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PRENATAL AND PERINATAL OUTCOME OF CONGENITAL FETAL OBSTRUCTIVE UROPATHY
Sonja Pop-Trajkovic,Vladimir Antic,Milan Trenkic
Acta Medica Medianae , 2008,
Abstract: Abnormalities of the urinary tract account for less than 25% of any detectedcongenital anomaly during pregnancy, and approximately 60% of them are obstructiveuropathies. After the diagnosis of obstructive uropathy is made, there is a need for makinga decision whether or not to terminate a pregnancy and to determine further diagnosticprocedures and best management before and after birth. Making the decision includesmultidisciplinary approach, and we have to know the outcome of anomalies. The aim ofthis study was to determine the outcome of antenatally detected obstructive uropathies inorder to optimize counseling of the parents, and to give the right direction to the physicianfor managing that particular pregnancy. This study included all patients presented to theConsilium for fetal anomalies of Institute for Gynecology and Obstetrics of Clinical Centerof Serbia and University Children Hospital, during the three-year-period. Antenataldiagnoses were compared with the results of autopsy, if the pregnancy was determined, orwith the information obtained from the parents and clinical and operative findings if thepregnancy was continued. Of 111 antenatally detected urinary tract anomalies, 60 patientswere diagnosed with fetal obstructive uropathy. Six pregnancies were terminated, andfrom 54 surviving infants, 5 had impaired renal function. Most of the children needed twoto three surgical interventions on average. The overall conclusion for obstructiveuropathies that can be drawn from this series is that the prognosis for renal function isexcellent when oligohydramnios is absent before birth and when proper urological care isgiven postnatally. Almost all renal failures were in the group with progressiveoligohydramnios in which labor was induced preterm. Poor outcome of fetuses withbilateral urinary tract obstruction combined with prolonged periods of olygohydramnios hasbeen repeatedly described.
Effects of Lactobacillus plantarum on gut barrier function in experimental obstructive jaundice  [cached]
Yu-Kun Zhou,Huan-Long Qin,Ming Zhang,Tong-Yi Shen
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i30.3977
Abstract: AIM: To investigate the mechanisms of Lactobacillus plantarum (L. plantarum) action on gut barrier in preoperative and postoperative experimental obstructive jaundice in rats. METHODS: Forty rats were randomly divided into groups of sham-operation, bile duct ligation (BDL), BDL + L. plantarum, BDL + internal biliary drainage (IBD), and BDL + IBD + L. plantarum. Ten days after L. plantarum administration, blood and ileal samples were collected from the rats for morphological examination, and intestinal barrier function, liver function, intestinal oxidative stress and protein kinase C (PKC) activity measurement. The distribution and expression of the PKC and tight junction (TJ) proteins, such as occludin, zonula occludens-1, claudin-1, claudin-4, junction adhesion molecule-A and F-actin, were examined by confocal laser scanning microscopy, immunohistochemistry, Western blotting, real-time fluorescent quantitative polymerase chain reaction assay. RESULTS: L. plantarum administration substantially restored gut barrier, decreased enterocyte apoptosis, improved intestinal oxidative stress, promoted the activity and expression of protein kinase (BDL vs BDL + L. plantarum, 0.295 ± 0.007 vs 0.349 ± 0.003, P < 0.05; BDL + IBD vs BDL + IBD + L. plantarum, 0.407 ± 0.046 vs 0.465 ± 0.135, P < 0.05), and particularly enhanced the expression and phosphorylation of TJ proteins in the experimental obstructive jaundice (BDL vs BDL + L. plantarum, 0.266 ± 0.118 vs 0.326 ± 0.009, P < 0.05). The protective effect of L. plantarum was more prominent after internal biliary drainage ( BDL + IBD vs BDL + IBD + L. plantarum, 0.415 ± 0.105 vs 0.494 ± 0.145, P < 0.05). CONCLUSION: L. plantarum can decrease intestinal epithelial cell apoptosis, reduce oxidative stress, and prevent TJ disruption in biliary obstruction by activating the PKC pathway.
Molecular Basis of Renal Adaptation in a Murine Model of Congenital Obstructive Nephropathy  [PDF]
Brian Becknell, Ashley R. Carpenter, Jordan L. Allen, Michael E. Wilhide, Susan E. Ingraham, David S. Hains, Kirk M. McHugh
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0072762
Abstract: Congenital obstructive nephropathy is a common cause of chronic kidney disease and a leading indication for renal transplant in children. The cellular and molecular responses of the kidney to congenital obstruction are incompletely characterized. In this study, we evaluated global transcription in kidneys with graded hydronephrosis in the megabladder (mgb?/?) mouse to better understand the pathophysiology of congenital obstructive nephropathy. Three primary pathways associated with kidney remodeling/repair were induced in mgb?/? kidneys independent of the degree of hydronephrosis. These pathways included retinoid signaling, steroid hormone metabolism, and renal response to injury. Urothelial proliferation and the expression of genes with roles in the integrity and maintenance of the renal urothelium were selectively increased in mgb?/? kidneys. Ngal/Lcn2, a marker of acute kidney injury, was elevated in 36% of kidneys with higher grades of hydronephrosis. Evaluation of Ngalhigh versus Ngallow kidneys identified the expression of several novel candidate markers of renal injury. This study indicates that the development of progressive hydronephrosis in mgb?/? mice results in renal adaptation that includes significant changes in the morphology and potential functionality of the renal urothelium. These observations will permit the development of novel biomarkers and therapeutic approaches to progressive renal injury in the context of congenital obstruction.
Associated congenital anomalies: Vestibular fistula, duodenal atresia and obstructive refluxing megaureter  [PDF]
Bukarica Svetlana S.,Marinkovi? Smiljana P.,Bori?ev Vladimir V.,Anti? Jelena
Medicinski Pregled , 2004, DOI: 10.2298/mpns0412573b
Abstract: Congenital gastrointestinal anomalies include spectrum of malformations, simple ones as well as complex, which are associated with anomalies of other organs and systems of organs. Most infants (50-60%) with imperforate anus also have genitourinary, cardiovascular, gastrointestinal and vertebral anomalies. This case report is of a female newborn with prenatally diagnosed duodenal atresia and right hydronephrosis. Clinical investigation revealed an imperforate anus with vestibular fistula. A plain abdominal x-ray showed a "double-bubble” sign, characteristic for duodenal atresia. Intraluminal membrane was excised and sigmoid colostomy was performed in general anesthesia on the first day of life. Ultrasound and intravenous pyelography confirmed a hydronephrotic right kidney and obstructive megaureter after Pena. In the fifth month of life, the ureter was tapered and reimplanted. Six months later, posterior sagittal anorectoplasty was performed. In the sewentheenth month of life the colostomy was closed. This child attained normal growth and development, normal bowel control, fecal continence without soiling, obstipation and urinary infections.
Obstructive Uropathy in Sudanese Patients  [cached]
El Imam M,Omran M,Nugud F,Elsabiq M
Saudi Journal of Kidney Diseases and Transplantation , 2006,
Abstract: In this paper we describe the causes, patterns of presentation, and management of obstructive uropathy in Sudanese patients in a retrospective multi-center audit. All patients who presented with obstructive uropathy during 2005 were included in this study. All of the patients were subjected to serial investigations including imaging and tests of renal function. Diversion, stenting, and/or definitive surgery were performed in order to relieve the obstruction. Five hundred twenty patients were diagnosed with obstructive uropathy during this period; 345 (66%) patients presented with chronic obstruction and 175 (34%) with acute obstruction. Of the study patients, 210 (40%) presented with significant renal impairment; 50 (23%) of them required emergent dialysis. The patterns of clinical presentation of the obstructed patients included pain at the site of obstruction in 48%, lower urinary tract symptoms in 42%, urine retention in 36.5%, mass effect in 22%, and anuria in 4%. Patients in the pediatric age group constituted 4% of the total. The common causative factors of obstruction included congenital urethral valves, pelvi-ureteral junction obstruction, urolithiasis, and iatrogenic trauma, especially in the obstetric practice. Renal function was completely recovered with early management in 100% of patients with acute obstruction and was stabilized in 90% of patients with chronic obstruction. Four patients were diagnosed with end-stage renal failure; two of them were transplanted. The mortality rate in this study was less than 0.3%.
A Choledochal Cyst Resulting in Obstructive Jaundice in a Case with Gallbladder Agenesis: Report of a Case and Review of the Literature
Abdullah B?yük,Cüneyt K?rk?l,Koray Karabulut,Selim S?zen
Balkan Medical Journal , 2012,
Abstract: Co-existence of gallbladder agenesis and choledochal cyst is a very rare congenital anomaly of the extrahepatic biliary system. The literature presents only five cases with this combination. Herein, we report the sixth case. Gallbladder agenesis is usually asymptomatic, while choledochal cyst often presents symptoms before adolescence. This is the report of a 42-year-old female patient with gallbladder agenesis and choledochal cyst leading to obstructive jaundice. Radiological diagnosis of choledochal cysts is not difficult. However, in cases with gallbladder agenesis, cystic dilatation in the choledochus may be misdiagnosed as mislocation of the gallbladder or contracted and/or sclero-atrophic gallbladder.
Twenty-one-year-old male with congenital anomalies, obstructive uropathy and chronic renal failure: Is this a case of townes Brocks syndrome?
EI Unuigbe, CA Azubike, EI Okaka, JO Osarenkhoe, VC Onuora
Nigerian Journal of Clinical Practice , 2007,
Abstract: Townes – Brocks syndrome is an autosomal dominant multiple malformations syndrome comprising of ear anomalies/hearing loss, limb defects, anal, genitourinary, eye, spine anomalies, heart defects and sometimes mental retardation. This report presents the case of a 21-year-old secondary school leaver as a likely case of Townes-Brocks syndrome. He was born with congenital abnormalities consisting of fixed flexion deformities of hands, wrist and elbows, urethral meatal stenosis, scoliosis and aortic stenosis. He was diagnosed with obstructive uropathy at the age of 19 years and subsequently developed chronic renal failure. The report aims to highlight the need for early recognition of potentially preventable conditions, which, if left unattended to, can lead to unnecessary fatality. Nigerian Journal of Clinical Practice Vol. 10 (1) 2007: pp.91-94
OBSTRUCTIVE UROPATHY AND ACUTE URINARY RETENTION CAUSED BY UTERINE FIBROID IN A NON-PREGNANT WOMEN - A CASE REPORT
Nirmala Jaget Lakkawar,,Suriya Desikan,Thirupurasundari Rangaswamy
Acta Facultatis Medicae Naissensis , 2010,
Abstract: A 38-year-old female gravida 2, para 2, sterilized patient was presented to the hospital with acute urinary retention and severe lower abdominal pain. Clinical and ultrasonographical examination revealed a marked distention of urinary bladder, enlarged uterus with posterior wall fibroid impacted in the pouch of Douglas. Intravenous pyelography revealed a moderate degree of bilateral hydroureter and hydronephrosis. However, the renal function tests were within normal range. Urine examination revealed pyuria and multi-drug resistant Staphylococcus aureus. Total abdominal hysterectomy was resorted after considering the medical and social factors. Histopathological examination revealed intramural leiomyoma, complex hyperplasia of the endometrium and chronic cervicitis. Detecting that the fibroid could contribute to the development of acute urinary retention, cystitis and its appropriate management along with the uneventful recovery of the patient indicated the validity of the approach that would have led to serious renal complications. This paper focuses on the acute complications of the uterine fibroid, multidisciplinary diagnostic approach, and the importance of immediate intervention to prevent subsequent renal damage.
Placental Vascular Obstructive Lesions: Risk Factor for Developing Necrotizing Enterocolitis  [PDF]
Laure Dix,Matthias Roth-Kleiner,Maria-Chiara Osterheld
Pathology Research International , 2010, DOI: 10.4061/2010/838917
Abstract: Necrotizing enterocolitis (NEC) is a severe neonatal disease affecting particularly preterm infants. Its exact pathogenesis still remains unknown. In this study, we have compared the prevalence of vascular obstructive lesions in placentae of premature newborns which developed NEC and of a control group. We further compared separately the findings of placentae of infants of less than 30 weeks of gestation, the age group in which NEC occurs most frequently. We found signs of fetal vascular obstructive lesions in 65% of the placentae of preterm patients developing NEC, compared to only 17% of the placentae of preterm patients in the control group. In the age groups below 30 weeks of gestation, 58.5% of placentae of later NEC patients presented such lesions compared to 24.5% in the control group. The significant difference between NEC and control group suggests a strong association between fetal vascular obstructive lesions and NEC. Therefore, we propose that fetal vascular obstructive lesions might be considered as a risk factor for the development of NEC in premature infants. 1. Introduction Necrotizing enterocolitis (NEC) is one of the most dreadful and unpredictable emergencies in premature infants [1, 2]. Its incidence is around 7% in very low-birth-weight infants (VLBW, birth weight <1500?g) [1, 3] and almost absent in full-term neonates [4]. The exact pathogenesis of NEC is still unknown. Many etiologic conditions have been described favorizing the development of NEC, such as gut immaturity, decreased gut motility, gastrointestinal bacterial colonization, and accelerated feeding [5–7]. Different authors suggested intestinal ischemia and hypoxia as important risk factors. The earlier proposed “diving reflex” in neonates suffering from severe hypoxic episodes with diversion of blood preferentially to heart, brain, and kidneys resulting in decreased perfusion of the intestinal tract could not explain all facets of the pathophysiology of NEC [8]. However, some pieces of evidence support the idea that hypoxic-ischemic events may play an important role in its etiology. (1) The ileocecal region which is often involved in NEC corresponds to an intestinal “watershed” area which might explain its susceptibility to hypoxic-ischemic events. (2) Reduced perfusion plays an important role in the pathophysiology of coagulation necrosis which represents one of the major histological findings of NEC [9]. (3) The rare condition of NEC in term infants is often associated with reduced intestinal perfusion secondary to congenital heart disease, patent ductus arteriosus,
Obstructive azoospermia as an unusual complication associated with herniorrhaphy of an omphalocele: a case report
Kazunari Tsuchihashi, Kazutoshi Okubo, Kentaro Ichioka, Takeshi Soda, Koji Yoshimura, Akihiro Kanematsu, Osamu Ogawa, Hiroyuki Nishiyama
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-234
Abstract: A 30-year-old Japanese man was diagnosed with obstructive azoospermia. He had undergone herniorrhaphy of an omphalocele immediately after birth. Reconstruction surgery of both seminal tracts was performed to pursue the possibility of naturally achieved pregnancy. Intra-operative findings demonstrated that both vasa deferentia were interrupted at the internal inguinal rings, although the abdominal end of the right vas leading to the seminal vesicle was found in the abdominal cavity. The discharge from the stump of the testicular end had no sperm, although the right epididymal tubules were dilated with motile sperm. Therefore, we performed right-sided vasovasostomy in the internal inguinal ring and ipsilateral epididymovasostomy simultaneously.To the best of our knowledge, this is the first report describing obstructive azoospermia as an unusual complication of herniorrhaphy of an omphalocele. It is important to pay attention to the existence of seminal tracts in such surgery as well as in inguinal herniorrhaphy.Obstructive azoospermia is one cause of male infertility. Obstruction of the seminal tracts can be caused by iatrogenic damage, by a congenital anomaly or by infectious diseases [1]. Although the most common iatrogenic cause is bilateral repair of an inguinal hernia, here we present a case of obstructive azoospermia caused by herniorrhaphy of an omphalocele immediately after birth. As far as we are aware, this is the first such report.A 30-year-old Japanese man who had undergone herniorrhaphy for an omphalocele immediately after birth was referred to our hospital. He presented to our hospital with 1 year of infertility after his marriage. Multiple semen analyses revealed azoospermia, but a scrotal examination revealed no abnormalities in the testes or in the vas deferens or epididymis on both sides. Magnetic resonance imaging of the scrotum revealed no abnormal findings in the seminal vesicles, the prostate or the ejaculatory ducts. An endocrinological examina
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