scholarly journals Minimally invasive treatment of iatrogenic complete left ureter obstruction after hysterectomy

2012 ◽  
Vol 2 (2) ◽  
pp. 144-147
Author(s):  
Yigit Akin ◽  
Isil Basara ◽  
Aliseydi Bozkurt
Keyword(s):  
Emergency Department ◽  
Treatment Options ◽  
Ureteral Injury ◽  
Invasive Treatment ◽  
Ureter Injury ◽  
Left Ureter ◽  
Ureter Obstruction ◽  
Chief Complaints ◽  
Treatment Prognosis

The iatrogenic ureter injuries are rare complications and may have serious consequences. The treatment options depend on situations. Pelvic surgeons, keep in mind that this kinds of complications, is very important for diagnosis and treatment, during the surgery. This report presents a case of a patient with iatrogenic left ureteral injury during hysterectomy. The patient visited emergency department of our hospital with the chief complaints of left lomber pain on the 17th day of hysterectomy. After evaluation in emergency clinic, the patient had an endoscopic treatment for iatrogenic ureter injury. The patient is still in follow-up period. We also review the literature and discuss diagnose, treatment, prognosis of iatrogenic ureter injuries. The treatmentoptions are still developing by technology.

scholarly journals Minimally invasive treatment options to borderline ovarian tumors

2016 ◽  
Author(s):  
Punita Bhardwaj ◽  
T. K. Das ◽  
S. Batra ◽  
Keyword(s):  
Early Stage ◽  
Treatment Options ◽  
Malignant Potential ◽  
Ovarian Tumors ◽  
Conservative Approach ◽  
Uncertain Malignant Potential ◽  
Invasive Treatment ◽  
Younger Women ◽  
Borderline Ovarian Tumors

Borderline Ovarian tumors are tumors of uncertain malignant potential. They have favour able prognosis. They occur in younger women and present at an early stage. They are difficult to diagnose preoperatively as macroscopic picture is a combination of benign and invasive ovarian tumors. Over the years surgical treatment has changed from radical to conservative approach without overlooking oncologic safety. Follows up is essential. Prolonged follow up (>10 yrs) is required because of later recurrences. Special attention is to be paid to the conserved ovary in follow up.

scholarly journals A Rare Case of Urinary Tract Fungal Ball Leading to Fungemia and Bilateral Chorioretinitis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Christopher Ferari ◽  
Chad Crigger ◽  
Chad Morley ◽  
David Duchene
Keyword(s):  
Urinary Tract ◽  
Type Ii Diabetes ◽  
Rare Complication ◽  
Obstructive Uropathy ◽  
Treatment Options ◽  
Type Ii ◽  
Invasive Treatment ◽  
Case Presentation ◽  
Fungal Ball

Background. Fungemia due to obstructive urinary tract fungal ball is exceedingly rare. These patients often have multiple predisposing conditions, including diabetes or antimicrobial exposure. While candiduria can be relatively common in this population, urinary tract fungal balls are a rare entity. Hospitalists should be aware of this rare complication in patients presenting with funguria. Case Presentation. We present a case of a 44-year-old male with type II diabetes, chronic hepatitis C secondary to injection drug use, and chronic kidney disease who developed a urinary tract fungal ball leading to fungemia and subsequent bilateral chorioretinitis, additionally complicated by emphysematous cystitis and pyelonephritis. Additional invasive treatment options beyond typical antifungals are often required in the case of urinary tract fungal ball, and in this case, bilateral nephrostomy tubes and micafungin were employed. Hospital course was complicated by C. tropicalis fungemia with subsequent bilateral fungal chorioretinitis on dilated fundus exam. This was effectively treated with cyclogyl and prednisolone drops along with bilateral voriconazole injections. Follow-up imaging and cultures showed resolution of fungemia, urinary tract masses, and chorioretinal infiltrates; however, recurrent polymicrobial UTIs continue to be an issue for this patient. Conclusions. Special multidisciplinary management is required in the treatment of urinary tract fungal balls with subsequent fungemia, including nephrostomy tubes, antifungal irrigation, ureterorenoscopy, and more powerful antifungals such as amphotericin B and 5-flucytosine. This management draws from a myriad of specialties, including urology, infectious disease, and interventional radiology. Additionally, the literature has demonstrated that only approximately half of patients with fungemia receive an ophthalmologic evaluation. Ophthalmologic and urologic cooperation is essential in the case of obstructive uropathy leading to fungemia as the obstructive uropathy must be relieved and these patients should receive a dilated fundus exam.

An Evidence-Based Review of Hyperbilirubinemia in the Late Preterm Infant, with Implications for Practice: Management, Follow-Up, and Breastfeeding Support

2007 ◽  
Vol 26 (6) ◽  
pp. 395-405 ◽  
Author(s):  
Joan Renaud Smith ◽  
Ann Donze ◽  
Lisa Schuller
Keyword(s):  
Emergency Department ◽  
Bowel Movement ◽  
Pediatric Emergency ◽  
Evidence Based ◽  
Pediatric Emergency Department ◽  
Late Preterm Infant ◽  
Breastfeeding Support ◽  
The Past ◽  
Chief Complaints

SIX-DAY-OLD BABY DANNY WAS brought to the pediatric Emergency Department (ED) by his parents with chief complaints of persistent sleeping, difficulty arousing for feedings, and a lack of interest in breastfeeding. Danny’s parents reported that he had had only two wet and very yellow diapers within the past 12 hours. Danny’s mother was concerned because he had not had a bowel movement for more than 48 hours.

scholarly journals Recurrent trichobezoar in a patient with Rapunzel syndrome

2021 ◽  
Vol 17 (1) ◽  
pp. 64-66
Author(s):  
Joanna Godlewska ◽  
◽  
Justyna Orpiszewska ◽  
Wojciech Górecki ◽  
◽  
...  
Keyword(s):  
Emergency Department ◽  
Foreign Body ◽  
Psychiatric Treatment ◽  
Psychological Care ◽  
Invasive Treatment ◽  
Rapunzel Syndrome ◽  
Postoperative Course ◽  
Proximal Small Intestine ◽  
Proximal Intestine

Rapunzel syndrome is a condition where a trichobezoar is formed in the stomach and proximal intestine due to hair ingestion. A 6-year-old girl presented to emergency department with abdominal pain, vomiting and a palpable epigastric mass. Laparotomy was performed for gastric foreign body; a trichobezoar that filled the stomach, duodenum and proximal small intestine was removed. Postoperative course was uncomplicated; the patient was discharged for further out-patient follow-up and psychological care. After 7 months, the girl presented with a recurrence. A recurrent trichobezoar was removed via laparotomy. The girl was started on psychiatric treatment and iron substitution for anaemia. Ten weeks after discharge, follow-up gastroscopy was negative for gastric foreign body. There are no guidelines for follow-up after trichobezoar removal. Since the disease may be recurrent, follow-up endoscopy should be considered in order to enable an early diagnosis and less invasive treatment.

scholarly journals Minimally invasive treatment of iatrogenic ureter injury after gynecological surgery

2020 ◽  
Vol 13 (5) ◽  
pp. 120-124
Author(s):  
S.V. Tsyganov ◽  
◽  
R.R. Safazada ◽  
A.S. Sobolev ◽  
◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Left Kidney ◽  
Social Maladjustment ◽  
Invasive Treatment ◽  
Ureter Injury ◽  
Left Ureter ◽  
Surgical Interventions ◽  
Minimally Invasive Surgical ◽  
Iatrogenic Trauma ◽  
Iatrogenic Damage

Introduction. Iatrogenic trauma of the ureters accounts for 1-5.7% of all injuries to the organs of the genitourinary system, it is this that presents the greatest difficulty for diagnosis and the greatest danger in terms of the rate and frequency of development of severe, life-threatening complications (phlegmon of the retroperitoneal space, urinary peritonitis, sepsis. Description of the clinical case. Patient A., 47 years old. On June 17, 2019, laparoscopic uterine extirpation was performed for fibroids. 06/22/2019, iatrogenic injury of the lower third of the left ureter was diagnosed. Percutaneous puncture nephrostomy on the left was performed as the first stage for urine diversion. At the second stage, ureteroscopy on the left was performed, in which a burn zone was determined in the lower third of the left ureter, up to 0.5 cm in length with a defect of 1/3 of the ureteral circumference. Left kidney stenting was performed. After 2 months, the ureteral stent was replaced. At control computed tomography (4 months after surgery), the left ureter was contrasted along the entire length, no urodynamic disturbances were revealed. Discussion. Open surgical interventions for iatrogenic trauma of the ureter are long and traumatic, require a long rehabilitation period, accompanied by social maladjustment of patients, therefore the use of X-ray endoscopic methods of treatment is an effective and alternative method of treating this pathology. Conclusion. In this case, timely detection of iatrogenic damage to the ureter made it possible to perform an effective minimally invasive surgical treatment, which saved the patient from possible severe complications.

Obstetrics and Gynecologic Emergencies

2019 ◽  
pp. 258-276
Author(s):  
Deena Bengiamin ◽  
Miranda Lewis
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Sexually Transmitted Infections ◽  
Vaginal Bleeding ◽  
Placenta Previa ◽  
Treatment Options ◽  
Care Providers ◽  
Sexually Transmitted ◽  
Chief Complaints ◽  
Obstetric Emergencies

Obstetrics and gynecologic emergencies cover a broad range of female conditions that may present to an emergency department (ED). Vaginal bleeding associated with abdominal pain in women is one of the top chief complaints that present to an ED. Emergency care providers need to be adept at recognizing obstetric emergencies like ectopic pregnancy, placenta previa, and placenta abruption. They also need to be prepared to care for the pregnant women who present with infections, trauma, and other disease processes. Sexually transmitted infections are prevalent, and diagnostic and treatment options from the ED are needed.

Active surveillance and watchful waiting for localized prostate cancer in elderly patients >70 years in a community-based setting: Results from the HAROW study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e16577-e16577
Author(s):  
Jan Herden ◽  
Dietrich Schnell ◽  
Axel Heidenreich ◽  
Lothar Weissbach
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Watchful Waiting ◽  
Treatment Options ◽  
Digital Rectal Examination ◽  
Clear Distinction ◽  
Inclusion Criteria ◽  
Invasive Treatment ◽  
Psa Testing

e16577 Background: Since more than half of patients with prostate cancer (PCa) are older than 70 years, this age group remains underrepresented in clinical trials. Possible non-invasive treatment options for these patients include Active Surveillance (AS) and Watchful Waiting (WW). In this prospective, non-interventional, health services research study, the use of different treatment options for localized PCa are observed under everyday conditions. The subgroups of patients ≥ 70 years, receiving AS- or WW are presented in terms of inclusion criteria, follow-up examinations and changes in treatment strategy. Methods: The study was conducted from July 2008 to July 2013 at 259 study centers in Germany, mainly office based urologists. The mean follow-up was 27.6 months. Clinical data (tumor category, digital rectal examination, PSA level, Gleason score, Charlson Comorbidity Index = CCI) and information about therapy and disease progression were collected at the time of study inclusion and subsequently at six-month intervals. According to the non-interventional study design, only recommendations were made for enrollment, course and discontinuation of AS and WW. The final therapeutic decision rested with treating physicians. Results: Overall, 2957 patients were enrolled, of whom 1165 were ≥ 70 years. 210 patients received AS and 87 patients received WW. AS patients were younger (73.9 vs. 76.8 years, p ≤ 0.001). The rate of low, intermediate and high risk tumors was 81.6%, 14.6% and 3.9% in the AS- and 39.1%, 43.5% and 17.4% in the WW-group (p ≤ 0.001). No differences were seen in the average number of PSA testing during the course of follow-up (AS = 3.97 vs WW = 3.79, p = 0.95). 37.6% of the AS patients and 12.4% of the WW patients received at least one follow-up biopsy. Conclusions: The results of HAROW indicate a clear distinction between AS and WW in terms of inclusion criteria. Interestingly, no clear distinction was seen in terms of follow-up examinations, since both groups were monitored frequently with PSA tests and even re-biopsies were performed in WW patients, neither of which is usually provided in WW programs.

scholarly journals Cervical cord decompression following embolisation of a giant cervical vertebro-vertebral arteriovenous fistula

2017 ◽  
Vol 23 (4) ◽  
pp. 399-404 ◽  
Author(s):  
George H Tse ◽  
Umang J Patel ◽  
Stuart C Coley ◽  
Richard A Dyde
Keyword(s):  
Vertebral Artery ◽  
Cervical Spinal Cord ◽  
Treatment Options ◽  
Walking Distance ◽  
Cervical Cord ◽  
Invasive Treatment ◽  
Coil Occlusion ◽  
Epidural Vein ◽  
Minimal Evidence

Arteriovenous fistulation between the vertebral arteries to extradural (epidural) veins, termed vertebro-vertebral arteriovenous fistulae, are uncommon diagnoses without established diagnostic algorithms or treatment options. Minimal evidence exists describing the management of this pathology. Endovascular treatment was performed under general anaesthesia by coil occlusion of the vertebral artery from the point of the fistula to the mid-vertebral artery. Repeat magnetic resonance angiographic imaging one week following the procedure confirmed an 80% reduction in the size of the epidural vein and decompression of the cervical spinal cord. At four-week follow-up there was significant qualitative improvement in the myelopathic symptoms including walking distance and pain. Normal physiological filling of the collapsed extradural vein was observed on follow-up digital subtraction angiography at five months. Catheter angiography by an experienced interventional neuro-radiologist is critical in defining the anatomy and providing minimally invasive treatment.

Emergency Department Admission and Mortality Rate for Suicidal Behavior

Crisis ◽  
2014 ◽  
Vol 35 (6) ◽  
pp. 406-414 ◽  
Author(s):  
Raimondo Maria Pavarin ◽  
Angelo Fioritti ◽  
Francesca Fontana ◽  
Silvia Marani ◽  
Alessandra Paparelli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Metropolitan Area ◽  
Suicidal Behavior ◽  
Mortality Risk ◽  
Illicit Drugs ◽  
Attempted Suicide ◽  
Cox Model ◽  
Emergency Department Admission ◽  
Completed Suicide

Background: The international literature reports that for every completed suicide there are between 8 and 22 visits to an Emergency Department (ED) for attempted suicide/suicidal behavior. Aims: To describe the characteristics of admission to emergency departments (EDs) for suicide-related presenting complaints in the metropolitan area of Bologna; to estimate the risk for all-cause mortality and for suicide; to identify the profiles of subjects most at risk. Method: Follow-up of patients admitted to the EDs of the metropolitan area of Bologna between January 2004 and December 2010 for attempted suicide. A Cox model was used to evaluate the association between sociodemographic variables and the general mortality risk. Results: We identified 505 cases of attempted suicide, which were more frequent for female subjects, over the weekend, and at night (8:00 p.m./8:00 a.m.). The most used suicide methods were psychotropic drugs, sharp or blunt objects, and jumping from high places. In this cohort, 3.6% of subjects completed suicide (4.5% of males vs. 2.9% of females), 2.3% within 1 year of the start of follow-up. The most common causes of death were drug use and hanging. In the multivariate analysis, those who used illicit drugs 24 hr prior to admission to the ED (hazard ratio [HR] = 3.46, 95% CI = 1.23–9.73) and patients who refused the treatment (HR = 6.74, 95% CI = 1.86–24.40) showed an increased mortality risk for suicide. Conclusion: Deliberate self-harm patients presenting to the ED who refuse treatment represent a specific target group for setting up dedicated prevention schemes.

Antiretroviral Treatment-Associated Labia Majora Lipohypertrophy: A Rare Case and Plastic Surgical Treatment Options

2017 ◽  
Vol 2 (1) ◽  
pp. 43
Author(s):  
Akmal Hisham ◽  
Devananthan Ilenghoven ◽  
Wan Syazli Wan Ahmad Kamal ◽  
Salina Ibrahim ◽  
Shah Jumaat Mohd Yussof
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Daily Living ◽  
Treatment Options ◽  
Hiv Positive ◽  
Highly Active ◽  
Labia Majora ◽  
The Face ◽  
Central Fat

The emergence of highly active antiretroviral therapy (HAART) has revolutionized the prognosis of HIV-infected patients. However, the extended use of HAART is associated with a disfiguring complication termed lipodystrophy, a disorder of body fat maldistribution causing peripheral fat loss (lipoatrophy) and central fat accumulation (lipohypertrophy). Lipoatrophy commonly affects the face, legs, buttocks and arm, whilst lipohypertrophy frequently favours the abdomen, breast and dorsocervical region. To our knowledge, we present only the second documented case in the literature of a labia majora lipohypertrophy in a HIV-positive patient receiving long-term HAART. The severity of labial abnormality caused significant physical and functional morbidities. Labiaplasty with dermolipectomy of the labia majora and excisional lipectomy of the mons pubis was successfully performed. At a 6-month follow-up, patient had no recurrence with resolution of symptoms and resumption of normal activities of daily living (ADL).

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