Unusual clinical scenarios in Urology and Andrology

This collection includes some unusual cases and how they were diagnosed and treated. Case 1: A case of a patient with primary hyperthyroidism presenting with a submucosal ureteral stone after endoscopic lithotripsy was described. After multiple endoscopic treatment, the stone was successfully removed by open ureterolithotomy recovering ureteral patency and normal renal function. Case 2: A case of burned-out testicular cancer with atypical lymphatic spread (stage II A) was presented. After right orchiectomy and complete remission of tumor markers, due to atypical metastases location and uncertain histology, the patient was treated with systemic therapy based on bleomycin, etoposide and cisplatin (PEB). At re-staging after chemotherapy computed tomography showed reduction of all node metastases and an observation protocol was proposed. Case 3: A patient was readmitted to hospital after 12 days from an uneventful Robot-Assisted Radical Prostatectomy (RARP) for prostate cancer due to lower abdominal pain plus abdominal distension, nausea and constipation not responsive to medical therapy. Computed Tomography showed colon and small bowel dilatation without any evidence of anatomical or mechanical obstruction. Laparoscopic abdominal exploration confirmed bowel distension without evidence of obstructing lesions. Ogilvie’s Syndrome or acute colonic pseudo-obstruction (ACPO) was diagnosed. The patient fully recovered and was discharged six days after the procedure. Case 4: A case of recurrent Acute Idiopathic Scrotal Edema (AISE) was diagnosed on clinical signs together with the decisive help of pathognomonic ultrasound findings as the “fountain sign”. Case 5: Small bilateral testicular nodules were diagnosed in a 30-years old patient undergoing scrotal ultrasound in follow up of acute lymphoblastic leukemia. Ultrasound guided testis sparing surgery was performed demonstrating Leydig cell tumors.

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An Invasive Hemolymphangioma of the Pancreas in a Young Woman

Combinatorial Chemistry & High Throughput Screening ◽

10.2174/1386207322666190103110747 ◽

2019 ◽

Vol 21 (10) ◽

pp. 798-800 ◽

Cited By ~ 1

Author(s):

Zhijun Zhang ◽

Qinghong Ke ◽

Weiliang Xia ◽

Xiuming Zhang ◽

Yan Shen ◽

...

Keyword(s):

Computed Tomography ◽

Case Report ◽

Young Woman ◽

Benign Tumor ◽

Abdominal Distension ◽

Accurate Diagnosis ◽

Cystic Tumor ◽

Rare Benign Tumor ◽

Radical Surgical Resection

Background: Hemolymphangioma is a rare benign tumor. To the best of our knowledge, there were only 10 reports of this tumor of the pancreas until March 2018. Case Report: Here, we reported a large invasive hemolymphangioma of the pancreas in a young woman with a complaint of abdominal distension and an epigastric mass about 3 weeks. She was found to have a huge multilocular cystic tumor at the neck and body of pancreas on computed tomography. She was eventually diagnosed with hemolymphangioma of the pancreas after operation. After 2 years of follow-up, there was no signs of recurrence. Conclusion: From our case and literature, we can conclude that hemolymphangioma of the pancreas is uncommon benign tumor, and it is hard to make an accurate diagnosis preoperatively. Radical surgical resection should be performed whenever possible. The prognosis of this disease seems good.

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Radiographic Assessment of Dogs with Congestive Heart Failure

Indian Journal of Animal Research ◽

10.18805/ijar.b-4352 ◽

2021 ◽

Author(s):

N. Saini ◽

S.K. Uppal ◽

A. Anand

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Dilated Cardiomyopathy ◽

Clinical Signs ◽

Abdominal Distension ◽

Cardiac Insufficiency ◽

Exercise Intolerance ◽

Pulmonary Vasculature ◽

Non Invasive ◽

Valvular Diseases

Background: Radiography is widely used for diagnosis of congestive heart failure as it enables non-invasive assessment of cardiac size, shape and pulmonary vasculature. So, the present study was conducted to record the radiographic changes in dogs with congestive heart failure.Methods: Fifty-one dogs with cardiac insufficiency brought to Teaching Veterinary Hospital of GADVASU, showing one of the clinical signs of chronic cough, dyspnea, exercise intolerance, abdominal distension, syncope and cyanosis were selected and were subjected to Lateral and Ventro-dorsal chest radiography. Result: Dilated cardiomyopathy was present in 24 dogs. Radiographically, pulmonary edema, cardiomegaly, vessel congestion were more common in dilated cardiomyopathy (DCM). Valvular diseases were present in 16 dogs and radiographically left atrial (LA) dilatation was present in dogs with valvular diseases. Pericardial effusions were present in 11 dogs showing enlarged globoid heart radiographically.

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Solitary staphylococcal liver abcess in a neonate

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v14i3.23477 ◽

2015 ◽

Vol 14 (3) ◽

pp. 299-301

Author(s):

Suman Das ◽

Dilip Kumar Paul ◽

Anish Chatterjee ◽

Sumantra Raut

Keyword(s):

Computed Tomography ◽

Medical Science ◽

Abdominal Distension ◽

High Fever ◽

Percutaneous Aspiration ◽

Intravenous Antibiotics ◽

Right Lobe ◽

Sepsis Screen ◽

The Right

A 28 days old neonate presented with high fever, abdominal distension, poor feeding and lethargy. Sepsis screen was positive; ultrasound and computed tomography of the abdomen demonstrated a multiloculated hepatic abcess in the right lobe of the liver. The baby was treated with intravenous antibiotics for 6 weeks and percutaneous aspiration of the abcess, resulting in excellent recovery.Bangladesh Journal of Medical Science Vol.14(3) 2015 p.299-301

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Cerebral Cavernous Hemangioma in a Dog

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.97398 ◽

2019 ◽

Vol 47 ◽

Author(s):

Viviane Motta dos Santos Moretto ◽

Luciana Maria Curtio Soares ◽

Esthefanie Nunes ◽

Uiara Hanna Araújo Barreto ◽

Valéria Régia Franco Sousa ◽

...

Keyword(s):

Computed Tomography ◽

Endothelial Cells ◽

Cavernous Hemangioma ◽

Clinical Signs ◽

Ct Scanning ◽

Ct Scans ◽

Elastic Fibers ◽

Post Contrast ◽

The Right ◽

The Brain

Background: Cerebral cavernous hemangioma is a rare neoplasm of vascular origin in the brain, characterized by abnormally dilated vascular channels surrounded by endothelium without muscle or elastic fibers. Presumptive diagnosis is performed by magnetic resonance or computed tomography (CT) scanning and can be confirmed by histopathology. The prognosis of intracranial cavernous hemangioma is poor, with progression of clinical signs culminating in spontaneous death or euthanasia. The purpose of this paper is to report a case of cerebral cavernous hemangioma in a dog, presenting the clinical findings, tomographic changes, and pathological findings.Case: This case involved a 2-year-old medium sized mixed breed female dog presenting with apathy, hyporexia, ataxia, bradycardia, dyspnea, and seizure episodes for three days. Hemogram and serum biochemistry of renal and hepatic function and urinalysis did not reveal any visible changes. CT scanning was also performed. The scans revealed a hyperdense nodule of 15.9 x 14 mm, with well defined borders, and a hypodense halo without post-contrast enhancement and mass effect in the right parietal lobe was observed in both transverse and coronal sections. Based on the image presented in the CT scans, the nodule was defined as a hemorrhagic brain lesion. The animal died after a seizure. The right telencephalon was subjected to necropsy, which revealed a reddish-black wel-defined nodule 1.7 cm in diameter extending from the height of the piriform lobe to the olfactory trine at the groove level and extending towards the lateral ventricle, with slight compression and deformation of the thalamus but no other macroscopic alterations in the other organs. The histopathology indicated that this nodular area in the encephalus contained moderate, well-delimited but unencapsulated cellularity, composed of large vascular spaces paved with endothelial cells filled with erythrocytes, some containing eosinophilic fibrillar material (fibrin) and others with organized thrombus containing occasional neutrophil aggregates. The endothelial cells had cytoplasm with indistinct borders, elongated nuclei, scanty crust-like chromatin, and cellular pleomorphism ranging from discrete to moderate, without mitotic figures.Discussion: The histological findings characterized the morphological changes in the brain as cavernous hemangioma, and the growth and compression of this neoplasm were considered the cause of the clinical signs of this dog. The main complaint was seizures, although ataxia and lethargy were also noted. These clinical signs are often related to changes in the anterior brain and brainstem. The literature does not list computed tomography as a complementary diagnostic method in cases of cerebral cavernous hemangioma in dogs, but CT scanning was useful in confirming cerebral hemorrhage. The main differential diagnosis for cerebral cavernous hemangioma would be a hamartoma, but what differentiates them histologically is the presence of normal interstices between the blood vessels, since no intervening neural tissue occurs in the case of cerebral hemangioma. Therefore, even in the absence of immunohistochemistry to more confidently confirm a cavernous hemangioma, the clinical signs, CT scans and especially the pathological findings were consistent with a case of cerebral cavernous hemangioma, a benign neoplasm with a poor prognosis due to the severe neurological changes it causes and its difficult treatment.

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Meckel’s diverticulum with intraperitoneal hemorrhage in a child detected with screening laparoscopy: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01347-9 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Kazuki Wakizaka ◽

Lee Wee Khor ◽

Kazuya Annen ◽

Tsuyoshi Fukushima ◽

Mitsuko Furuya ◽

...

Keyword(s):

Abdominal Pain ◽

Gastric Mucosa ◽

Meckel’S Diverticulum ◽

Lower Abdominal Pain ◽

Abdominal Distension ◽

Small Bowel Resection ◽

Massive Bleeding ◽

Meckel's Diverticulum ◽

Ectopic Gastric Mucosa ◽

Intraperitoneal Hemorrhage

Abstract Background The most common presentation of symptomatic Meckel’s diverticulum (MD) are intestinal obstruction, gastrointestinal hemorrhage, and inflammation of the MD with or without perforation. Intraperitoneal hemorrhage because of MD is extremely rare. We report a case of MD with intraperitoneal hemorrhage in a child detected with screening laparoscopy. Case presentation An 11-year-old girl presented to another hospital with lower abdominal pain and vomiting that lasted for 2 days. Acute appendicitis was suspected, and she was referred to our department. Abdominal enhanced computed tomography showed an abscess in the lower abdomen with ascites in the pelvis. She was diagnosed with a localized intra-abdominal abscess and the decision was made to treat with antibiotics. However, her abdominal pain worsened, with abdominal distension, tenderness and guarding. She was diagnosed with panperitonitis and the decision was made for surgery 5 h after admission. During surgery, laparoscopic observation from the umbilical region revealed 200 ml of fresh blood throughout the peritoneal cavity, originating from the mesentery of the ileum. MD was observed with bleeding from the surrounding mesentery. Small bowel resection was performed, and the patient was discharged on the 5th postoperative day. Pathological findings revealed an MD containing ectopic gastric mucosa and small intestinal ulcer perforation at the base of the MD. Conclusions We report an extremely rare case of an MD with intraperitoneal hemorrhage in a child. In pediatric cases, it is possible that perforation with ectopic gastric mucosa may cause massive bleeding because of rupture of the surrounding mesenteric blood vessels.

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ADENEXAL CYSTS

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.01.1855 ◽

2011 ◽

Vol 18 (01) ◽

pp. 32-40

Author(s):

TEHREEN RIAZ ◽

SARWAT JABEEN ◽

WASEEM TALIB ◽

Nabeela Shami

Keyword(s):

Demographic Data ◽

Lower Abdominal Pain ◽

Abdominal Distension ◽

Exploratory Laparotomy ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Ovarian Tumour ◽

Risk Of Malignancy ◽

Histopathologic Evaluation ◽

Operative Findings

Objectives: (1) To evaluate the risk of malignancy in surgically removed ovarian cysts that was before the operation neither simple nor complex. (2) To determine the relationship of age with type of ovarian tumour. (3) To categorize the management of these cases according to the intra-operative findings. (4) To analyze the occurrence of various histopathological types of tumour. Date Source: Medline Study Design: Single centered prospective descriptive study of 150 cases. Place and Duration of Study: Department of Obstetrics and Gynaecology at Shaikh Zayed Hospital Lahore from 1st July 2005 to,31st December 2006. Subject and method: 150 patients presented with adnexal cysts on preoperative ultrasonography, peroperative findings and histopathology reports. These patients were followed up in OPD. Results: Showed the distribution of non-neoplastic and neoplastic tumours which were 84% and 16% respectively. The occurrence of malignancy increased with advancing age especially after 45 years Common presentations were lower abdominal pain (53%) followed by menstrual disturbances (30%), abdominopelvic mass, abdominal distension and infertility. Risk of malignancy also increased with parity. 73% masses were unilateral, 84% benign masses were unilocular whilst 85% malignant masses were echogenic and the complex cysts with papillary projection and multiloculations showed 3-6 times higher risk of malignancy. Most patients were managed by exploratory laparotomy. Cystectomy and total abdominal hysterectomy were the commonest procedures performed. Regarding histopathologic evaluation 40% patients had tumours, 2.66% borderline malignancy and 13.3% malignant. 44% had non-neoplastic lesions. Serous and endometriotic cysts were the commonest benign histopathologic types and among malignant ones, epithelial ovarian tumours were the leading variants. Conclusions: Preoperative characterization of adnexal masses using sonographic and demographic data may have considerable potential in determining risk of malignancy and may be advantageous in terms of counseling patients for management.

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Chemotherapy induced liver toxicity in children with malignant diseases

Bulletin of Medical Sciences ◽

10.2478/orvtudert-2018-0002 ◽

2018 ◽

Vol 91 (1) ◽

pp. 37-41

Author(s):

Horváth Adrienne ◽

Papp Zsuzsanna Erzsébet

Keyword(s):

Liver Injury ◽

Maintenance Therapy ◽

Esophageal Varices ◽

Liver Toxicity ◽

Lymphoblastic Leukemia ◽

Treatment Options ◽

Clinical Signs ◽

Treatment Strategies ◽

Malignant Diseases ◽

Drug Induced

Abstract A broad spectrum of chemotherapy is being used in the therapy of childhood cancers, which may induce liver injury, impairing quality of life and efficacy of the treatment. History of, especially viral, liver diseases may increase toxicity. The aim of the paper is to assess the incidence, type and grade, predisposing factors and treatment options of drug-induced liver injury in children with malignant diseases under cytostatic therapy at the Hemato-Oncology Department of the Pediatric Clinic 2 from Targu-Mures, over a time period spanning from 2012 to 2017. The results of the study may serve as a foundation for such treatment strategies which would enable optimal outcomes with fewer cases of liver toxicity. During this period, we treated 26 patients with acute lymphoblastic leukemia (ALL), two patients with acute myeloblastic leukemia (AML), one patient with lymphoma and seven with solid tumors. We found liver toxicity in 77% of the patients treated for ALL, mainly during the maintenance therapy (65%) with oral 6-mercaptopurine and methotrexate. The most common clinical signs were anorexia, nausea, vomiting, abdominal pain and faltering weight gain. Cholestasis developed in two patients, while hepatocytolysis was the most common observed event (n = 24). Liver fibrosis, hypersplenism, portal hypertension and esophageal varices were found in two patients. One patient required endoscopic ligation of esophageal varices. Elevation of serum bilirubin appeared in two patients, while hypoproteinemia was observed in nine patients. None of the patients developed acute liver failure. We treated liver toxicity with hydration, alkalinization, i.v. Aspatofort, Aminosteril-N Hepa 8%, oral acetylcysteine, silymarin, ursodeoxycholic acid, Liv-52, Sargenor, and Essentiale forte. We found hepatotoxicity in 77% of the ALL patients undergoing chemotherapy, similar results have been published by other authors. Hepatotoxicity may develop through direct hepatic effects of cytostatics, or a preexisting liver disease impairs the metabolism and excretion of the drug, increasing its toxic effects. In our patients hepatotoxicity can be explained mainly by direct liver-injury, previous infections with hepatotropic viruses, such as cytomegalovirus, were detected only in three patients. Liver injury appeared in 77% of our ALL patients; 65% occurred during maintenance therapy with oral 6-mercaptopurine and methotrexate. Close followup of liver function during chemotherapy is mandatory for optimal results.

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Spontaneous and experimental poisoning by nitroxinil at 34% in goats

Pesquisa Veterinária Brasileira ◽

10.1590/1678-5150-pvb-6935 ◽

2021 ◽

Vol 41 ◽

Author(s):

João Ricardo C. Brito Junior ◽

Karoline L. Soares ◽

Yanca G.S. Soares ◽

Flaviane N.L. Oliveira ◽

Renato V. Alves ◽

...

Keyword(s):

Liver Injury ◽

Ambient Temperature ◽

Acute Liver Injury ◽

Clinical Signs ◽

Abdominal Distension ◽

High Ambient Temperature ◽

Histological Changes ◽

Physical Exercises ◽

Vascular Congestion ◽

High Doses

ABSTRACT: This study describes the epidemiological, clinical, and pathological aspects of spontaneous and experimental poisoning by nitroxinil at 34% concentration in goats. The outbreak occurred on a farm in the municipality of Prata, Paraíba state. Nitroxinil was administered to a herd of 120 goats, of which 18 presented with anorexia, vocalization, abdominal distension, weakness, staggering, and falls. Necropsy of three goats revealed that the main lesion was acute liver injury. Histologically the liver showed centrilobular necrosis associated with hemorrhage and hepatocyte degeneration. In the kidneys, tubular nephrosis with granular cylinder formations was observed. The lungs showed multifocal to coalescent areas of moderate interalveolar edema and vascular congestion. Experimental poisoning was carried out in two goats, with the same medication and doses administered on the farm. The experimental goats showed clinical signs and macroscopic and histological changes similar to the spontaneously poisoned goats. The diagnosis of nitroxinil poisoning was made based on epidemiological, clinical, and pathological data, and confirmed by experimental poisoning. The administration of nitroxinil in high doses, associated with high ambient temperature and physical exercises, can cause poisoning with high lethality in goats.

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Abdominal Distension Associated with Luminal Fungi in the Intestines of Axolotl Larvae

Case Reports in Veterinary Medicine ◽

10.1155/2015/851689 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Chiara Zullian ◽

Aurore Dodelet-Devillers ◽

Stéphane Roy ◽

Pierre Hélie ◽

Pascal Vachon

Keyword(s):

Clinical Signs ◽

Abdominal Distension ◽

Total Body Length ◽

Body Parts ◽

Research Model ◽

Cross Sectional ◽

Light Darkness ◽

Clear Plastic ◽

Total Body ◽

Plastic Containers

Axolotls show a remarkable regeneration capacity compared with higher vertebrates, regenerating missing appendages such as limbs and tail as well as other body parts (i.e., apex of the heart, forebrain, and jaw) after amputations which makes this animal a very interesting research model for tissue regeneration mechanisms. Larvae are individually housed in a 20% Holtfreter’s solution within clear plastic containers. The photoperiod light : darkness cycle is 12 : 12 h. Larvae with a total body length of less than 5 cm are fed once a day with large brine shrimp and blood worm. Albino larvae appeared to have a tendency to exhibit abdominal distention. No clinical signs of illness seemed to be associated with the condition; however, these animals exhibit a relatively slower growth rate. To better characterize this condition, we performed histological sectioning for cross sectional slide preparation on wild type and albino axolotl larvae following euthanasia. The only lesion seen in the albino larvae was a thickened gut wall and the presence of fungi within the intestines. We hypothesize that this may be due to a lower efficacy of the albino larvae’s immune system.

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Treatment of a periorbital cyst in a dog by creation of a permanent drainage opening

Tierärztliche Praxis Ausgabe K Kleintiere / Heimtiere ◽

10.15654/tpk-140927 ◽

2015 ◽

Vol 43 (06) ◽

pp. 421-426

Author(s):

A. Driesen ◽

S. Malberg ◽

M. Kramer ◽

C. Thiel ◽

S. Kaiser

Keyword(s):

Computed Tomography ◽

Nasal Cavity ◽

Treatment Option ◽

Clinical Signs ◽

Complete Excision ◽

Suitable Treatment ◽

Yorkshire Terrier

SummaryAn inflammatory periorbital cyst with secondary pressure atrophy of the maxilla was treated by surgical creation of a drainage opening to the nasal cavity in a 4-year-old Yorkshire Terrier. Following treatment, clinical signs resolved and computed tomography 5 weeks after surgery confirmed the permanence of the drainage opening. Eight months later, the dog showed no clinical abnormalities. Therefore, the procedure described in this report may offer a suitable treatment option in cases where the cyst’s size or localization prevents complete excision.

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