Diagnostic tests and algorithms used in the investigation of haematuria: systematic reviews and economic evaluation.

Science.gov (United States)

Rodgers, M; Nixon, J; Hempel, S; Aho, T; Kelly, J; Neal, D; Duffy, S; Ritchie, G; Kleijnen, J; Westwood, M

2006-06-01

To determine the most effective diagnostic strategy for the investigation of microscopic and macroscopic haematuria in adults. Electronic databases from inception to October 2003, updated in August 2004. A systematic review was undertaken according to published guidelines. Decision analytic modelling was undertaken, based on the findings of the review, expert opinion and additional information from the literature, to assess the relative cost-effectiveness of plausible alternative tests that are part of diagnostic algorithms for haematuria. A total of 118 studies met the inclusion criteria. No studies that evaluated the effectiveness of diagnostic algorithms for haematuria or the effectiveness of screening for haematuria or investigating its underlying cause were identified. Eighteen out of 19 identified studies evaluated dipstick tests and data from these suggested that these are moderately useful in establishing the presence of, but cannot be used to rule out, haematuria. Six studies using haematuria as a test for the presence of a disease indicated that the detection of microhaematuria cannot alone be considered a useful test either to rule in or rule out the presence of a significant underlying pathology (urinary calculi or bladder cancer). Forty-eight of 80 studies addressed methods to localise the source of bleeding (renal or lower urinary tract). The methods and thresholds described in these studies varied greatly, precluding any estimate of a 'best performance' threshold that could be applied across patient groups. However, studies of red blood cell morphology that used a cut-off value of 80% dysmorphic cells for glomerular disease reported consistently high specificities (potentially useful in ruling in a renal cause for haematuria). The reported sensitivities were generally low. Twenty-eight studies included data on the accuracy of laboratory tests (tumour markers, cytology) for the diagnosis of bladder cancer. The majority of tumour marker studies

Haematuria in association with Lynch syndrome

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Marwan Ma'ayeh

2012-04-01

Full Text Available A 40-year-old Caucasian male presented to the Emergency Department complaining of intermittent painless frank haematuria. Past medical history was significant for Hereditary Non-Polyposis Colon Cancer (HNPCC and a prophylactic total colectomy. Computed tomography urogram showed thickening in the posterior wall of the bladder. Cystoscopy showed a small bladder mass. Histology showed a papillary urothelial neoplasm of low malignant potential. HNPCC, also known as Lynch Syndrome, is an autosomal dominant disorder responsible for 3-5% of colorectal cancers. There are certain cancers known to be associated with HNPCC; colorectal cancer, endometrial, ovarian, stomach, pancreas, biliary tract, small bowel, brain, renal pelvic and ureteric tumours, sebaceous gland adenomas and keratocanthomas. An association with bladder tumours is not well established.

Cost-Effectiveness Analysis of Pharmacotherapy for Hematemesis-Melena Treatment in Hospitalized Patients with Hepatic Cirrhosis

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Doddy de Queljoe

2013-04-01

Full Text Available BACKGROUND: Acute variceal haemorrhage is a complication of cirrhosis that can be life threatening. It is a pharmacist’s duty to ensure therapeutic and pharmaceutical care which is not only safe and effective for the patient but also is cost-effective in order to attain improvement of the patient’s quality of life. Therefore, pharmacoeconomic evaluation especially cost-effectiveness analysis (CEA, which compares costs and consequences of drug therapy, is needed. This study was aimed to evaluate the therapeutic cost-effectiveness of hematemesis-melena treatment in hepatic cirrhotic patients. METHODS: A total of 42 patients receiving vitamin K and vitamin K-transamin were studied retrospectively from patients’ medical records in 2 years and analyzed with cost-effectiveness grid and average cost-effectiveness ratio (ACER based on Child-Turcotte-Pugh (CTP Score. RESULTS: Cost-effectiveness grid was dominant for vitamin K in patients with CTP Score A. ACER analysis showed a lower score for vitamin K in all patients included CTP Score classification. There was no significant difference in duration of cessation of bleeding treatment in patients with vitamin K compared with vitamin K-transamin in patients with CTP Score A and B, while significant difference was found in patients with CTP Score C. CONCLUSIONS: Vitamin K appeared to be more cost effective as compared with vitamin K-transamin in all patients. The use of vitamin K had greater benefit than the combination with transamin in all patients and CTP Score classification, and thus should be considered as a primary therapy. Therefore, transamin addition as an alternative therapy for hepatic cirrhosis patients with hematemesis-melena should be considered. KEYWORDS: CEA, cost-effectiveness analysis, child-turcotte-pugh score, hepatic cirrhosis, hematemesismelena, vitamin K, transamin.

Renal Embolization and Urothelial Sclerotherapy for Recurrent Obstructive Urosepsis and Intractable Haematuria from Upper Tract Urothelial Carcinoma

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Brown, Nicholas, E-mail: nibrown@cantab.net [St Vincent’s Hospital, Department of Interventional Radiology (Australia); Olayos, Elizabeth; Elmer, Sandra; Wong, Lih-Ming [St Vincent’s Hospital, Department of Urology (Australia); Brooks, Duncan M; Jhamb, Ashu [St Vincent’s Hospital, Department of Interventional Radiology (Australia)

2016-03-15

Management of intractable haematuria and obstructive urosepsis from upper tract urothelial carcinoma can be problematic in patients not suitable for surgery, chemotherapy or radiotherapy. Interventional radiology techniques provide alternative approaches in this setting, such as complete kidney embolization to cease urine output, percutaneous nephrostomy, antegrade injection of sclerotherapy agents and sterilisation of the upper collecting system. Related approaches have been successfully employed to sclerose renal cysts, lymphoceles, chyluria and intractable lower tract haemorrhage. No reports of percutaneous, antegrade sclerotherapy in the upper urinary tract have previously been published. We present a case of recurrent haematuria and obstructive urosepsis caused by invasive upper tract urothelial carcinoma in a non-operative patient, which was treated with renal embolisation and percutaneous upper tract urothelial sclerotherapy.

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

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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.

Squamous cell lung carcinoma presenting as melena: a case report and review of the literature

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Ibrahim Azar

2017-10-01

Full Text Available Lung cancer has a predilection to widely metastasize to the liver, bone, brain and adrenal glands. Metastasis of primary lung tumors to the stomach is infrequent, with only sporadic cases reported. Most cases are asymptomatic and diagnosed post-mortem on autopsy. The incidence of symptomatic gastrointestinal metastases is extremely rare. Herein, we describe a case of gastric metastasis by squamous cell lung carcinoma, presenting as melena and diagnosed by esophagogastroduodenoscopy. To the best of our knowledge, only twenty other cases in the English literature have reported symptomatic gastric metastasis of lung cancer diagnosed by endoscopic biopsy. A brief review of the literature shows gastric metastasis of lung cancer to have a predilection to occur most frequently in male smokers with the most common type of tumor likely to be squamous cell carcinoma.

Fast-track access to urologic care for patients with macroscopic haematuria is efficient and cost-effective

DEFF Research Database (Denmark)

Liedberg, Fredrik; Gerdtham, Ulf; Gralén, Katarina

2016-01-01

: In all 275 patients who called 'the Red Phone' hotline were investigated, and 47 of them (17%) were diagnosed with cancer and 36 of those had bladder cancer. Median time from patient-reported haematuria to diagnosis was 29 (interquartile range (IQR) 14-104) days and 50 (IQR 27-165) days...

Diagnosis of bladder tumours in patients with macroscopic haematuria

DEFF Research Database (Denmark)

Gandrup, Karen L; Løgager, Vibeke B; Bretlau, Thomas

2015-01-01

patients underwent CTU, MRU and flexible cystoscopy. Two uroradiologists individually reviewed the images without any clinical information, using a questionnaire. Patient records and pathology reports were also reviewed. RESULTS: At flexible cystoscopy, MRU and CTU, 32, 19 and 15 bladder lesions were...... identified, respectively. Histopathology showed that 13 of the 29 biopsied lesions were transitional cell carcinomas. Compared with the histopathology, the sensitivity and specificity for detection of tumours by CTU and MRU were 61.5% and 94.9%, and 79.9% and 93.4%, respectively. False-positive detection...... of bladder tumours, compared with histopathology, was reported in seven CTUs and nine MRUs, whereas the number of false-negative findings was five for CTUs and three for MRUs. CONCLUSIONS: Split-bolus CTU or MRU cannot replace cystoscopy in cases of macroscopic haematuria. MRU has a higher sensitivity than...

Single-phase DECT with VNCT compared with three-phase CTU in patients with haematuria

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Park, Jung Jae; Park, Byung Kwan; Kim, Chan Kyo [Sungkyunkwan University School of Medicine, Department of Radiology, Samsung Medical Center, Seoul (Korea, Republic of)

2016-10-15

To retrospectively evaluate the diagnostic performance of single-phase dual-energy CT (DECT) with virtual non-contrast CT (VNCT) compared with three-phase CT urography (CTU) in patients with haematuria. A total of 296 patients underwent three-phase CTU (NCT at 120 kVp; nephrographic phase and excretory phase DECTs at 140 kVp and 80 kVp) owing to haematuria. Diagnostic performances of CT scans were compared for detecting urothelial tumours and urinary stones. Dose-length product (DLP) was compared in relation to single-phase DECT and three-phase CTU Dose-length product (DLP) was compared in relation to single-phase DECT and three-phase CTU. Sensitivity and specificity for tumour were 95 % (19/20) and 98.9 % (273/276) on CTU, 95 % (19/20) and 98.2 % (271/276) on nephrographic phase DECT, and 90 % (18/20) and 98.2 % (271/276) on excretory phase DECT (P > 0.1). Of the 148 stones detected on NCT, 108 (73 %) and 100 (67.6 %) were detected on nephrographic phase and excretory phase VNCTs, respectively. The mean size of stones undetected on nephrographic and excretory VNCTs was measured as 1.5 ± 0.5 mm and 1.6 ± 0.6 mm, respectively. The mean DLPs of three-phase CTU, nephrographic phase DECT and excretory phase DECT were 1076 ± 248 mGy . cm, 410 ± 98 mGy . cm, and 360 ± 87 mGy . cm, respectively (P < 0.001). Single-phase DECT has a potential to replace three-phase CTU for detecting tumours with a lower radiation dose. (orig.)

Adenocarcinoma of the caecum metastatic to the bladder: an unusual cause of haematuria

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Hunt Roger

2006-10-01

Full Text Available Abstract Background Primary malignancies of colorectal origin can metastasise to the bladder. Reports are however extremely rare, particularly from the caecum. Case report The report describes the case of a 45-year old male with Duke's B caecal carcinoma treated with a laparoscopically-assisted right hemicolectomy and adjuvant 5-Fluorouracil chemotherapy. Subsequently, a metastatic lesion to the bladder was demonstrated and successfully excised by partial cystectomy. Conclusion In order that optimal therapeutic options can be determined, it is important for clinicians to distinguish between primary disease of the bladder and other causes of haematuria. Various immunohistochemical techniques attempt to differentiate primary adenocarcinoma of the bladder from secondary colorectal adenocarcinoma. Suspicion of metastatic disease must be raised when histologically unusual bladder tumours are identified.

Does this case hold the answer to one of the worse types of pain in medicine--that of loin pain haematuria syndrome (LPHS).

Science.gov (United States)

Russell, Alan; Chatterjee, Suman; Seed, Michael

2015-04-26

A patient with loin pain haematuria syndrome suffering chronic throbbing pulsing pain overlaid with prolonged periods of incapacitating colic and overnight vomiting was presented 10 months following diagnosis. Ultrasound was normal. No renal or ureteral stones, or filling defects were seen on CT. At cytoscopy, bladder and urethra were normal, and bloody urine effluxed from the left ureteric orifice. The ureters were normal at diagnosis, and developed new abutting non-penetrating calcifications by 8 months. Pain episodes of complete incapacitating intensity of 2-4 h duration were reduced to 10 min with 5 mg crushed tadalafil administered at onset. If tadalafil was delayed to after onset, the original course of agony resulted. Daily tadalafil reduced loin pain intensity, but not the exacerbations. Tadalafil efficacy may indicate that the pain exacerbations are due to spasm of ureter smooth muscle. 5 mg tadalafil taken at onset alleviated severe loin pain exacerbations in this case of loin pain haematuria syndrome. 2015 BMJ Publishing Group Ltd.

Percutaneous renal sympathetic nerve ablation for loin pain haematuria syndrome.

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Gambaro, Giovanni; Fulignati, Pierluigi; Spinelli, Alessio; Rovella, Valentina; Di Daniele, Nicola

2013-09-01

Loin pain haematuria syndrome (LPHS) is a severe renal pain condition of uncertain origin and often resistant to treatment. Nephrectomy and renal autotrasplantation have occasionally been performed in very severe cases. Its pathogenesis is controversial. A 40-year-old hypertensive lady was diagnosed with LPHS after repeated diagnostic imaging procedures had ruled out any renal, abdominal or spinal conditions to justify pain. Notwithstanding treatment with three drugs, she had frequent hypertensive crises during which the loin pain was dramatically exacerbated. Vascular causes of the pain and hypertension were investigated and excluded. Her renal function was normal. The patient was referred to a multidisciplinary pain clinic, but had no significant improvement in her pain symptoms despite the use of non-steroidal anti-inflammatory drugs, adjuvant antidepressants and opioid-like agents. The pain and the discomfort were so severe that her quality of life was very poor, and her social and professional activities were compromised. Nephrectomy and renal autotransplantation have occasionally been performed in these cases. Since visceral pain signals flow through afferent sympathetic fibres, we felt that percutaneous catheter-based radiofrequency ablation of the renal sympathetic nerve fibres (recently introduced for the treatment of drug-resistant hypertension) could be valuable for pain relief. We treated the patient with radiofrequency ablation (Medtronic Symplicity Catheter) applied only to the right renal artery. After a 6-month follow-up, the patient is pain free and normotensive with all drugs withdrawn. She has experienced no hypertensive crises in the meantime. This observation suggests that percutaneous sympathetic denervation could prove to be an effective mini-invasive strategy for the treatment of chronic renal pain, and LPHS in particular.

Marfan syndrome with antineutrophil cytoplasmic antibody-associated systemic vasculitis presenting as severe anaemia and haematuria after the Bentall procedure.

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Sijia, Li; Shuangxin, Liu; Wei, Shi; Yanhai, Cui

2013-08-01

One month previously, a 28-year old male underwent an emergency modified Bentall procedure because of Marfan syndrome with acute aortic dissection Stanford Class A. Computed tomography of the chest did not reveal severe graft stenosis of the anastomosis. To explore the cause of anaemia, renal dysfunction and macroscopic haematuria, the patient was tested for antineutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitis (AASV). Antimyeloperoxidase antibodies (MPO)-ANCA and antiproteinase 3 antibodies (PR3)-ANCA were strongly positive. Corticosteroid therapy was applied, followed by cyclophosphamide and azathioprine. In response to treatment, the MPO-ANCA and PR3-ANCA levels gradually decreased, proteinuria was alleviated and haemoglobin levels returned to normal after 6 months. This is the first report to highlight haemolytic anaemia and AASV with Marfan syndrome after surgery for aortic dissection.

Single-phase dual-energy CT urography in the evaluation of haematuria

International Nuclear Information System (INIS)

Ascenti, G.; Mileto, A.; Gaeta, M.; Blandino, A.; Mazziotti, S.; Scribano, E.

2013-01-01

Aim: To assess the value of a single-phase dual-energy computed tomography (DECT) urography protocol with synchronous nephrographic–excretory phase enhancement and to calculate the potential dose reduction by omitting the unenhanced scan. Materials and methods: Eighty-four patients referred for haematuria underwent CT urography using a protocol that included single-energy unenhanced and dual-energy contrast-enhanced with synchronous nephrographic–excretory phase scans. DECT-based images [virtual unenhanced (VUE), weighted average, and colour-coded iodine overlay] were reconstructed. Opacification degree by contrast media of the upper urinary tract, and image quality of virtual unenhanced images were independently evaluated using a four-point scale. The diagnostic accuracy in detecting urothelial tumours on DECT-based images was determined. The dose of a theoretical dual-phase single-energy protocol was obtained by multiplying the effective dose of the unenhanced single-energy acquisition by two. Radiation dose saving by omitting the unenhanced scan was calculated. Results: The degree of opacification was scored as optimal or good in 86.9% of cases (k = 0.72); VUE image quality was excellent or good in 83.3% of cases (k = 0.82). Sensitivity, specificity, positive predictive value, and negative predictive value for urothelial tumours detection were 85.7, 98.6, 92.3, and 97.1%. Omission of the unenhanced scan led to a mean dose reduction of 42.7 ± 5%. Conclusion: Single-phase DECT urography with synchronous nephrographic–excretory phase enhancement represents an accurate “all-in-one’’ approach with a radiation dose saving up to 45% compared with a standard dual-phase protocol.

Comparison between the efficacy of dimeric and monomeric non-ionic contrast media (iodixanol vs iopromide) in urography in patients with macroscopic haematuria

International Nuclear Information System (INIS)

Stacul, F.; Cova, M.; Pravato, M.; Floriani, I.

2003-01-01

Non-ionic dimers induce less diuresis than non-ionic monomers, resulting in increased opacification of the urinary tract in intravenous urography. This trial compared the diagnostic efficacy of iodixanol and iopromide in patients with macroscopic haematuria. One hundred consecutive patients with normal renal function and macroscopic haematuria entered a double blind, comparative, randomised, parallel trial. Contrast media were given with bolus injection in doses of 300 mgI/kg b.w. Radiographs were blindly evaluated by three radiologists who analysed different parameters (calyceal density and filling, papillary blush detection, delineation of collecting ducts, renal pelvis opacification, visualisation of ureters, bladder density, bladder distention) and estimated the diagnostic confidence (whether abnormal findings were definitely absent, probably absent, doubtful, probably present or certainly present). Radiological diagnoses were compared with final diagnoses. Results were summarised as the ratio of the odds of having a worse performance of iopromide vs iodixanol. Iodixanol showed a significantly better calyceal density and filling [odds ratio (OR): 1.96; 95% confidence interval (CI): 1.60-2.41], a significantly better pelvis opacification (OR 2.91; CI 2.02-4.18) and a significantly more frequent papillary blush detection (OR 1.95; CI 1.29-2.95). Iopromide showed a significantly better ureteral visualisation (OR 0.67; CI 0.48-0.92) and a significantly higher bladder distention (OR 0.59; CI 0.36-0.99). Iodixanol allowed a significantly higher diagnostic confidence as to calyceal evaluation (OR 1.35; CI 1.01-1.79). No significant differences were found with regard to other parameters. The results confirmed theoretical expectations. The higher opacification provided by iodixanol allowed better results and a higher diagnostic confidence in the upper excretory pathway. (orig.)

Single-phase dual-energy CT urography in the evaluation of haematuria.

Science.gov (United States)

Ascenti, G; Mileto, A; Gaeta, M; Blandino, A; Mazziotti, S; Scribano, E

2013-02-01

To assess the value of a single-phase dual-energy computed tomography (DECT) urography protocol with synchronous nephrographic-excretory phase enhancement and to calculate the potential dose reduction by omitting the unenhanced scan. Eighty-four patients referred for haematuria underwent CT urography using a protocol that included single-energy unenhanced and dual-energy contrast-enhanced with synchronous nephrographic-excretory phase scans. DECT-based images [virtual unenhanced (VUE), weighted average, and colour-coded iodine overlay] were reconstructed. Opacification degree by contrast media of the upper urinary tract, and image quality of virtual unenhanced images were independently evaluated using a four-point scale. The diagnostic accuracy in detecting urothelial tumours on DECT-based images was determined. The dose of a theoretical dual-phase single-energy protocol was obtained by multiplying the effective dose of the unenhanced single-energy acquisition by two. Radiation dose saving by omitting the unenhanced scan was calculated. The degree of opacification was scored as optimal or good in 86.9% of cases (k = 0.72); VUE image quality was excellent or good in 83.3% of cases (k = 0.82). Sensitivity, specificity, positive predictive value, and negative predictive value for urothelial tumours detection were 85.7, 98.6, 92.3, and 97.1%. Omission of the unenhanced scan led to a mean dose reduction of 42.7 ± 5%. Single-phase DECT urography with synchronous nephrographic-excretory phase enhancement represents an accurate "all-in-one'' approach with a radiation dose saving up to 45% compared with a standard dual-phase protocol. Copyright © 2012 The Royal College of Radiologists. All rights reserved.

Survey of ferns and clinico-pathological studies on the field cases of Enzootic bovine haematuria in Himachal Pradesh, a north-western Himalayan state of India

DEFF Research Database (Denmark)

Rai, Sarvesh K.; Sharma, Rinku; Kumari, Alka

2017-01-01

Enzootic bovine haematuria (EBH) in cattle occurs in upland areas of the world. In India, the disease is present in isolated pockets in the Himalayas and in the Nilgiri Hills. The variation in the disease incidence has been attributed to different environmental conditions and animal rearing pract...... bladder tissue, the field case was diagnosed as transitional cell adenocarcinoma with chronic lymphocytic cystitis.......B) in some of the ferns collected from Kullu and Chamba regions ranged from 0 to 358.6 ± 70.5 μg/g and 0 to 652.4 ± 50.0 μg/g, respectively. In addition, field cases of the disease in cattle were also studied in the EBH endemic districts. A total of sixteen cattle urine samples and one urinary bladder of EBH...

Circadian occurrence of variceal bleeding in patients with liver cirrhosis.

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Siringo, S; Bolondi, L; Sofia, S; Hermida, R C; Gramantieri, L; Gaiani, S; Piscaglia, F; Carbone, C; Misitano, B; Corinaldesi, R

1996-12-01

Several clinical events have a rhythmicity over the 24 h period. We assessed the presence of periodic rhythm in the occurrence of haematemesis in patients with liver cirrhosis under different daylight regimens, namely during standard time and during daylight savings. Over a 48 month period there were 212 consecutive admissions of 118 cirrhotics with variceal bleeding. Complete data were available for 181 episodes of bleeding: 121 (66.9%) started with haematemesis and 60 (33.1%) started with melaena. One hundred and two (56%) episodes occurred during daylight savings and 79 (44%) occurred during standard time. The cosinor test showed a 24 h biphasic peak for the occurrence of haematemesis (09.45 and 21.45 h). Moreover, a biphasic diurnal asymmetric frequency was also found by multiple component rhythmometry. The time peaks of onset of variceal haemorrhage did not change significantly during standard time and daylight savings. Patients with more than one haematemesis episode significantly bled over the same time interval. The present study confirms that over the 24 h period variceal bleeding in cirrhotic patients occurs with a predictable rhythmicity that does not seem to be under the control of the light-dark cycle. The finding of a chronorisk for variceal haemorrhage addresses specific questions for pathophysiological studies as well as for new treatment strategies.

Upper Gastrointestinal Bleeding in Children: A Tertiary United Kingdom Children’s Hospital Experience

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Omar Nasher

2017-11-01

Full Text Available The aim of this study was to review the aetiology, presentation and management of these patients with upper gastrointestinal bleeding (UGIB at a tertiary children’s unit in the United Kingdom. This was a retrospective single-institution study on children (<16 years who presented with acute UGIB over a period of 5 years using known International Classification of Diseases (ICD codes. A total of 32 children (17 males, 15 females were identified with a total median age at presentation of 5.5 years. The majority (24/32 of patients presented as an emergency. A total of 19/32 presented with isolated haematemesis, 8/32 with isolated melaena and 5/32 with a combination of melaena and haematemesis. On admission, the mean haemoglobin of patients who presented with isolated haematemesis was 11 g/dL, those with isolated melaena 9.3 g/dL and those with a combination 7.8 g/dL. Blood transfusion was required in 3/19 with haematemesis and 3/5 with haematemesis and melaena. A total of 19/32 underwent upper gastrointestinal endoscopy. Endoscopic findings were oesophageal varices (5/19 of which 4 required banding; bleeding gastric ulcer (1/19 requiring clips, haemospray and adrenaline; gastric vascular malformation (1/19 treated with Argon plasma coagulation therapy; duodenal ulcer (3/19 which required surgery in two cases; oesophagitis (5/19; and gastritis +/− duodenitis (3/19. A total of 13/32 patients did not undergo endoscopy and the presumed aetiology was a Mallory–Weiss tear (4/13; ingestion of foreign body (2/13; gastritis (3/13; viral illness (1/13; unknown (2/13. While UGIB is uncommon in children, the morbidity associated with it is very significant. Melaena, dropping haemoglobin, and requirement for a blood transfusion appear to be significant markers of an underlying cause of UGIB that requires therapeutic intervention. A multi-disciplinary team comprising gastroenterologists and surgeons is essential.

Peptic ulcer in the gallbladder. A case report

DEFF Research Database (Denmark)

Larsen, E H; Diederich, P J; Sørensen, Flemming Brandt

1985-01-01

Gastric mucosa can be found in the gallbladder as a congenital heterotopia. A case of a perforated peptic ulcer in the gallbladder with concomitant hemorrhage in heterotopic gastric mucosa causing hematemesis and melena is presented.......Gastric mucosa can be found in the gallbladder as a congenital heterotopia. A case of a perforated peptic ulcer in the gallbladder with concomitant hemorrhage in heterotopic gastric mucosa causing hematemesis and melena is presented....

Elom et al., Afr., J. Infect. Dis.

African Journals Online (AJOL)

NNACHI

Farming. 320. 88 (27.5%). Articians. 69. 18 (26%). Civil servant. 11. 2 (18.2%). TOTAL. 400. 108 (27%). Key: Pu = proteinuria; Hu = haematuria; Lu = leucocyturia. Intensity of Infection. Table 2 shows the relationship between proteinuria, haematuria and leucocyturia and ova excretion in urine of. S. haematobium infected ...

2010 SEPTEMBER EDITION FINAL.cdr

African Journals Online (AJOL)

haematuria. The diagnosis is mainly from the history of cyclical haematuria following a lower segment caesarean section, clinical evaluation, high index of suspicion and a simple investigation and confirmation at operation. The treatment of a vesico-uterine fistula is. 3 by surgical repair , preferably in conjunction with a.

sept 2 edition 2009.cdr

African Journals Online (AJOL)

User

aspergilloma or complications such as bronchiectasis are also known causes of haemoptysis world wide. However, cystic fibrosis (CF) is the commonest etiologic factor in Europe. Haematemesis may be misinterpreted as haemoptysis, particularly when accurate history is not possible in children. Therefore, bleeding from.

Clinical characteristics and outcome of patients with upper ...

African Journals Online (AJOL)

Conclusions: The common presentations were haematemesis and melaena, mainly in middle aged men with mortality in one out of seven patients. The high mortality may be due to co-morbidities and poor support services. Keywords: Upper gastrointestinal bleeding, Emergency department, Characteristics, Outcome ...

Clinical feature of disturbance in the lower gastrointestinal tract development after radiation to tumor in the pelvis and its countermeasure

International Nuclear Information System (INIS)

Ikeda, Sadahito; Sunagawa, Shigenobu; Matsumura, Shigejiro; Masaoka, Takao; Uegaki, Kazuo

1975-01-01

The clinical features and the countermeasure were examined on 40 disturbances in the lower gastrointestinal tract developed after radiotherapy of cancer of the uterus, the ovary and the penis. Two to nine months after the irradiation with 10,000 R of Telecobalt and about 5,000 mch of 60 Co, complications such as melena, stenosis and fistula formation were developed. Seventeen of the 40 patients complained of melena and were treated as outpatient. Of the rest 23 patients, 11 were radiation proctitis with a large amount of melena, 9 were recto-sigmoid stenosis, 2 were rectovaginal fistula and 1 was fecal fistula formation. These patients received internal therapy composed of transfusion, hemostatic agent, steroid, solcoseryl suppository, antiulcerative drug and vitamin. However, the prognosis of them, particularly of the patients who were exposed a large amount of radiation, was very poor and the death rate reached 9 to 43%. (Kanao, N.)

Renal artery pseudoaneurysm

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Luiz Inácio Roman

Full Text Available Abstract The renal artery pseudoaneurysm embody a rare vascular complication coming of percutaneous procedures, renal biopsy, nephrectomy, penetrating traumas and more rarely blunt traumas. The clinical can be vary according the patient, the haematuria is the symptom more commom. Is necessary a high level of clinical suspicion for your diagnosis, this can be elucidated by through complementary exams as the eco-color Doppler and the computed tomography scan (CT. This report is a case of a patient submitted a right percutaneous renal biopsy and that, after the procedure started with macroscopic haematuria, urinary tenesmus and hypogastric pain. The diagnosis of pseudoaneurysm was given after one week of evolution when the patient was hospitalized because gross haematuria, tachycardia, hypotension and hypochondrium pain. In the angiotomography revealed a focal dilation of the accessory right renal inferior polar artery, dilation of renal pelvis and all the ureteral course with presence hyperdenso material (clots inside the middle third of the ureter. The treatment for the majority of this cases are conservative, through arterial embolization, indicated for thouse of smaller dimensions in patients who are hemodynamically stable. However, it was decided by clinical treatment with aminocaproic acid 1 g, according to previous studies for therapy of haematuria. The patient received discharge without evidence of macroscopic haematuria and with normal renal ultrasound, following ambulatory care.

Clinical studies in the effect of sodium alginate on radiation esophagitis and proctitis

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Adachi, Hideki; Ono, Koji; Abe, Mitsuyuki; Inoue, Toshihiko; Imura, Toshio; Onoyama, Yasuto; Tanaka, Yoshimasa; Narabayashi, Isamu; Yoshikawa, Yuichi

1985-04-01

In the present study, we examined the effect of sodium alginate, a drug which has been used for the treatment of peptic ulcer, on radiation esophagitis or proctitis. Over seventy percent of patients suffered from swallowing pain due to radiation esophagitis were relieved from the pain within a week after an oral administration of sodium alginate. The extent of the improvement of the symptom did not significantly correlate with sex and age of the patients and with radiation doses delivered before occurrence of swallowing pain. For the treatment of radiation proctitis, an anal administration of sodium alginate was also effective. Melena, a major symptom of radiation proctitis, was decreased or disappeared in seventeen out of nineteen cases. The durations required for the improvement of melena varied from seven to seventy days. Endoscopical examinations of the rectum revealed reparation of erosions on the mucosal surface in parallel with the improvement of melena. (author).

Blødende øsofagusvaricer hos en syvårig dreng som formodet senkomplikation af navle-vene.kateter i neonatalperioden

DEFF Research Database (Denmark)

Rogvi, Rasmus Á; Gregersen Møller, Fie; Bergström, Anita

2016-01-01

A seven-year-old boy was admitted with haematemesis. The boy was originally born at 27 weeks' gestational age. His neonatal period had been complicated by sepsis, for which he was treated with antibiotics through an umbilical venous catheter (UVC). A gastroscopy showed grade III oesophageal varices...

gastrocolic fistula as a complication of benign gastric ulcer

African Journals Online (AJOL)

Colonoscopy was used in 4 patients and diagnosed fistula in 2. One patient who presented with haematemesis had the fistula diagnosed at surgery. All group A patients underwent partial gastrectomy with a Billroth I gastroduodenotomy and segmental colonic resection with primary anastomosis. There was no recurrence.

Gastroduodenal artery aneurysm - Post traumatic pancreatic pseudocyst drainage - An interesting case.

Science.gov (United States)

Zarin, Mohammad; Ali, Sajid; Majid, Abdul; Jan, ZakaUllah

2018-01-01

Pseudoaneurysms of the gastroduodenal artery (GDA) are rare and mostly associated with pancreatitis. However, they can occur as a possible complication following gastric or pancreatic surgery and thus prior recognition and prompt treatment is mandatory (Lee et al., 2009 [1]). We report a case of a ruptured GDA aneurysm in a patient who underwent roux-en-y-cystojejunostomy for traumatic pancreatic pseudocyst and this has rarely been reported in the literature. Our patient presented with melena one month post operatively. CT Angiogram showed pseudoaneurysm of the GDA and the origin of right gastroepiploic artery which was embolised. Our case highlights that GDA aneurysm must be considered in the differential for a patient who presents with melena following drainage of traumatic pancreatic pseudocyst and that it can be managed successfully with angioembolization. A young boy was operated for traumatic pancreatic pseudocyst. One month later, he presented with the complaints of melena. Patient was resuscitated initially and then CT Angiogram was planned that showed pseudo aneurysm of the GDA and the origin of right gastroepiploic artery. The aneurysm was embolised and patient was sent home later on. On two months follow up the patient was doing well and had no episode of melena. GDA aneurysm are rare and should be suspected in a patient with GI hemorrhage after surgery for traumatic pancreatic pseudocyst. The investigation of choice is CT Angiography and endovascular angioembolization is the treatment modality of choice. Copyright © 2017. Published by Elsevier Ltd.

1 Massive upper gastrointestinal bleeding and diffuse benign gastric ...

African Journals Online (AJOL)

Abstract: Benign gastric inflammatory hyperplasic polyps are benign lesions that rarely occur in young age. We report a case of diffuse benign gastric inflammatory hyperplastic polyps in a 19 year old male patient who presented with cough, nausea, and haematemesis. In the presented case symptoms such as nausea and.

Management of hemorrhage secondary to a pseudoaneurysm of the ...

African Journals Online (AJOL)

We report the case of a 31-year-old man with chronic pancreatitis and haematemesis secondary to a gastroduodenal artery pseudoaneurysm. No evidence-based guidelines exist regarding the optimal treatment modality for this condition. In referring to this case, we emphasise the value of coeliac arteriography for ...

Hepatogastric fistula: A rare complication of liver abscess

Directory of Open Access Journals (Sweden)

Shrihari Anikhindi

2015-01-01

Full Text Available Rupture of amebic liver abscess into stomach is a rare complication. We report a case of a young male presenting with haematemesis due to a rupture of left lobe amebic liver abscess into stomach. We discuss the diagnosis and management of this rare clinical entity.

Validation of a new test for Schistosoma haematobium based on detection of Dra1 DNA fragments in urine: evaluation through latent class analysis.

Directory of Open Access Journals (Sweden)

Olufunmilola Ibironke

2012-01-01

Full Text Available Diagnosis of urogenital schistosomiasis in chronically infected adults is challenging but important, especially because long term infection of the bladder and urinary tract can have dire consequences. We evaluated three tests for viable infection: detection of parasite specific DNA Dra1 fragments, haematuria and presence of parasite eggs for sensitivity (Se and specificity (Sp.Over 400 urine specimens collected from adult volunteers in an endemic area in Western Nigeria were assessed for haematuria then filtered in the field, the filter papers dried and later examined for eggs and DNA. The results were stratified according to sex and age and subjected to Latent Class analysis.Presence of Dra1 in males (Se=100%; Sp=100% exceeded haematuria (Se=87.6%: Sp=34.7% and detection of eggs (Se=70.1%; Sp=100%. In females presence of Dra1 was Se=100%: Sp=100%, exceeding haematuria (Se=86.7%: Sp=77.0% and eggs (Se=70.1%; Sp=100%. Dra1 became undetectable 2 weeks after praziquantel treatment. We conclude detection of Dra1 fragment is a definitive test for the presence of Schistosoma haematobium infection.

Chylothorax and chyloascites complicating cirrhosis of liver

International Nuclear Information System (INIS)

Hussain, M.; Ansarie, M.; Mehmood, K.

2004-01-01

Chylothorax and chyloascites is the accumulation of chyle in pleural and peritoneal spaces and are rarely seen. This case report describes the occurrence and management in an old lady. However, she expired due to frank haematemesis and encephalopathy. Chylothorax/chyloascites are difficult to manage and associated with poor prognosis. (author)

Hookworm infestation in children presenting with melena-case series

International Nuclear Information System (INIS)

Saeed, A.; Cheema, H.A.; Alvi, A; Suleman, H.

2008-01-01

Hookworm infection is common in children and can present with symptoms of upper gastrointestinal bleeding and severe anemia. Ten children below 5 years presenting with me lena and severe pallor were seen from December 2006 to May 2007 in the gastroenterology and hepatology department of children's hospital, Lahore. All patients had history of transfusion. Complete blood picture, eosinophil count with peripheral smear, stool complete examination for ova and cysts were performed in all cases while upper and lower gastrointestinal Endoscopies were performed in three patients to locate the source of bleeding. Stool routine examination in all these cases confirmed hook worm ova. These patients were managed with Antihelmenthic and stool complete examination was done three days after the medicine. There was no mortality. Though upper gastrointestinal bleeding with hookworm infestation is very rare but in the developing Countries it should be considered when other causes of upper gastrointestinal bleeding are ruled out. (author)

A crimean - congo hemorrhagic fever outbreak in northern balochistan

International Nuclear Information System (INIS)

Nadeem, M.; Ali, N.

2007-01-01

To describe the clinical characteristics, epidemiology, predictors of fatal outcome (PFO), and management effects of Crimean-Congo haemorrhagic fever (CCHF) patients during an outbreak in Northern Balochistan. Patients presenting with a fever of less than 2 weeks duration and bleeding manifestations were included. Clinical history was recorded and patients were placed on oral ribavirin, and hematological support. Diagnosis was established by PCR for CCHF or detection of CCHF specific IgM and IgG. Eighty-four patients were received, 34 (40.5%) were suspected of suffering from classical CCHF. All 34 (100%) patients presented with a history of fever and bleeding (epistaxis, gum bleeding, melena or haematuria). Mean platelet count was 30 x 109/L and mean ALT (alanine transferase) was 288 U/L. Among fatal cases, the mean platelet count was 18.4 x 10 9/L and ALT was 781 units/L. PCR for CCHF viral RNA performed on 10 patients was positive in 3 (30%) patients. CCHF specific IgM and IgG was positive in 17.6% (6/34). Four patients were brought in moribund condition and expired before treatment could be started, 4 patients expired during treatment and 76.5% (26/34) were cured. The overall mortality was 23.5% (8/34). Main predictors of fatal outcome were ALT z 150 units/L, activated partial thromboplastin time(aPT) z 60 seconds, prothrombin time (PT) z 34 seconds, aspartate transferase (AST) z 200 units/L, platelets o 20 x 109/L, and fibrinogen o 110 mg/dL. In this series of CCHF occurring in Northern parts of Balochistan, gastrointestinal tract bleeding was the worst prognostic factor associated with fatal outcome. Providing education to healthcare workers and at risk populations, hematological support, antiviral drugs, and barrier nursing may help reduce mortality. (author)

Sigmoidoscopy

Science.gov (United States)

Flexible sigmoidoscopy; Sigmoidoscopy - flexible; Proctoscopy; Proctosigmoidoscopy; Rigid sigmoidoscopy; Colon cancer sigmoidoscopy; Colorectal sigmoidoscopy; Rectal sigmoidoscopy; Gastrointestinal bleeding - sigmoidoscopy; Rectal bleeding - sigmoidoscopy; Melena - ...

Gastritis cystica polyposa in the unoperated stomach: A case report

International Nuclear Information System (INIS)

Lee, Yeo Jin; Kim, Kyung Ah; Chung, Yong Eun; Lim, Joon Seok; Jeon, Hyae Min

2012-01-01

Gastritis cystica polyposa (GCP) is an uncommon lesion that usually develops at the gastroenterostomy site. A 57 year old man visited a hospital with a complaint of melena. He did not have any surgical history or past medical history. Endoscopy was performed to evaluate the cause of melena, and a polypoid cystic mass in the stomach was found on an endoscopy and endoscopic ultrasonography. The polypoid cystic mass did not show any enhancing solid portion on a computed tomography. The gastric lesion was conclusively confirmed as GCP through endoscopic submucosal dissection. We report a rare case of GCP that occurred in an unoperated stomach

Gastritis cystica polyposa in the unoperated stomach: A case report

Energy Technology Data Exchange (ETDEWEB)

Lee, Yeo Jin; Kim, Kyung Ah; Chung, Yong Eun; Lim, Joon Seok; Jeon, Hyae Min [Severance Hospital/Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

2012-10-15

Gastritis cystica polyposa (GCP) is an uncommon lesion that usually develops at the gastroenterostomy site. A 57 year old man visited a hospital with a complaint of melena. He did not have any surgical history or past medical history. Endoscopy was performed to evaluate the cause of melena, and a polypoid cystic mass in the stomach was found on an endoscopy and endoscopic ultrasonography. The polypoid cystic mass did not show any enhancing solid portion on a computed tomography. The gastric lesion was conclusively confirmed as GCP through endoscopic submucosal dissection. We report a rare case of GCP that occurred in an unoperated stomach.

Portal hypertension due to choledochal cyst

International Nuclear Information System (INIS)

Athar, M.; Haider, M.H.R.; Khan, M.A.; Khaliq, T.; Ahmad, N.

2002-01-01

A case of portal hypertension secondary to choledochal cyst is reported. A young female presented with haematemesis, malena and splenomegaly in addition to the classic triad of jaundice, pain and abdominal mass. Oesophagogastroscopy revealed second degree varices. Excision of cyst and hepaticojejunostomy was performed. At six months follow up patient was completely asymptomatic with no endoscopic evidence of varices. (author)

Guillain-Barre syndrome in an adult patient with Henoch-Schonlein purpura.

Science.gov (United States)

Aggarwal, Puneet; Sahoo, Ratnakar; Gadpayle, A K; Kumar, Gunjan

2013-04-03

A 42-year-old man presented with pain in the abdomen, massive haematemesis and rashes over the body and development of bilateral lower limb weakness the next day. The patient was later diagnosed with Guillain-Barre syndrome with Henoch-Schonlein purpura. He was treated with intravenous immunoglobulins. At 3 months of follow-up and rehabilitation, patient showed complete recovery from weakness.

Guillain-Barre syndrome in an adult patient with Henoch-Schonlein purpura

OpenAIRE

Aggarwal, Puneet; Sahoo, Ratnakar; Gadpayle, A K; Kumar, Gunjan

2013-01-01

A 42-year-old man presented with pain in the abdomen, massive haematemesis and rashes over the body and development of bilateral lower limb weakness the next day. The patient was later diagnosed with Guillain-Barre syndrome with Henoch-Schonlein purpura. He was treated with intravenous immunoglobulins. At 3 months of follow-up and rehabilitation, patient showed complete recovery from weakness.

The role of endoscopy in pediatric gastrointestinal bleeding

Science.gov (United States)

Franke, Markus; Geiß, Andrea; Greiner, Peter; Wellner, Ulrich; Richter-Schrag, Hans-Jürgen; Bausch, Dirk; Fischer, Andreas

2016-01-01

Background and study aims: Gastrointestinal bleeding in children and adolescents accounts for up to 20 % of referrals to gastroenterologists. Detailed management guidelines exist for gastrointestinal bleeding in adults, but they do not encompass children and adolescents. The aim of this study was to assess gastrointestinal bleeding in pediatric patients and to determine an investigative management algorithm accounting for the specifics of children and adolescents. Patients and methods: Pediatric patients with gastrointestinal bleeding admitted to our endoscopy unit from 2001 to 2009 (n = 154) were identified. Retrospective statistical and neural network analysis was used to assess outcome and to determine an investigative management algorithm. Results: The source of bleeding could be identified in 81 % (n = 124/154). Gastrointestinal bleeding was predominantly lower gastrointestinal bleeding (66 %, n = 101); upper gastrointestinal bleeding was much less common (14 %, n = 21). Hematochezia was observed in 94 % of the patients with lower gastrointestinal bleeding (n = 95 of 101). Hematemesis (67 %, n = 14 of 21) and melena (48 %, n = 10 of 21) were associated with upper gastrointestinal bleeding. The sensitivity and specificity of a neural network to predict lower gastrointestinal bleeding were 98 % and 63.6 %, respectively and to predict upper gastrointestinal bleeding were 75 % and 96 % respectively. The sensitivity and specifity of hematochezia alone to predict lower gastrointestinal bleeding were 94.2 % and 85.7 %, respectively. The sensitivity and specificity for hematemesis and melena to predict upper gastrointestinal bleeding were 82.6 % and 94 %, respectively. We then developed an investigative management algorithm based on the presence of hematochezia and hematemesis or melena. Conclusions: Hematochezia should prompt colonoscopy and hematemesis or melena should prompt esophagogastroduodenoscopy. If no

Leiomyoblastoma of the stomach.

Directory of Open Access Journals (Sweden)

Sarda A

1992-07-01

Full Text Available A case of gastric leiomyoblastoma in a 37 year old male is presented. The patient presented with 3 episodes of melaena requiring blood transfusion on one occasion. There was no associated haematemesis, abdominal pain, obstruction or a palpable lump. The tumor was sessile and completely intraluminal with superficial ulceration displaying distinctive histologic features. Seven years after partial gastrectomy the patient has remained asymptomatic.

Massive upper gastrointestinal haemorrhage due to direct visceral erosion of splenic artery aneurysm.

Directory of Open Access Journals (Sweden)

Shahani R

1994-10-01

Full Text Available Six male patients (age group: 30-60 years with aneurysm of the splenic artery presented with massive upper gastrointestinal tract hemorrhage. Five patients presented with hematemesis and one with melena. Chronic pancreatitis was noted in all the patients, four of whom were chronic alcoholics. Endoscopy was not useful in diagnosis. Bleeding through the Ampulla of Vater was seen in the patient with melena. Angiography was diagnostic in all. Pancreatic resection including the aneurysm(2, and bipolar ligation with underrunning of the aneurysm (3 were the operative procedures. Distal pancreatectomy with pancreatogastrostomy was carried out in the patient with hemosuccus pancreaticus. If endoscopy is inconclusive, angiography and early intervention is recommended to reduce the high mortality associated with conservative management.

A designated centre for people with disabilities operated by Praxis Care, Co. Dublin

LENUS (Irish Health Repository)

Moloney, Fiachra

2014-01-01

This paper discusses the current status of imaging in the investigation of patients with haematuria. The physician must rationalize imaging so that serious causes such as malignancy are promptly diagnosed while at the same time not exposing patients to unnecessary investigations. There is currently no universal agreement about the optimal imaging work up of haematuria. The choice of modality to image the urinary tract will depend on individual patient factors such as age, the presence of risk factors for malignancy, renal function, a history of calculus disease and pregnancy, and other factors, such as local policy and practice, cost effectiveness and availability of resources. The role of all modalities, including conventional radiography, intravenous urography\\/excretory urography, ultrasonography, retrograde pyelography, multidetector computed tomography urography (MDCTU), and magnetic resonance urography, is discussed. This paper highlights the pivotal role of MDCTU in the imaging of the patient with haematuria and discusses issues specific to this modality including protocol design, imaging of the urothelium, and radiation dose. Examination protocols should be tailored to the patient while all the while optimizing radiation dose.

Synchronous gastric and duodenal metastases from head and neck squamous cell carcinoma: a unique presentation of upper gastrointestinal bleeding.

Science.gov (United States)

Tarangelo, Nicholas P; Kistler, C Andrew; Daitch, Zachary; Jiang, Wei; Quirk, Daniel M

2018-01-01

Metastatic disease to the stomach or duodenum is an infrequent diagnosis, and head and neck squamous cell carcinoma (HNSCC) is one of the least common primary malignancies that lead to gastric or duodenal metastases. We report the case of a 65-year-old man with human immunodeficiency virus infection and previously diagnosed HNSCC who presented with melena. The patient had a percutaneous endoscopic gastrostomy tube placed 3 months prior to his presentation. Laboratory testing was significant for normocytic anemia and a digital rectal examination was positive for melena. Esophagogastroduodenoscopy revealed numerous cratered nodules with contact bleeding in the stomach as well as the duodenum that appeared malignant. Biopsies of the gastric and duodenal nodules were positive for p40 and CK 5/6, consistent with metastatic squamous cell carcinoma.

Radiation enteritis. Evaluation of surgical cases

Energy Technology Data Exchange (ETDEWEB)

Sato, M.; Sano, M.; Minakuchi, N.; Narisawa, T.; Takahashi, T. (Akita Univ. (Japan))

1981-09-01

Radiation enteritis with severe complications including intestinal bleeding, fistula, and stenosis were treated surgically in 9 cases. These 9 cases included 7 cases of cancer of the uterine cervix and 2 single cases of seminoma and melanoma. The patients received /sup 60/Co or Linac x-ray external irradiation with or without intracavitary irradiation by a radium needle. Radiation injury began with melena, vaginorectal fistula, and intestinal obstruction 3 to 18 months after irradiation. One patient with melena underwent colostomy and survived 2 years. One of the three patients with vaginorectal fistula who had colostomy survived 1.5 years. In intestinal obstruction, one patients had bypass operation and three patients had resection of the intestine and the other had both. Leakage was noted in one patient, but the others had favorable prognosis.

Radiation enteritis

International Nuclear Information System (INIS)

Sato, Makoto; Sano, Masanori; Minakuchi, Naoki; Narisawa, Tomio; Takahashi, Toshio

1981-01-01

Radiation enteritis with severe complications including intestinal bleeding, fistula, and stenosis were treated surgically in 9 cases. These 9 cases included 7 cases of cancer of the uterine cervix and 2 single cases of seminoma and melanoma. The patients received 60 Co or Linac x-ray external irradiation with or without intracavitary irradiation by a radium needle. Radiation injury began with melena, vaginorectal fistula, and intestinal obstruction 3 to 18 months after irradiation. One patient with melena underwent colostomy and survived 2 years. One of the three patients with vaginorectal fistula who had colostomy survived 1.5 years. In intestinal obstruction, one patients had bypass operation and three patients had resection of the intestine and the other had both. Leakage was noted in one patient, but the others had favorable prognosis. (Ueda, J.)

Peptic ulcer in the gallbladder. A case report

DEFF Research Database (Denmark)

Larsen, E H; Diederich, P J; Sørensen, Flemming Brandt

1985-01-01

Gastric mucosa can be found in the gallbladder as a congenital heterotopia. A case of a perforated peptic ulcer in the gallbladder with concomitant hemorrhage in heterotopic gastric mucosa causing hematemesis and melena is presented....

YOUSSEF SYNDROME REVISITED

Directory of Open Access Journals (Sweden)

Aruna Menon

2017-10-01

Full Text Available Youssef’s syndrome, a rare entity, consists of cyclical haematuria or menouria, amenorrhea associated with vaginal leakage of urine. This was first described by M Youssef, an Egyptian Surgeon in 1957.1 Since then, reports of this rare urogenital fistula have appeared off and on in literature. We present a case subsequent to a ruptured uterus during a trial of labour after a previous Caesarean section. A 26-year-old lady, para 2, presented to the OPD with complaints of intermittent haematuria, increased frequency of micturition and lactational amenorrhea. She also gave history of occasional watery discharge per vaginum, which had subsided by the time of presentation.

An Unusual Presentation of Metanephric Adenofibroma: A Rare Case Report

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Kiran Agarwal

2017-10-01

Full Text Available Metanephric adenofibroma is a rare renal neoplasm with only a few case reports in literature. In majority of cases, it is asymptomatic. However, it may present with haematuria, polycythemia or hypertension. Radiologically, it is indistinguishable from other solid renal tumours. Definitive diagnosis can only be made on the basis of histopathology. It is a benign neoplasm and requires only surgical excision with no need for chemotherapy. Involvement of urinary bladder and presentation as bladder mass has never been reported. In this case report, we present a case of metanephric adenofibroma in a two-year-old male child manifesting with haematuria and urinary bladder mass.

Radiologic features of gastric leiomyosarcoma and leiomyoma

International Nuclear Information System (INIS)

Yang, Seoung Oh; Choi, Byung Ihn; Han, Man Chung; Kim, Chu Wan

1985-01-01

Smooth muscle tumors of stomach are unusual tumors, accounting for 1-3% of primary gastric malignancies. Diagnosis of these tumors is important because of the more favorable prognosis of this tumor than that of gastric carcinoma. A retrospective study was made in 18 patients who had pathology-proven gastric leiomyoma and leiomyosarcoma to identify radiologic characteristics for recent 6 years from Jan. 1978 to July. 1984 at Department of Radiology, Seoul National University Hospital. The results were as follows: 1. Age of 13 cases of gastric leiomyosarcoma ranged from 36 to 70 with average of 51 and the male to female ratio was 10 ; 3. Age of 5 cases of gastric leiomyoma ranged from 24 to 67 with average of 44 and the male to female ratio was 3 : 2. 2. Clinically, gastric leiomyosarcoma had epigastric pain in 7 cases, palpable mass in 4 cases, melena in 3 cases, haematemesis in 2 cases, 5 cases of gastric leiomyoma also had above symptoms respectively. 3. Of the 13 cases of gastric leiomyosarcoma studied by upper gastrointestinal examination, 6 cases (32%) involved the fundus, 10 cases (50%) in the body, 3 cases (18%) in the antrum. Of the 5 cases of gastric leiomyoma, 4 cases were confined to the fundus and 1 case in the body. 4. The size of the 13 gastric leiomyosarcoma ranged from 5 to more than 20 cm in diameter. The size of the 5 gastric leiomyomas ranged from 3 to 9 cm in diameter. 5. The growth type of gastric leiomysarcoma was exophytic in 8 cases, endogastric in 1 case and mixed pattern in 4 cases. The growth type of gastric leiomyoma were exophytic in 1 case, endogastric in 2 cases and mixed in 2 cases. 6. Mucosal pattern of gastric leiomyosarcoma were mainly effaced pattern in 10 cases (77%), but 3 cases (23%) showed irregular destruction. 1 case of gastric leiomyoma showed mucosal irregularity. 7. Ulceration was present in 10 cases of gastric leiomyosarcoma either single or multiple. 2 cases of gastric leiomyoma showed small ulcerations. Calciflation

Gastric diverticulosis and ulcerations in bitches

African Journals Online (AJOL)

ADEYEYE

2014-01-08

Jan 8, 2014 ... with complaints of anorexia and persistent vomition especially after meals. History also revealed that the dog had been treated for canine parvovirus enteritis two weeks prior to presentation. The clinical signs noticed were melena, persistent emesis observed often between 20-30 minutes after meals, ...

The epidemiology of human and animal schistosomiasis in the Senegal River Basin.

Science.gov (United States)

Vercruysse, J; Southgate, V R; Rollinson, D

1985-09-01

The results of four field surveys in Senegal are reported. 1. A snail survey in various parts of the Senegal River Basin, including the Senegal River, temporary rain-fed pools, swamps, irrigation canals and drains, ricefields and Lac de Guier was carried out. Three species of snails were commonly found: Bulinus guernei was the most common, occurring in permanent habitats, Bulinus senegalensis occurring in laterite pools in the eastern part of the Middle Valley, and also in the ricefields of Guédé Chantier and Lampsar; B. forskalii was found in small numbers in Lac de Guier and Richard Toll. Three B. guernei were found to be naturally infected with S. bovis. Neither B. jousseaumei, B. globosus nor B. umbilicatus were found in our surveys. 2. A survey for urinary schistosomiasis was carried out in 100 villages (walo, near the Senegal River) and 11 villages (diéré, away from the river) by delivering questionnaires in schools and by direct examinations of haematuria samples. The prevalence of haematuria varied between 0 and 33%. Generally, walos showed low rates of haematuria with the exception of Lampsar and Guédé Chantier, and diérés showed higher rates of haematuria. 3. Examination of 400 cattle at the abattoir St. Louis, revealed a prevalence of 80% of schistosome infection. Two species were present, S. bovis and less commonly S. curassoni. Sometimes high worm burdens were seen, but lesions appeared to be minimal because of high ratio of male to female worms. 4. Examinations of 5722 sheep and 1752 goats in the abattoir, Dakar revealed an overall prevalence of 2.1%. Of the infected animals, 97.3% were infected with S. curassoni and 2.7% with S. curasonni and S. bovis. Laboratory snail infection experiments showed that S. curassoni is marginally compatible with B. senegalensis, but incompatible with B. guernei.

Livstruende ekstrauterin hjørnegraviditet efter in vitro-fertilisation og bilateral salpingektomi

DEFF Research Database (Denmark)

Claudi, Anne; Steen-Hansen, Christian; Nørgaard, Lone Nikoline

2015-01-01

A woman with a history of bilateral salpingectomy achieved pregnancy after in vitro fertilization. At the gestational age of six weeks she experienced fatigue, haematemesis and abdominal pain. She was hospitalized on suspicion of a peptic ulcer. Several physicians rejected the possibility...... of an ectopic pregnancy due to the history of salpingectomy. The patient had intraabdominal bleeding and went through emergency surgery because of a ruptured interstitial pregnancy. The purpose of this case report is to recall the risk of interstitial pregnancy in pregnant women with a history of salpingectomy....

Autosomal Dominant Polycystic Kidney Disease, incidental finding with trauma: Case report and review of the literature

Directory of Open Access Journals (Sweden)

N.J. Gildenhuys

2017-03-01

In cases of blunt renal trauma with a history suggesting the possibility of a pre-existing lesion, the threshold for requesting CT of the abdomen should be lowered, even in absence of gross haematuria.

Urinvejsproblemer efter ketaminmisbrug

DEFF Research Database (Denmark)

Reinhardt, Susanne; Fode, Mikkel

2014-01-01

Ketamine is gaining popularity among Danish drug users. We present the first three reports of ketamine-induced urinary symptoms in Denmark. The patients were 22-27 years old and were all referred to urological departments due to microscopic or macroscopic haematuria. In addition, all three patien...... reported pain from the penis and the gut, respectively. No specific pathology was found and all patients admitted to ketamine abuse. The cases illustrate that Danish physicians must be aware of potential side effects to ketamine abuse.......Ketamine is gaining popularity among Danish drug users. We present the first three reports of ketamine-induced urinary symptoms in Denmark. The patients were 22-27 years old and were all referred to urological departments due to microscopic or macroscopic haematuria. In addition, all three patients...

Prediction of bleeding and prophylactic platelet transfusions in cancer patients with thrombocytopenia

DEFF Research Database (Denmark)

Vinholt, Pernille J; Alnor, Anne; Nybo, Mads

2016-01-01

Studies on markers for bleeding risk among thrombocytopenic cancer patients are lacking. This prospective observational cohort study investigated whether platelet parameters and a standardised bleeding questionnaire predicted bleeding or prophylactic platelet transfusions in patients with cancer ...... platelet transfusion but not bleeding. Bleeding risk factors were previous haematuria or gastrointestinal bleeding, infection, antiplatelet or anticoagulant treatment, high urea nitrogen, low haemoglobin or high creatinine....... or warfarin OR = 2.34, 95% CI 1.23–4.48; urea nitrogen OR = 1.15, 95% CI 1.07–1.25; creatinine OR = 1.01, 95% CI 1.01–1.01; and haemoglobin OR = 0.62, 95% CI 0.41–0.93. Specific information regarding previous gastrointestinal bleeding OR = 3.33, 95% CI 1.19–9.34 and haematuria OR = 3.00, 95% CI 1...

Antimicrobial susceptibility profile of community-acquired urinary ...

African Journals Online (AJOL)

M.S. Barry

2017-04-28

Apr 28, 2017 ... incontinence, Haematuria, turbid urine and fever with flank pain. Urinary infection ..... update by the Infectious Diseases Society of America and the Euro- ... from patients with urinary tract infection in Messalata Central Hospital,.

JUNE ISSUE 2008 FINAL.cdr

African Journals Online (AJOL)

Materials and Method: Records of adult patients scheduled for nephrectomy at ... Key Words: Nephrectomy, renal tumours, loin pain, haematuria, kidney injury .... over a ten-year period at the University of Port- ..... kidney since 80 years back.

NIGERIAN VETERINARY JOURNAL

African Journals Online (AJOL)

ADEYEYE

2Department of Veterinary Medicine, University of Nigeria, Nsukka. 3Veterinary. Teaching ... salivation, cornea opacity, haematuria and convulsion were observed in 20, 8, 2, 4, 1 and 3 of the patients ... intravenous fluid administration either for.

Childhood Acute Glomerulonephritis in Benin City | Ibadin | Nigerian ...

African Journals Online (AJOL)

, oliguria (47.6 percent) and pulmonary oedema (39.7 percent). Others were headache (11.1 percent) and convulsion (4.8 percent). Haematuria and proteinuria of varying degrees occurred in all the patients, while antecedent infections were ...

Diagnostic approach to chronic kidney disease | Naiker | South ...

African Journals Online (AJOL)

Chronic kidney disease (CKD) can be considered to be present if a patient has a glomerular filtration rate 3 months. These include proteinuria, haematuria and radiological abnormalities. Regardless of the stage of CKD, the approach is mainly similar.

Surgical results in cases of intestinal radiation injury

Energy Technology Data Exchange (ETDEWEB)

Deguchi, Hisatsugu; Ozawa, Tetsuro; Wada, Toshihiro; Tsugu, Yukio (Toho Univ., Tokyo (Japan). School of Medicine)

1991-05-01

Surgical procedures were performed on 25 patients suffering from late-phase intestinal tract disorders induced by irradiation. The primary diseases of these cases were almost exclusively gynecological in nature, such as cancer of the uterine cervix. Symptoms observed in these cases were overwhelming ileus followed by melena, fistulation and free perforation, as well as combination thereof. The most common portion involved was the recto-sigmoidal colon, followed by the ileo-cecum and ileum. As for the relationship of symptoms to the disordered portion, ileus was seen mainly in cases of disorders at the ileocecal portion; melena was observed exclusively in cases of disorders at the rectosigmoidal colon; fistulation was manifested mainly as recto-vaginal fistula or ileo-sigmoidal fistula; free perforation was observed at both the ileum and sigmoidal colon. Colostomy was the most frequent surgical method applied. Only 3 cases were able to undergo enterectomy. Other cases were subjected to enteroanastomosis or enterostomy. In most cases it was nearly in possible to excise the disordered portions. As for the effect of surgical procedures on symptoms, cases of melena or fistulation were all subjected to colostomy; the majority of these cases showed improvement in symptoms. Moreover, a high improvement ratio was obtained in cases of ileus which were subjected to enterectomy and enteroanastomosis. Cases of free perforation showed high improvement ratio irrespective of the surgical procedure given. As for postoperative complications, one case of free perforation at the ileum showed anastomotic leakage after partial resection. For cases suffering from late-phase intestinal tract disorders induced by irradiation, immediate resection of the disordered intestinal tract and anastomosis are ideal. However, conservative operations must be considered, based on the focal condition. (author).

Rectovesicovaginal fistula following rectovaginal fistula caused by radiation therapy for uterine cancer. A case report

Energy Technology Data Exchange (ETDEWEB)

Hara, Tsuneo; Shiba, Masahiro; Matsuoka, Yasuhiro; Kakimoto, Ken-ichi; Oda, Masayoshi; Koide, Takuo [Osaka Koseinenkin Hospital (Japan)

1997-07-01

A case of rectovesicovaginal fistula caused by pelvic radiation for uterine cancer is presented. A 62-year-old woman visited our department complaining of macroscopic hematuria, mictional pain and pollakisuria. She had a history of total hysterectomy and radiation therapy for cervical cancer 26 years earlier. Melena was noted in March 1994 and an escape of stool from the vagina followed nine months later. She consulted a surgeon about it, however no active treatment was performed before coming under our care. Computed tomography demonstrated that the posterior bladder wall was extremely thin and the possibility of the formation of vesical perforation was strongly suggested. We constructed transverse-colostomy, however, a rectovesicovaginal fistula developed seven months later. Therefore, in order to regain a dry life, an ileal conduit was constructed and her quality of life began to improve. It is probable that the rectovesicovaginal fistula could have been prevented if colostomy had been carried out soon after the appearance of melena or soon after the formation of the rectovaginal fistula. (author)

Rectovesicovaginal fistula following rectovaginal fistula caused by radiation therapy for uterine cancer. A case report

International Nuclear Information System (INIS)

Hara, Tsuneo; Shiba, Masahiro; Matsuoka, Yasuhiro; Kakimoto, Ken-ichi; Oda, Masayoshi; Koide, Takuo

1997-01-01

A case of rectovesicovaginal fistula caused by pelvic radiation for uterine cancer is presented. A 62-year-old woman visited our department complaining of macroscopic hematuria, mictional pain and pollakisuria. She had a history of total hysterectomy and radiation therapy for cervical cancer 26 years earlier. Melena was noted in March 1994 and an escape of stool from the vagina followed nine months later. She consulted a surgeon about it, however no active treatment was performed before coming under our care. Computed tomography demonstrated that the posterior bladder wall was extremely thin and the possibility of the formation of vesical perforation was strongly suggested. We constructed transverse-colostomy, however, a rectovesicovaginal fistula developed seven months later. Therefore, in order to regain a dry life, an ileal conduit was constructed and her quality of life began to improve. It is probable that the rectovesicovaginal fistula could have been prevented if colostomy had been carried out soon after the appearance of melena or soon after the formation of the rectovaginal fistula. (author)

ISSN 2073 ISSN 2073-9990 East Cent. Afr. J. surg. (Online) 9990 ...

African Journals Online (AJOL)

DELL

2005-04-29

Apr 29, 2005 ... Urinary tract infection was also common, being present in 58.9% of ... vesicostomy (42.9%), initial valve ablation (51.8%) and urethral catheterization 5.3%. ... 10% of the cases and included poor stream, gross haematuria and.

Eclampsia: Still a major problem in rural KwaZulu-Natal Province ...

African Journals Online (AJOL)

antenatal care, of whom 11 (22.4%) had risk factors including persistent proteinuria and haematuria. ... This clinical audit indicates that a number of cases of eclampsia could have been avoided if ..... possible that if the 'Free State Model' of.

Upper gastrointestinal endoscopy at the korle bu teaching hospital, accra, ghana.

Science.gov (United States)

Aduful, Hk; Naaeder, Sb; Darko, R; Baako, Bn; Clegg-Lamptey, Jna; Nkrumah, Kn; Adu-Aryee, Na; Kyere, M

2007-03-01

To study the indications for endoscopy, the endoscopic diagnosis and other lessons learnt. A retrospective and prospective audit of all upper gastrointestinal endoscopies performed in the Endoscopy Unit of the Korle-Bu Teaching Hospital from January 1995 to December 2002 was performed. A total of 6977 patients, 3777 males and 3200 females with age range 1 year 8 months to 93 years were endoscoped. The mean age of males was 43.5 +/- 0.5 and females 43.7 +/- 0.6 years. Epigastric pain (42.5%), dyspepsia (32.8%) and haematemesis and melaena (14.2%) were the commonest reasons for endoscopy. Chronic duodenal ulcer (19.6%), acute gastritis (12.7%), duodenitis (10.2%), oesophagitis (7.5%) were the commonest diagnoses. Normal endoscopy was reported in 41.1% patients, and was higher in the younger age group compared to the older (R = 0.973, P<0.001). Nine hundred and ninety (14.2%) patients were endoscoped for haematemesis and melaena of which chronic duodenal ulcer (32.1%), gastritis/gastric erosions (12.8%), oesophageal varices (9.8%), carcinoma of the stomach (6.4%), and duodenitis (4.2%), were the commonest causes. No lesion was found in 20.6% of these patients. Urease test was positive in 75% of all biopsy specimen and 85% in chronic duodenal ulcer, gastritis and duodenitis. The normal endoscopy rate is high and needs to be reduced in order to help prolong the lives of the endoscopes. Chronic duodenal ulcer is usually associated with H. pylori infection and is the commonest cause of upper gastrointestinal bleeding.

Afrimedic Vol. 4, No. 1 Final

African Journals Online (AJOL)

NAM

, fever and inability to pass urine. There was no history of purulent urethritis, haematuria, contact with anybody with chronic cough, weight loss and low back pain. There was no history of major trauma prior to onset of abdominal pain, but he.

Acute glomerulonephritis mimicking nephrotic syndrome

African Journals Online (AJOL)

2016-01-04

Jan 4, 2016 ... 0.3 cases per 100,000 person/ year.5 Thus, it is a disease of underdeveloped and ... The typical clinical presentation of PSGN which is a representative of a ... onset of microscopic haematuria, oedema, hypertension, oliguria ...

Polycystic Kidney Disease In Pregnancy In A Nigerian Woman ...

African Journals Online (AJOL)

Adult Polycystic Kidney disease (ADPKD) is a known but uncommon cause of haematuria in pregnancy in this environment. Other causes include, haemaglobinopathies, calculi, pyelonephritis, schistosomiasis, haemangiomata and neoplasms. Although ADPKD is the commonest single gene disorder of man affecting both ...

Pyloric obstruction due to massive eosinophilic infiltration in a young adult dog.

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Konstantinidis, Alexandros O; Mylonakis, Mathios E; Psalla, Dimitra; Soubasis, Nectarios; Papadimitriou, Dimitrios; Rallis, Timoleon S

2017-11-01

A 16-month-old dog was presented with chronic vomiting, anorexia, progressive weight loss, and melena. Exploratory laparotomy revealed a massive pyloric eosinophilic infiltration leading to pyloric obstruction that was treated successfully with pylorectomy. This is a novel clinical presentation of eosinophilic gastritis and highlights the need to consider it as a differential diagnosis for pyloric obstruction.

case reports atypical presentation of systemic lupus erythematosus ...

African Journals Online (AJOL)

2014-03-01

Mar 1, 2014 ... single episode of gross haematuria about twenty four hours prior to presentation to the hospital. He had passed very scanty non-bloody urine on the day of ad- mission. ... A Foley catheter was inserted to relieve the acute uri-.

1 The effectiveness of ultrasound in the diagnosis of bladder ...

African Journals Online (AJOL)

evaluating patients presenting with haematuria or suspected to have bladder tumours. It is cheap, ... world, transitional cell carcinoma (TCC) is the commonest, while in developing countries squamous cell ..... Fenlon, H., Bell, T., Ahari, H. & Hussain, S. (1997) Virtual cystoscopy: early clinical experience. Radiology 250 ...

Diagnosis, balances and energy indicators in municipalities of 'BASAL' project

International Nuclear Information System (INIS)

Pérez Martín, David; Soler Iglesias, Belkis; López López, Ileana; Moreno, Helsy; Matos, Yamilexis; Sanfiel, Caridad; Román, José Enrique

2015-01-01

Under the 'Basis for Environmental Sustainability Local Food' project (BASAL)) transverse energy-related activities were conducted. In this work we are analyzed and presented energy diagnoses in municipalities Los Palacios, Guira de Melena and Jimaguayú, capturing energy statistics in the 3 municipalities, energy balances and key energy indicators compared to support sustainability and decision making. (full text)

Successful intra-arterial alteplase infusion is a predictor of 12-month limb survival in patients with lower limb arterial occlusion

International Nuclear Information System (INIS)

Disini, L.; Wilson, P.; Cockburn, J.F.

2008-01-01

Aim: To determine the factors predicting amputation of the affected lower limb 12 months after thrombolysis for acute arterial occlusion. Materials and methods: The clinical endpoints of 39 patients (24 men, 15 women; average age 69 years) 1 year after catheter-directed thrombolysis with alteplase (mean dose 30 mg, mean duration 24 h) for lower limb arterial occlusion (30 native arteries, nine grafts) from January 2001 to June 2005 were assessed. The amputation rate at 12 months was analysed in relation to the thrombolytic outcome, type of vessel occluded, presence or absence of complications, and subsequent requirement for additional surgery on an elective basis using Fischer's exact test. Results: Successful thrombolysis, defined as complete clot dissolution based on angiographic imaging, was achieved in 64.1% of cases (19 native artery, six bypass graft) with a total complication rate of 23% (n = 9). The incidence of major haemorrhage was 7.5% (n = 3, hypotension and haematemesis, groin haematoma and hypotension, haematemesis). No patient had an intracranial bleed. One year after thrombolysis, 28.2% (n = 11) had further surgery (bypass graft, fasciotomy, embolectomy) and the amputation rate was 20.5% (n = 8). Statistical analysis showed that the amputation rate was significantly higher for patients with failed compared with successful thrombolysis (p = 0.02). The amputation rates did not reach statistical significance in relation to native artery or graft occlusion, presence or absence of complications, and whether or not additional surgery was required. Conclusion: Successful thrombolysis was a predictor for limb survival up to 12 months post-thrombolysis regardless of the type of vessel occlusion, presence of complications or additional surgical requirement

Comparison of findings using ultrasonography and cystoscopy in ...

African Journals Online (AJOL)

Cystoscopic examination (CE) has been accepted as the gold-standard test for detecting the late manifestations of schistosomiasis, including urothelial cancer of ... find it useful for more accurate diagnosis of haematuria and to identify bladder wall alterations in both adults and children in schistosomiasis-endemic regions.

Childhood Renal Neoplasms in Lagos Nigera- A 28 Year Review ...

African Journals Online (AJOL)

Childhood Renal Neoplasms in Lagos Nigera- A 28 Year Review. ... Most of the patients presented with abdominal mass with a unilaterally enlarged kidney, abdominal pain, haematuria and weight loss. All of them had nephrectomy as initial treatment followed by radiotherapy and chemotherapy. Nigerian Quarterly Journal ...

Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities: Case reports and literature review.

Science.gov (United States)

Park, Sang Woo; Cho, Eunae; Jun, Chung Hwan; Choi, Sung Kyu; Kim, Hyun Soo; Park, Chang Hwan; Rew, Jong Sun; Cho, Sung Bum; Kim, Hee Joon; Han, Mingui; Cho, Kyu Man

2017-01-01

Ectopic variceal bleeding is a rare (2-5%) but fatal gastrointestinal bleed in patients with portal hypertension. Patients with ectopic variceal bleeding manifest melena, hematochezia, or hematemesis, which require urgent managements. Definitive therapeutic modalities of ectopic varices are not yet standardized because of low incidence. Various therapeutic modalities have been applied on the basis of the experiences of experts or availability of facilities, with varying results. We have encountered eight cases of gastrointestinal ectopic variceal bleeding in five patients in the last five years. All patients were diagnosed with liver cirrhosis presenting melena or hematemesis. All patients were treated with various endoscopic modalities (endoscopic variceal obturation [EVO] with cyanoacrylate in five cases, endoscopic variceal band ligation (EVL) in two cases, hemoclipping in one case). Satisfactory hemostasis was achieved without radiologic interventions in all cases. EVO and EVL each caused one case of portal biliopathy, and EVL induced ulcer bleeding in one case. EVO generally accomplished better results of variceal obturations than EVL or hemoclipping, without serious adverse events. EVO may be an effective modality for control of ectopic variceal bleeding without radiologic intervention or surgery.

Peritonitis in Patients with Scrub Typhus

OpenAIRE

Lee, Chang-Hun; Lee, Jae-Hoon; Yoon, Ki Jung; Hwang, Jeong-Hwan; Lee, Chang-Seop

2012-01-01

Various complications have been reported in scrub typhus cases including acute respiratory distress syndrome, encephalitis, pneumonia, pericarditis, acute renal failure, and acute hepatic failure. Few studies have reported on the gastrointestinal manifestations of scrub typhus. Typical gastrointestinal manifestations in patients with scrub typhus include abdominal pain, nausea, vomiting, hematemesis, melena, and diarrhea. The two cases presented in this study are the first reported cases of p...

Los árboles

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Jaime Paredes Pardo

1964-09-01

Full Text Available Los árboles son hijos del viento que transporta las semillas. En los valles anda de prisa, tanto que a veces alcanza a los trenes y a la melena de los caballos que espanta la algarabía de los pasajeros. Como los trenes, el viento tiene una frente de humo. De niebla como las montañas. ¿Pensará el viento?

Prevalence of urinary Schistosomiasis in Umuowele, Agulu ...

African Journals Online (AJOL)

Fragment Length Polymorphism (PCR-RFLP) was used for snail species identification. Results: Haematuria revealed 48.1% prevalence rate among the pupils while PCR showed 58.3%. Three snails were also positive for schistosome infection one of which was identified as Bulinus truncatus while the other two belonged to ...

Is there a role for hyperbaric oxygen as primary treatment for grade IV radiation-induced haemorrhagic cystitis? a prospective pilot-feasibility study and review of literature

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Dellis, Athanasios [Surgical Department, University of Athens, Aretaieion Hospital (Greece); Deliveliotis, Charalambos [Urologic Department, University of Athens, Sismanoglio General Hospital (Greece); Kalentzos, Vasileios; Vavasis, Pavlos; Skolarikos, Andreas [Diving and Hyperbaric Oxygen Department, Naval and Veterans Hospital, Athens (Greece)

2014-05-15

Purpose: To examine the safety and efficacy of hyperbaric oxygen as the primary treatment for Grade IV radiation-induced haemorrhagic cystitis. Materials and Methods: Hyperbaric oxygen was prospectively applied as a primary treatment option in 11 patients with Grade IV radiation cystitis. Primary endpoint was the incidence of complete and partial response to treatment. Secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. Results: All patients completed therapy without complications for a mean follow-up of 17.82 months (range 3 to 34). Mean number of sessions needed was 32.8 (range 27 to 44). Complete and partial response rate was 81.8% and 18.2%, respectively. However, in three patients the first treatment session was not either sufficient or durable giving a 72.7% rate of durable effect. Interestingly, all 9 patients with complete response received therapy within 6 months of the haematuria onset compared to the two patients with partial response who received therapy at 8 and 10 months from the haematuria onset, respectively (p = 0.018). The need for blood transfusion (p = 0.491) and the total radiation dose (p = 0.259) were not correlated to success-rate. One patient needed cystectomy, while all patients were alive at the end of follow-up. Conclusions: Early primary use of hyperbaric oxygen to treat radiation-induced grade IV cystitis is an effective and safe treatment option. (author)

Is there a role for hyperbaric oxygen as primary treatment for grade IV radiation-induced haemorrhagic cystitis? a prospective pilot-feasibility study and review of literature

International Nuclear Information System (INIS)

Dellis, Athanasios; Deliveliotis, Charalambos; Kalentzos, Vasileios; Vavasis, Pavlos; Skolarikos, Andreas

2014-01-01

Purpose: To examine the safety and efficacy of hyperbaric oxygen as the primary treatment for Grade IV radiation-induced haemorrhagic cystitis. Materials and Methods: Hyperbaric oxygen was prospectively applied as a primary treatment option in 11 patients with Grade IV radiation cystitis. Primary endpoint was the incidence of complete and partial response to treatment. Secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. Results: All patients completed therapy without complications for a mean follow-up of 17.82 months (range 3 to 34). Mean number of sessions needed was 32.8 (range 27 to 44). Complete and partial response rate was 81.8% and 18.2%, respectively. However, in three patients the first treatment session was not either sufficient or durable giving a 72.7% rate of durable effect. Interestingly, all 9 patients with complete response received therapy within 6 months of the haematuria onset compared to the two patients with partial response who received therapy at 8 and 10 months from the haematuria onset, respectively (p = 0.018). The need for blood transfusion (p = 0.491) and the total radiation dose (p = 0.259) were not correlated to success-rate. One patient needed cystectomy, while all patients were alive at the end of follow-up. Conclusions: Early primary use of hyperbaric oxygen to treat radiation-induced grade IV cystitis is an effective and safe treatment option. (author)

Community-based study on CKD subjects and the associated risk factors.

Science.gov (United States)

Chen, Nan; Wang, Weiming; Huang, Yanping; Shen, Pingyan; Pei, Daoling; Yu, Haijin; Shi, Hao; Zhang, Qianying; Xu, Jing; Lv, Yilun; Fan, Qishi

2009-07-01

The study was performed to investigate the prevalence, awareness and the risk factors of chronic kidney disease (CKD) in the community population in Shanghai, China. A total of 2596 residents were randomly recruited from the community population in Shanghai, China. All were screened for albuminuria, haematuria, morning spot urine albumin-to-creatinine ratio and renal function. Serum creatinine, uric acid, cholesterol, triglyceride and haemoglobin were assessed. A simplified MDRD equation was used to estimate the glomerular filtration rate (eGFR). All studied subjects were screened by kidney ultrasound. Haematuria, if present in the morning spot urine dipstick test, was confirmed by microscopy. The associations among the demographic characteristics, health characteristics and indicators of kidney damage were examined. Two thousand five hundred and fifty-four residents (n = 2554), after giving informed consent and with complete data, were entered into this study. Albuminuria and haematuria were detected in 6.3% and 1.2% of all the studied subjects, respectively, whereas decreased kidney function was found in 5.8% of all studied subjects. Approximately 11.8% of subjects had at least one indicator of kidney damage. The rate of awareness of CKD was 8.2%. The logistic regression model showed that age, central obesity, hypertension, diabetes, anaemia, hyperuricaemia and nephrolithiasis each contributed to the development of CKD. This is the first Shanghai community-based epidemiological study data on Chinese CKD patients. The prevalence of CKD in the community population in Shanghai is 11.8%, and the rate of awareness of CKD is 8.2%. All the factors including age, central obesity, hypertension, diabetes, anaemia, hyperuricaemia and nephrolithiasis are positively correlated with the development of CKD in our studied subjects.

Evaluation of field recognizable morbidity indicators of Schistosoma haematobium infection among primary school children in Ghana

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Ato Kwamena Tetteh

2016-09-01

Materials and Methods — In all, 417 pupils in three primary schools (Kasseh sub-District, Dangme East District, Ghana, provided urine samples, which were examined for S. haematobium ova. The study utilized a structured questionnaire, the Urit 10V multi-stick urine reagent strips and the filtration method. Results — Overall, prevalence by microscopy was 20.9% (requires targeted treatment once every two years, and was higher (14.0% among the 10-15 years age group (χ2=22.44, p<0.001. The lowest prevalence was among the <6 (0.5%, 2/417 and ≥19 (1.4%, 6/417 years age groups. There was no significant difference in prevalence among females (7.9%, 33/417 and males (12.9%, 54/417 (χ2=2.58, p=0.108. Self-reported haematuria was 43.2% (targeted treatment once a year. There was a significant difference between female (16.1%, 67/417 and male (27.1%, 113/417 responses to self-reported haematuria (χ2=4.170, p<0.001. A lower consolidated mean prevalence of 11.7% was estimated among pupils who had ova in their urine and also exhibited three morbidity indicators (haematuria, leucocyturia and proteinuria. Combined and averaged sensitivity and specificity estimations (sensitivity = 55.4%, specificity = 67.8%, Positive Predictive Value (PPV = 53.4%, Negative Predictive Value (NPV = 64.2% of these morbidity indicators, was insufficient in equalizing the reliability of ova quantification. With the exception of leucocyturia, which was common among all pupils, 28.75% (25/87 of the infected individuals did not have any form of haematuria or proteinuria. Out of these, one pupil had heavy ova intensity (80 eggs/10ml of urine while the remaining 24 had low ova intensity infection (1-44 eggs/10ml of urine. Questionnaire correctly identified 56.3% of pupils with S. haematobium ova in their urine, also reporting bloody urine (PPV=27.2%; NPV=84.0%. It also identified 49.4% of pupils with ova, reporting painful urination (PPV=26.1%, NPV=82.5%. Conclusion — This study emphasizes the

Acute nierinsufficiëntie door bilaterale ureterobstructie na appendectomie bij een 6-jarige jongen

NARCIS (Netherlands)

van Linde, M. E.; van Pinxteren-Nagler, E.; Klinkert, P.; de Jong, T. P.; Schröder, C. H.

2000-01-01

A 6-year-old boy developed macroscopic haematuria on the 4th day after appendectomy for acute appendicitis, at which the appendix was found to be perforated. During the next few days the urine secretion decreased and malaise, pain in the lower abdomen, nausea and vomiting occurred. On a management

leech infestation

African Journals Online (AJOL)

GB

2013-03-01

Mar 1, 2013 ... fish, amphibians, and mammals. Infestation occurs by drinking infested water from quiet streams, pools and springs. They attach to their hosts ... trauma, foreign body ingestion, throat pain, fever, dysphagia and drug intake. He has no malena, haematuria, epistaxis or ecchymotic spots on the body. He had ...

Urinary cytokines in Schistosoma haematobium-infected schoolchildren from Tana Delta District of Kenya

DEFF Research Database (Denmark)

Njaanake, Kariuki H.; Simonsen, Paul Erik; Vennervald, Birgitte J

2014-01-01

urine filtration technique, for haematuria using dipstix and for eosinophil cationic protein (ECP), IL-6, IFN- γ, TNF-α and IL-10 levels using ELISA, and for S. haematobium-related urinary tract pathology using ultrasonography. In addition, venous blood was examined for serum IL-6, IFN- γ, TNF-α and IL...

Case Report - Persistent Haematuria and Chronic Pelvic Pain Due ...

African Journals Online (AJOL)

... of conception following an incomplete miscarriage. She recovered without complication within 2 weeks of its removal. Conclusion: This report highlights the need to discourage the insertion of IUCD by untrained health workers and to consider intra-vesical migration of IUCD in women of reproductive age with recurrent or ...

Congenital intrahepatic arterioportal and portosystemic venous fistulae with jejunal arteriovenous malformation depicted on multislice spiral CT

International Nuclear Information System (INIS)

Chae, Eun Jin; Goo, Hyun Woo; Yoon, Chong Hyun; Kim, Seong-Chul

2004-01-01

We report a symptomatic infant with very rare congenital arterioportal and portosystemic venous fistulae in the liver. Multislice CT after partial transcatheter embolisation revealed not only the complicated vascular architecture of the lesion, but also an incidental jejunal arteriovenous malformation which explained the patient's melena. The patient underwent ligation of the hepatic artery and resection of the jejunal arteriovenous malformation. Postoperative multislice CT clearly demonstrated the success of the treatment. (orig.)

Surgical management of radiation enterocolitis

International Nuclear Information System (INIS)

Sakaguchi, Masahiro; Katsumi, Masaharu; Ishimoto, Kiwao; Yamamoto, Shinji; Yukawa, Hirofumi; Koh, Kenzo; Yamaguchi, Kazuya; Ohta, Masataka; Hayashido, Motonori

1986-01-01

Radiotherapy for malignant tumors is effective and established. However, there are many complications in radiotherapy. A typical complication is radiation enterocolitis. It is difficult to treat severe histological damage to the irradiated tissues. This paper reports our experience with 26 patients with radiation enterocolitis for whom surgical treatment was given during a period of 16 years in our surgical department. The most frequent original disease requiring irradiation was cancer of the cervix uteri (15 cases) which was followed by cancer of the urinary bladder (7 cases). All of these patients had received external 60 Co irradiation. The ileum was the most frequent site of the lesion, followed by the rectum, sigmoid and descending colon. The period between the end of irradiation and the onset of enterocolitis ranged from 2 months to 10 years, with an average of 28 months. The main symptoms were intestinal obstruction in the ileum, and melena and fistula in the rectum and sigmoid colon. Intestinal resection was performed in 10 patients, a bypass operation in 4, and colostomy in 12. As to types of intestinal suture in these cases, Gambee's single layer method was thought useful from our experience. Colostomy as surgical management of melena and fistula did not yield satisfactory results. (author)

Selective Management for Gastrointestinal Hemorrhage caused by Choledochoduodenal Fistula

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Pawan Chansaenroj

2017-03-01

Full Text Available Background: To report a patient of choledochoduodenal fistulae (CDF who presented with melena and review a specific treatment for CDF. Methods: This study was designed as a retrospective chart review using patient’s clinical data, imaging, endoscopic report, treatment review, and literature review for treatment options. Results: A 74-year-old female presented with diffuse, non-tender abdominal pain and associated melena for one week. Physical examination showed mildly icteric sclera and mild epigastric tenderness on deep palpation. Initial diagnoses included cholangitis with anemia and acute kidney injury. Computed tomography of the abdomen revealed dilated common bile duct (CBD with a likely 1 cm stone at the distal common bile duct. The patient was given intravenous antibiotic and proper fluid administration. An ERCP was performed noting a fistula from the bile duct to the 2nd part of the duodenum with stone impaction. Sphincterotomy was performed from papilla to fistula. Balloon extraction of 1 cm stone from the CBD was done. Conclusion: The clinical presentation of CDF is generally quite nonspecific. In this case report, we present a presentation of a patient with gastrointestinal hemorrhage as an example of the presentation of CDF associated with a CBD stone. This study also discussed recent data concerning proposed treatment of CDF.

Superselective embolization with microcoil in acute gastronitestinal hemorrhage

International Nuclear Information System (INIS)

Ko, Eun Hye; Kim, Jae Kyu; Jang, Nam Kyu

2000-01-01

To evaluate the efficacy and safety of superselective arterial embolization using the microcoil in acute gastrointerstinal hemorrhage. We evaluated 11 of 42 patients who had undergone diagnostic angiography and transcatheter arterial embolization due to acute gastrointestinal hemorrhage and subsequently underwent superselective arterial embolization using the microcoil. Nine were males and two were females, and their age ranged from 33 to 70 (mean, 51) years. The etiologies were bleeding ulcer (n=3D5), pseudoaneurysm from pancreatitis (n=3D3), and postoperative bleeding (n=3D3). The symptoms were melena, hematemesis, and hematochzia, and the critical signs were cecreased hemoglobin and worsening of vital signs. All patients underwent superselective embolization using the microcatheter and microcoil. Bleeding occurred in the gastroduodenal artery (n=3D5), inferior pancreaticoduodenal artery (n=3D2), left gastric artery (n=3D2), right hepatic artery (n=3D1), and ileal branch of the superior mesenteric artery (n=3D1). All cases were treated succesfully, without complications. In one case in which there was bleeding in the right hepatic artery, reembolization with a microcoil was needed because of persistent melena. During follow up, three patients died from complications arising underlying diseases, namely disseminated intravascular coagulopathy, chronic renal failure, and adult resiratory distress syndrome. (author)=20

WEST AFRICAN JOURNAL OF MEDICINE

African Journals Online (AJOL)

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frequency, dysuria and a past history of childhood terminal haematuria. He also felt a palpable hard mass alone his penis. He was a fit young man, not pale and afebrile, in painful distress, with swollen indurated phallus and a hard mass along the urethra. A diagnosis of acute urinary retention secondary to urethral calculus.

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

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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.

Use of pertechnetate sup 99m Tc for abdominal scanning in localising an ileal duplication cyst: Case report and review of the literature

Energy Technology Data Exchange (ETDEWEB)

Lecouffe, P.; Venel, H.; Meuriot, S.; Marchandise, X. (Centre Hospitalier Universitaire, 59 - Lille (France). Service Associe de Medecine Nucleaire); Spyckerelle, C. (Centre Hospitalier Feron Vrau, 59 - Lille (France). Service de Pediatrie A)

1992-01-01

A 10-year-old boy presented with periumbilical postprandial pain and some melena. Physical examination was normal. All investigations were negative except pertechnetate Tc 99m abdominal scan which showed a very large and horn-shaped focus of high activity in the right flank. An ileal duplication was resected. It was lined by antral gastric muscosa with a large ulcer. The patient was treated successfully. Interest in abdominal pertechnetate scan is discussed. (orig.).

Full text

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IndexCopernicus Portal System

Case presentation. A seventy five year old Libyan man was seen in the urology department of Tripoli Medical Centre, Tripoli, Libya with six month history of left loin pain. The patient noted a mass in the left loin two days before he was assessed in the hospital. Also he started to vomit. There was no history of haematuria.

Platelet Levels and Implications For Pre-Dialysis Chronic Renal ...

African Journals Online (AJOL)

Platelet count is assumed to be normal in chronic renal insufficiency. However, the possible effect of loss of platelet function in chronic renal failure (CFR) in relation to occult chronic blood loss, haematuria and overall health of the patient has not been given the desired attention. The aim of this study was to determine the ...

Value of cystourethroscopy in the assessment of children with recurrent urinary tract infections and/or enuresis

DEFF Research Database (Denmark)

Nielsen, K K; Qvist, N; Kristensen, E S

1985-01-01

Forty-one children ages 6-14 years consecutively referred for recurrent urinary tract infections (RUTI) and/or enuresis constituted the study group. Cystourethroscopy (CUS) was carried out in 40 children and pathologic findings were revealed in 70% of children with RUTI in the absence of vesico...... patients with macroscopic haematuria during urinary tract infection were not managed differently following CUS....

The impact of repeated treatment with praziquantel of schistosomiasis in children under six years of age living in an endemic area for Schistosoma haematobium infection

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Mduluza T

2001-01-01

Full Text Available Praziquantel was given every eight weeks for two years to children aged under six years of age, living in a Schistosoma haematobium endemic area. Infection with S. haematobium and haematuria were examined in urine and antibody profiles (IgA, IgE, IgM, IgG1, IgG2, IgG3, and IgG4 against S. haematobium adult worm and egg antigens were determined from sera collected before each treatment. Chemotherapy reduced infection prevalence and mean intensity from 51.8% and 110 eggs per 10 ml urine, respectively, before starting re-treatment programme to very low levels thereafter. Praziquantel is not accumulated after periodic administration in children. Immunoglobulin levels change during the course of treatment with a shift towards 'protective' mechanisms. The significant changes noted in some individuals were the drop in 'blocking' IgG2 and IgG4 whereas the 'protecting' IgA and IgG1 levels increased. The antibody profiles in the rest of the children remained generally unchanged throughout the study and no haematuria was observed after the second treatment. The removal of worms before production of large number of eggs, prevented the children from developing morbidity.

Renal arteriovenous shunts, fistulae and malformations - angiographic case reports

International Nuclear Information System (INIS)

Esser, P.W.; Duex, A.

1989-01-01

Individual case reports serve to demonstrate the pathogenetically different renal arteriovenous shunt formations, such as congenital arteriovenous angioma, spontaneous arteriovenous aneurysm, iatrogenic arterio-venous fistula and neoplasia-conditioned arteriovenous fistula. These are discussed in detail, including treatment possibilities. The ranking of digital subtraction angiography is emphasised. Our case reports show that in preoperative diagnosis of pathological structures in the kidney, renovasography is an invaluable tool, especially with i.a. DSA technique, and is superior to all other methods such as sonography, CT, MR and colour-coded Doppler sonography. Due to improved techniques of angiography (markedly lower amounts of contrast medium when using catheters of narrow lumen) indication for i.a. DSA in haematuria of unknown origin should be liberal. Above all, the method should be performed at an early stage. If there is a NAD renal finding in the i.a. DSA renovasogram in renally conditioned haematuria even when using a 1024 x 1024 image matrix, it is advisable to perform selective renal arteriography to either exclude or confirm the existence of an intrarenal angioma, additionally in conventional sheet film technique because of the superior power of resolution. (orig.) [de

Hyperbaric oxygen as sole treatment for severe radiation - induced haemorrhagic cystitis

Energy Technology Data Exchange (ETDEWEB)

Dellis, Athanasios, E-mail: aedellis@gmail.com [Department of Surgery, National and Kapodistrian University of Athens, Aretaieion Academic Hospital, Athens (Greece); Papatsoris, Athanasios; Deliveliotis, Charalambos; Skolarikos, Andreas [Department of Urology, University of Athens, Sismanoglio General Hospital, Athens (Greece); Kalentzos, Vasileios [Department of Diving and Hyperbaric Oxygen, Naval and Veterans Hospital, Athens (Greece)

2017-05-15

Purpose: To examine the safety and efficacy of hyperbaric oxygen as the primary and sole treatment for severe radiation-induced haemorrhagic cystitis. Materials and methods: Hyperbaric oxygen was prospectively applied as primary treatment in 38 patients with severe radiation cystitis. Our primary endpoint was the incidence of complete and partial response to treatment, while the secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. Results: All patients completed therapy without complications with a mean follow-up of 29.33 months. Median number of sessions needed was 33. Complete and partial response rate was 86.8% and 13.2%, respectively. All 33 patients with complete response received therapy within 6 months of the haematuria onset. One patient needed cystectomy, while 33 patients were alive at the end of follow-up. Conclusions: Our study suggests the early primary use of hyperbaric oxygen for radiation-induced severe cystitis as an effective and safe treatment option. (author)

An Incidental Finding of AL-associated Amyloidosis Presenting as Gastric Ulcers

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Nadia Huq

2018-01-01

Full Text Available Gastrointestinal tract amyloidosis has been reported in rare instances and related symptoms are usually nonspecific to the disease process. We present a patient who initially had melena on anticoagulation and endoscopy revealed a bleeding gastric ulcer. Hemostasis was achieved. The patient had a recurrence of symptoms despite being off anticoagulation months later and at that time repeat endoscopy showed multiple gastric ulcers with surrounding friable mucosa. Biopsy results were significant for light chain associated-amyloidosis. This case represents a rare cause of gastric ulcer.

[Williams-Beuren syndrome (Williams syndrome). Case report].

Science.gov (United States)

Miklós, Györgyi; Fekete, György; Haltrich, Irén; Tóth, Miklós; Reismann, Péter

2017-11-01

Williams syndrome is a rare genetic disorder, that occurs equally in all ethnic groups and both sexes. The diagnosis might be missed during childhood in mild cases. However, establishing the diagnosis is important, not only to find the cause of intellectual disability but to look for cardiovascular, endocrine, psychiatry, urology and other conditions, which can occur at any age in the patients' lifetime. This case report presents the story of 47-year-old woman, who was admitted with haematemesis. During her stay on the ward, in the light of the distinctive facial features, mental retardation, and social behaviour patterns, the possibility of Williams syndrome emerged. Later, the diagnosis was confirmed by genetic analysis. This female is the oldest living patient with Williams syndrome in Hungary. Orv Hetil. 2017; 158(47): 1883-1888.

Schistosomiasis-induced squamous cell bladder carcinoma in an HIV-infected patient

DEFF Research Database (Denmark)

Marbjerg, Lis Høy; Øvrehus, Anne Lindebo Holm; Johansen, Isik Somuncu

2015-01-01

haematuria for more than a year. Investigations revealed invasive S. haematobium-associated squamous cell bladder cancer. If her origin had been taken into account, the diagnosis might have been made earlier. Awareness of the disease prevalence among HIV co-infected patients from endemic areas and timely...... screening of such patients is important for the early diagnosis of schistosomiasis and related complications, such as S. haematobium-associated squamous cell bladder cancer....

An Unusual Case Of Urinary Bladder Arteriovenous Malformation

LENUS (Irish Health Repository)

Gnanappiragasam, D

2016-07-01

A 45-year-old male presented with haematuria and urinary frequency. Computed Tomography (CT) urogram revealed gross thickening of the left bladder wall. Histology showed large vessels cuffed by eosinophonilic material suggestive of urinary bladder arteriovenous malformation (AVM). No further intervention was carried out as symptoms resolve after the resection. Follow up rigid cystoscopy and CT at 3 months showed resolution of all visible pathology and no evidence of recurrence.

Peutz-Jehgers syndrome (A case report)

International Nuclear Information System (INIS)

Kim, Byoung Geun; Park, Heung Il; Kwun, Chung Sik

1974-01-01

This is a report of rare case of Peutz-Jehgers syndrome in a 13 years old boys with chief complaints of melena and intermittent abdominal pain since 3 years of age. He has multiple small melanin pigmentations in the face, lower lip, and left buccal mucosa and numerous small and large polyps in the stomach, jejunum, ileum, colon, and rectum by roentgenologic studies. Hereditary features, mucocutaneous pigmentations, clinical manifestations, pathologic features, roentgen features, and differential diagnosis, and treatment of Peutz-Jehgers syndrome are discussed with a review of the literature

Peutz-Jehgers syndrome (A case report)

Energy Technology Data Exchange (ETDEWEB)

Kim, Byoung Geun; Park, Heung Il; Kwun, Chung Sik [Chonnam University School of Medicine, Kwangju (Korea, Republic of)

1974-10-15

This is a report of rare case of Peutz-Jehgers syndrome in a 13 years old boys with chief complaints of melena and intermittent abdominal pain since 3 years of age. He has multiple small melanin pigmentations in the face, lower lip, and left buccal mucosa and numerous small and large polyps in the stomach, jejunum, ileum, colon, and rectum by roentgenologic studies. Hereditary features, mucocutaneous pigmentations, clinical manifestations, pathologic features, roentgen features, and differential diagnosis, and treatment of Peutz-Jehgers syndrome are discussed with a review of the literature.

A teenager presents with fulminant hepatic failure and acute hemolytic anemia.

Science.gov (United States)

Bose, Somnath; Sonny, Abraham; Rahman, Nadeem

2015-03-01

A teenager was admitted to an outside hospital ED following an episode of melena. He had been complaining of intermittent abdominal pain, nausea, malaise, and easy fatigability for 2 months, with significant worsening of symptoms 2 weeks prior to this episode. He had no significant medical, surgical, or family history. On presentation at the outside ED, he was found to be profoundly icteric and encephalopathic. Initial laboratories suggested anemia, acute kidney injury, and acute liver failure, leading to a presumptive diagnosis of acute fulminant liver failure necessitating transfer to our institution.

Transarterial embolisation of renal arteriovenous malformation: safety and efficacy in 24 patients with follow-up

International Nuclear Information System (INIS)

Eom, H.-J.; Shin, J.H.; Cho, Y.J.; Nam, D.H.; Ko, G.-Y.; Yoon, H.-K.

2015-01-01

Aim: To evaluate the efficacy and safety of renal artery embolisation (RAE) for renal arteriovenous malformation (AVM) as well as its outcomes. Materials and methods: The technical and clinical success rates, radiological and laboratory findings, and complications of RAE for 31 renal AVMs in 24 patients (M:F=9:15, mean age 46 years) at two separate medical institutions were retrospectively evaluated. Technical success was defined as complete occlusion of feeding arteries with no residual nidus seen on post-treatment angiography. Clinical failure was defined as recurrence of haematuria, presence of AVM on follow-up ultrasound or computed tomography, repeated RAE or surgery for the control of haematuria. Overall clinical success was defined as resolution haematuria or disappearance of AVM on follow-up imaging after single or multiple sessions of RAE. Results: Types of renal AVM were AVM, arterio-venous fistula (AVF) with intranidal aneurysm, and acquired AVF in 19, 1, and 4 patients, respectively. 18 patients (75%) underwent a single session of RAE, while 6 patients (25%) had two or more sessions of RAE. The level of embolisation was feeder, segmental artery, and main renal artery in 28 (90%), 2 (6%), and 1 (4%) procedures, respectively. Coil, n-butyl 2-cyanoacrylate, and polyvinyl alcohol were the most frequently chosen embolic materials and were used in 19, 14, and 8 procedures, respectively. The clinical success rate after initial RAE was 67% (16/24). Overall clinical success rate, including multisession RAE, was 88% (21/24). The technical success rate of 31 procedures was 65% (20/31). Among 11 technical failures in 10 patients, 4 achieved clinical success without additional RAE, 3 underwent second session RAE to achieve clinical success, and 3 patients underwent nephrectomy due to recurrence. Conclusion: RAE is a safe and effective treatment for renal AVM. Technical failure of RAE does not always lead to clinical failure and multiple embolisation sessions may be

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 ...

YOUSSEF SYNDROME REVISITED

OpenAIRE

Aruna Menon; Prajakta S. Mehendale; Srinivas Sangisapu; Ajai Srivastava; Shilpa Asthana

2017-01-01

Youssef’s syndrome, a rare entity, consists of cyclical haematuria or menouria, amenorrhea associated with vaginal leakage of urine. This was first described by M Youssef, an Egyptian Surgeon in 1957.1 Since then, reports of this rare urogenital fistula have appeared off and on in literature. We present a case subsequent to a ruptured uterus during a trial of labour after a previous Caesarean section. A 26-year-old lady, para 2, presented to the OPD with complaints ...

Endoscopic evaluation of upper and lower gastro-intestinal bleeding

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Emeka Ray-Offor

2015-01-01

Full Text Available Introduction: A myriad of pathologies lead to gastro-intestinal bleeding (GIB. The common clinical presentations are hematemesis, melena, and hematochezia. Endoscopy aids localization and treatment of these lesions. Aims: The aim was to study the differential diagnosis of GIB emphasizing the role of endoscopy in diagnosis and treatment of GIB. Patients and Methods: A prospective study of patients with GIB referred to the Endoscopy unit of two health facilities in Port Harcourt Nigeria from February 2012 to August 2014. The variables studied included: Demographics, clinical presentation, risk score, endoscopic findings, therapeutic procedure, and outcome. Data were collated and analyzed using SPSS version 20 software. Results: A total of 159 upper and lower gastro-intestinal (GI endoscopies were performed during the study period with 59 cases of GI bleeding. There were 50 males and 9 females with an age range of 13-86 years (mean age 52.4 ΁ 20.6 years. The primary presentations were hematochezia, hematemesis, and melena in 44 (75%, 9 (15%, and 6 (10% cases, respectively. Hemorrhoids were the leading cause of lower GIB seen in 15 cases (41%. The majority of pathologies in upper GIB were seen in the stomach (39%: Gastritis and benign gastric ulcer. Injection sclerotherapy was successfully performed in the hemorrhoids and a case of gastric varices. The mortality recorded was 0%. Conclusion: Endoscopy is vital in the diagnosis and treatment of GIB. Gastritis and Haemorrhoid are the most common causes of upper and lower GI bleeding respectively, in our environment

Acute gastrointestinal bleeding following aortic valve replacement in a patient with Heyde's sindrome. Case report.

Science.gov (United States)

De Palma, G D; Salvatori, F; Masone, S; Simeoli, I; Rega, M; Celiento, M; Persico, G

2007-09-01

A 58-year old man was admitted to the hospital because of melena. He had a 1-year history of mechanical aortic valve replacement and coronary stent placement because of myocardial infarction and he was taking warfarin and clopidogrel. Esophagogastroduodenoscopy and colonoscopy were negative for bleeding. Capsule endoscopy showed bleeding diffuse angiodysplasia of the small bowel. The patient was treated with octreotide 20 mg, at monthly interval. After 25 months there had been no recurrence of gastrointestinal bleeding. The case suggests that mechanical valve replacement may not prevent gastrointestinal bleeding in Heyde syndrome and that octreotide treatment should be considered in these cases.

An Unusual Case of Gastrointestinal Bleeding

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Kristin N. Fiorino

2011-01-01

Full Text Available A 10-year-old boy presented with a 3-day history of worsening abdominal pain, fever, emesis and melena. Abdominal ultrasound revealed a right upper quadrant mass that was confirmed by computed tomography angiogram (CTA, which showed an 8 cm well-defined retroperitoneal vascular mass. 123Iodine metaiodobenzylguanidine (123MIBG scan indicated uptake only in the abdominal mass. Subsequent biopsy revealed a paraganglioma that was treated with chemotherapy. This case represents an unusual presentation of a paraganglioma associated with gastrointestinal (GI bleeding and highlights the utility of CTA and 123MIBG in evaluation and treatment.

Growth hormone used to control intractable bleeding caused by radiation-induced gastritis.

Science.gov (United States)

Zhang, Liang; Xia, Wen-Jie; Zhang, Zheng-Sen; Lu, Xin-Liang

2015-08-21

Intractable bleeding caused by radiation-induced gastritis is rare. We describe a 69-year-old man with intractable hemorrhagic gastritis induced by postoperative radiotherapy for the treatment of esophageal carcinoma. Although anti-secretory therapy with or without octreotide was initiated for hemostasis over three months, melena still occurred off and on, and the patient required blood transfusions to maintain stable hemoglobin. Finally growth hormone was used in the treatment of hemorrhage for two weeks, and hemostasis was successfully achieved. This is the first report that growth hormone has been used to control intractable bleeding caused by radiation-induced gastritis.

Palliative prostate radiotherapy for symptomatic advanced prostate cancer

International Nuclear Information System (INIS)

Din, Omar S.; Thanvi, Narottam; Ferguson, Catherine J.; Kirkbride, Peter

2009-01-01

Background and purpose: To report the results for the use of short-course palliative radiotherapy to the prostate for localised symptoms. Materials and methods: Fifty-eight patients were identified from radiotherapy records between 2003 and 2007. Data were collected retrospectively on patients' demographics, radiotherapy details and response. Symptoms and toxicity were scored, retrospectively, according to the following scale: 0 = no symptoms, 1 = mild symptoms, 2 = moderate symptoms, and 3 = severe symptoms. Results: All the 58 patients had advanced prostate carcinoma. The median age at radiotherapy was 76.6 years (range 54-91). Fifty-six patients (97%) had hormone refractory disease. Twenty-seven patients (47%) had evidence of metastatic disease. 20Gy in 5 fractions was the most commonly used fractionation. The most frequent baseline symptom was haematuria (54%). Eighty-nine percent (31/35) of the patients had a complete or partial resolution of symptoms at 4 months. Response rates for individual symptoms (including unknown responses) were: rectal symptoms (75%), pelvic pain (69%), urinary obstruction (54%) and haematuria (42%). A >50% reduction in PSA occurred in five patients. Toxicity was mild to moderate only and was self-limiting. Conclusion: Palliative radiotherapy to the prostate gland for local symptoms appears to be an effective means of palliation with minimal toxic side effects. Prospective studies are now required to assess its benefits in more detail.

Clinical presentation of renal cell carcinoma

International Nuclear Information System (INIS)

Rehman, R.A.; Ashraf, S.; Jamil, N.

2015-01-01

Most common malignant tumour of the kidney is Renal Cell Carcinoma (RCC) and is known for its unpredictable clinical behaviour. Aetiology and risk factors are not completely understood. Extensive workup is being done in the understanding of the disease, especially to diagnose early and to treat promptly. The objective of this study was to determine the clinical presentation and pathological pattern of RCC. Methods: After approval from ethical committee a retrospective review of records was conducted extending from January 2012 to January 2014 to identify clinical characteristics of renal cell carcinomas. The study included all renal cancer patients presented to Sheikh Zayed Hospital Lahore with in this specified period. The data was retrieved regarding, history, physical examination and necessary investigations such as ultrasonography of abdomen and pelvis and CT scan of abdomen and pelvis. Results: There were total of 50 cases. The male to female ratio was 3:2. Mean age of patients were 52.38 (18-93) years old. Most common clinical presentation was gross haematuria(66%).The mean tumour size was 8.34 (3-24) cm. Tumour histology were clear cell (84%), papillary transitional cell carcinoma (12%) and oncosytoma contributed 4%. Conclusion: We observed that large number of the patients with RCC presented with haematuria and most of them were male. Common pathological type was clear cell carcinoma. (author)

Protective effect of bile acid derivatives in phalloidin-induced rat liver toxicity

International Nuclear Information System (INIS)

Herraez, Elisa; Macias, Rocio I.R.; Vazquez-Tato, Jose; Hierro, Carlos; Monte, Maria J.; Marin, Jose J.G.

2009-01-01

Phalloidin causes severe liver damage characterized by marked cholestasis, which is due in part to irreversible polymerization of actin filaments. Liver uptake of this toxin through the transporter OATP1B1 is inhibited by the bile acid derivative BALU-1, which does not inhibit the sodium-dependent bile acid transporter NTCP. The aim of the present study was to investigate whether BALU-1 prevents liver uptake of phalloidin without impairing endogenous bile acid handling and hence may have protective effects against the hepatotoxicity induced by this toxin. In anaesthetized rats, i.v. administration of BALU-1 increased bile flow more than taurocholic acid (TCA). Phalloidin administration decreased basal (- 60%) and TCA-stimulated bile flow (- 55%) without impairing bile acid output. Phalloidin-induced cholestasis was accompanied by liver necrosis, nephrotoxicity and haematuria. In BALU-1-treated animals, phalloidin-induced cholestasis was partially prevented. Moreover haematuria was not observed, which was consistent with histological evidences of BALU-1-prevented injury of liver and kidney tissue. HPLC-MS/MS analysis revealed that BALU-1 was secreted in bile mainly in non-conjugated form, although a small proportion ( TCA > DHCA > UDCA. In conclusion, BALU-1 is able to protect against phalloidin-induced hepatotoxicity, probably due to an inhibition of the liver uptake and an enhanced biliary secretion of this toxin.

Primary Bladder Neurofibroma: A Rare Case with Clinical Implications and Diagnostic Challenges.

Science.gov (United States)

Umakanthan, Srikanth; Naik, Ramadas; Bukelo, Maryann Margaret; Rai, Sharada; Prabhu, Laxman

2015-09-01

Neurofibroma of the genito-urinary tract is rare. Urinary bladder is the commonest organ involved in cases of urinary tract involvement. Patients present early in life and there is male preponderance. We discuss here a case of primary neurofibroma of the urinary bladder in a 52-year-male presenting with haematuria, irritative bladder symptoms and pelvic mass. Cystoscopy showed a swelling in the left lateral wall. A transurethral biopsy revealed neurofibroma of the urinary bladder. Immunohistochemical studies confirmed the diagnosis.

Exsanguinating upper GI bleeds due to Unusual Arteriovenous Malformation (AVM of stomach and spleen: a case report

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Baqai Mohammad

2009-05-01

Full Text Available Abstract Background In this paper we are reporting one case of exsanguinating upper gastrointestinal tract (GIT bleed requiring massive blood transfusion and immediate life saving surgery. Case presentation A 30 years old female, 12 weeks pregnant was referred to our hospital from the earth-quake affected area of Kashmir with history of upper abdominal pain, haematemesis and melaena for one week. After stabilizing the patient, upper gastro-intestinal endoscopy was performed. It revealed gastric ulcer just distal to the gastro-esophageal junction on the lesser curvature. Biopsy from the ulcer edge led to profuse spurting of the blood and patient went into state of shock. Immediate resuscitation led to rebleeding and recurrence of post haemorrahagic shock. Conclusion The patient was immediately explored and total gastrectectomy with splenectomy concluded as life saving procedure. A review of literature was conducted to make this report possible.

An unusual cause of abdominal pain.

LENUS (Irish Health Repository)

Mc Cabe, Aileen

2011-01-01

A 26-year-old man presented to the Emergency Department with abdominal pain, diarrhoea, anorexia and haematemesis. The patient was previously diagnosed with latent tuberculosis (TB). On examination, his abdomen was diffusely tender, with localised guarding in the right iliac fossa. CT imaging of his abdomen and pelvis demonstrated a low volume of ascites, diffuse studding of the peritoneum, omental caking and several bulky low-density lymph nodes in the retroperitoneum. A laparoscopy was performed to obtain a peritoneal biopsy. Histology demonstrated fragments of peritoneum with necrotising granulomatous inflammatory infiltrate in keeping with an infectious process, favouring TB. He was commenced on rifampicin, isoniazid, pyrazinamide, ethambutol and pyridoxine under the direct observed therapy by the infectious diseases team. In view of his extensive peritoneal involvement, he was empirically started on high-dose prednisolone for symptomatic control and to reduce complications related to peritoneal adhesions.

A very rare case of bloody tears with enigmatic epistaxis and haematuria.

Science.gov (United States)

Ho, Jason Z S; de Silva, Julian; Olver, Jane

2011-03-01

Bloody tears are a rare symptom that can be caused by local or systemic pathology. We describe a very rare case of bloody tears that resulted from hyperthyroidism. A 15-year-old female patient presented with a 6-month history of bloody tears and epistaxis. Examination excluded local ocular and nasal pathology, including neoplasm and coagulopathy. Systemic investigations identified elevated thyroid function and following treatment her symptoms resolved. We discuss the mechanism by which hyperthyroidism may induce haemostatic dysfunction. We present the first case of bloody tears secondary to thyroid dysfunction.

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.

Prostatic carcinoma in two cats

International Nuclear Information System (INIS)

Caney, S.M.A.; Holt, P.E.; Day, M.J.; Rudorf, H.; Gruffydd-Jones, T.J.

1998-01-01

Clinical, radiological and pathological features of two cats with prostatic carcinoma are reported. In both cats the presenting history included signs of lower urinary tract disease with haematuria and dysuria. Prostatomegaly was visible radiographically in one cat; an irregular intraprostatic urethra was seen on retrograde contrast urethrography in both cats. In one of the cats, neoplasia was suspected on the basis of a transurethral catheter biopsy. Following a poor response to palliative treatment in both cases, euthanasia was performed with histological confirmation of the diagnosis

Co-infection with Schistosoma haematobium and soil-transmitted helminths in rural South Africa

DEFF Research Database (Denmark)

Molvik, Mari; Helland, Elin; Zulu, Siphosenkosi Gift

2017-01-01

trichiura in schoolgirls in the rural areas of KwaZulu-Natal, South Africa. We also explored if S. haematobium can serve as a predictor for soil-transmitted helminths in this area. From 15 selected schools, 726 primary schoolgirls aged 10–12 years provided both urine and stool samples. The samples were...... interval =1.58–2.93; pwater contact and haematuria) were significantly associated with A. lumbricoides and T. trichiura infection. We have demonstrated a highly significant correlation and overall association between urogenital...

Schistosoma haematobium infection and asymptomatic bacteriuria in young South African females

DEFF Research Database (Denmark)

Kildemoes, Anna M. O.; Kjetland, Eyrun Floerecke; Zulu, Siphosenkosi Gift

2015-01-01

Schistosoma haematobium eggs can induce lesions in the urinary and genital tract epithelia, as eggs pass through or get trapped in the tissue. Local inflammatory reactions induced by S. haematobium eggs might affect the ability of bacteria to establish mucosal super-infection foci. S. haematobium...... school students from a schistosomiasis endemic area in KwaZulu-Natal, South Africa. Furthermore, it was demonstrated that asymptomatic bacteriuria is not a bias for use of micro-haematuria as a proxy diagnostic measure for S. haematobium infection in this population....

Evaluation of the patients that followed up for upper gastrointestinal system bleeding

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Hüseyin Gölgeli

2014-09-01

Full Text Available Objective: In this study, it was aimed to evaluate demographic and laboratory characteristics of the patients with upper gastrointestinal system (GIS bleeding define the factors leading to bleeding. Methods: The study included 285 patients aged between 18 and 89 years who were followed and treated for upper GIS bleeding in our Internal Medicine Clinics. Patients’ demographic and aboratory data, endoscopic findings, treatment methods, ospitalization length and need for blood transfusions were determined. Results: The mean age was 62.7±18.3 years with the male/female ratio of 2.2/1. The most common finding was melena (45.3%, and the second melena with hematemesis (33%. 76.84% of the patients had the history of drug use, mostly non-steroid anti-inflammatory drugs (NSAIDs (45.26% and aspirin (23.86%. The mean hospitalization length was 8.3±4.9 days. Blood transfusion was required in 74.04% with the mean 3,14±1,41 units. Bleeding recurrence was seen in 10.25%. Duodenal ulcer was observed as the most common cause of GIS bleeding (29.82% and gastric ulcer was the second (21.75%. The treatment methods were medical in 73.34%, endoscopic sclerotherapy in 22.46%, hemoclips in 1.40% and band ligation in 0.70% of the patients. Upper GIS bleedings were mostly occurred in August (11.9% and least occurred in December (3.5%. Conclusion: The majority of the patients have history of drug use, like NSAIDs and aspirin leading to bleeding. We suggest that the usage of these drugs should be controlled and used only with accurate indications especially in elderly patients.

Bariatric surgery complications. Internal hernia: A potentially fatal condition. A case report and literature review

International Nuclear Information System (INIS)

Canadas, Raul; Lombana, Luis Jorge; Hernandez, Javier; Solano, Claudia; Suarez, Yanette; Torres, Diana; Alvarado, Jaime; Valencia, William; Garcia, Jairo; Hani, Albis

2007-01-01

In recent years, Obesity (defined as Body Mass Index > 30 kg/m2) has increased its prevalence reaching epidemic levels in countries such as The United States where it has became a national health issue. In Colombia the Obesity prevalence is figured around 14%. Treatment options for Obesity include life style modifications, pharmacologist management and surgical approach (Bariatric Surgery). This article describes a patient with previous bariatric surgery, who presents abdominal pain and melena owed to isquemic process of the alimentary limb caused by an internal hernia which is a potentially lethal condition if it is not highly suspected allowing its early diagnosis and treatment

Bronchial Leech Infestation in a 15-Year-Old Female.

Science.gov (United States)

Moslehi, Mohammad Ashkan; Imanieh, Mohammad Hadi; Adib, Ali

2016-01-01

Foreign body aspiration (FBA) is a common incidence in young children. Leeches are rarely reported as FBA at any age. This study describes a 15-year-old female who presented with hemoptysis, hematemesis, coughs, melena, and anemia seven months prior to admission. Chest X-ray showed a round hyperdensity in the right lower lobe. A chest computed tomography (CT) demonstrated an area of consolidation and surrounding ground glass opacities in the right lower lobe. Hematological investigations revealed anemia. Finally, bronchoscopy was performed and a 5 cm leech was found within the right B 7-8 bronchus and removed by forceps and a Dormia basket.

Microballoon Occlusion Test to Predict Colonic Ischemia After Transcatheter Embolization of a Ruptured Aneurysm of the Middle Colic Artery

International Nuclear Information System (INIS)

Tajima, Tsuyoshi; Yoshimitsu, Kengo; Inokuchi, Hiroyuki; Irie, Hiroyuki; Nishie, Akihiro; Hirakawa, Masakazu; Ishigami, Kousei; Ushijima, Yasuhiro; Okamoto, Daisuke; Honda, Hiroshi; Itoh, Hiroyuki; Morita, Masaru; Kakeji, Yoshihiro

2008-01-01

A 76-year-old woman presented with sudden massive melena, and superior mesenteric arteriography showed an aneurysm in the middle colic artery (MCA). Because she had a history of right hemicolectomy and ligation of the inferior mesenteric artery (IMA) during open abdominal aortic aneurysm repair, embolization of the MCA aneurysm was considered to pose a risk comparable to that of colonic ischemia. A microballoon occlusion test during occlusion of the MCA confirmed retrograde visualization of the IMA branches through the collateral arteries by way of the left internal iliac artery, and embolization was successfully performed using microcoils. No colonic ischemia or aneurysm rupture occurred after embolization.

Hemobilia, intrahepatic hematoma and acute thrombosis with cavernomatous transformation of the portal vein after percutaneous thermoablation of a liver metastasis

Energy Technology Data Exchange (ETDEWEB)

Francica, G.; Marone, G.; D' Angelo, V. [Divisione di Gastroenterologia, Ospedale ' ' Cardinale Ascalesi' ' , Naples (Italy); Solbiati, L. [Divisione di Ecografia e Radiologia Interventistica, Ospedale Generale Busto Arsizio (Italy); Siani, A. [Servizio di Radiologia, Ospedale Civile ' ' S. Maria Delle Grazie' ' , Pozzuoli (Italy)

2000-06-01

A 53-year-old-man underwent US-guided percutaneous thermal ablation with a cooled-tip needle of three liver metastases from gastric cancer. Six days later, the patient was re-admitted for melena, scleral jaundice, and anemia. Abdominal US disclosed echogenic material in the gallbladder lumen (hemobilia) and a focal lesion with mixed echotexture in segment III (hepatic hematoma). On day 5 portal cavernomatosis was diagnosed at US and confirmed by color Doppler and a helical CT exam. The case described emphasizes that radio-frequency interstitial hyperthermia may cause not only traumatic injury of the liver parenchyma but also thermally mediated damage of vascular structures. (orig.)

Hemobilia, intrahepatic hematoma and acute thrombosis with cavernomatous transformation of the portal vein after percutaneous thermoablation of a liver metastasis.

Science.gov (United States)

Francica, G; Marone, G; Solbiati, L; D'Angelo, V; Siani, A

2000-01-01

A 53-year-old-man underwent US-guided percutaneous thermal ablation with a cooled-tip needle of three liver metastases from gastric cancer. Six days later, the patient was re-admitted for melena, scleral jaundice, and anemia. Abdominal US disclosed echogenic material in the gallbladder lumen (hemobilia) and a focal lesion with mixed echotexture in segment III (hepatic hematoma). On day 5 portal cavernomatosis was diagnosed at US and confirmed by color Doppler and a helical CT exam. The case described emphasizes that radio-frequency interstitial hyperthermia may cause not only traumatic injury of the liver parenchyma but also thermally mediated damage of vascular structures.

[Hemorrhagic cystitis due to adenovirus in a renal transplant recipient: the first reported case in black Africa in a setting of a very beginning of a kidney transplantation program and review of the literature].

Science.gov (United States)

Ackoundou-N'Guessan, Clément; Coulibaly, Noël; Guei, Cyr Monley; Aye, Denis; N'guessan, Francis Yapi; N'Dah, Justin Kouame; Lagou, Delphine Amélie; Tia, Mélanie Weu; Coulibaly, Pessa Albert; Nzoue, Sita; Konan, Serges; Gnionsahe, Daze Apollinaire

2015-04-01

Viral infections are an important complication of transplantation. Polyomavirus are the commonest viruses that infect the renal allograft. Herpes virus nephropathy has also been described. In the past 15 years, adenovirus nephritis has emerged as a potentially life-threatening disease in renal transplant patients in developed countries. Most of the papers devoted to adenovirus nephritis are reported cases. The fate of such patients in resources-limited countries is not known. Herein, we describe the clinical, biological and prognostic findings of a black African transplanted patient with adenoviral hemorrhagic cystitis. This case is the very first of its kind reported in black Africa in a setting of a start of a renal transplantation pilot project. The patient is a 54-year-old man admitted at the nephrology service for gross haematuria and fever occurred 1 month after kidney transplantation. The diagnosis of adenoviral hemorrhagic cystitis has been suspected because the patient has displayed recurrent conjunctivitis and gastroenteritis well before transplantation, which was then confirmed by the real-time polymerase chain reaction performed on the blood. Conservatory measures associated with immunosuppression reduction have permitted the discontinuation of haematuria. This case has been discussed in regard of the epidemiology, the diagnosis, the treatment, the evolution and the prognosis of the adenoviral infection in the renal transplant patient. A review of the literature has been performed subsequently. Copyright © 2015 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.

Acute haemorrhagic diarrhoea syndrome in dogs: 108 cases.

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Mortier, F; Strohmeyer, K; Hartmann, K; Unterer, S

2015-06-13

No prospective studies including large numbers of dogs with acute haemorrhagic diarrhoea syndrome (AHDS) are published so far. The aim of this case-control study was to describe signalment, history, clinical signs, laboratory values and course of disease in dogs with AHDS. Dogs (108) with idiopathic acute haemorrhagic diarrhoea (schnauzer and Maltese. The syndrome was more likely to occur during winter. Vomiting preceded the onset of bloody diarrhoea in 80 per cent of dogs and haematemesis was observed in half of those cases. Median AHDS index at presentation was 12 (range 3-17). Haematocrit was generally high (median 57.1 per cent; range 33-76 per cent), but exceeded 60 per cent only in 31.4 per cent of dogs. Haematocrit of 48.1 per cent of dogs was above reference range, as was monocyte (50.0 per cent), segmented (59.6 per cent) and band neutrophil count (45.2 per cent). A rapid clinical improvement occurred during the first 48 hours. British Veterinary Association.

Upper gastrointestinal bleeding in irbid, jordan

International Nuclear Information System (INIS)

Banisalamah, A.A.; Mraiat, Z.M.

2007-01-01

To define the various causes of nonvariceal upper gastrointestinal bleeding, to outline management modalities and to determine the final outcome of patients. A retrospective analysis of patients presenting with upper gastrointestinal (UGI) bleeding from January 2003 to December 2006 (4 years) was conducted. Patients with endoscopically proven variceal bleeding were excluded. Out of the 120 patients, most of the patients belonged to an age group of more than 50 years (mean 48.5 years). Haematemesis was the most common presentation and Acute Gastric Mucosal Lesion (AGML) was the most frequently encountered lesion. The cause of bleeding was not identified in 10 patients (undetermined group). Twenty-two (18.3%) underwent surgery and we had an overall mortality of 15.8%. AGML being the leading cause can be managed conservatively most of the time. There is a male preponderance and the incidence and mortality increases with advancing age. The undetermined group remains a diagnostic problem. (author)

Survival following Treatment of Aortoesophageal Fistula with Dual Esophageal and Aortic Intervention

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Soumitra K. Ghosh

2011-01-01

Full Text Available Aortoesophageal fistulas are a rare but commonly fatal complication of esophageal cancer. Reports of successfully managed cases are few, with high mortality and morbidity usually resulting from failure to control the initial massive haemodynamic insult. We report the case of a 47-year-old Caucasian man with recently diagnosed advanced esophageal cancer who suffered an episode of massive haematemesis. Emergency gastroscopy revealed an arterial bleeding point in the proximal esophagus. A self-expanding metal esophageal stent was placed to achieve initial partial haemostasis. CT angiography confirmed an aortoesophageal fistula. An endoluminal stent device was thus inserted within the thoracic aorta stabilising the bleeding point. The patient subsequently made an uneventful recovery and was discharged on long-term antibiotics for palliative care. He survived for 2 months at home before dying of disseminated malignancy. The successful use of esophageal stenting as a means of achieving haemostasis, allowing time for endovascular intervention, is as yet a relatively unexplored area of management of this rare condition.

Blæresmerter og vandladningsforstyrrelser som følge af ketaminmisbrug

DEFF Research Database (Denmark)

Reinhardt, Susanne; Fode, Mikkel

2014-01-01

A recent study has shown that ketamine has become popular among Danish clubgoers. The drug can induce psychedelic effects but it also has serious urological side effects, such as frequency and urgency in relation to voiding as well as pain from the bladder and haematuria. Ketamine can also induce...... histological bladder changes. Mild changes are reversible on cessation of ketamine abuse but long-term abuse can cause fibrosis of the bladder and may necessitate cystectomy. Therefore, physicians should ask young patients with bladder symptoms of unknown pathology about ketamine abuse....

Intravesical or intrarectal instillation of Maalox for the treatment of radiation cystitis or proctitis

International Nuclear Information System (INIS)

Kawagoe, Koh; Kawana, Takashi

1989-01-01

Intravesical or intrarectal instillation of Maalox, a well-known material for protection of mucous epithelia, was performed in 3 cases of radiation cystitis and one case of radiation proctitis, resulting in successful control of hemorrhage. Four cases of uterine cervical cancer with radiotherapy, including 2 cases of primary and 2 cases of postoperative radiotherapy, were managed by Maalox treatment with intervals of one to nine years between radiotherapy and Maalox instillation. One of the three patients with hemorrhagic cystitis, who had received internal iliac arterial embolization at the another hospital, was to be performed the operation of the urinary tract diversion. 50-100 ml of original or 1/2 diluted Maalox was instilled into urinary bladder or rectum with clump of catheter for 30 min. to 1 hr. after sufficient irrigation with 500 ml of 100 times diluted isodine. Blood transfusion for anemia was done in all cases, and antibiotics, or anticoagulant agents were systematically administered in some cases. Macrohematuria or melena ceased within 2 to 8 days after initiation of Maalox therapy in all cases. In one of the three cases of hemorrhagic cystitis, macroscopic hematuria, which reappeared one year later, was also successfully treated by Maalox therapy. In a case of radiation proctitis, though the melena disappeared in 5 days, diarrhea continued and the patient died of the primary disease two months later with the formation of rectovaginal fistula. No ultimate way of treatment of radiation hemorrhagic cystitis or proctitis has been established, though both of them were clinically important and serious side effects of radiotherapy. Therefore, intravesical or intrarectal instillation of Maalox could become one of the leading ways of treatment of intractable hemorrhagic cystitis, because the technique was simple and the effectiveness was valid without any notable side effects. (author)

A fibreoptic endoscopic study of upper gastrointestinal bleeding at Bugando Medical Centre in northwestern Tanzania: a retrospective review of 240 cases.

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Jaka, Hyasinta; Koy, Mheta; Liwa, Anthony; Kabangila, Rodrick; Mirambo, Mariam; Scheppach, Wolfgang; Mkongo, Eliasa; McHembe, Mabula D; Chalya, Phillipo L

2012-07-03

Upper gastrointestinal (GI) bleeding is recognized as a common and potentially life-threatening abdominal emergency that needs a prompt assessment and aggressive emergency treatment. A retrospective study was undertaken at Bugando Medical Centre in northwestern Tanzania between March 2010 and September 2011 to describe our own experiences with fibreoptic upper GI endoscopy in the management of patients with upper gastrointestinal bleeding in our setting and compare our results with those from other centers in the world. A total of 240 patients representing 18.7% of all patients (i.e. 1292) who had fibreoptic upper GI endoscopy during the study period were studied. Males outnumbered female by a ratio of 2.1:1. Their median age was 37 years and most of patients (60.0%) were aged 40 years and below. The vast majority of the patients (80.4%) presented with haematemesis alone followed by malaena alone in 9.2% of cases. The use of non-steroidal anti-inflammatory drugs, alcohol and smoking prior to the onset of bleeding was recorded in 7.9%, 51.7% and 38.3% of cases respectively. Previous history of peptic ulcer disease was reported in 22(9.2%) patients. Nine (3.8%) patients were HIV positive. The source of bleeding was accurately identified in 97.7% of patients. Diagnostic accuracy was greater within the first 24 h of the bleeding onset, and in the presence of haematemesis. Oesophageal varices were the most frequent cause of upper GI bleeding (51.3%) followed by peptic ulcers in 25.0% of cases. The majority of patients (60.8%) were treated conservatively. Endoscopic and surgical treatments were performed in 30.8% and 5.8% of cases respectively. 140 (58.3%) patients received blood transfusion. The median length of hospitalization was 8 days and it was significantly longer in patients who underwent surgical treatment and those with higher Rockall scores (P bleeding, shock, hepatic decompensation, HIV infection, comorbidities, malignancy, age > 60 years and in patients with

Ascending colonic variceal bleeding: utility of phase-contrast MR portography in diagnosis and follow-up after treatment with TIPS and variceal embolization

International Nuclear Information System (INIS)

Chevallier, P.; Motamedi, J.P.; Oddo, F.; Padovani, B.; Demuth, N.; Caroli-Bosc, F.X.

2000-01-01

The authors describe the discovery of ascending colonic variceal veins via celiomesenteric diagnostic angiography following a bout of melena in a 44-year-old woman. Magnetic resonance imaging, including phase-contrast MR venography, allowed visualization of the portal and systemic veins immediately after the initial angiograms. The hemorrhagic episode did not resolve until after transjugular intrahepatic shunt insertion and selective variceal embolization through the shunt. At 1 week-, 3 months-, and 6 months post treatment, follow-up MR venography no longer revealed the presence of colonic varices. Colonoscopy at 6 months was normal and the patient did not have any further episodes of bleeding until a liver transplantation was performed after 9 months. (orig.)

Ecological approach of macrolide-lincosamides-streptogramin producing actinomyces from Cuban soils.

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González, I; Niebla, A; Lemus, M; González, L; Iznaga, I O; Pérez, M E; Vallin, C

1999-09-01

We report in this study the frequency of Streptomyces strains to produce macrolide-lincosamide-streptogramin (MLS) antibiotics isolated from Cuban soils. The screening assay is based on the induction of MLS-resistance phenotype in a clinical isolated strain of Staphylococcus aureus S-18. Our results suggest that of 800 Streptomyces strains isolated from different soil samples, 6% were positives in the screening test used. The ferralitic red soil from Pinar del Río (north) provided the major percentage (3.6%) of MLS producing strains. The other soil samples tested belonging to Guira de Melena and Bauta in Havana, Matanzas City, Topes De Collantes (Villa Clara), and Soroa Mountains (Pinar del Rio) hill reached very low percentages.

Severe gastrointestinal tract bleeding in a two-month-old infant due to congenital intrahepatic arterioportal fistula

Energy Technology Data Exchange (ETDEWEB)

Aarts, R. [Department of Radiology, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB Nijmegen (Netherlands); Ijland, M.M. [Department of Pediatrics, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB Nijmegen (Netherlands); Blaauw, I. de [Department of Pediatric Surgery, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB Nijmegen (Netherlands); Hoogeveen, Y. [Department of Radiology, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB Nijmegen (Netherlands); Boetes, C. [Department of Radiology, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB Nijmegen (Netherlands)]. E-mail: C.Boetes@rad.umcn.nl; van Proosdij, M. [Department of Radiology, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB Nijmegen (Netherlands)

2006-07-15

A 2-month-old boy was referred for assessment of severe upper gastrointestinal tract bleeding and melena. On physical examination, a continuous murmur was heard over the right upper quadrant of the abdomen. A splenomegaly and dilated veins were also noted on the abdominal wall. Liver functions were normal. There was no history of trauma or jaundice. Doppler ultrasonography, magnetic resonance arteriography and angiography suggested the presence of an intrahepatic arteriovenous fistula between the phrenic artery and the portal vein. Management consisted of successful embolization by coiling of the phrenic artery. To our knowledge this is the first documented case report of a congenital fistula between the phrenic artery and the portal vein.

Severe gastrointestinal tract bleeding in a two-month-old infant due to congenital intrahepatic arterioportal fistula

International Nuclear Information System (INIS)

Aarts, R.; Ijland, M.M.; Blaauw, I. de; Hoogeveen, Y.; Boetes, C.; van Proosdij, M.

2006-01-01

A 2-month-old boy was referred for assessment of severe upper gastrointestinal tract bleeding and melena. On physical examination, a continuous murmur was heard over the right upper quadrant of the abdomen. A splenomegaly and dilated veins were also noted on the abdominal wall. Liver functions were normal. There was no history of trauma or jaundice. Doppler ultrasonography, magnetic resonance arteriography and angiography suggested the presence of an intrahepatic arteriovenous fistula between the phrenic artery and the portal vein. Management consisted of successful embolization by coiling of the phrenic artery. To our knowledge this is the first documented case report of a congenital fistula between the phrenic artery and the portal vein

Urinary Schistosomiasis in Urban and Semi-Urban Communities in South-Eastern Nigeria

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Ogochukwu Caroline Okeke

2013-09-01

Full Text Available Background: In view of the massive rural-to-urban migration in Nigeria, investiga­tions on transmission of urinary schistosomiasis were carried out in ur­ban and semi-urban communities in Nike Lake area of Enugu State, Nigeria.Methods: Urine samples of school children were tested for micro-haematuria using reagent strips followed by microscopic examination for Schistosoma haemato­bium eggs. Water contact sites were also identified and sampled for snails.Results: The overall prevalence of S. haematobium eggs in school children was 4.64%. The mean intensity of infection was 1.14 + 0.41 eggs/10ml urine. Males had insignificantly higher prevalence and intensity of S. haematobium infec­tion than females. The youngest age group (4-7 years had no infection. The preva­lence of micro-haematuria (6.2% was higher than that of microscopy, and this correlated positively with prevalence (r=0.65, P < 0.01 and intensity (r=0.50, P < 0.01 of the infection. Potential intermediate host of human shistosome collected were: Bulinus globosus, B. senegalensis and Biomphalaria pfeifferi. How­ever, only B. globosus shed cercariae of S. haematobium, with a snail infection rate of 0.73%. Transmission was in the dry season coinciding with the drying of wells.Conclusion: The results revealed that urinary schistosomiasis is prevalent, and that B. globosus and not B. truncatus as previously reported is the main interme­diate host of urinary schistosomiasis in this part of Enugu State

Leiomyoma of urinary bladder with bladder stone

International Nuclear Information System (INIS)

Farouk, K.; Gondal, M.; Khan, A.

2008-01-01

Leiomyoma of the urinary bladder is a rare benign mesenchymal tumour. We describe here a case of leiomyoma of the urinary bladder in a 65-year-old gentleman who presented with haematuria, passage of clots and combined obstructive and irritative urinary symptoms. The investigations revealed a vesical calculus and a mass on the left lateral wall of the urinary bladder. Cystolitholapaxy and transurethral resection of the tumour was performed. Histopathological report of the resected tumour revealed a leiomyoma of the urinary bladder. So far, a leiomyoma of the urinary bladder and a concomitant vesical calculus have not been described in literature. (author)

PRIMARY SQUAMOUS CELL CARCINOMA OF RENAL PELVIS ASSOCIATED WITH RENAL CALCULUS AND RECURRENT PYONEPHROSIS

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Hoti Lal

2015-11-01

Full Text Available Primary Squamous Cell Carcinoma in the kidney is a rare malignant neoplasm associated with nephrolithiasis, typically monobacterial pyonephrosis and rarely Xanthogranulomatous pyelonephritis. It is an aggressive disease with a poor prognosis mostly due to lack of presenting clinical features like a palpable mass, gross haematuria and pain. We report a case presenting with renal calculus and pyonephrosis managed initially with percutaneous nephrostomy followed by nephrectomy due to complete loss of renal function. Histopathological evaluation revealed poorly differentiated squamous cell carcinoma which is managed by chemotherapy, although initially beneficial, patients later develop disseminated metastatic disease which holds a poor prognosis.

[Obstructive renal insufficiency caused by amoxicillin crystalluria].

Science.gov (United States)

Boursas, M; Benhassine, L; Kempf, J; Petit, B; Vuillemin, F

1997-01-01

A 76-year-old woman was admitted to the ICU for a meningitis with rhombencephalitis due to Listeria monocytogenes. The treatment included amoxicillin (250 mg.kg-1.day-1) and gentamicin (3 mg.kg-1.day-1 over 6 days). Neurological outcome was favourable. However at the 14th day, an acute renal failure occurred, following macroscopic haematuria and milkiness urine. CT scan and sonography confirmed the diagnosis of obstructive renal failure with bilateral ureteral obstruction. Crystalluria caused by amoxicillin was suspected. Endoscopic ureteral insertion of double-J catheters permitted the recovery of a normal renal function.

A Giant Brunneroma Causing Gastrointestinal Bleeding and Severe Anemia Requiring Transfusion and Surgery

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Nicola C. Frenkel

2017-01-01

Full Text Available Brunner’s gland hamartoma, also called hyperplasia, adenoma, and Brunneroma, is an extremely rare benign proliferative lesion of Brunner’s glands in the duodenum. While being mostly small and asymptomatic, they can result in gastrointestinal bleeding and obstruction. We report the case of a 54-year-old man presenting with melena and severe anemia requiring blood transfusion. CT scans showed a large mass of 8 cm in diameter, presumably arising in the duodenum. Endoscopic biopsies were not conclusive. As we were unable to determine the nature of the mass preoperatively and due to the severe symptoms, its size, and the uncertain malignant potential, a classic Whipple procedure was performed. The resected specimen showed extensive proliferation of Brunner’s glands without signs of malignancy.

Severe Hypertriglyceridemia due to a novel p.Q240H mutation in the Lipoprotein Lipase gene.

Science.gov (United States)

Soto, Angela Ganan; McIntyre, Adam; Agrawal, Sungeeta; Bialo, Shara R; Hegele, Robert A; Boney, Charlotte M

2015-09-04

Lipoprotein Lipase (LPL) deficiency is a rare autosomal recessive disorder with a heterogeneous clinical presentation. Several mutations in the LPL gene have been identified to cause decreased activity of the enzyme. An 11-week-old, exclusively breastfed male presented with coffee-ground emesis, melena, xanthomas, lipemia retinalis and chylomicronemia. Genomic DNA analysis identified lipoprotein lipase deficiency due to compound heterozygosity including a novel p.Q240H mutation in exon 5 of the lipoprotein lipase (LPL) gene. His severe hypertriglyceridemia, including xanthomas, resolved with dietary long-chain fat restriction. We describe a novel mutation of the LPL gene causing severe hypertriglyceridemia and report the response to treatment. A review of the current literature regarding LPL deficiency syndrome reveals a few potential new therapies under investigation.

The stomach and duodenum

International Nuclear Information System (INIS)

Amberg, J.R.; Juhl, J.H.

1987-01-01

Symptoms of epigastric pain raise the possibility of peptic ulcer disease and lead to an examination of the stomach and duodenum. Hematemesis or melena is also a strong indication. The nausea-vomiting complex on a subacute or chronic basis raises the possibility of an obstructive lesion. A palpable mass in the upper abdomen may involve the stomach. Weight loss and anorexia are less specific symptoms but can occur with gastric cancer. Major changes in indications have occurred now that ultrasonography, computed tomography (CT), and magnetic resonance (MR) imaging are available. No longer is the gut studied to detect extra-gut disease. Currently, the duodenal contour is not important in the search for pancreatic disease. All intra-abdominal structures can now be seen directly using CT or ultrasound

Percutaneous Trans-hepatic Obliteration for Bleeding Esophagojejunal Varices After Total Gastrectomy and Esophagojejunostomy

International Nuclear Information System (INIS)

Boku, Michiko; Sugimoto, Koji; Nakamura, Tetsu; Kita, Yasufumi; Zamora, Carlos A.; Sugimura, Kazuro

2006-01-01

A 72-year-old man who had undergone a total gastrectomy with a Roux-en-Y esophagojejunostomy for gastric cancer 6 years earlier presented to our hospital with massive hematemesis and melena. Endoscopic examination indicated esophageal varices with cherry-red spots and hemorrhage arising from beyond the anastomosis. Abdominal contrast-enhanced computed tomography and angiography revealed a dilated vein in the elevated jejunal limb supplying the varices. Percutaneous trans-hepatic obliteration (PTO) of the varices through the jejunal vein was performed using microcoils, ethanolamine oleate, and gelatin sponge cubes. Ten days after the procedure, endoscopic examination revealed reduction and thrombosis of the varices. We consider PTO to be an effective alternative method for treating ruptured esophagojejunal varices after total gastrectomy

An outbreak of canine aflatoxicosis in Gauteng Province, South Africa

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Luke F. Arnot

2012-03-01

Full Text Available Sporadic outbreaks of aflatoxicosis occur in dogs when they consume contaminated dog food. During 2011, low-cost brands of pelleted dog food were contaminated with very high concentrations of aflatoxins. Approximately 100 dogs were presented to the Onderstepoort Veterinary Academic Hospital. Clinically, the dogs were depressed to collapsed and icteric, with haematemesis, melaena and haematochezia. The most common pathological findings were icterus, gastro-enterorrhagia and hepatosis. On histopathological examination, fatty hepatosis and bile duct proliferation were observed. A consistent, very characteristic finding was the presence of a blue-grey granular material within the bile ducts. A total of 124 samples of the dog food fed to the affected dogs was analysed to determine aflatoxin concentrations. Concentrations ranged from below the limit of quantification (< 5 μg/kg to 4946 μg/kg and six samples were submitted to determine the ratio of aflatoxins in the feed. It is estimated that well over 220 dogs died in the Gauteng Province of South Africa as a result of this aflatoxin outbreak.

Post traumatic intra thoracic spleen presenting with upper GI bleed! – a case report

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Kinra Sonali

2006-11-01

Full Text Available Abstract Background Isolated splenic vein thrombosis with left sided portal hypertension is a rare cause of upper gastrointestinal bleed. Diagnosis is difficult and requires a high index of suspicion, especially in patients presenting with gastrointestinal bleed in the presence of splenomegaly and normal liver function tests. Case presentation A 64 year old male presented with haematemesis and melaena. An upper gastrointestinal endoscopy revealed the presence of antral erosions in the stomach and fundal varices. A computerised tomography scan of abdomen confirmed the presence of a diaphragmatic tear and the spleen to be lying in the left hemi thorax. The appearances of the splenic vein on the scan were consistent with thrombosis. Conclusion Left sided portal hypertension as a result of isolated splenic vein thrombosis secondary to trauma is rare. The unusual presentation of our case, splenic herniation into the left hemithorax, causing fundal varices leading to upper gastrointestinal bleed 28 years after the penetrating injury, makes this case most interesting. We believe that this has not been reported in literature before.

Congenital pyeloureteral junction stenosis -postoperative follow-up with MDCT urography

International Nuclear Information System (INIS)

Al-Amin, M.

2012-01-01

Full text: 30-year-old male patient with asymptomatic congenital hydronephrosis of the left kidney detected on routine ultrasound investigation in relation to haematemesis 7 years ago. It is established a pyeloureteral junction stenosis and has made a resection of the stenotic part of the segment with a further plastic by Anderson - Haynes - Kuester. The histological analysis of resected area found expressed muscle layer and chronic inflammatory infiltrates as same as the in miofibroepithel disembriogenesis. After that, there was a recidive of the hydronephrosis and a further replastic and endopyeloplastic surgery performed in Germany in 2008. Two years after that with multislice computed tomography and computed tomography urography showing recurrence of the disease. Hydronephrosis is nonobstructive, asymptomatic, with no gallstones visualized along the left ureter. There is a delayed drainage function of the left kidney, which does not separate contrast medium in the 60th minute of computed tomography urography. The diagnosis of the condition is a nonobstructive hydronephrosis recidive of the left kidney. There are no aberrant renal arteries or renal arteries stenosis on postprocessing imaging

Primary aortojejunal fistula: a rare cause for massive upper gastrointestinal bleeding.

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Paulasir, Sylvester; Khorfan, Rhami; Harsant, Christina; Anderson, Harry Linne

2017-04-26

A 68-year-old man presented to the emergency department with haematemesis and shock. Upper endoscopy and selective angiography could not identify the source of bleeding. He underwent selective embolisation of the gastroduodenal artery. The patient then had a period of about 24 hours with relative haemodynamic stability before having another episode of massive upper gastrointestinal bleed. A second attempt to embolise the common hepatic artery and distal coeliac axis was unsuccessful. Hence, he was urgently taken to the operating room for exploratory laparotomy. The source of bleeding could not be identified in the operating room. The patient went into cardiac arrest and expired. Autopsy revealed a fistula between proximal jejunum and a previously unknown abdominal aortic aneurysm (AAA). We present an entity that has only been described a few times in the literature while highlighting the importance of having a broad differential with upper gastrointestinal bleeding, especially when the source is not clearly evident. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A novel mutation causing mild, atypical fumarylacetoacetase deficiency (Tyrosinemia type I: a case report

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Kvittingen Eli-Anne

2009-12-01

Full Text Available Abstract A male patient, born to unrelated Belgian parents, presented at 4 months with epistaxis, haematemesis and haematochezia. On physical examination he presented petechiae and haematomas, and a slightly enlarged liver. Serum transaminases were elevated to 5-10 times upper limit of normal, alkaline phosphatases were 1685 U/L (180 s ( Fumarylacetoacetase (FAH protein and activity in cultured fibroblasts and liver tissue were decreased but not absent. 4-hydroxyphenylpyruvate dioxygenase activity in liver was normal, which is atypical for tyrosinemia type I. A novel mutation was found in the FAH gene: c.103G>A (Ala35Thr. In vitro expression studies showed this mutation results in a strongly decreased FAH protein expression. Dietary treatment with phenylalanine and tyrosine restriction was initiated at 4 months, leading to complete clinical and biochemical normalisation. The patient, currently aged 12 years, shows a normal physical and psychomotor development. This is the first report of mild tyrosinemia type I disease caused by an Ala35Thr mutation in the FAH gene, presenting atypically without increase of the diagnostically important toxic metabolites succinylacetone and succinylacetoacetate.

Churg-Strauss syndrome associated with AA amyloidosis: a case report.

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Maamar, Mouna; Tazi-Mezalek, Zoubida; Harmouche, Hicham; El Hamany, Zitouna; Adnaoui, Mohammed; Aouni, Mohammed

2012-01-01

Churg Strauss syndrome is a rare systemic and pulmonary vasculitis exceptionally associated with AA amyloidosis. We report the case of a 65-year old woman with past medical history of asthma. She developed polyarthralgia, headache and purpura. A laboratory workout found hypereosinophilia (1150/µL), positive p-ANCA, microscopic haematuria and proteinuria at 2g/day. A diagnosis of Churg-Strauss syndrome was established based on five criteria of the American College of Rheumatology (ACR). Renal biopsy showed an important type AA amyloid deposit. The patient was treated with steroids with a good response of the vasculitis and amyloidosis with disappearance of the proteinuria.

Childhood sarcoidosis in Denmark 1979-1994: incidence, clinical features and laboratory results at presentation in 48 children

DEFF Research Database (Denmark)

Hoffmann, A L; Milman, N; Byg, K E

2004-01-01

AIM: To describe the incidence, clinical presentation and paraclinical findings in childhood sarcoidosis in Denmark, 1979-1994. METHODS: Patients (n = 5536) with a diagnosis of sarcoidosis were drawn from the nationwide Patient Registry; 81 patients were ... examination (glucose, albumin, haemoglobin) was normal in 96% of the patients; the patient with nephrocalcinosis had albuminuria and haematuria. CONCLUSION: The incidence of sarcoidosis in Danish children is low and increases with age. Sarcoidosis in young children may present clinical features...... that are different from the appearance of those in older children and often constitute a diagnostic challenge. In older children, the clinical appearance has many features in common with the presentation in adults....

Childhood sarcoidosis in Denmark 1979-1994: incidence, clinical features and laboratory results at presentation in 48 children

DEFF Research Database (Denmark)

Hoffmann, A L; Milman, N; Byg, K E

2004-01-01

.7-15). In 1979-1994 the incidence was 0.29 per 100000 person-years incidence was 0.06 in children weight loss, abdominal discomfort, respiratory symptoms, lymphadenopathy......AIM: To describe the incidence, clinical presentation and paraclinical findings in childhood sarcoidosis in Denmark, 1979-1994. METHODS: Patients (n = 5536) with a diagnosis of sarcoidosis were drawn from the nationwide Patient Registry; 81 patients were ... examination (glucose, albumin, haemoglobin) was normal in 96% of the patients; the patient with nephrocalcinosis had albuminuria and haematuria. CONCLUSION: The incidence of sarcoidosis in Danish children is low and increases with age. Sarcoidosis in young children may present clinical features...

Interaktion mellem warfarin og oral miconazol-gel

DEFF Research Database (Denmark)

Ogard, C G; Vestergaard, Henrik

2000-01-01

We report a case of a 76 year-old woman who had been taking warfarin for seven years because of relapsing deep venous thrombosis. Her daily maintenance dose was 5 mg. Monthly measurements of international normalised ratio (INR) were stable between 2-3. She developed oral candidiasis and miconazole...... gel was prescribed. One week later she developed bleeding gums. Eight days later she was admitted to the hospital with haematuria. INR was > 10. Warfarin and the miconazole gel were withdrawn. She was treated with phytonadione. INR normalised after four days and she continued warfarin treatment....... Caution should be exercised whenever the combination of warfarin and miconazole gel are prescribed....

Esofagitis necrotizante aguda: Una entidad inusual Acute esophageal necrosis: An unusual entity

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Silvana E. Pramparo

2010-12-01

Full Text Available La esofagitis necrotizante aguda (ENA, también denominada esófago negro, es una rara enfermedad poco descripta en la literatura médica. Describimos el caso de un hombre de 80 años, con hemorragia digestiva alta quien desarrolló un esófago negro luego de un episodio de hipotensión. La necrosis fue confirmada histológicamente. Los pacientes se presentan con hematemesis y melena en más del 70% de los casos. Los hallazgos endoscópicos muestran una coloración negruzca de la mucosa esofágica. El diagnóstico se realiza con endoscopia y confirmación histológica. La mortalidad es alta (más del 50% aunque relacionada a las enfermedades de base del paciente. Por último, podemos decir que la sospecha es muy importante en el diagnóstico de ENA, particularmente en pacientes ancianos con enfermedades asociadas y evidencia de hemorragia digestiva alta. En este trabajo describimos las características clínicas, endoscópicas e histopatológicas de un paciente con ENA.Acute esophageal necrosis (AEN, also designated black esophagus, is a rare disorder that is poorly described in the medical literature. We present the case of an 80 years old man, with upper gastrointestinal bleeding who developed a black esophagus after hypotensive episodes. Necrosis was confirmed histologically. Hematemesis and melena are present in more than 70% of the cases. Endoscopic findings show black discoloration of the distal esophagus with proximal extension ending sharply at the gastroesophageal junction. Diagnosis is reached endoscopically with histological support. Mortality is high (up to 50% even though related to the patient's underlying condition. Finally, we may say that to keep in mind the posibility of AEN is a key factor in its diagnosis, particularly in older patients with associated morbidity and evidence of upper gastrointestinal bleeding. In the present report we describe the clinical, endoscopic and histophatological characteristics of a patient with a

Imaging management of spontaneous giant esophageal intramural hematoma

Energy Technology Data Exchange (ETDEWEB)

Hagel, J. [Univ. of British Columbia, Dept. of Radiology, Vancouver, British Columbia (Canada); Bicknell, S.G.; Haniak, W. [Lions Gate Hospital, Dept. of Radiology, Vancouver, British Columbia (Canada)]. E-mail: sbicknel@interchg.ubc.ca

2007-04-15

A woman, aged 84 years, presented to our emergency department with posteriorly radiating chest pain that began following dinner. She reported no change in bowel habits, hematochezia, or melena. She had previous peptic ulcer disease and a long-standing history of gastroesophageal reflux disease. Her medications included acetylsalicylic acid and rabeprazole. Electrocardiogram and troponin analyses were negative for ischemic heart disease. The emergency physician suspected an aortic dissection, and computed tomography (CT) chest and abdomen scans were performed with and without IV and oral contrast. The aorta was normal and the noncontrast images demonstrated a hyperdense mass (not shown) that did not enhance consistent with a large intramural hematoma extending from the upper esophagus (level of T2 vertebral body) to the fundus of the stomach (Figures 1A and B). (author)

Bevacizumab-Induced Reversible Thrombocytopenia in a Patient with Adenocarcinoma of Colon: Rare Adverse Effect of Bevacizumab

Directory of Open Access Journals (Sweden)

Jeevan Kumar

2012-01-01

Full Text Available We report a case of bevacizumab- (BEV- induced thrombocytopenia in a 59-year-old man with adenocarcinoma of colon. After colectomy, the patient was treated with twelve cycles of FOLFOX-4 (folinic acid, 5-fluorouracil, and oxaliplatin regimen. On relapse, he was treated with FOLFIRI (folinic acid, 5-fluorouracil, and irinotecan regimen along with BEV 10 mg/kg for 6 cycles. After that, BEV was continued for maintenance as a single agent at an interval of three weeks. After the13th cycle of BEV, the patient developed melena with epistaxis and thrombocytopenia, from which he recovered on withdrawal of BEV. On rechallenge with half the initial dose, there was once again a reversible drop in platelet count. The proposed mechanism of thrombocytopenia may be immune-mediated peripheral destruction of platelets.

Strongyloides stercoralis Hyperinfection Syndrome Presenting as Severe, Recurrent Gastrointestinal Bleeding, Leading to a Diagnosis of Cushing Disease

Science.gov (United States)

Yee, Brittany; Chi, Nai-Wen; Hansen, Lawrence A.; Lee, Roland R.; U, Hoi-Sang; Savides, Thomas J.; Vinetz, Joseph M.

2015-01-01

A 50-year-old male immigrant from Ethiopia presented for consultation after 3 years of hematochezia/melena requiring > 25 units of blood transfusions. Physical examination revealed severe proximal muscle wasting and weakness, central obesity, proptosis, and abdominal striae, accompanied by eosinophilia, elevated hemoglobin A1c, elevated 24-hour urinary cortisol, lack of suppression of 8 am cortisol levels by 1 mg dexamethasone, and inappropriately elevated random adrenocorticotropic hormone (ACTH) level. Histopathological examination of gastrointestinal biopsies showed large numbers of Strongyloides stercoralis, indicating Strongyloides hyperinfection. Treatment with 2 days of ivermectin led to resolution of gastrointestinal bleeding. This syndrome was due to chronic immunosuppression from a pituitary ACTH (corticotroph) microadenoma, of which resection led to gradual normalization of urine cortisol, improved glycemic control, resolution of eosinophilia, and no recurrence of infection. PMID:26195463

[Experiences in the treatment of benign prostatic hyperplasia with high power potassium-titanyl-phosphate (KTP) laser].

Science.gov (United States)

Lipiński, Marek I; Peszyński-Drews, Cezary; Jeromin, Marek Z; Jeromin, Leszek M

2006-01-01

Benign prostatic hyperplasia (BPH) exist in about 70% men after 60 years old. High power KTP laser is a new tool for the treatment of BPH. 49 men were treated by photoselective vaporisation of the prostate (PVP) from August 2003 to May 2004. Thirty patients with follow-up period longer than 12 weeks (12 to 26 weeks) were analyzed. Preoperative prostate volume ranged from 31 to 136 cc. PSA range, estimated before treatment, was normal in all patients (pts). International Prostate Symptom Score (I-PSS) estimated before treatment was over 24 and Quality of Life (QoL) was over 3 in all pts. The maximum peak urinary flow (Qmax) before treatment ranged from 7.2 to 14.1 ml/s. One patient was catheterized with Foley catheter at the finish of the procedure. Two pts required catheterization in the first day after treatment. In two pts increasing of body temperature to 38 degrees C was observed in the first day after treatment. Twenty four hours after treatment haematuria required catheterization was observed in one patient. Seven days after treatment in 4 pts massive haematuria was observed (two required hospitalisation). In one patient because of urinary retention 4 weeks after PVP transurethral resection of the prostate was performed. Four weeks after PVP I-PSS decreased from 24 to 20 and after 12 weeks to 15. The Qmax increased and ranged from 11.3 ml/s to 17.1 ml/s 4 weeks after PVP and 12 weeks after PVP ranged from 15.1 to 22.8 ml/s. Photoselective vaporization of the prostate reduces I-PSS in all patients 12 weeks after procedure. Short follow-up period and a limited number of patients in study group cannot lead to ultimate conclusions. However the results encourage to undertaking further studies on PVP for the treatment of BPH.

Uric acid, an important screening tool to detect inborn errors of metabolism: a case series.

Science.gov (United States)

Jasinge, Eresha; Kularatnam, Grace Angeline Malarnangai; Dilanthi, Hewa Warawitage; Vidanapathirana, Dinesha Maduri; Jayasena, Kandana Liyanage Subhashinie Priyadarshika Kapilani Menike; Chandrasiri, Nambage Dona Priyani Dhammika; Indika, Neluwa Liyanage Ruwan; Ratnayake, Pyara Dilani; Gunasekara, Vindya Nandani; Fairbanks, Lynette Dianne; Stiburkova, Blanka

2017-09-06

Uric acid is the metabolic end product of purine metabolism in humans. Altered serum and urine uric acid level (both above and below the reference ranges) is an indispensable marker in detecting rare inborn errors of metabolism. We describe different case scenarios of 4 Sri Lankan patients related to abnormal uric acid levels in blood and urine. CASE 1: A one-and-half-year-old boy was investigated for haematuria and a calculus in the bladder. Xanthine crystals were seen in microscopic examination of urine sediment. Low uric acid concentrations in serum and low urinary fractional excretion of uric acid associated with high urinary excretion of xanthine and hypoxanthine were compatible with xanthine oxidase deficiency. CASE 2: An 8-month-old boy presented with intractable seizures, feeding difficulties, screaming episodes, microcephaly, facial dysmorphism and severe neuro developmental delay. Low uric acid level in serum, low fractional excretion of uric acid and radiological findings were consistent with possible molybdenum cofactor deficiency. Diagnosis was confirmed by elevated levels of xanthine, hypoxanthine and sulfocysteine levels in urine. CASE 3: A 3-year-10-month-old boy presented with global developmental delay, failure to thrive, dystonia and self-destructive behaviour. High uric acid levels in serum, increased fractional excretion of uric acid and absent hypoxanthine-guanine phosphoribosyltransferase enzyme level confirmed the diagnosis of Lesch-Nyhan syndrome. CASE 4: A 9-year-old boy was investigated for lower abdominal pain, gross haematuria and right renal calculus. Low uric acid level in serum and increased fractional excretion of uric acid pointed towards hereditary renal hypouricaemia which was confirmed by genetic studies. Abnormal uric acid level in blood and urine is a valuable tool in screening for clinical conditions related to derangement of the nucleic acid metabolic pathway.

Biopsy of the prostate guided by transrectal ultrasound: relation between warfarin use and incidence of bleeding complications

Energy Technology Data Exchange (ETDEWEB)

Ihezue, C.U. [Department of Radiology, Southampton General Hospital (United Kingdom); Smart, J. [Department of Radiology, Southampton General Hospital (United Kingdom); Dewbury, K.C. [Department of Radiology, Southampton General Hospital (United Kingdom)]. E-mail: keith.dewbury@suht.swest.nhs.uk; Mehta, R. [Department of Radiology, Southampton General Hospital (United Kingdom); Burgess, L. [Department of Radiology, Southampton General Hospital (United Kingdom)

2005-04-01

AIM: To determine the relation between warfarin use and the frequency of bleeding complications after biopsy of the prostate guided by transrectal ultrasound (TRUS). METHODS: Overall, 1022 consecutive patients with suspected prostatic disease were followed after biopsy. Warfarin and aspirin use was determined on the day of the procedure. A TRUS-guided biopsy was performed and patients were offered a questionnaire to complete 10 days after the procedure, to determine any immediate or delayed bleeding complications. Follow-up telephone calls were made to those who had not replied within the stipulated period. RESULTS: Of the 1000 patients who replied, 49 were receiving warfarin, 220 were receiving aspirin and 731 were not receiving any anticoagulant drugs. Of the 49 subjects reporting current use of warfarin, 18 (36.7%) experienced haematuria, compared with 440 (60.2%) of the patients receiving no anti-coagulant drugs who reported haematuria. This was statistically significant (p=0.001). Of the group receiving warfarin, 4 (8.2%) experienced haematospermia whereas 153 (21%) of the group receiving no anticoagulant medication reported haematospermia. This difference also was statistically significant (p=0.030). Rectal bleeding was experienced by 7 (14.3%) of the group receiving warfarin compared with 95 (13%) in the group without anticoagulant medication, but this was not statistically significant (p=0.80). We also demonstrated that there was no statistically significant association between the severity of the bleeding complications and medication with warfarin. CONCLUSION: None of the group receiving warfarin experienced clinically important bleeding complications. Our results suggest that the frequency and severity of bleeding complications were no worse in the warfarin group than in the control group and that discontinuing anticoagulation medication before prostate biopsy may be unnecessary.

Biopsy of the prostate guided by transrectal ultrasound: relation between warfarin use and incidence of bleeding complications

International Nuclear Information System (INIS)

Ihezue, C.U.; Smart, J.; Dewbury, K.C.; Mehta, R.; Burgess, L.

2005-01-01

AIM: To determine the relation between warfarin use and the frequency of bleeding complications after biopsy of the prostate guided by transrectal ultrasound (TRUS). METHODS: Overall, 1022 consecutive patients with suspected prostatic disease were followed after biopsy. Warfarin and aspirin use was determined on the day of the procedure. A TRUS-guided biopsy was performed and patients were offered a questionnaire to complete 10 days after the procedure, to determine any immediate or delayed bleeding complications. Follow-up telephone calls were made to those who had not replied within the stipulated period. RESULTS: Of the 1000 patients who replied, 49 were receiving warfarin, 220 were receiving aspirin and 731 were not receiving any anticoagulant drugs. Of the 49 subjects reporting current use of warfarin, 18 (36.7%) experienced haematuria, compared with 440 (60.2%) of the patients receiving no anti-coagulant drugs who reported haematuria. This was statistically significant (p=0.001). Of the group receiving warfarin, 4 (8.2%) experienced haematospermia whereas 153 (21%) of the group receiving no anticoagulant medication reported haematospermia. This difference also was statistically significant (p=0.030). Rectal bleeding was experienced by 7 (14.3%) of the group receiving warfarin compared with 95 (13%) in the group without anticoagulant medication, but this was not statistically significant (p=0.80). We also demonstrated that there was no statistically significant association between the severity of the bleeding complications and medication with warfarin. CONCLUSION: None of the group receiving warfarin experienced clinically important bleeding complications. Our results suggest that the frequency and severity of bleeding complications were no worse in the warfarin group than in the control group and that discontinuing anticoagulation medication before prostate biopsy may be unnecessary

The impact of a school health programme on the prevalence and morbidity of urinary schistosomiasis in Mwera Division, Pangani District, Tanzania

DEFF Research Database (Denmark)

Magnussen, P; Ndawi, B; Sheshe, A K

2001-01-01

in class 5 (median age 14 years, range 11-17) by urine filtration techniques. Treatment was administered as 40 mg/kg praziquantel in a single dose at the beginning of the school year. The programme was implemented by schoolteachers and coordinated by the District Health Management Team in collaboration......The prevalence of urinary schistosomiasis among schoolchildren in Pangani District (Tanzania) was assessed rapidly by a questionnaire approach. Based on the results, a strategy of selective treatment with praziquantel was adopted. Eleven primary schools in Mwera Division, Pangani District...... parents pay for the treatment of children with episodes of visible haematuria during the school year. Communities also participated in the improvement of sanitary installations at the schools....

Adult Wilms' tumour: a case report with review of literature

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Gowda KM Srinivasa

2006-12-01

Full Text Available Abstract Background Wilms' tumor is the commonest primary malignant renal tumor in childhood. Rarely, it may present in the adult age group. Case presentation We report a 48-year-old male presenting with flank pain and haematuria. Abdominal ultrasound revealed a right renal mass measuring 11 × 10 cms, and a clinical diagnosis of renal cell carcinoma was made. Nephrectomy was performed, and a final diagnosis of adult Wilms' tumor was made based on the criteria proposed by Kilton et al. Conclusion The possibility of an adult Wilms' tumor should be considered when a patient presents with pain in the flank and a renal mass. Rarity of the tumor favors documentation in literature.

The missing foley catheter: an unusual finding in vesicouterine fistula.

Science.gov (United States)

Shephard, Steven N; Lengmang, Sunday J

2013-12-18

A 28-year-old G1P1 presented complaining of urine leakage per vaginum following caesarean delivery, accompanied by amenorrhoea, cyclic haematuria and cyclic pelvic pain. Examination findings were suggestive of vesicouterine fistula and the patient was taken for exploratory laparotomy, during which the foley catheter could not be identified within the bladder. During separation of the bladder from the uterus, the catheter was found to be traversing the fistulous tract into the uterine cavity. Vesicouterine fistula is a fairly uncommon type of urogenital fistula that is frequently associated with caesarean section. Surgical treatment remains the mainstay and successfully cured this patient. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2013.

Churg-Strauss Syndrome following PTU Treatment

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R. A. M. Quax

2009-01-01

Full Text Available Propylthiouracil (PTU is a frequently prescribed drug in the treatment of hyperthyroidism. The use of PTU is, however, accompanied by numerous potentially serious side effects including vasculitis. PTU-related vasculitides can present as haematuria, pulmonary haemorrhage, or cutaneous lesion together with aspecific symptoms such as fever, myalgia, arthralgia, and fatigue. Cerebral involvement is seldom observed. We present a 49-year-old female with Graves' disease and asthma, who developed paresis of the proximal extremities, eosinophilia, pulmonary, and cutaneous lesions following treatment with PTU. A cerebral vasculitis consistent with Churg-Strauss syndrome (CSS was suspected. Although cerebral involvement is seldom observed with PTU treatment, cerebral vasculitis should be considered in patients developing CNS symptoms.

'Horses for courses' in the upper gastrointestinal tract: a rational approach to diagnosis

International Nuclear Information System (INIS)

Mendelson, R.M.

1989-01-01

In Australia, the number of barium studies performed in teaching hospitals has fallen markedly while in the community at large a 113% increase occurred in the number of upper gastrointestinal endoscopic procedures performed between 1980 and 1986. Protagonists of primary endoscopy cite studies that report on the superiority of oesophagogastroduodenoscopy in patients with dyspepsia and related symptoms but several studies have shown that upper gastrointestinal barium studies miss very few important lesions. Fibreoptic endoscopy and radiology each have strengths and weaknesses which determine their respective places in the investigation of the different symptom complexes that are referable to the upper gastrointestinal tract. Double-contrast barium-meal examination is the suggested imaging modality for simple dyspepsia, for the oesophagitis-reflux-hiatus hernia complex and for dysphagia; while oesophagogastroduodenoscopy is the method of choice for the investigation of complicated dyspepsia, haematemesis and melaena. In patients who have previously undergone gastric surgery, endoscopy and radiology are complementary procedures - the former more accurate in the diagnosis of recurrent disease like ulceration, and the later useful for the delineation of anatomical changes. The time for the across-the-board replacement of barium studies by primary endoscopy has not yet arrived. 57 refs

Schistosoma liver disease; a clinico- pathological study

International Nuclear Information System (INIS)

Ali, Suzan Ibrahim

1996-05-01

Schistomiasis mansoni infection is a leading cause of severe morbidity in the Sudan. Most of the morbidity and mortality are due to the development of hepatic periportal fibrosis and consequent portal hypertension and bleeding varices. This is a hospital-based, retro-prospective study in the period from 1980-1995. Liver disease (i.e. periportal fibrosis) and its clinical presentation were studied in relation to the degree of fibrosis and other pathological, haematological, and biochemical parameters. The study identified the common hospital presenting symptoms, assessed factors that influence pathogenesis of periportal fibrosis and its severity, as well as, defined criteria which predict those patients who are at risk of bleeding. 898 patients were included. The common presenting symptoms were left hypochondrial pain, haematemesis and enlarged spleen (Towal). Males were found to have an increase prevalence of periportal fibrosis. Splenomegaly was found in almost all patients of the study of different age groups, but spleen size didn't show any significant difference between bleeders and non-bleeders (p=0.28). A sharp rise in the prevalence of bleeding was noted after the age of 16 years. Upper gastrointestinal bleeding was found to be more common

Conferencias anatomoclínicas: caso no. veintidos

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San Juan de Dios Hospital

1955-05-01

Enfermedad Actual: Se inició hace unos dos años por la aparición de constipación pertinaz, pirosis, acedías, dolor epigástrico y sensación de hambre dolorosa que calmaba con las comidas; ocasionalmente ha presentado melenas. Hace seis días, sintió intenso dolor epigástrico de tipo punzante, irradiado hacia el ángulo inferior del omoplato izquierdo, seguido poco después de gran distención abdominal con retención de heces y gases, vómito y hematemesis inicial. Estos fenómenos fueron tratados fuera del hospital con purgantes y enemas sin ningún resultado, pues no retuvo los enemas y vomitó los purgantes. El cuadro se agudizó adquiriendo los caracteres de un abdomen agudo, por lo cual ingresa al hospital.

Heterotopic pancreatic tissue of the stomach leading to gastric diverticulum and upper gastro-intestinal bleeding

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Silviu Stoian

2016-11-01

Full Text Available Heterotopic pancreatic tissue of the stomach is a rare condition. Gastric diverticulum is also a rare condition, mostly located at the fornix. Therefore, the existence of a pyloric gastric diverticulum containing a submucosal tumor proved to be heterotopic pancreatic tissue of the stomach is an extremely rare condition. The patient was a young thin male with epigastralgia chronically treated for gastritis/ulcer. Following an episode of melena, he underwent gastroscopy that diagnosed antral gastric diverticulum containing a polyp. The lesion was surgically removed. The pathology report stated: heterotopic pancreatic tissue of the stomach with secondary development of a traction diverticulum. Heterotopic pancreas tissue of the stomach is a rare condition but the association with gastric diverticulum is completely unusual. The possibility of the ectopic tissue leading to secondary diverticulum development should be considered.

The value of RI scintigraphy and angiography in small intestinal bleeding; Report of eight cases

Energy Technology Data Exchange (ETDEWEB)

Kurosawa, Susumu; Kuwata, Hajime; Kushibiki, Kyoko; Akimoto, Kimihiko; Hashimoto, Toshiyuki; Kojima, Toshiya (Showa General Hospital, Kodaira, Tokyo (Japan))

1991-07-01

We retrospectively reviewed eight cases of small intestinal bleeding and assessed the value of RI scintigraphy and angiography in diagnosing the bleeding site. The patients' average age was 56.2 years. Chief complaint was melena of variable degree. In most cases neither upper endoscopy nor colonoscopy was diagnostic. RI scientigraphy (Tc-99 labeled human serum albumin) showed 75% of positive rate whereas angiography showed 66.7% (4/6) of positive rate. All four cases of leiomyosarcoma and leiomyoma demonstrated hypervascular stain and/or extra-vasation in angiography whereas RI scintigraphy failed to detect active gastrointestinal bleeding in 2 of the 4 cases. Therefore angiography was considered useful for the detection of bleeding from leiomyoma and leiomyosarcoma which are often hypervascular. Scintigraphy is thought of most value in the demonstration of small amount of bleeding with minimum vascular abnormality. (author).

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.

Vesical Artery Embolization in Haemorrhagic Cystitis in Children

Energy Technology Data Exchange (ETDEWEB)

García-Gámez, Andrés, E-mail: agargamez@gmail.com; Bermúdez Bencerrey, Patricia, E-mail: PBERMUDE@clinic.ub.es [Hospital Clinic (Spain); Brio-Sanagustin, Sonia, E-mail: sbrio@santpau.cat [Hospital de la Santa Creu y Sant Pau (Spain); Guerrero Vara, Rubén, E-mail: rguerrerov@santpau.cat [Hospital Clinic (Spain); Sisinni, Luisa, E-mail: lsisinni@santpau.cat [Hospital de la Santa Creu y Sant Pau (Spain); Stuart, Sam, E-mail: sam.stuart@gosh.nhs.uk; Roebuck, Derek, E-mail: Derek.Roebuck@gosh.nhs.uk [Great Ormond Street Hospital for Children (United Kingdom); Gómez Muñoz, Fernando, E-mail: FEGOMEZ@clinic.ub.es [Hospital Clinic (Spain)

2016-07-15

Haemorrhagic cystitis is an uncommon and, in its severe form, potentially life-threatening complication of haematopoietic stem cell transplantation or cancer therapy in children. The severe form involves macroscopic haematuria with blood clots, urinary obstruction and/or renal impairment. There are many therapeutic options to treat acute haemorrhage, but only recombinant factor VII has a high level of clinical evidence in children. Supraselective vesical artery embolization (SVAE) is an increasingly used therapeutic procedure for controlling haemorrhage in adults, but is less commonly used in children. This might be due to several factors, such as the invasive nature of the procedure, lack of appropriate medical experience and possible long-term side effects. We present three cases of children successfully treated by means of effective SVAE.

Persistent Mullerian Duct Syndrome: a rare entity with a rare presentation in need of multidisciplinary management

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Lin Da Aw

Full Text Available ABSTRACT Main findings: A typical male looking adolescent with a legal female gender assignment presented with haematuria. Investigations led to the diagnosis of Persistent Mullerian Duct Syndrome. The condition is indeed a rare entity that needs a multidisciplinary team management. Case hypothesis: A case of Persistent Mullerian Duct Syndrome undiagnosed at birth because karyotyping was defaulted, thus resulting in a significant impact on the legal gender assignment and psychosocial aspects. Promising future implications: The reporting of this case is important to create awareness due to its rarity coupled with the rare presentation with hematuria as a possible masquerade to menstruation. There were not only medical implications, but also psychosocial and legal connotations requiring a holistic multidisciplinary management.

Urethral polyp in a 1-month-old child

Energy Technology Data Exchange (ETDEWEB)

Beluffi, Giampiero [Department of Radiodiagnosis, IRCCS Policlinico S. Matteo, Section of Paediatric Radiology, Piazzale Golgi, 2, I-27100, Pavia PV (Italy); Berton, Francesca; Gola, Giada [University of Pavia, IRCCS Policlinico S. Matteo, Institute of Radiology, Pavia (Italy); Chiari, Giorgio; Romano, Piero; Cassani, Ferdinando [IRCCS Policlinico S. Matteo, Division of Paediatric Surgery, Pavia (Italy)

2005-07-01

Urethral polyps are a rare finding in children, particularly in the very young. They are suspected by the presence of various clinical signs such as obstruction, voiding dysfunction and haematuria. There is an association with other urinary tract congenital anomalies. They are usually benign fibro-epithelial lesions with no tendency to recur and are treated by surgical ablation, fulguration or laser therapy. We report a 1-month-old boy with an antenatally diagnosed left ectopic pelvic kidney, postnatal urinary tract infection and no clinical signs of obstruction. Voiding cystourethrography to exclude vesico-ureteric reflux showed a trabeculated bladder and a mobile filling defect in the posterior urethra. Owing to its large size, cystotomy was necessary to remove the polyp successfully. (orig.)

A Narrative Review on the Pathophysiology and Management for Radiation Cystitis

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C. Browne

2015-01-01

Full Text Available Radiation cystitis is a recognised complication of pelvic radiotherapy. Incidence of radiation cystitis ranges from 23 to 80% and the incidence of severe haematuria ranges from 5 to 8%. High quality data on management strategies for radiation cystitis is sparse. Treatment modalities are subclassified into systemic therapies, intravesical therapies, and hyperbaric oxygen and interventional procedures. Short-term cure rates range from 76 to 95% for hyperbaric oxygen therapy and interventional procedures. Adverse effects of these treatment strategies are acceptable. Ultimately, most patients require multimodal treatment for curative purposes. Large randomised trials exploring emergent management strategies are required in order to strengthen evidence-based treatment strategies. Urologists encounter radiation cystitis commonly and should be familiar with diagnostic modalities and treatment strategies.

Persistent Mullerian Duct Syndrome: a rare entity with a rare presentation in need of multidisciplinary management.

Science.gov (United States)

Da Aw, Lin; Zain, Murizah M; Esteves, Sandro C; Humaidan, Peter

2016-01-01

A typical male looking adolescent with a legal female gender assignment presented with haematuria. Investigations led to the diagnosis of Persistent Mullerian Duct Syndrome. The condition is indeed a rare entity that needs a multidisciplinar team management. Case hypothesis: A case of Persistent Mullerian Duct Syndrome undiagnosed at birth because karyotyping was defaulted, thus resulting in a significant impact on the legal gender assignment and psychosocial aspects. Promising future implications: The reporting of this case is important to create awareness due to its rarity coupled with the rare presentation with hematuria as a possible masquerade to menstruation. There were not only medical implications, but also psychosocial and legal connotations requiring a holistic multidisciplinary management. Copyright® by the International Brazilian Journal of Urology.

Urethral polyp in a 1-month-old child

International Nuclear Information System (INIS)

Beluffi, Giampiero; Berton, Francesca; Gola, Giada; Chiari, Giorgio; Romano, Piero; Cassani, Ferdinando

2005-01-01

Urethral polyps are a rare finding in children, particularly in the very young. They are suspected by the presence of various clinical signs such as obstruction, voiding dysfunction and haematuria. There is an association with other urinary tract congenital anomalies. They are usually benign fibro-epithelial lesions with no tendency to recur and are treated by surgical ablation, fulguration or laser therapy. We report a 1-month-old boy with an antenatally diagnosed left ectopic pelvic kidney, postnatal urinary tract infection and no clinical signs of obstruction. Voiding cystourethrography to exclude vesico-ureteric reflux showed a trabeculated bladder and a mobile filling defect in the posterior urethra. Owing to its large size, cystotomy was necessary to remove the polyp successfully. (orig.)

Characteristics and Factors Associated with Death among Patients Hospitalized for Severe Fever with Thrombocytopenia Syndrome, South Korea, 2013.

Science.gov (United States)

Shin, Jaeseung; Kwon, Donghyok; Youn, Seung-Ki; Park, Ji-Hyuk

2015-10-01

In South Korea, nationwide surveillance for severe fever with thrombocytopenia syndrome (SFTS) began during 2013. Among 301 surveillance cases, 35 hospitalized case-patients in 25 areas were confirmed by using virologic testing, and 16 (46%) case-patients subsequently died. The SFTS cases occurred during May-November and peaked during June (9 cases, 26%). The incidence of SFTS was higher in the southern regions of South Korea. Age and neurologic symptoms, including decreased level of consciousness and slurred speech, were heavily associated with death; neurologic symptoms during the first week after disease onset were also associated with death. Although melena was common among patients who died, no other hemorrhagic manifestations were substantively more common among those who died. No effective treatments, including ribavirin, were identified. Expansion of SFTS surveillance to include the outpatient sector and development of an antibody test would enhance completeness of SFTS detection in South Korea.

Frequency of gastric varices in patients with portal hypertension based on endoscopic findings

International Nuclear Information System (INIS)

Mir, A.W.; Chaudry, A.A.; Mir, S.; Ahmed, N.; Khan, A.A.; Shahzadi, M.

2017-01-01

To find out the frequency of gastric varices in patients with portal hypertension based on endoscopic findings. Study Design: Descriptive Study. Place and Duration of Study: Department of Gastroenterology, Military Hospital, Rawalpindi from Jan to Jun 2011. Material and Methods: All patients fulfilling the inclusion criteria were selected through consecutive sampling. The patients presenting with hematemesis, melena or ascites with portal hypertension on ultrasound abdomen were admitted in the hospital. The patients were first stabilized hemodynamically and then kept empty stomach for at least four hours before endoscopy. The patients were sedated with intravenous midazolam and endoscopic findings obtained were entered on the patient proforma. Results: The overall frequency of gastric varices was 11 percent, whereas 89 percent had no gastric varices. Conclusion: A large number of patients with portal hypertension have gastric varices. It is recommended that endoscopy be carried out in all patients with identified portal hypertension. (author)

Bevacizumab for Refractory Gastrointestinal Bleeding in Rendu-Osler-Weber Disease

Science.gov (United States)

Bernardes, Carlos; Santos, Sara; Loureiro, Rafaela; Borges, Verónica; Ramos, Gonçalo

2018-01-01

Rendu-Osler-Weber disease, also known as hereditary hemorrhagic telangiectasia, is a rare autosomal dominant disorder which is often characterized by recurrent epistaxis, mucocutaneous and gastrointestinal telangiectasias, and visceral arteriovenous malformations. Patients with gastrointestinal involvement can present with a wide spectrum of severity, which may vary from uncomplicated iron deficiency anemia to continuous and refractory bleeding. We present the case of a 62-year-old female, who was admitted with anemia following several episodes of melena, and whose endoscopic examination revealed multiple angiodysplasias in the stomach and small bowel. Despite endoscopic and medical treatment attempts with hormonal agents and octreotide, she developed persistent hemorrhage and severe anemia, requiring frequent red blood cell transfusions. Immediately after initiating bevacizumab (7.5 mg/kg, every 3 weeks), complete cessation of bleeding episodes was observed. Currently, after 1 year of follow-up, she maintained sustained remission without the occurrence of adverse events. PMID:29662934

[A case of sigmoid colon cancer invading urinary bladder treated with preoperative mFOLFOX6 and urinary bladder conserving surgery].

Science.gov (United States)

Nishino, Takeshi; Katayama, Kazuhisa; Takahashi, Yuji; Tanaka, Takashi

2012-02-01

A 69-year-old man visited our hospital because of melena and anemia. Colonoscopy revealed a type 3 tumor at sigmoid colon, and by abdominal CT, we detected a sigmoid colon cancer invading the urinary bladder with a single liver metastasis. The patient required sigmoidectomy with partial hepatectomy and total urinary bladder resection. Preoperative chemotherapy with mFOLFOX6 was initiated as a part of multidisciplinary therapy. After the 6th course was completed, CT revealed a reduction in the primary tumor's size and the disappearance of liver metastasis. After the 8th course was completed, we performed urinary bladder conserving sigmoidectomy. The pathological diagnosis of the surgical specimen was tub1, pSS, ly0, v0, pN0, and pStage II. Down-sizing chemotherapy might improve the quality of life(QOL)of colon cancer patients with extensive invasion of the urinary bladder.

Sentinel Bleeding as a Sign of Gastroaortic Fistula Formation after Oesophageal Surgery

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M. Uittenbogaart

2014-01-01

Full Text Available Gastroaortic fistula formation is a very rare complication following oesophageal resection and, in most cases, leads to sudden death. We report the case of a 65-year-old male with an adenocarcinoma of the oesophagus who underwent neoadjuvant chemoradiation followed by a minimally invasive transthoracic oesophagectomy with gastric tube reconstruction and intrathoracic anastomosis. After an uneventful postoperative course and hospital discharge, the patient reported blood regurgitation on postoperative day 23. Endoscopy revealed an adherent blood clot on the oesophageal wall, which after dislocation caused exsanguination. Autopsy determined the cause of death being massive haemorrhage due to a gastroaortic fistula. The sudden onset of haemorrhage makes this condition particularly difficult to treat. Recognition of warning signs such as thoracic or epigastric pain, regurgitation of blood, or the passing of bloody stools or melena is crucial in the early detection of fistula and may improve patient outcome.

Treatment and follow-up of a case of bleeding duodenal varix

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Viveksandeep Thoguluva Chandrasekar

2013-01-01

Full Text Available Duodenal varices (DV are rare in patients with portal hypertension secondary to liver disease. Their tendency to bleed is less common than in gastroesophageal varices, but can sometimes produce a life-threatening bleed. They are often difficult to diagnose and treat. We present a case of a 35-year-old man with parenchymal liver disease admitted with complaints of hematemesis and melena. Upper gastrointestinal endoscopy was performed and a duodenal varix, with stigmata of a recent bleed, was noted in the second part of the duodenum. Five milliliters of N-butyl-2-cyanoacrylate glue was injected into the varix leading to obliteration. A follow-up study with an endoscopic ultrasound and repeat endoscopy showed near total obturation of the varix and success of the therapy. This report concludes that glue injection can effectively be used as a first-line treatment for bleeding duodenal varices.

Diagnostic imagings and embolotherapy for the superior mesenteric vein-inferior vena cava shunt

International Nuclear Information System (INIS)

Morita, Yutaka; Yamada, Masataka; Miyata, Mutsuhiko; Kubo, Kohzo.

1994-01-01

Diagnostic imaging and embolization therapy for the uncommon portal and mesenteric vein-inferior vena cave shunt (PV·SMV-IVC shunt) are reported. As the frequency of clinical symptoms such as hematemesis, melena and confusion caused by gastrointestinal varices, or hepatoencephalopathy was about 40%, it was important for this disease entity to be diagnosed with noninvasive diagnostic images. The careful examination of the area around the right renal vein was able to overcome the low diagnostic rate of 20-40% obtained with US and CT images. In cases of simple PV·SMV-IVC shut without gastrointestinal varices, embolization therapy using steel coils and done by the intravenous approach is easy and noninvasive. On the other hand, in cases of complex PV-SMV-IVC shunt with gastrointestinal varices, dual balloon occluded embolization therapy using a liquid sclerosing agent and done by the intravenous and portal approaches is preferable. (author)

Bleeding in cancer patients and its treatment: a review.

Science.gov (United States)

Johnstone, Candice; Rich, Shayna E

2017-12-18

Bleeding is a common problem in cancer patients, related to local tumor invasion, tumor angiogenesis, systemic effects of the cancer, or anti-cancer treatments. Existing bleeds can also be exacerbated by medications such as bevacizumab, nonsteroidal anti-inflammatory drugs (NSAIDs), and anticoagulants. Patients may develop acute catastrophic bleeding, episodic major bleeding, or low-volume oozing. Bleeding may present as bruising, petechiae, epistaxis, hemoptysis, hematemesis, hematochezia, melena, hematuria, or vaginal bleeding. Therapeutic intervention for bleeding should start by establishing goals of care, and treatment choice should be guided by life expectancy and quality of life. Careful thought should be given to discontinuation of medications and reversal of anticoagulation. Interventions to stop or slow bleeding may include systemic agents or transfusion of blood products. Noninvasive local treatment options include applied pressure, dressings, packing, and radiation therapy. Invasive local treatments include percutaneous embolization, endoscopic procedures, and surgical treatment.

Superior Sagittal Sinus Thrombosis Complicating Typhoid Fever in a Teenager

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P. O. Okunola

2012-01-01

Full Text Available Cerebral venous sinus (sinovenous thrombosis (CSVT is a rare life-threatening disorder in childhood that is often misdiagnosed. CSVT encompasses cavernous sinus thrombosis, lateral sinus thrombosis, and superior sagittal sinus thrombosis (SSST. We present an adolescent girl who was well until two weeks earlier when she had a throbbing frontal headache and fever with chills; she later had dyspnoea, jaundice, melena stool, multiple seizures, nuchal rigidity, and monoparesis of the right lower limb a day before admission. Urine test for Salmonella typhi Vi antigen was positive, and Widal reaction was significant. Serial cranial computerized tomography scans revealed an expanding hypodense lesion in the parafalcine region consistent with SSST or a parasagittal abscess. Inadvertent left parietal limited craniectomy confirmed SSST. She recovered completely with subsequent conservative management. Beyond neuropsychiatric complications of Typhoid fever, CSVT should be highly considered when focal neurologic deficits are present.

Clinical profile of patients with biopsy proven lupus nephritis at a tertiary care hospital from Northern Pakistan, 1995 to 2012.

Science.gov (United States)

Ali, Akhtar; Mehmood, Anjum; Ali, Muhammad Usman

2017-01-01

TTo highlight the clinical spectrum of biopsy-proven lupus nephritis by analysing any variations in its histological subtypes across gender, varying age groups, serum creatinine levels and anti-double stranded deoxyribonucleic acid levels. This retrospective, observational study was conducted at the Lady Reading Hospital in collaboration with the Fauji Foundation Hospital, Peshawar, Pakistan, and comprised patient records of biopsy-proven lupus nephritis from 1995 to 2012. The cases were analysed according to clinical presentations and histological pattern of systemic lupus erythematosus nephritis. EpiData 3.1 and SPSS 17 were used for data analyses. Of the 2,000 renal biopsies performed, lupus nephritis was found in 74(3.7%) cases. Of them, 63(85.1%) were females and 11(14.9%) males. The mean age of the cases was 23.88±9.73 years (range: 10-55 years). Class IV lupus nephritis was seen in 38(51.4%) patients, followed by Class II in 15(20.3%), Class III in 10(13.5%), Class V and VI in 4(5.4%) each and Class I in 3(4.1%). Out of the combined Class III and IV cases, 25(52.08%) had serum creatinine levels of >1.2 mg/dL, whereas positive anti-double stranded deoxyribonucleic acid titers up to 50 IU/L were seen in all of the 48(100%) such patients. Overall, microscopic haematuria was found in 52(70.3%) cases, followed by arthralgia in 40(54.1%). Moreover, 32(50.8%) females and 6(54.5%) males had Type IV nephritis. Class VI lupus nephritis, in particular, were significantly more prominent in 31-40 years of age group when compared to other histological subtypes and age groups (p=0.0096, odds ratio: 23.25, 95% confidence interval: 2.15-251.21). Female predominance was observed in all histological sub-types of lupus nephritis. Class IV lupus was the most common histological pattern. Microscopic haematuria was the most common clinical presentation.

Questioning the wisdom of tubeless percutaneous nephrolithotomy (PCNL): a prospective randomized controlled study of early tube removal vs tubeless PCNL.

Science.gov (United States)

Mishra, Shashikant; Sabnis, Ravindra B; Kurien, Abraham; Ganpule, Arvind; Muthu, Veeramani; Desai, Mahesh

2010-10-01

To establish the efficacy of early removal of a nephrostomy tube after percutaneous nephrolithotomy (PCNL), to challenge the wisdom of tubeless PCNL, as we hypothesized that it would result in a shorter hospital stay, comparable benefit and safety, while maintaining the option of check nephroscopy ensuring far superior stone clearance. In all, 22 patients were prospectively randomized equally into two groups, group 1 (early nephrostomy removal) or group 2 (tubeless) during a 1-month study period. Inclusion criteria for the study were: a simple stone of Foley catheter were used, while in group 2 only a 6 F retrograde ureteric catheter and Foley catheter were placed at the end of the procedure. Computed tomography (CT) with no contrast medium was done on the first morning after surgery before removing all catheters/tubes, and patients discharged subsequently. The variables assessed were stone clearance, hospital stay, analgesic requirement, postoperative complications and auxiliary procedures. The mean (SD) stone bulk was similar between the groups, at 2737 (946.9) and 2934.2 (2090.7) µL, respectively. Despite an on-table complete clearance, clearance assessed by CT was nine of 11 vs eight of 11 in groups 1 and 2, respectively. CT showed a 6 mm stone in one patient in group 1, while the remaining patients had stones of haematuria in none vs three (P= 0.21), urinoma none vs one, and fever in two vs one, respectively; one patient in group 1 required a check nephroscopy for a residual fragment. Overall clearance including re-treatment was 10/11 vs eight of 11 (P= 0.009), respectively. Early tube removal after PCNL results in an equivalent analgesic requirement, decrease in haemoglobin and hospital stay as tubeless PCNL. It has a significantly lower incidence of early haematuria, better clearance rates and preserves the option of check nephroscopy. It can be considered as an accepted standard of care, with the preserved advantages of tubeless PCNL. © 2010 THE AUTHORS

Should warfarin or aspirin be stopped prior to prostate biopsy? An analysis of bleeding complications related to increasing sample number regimes

International Nuclear Information System (INIS)

Chowdhury, R.; Abbas, A.; Idriz, S.; Hoy, A.; Rutherford, E.E.; Smart, J.M.

2012-01-01

Aim: To determine whether patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy with increased sampling numbers are more likely to experience bleeding complications and whether warfarin or low-dose aspirin are independent risk factors. Materials and methods: 930 consecutive patients with suspected prostatic cancer were followed up after biopsy. Warfarin/low-dose aspirin was not stopped prior to the procedure. An eight to 10 sample regime TRUS-guided prostate biopsy was performed and patients were offered a questionnaire to complete 10 days after the procedure, to determine any immediate or delayed bleeding complications. Results: 902 patients returned completed questionnaires. 579 (64.2%) underwent eight core biopsies, 47 (5.2%) underwent nine, and 276 (30.6%) underwent 10. 68 were taking warfarin [mean international normalized ratio (INR) = 2.5], 216 were taking low-dose aspirin, one was taking both, and 617 were taking neither. 27.9% of those on warfarin and 33.8% of those on aspirin experienced haematuria. 37% of those on no blood-thinning medication experienced haematuria. 13.2% of those on warfarin and 14.4% of those on aspirin experienced rectal bleeding. 11.5% of those on no blood-thinning medication experienced rectal bleeding. 7.4% of those on warfarin and 12% of those on aspirin experienced haematospermia. 13.8% of those on neither experienced haematospermia. Regression analysis showed a significant association between increasing sampling number and occurrence of all bleeding complication types. There was no significant association between minor bleeding complications and warfarin use; however, there was a significant association between minor bleeding complications and low-dose aspirin use. There was no severe bleeding complication. Conclusion: There is an increased risk of bleeding complications following TRUS-guided prostate biopsy with increased sampling numbers but these are minor. There is also an increased risk with low

[Horseshoe kidney, stone disease and prostate cancer: a case presentation].

Science.gov (United States)

Hermida Pérez, J A; Bermejo Hernández, A; Hernández Guerra, J S; Sobenes Gutierrez, R J

2013-01-01

The horseshoe kidney is the most common congenital renal fusion anomalies. It occurs in 0.25% of the population, or 1 in every 400 people. It is more frequent in males (ratio 2:1). The most observed complication of horseshoe kidney is stone disease, although there may be others such as, abdominal pain, urinary infections, haematuria, hydronephrosis, trauma and tumours (most commonly associated with hypernephroma and Wilms tumour). We describe a case of a male patient with horseshoe kidney, stone disease and adenocarcinoma of the prostate. One carrier of this condition who suffered a transitional cell carcinoma of the prostate was found in a review of the literature. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Laparoscopic bilateral nephroureterectomy and bladder cuff excision for native renal pelvic and ureteral transitional cell carcinoma after renal transplantation.

Directory of Open Access Journals (Sweden)

Chen C

2003-01-01

Full Text Available A 37-years-old female who was suffering from end-stage renal disease for about 6 years received allograft renal transplantation 4 years ago. She has been receiving 50mg of Cyclosporin A orally daily for immuno-suppression since then. Gross haematuria was noted and computerised tomography showed native left renal pelvic and ureteral multi-focal transitional cell carcinoma with severe hydronephrosis. Laparoscopic bilateral nephroureterectomy and bladder cuff excision were performed. In the past, history of previous operation was considered a relative contraindication for laparoscopic surgery. To our knowledge, we present the first case of laparoscopic treatment for native renal pelvic and ureteral transitional cell carcinoma after renal allograft transplantation without a hand-assisted device. This case shows the feasibility of laparoscopic bilateral nephroureterectomy in patients with transplanted kidneys.

A simple football injury leading to a grade 4 renal trauma.

Science.gov (United States)

Fanning, Deirdre Mary; Forde, James C; Mohan, Ponnusamy

2012-03-08

This case highlights the need for cautious management and serial regular examination of trauma patients. A 22-year-old Caucasian male presented to the emergency department 4 h following an injury sustained during football training. He complained of the immediate onset of severe left upper quadrant and left flank pain. He subsequently developed frank haematuria. On initial review, he was haemodynamically stable. CT of the abdomen and pelvis showed a grade 4 renal trauma. Over the following 36 h, he remained haemodynamically stable. On serial abdominal examinations however, he developed a rigid abdomen and was noted to have a haemoglobin drop. Interval CT scan showed a progression of his injury and the presence of a haemoperitoneum. An emergency laparotomy was performed resulting in a left nephrectomy. He made an uneventful recovery.

Xanthogranulomatous pyelonephritis in childhood: ultrasound and CT diagnosis

Energy Technology Data Exchange (ETDEWEB)

Cousins, C [City Hospital, Nottingham (United Kingdom); Somers, J [City Hospital, Nottingham (United Kingdom); Broderick, N [City Hospital, Nottingham (United Kingdom); Rance, C [City Hospital, Nottingham (United Kingdom); Shaw, D [Hospital for Sick Children, London (United Kingdom)

1994-06-01

Four cases of diffuse xanthogranulomatous pyelonephritis (XPN) in young children are presented. In three patients the clinical picture was one of weight loss, anaemia and neutrophilia with a large renal mass. The fourth presented with haematuria. Ultrasound (US) and CT findings were almost identical in all four patients. US showed the affected kidney was massively enlarged but retained a reniform shape. Dilated fluid spaces containing calculi were present. CT confirmed the US findings and revealed peripheral enhancement without contrast excretion, with dilated calyceal spaces producing the ''bear paw sign''. Extrarenal extension into abdominal wall and psoas muscle is typical and was well demonstrated by CT. The affected kidneys were non-functioning and nephrectomy was required. Typical US and CT features allow a confident diagnosis of XPN and appropriate early treatment. (orig.)

Xanthogranulomatous pyelonephritis in childhood: ultrasound and CT diagnosis

International Nuclear Information System (INIS)

Cousins, C.; Somers, J.; Broderick, N.; Rance, C.; Shaw, D.

1994-01-01

Four cases of diffuse xanthogranulomatous pyelonephritis (XPN) in young children are presented. In three patients the clinical picture was one of weight loss, anaemia and neutrophilia with a large renal mass. The fourth presented with haematuria. Ultrasound (US) and CT findings were almost identical in all four patients. US showed the affected kidney was massively enlarged but retained a reniform shape. Dilated fluid spaces containing calculi were present. CT confirmed the US findings and revealed peripheral enhancement without contrast excretion, with dilated calyceal spaces producing the ''bear paw sign''. Extrarenal extension into abdominal wall and psoas muscle is typical and was well demonstrated by CT. The affected kidneys were non-functioning and nephrectomy was required. Typical US and CT features allow a confident diagnosis of XPN and appropriate early treatment. (orig.)

Utility of diffusion-weighted imaging in the presurgical diagnosis of an infected urachal cyst

International Nuclear Information System (INIS)

Chouhan, Manil; Cuckow, Peter; Humphries, Paul D.

2011-01-01

Urachal cysts are one of a spectrum of urachal abnormalities that occur following failure of regression of the allantois and presumptive bladder between 4 weeks and 6 weeks of gestation. Infection is the most common complication of this rare congenital anomaly. The nonspecific presentation may mimic other pathological processes, underlining their clinical and radiological significance. Imaging investigations typically include US and CT, both of which are limited in their ability to characterize lesions. We report the case of a 5-year-old presenting with macroscopic haematuria in whom diffusion-weighted MRI (DWI) suggested the diagnosis of an infected urachal cyst, which was confirmed surgically. We discuss the radiological findings in multiple imaging modalities and present the application of DWI in this context as a means of improving the radiological diagnostic yield. (orig.)

A simple football injury leading to a grade 4 renal trauma.

LENUS (Irish Health Repository)

Fanning, Deirdre Mary

2012-01-01

This case highlights the need for cautious management and serial regular examination of trauma patients. A 22-year-old Caucasian male presented to the emergency department 4 h following an injury sustained during football training. He complained of the immediate onset of severe left upper quadrant and left flank pain. He subsequently developed frank haematuria. On initial review, he was haemodynamically stable. CT of the abdomen and pelvis showed a grade 4 renal trauma. Over the following 36 h, he remained haemodynamically stable. On serial abdominal examinations however, he developed a rigid abdomen and was noted to have a haemoglobin drop. Interval CT scan showed a progression of his injury and the presence of a haemoperitoneum. An emergency laparotomy was performed resulting in a left nephrectomy. He made an uneventful recovery.

Primary hyperoxaluria type 1: clinical manifestations in infancy and prenatal diagnosis

DEFF Research Database (Denmark)

Illum, N; Lavard, L; Danpure, C J

1992-01-01

biopsy demonstrated complete absence of alanine: glyoxylate aminotransferase catalytic activity and immunoreactive protein compatible with a diagnosis of primary hyperoxaluria type 1. He died at the age of 11 months, just before liver transplantation was made possible. Fetal liver biopsy in the mother......A 9-month-old Pakistani boy of consanguineous parents presented with uraemia preceded by pyuria from 5 weeks of age. He had no history of renal calculi or macroscopic haematuria. Renal biopsy revealed severe calcium oxalate deposition in the tubuli and fibrosis of the interstitial tissue. Liver......'s subsequent pregnancy showed normal enzymatic activity. Early detection and early replacement of the missing enzyme by liver transplantation are considered to be crucial for the survival of severely affected infants with the acute neonatal form of primary hyperoxaluria type 1. Persistent pyuria could...

Differentiation of saraca asoca crude drug from its adulterant.

Science.gov (United States)

Mathew, Samuel; Mathew, Gracy; Joy, P P; Skari, Baby P; Joseph, T S

2005-04-01

Saraca asoca commonly known as asoka, which is considered as a sacred tree by Hindus and Buddhists possesses various medicinal uses. The stem bark of the tree is the principal constituent of several ayurvedic preparations which are widely prescribed in leucorrhoea, haematuria, menorrhagia and other diseases of the female genitourinary system. Because of destructive extraction and the absence of an organized cultivation programme, the avilbility of the crude drug is diminishing and this has resulted in the sale of adulterants. The commonly used adulterant is the bark of Polyalthia longifolia which shows some similarity with that of asoka. Studies were conducted at Aromatic and Medicinal Plants Research station, Odakkali (Kerala Agricultural University) during 2001-2002 to evolve methods for differentiating the original drug from the adulterant species by anatomical biochemical and chromatographic techniques.

Surviving Sengstaken.

Science.gov (United States)

Jayakumar, S; Odulaja, A; Patel, S; Davenport, M; Ade-Ajayi, N

2015-07-01

To report the outcomes of children who underwent Sengstaken-Blakemore tube (SBT) insertion for life-threatening haemetemesis. Single institution retrospective review (1997-2012) of children managed with SBT insertion. Patient demographics, diagnosis and outcomes were noted. Data are expressed as median (range). 19 children [10 male, age 1 (0.4-16) yr] were identified; 18 had gastro-oesophageal varices and 1 aorto-oesophageal fistula. Varices were secondary to: biliary atresia (n=8), portal vein thrombosis (n=5), alpha-1-anti-trypsin deficiency (n=1), cystic fibrosis (n=1), intrahepatic cholestasis (n=1), sclerosing cholangitis (n=1) and nodular hyperplasia with arterio-portal shunt (n=1). Three children deteriorated rapidly and did not survive to have post-SBT endoscopy. The child with an aortooesophageal fistula underwent aortic stent insertion and subsequently oesophageal replacement. Complications included gastric mucosal ulceration (n=3, 16%), pressure necrosis at lips and cheeks (n=6, 31%) and SBT dislodgment (n=1, 6%). Six (31%) children died. The remaining 13 have been followed up for 62 (2-165) months; five required liver transplantation, two underwent a mesocaval shunt procedure and 6 have completed endoscopic variceal obliteration and are under surveillance. SBT can be an effective, albeit temporary, life-saving manoeuvre in children with catastrophic haematemesis. Copyright © 2015 Elsevier Inc. All rights reserved.

Accidental radioisotope burns - Management of late sequelae

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Varghese Bipin

2010-10-01

Full Text Available Accidental radioisotope burns are rare. The major components of radiation injury are burns, interstitial pneumonitis, acute bone marrow suppression, acute renal failure and adult respiratory distress syndrome. Radiation burns, though localized in distribution, have systemic effects, and can be extremely difficult to heal, even after multiple surgeries. In a 25 year old male who sustained such trauma by accidental industrial exposure to Iridium192 the early presentation involved recurrent haematemesis, pancytopenia and bone marrow suppression. After three weeks he developed burns in contact areas in the left hand, left side of the chest, abdomen and right inguinal region. All except the inguinal wound healed spontaneously but the former became a non-healing ulcer. Pancytopenia and bone marrow depression followed. He was treated with morphine and NSAIDs, epidural buprinorphine and bupivicaine for pain relief, steroids, antibiotics followed by wound excision and reconstruction with tensor fascia lata(TFL flap. Patient had breakdown of abdominal scar later and it was excised with 0.5 cm margins up to the underlying muscle and the wound was covered by a latissimis dorsi flap. Further scar break down and recurrent ulcers occurred at different sites including left wrist, left thumb and right heel in the next two years which needed multiple surgical interventions.

Desmoplastic round small cell tumor: a case report of a neoplasm of difficult diagnosis

International Nuclear Information System (INIS)

Ogata, Daniel Cury; Totsugui, Joel Takashi; Ditzel Filho, Leo Fernando da Silva; Ioshii, Sergio Ossamu; Machuca, Tiago Noguchi; Ogata, Alessandro Cury

2005-01-01

Desmoplastic Small Round Cell Tumor (DSRCT) is a rare neoplasm of difficult diagnosis, recently described by Gerald et al. There are reports of nearly 101 cases in the literature, being the intra-abdominal region its most common location and children and young adults its preferred age group. This paper reports a case of DSRCT in a young adult of 24 years of age. This patient presented unspecific symptoms of nausea, vomiting and a single episode of haematemesis. Upon physical examination a solid mass on the epigastrium and left hypochondrium was found. Image diagnostic procedures confirmed the existence of the expansive process and also revealed enlarged retroperitoneal lymphonodes. Diagnosis was achieved through videolaparoscopic biopsy. Histologic sections stained with hematoxylin/eosin were inconclusive and immunohistochemical analysis was required to establish the diagnosis. This analysis revealed positivity to epithelial and mesenchymal markers and weak positivity to chromogranin A, characteristic results of DSRCT. Due to the fact that the disease was locally advanced, the patient was treated with chemotherapy (cyclophosphamide and paclytaxel). However, since there was only partial response to the treatment, the patient refused to undergo any second line option of therapy. Presently, the patient is being submitted only to supportive care, within an 18-month follow-up program. (author)

Clinical application of endovascular stent-graft in the treatment of portal stenosis of cancerous thrombus

International Nuclear Information System (INIS)

Jiang Zaibo; Huang Mingsheng; Wang Jing; Li Zhengran; Qian Jiesheng; Guang Shouhai; Zhu Kangshun; Shan Hong; Zhang Xiongjun

2007-01-01

Objective: To explore the approach and early effects of endovascular stent-graft deployment in the treatment of portal stenosis of cancerous thrombus. Methods: Six cases with portal vein stenosis of cancerous thrombus, which caused by primary hepatic carcinoma (5 cases) and cholangiocarcinoma (1 case) and the severity of stenosis showed on contrast enhanced CT were more than 75% or occluded, were performed percutaneous transhepatic or transsplenic portography. FLUENCY TM endovascular stent-graft (10 mm diameter) was placed at the position of stenosis after gastroesophageal varices embolization. Portal pressure was measured pre- and post-deployment. Results: Stents were successfully placed in all patients. The average portal pressure decreased from 50.7 em H 2 O (1 cm H 2 O0.098 kPa) to 41.3 cm H 2 O after endovascular stent-graft deployment. The restenosis were found in 2 cases after one month. Haematemesis and refractory ascites appeared in one case respectively, the other 4 cases showed no significant symptoms above caused by portal hypertension. Conclusion: It is safe and feasible for endovascular stent-graft deployment in the treatment of portal stenosis of cancerous thrombus. Selecting the suitable indications, the symptoms of portal hypertension can be controlled effectively. (authors)

Pediatric gastric ganglioneuroma presenting as anemia

Directory of Open Access Journals (Sweden)

Katrina M. Morgan

2018-04-01

Full Text Available Primary gastric masses are rare in childhood, and a gastric ganglioneuroma has not been reported in the pediatric population. In this report, we describe a 12-year-old female who presented with iron deficiency anemia and melena. Endoscopy was performed to elucidate the source of her symptoms, and revealed a gastric mass with overlying ulceration. Following resection and pathologic examination, the mass was diagnosed as a solitary polypoid ganglioneuroma. A solitary polypoid ganglioneuroma is an uncommon, benign tumor of neural crest cell origin. They are most often asymptomatic and found incidentally, but can present with rectal bleeding, obstruction, pain, and changes in bowel function. Complete resection is the therapy of choice to prevent progression of symptoms or rare transformation into a malignant neuroblastic tumor, like neuroblastoma. As of the patient's last post-operative appointment, she was healthy with resolution of her anemia. Keywords: Ganglioneuroma, Pediatric, Gastric mass, Anemia, Neuroblastic tumor

Giant polypoid gastric heterotopia in the small intestine in a boy: A case report and literature review.

Science.gov (United States)

Cai, Jing; Yu, Haibo

2017-01-01

Heterotopic gastric mucosa has been described at various locations of the body; however, the polyp composed of heterotopic gastric mucosa in the small intestine is rare. A 15-year-old boy visited us for investigation of recurrent episodes of melena. Capsule endoscopy (CE) revealed a polypoid tumor in the ileum, with an active nearby hemorrhage. Contrast-enhanced computed tomography (CECT) showed a tumor in the right quadrant of the abdomen, with a diameter of about 18 × 14 mm. The patient was diagnosed with polypoid gastric heterotopia. We performed an operation to resect the lesion. The patient recovered smoothly after surgery and was discharged on postoperative day 7 and followed up for 3 months. He has not experienced gastrointestinal intestinal (GI) symptoms up to now. Giant polypoid gastric heterotopia in the small intestine is extremely rare, which can express as an occasional finding with or without symptoms. Surgical resection is the preferred therapy when symptoms appear.

Henoch–Schönlein purpura: a clinical case with dramatic presentation

Science.gov (United States)

Bento, João; Magalhães, Adriana; Moura, Conceição Souto; Hespanhol, Venceslau

2010-01-01

A case study involving a 55-year-old Caucasian male with end-stage glomerulosclerosis is presented here. Kidney biopsies showed no deposits on imunofluorescent microscopy. Relapsing massive haemoptysis and suspected bronchovascular malformation required lung lobectomy which revealed malformative and tortuous small blood vessels, with no vasculitis. Blood antinuclear antibodies, antineutrophil cytoplasmic antibodies and antiglomerular basement membrane antibodies were undetectable. Seric immunoglobulins and complement levels were normal. Three months later, arthralgia and joint oedema first appeared. Skin biopsy revealed vasculitis immune-reactive to immunoglobulin A. Systemic corticotherapy was then started. Two weeks later, the patient presented with abdominal pain melena and rectal bleeding (haematoquesia). Endoscopic study showed diffuse gastrointestinal haemorrhage. Angiographic study revealed diffuse lesions compatible with vasculitis and haemorrhage from multiple spots. Cyclophosphamide and then intravenous immunoglobulin were associated to treatment without response. Increasing blood loss occurred, with massive gastrointestinal haemorrhage and haemorrhagic ascitis. Death occurred due to uncontrolled diffuse bleeding. Necropsy findings showed generalised small vessels vasculitis compatible with Henoch–Schönlein purpura. PMID:22778211

GIST gástrico: revisión de la literatura a propósito de un caso

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Daniela V Blanco-Echezuría

2009-01-01

Full Text Available Los tumores del estroma gastrointestinal son los tumores mesenquimales más frecuentes del tubo digestivo. Corresponden a 0.1% a 3% de las neoplasias gastrointestinales y 5% a 6% de todos los sarcomas. Se trata de paciente femenina de 59 años de edad quien refiere en Enero de 2009 Rectorragia roja con coágulos, posteriormente Melena. La realización de una endoscopia digestiva superior reporta Tumor submucoso en fundus que se complementa con US endoscópico, evidenciando lesión submucosa en fundus gástrico, GIST gástrico. La sintomatología depende de la localización del proceso neoproliferativo, hallándose con mayor frecuencia en el estómago (60-70%. La supervivencia tras citorreducción R0 a 5 años es de 40% a 65%, con recurrencia del 20%, sin embargo, disminuye a 9-12 meses si la reducción fue incompleta.

Enteroscopic Tattooing for Better Intraoperative Localization of a Bleeding Jejunal GIST Facilitates Minimally Invasive Laparoscopically-assisted Surgery.

Science.gov (United States)

Iacob, Razvan; Dimitriu, Anca; Stanciulea, Oana; Herlea, Vlad; Popescu, Irinel; Gheorghe, Cristian

2016-03-01

We present the case of a 63-year-old man that was admitted for melena and severe anemia. Upper GI endoscopy and colonoscopy failed to identify the lesion responsible for bleeding, and enteroCT scan was also non-contributive to the diagnosis. Capsule endoscopy indicated possible jejunal bleeding but could not indicate the source of bleeding, recommending anterograde enteroscopy. Single balloon enteroscopy identified a 2 cm submucosal tumour in the distal part of the jejunum, with a macroscopic appearance suggesting a gastrointestinal stromal tumour (GIST). The tumor location was marked using SPOT tattoo and subsequently easily identified by the surgeon and resected via minimally invasive laparoscopic-assisted approach. Histological and immunohistochemical analysis indicated a low risk GIST. The unusual small size of the GIST as a modality of presentation, with digestive bleeding and anemia and the ability to use VCE/enteroscopy to identify and mark the lesion prior to minimally invasive surgery, represent the particularities of the presented case.

Large gangliocytic paraganglioma of the duodenum: A rare entity.

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Hernández, Alejandra Gordillo; Lanuza, Eduardo Dominguez-Adame; Matias, Auxiliadora Cano; Huertas, Rosario Perez; Rodriguez, Katherine Maria Gallardo; Perez, Purificacion Gallinato; Mompean, Fernando Oliva

2015-08-27

Gangliocytic paragangliomas are rare tumors that almost exclusively occur within the second portion of the duodenum. Although these tumors generally have a benign clinical course, they have the potential to recur or metastasize to regional lymph nodes. The case report presented here describes a 57-year-old female patient with melena, progressive asthenia, anemia, and a mass in the second-third portion of the duodenum that was treated by local excision. The patient was diagnosed with a friable bleeding tumor. The histologic analysis showed that the tumor was a 4 cm gangliocytic paraganglioma without a malignant cell pattern. In the absence of local invasion or distant metastasis, endoscopic resection represents a feasible, curative therapy. Although endoscopic polypectomy is currently considered the treatment of choice, it is not recommended if the size of the tumor is > 3 cm and/or there is active or recent bleeding. Patients diagnosed with a gangliocytic paraganglioma should be closely followed-up for possible local recurrence.

A large gastrointestinal stromal tumor of duodenum: a case report

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Hadi Ahmadi Amoli

2014-01-01

Case presentation: The patient is a forty six years old man. He complained of frequent colic pain in left upper quadrant of abdomen for two months before admitting to the hospital. The pain resolved spontaneously after a few hours. This situation almost has been repeated every week. The patient had severe repeated melena and faint for two weeks. As soon as the patient was entered the Sina Hospital in 2012, supportive care was started. Then upper gastrointestinal endoscopy was performed for him and the bleeding point was detected. Also abdominal and pelvic computed tomography with oral and intravenous contrast was done. Finally the patient was operated on tumor diagnosis in duodenal area according to classic Whipple procedure. Conclusion: Gastrointestinal bleeding is the most common symptom of gastrointestinal stromal tumors. The bleeding is minimal and chronic. It will be progress to sudden and severe bleeding. Diagnosis is done by upper gastrointestinal endoscopy and biopsy. The large tumors with high mitotic

Urethral Caruncle Presented as Premature Menarche in a 4-Year-Old Girl

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Manori Gamage

2018-01-01

Full Text Available Urethral caruncle (UC is a benign fleshy outgrowth at the urethral meatus. It was first described by Samuel Sharp in 1750 and occurs mainly at the posterior lip of the urethra, and the exact aetiology is still uncertain. More often it was seen in the postmenopausal women, and only few cases are reported in young girls. Patients may be asymptomatic and could find this as an incidental finding or they may present with symptoms such as dysuria, bleeding per vagina, haematuria, a mass protruding through vagina, and acute retention of urine. Here, we report the case history of a 4-year-old girl presented with vaginal bleeding which was taken as she has attended menarche and found to have urethral caruncle which was the cause for bleeding. Histology confirmed the diagnosis, and girl was completely cured following surgical excision.

Successful Pregnancy Following Repair of Vesicouterine Fistula Following Repeat Caesarean Section: A Case Report

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Dilruba Akter

2012-06-01

Full Text Available A lady, para 2, both delivered by caesarean section for prolonged labour, presented with the complaints of menouria and infertility for 3 years following her last caesarean section. She had history of haematuria during menstruation and her menstrual flow is scanty. Her first baby was female and alive, but her second baby was stillborn following prolonged and obstructed labour. This has been continuously blamed by family and others for happening that events. Her fistula was confirmed by ultrasound scan, histerography and cystoscopy. The vesicouterine fistula was treated by local repair with omental patch through transperitoneal approach. Pregnancy following one year of successful repair has turned her from miserable to happiness in life.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.11030 BSMMU J 2012; 5(1:76-78 

Urethral Caruncle Presented as Premature Menarche in a 4-Year-Old Girl.

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Gamage, Manori; Beneragama, D

2018-01-01

Urethral caruncle (UC) is a benign fleshy outgrowth at the urethral meatus. It was first described by Samuel Sharp in 1750 and occurs mainly at the posterior lip of the urethra, and the exact aetiology is still uncertain. More often it was seen in the postmenopausal women, and only few cases are reported in young girls. Patients may be asymptomatic and could find this as an incidental finding or they may present with symptoms such as dysuria, bleeding per vagina, haematuria, a mass protruding through vagina, and acute retention of urine. Here, we report the case history of a 4-year-old girl presented with vaginal bleeding which was taken as she has attended menarche and found to have urethral caruncle which was the cause for bleeding. Histology confirmed the diagnosis, and girl was completely cured following surgical excision.

Transcatheter arterial embolization for congenital renal arteriovenous malformation

International Nuclear Information System (INIS)

Zhou Jun; Hu Tingyang; Yuan Jianhua; Yu Wenqiang

2008-01-01

Objective: To evaluate the effectiveness of transcatheter arterial embolization for congenital renal arteriovenous malformation. Methods: Seven cases of congenital renal arteriovenous malformation causing gross hematuria were retrospectively studied. All of 7 cases were demonstrated by means of angiography and then the catheter was placed superselectively into the involved arterial end of the malformation undertaking embolization with gelfoam, dehydrated ethanol, coils, etc. Results: All the malformations of the 7 cases were successfully embolized with stoppage of gross hematuria within 24 hours. No serious complications occurred except lumbago, fever, gastrointestinal reaction for one week. There was no recurrence of haematuria and the renal function was also normal in all cases during the follow-up for 36 to 98 months. Conclusions: Transcatheter renal arterial angiography and embolization are the important and effective management for the diagnosis and treatment of congenital renal arteriovenous malformation. (authors)

Intravenous urography in children and youth

International Nuclear Information System (INIS)

Pedersen, H.K.; Gudmundsen, T.E.; Oestensen, H.; Pape, J.F.

1987-01-01

This report derives from Tromsoe in northern Norway. In a retrospective study of the indications for intravenous urography (IU) and the findings at IU in 740 patients (451 girls and 289 boys) aged 0-19 years, we found that urinary tract infections accounted for 69.4% of the IU in females and 30.1% of the IU in males, most often seen in the youngest patients. The pathological findings most frequently seen were anomalies (17 females and 10 males) and urinary tract obstruction (3 females and 15 males). The present study indicates the following: first, that the yield of IU in the primary investigation of children and youth suffering from enuresis and non-specific abdominal disturbancies is small; and second, that the use of IU in children and youth with urinary tract infection and haematuria should be questioned and reconsidered. (orig.)

Hyperbaric oxygen treatment in radiation reactions; Hyperbar oksygenbehandling ved straalereaksjoner

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Aanderud, Leif; Thorsen, Einar; Bratteboe, Guttorm; Forland, Martha; Kristensen, Gunnar

2000-07-01

Background: A national hyperbaric centre was established in 1994 at Haukeland Hospital with responsibility of all hyperbaric oxygen (HBO) treatment in Norway. In hypoxic tissues with symptomatic radiation reactions, hyperbaric oxygen induces the formation of collagen and angiogenesis resulting in permanently improved local microcirculation. Material and method: 234 patients received elective HBO treatment at Haukeland Hospital in 12997 with total of 4048 treatments. All 47 patients treated for radiation reactions in the pelvic area in 1997 received a questionnaire 3-15 months after HBO therapy, 81% reported. Results: Rectal bleeding and haematuria were reported as much improved in 61% and 55% respectively, while bladder incontinence was much improved in 46%. Interpretation: this treatment modality may be an alternative in symptomatic radiation reactions at the urinary bladder and the bowel when conventional treatment has given unsatisfactory results.

A Rare Case of Gastric Variceal Hemorrhage Secondary to Infiltrative B-Cell Lymphoma

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Adrienne Lenhart

2016-10-01

Full Text Available Portal hypertension commonly arises in the setting of advanced liver cirrhosis and is the consequence of increased resistance within the portal vasculature. Less commonly, left-sided noncirrhotic portal hypertension can develop in a patient secondary to isolated obstruction of the splenic vein. We present a rare case of left-sided portal hypertension and isolated gastric varices in a patient with large B-cell lymphoma, who was treated with splenic artery embolization. The patient is a 73-year-old male with no previous history of liver disease, who presented with coffee ground emesis and melena. On admission to hospital, he was found to have a hemoglobin level of 3.4 g/l. Emergent esophagogastroduodenoscopy showed isolated bleeding gastric varices (IGV1 by Sarin classification in the fundus and cardia with subsequent argon plasma coagulation injection. He was transferred to our tertiary center where work-up revealed normal liver function tests, and abdominal ultrasound showed patent hepatic/portal vasculature without cirrhosis. MRI demonstrated a large heterogeneously enhancing mass in the pancreatic tail, with invasion into the spleen and associated splenic vein thrombosis. Surgery consultation was obtained, but urgent splenectomy was not recommended. The patient instead underwent splenic artery embolization to prevent future bleeding from his known gastric varices. Pathology from a CT-guided biopsy was consistent with diffuse large B-cell lymphoma. PET imaging showed uptake in the splenic hilum/pancreatic tail region with no additional metastatic involvement. He was evaluated by the Hematology Department to initiate R-CHOP chemotherapy. During his outpatient follow-up, he reported no further episodes of melena or hematemesis. To the best of our knowledge, there have only been two published case reports of large B-cell lymphoma causing upper gastrointestinal bleeding from isolated gastric varices. These cases were treated with splenectomy or

Statistical-learning strategies generate only modestly performing predictive models for urinary symptoms following external beam radiotherapy of the prostate: A comparison of conventional and machine-learning methods

International Nuclear Information System (INIS)

Yahya, Noorazrul; Ebert, Martin A.; Bulsara, Max; House, Michael J.; Kennedy, Angel; Joseph, David J.; Denham, James W.

2016-01-01

Purpose: Given the paucity of available data concerning radiotherapy-induced urinary toxicity, it is important to ensure derivation of the most robust models with superior predictive performance. This work explores multiple statistical-learning strategies for prediction of urinary symptoms following external beam radiotherapy of the prostate. Methods: The performance of logistic regression, elastic-net, support-vector machine, random forest, neural network, and multivariate adaptive regression splines (MARS) to predict urinary symptoms was analyzed using data from 754 participants accrued by TROG03.04-RADAR. Predictive features included dose-surface data, comorbidities, and medication-intake. Four symptoms were analyzed: dysuria, haematuria, incontinence, and frequency, each with three definitions (grade ≥ 1, grade ≥ 2 and longitudinal) with event rate between 2.3% and 76.1%. Repeated cross-validations producing matched models were implemented. A synthetic minority oversampling technique was utilized in endpoints with rare events. Parameter optimization was performed on the training data. Area under the receiver operating characteristic curve (AUROC) was used to compare performance using sample size to detect differences of ≥0.05 at the 95% confidence level. Results: Logistic regression, elastic-net, random forest, MARS, and support-vector machine were the highest-performing statistical-learning strategies in 3, 3, 3, 2, and 1 endpoints, respectively. Logistic regression, MARS, elastic-net, random forest, neural network, and support-vector machine were the best, or were not significantly worse than the best, in 7, 7, 5, 5, 3, and 1 endpoints. The best-performing statistical model was for dysuria grade ≥ 1 with AUROC ± standard deviation of 0.649 ± 0.074 using MARS. For longitudinal frequency and dysuria grade ≥ 1, all strategies produced AUROC>0.6 while all haematuria endpoints and longitudinal incontinence models produced AUROC<0.6. Conclusions

Statistical-learning strategies generate only modestly performing predictive models for urinary symptoms following external beam radiotherapy of the prostate: A comparison of conventional and machine-learning methods

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Yahya, Noorazrul, E-mail: noorazrul.yahya@research.uwa.edu.au [School of Physics, University of Western Australia, Western Australia 6009, Australia and School of Health Sciences, National University of Malaysia, Bangi 43600 (Malaysia); Ebert, Martin A. [School of Physics, University of Western Australia, Western Australia 6009, Australia and Department of Radiation Oncology, Sir Charles Gairdner Hospital, Western Australia 6008 (Australia); Bulsara, Max [Institute for Health Research, University of Notre Dame, Fremantle, Western Australia 6959 (Australia); House, Michael J. [School of Physics, University of Western Australia, Western Australia 6009 (Australia); Kennedy, Angel [Department of Radiation Oncology, Sir Charles Gairdner Hospital, Western Australia 6008 (Australia); Joseph, David J. [Department of Radiation Oncology, Sir Charles Gairdner Hospital, Western Australia 6008, Australia and School of Surgery, University of Western Australia, Western Australia 6009 (Australia); Denham, James W. [School of Medicine and Public Health, University of Newcastle, New South Wales 2308 (Australia)

2016-05-15

Purpose: Given the paucity of available data concerning radiotherapy-induced urinary toxicity, it is important to ensure derivation of the most robust models with superior predictive performance. This work explores multiple statistical-learning strategies for prediction of urinary symptoms following external beam radiotherapy of the prostate. Methods: The performance of logistic regression, elastic-net, support-vector machine, random forest, neural network, and multivariate adaptive regression splines (MARS) to predict urinary symptoms was analyzed using data from 754 participants accrued by TROG03.04-RADAR. Predictive features included dose-surface data, comorbidities, and medication-intake. Four symptoms were analyzed: dysuria, haematuria, incontinence, and frequency, each with three definitions (grade ≥ 1, grade ≥ 2 and longitudinal) with event rate between 2.3% and 76.1%. Repeated cross-validations producing matched models were implemented. A synthetic minority oversampling technique was utilized in endpoints with rare events. Parameter optimization was performed on the training data. Area under the receiver operating characteristic curve (AUROC) was used to compare performance using sample size to detect differences of ≥0.05 at the 95% confidence level. Results: Logistic regression, elastic-net, random forest, MARS, and support-vector machine were the highest-performing statistical-learning strategies in 3, 3, 3, 2, and 1 endpoints, respectively. Logistic regression, MARS, elastic-net, random forest, neural network, and support-vector machine were the best, or were not significantly worse than the best, in 7, 7, 5, 5, 3, and 1 endpoints. The best-performing statistical model was for dysuria grade ≥ 1 with AUROC ± standard deviation of 0.649 ± 0.074 using MARS. For longitudinal frequency and dysuria grade ≥ 1, all strategies produced AUROC>0.6 while all haematuria endpoints and longitudinal incontinence models produced AUROC<0.6. Conclusions

Urinary schistosomiasis among preschool-age children in an endemic area of Kinondoni municipality, Dar es Salaam, Tanzania 2016

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Samwel Bushukatale Ng`weng`weta

2017-03-01

Full Text Available Objective: To examine the magnitude of Schistosoma haematobium (S. haematobium infection and the factors associated with exposure of preschool children in Kigogo Ward, Kinondoni District, Dar es Salaam. Methods: A quantitative cross-sectional survey of Class I pupils (preschool-age in 2015 was carried out from May to June 2016 to examine the prevalence and intensity of S. haematobium infection and associated factors. Urine samples were examined for haematuria, S. haematobium eggs and intensity. Parents or guardians were interviewed on their awareness and level of knowledge on urinary schistosomiasis disease (symptoms, mode of transmission, treatment and prevention, as well as their perceived risk of infection to young children. Potential sites of transmission were identified and searched for Bulinus spp., snails and the activities that exposed young children to infection were recorded. Results: A total of 424 pupils and 408 female parents or guardians were recruited. Haematuria was detected in 51 (12.0% pupils, S. haematobium eggs were observed in 8 (1.9% pupils and all were light infection. Bulinus spp., snails were identified mostly at cross-points of rivers. The large majority (91.7% of parents or guardians were aware of urinary schistosomiasis disease, but three quarter (76% did not consider it as a health problem. More than two thirds (71.3% reported that anybody could get urinary schistosomiasis; two thirds (65.9% reported that infection was likely to be acquired at cross-points of rivers. The large majority (> 90% had the notion that young children could be exposed; and all the activities that might lead a child to come into contact with potentially infested waters were judged to be risk factors. The larger majority (83.6% had a high level of knowledge on urinary schistosomiasis (transmission, symptoms, availability of modern treatment and the preventive measures, reflecting the ongoing advocacy campaigns. Conclusions: Young children left

Suprapubic micturition cystourethrography

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Mohammed, S.H.

Suprapubic micturition cystourethrography is performed by puncturing the bladder aseptically, in the midline, 1 to 2 cm above the symphysis pubis with an 18 to 21 gauge needle. The needle is pointed 10 to 15/sup 0/ cranially to avoid puncture of the trigonum and urethra. Anaesthesia, antibiotic protection, and diuretics are not necessary. In 225 examinations performed on 200 patients, the only complications noted were transient haematuria (1.5%) and slight extravasation of contrast medium through the puncture sites (8%). None required any therapeutic measures. In 4 patients puncturing of the bladder needed ultrasound guidance. The technique is ideal for the study of vesicoureteral reflux, neurogenic bladder, urethral strictures, posterior urethral valves and other urethral pathology. It is also useful in balloon catheter dilatation of urethral strictures. Suprapubic micturition cystourethrography is safe, efficient and time-saving. It is well accepted by the patients and carries little risk of urinary infection.

Mycoplasma canis and urogenital disease in dogs in Norway

DEFF Research Database (Denmark)

L'Abee-Lund, T.M.; Heiene, R.; Friis, N.F.

2003-01-01

Mycoplasmas identified as Mycoplasma canis were isolated from nine dogs with clinical signs of urogenital disease in Norway over a period of 20 months. Some of the dogs had been treated unsuccessfully with antibiotics, and three were euthanased as a result of severe persistent disease. Seven...... of the dogs had a urinary tract infection, one had chronic purulent epididymitis and one had chronic prostatitis. Overt haematuria was frequently observed among the dogs with cystitis. M canis was isolated in pure culture from seven of the dogs and in mixed culture from the other two. In three cases...... the mycoplasma was cultivated only from urinary sediment, and it was typically obtained in smaller numbers than would be considered indicative of a urinary tract infection. In contrast with most mycoplasmas, the M canis isolated from all the dogs grew on ordinary blood agar plates used for routine...

Management of the complications of BPH/BOO

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Mark J Speakman

2014-01-01

Full Text Available Most men will develop histological BPH if they live long enough. Approximately, half will develop benign prostatic enlargement (BPE and about half of these will get BOO with high bladder pressures and low flow, this in turn leads to detrusor wall hypertrophy. Many of these men will only have lower urinary tract symptoms (LUTS but a significant number will also suffer the other complications of BPH. These include urinary retention (acute and chronic, haematuria, urinary tract infection, bladder stones, bladder wall damage, renal dysfunction, incontinence and erectile dysfunction. Recognition of the complications of BPH/BOO early allows more effective management of these complications. This is particularly important for the more serious urinary infections and also for high-pressure chronic retention (HPCR. Complications of LUTS/BPH are very rare in clinical trials because of their strict inclusion and exclusion criteria but are more common in real life practice.

Management of the complications of BPH/BOO.

Science.gov (United States)

Speakman, Mark J; Cheng, Xi

2014-04-01

Most men will develop histological BPH if they live long enough. Approximately, half will develop benign prostatic enlargement (BPE) and about half of these will get BOO with high bladder pressures and low flow, this in turn leads to detrusor wall hypertrophy. Many of these men will only have lower urinary tract symptoms (LUTS) but a significant number will also suffer the other complications of BPH. These include urinary retention (acute and chronic), haematuria, urinary tract infection, bladder stones, bladder wall damage, renal dysfunction, incontinence and erectile dysfunction. Recognition of the complications of BPH/BOO early allows more effective management of these complications. This is particularly important for the more serious urinary infections and also for high-pressure chronic retention (HPCR). Complications of LUTS/BPH are very rare in clinical trials because of their strict inclusion and exclusion criteria but are more common in real life practice.

Suprapubic micturition cystourethrography

International Nuclear Information System (INIS)

Mohammed, S.H.; Kamuzu Central Hospital, Lilongwe

1988-01-01

Suprapubic micturition cystourethrography is performed by puncturing the bladder aseptically, in the midline, 1 to 2 cm above the symphysis pubis with an 18 to 21 gauge needle. The needle is pointed 10 to 15 0 cranially to avoid puncture of the trigonum and urethra. Anaesthesia, antibiotic protection, and diuretics are not necessary. In 225 examinations performed on 200 patients, the only complications noted were transient haematuria (1.5%) and slight extravasation of contrast medium through the puncture sites (8%). None required any therapeutic measures. In 4 patients puncturing of the bladder needed ultrasound guidance. The technique is ideal for the study of vesicoureteral reflux, neurogenic bladder, urethral strictures, posterior urethral valves and other urethral pathology. It is also useful in balloon catheter dilatation of urethral strictures. Suprapubic micturition cystourethrography is safe, efficient and time-saving. It is well accepted by the patients and carries little risk of urinary infection. (orig.)

Hypertension and Biliary Ductopenia in a Patient with Duplication of Exon 6 of the Gene

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J. Uberos

2012-01-01

Full Text Available We describe a neonatal patient with biliary ductopenia featuring duplication of exon 6 of the JAG1 gene. Facial alterations were observed, consisting of a prominent forehead, sunken eyes, upward slanting palpebral fissures, hypertelorism, flat nasal root and prominent chin. From birth, these were accompanied by the development of haematuria and renal failure and by renal Doppler findings indicative of peripheral renal artery stenosis. JAG1 gene mutations on chromosome 20 have been associated with various anomalies, including biliary cholestasis, vertebral abnormalities, eye disorders, heart defects and facial dysmorphia. This syndrome, first described by Alagille, is an infrequent congenital disorder caused by a dominant autosomal inheritance with variable expressivity. Anatomopathological effects include the destruction and disappearance of hepatic bile ducts (ductopenia. The duplication of exon 6 of JAG1 has not previously been described as an alteration related to the Alagille syndrome with peripheral renal artery stenosis.

Ileal polypoid lymphangiectasia bleeding diagnosed and treated by double balloon enteroscopy.

Science.gov (United States)

Park, Min Seon; Lee, Beom Jae; Gu, Dae Hoe; Pyo, Jeung-Hui; Kim, Kyeong Jin; Lee, Yun Ho; Joo, Moon Kyung; Park, Jong-Jae; Kim, Jae Seon; Bak, Young-Tae

2013-12-07

Intestinal lymphangiectasia is a rare disease characterized by focal or diffuse dilated enteric lymphatics with impaired lymph drainage. It causes protein-losing enteropathy and may lead to gastrointestinal bleeding. Commonly, lymphangiectasia presents as whitish spots or specks. To our knowledge, small bowel bleeding resulting from polypoid intestinal lymphangiectasia has not been reported. Here, we report a rare case of active bleeding from the small bowel caused by polypoid lymphangiectasia with a review of the relevant literature. An 80-year-old woman was hospitalized for melena. Esophagogastroduodenoscopy could not identify the source of bleeding. Subsequent colonoscopy showed fresh bloody material gushing from the small bowel. An abdominal-pelvic contrast-enhanced computed tomography scan did not reveal any abnormal findings. Video capsule endoscopy showed evidence of active and recent bleeding in the ileum. To localize the bleeding site, we performed double balloon enteroscopy by the anal approach. A small, bleeding, polypoid lesion was found in the distal ileum and was successfully removed using endoscopic snare electrocautery. © 2013 Baishideng Publishing Group Co., Limited. All rights reserved.

UPPER GASTRO-INTESTINAL BLEEDING IN THE YOUNG - GASTRIC GIST TUMOR OR PEPTIC ULCER DISEASE?

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Ayodele Atolagbe

2015-09-01

Full Text Available GIST tumors is very unusual in the young and middle aged and a high index of suspicion is needed for the diagnosis in young patients who present with upper gastrointestinal bleeding. Appropriate imaging such as a Computed tomographic scan (CT scan may identify this tumor which may easily be misdiagnosed as a bleeding Peptic Ulcer Disease in the young. We present a case of a healthy 38 year old man with no alcohol use who presented with epigastric pain and melena and subsequent torrential bleeding uncontrolled during endoscopy necessitating an emergency exploratory laparotomy by the general surgery team. The bleeding intraluminal component of the tumor with gross splenic and pancreatic involvement was identified and surgical management consisted of a wedge resection of the greater curvature of the stomach incorporating the tumor and the spleen with successful dissection of the tumor off the tail of the pancreas. Histology was positive for C-KIT and DOG-1 markers. Postoperative course was uneventful and he is presently on Imatinib Mesylate.

PATHOGENESIS OF HEMORRHAGIC DUE TO DENGUE VIRUS

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Arief Suseno

2015-01-01

Full Text Available Dengue is a viral disease that is mediated by a mosquito, which causes morbidity and mortality. Viruses can increase vascular permeability which can lead to hemorrhagic diathesis or disseminated intravascular coagulation (DIC known as dengue hemorrhagic fever (DHF. In Indonesia, dengue hemorrhagic fever (DHF are caused by dengue virus infection which was found to be endemic accompanied by an explosion of extraordinary events that appear at various specified period. The diagnosis of dengue is determined based on the criteria of the World Health Organization (WHO, 1999, which are sudden high fever accompanied by a marked tendency to hemorrhage positive tourniquet test, petechiae, ecchymosis, purpura, mucosal hemorrhagic, hematemesis or melena and thrombocytopenia. The problem that still exists today is the mechanism of thrombocytopenia in patients with varying degrees of dengue involving levels of vWF (von Willebrand factor and prostaglandin I2 (PGI2 can not be explained. The mechanism of hemorrhagic in dengue virus infections acquired as a result of thrombocytopenia, platelet disfunction decreased coagulation factors, vasculopathy with endothelial injury and disseminated intravascular coagulation (DIC.

Occurrence of acute febrile dermatitis at the site of chronic radiodermatitis of 25 years duration

International Nuclear Information System (INIS)

Aoshima, Toshiyuki; Furukawa, Ikuko; Furukawa, Hiroo

1994-01-01

The patient was a 72-year-old female who underwent radiation therapy following surgical treatment for an ovarian tumor in 1963. Radiation therapy resulted in chronic radiodermatitis which has persisted since then. Twenty-five years after radiation therapy, painful indurative erythema appeared on her leoins (the site of irradiation) accompanied by fever. Histologically, acanthosis, edema and capillary dilatation in the upper dermis, amorphous collagen fibers and scarcity of vasculature in the deep dermis were observed. We found no mitosis but did observe swollen keratinocytes in the epidermal layer. The patient did not respond to antibiotics; however, the administration of oral steroids gradually alleviated the fever and local symptoms. Steroids could not be completely discontinued; she was given low-dose steroids for maintenance of remission. We speculated that the acute inflammatory reaction which was superimposed on the patient's chronic radiodermatitis constituted the earliest signs of malignant transformation. Intermittent bloody stools due to radiation colitis had been present since 3 years before, but after administration of steroids, melena was no longer seen. (author)

Occurrence of acute febrile dermatitis at the site of chronic radiodermatitis of 25 years duration

Energy Technology Data Exchange (ETDEWEB)

Aoshima, Toshiyuki; Furukawa, Ikuko; Furukawa, Hiroo (Otsu Red Cross Hospital, Shiga (Japan))

1994-02-01

The patient was a 72-year-old female who underwent radiation therapy following surgical treatment for an ovarian tumor in 1963. Radiation therapy resulted in chronic radiodermatitis which has persisted since then. Twenty-five years after radiation therapy, painful indurative erythema appeared on her leoins (the site of irradiation) accompanied by fever. Histologically, acanthosis, edema and capillary dilatation in the upper dermis, amorphous collagen fibers and scarcity of vasculature in the deep dermis were observed. We found no mitosis but did observe swollen keratinocytes in the epidermal layer. The patient did not respond to antibiotics; however, the administration of oral steroids gradually alleviated the fever and local symptoms. Steroids could not be completely discontinued; she was given low-dose steroids for maintenance of remission. We speculated that the acute inflammatory reaction which was superimposed on the patient's chronic radiodermatitis constituted the earliest signs of malignant transformation. Intermittent bloody stools due to radiation colitis had been present since 3 years before, but after administration of steroids, melena was no longer seen. (author).

May 2016 critical care case of the month

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Al-Jashaami L

2016-05-01

Full Text Available No abstract available. Article truncated after first 150 words. History of Present Illness: A 50-year-old African American woman presented with weakness, altered mental status and constipation of 12 days duration. She was complaining of abdominal distension with diffuse pain and bloating. She denied melena, hematochezia or hematemesis. She had a history weight loss, anorexia and fatigue which had evolved over the past few months leading to recent severe weakness and inability to get out of bed. Past Medical History, Social History and Family History: Her past medical history included HIV infection with AIDS and noncompliance with her antiretroviral medications. Her most recent CD4 count was <20 cells/uL and viral load of 554,483 copies/mL. Physical Examination: Vital signs: Blood pressure, 120/80 mmHg, heart rate, 105/min, temperature, 98.6° and respiratory rate, 20/min. General: Physical examination showed a lethargic female who was poorly responsive to questioning. Abdomen: Distended, tympanic abdomen with hypoactive bowel sounds and diffuse tenderness. Radiography: Plain x-ray examination of ...

Two cases of colorectal cancer complicating radiation enterocolitis

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Honma, Kaneatsu; Muto, Yoshihiro; Kusano, Toshiomi; Tokumine, Akio; Okushima, Norihiko; Tamashiro, Tetsuo

1993-01-01

A 74-year-old woman presented with bowel movement disorder. She had received radiation therapy with 60 Gy for uterine cervical cancer approximately 20 years before. Barium enema and colonofiberscopy revealed radiation enterocolitis. Thereafter, the patient was admitted to the hospital due to stricture of the sigmoid colon and an increased CEA and was diagnosed as having Borrmann II type colorectal well differentiated adenocarcinoma. Histological examination revealed stage I with no associated lymph node metastases. She is alive 3 years and 10 month after surgery. The other patient was a 65 year-old woman with a history of cervical cancer. Twenty-one years after combined hysterectomy and postoperative external irradiation of 45 Gy, the patient presented with melena. Detailed examination revealed colorectal adenocarcinoma. Simultaneously, barium enema revealed radiation enterocolitis. At surgery, intrapelvic area was found to be frozen due to irradiation. She has no evidence of metastasis 2 years after surgery. As can be shown in the two patients, patients developing radiation enterocolitis should be followed up periodically for the early detection of coexistent colorectal cancer. (N.K.)

A Retrospective Analysis of Cyanoacrylate Injection versus Hemoclip Placement for Bleeding Dieulafoy’s Lesion in Duodenum

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Yu Jiang

2018-01-01

Full Text Available Background. Duodenal Dieulafoy’s lesion (DL is a rare disease that may lead to lethal hemorrhage in the upper gastrointestinal tract. The best technique for endoscopic intervention still remains unclear. In the present study, we performed a retrospective analysis of cyanoacrylate injection versus hemoclip placement for treating bleeding DLs. Materials and Methods. We retrospectively analyzed eighteen patients from three medical centers between October 2008 and February 2016; six patients received cyanoacrylate injection, while hemoclips were placed in 12 patients during the upper gastrointestinal endoscopy. Results. All patients received first endoscopic examination and/or endotherapy within 12 hours of admission to hospital. No difference was observed in the primary hemostasis rate or the recurrent hemorrhage rate between the cyanoacrylate injection (CI group and the hemoclip placement (HP group, except that in one patient from the HP group melena was found three days after the first endotherapy. This patient received cyanoacrylate injection once again. Conclusion. Both cyanoacrylate injection and hemoclip placement are effective in treating duodenal DL, and neither of them causes significant side effects.

Transrectal ultrasound-guided biopsy of the prostate: aspirin increases the incidence of minor bleeding complications

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Halliwell, O.T.; Yadegafar, G.; Lane, C.; Dewbury, K.C.

2008-01-01

Aim: To assess whether patients taking aspirin were more likely to experience bleeding complications after transrectal ultrasound (TRUS)-guided prostate biopsy. Materials and methods: Three hundred and eighty-seven patients taking aspirin who underwent prostate biopsy over a 3.5 year period and 731 patients not taking aspirin over a 2 year period returned a questionnaire assessing the incidence and severity of bleeding complications. Results: Patients taking aspirin had a significantly higher cumulative incidence of haematuria and rectal bleeding, but not of haemospermia. They also had a longer mean duration of bleeding, but no increase in bleeding severity. Severe bleeding was very uncommon in both groups and no patients required intervention for bleeding complications. Conclusion: Aspirin exacerbates minor bleeding complications in patients undergoing TRUS guided biopsy of the prostate, but in this large group of aspirin-taking patients no dangerous bleeding complications were encountered. It may be that the risks associated with aspirin cessation outweigh the risks of haemorrhagic complications

Primary Intramural Vesical Endometriosis Mimicking Urothelial Carcinoma in a Middle Aged Female

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Shirazi N

2015-10-01

Full Text Available Endometriosis is the presence of ectopic endometrial tissue outside the uterus. Presence of endometrial glands and/or stroma may interfere with the normal physiological process by their infiltrative nature or by forming adhesions. Endometriosis occurs in 15-20% of women of child bearing age and commonly involves the ovaries, utero-sacral ligaments, fallopian tubes, rectum, scar sites and cervico-vaginal regions. Incidence of urinary tract involvement is estimated to be 1%. We report a case of a 38 year female presenting with low back pain, single episode of haematuria and burning during micturition. Urine culture was negative. There was no past history of pelvic surgery. On cystoscopy, a growth was visualised in the posterior urinary bladder wall suspicious of neoplastic origin. Tansurethral resection of bladder nodule was done and sent for histopathology, on which it was diagnosed as endometriosis. The case merits interest due to its atypical clinical presentation and the rarity of the lesion at this site.

Benign prostatic hyperplasia and male lower urinary symptoms: A guide for family physicians

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Farhad Fakhrudin Vasanwala

2017-07-01

Full Text Available Male patients with lower urinary tract symptoms (LUTS and benign prostatic hyperplasia (BPH are increasingly seen by family physicians worldwide due to ageing demographics. A systematic way to stratify patients who can be managed in the community and those who need to be referred to the urologist is thus very useful. Good history taking, physical examination, targeted blood or urine tests, and knowing the red flags for referral are the mainstay of stratifying these patients. Case selection is always key in clinical practice and in the setting of the family physician. The best patient to manage is one above 40 years of age, symptomatic with nocturia, slower stream and sensation of incomplete voiding, has a normal prostate-specific antigen level, no palpable bladder, and no haematuria or pyuria on the labstix. The roles of α blockers, 5-α reductase inhibitors, and antibiotics in a primary care setting to manage this condition are also discussed.

Rapid diagnosis of schistosomiasis in Yemen using a simple questionnaire and urine reagent strips.

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Bassiouny, H K; Hasab, A A; El-Nimr, N A; Al-Shibani, L A; Al-Waleedi, A A

2014-05-01

Schistosomiasis ranks second to malaria in terms of socioeconomic and public health importance in Yemen. This study assessed the validity of a morbidity questionnaire and urine reagent strips as a rapid tool for screening schoolchildren for urinary schistosomiasis as compared with the presence of eggs in urine as the gold-standard parasitological diagnosis. The study examined urine samples and interviewed 696 children (mean age 12.5 years) attending a primary-preparatory school in south Yemen. Urinary schistosomiasis was confirmed in 126 (18.1%) children. Diagnostic performance was poor for 2 items in the morbidity questionnaire (self-reported history of previous infection and self-reported history of antischistosomal treatment). However, self-reported dysuria, self-reported haematuria in the questionnaire and microhaematuria by reagent strips (alone or with macrohaematuria) revealed good diagnostic performance. The results indicated that reagent strips are a valid method for detection of microhaematuria for identifying individuals and communities infected with Schistosoma haematobium.

Transrectal ultrasound-guided biopsy of the prostate: aspirin increases the incidence of minor bleeding complications

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Halliwell, O.T. [Department of Radiology, Southampton General Hospital, Southampton (United Kingdom)], E-mail: hallo99@doctors.org.uk; Yadegafar, G. [Public Health Sciences and Medical Statistics Division, School of Medicine, Southampton General Hospital, Southampton University, Southampton (United Kingdom); Lane, C.; Dewbury, K.C. [Department of Radiology, Southampton General Hospital, Southampton (United Kingdom)

2008-05-15

Aim: To assess whether patients taking aspirin were more likely to experience bleeding complications after transrectal ultrasound (TRUS)-guided prostate biopsy. Materials and methods: Three hundred and eighty-seven patients taking aspirin who underwent prostate biopsy over a 3.5 year period and 731 patients not taking aspirin over a 2 year period returned a questionnaire assessing the incidence and severity of bleeding complications. Results: Patients taking aspirin had a significantly higher cumulative incidence of haematuria and rectal bleeding, but not of haemospermia. They also had a longer mean duration of bleeding, but no increase in bleeding severity. Severe bleeding was very uncommon in both groups and no patients required intervention for bleeding complications. Conclusion: Aspirin exacerbates minor bleeding complications in patients undergoing TRUS guided biopsy of the prostate, but in this large group of aspirin-taking patients no dangerous bleeding complications were encountered. It may be that the risks associated with aspirin cessation outweigh the risks of haemorrhagic complications.

Nutcracker syndrome

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Jolley, Ingrid

2014-01-01

Purpose: The purpose of this case study is to highlight the symptoms of the Nutcracker Syndrome (NCS), the methods of clinical investigations and the importance of differential diagnosis. Introduction: The NCS refers to left renal vein entrapment caused by abnormal branching patterns of the superior mesenteric artery from the aorta. 1,2 Clinical case presentation: A 27 years old female presented to the emergency department with complaints of abdominal discomfort, bloating, loose bowel motions and irregular micro-haematuria. The radiologist's report indicated the findings from computed tomography examination to be consistent with anterior NCS. Discussion: In most of the NCS cases the clinical symptoms are non-specific. 3 The syndrome is caused by a vascular disorder, but its clinical manifestation can relate to a wide range of abdominal, urological, endovascular or gynaecological pathologies. 4 Conclusion: Nutcracker Syndrome is a relatively rare disease and underdiagnosed may lead to left renal vein thrombosis

Duodenal angiodysplasia: case report and literature review Angiodisplasia duodenal: relato de caso e revisão da literatura

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Roberto Pelegrini Coral

2007-06-01

Full Text Available BACKGROUND: Angiodysplasia is a distinct mucosal vascular lesion associated with acute or chronic gastrointestinal bleeding. It occurs most frequently in the right colon and is extremely rare. Its etiology is unknown, but theories of its pathogenesis have evolved from its similarity to colonic angiodysplasia and the lesion appears to be associated with renal insufficiency. CASE REPORT: Sixty-five-year-old woman with repeated melena and severe anemia due to angiodysplasia in the first portion of the duodenum. The diagnosis was done by upper endoscopy. As the patient presented repeated gastrointestinal bleeding with hemodynamic instability and recurrent anemia, surgery was indicated. At laparotomy the lesion was identified and resected with an Y-en-Roux reconstruction. The patient went on well at the immediate and late (four years postoperative periods with no more recurrent gastrointestinal bleeding. CONCLUSION: Although most of the patients suffering from gastrointestinal angiodysplasia goes on well with conservative management, there is a small portion of them that will need a more aggressive approach, as in this case.RACIONAL: Angiodisplasia duodenal é uma lesão vascular distinta da mucosa intestinal associada com sangramento agudo ou crônico. Embora seja extremamente rara no duodeno, ocorre com maior freqüência no cólon direito. Tem etiologia desconhecida, mas sua patogênese parece semelhante com a do cólon. Em alguns casos está associada à insuficiência renal. RELATO DO CASO: Paciente de 65 anos de idade com episódios repetidos de melena e anemia severa devido à presença de lesão angiodisplásica na primeira porção do duodeno, cujo diagnóstico fôra estabelecido por endoscopia digestiva alta. Como ela apresentara-se com episódios repetidos de hemorragia digestiva alta acompanhados de instabilidade hemodinâmica, foi-lhe indicada cirurgia. À laparotomia, identificou-se a lesão, que foi ressecada, sendo realizada reconstru

Comparison of four different preparation protocols to achieve bladder distension in patients with gross haematuria undergoing a CT urography

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Helenius, Malin; Segelsjo, Monica; Dahlman, Par; Magnusson, Anders

2012-01-01

Introduction: CT examination has been shown to be effective in detecting bladder cancer. Proper evaluation of the bladder requires it to be well distended. The purpose of the present study was to establish a preparation protocol to achieve satisfactory bladder distension without causing unacceptable patient discomfort. Material and method: We used four different preparation protocols (1: 0.5 L of fluid intake during a 1-h period, 2: Same as 1 with the addition of IV diuretics when the patient was examined, 3: 1 L of fluid intake during a 2-h period, 4: Same as 3 with the additional instruction to empty the bladder after 1 h. In protocols 1–3, the patients were asked not to empty their bladder during the preparation time). Bladder volume was calculated and bladder distension was judged as satisfactory or not by the radiologist. The patients answered questions about their ability to follow the preparation protocol and were requested to rate their need to empty the bladder pre-, during and post-examination. Results: Protocol 1 had the lowest bladder volume. Protocols 2, 3 and 4 were similar in bladder volume. However, Protocol 2 caused unacceptable patient discomfort, and the compliance was lowest in Protocol 4. Conclusion: Protocol 3, drinking 1 L of fluid during a 2-h period, gave satisfactory bladder distension, did not cause unacceptable discomfort in patients and did not have the lowest compliance.

Prevalence and factors associated with urogenital schistosomiasis among primary school children in barrage, Magba sub-division of Cameroon

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Anna Longdoh Njunda

2017-07-01

Full Text Available Abstract Background The purpose of this study was to determine the prevalence and intensity as well as the factors associated with urogenital schistosomiasis (US in Barrage, a rural community around the Mape΄ dam, in the West region of Cameroon not previously documented for transmission. Methods In this cross sectional parasitological survey, 382 children were enrolled from three primary schools in the study area between March and May 2016. A semi-structured questionnaire was used to collect information on demographics, clinical and predisposing factors. The syringe filtration technique was used to analyse urine samples. Samples with visible or gross haematuria were recorded prior to filtration. The Pearson chi-square, the student T-test and logistic regression were all performed as part of the statistical analyses. Results The overall prevalence of US was 41.1% (95% CI: 36.1–46.2. Infection was more common in children below 10 years (p = 0.009, in males (p = 0.029, and in children who frequently come into contact with water from the dam (p < 0.001. Furthermore, US was more common in children attending Ecole Public (EP Manbonko Bord (81.1%, p < 0.001 which is very close to the dam and in children from a fishing background (80.9%, p < 0.001. On the contrary, knowledge about schistosomiasis was not observed to be associated with prevalence. In this study, the intensity of infection was observed to be higher in children below 10 years (p < 0.001, in males (p = 0.001, and in children attending EP Manbonko Bord (p < 0.001. The intensity of infection was also highest in children presenting with haematuria (p < 0.001. Frequent contact with water from the dam and having parents whose occupation was fishing were identified as the associated factors for US. Conclusion A high prevalence of US was observed in school-aged children in the study area especially in those attending EP Manbonko Bord. Limiting contact with water from the dam

Development and Improvement of Simple Colonic Mucosal Ulcer during Treatment of Severe Ulcerative Colitis with Tacrolimus

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Ayumi Ito

2017-03-01

Full Text Available Diarrhea, melena, and lower abdominal pain developed in a male in his 20s and colonoscopy showed pancolitis-type severe ulcerative colitis (UC. Treatment was initiated with 4,000 mg of 5-aminosalicylic acid and 60 mg/day of prednisolone, but the symptoms and inflammatory reaction worsened with prednisolone dose reduction. Tacrolimus was added to the treatment, which subsequently induced remission. Serial colonoscopies during the treatment showed improvement in ulcer and mucosal edema throughout the entire large intestine, but a new solitary round ulcer appeared at the end of the ileum. Since no signs of Behçet’s disease were noted, it was considered as a simple ulcer, a complication of UC. Tacrolimus treatment was continued based on continued improvement in clinical features and colonic mucosa, excluding the end of the ileum. Colonoscopy at 6 months after initiation of tacrolimus showed healing of the large intestinal mucosa, although mild congestion was still noted. The solitary round ulcer at the end of the ileum improved to a small erosion. We report the improvement of a simple ulcer that developed during tacrolimus treatment.

Actions aimed at reducing the vulnerability of a mangrove sector south of the province of Artemisa, Cuba

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Jorge Luis López Pérez

2018-05-01

Full Text Available For the geographical location of the area under study, Playa Cajío, Güira de Melena municipality, Artemisa province; The mangroves have suffered serious alterations, mainly due to global climate changes, especially sea level rise, hurricanes and storms, which have caused severe sea penetrations, as well as prolonged droughts. The present investigation had as starting point four fundamental studies carried out, as main antecedents, following as a general objective, proposing actions aimed at the restoration of the mangrove of the "El Cajío" sector, based on an integral program (water rehabilitation project, reforestation, monitoring and control, vulnerability. To do this, theoretical methods of documentary research were used, as well as in situ diagnosis, as the first descriptive stage that demonstrated the state of deterioration of the forest, in a second stage or integral management, the water rehabilitation and mitigation projects were elaborated. sources that affect the good development of the mangrove, reforestation and monitoring and control, all with community participation and involved organisms, culminating with the reforestation and the success of it. In addition, vulnerability studies were carried out in the area, which places it in a medium to high position.

Esophageal Squamous Cell Carcinoma Presenting with Streptococcus intermedius Cerebral Abscess

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Rabih Nayfe

2017-01-01

Full Text Available Background. Cerebral abscess is caused by inoculation of an organism into the brain parenchyma from a site distant from the central nervous system. Streptococcus intermedius (S. intermedius is a commensal organism that is normally present in the aerodigestive tract and was reported to be the cause of brain abscesses after esophageal dilatation or upper endoscopy. Case Presentation. We report the case of a 53-year-old female who presented with hematemesis and melena followed by left-sided weakness. Initially, her hemiplegia was found to be secondary to a right thalamic brain abscess caused by S. intermedius. Investigations led to the diagnosis of a mid-esophageal squamous cell carcinoma. We hypothesize that the cause of the abscess with this bacterium that naturally resides in the digestive tract and oral cavity is secondary to hematogenous spread from breach in the mucosal integrity from ulceration due to the cancer. Conclusion. To our knowledge, our case is the first in the literature to describe a brain abscess caused by S. intermedius in association with a previously undiagnosed esophageal squamous cell carcinoma without any prior esophageal intervention.

Esofagitis necrotizante aguda: Una entidad inusual

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Silvana E. Pramparo

2010-12-01

Full Text Available La esofagitis necrotizante aguda (ENA, también denominada esófago negro, es una rara enfermedad poco descripta en la literatura médica. Describimos el caso de un hombre de 80 años, con hemorragia digestiva alta quien desarrolló un esófago negro luego de un episodio de hipotensión. La necrosis fue confirmada histológicamente. Los pacientes se presentan con hematemesis y melena en más del 70% de los casos. Los hallazgos endoscópicos muestran una coloración negruzca de la mucosa esofágica. El diagnóstico se realiza con endoscopia y confirmación histológica. La mortalidad es alta (más del 50% aunque relacionada a las enfermedades de base del paciente. Por último, podemos decir que la sospecha es muy importante en el diagnóstico de ENA, particularmente en pacientes ancianos con enfermedades asociadas y evidencia de hemorragia digestiva alta. En este trabajo describimos las características clínicas, endoscópicas e histopatológicas de un paciente con ENA.

A Patient with Microcytic Anemia and Fever

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Sacha Bhatia

2006-01-01

Full Text Available A 62-year-old man with a history of mechanical aortic valve insertion and ascending aorta replacement in 1997 presented to his family doctor in August 2004 with a two-week history of melena after recently returning from a six-month vacation in Mexico. The patient had no other abdominal complaints. He took warfarin but did not take nonsteroidal anti-inflammatory agents, acetylsalicylic acid or alcohol. The patient had no history of liver or peptic ulcer disease. He had lost 7 kg over the past month, but did not complain of fever or night sweats. On physical examination, vital signs were normal, the second heart sound was mechanical, and there were no abnormal findings. Laboratory investigations showed a borderline microcytic anemia (hemoglobin 76 g/L; mean corpuscular volume 79 fL; mean corpuscular hemoglobin concentration 323 g/L, a therapeutic international normalized ratio (2.6 and an elevated creatinine level (112 µmol/L. His stool was positive for occult blood, although the ferritin level was high (623 µg/L. Other routine blood work was normal. The patient was admitted to hospital for investigation of the anemia.

Bleeding ectopic duodenal varix: use of a new microvascular plug (MVP) device along with transjugular intrahepatic portosystemic shunt (TIPSS).

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Bhardwaj, Richa; Bhardwaj, Gaurav; Bee, Erik; Karagozian, Raffi

2017-08-16

Ectopic varices (ECV) occur along the gastrointestinal (GI) tract outside the common variceal sites and represent 2%-5% of all GI variceal bleeds with mortality rates up to 40%. Management is challenging because of inaccessibility and increased risk of rebleeding. We report what is to our knowledge the first clinical use of a new microvascular plug (MVP) with transjugular intrahepatic portosystemic shunt (TIPSS) for a bleeding duodenal varix (DV). A 68-year-old man presented with melena. Endoscopy demonstrated a grade II varix in the second part of the duodenum with red wale sign. TIPSS was performed and portogram revealed a single DV. Poststent placement venogram revealed a persistent varix and hence a 5-7 mm MVP was deployed. Subsequent imaging showed cessation of blood through the DV. The patient had no further bleeding. TIPSS with embolisation is an effective treatment for ECV. This MVP offers advantages due to its size and compatibility and can be redeployed in case of suboptimal placement. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A rare case of iron-pill induced gastritis in a female teenager: A case report and a review of the literature.

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Meliţ, Lorena Elena; Mărginean, Cristina Oana; Mocanu, Simona; Mărginean, Maria Oana

2017-07-01

The treatment of iron-deficiency anemia with oral iron supplements can present side-effects on the GI tract mucosa including necrosis, ulceration, or ischemia. The particular endoscopic findings and the histopathological exam will establish the diagnosis of erosive gastritis with iron deposits in the gastric mucosa. We present the case of a 14-year-old female admitted in our clinic for upper digestive hemorrhage, nausea, melena, and abdominal pain. Her personal history revealed iron deficiency anemia receiving oral iron supplements for approximately 2 weeks. The laboratory tests at the moment of admission pointed out anemia, increased level of serum iron, increased liver transaminases, a decreased level of ferritin, but with normal levels of both total iron-binding capacity and transferrin. The eso-gastro-duodenoscopy revealed multiple brown deposits on the surface of the gastric mucosa and multiple hemorrhagic lesions, under the aspect of erosions all over the gastric mucosa, but more severe in the antral part, and the histopathological exam confirmed the presence of iron deposits at this level. Iron-pill induced gastritis is a rare, under-diagnosed entity that can be present even at pediatric ages with potential severe clinical impact.

Adenocarcinoma at Anastomotic Site of Ureterosigmoidostomy Potentially of Urothelial Origin Spreading to the Upper Urinary Tract

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Katsuhiro Makino

2015-01-01

Full Text Available Ureterosigmoidostomy is associated with the risk of several late complications including cancer development at anastomotic sites. We present an unusual case with adenocarcinoma of the anastomotic site associated with multiple adenocarcinoma lesions in the upper urinary tract. A 69-year-old man complained of persistent melena and hematuria. He had undergone radical cystectomy for high-grade bladder cancer and ureterosigmoidostomy 30 years before. Colonoscopy showed a tumor at the right ureterocolonic anastomosis, which was endoscopically resected and histologically diagnosed as adenocarcinoma. Seven years later, a tumor of the left ureterocolonic anastomosis associated with hydronephrosis was found. He underwent temporal percutaneous nephrostomy followed by sigmoidectomy and left ureterocutaneostomy. Eighteen months after the operation, computed tomography (CT detected left renal pelvic tumor with a mass along the former nephrostomy tract. Left nephroureterectomy and resection of the nephrostomy tract tumor revealed adenocarcinoma with multiple lesions of adenocarcinoma in the ureter. These tumors showed atypical immunohistochemistry as a colonic adenocarcinoma: positive for cytokeratin 7, negative for cytokeratin 20, and negative for β-catenin nuclear accumulation. Anastomotic site adenocarcinoma of the present case is potentially of urothelial origin because of unusual clinical manifestation and immunohistochemistry as a colon cancer.

Intussusception of the small intestine caused by a primary melanoma?

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Schoneveld, M; De Vogelaere, K; Van De Winkel, N; Hoorens, A; Delvaux, G

2012-01-01

Although the gastrointestinal tract is a fairly frequent site of melanoma metastases, reports of small bowel intussusception caused by melanoma are very rare. We report the case of a 77-year-old man who was admitted to our hospital with epigastric pain, melena and anaemia. After clinical examination, laboratory evaluation and radiological work-up the diagnosis of a jejunal intussusception was made. Exploratory laparoscopy revealed a large tumour arising from the jejunum, approximately 20 cm distal to the angle of Treitz. Small bowel resection with an end-to-end anastomosis was performed. Histological examination showed an intestinal melanoma. There are different theories concerning the origin of malignant melanoma in the small bowel. Although the small and large intestines normally contain no melanocytes, these cells have occasionally been found in the alimentary and respiratory tracts and even in lymph nodes, which supports the theory of a primary origin of melanoma at these sites. Since this was a solitary intestinal lesion and there was no history of cutaneous melanoma, we conclude that this could be an example of a very rare primary melanoma of the small intestine.

Intussusception of the Small Intestine Caused by a Primary Melanoma

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M. Schoneveld

2012-01-01

Full Text Available Although the gastrointestinal tract is a fairly frequent site of melanoma metastases, reports of small bowel intussusception caused by melanoma are very rare. We report the case of a 77-year-old man who was admitted to our hospital with epigastric pain, melena and anaemia. After clinical examination, laboratory evaluation and radiological work-up the diagnosis of a jejunal intussusception was made. Exploratory laparoscopy revealed a large tumour arising from the jejunum, approximately 20 cm distal to the angle of Treitz. Small bowel resection with an end-to-end anastomosis was performed. Histological examination showed an intestinal melanoma. There are different theories concerning the origin of malignant melanoma in the small bowel. Although the small and large intestines normally contain no melanocytes, these cells have occasionally been found in the alimentary and respiratory tracts and even in lymph nodes, which supports the theory of a primary origin of melanoma at these sites. Since this was a solitary intestinal lesion and there was no history of cutaneous melanoma, we conclude that this could be an example of a very rare primary melanoma of the small intestine.

Enhancing the Detection of Dysmorphic Red Blood Cells and Renal Tubular Epithelial Cells with a Modified Urinalysis Protocol.

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Chu-Su, Yu; Shukuya, Kenichi; Yokoyama, Takashi; Lin, Wei-Chou; Chiang, Chih-Kang; Lin, Chii-Wann

2017-01-11

Urinary sediment is used to evaluate patients with possible urinary tract diseases. Currently, numerous protocols are applied to detect dysmorphic red blood cells (RBCs) and renal tubular epithelial cells (RTECs) in urinary sediment. However, distinct protocols are used by nephrologists and medical technologists for specimen concentration and observation, which leads to major discrepancies in the differential counts of formed elements such as dysmorphic RBCs and RTECs and might interfere with an accurate clinical diagnosis. To resolve these problems, we first tested a modified urinalysis protocol with an increased relative centrifuge force and concentration factor in 20 biopsy-confirmed glomerulonephritis patients with haematuria. We successfully improved the recovery ratio of dysmorphic RBCs in clinical specimens from 34.7% to 42.0% (P dysmorphic RBCs were detected using a bright field microscope, with results comparable to those using a standard phase contrast microscope. Finally, we applied Sternheimer stain to enhance the contrast of RTECs in the urinary sediments. We concluded that this modified urinalysis protocol significantly enhanced the quality of urinalysis.

A very large leiomyoma of the urethra: a case report.

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Fedelini, Paolo; Chiancone, Francesco; Fedelini, Maurizio; Fabiano, Marco; Persico, Francesco; Di Lorenzo, Domenico; Meccariello, Clemente

2017-02-28

Leiomyomas are benign mesenchymal tumours of smooth muscle origin. They are the most common uterine masses in women of reproductive age group and may be related to the hormonal status. Urethral leiomyomas are very rare. According to the literature, the mean diameter of the urethral leiomyomas is 3.7 cm. We report a case of a very large leiomyoma of the urethra. A 40-year-old women woman was admitted to our department for a giant vaginal mass. She complained of haematuria, dysuria, recurrent urinary tract infections and dyspareunia. The physical evaluation demonstrated a 6 × 5.5 cm neoformation involving the distal tract of the urethra. The patient underwent an ultrasonography and then a magnetic resonance that suggested the diagnosis of leiomyoma. The neoformation was excised through a suburethral incision. The patient was discharged after 3 days and no intraoperative and postoperative complications occurred. The Foley catheter was removed after a week. The patient was continent to urine, and at 6 months follow-up, the patient was symptom free and no recurrences occurred.

Virtual Cystoscopy

International Nuclear Information System (INIS)

Mejia Restrepo, Jorge; Aldana S, Natalia; Munoz Sierra, Juan; Lopez Amaya, Juan

2011-01-01

Introduction: virtual cystoscopy is a minimally invasive procedure that facilitates the evaluation of the urinary tract, allowing intraluminal navigation through the urinary tract structures on the basis of CT imaging reconstructions. it allows detection of various pathologies of the system, through high-sensitivity, three-dimensional lesion visualization with some advantages over conventional cystoscopy. Objective: to describe the technique used for virtual cystoscopy at our institution,and present some representative cases. Materials and methods: We describe the main indications, advantages and limitations of the method, followed by a description of the technique used in our institution, and finally, we present five representative cases of bladder and urethral pathology. Conclusion: virtual cystoscopy is a sensitive technique for the diagnosis of bladder tumors, even those smaller than 5mm. it is the preferred method in patients who have contraindications for conventional cystoscopy, such as prostate hyperplasia, urethral stenoses and active haematuria.it is less invasive and has a lower complication rate when compared with conventional cystoscopy. It has limited use in the assessment of the mucosa and of small, flat lesions.

Primitive neuroectodermal tumour of the kidney with vena caval and atrial tumour thrombus: a case report

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Ong Poh

2008-08-01

Full Text Available Abstract Introduction Renal primitive neuroectodermal tumour is an extremely rare malignancy. Case presentation A 21-year-old woman presented with microscopic haematuria, a palpable right loin mass, dyspnoea, dizziness and fatigue. Initial ultrasound scan of the kidneys revealed an 11 cm right renal mass with venous extension into the inferior vena cava. Computed tomography of the thorax and abdomen revealed an extension of the large renal mass into the right renal vein, inferior vena cava and up to the right atrium. A small paracaval lymph node was noted and three small metastatic nodules were identified within the lung parenchyma. The patient underwent a radical nephrectomy and inferior vena caval tumour (level IV thrombectomy with cardiopulmonary bypass and deep hypothermic circulatory arrest. Immunohistochemical staining of the specimen showed a highly specific cluster of differentiation (CD 99, thus confirming the diagnosis of a primitive neuroectodermal tumour. Conclusion It is important that a renal primitive neuroectodermal tumour be considered, particularly in young patients with a renal mass and extensive thrombus.

Appropriateness and diagnostic yield of referrals for oesophagogastroduodenoscopy at the Korle Bu Teaching Hospital.

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Tachi, K; Nkrumah, K N

2011-01-01

Increasing endoscopy workload in open-access services necessitates adoption of appropriateness criteria to check abuse and improve yield. To assess the appropriateness of referrals for oesophagogastroduodenoscopy (OGD) and its relationship to yield at Korle-Bu Teaching Hospital (KBTH), Accra. Referrals, signs, and symptoms of 375 consecutive patients for diagnostic oesophagogastroduodenoscopy were evaluated over four months. Indications were categorized as appropriate or inappropriate using the American Society of Gastrointestinal Endoscopy (ASGE) guidelines and endoscopic findings (yield) categorized as positive or negative. The relationship between these was analyzed and the diagnostic accuracy of the guidelines determined. There were 209 (55.7%) females, and 316 (84.3%) open-access procedures. Mean age was 46±17 years. Dyspepsia, 272 (72.5%) and epigastric tenderness, 192 (41.4 %) were the commonest symptom and sign respectively. Only 133 (35.5%) reported alarm symptoms. Appropriate referrals constituted 221(58.9%). Inappropriate referral rate was similar for endoscopists and non-endoscopists. Positive yield was 62.7%. Male sex, age > 45 years, haematemesis, persistent vomiting, gastroenterologists' referrals and epigastric tenderness were the best predictors of positive yield. Gastritis, 121 (32.3%), duodenal ulcer, 48 (12.5%) and oesophagitis, 36 (9.6%) were the leading endoscopy diagnoses. Carcinomas were reported only after 45 years and 18 (81.8%) of the cases had alarm symptoms. Inappropriate referral for OGD rate is high in Accra. Yield is improved by adherence to the ASGE guidelines but its accuracy as a screening tool for OGD at Korle- Bu Teaching Hospital is too low to recommend it for adoption.

[Laparoscopic gastric sleeve in gastric volvulus secondary to diaphragmatic eventration in an adult patient].

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Gálvez-Valdovinos, Ramiro; Marín-Santillán, Ernesto; Funes-Rodríguez, Juan Francisco; López-Ambriz, Gustavo

2016-01-01

Acute gastric volvulus is a rare, but potentially life-threatening, cause of upper gastrointestinal obstruction. Male of 60 years old with severe epigastric pain and abdominal distension with haematemesis on two occasions. The patient was haemodynamically stable, with abdominal distension and palpable epigastric fullness. Hematic cytology showed: haemoglobin 8.2g/dl and haematocrit 27%. Abdominal X-ray showed an elevation of left diaphragm with a hugely dilated stomach. A nasogastric tube was inserted. Endoscopy was performed. There was no active bleeding, but it was impossible to reach the duodenum due to the stomach distortion. The upper gastrointestinal X-ray study showed the appearance of an inverted stomach in the chest and an organoaxial gastric torsion. The CT scans of thorax and abdomen showed a gastric ascent into the thoracic cavity. Laparoscopic surgery was performed, finding the left hemi-diaphragm elevated, and the stomach, splenic angle of the colon, the spleen and tail of the pancreas were also raised. A linear gastrectomy (gastric sleeve) was performed. The postoperative progress was satisfactory. Oral feeding was started 72 hours after surgery, and the patient was discharged, and has remained asymptomatic during the following by 8 years. Emergency physicians must maintain a high level of suspicion in patients that present with signs and symptoms suggesting upper digestive tract occlusion. The gastric sleeve is an excellent alternative to avoid recurrence of gastric volvulus. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Ribavirin: an effective treatment of crimean-congo hemorrhagic fever

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Sheikh, A.S.

2004-01-01

Objective: To determine the efficiency of Ribavirin, an anti-viral drug, in patients diagnosed to have CCHF. Patients and Methods: A total of 94 cases were included in the study on high index of suspicion of CCHF. The major criteria of admission were a short history of high-grade fever associated with bleeding from more than one site, i.e., haematemesis, epistaxis etc. the mean age was 34.71 plus minus 12.81 years. All the suspected cases were kept in isolation unit of the hospital and barrier nursing was advised. Results: All the 94 cases were sent to CDC, Atlanta, USA for confirmation and 39 (41.4%) were confirmed to have CCHF. Symptomatic treatment like platelet concentration transfusions, fresh-blood transfusions and antipyretics were given to all cases. Oral Ribavirin was given only to the confirmed cases. It was started in a dose of 2 gm initially, followed by 1 gm 6 hourly for 4 days and then 500 mg 8 hours for 6 days. After a mean period of 2.30 plus minus 0.69 days to treatment with Ribavirin, the clinical as well as the laboratory parameters started improving and returned to normal level after 10 -day course of treatment. Mild anemia and thrombocytosis were seen as adverse effects in some of the patients. Conclusion: For treatment of this fatal disease, we recommended use of oral Ribavirin in all patients diagnosed to have CCHF in the above-mentioned doses, on the basis of our study results.(author)

Acute radiotherapy toxicity in 57 dogs with gross and microscopic mast cell tumours.

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Blackwood, L; Tanis, J B; Harper, A; Amores-Fuster, I; Killick, D R; Finotello, R

2018-05-15

Mast cell tumours (MCTs) are commonly treated with radiation therapy, most often in a microscopic disease setting. Poorer outcomes are expected in patients with gross disease, and irradiation of gross disease may be associated with greater toxicity. The aim of this study was to compare acute radiation adverse events (AE) in dogs with gross and microscopic MCTs receiving radiotherapy. Fifty-seven dogs were included, 28 with gross disease and 29 with microscopic. In order to assess mucosal and skin toxicity, patients were assigned to 2 groups: head (29 patients, 14 patients with gross and 15 microscopic) and other sites (28 patients, 14 each). All were treated with external beam radiotherapy, and toxicity assessed at the end of treatment and 10 to 14 days later (first recheck). All patients developed some acute radiation toxicity by the end of the course. However, there was no difference in the severity of toxicity between gross and microscopic disease in either site group at either time point. The only variable associated with an increased frequency of grade 2 or 3 toxicity at the first recheck was the use of prednisolone prior to radiotherapy (P = .05). No other factors were identified which were associated with increased toxicity. For the head group, the site of highest grade toxicity was mucosa or, if included in the field, nasal planum, which was often more severely affected than the mucosa. No significant late toxicity was identified. Two dogs developed acute haematemesis during the radiotherapy course, but both completed the course without further events. © 2018 John Wiley & Sons Ltd.

TIPS Placement via Combined Transjugular and Transhepatic Approach for Cavernous Portal Vein Occlusion: Targeted Approach

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Natanel Jourabchi

2013-01-01

Full Text Available Purpose. We report a novel technique which aided recanalization of an occluded portal vein for transjugular intrahepatic portosystemic shunt (TIPS creation in a patient with symptomatic portal vein thrombosis with cavernous transformation. Some have previously considered cavernous transformation a contraindication to TIPS. Case Presentation. 62-year-old man with chronic pancreatitis, portal vein thrombosis, portal hypertension and recurrent variceal bleeding presents with melena and hematemesis. The patient was severely anemic, hemodynamically unstable, and required emergent portal decompression. Attempts to recanalize the main portal vein using traditional transjugular access were unsuccessful. After percutaneous transhepatic right portal vein access and navigation of a wire through the occluded main portal vein, an angioplasty balloon was inflated at the desired site of shunt takeoff. The balloon was targeted and punctured from the transjugular approach, and a wire was passed into the portal system. TIPS placement then proceeded routinely. Conclusion. Although occlusion of the portal vein increases difficulty of performing TIPS, it should not be considered an absolute contraindication. We have described a method for recanalizing an occluded portal vein using a combined transhepatic and transjugular approach for TIPS. This approach may be useful to relieve portal hypertension in patients who fail endoscopic and/or surgical therapies.

Surgical management of bleeding esopageal varices: the Tikur Anbessa hospital experience.

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Kassa, Endale; Jhonson, Orval

2005-10-01

Surgery is one of the modalities of treatment of portal hypertension with bleeding esophageal varices. Between 1992 and 2003, a total of 33 patients with esophageal varices secondary to hepatic or pre-hepatic causes of portal hypertension underwent proto-azygeal disconnection surgery at Tikur Anbessa Hospital, Addis Ababa University. Twenty-five, (69. 7%) were men and 8 (24.3%) were women. Their age ranged between 13 and 54 years with a mean age of 24.3 years. Eighty two percent of the patients had hematemesis and melena. Thirty-two, (97%) patients had splenomegaly and of these; 27 (84%) had splenomegaqly with hyperslenism. Twenty-one, (63.6%) and 12 (36.6%) patients had child's A and B functional class, respectively. None of the patients was in class C. The condition of the liver as assessed macroscopically at surgery showed portal fibrosis in 22 (66.7%), cirrhosis in 3 (9.1%) and normal liver in 8 (24.2%) patients. There was no significant correlation between variceal bleeding episode and type of liver pathology. Four patients (12%) died after surgery and re-bleeding occurred in one (3%) patients. Porto-azygeal disconnection surgery can be done safely in patients with esophageal varices and good liver function in order to prevent further bleeding episode.

Recidivas de hemorragia digestiva alta en pacientes atendidos en el Hospital General Docente Dr. Ernesto Guevara de la Serna

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Alina Torreblanca Xiques

2014-11-01

Full Text Available Se realizó un estudio descriptivo en pacientes con hemorragia digestiva alta por úlcera péptica que hicieron resangrado, con el objetivo de caracterizarlos. Se estudiaron las variables de grupos de edades y sexo afectados, los hallazgos endoscópicos, las formas de presentación, así como factores asociados. La población de estudio estuvo constituida por los 82 pacientes, que ingresaron en el servicio de gastroenterología del Hospital Provincial Docente “Dr. Ernesto Guevara de la Serna” de la provincia de Las Tunas, desde febrero 2012 a febrero del 2014. El sexo más afectado fue el masculino, predominando en la sexta década de la vida, la gastritis erosiva hemorrágica es el hallazgo endoscópico que se presentó con mayor frecuencia, siendo la cara anterior del bulbo duodenal la ubicación topográfica más afectada. La hipertensión arterial fue la enfermedad asociada a la hemorragia digestiva alta que predominó, en 45 pacientes, presentando como factor frecuente la ingestión de antiinflamatorios no estereoideos (AINES, constituyendo la melena la forma de aparición más frecuente

Delayed bleeding and hemorrhage of mucosal defects after gastric endoscopic submucosal dissection on second-look endoscopy.

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Ono, Shoko; Ono, Masayoshi; Nakagawa, Manabu; Shimizu, Yuichi; Kato, Mototsugu; Sakamoto, Naoya

2016-04-01

Although second-look endoscopy is performed within several days after gastric endoscopic submucosal dissection (ESD), there has been no evidence supporting the usefulness of the intervention. We investigated the relationship between delayed bleeding and hemorrhage of mucosal defects after ESD on second-look endoscopy and analyzed risk factors of active bleeding on second-look endoscopy. A total of 441 consecutive ESD cases with gastric cancer or adenoma were retrospectively analyzed. Second-look endoscopy was performed in the morning after the day of ESD. Bleeding of mucosal defects on second-look endoscopy was classified according to the Forrest classification, and active bleeding was defined as Forrest Ia or Ib. Delayed bleeding was defined as hematemesis or melena after second-look endoscopy. A total of 406 second-look endoscopies were performed, and delayed bleeding occurred in 11 patients. The incidence rate of delayed bleeding after second-look endoscopy in patients with Forrest Ia or Ib was significantly higher than that in patients with Forrest IIa, IIb or III (7.69 vs. 2.02 %, p 35 mm, the odds ratio of active bleeding on second-look endoscopy was 1.9. Active bleeding of mucosal defects on second-look endoscopy is a risk factor for delayed bleeding.

Two forensic autopsy cases of death due to upper gastrointestinal hemorrhage: a comparison of postmortem computed tomography and autopsy findings.

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Suzuki, Hideto; Hasegawa, Iwao; Hoshino, Norio; Fukunaga, Tatsushige

2015-05-01

In this report, we describe two autopsy cases of death due to upper gastrointestinal hemorrhage (Case 1: gastric ulcer, Case 2: aortoduodenal fistula). Postmortem computed tomography (CT) images from both cases revealed pooling of gastric fluid, which contained high attenuation areas, although these images also mirrored the different sources of the gastrointestinal hemorrhage. Fluid collection was observed in the small intestine for both cases, although the high attenuation areas were only remarkable in Case 2. The autopsy in Case 1 revealed a peptic ulcer, with small vessels exposed on the surface of the ulcer. Melena was also observed throughout the intestine, although clotting was only observed inside the stomach. The autopsy in Case 2 revealed diffuse massive clotting from the stomach to the upper portion of the ileum, which was due to a primary aortoduodenal fistula. Given our autopsy findings, the extent of the high attenuation areas in the digestive tract during postmortem CT scanning may be correlated with the speed of the gastrointestinal hemorrhage before death. Carefully evaluating the radiodensity of the gastrointestinal contents during postmortem CT scanning may indicate the primary site of the hemorrhage before the autopsy, thereby facilitating the accurate identification of the cause of death during forensic autopsy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Gastric Glomus Tumor: A Rare Cause of Upper Gastrointestinal Bleeding

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Yoshinori Handa

2015-01-01

Full Text Available A 24-year-old woman was referred to our department because of melena. These symptoms combined with severe anemia prompted us to perform an emergency upper endoscopy, which showed bleeding from an ulcerated 30 mm submucosal tumor in the gastric antrum. A computed tomography scan revealed a homogeneously enhanced mass, and endoscopic ultrasonography identified a well-demarcated mass in the third and fourth layers of the gastric wall. Because analysis of the possible medical causes remained inconclusive and the risk of rebleeding, laparoscopy-assisted gastric wedge resection was performed after administration of 10 units of red cell concentrate. Histological and immunohistological analysis revealed the tumor to be a gastric glomus tumor. Gastric submucosal tumors remain challenging to diagnose preoperatively as they show a variety of radiologic and clinicopathologic features and are associated with the risk of bleeding upon biopsy, as is indicated in the guidelines for gastric submucosal tumors. Gastric glomus tumors characteristically present with exsanguinating gastrointestinal hemorrhaging that often requires blood transfusion. Additionally, gastric submucosal tumors typically occur in elderly patients; however, this case involved a young patient who was 24 years old. Here, we describe this case in order to identify features that may aid in early differentiation of gastric submucosal tumors.

Primary aortoduodenal fistula after radiotherapy. Report of a case

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Oshima, Takeshi; Inoue, Hitoshi; Oshima, Akira; Minami, Tomohito; Matsumine, Takao [Tokyo Metropolitan Fuchu Hospital (Japan)

1999-10-01

Aortoduodenal fistula is a rare and life-threatening cause of gastrointestinal hemorrhage. The patient was a 44-year-old woman who repeated intermittent hematemesis and melena after hysterectomy, para-aortic lymph node dissection, and subsequent radiotherapy. Angiography revealed no bleeding point. Upper gastrointestinal endoscopy showed an ulcer at the third portion of the duodenum. Emergency laparotomy revealed an aortoduodenal fistula which was inferred to be caused by radiotherapy because no recurrence of malignancy was detected. After the fistula was closed, the patient repeated hematemesis and anal bleeding. She died of acute hemorrhagic shock, in spite of three operations including axillo-femoral bypass. We propose that radiation might have played a role in the pathogenesis of the aortoduodenal fistula in our case. The new case of primary aortoduodenal fistula following radiotherapy is added to four cases previously reported in the literature. Six cases in which the lesion of the duodenum could be demonstrated by endoscopy, have been reported in Japan. Aortoduodenal fistula should be considered as a probable diagnosis in patients presenting massive gastrointestinal hemorrhage after radiotherapy. Rapid surgical treatments are needed, and operative procedures to be considered include resection of the aorta with aortic stump closure and axillo-femoral bypass. (author)

Brunner’s Gland Hamartoma: A Rare Cause of Gastrointestinal Bleeding – Case Report and Review of the Literature

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David R Stolpman

2002-01-01

Full Text Available An unusual cause of upper gastrointestinal bleeding is described in a previously healthy 45-year-old man who was admitted to hospital with weakness and fatigue, and had experienced an episode of melena two days before admission. His medical and surgical history was unremarkable. Upon admission to hospital, he showed evidence of iron-deficiency anemia, with a hemoglobin concentration of 61 g/L (normal range 135 to 175 g/L, a mean corpuscular volume of 73 fL (normal range 85.0 to 95.0 fL and a ferritin concentration of 1.0 µg/L (normal range in males 15 to 400 µg/L. Upper gastrointestinal endoscopy revealed a 3.5 cm ulcerated submucosal mass in the third portion of the duodenum, for which mucosal biopsies were nondiagnostic. A subsequent endoscopic ultrasound revealed a 2.7×4.0 cm hyperechoic, cystic, submucosal tumour in the third portion of the duodenum. Endoscopic ultrasound-guided fine needle aspiration revealed no malignant cells. The patient eventually underwent a resection of the third portion of his duodenum. Surgical pathology revealed that this tumour was a Brunner’s gland hamartoma, 4.5 cm in its greatest dimension.

Colonoscopic findings and management of patients with outbreak typhoid fever presenting with lower gastrointestinal bleeding.

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Shaikhani, Mohammad A R; Husein, Hiwa A B; Karbuli, Taha A; Mohamed, Mohamed Abdulrahman

2013-09-01

Lower gastrointestinal bleeding (LGIB) along with intestinal perforation is a well-known complication of typhoid fever. Reports of colonoscopic appearance and intervention of typhoid perforation involve only few cases. This series reports the colonoscopic findings and the role of colonoscopic hemostatic interventions in controlling the bleeding ileocolonic lesions. During the typhoid fever outbreak in Sulaymaniyah City in Iraqi Kurdistan Region, we received 52 patients with LGIB manifesting as fresh bleeding per rectum or melena. We performed total colonoscopy with ileal intubation for all cases. The findings were recorded and endoscopic hemostatic intervention with adrenaline-saline injection and argon plasma coagulation was applied to actively bleeding lesion. These patients were young, 11-30 years of age, with female preponderance. Blood culture was positive in 50 %. Colonoscopic findings were mostly located in the ileocecal region, although other areas of the colon were involved in many cases. Twenty-four percent of the cases required endoscopic hemostatic intervention by adrenaline injection with argon plasma coagulation which was effective in all patients except one who died in spite of surgical intervention in addition of endoscopic hemostasis. Dual endoscopic hemostatic intervention can be a safe and effective management option for patients with LGIB due to typhoid fever.

[The diagnostic performance of color Doppler ultrasonography for newborn four cases of midgut volvulus accompanied by intestinal malrotation].

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Ikeshima, Yukari; Hisano, Katsuya; Morisawa, Takeshi; Inoue, Kozue; Shimamoto, Masahiro; Koujitani, Toshiaki; Yonetani, Masahiko; Yasufuku, Masao

2014-03-01

Midgut volvulus accompanied by intestinal malrotation is classified as a surgical emergency disease of the newborn, which emerges with the bilious vomiting or melena. This report presents four patients of this disease in our hospital, evaluated by color Doppler ultrasonography before surgical operation. All four patients were presented by bilious vomiting at the onset. By color Doppler ultrasonography method, the whirlpool sign which is the view of intestine and superior mesenteric vein rotated around with the axis of superior mesenteric artery, were shown in all cases. This whirlpool sign led to the diagnosis of midgut volvulus accompanied by intestinal malrotation. Intestinal contrast imaging was tested in three patients for the purpose of confirming the diagnosis. Repair of the volvulus and a ladd operation was performed in all four patients, without the excision of intestine because of no intestinal ischemic change. The clinical courses of four cases were good, and all patients were discharged within 17 days. Early diagnosis and timely surgical operation are essential for decreasing the possibility of occurring intestinal ischemic changes and improving clinical outcome after surgical operation. We propose that color Doppler ultrasonography is the powerful tool for the diagnosis of this disease, especially for the newborn, for whom the available diagnostic tests are limited.

Clinicopathological features and managements of radiation enterocolitis

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Takashima, Shigeki; Kinami, Yoshio [Kanazawa Medical Univ., Ishikawa (Japan)

1990-11-01

During the past 12 years, delayed radiation enterocolitis developed in 22 patients treated for uterine cervical cancer or endometrial cancer. Their ages ranged from 36 to 77 years with an average age of 62. Ten patients received external irradiation and the other 12 patients received the combined external and internal irradiation. Radiation doses were 50 Gy-156 Gy with an average dose of 80 Gy. All patients had early radiation effects manifested by myxoid bloody stool (82%), diarrhea (46%), defecation disorder (18%), and tenesmus like symptoms (9%). These symptoms resolved within one month after irradiation. The most common symptom for delayed radiation effects was anal hemorrhage and melena (73%), followed by ileus like symptoms and abdominal pain (14%). Defecation disorder, diarrhea, and anemia were observed in one each patient (5%). Latency period ranged from 4 months to 13 years after radiation treatment, with the greatest number (86%) having it within one year and 3 months. There was no definitive correlation between radiation doses and latency period. Histopathological features included marked proliferation extending from the submucosal layer to the muscular layer, endometrial thickening of the small vessels, and thrombopoiesis. Although surgical treatment was performed in 20 patients, favorable outcome was not achieved. (N.K.).

Kocuria kristinae endocarditis related to diabetic foot infection.

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Citro, Rodolfo; Prota, Costantina; Greco, Luigi; Mirra, Marco; Masullo, Alfonso; Silverio, Angelo; Bossone, Eduardo; Piscione, Federico

2013-06-01

We report an unusual case of endocarditis occurring in a 74-year-old man with a history of systemic hypertension, diabetes mellitus and minor amputation for left forefoot ulcer. The patient was hospitalized for vacuum-assisted closure therapy to aid in wound healing. After the first treatment session, the patient reported abdominal pain with haematemesis and fever (40 °C). Owing to persistent fever, three blood cultures were performed, all positive for Kocuria kristinae. The identification was based on biochemical tests and automated systems. The speciation of the micro-organism was achieved with MALDI-TOF and then confirmed by 16S rRNA gene sequencing. Transthoracic echocardiographic examination showed the presence of a large vegetation (38×20 mm) on the posterior mitral leaflet and moderate mitral regurgitation. Since there are no current guidelines for the treatment of K. kristinae endocarditis, empiric antibiotic therapy with intravenous sulbactam/ampicillin (1.5 g twice daily) and gentamicin (6 mg kg(-1) per day) was started. After 7 days of hospitalization, the patient's condition suddenly worsened because of the occurrence of haemorrhagic stroke. Despite inotropic support and rifampicin infusion, the haemodynamic status progressively deteriorated. After an initial improvement, he worsened again, becoming stuporous, hypotensive and dyspnoeic. In the following days, the patient developed compartment syndrome resulting in right foot ischaemia. Unfortunately, 25 days after hospitalization, the patient died of multiple organ failure from overwhelming sepsis. To the best of our knowledge, this is the first case of K. kristinae endocarditis on a native valve that is not related to a central venous catheter but associated with diabetic foot infection.

An observational European study on clinical outcomes associated with current management strategies for non-variceal upper gastrointestinal bleeding (ENERGIB-Turkey).

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Mungan, Zeynel

2012-01-01

This observational, retrospective cohort study assessed outcomes of the current management strategies for nonvariceal upper gastrointestinal bleeding in several European countries (Belgium, Greece, Italy, Norway, Portugal, Spain, and Turkey) (NCT00797641; ENERGIB). Turkey contributed 23 sites to this study. Adult patients (≥18 years old) consecutively admitted to hospital and who underwent endoscopy for overt non-variceal upper gastrointestinal bleeding (hematemesis, melena or hematochezia, with other clinical/laboratory evidence of acute upper GI blood loss) were included in the study. Data were collected from patient medical records regarding bleeding continuation, re-bleeding, pharmacological treatment, surgery, and mortality during a 30-day follow-up period. A total of 423 patients (67.4% men; mean age: 57.8 ± 18.9 years) were enrolled in the Turkish study centers, of whom 96.2% were admitted to hospital with acute non-variceal upper gastrointestinal bleeding. At admission, the most common symptom was melena (76.1%); 28.6% of patients were taking aspirin, 19.9% were on non-steroidal anti-inflammatory drugs, and 7.3% were on proton pump inhibitors. The most common diagnoses were duodenal (45.2%) and gastric (27.7%) ulcers and gastritis/gastric erosions (26.2%). Patients were most often managed in general medical wards (45.4%). A gastrointestinal team was in charge of treatment in 64.8% of cases. Therapeutic procedures were performed in 32.4% of patients during endoscopy. After the endoscopy, most patients (94.6%) received proton pump inhibitors. Mean (SD) hospital stay was 5.36 ± 4.91 days. The cumulative proportions of continued bleeding/re-bleeding, complications and mortality within 30 days of the non-variceal upper gastrointestinal bleeding episode were 9.0%, 5.7% and 2.8%, respectively. In the Turkish sub-group of patients, the significant risk factors for bleeding continuation or re-bleeding were age >65 years, presentation with hematemesis or shock

Caracterización clínico-terapéutica del sangramiento digestivo alto: Hospital "Dr. Salvador Allende". Primer semestre 2006 Clinicotherapeutical characterization of upper digestive bleeding: "Dr. Salvador Allende" Hospital. First semester 2006

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José de Jesús Rego Hernández

2007-12-01

Full Text Available La hemorragia digestiva constituye una de las principales causas de ingreso hospitalario por enfermedades del tracto gastrointestinal, En la mayoría de casos se presenta de forma aguda y con importantes repercusiones sistémicas, por lo que obliga a adoptar medidas urgentes para estabilizar a los pacientes y permitir efectuar un tratamiento específico adecuado, Esta entidad sigue ocasionando una mortalidad elevada, que se acumula en determinados grupos de riesgo como son los pacientes con edad avanzada y enfermedades graves asociadas, por lo que se decide realizar la caracterización clínico-terapéutica del sangramiento digestivo alto en el Hospital "Dr, Salvador Allende" durante el primer semestre del 2006 mediante un estudio descriptivo que tomó como fuente la revisión de las 161 historias clínicas de los pacientes egresados con este diagnóstico en ese período, El 73,3 % de los pacientes con sangramiento digestivo alto fueron mayores de 60 años de edad; no existieron diferencias en cuanto al sexo; el café y el tabaquismo fueron los hábitos tóxicos más reportados; los antiinflamatorios no esteroides, el grupo farmacológico más relacionado con esta entidad y dentro de ellos, el ácido acetilsalicílico, y la melena, la manifestación clínica más frecuente, En el 91,9 % la pauta de tratamiento fue adecuada, así como el tratamiento en general; hubo solo la asociación irracional de un inhibidor de la bomba de protones con un anti-H2Digestive haemorrhage is one of the main cause of hospital admission due to gastrointestinal tract diseases. In most of the cases, it appears in an acute form, and with important systemic repercussions that lead to the adoption of emergency measures to stabilize the patients and to apply an adequate specific treatment. This entity is still causing a high mortality that is accumulated in certain risk groups as the elderly patients with severe associated diseases. That's why, it was decided to make the

Simple questionnaire and urine reagent strips compared to microscopy for the diagnosis of Schistosoma haematobium in a community in northern Ghana.

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Bogoch, Isaac I; Andrews, Jason R; Dadzie Ephraim, Richard K; Utzinger, Jürg

2012-10-01

To evaluate the utility of a simple questionnaire and urine reagent strip testing for the rapid diagnosis of Schistosoma haematobium in rural northern Ghana. Cross-sectional parasitological and questionnaire survey in a community in northern Ghana. Participants provided two urine specimens that were examined under a microscope using a centrifugation method. The first urine sample was additionally subjected to reagent strip testing. A short questionnaire was administered to all participants. Microscopy of urine samples obtained from 208 individuals aged 1-77 years revealed an S. haematobium prevalence of 6.8%. The presence of any blood or protein on a urine reagent strip was 100% and 42% sensitive, and 93% and 80% specific for S. haematobium diagnosis. Questionnaires were completed by 198 individuals. Self-reported haematuria showed a sensitivity of 53% and a specificity of 85%. A dichotomous two-question panel was helpful in S. haematobium diagnosis, with working and playing near the river significantly associated with S. haematobium infection (P < 0.001). The use of urine reagent strips, coupled with questions pertaining to water contact patterns, might be considered for point-of-contact diagnosis of S. haematobium where microscopy is unavailable. © 2012 Blackwell Publishing Ltd.

Primary Signet-Ring Cell Adenocarcinoma of the Urinary Bladder Treated with Partial Cystectomy: A Case Report and Review of the Literature

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Umesh Jayarajah

2017-01-01

Full Text Available Primary signet-ring cell carcinoma is a variant of adenocarcinoma which is extremely rare, associated with poor prognosis and generally found to be resistant to chemotherapy and radiotherapy. We report a case of primary signet-ring cell carcinoma of the bladder which was successfully treated with partial cystectomy. A 71-year-old female with a history of type 2 diabetes, hypertension, and ischaemic heart disease presented with painless haematuria for 2 months’ duration. The abdominal ultrasonography showed a localised polypoidal vesical growth arising from the bladder dome. Cystoscopy revealed an exophytic solid tumour in the anterior fundal wall. A deep transurethral resection of bladder tumour was done and histology revealed an adenocarcinoma composed of mucinous and signet-ring cell components. Later, considering the patient’s age and the poor general condition, a partial cystectomy was done. Follow-up cystoscopy and ultrasonography were done at 12 months and there was no evidence of tumour recurrence and the patient is currently symptom-free. Partial cystectomy may be considered in patients with localised tumour without evidence of metastasis and poor general condition. Regular cystoscopies and ultrasound imaging are necessary for follow-up and early identification of recurrences.

External beam radiotherapy for carcinoma of the prostate: a retrospective study

International Nuclear Information System (INIS)

Mithal, N.P.; Hoskin, P.J.

1993-01-01

Two hundred and thirty-seven consecutive patients receiving radiotherapy for primary prostatic carcinoma have been reviewed. The presenting symptoms included acute retention, chronic outflow obstruction and haematuria. The diagnosis was confirmed at trans-urethral resection of the prostate (TURP) in 95%; all but seven patients had adenocarcinoma. The clinical stage at presentation was T 0 (3%), T 1 (9%), T 2 (49%), T 3 (21%) and T 4 (17%). Two hundred and six patients received primary radiotherapy, 38 had concurrent endocrine therapy. Local relapse alone occurred in 38 patients (16%), distant relapse alone occurred in 30 (13%), and both local and distant relapse occurred in 30 (13%). Median time to local relapse alone was 25 months, distant relapse alone 14 months, and local and distant relapse 22 months. Overall survival was related to stage and grade at presentation. No influence of endocrine therapy, dose or planning technique was seen, but a significant advantage for those patients treated using a planned volume compared with parallel opposed fields was observed. Acute radiation toxicity affecting the bladder occurred in 42% and the bowel in 45%. Late toxicity affecting the bladder occurred in 7% and the bowel in 2%. (author)

Safe percutaneous suprapubic catheterisation.

Science.gov (United States)

Goyal, N K; Goel, A; Sankhwar, S N

2012-11-01

We describe our technique of percutaneous suprapubic catheter insertion with special reference to steps that help to avoid common complications of haematuria and catheter misplacement. The procedure is performed using a stainless steel reusable trocar under local infiltrative anaesthesia, usually at the bedside. After clinical confirmation of a full bladder, the trocar is advanced into the bladder through a skin incision. Once the bladder is entered, the obturator is removed and the assistant inserts a Foley catheter followed by rapid balloon inflation. Slight traction is applied to the catheter for about five minutes. Patients with previous lower abdominal surgery, an inadequately distended bladder or acute pelvic trauma do not undergo suprapubic catheterisation using this method. The procedure was performed in 72 men (mean age: 42.4 years, range: 18-78 years) with urinary retention with a palpable bladder. The average duration of the procedure was less than five minutes. No complications were noted in any of the patients. Trocar suprapubic catheter insertion is a safe and effective bedside procedure for emergency bladder drainage and can be performed by resident surgeons. The common complications associated with the procedure can be avoided with a few careful steps.

A histomorphologic and ultrastructural study of the malignant tumours of the renal pelvis.

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Tyagi N

1993-10-01

Full Text Available The study was carried at two different centres. Only 9 cases of primary malignant tumours of the renal pelvis could be collected during the period of 7 years (1984-1990. Renal pelvis malignancies constituted 0.21% of all the malignancies and 12.16% of all the malignant growths of the kidney (9 out of 74 cases. The age of these patients ranged from 24 to 70 years; the mean being 41.7 years. Male/female ratio was 8:1. Common triad of complaints (pain, haematuria and lump was noticed in 22.2% of patients. Individually they were noticed in 77.8%, 66.7% and 44.4% of patients respectively. Transitional cell carcinoma was the commonest, seen in 7 patients (77.8% whereas squamous cell carcinoma and adenocarcinoma were noticed in one patient (11.1% each. Hydronephrosis, chronic pyelonephritis and nephrolithiasis were noticed in 66.7%, 44.4% and 22.2% of patients respectively. Ultrastructural study of urothelial tumours revealed tumour cells in various stages of differentiation with loss of intercellular junctions and dense collection of rough endopasmic reticulum fibrils around the nucleus.

Comparison of post contrast CT urography phases in bladder cancer detection

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Helenius, Malin; Dahlman, Par; Lonnemark, Maria; Magnusson, Anders [Uppsala University Hospital, Department of Surgical Sciences, Section of Radiology, Uppsala (Sweden); Brekkan, Einar [Uppsala University Hospital, Department of Surgical Sciences, Section of Urology, Uppsala (Sweden); Wernroth, Lisa [Uppsala University Hospital, Uppsala Clinical Research Center, Uppsala (Sweden)

2016-02-15

The aim of this study was to investigate which post-contrast phase(s) in a four-phase CT urography protocol is (are) most suitable for bladder cancer detection. The medical records of 106 patients with visible haematuria who underwent a CT urography examination, including unenhanced, enhancement-triggered corticomedullary (CMP), nephrographic (NP) and excretory (EP) phases, were reviewed. The post-contrast phases (n = 318 different phases) were randomized into an evaluation order and blindly reviewed by two uroradiologists. Twenty-one patients were diagnosed with bladder cancer. Sensitivity for bladder cancer detection was 0.95 in CMP, 0.83 in NP and 0.81 in EP. Negative predictive value (NPV) was 0.99 in CMP, 0.96 in NP and 0.95 in EP. The sensitivity was higher in CMP than in both NP (p-value 0.016) and EP (p-value 0.0003). NPV was higher in CMP than in NP (p-value 0.024) and EP (p-value 0.002). In the CT urography protocol with enhancement-triggered scan, sensitivity and NPV were highest in the corticomedullary phase, and this phase should be used for bladder assessment. (orig.)

Comparison of post contrast CT urography phases in bladder cancer detection

International Nuclear Information System (INIS)

Helenius, Malin; Dahlman, Par; Lonnemark, Maria; Magnusson, Anders; Brekkan, Einar; Wernroth, Lisa

2016-01-01

The aim of this study was to investigate which post-contrast phase(s) in a four-phase CT urography protocol is (are) most suitable for bladder cancer detection. The medical records of 106 patients with visible haematuria who underwent a CT urography examination, including unenhanced, enhancement-triggered corticomedullary (CMP), nephrographic (NP) and excretory (EP) phases, were reviewed. The post-contrast phases (n = 318 different phases) were randomized into an evaluation order and blindly reviewed by two uroradiologists. Twenty-one patients were diagnosed with bladder cancer. Sensitivity for bladder cancer detection was 0.95 in CMP, 0.83 in NP and 0.81 in EP. Negative predictive value (NPV) was 0.99 in CMP, 0.96 in NP and 0.95 in EP. The sensitivity was higher in CMP than in both NP (p-value 0.016) and EP (p-value 0.0003). NPV was higher in CMP than in NP (p-value 0.024) and EP (p-value 0.002). In the CT urography protocol with enhancement-triggered scan, sensitivity and NPV were highest in the corticomedullary phase, and this phase should be used for bladder assessment. (orig.)

A Case of Definitive Therapy for Localised Prostate Cancer: Report of a Urological Nightmare

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Andreas Sommerhuber

2012-01-01

Full Text Available Radical prostatectomy, external beam radiotherapy and permanent brachytherapy are the most common treatment options for nonmetastatic localised adenocarcinoma of the prostate (PCa. Accurate pretherapeutic clinical staging is difficult, the number of positive cores after biopsy does not imperatively represent the extension of the cancer. Furthermore postoperative upgrading in Gleason score is frequently observed. Even in a localised setting a certain amount of patients with organ-confined PCa will develop biochemical progression. In case of a rise in PSA level after radiation the majority of patients will receive androgen deprivation therapy what must be considered as palliative. If local or systemic progressive disease is associated with evolving neuroendocrine differentiation hormonal manipulation is increasingly ineffective; radiotherapy and systemic chemotherapy with a platinum agent and etoposide are recommended. In case of local progression complications such as pelvic pain, gross haematuria, infravesical obstruction and rectal invasion with obstruction and consecutive ileus can possibly occur. In this situation palliative radical surgery is a therapy option especially in the absence of distant metastases. A case with local and later systemic progression after permanent brachytherapy is presented here.

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.)

Impacto de la aplicación de un software para la programación y control de los medios mecanizados en una unidad productora del municipio Güira de Melena

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Damián Lora Cabrera; Pedro D. Sotto Batista; Manuel Fernández Sánchez; Noel Fuentes Ramírez; Mayra Wong Barreiro

2011-01-01

Este trabajo investigativo tiene como objetivo el estudio del impacto de la aplicación en una unidad productiva del software desarrollado por el IIMA en la programación y el control del trabajo de la maquinaria agrícola. El desarrollo agropecuario resulta imposible sin el empleo de la mecanización, pero para garantizar la máxima productividad durante la jornada, con una alta calidad y con el mínimo de gastos de trabajo se deben establecer en el sistema productivo, métodos de organización que ...

Short term outcomes of prostate biopsy in men tested for cancer by prostate specific antigen: prospective evaluation within ProtecT study.

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Rosario, Derek J; Lane, J Athene; Metcalfe, Chris; Donovan, Jenny L; Doble, Andy; Goodwin, Louise; Davis, Michael; Catto, James W F; Avery, Kerry; Neal, David E; Hamdy, Freddie C

2012-01-09

To measure the effect of the adverse events within 35 days of transrectal ultrasound guided biopsy from the perspective of asymptomatic men having prostate specific antigen (PSA) testing; to assess early attitude to re-biopsy; to estimate healthcare resource use associated with adverse events due to biopsy; and to develop a classification scheme for reporting adverse events after prostate biopsy. Prospective cohort study (Prostate Biopsy Effects: ProBE) nested within Prostate Testing for Cancer and Treatment (ProtecT) study. Participants Between 1999 and 2008, 227,000 community dwelling men aged 50-69 years were identified at 352 practices and invited to counselling about PSA testing. 111,148 attended a nurse led clinic in the community, and 10,297 with PSA concentrations of 3-20 ng/mL were offered biopsy within ProtecT. Between February 2006 and May 2008, 1147/1753 (65%) eligible men (mean age 62.1 years, mean PSA 5.4 ng/mL) having 10 core transrectal ultrasound guided biopsy under antibiotic cover in the context of ProtecT were recruited to the ProBE study. Purpose designed questionnaire administered at biopsy and 7 and 35 days after the procedure to measure frequency and effect of symptoms related to pain, infection, and bleeding; patients' attitude to repeat biopsy assessed immediately after biopsy and 7 days later; participants' healthcare resource use within 35 days of biopsy evaluated by questionnaire, telephone follow-up, and medical note review; each man's adverse event profile graded according to symptoms and healthcare use. Pain was reported by 429/984 (43.6%), fever by 172/985 (17.5%), haematuria by 642/976 (65.8%), haematochezia by 356/967 (36.8%), and haemoejaculate by 605/653 (92.6%) men during the 35 days after biopsy. Fewer men rated these symptoms as a major/moderate problem-71/977 (7.3%) for pain, 54/981 (5.5%) for fever, 59/958 (6.2%) for haematuria, 24/951 (2.5%) for haematochezia, and 172/646 (26.6%) for haemoejaculate. Immediately after

Safety and efficacy of endoscopic retrograde cholangiopancreatography for common bile duct stones in liver cirrhotic patients.

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Li, De-min; Zhao, Jie; Zhao, Qiu; Qin, Hua; Wang, Bo; Li, Rong-xiang; Zhang, Min; Hu, Ji-fen; Yang, Min

2014-08-01

In order to investigate the safety and efficacy of endoscopic retrograde cholangiopancreatograpy (ERCP) in liver cirrhosis patients with common bile duct stones, we retrospectively analyzed data of 46 common bile duct stones patients with liver cirrhosis who underwent ERCP between 2000 and 2008. There were 12 cases of Child-Pugh A, 26 cases of Child-Pugh B, and 8 cases of Child-Pugh C. 100 common bile duct stones patients without liver cirrhosis were randomly selected. All the patients were subjected to ERCP for biliary stones extraction. The rates of bile duct clearance and complications were compared between cirrhotic and non-cirrhotic patients. The success rate of selective biliary cannulation was 95.6% in liver cirrhotic patients versus 97% in non-cirrhotic patients (P>0.05). The bile duct clearance rate was 87% in cirrhotic patients versus 96% in non-cirrhotic patients, but the difference was not statistically significant. Two liver cirrhotic patients (4.35%, 2/46) who were scored Child-Pugh C had hematemesis and melena 24 h after ERCP. The hemorrhage rate after ERCP in non-cirrhotic patients was 3%. The hemorrhage rate associated with ERCP in Child-Pugh C patients was significantly higher (25%, 2/8) than that (3%, 3/100) in non-cirrhotic patients (Pbile duct stones. Hemorrhage risk in ERCP is higher in Child-Pugh C patients.

Superior mesenteric arterial branch occlusion causing partial jejunal ischemia: a case report

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Van De Winkel Nele

2012-02-01

Full Text Available Abstract Introduction Ischemic bowel disease comprises both mesenteric ischemia and colonic ischemia. Mesenteric ischemia can be divided into acute and chronic ischemia. These are two separate entities, each with their specific clinical presentation and diagnostic and therapeutic modalities. However, diagnosis may be difficult due to the vague symptomatology and subtle signs. Case presentation We report the case of a 68-year-old Caucasian woman who presented with abdominal discomfort, anorexia, melena and fever. A physical examination revealed left lower quadrant tenderness and an irregular pulse. Computed tomography of her abdomen as well as computed tomography enterography, enteroscopy, angiography and small bowel enteroclysis demonstrated an ischemic jejunal segment caused by occlusion of a branch of the superior mesenteric artery. The ischemic segment was resected and an end-to-end anastomosis was performed. The diagnosis of segmental small bowel ischemia was confirmed by histopathological study. Conclusion Mesenteric ischemia is a pathology well-known by surgeons, gastroenterologists and radiologists. Acute and chronic mesenteric ischemia are two separate entities with their own specific clinical presentation, radiological signs and therapeutic modalities. We present the case of a patient with symptoms and signs of chronic mesenteric ischemia despite an acute etiology. To the best of our knowledge, this is the first report presenting a case of acute mesenteric ischemia with segmental superior mesenteric artery occlusion.

Acute Copper Sulfate Poisoning: Case Report and Review of Literature

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Mahesh Chand Meena

2014-09-01

Full Text Available Background: Copper sulfate ingestion is a relatively popular method for committing suicide in Indian subcontinent. It causes a high mortality rate, and so a growing concern has been raised to identify the severe alarming signs suggestive of poor prognosis and to improve treatment approaches. Case report: A 22-year-old unmarried man working as a painter was found unconscious at his friend residence. The patient developed hypotension, hemorrhagic gastroenteritis with hematemesis and melena, renal and hepatic failure, severe metabolic acidosis and intravascular hemolysis during admission at hospital. His signs were refractory to treatment with fluid replacement therapy, vasoactive drugs, antiemetic drugs, ranitidine, furosemide, methylene blue and 2,3 dimercaptopropane-1-sulphonate. He died six hours post-admission. In post-mortem examinations, there were multiple sub-pleural and sub-epicardial hemorrhages and the gastrointestinal mucosa was congested, hemorrhagic, and greenish blue in color. The liver, on histological examination, showed sub-massive hepatic necrosis. On toxicological analyses, copper sulfate was detected in preserved viscera and results for other heavy metals were negative. Conclusion: Hypotension, cyanosis, uremia and jaundice can be considered as signs of poor prognosis in copper sulfate poisoning. Copper sulfate ingestion is life-threatening due to its deleterious effects on the upper GI, kidneys, liver and blood. Having no time to waste, aggressive treatments should be immediately instituted and signs of poor prognosis should be kept in mind.

Clinical picture and treatment of complications of lower part of large intestine resulting from radiotherapy for intra-pelvic cancer

International Nuclear Information System (INIS)

Ikeda, Yoshihito; Sunagawa, Keishin; Matsumura, Shigejiro; Watanabe, Kenji; Masaoka, Yoshio

1976-01-01

The authors described clinical pictures and those treatments of 40 patients with complications of the lower part of the large intestine resulting from radiotherapy for cancer of the uterus, ovarium or the penis. As the radiotherapy, 60 Co-telecobalt (6,000-16,000R) and 60 Co-needle (1,000-8,568 mch) intracavitary irradiation were used alone or in combination. Findings in the complications of the lower part of the large intestine were classified into Grade I (13 cases), II (14), III (14), and IV (4) according to Sherman. The prodromal symptoms of the complications appeared in 2-6 months following the irradiation in more than a half of the patients, and it appeared within a year in most of the patients. Most of the patients complained about melena, anemia, proctagra, tenesmus and diarrhea. In the cases of Grade III, the symptoms of ileus such as constipation, abdominal distention, and abdominal pain appeared. Internal treatment was given principally, and preternal anus was made when frequent blood transfusion was required. Fourteen cases of those in Grade I and II recovered within 1-3 years. The cases which received proctostomy, including those who had bleeding, stricture and fistulation, had favorable prognosis. This result suggested that the radiotherapy for intra-pelvic cancer should be controlled to prevent further development of the complications in the rectum beyond Grade I. (Serizawa, K.)

Menetriere's disease associated with gastric adenocarcinoma in a child: imaging aspect

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Silva, Pedro Henrique Ramos Quintino da; Batista, Renan Pedroso; Rigo, Paula; Toma, Ricardo Katsuya; Oliveira, Luiz Antonio Nunes de; Suzuki, Lisa

2016-01-01

Female patient aged 18 years and 8 months, with diagnosis of hypertrophic gastritis since the age of 10, when she started having sporadic vomiting, weight loss, and anemia (Hb = 5.0 at diagnosis in August 2007). On her first upper gastrointestinal endoscopy (UGE) performed at the Instituto da Crianca (ICr) at HC-FMUSP, in August 2007, it was seem globally hypertrophied and swollen gastric mucosa, with an infiltrative lesion with ill-defined margins. A biopsy confirmed hyperplastic gastritis with a pattern of Menetrier's disease. Outpatient follow-up was initiated at Pediatric Gastroenterology Service of ICr in January 2008, with periodic clinical evaluation and UGE. The patient progressed in the following months with poor appetite and episodes of upper gastrointestinal bleeding and melena, requiring hospitalization in the city of origin and transfusions of blood concentrates. In the following years, she showed less recurrent episodes of bleeding than as seen in the first years after diagnosis, but continued undergoing serial UGEs for disease control and malignant surveillance, maintaining the same macroscopic and microscopic pattern. The patient has been submitted to extensive research for Helicobacter pylori in gastric biopsies, all with negative results, the same occurring with immunophenotyping for cytomegalovirus (CMV). Clinically, she continued to show poor weight gain, but with proper growth and no generalized edema at any time. (author)

An outbreak of aflatoxin poisoning in dogs associated with aflatoxin B1-contaminated maize products.

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Wouters, Angelica Terezinha Barth; Casagrande, Renata Assis; Wouters, Flademir; Watanabe, Tatiane Terumi Negrão; Boabaid, Fabiana Marques; Cruz, Cláudio Estêvão Farias; Driemeier, David

2013-03-01

An aflatoxicosis outbreak affected 65 dogs from 9 different farms after they were fed diets with cooked corn meal as a common ingredient. Of the dogs, 60 died. Numerous dogs died on additional farms, but those dogs were not included in the study. The farmers acquired the contaminated maize products, in the form of whole corn grain or as corn meal, from the same supplier. The corn product was mixed with meat that was left over from home or commercial rations to form corn polenta, which was fed to the dogs. Necropsy was performed on 3 dogs. Two of the dogs died after a few days of refusing food, showing anorexia, polydipsia, icteric mucous membranes, hematemesis, hematochezia, or melena, and bleeding of the skin, eye, ear, and mouth. The primary necropsy findings included jaundice, hemorrhages in several organs, and yellowish enlarged liver with enhanced lobular pattern. The dog that experienced chronic ascites had a yellowish liver with reduced volume, irregular surface, and increased consistency. The main histological findings included hepatocyte fatty degeneration, biliary duct hyperplasia, cholestasis and, in the chronic case, hepatic fibrosis. High-performance liquid chromatography analysis of the corn meal from 2 affected farms revealed 1,640 ppb and 1,770 ppb of aflatoxin B1, respectively. The current study demonstrates an additional way that dogs can be exposed to, poisoned, and killed by aflatoxin.

Menetriere's disease associated with gastric adenocarcinoma in a child: imaging aspect

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Silva, Pedro Henrique Ramos Quintino da; Batista, Renan Pedroso [Universidade de Sao Paulo (HC/FM/USP), Sao Paulo, SP (Brazil). Faculdade de Medicina; Rigo, Paula; Toma, Ricardo Katsuya; Oliveira, Luiz Antonio Nunes de; Suzuki, Lisa, E-mail: lisa.suzuki@gmail.com [Universidade de Sao Paulo (HC/FM/USP), Sao Paulo, SP (Brazil). Instituto da Crianca

2016-09-15

Female patient aged 18 years and 8 months, with diagnosis of hypertrophic gastritis since the age of 10, when she started having sporadic vomiting, weight loss, and anemia (Hb = 5.0 at diagnosis in August 2007). On her first upper gastrointestinal endoscopy (UGE) performed at the Instituto da Crianca (ICr) at HC-FMUSP, in August 2007, it was seem globally hypertrophied and swollen gastric mucosa, with an infiltrative lesion with ill-defined margins. A biopsy confirmed hyperplastic gastritis with a pattern of Menetrier's disease. Outpatient follow-up was initiated at Pediatric Gastroenterology Service of ICr in January 2008, with periodic clinical evaluation and UGE. The patient progressed in the following months with poor appetite and episodes of upper gastrointestinal bleeding and melena, requiring hospitalization in the city of origin and transfusions of blood concentrates. In the following years, she showed less recurrent episodes of bleeding than as seen in the first years after diagnosis, but continued undergoing serial UGEs for disease control and malignant surveillance, maintaining the same macroscopic and microscopic pattern. The patient has been submitted to extensive research for Helicobacter pylori in gastric biopsies, all with negative results, the same occurring with immunophenotyping for cytomegalovirus (CMV). Clinically, she continued to show poor weight gain, but with proper growth and no generalized edema at any time. (author)

Caracterización de pacientes con sangramiento digestivo alto Characterization of patients presenting with high digestive bleeding

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Jean Le'Clerc Nicolás

2010-06-01

Full Text Available INTRODUCCIÓN. El sangramiento digestivo alto continúa siendo un problema de salud, y junto al abdomen agudo, las heridas y los traumatismos es prácticamente la razón de ser de una guardia de cirugía. MÉTODOS. Se realizó un estudio observacional, descriptivo y de corte transversal, cuyo universo estuvo constituido por todos los pacientes con este diagnóstico ingresados en el Hospital Docente Clinicoquirúrgico «Joaquín Albarrán», entre enero del 2006 y diciembre del 2007 (2 años. RESULTADOS. Las edades más frecuentes estuvieron entre los 70 y 79 años, y fue más frecuente el sexo masculino y el antecedente de enfermedad cardiovascular. La melena fue la principal manifestación clínica. La endoscopia solo se realizó en el 25,16 % de los casos, y en ella se observó principalmente duodenitis y gastritis. Como medidas terapéuticas más comunes se practicaron la hidratación y el uso sondas de Levine. Solo el 20,48 % de los pacientes recibieron tratamiento contra Helicobacter pylori. La estadía hospitalaria promedio fue de 6 días o más. CONCLUSIONES. Las medidas generales de apoyo hemodinámico y la estrecha vigilancia de los pacientes pueden lograr salvaguardar sus vidas aunque no se disponga de un diagnóstico certero. La infección por Helicobacter pylori y su asociación a lesiones erosivas o ulcerosas de la mucosa gastroduodenal no ha sido totalmente asimilada en el pensamiento médico de los cirujanos. La función de la cirugía es cada vez menor en la terapéutica del sangramiento digestivo alto, a pesar de ser uno de los pilares fundamentales para enfrentarlo.INTRODUCTION. High digestive bleeding remains as health problem and together with acute abdomen, wounds and traumatisms is practically the main responsibility of a surgery rounds. METHODS. A cross-sectional, descriptive and observational study was conducted in a sample including all patients with this diagnosis admitted in "Joaquín Albarrán" Clinical Surgical

Urinary stone detection and characterisation with dual-energy CT urography after furosemide intravenous injection: preliminary results

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Botsikas, Diomidis; Hansen, Catrina; Stefanelli, Salvatore; Becker, Christoph D.; Montet, Xavier [Geneva University Hospital, Radiology Department, Geneva (Switzerland)

2014-03-15

To investigate the added advantage of IV furosemide injection and the subsequent urine dilution in the detection of urinary calculi in the excretory phase of dual-source dual-energy (DE) computed tomography (CT) urography, and to investigate the feasibility of characterising the calculi through diluted urine. Twenty-three urinary calculi were detected in 116 patients who underwent DECT urography for macroscopic haematuria with a split bolus two- or three-acquisition protocol, including a true unenhanced series and at least a mixed nephrographic excretory phase. Virtual unenhanced images were reconstructed from contrast-enhanced DE data. Calculi were recorded on all series and characterised based on their X-ray absorption characteristics at 100 kVp and 140 kVp in both true unenhanced and nephrographic excretory phase series. All calculi with a diameter more than 2 mm were detected in the virtual unenhanced phase and in the nephrographic excretory phase. Thirteen of these calculi could be characterised in the true unenhanced phase and in the mixed nephrographic excretory phase. The results were strictly identical for both phases, six of them being recognised as non-uric acid calculi and seven as uric acid calculi. Mixed nephrographic excretory phase DECT after furosemide administration allows both detection and characterisation of clinically significant calculi, through the diluted urine. (orig.)

Non-thrombocytopenic purpura in familial Mediterranean fever-comorbidity with Henoch-Schönlein purpura or an additional rare manifestation of familial Mediterranean fever?

Science.gov (United States)

Ben-Chetrit, Eldad; Yazici, Hasan

2016-07-01

Henoch-Schönlein purpura is a relatively common vasculitis mainly affecting children. It is characterized by purpuric skin rash, abdominal cramping, and haematuria. Skin biopsies taken from Henoch-Schönlein purpura lesions disclose perivascular IgA deposits. FMF is an autoinflammatory disease characterized by recurrent attacks of fever lasting 2-3 days which resolve spontaneously. Typical manifestations of the disease are peritonitis, pleuritis, pericarditis, arthritis and erysipelas-like erythema usually affecting the lower limbs. Over the years many reviews emphasized the clinical impression that Henoch-Schönlein purpura is more common among FMF patients than in healthy control population. In this review we summarize these reports and show that sometimes Henoch-Schönlein purpura associated with FMF differs from typical isolated Henoch-Schönlein purpura, and this is also the case with polyarteritis nodosa and SpA associated with FMF. It is suggested that these clinical manifestations (polyarteritis nodosa, Henoch-Schönlein purpura and SpA) should be considered to be associated with FMF as part of what we call FMF rather than as co-existing additional separate clinical entities. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Primary malignant melanoma of the female urethra: Report of a rare neoplasm of the urinary tract

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Namita Bhutani

Full Text Available Introduction: Melanoma is a malignant tumor that can affect any area of the anatomical economy. Its occurance in the female urethra is extremely rare. We report a case of primary malignant urethral melanoma developed in an elderly female patient. Presentation of case: A 70 years old female presented with dysuria, poor stream, gross haematuria, intermittent blood spots, and a painful mass. On physical examination, there were no suspicious lesions on the skin. On external genital examination, a lesion at the level of the urethral meatus was observed. The mass was removed by wide local excision under spinal anaesthesia. The pathological diagnosis was malignant melanoma of the urethra. Discussion: The common presentations include bleeding and/or discharge per urethra, voiding dysfunction and the presence of tumor mass. Survival depends on the stage, location and size of the neoplasm at the time of diagnosis. Despite major surgery, radiotherapy or immunotherapy; malignant melanoma usually has a poor prognosis. Conclusion: Melanoma of the female urethra is an extremely uncommon pathology leading to paucity of literature and any definite recommendations regarding management. The histological and immunohistochemical findings can be helpful in making an early and accurate diagnosis of malignant melanoma in the urogenital region. Keywords: Case report, Female urethral cancer, Immunohistochemistry, Malignant melanoma, Urethral neoplasm

Use of Flexible Cystoscopy to Insert a Foley Catheter over a Guide Wire in Spinal Cord Injury Patients: Special Precautions to be Observed.

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Vaidyanathan, Subramanian; Soni, Bakul; Singh, Gurpreet; Hughes, Peter; Oo, Tun

2011-01-01

When urethral catheterisation is difficult or impossible in spinal cord injury patients, flexible cystoscopy and urethral catheterisation over a guide wire can be performed on the bedside, thus obviating the need for emergency suprapubic cystostomy. Spinal cord injury patients, who undergo flexible cystoscopy and urethral catheterisation over a guide wire, may develop potentially serious complications. (1) Persons with lesion above T-6 are susceptible to develop autonomic dysreflexia during cystoscopy and urethral catheterisation over a guide wire; nifedipine 5-10 milligrams may be administered sublingually just prior to the procedure to prevent autonomic dysreflexia. (2) Spinal cord injury patients are at increased risk for getting urine infections as compared to able-bodied individuals. Therefore, antibiotics should be given to patients who get haematuria or urethral bleeding following urethral catheterisation over a guide wire. (3) Some spinal cord injury patients may have a small capacity bladder; in these patients, the guide wire, which is introduced into the urinary bladder, may fold upon itself with the tip of guide wire entering the urethra. If this complication is not recognised and a catheter is inserted over the guide wire, the Foley catheter will then be misplaced in urethra despite using cystoscopy and guide wire.

[KTP (green light) laser for the treatment of benign prostatic hyperplasia. Preliminary evaluation].

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Coz, Fernando; Domenech, Alfredo

2007-09-01

Photoselective vaporization of benign prostatic hyperplasia (BPH) is a minimally invasive technique, consisting of vaporization of prostatic tissue by KTP green light laser with a power of 80 W. The purpose of this study was to describe our experience with this technique. KTP laser photoselective vaporization was performed in 18 patients, with lower obstructive uropathy secondary to benign prostatic hyperplasia at Santiago Military hospital from December 2005. Preoperative characteristics, postoperative results and complications were recorded. Mean prostatic volume was 55 cc (range: 24 to 78). Mean operating time was 83 minutes (range: 40 to 120). In sixteen patients, the Foley catheter was removed before 24 hours. The mean preoperative AUA score was 22 and decreased to 11.4 after 30 days. The mean maximum preoperative urine flow rate was 9 ml/s and increased to 18.2; 22.1; 22.5; 25.3 and 27.2 ml/s on days 1, 7, 14, 21 and 30, respectively. Only minor complications were observed: delayed removal of the Foley catheter (11.1%), dysuria (16.6%) and late haematuria (11.1%). KTP laser photoselective vaporization of BPH is a safe technique, that is easy to learn, with good short-term functional results, associated with low complication rate.

Use of Flexible Cystoscopy to Insert a Foley Catheter over a Guide Wire in Spinal Cord Injury Patients: Special Precautions to be Observed

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Subramanian Vaidyanathan

2011-01-01

Full Text Available When urethral catheterisation is difficult or impossible in spinal cord injury patients, flexible cystoscopy and urethral catheterisation over a guide wire can be performed on the bedside, thus obviating the need for emergency suprapubic cystostomy. Spinal cord injury patients, who undergo flexible cystoscopy and urethral catheterisation over a guide wire, may develop potentially serious complications. (1 Persons with lesion above T-6 are susceptible to develop autonomic dysreflexia during cystoscopy and urethral catheterisation over a guide wire; nifedipine 5–10 milligrams may be administered sublingually just prior to the procedure to prevent autonomic dysreflexia. (2 Spinal cord injury patients are at increased risk for getting urine infections as compared to able-bodied individuals. Therefore, antibiotics should be given to patients who get haematuria or urethral bleeding following urethral catheterisation over a guide wire. (3 Some spinal cord injury patients may have a small capacity bladder; in these patients, the guide wire, which is introduced into the urinary bladder, may fold upon itself with the tip of guide wire entering the urethra. If this complication is not recognised and a catheter is inserted over the guide wire, the Foley catheter will then be misplaced in urethra despite using cystoscopy and guide wire.

Successful treatment of vaginal malakoplakia in a young cat

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Ryan P Cattin

2016-10-01

Full Text Available Case summary A 3-year-old, female, spayed, domestic shorthair cat presented for dysuria and haematuria, unresponsive to antibiotic treatment. A small, fleshy, erythematous mass protruded from the vaginal vault. Ultrasound identified a vaginal mass effect with mixed echogenicity measuring in excess of 3 cm. Vaginoscopy confirmed an extensive, fleshy, irregular mass that was characterised histologically as pyogranulomatous vaginitis, with periodic acid–Schiff-positive macrophages containing gram-negative bacteria. Fluorescence in situ hybridisation analysis demonstrated invasive intracellular Escherichia coli. Vaginal malakoplakia was diagnosed. Tissue culture and antimicrobial susceptibility of E coli was used to guide treatment. A 6 week course of enrofloxacin 5 mg/kg q24h resulted in complete resolution of the mass and clinical signs. Relevance and novel information Malakoplakia is a rare chronic inflammatory condition that has been previously reported in the bladder of two cats. The pathogenesis of malakoplakia is thought to involve ineffective killing of bacteria (eg. E coli , similar to granulomatous colitis in Boxers and French Bulldogs. The literature on malakoplakia in cats is sparse. This is the first reported feline case with vaginal involvement, intracellular E coli and successful treatment with a fluoroquinolone. Malakoplakia is an important, non-neoplastic differential diagnosis when a mass is identified in the urogenital system of a young cat.

An outbreak of schistosomiasis in travellers returning from endemic areas: the importance of rigorous tracing in peer groups exposed to risk of infection.

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Blach, Ola; Rai, Bhavan; Oates, Ken; Franklin, Grant; Bramwell, Steve

2012-03-01

Each year, schools across Scotland send their students on exchange programmes to Malawi. Between 2005 and 2009, 22.8% of Scotland's new cases of schistosomiasis were from freshwater exposure in Malawi, with 41.5% diagnosed in 15-24 year olds. In January 2011, a 17-year-old male presented to our urology department with visible haematuria following freshwater exposure during a school trip to Malawi. He was subsequently diagnosed with urinary schistosomiasis. The potential involvement of other individuals from the trip prompted further public health enquiry. The school, public health department and education authorities were notified promptly and all individuals potentially exposed to Schistosoma haematobium were invited for screening. All 21 participants of the exchange programme underwent serological screening. Thirteen tested positive for Schistosoma infection. Only two individuals displayed symptoms of schistosomiasis; the other 11 were asymptomatic. Infection rates, even following a limited exposure to S. haematobium, are high. The majority of seropositive cases may never have symptoms. Therefore, a history of foreign travel to endemic schistosomiasis areas should be sought from any young person presenting with visible heamaturia and appropriate tests instigated. Schools should adopt policies forbidding activities involving freshwater exposure in Malawi. Effective public health measures must be set in place to trace and treat any other possible cases of exposure.

The epidemiology and control of urinary schistosomiasis and soil-transmitted helminthiasis in schoolchildren on Unguja Island, Zanzibar.

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Stothard, J Russell; French, Michael D; Khamis, I Simba; Basáñez, María-Gloria; Rollinson, David

2009-10-01

As part of a 4-year control programme beginning in 2003 and entitled Piga Vita Kichocho, around 140,000 school-aged children on Unguja Island, Zanzibar were treated annually with a combination of praziquantel and albendazole. To provide information on the impact of this intervention, a subset of children, originating from 24 sentinel schools, were monitored in 2004, 2005 and 2006 using both parasitological and behavioural questionnaire methods. Overall, prevalence of urinary schistosomiasis fell by 52%, intensity by 55% and gross haematuria by 82%. There was a positive and statistically significant correlation between areas of elevated disease prevalence and areas of predicted high transmission based upon local occurrence of the permissive intermediate snail host. In areas of low transmission, urinary schistosomiasis was greatly reduced, but, by contrast, other intervention strategies are needed to complement and synergise with chemotherapy in high transmission areas. Whereas significant reductions were documented in the prevalence of both Trichuris trichiura and hookworm, prevalence of Ascaris lumbricoides significantly increased over the monitoring period. Through a detailed analysis of named child records, evidence of predisposition to helminth (re)infection and individual bias towards polyparasitism was detected, highlighting the often overlapping distribution of these parasites within the school-aged child.

A 3-year follow-up of a patient with acute renal failure caused by thrombotic microangiopathy related to antiphospholipid syndrome: case report.

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Zhou, X-J; Chen, M; Wang, S-X; Zhou, F-D; Zhao, M-H

2017-06-01

Background Microvascular manifestations of antiphospholipid antibody syndrome in the kidneys include acute renal failure, thrombotic microangiopathy and hypertension. Therapy has been largely empiric. Case report A 49-year-old Chinese man presented with anuric acute renal failure without abundant proteinuria and heavy haematuria, but markedly low levels of urinary sodium, potassium and chlorine upon admission. On day 1 of hospitalization, his thrombocytopenia, anaemia and renal failure showed rapid progression. The presence of lupus anticoagulant and vascular ischaemia of the small vessels in renal arteriography were also observed. Anticoagulants, continuous renal replacement therapy, glucocorticoids and six sessions of plasma exchange were started. After the fourth plasma exchange (on day 20), his urine output increased and began to normalize. On day 25, haemodialysis was stopped and his general condition gradually improved. A renal biopsy was subsequently performed, and the histopathological diagnosis was thrombotic microangiopathy due to antiphospholipid antibody syndrome. A further 3-year follow-up showed that his haemoglobin level, platelet count and serum creatinine were within the normal range, with stable blood pressure. Conclusion Treatment modalities such as anticoagulation, immunosuppression and plasma exchange are likely to be necessary when severe acute renal failure combined with thrombotic microangiopathy present in nephropathy of antiphospholipid antibody syndrome.

Xanthine urolithiasis in a cat: a case report and evaluation of a candidate gene for xanthine dehydrogenase.

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Tsuchida, Shuichi; Kagi, Akiko; Koyama, Hidekazu; Tagawa, Masahiro

2007-12-01

Xanthine urolithiasis was found in a 4-year-old spayed female Himalayan cat with a 10-month history of intermittent haematuria and dysuria. Ultrasonographs indicated the existence of several calculi in the bladder that were undetectable by survey radiographic examination. Four bladder stones were removed by cystotomy. The stones were spherical brownish-yellow and their surface was smooth and glossy. Quantitative mineral analysis showed a representative urolith to be composed of more than 95% xanthine. Ultrasonographic examination of the bladder 4.5 months postoperatively indicated the recurrence of urolithiasis. Analysis of purine concentration in urine and blood showed that the cat excreted excessive amounts of xanthine. In order to test the hypothesis that xanthinuria was caused by a homozygote of the inherited mutant allele of a gene responsible for deficiency of enzyme activity in purine degradation pathway, the allele composition of xanthine dehydrogenase (XDH) gene (one of the candidate genes for hereditary xanthinuria) was evaluated. The cat with xanthinuria was a heterozygote of the polymorphism. A single nucleotide polymorphism analysis of the cat XDH gene strongly indicated that the XDH gene of the patient cat was composed of two kinds of alleles and ruled out the hypothesis that the cat inherited the same recessive XDH allele suggesting no activity from a single ancestor.

Placement of retrievable self-expandable metallic stents with barbs into patients with obstructive prostate cancer.

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Song, Ho-Young; Kim, Choung Soo; Jeong, In Gab; Yoo, Dalsan; Kim, Jin Hyoung; Nam, Deok Ho; Bae, Jae-Ik; Park, Jung-Hoon

2013-03-01

To evaluate the technical feasibility and clinical effectiveness of retrievable self-expandable metallic stents with barbs in patients with obstructive prostate cancer. Retrievable self-expandable metallic stents with eight barbs each were inserted into eight consecutive patients with obstructive prostate cancer. Patient ages ranged from 55 to 76 years (mean, 69 years). All eight patients had previously received hormone therapy, and three had undergone palliative transurethral prostatectomy. Stents were removed using a 21-F stent removal set if they caused complications. Stent placement was technically successful and well tolerated in all patients. One had severe incontinence, which improved spontaneously, and two had gross haematuria, which disappeared spontaneously within 4 days. Peak urine flow rates and post-void residual urine volumes 1 month after stent placement were 5.6-10.2 ml/s (mean, 8.3 ml/s), and 5-45 ml (mean, 27 ml), respectively. During a mean follow-up of 192 days (range, 39-632 days), one patient required stent removal after 232 days because of stone formation within the stent. No further intervention was required because the mass improved after stent removal. These preliminary results suggest that retrievable stents with eight barbs are both feasible to place and effective in patients with obstructive prostate cancer.

A rare complication of ESWL: focal metastatic multiple organ abscesses in a horseshoe kidney.

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Kuyumcuoglu, Ugur; Eryildirim, Bilal; Tuncer, Murat; Faydaci, Gokhan; Aktoz, Tevfik; Akdere, Hakan; Sarıca, Kemal

2014-06-30

Extracorporeal shock wave lithotripsy (ESWL) is an effective treatment modality in the minimal invasive management of urinary system stone disease. Although the majority of the complications occuring after ESWL are minor (most common ones are gross haematuria, pain, perinephritic hematoma); bacteriuria may also occur in some cases which sometimes can lead to sepsis and even metastatic abscess formation in a very rare part of the cases treated. In this rare situation infection agent spreads quickly via hematogenous route and causes abscess formation in different parts of the body. Majority of such cases usually have an underlying systemic disease like diabetes mellitus (DM), malignancy, HIV or steroid use which lead to disruption of immune system functions. Abscess formation following ESWL is extremely rare and usually limited with some case reports published in the literature. Herein, we present a diabetic case with formation of multiple abscess foci in kidney, as well as in lungs and liver following ESWL. The patient was first admitted to our emergency department with high fever and respiratory distress and misdiagnosed as metastatic tumor foci based on radiologic findings. To the best of our knowledge, our case is the first one in the literature in whom simultanous abscess formation in multiple organ systems has been documented following an otherwise uneventful ESWL.

[The usefullness of percutaneous transluminal balloon angioplasty in the management of budd-Chiari syndrome].

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Kim, Se Hwan; Yu, Kyung Sool; Baek, Seung Min; Lee, Seung Yup; Kim, Hyun Su; Tak, Won Young; Kweon, Young Oh; Kim, Sung Kook; Choi, Yong Hwan; Chung, Joon Mo

2002-06-01

Membranous obstruction is the most common cause of Budd-Chiari syndrome in Orientals. Recently, percutaneous transluminal balloon angioplasty (PTBA) has been successfully applied as a treatment of membranous obstruction. We evaluated etiologies and clinical manifestations in our cases and the usefulness of PTBA. Twelve cases of Budd-Chiari syndrome were analyzed. 50.3 years was the average age of the cases (ranging from 37 to 67 years). Major symptoms or signs were superficial collateral vessels on the chest or the abdomen in 6 cases, ascites in 3, abdominal pain in 4, hepatomegaly in 4, splenomegaly in 3, melena or hematemesis in 2, and leg edema in 2. Upper gastrointestinal endoscopy showed esophageal varices in 6 cases and two of these 6 cases had gastric varices. Of 8 cases with liver cirrhosis, 4 were classified as Child-Pugh class A and 4 as B. Four patients with cirrhosis had concurrent hepatocellular carcinoma including 1 patient who was HBs Ag positive. Etiologies were membranous obstruction in 11 cases and protein C deficiency in 1 case. The main site of obstruction was IVC in 8 and hepatic vein in 4. PTBA was successfully performed in 8 cases of membranous obstruction. During the mean follow-up period of 27.6 months (12-40 months), there were no reobstructions except in 2 cases. The most common cause of Budd-Chiari syndrome in our cases was membranous obstruction of IVC. Percutaneous transluminal balloon angioplasty is a very useful treatment method.

Radiation proctitis and its surgical problems

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Ichikawa, Hideyuki; Hayashi, Shiro; Yasuna, Osamu; Yamaura, Yoshinori

1985-01-01

Radiation proctitis was investigated in terms of clinico-pathological findings, the method of treatment and therapeutic results in 11 patients (7 with cervical cancer, 1 with ovarian cancer, and 3 with cancer of the bladder). Four of the patients with cervical cancer were treated with 4,136-5,000 rad of WCo combined with brachytherapy of WCo or TXCs, one patient with 6,000 rad of WCo alone, one with 3,000 rad of x-ray alone, and one with 4,900 rad of x-ray combined with brachytherapy of TXCs. A patient with ovarian cancer was treated with 6,000 rad of x-ray and three patients with cancer of the bladder were treated with 4,200-6,330 rad of x-ray. Radiation proctitis developed early (4 months to 1 year after therapy) in 8 patients and late (4 years to 19 years after therapy) in the other 3 patients. Common symptoms were melena, constipation and sensation of gastric fullness. According to the Sherman's classification, proctitis was grade III or IV (showing constriction, ulcer or fistula) in all patients. Although the lesion could be resected in one patient, only colostomy was performed in the other 10 patients. It is recommended that care should be taken in deciding the method of exposure to the pelvic viscera and exposure doses for the prevention of radiation proctitis, and that intestinal lesions should be resected before far-advanced intestinal disturbance developes. (Namekawa, K.).

Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

International Nuclear Information System (INIS)

Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo

2012-01-01

Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

Percutaneous transhepatic stent placement in the management of portal venous stenosis after curative surgery for pancreatic and biliary neoplasms.

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Kim, Kyung Rae; Ko, Gi-Young; Sung, Kyu-Bo; Yoon, Hyun-Ki

2011-04-01

The purpose of this study was to evaluate the efficacy and safety of stent placement in the management of portal venous stenosis after curative surgery for pancreatic and biliary neoplasms. From September 1995 to April 2007, percutaneous transhepatic portal venous stent placement was attempted in 19 patients with postoperative portal venous stenosis. Portal venous stenosis was a complication of surgery in 11 patients and caused by tumor recurrence in eight patients. The clinical manifestations were ascites, hematochezia, melena, esophageal varices, and abnormal liver function. Stents were placed in the stenotic or occluded lesions after percutaneous transhepatic portography. Technical and clinical success, stent patency, and complications were evaluated. Stent placement was successful in 18 patients (technical success rate, 95%). Clinical manifestations improved in 16 patients (clinical success rate, 84%). The mean patency period among the 18 patients with technical success was 21.3 ± 23.2 months. The mean patency period of the benign stenosis group (30.1 ± 25.6 months) was longer than that of the tumor recurrence group (7.3 ± 7.7 months), and the difference was statistically significant (p = 0.038). There were two cases of a minor complication (transient fever) and three cases of major complications (septicemia, liver abscess, and acute portal venous thrombosis). Percutaneous transhepatic stent placement can be safe and effective in relieving portal venous stenosis after curative surgery for pancreatic and biliary neoplasms. Patients with benign stenosis had more favorable results than did those with tumor recurrence.

Clinical, clinicopathologic, radiographic, and ultrasonographic abnormalities in dogs with fatal acute pancreatitis: 70 cases (1986-1995)

International Nuclear Information System (INIS)

Hess, R.S.; Saunders, H.M.; Van Winkle, T.J.; Shofer, F.S.; Washabau, R.J.

1998-01-01

To determine clinical, clinicopathologic, radiographic, ultrasonographic, and coagulation abnormalities in dogs in which acute pancreatitis was fatal. Retrospective study. 70 dogs. History, clinical signs, and physical examination findings at the time of initial evaluation at the veterinary teaching hospital; results of pretreatment laboratory tests, abdominal radiography, and ultrasonography; and histologic abnormalities were obtained from medical records. Clinical signs included anorexia, vomiting, Weakness, diarrhea, polyuria and polydipsia, neurologic abnormalities, melena, weight loss, hematemesis, and passage of frank blood in feces. At the time of initial examination at the veterinary teaching hospital, 68 (97%) dogs were dehydrated, 18 (26%) were icteric, 22 (32%) were febrile, 40 (58%) had signs of abdominal pain, and 30 (43%) were classified as overweight or obese. Most dogs had leukocytosis, neutrophilia with a left shift, and thrombocytopenia. Various serum biochemical abnormalities were identified, including hypoglycemia, azotemia, hypercalcemia and other electrolyte abnormalities, hypoalbuminemia, high hepatic and pancreatic enzyme activities, hypercholesterolemia, and lipemia. For 17 of 28 (61%) dogs, results of coagulation function tests were abnormal. Results of abdominal ultrasonography and radiography were consistent with a diagnosis of acute pancreatitis in 23 of 34 (68%) and 10 of 41 (24%) dogs, respectively. For 2 dogs, results of abdominal ultrasonography were not suggestive of acute pancreatitis, but results of abdominal radiography were. Clinical signs and results of clinicopathologic tests are inconsistent. Abdominal ultrasonography may be valuable in the diagnostic evaluation of dogs suspected to have acute pancreatitis

Evaluation of Superselective Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate in Treating Lower Gastrointestinal Bleeding: A Retrospective Study on Seven Cases

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Yuan Zhao

2016-01-01

Full Text Available Background. To investigate the safety and efficacy of superselective transcatheter arterial embolization (TAE with n-butyl cyanoacrylate (NBCA in treating lower gastrointestinal bleeding caused by angiodysplasia. Methods. A retrospective study was performed to evaluate the clinical data of the patients with lower gastrointestinal bleeding caused by angiodysplasia. The patients were treated with superselective TAE with NBCA between September 2013 and March 2015. Angiography was performed after the embolization. The clinical signs including melena, anemia, and blood transfusion treatment were evaluated. The complications including abdominal pain and intestinal ischemia necrosis were recorded. The patients were followed up to evaluate the efficacy in the long run. Results. Seven cases (2 males, 5 females; age of 69.55±2.25 were evaluated in the study. The embolization was successfully performed in all cases. About 0.2–0.8 mL (mean 0.48±0.19 mL NCBA was used. Immediate angiography after the embolization operation showed that the abnormal symptoms disappeared. The patients were followed up for a range of 2–19 months and six patients did not reoccur. No serious complications, such as femoral artery puncture point anomaly, vascular injury, and intestinal necrosis perforation were observed. Conclusion. For the patients with refractory and repeated lower gastrointestinal hemorrhage due to angiodysplasia, superselective TAE with NBCA seem to be a safe and effective alternative therapy when endoscopy examination and treatment do not work.

Prospective study of cardiac troponin I release in patients with upper gastrointestinal bleeding.

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Iser, David M; Thompson, Alexander J V; Sia, Koon Ket; Yeomans, Neville D; Chen, Robert Y M

2008-06-01

The rate of cardiac injury in upper gastrointestinal hemorrhage is unclear. The aims of this study were to determine prospectively the risk of cardiac troponin I release and associated adverse cardiac events in patients with acute upper gastrointestinal hemorrhage. From January to September 2003, we prospectively studied patients with documented hematemesis and melena referred to the gastroenterology unit in a tertiary teaching hospital in Melbourne, Australia. Serial assays for cardiac troponin I were performed at 0, 12 and 24 h. Serial creatine kinase levels and electrocardiographs were also performed. Clinical and biochemical data were collected. The primary endpoint was a troponin level >0.5 microg/L within 24 h of recruitment. Various clinical variables were then compared between the groups of patients with or without troponin rise. A total of 156 patients were included in the study. The mean age was 67 years (range 19-96). There were 104 (67%) male patients. A troponin level of greater than 0.5 microg/L was found in 30/156 (19%); 126 (81%) patients had normal troponin levels. Age greater than 65 years, signs of hemodynamic instability at presentation, a recent history of cardiac disease, cardiovascular compromise following endoscopy, and re-bleeding were associated with troponin release. Upper gastrointestinal bleeding is associated with a risk of cardiac injury of up to 19%. Troponin assay could be used to screen for cardiac damage, especially in elderly patients who present with hemodynamic instability.

A rare case of digestive hemorrhage in an elderly patient: diagnosis and treatment difficulties.

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Jinga, Mariana; Jurcuţ, C; Vasilescu, Florina; Becheanu, G; Stancu, Simona Hildegard; Ciobaca, L; Mircescu, G; Jinga, V

2012-01-01

Abdominal pain represents one of the most common clinical conditions. However, there are some challenging cases in which an extensive work-up is mandatory for the diagnosis. We present the case report of a 65-year-old man admitted to our department for diffuse abdominal pain, nausea, vomiting, diarrhea, painful joints and rectal tenesmus. He initially had an urticarial rash, followed by palpable purpura involving the lower extremities. The diarrheic stools evolved towards melena. Endoscopic examination of the upper gastrointestinal tract showed hiatal hernia, superficial erosions in the stomach and multiple areas of deep and superficial ulcerations disseminated from the second to the third portion of the duodenum. Terminal ileum intubation at colonoscopy showed redness, edema, swelling, petechiae and ecchymosis, irregular erosions and ulcers. Endoscopic biopsy specimens showed non-specific inflammation. Computed tomography showed moderate ascites, small pleural effusion, mesenteric lymphadenopathy and small bowel wall thickening at the level of the second duodenum, proximal jejunum and segments of ileum. The urine analysis revealed microscopic hematuria with nephrotic range proteinuria, red cells and cellular casts. Therapy with corticosteroids and pulses of cyclophosphamide was started with significant clinical improvement. Three weeks after the first admission, the patient developed an acute peritonitis due to an intestinal perforation and acute mesenteric ischemia of the small bowel. We concluded that the patient had a Henoch-Schönlein type vasculitis with acute mesenteric ischemia and perforation of the small bowel.

Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

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Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

2012-03-15

Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

PROPOSAL OF A CLINICAL CARE PATHWAY FOR THE MANAGEMENT OF ACUTE UPPER GASTROINTESTINAL BLEEDING.

Science.gov (United States)

Franco, Matheus Cavalcante; Nakao, Frank Shigueo; Rodrigues, Rodrigo; Maluf-Filho, Fauze; Paulo, Gustavo Andrade de; Libera, Ermelindo Della

2015-12-01

Upper gastrointestinal bleeding implies significant clinical and economic repercussions. The correct establishment of the latest therapies for the upper gastrointestinal bleeding is associated with reduced in-hospital mortality. The use of clinical pathways for the upper gastrointestinal bleeding is associated with shorter hospital stay and lower hospital costs. The primary objective is the development of a clinical care pathway for the management of patients with upper gastrointestinal bleeding, to be used in tertiary hospital. It was conducted an extensive literature review on the management of upper gastrointestinal bleeding, contained in the primary and secondary information sources. The result is a clinical care pathway for the upper gastrointestinal bleeding in patients with evidence of recent bleeding, diagnosed by melena or hematemesis in the last 12 hours, who are admitted in the emergency rooms and intensive care units of tertiary hospitals. In this compact and understandable pathway, it is well demonstrated the management since the admission, with definition of the inclusion and exclusion criteria, passing through the initial clinical treatment, posterior guidance for endoscopic therapy, and referral to rescue therapies in cases of persistent or rebleeding. It was also included the care that must be taken before hospital discharge for all patients who recover from an episode of bleeding. The introduction of a clinical care pathway for patients with upper gastrointestinal bleeding may contribute to standardization of medical practices, decrease in waiting time for medications and services, length of hospital stay and costs.

Carcinoma basalóide escamoso: uma forma rara e agressiva de câncer do esôfago e revisão da literatura Basaloid squamous carcinoma of the esophagus: a rare and aggressive form of esophageal cancer and literature review

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Maria Aparecida Coelho de Arruda Henry

2007-03-01

Full Text Available RACIONAL: O carcinoma basalóide escamoso ocorre com maior freqüência no trato aerodigestivo superior e raramente acomete o esôfago. OBJETIVO: Apresentar os aspectos clínico-patológicos e os atributos imunoistoquímicos de um paciente com carcinoma basalóide escamoso do esôfago. RELATO DO CASO: Dos 134 pacientes com câncer do esôfago atendidos no Hospital Universitário de Botucatu-Unesp, São Paulo, de 1990 a 1999, somente um paciente (0,74% apresentou carcinoma basalóide escamoso do esôfago. Tratava-se de paciente masculino, 41 anos, branco, lavrador com disfagia, regurgitação e emagrecimento há três meses. Referia tabagismo e etilismo há muitos anos. O esofagograma e o exame endoscópico revelaram lesão vegetante no terço distal do esôfago. A biópsia demonstrou neoplasia intraepitelial de alto grau associada a blocos de células basalóides que infiltravam o cório da mucosa, caracterizando o carcinoma basalóide escamoso. Os marcadores imunoistoquímicos foram positivos para o antígeno carcinoembriônico e para citoceratinas de alto peso molecular. A tomografia computadorizada revelou múltiplas metástases nos pulmões, fígado, e nódulos linfáticos regionais, documentando a fase avançada de evolução da doença. O tratamento consistiu apenas na realização de gastrostomia. O paciente apresentou queda acentuada do estado geral e evoluiu para óbito com quadro de melena quatro meses após o diagnóstico. CONCLUSÃO: O carcinoma basalóide escamoso é uma forma rara e agressiva de câncer do esôfago e o prognóstico depende do estadiamento da lesão e das condições clínicas do paciente no momento do diagnóstico.BACKGROUND: Basaloid squamous carcinoma is more frequently found in the upper aerodigestive tract, being rarely found in the esophagus. AIM: To present the pathological and clinical aspects, as well as immunhistochemical attributes of a basaloid squamous carcinoma of the esophagus patient. CASE REPORT: Of

Trombosis portal y mesentérica asociada al déficit de la proteína S Portal and mesenteric thrombosis associated with protein S deficiency

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J. A. Chirinos Vega

2008-02-01

Full Text Available Introducción: la causa más frecuente de trombosis portal (TP es la cirrosis hepática, mientras que los estados hipercoagulables son raramente identificados como etiología de la TP. Presentamos un caso de TP y mesentérica secundaria al déficit de la proteína S (pS. Caso clínico: paciente mujer de 74 años, que debuta con dolor abdominal difuso de 2 semanas de evolución y hemorragia digestiva alta tipo melena secundaria a varices esofágicas. En el estudio se objetiva un hígado heterogéneo, esplenomegalia y ascitis, así como una trombosis portal completa no oclusiva del hilio hepático y de sus ramas y de la vena mesentérica superior con circulación colateral. El estudio etiológico de hepatopatía fue negativo, incluyendo una biopsia hepática que mostraba cambios arquitecturales secundarios al flujo hemático disminuido compatible con hipertensión portal no cirrótica. El estudio de hipercoagulabilidad fue positivo para un déficit de proteína S. pS libre 56%, pS total 107%. Desde entonces se inició tratamiento anticoagulante sin presentar descompensaciones posteriores. Discusión: la trombosis portal suele manifestarse con síntomas inespecíficos, siendo la forma de presentación más frecuente la hemorragia digestiva alta como el caso que nos ocupa. La cirrosis es una de las causas más frecuentes de trombosis portal, sin embargo existe hasta un 65% de estos pacientes que tienen una enfermedad protrombótica asociada, como es el déficit de proteína S. Nuestro caso remarca la importancia de realizar estudios de factores trombogénicos en pacientes con TP, incluso cuando la etiología se puede atribuir a una cirrosis.Introduction: liver cirrhosis is the main cause of portal thrombosis (PT, while hypercoagulability syndromes are rarely found as the etiology of PT. We report a case of portal and mesenteric thrombosis secondary to protein S deficiency. Case report: a 74-year-old woman was admitted with melena secondary to upper

Unsuspected urological anomalies in asymptomatic cryptorchid boys

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Pappis, C.H.; Argianas, S.A.; Bousgas, D.; Athanasiades, E.; Pendeli Children's Hospital, Athens

1988-01-01

In a period of 6 years 144 asymptomatic boys with cryptorchidism, of mean age 7 ± SD 3.5 years, underwent orchiopexy. None of these boys referred to a history of a known urological anomaly, urinary tract infection haematuria, palpable mass in the renal region, bladder extrophy, epispadias, hypospadias or anorectal malformation. On the third day after orchiopexy an intravenous pyelography was done in every boy following testicular protection against irradiation. Ultrasonic investigation was not available at that time. There were minor urological abnormalities in 36 (25%) boys and major ones in 8 (5.5%) boys. A major anomaly is defined as one resulting in significant loss of renal substance (one case of single kidney and three cases of unilateral renal hypoplasia), or requiring surgical correction for conservation of the renal substance (one case of ureterocele, two cases of pelviureteric stenosis and one case of vesicoureteric stenosis with ipsilateral hydronephrosis). The unsuspected major urological abnormalities are usually ipsilateral to the more undescended testis. They may be associated with a hernia and are more frequent in bilateral cryptorchidism. In conclusion we encourage the routine use of IVP, or ultrasonic investigation or dynamic renal scanning (99 mTc -DTPA), if it is possible, in all patients undergoing orchiopexy for the detection of an unsuspected major renal anomaly. (orig.)

Anti-proteinase 3 antibodies in diffuse systemic sclerosis (SSc with normotensive renal impairment: is it suggestive for an overlapping between SSc and idiopathic vasculitis?

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V. Campanella

2011-09-01

Full Text Available Objective. To test the prevalence of anti-neutrophil cytoplasmic antibodies (ANCA in systemic sclerosis (SSc and to verify a possible association of ANCA with normotensive renal involvement in SSc. Patients and methods: 51 patients affected by SSc, 35 with diffuse scleroderma (dSSc and 16 with limited scleroderma (lSSc, were tested for ANCA by indirect immunofluorescence (IIF on human ethanol and formalin-acetone-fixed granulocytes (before and after DNase treatment, by conventional enzyme linked immuno-sorbent assay (ELISA and by capture-ELISA. Results. Six out of 51 selected SSc patients had ANCA by IIF (11.7% and five presented a perinuclear/nuclear atypical ANCA pattern. In all cases we only found anti-proteinase3 (aPR3 antibodies. All ANCA positive patients had diffuse form of SSc (17.1%, all were anti-Scl70 positive (aScl70, five patients had proteinuria, three had microscopic haematuria. All ANCA positive patients were normotensive with normal renin plasma levels, the mean erythrocyte sedimentation rate (ESR was higher in this group compared to the other SSc patients. Conclusions. Our study shows that aPR3 is not rare in dSSc. According to the clinical and serological findings and to the recent literature, we can hypothesise that when ANCA are found in SSc, an overlapping of scleroderma with systemic necrotizing vasculitis should be suspected.

Non-Hodgkin's lymphoma presenting as a primary bladder tumor: a case report

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Molinos-Castro Sonia

2010-04-01

Full Text Available Abstract Introduction Primary lymphoma of the bladder represents 0.2% of all bladder malignancies. Secondary involvement of the bladder by malignant lymphoma occurs in 10% to 50% of cases. Most lymphomas of the bladder are non-Hodgkin's lymphomas of the B-cell type, with preponderance among women. The impact of positron emission tomography (PET on tumor staging has recently become very important due to its use in the study of diagnosis extension and individual therapy design. Case presentation We report the case of a 79-year-old Caucasian man with intermittent haematuria as the presenting symptom of non-Hodgkin's lymphoma of the bladder. He was first diagnosed with primary lymphoma of the bladder using the current staging method, but a positron emission tomography study subsequently revealed that he instead had a secondary involvement of the bladder. Conclusion The staging of non-Hodgkin's lymphomas, which is useful in order to plan accurate therapy, has been changing since the introduction of positron emission tomography scanning. Primary lymphomas of the bladder, although very rare, may be even more uncommon when this imaging technique is used to assess the extension of the disease. Although the interpretation of this technique has some limitations that should be taken into account, the extensive use of positron emission tomography should nonetheless help improve the diagnosis of this disease.

Careful assessment key in managing prostatitis.

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Gujadhur, Rahul; Aning, Jonathan

2015-04-01

Prostatitis is a common condition estimated to affect up to 30% of men in their lifetime, it is most prevalent in men aged between 35 and 50. Prostatitis is subclassified into: acute bacterial prostatitis, chronic bacterial prostatitis, chronic pelvic pain and asymptomatic inflammatory prostatitis. Acute bacterial prostatitis presents with acute onset pelvic pain which may or may not be related to voiding, lower urinary tract symptoms, sometimes haematuria or haematospermia and systemic symptoms such as fever and rigors. A documented history of recurrent urinary tract infections is the key feature of chronic bacterial prostatitis. Duration of symptoms > 3 months defines chronicity. The key symptom of chronic pelvic pain syndrome is pain. Patients may describe pain during or after ejaculation as their predominant symptom. Clinical assessment includes a thorough history and examination. A digital rectal examination should be performed after a midstream urine (MSU) sample has been collected for urine dipstick, microscopy and culture. The prostate should be checked for nodules. In acute bacterial prostatitis the MSU is the only laboratory investigation required. Chronic pelvic pain syndrome may be multifactorial and part of a more generalised pain disorder. Pelvic floor muscle abnormalities, altered neuroendocrine pathways, chemically induced inflammation, bacterial infection, autoimmune processes, dysfunctional voiding as well intraprostatic ductal reflux mechanisms have all been identified in men with chronic pelvic pain syndrome.

Problems in early diagnosis of bladder cancer in a spinal cord injury patient: Report of a case of simultaneous production of granulocyte colony stimulating factor and parathyroid hormone-related protein by squamous cell carcinoma of urinary bladder

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Singh Gurpreet

2002-08-01

Full Text Available Abstract Background Typical symptoms and signs of a clinical condition may be absent in spinal cord injury (SCI patients. Case presentation A male with paraplegia was passing urine through penile sheath for 35 years, when he developed urinary infections. There was no history of haematuria. Intravenous urography showed bilateral hydronephrosis. The significance of abnormal outline of bladder was not appreciated. As there was large residual urine, he was advised intermittent catheterisation. Serum urea: 3.5 mmol/L; creatinine: 77 umol/L. A year later, serum urea: 36.8 mmol/l; creatinine: 632 umol/l; white cell count: 22.2; neutrophils: 18.88. Ultrasound: bilateral hydronephrosis. Bilateral nephrostomy was performed. Subsequently, blood tests showed: Urea: 14.2 mmol/l; Creatinine: 251 umol/l; Adjusted Calcium: 3.28 mmol/l; Parathyroid hormone: A repeat ultrasound scan demonstrated a tumour arising from right lateral wall; biopsy revealed squamous cell carcinoma. In view of persistently high white cell count and high calcium level, immunohistochemistry for G-CSF and PTHrP was performed. Dense staining of tumour cells for G-CSF and faintly positive staining for C-terminal PTHrP were observed. This patient expired about five months later. Conclusion This case demonstrates how delay in diagnosis of bladder cancer could occur in a SCI patient due to absence of characteristic symptoms and signs.

ECIL guidelines for the prevention, diagnosis and treatment of BK polyomavirus-associated haemorrhagic cystitis in haematopoietic stem cell transplant recipients.

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Cesaro, Simone; Dalianis, Tina; Hanssen Rinaldo, Christine; Koskenvuo, Minna; Pegoraro, Anna; Einsele, Hermann; Cordonnier, Catherine; Hirsch, Hans H

2018-01-01

To define guidelines for BK polyomavirus (BKPyV)-associated haemorrhagic cystitis (BKPyV-HC) after paediatric and adult HSCT. Review of English literature and evidence-based recommendations by expert consensus. BKPyV-HC occurs in 8%-25% of paediatric and 7%-54% of adult recipients undergoing allogeneic HSCT. Diagnosis requires the triad of cystitis, macro-haematuria and high urine BKPyV loads >7 log10 copies/mL, and exclusion of other relevant aetiologies. BKPyV viraemia is frequent and may serve as a more specific semiquantitative follow-up marker. No randomized controlled trials are available to inform antiviral prophylaxis or treatment. However, hyper-hydration and/or bladder irrigation showed limited prophylactic value. Fluoroquinolones are not effective for prophylaxis or treatment, but rather increase antibiotic resistance. Hyperbaric oxygen or fibrin glue is marginally effective based on small case series from correspondingly equipped centres. Although cidofovir has been reported to improve and/or reduce BKPyV viraemia or viruria, the current data do not support its regular use. BKPyV-HC remains a disabling unmet clinical need in HSCT that requires novel approaches supported by proper clinical trials. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A rare complication of ESWL: Focal metastatic multiple organ abscesses in a horseshoe kidney

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Ugur Kuyumcuoglu

2014-06-01

Full Text Available Extracorporeal shock wave lithotripsy (ESWL is an effective treatment modality in the minimal invasive management of urinary system stone disease. Although the majority of the complications occuring after ESWL are minor (most common ones are gross haematuria, pain, perinephritic hematoma; bacteriuria may also occur in some cases which sometimes can lead to sepsis and even metastatic abscess formation in a very rare part of the cases treated. In this rare situation infection agent spreads quickly via hematogenous route and causes abscess formation in different parts of the body. Majority of such cases usually have an underlying systemic disease like diabetes mellitus (DM, malignancy, HIV or steroid use which lead to disruption of immune system functions. Abscess formation following ESWL is extremely rare and usually limited with some case reports published in the literature. Herein, we present a diabetic case with formation of multiple abscess foci in kidney, as well as in lungs and liver following ESWL. The patient was first admitted to our emergency department with high fever and respiratory distress and misdiagnosed as metastatic tumor foci based on radiologic findings. To the best of our knowledge, our case is the first one in the literature in whom simultanous abscess formation in multiple organ systems has been documented following an otherwise uneventful ESWL.

Dosimetry, clinical factors and medication intake influencing urinary symptoms after prostate radiotherapy: An analysis of data from the RADAR prostate radiotherapy trial

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Yahya, Noorazrul; Ebert, Martin A.; Bulsara, Max; Haworth, Annette; Kennedy, Angel; Joseph, David J.; Denham, Jim W.

2015-01-01

Purpose/objective: To identify dosimetry, clinical factors and medication intake impacting urinary symptoms after prostate radiotherapy. Material and methods: Data describing clinical factors and bladder dosimetry (reduced with principal component (PC) analysis) for 754 patients treated with external beam radiotherapy accrued by TROG 03.04 RADAR prostate radiotherapy trial were available for analysis. Urinary symptoms (frequency, incontinence, dysuria and haematuria) were prospectively assessed using LENT-SOMA to a median of 72 months. The endpoints assessed were prevalence (grade ⩾1) at the end of radiotherapy (representing acute symptoms), at 18-, 36- and 54-month follow-ups (representing late symptoms) and peak late incidence including only grade ⩾2. Impact of factors was assessed using multivariate logistic regression models with correction for over-optimism. Results: Baseline symptoms, non-insulin dependent diabetes mellitus, age and PC1 (correlated to the mean dose) impact symptoms at >1 timepoints. Associations at a single timepoint were found for cerebrovascular condition, ECOG status and non-steroidal anti-inflammatory drug intake. Peak incidence analysis shows the impact of baseline, bowel and cerebrovascular condition and smoking status. Conclusions: The prevalence and incidence analysis provide a complementary view for urinary symptom prediction. Sustained impacts across time points were found for several factors while some associations were not repeated at different time points suggesting poorer or transient impact

Urinary lithiasis and urinary tract malformations in children: A retrospective study of 34 cases

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Jamila Chahed

2011-01-01

Full Text Available Background: Although the association of urinary lithiasis and urinary tract malformation is not rare, their management poses challenges. The aim of this study was to evaluate the relationship between urolithiasis and malformations of the urinary system. There were 34 patients (19 males and 15 females with a mean age of 4.8 years (range, 2 months to 14 years. All patients had urinary lithiasis with a urinary tract malformation. Abdominal pain was the most frequent clinical symptom (38%. Urinary infection was found in 7 patients (21% and macroscopic haematuria was present in 10 patients (29%. The most frequent urinary tract malformations were megaureter (8 cases, uretero-pelvic junction obstruction (7 cases and vesico-ureteric reflux (8 cases, but its malformative origin could not be confirmed. Treatment consisted of lithiasis extraction in 32 cases associated with specific treatment of the uropathy in 27 cases. Postoperative outcome was uneventful in all cases. In fact, urinary lithiasis and urinary tract malformation association is not rare. Indeed, 9-34% of urinary lithiasis are noted to be associated with urinary tract malformation. Positive diagnosis relies specifically on kidney ultrasound, intravenous urography, and urethrocystography. Treatment depends on the type of urinary tract malformation, localisation and size of the urinary lithiasis. Conclusion: In conclusion, urinary lithiasis and urinary tract malformation association is a frequent eventuality. Surgical intervention is the usual mode of treatment.

Mucosa associated lymphoid tissue (MALT lymphoma) of the urinary bladder: a case report

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Tsang, T.; Masters, J.; Chan, K.; Jose, C.

2003-01-01

Full text: Mucosa associated lymphoid tissue (MALT lymphoma) of the urinary bladder is a rare condition. The best treatment approach for this disease is controversial. A case report on a patient with MALT lymphoma of the urinary bladder. The relevant current literature was reviewed. A 79 year old lady presented with haematuria in 2002. Ultrasound of the pelvis showed a large tumour in the bladder. Cystoscopy revealed a mass arising from the bladder. Transurethral resection of the tumour was performed. Histology showed Non Hodgkin's lymphoma of MALT type. CT showed a 8.9 X 7.6 cm solid tumour involving almost whole of the bladder. The patient could not tolerate anti helicobacter treatment and was then treated with radiotherapy. The pelvis was treated with 18 MV photons with a 3 field technique in 2 phases, with CT planning. In phase 1, the pelvis was treated to 24 Gy in 12 fractions, over 2.5 weeks. Phase 2 was treated to a reduced pelvic field, to a dose of 16 Gy in 8 fractions over 1.5 weeks. Five months after radiotherapy, repeat cystoscopy and biopsy of bladder base showed no evidence of malignancy. MALT lymphoma of the urinary bladder responds well to radiotherapy and permits bladder preservation. The current literature in management of MALT lymphoma of urinary bladder is reviewed

Assessment of Extracorporeal Shock Wave Lithotripsy (ESWL) Therapeutic Efficiency in Urolithiasis.

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Tomescu, P; Pănuş, A; Mitroi, G; Drăgoescu, O; Stoica, L; Dena, S; Enache, E

2009-01-01

Extracorporeal shock wave lithotripsy (ESWL) revolutionized the treatment of urolithiasis and gradually became the favorite treatment option so that today it is considered to be the first line of treatment for more than 75% of the patients with urolithiasis. The purpose of this study was the assessment of the therapeutic efficiency, complications and limitations of ESWL in urolithiasis in the initial experience using a third generation electromagnetic lithotripter.  Between 2007 and 2008 we performed ESWL for 167 patients with urolithiasis. We recorded 92 patients with single stone (55.1%) and 72 with multiple lithiasis (44.9%). Stone size varied between 7 and 24 mm with an average of 12.3±7.1 mm. Radioopac stones were found in 104 patients (62.3%) while radiolucent stones in 63 only (37.6%).    Complete stone disintegration and clearance was achieved in most cases (86.2%). Complications were mostly minor and rare (transitory haematuria, renal colic). Severe complications (renal hematoma, steinstrasse) were diagnosed for a limited number of patients (3.6%) and their management was mostly nonsurgical or minimally invasive (retrograde ureteroscopy). ESWL is therefore the first line of treatment for urolithiasis with stone size smaller than 2.5 cm. It has an efficiency rate above 85%, low procedure time, high safety and good tolerability (new generation lithotripters do not require anesthesia) and minimal complications.

Treatment of lower ureteric stones by ESWL and ICPL: a comparative study.

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Islam, M S; Shameem, I A; Alam, A K M K; Kibria, S A M G

2005-12-01

This study was carried-out to find-out better and effective treatment option for Lower Ureteric Stones (LUS) by comparing Extracorporeal Shock Wave Lithotripsy (ESWL) with ureterorenoscopic (URS) Intracorporeal Pneumatic Lithotripsy (ICPL). A total of 60 patients attending the outpatient department of Bangabandhu Sheikh Mujib Medical University (BSMMU) with lower ureteric stones were divided into two groups, 30 in group-I (URS + ICPL) and the remaining 30 in group-II (ESWL). In group-I, 60% were male with mean age of 32.76 years and in group-II, 40% were male with mean age of 36.23 years. The ratio of involvement of right to left ureter was 1.7:1. The mean stone size was 10.7 + 2.69 mm (SD) in group-I and 9.9 + 1.97 mm (SD) in group-II. The differences in age, sex and side of involvement of ureter were not significant (p > 0.05) between the two groups. Among the groups 24 (80%) in group-I and 26 (86.61%) of patients in group-II were found stone free. The post procedure loin pain, fever and haematuria were more common in group-I than in group-II. The LUTS and loin pain were significantly more in group-I than in group-II (p ESWL was found effective method than URS + ICPL for the treatment of lower ureteric stones.

Lymphoma of the Urinary Bladder

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Anthony Kodzo-Grey Venyo

2014-01-01

Full Text Available Background. Lymphoma of the urinary bladder (LUB is rare. Aims. To review the literature on LUB. Methods. Various internet databases were used. Results. LUB can be either primary or secondary. The tumour has female predominance; most cases occur in middle-age women. Secondary LUB occurs in 10% to 25% of leukemias/lymphomas and in advanced-stage systemic lymphoma. Less than 100 cases have been reported. MALT typically affects adults older than 60 years; 75% are female. Diffuse large B-cell lymphoma is also common and may arise from transformation of MALT. LUB presents with haematuria, dysuria, urinary frequency, nocturia, and abdominal or back pain. Macroscopic examination of LUBs show large discrete tumours centred in the dome or lateral walls of the bladder. Positive staining of LUB varies by the subtype of lymphoma; B-cell lymphomas are CD20 positive. MALT lymphoma is positively stained for CD20, CD19, and FMC7 and negatively stained for CD5, CD10, and CD11c. LUB stains negatively with Pan-keratin, vimentin, CK20, and CK7. MALT lymphoma exhibits t(11; 18(q21: 21. Radiotherapy is an effective treatment for the MALT type of LUB with no recurrence. Conclusions. LUB is diagnosed by its characteristic morphology and immunohistochemical characteristics. Radiotherapy is a useful treatment.

Gastric obstruction secondary to metastatic breast cancer: a case report and literature review

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Hussain Tasadooq

2012-08-01

Full Text Available Abstract Introduction Gastrointestinal tract soft tissues metastasis is a well-known occurrence with invasive lobular breast cancer subtypes. Gastric involvement is more common, with reports of both diffuse and localized involvements. Usually, a gastric localized involvement presents as wall thickening with an appearance similar to that of a gastrointestinal stromal tumour; rarely does a localized metastatic deposit grow aggressively to present as a large tumour causing obstructive symptoms. Our case highlights one such unusual presentation in a patient presenting with non-specific gastrointestinal symptoms. To the best of our knowledge, there have been no previous reports on a similar presentation occurring from a localized metastasis. Case presentation A 65-year-old Caucasian woman awaiting an outpatient oral gastroduodenoscopy for symptoms of intermittent vomiting, epigastric pains and weight loss of six weeks’ duration presented acutely with symptoms of haematemesis and abdominal distension. An initial contrast-enhanced computed tomography scan showed a grossly dilated stomach with a locally advanced stenosing tumour mass at the pylorus. Our patient had a history of left mastectomy and axillary clearance followed by adjuvant endocrine therapy for an oestrogen receptor- and progesterone receptor-positive, grade 2, invasive lobular breast cancer. The oral gastroduodenoscopy confirmed the computed tomography findings; biopsies of the pyloric mass on immunohistochemistry stains were strongly positive for pancytokeratin and gross cystic disease fluid proteins, consistent with an invasive lobular breast cancer metastasis. She received a palliative gastrojejunal bypass and her adjuvant endocrine treatment was switched over to exemestane. Conclusion Our case highlights the aggressive behaviour of a localized gastric metastasis that is unusual and unexpected. Gastrointestinal symptomatology can be non-specific and, at times, non-diagnostic on

Methylene blue MMX® tablets for chromoendoscopy. Bioavailability, colon staining and safety in healthy volunteers undergoing a full colonoscopy.

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Di Stefano, A F D; Radicioni, M M; Vaccani, A; Fransioli, A; Longo, L; Moro, L; Repici, A

2018-06-01

Methylene blue-MMX® tablets are proposed as an aid for detection and visualisation of adenomas and carcinomas in patients undergoing colonoscopy, by improving their detection rate and highlighting the presence of the intestinal dysplastic lesions. Single total doses of 100 and 200 mg were administered to healthy volunteers undergoing a bowel cleansing preparation and a full colonoscopy to investigate the colonic staining. The pharmacokinetics of methylene blue and the safety after exposure to the tablets were also investigated. With 200 mg, the best staining, assessed as the sum of acceptable and good staining, was achieved in the ascending colon and rectosigmoid (75% subjects each), the transverse and the descending colon (approximately 63% each). Absence of staining or overstaining were reported for no colonic region of interest in any subject. Similar results were observed in the 100 mg dose group. Methylene blue blood concentrations reached a peak (C max ) in a median time (T max ) of 12 h with 100 mg and 16 h with 200 mg. AUC 0-t was 10.7 ± 6.7 μg/mLxh after 100 mg and 25.2 ± 7.4 μg/mLxh after 200 mg. Half-life ranged between 9 and 22 h after the lower dose and between 6 and 26 h after the higher dose. The cumulative excretion was about 28% after 100 mg and about 39% after 200 mg. The overall frequency of adverse events was 39%, but only one was related to the product: abnormal transaminases. The most frequent adverse event was a transient polyuria (17%). One serious adverse event (gastrointestinal haemorrhage) led the subject to study discontinuation and hospitalisation and another subject withdrew the study due to one adverse event (haematemesis). Either event was not related to methylene blue. Copyright © 2017. Published by Elsevier Inc.

Degradation of Red Ferralitic (Rhodic Ferralsol soils grown with tobacco (Nicotiana tabacum L. in the Artemisa province, Cuba

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Óscar Ricote Jorge

2017-01-01

Full Text Available “Partido” is a tobacco growing area which extends for some 3000 hectares among the municipalities of San Antonio de los Baños, Güira de Melena and Alquízar in the Cuban province of Artemisa. Predominant soils are Red Ferralitic (Rhodic Ferralsol according to the World Reference Base, with a strong tendency to alkalinization which has a negative impact on the quality of their agricultural use. The aim of this research was to quantify the geographical extension of the degradation process, to determine how deep it happens along the soil profile and to establish its possible relationship with the quality and quantity of water applied to tobacco fields. The chemical, physical and mineralogical analyses of two test pits carried out in the area were compared: one profile without agricultural use with one characteristic soil profile under continuous production. After being subjected to the same irrigation regime in laboratory conditions, it was concluded that degradation affects to 89.56% of the area of tobacco soils evaluated. This phenomenon occurs very deeply along the soil profile and happens downwards, causing the accumulation of calcium and the loss of sodium and potassium in the superficial horizon, what is shown in pH rises. Such processes, associated to irrigation water and to insufficient rainfall regime which are traditional in the territory, have led to changes in the mineralogical composition of these tobacco soils appearance of minerals such as gibbsite which was absent in uncultivated Red Ferralitic soils, which involve the modification of soil classification at gender level.

Sirolimus alternative to blood transfusion as a life saver in blue rubber bleb nevus syndrome: A case report.

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Wang, Ke-Ling; Ma, Shu-Fang; Pang, Ling-Yu; Zhang, Meng-Na; Hu, Lin-Yan; Liu, Meng-Jia; Zou, Li-Ping

2018-02-01

Blue rubber bleb nevus syndrome (BRBNS) is a rare disease characterized by multiple venous malformations. The gastrointestinal bleeding and secondary iron deficiency anemia are the most common complications. There are currently no effective treatments for BRBNS. Here, we report a case of successful treatment with a small dose of sirolimus of a BRBN patient with a de novo gene mutation. A 12-year-old female was admitted to our hospital with multiple hemangiomas for 12 years. The patient often displayed melena; she recently received transfusion of 2 units of red blood cells once every 2 weeks. Multiple fist-sized hemangiomas were piled up on both sides and back of the neck, and were also noted on the arms, legs, chest, back, and on the tip of the tongue. The laboratory findings demonstrated severe anemia. Blood sample sequencing detected a heterozygous de novo mutation c.2545C > Tin the TEK gene. Based on these findings, final diagnosis of Blue rubber bleb nevus syndrome (BRBNS) was made. After the diagnosis, low-dose sirolimus was orally administered. The patient's hemoglobin was increased after treatment with sirolimus for 1 month. Since the initial treatment with sirolimus, she had not received any blood transfusions. The skin and mucosal hemangioma decreased significantly, and new digestive tract hemorrhage, muscle hematoma, or adverse drug reactions were not observed. we report a case of a mutation in exon 15 of the TEK gene leading to BRBN. It was successfully treated with a small dose of sirolimus as an alternative to blood transfusion in order to save the of BRBN patient's life.

Prolapsing Gastric Polyp Causing Intermittent Gastric Outlet Obstruction.

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Kosai, Nik Ritza; Gendeh, Hardip Singh; Norfaezan, Abdul Rashid; Razman, Jamin; Sutton, Paul Anthony; Das, Srijit

2015-06-01

Gastric polyps are often an incidental finding on upper gastrointestinal endoscopy, with an incidence up to 5%. The majority of gastric polyps are asymptomatic, occurring secondary to inflammation. Prior reviews discussed Helicobacter pylori (H pylori)-associated singular gastric polyposis; however, we present a rare and unusual case of recurrent multiple benign gastric polyposis post H pylori eradication resulting in intermittent gastric outlet obstruction. A 70-year-old independent male, Chinese in ethnicity, with a background of diabetes mellitus, hypertension, and a simple renal cyst presented with a combination of melena, anemia, and intermittent vomiting of partially digested food after meals. Initial gastroscopy was positive for H pylori; thus he was treated with H pylori eradication and proton pump inhibitors. Serial gastroscopy demonstrated multiple sessile gastric antral polyps, the largest measuring 4 cm. Histopathologic examination confirmed a benign hyperplastic lesion. Computed tomography identified a pyloric mass with absent surrounding infiltration or metastasis. A distal gastrectomy was performed, whereby multiple small pyloric polyps were found, the largest prolapsing into the pyloric opening, thus explaining the intermittent nature of gastric outlet obstruction. Such polyps often develop from gastric ulcers and, if left untreated, may undergo neoplasia to form malignant cells. A distal gastrectomy was an effective choice of treatment, taking into account the polyp size, quantity, and potential for malignancy as opposed to an endoscopic approach, which may not guarantee a complete removal of safer margins and depth. Therefore, surgical excision is favorable for multiple large gastric polyps with risk of malignancy.

The role of surgery in the therapeutic approach of gastric cancer liver metastases.

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Mastoraki, Aikaterini; Benetou, Christina; Mastoraki, Sotiria; Papanikolaou, Ioannis S; Danias, Nikolaos; Smyrniotis, Vassilios; Arkadopoulos, Nikolaos

2016-09-01

Gastric cancer (GC) currently prevails as the second cause of death by malignancy worldwide. Estimations suggest that 35 % of affected patients appear with synchronous distant metastases. The vast majority of patients present with hepatic metastatic disease, sometimes accompanied by synchronous peritoneal and lung dissemination. The disease mostly remains asymptomatic at an early stage, with few reported cases of incidental abdominal discomfort. As the cancer advances, symptoms such as nausea or vomiting arise, along with indigestion and dysphagia, blood loss in the form of melena or hematemesis, as well as anorexia and weight loss. Having spread to the liver, it also causes jaundice due to hepatomegaly and general inanition. Despite recent research on the therapeutic strategies against GC metastatic disease, surgical resection appears the only potentially curative approach. Unfortunately, the majority of patients are not eligible to undergo surgical intervention. With regard to treatment modalities of the advanced stage disease, the role of metastasectomy is still debatable and quite unclear, while prolonged survival was succeeded only under certain specific circumstances. Systemic chemotherapy remains however another option, as well as local management in the form of cryotherapy, radiofrequency ablation, or transcatheter arterial chemoembolization. The aims of this review were to evaluate the results of surgical treatment for metastatic GC with special reference to the extent of its histological spread and to present the recent literature in order to provide an update on the current concepts of advanced surgical management of this entity. Relevant publications in the last two decades are briefly reviewed.

Clinical utility of dabigatran in United Arab Emirates

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Shehab, Abdulla; Elnour, Asim A.; Sadik, Adel; Mandil, Mahmoud Abu; AlShamsi, Ali; Suwaidi, Aesha Al; Bhagavathula, AkshayaSrikanth; Erkekoglu, Pinar; Hamad, Farah; Nuaimi, Saif K. Al

2015-01-01

Objectives: To provide early data regarding clinical utility of dabigatran in Al-Ain, United Arab Emirates (UAE). Methods: This was an ethics approved retrospective cross sectional study. We retrieved a total of 76 patients who were using dabigatran from September to December 2014 in the Cardiology Clinic at Al-Ain Hospital, Al-Ain, UAE. The primary analysis was designed to test the frequency of bleeding events (rate) with dabigatran 75, 110, and 150 mg. Results: The mean age ± standard deviation of cohort was 67.9 ± 1.5 years (range; 29-98 years), composed of males (52.6%) with mean age of 66.3 ± 1.7 years, and females (47.4%) with mean age of 69.6 ± 1.1 years. The highest age group was those between 61-80 years (60.5%). Most comprised the age strata of ≤75 years (73.7%). The main indication for dabigatran use was atrial fibrillation. The rate of bleeding with dabigatran was 18/76 (23.7%), and melena was the leading cause of bleeding 8/76 (10.7%). The hospitalization rate was 67.1%, dabigatran withdrawal rate was 0.01%, and mortality rate was 6.5%. The cohort had exhibited incidences of minor bleeding with one fatal major bleeding, high co-morbidities, admission, and readmission, which was not directly linked to dabigatran. We did not identify any relation of death due to dabigatran. Conclusion: Dabigatran is a suitable alternative to warfarin obviating the need for repetitive international normalized ratio monitoring, however, it may need plasma drug monitoring. PMID:26593161

Esophageal diverticula and cancer.

Science.gov (United States)

Herbella, F A M; Dubecz, A; Patti, M G

2012-02-01

Esophageal diverticula are rare. The association of cancer and diverticula has been described. Some authors adopt a conservative non-surgical approach in selected patients with diverticula whereas others treat the symptoms by diverticulopexy or myotomy only, leaving the diverticulum in situ. However, the risk of malignant degeneration should be may be taken in account if the diverticulum is not resected. The correct evaluation of the possible risk factors for malignancy may help in the decision making process. We performed a literature review of esophageal diverticula and cancer. The incidence of cancer in a diverticulum is 0.3-7, 1.8, and 0.6% for pharyngoesophageal, midesophageal, and epiphrenic diverticula, respectively. Symptoms may mimic those of the diverticulum or underlying motor disorder. Progressive dysphagia, unintentional weight loss, the presence of blood in the regurgitated material, regurgitation of peaces of the tumor, odynophagia, melena, hemathemesis, and hemoptysis are key symptoms. Risk factors for malignancy are old age, male gender, long-standing history, and larger diverticula. A carcinoma may develop in treated diverticula, even after resection. Outcomes are usually quoted as dismal because of a delayed diagnosis but several cases of superficial carcinoma have been described. The treatment follows the same principals as the therapy for esophageal cancer; however, diverticulectomy is enough in cases of superficial carcinomas. Patients must be carefully evaluated before therapy and a long-term follow-up is advisable. © 2011 Copyright the Authors. Journal compilation © 2011, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

PROPOSAL OF A CLINICAL CARE PATHWAY FOR THE MANAGEMENT OF ACUTE UPPER GASTROINTESTINAL BLEEDING

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Matheus Cavalcante FRANCO

2015-12-01

Full Text Available Background - Upper gastrointestinal bleeding implies significant clinical and economic repercussions. The correct establishment of the latest therapies for the upper gastrointestinal bleeding is associated with reduced in-hospital mortality. The use of clinical pathways for the upper gastrointestinal bleeding is associated with shorter hospital stay and lower hospital costs. Objective - The primary objective is the development of a clinical care pathway for the management of patients with upper gastrointestinal bleeding, to be used in tertiary hospital. Methods - It was conducted an extensive literature review on the management of upper gastrointestinal bleeding, contained in the primary and secondary information sources. Results - The result is a clinical care pathway for the upper gastrointestinal bleeding in patients with evidence of recent bleeding, diagnosed by melena or hematemesis in the last 12 hours, who are admitted in the emergency rooms and intensive care units of tertiary hospitals. In this compact and understandable pathway, it is well demonstrated the management since the admission, with definition of the inclusion and exclusion criteria, passing through the initial clinical treatment, posterior guidance for endoscopic therapy, and referral to rescue therapies in cases of persistent or rebleeding. It was also included the care that must be taken before hospital discharge for all patients who recover from an episode of bleeding. Conclusion - The introduction of a clinical care pathway for patients with upper gastrointestinal bleeding may contribute to standardization of medical practices, decrease in waiting time for medications and services, length of hospital stay and costs.

Transperineal Prostate Core Needle Biopsy: A Comparison of Coaxial Versus Noncoaxial Method in a Randomised Trial

International Nuclear Information System (INIS)

Babaei Jandaghi, Ali; Habibzadeh, Habib; Falahatkar, Siavash; Heidarzadeh, Abtin; Pourghorban, Ramin

2016-01-01

PurposeTo compare the procedural time and complication rate of coaxial technique with those of noncoaxial technique in transperineal prostate biopsy.Materials and MethodsTransperineal prostate biopsy with coaxial (first group, n = 120) and noncoaxial (second group, n = 120) methods was performed randomly in 240 patients. The procedural time was recorded. The level of pain experienced during the procedure was assessed on a visual analogue scale (VAS), and the rate of complications was evaluated in comparison of the two methods.ResultsThe procedural time was significantly shorter in the first group (p < 0.001). In the first group, pain occurred less frequently (p = 0.002), with a significantly lower VAS score being experienced (p < 0.002). No patient had post procedural fever. Haematuria (p = 0.029) and haemorrhage from the site of biopsy (p < 0.001) were seen less frequently in the first group. There was no significant difference in the rate of urethral haemorrhage between the two groups (p = 0.059). Urinary retention occurred less commonly in the first group (p = 0.029). No significant difference was seen in the rate of dysuria between the two groups (p = 0.078).ConclusionsTransperineal prostate biopsy using a coaxial needle is a faster and less painful method with a lower rate of complications compared with conventional noncoaxial technique.

A designated centre for people with disabilities operated by The Cheshire Foundation in Ireland, Cork

LENUS (Irish Health Repository)

O’Connell, L

2018-02-01

Ureteric stents are frequently inserted post endourological procedures. However, subsequent endoscopic stent removal requires a second procedure for the patient and the availability of necessary resources. Longer duration of indwelling stents can lead to increased risk of symptoms and complications. The use of magnetic stents removed with a magnetic retrieval device (BlackStar©), offers an alternative which obviates the need for cystoscopy. We assessed the outcomes for this novel method of stent removal in our institution. A retrospective analysis was performed of all patients undergoing magnetic stent insertion and subsequent removal in a nurse-led clinic over a nine-month period. Patients were followed up with a prospective validated Ureteral Stent Symptoms Questionnaire (USSQ)3. A cost analysis was also performed. In total, 59 patients were treated using magnetic stents. The complication rate was low (6.7%). The median duration of indwelling stent was 5.8 days (range 1-11 days). Patients reported haematuria and lower urinary tract symptoms but >90% experienced no functional impairment with minimal days of employment lost (mean 0.75 days). All patients reported satisfaction with nurse-led stent removal and 97% were happy to have stents removed via this method in the future. The total financial savings were estimated at €47,790 over this period. Nurse-led removal of magnetic stents is safe and well tolerated by patients and enables expedient stent removal. It also provides a significant cost benefit and frees up valuable endoscopic resources.

Foreign bodies in the urinary bladder and their management: a Pakistani experience.

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Mannan, A; Anwar, S; Qayyum, A; Tasneem, R A

2011-01-01

This was a retrospective study conducted to assess the nature, presentation, mode of insertion, diagnosis and management of foreign bodies in the urinary bladder. Between January 1998 and December 2007, 20 patients with foreign bodies in their urinary bladder were treated at our centre. The records of these patients were reviewed and analysed for their symptoms, mode of insertion, diagnosis, management and complications. A total of 20 foreign bodies were recovered from the urinary bladders during the study period. These included JJ stents with calculi, intrauterine contraceptive devices with stones, a rubber stick, ribbon gauze, encrusted pieces of Foley catheter, proline thread with calculus, a suture needle, broken cold knives, the ceramic beak of a paediatric resectoscope, a knotted suprapubic tube, a hair clip, a nail, an electrical wire and a hairpin. The common presenting features were dysuria and haematuria. The diagnosis was established radiologically in most of the cases. The circumstances of insertion were variable; iatrogenic in 16 (80.0 percent) cases, sexual stimulation in two (10.0 percent), accidental insertion by a child in one (5.0 percent) and physical torture in one (5.0 percent). 17 (85.0 percent) foreign bodies were recovered endoscopically, and cystolithotomy was required in three (15.0 percent) patients. The instances of foreign bodies in the urinary bladder are uncommon. A diagnosis is usually made radiologically. Iatrogenic foreign bodies were found to be the most frequent type of insertion encountered. Endoscopic retrieval is usually successful, with minimal morbidity.

Catheter-less robotic radical prostatectomy using a custom-made synchronous anastomotic splint and vesical urinary diversion device: report of the initial series and perioperative outcomes.

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Tewari, Ashutosh; Rao, Sandhya; Mandhani, Anil

2008-09-01

To study the feasibility of avoiding a urethral catheter after robotic radical prostatectomy by using suprapubic diversion with a urethral splint, as urethral catheterization is often a source of major discomfort and pain to the patient, and can cause more concern to the patient than the procedure; we present the outcomes of a pilot study. This pilot study involved 30 patients; in group 1 (the study group of 10 patients) we used a custom-made suprapubic catheter which provided a small anastomotic splint, multiple holes for drainage and the ability to retract the splint to give a voiding trial before removing the drainage device. Group 2 was a control group of 20 patients who had standard urethral catheterization with an 18 F Silastic Foley catheter. Demographic, intraoperative and outcome data were measured and analysed. Urethral symptoms were recorded using a specially developed questionnaire. The two groups were comparable in terms of age, serum prostate specific antigen level, body mass index, Gleason scores, tumour stage, operative duration, amount of bleeding, console times, anastomotic leakage and postoperative retention rates. The study group had significantly less penile shaft or tip pain and discomfort during walking or sleeping. No patient in either group had haematuria or clot retention requiring irrigation. Urethral catheter-less robotic radical prostatectomy is feasible. The advantages are decreased penile shaft and tip pain, and decreased patient discomfort and an earlier return of continence.

Delay in diagnosis of cancer as a patient safety issue - a root cause analysis based on a representative case report

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Mansour Paul

2011-07-01

Full Text Available Abstract Background It is well known in the literature that imaging has almost no value for diagnosis of superficial bladder cancer. However, wide gap exists between knowledge on diagnosis of bladder cancer and actual clinical practice. Case presentation Delay in diagnosis of bladder cancer in a male person with tetraplegia occurred because of reliance on negative flexible cystoscopy and single biopsy, negative ultrasound examination of urinary bladder, and computerised tomography of pelvis. Difficulties in scheduling cystoscopy also contributed to a delay of nearly ten months between the onset of haematuria and establishing a histological diagnosis of vesical malignancy in this patient. The time interval between transurethral resection and cystectomy was 42 days. This delay was mainly due to scheduling of surgery. Conclusion We learn from this case that doctors should be aware of the limitations of negative flexible cystoscopy and single biopsy, cytology of urine, ultrasound examination of urinary bladder, and computed tomography of pelvis for diagnosis of bladder cancer in spinal cord injury patients. Random bladder biopsies must be considered under general anaesthesia when there is high suspicion of bladder cancer. Spinal cord injury patients with lesions above T-6 may develop autonomic dysreflexia; therefore, one should be extremely well prepared to prevent or manage autonomic dysreflexia when performing cystoscopy and bladder biopsy. Spinal cord injury patients, who pass blood in urine, should be accorded top priority in scheduling of investigations and surgical procedures.

Magnetic Stent Removal in a Nurse-Led Clinic; a Nine-Month Experience.

LENUS (Irish Health Repository)

O’Connell, L

2018-02-01

Ureteric stents are frequently inserted post endourological procedures. However, subsequent endoscopic stent removal requires a second procedure for the patient and the availability of necessary resources. Longer duration of indwelling stents can lead to increased risk of symptoms and complications. The use of magnetic stents removed with a magnetic retrieval device (BlackStar©), offers an alternative which obviates the need for cystoscopy. We assessed the outcomes for this novel method of stent removal in our institution. A retrospective analysis was performed of all patients undergoing magnetic stent insertion and subsequent removal in a nurse-led clinic over a nine-month period. Patients were followed up with a prospective validated Ureteral Stent Symptoms Questionnaire (USSQ)3. A cost analysis was also performed. In total, 59 patients were treated using magnetic stents. The complication rate was low (6.7%). The median duration of indwelling stent was 5.8 days (range 1-11 days). Patients reported haematuria and lower urinary tract symptoms but >90% experienced no functional impairment with minimal days of employment lost (mean 0.75 days). All patients reported satisfaction with nurse-led stent removal and 97% were happy to have stents removed via this method in the future. The total financial savings were estimated at €47,790 over this period. Nurse-led removal of magnetic stents is safe and well tolerated by patients and enables expedient stent removal. It also provides a significant cost benefit and frees up valuable endoscopic resources.

Anti-proteinase 3 anti-neutrophil cytoplasm autoantibodies recapitulate systemic vasculitis in mice with a humanized immune system.

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Mark A Little

Full Text Available Evidence is lacking for direct pathogenicity of human anti-proteinase-3 (PR3 antibodies in development of systemic vasculitis and granulomatosis with polyangiitis (GPA, Wegener's granulomatosis. Progress in study of these antibodies in rodents has been hampered by lack of PR3 expression on murine neutrophils, and by different Fc-receptor affinities for IgG across species. Therefore, we tested whether human anti-PR3 antibodies can induce acute vasculitis in mice with a human immune system. Chimeric mice were generated by injecting human haematopoietic stem cells into irradiated NOD-scid-IL2Rγ⁻/⁻ mice. Matched chimera mice were treated with human IgG from patients with: anti-PR3 positive renal and lung vasculitis; patients with non-vasculitic renal disease; or healthy controls. Six-days later, 39% of anti-PR3 treated mice had haematuria, compared with none of controls. There was punctate bleeding on the surface of lungs of anti-PR3 treated animals, with histological evidence of vasculitis and haemorrhage. Anti-PR3 treated mice had mild pauci-immune proliferative glomerulonephritis, with infiltration of human and mouse leukocytes. In 3 mice (17% more severe glomerular injury was present. There were no glomerular changes in controls. Human IgG from patients with anti-PR3 autoantibodies is therefore pathogenic. This model of anti-PR3 antibody-mediated vasculitis may be useful in dissecting mechanisms of microvascular injury.

Self-testing for cancer: a community survey

International Nuclear Information System (INIS)

Wilson, Sue; Ryan, Angela V; Greenfield, Sheila M; Clifford, Sue C; Holder, Roger L; Pattison, Helen M; Fitzmaurice, David A; McManus, Richard J

2008-01-01

Cancer-related self-tests are currently available to buy in pharmacies or over the internet, including tests for faecal occult blood, PSA and haematuria. Self-tests have potential benefits (e.g. convenience) but there are also potential harms (e.g. delays in seeking treatment). The extent of cancer-related self-test use in the UK is not known. This study aimed to determine the prevalence of cancer-related self-test use. Adults (n = 5,545) in the West Midlands were sent a questionnaire that collected socio-demographic information and data regarding previous and potential future use of 18 different self-tests. Prevalence rates were directly standardised to the England population. The postcode based Index of Multiple Deprivation 2004 was used as a proxy measure of deprivation. 2,925 (54%) usable questionnaires were returned. 1.2% (95% CI 0.83% to 1.66%) of responders reported having used a cancer related self test kit and a further 36% reported that they would consider using one in the future. Logistic regression analyses suggest that increasing age, deprivation category and employment status were associated with cancer-related self-test kit use. We conclude that one in 100 of the adult population have used a cancer-related self-test kit and over a third would consider using one in the future. Self-test kit use could alter perceptions of risk, cause psychological morbidity and impact on the demand for healthcare

Risk factors for and management of graft pancreatitis.

Science.gov (United States)

Nadalin, Silvio; Girotti, Paolo; Königsrainer, Alfred

2013-02-01

Systematic and detailed analysis of risk factors, pathophysiology, clinical manifestation, diagnosis and management of graft pancreatitis in its different forms, that is acute and chronic graft pancreatitis (A-GP and C-GP), and A-GP being further distinguished into: physiological (P-AGP), early (E-AGP) and late AP (L-AGP). Graft pancreatitis is the second most-frequent complication following pancreas transplantation. P-AGP is an unavoidable entity related to ischemic reperfusion injury. It is usually clinically silent. It is a timely and prognostically self-limited process. E-AGP occurs within 3 months after pancreas transplantation (PTx) in 35% of cases and is associated with high rates of graft loss (78-91%). Clinical signs are pain, systemic inflammatory response (SIRS) and haematuria. Therapy can be medical, interventional and surgical. L-AGP occurs 3 months following PTx in 14-25% of cases and represents an uncommon cause of graft loss. Typical clinical signs are pain, abdominal tenderness and fever. Typical laboratory signs are hyperamylasaemia, hyperglycaemia and hypercreatininaemia. Therapy is usually conservative. C-GP is difficult to be distinguished from chronic rejection and is associated to graft loss in 4-10% of cases. Recurrent A-GPs and infections are the main risk factors. Specific symptoms are chronic abdominal malaise, constipation and recurrence of DM. Isolated hyperglycaemia is typical of C-GP. The therapy is usually conservative. This systematic analysis of different manifestations of graft pancreatitis provides the basis for a clinical approach to tackling this complex entity.

The one-stop clinic as the standard of out-patient care in a hospital urology department

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Alvaro Páez

2011-10-01

Full Text Available PURPOSE: To evaluate the performance of a 'one-stop' clinic in terms of proportion of discharges or inclusion in surgical waiting lists. MATERIALS AND METHODS: All patients were referred from primary care facilities (population 220.646 and from different departments in the hospital. Eight senior urologists, two registered nurses and two nurse attendants participated in the experience. Prior to the start of the project, referral protocols had been agreed with the primary care physicians involved. Compliance with the protocols was periodically tested. Eventually 5537 first visits (January-December 2009 where evaluable. RESULTS: Overall, the 'one-stop' format proved feasible in 74.2% of the patients (4108/5537. Patients, who successfully used the 'one-stop' format, were significantly younger than those who required additional consultations (43 vs 50 years old, respectively, Student's t test < 0.001. For obvious reasons the 'one-stop' format was universally possible in male sterilization and penile phimosis patients. Similarly, the 'one-stop' policy was applied in most consultations due to male sexual dysfunction (75% and urinary tract infection (73%. Other health problems, such as haematuria (62% and renal colic (46%, required more than one visit so that care of the patient reverted to the traditional, outpatient care model. CONCLUSION: A 'one-stop' philosophy is feasible for a number of procedures in a urological outpatient clinic. The costs to implement such an approach would be limited to managerial expenditure.

A pilot study combining a GC-sensor device with a statistical model for the identification of bladder cancer from urine headspace.

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Tanzeela Khalid

Full Text Available There is a need to reduce the number of cystoscopies on patients with haematuria. Presently there are no reliable biomarkers to screen for bladder cancer. In this paper, we evaluate a new simple in-house fabricated, GC-sensor device in the diagnosis of bladder cancer based on volatiles. Sensor outputs from 98 urine samples were used to build and test diagnostic models. Samples were taken from 24 patients with transitional (urothelial cell carcinoma (age 27-91 years, median 71 years and 74 controls presenting with urological symptoms, but without a urological malignancy (age 29-86 years, median 64 years; results were analysed using two statistical approaches to assess the robustness of the methodology. A two-group linear discriminant analysis method using a total of 9 time points (which equates to 9 biomarkers correctly assigned 24/24 (100% of cancer cases and 70/74 (94.6% controls. Under leave-one-out cross-validation 23/24 (95.8% of cancer cases were correctly predicted with 69/74 (93.2% of controls. For partial least squares discriminant analysis, the correct leave-one-out cross-validation prediction values were 95.8% (cancer cases and 94.6% (controls. These data are an improvement on those reported by other groups studying headspace gases and also superior to current clinical techniques. This new device shows potential for the diagnosis of bladder cancer, but the data must be reproduced in a larger study.

Experience of extracorporeal shock wave lithotripsy for kidney and upper ureteric stones by electromagnetic lithotripter

International Nuclear Information System (INIS)

Wazir, B.G.; Haq, M.I.H.; Faheem-ul-Haq; Nawaz, A.; Nawaz, A.; Ikramullah; Jamil, M.

2010-01-01

Background: Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive treatment of urinary stones which breaks them, by using externally applied, focused, high intensity acoustic pulse, into smaller pieces so that they can pass easily through ureter. Shock wave generation, focusing, coupling and stone localisation by fluoroscope or ultrasound are the basic components of ESWL. ESWL has some complications and is contraindicated in certain situations. The aim of this study was to evaluate the effectiveness and safety of ESWL in kidney and upper ureteric stones by Electromagnetic Lithotriptor. Methods: All adult patients with renal and upper ureteric stones having a diameter of up to 1 Cm were included in the study. Basic evaluation such as history, examination, ultrasound and excretory urography were performed. Electromagnetic lithotripsy was done and data were collected on a printed proforma from January 1, 2008 to March 30, 2009 in Institute of Kidney Diseases, Peshawar. Results: Out of a total of 625 patients 463 were male and 162 were female; 67.36% of patients were having renal stones, 23.84% upper ureteric and 8.8% both renal and ureteric stones. Complications noted were renal colic in 9.76%, haematuria in 3.2%, stein strasse in 2.72%, and fever in 1.12% of patients. The stone free rate was 89% and 7% of patients were having stone fragments <4 mm. ESWL failed in 4% of patients. Conclusion: ESWL is a safe and effective way of treating kidney and upper ureteric stones. (author)

Transperineal Prostate Core Needle Biopsy: A Comparison of Coaxial Versus Noncoaxial Method in a Randomised Trial

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Babaei Jandaghi, Ali [Guilan University of Medical Sciences, Department of Radiology, Poursina Hospital (Iran, Islamic Republic of); Habibzadeh, Habib; Falahatkar, Siavash [Guilan University of Medical Sciences, Urology Research Center, Razi Hospital (Iran, Islamic Republic of); Heidarzadeh, Abtin [Guilan University of Medical Sciences, Department of Community Medicine (Iran, Islamic Republic of); Pourghorban, Ramin, E-mail: ramin-p2005@yahoo.com [Shahid Beheshti University of Medical Sciences, Department of Radiology, Modarres Hospital (Iran, Islamic Republic of)

2016-12-15

PurposeTo compare the procedural time and complication rate of coaxial technique with those of noncoaxial technique in transperineal prostate biopsy.Materials and MethodsTransperineal prostate biopsy with coaxial (first group, n = 120) and noncoaxial (second group, n = 120) methods was performed randomly in 240 patients. The procedural time was recorded. The level of pain experienced during the procedure was assessed on a visual analogue scale (VAS), and the rate of complications was evaluated in comparison of the two methods.ResultsThe procedural time was significantly shorter in the first group (p < 0.001). In the first group, pain occurred less frequently (p = 0.002), with a significantly lower VAS score being experienced (p < 0.002). No patient had post procedural fever. Haematuria (p = 0.029) and haemorrhage from the site of biopsy (p < 0.001) were seen less frequently in the first group. There was no significant difference in the rate of urethral haemorrhage between the two groups (p = 0.059). Urinary retention occurred less commonly in the first group (p = 0.029). No significant difference was seen in the rate of dysuria between the two groups (p = 0.078).ConclusionsTransperineal prostate biopsy using a coaxial needle is a faster and less painful method with a lower rate of complications compared with conventional noncoaxial technique.

Anti-proteinase 3 anti-neutrophil cytoplasm autoantibodies recapitulate systemic vasculitis in mice with a humanized immune system.

LENUS (Irish Health Repository)

Little, Mark A

2012-01-01

Evidence is lacking for direct pathogenicity of human anti-proteinase-3 (PR3) antibodies in development of systemic vasculitis and granulomatosis with polyangiitis (GPA, Wegener\\'s granulomatosis). Progress in study of these antibodies in rodents has been hampered by lack of PR3 expression on murine neutrophils, and by different Fc-receptor affinities for IgG across species. Therefore, we tested whether human anti-PR3 antibodies can induce acute vasculitis in mice with a human immune system. Chimeric mice were generated by injecting human haematopoietic stem cells into irradiated NOD-scid-IL2Rγ⁻\\/⁻ mice. Matched chimera mice were treated with human IgG from patients with: anti-PR3 positive renal and lung vasculitis; patients with non-vasculitic renal disease; or healthy controls. Six-days later, 39% of anti-PR3 treated mice had haematuria, compared with none of controls. There was punctate bleeding on the surface of lungs of anti-PR3 treated animals, with histological evidence of vasculitis and haemorrhage. Anti-PR3 treated mice had mild pauci-immune proliferative glomerulonephritis, with infiltration of human and mouse leukocytes. In 3 mice (17%) more severe glomerular injury was present. There were no glomerular changes in controls. Human IgG from patients with anti-PR3 autoantibodies is therefore pathogenic. This model of anti-PR3 antibody-mediated vasculitis may be useful in dissecting mechanisms of microvascular injury.

A case of gastrointestinal bleeding due to right hepatic artery pseudoaneurysm following total remnant pancreatectomy: A case report

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Atsushi Fujio

Full Text Available Introduction: Pseudoaneurysm is a serious complication after pancreatic surgery, which mainly depends on the presence of a preceding pancreatic fistula. Postpancreatectomy hemorrhage following total pancreatectomy is a rare complication due to the absence of a pancreatic fistula. Here we report an unusual case of massive gastrointestinal bleeding due to right hepatic artery (RHA pseudoaneurysm following total remnant pancreatectomy. Presentation of case: A 75-year-old man was diagnosed with intraductal papillary mucinous carcinoma recurrence following distal pancreatectomy and underwent total remnant pancreatectomy. After discharge, he was readmitted to our hospital with melena because of the diagnosis of gastrointestinal bleeding. Gastrointestinal endoscopy was performed to detect the origin of bleeding, but an obvious bleeding point could not be detected. Abdominal computed tomography demonstrated an expansive growth, which indicated RHA pseudoaneurysm. Emergency angiography revealed gastrointestinal bleeding into the jejunum from the ruptured RHA pseudoaneurysm. Transcatheter arterial embolization was performed; subsequently, bleeding was successfully stopped for a short duration. Because of improvements in his general condition, the patient was discharged. Discussion: To date, very few cases have described postpancreatectomy hemorrhage following total remnant pancreatectomy. We suspect that the aneurysm ruptured into the jejunum, possibly because of the scarring and inflammation associated with his two complex surgeries. Conclusion: Pseudoaneurysm should be considered when the fragility of blood vessels is suspected, despite no history of anastomotic leak and intra-abdominal abscess. Our case also highlighted that detecting gastrointestinal bleeding is necessary to recognize sentinel bleeding if the origin of bleeding is undetectable. Abbreviations: PPH, RHA, CT, IPMC, RCCs, POD, LHA, GIE, TAE, Keywords: Case report, Pseudoaneurysm, Total

Sangramento intracraniano em paciente hemofílico

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Maria Carolina Pereira da Rocha

2016-10-01

Full Text Available Introdução: A hemofilia é uma coagulopatia congênita ou adquirida na qual há deficiência de fatores VIII (Hemofilia A e IX (Hemofilia B. A doença não tem cura e é classificada em leve, moderada ou grave conforme o grau de atividade coagulante do fator deficiente. O quadro clínico clássico é a presença e hematomas e hemartroses, mas também pode haver hematúria, hemorragia de rinofaringe ou língua, epistaxe, melena, hematêmese, sangramentos abdominais, torácicos e no sistema nervoso central. Objetivos: Relatar um caso de hemorragia intracraniana em um paciente portador de hemofilia A e comparar com os dados da literatura. Metodologia: As informações foram obtidas por meio de revisão do prontuário e acompanhamento da evolução do paciente, entrevista com o acompanhante do paciente e revisão da literatura. Relato do Caso: Paciente de 20 meses, portador de hemofilia A moderada, é levado ao Pronto Atendimento com queixa de irritabilidade, sonolência e náuseas há 3 dias. É encaminhado ao Conjunto Hospitalar de Sorocaba por suspeita de sangramento intracraniano. Conclusão: O diagnóstico de hemorragia intracraniana em pacientes hemofílicos deve ser questionado sempre que há alterações do estado de consciência ou do estado neurológico normal, mesmo que discretas. As medidas apropriadas aumentam as chances de bom prognóstico e ausência de sequelas neurológicas.

Correlation of metastasis characteristics with prognosis in gastric mixed adenoneuroendocrine carcinoma: Two case reports.

Science.gov (United States)

Tang, Qiang; Zhou, Zili; Chen, Jinhuang; Di, Maojun; Ji, Jintong; Yuan, Wenzheng; Liu, Zhengyi; Wu, Liang; Zhang, Xudan; Li, Kang; Shu, Xiaogang

2017-12-01

This article is aimed to retrospect the clinicopathological data of 2 cases of gastric MANENCs. MANEC is a rare biphasic tumor type that is coexistence of dual neuroendocrine and adenocarcinoma differentiation with each composing exceeding 30% volume. Gastric MANEC have just been reported anecdotally in the literature due to their rarity and heterogeneity. According to our study, these neoplasms have 3 different metastasis patterns: only adenocarcinomatous or neuroendocrine carcinoma and both of the 2 components. We first focus on the correlation of metastasis characteristics with prognosis in gastric MANEC, which may be potential implications for the choice of chemotherapy. The 2 cases of patient shared several symptoms: epigastric discomfort, weight loss, hematemesis, or melena. The 2 patients were diagnosis as MANEC based on the identification of histopathological analysis. In case 1, the poor differentiated adenocarcinoma accounted for 30%, the neuroendocrine part account for 70% and both of the 2 components metastasized to the lymph nodes, whereas in case 2, poorly differentiated adenocarcinoma accounted for 70%, the neuroendocrine part for 30% and only the glandular component invaded regional lymph nodes. The first patient underwent laparoscopic radical gastrectomy and underwent adjuvant chemotherapy, combination of cisplatin, and etoposide successfully. The second patient received radical gastronomy, and did not receive any chemotherapy due to general weakness. The first patient is alive with no evidence of recurrence, and the second patient died 6 months after the operation. The assessment of metastatic sites should be a routine pathological practice, which is crucial for clinical decision-making and the selection of management. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Upper gastrointestinal bleeding: audit of a single center experience in Western India

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Jignesh B. Rathod

2011-11-01

Full Text Available Upper gastrointestinal (GI bleeding is defined as bleeding proximal to the ligament of Treitz. The most important aspect of management of GI bleeding is to locate the site and cause of bleeding. The aim of the study is to find out the common etiology, presentation and management, including the role of upper GI endoscopy. Recent advances have meant that endoscopic hemostatic methods are now associated with a reduced rate of re-bleeding, cost, blood transfusion, length of hospital stay and mortality. A prospective study of 50 cases was carried out between August 2001 and July 2003. Patients with signs and symptoms suggestive of upper GI bleeding (UGIB such as hematemesis, melena, aspirated blood from nasogastric tubes, profuse hematochezia, etc., were included in the study. The patients were selected randomly. The most common cause of UGIB in the present study was acute erosive gastritis (34% followed by portal hypertension (24% and peptic ulcer (22%. All 50 patients underwent upper GI endoscopy, of whom 39 patients were treated conservatively and 11 patients underwent endotherapy to control bleeding. Out of 39 patients treated non-endoscopically, 6 cases required laparotomy to control UGIB. 8 of 50 cases had past history of UGIB, 5 of whom had a previous history of endotherapy. One case was treated with devascularization as routine hemostatic methods failed. So, initial method of choice to control the bleeding was endotherapy and surgery was undertaken if an endoscopic method failed. The most common cause of hematemesis in our setting was acute erosive gastritis followed by portal hypertension. Endoscopy is a valuable minimal invasive method to diagnose and treat upper GI bleeding.

Is Endoscopic Therapy Safe for Upper Gastrointestinal Bleeding in Anticoagulated Patients With Supratherapeutic International Normalized Ratios?

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Shim, Choong Nam; Chung, Hyun Soo; Park, Jun Chul; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan; Kim, Ha Yan; Kim, Dong Wook; Lee, Hyuk

2016-01-01

The management of upper gastrointestinal bleeding (UGIB) in anticoagulated patients with supratherapeutic international normalized ratios (INRs) presents a challenge. The purpose of the study was to evaluate the safety of endoscopic therapy for UGIB in anticoagulated patients with supratherapeutic INR in terms of rebleeding and therapeutic outcomes. One hundred ninety-two anticoagulated patients who underwent endoscopic treatment for UGIB were enrolled in the study. Patients were divided into 2 groups based on the occurrence of rebleeding within 30 days of the initial therapeutic endoscopy: no-rebleeding group (n = 168) and rebleeding group (n = 24). The overall rebleeding rate was 12.5%. Bleeding from gastric cancer and bleeding at the duodenum were significantly related to rebleeding in a univariate analysis. Multivariate analysis determined that presenting symptoms other than melena (hematemesis, hematochezia, or others) (odds ratio, 3.93; 95% confidence interval, 1.44-10.76) and bleeding from gastric cancer (odds ratio, 6.10; 95% confidence interval, 1.27-29.25) were significant factors predictive of rebleeding. Supratherapeutic INR at the time of endoscopic therapy was not significantly associated with rebleeding in either univariate or multivariate analysis. Significant differences in bleeding-related mortality, additional intervention to control bleeding, length of hospital stay, and transfusion requirements were revealed between the rebleeding and no-rebleeding groups. There were no significant differences in therapeutic outcomes between patients with INR within the therapeutic range and those with supratherapeutic INR. Supratherapeutic INR at the time of endoscopic therapy did not change rebleeding and therapeutic outcomes. Thus, we should consider endoscopic therapy for UGIB in anticoagulated patients, irrespective of INR at the time of endoscopic therapy.

Stereotactic body radiation therapy for primary and metastatic liver tumors: A single institution phase i-ii study

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Mendez Romero, Alejandra; Wunderink, Wouter [Erasmus MC - Daniel den Hoed Cancer Center, Rotterdam (Netherlands). Dept. of Radiation Oncology; Hussain, Shahid M. [Univ. of Nebraska Medical Center, Omaha, NE (US). Dept. of Radiology] (and others)

2006-09-15

The feasibility, toxicity and tumor response of stereotactic body radiation therapy (SBRT) for treatment of primary and metastastic liver tumors was investigated. From October 2002 until June 2006, 25 patients not suitable for other local treatments were entered in the study. In total 45 lesions were treated, 34 metastases and 11 hepatocellular carcinoma (HCC). Median follow-up was 12.9 months (range 0.5-31). Median lesion size was 3.2 cm (range 0.5-7.2) and median volume 22.2 cm{sup 3} (range 1.1-322). Patients with metastases, HCC without cirrhosis, and HCC < 4 cm with cirrhosis were mostly treated with 3x12.5 Gy. Patients with HCC =4cm and cirrhosis received 5x5 Gy or 3x10 Gy. The prescription isodose was 65%. Acute toxicity was scored following the Common Toxicity Criteria and late toxicity with the SOMA/LENT classification. Local failures were observed in two HCC and two metastases. Local control rates at 1 and 2 years for the whole group were 94% and 82%. Acute toxicity grade =3 was seen in four patients; one HCC patient with Child B developed a liver failure together with an infection and died (grade 5), two metastases patients presented elevation of gamma glutamyl transferase (grade 3) and another asthenia (grade 3). Late toxicity was observed in one metastases patient who developed a portal hypertension syndrome with melena (grade 3). SBRT was feasible, with acceptable toxicity and encouraging local control. Optimal dose-fractionation schemes for HCC with cirrhosis have to be found. Extreme caution should be used for patients with Child B because of a high toxicity risk.

OnabotulinumtoxinA in urinary incontinence: Prospective Study of a Case Series.

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Martín-Martínez, A; Fernández-Mederos, A; García-Hernández, J Á

2017-09-01

To assess the safety and efficacy of a single intravesical injection of onabotulinumtoxinA (OnaBTA) for treating urge urinary incontinence (UUI) in women. We performed a prospective case-series study of consecutive patients with refractory UUI treated with an intravesical injection of OnaBTA. The patients were administered 100 units of OnaBTA injected into the bladder wall following 4 weeks of flushing with anticholinergic agents or beta 3 agonists. The urodynamic and clinical endpoints were evaluated before and 6 months after the injection of OnaBTA. The primary study endpoint was the number of episodes of urinary leakage. A total of 204 of the 210 selected patients conducted a valid visit 6 months after the therapeutic application. At 6 months of treatment with OnaBTA, 110 (53.9%) patients remained continent and were considered a success. However, 57 (27.9%) patients experienced one episode of urinary leakage per day, and 37 (18.2%) had 2 or more. In terms of the urodynamic parameters, we observed the following changes: increase in maximum bladder capacity (P<.0001) and reduced maximum pressure of the detrusor (P<.0001). In terms of the safety profile, 8 (3.9%) patients had self-limiting haematuria during the procedure, which resolved spontaneously, and 9 (4.4%) patients had acute urinary retention that required intermittent catheterisation. This study supports the use of OnabotulinumtoxinA in patients with urge urinary incontinence that does not respond to medical treatment. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Gemcitabina e ifosfamida no tratamento do linfoma de Hodgkin refratário ou recidivado após múltiplas terapias Gemcitabine and ifosfamide in the treatment of Hodgkin's lymphoma refractory to or relapsed after multiple therapies

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Luís Fernando Pracchia

2007-12-01

Full Text Available Patients with Hodgkin's lymphoma relapsed after or refractory to multiple therapies (rHL have a dismal prognosis. Monotherapy with gemcitabine can promote an overall response rate of about 40% in these patients and its association with alkylating agents can provide better results. We retrospectively evaluated 17 rHL cases. All were treated with the combination of gemcitabine (1.0 g/m²; D1 and D8 and ifosfamide (1.0 g/m²; D1 to D5 in a 21-day cycle. Treatment response was evaluated according to the Cotswolds criteria. Toxicity was evaluated according to WHO criteria. The median age of all patients was 34 years (18-53. Nine of them (53% were men and eight (47% had Stage III/IV. The median number of previous treatments was 2 (2-3; two patients had already been treated with autologous stem cell transplant. Overall response rate to the combined regimen was 62.5% (95% CI = 38.8% - 86.2% and the median progression-free survival was 15 months (95% CI = 4 - 24 months. Fifty-six cycles were evaluated for toxicity. The most frequent toxicities observed by cycle were: hepatic Grade I/II in 48.2% of the cycles and Grade III/IV in 1.8%; anemia Grade I/II in 45%; neutropenia Grade I/II in 36% and Grade III/IV 16%. Grade III/IV renal toxicity on any degree of haematuria were not observed. Combined therapy with Gemcitabine and Ifosfamide promoted responses in more than half of the evaluated patients with an acceptable toxicity profile.

Intravesical Glycosaminoglycan Replacement with Chondroitin Sulphate (Gepan(®) instill) in Patients with Chronic Radiotherapy- or Chemotherapy-Associated Cystitis.

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Schwalenberg, Thilo; Berger, Frank Peter; Horn, Lars Christian; Thi, Phuc Ho; Stolzenburg, Jens-Uwe; Neuhaus, Jochen

2015-08-01

Intravesical instillation of glycosaminoglycans is a promising option for the treatment of chronic cystitis, as it supports the regeneration of the damaged urothelial layer. We investigated the efficacy of short-term intravesical chondroitin sulphate treatment (six courses of instillation) in patients with chronic radiotherapy- or chemotherapy-associated cystitis. This prospective, observational study included patients with chronic radiotherapy- or chemotherapy-associated cystitis, who received six once-weekly intravesical instillations of 0.2% chondroitin sulphate 40 mL. Every week, patients recorded their symptoms and their benefits and tolerance of treatment, using a self-completed questionnaire. The study included 16 patients (mean age 68.5 years; 50% male). During the study, a reduction in all evaluated parameters was observed. After one dose of chondroitin sulphate, symptom improvement was observed in 38% of patients, and after the second dose, an additional 31% of patients showed improvement. At week 6, 80% of patients had either improved or were symptom free, and significant improvements in urinary urgency (p = 0.0082), pollakisuria (p = 0.0022), urge frequency (p = 0.0033) and lower abdominal pain (p = 0.0449) were observed. Haematuria, present in 9 of the 16 patients at baseline, was completely resolved in all cases after 6 weeks. The majority of patients (93%) evaluated the tolerance of chondroitin sulphate as 'good' or 'very good'. No treatment-related adverse events were reported. Intravesical administration of chondroitin sulphate was effective for the treatment of radiotherapy- or chemotherapy-associated cystitis. Even short-term treatment appears to be effective in reducing symptoms and improving the quality of life of patients.

Management strategies for idiopathic urethritis.

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Henderson, L; Farrelly, P; Dickson, A P; Goyal, A

2016-02-01

Williams and Mikhael (1971) described idiopathic urethritis (IU) as a self-limiting condition that affects boys aged 5-15 years, with symptoms of urethrorrhagia, dysuria and haematuria. However, a proportion of boys will remain symptomatic for several years, and may develop urethral stricture (Poch et al., 2007; Palagiri et al., 2003). There is no universally effective treatment for IU, although various strategies have been employed. To review the presentation and long-term outcomes of boys with IU, and present the efficacy of management strategies that have been utilised. A retrospective review was performed of all boys with IU. It was based on clinical and cystoscopic findings for presentation, medical history, management and clinical progress. Fifty-four boys were included, with a median age of 11 years (range 5-15 years) at presentation. The median duration of symptoms was 18 months (range 2-132 months). The median follow-up was 18.5 months (range 1-120 months). Seven (13.0%) boys had early urethral stricture at initial cystourethroscopy, and one (1.9%) developed stricture during follow-up. Thirty-six boys (66.7%) had previous circumcision and four (7.4%) had meatal stenosis. Eight (14.8%) had previous hypospadias repair. Whilst 50% of boys with IU do not require any specific treatment, those with severe/unremitting symptoms may benefit from a trial of urethral steroids or short-term urethral catheterisation. The mechanisms of benefit from these modalities are unclear and they require further evaluation. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Post-biopsy arteriovenous fistula in transplant kidney: Treatment with superselective transcatheter embolisation

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Lorenzen, Jörn; Schneider, A.; Körner, K.; Regier, M.; Adam, G.; Nolte-Ernsting, C.

2012-01-01

Purpose: To evaluate the technical success and therapeutic effect of superselective embolisation of arteriovenous fistulas in renal allografts. Materials and methods: Between 2000 and 2009, 20 patients underwent angiography of 24 AV fistulas (AVF) following percutanous biopsy of the transplanted kidney. Indications for angiography were the diagnosis of AVF by ultrasound and in addition persistent or worsening transplant renal function, or haematuria. Superselective catheterisation of the fistula was performed with a coaxial microcatheter and microcoils were used to occlude the fistula. To assess the short-term effect of embolisation, serum creatinine values were evaluated before embolisation, in the first week after embolisation and after a period of minimum 42 days after the procedure. Results: Angiography identified a single AVF in 16 patients and two AVFs in 4 patients. In 19 patients, successful embolisation was achieved without complications. In one patient, a second session was needed to embolise the AVF completely. The mean serum creatinine level of all patients with embolisation dropped significantly (p = 0.0014) from 4.4 mg/dl (range: 1.4–11.6 mg/dl, standard deviation: 3.0) before embolisation to 2.7 mg/dl after embolisation (range: 1.0–7.0 mg, standard deviation: 1.8). No patient showed an increase in serum creatinine. Long-term outcomes of the renal allograft revealed a well-functioning allograft in 19/20 patients. One patient returned to haemodialysis due to acute rejection. Conclusion: Superselective transcatheter embolisation is a safe and highly effective treatment for AVFs in renal allografts. Renal function was improved in the majority of patients.

Enterovesical fistulas complicating Crohn's disease: clinicopathological features and management.

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Yamamoto, T; Keighley, M R

2000-08-01

Enterovesical fistula is a relatively rare condition in Crohn's disease. This study was undertaken to examine clinicopathological features and management of enterovesical fistula complicating Crohn's disease. Thirty patients with enterovesical fistula complicating Crohn's disease, treated between 1970 and 1997, were reviewed. Urological symptoms were present in 22 patients; pneumaturia in 18, urinary tract infection in 7, and haematuria in 2. In 5 patients clinical symptoms were successfully managed by conservative treatment, and they required no surgical treatment for enterovesical fistula. Twenty-five patients required surgery. All the patients were treated by resection of diseased bowel and pinching off the dome of the bladder. No patients required resection of the bladder. The Foley catheter was left in situ for an average of 2 weeks after operation. Three patients developed early postoperative complications; two bowel anastomotic leaks, and one intra-abdominal abscess. All these complications were associated with sepsis and multiple fistulas at the time of laparotomy. After a median follow-up of 13 years, 3 patients having postoperative sepsis (anastomotic leak or abscess) developed a recurrent fistula from the ileocolonic anastomosis to the bladder, which required further surgery. In the other 22 patients without postoperative complications there has been no fistula recurrence. In conclusion, the majority of patients with enterovesical fistula required surgical treatment: resection of the diseased bowel and oversewing the defect in the bladder. The fistula recurrence was uncommon, but the presence of sepsis and multiple fistulas at the time of laparotomy increased the incidence of postoperative complications and fistula recurrence.

Schematic X-ray diagnostic examination for the acute phase after a blunt thoraco-abdominal injury

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Kingma, L.M.

1981-01-01

The radiodiagnostic examination in the acute phase after a blunt thoracoabdominal injury can be made more reliable by repeating the examination after half an hour. The classical radiodiagnostic examination of the thorax and the abdomen is completed by a detail view of the upper abdomen. This X-ray plays a decisive part in the diagnosis of lesions of the liver, the spleen and both hemi-diafragms. The intravenous urogram is not only important because of the information gained about the condition of the urinary tract, but is also of great value to the management of shock and to regulate the infusion of fluids in the acute phase. One of the most important conclusions from this investigation is that the exclusion of pathology in trauma-patients is just as important as the demonstration of it. By ignoring the indications for urography and the significance of possible haematuria unnecessary loss of time can be avoided. The statistical relevance of the observations is shown in many examples, with the exception of the time-limits imposed in the selection of the patients. It could not be proved that the X-ray scheme is only of more value in the early post traumatic period. There was no correlation found between the passage of time since trauma and the significance of the results of the radiodiagnostic examination. Finally, advice is given about a scheme for the radiodiagnostic examination of patients with a blunt thoraco-abdominal injury, based upon the observations and conclusions in this dissertation. (Auth.)

Novel Approach to Treat Uncomplicated Sigmoid Volvulus Combining Minimally Invasive Surgery with Enhanced Recovery, in a Rural Hospital in Zambia.

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van der Naald, Niels; Prins, Marloes I; Otten, Kars; Kumwenda, Dayson; Bleichrodt, Robert P

2018-06-01

In sub-Saharan Africa, sigmoid volvulus is a frequent cause of bowel obstruction. The aim of this study was to evaluate the results of acute sigmoid resection and anastomosis via a mini-laparotomy in patients with uncomplicated sigmoid volvulus, following the principles of "Enhanced Recovery After Surgery (ERAS)", in a low-resource setting. Patients with uncomplicated sigmoid volvulus were operated acutely, via a mini-laparotomy, according to the principles of ERAS. Intraoperative complications, duration of operation, morbidity, mortality and length of hospital stay were evaluated, retrospectively. From 1 March 2012 to 1 September 2017, 31 consecutive patients were treated with acute sigmoid resection and anastomosis, via a mini-laparotomy. There were 29 men and 2 women, median age 57 (range 17-92) years. Patients were operated after a median period of 4 (range 1.5-18) hours. The median duration of the operative procedure was 50 (range 30-105) minutes. Two patients died (6.3%). One patient died during an uncomplicated operation. The cause of death is unknown. One patient with a newly diagnosed HIV infection had an anastomotic dehiscence. After Hartmann's procedure, he died on the 17th post-operative day as a result of a HIV-related double-sided pneumonia, without signs of abdominal sepsis. One patient had an urinary retention and 1 patient haematuria after bladder catheter insertion. Acute sigmoid resection and primary anastomosis via a mini-laparotomy for uncomplicated sigmoid volvulus, without preoperative endoscopic decompression is a safe procedure with a low morbidity and mortality.

Challenges and outcome of Wilms′ tumour management in a resource-constrained setting

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Wilde J.C.H

2010-01-01

Full Text Available Background: To review the results of Wilms′ tumour patients in a tertiary referral hospital in a developing country and to find ways of improving long-term survival. Patients and Methods: Between January 1998 and May 2004, 40 patients with Wilms′ tumour (WT were admitted to Queen Elizabeth Central Hospital. Their files were reviewed and general physical condition on admission, pre-operative investigations, management and outcome were noted. Results: The mean age of presentation was 4.2 years with an equal distribution between the sexes. The mean BMI was 15 kg/m2 and more than 80% of the patients were either mildly (PCV <33% or severely anaemic (PCV <24%. All patients presented with abdominal distension. Half of them had additional complaints including abdominal pain, haematuria, dyspnoea, oedema and or weight loss. Thirty-nine out of the forty patients received pre-operative chemotherapy. Of the 36 patients that underwent surgery, 32 underwent total nephrectomy, one a partial nephrectomy, and in three the tumour was irresectable. There were no intra-operative tumour ruptures. Only 15% of the patients completed their post-operative course of chemotherapy. The 1-year survival lies between 25% and 53%. Fifteen of the 36 patients operated were known to have a recurrence. Conclusion: The patients presented in an advanced stage of the disease. Survival rates are disappointing and recurrence rates are high. Some improvement in outcome may be expected with the implementation of more aggressive treatment protocols but early diagnosis, completion of treatment regimens are needed. Pro-active follow-up is essential to measure outcome.

ER stress and basement membrane defects combine to cause glomerular and tubular renal disease resulting from Col4a1 mutations in mice

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Frances E. Jones

2016-02-01

Full Text Available Collagen IV is a major component of basement membranes, and mutations in COL4A1, which encodes collagen IV alpha chain 1, cause a multisystemic disease encompassing cerebrovascular, eye and kidney defects. However, COL4A1 renal disease remains poorly characterized and its pathomolecular mechanisms are unknown. We show that Col4a1 mutations in mice cause hypotension and renal disease, including proteinuria and defects in Bowman's capsule and the glomerular basement membrane, indicating a role for Col4a1 in glomerular filtration. Impaired sodium reabsorption in the loop of Henle and distal nephron despite elevated aldosterone levels indicates that tubular defects contribute to the hypotension, highlighting a novel role for the basement membrane in vascular homeostasis by modulation of the tubular response to aldosterone. Col4a1 mutations also cause diabetes insipidus, whereby the tubular defects lead to polyuria associated with medullary atrophy and a subsequent reduction in the ability to upregulate aquaporin 2 and concentrate urine. Moreover, haematuria, haemorrhage and vascular basement membrane defects confirm an important vascular component. Interestingly, although structural and compositional basement membrane defects occurred in the glomerulus and Bowman's capsule, no tubular basement membrane defects were detected. By contrast, medullary atrophy was associated with chronic ER stress, providing evidence for cell-type-dependent molecular mechanisms of Col4a1 mutations. These data show that both basement membrane defects and ER stress contribute to Col4a1 renal disease, which has important implications for the development of treatment strategies for collagenopathies.

Multidetector computed tomography urography for diagnosing upper urinary tract urothelial tumour.

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Cowan, Nigel C; Turney, Ben W; Taylor, Nia J; McCarthy, Catherine L; Crew, Jeremy P

2007-06-01

To evaluate multidetector computed tomography urography (MDCTU) for diagnosing upper urinary tract (UUT) urothelial tumour by comparison with retrograde ureteropyelography (RUP). MDCTU and RUP were used in a selected series of adult patients presenting with haematuria. Entry criteria were based on findings on intravenous urography and were chosen to ensure a high prevalence of UUT urothelial tumour to allow a valid retrospective comparison of the diagnostic techniques. MDCTU and RUP studies were scored for the presence and absence of UUT urothelial tumour by two radiologists, retrospectively and independently, and while unaware of the demographic and clinical information. The reference standards were the histopathology and clinical follow-up. MDCTU and RUP were used in 106 patients over a 24-month period. RUP was attempted in 151 of 212 UUTs; the corresponding MDCTU for each UUT was reviewed. MDCTU was a true-positive (TP) for urothelial tumour in 31, true-negative (TN) in 111, false-positive (FP) in eight and false-negative (FN) in one UUT, giving a sensitivity of 0.97, a specificity of 0.93, a positive predictive value (PPV) of 0.79 and a negative PV (NPV) of 0.99. RUP was technically successful and diagnostic in 96% of the UUTs (143/151). For diagnosing urothelial tumour, RUP was TP in 26, TN in 112, FP in four and FN in one UUT, giving a sensitivity of 0.97, specificity of 0.93, a PPV of 0.79 and NPV of 0.99. This study validates quantitatively the use of MDCTU for diagnosing UUT urothelial tumour.

Management of overt upper gastrointestinal bleeding in a low resource setting: a real world report from Nigeria.

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Alatise, Olusegun I; Aderibigbe, Adeniyi S; Adisa, Adewale O; Adekanle, Olusegun; Agbakwuru, Augustine E; Arigbabu, Anthony O

2014-12-10

Upper gastrointestinal bleeding (UGIB) remains a common medical problem worldwide that has significant associated morbidity, mortality, and health care resource use. This study outlines the aetiology, clinical presentation, and treatment outcomes of patients with UGIB in a Nigerian low resource health facility. This was a descriptive study of consecutive patients who underwent upper gastrointestinal (GI) endoscopy for upper GI bleeding in the endoscopy unit of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria from January 2007 to December 2013. During the study period, 287 (12.4%) of 2,320 patients who underwent upper GI endoscopies had UGIB. Of these, 206 (72.0%) patients were males and their ages ranged from 3 to 100 years with a median age of 49 years. The main clinical presentation included passage of melaena stool in 268 (93.4%) of individuals, 173 (60.3%) had haematemesis, 110 (38.3%) had haematochezia, and 161 (56.1%) were dizzy at presentation. Observed in 88 (30.6%) of UGIB patients, duodenal ulcer was the most common cause, followed by varices [52 (18.1%)] and gastritis [51 (17.1%)]. For variceal bleeding, 15 (28.8%) and 21 (40.4%) of patients had injection sclerotherapy and variceal band ligation, respectively. The overall rebleeding rate for endoscopic therapy for varices was 16.7%. For patients with ulcers, only 42 of 55 who had Forrest grade Ia to IIb ulcers were offered endoscopic therapy. Endoscopic therapy was áin 90.5% of the cases. No rebleeding followed endoscopic therapy for the ulcers. The obtained Rockall scores ranged from 2 to 10 and the median was 5.0. Of all patients, 92.7% had medium or high risk scores. An increase in Rockall score was significantly associated with length of hospital stay and mortality (p < 0.001). The overall mortality rate was 5.9% (17 patients). Endoscopic therapy for UGIB in a resource-poor setting such as Nigeria is feasible, significantly reduces morbidity and mortality

Acquired hemophilia as the cause of life-threatening hemorrhage in a 94-year-old man: a case report

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Blanchard Elizabeth

2010-07-01

Full Text Available Abstract Introduction Acquired factor VIII deficiency is a rare entity that can lead to severe and life-threatening bleeding. We describe a case of severe bleeding from the tongue secondary to acquired hemophilia and discuss treatment options, including aminocaproic acid and recombinant factor VIII, which have not been widely reported in the literature for the management of such patients. Case presentation A 94-year-old Caucasian man presented to our institution with diffuse bruising and extensive bleeding from the tongue secondary to mechanical trauma. He had no prior history of bleeding and his medical history was unremarkable except for dementia and hypertension. Coagulation studies revealed a prolonged activated partial thromboplastin time and a mixing study was consistent with the presence of an inhibitor. Quantitative assays revealed a reduced level of factor VIII activity (1% and the presence of a factor VIII inhibitor, measured at seven Bethesda units, in the serum. Oral prednisone therapy (60mg/day was given. He also received intravenous aminocaproic acid and human concentrate of factor VIII (Humate-P and topical anti-thrombolytic agents (100 units of topical thrombin cream. His hospital course was prolonged because of persistent bleeding and the development of profuse melena. He required eight units of packed red blood cells for transfusion. Hospitalization was also complicated by bradycardia of unclear etiology, which started after infusion of aminocaproic acid. His activated partial thromboplastin time gradually normalized. He was discharged to a rehabilitation facility three weeks later with improving symptoms, stable hematocrit and resolving bruises. Conclusions Clinicians should suspect a diagnosis of acquired hemophilia in older patients with unexplained persistent and profound bleeding from uncommon soft tissues, including the tongue. Use of factor VIII (Humate-P and aminocaproic acid can be useful in this coagulopathy but

A retrospective, unicentric evaluation of complicated diverticulosis jejuni: Symptoms, treatment and postoperative course

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Patrick eTeoule

2015-11-01

Full Text Available BackgroundIn contrast to the diverticulosis of the colon jejunal diverticulosis is a rare condition. The incidence is 0.06% up to 5% in large autopsy series. Complicated diverticulosis jejuni (CDJ often presents with unspecific symptoms. Therefore diagnosis is often a challenging diagnosis and due to the clinical rarity no generally valid recommendation of perioperative management exists. Patients and MethodsWe considered only patients that were operated in our centre between April 2007 and August 2014. Patients were identified by data bank search via International Statistical Classification of Diseases and Related Health Problems (ICD diagnosis code K57.10. Data was manually screened and patients with Meckel’s and duodenal diverticula were excluded from this study. Eleven consecutive patients with CDJ were finally included in this study. We analysed symptoms, diagnostic procedures, surgical treatment and postoperative morbidity and mortality. ResultsThe median age of our patients was 76 years (range 34 87. CDJ presented most frequently as intestinal bleeding or as diverticulitis. Clinical symptoms were unspecific abdominal pain, hematemesis or melena, ileus, nausea and emesis as well as patients with acute abdomen. Esophagogastroduodenoscopies confirmed CDJ in two of three patients. An abdominal CT-scan only helped to diagnose CDJ in two of ten patients. Eight (72.7% patients received an open segmental resection with primary anastomosis. In three (27.3% cases a reoperation was necessary. Overall morbidity rate was 45.5% and perioperative mortality was 9.1%. Conclusions Due to the acute character of the disease patients with CDJ are seriously ill. To diagnose patients with CDJ remains challenging as diagnostic investigations are usually not helpful in confirming diagnosis. Still, diagnosis of CDJ is most frequently confirmed intraoperatively.Keywords: complicated jejunal diverticulitis, perioperative management, acute abdomen, visceral surgery

Hemorragia digestiva alta no varicosa: comportamiento e índice de Rockall

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John Karol Ramírez

Full Text Available Introducción: la hemorragia digestiva alta no varicosa es actualmente una emergencia quirúrgica de difícil manejo, hecho que motivó el conocer su comportamiento y, usando el índice de Rockall, el riesgo de los afectados de sufrir resultados adversos durante su evolución, aquellos de posible alta precoz y las causas que la impiden. Métodos: estudio descriptivo de corte transversal realizado en el Hospital General Docente "Ernesto Guevara de la Serna" con 182 pacientes atendidos entre 2009 y 2010. Resultados: los hombres fueron los más afectados (54,4 % y el grupo de 60-80 años tuvo el mayor número de casos. La úlcera gastroduodenal fue la primera causa (52,7 %. La melena se presentó como manifestación inicial en el 60,4 % de los pacientes. La hipertensión arterial fue la comorbilidad más frecuente (60,7 %. El 44,5 % de los pacientes necesitó transfusión sanguínea. La mortalidad fue del 8,2 %. La mayor parte de la muestra se ubicó en el grupo de riesgo intermedio de Rockall (40,1 %. Recibió alta precoz solo el 11,5 % de los pacientes, y la inestabilidad hemodinámica (38 % fue la mayor responsable de este bajo número. El Rockall tuvo sensibilidad del 98,3 %, especificidad del 56,9 %, valor predictivo positivo del 52,3 %, valor predictivo negativo del 98,6 % y una exactitud del 70,9 %. En los pacientes clasificados de bajo riesgo la única complicación fue la recidiva (1,4 %. Conclusiones: el alta precoz puede ser dada a pacientes con Rockall bajo, siempre que se preste especial atención a la estabilidad hemodinámica.

Profile of peptic ulcer disease and its risk factors in Arar, Northern Saudi Arabia.

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Albaqawi, Afaf Shuaib Badi; El-Fetoh, Nagah Mohamed Abo; Alanazi, Reem Faleh Abdullah; Alanazi, Najah Salah Farhan; Alrayya, Sara Emad; Alanazi, Arwa Nughaymish Mulfi; Alenezi, Shoug Zeid Trad; Alanazi, Rehab Abdallah Alrkowi; Alshalan, Anfal Muaddi; Alenezi, Omar Tabaan; Ali, Wafaa Mohamed Bakr

2017-11-01

Peptic ulcer disease is a multifactorial health problem, and its prevalence and risk factors have changed considerably within the past century. To determine the prevalence of peptic ulcer among the population of Arar city and to identify risk factors for peptic ulcer and to estimate their relative impact on ulcer incidence. A cross-sectional study was carried out on the population of Arar city, Northern Saudi Arabia from November 01, 2016 to April 30, 2017. Data were analyzed by SPSS version 16, using descriptive statistics, prevalence, and Chi-square test. Total prevalence of peptic ulcer among the studied respondents was thus: 21.9% had peptic ulcer; 16.2% gastric ulcer and 5.6% duodenal ulcer. In 19.7% of the cases, the pain was severe, 92.4% reported that pain was precipitated by certain food. In addition to heartburn, 78.8% reported loss of appetite, 71.2% indigestion, 66.7% regurgitation, 59.1% nausea and vomiting and 42.4% with chest pain. Regarding the risk factors, coffee drinking came in first place (81.8%) followed by physical stress in 77.3%, spicy food in 57.6%, prolonged use of Non-steroidal anti-inflammatory drugs (NSAIDs) in 33.3% and Helicobacter pylori (H. pylori) infection in 24.2%. A further 22.7% reported melena as a complication while only 10.6% reported hematemesis. This is the first population-based study in Arar, Northern Saudi Arabia reporting point prevalence of peptic ulcer disease. The rate of 16.2% for gastric ulcer and 5.6% for duodenal ulcers are substantially high. Coffee drinking, physical stress, spicy food, prolonged use of NSAID and H. pylori infection were the reported risk factors. Population-based endoscopic studies are recommended.

Outcomes of patients hospitalized with peptic ulcer disease diagnosed in acute upper endoscopy.

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Malmi, Hanna; Kautiainen, Hannu; Virta, Lauri J; Färkkilä, Martti A

2017-11-01

The incidence and complications of peptic ulcer disease (PUD) have declined, but mortality from bleeding ulcers has remained unchanged. The aims of the current study were to evaluate the significance of PUD among patients admitted for acute upper endoscopy and to evaluate the survival of PUD patients. In this prospective, observational cohort study, data on 1580 acute upper endoscopy cases during 2012-2014 were collected. A total of 649 patients were included with written informed consent. Data on patients' characteristics, living habits, comorbidities, drug use, endoscopy and short-term and long-term survival were collected. Of all patients admitted for endoscopy, 147/649 (23%) had PUD with the main symptom of melena. Of these PUD patients, 35% had major stigmata of bleeding (Forrest Ia-IIb) in endoscopy. Patients with major stigmata had significantly more often renal insufficiency, lower level of blood pressure with tachycardia and lower level of haemoglobin, platelets and ratio of thromboplastin time. No differences in drug use, Charlson comorbidity class, BMI, smoking or alcohol use were found. Of the PUD patients, 31% were Helicobacter pylori positive. The 30-day mortality was 0.7% (95% confidence interval: 0.01-4.7), 1-year mortality was 12.9% (8.4-19.5) and the 2-year mortality was 19.4% (13.8-26.8), with no difference according to major or minor stigmata of bleeding. Comorbidity (Charlson>1) was associated with decreased survival (P=0.029) and obesity (BMI≥30) was associated with better survival (P=0.023). PUD is still the most common cause for acute upper endoscopy with very low short-term mortality. Comorbidity, but not the stigmata of bleeding, was associated with decreased long-term survival.

Bleeding 'downhill' esophageal varices associated with benign superior vena cava obstruction: case report and literature review.

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Loudin, Michael; Anderson, Sharon; Schlansky, Barry

2016-10-24

Proximal or 'downhill' esophageal varices are a rare cause of upper gastrointestinal hemorrhage. Unlike the much more common distal esophageal varices, which are most commonly a result of portal hypertension, downhill esophageal varices result from vascular obstruction of the superior vena cava (SVC). While SVC obstruction is most commonly secondary to malignant causes, our review of the literature suggests that benign causes of SVC obstruction are the most common cause actual bleeding from downhill varices. Given the alternative pathophysiology of downhill varices, they require a unique approach to management. Variceal band ligation may be used to temporize acute variceal bleeding, and should be applied on the proximal end of the varix. Relief of the underlying SVC obstruction is the cornerstone of definitive treatment of downhill varices. A young woman with a benign superior vena cava stenosis due to a tunneled internal jugular vein dialysis catheter presented with hematemesis and melena. Urgent upper endoscopy revealed multiple 'downhill' esophageal varices with stigmata of recent hemorrhage. As there was no active bleeding, no endoscopic intervention was performed. CT angiography demonstrated stenosis of the SVC surrounding the distal tip of her indwelling hemodialysis catheter. The patient underwent balloon angioplasty of the stenotic SVC segment with resolution of her bleeding and clinical stabilization. Downhill esophageal varices are a distinct entity from the more common distal esophageal varices. Endoscopic therapies have a role in temporizing active variceal bleeding, but relief of the underlying SVC obstruction is the cornerstone of treatment and should be pursued as rapidly as possible. It is unknown why benign, as opposed to malignant, causes of SVC obstruction result in bleeding from downhill varices at such a high rate, despite being a less common etiology of SVC obstruction.

Portal hypertension and an atypical reactive arthritis like presentation in a patient infected with hepatitis C virus genotype 3

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Moushumi Lodh

2014-01-01

Full Text Available Background: Reactive arthritis (ReA is defined as a peripheral arthritis lasting longer than 1 month, associated with urethritis, cervicitis, or diarrhea. The reported annual incidence of ReA is approximately 30-40 cases per 100,000 adults, occurring commonly in the age group of 16 and 35 years. It is known to be associated with gastrointestinal infections with Shigella, Salmonella, and Campylobacter species and other microorganisms, as well as with genitourinary infections (especially with Chlamydia trachomatis. Case Report: This article reports the case of a 53-year-old, post-right total hip replacement, Indian man, with ReA, who presented with fever, respiratory distress, and abdominal discomfort. He complained of itching, tingling sensation, pain on urination, and retention of urine. He had right hip joint pain for 3 weeks, inability to move right leg since 10 days, and melena since 1 week. Laboratory tests revealed anemia, high liver and kidney function tests, elevated erythrocyte sedimentation rate, C reactive protein, procalcitonin and occult blood in stool. He tested positive for hepatitis C virus genotype 3. Gastroduodenoscopy revealed multiple apthoid ulcers at D2 and large gastric varix. Ultrasonography of whole abdomen revealed cholelithiasis and splenomegaly. Skin lesions and arthritis led to the diagnosis of associated ReA. The patient was managed conservatively and discharged in a stable condition. Conclusions: Our case is unlike classical ReA because the patient is older, HLA B27 negative, and without florid urethritis. Admitted for fever and lower urinary tract symptoms, along with respiratory distress, the primary objective of the emergency doctors was to prevent the patient from progressing to organ failure. The diagnosis of underlying atypical/incomplete ReA could easily have been missed without adequate awareness, dermatological consultation, and a skin biopsy.

Locations and Mucosal Lesions Responsible for Major Gastrointestinal Bleeding in Patients on Warfarin or Dabigatran.

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Kolb, Jennifer M; Flack, Kathryn Friedman; Chatterjee-Murphy, Prapti; Desai, Jay; Wallentin, Lars C; Ezekowitz, Michael; Connolly, Stuart; Reilly, Paul; Brueckmann, Martina; Ilgenfritz, John; Aisenberg, James

2018-03-27

Different oral anticoagulants may be associated with gastrointestinal bleeding (GIB) from different locations or mucosal lesions. We aimed to test this hypothesis. Two blinded gastroenterologists independently analyzed source documents from the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial of dabigatran 150 mg BID (D150), dabigatran 110 mg BID (D110) versus warfarin in non-valvular atrial fibrillation (NVAF). Major GIB events (total n = 546) and life-threatening GIB events (n = 258) were more common with D150 versus warfarin (RR 1.57 [1.28-1.92] and RR 1.62 [1.20-2.18], respectively) and similar for D110 compared to warfarin (RR 1.11 [0.89-1.38] and RR 1.16 [0.84-1.61], respectively). Fatal bleeding was similarly rare across treatment groups. Lower GI major bleeding and life-threatening bleeding were more common with D150 compared to warfarin (RR 2.23 [1.47, 3.38] and RR 2.64 [1.36, 5.13], respectively) and with D110 compared to warfarin (RR 1.78 [1.16, 2.75] and RR 2.00 [1.00, 4.00], respectively). MGIB from colonic angiodysplasia was increased with dabigatran versus warfarin (P < 0.01 for both dose comparisons). Subacute and chronic MGIB events were more common with D150 than with warfarin (RR 1.72 [1.06, 2.78] and RR 1.66 [1.12, 2.45], respectively), as were hematochezia or melena (RR 1.67 [1.18, 2.36] and RR 1.72 [1.20, 2.47], respectively). In a chronic NVAF population, D150 but not D110 is associated with increased major and life-threatening GI bleeding in comparison with warfarin. At both dabigatran doses, increased bleeding from the colorectum, in particular from angiodysplasia, is seen.

[Antithrombotic therapy and nonvariceal upper gastrointestinal bleeding].

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Belanová, Veronika; Gřiva, Martin

2015-12-01

The incidence of acute upper gastrointestinal bleeding is about 85-108/100,000 inhabitants per year, nonvariceal bleeding accounts for 80-90%. Antiplatelet and anticoagulation treatment are the significant risk factors for upper gastrointestinal bleeding. To evaluate the occurrence of upper gastrointestinal bleeding in the general community of patients in a county hospital. And to compare the role played by antiplatelet and anticoagulation drugs and other risk medication. Retrospective analysis of patients over 18 years of age who underwent endoscopy for acute upper gastrointestinal bleeding or anaemia (haemoglobinupper gastrointestinal tract during a hospital stay in 2013 (from January to June). We included 111 patients of average age 69±15 years, men 60%. Nonvariceal bleeding accounted for 90% of the cases. None of the patients with variceal bleeding (10% of patients) took antiplatelet or anticoagulation therapy. There were 100 patients with nonvariceal bleeding of average age 70±15, 61% men. With the symptoms of acute bleeding (hematemesis, melena) presented in 73% of patients. The most frequent cause of bleeding was gastric and duodenal ulcer (54%). 32% of patients with nonvariceal bleeding had antiplatelets, 19% anticoagulants and 10% used nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors or corticosteroids. 30-days mortality of patients with nonvariceal bleeding was 11%, annual mortality was 23%. There was no significant difference in mortality, blood transfusion requirements or surgical intervention between the patients with antithrombotic agents and without them. 25% of patients (8 patients) using acetylsalicylic acid did not fulfil the indication for this treatment. Among the patients examined by endoscopy for symptomatic nonvariceal bleeding and/or anaemia (haemoglobingastrointestinal bleeding. With regard to that, it is alarming, that there still exists a nonnegligible percentage of patients taking acetylsalicylic acid even

A novel hemostatic powder for upper gastrointestinal bleeding: a multicenter study (the "GRAPHE" registry).

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Haddara, Sami; Jacques, Jeremie; Lecleire, Stéphane; Branche, Julien; Leblanc, Sarah; Le Baleur, Yann; Privat, Jocelyn; Heyries, Laurent; Bichard, Philippe; Granval, Philippe; Chaput, Ulriikka; Koch, Stephane; Levy, Jonathan; Godart, Bruno; Charachon, Antoine; Bourgaux, Jean-François; Metivier-Cesbron, Elodie; Chabrun, Edouard; Quentin, Vincent; Perrot, Bastien; Vanbiervliet, Geoffroy; Coron, Emmanuel

2016-12-01

Background and study aims: The hemostatic powder TC-325 (Hemospray; Cook Medical, Winston-Salem, North Carolina, USA) has shown promising results in the treatment of upper gastrointestinal bleeding (UGIB) in expert centers in pilot studies. The aim of this study was to evaluate the feasibility and efficacy of TC-325 in a large prospective registry of use in routine practice. Patients and methods: The data of all patients treated with TC-325 were prospectively collected through a national registry. Outcomes were the immediate feasibility and efficacy of TC-325 application, as well as the rates of rebleeding at Day 8 and Day 30. Multivariate analysis was performed to determine predictive factors of rebleeding. Results: A total of 202 patients were enrolled and 64 endoscopists participated from 20 centers. TC-325 was used as salvage therapy in 108 patients (53.5 %). The etiology of bleeding was an ulcer in 75 patients (37.1 %), tumor in 61 (30.2 %), postendoscopic therapy in 35 (17.3 %), or other in 31 (15.3 %). Application of the hemostatic powder was found to be very easy or easy in 31.7 % and 55.4 %, respectively. The immediate efficacy rate was 96.5 %. Recurrence of UGIB was noted at Day 8 and Day 30 in 26.7 % and 33.5 %, respectively. Predictive factors of recurrence at Day 8 were melena at initial presentation and use of TC-325 as salvage therapy. Conclusion: These multicenter data confirmed the high rate of immediate hemostasis, excellent feasibility, and good safety profile of TC-325, which could become the treatment of choice in bleeding tumors or postendoscopic bleeding but not in bleeding ulcers where randomized studies are needed. ClinicalTrials.gov (NCT02595853). © Georg Thieme Verlag KG Stuttgart · New York.

Clinico-hemato-biochemical profile of dogs with liver cirrhosis

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M. A. Elhiblu

2015-04-01

Full Text Available Aim: The aim of this study was to determine the relevant tools in the diagnosis of liver cirrhosis in dogs. Material and Methods: A total of 140 dogs presented at Veterinary Teaching Hospital, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, showing clinical signs of hepatic insufficiency were subjected to clinico-hemato biochemical, urological, ultrasonographic (USG, and USG guided fine-needle biopsy examinations by standard methods. On the basis of these results, 6 dogs out of 140 dogs were found to be suffering from liver cirrhosis. Six clinically healthy dogs constituted the control group. Results: The dogs suffering from liver cirrhosis manifested inappetence, halitosis, abdominal distension, weight loss, melena, icterus, anemia, and neutrophilic leukocytosis with the left shift. Levels of hemoglobin, lymphocytes, packed cell volume, mean corpuscular volume, mean corpuscular Hb (MCH, and platelet count were significantly lower in liver cirrhosis group than control group while total leukocyte count, neutrophils, and MCH concentration were significantly higher. Glucose, total protein, albumin, A/G ratio, and fibrinogen were significantly lower, and creatinine, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, prothrombin time, and APTT were significantly higher than the control values. Ultrasound revealed diffuse increase in echogenicity with rounded and irregular liver margins. Cytological examination of the ascitic fluid and fine-needle aspiration biopsy of liver was not fruitful in the diagnosis of liver cirrhosis. Conclusions: Liver cirrhosis causes clinical and hemo-biochemical alterations, which require special consideration when treating diseased animals. USG, diffuse increase in echogenicity of liver, rounding and irregularity of liver margins and microhepatica were the consistent findings. It is suggested that USG along with hemo-biochemical alterations may be used as a diagnostic tool for

Hemobilia caused by a ruptured hepatic cyst: a case report

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Dutta Sudhir

2011-01-01

Full Text Available Abstract Introduction Hemobilia is a rare cause of upper gastrointestinal bleeding. More than 50% of hemobilia cases are related to iatrogenic trauma from hepatobiliary procedures, and needle biopsy of the liver represents the most common cause. A minority of hemobilia cases are due to hepatobiliary disorders such as cholangitis, hepatobiliary cancers, choledocholithiasis, and vascular abnormalities in the liver. The classic presentation of hemobilia is the triad of right upper quadrant (biliary pain, obstructive jaundice, and upper gastrointestinal bleeding. We report a rare case of hemobilia caused by a spontaneous hepatic cyst rupture, where our patient presented without the classical symptoms, in the absence of therapeutic or pathological coagulopathy, and in the absence of spontaneous or iatrogenic trauma. Case presentation A 91-year-old African-American woman was referred to our out-patient gastroenterology clinic for evaluation of mild epigastric pain and intermittent melena. An abdominal computed tomography scan was remarkable for multiple hepatic cysts. Esophagogastroduodenoscopy revealed multiple blood clots at the ampulla of Vater. Endoscopic retrograde cholangiopancreatography showed a single 18 mm-sized filling defect in the common hepatic duct wall at the junction of the right and left hepatic duct, adjacent to one of the hepatic cysts. The ruptured hepatic cyst communicated to the bile ducts and was the cause of hemobilia with an atypical clinical presentation. Conclusion Hemobilia is an infrequent cause of upper gastrointestinal bleeding and rarely occurs due to hepatic cyst rupture. To the best of our knowledge, this is only the second case report in the literature that describes hemobilia due to hepatic cyst rupture. However, it is the first case in the literature of hemobilia due to hepatic cyst rupture in the absence of iatrogenic or spontaneous trauma, and in the absence of a spontaneous or pathological coagulopathy.

Lower Urinary Tract Symptoms: Prevalence, Perceptions, and Healthcare-Seeking Behavior amongst Nigerian Men

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Rufus Wale Ojewola

2016-12-01

Full Text Available Purpose: The aim of this study was to determine the prevalence of lower urinary tract symptoms (LUTS and the factors influencing the healthcare-seeking behavior of men with LUTS. Materials and Methods: A cross-sectional survey was performed of 658 men selected using multi-staged sampling techniques. They were interviewed about LUTS and their healthcare-seeking behavior. The data were analysed using PASW Statistics ver. 18. Associations between specific factors and healthcare-seeking behavior were examined using the chi-square and Fisher exact tests. Results: The overall prevalence of LUTS was 59.1%. Storage symptoms (48.2% were more prevalent than voiding (36.8% or post-micturition (29.9% symptoms. Approximately a quarter (25.5% had a poor quality of life (QoL score. The average duration of symptoms before seeking help was 3.4 years. Almost half (46.8% of the men with LUTS had never sought help. Perceptions of LUTS as an inevitable part of ageing, subjective feelings of wellness, financial constraints, and fear of surgery were the most common reasons for not seeking help. The most common reasons for seeking help were to moderate-severe symptoms, impaired QoL, and fear of cancer. Severe LUTS, impaired QoL, and the concomitant presence of erectile dysfunction, dysuria, or haematuria were clinical factors that positively influenced healthcare-seeking behavior. Conclusions: In this population-based study, we found that the prevalence of LUTS was very high amongst adult males. However, only about half of these men sought medical attention. Their healthcare-seeking behavior was influenced by severity of symptoms, QoL scores, and socio-demographic factors such as educational status.

Comparison of virtual cystoscopy and ultrasonography for bladder cancer detection: A meta-analysis

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Qu Xinhua; Huang Xiaolu; Wu Lianming; Huang Gang; Ping Xiong; Yan Weili

2011-01-01

Background and purpose: Bladder cancer is the most commonly diagnosed malignancy in patients presenting with haematuria. Early detection is crucial for improving patient prognosis. We therefore performed a meta-analysis to evaluate and compare the detection validity (sensitivity and specificity) of virtual cystoscopy (VC) and ultrasonography (US). Methods: We searched MEDLINE, EMBASE, PubMed and the Cochrane Library for studies evaluating diagnosis validity of VC and US between January 1966 and December 2009. Meta-analysis methods were used to pool sensitivity and specificity and to construct a summary receiver-operating characteristic (SROC) curve. Results: A total of 26 studies that included 3084 patients who fulfilled all of the inclusion criteria were considered for inclusion in the analysis. The pooled sensitivity for bladder cancer detection using CT virtual cystoscopy (CTVC), MR virtual cystoscopy (MRVC) and US was 0.939 (95% CI, 0.919-0.956), 0.908 (95% CI, 0.827-0.959) and 0.779 (95% CI, 0.744-0.812), respectively. The pooled specificity for bladder cancer detection using CTVC, MRVC and US was 0.981 (95% CI, 0.973-0.988), 0.948 (95% CI, 0.884-0.983) and 0.962 (95% CI, 0.953-0.969), respectively. The pooled diagnostic odd ratio (DOR) estimate for CTVC (604.22) were significantly higher than for MRVC (144.35, P < 0.001) and US (72.472, P < 0.001). Conclusion: Our results showed that both CTVC and MRVC are better imaging methods for diagnosing bladder cancer than US. CTVC has higher diagnostic value (sensitivity, specificity and DOR) for the detection of bladder cancer than either MRCT or US.

Ketamine-associated lower urinary tract destruction: a new radiological challenge

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Mason, K., E-mail: k.mason@doctors.org.u [Bristol Royal Infirmary, Bristol (United Kingdom); Cottrell, A.M. [North Bristol NHS Trust, Bristol (United Kingdom); Corrigan, A.G. [Bristol Royal Infirmary, Bristol (United Kingdom); Gillatt, D.A.; Mitchelmore, A.E. [North Bristol NHS Trust, Bristol (United Kingdom)

2010-10-15

Aim: Ketamine is a short-acting dissociative anaesthetic whose hallucinogenic side effects have led to an increase in its illicit use amongst club and party goers. There is a general misconception amongst users that it is a safe drug with few long term side effects, however ketamine abuse is associated with severe urinary tract dysfunction. Presenting symptoms include urinary frequency, nocturia, dysuria, haematuria and incontinence. Materials and methods: We describe the radiological findings found in a series of 23 patients, all with a history of ketamine abuse, who presented with severe lower urinary tract symptoms (LUTS). Imaging techniques used included ultrasonography (US), intravenous urography (IVU), and computed tomography (CT). These examinations were reviewed to identify common imaging findings. All patients with positive imaging findings had also undergone cystoscopy and bladder wall biopsies, which confirmed the diagnosis. The patients in this series have consented to the use of their data in the ongoing research into ketamine-induced bladder pathology. Results: Ultrasound demonstrated small bladder volume and wall thickening. CT revealed marked, generalized bladder wall thickening, mucosal enhancement, and perivesical inflammation. Ureteric wall thickening and enhancement were also observed. In advanced cases ureteric narrowing and strictures were identified using both CT and IVU. Correlation of clinical history, radiological and pathological findings was performed to confirm the diagnosis. Conclusion: This case series illustrates the harmful effects of ketamine on the urinary tract and the associated radiological findings. Delayed diagnosis can result in irreversible renal tract damage requiring surgical intervention. It is important that radiologists are aware of this emerging clinical entity as early diagnosis and treatment are essential for successful management.

Comparison of virtual cystoscopy and ultrasonography for bladder cancer detection: A meta-analysis

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Qu Xinhua; Huang Xiaolu [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127 (China); Department of Ultrasonic, Ninth People' s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011 (China); Wu Lianming [Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127 (China); Huang Gang [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127 (China); Ping Xiong, E-mail: pxiong6@126.com [Department of Ultrasonic, Ninth People' s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011 (China); Yan Weili, E-mail: wl_yan67@126.com [Department of Nuclear Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127 (China)

2011-11-15

Background and purpose: Bladder cancer is the most commonly diagnosed malignancy in patients presenting with haematuria. Early detection is crucial for improving patient prognosis. We therefore performed a meta-analysis to evaluate and compare the detection validity (sensitivity and specificity) of virtual cystoscopy (VC) and ultrasonography (US). Methods: We searched MEDLINE, EMBASE, PubMed and the Cochrane Library for studies evaluating diagnosis validity of VC and US between January 1966 and December 2009. Meta-analysis methods were used to pool sensitivity and specificity and to construct a summary receiver-operating characteristic (SROC) curve. Results: A total of 26 studies that included 3084 patients who fulfilled all of the inclusion criteria were considered for inclusion in the analysis. The pooled sensitivity for bladder cancer detection using CT virtual cystoscopy (CTVC), MR virtual cystoscopy (MRVC) and US was 0.939 (95% CI, 0.919-0.956), 0.908 (95% CI, 0.827-0.959) and 0.779 (95% CI, 0.744-0.812), respectively. The pooled specificity for bladder cancer detection using CTVC, MRVC and US was 0.981 (95% CI, 0.973-0.988), 0.948 (95% CI, 0.884-0.983) and 0.962 (95% CI, 0.953-0.969), respectively. The pooled diagnostic odd ratio (DOR) estimate for CTVC (604.22) were significantly higher than for MRVC (144.35, P < 0.001) and US (72.472, P < 0.001). Conclusion: Our results showed that both CTVC and MRVC are better imaging methods for diagnosing bladder cancer than US. CTVC has higher diagnostic value (sensitivity, specificity and DOR) for the detection of bladder cancer than either MRCT or US.

IGF-1, IGFBP-3 and ALS in adult patients with chronic kidney disease.

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Lepenies, Julia; Wu, Zida; Stewart, Paul M; Strasburger, Christian J; Quinkler, Marcus

2010-04-01

Insulin-like growth factor I (IGF-1) is for the most part bound in a ternary complex with IGF-binding protein-3 (IGFBP-3) and acid-labile subunit (ALS). This ternary complex is a storage form of IGF-1 in blood and passes not through the renal glomerulus. Little information is available in regard to the components of the ternary complex in adult renal disease. To investigate levels of serum IGF-1, IGFBP-3 and ALS in relation to renal function and extent of proteinuria. We measured IGF-1, IGFBP-3 and ALS concentrations in 137 patients who were investigated due to proteinuria and/or haematuria and/or renal impairment. The patients received renal biopsies and the histological diagnosis was documented. Urinary albumin excretion and relevant clinical parameter were evaluated. IGF-1 showed a highly positive correlation to IGFBP-3 and ALS, and the latter to IGFBP-3. IGF-1, IGFBP-3 and ALS decreased with increasing age. IGF-1 and IGFBP-3 showed no significant change depending on the creatinine clearance. However, ALS decreased with decreasing renal function. In patients with heavy proteinuria ALS levels, but not IGF-1 and IGFBP-3 levels, decreased significantly. Patients with chronic ischaemic renal damage and diabetic glomerulopathy showed higher IGF-1 and IGFBP-3 levels compared to patients with thin glomerular basement membrane disease despite their older age. IGF-1 and IGFBP-3 levels seem to be independent of renal function and severity of proteinuria. However, ALS levels are altered in renal failure and nephrotic syndrome, which may be due to increased renal loss or diminished hepatic production or both. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

Bladder Cancer in HIV-infected Adults: An Emerging Issue? Case-Reports and Systematic Review.

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Sylvain Chawki

Full Text Available Non-AIDS-related malignancies now represent a frequent cause of death among HIV-infected patients. Albeit bladder cancer is one of the most common malignancies worldwide, it has been rarely reported among HIV-infected patients. We wished to assess the prevalence and characteristics of bladder cancer in HIV-infected patients.We conducted a single center retrospective study from 1998 to 2013 in a university hospital in Paris. Cases of bladder cancer among HIV-infected patients were identified using the electronic records of the hospital database and of the HIV-infected cohort. Patient characteristics and outcomes were retrieved from patients charts. A systematic review of published cases of bladder cancers in patients with HIV-infection was also performed.During the study period we identified 15 HIV-infected patients (0.2% of the cohort with a bladder cancer. Patients were mostly men (73% and smokers (67%, with a median age of 56 years at cancer diagnosis. Bladder cancer was diagnosed a median of 14 years after HIV-infection. Most patients were on ART (86% with median current and nadir CD4 cell counts of 506 and 195 cells/mm3, respectively. Haematuria (73% was the most frequent presenting symptom and HPV-associated lesions were seen in 6/10 (60% patients. Histopathology showed transitional cell carcinoma in 80% and a high proportion of tumors with muscle invasion (47% and high histologic grade (73%. One-year survival rate was 74.6%. The systematic review identified 13 additional cases of urothelial bladder cancers which shared similar features.Bladder cancers in HIV-infected patients remain rare but may occur in relatively young patients with a low nadir CD4 cell count, have aggressive pathological features and can be fatal.

Screening for Ptaquiloside in Ferns: Using Herbarium Specimens for Qualitative Mapping Purposes.

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Rasmussen, Lars Holm; Pedersen, Henrik AErenlund

2017-11-01

Ptaquiloside (PTA) is a noxious carcinogen found widespread in Bracken (Pteridium sp.) but with scattered and unresolved distribution outside the genus. The carcinogen causes Bovine Enzootic Haematuria among cattle all-over the World and is under suspicion of causing human cancers. To set-up a methodology for large-scale qualitative studies on the distribution of PTA in ferns using already available herbarium specimens as source. PTA and the main degradation product pterosin B (PtB) were quantified in aqueous frond extracts by HPLC-DAD. PTA was quantified after forced reaction into PtB. Optimal reaction conditions were tested using hydrochloric acid, sulphuric acid, trifluoroacetic acid (TFA), acetic acid and temperature as the experimental variables. A pair-wise test for PTA degradation in plant-press were used to explore the effect of this preservation regime. A selection of up to 50 years old Bracken herbarium specimens were tested for PTA and PtB. The methodology was applied on 21 fern species from Denmark. An optimised TFA-based method results in 30.7% higher conversion and a 1:1 reaction between PTA and PtB. Full three-dimensional resolution of the analyte was obtained. Preservation of fronds in a plant press increase formation of PtB. Hence, the method is only suitable for qualitative studies. Presence of PTA and PtB were found in samples up to 50 years old. Among 21 ferns tested, the compounds were only found in Pteridium aquilinum. Herbarium specimens up to 50 years old can be used for explorative risk assessment of ferns using HPLC-DAD for quantification and identification. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Holmium laser urethrotomy for treatment of traumatic stricture urethra: a review of 78 patients.

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Hussain, Manzoor; Lal, Murli; Askari, Syed Hasan; Hashmi, Altaf; Rizvi, Syed Adibul Hasan

2010-10-01

To evaluate the efficacy and long-term results of laser urethrotomy as minimally invasive treatment for traumatic stricture urethra. Between January 2006 and June 2008, 78 male patients were treated with Holmium Laser urethrotomy. 16 Fr urethroscope was used through which 600um laser fiber was introduced through side channel. Stricture was visualized and incised at 12 o'clock position with energy set at 1500-2000 MJ at pulse rate of 10-12. Two other incisions were given at 2 and 10 o'clock positions. Further ablation was done till 16Fr Foley's catheter was passed. Patients were followed in a stricture clinic. Patients age ranged from 15-73 years. All strictures were due to trauma, Road traffic accident in 40 (52%) post catheter trauma 4 (5%), fall as ride 27 (35%) and failed urethroplasty 7 (8%). Site of stricture was bulbar 57 (73%), bulbomembranous 16 (20%) and membranoprostatic 5 (2.5%). Length of stricture ranged from 0.8-2.5 cms. At 3 months follow-up, 60 (77%) patients remained catheter and symptoms free while 18 (23%) developed recurrence of stricture but at the end of 36 months follow-up success rate decreased to 47 (60%). Among those who developed re-strictures, 6 ( 7.6%) had 2nd sitting laser while 4 (5.1%) had urethroplasty, and others were on intermittent dilatation. Immediate complications were sepsis 10 (13%), extravasation 2 (4%), failed urethrotomy 2 (4%) and mild haematuria 3 (5.8%). Hospital stay ranged from day care to 3 days. Laser urethrotomy is minimally invasive and an effective treatment for short strictures in bulbarurethra. The recurrence rate is 40% in the long-term follow-up and is more commonly seen in completely obliterated strictures.

The early toxicity of escalated versus standard dose conformal radiotherapy with neo-adjuvant androgen suppression for patients with localised prostate cancer: Results from the MRC RT01 trial (ISRCTN47772397)

International Nuclear Information System (INIS)

Dearnaley, David P.; Sydes, Matthew R.; Langley, Ruth E.; Graham, John D.; Huddart, Robert A.; Syndikus, Isabel; Matthews, John H.L.; Scrase, Christopher D.; Jose, Chakiath C.; Logue, John; Stephens, Richard J.

2007-01-01

Background: Five-year disease-free survival rates for localised prostate cancer following standard doses of conventional radical external beam radiotherapy are around 80%. Conformal radiotherapy (CFRT) raises the possibility that radiotherapy doses can be increased and long-term efficacy outcomes improved, with safety an important consideration. Methods: MRC RT01 is a randomised controlled trial of 862 men with localised prostate cancer comparing Standard CFRT (64 Gy/32 f) versus Escalated CFRT (74 Gy/37 f), both administered with neo-adjuvant androgen suppression. Early toxicity was measured using physician-reported instruments (RTOG, LENT/SOM, Royal Marsden Scales) and patient-reported questionnaires (MOS SF-36, UCLA Prostate Cancer Index, FACT-P). Results: Overall early radiotherapy toxicity was similar, apart from increased bladder, bowel and sexual toxicity, in the Escalated Group during a short immediate post-radiotherapy period. Toxicity in both groups had abated by week 12. Using RTOG Acute Toxicity scores, cumulative Grade ≥2 bladder and bowel toxicity was 38% and 30% for Standard Group and 39% and 33% in Escalated Group, respectively. Urinary frequency (Royal Marsden Scale) improved in both groups from pre-androgen suppression to 6 months post-radiotherapy (p < 0.001), but bowel and sexual functioning deteriorated. This pattern was supported by patient-completed assessments. Six months after starting radiotherapy the incidence of RTOG Grade ≥2 side-effects was low (<1%); but there were six reports of rectal ulceration (6 Escalated Group), six haematuria (5 Escalated Group) and eight urethral stricture (6 Escalated Group). Conclusions: The two CFRT schedules with neo-adjuvant androgen suppression have broadly similar early toxicity profiles except for the immediate post-RT period. At 6 months and compared to before hormone therapy, bladder symptoms improved, whereas bowel and sexual symptoms worsened. These assessments of early treatment safety will be

A Prospective Pilot Study to Validate the Management Protocol for Patients Presenting with Acute Urinary Retention: A Community-Based, Nonhospitalised Protocol

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Shyamala S. Gopi

2006-01-01

Full Text Available Acute urinary retention (AUR in males is managed conventionally by hospital admission, alpha-adrenergic therapy, and trial without catheter. To reduce inpatient bed pressures, we set up a protocol to manage such patients in the community. We review our results in this paper. We performed a prospective study of male patients presenting to our acute admissions ward and Accident and Emergency department over 6 months. Patients with chronic urinary retention, macroscopic haematuria, sepsis, urinary tract infection, and/or serum creatinine >130 mmol/l were excluded from the study. Those enrolled were catheterised, commenced on alfuzosin (10 mg nocte, and discharged to the community. A trial without catheter (TWOC was performed 5—7 days later. QoL/IPSS, peak flow rate, and residual volume assessment were performed following successful TWOC 3 months later.Thirty-one male patients with a median age of 69 years were studied and the median residual volume following catheterisation was 900 ml. The aetiology of AUR was benign prostatic hyperplasia (BPH in 29 patients and constipation in the remaining 2 patients. TWOC was successful in 19 patients (61.3% following first TWOC, 26 (83.9% following second trial of voiding. The mean peak flow rate was 6.5 ml/sec and postvoid scan 165 ml, following an immediate TWOC. At 3 months follow-up, mean peak flow rate was 13.2 ml/sec, postvoid scan 26.5 ml, IPSS 4.5, and QoL score was 2. This study has shown that AUR can be managed safely and effectively in the community. Effective communication with the nurse urology specialist, general practitioner, and emergency department are crucial for the successful implementation of the protocol.

Salvage brachytherapy for local recurrences of prostate cancer treated previously with radiotherapy.

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Gawkowska-Suwinska, Marzena; Fijałkowski, Marek; Białas, Brygida; Szlag, Marta; Kellas-Ślęczka, Sylwia; Nowicka, Elżbieta; Behrendt, Katarzyna; Plewicki, Grzegorz; Smolska-Ciszewska, Beata; Giglok, Monika; Zajusz, Aleksander; Owczarek, Grzegorz

2009-12-01

The aim of the study was to analyze early effects and toxicity of salvage high dose rate brachytherapy for local recurrences of adenocarcinoma of the prostate after external beam radiotherapy (EBRT). In MCS Memorial Institute of Oncology in Gliwice a research programme on salvage HDR brachytherapy for local recurrences of prostate cancer treated previously with EBRT has been ongoing since February 2008. The treatment consisted of 3 fractions of 10 Gy each given every 14 days. Maximal urethral doses were constrained to be ≤ 120% of the prescribed dose. Maximal bladder and rectum doses were constrained to be ≤ 70% of the prescribed dose. Fifteen eligible patients were treated and analyzed from February 2008. All patients completed the treatment without major complications. The most common early complications were: macroscopic haematuria, pain in lower part of the abdomen, and transient dysuria. During the first week after the procedure a transient increase in IPSS score was noticed. The Foley catheter was removed on day 2 to 5. No complications after spinal anaesthesia were observed. Acute toxicity according to EORTC/RTOG was low. For bladder EORTC/RTOG score ranged from 0 to 2. Only in two patients grade 1 toxicity for rectum was observed. The follow-up ranged from 3 to 9 months. In one patient grade 2 rectal toxicity was observed, and one had urethral stricture. Other patients did not have any other significant late toxicity of the treatment. Two patients developed bone metastases. Salvage brachytherapy for localized prostate cancer (3 × 10 Gy every 14 days) seems to be a safe and well tolerated procedure. A significant decline in prostate-specific antigen (PSA) level is seen in patients with hormone-responsive cancer. Long-term efficiency and toxicity of the procedure are yet to be established.

Photoselective Vaporisation of the Bladder for the Management of Radiation Cystitis - Technique and Initial Outcomes.

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Pascoe, Claire; Christidis, Daniel; Manning, Todd; Lamb, Benjamin W; Murphy, Declan G; Lawrentschuk, Nathan

2018-05-16

Objective To describe our technique utilising photoselective vaporisation of the bladder (PVB) for the management of haemorrhagic cystitis and initial results of 12 patients. Materials and Method An audit of theatre records of a single surgeon was performed to identify patients who had undergone PVB for management of radiation-cystitis. Rigid cystoscopy was performed. Ureteric catheters were placed and active bleeding sites targeted to optimise vision. Ablation was commenced using the vaporize function. When lasering around delicate structures the coagulation function was used. Ureteric catheters remained in situ for 24h. An 18Fr Foley catheter was placed. When urine output was clear continuous bladder irrigation was ceased. Both uretetric catheters and Foley catheter were removed prior to the 24hour mark. Results 12 patients were identified. 8 had previously required blood transfusion secondary to bladder haemorrhage. 9 were successfully treated and 2 saw improvement in haematuria but required a repeat procedure at 3 weeks post operatively. 4 went on to receive hyperbaric oxygenation as consolidative therapy. 1 patient was unsuccessfully treated and went on to cystectomy. There were no mortalities. No patients sustained bladder perforation or damage to surrounding structures. Conclusion Radiation cystitis can be life threatening and remains a challenge for the urologist with traditional intra-vescical treatments such as aluminium or formalin having variable results. We present an alternate technique using PVB to ablate the bladder mucosa, with good results. Consolidation with hyperbaric oxygen therapy may be considered. Our study is limited by small sample size and the presence of bilateral ureteric catheters leaving the bladder free from urine may impact immediate post operative outcomes. These initial results are promising however further prospective evaluation with a larger cohort and pre and post operative cystograms would enable better evaluation of this

Management of a case of colovesical fistula with fecaluria as first sign

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Gingu C

2015-04-01

Full Text Available Introduction. Fecaluria and pneumaturia are the patognomonic signs of an abnormal communication between the bladder and the intestinal tract. Therefore, when a history of digestive signs, symptoms or digestive diseases is missing, this borderline pathology leads the patients in the care of urologists. From diagnosis to treatment the management of these cases can be difficult and challenging. Materials and Methods. A 48 year old patient, without any significant medical history, presented to the emergency room for fecaluria, pneumaturia and an episode of haematuria. He had no prior digestive symptoms. The contrast enhanced abdominal and pelvic CT scan revealed a pelvic mass involving the sigmoid colon and the dome and the posterior wall of the bladder. The cystoscopy objectifies a tumor mass involving the right postero-lateral bladder wall, with extravasation of faeces. A biopsy was taken and the frozen section found mainly uncertain inflammatory type tissue. A colonoscopy couldn’t be done because of an impassable obstacle at 15 cm from the anus. Together with general surgeons we decided for en bloc resection of the tumor with partial cystectomy, right ureterocystoneostomy and rectosigmoid resection with mechanic end to end anastomosis. Results. The postoperative period was uneventful. The histopathological examination revealed an abscessed sigmoid diverticulum with vesico-sigmoid fistula and perilesional inflammatory tissue. Two years after the surgery the patient is asymptomatic with a normal function of the right kidney and restored bladder capacity. Conclusions. Being a borderline pathology, patients with fecaluria and pneumaturia and lack of digestive symptoms are referred and managed by the urologists. Despite extensive investigations, even when preoperative biopsies reveal inflammatory tissue the patients should be treated as oncologic cases. A close cooperation with general surgeons for en bloc multiorgan resection within oncologic

Safety and efficacy of transurethral pneumatic lithotripsy for bladder calculi in children

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Khosa, A.S.; Hussain, M.; Hussain, M.

2012-01-01

Objective: To determine the safety and efficacy of transurethral pneumatic lithotripsy for bladder calculi in children. Method: The study included 100 children up to 15 years of age undergoing pneumatic cystolithoclast for bladder stones. The descriptive study was conducted from September 2006 to February 2007 at the Sindh Institute of Urology and Transplantation, Karachi. The inclusion criteria was children up to 15 years of age with a bladder stone of up to 3 cm, pre-operative negative urine culture, no coagulopathy and fit for general anaesthesia. An X-ray and ultrasound of Kidney and Urinary Bladder (KUB) was mandatory. The procedure was done under general anaesthesia with a single dose of pre-operative antibiotic. A mini-scope of 4 FR or a semi-rigid ureteroscope of 7/8.5 FR with pneumatic wolf lithoclast was used for the fragmentation of stones. Duration of procedure, any per-operative and post-operative complications and the duration of hospital stay were recorded. Post-operatively, the patient underwent ultrasound Kidney and Urinary Bladder at the first follow-up to assess stone clearance after one week. Result: Mean patients age was 4.95+-3.3 years. The male-to-female ratio was 11.5: 1 The mean hospital stay was 9.2 +- 2.5 hours. The mean operating time was 25 (10 -65) minutes. Ten (10%) patients developed minor complications out of which 5 (5%) developed haematuria and 4 (4%) developed difficulty in passing urine. One (1%) of the patients developed post-operative retention of urine. All the patients were stone free after the procedure. Conclusion: The transurethral pneumatic lithoclast is very effective and safe in children with bladder stones up to 3 cm. (author)

Endovascular control of haemorrhagic urological emergencies: an observational study

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Thorpe Peter

2006-09-01

Full Text Available Abstract Background Transarterial embolisation (TAE is an effective method in control of haemorrhage irrespective of the nature of urological emergency. As the technique and technology have evolved, it is now possible to perform highly selective embolisation. The aim of this study was to critically appraise feasibility and efficacy of therapeutic TAE in control of haemorrhagic urological emergencies using selective and non-selective embolisation. Specifically, we aimed to assess the impact of timing of embolisation on the requirement of blood transfusion and long-term morphological and functional follow-up of embolised organs. Methods This is a single institutional observational study carried out between March 1992 and March 2006. Records of all patients who underwent selective and non-selective angioembolisation to control bleeding in urological emergencies were reviewed. Data on success rate, periprocedural complications, timing of embolisation, requirement of blood transfusion and the long-term morphological and functional outcomes of embolised organs was recorded. Results Fourteen patients underwent endovascular control of bleeding as a result of trauma, iatrogenic injury and spontaneous perinephric haemorrhage during a period of 14 years. All these patients would have required emergency open surgery without the option of embolisation procedure. The mean time between the first presentation and embolisation was 22 hours (range 30 minutes to 60 hours. Mean pre-embolisation transfusion requirement was 6.8 units (range 0–22 units. None of the patients with successful embolisation required post-procedural blood transfusion. Permanent haemostasis was achieved in all but one patient, who required emergency nephrectomy. There were no serious procedure related post-embolisation complications. Conclusion Endovascular control using transarterial angioembolisation is an effective method for managing haematuria or haemorrhage in urological emergencies

Evaluation of multidetector computed tomography urography and ultrasonography for diagnosing bladder cancer

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Knox, M.K. [Nuffield Department of Surgery, University of Oxford, Oxford (United Kingdom); Cowan, N.C. [Nuffield Department of Surgery, University of Oxford, Oxford (United Kingdom); Department of Radiology, Churchill Hospital, Oxford OX3 7LJ (United Kingdom)], E-mail: nigel.cowan@nds.ox.ac.uk; Rivers-Bowerman, M.D.; Turney, B.W. [Nuffield Department of Surgery, University of Oxford, Oxford (United Kingdom)

2008-12-15

Aim: To evaluate and compare the diagnostic accuracy of multidetector computed tomography urography (CTU) and ultrasonography (US) for diagnosing bladder cancer. Materials and methods: A consecutive series of 143 patients over 40-years of age, presenting with macroscopic haematuria and without urinary tract infection underwent same-day CTU, US, and flexible cystoscopy. CTU and US were independently rated on a five-point scale for the presence of bladder cancer without knowledge of the reference standard of flexible or rigid cystoscopy and/or biopsy results. Diagnostic accuracy was assessed by receiver operating characteristic (ROC) analysis and likelihood ratios. Results: For CTU, a rating of 5 (definitely tumour) was highly specific for bladder cancer (96.5%, 95%CI: 91.3-99%), effectively confirming diagnosis (positive likelihood ratio 25.6, 95%CI: 9.7-67.4). For US, specificity was also high (94.7%, 95%CI: 88.9-98%) with a positive likelihood ratio of 13.1 (95%CI: 5.8-29.6). Sensitivity at this rating was substantially higher for CTU (89.7%, 95%CI: 72.7-97.8%) than US (69%, 95%CI: 49.2-84.7%). Standardized partial area (A{sub z}) under the ROC curve between 95-100% specificity, representing the average sensitivity in this range, was significantly greater (0.88 versus 0.61, p < 0.05) for CTU than US. Conclusion: The specificities of CTU and US for the diagnosis of bladder cancer were similar, but CTU was more sensitive. Although the sensitivity of CTU was not high enough to replace flexible cystoscopy in the diagnostic pathway, the high specificity enables direct referral to rigid cystoscopy, bypassing flexible cystoscopy and expediting diagnosis and treatment in those patients testing positive.

Evaluation of multidetector computed tomography urography and ultrasonography for diagnosing bladder cancer

International Nuclear Information System (INIS)

Knox, M.K.; Cowan, N.C.; Rivers-Bowerman, M.D.; Turney, B.W.

2008-01-01

Aim: To evaluate and compare the diagnostic accuracy of multidetector computed tomography urography (CTU) and ultrasonography (US) for diagnosing bladder cancer. Materials and methods: A consecutive series of 143 patients over 40-years of age, presenting with macroscopic haematuria and without urinary tract infection underwent same-day CTU, US, and flexible cystoscopy. CTU and US were independently rated on a five-point scale for the presence of bladder cancer without knowledge of the reference standard of flexible or rigid cystoscopy and/or biopsy results. Diagnostic accuracy was assessed by receiver operating characteristic (ROC) analysis and likelihood ratios. Results: For CTU, a rating of 5 (definitely tumour) was highly specific for bladder cancer (96.5%, 95%CI: 91.3-99%), effectively confirming diagnosis (positive likelihood ratio 25.6, 95%CI: 9.7-67.4). For US, specificity was also high (94.7%, 95%CI: 88.9-98%) with a positive likelihood ratio of 13.1 (95%CI: 5.8-29.6). Sensitivity at this rating was substantially higher for CTU (89.7%, 95%CI: 72.7-97.8%) than US (69%, 95%CI: 49.2-84.7%). Standardized partial area (A z ) under the ROC curve between 95-100% specificity, representing the average sensitivity in this range, was significantly greater (0.88 versus 0.61, p < 0.05) for CTU than US. Conclusion: The specificities of CTU and US for the diagnosis of bladder cancer were similar, but CTU was more sensitive. Although the sensitivity of CTU was not high enough to replace flexible cystoscopy in the diagnostic pathway, the high specificity enables direct referral to rigid cystoscopy, bypassing flexible cystoscopy and expediting diagnosis and treatment in those patients testing positive

Holmium laser urethrotomy for treatment of traumatic stricture urethra: A review of 78 patients

International Nuclear Information System (INIS)

Hussain, M.; Lal, M.; Askari, S.H.; Hashmi, A.; Rizvi, S.A.H.

2010-01-01

To evaluate the efficacy and long-term results of laser urethrotomy as minimally invasive treatment for traumatic stricture urethra. Methods: Between January 2006 and June 2008, 78 male patients were treated with Holmium Laser urethrotomy. 16 Fr urethroscope was used through which 600um laser fiber was introduced through side channel. Stricture was visualized and incised at 12 o'clock position with energy set at 1500-2000 MJ at pulse rate of 10-12. Two other incisions were given at 2 and 10 o'clock positions. Further ablation was done till 16 Fr Foley's catheter was passed. Patients were followed in a stricture clinic. Results: Patients age ranged from 15-73 years. All strictures were due to trauma, Road traffic accident in 40(52%) post catheter trauma 4(5%), fall as ride 27(35%) and failed urethroplasty 7(8%). Site of stricture was bulbar 57(73%), bulbomembranous 16(20%) and membranoprostatic 5(2.5%). Length of stricture ranged from 0.8-2.5 cms. At 3 months follow-up, 60(77%) patients remained catheter and symptoms free while 18(23%) developed recurrence of stricture but at the end of 36 months follow-up success rate decreased to 47 (60%). Among those who developed re-strictures, 6(7.6%) had second sitting laser while 4(5.1%) had urethroplasty, and others were on intermittent dilatation. Immediate complications were sepsis 10(13%), extravasation 2(4%), failed urethrotomy 2(4%) and mild haematuria 3(5.8%). Hospital stay ranged from day care to 3 days. Conclusion: Laser urethrotomy is minimally invasive and an effective treatment for short strictures in bulbar urethra. The recurrence rate is 40% in the long-term follow-up and is more commonly seen in completely obliterated strictures. (author)

Prevalence and risk factors for proteinuria: the National Kidney Foundation of Malaysia Lifecheck Health Screening programme.

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Ong, Loke Meng; Punithavathi, Narayanan; Thurairatnam, Dharminy; Zainal, Hadzlinda; Beh, Mei Li; Morad, Zaki; Lee, Sharleen Ys; Bavanandan, Sunita; Kok, Lai Sun

2013-08-01

Treatment of chronic kidney disease (CKD) poses a huge burden to the healthcare system. To address the problem, the National Kidney Foundation of Malaysia embarked on a programme to screen for proteinuria and educate the public on CKD. The public was invited for health screening and the data collected over a 21 month period was analyzed. In total, 40400 adults from all the states in Malaysia were screened. The screening population had a mean age of 41 years, 30.1% had hypertension and 10.6% had diabetes. Proteinuria was detected in 1.4% and haematuria in 8.9% of the participants. Factors associated with the highest risk for proteinuria were the presence of diabetes (adjusted odds ratio (OR) 2.63 (95% confidence interval (CI) 2.16-3.21)), hypertension (OR 2.49 (95% CI 2.03-3.07)) and cardiac disease (OR 2.05 (95% CI 1.50-2.81)). Other risk factors identified were lower educational level, family history of kidney disease, hypercholesterolaemia, obesity and lack of regular exercise. Chinese had the lowest risk for proteinuria among the races (OR 0.71 (95% CI 0.57-0.87) compared with Malays). The combination of high blood glucose and high blood pressure (BP) substantially increased the risk for proteinuria (OR 38.1 for glucose ≥ 10 mmol/L and systolic BP ≥ 180 mm Hg and OR 47.9 for glucose ≥ 10 mmol/L and diastolic BP ≥ 110 mm Hg). The prevalence of proteinuria in Malaysia is similar to other countries. The major risk factors for proteinuria were diabetes, hypertension and cardiac disease. The presence of both high blood pressure and high blood glucose exert a synergistic effect in substantially increasing the risk for proteinuria. © 2013 The Authors. Nephrology © 2013 Asian Pacific Society of Nephrology.

Novel INF2 mutations in an Italian cohort of patients with focal segmental glomerulosclerosis, renal failure and Charcot-Marie-Tooth neuropathy.

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Caridi, Gianluca; Lugani, Francesca; Dagnino, Monica; Gigante, Maddalena; Iolascon, Achille; Falco, Mariateresa; Graziano, Claudio; Benetti, Elisa; Dugo, Mauro; Del Prete, Dorella; Granata, Antonio; Borracelli, Donella; Moggia, Elisabetta; Quaglia, Marco; Rinaldi, Rita; Gesualdo, Loreto; Ghiggeri, Gian Marco

2014-09-01

Mutations of INF2 represent the major cause of familial autosomal dominant (AD) focal segmental glomerulosclerosis (FSGS). A few patients present neurological symptoms of Charcot-Marie-Tooth (CMT) disease but the prevalence of the association has not been assessed yet. We screened 28 families with AD FSGS and identified 8 INF2 mutations in 9 families (32 patients overall), 3 of which were new. Mutations were in all cases localized in the diaphanous-inhibitory domain (DID) of the protein. Clinical features associated with INF2 mutations in our patient cohort included mild proteinuria (1.55 g/L; range 1-2.5) and haematuria as a unique symptom that was recognized at a median age of 21.75 years (range 8-30). Eighteen patients developed end-stage renal disease during their third decade of life; 12 patients presented a creatinine range between 1.2 and 1.5 mg/dL and 2 were healthy at 45 and 54 years of age. CMT was diagnosed in four cases (12.5%); one of these patients presented an already known mutation on exon 2 of INF2, whereas the other patients presented the same mutation on exon 4, a region that was not previously associated with CMT. We confirmed the high incidence of INF2 mutations in families with AD FSGS. The clinical phenotype was mild at the onset of the disease, but evolution to ESRD was frequent. The incidence of CMT has, for the first time, been calculated here to be 12.5% of mutation carriers. Our findings support INF2 gene analysis in families in which renal failure and/or neuro-sensorial defects are inherited following an AD model. © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Assessment of prostatic fiducial marker introduction: patient morbidity, staff satisfaction and improved treatment field placement

International Nuclear Information System (INIS)

Brown, Simon; Lehman, Margot; Ferrari-Anderson, Janet; Glyde, Alan; Burmeister, Elizabeth; Nicol, David

2011-01-01

Increased accuracy when using fiducial markers for prostate localisation is well documented. This project aimed to establish the improvement in accuracy when using gold markers for daily prostate localisation, to assess patient satisfaction and morbidity from the transrectal implantation of gold seed markers and establish staff attitudes towards the newly introduced processes. Twenty patients with prostate cancer had three gold seeds implanted into the base, apex and central zone of the prostate transrectally using ultrasound guidance. Surveys were conducted to assess staff and patient satisfaction with the process of gold seed localisation. The gold markers were used to localise the prostate on a daily basis using megavoltage electronic portal imaging. Measurements were taken to establish the increase in accuracy when using gold fiducial markers compared with using the surrounding bony anatomy. Inter-fraction motion (1 standard deviation (SD)) of the fiducial markers was 2.20, 4.28 and 4.27 mm in the LR, SI and AP directions, respectively. Intra-fraction prostate motion (1 SD) was measured as 0.8 mm LR, 1.1 mm SI and 2.0 mm AP. The patient survey showed that the insertion and associated side effects were acceptable, with 5% of patients stating that the seed insertion was worse than the prostate biopsy, and 23.1% of patients experienced short duration (1–2 days) haematuria. The staff survey showed that daily online image guidance was achievable without affecting patient throughput. Thirty percent of treatment staff believed that performing online daily localisation did not add any extra time to a standard treatment, and the remaining 70% thought that the added time was minimal (2–4 min). Gold fiducial markers are an accurate, reliable and tolerable method of daily prostate localisation.

Plasma exchange for paediatric kidney disease-indications and outcomes: a single-centre experience.

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Reddy, Sudheer Kumar; Jahan, Afsana; Chaturvedi, Swasti; Agarwal, Indira

2015-12-01

Outcome data in paediatrics regarding the use of plasmapheresis for immunological kidney disease are scarce. We aimed to evaluate the role of plasmapheresis in children presenting with severe renal impairment secondary to immunological kidney diseases. A retrospective chart review of children admitted between January 2009 and August 2013 to the Paediatric Nephrology Unit, Christian Medical College, Vellore, India, and requiring plasma exchange was undertaken. Demographic and clinical data were studied and descriptive statistics applied for analysis. Sixteen children underwent plasmapheresis with a male:female ratio of 10:6 and a mean age of 10.2 years (range 5-15 years). Twelve children had atypical haemolytic uraemic syndrome, two had anti-glomerular basement disease and one each had lupus nephritis with neurological manifestation and anti-nuclear cytoplasmic antibody-associated vasculitis. The mean serum creatinine at presentation was 6.52 [interquartile range (IQR) 4.96-7.85] mg/dL with a mean eGFR of 43 (IQR 27.54-56.7) mL/min/1.73 m(2). Other presenting features included nephrotic range proteinuria (69%), gross haematuria (27%), hypertension (94%) and seizures (37.5%). All children received 1.5 times plasma volume plasmapheresis (mean 11 sessions, range 5-26), dialysis and immunosuppressive therapy. The mean duration of follow-up was 4 months (range 2-24 months) with a majority of the children (15/16, 93.75%) surviving acute illness. One child died of overwhelming sepsis and another was lost to follow-up. Of the survivors, eight had eGFR >60 mL/min/1.73 m(2), while eGFR was 15-60 mL/min/1.73 m(2) in the remaining six children. Eight children were still requiring antihypertensive medications and two were continuing peritoneal dialysis at the last follow-up. Thus early introduction of plasmapheresis along with other supportive therapy in immunological kidney disease may improve outcome.

Chitinase 3-like 1 protein levels are elevated in Schistosoma haematobium infected children.

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Laura J Appleby

Full Text Available Currently there are few studies characterising the nature and aetiology of human schistosome-related inflammatory processes. The aim of this study was to determine the relationship between Chitinase 3-like 1 (CHI3L1, also known as YKL-40, a molecule associated with inflammatory processes, and schistosome infection, morbidity and systemic cytokine levels.Serological levels of CHI3L1 and a panel of cytokines (IFN-y, IL-4/5/6/9/10/13 and 17 were measured in two Zimbabwean populations resident in a high and low schistosome infection area. CHI3L1 levels were related to schistosome infection, haematuria status and cytokine levels after allowing for confounding variables. The effect of antihelminthic treatment with praziquantel on CHI3L1 levels was determined in 246 participants 6 weeks post-treatment.CHI3L1 levels increased with age in both areas but were significantly higher in the high infection areas compared to the low infection area. CHI3L1 levels were also higher in infected compared to uninfected individuals with this difference being significant in the youngest age group. Curative antihelminthic treatment resulted in a significant decrease in CHI3L1 levels. Of the cytokines, only IL-10 and IL-17 had a significant association with CHI3L1 levels, and this association was negative.Serum CHI3L1 levels differ between infected and uninfected people before and after antihelminthic treatment. The greatest difference occurs in the youngest age group, in keeping with the period when schistosome-related pathological processes are initiated. Following from previous studies in non-infectious diseases showing that CHI3L1 is a biomarker for the inflammatory process, this study suggests that the potential for CHI3L1 as a biomarker for schistosome-related pathology should be explored further.

Acute GI bleeding by multiple jejunal gastrointestinal autonomic nerve tumour associated with neurofibromatosis type I Urgencia quirúrgica por sangrado intestinal debido a tumor intestinal de nervios autónomos asociados a neurofibromatosis tipo I

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M. Keese

2007-10-01

Full Text Available We describe a surgical emergency due to GI-bleeding caused by gastrointestinal autonomic nerve tumours (GANT's in a patient with von Recklinghausen's disease. A 72 year old female patient with von Recklinghausen's disease was admitted with maelena. Endoscopy showed no active bleeding in the stomach and the colon. Therefore an angio-CT-scan was performed which revealed masses of the proximal jejunum as source of bleeding. Laparotomy was indicated and a 20 cm segment of jejunum which carried multiple extraluminal tumours was resected. The source of the bleeding was a 2 cm tumour which had eroded the mucosal surface. Immunohistologically, evidence of neuronal differentiation could be shown in the spindle-formed cells with positive staining for C-Kit (CD 117, CD 34, and a locally positive staining for synaptophysine and S100. This case report illustrates the association between neurofibromatosis and stromal tumours and should alert surgeons and gastroenterologist about gastrointestinal manifestations in patients with von Recklinghausen's disease.Se describe una urgencia quirúrgica por sangrado intestinal debido a tumor gastrointestinal de nervios autónomos (GANT asociado a enfermedad de von Recklinghausen. Una mujer de 72 años con neurofibromatosis fue ingresada con signos de melena. La endoscopia digestiva alta y baja fue negativa. Se indicó TAC con contraste que advirtió tumores yeyunales como causa del sangrado. Se realizó laparotomía y resección de un segmento de 20 cm de yeyuno que incluía varios tumores. La causa del sangrado activo fue lesión en mucosa intestinal por erosión tumoral. El análisis por inmunohistoquímica de la pieza mostró diferenciación neuronal, con células fusiformes con tinción positiva para el C-Kit (CD 117, CD 34. Esta nota clínica pone de manifiesto la asociación entre la neurofibromatosis y los tumores estromales y debe alertar a gastroenterólogos y cirujanos sobre las posibles manifestaciones

The Co- Infection of Crime Congo Hemorrhagic Fever and Brucellosis: A Case Report

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A Saghafipour

2012-07-01

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Background and Objectives: Crimean-Congo Hemorrhagic fever (CCHF is a viral disease transmitted to ruminants or human by the bite of mature tick vectors. It can be transmitted through contact with the infectious blood or viraemic tissues during slaughter and hospital contacts. 80% of the cases are sub clinical and the rest of them are presenting with an acute febrile and occasionally hemorrhagic disease. The mortality rate of the fulminate form of the disease is equal to 20% to 50%. The hemorrhage is usually in the form of hematoma, melena, nose, conjunctiva, uterine or subcutaneous bleeding. CCHF complications are: encephalitis, optic neuropathy, hepatitis, renal failure and myocardial necrosis.

Case Report: In this article, we’ve discussed a CCHF patient who presented with high fever, myalgia, headache, nausea, vomiting, abdominal pain, diffuse cutaneous and gingival hemorrhage during the course of the disease while the patient was hospitalized. Profound jaundice, petechia and global ecchymosis were considerable. Lab data showed at the beginning of hospitalization that the number of liver enzymes was increased up to 8-10 times. The number of placates were lower than 150000 ml. Moreover, during the first three days there was a decrease in the number of white blood cells and PTT was abnormal. (AST was higher than 100 units per litre. The results of serologic examination of IgM- ELISA virus for CCHF on day 5 and IgG-ELISA on day 10–which were carried out in pasture Institute-were reported to be positive. According to the patient’s history and clinical symptoms, he was also suspicious for Brucellosis and the lab data demonstrated that he is also infected with Brucella. (Wright=1.320, 2ME=1.160 (The patient was a 22 year old man, sheep farmer, residing in the GhalehKamkar area of Qom City.

Effect of Gastric Acid Suppressant Prophylaxis on Incidence of Gastrointestinal Bleeding in Pediatric Intensive Care Unit

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Tahoora Abdollahi

2016-11-01

Full Text Available Background: Critically ill children admitted to pediatric intensive care unit (PICU are at increased risk of gastrointestinal bleeding due to stress related mucosal injury. Reducing gastric acid by acid suppressant medication is the accepted prophylaxis treatment, but there is not any definitive guideline for using prophylaxis in PICU patients. The present study aimed to assess the effect of Proton Pump Inhibitor (PPI and H2 Blocker (H2B prophylaxis on gastrointestinal bleeding in admitted patients of PICU, Mashhad- Iran.Materials and Methods: In this study, 100 patients admitted in PICU divided into two equal groups on the first day of admission. They received ranitidine or pantoprazole as prophylaxis of stress ulcer. Those patients who had history of gastrointestinal bleeding or coagulation disorder were excluded. 100 PICU patients who had not received prophylaxis during last 6 months retrospectively evaluated as control of the study. Data were collected as demographic characteristics, admission reason, definitive diagnosis, receiving corticosteroid and mechanical ventilation in each patient. Gastrointestinal bleeding (hematemesis, coffee ground aspirate, and melena and clinically significant gastrointestinal bleeding were daily monitored. Data analyzed through descriptive statistical tests, Chi-square, logistic regression, t-test and using SPSS-16 software.Results: Among 204 patients (control group=105 and case group=99, incidence of gastrointestinal bleeding (GB was 13.2% in which 6.9% of cases presented with clinically significant gastrointestinal bleeding (CSGB. Loss of consciousness and respiratory distress were the main reason of admission. There was no significant differences between the incidence of (GB and (CSGB in experimental and control groups (P>0.05 as well as ranitidine and pantoprazole prophylaxis (P>0.05. Significant risk factors of (GB were mechanical ventilation and loss of consciousness and corticosteroid therapy

Lower digestive hemorrhage study algorithm in elderly patients and red cells mark scintigraphy role

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Abella, O.; Almeida, C.A.; Fitzimons, C.; Rial, M.T.

2002-01-01

Aims: Show the utility of this technique in the detection of Lower Digestive Hemorrhage (LDH) in elderly patients and propose a study algorithm. Materials and Methods: We study 39 patients (20 women and 19 men), between 61 and 92 years (media 76,3 years), in the last three years, that we strongly presume they have a LDH. In all of them we lay aside the upper digestive hemorrhage with endoscopies. In all the cases we perform a video-colonoscopy after the scintigraphy adopting in every case if its necessary surgery, medication or expectant conduct. We use the modified red cells mark 'in vivo' method (mark efficiency of 82%). We obtain anterior images of the abdomen with a planar Gamma Camera. Sequential images of 1 minute duration in the first hour post-injection I.V. of 740 MBq of Tc99- pertechnetate -Stannous Chloride and hen static images with 400 K counts at 60, 120, 180 and 240 minutes and one image at 24 hours were acquired, in two cases repeat the study. We don't do selective angiographies because we consider this a high risk and low cost / benefit study in elderly patients (high association with cardiopathy). Result: Patient with final diagnosis for VCC or Surgery: Angio dysplasia (38%), Diverticulosis (20%), Ischemic colitis (11%), Ulcerous colitis (8%) and Colon adenocarcinoma (2%). In some cases were two pathologies involved (13%). The scintigraphies were positive in 92% and negative in 8% of the cases. All the positives were in massive or recidivated bleeding and the negatives in intermittent low volume bleedings or patients with discreet melena or hidden blood in feces. The diagnostic efficiency of 92% was compare with non-invasive methods (video-colonoscopy 81% and selective angiography) and we comment the possible causes of false negatives. Conclusion: We propose a study algorithm for intermittent and low intensity LDH cases and another for higher magnitude LDH

Clinical manifestations and hematological and serological findings in children with dengue infection

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Mulya Rahma Karyanti

2011-06-01

Full Text Available Background Dengue hemorrhagic fever (DHF is endemic to Indonesia and remains a public health problem, with its highest incidence in children. There have been few reports on the clinical, hematological and serological data in children \\\\lith dengue. Objective To assess the clinical and laboratory profiles of children \\\\lith dengue infection in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Methods Clinical, hematological and serological infonnation from children diagnosed v.ith dengue infection in Cipto Mangunkusumo Hospital were collected from 2007 to 2009. Results Of611 children admitted with dengue, 143 (23.4% had dengue fever (DF, 252 (41.2% had DHF grades I and II; and 216 (35.4% had DHF grades III and IV. Of the 81 cases where dengue serotypes were identified, 12.3% were DENV1, 35.8% were DENV-2, 48.2% were DENV-3 and 3.7% were DENV-4. Mean age of subjects was 8.9 years (SD 4.4, and 48.4% of cases were boys. The mean length of fever before hospital admission was 4.2 days (SD 1.1 and mean length of stay in the hospital was 4 days (SD 2.7. Common symptoms observed were petechiae, hepatomegaly and epistaxis. Complications found mostly in those with dengue shock syndrome (DSS were hematemesis (30 cases, 4.9% of all patients, encephalopathy (19 cases, 3.1 % and melena (17 cases, 2.8%. Conclusion Signs and symptoms of fever, bleeding manifestations and thrombocytopenia were present in children 'With DF and DHF, while signs of increased vascular permeability were found only in those 'With DHF. Encephalopathy and gastrointestinal bleeding were found mostly in DSS cases. At admission, leukopenia was found in more DF patients than in DHF patients. Absence of leukopenia may be a sign of more severe dengue infection.

Interleukin-6-deficient mice refractory to IgA dysregulation but not anorexia induction by vomitoxin (deoxynivalenol) ingestion.

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Pestka, J J; Zhou, H R

2000-07-01

Dietary exposure to the trichothecene vomitoxin (VT) causes feed refusal and elevates IgA production in the mouse. Based on the observations that IL-6 can cause anorexia and promote IgA production and that gene expression of this cytokine is increased in vivo and ex vivo on VT exposure, we hypothesized that IL-6 is an essential cytokine in VT-induced feed refusal and IgA dysregulation. To test this hypothesis, the effects of dietary VT on feed intake, weight gain, serum IgA levels and kidney mesangial IgA deposition in an IL-6-"knockout" mouse (B6129-IL6(tmi Kopf)) were compared to those in both a corresponding "wildtype" (B6129F2) and a previously characterized "sentinel" strain (B6C3F1) that possess the intact gene for this cytokine. IL-6 deficiency did not alter the capacity of VT to cause feed refusal or impair weight gain. VT-fed B6129F2 and B6C3F1 mice had significantly higher serum IgA concentrations than did their corresponding controls fed clean diet, whereas significant differences were not observed between IL-6 KO mice fed VT or control diets. Kidneys taken from VT-fed wild-type and sentinel mice had significantly increased mesangial IgA deposition as compared to controls. While slight increases in mesangial IgA were observed in VT-fed IL-6 KO mice, mean fluorescence intensities were significantly less than that found in the corresponding wild-type and sentinel strains. IL-6 KO mice appeared to be less prone to the development of microscopic haematuria following VT exposure than were the corresponding wild-type and sentinel strains. In total, the results suggested that IL-6-deficient mice were refractory to VT-induced dysregulation of IgA production and development of IgA nephropathy, whereas chronic VT-mediated nutritional effects related to feed intake and weight gain were unaffected.

Uterine artery embolization for uterine fibroids: mid-long term follow up

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Guo Wenbo; Yang Jianyong; Chen Wei; Zhuang Wenquan; Li Lijuan; Zhu Yunxiao

2006-01-01

Objective: To evaluate the mid-long term effects of uterine fibroids embolization. Methods: Uterine artery embolization (UAE) was performed in 110 patients with uterine fibroids with follow up of 48-72 months. All the patients were examined with transvaginal color ultrasound. 51 cases were embolized with mixed liquor of lipiodol and pingyangmycin and another 59 cases with polyvinyl alcohol particles (350-700 μm, in diameter). The mid-long term clinical effects, complications, change of serum sexual hormone, pregnancy and delivery after UAE were observed. Results; Bilateral uterine artery embolization was performed in 110 cases with following outcomes in improvements of menorrhagia in 93/94 (98.9%) and the bulked-related symptoms in 26/26 (100%), decrease of the volumes of uterus 51.5% ± 3.1% (t value 2.861, P<0.01) and fibroids 64.2% ± 6.6% (t value 2.664, P<0.01). No statistical differences in serum levels of luteinizing, follicle stimulating hormone and estradiol before and after the uterine artery embolization were found. All events included abdominal pain in 6/110 (5.5%), fever in 90/110 (81.8%), colporrhagia in 95/110 (86.4%), haematuria in 11/110 (10.0%), non-targeted embolization of bladder in 1/110 (0.9%), transient amenorrhea in 3/110 (2.7%), permanent amenorrhea due to ovarian failure in 3/110 (2.7%), failure of embolization in 1/110 (0.9%) and recurrence after uterine fibroids embolization in 4/110 (3.6%). There were 7 times of pregnancies in 5 patients, including 4 times of deliveries in 4 patients, and one patient accepted artificial abortion 3 times, but with no fibroids recurrences or enlargement under ultrasound follow up. Conclusion: The mid-long term effects of uterine fibroids embolization are positive, stable and safe, but with a low recurrence rate slight ovarian functional change and still safe for pregnancy and delivery. (authors)

Extensive hemangiomatosis diagnosed by scintigraphy with 99mTc-labeled red blood cells in a patient with lower gastrointestinal bleeding

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Souza, D.S.F.; Ichiki, W.A.; Borges, A.C.; Coura Filho, G.B.; Vecchia, J.F.; Sapienza, M.T.; Ono, C.R.; Watanabe, T.; Costa, P.L.A.; Hironaka, F.; Cerri, G.G.; Buchpiguel, C.A.

2008-01-01

Full text: Introduction: The gastrointestinal bleeding may be caused by vascular tumors and other lesions like inflammatory disorders, intestinal obstruction or vascular malformation. The Klippel-Trenaunay syndrome and blue rubber bleb nevus syndrome are hemangiomatosis diseases that may involve the gastrointestinal tract and cause recurrent hemorrhage. The signs and symptoms usually appear at childhood. Case report: male patient, 31 years old, presenting three days of gastrointestinal bleeding and an hemorrhage shock (Hb=3,9). Previous reports of small volume bleeding since childhood and schistossomosis. Dilated veins, hemorrhoid and port wine stain lesions were detected at physical examination in perineal region, penis and scrotum. Inferior limbs were symmetric at inspection. The upper endoscopy showed esophageal varices with no signs of active bleeding. The scintigraphy with 99m Tc-labeled red blood cells showed active hemorrhage at recto-sigmoid topography during the first hour of study. Extensive and heterogeneous uptake was seen in gluteus, posterior right thigh and scrotum at the second and fifth hours of study. Then the hypothesis of vascular tumor was considered. The magnetic resonance (MR) of pelvis demonstrated extensive hemangiomatosis at the regions described by the scintigraphy. The clinical and imaging findings suggested the diagnosis of Klippel-Trenaunay syndrome. Discussion: The Klippel-Trenaunay syndrome is a rare disease characterized by congenital vascular and lymphatic malformations (port wine stain lesions, congenital varices) and bone growth and soft tissue disorder. Dilated veins may involve abdominal and pelvic structures, with rectal bleeding and haematuria occurring on average of 20%. The clinical investigation must approach the type, the extent and the severity of the malformation, since the morbidity and the mortality depends on the visceral involvement. The Doppler ultrasound, scanometry of lower extremities, MR, angiography and

C-arm CT-guided renal arterial embolisation followed by radiofrequency ablation for treatment of patients with unresectable renal cell carcinoma

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Duan, X.-H.; Li, Y.-S.; Han, X.-W.; Wang, Y.-L.; Jiao, D.-C.; Li, T.-F.; Chen, P.-F.; Fang, Y.

2016-01-01

Aim: To explore the value of using flat detector (FD) equipped angiographic C-arm CT (CACT) systems in treating unresectable renal cell carcinoma (RCC) by selective renal arterial embolisation (RAE) followed by radiofrequency ablation (RFA) (RAE-RFA). Materials and methods: A total of 28 patients who were not candidates for surgery were enrolled. The average size of tumours was 6.7±2.2 cm (range 4.1–9.6 cm). Twenty-eight tumours were treated with CACT-guided RFA, 5–7 days after CACT-guided RAE. Results: CACT-guided RAE-RFA was technically successful in all patients. Tumour enhancement disappeared after a single RAE-RFA session in 20 patients, after two RAE-RFA sessions in four patients and after three RAE-RFA sessions in the other four patients. One patient died of lung metastasis and haematuria 13 months after RAE-RFA, and another patient died of pulmonary heart disease 23 months after repeat RAE-RFA. In the 26 living patients, tumours remained controlled during a mean follow-up period of 27 months and showed significant reduction in tumour size (6.7±2.2 cm to 3.9±1.7 cm, p<0.01). There were no significant changes in creatinine levels or urea nitrogen concentrations before and after the last RAE-RFA (p>0.05). There were no serious complications during and after the procedure. Conclusion: CACT-guided RAE followed by RFA appears to be a safe and effective technique for treating patients with inoperable RCC. - Highlights: • Selective RAE combined with RFA (RAE-RFA) is used to treat unresectable RCC. • We assessed the C-arm CT (CACT) based needle guidance system to perform RAE-RFA. • Tumors were controlled and reduced in size following CACT-guided RAE-RFA. • No significant changes in renal function occurred post-CACT-guided RAE-RFA. • CACT-guided RAE-RFA for treating RCC appears to be a safe and effective technique.

[Combined treatment of endometriosis: radical yet gentle].

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Alkatout, Ibrahim; Wedel, Thilo; Maass, Nicolai

2018-02-01

Endometriosis is the second most common benign female genital disease after uterine myoma. This review discusses the management of individual patients. This should take into account the severity of the disease and whether the patient desires to have children. Particular emphasis is laid on the anatomical intersections which, when injured, can lead to persistent damage of the anterior, middle or posterior compartment and are not infrequently the cause of urological and urogynaecological follow-up measures. Typical symptoms of endometriosis include chronic pelvic pain, subfertility, dysmenorrhoea, deep dyspareunia, cyclical bowel or bladder symptoms (e. g. dyschezia, bloating, constipation, rectal bleeding, diarrhoea and haematuria), abnormal menstrual bleeding, chronic fatigue and low back pain. Approx. 50 % of all female teenagers and up to 32 % of all women of reproductive age who have been operated for chronic pelvic pain or dysmenorrhoea suffer from endometriosis. The time interval between the first unspecific symptoms and the medical diagnosis of endometriosis is about 7 years. This is caused not only by the non-specific nature of the symptoms but also by the frequent lack of awareness on the part of the cooperating disciplines with which the patients have first contact. As the pathogenesis of endometriosis is not clearly understood, causal treatment is still impossible. Treatment options include expectant management, analgesia, hormonal medical therapy, surgical intervention and the combination of medical treatment before and/or after surgery. The treatment should be as radical as necessary and as minimal as possible. The recurrence rate among treated patients lies between 5 % and > 60 % and is very much dependent on integrated management and surgical skills. Consequently, to optimise the individual patient's treatment, a high degree of interdisciplinary cooperation in diagnosis and treatment is crucial and should be reserved to appropriate

A comparison of urinary tract pathology and morbidity in adult populations from endemic and non-endemic zones for urinary schistosomiasis on Unguja Island, Zanzibar

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Khamis Simba

2009-11-01

Full Text Available Abstract Background Renal tract involvement is implicated in both early and late schistosomiasis leading to increased disease burden. Despite there being good estimates of disease burden due to renal tract disease secondary to schistosomiasis at the global level, it is often difficult to translate these estimates into local communities. The aim of this study was to assess the burden of urinary tract pathology and morbidity due to schistosomiasis in Zanzibar and identify reliable clinical predictors of schistosomiasis associated renal disease. Methods A cross-sectional comparison of Ungujan men and women living within either high or low endemic areas for urinary schistosomiasis was conducted. Using urine analysis with reagent strips, parasitological egg counts, portable ultrasonography and a qualitative case-history questionnaire. Data analysis used single and multiple predictor variable logistic regression. Results One hundred and sixty people were examined in the high endemic area (63% women and 37% men, and 101 people in the low endemic area (61% women and 39% men. In the high endemic area, egg-patent schistosomiasis and urinary tract pathology were much more common (p = 1 × 10-3, 8 × 10-6, respectively in comparison with the low endemic area. Self-reported frothy urine, self-reported haematuria, dysuria and urgency to urinate were associated with urinary tract pathology (p = 1.8 × 10-2, p = 1.1 × 10-4, p = 1.3 × 10-6, p = 1.1 × 10-7, respectively as assessed by ultrasonography. In a multi-variable logistic regression model, self-reporting of schistosomiasis in the past year, self-reporting of urgency to urinate and having an egg-positive urine sample were all independently associated with detectable urinary tract abnormality, consistent with schistosomiasis-specific disease. Having two or more of these features was moderately sensitive (70% as a predictor for urinary tract abnormality with high specificity (92%. Conclusion Having two

Dynamics of paediatric urogenital schistosome infection, morbidity and treatment: a longitudinal study among preschool children in Zimbabwe.

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Osakunor, Derick Nii Mensah; Mduluza, Takafira; Midzi, Nicholas; Chase-Topping, Margo; Mutsaka-Makuvaza, Masceline Jenipher; Chimponda, Theresa; Eyoh, Enwono; Mduluza, Tariro; Pfavayi, Lorraine Tsitsi; Wami, Welcome Mkululi; Amanfo, Seth Appiah; Murray, Janice; Tshuma, Clement; Woolhouse, Mark Edward John; Mutapi, Francisca

2018-01-01

Recent research has shown that in schistosome-endemic areas preschool-aged children (PSAC), that is, ≤5 years, are at risk of infection. However, there exists a knowledge gap on the dynamics of infection and morbidity in this age group. In this study, we determined the incidence and dynamics of the first urogenital schistosome infections, morbidity and treatment in PSAC. Children (6 months to 5 years) were recruited and followed up for 12 months. Baseline demographics, anthropometric and parasitology data were collected from 1502 children. Urinary morbidity was assessed by haematuria and growth-related morbidity was assessed using standard WHO anthropometric indices. Children negative for Schistosoma haematobium infection were followed up quarterly to determine infection and morbidity incidence. At baseline, the prevalence of S haematobium infection and microhaematuria was 8.5% and 8.6%, respectively. Based on different anthropometric indices, 2.2%-8.2% of children were malnourished, 10.1% underweight and 18.0% stunted. The fraction of morbidity attributable to schistosome infection was 92% for microhaematuria, 38% for stunting and malnutrition at 9%-34%, depending on indices used. S haematobium -positive children were at greater odds of presenting with microhaematuria (adjusted OR (AOR)=25.6; 95% CI 14.5 to 45.1) and stunting (AOR=1.7; 95% CI 1.1 to 2.7). Annual incidence of S haematobium infection and microhaematuria was 17.4% and 20.4%, respectively. Microhaematuria occurred within 3 months of first infection and resolved in a significant number of children, 12 weeks post-praziquantel treatment, from 42.3% to 10.3%; P<0.001. We demonstrated for the first time the incidence of schistosome infection in PSAC, along with microhaematuria, which appears within 3 months of first infection and resolves after praziquantel treatment. A proportion of stunting and malnutrition is attributable to S haematobium infection. The study adds scientific evidence to the calls for

Missed signs of autonomic dysreflexia in a tetraplegic patient after incorrect placement of urethral Foley catheter: a case report.

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Vaidyanathan, Subramanian; Soni, Bakul M; Oo, Tun; Hughes, Peter L; Singh, Gurpreet

2014-01-01

Autonomic dysreflexia is poorly recognised outside of spinal cord injury centres, and may result in adverse outcomes including mortality from delayed diagnosis and treatment. We present a spinal cord injury patient, who developed autonomic dysreflexia following incorrect placement of urethral Foley catheter. Health professionals failed to recognise signs and symptoms of autonomic dysreflexia as well as its significance in this tetraplegic patient. A tetraplegic patient started sweating profusely following insertion of a Foley catheter per urethra. The catheter was draining urine; there was no bypassing, no bleeding per urethra, and no haematuria. Patient's wife, who had been looking after her tetraplegic husband for more than forty years, told the health professionals that the catheter might have been placed incorrectly but her concerns were ignored. Ultrasound scan of urinary tract revealed no urinary calculi, no hydronephrosis. The balloon of Foley catheter was not seen in urinary bladder but this finding was not recognised by radiologist and spinal cord physician. Patient continued to sweat profusely; therefore, CT of pelvis was performed, but there was a delay of ten days. CT revealed the balloon of Foley catheter in the over-stretched prostate-membranous urethra; the tip of catheter was not located within the urinary bladder but was lying distal to bladder neck. Flexible cystoscopy was performed and Foley catheter was inserted into the bladder over a guide wire. The intensity of sweating decreased; noxious stimuli arising from traumatised urethra might take a long while to settle. Inserting a catheter in a tetraplegic patient should be carried out by a senior health professional, who is familiar with spasm of bladder neck which occurs frequently in tetraplegic patients. Facilities for urgent CT scan should be available to check the position of Foley catheter in spinal cord injury patients when a patient manifests signs and symptoms of autonomic dysreflexia

High prevalence of urinary schistosomiasis in two communities in South Darfur: implication for interventions

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Ali Gafar A

2011-02-01

Full Text Available Abstract Background There are few data on the prevalence of schistosomiasis in Darfur. We conducted this study in response to reports of 15 laboratory confirmed cases of schistosomiasis and visible haematuria among children from two communities in South Darfur. The aim of the study was to estimate the prevalence of schistosomiasis in the area and to decide on modalities of intervention. Methods A cross-sectional survey involving 811 children and adults from schools and health facilities was conducted in two communities of South Darfur in March 2010. Urine samples were collected and examined for ova of Schistosoma haematobium using a sedimentation technique. A semi-structured format was used to collect socio-demographic characteristics of the participants. Results Eight hundred eleven (811 urine samples were collected, 415 from Alsafia and 396 from Abuselala. Of the collected samples in 56.0% (95% Confidence Interval (CI; 52.6-59.4 Schistosoma eggs were found. The prevalence was high in both Abuselala 73.3% (95% CI; 68.9-77.6 and Alsafia 39.5% (95% CI; 34.8-44.2. More males (61.7%, 95%CI; 56.5-64.9 were infected than females (52.1%, 95%CI; 48.2-56.0. Children in the age group 10-14 has the highest (73.0%, 95%CI; 68.7-77.2 infection rate. School age children (6-15 years are more likely to be infected than those >15 years (Adjusted Odds Ratio (AOR = 2.70, 95% CI; 1.80-4.06. Individuals in Abuselala are more likely to be infected than those who live in Alsafia (AOR = 4.3, 95% CI; 3.2-5.9. Conclusion The findings of this study indicate that S. hematobium is endemic in Alsafia and Abuselala South Darfur in Sudan with a high prevalence of infection among older children. This signifies the importance of urgent intervention through Mass Drug Administration (MDA to halt the infection cycle and tailored health messages to targeted groups. Based on the findings MDA was conducted in the villages.

High prevalence of urinary schistosomiasis in two communities in South Darfur: implication for interventions.

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Deribe, Kebede; Eldaw, Abdeljbar; Hadziabduli, Samir; Kailie, Emmanuel; Omer, Mohamed D; Mohammed, Alam E; Jamshed, Tanole; Mohammed, Elmonshawe A; Mergani, Ali; Ali, Gafar A; Babikir, Khalid; Adem, Abdulrahman; Hashim, Farouq

2011-02-07

There are few data on the prevalence of schistosomiasis in Darfur. We conducted this study in response to reports of 15 laboratory confirmed cases of schistosomiasis and visible haematuria among children from two communities in South Darfur. The aim of the study was to estimate the prevalence of schistosomiasis in the area and to decide on modalities of intervention. A cross-sectional survey involving 811 children and adults from schools and health facilities was conducted in two communities of South Darfur in March 2010. Urine samples were collected and examined for ova of Schistosoma haematobium using a sedimentation technique. A semi-structured format was used to collect socio-demographic characteristics of the participants. Eight hundred eleven (811) urine samples were collected, 415 from Alsafia and 396 from Abuselala. Of the collected samples in 56.0% (95% Confidence Interval (CI); 52.6-59.4) Schistosoma eggs were found. The prevalence was high in both Abuselala 73.3% (95% CI; 68.9-77.6) and Alsafia 39.5% (95% CI; 34.8-44.2). More males (61.7%, 95%CI; 56.5-64.9) were infected than females (52.1%, 95%CI; 48.2-56.0). Children in the age group 10-14 has the highest (73.0%, 95%CI; 68.7-77.2) infection rate. School age children (6-15 years) are more likely to be infected than those >15 years (Adjusted Odds Ratio (AOR) = 2.70, 95% CI; 1.80-4.06). Individuals in Abuselala are more likely to be infected than those who live in Alsafia (AOR = 4.3, 95% CI; 3.2-5.9). The findings of this study indicate that S. hematobium is endemic in Alsafia and Abuselala South Darfur in Sudan with a high prevalence of infection among older children. This signifies the importance of urgent intervention through Mass Drug Administration (MDA) to halt the infection cycle and tailored health messages to targeted groups. Based on the findings MDA was conducted in the villages.

Paraganglioma of the urinary bladder: a clinicopathologic spectrum of a series of 14 cases emphasizing diagnostic dilemmas.

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Menon, Santosh; Goyal, Pankaj; Suryawanshi, Pallavi; Tongaonkar, Hemant; Joshi, Amit; Bakshi, Ganesh; Desai, Sangeeta

2014-01-01

Paraganglioma (PG) of the urinary bladder is a rare neuroendocrine neoplasm, accounting for bladder tumours. Distinction from urothelial carcinoma is imperative as management and prognosis vary markedly. In this report, we describe our experience with the histopathology of paragangliomas of the urinary bladder with emphasis on the histologic features that have led to their being misdiagnosed as conventional urothelial cancer and, most importantly, those that will help pathologists recognize this rare tumor of the bladder. All cases of PG of urinary bladder diagnosed at our institute from 2002-2012 were retrieved and diagnosis confirmed in accordance with WHO classification. Clinical and treatment details were obtained from hospital medical records. Fourteen cases of PG of urinary bladder including 5 consult cases were analysed. These included 11 transurethral resections ± partial cystectomies, 2 partial cystectomies and 1 radical cystectomy. Two out of the 5 consult cases had been submitted with a diagnosis of urothelial carcinoma and 1 with that of a rhabdomyosarcoma. Age ranged from 15-84 years (median, 43 years) with a male to female ratio of 1:2.5. Presenting symptoms were haematuria, dysuria and flank pain; only 1 case had antecedent hypertension. Histologically, typical 'zellballen' (72%), diffuse (21%) and ribbon-like (7%) growth patterns amidst a richly vascularised stroma were seen. Muscularis propria invasion and necrosis was present in 72% and 21%, respectively. Substantial cautery artifacts led to misdiagnosis in the 3 erroneous cases. Tumour cells were positive for chromogranin, synaptophysin; sustentacular cells were S-100 positive. Follow up was available in 6 patients; median follow-up was 29 months (8-120 months). One patient developed distant metastasis in cervical lymph node 10 years after diagnosis; remaining were alive without evidence of disease. Paraganglioma of the urinary bladder is a rare tumor and may be misdiagnosed as urothelial cancer

Arteriovenous fistulae after renal biopsy: diagnosis and outcomes using Doppler ultrasound assessment.

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Sosa-Barrios, R Haridian; Burguera, Victor; Rodriguez-Mendiola, Nuria; Galeano, Cristina; Elias, Sandra; Ruiz-Roso, Gloria; Jimenez-Alvaro, Sara; Liaño, Fernando; Rivera-Gorrin, Maite

2017-12-20

Percutaneous renal biopsy (PRB) is an important technique providing relevant information to guide diagnosis and treatment in renal disease. As an invasive procedure it has complications. Most studies up to date have analysed complications related to bleeding. We report the largest single-center experience on routine Doppler ultrasound (US) assessment post PRB, showing incidence and natural history of arteriovenous fistulae (AVF) post PRB. We retrospectively analysed 327 consecutive adult PRB performed at Ramon Cajal University Hospital between January 2011 and December 2014. All biopsies were done under real-time US guidance by a trained nephrologist. Routine Doppler mapping and kidney US was done within 24 h post biopsy regardless of symptoms. Comorbidities, full blood count, clotting, bleeding time and blood pressure were recorded at the time of biopsy. Post biopsy protocol included vitals and urine void checked visually for haematuria. Logistic regression was used to investigate links between AVF, needle size, correcting for potential confounding variables. 46,5% were kidney transplants and 53,5% were native biopsies. Diagnostic material was obtained in 90,5% (142 grafts and 154 native). Forty-seven AVF's (14.37%) were identified with routine kidney Doppler mapping, 95% asymptomatic (n = 45), 28 in grafts (18.4%) and 17 natives (9.7%) (p-value 0.7). Both groups were comparable in terms of comorbidities, passes, cylinders or biopsy yield (p-value NS). 80% were <1 cm in size and 46.6% closed spontaneously in less than 30 days (range 3-151). Larger AVF's (1-2 cm) took a mean of 52 days to closure (range 13-151). Needle size was not statistically significant factor for AVF (p-value 0.71). Contrary to historical data published, AVF's are a common complication post PRB that can be easily missed. Routine US Doppler mapping performed by trained staff is a cost-effective, non-invasive tool to diagnose and follow up AVF's, helping to assess management.

Why overestimate or underestimate chronic kidney disease when correct estimation is possible?

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De Broe, Marc E; Gharbi, Mohamed Benghanem; Zamd, Mohamed; Elseviers, Monique

2017-04-01

There is no doubt that the introduction of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines 14 years ago, and their subsequent updates, have substantially contributed to the early detection of different stages of chronic kidney disease (CKD). Several recent studies from different parts of the world mention a CKD prevalence of 8-13%. However, some editorials and reviews have begun to describe the weaknesses of a substantial number of studies. Maremar (maladies rénales chroniques au Maroc) is a recently published prevalence study of CKD, hypertension, diabetes and obesity in a randomized, representative and high response rate (85%) sample of the adult population of Morocco that strictly applied the KDIGO guidelines. When adjusted to the actual adult population of Morocco (2015), a rather low prevalence of CKD (2.9%) was found. Several reasons for this low prevalence were identified; the tagine-like population pyramid of the Maremar population was a factor, but even more important were the confirmation of proteinuria found at first screening and the proof of chronicity of decreased estimated glomerular filtration rate (eGFR), eliminating false positive results. In addition, it was found that when an arbitrary single threshold of eGFR (55 years of age), particularly in those without proteinuria, haematuria or hypertension. It also resulted in a significant 'underdiagnosis' (false negatives) in younger individuals with an eGFR >60 mL/min/1.73 m2 and below the third percentile of their age-/gender-category. The use of the third percentile eGFR level as a cut-off, based on age-gender-specific reference values of eGFR, allows the detection of these false positives and negatives. There is an urgent need for additional quality studies of the prevalence of CKD using the recent KDIGO guidelines in the correct way, to avoid overestimation of the true disease state of CKD by ≥50% with potentially dramatic consequences. © The Author 2017. Published by Oxford

Efficacy and safety of 120w greenlight photoselective vaporisation of prostate in patients receiving anticoagulant drugs

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Cakiroglu, B.; Gozukucuk, R.; Sinanoglu, O.

2013-01-01

-operative period for macroscopic haematuria and transient urinary retention. (author)

The changing practice of transurethral resection of the prostate.

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Young, M J; Elmussareh, M; Morrison, T; Wilson, J R

2018-04-01

Introduction Transurethral resection of the prostate (TURP) is considered the gold standard surgical treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. The number of TURPs performed has declined significantly over the last three decades owing to pharmaceutical therapy. TURP data from a single institution for the years 1990, 2000 and 2010 were compared to assess the difference in performance. Methods A retrospective analysis was undertaken of all patients who underwent TURP between January and December 2010. These findings were compared with historical data for the years 1990 and 2000: 100 sets of case notes were selected randomly from each of these years. Results The number of TURPs performed fell from 326 in 1990 to 113 in 2010. The mean age of patients increased from 70.6 years to 74.0 years. There was also a significant increase in the mean ASA grade from 1.9 to 2.3. The most common indication for TURP shifted from LUTS to acute urinary retention. No significant change in operating time was observed. The mean resection weight remained constant (22.95g in 1990, 22.55g in 2000, 20.76g in 2010). A reduction in transfusion rates was observed but there were higher rates of secondary haematuria and bladder neck stenosis. There was an increase from 2% to 11.5% of patients with long-term failure to void following TURP. Conclusions The number of TURPs performed continues to decline, which could lead to potential training issues. Urinary retention is still by far the most common indication. However, there has been a significant rise in the percentage of men presenting for TURP with high pressure chronic retention. The number of patients with bladder dysfunction who either have persistent storage LUTS or eventually require long-term catheterisation or intermittent self-catheterisation has increased markedly, which raises the question of what the long-term real life impact of medical therapy is on men with LUTS secondary to benign

Accidental Radiogold ({sup 198}Au) Liver Scan Overdose with Fatal Outcome

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Baron, J. M.; Yachnin, S.; Polcyn, R.; Fitch, F. W.; Sturner, W. Q. [Pritzker School of Medicine of the University of Chicago and Argonne Cancer Research Hospital (operated by the University of Chicago for the United States Atomic Energy Commission), Chicago, IL (United States)

1969-10-15

The first reported instance of accidental overdosage with intravenously administered radioactive colloidal gold ({sup 198}Au) given for liver scanning is described. A 73-year-old female with erythremic myelosis accompanied by hepatosplenomegaly received 200 millicuries instead of the intended dose of 200 microcuties. She was transferred to the Argonne Cancer Research Hospital at the University of Chicago the following day. External monitoring on the second day showed 35 mR/h at 1 metre. Total body scanning of the patient without administration of additional isotope revealed high activity and an abnormally extensive reticuloendothelial uptake. Blood activity at that time was 0.04 microcuries per millilitre of whole blood. Estimated radiation dosage to be received by the bone marrow was 400-500 Rand by the liver was 7000-8000 R. There were no symptoms of acute radiation exposure. The patient was placed in strict isolation on the fifth day, and surgical scrub precautions were continued until day 63. Supportive care included buffy . coat and platelet packs, prophylactic sterilization of the gastrointestinal tract, and, later, androgen and corticosteroids. The expected decrease in peripheral blood lymphocytes, granulocytes, and platelets occurred in the order mentioned. Liver size decreased, but function tests did not deteriorate. There was no difficulty with clinical infection during the granulocytopenic phase. Lymphocytes and, later, granulocytes showed recovery to subnormal levels, but platelets failed to rise above 8000/mm{sup 3} after the 21st day. The patient developed haematuria and purpura, and suffered a terminal spontaneous intracerebral haemorrhage on the 69th day. At post mortem there was evidence for patchy areas of granulocytic and erythroid marrow regeneration, and some extramedullary sites contained isolated clones of young red cell precursors. There were no specific changes in the liver. The lack of effective methods to mobilize or metabolize colloidal

Abscesso renal em recém-nascidos: um relato de caso

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Izilda das Eiras Tamega

2016-10-01

Full Text Available Introdução: O abscesso renal se caracteriza pela coleção de material purulento dentro do parênquima e pode ser causado por disseminação hematogênica, ascensão pelo trato urinário e infecção de área adjacente. Sua clínica na infância é inespecífica, e pode envolver dor abdominal ou lombar, febre e calafrios, mal- estar, anorexia e perda de peso. Sua ocorrência na infância é rara, mas o diagnóstico e tratamento precoces são fundamentais para a reduzir a mortalidade. Objetivo: Relatar caso de RN admitida no CHS com abdome agudo devido a um abscesso renal. Metodologia: Informações obtidas por meio de revisão de prontuário e literatura. Relato de caso: RN de EPB, sexo feminino, 13 dias de vida, encaminhada de Tietê com queixa de irritabilidade e distensão abdominal iniciadas no primeiro dia de vida, 2 episódios de hematêmese e 4 episódios de melena. Medicada na origem com ampicilina e gentamicina e transferida para o CHS. RN de parto normal, IG =39 semanas, peso ao nascimento=3750g, sem intercorrências relatadas no pré-natal e parto. Ao exame, apresentava-se em REG, descorada 2+/4, com abdome globoso, distendido, RHA +, flácido, doloroso à palpação, fígado a 2cm RCD, baço não palpável, sem demais alterações. Foi introduzida antibioticoterapia e realizado transfusão de concentrado de hemácias, mas a paciente evoluiu com instabilidade hemodinâmica e indicada laparotomia de urgência. No intra- operatório, foi identificado abscesso renal à direita, submetido à drenagem. A paciente evoluiu bem, com boa aceitação do leite materno e sem distensão abdominal e recebeu alta. Conclusão: O abscesso renal em recém-nascido é uma doença rara de difícil diagnóstico, cujo manejo adequado é imprescindível a fim de evitar lesão renal.

Caracterización clínica de los casos de dengue hospitalizados en la E.S.E. Hospital ""Antonio Roldán Betancur"", Apartadó, Antioquia, Colombia, 2000.

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Margarita Arboleda

2006-06-01

Full Text Available Introducción. Desde 1998 se vienen notificando casos de dengue hemorrágico en el municipio de Apartadó y actualmente el dengue se considera endemo-epidémico. Objetivo. Describir el comportamiento clínico del dengue en pacientes hospitalizados por esta causa en la Empresa Social del Estado Hospital Antonio Roldán Betancur de Apartadó en el año 2000. Materiales y métodos. Estudio descriptivo retrospectivo de revisión de historias clínicas de pacientes hospitalizados por dengue. Resultados. Se hospitalizaron 45 casos con diagnóstico serológico de dengue. Tres (6,7% pacientes con dengue clásico, 22 (48,9% con dengue con manifestaciones hemorrágicas y 20 (44,4% con dengue hemorrágico. La edad osciló entre 4 meses y 68 años con un promedio de 22,1 años. La mayoría procedía del área urbana (82,8%. Las manifestaciones clínicas más frecuentes fueron: fiebre (100%, mialgias y artralgias (71,1%, cefalea (70,5% y dolor abdominal (67,5%. Las manifestaciones hemorrágicas más frecuentes fueron petequias (60%, hematuria (31,7%, equimosis en sitios de venopunción (24,4%, melenas (22,2%, hematemesis (15,5% y hemorragias vaginales anormales (15,5%. El recuento de plaquetas osciló entre 11.000 y 186.000/mm3, con un promedio de 48.688. Los hematocritos oscilaron entre 26 y 59%, con un promedio de 41,5%. Fallecieron 4 (8,8% pacientes, tres de éstos menores de un año. En el 40% de los casos se hicieron otros diagnósticos simultáneamente, siendo malaria la coinfección más frecuente, con 17,7% (8/45 de los casos. Conclusión. En este estudio las personas en edad productiva tuvieron mayor riesgo de sufrir dengue y la población menor de un año fue la de mayor riesgo de letalidad; existe, además, la posibilidad de coinfección con otras enfermedades, particularmente malaria.

Fístula bilio-duodenal pós colecistite aguda: Relato de caso

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Marina Araújo Fonte Boa

2016-12-01

Full Text Available As fístulas biliares internas espontâneas são comunicações estabelecidas entre qualquer segmento da árvore biliar e dos órgãos abdominais. Elas constituem uma afecção rara apesar de compreender uma complicação da colecistite, patologia freqüente da prática cirúrgica. As fístulas bilioentericas ocorrem em 3-5% dos doentes com colelitíase, sendo 68% destas bilioduodenais. O objetivo desse manuscrito é relatar um caso de fístula bilioduodenal complicada com hemobilia e hemorragia digestiva, descrevendo a conduta adotada. Os dados foram coletados entre dezembro/2015 a abril/2016 através da analise de prontuário fornecido pelo Hospital Universitário Sul Fluminense (HUSF. Trata-se de um paciente masculino, 75 anos, atendido no HUSF-Vassouras/RJ com diagnóstico sindrômico de abdome agudo inflamatório por colecistite aguda, submetido a tratamento conservador para regressão da inflamação peri-colecística, diminuindo assim, o risco de lesões iatrogênicas da árvore biliar em posterior cirurgia. Evoluiu com melena, que foi investigada por endoscopia digestiva alta onde foi observada úlcera de bulbo duodenal com drenagem de secreção purulenta pela sua luz; e tomografia computadorizada de abdome que evidenciou presença de aerobilia indicando presença de fístula bileodigestiva. O tratamento conservador consistiu-se em antibioticoterapia e reposição volêmica, optado devido à remissão do quadro de colecistite após desobstrução pela fístula, devido à hemorragia que cessou espontaneamente e também pelo risco da realização do procedimento cirúrgico em paciente idoso com intensa resposta inflamatória sistêmica. Não é comum na literatura médica a ocorrência de fístulas biliodigestivas com sinais e sintomas hemorrágicos. O quadro clínico geralmente é inespecífico e frequentemente atrasado devido à falta de sinais e sintomas patognomônicos.

Evaluation of hepatocyte-derived microRNA-122 for diagnosis of acute and chronic hepatitis of dogs

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S. R. Eman

2018-05-01

Full Text Available Aim: This study was performed to evaluate the diagnostic value of hepatocyte-derived microRNA (miRNA-122 in acute and chronic hepatitis of dogs. Materials and Methods: A total of 26 dogs presented at Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Cairo University, 16 dogs out of 26 showing clinical signs of hepatic insufficiency were subjected to clinical, ultrasonographic, hematobiochemical and ultrasound-guided fine-needle biopsy for cytological and histopathological investigations. On the basis of these results, 7 dogs out of 16 dogs were found to be suffering from acute hepatitis and 9 dogs suffering from chronic hepatitis. 10 clinically healthy dogs were kept as control. Serum hepatocyte-derived miRNA-122 was analyzed by real-time quantitative polymerase chain reaction in all dogs. Results: The dogs suffering from acute hepatitis manifested jaundice, vomiting, and depression while dogs with chronic hepatitis manifested anorexia, abdominal distension, weight loss, and melena. Hematological parameters showed normocytic normochromic anemia and thrombocytopenia in both acute and chronic hepatitis groups. Alanine aminotransferase (ALT, aspartate aminotransferase (AST, alkaline phosphatase (ALP, and total bilirubin were significantly higher than control values in acute hepatitis. In chronic hepatitis, total protein and albumin were significantly lower than control values with normal ALT, AST, ALP, and gamma-glutamyltransferase values. Ultrasonography revealed a diffuse decrease in hepatic echogenicity in acute hepatitis while the increase in hepatic echogenicity and anechoic ascetic fluid in chronic hepatitis. Cytology revealed hepatic vacuolar degeneration and histopathology revealed necrosis and apoptosis of hepatocyte in acute hepatitis while revealed massive fibrous tissue proliferation in hepatic parenchyma in chronic hepatitis. Serum miRNA-122 analysis, normalized for glyceraldehyde-3- phosphate dehydrogenase expression

Tratamento cirúrgico da hipertensão portal esquistossomótica no hc/ufpe: análise de 131 casos

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Álvaro Antônio Bandeira Ferraz

Full Text Available OBJETIVO: A hipertensão portal esquistossomótica com antecedente de hemorragia digestiva foi tratada com esplenectomia + ligadura da veia gástrica esquerda (LVGE + desvascularização da grande curvatura do estômago + esclerose endoscópica pós-operatória. Quando da existência de varizes de fundo gástrico, realizamos a abertura do fundo gástrico e sutura obliterante destas varizes. O objetivo deste trabalho foi avaliar a recidiva de hemorragia digestiva, repercussões laboratoriais e mortalidade do tratamento cirúrgico/endoscópico. MÉTODOS: Entre 1992 e 1998, foram operados no HC-UFPE 131 pacientes. O seguimento médio foi de 30 meses, em 111 pacientes, que foram solicitados a retornar ao ambulatório do HC-UFPE para a realização de controle clínico e laboratorial. RESULTADOS: A recidiva hemorrágica foi de 14,4% (16/111 e uma mortalidade de 5,4% (6/111. A recidiva de hemorragia digestiva alta foi exteriorizada através de hematemese em oito pacientes e oito por melena. Dos seis pacientes que foram a óbito, três apresentavam diagnóstico de linfoma, hepatocarcinoma e infarto agudo do miocárdio, respectivamente. Dois pacientes foram a óbito no pós-operatório imediato (sepse e coagulação intravascular disseminada. O sexto paciente foi a óbito por recidiva da hemorragia digestiva alta. Em nove pacientes, 13,2%, foi diagnosticada trombose da veia porta. Os dados laboratoriais, hematológicos e de função hepática também foram analisados. CONCLUSÕES: Os autores concluíram que o tratamento cirúrgico da hipertensão portal esquistossomótica, através da esplenectomia + LVGE + desvascularização da grande curvatura do estômago + esclerose endoscópica pós-operatória determina resultados compatíveis com a literatura em relação à recidiva de sangramento, mas preserva a funcionalidade hepática.

Can catheter-directed thrombolysis be applied to acute lower extremity artery embolism after recent cerebral embolism from atrial fibrillation?

International Nuclear Information System (INIS)

Si, T.-G.; Guo, Z.; Hao, X.-S.

2008-01-01

Purpose: To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute limb embolism in patients with recent cerebral embolism due to atrial fibrillation. Materials and methods: Eight patients (six men, two women; mean age 63.5 years) with acute embolic occlusion of two left common iliac arteries, four femoral arteries (three left; one right), and two right popliteal arteries were treated. All patients had a history of recent cerebral embolism (mean 6 days, range 5-15 days) and all had a history of atrial fibrillation (duration 5-10 years). Catheter-directed thrombolysis started a few hours (mean 6.2 h; range 3-10 h) after the onset of arterial embolism. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 F end-hole catheter and, subsequently, two additional boluses of 5 mg rt-PA were injected into the emboli. In patients with residual emboli, infusion with rt-PA (1 mg/h) was continued. Percutaneous transluminal angioplasty was performed in three patients, and a stent was deployed in one patient. Results: Technical success was achieved in all patients. Clinical success rate was 87.5% (7/8). The one clinical failure was secondary to chronic occlusion of outflow runoff vessels. The mean duration of continuous rt-PA infusion was 3.6 h, the mean total dose of rt-PA administered was 23.6 mg (range 20-28 mg). There was no significant change in stroke scale scores during thrombolysis and no intracerebral haemorrhage was found at computed tomography (CT) after thrombolysis. Minor complications included haematomata at puncture sites (6/8), bleeding around the vascular sheath (2/8), and haematuria (1/8). During the follow-up period of 3-6 months, one patient suffered from recurrent cerebral embolism and died. Conclusions: Catheter-directed thrombolysis with rt-PA is an option for acute lower extremity arterial embolism in patients with recent cerebral embolism and a history of

Can catheter-directed thrombolysis be applied to acute lower extremity artery embolism after recent cerebral embolism from atrial fibrillation?

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Si, T.-G. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China); Guo, Z. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China)], E-mail: dr.guozhi@yahoo.com.cn; Hao, X.-S. [Department of interventional treatment, Tianjin medical university cancer Hospital and Institution, Tianjin (China)

2008-10-15

Purpose: To assess the feasibility and efficacy of catheter-directed thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute limb embolism in patients with recent cerebral embolism due to atrial fibrillation. Materials and methods: Eight patients (six men, two women; mean age 63.5 years) with acute embolic occlusion of two left common iliac arteries, four femoral arteries (three left; one right), and two right popliteal arteries were treated. All patients had a history of recent cerebral embolism (mean 6 days, range 5-15 days) and all had a history of atrial fibrillation (duration 5-10 years). Catheter-directed thrombolysis started a few hours (mean 6.2 h; range 3-10 h) after the onset of arterial embolism. Two 5 mg boluses of rt-PA were injected into the proximal clot through a 5 F end-hole catheter and, subsequently, two additional boluses of 5 mg rt-PA were injected into the emboli. In patients with residual emboli, infusion with rt-PA (1 mg/h) was continued. Percutaneous transluminal angioplasty was performed in three patients, and a stent was deployed in one patient. Results: Technical success was achieved in all patients. Clinical success rate was 87.5% (7/8). The one clinical failure was secondary to chronic occlusion of outflow runoff vessels. The mean duration of continuous rt-PA infusion was 3.6 h, the mean total dose of rt-PA administered was 23.6 mg (range 20-28 mg). There was no significant change in stroke scale scores during thrombolysis and no intracerebral haemorrhage was found at computed tomography (CT) after thrombolysis. Minor complications included haematomata at puncture sites (6/8), bleeding around the vascular sheath (2/8), and haematuria (1/8). During the follow-up period of 3-6 months, one patient suffered from recurrent cerebral embolism and died. Conclusions: Catheter-directed thrombolysis with rt-PA is an option for acute lower extremity arterial embolism in patients with recent cerebral embolism and a history of

Prevalence of the use of cancer related self-tests by members of the public: a community survey

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Marriott John

2006-08-01

Full Text Available Abstract Background Self-tests are those where an individual can obtain a result without recourse to a health professional, by getting a result immediately or by sending a sample to a laboratory that returns the result directly. Self-tests can be diagnostic, for disease monitoring, or both. There are currently tests for more than 20 different conditions available to the UK public, and self-testing is marketed as a way of alerting people to serious health problems so they can seek medical help. Almost nothing is known about the extent to which people self-test for cancer or why they do this. Self-tests for cancer could alter perceptions of risk and health behaviour, cause psychological morbidity and have a significant impact on the demand for healthcare. This study aims to gain an understanding of the frequency of self-testing for cancer and characteristics of users. Methods Cross-sectional survey. Adults registered in participating general practices in the West Midlands Region, will be asked to complete a questionnaire that will collect socio-demographic information and basic data regarding previous and potential future use of self-test kits. The only exclusions will be people who the GP feels it would be inappropriate to send a questionnaire, for example because they are unable to give informed consent. Freepost envelopes will be included and non-responders will receive one reminder. Standardised prevalence rates will be estimated. Discussion Cancer related self-tests, currently available from pharmacies or over the Internet, include faecal occult blood tests (related to bowel cancer, prostate specific antigen tests (related to prostate cancer, breast cancer kits (self examination guide and haematuria tests (related to urinary tract cancers. The effect of an increase in self-testing for cancer is unknown but may be considerable: it may affect the delivery of population based screening programmes; empower patients or cause unnecessary anxiety

Inadvertent positioning of suprapubic catheter in urethra: a serious complication during change of suprapubic cystostomy in a spina bifida patient - a case report.

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Vaidyanathan, Subramanian; Hughes, Peter L; Soni, Bakul M; Oo, Tun; Singh, Gurpreet

2009-12-22

Spinal cord injury patients are at risk for developing unusual complications such as autonomic dysreflexia while changing suprapubic cystostomy. We report a male patient with spina bifida in whom the Foley catheter was placed in the urethra during change of suprapubic cystostomy with serious consequences. A male patient, born in 1972 with spina bifida and paraplaegia, underwent suprapubic cystostomy in 2003 because of increasing problems with urethral catheter. The patient would come to spinal unit for change of suprapubic catheter every four to six weeks. Two days after a routine catheter change in November 2009, this patient woke up in the morning and noticed that the suprapubic catheter had come out. He went straight to Accident and Emergency. The suprapubic catheter was changed by a health professional and this patient was sent home. But the suprapubic catheter did not drain urine. This patient developed increasing degree of pain and swelling in suprapubic region. He did not pass any urine per urethra. He felt sick and came to spinal unit five hours later. About twenty ml of contrast was injected through suprapubic catheter and X-rays were taken. The suprapubic catheter was patent; the catheter was not blocked. The Foley catheter could be seen going around in a circular manner through the urinary bladder into the urethra. The contrast did not opacify urinary bladder; but proximal urethra was seen. The tip of Foley catheter was lying in proximal urethra. The balloon of Foley catheter had been inflated in urethra. When the balloon of Foley catheter was deflated, this patient developed massive bleeding per urethra. A sterile 22 French Foley catheter was inserted through suprapubic track. The catheter drained bloody urine. He was admitted to spinal unit and received intravenous fluids and meropenem. Haematuria subsided after 48 hours. The patient was discharged home a week later in a stable condition. This case shows that serious complications can occur during

Telomerase Activity, Cytokeratin 20 and Cytokeratin 19 in Urine Cells of Bladder Cancer Patients

International Nuclear Information System (INIS)

Morsi, M.I.; Youssef, A.I.; El-Sedafi, A.S.; Ghazal, A.A.; Zaher, E.R.; Hassouna, M.E.

2006-01-01

Aim of the Study: This work aims to search for markers suitable for the screening of bladder cancer, which should be specific, sensitive, reproducible, non-invasive and at acceptable cost. Patients and Methods: The study included 50 patients diagnosed as bladder cancer (35 TCC, 15 SCC) of different stages and grades, 30 patients with various urothelial diseases, besides 20 apparently healthy subjects of matched age and sex to the malignant group. A random midstream urine sample was collected in a sterile container for the determination of telomerase by RT-PCR, keratin 19 by ELSA CYFRA 21-1 IRMA kit, keratin 20 by RT-PCR and immunohistochemical staining, and urine cytology. Results: For all parameters (telomerase, K19, K20 and cytology) the malignant group was significantly different from both the benign and the control groups. None of the four studied parameters was correlated to the stage of the disease, and when it comes to grade, only KI9 showed a significant positive correlation with grade both in TCC and SCe. When ROC curves for all parameters were compared, K 19 had the largest area under the curve, and then comes K20 . o Conclusion: K 19 may be used as a biological marker for the diagnosis of bladder cancer. K 19 could not be used for differential diagnosis of different types of bladder cancer, meanwhile it could be a marker for differentiation that decreases in less differentiated tumors. As a tumor marker, K20 reflects inability to differentiate tumor type or grade in TCC, while in SCC of the bladder it is correlated with the grade. As a method, RT-PCR is superior to immunostaining for the detection of bladder cancer, meanwhile K20 immunohistochemistry ([HC) results were much better than urine cytology as a bladder cancer screening test. haematuria and inflammation reduced the specificity of telomerase assay, which reduced its validity as a tumor marker of bladder cancer. K 19 and K20 are the best candidates as screening tests for the diagnosis of bladder

Extensive hemangiomatosis diagnosed by scintigraphy with 99mTc-labeled red blood cells in a patient with lower gastrointestinal bleeding

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Souza, D.S.F.; Ichiki, W.A.; Borges, A.C.; Coura Filho, G.B.; Vecchia, J.F.; Sapienza, M.T.; Ono, C.R.; Watanabe, T.; Costa, P.L.A.; Hironaka, F.; Cerri, G.G.; Buchpiguel, C.A. [Universidade de Sao Paulo (FM/USP), SP (Brazil). Inst. de Radiologia. Servico de Medicina Nuclear

2008-07-01

Full text: Introduction: The gastrointestinal bleeding may be caused by vascular tumors and other lesions like inflammatory disorders, intestinal obstruction or vascular malformation. The Klippel-Trenaunay syndrome and blue rubber bleb nevus syndrome are hemangiomatosis diseases that may involve the gastrointestinal tract and cause recurrent hemorrhage. The signs and symptoms usually appear at childhood. Case report: male patient, 31 years old, presenting three days of gastrointestinal bleeding and an hemorrhage shock (Hb=3,9). Previous reports of small volume bleeding since childhood and schistossomosis. Dilated veins, hemorrhoid and port wine stain lesions were detected at physical examination in perineal region, penis and scrotum. Inferior limbs were symmetric at inspection. The upper endoscopy showed esophageal varices with no signs of active bleeding. The scintigraphy with {sup 99m}Tc-labeled red blood cells showed active hemorrhage at recto-sigmoid topography during the first hour of study. Extensive and heterogeneous uptake was seen in gluteus, posterior right thigh and scrotum at the second and fifth hours of study. Then the hypothesis of vascular tumor was considered. The magnetic resonance (MR) of pelvis demonstrated extensive hemangiomatosis at the regions described by the scintigraphy. The clinical and imaging findings suggested the diagnosis of Klippel-Trenaunay syndrome. Discussion: The Klippel-Trenaunay syndrome is a rare disease characterized by congenital vascular and lymphatic malformations (port wine stain lesions, congenital varices) and bone growth and soft tissue disorder. Dilated veins may involve abdominal and pelvic structures, with rectal bleeding and haematuria occurring on average of 20%. The clinical investigation must approach the type, the extent and the severity of the malformation, since the morbidity and the mortality depends on the visceral involvement. The Doppler ultrasound, scanometry of lower extremities, MR, angiography and

Hipernefroma gigante: a propósito de un caso Giant hypernephroma: apropos of a case

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Rafael Pinilla González

2008-03-01

Full Text Available El hipernefroma constituye el 3 % de todos los tumores malignos y es el tumor renal más frecuente del adulto. Se sospechaba la existencia de un carcinoma renal ante la presencia de hematuria, lumbalgia y tumor abdominal palpable. En la actualidad, el empleo sistemático de la ultrasonografía y la tomografía axial computarizada ha posibilitado la detección de masas renales incidentales y mejorado el pronóstico de estos pacientes. Se describe el caso de un paciente del sexo masculino, de 45 años de edad, con dolor en el lado izquierdo del abdomen y tumoración de crecimiento rápido, que se hizo muy dolorosa en los dos días previos a la operación. Por incremento notable del dolor y por no tener la posibilidad de realizar estudios imaginológicos, se decide operar de urgencia. Se diagnosticó un hipernefroma izquierdo con sangrado intratumoral y se realizó nefrectomía izquierda. El informe histológico confirmó un carcinoma de células renales del tipo de células claras. El paciente fue valorado antes del alta por el oncólogo, quien propuso seguimiento solamenteThe hypernephroma accounts for 3 % of all the malignant tumors and it is the most frequent renal tumor in adults. It was suspected the existence of a renal carcinoma in the presence of haematuria, low back pain and palpable abdominal tumor. Nowadays, the systematic use of ultrasonography and computerized axial tomography has made possible the detection of incidental renal masses, and has improved the prognosis of these patients. The case of a 45-year-old patient with pain on the left side of the abdomen and tumor of fast growth that became very painful 2 days before the operation was described. Due to a marked increase of pain and to the impossibility of carrying out imaging studies, it was decided to perform emergency surgery. A left hypernephroma with intratumoral bleeding was diagnosed and left nephrectomy was performed. The histological report confirmed a clear-cell renal

Geographical, clinical, clinicopathological and radiographic features of canine angiostrongylosis in Irish dogs: a retrospective study

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Gallagher Barbara

2012-03-01

Full Text Available Abstract Background Angiostrongylus vasorum infection is associated with high morbidity and mortality in dogs. Although recognised in Ireland, there are no large series of cases reported. The aim of this retrospective study was to identify pertinent clinical and geographical features in Irish dogs. Results The case records of dogs presenting to the University College Dublin Veterinary Hospital (1999-2010 were reviewed. A contemporaneous review of external faecal parasitology and post mortem submissions was also performed. A positive diagnosis of angiostrogylosis was identified in 49 dogs including 24 clinical, 10 post mortem and 15 external faecal sample cases. The majority (n = 44 (90% resided on the East Coast. In the clinical cases, the median age was 20 months, 29% of cases were older than 2 years. Clinical features included cardiorespiratory (63%, coagulopathic (71% and other (63% signs. Cough (n = 10, dyspnoea (n = 5 and tachypnoea (n = 3 were the most common cardiorespiratory abnormalities. Of animals with evidence of coagulopathy, excessive haemorrhage from a wound (n = 5, airway haemorrhage (n = 9, epistaxis (n = 3, haematoma (n = 4, suspected haemarthrosis (n = 3, neurological signs (n = 2 and haematuria (n = 1 were found. Ten dogs were anaemic, of which two were severe (haematocrit ≤ 0.20 L/L. Ten animals had thrombocytopenia, with four severely affected (≤50 × 109/L. PT and APTT values were prolonged in 4 (24% of 17 and a BMBT was prolonged in 5 (63% of 8 cases. Vague signs of exercise intolerance (n = 6, lethargy (n = 6 and weakness (n = 2 were identified, with two (8% animals having only these signs. In one animal the diagnosis appeared to be incidental. Thoracic radiographs (n = 19 identified abnormalities in 100% of cases. Four (17% animals died before or within 24 hours of treatment and post mortem examinations confirmed angiostrongylosis. Fenbendazole was administered in 19 cases, 18 (95% recovered. Two animals were

Elective hemi transurethral resection of prostate: a safe and effective method of treating huge benign prostatic hyperplasia

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Abidi, S.S.; Feroz, I.; Aslam, M.; Fawad, A.

2012-01-01

To evaluate the safety and efficacy of elective hemi-resection of prostate in patients with huge gland, weighing more than 120 grams. Study Design: Multi centric, analytical comparative study. Place and Duration of Study: Department of Urology, Karachi Medical and Dental College, Abbasi Shaheed Hospital and Dr. Ziauddin Hospital, Karachi, from August 2006 to July 2009. Methodology: All benign cases were included in this study and divided into two groups. In group A, patients having huge prostate (> 120 grams) were placed and hemi TURP was performed. In group B, patients having 60 to 100 grams prostate were placed and conventional Blandy's TURP was performed. Results of both groups were compared in terms of duration of surgery, amount of tissue resected, operative bleeding, postoperative complications, duration of postoperative catheterization, re-admission and re-operations. Effectiveness of procedure was assessed by a simple questionnaire filled by the patients at first month, first year and second year. Patients satisfaction in terms of their ability to void, control urination, frequency, urgency, urge incontinence, haematuria, recurrent UTI, re-admission and re-operations were also assessed. Fisher exact test was applied to compare the safety and efficacy of variables. Results: In group A and B, average age range was 72 and 69 years, average weight of prostate was 148 and 70 grams, average duration of surgery was 102 and 50 minutes respectively. Average weight of resected tissue was 84 and 54 grams and haemoglobin loss was two grams and one gram respectively. Total hospital stay was 5 and 4 days. Total duration of indwelling Foley's catheter (postoperative) was 5 days and 2 days. Patient satisfaction in term of urine flow, urinary control, improvement in frequency and nocturia were comparable in both groups. UTI and re-admission was more in hemi resection group. At the end of 2 years follow-up, there is no statistical difference between the safety and efficacy

Therapeutic Endoscopy for the Control of Nonvariceal Upper Gastrointestinal Bleeding in Children: A Case Series.

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Banc-Husu, Anna M; Ahmad, Nuzhat A; Chandrasekhara, Vinay; Ginsberg, Gregory G; Jaffe, David L; Kochman, Michael L; Rajala, Michael W; Mamula, Petar

2017-04-01

Gastrointestinal bleeding is one of the most common indications for urgent endoscopy in the pediatric setting. The majority of these procedures are performed for control of variceal bleeding, with few performed for nonvariceal upper gastrointestinal (NVUGI) bleeding. The data on therapeutic endoscopy for NVUGI are sparse. The aims of our study were to review our experience with NVUGI bleeding, describe technical aspects and outcomes of therapeutic endoscopy, and determine gastroenterology fellows' training opportunities according to the national training guidelines. We performed a retrospective review of endoscopy database (Endoworks, Olympus Inc, Center Valley, PA) from January 2009 to December 2014. The search used the following keywords: bleeding, hematemesis, melena, injection, epinephrine, cautery, clip, and argon plasma coagulation. The collected data included demographics, description of bleeding lesion and medical/endoscopic therapy, rate of rebleeding, relevant laboratories, physical examination, and need for transfusion and surgery. The study was approved by the institutional review board. During the study period 12,737 upper endoscopies (esophagogastroduodenoscopies) were performed. A total of 15 patients underwent 17 esophagogastroduodenoscopies that required therapeutic intervention to control bleeding (1:750 procedures). The mean ± standard deviation (median) age of patients who required endoscopic intervention was 11.6 ± 6.0 years (14.0 years). Seven out of 17 patients received dual therapy to control the bleeding lesions. All but 3 patients received medical therapy with intravenous proton pump inhibitor, and 3 received octreotide infusions. Six of the patients experienced rebleeding (40%), with 4 out of 6 initially only receiving single modality therapy. Two of these patients eventually required surgical intervention to control bleeding and both patients presented with bleeding duodenal ulcers. There were no cases of aspiration

Current approaches to gastric cancer in Peru and Mexico.

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Santos, Erlan

2017-01-01

In Peru, the incidence of gastric cancer is reported to be around 15.8 per 100,000 inhabitants and it is the second most common oncological disease in men and the third one in women. Additionally, a high mortality index was reported, especially among poor people. To address this issue, in 2008, Peru initiated several insurance treatment plans of oncological diseases with promising results. In Mexico, there is a high predominance of gastric cancer in male gender compared to female gender, even reaching a 2/1 ratio, and the detection rate of early gastric cancer is low (10% to 20%) which results in a mainly palliative treatment with an overall survival rate in 5 years about 10% to 15% only. In Peru, the average age at diagnosis is around 62.96±14.75 years old and the most frequent symptoms includes abdominal pain, indigestion, loss of appetite, weight loss and gastrointestinal bleeding, while in Mexico, some studies reported an average age at diagnosis around 60.3±4.1 years old (range, 23-78 years old) and the most frequent symptoms were postprandial fullness (74.4%), abdominal pain (37.2%), weight loss (18.6%), and melena (4.6%). The anemia rate was 65.1% with a mean Hb level of 6.14 g/dL. In Peru, the most common gastric cancer type is the intestinal-type adenocarcinoma (around 34%), followed by the diffuse-type adenocarcinoma (18.7%), whilst among Mexicans, the diffuse-type was reported in 55.2% of cases, the intestinal-type was reported in 28.2% and the undifferentiated-type corresponded to 6%. In both, Peru and Mexico, 90% of the associated factors includes tabaquismo, diets rich in salt, smoked foods, and a sedentary lifestyle. Family inheritance and advanced age and pharmacological-resistant Helicobacter pylori infection are also important. Poverty has been heavily associated with a higher incidence of gastric cancer. The management of gastric cancer patients in Peru is carried out by general surgeons or general surgical oncologists. In recent years, efforts

The value of MR enteroclysis with air infusion in the diagnosis of small bowel disease

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Zhang Shizheng; Ren Xiaojun; Zhang Qiaowei

2004-01-01

Objective: To investigate the value of MR enteroclysis with air infusion in the diagnosis of small bowel disease. Methods: Sixteen patients with suspected small bowel disease, but without acute inflammatory disease or bowel obstruction, received MR enteroclysis with air infusion. There were 12 males and 4 females, and their age ranged from 17 to 75 years. 10 patients had abdominal pain, 4 with melena or blood stool, and 2 with diarrhea. The longest course was 7 years, and the shortest 1 week. Before MR imaging, a nasoenteric catheter was inserted into the distal part of duodenum, and about 1000 ml of air was infused through the tube to distend the small bowel. 20 mg of IV anisodamine was given to reduce small-bowel peristalsis. All patients were imaged with fat-saturated Gd-DTPA enhanced coronal and axial T 1 -weighted spin-echo (SE) sequence and fast spoiled gradient echo (FSPGR) sequence. Comparison between the diagnosis of MRI and the results of surgery, pathology or clinic was performed to assess the sensitivity and specificity of MRI. Results: 5 cases were normal, 6 with Crohn disease, 2 with gastric intestinal stromal tumor (GIST), and 1 each of lymphoma, tuberculosis and irritable bowel syndrome. The lumen of normal small bowel in MR enteroclysis was no signal, the wall was outlined as middle signal by intraluminal air and surrounding air-distended bowel and was between 1-3 mm thick, and the diameter of the lumen was between 17-28 mm. Crohn disease showed segmental mural thickening, increased enhancement, luminal stricture, and even extraluminal inflammatory mass or fistula. Intestinal tuberculosis invaded the distal section of ileum, cecum, and the proximal ascending colon, the wall thickened and enhanced apparently, and cecum and proximal ascending colon shortened. GIST showed a mass that was iso-signal on T 1 WI, high signal on T 2 WI, and enhanced significantly after IV Gd-DTPA. 1 recurrent lymphoma of ileum showed mural thickening and increased

NON-CONTRAST MAGNETIC RESONANCE UROGRAPHY

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Arpita C

2016-07-01

Full Text Available BACKGROUND AND PURPOSE Magnetic Resonance (MR urography with its optimal contrast resolution and lack of ionizing radiation provides a comprehensive examination of the entire urinary tract noninvasively. MR urography is clinically useful in the evaluation of suspected urinary tract obstruction, haematuria, congenital anomalies, and surgically altered anatomy. It is particularly useful in cases of where there is contraindication of ionizing radiation and in paediatric and pregnant patients. The common MR urographic techniques are: Static-fluid MR urography and excretory MR urography. Static-fluid MR urography uses of heavily T2-weighted sequences to image the urinary tract as a static collection of fluid, can be repeated sequentially (Cine MR urography to better demonstrate the ureters in their entirety and to confirm the presence of fixed stenoses. Excretory MR urography is performed during the excretory phase of enhancement after the intravenous administration of gadolinium-based contrast material; thus, the patient must have sufficient renal function to allow the excretion. Static-fluid and excretory MR urography can be combined with conventional MR imaging for comprehensive evaluation of the urinary tract. The limitations are limited availability, high cost, relatively long examination time, low spatial resolution compared to IVU (Intravenous Urogram and CT Urography; sensitivity to motion (breathing and ureteral peristalsis inherent contraindications like patients with pacemakers, claustrophobia, and relative insensitivity for calcification and ureteric calculi. In this article, an attempt has been made to demonstrate the potential of static-fluid MRU to demonstrate a spectrum of urologic pathology involving the kidneys, ureters, and bladder while discussing the limitations. METHODS Thirty patients with urinary tract abnormalities were evaluated with MR urography performed between May 2014 to April 2016 using routine MR sequences and

Lessons we learn from review of urological procedures performed during three decades in a spinal cord injury patient: a case report.

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Vaidyanathan, Subramanian; Soni, Bakul M; Hughes, Peter L; Singh, Gurpreet; Mansour, Paul; Oo, Tun

2009-12-16

We review urological procedures performed on a spinal cord injury patient during three decades. A 23-year-old male patient sustained T-12 paraplegia in 1971. In 1972, intravenous urography showed both kidneys functioning well; division of external urethral sphincter was performed. In 1976, reimplantation of left ureter (Lich-Gregoir) was carried out for vesicoureteric reflux. As reflux persisted, left ureter was reimplanted by psoas hitch-Boari flap technique in 1978. This patient suffered from severe pain in legs; intrathecal injection of phenol was performed twice in 1979. The segment bearing the scarred spinal cord was removed in September 1982. This patient required continuous catheter drainage. Deep median sphincterotomy was performed in 1984. As the left kidney showed little function, left nephroureterectomy was performed in 1986. In an attempt to obviate the need for an indwelling catheter, bladder neck resection and tri-radiate sphincterotomy were carried out in 1989; but these procedures proved futile. UroLume prosthesis was inserted and splinted the urethra from prostatic apex to bulb in October 1990. As mucosa was apposing distal to stent, in November 1990, second UroLume stent was hitched inside distal end of first. In March 1991, urethroscopy showed the distal end of the distal stent had fragmented; loose wires were removed. In April 1991, this patient developed sweating, shivering and haematuria. Urine showed Pseudomonas. Suprapubic cystostomy was performed. Suprapubic cystostomy was done again the next day, as the catheter was pulled out accidentally during night. Subsequently, a 16 Fr Silastic catheter was passed per urethra and suprapubic catheter was removed. In July 1993, Urocoil stent was put inside UroLume stent with distal end of Urocoil stent lying free in urethra. In September 1993, this patient was struggling to pass urine. Urocoil stent had migrated to bladder; therefore, Urocoil stent was removed and a Memotherm stent was deployed. This

The prevalence and natural history of urinary symptoms among recreational ketamine users.

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Winstock, Adam R; Mitcheson, Luke; Gillatt, David A; Cottrell, Angela M

2012-12-01

Study Type--Symptom prevalence (prospective cohort) Level of Evidence 1b. What's known on the subject? and What does the study add? Case series have described lower urinary tract symptoms associated with ketamine use including severe pain, frequency, haematuria and dysuria. Little is known regarding the frequency of symptoms, relationship of symptoms with dose and frequency of use and natural history of symptoms once the ketamine user has stopped. This study describes the prevalence of ketamine use in a population of recreational drug users in a dance music setting. It shows a dose-frequency relationship with ketamine use. It shows that urinary symptoms associated with recreational ketamine use may lead to a considerable demand on health resources in the primary-, secondary- and emergency-care settings. It shows that symptoms may improve once ketamine use is decreased. • To investigate the prevalence and natural history of urinary symptoms in a cohort of recreational ketamine users. • A purposeful sampling technique was used. • Between November 2009 and January 2010 participants were invited to undertake an on-line questionnaire promoted by a national dance music magazine and website. • Data regarding demographics and illicit drug-use were collected. • Among respondents reporting recent ketamine use, additional information detailing their ketamine use, experience of urinary symptoms and use of related healthcare services was obtained. • In all, 3806 surveys were completed, of which 1285 (33.8%) participants reported ketamine use within the last year. • Of the ketamine users, 17% were found to be dependent on the drug; 26.6% (340) of recent ketamine users reported experiencing urinary symptoms. • Urinary symptoms were significantly related to both dose of ketamine used and frequency of ketamine use. • Of 251 users reporting their experience of symptoms over time in relationship to their use of ketamine, 51% reported improvement in urinary symptoms

Initiating NTD programs targeting schistosomiasis and soil-transmitted helminthiasis in two provinces of the Democratic Republic of the Congo: Establishment of baseline prevalence for mass drug administration.

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Kabore, Achille; Ibikounle, Moudachirou; Tougoue, Jean Jacques; Mupoyi, Sylvain; Ndombe, Martin; Shannon, Scott; Ottesen, Eric A; Mukunda, Faustin; Awaca, Naomi

2017-02-01

Schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) are widely distributed in the Democratic Republic of the Congo (DRC) and constitute a serious public health problem. As recommended by the World Health Organization (WHO), before launching mass chemotherapy to control these diseases, parasitological surveys were conducted in sentinel sites in six health zones (HZs) in Bandundu and Maniema provinces. Baseline prevalence and intensity of infection for SCH and STH were determined to establish the appropriate treatment plan using Praziquantel (PZQ) and Albendazole (ALB). Parasitological surveys were conducted from April to May 2015 in twenty-six selected sampling units (schools) for baseline mapping in six HZs: Fifty school children (25 females and 25 males) aged 9-15 years were randomly selected per sampling unit. A total of 1300 samples (urine and stool) were examined using haematuria dipsticks, parasite-egg filtration and the point-of-care Circulating Cathodic Antigen (POC-CCA) assay for urine samples and the Kato-Katz technique for stool specimens. Three species of schistosomes (S. mansoni, S. haematobium and S. intercalatum) and three groups of STH (hookworm, Ascaris and Trichuris) were detected at variable prevalence and intensity among the schools, the HZs and the provinces. In Bandundu, no SCH was detected by either Kato-Katz or the POC-CCA technique, despite a high prevalence of STH with 68% and 80% at Kiri and Pendjua HZs, respectively. In Maniema, intestinal schistosomiasis was detected by both Kato-Katz and POC-CCA with an average prevalence by Kato-Katz of 32.8% and by POC-CCA of 42.1%. Comparative studies confirmed the greater sensitivity (and operational feasibility) of the POC-CCA test on urine compared to Kato-Katz examination of stool for diagnosing intestinal schistosomiasis even in areas of comparatively light infections. STH was widely distributed and present in all HZs with a mean prevalence (95% CI) of 59.62% (46.00-65.00%). The

Assessment of cardiovascular risk and target organ damage among adult patients with primary hypertension in Thika Level 5 Hospital, Kenya: a criteria-based clinical audit.

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Mwita, Clifford Chacha; Akello, Walter; Sisenda, Gloria; Ogoti, Evans; Tivey, David; Munn, Zachary; Mbogo, David

2013-06-01

Appropriate management of hypertension reduces the risk of death from stroke and cardiac disease and includes routine assessment for target organ damage and estimation of cardiovascular risk. However, implementation of evidence-based hypertension management guidelines is unsatisfactory. We explore the use of audit and feedback as a quality improvement (QI) strategy for reducing the knowledge practice gap in hypertension care in a resource poor setting. The aim of this study is to determine the level of compliance to evidence-based guidelines on assessment of cardiovascular risk and target organ damage among patients with hypertension in Thika Level 5 Hospital in central Kenya and to implement best practice with regard to evidence utilisation among clinicians in the hospital. A retrospective clinical audit done in three phases spread over 5 months. Phase one involved identifying five audit criteria on assessment of cardiovascular risk and target organ damage in patients with hypertension and conducting a baseline audit in which compliance to audit criteria, blood pressure control and drug prescription practices were assessed. Phase two involved identifying barriers to compliance to audit criteria and strategies to overcoming these barriers. The third phase was a follow-up audit. There was no use of a cardiovascular risk assessment tool in both audits (0% vs. 0%; P = 1.00). Testing urine for haematuria and proteinuria reduced from 13% to 8% (P = 0.230) while taking a blood sample for measuring blood glucose, electrolytes and creatinine levels improved from 11% to 17% (P = 0.401). Performance of fundoscopy and electrocardiography remained unchanged at 2% and 8%, respectively (P = 0.886 and P = 0.898). High patient load was identified as the biggest barrier to implementation of best practice. Blood pressure control improved from 33% to 70% (P ≤ 0.001), whereas the proportion of patients on two or more recommended antihypertensive drugs rose

[Low grade renal trauma (Part II): diagnostic validity of ultrasonography].

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Grill, R; Báca, V; Otcenásek, M; Zátura, F

2010-04-01

hypoechogenic areas of varying sizes in the renal cortex. A negative ultrasonographic finding is no proof of the absence of renal trauma. As low-grade renal injury is difficult to detect by mere clinical examination or by a single imaging method, the authors regard as necessary to actively look for them, taking into consideration the mechanism of injury, haematuria findings and evaluation of ultrasonographic and CT scans.

Clinical manifestation and pathophysiology of Crimean-Congo hemorrhagic fever on human

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Siavash Hamzehpour

2017-10-01

Full Text Available The Crimean-Congo hemorrhagic fever is a febrile and acute viral disease, and it is sporadic and epidemic in human societies, although it is special for animals (1. The disease was first identified in the Crimean Peninsula in the years 1945-1944 and was called the Crimean Hemorrhagic Fever. In 1956, the epidemic of the disease in the Congo also occurred, and due to the similarity of the disease agent, the combination of names of these two regions was used for naming the disease (2. The cause of this disease is a single-stranded viraemia virus from the genus Neurovirus and the Bunyaviridae family (3. One of the ways to transmit the disease is tick bites, and the hyaloma ticks are the most important constituent of the Crimean-Congo fever vein and the reservoir. In addition to transmitting the disease to vertebrates, due to a vertical and horizontal transmission, they transmit it to the next generation (4. Also, human contact with meat, blood and contaminated secretions of livestock in a livestock eradication period causes the transmission of the disease (5. Human to human transmission, which is more often seen as a hospital infection, is also a means of transmitting the disease (6. The incubation period after a tick bite is 1 to 3 days and a maximum of 9 days, and is slightly longer after contact with contaminated blood or tissue about 5-6 days, and finally 14 days (7. In the early stages of the disease, symptoms are sudden which include severe headaches, fever, chills, muscle pain, especially the back and leg muscles, neck stiffness, dizziness, reddening of the eyes, fear of light, nausea, vomiting and diarrhea. Then, a severe generalized muscle pain appears, mostly at the back and hamstring, and the patient complains of back pain and epigastric pain (8. In the examination of patients, facial flushing and chest thigtness, hyperemia of throat mucusand petechialsare common symptoms which draw attention. Hemorrhagic phenomena include melena

Diagnostic and Therapeutic Yield of Endoscopy in Patients with Elevated INR and Gastrointestinal Bleeding.

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Peloquin, Joanna M; Seraj, Siamak M; King, Lindsay Y; Campbell, Emily J; Ananthakrishnan, Ashwin N; Richter, James M

2016-06-01

Gastrointestinal bleeding is a well-known risk of systemic anticoagulation. However, bleeding in the setting of supratherapeutic anticoagulation may have a milder natural history than unprovoked bleeding. It is a common clinical gestalt that endoscopy is common, but bleeding source identification or intervention is uncommon, yet few data exist to inform this clinical impression. Consequently, we sought to examine our institutional experience with gastrointestinal bleeding in the setting of supratherapeutic international normalized ratio (INR) with the aim of identifying predictors of endoscopically identifiable lesions, interventions, and outcomes. A retrospective review was conducted at a tertiary referral academic medical center to identify patients presenting with gastrointestinal bleeding in the setting of warfarin and a supratherapeutic INR (>3.5) who underwent an endoscopic procedure. Relevant clinical covariates, endoscopic findings, need for intervention, and outcomes were collected by review of the medical record. Logistic regression adjusting for potential confounders identified predictors of endoscopically significant lesions as well as intervention and outcomes. A total of 134 patients with INR 3.5 or greater (mean 5.5, range 3.5-17.1) presented with symptoms of gastrointestinal bleeding, most commonly as melena or symptomatic anemia. Antiplatelet agents were used by 54% of patients, and 60% of patients were on concomitant acid suppression on admission. Procedures included esophagogastroduodenoscopy (upper endoscopy; EGD) (n = 128), colonoscopy (n = 73), and video capsule endoscopy (n = 32). Active bleeding at first EGD or colonoscopy was found in only 19 patients (18%), with endoscopic intervention in only 26 patients (25%). At a critical threshold of INR 7.5 at presentation, the likelihood of finding an endoscopically significant lesion fell to therapy (odds ratio [OR] 2.59; 95% confidence interval [CI], 1.13-5.94), timing of EGD within 12 hours of

THROMBOCYTOPENIA AT A TERTIARY CARE CENTRE

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Ravindra Kumar Sudarsi

2016-07-01

Full Text Available BACKGROUND AND OBJECTIVES The aetiologies of thrombocytopenia are diverse. Various studies on thrombocytopenia done in the past have related to specific aetiologies. This study attempts to determine the common aetiologies of thrombocytopenia and bleeding manifestations in adult patients admitted under Department of Medicine. METHODS Patients older than 18 years of age who were first time found to have thrombocytopenia at admission under Department of Medicine between 1st October 2014 and 31st September 2015 were followed up during their stay in hospital and the diagnosis made, bleeding manifestations, and requirement of platelet transfusions were recorded. RESULTS 200 patients were included in the study. Dengue/dengue-like fever was the diagnosis made in 30% of patients followed by malaria (22%, undiagnosed aetiology (9%, HELLP (6%, snake bite and sepsis 5% each, ITP and megaloblastic anaemia 4.5% each, haematological malignancies and CTD 3% each, and other rare causes formed the rest. Bleeding secondary to thrombocytopenia was seen in 36 patients. 22.2% of them were diagnosed as dengue, 19.4% had malaria, 16.7% had ITP, 11.1% of patients with HELLP, 8.3% each had malignancy and undiagnosed viral infections, 5.6% each had CTD and MDS, and 2.8% had aplastic anaemia. Dengue fever was responsible for thrombocytopenia-related bleeding in 8 cases, ITP in 6 cases, malaria in 7 cases, HELLP in 4 cases, malignancy and undiagnosed aetiology 3 cases each, CTD and MDS 2 cases each, and aplastic anaemia in 1 case. The common bleeding manifestations were GIT (Melena, petechial rash, and menorrhagia occurring in 33.3%, 22.2% and 13.8% of total number of patients respectively. 30.5% of those who had bleeding secondary to thrombocytopenia had platelet count <5000/μL. 68.7% of those with platelet count <5000/μL had bleeding manifestation. 36.6% of those who had bleeding secondary to thrombocytopenia had platelet count 5,000-10,000/μL. 65.0% of those with

Combined external beam therapy (EBT) and brachytherapy in the treatment of localized prostate carcinoma : The 1979-1993 Centre Francois Baclesse experience

International Nuclear Information System (INIS)

Brune, D.; Coueette, J-E.; Lesaunier, F.; Benabib, D.; Mace-Lesec'h, J.; Henry-Amar, M.

1996-01-01

Purpose: To improve efficacy and minimize rectal, vesical and urethral morbidity. Patients and Methods: Three 192 Ir brachytherapy (BT) techniques were developed: transurethral BT and interstitial BT with low dose rate (TBT-LDR and IBT-LDR), and IBT with high DR (IBT-HDR). EBT delivered 43.2 Gy in 18 fr/32 d in pelvic volume. BT-LDR delivered 15 Gy with mean urethral dose 80-90 Gy and maximal rectal dose 50-60 Gy to rectum. BT-HDR delivered 9.4 Gy in 2 fractions over a 2-3 days period, with urethral dose 18 Gy and rectal dose 9.4 Gy. 161 pts were treated with TBT-LDR, 185 with IBT-LDR and 40 with IBT-HDR. Mean age was 69 yrs; 90% were T2-T3; 76% had Gleason grade 10 ng/ml (IEA). Results: IBT induced better event-free survival (EFS) than TBT, with no difference between IBT-LDR and IBT-HDR. While IBT and TBT were equivalent in T1 (5-yr EFS 88% vs 83%) pts, IBT was superior to TBT in T2 (64% vs 51%) and T3 (43% vs 31%) pts. In IBT, very localized tumour (T1 a T1 b T2 a , n=51) pts had better 5-yr EFS, local recurrence-free survival and distant recurrence-free survival than pts with more advanced tumour (T2 b T3T4, n=141), 77%, 92% and 85% vs 41%, 78% and 61%, respectively. EFS highly correlated with initial PSA (p<0.001). PSA returned to normal value within 7 mo (maxi 2 yrs) in 78% of pts with very localized tumour vs 44% in other pts; EFS also highly correlated with normalization of PSA (p<0.001). Rectal morbidity was very low in both techniques (4 grade 3 in IBT pts). Urinary morbidity was limited: 5-yr cumulative rate of grade 2 haematuria 3%, grade 2-3 dysuria 7%, grade 2-3 incontinence 28% (mostly after prostate resection, 44% vs 18%). Sexual function at diagnosis was documented in 129 pts in whom it was well preserved in 27%. Among the latter, the cumulative risk of impotency was 11% at 1 yr, 21% at 2 yrs and 35% at 3 yrs. Conclusions: In locally advanced prostate tumour, IBT appears to induce better results than TBT because the overall prostate volume is

A RETROSPECTIVE STUDY ON CLINICAL PRESENTATION OF STEROID SENSITIVE NEPHROTIC SYNDROME

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Sosamma M. M

2016-09-01

. Nine cases presented with respiratory tract infection. Thirty three cases presented with anorexia, one case presented with diarrhoea, ascites was present in twenty one cases and hypertension was present in eleven cases. Haematuria was seen in fourteen cases and gross proteinuria was seen in all the sixty cases. CONCLUSION The study successfully evaluates the gender frequency, age group affected and signs and symptoms that are commonly involved in steroid sensitive nephrotic syndrome. The present study draws the following conclusions;  Majority of the cases belonged to male sex.  Age group four years to eight years were affected in majority of the cases.  Almost all cases presented with gross proteinuria and oedema.

PREVALENCE OF BENIGN PROSTATIC HYPERPLASIA AND PROSTATE CANCER IN AFRICANS AND AFRICANS IN THE DIASPORA.

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Yeboah, E D

2016-01-01

There have been several publications on population or community prevalence of benign prostatic hyperplasia and prostate cancer from various countries and races but few reports are from Africa on Africans. A review on the prevalence of benign prostatic hyperplasia and prostate cancer in Africans and other races. The current literature on prevalence of benign prostatic hyperplasia (BPH), prostate cancer (PC), and benign prostatic hyperplasia co-existing with prostate cancer in Africans and other races is reviewed. Benign prostatic hyperplasia (BPH) prevalence in Ghana is responsible for 60% acute retention of urine and 28.6% of haematuria. Worldwide prevalence of BPH varies from 20 - 62% in men over 50 years and this includes USA, UK, Japan and Ghana. Reports from South Africa indicate prevalence of over 50% in adult males of 60 years. BPH co-existing with PC - Reports from USA, UK and Japan and Ghana reveal moderate association of BPH and PC. The co-existence of PC in patients being treated for BPH is 3 - 20% Prostate Cancer prevalence - There is high prevalence in USA, Scandinavian Countries, African Americans (AA) and Caribbean blacks. Ghana, Trinidad & Tobago have reported high prevalence of 6 -10% in men aged 50 years and above but others reported low prevalence in Africans from Africa. The low reporting from Africa of 10 - 40:100,000 is attributable to under reporting, absence of PSA screening/testing, lack of reliable cancer registries and poor medical facilities. Economic Costs of BPH and PC: BPH in the USA national direct costs are estimated at U$4Billion and individual costs of US$1536 annually. In Ghana, individual costs for BPH medications range from US$300 - 550 per year and cost for simple prostatectomy/TURP is estimated at US$1100. For prostate cancer, individual direct costs from Europe range from 6,575 - 12,000 euros, £2818.00 UK and over U$12,000 - 20,000 in USA per annum. In Ghana, individual direct costs ranges, for radical prostatectomy and

In vivo measurement of urethral dose profiles

International Nuclear Information System (INIS)

Toye, W.C.; Royal Melbourne Institute of Technology,; Duchesne, G.M.; Das, K.R.; Cee, A.; Mameghan, H.; Johnston, P.N.

2001-01-01

Full text: Quality assurance becomes a critical requirement when radiographs are routinely used in planning of treatments. In HDR prostate brachytherapy, the surrounding organs at risk of complications are the bladder and the rectum. However, of particular concern is the urethra that runs centrally through the prostate gland, as an unavoidably high dose can occur in the central region in order to achieve a minimum peripheral dose to a small target volume. Although high urethral doses have previously been related to increased urinary symptoms, some recent studies have not found such a correlation. The aim of this study was firstly, to identify dosimetric indicators of urethral morbidity following HDR prostate brachytherapy (4F x of 5.0 Gy), and secondly, to test the validity of calculated dose values. The in vivo measurements utilised a TLD (LiF:Mg,Ti) train formed by loading eight TLD rods alternating with 1,0 cm brass spacers into a fine plastic flexible tube. The length and diameter of plastic tubing was approximately 45cm and 0.15cm respectively, while the train length was 11.8 cm from the tip of the tube. The TLD train was placed into the central lumen of an 18 F three-way urethral catheter prior to its insertion. Significant urinary morbidity was defined prospectively as a score of a total of 3 or more points for severity from 5 symptoms categories. The five symptoms evaluated were hesitancy, frequency/nocturia, dysuria, haematuria and incontinence. The introduction of in vivo measurements to enhance the existing dosimetric analysis may be required to fully test the quantitative relationships (e.g. dose-volume ratios). Placement of TLDs within the urethra results in measurements whose accuracy is unaffected by internal organ motion as the hollow urethra must move with the prostate. The dose recorded by the TLDs is determined independently of the predictive algorithm used by the treatment planning system, and prostate location errors (e.g. due to image

Gastrointestinal Stromal Tumors (GIST) of the Stomach: Retrospective Experience with Surgical Resection at the National Cancer Institute

International Nuclear Information System (INIS)

NAGUIB, Sh.F.; ZAGHLOUL, A.S.; El MARAKBY, H.

2008-01-01

Gastric Gist's account for more than half of all gastrointestinal stromal tumors and represent less than 5% of all gastric tumors. The peak age for harboring Gist of the stomach is around 60 years and a slight male preponderance is reported. These tumors are identified by expression of CD117 or CD34 antigen. Symptoms at presentation usually include bleeding, ab¬dominal pain or abdominal mass. Endoscopically, they typically appear as a submucosal mass with or without ulceration and on CT scans an extra gastric mass is usually seen. Complete surgical resection provides the only chance for cure, with only l-2 cm free margins needed. However, local recurrence and/or metastases supervene in almost half the patients treated with surgery alone, even when no gross residual is left. Thereby imatinib mesylate was advocated as an adjuvant to surgery, which appears to have improved disease-free and overall survival. Aim of the Work: The aim of this work was to assess clinico-pathological features of gastrointestinal stromal tumors (GIST) of the stomach and to appraise the results of treatment by surgery in patients treated at the National Cancer Institute (NCI) of Cairo between January 2002 and December 2007. Patients and Methods: Nineteen patients with histologically and immuno-histochemically proven GIST of the stomach were treated by surgery at the NCI during the 6-year study period. Preoperative assessment included detailed history, clinical examination, full laboratory tests, endoscopy, abdominal ultrasound and CT. General medical assessment included chest X-ray, ECG and echocardiography. Results: The patients' age ranged from 26 to 77 years with a median of 51 years. Obvious male/female preponderance was noticed (68.4% to 31.6%). Tumors were located at the upper 1/3 in 42.1%, at the middle 1/3 in 31.6% and at the lower 1/3 in 26.3%. The most common clinical presentation was related to bleeding (hematemesis, melena or anaemia) and was seen in 63.2%. No tumors were

[Gastric Cancer in Early Stage: study of 371 lesions in 340 patients in the E. Rebagliati National, Lima-Peru].

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Espejo Romero, Hernán; Navarrete Siancas, Jesús

2005-01-01

lesions in 54.6% in other types of cancer 12.7%. Present in 65%, of which 50% of them were uncompleted. Dyspepsia 82.2%, hyperoxia 32.9%, loss of weight 23.3%, non-characteristic pain 23.3%, ulcer pain 20.5%, melena 8.2%, anemia 7.7%, diarrhea and/or constipation 7.4%, vomiting 2.2%, hematemesis 1.9%. O (63.2%) A (24.7%) B (11.3%) AB (0.6%). This was determined in 70 patients: In 55 with ulcer, none showed achlorhydria 0%, 20 (36%) hypochlorhydria, 20 (36%) normochlorhydria and 15 (28%) hyperacidity. In 16 in an elevated form 13 (87.5%) with achlorhydria, 1 (6.5%) with hypochlorhydria, 1 (6.5%) with normal acidity. Average in ulcerated cases DAB 3.04 +/- 1.25 mEqh and DAM 12.31 +/- 8.00. In elevated cases: DAB 0.89 +/- 0.32 and DAM 2.20 +/- 0.95 mEqh.

[Virtual CT-pneumocystoscopy: indications, advantages and limitations. Our experience].

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Regine, Giovanni; Atzori, Maurizio; Buffa, Vitaliano; Miele, Vittorio; Ialongo, Pasquale; Adami, Loredana

2003-09-01

The use of CT volume-rendering techniques allows the evaluation of visceral organs without the need for endoscopy. Conventional endoscopic evaluation of the bladder is limited by the invasiveness of the technique and the difficulty exploring the entire bladder. Virtual evaluation of the bladder by three-dimensional CT reconstruction offers potential advantages and can be used in place of endoscopy. This study investigates the sensitivity of virtual CT in assessing lesion of the bladder wall to compare it with that of conventional endoscopy, and outlines the indications, advantages and disadvantages of virtual CT-pneumocystography. Between September 2001 and May 2002, 21 patients with haematuria and positive cystoscopic findings were studied. After an initial assessment by ultrasound, the patients underwent pelvic CT as a single volumetric scan after preliminary air distension of the bladder by means of 12 F Foley catheter. The images were processed on an independent workstation (Advantage 3.0 GE) running dedicated software for endoluminal navigation. The lesions detected by endoscopy were classified as sessile or pedunculated, and according to size (more or less than 5 mm). Finally, the results obtained at virtual cystoscopy were evaluated by two radiologists blinded to the conventional cystoscopy results. Thirty lesions (24 pedunculated, 6 sessile) were detected at conventional cystoscopy in 16 patients (multiple polyposis in 3 cases). Virtual cystoscopy identified 23 lesions (19 pedunculated and 4 sessile). The undetected lesions were pedunculated <5 mm (5 cases) and sessile (2 cases). One correctly identified pedunculated lesion was associated with a bladder stone. Good quality virtual images were obtained in all of the patients. In only one patient with multiple polyposis the quality of the virtual endoscopic evaluation was limited by the patient's intolerance to bladder distension, although identification of the lesions was not compromised. The overall

The perception, beliefs and practices toward genitourinary schistosomiasis by inhabitants of selected endemic areas (Edo/Delta States in south-eastern Nigeria Percepção, crenças e práticas sobre a esquistossomose genito-urinária de habitantes de áreas endêmicas selecionadas (Edo/Estados Delta no sudeste da Nigéria

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Nnamdi Callistus D. Ukwandu

2004-08-01

Full Text Available Well-structured questionnaire on the perception, impression and response to genitourinary bilharziasis (Genitourinary schistosomiasis was administered and explained in local languages: 'Igbo' 'Esan' 'Ezon' Itshekiri and Bini to 33815 inhabitants of selected endemic areas in south-eastern Nigeria from January, 1999 to December, 2001. Out of this number, 3815 (11.3% were properly filled and returned. About 42.0% of the inhabitants admitted knowledge of the disease, while 14 (0.4% knew about the aetiologic agent. About 181 (5.0% who responded, admitted procuring treatment, while 100 (5.0% declined to seek treatment of any sort. The relationships between water-bodies and human activities, and infection were well discussed. Amongst those who admitted knowledge of the disease but no knowledge of its etiologic agent, declined seeking treatment of any kind, but believe the disease is a natural phenomenon in ones developmental stage and therefore of no morbidity and mortality. Laboratory analysis of urine, faeces, semen and HVS was employed to assess questionnaire responses, and in some cases, physical examination was utilized to augment laboratory analysis in confirming urinal diagnosis. Haematuria was only directly related to egg count in the early part of life. Females were significantly haematuric and excreted more ova than males (p Um questionário bem estruturado sobre a percepção e práticas e crenças sobre a esquistossomose genito-urinária foi administrado e explicado em dialetos locais: "Igbo" "Esan" "Ezon" Itshekiri e Bini a 33815 habitantes de áreas endêmicas selecionadas no sudeste da Nigéria, de janeiro de 1999 a dezembro de 2001. Deste total, 3815 (11,3% foram preenchidos adequadamente e devolvidos. Cerca de 42,0% dos habitantes admitiram conhecer a doença, enquanto 14 (0,4% conheciam o agente etiológico. Cerca de 181 (5,0% dos que responderam admitiram ter procurado tratamento, enquanto 100 (5,0% não procuraram tratamento de

Histopathological aspects of Bovine Enzootic Hematuria in Brazil Aspectos histopatológicos da Hematúria Enzoótica Bovina no Brasil

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Paulo Vargas Peixoto

2003-06-01

Full Text Available The bladder lesions of 59 cattle, from the States of Rio de Janeiro, São Paulo, Minas Gerais, Espírito Santo, Rio Grande do Sul, Santa Catarina, Paraná and Amazon, affected by Bovine Enzootic Haematuria (BEH, were studied histologically. The objective of this study was to describe and reclassify neoplastic and non-neoplastic alterations not yet reported, according to the more complete current nomenclature used in human medicine. There was an almost complete identity with alterations observed in the bladder of man. Due to the occurrence of two or more neoplasms in the same animal, differences in the methodology and in the concept of classification, a more precise comparison was not possible. Coexistence of different types of epithelial and/or mesenchymal tumour growth was frequently seen. Rare neoplasms or differentiations not previously described were found in the bladder of some animals affected by BEH. These were trabecular carcinoma with Paneth cells differentiation, mesonephroid adenoma, mesonephroid adenocarcinoma, "signet ring" cell carcinoma, plasmocytoid carcinoma, chromophobe cell carcinoma and nested type of transitional cell carcinoma. Haemangiosarcomas originating from haemangiomas were also observed. This study also revealed the occurrence of many tumors with anaplasia and pronounced infiltrative features, but which did not metastasize. The elucidation of the cause of this "barrier against metastases" and its relationship with chemical carcinogenesis induced by the ptaquiloside, the active principle of bracken fern (Pteridium aquilinum, could be of interest to future research on the control ofneoplasia in man and animals.Com o objetivo de descrever alterações neoplásicas e não-neoplásicas ainda não relatadas e, paralelamente, reclassificá-las de acordo com nomenclatura mais completa e atual utilizada em medicina humana, foram estudadas, histologicamente, lesões da bexiga de 59 bovinos com Hematúria Enzoótica (HEB

Squamous metaplasia as a manifestation of urogenital schistosomiasis and its complications

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A. Yu. Kolmakov

2016-01-01

Full Text Available Background. Leukoplakia or squamous metaplasia (SM of the bladder detect with the endoscopic diagnostic with urothelial biopsy. The reason for the development of SM, besides irritation of a mucous membrane by chemical reagents or drugs, is prolonged exposure of schistosome eggs (Schistosoma haematobium, penetrating into the bladder during invasion. The most common cause of urothelial SM is urogenital schistosomiasis (US and one of the most known and dangerous its complications is schistosomiasis bladder cancer (sBC. Features of cellular mechanisms linking the schistosomes invasion with the development of sBC are not well studied. Urothelial SM use to indicate by the presence of cancerous transformation, or may be a marker of long-term inflammation. The flow of squamous cell carcinoma of the bladder usually is accompanied by a keratinizing SM. Taking into account the socio-political conditions of the modern world and the development of tourism, the relevance of the diagnosis and treatment of patients with those diseases continues to grow. Materials and methods. The results of observation the group of 181 residents of the Republic of Angola with gross haematuria analyzed from 2009 till 2010. US verified in all cases. We conducted urine tests for detection of schistosomes, cytological examination of urine sediment (CEUS, ultrasound and endoscopic diagnostic methods, biopsy of the urothelium. The database of the hospitals used in the statistical analysis.Results. In 142 (78.5 % cases uncomplicated US confirmed, at 39 (21.5 % patients sBC revealed. Schistosomes invasion and trichomonas were combined in 21 (14.8 % cases. Changes and thickness of the bladder wall by ultrasound were accompanied with the SM in 26.8 % cases. The combination of SM and hydronephrosis caused by ureteral stenosis due to US were founded in 2 (1.4 % cases. The coincidence cases of PM with ultrasound picture, featuring for manifestations US did not exceed 14

Value of Glasgow-Blatchford score in predicting early prognosis of cirrhotic patients with esophagogastric variceal bleeding

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CUI Shu

2017-10-01

Full Text Available ObjectiveTo investigate the value of Glasgow-Blatchford score (GBS, Child-Turcotte-Pugh (CTP score, and Model for End-Stage Liver Disease (MELD score in predicting the 1- and 6-week prognosis of cirrhotic patients with esophagogastric variceal bleeding via a comparative analysis. MethodsA retrospective analysis was performed for the clinical data of 202 cirrhotic patients with esophagogastric variceal bleeding who were hospitalized in Tianjin Third Central Hospital from January 1 to December 31, 2014. According to the endpoint of death at 6 weeks after admission, the patients were divided into 1-week death group (10 patients, 6-week death group (23 patients, and survival group (179 patients. The Glasgow-Blatchford score, MELD score, CTP score, and CTP score and classification were calculated on admission, and these scores were compared between the three groups. The two-independent-samples t test was used for comparison of normally distributed continuous data between groups, and the non-parametric Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The chi-square test or the Fisher′s exact test was used for comparison of categorical data between groups. The Z test was used for comparison of the area under the receiver operating characteristic curve (AUC of these three scoring systems. ResultsThere were significant differences between the 1-week death group and the survival group in the incidence rates of liver cancer with vascular invasion or metastasis (χ2=4.559, P=0.033, hepatic encephalopathy (χ2=25.568, P＜0.01, melena (χ2=0.842, P=0.04, and heart failure (P=0.003, pulse rate (Z=-2.943, P=0.003, CTP classification (χ2=12.22, P=0.002, CTP score (Z=-2.505, P=0.012, MELD score (t=-2.395, P=0.018, and GBS score (Z=-2545, P=0.011. There were significant differences between the 6-week death group and the survival group in the incidence rates of liver cancer (χ2=9.374, P=0.002, liver

Margem de segurança do meloxicam em cães: efeitos deletérios nas células sangüíneas e trato gastrintestinal Margin of safety of meloxicam in dogs: deleterious effects on blood cells and gastrointestinal tract

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Marilac Maria Arnaldo Alencar

2003-06-01

accomplished. In group I there were no significative alterations. In group II, all the dogs showed moderate episodes of vomit and diarrhea. The blood-cell profile was not modified. Two dogs had hematocrit and hemoglobin reduction. In the necropsy, hemorrhagic spots and moderate gastroduodenal lesions were seen. The microscopic analysis revealed the presence of gastritis and ulcerative enteritis. In group III, four dogs (80% showed vomit and diarrhea, without alteration in blood-cell profile. The microscopic analysis showed mild lesions in the gastric mucosa and hemorrhagic spots in the duodenum of four dogs. Histology showed lesions suggesting mild gastroenteritis. In group IV, all the dogs (n=5 showed vomit and blood diarrhea. Four of them showed anemia (p <0.05. Four and five dogs, respectively, had hematocrit and hemoglobin reduction. In addition, there was a significant (p<0.05 leukocytosis, neutrophilia and linfopenia in 60% of the dogs. The necropsy showed hiperemia, hemorrhage and severe gastric ulcers in all the dogs. In the microscopic analyses, gastroenteritis ulcerative was present in all the animals. In group V, the dogs (n=5 had serious vomit, diarrhea and melena episodes. The dogs that bore the treatment (n=4 had anemia and leukocytosis with neutrophilia and linfopenia significatives (p<0.05. All the dogs had hematocrit and hemoglobin reduction. In the necropsy, hemorrhages and severe gastroduodenal ulceration were seen. The microscopic analysis showed severe gastroenteritis. It can be concluded that, although meloxicam is a COX-2 selective inhibitor, it induces deleterious effects on gastrointestinal tract and blood cells of dogs, when given five or ten times the therapeutic dose, which demonstrate its low margin of safety in this animal specie.

Gastric lymphoma of mucosa associated lymphoid tissue (MALT) type: longterm treatment results

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Fung, Claire Y; Kachnic, Lisa A; Daly, William; Younger, Jerry; Harris, Nancy L; Graeme-Cook, Fiona

1995-07-01

Objective: In recent years, a large proportion of non-Hodgkin's lymphomas of the stomach are recognized as low grade tumors of the mucosa associated lymphoid tissue (MALT) type. Since the MALT morphological subtype has only gained acceptance as a malignant lymphoma after the establishment of the Working Formulation, there is limited information about its natural history, disease pattern, and longterm treatment outcome. This study is an analysis of these parameters in patients with primary MALT lymphoma of the stomach. Materials and Methods: Consecutive patients with primary gastric MALT lymphoma who received definitive treatment at the Massachusetts General Hospital between (4(78)) and (2(95)) were included in the study. The diagnosis was pathologically verified in all cases. Clinical staging studies included chest X-ray +/- chest CT, abdomino-pelvic CT or bipedal lymphangiogram, barium swallow, and bone marrow biopsy. Treatment strategies included combinations of partial or total gastrectomy, radiation (RT) and chemotherapy (chemo). RT was given via multifield technique, with 10-25MV photons, to doses of 36-50.4 Gy (1.1-1.8 Gy per fraction, 5 days a week). Survival analyses were performed by the Kaplan-Meier actuarial method. Results: There were twenty-two patients between the ages of 45 - 93 years, with a mean follow-up of 67 months. Ten were male and 12 female. The most frequent presenting symptoms were epigastric pain (77%), dyspepsia (65%), and melena (41%). The mean duration of symptoms was 27 months. Eighteen cases were clinical stage (cs)I, two csII, one csIII, and one csIV. The treatment approaches were: 1) csI:6 gastrectomy alone, 7 gastrectomy and RT, 1 gastrectomy and chemo, 2 RT alone, 1 chemo and RT, 1 no therapy; 2) csII: 2 gastrectomy and RT; 3) csIII: 1 gastrectomy and chemo; 4) csIV: 1 chemo and RT. Among 16 gastrectomy specimens, multifocal gastric involvement was evident in 50%. The most frequently involved sites were the body (63%) and antrum

Transurethral radiofrequency collagen denaturation for the treatment of women with urinary incontinence.

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Kang, Diana; Han, Julia; Neuberger, Molly M; Moy, M Louis; Wallace, Sheila A; Alonso-Coello, Pablo; Dahm, Philipp

2015-03-18

evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We included in the analysis one small sham-controlled randomised trial of 173 women performed in the United States. Participants enrolled in this study had been diagnosed with stress UI and were randomly assigned to transurethral radiofrequency collagen denaturation (treatment) or a sham surgery using a non-functioning catheter (no treatment). Mean age of participants in the 12-month multi-centre trial was 50 years (range 22 to 76 years).Of three patient-important primary outcomes selected for this systematic review, the number of women reporting UI symptoms after intervention was not reported. No serious adverse events were reported for the transurethral radiofrequency collagen denaturation arm or the sham treatment arm during the 12-month trial. Owing to high risk of bias and imprecision, we downgraded the quality of evidence for this outcome to low. The effect of transurethral radiofrequency collagen denaturation on the number of women with an incontinence quality of life (I-QOL) score improvement ≥ 10 points at 12 months was as follows: RR 1.11, 95% CI 0.77 to 1.62; participants = 142, but the confidence interval was wide. For this outcome, the quality of evidence was also low as the result of high risk of bias and imprecision.We found no evidence on the number of women undergoing repeat continence surgery. The risk of other adverse events (pain/dysuria (RR 5.73, 95% CI 0.75 to 43.70; participants = 173); new detrusor overactivity (RR 1.36, 95% CI 0.63 to 2.93; participants = 173); and urinary tract infection (RR 0.95, 95% CI 0.24 to 3.86; participants = 173) could not be established reliably as the trial was small. Evidence was insufficient for assessment of whether use of transurethral radiofrequency collagen denaturation was associated with an increased rate of urinary retention, haematuria and hesitancy compared with sham treatment in 173 participants. The GRADE