Forgotten stone in a ureteral stump increased the risk of an ureterocutaneous fistula

AbstractHere we report a female patient with diabetes who underwent right nephrectomy 18 years ago for pyonephrosis and renal stone formation. Before she was performed the right nephrectomy, a ureteral calculus impacted in the right ureteral stump was diagnosed. However, after 18 years, a right ureterocutaneous fistula was diagnosed, and the calculus was still found in the ureteral stump of the patient. As a result, a fistula caused by the ureter-impacted calculus was highly suspected. We successfully performed a right ureterectomy, fistulectomy, and debridement on the patient. From our experience in this case, we strongly recommend that a calculus impacted in the ureteral stump should be removed to prevent the occurrence of postoperative complications such as ureterocutaneous fistula

Traumatic asphyxia combined with diffuse axonal injury

AbstractTraumatic asphyxia, a rare, blunt chest trauma-related condition, indicates severe injury and is characterized by subconjunctival hemorrhage, facial edema, cyanosis, and petechiae. This condition mostly appears on the upper chest and face. Rapid oxygen administration with effective ventilation is essential in the treatment of traumatic asphyxia. Prognosis depends on rescue time and associated injuries. Most neurologic symptoms resolve within 24–48 hours and have relatively satisfactory results over a long-term follow-up. We herein report the case of severe and complicated thoracoabdominal compression with a delayed change in consciousness. Susceptibility-weighted magnetic resonance imaging revealed diffuse axonal injury with multifocal microhemorrhages in the brain stem, basal ganglia, internal capsules, and the genu and splenium of the corpus callosum. The patient was in the intensive care unit for more than 21 days

Fixed or mobile-bearing total knee arthroplasty

Fixed and mobile-bearing in total knee arthroplasty are still discussed controversially. In this article, biomechanical and clinical aspects in both fixed and mobile-bearing designs were reviewed. In biomechanical aspect, the mobile-bearing design has proved to provide less tibiofemoral contact stresses under tibiofemoral malalignment conditions. It also provides less wear rate in in-vitro simulator test. Patients with posterior stabilized mobile-bearing knees had more axial tibiofemoral rotation than patients with posterior stabilized fixed-bearing knees during gait as well as in a deep knee-bend activity. However, in clinical aspect, the mid-term or long-term survivorship of mobile-bearing knees has no superiority over that of fixed-bearing knees. The theoretical advantages for mobile-bearing design to provide a long-term durability have not been demonstrated by any outcome studies. Finally, the fixed-bearing design with all-polyethylene tibial component is suggested for relatively inactive, elder people. The mobile-bearing design is suggested for younger or higher-demand patients due to the potential for reduced polyethylene wear and more normal kinematics response after joint replacement. For younger surgeon, the fixed-bearing design is suggested due to less demand for surgical technique. For experienced surgeon, one familiar surgical protocol and instrumentation is suggested rather than implant design, either fixed-bearing or mobile-bearing

Bilateral Ureteral Leiomyoma With Bilateral Ureteropelvic Junction Obstruction

Leiomyomas are benign tumors characterized by overgrowth of visceral smooth muscle in the respiratory, gastrointestinal, and female reproductive tracts. They rarely develop in the urinary system and only 10 cases of unilateral ureteral leiomyoma (UL) have been reported since 1955. No cases of bilateral UL or ureteropelvic junction obstruction due to UL have ever been reported. We present a case of bilateral UL with bilateral ureteropelvic junction obstruction. To the best of our knowledge, this is the first such case report in the English literature

Temporal Arteritis

Temporal arteritis, a chronic inflammatory vasculitis involving medium- and large-sized arteries, has rarely been reported in Asia. However, we report 2 cases, in which the patients initially presented with headache. Physical examination disclosed engorged, hard and palpable vessels in the temporal areas. Temporal-artery biopsy revealed 2 different types of arteritis: the multinucleated giant cell type and the panarteritis type without multinucleated giant cells. One patient was positive for immunoglobulin G anticardiolipin antibody. The pathologic findings of the different subsets of temporal arteritis, and the relationship between anticardiolipin antibody and the extent of vascular complications of temporal arteritis, are discussed

Spontaneous Dissecting Aneurysm of the Renal Artery: A Case Report

Primary dissecting aneurysms of the renal artery are exceedingly rare. The triad of flank pain, hematuria, and hypertension of acute onset in the absence of urinary obstruction should suggest this rare condition. We report a case of spontaneous dissecting aneurysm of the renal artery treated using conservative medical treatment. The diagnosis, therapeutic management, and outcome are discussed

Rupture of Renal Pelvis in an Adult with Congenital Ureteropelvic Junction Obstruction After Blunt Abdominal Trauma

Isolated injury to the renal pelvis following blunt abdominal trauma is very rare. However, a pre-existing renal abnormality will increase the risk of rupture. We present a 24-year-old man with rupture of the left renal pelvis following blunt abdominal trauma. He had pre-existing left ureteropelvic junction (UPJ) obstruction. Delayed computed tomography scan with excretory phase revealed contrast medium extravasation from the left UPJ, and left renal pelvis rupture was diagnosed. He was managed successfully with ureteral double-J stenting for 2 months

Evaluation of Intrarenal Blood Flow by Doppler Ultrasonography Immediately after Extracorporeal Shock Wave Lithotripsy on Hydronephrotic Kidney

Extracorporeal shock wave lithotripsy (ESWL) is an effective and relatively noninvasive mode of treatment for urinary calculi. The aim of this study was to test whether therapeutic ESWL induces changes in renal parenchymatous blood flow and to evaluate shock wave side effects on the renal parenchyma. A total of 45 patients who underwent ESWL for ureteropelvic stone between January 2002 and July 2003 were included in this prospective study. Color Doppler sonography before and 30 minutes after ESWL showed no significant morphologic change. Resistive index (RI) was used to estimate renovascular resistance. The RI significantly increased in obstructed hydronephrotic kidneys. However, no significant change was observed in both treated and untreated kidneys before and after treatment. Hydronephrotic kidneys do not have a higher risk of post-ESWL renovascular resistance interference. The measurement of changes in RI with Doppler ultrasonography may provide useful information for clinical diagnosis of renal tubulointerstitial and vascular damage