RESUMO
Background: In this study we aimed to assess and compare the rate of sem-irigid ureterorenoscope in the treatment of upper and lower ureter stones through pneumatic lithotripsy (PL). Materials and Methods: Ninety-two patients with a mean age±SD of 45±15years who had had a surgical procedure performed by the same experienced surgeon between January 2013 and July 2015 were included in the study. The mean±SD stone size was 8.8±2.6 mm. Forty-two of the patients (45.7%) had upper ureter stones and 50 (54.3%) had lower ureter stones in order to increase the success rate and avoid stone migration. The medical files of the patients were reviewed regarding age, sex, stone size, stone location, success rate, complications, and presence of hydronephrosis. Success was operationally defined as the complete fragmentation of stone to very small parts that could pass or complete extraction of the stone. Results: Eighty-four of the patients were stone free (91%). The success rates for patients with upper or lower ureteric stones were 93% and 90%, respectively (P=0.63). There were no complications during the operation. However, 4 patients (4.4%) had postoperative complications in terms of urinary tract infection or urosepsis. Those were accurately managed by the suitable medical treatment. Conclusion: Semi-rigid ureterorenoscopy by using PL was a safe and practical treatment option for managing the upper and lower ureter stones. Performing the tips and tricks of ureterorenoscopy by an experienced surgeon seems to enhance the success rate, especially in upper ureter stones.
RESUMO
BACKGROUND: Hypersensitivity is a rare adverse drug reaction (ADR) associated with anti-epileptic medications. Phenytoin is one of the commonly used drugs for treatment of epilepsy that encounters a hypersensitivity reaction. This reaction can be ranged from mild cutaneous rash to anticonvulsant hypersensitivity syndrome (AHS) or drug reaction with eosinophilia and systemic symptoms (DRESS) that includes fever, rash, eosinophilia and involvement of multiple internal organs. CASE PRESENTATION: A 15 year old middle eastern female patient from Gaza strip with free past medical and allergic history. She presented to An-Najah National University Hospital (NNUH) in Nablus with intermittent high grade fever, jaundice, rash and skin peeling. On examination, she had axillary and inguinal lymphadenopathy, moderate splenomegaly and diffuse maculopapular rash. The patient was on phenytoin which started 1 month prior to her presentation as a seizure prophylaxis due to previous head injury. Eventually, the patient was diagnosed with AHS/DRESS. CONCLUSIONS: AHS is a diagnosis of exclusion and it is significantly underreported that requires a high index of suspicion. We liked to share this case and shed the light in more details on AHS/DRESS. Our goal was to help making AHS more reported in the literature in adolescent patients, as well as to make physicians more alert of this condition's seriousness when they prescribe antiepileptic medications in particular. In this report, we included the first case of AHS which was reported in an adolescent patient in Palestine. Moreover, we reviewed the available literature for a better understanding of the pathophysiology and management of AHS. We still believe that the full understanding of the pathogenesis of AHS is lacking, and also we are lacking a clinical tool or scoring system to determine the severity of AHS/DRESS.
