journals (Sweden)

Kocaman Umit

2016-12-01

Full Text Available Sciatica is defined as pain in the sciatic nerve distribution. The most common reason of sciatica is radiculopathy due to lumbar disc hernia. Other causes can be congenital, acquired, infectious, neoplastic, or inflammatory. The piriformis syndrome is another cause. The pain starts in an insidious manner when the cause of sciatica is an extraspinal tumor. It is intermittent at first but a constant and progressive pain that does not decrease with position or rest gradually develops in all patients. The possibility of an intraabdominal or pelvic mass should always be considered and the relevant tests requested when the cause of the sciatica cannot be explained. We present an 83-year-old male who presented with non-traumatic and non-vascular lumbosacral plexopathy due to a large hematoma in the left adductor muscle following the use of warfarin sodium.

Diuretic 99mTc DTPA renography in assessment of renal function and drainage in infants with antenatally detected hydronephrosis.

Science.gov (United States)

Radulović, Marija; Pucar, Dragan; Jauković, Ljiljana; Sisić, Marija; Krstić, Zoran; Ajdinović, Boris

2015-12-01

The controversy over the postnatal management of infants with antenataly detected hydronephrosis (ANH) still exists. We presented the results of diuretic 99mTc diethylenetriamine pentaacetic acid (DTPA) renography in 30 infants with the antenatal diagnosis of unilateral renal pelvic dilatation. The aim of this study was to assess the renal function determined by the pattern of drainage and split renal function (SRF) on diuretic renography and to correlate these findings with anteroposterior pelvic diameter (APD) estimated by ultrasonography. A total of 30 infants with 60 renal units (RU) (25 boys and 5 girls, median age 6.0 months, range 2-24) presented with unilateral hydronephrosis on ultrasound in the newborn period, underwent DTPA diuretic renal scintigraphy (F+15 protocol). The median APD evaluated on perinatal ultrasound was 15 mm (range 5-30). The postnatal associated clinical diagnosis were pelviureteric junction obstruction (PUJ), simple hydronephrosis, megaureter, vesicoureteral reflux (VUR) and posterior urethral valves in 11, 10, 6, 2 and 1 infant, respectively. Images and Tmax/2 after diuretic stimulation on the background subtracted renographic curves were used as the criteria for classifying the drainage as good, partial, and poor or no drainage. The SRF was calculated with the integral method. Good drainage was shown in 36/60, partial drainage in 13/60 and poor or no drainage in 11/60 RU. The SRF > 40% was observed in 55/60 RU, with no RU showing SRF lower than 23.5%. In infants with severe ANH the obstruction was not excluded in 94.1%. Diuretic renography in antenatally detected hydronephrosis should be a useful tool in postnatal follow up, especially in differentiating nonobstructive hydronephrosis from obstructive. It is also importanat to assess and monitor the SRF. Our results suggest that even in the presence of partial or no drainage, SRF may not be significantly impaired.

Computed Tomography and Ultrasound Diagnosis of Spontaneous Subcapsular Renal Hematoma

Directory of Open Access Journals (Sweden)

Samer Assaf

2018-01-01

Full Text Available History of present illness: A 58-year-old female with history of thrombotic disorder presented to emergency department (ED with constant, sharp pain in her lower abdomen radiating to her back for the past day. She denied nausea, vomiting, changes in bowel habits, or recent abdominal trauma. The patient had been recently transitioned from warfarin to enoxaparin after having a shoulder surgery one week prior to her presentation. On exam, the patient was tachycardic, hypotensive, and pale. She had significant abdominal tenderness to the left upper and lower quadrants, and left flank. Her initial hemoglobin (Hbg was 8.9 g/dL, but dropped to 6.1 g/dL during her ED course, requiring emergent blood transfusion. Significant findings: Bedside ultrasound was performed and demonstrated a hypoechoic area within the left kidney (images not shown. The non-contrast computed tomography (CT of the abdomen and pelvis shows a significantly enlarged left kidney and a region of high-attenuation encapsulating the left kidney, concerning for acute hemorrhage. Discussion: The cause for spontaneous subcapsular renal hematoma (SPH is not entirely clear.1 It may mimic acute appendicitis or a dissecting aneurysm.2 The use of ultrasound in the emergency setting can detect SPH; however, CT is preferred because it can distinguish between a renal mass, abscess, or collection of blood.3 Most SPH cases are associated with renal tumors, and radical nephrectomy is recommended.4 When the etiology cannot be determined, conservative management may be appropriate.5 The use of anticoagulant and antiplatelet medications may be a predisposing factor, since their usage has been implicated in cases of SPH in the past.4,6 This patient was evaluated by interventional radiology, but she was not a candidate for embolization due to a significant contrast allergy. She was therefore admitted to general surgery and underwent exploratory laparotomy. A left-sided adrenal mass was discovered with

Laparoscopic treatment of UPJ obstruction in ectopic pelvic kidneys in children

Directory of Open Access Journals (Sweden)

A. Marte

2012-10-01

Full Text Available Aims: to assess the feasibility and safety of a laparoscopic approach to uPJ obstruction (uPJo in ectopic pelvic kidneys. Material and Methods: in a retrospective analysis we selected 14 children, aged 6months to 17 years, 12 males, 2 females, who had been treated in our department between January 2004 and June 2011. 9 patients presented ureteropelvic junction obstruction (in 3 cases pelvic stones coexisted with normal/moderately reduced (≥25% relative function at radionuclide scan (MAg3, 3 nonfunctioning kidneys associated or not to hypertension, 2 congenital hypo-dysplastic kidneys. the evaluation of each patient involved the medical history, ultrasound examination, VCug, MAg3 diuresis renogram and Mri in some cases. of the patients presenting uPJo, 5 underwent dismembered pyeloplasty with pyelolithotomy, if required, and 4 pelvic derotation with straightening of the uretero-pelvic junction. A previous cystoscopic placement of a double J stent was utilized. this facilitated the identification and dissection around the pelvis. With the patient in trendelenburg position we utilized an umbilical trocar and two trocar in the right and left iliac fossae; an additional trocar, when required, was inserted more cephalad on the midclavear line contralaterally to the lesion. the derotation of ureteropelvic junction was obtained by freeing the kidney’s lower pole and by placing intraperitoneally the junction protected with a double J stent. this was obtained by suturing the peritoneum behind the ureteropelvic junction resulting in a forward rotation of the major axis of the kidney and a straightening of the junction. the 5 patients presenting nonfunctioning ectopic kidneys underwent laparoscopic nephrectomy. While the removal of congenital hypoplasic kidneys resulted easy, the removal of nonfunctioning kidneys was more difficult due to their complex vascular situation and for the embryonic disposition. Results: the operating time varied between 40 to

Radiographic assessment of pelvic trauma

International Nuclear Information System (INIS)

Rubenstein, J.D.

1983-01-01

Assessment of pelvic fractures requires an understanding of the bony and soft-tissue anatomy of the pelvis. Pelvic injuries may be classified into major and minor groups. Minor fractures usually result from athletic trauma in the young or falls in the elderly and can generally be adequately evaluated with routine radiography. Major fractures are most often caused by motor vehicle accidents, falls from a height or industrial accidents and require more sophisticated examination. However, the investigation of injuries in either category should be directed by a knowledge of the history and physical findings. The classification of pelvic injuries used at Sunnbrook Medical Centre is based on mechanisms of injury

Large Renal Artery Aneurysm Treated with Guglielmi Detachable Coils: Procedural and 4-Year Follow-up Results

International Nuclear Information System (INIS)

Damascelli, Bruno; Bartorelli, Antonio L.; Ticha, Vladimira; Trabattoni, Daniela; Lanocita, Rodolfo

2008-01-01

A large aneurysm of the left renal artery was found incidentally during abdominal ultrasound in a 39-year-old woman with no medical or family history of cardiovascular disease. Vascular pathology with a dysplastic appearance was confirmed by magnetic resonance angiography and the patient was offered transcatheter embolization. Since the position and size of the neck of the aneurysm could not be determined at angiography, detachable platinum coils were used for occlusion. The procedure was performed without complications. During a 4-year follow-up no alterations of renal function, recanalization of the aneurysm, or perfusion defects in the rest of the left renal circulation were noted.

Laparoscopic Pelvic Exenteration for Locally Advanced Rectal Cancer, Technique and Short-Term Outcomes.

Science.gov (United States)

Pokharkar, Ashish; Kammar, Praveen; D'souza, Ashwin; Bhamre, Rahul; Sugoor, Pavan; Saklani, Avanish

2018-05-09

Since last two decades minimally invasive techniques have revolutionized surgical field. In 2003 Pomel first described laparoscopic pelvic exenteration, since then very few reports have described minimally invasive approaches for total pelvic exenteration. We report the 10 cases of locally advanced rectal adenocarcinoma which were operated between the periods from March 1, 2017 to November 11, 2017 at the Tata Memorial Hospital, Mumbai. All male patients had lower rectal cancer with prostate involvement on magnetic resonance imaging (MRI). One female patient had uterine and fornix involvement. All perioperative and intraoperative parameters were collected retrospectively from prospectively maintained electronic data. Nine male patients with diagnosis of nonmetastatic locally advanced lower rectal adenocarcinoma were selected. All patients were operated with minimally invasive approach. All patients underwent abdominoperineal resection with permanent sigmoid stoma. Ileal conduit was constructed with Bricker's procedure through small infraumbilical incision (4-5 cm). Lateral pelvic lymph node dissection was done only when postchemoradiotherapy MRI showed enlarged pelvic nodes. All 10 patients received neoadjuvant chemo radiotherapy, whereas 8 patients received additional neoadjuvant chemotherapy. Mean body mass index was 21.73 (range 19.5-26.3). Mean blood loss was 1000 mL (range 300-2000 mL). Mean duration of surgery was 9.13 hours (range 7-13 hours). One patient developed paralytic ileus, which was managed conservatively. One patient developed intestinal obstruction due to herniation of small intestine behind the left ureter and ileal conduit. The same patient developed acute pylonephritis, which was managed with antibiotics. Mean postoperative stay was 14.6 days (range 9-25 days). On postoperative histopathology, all margins were free of tumor in all cases. Minimally invasive approaches can be used safely for total pelvic exenteration in locally advanced

Double-barrelled wet colostomy formation after pelvic exenteration for locally advanced or recurrent rectal cancer.

Science.gov (United States)

Bloemendaal, A L A; Kraus, R; Buchs, N C; Hamdy, F C; Hompes, R; Cogswell, L; Guy, R J

2016-11-01

In advanced pelvic cancer it may be necessary to perform a total pelvic exenteration. In such cases urinary tract reconstruction is usually achieved with the creation of an ileal conduit with a urinary stoma on the right side of the patient's abdomen and an end colostomy separately on the left. The potential morbidity from a second stoma may be avoided by the use of a double-barrelled wet colostomy (DBWC), as a single stoma. Another advantage is the possibility of using a vertical rectus abdominis muscle flap for perineal reconstruction. All patients undergoing formation of a DBWC were included. A DBWC was formed in 10 patients. One patient underwent formation of a double-barrelled wet ileostomy. In this technical note we present our early experience in 11 cases and a video of DBWC formation in a male patient. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

A randomized clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength.

Science.gov (United States)

Culligan, Patrick J; Scherer, Janet; Dyer, Keisha; Priestley, Jennifer L; Guingon-White, Geri; Delvecchio, Donna; Vangeli, Margi

2010-04-01

The purpose of this study is to determine whether a Pilates exercise program and a pelvic floor muscle-training (PFMT) program could provide similar improvements in pelvic muscle strength. Sixty-two women with little or no pelvic floor dysfunction were randomized to Pilates or PFMT. Each group had 24 biweekly 1-h sessions with either a physical therapist or Pilates instructor. Strength was measured via perineometry (cmH(2)O). Two questionnaires--pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7)--were also collected. At baseline, the Pilates and PFMT groups measured 14.9 +/- 12.5 and 12.5 +/- 10.4 cmH(2)O, respectively (p = 0.41). Both the Pilates and PFMT groups got stronger (6.2 +/- 7.5 cmH(2)O, p = 0.0002 and 6.6 +/- 7.4 cmH(2)O, p = 0.0002, respectively), with no difference between groups p = 0.85. PFIQ and PFDI scores improved from baseline but not between groups. Further study is required to determine if Pilates can actually treat pelvic floor dysfunction.

The Number of Positive Pelvic Lymph Nodes and Multiple Groups of Pelvic Lymph Node Metastasis Influence Prognosis in Stage IA-IIB Cervical Squamous Cell Carcinoma

Directory of Open Access Journals (Sweden)

Yu Liu

2015-01-01

Full Text Available Background: Pelvic lymph node metastasis (LNM is an important prognostic factor in cervical cancer. Cervical squamous cell carcinoma accounts for approximately 75-80% of all cervical cancers. Analyses of the effects of the number of positive lymph nodes (LNs, unilateral versus bilateral pelvic LNM and a single group versus multiple groups of pelvic LNM on survival and recurrence of cervical squamous cell carcinoma are still lacking. The study aimed to analyze the effects of the number of positive pelvic LNs and a single group versus multiple groups of pelvic LNM on survival and recurrence. Methods: We performed a retrospective review of 296 patients diagnosed with Stage IA-IIB cervical squamous cell carcinoma who received extensive/sub-extensive hysterectomy with pelvic lymphadenectomy/pelvic LN sampling at Peking University People′s Hospital from November 2004 to July 2013. Ten clinicopathological variables were evaluated as risk factors for pelvic LNM: Age at diagnosis, gravidity, clinical stage, histological grade, tumor diameter, lymph-vascular space involvement (LVSI, depth of cervical stromal invasion, uterine invasion, parametrial invasion, and neoadjuvant chemotherapy. Results: The incidence of pelvic LNM was 20.27% (60/296 cases. Pelvic LNM (P = 0.00 was significantly correlated with recurrence. Pelvic LNM (P = 0.00, the number of positive pelvic LNs (P = 0.04 and a single group versus multiple groups of pelvic LNM (P = 0.03 had a significant influence on survival. Multivariate analysis revealed that LVSI (P = 0.00, depth of cervical stromal invasion (P = 0.00 and parametrial invasion (P = 0.03 were independently associated with pelvic LNM. Conclusions: Patients with pelvic LNM had a higher recurrence rate and poor survival outcomes. Furthermore, more than 2 positive pelvic LNs and multiple groups of pelvic LNM appeared to identify patients with worse survival outcomes in node-positive IA-IIB cervical squamous cell carcinoma. LVSI

Effect of Hemodialysis on Left and Right Ventricular Volume and Function

International Nuclear Information System (INIS)

Han, Jin Suk; Koh, Chang Soon

1985-01-01

With the improvement of hemodialysis, the course of thc discase in patient with endstage renal disease has been clearly improved. Nevertheless, among several shortcomings to our present mode of renal replacement therapy, cardiovascular complications have been the leading cause of morbidity and mortality. Several factors such as anemia, arteriovenous shunting of blood, intermittent extracorporeal circulation and hypertension may be contributing. But little is known about the quantitative cardiac hemodynamic characteristics occurred during hemodialysis. The purpose of this study is to observe the sequential hemodynamic changes before, during and after the hemodialysis and to investigate: reliable parameters in the detection of ventricular dysfunction. In the present study, equilibrium radionuclide cardiac angiography was performed and left and right ventricular volume indices, ejection phase indices of both ventricular, performance were measured in the 16 stable patients with chronic renal failure treated with maintenance hemodialysis sequentially i.e. before, during (carly and late phase) and after the hemodialysis. The results obtained were as follows; 1) The indices of the left ventricular function were not changed during the hemodialysis but increased after the hemodialysis. 2) The indices of the right ventricular function(EF, SVI) were significantly decreased in the early phase (15, 30 minutes after starting extracorporeal circulation) but recovered after the hemodialysis, 3) The ratio of right ventricular to left ventricular ejection fraction was significantly decreased in the early phase and the lung volume indices were significantly increased at the same phase. As a conclusion, hemodialysis improves left ventricular function maybe du to increased contractility, and effects on the right ventricular function maybe due to the increased lung volume in the early phase of hemodialysis.

Effect of Hemodialysis on Left and Right Ventricular Volume and Function

Energy Technology Data Exchange (ETDEWEB)

Han, Jin Suk; Koh, Chang Soon [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1985-09-15

With the improvement of hemodialysis, the course of thc discase in patient with endstage renal disease has been clearly improved. Nevertheless, among several shortcomings to our present mode of renal replacement therapy, cardiovascular complications have been the leading cause of morbidity and mortality. Several factors such as anemia, arteriovenous shunting of blood, intermittent extracorporeal circulation and hypertension may be contributing. But little is known about the quantitative cardiac hemodynamic characteristics occurred during hemodialysis. The purpose of this study is to observe the sequential hemodynamic changes before, during and after the hemodialysis and to investigate: reliable parameters in the detection of ventricular dysfunction. In the present study, equilibrium radionuclide cardiac angiography was performed and left and right ventricular volume indices, ejection phase indices of both ventricular, performance were measured in the 16 stable patients with chronic renal failure treated with maintenance hemodialysis sequentially i.e. before, during (carly and late phase) and after the hemodialysis. The results obtained were as follows; 1) The indices of the left ventricular function were not changed during the hemodialysis but increased after the hemodialysis. 2) The indices of the right ventricular function(EF, SVI) were significantly decreased in the early phase (15, 30 minutes after starting extracorporeal circulation) but recovered after the hemodialysis, 3) The ratio of right ventricular to left ventricular ejection fraction was significantly decreased in the early phase and the lung volume indices were significantly increased at the same phase. As a conclusion, hemodialysis improves left ventricular function maybe du to increased contractility, and effects on the right ventricular function maybe due to the increased lung volume in the early phase of hemodialysis.

[Quality of life in women with pelvic floor dysfunction].

Science.gov (United States)

Segedi, Ljiljana Mladenović; Ilić, Katarina Parezanović; Curcić, Aleksandar; Visnjevac, Nemanja

2011-11-01

Pelvic floor dysfunction is a frequent problem affecting more than 50% of women in peri- and postmenopause. Considering that ageing and menopause befall in the significant factors causing this issue, as well as the expected longevity of women in the world and in our country, pelvic floor dysfunction prevelence is foreseen to be even higher. The aim of the study was to evaluate impact of the symptoms of pelvic dysfunction on quality of life and examine body image satisfaction in adult women with pelvic organ prolapse presenting to tertiary care clinic for surgical treatment. This prospective case-control study included 50 patients who presented to tertiary care gynecology clinic for surgical treatment and 50 controls with normal pelvic floor support and without urinary incontinence who presented tertiary care gynecology clinic for other reasons. Both, patients and controls, completed two quastionnaires recommended for the evaluation of symptoms (Pelvic floor distress inventory - short forms) and quality of life impact (Pelvic floor impact questionnaire - short form) of pelvic organ prolapse, and Body Image Scale. The patients scored significantly worse on the prolapse, urinary, colorectal scales and overall score of Pelvic floor distress inventory--20 than controls subjects (134.91 vs 78.08; p self-conscious (78% vs 42%; p body. There was a positive correlation between decreased quality of life and body image in women with pelvic dysfunction. Women with pelvic floor dysfunction have decreased quality of life and body image.

Evaluation of Severity Score in Patients with Lower Limb and Pelvic Fractures Injured in Motor Vehicle Front-Impact Collisions.

Science.gov (United States)

Gokalp, Mehmet Ata; Hekimoglu, Yavuz; Gozen, Abdurrahim; Guner, Savas; Asirdizer, Mahmut

2016-12-01

BACKGROUND Lower limb and pelvic injuries and fractures occur at a very high incidence in motor vehicle accidents. In this study, the characteristics (e.g., body side, bone location, and fracture severity) of lower limb and pelvic fractures that occurred during front-impact collisions were correlated with the injured patients' sex, age, and position in the vehicle. MATERIAL AND METHODS We retrospectively evaluated 191 patients (136 males, 55 females) who were injured in motor vehicle accidents, specifically in frontal collisions. RESULTS This study revealed that most of lower limb and pelvic fractures occurred in males (71.2%; p=.000), 19-36 years old (55.5%; p=.000), small vehicles (86.4%; p=.000), and rear seat passengers (49.2%; p=.000). Fractures most commonly occurred in the left side of the body (46.6%; p=.000) and upper legs (37.7%; p=.000). Severity scores were higher (2.76) in males than females (2.07). No statistically significant was found in severity scores of patients and other personal characteristics and fracture features of patients with lower limb and pelvic fractures who were injured in a vehicle during front-impact collisions (p>0.05). CONCLUSIONS The results of this study will be useful for the automobile industry, forensics and criminal scientists, and for trauma research studies.

Occupational lifting and pelvic pain during pregnancy:

DEFF Research Database (Denmark)

Larsen, Pernille Stemann; Strandberg-Larsen, Katrine; Juhl, Mette

2013-01-01

OBJECTIVES: Pelvic pain during pregnancy is a common ailment, and the disease is a major cause of sickness absence during pregnancy. It is plausible that occupational lifting may be a risk factor of pelvic pain during pregnancy, but no previous studies have examined this specific exposure. The aim...... of this study was to examine the association between occupational lifting and pelvic pain during pregnancy. METHODS: The study comprised 50 143 pregnant women, enrolled in the Danish National Birth Cohort in the period from 1996-2002. During pregnancy, the women provided information on occupational lifting...... (weight load and daily frequency), and six months post partum on pelvic pain. Adjusted odds ratios for pelvic pain during pregnancy according to occupational lifting were calculated by logistic regression. RESULTS: Any self-reported occupational lifting (>1 time/day and loads weighing >10 kg...

Are routine pelvic radiographs in major pediatric blunt trauma necessary?

Science.gov (United States)

Lagisetty, Jyothi; Slovis, Thomas; Thomas, Ronald; Knazik, Stephen; Stankovic, Curt

2012-07-01

Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children. To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma. We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture. Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients.

Pelvic pain in a young patient: Sclerosing stromal tumor

Directory of Open Access Journals (Sweden)

Huriye Ayşe Parlakgümüş

2013-03-01

Full Text Available Introduction: Sclerosing stromal tumors are rare, benign sex chord stromal tumors. They are usually unilateral and are seen in second or third decades. The complaint at admission may be menstrual irregularity, pelvic pain, palpable pelvic mass, precocious puberty and postmenopausal bleeding. Because the complaint at admission and radiological findings are not specific to SSTs preoperative diagnosis is challenging. Herein we present the sonographical, intraoperative and histopathological findings of a SST diagnosed during laparoscopy in a patient who admitted with chronic pelvic pain and received pelvic inflammatory disease and endometriosis treatment and differential diagnosis of SSTs with the other ovarian tumors. Case report: 24 years old nulliparous patient first admitted to the gynecology department with the complaint of foul smelling vaginal discharge and pelvic pain. The diagnosis was pelvic inflammatory disease and the patient received antibiotics. The pelvic examination was normal except the mass in the right ovary which had similar echogenity to the ovary. Because of the pelvic pain the mass was assumed to be an endometrioma and the patient was prescribed an oral contraceptive treatment for 3 months. Because of the persistent pelvic pain a diagnostic laparoscopy was performed which revealed a 2 cm, pinkish- white, exophytic lesion originating from the right ovary. Pathological examination reported the mass to be a sclerosing stromal tumor. After the treatment the patient no longer complained of vaginal discharge but pelvic pain still persisted. After the operation the patient no longer complained of pelvic pain. Conclusion: Although SSTs are rare, they should be kept in mind when a young patient admits with menstrual irregularity, pelvic pain and hirsutism, particularly if the pain is refractory to treatment.

Use of end-to-side arterial and venous anastomosis techniques for renal transplantation in two dogs.

Science.gov (United States)

Phillips, Heidi; Aronson, Lillian R

2012-02-01

A sexually intact male Old English Sheepdog and a sexually intact female Bull Terrier were evaluated for renal dysplasia and chronic renal failure, respectively. Both dogs were anemic and had high serum concentrations of urea nitrogen and creatinine. Electrolyte abnormalities (calcium and phosphorus) were also evident. The decision was made to pursue renal transplantation, and donor dogs were identified. End-to-side anastomosis of the renal artery and vein of each donor's left kidney to the recipient's ipsilateral external iliac artery and vein, respectively, was performed. The left caudal abdominal musculature was scarified by making an incision, and nephropexy to that musculature was performed with a simple interrupted pattern of polypropylene sutures. No intraoperative or postoperative complications associated with the vascular anastomoses were encountered. Azotemia, anemia, and electrolyte imbalances resolved after transplantation. The end-to-side anastomosis technique described here, which is a preferred method in human medicine, was successful, providing an alternative to other renal transplantation techniques in dogs. Additional studies are needed to determine whether any vascular anastomosis technique is preferable for use in dogs requiring renal transplantation.

Extracorporeal shock wave lithotripsy (ESWL) of a renal calculus in a liver transplant recipient: report of a severe complication--a case report.

Science.gov (United States)

Friedersdorff, F; Buckendahl, J; Fuller, T F; Cash, H

2010-11-01

Extracorporeal shock wave lithotripsy (ESWL) has evolved as a standard treatment modality for calculi of the upper urinary tract. Noninvasive ESWL shows rare life-threatening complications. Herein we have reported the case of a liver transplant recipient who developed severe renal hemorrhage after ESWL of a renal calculus. Transfusion of erythrocytes and platelets led to anaphylactic shock with acute renal failure requiring intensive care. The patient fully recovered shortly thereafter and was discharged home with a residual left kidney stone measuring 8 mm. A 55-year-old man with a single left kidney underwent ESWL due to symptomatic left nephrolithiasis. He had undergone successful liver transplantation 11 years earlier. At the time of ESWL his liver functions were normal and his serum creatinine level was 1.3 mg/dL. Two weeks before the treatment a double pigtail ureteral stent was inserted because of a symptomatic left hydronephrosis. Several hours after ESWL treatment the patient complained of left-sided flank pain. An ultrasound revealed a large subcapsular hematoma of the left kidney, which was confirmed using abdominal computed tomography (CT). With the patient being hemodynamically stable, we opted for conservative management. Despite postinterventional complications, the patient made a fast recovery. ESWL is a noninvasive, safe, and efficient method to treat renal calculi. Patients who are at risk for hemorrhage should undergo close postinterventional monitoring, including red blood cell count and renal ultrasound. Copyright © 2010 Elsevier Inc. All rights reserved.

Pelvic Mass Due to Transmigrated IUD

Directory of Open Access Journals (Sweden)

Nadereh Behtash

2010-03-01

Full Text Available Intrauterine device (IUD, a conventional method of contraception is rarely associated with uterine perforation and extra uterine dislocation. A 29 years old woman complaining of vaginal bleeding was referred for pelvic mass identified in ultrasound. The mass was confirmed with CT scan. In laparatomy we found an IUD in cul-de-sac and pelvic mass was apparently an organized hematoma. Transmigrated IUD can induce organized hematomas presenting as a pelvic mass."n© 2010 Tehran University of Medical Sciences. All rights reserved.

Pelvic Pain

Science.gov (United States)

... OLPP) Office of Science Policy, Reporting, and Program Analysis (OSPRA) Division of Extramural Research (DER) Extramural Scientific ... treat my pain? Can pelvic pain affect my emotional well-being? How can I cope with long- ...

Pelvic Exam

Science.gov (United States)

... each step so that nothing comes as a surprise to you. After the pelvic exam After the ... Clinic does not endorse any of the third party products and services advertised. Advertising and sponsorship policy ...

Pelvic floor function during and after first pregnancy

NARCIS (Netherlands)

Brummen, H.J. van

2006-01-01

This study evaluated the effects the first pregnancy and childbirth on the pelvic floor. Pregnancy and vaginal delivery can negatively affect pelvic floor function. Micturition symptoms, defecation symptoms and sexual dysfunction are all signs of an impaired pelvic floor function. These symptoms are

Patterns of left ventricular remodeling among patients with essential and secondary hypertension

OpenAIRE

Radulescu,Dan; Stoicescu,Laurentiu; Buzdugan,Elena; Donca,Valer

2013-01-01

Background: High blood pressure causes left ventricular hypertrophy, which is a negative prognostic factor among hypertensive patients. Aim: To assess left ventricular geometric remodeling patterns in patients with essential hypertension or with hypertension secondary to parenchymal renal disease. Material and Methods: We analyzed data from echocardiograms performed in 250patients with essential hypertension (150 females) and 100 patients with secondary hypertension (60 females). The interven...

Preoperative evaluation of locally spreaded pelvic tumors

International Nuclear Information System (INIS)

Baramia, M.; Todua, F.; Gotsadze, D.; Khutulashvili, N.; Lashkhi, K.; Nadareishvili, A.

1998-01-01

Am of the study: preoperative evaluation of patients with locally advanced pelvic tumors subjected to pelvic exenteration. Determine operability to avoid explorative laparatomies, which cause serious complications in these patients. Evaluate condition of urinary system in case of this pathology. Materials and methods: 34 patients with locally advanced pelvic tumors where pelvic exenteration was attempted were studied. Along with other methods of diagnostic CT and MRI were performed. Results: In all patients secondary involvement of the urinary bladder was noted. In 30 patients CT and MR findings were confirmed (88,2%) intraoperatively and different types of pelvic organs exenteration were performed. In 1 case spread of tomoruos infiltrate to the pelvic wall and common iliac vessels was detected intraoperatively (patient had history of radiation therapy). In 2 cases carcinomatosis of the peritoneum was found. In 1 case involvement of urinary bladder was simulated by close attachment of enlarged uterus. Conclusion: Obtained results show, that CT and MR are highly informative methods of disease spread evaluation and thus determining operability. Radiotherapy performed prior to operation sets difficulties in differentiation for tumourous infiltrate and post-radiotherapy changes in pelvis. (Full text)

Physical exercise and pelvic girdle pain in pregnancy

DEFF Research Database (Denmark)

Andersen, Linda Kahr; Backhausen, Mette; Hegaard, Hanne Kristine

2015-01-01

OBJECTIVE: Pelvic girdle pain is a frequent cause of sick leave among pregnant women in Denmark. Studies regarding prevention of pelvic girdle pain are sparse. The aim of this study was to examine the association between physical exercise and pelvic girdle pain in pregnancy. STUDY DESIGN: A nested...... case-control study within the Danish National Birth Cohort (n = 5304). METHODS: This study used self-reported data on pelvic girdle pain obtained from an interview six months after childbirth. Information on physical exercise was obtained from the pregnancy interview around gestational week 16....... The association was estimated using logistic regression analysis. RESULTS: Physical exercise in pregnancy was associated with decreased risk of overall pelvic girdle pain (OR = 0.87; 95% CI: 0.77-0.99, p = 0.028). Tests for trend indicated decreasing odds for pelvic girdle pain with increasing number of hours per...

Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction

Science.gov (United States)

Faubion, Stephanie S.; Shuster, Lynne T.; Bharucha, Adil E.

2012-01-01

Nonrelaxing pelvic floor dysfunction is not widely recognized. Unlike in pelvic floor disorders caused by relaxed muscles (eg, pelvic organ prolapse or urinary incontinence, both of which often are identified readily), women affected by nonrelaxing pelvic floor dysfunction may present with a broad range of nonspecific symptoms. These may include pain and problems with defecation, urination, and sexual function, which require relaxation and coordination of pelvic floor muscles and urinary and anal sphincters. These symptoms may adversely affect quality of life. Focus on the global symptom complex, rather than the individual symptoms, may help the clinician identify the condition. The primary care provider is in a position to intervene early, efficiently, and effectively by (1) recognizing the range of symptoms that might suggest nonrelaxing pelvic floor dysfunction, (2) educating patients, (3) performing selective tests when needed to confirm the diagnosis, and (4) providing early referral for physical therapy. PMID:22305030

Imaging pelvic floor disorders. 2. rev. ed.

International Nuclear Information System (INIS)

Stoker, Jaap; Taylor, Stuart A.; DeLancey, John O.L.

2008-01-01

This volume builds on the success of the first edition of imaging pelvic floor disorders and is aimed at those practitioners with an interest in the imaging, diagnosis and treatment of pelvic floor dysfunction. Concise textual information from acknowledged experts is complemented by high-quality diagrams and images to provide a thorough update of this rapidly evolving field. Introductory chapters fully elucidate the anatomical basis underlying disorders of the pelvic floor. State of the art imaging techniques and their application in pelvic floor dysfunction are then discussed in detail. Additions since the first edition include consideration of the effect of aging and new chapters on perineal ultrasound, functional MRI and MRI of the levator muscles. The closing sections of the book describe the modern clinical management of pelvic floor dysfunction, including prolapse, urinary and faecal incontinence and constipation, with specific emphasis on the integration of diagnostic and treatment algorithms. (orig.)

Imaging pelvic floor disorders. 2. rev. ed.

Energy Technology Data Exchange (ETDEWEB)

Stoker, Jaap [Amsterdam Univ. (Netherlands). Dept. of Radiology; Taylor, Stuart A. [University College Hospital, London (United Kingdom). Dept. of Specialist X-Ray; DeLancey, John O.L. (eds.) [Michigan Univ., Ann Arbor, MI (United States). L4000 Women' s Hospital

2008-07-01

This volume builds on the success of the first edition of imaging pelvic floor disorders and is aimed at those practitioners with an interest in the imaging, diagnosis and treatment of pelvic floor dysfunction. Concise textual information from acknowledged experts is complemented by high-quality diagrams and images to provide a thorough update of this rapidly evolving field. Introductory chapters fully elucidate the anatomical basis underlying disorders of the pelvic floor. State of the art imaging techniques and their application in pelvic floor dysfunction are then discussed in detail. Additions since the first edition include consideration of the effect of aging and new chapters on perineal ultrasound, functional MRI and MRI of the levator muscles. The closing sections of the book describe the modern clinical management of pelvic floor dysfunction, including prolapse, urinary and faecal incontinence and constipation, with specific emphasis on the integration of diagnostic and treatment algorithms. (orig.)

A Suspected Pelvic Aneurysmal Bone Cyst in Pregnancy

Directory of Open Access Journals (Sweden)

Rayan Elkattah

2013-01-01

Full Text Available Albeit rare, the majority of identified bone lesions in pregnancy spare the pelvis. Once encountered with a pelvic bone lesion in pregnancy, the obstetrician may face a challenging situation as it is difficult to determine and predict the effects that labor and parturition impart on the pelvic bones. Bone changes and pelvic bone fractures have been well documented during childbirth. The data regarding clinical outcomes and management of pregnancies complicated by pelvic ABCs is scant. Highly suspected to represent an aneurysmal bone cyst, the clinical evaluation of a pelvic lesion in the ilium of a pregnant individual is presented, and modes of delivery in such a scenario are discussed.

Are routine pelvic radiographs in major pediatric blunt trauma necessary?

International Nuclear Information System (INIS)

Lagisetty, Jyothi; Slovis, Thomas; Thomas, Ronald; Knazik, Stephen; Stankovic, Curt

2012-01-01

Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children. To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma. We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture. Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS <14, positive urinalysis, abdominal pain/tenderness, femur fracture) and five high-risk mechanisms of injury (unrestrained motor vehicle collision [MVC], MVC with ejection, MVC rollover, auto vs. pedestrian, auto vs. bicycle). Pelvic fractures in pediatric major blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients. (orig.)

Are routine pelvic radiographs in major pediatric blunt trauma necessary?

Energy Technology Data Exchange (ETDEWEB)

Lagisetty, Jyothi [Memorial Hermann Medical Center, Emergency Medicine Department, Houston, TX (United States); Slovis, Thomas [Wayne State University School of Medicine, Department of Radiology, Pediatric Imaging, Children' s Hospital of Michigan, Detroit, MI (United States); Thomas, Ronald [Children' s Hospital of Michigan, Wayne State University of Medicine, Department of Pediatrics, Detroit, MI (United States); Knazik, Stephen; Stankovic, Curt [Wayne State University of Medicine, Division of Emergency Medicine, Children' s Hospital of Michigan, Detroit, MI (United States)

2012-07-15

Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children. To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma. We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture. Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS <14, positive urinalysis, abdominal pain/tenderness, femur fracture) and five high-risk mechanisms of injury (unrestrained motor vehicle collision [MVC], MVC with ejection, MVC rollover, auto vs. pedestrian, auto vs. bicycle). Pelvic fractures in pediatric major blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients. (orig.)

Association between preterm labour and pelvic floor muscle function.

Science.gov (United States)

Aran, Turhan; Pekgöz, Ipek; Bozkaya, Hasan; Osmanagaoglu, Mehmet A

2018-03-23

We hypothesised that the pressure on the cervix increases with advancing gestation and it may lead to a cervical shortening and cause preterm labour in women with weak pelvic floor muscles. The aim of this prospective study was to measure vaginal resting pressure and pelvic floor muscle strength in the first trimester of pregnancy and to investigate their effects on labour. A study was conducted on the pregnant women with a low risk for preterm birth. The pelvic floor muscle strength and vaginal resting pressure were assessed in 320 pregnant women at their first trimester with a vaginal pressure measurement device. Fifty-two pregnant women were hospitalised for tocolytic therapy because of spontaneous preterm labour. Thirty-two of them (10.2%) had a preterm delivery despite the tocolytic therapy. Both the vaginal resting pressure (p = .009, 95%CI: 0.8; 5.9) and the pelvic floor muscle strength (p = .01, 95%CI: 3.5; 13.1) were significantly lower in the women with a preterm labour. Impact statement What is already known on this subject? The pelvic floor muscles have an essential role in continence and provide support to the pelvic organs. They also have an impact on labour. The pelvic floor muscles should distend to allow the passage of the foetus during labour. The rotation and flexion of the foetal head is due to the pelvic floor resistance. The effect of a vaginal birth on the pelvic floor's function is readily understood. On the other hand, the effect of the pelvic floor muscle function on labour is still controversial. What do the results of this study add? This prospective study showed that there is a negative association between the pelvic floor muscle strength and preterm labour. This is the first clinical study indicating that weak pelvic floor muscles may cause a preterm labour. What are the implications of these findings for clinical practice and/or further research? Pelvic floor physical therapy may be an alternative preventive strategy to reduce

Primary renal undifferentiated sarcoma as an infiltrative mass in a 12 year old boy

International Nuclear Information System (INIS)

Kim, Yong Hee; Kim, Myung Joon; Lee, Mi Jung; Kim, Se Hwa

2015-01-01

Undifferentiated sarcomas are rare tumors not classified into any sarcoma subtype. Due to their rarity, imaging findings of undifferentiated sarcomas are poorly characterized. The purpose of this report was to present imaging findings of a pathologically confirmed undifferentiated sarcoma originated from the left kidney of a 12-year-old boy. The mass was infiltrative involving the renal pelvis. It mimicked massive hilar lymphadenopathy with a preserved renal contour visible by both ultrasonography and CT. Renal vein thrombosis was also observed. Although undifferentiated sarcomas are rare, they should be considered in differential diagnosis of infiltrative renal masses with renal pelvis invasion in children

Primary renal undifferentiated sarcoma as an infiltrative mass in a 12 year old boy

Energy Technology Data Exchange (ETDEWEB)

Kim, Yong Hee; Kim, Myung Joon; Lee, Mi Jung [Dept. of Radiology and Research Institute of Radiological Science, Severance Children' s Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Se Hwa [Dept. of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

2015-09-15

Undifferentiated sarcomas are rare tumors not classified into any sarcoma subtype. Due to their rarity, imaging findings of undifferentiated sarcomas are poorly characterized. The purpose of this report was to present imaging findings of a pathologically confirmed undifferentiated sarcoma originated from the left kidney of a 12-year-old boy. The mass was infiltrative involving the renal pelvis. It mimicked massive hilar lymphadenopathy with a preserved renal contour visible by both ultrasonography and CT. Renal vein thrombosis was also observed. Although undifferentiated sarcomas are rare, they should be considered in differential diagnosis of infiltrative renal masses with renal pelvis invasion in children.

In Vivo MR Imaging of Magnetically Labeled Mesenchymal Stem Cells in a Rat Model of Renal Ischemia

Energy Technology Data Exchange (ETDEWEB)

Jung, Sung Il [Konkuk University Medical Center, Seoul (Korea, Republic of); Kim, Seung Hyup [Seoul National University Medical Research Center, Seoul (Korea, Republic of); Kim, Hyo Cheol; Chung, Se Young; Moon, Woo Kyung; Kim, Hoe Suk [Seoul National University Hospital, Seoul (Korea, Republic of); Choi, Jong Sun [Dongguk University International Hospital, Goyang (Korea, Republic of); Moon, Min Hoan [Cheil General Hospital and Women' s Healthcare Center, Seoul (Korea, Republic of); Son, Kyu Ri; Sung, Chang Kyu [Seoul National University Boramae Hospital, Seoul (Korea, Republic of)

2009-06-15

This study was designed to evaluate in vivo MR imaging for the depiction of intraarterially injected superparamagnetic iron oxide (SPIO)-labeled mesenchymal stem cells (MSCs) in an experimental rat model of renal ischemia. Left renal ischemia was induced in 12 male Sprague- Dawley rats by use of the catheter lodging method. In vivo MR signal intensity variations depicted on T2*-weighted sequences were evaluated in both the left and right kidneys prior to injection (n = 2), two hours (n = 4), 15 hours (n = 2), 30 hours (n = 2) and 72 hours (n = 2) after injection of SPIO-labeled MSCs in both kidneys. Signal intensity variations were correlated with the number of Prussian blue stain-positive cells as visualized in histological specimens. In an in vivo study, it was determined that there was a significant difference in signal intensity variation for both the left and right cortex (40.8 {+-} 4.12 and 26.4 {+-} 7.92, respectively) and for both the left and right medulla (23.2 {+-} 3.32 and 15.2 {+-} 3.31, respectively) until two hours after injection (p < 0.05). In addition, signal intensity variation in the left renal cortex was well correlated with the number of Prussian blue stain-positive cells per high power field (r = 0.98, p < 0.05). Intraarterial injected SPIO-labeled MSCs in an experimental rat model of renal ischemia can be detected with the use of in vivo MR imaging immediately after injection.

Renal Nerve Stimulation-Induced Blood Pressure Changes Predict Ambulatory Blood Pressure Response After Renal Denervation.

Science.gov (United States)

de Jong, Mark R; Adiyaman, Ahmet; Gal, Pim; Smit, Jaap Jan J; Delnoy, Peter Paul H M; Heeg, Jan-Evert; van Hasselt, Boudewijn A A M; Lau, Elizabeth O Y; Persu, Alexandre; Staessen, Jan A; Ramdat Misier, Anand R; Steinberg, Jonathan S; Elvan, Arif

2016-09-01

Blood pressure (BP) response to renal denervation (RDN) is highly variable and its effectiveness debated. A procedural end point for RDN may improve consistency of response. The objective of the current analysis was to look for the association between renal nerve stimulation (RNS)-induced BP increase before and after RDN and changes in ambulatory BP monitoring (ABPM) after RDN. Fourteen patients with drug-resistant hypertension referred for RDN were included. RNS was performed under general anesthesia at 4 sites in the right and left renal arteries, both before and immediately after RDN. RNS-induced BP changes were monitored and correlated to changes in ambulatory BP at a follow-up of 3 to 6 months after RDN. RNS resulted in a systolic BP increase of 50±27 mm Hg before RDN and systolic BP increase of 13±16 mm Hg after RDN (Pefficacy of RDN and predict BP response to RDN. © 2016 American Heart Association, Inc.

Pelvic X-ray misses out on detecting sacral fractures in the elderly - Importance of CT imaging in blunt pelvic trauma.