scholarly journals Blunt Renal Trauma in a Pre-Existing Renal Lesion

2006 ◽  
Vol 6 ◽  
pp. 2334-2338 ◽  
Author(s):  
G.V. Soundra Pandyan ◽  
Idris Omo-Adua ◽  
Mohammed Al Rashid ◽  
Ahmed Bakheet Zaharan
Keyword(s):  
Traffic Accident ◽  
Past History ◽  
Spiral Ct ◽  
Renal Trauma ◽  
Renal Lesion ◽  
Vascular Control ◽  
Macroscopic Hematuria ◽  
Traumatic Injuries ◽  
Retrograde Pyelogram ◽  
History Of

A 70-year-old male presented with direct trauma to his loin with gross hematuria, as an isolated case of blunt renal trauma (BRT) due to a traffic accident. A pre-existing renal lesion (PERL) was strongly suspected by his past history of gross macroscopic hematuria and monotrauma to the kidney without other associated injuries. Spiral CT scan with contrast and a retrograde pyelogram (RGP) confirmed an occult complex renal cyst. The gold standard of CT diagnosis in this situation is stressed. Computed tomography is particularly useful in evaluating traumatic injuries to kidneys with pre-existing abnormalities. The decision on the initial course of conservative management, ureteral retrograde stenting to drain extravasation, and its final outcome are discussed. Radical nephroureterectomy was carried out by a transperitoneal approach with an early vascular control of the renal pedicle. A brief review of recent literature has been undertaken.

scholarly journals An unusual case of penetrating head injury following road traffic accident

2015 ◽  
Vol 6 (5) ◽  
pp. 75-77
Author(s):  
Mithilesh Kumar Pandey ◽  
Kaushik Roy ◽  
Gaurab Chaudhuri ◽  
Suniti Kumar Saha
Keyword(s):  
Foreign Body ◽  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Past History ◽  
Infratemporal Fossa ◽  
Penetrating Trauma ◽  
Neck Region ◽  
History Of ◽  
Radiolucent Foreign Body

A 35 year old male was presented with discharging sinus at left frontozygomatic region with trismus for last 1 month. The patient had a past history of penetrating trauma in the vicinity of the left frontozygomatic area following road traffic accident 6 months back. 3D-CT skull was showed a linear dense radiolucent foreign body obliquely placed in the left temporal and infratemporal fossa. Trismus due to trauma usually follows road accidents leading to massive faciomaxillary injury.  But in this case an initial minor penetrating injury was presented trismus in delayed fashion.  The aero digestive tract is the commonest site involved in foreign body lodgement in head and neck region. However the lodgement of foreign-body in an area of infratemporal fossa with unusual symptoms of trismus is quite rare and only few cases have been reported in the literature so far following a road traffic accident.DOI: http://dx.doi.org/10.3126/ajms.v6i5.12329 Asian Journal of Medical Sciences Vol.6(5) 2015 75-77 

PREVALENCE AND RELATED FACTORS OF POSTNATAL DEPRESSION IN HIV INFECTED WOMEN

2014 ◽  
pp. 140-152
Author(s):  
Manh Hoan Nguyen ◽  
Ngoc Thanh Cao
Keyword(s):  
Regression Analysis ◽  
Postpartum Depression ◽  
Hiv Infection ◽  
Postnatal Depression ◽  
Past History ◽  
Depression Scale ◽  
Multivariate Regression Analysis ◽  
Related Factors ◽  
History Of ◽  
History Of Depression

Background and Objective: HIV infection is also a cause of postpartum depression, however, in Vietnam, there has not yet the prevalence of postpartum depression in HIV infected women. The objective is to determine prevalence and related factors of postpartum depression in HIV infected women. Materials and Methods: From November 30th, 2012 to March 30th, 2014, a prospective cohort study is done at Dong Nai and Binh Duong province. The sample includes135 HIV infected women and 405 non infected women (ratio 1/3) who accepted to participate to the research. We used “Edinburgh Postnatal Depression Scale (EPDS) as a screening test when women hospitalized for delivery and 1 week, 6weeks postpartum. Mother who score EPDS ≥ 13 are likely to be suffering from depression. We exclude women who have EPDS ≥ 13 since just hospitalize. Data are collected by a structural questionaire. Results: At 6 weeks postpartum, prevalence of depression in HIV infected women is 61%, in the HIV non infected women is 8.7% (p < 0.001). There are statistical significant differences (p<0.05) between two groups for some factors: education, profession, income, past history of depression, child’s health, breast feeding. Logistical regression analysis determine these factors are related with depression: late diagnosis of HIV infection, child infected of HIV, feeling guilty of HIV infected and feeling guilty with their family. Multivariate regression analysis showed 4 factors are related with depression: HIV infection, living in the province, child’s health, past history of depression. Conclusion: Prevalence of postpartum depression in HIV infected women is 61.2%; risk of depression of postnatal HIV infected women is 6.4 times the risk of postnatal HIV non infected women, RR=6.4 (95% CI:4.3 – 9.4). Domestic women have lower risk than immigrant women from other province, RR=0.72 (95% CI:0.5 – 0.9). Past history of depression is a risk factor with RR=1.7 (95% CI:1.02 – 0.9. Women whose child is weak or die, RR=1.7(95% CI:0.9 – 3.1). Keywords: Postpartum depression, HIV-positive postpartum women

Nonlocal Gravity

2017 ◽  
Author(s):  
Bahram Mashhoon
Keyword(s):  
Gravitational Field ◽  
Gravitational Lensing ◽  
Past History ◽  
Lorentz Invariance ◽  
Minkowski Spacetime ◽  
Field Measurements ◽  
Local Principle ◽  
History Of ◽  
Expansion Of The Universe ◽  
Nearby Galaxies

A postulate of locality permeates through the special and general theories of relativity. First, Lorentz invariance is extended in a pointwise manner to actual, namely, accelerated observers in Minkowski spacetime. This hypothesis of locality is then employed crucially in Einstein’s local principle of equivalence to render observers pointwise inertial in a gravitational field. Field measurements are intrinsically nonlocal, however. To go beyond the locality postulate in Minkowski spacetime, the past history of the accelerated observer must be taken into account in accordance with the Bohr-Rosenfeld principle. The observer in general carries the memory of its past acceleration. The deep connection between inertia and gravitation suggests that gravity could be nonlocal as well and in nonlocal gravity the fading gravitational memory of past events must then be taken into account. Along this line of thought, a classical nonlocal generalization of Einstein’s theory of gravitation has recently been developed. In this nonlocal gravity (NLG) theory, the gravitational field is local, but satisfies a partial integro-differential field equation. A significant observational consequence of this theory is that the nonlocal aspect of gravity appears to simulate dark matter. The implications of NLG are explored in this book for gravitational lensing, gravitational radiation, the gravitational physics of the Solar System and the internal dynamics of nearby galaxies as well as clusters of galaxies. This approach is extended to nonlocal Newtonian cosmology, where the attraction of gravity fades with the expansion of the universe. Thus far only some of the consequences of NLG have been compared with observation.

Do Deeper Levels of Cervical Biopsies Preceded by a Pap Smear Diagnosis of LSIL, ASCUS, or NILM/HPV+ Increase the Yield of Identifying Clinically Significant Lesions?

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S163-S164
Author(s):  
K G Manjee ◽  
W G Watkin
Keyword(s):  
Pap Smear ◽  
Past History ◽  
Prior History ◽  
Cervical Biopsy ◽  
P16 Immunohistochemistry ◽  
Hpv Status ◽  
Significant Difference ◽  
History Of ◽  
Clinically Significant ◽  
Almost All

Abstract Introduction/Objective Cervical biopsy is performed following an abnormal pap smear or positive HPV testing in an attempt to uncover clinically significant lesions [HSIL/invasive carcinoma (HSIL+)]. An excisional procedure is considered if biopsy confirms HSIL+. When preceded by pap smear of LSIL, ASCUS, NILM/HPV+ or persistent HPV, continued surveillance is recommended for biopsies showing no SIL or LSIL. In our laboratory, cervical biopsies are routinely sectioned at 3 levels. Deeper levels are often ordered when initial sections are non-diagnostic. p16 immunohistochemistry, with or without deeper levels, is often ordered to confirm HSIL, or to differentiate HSIL from mimics. In this study, we examine whether and in what clinical situations does obtaining additional levels uncover clinically significant lesions. Methods 430 cervical biopsies between January-May 2018, with recent cytology of LSIL, ASCUS or NILM/HPV+ were identified in the pathology database. HPV status (if known), final biopsy diagnosis and past history of LSIL/HSIL were recorded. For each biopsy, orders for additional levels and/or p16 immunohistochemistry were recorded resulting in 4 categories: C1-no additional levels or p16, C2-deeper only, C3-deeper+p16 and C4-p16 only. Final diagnoses were divided into HSIL+, LSIL and no SIL. Results There was no significant difference in prior history of LSIL/HSIL and HPV status between all categories. Biopsy results were as follows: HSIL+: 11/222 (5%) C1; 1/78 (1%) C2; 7/43 (16%) C3; 15/87 (17%) C4 LSIL: 91/222 (41%) C1; 7/78 (9%) C2; 16/43 (37%) C3; 35/87 (40%) C4 No SIL: 120/222 (54%) C1; 70/78 (90%) C2; 20/43 (46%) C3; 37/87 (42%) C4 The average number of additional levels in C2 and C3 was 3.8 and 1.8, respectively. Conclusion Deeper levels alone did not enhance the detection of HSIL+. Almost all LSIL/HSIL were detected when initial levels were diagnostic or suspicious and supported by p16 immunohistochemistry. 3 levels are adequate to detect clinically significant lesions.

scholarly journals Tapering body stiffness shortens upper gastrointestinal examination via transoral insertion with ultrathin endoscope

2020 ◽  
Vol 08 (12) ◽  
pp. E1748-E1753
Author(s):  
Satoshi Ono ◽  
Shun Ito ◽  
Kyohei Maejima ◽  
Shosuke Hosaka ◽  
Kiyotaka Umeki ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Past History ◽  
Insertion Time ◽  
Trade Off ◽  
Examination Time ◽  
Total Examination Time ◽  
History Of ◽  
Food Residues ◽  
Gastrointestinal Examination ◽  
Upper Gastrointestinal

Abstract Background and study aims Ultrathin endoscopes are commonly used for surveillance esophagogastroduodenoscopy (EGD) to reduce discomfort associated with scope insertion. However, the flexibility of an ultrathin endoscope is a trade-off between reducing discomfort and lengthening examination time. Patients and methods The EG17-J10 (EG17) is a novel ultrathin endoscope characterized by its tapering body stiffness; however, the flexibility of its tip is comparable to that of the traditional ultrathin endoscope EG16-K10 (EG16). We compared EGD examination time between EG17 and EG16. A total of 319 examinees who underwent EGD from November 2019 to January 2020 at the Chiba-Nishi General Hospital were enrolled. Six examinees were excluded due to past history of surgical resection of the upper gastrointestinal tract or too much food residues; 313 examinees (EG17, 209; EG16,104) were retrospectively analyzed. The examination time was divided into three periods: esophageal insertion time (ET), gastroduodenal insertion time (GDT), and surveillance time of the stomach (ST). The total amount of ET, GDT, and ST was defined as total examination time (TT). Results TT of EGD using EG17 was significantly shorter compared to EGD using EG16 (222.7 ± 68.9 vs. 245.7 ± 78.5 seconds) (P = 0.004). Among the three periods of examination time, ET (66.7 ± 24.1 vs. 76.0 ± 24.1 seconds) (P = 0.001) and GDT (47.9 ± 17.4 vs. 55.2 ± 35.2 seconds) (P = 0.007) of EGD using EG17 were significantly shorter compared to EGD using EG16, except for ST (108.1 ± 51.5.1 vs. 114.5 ± 50.1 seconds) (P = 0.148). Conclusion An ultrathin endoscope with tapering body stiffness can shorten EGD examination time, mainly due to the shortening of insertion time.

scholarly journals Presence of low voltage area predicts atrial tachyarrhythmia inducibility with atrial burst pacing after pulmonary vein isolation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Kawai ◽  
K Nagaoka ◽  
S Takase ◽  
K Sakamoto ◽  
H Ikuta ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Low Voltage ◽  
Past History ◽  
Univariate Analysis ◽  
Atrial Tachyarrhythmia ◽  
Chads2 Score ◽  
Atrial Capture ◽  
History Of

Abstract Background Induction of atrial fibrillation (AF)/atrial tachycardia (AT) by atrial burst pacing following ablation procedure may reflect the presence of residual substrates in the atria that maintain AF. However, the relation between the inducibility and left atrial low voltage area (LVA) has not been established. Methods Fifty-nine patients (65 years old, 43 males) with persistent AF who underwent pulmonary vein isolation (PVI)-based ablation were studied. All patients underwent left atrial voltage mapping during sinus rhythm and atrial burst pacing after PVI. Atrial burst pacing was performed with 30-beat at an amplitude of 10V from the ostium of the coronary sinus; increasing from 240 to 320 ppm in steps of 20 ppm or failure to 1:1 atrial capture. Inducibility was defined as AF/AT lasting more than 5 minutes following burst pacing. Left atrial LVA and other co-variates were analyzed with regard to burst pacing positivity. Results AF/AT was induced by burst pacing in 23 patients (39%). Univariate analysis revealed that past history of stroke, CHADS2 score and presence of left atrial LVA were significantly associated with the inducibility of AF/AT. Multivariate analysis revealed that only the presence of LVA was associated with the inducibility (OR 1.5: per 10% increase; p=0.04). We focused on the relationship between the extent of LVA and burst positivity. AF/AT inducibility increased as low voltage area increased, and it was as high as 72.7% when low voltage area was more than 20% (P&lt;0.05). Interestingly, induced arrhythmia type was AT rather than AF when low voltage area was more than 20%. Conclusions Presence of left atrial LVA is an independent predictor of atrial tachyarrhythmia inducibility after PVI in patients with persistent AF. A large amount of low voltage area is related to AT inducibility rather than AF. Extent of LVA and burst positivity Funding Acknowledgement Type of funding source: None

scholarly journals P54 Development of ocular toxoplasmosis and panuveitis in a patient receiving infliximab for psoriatic arthritis

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Mariam Malik ◽  
Himashi Anver ◽  
Ernest Wong
Keyword(s):  
Psoriatic Arthritis ◽  
Past History ◽  
Acute Infection ◽  
Immunosuppressive Treatment ◽  
Ocular Toxoplasmosis ◽  
Close Monitoring ◽  
Horse Riding ◽  
Increased Risk ◽  
History Of ◽  
Acute Toxoplasmosis

Abstract Background Toxoplasma gondii is thought to infect up to a third of world’s population. Incidence rate of 0.4/100,000 has been calculated in Britain, culminating in a life-time risk of 18/100,000. Cats are primary hosts, but humans and warm-blooded animals can be infected by consumption of contaminated food/water. Although in most patients, it’s self-limiting, it can be devastating in immunosuppressed patients and may cause eye manifestations, cerebral abscesses or disseminated infection. Immunosuppressive therapies including treatment with biologics increases the risk and may also cause toxoplasmosis reactivation. Methods This is case of 57 year old lady with psoriatic arthritis. She has past history of congenital vision impairment in the left eye and is HLA B27 negative. She enjoyed horse-riding and had a pet dog. Initially she was started on methotrexate. Sulfasalazine was added later. Due to ongoing active disease, etanercept was used for 6 months, before being switched to cetrolizumab due to ineffectiveness. She had this for 5 months and then switched to infliximab, 3mg/kg, 8 weekly. In May 2019, she was seen by Ophthalmology for 2 weeks history of blurred vision and floaters in right eye. She was diagnosed to have panuveitis and had positive IgM for toxoplasma. Bloods revealed negative TB screen, HIV, Hep B&C, syphilis, lyme and anti-streptolysin antibody tests were negative. Infliximab levels were sub-therapeutic. She was commenced on 30mg prednisolone for possible inflammatory process secondary to seronegative arthropathy, but acute toxoplasmosis could not be excluded. Hence, she was started on azithromycin and had vitreous biopsy. Toxoplasma was detected in the sample, confirming acute infection. Methotrexate and infliximab were stopped. MRI head ruled out intracranial involvement. Following treatment of acute toxoplasmosis, adalimumab is now being considered for management of her inflammatory disease, with close monitoring by local infectious-disease team and specialist ophthalmology unit. Results This lady developed ocular toxoplasmosis and panuveitis, whilst on immunosuppression for psoriatic arthritis. She was a horse-rider and had exposure to dogs. Diagnosing toxoplasma in immunocompromised can be difficult. Isolation of T. gondii in tissue usually confirms diagnosis. Some forms of immunosuppressive treatment may be associated with increased risk of reactivation of toxoplasmosis but there is not much evidence to assess the relative risk of various therapies. Conclusion Ocular toxoplasmosis needs to be considered in patients receiving immunosupression and presenting with inflammatory eye symptoms. Management requires specialist input and close monitoring. Further research into diagnostic techniques, possibility of using prophylaxis in high-risk patients and management guidelines would be helpful. Disclosures M. Malik None. H. Anver None. E. Wong None.

Uretero-Iliac artery fistula: a rare cause of haematuria

2020 ◽  
Vol 13 (9) ◽  
pp. e232189
Author(s):  
Natalia Hernandez ◽  
Bethany Desroches ◽  
Eric Peden ◽  
Raj Satkunasivam
Keyword(s):  
Iliac Artery ◽  
Percutaneous Nephrostomy ◽  
Arterial System ◽  
Endoscopic Evaluation ◽  
Stent Removal ◽  
Retrograde Pyelogram ◽  
History Of ◽  
Gross Haematuria ◽  
Multiple Episodes

A woman in her mid-forties with a history of cervical cancer requiring chemoradiation presented with bilateral ureteral strictures secondary to radiation therapy. The ureteral obstruction was initially relieved with bilateral percutaneous nephrostomy tubes, and subsequently, bilateral ureteral stents. Over the course of 8 months, she presented with multiple episodes of severe gross haematuria. This persisted even after stent removal and conversion back to percutaneous nephrostomy tubes. The initial evaluation, done with concern for an uretero-iliac artery fistula, which included bilateral retrograde pyelograms and CT angiography was non-diagnostic. Given continued haematuria, repeat endoscopic evaluation was undertaken; on retrograde pyelogram, brisk contrast was seen to pass into the arterial system, consistent with a left ureteroarterial fistula. The patient underwent endovascular iliac artery stent placement. Subsequently, the patient underwent resection of the iliac artery with endovascular graft in situ, left distal ureterectomy with proximal ureteral ligation following femoral-to-femoral bypass. This allowed for complete resolution of the patient’s gross haematuria episodes.

Sign in / Sign up

Export Citation Format

Share Document