Nephropleural fistula after supracostal approach for PCNL: report of two cases with review of literature

2021 ◽  
Vol 14 (4) ◽  
pp. e241360
Author(s):  
Abhishek Bhat ◽  
Jonathan E Katz ◽  
Nicholas Smith ◽  
Hemendra N Shah
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Stent Placement ◽  
Delayed Diagnosis ◽  
Tube Thoracostomy ◽  
X Rays ◽  
Chest Imaging ◽  
Review Of Literature ◽  
Retrograde Pyelography ◽  
Diagnosis And Management ◽  
Double J Stent

Nephropleural fistula is a rarely encountered complication of percutaneous nephrolithotomy (PCNL). Only 11 cases have been reported in literature to date. Often associated with supracostal punctures, the presentation is frequently delayed. Diagnosis is based on imaging, mainly X-rays and CT along with retrograde pyelography that establishes the fistulous connection. A difficult to diagnose condition, any patient with a supracostal access PCNL who presents with delayed symptoms of breathlessness and has leucocytosis with fluid in the lungs on chest imaging should be suspected to have a nephropleural fistula. The management involves intercostal tube thoracostomy to relieve symptoms and drainage of the operated kidney by double-J stent placement, if not placed already. Prompt recognition and management results in excellent recovery with no sequelae. We present our experience with two such cases and our aim was to familiarise the practising urologist regarding the diagnosis and management of this infrequent condition.

Complications and surgical results of stone-directed antegrade pyelography compared to the retrograde pyelographic access method in percutaneous nephrolithotomy using ‘bull’s eye’ technique: A randomized clinical trial

2021 ◽  
pp. 205141582199372
Author(s):  
Dariush Irani ◽  
Abdolreza Haghpanah ◽  
Mohammad Mehdi Hosseini ◽  
Leila Malekmakan ◽  
Mohammad Ali Ashraf ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Percutaneous Nephrolithotomy ◽  
Renal Stones ◽  
Surgical Results ◽  
Retrograde Pyelography ◽  
Antegrade Approach ◽  
Antegrade Pyelography ◽  
Significant Difference ◽  
Bull's Eye

Objectives: This study aimed to evaluate the differences in outcomes and complications in stone-directed antegrade pyelography using the ‘bull’s eye’ technique in patients with renal stones versus the conventional method of percutaneous nephrolithotomy (PCNL). Although conventional PCNL access using retrograde pyelography is useful, it is time-consuming and may cause postoperative discomfort. Herein, we report our experience in the application of this new technique. Methods: Between January 2017 and June 2018, 100 patients participated in this randomized clinical trial. Stone-directed antegrade pyelography using the ‘bull’s eye’ technique under fluoroscopic guidance was used for percutaneous access in the intervention group. The second group, consisting of those who had undergone conventional PCNL using retrograde pyelography and ‘bull’s eye’ technique in the same period, were considered as the controls. Pre- and postoperative laboratory examinations, surgical results and complications were recorded and compared between the two groups. Results: A single calyceal puncture in partial staghorn and staghorn stone patients was sufficient in 72.2% of the antegrade group and in 78.9% of the retrograde group ( p=0.69). The double-puncture technique was necessary for 71.9% of renal pelvis stones in the antegrade group and for 9.4% in the retrograde group ( p<0.001). The antegrade approach reduced the mean operative time and analgesic requirement significantly ( p<0.001). No statistically significant difference, however, was found between the two groups regarding stone migration to the ureter, radiation time and postoperative complications. Conclusions: The stone-directed antegrade approach using the ‘bull’s eye’ technique is a safe and accurate method in PCNL access in patients with radiopaque and semi-opaque renal stones.

scholarly journals Adult onset Still’s disease in the elderly: a case-based literature review

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Arash Mollaeian ◽  
Jingjing Chen ◽  
Nina N. Chan ◽  
Gregory A. Nizialek ◽  
Christopher J. Haas
Keyword(s):  
Delayed Diagnosis ◽  
The Elderly ◽  
Adult Onset Still’S Disease ◽  
Inflammatory Disorder ◽  
Adult Onset ◽  
Still’S Disease ◽  
Diagnosis And Management ◽  
Still's Disease ◽  
Area Of Interest ◽  
Adult Onset Still's Disease

Abstract Background Adult onset Still’s disease (AOSD) is a rare inflammatory disorder that classically presents with high spiking fevers, evanescent rash, and arthritis. The diagnosis is one of exclusion and can be further complicated by atypical presentations, particularly in elderly patients in whom AOSD is very rare. Case presentation A case of AOSD in a 73-year-old woman with a non-classic presentation, leading to delayed diagnosis and management, is presented along with a review of the English literature for AOSD cases in elderly people over 70 years of age. Thirty nine case reports and series were identified and the current case was added, totaling 42 individual cases. Significant findings included a four-times higher prevalence in females, a higher prevalence of macrophage activation syndrome despite lower mortality, the presence of pruritic rash in almost one fifth of the cases, and high prevalence of delayed diagnosis. Conclusions AOSD in the elderly may vary from the classic criteria described in the medical literature and may lead to delayed diagnosis and management. Further evaluation and better characterization of AOSD in the elderly remains an area of interest.

scholarly journals Huge Ovarian Cyst- A Case Report

2020 ◽  
Vol 2 (2) ◽  
pp. 87-90
Author(s):  
Sunita Maharjan ◽  
Ganesh Dangal ◽  
Aruna Karki ◽  
Hema Pradhan ◽  
Ranjana Shrestha ◽  
...  
Keyword(s):  
Ovarian Cyst ◽  
Ovarian Tissue ◽  
Delayed Diagnosis ◽  
Lower Abdominal Pain ◽  
Exploratory Laparotomy ◽  
Sudden Onset ◽  
Ultrasound Finding ◽  
Emergency Laparotomy ◽  
Diagnosis And Management ◽  
The Right

Ovarian cyst torsion (also termed as adnexal torsion) refers to partial or complete rotation of the ovary and a portion of fallopian tube along with its supply to vascular pedicle. It occurs commonly in females of all age group, more on the right side (60%) and often with acute lower abdominal pain lasting for few hours up to 24 hours. Ovarian cyst torsion is one of the devastating conditions hampering blood supply of ovary which may lead to total necrosis of ovarian tissue like in our case. Delayed diagnosis and management can lead to various complications. Here, we present a case of 46 years old perimenopausal female, para 2, living 2 who presented to our emergency department with complain of sudden onset severe pain abdomen since morning. Emergency exploratory laparotomy was done due to high clinical suspicion of torsion based on previous ultrasound finding of ovarian cyst done a day prior to the presentation. On intraoperative finding, the cyst was already necrosed. Due to timely diagnosis and management by emergency laparotomy, anticipated complications were reduced.    

Diagnosis and Management of Suspected Pediatric Autoimmune Encephalitis: A Comprehensive, Multidisciplinary Approach and Review of Literature

2021 ◽  
pp. 088307382110646
Author(s):  
Melissa A. Wright ◽  
Cristina C. Trandafir ◽  
Gary R. Nelson ◽  
Aimee O. Hersh ◽  
C. J. Inman ◽  
...  
Keyword(s):  
Iterative Process ◽  
Multidisciplinary Approach ◽  
Pediatric Patients ◽  
Treatment Initiation ◽  
Young Patients ◽  
Autoimmune Encephalitis ◽  
Comprehensive Approach ◽  
Review Of Literature ◽  
Duration Of Treatment ◽  
Diagnosis And Management

Autoimmune encephalitis is an increasingly recognized entity in children. When treated promptly, favorable outcomes are seen in a majority of pediatric patients. However, recognition of autoimmune encephalitis in young patients is challenging. Once autoimmune encephalitis is suspected, additional difficulties exist regarding timing of treatment initiation and duration of treatment, as evidence to guide management of these patients is emerging. Here, we review available literature regarding pediatric autoimmune encephalitis and present our institution's comprehensive approach to the evaluation and management of the disease. These guidelines were developed through an iterative process involving both pediatric neurologists and rheumatologists.

scholarly journals Double-J stents forgotten for four years: a case report

2019 ◽  
Vol 28 (3) ◽  
pp. 280-3
Author(s):  
Johannes Cansius Prihadi ◽  
Christopher Kusumajaya
Keyword(s):  
Renal Failure ◽  
Case Report ◽  
Percutaneous Nephrolithotomy ◽  
Legal Issues ◽  
Ureteral Stents ◽  
Double J Stent

Placement of double-J ureteral stents after endourologic procedures and some open urological surgeries are practical and safe. However, when neglected in situ, undesired problems may occur, leading to serious medical and legal issues. Complications from ureteral stents with protracted indwelling durations include urosepsis, renal failure, encrustation, and spontaneous fractures which may be retained or voided in the urine (stenturia). We report a 40-year-old woman of forgotten double-J ureteral stents, inserted 4 years prior to this study during a gynecologic operation. The patient had pulled out the double-J stents from her urethra herself and presented with impending sepsis. Then, she underwent ureterorenoscopic lithotripsy, but it failed to remove the remaining encrusted double-J stent. As a result, percutaneous nephrolithotomy was performed successfully and she had symptom-free thereafter.

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