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3.
BMJ Case Rep ; 14(8)2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344650

RESUMO

A 28-year-old woman came for non-traumatic right flank pain with hypotension and right flank mass. She had multiple hyperpigmented skin papules located on the centre area of her face, and angiomas on her toes. She was anaemic and had a blood transfusion on top of aggressive fluid resuscitation. Abdominal CT showed bilaterally enlarged kidneys and fluid collection in the right perirenal space (haemorrhage). The consideration was an angiomyolipoma in spontaneous perinephric haemorrhage. We considered tuberous sclerosis complex (TSC) and did genetic testing. Results revealed mutations in the TSC2 gene, consistent with the diagnosis of TSC. No immediate surgical plans were considered at that time. She opted to be discharged against medical advice and was scheduled for a close outpatient follow-up. The patient followed up after 2 weeks, already on sirolimus 2 mg once daily. She reported improved overall well-being and a decrease in the flank mass size.


Assuntos
Angiomiolipoma , Neoplasias Renais , Lipoma , Esclerose Tuberosa , Adulto , Angiomiolipoma/diagnóstico por imagem , Angiomiolipoma/genética , Feminino , Dor no Flanco , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/genética , Esclerose Tuberosa/complicações , Esclerose Tuberosa/genética
11.
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
12.
Am J Emerg Med ; 47: 158-163, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33813147

RESUMO

BACKGROUND/AIM: Computed tomography (CT) is generally used for ureteral stone diagnosis. Unnecessary imaging use should be reduced to prevent increased radiation exposure and lower costs. For this reason, scoring systems that evaluate the risk of ureteral stones have been developed. In this study, we aimed to investigate the diagnostic accuracy of the modified STONE score (MSS) and its ability to predict ureteral stones. MATERIALS AND METHODS: The research was conducted as a multi-center, prospective and observational study. Patients aged 18 and over who presented to EDs with complaints of flank pain and who received a CT were included. Patients were divided into two groups based on the presence or absence of stones, and the categories of the MSS were determined. The ability of the MSS to predict the ureteral stone and its diagnostic accuracy were calculated. RESULTS: The median age (min/max) of the 367 study patients was 37 (18/91), and 244 (66.5%) were male. A ureteral stone was present in 228 (73.0%) patients. Male gender, previous stone history, duration of pain less than 6 h, presence of hematuria, and CRP value below 0.5 mg/dL were significantly more common in the group with stones. The prevalence of ureter stones in the MSS high-risk group was 96.0%. The area under the receiver operating characteristic curve and sensitivity of the MSS was 0.903 and 0.81, respectively. CONCLUSION: The modified STONE score has high diagnostic performance in suspected urinary stone cases. This scoring system can assist clinicians with radiation reducing decision-making.


Assuntos
Técnicas de Apoio para a Decisão , Serviço Hospitalar de Emergência/estatística & dados numéricos , Dor no Flanco/diagnóstico , Cálculos Ureterais/diagnóstico , Adulto , Idoso , Feminino , Dor no Flanco/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Turquia/epidemiologia , Procedimentos Desnecessários , Cálculos Ureterais/epidemiologia , Adulto Jovem
13.
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
14.
BMJ Case Rep ; 14(4)2021 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-33910802

RESUMO

We present a case of an iatrogenic complete left proximal ureteric injury after a lumbar 1 laminectomy and intradural tumour excision and lumbar 4/5 transforaminal lumbar interbody fusion. Initial management included a percutaneous nephrostomy for urinary diversion followed by definitive urinary reconstruction with an ileal ureter.


Assuntos
Nefrostomia Percutânea , Fusão Vertebral , Ureter , Dor no Flanco , Humanos , Laminectomia/efeitos adversos , Vértebras Lombares/cirurgia , Região Lombossacral , Nefrostomia Percutânea/efeitos adversos , Ureter/diagnóstico por imagem , Ureter/cirurgia
15.
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
17.
Am J Emerg Med ; 47: 70-73, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33774453

RESUMO

PURPOSE: The aim of this study was to determine if contrast-enhanced CT can safely exclude obstructive urolithiasis in patients with flank plain. We performed a retrospective cohort analysis to compare the negative predictive values of contrast-enhanced and non-contrast CTs for the detection of obstructing urolithiasis. METHODS: Through report analysis, we identified all non-contrast and contrast-enhanced CT examinations of the abdomen and pelvis performed on adult patients in the emergency department at a single, multi-site academic medical institution in 2017 with an indication of flank pain. The prevalence of obstructive urolithiasis in each group was calculated. We subsequently analyzed 200 consecutive studies from each of these groups (reported negative for obstructive urolithiasis) for negative predictive value calculation. Follow up abdominal imaging within 7 days from original presentation was used as a reference standard for analysis. RESULTS: In the noncontrast group, 1 study out of 200 was false negative (negative predictive value = 99.5%). In the contrast-enhanced group, there were no false negatives (negative predictive value = 100%). The prevalence of obstructive urolithiasis was 44.0% (351/797) in the noncontrast group and 18.7% (86/459) in the contrast-enhanced group. CONCLUSION: Our results suggest that contrast-enhanced CT can safely exclude obstructing ureteral calculi in the setting of acute flank pain. This finding is of clinical relevance given the inherent benefit of IV contrast in diagnosing abdominopelvic pathology.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Tomografia Computadorizada por Raios X/métodos , Urolitíase/diagnóstico , Adulto , Idoso , Meios de Contraste/administração & dosagem , Feminino , Dor no Flanco/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/estatística & dados numéricos
18.
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
20.
Can J Urol ; 28(1): 10556-10559, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33625347

RESUMO

Non-obstructive, chronic flank pain in urologic patients can be a challenging problem to manage. In this series, we examined the efficacy of celiac plexus blockade in providing pain relief and reducing opiate use in 14 adult urology patients with non-obstructive flank pain for > 1 year. Demographic, clinical, and procedural variables were collected from the medical record for retrospective analysis. Subjective improvement in pain occurred in 11 individuals (79%), and 5 (50%) were able to reduce their daily morphine equivalent dose (MED). Celiac plexus blockade is a viable option for symptomatic relief in urologic patients with non-obstructive chronic flank pain.


Assuntos
Bloqueio Nervoso Autônomo , Plexo Celíaco , Dor Crônica/terapia , Dor no Flanco/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
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