Percutaneous nephrolithotomy: implementation of digital insertion and dissection as an adjunct to the technique

BACKGROUND: Percutaneous nephrolithotomy (PCNL) was established as a minimally invasive treatment option for kidney stones in the 1970s and is considered a safe and effective procedure, with stone clearance rates of 78-95%. The ideal puncture should maximize the effectiveness of the procedure in terms of stone-free status and minimize the risk of complications. CLINICAL CASE: We present the case of a 36-year-old male patient with bilateral lower back pain. A CT urography scan was performed that revealed bilateral lithiasis. The stone on the right side was consistent with an incomplete staghorn stone and a right retrorenal colon was identified. Left flexible nephrolithotripsy and subsequent right percutaneous nephrolithotomy were performed. A puncture was made under fluoroscopic guidance supported by previous digital dissection of all layers of the abdominal wall until gaining access to the retroperitoneum. Colonic lesion was prevented and a tunnel through which the renal unit could be palpated was formed. CONCLUSIONS: The technique of digital insertion and dissection offers safe access to the renal unit that is useful in patients presenting with risk factors for a potential complication. KEYWORDS: Digital; Kidney; Lithiasis; Percutaneous nephrolithotomy.

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An Unusual Presentation of Pyelonephritis: Is It COVID-19 Related?

SN Comprehensive Clinical Medicine ◽

10.1007/s42399-021-00909-0 ◽

2021 ◽

Author(s):

L. J. van ‘t Hof ◽

L. Pellikaan ◽

D. Soonawala ◽

H. Roshani

Keyword(s):

Late Onset ◽

Blood Clot ◽

Time Frame ◽

Venous Occlusion ◽

Late Complications ◽

Organ Injury ◽

Vein Thrombosis ◽

Lower Back ◽

The Right ◽

Renal Infection

AbstractIn severe cases of COVID-19, late complications such as coagulopathy and organ injury are increasingly described. In milder cases of the disease, the exact time frame and causal path of late-onset complications have not yet been determined. Although direct and indirect renal injury by SARS-CoV-2 has been confirmed, hemorrhagic renal infection or coagulative problems in the urinary tract have not yet been described. This case report describes a 35-year-old female without relevant medical history who, five days after having recovered from infection with SARS-CoV-2, had an unusual course of acute pyelonephritis of the right kidney and persistent fever under targeted antibiotic treatment. A hemorrhagic ureteral obstruction and severe swollen renal parenchyma preceded the onset of fever and was related to the developing pyelonephritis. Sudden thrombotic venous occlusion in the right eye appeared during admission. Symmetrical paresthesia in the limbs in combination with severe lower back pain and gastro-intestinal complaints also occurred and remained unexplained despite thorough investigation. We present the unusual combination of culture-confirmed bacterial hemorrhagic pyelonephritis with a blood clot in the proximal right ureter, complicated by retinal vein thrombosis, in a patient who had recovered from SARS-CoV-2-infection five days before presentation. The case is suspect of a COVID-19-related etiology.

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Successful surgical rescue of delayed onset diaphragmatic hernia following radiofrequency ablation using a thoracoscopic approach for hepatocellular carcinoma: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01213-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Atsushi Morito ◽

Shigeki Nakagawa ◽

Katsunori Imai ◽

Norio Uemura ◽

Hirohisa Okabe ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Small Intestine ◽

Radiofrequency Ablation ◽

Diaphragmatic Hernia ◽

Invasive Treatment ◽

Thoracoscopic Approach ◽

Case Presentation ◽

Medial Segment ◽

Liver Surface ◽

The Right

Abstract Background Radiofrequency ablation (RFA) is widely used as a minimally invasive treatment for hepatocellular carcinoma (HCC). RFA has a low risk of complications, especially compared with liver resection. Nevertheless, various complications have been reported after RFA for HCC; however, diaphragmatic hernia (DH) is extremely rare. Case presentation A 78-year-old man underwent thoracoscopic RFA for HCC located at the medial segment adjacent to the diaphragm approximately 7 years before being transported to the emergency department due complaints of nausea and abdominal pain. Computed tomography revealed a prolapsed small intestine through a defect in the right diaphragm, and emergency surgery was performed. The cause of diaphragmatic hernia was the scar of RFA. We confirmed that the small intestine had prolapsed into the right diaphragm, and we resected the necrotic small intestine and repaired the right diaphragm. Herein, we report a case of ileal strangulation due to diaphragmatic hernia after thoracoscopic RFA. Conclusions Care should be taken when performing thoracoscopic RFA, especially for tumors located on the liver surface adjacent to the diaphragm. Patients should be carefully followed up for possible DH, even after a long postoperative interval.

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Isolated giant true intercostal artery aneurysm with arteriovenous fistula: A case report

Vascular ◽

10.1177/17085381211041323 ◽

2021 ◽

pp. 170853812110413

Author(s):

Kenichi Honma ◽

Terutoshi Yamaoka ◽

Daisuke Matsuda

Keyword(s):

Minimally Invasive ◽

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Artery Aneurysm ◽

Rare Condition ◽

Intercostal Artery ◽

Spinal Cord Infarction ◽

Invasive Treatment ◽

Intercostal Artery Aneurysm ◽

The Right

Objectives Intercostal artery aneurysm (IAA) is a very rare condition. Interestingly, only one study reported a case of intercostal aneurysm caused by an arteriovenous fistula (AVF). Here, we report the case of a patient with non-ruptured isolated giant true IAA caused by an AVF (size, 28 × 41 mm). Methods Treatment options for IAA include open surgery and endovascular treatment (EVT). We chose EVT, as it is minimally invasive. The right 11th intercostal artery and aneurysm diverged from the aorta. Two outflow arteries, one inflow artery, and an AVF from the aneurysm were confirmed, and coil embolization was performed. The artery of Adamkiewicz did not communicate with the right 11th intercostal artery. We performed angiography and confirmed occlusion of IAA with endoleak. Results There were no clinical findings indicative of spinal cord infarction after treatment. The patient did not develop complications and was discharged the day after treatment. Endoleak was not observed on computed tomography angiography findings at 1 month after treatment. Conclusions In our patient, an AVF might have caused IAA. Endovascular treatment for non-ruptured isolated giant IAA is a safe and minimally-invasive treatment. We found that performing EVT is beneficial when the size of the IAA exceeds 30 mm.

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Iatrogenic hydrohemothorax during percutaneous nephrolithotomy: A case report

Open Access Research Journal of Multidisciplinary Studies ◽

10.53022/oarjms.2021.1.2.0011 ◽

2021 ◽

Vol 1 (2) ◽

pp. 079-082

Author(s):

Tae Yeon Kim ◽

Kyu Nam Kim ◽

Lee Kwang Hyun ◽

Bo Seok Kwon ◽

Jo Hyung Jun

Keyword(s):

Percutaneous Nephrolithotomy ◽

Renal Stone ◽

Vital Signs ◽

Pulmonary Complications ◽

Fluid Retention ◽

Air Bubbles ◽

Close Cooperation ◽

The Right ◽

Pleural Injury ◽

Routine Chest

Background: Percutaneous nephrolithotomy (PNL) is a widely used surgical method for renal stone management. However, it can be associated with several complications. Case: We report an acute hemothorax during PNL in 57-year-old male patient with a stone. After observing air bubbles at the diaphragm on the laparoscopic screen, we considered pulmonary complications. A chest radiograph demonstrated a shade that measured 130 mm wide and 70 mm long and fluid retention on the right side of the chest. During drainage of 200 ml of blood through a chest tube, the patient’s vital signs became unstable. After the patient received hydration and intravenous injection of vasopressor, his vital signs stabilized. Conclusions: Pulmonary complications due to pleural injury during PNL can result in death, but the complications can be managed by early diagnosis and treatment. Close cooperation between surgeon and anesthesiologist and routine chest radiographs after PNL can reduce the pulmonary complications.

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Clinical and morphological study of calf enlargement following S-1 radiculopathy

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1992000300021 ◽

1992 ◽

Vol 50 (3) ◽

pp. 383-386 ◽

Cited By ~ 1

Author(s):

Osvaldo J. M. Nascimento ◽

Marcos R. G. de Freitas ◽

Myrian D. Hahn ◽

Abelardo Q. C. Araújo

Keyword(s):

Gastrocnemius Muscle ◽

Rare Condition ◽

Satisfactory Explanation ◽

Lower Back ◽

Left Buttock ◽

Left Calf ◽

One Year ◽

The Right ◽

Gastrocnemius Muscles

Calf enlargement following sciatica is a rare condition. It is reported the case of a 28-year-old woman who complained of repeated episodes of lower back pain radiating into the left buttock and foot. One year after the beginning of her symptoms, she noticed enlargement of her left calf. X-ray studies disclosed L5-S1 disk degeneration. EMG showed muscle denervation with normal motor conduction velocity. Open biopsies of the gastrocnemius muscles were performed. The left gastrocnemius muscle showed hypertrophic type 2 fibers in comparison with the right gastrocnemius. Electron microscopy showed mildly increased number of mitochondria in these fibers. A satisfactory explanation for denervation hypertrophy has yet to be provided.

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Percutaneous nephrolithotomy of a staghorn stone in thoracic ectopic kidney

International Journal of Urology ◽

10.1111/j.1442-2042.2007.01765.x ◽

2007 ◽

Vol 14 (6) ◽

pp. 558-560 ◽

Cited By ~ 6

Author(s):

Pratipal Singh ◽

Vivek Vijjan ◽

Manu Gupta ◽

Deepak Dubey ◽

Aneesh Srivastava

Keyword(s):

Percutaneous Nephrolithotomy ◽

Ectopic Kidney ◽

Staghorn Stone

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Lower back pain with sciatic disorder following L5 dermatome caused by herpes zoster infection

Orthopedic Reviews ◽

10.4081/or.2015.6046 ◽

2015 ◽

Vol 7 (3) ◽

Cited By ~ 2

Author(s):

Roslind Karolina Hackenberg ◽

Arnd Von den Driesch ◽

Dietmar Pierre König

Keyword(s):

Back Pain ◽

Herpes Zoster ◽

Lower Back Pain ◽

Pain Treatment ◽

Acute Onset ◽

Mri Scan ◽

Lower Back ◽

Acyclovir Treatment ◽

Magnetic Resonance Imaging Mri ◽

The Right

We report the case of a 62-year-old patient with lower back pain radiating into the right leg accompanied by numbness. The pain had an acute onset and was resistant to conservative pain treatment. A magnetic resonance imaging (MRI) scan of the lumbar spine showed no degenerative discovertebral lesions, but a swelling of the nerve root supplying the affected dermatome. For pain treatment the patient received lumbar epidural infiltrations. During this treatment the patient suddenly developed a skin rash with grouped vesicular blisters on an erythematous ground. After the diagnosis of a lumbar herpes zoster and an acyclovir treatment, the patient could be discharged in an ameliorated condition. This case demonstrates the importance to consider rare causes of lumbosciatic pain and disorders and to acknowledge unspecific changes in a MRI scan.

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Cone beam computed tomography for detecting residual stones in percutaneous nephrolithotomy, a randomized controlled trial (CAPTURE) protocol

Trials ◽

10.1186/s13063-021-05794-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

R. A. Kingma ◽

I. J. de Jong ◽

M. J. W. Greuter ◽

S. Roemeling

Keyword(s):

Computed Tomography ◽

Randomized Controlled Trial ◽

Percutaneous Nephrolithotomy ◽

Cone Beam Computed Tomography ◽

Controlled Trial ◽

Cone Beam ◽

Total Study Population ◽

Randomized Controlled ◽

Free Status

Abstract Introduction Percutaneous nephrolithotomy (PCNL) is the standard surgical treatment method for large kidney stones. Its aim is to achieve a stone-free status, since any residual fragments (RFs) after PCNL are likely to cause additional morbidity or stone growth. Enhancing intraoperative detectability of RFs could lead to increased stone-free rates and decreased re-intervention rates. Cone beam computed tomography (CBCT) has recently been introduced in urology as a feasible method for intraoperatively imaging RFs. The aim of this trial is to determine the added value of CBCT in percutaneous nephrolithotomy, by measuring differences in stone-related morbidity for patients with procedures in which a CBCT is used versus patients with procedures without the use of CBCT. Methods The CAPTURE trial is an investigator-initiated single-center, randomized controlled trial (RCT) in adult patients who have an indication for percutaneous nephrolithotomy. A contemporary percutaneous nephrolithotomy is performed. Once the surgeon is convinced of a stone-free status by means of fluoroscopy and nephroscopy, randomization allocates patients to either the study group in whom an intraoperative CBCT scan is performed or to the control group in whom no intraoperative CBCT scan is performed. The main endpoint is the stone-free status as assessed four weeks postoperatively by low-dose non-contrast abdominal CT, as a standard follow-up procedure. Secondary endpoints include the number of PCNL procedures required and the number of stone-related events (SREs) registered. The total study population will consist of 320 patients that undergo PCNL and are eligible for randomization for an intraoperative CBCT scan. Discussion We deem a randomized controlled trial to be the most effective and reliable method to assess the efficacy of CBCT in PCNL. Though some bias may occur due to the impossibility of blinding the urologist at randomization, we estimate that the pragmatic nature of the study, standardized circumstances, and follow-up methods with pre-defined outcome measures will result in a high level of evidence. Trial registration Netherlands Trial Register (NTR) NL8168, ABR NL70728.042.19. Registered on 15 October 2019. Prospectively registered.

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THE INFLUENCE OF EXTERNAL AND INTERNAL FACTORS ON THE CHEWING EFFICIENCY OF THE DENTITION

The actual problems in dentistry ◽

10.18481/2077-7566-2019-15-1-109-116 ◽

2019 ◽

Vol 15 (1) ◽

pp. 109-116

Author(s):

Сергей Лазарев ◽

Sergey Lazarev ◽

Тху Чанг Ле ◽

Thu Chang Le

Keyword(s):

Spinal Column ◽

Cervical Vertebra ◽

Weight Lifting ◽

Internal Factors ◽

Left Hand ◽

Lower Jaw ◽

Lower Back ◽

Chewing Efficiency ◽

Weightlessness Condition ◽

The Right

Subject. Going upright in human evolution changed the position of the spinal column and head. The position of the spine affects the occlusion through the rotational movements of the first cervical vertebra. The dentofacial system also evolved: the gaps disappeared between the canines and the adjacent teeth; sex differences of teeth were almost erased. As a result, the chewing became more adapted to speech reducing the dominant influence of the canines. Food influenced on the shape of teeth, the occlusion, the lower jaw movement. People use premolars and first molars for chewing soft food, which diminished the chewing efficiency of second molars. The function-dominant chew side also develops dentofacial system. Aim ― research regularities of jaw chewing in stress strain. Methods. Silicone occlusion impressions were obtained from each subject in stress conditions and physical activities. Results. Subjects with a dominant right hand have more amounts of match supracontacts at the right jaw side than at the left one. At opposite side of the spectrum, subjects with a dominant left hand have more amounts of match supracontacts at the left jaw side than at the right one. Ambidextrousnesses have approximately equal amounts at the right and left jaw sides. This is evidence of the force movement at the dominant chewing side. Conclusion. While subjects were falling, the low jaw moved forward resting up against on the canines. In other words, in weightlessness condition the falling subjects were searching for the point of support, which was the occlusion. In the results, it redirected and reduced the kinetic energy of falling bodies and levers of operating forces. The number of supracontact points during lifting is less than in the position of weightlessness. In other words, during the weight lifting the subjects have support points: the lower back and legs. And the occlusion becomes the third point of support only when lifting the extreme physical exertions.

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OVARIAN VEIN SYNDROME: A CASE REPORT

International Journal of Advanced Research ◽

10.21474/ijar01/13847 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1102-1104

Author(s):

Abderrazak Benazzouz ◽

◽

Yassine Karmouch ◽

Fouad Hajji ◽

Rachid Zaini ◽

...

Keyword(s):

Case Report ◽

Chronic Disease ◽

Renal Colic ◽

Ct Urography ◽

Ovarian Vein ◽

Extrinsic Compression ◽

Multiparous Women ◽

The Right

The ovarian Vein Syndrome was first reported in 1964, yet its existence as a true pathophysiological entity remains controversial. It may present as an acute ora chronic disease, typically affecting young, multiparous women. We present in this article a 32-year-old patient with chronic renal colic, ultrasound and CT urography showing an extrinsic compression of the right lumbar ureter by the ovarian vein, a ligation, anda resection of the ovarian vein were performed by transperitoneal laparoscopy.

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