RESUMEN
BACKGROUND: Uterine rupture and associated injury to the maternal bladder and urethra have been rarely reported. All those cases were associated with a scarred uterus or augmentation of labor. We report a case of simultaneous bladder, urethral and uterine rupture in an unscarred uterus following delivery at home. CASE: A 22-year-old woman was referred from a peripheral hospital to the emergency unit of the Medical Faculty, Yüzüncü Yil University, after delivering at home. On vaginal examination, the bladder neck and proximal one third of the urethra were ruptured. Intraoperatively it appeared that the posterior wall of the bladder and bladder base had ruptured and separated from the level of the interureteric ridge. An extensive rupture of the lower uterine segment to the left sidewall of the uterus was seen. CONCLUSION: To prevent these complications, uneducated, traditional birth attendants should be replaced by at least midwives, and the rate of unsupervised home delivery should be reduced.
Asunto(s)
Parto Domiciliario/efectos adversos , Uretra/lesiones , Vejiga Urinaria/lesiones , Rotura Uterina/etiología , Adulto , Femenino , Humanos , Embarazo , Rotura Espontánea , Esfuerzo de Parto , Uretra/cirugía , Vejiga Urinaria/cirugía , Rotura Uterina/cirugía , Útero/lesiones , Útero/cirugíaRESUMEN
OBJECTIVES: The aim of the study was to compare serum levels of cytokeratin-18 of patients with bladder cancer with those of the healthy controls, and to investigate the relation between cytokeratin level and the tumor stage. DESIGN AND METHODS: Serum cytokeratin-18 levels of 38 patients with bladder cancer and of 25 healthy people were determined. Tumor stage was T(1) in 12 patients, T(2) in 9 patients, T(3) in 10 patients and T(4) in 7 patients. The serum cytokeratin-18 levels in these cases were analyzed with respect to the stage of the tumor. RESULTS: Cytokeratin-18 level in the patient group was found to be significantly higher than that of the control group (p < 0.010) when the groups were totally compared. However, when the levels in patients with different tumor stages were compared with that of the controls, the difference was not significant in patients with stage 1 and 2 tumors (p > 0.05). Regarding the cut off value as 4.0 ng/mL, sensitivity and specificity for serum cytokeratin-18 were found to be 53% and 72% respectively. When sensitivity was calculated with respect to tumor stages, it was 8% for T(1,) 33% for T(2,) 90% for T(3) and 100% for T(4.) On the other hand, considering higher stage (T(3) and T(4)) tumors only, the sensitivity was calculated as 94%, but the sensitivity for lower stage (T(1) and T(2)) tumors was 19%. CONCLUSIONS: It is clear that serum cytokeratin-18 level increases in patients with bladder cancer. However, it can only be useful as a tumor marker in the diagnosis of T(3) and higher staged tumors. This study indicated that cytokeratin-18 does not have any diagnostic value in lower stage bladder cancers.
Asunto(s)
Biomarcadores de Tumor/sangre , Queratinas/sangre , Neoplasias de la Vejiga Urinaria/sangre , Análisis por Conglomerados , Grupos Control , Femenino , Humanos , Mediciones Luminiscentes , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Sensibilidad y Especificidad , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
We report a 52-year-old woman with a right renal pelvic stone, mimicking a left upper ureteral stone in a kidney-ureter-bladder film. Computed tomography detected the exact anatomical location of the stone, which was not possible by intravenous urography and ultrasonography. In this study, we discuss diagnostic modalities of the urinary calculi in the light of the literature.
Asunto(s)
Cálculos Renales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Cálculos Ureterales/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Ultrasonografía , UrografíaRESUMEN
Sildenafil citrate is an effective oral drug for erectile dysfunction. The main action of sildenafil is the enhancement of the effect of nitric oxide (NO) by inhibiting the cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase-5 (PDE-5), an enzyme responsible for degradation of cGMP. NO is also present in the nasal mucosa and is responsible for vasodilation causing congestion and nasal obstruction. The aim of this study was to detect the effect of sildenafil on nasal mucosa in terms of nasal obstruction. A total of 16 patients presented to urology clinic suffering from impotence and medicated with sildenafil were included in the study. Before and after oral administration of 50 mg sildenafil, in all of the patients the nasal patency was examined by active anterior rhinomanometry (a method of assessing nasal resistance) using air pressure of 150 Pascal. In addition, all patients were asked about their sensation of nasal patency to detect the symptomatic nasal obstruction. There was a significant decrease in nasal air flow values (cm(3)/s) (p < 0.05). Except for three cases, all patients indicated that they had the sensation of nasal obstruction after the use of sildenafil (p < 0.05). Nasal obstruction is a common complaint for the patients using Sildenafil.