Ultrasound Guided Percutaneous Nephrolithotomy in Mesh-Repaired Incisional Hernia

Objectives. To describe our technique of percutaneous nephrolithotomy (PNL) in patients with mesh-repaired flank incisional hernia. Polypropylene mesh which is used for fascia strengthening in hernia repair elicits intense inflammatory reaction and the consequent fibrosis alters the characteristics of abdominal wall. Thus, prior history of flank hernia repair with mesh may result in percutaneous nephrolithotomy failure. Materials and Methods. Demographic data, renal stones characteristics, and any complication during surgery and follow-up of patients who were treated by PNL during 2011 to 2020 and had mesh in their flank region were collected. Results. Percutaneous nephrolithotomy was performed without any problem in 8 patients with guide of ultrasonography. Conclusion. Based on our experience, ultrasound-guided PNL is feasible and hypothetically superior to fluoroscopy in such circumstances.

Management of Mutrashmari (Urolithiasis)- A Case Report

Ashmari comes under Mutravaha srotovikara and Ashtamahagada as described in Susruta Samhita.The prevalence of urinary stone is approximately 3 to 5% in general population and is increasing across the world mainly due to metabolic derangement, global climatic changes. Acharya Susruta said, before attempting surgical procedures one should try with oral medications like ghrita, paneeyakshara, taila etc. which possesses properties like chedana, lekhana, bhedana and mutrala for facilitating the disintegration of urinary stones. A 39 years old male patient came to OPD at Taranath Govt. Ayurveda Medical College, Ballari on 20 May 2021 presented with complaints of pain in right flank region, pain in right loin radiating to groin, burning micturition, orange coloured urine for 2 days, diagnosed as Urolithiasis and advised for surgery. He visited our hospital to avoid the surgery and for the treatment of the same. Kokilaksha Paneeya Kshara and Punarnavadi Kashaya given to patient for 28 days and got relief from symptoms. Key words: Ashmari, Ashtamahagada, Paneeya kshara, Punarnavadi Kashaya.

Doxorubicin Paradoxically Ameliorates Tumor-Induced Inflammation in Young Mice

Doxorubicin (DOX) is one of the most widely used chemo-therapeutic agents in pediatric oncology. DOX elicits an inflammatory response in multiple organs, which contributes to DOX-induced adverse effects. Cancer itself causes inflammation leading to multiple pathologic conditions. The current study investigated the inflammatory response to DOX and tumors using an EL4-lymphoma, immunocompetent, juvenile mouse model. Four-week old male C57BL/6N mice were injected subcutaneously with EL4 lymphoma cells (5 × 104 cells/mouse) in the flank region, while tumor-free mice were injected with vehicle. Three days following tumor implantation, both tumor-free and tumor-bearing mice were injected intraperitoneally with either DOX (4 mg/kg/week) or saline for 3 weeks. One week after the last DOX injection, the mice were euthanized and the hearts, livers, kidneys, and serum were harvested. Gene expression and serum concentration of inflammatory markers were quantified using real-time PCR and ELISA, respectively. DOX treatment significantly suppressed tumor growth in tumor-bearing mice and caused significant cardiac atrophy in tumor-free and tumor-bearing mice. EL4 tumors elicited a strong inflammatory response in the heart, liver, and kidney. Strikingly, DOX treatment ameliorated tumor-induced inflammation paradoxical to the effect of DOX in tumor-free mice, demonstrating a widely divergent effect of DOX treatment in tumor-free versus tumor-bearing mice.

Spontaneous subcapsular renal haematoma in a diabetic patient with acute pyelonephritis

Spontaneous renal subcapsular haematoma is not a common clinical condition. It is mainly caused by renal tumours, vascular diseases, trauma, anticoagulation, and urological interventions. Patients present with sudden onset abdominal pain mainly in the flank region, haematuria, and abdominal tenderness. We report a case of 42-year-old diabetic patient who presented with a history of fever and left flank pain with clinical signs of pyelonephritis, on whom abdominal ultrasound and computed tomography demonstrated a subcapsular renal haematoma which was confirmed by percutaneous aspiration. Management with antibiotics and percutaneous nephrostomy proved successful.

Prediction and understanding of soft proton contamination in XMM-Newton: a machine learning approach

<p>One of the major and unfortunately unforeseen sources of background for the current generation of X-ray telescopes flying mainly in the magnetosphere are soft protons with few tens to hundreds of keV concentrated. One such telescope is the X-ray Multi-Mirror Mission (XMM-Newton) by ESA. Its observing time lost due to the contamination is  about 40%. This affects all the major broad science goals of XMM, ranging from cosmology to astrophysics of neutron stars and black holes. The soft proton background could dramatically impact future X-ray missions such Athena and SMILE missions. Magnetopsheric processes that trigger this background are still poorly understood. We use a machine learning approach to delineate related important parameters and to develop a model to predict the background contamination using 12 years of XMM observations. As predictors we use the location of XMM, solar and geomagnetic activity parameters. We revealed that the contamination is most strongly related to the distance in southern direction, ZGSE, (XMM observations were in the southern hemisphere), the solar wind velocity and the location on the magnetospheric magnetic field lines. We derived simple empirical models for the best two individual predictors and a machine learning model which utilizes an ensemble of the predictors (Extra Trees Regressor) and gives better performance. Based on our analysis, future X-Ray missions in the magnetosphere should minimize observations during  times  associated with high solar wind speed  and avoid closed magnetic field lines, especially at the dusk flank region at least in the southern hemisphere. </p>

Spontaneous subcapsular and perirenal haemorrhage with retroperitoneal haematoma in a patient with ovarian melanoma metastases

A 47-year-old woman was admitted to our clinic for intensive pain in the left flank region. The transvaginal ultrasound showed a left adnexal solid mass with ascites. She had undergone surgical removal of skin melanoma in 2008, but in September 2019, intracardiac metastasis resulting from it had been discovered. CT performed in March 2020 had been negative for other metastases. A full abdomen ultrasound was not performed. During the night, the patient began to show signs and symptoms of hypovolaemic shock. The patient was urgently transferred to the operating room for a video laparoscopy. A vast left retroperitoneal haematoma was diagnosed along with voluminous enlargement of the left ovary. We proceeded with a left adnexectomy and blood transfusion. Subsequent contrast-enhanced CT revealed a left subcapsular, perirenal haematoma and a voluminous retroperitoneal haematoma. Kidney metastasis was also seen. The final histological diagnosis was metastatic amelanotic malignant melanoma of the ovary.

A Rare Case of Rib Fractures During Centrifuge Training

ABSTRACT There are several injuries potentially related to high-G exposure, including neck and back pain, spinal fractures, and pneumomediastinum. We present a young military pilot diagnosed with isolated fractures of the right 9th and 10th ribs via X-ray after high-G exposure (maximum G level: 9G). This patient presented with progressive and localized pain in the right anterior chest and flank region. After conservative treatment with rest and pain management, he recovered from the rib fractures and completed all profile challenges in the advanced high-G training program. A review of the annual health examination of the pilot did not show any rib lesions or other related illnesses. He was qualified for flying class II and considered fit for flight training. His medication history was unremarkable, and he did not have a family history of malignancy, osteoporosis, or osteopenia. He also denied having previously experienced trauma of the rib cage or participated in any strenuous military training program or exercise before centrifuge training. The potential explanations for the multiple rib fractures are repetitive stress from the anti-G straining maneuver and anti-G suit compression of the abdominal bladder. To our knowledge, consecutive rib fractures related to high-G exposure have never been documented. This report may increase the awareness of flight surgeons and training units regarding the risk of chest wall injuries during high-G exposure and encourage them to use multiple diagnostic tools to determine the correct diagnosis.

Primary Renal Pelvis Squamous Cell Carcinoma: A Case Report

Background: Primary renal pelvic squamous cell carcinoma (SCC) is exceedingly rare neoplasm and poor prognosis. We reported a patient who underwent surgery for radical nephrectomy.Methods and results: The patient was a 72-year old man, who visited doctors with complaints of dull aching in right flank region and occasional gross hematuria. Abdominal contrast-enhanced magnetic resonance imaging (MRI) revealed a neoplasm and hydronephrosis in the right kidney. The preoperative diagnosis of malignant tumor in right kidney was made by urologist, and open radical nephrostomy was performed. The resected tumor was shown histologically to be squamous cell carcinoma of right renal pelvis.Conclusions: Renal SCC is a rare tumor usually presented in advanced stage with poor prognosis. Early diagnosis and surgical treatment are beneficial for patients’ survival. Most patients are associated with risk factors of Renal SCC such as renal calculi and infection, but patient with no risk factors shouldn’t be ignored. We encountered a rare case with no risk factors.

Effects Of Cryofrequency on Localized Adiposity in Flanks

Background: Cryofrequency is a characteristic used in clinical practice to reduce localized and flaccid adiposity, and promotes heat in our tissues by maintaining a surface. Objective: To investigate the effects of Cryofrequency in the reduction of adiposity located on the flank region. Methods: This is an experimental study, consisting of 30 female volunteers between 20 and 40 years old with flank fat. The applications were performed once a week, totaling eight applications, using the Andrus Criofrequência  - ADOXY MEDICAL, with parameters of 350 w of power, monopolar mode on the region of right and left flanks, with an area of 10 cm in height and 20 cm in width, for 8 minutes per area. The evaluations were performed before and after 4 and 8 Cryofrequency applications. Results: There was a reduction of the adiposity located in the flank region, with a significant decrease in the values of perimetry, plicometry and ultrasonography, and positive results in the questionnaire evaluating satisfaction and criofrequence reactions. Conclusion: Cryofrequency was effective for the treatment of localized adiposity, generating a positive satisfaction among the evaluated volunteers.

Chronic Ulcer on Flank Region as First Manifestation of Crohn’s Disease

Crohn’s disease is difficult to diagnose owing to its varied symptoms, among which fistulae are a late-stage symptom that appears mainly in the form of a perianal fistula. A patient who was previously healthy without clinical history visited our hospital with an ulcer of unknown cause at the right flank and gluteal region. Using computed tomography (CT) and colonoscopy, we diagnosed the ulcer as an enterocutaneous fistula caused by Crohn’s disease and successfully treated it with general surgery. In young, lean men with skin lesions of unknown cause, a CT or colonoscopy test may be useful for diagnosing underlying gastrointestinal problems.