scholarly journals Emphysematous pyelonephritis: is conservative management effective? Our experience and review of literature

2020 ◽  
Vol 7 (3) ◽  
pp. 849
Author(s):  
Atul Kumar Khandelwal
Keyword(s):  
Percutaneous Drainage ◽  
Early Stage ◽  
Abdominal Mass ◽  
Review Of Literature ◽  
Emphysematous Pyelonephritis ◽  
Life Threatening ◽  
Laboratory Investigations ◽  
Time Of Presentation ◽  
Time Of Admission

Background: Emphysematous pyelonephritis (EPN) is a urologic emergency caused by a life-threatening necrotizing infection of the kidney leading to an accumulation of gas in the renal parenchyma and perirenal tissue. we present the clinical details and outcome of twelve patients of managed at our institute and discuss their management and outcomes.Methods: Twelve consecutive patients with EPN were managed in our institute from July 2014 to July 2018. Data on demographic profile, clinical features, laboratory investigations, imaging studies, outcome of patients and follow up details were recorded.Results: Out of 12 patients with EPN, nine were female and three were male. Ten patients were diabetic (83%). All the diabetic patient had raised blood sugar at the time of admission ureteric stone was present in two nondiabetic patients. All the patients had fever at the time of presentation while localized flank pain was present in 6 (50%) patients. On examination, renal angle tenderness was present in ten patients while abdominal mass found in three patients. Pyuria was found in all patients while leukocytosis found in 10 patients. Two patients had thrombocytopenia while 4 had deranged renal parameters at the time of admission. Urine culture showed Escherichia coli in 8 patients and Klebsiella in two patients. Four patients required percutaneous drainage. Interval nephrectomy was done in one patient due to non-functioning kidney.Conclusions: Majority of patients diagnosed as emphysematous pyelonephritis were managed conservatively due to diagnosed at an early stage. Percutaneous drainage is successfully utilized in patients with more advanced disease.

scholarly journals Granulosa Cell Tumor of the Ovary: A Retrospective Study of 31 Cases and a Review of the Literature

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Manel Dridi ◽  
Nesrine Chraiet ◽  
Rim Batti ◽  
Mouna Ayadi ◽  
Amina Mokrani ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Mitotic Index ◽  
Granulosa Cell ◽  
Early Stage ◽  
Abdominal Mass ◽  
Univariate Analysis ◽  
Hepatic Metastases ◽  
Stage I

Background. Adult granulosa cell tumors (AGCTs) are the most common sex cord-stromal tumors. Unlike epithelial ovarian tumors, they occur in young women and are usually detected at an early stage. The aim of this study was to report the clinical and pathological characteristics of AGCT patients and to identify the prognostic factors. Methods. All cases of AGCTs, treated at Salah Azaïz Institute between 1995 and 2010, were retrospectively included. Kaplan-Meier’s statistical method was used to assess the relapse-free survival and the overall survival. Results. The final cohort included 31 patients with AGCT. The mean age was 53 years (35–73 years). Patients mainly presented with abdominal mass and/or pain (61%, n=19). Mean tumor size was 20 cm. The majority of patients had a stage I disease (61%,  n=19). Two among 3 patients with stage IV disease had liver metastasis. Mitotic index was low in 45% of cases (n=14). Surgical treatment was optimal in almost all cases (90%, n=28). The median follow-up time was 14 years (1–184 months). Ten patients relapsed (32%) with a median RFS of 8.4 years (6.8–9.9 years). Mean overall survival was 13 years (11–15 years). Stage I disease and low-to-intermediate mitotic index were associated with a better prognosis in univariate analysis (resp., p=0.05 and p=0.02) but were not independent prognostic factors. Conclusion. GCTs have a long natural history with common late relapses. Hence, long active follow-up is recommended. In Tunisian patients, hepatic metastases were more frequent than occidental series. The prognosis remains good and initial staging at diagnosis is an important prognostic factor.

scholarly journals Gas in the Kidney (Emphysematous Pyelonephritis) often Misdiagnosed as Colonic Gas

2016 ◽  
Vol 33 (2) ◽  
pp. 91-94
Author(s):  
Mohammad Ali Zulkifl ◽  
Mir Rasekh Alam
Keyword(s):  
Prognostic Factor ◽  
Characteristic Feature ◽  
Diabetic Patient ◽  
Ct Scan ◽  
Medical Management ◽  
Percutaneous Drainage ◽  
Emphysematous Pyelonephritis ◽  
Life Threatening ◽  
Prompt Diagnosis

Emphysematous pyelonephritis (EPN) is a serious and often life threatening infection of the renal and perirenal tissues. The characteristic feature of this infection is the presence of gas within the kidney and perinephric tissues. EPN usually occurs in diabetic women. CT Scan is the investigation of choice not only to establish the diagnosis but also to plan the line of management. Renal preservation must be the aim of management. This can be achieved to a great extent by medical management combined with percutaneous drainage of obstructed kidney. However nephrectomy is indicated in life threatening infection of the kidney. Prompt diagnosis and the timing of drainage could be the prognostic factor. A case of EPN in a diabetic patient who was successfully managed by nephrectomy is presented.J Bangladesh Coll Phys Surg 2015; 33(2): 91-94

scholarly journals Causes and Management of Acute Abdominal Pain in Children: A Review Article

2021 ◽  
pp. 14-22
Author(s):  
May Abdullah S. Alanazi ◽  
Abdulaziz Muslih Muhaylan Alsharari ◽  
Ibrahim Awadh R. Alanazi ◽  
Abdulaziz Mashan R. Alanazi
Keyword(s):  
Abdominal Pain ◽  
Emergency Room ◽  
Acute Abdominal Pain ◽  
Symptomatic Treatment ◽  
Review Article ◽  
Pain Site ◽  
Life Threatening ◽  
Laboratory Investigations ◽  
Surgical Conditions

Acute abdominal pain is one of the commonest prevalent grievances in children, and it frequently requires emergency room diagnosis and management. Abdominal pain in children differs with age, concomitant symptoms, and pain site. While most cases of acute abdominal embarrassment are self-limiting and benevolent, there are certain diseases that can be life-threatening and necessitate instant care, such as appendicitis, intussusception, or intestinal obstruction. To decide the cause of acute abdominal pain and recognize children with surgical conditions, scrupulous history taking and numerous physical checkups are mandatory.The most important and realistic first goal in the evaluation of acute AP is to distinguish between surgical and nonsurgical situations, which are further divided into urgent and non-urgent categories. A thorough history and physical examination, laboratory investigations to evaluate comorbidity, and imaging scans are usually used for these purposes. Management decisions should necessitate teamwork between the emergency room physician, a surgeon, and a radiologist. Consecutivereassessment and symptomatic treatment with hardworking follow-up are necessary for management as soon aspossible in urgent disorder.

scholarly journals Ethanol combined with coil embolisation for the treatment of arteriovenous malformations in a patient with Parkes Weber syndrome

2020 ◽  
Vol 102 (3) ◽  
pp. e54-e56
Author(s):  
Q Zhao ◽  
Lian Liu ◽  
Z Liao ◽  
Y Pan ◽  
Jingyan Liu ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Vascular System ◽  
Early Stage ◽  
Therapeutic Option ◽  
Coil Embolisation ◽  
Weber Syndrome ◽  
Congenital Condition ◽  
Initial Procedure ◽  
Life Threatening

Parkes Weber syndrome is a rare congenital condition of the vascular system with severe symptoms and life-threatening complications. The challenge is to manage the arteriovenous malformations, and there is no consensus on optimal treatment. We report the case of an 18-year-old woman with Parkes Weber syndrome who was treated with ethanol combined with coil embolisation at an early stage. After two sessions of embolisation, a significant devascularisation was achieved. No sign of recurrence was observed two years after the initial procedure. The patient’s symptoms and signs were greatly relieved during the follow-up period. This case raises awareness of Parkes Weber syndrome and highlights the importance of timely intervention, as well as offering a promising therapeutic option for this condition.

scholarly journals Emphysematous pyelonephritis in an infant from Sokoto, north-western Nigeria

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Fatima B. Jiya ◽  
Paul K. Ibitoye ◽  
Nma M. Jiya ◽  
Maryam Amodu-Sanni ◽  
Yahaya Mohammed ◽  
...  
Keyword(s):  
Abdominal Mass ◽  
Male Infant ◽  
University Teaching ◽  
Emphysematous Pyelonephritis ◽  
Left Flank ◽  
Paediatric Unit ◽  
Life Threatening ◽  
History Of ◽  
Excessive Crying ◽  
North Western

Introduction: Emphysematous pyelonephritis is a life-threatening necrotising bacterial infection of the kidneys. It is rare among children and can be fatal if not promptly identified and treated.Case presentation: A 7-month-old male infant presented to the Emergency Paediatric Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, on 12 November 2019 with a 5-day history of fever and vomiting, and a 3-day history of a progressively enlarging, left-side abdominal mass. There was associated excessive crying on micturition, refusal to feed and weight loss. He looked ill and was in respiratory distress, irritable, febrile (38.8 °C), moderately dehydrated and pale. His weight and length were 5.5 kg and 64 cm. He had a tender, firm and ballotable abdominal mass on the left flank measuring 8 cm × 10 cm. His pulse rate was 140 beats/min, blood pressure 60/40 millimetres of mercury and respiratory rate was 65 cycles/min. He had widespread coarse crepitations and normal heart sounds on chest auscultation.Management and outcome: An initial diagnosis of sepsis was made. Other considerations were nephroblastoma and neuroblastoma. Ceftriaxone and blood transfusion were commenced with subsequent administration of intravenous fluids. Further radiologic investigations revealed emphysematous pyelonephritis. The patient had percutaneous drainage and extended spectrum β-lactamase-producing Escherichia coli (sensitive to meropenem) which was isolated from the aspirate culture after 48 h of incubation. Meropenem could not be commenced because of non-availability and high cost. The patient subsequently deteriorated and died from septic shock.Conclusion: Emphysematous pyelonephritis has a fulminant course when not diagnosed promptly and treated adequately.

scholarly journals P100 Recruitment barriers in multicentre collaborative studies as demonstrated by a single unit experience of the Management of Acutely Symptomatic Hernias (MASH) study

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
A Wilkins ◽  
A Findlay ◽  
J Yau ◽  
C Ettles ◽  
Charles Findlay
Keyword(s):  
Abdominal Wall Hernia ◽  
Recruitment Rate ◽  
Collaborative Studies ◽  
Recruitment Bias ◽  
Insufficient Time ◽  
Time Of Presentation ◽  
Time Of Admission ◽  
Recruitment Barriers ◽  
Surgical Unit

Abstract Introduction MASH is a multi-centre prospective cohort study assessing the management of patients presenting with symptomatic abdominal wall hernia. Consenting patients are recruited during acute admission, with telephone follow up at day 30 and 90. We performed a retrospective review of all patients referred to a single general surgical unit with a symptomatic hernia to quantify recruitment rate and identify barriers to recruitment. Methods Patients meeting the inclusion criteria 1st August to 18th September were identified from prospective handover lists and electronic records and compared to the prospectively compiled screening log. Reason for not enrolment was coded according to protocol with an additional code added for patients not identified at time of admission. Results 8/23 (35%) eligible patients were enrolled. 15/23 (65%) were not enrolled due to; Patient not identified at time of admission n = 9 (60%), declined n = 2 (13.3%), too unwell to consent n = 2 (13.3%), translational barrier n = 1 (6.6%) and lacking capacity n = 1 (6.6%). Patients not identified at time of admission included those seen by clinicians not involved in study (new starters and locums) and those discharged directly from A&E with insufficient time and resources to gain consent. Conclusion In our unit 65% of eligible patients were not recruited, the majority of whom were missed at time of presentation. This study will generate important information on management and outcomes of acute hernias however strategies are required to recognise and mitigate recruitment bias. Staff turnover may be a significant factor in prospective studies, particularly those prolonged during the COVID-19 pandemic.

scholarly journals Vaginal Rhabdomyosarcoma in a patient with advanced cervical cancer; a case report and review of literature

2021 ◽  
Vol 10 (5) ◽  
pp. 2064
Author(s):  
Archana Kumari ◽  
Rinchen Zangmo ◽  
Deepali Garg ◽  
Juhi Bharti ◽  
Richa Vatsa ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Primary Tumour ◽  
Abdominal Mass ◽  
Review Of Literature ◽  
Lower Abdomen ◽  
Soft Tissue Tumours ◽  
Primary Malignancy ◽  
Rare Tumour ◽  
Local Examination

Rhabdomyosarcoma is very rare in adults accounting for less than 5% of all soft tissue tumours and less than 1% of all malignancies. Vagina is one of the least common sites for occurrence of Rhabdomyosarcoma in the genital tract. We present a case of a 53-year-old woman who is a follow up case of cervical cancer stage IIIB, managed by radiotherapy and chemotherapy. She was doing well till 5 years of her treatment for cervical cancer when she presented with complaints of pain lower abdomen and discharge per vaginum for 10 days. On examination she was found to have an abdominal mass of 18 weeks size and on local examination there was 4X4 cm fixed mass on lower third of vagina arising from left side. MRI abdomen and pelvis was done. Biopsy from the vaginal mass showed features of Rhabdomyosarcoma. Further follow up of the patient was not possible due to lockdown in view of the pandemic. She was last contacted telephonically on 25th March 2020; she said she was waiting for the lockdown to be lifted so that her further management can take place. This is just one patient; there are many more with other medical conditions all over the world who are losing their lives because of not being able to access medical care due to the present pandemic. New growth in the region of local recurrence in a known malignancy cannot necessarily be the recurrence of the primary tumour. It is important to keep our mind open to other differentials apart from the recurrence of primary malignancy, sometimes it can turn out to be a very rare tumour as we encountered in our case.

scholarly journals Old Wine in a New Bottle: Acromegaly Presenting as Diabetic Ketoacidosis

2021 ◽  
Author(s):  
Sowrabha Bhat ◽  
Subhodip Pramanik ◽  
Pradip Mukhopadhyay ◽  
Subhankar Chowdhury
Keyword(s):  
Diabetic Ketoacidosis ◽  
Insulin Signalling ◽  
Early Stage ◽  
Review Of Literature ◽  
Peripheral Insulin Resistance ◽  
The Face ◽  
Tissue Changes ◽  
Soft Tissue Changes ◽  
High Index Of Suspicion

Acromegaly is a rare disease characterised by chronic excess of Growth Hormone (GH) levels. Insulin signalling is impaired, gluconeogenesis is excess and peripheral insulin resistance is increased in acromegaly causing hyperglycaemia and diabetes. Diabetic Ketoacidosis (DKA) is a rare but known complication of diabetes in acromegaly. Most cases of acromegaly come into light due to the classical soft tissue changes in the face and extremities. A high index of suspicion is required to diagnose this condition in early stage. Here, a case of 22-years-old male presented with DKA and on investigation was found to have acromegaly due to a GH secreting pituitary macroadenoma. This management and subsequent follow-up of the case along with review of literature is also done. Such a presentation of acromegaly was rare but rewarding.

scholarly journals Pneumonia-related pneumatoceles in infants: CT assessment and image-guided treatment

2021 ◽  
Author(s):  
Elisa Mercanzin ◽  
Pietro Andrea Bonaffini ◽  
Antonino Barletta ◽  
Francesco Stanco ◽  
Clarissa Valle ◽  
...  
Keyword(s):  
Percutaneous Drainage ◽  
Potential Role ◽  
Scientific Literature ◽  
Case Series ◽  
Consensus Guidelines ◽  
Successful Management ◽  
Image Guided ◽  
Life Threatening

Lung pneumatoceles represent a potential life-threatening complication of pneumonia in infants, especially when they do not spontaneously reabsorb. In this category of patients, scientific literature lacks and no consensus guidelines for management have been proposed. Imaging plays a key role in the diagnosis, characterization, and follow-up of pneumatoceles. Image-guided percutaneous drainage can be considered a safe and effective treatment in children, although it is not widely recognized in newborns and infants. The aim of this case series review is to describe the main CT features of complicated or persistent pneumatoceles in infants and to highlight the potential role of image-guided percutaneous drainage as an effective approach for their treatment. Successful management of four infants affected by pneumonia-related pneumatoceles with percutaneous drainage is presented.

Sign in / Sign up

Export Citation Format

Share Document