Management of Infants Diagnosed with Antenatal Hydronephrosis and Determining the Need for Surgical Intervention

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Muhammet Mesut Nezir Engin
Keyword(s):  
Surgical Intervention ◽  
Antenatal Hydronephrosis

scholarly journals A study on postnatal evaluation and follow-up of infants with antenatally detected hydronephrosis

2017 ◽  
Vol 4 (5) ◽  
pp. 1677
Author(s):  
Soundaiyan Balasankar ◽  
Jeyaraman Balasubramanian
Keyword(s):  
Urinary Tract ◽  
Surgical Intervention ◽  
P Value ◽  
Postnatal Life ◽  
Antenatal Hydronephrosis ◽  
Urinary Tract Anomaly ◽  
Antenatal Ultrasonography ◽  
Significant Pathology ◽  
Anteroposterior Renal Pelvic Diameter

Background: Antenatal hydronephrosis(ANH) has now become a frequent diagnosis with the increasing use of antenatal ultrasonography. Objective of present study was to evaluate and follow up infants with antenatally detected hydronephrosis and to determine whether there is significant correlation between anteroposterior renal pelvic diameter detected in antenatal USG and urinary tract anomalies detected postnatally.Methods: After obtaining an informed consent, all neonates with antenatal ultrasound showing hydronephrosis (n=80) were enrolled in the study. Postnatal ultrasound was done at 3 days ,1 month and 6 months of postnatal life. Atleast 6 months followup was done to look for spontaneous resolution or other significant pathology. Micturating cystourethrography/radionuclide scan done in selected cases.Results: Out of 80 cases ,43 had mild,24 had moderate and 13 had severe degrees of hydronephrosis.31 of them (9 mild,10 moderate and 12 with severe hydronephrosis) had postnatal anomaly detected.14 of them (1 mild, 4 moderate and 9 with severe hydronephrosis) underwent surgery. As the grade of antenatal hydronephrosis increases from mild, moderate to severe, the relative risk of postnatal anomaly and requirement of surgical intervention also increased (p value<0.0001).Conclusions: Antenatal hydronephrosis may be associated with significant postnatal urinary tract anomaly with risk quantified by the measurement of anteroposterior renal pelvic diameter(APPD). 

scholarly journals Evaluation of the Patients with Antenatal Hydronephrosis Diagnosed Ureteropelvic Junction Obstruction with the Hydronephrosis Severity Score

2021 ◽  
Author(s):  
Gökçen Erfidan ◽  
Eren Soyaltın ◽  
Tunç Özdemir ◽  
Secil Arslansoyu Çamlar ◽  
Demet Alaygut ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Severity Score ◽  
Ureteropelvic Junction Obstruction ◽  
Surgical Intervention ◽  
Outlet Obstruction ◽  
Case Series ◽  
Horseshoe Kidney ◽  
Ureteropelvic Junction ◽  
Ureterovesical Junction ◽  
Antenatal Hydronephrosis

Objective: Ureteropelvic junction obstruction is the main cause of obstructive antenatal hydronephrosis. Although surgery is the traditional treatment modality, there is still no consensus on surgical indications. We aimed to analyse the patients referred as antenatal hydronephrosis and diagnosed with ureteropelvic junction obstruction with Hydronehprosis Severity Score that has been developed by Babu at al. Method: The patients who were admitted with antenatal hydronephrosis in 2013-2018 and diagnosed as ureteropelvic junction obstruction and followed up in our clinic for at least one year were evaluated. The cases with unilateral hydronephrosis were included. Those with vesicoureteral reflux, horseshoe kidney, hydroureter, ureterovesical junction obstruction were excluded. Renal ultrasonography and nuclear scintigraphy results were re-evaluated. They were grouped as mild (0-4), moderate (5-8) and severe (9-12) based on scoring of three parameters; differantial renal function, drainage curve pattern and US grade. Clinical outcomes were also classified in three groups; resolution (grade 1-no hydronephrosis), persistance (grade 2-3 hydronephrosis) and surgical intervention. The relation between the scores and clinical outcomes were analysed. Results: A total of 57 patients were evaluated. 2 with horseshoe kidney, 4 with vesicoureteralreflux, 7 with bilateral hydronephrosis, 4 with ureteric outlet obstruction, 12 with incomplete records were excluded. Finally, 28 patients were included. Hydronephrosis was resolved in 4 (14.2%), persisted in 5 (17.8%) and surgical intervention was required in 19 (67.8%) patients. 1/5 patients with mild, 15/20 patients with moderate and 3/3 patients with severe HSS underwent surgery. 77.2% of the patients with a total score of ≥6 initially required surgical intervention at their follow-up. Conclusion: HSS may provide a significant predictive value for surgical intervention for the patients classified as “mild” or “severe” at the initial evaluation. In the “moderate” group, the risk increases in the patients with HSS≥6. Existing data should be evaluated with larger case series.

scholarly journals Outcome of antenatal hydronephrosis in northeastern Thailand

2014 ◽  
Vol 8 (5) ◽  
pp. 631-635
Author(s):  
Pongsatorn Paopongsawan ◽  
Suwannee Wisanuyotin ◽  
Ratana Komwilaisak ◽  
Junya Jirapradittha ◽  
Apichat Jiravuttipong ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Lung Hypoplasia ◽  
Antenatal Hydronephrosis ◽  
Factors Associated ◽  
Antenatal Ultrasonography ◽  
Ultrasound Findings ◽  
Poor Outcomes ◽  
Stage Renal Disease ◽  
Tract Infections ◽  
End Stage

Abstract Background: Antenatal hydronephrosis (ANH) is a condition characterized by fetal renal pelvic dilatation during pregnancy. It is detected in 1%-5% of all pregnancies. Most cases of ANH are physiological in nature, but some are pathological and can cause morbidity. Objective: To determine: (a) the causes of ANH; (b) the factors associated with complications; and, (c) the factors associated with surgical intervention. Methods: We reviewed the medical records of infants diagnosed with ANH; defined by a renal pelvic anteroposterior diameter ≥5 mm (based on antenatal ultrasonography) and being followed-up at Srinagarind Hospital. Results: Forty-six infants (32 boys and 14 girls) with ANH were identified. Over half (57%) were born in our hospital (in-hospital) with the condition. The two most common causes of ANH were ureteropelvic junction obstruction (32%) and transient hydronephrosis (22%). Of the 63 abnormal kidneys, 52% needed surgical intervention. Twenty-two patients (48%) had urinary tract infections and most had more than 1 episode. None of the 46 patients had end-stage renal disease, but one died because of lung hypoplasia during the neonatal period. The severity of ANH and time of first postnatal ultrasonography were related to medical complications, while bilateral ANH and more severe ANH were associated with the need for surgical intervention. A milder degree of ANH and postnatal ultrasound findings were significantly associated with transient hydronephrosis. Conclusion: Most cases of ANH were pathological and half required surgical intervention. Severe ANH and delayed investigation were associated with poor outcomes.

Thrombolysis in Arterial Occlusion

1999 ◽  
Vol 82 (S 01) ◽  
pp. 109-111 ◽  
Author(s):  
Raymond Verhaeghe
Keyword(s):  
Clinical Practice ◽  
Thrombolytic Therapy ◽  
Hemorrhagic Stroke ◽  
Surgical Intervention ◽  
Bypass Graft ◽  
Surgical Techniques ◽  
Arterial Occlusion ◽  
Second Step ◽  
Severe Bleeding ◽  
Initial Management

SummaryIntra-arterial thrombolytic therapy has replaced systemic intravenous infusion of thrombolytic agents as a treatment modality for arterial occlusion in the limbs. Several catheter-guided techniques and various infusion methods and schemes have been developed. At present there is no scientific proof of definite superiority of any agent in terms of efficacy or safety but clinical practice favours the use of urokinase or alteplase. Studies which compared thrombolysis to surgical intervention suggest that thrombolytic therapy is an appropriate initial management in patients with acute occlusion of a native leg artery or a bypass graft. Underlying causative lesions are treated in a second step by endovascular or open surgical techniques. Severe bleeding is the most feared complication: the risk of hemorrhagic stroke is 1-2%.

Surgical treatment of alveolar echinococcosis: a single centre experience and systematic review of the literature

2019 ◽  
Vol 98 (4) ◽  
pp. 167-173
Keyword(s):  
Case Report ◽  
Echinococcus Multilocularis ◽  
Alveolar Echinococcosis ◽  
Lymphatic System ◽  
Surgical Intervention ◽  
Clinical Symptoms ◽  
Safety Margin ◽  
Surgical Removal ◽  
Single Centre Experience ◽  
Therapeutic Procedures

Introduction: Alveolar echinococcosis (AE) is a zoonosis caused by Echinococcus multilocularis. AE is primarily localised in the liver. Echinococcus multilocularis imitates tumour-like behaviour. It can metastasise through blood or lymphatic system to distant organs. Echinococcosis often remains asymptomatic due to its long incubation period and indistinct symptoms. Clinical symptoms are determined by the parasite’s location. Diagnosis of echinococcosis is based on medical history, clinical symptoms, laboratory tests, serology results, imaging methods and final histology findings. Surgical removal of the cyst with a safety margin, followed by chemotherapy is the therapeutic method of choice. Case report: We present a case report of alveolar echinococcosis in a thirty-year-old female patient in whom we surgically removed multiple liver foci of alveolar echinococcosis. The disease recurred after two years and required another surgical intervention. Conclusions: Alveolar echinococcosis is a disease with a high potential for a complete cure provided that it is diagnosed early and that the recommended therapeutic procedures are strictly adhered to.

Outcomes of endoscopic surgical intervention for acromegaly - the Wessex experience

2018 ◽  
Author(s):  
Louise Curtis ◽  
N Mathad ◽  
Aabir Chakraborty ◽  
Sarah Brewster ◽  
Kate Millar ◽  
...  
Keyword(s):  
Surgical Intervention

Acute Aortic Intramural Hematoma Presenting with Painless Recurrent Syncope

2012 ◽  
Vol 15 (5) ◽  
pp. 286
Author(s):  
Jan Droste ◽  
Heidar Zafarani Zadeh ◽  
Mohammed Arif ◽  
Ian Craig ◽  
A K Thakur
Keyword(s):  
Aortic Wall ◽  
Surgical Intervention ◽  
Intramural Hematoma ◽  
Pericardial Tamponade ◽  
Transthoracic Echocardiogram ◽  
Type A Aortic Dissection ◽  
Severe Hypotension ◽  
Patient’S History ◽  
Aortic Intramural Hematoma ◽  
Venous Pulse

<p>A patient presented with recurrent syncope due to transient severe hypotension. The patient's history, physical examination, and initial baseline investigation did not suggest a cardiovascular cause. After fluid resuscitation, a raised jugular venous pulse was noted. Bedside transthoracic echocardiogram showed a pericardial effusion and a proximally dilated aorta. Computed tomography of the thorax confirmed these findings and also demonstrated an intramural hematoma of the proximal aortic wall.</p><p>The patient was transferred to a cardiothoracic center, where he was at first treated medically. He then developed sudden cardiogenic shock due to pericardial tamponade and was successfully operated on.</p><p>It is important to recognize an acute intramural hematoma of the proximal aortic wall as a cardiothoracic emergency. This condition can present atypically, but nevertheless warrants urgent surgical intervention, equal to type A aortic dissection. Echocardiography can help in making the diagnosis.</p>

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