scholarly journals Ectopic adrenal tissue in the kidney: A systematic review

2021 ◽  
Vol 93 (4) ◽  
pp. 481-488
Author(s):  
Davide De Marchi ◽  
Alessandro Tafuri ◽  
Guglielmo Mantica ◽  
Aliasger Shakir ◽  
Federico Scarfò ◽  
...  
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Correct Diagnosis ◽  
Rare Event ◽  
Case Series ◽  
Clinical Aspects ◽  
Renal Neoplasm ◽  
Adrenal Tissue ◽  
Adrenal Rest ◽  
Ectopic Adrenal Tissue

Introduction: Ectopic adrenal tissue in the kidney, including “Ectopic adrenal tissue” and “Adrenal-renal fusion”, is a rare event with a specific behavior which may be difficult to distinguish clinically from renal neoplasms. We performed a systematic review on ectopic adrenal tissue variants reported in the literature underlining its clinical aspects. Methods: Manuscripts which presented a case report or case series of ectopic adrenal tissue in the kidney were included even if published in original articles, reviews, or letters to the editor. A specific search on SCOPUS®, PubMed®, and Web of Science® database was performed. Only English language papers published in a period ranging between August 1991 and April 2020 were considered. Additionally, a case we had at our institution is described, and its characteristics are included. Data on clinical presentation, type of adrenal anomaly, location, anatomopathological and immune-histotype characteristics were collected. Results: We identified 888 manuscripts. Among these 29 were included in this systematic review. Overall, 39 patients with renal adrenal fusion or adrenal ectopia were considered. In most cases, the diagnosis was made incidentally, or following investigation for flank pain, abdominal pain, or endocrinological disorders. CT scan frequently identified a solid vascularized lesion that was difficult to distinguish from renal neoplasm. Adrenal fusion was mostly located at the level of the upper pole. Adrenal rest was found in the renal parenchyma, renal hilum, or retroperitoneum in close proximity to the renal peduncle. Often these ectopic adrenal tissue lesions follow a benign behavior and can be classified as functioning or non-functioning adenomas. Rarely, they may experience neoplastic degeneration. The most frequently positive markers were inhibin, vimentin, melan-A, synaptophysin and anti-p450 scc. Conclusions: Ectopic adrenal tissue in the kidney is a rare event with specific clinical characteristics that need to be identified in order to arrive at a correct diagnosis and carry out appropriate treatment management.

scholarly journals Psychiatric Presentations Heralding Hashimoto’s Encephalopathy: A Systematic Review and Analysis of Cases Reported in Literature

2017 ◽  
Vol 08 (02) ◽  
pp. 261-267 ◽  
Author(s):  
Vikas Menon ◽  
Karthick Subramanian ◽  
Jaiganesh Selvapandian Thamizh
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Depressive Disorders ◽  
Psychiatric Symptoms ◽  
Case Reports ◽  
Correct Diagnosis ◽  
Oral Steroid ◽  
Clinical Aspects ◽  
Systematic Analysis ◽  
Hashimoto’S Encephalopathy

ABSTRACTHashimoto’s encephalopathy (HE) may often present initially with psychiatric symptoms. These presentations are often variable in clinical aspects, and there has been no systematic analysis of the numerous psychiatric presentations heralding an eventual diagnosis of HE which will guide clinicians to make a correct diagnosis of HE. This systematic review was done to analyze the demographic characteristics, symptom typology, and clinical and treatment variables associated with such forerunner presentations. Electronic databases such as PubMed, ScienceDirect, and Google Scholar databases were searched to identify potential case reports that described initial psychiatric presentations of HE in English language peer-reviewed journals. The generated articles were evaluated and relevant data were extracted using a structured tool. We identified a total of forty articles that described 46 cases. More than half of the total samples (54.4%) were above the age of 50 years at presentation. The most common psychiatric diagnosis heralding HE was acute psychosis (26.1%) followed by depressive disorders (23.9%). Dementia (10.9%) and schizophrenia (2.2%) were uncommon presentations. Antithyroid peroxidase antibodies were elevated in all patients but not antithyroglobulin antibodies. Preexisting hypothyroidism was absent in majority of cases (60.9%). Steroid doses initiated were 500–1000 mg of intravenous methylprednisolone for majority (52.1%) of patients while oral steroid maintenance was required for a significant minority (39.1%). Psychiatric manifestations of HE may be heterogeneous and require a high index of clinical suspicion, especially in older adults. A range of clinical and treatment variables may assist clinicians in making a faster diagnosis and instituting prompt and effective management.

scholarly journals Hunger strikes in prisons: a narrative systematic review of ethical considerations from a physician’s perspective

2017 ◽  
Vol 35 (2) ◽  
pp. 135-142 ◽  
Author(s):  
G. Gulati ◽  
B. D. Kelly ◽  
D. Meagher ◽  
H. Kennedy ◽  
C. P. Dunne
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Case Series ◽  
Database Search ◽  
World Medical Association ◽  
Hunger Strike ◽  
Ethical Considerations ◽  
Dual Loyalty ◽  
The World ◽  
Physician’S Perspective

ObjectivesWe sought to identify and review published studies that discuss the ethical considerations, from a physician’s perspective, of managing a hunger strike in a prison setting.MethodsA database search was conducted to identify relevant publications. We included case studies, case series, guidelines and review articles published over a 20-year period. Non-English language publications were translated.ResultsThe review found 23 papers from 12 jurisdictions published in five languages suitable for inclusion.ConclusionsKey themes from included publications are identified and summarised in the context of accepted guidelines from the World Medical Association. Whilst there seems to be an overall consensus favouring autonomy over beneficence, tensions along this fine balance are magnified in jurisdictions where legislation leads to a dual loyalty conflict for the physician.

Thrombolytic Salvage of the Frostbitten Upper Extremity: A Systematic Review

Hand ◽  
2020 ◽  
pp. 155894472094006
Author(s):  
James Drinane ◽  
Adee J. Heiman ◽  
Joseph A. Ricci ◽  
Ashit Patel
Keyword(s):  
Systematic Review ◽  
Thrombolytic Therapy ◽  
Upper Extremity ◽  
Animal Studies ◽  
English Language ◽  
Case Series ◽  
Current Data ◽  
Ischemic Tissue ◽  
Promising Treatment ◽  
Salvage Rate

Background Vascular thrombosis secondary to frostbite can lead to ischemic tissue damage in severe cases. Threatened extremities may be salvaged with thrombolytics to restore perfusion; however, current data are limited to single institution case series. The authors performed a systematic review to determine the efficacy of thrombolytic therapy in treating upper extremity frostbite. Methods PubMed, EBSCO, and Google Scholar were queried using the keywords “thrombolytics,” “frostbite,” “fibrinolytics,” and “tPA.” Exclusion criteria were failure to delineate anatomic parts injured, failure to report number of limbs salvaged, animal studies, and non-English language publications. Thrombolytic therapy was defined as intraarterial (IA) or intravenous (IV) administration of tissue plasminogen activator (tPA), alteplase, urokinase, streptokinase, or any tPA derivative. Results A total of 42 studies were identified, with 13 satisfying inclusion criteria. Eight studies reported catheter-directed IA thrombolysis, four reported systemic IV administration, and 1 reported both methods. A total of 157 patients received thrombolytics. In all, 73 upper extremity digits were treated by IA route and 136 digits were treated by IV route. Overall upper extremity digit salvage rate was 59%. There was a significantly higher salvage rate in digits treated by the IA route compared to the IV route. Conclusions Thrombolytics, particularly when administered by the intra-arterial route, are emerging as a promising treatment of severe frostbite of the upper extremity, increasing digit salvage rates.

scholarly journals 119. Nocardia Bacteremia Is Almost Always Associated with Immune Compromise or an Intravascular Device: Single-Center Case Series and Systematic Review of the Literature

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S90-S90
Author(s):  
Eloise Williams ◽  
Adam W Jenney ◽  
Denis W Spelman
Keyword(s):  
Systematic Review ◽  
Literature Review ◽  
Systematic Literature Review ◽  
English Language ◽  
Case Series ◽  
Blood Cultures ◽  
Single Center ◽  
Intravascular Device ◽  
Pubmed Database ◽  
All Cause Mortality

Abstract Background Nocardia bacteremia is a rare but important phenomenon, with previous studies describing a 50% mortality rate. We undertake a single-center review and the largest systematic review of Nocardia bacteremia performed over the past 20 years. Methods A single-center review of cases of Nocardia bacteremia was performed using hospital microbiology records from January 1, 2010 to December 31, 2017. A systematic literature review was also performed to identify cases of Nocardia bacteremia described in the English language literature between January 1, 1999 and December 31, 2018 using the NCBI PubMed database and snowballing from citations of relevant publications. Results Single-center case series: Four cases of Nocardia bacteremia are described. Three patients had an intravascular device in situ prior to the onset of Nocardia bacteremia and three patients were immunocompromised; one patient had both risk factors. Systematic literature review: A systematic review identified 50 publications that described 85 cases with sufficient patient data to be reviewed in detail. Including the 4 cases described in our institution, 89 cases of Nocardia bacteremia were included in the analysis. The median age was 57 years [interquartile range (IQR) 42–68] and 69% were male. Eighty-two percent of cases were immunocompromised and 38% had endovascular devices. Pulmonary infection was the most common concurrent site of clinical disease (66%), followed by central nervous system (25%), pleural (17%) disease, and endocarditis (11%). Blood cultures were the only positive microbiological specimen that isolated Nocardia in 45% of cases. Median incubation time to blood culture positivity was 4 days [IQR 3–6]. Thirty-day all-cause mortality was 24% and overall all-cause mortality was 42%. Conclusion Four new cases of Nocardia bacteremia are described. Isolation of Nocardia from blood cultures is rare but represents serious infection with high associated overall mortality. Nocardia bacteremia is most frequently identified in immunocompromised patients and those with intravascular devices. Disclosures All authors: No reported disclosures.

Wunder-women: Systematic review of causes, treatment and outcomes of Wunderlich syndrome during pregnancy

2018 ◽  
Vol 12 (2) ◽  
pp. 134-144
Author(s):  
Thomas Ahn ◽  
Matthew J Roberts ◽  
Anojan Navaratnam ◽  
Eric Chung ◽  
Simon T Wood
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Case Reports ◽  
Contemporary Literature ◽  
Case Series ◽  
Artery Aneurysm ◽  
Well Being ◽  
Renal Neoplasm ◽  
Level Of Evidence ◽  
Meta Analyses

Objective: The objective of this article is to conduct a contemporary literature review on Wunderlich syndrome, or spontaneous renal haemorrhage (SRH), among pregnant women to describe contemporary aetiology, investigations and management patterns. Methods: A systematic review of MEDLINE and CENTRAL in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. All articles, including case reports and case series on SRH published from 2000 to 2016, were included. Full-text manuscripts describing SRH among pregnant women were reviewed for clinical parameters, which were collated and analysed. Results: Twenty cases of SRH in pregnant women were identified. The median age and gestation were 32.1 years and 26.5 weeks, respectively, with SRH most commonly occurring in the third trimester (nine patients; 45%) and due to renal neoplasm, specifically angiomyolipoma (AML; 12 patients; 60%), followed by renal artery aneurysm (RAA; five patients; 25%). Surgical intervention (55%) was most commonly used for acute SRH. Foetal demise was not uncommon (15%). Conclusions: SRH in pregnant women is an uncommon but complex urological and obstetric emergency with potentially catastrophic consequences. A multidisciplinary approach is key to timely diagnosis and appropriate management considering the well-being both of mother and foetus. Pre-emptive diagnosis and intervention may reduce complications. Level of evidence: 4

scholarly journals Gastrointestinal manifestations of COVID-19 in children: a systematic review and meta-analysis

2020 ◽  
pp. flgastro-2020-101529 ◽  
Author(s):  
Anthony K Akobeng ◽  
Ciaran Grafton-Clarke ◽  
Ibtihal Abdelgadir ◽  
Erica Twum-Barimah ◽  
Morris Gordon
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Case Reports ◽  
Meta Analysis ◽  
Gastrointestinal Symptoms ◽  
Case Series ◽  
Risk Of Bias ◽  
Gastrointestinal Manifestations ◽  
Published Evidence ◽  
Pooled Prevalence

ObjectivesTo summarise the published evidence on the gastrointestinal manifestations of COVID-19 in children and to determine the prevalence of gastrointestinal symptoms.MethodsIn this systematic review and meta-analysis, we searched PubMed, Embase, CINAHL and the WHO’s database of publications on novel coronavirus. We included English language studies that had described original demographic and clinical characteristics of children diagnosed with COVID-19 and reported on the presence or absence of gastrointestinal symptoms. Meta-analysis was conducted using the random-effects model. The pooled prevalence of gastrointestinal symptoms was expressed as proportion and 95% CI.ResultsThe search identified 269 citations. Thirteen studies (nine case series and four case reports) comprising data for 284 patients were included. Overall, we rated four studies as having a low risk of bias, eight studies as moderate and one study as high risk of bias. In a meta-analysis of nine studies, comprising 280 patients, the pooled prevalence of all gastrointestinal symptoms was 22.8% (95% CI 13.1% to 35.2%; I2=54%). Diarrhoea was the most commonly reported gastrointestinal symptom followed by vomiting and abdominal pain.ConclusionsNearly a quarter of children with COVID-19 have gastrointestinal symptoms. It is important for clinicians to be aware of the gastrointestinal manifestation of COVID-19.PROSPERO registration numberCRD42020177569.

scholarly journals Association of hearing loss in the patients with treated with lamivudine: a systematic review protocol

2020 ◽  
Vol 7 (4) ◽  
pp. 262
Author(s):  
Kalpesh Joshi ◽  
Mahesh Belhekar
Keyword(s):  
Systematic Review ◽  
Hearing Loss ◽  
English Language ◽  
Case Series ◽  
World Health ◽  
Study Cohort ◽  
Lamivudine Therapy ◽  
Screening Process ◽  
Manual Search ◽  
Cochrane Reviews

<p class="abstract"><strong>Background:</strong> Hearing loss has been reported with lamivudine therapy. The World Health Organization (WHO) international database of suspected adverse drug reactions (Vigibase) prioritised clinical review of lamivudine and hearing loss in 2015. This manuscript provides the details of research protocol for a systematic review of association of lamivudine with hearing loss.</p><p class="abstract"><strong>Methods: </strong>English-language publications that assess hearing loss within patients who are receiving lamivudine therapy will be included. All study types like clinical trial designs, case-control study, cohort study, retrospective study, case-series or a case report will be included. Preclinical studies, studies enrolling patients with known differential diagnosis such as presbycusis etc will be excluded. Electronic databases (PubMed, Cochrane reviews, Embase and Google scholar), international clinical trials registry, clinicaltrials.gov and pharmaceutical company clinical study registries will be searched for key words related to lamivudine and hearing loss. After a thorough electronic/manual search of manuscript they will undergo a screening process and selected articles will be assessed for risk of bias using online ROBINS-I tool. We will explore outcomes as an observational systematic review.</p><p class="abstract"><strong>Conclusions:</strong> This review will provide detailed benefit-risk analysis of lamivudine with respect to hearing loss in patients with chronic conditions such as Human immunodeficiency virus (HIV) and Hepatitis B virus (HBV) infection.</p><p class="abstract"><strong>Trial Registration:</strong> PROSPERO registration number is CRD42018112205.0.001.</p>

Differentiating Intrarenal Ectopic Adrenal Tissue From Renal Cell Carcinoma in the Kidney

2018 ◽  
Vol 26 (7) ◽  
pp. 588-592 ◽  
Author(s):  
Mustafa Q. Yousif ◽  
Ziyan T. Salih ◽  
Barry R. DeYoung ◽  
Shadi A. Qasem
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Positive Staining ◽  
Diagnostic Challenge ◽  
Cell Renal Cell Carcinoma ◽  
Adrenal Tissue ◽  
Adrenal Rest ◽  
Ectopic Adrenal Tissue ◽  
Immunohistochemical Stains

Background. Adrenal rest (AR) is the presence of ectopic adrenal cortical tissue, often identified incidentally during autopsy (20% of postmortem examination). In the kidney, AR can be found in 6% of the general population. Ectopic adrenal tissue is of no functional significance but may in some cases, pose a diagnostic challenge for the pathologist, especially in the context of renal clear cell renal cell carcinoma (RCC) and small needle biopsies. Aim. To investigate the utility of immunohistochemical stains in distinguishing AR from RCC. Methods. Archival cases of AR, in our institution, were reviewed and compared with a cohort of RCC cases using a panel of immunohistochemical stains, including PAX2, PAX8, calretinin, and inhibin. Results. Nine of 10 (90%) cases of AR showed positive staining for inhibin and negative staining for calretinin, PAX2 and PAX8. One AR case was positive for PAX2 and PAX8 in addition to inhibin. All (100%) RCC cases were positive for PAX2 and PAX8, but negative for inhibin and calretinin. Conclusions. A panel of PAX2, PAX8 and inhibin may be useful markers for distinguishing AR from RCC. Calretinin was noncontributory in our study.

scholarly journals A Systematic Review and Single-Centre Experience of Ureterorenoscopy Under Local Anesthetic: A Safer Option for Anesthetically High-Risk Patients?

2019 ◽  
Vol 2 (2) ◽  
pp. e1-e14
Author(s):  
Ali Tasleem ◽  
Sachin Yallappa ◽  
Michael Mikhail ◽  
Tarik Amer ◽  
Peter Pietrzak ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Spinal Anaesthesia ◽  
English Language ◽  
Transitional Cell ◽  
Case Series ◽  
Single Centre Experience ◽  
Intravenous Analgesia ◽  
Lidocaine Gel ◽  
Risk Patients

Patients are living longer with an increasing number of co-morbidities. Minimally invasive ureterorenoscopy (URS) to manage upper tract calculi or transitional cell carcinoma (TCC) can be performed under general or spinal anaesthesia, however certain co-morbid patients are not suitable for this and may benefit from a different approach. We report on URS under local anaesthesia (LA) using intra-ureteric marcaine as the primary form of anaesthesia. We also aimed to perform a robust systematic review of this topic.   A retrospective analysis over 6 years was undertaken on all patients who underwent URS for calculi or TCC under LA, with the use of intra-urethral lidocaine gel (2%) and intra-ureteric marcaine (0.5%, 20ml) with sedoanalgesia as an adjunct. A systematic review and all English Language articles on ureteroscopic procedures with the use of LA with or without intravenous sedoanalgesia were selected and data extracted.   In our case series, twelve patients had a total of 42 procedures. Stone size varied from 4-35mm. Twenty-two percent of procedures (9/41) did not require any sedation or intravenous analgesia as an adjunct to the bupivacaine with a further 49% (20/41) requiring midazolam. (The anaesthetic chart was not available for one procedure). No procedures were abandoned and there were no conversions to general/spinal anaesthesia. There were no complications secondary to the use of LA. Eighty-one percent of cases (34/42) were performed as day-case or overnight stays. The complication rate was similar to that for conventional anaesthesia. The systematic review yielded 1121 procedures from 11 papers and 7 countries. In 32 cases the procedure was converted to general anaesthesia.  Stone clearance rates were between 78-100%. The procedures were well tolerated in 80-90% of cases.   This study highlights that URS can be safely performed under LA. It is well tolerated and represents an option for carefully selected patients who have been adequately counselled, and who would be at high risk from anaesthesia. Such patients may otherwise be considered “unfit” for endourological intervention.    

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