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1
Julia Patrick Engkasan, Chua Li Shun, and Farooq Azam Rathore. "Bladder drainage options for people with spinal cord injury: A Mini-Review." Journal of the Pakistan Medical Association 73, no. 10 (September 13, 2023): 2123–25. http://dx.doi.org/10.47391/jpma.23-77.
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Neurogenic bladder is one of the negative consequences following a spinal cord injury (SCI). SCI patients who have neurogenic bladder depend on alternative methods to drain urine from their bladder. These include indwelling catheters, reflex voiding , suprapubic tapping and intermittent catheterisation. This review summarizes evidence from the literature of five selected complications (renal failure, urinary tract infections, calculi, urethral stricture, and bladder cancer) that could result from use of the different bladder drainage methods. There is inconsistent evidence to support the superiority of intermittent over indwelling catheterisation on risk of renal impairment, urethral stricture, and renal calculi. Indwelling catheterisations are associated with higher risk of bladder calculi and cancer. Caution needs to be taken when interpreting this review, as many of its findings are from retrospective studies, and more than a decade old. Clinicians need to communicate the evidence to their patients when making the decision on method of bladder drainage. Keywords: Rehabilitation Catheterisation Incontinence Urology Paraplegia Renal failure.
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Yang, Yongjin, Muchun Zhang, Hongjiao Yu, Jinguo Wang, Junyan Liu, Kaixing He, and Jialin Gao. "Percutaneous nephrolithotomy and retroperitoneal laparoscopy in treatment of retrocaval ureter with right renal and ureteral calculi: a case report." Journal of International Medical Research 48, no. 9 (September 2020): 030006052094791. http://dx.doi.org/10.1177/0300060520947917.
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Retrocaval ureter is a rare disease associated with abnormal embryonic development. Here, we describe a patient who exhibited retrocaval ureter complicated by renal and ureteral calculi, which were treated by percutaneous nephrolithotomy combined with retroperitoneal laparoscopy. A 64-year-old man was admitted to our hospital because of intermittent back pain that had been present for more than 10 years. During hospitalization, he was diagnosed with retrocaval ureter, right renal calculi, and right ureteral calculi with right hydronephrosis; he underwent percutaneous nephrolithotomy combined with retroperitoneal laparoscopic surgery. After the operation, his condition was stable and he exhibited good recovery. Our findings in this case suggest that percutaneous nephrolithotomy combined with retroperitoneal laparoscopy is a suitable option for the treatment of retrocaval ureter with renal and ureteral calculi.
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Stojanovic, Dragos, Mirjana Stojanovic, Predrag Milojevic, Zorica Caparevic, Djordje Lalosevic, and Dragan Radovanovic. "Strategies for endoscopic and surgical management of common bile duct stones." Medical review 56, no. 1-2 (2003): 69–75. http://dx.doi.org/10.2298/mpns0302069s.
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Introduction Common bile duct calculi represent a pathologic entity involving obstructive icterus, cholangitis, hepatic cirrhosis or pancreatitis. Common bile duct calculi mostly have a secondary origin (from gallbladder) in 95% of cases, while primary choledocholithiasis is rare. Classification From surgical aspect, common bile duct calculi can be: 1. Asymptomatic, without manifested symptoms or signs,2. Mobile, with intermittent biliar obstruction and disobstruction, 3. Fixed, with obstruction and signs of hepato-biliary and/or bilio-pancreatic duct, 4. Transitory, microcalculi which pass through Vater's Papilla by propulsion into duodenum with symptoms. Discussion Modern biliary surgery includes diagnosis of common bile duct calculi, and if possible preoperative endoscopic (endoluminal) surgery, which is less invasive for patients. If such approach is not possible, it is necessary to perform stone extraction and cholecystectomy. Conclusion Common bile duct calculi represent a common disease of the digestive system. Endoscopic diagnostic procedure is very important in management of choledocholithiasis Endoscopic treatment of common bile duct calculi prior to cholecystectomy is a method of choice and a strategy for associated cholecysto-choledocholithiasis.
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Ali, S. K. Sekendar, Aritra Chatterjee, and Narendra Nath Mukhopadhyay. "A huge right staghorn renal calculi: a case report of inevitable open surgery." International Journal of Research in Medical Sciences 11, no. 1 (December 30, 2022): 375. http://dx.doi.org/10.18203/2320-6012.ijrms20223667.
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Staghorn renal calculi in a developing country, very often associated with insidious growth, late presentation, complication & recurrence, present an economic burden to the patient & challenge to the treating surgeon. A 70 years old male patient presented to the surgery dept. of our medical college with chief complaints of intermittent pain in right side of abdomen since 4 years, with increased frequency for last 5 days & radiating to back, non-radiating to groin, had h/o intermittent low grade fever and 3-4 times hematuria. Right sided pyelolithotomy done and a huge staghorn calculi that is extending into renal calyces is removed. Post operatively patient uneventful. In the last few decades, with improvement in endourological surgery, the indications for open surgery in stone diseases have become rare, although open surgery still has a role in selected cases such as complex stone burden, renal anatomic complications.
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Shrivastava, Nikita, Priyank Bhargava, and Gautam Ram Choudhary. "Endourological management of ureteric stump syndrome." BMJ Case Reports 16, no. 9 (September 2023): e255126. http://dx.doi.org/10.1136/bcr-2023-255126.
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A man in his 50s presented with right flank pain and intermittent haematuria for 15 days. He was evaluated and diagnosed to have bilateral staghorn renal calculi with left poorly functioning kidney. He underwent right kidney stone clearance followed by laparoscopic left simple nephrectomy. Postoperatively, he developed recurrent urinary tract infections. On evaluation, non-contrast CT of the abdomen revealed calculus in left ureteral stump and he was diagnosed to have ureteric stump syndrome. He underwent ureteroscopy which revealed multiple stump calculi and complete stone clearance was achieved. Currently, the patient is asymptomatic and doing well after a follow-up of 1 year.
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Barroso, U., R. Jednak, P. Fleming, J. S. Barthold, and R. González. "Bladder calculi in children who perform clean intermittent catheterization." BJU International 85, no. 7 (December 24, 2001): 879–84. http://dx.doi.org/10.1046/j.1464-410x.2000.00625.x.
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Freeman, Hugh J., Andrew Seal, and David Li. "Laminated Intestinal Calculi – A Rare Complication of Crohn's Disease." Canadian Journal of Gastroenterology 9, no. 1 (1995): 13–16. http://dx.doi.org/10.1155/1995/763256.
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A 59-year-old male with a 36-year history of Crohn's disease and repeated resections for small intestinal strictures developed anemia and symptoms of an intermittent partial bowel obstruction. Barium studies showed recurrent small intestinal strictures as well as filling defects in a dilated loop proximal to a stenosed segment. Subsequent abdominal films and a computed tomographic study suggested laminated radiopaque calculi with peripheral calcification in the dilated small intestinal loop. Resection of the strictured segment confirmed the presence of intestinal enterolithiasis.
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Patil, Santosh, Vinay S. Kundargi, Siddanagouda B. Patil, Basavesh S. Patil, and Saurabh M. Thakkar. "A rare case of a giant vesical diverticular calculus managed successfully by endoscopy." International Surgery Journal 10, no. 2 (January 27, 2023): 306–8. http://dx.doi.org/10.18203/2349-2902.isj20230272.
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Vesical diverticula occur in the setting of bladder outlet obstruction (BOO) and neurogenic vesicourethral dysfunction. Vesical diverticular calculi are rare, especially for minimally invasive endoscopic lithotripsy treatment. A male patient of around 80 years presented with complaints of urinary intermittency and dribbling for 3 to 4 days. On investigation, the patient was found to have a calculus within a diverticulum in the urinary bladder. After counselling, cystolithotripsy + transurethral resection (CLT+TURP) of the prostate under spinal anaesthesia was performed. Usually, open surgery is recommended for the management of vesical diverticular calculi. However, CLT+TURP was the best option, in this case, keeping in mind the patient’s age and comorbidities. Simultaneous endoscopic resection of the prostate gland would help to treat the cause.
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Pitts, Daniel, David Chalmers, and Brian Jumper. "Symptomatic Infundibulopelvic Dysgenesis in an Adolescent." Case Reports in Urology 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/307319.
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Infundibulopelvic dysgenesis is a rare condition characterized by congenital malformation of the pelvicalyceal system. We present the case of an 18-year-old boy with chronic intermittent right flank pain and cystic dilation with parenchymal thinning on ultrasonography. The left kidney was normal. The patient denied dysuria, constipation, and history of UTIs or renal calculi. Cystoscopy with retrograde pyelogram showed marked stenosis of the right pelvicalyceal system and anatomy unfavorable to stenting. The patient’s symptoms were unresponsive to conservative management. Reconstruction of the right collecting system was unsuccessful and a simple nephrectomy was performed, which led to complete resolution of his symptoms.
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Rajan, Swati, Irfan Haris, Sameer Ahmed, and M. V. Krishna. "A Case of Recurrent Renal Calculi Secondary to Parathyroid Adenoma: A Case Report." Assam Journal of Internal Medicine 14, no. 1 (January 2024): 44–48. http://dx.doi.org/10.4103/ajoim.ajoim_9_23.
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Abstract Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by hypercalcemia and excessive secretion of parathyroid hormone (PTH). We report the case of a 71-year-old woman who presented with intermittent abdominal pain, associated with fever and chills. She also experienced early morning face puffiness, decreased appetite, and nausea for the past 7 days. The patient has a history of recurrent renal calculi. Routine blood investigation showed anemia, as well as thrombocytopenia with deranged renal function with hyperkalemia, hypercalcemia, and low-normal phosphorus levels. A plain CT KUB scan showed bilateral hydroureteronephrosis, which was determined to be secondary to renal calculi, the largest measuring 24 × 16 mm (HU:1300). The patient underwent two sessions of hemodialysis and was then scheduled for bilateral URSL with bilateral DJ stenting. After the procedure, the patient’s serial renal function tests returned to normal. Further evaluation for hypercalcemia revealed very high levels of PTH, and a magnetic resonance imaging of the neck revealed a right parathyroid adenoma. The patient subsequently underwent parathyroidectomy, and post-procedure serial PTH and calcium levels were found to be normal.
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Dare, Gowardhan, Murtaza Akhtar, and Swanand Chaudhary. "Unilateral hydronephrosis in adults: etiology, clinical presentations and management." International Surgery Journal 6, no. 6 (May 28, 2019): 2028. http://dx.doi.org/10.18203/2349-2902.isj20192360.
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Background: Hydronephrosis is dilatation of renal pelvis and calyces resulting from intermittent and incomplete obstruction to the urine outflow with incidence of 1:100. This study aims to evaluate etiological factors, clinical presentations, diagnostic modalities and management options of unilateral hydronephrosis.Methods: In a tertiary care based observational study, patients more than 18 years age of either gender with unilateral loin pain with or without lump in loin were clinically diagnosed as unilateral hydronephrosis and confirmed on imaging studies were enrolled as subjects. Pregnant patients and patients not consenting were excluded. Patients with mild unilateral hydronephrosis were managed conservatively. Those of moderate to severe grade were investigated with CT urography and those with no excretion of dye in affected kidney were further investigated with DTPA scan. In patients with function of less than 10% on DTPA scan were subjected for nephrectomy.Results: Of the total 72 patients of unilateral hydronephrosis enrolled, 50 (69.44%) were due to ureteric calculi, 18 (25%) were PUJ obstruction and 4 (5.56%) were renal calculi. Highest incidence was seen in third and fourth decade with Males to female ratio of 1.25:1. Commonest symptom was pain in abdomen followed by hematuria. Ureteric calculi of size less than 7 mm were given conservative trial and rests were managed surgically. Out of total 72 patients 43 patients were managed conservatively and rest 29 were treated surgically.Conclusions: Ureteric calculus, pelviureteric junction obstruction and renal calculus were the etiological factors causing unilateral hydronephrosis and management was as per etiology.
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Chavarkar, Sneha P., Amit K. Agrawal, Alok C. Shrivastava, and Anuradha V. Shrikhande. "A rare case report of primary renal squamous cell carcinoma." International Journal of Research in Medical Sciences 5, no. 2 (January 23, 2017): 697. http://dx.doi.org/10.18203/2320-6012.ijrms20170176.
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Primary renal squamous cell carcinoma is a very rare entity. Only few cases are reported in the world literature. Most of the patients present at a late stage resulting in poor prognosis. We report a 44 year old female who presented with a history of lump in right flank accompanied with a dull intermittent pain for 2 months duration which intensified in the last 15 days. Antecedent risk factors like renal calculi, analgesic use were absent. Computed Tomography (CT) examination revealed a mass arising from the superior pole of kidney with extension to the posterior segment of liver. Histopathology following nephrectomy showed histological features of well differentiated squamous cell carcinoma.
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Santos, Renato de Lima, Tatiane de Fátima Brandão de Oliveira, Taismara Simas de Oliveira, João Felipe Brito Galvão, Tatiane Alves da Paixão, and Barbara Goloubeff. "Cholelithiasis with atrophy of the right lateral hepatic lobe in a horse." Ciência Rural 37, no. 2 (April 2007): 586–89. http://dx.doi.org/10.1590/s0103-84782007000200049.
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A 22 year-old horse developed cholelithiasis with marked atrophy of the right lateral hepatic lobe. The horse had a history of intermittent colic since three years of age, and one of the first episodes of colic was associated with icterus. The size of the right lateral hepatic lobe was extremely reduced. There was a large choledocholith in the common hepatic duct, and several hepatoliths and choleliths in the intra- and extra-hepatic billiary ducts. Microscopically, there was severe atrophy of the right lobe with diffuse proliferation of connective tissue and billiary ducts. The left lateral lobe had peri-portal fibrosis with proliferation of billiary ducts, and billiary stasis. Chemical analysis of the calculi detected amorphous and triple phosphate, bilirubin, calcium, and iron.
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Lindberg, C. G., T. Berggren, E. Lindstedt, C. Lundstedt, and H. Stridbeck. "Percutaneous Rotational Lithotripsy of Urinary Bladder Stones." Acta Radiologica 34, no. 3 (May 1993): 270–72. http://dx.doi.org/10.1177/028418519303400314.
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Mechanical rotational lithotripsy of urinary bladder stones, up to 20 mm in diameter, was performed in 6 male patients with the Rotolith lithotriptor. The lithotriptor was introduced through a 10 F (OD 3.3 mm) suprapubically inserted sheath, and the procedure was performed under intermittent fluoroscopy and inspection through a transurethral cystoscope. In 3 patients, the bladder stones were fragmented to pieces small enough to be evacuated through the cystoscope. The instrument, which is designed for lithotripsy of gallbladder stones, was less efficient for fragmentation of urinary bladder calculi, primarily due to the large volume of the human urinary bladder, and possibly because of the higher gravity of bladder stones. There was no substantial damage to the mucosa of the urinary bladder.
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Vaidyanathan, Subramanian, Bakul Soni, Gurpreet Singh, and Peter Hughes. "Postoperative Complications Leading to Death after Coagulum Pyelolithotomy in a Tetraplegic Patient: Can We Prevent Prolonged Ileus, Recurrent Intestinal Obstruction due to Adhesions Requiring Laparotomies, Chest Infection Warranting Tracheostomy, and Mechanical Ventilation?" Case Reports in Urology 2013 (2013): 1–6. http://dx.doi.org/10.1155/2013/682316.
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A 22-year-old male sustained C-6 tetraplegia in 1992. In 1993, intravenous pyelography revealed normal kidneys. Suprapubic cystostomy was performed. He underwent open cystolithotomy in 2004 and 2008. In 2009, computed tomography revealed bilateral renal calculi. Coagulum pyelolithotomy of left kidney was performed. Pleura and peritoneum were opened. Peritoneum could not be closed. Following surgery, he developed pulmonary atelectasis; he required tracheostomy and mechanical ventilation. He did not tolerate nasogastric feeding. CT of abdomen revealed bilateral renal calculi and features of proximal small bowel obstruction. Laparotomy revealed small bowel obstruction due to dense inflammatory adhesions involving multiple small bowel loops which protruded through the defect in sigmoid mesocolon and fixed posteriorly over the area of previous intervention. All adhesions were divided. The wide defect in mesocolon was not closed. In 2010, this patient again developed vomiting and distension of abdomen. Laparotomy revealed multiple adhesions. He developed chest infection and required ventilatory support again. He developed pressure sores and depression. Later abdominal symptoms recurred. This patient’s general condition deteriorated and he expired in 2011.Conclusion. Risk of postoperative complications could have been reduced if minimally invasive surgery had been performed instead of open surgery to remove stones from left kidney. Suprapubic cystostomy predisposed to repeated occurrence of stones in urinary bladder and kidneys. Spinal cord physicians should try to establish intermittent catheterisation regime in tetraplegic patients.
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Kedari, Prashant, Milind Joshi, Vaibhav Kapoor, and Sushant Khurana. "A comprehensive case study of cholecystectomy in a patient with a gallbladder laden with 442 stones." International Surgery Journal 11, no. 4 (March 27, 2024): 668–71. http://dx.doi.org/10.18203/2349-2902.isj20240761.
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Cholelithiasis (gallstones), crystalline formations in the gallbladder, presents a common yet intricate medical concern. These stones can vary in size and composition, ranging from cholesterol to pigment-based stones. Treatment often involves surgical intervention, with laparoscopic procedures being a minimally invasive and effective option. However, complications arise when multiple stones are present, leading to heightened inflammation and recurrent symptoms. In this study, we present a case of a 34-year-old, male who came with complaints of abdominal pain and bloating, intermittent nausea, vomiting, and jaundice for more than 5 days. He was diagnosed with multiple calculi in the gallbladder (acute cholecystitis with cholelithiasis) based on ultrasonography. Since the patient had jaundice, he was suggested to get a magnetic resonance cholangiopancreatography (MRCP) to rule out any pathoanatomy. He received treatment by laparoscopic cholecystectomy and showed improvement within 5 days of surgery.
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Symeonidis, Evangelos N., Dimitrios Memmos, Anastasios Anastasiadis, Ioannis Mykoniatis, Eliophotos Savvides, Georgios Langas, Panagiotis Baniotis, et al. "Jackstone: A Calculus “Toy” in the Bladder. A Case Report of Rare Entity and Comprehensive Review of the Literature." Acta medica Lituanica 29, no. 1 (January 26, 2022): 6. http://dx.doi.org/10.15388/amed.2021.29.1.6.
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Background: An uncommon type of urinary calculus, Jackstone was named after its distinct resemblance to the children’s game “Jacks.” It typically involves the bladder and, to a lesser extent, the upper urinary tract.Case Presentation: Herein, we report a case of Jackstone vesical calculus in a 75-year-old male undergoing elective open prostate surgery for benign prostate hyperplasia refractory to medical treatment. Preoperative clinical examination revealed intermittent gross hematuria and symptoms suggestive of bladder outlet obstruction, while radiological investigation confirmed the presence of a solitary star-shaped spike-like bladder stone along with an overly enlarged prostate. Following open simple prostatectomy and concomitant intact stone removal, our patient made an uneventful postoperative recovery.Conclusion: This case highlights an infrequent subtype of bladder lithiasis and further expands upon the importance of promptly treating the underlying cause once this rare entity is detected. A comprehensive review of the literature on Jackstone calculi is further presented.
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Ding, Xiaobo, Jingjing Guan, Jingyan Tian, Yuchuan Hou, Chunxi Wang, and Yanbo Wang. "Subcostal artery bleeding after percutaneous nephrolithotomy: a case report and literature review." Journal of International Medical Research 46, no. 10 (August 20, 2018): 4350–53. http://dx.doi.org/10.1177/0300060518791704.
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Postoperative bleeding is a dangerous complication after percutaneous nephrolithotomy (PCNL). Pseudoaneurysm, arteriovenous fistula, and arterial laceration are the three most common causes of post-PCNL bleeding. Subcostal artery bleeding is a rare cause. We herein present a clinical case involving a 43-year-old man who presented with right renal complex calculi and was managed by PCNL in the prone position using an inferior calyceal puncture approach. Intermittent extreme bleeding occurred 1 day postoperatively, and immediate renal angiography was performed. However, we found no sign of a pseudoaneurysm, arteriovenous fistula, or arterial laceration. Another well-trained and experienced doctor also found no pseudoaneurysm, arteriovenous fistula, or arterial laceration. After adjusting the catheter position, subcostal artery bleeding finally appeared and was successfully controlled by coils. This finding indicates that subcostal artery damage is one cause of post-PCNL bleeding. We suggest that clinicians should carefully and patiently perform angiography and/or embolization to avoid misdiagnosis and mistreatment.
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Asif Khan, Mohammad, Mehjabeen Fatimah, and Saiyad Shah Alam. "Nephrolithiasis (Hisat-E-Kulyah) and Its Management: An Overview." Research in Pharmacy and Health Sciences in Volume 4, Issue 3: July 2018- September 2018 4, no. 3 (September 30, 2018): 507–11. http://dx.doi.org/10.32463/rphs.2018.v04i03.19.
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Nephrolithiasis is one of the most common health problems that affect approximately 15 % population worldwide and about 2.3% population of India. Most (75% to 80%) kidney stones are calcium stones, composed of calcium oxalate and/or calcium phosphate. These stones are generally associated with high concentration of calcium in the blood or urine. The classical features of renal colic are sudden severe pain. It is usually caused by the stones in the kidney, renal pelvis or ureter, causing dilatation, stretching and spasm of the ureter. Pain starts in the loin about the level of the costovertebral angle. Typical symptoms of acute renal colic are intermittent colicky flank pain that may radiate to the lower abdomen or groin, often associated with nausea and vomiting. Many stones are asymptomatic and discovered during investigations for other conditions. Small urinary calculi pass out of the body without any clinical intervention. According to Jaleenoos (Galen) renal stones are formed when rooh (gaseous matter) is trapped in the spaces of the kidney and consolidates to form hard substances. Another cause of renal calculi is ulceration of the kidney, in which pus accumulates and solidifies, thereby forming renal stones or at least establishing a nidus for the formation of stones. Avicenna contends that the persistence of “morbid matter” in the urinary tract is instrumental in the formation of ghaliz madda (viscid matter). In Unani system of medicine the main aim of management for nephrolithiasis is to make morbid and abnormal humors easily extractible from the body through the excretory system. This paper will deal with the literature, clinical aspect and management of the Nephrolithiasis in Unani System of Medicine
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Yoshino, Tateki, and Hiroyuki Moriyama. "Case of the Diffuse Form of Xanthogranulomatous Pyelonephritis." Case Reports in Urology 2013 (2013): 1–3. http://dx.doi.org/10.1155/2013/936035.
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Xanthogranulomatous pyelonephritis (XGP) is a rare entity and constitutes less than 1% of chronic pyelonephritis. A 71-year-old male was introduced to our department with general malaise and abnormal findings of computed tomography (CT). Abnormal findings of complete blood count and laboratory examination included an elevated WBC count and C-reactive protein. Urinalysis showed combined hematuria and pyuria, andEscherichia coliwas detected in urine culture. Abdominal CT revealed left hydronephrosis with staghorn renal calculi and thin cortex of the left kidney. Because of poor condition, the patient underwent construction of the left nephrostomy. After that, the remission of the inflammation was achieved. Several months after the construction, frequent obstructions of nephrostomy catheter because of turbid urine and intermittent fever elevation were observed. The patient and his family desired left nephrectomy despite his poor condition in general. Surgical dissection was very difficult due to fixed mass. Not long after that the patient died due to sepsis and cardiovascular failure. Microscopic findings of the left kidney revealed infiltration of lymphocytes and lipid-laden macrophages (xanthoma cells) corresponding to XGP.
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Symeonidis, Evangelos N., Chrysovalantis Toutziaris, Antonios Katsimantas, and Georgios Dimitriadis. "Incidental Detection of Preputial Calculus in a Patient with Partial Phimosis: Is it as Rare as We Believed?" Acta medica Lituanica 28, no. 1 (March 9, 2021): 10. http://dx.doi.org/10.15388/amed.2021.28.1.10.
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Background: Preputial stone disease is the rarest type of urolithiasis. Adult males with severe phimosis and poor hygiene are mainly affected.Case Presentation: A 90-year-old male sought treatment for steadily worsening urinary frequency, intermittency, incontinence, and pain at the tip of his penis of 3-days duration. Clinical examination revealed a palpable distended urinary bladder, a partial phimosis and a round, hard on palpation, and partly ulcerative lesion at the tip of the foreskin. A single, 1 cm in maximum diameter stone, was incidentally discovered beneath the prepuce and subsequently removed from the preputial sac. The patient refused further treatment with circumcision, and opted for conservative therapy of benign prostate hyperplasia.Conclusion: Personal hygiene remains the cornerstone in the prevention of the preputial calculi formation, while circumcision represents the mainstay of treatment for definite stone removal and elimination of the precipitating causes.
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Ehnen, S. J., T. J. Divers, D. Gillette, and V. B. Reef. "Obstructive nephrolithiasis and ureterolithiasis associated with chronic renal failure in horses: Eight cases ( 1981-1987)." Journal of the American Veterinary Medical Association 197, no. 2 (July 15, 1990): 249–53. http://dx.doi.org/10.2460/javma.1990.197.02.249.
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Summary Eight adult horses with obstructive nephrolithiasis and/or ureterolithiasis were examined between 1981 and 1987. One horse had bilateral ureteral obstruction at hospital admission; the others had unilateral ureteral obstruction. All horses had similar bilateral renal pathologic findings that were compatible with chronic intermittent or complete obstruction. Horses were referred for evaluation of weight loss, poor performance, and/or decreased appetite. Clinical findings, laboratory results, and/or postmortem findings in all horses supported the diagnosis of chronic renal failure. Age of the 8 horses varied between 2 and 17 years; 5 of the 8 were between 2 and 3 years old. Seven horses were Thoroughbreds and 1 was a Standardbred. Of the horses examined, 4 were females and 4 were males (2 geldings). Diagnosis of obstructive nephrolithiasis and/or ureterolithiasis was made in all of the hospitalized horses based on examination per rectum and/or renal ultrasonographic findings. Surgical removal of the obstructing calculi was performed in one horse. Although etiopathogenesis could not be proven, histopathologic findings in the kidneys of the horses of our study were suggestive of renal failure secondary to obstructive urinary disease.
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Gawali, Amey, Piyush Singhania, Ajinkya Patil, Kapil Vishwakarma, and Sharang Kulkarni. "Lost in the shadows: shedding light on forgotten ureteral stent syndrome." MGM Journal of Medical Sciences 11, no. 3 (July 2024): 572–75. http://dx.doi.org/10.4103/mgmj.mgmj_181_24.
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Abstract Ureteral stents have been essential in urology for over four decades, yet the challenge of retained or forgotten stents persists. This syndrome occurs when a DJ stent remains beyond its recommended removal time, typically more than 2 weeks, leading to complications like migration, fragmentation, and encrustation. We present a case of a 50-year-old woman with a two-month history of right flank pain, burning urination, and intermittent fever. She had undergone right stent lithotripsy 3 years prior. Imaging revealed a fractured double J stent with significant renal and bladder stones, extensive ureteral encrustation, and a large retroperitoneal collection. The right kidney showed cortical thinning and gross hydronephrosis. Initial management included broad-spectrum antibiotics, a pigtail catheter, and percutaneous nephrostomy. In a second session, mechanical cystolithotripsy and percutaneous nephrolithotomy removed the bladder and renal calculi, and the fractured stent ends. The patient recovered uneventfully. Forgotten ureteral stents often require staged endoscopic interventions due to encrustation. Timely stent removal is critical and often overlooked due to inadequate counseling. Establishing a stent registry and an automated reminder system via a mobile app could help prevent these occurrences.
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Asadi Ardebili, Ahmad, and Seyed Amin Razavi. "Successful Treatment of Urolith in a Neutered Persian Cat: A Case Report." Small Animal Advances 2, no. 1 (March 25, 2023): 01–04. http://dx.doi.org/10.58803/saa.2023.2.1.01.
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Introduction: Uroliths or calculi are the formations of stones in the bladder. The formation of stones is influenced by specific metabolic conditions such as nutritional factors (e.g., protein-rich diet), hydration (lack of water), pH modification, low urine volume, hypercalcemia, or hypophosphatemia. In pet medicine, urolithiasis is common, particularly in cats. Case report: In October 2022, a 2-year-old neutered male Persian cat with a weight of 4 kg was referred to Ardebili Veterinary Pet Clinic (Mashhad, Iran) due to urinating outside the litter box, painful urination, and blood in the urine. A physical examination, ultrasonography, and blood analysis were performed. The physical examination included an assessment of the cat’s body temperature, heart rate, respiratory rate, mental state, mucous membrane color, capillary refill time, cardiopulmonary auscultation, and abdominal palpation. The cat appeared to be in good general health. No abnormalities were detected during the palpation of the bladder. Ultrasonography was performed using a real-time scanner with a 7.5-10 MHz broadband curvilinear probe, and the kidney parenchyma was examined. During the examination, a urolith with a size of 1 mm was observed. According to history and ultrasonography, and physical examination, the diagnosis was urolithiasis. To treat intermittent bladder pain, a spasmolytic drug (Prazosin) was administered at a dose of 0.5 mg/kg for 7 days. By the second day, the symptoms of pain had subsided. Additionally, ciprofloxacin at 20 mg/kg was used to combat infections. Fluoxetine at a 1 mg/kg dose was also administered to control inappropriate urination outside the litter box. After 3 days, the owner reported that the pet’s health improved, and most clinical signs disappeared. Conclusion: Administering appropriate medication (spasmolytic drug, antibiotic, and antidepressant in case of depressed animal and behavioral problems) can alleviate the calculi crystals in a cat’s urinary bladder and prevent future recurrences. In this instance, fluoxetine was discovered to be a successful option for managing pain and solving behavioral problems.
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Xiong, Yang, Jin Li, and Han-Jie Yang. "Concomitant treatment of ureteral calculi and ipsilateral pelvic sciatic nerve schwannoma with transperitoneal laparoscopic approach: A case report." World Journal of Clinical Cases 12, no. 11 (April 16, 2024): 1947–53. http://dx.doi.org/10.12998/wjcc.v12.i11.1947.
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BACKGROUND Schwannomas are rare peripheral neural myelin sheath tumors that originate from Schwann cells. Of the different types of schwannomas, pelvic sciatic nerve schwannoma is extremely rare. Definite preoperative diagnosis of pelvic schwannomas is difficult, and surgical resection is the gold standard for its definite diagnosis and treatment. CASE SUMMARY We present a case of pelvic schwannoma arising from the sciatic nerve that was detected in a 40-year-old man who underwent computed tomography for intermittent right lower back pain caused exclusively by a right ureteral calculus. Subsequently, successful transperitoneal laparoscopic surgery was performed for the intact removal of the stone and en bloc resection of the schwannoma. The total operative time was 125 min, and the estimated blood loss was inconspicuous. The surgical procedure was uneventful. The patient was discharged on postoperative day 5 with the simultaneous removal of the urinary catheter. However, the patient presented with motor and sensory disorders of the right lower limb, caused by partial damage to the right sciatic nerve. No tumor recurrence was observed at the postoperative appointment. CONCLUSION Histopathological examination of the specimen confirmed the diagnosis of a schwannoma. Thus, laparoscopic surgery is safe and feasible for concomitant extirpation of pelvic schwannomas and other pelvic and abdominal diseases that require surgical treatment.
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P Dhangar, Sanjay, Rishabh Mehta, and Vasistha Martha. "RIRS A Boon for The Crossed Ectopic Non fused Kidney Calculi Patients First Case Report." Annals of Urology 6, no. 1 (July 8, 2024): 1–3. http://dx.doi.org/10.52338/aou.2024.4009.
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Introduction : The incidence of ectopic kidney in autopsy series is around 1 in 900 otherwise it is 1 in 3000. There are various treatment modalities that can be utilised to treat these renal calculi e.g., extracorporeal shock wave lithotripsy, laproscopy assisted per-cutaneous nephrolithotomy, retrograde intra-renal surgery using the flexible ureteroscope, laproscopic/robotic pyelolithotomy and open surgery. We here describe a case of RIRS for stone in the pelvis of ectopic left kidney located on the right side just below the right kidney, it was crossed but not fused. To the best of our knowledge, this is first such case to be reported in crossed non-fused ectopic kidney. Case Report : A 33 years young male came with complaints of intermittent pain right loin for 2-3 months, mild initially but severe for last 24 hours. Physical examination suggested mild tenderness right iliac fossa. Ultrasonography and intravenous pyelography suggested ectopic left kidney located on right side below the right kidney in the right iliac fossa and not fused or attached to the right kidney with a large 21mm pelvic calculus with mild hydronephrosis. He later underwent retrograde intra-renal surgery where stone was completely lased and double J stent was kept at the end of the procedure. Results : Complete stone clearance was confirmed visually and under c-arm. Post operative USG and x-ray KUB showed no residual calculus. Patient was discharged on second postop day. There were no post-op complications. The double J stent was removed after two weeks. Conclusion : RIRS is a very good option to treat stones in an ectopic kidney. It may require more than one session sometimes, but considering the minimal invasive nature, the bothersome is less. Disposable ureteroscopes have further revolutionised the armamentarium of the urologist, who can now offer a personalised treatment plan for each patient. Keywords : RIRS, ectopic kidney, crossed ectopic non-fused kidney, stone in ectopic kidney, minimal invasive laser surgery
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Hird, Amanda E., Refik Saskin, Ying Liu, Yuna Lee, Khaled Ajib, Rano Matta, Ronald Kodama, et al. "Association between chronic bladder catheterisation and bladder cancer incidence and mortality: a population-based retrospective cohort study in Ontario, Canada." BMJ Open 11, no. 9 (September 2021): e050728. http://dx.doi.org/10.1136/bmjopen-2021-050728.
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ObjectivesTo compare the risk of bladder cancer and bladder cancer mortality among patients with chronic bladder catheterisation (indwelling or intermittent) to patients from the general population.DesignRetrospective cohort study.SettingPopulation-based study in Ontario, Canada between 2003 and 2018.ParticipantsAdult patients 18–90 years of age with chronic bladder catheterisation were hard matched to patients from the general population without a history of bladder catheterisation.InterventionsThe presence of a chronic catheter was defined as a minimum of two physician encounters for bladder catheterisation, suprapubic tube insertion or home care for catheter care separated by at least 28 days. Urinary tract infection (UTI) rates were collected.Main outcome measuresBladder cancer and bladder cancer-specific mortality after a 1-year lag period were compared between groups.ResultsWe identified 36 903 patients with chronic catheterisation matched to 110 709 patients without a history of catheterisation. Patients were followed for a median of 8.8 years (IQR: 5.2–11.9 years). The median age was 62 years (IQR: 50–71) and 52% were female. More patients in the catheter group developed bladder cancer (393 (1.1%) vs 304 (0.3%),p<0.001). There were 106 (0.3%) bladder cancer deaths in the catheter group and 59 (0.1%) in the comparison group (p<0.001). Chronic catheterisation (adjusted subdistribution HR (sdHR)=4.80, 95% CI: 4.26 to 5.42,p<0.001) and the number of UTIs (adjusted sdHR=1.04 per UTI, 95% CI: 1.04 to 1.05,p<0.001) were independent predictors of bladder cancer. The relative rate of bladder cancer-specific death was more than eightfold higher among patients with chronic catheterisation (adjusted sdHR=8.68, 95% CI: 6.97 to 10.81,p<0.001). Subgroup analysis among patients with neurogenic bladder and bladder calculi similarly revealed an increased risk of bladder cancer diagnosis and mortality. Bladder cancer risk was highest among patients in the two longest catheter duration quintiles (2.9–5.9 and 5.9–15.5 years).ConclusionsThis is the first study to quantify the increase in bladder cancer incidence and mortality in a large, diverse cohort of patients with chronic indwelling or intermittent bladder catheterisation. The risk was highest among patients with a chronic catheter beyond 2.9 years.
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Rouf, M. Abdur, Baikaly Ferdous, Abdul Alim Sheikh, M. Ziaur Rahman, Salma Chowdhury, Tanvirul Hasan, and ABM Moniruddin. "Umbolith: A Rare Case of Umbilical Lithiasis in Adult." KYAMC Journal 12, no. 2 (September 6, 2021): 111–13. http://dx.doi.org/10.3329/kyamcj.v12i2.55446.
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A 20-year old non-diabetic non-hypertensive non-smoker male farmer presented with purulent umbilical discharge for one year. He used to live an unhygienic life. He had throbbing pain, intermittent fever preceded by chills and rigors for fifteen days. He was treated with various antibiotics, analgesics, antipyretics for a long time by local physicians. But he was not cured. The umbilical and periumbilical area were found inflamed, edematous and red with a palpable small hard infra umbilical mass. The mass was irreducible, non-pulsatile, non-compressible and not trans illuminating with no visible and no palpable impulse on coughing. Just prior to incision, a probe was introduced through the umbilicus that had not passed beyond the abdominal wall into the peritoneal cavity indicating that it was a sinus and not a fistula.The infra-umbilical smile incision was deepened and a flap was raised upwards until multiple small calculi of variable consistency were found at a depth. These were extracted. The sinus tract and the accompanying small abscess cavity were excised and sent to the laboratory for culture and sensitivity tests, histopathological examination and other relevant tests. The studies revealed Staphylococcus aureus sensitive to gentamycin and amikacin. The histopathological examination revealed acute inflammatory cells with no granuloma and no malignancy. The patient was given parenteral antibiotics as per the sensitivity test result plus metronidazole against possible anaerobic co-infection. The post-operative period was smooth and uneventful. We like to share our experience of managing this very rare disease of umbilical lithiasis. KYAMC Journal.2021;12(02): 111-113
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Dhangar, Sanjay P., Vinayak J. Shenage, and Manisha Shengal. "Various Foreign Bodies Causing Bladder Stones in Females: The Lessons Learnt." New Indian Journal of Surgery 12, no. 2 (June 15, 2021): 33–38. http://dx.doi.org/10.21088/nijs.0976.4747.12221.5.
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Background: Bladder stones are common in males but not so common in females. They account for nearly 5% of the urinary system stone disease. We here share our journey of bladder calculi in female patients and will let you know various foreign bodies that can cause bladder calculus, various treatment modalities that exist to treat them and the lessons that we learnt. Methods: We did a retrospective study from August 2016 to July 2020 at SMBT IMS & RC, Nashik. A total nine patients were included out of the total twentythree bladder stone patients. Diagnostic investigations included X-ray of kidney, ureter and bladder region, ultrasonography of abdomen and pelvis, computed tomography and if needed, cystoscopy before every planned surgical procedure. Results: Nine patients of complicated bladder stone with or without foreign body were treated in the study. Two patients required open surgery. Six patients underwent per urethral cystolithotripsy for their stones and one patient underwent suprapubic percutaneous cystolithotripsy. Psychiatric evaluation was done for one patient. Clean intermittent catheterisation was advised for the neurogenic bladder patient. Conclusion: To find and treat a bladder stone in a female patient is much easy as compared to find out the cause of that stone. The reason being the rarity of bladder calculus in females, more so the secondary calculus. Therefore, whenever you find a bladder calculus in female patient you should find out the cause by taking prior proper history, doing proper clinical examination, ordering relevant investigations and treating them as per the current strategies. Keywords: Bladder calculus females; Foreign body; Calculus over foreign body; Giant bladder calculus; Fragmented D J stent.
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Nuswantoro, Yoga, and Efa Anggraini. "THE SYSTEMATIC REVIEW OF RADIOLOGIC IMAGING IN SUSPECTED RENAL COLIC." Journal of Advanced Research in Medical and Health Science (ISSN 2208-2425) 10, no. 1 (January 9, 2024): 37–44. http://dx.doi.org/10.61841/1q9s5a78.
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Background: Renal colic, a common cause of morbidity, is characterized by acute, intermittent flank pain. Diagnosis involves a combination of history, physical exam, laboratory testing, and imaging studies. In recent years, the assessment of individuals suspected of having renal colic has become increasingly dependent on imaging. Renal ultrasound is not reliable for seeing ureteral calculi and may miss smaller stones. Besides, the use of CT increased radiation exposure and high medical costs. The aim: This study aims to determine the radiologic imaging in patients with suspected renal colic. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like PubMed and ScienceDirect, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Results: In the PubMed database, the results of our search brought up 162 articles, whereas the results of our search on ScienceDirect brought up 135 articles. The results of the search conducted by title screening yielded a total 25 articles for PubMed and 15 articles for ScienceDirect. We compiled a total of 21 papers, 17 of which came from PubMed and 4 of which came from ScienceDirect. We excluded 2 review articles, 4 duplicate articles, 1 non-full text article, 1 article having ineligible subject and 4 articles having insufficient outcomes data. In the end, we included nine research that met the criteria. Conclusion: The use of point-of-care ultrasound (POCUS) in patients with suspected renal colic may avoid the use of CT. Although, the accuracy is lower than CT, but it can reduce medical expense and induced radiation exposure.
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Labib, K. A., and K. Bishay. "A294 CHOLESTASIS SECONDARY TO XANTHOGRANULOMATOUS CHOLANGITIS: A CASE REPORT." Journal of the Canadian Association of Gastroenterology 7, Supplement_1 (February 14, 2024): 238–39. http://dx.doi.org/10.1093/jcag/gwad061.294.
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Abstract Background An 86-year-old female presented with four weeks of intermittent abdominal pain, postprandial nausea with an associated 10 lbs weight loss. Initial labs demonstrated a predominantly cholestatic liver enzyme elevation. Imaging revealed a thickened gallbladder with dilated CBD up to 15mm with no calculi, obstruction or pancreatic mass. EUS demonstrated a prominent ampulla with an area of hyperechogenicity, and ERCP was completed with sphincterotomy and biopsy of the ampulla. A cholangiogram showed a prominent common bile duct and a smooth distal taper without filling defects. Tumor markers, ampullary biopsy, and cytology of CBD brushings were negative for malignancy. Repeat ERCP for non-resolving symptoms with an extension of the sphincterotomy, brushings and insertion of a metal stent was completed without improvement in liver enzymes and a standard hepatitis workup returned negative. Her clinical course was further complicated by recurrent gram-negative bacteremia with CT findings of innumerable abscesses or metastasis in the liver. A US-guided targeted liver biopsy revealed large duct periductal tissue expansion by foamy macrophages with admixed neutrophils, eosinophils, plasma cells, and lymphocytes. These features were consistent with xanthogranulomatous cholangitis. We were planning to start ursodiol given the small duct disease however the patient succumbed to recurrent bacteremia and passed away. Aims Review of methods to attain diagnosis of xanthogranulomatous cholangitis. Methods Case Report. Results Diagnosis of xanthogranulomatous cholangitis can be attained from targetted US-guided biopsy, surgical excision, or EUS-guided CBD biopsy. Conclusions Xanthogranulomatous cholangitis is an extremely rare entity described in limited case reports, frequently mimicking neoplastic disease. Pathology is difficult to attain and historically case reports required surgical resections. One recent case reported diagnosis confirmed via EUS-guided FNA of the CBD. In our case, we attained the diagnosis through a targeted liver biopsy. Pathology of xanthogranulomatous cholangitis typically demonstrates foamy histiocytes, lipid-laden macrophages, eosinophils, lymphocytes, plasma cells, and fibrosis indicating xathogranulomas. The pathogenesis is thought to be an extension of xanthogranulomatous cholecystitis in which bile is extravasated into the gallbladder wall through Rokitansky-Aschoff sinuses or ulceration of the mucosa resulting in an inflammation caused by fibroblasts and macrophages as they phagocytose the lipids in bile, resulting in the formation of xanthoma cells. Given the rarity of the disease, there is no guideline on management and a majority of patients reported underwent surgical excision. This case demonstrates the utility of liver biopsy to establish this rare diagnosis, allowing for better detection and subsequently better-studied management. Funding Agencies None
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Vaidyanathan, S., I. D. Watson, O. Jonsson, A. Z. Buczynski, F. Grases, I. P. Heilberg, T. Yasui, et al. "Recurrent vesical calculi, hypercalciuria and biochemical evidence of increased bone resorption in an adult male with paraplegia due to spinal cord injury: is there a role for intermittent oral disodium etidronate therapy for prevention of calcium phosphate bladder stones?" Spinal Cord 43, no. 5 (January 18, 2005): 269–77. http://dx.doi.org/10.1038/sj.sc.3101713.
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Barroso, Ubirajara, Roman Jednak, Patricia Fleming, Julia Spencer Barthold, and Ricardo Gonzalez. "BLADDER CALCULI IN CHILDREN WHO PERFORM CLEAN INTERMITTENT CATHETERIZATION." Journal of Urology, April 1999, 200. http://dx.doi.org/10.1097/00005392-199904010-00801.
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"Bladder calculi in children who perform clean intermittent catheterization." Journal of Pediatric Surgery 36, no. 1 (January 2001): 248. http://dx.doi.org/10.1016/s0022-3468(01)80068-3.
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Paz, Dean C., Abigael C. Gunther, Michael C. Higham, Lynne G. Stephenson, Anthony J. Laporta, K. Dean Gubler, and Rebecca J. Ryznar. "Exploring the relationship of supernumerary recurrent renal calculi formation and tick-borne infections: a case report." Frontiers in Cellular and Infection Microbiology 14 (January 26, 2024). http://dx.doi.org/10.3389/fcimb.2024.1194307.
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A 51-year-old male with a history of Cacchi-Ricci disease and long-standing infection with various species of Borrelia, Babesia, and Bartonella presented with recurrent symptoms of right-sided flank pain. Numerous renal calculi were identified on imaging. The etiology of the calculi had not been previously elucidated. Symptoms intermittently date back to 2002 when uric acid stones were identified. Subsequent calculi analysis revealed calcium oxalate stones. Despite the commonality of nephrolithiasis in patients with Cacchi-Ricci disease, the extreme number of calculi and recurrent presentation of symptoms persisted despite a plethora of medical evaluations, dietary changes, and hereditary testing. This case raises questions of etiology including possible immune deficiency and whether his uncommon microbial history contributes to recurrent stone formation.
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Fadel, Jonathan, Nadine Akoum, Michele Lodde, and Paul Toren. "Case – Gigantic obstructive calculi in continent urinary diversion." Canadian Urological Association Journal 16, no. 7 (February 28, 2022). http://dx.doi.org/10.5489/cuaj.7698.
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Stone formation is a well-documented, long-term complication after continent urinary diversions, with a reported incidence varying from 30–50%.1 Contributing factors include metabolic abnormalities, urinary stasis, persistent mucus production by the intestinal segment, presence of foreign bodies, recurrent infections, non-absorbable sutures, and poor compliance of patients with clean intermittent catheterization techniques.2,3
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Ecer, Gökhan, Arif Aydin, Mehmet Giray Sönmez, Muzaffer Tansel Kılınç, Selçuk Güven, and Mehmet Balasar. "An overlooked complication of the clean intermittent catheters: prostate calculi." World Journal of Urology, May 15, 2023. http://dx.doi.org/10.1007/s00345-023-04417-9.
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Gracy Sokiya, Divya Sharma, and Gaurav Sharma. "Non-Invasive Ayurvedic Management of Cholelithiasis - A Case Study." AYUSHDHARA, May 10, 2023, 51–54. http://dx.doi.org/10.47070/ayushdhara.v10isuppl2.1217.
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Cholelithiasis or gall stones is one of the most common diseases of biliary tree. Modern medicine majorly relies on surgical management of the disease as conservative treatment is usually futile. Although, Ayurvedic sciences has no mention of gallstones but the contextual representation of stones comes under Bastigata Ashmari (renal calculi). After thoroughly revising Ayurvedic texts, we discover that the bile secreted from gallbladder can correspond to Accha Pitta mentioned in Ayurveda due to its similarity in location and function. Case Report: A 64-year-old male patient approached with complaints of heaviness of abdomen, mild-to-moderate intermittent abdomen pain, nausea and with ultrasonography report which was suggestive of chronic cholecystitis with cholelithiasis measuring 0.44cm. Conclusion: The patient was diagnosed with Pittashmari and Ayurvedic treatment protocol was followed for approx. 2 months resulting in dissolution of stone and relief in signs and symptoms. Hence our article is a step further for understanding and pursuing conventional and non-surgical management of cholelithiasis.
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Ilangovan, S., J. Neves, A. Bex, and M. Tran. "593 Squamous Cell Carcinoma in Renal Pelvis of a Fused Pelvic Kidney; Case Report and Literature Review." British Journal of Surgery 109, Supplement_6 (August 19, 2022). http://dx.doi.org/10.1093/bjs/znac269.379.
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Abstract This case report details a rare case of squamous cell carcinoma present in the renal pelvis of a fused pelvic kidney, a congenital complete renal fusion anomaly. A 52-year-old man with no previous urological history presented with intermittent haematuria and weight loss. He was found to have a large complex mass (14.3 cm×4.5 cm×15.5 cm) in the right moiety of a pelvic fused kidney on CT and subsequently underwent an open hemi-nephrectomy. He recovered well following surgery, however, unfortunately developed rapid recurrence, and died from disease progression after 6 months. This report demonstrates the use of 3D anatomical reconstruction to help pre-operative planning of complex surgical cases. We also include histological analysis of the tumour in detail. This case report emphasises that squamous cell carcinoma can occur due to precipitating factors such as renal calculi or infection, which are more prevalent in fusion anomalies of the kidney. Although a rare malignancy, this tumour type is associated with an aggressive behaviour and poor prognosis.
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Diplomatico, Mario, Pierluigi Marzuillo, Daniela Capalbo, Michela Stanco, Rosaria Marotta, and Stefano Guarino. "Twelve-year-old boy presenting with recurrent abdominal pain and 25 urinary calculi." Archives of disease in childhood - Education & practice edition, September 15, 2018, edpract-2018-315073. http://dx.doi.org/10.1136/archdischild-2018-315073.
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A 12-year-old boy, with intermittent abdominal pain from 3 years of age, presented with increased frequency of right lower quadrant pain (at least three episodes per week over the past six months) and pain during micturition affecting school attendance. His family history included referred urolithiasis. An abdominal ultrasound performed 1 year before our visit showed a small stone of 4 mm in the right renal pelvis for which he did not receive any therapy. The patient brought 25 hard stones with irregular outline, 2–8 mm in diameter, of deep brown/grey colour that he claimed to have found in his underwear (figure 1). On examination, he looked well with normal vital signs and unremarkable cardiorespiratory and abdominal examinations. Plasma creatinine was 0.41 mg/dL (36.1 μmol/L), urinalysis and urine tests were all normal (including 24 hour calcium, phosphorus, oxalate, citrate, uric acid and cystine). Repeat kidney and urinary tract ultrasound showed no evidence of calculi.Figure 1Twenty-five hard formations brought along by the patient from home.Question 1Which is the most likely diagnosis?Cystinuria.Dent disease.Idiopathic urolithiasis.Factitious disorder imposed on self.Familial hypomagnesemia with hypercalciuria and nephrocalcinosis.Question 2How would you confirm your diagnostic suspicion?Reassurance and clinical follow-up.Mass spectrometry of stones.CT urography.Increase oral fluid intake and administration of potassium citrate.Question 3How would you manage this condition?Administration of placebo.Psychological consultation.Observed 24 hour urine collection.All of the above.Answers can be found on page 2.
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B, Rajanna, Shivakumar T, Muralidhar B R, and Sachin Sachin. "A PROSPECTIVE STUDY ON THE MANAGEMENT OF UPPER URETERIC CALCULI AT A TERTIARY CARE CENTRE." INDIAN JOURNAL OF APPLIED RESEARCH, June 1, 2023, 11–13. http://dx.doi.org/10.36106/ijar/2705874.
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Background: Various options are available for the management of ureteric colic, including conservative management, medical expulsion therapy, and surgical intervention. Primary management of ureteric stones is dependent on various factors, including patient presentation, clinical assessment, and stone characteristics. In the present study, we evaluated and managed all the upper ureteric calculi with respect to feasibility of various procedures, clearance of the stones and their complications. A cross- Methods: sectional study was conducted among 70 patients > 12 years of age with upper ureteric calculi attending Hassan institute of medical sciences, Hassan. All Procedure related complications & side effects during admission & follow-up were documented. 33 (42.9%) patients Results: underwent URSL(Pneumatic) and 33(42.9%) underwent Laser URSL. During guidewire insertion under uoroscopic guidance using cystoscope, the stones were dislodged and migrated in 7 patients and among them 5(6.5%) in ICL (Pneumatic with ureteroscopy) and 2(2.6%) in Laser ureteroscopy procedure. The migrated stone treated with PCNL/RIRS depending upon the size of stones. Stone fragments were migrated in 2 patients who underwent Pneumatic ICL lithotripsy and 1(1.3%) in patients who underwent Laser lithotripsy and it is conrmed byuoroscopy. In 4 (5.2%) of our patient's stones were impacted and large (>20mm) and guidewire could not be negotiated across the stone and hence Ureterolithotomy (Open /Lap) performed and other 2 (2.6%) of our patients did not accept invasive procedures and hence underwent ESWL and 5 (6.5%) were treated medically. In medical treatment, all the patients advised to take Tamsulosin 0.4 mg HS & NSAID'S for 4 weeks and advised to drink water >3.5 litre orally so as to achieve 2.5 litre of urine output. 2(2.6%) patients could not complete the course because of intermittent pain, so they advise URSL, remaining 2 patients completed the course but there was no clearance of the stone, NCCT KUB done and advised for denitive treatment. Stone clearance was higher in LAP/OPEN Conclusion: ureterolithotomy, Laser Lithotripsy. However, the difference in stone clearance rate between various procedures was not signicant. It can be stated that non-invasive procedures are as effective as open surgeries. However, selection of treatment should be based upon the factors such as size, location, Hounseeld units and others which can optimize the outcome for patients who have upper ureteral calculi.
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Brighouse, James, and Vinay Shivamurthy. "O20 Approach to parotid swelling." Rheumatology Advances in Practice 5, Supplement_1 (October 1, 2021). http://dx.doi.org/10.1093/rap/rkab067.019.
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Abstract Case report - Introduction The rarity of paediatric salivary gland disease and the lack of pathognomonic signs are likely to contribute to delay in diagnosis and make a structured approach to parotid swelling particularly important. Here we discuss a case of a 4-year-old girl with recurrent parotid swelling and some features to suggest multisystem involvement. Case report - Case description A partially immunised, 4-year-old girl with a history of eczema and vitiligo presented with a 3-month history of intermittent painless pre-auricular swelling. She had 2 days of fever at onset but was otherwise afebrile. She reported intermittent joint pain without swelling. There was no cough, coryza, sore throat, dryness of the mouth or eyes, rash, systemic upset, and no other evidence of multisystem involvement on systems review. She had no unwell contacts and no family history of autoimmune disease. On examination she had bilateral pre-auricular swelling which was non-tender, not fluctuant, and had no overlying skin changes. No calculi were identified on bimanual palpation of the parotid ducts and no pus was visible at the opening. Respiratory, cardiovascular, abdominal, musculoskeletal, and skin examination were unremarkable. Her bloods showed microcytic anaemia, raised ESR (peak 97mm/hr), CRP (peak 30mg/l), CK (peak 628 IU/l), and LDH (peak 512 IU/l), but normal ferritin and ACE. Serology showed ANA 1/10240, RNP Ab positive, negative myositis specific ENA, dsDNA, and rheumatoid factor, and normal complement. Infection screen, including TSpot, and screening for immunodeficiency were negative. Her urine dipstick was normal. Interferon signature was abnormal with very high levels. Parotid ultrasound scan showed heterogenous enlargement of all major salivary glands and lacrimal glands with reactive cervical lymph nodes. CT chest demonstrated basal ground-glass change and hilar, mediastinal, and axillary lymphadenopathy. Parotid biopsy was normal on two occasions, with no evidence of lymphoma or granulomatous disease. At this stage she was treated for undifferentiated autoimmune connective tissue disease with steroids and mycophenolate mofetil. Due to the lack of improvement and persistently mildly elevated CK and LDH, MRI thighs was subsequently performed. This demonstrated mild myositis prompting a muscle biopsy which showed typical features of juvenile dermatomyositis. She was therefore commenced on intravenous immunoglobulin and subcutaneous methotrexate. Case report - Discussion This is an unusual presentation of juvenile dermatomyositis with no typical clinical features of skin or muscle involvement, negative myositis ENA, and only mildly elevated CK, where parotitis was the main presenting feature. Despite a dramatic reduction in mumps following routine immunisation, viral adenitis remains the most common cause of parotid swelling. The most prominent features are unilateral or bilateral parotid swelling with fever and headache and, unlike this case, typically resolve in 1—2 weeks. Bacterial adenitis may be suggested by erythema and purulent secretions and may be precipitated by preceding viral sialadenitis, dehydration, or damage by calculi. Obstruction and inflammation caused by calculi, sialolithiasis, are suggested by pain with meals and almost complete resolution in between. A single short episode of parotid swelling without multisystem involvement will most commonly be caused by one of the above and would not require extensive investigation. Management consists of one or more of: ensuring adequate hydration, warm compresses, analgesia, salivary gland massage, sialagogues, antibiotics, and safety netting advice. More prolonged painful swelling despite sialagogues and antibiotics would warrant sialography to look for calculi, and prolonged painless swelling, particularly with the presence of any red flags, should prompt investigation for tumours or haematological malignancy. Only in recurrent, treatment refractory episodes, or, in cases such as this, where a thorough history and examination suggest multisystem involvement, would more extensive investigation be warranted to look for inflammatory causes of parotitis. Case report - Key learning points The differential diagnosis for parotid swelling is broad so a structured approach is essential. Extent of investigation should be guided by the history, particularly the clinical course and the evidence of multisystem involvement. It may be reasonable not to investigate at all in cases of isolated resolved or resolving parotid gland swelling without systemic upset and normal systems review. Where there are features to suggest multisystem disease, early referral to rheumatology for further investigation and treatment is needed.
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Kamil, Shireen Sabah, ImadHadi Hameed, and Lena Fadhil Hamza. "Acoruscalamus: Parts used, Insecticidal, Anti-Fungal, Antitumour and Anti-Inflammatory Activity: A Review." International Journal of Pharmaceutical Quality Assurance 8, no. 03 (September 27, 2017). http://dx.doi.org/10.25258/ijpqa.v8i03.9578.
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Acoruscalamusis a herb used for the appetite and as an aid to the digestion. It is used for fevers, stomach cramps and cholic. Their rhizomes were used for toothache and powdered rhizome for congestion. The rhizome part is also used to treat several diseases like asthma and bronchitis and as sedative. Native tribes treated cough by making a decoction of the plant as a carminative and also for cholic. It is a main medhya drug, which has the property of improving the memory power and intellect. Acoruscalamusis used in the conditions of vata and kapha, stomatopathy, hoarseness, flatulence, dyspepsia, helminthiasis, amenorrhea, dysmenorrheal, nephropathy, calculi, stragury.Acoruscalamusleaves, rhizomes and its essential oil has many biological activities16 like antispasmodic, carminative and also used for treatment of epilepsy, mental ailments, chronic diarrhea, dysentery, bronchial catarrh, intermittent and tumors. It also has the insecticidal, antifungal, antibacterial, tranquilizing, antidiarrhoeal, antidyslipidemic, neuroprotective, antioxidant, anticholinesterase, spasmolytic, vascular modulator activities. The parts used in most of the experimental studies are the leaves, roots and stem of the plant. The dry rhizome contains some of the yellow aromatic oil, calamus oil that are responsible for their medicinal and insecticidal properties. Studies were also done on their rhizome part and in its oils in order to identify the active constituents and its medicinal values.
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Khan, Naeem Ahmad, Nasir Raza Zaidi, Saleem Qureshi, Qamar Sardar Sheikh, and Nadeem Waraich. "Mucocele of Appendix." Annals of King Edward Medical University 9, no. 4 (July 14, 2016). http://dx.doi.org/10.21649/akemu.v9i4.1360.
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A 55 years old patient presented with pain in the right lumber region/Right iliac fossa for last two months. He also complains of fever off and on for last 2-3 months. He got intermittent treatment from one of the rural health centre in Manga Mendi Lahore. On examination in surgical emergency there was a mobile mass felt in the right iliac fossa. On abdominal ultrasound there was a long 11 X 5 cm well defined tubular mass with blind end is seen in the right iliac fossa. The mass is mobile while pressing with the ultrasound probe. This tubular structure shows typical Onion skin appearance. There was no evidence of any free fluid in the vicinity & in pelvis. No evidence of enlarged mesenteric lymph nodes noted in Right Iliac fossa. This tubular mass was clearly separated from the iliac vessels & ileal loops. Other findings on ultrasound was bilateral multiple renal cysts and two calculi impacted in the right utero-vesical junction with mild to moderate retrospective obstructive uropathy. The diagnosis on ultrasound was Mucocele of Appendix. On surgery there was large 11-12 cm tubular mass seen in the right iliac fossa which is freely mobile. The mass was surgically removed. On dissection there was whitish thick secretion seen coming out of the tubular mass. On histopathology Mucocele of appendix is confirmed
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Nizam, Sharmin. "P13 Finding an answer for an adolescent with back pain." Rheumatology Advances in Practice 5, Supplement_1 (October 1, 2021). http://dx.doi.org/10.1093/rap/rkab068.012.
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Abstract Case report - Introduction This is the case of an adolescent referred to rheumatology following 5 years of back pain. After years of trying a number of treatments without much success, the cause was found to be a previously undiagnosed urological pathology. The case highlights awareness of non-rheumatological causes and incidental findings which can redirect a patient towards more appropriate treatment and reduce the potential for long-term adverse health issues and anxiety. Case report - Case description B was referred age 16 to rheumatology with a 5-year history of lower back pain. She had previously seen paediatricians with symptoms initially attributed to constipation due to intermittent straining and hard stool. However, constipation remedies had not relieved the pain which progressed gradually to a more persistent dull ache with impact on daily activities. Various analgesics (including paracetamol and non-steroidal anti-inflammatories), exercises and acupuncture had not helped. There was no history of recurrent urinary tract infections or symptom correlation with fluid intake, menstruation or bowel habit. No inflammatory features or connective tissue disease symptoms were noted and family history was unremarkable Clinical examination was normal apart from mild tenderness in the lumbar region. Rheumatoid factor was borderline positive (15 iu/mL) with the rest of blood tests normal including renal function, inflammatory markers (CRP, ESR), anti CCP and ANA. She had minimal microscopic haematuria without proteinuria. MRI spine in 2015 was normal. In view of her young age and symptoms affecting daily activities, STIR sequence spinal MRI was requested. This excluded any new or old inflammatory changes but incidentally identified a dilated left pelvi-calyceal system. Renal ultrasound confirmed a grossly hydronephrotic left kidney with hydroureter and minimal renal tissue suggesting longstanding obstruction. No calculi were seen. The patient was referred to urologists. Further investigations (including MRI abdomen) confirmed similar findings and a distal ureteric stricture. A MAG 3 renogram showed a normal right kidney but only 12% functioning of the left kidney. Urologists have advised surgery (removal of left kidney and ureter) which may relieve symptoms or a conservative non-surgical approach (continue analgesia, physiotherapy and monitoring). The patient and her family are relieved to have a possible cause identified and are considering the surgical option due to ongoing flank discomfort. Case report - Discussion This was an interesting finding of hydroureter and hydronephrosis causing longstanding back pain presenting to rheumatologists. Until completion of the spondyloarthropathy protocol MRI (STIR images), aetiology had been unclear. Hydronephrosis and hydroureter has no specific age or racial predilection. Signs and symptoms may depend on whether obstruction is acute/chronic. Chronic cases may be asymptomatic or present as a dull discomfort (like this case). Some cases may only present in adulthood with pain precipitated by fluid intake. Blood tests may show impaired kidney function. Post-mortem studies suggest 50% of people have at least one renal abnormality (e.g., renal cysts, duplex ureters) with autopsy series incidence of hydronephrosis reported as 3.1%. Causes include anatomical abnormalities such as vesico-ureteric reflux, urethral strictures (usually present in childhood), calculi, benign prostatic hyperplasia, or intrapelvic neoplasms, pregnancy and infections (e.g., TB). Sudden onset unilateral renomegaly was reported in one case of primary Sjogren’s with lymphocytic interstitial nephritis and positive Sjogren’s autoantibodies. Our patient has no clinical or serological evidence of connective tissue disease. Minor pelvi-calyceal distension can occur as a normal finding in well-hydrated patients and pregnancy. However, significant hydronephrosis requires assessment to determine cause as it may affect long term renal function. Imaging via computed tomography, ultrasound and urograms can help guide further management. In this case the preceding cause and duration of pathology is unknown. Sterile, giant hydronephrosis treatment options include observation and ureteric stent or nephrostomy in patients unfit for surgery. Nephrectomy is advised for pain and recurrent infection in a non-functioning kidney. Complications may include bowel perforation, vascular injury and urine leakage. Both open and minimally invasive procedures have good reported outcomes. The COVID-19 pandemic and exams have affected timing of any elective procedures and the patient understands surgery may or may not offer complete symptom resolution. Case report - Key learning points
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Syrimi, Zoe, Susannah Brockbank, Alastair Scott, and Julie Dawson. "OA13 Trust your gut: it has the answer." Rheumatology Advances in Practice 8, Supplement_1 (November 1, 2024). http://dx.doi.org/10.1093/rap/rkae117.013.
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Abstract Introduction We report the case of a 51-year-old man who presented over seven years to multiple specialities, including rheumatology on several occasions, with arthralgia, fevers and weight loss. He was found to have raised inflammatory markers, lymphadenopathy and pericardial and pleural effusions but despite extensive investigation over this time, the cause for his presentation remained elusive. After many years, he developed gastrointestinal symptoms, which led us to the unifying diagnosis of Whipple’s disease. Case description This patient initially presented to rheumatology in 2017 with left ankle pain. His only medical history was renal calculi. He was diagnosed with gout and osteoarthritis and was discharged. Two years later, he presented with fevers. Investigations revealed raised inflammatory markers, small pericardial and pleural effusions and small-volume upper abdominal lymphadenopathy. He was treated with colchicine for pericarditis with some improvement. He presented again in 2021 with chest and flank pain and breathlessness. CTPA revealed an ongoing small pericardial effusion and small-volume intrathoracic and intra-abdominal lymphadenopathy. Inflammatory markers remained raised (CRP 30-50, ESR 20-30). He had now begun to lose weight. He was referred to the cancer of unknown primary service, who monitored his lymphadenopathy. In January 2022, he underwent an open biopsy of a mesenteric lymph node, which revealed non-caseating granulomas and no evidence of malignancy. He was referred again to rheumatology due to ongoing migratory joint pains in his wrists, ankles and knees. Rheumatoid factor, anti-CCP, antinuclear antibody and serum ACE had been negative on several occasions. He underwent a PET scan that revealed persistent lymphadenopathy with low to moderate avidity, borderline splenomegaly and a slightly prominent marrow signal. He then had a bone marrow biopsy that showed no significant abnormality. In December 2023, we settled on a probable diagnosis of sarcoidosis. He was treated with a trial of steroid without much symptomatic improvement and there was a plan to initiate Methotrexate. However, he then developed nausea and vomiting and was noted to have a new iron deficiency anaemia. He was referred to gastroenterology and underwent an upper endoscopy, which was macroscopically normal, but microscopically showed findings in keeping with Whipple’s disease (WD) with PAS-positive staining. Duodenal biopsy PCR confirmed this. He is now awaiting input from the infectious diseases team and long-term antibiotic treatment. Discussion WD is caused by the bacterium Tropheryma whipplei. There are four commonly recognised manifestations of T. whipplei infections: 1) classic WD, 2) localised chronic infections, 3) acute infections and 4) asymptomatic carriage. Our patient has classic WD, and his case exemplifies the disease course and diagnostic challenges. Classic WD is a rare, chronic, multisystem infectious disease. It is reported as most often affecting middle-aged white males of European ancestry. It can be divided into an early phase with intermittent arthralgias or arthritis and fever, a middle phase with gastrointestinal symptoms and weight loss, and a late phase with predominant neurological symptoms. Arthritis is the presenting symptom in 60-70% of cases and occurs in 90% of all cases. Given this, around half of patients are initially misdiagnosed as having an inflammatory rheumatic disease. As in the case of our patient, joint manifestations do not correlate with intestinal symptoms and can precede intestinal manifestations by a mean interval of six years. Joint involvement in WD is typically a migratory oligo- or polyarthritis or arthralgia primarily involving large and medium joints, most commonly the knees, ankles and wrists. Less commonly affected joints are elbows, hips and shoulders. WD should be considered in all patients with the four cardinal symptoms of arthralgias, diarrhoea, abdominal pain, and weight loss after more common differentials have been excluded. In patients without gastrointestinal symptoms, having suspicion of the disease is more difficult; however, consideration should be made in patients with seronegative arthritis, who do not respond to immunosuppressive treatment. Other clinical syndromes in which WD should be considered include fever of unknown origin, chronic serositis, generalised lymphadenopathy, progressive central nervous system disease or early onset cognitive deficits. Although histology revealing non-caseating granulomas is the hallmark of sarcoidosis, they are non-specific and can be found in many other diseases. Key learning points • WD has a reputation as a great mimicker of many diseases and there is still often a considerable delay to diagnosis, even in typical cases, given the natural history of the disease and its rarity. WD should be considered in patients with seronegative arthritis not following a typical disease course, particularly if they develop gastrointestinal symptoms. WD is also a pertinent differential in patients with persistent constitutional upset with unexplained lymphadenopathy or serositis. It should be remembered that non-caseating granulomas can be found in many diseases and that sarcoidosis remains a diagnosis of exclusion among granulomatous disorders.
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"Installation classée implantée en face de propriétés privées. Nuisances sonores diurnes et nocturnes (bruit de ventilation). Action en responsabilité de deux voisins fondée sur l’existence d’un trouble anormal de voisinage. Intervention d’un expert judiciaire. Mesure des seuils de niveau limite admissible ou d’émergence par rapport au niveau sonore initial (arrêté du 20 août 1985 modifié par l’arrêté du 23 janvier 1997). Modalités de calcul de l’émergence sonore. Bruits intermittents à intégrer (non). Dépassement du seuil de 3 décibels A : présomption de nuisances sonores. Nuisances sonores excessives et persistantes excédant les inconvénients normaux de voisinage. Obligation pour la société de faire procéder à des travaux sous astreinte. Indemnisation du préjudice des propriétaires voisins. Cour d’appel de Dijon, Ch. civ., 8 décembre 2009, SAS RHOVYL." Revue Juridique de l'Environnement 35, no. 2 (2010): 285–89. http://dx.doi.org/10.3406/rjenv.2010.5288.
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