The efficacy and safety of retrograde ureteral stenting in the management of complicated cases of ureteral obstruction caused by urolithiasis.

PURPOSE: To investigate the efficacy and safety of retrograde double J stent (RDJS) placement in the management of complicated obstructive uropathy caused by urolithiasis. PATIENTS AND METHODS: An observational study done at a tertiary center was implemented in which a total of 27 patients (10 males, 17 females) with average age of 48.74 years (range: 15-88) who underwent RDJS or percutaneous nephrostomy (PCN) between 2017 and 2021 due to complicated obstruction caused by urolithiasis were included. RESULTS: A total of 27 patients (10 males, 17 females) with average age of 48.74 years (range: 15-88) who underwent kidney decompression between 2017 and 2021 due to complicated unilateral or bilateral kidney obstruction caused by ureteral stones were included. Twenty-two patients (81.48%) underwent successful RDJS placement, two patients had RDJS placement then PCN was also placed, and two patients underwent PCN placement. Three patients needed an intensive care unit "ICU" after intervention, two of them were in the ICU before intervention. All septic parameters were normalized within a short period postoperatively. Two patients with failed previous ureteroscopy had a successful RDJS placement. CONCLUSION: Retrograde DJS placement is a feasible option in the management of complicated cases of obstructive uropathy caused by urolithiasis. Short hospitalization period, low rate of complications and better quality of life are the most prominent advantages of RDJS placement. In the hands of experienced surgeons, RDJS should be offered as the first choice of decompression for obstructive uropathy caused by urolithiasis.

Eosinophilic Fasciitis Presenting as Chronic Nonspecific Symptoms in a Young Adult.

Eosinophilic fasciitis (EF) is a rare inflammatory disease affecting various connective tissues. It is characterized by induration of the skin as well as scleroderma-like manifestations that are progressive and bilaterally symmetrical. Additionally, the joints and muscles are commonly involved, and rarely, there can be involvement of internal organs. The diagnosis of EF is based on clinical, laboratory, radiological, and a full-thickness skin biopsy involving the fascia. The biopsy is often diagnostic and shows eosinophilic inflammation. Systemic corticosteroids specifically prednisone and prednisolone remain the preferred treatment of choice and may be combined with immunosuppressive therapy in a subset of patients. We herein report a patient complaining of chronic nonspecific symptoms that were diagnosed with EF. The patient was treated with steroids with marked improvement of his overall condition.

Acute Renal Failure Caused by Undiagnosed Pelvic Organ Prolapse in a Postmenopausal Woman: A Diagnosis Not to Be Missed.

Pelvic organ prolapse (POP) is a common condition mainly affecting postmenopausal women, characterized by the descent of pelvic organs through the vaginal canal. While often asymptomatic, POP can manifest with various symptoms such as a painless bulge or pressure sensation, abdominal pain, urinary complaints, and discomfort during intercourse. Severe cases can lead to urinary tract obstruction, hydronephrosis, and renal dysfunction. This case study presents an elderly female with bilateral severe hydronephrosis and pyelonephritis due to undiagnosed POP. Imaging revealed obstructive uropathy resulting from bilateral ureteric compression caused by cystocele and uterine prolapse. The patient's condition improved with antibiotics and supportive management. A vaginal hysterectomy was performed, which led to the resolution of the urinary tract obstruction. This case emphasizes the importance of considering POP in elderly women with urinary symptoms and the need for proactive screening. It highlights the significance of appropriate management to prevent irreversible renal damage. Different treatment modalities, including surgery and pessaries, are discussed, to emphasize the significance of tailoring treatments to individual patient characteristics.

A rare presentation of Zinner syndrome as recurrent epididymitis: A case report.

Zinner syndrome is a rare congenital malformation characterized by ipsilateral renal agenesis, atresia of the ejaculatory duct, and cystic distension of the seminal vesicles. Symptoms typically arise in adolescence or adulthood and may include painful urination, perineal discomfort, and post-ejaculatory pain. Diagnosis, often made between the ages of 20 and 50 years, involves differentiating Zinner syndrome from other cystic disorders using techniques such as cystoscopy, MRI, intravenous urography, and transrectal ultrasound. Treatment varies based on symptom severity, ranging from conservative approaches to invasive surgeries. Regular follow-up is essential to identify complications and preserve fertility. Herein, we present a 27-year-old male with recurrent scrotal swelling and erythema incidentally diagnosed with Zinner syndrome. The patient had a history of recurrent epididymitis and was found to have cystic dilatation of the seminal vesicle, ipsilateral renal agenesis, and obstruction of the left ejaculatory duct on imaging. Given the patient's mild symptoms, he was managed conservatively with antibiotics and pain medication, resulting in significant improvement.

Kindler Syndrome Presenting as Colitis in an Infant.

Kindler syndrome (KS) is an autosomal recessive genodermatosis characterized by skin atrophy, blistering, photosensitivity, and mucosal inflammation. We present a unique case of KS with early and severe neonatal onset in a two-month-old female who presented with severe failure to thrive (FTT) and chronic diarrhea since birth. The infant also had multiple fluid-filled cysts on her foot since birth, which resolved and reappeared at different sites. Anemia, hyponatremia, and coloboma of the right iris were also observed. Whole exome sequencing revealed a homozygous mutation in the FERMT1 gene, confirming the diagnosis of KS. Our case demonstrates a distinct clinical phenotype involving severe colitis and FTT in addition to the typical skin manifestations of KS. This atypical presentation highlights the need for further investigations to gain insights into the impact of the kindlin-1 defect on organs beyond the skin and to explore potential therapeutic approaches for managing severe colitis in affected patients.

Acute Myocardial Infarction as the First Presentation of Systemic Lupus Erythematosus in a 23-Year-Old Patient.

ST-segment elevation myocardial infarction (STEMI) in young adults is a rare occurrence that requires a thorough investigation to determine the underlying cause. Herein, a young female patient presented with dull retrosternal chest pain associated with nausea and left arm numbness. Cardiac-specific troponin was elevated and the electrocardiogram revealed ST-segment elevation in the inferior wall leads indicative of myocardial infarction. The patient was started on dual antiplatelet therapy (DAPT) and emergency coronary angiography was performed, revealing a 20% stenosis in the left circumflex artery and evidence of a thrombotic lesion in the posterolateral branch (PLB), which was deemed unsuitable for intervention. During the diagnostic workup, the patient tested positive for antinuclear antibodies and was ultimately diagnosed with systemic lupus erythematosus (SLE) and antiphospholipid syndrome. This case highlights the rarity of STEMI as an initial presentation of SLE. It emphasizes the importance of considering autoimmune disorders in young patients with acute myocardial infarction and the need for a comprehensive evaluation and appropriate management in such cases.

A necrotic primary central nervous system lymphoma in immunocompetent patient with MYC and BCL6 rearrangements (double-hit lymphoma): a case report.

Primary Central Nervous System Lymphoma (PCNSL) is a rare, aggressive extranodal non-Hodgkin lymphoma. It is critical to get a diagnosis and start therapy as soon as possible to improve clinical results. Despite a new medicinal strategy that has increased survivability, the survival rate is still quite low. This report presents a new case of PCNSL that appears in an immunocompetent patient with two different rare genetic rearrangements and a necrotic histological appearance.