Sample records for solitary proximal ureteral

  1. Large proximal ureteral stones: Ideal treatment modality?

    B Kadyan


    Conclusion: Laparoscopic transperitoneal ureterolithotomy is a minimally invasive, safe and effective treatment modality and should be recommended to all patients of impacted large proximal stones, which are not amenable to URS or extracorporeal shock-wave lithotripsy or as a primary modality of choice especially if patient is otherwise candidate for open surgery.

  2. Differences in Ureteroscopic Stone Treatment and Outcomes for Distal, Mid-, Proximal, or Multiple Ureteral Locations

    Perez Castro, Enrique; Osther, Palle J S; Jinga, Viorel


    Ureteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones.......Ureteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones....

  3. An unusual case: right proximal ureteral compression by the ovarian vein and distal ureteral compression by the external iliac vein

    Halil Ibrahim Serin


    Full Text Available A 32-years old woman presented to the emergency room of Bozok University Research Hospital with right renal colic. Multidetector computed tomography (MDCT showed compression of the proximal ureter by the right ovarian vein and compression of the right distal ureter by the right external iliac vein. To the best of our knowledge, right proximal ureteral compression by the ovarian vein together with distal ureteral compression by the external iliac vein have not been reported in the literature. Ovarian vein and external iliac vein compression should be considered in patients presenting to the emergency room with renal colic or low back pain and a dilated collecting system.

  4. Encrustation of the Ureteral Double J Stent in Patients with a Solitary Functional Kidney – a Case Report

    Milicevic, Snjezana; Bijelic, Radojka; Jakovljevic, Branislava


    Introduction: The efficacy of ureteric stents in the management of various urological conditions causing the upper urinary tract obstruction has been extensively proven, and their contribution to urology remains enormous. The clinical use of ureteric stents is associated with several complications. “Stent syndrome,” encrustation, migration and urothelial hyperplasia are the most common problems related to long-term ureteral stenting. Case report: This work presents an interesting case from our practice: a complete encrustation of a classical polyurethane double J stent two and a half months after its initial instillation, in a 70 year old man, with a solitary functioning kidney, as well as successful removal of it by using a simultaneous treatment of extracorporeal lithotripsy and ureteroscopy with a contact disintegration of encrustations and with percutaneous nephrostomy, as an auxiliary procedure for providing of additional urine derivation. Conclusion: These problems can be overcome by the introduction of new advanced ureteral stent designs and biomaterials. PMID:26543316

  5. [Acute renal failure due to obstructive ureteral stone associated with norovirus gastroenteritis in an infant with congenital solitary kidney].

    Kato, Taiki; Hamano, Atsushi; Kawamura, Hideki


    We report a 35 month-old boy with acute renal failure caused by an obstructive ureteral stone associated with norovirus gastroenteritis. He visited his family physician because of fever, abdominal pain and vomiting. He was diagnosed as acute gastroenteritis. The symptoms relieved once, but abdominal pain and vomiting recurred two days after the visit and the volume of urine decreased. He was diagnosed as norovirus gastoenteritis and acute renal failure which was unresponsive to fluid replacement. Ultrasound study of the abdomen showed a solitary kidney with mild hydronephrosis. He was then admitted to our hospital. He was finally diagnosed as acute postrenal failure due to obstructive ureteral stone with left solitary kidney by abdominal computer tomography (CT). We performed transurethral catheterization immediately. The creatinine and blood urea nitrogen returned to normal level in 2 days. The CT performed on the 28th day post operation showed disappearance of the stone after uric alkalization. Recently, some cases of postrenal failure due to bilateral obstructive ureteral stones, mainly ammonium acid urate stones, associated with viral gastroenteritis were reported. As clinical features, they are common in boys three years or younger after an episode of rotavirus gastroenteritis with high uric acid concentration. By far, the most common cause of acute renal failure in patients with severe gastroenteritis is prerenal failure resulting from hypovolemia. But postrenal cause due to bilateral obstructive stones should be taken in a consideration.

  6. Retrograde versus Antegrade Approach for the Management of Large Proximal Ureteral Stones

    Mykoniatis, Ioannis; Isid, Ayman; Gofrit, Ofer N.; Rosenberg, Shilo; Hidas, Guy; Landau, Ezekiel H.; Pode, Dov; Duvdevani, Mordechai


    Objective. To evaluate and compare the efficacy and safety of retrograde versus antegrade ureteroscopic lithotripsy for the treatment of large proximal ureteral stones. Patients and Methods. We retrospectively analyzed the medical records of patients with proximal ureteral stones >15 mm, treated in our institution from January 2011 to January 2016. Intraoperative parameters, postoperative outcomes, and complications were recorded and compared between the two techniques. Results. Our analysis included 57 patients. Thirty-four patients (59.6%) underwent retrograde and 23 patients (40.4%) underwent antegrade ureteroscopy. There was no significant difference in patients' demographics and stone characteristics between the groups. Stone-free rate was significantly higher (p = 0.033) in the antegrade group (100%) compared to retrograde one (82.4%). Fluoroscopy time, procedure duration, and length of hospitalization were significantly (p < 0.001) lower in retrograde approach. On the other hand, the need for postoperative stenting was significantly lower in the antegrade group (p < 0.001). No difference was found between the groups (p = 0.745) regarding postoperative complications. Conclusions. Antegrade ureteroscopy is an efficient and safe option for the management of large proximal ureteral stones. It may achieve high stone-free rates compared to retrograde ureteroscopy with the drawback of longer operative time, fluoroscopy time, and length of hospitalization. PMID:27766263

  7. Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis

    Hu, Henglong; Lu, Yuchao; Zhang, Jiaqiao; Qin, Baolong; Wang, Yufeng; Zhang, Zongbiao


    Object To compare the safety and efficacy of rigid ureteroscopic lithotripsy (rigid URSL) and percutaneous nephrolithotomy (PCNL) in treating large proximal ureteral stones. Methods A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science databases was performed to find out relevant studies. After literature screening according to the predetermined inclusion and exclusion criteria, data of eligible studies was extracted and then a meta-analysis was conducted via RevMan 5.3 software. Results Five randomized controlled trials (RCTs), one prospective and four retrospective cohort studies involving 837 patients were included. Patients underwent rigid URSL were associated with shorter operation time (WMD, -23.66min; 95%CI, −45.00 to -2.32; p = 0.03), shorter hospital stay (WMD, -2.76d; 95%CI, −3.51 to −2.02; phematuria (RR, 0.38; 95%CI, 0.25 to 0.57; p < 0.0001). No significant difference was observed in terms of incidence of embolization, pain and ureterostenosis. When cohort studies or studies in which flexible ureteroscopy was used as an intraoperative auxiliary procedure were excluded, we both found that most of the results kept stable. Conclusions Both PCNL and rigid URSL are safe for patients with large proximal ureteral stones while PCNL is more effective in stone clearance. PMID:28182718

  8. Flexible Ureteroscopy versus Retroperitoneal Laparoscopic Ureterolithotomy for the Treatment of Proximal Ureteral Stones >15 mm: A Single Surgeon Experience.

    Tugcu, Volkan; Resorlu, Berkan; Sahin, Selcuk; Atar, Arda; Kocakaya, Ramazan; Eksi, Mithat; Tasci, Ali Ihsan


    To compare safety and effectiveness of flexible ureteroscopy (F-URS) and laparoscopic retroperitoneal ureterolithotomy (L-RU) in treatment of proximal ureteral stones larger than 15 mm. This study included 103 patients treated with L-RU (Group I), and 80 patients treated with F-URS (Group II) due to proximal ureteral stones larger than 1.5 cm, in a single center. Patients' characteristics and procedure-related parameters including success rate, operation time, hospital stay, postoperative visual analogue scale (VAS) scores, auxiliary procedures, and complications were compared between Groups I and II. It was seen that both methods were effective in the treatment of large ureteral stones; however, R-LU provided a higher stone-free rate (100 vs. 87.5%), a lower complication rate (10.6 vs. 23.7%), and a shorter operation time (65.4 vs. 75.1 min). On the other hand, patients treated with F-URS had less postoperative pain, a shorter hospital stay, a faster return to daily activities. For treatment of large proximal ureteral stones, L-RU provides significantly higher success and lower retreatment rate compared with F-URS. Our results also indicate that R-LU, which has been regarded as an invasive procedure is not as invasive as it is thought to be, and it must be kept in mind that F-URS may cause complications despite its noninvasive nature. © 2015 S. Karger AG, Basel.

  9. Total ureterectomy and ileal ureteric replacement for TCC ureter in a solitary kidney.

    Banerji, John S; George, Arun J P


    Traditional treatment of upper tract transitional cell carcinoma (TCC) is nephroureterectomy with a bladder cuff. This is in keeping with the nature of the disease, in that TCC is a panurothelial disease. However, there are a few rare occasions when this would mean making a subject anephric, as in a TCC in a solitary kidney or bilateral synchronous/metachronous disease. We present a case of a patient with a dysplastic, poorly functioning left kidney and with a TCC of the ureter on the right side.

  10. Ultrasonography-guided PNL in comparison with laparoscopic ureterolithotomy in the management of large proximal ureteral stone

    Hossein Karami


    Full Text Available Purpose: The aim of study was to evaluate the clinical outcomes of PNL in comparison with laparoscopic ureterolithotomy (LUL in proximal ureteral stones larger than 1 cm. Materials and Methods: A total of 80 patients who were candidates for treatment of large ureteral stones in our urology center were enrolled in the study between September 2004 and September 2008. By using patient randomization, they were assigned into two forty-patient groups (PNL and LUL. After evaluating the patients with laboratory tests and IVP, PNL was performed under sonography guidance in the prone position or the patients were submitted to classic laparoscopic ureterolithotomy (LUL transperitoneally. All patients underwent postoperative assessments including KUB and ultrasonography. Results: A hundred-percent success was achieved in both groups. The mean age of the patients were 39.4 (16-63 and 35.2 (18-57 years old in PNL and LUL groups, respectively. The mean stone size in PNL group was 14.2 (10-25 mm and in LUL group was 13.5 (10-28 mm. The duration of the operations were 54.35 (50-82 minutes, and 82.15 (73-180 minutes (P < 0.0001; and the average hospital stay days were 2.6 (2-5 and 3.5 (3-8 days (p = 0.011 in groups PNL and LUL, accordingly. The mean Hb decrease in PNL group was 0.9mg/dL and in LUL group was 0.4mg/dL (p = 0.001. No statistically significant differences in terms of blood transfusion, fever, ICU admission, and prolonged urinary leakage were detected in both groups. Conclusion: According to our study, percutaneous nephrolithotomy under ultrasonography guidance is comparable with the laparoscopic ureterolithotomy for the treatment of proximal ureteral stones larger than 1 cm.

  11. Bladder augmentation: Distal ureterocystoplasty with proximal ureteric reimplantation: A novel technique

    Ramesh Babu


    Full Text Available A novel technique of bladder augmentation is reported, wherein the distal dilated ends of tortuous ureters were used for ureterocystoplasty while proximal remaining ureters reimplanted back into the native bladder.

  12. Management of impacted proximal ureteral stone: Extracorporeal shock wave lithotripsy versus ureteroscopy with holmium: YAG laser lithotripsy

    Mostafa Khalil


    Conclusion: Both procedures can be used effectively and safely as a primary treatment for impacted stone in the proximal ureter; however, the URSL has a significantly higher initial stone-free rate and lower re-treatment rate.

  13. Low-cost semirigid ureteroscopy is effective for ureteral stones: Experience of a single high volume center

    Roberto Giulianelli


    Full Text Available Aim of the study: To demonstrate how, in a center with a large number of patients, as our center is, it is possible to perform ureterolithotripsy using a limited set of instruments. Methods: We evaluated medical charts of our center related to semirigid ureteral ureteroscopy (URS with ureterolithotripsy using Holmium laser performed from July 2004 to July 2011. Overall, 658 URS for ureteral stones were performed in 601 patients, of which 204 in proximal ureter (31%, 86 in the mid (13.06% and 368 (57.76% in the distal ureter. In 504 patients (76.5% ureterohydronephrosis (Grade II-III was observed. In 57 patients (8.6%, we performed a bilateral approach at the same time, but most patients had a solitary distal ureteral stone. 106 patients (16.1% had more than one stone in their distal ureter and 96 (14.8% had a proximal ureteral stone treated in the same surgery as well. Results: The overall stone-free rate for ureteral stones was 86.1% (567/658. Success rates for proximal, medial and distal ureteral stones were 68.13% (139/204 patients, 84.8% (73/86 patients and 96.4% (355/368 patients, respectively. One hundred and twenty patients (18.3% required additional surgical treatment for their stones beyond the initial URS, including a second URS in 97 patients (14.74% and URS plus Retrograde Intra-Renal Surgery (RIRS in 23 patients (3.54%. The overall stonefree rate after the second treatment was 99.3%. Intra-operative complications accounted for 5.92% and consisted of ureteral perforations in 16 pts (2.4%, erosions of urothelium leading to significant bleeding in 15 pts (2.27%, severe pain in 4 pts (0.6%, fever in 3 pts (0.45% and one case of ureteral avulsion (0.15%. Conclusions: This study demonstrates that the use of Holmium laser lithotripsy is a safe and effective means of treating ureteral stones regardless of sex, age, stone location, or stone size. The instrumentation we used was extremely limited, in order to reduce costs related to the

  14. Minimally invasive percutaneous nephrolithotomy improves stone-free rates for impacted proximal ureteral stones: A systematic review and meta-analysis

    Gao, Zi-Ming; Gao, Shan; Qu, Hong-Chen; Li, Kai; Li, Ning; Liu, Chun-Lai; Zhu, Xing-Wang; Liu, Yi-Li; Wang, Ping; Zheng, Xiao-Hua


    Background Urinary stones are common medical disorders and the treatment of impacted proximal ureteral stones (IPUS) is still a challenge for urologists. The aim of this study was to compare the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MI-PCNL) and ureteroscopic lithotripsy (URL) in the treatment of IPUS via a meta-analysis. Methods We collected studies using PubMed, Embase, and Cochrane Library from 1978 to November 2016 and analyzed them using Stata 12.0 and RevMan 5.3. Odds ratios (ORs) and standard mean difference (SMD) were calculated for binary and continuous variables respectively, accompanied with 95% confidence intervals (CIs). All study procedures followed the PRISMA guidelines. Results Five prospective studies were included in our meta-analysis, with 242 MI-PCNL and 256 URL cases. MI-PCNL was associated with a longer postoperative hospital stay than URL (SMD, 3.14; 95% CI, 1.27 to 5.55). However, no significant difference was observed in operative time (SMD, -0.38; 95% CI, -3.15 to 2.38). In addition, MI-PCNL had higher initial (OR, 11.12; 95% CI, 5.56 to 22.24) and overall stone-free rates (OR, 8.70; 95% CI, 3.23 to 23.45) than URL, along with lower possibilities of surgical conversion (OR, 0.11; 95% CI, 0.03 to 0.49) and postoperative shock wave lithotripsy (OR, 0.06; 95% CI, 0.02 to 0.18). Regarding complications, no significant differences were observed between MI-PCNL and URL (OR, 1.39; 95% CI, 0.93 to 2.10), except for hematuria (OR, 4.80; 95% CI, 1.45 to 15.94). Conclusions MI-PCNL is optimal and should be considered as the preferred treatment method for IPUS, as it has better efficacy and a safety profile similar to that of URL. However, further high quality studies with larger sample size are required in future. PMID:28152097

  15. [Ureteral reimplantation].

    Aboutaieb, R; Rabii, R; Joual, A; el Mrini, M; Benjelloun, S


    Various techniques of ureteral reimplantation have been described for different indications. After a retrospective study concerning 109 cases and 178 ureteral reimplantations, the authors propose the selective indications for each technique noting the most important results. The indications for reimplantations are numerous and varied: enterocystoplasty (60 cases), iatrogenic lesion of the pelvic ureter (11 cases), inflammatory stenosis (13 cases), renal transplantation (20 cases), primary megaureter (4 cases), stenosis of reimplantation (2 cases). 5 techniques were used in this study: Leduc-Camey, Leadbetter-Politano, Direct, Manchette, Lich-Gregoir. We conclude that in ureterodigestive reimplantation, Leduc-Camey modified method is indicated. In renal transplantation, Lich-Gregoir is the ideal technique. In primary megaureter, the Leadbetter-Politano procedure possibly with ureter modelling improves the results. In iatrogenic lesions of the pelvic ureter, Leadbetter-Politano technique and possibly a hitch-bladder gives a good result.

  16. Laparoscopic ureteral reimplant for ureteral stricture

    Rodrigo S. Q. Soares


    Full Text Available PURPOSE: Evaluate the initial experience of laparoscopic ureteral reimplant for ureteral stenosis. MATERIALS AND METHODS: From January 2004 to June 2008, 10 patients underwent 11 laparoscopic reconstruction surgeries for ureteral stenosis. Seven cases of stenosis of the distal ureter, two at the level of iliac vessels, a case of bilateral distal stenosis and one in the medium third. Eight ureteroneocystotomies were performed by extravesical technique with anti-reflux mechanism, two cases of vesical reimplant with Boari technique and one case using the psoas hitch technique. RESULTS: The average surgical time was 166 minutes (115-245 min, mean blood loss was 162 mL (100-210 mL and the average hospital stay was 2.9 days (2-4 days. There were two complications: a lesion of the sigmoid colon identified peroperatively and treated with laparoscopic sutures with good evolution, and a case of ureteral stone obstruction at the 30th day postoperative, treated by laser ureterolitotripsy. All patients had resolution of the stenosis at an average follow-up period of 18 months (3-54 months. CONCLUSIONS: Laparoscopic surgery represents a feasible, safe and low morbidity technique for ureteral reimplant in ureteral stenosis.

  17. A review of ureteral injuries after external trauma


    Introduction Ureteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this article is to review the literature since 1961 with the primary objective to present the largest medical literature review, to date, regarding ureteral trauma. Several anatomic and physiologic considerations are paramount regarding ureteral injuries management. Literature review Eighty-one articles pertaining to traumatic ureteral injuries were reviewed. Data from these studies were compiled and analyzed. The majority of the study population was young males. The proximal ureter was the most frequently injured portion. Associated injuries were present in 90.4% of patients. Admission urinalysis demonstrated hematuria in only 44.4% patients. Intravenous ureterogram (IVU) failed to diagnose ureteral injuries either upon admission or in the operating room in 42.8% of cases. Ureteroureterostomy, with or without indwelling stent, was the surgical procedure of choice for both trauma surgeons and urologists (59%). Complications occurred in 36.2% of cases. The mortality rate was 17%. Conclusion The mechanism for ureteral injuries in adults is more commonly penetrating than blunt. The upper third of the ureter is more often injured than the middle and lower thirds. Associated injuries are frequently present. CT scan and retrograde pyelography accurately identify ureteral injuries when performed together. Ureteroureterostomy, with or without indwelling stent, is the surgical procedure of choice of both trauma surgeons and urologists alike. Delay in diagnosis is correlated with a poor prognosis. PMID:20128905

  18. Bilateral guaifenesin ureteral calculi.

    Whelan, Chris; Schwartz, Bradley F


    We report on a patient with bilateral ureteral calculi composed of guaifenesin metabolite as determined by infrared spectroscopy. These stones may be associated with excessive guaifenesin intake related to the current popularity of ephedrine preparations.

  19. Sonography in acute ureteric colic: an experience in Dhulikhel Hospital.

    Joshi, K S; Karki, S; Regmi, S; Joshi, H N; Adhikari, S P


    Computed tomography is considered as an imaging modality of choice in acute ureteric colic. However due to concerns regarding radiation exposure, sonograms are re-emerging as imaging methods in such situations. To evaluate the role of sonography in detection of calculus in acute ureteric colic. Total 384 patients were enrolled. Hydronephrosis was graded as mild, moderate or severe. Calculus was detected as an intraluminal echogenic focus with distal shadowing with twinkling artifact. Number, size and position of the calculi were assessed. Patients were categorized into four groups:I. ureteric colic only II. ureteric colic with hematuria III. ureteric colic with hydronephrosis and IV. ureteric colic with hematuria and hydronephrosis and then the possibility of detection of calculi has been compared among these groups. Out of 384 patients, 254 were found to have calculi ranging between 2.7-27 mm. Nineteen had in the pelvis/ pelviureteric junction, 64 in proximal ureter, 125 in distal ureter, 6 at iliac crossing and 40 at vesicoureteric junction. Two hundred forty one had single and 14 had multiple calculi. Calculus detection is easier in category III and IV patients. The sensitivity and specificity of ultrasonography were 87.98% and 93.07%. Degree of hydronephrosis is strongly correlated with the number of calculi but weakly correlated with the size of the calculus. Sonogram can be used in all cases of acute ureteric colic. Hydronephrosis is the most important finding because it paves the way out for the detection of calculus.

  20. Solitary intraosseous neurofibroma of the tibia

    Huang, Guo-Shu; Chang, Wei-Chou; Juan, Chun-Jung; Chen, Cheng-Yu. [National Defense Medical Center, Department of Radiology, Tri-Service General Hospital, Neihu 114, Taipei (Taiwan); Lee, Chian-Her [National Defense Medical Center, Department of Orthopedic Surgery, Tri-Service General Hospital, Neihu 114, Taipei (Taiwan); Lee, Herng-Sheng [National Defense Medical Center, Department of Pathology, Tri-Service General Hospital, Neihu 114, Taipei (Taiwan)


    A solitary intraosseous neurofibroma is rare and mostly occurs in the mandible. We report a case of a solitary intraosseous neurofibroma of the tibia. The radiographic findings were nonspecific and showed an eccentrically located, osteolytic lesion with a thin sclerotic border in the diaphysis of the left proximal tibia. The entity of intraosseous neurofibroma is briefly reviewed. (orig.)

  1. Ureteroscopic removal of forgotten ureteral stent

    Kawahara, Takashi; Ishida, Hiroaki; Kubota, Yoshinobu; Matsuzaki, Junichi


    A 69-year-old female had a right ureteral stent placed due to ureteral stricture resulting from cervical cancer in March 2008. The ureteral stent migrated to the ureter and was not exchanged. A new ureteral stent was inserted, and was exchanged every 3 months. The patient was referred to our department to remove the forgotten ureteral stent. In January 2012, her old ureteral stent was removed ureteroscopically, and no ureteral stent encrustation was found. PMID:22707678

  2. [Exceptional iatrogenic ureteral rupture].

    Martínez-Vieira, Almudena; Valera-Sánchez, Zoraida; Sousa-Vaquero, José María; Palacios-González, Carmen; García-Poley, Antonio; Bernal-Bellido, Carmen; Alamo-Martínez, José María; Millán-López, Ana; Blanco-Domínguez, Manuel; Galindo-Galindo, Antonio


    Rupture of the ureter is an infrequent event that can have serious consequences. The most frequent cause is surgical iatrogenic ureter disease. Other possible causes are urological procedures and urographic studies. In our patient, which, to our knowledge, is the first to be reported in the literature, the ureteral rupture was produced by a traumatic urinary catheterism, because the balloon was filled inside the ureter. The normal presentation is nephritic colic, although acute abdomen is also a possibility. The possibility of ureteral rupture in abdominopelvic surgery or in urological techniques should be evaluated when patients present these clinical symptoms. Treatment is surgical, although in some cases conservative measures can be used.

  3. Ureteral retrograde brush biopsy

    ... biopsy URL of this page: // Ureteral retrograde brush biopsy To use ... minutes. A cystoscope is first placed through the urethra into the bladder. Cystoscope is a tube with a ... results may show cancer cells ( carcinoma ). This test is often used to ...

  4. A review of ureteral injuries after external trauma

    Marttos Antonio C


    Full Text Available Abstract Introduction Ureteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this article is to review the literature since 1961 with the primary objective to present the largest medical literature review, to date, regarding ureteral trauma. Several anatomic and physiologic considerations are paramount regarding ureteral injuries management. Literature review Eighty-one articles pertaining to traumatic ureteral injuries were reviewed. Data from these studies were compiled and analyzed. The majority of the study population was young males. The proximal ureter was the most frequently injured portion. Associated injuries were present in 90.4% of patients. Admission urinalysis demonstrated hematuria in only 44.4% patients. Intravenous ureterogram (IVU failed to diagnose ureteral injuries either upon admission or in the operating room in 42.8% of cases. Ureteroureterostomy, with or without indwelling stent, was the surgical procedure of choice for both trauma surgeons and urologists (59%. Complications occurred in 36.2% of cases. The mortality rate was 17%. Conclusion The mechanism for ureteral injuries in adults is more commonly penetrating than blunt. The upper third of the ureter is more often injured than the middle and lower thirds. Associated injuries are frequently present. CT scan and retrograde pyelography accurately identify ureteral injuries when performed together. Ureteroureterostomy, with or without indwelling stent, is the surgical procedure of choice of both trauma surgeons and urologists alike. Delay in diagnosis is correlated with a poor prognosis.

  5. Ureteral strictures revisited…trying to see the light at the end of the tunnel: a comprehensive review.

    Tyritzis, Stavros I; Wiklund, Nils Peter


    A ureteral stricture is a rather rare urological event defined as a narrowing of the ureter causing a functional obstruction and renal failure, if left untreated. The aim of this review article is to summarize and discuss current knowledge on the incidence, pathogenesis, management, and follow up of proximal, mid, and distal ureteral strictures.

  6. Antegrade deligation of iatrogenic distal ureteric obstruction utilising a high pressure balloon dilatation technique.

    Rajendran, Simon


    BACKGROUND: Iatrogenic trauma is the leading cause of ureteric injury with an incidence in abdominal and pelvic surgery varying between 0.4 and 2.5%. CASE: We report a case of ureteric obstruction caused by a haemostatic clip. There was associated rupture of the ureter proximal to the clip with intra-peritoneal leakage of urine. The patient was unfit for surgery and was managed by a novel procedure of endoluminal balloon deligation. CONCLUSION: Ureteric injuries are rare but potentially serious complications. They require prompt diagnosis and management depends on the patients\\' clinical condition, extent of injury and interval from injury to diagnosis. We have successfully demonstrated a new technique to treat ureteric obstruction caused by a haemostatic clip with associated ureteral rupture in a patient unfit for surgery.

  7. Percutaneous antegrade ureteric stent removal using a rigid alligator forceps.

    Given, M F


    To evaluate the safety and efficacy of percutaneous antegrade ureteric stent removal using a rigid alligator forceps. Twenty patients were included in our study. Indications for ureteric stent insertion included stone disease (n = 7), malignancy (n = 8) and transplant anastomotic strictures (n = 5). Stent retrieval was carried out for proximal stent placement\\/migration in seven patients and encrustation in the remaining 13. Twenty-two stents were successfully retrieved in 20 patients. There was one technical failure (5%). There were no major complications. We had four minor complications, which included nephrostomy site pain (n = 2), periprocedural sepsis (n = 1) and a small urinoma (n = 1). All patients settled with conservative management. Percutaneous radiologically guided antegrade ureteric stent removal with an alligator forceps is safe and effective, particularly when initial surgical removal has failed.

  8. Laparoscopic ureterolithotomy for lower ureteric stones: Steps to make it a simple procedure

    Anil Mandhani


    Full Text Available Despite advances in endoscopy and availability of holmium lithotripsy there are ureteric stones, which primarily need to be treated with laparoscopic ureterolithotomy. Literature is replete with the stone retrieval in upper ureteric stone but there are a very few reports on stones removal from ureter below the lower sacroiliac joint. Putting a double J stent before starting the procedure does not give any extra advantage; rather it takes away significant operating room time. This point of technique describes port placement strategy, proximal ureteral occlusion; stone localization, ureterotomy, stone retrieval and laparoscopic stenting are the important steps where one would like to be careful enough to complete the procedure successfully.

  9. Management Of Encrusted Ureteral stents


    Objectives: To present our experience in managing encrusted ureteral stents and to review the .... A single anesthetic session was required in 18 patients (81.8%) and ... fluid intake, chemotherapy-induced hyperuricosuria, persistent or.

  10. [Current treatment of ureteral lithiasis].

    Reina Ruiz, C; Quintero Rodríguez, R; Espinosa Olmedo, J; Arrabal Martín, M; Campoy Martínez, P; Salazar Murillo, R; García Pérez, M


    The treatment of ureteral lithiasis has undergone a revolution since the arrival of new techniques offering different therapeutical choices for which time is gradually elucidating the indications for each of the new procedures; although, to a large extent, a degree of controversy still persists. This paper reviews the different methods for ureteral lithiasis; spontaneous ejection and medical treatment, surgery, early endoscopic manoeuvres, backward and forward urethroscopy and, finally, extracorporeal lithority. This therapeutical experience in 3 series of ureteral lithiasis addressed with different criteria are revised together with 182 obstructive calculi of the lumbar ureter. We believe that grading the ureteral calculi according to their anatomical and functional features improves the results, since improved adjustment can be achieved for the indications of the various methods. Also it is noted that support endourology for extracorporeal lithotrity does not improve the results of treatment in lumbar calculi under 2 cm, and therefore our current approach is towards "in situ" treatment without complementary manoeuvres. Finally we show the therapeutic algorithm we are following actually to manage ureteral litiasis.

  11. 21 CFR 876.4620 - Ureteral stent.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ureteral stent. 876.4620 Section 876.4620 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4620 Ureteral stent. (a) Identification. A ureteral...

  12. Shock Wave Lithotripsy in Ureteral Stones: Evaluation of Patient and Stone Related Predictive Factors

    Ozgur Yazici


    Full Text Available ABSTRACTPurpose:To evaluate the patient and stone related factors which may influence the final outcome of SWL in the management of ureteral stones.Materials and Methods:Between October 2011 and October 2013, a total of 204 adult patients undergoing SWL for single ureteral stone sizing 5 to 15 mm were included into the study program. The impact of both patient (age, sex, BMI, and stone related factors (laterality, location, longest diameter and density as CT HU along with BUN and lastly SSD (skin to stone distance on fragmentation were analysed by univariate and multivariate analyses. Results: Stone free rates for proximal and distal ureteral stones were 68.8% and 72.7%, respectively with no statistically significant difference between two groups (p=0.7. According to univariate and multivariate analyses, while higher BMI (mean: 26.8 and 28.1, p=0.048 and stone density values (mean: 702 HU and 930 HU, p<0.0001 were detected as statistically significant independent predictors of treatment failure for proximal ureteral stones, the only statistically significant predicting parameter for the success rates of SWL in distal ureteral stones was the higher SSD value (median: 114 and 90, p=0.012.Conclusions:Our findings have clearly shown that while higher BMI and increased stone attenuation values detected by NCCT were significant factors influencing the final outcome of SWL treatment in proximal ureteral stones; opposite to the literature, high SSD was the only independent predictor of success for the SWL treatment of distal ureteral stones.

  13. Modern Approach to Ureteral Stones

    Geert G. Tailly


    Full Text Available Urolithiasis is a very common affliction of mankind. In western countries incidence is increasing steadily. An increasing proportion of patients are presenting with ureteral stones, of which renal colic most often is the first complaint and the most common reason for an emergency visit to a urologist. Proper imaging strategy is of paramount importance in the diagnosis of acute flank pain and in the subsequent therapy planning once a ureteral stone is diagnosed. Renal colic during pregnancy poses specific problems, both in imaging and therapy. Apart from the adequate treatment of renal colic, modern therapy of those ureteral calculi that will not pass spontaneously will consist of a judicious combination of ESWL (extracorporeal shock wave lithotripsy, endourology, and laparoscopy. Open surgery should only be reserved for limited and very specific indications. Although beyond the scope of this article, metaphylaxis should take an important role in the follow-up of stone patients in general.

  14. Ureteral Access Sheath Influence on the Ureteral Wall Evaluated by Cyclooxygenase-2 and Tumor Necrosis Factor-α in a Porcine Model

    Lildal, Søren Kissow; Nørregaard, Rikke; Andreassen, Kim Hovgaard; Christiansen, Frederikke Eichner; Jung, Helene; Pedersen, Malene Roland


    Abstract Objective: To examine the effect of ureteral access sheath (UAS) on the expression of the pro-inflammatory mediators cyclooxygenase-2 (COX-2) and tumor necrosis factor-α (TNF-α) in the ureteral wall. Material and Methods: In 22 pigs an UAS was inserted and removed after 2 minutes on one side and 2 hours on the contralateral side. Postoperatively ureters were excised in vivo, and tissue samples from the distal (2 minutes/2 hours) and proximal ureter (2 minutes/2 hours) were snap-frozen before quantitative polymerase chain reaction analysis of COX-2 and TNF-α. Five unmanipulated ureteral units from other pigs served as the control group. Results: Compared to controls COX-2 mRNA was significantly upregulated in all UAS treated ureteral groups. Similarly, TNF-α mRNA was upregulated in all groups except the 2-minute proximal ureteral group. Both COX-2 and TNF-α expression were significantly higher in the distal than in the proximal ureter in the UAS treated ureters. After UAS insertion for 2 minutes, expression levels in the distal ureter were increased 6.5- and 8-fold for COX-2 and TNF-α, respectively; and after 2 hours of UAS placement COX-2 and TNF-α mRNA expression levels were increased 9- and 9.5-fold, respectively. Conclusion: The pro-inflammatory mediators COX-2 and TNF-α were significantly upregulated in the ureteral wall by the influence of UAS. These findings may have implications for postoperative pain, drainage, and complications. PMID:27998175

  15. Low power laser in the management of ureteral stones.

    Tayib, Abdulmalik M


    To evaluate the outcome of the low power Holmium-Yag laser in management of ureteral stones, and to report the incidence rate of different types of stones. One hundred and seventy patients underwent ureteroscopy and fragmentation of ureteral stones at the International Medical Center, Jeddah, Kingdom of Saudi Arabia between March 2007 and August 2009. Stones were measured by their largest diameter on CT and classified according to their location from the ureter to the proximal middle and distal ureteral stones. We utilized 8-11 F Semi rigid or 7.5 F flexible ureteroscopes to identify the stones, and all stones were fragmented and evaporated using a 10 watt lower power Holmium-yag laser lithotripter. All stones were completely evaporated and fragmented using the Holmium-yag laser through ureteroscopy. The age of the patients varied between 21-76 years with a mean age of 38.6 years (males 113, and females 57). The largest diameter of the largest stone was 6-12mm (mean 8 mm) and classified according to its location in the ureter into proximal (93 [54.7%]), middle (26 [15.3%]), or distal ureteral stones (51 [30%]). We performed stone analysis in 122 patients (oxalate [n=87], uric acid [n=16], cystine [n=11], and calcium phosphate [n=8]). Laser lithotripsy using low power 10 watt laser lithotripter is safe and effective method for stone evaporation and disintegration, and can be carried out as a day care procedure. The types of stones in Saudi Arabia are same as it has been reported before in the literature.

  16. "Knot Stent": An Unusual Cause of Acute Renal Failure in Solitary Kidney

    Kamal Moufid


    Full Text Available The insertion of indwelling ureteric stents is a routine procedure in urology practice. Complications secondary to the insertion of these stents have also increased, such as stent encrustation, stent fragmentation, stone formation, and recurrent urinary tract infections. Knot formation within the renal pelvis or in the coiled portion of the ureteral stent is an extremely rare condition, with less than 15 cases reported in literature. The authors report a rare case of knotted stent, complicated by an obstructive acute renal failure and urosepsis, in a patient with a solitary functioning kidney.

  17. Diagnosis of ureteral obstruction in patients with compromised renal function: the role of noninvasive imaging modalities.

    Shokeir, Ahmed A; El-Diasty, Tarek; Eassa, Waleed; Mosbah, Ahmed; El-Ghar, Mohamed Abou; Mansour, Osama; Dawaba, Mohamed; El-Kappany, Hamdy


    We compared the role of noncontrast computerized tomography (NCCT), magnetic resonance urography (MRU), and combined abdominal radiography (KUB) and ultrasonography (US) in the diagnosis of the cause of ureteral obstruction in patients with compromised renal function. The study included 149 patients, of whom 110 had bilateral obstruction and 39 had obstruction of a solitary kidney. Therefore, the total number of renal units was 259. All patients had renal impairment with serum creatinine greater than 2.5 mg/dl. Besides conventional KUB and US all patients underwent NCCT and MRU. The gold standard for diagnosis of the cause of obstruction included retrograde or antegrade ureterogram, ureteroscopy and/or open surgery. The sensitivity, specificity and overall accuracy of NCCT, MRU, and combined KUB and US in the diagnosis of ureteral obstruction were calculated in comparison with the gold standard. The definitive cause of ureteral obstruction was calculous in 146 and noncalculous in 113 renal units, including ureteral stricture in 65, bladder or ureter in 43, extraurinary collection in 3 and retroperitoneal fibrosis in 2. The site of stone impaction was identified by NCCT in all 146 renal units (100% sensitivity), by MRU in 101 (69.2% sensitivity), and by combined KUB and US in 115 (78.7% sensitivity) with a difference of significant value in favor of NCCT (p MRU in 54 of 65 (83%). Bladder and ureteral tumors causing ureteral obstruction could be diagnosed in approximately half of the patients by NCCT (22 of 43) and in all except 1 by MRU (42 of 43). NCCT and MRU could identify all extraurinary causes of obstruction. Overall of the 113 kidneys with noncalculous obstruction the cause could be identified by MRU in 101 (89% sensitivity), by NCCT in 45 (40% sensitivity), and by combined KUB and US in only 20 (18% sensitivity) with a difference of significant value in favor of MRU (p MRU is superior for identifying noncalculous lesions.

  18. Bumblebees and solitary bees

    Henriksen, Casper Christian I

    Summary: The effects of farming system, flower resources and semi-natural habitats on bumblebees and solitary bees in intensively cultivated landscapes in Denmark were investigated in two sets of studies, in 2011 and 2012. The pan trap colour preferences of bumblebees and solitary bees were also...... assessed. In 2011, bumblebees and solitary bees were trapped in road verges bordering 14 organic (organic sites) and 14 conventional (conventional sites) winter wheat fields. The quantity and quality of local flower resources in the road verge and adjacent field headland were estimated as overall density...... use as a proxy at four different scales (250, 500, 750 and 1000 m). In 2012, the effect of a four-fold larger area of organic arable fields in simple, homogeneous landscapes on bumblebees and solitary bees was investigated in eight circular landscapes (radius 1000 m). Bumblebees and solitary bees were...

  19. Artificial Ureter in Patients with Extensive Ureteral Damage.

    Yazdani, Mohammad; Javid, Amir; Mohammadi Sichani, Mehrdad; Gharaati, Mohammad Reza; Yazdani, Emad


    loss of significant lengths of ureter when substitution with bowel or bladder fails is a disaster in urology. This study is conducted to evaluate the results of subcutaneous nephron-vesical bypass (SNVB) in ureteral damage of different etiologies. Seventeen SNVB were employed in patients with ureteral injuries. We employed a device consisted of an internal silicone tube covered by a coiled PTFE tube to replace the ureter. This is called artificial ureter (AU). Proximal end of the AU was introduced in the kidney percutaneously, the tube was passed through a subcutaneous tunnel, while the distal end was inserted in the bladder through a small suprapubic incision. Follow-up ranged from six months to ten years. We removed the prosthetic ureter in one patient due to gross hematuria two months after insertion. One of the patients was reoperated two days after the procedure because of urinary leakage. In all other patients, the procedure was safe and effective. Subcutaneous nephron-vesical bypass is a safe and appealing alternative to a nephrostomy tube. This is a permanent device with no need for exchange. The technique can be applied in ureteral injuries due to various causes.

  20. Diagnosis and management of ureteral complications following renal transplantation

    Brian D. Duty


    Full Text Available When compared with maintenance dialysis, renal transplantation affords patients with end-stage renal disease better long-term survival and a better quality of life. Approximately 9% of patients will develop a major urologic complication following kidney transplantation. Ureteral complications are most common and include obstruction (intrinsic and extrinsic, urine leak and vesicoureteral reflux. Ureterovesical anastomotic strictures result from technical error or ureteral ischemia. Balloon dilation or endoureterotomy may be considered for short, low-grade strictures, but open reconstruction is associated with higher success rates. Urine leak usually occurs in the early postoperative period. Nearly 60% of patients can be successfully managed with a pelvic drain and urinary decompression (nephrostomy tube, ureteral stent, and indwelling bladder catheter. Proximal, large-volume, or leaks that persist despite urinary diversion, require open repair. Vesicoureteral reflux is common following transplantation. Patients with recurrent pyelonephritis despite antimicrobial prophylaxis require surgical treatment. Deflux injection may be considered in recipients with low-grade disease. Grade IV and V reflux are best managed with open reconstruction.

  1. Analysis of ureteral length in adult cadavers

    Hugo F. F. Novaes


    Full Text Available Introduction In some occasions, correlations between human structures can help planning surgical intra-abdominal interventions. The previous determination of ureteral length helps pre-operatory planning of surgeries, reduces costs of auxiliary exams, the correct choice of double-J catheter with low morbidity and fewer symptoms, and an adequate adhesion to treatment. Objective To evaluate ureteral length in adult cadavers and to analyze its correlation with anthropometric measures. Materials and Methods: From April 2009 to January 2012 we determined ureteral length of adult cadavers submitted to necropsy and obtained the following measures: height, distance from shoulder to wrist, elbow-wrist, xiphoid appendix-umbilicus, umbilicus-pubis, xiphoid appendix-pubis and between iliac spines. We analyzed the correlations between ureteral length and those anthropometric measures. Results We dissected 115 ureters from 115 adult corpses from April 2009 to January 2012. Median ureteral length didn't vary between sexes or according to height. It was observed no correlation among ureteral length and all considered anthropometric measures in all analyzed subgroups and in general population. There were no significant differences between right and left ureteral measures. Conclusions There is no difference of ureteral length in relation to height or gender (male or female. There is no significant correlation among ureteral length and the considered anthropometric measures.

  2. Stents for malignant ureteral obstruction

    Kristina Pavlovic


    Full Text Available Malignant ureteral obstruction can result in renal dysfunction or urosepsis and can limit the physician's ability to treat the underlying cancer. There are multiple methods to deal with ureteral obstruction including regular polymeric double J stents (DJS, tandem DJS, nephrostomy tubes, and then more specialized products such as solid metal stents (e.g., Resonance Stent, Cook Medical and polyurethane stents reinforced with nickel-titanium (e.g., UVENTA stents, TaeWoong Medical. In patients who require long-term stenting, a nephrostomy tube could be transformed subcutaneously into an extra-anatomic stent that is then inserted into the bladder subcutaneously. We outline the most recent developments published since 2012 and report on identifiable risk factors that predict for failure of urinary drainage. These failures are typically a sign of cancer progression and the natural history of the disease rather than the individual type of drainage device. Factors that were identified to predict drainage failure included low serum albumin, bilateral hydronephrosis, elevated C-reactive protein, and the presence of pleural effusion. Head-to-head studies show that metal stents are superior to polymeric DJS in terms of maintaining patency. Discussions with the patient should take into consideration the frequency that exchanges will be needed, the need for externalized hardware (with nephrostomy tubes, or severe urinary symptoms in the case of internal DJS. This review will highlight the current state of diversions in the setting of malignant ureteral obstruction.

  3. Treatment of ureteral calculus obstruction with laser lithotripsy in an Atlantic bottlenose dolphin (Tursiops truncatus).

    Schmitt, Todd L; Sur, Roger L


    An adult female bottlenose dolphin (Tursiops truncatus) presented with acute anorexia secondary to progressive azotemia (blood urea nitrogen = 213 mg/dl, creatinine [Cr] = 9.5 mg/dl) and electrolyte abnormalities (K = 7.4 mEq/L). It was later diagnosed with postrenal obstruction secondary to bilaterally obstructing ureteral calculi seen on ultrasound. Treatment of the obstruction required two endoscopic procedures, cystoscopy for ureteral stent placement and ureteroscopy to perform intracorporeal lithotripsy on the obstructing calculi. Before the first procedure, the dolphin's azotemia was stabilized with aggressive fluid therapy, peritoneal dialysis, and treatment for acidosis. Diuresis subsequent to the fluid therapy enabled passage of the right obstructing urolith. For both endoscopic procedures, the dolphin was placed in left lateral recumbency due to the peritoneal dialysis catheter in the right retroperitoneal region. For the first procedure, a 12-French (Fr) flexible cystoscope was inserted retrograde into the bladder via the urethra, whereupon a calculus was seen obstructing the left ureteral orifice. A 4.8-Fr, 26-cm double-pigtail ureteral stent was placed up the left ureter to relieve the postrenal obstruction. Inadvertent proximal migration of the left ureteral stent occurred during the procedure. However, renal parameters (serum Cr = 5.8, K = 5.4) improved significantly by the next day. For the second procedure, 28 hr later, ureteroscopy was performed to treat the calculus and replace the existing stent with a longer stent. The left ureteral calculus was pulverized into tiny fragments by using a holmium:yttrium-aluminum-garnet laser inserted through a 6.9-Fr semirigid ureteroscope. The migrated stent was visualized in the distal left ureter and replaced with a 90-cm single-pigtail ureteral stent that was sutured exterior to the urogenital slit and removed 3 days later. Renal function normalized over the next several days, and the dolphin recovered over

  4. Management of ureteral stenting for postrenal failure during pregnancy after ureteral reimplantation: a case report.

    Yoneoka, Yutaka; Kaku, Shoji; Tsuji, Shunichiro; Yamashita, Hiroto; Inoue, Takashi; Kimura, Fuminori; Murakami, Takashi


    Vesicoureteral reflux is thought to predispose to urinary tract infection and renal scarring, and ureteral reimplantation in childhood remains the gold standard for its treatment. It has been reported that the risk of postrenal failure during pregnancy is increased among women with Politano-Leadbetter ureteral reimplantation. In previous case reports on patients with progressive hydronephrosis and renal failure during pregnancy after ureteral reimplantation, percutaneous nephrostomy was always required, so there has been no information about the clinical management of such patients by ureteral stenting. Here we report a patient with a history of bilateral ureteral reimplantation, in whom severe hydronephrosis during pregnancy was managed with ureteral stents. A primigravida with severe hydronephrosis was referred to us at 29 weeks of gestation. Bilateral Politano-Leadbetter ureteral reimplantation had been performed at the age of 3 years. She was hospitalized immediately, and bilateral ureteral stents were successfully inserted. Post-obstructive diuresis occurred after the stents were placed. Urinary tract infection developed after removal of the urethral catheter 1 week later, but responded to antibiotic therapy and catheter replacement. Labor was induced at 39 weeks of gestation, with vaginal delivery of a healthy male infant. Both stents were found to have spontaneously migrated into the urethra after delivery. Repeat stenting under spinal anesthesia was required to improve postpartum symptoms of back pain and fever. Right distal ureteral obstruction persisted at 6 months after delivery and repeat ureteral reimplantation is planned. General obstetricians will not necessarily pay attention to a history of Politano-Leadbetter ureteral reimplantation, but these patients should undergo careful monitoring of renal function and urinary tract morphology during perinatal care. In the present case, ureteral stenting was effective for postrenal failure during pregnancy

  5. Ureteral sciatic hernia: a case report

    Choi, So Young; Han, Hyun Young; Park, Suk Jin; Choe, Hyoung Shim; Kim, Eun Tak [Eulji University Hospital, Daejeon (Korea, Republic of)


    A ureteral hernia that occurs through the sciatic foramen is very rare. We present a case of a ureteral sciatic hernia with hydronephrosis. Intravenous urography (IVU) showed the presence of a curved, laterally displaced ureter, and computed tomography (CT) clearly depicted the herniated ureter through the sciatic foramen. The patient was treated transiently with a double J catheter.

  6. Ureteritis cystica: A rare benign lesion

    F. Ibrahim


    Full Text Available Ureteritis cystica is an uncommon benign pathology of the ureter. The etiology is unclear but the diagnosis has become much easier to make with the routine use of ureteroscopy for diagnosis of ureteric lesions. We present a case of a 63 year old Sudanese woman with a history of repeated attacks of right loin pain in whom magnetic resonance urography (MRU showed multiple filling defects in the right ureter. These were initially thought to be malignant urothelial lesions. Ureteroscopy revealed cystic smooth walled masses which discharged tiny turbid fluid on biopsy. An intraoperative diagnosis of ureteritis cystica was confirmed. The patient was managed conservatively.

  7. Treatment of ureteral stones: A prospective randomized controlled trial on comparison of Ho:YAG laser and pneumatic lithotripsy

    Robab Maghsoudi


    Full Text Available Objectives: To study the treatment of ureteric stones by HO:YAG laser lithotripsy and pneumatic lithotripsy and to evaluate the results of the two treatment modalities to assess effectiveness and complications. Materials and Methods: Over 1-year period, a total of 79 patients with 82 ureteral stones were randomized into two groups. In group 1 (39 cases with 41 ureteral stones ureteroscopic HO:YAG laser lithotripsy was performed using a rigid 8 Fr-ureteroscope (LL group. In group 2 (40 cases with 41 ureteral stones pneumatic lithotripsy was performed in like manner. Efficacy safety and complications in both groups were analyzed. Results: A total of 79 patients with 82 calculi were treated. Two cases in LL group and one in PL group had bilateral ureteral stones. Mean stone size was 12.07 mm in LL group and 10.2 mm in PL group. Stones located in lower ureter in 30 cases on LL group and 29 cases in PL group. Proximal migration of stone occurred in 1 case on LL group and in 3 cases on PL group. Successful fragmentation occurred in 37 cases on LL group and in 30 cases on PL group. Stone-free rate after 1 month in the base of Kidney Ureter Bladder (KUB and sonography was 95% in LL group and 80.5% in PL group. Ureteral perforation, urinoma, and urosepsis were not seen in both groups. Conclusion: HO:YAG laser has advantages over PL in high efficacy of stone fragmentation and a low-retrograde migration of ureteral stone treatment. Other complication of ureteral stone treatment with LL and PL are the same and very rare.

  8. Solitary Tibial Osteolytic Lesion

    Emilios E. Pakos


    Full Text Available We report an unusual case of solitary osteolytic tibial metastasis from a primary endometrial cancer in a 62-year-old woman. The primary cancer was treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy combined with postoperative external beam radiotherapy, while the tibial metastasis was treated with an above knee amputation. The rarity of the case lies on the fact that metastases distally to the elbow and knee are uncommon and endometrial cancer rarely gives distal bone metastases and particularly solitary to the extremities.

  9. Molecular pathology of murine ureteritis causing obstructive uropathy with hydronephrosis.

    Osamu Ichii

    Full Text Available Primary causes of urinary tract obstruction that induces urine retention and results in hydronephrosis include uroliths, inflammation, and tumors. In this study, we analyzed the molecular pathology of ureteritis causing hydronephrosis in laboratory rodents.F2 progenies of C57BL/6 and DBA/2 mice were studied histopathologically and by comprehensive gene expression analysis of their ureters. Incidence of hydronephrosis was approximately 5% in F2 progenies. Histopathologically, this hydronephrosis was caused by stenosis of the proximal ureter, which showed fibrosis and papillary malformations of the proliferative epithelium with infiltrations of B-cell-dominated lymphocytes. Additionally, CD16-positive large granular leukocytes and eosinophils infiltrated from the ureteral mucosa to the muscular layer. Eosinophilic crystals were characteristically observed in the lumen of the ureter and the cytoplasm of large granular leukocytes, eosinophils, and transitional epithelial cells. Comprehensive gene profiling revealed remarkably elevated expression of genes associated with hyperimmune responses through activation of B cells in diseased ureters. Furthermore, diseased ureters showed dramatically higher gene expression of chitinase 3-like 3, known as Ym1, which is associated with formation both of adenomas in the transitional epithelium and of eosinophilic crystals in inflammatory conditions. The Ym1 protein was mainly localized to the cytoplasm of the transitional epithelium, infiltrated cells, and eosinophilic crystals in diseased ureters.We determined that the primary cause of hydronephrosis in F2 mice was ureteritis mediated by the local hyperimmune response with malformation of the transitional epithelium. Our data provide a novel molecular pathogenesis for elucidating causes of aseptic inflammation in human upper urinary tracts.

  10. Pseudotumoral tuberculous ureteritis: a case report

    Bouchikhi Ahmed-Amine


    Full Text Available Abstract Introduction Tuberculosis is still endemic in Morocco and the urogenital form is common. This form is characterized by clinical polymorphism. However, the isolated ureteric form is very rare. The differential diagnosis might be raised in tumoral cases while undertaking surgical excision which is the realistic choice. Hence, we report an isolated ureteric tuberculosis case, and we discuss the clinical, imaging, diagnostic and therapeutical features. Case presentation A 30-year-old Moroccan man consulted us for left back pain associated with urinary frequency and a few macroscopic episodes of hematuria for the past six months. A computed tomography urography revealed a left hydronephrosis and hydroureter secondary to focal wall thickening of the left lumbar ureter. Hence, we had diagnosed a ureteral tumor. However, a clinical examination showed irritative voiding symptoms and epididymal disorders associated with prostate infection suggesting a Koch’s bacillus assessment of the patient’s urine of which the results proved strongly positive. The treatment consisted of establishing a double-J ureteric stent to drain the left kidney, followed by antituberculous antibiotics. Conclusion Urogenital tuberculosis is common in endemic countries, however isolated ureter affection is rare. It is important to consider a ureteral tuberculosis diagnosis whenever ureteral thickening is revealed in a patient living in a country in which tuberculosis is endemic.

  11. Ureteral Stenting after Uncomplicated Ureteroscopy for Distal Ureteral Stones: A Randomized, Controlled Trial

    Y. El Harrech


    Full Text Available Objectives. We compared outcome and complications after uncomplicated ureteroscopic treatment of distal ureteral calculi with or without the use of ureteral stents. Materials and Methods. 117 patients, prospectively divided into three groups to receive a double j stent (group 1, 42 patients, ureteral stent (group 2, 37 patients, or no stent (group 3, 38 patients, underwent ureteroscopic treatment of distal ureteral calculi. Stone characteristics, operative time, postoperative pain, lower urinary tract symptoms (LUTS, analgesia need, rehospitalization, stone-free rate, and late postoperative complications were all studied. Results. There were no significant differences in preoperative data. There was no significant difference between the three groups regarding hematuria, fever, flank pain, urinary tract infection, and rehospitalisation. At 48 hours and 1 week, frequency/urgency and dysuria were significantly less in the nonstented group. When comparing group 1 and group 3, patients with double j stents had statistically significantly more bladder pain (P=0.003, frequency/urgency (P=0.002, dysuria (P=0.001, and need of analgesics (P=0.001. All patients who underwent imaging postoperatively were without evidence of obstruction or ureteral stricture. Conclusions. Uncomplicated ureteroscopy for distal ureteral calculi without intraoperative ureteral dilation can safely be performed without placement of a ureteral stent.

  12. A guidewire introducer as a ureteral foreign body: A case report.

    Sener, Tarik Emre; Cloutier, Jonathan; Audouin, Marie; Villa, Luca; Traxer, Olivier


    A 63-year-old male, previously treated for a ureteral tumour by a right-sided segmental ureterectomy and end-to-end anastomosis of ureteral segments, was referred to our clinic for endoscopic follow-up. During his follow-up, he was diagnosed with partial right-sided ureteral stricture which eventually progressed to complete obstruction. During the ureteroscopy, as the stenotic segment did not allow passage of an hydrophilic guidewire, an antegrade-retrograde approach was decided. On the antegrade endoscopic view, a near-complete stenosis was diagnosed and a nephrostomy catheter (12 Fr) was placed. A second intervention was planned and from the nephrostomy tract, the ureteroscope was placed into the right pyelocaliceal system. The diagnostic ureteroscopy revealed a foreign object proximal to the stenotic area. Right-sided segmental ureterectomy of the stenotic segment with ureteroneocystostomy and removal of the foreign object was performed. This is the only case in literature to reveal a guidewire introducer as a ureteral foreign body. This case also highlights the importance of the fragility of the ureter, the importance of the equipment, of always being watchful during a surgery, and the importance of checking the integrity of the equipment at the end of each procedure.

  13. Malignant Ureteral Obstruction: Functional Duration of Metallic versus Polymeric Ureteral Stents.

    Po-Ming Chow

    Full Text Available Ureteral obstruction caused by extrinsic compression is often associated with intra-abdominal cancers. Internal drainage with ureteral stents is typically the first-line therapy to relieve such obstructions. Novel designs of ureteral stents made of different materials have been invented to achieve better drainage. In this study, we described the functional outcomes of a Resonance metallic ureteral stent (Cook Medical, Bloomington, Indiana, USA in patients with malignant ureteral obstruction and compare the functional duration of Resonance stents with regular polymeric stents in the same cohort.Cancer patients who received polymeric stents and subsequent Resonance stents for ureteral obstruction between July 2009 and November 2012 were included in a chart review. Stent failure was detected by clinical symptoms, imaging studies, and renal function tests. The functional durations of each stent were calculated, and possible factors affecting stent patency were investigated.A total of 50 stents were successfully inserted into 50 ureteral units in 42 patients with malignant ureteral obstruction. There were 7 antegrade stents and 43 retrograde stents. There were no major complications. Stent-related symptoms were similar in both kinds of stents. After polymeric stents were replaced with Resonance metallic stents, hydronephrosis subsided or remained stable in 90% (45/50 of the ureteral units. Serum creatinine decreased or remained stable in 90% (38/42 of these patients. The Resonance stent exhibited a mean increase in functional duration of 4 months compared with the polymeric stents (p<0.0001, and 50% (25/50 of the Resonance stents exhibited a significant increase in functional duration (more than 3 months. Pre-operative serum creatinine < 2 was associated with a substantial increase in stent duration.Resonance stents are effective and safe in relieving malignant ureteral obstructions after polymeric stents failure. Resonance stents can provide a

  14. [Ambulatory ureteral lithotripsy with "Modulith SL-20"].

    González Enguita, C; Calahorra Fernández, F J; García de la Peña, E; Rodríguez-Miñón Cifuentes, J L; Vela Navarrete, R


    Analysis of our experience in 'in situ' ambulatory shockwave extracorporeal lithofragmentation of ureteral stones in 104 patients seen in the Lithotrity Unit, Urology Service, Fundación "Jiménez Díaz". Using Modulith SL 20, a third generation lithotripter, 'in situ' disintegration was achieved in 82.69% of cases, 51.92% of which were fragmented in a single lithotrity session. As a first choice, no ureteral handling was used in any of the patients prior to lithotrity. In 9.62% of patients it was necessary to place a 'double J' by-pass catheter, due to the disease presenting with a septic picture. The patient's position was either dorsal or ventral decubitus depending on the lithiatic site, while location and focusing of the stones was done radiologically. All patients were treated ambulatory without hospitalization. Only 18% was given oral or i.v. anaesthesia. Fursemide 40 mg was administered to all patients shortly before starting the session. Each patient received an average of 3,200 shockwaves per session (14-18 Kv, average 16 Kv). Haematuria was the single and modest side effect that happened during the 24 hours following lithofragmentation in 30% of patients, while 20% reported slight discomfort at the time of eliminating the gritted stones. We conclude stating that 'in situ' shockwave extracorporeal lithotrity of ureteral stones with Modulith SL 20 allows for elective disintegration of ureteral stones in whatever location they are found, due to the patient's easy positioning. The simple location and focusing of ureteral stones has allowed us to treat and solve some cases of ureteral lithiasis at the precise moment of the nephritic colic painful emergency, thus speeding up and facilitating the resolution of the condition. Our results and our strategy imply a new change of direction in the management of these lithiasis, as opposed to the well established and historical doctrines in existence regarding stones with ureteral location.

  15. Solitary midbrain metastasis.

    Ongerboer de Visser, B W; Moffie, D


    The available clinical and pathological data of 5 cases with solitary midbrain metastasis including 2 of the present study are reviewed. Progressive dementia occurred in one case and mild dementia in another who also developed ocular symptoms. Ocular symptoms with sensory and coordination disturbances were seen in one, and only ocular symptoms in another case. Right-sided hemiplegia of 5 years duration occurred in the remaining case. Survival in tegmentum lesions is short.

  16. Ureteral metastasis from prostate cancer.

    Hongo, Hiroshi; Kosaka, Takeo; Yoshimine, Shunsuke; Oya, Mototsugu


    A 59-year-old man had an elevated prostate-specific antigen (PSA) concentration (439 ng/mL) in December 2008. We diagnosed prostatic adenocarcinoma by prostate needle biopsy. CT and MRI showed a prostatic tumour with bone and lymph node metastases. Combined androgen blockade therapy reduced the PSA level temporarily. After the PSA level gradually started to increase again and reached 27.27 ng/mL in October 2010, the patient was diagnosed with castration-resistant prostate cancer and treated with docetaxel chemotherapy. Radiological examination detected left hydronephrosis and a tumour in the left lower ureter in March 2011. Retrograde pyelography and urine cytology of class 3 from the left ureter indicated that the ureteral mass was a urothelial carcinoma. A left nephroureterectomy was performed. After the operation, the pathological examination showed a metastatic prostate carcinoma, accompanied by a decrease in the serum PSA level from 59.56 to 45.33 ng/mL.

  17. Histopathological correlations to ureteral lesions visualized during ureteroscopy

    Lildal, Søren Kissow; Sørensen, Flemming Brandt; Andreassen, Kim Hovgaard


    PURPOSE: To correlate ureteral lesions visualized during ureteroscopy with histopathological findings. MATERIALS AND METHODS: Ureteral access sheaths (UAS) sized 13/15 Fr. were inserted bilaterally in 22 laboratory pigs. During retraction of the UAS with a semirigid ureteroscope inside, ureteral...

  18. Ureteroscopy and holmium:YAG laser lithotripsy: an emerging definitive management strategy for symptomatic ureteral calculi in pregnancy

    Watterson, James D.; Girvan, Andrew R.; Beiko, Darren T.; Nott, Linda; Wollin, Timothy A.; Razvi, Hassan A.; Denstedt, John D.


    Objectives: Symptomatic urolithiasis in pregnancy that does not respond to conservative measures has traditionally been managed with ureteral stent insertion or percutaneous nephrostomy (PCN). Holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy using state-of-the-art ureteroscopes represents an emerging strategy for definitive stone management in pregnancy. The purpose of this study was to review the results of holmium laser lithotripsy in a cohort of patients who presented with symptomatic urolithiasis in pregnancy. Methods: A retrospective analysis was conducted at 2 tertiary stone centers from January 1996 to August 2001 to identify pregnant patients who were treated with ureteroscopic holmium laser lithotripsy for symptomatic urolithiasis or encrusted stents. Eight patients with a total of 10 symptomatic ureteral calculi and 2 encrusted ureteral stents were treated. Mean gestational age at presentation was 22 weeks. Mean stone size was 8.1 mm. Stones were located in the proximal ureter/ureteropelvic junction (UPJ) (3), mid ureter (1), and distal ureter (6). Results: Complete stone fragmentation and/or removal of encrusted ureteral stents were achieved in all patients using the holmium:YAG laser. The overall procedural success rate was 91%. The overall stone-free rate was 89%. No obstetrical or urological complications were encountered. Conclusions: Ureteroscopy and holmium laser lithotripsy can be performed safely in all stages of pregnancy providing definitive management of symptomatic ureteral calculi. The procedure can be done with minimal or no fluoroscopy and avoids the undesirable features of stents or nephrostomy tubes.

  19. Solitary intraosseous neurofibroma of mandible.

    Vivek N


    Full Text Available Solitary intraosseous neurofibroma is a rare benign non-odontogenic tumor. Although neurofibromas occur predominantly as a feature of neurofibromatosis affecting the soft tissue, a few cases of solitary intraosseous neurofibromas of the jaw have been reported. We herewith report a case of solitary intraosseous neurofibroma of mandible in a middle-aged woman with a discussion on its clinical, radiological, and histopathological presentation along with review of cases.

  20. Taking the STING Out of Ureteral Obstruction

    Aw, Ivan; Tan, Philip Huang Min; Clarke, David


    Abstract Vesicoureteral reflux (VUR) is diagnosed in ∼1% of children. The main goal of treatment is preservation of renal function by preventing recurrent urinary tract infection (UTI) refractory to antibiotic therapy. Surgical treatment options include endoscopic injection or ureteral reimplantation. Subureteral Teflon (polytetrafluoroethylene) injection (STING) is an endoscopic treatment option no longer in common practice. Use of Teflon is no longer advised because of a number of documented complications secondary to local and distant migration of injected material. We present a case of delayed ureteral obstruction secondary to the STING procedure occurring 21 years after initial surgery and managed using a novel endoscopic method. PMID:27785466

  1. Ureteritis Cystica: A Radiologic Pathologic Correlation

    Jennifer G Rothschild


    Full Text Available Ureteritis cystica (UC is a benign condition that commonly affects the ureter and can mimic other conditions such as transitional cell carcinoma, blood clots, air bubbles, radiolucent stones, fibroepithelial polyps, and sloughed renal papillae. Radiographically, UC is characterized by multiple small, round, lucent defects, which cause scalloping of the ureteral margins when seen in profile. The scalloping is produced by the projection of the submucosal cysts into the lumen and represents an important differential feature of this disease. We present a case of UC with a radiological pathological correlation.

  2. An ancillary CT finding of intrapulmonary solitary fibrous tumor: A case report

    Lee, Dong Jun; Rho, Ji Young; Kwon, Ah Young [CHA Bundang Medical Center, CHA University, Seongnam (Korea, Republic of)


    Intrapulmonary solitary fibrous tumor is extremely rare. A few reports have presented typical CT findings such as well-defined, variable—sized, heterogeneously or homogenously well-enhanced intrapulmonary nodules. We report herein a rare case of intrapulmonary solitary fibrous tumor that showed typical clinical and CT features, and we also provide an ancillary CT finding that shows a distinguishable tubular vascular structure within the nodule. The tubular vascular structure was conjoined to the proximal pulmonary vein. In this study, we highlight an ancillary CT finding reported for the first time for the diagnosis of a patient with intrapulmonary solitary fibrous tumor.

  3. [Pseudocystic ureteritis. Apropos of a case].

    Joual, A; Sarf, I; Aboutaieb, R; el Mrini, M; Benjelloun, S


    The authors report one case of ureteritis cystica in a young adult. The diagnosis was made by intravenous urography and confirmed by histologic examination. The patient was treated surgically (nephro-ureterectomy). The etiopathogenic, clinical and therapeutic aspects are discussed with a review of literature.

  4. Forgotten Ureteral Stents: An Avoidable Morbidity.

    Murtaza, Badar; Alvi, Sarwar


    To assess the clinical presentation of forgotten ureteral stents and highlight the etiological factors resulting in the retention of these stents. Observational study. Department of Urology, Armed Forces Institute of Urology, Rawalpindi, from January 2010 to June 2011. Thirty-eight patients, with forgotten ureteral stents, retained for more than 6 months duration, were enrolled. A detailed evaluation was performed, along with the questions regarding the patients' opinion about the ureteral stents. They were specially asked whether they knew about the stents or were they formally informed regarding the stents. Subsequently, the patients were managed according to their clinical condition. The male to female ratio was 2.1:1 aged 23 - 69 years, mean being 40.24 ±12.59 years. The time of presentation after the ureteral stenting was 7 - 180 months (mean = 28.89 ±33.435 years). Seven patients (18.4%) reported with chronic kidney disease, including ESRD in two cases. Recurrent UTI was seen in 28 cases (73.6%), calculus formed over the stents in 20 cases (52.6%), and stent fragmented in 5 patients (13.1%). Majority of patients, (n = 23, 60.5%), were not even aware of the placement of these stents while 8 (21.0%) knew but were reluctant about its removal. In 3 cases (7.8%), the relatives knew about the stent but never informed the patients. The stent had been removed in 2 cases (5.2%), but the other broken fragment was missed. One case (2.6%) each had a misconception about the permanent placement of the stents like cardiac stents and regarding degradation of the stents in situ. Forgotten ureteral stents produce clinical features ranging from recurrent UTI to ESRD. This preventable urological complication is primarily due to the unawareness or ignorance of the patients and their relatives regarding the stent.

  5. Comparison of Two Types of Double-J Ureteral Stents that Differ in Diameter and the Existence of Multiple Side Holes along the Straight Portion in Malignant Ureteral Strictures

    Song, Myung Gyu, E-mail:; Seo, Tae-Seok, E-mail:; Lee, Chang Hee, E-mail:; Kim, Kyeong Ah, E-mail: [Korea University College of Medicine, Department of Radiology, Korea University Guro Hospital (Korea, Republic of); Kim, Jun Suk, E-mail:; Oh, Sang Cheul, E-mail: [Korea University College of Medicine, Department of Oncology, Korea University Guro Hospital (Korea, Republic of); Lee, Jae-Kwan, E-mail: [Korea University College of Medicine, Department of Gynecology, Korea University Guro Hospital (Korea, Republic of)


    PurposeThis study was decided to evaluate the impact of diameter and the existences of multiple side holes along the straight portion of double-J ureteral stents (DJUS) on early dysfunction of stents placed for malignant ureteral strictures.MethodsBetween April 2007 and December 2011, 141 DJUSs were placed via a percutaneous nephrostomy (PCN) tract in 110 consecutive patients with malignant ureteral strictures. 7F DJUSs with multiple side holes in the straight portion were placed in 58 ureters of 43 patients (Group 1). 8F DJUSs with three side holes in the proximal 2-cm of the straight portion were placed in 83 ureters of 67 patients (Group 2). The incidence of early DJUS dysfunction was compared between the two groups, and nephrostographic findings were evaluated in the cases of early dysfunction.ResultsEarly dysfunction of the DJUS was noted in 14 of 58 patients (24.1 %) in Group 1, which was significantly higher (p = 0.001) than in Group 2 in which only 1 of 83 patients (1.2 %) had early dysfunction of the DJUS. Nephrostographic findings of early dysfunction included dilatation of the pelvicalyceal system, filling defects in the ureteral stent, and no passage of contrast media into the urinary bladder.ConclusionsIn malignant ureteral strictures, multiple side holes in the straight portion of the 7-F DJUS seem to cause early dysfunction. The 8F DJUSs with three side holes in the proximal 2-cm of the straight portion may be superior at preventing early dysfunction.

  6. Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy.

    Juan, Hsu-Cheng; Lin, Hung-Yu; Chou, Yii-Her; Yang, Yi-Hsin; Shih, Paul Ming-Chen; Chuang, Shu-Mien; Shen, Jung-Tsung; Juan, Yung-Shun


    To assess the effects of abdominal fat on shock wave lithotripsy (SWL). We used pre-SWL unenhanced computed tomography (CT) to evaluate the impact of abdominal fat distribution and calculus characteristics on the outcome of SWL. One hundred and eighty-five patients with a solitary ureteric calculus treated with SWL were retrospectively reviewed. Each patient underwent unenhanced CT within 1 month before SWL treatment. Treatment outcomes were evaluated 1 month later. Unenhanced CT parameters, including calculus surface area, Hounsfield unit (HU) density, abdominal fat area and skin to calculus distance (SSD) were analysed. One hundred and twenty-eight of the 185 patients were found to be calculus-free following treatment. HU density, total fat area, visceral fat area and SSD were identified as significant variables on multivariate logistic regression analysis. The receiver-operating characteristic analyses showed that total fat area, para/perirenal fat area and visceral fat area were sensitive predictors of SWL outcomes. This study revealed that higher quantities of abdominal fat, especially visceral fat, are associated with a lower calculus-free rate following SWL treatment. Unenhanced CT is a convenient technique for diagnosing the presence of a calculus, assessing the intra-abdominal fat distribution and thereby helping to predict the outcome of SWL. • Unenhanced CT is now widely used to assess ureteric calculi. • The same CT protocol can provide measurements of abdominal fat distribution. • Ureteric calculi are usually treated by shock wave lithotripsy (SWL). • Greater intra-abdominal fat stores are generally associated with poorer SWL results.

  7. Pyelo-cystic Reflux in F-18 FDG PET Scan Due to Ureteral Obstruction

    Reyhan, Mehmet [Baskent Univ., Adana (Turkmenistan)


    A 72-year-old woman with a history of cervical cancer was treated with brachytherapy and chemotherapy. Combined F-18 FDG PET/CT performed for restaging demonstrated increased FDG uptake in a hypodense cystic lesion at the posterior part of the right renal cortex and a hypermetabolic soft tissue mass at the right parailiac region suggestive of a metastatic lymph node causing ureteral obstruction. There had been no FDG uptake in the cystic lesion on the FDG PET/CT study performed 1 year before. These findings suggest that the increased FDG uptake in the cystic lesion was caused by pyelocystic reflux due to ureteral obstruction secondary to parailiac lymph node metastasis (Figs. 1 and 2). Several renal lesions may have increased metabolism, such as renal cell carcinoma, lymphoma, oncocytoma, adult Wilms' tumor, angiomyolipoma, metastatic lesions, xanthogranulo-matous pyelonephritis and infected cyst. Most of these lesions are solid. Some infected renal cysts may be FDG avid, but in this situation increased FDG uptake is observed on the wall of the cyst. In our case, FDG uptake was seen in the entire cystic lesion. The patient had no symptoms or laboratory findings related to infection. Cysts are the most common space-occupying lesions of the kidney. The vast majority of these are simple cysts that are usually unilateral and solitary. Simple cysts are asymptomatic, except when complications exist such as hemorrhage, infection or rupture. There have been a few reports on spontaneous communications between renal cysts and the pyelocaliceal system, in most cases involving ruptures of the cysts into the pyelocaliceal system due to increased intracystic pressure caused by bleeding or infection of the cyst. In the present case, the cause of the connection between the cystic cavity and the pyelocaliceal system is the increased pressure in the renal pelvic cavity due to the ureteral obstruction secondary to parailiac lymph node metastasis.

  8. Solitary eyelid schwannoma

    Renu M Magdum


    Full Text Available Schwannomas are rare benign tumors arising from Schwann cells of peripheral nerves that form the neural sheath. While there have been reports of such tumors in the orbit, solitary schwannomas arising from the eyelids are very rare. There are reports of schwannomas being erroneously diagnosed as chalazion, inclusion cysts or even eyelid malignancy. We are reporting a case of a 20-year-old female who presented with a painless, non-tender, slow-growing mass in the upper eyelid of the right eye. The external appearance of the mass was suggestive of an implantation cyst of the eyelid and it could be completely excised as it had a well-defined capsule. Histopathological examination showed characteristic hypercellular and hypocellular areas with fusiform nuclei that tended to form palisades. The purpose of reporting this case of schwannoma in a young female is to recommend the inclusion of this entity as a differential diagnosis of well-defined lid tumors.

  9. Solitary Polypoid Laryngeal Xanthoma

    Francisco Vera-Sempere


    Full Text Available We report the case of a 51-year-old male smoker with diabetes mellitus and hyperlipidaemia and a long history of human immunodeficiency virus (HIV/hepatitis C virus (HCV infection treated with various antiretroviral regimes, who was referred to the otolaryngology department with progressive dysphonia. Fibre-optic laryngoscopy showed a solitary, yellowish-white pedunculated polyp on the anterior third of the left cord, with no other abnormality. Pathological analysis revealed a polypoid laryngeal xanthoma that was immunoreactive against CD68, perilipin, and adipophilin. This unusual laryngeal lesion in the clinical context of our patient suggests a possible role of antiretroviral treatment in the pathogenesis of these xanthomas.

  10. Solitary fibrous tumor

    Manlio Mencoboni


    Full Text Available Solitary fibrous tumor (SFT is a rare mesenchymal neoplasm which may be found everywhere in the body. It is now distinguished into two forms, pleural and extrapleural, which morphologically resemble each other. Abdomi­nal localizations are quite rare, with 10 cases only reported in bladder; rarely they can be source of paraneoplastic syndromes (i.e., hypoglycemia secondary to insulin-like growth factor. In April 2006 a 74-year-old white male presented with chills, diaphoresis and acute abdominal pain with hematuria. At admission in emergency he underwent an abdominal X-ray (no pathological findings and an ultrasound examination of the kidneys and urinary tract, which revealed a pelvic hyperechogenic neoformation measuring approximately 10¥8¥7 cm, compressing the bladder. Blood chemistry at admission revealed only a mild neutrophilic leucocytosis (WBC 16600, N 80%, L 11%, elevated fibrinogen and ESR, and hypoglycemia (38 mg/dL. Macro­scopic hematuria was evident, while urinocolture was negative. Contrast enhanced CT scan of the abdomen and pelvic region revealed a large round neoformation dislocating the bladder, with an evident contrast-enhanced periphery and a central necrotic area. Continuous infusion of glucose 5% solution was necessary in order to maintain blood glucose levels above 50 mg/dL. The patient underwent complete surgical resection of an ovoidal mass coated by adipose tissue, with well delimited margins; histological findings were consistent with solitary fibrous tumor (SFT. Hypoglycemia resolved completely with removal of the growth. In this case report we describe a SFT growing in the bladder, a quite rare localization, which presented a unique hypoglycemia. In contrast to the majority of cases reported in the literature, the behavior of this SFT was not aggressive, and, since the patient is still alive, surgical resection was considered conclusive.

  11. [Intrinsic ureteral endometriosis: description of a striking instance].

    Antonelli, Alessandro; Finotto, Elena; Zambolin, Tiziano; Fisogni, Simona; Simeone, Claudio


    Intrinsic ureteral endometriosis is a very rare condition. A 41 y. o. woman with right hydroureteronephrosis and other aspecific symptoms came to our attention. The CT scan showed an ureteral obstacle causing the hydroureteronephrosis. She underwent ureterorenoscopy with biopsies of the lesion that did not result to be diriment. Suspecting a ureteral neoplasm, the patient then underwent ureteral resection and ureterocystoneostomy, and the extemporary histological examination resulted as endometriosis. The abdominal exploration showed a parametrial and a peritoneal growth - both compatible with the extemporary histological examination - that were also excised. The post-operative course was uneventful. The definitive hystological examination confirmed the perioperatory diagnosis. Intrinsic ureteral endometriosis is confirmed as a rare pathology with an indefinite clinical presentation; its typical presentation, namely cyclic hematuria, seems to be an anecdotal feature. Therefore the diagnostics of intrinsic ureteral endometriosis is still difficult even despite such a striking presentation.

  12. A mathematical simulation of the ureter: effects of the model parameters on ureteral pressure/flow relations.

    Vahidi, Bahman; Fatouraee, Nasser; Imanparast, Ali; Moghadam, Abbas Nasiraei


    Ureteral peristaltic mechanism facilitates urine transport from the kidney to the bladder. Numerical analysis of the peristaltic flow in the ureter aims to further our understanding of the reflux phenomenon and other ureteral abnormalities. Fluid-structure interaction (FSI) plays an important role in accuracy of this approach and the arbitrary Lagrangian-Eulerian (ALE) formulation is a strong method to analyze the coupled fluid-structure interaction between the compliant wall and the surrounding fluid. This formulation, however, was not used in previous studies of peristalsis in living organisms. In the present investigation, a numerical simulation is introduced and solved through ALE formulation to perform the ureteral flow and stress analysis. The incompressible Navier-Stokes equations are used as the governing equations for the fluid, and a linear elastic model is utilized for the compliant wall. The wall stimulation is modeled by nonlinear contact analysis using a rigid contact surface since an appropriate model for simulation of ureteral peristalsis needs to contain cell-to-cell wall stimulation. In contrast to previous studies, the wall displacements are not predetermined in the presented model of this finite-length compliant tube, neither the peristalsis needs to be periodic. Moreover, the temporal changes of ureteral wall intraluminal shear stress during peristalsis are included in our study. Iterative computing of two-way coupling is used to solve the governing equations. Two phases of nonperistaltic and peristaltic transport of urine in the ureter are discussed. Results are obtained following an analysis of the effects of the ureteral wall compliance, the pressure difference between the ureteral inlet and outlet, the maximum height of the contraction wave, the contraction wave velocity, and the number of contraction waves on the ureteral outlet flow. The results indicate that the proximal part of the ureter is prone to a higher shear stress during

  13. Ureteral Metastasis Secondary to Prostate Cancer: A Case Report

    I. Morales


    Full Text Available Prostate cancer is very frequent, but secondary ureteral metastasis are extremely rare. We present a 55 year old man with a 2 month history of right flank pain and lower urinary tract symptoms. Prostatic specific antigen of 11.3 ng/mL. Computed tomography showed right hydroureteronephrosis, a developing urinoma and right iliac adenopathies. He underwent right ureteronephrectomy, iliac lymphadenectomy and prostate biopsy. Pathology revealed prostatic carcinoma infiltrating the ureteral muscularis propria, without mucosal involvement. There are 46 reported cases of prostate cancer with ureteral metastases. Ureteral metastasis are a rare cause of renal colic and need of a high index of suspicion.

  14. Challenges in treatment and diagnosis of forgotten/encrusted double-J ureteral stents: the largest single-center experience.

    Adanur, Senol; Ozkaya, Fatih


    We aimed to evaluate the effectiveness of the endourologic management of forgotten and/or encrusted ureteral stents together with our single-center experience. Fifty-four patients with forgotten double-J ureteral stents were treated in our center between January 2008 and March 2014. Encrustation and the related stone burdens were estimated by using computerized tomography and kidney-ureter-bladder radiography. The management method was chosen based on the stone burden or clinical and radiological findings. Fifty-four patients, 39 males and 15 females, were included in the study. The average age of the patients was 38.2 ± 25.06 (2-86) years. The average indwelling time of the ureteral stents was 22.6 ± 30.3 (6-144) months. Six of the patients with forgotten stents had solitary kidneys. The double-J stent (DJS) was fragmented in four (7.4%) patients. A urinary system infection was present in 15 (27.7%) of the patients. The ureteral stents and related stones were successfully removed without any complications by combined endourologic techniques to achieve a stone-free state in all patients except for patient with 110 months of forgotten stent time in whom nephrectomy was performed for a nonfunctioning kidney related to the forgotten stent. Forgotten/encrusted DJS may lead to complications in a range of urinary system infections, up to a loss of renal function. They can be safely and successfully removed, and the renal function can be preserved by endourologic techniques, starting with the least invasive procedures in centers highly experienced.

  15. Renal access in PNL under sonographic guidance: Do we really need to insert an open end ureteral catheter in dilated renal systems? A prospective randomized study.

    Eryildirim, Bilal; Tuncer, Murat; Camur, Emre; Ustun, Fatih; Tarhan, Fatih; Sarica, Kemal


    To evaluate the true necessity of open end ureteral catheter insertion in patients with moderate to severe pelvicalyceal system dilation treated with percutaneous nephrolithotomy (PNL) under sonographic guidance. 50 cases treated with PNL under sonographic guidance in prone position for solitary obstructing renal stones were evaluated. Patients were randomly divided into two groups; Group 1: Patients in whom a open end ureteral catheter was inserted prior to the procedure; Group 2: Patients receiving no catheter before PNL. In addition to the duration of the procedure as a whole and also all relevant stages as well, radiation exposure time, hospitalization period, mean nephrostomy tube duration, mean drop in Hb levels and all intra and postoperative complications have been evaluated. Mean size of the stones was 308.5 ± 133.2 mm2. Mean total duration of the PNL procedure in cases with open end ureteral catheter was significantly longer than the other cases (p < 0.001). Evaluation of the outcomes of the PNL procedures revealed no statistically significant difference between two groups regarding the stone-free rates (86% vs 84%). Additionally, there was no significant difference with respect to the duration of nephrostomy tube, hospitalization period and secondary procedures needed, complication rates as well as the post-operative Hb drop levels in both groups (p = 0.6830). Our results indicate that the placement of an open end ureteral catheter prior to a PNL procedure performed under sonographic access may not be indicated in selected cases presenting with solitary obstructing renal pelvic and/or calyceal stones.

  16. Proximal Hypospadias

    Kate H. Kraft


    Full Text Available Hypospadias results from abnormal development of the penis that leaves the urethral meatus proximal to its normal glanular position. Meatal position may be located anywhere along the penile shaft, but more severe forms of hypospadias may have a urethral meatus located at the scrotum or perineum. The spectrum of abnormalities may also include ventral curvature of the penis, a dorsally redundant prepuce, and atrophic corpus spongiosum. Due to the severity of these abnormalities, proximal hypospadias often requires more extensive reconstruction in order to achieve an anatomically and functionally successful result. We review the spectrum of proximal hypospadias etiology, presentation, correction, and possible associated complications.

  17. Forgotten ureteric stents in renal transplant recipients: three case reports.

    Bardapure, Mallikarjun; Sharma, Ajay; Hammad, Abdul


    Ureteric stents are widely used in renal transplantation to minimize the early urological complications. Ureteric stents are removed between two and 12 weeks following trans-plantation, once the vesico-ureteric anastomosis is healed. Ureteric stents are associated with considerable morbidity due to complications such as infection, hematuria, encrustations and migration. Despite the patient having a regular follow-up in the renal transplant clinic, ureteric stents may be overlooked and forgotten. The retained or forgotten ureteric stents may adversely affect renal allograft function and could be potentially life-threatening in immunocompromised transplant recipients with a single transplant kidney. Retrieving these retained ureteric stents could be challenging and may necessitate multimodal urological treatments. We report three cases of forgotten stents in renal transplant recipients for more than four years. These cases emphasize the importance of patient education about the indwelling ureteric stent and possibly providing with a stent card to the patient. Maintaining a stent register, with a possible computer tracking system, is highly recommended to prevent such complications.

  18. Microscopic hematuria and calculus-related ureteral obstruction.

    Stewart, D P; Kowalski, R; Wong, P; Krome, R


    The evaluation of patients with ureteral calculi in the emergency department has historically included urinalysis (UA) and intravenous pyelograms (IVP). This retrospective study was done to determine if a statistically significant relationship existed between the degree of calculus-related ureteral obstruction, proven by IVP, and the presence or absence of microscopic hematuria. Urine red blood cells were recorded as less than 3 rbc/hpf (negative) or greater than or equal to 3 rbc/hpf (positive). IVPs were recorded as nonsevere or severe. IVP criteria were based on the presence or absence of extravasation, greater than 2-hour ureteral filling times, and a numerical scoring system of 1 to 4 for ureteral or calyceal dilatation and nephrogenic effect. Eighty-nine men (72%) had non-severe obstructions and 34 (28%) had severe obstructions. Twenty-five women (68%) had nonsevere obstructions and 12 (32%) had severe obstructions. Of the 28 patients with normal UAs, 11 had severe ureteral obstructions and 17 had nonsevere ureteral obstructions. There were no statistically significant differences between the presence or absence of significant microscopic hematuria and the presence or absence of severe ureteral obstruction. Microscopic hematuria is neither sensitive nor specific in determining the degree of calculus-related ureteral obstruction.

  19. Endourological management of ureteral obstruction after renal transplantation

    Bosma, RJ; vanDriel, MF; vanSon, WJ; deRuiter, AJ; Mensink, HJA


    Purpose: We evaluated endourological treatment of ureteral obstruction after renal transplantation. Materials and Methods: Between January 1986 and December 1993, 582 kidney transplantations were performed at our center, and ureteral obstruction was suspected in 31 cases (5.3%). Results: Initial tre

  20. Ureteral injuries during photoselective vaporization of the prostate

    Højgaard, M; Mikines, K.J.


    orifices are described, with hidden orifices, intravesical prostatic adenomas and prior prostatectomy as risk factors for laser-related injuries to ureteral orifices. A laser-coagulated ureteral orifice does not seem to regain patency spontaneously, so rapid nephrostomy and subsequent DJ stenting...

  1. Forgotten ureteric stents in renal transplant recipients: Three case reports

    Mallikarjun Bardapure


    Full Text Available Ureteric stents are widely used in renal transplantation to minimize the early urological complications. Ureteric stents are removed between two and 12 weeks following trans-plantation, once the vesico-ureteric anastomosis is healed. Ureteric stents are associated with considerable morbidity due to complications such as infection, hematuria, encrustations and migration. Despite the patient having a regular follow-up in the renal transplant clinic, ureteric stents may be overlooked and forgotten. The retained or forgotten ureteric stents may adversely affect renal allograft function and could be potentially life-threatening in immunocompromised transplant recipients with a single transplant kidney. Retrieving these retained ureteric stents could be challenging and may necessitate multimodal urological treatments. We report three cases of forgotten stents in renal transplant recipients for more than four years. These cases emphasize the importance of patient education about the indwelling ureteric stent and possibly providing with a stent card to the patient. Maintaining a stent register, with a possible computer tracking system, is highly recommended to prevent such complications.

  2. [Appendicular ureteroplasty to repair a ureteric lesion during disk surgery].

    Joual, Abdenbi; Taha, Abdellatif; Querfani, Badereddine; Sahnoun, Abderrazak; Hamid, Fekak; El Mrini, Mohamed


    Extensive ureteric lesions raise difficult problems of surgical repair. This is also the case for upper ureteric lesions that often require replacement of the damaged segment or even autologous transplantation. The authors report a case of iatrogenic ureteric lesion resulting in a large defect in a patient operated 6 months previously for an L4-L5 disk hernia, which was treated successfully by interposition of an appendicular graft between the two ureteric stumps. In the light of this case, the authors discuss the various appearances of iatrogenic ureteric lesions with particular emphasis on the value of appendicular ureteroplasty due to its simplicity and low morbidity, while waiting for progress in the field of biocompatible substitutes.

  3. Severe Vesico-ureteral Reflux and Urine Sequestration: Mathematical Relations and Urodynamic Consequences

    de Jesus, Lisieux Eyer


    Some simple mathematical formulae to calculate the volumes of proximal pyeloureteral reflexive systems are presented, and the results are compared to bladder capacity values. Using the results of the calculi, the author discusses possible implications of severe urinary sequestration in the pyeloureteral systems. Using geometrical and topological approximations we calculate the volumes of ureters and renal pelvises, applying in vivo measurements obtained from conventional ultrasound, retrograde cystourethrograms and topographic anatomic references. Approximations use 2 decimals and assumed $\\pi$ value was 3.14. Ureteral and pyelic volumes are calculated, respectively, from the mathematical formula for the cylinder and cone volumes. Dolicomegaureter are compensated using proportional calculi. Bladder volumes are estimated from conventional formulae. Proximal urinary sequestration is compared between infants and older children with VUR. Mechanisms of direct induction of bladder urodynamic failure from VUR are su...

  4. Endourological Management of Forgotten Encrusted Ureteral Stents

    Kusuma V. R. Murthy


    Full Text Available PURPOSE: To present our experience and discuss the various endourological approaches for treating forgotten encrusted ureteral stents associated with stone formation. MATERIALS AND METHODS: From July 2006 to December 2008, 14 patients (11 men and 3 women with encrusted ureteral stents were analyzed. The average indwelling time of the stent was 4.9 years (range 1 to 12. Plain-film radiography was used to evaluate encrustation, stone burden, and fragmentation of the stents. Intravenous urogram and a Tc99m diethylene triamine penta acetic-acid renogram was used to assess renal function. RESULTS: In seven patients, the entire stent was encrusted, in three patients the encrustation was confined to the ureteral and lower coil part of the stent, two patients had encrustation of the lower coil, and minimal encrustation was observed in two patients. Percutaneous nephrolithotomy was performed in 5 cases and retrograde ureteroscopy with intra-corporeal lithotripsy in 9 patients. Cystolithotripsy was used to manage the distal coil of the encrusted stent in eight patients. Simple cystoscopic removal of the stents with minimal encrustation was carried-out in two cases. Looposcopy and removal of the stent was performed in one patient with an ileal conduit and retained stent. Only one patient required open surgical removal of the stent. Thirteen out of 14 patients were rendered stone and stent free in one session. All except two stents were removed intact and stone analysis of encrustation and calcification revealed calcium oxalate and calcium phosphate in the majority of the cases. CONCLUSION: Endourological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.

  5. Solitary mastocytoma in an adult

    Jain V


    Full Text Available A 24-year old female developed late onset solitary mastocytoma on the left forearm. She complained of intense pruritus off and on which was not associated with flushing of face and blister formation over the nodule. Darier′s sign was positive. Excisional biopsy was done and histopathology confirmed the diagnosis.

  6. Solitary waves and homoclinic orbits

    Balmforth, N.J.


    The notion that fluid motion often organizes itself into coherent structures has increasingly permeated modern fluid dynamics. Such localized objects appear in laminar flows and persist in turbulent states; from the water on windows on rainy days, to the circulations in planetary atmospheres. This review concerns solitary waves in fluids. More specifically, it centres around the mathematical description of solitary waves in a single spatial dimension. Moreover, it concentrates on strongly dissipative dynamics, rather than integrable systems like the KdV equation. One-dimensional solitary waves, or pulses and fronts as they are also called, are the simplest kinds of coherent structure (at least from a geometrical point of view). Nevertheless, their dynamics can be rich and complicated. In some circumstances this leads to the formation of spatio-temporal chaos in the systems giving birth to the solitary waves, and understanding that phenomenon is one of the major goals in the theory outlined in this review. Unfortunately, such a goal is far from achieved to date, and the author assess its current status and incompleteness.

  7. The bladder ran dry: bilateral ureteral obstruction.

    Schattner, Ami; Drahy, Yosef; Dubin, Ina


    A relatively young healthy man (barring obesity and distant gouty arthritis) was admitted with severe acute kidney injury (serum creatinine, 15.9 mg/dL) following acute gastroenteritis and occasional use of diclofenac. Abdominal ultrasound revealed mild left hydronephrosis due to staghorn stone and normal right kidney. Soon after, complete anuria necessitating haemodialysis developed without pain or evidence of infection. CT imaging revealed stones obstructing the right ureter. Following urological surgery, postobstructive diuresis developed and the serum creatinine came down to near normal. The stones were identified as uric acid stones.Anuria has a relatively narrow differential and painless (partially non-dilated) bilateral ureteral obstruction is a distinctly unusual cause. A review of the literature to cover all reported causes of bilateral ureteral obstruction is presented. Only a minority of cases were not associated with an underlying malignant disease or its treatment. The multifactorial aetiology of the patient's acute kidney injury (volume depletion, diclofenac and obstructive uropathy) is presented and discussed. © 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.


    Dejan Bratuš


    Full Text Available Background. In the article a case report of an eleven years old child who suffered an air rifle gunshot injury of his right ureter is presented.Methods. The child was admitted to the hospital without any subjective complaints while both ultrasound and CT scan showed a metallic alien body just below the hilus of his right kidney with no surrounding liquid collection. After the condition of the child had worsened with right lumbar and abdominal pain, the control CT scan showed a huge urinoma in his right retroperitoneum.Results. During a surgical exploration an ureteral injury was found with the pellet lying inside the right ureter just below the injury, causing an obstruction of the ureter. After the removal of the pellet and suturing of the ureter over a double J stent the child recovered without any sequels.Conclusions. The ureter is the least often injured genitourinary organ. The management of these injuries is usually straightforward and is primarily a problem of recognition at the initial presentation, especially of a patient with multiple injuries. The delayed presentation is principally responsible for the morbidity that is associated with a ureteral injury.

  9. [Experimental study regarding the ureteral cicatrization pattern in rabbit].

    Pintilie, R A; Grigorovici, Mirela


    This study aimed to elaborate an experimental model for ureteral cicatrization following surgical lesion, with direct involvement in urological therapy. The study was realized on a group of 9 female rabbits on which we have performed ureteral surgery. First surgical event consisted in partial cut of the left ureter following transperitoneal approach, ureteral stent insertion and the suture of the ureteral wound. The second surgical event has accomplished the harvesting of the ureteral fragment during cicatrisation process and was performed at various times from the first surgical event, accordingly at 1, 2, 3...6 days--on different rabbits. 3 rabbits composed the witness group. Fragments were fixed in formol 4%, and histologically stained with hematoxilin-eosin and van Gieson. In the first two days we have observed an obvious inflammatory process on the postoperative ureteral scar. In days 3 and 4, the limited fibrosis appeared in the 2nd day engaged a peak in the 4th day when appeared a sketch of ureteral lumen constriction. In the 5th and 6th day the fibrosis process underwent a moderate resolution, simultaneously with a local diffuse congestion, marker for the remodeling processes of the connective matrix. Animal cicatrisation model follows the same pattern as in human but at different timing so as extrapolation requires considering these facts.


    Chun-yan Li; Hong-qing Wang; Hai-yuan Liu; Jing-he Lang


    Objective To investigate the clinical features and management ofureteral endometriosis.Methods Patients surgically and histologically diagnosed as ureteral endometriosis from January 2001 to January 2007 in Peking Union Medical College Hospital were retrospectively reviewed.Results Ten patients were diagnosed as ureteral endometriosis among 7561 cases with surgically and histologically proved diagnosis of endometriosis,with an incidence of 0.132%.Nine out of 10 patients were extrinsic ureteral endometriosis and concomitant with severe pelvic endometriosis,and the other was intrinsic ureteral endometriosis.Hormone therapy failed in 2 patients with urinary tract obstruction.Ureterolysis was performed in 6 patients and ureterectomy was performed in 4 patients.One ease of ureteral recurrence was observed in a postmenopausal woman without hormonal replacement therapy who received laparoscopic ureterolysis and hysterectomy with bilateral adnexectomy.No relapse was observed in the other 9 patients.Conclusions Ureteral endometriosis is a rare entity.The upper urinary tract should be evaluated in patients with severe endometriosis,even in postmenopausal women.The treatment of ureteral endometriosis usually requires surgery,while ureterolysis should not be performed in patients with extensive disease.As a form of adjuvant therapy of surgery,hormonal therapy is an appropriate option.

  11. Percutaneous ureteral stent placement for the treatment of a benign ureteral obstruction in a Sumatran tiger (Panthera tigris sumatrae).

    Delk, Katie W; Wack, Raymund F; Burgdorf-Moisuk, Anne; Palm, Carrie A; Zwingenberger, Allison; Glaiberman, Craig B; Ferguson, Kenneth H; Culp, William T N


    A 15-year-old, 113 kg intact male Sumatran tiger (Panthera tigris sumatrae) was evaluated for weight loss, polydipsia, and intermittent hematuria. The tiger was immobilized for diagnostic testing including blood work, urinalysis, and abdominal ultrasound. Laboratory testing demonstrated macro- and microhematuria, azotemia, and an increased urine protein:creatinine ratio. Abdominal ultrasound revealed bilateral ureterolithiasis as well as hydronephrosis and ureteral dilation. Ultrasonography performed 5 months later revealed worsening of the right-sided hydronephrosis and hydroureter and a decrease in the severity of dilation on the left side presumably from passage of the left-sided ureteral calculi. Nephroureteral decompression via the placement of a stent was elected. A pigtail ureteral catheter (8.2 French diameter) was placed in the right ureter via an antegrade percutaneous approach utilizing ultrasound and fluoroscopic-guidance. Following stent placement, macrohematuria resolved although microhematuria was noted in opportunistic urine samples. Five months after stent placement, the azotemia had mildly progressed, the urine protein:creatinine ratio was improved, the right hydronephrosis and hydroureter had completely resolved, and the ureteral stent remained in the appropriate position. The tiger had clinically improved with a substantial increase in appetite, weight, and activity level. Ureteral stenting allowed for nephroureteral decompression in the captive large felid of this report, and no complications were encountered. Ureteral stenting provided a minimally invasive method of managing ureteral obstruction in this patient and could be considered in future cases due to the clinical improvement and low morbidity.

  12. Vesical-ureteral reflux in children; Reflux vesico-ureteral chez l`enfant

    Desvignes, V.; Palcoux, J.B. [Hotel-Dieu, 63 - Clermont-Ferrand (France); Cochat, P. [Hopital Edouard-Herriot, 69 - Lyon (France)


    The vesical-ureteral reflux is the most frequent uropathy in children. The diagnosis is made by uretero-cystography, often after pyelonephritis, sometimes after ante-natal diagnosis from echographic abnormalities. Spontaneous recovery is possible in 50 to 80% of cases. This is especially true in grade 1, 2 and 3, however complications may occur. They are more frequent in the case of reflux nephropathy with a resulting risk of hypertension and chronic renal failure. The therapeutic choice is between the conservative management with urinary antiseptics ad the surgical treatment with ureters re-implantation or endoscopic treatment. The therapeutic indications take into account vesical-ureteral reflux grades, the child`s age, the associated diseases and the child`s and parents` compliance. (authors). 22 refs., 2 figs.

  13. How experimentally to detect a solitary superconductivity in dirty ferromagnet-superconductor trilayers?

    Avdeev, Maxim V.; Proshin, Yurii N.


    We theoretically study the proximity effect in the thin-film layered ferromagnet (F) - superconductor (S) heterostructures in F1F2S design. We consider the boundary value problem for the Usadel-like equations in the case of so-called ;dirty; limit. The ;latent; superconducting pairing interaction in F layers taken into account. The focus is on the recipe of experimental preparation the state with so-called solitary superconductivity. We also propose and discuss the model of the superconducting spin valve based on F1F2S trilayers in solitary superconductivity regime.

  14. Use of Mitrofanoff and Yang–Monti Techniques as Ureteric ...

    Distal ureteric stricture is a common complication of urinary schistosomiasis which is a ... We report the case of a 17-year-old Nigerian with a long standing recurrent painless ... The patient had bilateral tube nephrostomy and antibiotic therapy.

  15. Spontaneous ureteral rupture in a patient with systemic lupus erythematosus

    Benson, C.H.; Pennebaker, J.B.; Harisdangkul, V.; Songcharoen, S.


    A patient with known systemic lupus erythematosus had fever and symptoms of a lower urinary tract infection. Bone scintigraphy showed left ureteral perforation and necrosis with no demonstrable nephrolithiasis. It is speculated that this episode was due to lupus vasculitis.

  16. An Indwelling Ureteral Stent Forgotten for Over 12 Years

    Bidnur, Samir; Huynh, Melissa; Hoag, Nathan


    Abstract Ureteral stents are one of the most commonly used urologic devices with the purpose of establishing and maintaining ureteral patency. They are also associated with a number of complications including infection, migration, stent-related symptoms, and encrustation, leading to lithiasis. Prolonged stent dwell time is associated with a greater degree of these complications. We present the case of a 36-year-old man who presented with a severely encrusted ureteral stent that had been placed 12.5 years prior for an obstructive left-sided ureteral stone and was lost to follow-up. The patient underwent a combination of percutaneous nephrolithomy, cystolitholapaxy, and ureteroscopy to remove the stent and associated 1.7 cm renal pelvic stone and 4.1 cm bladder stone, necessitating two operative sittings to render him stone free. PMID:27579442

  17. Outcome of ureteroscopy for the management of distal ureteric ...

    M. El-Qadhi

    Significant advancement has been made in the medical and surgical management of urolithiasis over ... (MET) for stone passage, antegrade ureteroscopy, laparoscopic and open ureterolithotomy [6]. Ureteroscopy remained ..... Extracorporeal shock wave lithotripsy vs uretroscopic management for ureteral calculi. Cochrane ...

  18. Inoperable aggressive mesenteric fibromatosis with ureteric fistula

    Khanna, Paritosh C. [Radiology Department, Nanavati Hospital, Mumbai (India)]. E-mail:; Lath, Chinar [Radiology Department, Nanavati Hospital, Mumbai (India); Gadewar, Swapna B. [Radiology Department, Nanavati Hospital, Mumbai (India); Agrawal, Dilpesh [Internal Medicine Department, Wockhardt Hospital, Mumbai (India)


    The purpose of our report is to illustrate an aggressive case of mesenteric fibromatosis in a 17-year-old girl with a ureteric fistula and to review imaging and pathological features, natural history and treatment options of this disease. Our patient underwent computed tomography that revealed a widespread intra-abdominal mass. The necrotic centre of this mass had a fistulous communication with the right ureter. Fibromatoses represent a spectrum of uncommon benign conditions characterised by proliferating fibrous tissue. The deep intra-abdominal form of mesenteric fibromatosis (MF), one of the rare subtypes of the 'fibromatoses' or 'desmoid tumours', grows rapidly and may become extensive. Surgery provides good results in limited disease and non-surgical modalities in cases of unresectable and residual disease.

  19. Ureteral stent retrieval using the crochet hook technique in females.

    Takashi Kawahara

    Full Text Available INTRODUCTION: We developed a method for ureteral stent removal in female patients that requires no cystoscopy or fluoroscopic guidance using a crochet hook. In addition, we also investigated the success rate, complications and pain associated with this procedure. METHODS: A total of 40 female patients (56 stents underwent the removal of ureteral stents. All procedures were carried out with the patients either under anesthesia, conscious sedation, or analgesic suppositories as deemed appropriate for each procedure including Shock Wave Lithotripsy (SWL, Ureteroscopy (URS, Percutaneous Nephrolithotomy (PCNL, and ureteral stent removal. At the time of these procedures, fluoroscopy and/or cystoscopy were prepared, but they were not used unless we failed to successfully remove the ureteral stent using the crochet hook. In addition, matched controls (comprising 50 stents which were removed by standard ureteral stent removal using cystoscopy were used for comparison purposes. RESULTS: A total of 47 of the 56 stents (83.9% were successfully removed. In addition, 47 of 52 (90.4% were successfully removed except for two migrated stents and two heavily encrusted stents which could not be removed using cystoscopy. Ureteral stent removal using the crochet hook technique was unsuccessful in nine patients, including two encrustations and two migrations. Concerning pain, ureteral stent removal using the crochet hook technique showed a lower visual analogue pain scale (VAPS score than for the standard technique using cystoscopy. CONCLUSIONS: Ureteral stent removal using a crochet hook is considered to be easy, safe, and cost effective. This technique is also easy to learn and is therefore considered to be suitable for use on an outpatient basis.

  20. Solitary angiokeratoma of the tongue.

    Sion-Vardy, Netta; Manor, Esther; Puterman, Max; Bodner, Lipa


    Angiokeratoma is a rare cutaneous lesion. It can be either a generalized systemic form, presenting as multiple asymptomatic papules on the skin, associated with metabolic diseases or a solitary cutaneous form. Oral cavity involvement is more common in the systemic form, as a part of a more generalized cutaneous disease, but very rare in the localized form of angiokeratoma. A 45-year-old female presented with a painless lesion on the tongue of one months duration, which bled occasionally. On clinical examination, a lesion of approximately 5 mm in diameter was observed on the left surface of the tongue. The lesion was purple in color with a granulomatous appearance. There were no other changes in the oral mucosa. On dermatologic examination, no angiokeratomas were found, anywhere on the skin. The lesion was excised under local anesthesia. The histologic diagnosis was angiokeratoma. A case of a solitary angiokeratoma of the tongue is reported. We report here the third intra-oral case and the second case in the tongue with solitary angiokeratoma.

  1. Hemiresective reconstruction of a redundant ileal conduit with severe bilateral ileal conduit-ureteral re fl ux.

    Fujimura, Tetsuya; Minowada, Shigeru; Kishi, Hiroichi; Hamasaki, Kimihisa; Saito, Kiyoshi; Kitamura, Tadaichi


    A 58-year-old man was referred to our hospital with high fever and anuria. Since undergoing a total pelvic exenteration due to bladder-invasive sigmoid colon cancer, urinary tract infections had frequently occurred. We treated with the construction of a bilateral percutaneous nephrostomy (PCN), and chemotherapy. Although we replaced the PCN with a single J ureteral catheter after an improvement of infection, urinary infection recurred because of an obstruction of the catheter. Urological examinations showed that an ileal conduit-ureteral reflux caused by kinking of the ileal loop was the reason why frequent pyelonephritis occurred. We decided to resect the proximal segment to improve conduit-ureteral reflux for the resistant pyelonephritis. After the surgery, the excretory urogram showed improvement and the urinary retention at the ileal conduit disappeared. Three years after the operation, renal function has been stable without episodes of pyelonephritis. Here we report a case of open repair surgery of an ileal conduit in a patient with severe urinary infection.

  2. Symptomatic small non-obstructing lower ureteric calculi: comparison of ureteroscopy and extra corporeal shock wave lithotripsy.

    Andankar M


    Full Text Available OBJECTIVE: To compare the success, efficacy and complications of ureteroscopy (URS and extra corporeal shock wave lithotripsy (ESWL for the treatment of symptomatic small non obstructing lower ureteric calculi. SUBJECTS AND METHODS: This prospective non-randomised study was conducted simultaneously at two urological referral centres, included 280 patients with symptomatic small (4-10 mm lower ureteric calculi (situated below the sacroiliac joint, with good renal function on intravenous urography. Patients were offered both the treatment options. One hundred and sixty patients chose ureteroscopy, whereas 120 patients were treated by ESWL. Standard techniques of ureteroscopy and ESWL were employed. Patients were followed-up to assess the success rates and complications of the two procedures. RESULTS: Ureteroscopy achieved complete stone clearance in one session in 95% of patients. In six patients ureteroscopy had failed initially and was later accomplished in second session improving the success rate to 98.7%. Two patients had a proximal migration of calculus that needed ESWL. Of the 120 patients treated by ESWL, 90% achieved stone free status at three months. Ureteroscopy was needed for twelve patients (10% where ESWL failed to achieve stone clearance. There were no significant ESWL related complications. ESWL was administered on outpatient basis, while patients needed hospitalisation and anaesthesia for ureteroscopy. CONCLUSION: ESWL can be the primary mode of treatment for symptomatic small non-obstructing lower ureteric calculi as it is minimally invasive and safe. Ureteroscopy can be offered to patients who demand immediate relief or when ESWL fails.

  3. Magnetic resonance urography for diagnosis of pediatric ureteral stricture.

    Arlen, Angela M; Kirsch, Andrew J; Cuda, Scott P; Little, Stephen B; Jones, Richard A; Grattan-Smith, J Damien; Cerwinka, Wolfgang H


    Ureteral stricture is a rare cause of hydronephrosis in children and is often misdiagnosed on ultrasound (US) and diuretic renal scintigraphy (DRS), requiring intraoperative diagnosis. We evaluated ureteral strictures diagnosed by magnetic resonance urography (MRU) at our institution. Children with ureteral stricture who underwent MRU were identified. Patient demographics, prior imaging, MRU findings, and management were assessed. The efficacy of MRU in diagnosis of stricture was compared with US and DRS. Patients with ureteropelvic or ureterovesical junction obstruction were excluded. Twenty-eight ureteral strictures diagnosed by MRU between 2003 and 2013 were identified; 22% of strictures were diagnosed by DRS ± US. The mean age at MRU diagnosis was 2.4 years (range 4 weeks-15 years). Hydronephrosis was the most common presentation, accounting for 20 (71%) cases. Other etiologies included pain (3), incontinence (2), and urinary tract infection, cystic kidney, and absent kidney, present in one case each. A mean of 2.7 imaging studies was obtained prior to MRU diagnosis. Twenty-one (75%) ureteral strictures required surgical intervention, with the approach dependent upon location. MRU provides excellent anatomic and functional detail of the collecting system, leading to accurate diagnosis and management of ureteral stricture in children. Copyright © 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  4. The Role of Pharmacology in Ureteral Physiology and Expulsive Therapy

    Jerde, Travis J.; Nakada, Stephen Y.


    Research in the field of ureteral physiology and pharmacology has traditionally been directed toward relaxation of ureteral spasm as a mechanism of analgesia during painful ureteral obstruction, most often stone-induced episodes. However, interest in this field has expanded greatly in recent years with the expanded use of alpha-blocker therapy for inducing stone passage, a usage now termed "medical expulsive therapy". While most clinical reports involving expulsive therapy have focused on alpha receptor or calcium channel blockade, there are diverse studies investigating pharmacological ureteral relaxation with novel agents including cyclooxygenase inhibitors, small molecule beta receptor agonists, neurokinin antagonists, and phosphodiesterase inhibitors. In addition, cutting edge molecular biology research is revealing promising potential therapeutic targets aimed at specific molecular changes that occur during the acute obstruction that accompanies stone disease. The purpose of this report is to review the use of pharmacological agents as ureteral smooth muscle relaxants clinically, and to look into the future of expulsive therapy by reviewing the available literature of ureteral physiology and pharmacology research.

  5. Dissolution of Ureteral Uric Acid Calculi with Local Litholytic Irrigation

    CHEN Zhiqiang; YAO Linfang; YE Zhangqun; YANG Weimin


    Summary: This study was designed to evaluate the efficacy of local litholytic irrigation (LLI) in the treatment of ureteral uric acid calculi. Fourteen cases of ureteral uric acid calculi were diagnosed by abdominal plain radiography (KUB),retrograde urography,ultrasonography(B-mode ultrasound),spiral computerized tomography(CT) and blood biochemical examinations. A ureteral catheter was passed retrogradely across ureteral calculi by cystoscopy. LLI with tromethamine-E(THAM-E) was performed via the ureteral catheter after the improvement of renal function and general situation and the control of urinary tract infection under the condition of intravenous application of antibiotics. The irrigation rate varied from 1000 to 1500 ml per day. Retrograde pyelography demonstrated complete dissolution of all the stones,13 cases within 10 days and 1 within 12 days. Mild hematuria was observed in the majority of the cases and temporary aggravated lumbago in 1 case,with no other side effects. It is concluded that LLI is a practical and effective method in the treatment of ureteral uric acid calculi for its advantages of shorter duration,lower cost,less physical suffering and no severe complications.

  6. The GDNF target Vsnl1 marks the ureteric tip.

    Ola, Roxana; Jakobson, Madis; Kvist, Jouni; Perälä, Nina; Kuure, Satu; Braunewell, Karl-Heinz; Bridgewater, Darren; Rosenblum, Norman D; Chilov, Dmitri; Immonen, Tiina; Sainio, Kirsi; Sariola, Hannu


    Glial cell line-derived neurotrophic factor (GDNF) is indispensable for ureteric budding and branching. If applied exogenously, GDNF promotes ectopic ureteric buds from the Wolffian duct. Although several downstream effectors of GDNF are known, the identification of early response genes is incomplete. Here, microarray screening detected several GDNF-regulated genes in the Wolffian duct, including Visinin like 1 (Vsnl1), which encodes a neuronal calcium-sensor protein. We observed renal Vsnl1 expression exclusively in the ureteric epithelium, but not in Gdnf-null kidneys. In the tissue culture of Gdnf-deficient kidney primordium, exogenous GDNF and alternative bud inducers (FGF7 and follistatin) restored Vsnl1 expression. Hence, Vsnl1 characterizes the tip of the ureteric bud epithelium regardless of the inducer. In the tips, Vsnl1 showed a mosaic expression pattern that was mutually exclusive with β-catenin transcriptional activation. Vsnl1 was downregulated in both β-catenin-stabilized and β-catenin-deficient kidneys. Moreover, in a mouse collecting duct cell line, Vsnl1 compromised β-catenin stability, suggesting a counteracting relationship between Vsnl1 and β-catenin. In summary, Vsnl1 marks ureteric bud tips in embryonic kidneys, and its mosaic pattern demonstrates a heterogeneity of cell types that may be critical for normal ureteric branching.


    Lildal, Søren Kissow; Nørregaard, Rikke; Andreassen, Kim Hovgaard;


    OBJECTIVE: To examine the effect of ureteral access sheaths (UAS) on the expression of the proinflammatory mediators cyclooxygenase-2 (COX-2) and tumour necrosis factor-α (TNF-α) in the ureteral wall. MATERIAL AND METHODS: In 22 pigs a ureteral access sheath was inserted and removed after 2 minutes......, respectively. CONCLUSION: The pro-inflammatory mediators COX-2 and TNF-α were significantly up-regulated in the ureteral wall by the influence of ureteral access sheaths. These findings may have implications for postoperative pain, drainage and complications....

  8. Multi-component optical solitary waves

    Kivshar, Y. S.; Sukhorukov, A. A.; Ostrovskaya, E. A.


    We discuss several novel types of multi-component (temporal and spatial) envelope solitary waves that appear in fiber and waveguide nonlinear optics. In particular, we describe multi-channel solitary waves in bit-parallel-wavelength fiber transmission systems for highperformance computer networks......, multi-color parametric spatial solitary waves due to cascaded nonlinearities of quadratic materials, and quasiperiodic envelope solitons due to quasi-phase-matching in Fibonacci optical superlattices. (C) 2000 Elsevier Science B.V. All rights reserved....

  9. Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy

    Juan, Hsu-Cheng; Chou, Yii-Her [Kaohsiung Medical University Hospital, Department of Urology, Kaohsiung (China); Lin, Hung-Yu [Kaohsiung Medical University, Graduate Institute of Medicine, Kaohsiung (China); E-Da Hospital/ I-Shou University, Department of Urology, Kaohsiung (China); Yang, Yi-Hsin [Kaohsiung Medical University, Institute of Oral Health Sciences, Kaohsiung (China); Shih, Paul Ming-Chen [Kaohsiung Municipal Hsiao-Kang Hospital, Department of Radiology, Kaohsiung (China); Kaohsiung Medical University, Department of Radiology, Kaohsiung (China); Chuang, Shu-Mien [Yuh-Ing Junior College of Health Care and Management, Kaohsiung (China); Shen, Jung-Tsung [Kaohsiung Municipal Hsiao-Kang Hospital, Department of Urology, Kaohsiung (China); Juan, Yung-Shun [Kaohsiung Medical University Hospital, Department of Urology, Kaohsiung (China); Kaohsiung Medical University, Graduate Institute of Medicine, Kaohsiung (China); Kaohsiung Medical University, Department of Urology, Faculty of Medicine, Kaohsiung (China)


    To assess the effects of abdominal fat on shock wave lithotripsy (SWL). We used pre-SWL unenhanced computed tomography (CT) to evaluate the impact of abdominal fat distribution and calculus characteristics on the outcome of SWL. One hundred and eighty-five patients with a solitary ureteric calculus treated with SWL were retrospectively reviewed. Each patient underwent unenhanced CT within 1 month before SWL treatment. Treatment outcomes were evaluated 1 month later. Unenhanced CT parameters, including calculus surface area, Hounsfield unit (HU) density, abdominal fat area and skin to calculus distance (SSD) were analysed. One hundred and twenty-eight of the 185 patients were found to be calculus-free following treatment. HU density, total fat area, visceral fat area and SSD were identified as significant variables on multivariate logistic regression analysis. The receiver-operating characteristic analyses showed that total fat area, para/perirenal fat area and visceral fat area were sensitive predictors of SWL outcomes. This study revealed that higher quantities of abdominal fat, especially visceral fat, are associated with a lower calculus-free rate following SWL treatment. Unenhanced CT is a convenient technique for diagnosing the presence of a calculus, assessing the intra-abdominal fat distribution and thereby helping to predict the outcome of SWL. (orig.)

  10. Results of radiotherapy on ureteric obstruction in muscle-invasive bladder cancer

    Honnens De Lichtenberg, Mette; Miskowiak, J; Rolff, H


    To evaluate the effect of radiotherapy on ureteric obstruction due to muscle-invasive bladder cancer.......To evaluate the effect of radiotherapy on ureteric obstruction due to muscle-invasive bladder cancer....

  11. Removal of ureteral calculi in two geldings via a standing flank approach.

    Frederick, Jeremy; Freeman, David E; MacKay, Robert J; Matyjaszek, Sarah; Lewis, Jordan; Sanchez, L Chris; Meyer, Stephanie


    Two geldings, aged 11 and 17 years, were examined for treatment of ureteroliths located approximately 10 cm proximal to the bladder. Ureteral obstruction was an incidental finding in 1 horse that was referred because of urinary tract obstruction and a cystic calculus. This horse did not have clinical or laboratory evidence of renal failure, although severe hydronephrosis was evident on transabdominal ultrasonography. The second patient had a serum creatinine concentration of 6.3 mg/dL (reference range, 0.8 to 2.2 mg/dL) and mild hydronephrosis of the affected left kidney. In both patients, the obstructed ureter was exteriorized through a flank incision as a standing procedure, and the calculus was crushed and removed with a uterine biopsy forceps introduced through a ureterotomy approximately 25 cm proximal to the calculus. The cystic calculus was removed through a perineal urethrostomy by lithotripsy, piecemeal extraction, and lavage. The horse without azotemia developed pyelonephritis in the affected kidney and was euthanatized because of complications of a nephrectomy 13 months later. In the horse with azotemia, the serum creatinine concentration decreased after surgery, and the horse returned to its intended use. However, it was euthanatized approximately 2 years after surgery because of progressive renal failure, and a large nephrolith was found in the previously unobstructed right kidney. The technique used for ureterolith removal was successful in both horses in this report, did not require sophisticated equipment, and could be effective in the early stages of ureteral obstruction as a means of restoring urine flow and renal function. The outcome in the horse with advanced unilateral renal disease without azotemia would suggest that nephrectomy should be considered as a treatment in such patients.

  12. [Solitary plasmocytoma of the mandible].

    Laurent, F; Chausse, J M; Toccanier, M F; Kuffer, R


    The authors present a case of solitary bony plasmocytoma of the mandibule, with local amyloid deposition. Diagnosis was made at extemporaneous pathological examination, then confirmed by the examination of the fixed surgical sample. Immunoenzymologically the proliferation proved to be monoclonal, with secretion of kappa light chain. The patient was treated by surgical curettage and homologous cancelous bone filling, followed by 5,500 rads of electrontherapy. He was then regularly controlled during 8 years and remained free from local recurrence. All investigations in search of dissemination (Kahler disease) remained negative.

  13. Solitary Fibrous Tumor of the Stomach

    Hussain, Qulsoom; Shafique, Khurram; Hurairah, Abu; Grossman, Evan B.


    Solitary fibrous tumor is a rare mesenchymal neoplasm that usually originates from the pleura, but has been reported in other extrapleural locations. We report a rare case of a solitary fibrous tumor of the stomach, which was successfully treated with endoscopic mucosal resection. PMID:28286800

  14. Solitary Waves in Relativistic Electromagnetic Plasma

    XIE Bai-Song; HUA Cun-Cai


    Solitary waves in relativistic electromagnetic plasmas are obtained numerically. The longitudinal momentum of electrons has been taken into account in the problem. It is found that in the moving frame with electromagnetic field propagating the solitary waves can exist in both cases, where the vector potential frequency is larger or smaller than the plasma characteristic frequency.

  15. Outcomes of Extravesical Versus Intravesical Ureteral Reimplantation

    Leah P. McMann


    Full Text Available Purpose: The purpose of our study was to examine outcomes and compare length of stay after extravesical and intravesical ureteral reimplantation at our institution. Materials and Methods: Retrospective review was performed of 30 patients (55 ureters with vesicoureteral reflux who underwent either the Cohen (intravesical cross-trigonal procedure or the extravesical (detrusorrhaphy approach. Each patient had documented follow-up consisting of a postoperative renal ultrasound and/or a voiding cystourethrogram (VCUG. Inclusion criteria was the presence of primary vesicoureteral reflux. Exclusion criteria were patients who had undergone a previous repair and patients in whom results of neither the renal ultrasound nor the VCUG were available. Results: There were no significant cases of obstruction or wound infection with either approach. Two patients who underwent the extravesical approach had persistent reflux on VCUG three months postoperatively, but both resolved by fifteen months. Average length of stay was only 3.00 ± 1.33 days for the extravesical approach, compared to 5.36 ± 1.75 days for the intravesical approach ( P = .0003 . Conclusions: Given that by fifteen months success rates were the same with either approach, the extravesical approach is comparable to the intravesical technique and is a viable option in terms of outcome and economics given the shorter length of hospital stay.

  16. Forgotten and fragmented ureteral j stent with stone formation: combined endoscopic management.

    Sen, Volkan; Bozkurt, Halil Ibrahim; Yonguc, Tarık; Aydogdu, Ozgu; Yarimoglu, Serkan; Degirmenci, Tansu; Minareci, Suleyman


    Ureteral stents are widely used in endo-urological procedures. However, ureteral stents can be forgotten and cause serious complications, including fragmentation, migration and urosepsis.There are few reports about forgotten and fragmented ureteral stents with stone formation. We aimed to present this rare case with successful combined endo-urological management.

  17. Post appendectomy acalculus bilateral ureteric obstruction: A rare entity in children

    Vipul Gupta


    Full Text Available Bilateral acalculus ureteric obstruction is described as rare sequelae of acute appendicitis in two paediatric patients aged 6 and 11 years presented with features of anuria. Imaging and endoscopic evaluation confirmed bilateral ureteric obstruction secondary to bladder wall oedema as an inflammatory reaction to appendix. Both cases recovered following bilateral ureteric stenting and are doing well.

  18. Forgotten and fragmented ureteral j stent with stone formation: combined endoscopic management

    Volkan Sen


    Full Text Available ABSTRACTObjective : Ureteral stents are widely used in endo-urological procedures. However, ureteral stents can be forgotten and cause serious complications, including fragmentation, migration and urosepsis.There are few reports about forgotten and fragmented ureteral stents with stone formation. We aimed to present this rare case with successful combined endo-urological management.

  19. [Subcutaneous ureteral bypass devices as a treatment option for bilateral ureteral obstruction in a cat with ureterolithiasis].

    Heilmann, Romy M; Pashmakova, Medora; Lamb, Jodie H; Spaulding, Kathy A; Cook, Audrey K


    A 6-year-old female spayed Domestic Shorthair cat was presented with acute lethargy, dehydration, marked azotemia, metabolic acidosis, left-sided renomegaly, and bilateral hydronephrosis. Ureterolithiasis and ureteral obstruction were suspected based on further diagnostics including abdominal sonography. Medical treatment was not successful. Fluoroscopically guided antegrade pyelography confirmed the diagnosis of bilateral ureteral obstruction due to ureterolithiasis. Subcutaneous ureteral bypass (SUB) devices were placed bilaterally, followed by close patient monitoring. Frequent reassessment of patient parameters and blood work served to adjust the fluid needs of the patient and to ensure proper hydration, correction of azotemia at an appropriate rate, and cardiovascular stability. After significant improvement of all patient parameters within 5 days, the patient was discharged from the hospital. Treatment included a dietary change to reduce the risk of stone formation as well as a phosphorus binder. Clinical and clinicopathologic parameters were unchanged at the 1- and 4- and 7-month rechecks (consistent with IRIS CKD stage II-NP-AP0), and both SUB devices continued to provide unobstructed urine flow. Bilateral placement of subcutaneous ureteral bypass devices may be a safe and potentially effective treatment option for acute bilateral ureteral obstruction in cats with ureterolithiasis. Strict patient monitoring and patient-centered postoperative treatment decisions are crucial to successful treatment outcomes.

  20. Stone Formation and Fragmentation in Forgotten Ureteral Double J Stent

    Okan Bas


    Full Text Available Aim: Nowadays, ureteral stents play an essential role in various endourological and open surgical procedures and common procedures performed in daily urological practice. However, stents can cause significant complications such as migration, infection, fragmentation, stone formation and encrustation, especially when forgotten for a long period. Objectives: We present our experience in endoscopic management of forgotten ureteral stents with a brief review of current literature. Case presentation: A total of 2 patients with forgotten ureteral stents were treated with endourological approaches in our department. Indwelling durations were 18 months and 36 months. After treatment both patients were stone and stent free. Conclusion: An endourological approach is effective for stent and stone removal after a single anesthesia session with minimal morbidity and short hospital stay. However, therapeutic strategy is also determined by the technology available. The best treatment would be the prevention of this complication by providing detailed patient education.

  1. Therapeutic ureteral occlusion with Ifabond cyanoacrylate glue: an interesting solution.

    Oderda, Marco; Lacquaniti, Sergio; Fraire, Flavio; Antolini, Jacopo; Camilli, Marco; Mandras, Roberto; Puccetti, Luca; Varvello, Francesco; Fasolis, Giuseppe


    The aim of this study was to present a novel approach for complete and permanent ureteral occlusion using a percutaneous injection of Ifabond cyanoacrylate glue. We describe in detail all the steps of our surgery, performed on a 79-year-old patient with urinary leakage from ureteral stump following radical cystectomy. N-hexyl-cyanoacrylate glue (Ifabond) was used to occlude the distal ureter and solve the leakage. Our approach was successful, sparing our already frail patient further surgical procedures. Six months pyelography confirmed the complete ureteral blockage with absence of extravasation. In complicated scenarios with urinary leakages and frail patients, synthetic glues such as Ifabond might represent an interesting therapeutic option to solve the fistulas, leading to durable success with a minimally invasive approach.

  2. Acute bilateral ureteral obstruction following Dextranomer/hyaluronic acid polymer injection: A case report

    Arnon Lavi


    Full Text Available Ureteral obstruction following bulking agent injection for treatment of vesicoureteral reflux is rare. Herein we report a case of acute bilateral ureteral obstruction following bilateral Dextranomer/hyaluronic acid polymer injection. The obstruction which manifested hours following the injection, was treated with prompt insertion of bilateral ureteral stents. The stents were removed 4 weeks later with complete resolution of the obstruction. We believe that ureteral stenting is an excellent solution for acute ureteral obstruction following Dextranomer/hyaluronic acid polymer injection

  3. Verification of relationships between anthropometric variables among ureteral stents recipients and ureteric lengths: a challenge for Vitruvian-da Vinci theory.

    Acelam, Philip A


    To determine and verify how anthropometric variables correlate to ureteric lengths and how well statistical models approximate the actual ureteric lengths. In this work, 129 charts of endourological patients (71 females and 58 males) were studied retrospectively. Data were gathered from various research centers from North and South America. Continuous data were studied using descriptive statistics. Anthropometric variables (age, body surface area, body weight, obesity, and stature) were utilized as predictors of ureteric lengths. Linear regressions and correlations were used for studying relationships between the predictors and the outcome variables (ureteric lengths); P-value was set at 0.05. To assess how well statistical models were capable of predicting the actual ureteric lengths, percentages (or ratios of matched to mismatched results) were employed. The results of the study show that anthropometric variables do not correlate well to ureteric lengths. Statistical models can partially estimate ureteric lengths. Out of the five anthropometric variables studied, three of them: body frame, stature, and weight, each with a Pvariables: age (R (2)=0.01; P=0.20) and obesity (R (2)=0.03; P=0.06), were found to be poor estimators of ureteric lengths. None of the predictors reached the expected (match:above:below) ratio of 1:0:0 to qualify as reliable predictors of ureteric lengths. There is not sufficient evidence to conclude that anthropometric variables can reliably predict ureteric lengths. These variables appear to lack adequate specificity as they failed to reach the expected (match:above:below) ratio of 1:0:0. Consequently, selections of ureteral stents continue to remain a challenge. However, height (R (2)=0.68) with the (match:above:below) ratio of 3:3:4 appears suited for use as estimator, but on the basis of decision rule. Additional research is recommended for stent improvements and ureteric length determinations.

  4. Endoscopic treatment of vesico-ureteral reflux: Experience of 99 ureteric moieties

    Minu Bajpai


    Full Text Available Aims: To study the outcome of endoscopic hyaluronic acid/dextranomer injection in patients with vesico-ureteric reflux (VUR. Materials and Methods: Sixty-three children were evaluated with a median follow up of 18 months (12-55 months before injecting hyaluronic acid/dextranomer in a total of 99 ureteric moieties. Median age at presentation was 24 months (6-72 months. Primary VUR was the main presenting diagnosis in 60%. Patients were monitored for urinary tract infection (UTI, glomerular filtration rate (GFR, renal scarring, persistence, or appearance of contra-lateral reflux. Results: Grade III VUR was the most common (38% followed by Grade IV (24%, Grade V (17%, Grade II (14%, and Grade I (7%. Most common cause for VUR was Primary (60%, followed by posterior urethral valve (PUV (19%, bladder exstrophy (5%, anorectal malformation (ARM, epispadias, and duplex system. Analysis of patients characteristics at presentation revealed renal scarring (40%, split renal functions 1.4 mg/dL (10%. Complete resolution (100% of Grade I and Grade II VUR was achieved after single injection. For Grade III VUR, single injection resolved reflux in 85.5% ureters, 100% resolution was seen after 2 nd injection. In Grade IV VUR, 1 st injection resolved VUR in 83.3% ureters, 95.8% ureters were reflux free after 2 nd injection, and 100% resolution was seen after 3 rd injection. In Grade V VUR, 94% ureters showed absent reflux after three injections. Conclusion: Hyaluronic acid/dextranomer injection holds promise even in higher grades of VUR.

  5. Proximal renal tubular acidosis

    Renal tubular acidosis - proximal; Type II RTA; RTA - proximal; Renal tubular acidosis type II ... by alkaline substances, mainly bicarbonate. Proximal renal tubular acidosis (Type II RTA) occurs when bicarbonate is not ...

  6. Transversally periodic solitary gravity–capillary waves

    Milewski, Paul A.; Wang, Zhan


    When both gravity and surface tension effects are present, surface solitary water waves are known to exist in both two- and three-dimensional infinitely deep fluids. We describe here solutions bridging these two cases: travelling waves which are localized in the propagation direction and periodic in the transverse direction. These transversally periodic gravity–capillary solitary waves are found to be of either elevation or depression type, tend to plane waves below a critical transverse period and tend to solitary lumps as the transverse period tends to infinity. The waves are found numerically in a Hamiltonian system for water waves simplified by a cubic truncation of the Dirichlet-to-Neumann operator. This approximation has been proved to be very accurate for both two- and three-dimensional computations of fully localized gravity–capillary solitary waves. The stability properties of these waves are then investigated via the time evolution of perturbed wave profiles. PMID:24399922

  7. Solitary Fibrous Tumor of the Uterus

    Po-Wei Chu


    Conclusion: The behavior of solitary fibrous tumors arising from the uterus is difficult to evaluate; therefore, complete surgical excision featuring clear margins and comprehensive follow-up is recommended.

  8. Management of the Solitary Pulmonary Nodule.

    Chan, Edward Y; Gaur, Puja; Ge, Yimin; Kopas, Lisa; Santacruz, Jose F; Gupta, Nakul; Munden, Reginald F; Cagle, Philip T; Kim, Min P


    Context .- Optimal management of the patient with a solitary pulmonary nodule entails early diagnosis and appropriate treatment for patients with malignant tumors, and minimization of unnecessary interventions and procedures for those with ultimately benign nodules. With the growing number of high-resolution imaging modalities and studies available, incidentally found solitary pulmonary nodules are an increasingly common occurrence. Objective .- To provide guidance to clinicians involved in the management of patients with a solitary pulmonary nodule, including aspects of risk stratification, workup, diagnosis, and management. Data Sources .- Data for this review were gathered from an extensive literature review on the topic. Conclusions .- Logical evaluation and management pathways for a patient with a solitary pulmonary nodule will allow providers to diagnose and treat individuals with early stage lung cancer and minimize morbidity from invasive procedures for patients with benign lesions.

  9. The efficacy of tamsulosin in lower ureteral calculi

    Griwan M


    Full Text Available Context: There has been a paradigm shift in the management of ureteral calculi in the last decade with the introduction of new less invasive methods, such as ureterorenoscopy and extracorporeal shock wave lithotripsy (ESWL. Aims: Recent studies have reported excellent results with medical expulsive therapy (MET for distal ureteral calculi, both in terms of stone expulsion and control of ureteral colic pain. Settings and Design: We conducted a comparative study in between watchful waiting and MET with tamsulosin. Materials and Methods: We conducted a comparative study in between watchful waiting (Group I and MET with tamsulosin (Group II in 60 patients, with a follow up of 28 days. Statistical Analysis: Independent ′t′ test and chi-square test. Results: Group II showed a statistically significant advantage in terms of the stone expulsion rate. The mean number of episodes of pain, mean days to stone expulsion and mean amount of analgesic dosage used were statistically significantly lower in Group II (P value is 0.007, 0.01 and 0.007, respectively as compared to Group I. Conclusions: It is concluded that MET should be considered for uncomplicated distal ureteral calculi before ureteroscopy or extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage.


    This report presents a model developed to study growth and differentiation of primary cultures of ureteric epithelial cells from embryonic C57BL/6N mouse urinary tracts. Single cells were resuspended in medium and plated onto transwells coated with collagen IV and laminin. Basa...

  11. Conservative numerical methods for solitary wave interactions

    Duran, A; Lopez-Marcos, M A [Departamento de Matematica Aplicada y Computacion, Facultad de Ciencias, Universidad de Valladolid, Paseo del Prado de la Magdalena s/n, 47005 Valladolid (Spain)


    The purpose of this paper is to show the advantages that represent the use of numerical methods that preserve invariant quantities in the study of solitary wave interactions for the regularized long wave equation. It is shown that the so-called conservative methods are more appropriate to study the phenomenon and provide a dynamic point of view that allows us to estimate the changes in the parameters of the solitary waves after the collision.

  12. Ureteroscopy and holmium laser lithotripsy: Is this procedure safe in pregnant women with ureteral stones at different locations?

    Senol Adanur


    Full Text Available Objectives: The aim of this study was to assess the safety and effectiveness of ureteroscopy and Holmium: Yttrium-Aluminum-Garnet lithotripsy for the treatment of ureteral stones with different localizations in symptomatic pregnant women. Methods: A retrospective analysis was performed on 19 pregnant patients referred to our center between January 2005 and December 2012 with symptomatic hydronephrosis requiring surgical intervention. 7.5 F and 9.5 F semirigid ureterorenoscopy with Holmium laser lithotripsy was used for treatment in all patients. Complications were stratified according to modified Clavien criteria. Results: The mean age of patients was 25.4 (18-41 years, and the mean gestation duration was 24.8 (7-33 weeks. Six cases (31.5% had a history of stone. Solitary kidney secondary to previous nephrectomy was observed in 2 patients and 1 patient had a hypoplastic kidney. Abdominal ultrasonography was used as the main diagnostic tool. Mean stone size was 9.2 mm (6-13. The location of the stones was the lower, middle, and upper ureter in 8 (42.1%, 5 (26.3% and 6 (31.5% cases, respectively. All stones were fragmented with Holmium laser lithotripsy. Of the 19 patients, 11 (57.8% required doublr J stent insertion peroperatively. Intraoperative urological and obstetric complications were not observed. Postoperatively two complications were noted. According to Clavien criteria a complication was level 1, and the other was level 2. Conclusions: For treatment of pregnant women with symptomatic ureteral stones in every location, Holmium laser lithotripsy with a semirigid ureteroscopy can be used as judicious treatment. This approach is effective and safe with an acceptable complication rate.

  13. The Cost-Effectiveness of Treatment Modalities for Ureteral Stones

    Justin Ji-Yuen Siu MD


    Full Text Available Additional intervention and medical treatment of complications may follow the primary treatment of a ureteral stone. We investigated the cost of the treatment of ureteral stone(s within 45 days after initial intervention by means of retrospective analysis of the National Health Insurance Research Database of Taiwan. All patients of ages ≥20 years diagnosed with ureteral stone(s( International Classification of Diseases, Ninth Revision, Clinical Modification/ICD-9-CM: 592.1 from January 2001 to December 2011 were enrolled. We included a comorbidity code only if the diagnosis appeared in at least 2 separate claims in a patient’s record. Treatment modalities (code included extracorporeal shock-wave lithotripsy (SWL; 98.51, ureteroscopic lithotripsy (URSL; 56.31, percutaneous nephrolithotripsy (PNL; 55.04, (open ureterolithotomy (56.20, and laparoscopy (ie, laparoscopic ureterolithotomy; 54.21. There were 28 513 patients with ureteral stones (13 848 men and 14 665 women in the randomized sample of 1 million patients. The mean cost was 526.4 ± 724.1 United States Dollar (USD. The costs of treatment were significantly increased in patients with comorbidities. The costs of treatment among each primary treatment modalities were 1212.2 ± 627.3, 1146.7 ± 816.8, 2507.4 ± 1333.5, 1533.3 ± 1137.1, 2566.4 ± 2594.3, and 209.8 ± 473.2 USD in the SWL, URSL, PNL, (open ureterolithotomy, laparoscopy (laparoscopic ureterolithotomy, and conservative treatment group, respectively. In conclusion, URSL was more cost-effective than SWL and PNL as a primary treatment modality for ureteral stone(s when the possible additional costs within 45 days after the initial operation were included in the calculation.

  14. Hook Phenomenon: Intermittent distal ureteral obstruction following reimplantation

    M. Mehdizadeh "


    Full Text Available Background/Objectives: To evaluate the child with intermittent ureteral obstruction following antireflux surgery and to introduce a new imaging technique for diagnosis of the socalled “hook” phenomenon, the most serious complication of antireflux surgery. Patients and Methods: Twenty-five children with a history of antireflux surgery who were referred for either persistent urinary tract infection (UTI or progressive hydronephrosis were included in the study. All the children with signs and symptoms of voiding dysfunction or persistent reflux were excluded. A new imaging technique was devised to evaluate these patients for the presence of “hook phenomenon”, in which a renal ultrasound was performed both on a full bladder and after voiding. If dilatation of the urinary tract was detected on full bladder, and this dilatation decreased dramatically following micturition, then a catheter was passed into the bladder and was filled with normal saline (based on the estimated bladder capacity in order to avoid over-distension. An intravenous urogram and saline cystogram were performed simultaneously. After 20 minutes, 2 abdominal radiographs were obtained on full and emptied bladder, both. Results: On the intravenous urogram, some children showed typical “J- hook-shaped” ureters. In all the cases marked hydronephrosis was noted, with no contrast material seen entering the bladder on the 20 minute radiogram. Upon evacuation of the bladder, both ureters promptly drained into the bladder and the”J-hooking” of the ureters and hydronephrosis resolved. Conclusion: "J- hook phenomenon” is one of the most common causes of hydronephrosis and hydroureter following ureteral re-implantation is intermittent ureteral obstruction from creation of the new ureteral hiatus at an inappropriate site. This complication is frequently misdiagnosed as irreversible uretero-vesical junction obstruction from ischemia or fibrosis. Once the diagnosis of “J- hook


    Nishiyama, Ryuichi; Kubota, Masashi; Kanno, Toru; Okada, Takashi; Higashi, Yoshihito; Yamada, Hitoshi


    A 69-year-old woman visited our hospital with a chief complaint of fever. Five years ago, she was diagnosed as ascending colon cancer and received right hemi-colectomy. One year later, local recurrence with right hydronephrosis was detected, and she received chemotherapy -4 cycles of modified fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) plus bevacizumab, and 12 cycles of fluorouracil, leucovorin, and irinotecan (FOLFIRI) plus bevacizumab- for two years. Local recurrence and right hydronephrosis disappeared on positron emission tomography performed 4 years postoperatively. This time, abdominal computed tomography for investigation of fever showed a relapse of right hydronephrosis and pyonephrosis. Cystoscopy revealed non-papillary tumor from the right ureteral orifice. Pelvic magnetic resonance imaging showed multiple tumors in the right ureter, and the distal lesion projecting into the bladder. After the general condition became well by right nephrostomy for infection control, transurethral resection of bladder tumor was performed. Histological examination of the specimen revealed a metastatic tubular adenocarcinoma (colon origin). Although right nephrectomy was performed for pyonephrosis control, she died of local progression of ascending colon cancer 10 months after first visit. Intraluminal ureteral progression of carcinoma originating from organs other than urinary tract is very rare. To our knowledge, this is the 9th report in the English or Japanese literature. In this case we could not rule out primary ureteral cancer preoperatively, and histological examination revealed intraluminal ureteral dissemination of ascending colon cancer.

  16. Placement of subcutaneous ureteral bypasses without fluoroscopic guidance in cats with ureteral obstruction: 19 cases (2014-2016).

    Livet, Véronique; Pillard, Paul; Goy-Thollot, Isabelle; Maleca, David; Cabon, Quentin; Remy, Denise; Fau, Didier; Viguier, Éric; Pouzot, Céline; Carozzo, Claude; Cachon, Thibaut


    The purpose of this study was to describe the perioperative and postoperative complications as well as short-term and long-term outcomes in cats with ureteral obstructions treated by placement of a subcutaneous ureteral bypass (SUB) device without imaging control. The second objective of this study was to compare cats treated by SUB device with cats treated by traditional surgical intervention. Data were obtained retrospectively from the medical records (2014-2016) of cats that underwent SUB placement (SUB cats) and cats that underwent traditional ureteral surgery (C cats). Nineteen SUB devices were placed without fluoroscopic, radiographic or ultrasonographic guidance in 13 cats. Fifteen traditional interventions (ureterotomy and neoureterocystostomy) were performed in 11 cats. Successful placement of the SUB device was achieved in all cats with only one major intraoperative complication (kinking of the kidney catheter) and one minor intraoperative complication (misplacement of the kidney catheter). Eleven SUB cats recovered from the surgical procedure; two SUB cats and three C cats died during the anaesthesia recovery period. Postoperative SUB complications included anaemia (n = 2), urinary tract infection (UTI) (n = 4), non-infectious cystitis (n = 5) and SUB device obstruction (n = 1). Postoperative traditional surgery complications included anaemia (n = 7), UTIs (n = 6), non-infectious cystitis (n = 1), re-obstruction (n = 4) and ureteral stricture (n = 1). Median postoperative duration of hospitalisation (3 days) was significantly shorter for SUB cats than for C cats (P = 0.013). Ten SUB cats (76.9%) and four C cats (40%) were still alive at a median follow-up of 225 days and 260 days, respectively. Owners were completely (90%) or mostly (10%) satisfied with the SUB device placement. SUB device placement appears to be an effective and safe option for treating ureteral obstruction in cats, and this study has shown that fluoroscopic guidance is not essential in

  17. Management of iatrogenic ureteric injury with retrograde ureteric stenting: an analysis of factors affecting technical success and long-term outcome.

    Chung, Daniel; Briggs, James; Turney, Benjamin W; Tapping, Charles Ross


    Background Iatrogenic ureteral injuries arise as serious complication following obstetrics, gynecological, general, and urological surgery with incidence in the range of 0.5-10%. Retrograde placement of double-J ureteric stent is a possible treatment option if the injury is not recognized at the time of surgery. Purpose To assess technical success and long-term outcome associated with retrograde ureteric stent insertion for iatrogenic ureteric injury. Material and Methods Between 1999 and 2011, 26 patients with initially unrecognized iatrogenic ureteric injury underwent initial management with retrograde ureteric stenting. Full case-notes were available for review in 25 patients. Results The mean interval from injury to attempted stenting was 19.4 days. Successful retrograde ureteric stenting was achieved in 21/25 patients (81%). Retrograde stenting failed in four patients, and nephrostomy followed by alternative procedures were performed instead. At a median follow-up interval of 9.7 months, normal anatomy was demonstrated on 12/21 patients (57%) and a stricture was observed in 6/21 patients (28%) with three requiring surgical intervention. Conclusion Retrograde stenting is a safe and efficient initial management in patients with iatrogenic ureteric injuries.

  18. Verification of relationships between anthropometric variables among ureteral stents recipients and ureteric lengths: a challenge for Vitruvian-da Vinci theory

    Acelam PA


    Full Text Available Philip A Acelam Walden University, College of Health Sciences, Minneapolis, MN, USA Objective: To determine and verify how anthropometric variables correlate to ureteric lengths and how well statistical models approximate the actual ureteric lengths. Materials and methods: In this work, 129 charts of endourological patients (71 females and 58 males were studied retrospectively. Data were gathered from various research centers from North and South America. Continuous data were studied using descriptive statistics. Anthropometric variables (age, body surface area, body weight, obesity, and stature were utilized as predictors of ureteric lengths. Linear regressions and correlations were used for studying relationships between the predictors and the outcome variables (ureteric lengths; P-value was set at 0.05. To assess how well statistical models were capable of predicting the actual ureteric lengths, percentages (or ratios of matched to mismatched results were employed. Results: The results of the study show that anthropometric variables do not correlate well to ureteric lengths. Statistical models can partially estimate ureteric lengths. Out of the five anthropometric variables studied, three of them: body frame, stature, and weight, each with a P<0.0001, were significant. Two of the variables: age (R2=0.01; P=0.20 and obesity (R2=0.03; P=0.06, were found to be poor estimators of ureteric lengths. None of the predictors reached the expected (match:above:below ratio of 1:0:0 to qualify as reliable predictors of ureteric lengths. Conclusion: There is not sufficient evidence to conclude that anthropometric variables can reliably predict ureteric lengths. These variables appear to lack adequate specificity as they failed to reach the expected (match:above:below ratio of 1:0:0. Consequently, selections of ureteral stents continue to remain a challenge. However, height (R2=0.68 with the (match:above:below ratio of 3:3:4 appears suited for use as

  19. Colloidal solitary waves with temperature dependent compressibility

    Azmi, A.; Marchant, T. R.


    Spatial solitary waves which form in colloidal suspensions of dielectric nanoparticles are considered. The interactions, or compressibility, of the colloidal particles, is modelled using a series in the particle density, or packing fraction, where the virial, or series, coefficients depend on the type of particle interaction model. Both the theoretical hard disk and sphere repulsive models, and a model with temperature dependent compressibility, are considered. Experimental results show that particle interactions can be temperature dependent and either repulsive or attractive in nature, so we model the second virial coefficient using a physically realistic temperature power law. One- and two-dimensional semi-analytical colloidal solitary wave solutions are found. Trial functions, based on the form of the nonlinear Schrödinger equation soliton, are used, together with averaging, to develop the semi-analytical solutions. When the background packing fraction is low, the one-dimensional solitary waves have three solutions branches (with a bistable regime) while the two-dimensional solitary waves have two solution branches, with a single stable branch. The temperature dependent second virial coefficient results in changes to the solitary wave properties and the parameter space, in which multiple solutions branches occur. An excellent comparison is found between the semi-analytical and numerical solutions.

  20. Adjustable solitary waves in electroactive rods

    Wang, Y. Z.; Zhang, C. L.; Dai, H.-H.; Chen, W. Q.


    This paper presents an asymptotic analysis of solitary waves propagating in an incompressible isotropic electroactive circular rod subjected to a biasing longitudinal electric displacement. Several asymptotic expansions are introduced to simplify the rod governing equations. The boundary conditions on the lateral surface of the rod are satisfied from the asymptotic point of view. In the limit of finite-small amplitude and long wavelength, a set of ten simplified one-dimensional nonlinear governing equations is established. To validate our approach and the derivation, we compare the linear dispersion relation with the one directly derived from the three-dimensional linear theory in the limit of long wavelength. Then, by the reductive perturbation method, we deduce the far-field equation (i.e. the KdV equation). Finally, the leading order of the electroelastic solitary wave solution is presented. Numerical examples are provided to show the influences of the biasing electric displacement and material constants on the solitary waves. It is found that the biasing electric displacement can modulate the velocity of solitary waves with a prescribed amplitude in the electroactive rod, a very interesting result which may promote the particular application of solitary waves in solids with multi-field coupling.

  1. Solitary Spinal Epidural Metastasis from Gastric Cancer

    Taisei Sako


    Full Text Available Solitary epidural space metastasis of a malignant tumor is rare. We encountered a 79-year-old male patient with solitary metastatic epidural tumor who developed paraplegia and dysuria. The patient had undergone total gastrectomy for gastric cancer followed by chemotherapy 8 months priorly. The whole body was examined for suspected metastatic spinal tumor, but no metastases of the spine or important organs were observed, and a solitary mass was present in the thoracic spinal epidural space. The mass was excised for diagnosis and treatment and was histopathologically diagnosed as metastasis from gastric cancer. No solitary metastatic epidural tumor from gastric cancer has been reported in English. Among the Japanese, 3 cases have been reported, in which the outcome was poor in all cases and no definite diagnosis could be made before surgery in any case. Our patient developed concomitant pneumonia after surgery and died shortly after the surgery. When a patient has a past medical history of malignant tumor, the possibility of a solitary metastatic tumor in the epidural space should be considered.

  2. Ureteral inguinal hernia: an uncommon trap for general surgeons

    Yahya, Zarif; Al-habbal, Yahya; Hassen, Sayed


    Inguinal hernias involving the ureter, a retroperitoneal structure, is an uncommon phenomenon. It can occur with or without obstructive uropathy, the latter posing a trap for the unassuming general surgeon performing a routine inguinal hernia repair. Ureteral inguinal hernia should be included as a differential when a clinical inguinal hernia is diagnosed concurrently with unexplained hydronephrosis, renal failure or urinary tract infection particularly in a male. The present case describes a patient with a known ureteroinguinal hernia who proceeded to having a planned hernia repair and ureteric protection. The case is a reminder that when faced with an unexpected finding such an indirect sliding inguinal hernia, extreme care should be taken to ensure that no structures are inadvertently damaged and that a rare possibility is the entrapment of the ureter in the inguinal canal. PMID:28275027

  3. Independent roles of Fgfr2 and Frs2α in ureteric epithelium

    Sims-Lucas, Sunder; Cusack, Brian; Eswarakumar, Veraragavan P.; Zhang, Jue(Institute for Fundamental Theory, Department of Physics, University of Florida, Gainesville, FL, 32611, U.S.A.); Wang, Fen; Bates, Carlton M.


    Mice with conditional deletion of fibroblast growth factor receptor 2 (Fgfr2) in the ureteric bud using a Hoxb7cre line (Fgfr2UB−/−) develop severe ureteric branching defects; however, ureteric deletion of fibroblast growth factor receptor substrate 2α (Frs2α), a key docking protein that transmits fibroblast growth factor receptor intracellular signaling (Frs2αUB−/−) leads to mild ureteric defects. Mice with point mutations in the Frs2α binding site of Fgfr2 (Fgfr2LR/LR) have normal kidneys. ...

  4. Retroperitoneal fibrosis: A rare cause of both ureteral and small bowel obstruction

    Faisal Aziz; Srinivasulu Conjeevaram; Than Phan


    Retroperitoneal fibrosis (RPF) is a rare condition of unclear etiology. It can cause ureteral obstruction. We present the unique case of a 54 years old female, who initially presented with spontaneous perforation of the cecum. Upon exploring the abdomen, the classical glistening white, unyielding retroperitoneal fibrosis was encountered. A right hemicolectomy was performed.Subsequently, the patient presented with bilateral ureteral obstruction, and later on with small bowel obstruction. Ureteral obstruction was treated with stents,and small bowel obstruction was treated with bypass.To our knowledge no case of idiopathic RPF presenting with features of both bilateral ureteral and small bowel obstruction has been reported in the literature.

  5. Acute ureteric calculus obstruction: unenhanced spiral CT versus HASTE MR urography and abdominal radiograph.

    Regan, F; Kuszyk, B; Bohlman, M E; Jackman, S


    The aim of this study is to compare the performance of unenhanced spiral CT to the combination of HASTE MR urography (MRU) and plain abdominal radiography (KUB) in patients suspected of having acute calculus ureteric obstruction. 64 patients with suspected acute calculus ureteric obstruction were evaluated. The presence of perirenal fluid, presence and level of ureteric obstruction and calculi were assessed on both techniques. 44 of 64 (69%) patients had acute calculus ureteric obstruction based on clinical, radiographic or surgical findings. MRU showed perirenal fluid in acute ureteric obstruction (77%) with a greater sensitivity than CT showed stranding (45%). The combination of fluid and ureteric dilation on MRU showed a sensitivity of 93% (CT 80%), specificity of 95% (CT 85%), and accuracy of 94% (CT 81%). There were 61 findings of either fluid or ureteric dilatation on MRU in 44 acutely obstructed kidneys compared with 37 similar findings on CT (p0.75) in the finding of perirenal fluid on MRU, there was only fair interobserver agreement (KappaMRU/KUB showed ureteric calculi in 21/29 (72%) of patients with calculi seen by CT. Overall, MRU/KUB revealed 2.4 abnormalities per acutely obstructed ureter compared with 1.8 abnormalities detected by CT. MRU/KUB using HASTE sequences can diagnose the presence of acute calculus ureteric obstruction with similar accuracy to spiral CT. The technique has less observer variability and is more accurate than CT in detecting evidence of obstruction such as perirenal fluid.

  6. Role of ureteric stents in relieving obstruction in patients with obstructive uropathy

    M Shehab


    Conclusion: The predictors of renal recoverability revealed that ureteral stents alone can help in regaining renal function and significant improvement of clinical condition in patients with obstructive uropathy.

  7. Ureteric re-implant for the strictured renal allograft: How I do it.

    McGregor, Thomas; Kroczak, Tadeuz; Huang, Chun; Koulack, Joshua


    Ureteric stricture is the most common urologic complication following renal transplantation. Initial treatment should consist of endoscopic management, however patients that fail endoscopic management or strictures that are not amendable to endoscopic management are appropriate candidates for open surgical repair. In this manuscript we describe the steps and surgical technique we use to manage complicated ureteric strictures refractory to endoscopic management at our center. Ureteric re-implant with the use of a Boari flap is a safe, effective and definitive option for repair of ureteric strictures following renal transplantation. This approach provides excellent long term outcomes in terms of renal function preservation and negligible recurrence rates.

  8. Laparoscopic conservative management of ureteral endometriosis: a survey of eighty patients submitted to ureterolysis

    Camanni, Marco; Bonino, Luca; Delpiano, Elena Maria; Berchialla, Paola; Migliaretti, Giuseppe; Revelli, Alberto; Deltetto, Francesco


    Background this study aims to evaluate the effectiveness and safety of laparoscopic conservative management of ureteral endometriosis. Methods Eighty cases of histologically confirmed endometriosis affecting the ureter, 10 of which with bladder involvement were prospectively studied. In detail, patients were 13 women with ureteral stenosis (7 with hydronephrosis), 32 with circular lesions totally encasing the ureter, and 35 with endometriotic foci on the ureteral wall, but not completely encasing it. They were submitted to laparoscopic ureterolysis with or without partial cystectomy, ureteroneocistostomy. The rate of surgical complications, the recurrence rate, the patients' satisfaction rate was assessed during 22 months (median) follow-up. Results Laparoscopic ureterolysis was employed for all patients and set free the ureter from the disease in 95% of cases, whereas ureteroneocystostomy was necessary for 4 patients showing severe stenosis with hydronephrosis, among which 2 had intrinsic endometriosis of the ureteral muscularis. Three post-surgery ureteral fistulae occurred in cases with ureteral involvement longer than 4 cm: two cases were successfully treated placing double J catheter, the third needed ureteroneocistostomy. During follow-up, ureteral endometriosis recurred in 2 patients who consequently underwent ureteroneocystostomy. Most patients expressed high satisfaction rate throughout the whole follow-up period. Conclusion laparoscopic ureterolysis is effective and well tolerated in most cases of ureteral endometriosis. Ureteroneocystostomy is a better strategy for patients with extended (more than 4 cm) ureteral involvement or with severe stenosis with or without hydronephrosis. PMID:19818156

  9. Laparoscopic conservative management of ureteral endometriosis: a survey of eighty patients submitted to ureterolysis

    Migliaretti Giuseppe


    Full Text Available Abstract Background this study aims to evaluate the effectiveness and safety of laparoscopic conservative management of ureteral endometriosis. Methods Eighty cases of histologically confirmed endometriosis affecting the ureter, 10 of which with bladder involvement were prospectively studied. In detail, patients were 13 women with ureteral stenosis (7 with hydronephrosis, 32 with circular lesions totally encasing the ureter, and 35 with endometriotic foci on the ureteral wall, but not completely encasing it. They were submitted to laparoscopic ureterolysis with or without partial cystectomy, ureteroneocistostomy. The rate of surgical complications, the recurrence rate, the patients' satisfaction rate was assessed during 22 months (median follow-up. Results Laparoscopic ureterolysis was employed for all patients and set free the ureter from the disease in 95% of cases, whereas ureteroneocystostomy was necessary for 4 patients showing severe stenosis with hydronephrosis, among which 2 had intrinsic endometriosis of the ureteral muscularis. Three post-surgery ureteral fistulae occurred in cases with ureteral involvement longer than 4 cm: two cases were successfully treated placing double J catheter, the third needed ureteroneocistostomy. During follow-up, ureteral endometriosis recurred in 2 patients who consequently underwent ureteroneocystostomy. Most patients expressed high satisfaction rate throughout the whole follow-up period. Conclusion laparoscopic ureterolysis is effective and well tolerated in most cases of ureteral endometriosis. Ureteroneocystostomy is a better strategy for patients with extended (more than 4 cm ureteral involvement or with severe stenosis with or without hydronephrosis.

  10. Medical expulsive therapy for distal ureteric stones: tamsulosin versus silodosin

    Vittorio Imperatore


    Full Text Available Objectives: To compare the efficacy and safety of tamsulosin and silodosin in the context of medical expulsive therapy (MET of distal ureteric stones. Patients and methods: Observational data were collected retrospectively from patients who received silodosin (N = 50 or tamsulosin (N = 50 as MET from January 2012 to January 2013. Inclusion criteria were: patients aged ≥ 18 years with a single, unilateral, symptomatic, radiopaque ureteric stone of 10 mm or smaller in the largest dimension located between the lower border of the sacroiliac joint and the vesico-ureteric junction. Stone expulsion rate, stone expulsion time, number of pain episodes, need for analgesics use, incidence of side effects were compared. Results: Stone-expulsion rate in the silodosin and in the tamsulosin groups were 88% and 82%, respectively (p not significant. Mean expulsion times were 6.7 and 6.5 days in the silodosin and tamsulosin group, respectively (p not significant. Mean number of pain episodes were 1.6 and 1.7 in the silodosin and tamsulosin group, respectively (p not significant. The mean number of analgesic requirement was 0.84 and 0.9 for the silodosin and tamsulosin group, respectively (p not significant. Overall, incidence of side effects was similar in both groups. Patients taking silodosin experienced an higher incidence of retrograde ejaculation but a lower incidence of side effects related to peripheral vasodilation when compared to patients taking tamsulosin. Subgroup analysis demonstrated significantly lower mean expulsion times and pain episodes in patients with stones ≤ 5 mm in both groups. Conclusions: Tamsulosin and silodosin are equally effective as MET for distal ureteric stones sized 10 mm or smaller. MET with silodosin is associatd with a lower incidence of side effects related to peripheral vasodilation but an higher incidence of retrograde ejaculation when compared to tamsulosin.

  11. Acute bilateral ureteral obstruction secondary to guaifenesin toxicity.

    Cockerill, Patrick A; de Cógáin, Mitra R; Krambeck, Amy E


    Several medications or their metabolites have been associated with urolithiasis, although overall they remain an infrequent cause of urolithiasis. Guaifenesin stones were originally reported as complexed with ephedrine, and subsequent reports have demonstrated pure guaifenesin stones, occurring after long term abuse. We report a case of a 23-year-old male who ingested a large, one time dose of guaifenesin, resulting in acute bilateral ureteral obstruction, which, to our knowledge, is the first such reported case in the literature.

  12. Intraoral solitary neurofibroma in an infant

    Narwal Anjali


    Full Text Available Neurofibroma is a non-circumscribed, thick and irregular benign tumor of the peripheral nerve sheath. On the skin, the diffuse and soft nature of neurofibroma often resembles "a bag of worms". It can develop at any point along a nerve and often form by late adolescence. Although neurofibromas occur predominantly as a feature of neurofibromatosis affecting the soft tissue, a few cases of solitary intraoral neurofibromas have also been reported. Solitary intraosseous neurofibroma in the oral cavity is a rare benign tumor with very few cases reported in literature. This case report presents a case of intraosseous solitary neurofibroma of maxilla in a 5-month-old male child due to the rarity of this tumor at this site in very early age, along with a discussion of its clinical, radiological, and histopathological presentation.

  13. Evaluating kidney damage from vesico-ureteral reflux in children

    Zaffanello M


    Full Text Available To review the most relevant clinical studies that evaluate kidney damage in children with primary vesico-ureteral reflux (VUR, we reviewed and compared randomized controlled trials and clinical trials from scientific literature. In these studies, vesico-ureteral reflux was diagnosed by voiding cystourethrogram and kidney damage was assessed by either DMSA scan or urography. Relative risk with 95% confidence intervals was calculated using Review Manager Software (The Cochrane Collaboration, 2000. The overall relative risk of kidney damage shown by DMSA scan and urography was statistically higher in children with vesico-ureteral reflux of various degrees than in controls (3.7 times and 2.8 times, respectively. However, in high-grade VUR, the relative risk of congenital kidney damage was 5.6 times that of controls. We conclude that severe VUR is frequently associated with early kidney damage, perhaps with prenatal onset. Progression of kidney damage may depend on the severity of VUR and untreated urinary tract infections. Prevention of congenital kidney damage from severe VUR is possible when there is early intervention, even during fetal growth.

  14. Papain immobilized polyurethane as an ureteral stent material.

    Maria Manohar, Cynthya; Doble, Mukesh


    Long term use of polyurethane-based ureteral stent is hampered by the development of infection due to the formation of bacterial biofilm and salt deposition. Here papain, is covalently immobilized to polyurethane using glutarldehyde and is investigated as a possible anti-infective ureteral stent material. Fourier transform infrared spectrum confirmed its immobilization. Immobilized enzyme retained 85% of the activity of the free enzyme and about 12% loss of enzyme was observed from the polymer surface in one month. The modified polyurethane showed 8 log reduction in Staphylococcus aureus and 7 log reduction in Escherichia coli live colonies and 3-4 times decrease in the protein and carbohydrate in the biofilms than bare polymer. The amount of calcium and magnesium salts deposited on the polymer surface reduced by 40% after enzyme immobilization. 80% of L6 myoblast cells were viable on this material which indicated that it was noncytotoxic. A linear regression equation with hydrophilicity of the polymer surface and the cell surface hydrophobicity as the two independent variables was able to predict the number of live cells attached on the modified PU. This study indicated the possibility of using such an approach to overcome the problems of ureteral stent associated biofilm and salt encrustation.

  15. Renal Autotransplantation for Iatrogenic High-Grade Ureteric Stricture

    Jose Soto Soto


    Full Text Available A 47-year-old Hispanic woman developed a chronically obstructed left kidney, due to a long-segment ureteric stricture deemed not amenable to reimplantation, following left ovarian cyst excision in 2004. Therefore, a ureteral stent requiring exchange every 3 months was necessary, due to hydronephrosis, recurrent urosepsis, chronic pain, and a poor quality of life. Her medical history was complicated by hypertension, poorly controlled diabetes mellitus, and microalbuminuria, suggesting early diabetic nephropathy. A left nephrectomy was recommended. This was deferred, due to concern for progressive kidney failure associated with her comorbidities. A radionuclide Tc-99m MAG3 renal scan revealed differential perfusion as follows: 44% left kidney and 56% right kidney, with symmetrical uptake on the renogram phase and delayed excretion on the left, which were correctted following furosemide administration. A left ureteronephrectomy with autotransplantation of the left kidney and ureteroneocystostomy was performed in 2009. Since then, the patient has experienced no further complications or need for invasive procedures, with excellent diabetic control and stable renal function (eGFR > 60 mL/min/1.73 m2. This technique is seldom employed in the surgical management of complex ureteral injuries, but may be an alternative for appropriate cases.

  16. A radiographic study of solitary bone cysts

    Kim, Kyung Rak; Hwang, Eui Hwan; Lee, Sang Rae [Dept. of Oral and Maxillofacial Radiology, Division of Dentistry, Kyung Hee University, Seoul (Korea, Republic of)


    The aim of this study was to evaluate the clinical, radiographic and histopathologic features of 23 cases of solitary bone cyst by means of the analysis of radiographs and biopsy specimens in 23 persons visited the Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University and Chunbuk National University. The obtained results were as follows; 1. The incidence of solitary bone cyst was almost equal in males (52.2%) and in females(42.8%) and the prevalent age of the solitary bone cyst were the second decade (47.8%) and the third decade (21.7%). 2. In the signs and symptoms of solitary bone cyst, pain or tenderness revealed in 17.4%, swelling revealed in 13.0%, pain and swelling revealed in 21.7%, paresthesia revealed in 4.4% and 43.5% were a symptom and the tooth vitality involved in the solitary bone cyst, 76.5% were posterior and 23.5% were either positive or negative. 3. In the location of the solitary bone cyst, 47.8% present posterior region, 21.7% present anterior region, 21.6% present anterior and posterior region, 4.4% present condylar process area. 4. In the hyperostotic border of the solitary bone cyst, 47.8% were seen entirely, 21.8% were seen partially, and 30.4% were not seen. 5. In the change of tooth, 59.1% were loss of the alveolar lamina dura, 13.6% were root resorption 4.55% were tooth displacement, 4.55% were root resorption and tooth displacement. 6. In the change of cortical bone of the solitary bone cyst, 39.1% were intact and 60.9% were thinning and expansion of cortical bone. 7. In the histopathologic findings of 9 cases, 33.3% were thin connective tissue wall, 11.1% were thickened myxo-fibromatous wall, 55.6% were thickened myxofibromatous wall with dysplastic bone formation.

  17. Uphill solitary waves in granular flows

    Martínez, E.; Pérez-Penichet, C.; Sotolongo-Costa, O.; Ramos, O.; Måløy, K. J.; Douady, S.; Altshuler, E.


    We have experimentally observed uphill solitary waves in the surface flow on a granular material. A heap is constructed by injecting sand between two vertical glass plates separated by a distance much larger than the average grain size, with an open boundary. As the heap reaches the open boundary, solitary fluctuations appear on the flowing layer and move “up the hill” (i.e., against the direction of the flow). We explain the phenomenon in the context of stop-and-go traffic models.

  18. Scintigraphic Demonstration of Urine Extravasation Secondary to Acute Ureteral Obstruction: A Case Report and Some Considerations about Acute Ureteral Obstruction

    Federico M. Sarmiento


    Full Text Available Acute ureteral obstruction produces renal damage and complications that are proportional to the severity and length of the obstruction. Anatomic diagnosis of the obstruction may be insufficient to manage the patient. Intravenous urogram (IVU is the method usually advised by radiologists to obtain functional information, but requires iodinated contrast agents. IVU anatomic information is superior to anatomic information obtained with renal scintigraphy, but normally the physician already has the anatomic information (unenhanced CT or ultrasound. A renal scan offers better physiologic information than the IVU, has neither adverse effects nor complications, is accurate to confirm or discard significant ureteral obstruction, and depicts obstruction complications. This paper presents a patient with spontaneous urine extravasation secondary to acute renal obstruction who is diagnosed with renal scintigraphy. The authors describe the scintigraphic signs of extraperitoneal, diffuse perinephric, urine extravasation and emphasize the role of renal scintigraphy in diagnosis and follow-up of renal colic.

  19. Proximal Biceps Tendonitis

    ... tendons that attach the top of the biceps muscle to the shoulder are the proximal tendons . There are two proximal ... ll want to do exercises that strengthen the muscles of your shoulder and upper arm. Strong muscles will keep the ...

  20. The results of 15 years of consistent strategy in treating antenatally suspected pelvi-ureteric junction obstruction

    Thorup, Jørgen Mogens; Jokela, R; Cortes, Dina;


    To determine how to select patients for surgery among those with antenatally detected pelvi-ureteric junction (PUJ) obstruction.......To determine how to select patients for surgery among those with antenatally detected pelvi-ureteric junction (PUJ) obstruction....

  1. Unilateral versus bilateral ultrasound-guided transversus abdominis plane blocks during ureteric shock wave lithotripsy: A prospective randomized trial

    Ali Mohamed Ali Elnabtity


    Conclusion: Ultrasound-guided unilateral TAP block is as safe and effective analgesic technique as bilateral TAP blocks during unilateral ureteric SWL. It can be used as the sole analgesic technique during ureteric SWL.

  2. From bell-shaped solitary wave to W/M-shaped solitary wave solutions in an integrable nonlinear wave equation

    Aiyong Chen; Jibin Li; Chunhai Li; Yuanduo Zhang


    The bifurcation theory of dynamical systems is applied to an integrable non-linear wave equation. As a result, it is pointed out that the solitary waves of this equation evolve from bell-shaped solitary waves to W/M-shaped solitary waves when wave speed passes certain critical wave speed. Under different parameter conditions, all exact explicit parametric representations of solitary wave solutions are obtained.

  3. A Novel Type of Ureteral Stents in the Treatment of a Bilateral Iatrogenic Transaction of the Ureters

    Ernesto Mazza


    Full Text Available This report illustrates the case of a patient who suffered an iatrogenic complete injury of both ureters after a complex surgical procedure to remove a large sacral chordoma. Ureteral recanalization was achieved with two removable, autoexpandable, and polytetrafluoroethylene covered nitinol stents. To our knowledge, we describe the first application of this type of stents to treat a bilateral ureteral transection. Despite the bad general conditions of the patient, the ureteral stents successfully restored and maintained the bilateral ureteral continuity.

  4. The solitary sellar plasmacytoma: a diagnostic challenge

    Soejbjerg, Anne; Dyve, Suzan; Baerentzen, Steen


    UNLABELLED: Solitary sellar plasmacytomas are exceedingly rare and difficult to distinguish from other pituitary tumors. We report a case of a 62-year-old woman presenting with blurred vision of the right eye and tenderness of the right temporal region, which was interpreted as temporal arteritis...

  5. Clinical implications of the solitary functioning kidney

    Westland, R.; Schreuder, M.F.; Goudoever, J.B. van; Sanna-Cherchi, S.; Wijk, J.A. van


    Congenital anomalies of the kidney and urinary tract are the major cause of ESRD in childhood. Children with a solitary functioning kidney form an important subgroup of congenital anomalies of the kidney and urinary tract patients, and a significant fraction of these children is at risk for progress

  6. Solitary waves on nonlinear elastic rods. I

    Sørensen, Mads Peter; Christiansen, Peter Leth; Lomdahl, P. S.


    Acoustic waves on elastic rods with circular cross section are governed by improved Boussinesq equations when transverse motion and nonlinearity in the elastic medium are taken into account. Solitary wave solutions to these equations have been found. The present paper treats the interaction between...

  7. Shallow Water Waves and Solitary Waves

    Hereman, Willy


    Encyclopedic article covering shallow water wave models used in oceanography and atmospheric science. Sections: Definition of the Subject; Introduction and Historical Perspective; Completely Integrable Shallow Water Wave Equations; Shallow Water Wave Equations of Geophysical Fluid Dynamics; Computation of Solitary Wave Solutions; Numerical Methods; Water Wave Experiments and Observations; Future Directions, and Bibliography.

  8. Solitary waves on nonlinear elastic rods. II

    Sørensen, Mads Peter; Christiansen, Peter Leth; Lomdahl, P. S.


    In continuation of an earlier study of propagation of solitary waves on nonlinear elastic rods, numerical investigations of blowup, reflection, and fission at continuous and discontinuous variation of the cross section for the rod and reflection at the end of the rod are presented. The results...

  9. Peptide Toxins in Solitary Wasp Venoms

    Konno, Katsuhiro; Kazuma, Kohei; Nihei, Ken-ichi


    Solitary wasps paralyze insects or spiders with stinging venom and feed the paralyzed preys to their larva. Accordingly, the venoms should contain a variety of constituents acting on nervous systems. However, only a few solitary wasp venoms have been chemically studied despite thousands of species inhabiting the planet. We have surveyed bioactive substances in solitary wasp venoms found in Japan and discovered a variety of novel bioactive peptides. Pompilidotoxins (PMTXs), in the venoms of the pompilid wasps Anoplius samariensis and Batozonellus maculifrons, are small peptides consisting of 13 amino acids without a disulfide bond. PMTXs slowed Na+ channel inactivation, in particular against neuronal type Na+ channels, and were rather selective to the Nav1.6 channel. Mastoparan-like cytolytic and antimicrobial peptides are the major components of eumenine wasp venoms. They are rich in hydrophobic and basic amino acids, adopting a α-helical secondary structure, and showing mast cell degranulating, antimicrobial and hemolytic activities. The venom of the spider wasp Cyphononyx fulvognathus contained four bradykinin-related peptides. They are hyperalgesic and, dependent on the structure, differently associated with B1 or B2 receptors. Further survey led to the isolation of leucomyosuppressin-like FMRFamide peptides from the venoms of the digger wasps Sphex argentatus and Isodontia harmandi. These results of peptide toxins in solitary wasp venoms from our studies are summarized. PMID:27096870

  10. Peptide Toxins in Solitary Wasp Venoms

    Katsuhiro Konno


    Full Text Available Solitary wasps paralyze insects or spiders with stinging venom and feed the paralyzed preys to their larva. Accordingly, the venoms should contain a variety of constituents acting on nervous systems. However, only a few solitary wasp venoms have been chemically studied despite thousands of species inhabiting the planet. We have surveyed bioactive substances in solitary wasp venoms found in Japan and discovered a variety of novel bioactive peptides. Pompilidotoxins (PMTXs, in the venoms of the pompilid wasps Anoplius samariensis and Batozonellus maculifrons, are small peptides consisting of 13 amino acids without a disulfide bond. PMTXs slowed Na+ channel inactivation, in particular against neuronal type Na+ channels, and were rather selective to the Nav1.6 channel. Mastoparan-like cytolytic and antimicrobial peptides are the major components of eumenine wasp venoms. They are rich in hydrophobic and basic amino acids, adopting a α-helical secondary structure, and showing mast cell degranulating, antimicrobial and hemolytic activities. The venom of the spider wasp Cyphononyx fulvognathus contained four bradykinin-related peptides. They are hyperalgesic and, dependent on the structure, differently associated with B1 or B2 receptors. Further survey led to the isolation of leucomyosuppressin-like FMRFamide peptides from the venoms of the digger wasps Sphex argentatus and Isodontia harmandi. These results of peptide toxins in solitary wasp venoms from our studies are summarized.

  11. Giant solitary fibrous tumour of the liver

    T. Terkivatan (Türkan); M. Kliffen (Mike); J.H.W. de Wilt (Johannes); A.N. van Geel (Albert); A.M.M. Eggermont (Alexander); C. Verhoef (Kees)


    textabstractBackground: Solitary fibrous tumour (SFT) is an uncommon mesenchymal neoplasm that most frequently affects the pleura, although it has been reported with increasing frequency in various other sites such as in the peritoneum, pericardium and in non-serosal sites such as lung parenchyma,

  12. Solitary Wave Solutions for Zoomeron Equation

    Amna IRSHAD


    Full Text Available Tanh-Coth Method is applied to find solitary wave solutions of the Zoomeron equation which is of extreme importance in mathematical physics. The proposed scheme is fully compatible with the complexity of the problem and is highly efficient. Moreover, suggested combination is capable to handle nonlinear problems of versatile physical nature.

  13. Solitary fibrous tumour of the vagus nerve.

    Scholsem, Martin; Scholtes, Felix


    We describe the complete removal of a foramen magnum solitary fibrous tumour in a 36-year-old woman. It originated on a caudal vagus nerve rootlet, classically described as the 'cranial' accessory nerve root. This ninth case of immunohistologically confirmed cranial or spinal nerve SFT is the first of the vagus nerve.

  14. Solitary Wave Propagation Influenced by Submerged Breakwater

    王锦; 左其华; 王登婷


    The form of Boussinesq equation derived by Nwogu (1993) using velocity at an arbitrary distance and surface elevation as variables is used to simulate wave surface elevation changes. In the numerical experiment, water depth was divided into five layers with six layer interfaces to simulate velocity at each layer interface. Besides, a physical experiment was carried out to validate numerical model and study solitary wave propagation.“Water column collapsing”method (WCCM) was used to generate solitary wave. A series of wave gauges around an impervious breakwater were set-up in the flume to measure the solitary wave shoaling, run-up, and breaking processes. The results show that the measured data and simulated data are in good agreement. Moreover, simulated and measured surface elevations were analyzed by the wavelet transform method. It shows that different wave frequencies stratified in the wavelet amplitude spectrum. Finally, horizontal and vertical velocities of each layer interface were analyzed in the process of solitary wave propagation through submerged breakwater.

  15. Solitary wave interactions of the GRLW equation

    Ramos, J.I. [Room I-320-D, E.T.S. Ingenieros Industriales, Universidad de Malaga, Plaza El Ejido, s/n 29013 Malaga (Spain)]. E-mail:


    An approximate quasilinearization method for the solution of the generalized regularized long-wave (GRLW) equation based on the separation of the temporal and spatial derivatives, three-point, fourth-order accurate, compact difference equations, is presented. The method results in a system of linear equations with tridiagonal matrices, and is applied to determine the effects of the parameters of the GRLW equation and initial conditions on the formation of undular bores and interactions/collisions between two solitary waves. It is shown that the method preserves very accurately the first two invariants of the GRLW equation, the formation of secondary waves is a strong function of the amplitude and width of the initial Gaussian conditions, and the collision between two solitary waves is a strong function of the parameters that appear in the GRLW equation and the amplitude and speed of the initial conditions. It is also shown that the steepening of the leading and trailing waves may result in the formation of multiple secondary waves and/or an undular bore; the former interacts with the trailing solitary wave which may move parallel to or converge onto the leading solitary wave.

  16. Is joint hypermobility associated with vesico-ureteral refl ux? An assessment of 50 patients.

    Eerde, M. van Albertien; Verhoeven, J.M. Virginie; Jong, P.V.M. de Tom; Putte, M. van de Elise; Giltay, C. Jacques; Engelbert, H.H. Raoul


    Recent studies have already shown associations between generalized joint hypermobility (GJH) and voiding and defecation dysfunction and/or slow transit constipation. Changes in extracellular matrix composition in vesico-ureteric junction of vesico-ureteral refl ux (VUR) patients were also observed p

  17. Analysis of 136 ureteral injuries in gynecological and obstetrical surgery from completed insurance claims

    Hove, L.D.; Michelsen, Jonas Bock; Christoffersen, J.K.


    . Evaluation of claims concerning ureteral injuries reported to the Danish Patient Insurance Association. Setting. Danish Patient Insurance Association. Sample. All registered claims for ureteral injuries from 1996 to 2006. Methods. Retrospective study of medical records and data from Danish Patient Insurance...

  18. Ureteropyeloscopy and homium: YAG laser lithotripsy for treatment of ureteral calculi (report of 356 cases)

    Wu, Zhong; Din, Qiang; Jiang, Hao-wen; Zen, Jing-cun; Yu, Jiang; Zhang, Yuanfang


    Objective: To evaluate the efficacy and safety of holmium YAG laser lithotripsy for the treatment of ureteral calculi. Methods: A total of 356 patients underwent ureteropyeloscopic lithotripsy using holmium YAG laser with a semirigid uretesopyeloscope, 93 upper, 135 middle, and 128 lower ureteral stones were treated. Results: The overall successful fragmentation rate for all ureteral stones in a single session achieved 98% (349/356). The successful fragmentation rate stratified by stone location was 95% 88/93 in the upper ureter, 99% (134/135) in the mid ureter , and 99%(127/128) in the distal ureter. 12 cases with bilateral ureteral stones which caused acute renal failure and anuria were treated rapidly and effectively by the holmium YAG laser lithotripsy. No complications such as perforation and severe trauma were encountered during the operations. 2 weeks 17months (with an average of 6.8 month ) follow up postoperatively revealed that the overall stone-free rate was 98%(343/349) and no ureteral stenosis was found. Conclusions Holmium YAG laser lithotripsy is a highly effective, minimally invasive and safe therapy for ureteral calculi. It is indicated as a first choice of treatment for patients with ureteral calculi, especially for the ones with mid- lower levels of ureteral calculi.

  19. Analysis of 136 ureteral injuries in gynecological and obstetrical surgery from completed insurance claims

    Hove, L.D.; Michelsen, Jonas Bock; Christoffersen, J.K.;


    Association. Main outcome measures. Preventable ureteral injuries. Results. From 1996 to 2006, 136 submitted claims concerning ureteral injuries were registered. Among these, 73 claims were approved (54%), and compensation paid. In 44 of these, the injury was caused by negligence. Failure to dissect...

  20. Large solitary ovarian metastasis from colorectal cancer diagnosed by endoscopic ultrasound

    Bhavani Moparty; Guillermo Gomez; Manoop S Bhutani


    A case is presented of rectal carcinoma in which during staging by endoscopic ultrasound (EUS) a second large extrarectal mass was seen not otherwise visualized on computer tomograghy (CT) that was a solitary ovarian metastasis. The surgeon was alerted to the EUS finding prior to the planned laparoscopic colectomy. On retrospecive review of the CT pelvis after surgery, the radiologist could still not diagnose the ovarian lesion separated from the primary rectal tumor due to their close proximity. However, on EUS we were able to clearly see on real-time imaging that there was a distinct peri-rectal mass apart from the primary rectal tumor.

  1. Characterization of nanostructured ureteral stent with gradient degradation in a porcine model

    Wang XQ


    Full Text Available Xiaoqing Wang,1 Hongli Shan,2 Jixue Wang,1 Yuchuan Hou,1 Jianxun Ding,3 Qihui Chen,1 Jingjing Guan,1 Chunxi Wang,1 Xuesi Chen31Department of Urology, the First Hospital of Jilin University, 2Department of Clinical Laboratory, the First Hospital of Jilin University, 3Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, People’s Republic of ChinaAbstract: A tubular poly(ε-caprolactone (PCL/poly(lactide-co-glycolide (PLGA ureteral stent composed of nanofibers with micropores was fabricated by double-needle electrospinning. The stent was ureteroscopically inserted into six Changbai pigs, and the commercial polyurethane Shagong® stent was inserted into four pigs as control. Intravenous pyelography revealed that the PCL/PLGA stent gradually degraded from the distal end to proximal terminal, and all stents were completely degraded at 10 weeks post-insertion. No significant difference was observed in hydronephrosis severity between the two groups. The levels of serum creatinine and urine pH remained similar throughout the study in the two groups, but the number of white blood cells in the urine was significantly higher in the Shagong® stent group. On Day 70, histological evaluation indicated equivalent histological severity scores in the middle and distal ureter sections and bladder in the two groups. However, the PCL/PLGA stent-implanted pigs had significantly lower mean severity scores in the kidney and proximal ureter sites. These data revealed that the PCL/PLGA stent degraded in a controlled manner, did not induce obstruction, and had a lower urothelial impact in comparison to the Shagong® stent, indicating that the stent exhibited great potential for clinical application.Keywords: nanocomposites, polyesters, poly(ε-caprolactone, poly(lactide-co-glycolide, hydronephrosis severity

  2. Treatment of benign ureteral stricture by double J stents using high-pressure balloon angioplasty

    YU Hua-liang; YE Lin-yang; LIN Mao-hu; YANG Yu; MIAO Rui; HU Xiao-juan


    Background Balloon dilatation angioplasty is a minimally invasive surgery for treating benign ureteral stricture. The aim of this study was to investigate the effect of placing double J (D-J) stents using high-pressure balloon angioplasty in treating benign ureteral stricture.Methods A total of 42 patients (48 cases) with benign ureteral stricture (42 had benign ureteral stricture) were investigated by inserting dual D-J stents using high-pressure balloon angioplasty. The control group contained 50 patients (57 cases) employing the conventional balloon angioplasty with a single D-J stent inserted for comparison.Results The overall effective rate of the treated and control groups was 87.8% (36/41) and 62.7% (32/51), respectively (P <0.05).Conclusion This new approach produces a better curative effect than the conventional balloon angioplasty with a single D-J stent insertion in treating benign ureteral stricture.

  3. The ureteric bud epithelium: morphogenesis and roles in metanephric kidney patterning.

    Nagalakshmi, Vidya K; Yu, Jing


    The mammalian metanephric kidney is composed of two epithelial components, the collecting duct system and the nephron epithelium, that differentiate from two different tissues -the ureteric bud epithelium and the nephron progenitors, respectively-of intermediate mesoderm origin. The collecting duct system is generated through reiterative ureteric bud branching morphogenesis, whereas the nephron epithelium is formed in a process termed nephrogenesis, which is initiated with the mesenchymal-epithelial transition of the nephron progenitors. Ureteric bud branching morphogenesis is regulated by nephron progenitors, and in return, the ureteric bud epithelium regulates nephrogenesis. The metanephric kidney is physiologically divided along the corticomedullary axis into subcompartments that are enriched with specific segments of these two epithelial structures. Here, we provide an overview of the major molecular and cellular processes underlying the morphogenesis and patterning of the ureteric bud epithelium and its roles in the cortico-medullary patterning of the metanephric kidney.

  4. Comparison of a biodegradable ureteral stent versus the traditional double-J stent for the treatment of ureteral injury: an experimental study.

    Fu, Wei-Jun; Wang, Zhong-Xin; Li, Gang; Cui, Fu-Zhai; Zhang, Yuanyuan; Zhang, Xu


    Ureteral injury remains a major clinical problem; here we developed a biodegradable ureteral stent and compared its effectiveness with a double-J stent for treating ureteral injury. Eighteen dogs with injured ureters were subdivided into two groups. In group A, one injured ureter was treated with a biodegradable stent, whereas only end-to-end anastomosis was performed on the other side. In group B, one injured ureter was treated with a biodegradable stent, while a double-J stent was used on the other side. Intravenous urography, radioactive renography, histological examinations, scanning electron microscopy (SEM) and elemental composition analysis were performed at 40, 80 and 120 days postoperatively. Results showed that the biodegradable stent could effectively prevent hydronephrosis and hydroureter secondary to ureteral injury. Moreover all biodegradable stents gradually degraded and discharged completely in 120 days. SEM and elemental composition analysis of the surface of the double-J stent confirmed calcification at 80 days and calcific plaque at 120 days, while no signs of calcification were found in the biodegradable stent group. Histological studies found no difference between the biodegradable stented ureters and double-J stented ureters. It is concluded that the biodegradable ureteral stent was more advantageous than the double-J stent for treating ureteral injury in a canine model.

  5. Therapeutic ureteral occlusion in advanced pelvic malignant tumors

    Kinn, A.C.; Ohlsen, H.; Brehmer-Andersson, E.; Brundin, J.


    A technique for ureteral occlusion, combining insertion of nylon plugs with injection of polidocanol, is described. The method was used in 15 patients with vesicovaginal fistulas after operation and irradiation for advanced gynecological malignancy, or with severe malfunction and fibrosis of the bladder after radiotherapy for bladder carcinoma. The urinary leakage ceased in 11 patients, was greatly diminished in 2 and was unchanged in 2. Migration of plugs to the renal pelvis was the most serious complication and may have been the cause of pyelonephritis in 1 case. The technique is recommended for patients with a short life expectancy and uncontrolled, distressing leakage of urine.

  6. Huge pelvic mass secondary to wear debris causing ureteral obstruction.

    Hananouchi, Takehito; Saito, Masanobu; Nakamura, Nobuo; Yamamoto, Tetsuya; Yonenobu, Kazuo


    We report an unusual granulomatous reaction of wear debris that produced a huge pelvic mass causing ureteral obstruction. A 72-year-old woman, who received a cemented total hip arthroplasty 30 years ago, was referred to the department of gynecology for examination of a pelvic mass. A computed tomography scan revealed a huge homogenous mass, measuring approximately 20 x 16 x 12 cm, including extensive osteolysis of the left pelvis around the acetabular component. Intravenous pyelogram revealed complete obstruction of the left ureter resulting in hydronephrosis of the left kidney. Histological examination from the biopsy specimen detected polyethylene wear debris in the mass.

  7. Routine intraoperative ureteric stenting for kidney transplant recipients.

    Wilson, C H; Bhatti, A A; Rix, D A; Manas, D M


    Major urological complications (MUCs) after kidney transplantation contribute to patient morbidity and compromise graft function. The majority arise from the vesico-ureteric anastomosis and present early after transplantation. Ureteric stents have been successfully used to treat such complications. A number of centres have adopted a policy of universal prophylactic stenting, at the time of graft implantation, to reduce the incidence of urine leaks and ureteric stenosis. Stents are associated with specific complications and some centres advocate a policy of only stenting selected anastomoses. To examine the benefits and harms of routine ureteric stenting to prevent urological complications in kidney transplant recipients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE, EMBASE, reference lists of articles, books and abstracts and contacted companies, authors and experts to identify relevant randomised controlled trials (RCTs). All RCTs and quasi-RCTs were included in our meta-analysis. Four reviewers assessed the trials for quality against four criteria (allocation concealment, blinding, intention-to-treat and completeness of follow-up). The primary outcome was the incidence of MUCs. Further outcomes of interest were graft and patient survival and the incidence of adverse events (urinary tract infection (UTI), haematuria, irritative symptoms, pain and stent migration). Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) with 95% confidence intervals (CI). Seven RCTs (1154 patients) of low or moderate quality were identified. The incidence of MUCs was significantly reduced (RR 0.24, 95% CI 0.07 to 0.77, P = 0.02, NNT 13) by universal prophylactic stenting. This was dependent on whether the same surgeon performed, or was in attendance, during the operations. Two patients lost their grafts to infective urinary tract complications in the stented group

  8. Proximal Probes Facility

    Federal Laboratory Consortium — The Proximal Probes Facility consists of laboratories for microscopy, spectroscopy, and probing of nanostructured materials and their functional properties. At the...

  9. The first use of Resonance® metallic ureteric stent in a case of obstructed transplant kidney

    Abdulmajed, Mohamed I.; Jones, Vaughan W.; Shergill, Iqbal S.


    INTRODUCTION To date, double JJ stent is the mainstay ureteric stent used in a transplant kidney. We herein report the first use of Resonance® metallic ureteric stent to manage ureteric obstruction in a transplant kidney. PRESENTATION OF CASE A 45-year-old lady underwent an uneventful living related donor renal transplantation. Due to post-operative pelvi-ureteric obstruction and recurrent obstruction following multiple distal stent migration and expulsion necessitated frequent nephrostomy insertion and antegrade stenting, she underwent challenging but successful retrograde insertion of a 12 centimetres long and size 6.0 French Cook Resonance® metallic ureteric stent which was performed under general anaesthesia. DISCUSSION Metallic ureteric stents are a fairly recent introduction to modern urology and they have been successfully used in the management of benign and malignant obstruction of ureter. CONCLUSION This is the first case of therapeutic metallic ureteric stent insertion in a transplant kidney. PMID:24858983

  10. On the solitary wave paradigm for tsunamis

    Madsen, Per A.; Fuhrman, David R.; Schäffer, Hemming Andreas


    Since the 1970s, solitary waves have commonly been used to model tsunamis especially in experimental and mathematical studies. Unfortunately, the link to geophysical scales is not well established, and in this work we question the geophysical relevance of this paradigm. In part 1, we simulate...... of finite amplitude solitary wave theory in laboratory studies of tsunamis. We conclude that order-of-magnitude errors in effective temporal and spatial duration occur when this theory is used as an approximation for long waves on a sloping bottom. In part 3, we investigate the phenomenon of disintegration...... of long waves into shorter waves, which has been observed e.g. in connection with the Indian Ocean tsunami in 2004. This happens if the front of the tsunami becomes sufficently steep, and as a result the front turns into an undular bore. We discuss the importance of these very short waves in connection...

  11. A Solitary Plasmocytoma Case Causing Horner Syndrome

    Mustafa Vayvada


    Full Text Available Solitary plasmacytoma is a rare plasma cell tumour, when seen in the chest wall, it is important to diagnose since the treatment scheme and prognosis will vary, compared to primary malignant tumours of the chest wall. A 60-year-old male presented to our clinic with left shoulder pain radiating to the left axilla. Horner%u2019s syndrome symptoms were present, in further examination a chest wall mass located in the left upper lung lobe region was detected. Histopathologic diagnosis was solitary plasmocytoma via video-assisted thoracoscopy. The primary tumor of the rib malignancy causing Horner%u2019s syndrome is discussed with reference to the relevant literature.

  12. Hypokalemia associated with a solitary pulmonary nodule

    Saeian, Samira; Ghayumi, Seiyed Mohammad Ali; Shams, Mesbah


    Abstract Background: Differential diagnosis of hypokalemia and adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome often presents challenging in endocrinology and requires careful clinical, biochemical, radiological, and pathological investigations. Hypokalemia is a common abnormality and systematic approach is required to avoid delays in diagnosis of important underlying causes. Case Summary: A 49-year-old woman presented with moderate hypokalemia. Further evaluation showed hypercortisolism due to ectopic ACTH secretion. Chest computed tomography (CT) revealed a peripheral solitary pulmonary nodule. Excision biopsy of the nodule showed carcinoid tumor. After excision biopsy, all of the patient's symptoms improved and electrolytes and ACTH levels also became normal. Conclusion: Carciniod tumors should be considered as a differential diagnosis in patients presenting with hypokalemia and ectopic ACTH syndrome. Carcinoid tumor often present as solitary pulmonary nodule and excision biopsy can be curative. PMID:27977570

  13. Asymptotic Linear Stability of Solitary Water Waves

    Pego, Robert L.; Sun, Shu-Ming


    We prove an asymptotic stability result for the water wave equations linearized around small solitary waves. The equations we consider govern irrotational flow of a fluid with constant density bounded below by a rigid horizontal bottom and above by a free surface under the influence of gravity neglecting surface tension. For sufficiently small amplitude waves, with waveform well-approximated by the well-known sech-squared shape of the KdV soliton, solutions of the linearized equations decay at an exponential rate in an energy norm with exponential weight translated with the wave profile. This holds for all solutions with no component in (that is, symplectically orthogonal to) the two-dimensional neutral-mode space arising from infinitesimal translational and wave-speed variation of solitary waves. We also obtain spectral stability in an unweighted energy norm.

  14. From solitary wave to traveling surge



    The solution of kinetic Alfven wave under action of anomalous resistance has two branches: the slow wave, VPVA cosθ will be in a wave-broken state. Such traveling surge structure is a typical self-organization phenomenon and its wave form is determined by parameter β which represents the magnitude of resistance. High β leads to shock-like structure and low β to the appearance of some solitary waves in front of the shock. According to the study on solitary wave, shock wave and traveling surge in conjunction with self-organization of nonlinear dynamics, a general definition of wave can be given.

  15. Partial Differential Equations and Solitary Waves Theory

    Wazwaz, Abdul-Majid


    "Partial Differential Equations and Solitary Waves Theory" is a self-contained book divided into two parts: Part I is a coherent survey bringing together newly developed methods for solving PDEs. While some traditional techniques are presented, this part does not require thorough understanding of abstract theories or compact concepts. Well-selected worked examples and exercises shall guide the reader through the text. Part II provides an extensive exposition of the solitary waves theory. This part handles nonlinear evolution equations by methods such as Hirota’s bilinear method or the tanh-coth method. A self-contained treatment is presented to discuss complete integrability of a wide class of nonlinear equations. This part presents in an accessible manner a systematic presentation of solitons, multi-soliton solutions, kinks, peakons, cuspons, and compactons. While the whole book can be used as a text for advanced undergraduate and graduate students in applied mathematics, physics and engineering, Part II w...

  16. [Solitary fibrous tumours of the kidney].

    Gres, Pascal; Avances, Christophe; Ben Naoum, Kamel; Chapuis, Héliette; Costa, Pierre


    Solitary fibrous tumours (SFT) are mesenchymal tumours that usually arise from the pleura. Renal SFT are exceptional (9 cases reported in the literature). The authors report a new case discovered during assessment of HT and treated by radical right nephrectomy. The histological appearance is characteristic: a tumour with a fibrous centre, composed of a monomorphic proliferation of spindle cells, with positive CD 34, CD 99, and bcl 2 labelling. The prognosis after complete resection is generally favourable.

  17. Solitary vascular malformation of the clitoris.

    Haritharan, T; Islah, M; Zulfiqar, A; Thambi Dorai, C R


    Isolated involvement of the clitoris by vascular malformation (VM) is very rare. Clinically, the lesion simulates female pseudohermaphroditism. A five-year-old girl presented with clitoromegaly and a clinical diagnosis of solitary VM of the clitoris was made. Magnetic resonance imaging showed characteristic features and confirmed the diagnosis and the extent of the VM. This is the first reported case of isolated involvement of the clitoris by VM to be diagnosed preoperatively.

  18. Two-color walking Peregrine solitary waves.

    Baronio, Fabio; Chen, Shihua; Mihalache, Dumitru


    We study the extreme localization of light, evolving upon a non-zero background, in two-color parametric wave interaction in nonlinear quadratic media. We report the existence of quadratic Peregrine solitary waves, in the presence of significant group-velocity mismatch between the waves (or Poynting vector beam walk-off), in the regime of cascading second-harmonic generation. This finding opens a novel path for the experimental demonstration of extreme rogue waves in ultrafast quadratic nonlinear optics.

  19. Solitary paralysis of the triceps muscle due to trauma.

    Mizuno, K; Fujita, K; Yamada, M; Saura, R; Hirohata, K


    We report a rare solitary paralysis of the triceps muscle. The patient, an 18-year-old man who had had a work-related accident, sustained a severe contusion of the proximal posterolateral arm after being struck by a piece of lumber. This injury produced an extraordinary amount of soft-tissue swelling in the region of the trauma. After the accident it was noted that active flexion of the elbow was preserved, but active extension was absent. Three months after injury, surgical exploration of the radial nerve and its rami musculares to the three heads of the triceps muscle was undertaken. Dense adhesions were found fixing the rami musculares to the surfaces of the triceps muscle. Neurolysis of the rami musculares was performed, leading to complete recovery of the triceps muscle. The etiology of this isolated paralysis of the triceps muscle was determined to be dense adhesions compressing and compromising the function of the rami musculares to the three heads of the triceps muscle. These adhesions formed because of severe posttraumatic bleeding into the potential posterior humeral space, where the rami musculares are found.

  20. Which ureteral access sheath is compatible with your flexible ureteroscope?

    Al-Qahtani, Saeed M; Letendre, Julien; Thomas, Alexandre; Natalin, Ricardo; Saussez, Thibaud; Traxer, Olivier


    Our aim is to evaluate different ureteral access sheaths (UASs), which are available in the international market and their compatibility with different available flexible ureteroscopes (F-URSs) to help the urologist choose the proper ureteral access sheath for his or her endoscope before commencing the procedure. A total of 21 UASs and 12 F-URSs were evaluated. Measurements were obtained in French (F) units considering different characteristics for each UAS and each F-URS. Insertion test without friction between F-URS and UAS was considered as a successful test and was referred as (YES). All UASs and F-URSs were successfully submitted to the insertion test. All F-URSs that were inserted into UASs without friction had an internal diameter of at least 12F. Different lengths of UAS did not influence the test outcome. This study was able to establish a correlation table between different UASs and different flexible ureteroscopes. As of now, the 12/14F UAS is considered the universal UAS that accepts all F-URSs that are available in the endourology field. Nevertheless, we are expecting a significant change with the new standard size 10/12F UAS as well as huge advances in minimizing the size of different endoscopes.

  1. TROP2 expressed in the trunk of the ureteric duct regulates branching morphogenesis during kidney development.

    Tsukahara, Yuko; Tanaka, Minoru; Miyajima, Atsushi


    TROP2, a cell surface protein structurally related to EpCAM, is expressed in various carcinomas, though its function remains largely unknown. We examined the expression of TROP2 and EpCAM in fetal mouse tissues, and found distinct patterns in the ureteric bud of the fetal kidney, which forms a tree-like structure. The tip cells in the ureteric bud proliferate to form branches, whereas the trunk cells differentiate to form a polarized ductal structure. EpCAM was expressed throughout the ureteric bud, whereas TROP2 expression was strongest at the trunk but diminished towards the tips, indicating the distinct cell populations in the ureteric bud. The cells highly expressing TROP2 (TROP2(high)) were negative for Ki67, a proliferating cell marker, and TROP2 and collagen-I were co-localized to the basal membrane of the trunk cells. TROP2(high) cells isolated from the fetal kidney failed to attach and spread on collagen-coated plates. Using MDCK cells, a well-established model for studying the branching morphogenesis of the ureteric bud, TROP2 was shown to inhibit cell spreading and motility on collagen-coated plates, and also branching in collagen-gel cultures, which mimic the ureteric bud's microenvironment. These results together suggest that TROP2 modulates the interaction between the cells and matrix and regulates the formation of the ureteric duct by suppressing branching from the trunk during kidney development.

  2. TROP2 expressed in the trunk of the ureteric duct regulates branching morphogenesis during kidney development.

    Yuko Tsukahara

    Full Text Available TROP2, a cell surface protein structurally related to EpCAM, is expressed in various carcinomas, though its function remains largely unknown. We examined the expression of TROP2 and EpCAM in fetal mouse tissues, and found distinct patterns in the ureteric bud of the fetal kidney, which forms a tree-like structure. The tip cells in the ureteric bud proliferate to form branches, whereas the trunk cells differentiate to form a polarized ductal structure. EpCAM was expressed throughout the ureteric bud, whereas TROP2 expression was strongest at the trunk but diminished towards the tips, indicating the distinct cell populations in the ureteric bud. The cells highly expressing TROP2 (TROP2(high were negative for Ki67, a proliferating cell marker, and TROP2 and collagen-I were co-localized to the basal membrane of the trunk cells. TROP2(high cells isolated from the fetal kidney failed to attach and spread on collagen-coated plates. Using MDCK cells, a well-established model for studying the branching morphogenesis of the ureteric bud, TROP2 was shown to inhibit cell spreading and motility on collagen-coated plates, and also branching in collagen-gel cultures, which mimic the ureteric bud's microenvironment. These results together suggest that TROP2 modulates the interaction between the cells and matrix and regulates the formation of the ureteric duct by suppressing branching from the trunk during kidney development.

  3. Ureteroscopic pneumatic lithotripsy for treatment of complicated ureteral calculi%输尿管镜气压弹道碎石术治疗复杂性输尿管结石

    王文生; 薛建; 俞小明; 张钢; 李鑫; 李保国; 唐科伟


    目的 探讨输尿管镜气压弹道碎石术治疗复杂性输尿管结石的疗效.方法 采用输尿管镜气压弹道碎石术治疗复杂性输尿管结石56例,其中输尿管上段结石15例,中下段结石41例,体外冲击波碎石术(ESWL)失败25例,合并高热8例.结果 56例患者中,中下段结石均一次完全粉碎,成功率100.0%(41/41).上段结石一次完全粉碎10例,成功率66.7%(10/15).3例结石术中移位至肾脏,后辅以ESWL治疗1~2次,1例进镜困难终止手术,1例因输尿管穿孔改行开放手术.术后4周结石总清除率87.5%(49/56).8例合并高热者均急诊手术,7例一次结石粉碎成功,1例结石移位至肾脏,但梗阻均经手术得以解除,术后高热停止.输尿管穿孔发生率为1.8%(1/56).结论 输尿管镜气压弹道碎石术治疗复杂性输尿管结石安全、有效.%Objective To evaluate the therapeutic efficacy of ureteroscopic pneumatic lithotripsy for treatment of complicated ureteral calculi. Methods Clinical data of 56 cases with complicated ureteral calculi who were treated with ureteroscopic pneumatic lithotripsy was reviewed. Among them 15 cases were proximal ureteral calculi,41 cases were middle and distal ureteral calculi. Treatment by extracorporeal shockwave lithotripsy (ESWL) failed in 25 cases,8 cases complicated with fever. Results In 41 cases with middle and distal ureteral calculi, successful lithotripsy was achieved after the first treatment session,the success rate was 100.0% (41/41). In 15 cases with proximal ureteral calculi ,successful lithotripsy was achieved in 10 cases after the first treatment session,the success rate was 66.7%(l0/15). Calculi migrated to kidney in 3 cases who treated by ESWL for 1-2 times. The failure was due to ureteral kink in 1 case and due to ureteral perforation that required surgical repair in another case. Forty-nine cases were calculi-free after 4 weeks,the calculi-free rate was 87.5%(49/56). Emergency operation was performed in 8

  4. Psoas hitch ureteral reimplantation in adults--analysis of a modified technique and timing of repair.

    Ahn, M; Loughlin, K R


    The psoas hitch ureteral reimplantation technique has been used with great success to bridge defects in ureteral length due to injury or planned resection. Several surgical principles have been historically stressed when performing this procedure, including adequate mobilization of the bladder, fixation of the bladder to the psoas tendon before reimplantation, the use of a submucosal nonrefluxing-type ureteral anastomosis, and a 6-week delay before attempting repair after a surgical injury. We retrospectively reviewed patients who underwent ureteroneocystostomy with a psoas hitch, evaluated the relevance of these principles, and describe a modification of the technique. All patients undergoing psoas hitch ureteral reimplantation were reviewed. The indications, complications, and long-term outcomes were assessed. Between 1989 and 1999, 24 patients underwent psoas hitch reimplantation at our institution. The indications were operative injury in 11, planned surgical resection during nonurologic pelvic surgery in 4, cancer in 4, stricture in 4, and trauma in 1. Refluxing-type ureteral anastomoses were performed in 17 cases. One case of postoperative urosepsis occurred. A delayed repair after operative injury did not improve the operative time or overall morbidity. No cases of chronic flank pain, recurrent pyelonephritis, persistent severe hydronephrosis, or compromised renal function, as measured by a change in baseline serum creatinine level, occurred. No patient required reoperation for either early or delayed complications or failure of the repair at a follow-up of 1 to 122 months (mean 32.75). Psoas hitch ureteral reimplantation is an effective means of treating defects in ureteral length. Immediate repair may be safely undertaken as soon as the ureteral injury is recognized. Long-term sequelae are unusual in adults, even when using refluxing-type ureteral anastomoses.

  5. Stable complex solitary waves of Sasa Satsuma equation

    Sasanka Ghosh


    Existence of a new class of complex solitary waves is shown for Sasa Satsuma equation. These solitary waves are found to be stable in a certain domain of the parameter and become chaotic if the parameter exceeds the value 2.4. Significantly, the complex solitary waves propagate at higher bit rate over the most stable solitons under the same conditions of the input parameters.

  6. Numerical Study on Breaking Criteria for Solitary Waves

    Chung-ren CHOU; Ruey-syan SHIH; John Z. YIM


    Studies of the breaking criteria for solitary waves on a slope are presented in this paper. The boundary element method is used to model the processes of shoaling and breaking of solitary waves on various slopes. Empirical formulae that can be used to characterize the breaking of solitary waves are presented. These include the breaking index, the wave height, the water depth, and the maximum particle velocity at the point of breaking. Comparisons with the results of other researches are given.

  7. The cruel and unusual phenomenology of solitary confinement

    Shaun eGallagher


    Full Text Available What happens when subjects are deprived of intersubjective contact? This paper looks closely at the phenomenology and psychology of one example of that deprivation: solitary confinement. It also puts the phenomenology and psychology of solitary confinement to use in the legal context. Not only is there no consensus on whether solitary confinement is a cruel and unusual punishment, there is no consensus on the definition of the term ‘cruel’ in the use of that legal phrase. I argue that we can find a moral consensus on the meaning of ‘cruelty’ by looking specifically at the phenomenology and psychology of solitary confinement.

  8. The cruel and unusual phenomenology of solitary confinement.

    Gallagher, Shaun


    What happens when subjects are deprived of intersubjective contact? This paper looks closely at the phenomenology and psychology of one example of that deprivation: solitary confinement. It also puts the phenomenology and psychology of solitary confinement to use in the legal context. Not only is there no consensus on whether solitary confinement is a "cruel and unusual punishment," there is no consensus on the definition of the term "cruel" in the use of that legal phrase. I argue that we can find a moral consensus on the meaning of "cruelty" by looking specifically at the phenomenology and psychology of solitary confinement.


    Shivaji D


    Full Text Available Cylindroma is a rare tumour which originates from skin appendages. Cylindromas are of two types namely solitary and multiple. Malignant transformation of cylindroma is unusual and is extremely rare in solitary type. They show strong predilection for middle aged and elderly females. We report a case of a 70 year old male patient presented with nodular swelling along with surface ulceration in the right axillary region since six months, which on histopathological examination revealed a case of malignant transformation of benign solitary cylindroma. We report a rare case of malignant cylindroma arising in a patient with solitary cylindroma at an unusual site

  10. Proximal humerus fractures.

    Price, Matthew C; Horn, Pamela L; Latshaw, James C


    Proximal humerus fractures are among the most common fractures associated with osteoporosis. With an aging population, incidence of these fractures will only increase. The proximal humerus not only forms the lateral portion of the shoulder articulation but also has significant associations with musculoskeletal and neurovascular structures. As a result, fractures of the proximal humerus can significantly impact not only the function of the shoulder joint, but the health and function of the entire upper extremity as well. Understanding of these fractures, the management options, and associated nursing care, can help reduce morbidity rate and improve functional outcomes.

  11. Outcome of shock wave lithotripsy as monotherapy for large solitary renal stones (>2 cm in size without stenting

    Shanmugasundaram Rajaian


    Full Text Available Purpose : To evaluate the outcome of shock wave lithotripsy (SWL as monotherapy for solitary renal stones larger than 2 cm without ureteral stenting. Materials and Methods : Our retrospective study included patients with solitary renal radio opaque stones larger than 2 cm treated with SWL using electromagnetic Dornier Compact S lithotripter device (Wessling, Germany for a period of 3 years (September 2002-2005. Stone clearance was assessed at 1 week, 1 month, and 3 months with plain X-rays of kidney, ureter, and bladder region, ultrasonography, and tomograms. Stone-free status, morbidity of the procedure, and fate of clinically insignificant residual fragments (CIRF were studied. A stone-free state was defined as no radiologic evidence of stone. Success was defined as complete clearance + CIRF. Results : Fifty-five patients, aged 11-65 years (mean 49.8 underwent SWL. Of them, only two were children. Male-to-female ratio was 3:1. The stone size was 21-28 mm (average 24 mm. The mean number of shocks were 3732 (range 724-12,100 and average energy level was 14 kV (range 11-16 kV. The mean follow-up was 18 months (range 3-22 months. Over all, stone-free status was achieved in 50% and success in 81% at 3 months. Stone clearance was not affected by stone location. Stones 26 mm (P = -0.10. Of 54 patients, 39 developed steinstrasse with mean length of 3.2 cm (range 1.4-6.2 cm and only four required intervention. Effectiveness quotient (EQ for SWL monotherapy for solitary renal stones more than 2 cm was 25.3%. The EQ for stones <25 mm and those more than 25 mm were 28.4% and 10% (P = -0.12, respectively. There was a lesser trend of difference between stones with size <25 and more than 25 mm. During the last review, the overall stone-free rate was 67.2%. Conclusions : SWL monotherapy was safe but significantly less effective for solitary renal stones larger than 2 cm. It can only be suggested to those who refuse surgical intervention. Pretreatment DJ

  12. Use of Corticosteroids for Urinary Tuberculosis Patients at Risk of Developing Ureteral Obstruction

    Matsui, Kosuke; Furumoto, Akitsugu; Ohba, Kojiro; Mochizuki, Kota; Tanaka, Takeshi; Takaki, Masahiro; Morimoto, Konosuke; Ariyoshi, Koya


    A 77-year-old man with urinary tuberculosis developed post renal anuria two days after starting an anti-tuberculosis drug regimen. He had bilateral hydronephrosis, and his right kidney was radiologically diagnosed to be non-functioning. A transurethral catheter was placed in the left ureter. No improvement in the ureteral stricture was noted during the initial three weeks of treatment; however, the stricture did thereafter improve after the commencement of oral prednisolone. In cases of urinary tuberculosis, ureteral stricture can deteriorate and result in ureteral obstruction during anti-tuberculosis treatment. Pre-emptive administration of corticosteroids may be beneficial for preventing such stricture in patients with a pre-existing ureteral lesion. PMID:27904125

  13. Forgotten/retained double J ureteric stents: A source of severe morbidity in children.

    Nerli, Rajendra B; Magdum, Prasad V; Sharma, Vikas; Guntaka, Ajay Kumar; Hiremath, Murigendra B; Ghagane, Shridhar


    The increase in the usage of double J (DJ) ureteral stents in the management of a variety of urinary tract disease processes mandates familiarity with these devices, their consequences and their potential complications, which at times can be devastating. We retrospectively reviewed our series of children with forgotten/retained DJ ureteric stents. Hospital records of all patients' forgotten/retained DJ ureteral stent at our hospital were reviewed for age, gender, indication for insertion of DJ stent, duration of stent insertion, radiological images and surgical procedures performed. During the study period, January 2000 to December 2014 (a 15-year period), a total of 14 children underwent removal of forgotten/retained DJ ureteral stent. A combination of extracorporeal shock wave lithotripsy, cystolitholapaxy and percutaneous nephrolithotomy was done to free the DJ stent and extract it. Forgotten/retained stents in children are a source of severe morbidity, additional/unnecessary hospitalisation and definitely financial strain.

  14. [Strategy changes in the treatment of ureteral lithiasis and nephritic colic].

    González Enguita, C; Calahorra Fernández, F J; García de la Peña, E; Rodríguez-Miñón Cifuentes, J L; Vela Navarrete, R


    Since lithotripters were first introduced to the clinical practice in 1980, extracorporeal shock wave lithotrite (ESWL) has been universally recognized as the first choice to resolve urinary tract lithiasis, ureteral calculi being the most susceptible lithiasic site for controversy. The urologist approach to the lithiasic patient has changed mainly as compared to that of ureteral calculi. These profound changes translate an undeniable advance of the extracorporeal procedures versus those of endourology, basically based on ESWL low morbidity. In those cases when lithiasis is found in a situation of nephritic colic, there is a real therapeutical chance with ESWL, thus leading to drug therapy losing its major role. We present 768 patients with ureteral lithiasis (1991-1994), 20-25% of which were examined for a nephritic colic. Once the colic situation is overcome in all instances, 35% will require a new lithotrite for complete lithiasic resolution. Overall, our rate of successful ureteral lithiasis resolution is 97% (30% need repeated session).

  15. Efficacy of nifedipine and alfuzosin in the management of distal ureteric stones: A randomized, controlled study



    Conclusion: The use of alfuzosin and nifedipine as a medical expulsive therapy for distal ureteric stones proved to be safe and effective in term of increased stone-expulsion rate, reduced pain attacks and decrease hospital re-admissions.

  16. Metallic stent in the treatment of ureteral obstruction: Experience of single institute

    Chien-Chang Li


    Conclusion: Patients with ureteral obstructions can be treated sufficiently with the Resonance® metallic stent. Patients who had gynecological malignancies and received radiotherapy had a higher failure rate after Resonance® metallic stent insertion.

  17. Ureteroscopy for treatment of obstructing ureteral calculi in pregnant women: Single center experience

    T.K. Fathelbab


    Conclusion: Ureteroscopy is a safe and effective therapeutic option for the treatment of obstructing ureteral stones in pregnancy with stone-free and complication rates comparable to the non-pregnant population.

  18. Coal - proximate analysis



    This Standard establishes a practice for the proximate analysis of coal, that is, the coal is analysed for the content of moisture, ash and volatile matter; fixed carbon is calculated. The standard provides a basis for the comparison of coals.

  19. Bulk solitary waves in elastic solids

    Samsonov, A. M.; Dreiden, G. V.; Semenova, I. V.; Shvartz, A. G.


    A short and object oriented conspectus of bulk solitary wave theory, numerical simulations and real experiments in condensed matter is given. Upon a brief description of the soliton history and development we focus on bulk solitary waves of strain, also known as waves of density and, sometimes, as elastic and/or acoustic solitons. We consider the problem of nonlinear bulk wave generation and detection in basic structural elements, rods, plates and shells, that are exhaustively studied and widely used in physics and engineering. However, it is mostly valid for linear elasticity, whereas dynamic nonlinear theory of these elements is still far from being completed. In order to show how the nonlinear waves can be used in various applications, we studied the solitary elastic wave propagation along lengthy wave guides, and remarkably small attenuation of elastic solitons was proven in physical experiments. Both theory and generation for strain soliton in a shell, however, remained unsolved problems until recently, and we consider in more details the nonlinear bulk wave propagation in a shell. We studied an axially symmetric deformation of an infinite nonlinearly elastic cylindrical shell without torsion. The problem for bulk longitudinal waves is shown to be reducible to the one equation, if a relation between transversal displacement and the longitudinal strain is found. It is found that both the 1+1D and even the 1+2D problems for long travelling waves in nonlinear solids can be reduced to the Weierstrass equation for elliptic functions, which provide the solitary wave solutions as appropriate limits. We show that the accuracy in the boundary conditions on free lateral surfaces is of crucial importance for solution, derive the only equation for longitudinal nonlinear strain wave and show, that the equation has, amongst others, a bidirectional solitary wave solution, which lead us to successful physical experiments. We observed first the compression solitary wave in the

  20. Mast Cells and MCPT4 Chymase Promote Renal Impairment after Partial Ureteral Obstruction

    Maguelonne Pons


    Full Text Available Obstructive nephropathy constitutes a major cause of pediatric renal progressive disease. The mechanisms leading to disease progression are still poorly understood. Kidney fibrotic lesions are reproduced using a model of partial unilateral ureteral obstruction (pUUO in newborn mice. Based on data showing significant mast cell (MC infiltration in patients, we investigated the role of MC and murine MCPT4, a MC-released chymase, in pUUO using MC- (Wsh/sh, MCPT4-deficient (Mcpt4−/−, and wild-type (WT mice. Measurement of kidney length and volume by magnetic resonance imaging (MRI as well as postmortem kidney weight revealed hypotrophy of operated right kidneys (RKs and compensatory hypertrophy of left kidneys. Differences between kidneys were major for WT, minimal for Wsh/sh, and intermediate for Mcpt4−/− mice. Fibrosis development was focal and increased only in WT-obstructed kidneys. No differences were noticed for local inflammatory responses, but serum CCL2 was significantly higher in WT versus Mcpt4−/− and Wsh/sh mice. Alpha-smooth muscle actin (αSMA expression, a marker of epithelial–mesenchymal transition (EMT, was high in WT, minimal for Wsh/sh, and intermediate for Mcpt4−/− RK. Supernatants of activated MC induced αSMA in co-culture experiments with proximal tubular epithelial cells. Our results support a role of MC in EMT and parenchyma lesions after pUUO involving, at least partly, MCPT4 chymase. They confirm the importance of morphologic impairment evaluation by MRI in pUUO.

  1. Idiopathic retroperitoneal fibrosis causing unilateral ureteral and sigmoid colon obstruction

    Yan, Ting; Wang, Yujuan; Liu, Zhijun; Zhang, Xiaolei; Wu, Qian; Xi, Mingrong


    Abstract Objective: The present report aimed to present a unique case of idiopathic retroperitoneal fibrosis (RPF) presenting features of unilateral ureteral and sigmoid colon obstruction. RPF is a rare disorder with unclear etiology. Case report: A 43-year-old female had a 10-day history of lower right abdominal and lumbar pain. Gynecological examination, ultrasound, and computed tomography (CT) were all suggestive of right ovarian tumor. An enhanced CT showed right-sided hydronephrosis. The patient was diagnosed as having ovarian cancer. Ten days after hospitalization, a right intraureteral stent with a double-J catheter was inserted. Upon exploring the abdomen, unyielding RPF was encountered. A partial sigmoidectomy and colostomy were performed. Postoperative pathological results suggested idiopathic RPF. She received steroid treatments. Conclusion: RPF is a rare disease that can be misdiagnosed. Our understanding about its presentation has to be improved and it should be considered as a differential diagnosis for patients presenting with abdominal diseases. PMID:28207528

  2. Encrustation and stone formation: complication of indwelling ureteral stents.

    Schulze, K A; Wettlaufer, J N; Oldani, G


    Severe encrustation and stone formation on indwelling ureteral stents in 2 patients with a lithogenic history are reported. In both cases this complication occurred in the presence of sterile urine and treatment required pyelolithotomy in one and renal pelvic irrigation with urologic G solution in the other. Analyses of these stones revealed struvite and apatite, respectively. Dissolution of encrustations and stones via renal pelvic irrigation is suggested as a viable alternative to surgical intervention for this problem. A review of the literature shows a correlation between chronic stone formers and stent encrustation, rather than from bacteriuria alone. Long-term antibiotic suppression, more frequent followup with abdominal roentgenograms, and shorter periods of internal stenting are suggested for patients with a lithogenic history.

  3. Proximal Focal Femoral Deficiency

    Vishal Kalia, Vibhuti


    Proximal focal femoral deficiency (PFFD) is a developmental disorder of the proximal segment of thefemur and of acetabulum resulting in shortening of the affected limb and impairment of the function. It isa spectrum of congenital osseous anomalies characterized by a deficiency in the structure of the proximalfemur. The diagnosis is often made by radiological evaluation which includes identification and descriptionof PFFD and evaluation of associated limb anomalies by plain radiographs. Contra...

  4. Lessons learned over a decade of pediatric robotic ureteral reimplantation

    Baek, Minki


    The da Vinci robotic system has improved surgeon dexterity, ergonomics, and visualization to allow for a minimally invasive option for complex reconstructive procedures in children. Over the past decade, robot-assisted laparoscopic ureteral reimplantation (RALUR) has become a viable minimally invasive surgical option for pediatric vesicoureteral reflux (VUR). However, higher-than-expected complication rates and suboptimal reflux resolution rates at some centers have also been reported. The heterogeneity of surgical outcomes may arise from the inherent and underestimated complexity of the RALUR procedure that may justify its reclassification as a complex reconstructive procedure and especially for robotic surgeons early in their learning curve. Currently, no consensus exists on the role of RALUR for the surgical management of VUR. High success rates and low major complication rates are the expected norm for the current gold standard surgical option of open ureteral reimplantation. Similar to how robot-assisted laparoscopic surgery has gradually replaced open surgery as the most utilized option for prostatectomy in prostate cancer patients, RALUR may become a higher utilized surgical option in children with VUR if the adoption of standardized surgical techniques that have been associated with optimal outcomes can be adopted during the second decade of RALUR. A future standard of RALUR for children with VUR whose parents seek a minimally invasive surgical option can arise if widespread achievement of high success rates and low major complication rates can be obtained, similar to the replacement of open surgery with robot-assisted laparoscopic radical prostectomy as the new strandard for men with prostate cancer. PMID:28097262

  5. Preventing the Forgotten Ureteral Stent by Using a Mobile Point-of-Care Application.

    Ziemba, Justin B; Ludwig, Wesley W; Ruiz, Leticia; Carvalhal, Eduardo; Matlaga, Brian R


    The forgotten ureteral stent (FUS) can lead to patient morbidity. To date, tracking ureteral stents is a cumbersome task, given their high frequency of insertion and variable indwelling times. To simplify this process, an application was developed to track patients with indwelling ureteral stents. We report our initial user experience and clinical outcomes with this application. Ureteral Stent Tracker™ (UST) is a secure, Health Insurance Portability and Accountability Act (HIPPA)-compliant, cloud-based point-of-care application. It is designed for logging stent insertion, scheduling the date of anticipated stent extraction, and confirming stent removal. It is accessible via a mobile phone application or web browser interface. We consecutively enrolled all patients who underwent ureteral stent insertion for any indication by two urologists from January 10, 2015, to October 10, 2016. A retrospective chart review was performed of all patients included in the UST database. Data extracted included patient demographics, diagnosis, procedure, and stent characteristics. A total of 115 patients were included with a mean age of 52.4 years; 54% (62/115) were male and 58% (67/115) were Caucasian. This cohort represented 146 ureteral stent care plans with 23 patients (23/115; 20%) having more than one care plan during the study period. The most common procedure performed was ureteroscopy (70/146; 48%) for a diagnosis of nephrolithiasis (108/146; 74%). The median indwelling ureteral stent time was 14 days (interquartile range: 7-45 days). A total of three patients (3/115; 3%) did not return for their scheduled extraction, but were identified only through the application. Each patient was contacted, resulting in effective removal of all three stents in the office. Tracking of ureteral stents is critical to prevent the patient safety issue of the FUS. The UST is a secure, HIPPA-compliant, cloud-based application, which once incorporated into the workflow of a urologic practice

  6. Distal Ureteral Diameter Ratio is Predictive of Breakthrough Febrile Urinary Tract Infection.

    Arlen, Angela M; Leong, Traci; Guidos, Paul J; Alexander, Siobhan E; Cooper, Christopher S


    Distal ureteral diameter ratio is an objective measure that is prognostic of spontaneous resolution of vesicoureteral reflux. Along with likelihood of resolution, improved identification of children at risk for recurrent febrile urinary tract infections may impact management decisions. We evaluated the usefulness of ureteral diameter ratio as a predictive factor for breakthrough febrile urinary tract infections. Children with primary vesicoureteral reflux and detailed voiding cystourethrogram were identified. Ureteral diameter ratio was computed by measuring largest ureteral diameter within the pelvis and dividing by the distance between L1 and L3 vertebral bodies. Demographics, vesicoureteral reflux grade, laterality, presence/absence of bladder-bowel dysfunction, and ureteral diameter ratio were tested in univariate and multivariable analyses. Primary outcome was breakthrough febrile urinary tract infections. We analyzed 112 girls and 28 boys with a mean ± SD age of 2.5 ± 2.3 years at diagnosis. Vesicoureteral reflux was grade 1 to 2 in 64 patients (45.7%), grade 3 in 50 (35.7%), grade 4 in 16 (11.4%) and grade 5 in 10 (7.2%). Mean ± SD followup was 3.2 ± 2.7 years. A total of 40 children (28.6%) experienced breakthrough febrile urinary tract infections. Ureteral diameter ratio was significantly greater in children with (0.36) vs without (0.25) breakthrough febrile infections (p = 0.004). Controlling for vesicoureteral reflux grade, every 0.1 U increase in ureteral diameter ratio resulted in 1.7 times increased odds of breakthrough infection (95% CI 1.24 to 2.26, p urinary tract infections independent of reflux grade. Ureteral diameter ratio provides valuable prognostic information about risk of recurrent pyelonephritis and may assist with clinical decision-making. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  7. Extraction of a long-forgotten ureteral stent by ureteroscopic pneumatic lithotripsy

    江军; 朱方强; 姜庆; 王洛夫


    @@ A long-forgotten ureteral stent is occasionally encountered in urological practice. It can be complicated by encrustation and may pose a management and legal dilemma. Here, we report on a long-forgotten ureteral stent that had completely calcified after 30 months in a patient with chronic renal insufficiency due to obstructive uropathy. The stent was extracted successfully by means of ureteroscopic pneumatic lithotripsy.

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

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


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

  9. Localization and solitary waves in solid mechanics

    Champneys, A R; Thompson, J M T


    This book is a collection of recent reprints and new material on fundamentally nonlinear problems in structural systems which demonstrate localized responses to continuous inputs. It has two intended audiences. For mathematicians and physicists it should provide useful new insights into a classical yet rapidly developing area of application of the rich subject of dynamical systems theory. For workers in structural and solid mechanics it introduces a new methodology for dealing with structural localization and the related topic of the generation of solitary waves. Applications range from classi

  10. Microtubules: A network for solitary waves

    Zdravković Slobodan


    Full Text Available In the present paper we deal with nonlinear dynamics of microtubules. The structure and role of microtubules in cells are explained as well as one of models explaining their dynamics. Solutions of the crucial nonlinear differential equation depend on used mathematical methods. Two commonly used procedures, continuum and semi-discrete approximations, are explained. These solutions are solitary waves usually called as kink solitons, breathers and bell-type solitons. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. III45010

  11. Asymptotic Methods for Solitary Solutions and Compactons

    Ji-Huan He


    Full Text Available This paper is an elementary introduction to some new asymptotic methods for the search for the solitary solutions of nonlinear differential equations, nonlinear differential-difference equations, and nonlinear fractional differential equations. Particular attention is paid throughout the paper to giving an intuitive grasp for the variational approach, the Hamiltonian approach, the variational iteration method, the homotopy perturbation method, the parameter-expansion method, the Yang-Laplace transform, the Yang-Fourier transform, and ancient Chinese mathematics. Hamilton principle and variational principles are also emphasized. The reviewed asymptotic methods are easy to be followed for various applications. Some ideas on this paper are first appeared.

  12. Solitary lucent epiphyseal lesions in children

    Gardner, D.J.; Azouz, E.M.


    We evaluated retrospectively the varying radiographic appearances of 15 solitary lucent epiphyseal lesions occurring in children. Imaging modalities used included plain films, conventional tomography, nuclear scintigraphy, and computed tomography. 40% of the lesions (6) were due to osteomyelitis. The remaining lesions included tuberculosis (1), foreign body granuloma (1), chondroblastoma (2), chondromyoxid fibroma (1), enchondroma (1), osteoid osteoma (2), and eosinophilic granuloma (1). Although the radiographic appearances of such lesions may be particularly characteristic, pathologic correlation is frequently necessary. The high incidence of osteomyelitis in our cases emphasizes its importance as a cause for a lucent epiphyseal lesion.

  13. [Solitary naso-sinusal fibrous tumor].

    Martínez, V; Jiménez, M L; Cuatrecasas, M; Jürgens, A; de Amesti, C; Orus, C; Fabra, J M


    Here we present two clinical cases of solitary naso-sinusal fibrous tumour. This tumour has a mesenchymal origin and has an evident pleural location, with well defined immunohistochemical and ultrastructural characteristics. The clinical manifestation is an apparent benign tumour with an inclination to local aggressiveness. The most effective treatment seems to be surgical removal, but given the low number of cases mentioned (there are only eight cases reported in international literature), and the tendency to eventual recurrence, called for cobalt therapy after surgery. The evolution of clinical cases is irregular.

  14. Sexual Reproductive Biology of a Colonial Rotifer Sinantherina socialis (Rotifera: Monogononta): Do mating strategies vary between colonial and solitary rotifer species?

    Rico-Martínez, Roberto; Walsh, Elizabeth J.


    In many aquatic invertebrates including monogonont rotifers, sex provides genetic variation and dormant stages that allows dispersal in time and space. While the reproductive biology of some solitary monogonont rotifer species is known, little is known concerning mating behaviors in colonial rotifers. Coloniality poses unique challenges to the typical mating behavior of solitary rotifers. For instance, most species engage in circling behavior, where the male swims in close proximity to the female. In colonial forms, access to a particular female may be hindered by nearby colony mates. Here we provide descriptions of (1) male morphology, (2) mating behavior, and (3) types of eggs of the widespread colonial rotifer Sinantherina socialis, and discuss modifications in mating strategies as a consequence of coloniality. Two important differences from mating patterns documented in solitary rotifers were found in S. socialis. First, duration of circling phase of mating is protracted for males encountering small colonies of females as compared to solitary females. Males encountering single females removed from their colonies behave similarly to those of solitary species. Second, duration of copulation in S. socialis is the shortest reported for any rotifer species. Endogamy might occur in this species as sons copulate with their sisters and mothers, at least under laboratory conditions. Examples of behaviour in linked video clips. PMID:24932095

  15. [Pathological proximal femur fracture: consider also primary bone tumour].

    van de Sande, Michiel A J; van Rijswijk, Carla S P; Dijkstra, P D Sander; Taminiau, Antonie M H


    Two male and one female patient, aged 64, 70 and 51 respectively, were surgically treated for pathological fracture of the proximal femur without preoperative biopsy. In contrast to their benign radiological diagnosis, all three patients were finally diagnosed as having a malignant primary bone tumour. The proximal femur is the primary location of pathological fractures in the appendicular skeleton. Metastases to bone are the most common cause of a destructive lesion of the skeleton in an adult. Although rare, a primary bone tumour must be included in differential diagnosis of a pathological fracture. A systematic diagnostic strategy is critical to avoid complications that make curative treatment impossible. A solitary bone lesion seen on radiography should never be assumed to be a bone metastasis. Without further diagnostic research, surgical treatment for a pathological fracture should never be commenced before a definitive diagnosis is made.

  16. Ureteric complications in live related donor renal transplantation - impact on graft and patient survival

    A Srivastava


    Full Text Available Objective : The study was performed with an aim to determine the incidence of ureteric complications in live related donor renal transplantation, and to study the effect of ureteric complications on long term graft and patient survival. Patients And Methods: Records of 1200 consecutive live related renal transplants done from 1989-2002 were reviewed. Twenty-six ureteric complications were noted to occur and treatment modalities employed were documented. In the non complication group sufficient data for evaluation was available in 867 patients. Survival analysis were performed using Kaplan-Meier techniques. Results: The overall incidence of urological complications is 2.9%. Complications occurred at a mean interval of 31.9 days after renal transplantation. Ureteric complications occurred in 2% patients with stented and 7.7% patients with non stented anastomosis (p=0.001. Mean follow up following renal transplantation was 37.4 months. Survival analysis showed that ureteric complications did not increase the risk of graft fai lu re or patient death. Conclusions: Ureteric complications in live related donor renal transplantation occurred in 2.9 % patients and did not impair graft and patient survival.

  17. Effect of Diuretics on Ureteral Stone Therapy with Extracorporeal Shock Wave Lithotripsy

    Zomorrodi A


    Full Text Available To evaluate the effect of diuretics on ureteral stone fragmentation and clearance during therapy with extra corporeal shock wave lithotripsy (ESWL, we studied 87 patients with ureteral stone at different levels and treated with ESWL. The patients were randomized into two groups treated by standard ESWL; the treatment protocol included 3500 shock wave per patient in each session, energy of the shock in two groups was 13 to 9 kv per patient, and the number of sessions was 3 per patient. The first group included 43 patients who received only ESWL, while the second group of 44 patients received as well 40 mg of furosemide. Stone fragmentation rate was 81% and 93.1% and stone clearance rate was 68.2% and 88.4% for the first and the second groups, respectively. With diuretics, fragmentation was18.8% more in the middle ureteral stones, 16.9% more in the upper tract stones, and 5.4% more in the distal stones. Moreover, clearance of fragmented stones was 38%, 28%, 15.4% more at middle and upper and distal ureteral stone, respectively. We conclude that the stone fragmentation and clearance were higher with ESWL and diuretics than without diuresis. Diuresis is safe and has some advantage at increasing the effect of ESWL on ureteral stones especially the middle ureteral calculi.

  18. Unenhanced CT for the evaluation of acute ureteric colic: the essential pictorial guide.

    Kennish, Steven J; Wah, Tze M; Irving, Henry C


    Acute ureteric colic is a common emergency, often dealt with by the emergency physician or general practitioner and referred on to the urologist. Unenhanced CT of the kidneys, ureters and bladder (CTKUB) is the 'gold standard' imaging investigation for establishing a diagnosis and guiding management. An appreciation of the CTKUB signs, which support or refute a diagnosis of ureteric colic, is highly valuable to the clinician when making a urological referral, and to the urologist, who must make appropriate management plans. All salient diagnostic and supportive features of ureteric colic are carefully illustrated, as are important radiological mimics, with the objectives of educating and informing the non-radiologist. Ready access to the picture archive and communication system (PACS) allows all specialists involved to interpret the radiological report with the benefit of images. A stone within the ureter may not always be readily apparent. Soft tissue rim sign around a calcific focus is an important indicator of a ureteric stone, whereas a comet tail sign suggests a phlebolith (a calcified venous thrombosis), a radiological mimic of a ureteric stone. Numerous secondary signs of ureteric obstruction may be present including hydronephrosis and perinephric stranding, and can help to confirm the diagnosis. The relative diagnostic weighting of signs is discussed, and a checklist is provided to assist with interpretation. Unexpected alternative radiological diagnoses are also illustrated, which may have significant management consequences necessitating specialist referral.

  19. Study on Solitary Waves of a General Boussinesq Model


    In this paper, we employ the bifurcation method of dynamical systems to study the solitary waves and periodic waves of a generalized Boussinesq equations. All possible phase portraits in the parameter plane for the travelling wave systems are obtained. The possible solitary wave solutions, periodic wave solutions and cusp waves for the general Boussinesq type fluid model are also investigated.

  20. Exact solitary wave solutions of nonlinear wave equations


    The hyperbolic function method for nonlinear wave equations ispresented. In support of a computer algebra system, many exact solitary wave solutions of a class of nonlinear wave equations are obtained via the method. The method is based on the fact that the solitary wave solutions are essentially of a localized nature. Writing the solitary wave solutions of a nonlinear wave equation as the polynomials of hyperbolic functions, the nonlinear wave equation can be changed into a nonlinear system of algebraic equations. The system can be solved via Wu Elimination or Grbner base method. The exact solitary wave solutions of the nonlinear wave equation are obtained including many new exact solitary wave solutions.

  1. The lifecycle of axisymmetric internal solitary waves

    J. M. McMillan


    Full Text Available The generation and evolution of solitary waves by intrusive gravity currents in an approximate two-layer fluid with equal upper- and lower-layer depths is examined in a cylindrical geometry by way of theory and numerical simulations. The study is limited to vertically symmetric cases in which the density of the intruding fluid is equal to the average density of the ambient. We show that even though the head height of the intrusion decreases, it propagates at a constant speed well beyond 3 lock radii. This is because the strong stratification at the interface supports the formation of a mode-2 solitary wave that surrounds the intrusion head and carries it outwards at a constant speed. The wave and intrusion propagate faster than a linear long wave; therefore, there is strong supporting evidence that the wave is indeed nonlinear. Rectilinear Korteweg-de Vries theory is extended to allow the wave amplitude to decay as r-p with p=½ and the theory is compared to the observed waves to demonstrate that the width of the wave scales with its amplitude. After propagating beyond 7 lock radii the intrusion runs out of fluid. Thereafter, the wave continues to spread radially at a constant speed, however, the amplitude decreases sufficiently so that linear dispersion dominates and the amplitude decays with distance as r-1.

  2. Radiation therapy for the solitary plasmacytoma

    Esengül Koçak


    Full Text Available Plasma-cell neoplasms are classically categorized into four groups as: multiple myeloma (MM, plasma-cell leukemias, solitary plasmacytomas (SP of the bone (SPB, and extramedullary plasmacytomas (EMP. These tumors may be described as localized or diffuse in presentation. Localized plasma-cell neoplasms are rare, and include SP of the skeletal system, accounting for 2-5% of all plasma-cell neoplasms, and EMP of soft tissue, accounting for approximately 3% of all such neoplasms. SP is defined as a solitary mass of neoplastic plasma cells either in the bone marrow or in various soft tissue sites. There appears to be a continuum in which SP often progresses to MM. The main treatment modality for SP is radiation therapy (RT. However, there are no conclusive data in the literature on the optimal RT dose for SP. This review describes the interrelationship of plasma-cell neoplasms, and attempts to determine the minimal RT dose required to obtain local control.

  3. Long solitary internal waves in stable stratifications

    W. B. Zimmerman


    Full Text Available Observations of internal solitary waves over an antarctic ice shelf (Rees and Rottman, 1994 demonstrate that even large amplitude disturbances have wavelengths that are bounded by simple heuristic arguments following from the Scorer parameter based on linear theory for wave trapping. Classical weak nonlinear theories that have been applied to stable stratifications all begin with perturbations of simple long waves, with corrections for weak nonlinearity and dispersion resulting in nonlinear wave equations (Korteweg-deVries (KdV or Benjamin-Davis-Ono that admit localized propagating solutions. It is shown that these theories are apparently inappropriate when the Scorer parameter, which gives the lowest wavenumber that does not radiate vertically, is positive. In this paper, a new nonlinear evolution equation is derived for an arbitrary wave packet thus including one bounded below by the Scorer parameter. The new theory shows that solitary internal waves excited in high Richardson number waveguides are predicted to have a halfwidth inversely proportional to the Scorer parameter, in agreement with atmospheric observations. A localized analytic solution for the new wave equation is demonstrated, and its soliton-like properties are demonstrated by numerical simulation.

  4. The solitary sellar plasmacytoma: a diagnostic challenge

    Anne Soejbjerg


    Full Text Available Solitary sellar plasmacytomas are exceedingly rare and difficult to distinguish from other pituitary tumors. We report a case of a 62-year-old woman presenting with blurred vision of the right eye and tenderness of the right temporal region, which was interpreted as temporal arteritis. MRI revealed a pituitary mass lesion (20mm×14mm×17mm without compression of the optic chiasm and her pituitary function was normal. Pituitary surgery was undertaken due to growth of the lesion, and histopathological examination showed a highly cellular neoplasm composed of mature monoclonal plasma cells. Subsequent examinations revealed no evidence of extrasellar myeloma. The patient received pituitary irradiation and has remained well and free of symptoms apart from iatrogenic central diabetes insipidus. Until now, only eight cases of solitary sellar plasmacytoma have been reported. Most frequent symptoms stem from compression of the cranial nerves in the cavernous sinus (III, IV, V, whereas the anterior pituitary function is mostly intact.

  5. Solitary fibrous tumor surrounding the carotid sheath.

    Gómez-Oliveira, Guillermo; Alvarez-Flores, Modesto; Arribas-García, Ignacio; Martínez-Gimeno, Carlos


    Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms that are mostly found arising from the pleura. Although SFTs recently have been reported in other regions, they are rare in the head and neck and have often been misdiagnosed due to their rarity. SFTs are benign in most cases. Clinically, SFTs usually manifest as well-circumscribed, slow-growing, smooth and painless masses. Symptoms are often minimal, although they may include sore throat, difficulty in swallowing, change of voice or trismus. CT-Scan and MRI are the most sensitive imaging procedures used. The treatment of choice is complete surgical excision of the lesion. Because recurrences have been noted up to 30 years after surgery, long-term follow up is mandatory. In this article, we present a case of a Solitary Fibrous Tumor arising in the parapharyngeal space in a 20-year-old man, involving the carotid sheath, treated by surgical excision with no recurrence after 1 year. The clinical presentation, surgical management and pathological findings are described.

  6. Single ectopic ureteral orifice with bilateral duplicated renal collecting systems in an adult girl: Diagnosis by magnetic resonance urography.

    Tang, Min; Wang, Quanrongzi; Liu, Bianjiang; Li, Jie; Lu, Qiang; Song, Ninghong; Wang, Zengjun; Zhang, Wei


    Renal duplication accompanied by ureteral ectopia is an uncommon urinary congenital abnormality. We report the case of a 21-year-old girl who suffered from lifelong continuous urinary leakage. She was finally diagnosed with bilateral duplicated collecting systems complicated with right ectopic ureteral orifice - an extremely rare case. The patient underwent ureteric re-implantation for the ectopic side, and her urinary incontinence ceased soon thereafter. In this case, traditional imaging failed to show the exact insertion of an ectopic ureter. However, magnetic resonance urography combined with retrograde intubation radiography successfully depicted the point of ureteric insertion, which may make the diagnostic process accurate and efficient.

  7. Neighborhoods and manageable proximity

    Stavros Stavrides


    Full Text Available The theatricality of urban encounters is above all a theatricality of distances which allow for the encounter. The absolute “strangeness” of the crowd (Simmel 1997: 74 expressed, in its purest form, in the absolute proximity of a crowded subway train, does not generally allow for any movements of approach, but only for nervous hostile reactions and submissive hypnotic gestures. Neither forced intersections in the course of pedestrians or vehicles, nor the instantaneous crossing of distances by the technology of live broadcasting and remote control give birth to places of encounter. In the forced proximity of the metropolitan crowd which haunted the city of the 19th and 20th century, as well as in the forced proximity of the tele-presence which haunts the dystopic prospect of the future “omnipolis” (Virilio 1997: 74, the necessary distance, which is the stage of an encounter between different instances of otherness, is dissipated.

  8. Atrofia muscular proximal familiar

    José Antonio Levy


    Full Text Available Os autores relatam dois casos de atrofia muscular proximal familiar, moléstia caracterizada por déficit motor e atrofias musculares de distribuição proximal, secundárias a lesão de neurônios periféricos. Assim, como em outros casos descritos na literatura, foi feito inicialmente o diagnóstico de distrofia muscular progressiva. O diagnóstico correto foi conseguido com auxílio da eletromiografia e da biopsia muscular.

  9. Proximity and IPO Underpricing

    Nielsson, Ulf; Wójcik, Dariusz


    This paper analyses the relationship between issuers' location and IPO underpricing in the U.S. from 1986 to 2014. Issuers headquartered in rural areas are associated with lower underpricing compared to urban firms. This finding is consistent with strong local bias in rural areas accompanied...... by superior local information, which associates with more accurate pricing and less money left on the table. The paper further finds that refined measures of local bias, such as proximity to finance professionals and density of financial expertise, correlate more with IPO underpricing than proximity to large...

  10. Solitary plasmacytoma of spine with amyloidosis

    Cui-yun SUN


    Full Text Available Objective To report the diagnosis and treatment of one case of solitary plasmacytoma of spine with amyloidosis and investigate the clinicopathological features combined with literatures. Methods and Results The patient was a 46-year-old woman. She suffered from weakness of both lower limbs, unsteady gait and numbness of toes for 20 d. MRI examination revealed an irregular mass behind the spinal cord at T5-7 level and T6-7 vertebral body accessory. The enhanced MRI showed obvious heterogeneous enhancement. The border was clear and spinal dura mater was compressed to shift forward. During operation, T5-7 processus spinosus and vertebral laminae were eroded, and the cortex of bone showed "moth-eaten" erosion. The intraspinal and extradural lesion had rich blood supply, loose bone structure and intact spinal dura mater. Histologically, tumor cells were composed of intensive small cells, and focal plasmacytoid cells were seen. Flake pink staining substance was among them. Artificial cracks were common and multinuclear giant tumor cells were scatteredly distributed. Immunohistochemical analysis showed the cytoplasm of tumor cells were diffusely positive for CD138, CD38 and vimentin (Vim,scatteredly positive for leukocyte common antigen (LCA, and negative for immune globulin κ light chain(IgGκ and λ light chain (IgGλ, CD99, S-100 protein (S-100, pan cytokeratin (PCK, epithelial membrane antigen (EMA, HMB45 and CD34. The Ki-67 labeling index was 1.25%. Congo red staining showed the pink staining substance was brownish red. Hybridization in situ examination showed the DNA content of IgGκ was more than that of IgGλ. The final pathological diagnosis was solitary plasmacytoma of spine with amyloidosis. The patient was treated with postoperative chemotherapy, and there was no recurrence or metastasis during 18-month follow-up period. Conclusions Solitary plasmacytoma of spine with amyloidosis is a rare tumor. The imaging features can offer a few

  11. A study of ureteric peristalsis using a single catheter to record EMG, impedance, and pressure changes.

    Roshani, H; Dabhoiwala, N F; Tee, S; Dijkhuis, T; Kurth, K H; Ongerboer de Visser, B W; de Jong, J M; Lamers, W H


    Ureteric peristalsis transports a urinary bolus from the renal pelvis to the bladder. We developed an intraluminal catheter with a pressure transducer on it to study intraluminal pressure changes and a twin bipolar electrode to record the ureteric EMG and impedance (Z) changes during a peristaltic wave. Five female New Yorkshire pigs (50-60 kg) were studied under light halothane anesthesia (5% at induction/1% for maintenance). A steady state of hydration was maintained using intravenous saline infusion. EMG spike burst activity was studied at a 10-cm interval using low (0-30) Hz filters. Impedance between the same electrodes is measured simultaneously in higher frequencies (1-5 KHz) as a function of ureteric motor activity. Pressure generation in the ureteric lumen was also measured simultaneously by a transducer on the same catheter. A digital signal processing program (Poly 4.9) was used for analysis. Parenteral furosemide was used to induce diuresis. Resting ureteric impedance (Z(R)) decreases to Z(B) (Z bolus) during the passage of the urinary bolus. Passage of a contractile zone during a peristaltic wave increases impedance from Z(B) to its Z(R) level and initiates a pressure rise. Bolus length (the length Z(B)) is not constant and decreases distally. EMG corresponds well in time to impedance. Z(R) disappears after infusion of furosemide because of increased urine load and changes of intraluminal ionic environment. The contractile segment of a ureteric peristaltic wave appears to be represented by an elevated Z segment (Z(C)). Pressure rise is recorded only at the beginning of a contractile zone. A specially adapted intraluminal catheter can be used to study peristalsis in the upper urinary tract. One can study all the three components of ureteric peristalsis (excitation, contraction, and intraluminal pressure rise) using such a catheter.

  12. Transurethral exchange of double-J ureteral stent using goose- neck snare

    Kang, Chang Ho; Kim, Yun Hwan; Cho, Sung Bum; Kim, Chul Joong; Kim, Hyoung Rae; Kim, Hong Weon; Suh, Won Hyuck [College of Medicine, Korea University, Seoul (Korea, Republic of); Cho, Sung Bum [Eulji Hospital, Eulji College of Medicine, Taejon (Korea, Republic of)


    To evaluate the usefulness of transurethral exchange of double-J ureteral stent as an effective alternative to the cystoscopic approach. There were 20 exchange cases involving seven patients (six women and one man) who initially underwent anterograde manipulation of a double-J ureteral stent. Indications for stent placement were ureteral stricture caused by malignancy in six patients (cervical carcinoma (n=3D5), stomach carcinoma (n=3D1)), and renal tuberculosis in one. An 8-F Nelaton catheter was inserted in the bladder via the urethra and contrast material was injected until the bladder was fully distended. The distal end of a double-J ureteral stent was extracted to the urethral orifice using a goose-neck snare and a 0.035{sup s}tiff guide wire was then advanced to the renal pelvis through the stent. After that, the stent was removed and a 4-F Cobra catheter was advanced to the renal pelvis along the guide wire. Contrast material was injected through the catheter, and the renal pelvis, calyx and ureter were opacified. The 0.035 stiff guide wire was again inserted via the catheter, and a new double-J ureteral stent was inserted, and the catheter removed. Finally, the new double-J stent was properly located within the renal pelvis and the bladder. Double-J ureteral stents were successfully exchanged in 19 of 20 exchange cases. After the procedure, all patients reported tolerable, minimal lower abdominal pain. Transurethral exchange of double-J ureteral stent is a useful alternative to cystoscopy. (author)

  13. Ketoprofen-eluting biodegradable ureteral stents by CO2 impregnation: In vitro study.

    Barros, Alexandre A; Oliveira, Carlos; Reis, Rui L; Lima, Estevão; Duarte, Ana Rita C


    Ureteral stents are indispensable tools in urologic practice. The main complications associated with ureteral stents are dislocation, infection, pain and encrustation. Biodegradable ureteral stents are one of the most attractive designs with the potential to eliminate several complications associated with the stenting procedure. In this work we hypothesize the impregnation of ketoprofen, by CO2-impregnation in a patented biodegradable ureteral stent previously developed in our group. The biodegradable ureteral stents with each formulation: alginate-based, gellan gum-based were impregnated with ketoprofen and the impregnation conditions tested were 100 bar, 2 h and three different temperatures (35 °C, 40 °C and 50 °C). The impregnation was confirmed by FTIR and DSC demonstrated the amorphization of the drug upon impregnation. The in vitro elution profile in artificial urine solution (AUS) during degradation of a biodegradable ureteral stent loaded with ketoprofen was evaluated. According to the kinetics results these systems have shown to be very promising for the release ketoprofen in the first 72 h, which is the necessary time for anti-inflammatory delivery after the surgical procedure. The in vitro release studied revealed an influence of the temperature on the impregnation yield, with a higher impregnation yield at 40 °C. Higher yields were also obtained for gellan gum-based stents. The non-cytotoxicity characteristic of the developed ketoprofen-eluting biodegradable ureteral stents was evaluated in L929 cell line by MTS assay which demonstrated the feasibility of this product as a medical device.

  14. Sema4C-Plexin B2 signalling modulates ureteric branching in developing kidney.

    Perälä, Nina; Jakobson, Madis; Ola, Roxana; Fazzari, Pietro; Penachioni, Junia Y; Nymark, Mariann; Tanninen, Tiina; Immonen, Tiina; Tamagnone, Luca; Sariola, Hannu


    Semaphorins, originally identified as axon guidance molecules, have also been implicated in angiogenesis, function of the immune system and cancerous growth. Here we show that deletion of Plexin B2 (Plxnb2), a semaphorin receptor that is expressed both in the pretubular aggregates and the ureteric epithelium in the developing kidney, results in renal hypoplasia and occasional double ureters. The rate of cell proliferation in the ureteric epithelium and consequently the number of ureteric tips are reduced in the kidneys lacking Plexin B2 (Plxnb2-/-). Semaphorin 4C, a ligand for Plexin B2, stimulates branching of the ureteric epithelium in wild type and Plxnb2+/- kidney explants, but not in Plxnb2-/- explants. As shown by co-immunoprecipitation Plexin B2 interacts with the Ret receptor tyrosine kinase, the receptor of Glial-cell-line-derived neurotrophic factor (Gdnf), in embryonic kidneys. Isolated Plxnb2-/- ureteric buds fail to respond to Gdnf by branching, but this response is rescued by Fibroblast growth factor 7 and Follistatin as well as by the metanephric mesenchyme. The differentiation of the nephrogenic mesenchyme, its morphology and the rate of apoptosis in the Plxnb2-/- kidneys are normal. Plexin B2 is co-expressed with Plexin B1 (Plxnb1) in the kidney. The double homozygous Plxnb1-Plxnb2-deficient mice show high embryonic lethality prior to onset of nephrogenesis. The only double homozygous embryo surviving to E12 showed hypoplastic kidneys with ureteric branches and differentiating mesenchyme. Taken together, our results show that Sema4C-Plexin B2 signalling regulates ureteric branching, possibly through modulation of Gdnf signalling by interaction with Ret, and suggest non-redundant roles for Plexin B1 and Plexin B2 in kidney development. Copyright © 2010 International Society of Differentiation. Published by Elsevier B.V. All rights reserved.

  15. Weak bond detection in composites using highly nonlinear solitary waves

    Singhal, Taru; Kim, Eunho; Kim, Tae-Yeon; Yang, Jinkyu


    We experimentally investigate a diagnostic technique for identifying a weak bond in composites using highly nonlinear solitary waves (HNSWs). We set up a one-dimensional chain of granular crystals, consisting of spherical particles with nonlinear interactions, to generate HNSWs. These solitary wave packets are transmitted into an inspection area of composites by making a direct contact with the chain. We demonstrate that a strong type of solitary waves injected to the weak bond area can break the weak bond of laminates, thereby causing delamination. Then, to identify the creation of the delamination, we transmit a weak type of solitary waves by employing the same apparatus, and measure the solitary waves reflected from the specimens. By analyzing these reflected solitary waves, we differentiate the weak bond samples with the pristine bond ones in an efficient and fast manner. The diagnostic results based on the proposed method are compared with the strength and energy release rate at bond interfaces, which are measured via standard testing methods such as three point bending and end notched flexure tests. This study shows the potential of solitary wave-based detection of weak bonds for hot spot monitoring of composite-based structures.

  16. Effect of ipsilateral ureteric obstruction on contralateral kidney and role of renin angiotensin system blockade on renal recovery in experimentally induced unilateral ureteric obstruction

    Shasanka S Panda


    Full Text Available Aims: To study, the effects of ipsilateral ureteric obstruction on contralateral kidney and the role of renin angiotensin system (RAS blockade on renal recovery in experimentally induced unilateral ureteric obstruction. Materials and Methods: Unilateral upper ureteric obstruction was created in 96 adult Wistar rats that were reversed after pre-determined intervals. Losartan and Enalapril were given to different subgroups of rats following relief of obstruction. Results: The severity of dilatation on the contralateral kidney varied with duration of ipsilateral obstruction longer the duration more severe the dilatation. There is direct correlation between renal parenchymal damage, pelvi-ureteric junction (PUJ fibrosis, inflammation and severity of pelvi-calyceal system dilatation of contralateral kidney with duration of ipsilateral PUJ obstruction. Conclusions: Considerable injury is also inflicted to the contralateral normal kidney while ipsilateral kidney remains obstructed. Use of RAS blocking drugs has been found to significantly improve renal recovery on the contralateral kidney. It can, thus, be postulated that contralateral renal parenchymal injury was mediated through activation of RAS.

  17. Solitary second metatarsal metastasis as the first site of distant spread in TCC urinary bladder: A case report.

    Yadav, Siddharth; Kumar, Rajeev


    Metastasis to the skeleton is uncommon in muscle-invasive carcinoma of the urinary bladder. When present, it most commonly involves the axial and proximal appendicular skeleton, and acrometastasis (metastasis to hand and foot) is very rare. We report a patient who developed a solitary metastatic lesion of the left metatarsal 2 weeks after radical cystectomy. The lack of suspicion and magnetic resonance imaging findings suggestive of inflammation led to a diagnosis of tubercular osteomyelitis and antitubercular therapy was started. The patient developed nodal metastasis and, because the foot lesion did not respond to treatment, fine needle aspiration cytology from it revealed poorly differentiated metastatic cancer.

  18. Steerable Capacitive Proximity Sensor

    Jenstrom, Del T.; Mcconnell, Robert L.


    Steerable capacitive proximity sensor of "capaciflector" type based partly on sensing units described in GSC-13377 and GSC-13475. Position of maximum sensitivity adjusted without moving sensor. Voltage of each driven shield adjusted separately to concentrate sensing electric field more toward one side or other.

  19. Children's proximal societal conditions

    Stanek, Anja Hvidtfeldt


    This article will argue for and unfold the conceptualization of children’s proximal societal conditions. Through out different research project in which children’s everyday life in different day care settings and in schools has been studied, it becomes clear that ‘the societal’ is not something t...

  20. Proximate Analysis of Coal

    Donahue, Craig J.; Rais, Elizabeth A.


    This lab experiment illustrates the use of thermogravimetric analysis (TGA) to perform proximate analysis on a series of coal samples of different rank. Peat and coke are also examined. A total of four exercises are described. These are dry exercises as students interpret previously recorded scans. The weight percent moisture, volatile matter,…

  1. A solitary fibrous tumor of the kidney

    Anuruddha M Abeygunasekera


    Full Text Available A solitary fibrous tumor (SFT is an uncommon spindle cell neoplasm that usually occurs in the pleura, but may occur in extrapleural sites. Its occurrence in the kidney is rare. We report a SFT, clinically thought to be a renal cell carcinoma arising in the kidney of a 68-year-old female. The tumor was well-circumscribed and composed of a mixture of spindle cells and dense collagenous bands. Immunohistochemical studies revealed reactivity for CD34, CD99, and Bcl-2 protein, with no staining for keratin or muscle markers, confirming the diagnosis. The immunohistochemical study was the key to diagnosis. Several younger members of her family had colorectal and lung cancers suggesting the possibility of a familial or genetic susceptibility.

  2. Solitary waves of the splitted RLW equation

    Zaki, S. I.


    A combination of the splitting method and the cubic B-spline finite elements is used to solve the non-linear regularized long wave (RLW) equation. This approach involves a Bubnov-Galerkin method with cubic B-spline finite elements so that there is continuity of the dependent variable and its first derivative throughout the solution region. Time integration of the resulting systems is effected using a Crank-Nicholson approximation. In simulations of the migration of a single solitary wave this algorithm is shown to have higher accuracy and better conservation than a recent splitting difference scheme based on cubic spline interpolation functions, for different amplitudes ranging from a very small ( ⩾0.03) to a considerably high amplitudes ( ⩽0.3). The development of an undular bore is modeled.

  3. Numerical Simulation of Solitary Kinetic Alfven Waves

    DING Jian; LI Yi; WANG Shui


    Using the two-fluid model in the case of α1 (α=β/2Q, β is the ratio of thermal pressure to magnetic pressure, and Q=m,e/m,I), we numerically investigate the interactions between two solitary kinetic Alfven waves (SKAWs) and between an SKAW and a density discontinuity. The results show that the two SKAWs would remain in their original shapes and propagate at their initiating speeds, which indicates that SKAWs behave just like standard solitons. The simulation also shows that SKAWs will reflect and refract when crossing a discontinuity and propagating into a higher density region. The transmission wave is an SKAW with increasing density, and the reverberation is a disturbance with lower amplitude.

  4. Benign solitary solid cold thyroid nodules

    Døssing, Helle; Bennedbaek, Finn Noe; Karstrup, Steen;


    PURPOSE: To evaluate the effects of ultrasonography (US)-guided interstitial laser photocoagulation (ILP) on the volume of benign solitary solid cold thyroid nodules and any nodule-related symptoms. MATERIALS AND METHODS: ILP was performed in 16 patients with normal thyroid function and a solid...... to evaluate the size of the untreated thyroid nodule. RESULTS: In the 16 patients treated with ILP, the mean thyroid nodule volume decreased from 10 to 5.4 mL (P .... Pressure symptoms were significantly reduced (P =.0002) after 6 months. The treatment was well-tolerated in all patients. No significant change in thyroid nodule volume was seen in the control group. CONCLUSION: US-guided ILP could become a useful nonsurgical alternative in the treatment of the benign...

  5. Solitary Plasmacytoma of the Chest Wall

    Servet Kayhan


    Full Text Available A previously healthy 55-year-old man with right sided lateral chest pain admitted to clinic. It was found a solid and painful mass at the right 4th rib in physical examination. Chest X-ray and thoracic computarized tomography showed an opacity measured 60x33 mm within the right chest wall destructing the 4th rib. Needle aspiration was performed from tumor and cytologic examination showed atypic plasma cell infiltration. The patient was scheduled for a chest wall resection and reconstructive surgery. Examination of a permanent section showed that the chest wall tumor was solitary plasmacytoma. There was no evidence of multiple myeloma recurrence after two years from the operation.

  6. Transparent lattices and their solitary waves.

    Sadurní, E


    We provide a family of transparent tight-binding models with nontrivial potentials and site-dependent hopping parameters. Their feasibility is discussed in electromagnetic resonators, dielectric slabs, and quantum-mechanical traps. In the second part of the paper, the arrays are obtained through a generalization of supersymmetric quantum mechanics in discrete variables. The formalism includes a finite-difference Darboux transformation applied to the scattering matrix of a periodic array. A procedure for constructing a hierarchy of discrete Hamiltonians is indicated and a particular biparametric family is given. The corresponding potentials and hopping functions are identified as solitary waves, pointing to a discrete spinorial generalization of the Korteweg-deVries family.

  7. Solitary vortex couples in viscoelastic Couette flow

    Groisman, A; Groisman, Alexander; Steinberg, Victor


    We report experimental observation of a localized structure, which is of a new type for dissipative systems. It appears as a solitary vortex couple ("diwhirl") in Couette flow with highly elastic polymer solutions. A unique property of the diwhirls is that they are stationary, in contrast to the usual localized wave structures in both Hamiltonian and dissipative systems which are stabilized by wave dispersion. It is also a new object in fluid dynamics - a couple of vortices that build a single entity somewhat similar to a magnetic dipole. The diwhirls arise as a result of a purely elastic instability through a hysteretic transition at negligible Reynolds numbers. It is suggested that the vortex flow is driven by the same forces that cause the Weissenberg effect. The diwhirls have a striking asymmetry between the inflow and outflow, which is also an essential feature of the suggested elastic instability mechanism.

  8. Solitary Fibrous Tumor of the Cerebello-Pontine Angle

    Biggs, Nigel D.; Fagan, Paul A.; Turner, Jennifer J.; Doust, Bruce


    A case is presented of solitary fibrous tumor occurring in the cerebello-pontine angle. There have been only two other reported cases of a solitary fibrous tumors in this region. Imaging studies showed the tumor to be characteristic in shape and position of an acoustic tumor. However, at surgery the tumor was found to have a “rock hard” consistency. Solitary fibrous tumor differs from acoustic schwannoma and meningioma in its histopathological features and in this case, regrowth, after incomplete excision, was extremely rapid. ImagesFigure 2Figure 3Figure 4Figure 5Figure 6 PMID:17171119

  9. Generation of Solitary Rossby Waves by Unstable Topography

    YANG Hong-Wei; YIN Bao-Shu; DONG Huan-He


    The effect of topography on generation of the solitary Rossby waves is researched. Here, the topography, as a forcing for waves generation, is taken as a function of longitude variable x and time variable t, which is called unstable topography. With the help of a perturbation expansion method, a forced mKdv equation governing the evolution of amplitude of the solitary Rossby waves is derived from quasi-geostrophic vortieity equation and is solved by the pseudo-spectral method. Basing on the waterfall plots, the generational features of the solitary Rossby waves under the influence of unstable topography and stable topography are compared and some conclusions are obtained.

  10. Ureteric Obstruction Caused by a Migrated Intrauterine Device

    Xuesong Yang


    Full Text Available We present an extremely rare case of ureteric obstruction caused by a migrated intrauterine device. A 36-year-old female with complaints of almost 10 months left flank pain presented to our hospital. She used an IUD for contraception for 6 months after the birth of her first child. The IUD was not visible then. Ultrasonography (US revealed that left severe hydronephrosis and upper ureterectasis. Pelvic computed tomography (CT found that IUD was located very close to the lower ureter which was adjacent to the third anatomize physiological narrow. Laparoscopy was performed to remove the migrated IUD. After 5 months of surgery, left hydronephrosis was exacerbated. This time we chose to perform the ureterocystostomy to relieve the hydronephrosis. We reported this rare case to remind that we must keep alert to the loss of the IUD to prevent it may cause severe injury of the nearby organs. IUD must be carefully researched for possible perforation of the uterus and migration to the pelvic organs.

  11. Chronic partial ureteral obstruction and the developing kidney

    Chevalier, Robert L. [University of Virginia, Department of Pediatrics, Box 800386, Charlottesville, VA (United States)


    Although congenital urinary tract obstruction is a common disorder, its pathophysiology remains poorly understood and clinical practice is controversial. Animal models have been used to elucidate the mechanisms responsible for obstructive nephropathy, and the models reveal that renal growth and function are impaired in proportion to the severity and duration of obstruction. Ureteral obstruction in the neonatal rat or mouse leads to activation of the renin-angiotensin system, renal infiltration by macrophages, and tubular apoptosis. Nephrons are lost by glomerular sclerosis and the formation of atubular glomeruli, and progressive injury leads to tubular atrophy and interstitial fibrosis. Recovery following release of obstruction depends on the timing, severity, and duration of obstruction. Growth factors and cytokines are produced by the hydronephrotic kidney, including MCP-1 and TGF-{beta}1, which are excreted in urine and can serve as biomarkers of renal injury. Because MRI can be used to monitor renal morphology, blood flow, and filtration rate, its use might supplant current imaging modalities (ultrasonography and diuretic renography), which have significant drawbacks. Combined use of MRI and new urinary biomarkers should improve our understanding of human congenital obstructive nephropathy and should lead to new approaches to evaluation and management of this challenging group of patients. (orig.)

  12. Ureteric Injury due to the Use of LigaSure

    Muazzam Tahir


    Full Text Available Background. LigaSure is a bipolar clamping device used in open and laparoscopic surgeries for producing haemostasis in vascular pedicles up to 7 mm in diameter (“Covidien LigaSure technology: consistent, reliable, trusted vessel sealing,” 2012. The use of LigaSure has made securing haemostasis and tissue dissection relatively easy especially in laparoscopic surgery; however, if not used with care it can cause damage to the surrounding structures through lateral spread of energy. Case Report. This case report discusses the induction of a thermal ureteral injury associated with the use of LigaSure. An 80-year-old gentleman was operated for bowel cancer. LigaSure was used for securing haemostasis and tissue dissection. Postoperatively, he was found to have damage to the right ureter secondary to lateral spread of energy from the jaws of LigaSure with high abdominal drain output. Conclusion. Judicious and careful use of electrosurgical devices should be done to prevent inadvertent damage to the surrounding structures. Early recognition and involvement of a urologist can prevent long-term complications.

  13. Updates on the use of ureteral stents: focus on the Resonance® stent

    Thomas MT Turk


    Full Text Available Manoj V Rao, Anthony J Polcari, Thomas MT TurkDepartment of Urology, Loyola University Medical Center, Maywood, IL, USAAbstract: The Resonance® metallic ureteral stent is one of the latest additions to the urologist’s armamentarium in managing ureteral obstruction. One advantage of this stent over traditional polymer-based stents is resistance to encrustation with stone material, which allows longer dwell times and less frequent exchange procedures. Although exchanging a metallic stent is slightly more complicated than exchanging a polymer stent, the fluoroscopic techniques required are familiar to most urologists. The Resonance stent is also more resistant to compression by external forces, potentially allowing greater applicability in patients with metastatic cancer. Furthermore, the use of this stent in patients with benign ureteral obstruction is shown to be associated with significant cost reduction. Clinical studies on the use of this stent are accumulating and the results are mixed, although Level 1 evidence is lacking. In this article we present a comprehensive review of the available literature on the Resonance metallic ureteral stent.Keywords: resonance, metallic, ureteral, stent, obstruction

  14. Degradation and antibacterial properties of magnesium alloys in artificial urine for potential resorbable ureteral stent applications.

    Lock, Jaclyn Y; Wyatt, Eric; Upadhyayula, Srigokul; Whall, Andrew; Nuñez, Vicente; Vullev, Valentine I; Liu, Huinan


    This article presents an investigation on the effectiveness of magnesium and its alloys as a novel class of antibacterial and biodegradable materials for ureteral stent applications. Magnesium is a lightweight and biodegradable metallic material with beneficial properties for use in medical devices. Ureteral stent is one such example of a medical device that is widely used to treat ureteral canal blockages clinically. The bacterial colony formation coupled with the encrustation on the stent surface from extended use often leads to clinical complications and contributes to the failure of indwelling medical devices. We demonstrated that magnesium alloys decreased Escherichia coli viability and reduced the colony forming units over a 3-day incubation period in an artificial urine (AU) solution when compared with currently used commercial polyurethane stent. Moreover, the magnesium degradation resulted in alkaline pH and increased magnesium ion concentration in the AU solution. The antibacterial and degradation properties support the potential use of magnesium-based materials for next-generation ureteral stents. Further studies are needed for clinical translation of biodegradable metallic ureteral stents.

  15. Percutaneous Management of Ureteral Injuries that are Diagnosed Late After Cesarean Section

    Ustunsoz, Bahri; Ugurel, Sahin; Duru, Namik Kemal; Ozgok, Yasar; Ustunsoz, Ayfer [GATA Medical Faculty, Ankara (Turkmenistan)


    We wanted to present the results of percutaneous management of ureteral injuries that were diagnosed late after cesarean sections (CS). Twenty-two cases with 24 ureteral injuries that were diagnosed late after CS underwent percutaneous nephrostomy (PN), antegrade double J (DJ) catheter placement and balloon dilatation or a combination of these. The time for making the diagnosis was 21 +- 50.1 days. The injury site was the distal ureter in all cases (the left ureter: 13, the right ureter: 7 and bilateral: 2). Fifteen complete ureteral obstructions were detected in 13 cases. Ureteral leakage due to partial (n = 4) or complete (n = 3) rupture was noted in seven cases. Two cases had ureterovaginal fistula. All the cases were initially confirmed with antegrade pyelography and afterwards they underwent percutaneous nephrostomy. Balloon dilatation was needed in three cases. Antegrade DJ stents were placed in 10 cases, including the three cases with balloon dilatation. Repetititon of percutaneous nephrostomy with balloon dilatation and DJ stent placement was needed in one case with complete obstruction. All the cases were followed-up with US in their first week and then monthly thereafter for up to two years. Eighteen ureters (75%) were managed by percutaneous procedures alone. A total of six ureter injuries had to undergo surgery (25%). Percutaneous management is a good alternative for the treatment of post-CS ureteral injuries that are diagnosed late after CS. Percutaneous management is at least preparatory for a quarter of the cases where surgery is unavoidable

  16. Optimal management of distal ureteric strictures following renal transplantation: a systematic review.

    Kwong, Justin; Schiefer, Danielle; Aboalsamh, Ghaleb; Archambault, Jason; Luke, Patrick P; Sener, Alp


    Our objective was to define optimal management of distal ureteric strictures following renal transplantation. A systematic review on PubMed identified 34 articles (385 patients). Primary endpoints were success rates and complications of specific primary and secondary treatments (following failure of primary treatment). Among primary treatments (n = 303), the open approach had 85.4% success (95% CI 72.5-93.1) and the endourological approach had 64.3% success (95% CI 58.3-69.9). Among secondary treatments (n = 82), the open approach had 93.1% success (95% CI 77.0-99.2) and the endourological approach had 75.5% success (95% CI 62.3-85.2). The most common primary open treatment was ureteric reimplantation (n = 33, 81.8% success, 95% CI 65.2-91.8). The most common primary endourological treatment was dilation (n = 133, 58.6% success, 95% CI 50.1-66.7). Fourteen complications, including death (4 weeks post-op) and graft loss (12 days post-op), followed endourological treatment. One complication followed open treatment. This is the first systematic review to examine the success rates and complications of specific treatments for distal ureteric strictures following renal transplantation. Our review indicates that open management has higher success rates and fewer complications than endourological management as a primary and secondary treatment for post-transplant distal ureteric strictures. We also outline a post-transplant ureteric stricture evaluation and treatment algorithm.

  17. Does a retrograde pyelography prior to ureteroscopy influence stone-free rates and complication rates in ureteral calculi?

    Seklehner, Stephan; Heißler, Ortwin; Engelhardt, Paul F; Riedl, Claus


    To evaluate the impact of retrograde pyelography (RPG) in patients treated with ureteroscopy (URS) for ureteral calculi. Retrospective analysis of patients treated with and without RPG prior to URS at a single institution from 2010 to 2013. Assessment of stone-free rates and intraoperative complications. Out of 469 URS, 211 (45%) were done with and 258 (55%) without RPG. Complete stone removal was achieved in 86.8% without RPG compared to 73% with RPG (p=0.0001). Partial stone removal rates were similar in both groups (p=0.77). Stone removal was not achieved in 9.3 vs. 22.7% (p=0.0001), with concordant findings in the distal (7.4 vs. 16.9%, p=0.007) and the proximal ureter (14.5 vs. 38.6%, p=0.002). Patients with RPG had a threefold higher chance of an unsuccessful URS (OR 3.05, 1.71-5.43, pRPG prior to URS had significantly inferior stone-free rates. RPG was identified as an independent risk factor for inferior results. RPG neither facilitates nor diminishes complication rates during URS. © 2014 S. Karger AG, Basel.

  18. Site-specific Quantification of Bone Quality using Highly Nonlinear Solitary Waves

    Yang, Jinkyu; Borkowski, Sean; Silvestro, Claudio; De Nardo, Luigi; Daraio, Chiara; Ebramzadeh, Edward


    Osteoporosis is a well recognized problem affecting millions of individuals worldwide. Consequently, the need to effectively, efficiently, and affordably diagnose and identify those at risk is essential; moreover, site-specific assessment of bone quality is necessary, not only in the process of risk assessment, but may also be desirable for other applications. The present study evaluated a new one-dimensional granular crystal sensor, composed of a tightly packed chain of beads under Hertzian contact interaction, representing the most suitable fundamental component for solitary wave generation and propagation. First, the sensitivity of the novel sensor was tested using densities of rigid polyurethane foam, representing clinical bone quality ranging from healthy, to severely osteoporotic. Once the relationship between the signal response and known densities was established, the sensor was used to measure several sites located in the proximal femur of ten human cadaveric specimens. The accuracy of the model was ...

  19. Head-on collision and overtaking collision between an envelope solitary wave and a KdV solitary wave in a dusty plasma.

    Zhang, Heng; Duan, Wen-Shan; Qi, Xin; Yang, Lei


    Head-on collision and overtaking collision between a KdV solitary wave and an envelope solitary wave are first studied in present paper by using Particle-in-cell (PIC) method in a dusty plasma. There are phase shifts of the KdV solitary wave in both head-on collision and the overtaking collision, while no phase shift is found for the envelop solitary wave in any cases. The remarkable difference between head-on collision and the overtaking collision is that the phase shift of KdV solitary wave increases as amplitude of KdV solitary wave increases in head-on collision, while it decreases as amplitude of the KdV solitary wave increases in the overtaking collision. It is found that the maximum amplitude during the collision process is less than sum of two amplitudes of both solitary waves, but is larger than either of the amplitude.

  20. A plethora of generalised solitary gravity-capillary water waves

    Clamond, Didier; Duran, Angel


    The present study describes, first, an efficient algorithm for computing gravity-capillary solitary waves solutions of the irrotational Euler equations and, second, provides numerical evidences of the existence of (likely) an infinite number of generalised solitary waves (i.e. solitary waves with undamped oscillatory wings). Using conformal mapping, the unknown fluid domain (which is to be determined) is mapped into a uniform strip of the complex plane. A Babenko-like equation is then derived from a Lagrangian expressed in the transformed domain. The Babenko equation is then solved numerically using a Levenberg-Marquardt algorithm. Various interesting solutions are computed, some of them being known, some seem to be new. The emergence of generalised solitary waves is shown when the Bond number is increased.

  1. Oblique solitary waves in a five component plasma

    Sijo, S.; Manesh, M.; Sreekala, G.; Venugopal, C., E-mail: [School of Pure and Applied Physics, Mahatma Gandhi University, Kottayam, 686 560 Kerala (India); Neethu, T. W. [Department of Physics, CMS College, Mahatma Gandhi University, Kottayam, 686 001 Kerala (India); Renuka, G. [Kerala State Council for Science, Technology and Environment, Thiruvananthapuram, 695 004 Kerala (India)


    We investigate the influence of a second electron component on oblique dust ion acoustic solitary waves in a five component plasma consisting of positively and negatively charged dust, hydrogen ions, and hotter and colder electrons. Of these, the heavier dust and colder photo-electrons are of cometary origin while the other two are of solar origin; electron components are described by kappa distributions. The K-dV equation is derived, and different attributes of the soliton such as amplitude and width are plotted for parameters relevant to comet Halley. We find that the second electron component has a profound influence on the solitary wave, decreasing both its amplitude and width. The normalized hydrogen density strongly influences the solitary wave by decreasing its width; the amplitude of the solitary wave, however, increases with increasing solar electron temperatures.

  2. Solitary pulmonary granuloma with marked enhancement on dynamic CT scanning

    Stark, P.; Wong, V.; Gold, P.


    A patient is described who presented with a vividly enhancing solitary pulmonary nodule during dynamic CT scanning. This mass proved to represent a granuloma due to coccidioidomycosis. The presumptive mechanism of enhancement as well as the differential diagnosis are discussed.

  3. Proximity Networks and Epidemics

    Toroczkai, Z


    Disease spread in most biological populations requires the proximity of agents. In populations where the individuals have spatial mobility, the contact graph is generated by the "collision dynamics" of the agents, and thus the evolution of epidemics couples directly to the spatial dynamics of the population. We first briefly review the properties and the methodology of an agent-based simulation (EPISIMS) to model disease spread in realistic urban dynamic contact networks. Using the data generated by this simulation, we introduce the notion of dynamic proximity networks which takes into account the relevant time scales for disease spread: contact duration, infectivity period and rate of contact creation. This approach promises to be a good candidate for a unified treatment of epidemic types that are driven by agent collision dynamics. In particular, using a simple model, we show that it can can account for the observed qualitative differences between the degree distributions of contact graphs of diseases with ...

  4. Proximate analysis of coal

    Donahue, C.J.; Rais, E.A. [University of Michigan, Dearborn, MI (USA)


    This lab experiment illustrates the use of thermogravimetric analysis (TGA) to perform proximate analysis on a series of coal samples of different rank. Peat and coke are also examined. A total of four exercises are described. These are dry exercises as students interpret previously recorded scans. The weight percent moisture, volatile matter, fixed carbon, and ash content are determined for each sample and comparisons are made. Proximate analysis is performed on a coal sample from a local electric utility. From the weight percent sulfur found in the coal (determined by a separate procedure the Eschka method) and the ash content, students calculate the quantity of sulfur dioxide emissions and ash produced annually by a large coal-fired electric power plant.

  5. Proximal femoral fractures

    Palm, Henrik; Teixidor, Jordi


    BACKGROUND: In hip fracture surgery, the exact choice of implant often remains somewhat unclear for the individual surgeon, but the growing literature consensus has enabled publication of evidence-based surgical treatment pathways. The aim of this article was to review author pathways and national...... guidelines for hip fracture surgery and discuss a method for future pathway/guideline implementation and evaluation. METHODS: By a PubMed search in March 2015 six studies of surgical treatment pathways covering all types of proximal femoral fractures with publication after 1995 were identified. Also we...... searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery. RESULTS: Pathway consensus is outspread (internal fixation for un...

  6. Proximal Focal Femoral Deficiency

    Vishal Kalia, Vibhuti


    Full Text Available Proximal focal femoral deficiency (PFFD is a developmental disorder of the proximal segment of thefemur and of acetabulum resulting in shortening of the affected limb and impairment of the function. It isa spectrum of congenital osseous anomalies characterized by a deficiency in the structure of the proximalfemur. The diagnosis is often made by radiological evaluation which includes identification and descriptionof PFFD and evaluation of associated limb anomalies by plain radiographs. Contrast arthrography orMagnetic Resonance Imaging is indicated when radiological features are questionable and to disclose thepresence and location of the femoral head and any cartilagenous anlage. The disorder is more commonlyunilateral and is apparent at birth. However, bilateral involvement is rarely seen. Therapy of the disorder isdirected towards satisfactory ambulation and specific treatment depending on the severity of dysplasia.

  7. Solitary plasmacytoma of the rib: A rare case

    Rikki Singal


    Full Text Available Localized solitary plasmacytoma of the bone is a rare disease and is characterized by only one or two isolated bone lesions with no evidence of disease dissemination. We report a case of solitary plasmacytoma of the rib in a 43-year-old female. The patient underwent complete en-bloc resection of the chest wall including rib, muscle, and parietal pleura. Patient is asymptomatic without any recurrence after two and half years of follow up.

  8. Solitary mesenteric vascular anomaly presenting as acute abdomen

    Thambidorai C


    Full Text Available A 4-year-old girl with a solitary vascular anomaly of the mesentery presented with acute lower abdominal pain. Despite the use of ultrasound, computed tomography scan and image-guided core biopsies, the lesion was initially mistaken for an inflammatory intra-abdominal mass. The correct diagnosis was made at laparotomy. Solitary vascular anomaly of the mesentery is rare and its presentation as an acute abdomen has not been reported before.

  9. Solitary osteochondroma arising from cervical spina bifida occulta.

    Ofluoglu, Ali Ender; Abdallah, Anas; Gokcedag, Akin


    Solitary osteochondromas are common benign long bone tumors originating from cartilage. They may produce a wide variety of symptoms and complications depending on their spinal location. These may include compressive myelopathy, nerve root compression, pathologic fracture and malignant degeneration, or in some cases only pain. Solitary cervical spine osteochondromas have been reported mostly in the neural arch or vertebral body. This report describes a patient presenting with neck pain, with a benign osteochondroma arising in the right bifid C5 lamina.

  10. [Adenocarcinoma of lung cancer with solitary metastasis to the stomach].

    Koh, Sung Ae; Lee, Kyung Hee


    Although hematogenous metastasis of cancer to the gastrointestinal track is rare, it sometime has been reported in patients with malignant melanoma and breast cancer. However, it is extremely rare for lung cancer to metastasize to the stomach, not to mention solitary gastric metastasis. Herein, the authors report a case of a 69-year-old man who was initially diagnosed with lung cancer with synchronous primary gastric cancer which proved to be lung cancer with solitary gastric metastasis after the operation.

  11. Ureteral obstruction associated with pelvic inflammatory disease in a long-term intrauterine contraceptive device user.

    Yonemura, Shigenori; Moriya, Mitsuhiko; Hori, Yasuhide; Arima, Kiminobu; Toyoda, Nagayasu; Sugimura, Yoshiki


    We report herein a case of ureteral obstruction associated with pelvic inflammatory disease in a long-term intrauterine contraceptive device (IUD) user. A 62-year-old woman presented with a 2-week history of left flank pain and high fever, but no abdominal pain. She had forgotten the use of an IUD. Retrograde pyelography showed a stricture in the lower third of the left ureter. Magnetic resonance showed swelling of the uterus wall and left parametria, but did not reveal the presence of an IUD. Subtotal hysterectomy, bilateral salpingo-oophorectomy and left nephronureterectomy was performed. The IUD was then found in the uterine cavity. The results of pathological and bacteriological findings for Actinomyces infection were negative. Therefore we diagnosed this case as ureteral obstruction associated with pelvic inflammatory disease. Ureteral obstruction associated with pelvic inflammatory disease in a long-term IUD user is extremely rare.

  12. Solitary Wave in One-dimensional Buckyball System at Nanoscale

    Xu, Jun; Zheng, Bowen; Liu, Yilun


    We have studied the stress wave propagation in one-dimensional (1-D) nanoscopic buckyball (C60) system by molecular dynamics (MD) simulation and quantitative modeling. Simulation results have shown that solitary waves are generated and propagating in the buckyball system through impacting one buckyball at one end of the buckyball chain. We have found the solitary wave behaviors are closely dependent on the initial temperature and impacting speed of the buckyball chain. There are almost no dispersion and dissipation of the solitary waves (stationary solitary wave) for relatively low temperature and high impacting speed. While for relatively high temperature and low impacting speed the profile of the solitary waves is highly distorted and dissipated after propagating several tens of buckyballs. A phase diagram is proposed to describe the effect of the temperature and impacting speed on the solitary wave behaviors in buckyball system. In order to quantitatively describe the wave behavior in buckyball system, a simple nonlinear-spring model is established, which can describe the MD simulation results at low temperature very well. The results presented in this work may lay a solid step towards the further understanding and manipulation of stress wave propagation and impact energy mitigation at nanoscale. PMID:26891624

  13. On cusped solitary waves in finite water depth

    Liao, Shijun


    It is well-known that the Camassa-Holm (CH) equation admits both of the peaked and cusped solitary waves in shallow water. However, it was an open question whether or not the exact wave equations can admit them in finite water depth. Besides, it was traditionally believed that cusped solitary waves, whose 1st-derivative tends to infinity at crest, are essentially different from peaked solitary ones with finite 1st-derivative. Currently, based on the symmetry and the exact water wave equations, Liao [1] proposed a unified wave model (UWM) for progressive gravity waves in finite water depth. The UWM admits not only all traditional smooth progressive waves but also the peaked solitary waves in finite water depth: in other words, the peaked solitary progressive waves are consistent with the traditional smooth ones. In this paper, in the frame of the linearized UWM, we further give, for the first time, the cusped solitary waves in finite water depth, and besides reveal a close relationship between the cusped and p...

  14. Solitary mammals provide an animal model for autism spectrum disorders.

    Reser, Jared Edward


    Species of solitary mammals are known to exhibit specialized, neurological adaptations that prepare them to focus working memory on food procurement and survival rather than on social interaction. Solitary and nonmonogamous mammals, which do not form strong social bonds, have been documented to exhibit behaviors and biomarkers that are similar to endophenotypes in autism. Both individuals on the autism spectrum and certain solitary mammals have been reported to be low on measures of affiliative need, bodily expressiveness, bonding and attachment, direct and shared gazing, emotional engagement, conspecific recognition, partner preference, separation distress, and social approach behavior. Solitary mammals also exhibit certain biomarkers that are characteristic of autism, including diminished oxytocin and vasopressin signaling, dysregulation of the endogenous opioid system, increased Hypothalamic-pituitary-adrenal axis (HPA) activity to social encounters, and reduced HPA activity to separation and isolation. The extent of these similarities suggests that solitary mammals may offer a useful model of autism spectrum disorders and an opportunity for investigating genetic and epigenetic etiological factors. If the brain in autism can be shown to exhibit distinct homologous or homoplastic similarities to the brains of solitary animals, it will reveal that they may be central to the phenotype and should be targeted for further investigation. Research of the neurological, cellular, and molecular basis of these specializations in other mammals may provide insight for behavioral analysis, communication intervention, and psychopharmacology for autism.

  15. Dextranomer/hyaluronic acid copolymer (Deflux) implants mimicking distal ureteral calculi on CT

    Nelson, Caleb P. [Children' s Hospital Boston, Department of Urology, Boston, MA (United States); Chow, Jeanne S. [Children' s Hospital Boston, Department of Radiology, Boston, MA (United States)


    Periureteral or subtrigonal injection of dextranomer/hyaluronic acid (Dx/HA) copolymer (Deflux, Q-Med, Uppsala, Sweden) is an increasingly common endoscopic treatment for vesicoureteral reflux. We report a confusing radiographic finding of bilateral calcified Dx/HA injections initially thought to represent bilateral distal ureteral stones in a boy who presented with intermittent periumbilical pain. Urologists, radiologists, and emergency room physicians should be aware of the potential for calcification of ureteral implants of Dx/HA, and of the potentially confusing radiographic images that may result. (orig.)

  16. TROP2 Expressed in the Trunk of the Ureteric Duct Regulates Branching Morphogenesis during Kidney Development

    Yuko Tsukahara; Minoru Tanaka; Atsushi Miyajima


    TROP2, a cell surface protein structurally related to EpCAM, is expressed in various carcinomas, though its function remains largely unknown. We examined the expression of TROP2 and EpCAM in fetal mouse tissues, and found distinct patterns in the ureteric bud of the fetal kidney, which forms a tree-like structure. The tip cells in the ureteric bud proliferate to form branches, whereas the trunk cells differentiate to form a polarized ductal structure. EpCAM was expressed throughout the ureter...

  17. A rare cause of anuria: Bilateral synchronous isolated mid-ureteric tubercular lesions

    Anuj D Dangi


    Full Text Available A young female presenting with right flank pain, fever, raised creatinine and bilateral hydronephrosis was treated with antibiotics elsewhere, with presumptive diagnosis of bilateral pyelonephritis. She had partial relief in symptoms and her creatinine level showed an improvement. Three months later during evaluation at our center she had anuria, hypertensive crisis and pulmonary edema which were managed with emergency bilateral percutaneous nephrostomies. Cross-sectional imaging and ureteroscopy suggested bilateral synchronous intramural mid-ureteric lesions as underlying pathology. Histopathology of the ureteric segments during laparotomy revealed caseating granulomas suggestive of tuberculosis. This clinical presentation has not been previously described in urinary tuberculosis.

  18. A rare cause of massive haematuria: Internal iliac artery-ureteric fistula.

    Rao, Ahsan M; Khalil, Ahmed; Suttie, Stuart


    Ureteric fistula into the arterial tree is a well-recognised, but uncommon condition. The involvement of internal iliac artery is rare. We present a rare case of fistulous communication and subsequent infection of an internal iliac artery aneurysm and ureter secondary to insertion of ureteric stent following endovascular exclusion of the aneurysm and its management. Nephrostogram identified the fistula not seen on computerised tomography. This case highlights the awareness of such pathology allowing for prompt recognition of the condition and importance of appropriate imaging.

  19. Pneumatic v electrokinetic lithotripsy in treatment of ureteral stones.

    Vorreuther, R; Klotz, T; Heidenreich, A; Nayal, W; Engelmann, U


    Recently, a new device (Combilith) for electrokinetic lithotripsy (EKL) has become available which is very similar to the well-known device for pneumatic (ballistic) lithotripsy (Swiss Lithoclast). The Lithoclast uses air pressure to push a projectile within the handpiece against the end of a metal probe, which is thereby accelerated and thrown like a jackhammer against the stone. In principle, the same stroking movement of a small metal probe is provided by EKL; the difference is that instead of a projectile, a magnetic core within the handpiece is accelerated by the electromagnetic principle. This paper compares the clinical efficacy and the features of the two devices. Testing the devices on a stone model, taking into account stone propulsion, the systems turned out to equally effective regarding stone disintegration. However, stone displacement was more pronounced with the Lithoclast applied on easily breaking stones. In a second experiment, an optoelectronic movement-measuring apparatus (Zimmer camera) was employed to measure the range and velocity of the movement of the probe tip without any contact. The linear acceleration velocity ranged from 5 to a maximum of 12.5 m/sec with both systems, but the maximum height of the stroke was 2.5 mm with the Lithoclast and 1 mm with EKL. After the initial break-up of soft stones, further impact of the probe tip against the stone resulted merely in propulsion; thus, the greater probe stroke height is the cause of the stone displacement. In a clinical trial, 22 ureteral stones were treated with the Lithoclast and 35 with the EKL. The two devices were equally effective in terms of stone disintegration and safety margin. Fixation using a Dormia basket was necessary in 12 cases (8 Lithoclast, 4 EKL). Although a difference in probe stroke height was noted when comparing pneumatic and electrokinetic lithotripsy, there were no clinically significant differences in the efficacy of stone fragmentation or stone-free rates. At the

  20. Proximal Tibiofibular Joint: An overview

    Tze Wang Chan


    Full Text Available Proximal tibiofibular joint is a frequently neglected joint which can be a source of lateral knee pain. Open surgery is the current mainstay of surgical management of proximal tibiofibular joint disorders. The proximal tibiofibular arthroscopy allows access to the joint and adjacent important ligamentous structures. This forms the basis of further development of arthroscopic procedures for a variety of pathologies.

  1. Solitary fibrous tumor of the pleura.

    Marak, Creticus P; Dorokhova, Olena; Guddati, Achuta K


    Solitary fibrous tumor of the pleura (SFTP) is a rare tumor of mesenchymal origin which can grow to a large size and present with symptoms of cough and pleuritic chest pain. No specific etiological factors for SFTPs are known and they may grow undetected for several years. These tumors are usually benign and may mimic a variety of malignancies. SFTPs are often detected as peripheral opacities on chest X-ray. Unfortunately, fine needle aspiration rarely provides adequate information for a definitive diagnosis. Imaging with computed tomography provides details about the size and extent of any invasion into adjacent tissues. Surgical resection is the mainstay of treatment, and immunohistochemistry of the resected tumor often provides confirmation of the diagnosis. Some SFTPs have been observed to be malignant, and surgical intervention is often lifesaving. There is no adequate data to support the usage of radiotherapy and chemotherapy in the treatment of SFTPs. This tumor exemplifies malignancies which require surgical resection to preempt worse outcomes. Awareness of their presentation and clinical course may help the clinician provide a prompt referral to the thoracic surgeon for resection.

  2. Food searching and superparasitism in solitary parasitoids

    Sirot, Etienne; Bernstein, Carlos

    Optimality theory predicts that, provided that a larva resulting from superparasitism has some chance of winning the competition with the other larvae present in the host, under certain conditions, solitatry parasitoids should resort to superparasitism. Both theoretical and experimental studies have shown that the life expectancy of the parasitoid has a strong influence on the decision to reject or to accept superparasitism. In many species, life expectancy on its turn depends on the feeding behaviour of the parasitoids, which have to forage for non-host food (mainly plant materials), for the maintenance of their energy reseves. As many solitary parasitoids do not find non-host food in their host patches, they have to choose at each instant whether to search for food or to search for hosts. In this paper, we develop a stochastic dynamic programming model to study the behavioural choice between host and food searching, and its consequences for the acceptance and rejection of superparasitism. We study the influence of habitat quality and parasitoid physiological state on the optimal choice. The model predicts that the crucial point determining the optimal strategy is the balance between egg-and time-limitation.

  3. Intracranial solitary fibrous tumor: Imaging findings

    Clarencon, Frederic, E-mail: [Department of Neuroradiology, Pitie-Salpetriere Hospital, APHP, 75013 Paris (France); Bonneville, Fabrice [Department of Neuroradiology, Hopital Rangueil, Toulouse University Hospital, 31000 Toulouse (France); Rousseau, Audrey [Department of Neuropathology, Pitie-Salpetriere Hospital (France); Galanaud, Damien [Department of Neuroradiology, Pitie-Salpetriere Hospital, APHP, 75013 Paris (France); Kujas, Michele [Department of Neuropathology, Pitie-Salpetriere Hospital (France); Naggara, Olivier [Department of Neuroradiology, St Anne Hospital, 75014 Paris (France); Cornu, Philippe [Department of Neurosurgery, Pitie-Salpetriere Hospital (France); Chiras, Jacques [Department of Neuroradiology, Pitie-Salpetriere Hospital, APHP, 75013 Paris (France)


    Objective: To study the neuroimaging features of intracranial solitary fibrous tumors (ISFTs). Materials and methods: Retrospective study of neuroimaging features of 9 consecutive histopathologically proven ISFT cases. Location, size, shape, density, signal intensity and gadolinium uptake were studied at CT and MRI. Data collected from diffusion-weighted imaging (DWI) (3 patients), perfusion imaging and MR spectroscopy (2 patients), and DSA (4 patients) were also analyzed. Results: The tumors most frequently arose from the intracranial meninges (7/9), while the other lesions were intraventricular. Tumor size ranged from 2.5 to 10 cm (mean = 6.6 cm). They presented multilobular shape in 6/9 patients. Most ISFTs were heterogeneous (7/9) with areas of low T2 signal intensity that strongly enhanced after gadolinium administration (6/8). Erosion of the skull was present in about half of the cases (4/9). Components with decreased apparent diffusion coefficient were seen in 2/3 ISFTs on DWI. Spectroscopy revealed elevated peaks of choline and myo-inositol. MR perfusion showed features of hyperperfusion. Conclusion: ISFT should be considered in cases of extra-axial, supratentorial, heterogeneous, hypervascular tumor. Areas of low T2 signal intensity that strongly enhance after gadolinium injection are suggestive of this diagnosis. Restricted diffusion and elevated peak of myo-inositol may be additional valuable features.

  4. Solitary magnetic perturbations at the ELM onset

    Wenninger, RP; Boom, JE; Burckhart, A; Dunne, MG; Dux, R; Eich, T; Fischer, R; Fuchs, C; Garcia-Munoz, M; Igochine, V; Hoelzl, M; Luhmann, NC; Lunt, T; Maraschek, M; Mueller, HW; Park, HK; Schneider, PA; Sommer, F; Suttrop, W; Viezzer, E


    Edge localised modes (ELMs) allow maintaining sufficient purity of tokamak H-mode plasmas and thus enable stationary H-mode. On the other hand in a future device ELMs may cause divertor power flux densities far in excess of tolerable material limits. The size of the energy loss per ELM is determined by saturation effects in the non-linear phase of the ELM, which at present is hardly understood. Solitary magnetic perturbations (SMPs) are identified as dominant features in the radial magnetic fluctuations below 100kHz. They are typically observed close (+-0.1ms) to the onset of pedestal erosion. SMPs are field aligned structures rotating in the electron diamagnetic drift direction with perpendicular velocities of about 10km/s. A comparison of perpendicular velocities suggests that the perturbation evoking SMPs is located at or inside the separatrix. Analysis of very pronounced examples showed that the number of peaks per toroidal turn is 1 or 2, which is clearly lower than corresponding numbers in linear stabil...

  5. Solitary caecum diverticulitis mimicking acute appendicitis.

    Hot, Semih; Eğin, Seracettin; Gökçek, Berk; Yeşiltaş, Metin; Alemdar, Ali; Akan, Arzu; Karahan, Servet Rüştü


    Solitary cecum diverticulum is a benign formation, but it can be complicated with inflammation, perforation and bleeding. Cecum diverticulitis (CD) is the most common complication of caecal diverticulum and it has the highest incidence among Asians, but it is a rare condition in the western world. The incidence of colonic diverticular disease can vary according to national origin, cultural structure and nutritional habits. CD is not common in our country, but it is an important situation because of its clinical similarity with the commonly seen acute right side abdominal diseases like acute appendicitis. Preoperative diagnosis is difficult, and hence, the actual frequency is not known. The treatment of CD can vary from medical therapy to right hemi colectomy. In this study, we presented ten CD cases on whom surgical resection was performed in our surgery unit during the last 8 years. Our purpose was to increase the awareness of surgeons about this situation, and so, make them pay attention for not having their first experience in the operating room.

  6. Proximate Composition Analysis.


    The proximate composition of foods includes moisture, ash, lipid, protein and carbohydrate contents. These food components may be of interest in the food industry for product development, quality control (QC) or regulatory purposes. Analyses used may be rapid methods for QC or more accurate but time-consuming official methods. Sample collection and preparation must be considered carefully to ensure analysis of a homogeneous and representative sample, and to obtain accurate results. Estimation methods of moisture content, ash value, crude lipid, total carbohydrates, starch, total free amino acids and total proteins are put together in a lucid manner.

  7. Endoscopic placement of double-J ureteric stents in children as a treatment for primary obstructive megaureter

    Carroll Daniel


    Full Text Available Aim: To determine the efficacy and potential complications of double-J ureteric stents in the treatment of persistent or progressive primary obstructive megaureter in pediatric patients within our institution. Materials and Methods: A retrospective case-note review of all patients with double-J ureteric stents, between 1997 and 2004, was performed. In all, 38 stents were inserted in 31 patients aged between 2 months and 15 years of age. Complications and results of follow-up investigations and the need for follow-up investigations were recorded. Patients were followed up clinically and radiologically for a minimum of 2 years following stent insertion. Results: Endoscopic placement of double-J ureteric stents in childhood is straightforward and complications are uncommon (8/38 insertions. In non-resolving or progressive primary non-refluxing megaureter, double-J ureteric stenting alone is effective with resolution of primary non-refluxing megaureter in 66% of cases (25/38 insertions. Conclusions: Ureteric stenting provides an alternative to early surgery in patients with primary non-refluxing megaureter. The youngest patient in our series was 2 months old at the time of endoscopic ureteric double-J stent insertion. Endoscopic placement of ureteric double-J stents should be considered as a first-line treatment in the management of persistent or progressive non-refluxing megaureter leading to progressive hydronephrosis or pyonephrosis.

  8. Genetic analysis reveals an unexpected role of BMP7 in initiation of ureteric bud outgrowth in mouse embryos.

    Alexandre Gonçalves

    Full Text Available BACKGROUND: Genetic analysis in the mouse revealed that GREMLIN1 (GREM1-mediated antagonism of BMP4 is essential for ureteric epithelial branching as the disruption of ureteric bud outgrowth and renal agenesis in Grem1-deficient embryos is restored by additional inactivation of one Bmp4 allele. Another BMP ligand, BMP7, was shown to control the proliferative expansion of nephrogenic progenitors and its requirement for nephrogenesis can be genetically substituted by Bmp4. Therefore, we investigated whether BMP7 in turn also participates in inhibiting ureteric bud outgrowth during the initiation of metanephric kidney development. METHODOLOGY/PRINCIPAL FINDINGS: Genetic inactivation of one Bmp7 allele in Grem1-deficient mouse embryos does not alleviate the bilateral renal agenesis, while complete inactivation of Bmp7 restores ureteric bud outgrowth and branching. In mouse embryos lacking both Grem1 and Bmp7, GDNF/WNT11 feedback signaling and the expression of the Etv4 target gene, which regulates formation of the invading ureteric bud tip, are restored. In contrast to the restoration of ureteric bud outgrowth and branching, nephrogenesis remains aberrant as revealed by the premature loss of Six2 expressing nephrogenic progenitor cells. Therefore, very few nephrons develop in kidneys lacking both Grem1 and Bmp7 and the resulting dysplastic phenotype is indistinguishable from the one of Bmp7-deficient mouse embryos. CONCLUSIONS/SIGNIFICANCE: Our study reveals an unexpected inhibitory role of BMP7 during the onset of ureteric bud outgrowth. As BMP4, BMP7 and GREM1 are expressed in distinct mesenchymal and epithelial domains, the localized antagonistic interactions of GREM1 with BMPs could restrict and guide ureteric bud outgrowth and branching. The robustness and likely significant redundancy of the underlying signaling system is evidenced by the fact that global reduction of Bmp4 or inactivation of Bmp7 are both able to restore ureteric bud outgrowth

  9. The Comparison of Ultrasonography and Non Enhanced Helical Computed Tomography in the Diagnosis of Ureteral Calculi

    İlhan Kılınç


    Full Text Available Intravenous urography, ultrasonography, and non-contrast spiral computed tomography have been used to diagnose ureteral calculi. We aimed to compare the accuracy of non-contrast spiral computed tomography with ultrasonography in the evaluation of patients with renal colic.Fourty-one patients with flank pain were examined with both computed tomography and ultrasonography over a period of 11 months. Findings of ultrasonography and computed tomography of 28 patients in whom üreteral stones were confirmed by standart methods were comparedUreteral calculi were diagnosed in 28 of 41 patients. Ureteral stones could be demonstrated in 18 patients by ultrasonography and in 27 patients by computed tomography. Ultrasonography showed 64.3% sensitivity and 100% specificity in the diagnosis of ureterolithiasis; computed tomography showed 96.4% and 100%, respectively. Spiral computed tomography is superior to ultrasonography in the demonstration of ureteral calculi in patients with renal colic. But because of higher cost and higher radiation dose, it should be reserved for symptomatic cases in whom ultrasonography is non-diagnostic.

  10. Repeat knot formation in a patient with an indwelling ureteral stent

    Brian Eisner


    Full Text Available A patient treated for nephrolithiasis formed knots in 2 occasions, in 2 separate indwelling ureteral stents. This rare complication may make stent removal difficult. To our knowledge, this is the first case report of repeat knot formation in a single patient.

  11. Clinical implications and applications of the twinkling sign in ureteral calculus: a preliminary study.

    Sharma, Gyanendra; Sharma, Anshu


    Twinkling is an artifact seen on color Doppler ultrasound as a rapidly changing mixture of red and blue behind a stationary echogenic structure. We studied the presence or absence of this artifact in ureteral calculi detected on ultrasound and correlated it with clinical parameters. We evaluated 284 ureteral calculi seen on color Doppler ultrasound. The twinkling artifact was graded as 0 to 2 and correlated with the presence or absence of pain, symptom duration, degree of hydronephrosis and passage of a Glidewire® guidewire across the ureteral calculus during ureterorenoscopy. The presence or absence of twinkling was not associated with the degree of hydronephrosis. Twinkling was absent in 92% of patients with significant pain and grade 2 twinkling was seen in 69.5% without significant pain. Twinkling was dominantly absent in patients with a recent colic episode, while 77% who presented 2 to 15 days after a colic episode had grade 2 twinkling. The guidewire was difficult to pass in cases with absent twinkling compared to those with grade 2 twinkling, in which the guidewire and ureteral catheter crossed the calculus easily. Absent twinkling is associated with significant pain, a recent colic episode and difficult guidewire passage across the calculus. These findings suggest that absent twinkling implies significant obstruction, while its presence indicates no significant obstruction. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  12. Validation of screening examinations of the ureteral orifices in dogs: Comparison of ultrasonography with dissection.

    Balogh, O; Degrandi, F; Hässig, M; Reichler, I M


    In dogs, ultrasonography is performed to locate the ureteral orifices in the urinary bladder, but reference values for their normal location using this technique are missing. In this study, the ureterovesical-vesicourethral and inter-ureterovesical distances were determined in 20 freshly euthanized medium size dogs by detecting artificially produced ureteral jets in color-flow Doppler ultrasonography at two different bladder volumes, and comparing them to manual measurements in the dissected bladder. All distances determined by ultrasonography were in agreement with values found by dissection (P ≥ 0.100). With increasing bladder volume only the left ureterovesical-vesicourethral distance changed (P = 0.041). The right ureteral opening was more cranial than the left in 16 dogs. The inter-ureterovesical distances differed by gender (P = 0.016), but spay/neuter status had no influence (P ≥ 0.847). In conclusion, ultrasonography is a reliable modality for screening ureteral orifices in medium size dogs and agrees with anatomical findings.

  13. Lumbar Ureteral Stenosis due to Endometriosis: Our Experience and Review of the Literature

    Salvatore Butticè


    Full Text Available Endometriosis is a chronic gynaecological disorder characterized by the presence of endometrial tissue outside the uterus. The disease most often affects the ovaries, uterine ligaments, fallopian tubes, and cervical-vaginal region. Urinary tract involvement is rare, accounting for around 1%-2% of all cases, of which 84% are in the bladder. We report a case of isolated lumbar ureteral stenosis due to endometriosis in a 37-year-old patient. The patient came to our observation complaining from lumbar back pain and presented with severe fever. The urological examination found monolateral left positive sign of Giordano. Blood tests evidenced marked lymphocytosis and increased valued of C-reactive protein. Urologic ultrasound showed hydronephrosis of first degree in the left kidney and absence of images related to stones bilaterally. Uro-CT scan evidenced ureteral stenosis at the transition between the iliac and pelvic tracts. We addressed the patient to surgery, and performed laparoscopic excision of the paraureteral bulk, endoscopic mechanical ureteral dilation, and stenting. The histological examination evidenced glandular structures lined by simple epithelium and surrounded by stroma. Immunohistochemical test of the glandular epithelium showed positivity for estrogen and progesterone receptors and moreover stromal cells were positive for CD10. The finding suggested a very rare diagnosis of isolated lumbar ureteral endometriosis.

  14. Ureteral diameter in low-risk vesicoureteral reflux in infancy and childhood

    Hellstroem, M.; Hjaelmaas, K.; Jacobsson, B.; Jodal, U.

    In order to improve the accuracy of the grading of vesicoureteral reflux (VUR), reference values for ureteral diameter at micturition cystourethrography (MCUG) were established in infants and children with low-risk VUR. Low-risk VUR was defined as VUR not associated with infection, obstruction, calculi, duplication, malformations (except for hypospadia) or neurogenic bladder disturbances. Forty-six children (age 1 day - 14 years) were selected by examining the records of 12000 MCUG:s performed 1960-1983. Ureteral diameter was measured at the widest point of the ureter on the films from MCUG:s and urographies. Ureteral diameter was slightly larger at MCUG than at urography in the same individuals but the difference was not significant. The ureteral diameter at MCUG also correlated closely to normal values at urography in a previous study. It is proposed that the reference values obtained at MCUG in the present investigation can be used for the differentiation between dilatation and no dilatation in the grading of VUR.

  15. Ureteropelvic junction obstruction and ureteral strictures treated by simple high-pressure balloon dilation

    Osther, P J; Geertsen, U; Nielsen, H V


    years, success was achieved in only 25% of cases. There were no major complications. It was concluded that simple high-pressure balloon dilation is a safe and reasonably effective technique for the management of most ureteral strictures and congenital UPJO with symptom debut in adult life. Balloon...... dilation seems to have no place in the treatment of primary congenital UPJO in children....

  16. Solitary infantile myofibromatosis of the cranial vault: case report.

    Merciadri, Paolo; Pavanello, Marco; Nozza, Paolo; Consales, Alessandro; Ravegnani, Giuseppe Marcello; Piatelli, Gianluca; Gandolfo, Carlo; Cama, Armando


    Infantile myofibromatosis is a mesenchymal disorder of early childhood characterized by the formation of tumors in the skin, muscle, viscera, bone, and subcutaneous tissue. Although relatively rare overall, it represents the most common fibrous tumor of infancy. The etiology of this disorder is unknown. Infantile myofibromatosis can present as a solitary or multicentric form. With the multicentric form, bone is often involved, but solitary bone lesions account for only 10% of the cases. Imaging findings are not pathognomonic, and the differential diagnosis usually includes eosinophilic granuloma (Langerhans cell histiocytosis), osteomyelitis, metastasis, osteoblastoma, epidermoid cyst, hemangioma, fibrous dysplasia, fibrosarcoma, and meningioma. A histological pattern is typical, but there are no histopathological differences between the solitary and multicentric forms. Solitary lesions generally have a favorable prognosis if totally removed, with a 10% recurrence rate; incompletely resected lesions recur. We report the case of a 9-year-old boy who came to our attention with a solitary infantile myofibroma of the calvarium, appearing as a tight-elastic, lightly tender mass in the left frontal area, eroding both the inner and the outer tables. Histopathologically, the specimens showed a spindle-cell tumor with dense reticulin fiber network and expression of smooth muscle actin. Fifty-eight months MR follow-up after total removal showed no residual or relapse.

  17. Laparoscopic Rectopexy in Solitary Rectal Ulcer

    Hassan Salmanroughani


    Full Text Available Patients with Solitary Rectal Ulcer Syndrome (SRUS come to a physician with passage of mucus and bloody liquid within defecation. The treatment for SRUS is depended to the severity of symptoms and the existance of rectal prolapse. This study is a report of the assessing of rectopexy as surgical modalities for 62 medical treatment resistant SRUS patients who were referred to the gastrointestinal department of Shahid Sadoughi Medical University and Mojibian hospital. The present non-randomized clinical trial was carried out in 62 SRUS patients from 1991 till 2005. In these patients SRUS was confirmed by histology. They were symptomatic after conservative therapy and referred for surgical intervention. All of them had been undergone abdominal rectopexy by two laparoscopic surgeons. In our study, rectal bleeding and history of digitalization had the highest and lowest frequency of symptoms and signs in our cases respectively. Abdominal rectopexy was done in 39 cases and complete recovery in our cases was 69.23%. Complete recovery rate in cases with dysplasia (63.8% was significantly higher than cases without that (P=0.04. Complete recovery rate in cases that had finger defecation (85% was significantly higher than cases without that (50% (P=0.03. Laparoscopic rectopexy is one of the main surgical techniques for treatment of SRUS. This technique can present complete recovery for SRUS patients. Some of them include topical medications, behavior modification supplemented by fiber and biofeedback and surgery were more available and studied. But it seems that education of SRUS patient conservative treatment remain cornerstone in the SRUS management.

  18. Solitary pancreas retransplant: Study of 22 cases

    Tércio Genzini


    Full Text Available Objective: To present our experience with pancreas retransplantin patients previously submitted to simultaneous pancreas-kidneytransplant, pancreas after kidney transplant and pancreastransplant alone. Methods: Between January/1996 and December/2005, 330 pancreas transplants were performed: 308 primarytransplants and 22 (6% retransplants of solitary pancreas. Thefollowing variables were analyzed: patient age; time elapsedbetween the first and the second transplant; causes of loss of thefirst graft; technical characteristics of the transplant andretransplant and the criteria for selecting donors for retransplant.These clinical data were submitted to statistical analysis. Results:The mean age of patients was 34.3 years and the mean elapsedtime between the first and second transplant was 19.3 months.The causes of the first graft loss were venous (8; 35% and arterial(5; 23% thrombosis, chronic rejection (4; 18%, ischemia/reperfusion injury (2, reflux pancreatitis (1, primary non-function(1 and sepsis (1. A second transplant was performed in thesame iliac fossa in 16 patients (72%. Venous drainage wasperformed in the iliac vein in 16 patients (72%, in the inferior venacava in 5 patients (22% and in the portal vein in one patient. 6 allbladder drainage was the technique used in 18 (82% cases andenteric drainage, in 4 patients (18%. Immunosuppressive regimenapplied to all cases was quadruple therapy with antilymphocyteinduction, tacrolimus, mycophenolate mofetil and steroids. Therewas one early death due to sepsis. One-year patient and pancreasgraft survival rates for retransplants were, respectively, 95% and85%. There was no additional risk for removing the pancreas graftat retransplant. Conclusion: Pancreas retransplant was technicallyfeasible in all cases and results similar to those described in theliterature were found for primary pancreas transplant.

  19. Clinicopathological analysis of solitary fibrous tumor

    Xiumei Zhang; Hai Wang; Shujing Wang; Jinfeng Miao; Zhengai Piao; Yingying Dong


    Objective: The aim of this study was to investigate the clinicopathologic characteristics, diagnosis and differential diagnosis, molecular genetics, treatment and prognosis of solitary fibrous tumor (SFT). Methods: The clinicopathological manifestations were analyzed retrospectively in 22 patients with surgically confirmed SFT. Results: There were 12 male patients and 10 female patients, with the age range 33–67 (mean 48.62) years. The SFTs originated from different from parts of the body, including 13 in the chest, 2 in the lungs, 3 in the abdomen, 1 in the lumbosacral area, 2 in the pelvis, and 1 in the left shoulder. There were 19 benign and 3 malignant tumors. Major clinical presentations were local masses and compression symptoms. Microscopy: the tumor was composed of areas of alternating hypercellularity and hypocellularity. The tumor cells were spindle to short-spindle shaped and arranged in fascicular or storiform pattern and hemangiopericytoma-like structure was presented. Immunohistochemically, Vimentin positive rate was 100% (22/22), Bcl-2 positive rate was 95.5% (21/22), CD99 positive rate was 86.4% (19/22), CD34 positive rate was 81.8 (18/22), focally positive for P53, as well as negative CK, S100 and Desmin. Ki67 labelling index was 2%–30%. Conclusion: SFT is a rare tumor which may be found in various parts of human body. SFT mostly is a benign tumor, but a few could be malignant. Its diagnosis mainly rely on its morphologic features and immunohistochemical profiles. The major treatment is to completely resect it by operation and long-term clinical follow-up is necessary.

  20. Gene expression profiling of solitary fibrous tumors.

    François Bertucci

    Full Text Available BACKGROUND: Solitary fibrous tumors (SFTs are rare spindle-cell tumors. Their cell-of-origin and molecular basis are poorly known. They raise several clinical problems. Differential diagnosis may be difficult, prognosis is poorly apprehended by histoclinical features, and no effective therapy exists for advanced stages. METHODS: We profiled 16 SFT samples using whole-genome DNA microarrays and analyzed their expression profiles with publicly available profiles of 36 additional SFTs and 212 soft tissue sarcomas (STSs. Immunohistochemistry was applied to validate the expression of some discriminating genes. RESULTS: SFTs displayed whole-genome expression profiles more homogeneous and different from STSs, but closer to genetically-simple than genetically-complex STSs. The SFTs/STSs comparison identified a high percentage (∼30% of genes as differentially expressed, most of them without any DNA copy number alteration. One of the genes most overexpressed in SFTs encoded the ALDH1 stem cell marker. Several upregulated genes and associated ontologies were also related to progenitor/stem cells. SFTs also overexpressed genes encoding therapeutic targets such as kinases (EGFR, ERBB2, FGFR1, JAK2, histone deacetylases, or retinoic acid receptors. Their overexpression was found in all SFTs, regardless the anatomical location. Finally, we identified a 31-gene signature associated with the mitotic count, containing many genes related to cell cycle/mitosis, including AURKA. CONCLUSION: We established a robust repertoire of genes differentially expressed in SFTs. Certain overexpressed genes could provide new diagnostic (ALDH1A1, prognostic (AURKA and/or therapeutic targets.

  1. Solitary median maxillary central incisor (SMMCI syndrome

    Hall Roger K


    Full Text Available Abstract Solitary median maxillary central incisor syndrome (SMMCI is a complex disorder consisting of multiple, mainly midline defects of development resulting from unknown factor(s operating in utero about the 35th–38th day(s from conception. It is estimated to occur in 1:50,000 live births. Aetiology is uncertain. Missense mutation in the SHH gene (I111F at 7q36 may be associated with SMMCI. The SMMCI tooth differs from the normal central incisor, in that the crown form is symmetric; it develops and erupts precisely in the midline of the maxillary dental arch in both primary and permanent dentitions. Congenital nasal malformation (choanal atresia, midnasal stenosis or congenital pyriform aperture stenosis is positively associated with SMMCI. The presence of an SMMCI tooth can predict associated anomalies and in particular the serious anomaly holoprosencephaly. Common congenital anomalies associated with SMMCI are: severe to mild intellectual disability, congenital heart disease, cleft lip and/or palate and less frequently, microcephaly, hypopituitarism, hypotelorism, convergent strabismus, oesophageal and duodenal atresia, cervical hemivertebrae, cervical dermoid, hypothyroidism, scoliosis, absent kidney, micropenis and ambiguous genitalia. Short stature is present in half the children. Diagnosis should be made by eight months of age, but can be made at birth and even prenatally at 18–22 weeks from the routine mid-trimester ultrasound scan. Management depends upon the individual anomalies present. Choanal stenosis requires emergency surgical treatment. Short stature may require growth hormone therapy. SMMCI tooth itself is mainly an aesthetic problem, which is ideally managed by combined orthodontic, prosthodontic and oral surgical treatment; alternatively, it can be left untreated.

  2. Laparoscopic reconstruction of iatrogenic-induced lower ureteric strictures: Does timing of repair influence the outcome?

    George P Abraham


    Full Text Available Context: Influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric strictures Aims: To assess the influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric strictures in our adult patient population. Settings and Design: Single surgeon operative experience in two institutes. Retrospective analysis. Materials and Methods: All patients were worked up in detail. All patients underwent cystoscopy and retrograde pyelography prior to laparoscopic approach. Patients were categorised into two groups: early repair (within seven days of inciting event and delayed repair (after two weeks. Operative parameters and postoperative events were recorded. Postprocedure all patients were evaluated three monthly. Follow-up imaging was ordered at six months postoperatively. Improvement in renal function, resolution of hydronephrosis and unhindered drainage of contrast through the reconstructed unit on follow-up imaging was interpreted as a satisfactory outcome. Statistical Analysis Used: Mean, standard deviation, equal variance t test, Mann Whitney Z test, Aspin-Welch unequal variance t test. Results: Thirty-six patients (37 units, 36 unilateral and 1 simultaneous bilateral underwent laparoscopic ureteral reconstruction of lower ureteric stricture following iatrogenic injury - 21 early repair (Group I and 15 delayed repair (Group II. All patients were hemodynamically stable at presentation. Early repair was more technically demanding with increased operation duration. There was no difference in blood loss, operative complications, postoperative parameters, or longterm outcome. Conclusions: In hemodynamically stable patients, laparoscopic repair of iatrogenically induced lower ureteric strictures can be conveniently undertaken without undue delay from the inciting event. Compared to delayed repairs, the procedure is technically more demanding but morbidity incurred and outcome is at par.

  3. Robot-assisted Surgery for Benign Ureteral Strictures: Experience and Outcomes from Four Tertiary Care Institutions.

    Buffi, Nicolò Maria; Lughezzani, Giovanni; Hurle, Rodolfo; Lazzeri, Massimo; Taverna, Gianluigi; Bozzini, Giorgio; Bertolo, Riccardo; Checcucci, Enrico; Porpiglia, Francesco; Fossati, Nicola; Gandaglia, Giorgio; Larcher, Alessandro; Suardi, Nazareno; Montorsi, Francesco; Lista, Giuliana; Guazzoni, Giorgio; Mottrie, Alexandre


    Minimally invasive treatment of benign ureteral strictures is still challenging because of its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach. To evaluate outcomes for robotic ureteral repair in a multi-institutional cohort of patients treated for ureteropelvic junction obstruction and ureteral stricture (US) at four tertiary referral centres. This retrospective study reports data for 183 patients treated with standard robot-assisted pyeloplasty (PYP) and robotic uretero-ureterostomy (UUY) at four high-volume centres from January 2006 to September 2014. Robotic PYP and robot-assisted UUY were performed according to previously reported surgical techniques. Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. No robot-assisted UUY cases required surgical conversion, while 2.8% of PYP cases were not completed robotically. The median operative time was 120 and 150min for robot-assisted PYP and robot-assisted UUY, respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11% (n=20) and complications were mostly of low grade. The high-grade complication rate was 2.2% (n=4). At median follow-up of 24 mo, the overall success rate was >90% for both procedures. The study limitations include its retrospective nature and the heterogeneity of the study population. Robotic surgery for benign US is safe and effective, with limited risk of high-grade complications and good intermediate-term results. In this study we review the use of robotic surgery at four different tertiary care centres in the treatment of patients affected by benign ureteral strictures. Our results demonstrate that robotic surgery is a safe alternative to the standard open approach in the treatment of ureteral strictures. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All

  4. Ureteral stent duration and the risk of BK polyomavirus viremia or bacteriuria after kidney transplantation.

    Wingate, Jonathan T; Brandenberger, Jared; Weiss, Andrew; Scovel, Lauren G; Kuhr, Christian S


    Ureteral stents are used in kidney transplantation (KTX) to decrease post-operative complications, but they are associated with BK polyomavirus viremia (BKV). Our primary outcome was to determine the association between ureteral stent duration and BKV. Secondary outcome measures were the association between bacteriuria and stent duration or use of ureteral stent strings. Between January 2010 and January 2015, 403 patients underwent KTX at the Virginia Mason Medical Center and met inclusion criteria. Stent duration was classified as short (3 weeks). Multivariate logistic regression models were created to assess for factors associated with BKV. The covariates in the BKV model were chosen a priori based on stent duration and risk factors previously described in the literature. Ureteral stents were placed in 304 (75.4%) transplants. Stent strings were left attached in 166 (54.6%) patients. On multivariate analyses, long stent duration was significantly associated with increased risk of BKV compared with no stent (odds ratio [OR] 1.92, P=.044, 95% confidence interval [CI] 1.04-3.74). Short stent duration was not associated with BKV. Sixty-two (15.4%) patients had bacteriuria. Bacteriuria was associated with female gender (OR 2.77, P<.001, 95% CI 1.58-4.95), and there was a dose-dependent effect with stent duration compared with no stent-short duration (OR 2.46, P=.049, 95% CI 1.05-6.49) and long duration (OR 3.58, P=.004, 95% CI 1.58-9.25). Stent strings were not associated with either complication. The association between ureteral stents and BKV may be dose dependent. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Ureteral Stent Insertion in the Management of Renal Colic during Pregnancy.

    Choi, Chang Il; Yu, Young Dong; Park, Dong Soo


    To determine an optimal invasive intervention for renal colic patients during pregnancy after conservative treatments have been found to be unhelpful. Among the available invasive interventions, we investigated the reliability of a ureteral stent insertion, which is considered the least invasive intervention during pregnancy. Between June 2006 and February 2015, a total of 826 pregnant patients came to the emergency room or urology outpatient department, and 39 of these patients had renal colic. The mean patient age was 30.49 years. In this retrospective cohort study, the charts of the patients were reviewed to collect data that included age, symptoms, the lateralities and locations of urolithiasis, trimester, pain following treatment and pregnancy complications. Based on ultrasonography diagnoses, 13 patients had urolithiasis, and 13 patients had hydronephrosis without definite echogenicity of the ureteral calculi. Conservative treatments were successful in 25 patients. Among these treatments, antibiotics were used in 15 patients, and the remaining patients received only hydration and analgesics without antibiotics. Several urological interventions were required in 14 patients. The most common intervention was ureteral stent insertion, which was performed in 13 patients to treat hydronephrosis or urolithiasis. The patients' pain was relieved following these interventions. Only one patient received percutaneous nephrostomy due to pyonephrosis. No pregnancy complications were noted. Ureteral stent insertion is regarded as a reliable and stable first-line urological intervention for pregnant patients with renal colic following conservative treatments. Ureteral stent insertion has been found to be equally effective and safe as percutaneous nephrostomy, which is associated with complications that include bleeding and dislocation, and the inconvenience of using external drainage system.

  6. The novel multi-solitary wave solution to the fifth-order KdV equation

    Zhang Yi; Chen Deng-Yuan


    By using Hirota's method, the novel multi-solitary wave solutions to the fifth-order KdV equation are obtained.Furthermore, various new solitary wave solutions are also derived by a reconstructed bilinear Backlund transformation.

  7. Diffractons: Solitary Waves Created by Diffraction in Periodic Media

    Ketcheson, David I.


    A new class of solitary waves arises in the solution of nonlinear wave equations with constant impedance and no dispersive terms. These solitary waves depend on a balance between nonlinearity and a dispersion-like effect due to spatial variation in the sound speed of the medium. A high-order homogenized model confirms this effective dispersive behavior, and its solutions agree well with those obtained by direct simulation of the variable-coefficient system. These waves are observed to be long-time stable, globally attracting solutions that arise in general as solutions to nonlinear wave problems with periodically varying sound speed. They share some properties with known classes of solitary waves but possess important differences as well.

  8. Shoaling Large Amplitude Internal Solitary Waves in a Laboratory Tank

    Allshouse, Michael; Larue, Conner; Swinney, Harry


    The shoaling of internal solitary waves onto the continental shelf can change both the wave dynamics and the state of the environment. Previous observations have demonstrated that these waves can trap fluid and transport it over long distances. Through the use of a camshaft-based wavemaker, we produce large amplitude shoaling waves in a stratified fluid in a laboratory tank. Simulations of solitary waves are used to guide the tuning of the wave generator to approximate solitary waves; thus nonlinear waves can be produced within the 4m long tank. PIV and synthetic schlieren measurements are made to study the transport of fluid by the wave as it moves up a sloping boundary. The results are then compared to numerical simulations and analyzed using finite time Lyapunov exponent calculations. This Lagrangian analysis provides an objective measure of barriers surrounding trapped regions in the flow. Supported by ONR MURI Grant N000141110701 (WHOI).

  9. A rare gigantic solitary cysticercosis pseudotumour of the neck

    Seif J Uledi


    Full Text Available Cysticercosis is one of the ancient parasitic infections and endemic in many parts of the developing world. Humans acquire cysticercosis when they ingest pork tapeworm eggs either through faecal-oral route by eating faecally contaminated food or by auto infection.The clinical picture largely depends on the location of larval encystment. Neurocysticercosis is the most common form of presentation. Solitary extra neural lesions are quite rare and fairly small in size.We present a very unique case of 56 year old Malawian female with a very rare, long standing gigantic solitary cysticercosis pseudo tumour of the neck. By far, there is no documented report on incorrigible cysticercosis lesion with such a sheer size.Solitary extraneural cysticercosis lesions may mimic other soft tissue masses; therefore it is important for clinicians working in endemic regions to consider cysticercosis as a differential diagnosis when evaluating patients with soft tissue lesions.

  10. Giant solitary trichoepithelioma with desmoplasia on histopathology: An unusual finding

    Sundeep Chowdhry


    Full Text Available Trichoepithelioma is a well-recognized hamartoma of hair germ clinically presenting as solitary or multiple papules. Uncommonly, it may present as a large solitary lesion, termed as giant solitary trichoepithelioma (GST. A 50-year old man presented with a large, pedunculated mass over the root of nose obstructing visual field. It was excised and sent for histopathological examination. H&E staining revealed in addition to characteristic features of trichoepithelioma, a desmoplastic hypocellular stroma. After taking into account the clinical and histopathological features, a diagnosis of GST was made. This case is the first case to the best of authors’ knowledge describing desmoplastic stroma in a case of GST. It is also noteworthy because it reports the largest GST described so far over the nose.

  11. On solitary patterns in Lotka-Volterra chains

    Zilburg, Alon; Rosenau, Philip


    We present and study a class of Lotka-Volterra chains with symmetric 2N-neighbors interactions. To identify the types of solitary waves which may propagate along the chain, we study their quasi-continuum approximations which, depending on the coupling between neighbors, reduce into a large variety of partial differential equations. Notable among the emerging equations is a bi-cubic equation {u}t={[{{bu}}2+2κ {{uu}}{xx}+{({u}{xx})}2]}x which we study in some detail. It begets remarkably stable topological and non-topological solitary compactons that interact almost elastically. They are used to identify discretons, their solitary discrete antecedents on the lattice, which decay at a doubly exponential rate. Many of the discrete modes are robust while others either decompose or evolve into breathers.

  12. Solitary calvarial metastases : An unusual presentation of thoracic neuroblastoma

    Grover S


    Full Text Available A primary thoracic origin occurs only in 20% of neuroblastomas, and their classical presentation is mediastinal or cord compression. Skeletal metastases of neuroblastomas are characteristically multiple, and calvarial deposits usually show simultaneous involvement of orbit. Solitary metastases in neuroblastoma, is an unusual entity and its presentation as a large calvarial mass, especially from a thoracic primary, is rare. Furthermore, calvarial metastases are relatively uncommon in children compared to adults. We discuss the clinical, radiographic, CT features, and differential diagnosis of a large calvarial mass with sunray spiculation in a child, which was due to a solitary metastases from an occult thoracic neuroblastoma. The possibility of neuroblastoma presenting in this unique fashion and the importance of considering a chemosensitive tumor such as neuroblastoma in the differential diagnosis of a solitary calvarial mass in a child is highlighted by our report.

  13. Solitary and freak waves in superthermal plasma with ion jet

    Abdelsalam, U. M.; Abdelsalam


    The nonlinear solitary and freak waves in a plasma composed of positive and negative ions, superthermal electrons, ion beam, and stationary dust particles have been investigated. The reductive perturbation method is used to obtain the Korteweg-de Vries (KdV) equation describing the system. The latter admits solitary wave solution, while the dynamics of the modulationally unstable wavepackets described by the KdV equation gives rise to the formation of freak/rogue excitation described by the nonlinear Schrödinger equation. In order to show that the characteristics of solitary and freak waves are influenced by plasma parameters, relevant numerical analysis of appropriate nonlinear solutions are presented. The results from this work predict nonlinear excitations that may associate with ion jet and superthermal electrons in Herbig-Haro objects.

  14. Quantum ion-acoustic solitary waves in weak relativistic plasma

    Biswajit Sahu


    Small amplitude quantum ion-acoustic solitary waves are studied in an unmagnetized twospecies relativistic quantum plasma system, comprised of electrons and ions. The one-dimensional quantum hydrodynamic model (QHD) is used to obtain a deformed Korteweg–de Vries (dKdV) equation by reductive perturbation method. A linear dispersion relation is also obtained taking into account the relativistic effect. The properties of quantum ion-acoustic solitary waves, obtained from the deformed KdV equation, are studied taking into account the quantum mechanical effects in the weak relativistic limit. It is found that relativistic effects significantly modify the properties of quantum ion-acoustic waves. Also the effect of the quantum parameter on the nature of solitary wave solutions is studied in some detail.

  15. Numerical Simulation of Cylindrical Solitary Waves in Periodic Media

    Quezada de Luna, Manuel


    We study the behavior of nonlinear waves in a two-dimensional medium with density and stress relation that vary periodically in space. Efficient approximate Riemann solvers are developed for the corresponding variable-coefficient first-order hyperbolic system. We present direct numerical simulations of this multiscale problem, focused on the propagation of a single localized perturbation in media with strongly varying impedance. For the conditions studied, we find little evidence of shock formation. Instead, solutions consist primarily of solitary waves. These solitary waves are observed to be stable over long times and to interact in a manner approximately like solitons. The system considered has no dispersive terms; these solitary waves arise due to the material heterogeneity, which leads to strong reflections and effective dispersion.

  16. Some properties of fuzzy soft proximity spaces.

    Demir, İzzettin; Özbakır, Oya Bedre


    We study the fuzzy soft proximity spaces in Katsaras's sense. First, we show how a fuzzy soft topology is derived from a fuzzy soft proximity. Also, we define the notion of fuzzy soft δ-neighborhood in the fuzzy soft proximity space which offers an alternative approach to the study of fuzzy soft proximity spaces. Later, we obtain the initial fuzzy soft proximity determined by a family of fuzzy soft proximities. Finally, we investigate relationship between fuzzy soft proximities and proximities.

  17. Some Properties of Fuzzy Soft Proximity Spaces

    Demir, İzzettin; Özbakır, Oya Bedre


    We study the fuzzy soft proximity spaces in Katsaras's sense. First, we show how a fuzzy soft topology is derived from a fuzzy soft proximity. Also, we define the notion of fuzzy soft δ-neighborhood in the fuzzy soft proximity space which offers an alternative approach to the study of fuzzy soft proximity spaces. Later, we obtain the initial fuzzy soft proximity determined by a family of fuzzy soft proximities. Finally, we investigate relationship between fuzzy soft proximities and proximities. PMID:25793224

  18. Clinical analysis of bone scanning in solitary lesion


    A rational analysis procedure for solitary lesions on whole bone scan-ning was offered. This study was undertaken to analyze retrospectively solitary le-sions which obtained final diagnose through the following aspects: (1) diagnosis ofbone metastasis, (2) the incidence of bone metastasis in different tumor, (3) the mostpossible lesion sites indicating bone metastasis, (4) morphological analysis of solitarylesions. The results are: (1) The incidence of solitary lesions in 2465 cases on wholebone scanning is 15.3%. (2) The rate of bone metastasis is 24.8% in 282 patientswith primary malignancy. The rate of bone metastasis is 6.3% in 64 patients withoutprimary malignancy, and the total diagnostic rate of bone metastasis is 21.4% in 346patients. (3) In patients with primary malignancy, the incidence of bone metastasis ofsolitary lesions is as follows respectively: bronchi cancer 36.1%(22/61); breast cancer23.8%(20/84); prostate gland 17.2%(5/29); other urinary system cancer 22.2%(4/18):G.I. system cancer 16.9%(10/59); others 29.0%(9/31). There is no significant differ-ence in different cancer. (4) In patients without primary malignancy, 93.7%(60/64) ofsolitary lesions are benign. (5) From anatomical point of view, we found the diagnos-tic rate of bone metastasis is as follow: 30% in spine; 34.2% in pelvis; 36.4% in skull;10.8% in other bones. There are significant differences in four groups. It is concludedthat: (1) The diagnostic rate of bone metastasis in solitary lesions is 21.4%. (2) Themost possible solitary lesions indicating osseous tumor spread are at spine, pelvic andskull. (3) Special attention to "cold" and streak like lesions should be paid. (4) Aclinical analysis procedure for diagnosis of solitary lesions has been summarized outhere.``

  19. Serotonin enhances solitariness in phase transition of the migratory locust

    Xiaojiao eGuo


    Full Text Available The behavioral plasticity of locusts is a striking trait presented during the reversible phase transition between solitary and gregarious individuals. However, the results of serotonin as a neurotransmitter from the migratory locust Locusta migratoria in phase transition showed an alternative profile compared to the results from the desert locust Schistoserca gregaria. In this study, we investigated the roles of serotonin in the brain during the phase change of the migratory locust. During the isolation of gregarious nymphs, the concentration of serotonin in the brain increased significantly, whereas serotonin receptors (i.e. 5-HT1, 5-HT2 and 5-HT7 we identified here showed invariable expression patterns. Pharmacological intervention showed that serotonin injection in the brain of gregarious nymphs did not induced the behavior change toward solitariness, but injection of this chemical in isolated gregarious nymphs accelerated the behavioral change from gregarious to solitary phase. During the crowding of solitary nymphs, the concentration of serotonin in the brain remained unchanged, whereas 5-HT2 increased after 1 h of crowding and maintained stable expression level thereafter. Activation of serotonin-5-HT2 signaling with a pharmaceutical agonist inhibited the gregariousness of solitary nymphs in crowding treatment. These results indicate that the fluctuations of serotonin content and 5-HT2 expression are results of locust phase change. Overall, this study demonstrates that serotonin enhances the solitariness of the gregarious locusts. Serotonin may regulate the withdrawal-like behavioral pattern displayed during locust phase change and this mechanism is conserved in different locust species.

  20. Solitary Eccrine Syringofibroadenoma and Successful Treatment with Cryotherapy.

    Ozkaya, Dilek Biyik; Su, Ozlem; Bahalı, Anıl Gülsel; Topukçu, Bugce; Dizman, Didem; Tosuner, Zeynep; Demirkesen, Cuyan; Onsun, Nahide


    First described in 1963, eccrine syringofibroadenoma (ESFA) is a rare benign tumor that proliferates with differentiation toward ductal eccrine structures. There are many clinical presentations, including plaques, papules, verrucous plaques, keratotic tumors, and solitary tumors. The age of onset varies, with presentation between 16 and 80 years; however, solitary lesions are seen most commonly in the seventh and eighth decades. Here, we present the case of a 72-year-old woman referred to our outpatient clinic with a nodule on her leg. The histopathology result was ESFA. The lesion regressed after six cryotherapy sessions. Physicians should consider the possibility of ESFA and must remember its malignant potential in elderly patients.

  1. A case of congenital solitary Langerhans cell histiocytoma.

    Ricciardo, Bernadette


    A newborn baby boy was referred to the Paediatric Dermatology Unit with a solitary asymptomatic nodule overlying his right nasolabial fold. Complete physical examination, full blood count, serum chemistry, liver function tests and baseline imaging were unremarkable. Histopathological examination showed an atypical dermal infiltrate of mononuclear cells that stained positive with CD1a and S100. A diagnosis of congenital solitary Langerhans cell histiocytoma was made. The lesion completely resolved by 4 months of age. The baby is now 15 months old and repeat systemic evaluation has remained normal.

  2. Measurement of velocity field in parametrically excited solitary waves

    Gordillo, Leonardo


    Paramerically excited solitary waves emerge as localized structures in high-aspect-ratio free surfaces subject to vertical vibrations. Herein, we provide the first experimental characterization of the hydrodynamics of thess waves using Particle Image Velocimetry. We show that the underlying velocity field of parametrically excited solitary waves is mainly composed by an oscillatory velocity field. Our results confirm the accuracy of Hamiltonian models with added dissipation in describing this field. Remarkably, our measurements also uncover the onset of a streaming velocity field which is shown to be as important as other crucial nonlinear terms in the current theory. The observed streaming pattern is particularly interesting due to the presence of oscillatory meniscii.

  3. Solitary structures with ion and electron thermal anisotropy

    Khusroo, Murchana


    Formation of electrostatic solitary structures are analysed for a magnetised plasma with ion and electron thermal anisotropies. The ion thermal anisotropy is modelled with the help of the Chew-Goldberger-Low (CGL) double adiabatic equations of state while the electrons are treated as inertia-less species with an anisotropic bi-Maxwellian velocity distribution function. A negative electron thermal anisotropy $(T_{e\\perp}/T_e{\\parallel}>1)$ is found to help form large amplitude solitary structures which are in agreement with observational data.

  4. Proximal Biceps Tenodesis

    Kovack, Thomas J.; Idoine, John D.; Jacob, Paul B.


    Purpose: To (1) better define the anatomy of the proximal shoulder in relation to the long head of the biceps tendon, (2) compare the length-tension relationship of the biceps tendon in the native shoulder with that after arthroscopic and open tenodesis techniques using interference screws, and (3) provide surgical recommendations for both procedures based on study findings. Study Design: Descriptive laboratory study. Methods: Twenty fresh-frozen cadaveric shoulders were dissected for analysis. Initial anatomic measurements involving the proximal long head of the biceps tendon (BT) were made, which included: the labral origin to the superior bicipital groove (LO-SBG), the total tendon length (TTL), the musculotendinous junction (MTJ) to the inferior pectoralis major tendon border, the MTJ to the superior pectoralis major tendon border, and the biceps tendon diameter (BTD) at 2 different tenodesis locations. These same measurements were made again after completing a simulated suprapectoral arthroscopic and open subpectoral tenodesis, both with interference screw fixation. Statistical comparisons were then made between the native anatomy and that after tenodesis, with the goal of assessing the accuracy of re-establishing the normal length-tension relationship of the long head of the BT after simulated arthroscopic suprapectoral and open subpectoral tenodesis with tenodesis screws. Results: For all cadavers, the mean TTL was 104.1 mm. For the arthroscopic suprapectoral technique, the mean LO-SBG was 33.6 mm, and the mean tendon resection length was 12.8 mm in males and 5.0 mm in females. The mean BTD was 6.35 mm at the arthroscopic suprapectoral tenodesis site and 5.75 mm at the open subpectoral tenodesis site. Males were found to have statistically longer TTL and LO-SBG measurements (111.6 vs 96.5 mm [P = .027] and 37.2 vs 30.0 mm [P = .009], respectively). In the native shoulder, the mean distances from the MTJ to the superior and inferior borders of the pectoralis

  5. Generalized Proximal ψ-Contraction Mappings and Best Proximity Points

    Winate Sanhan


    Full Text Available We generalized the notion of proximal contractions of the first and the second kinds and established the best proximity point theorems for these classes. Our results improve and extend recent result of Sadiq Basha (2011 and some authors.

  6. Effect of nonthermal ion distribution and dust temperature on nonlinear dust-acoustic solitary waves

    K Annou; R Annou


    Dust-acoustic solitary waves in unmagnetized dusty plasma whose constituents are inertial charged dust grains, Boltzmannian electrons and nonthermal ions have been investigated by taking into account finite dust temperature. The pseudopotential has been used to study solitary solution. The existence of solitary waves having negative potential is reported.

  7. Single-peak solitary wave solutions for the variant Boussinesq equations

    Hong Li; Lilin Ma; Dahe Feng


    This paper presents all possible smooth, cusped solitary wave solutions for the variant Boussinesq equations under the inhomogeneous boundary condition. The parametric conditions for the existence of smooth, cusped solitary wave solutions are given using the phase portrait analytical technique. Asymptotic analysis and numerical simulations are provided for smooth, cusped solitary wave solutions of the variant Boussinesq equations.

  8. Existence,Orbital Stability and Instability of Solitary Waves for Coupled BBM Equations

    Li-wei Cui


    This paper is concerned with the orbital stability/instability of solitary waves for coupled BBM equations which have Hamiltonian form.The explicit solitary wave solutions will be worked out first.Then by detailed spectral analysis and decaying estimates of solutions for the initial value problem,we obtain the orbital stability/instability of solitary waves.

  9. Effect of ciprofloxacin and N-acetylcysteine on bacterial adherence and biofilm formation on ureteral stent surfaces

    El-Feky, Mohamed A; El-Rehewy, Mostafa S; Hassan, Mona A; Abolella, Hassan A; Abd El-Baky, Rehab M; Gad, Gamal F


    The aim of this study was to evaluate the effect of ciprofloxacin (CIP), N-acetylcysteine (NAC) alone and in combination on biofilm production and pre-formed mature biofilms on ureteral stent surfaces...

  10. Ureteral Stent Placement for Ureteral Calculi during Pregnancy:An Analysis of 50 Cases%输尿管支架置入术治疗孕期输尿管结石50例临床分析

    王进峰; 卢晓明; 王礼平; 尹九湖


    ABSTRACT:Objective To explorer the value of ureteral stent placement in the treatment of ure-teral calculi during pregnancy.Methods Clinical data of 50 patients who underwent ureteral stent placement for ureteral calculi during pregnancy were retrospectively analyzed.Auxiliary examina-tion confirmed that all patients had ureteral calculi complicated by renal colic and failed to respond to conservative drug treatment.Among the 50 patients,25 had right ureteral calculi,22 had left u-reteral calculi,3 had bilateral ureteral calculi,31 had middle/upper ureteral calculi,and 19 had lower ureteral calculi.Results Thirty-seven patients successfully underwent cystoscopic catheter-ization after topical anesthesia.Twelve patients underwent successful ureteroscopic catheterization after failed cystoscopic catheterization.One patient underwent successful percutaneous renal an-terograde catheterization under local anaesthesia after failed retrograde catheterization.After treatment,renal colic was relieved obviously and hydronephrosis was alleviated to varying degrees with no threatened abortion in all patients.Postoperative reexamination showed that ureteral stents were placed appropriately in 48 patients and were located in upper ureter in 1 patient.In ad-dition,ureteral stents fell out in 1 patient when urinary catheter was removed on postoperative day 3.However,ureteral stents were appropriately placed after recatheterization in this patient. Conclusion Ureteral stent placement is a simple,effective,safe and reliable treatment for ureteral calculi during pregnancy.%目的:探讨输尿管支架置入术在治疗孕期输尿管结石中的应用价值。方法对50例输尿管支架置入术治疗的孕期输尿管结石患者的临床资料进行回顾性分析。50例患者均经辅助检查证实输尿管结石,同时合并肾绞痛,经药物保守治疗无效,其中右输尿管结石25例、左输尿管结石22例、双侧输尿管结石3例,31例

  11. [A 8-year-forgotten ureteral stent after kidney transplantation: treatment and long-term follow-up].

    Lasaponara, Fedele; Dalmasso, Ettore; Santià, Silvia; Sedigh, Omidreza; Bosio, Andrea; Pasquale, Giovanni; Segoloni, Giuseppe P; Fontana, Dario


    Forgotten indwelling ureteral stents can cause significant urological complications. Only few cases are reported after kidney transplantation. We present a case of a 39-year-old woman, transplanted in 1993 and referred to our Transplant Center 8 years later, because of a serious urinary tract infection with renal function impairment. Abdominal CT scan showed pyelonephritis and hydronephrosis in the transplanted kidney and the presence of a calcific ureteral stent, which had been forgotten in situ for 8 years. The stent was removed, but it was impossible to replace it with a new stent both retrogradely and anterogradely, because of a tight obstruction of the mid ureter. So a uretero-ureteral anastomosis with up urinary tract was performed. No intra- or post-operative complications occurred. At 9 years' follow-up, the patient shows an optimal renal function, with no urinary tract infection. A forgotten ureteral stent in a transplanted kidney can cause a lot of complications and can lead to graft loss. The prosthesis may cause an irreversible ureteral damage, so, as in our experience, forgetting a ureteral stent can result in a complex surgery.


    ZhuYanjuan; ZhangChunhua


    The solitary wave solutions of the combined KdV-mKdV-Burgers equation and the Kolmogorov-Petrovskii-Piskunov equation are obtained by means of the direct algebra method, which can be generalized to deal with high dimensional nonlinear evolution equations.

  13. Reconstructive surgery in eight children with solitary kidneys

    Thorup, Jørgen Mogens


    Within a 10-year period reconstructive urinary tract surgery has been carried out in eight children with solitary kidneys. The children were 0-5 years old. Six had unilateral renal agenesis and two had unilateral multicystic kidney. In five children ureteroneocystostomy was performed, in two...

  14. Observations of Solitary Structures in a Magnetized, Plasma Loaded Waveguide

    Lynov, Jens-Peter; Michelsen, Poul; Pécseli, Hans;


    Two types of solitary structure were investigated experimentally and numerically in a magnetized, plasma-loaded waveguide. One was identified as an ordinary KdV soliton and its properties were investigated with particular attention to the damping by resonant particles. The other type of pulse...


    王涛; 高天赋


    Remote sensing and in situ observations of internal tides, solitary waves and bores in shallow water are briefly reviewed in this paper. The emphasis is laid on interpreting SAR images based on oceanographic measurements, and analyzing characteristics of internal waves in the China Seas. Direc-tions for future research are discussed.



    Remote sensing and in situ observations of internal tides, solitary waves and bores in shallow water are briefly reviewed in this paper. The emphasis is laid on interpreting SAR images based on oceanographic measurements, and analyzing characteristics of internal waves in the China Seas. Directions for future research are discussed.

  17. Sound exposure of professional orchestral musicians during solitary practice.

    O'Brien, Ian; Driscoll, Tim; Ackermann, Bronwen


    It is broadly acknowledged that professional orchestral musicians risk noise-induced hearing pathologies due to sound exposure in rehearsal and performance. While much has been published regarding orchestral sound levels, little is known of the sound exposure these musicians experience during solitary practice, despite the many hours they spend engaged in this activity. This study aimed to determine sound exposure during solitary practice of 35 professional orchestral musicians, representing players of most orchestral instruments. To allow cross-comparison, participants were assessed playing similar repertoire in a controlled environment, recording simultaneously at each ear to determine sound exposure levels. Sound levels were recorded between 60 and 107 dB L(Aeq), with peak levels between 101 and 130 dB L(C,peak). For average reported practice durations (2.1 h per day, five days a week) 53% would exceed accepted permissible daily noise exposure in solitary practice, in addition to sound exposure during orchestral rehearsals and performances. Significant inter-aural differences were noted in violin, viola, flute/piccolo, horn, trombone, and tuba. Only 40% used hearing protection at any time while practicing. These findings indicate orchestral musicians at risk of noise-induced hearing loss in ensemble face significant additional risks during solitary practice. Data presented will enable more effective and targeted management strategies for this population.

  18. Solitary waves in a nonintegrable Fermi-Pasta-Ulam chain

    Truskinovsky, Lev; Vainchtein, Anna


    We present a family of exact solutions describing discrete solitary waves in a nonintegrable Fermi-Pasta-Ulam chain. The family is sufficiently rich to cover the whole spectrum of known behaviors from delocalized quasicontinuum waves moving with near-sonic velocities to highly localized anticontinuum excitations with only one particle moving at a time.

  19. Transarterial Onyx Embolization of an Orbital Solitary Fibrous Tumor

    Hashemi, Nafiseh; Ling, Jeanie D.; Soparkar, Charles; Sami, Mirwat; Ellezam, Benjamin; Klucznik, Richard; Lee, Andrew G.; Chévez-Barrios, Patricia


    Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm sometimes found in the orbit. We report a case of an aggressive orbital SFT with enlarged feeding vessels that was successfully resected immediately after transarterial embolization with Onyx (ethylene vinyl alcohol copolymer). To our knowledge, this is the first report showing the histopathology of Onyx embolization material in an orbital SFT. PMID:27171911

  20. Solitary Wave in Linear ODE with Variable Coefficients

    LIU Shi-Da; FU Zun-Tao; LIU Shi-Kuo; XIN Guo-Jun; LIANG Fu-Ming; FENG Bei-Ye


    In this paper, the linear ordinary differential equations with variable coefficients are obtained from thecontrolling equations satisfied by wavelet transform or atmospheric internal gravity waves, and these linear equationscan be further transformed into Weber equations. From Weber equations, the homoclinic orbit solutions can be derived,so the solitary wave solutions to linear equations with variable coefficients are obtained.

  1. Solitary Wave and Wave Front as Viewed From Curvature

    LIU Shi-Kuo; FU Zun-Tao; LIU Shi-Da; LIANG Fu-Ming; XIN Guo-Jun


    The solitary wave and wave front are two important behaviors of nonlinear evolution equations. Geometri cally, solitary wave and wave front are all plane curve. In this paper, they can be represented in terms of curvature c(s), which varies with arc length s. For solitary wave when s →±∞, then its curvature c(s) approaches zero, and when s = 0, the curvature c(s) reaches its maximum. For wave front, when s →±∞, then its curvature c(s) approaches zero, and when s = 0, the curvature c(s) is still zero, but c'(s) ≠ 0. That is, s = 0 is a turning point. When c(s) is given, the variance at some point (x, y) in stream line with arc length s satisfies a 2-order linear variable-coefficient ordinary differential equation. From this equation, it can be determined qualitatively whether the given curvature is a solitary wave or wave front.

  2. Solitary plane waves in an isotropic hexagonal lattice

    Zolotaryuk, Yaroslav; Savin, A.V.; Christiansen, Peter Leth


    Solitary plane-wave solutions in a two-dimensional hexagonal lattice which can propagate in different directions on the plane are found by using the pseudospectral method. The main point of our studies is that the lattice model is isotropic and we show that the sound velocity is the same for diff...

  3. A Stylistic Appreciation of William Wordsworth's The Solitary Reaper



    This paper, based on the literary stylistic approach, is about the analysis of William Wordsworth's lyrics The Solitary Reaper. The features in its metrics, lexis and imagery explicitly reveal the poet's love for human, passion for nature and principle of simplicity.

  4. Exact Periodic Solitary Solutions to the Shallow Water Wave Equation

    LI Dong-Long; ZHAO Jun-Xiao


    Exact solutions to the shallow wave equation are studied based on the idea of the extended homoclinic test and bilinear method. Some explicit solutions, such as the one soliton solution, the doubly-periodic wave solution and the periodic solitary wave solutions, are obtained. In addition, the properties of the solutions are investigated.

  5. Internal solitary waves in the Red Sea: An unfolding mystery

    da Silva, J.C.B.; Magalhães, J.M.; Gerkema, T.; Maas, L.R.M.


    The off-shelf region between 16.0 degrees and 16.5 degrees N in the southern Red Sea is identified as a new hotspot for the occurrence of oceanic internal solitary waves. Satellite observations reveal trains of solitons that, surprisingly, appear to propagate from the center of the Red Sea, where it

  6. Solitary Wave and Wave Front as Viewed From Curvature

    LIUShi-Kuo; FUZun-Tao; LIUShi-Da; LIANGFu-Ming; XINGuo-Jun


    The solitary wave and wave front are two important behaviors of nonlinear evolution equations. Geometrically, solitary wave and wave front are all plane curve. In this paper, they can be represented in terms of curvature c(s),which varies with arc length s. For solitary wave when s→±∞, then its curvature c(s) approaches zero, and whens = 0, the curvature c(s) reaches its maximum. For wave front, when s→±∞, then its curvature c(s) approaches zero,and when s = 0, the curvature c(s) is still zero, but c'(s)≠0. That is, s = 0 is a turning point. When c(s) is given,the variance at some point (x, y) in stream line with arc length s satisfies a 2-order linear variable-coeffcient ordinary differential equation. From this equation, it can be determined qualitatively whether the given curvature is a solitary wave or wave front.

  7. Solitary fibrous tumor of the thyroid with capsular invasion.

    Bohórquez, Concepción Lara; González-Cámpora, Ricardo; Loscertales, Miguel Congregado; Escudero, Antonio García; Mezquita, Jesús Congregado


    This report describes the clinical and pathologic findings of a peculiar case of solitary fibrous tumor of the thyroid gland that showed capsular invasion. After four and a half years of follow-up, neither local recurrence nor metastasis has developed.

  8. Percutaneous nephrolithotomy in patients with a solitary kidney

    Tufan Süelözgen


    Full Text Available Material and method: The results of percutaneous nephrolithotomy applied to 716 patients in our clinic between January 2008 and January 2014 were retrospectively evaluated. Age, gender, urinary calculi size (mm2, urinary calculi localization, ESWL history, operation duration (min, fluoroscopy duration (sec, access type, reason of solitary kidney, hemoglobin drawdown (g/dl and operation success of the patients with a solitary kidney were recorded. The patients having no preoperative and postoperative non contrast abdominal tomography were excluded from the study. Results: Fifteen of nineteen patients (79% were men and 4 of them (21% were women. The average age of the patients was 42.52 ± 16.72 (14-72. Ten patients had anatomical solitary kidney and nine patients had physiological solitary kidney. In fact counter kidney was non functional in 9 patients (47% whereas there was agenesis in 2 (11% and outcome of nephrectomy in 8 (42% patients. In our study, presence of residual stone less than 4 mm at 1st month postoperative non contrast abdominal tomography was accepted as a successful result and accordingly our success rate was detected as 84%. Mean urinary calculi size was 405 ± 252.9 mm2; urinary calculi localization was pelvic, lower pole, upper-middle pole, middle-lower pole and staghorn in 11 (58%, 4 (21%, 1 (5%, 1 (5% and 1 (5% patients, respectively; previous ESWL history was 16%; operation duration was 55.47-± 28.1 min and fluoroscopy duration 131.10 ± 87.6 sec; access type was subcostal in 79%, supracostal in 10.5% and multiple in 10.5%; hemoglobin drawdown was 1.75 ± 0.97 mg/dl. Conclusions: PNL can be effectively and safely administered for the treatment of solitary kidney. In the treatment of large urinary calculi in patients with a solitary kidney, PNL has some advantages such as short surgery duration, less complication, acceptable hemoglobin drawdown and high success rates. According to our study, PNL operation in patients with a

  9. Solitary Large Hepatocellular Carcinoma: Staging and Treatment Strategy.

    Po-Hong Liu

    Full Text Available Controversies exist on staging and management of solitary large (>5 cm hepatocellular carcinoma (HCC. This study aims to evaluate the impact of tumor size on Barcelona Clinic Liver Cancer (BCLC staging and treatment strategy.BCLC stage A and B patients were included and re-classified as single tumor 2-5 cm or up to 3 tumors ≤3 cm (group A; n = 657, single tumor >5 cm (group SL; n = 224, and multiple tumors >3 cm (group B; n = 351. Alternatively, 240 and 229 patients with solitary large HCC regardless of tumor stage received surgical resection (SR and transarterial chemoembolization (TACE, respectively. The propensity score analysis identified 156 pairs of patients from each treatment arm for survival comparison.The survival was significantly higher for group A but was comparable between group SL and group B patients. Of patients with solitary large HCC, the 1-, 3- and 5-year survival rates were 88% versus 74%, 76% versus 44%, and 63% versus 35% between SR and TACE group, respectively (p<0.001. When baseline demographics were adjusted in the propensity model, the respective 1-, 3- and 5-year survival rates were 87% versus 79%, 76% versus 46%, and 61% versus 36% (p<0.001. The Cox proportional hazards model identified TACE with a 2.765-fold increased risk of mortality compared with SR (95% confidence interval: 1.853-4.127, p<0.001.Patients with solitary large HCC should be classified at least as intermediate stage HCC. SR provides significantly better survival than TACE for solitary large HCC regardless of tumor stage. Further amendment to the BCLC classification is mandatory.

  10. Solitary waves of the EW and RLW equations

    Ramos, J.I. [Room I-320-D, E.T.S. Ingenieros Industriales, Universidad de Malaga, Plaza El Ejido, s/n, 29013 Malaga (Spain)]. E-mail:


    Eight finite difference methods are employed to study the solitary waves of the equal-width (EW) and regularized long-wave (RLW) equations. The methods include second-order accurate (in space) implicit and linearly implicit techniques, a three-point, fourth-order accurate, compact operator algorithm, an exponential method based on the local integration of linear, second-order ordinary differential equations, and first- and second-order accurate temporal discretizations. It is shown that the compact operator method with a Crank-Nicolson discretization is more accurate than the other seven techniques as assessed for the three invariants of the EW and RLW equations and the L {sub 2}-norm errors when the exact solution is available. It is also shown that the use of Gaussian initial conditions may result in the formation of either positive or negative secondary solitary waves for the EW equation and the formation of positive solitary waves with or without oscillating tails for the RLW equation depending on the amplitude and width of the Gaussian initial conditions. In either case, it is shown that the creation of the secondary wave may be preceded by a steepening and an narrowing of the initial condition. The creation of a secondary wave is reported to also occur in the dissipative RLW equation, whereas the effects of dissipation in the EW equation are characterized by a decrease in amplitude, an increase of the width and a curving of the trajectory of the solitary wave. The collision and divergence of solitary waves of the EW and RLW equations are also considered in terms of the wave amplitude and the invariants of these equations.

  11. Multimodal stone therapy for two forgotten and encrusted ureteral stents: a case report


    Introduction Ureteral stent placement is a common procedure in daily urologic practice. To manage the problems of forgotten stents for many years needs multimodal stone therapy. Case presentation We present a case of a 26-years-old Caucasian, white woman with two forgotten encrusted ureteral stents for 48 months. Multimodal stone therapy including extracorporeal shock wave (SWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS), cystolithotripsy with Lithoclast, and open surgery was necessary to remove all the stones. Using the described combination of techniques, our patient was rendered stone and stent free. Urologists should bear in mind the presence of severe encrustations when they have to deal with a forgotten stent. Conclusion This case shows that combined urologic techniques can achieve successful and safe management of forgotten stents, but treatment should be tailored to the volume of encrustation and associated stone. PMID:19183439

  12. Diagnóstico Ecográfico de Refluxo Vesico-Ureteral

    Santos, José Fonseca


    Objectivo: Comparação de Ecocistografia e da Cistografia Radiológica no diagnóstico do refluxo vesico-ureteral.Material e Métodos: De Abril a Agosto de 1999, foram examinadas 25 crianças (8 raparigas e 17 rapazes, com idades compreendidas entre os 8 dias e os 14 anos), com 50 unidades renoureterais, para o diagnóstico de refluxo vesico-ureteral, realizando Ecocistografia e Cistografia Radiológica na mesma sessão. As indicações para o exame foram infecção do tracto urinário, diagnóstico pré-na...

  13. Intelligent Optimization of the Film-to-Fiber Ratio of a Degradable Braided Bicomponent Ureteral Stent

    Xiaoyan Liu


    Full Text Available A hierarchical support vector regression (SVR model (HSVRM was employed to correlate the compositions and mechanical properties of bicomponent stents composed of poly(lactic-co-glycolic acid (PGLA film and poly(glycolic acid (PGA fibers for urethral repair for the first time. PGLA film and PGA fibers could provide ureteral stents with good compressive and tensile properties, respectively. In bicomponent stents, high film content led to high stiffness, while high fiber content resulted in poor compressional properties. To simplify the procedures to optimize the ratio of PGLA film and PGA fiber in the stents, a hierarchical support vector regression model (HSVRM and particle swarm optimization (PSO algorithm were used to construct relationships between the film-to-fiber weight ratio and the measured compressional/tensile properties of the stents. The experimental data and simulated data fit well, proving that the HSVRM could closely reflect the relationship between the component ratio and performance properties of the ureteral stents.

  14. Beware! Fungal urosepsis may follow endoscopic intervention for prolonged indwelling ureteral stent.

    Gautam, Gagan; Singh, A K; Kumar, Rajeev; Hemal, A K; Kothari, Atul


    We present a 38-year-old lady with a prolonged indwelling ureteral stent that had been placed for pain relief after development of Steinstrasse following extracorporeal lithotripsy for a 2.5-cm left renal calculus. The patient developed candidal urosepsis within 6 hours after ureteroscopy and percutaneous nephrolithotomy (PCNL) for the removal of residual fragments. She subsequently recovered on systemic antifungal therapy in the form of intravenous amphotericin B and achieved complete stone clearance after repeat ureteroscopy and PCNL. Fungal urosepsis is known to complicate the postoperative course in chronically debilitated patients with poor nutritional status or those with diabetes or other significant comorbities. To our knowledge, this is the first reported case of a patient with no significant comorbities developing fungal urosepsis after endoscopic intervention for a long-term indwelling ureteral stent.

  15. Uretero-Internal Pudendal Artery Fistula with Longterm Indwelling of Ureteral Stent: A Case Report

    Hideo Yuki


    Full Text Available A 74-year-old woman presenting with bilateral ureteral stricture was referred to our hospital. She had undergone radical hysterectomy and adjuvant irradiation therapy for cervical cancer in 2000. Double-J stents were inserted in both the ureters and replaced at regular intervals. Eighteen months after ureteral stenting, she complained of gross hematuria and was managed with hemostatic agents. During a routine replacement of the right double-J stent, massive bleeding was observed from the urethra which continued intermittently. The source of bleeding was not identified on computed tomography and angiography. We kept her at rest, which reduced the bleeding. However, she required intermittent transfusions. Angiography was performed at the time of bleeding on March 5, 2011. A uretero-internal pudendal artery fistula was found, and coil embolization was performed. Thereafter, hematuria did not recur up to the last followup in July 2011.

  16. Use of Corticosteroids for Urinary Tuberculosis Patients at Risk of Developing Ureteral Obstruction

    Matsui, Kosuke; Furumoto, Akitsugu; Ohba, Kojiro; Mochizuki, Kota; Tanaka, Takeshi; Takaki, Masahiro; Morimoto, Konosuke; Ariyoshi, Koya


    A 77-year-old man with urinary tuberculosis developed post renal anuria two days after starting an anti-tuberculosis drug regimen. He had bilateral hydronephrosis, and his right kidney was radiologically diagnosed to be non-functioning. A transurethral catheter was placed in the left ureter. No improvement in the ureteral stricture was noted during the initial three weeks of treatment; however, the stricture did thereafter improve after the commencement of oral prednisolone. In cases of urina...


    Rajesh Rathore


    Full Text Available The incidence of urolithiasis varies according to geographic area, age, and sex distribution. 1 Various studies have shown that in economically developed countries the prevalence rate ranged between 4% and 20%. Urolithiasis may affect up to 10% of the population over the course of a lifetime. In India, upper and lower urinary tract stones occur frequently, but the incidence shows wide regional variation. Smaller stones (Up to 5 mm may cause severe symptoms such as flank pain and nausea, but pass without intervention. Though, they may need supportive care, but larger stones need intervention. Surgery has been used to remove stones (Lithotomy or to break them all into small pieces (Lithotripsy since antiquity. Twenty five years ago, open surgery was the sole form of therapy for urolithiasis, but now endourology is the surgical treatment of choice. 2 URETERIC JET When the bolus of urine being transmitted through the ureter reaches the terminal portion. It is ejected forcefully into the bladder through the Vesicoureteric Junction (VUJ. This creates a jet of urine that can be seen within the urinary bladder during cystoscopy and grey-scale Ultrasonography (US. Urine secreted from the renal glomeruli is excreted into the upper urinary tract including the collecting system, calyces-pelvis system, and ureter. Although, the precise mechanism of urine drainage through the whole system remains somewhat contentious. The trigger of ureteric jets is undoubtedly the pumping effect of calyceal peristalsis. 3 The latter comprises an autonomic and rhythmic minor calyceal peristalsis and a pressure-dependent major calyceal peristalsis, and the pressure of the major calyces comes from the resistance of the intrinsic tone of the upper ureter to the urine draining in the renal pelvic volume and tone and the rate of urine inflow. 4 Continuous discrete boluses of urine drainage into the ureter from pelvis, then fill the ureter, and finally, a ureteric jet is produced

  18. Ureteric erosion and obstruction: A rare but dreaded complication of intrauterine contraceptive device

    Priyadarshi, Vinod; Sehgal, Nidhi; Sen, Dipanwita


    Though intrauterine contraceptive device (IUCD) is a safe and most frequently used long-term contraceptive method, it has some complications. Uterine perforation and intra-abdominal migration have been reported often, but a retroperitoneal migration is exceptional. Here, we are reporting an IUCD which perforated the uterus and migrated to the retroperitoneum; impinging into and obstructing left ureter causing severe hydroureteronephrosis due to the development of the left lower ureteric stricture. PMID:28216944

  19. Ureteric erosion and obstruction: A rare but dreaded complication of intrauterine contraceptive device

    Vinod Priyadarshi


    Full Text Available Though intrauterine contraceptive device (IUCD is a safe and most frequently used long-term contraceptive method, it has some complications. Uterine perforation and intra-abdominal migration have been reported often, but a retroperitoneal migration is exceptional. Here, we are reporting an IUCD which perforated the uterus and migrated to the retroperitoneum; impinging into and obstructing left ureter causing severe hydroureteronephrosis due to the development of the left lower ureteric stricture.

  20. Effect of Simvastatin on Renal Fibrosis after Unilateral Ureteral Obstruction in Rat

    M.H. Khayat Nouri


    Full Text Available Introduction & Objective: Comparative reductase inhibitors, such as simvastatin increase HDL-cholestrol and decrease serum triglyceride and cholesterol. It is widely recognized that statins have organ protective nature and most effective for organ damage progressing. Obstructive uropathy can be used to indicate any obstruction to urinary flow; which causes a developing of hydronephrosis, tubular atrophy and associated renal impairment. The aim of this study was evaluation of the simvastatin effect on renal fibrosis after unilateral ureteral obstruction in rat. Materials & Methods: In this experimental study, 50 adult male Sprague-Dawley rats were subjected to unilateral ureteral obstruction (UUO and randomly divided into five groups (ten rats in each group as follows: (1 control group; (2 UUO; (3 UUO/SIM; (4 Sham-operated; (5 Sham/SIM. Control animals received orally drug solvent by gavage for 15 days (started one day before operation. Unilateral ureteral obstruction was performed in groups 2 and 3 and sham operations were performed in groups 4 and 5. In group 2 animals received drug solvent and in group 3 animals received simvastatin (2 mg/kg/twice daily for 15 days (started one day before operation. Rats were sacrificed either at day 14 for histopathological evaluation with H&E, masson-trichrome and PAS technique. Results: In this investigation histopathologic evaluation approved that in UUO group, renal interstitial fibrosis, tubular epithelial necrosis, hemorrhage, interstitial infiltration of mononuclear cells, tubular atrophy, glumerular tufts expanding, periglomerular sclerosis, subcapsular fibrosis, glomerulosclerosis and peritubular capillaries edema were observed. But in simvastatin treated animals this histopatologic lesions and fibrosis significantly (p<0.05 decreased. There was no difference between control and sham groups.Conclusion: In this investigation our results showed that ureteral obstruction increased renal fibrosis and

  1. Ureteral Stent Insertion in the Management of Renal Colic during Pregnancy


    To determine an optimal invasive intervention for renal colic patients during pregnancy after conservative treatments have been found to be unhelpful. Among the available invasive interventions, we investigated the reliability of a ureteral stent insertion, which is considered the least invasive intervention during pregnancy. Between June 2006 and February 2015, a total of 826 pregnant patients came to the emergency room or urology outpatient department, and 39 of these patients had renal col...

  2. Noninvasive management of obstructing ureteral stones using electromagnetic extracorporeal shock wave lithotripsy.

    Sighinolfi, M C; Chiara, S M; Micali, S; Salvatore, M; De Stefani, S; Stefano, D S; Saredi, G; Mofferdin, A; Grande, M; Bianchi, G; Giampaolo, B


    Extracorporeal shock wave lithotripsy (ESWL) represents noninvasive management of urolithiasis. Since the first HM3 model, technological progress has improved the efficacy and safety of this treatment. The current study aimed to evaluate the role of ESWL as a first-line emergency therapy of renal colic due to ureteral stone with impaired renal function. This prospective study enrolled all the patients admitted from the emergency room with acute renal colic meeting the following criteria: serum creatinine level ranging from 1.5 to 2.5 mg/dl, hydronephrosis, ureteral stones 6 to 15 mm in size, body mass index less than 30, normal renal function at baseline, and no evidence of urinary tract infection. The patients were submitted to a single-session emergency treatment using Dornier Litothripter S. Follow-up assessment, performed at 24 and 72 h, included radiologic and ultrasound examinations with renal function serum assessment. The end points were a decrease in creatinine level and a stone-free condition. A total of 40 patients were eligible for the study. The mean creatinine level at admission was 1.93 +/- 0.26 mg/dl. After the treatment, renal function recovery occurred for 34 subjects (85%), with a significant global decrease in creatinine levels (p = 0.00). The global stone-free rate 72 h after SWL was 67.5% (27/40). The patients with residual fragments were managed using re-SWL (n = 7) and endoscopic technique (n = 6). Emergency SWL represents an effective tool in the treatment of ureteral stones with hydronephrosis and slight renal impairment. Although complete stone clearance after one treatment still remains a difficult target, the actual role of SWL in the management of acute obstruction is to obtain ureteral canalization and renal function recovery.

  3. Repair of a common bile duct defect with a decellularized ureteral graft

    Cheng, Yao; Xiong, Xian-Ze; Zhou, Rong-Xing; Deng, Yi-Lei; Jin, Yan-Wen; Lu, Jiong; Li, Fu-Yu; Cheng, Nan-Sheng


    AIM To evaluate the feasibility of repairing a common bile duct defect with a decellularized ureteral graft in a porcine model. METHODS Eighteen pigs were randomly divided into three groups. An approximately 1 cm segment of the common bile duct was excised from all the pigs. The defect was repaired using a 2 cm long decellularized ureteral graft over a T-tube (T-tube group, n = 6) or a silicone stent (stent group, n = 6). Six pigs underwent bile duct reconstruction with a graft alone (stentless group). The surviving animals were euthanized at 3 mo. Specimens of the common bile ducts were obtained for histological analysis. RESULTS The animals in the T-tube and stent groups survived until sacrifice. The blood test results were normal in both groups. The histology results showed a biliary epithelial layer covering the neo-bile duct. In contrast, all the animals in the stentless group died due to biliary peritonitis and cholangitis within two months post-surgery. Neither biliary epithelial cells nor accessory glands were observed at the graft sites in the stentless group. CONCLUSION Repair of a common bile duct defect with a decellularized ureteral graft appears to be feasible. A T-tube or intraluminal stent was necessary to reduce postoperative complications. PMID:28082809

  4. Factors determining renal impairment in unilateral ureteral colic secondary to calcular disease: a prospective study.

    Al-Ani, Ammar; Al-Jalham, Khaled; Ibrahim, Tarek; Majzoub, Ahmad; Al-Rayashi, Maged; Hayati, Ahmed; Mubarak, Walid; Al-Rayahi, Jehan; Khairy, Ahmed T


    To evaluate all possible risk factors that can cause impairment of overall renal function in patients with unilateral ureteral calculus and a normal contralateral kidney. This is a prospective study of 90 patients who presented to our institute complaining of renal colic secondary to unilateral ureteral calculus. All patients were evaluated with a thorough history, physical examination, and laboratory and radiological investigations including renal function testing, urine analysis, non-contrast computed topography, and radionucleotide scan. Patients were divided into two groups according to their calculated creatinine clearance using the Modification of Diet in Renal Disease (MDRD) formula. Group I (favorable group) had a creatinine clearance >60 ml/min, while group II (unfavorable group) had a creatinine clearance II included 36 patients (40 %). On univariate analysis, factors that were associated with overall renal function impairment were patients' age, urea-to-creatinine ratio (UCR), use of nonsteroidal anti-inflammatory drugs, stone location, and presence of obstruction. However, using binary logistic regression analysis, only patients' age, UCR, and presence of obstruction sustained statistical significance in association with renal function impairment. The study of factors that help explain the presence of renal impairment in patients with unilateral ureteral calculus is important in the clinical setting. Patients' age, urea-to-creatinine ratio, and degree of obstruction seem to be significantly associated with overall renal function impairment.

  5. Modulation of ureteric Ca signaling and contractility in humans and rats by uropathogenic E. coli.

    Floyd, Rachel V; Winstanley, Craig; Bakran, Ali; Wray, Susan; Burdyga, Theodor V


    Ascending urinary tract infections, a significant cause of kidney damage, are predominantly caused by uropathogenic Escherichia coli (UPEC). However, the role and mechanism of changes in ureteric function during infection are poorly understood. We therefore investigated the effects of UPEC on Ca signaling and contractions in rat (n = 17) and human (n = 6) ureters. Ca transients and force were measured and effects of UPEC on the urothelium were monitored in live tissues. In both species, luminal exposure of ureters to UPEC strains J96 and 536 caused significant time-dependent decreases in phasic and high K depolarization-induced contractility, associated with decreases in the amplitude and duration of the Ca transients. These changes were significant after 3-5 h and irreversible over the next 5 h. The infection causes increased activity of K channels, causing inhibition of voltage-gated Ca entry, and K channel blockers could reverse the effects of UPEC on ureteric function. A smaller direct effect on Ca entry also occurs. Nonpathogenic E. coli (TG2) or abluminal application of UPEC did not produce changes in Ca signaling or contractility. UPEC exposure also caused significant impairment of urothelial barrier function; luminal application of the Ca channel blocker nifedipine caused a reduction in contractions as it entered the tissue, an effect not observed in untreated ureters. Thus, UPEC impairs ureteric contractility in a Ca-dependent manner, largely caused by stimulation of potassium channels and this mechanism is dependent on host-urothelium interaction.

  6. Melatonin protects kidney against apoptosis induced by acute unilateral ureteral obstruction in rats

    Badem, Hüseyin; Cakmak, Muzaffer; Yilmaz, Hakki; Kosem, Bahadir; Karatas, Omer Faruk; Bayrak, Reyhan; Cimentepe, Ersin


    Introduction To investigate whether there was a protective effect of melatonin on apoptotic mechanisms after an acute unilateral obstruction of the kidney. Material and methods A total of 25 rats consisting of five groups were used in the study, designated as follows: Group 1: control, Group 2: sham, Group 3: unilateral ureteral obstruction treated with only saline, Group 4: unilateral ureteral obstruction treated with melatonin immediately, and Group 5: unilateral obstruction treated with melatonin one day after obstruction. Melatonin was administered as a 10 mg/kg dose intraperitoneally. The kidneys were evaluated according to the apoptotic index and Ki-67 scores. Results Comparison of all obstruction groups (Group 3, 4, and 5), revealed that the apoptotic index was significantly higher in Groups 1 and 2. Despite melatonin reduced apoptotic mechanisms in Groups 4 and 5, there was no significant difference between Groups 4 and 5 in terms of the reduction of apoptosis. However, the reduction of apoptosis in the melatonin treated group did not decrease to the level of Groups 1 and 2. Conclusions Despite melatonin administration, which significantly reduces the apoptotic index occurring after acute unilateral ureteral obstruction, the present study did not observe a return to normal renal histology in the obstruction groups. PMID:27551563


    Meril Ann Soman


    Full Text Available Anomalies of the urinary system constitute approximately 30% of all the congenital malformations. There are various associated anomalies involving number, size, shape, position and vascularity of the kidneys. Unascended kidneys refers to a halt in the migration of the kidneys during their normal embryological development. Defect in the ascent of the kidneys are closely related with variations in the branching pattern of aorta. Here we report a case of an unilateral unascended right kidney in a male cadaver encountered during routine medical dissection. A left sided ureteric calculi was also seen as an incidental finding in the same cadaver. Ureterolithiasis occurs worldwide in all sets of population with 80% of the stones found in the male sex in the age group of 30- 60 years. There are various factors which favour the formation of ureteric calculi which includes geographical, socio-economical as well as the mineral content of water consumed and some general medical causes. An attempt has been made to document the causes for this variation and the preventive measures that can be adopted to prevent the formation of ureteric calculi.

  8. Comparison of Pneumatic and Laser Lithotripsy in the Endoscopic Treatment of Upper Ureteral Stones

    Ozer Guzel


    Full Text Available Aim: We aimed to compare the success rate of the use of a pneumatic and a holmium laser lithotripter for endoscopic treatment of upper ureteral calculi with semirigid uretero-renoscopy (URS. Material and Method: A total of 74 patients were included in this study. The patients were divided into two groups; a ballistic lithotripter was used for group 1 containing 33 and a Holmium-YAG laser lithotripter for the remaining 41 patients in group 2. Both groups were compared in terms of stone size the duration of the operation, postoperative hospitalization time, stone-free rate and complications. Results: The mean age of the patients was 47.6. The mean stone size in groups 1 and 2 were 16.4mm and 11.0mm, respectively (p=0.043. The mean stone-free rate groups 1 and 2 were 78.7% and 80.5% respectively at the approximately 1 month follow-up (p=0.391. In group 1 two patients and in group 2 two patients had a minor complication (ClavienI-II. In group 1 three patients had major complications due to ureteral perforation (Clavien 3a and 3b. No major complications (Clavien III-V occurred in Group 2. Discussion: Based on these findings laser lithotripsy can be regarded as safer. If laser lithotripter is available in medical centers, we argue that it should be the first choice for the treatment of upper ureteral stones.


    Sebastiano Cimino


    Full Text Available Background: Pneumatic lithotripsy (PL and Holmium:YAG laser lithotripsy (LL are two valid mini-invasive approaches in the treatment of urologic stones disease. The aim of this study was to compare stone free rates between these two treatment options. Material and methods: From January 2010 to January 2011, 120 consecutive patients with single and primary ureteral stones were prospectively enrolled in this prospective study. The study was single-blinded and none of the patients knew which approach for stone fragmentation would be used. Results: The ureteral stone-free rate (SFRs in the PL group was 80.7% and 86.1 % in the LL group (p=0.002. The mean operating time was 60 (± 25 minutes in the LL group and 61 (± 21 minutes in the PL group, without significant differences (p=0.68. Multivariate logistic analysis revealed that stone location was not significantly predictive of SFRs (p=0.47. None of the patients had blood transfusions and no other severe complications appeared in either group. Conclusions: In our study LL was significantly associated with a stone 80.7% in the PL group and 86.1% in the LL group (p<0.05. Also, Holmium:YAG laser lithotripsy was demonstrated to be the more efficacious endoscopic procedure for the treatment of ureteral stones, allowing stones to be successfully fragmented, with few complications.

  10. Fractures of the proximal humerus

    Brorson, Stig


    Fractures of the proximal humerus have been diagnosed and managed since the earliest known surgical texts. For more than four millennia the preferred treatment was forceful traction, closed reduction, and immobilization with linen soaked in combinations of oil, honey, alum, wine, or cerate....... The bandages were further supported by splints made of wood or coarse grass. Healing was expected in forty days. Different fracture patterns have been discussed and classified since Ancient Greece. Current classification of proximal humeral fractures mainly relies on the classifications proposed by Charles......, classification of proximal humeral fractures remains a challenge for the conduct, reporting, and interpretation of clinical trials. The evidence for the benefits of surgery in complex fractures of the proximal humerus is weak. In three systematic reviews I studied the outcome after locking plate osteosynthesis...

  11. Effects of PDE5 Inhibitors and sGC Stimulators in a Rat Model of Artificial Ureteral Calculosis.

    Peter Sandner

    Full Text Available Urinary colics from calculosis are frequent and intense forms of pain whose current pharmacological treatment remains unsatisfactory. New and more effective drugs are needed to control symptoms and improve stone expulsion. Recent evidence suggested that the Nitric Oxide (NO / cyclic guanosine monophosphate (cGMP/phosphodiesterase type 5 (PDE5 system may contribute to ureteral motility influencing stone expulsion. We investigated if PDE5 inhibitors and sGC stimulators influence ureteral contractility, pain behaviour and stone expulsion in a rat model of ureteral calculosis. We investigated: a the sex-specific PDE5 distribution in the rat ureter; b the functional in vitro effects of vardenafil and sildenafil (PDE5 inhibitors and BAY41-2272 (sGC stimulator on induced ureteral contractility in rats and c the in vivo effectiveness of vardenafil and BAY41-2272, alone and combined with ketoprofen, vs hyoscine-N-butylbromide alone or combined with ketoprofen, on behavioural pain indicators and stone expulsion in rats with artificial calculosis in one ureter. PDE5 was abundantly expressed in male and female rats' ureter. In vitro, both vardenafil and BAY41-2272 significantly relaxed pre-contracted ureteral strips. In vivo, all compounds significantly reduced number and global duration of "ureteral crises" and post-stone lumbar muscle hyperalgesia in calculosis rats. The highest level of reduction of the pain behaviour was observed with BAY41-2272 among all spasmolytics administered alone, and with the combination of ketoprofen with BAY41-2272. The percentage of stone expulsion was maximal in the ketoprofen+BAY41-2272 group. The NO/cGMP/PDE5 pathway is involved in the regulation of ureteral contractility and pain behaviour in urinary calculosis. PDE5 inhibitors and sGC stimulators could become a potent new option for treatment of urinary colic pain.

  12. The infrastructure of psychological proximity

    Nickelsen, Niels Christian Mossfeldt

    ). The experience of psychological proximity between patient and nurse is provided through confidence, continuity and the practical set-up. This constitutes an important enactment of skillfulness, which may render telemedicine a convincing health service in the future. Methodology: The study draws on a pilot...... (Langstrup & Winthereik 2008). This study contributes by showing the infrastructure of psychological proximity, which is provided by way of device, confidence, continuity and accountability....

  13. Phytochemistry and proximate composition of ginger ( Zingiber ...

    Phytochemistry and proximate composition of ginger ( Zingiber officinale ) ... steroids, flavonoids and terpenoids were present, while reducing sugars, tannins, oils and ... proximate analysis, Zingiberaceae, zingerone, methanolic extraction

  14. Reconstructive surgery in eight children with solitary kidneys

    Thorup, Jørgen Mogens


    Within a 10-year period reconstructive urinary tract surgery has been carried out in eight children with solitary kidneys. The children were 0-5 years old. Six had unilateral renal agenesis and two had unilateral multicystic kidney. In five children ureteroneocystostomy was performed, in two...... of them because of reflux. In two children pyeloureteroplasty was performed, and in one both ureteroneocystostomy and pyeloureteroplasty. The multicystic kidneys were removed. The renal function was poor preoperatively in five children; two of these also had urosepsis. These children were all under 15...... months of age. Postoperatively, the renal function was subnormal (although improved) in two children; in six it was normal. The most important prognostic factors in solitary kidneys with urinary tract obstruction are infection and developmental injury....

  15. Electron acoustic solitary waves with kappa-distributed electrons

    Devanandhan, S; Singh, S V; Lakhina, G S, E-mail: [Indian Institute of Geomagnetism, New Panvel (West), Navi Mumbai (India)


    Electron acoustic solitary waves are studied in a three-component, unmagnetized plasma composed of hot electrons, fluid cold electrons and ions having finite temperatures. Hot electrons are assumed to have kappa distribution. The Sagdeev pseudo-potential technique is used to study the arbitrary amplitude electron-acoustic solitary waves. It is found that inclusion of cold electron temperature shrinks the existence regime of the solitons, and soliton electric field amplitude decreases with an increase in cold electron temperature. A decrease in spectral index, {kappa}, i.e. an increase in the superthermal component of hot electrons, leads to a decrease in soliton electric field amplitude as well as the soliton velocity range. The soliton solutions do not exist beyond T{sub c}/T{sub h}>0.13 for {kappa}=3.0 and Mach number M=0.9 for the dayside auroral region parameters.


    LU Ji; YU Xi-ping


    Solitary wave fission over an underwater step is numerically investigated. The numerical model is based on the enhanced Boussinesq equations, which appropriately represent both the nonlinearity and dispersivity of surface water waves. The finite difference method defined on the staggered grid in space with an implicit scheme for time stepping is employed for the numerical solution of the governing equations. It is demonstrated that Boussinesq type equations, though they are vertically integrated, can describe the details of the solitary wave fission process with very good accuracy. Numerical results of the reflected and transmitting wave heights, the number of solitons emitted from the transmitting wave and their amplitudes all agree very well with the analytical solution derived from KdV equation by virtue of a linear long wave approximation in the vicinity of the underwater step.

  17. [Solitary fibrous tumor of endometrium--a case report].

    Dvořák, O; Dvořáková, E; Laco, J; Spaček, J


    Solitary fibrous tumor (SFT) is an uncommon mesenchymal tumor. We present a case of SFT occurring in endometrium. Case report. Department of Obstetrics and Gynecology, The Fingerland Department of Pathology, Medical Faculty of Charles University and Faculty Hospital Hradec Králové. We report a case of 57 years old woman with SFT arising from the endometrium, which was diagnosed and treated at our department. Histological finding was supported by typical immunohistochemical profile of the tumor. Aggressive nature of the tumor wasnt showed. The patient underwent abdominal hysterectomy with bilateral adnexectomy and is followed up in regular periods. Occurence of solitary fibrous tumor (SFT) in the female genital tract is extremely rare. To the best of our knowledge, we report the first case of SFT occurring in endometrium. Because of potencial aggressive behaviour of the tumor complete surgical excision and close follow-up is highly recommended.

  18. Primary Intrapulmonary Thymoma Presenting as a Solitary Pulmonary Nodule

    Jung, Woohyun; Kang, Chang Hyun; Kim, Young Tae; Park, In Kyu


    Primary intrapulmonary thymoma (PIT) is a very rare lesion of uncertain pathogenesis. PIT should be considered when the histopathological appearance of a lung tumor shows features that are uncommon but similar to those of a thymoma. In this case report, we discuss the case of a 59-year-old female with a solitary pulmonary nodule that was confirmed to be PIT on the basis of pathological tests. Treatment with complete resection showed good results. PMID:28180106

  19. The frustrated Brownian motion of nonlocal solitary waves

    Folli, Viola


    We investigate the evolution of solitary waves in a nonlocal medium in the presence of disorder. By using a perturbational approach, we show that an increasing degree of nonlocality may largely hamper the Brownian motion of self-trapped wave-packets. The result is valid for any kind of nonlocality and in the presence of non-paraxial effects. Analytical predictions are compared with numerical simulations based on stochastic partial differential equation

  20. Exact Solitary Wave Solution in the ZK-BBM Equation

    Juan Zhao


    Full Text Available The traveling wave solution for the ZK-BBM equation is considered, which is governed by a nonlinear ODE system. The bifurcation structure of fixed points and bifurcation phase portraits with respect to the wave speed c are analyzed by using the dynamical system theory. Furthermore, the exact solutions of the homoclinic orbits for the nonlinear ODE system are obtained which corresponds to the solitary wave solution curve of the ZK-BBM equation.

  1. Existence of solitary waves in dipolar quantum gases

    Antonelli, Paolo


    We study a nonlinear Schrdinger equation arising in the mean field description of dipolar quantum gases. Under the assumption of sufficiently strong dipolar interactions, the existence of standing waves, and hence solitons, is proved together with some of their properties. This gives a rigorous argument for the possible existence of solitary waves in BoseEinstein condensates, which originate solely due to the dipolar interaction between the particles. © 2010 Elsevier B.V. All rights reserved.

  2. Nonlinear dynamics of DNA - Riccati generalized solitary wave solutions

    Alka, W.; Goyal, Amit [Department of Physics, Panjab University, Chandigarh-160014 (India); Nagaraja Kumar, C., E-mail: [Department of Physics, Panjab University, Chandigarh-160014 (India)


    We study the nonlinear dynamics of DNA, for longitudinal and transverse motions, in the framework of the microscopic model of Peyrard and Bishop. The coupled nonlinear partial differential equations for dynamics of DNA model, which consists of two long elastic homogeneous strands connected with each other by an elastic membrane, have been solved for solitary wave solution which is further generalized using Riccati parameterized factorization method.

  3. Nonlinear dynamics of DNA - Riccati generalized solitary wave solutions

    Alka, W.; Goyal, Amit; Nagaraja Kumar, C.


    We study the nonlinear dynamics of DNA, for longitudinal and transverse motions, in the framework of the microscopic model of Peyrard and Bishop. The coupled nonlinear partial differential equations for dynamics of DNA model, which consists of two long elastic homogeneous strands connected with each other by an elastic membrane, have been solved for solitary wave solution which is further generalized using Riccati parameterized factorization method.

  4. Phase modulated solitary waves controlled by bottom boundary condition

    Mukherjee, Abhik


    A forced KdV equation is derived to describe weakly nonlinear, shallow water surface wave propagation over non trivial bottom boundary condition. We show that different functional forms of bottom boundary conditions self-consistently produce different forced kdV equations as the evolution equations for the free surface. Solitary wave solutions have been analytically obtained where phase gets modulated controlled by bottom boundary condition whereas amplitude remains constant.

  5. Conjugate flows and amplitude bounds for internal solitary waves

    N. I. Makarenko


    Full Text Available Amplitude bounds imposed by the conservation of mass, momentum and energy for strongly nonlinear waves in stratified fluid are considered. We discuss the theoretical scheme which allows to determine broadening limits for solitary waves in the terms of a given upstream density profile. Attention is focused on the continuously stratified flows having multiple broadening limits. The role of the mean density profile and the influence of fine-scale stratification are analyzed.

  6. Solitary rectal ulcer syndrome in children: A literature review

    Dehghani, Seyed Mohsen; Malekpour, Abdorrasoul; HAGHIGHAT, MAHMOOD


    Solitary rectal ulcer syndrome (SRUS) is a benign and chronic disorder well known in young adults and less in children. It is often related to prolonged excessive straining or abnormal defecation and clinically presents as rectal bleeding, copious mucus discharge, feeling of incomplete defecation, and rarely rectal prolapse. SRUS is diagnosed based on clinical symptoms and endoscopic and histological findings. The current treatments are suboptimal, and despite correct diagnosis, outcomes can ...

  7. Solitary Fibrous Tumors and So-Called Hemangiopericytoma

    Nicolas Penel


    Full Text Available We have reviewed the literature data regarding the spectrum of tumors including solitary fibrous tumor and hemangiopericytoma with special focus on definition of the disease, discussion of the criteria for malignancy, and the key elements of standard treatment of localized disease. We have discussed the emerging concepts on the tumor biology and the different systemic treatments (chemotherapy and molecular-targeted therapies.

  8. Turing patterns and solitary structures under global control

    Pismen, L M


    Striped Turing patterns and solitary band and disk structures are constructed using a three-variable multiscale model with cubic nonlinearity and global control. The existence and stability conditions of regular structures are analysed using the equation of motion of curved boundaries between alternative states of the short-range component. The combined picture of transitions between striped and spotted patterns with changing level of global control is in qualitative agreement with the results of the computer experiment by Middya and Luss

  9. Magnetic resonance urography enhanced by gadolinium and diuretics: a comparison with conventional urography in diagnosing the cause of ureteric obstruction.

    Jung, P; Brauers, A; Nolte-Ernsting, C A; Jakse, G; Günther, R W


    To compare the ability of magnetic resonance urography (MRU), enhanced using gadolinium and frusemide diuresis, and conventional intravenous urography (IVU) to diagnose the cause of ureteric obstruction. The study included 82 patients in whom IVU showed or suggested obstruction and who also underwent MRU. The images from both methods were interpreted by various investigators independently; two evaluated the IVU and two others the MRU, the latter being unaware of the diagnosis after IVU. If the diagnosis remained unclear, further investigations (e.g. computed tomography, retrograde pyelography or ureteroscopy) were conducted. The diagnoses were ureteric calculi in 72 patients, ureteric tumours in eight and extra-ureteric tumours in two. In those with urolithiasis, the diagnosis was correct with IVU in 49 patients and with MRU in 64. The diagnosis in this group was incorrect with MRU in only two patients. The main reason for the failure of IVU was absent contrast medium excretion. Three of eight patients with ureteric tumours were correctly diagnosed by IVU but in three patients the diagnosis was incorrect. MRU correctly diagnosed seven of the eight patients in this group, with no false diagnosis. IVU is currently likely to remain the standard procedure for imaging the upper urinary tract, but this study shows the potential of MRU when enhanced with gadolinium and frusemide. MRU may be helpful if there is a dilated system with no excretory function, in pregnant women, in children and in those with contrast medium allergy.

  10. Time-resolved dynamic contrast-enhanced MR urography for the evaluation of ureteral peristalsis: initial experience.

    Kim, Sooah; Jacob, Jason S; Kim, Danny C; Rivera, Rafael; Lim, Ruth P; Lee, Vivian S


    To determine the feasibility of time-resolved dynamic contrast-enhanced magnetic resonance urography (MRU) for the evaluation of ureteral peristalsis using a data-sharing 3D gradient echo sequence with spiral k-space filling. Eight patients (M=3, F=5, mean 48.1 years) were referred for MRU for the evaluation for renal mass (n=3), hematuria (n=2), urinary tract tuberculosis (n=1), postoperative bladder cancer (n=1), and postoperative ureteric reimplantation (n=1). Dynamic MRU was performed for 120 seconds at 1.5T after intravenous furosemide and gadolinium administration using an oblique sagittal, time-resolved T1 3D gradient echo sequence with 1 second effective temporal resolution. Study quality was assessed based on artifacts and extent of ureteric visualization. Frequency of peristalsis from the renal pelvis to urinary bladder was evaluated for each subject. A total of 16 ureters were examined. Image quality was good in four ureters, satisfactory in 11 ureters, and poor in one ureter. Mean peristaltic frequency was 3.5 waves per minute (range, 2.5-6.5 waves/minute) in normal ureters (n=11). Five ureters were considered abnormal (one urinary tract tuberculosis and four postsurgical ureters), and all had decreased or no peristalsis (0-1.5 waves per minute). MRU using a time-resolved, data-sharing 3D contrast-enhanced technique is able to demonstrate ureteral peristalsis and permits quantification of ureteral peristaltic frequency. Copyright (c) 2008 Wiley-Liss, Inc.

  11. Pharmacological Relaxation of the Ureter When Using Ureteral Access Sheaths during Ureterorenoscopy: A Randomized Feasibility Study in a Porcine Model

    Søren Kissow Lildal


    Full Text Available Objective. High intraluminal pressure during ureterorenoscopy (URS increases risk of infectious and haemorrhagic complications. Intrarenal pressure may be reduced by the use of ureteral access sheaths (UASs, which on the other hand may cause ureteral damage. We have previously shown that the β-agonist isoproterenol (ISO, when administered topically in the irrigation fluid, is able to inhibit ureteral muscle tone and lower intrarenal pressure during URS. The aim of this study was to examine the effect of ISO on the success rate of UAS insertion in a porcine model. Materials and Methods. 22 pigs in which a UAS could not initially be placed were randomized to endoluminal irrigation with either ISO (0.1 μg/mL or saline before a new insertion trial. Subsequently, it was registered whether the UAS could be passed without resistance. During extraction of the sheath, any ureteral lesions were characterized ureteroscopically using the PULS classification system. Surgeons were blinded to randomization. Results. In the ISO group, the observed effect of irrigation was 63% successful UAS insertions, compared to 27% in the saline group. No serious lesions (ureteral lesions.

  12. Energetics of internal solitary waves in a background sheared current

    K. G. Lamb


    Full Text Available The energetics of internal waves in the presence of a background sheared current is explored via numerical simulations for four different situations based on oceanographic conditions: the nonlinear interaction of two internal solitary waves; an internal solitary wave shoaling through a turning point; internal solitary wave reflection from a sloping boundary and a deep-water internal seiche trapped in a deep basin. In the simulations with variable water depth using the Boussinesq approximation the combination of a background sheared current, bathymetry and a rigid lid results in a change in the total energy of the system due to the work done by a pressure change that is established across the domain. A final simulation of the deep-water internal seiche in which the Boussinesq approximation is not invoked and a diffuse air-water interface is added to the system results in the energy remaining constant because the generation of surface waves prevents the establishment of a net pressure increase across the domain. The difference in the perturbation energy in the Boussinesq and non-Boussinesq simulations is accounted for by the surface waves.

  13. Solitary wave shoaling and breaking in a regularized Boussinesq system

    Senthilkumar, Amutha


    A coupled BBM system of equations is studied in the situation of water waves propagating over decreasing fluid depth. A conservation equation for mass and a wave breaking criterion valid in the Boussinesq approximation is found. A Fourier collocation method coupled with a 4-stage Runge-Kutta time integration scheme is employed to approximate solutions of the BBM system. The mass conservation equation is used to quantify the role of reflection in the shoaling of solitary waves on a sloping bottom. Shoaling results based on an adiabatic approximation are analyzed. Wave shoaling and the criterion of breaking solitary waves on a sloping bottom is studied. To validate the numerical model the simulation results are compared with those obtained by Grilli et al.[16] and a good agreement between them is observed. Shoaling of solitary waves of two different types of mild slope model systems in [8] and [13] are compared, and it is found that each of these models works well in their respective regimes of applicability.

  14. Numerical Modelling of Solitary Wave Experiments on Rubble Mound Breakwaters

    Guler, H. G.; Arikawa, T.; Baykal, C.; Yalciner, A. C.


    Performance of a rubble mound breakwater protecting Haydarpasa Port, Turkey, has been tested under tsunami attack by physical model tests conducted at Port and Airport Research Institute (Guler et al, 2015). It is aimed to understand dynamic force of the tsunami by conducting solitary wave tests (Arikawa, 2015). In this study, the main objective is to perform numerical modelling of solitary wave tests in order to verify accuracy of the CFD model IHFOAM, developed in OpenFOAM environment (Higuera et al, 2013), by comparing results of the numerical computations with the experimental results. IHFOAM is the numerical modelling tool which is based on VARANS equations with a k-ω SST turbulence model including realistic wave generation, and active wave absorption. Experiments are performed using a Froude scale of 1/30, measuring surface elevation and flow velocity at several locations in the wave channel, and wave pressure around the crown wall of the breakwater. Solitary wave tests with wave heights of H=7.5 cm and H=10 cm are selected which represent the results of the experiments. The first test (H=7.5 cm) is the case that resulted in no damage whereas the second case (H=10 cm) resulted in total damage due to the sliding of the crown wall. After comparison of the preliminary results of numerical simulations with experimental data for both cases, it is observed that solitary wave experiments could be accurately modeled using IHFOAM focusing water surface elevations, flow velocities, and wave pressures on the crown wall of the breakwater (Figure, result of sim. at t=29.6 sec). ACKNOWLEDGEMENTSThe authors acknowledge developers of IHFOAM, further extend their acknowledgements for the partial supports from the research projects MarDiM, ASTARTE, RAPSODI, and TUBITAK 213M534. REFERENCESArikawa (2015) "Consideration of Characteristics of Pressure on Seawall by Solitary Waves Based on Hydraulic Experiments", Jour. of Japan. Soc. of Civ. Eng. Ser. B2 (Coast. Eng.), Vol 71, p I

  15. Bifurcation and Solitary-Like Solutions for Compound KdV-Burgers-Type Equation

    Yin Li


    Full Text Available Firstly, based on the improved sub-ODE method and the bifurcation method of dynamical systems, we investigate the bifurcation of solitary waves in the compound KdV-Burgers-type equation. Secondly, numbers of solitary patterns solutions are given for each parameter condition and numerical simulations are used to display the dynamical characteristics. Finally, we obtain twelve solitary patterns solutions under some parameter conditions, such as the trigonometric function solutions and the hyperbolic function solutions.

  16. Cap mesenchyme cell swarming during kidney development is influenced by attraction, repulsion, and adhesion to the ureteric tip.

    Combes, Alexander N; Lefevre, James G; Wilson, Sean; Hamilton, Nicholas A; Little, Melissa H


    Morphogenesis of the mammalian kidney requires reciprocal interactions between two cellular domains at the periphery of the developing organ: the tips of the epithelial ureteric tree and adjacent regions of cap mesenchyme. While the presence of the cap mesenchyme is essential for ureteric branching, how it is specifically maintained at the tips is unclear. Using ex vivo timelapse imaging we show that cells of the cap mesenchyme are highly motile. Individual cap mesenchyme cells move within and between cap domains. They also attach and detach from the ureteric tip across time. Timelapse tracks collected for >800 cells showed evidence that this movement was largely stochastic, with cell autonomous migration influenced by opposing attractive, repulsive and cell adhesion cues. The resulting swarming behaviour maintains a distinct cap mesenchyme domain while facilitating dynamic remodelling in response to underlying changes in the tip. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Case report of a ureteral obstruction by Candida albicans fungus balls detected by magnetic resonance imaging in kidney transplant recipient.

    Arichi, Naoko; Yasumoto, Hiroaki; Ogawa, Kohei; Nagami, Taichi; Anjiki, Haruki; Nakamura, Shigenobu; Mitsui, Yozo; Hiraoka, Takeo; Sumura, Masahiro; Shiina, Hiroaki


    In kidney transplant recipients, acute renal failure resulting from a ureteral obstruction by fungus balls is uncommon. We report a 60-year-old man diagnosed with ureteral obstruction caused by Candida albicans fungus balls early after transplant. Diagnosis was made by a T2-weighted magnetic resonance image, which demonstrated fungus balls as a low-intensity mass in the pelvis and microscopic examination findings in the urine. The patient was treated successfully with an antifungal agent and direct irrigation. It should be noted that fungus balls may cause ureteral obstruction of transplanted kidneys, possibly resulting in graft failure. Imaging of the kidneys and collecting system and aggressive debridement that adds to systemic therapy are necessary for early diagnosis and are central to a successful outcome.

  18. Transition from Solitons to Solitary Waves in the Fermi-Pasta-Ulam Lattice

    Wen, Zhenying; Wei, Nian


    In this paper, we study the smooth transition from solitons to solitary waves in localization, relation between energy and velocity, propagation and scattering property in the Fermi-Pasta-Ulam lattice analytically and numerically. A soliton is a very stable solitary wave that retains its permanent structure after interacting with other solitary waves. A soliton exists when the energy is small, and it becomes a solitary wave when the energy increases to the threshold. The transition could help to understand the distinctly different heat conduction behaviors of the Fermi-Pasta-Ulam lattice at low and high temperature.

  19. Experimental study of nonlinear dust acoustic solitary waves in a dusty plasma

    Bandyopadhyay, P; Sen, A; Kaw, P K


    The excitation and propagation of finite amplitude low frequency solitary waves are investigated in an Argon plasma impregnated with kaolin dust particles. A nonlinear longitudinal dust acoustic solitary wave is excited by pulse modulating the discharge voltage with a negative potential. It is found that the velocity of the solitary wave increases and the width decreases with the increase of the modulating voltage, but the product of the solitary wave amplitude and the square of the width remains nearly constant. The experimental findings are compared with analytic soliton solutions of a model Kortweg-de Vries equation.

  20. Solitary Plasmacytoma of the Cecum and the Ascending Colon: Surgical Resection as a Treatment Modality

    Dalgic, Tahsin; Bostanci, Erdal Birol; Cakir, Tebessum; Ozer, Ilter; Ulas, Murat; Aydog, Gulden; Akoglu, Musa


    Colonic solitary plasmacytoma is a rare disease, with few reports occurring in the literature. Solitary plasmacytoma is defined as a plasma cell tumour with no evidence of bone marrow infiltration. Plasmacytoma can present as a solitary tumour in bone or in other parts of the body. The gastrointestinal tract is rarely the site of the disease. We report on the case of a 51-year-old man presenting with a colonic symptomatic mass with unclear biopsy results. A resected specimen showed a solitary plasmacytoma. Surgical resection was an adequate treatment modality in this case. Endoscopic resection, radiotherapy, and chemotherapy are also preferred treatments in selected gastrointestinal plasmacytoma cases. PMID:25954564

  1. Solitary Plasmacytoma of the Cecum and the Ascending Colon: Surgical Resection as a Treatment Modality

    Tahsin Dalgic


    Full Text Available Colonic solitary plasmacytoma is a rare disease, with few reports occurring in the literature. Solitary plasmacytoma is defined as a plasma cell tumour with no evidence of bone marrow infiltration. Plasmacytoma can present as a solitary tumour in bone or in other parts of the body. The gastrointestinal tract is rarely the site of the disease. We report on the case of a 51-year-old man presenting with a colonic symptomatic mass with unclear biopsy results. A resected specimen showed a solitary plasmacytoma. Surgical resection was an adequate treatment modality in this case. Endoscopic resection, radiotherapy, and chemotherapy are also preferred treatments in selected gastrointestinal plasmacytoma cases.

  2. Calculation and analysis of solitary waves and kinks in elastic tubes


    The paper is devoted to analysis of different models that describe waves in fluid-filled and gas-filled elastic tubes and development of methods of calculation and numerical analysis of solutions with solitary waves and kinks for these models. Membrane model and plate model are used for tube. Two types of solitary waves are found. One-parametric families are stable and may be used as shock structures. Null-parametric solitary waves are unstable. The process of split of such solitary waves is ...

  3. Interaction of Submerged Breakwater by a Solitary Wave Using WC-SPH Method

    Afshin Mansouri


    Full Text Available Interaction of a solitary wave and submerged breakwater is studied in a meshless, Lagrangian approach. For this purpose, a two-dimensional smoothed particle hydrodynamics (SPH code is developed. Furthermore, an extensive set of simulations is conducted. In the first step, the generated solitary wave is validated. Subsequently, the interaction of solitary wave and submerged breakwater is investigated thoroughly. Results of the interaction of solitary wave and a submerged breakwater are also shown to be in good agreement with published experimental studies. Afterwards, the effects of the inclination and length of breakwater as well as distance between two breakwaters are evaluated on damping ratio of breakwater.

  4. Immediate and late management of iatrogenic ureteric injuries: 28 years of experience

    El Abd, Ahmed S.; El-Abd, Shawky A.; El-Enen, Mohamed Abo; Tawfik, Ahmed M.; Soliman, Mohamed G.; Abo-Farha, Mohamed; Gamasy, Abd-El Naser El; El-Sharaby, Mahmoud; El-Gamal, Samir


    Objective To evaluate the long-term results after managing intraoperative and late-diagnosed cases of iatrogenic ureteric injury (IUI), treated endoscopically or by open surgery. Patients and methods Patients immediately diagnosed with IUI were managed under the same anaesthetic, while those referred late had a radiological assessment of the site of injury, and endoscopic management. Open surgical procedures were used only for the failed cases with previous diversion. Results In all, 98 patients who were followed had IUI after gynaecological, abdominopelvic and ureteroscopic procedures in 60.2%, 14.3% and 25.5%, respectively. The 27 patients diagnosed during surgery were managed immediately, while in the late-referred 71 patients ureteroscopic ureteric realignment with stenting was successful in 26 (36.6%). Complex open reconstruction with re-implantation or ureteric substitution, using bladder-tube or intestinal-loop procedures, was used in 27 (60%), 16 (35.5%) and two (4.5%) patients of the late group, respectively. A long-term radiological follow-up with a mean (range) of 46.6 (24.5–144) months showed recurrent obstruction in 16 (16.3%) patients managed endoscopically and reflux in six (8.3%) patients. Three renal units only (3%) were lost in the late-presenting patients. Conclusion Patients managed immediately had better long-term results. More than a third of the late-diagnosed patients were successfully managed endoscopically with minimal morbidity. Open reconstruction by an experienced urologist who can perform a complex substitutional procedure was mandatory to preserve renal units in the long-term. PMID:26609443

  5. Double-J Versus External Ureteral Stents in Kidney Transplantation: A Retrospective Analysis



    Full Text Available Background Kidney transplantation has long been recognized as the best available therapy for end stage kidney disease. Objectives This study aimed to compare outcomes of double-J versus percutaneous ureteral stent placement in renal transplantation. Patients and Methods A retrospective analysis was performed on data of renal transplantations performed at our institution in a 12-month period. In this period, external and double-J stents were used in parallel. Length of hospital stay and stent-associated complications were evaluated. Results In 76 kidney transplants, 43 external (group 1 and 33 double-J (group 2 urinary stents were used. No significant difference was observed in the number of urinary tract infections, ureteric stenosis or necrosis. The mean overall length of hospital stay was comparable in both groups (20.7 days in group 1 vs 19.3 days in group 2, P = 0.533. For patients without immunological complications, the hospital stay was significantly reduced using double-J stents (12.9 days in group 1, 10.8 days in group 2, P = 0.018. Leakage of the ureteroneocystostomy occurred in 6 out of 43 patients in group 1 (13.9%. No case of anastomotic insufficiency was observed in group 2 (P = 0.035. Macrohematuria was detected in 13 out of the 43 patients in group 1 (30.2%, compared to 3 out of 33 patients in group 2 (9.1%; P = 0.045. Conclusions This nonrandomized comparison of stent types in kidney transplantation supports the use of prophylactic double-J stents in terms of decreased ureteric complications and reduced length of hospital stay.

  6. Comparison of the trauma degree after retroperitoneoscopy and percutaneous nephtoscopy treatment of complicated upper ureteral calculi

    Shu-Run Zhao; Zhan-Peng Lu


    Objective:To compare the trauma degree after retroperitoneoscopy and percutaneous nephtoscopy treatment of complicated upper ureteral calculi.Methods:A total of 82 cases of patients with complicated upper ureteral calculi who received surgical treatment in our hospital from July 2013 to January 2015 were included for study. According to the different surgical methods, included subjects were randomly divided into observation group 41 cases and control group 41 cases. Control group received percutaneous nephtoscopy treatment, observation group received retroperitoneoscopy treatment, and then differences in early postoperative coagulation indicators, blood glucose and insulin levels, stress protein levels as well as PI3K/Akt and p38MAPK signaling pathway expression were compared between two groups.Results:Early postoperative PLCR, PDW, APTT and D-D values of observation group were lower than those of control group while Ca2+ value was higher than that of control group; early postoperative GLU, fasting lactate, fasting lactate/pyruvic acid and HOMA-IR values of observation group were lower than those of control group while HOMA-β value was higher than that of control group; early postoperative HSP70, DNA ligaseⅣ, JAB1 and ATF4 expression levels of observation group were higher than those of control group whileβ-tubulin and IFIT1 expression levels were lower than those of control group; early postoperative p38MAPK mRNA and protein expression levels of observation group were lower than those of control group while PI3K and Akt mRNA and protein expression levels were higher than those of control group.Conclusion: Retroperitoneoscopy treatment of patients with complicated upper ureteral calculi causes less injury to patients and less effect on internal environment, and helps to patients’ early postoperative rehabilitation.

  7. Evaluation of pneumatic versus holmium:YAG laser lithotripsy for impacted ureteral stones.

    Binbay, Murat; Tepeler, Abdulkadir; Singh, Avinash; Akman, Tolga; Tekinaslan, Erdem; Sarilar, Omer; Baykal, Murat; Muslumanoglu, Ahmet Yaser


    We prospectively analyzed and compared the effectiveness and complications of pneumatic lithotripter with a holmium:yttrium-aluminum-garnet (Ho:YAG) laser for the ureterorenoscopic management of impacted ureteral stones. From January 2006 to January 2008, we performed retrograde endoscopic treatment in 288 patients with ureteral stones in our clinic. The patients with impacted stones were randomized into two groups according to the lithotripter used to fragment the stone: pneumatic (n = 40) and laser (n = 40). The preoperative, operative, and post-operative follow-up findings were analyzed and compared. The average stone size was similar in both groups (118.8 ± 58.3 mm(2) vs. 110.7 ± 54.4 mm(2)). The calculi were located in the distal ureter in most of the patients in both groups (65% in pneumatic group and 52.5% in laser group). The operation time was significantly diminished in the laser group (P = 0.001). The stone-free rates after a single ureteroscopic procedure were 80 and 97.5% in the pneumatic and laser groups, respectively (P = 0.03). Auxiliary treatments were needed in seven patients in the pneumatic group, while only one patient in the laser group (P = 0.05) needed this treatment. After the additional procedures, a 100% success rate was achieved in both groups. The rate of double J stent insertion was significantly higher in the pneumatic group (P = 0.01). In the pneumatic group, four cases of stone up-migration and one case of post-operative stricture were seen, whereas only one case of stone up-migration was noted in the laser group. Our comparative study has shown that the use of Ho:YAG as an intracorporeal lithotripter during ureteroscopic management of impacted ureteral stones is highly efficient with high success rates, regardless of the stone location.

  8. Serum cytocines values in patients after endoscopic surgery for ureteral lithiasis.

    Bantis, Athanasios; Tsakaldimis, Georgios; Zissimopoulos, Athanasios; Kalaitzis, Christos; Gianakopoulos, Stilianos; Pitiakoudis, Michail; Polichronidis, Alexandros; Touloupidis, Stavros


    Obstructive uropathy due to ureteral stones can cause renal infection and, if left untreated, can cause impairment of renal function. Endoscopic surgery such as ureteroscopy (URS) and laser lithotripsy are the primary therapeutic approach. Cytokines as non invasive markers may have a role to diagnose ureteral damage and infection. We aimed to evaluate serum cytokine levels of tumor necrosis factor-a (TNFa) and interleukin-6 (IL6) in patients undergoing URS and holmium laser lithotripsy. The study included 40 patients (male 25 and 15 female) with a mean age of 47 years and 10 healthy blood donors serving as the control group. None of them had any additional systemic diseases, previous insertion of a ureteral double "j" stent or of a nephrostomy tube, neoplasmatic disease ot renal insufficiency. Routine urine examination and urine culture were obtained to exclude urinary infection. Preoperatively and 1h, 2h, 24h and 48h postoperatively serum samples of TNF-a and IL-6 were collected and measured. Serum TNFa and IL-6 values were correlated with the other variables measured from blood samples after the URS using paired samples Students t-test with confidence interval 95%. A P value of less than 0.01 was considered statistically significant. Correlation between serum TNF-a and IL6 levels with healthy donors were statistically significant in 1h (0.004), 2h (0.001), 24h (0.001) and 48h (0.001 and 0.001) postoperatively, respectively. In conclusion, our study shows that cytokines could be helpful as markers of renal tissue damage. However, further studies are needed to get more accurate results.

  9. Emphysematous pyelonephritis in type II diabetes: A case report of an undiagnosed ureteric colic.

    Vollans, Samuel R; Sehjal, Ranjit; Forster, James A; Rogawski, Karol M


    Emphysematous pyelonephritis (EPN) is a severe acute necrotising infection of the renal parenchyma and perirenal tissue, characterised by gas formation. 90% of cases are seen in association with diabetes mellitus. We report a case of undiagnosed ureteric obstruction in a type II diabetic, leading to EPN requiring emergency nephrectomy. A 59-year-old type II tablet controlled diabetic woman presented complaining of a five day history of right sided abdominal pain associated with vomiting, abdominal distension and absolute constipation. There were no lower urinary tract symptoms. Past surgical history included an open appendectomy and an abdominal hysterectomy. On examination, she was haemodynamically stable, the abdomen was soft, distended, and tender in the right upper and lower quadrants with no bowel sounds. Investigations revealed a CRP of 365 and 2+ blood and nitrite positive on the urine dipstick. The AXR was reported as normal on admission, however when reviewed in retrospect revealed the diagnosis. She was managed, therefore, as having adhesional bowel obstruction and a simple UTI. After four days, a CT was organised as she was not settling. This showed a right pyohydronephrosis with gas in the collecting system secondary to an 8 mm obstructing ureteric calculus. The kidney was drained percutaneously via a nephrostomy and the patient was commenced on a broad spectrum intravenous antibiotics. Despite this, she went on to need an emergency nephrectomy for uncontrolled severe sepsis. She was discharged in good health 15 days later. EPN carries a mortality of up to 40% with medical management alone. Early recognition of EPN in an obstructed kidney is essential to guide aggressive management, and in the presence of continued severe sepsis or organ dysfunction an urgent nephrectomy should be carried out. Diabetic patients who are known to have renal or ureteric calculi, whether symptomatic or not, should be considered for percutanous or ureteroscopic treatment. In

  10. A second cycle of tamsulosin in patients with distal ureteric stones: a prospective randomized trial.

    Porpiglia, Francesco; Fiori, Cristian; Ghignone, Gianpaolo; Vaccino, Davide; Billia, Michele; Morra, Ivano; Ragni, Francesca; Scarpa, Roberto M


    To evaluate, in a prospective randomized pilot study, the effectiveness and safety of tamsulosin, administered in patients with distal ureteric stones and who have already undergone an unsuccessful first cycle of medical expulsive therapy (MET). We evaluated the effectiveness and safety of tamsulosin, administered as a further therapy, in patients previously unsuccessfully treated with combined expulsive 10-day therapy (tamsulosin + deflazacort) for distal ureteric stones. Ninety-one patients were enrolled and randomized into two groups, each receiving a different therapy for 10 days. Group A (46 patients) received a further cycle of tamsulosin (0.4 mg daily), and group B (45) did not. Age, gender, stone size, time to expulsion, number of acute episodes of colic during treatment and analgesic consumption were recorded. Patients who were not stone-free after the study period had ureteroscopy. The results were compared statistically using Student's t-, chi-square test and Fisher's exact test. The groups were comparable in age, gender and stone size (5.93 mm for group A and 6.03 mm for group B). The expulsion rate was significantly higher in group A (80%) than in group B (49%) (P < 0.01), whilst there were no differences between the groups in the number of colic episodes and analgesic use. There were no reported side-effects of medical therapy. A second cycle of 10 days of MET with tamsulosin in nonresponders to a 10-day first cycle of MET with tamsulosin and deflazacort is safe and effective, and therefore should be considered as an option in the management of uncomplicated distal ureteric stones.

  11. Ureteral Stents and Foley Catheters-Associated Urinary Tract Infections: The Role of Coatings and Materials in Infection Prevention

    Joey Lo


    Full Text Available Urinary tract infections affect many patients, especially those who are admitted to hospital and receive a bladder catheter for drainage. Catheter associated urinary tract infections are some of the most common hospital infections and cost the health care system billions of dollars. Early removal is one of the mainstays of prevention as 100% of catheters become colonized. Patients with ureteral stents are also affected by infection and antibiotic therapy alone may not be the answer. We will review the current evidence on how to prevent infections of urinary biomaterials by using different coatings, new materials, and drug eluting technologies to decrease infection rates of ureteral stents and catheters.

  12. Combined percutaneous and transurethral lithotripsy for forgotten ureteral stents with giant encrustation.

    Rabani, Seyed Mohammadreza


    Ureteral stents are widely used in many urologic practices. However, stents can cause significant complications including migration, fragmentation, and encrustation and it may possibly be forgotten. Successful management of a retained, encrusted stent requires combined endourological approaches. To present our experience with the approaches for treating forgotten ureteral stents associated with giant stone formation. Seventy four patients with forgotten ureteral stents were managed by different open (nephrolithotomy and/or cystolithotomy), or endoscopic procedures in our center. Among these, 11 patients had severe encrustation (stones larger than 35 mm within the bladder or kidney) and seven patients of this group, presented at our department between July 2007 and December 2010. Combined endourological procedures percutaneous nephrolithotripsy (PCNL), cystolithotripsy (CLT), transurethral lithotripsy (TUL) were performed in one or 2 separate sessions. In these 7 patients the whole of the stents, especially both ends were encrusted. Initially, cystolithotripsy, retrograde ureteroscopy and TUL were performed in the dorsal lithotomy position. Following this, a gentle attempt was made to retrieve the stent with the help of an ureteroscopic grasper. In some cases the stent was grasped by a hemostat clamp out of the urethral meatus with a gentle traction to facilitate lithotripsy in the ureter and even in the kidney. Finally, a ureteric catheter was placed adjacent to the stent for injection of radio-contrast material to delineate the renal pelvis and the calyces. Then in the same session or later in another session the patient was placed in the prone position and PCNL of the upper coil of the encrusted stent along with calculus was done and the stent was removed. In 5 out of seven patients, the initial indication for stent placement was for urinary stone disease after open nephrolithotomy and pyeloplasty in other centers and in two patients after TUL. All patients

  13. Successful resuscitation after suspected carbon dioxide embolism during laparoscopic ureteric reconstructive surgery

    Kalpana S Vora


    Full Text Available Carbon dioxide (CO2 embolism is a rare but potentially fatal complication of laparoscopic surgery. We report a case of presumed CO2 embolism in a 35-year-old female during laparoscopic ureteric reconstructive surgery. After 2 h of operating time, a sudden decrease in end-tidal carbon dioxide and deterioration of hemodynamic status followed by cardiac arrest with pulseless electrical activity suggested gas embolism. Immediate cardiopulmonary resuscitation and inotropic support resulted in successful outcome. Thus, early recognition of the complication and prompt treatment can avoid catastrophy.

  14. Extravasation of Urine Associated with Bilateral Complete Ureteral Duplication, Vesicoureteral Reflux and Benign Prostatic Hyperplasia.

    Suzuki, Issei; Kaga, Kanya; Takei, Kohei; Tokura, Yuumi; Sakamoto, Kazumasa; Nishihara, Daisaku; Mizuno, Tomoya; Yuki, Hideo; Betsunoh, Hironori; Abe, Hideyuki; Yashi, Masahiro; Fukabori, Yoshitatsu; Yamanishi, Tomonori; Kamai, Takao


    We report a rare case of extravasation of urine, which may be associated with bilateral complete ureteral duplication, vesicoureteral reflux (VUR), and benign prostatic hyperplasia (BPH). A 71-year-old male presented with a complaint of right abdominal pain. An extravasation of urine was noted, and was improved by indwelling urethral catheterization. Transurethral resection of the prostate and the endoscopic subureteral injection of dextanomer/hyaluronic acid were performed for the treatment of BPH and VUR, respectively. The post-surgery recovery was successful.

  15. Ureteral Involvement Within an Incarcerated Inguinal Hernia in a Patient With Crossed-fused Renal Ectopia

    Udit Singhal


    Full Text Available Crossed-fused renal ectopy is an uncommon abnormality of the genitourinary tract that results from errors during embryological development. Ureteral herniation represents another rare anatomic event and can often occur from spontaneous, postoperative, and congenital causes (Allam, Johnson, Grewal & Johnson 2015; Pollack, Popky & Blumberg 1975. Here, we discuss the complex clinical course of a patient with crossed-fused renal ectopia who presents with symptoms due to ureteroinguinal herniation and provide a brief overview of the literature. We highlight the clinical considerations in the management of this patient and provide a potential anatomical and embryological explanation for his presentation.

  16. Interaction between the solitary bee Chelostoma florisomne and its nest parasite Sapyga clavicornis-empty cells reduce the impact of parasites

    Munster-Swendsen, Mikael; Calabuig, Isabel


    Chelostoma, empty cells, interaction, mortality, nest architecture, nest parasite, protection, Sapyga, solitary bee......Chelostoma, empty cells, interaction, mortality, nest architecture, nest parasite, protection, Sapyga, solitary bee...

  17. BGK electron solitary waves: 1D and 3D

    L.-J. Chen


    Full Text Available This paper presents new results for 1D BGK electron solitary wave (phase-space electron hole solutions and, based on the new results, extends the solutions to include the 3D electrical interaction (E ~ 1/r 2 of charged particles. Our approach for extending to 3D is to solve the nonlinear 3D Poisson and 1D Vlasov equations based on a key feature of 1D electron hole (EH solutions; the positive core of an EH is screened by electrons trapped inside the potential energy trough. This feature has not been considered in previous studies. We illustrate this key feature using an analytical model and argue that the feature is independent of any specific model. We then construct azimuthally symmetric EH solutions under conditions where electrons are highly field-aligned and ions form a uniform background along the magnetic field. Our results indicate that, for a single humped electric potential, the parallel cut of the perpendicular component of the electric field (E⊥ is unipolar and that of the parallel component (E|| bipolar, reproducing the multi-dimensional features of the solitary waves observed by the FAST satellite. Our analytical solutions presented in this article capture the 3D electric interaction and the observed features of (E|| and E⊥. The solutions predict a dependence of the parallel width-amplitude relation on the perpendicular size of EHs. This dependence can be used in conjunction with experimental data to yield an estimate of the typical perpendicular size of observed EHs; this provides important information on the perpendicular span of the source region as well as on how much electrostatic energy is transported by the solitary waves.

  18. Eady Solitary Waves: A Theory of Type B Cyclogenesis.

    Mitsudera, Humio


    Localized baroclinic instability in a weakly nonlinear, long-wave limit using an Eady model is studied. The resulting evolution equations have a form of the KdV type, including extra terms representing linear coupling. Baroclinic instability is triggered locally by the collision between two neutral solitary waves (one trapped at the upper boundary and the other at the lower boundary) if their incident amplitudes are sufficiently large. This characteristic is explained from the viewpoint of resonance when the relative phase speed, which depends on the amplitudes, is less than a critical value. The upper and lower disturbances grow in a coupled manner (resembling a normal-mode structure) initially, but they reverse direction slowly as the amplitudes increase, and eventually separate from each other.The motivation of this study is to investigate a type of extratropical cyclogenesis that involves a preexisting upper trough (termed as Type B development) from the viewpoint of resonant solitary waves. Two cases are of particular interest. First, the author examines a case where an upper disturbance preexists over an undisturbed low-level waveguide. The solitary waves exhibit behavior similar to that conceived by Hoskins et al. for Type B development; the lower disturbance is forced one sidedly by a preexisting upper disturbance initially, but in turn forces the latter once the former attains a sufficient amplitude, thus resulting in mutual reinforcement. Second, if a weak perturbation exists at the surface ahead of the preexisting strong upper disturbance, baroclinic instability is triggered when the two waves interact. Even though the amplitude of the lower disturbance is initially much weaker, it is intensified quickly and catches up with the amplitude of the upper disturbance, so that the coupled vertical structure resembles that of an unstable normal mode eventually. These results describe the observed behavior in Type B atmospheric cyclogenesis quite well.

  19. En Bloc Resection of Solitary Functional Secreting Spinal Metastasis.

    Goodwin, C Rory; Clarke, Michelle J; Gokaslan, Ziya L; Fisher, Charles; Laufer, Ilya; Weber, Michael H; Sciubba, Daniel M


    Study Design Literature review. Objective Functional secretory tumors metastatic to the spine can secrete hormones, growth factors, peptides, and/or molecules into the systemic circulation that cause distinct syndromes, clinically symptomatic effects, and/or additional morbidity and mortality. En bloc resection has a limited role in metastatic spine disease due to the current paradigm that systemic burden usually determines morbidity and mortality. Our objective is to review the literature for studies focused on en bloc resection of functionally active spinal metastasis as the primary indication. Methods A review of the PubMed literature was performed to identify studies focused on functional secreting metastatic tumors to the spinal column. We identified five cases of patients undergoing en bloc resection of spinal metastases from functional secreting tumors. Results The primary histologies of these spinal metastases were pheochromocytoma, carcinoid tumor, choriocarcinoma, and a fibroblast growth factor 23-secreting phosphaturic mesenchymal tumor. Although studies of en bloc resection for these rare tumor subtypes are confined to case reports, this surgical treatment option resulted in metabolic cures and decreased clinical symptoms postoperatively for patients diagnosed with solitary functional secretory spinal metastasis. Conclusion Although the ability to formulate comprehensive conclusions is limited, case reports demonstrate that en bloc resection may be considered as a potential surgical option for the treatment of patients diagnosed with solitary functional secretory spinal metastatic tumors. Future prospective investigations into clinical outcomes should be conducted comparing intralesional resection and en bloc resection for patients diagnosed with solitary functional secretory spinal metastasis.



    SOLITARY PARAGANGLIOMA OF THE HYPOGLOSSAL NERVE:: Case Report BACKGROUND AND IMPORTANCE:: We report the case history of solitary hypoglossal paraganglioma in a 64-year-old woman. The surgical difficulties encountered in the removal of this challenging tumour are discussed with literature review. CLINICAL PRESENTATION:: A 64-year-old woman presented with a short history of dysphonia, occasional dysphagia, tinnitus, altered taste, and unilateral left sided tongue wasting. On examination there was left lower motor hypoglossal paralysis. Imaging showed a discrete enhancing lobulated mass, measuring 2cm x 2cm, in the region of the hypoglossal nerve extending into the hypoglossal canal suggestive of hypoglossal paraganglioma. A left dorsolateral sub occipital craniotomy was carried out in the sitting position. The hypoglossal nerve appeared to be enlarged and the jugular foramen was normal. Complete surgical debulking of the tumour was not attempted due to its vascular nature. The nerve was decompressed and neuropathology confirmed a low grade paraganglioma arising from the hypoglossal nerve. The patient is scheduled to receive stereotactic radiation for further management. CONCLUSION:: When a case of solitary hypoglossal paraganglioma is encountered in clinical practice, the aim of management should be mainly focussed on achieving a diagnosis and preserving the hypoglossal nerve function. If there is evidence of vascularity in the lesion noted in the MRI scan, a pre-operative angiogram should be performed with a view for embolisation.We decompressed the hypoglossal canal and achieved a good improvement in the patient\\'s symptoms. We recommend stereotactic radiosurgery for remnant and small hypoglossal tumours and regular follow up with MRI scans.


    Raza, Kazim


    SOLITARY PARAGANGLIOMA OF THE HYPOGLOSSAL NERVE:: Case Report BACKGROUND AND IMPORTANCE:: We report the case history of solitary hypoglossal paraganglioma in a 64-year-old woman. The surgical difficulties encountered in the removal of this challenging tumour are discussed with literature review. CLINICAL PRESENTATION:: A 64-year-old woman presented with a short history of dysphonia, occasional dysphagia, tinnitus, altered taste, and unilateral left sided tongue wasting. On examination there was left lower motor hypoglossal paralysis. Imaging showed a discrete enhancing lobulated mass, measuring 2cm x 2cm, in the region of the hypoglossal nerve extending into the hypoglossal canal suggestive of hypoglossal paraganglioma. A left dorsolateral sub occipital craniotomy was carried out in the sitting position. The hypoglossal nerve appeared to be enlarged and the jugular foramen was normal. Complete surgical debulking of the tumour was not attempted due to its vascular nature. The nerve was decompressed and neuropathology confirmed a low grade paraganglioma arising from the hypoglossal nerve. The patient is scheduled to receive stereotactic radiation for further management. CONCLUSION:: When a case of solitary hypoglossal paraganglioma is encountered in clinical practice, the aim of management should be mainly focussed on achieving a diagnosis and preserving the hypoglossal nerve function. If there is evidence of vascularity in the lesion noted in the MRI scan, a pre-operative angiogram should be performed with a view for embolisation.We decompressed the hypoglossal canal and achieved a good improvement in the patient\\'s symptoms. We recommend stereotactic radiosurgery for remnant and small hypoglossal tumours and regular follow up with MRI scans.

  2. Research on consistency of identifying solitary pulmonary masses with CT

    Qiuping Wang; Gang Niu; Yun Zhang; Yongqian Qiang; Zicheng Li; Youmin Guo


    Objective:To research on consistency of identifying solitary pulmonary masses with CT.Methods:Three observers with different working backgrounds in imaging diagnosis individually interpreted the same group images of solitary pulmonary mass, by 12 indexes of objective signs.The differences in interpretation resulted in ante- and post-interpretations were assessed by the x2 test.The agreement of two interpretations from the same observer was confirmed with the kappa test.A double-blind method was adopted for analysis.Results:The agreement rates of ante- and post-interpreting from the three observers were respectively 82.65%(486/588) 80.27%(472/588) and 84.86% (499/588) while their interpreting results were generally accordant without significant difference(x2 = 4.975, df= 2,P = 0.083) however there was difference between the observer 2 and observer 3(x2 = 4.875, df= 1, P = 0.027).There were five indexes with k > 0.40 of ante- and post-interpreting results of the three observers, including clarity of nodule borderline, presence of sentus, uniformity of density, existence of cavity and calcification in pathological region, among them, the agreement rate of interpreting borderline and cavity was higher(k > 0.07); the blood vessel convergence poorer(0 < k ≤ 0.40); the other six CT signs of interpretation were slightly different.Conclusion:The ability to identify solitary pulmonary mass was inconsistent, and needs to be improved further.

  3. Breathing solitary-pulse pairs in a linearly coupled system

    Dana, Brenda; Bahabad, Alon


    It is shown that pairs of solitary pulses (SPs) in a linearly-coupled system with opposite group-velocity dispersions form robust breathing bound states. The system can be realized by temporal-modulation coupling of SPs with different carrier frequencies propagating in the same medium, or by coupling of SPs in a dual-core waveguide. Broad SP pairs are produced in a virtually exact form by means of the variational approximation. Strong nonlinearity tends to destroy the periodic evolution of the SP pairs.

  4. Blastomycosis presenting as solitary nodule: A rare presentation

    Ashish Dhamija


    Full Text Available Blastomycosis is a chronic granulomatous and suppurative mycosis, caused by Blastomyces dermatitidis, which in the great majority of cases presents as a primary pulmonary disease. Primary cutaneous blastomycosis is very rare. We present a 57-year-old female patient with a solitary, slowly progressive nodule over upper lip of 2½ months duration. Initially, differential diagnosis of cutaneous leishmaniasis, pyoderma and deep mycoses were entertained. Slit smear preparation was suspicious of deep mycotic infection which was subsequently confirmed by biopsy and culture.

  5. Solitary Fibrous Tumor in Bladder:A Case Report

    王涛; 陈瑞宝; 乔建坤; 胡涛; 刘继红; 杨为民; 叶章群


    Solitary fibrous tumor(SFT) in bladder is extremely rare.In this study,we reported one case of bladder SFT and reviewed the only ten cases of the disease that had been reported so far.The patient suffered from residual urine sensation and urethral pain.Cystoscopy revealed a 7-cm protruding mass at the dome of the bladder,and bladder mucosa biopsy showed normal differentiation of the bladder mucosa with a small amount of inflammatory cells.Radical resection of the tumor was performed in this patient.Patholog...

  6. Coherent structures in wave boundary layers. Part 2. Solitary motion

    Sumer, B. Mutlu; Jensen, Palle Martin; Sørensen, Lone B.;


    in an oscillating water tunnel. Two kinds of measurements were made: bed shear stress measurements and velocity measurements. The experiments show that the solitary-motion boundary layer experiences three kinds of flow regimes as the Reynolds number is increased: (i) laminar regime; (ii) laminar regime where...... the boundary-layer flow experiences a regular array of vortex tubes near the bed over a short period of time during the deceleration stage; and (iii) transitional regime characterized with turbulent spots, revealed by single/multiple, or, sometimes, quite dense spikes in the bed shear stress traces...

  7. A case report of reactive solitary eccrine syringofibroadenoma

    Tiwary, Anup K.; Firdous, J.; Mishra, Dharmendra K.; Chaudhary, Shyam S.


    Eccrine syringofibroadenoma is a very rare benign tumour of acrosyringium of eccrine sweat duct. Based on the evidences of known etiological factors, two forms have been proposed; reactive and nonreactive. Reactive forms are rarer, and on even rarer occasions, trauma complicated by secondary nonspecific infections may lead to the development of reactive eccrine syringofibroadenoma, as in our case. Here, we are documenting a case of reactive solitary eccrine syringofibroadenoma in a 65-year-old male presenting with coalescing, firm, pinkish, verrucous nodules and painful deep ulceration on the right sole preceded by trauma and secondary infection. Histopathologic revelation of distinctive microscopic findings confirmed the diagnosis in our case. PMID:28217470

  8. Metastatic melanoma mimicking solitary fibrous tumor: report of two cases.

    Bekers, Elise M; van Engen-van Grunsven, Adriana C H; Groenen, Patricia J T A; Westdorp, Harm; Koornstra, Rutger H T; Bonenkamp, Johannes J; Flucke, Uta; Blokx, Willeke A M


    Malignant melanomas are known for their remarkable morphological variation and aberrant immunophenotype with loss of lineage-specific markers, especially in recurrences and metastases. Hot spot mutations in BRAF, NRAS, GNAQ, and GNA11 and mutations in KIT are oncogenic events in melanomas. Therefore, genotyping can be a useful ancillary diagnostic tool. We present one case each of recurrent and metastatic melanoma, both showing histological and immunohistochemical features of solitary fibrous tumor (SFT). Mutational analysis detected BRAF and NRAS mutations in the primary and secondary lesions, respectively. This result confirmed the diagnosis of recurrent/metastastic melanoma.

  9. Experiments and computation of onshore breaking solitary waves

    Jensen, A.; Mayer, Stefan; Pedersen, G.K.


    This is a combined experimental and computational study of solitary waves that break on-shore. Velocities and accelerations are measured by a two-camera PIV technique and compared to theoretical values from an Euler model with a VOF method for the free surface. In particular, the dynamics of a so......-called collapsing breaker is scrutinized and the closure between the breaker and the beach is found to be akin to slamming. To the knowledge of the authors, no velocity measurements for this kind of breaker have been previously reported....

  10. [A solitary neurofibroma in the parotid gland from nervus vagus].

    Fagö-Olsen, Helena Anna; Hahn, Christoffer Holst


    A 37-year-old male, without stigmata of neurofibromatosis type 1, developed a firm mass below the right ear over several months without facial palsy. Clinical examination and ultra-sonography revealed a tumour in the parotid gland. Fine needle aspirationbiopsy was inconclusive. During complete resection, the tumour revealed an unusual anatomic location from the superficial lobe of the parotid to the deep and further into the parapharyngeal space. The pathological examination showed a solitary neurofibroma. In this case report, preoperative diagnosis, therapy and follow-up of this rare tumour in the parotid gland from n. vagus are discussed.


    LIU Zhi-fang; ZHANG Shan-yuan


    A new nonlinear wave equation of a finite deformation elastic circular rod simultaneously introducing transverse inertia and shearing strain was derived by means of Hamilton principle. The nonlinear equation includes two nonlinear terms caused by finite deformation and double geometric dispersion effects caused by transverse inertia and transverse shearing strain. Nonlinear wave equation and corresponding truncated nonlinear wave equation were solved by the hyperbolic secant function finite expansion method. The solitary wave solutions of these nonlinear equations were obtained. The necessary condition of these solutions existence was given also.

  12. Flow and sediment transport induced by a plunging solitary wave

    Sumer, B. Mutlu; Sen, M.Berke; Karagali, Ioanna


    , and for observation of the morphological changes. The two experimental conditions were maintained as similar as possible. The experiments showed that the complete sequence of the plunging solitary wave involves the following processes: Shoaling and wave breaking; Runup; Rundown and hydraulic jump; and Trailing wave...... affected, by as much as a factor of 2, in the runup and hydraulic jump stages. The pore-water pressure measurements showed that the sediment at (or near) the surface of the bed experiences upward-directed pressure gradient forces during the downrush phase. The magnitude of this force can reach values...

  13. Solitary fibrous tumor arising in an intrathoracic goiter

    Larsen, Stine Rosenkilde; Godballe, Christian; Krogdahl, Annelise


    . CONCLUSION: The histological appearance and immunohistochemical reaction pattern of SFT is characteristic. The entity should be considered when dealing with a spindle cell lesion in the thyroid gland. All cases of this site of origin reported have had a benign clinical course. As only a small number of cases......BACKGROUND: Solitary fibrous tumor (SFT) is a rare spindle cell tumor most often found in the mediastinal pleura. Nineteen cases of SFT arising in the thyroid gland have been reported. We report a case of SFT of the thyroid gland with immunohistochemical and cytogenetic investigation. SUMMARY: A 58...

  14. Solitary fibrous tumor of the orbit presenting in pregnancy

    Das Jayanta


    Full Text Available A 32-year-old woman, three months pregnant, reported with the complaint of protrusion of the right eye for six months. She gave history of rapid protrusion of eyeball for the last two months along with the history of double vision for the last one month. Computer tomography (CT scan revealed a well-defined mass lesion in the intraconal space of the right orbit which was excised through a lateral orbitotomy approach. Histological examination and immunohistochemistry revealed a solitary fibrous tumor, which showed a rapid progression in pregnancy.

  15. Effect of beraprost sodium (BPS) in a new rat partial unilateral ureteral obstruction model.

    Takenaka, Masahiko; Machida, Noboru; Ida, Nobutaka; Satoh, Nahoko; Kurumatani, Hajimu; Yamane, Yoshihisa


    Unilateral ureteral obstruction (UUO) is a representative model for investigating the common mechanism of decreasing renal function in chronic renal failure. In this study, we present a new partial UUO model in adult rats and evaluated the effect of beraprost sodium (BPS: stable prostaglandin I(2) (PGI(2)) analog). We could make reproductive and uniform partial UUO by ligating the left ureter together with a 0.5 mm diameter stainless steel wire with nylon thread, and withdrawing the stainless wire. One week later, the ureteral obstruction was released. After 3 weeks from the release of UUO, all animals of control group, without BPS administration, developed basophilic degeneration of tubular epithelium, tubular dilatation and interstitial fibrosis. The areas of tubular degeneration and fibrosis were significantly reduced in the BPS group, orally administered BPS 300 microg/kg twice a day from the next day of the release of obstruction, than in control group. In conclusion, we can established the adult rat partial UUO-release model and revealed that BPS can inhibit renal tubular damage and tubulointerstitial fibrosis.

  16. Cost-effective analysis of pneumatic and laser lithotripsy techniques in ureteral stones

    Mehmet Bilgehan Yüksel


    Full Text Available Objective: Ureteroscopic lithotripsy (URSL is a commontreatment alternative in ureteral stones. We aimedto evaluate pneumatic and laser lithotripsy techniques,which are used for fragmentation of stones.Materials and methods: The data of 100 patients whounderwent URSL by using pneumatic and laser lithotriptorswere analyzed. The sample divided in 2 groups, eachincluding 50 patients. URSL was performed in lithotomyposition under general anesthesia. The absence of residualstone at second week urinary system graphy wasaccepted as the criteria of success. We evaluated thepresence of differences in terms of efficiency and costeffectivityof pneumatic and laser lithotripsy techniques.Results: The mean ages were 42 and 45 years, respectively.The mean operation time was 43.1 min in pneumaticgroup and 40 min in laser group. Stone-free rates werefound 93.9% and 78%, respectively. The stone migrationrate was determined 16% in pneumatic group and 4.1% inlaser group. Complication rates were 4.1% in pneumaticgroup and 8% in laser group. The cost analysis showedthat pneumatic lithotriptor device cost 10000 TL and laserlithotriptor system cost 76000 TL. Nevertheless, the SocialSecurity Administration paid the same cost for bothlithotripsy techniques.Conclusion: Higher stone-free and lower stone migrationrates were determined in laser lithotripsy application.Therefore, low incidence of the requirement of subsequentsecondary treatments for residual stones in lasertreatment decreased the treatment costs. Nevertheless,the cost is significantly higher in laser technique. It requiresmore detailed studies.Key words: Ureteral stone, ureteroscopy, lithotripsy, efficiency,cost

  17. Management of Ureteric Calculi in Dhule City of North-western Maharashtra

    Lokesh Patni


    Full Text Available Background: Urolithiasis, usually affecting people in the prime of life, causes significant morbidity and loss of productivity. Uretericstones account for 2/3rd of all urinary calculi brought to attention of doctors. The damaging effects of the calculi may result in obstruction with dilatation of the urinary tract, leading to stasis and severe infection. Aims and Objectives: To evaluate patients with urinary stones with regards to the incidence, age, sex,clinical presentation, site, size, side, management and their complications. Material and Methods:It was a prospective study carried out by Department of Surgery at Annasaheb Chudaman Patil Memorial Medical College, and Hospital Dhule for a period of two years. Patients were selected after they were diagnosed as having ureteric calculi. The patients were treated by conservative or surgical methods, and the outcome was monitored. Statistical analysis of the data was done for obtaining results.Result: The majority of the patients were males with peak age group in the second and third decade. Pain in abdomen or loin tenderness was the most common presenting symptom. Most of the patients were treated by conservative medical management. Endourological procedures were the most commonly performed surgical intervention. Conclusion: Most of the patients with ureteric calculi present with painin abdomen and majority can be treated by medical management. With the availability of better facilities the requirement for open surgery is decreasing and endourological procedures are becoming the means of surgical intervention.Complications are minimal with surgical expertise for endourological procedures.

  18. [Tubeless cutaneous ureterostomy through a single stoma with new extraperitoneal ureteral route up to stoma].

    Ishizuka, E; Iwasaki, A; Oogo, Y; Ueki, T; Sawada, T


    Tubeless cutaneous ureterostomy through a single stoma has been said to be difficult to establish in patients with normal ureters or normal ureters combined with thick fatty abdominal wall, because of the poor blood supply at the end of the ureters. The technical improvements observed were as follows: 1) The peritoneal fold and the upward traction of the gonadal vessels decrease the ureteral tension and keep the blood supply to the ureters in the extraperitoneal approach. 2) The gonadal vessels and its surrounding tissue, covering the subcutaneous fatty tissue, help the ureteral adhesion at the anastomotic site. 3) Full diminution of the skin defect caused by flap formation, decreases the horizontal tension of the side-to-side anastomized ureters. Sixteen patients with normal ureters underwent this procedure. In a short-term (4-37 months) observation, 4 of the patients, including one with thick abdominal fat, showed unilateral hydronephrosis and 2 patients unilateral non-function kidney. The remaining 10 patients had no complications. Moreover, all the patients have kept their ureterostomies tubeless and their serum blood urea nitrogen and creatinine levels were within normal limits except for one patient. It is reasonably concluded that the new method will result in success clinically even in patients with normal ureters and thick abdominal fatty tissue.

  19. A mathematical model for the induction of the mammalian ureteric bud.

    Lawson, Brodie A J; Flegg, Mark B


    Congenital abnormalities of the kidney and urinary tract collectively form the most common type of prenatally diagnosed malformations. Whilst many of the crucial genes that direct the kidney developmental program are known, the mechanisms by which kidney organogenesis is achieved is still largely unclear. In this paper, we propose a mathematical model for the localisation of the ureteric bud, the precursor to the ureter and collecting duct system of the kidney. The mathematical model presented fundamentally implicates Schnakenberg-like ligand-receptor Turing patterning as the mechanism by which the ureteric bud is localised on the Wolfian duct as proposed by Menshykaul and Iber (2013). This model explores the specific roles of regulatory proteins GREM1 and BMP as well as the domain properties of GDNF production. Our model demonstrates that this proposed pattern formation mechanism is capable of naturally predicting the phenotypical outcomes of many genetic experiments from the literature. Furthermore, we conclude that whilst BMP inhibits GDNF away from the budding site and GREM1 permits GDNF to signal, GREM1 also stabilises the effect of BMP on GDNF signalling from fluctuations in BMP sensitivity but not signal strength.

  20. [Ureterorenoscopy (URS) in treatment of ureteral calculi. II. Ureteroscopic treatment of calculus debris after ESWL].

    Fernandez De la Maza, S; Noldus, J; Huland, H


    We were interested in the efficacy and morbidity of the ureteroscopy (URS) in the treatment of "steinstrasse" after ESWL. From 1991 to 1996, 27 patients with "steinstrasse" were treated with a total of 32 ureteroscopic procedures. The URS alone had a stonefree success rate of 43.7% (n = 14). URS combined with ESWL was effective in 43.7% (n = 14), leading to an overall success rate of 87.4%. In 4 cases (12.6%) a second therapy was necessary (in 3 cases a second URS + ESWL and in one patient a nephrectomy due to septic pyonephrosis. The overall rate of auxiliary ESWL after URS was 53.1%. Mean operating time was 72 minutes (20-180 min). The rate of complications was 21.8% (n = 7) and mainly due to ureteral perforations or postoperative fever but none suffered from late complications like ureteral stricture. All treated patients received a double-J-stent and antibiotics. The treatment of "steinstrasse" in the middle portion of the ureter proved to be more difficult due to the anatomical position of the ureter and lasted in a longer operating time as the upper or distal "steinstrasse". The stone extraction and the lithoclast-lithotripsy alone or in combination were the most frequent used ureteroscopic procedures to eliminate stone fragments. The URS alone or in combination with the ESWL for the treatment of "steinstrasse" is a highly effective and safe approach.

  1. Application of Skin Electrical Conductance of Acupuncture Meridians for Ureteral Calculus: A Case Report

    Wu-Chou Lin


    Full Text Available Renal colic is a common condition seen in the emergency department (ED. Our recent study showed that measures of electrical conductance may be used as supplementary diagnostic methods for patients with acute renal colic. Here, we describe the case of a 30-year-old male subject with a left ureteral calculus who presented with frequency and normal-looking urine. He had already visited the outpatient department, but in vain. Normal urinalysis and nonobstructive urogram were reported at that time. Two days later, he was admitted to the ED because of abdominal pain in the left lower quadrant. The urinalysis did not detect red blood cells. Ultrasonography did not indicate hydronephrosis. The meridian electrical conductance and index of sympathovagal balance were found to be abnormal. High level of electrical conductance on the left bladder meridian was found. An unenhanced helical computed tomography was scheduled to reveal a left ureterovesical stone. Ureteroscopic intervention was later uneventfully performed, and the patient's pain was relieved. The follow-up measurements showed that the meridian parameters had returned to normal one month after treatment. This case suggests that bladder meridian electrical conductance might be used as a supplemental method for ureteral calculus diagnosis.

  2. Metformin prevents renal interstitial fibrosis in mice with unilateral ureteral obstruction.

    Cavaglieri, Rita C; Day, Robert T; Feliers, Denis; Abboud, Hanna E


    Unilateral ureteral obstruction causes important tubulo-interstitial fibrosis in the kidney. Metformin reduces fibrosis in mice with diabetic nephropathy. We examined the effects of metformin in a mouse model of unilateral ureteral obstruction (UUO). Expression of inflammation and fibrosis markers was studied by immunohistochemistry, immunoblot and quantitative real-time polymerase chain reaction. Seven days after UUO, kidneys presented dilated tubules, expansion of the tubulo-interstitial compartment, and significant infiltration of inflammatory cells. Macrophage infiltration and inflammation markers expression were increased in obstructed kidneys and reduced by metformin. Metformin reduced expression of extracellular matrix proteins and profibrotic factor TGFβ in obstructed kidneys, measured by immunohistochemistry. Interstitial fibroblast activation was evident in obstructed kidneys and ameliorated by metformin. UUO did not affect adenosine monophosphate-activated kinase (AMPK) activity, but metformin activated AMPK. Our results show that metformin prevents or slows down the onset of renal inflammation and fibrosis in mice with UUO, an effect that could be mediated by activation of AMPK.

  3. Circumcaval Ureter with Vesico Ureteral Reflux: The First Association in Literature

    Ilhan Ciftci


    Full Text Available A circumcaval ureter is a rare congenital anomaly in which the ureter passes behind, and is compressed by, the inferior vena cava. Its etiology is assumed to be abnormal embryologic development of the inferior vena cava as a result of atrophy failure of the right subcardinal vein in the lumbar portion. A circumcaval ureter is also termed a retrocaval ureter. The right supracardinal system fails to develop, whereas the right posterior cardinal vein persists. With one reported exception, the anomaly always occurs on the right side. Patients with this anomaly may develop partial right ureteral obstruction or recurrent urinary tract infections. Therapeutic options include surgical relocation of the ureter anterior to the cava. A 14-year-old female patient came with complaints of fever, intermittent colic and dysuria 4 years ago. A right ureteric fourth-grade VUR and circumcaval ureter were established. An anomaly in which both of these are together could not be found in literature. If after the VUR treatment he has progressive abdomen pain and advancing hydronephrosis, a circumcaval ureter as an additive anomaly must not be forgotten. For that reason, in a patient having a urinary system anomaly, a likely extra anomaly should be searched. [Arch Clin Exp Surg 2012; 1(3.000: 191-194

  4. A new approach in ureteral access sheath locating in retrograde intrarenal surgery (RIRS by endovisional technique

    Mehmet Giray Sönmez


    Full Text Available Objective: To compare the results of patients who underwent retrograde intrarenal surgery (RIRS using endovisional technique for ureteral sheat locating with control group in which endovisional technique was not applied. Material and Methods: Of the 41 patients who underwent RIRS treatment for kidney stone, between March 2014- August 2015, 19 patients treated with endovisional technique formed the study group and remaining 22 patients formed the control group. Patients were evaluated for age and gender, baseline and post procedural creatinine level, duration of operation, fluoroscopy and hospitalization time, size and localization of the stone, presence of multiple stones, previous shock wave lithotripsy (SWL procedure, double J catheter requirement, complication rate, residual stone rate and absence of stone ratio. Results: There was no statistically significant difference between age, gender, location of the stone, previous SWL procedure, presence of multiple stones, baseline and postprocedural creatinine level, absence of stone ratio, double J catheter requirement and hospitalization duration between the groups. The duration of operation and fluoroscopy of the patients were significantly shorter than the control group (p = 0.036 and p < 0.001, respectively. The complication rates of the endovisional technique group was significantly lower than that of the control group (p = 0.032. Conclusion: Endovisional technique is considered to be an appropriate and useful technique in order to locate the sheath safely in patients who has difficulty in ureteral access sheath locating and to decrease the duration of operation and fluoroscopy.

  5. Anti-Fibrotic Effect of Natural Toxin Bee Venom on Animal Model of Unilateral Ureteral Obstruction

    Hyun Jin An


    Full Text Available Progressive renal fibrosis is the final common pathway for all kidney diseases leading to chronic renal failure. Bee venom (BV has been widely used as a traditional medicine for various diseases. However, the precise mechanism of BV in ameliorating the renal fibrosis is not fully understood. To investigate the therapeutic effects of BV against unilateral ureteral obstruction (UUO-induced renal fibrosis, BV was given intraperitoneally after ureteral ligation. At seven days after UUO surgery, the kidney tissues were collected for protein analysis and histologic examination. Histological observation revealed that UUO induced a considerable increase in the number of infiltrated inflammatory cells. However, BV treatment markedly reduced these reactions compared with untreated UUO mice. The expression levels of TNF-α and IL-1β were significantly reduced in BV treated mice compared with UUO mice. In addition, treatment with BV significantly inhibited TGF-β1 and fibronectin expression in UUO mice. Moreover, the expression of α-SMA was markedly withdrawn after treatment with BV. These findings suggest that BV attenuates renal fibrosis and reduces inflammatory responses by suppression of multiple growth factor-mediated pro-fibrotic genes. In conclusion, BV may be a useful therapeutic agent for the prevention of fibrosis that characterizes progression of chronic kidney disease.

  6. Allium stent for the treatment of a malignant ureteral stenosis: a paradigmatic case.

    Oderda, Marco; Lacquaniti, Sergio; Fasolis, Giuseppe


    The aim of this study was to present a paradigmatic case where the new-generation Allium URS stent was the optimal choice to treat a malignant ureteral stenosis. We describe in detail all the steps of our surgery, performed on a 69-year-old patient with left hydronephrosis caused by lumbo-aortic nodal metastases compressing the ureter. The patient was intolerant to double-J stent due to strong irritative urinary symptoms. Allium URS stent was positioned under fluoroscopy in replacement of pre-existing double-J stent. Our approach was successful and irritative urinary symptoms disappeared. At 6 months, the Allium URS was correctly positioned and no hydronephrosis was detected on ultrasound. The stent can be left in place for a maximum of 3 years. In complicated scenarios of chronic ureteral stenosis, the new-generation Allium URS can be an interesting option to treat the obstruction while sparing the patient the irritative urinary symptoms and periodic replacements typical of a double-J stent.

  7. Diagnosis of acute flank pain caused by ureteral stones: value of combined direct and indirect signs on IVU and unenhanced helical CT

    Wang, Li-Jen; Wong, Yon-Cheong [Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing St., Gueishan, 33333, Taipei (Taiwan); Ng, Chip-Jin; Chen, Jih-Chang; Chiu, Te-Fa [Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing St., Gueishan, 33333, Taipei (Taiwan)


    The aim of this study was to assess the usefulness of combined direct and indirect signs on intravenous urography (IVU) and unenhanced helical computed tomography (UHCT) for the diagnosis of ureteral stones in emergency patients with acute flank pain. During an 8-month period, 82 emergency patients with acute flank pain undergoing IVU and UHCT with sufficient clinical follow-up formed the study group. The presence or absence of direct sign (visualization of ureteral stones) and indirect signs on IVU and UHCT was recorded. The diagnostic accuracy of each direct/indirect sign and their combination for the diagnosis of ureteral stones on IVU and UHCT were analyzed and compared. Of the 82 patients, 66 had ureteral stones, four had passed urinary stones prior to imaging and 12 had other diseases. The diagnostic accuracies of direct signs on IVU and UHCT for the diagnosis of ureteral stones were 79.3 and 98.8%, respectively, which was more accurate than that of any single indirect sign on IVU and UHCT. However, the diagnostic accuracy of ureteral stones by IVU increased to 90.2% when using diagnostic criteria requiring the presence of a direct sign or at least three indirect signs, and by UHCT, it increased to 100% when using diagnostic criteria requiring the presence of a direct sign with at least one indirect sign. Therefore, for emergency patients with acute flank pain, the use of the above combinations of direct/indirect signs is useful as the diagnostic criterion for ureteral stones. (orig.)



    Using direct algebraic method,exact solitary wave solutions are performed for a class of third order nonlinear dispersive disipative partial differential equations. These solutions are obtained under certain conditions for the relationship between the coefficients of the equation. The exact solitary waves of this class are rational functions of real exponentials of kink-type solutions.

  9. Laboratory Generation of Solitary Waves:An Inversion Technique to Improve Available Methods

    A.Romano; M.Guerrini; G.Bellotti; 琚烈红


    Solitary waves are often used in laboratory experiments to study tsunamis propagation and interaction with coasts. However, the experimental shape of the waves may differ from the theoretical one. In this paper, a correction technique aiming at minimizing the discrepancies between the two profiles is presented. Laboratory experiments reveal their effectiveness in correcting the experimental shape of solitary waves, mainly for low nonlinearities.

  10. Solitary Solution of Discrete mKdV Equation by Homotopy Analysis Method

    XU Xi-Xiang; WANG Zhen; YANG Hong-Xiang; ZOU Li; LU Rong-Wu; ZHANG Hong-Qing


    In this paper, we apply homotopy analysis method to solve discrete mKdV equation and successfully obtain the bell-shaped solitary solution to mKdV equation. Comparison between our solution and the exact solution shows that homotopy analysis method is effective and validity in solving hybrid nonlinear problems, including solitary solution of difference-differential equation.

  11. Large Amplitude Solitary Waves in a Fluid-Filled Elastic Tube



    By usign the potential method to a fluid filled elastic tube, we obtained a solitary wave solution.Compared with recluetive perturbation method, this method can be used for larger amplitude solitary waves. The result is in agreement with that of small amplitude approximation from reduetive perturbation method when the amplitude is small enough.

  12. Large Amplitude Solitary Waves in a Fluid-Filled Elastic Tube

    DUAN Wen-Shan


    By using the potential method to a fluid filled elastic tube, we obtained a solitary wave solution. Comparedwith reductive perturbation method, this method can be used for larger amplitude solitary waves. The result is inagreement with that of small amplitude approximation from reductive perturbation method when the amplitude is smallenough.

  13. Solitary cysticercosis of the biceps brachii in a vegetarian: a rare and unusual pseudotumor

    Abdelwahab, Ibrahim Fikry [Department of Radiology, New York Methodist Hospital Affiliated with Weill Medical College of Cornell University, 506 Sixth Street, Brooklyn, NY 11215 (United States); Klein, Michael J. [Department of Pathology, Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029 (United States); Hermann, George [Department of Radiology, Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029 (United States); Abdul-Quader, Mohammed [Department of Radiology, Columbia Presbyterian Medical Center, 177 Fort Washington Avenue, New York, NY 10032 (United States)


    We report a 40-year-old man with cysticercosis presenting as a solitary tumor in the biceps brachii muscle. Physical examination revealed an intramuscular mass and magnetic resonance imaging suggested a cyst. The histologic diagnosis was a cysticercus. Such solitary presentation of muscular cysticercosis is extremely rare with only a handful of sporadic reports in the literature. (orig.)

  14. A double optical solitary wave in a nonlinear Schr(o)dinger-type equation

    Yin Jiu-Li; Ding Shan-Yu


    A qualitative analysis method to efficiently solve the shallow wave equations is improved,so that a more complicated nonlinear Schr(o)dinger equation can be considered.By using the detailed study,some quite strange optical solitary waves are obtained in which the bright and dark optical solitary waves are allowed to coexist.

  15. Solitary Wave Generation from Constant Continuous Wave in Asymmetric Oppositely Directed Waveguide Coupler

    Kazantseva E.V.


    Full Text Available In a model which describes asymmetric oppositely directed nonlinear coupler it was observed in numerical simulations a phenomenon of solitary wave generation from the input constant continuous wave set at the entrance of a waveguide with negative refraction. The period of solitary wave formation decreases with increase of the continuum wave amplitude.

  16. Vlasov Simulation of Electrostatic Solitary Structures in Multi-Component Plasmas

    Umeda, Takayuki; Ashour-Abdalla, Maha; Pickett, Jolene S.; Goldstein, Melvyn L.


    Electrostatic solitary structures have been observed in the Earth's magnetosheath by the Cluster spacecraft. Recent theoretical work has suggested that these solitary structures are modeled by electron acoustic solitary waves existing in a four-component plasma system consisting of core electrons, two counter-streaming electron beams, and one species of background ions. In this paper, the excitation of electron acoustic waves and the formation of solitary structures are studied by means of a one-dimensional electrostatic Vlasov simulation. The present result first shows that either electron acoustic solitary waves with negative potential or electron phase-space holes with positive potential are excited in four-component plasma systems. However, these electrostatic solitary structures have longer duration times and higher wave amplitudes than the solitary structures observed in the magnetosheath. The result indicates that a high-speed and small free energy source may be needed as a fifth component. An additional simulation of a five-component plasma consisting of a stable four-component plasma and a weak electron beam shows the generation of small and fast electron phase-space holes by the bump-on-tail instability. The physical properties of the small and fast electron phase-space holes are very similar to those obtained by the previous theoretical analysis. The amplitude and duration time of solitary structures in the simulation are also in agreement with the Cluster observation.

  17. Solitary extramedullary plasmacytoma in retroperitoneum: A case report and review of the literature

    Wei Hong; Xin-Min Yu; Ming-Qiang Jiang; Bo Chen; Xin-Bao Wang; Li-Tao Yang; Yi-Ping Zhang


    Extramedullary plasmacytoma (EPM) is a plasma cell tumor arising outside of the bone marrow. Solitary EMP is an uncommon neoplasm and rarely occurs in the retroperitoneum and lacks distinctive clinical manifestations. We report a 26-year-old man with a solitary EMP in the retroperitoneum and discuss its clinical features, diagnosis and treatment.

  18. Dispersal of solitary bees and bumblebees in a winter oilseed rape field

    Calabuig, Isabel


    Dispersal distributions of solitary bees and bumblebees were studied in a winter oilseed rape field. Window-traps were placed in the rape field along a line transect perpendicular to the field edge. 19 species of solitary bees were recorded and all but four species are polylectic, including...

  19. Differential Properties of Venom Peptides and Proteins in Solitary vs. Social Hunting Wasps

    Lee, Si Hyeock; Baek, Ji Hyeong; Yoon, Kyungjae Andrew


    The primary functions of venoms from solitary and social wasps are different. Whereas most solitary wasps sting their prey to paralyze and preserve it, without killing, as the provisions for their progeny, social wasps usually sting to defend their colonies from vertebrate predators. Such distinctive venom properties of solitary and social wasps suggest that the main venom components are likely to be different depending on the wasps’ sociality. The present paper reviews venom components and properties of the Aculeata hunting wasps, with a particular emphasis on the comparative aspects of venom compositions and properties between solitary and social wasps. Common components in both solitary and social wasp venoms include hyaluronidase, phospholipase A2, metalloendopeptidase, etc. Although it has been expected that more diverse bioactive components with the functions of prey inactivation and physiology manipulation are present in solitary wasps, available studies on venom compositions of solitary wasps are simply too scarce to generalize this notion. Nevertheless, some neurotoxic peptides (e.g., pompilidotoxin and dendrotoxin-like peptide) and proteins (e.g., insulin-like peptide binding protein) appear to be specific to solitary wasp venom. In contrast, several proteins, such as venom allergen 5 protein, venom acid phosphatase, and various phospholipases, appear to be relatively more specific to social wasp venom. Finally, putative functions of main venom components and their application are also discussed. PMID:26805885

  20. Stability of Solitary Waves for Three Coupled Long Wave - Short Wave Interaction Equations

    Borluk, H.; Erbay, S.


    In this paper we consider a three-component system of one dimensional long wave-short wave interaction equations. The system has two-parameter family of solitary wave solutions. We prove orbital stability of the solitary wave solutions using variational methods.

  1. Solitary central osteoma of mandible in a geriatric patient: Report and review

    Bhujbal, Ravi B.; Nayak, Ajay G.


    Solitary central osteomas of jaw are extremely rare lesions with only few previously documented cases. This paper reports a case of large solitary central osteoma involving mandible symphysis- parasymphysis region in an elderly female patient. A brief review of similar cases reported in the literature is also provided in this paper. Key words:Osteomas, osteogenic,bone, tumor, jaw, mandible. PMID:27034765

  2. Intramedullary Chondrosarcoma of Proximal Humerus

    Pratiksha Yadav


    Full Text Available Primary chondrosarcoma is the third most frequent primary malignancy of bone after myeloma and osteosarcoma. It is ranging from slow growing nonmetastasising lesions to highly aggressive lesions. We report a case of primary intramedullary chondrosarcoma of proximal humerus. A 60-year-old female presented with pain and hard swelling involving the left arm for 5 months. Radiograph showed a lucent expansile intramedullary lesion with matrix calcification and associated soft tissue mass. CT confirmed the finding. MRI showed a lobulated lesion which is hyperintense on T2WI with low signal fibrous septae. Increased tracer uptake was seen on bone scan. Histopathology confirmed the radiology diagnosis. The patient underwent wide resection and endoprosthetic reconstruction of proximal humerus.

  3. Proximate analysis for amazon biomass

    Oliveira, Antonio Geraldo de Paula; Feitosa Netto, Genesio Batista; Nogueira, Manoel Fernandes Martins; Coutinho, Manoel Fernandes Martins; Coutinho, Hebert Willian Martins; Rendeiro, Goncalo [Universidade Federal do Para (UFPA), Belem, PA (Brazil). Lab. de Engenharia Mecanica (LABGAS)], e-mail:, e-mail:, e-mail:


    In order to asses the potentiality of Amazon biomass to generate power, either to supply electric energy to the grid or as fuel to plants supplying power for off-grid location, data for their proximate analysis must be available. A literature review on the subject indicated a lack of information and data concerning typical Amazon rain forest species. This work aimed to characterize (proximate analysis) 80 Amazon species in order to evaluate the energy resource from woody biomass wastes in Amazon region. Higher Heating Value, Carbon, Volatile and Ash contents were measured in a dry basis. The measurements were performed obeying the following Brazilian standards, NBR 6923, NBR 8112, NBR 8633, NBR 6922. (author)

  4. Management of urine leak after laparoscopic cyst decortication with retrograde endoscopic fibrin glue application and ureteral stent placement.

    Chen, Mang L; Tomaszewski, Jeffrey J; Matoka, Derek J; Ost, Michael C


    Urine leakage is an uncommon complication after renal cyst decortication that typically resolves with adequate drainage. With prolonged large volume urine leakage from a perinephric drain, however, consideration for open surgical repair must be taken into account. We present the successful management of persistent urine leakage after laparoscopic cyst decortication with endoscopic retrograde fibrin glue injection and ureteral stent placement.

  5. Is There Hope for Renal Growth on Imaging Studies Following Ureteral Reimplant for Boys With Fetal Hydronephrosis and Urinary Reflux?

    Ming-Hsien Wang


    Full Text Available Reflux nephropathy is thought to be the etiology for renal maldevelopment. We present two boys with fetal hydronephrosis and sterile vesicoureteral reflux (VUR. There was lack of renal growth of the refluxing renal units on surveillance renal ultrasound. Parents elected to undergo open ureteral reimplants. Post-surgical ultrasounds demonstrated improved renal growth.

  6. Hydronephrosis in the mouse: the effects of the short-ear gene, sex and ureteral vascular system.

    Wallace, M E


    The short-ear gene in the mouse, se, affects a number of soft tissues; skeletal effects result in reduced body cavities. A high incidence of hydronephrosis in short-ear genotypes has been ascribed to pressure on the lower ureter resulting from crowding of organs in the body cavity. This study concerns the ureteral vascular system as observed in 861 autopsies of mice of varying age, of the three short-ear genotypes, drawn from ten stocks. Incidence and expression of hydronephrosis is greater in short-ear males than in females, and the ratio between the two varies from one stock to another. This study seeks an explanation. Short-ear genotypes have an abnormally high incidence of unusual ureteral veins, hydronephrosis being strongly associated with the more posterior ones. Ureteraonadal and iliac veins. The spermatic vein's more posterior position, compared with the ovarian, is strongly correlated with the sex difference in posterior ureteral venation and thus with the sex difference in incidence of hydronephrosis. Stocks are compared according to the amount of selection for fitness of short-ear genotypes; there is a reduced incidence of hydronephrosis with selection, accompanied by fewer posterior ureteral veins. Age also affects hydronephrosis; its expression increases slightly with age, and the male sese progeny of young mothers appear to be particularly prone to hydronephrosis. Three skeletal mutants segregate; of these fidget, fi, causes a type of hydronephrosis differing somewhat from that caused by se.

  7. Linkage study of 14 candidate genes and loci in four large Dutch families with vesico-ureteral reflux

    Eerde, A.M. van; Koeleman, B.P.C.; Kamp, J.M. van de; Jong, T.P.V.M. de; Wijmenga, C.; Giltay, J.C.


    Vesico-ureteral reflux (VUR) is a major contributing factor to end-stage renal disease in paediatric patients. Primary VUR is a familial disorder, but little is known about its genetic causes. To investigate the involvement of 12 functional candidate genes and two reported loci in VUR, we performed

  8. Astragaloside IV Inhibits the Up-Regulation of Wnt/β-Catenin Signaling in Rats with Unilateral Ureteral Obstruction

    Li Wang


    Full Text Available Objective: To investigate the effect of Astragaloside IV (AS-IV on the regulation of the Wnt/β-catenin signaling pathway in rats with unilateral ureteral obstruction (UUO. Methods: Rat renal interstitial fibrosis models were prepared using unilateral ureteral ligation. Rats were randomly divided into sham group, sham group with AS-IV (33mg/kg, unilateral ureteral obstruction group, and unilateral ureteral obstruction group receiving varied doses of AS-IV (3.3, 10, and 33 mg/kg. Immunohistochemical analysis, real-time fluorescence quantitative PCR (FQ-PCR, and western blot were used to detect the expression of genes and proteins associated with the Wnt/β-catenin signaling pathway in renal tissues. Results: Levels of Wnt3, Wnt4, and Frizzled gene expression increased significantly in the UUO model; AS-IV was associated with the downregulation of the expression of Wnt3, Wnt4, Frizzled4, p-LRP5, p-LRP6, disheveled, β-catenin, LEF-1, TCF-1, Snail, Jagged 1, Twist, MMP2, and MMP7 proteins in a concentration-dependent manner, while the expression of APC, CK1, and E-cadherin was increased. Conclusions: AS-IV effectively inhibits the up-regulation of proteins in the Wnt/β-catenin signaling pathway in UUO-model rats, indicating its possible inhibitory effects on renal interstitial fibrosis.

  9. Oceanic pycnocline depth retrieval from SAR imagery in the existence of solitary internal waves


    Oceanic pycnocline depth is usually inferred from in situ measurements. It is attempted to estimate the depth remotely. As solitary internal waves occur on oceanic pycnocline and propagate along it, it is possible to retrieve the depth indirectly in virtue of the solitary internal waves. A numerical model is presented for retrieving the pycnocline depth from synthetic aperture radar (SAR) images where the solitary internal waves are visible and when ocean waters are fully stratified. This numerical model is constructed by combining the solitary internal wave model and a two-layer ocean model. It is also assumed that the observed groups of solitary internal wave packets on the SAR imagery are generated by local semidiurnal tides. A case study in the East China Sea shows a good agreement with in situ CTD (conductivity-temperature-depth) data.

  10. Electrostatic Korteweg-deVries solitary waves in a plasma with Kappa-distributed electrons

    Choi, C.-R.; Min, K.-W. [Department of Physics, Korea Advanced Institute of Science and Technology, Taejon 305-701 (Korea, Republic of); Rhee, T.-N. [National Fusion Research Institute, Daejeon 305-333 (Korea, Republic of)


    The Korteweg-deVries (KdV) equation that describes the evolution of nonlinear ion-acoustic solitary waves in plasmas with Kappa-distributed electrons is derived by using a reductive perturbation method in the small amplitude limit. We identified a dip-type (negative) electrostatic KdV solitary wave, in addition to the hump-type solution reported previously. The two types of solitary waves occupy different domains on the {kappa} (Kappa index)-V (propagation velocity) plane, separated by a curve corresponding to singular solutions with infinite amplitudes. For a given Kappa value, the dip-type solitary wave propagates faster than the hump-type. It was also found that the hump-type solitary waves cannot propagate faster than V = 1.32.

  11. Generation of internal solitary waves by frontally forced intrusions in geophysical flows.

    Bourgault, Daniel; Galbraith, Peter S; Chavanne, Cédric


    Internal solitary waves are hump-shaped, large-amplitude waves that are physically analogous to surface waves except that they propagate within the fluid, along density steps that typically characterize the layered vertical structure of lakes, oceans and the atmosphere. As do surface waves, internal solitary waves may overturn and break, and the process is thought to provide a globally significant source of turbulent mixing and energy dissipation. Although commonly observed in geophysical fluids, the origins of internal solitary waves remain unclear. Here we report a rarely observed natural case of the birth of internal solitary waves from a frontally forced interfacial gravity current intruding into a two-layer and vertically sheared background environment. The results of the analysis carried out suggest that fronts may represent additional and unexpected sources of internal solitary waves in regions of lakes, oceans and atmospheres that are dynamically similar to the situation examined here in the Saguenay Fjord, Canada.

  12. Fluorine-18 fluorodeoxyglucose positron emission tomography in the management of solitary pulmonary nodule: a review.

    Divisi, Duilio; Barone, Mirko; Zaccagna, Gino; Crisci, Roberto


    Solitary pulmonary nodules are common radiologic findings and their detection has increased due to the introduction and improvement of diagnostics. Since a nodule can be an expression of early lung cancers, a proper classification and management are required because its treatment might lead to decreased morbidity and mortality. In this regard, prominent guidelines are available although they are characterized sometimes by discordant and misleading evidences. Furthermore, the same results of studies in the literature appear conflicting. Aim of this work is to evaluate the role of imaging through an extensive literature review but focusing on 18-fluorine fluorodeoxyglucose positron emission tomography combined with computed tomography ((18)F-FDG-PET/CT) in order to assess the limits and future perspectives of solitary pulmonary nodule characterization in early detection of lung cancer. Key messages Detection of solitary pulmonary nodules has increased. Management of solitary pulmonary nodules is still debated. Future perspectives of early solitary pulmonary nodule characterization.

  13. Generation of internal solitary waves by frontally forced intrusions in geophysical flows

    Bourgault, Daniel; Galbraith, Peter S.; Chavanne, Cédric


    Internal solitary waves are hump-shaped, large-amplitude waves that are physically analogous to surface waves except that they propagate within the fluid, along density steps that typically characterize the layered vertical structure of lakes, oceans and the atmosphere. As do surface waves, internal solitary waves may overturn and break, and the process is thought to provide a globally significant source of turbulent mixing and energy dissipation. Although commonly observed in geophysical fluids, the origins of internal solitary waves remain unclear. Here we report a rarely observed natural case of the birth of internal solitary waves from a frontally forced interfacial gravity current intruding into a two-layer and vertically sheared background environment. The results of the analysis carried out suggest that fronts may represent additional and unexpected sources of internal solitary waves in regions of lakes, oceans and atmospheres that are dynamically similar to the situation examined here in the Saguenay Fjord, Canada.

  14. Plating of proximal humeral fractures.

    Martetschläger, Frank; Siebenlist, Sebastian; Weier, Michael; Sandmann, Gunther; Ahrens, Philipp; Braun, Karl; Elser, Florian; Stöckle, Ulrich; Freude, Thomas


    The optimal treatment for proximal humeral fractures is controversial. Few data exist concerning the influence of the surgical approach on the outcome. The purpose of this study was to evaluate the clinical and radiological outcomes of proximal humeral fractures treated with locking plate fixation through a deltopectoral vs an anterolateral deltoid-splitting approach. Of 86 patients who met the inclusion criteria, 70 were available for follow-up examination. Thirty-three patients were treated through a deltopectoral approach and 37 through an anterolateral deltoid-splitting approach. In all cases, open reduction and internal fixation with a PHILOS locking plate (Synthes, Umkirch, Germany) was performed. Clinical follow-up included evaluation of pain, shoulder mobility, and strength. Constant score and Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed. A clinical neurological examination of the axillary nerve was also performed. Consolidation, reduction, and appearance of head necrosis were evaluated radiographically. After a mean follow-up of 33 months, Constant scores, DASH scores, and American Shoulder and Elbow Surgeons scores showed no significant differences between the groups. Clinical neurologic examination of the axillary nerve revealed no obvious damage to the nerve in either group. Deltopectoral and anterolateral detoid-splitting approaches for plate fixation of proximal humeral fractures are safe and provide similar clinical outcomes. The results of this study suggest that the approach can be chosen according to surgeon preference.

  15. Dust Acoustic Solitary Waves in Saturn F-ring's Region

    E.K. El-Shewy; M.I. Abo el Maaty; H.G. Abdelwahed; M.A.Elmessary


    Effect of hot and cold dust charge on the propagation of dust-acoustic waves (DAWs) in unmagnetized plasma having electrons, singly charged ions, hot and cold dust grains has been investigated.The reductive perturbation method is employed to reduce the basic set of fluid equations to the Kortewege-de Vries (KdV) equation.At the critical hot dusty plasma density NhO, the KdV equation is not appropriate for describing the system.Hence, a set of stretched coordinates is considered to derive the modified KdV equation.It is found that the presence of hot and cold dust charge grains not only significantly modifies the basic properties of solitary structure, but also changes the polarity of the solitary profiles.In the vicinity of the critical hot dusty plasma density NhO, neither KdV nor mKdV equation is appropriate for describing the DAWs.Therefore, a further modified KdV (fmKdV) equation is derived, which admits both soliton and double layer solutions.

  16. Measurement of Ultra-Short Solitary Electromagnetic Pulses

    Eva Gescheidtova


    Full Text Available In connection with the events of the last few years and with the increased number of terrorist activities, the problem of identification and measurement of electromagnetic weapons or other systems impact occurred. Among these are also microwave sources, which can reach extensive peak power of up to Pmax = 100 MW. Solitary, in some cases several times repeated, impulses lasting from tp E <1, 60>ns, cause the destruction of semiconductor junctions. These days we can find scarcely no human activity, where semiconductor structures are not used. The problem of security support of the air traffic, transportation, computer nets, banks, national strategic data canter’s, and other applications crops up. Several types of system protection from the ultra-short electromagnetic pulses present itself, passive and active protection. The analysis of the possible measuring methods, convenient for the identification and measurement of the ultra-short solitary electromagnetic pulses in presented in this paper; some of the methods were chosen and used for practical measurement. This work is part of Research object MSM262200022 "Research of microelectronic systems".

  17. Right sided double inferior vena cava with obstructed retrocaval ureter: Managed with single incision multiple port laparoscopic technique using "Santosh Postgraduate Institute tacking ureteric fixation technique".

    Kumar, Santosh; Singh, Shivanshu; Garg, Nitin


    Right double inferior vena cava with obstructed retrocaval ureter is an extremely rare anomaly with only a few reported cases in the literature. To the best of our knowledge, this is the first case report describing ureteric repair by use of a single-incision laparoscopic technique. In addition, this report addresses the underlying surgical challenges of this repair and provides a brief review of the embryology of this anomaly. The "Santosh Postgraduate Institute ureteric tacking fixation technique" provides ease of end-to-end uretero-ureteric anastomosis in a single-incision laparoscopic surgery.

  18. Ash Aggregates in Proximal Settings

    Porritt, L. A.; Russell, K.


    Ash aggregates are thought to have formed within and been deposited by the eruption column and plume and dilute density currents and their associated ash clouds. Moist, turbulent ash clouds are considered critical to ash aggregate formation by facilitating both collision and adhesion of particles. Consequently, they are most commonly found in distal deposits. Proximal deposits containing ash aggregates are less commonly observed but do occur. Here we describe two occurrences of vent proximal ash aggregate-rich deposits; the first within a kimberlite pipe where coated ash pellets and accretionary lapilli are found within the intra-vent sequence; and the second in a glaciovolcanic setting where cored pellets (armoured lapilli) occur within Diamond Mine, Canada, are the residual deposits within the conduit and vent of the volcano and are characterised by an abundance of ash aggregates. Coated ash pellets are dominant but are followed in abundance by ash pellets, accretionary lapilli and rare cored pellets. The coated ash pellets typically range from 1 - 5 mm in diameter and have core to rim ratios of approximately 10:1. The formation and preservation of these aggregates elucidates the style and nature of the explosive phase of kimberlite eruption at A418 (and other pipes?). First, these pyroclasts dictate the intensity of the kimberlite eruption; it must be energetic enough to cause intense fragmentation of the kimberlite to produce a substantial volume of very fine ash (sustained plume attended by concomitant production of pyroclastic density currents. The size and internal structure of the armoured lapilli provide constraints on the nature of the initial explosive phase of eruption at Kima'Kho. Their proximity to the vent also indicates rapid aggregation within the eruption plume. Within both sequences rapid aggregation of ash particles occurred in proximity to the vent. However, the conditions were substantially different leading to the production of armoured

  19. [Proximal and total femur replacement].

    Pennekamp, P H; Wirtz, D C; Dürr, H R


    Reconstruction of segmental bone defects of the proximal femur following wide tumor resection or revision arthroplasty. Aggressive benign or primary malignant bone tumors of the proximal femur; destructive metastases; massive segmental bone defects of the proximal femur; periprosthetic fractures. Local infection; very short life expectancy (acetabular bone stock. Anterolateral approach. Exposure and detachment of the iliopsoas and gluteus medius muscle from the proximal femur with a sufficient safety margin to the bone; distal transsection of the vastus lateralis/intermedius and rectus femoris muscle according to the extraosseous tumor extension; distal femur osteotomy al least 3 cm beyond the farthest point of tumor extension; in case of total femur replacement, additional lateral arthrotomy of the knee with resection of the ligaments and menisci; reaming of the medullary canal after securing the shaft with a Verbrugge clamp; trial assembly and reduction followed by the definitive implantation of the prosthesis with adjustment of the femoral neck anteversion in 5° increments; soft tissue reconstruction and fixation to an attachment tube covering the prosthesis; in case of total femur replacement, the preparation of the tibia is followed by the coupling of the tibial and femoral components. Infection prophylaxis, 20 kg partial weight bearing, continuous passive motion. A total of 20  patients with proximal femur replacement and 2 patients with total femur replacement implanted between June 2007 and December 2011 were retrospectively reviewed. Three patients had primary malignant bone tumors, while 19 patients underwent resection for metastatic disease. The mean age at surgery was 62.0 ± 18.1 years (18-82 years). Fifteen patients with a mean follow-up of 20.3 ± 17.2 months (4-51 months) were studied. Among the 22 cases, periprosthetic infection occurred in 3 patients (13.6%), dislocation in 2 patients (9.1%). Evaluation of the functional

  20. Preclinical evaluation of a newly designed ureteral stent and magnetic retrieval catheter for minimally invasive stent removal.

    Wang, Jin; Feng, JiaYu; Hu, WenGang; Song, YaJun; Xu, XiaoTing; Fan, MingQi; Huang, ChiBing


    To develop a simple minimally invasive method for ureteral stent removal that does not require cystoscopy or fluoroscopic guidance. We developed a novel ureteral stent comprising the main body of a stent and an iron oxide-coated net that was woven of processed polyester sutures. The ureteral stent was retrieved by a magnetic retrieval catheter with small hooks on the neck surface. Detailed analysis of the necessary mechanical and magnetic properties was performed, and we conducted retrieval tests of the ureteral stent from a specially designed urinary system model. The breaking strength and Young modulus of the processed polyester sutures were 10.12 ± 0.30 N and 9143 ± 7 N/tex, respectively. Thermogravimetric tests showed that the iron (III) oxide powders on the processed sutures accounted for 23% of the total weight. The magnetization value of the magnetic retrieval catheter was 578 emu/g. The dissolution times of polyvinyl alcohol wrapped the net in saline or urine were 24.2 ± 2.0 and 23.6 ± 3.1 hours, respectively. All stents in both the experimental and the control groups were successfully removed from the specially designed urinary model. However, the retrieval time in the experimental group was significantly shorter than that in the control group (38.6 ± 12.6 vs 59 ± 15.7 seconds; P <.05). Ureteral stent removal using a magnetic retrieval catheter with small capture devices is considered feasible. This technique is easy to learn and should be considered as suitable for use on an outpatient basis. Copyright © 2014 Elsevier Inc. All rights reserved.