Percutaneous nephrolithotripsy for renal pelvis stone in a crossed fused ectopic kidney: a case report

Crossed renal ectopia is the second most common fusion anomaly of the kidney after horseshoe kidney. The incidence of both fused and unfused cases is 1 in 7000 in autopsies. Percutaneous nephrolithotripsy (PCNL) is a well-established technique in the surgical management of nephrolithiasis. The conventional fluoroscopic guidance of PCNL will be of limited value in ectopic anomalous kidneys due to the abnormal anatomical landmarks with consequent compromise of the procedure’s safety.  A 30-year old male patient, previously healthy, presented to our urology outpatient clinic complaining of dull flank pain of six month duration with tenderness in the right renal area and an enlarged right kidney and 1 episode of gross haematuria. Radiological investigations showed left side crossed ectopia with nephrolithiasis. Patient was managed successfully by fluoroscopic guided percutaneous nephrolithotripsy. The position of the stone-containing ectopic kidney can make it easy to reach the pelvis of the target kidney without injuring any adjoining structure. The superimposition of the different soft tissue densities in the radiologic view may limit the ability of the operator to distinguish between different tissue identities. Laparoscopic guidance can represent as a practical solution to this technical problem

External oblique intercostal block in open nephrectomy patients - A zenith in analgesia for anterolateral upper abdominal surgeries: A case series

Open nephrectomy is a common surgery usually performed for malignant and non-malignant renal pathologies. The external oblique intercostal block (EOIB) blocks the anterior and lateral cutaneous nerves from T6 to T10 and provides somatic analgesia. We present a case series of the use of EOIB in patients undergoing open nephrectomy by subcostal incision. Ten patients were given EOIB, which included patients undergoing simple nephrectomy for non-functioning kidneys and radical nephrectomy for renal mass. The patients had satisfactory numerical rating scale scores, mostly <4 for 24 h. Post-operative opioid consumption was minimal. The external oblique fascial plain block is a novel thoracic block that provides reliable upper thoracoabdominal somatic analgesia. It can certainly be considered a suitable option in surgeries such as nephrectomies that involve an upper lateral abdominal wall incision

Measurement of endothelial function and its clinical utility for cardiovascular risk

Over the past two decades, the central role of the endothelium in the initiation, progression, and clinical sequelae of atherosclerosis has been increasingly recognized. Assessment of the pathobiology of the endothelium and its ability to act as a potential therapeutic target remains an area of active research interest. Whilst endothelial function has been shown to be a marker for risk of cardiovascular events in high-risk groups, there remains considerable debate about the most appropriate way to assess this. We discuss the different clinical methods to assess endothelial function, focusing on flow-mediated dilatation (FMD) of the brachial artery, highlighting the importance of using a standardized methodology, as well as discussing the clinical limitations of using FMD in individuals

Classification of aortic stenosis by flow and gradient patterns provides insights into the pathophysiology of disease

Different patterns of flow and valve gradients can lead to diagnostic uncertainty about the severity of aortic stenosis (AS). Consecutive patients with severe AS (valve area &lt;1 cm2) underwent echocardiography and computed tomography. Patients were classified into 4 groups (high-gradient/normal flow [HGNF], high-gradient/low flow [HGLF], low-gradient/normal flow [LGNF], and low-gradient/low flow [LGLF]). Low flow was defined as stroke volume index &lt;35 mL/m2 and low gradient as a mean aortic gradient &lt;40 mm Hg. Aortic valve calcification (AVC) was calculated using the Agatston score. Of 181 patients, 56, 30, 46, and 49 had HGNF, HGLF, LGNF and LGLF with median AVC of 2048, 2015, 1366, and 1178 AU/m2 (P &lt; .0001) and valvuloarterial impedance of 4.5, 6.4, 4.2, and 5.9, respectively (P &lt; .0001). Among those with LGLF, AVC was lower in patients with preserved compared to reduced left ventricular ejection fraction (1018 vs 2550 AU/m2; P &lt; .0001), but valvuloarterial impedance was similar (P = .33). The LGLFAS with preserved ejection fraction is associated with lower AVC and may identify patients with less severe AS in association with an adaptive ventricular response to high afterload