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J. Kouranloo,J. Ghorobi,M. Rouzrokh,M. Mohkam M. Amirfyze
Acta Medica Iranica , 2006,
Abstract: Uretero pelvic junction (UPJ) obstruction is a common cause of hydronephrosis in infants. The frequent use of fetal ultrasound is allowing early (prenatal) diagnosis of numerous uropathies previously delayed until the child either became symptomatic or had a palpable mass. Newborn with severe obstruction often has marked improvement following correction, therefore, early diagnosis and operation are important. From 1993 to 2002, 21 patients were operated on for severe UPJ obstruction who were diagnosed before 6 weeks of age. Only 10 patients (63%) had antenatal ultrasonographic diagnosis, the remaining were diagnosed by postnatal ultrasound and IVP or radionuclide scan for palpable renal enlargement or for associated anomalies. Eighteen of them had unilateral and three had bilateral obstruction. Twenty-four pyeloplasties were done; all pyeloplasties were dismembered with tailoring of the dilatated renal pelvis. Postoperative renal function was followed with laboratory blood test, urine test or radionuclide scan or IVP. Postoperative complications included urinary tract infection in three patients and postoperative stenosis in one patient were seen. No mortality occurred on infants in unilateral but one occurred in bilateral obstruction. Also, there was one unrelated late death. We report documented functional improvement with minimal complications in unilateral or bilateral pyeloplasty in newborns with UPJ obstruction. We recommend that if the initial scan shows substantially reduced function in the obstructed kidney, a pyeloplasty (rather than nephrectomy) generally should be performed, because the newborn kidney has tremendous capacity for improvement in renal function following decompression.
Closed External End Double J Catheter as a Nephrostent in Pyeloplasty for Infants with Uretero-Pelvic Junction Obstruction
Seyed Mohammad Reza Rabani
Iranian Journal of Medical Sciences , 2010,
Abstract: Uretero-Pelvic Junction Obstruction (UPJO) is a common congenitalanomaly that may need pyeloplasty to prevent renalfunction deterioration. The purpose of this study was to describea modified use of jj stent catheter in pyeloplasty for infantwith UPJO. A series of 12 children, between 3 and 10months, underwent stenting open pyeloplasty. In each patient a6 French Foley catheter was placed within the bladder. One mlsterile methylene blue was instilled into the catheter, which wasclamped during the operation time. During a dismembered pyeloplasty,a small (3F) double j stent was placed through theflank into renal pelvis, passing the flank skin, muscles and enteringvia lower pole posteriorly to pass the anastomosis andentering the ureter and urinary bladder, confirmed by observingmethylene blue within the wound. The external end of the jjcatheter was doubled up and sutured to the flank skin and thenremoved 4 weeks later. No procedure related complication(s)such as extravasation, infection, and stent displacement wasseen. The duration of follow up was 6 months to 3 years. Thismethod of stenting pyeloplasty is easily tolerated and causes noneed for endoscopic removal of the catheter. It is an invaluabletechnique of pyeloplasty with stenting in very small children,and needs no external appliance.Iran J Med Sci 2010; 35(4): 319-322.Keywords ● Hydronephrosis ● newborn infant
Vesicopyelostomy in a pelvic kidney with uretero-pelvic junction obstruction and multiple renal calculi (a case report).  [cached]
Goel A,Vaidyanathan S,Rao M,Rao C
Journal of Postgraduate Medicine , 1984,
Gender influence on defecographic abnormalities in patients with posterior pelvic floor disorders  [cached]
Céline Savoye-Collet, Guillaume Savoye, Edith Koning, Anne-Marie Leroi, Jean-Nicolas Dacher
World Journal of Gastroenterology , 2010,
Abstract: AIM: To compare defecographic abnormalities in symptomatic men and women and to analyze differences between men and age- and symptom-matched women.METHODS: Sixty-six men (mean age: 55.4 years, range: 20-81 years) who complained of constipation and/or fecal incontinence and/or pelvic pain underwent defecography after intake of a barium meal. Radiographs were analyzed for the diagnosis of rectocele, enterocele, intussusception and perineal descent. They were compared with age- and symptom-matched women (n = 198) who underwent defecography during the same period.RESULTS: Normal defecography was observed in 22.7% of men vs 5.5% of women (P < 0.001). Defecography in men compared with women showed 4.5% vs 44.4% (P < 0.001) rectocele, and 10.6% vs 29.8% (P < 0.001) enterocele, respectively. No difference was observed for the diagnosis of intussusception (57.6% vs 44.9%). Perineal descent at rest was more frequent in women (P < 0.005).CONCLUSION: For the same complaint, diagnosis of defecographic abnormalities was different in men than in women: rectocele, enterocele and perineal descent at rest were observed less frequently in men than in women.
Pelvic Rib: Developmental Anomaly, A Case Report
Hakan Tuna,Nurettin Ta?tekin,Ercüment ünlü,Tevfik Fikret ?ermik
Romatizma , 2008,
Abstract: Pelvic rib is a rare and benign developmental abnormality. It typically appears as a rib or phalanx-like bone in radiological evaluation. Cortical type bone is pronounced in its structure and pseudo-articulation can exist. It is generally asymptomatic and does not require surgical treatment. In differential diagnosis, myositis ossificans and avulsion injury must be ruled out. In our case, this developmental abnormality was identified accidentally by radiographic evaluation of a patient who had trauma. Therefore, pelvic rib should be remembered in differential diagnosis of developmental skeletal abnormalities.
Uretero-Iliac Artery Fistula: A Diagnostic and Therapeutic Challenge  [PDF]
Muhammad Z. Aslam,Ferhad Kheradmund,Nilay Patel,David Cranston
Advances in Urology , 2010, DOI: 10.1155/2010/276497
Abstract: Uretero-Iliac artery fistulas (UAFs) are very uncommon in urological practice. The rarity of this clinical entity may lead to a delayed or missed diagnosis which can result in life-threatening consequences. We present a case of a right ureteric and right external iliac artery fistula, its presentation, diagnosis, and management along with the review of the literature. 1. Case Report A 54-year-old lady underwent Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy followed by pelvic radiotherapy for carcinoma of the cervix. She presented 3 years later with a history of recurrent frank hematuria and haemodynamic instability. Her haemoglobin on admission was 6.9?g/dl. A cystoscopy demonstrated areas of radiotherapy changes only. A CT scan demonstrated blood clots within the right collecting system. Progressive right-sided hydronephrosis was noted along with progressive deterioration in renal function. A nephrostomy and subsequent antegrade stenting were performed on the right side. Over the next few weeks, the patient went on to have periodic stent changing to improve the renal functions and massive blood transfusions performed to stabilize the dropping haemoglobin. During a subsequent attempt to replace the right ureteric stent, the bladder filled with bright red blood clot as soon as the stent was removed. A retrograde ureteropyelogram was performed, which directly and inferolaterally demonstrated contrast flow in the line of the external iliac artery suggesting a ureteroarterial fistula. A Digital Subtraction Angiographic run confirmed a hemodynamically significant uretero-external iliac arterial fistula (Figure 1). Vascular access was promptly secured and a flush aortogram followed by superselective runs identified a false aneurysm of the right common iliac artery (Figure 2). A covered 12?mm 60?mm FLUENCY plus vascular stent graft (C. R. Bard, Inc.) was placed in the right common and external iliac artery (Figure 3). Followup arteriography showed the false aneurysm not to be filling. A retrograde study performed 4 days later had shown no leakage. A further followup 8 weeks later had shown the patient to be completely asymptomatic. Figure 1: Uretero-external iliac artery fistula demonstrated on angiographic run. Figure 2: False aneurysm of the right common iliac artery demonstrated. Figure 3: A covered stent securely placed in the right common and external iliac artery. 2. Discussion Uretero-iliac artery fistula (UAF) is a rare but potentially life-threatening condition [1]. The usual presenting symptom varies from intractable microscopic
Robotic image-guided reirradiation of lateral pelvic recurrences: preliminary results
Sylvain Dewas, Jean Bibault, Xavier Mirabel, Philippe Nickers, Bernard Castelain, Thomas Lacornerie, Hajer Jarraya, Eric Lartigau
Radiation Oncology , 2011, DOI: 10.1186/1748-717x-6-77
Abstract: Sixteen patients previously treated with radiotherapy were reirradiated with CyberKnife? for lateral pelvic lesions. Recurrences of primary rectal cancer (4 patients), anal canal (6), uterine cervix cancer (4), endometrial cancer (1), and bladder carcinoma (1) were treated. The median dose of the previous treatment was 45 Gy (EqD2 range: 20 to 96 Gy). A total dose of 36 Gy in six fractions was delivered with the CyberKnife over three weeks. The responses were evaluated according to RECIST criteria.Median follow-up was 10.6 months (1.9 to 20.5 months). The actuarial local control rate was 51.4% at one year. Median disease-free survival was 8.3 months after CyberKnife treatment. The actuarial one-year survival rate was 46%. Acute tolerance was limited to digestive grade 1 and 2 toxicities.Robotic stereotactic radiotherapy can offer a short and well-tolerated treatment for lateral pelvic recurrences in previously irradiated areas in patients otherwise not treatable. Efficacy and toxicity need to be evaluated over the long term, but initial results are encouraging.Cancers such as prostate adenocarcinoma, epidermoid carcinoma of the uterine cervix, and adenocarcinoma of the rectum receive pelvic radiotherapy as part of their initial treatment. Locoregional recurrence occurs in 3% to 15% of patients treated for rectal adenocarcinoma [1] and 1.5% to 40% of patients treated for carcinoma of the uterine cervix [2]. Better systematic monitoring of these pathologies, as well as progress in imaging, enabled earlier diagnosis of locoregional pelvic recurrences. However, in cases of lateral pelvic recurrence, therapeutic options are often limited. In these situations, surgery is often proposed, but unfortunately, few patients are found eligible because of the lateral location, the proximity of the iliac vessels and the associated surgical morbidity. Traditionally, an invasion of the lateral pelvic wall and/or envelopment of the iliac vessels are contraindications to a local radic
Comparison of Multi-Detector Computed Tomography Findings with Surgical and Histopathological Results in Women with a Gynecologic Pelvic Mass
Mohammad Kazem Tarzamni,Elahe Madarek,Seyed Ali Hazanian
Iranian Journal of Radiology , 2010,
Abstract: Background/Objective: The preoperative characterization of a pelvic mass is of outmost importance which is often not possible until surgery and pathologic examinations are performed. Exploratory laparotomy was the treatment of choice for the diagnosis and therapy of pelvic masses until the past decade. The main objective of imaging in the evaluation of a pelvic mass is the determination of malignancy. A reliable imaging technique to detect and characterize a pelvic mass would allow for appropriate subspecial-ty referral and optimal preoperative planning. Multidetector CT (MDCT) is a relatively new method, which has been proposed to be highly sensitive in this regard. This study aims at evaluating the accuracy of 64-slice MDCT in determining the nature of gynecological pelvic masses."nPatients and Methods: In an analytic-descriptive study, 95 women with clinically suspected pelvic mass were recruited during a 23-month period in Tabriz Imam Khomeini and Alzahra Hospitals. 64-slice MDCT was employed for preoperative evaluation of pelvic masses and accordingly, nature, extensions and stage of the mass were determined. These findings were interpreted considering the results of operation and histopathological examination as the gold standard. "nResults: Ninety-five women with a mean age of 48.63±13.93 (17-74) years were enrolled in this study. Based on the results of the gold standard methods, there were 30 cases with benign pathology and 65 cases with malignant entity. The result of the MDCT was a sensitivity, specificity and accuracy of 92.8%, 88% and 91.5%, respectively. The sensitivity of MDCT was low in determining the extension of pelvic masses to surrounding tissues (72.7%) and for abdominal involvement (peritoneal seeding and liver extension) (81.8%). The specificities were relatively high (93%-94.3%). Staging of the pelvic masses by the 64-slice MDCT was concordant to the results of operation and histopathological evaluations in 81.5% and 84.6% of the cases, respectively."nConclusion: Based on our results, 64-slice MDCT is highly sensitive and specific in preoperative discrimination of benign and malignant gynecological pelvic masses. On the other hand, it should be born in mind that the staging of the pathology in a portion of these patients might be underestimated by this modality.
Uretero-transappendix-cystoneostomy as a technique for the reconstruction of the lower part of the ureter  [PDF]
Milovi? Novak,Janji? Pero,Ban?evi? Vladimir,Kupre?anin Sr?an
Vojnosanitetski Pregled , 2005, DOI: 10.2298/vsp0512931m
Abstract: Background. Any large missing part of the ureter may be replaced by transureteroureterostomy, psoas hitch, Boari flap, nephrectomy, renal autotransplanation or by the implementation of an intestinal graft. Case report. A patient with a defect of the lumbal- pelvic portion of the right ureter, after the management of a penetrating and perforating gun shot wound was presented. The missing part of the ureter was successfully replaced with an appendix. The technique of uretero-transappendixcystoneostomy complete with a Boari flap and a psoas hitch was used. Conclusion. By the use of an original combination of surgical techniques, a large defect of the ureter and the defect of the bladder, as well as the preservation of the renal function was achieved in a more successful manner.
Lack of Tryptophan Hydroxylase-1 in Mice Results in Gait Abnormalities  [PDF]
Georgette L. Suidan, Daniel Duerschmied, Gregory M. Dillon, Veronique Vanderhorst, Thomas G. Hampton, Siu Ling Wong, Jaymie R. Voorhees, Denisa D. Wagner
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0059032
Abstract: The role of peripheral serotonin in nervous system development is poorly understood. Tryptophan hydroxylase-1 (TPH1) is expressed by non-neuronal cells including enterochromaffin cells of the gut, mast cells and the pineal gland and is the rate-limiting enzyme involved in the biosynthesis of peripheral serotonin. Serotonin released into circulation is taken up by platelets via the serotonin transporter and stored in dense granules. It has been previously reported that mouse embryos removed from Tph1-deficient mothers present abnormal nervous system morphology. The goal of this study was to assess whether Tph1-deficiency results in behavioral abnormalities. We did not find any differences between Tph1-deficient and wild-type mice in general motor behavior as tested by rotarod, grip-strength test, open field and beam walk. However, here we report that Tph1 (?/?) mice display altered gait dynamics and deficits in rearing behavior compared to wild-type (WT) suggesting that tryptophan hydroxylase-1 expression has an impact on the nervous system.
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