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8.
Am J Case Rep ; 22: e931758, 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33941758

RESUMO

BACKGROUND Certain health conditions have been proven to have an effect on the severity of COVID-19, the disease caused by SAR-COV-2. The list of identified comorbid conditions includes hematological diseases, with sickle cell disease (SCD) falling into this category. CASE REPORT This case series examines the history, presentation, and clinical course of 5 patients with SCD who tested positive for SAR-COV-2 during the spring and summer of 2020. These patients experienced COVID-19 severities ranging from a mild cough and congestion to 8-day hospitalizations requiring blood transfusions. CONCLUSIONS While there is still a great amount of research on the interaction between COVID-19 and SCD needed, from this study we have concluded that patients with SCD do not always present with the classic COVID-19 triad of cough, shortness of breath, and fever. Often, these patients present with symptoms of vaso-occlusive crisis (VOC), including severe leg, flank, and chest pain, as was seen in 4 of 5 of our patients. We, and several other researchers, believe that this association between COVID-19 and VOC could be due to COVID-19 triggering inflammatory cytokines (notably IL-6) leading to system-wide inflammation, which induces sickling of the red blood cells. Based on this report, we recommend that SCD patients presenting with VOC who have had exposure to SAR-COV-2 be promptly tested for SAR-COV-2 to guide treatment and reduce mortality and morbidity in this vulnerable population.


Assuntos
Anemia Falciforme/complicações , Dor no Peito/etiologia , Dor no Flanco/etiologia , SARS-CoV-2 , Adulto , Anemia Falciforme/terapia , Transfusão de Sangue , COVID-19/complicações , COVID-19/diagnóstico , Citocinas/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Ned Tijdschr Geneeskd ; 1652021 04 26.
Artigo em Holandês | MEDLINE | ID: mdl-33914435

RESUMO

In this case report we present a 54-year-old female with progressive pain in the left flank. Physical examination showed a non-mobile, painless mass in the left upper abdomen. CT revealed an exceptionally large kidney stone. Stone removal (448 g) was performed by hand-assisted laparoscopic nephrectomy.


Assuntos
Dor no Flanco/etiologia , Hematúria/etiologia , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Feminino , Dor no Flanco/diagnóstico por imagem , Hematúria/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Nefrectomia/métodos , Resultado do Tratamento
10.
Ann R Coll Surg Engl ; 103(6): e206-e207, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33851874

RESUMO

Urinary stones are a common health problem, necessitating frequent outpatient visits and hospital admissions. Ureteric stones demand special attention, given their propensity for upstream hydroureteronephrosis and loss of renal function. They are usually predisposed by diverse anatomical, functional or metabolic abnormalities of the urinary tract and have an early symptomatic presentation. We report an exceptional clinical presentation of a huge ureteric stone yet functional renal moiety with no obvious anatomical or metabolic predilection for urolithiasis, and its minimally invasive management in a young woman. We emphasise that swift salvaging of the renal function is of utmost importance in these cases. Open exploration can be avoided in favour of laparoscopic ureterolithotomy with better cosmesis and early recovery.


Assuntos
Rim/fisiologia , Cálculos Ureterais/diagnóstico por imagem , Feminino , Dor no Flanco/etiologia , Humanos , Rim/anatomia & histologia , Rim/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Cálculos Ureterais/complicações , Cálculos Ureterais/cirurgia , Adulto Jovem
12.
J Pediatr Health Care ; 35(3): 327-331, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33674161

RESUMO

A 13-year-old patient presented to the emergency department with a history of abdominal pain and right flank pain. Two days before, she was evaluated at her pediatrician's office and was diagnosed with acute gastroenteritis and sent home. In the emergency department, the patient was diagnosed with ureterolithiasis after a physical examination, laboratory work, and imaging findings. She was treated successfully with conservative medical management. Symptomatic presentation of ureterolithiasis can include abdominal pain, flank pain, hematuria, dysuria, urgency, nausea, and vomiting. Nurse practitioners need to recognize nonspecific symptoms of ureterolithiasis for accurate diagnosis and treatment. Risk factors, signs and symptoms, prevention, and treatment options for ureterolithiasis are discussed.


Assuntos
Ureterolitíase , Dor Abdominal/etiologia , Adolescente , Serviço Hospitalar de Emergência , Feminino , Dor no Flanco/etiologia , Hematúria , Humanos , Ureterolitíase/diagnóstico , Ureterolitíase/diagnóstico por imagem
15.
Int J Radiat Oncol Biol Phys ; 110(2): 438-443, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33385498

RESUMO

PURPOSE: The adrenal gland is a common site of metastasis in patients with advanced cancer, but it is rarely symptomatic. A subset of patients develop a complex pain syndrome with anorexia, nausea, and poorly localized visceral pain in the back, flank, or epigastric region. These symptoms can affect quality of life and are occasionally challenging to palliate. The role of palliative radiation therapy (PRT) in these patients is unclear. This population-based retrospective study evaluates PRT practices for patients with adrenal metastases and aims to describe treatment response and acute toxicity. METHODS AND MATERIALS: Patients who received PRT to an adrenal metastasis between the years of 1985 and 2015 were identified in a provincial database. Patient demographics, tumor factors, symptom burden, radiation therapy prescriptions, and response to treatment were collected. Variables were summarized using descriptive statistics. The Kaplan-Meier test was used to assess survival. Factors associated with clinical response were evaluated using univariate and logistic regression analysis. Factors associated with survival were evaluated using univariate and Cox proportional hazards model. RESULTS: One hundred patients who received 103 separate courses of PRT were identified. The majority had a lung primary (82%). The most common baseline symptoms were pain (90%) and gastrointestinal upset (13%). Prescriptions ranged from 600 cGy in a single fraction to 4500 cGy in 25 fractions. Seventy percent of patients experienced an improvement in pain (either a complete or partial response). Forty-three percent of patients developed acute toxicity from treatment. Median survival was 3 months. CONCLUSIONS: Compared with other anatomic sites, conventional PRT is uncommonly delivered to adrenal metastases. Despite heterogeneity in tumor histology and radiation therapy prescriptions, treatment was associated with an overall pain response of 70%. Prophylactic antiemetics to decrease radiation-induced nausea are required before treatment. Given the poor prognosis of this population, short fractionations are indicated.


Assuntos
Neoplasias das Glândulas Suprarrenais/radioterapia , Cuidados Paliativos/métodos , Padrões de Prática Médica , Dor Abdominal/etiologia , Dor Abdominal/radioterapia , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/mortalidade , Neoplasias das Glândulas Suprarrenais/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Anorexia/etiologia , Dor nas Costas/etiologia , Dor nas Costas/radioterapia , Colúmbia Britânica , Dor do Câncer/etiologia , Dor do Câncer/radioterapia , Fracionamento da Dose de Radiação , Feminino , Dor no Flanco/etiologia , Dor no Flanco/radioterapia , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Náusea/etiologia , Náusea/prevenção & controle , Cuidados Paliativos/estatística & dados numéricos , Modelos de Riscos Proporcionais , Qualidade de Vida , Análise de Regressão , Estudos Retrospectivos
16.
Urology ; 148: e13-e14, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33217453

RESUMO

The COVID-19 disease is spreading rapidly worldwide, and no vaccine or very effective drug has been found yet. However, the transmission rate of the disease can be reduced by taking precautions. Therefore, it is essential to detect the patients early to prevent the spread of the disease.1,2 We report a case of 26-year-old male patient who was admitted to our urology outpatient clinic with the complaint of flank pain and had incidental findings of COVID-19 in the lung bases on abdominal CT.


Assuntos
COVID-19/diagnóstico , Dor no Flanco/etiologia , Adulto , Humanos , Pulmão/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios X
17.
Am J Emerg Med ; 43: 291.e1-291.e3, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33059989

RESUMO

Acute renal failure with severe loin pain and patchy renal ischemia after anaerobic exercise (ALPE) is gradually gaining recognition. In this case series, we describe the presentation of ALPE in the emergency department setting and its clinical course. In Case 1, an 18-year-old man presented with acute-onset nausea, vomiting, and right flank pain after playing basketball, with a creatinine level of 6.42 mg/dL on initial presentation. He received fluid therapy and intravenous furosemide for 2 days. His creatinine level was 1.80 mg/dL on day 8 and finally declined to 0.71 mg/dL on day 39. In Case 2, a 31-year-old man presented with acute-onset nausea and right lower abdominal pain after swimming, with a creatinine level of 4.68 mg/dL on initial presentation. He only received fluid therapy, and his creatinine level finally declined to 0.90 mg/dL on day 11. In both cases, severe loin pain began after anaerobic exercise, and acute kidney injury without myoglobinuria was observed. The findings of our case series suggest that emergency physicians should consider ALPE in the differential diagnosis of abdominal and loin pain accompanied by an elevated creatinine level in young patients because it can be treated conservatively and has a good prognosis. Moreover, watchful waiting is recommended for ALPE while also emphasizing the need to exclude potentially life threatening or treatable kidney diseases.


Assuntos
Injúria Renal Aguda/etiologia , Esforço Físico , Dor Abdominal/etiologia , Adulto , Basquetebol , Dor no Flanco/etiologia , Humanos , Isquemia/etiologia , Masculino , Natação , Adulto Jovem
18.
Ger Med Sci ; 18: Doc11, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33299389

RESUMO

Primary mucinous adenocarcinoma of the renal pelvis is an extremely rare tumor with only a handful of cases reported to date. Clinical and radiological features are not specific, and hence, histopathological examination holds the key for definitive diagnosis. This tumor has mainly been described in the elderly population, with less than five cases reported in individuals aged <35 years. Here, we report a case of primary mucinous adenocarcinoma of the renal pelvis in a young male. A 31-year-old male presented with a history of right-sided flank pain for the past year. On examination, he had right-sided costovertebral tenderness. Computed tomography (CT) scan revealed the presence of a hyperdense mass lesion in the right renal pelvis with severe hydronephrosis and cortical thinning. Because of the non-functioning status, right nephrectomy was performed. To our surprise, histopathology showed the presence of mucinous adenocarcinoma of the renal pelvis with carcinoma in situ of the ureter. This case describes a rare presentation of primary mucinous adenocarcinoma of the renal pelvis, and highlights the importance of histopathological examination in reaching the correct diagnosis.


Assuntos
Adenocarcinoma Mucinoso , Neoplasias Renais , Pelve Renal , Nefrectomia/métodos , Ureter , Adenocarcinoma Mucinoso/patologia , Adenocarcinoma Mucinoso/fisiopatologia , Adenocarcinoma Mucinoso/cirurgia , Adulto , Carcinoma in Situ/patologia , Carcinoma in Situ/cirurgia , Dor no Flanco/diagnóstico , Dor no Flanco/etiologia , Humanos , Hidronefrose/diagnóstico , Hidronefrose/etiologia , Neoplasias Renais/patologia , Neoplasias Renais/fisiopatologia , Neoplasias Renais/cirurgia , Pelve Renal/diagnóstico por imagem , Pelve Renal/patologia , Masculino , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos , Ureter/diagnóstico por imagem , Ureter/patologia , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia
19.
BMC Womens Health ; 20(1): 190, 2020 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-32883302

RESUMO

BACKGROUND: Endometriosis is an estrogen-dependent disease defined by the presence of endometrial glands and stroma out of the uterine cavity. Its prevalence is estimated to be 2-10% in reproductive aged women. Endometriosis occurrence is estimated to be 2.55% in postmenopausal patients due to the decreased levels of estrogen. Endometriosis can present in three different forms: superficial peritoneal implants, ovarian endometriomas, and deep infiltrating endometriosis. Ovarian endometriomas are the most common form of endometriosis. Even though endometriomas have been encountered in various localizations, a free abdominal endometrioma was only reported once in a premenopausal patient. Here, we are reporting the first case of a free large endometrioma in a postmenopausal patient. CASE PRESENTATION: A 67-year-old woman presented to the emergency department at our university hospital complaining of constipation and right flank pain. She suffered from uncontrolled primary hypertension and type 2 diabetes mellitus. On presentation, she was afebrile, hypertensive, and tachycardic. An abdominal CT scan revealed a large cystic mass measuring 17 × 26 cm in the anterior-posterior and transverse diameters respectively. The cyst caused bowel obstruction and right sided hydronephrosis. The patient underwent laparotomy and during the surgical exploration a large abdominal cyst adhered to the greater omentum was found. The cyst received plenteous blood supply from the greater omentum. The uterus and both ovaries were completely normal and didn't have any connection to the cyst. An en-bloc cystectomy was performed successfully. The final histopathology report confirmed an abdominal endometrioma. The patient had an uneventful postoperative recovery. CONCLUSIONS: Endometriomas might reach large sizes regardless of their location or the patient's age. The close relation of free abdominal endometriomas with the greater omentum suggests that these were developed from endometriotic omental implants. Endometrioma is rare in postmenopausal women. However, it should be considered as a possible differential diagnosis at any age.


Assuntos
Constipação Intestinal/etiologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Endometriose/diagnóstico , Dor no Flanco/etiologia , Pós-Menopausa , Idoso , Diabetes Mellitus Tipo 2/complicações , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Endometriose/complicações , Endometriose/cirurgia , Feminino , Humanos , Hipertensão/complicações , Laparotomia , Omento/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
BMJ Case Rep ; 13(8)2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32843402

RESUMO

A 38-year-old man with no medical history presented with bilateral flank and epigastric abdominal pain. CT abdomen and pelvis demonstrated diffuse nodules and lymphadenopathy, which were biopsied and showed chronic inflammatory changes. He later presented with pleuritic chest pain and was sent for a CT chest angiogram, which revealed perivascular inflammation involving the thoracic aortic arch, supra-aortic branch vessels and descending thoracic aorta. Further work-up showed vasculitic involvement of the coeliac, superior mesenteric and femoral arteries with heavy collateralisation. These findings were most consistent with widespread Takayasu arteritis that had been untreated for nearly 20 years. It was necessary to define the degree of active inflammation and need for immediate therapy, as the patient had a concomitant latent tuberculosis infection that precluded the use of immunosuppressive medications. This report illustrates an unusual case of Takayasu arteritis and highlights the presentation, diagnosis and work-up of suspected cases.


Assuntos
Arterite de Takayasu , Abdome/diagnóstico por imagem , Adulto , Angiografia , Dor no Flanco/etiologia , Humanos , Masculino , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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