Primary Clear Cell Adenocarcinoma of a Urethral Diverticulum Treated with Multidisciplinary Robotic Anterior Pelvic Exenteration

Primary urethral carcinoma is extremely rare and is marked by a variety of clinical symptoms. Primary carcinoma of a urethral diverticulum is still rarer and clear cell adenocarcinoma of the urethra is particularly uncommon (Swartz et al., 2006). Such infrequency has led to inadequate management guidance in the literature for a disease that is often late in presentation and carries substantial morbidity and mortality. This treatable but grave disease deserves definitive curative treatment. We present the first published instance in which it was treated with robotic anterior exenteration. In our case, a 47-year-old female was referred to the urology service for investigation of recurring urinary tract infections. During the workup, the patient was found to have an advanced clear cell urethral adenocarcinoma originating in a urethral diverticulum. We discuss the natural history of this condition, its consequences, and the first instance of its treatment using robotic anterior pelvic exenteration

Elderly Trauma in Philadelphia: An Urban Trauma Center\u27s Experience

Purpose: Trauma remains one of the major causes of death in the United States and traditionally is considered an affliction of youth. With the much anticipated “Silver Tsunami” of baby-boomers now hitting America, the fastest growing trauma population is now that of older adults; defined as those over 65 years of age. We aimed to better describe the outcomes of these patients. Methods: We conducted a retrospective chart review of patients identified by the Hospital of the University of Pennsylvania’s institutional trauma registry. Patients treated between July 1st, 2001 and June 30th, 2011 were included and divided into the following cohorts: 65-74 years, 75-84 years and 85 years and older. Demographics included age, mechanism of injury and ISS. Differences in mortality and hospital and ICU length of stay were considered. Results: The mean age of each cohort was 69.3 ± 2.9 years, 79.4 ± 2.8 years and 89 ± 3.5 years, respectively. Injury severity scores by cohort were 11.0 ± 10.6, 12.1 ± 11.3 and 9.9 ± 9.7 respectively. Hospital length of stay for the 65-74 cohort was 5.0 ± 8.6 days with 0.8 ± 3.6 days in the ICU for an ISS± 13.0 hospital days with 4.3 ± 3.3 days in the ICU for an ISS \u3e16 (p =16. For an ISS of65-74, 75-84 and 85 and older groups was 3.3, 4.1 and 5.6 percent respectively (p=16 this changed to 16.9, 21.5 and 24.3 percent respectively (p = \u3c0.05). Conclusions Older patients with less severe injury patterns did not demonstrate a difference in hospital length of stay. Patients over the age of 85 with severe injuries had a shorter length of stay than younger cohorts. ICU stay was over three days among the most severely injured members of all cohorts but was shorter in the most severely injured members of the oldest cohort. In hospital mortality was significantly increased in the oldest cohort with severe injury

Use of Therapeutic Hypothermia in Cocaine-Induced Cardiac Arrest: Further Evidence

Therapeutic hypothermia is an important and successful treatment that has been endorsed only in specific clinical settings of cardiac arrest. Inclusion criteria thus far have not embraced drug-induced cardiac arrest, but clinical evidence has been mounting that therapeutic hypothermia may be beneficial in such cases. A 59-year-old man who experienced a cocaine-induced cardiac arrest had a full neurological recovery after use of therapeutic hypothermia. The relevant pathophysiology of cocaine-induced cardiac arrest is reviewed, the mechanism and history of therapeutic hypothermia are discussed, and the clinical evidence recommending the use of therapeutic hypothermia in cocaine-induced cardiac arrest is reinforced

Primary Clear Cell Adenocarcinoma of a Urethral Diverticulum Treated with Multidisciplinary Robotic Anterior Pelvic Exenteration

Primary urethral carcinoma is extremely rare and is marked by a variety of clinical symptoms. Primary carcinoma of a urethral diverticulum is still rarer and clear cell adenocarcinoma of the urethra is particularly uncommon (Swartz et al., 2006). Such infrequency has led to inadequate management guidance in the literature for a disease that is often late in presentation and carries substantial morbidity and mortality. This treatable but grave disease deserves definitive curative treatment. We present the first published instance in which it was treated with robotic anterior exenteration. In our case, a 47-year-old female was referred to the urology service for investigation of recurring urinary tract infections. During the workup, the patient was found to have an advanced clear cell urethral adenocarcinoma originating in a urethral diverticulum. We discuss the natural history of this condition, its consequences, and the first instance of its treatment using robotic anterior pelvic exenteration

A 52-Year-Old Male with Bilaterally Duplicated Collecting Systems with Obstructing Ureteral Stones: A Case Report

Collecting system duplication is marked by a variety of clinical syndromes. Bilateral and obstructed duplicated systems, particularly with asymmetric levels of duplication, are rare and typically due to ureteric bud development anomalies. The infrequency with which this condition exists makes it a formidable challenge for physicians and patients. To our knowledge, we present the first case report of bilateral obstruction of bilaterally duplicated collecting systems. In our case, a 52-year-old male complaining of low back pain, constipation, urinary urgency and hematuria was found to have bilateral obstructing stones as well as asymmetrical bilateral collecting system duplication. We discuss the natural history of this condition, its consequences and identification

Pediatric dog bite with peritoneal violation

While dog bites are common in pediatric trauma centers, peritoneal violation from a dog bite is an uncommon finding given the significant bite force required to traverse the abdominal wall musculature. A very high incidence of clinical suspicion is necessary in order to avoid missing this rare, potentially life-threatening injury. In this instance, we report a case of peritoneal violation, retroperitoneal hematoma, colonic contusion, and mesenteric injury in a four year old male suffering from a dog attack in which computed axial tomography (CT) scanning was key in identifying the injuries. We also review the natural history (and injury patterns) of canine attacks in the United States. Keywords: Pediatric, Trauma, Bites and sting