Young woman with nutcracker syndrome without main clinic manifestation: Hematuria-Case report.

INTRODUCTION: The nutcracker syndrome occurs due to the compression of the left renal vein between the aorta and the superior mesenteric artery. The diagnosis of the syndrome is often difficult and under diagnosed. The main clinical manifestations are hematuria and pelvic or back pain. PRESENTATION OF CASE: A 25 years old female patient with severe abdominal pain in the lower abdomen without hematuria. Diagnosis with nutcracker syndrome after performing computed tomography. Presented the first episode of pain with 17 years old and was diagnosed at age 25. DISCUSSION: In the nutcracker syndrome anatomical changes do not generate specific symptoms, causing the disease to be underdiagnosed. In this syndrome, there is increased pressure on the left renal vein, generating several signs and symptoms, and hematuria is one of present. Our patient did not have hematuria. Because of common symptoms, it makes nutcracker syndrome difficult diagnosis, confusing with other diseases, especially with nephrolithiasis. It is usually diagnosed after exclusion of other diseases. CONCLUSION: The diagnosis of nutcracker syndrome is done after exclusion of other causes of chronic pelvic pain. In most cases, macroscopic and microscopic hematuria are present but was unobserved in this case. Making it more difficult diagnosis.

Treatment of biliary lithiasis by extracorporeal lithotripsy

Os autores apresentam sua experiencia no tratamento de 95 pacientes portadores de calculos de vesicula e um paciente portador de calculo de coledoco. O processo de fragmentacao de calculos por ondas de choque esta bem indicado em pacientes portadores de litiase unica de ate 30 mm ou multipla (ate tres), cujo volume total nao ultrapasse 4,19 ml em vesicula funcionante (Boyden +). A litolise oral foi utilizada como coadjuvante do tratamento por litotripsina, utilizando-se os acidos quenodesoxicolicoe ursodesoxicolico em dose unica diaria, por 6 meses. Foram realizadas reavaliacoes clinicas e ultra-sonograficas dos pacientes com uma semana, 3 meses e 6 meses passados do tratamento e observou-se crescente taxa de pacientes livres de calculos, a saber: uma semana-7,69 por cento livres de calculos; 3 meses-36,95 por cento livres de calculos; 6 meses-55,00 por cento livres de calculos...