An Unusual Presentation of a Rare Combination of Double Moiety and Vaginal Ureter Insertion.

The association between a duplex renal collecting system and ectopic ureter insertion is well-established. Although congenital genitourinary abnormalities are usually detected during childhood, incidentally, or due to underlying symptoms or medical complications, a few cases might not be diagnosed/treated until adulthood. Herein, we present a case of a 43-year-old lady who came to the emergency department with acute left flank pain associated with a burning sensation during micturition for four days. Imaging showed a duplex collecting system, and findings suggestive of obstructive uropathy. The patient underwent an initial trial of left ureteroscopy that was unsuccessful. Therefore, the interventional radiology (IR) department was consulted to perform left percutaneous nephrostomy insertion with antegrade ureteric stenting, where the patient was noted to have ectopic ureter insertion into the anterior wall of the vagina by antegrade ureterogram. The patient underwent ureter re-implantation to save the kidney from further insult.

The predictive value of CTSI scoring system in non-operative management of patients with splenic blunt trauma: The experience of a level 1 trauma center.

Background: The spleen is one of the most injured organs following blunt abdominal trauma. The management options can be either operative or non-operative management (NOM) with either conservative management or splenic artery embolization. The implementation of CT in emergency departments allowed the use of CT imaging as a primary screening tool in early decision-making. Consecutively, new splenic injury scoring systems, such as the CT severity index (CTSI) reported was established. Aim: The main aim of this study is to evaluate the effect of the implementation of CTSI scoring system on the management decision and outcomes in patients with blunt splenic trauma over 8 years in a level 1 trauma center. Methods: This is a retrospective study including all adult patients with primary splenic trauma, having NOM and admitted to our hospital between 2013 and 2021. Results: The analyses were conducted on ninety-nine patients. The average sample age was 32.7 ± 12.3 years old. A total of (63/99) patients had splenic parenchyma injury without splenic vascular injury. There is a statistically significant association between CTSI grade 3 injury and the development of delayed splenic vascular injury (p < 0.05). There is an association between severity of initial CTSI score and the risk of NOM/clinical failure (p = 0.02). Conclusion: Our findings suggest implementing such a system in a level 1 trauma center will further improve the outcome of treatment for splenic blunt trauma. However, CTSI grade 3 is considered an increased risk of NOM failure, and further investigations are necessary to standardize its management.

Comprehensive Assessment of Ultrasound's Role in Carpal Tunnel Syndrome in Reference to Electromyography.

Carpal tunnel syndrome (CTS) is the most common peripheral mononeuropathy related to entrapment syndrome. An increase in the median nerve cross-sectional area (CSA) is visualized using ultrasound (US) imaging for CTS patients. This study aims to correlate, for the first time in the state of Qatar, the findings of US imaging and electromyography (EMG) in patients with CTS for diagnostic and classification purposes. First, US CSA was numerically obtained from patients' records. Second, EMG findings were gathered as normal, mild, moderate, and severe CTS. After that, we performed a different statistical approach than those used in the literature, using one-way analysis of variance (ANOVA) and post hoc tests for the final analysis. In summary, we found that the US seems unable to differentiate some normal from mild CTS cases; however, it appears to be excellent at differentiating moderate from severe CTS cases.