Cases reported "Kidney Calculi"

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1/133. Use of hemiacidrin in management of infection stones.

    Unless all fragments are removed at the time of surgery for struvite stones a high incidence of recurrent infection and stone formation is likely. To reduce the recurrence rate of such stones the renal pelvis is irrigated postoperatively with 10 per cent hemiacidrin solution for at least 48 hours or until all fragments have been dissolved. We have managed successfully 35 patients (36 kidneys) without enxountering any complications. Included in our most recent series are 2 patients with solitary kidneys who had successful dissolution of stone fragments. Absolute contraindications to the use of hemiacidrin are infected urine, fever or flank discomfort. Although we have found hemiacidrin dissolution of renal stones to be safe and effective it is essential that the clinician be aware of the proper technique and its possible complications.
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2/133. Reconstructive renal surgery using a water jet.

    PURPOSE: We describe the successful application of a water jet to reconstructive renal surgery. MATERIALS AND methods: Two consecutive patients underwent reconstructive renal surgery using a waterjet apparatus for a 4.0x6.5 cm. well encapsulated tumor of the lower pole of the left kidney and a 4.5x2.5 cm. staghorn calculus of the left kidney, respectively. The water jet apparatus (Parenchimotom 01) consists of a pressure generating pump and a flexible hose connected to the hand piece, and a nozzle with a pinhole opening of 0.3 mm. RESULTS: Both patients underwent surgery through a left lumbar incision. Partial nephrectomy was performed in 1 patient and anatrophic nephrotomy for stone removal in the other. dissection time was 25 and 12 minutes, with blood loss of 150 and 100 ml., respectively. No temporary vascular clamping or local hypothermia was necessary. Both patients were discharged home 10 days after surgery and at followup no negative sequelae were attributable to the procedure. CONCLUSIONS: The operative procedures proved easy, fast and effective. No temporary vessel clamping or hypothermia was required. Using a water jet is a novel approach that is helpful in renal surgery.
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3/133. color-Doppler in the imaging work-up of primary hyperparathyroidism.

    Primary hyperparathyroidism (PHP) is a rare disease that must be suspected in all the cases of recurrent calcium nephrolithiasis, and that may be totally corrected by surgery. The imaging techniques permit to locate the hyperplastic gland or adenoma before intervention, but their usefulness in patients without a history of previous neck surgery is still debated. Several imaging techniques have been proposed with the aim of locating parathyroid hyperfunctioning glands, including high resolution sonography (US) with color-Doppler (CD), scintigraphy, computed tomography (CT) and magnetic resonance imaging (MRI). We report here a case of recurrent calcium oxalate nephrolithiasis sustained by PHP, which demonstrates how US coupled with CD and echocontrast enhancement is useful in the preoperative location of parathyroid glands. US is the first choice technique in the evaluation of PHP because it is less expensive and useful in detailing lesions of the neck when carried out by a skilled operator. CD should be regarded as a useful complement of US enhancing its sensitivity (80 vs 90%) especially in the cases of associated thyroid gland diseases. Tc-99m SESTAMIBI scintigraphy coupled with MRI is mandatory in high risk surgical patients, namely in those undergoing repeated neck surgery. In conclusion, considering that surgeon must explore all the four parathyroid glands (because of the possibility of multiple adenomas or hyperplasia) a well definite location of the adenomatous lesion may reduce the risks and the time of intervention, and allow the use of alternative procedures, such as videoscopic surgery. On this view and in terms of economy, only US and CD coupled with Tc-99 SESTAMIBI scintigraphy should be considered before surgery.
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4/133. Acute pancreatitis caused by extracorporeal shock wave lithotripsy for bilateral renal pelvic calculi.

    An elderly woman with a history of cholecystectomy and a re-operation for postoperative peritonitis underwent extracorporeal shock wave lithotripsy (ESWL) for right and left renal pelvic calculi, 11 x 6 and 12 x 5 mm in size, to which 2400 and 1400 shots at 20 kV were given, respectively, on the same day. During the evening after the operation, the patient started to complain of upper abdominal pain. Laboratory examination on the next day revealed elevations in blood and urine amylase levels and a diagnosis of pancreatitis was made. Conservative treatment, including administration of protease inhibitor, did not improve her symptoms; abdominal distension became marked and she underwent laparotomy. Necrosection and indwelling of several drain tubes in abdomen were performed with an operative diagnosis of acute necrotic pancreatitis. With daily irrigation of drain tubes and treatment for methicillin-resistant Staphyloococcus aureus infection of the lungs and abdominal cavity, septicemia and duodenal fistula, the patient gradually recovered and was discharged on postoperative day 151. It was suggested that ESWL was responsible for the acute pancreatitis. Either an obstruction of the pancreatic duct by fragments of common duct stone, or mechanical injury of the pancreas due to adhesion between the pancreas and surrounding tissue caused by the lapalotomy, was considered as a possible cause of pancreatitis. To our knowledge, there has been no previous report of severe acute pancreatitis and the present case suggests that ESWL may cause severe pancreatic even in cases without stone shadow in the bile, common duct or pancreatic duct.
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5/133. adrenal insufficiency masquerading as sepsis in a patient with tetraparesis: a case report.

    Several endocrine changes have been reported in patients with tetraplegia after spinal cord injury (SCI). These changes should be considered when prescribing medications that influence the endocrine pathways. megestrol acetate has gained acceptance as a way to promote weight gain in cachectic patients without significant adverse effects. We present a case of a 51-year-old man with C5-C6 tetraparesis who was only 67% of his ideal body weight and was placed on megestrol acetate 5 months before admission for a urologic procedure. Postoperatively, the patient had severe hypotension and tachycardia that was interpreted as a septic or cardiac event. Further workup revealed subnormal levels of 8AM cortisol. An adrenocorticotrophic hormone stimulation test demonstrated results consistent with adrenal suppression. hydrocortisone supplementation was started, and 6 months later cortisol levels were within normal limits. cachexia, hypotension, and mild tachycardia are not uncommon in patients with SCI. When severe hypotension and tachycardia are seen in patients with tetraplegia, the diagnosis of adrenal insufficiency should be considered.
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6/133. Three-dimensional CT scan stone reconstruction for the planning of percutaneous surgery in a morbidly obese patient.

    A three-dimensional spiral CT (3D CT) reconstruction of staghorn stones provides a precise picture of its extent and branching within the kidney. The author reports a case of a large renal staghorn stone in a morbidly obese woman, further complicated by malrotation and hypermobility of the kidney. Two-dimensional plain CT was unable to provide sufficient information for a safe percutaneous approach. This was achieved by means of 3D CT, which also was very helpful during the procedure. Although 3D CT should by no means be routinely employed, it is a valuable tool for pretreatment decision-making and intraoperative orientation in selected cases.
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7/133. Terminal renal failure due to oxalosis in 14 patients.

    The present status of regular dialysis and renal transplantation in patients with end-stage renal disease secondary to primary hyperoxaluria is reported. Clinical studies include one personal case with an 18-month period of follow-up and data concerning thirteen patients treated in 10 centres in europe which have been collected through a cooperative survey carried out with the assistance of Registry of the EDTA. On January 1 st, 1974, mean survival of patients with oxalosis treated by RDT was 30.4 months (range 6 to 102 months). Five cadaveric renal transplants have been performed in four patients; two patients are surviving with grafts functioning for 18 and 45 months. dialysis and/or transplantation should be performed in patients with oxalosis early enough to prevent ischaemic, cardiac and neuromusclar complications which occur at the end-stage of the disease. Evidence for blood coagulation disorders, particularly chronic consumption coagulopathy, should be investigated for with adequate laboratory methods and long-term heparin therapy instituted if necessary. No convincing reports concerning the efficiency of the various drugs which have been tried out to reduce the biosynthesis of oxalic acid in patients with oxalosis have been issued to this date.
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8/133. Spontaneous thrombosis of an iatrogenic arteriovenous fistula of the kidney.

    A 44-year-old woman underwent radial nephrotomy for a symptomatic stone in a caliceal diverticulum. Five days after an uneventful postoperative course of 1 week, she presented with gross hematuria. Routine ultrasound demonstrated a hypoechoic lesion in the kidney; color-coded sonography revealed an arteriovenous fistula. The hematuria ended before the scheduled angiography to embolize the fistula was performed. Repeated color-coded sonography revealed spontaneous thrombosis of the lesion. The follow-up examination 6 months later confirmed these findings. As traumatic arteriovenous fistulas have a good chance of spontaneous closure, invasive treatment should be postponed for as long as possible.
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9/133. Voided urine cytology of papillary renal cell carcinoma and renal calculus: report of a case with emphasis on the importance of cytologic screening in high-risk individuals.

    BACKGROUND: Preoperative diagnosis of cases of renal calculus complicated with papillary renal cell carcinoma (RCC) by image analysis is usually difficult. CASE: A 50-year-old man who had a past history of renal calculus suffered from macrohematuria and abdominal pain for one month was admitted to our hospital. Ultrasonographic examination revealed a 4-cm tumor shadow in the right kidney; it was hypovascular in arteriography. Papillary cell clusters with abundant cytoplasm were found by the cytologic examination of voided urine. Their nuclei were oval and situated eccentrically in the cytoplasm. The nuclear/cytoplasmic ratio was increased. Fine, granular chromatin was distributed evenly, and the nuclear membrane was thin and nearly smooth. Several small nucleoli were evident. All these findings were indicative of a diagnosis of papillary RCC. histology of nephrectomy specimens confirmed the diagnosis. CONCLUSION: Voided urine cytology can be useful for screening and follow-up of patients with papillary RCC.
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10/133. Laparoscopic nephrectomy and autotransplantation for severe iatrogenic ureteral injuries.

    OBJECTIVES: To evaluate the efficacy of laparoscopic nephrectomy with autotransplantation in cases of severe proximal ureteral damage. Many patients with complex proximal ureteral injuries have good functional renal parenchyma and wish to salvage their kidney. Autotransplantation is a viable alternative to nephrectomy in these frustrating situations. methods: Two patients, aged 32 and 36 years, underwent laparoscopic nephrectomy and autotransplantation for treatment of severe proximal ureteral injuries. The injuries included a ureteropelvic junction avulsion and a proximal ureteral avulsion, respectively. Both patients had good functional renal parenchyma. A transperitoneal laparoscopic approach was used, and the kidney was removed by way of a Gibson incision. RESULTS: The procedures were successful, with immediate return of renal function in both patients. A pyeloureterostomy to the native distal ipsilateral ureter was required in one and a direct ureterovesical anastomosis was performed in the other. In the 2 patients, the warm ischemia time was 4.5 and 4 minutes, the transplant operative time 175 and 150 minutes, and the estimated blood loss 150 and 75 mL, respectively. No intraoperative complications occurred. At follow-up, the kidneys were functional, and the patients had returned to their normal activity. CONCLUSIONS: Laparoscopic nephrectomy with autotransplantation is an excellent alternative to nephrectomy or bowel interposition in patients with proximal ureteral loss, irrespective of the contralateral renal function. This procedure is associated with acceptable morbidity and preserves the renal function. This approach is desirable in those patients who have had complications from other surgical procedures and are otherwise facing the loss of a normally functioning kidney.
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