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1.
Medicine (Baltimore) ; 102(2): e32509, 2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36637926

RESUMO

RATIONALE: Renal nutcracker syndrome is a rare phenomenon that often causes various disability symptoms. The treatment protocol has been explored for a long time, but no consensus has been reached. PATIENT CONCERNS: Here, we report the case of a 19-year-old male suffering with nutcracker syndrome, including left-sided flank pain and intermittent gross hematuria. DIAGNOSES: The patient was diagnosed with renal nutcracker syndrome, and the pressure gradient between the left renal vein and inferior vena cava was >5 mm Hg. INTERVENTIONS: The patient underwentrobotic-assisted combined transposition of left renal vein and gonadal vein. OUTCOMES: Flank pain and gross hematuria ceased spontaneously after surgery without occurrence. LESSONS: Robotic-assisted combined transposition of the left renal vein and gonadal vein is a safe and promising option for this condition.


Assuntos
Síndrome do Quebra-Nozes , Procedimentos Cirúrgicos Robóticos , Masculino , Humanos , Adulto Jovem , Adulto , Veias Renais/cirurgia , Hematúria/etiologia , Hematúria/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Síndrome do Quebra-Nozes/complicações , Síndrome do Quebra-Nozes/cirurgia , Dor no Flanco/etiologia
4.
Medicine (Baltimore) ; 101(50): e32114, 2022 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-36550842

RESUMO

Simple renal cysts are the most common masses in the kidney. Most are asymptomatic and are incidentally detected on imaging examinations performed for other reasons. This study aimed to compare the results of 40 and 120 minutes ethanol sclerotherapies that were performed in a single session to treat incidentally found simple renal cysts. We retrospectively reviewed 63 renal cysts in 62 patients treated by single session percutaneous ethanol sclerotherapy. Thirty-one patients with 32 cysts underwent a 40 minutes sclerotherapy (group A), and 31 patients with 31 cysts underwent a 120 minutes retention technique (group B). Under ultrasonographic and fluoroscopic guidance, cystic fluid was completely aspirated, and 50% of the aspirated volume was replaced with 99.5% ethanol (a maximum of 100 mL). Imaging follow-up of the patients was performed 3 months after sclerotherapy. The technical success rates were 100% in both groups. Eighteen patients (29.0%) were symptomatic (flank pain or discomfort). Indications of the other patients were large cysts (>5 cm; 46%) and an increment in the diameter on serial studies (25.4%). A significant difference between the 2 groups in terms of age, cyst diameter, volume of aspirated fluid, volume of injected ethanol, and percentage of reduction in cyst diameter (P > .05) was not found. After treatment, flank pain or discomfort resolved in 17 of 18 (94.4%) symptomatic patients. One patient complained of persistent flank pain; however, no significant abnormality was detected on post-procedural computed tomography images. There were no other complications after therapy in the 2 groups. Single session ethanol sclerotherapy with a 40 minutes retention technique is an effective, safe, and cost-effective method for the treatment of incidentally found simple renal cysts. Although the procedural time was reduced, there was no significant difference in therapeutic efficacy between the 40 and 120 minutes therapies.


Assuntos
Cistos , Doenças Renais Císticas , Humanos , Escleroterapia/métodos , Etanol/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Estudos Retrospectivos , Dor no Flanco/etiologia , Resultado do Tratamento , Doenças Renais Císticas/terapia , Doenças Renais Císticas/tratamento farmacológico , Cistos/terapia , Cistos/tratamento farmacológico
9.
Pediatr Int ; 64(1): e15189, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35522839

RESUMO

BACKGROUND: Kidney biopsies are crucial in the diagnosis of kidney diseases but they carry the risk of various complications, most commonly hematoma. Here we tried to identify the predictors of hematomas as a complication of kidney biopsies and we constructed an algorithm to stratify the risk. METHODS: The present report retrospectively reviewed 118 pediatric percutaneous kidney biopsies of native kidneys in 102 children (59 females) with the median age of 9 years (range: 1-19 years) at Kumamoto University Hospital between August 2008 and October 2019. We defined hematoma size using the hematoma index: the short axis of the hematoma/major axis of the kidney on ultrasonography. The inclusion criteria for a hematoma as a complication of a kidney biopsy were hematoma index ≥0.1 and the presence of concomitant, post-kidney biopsy fever or flank pain. RESULTS: Eight patients presented with a hematoma as a complication. All had hematoma index ≥0.1 and age ≥6 years. On univariate logistic analysis, these patients had a larger hemoglobin (Hgb) decrease on post-biopsy day 1, which was unrelated to a Hgb decrease 2 h after the biopsy, than the patients with no hematoma. All eight patients with a hematoma presented with a fever or flank pain on post-biopsy days 5 to 7, underscoring the need to observe patients with decreased Hgb carefully for about 1 week after a biopsy. CONCLUSION: Predictors of hematoma as a complication in children after a kidney biopsy were hematoma index ≥0.1, age >6 years, and Hgb decrease ≥15% on post-biopsy day 1.


Assuntos
Biópsia , Febre , Dor no Flanco , Hematoma , Adolescente , Biópsia/efeitos adversos , Criança , Pré-Escolar , Feminino , Febre/etiologia , Dor no Flanco/etiologia , Hematoma/etiologia , Hemoglobinas , Humanos , Lactente , Rim/diagnóstico por imagem , Rim/patologia , Masculino , Estudos Retrospectivos , Adulto Jovem
10.
Scand J Trauma Resusc Emerg Med ; 30(1): 29, 2022 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-35449010

RESUMO

BACKGROUND: The effects of early integration of point-of-care ultrasound (PoCUS) into patient care are uncertain. This study aims to investigate the effects of early PoCUS on patients with acute flank pain. METHODS: Adult non-traumatic patients with acute flank pain receiving PoCUS were enrolled. Expert physicians reviewed the medical records and made the "final diagnosis" for the cause of acute flank pain. The primary outcome was the relationship between the door to ultrasound (US) time and length of stay (LOS). The secondary outcomes included the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the sonographic diagnosis, compared with the final diagnosis. RESULTS: Eight hundred and eighty-eight patients were included in the analysis. Patients receiving early PoCUS (≤120 min) had a shorter LOS (128 vs. 217 min, p < 0.0001). Patients in the late POCUS group (> 120 min) had a trend to receive more CT scans. The disease distribution, sensitivity, specificity, PPV, and NPV were similar in patients receiving early or late PoCUS for target diagnoses. After adjusting for the confounders, early PoCUS (OR, 2.77, 95% CIs, 1.93-3.98) had a positive impact on shorter LOS. In addition, the effect of early PoCUS became more prominent (OR, 4.91, 95% CIs, 3.39-7.13) on LOS in less than 3 h. CONCLUSIONS: Early integration of PoCUS is significantly related to shorter LOS in patients with acute flank pain without increasing morbidity and mortality. Our results suggested "PoCUS early" in these patients to possibly alleviate emergency department crowding. Trial registration NCT04149041 at the ClinicalTrial.gov.


Assuntos
Dor no Flanco , Sistemas Automatizados de Assistência Junto ao Leito , Adulto , Serviço Hospitalar de Emergência , Dor no Flanco/diagnóstico por imagem , Dor no Flanco/etiologia , Humanos , Tempo de Internação , Testes Imediatos , Ultrassonografia/métodos
12.
J Emerg Med ; 63(3): e82-e86, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35279354

RESUMO

BACKGROUND: Urinomas are rare and generally result from trauma to any part of the urinary collecting system. Appropriate imaging is crucial in the timely diagnosis and management of urinomas and for ruling out other etiologies such as subcapsular renal hematomas and perinephric abscesses. CASE REPORT: A 31-year-old woman with no past medical history or known trauma presented to the Emergency Department (ED) with a week of right flank pain, abdominal pain, and intermittent fevers. On point-of-care ultrasound (POCUS), she was found to have a complex right perinephric collection, later confirmed with computed tomography (CT) imaging. She was treated with intravenous (IV) antibiotics and discharged after a 3-day hospital admission with instructions to follow up with Urology. A day later, she was readmitted with worsening bilateral flank pain and persistent fevers. Image-guided percutaneous aspirations of her bilateral perinephric fluid collections revealed both urine and blood. A right ureteral stent was then placed with ultimate resolution of her symptoms. Why Should an Emergency Physician Be Aware of This? Urinomas without history of trauma are rare and should be on the differential for patients presenting with flank pain and infectious symptoms. Urinomas or other expanding perinephric fluid collections can result in superimposed infection, rupture, secondary hypertension, and renal failure. Here, we present an atypical case of atraumatic bilateral renal subcapsular urinomas with hemorrhagic components in a young and healthy woman. Our case further outlines the utility of POCUS in the ED for the timely diagnosis and management of this disease process.


Assuntos
Nefropatias , Urinoma , Humanos , Feminino , Adulto , Urinoma/etiologia , Dor no Flanco/etiologia , Rim/diagnóstico por imagem , Ultrassonografia
15.
Am J Emerg Med ; 51: 429.e3-429.e5, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34325928

RESUMO

Acute flank pain associated with hematuria and unilateral hydronephrosis is a classic presentation for an obstructing ureteral stone. However, in the setting of hemorrhagic cystitis, blood can acutely obstruct the distal ureter and infrequently result in hydronephrosis. We present a case of an adult female patient with hemorrhagic cystitis who presented with acute right flank pain associated with unilateral hydronephrosis and perinephric fluid on point-of-care ultrasound (PoCUS) in the absence of renal or ureteral abnormality on CT scan hours earlier. Her symptoms resolved, urine cultures showed no growth, and her outpatient follow-up was unremarkable. We suspect given the acute onset of right obstructive uropathy, an unremarkable CT just hours earlier, and the brief nature of her symptoms, that blood obstructed her distal UVJ leading to acute and transient obstructive uropathy.


Assuntos
Cistite/diagnóstico , Hemorragia/etiologia , Hidronefrose/etiologia , Obstrução Ureteral/diagnóstico por imagem , Dor Aguda/etiologia , Líquidos Corporais/diagnóstico por imagem , Cistite/complicações , Feminino , Dor no Flanco/etiologia , Humanos , Hidronefrose/diagnóstico por imagem , Pessoa de Meia-Idade , Sistemas Automatizados de Assistência Junto ao Leito , Tomografia Computadorizada por Raios X , Ultrassonografia , Obstrução Ureteral/complicações
16.
Ann R Coll Surg Engl ; 104(6): e168-e170, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34939847

RESUMO

Renal cell cancer (RCC) commonly presents as an asymptomatic incidental mass on imaging for other abdominal pathologies. Because of its hypervascular nature, spontaneous haemorrhage, although very rare, can be seen with RCC. Spontaneous haemorrhage may present with flank pain, fever and sudden abdominal distension with or without haemorrhagic shock. Although unusual, spontaneous haemorrhage is potentially serious, and therefore clinicians should be aware of such events. Imaging may be difficult to interpret in view of intratumoral and perinephric haemorrhage. Prompt diagnosis and treatment is essential for a successful outcome. We report a case of massive intratumoral bleed in RCC in a young male and its management by renal artery angioembolisation followed by radical nephrectomy.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Dor no Flanco/etiologia , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Masculino , Nefrectomia/métodos
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