Treatment of Fraleys syndrome by upper-pole nephrectomy.
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CONTEXT: Fraleys syndrome is characterized by vascular compression on the superior infundibulum with secondary dilatation of the upper pole calyx, mostly located on the right side. CASE REPORT: We present the case of a 22-year-old woman with vascular compression of the upper-pole infundibulocalyceal system (Fraleys syndrome). The patient had a history of frequent hospitalizations for emergency care due to lumbar pain over the past twelve months. The diagnosis was obtained following renal arteriography. Since the surgical treatment by means of upper-pole nephrectomy, the patient has not had any further symptoms. (+info)
Clinical characteristics of renal infarction in an Asian population.
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INTRODUCTION: Renal infarction is a rare and easily missed disease. There is even less meaningful information on renal infarction in the Asian population. Thus, the aim of this study was to clarify the clinical characteristics of the disease in Asian patients. CLINICAL PICTURE: Over a period of 10 years, 38 Chinese patients with renal infarction diagnosed by contract-enhanced CT or angiography were enrolled in this study. Their demographic data, clinical characteristics, laboratory and image results, risk factors or suspected causes, treatment and final outcomes were retrospectively reviewed. The results were also compared with the analogous Western data. The mean age of the sample population was 60.8 +/- 17.6 years, with patients aged over 50 years and males predominating. The most common symptoms/signs were abdominal (57.9%) and flank pain/tenderness (50%). Only 23.7% of patients had suffered previous thromboembolic events such as coronary or peripheral artery diseases, or cerebral infarction. Cardiogenic factors, such as atrial fibrillation, intra-cardiac thrombus, infective endocarditis and valvular heart disease, were the main causes of renal infarction (57.9%). The most common laboratory abnormalities were elevated serum LDH (92.1%) and proteinuria (76.3%). Only half of the cases involved haematuria at initial presentation. TREATMENT AND OUTCOME: One-third of the sample suffered renal impairment after the renal infarction. Overall mortality rate during admission was 13.2% (n = 5). The cause of death was usually not the renal infarction itself but rather the underlying disease and its complications. There was no difference in outcome for anticoagulation treatment with or without thrombolytics. Compared to their Western counterparts, the proportion of males (71.1% versus 48.3%) and bilateral renal infarctions (31.6% versus 12.4%) were significantly higher, and the percentage of leukocytosis (50% versus 85%) significantly lower in our Asian patients. CONCLUSION: Clinical presentation of renal infarction is usually non-specific and differs for Asian and Western populations. In our Asian patients, the most common clinical characteristics were abdominal pain/tenderness, flank pain/tenderness, elevated serum LDH and proteinuria. Early diagnosis and treatment are imperative because of the high rate of renal impairment and associated mortality. If this disease is suspected, contrast-enhanced CT is suggested to exclude or confirm renal infarction and anticoagulation alone is currently the favored treatment. (+info)
Decreased renal parenchymal density on unenhanced helical computed tomography for diagnosis of ureteral stone disease in emergent patients with acute flank pain.
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BACKGROUND: The purpose of this study was to determine the usefulness and optimal cutoff point of decreased renal parenchymal density (DRD) for diagnosis of ureteral stone disease (USD) in emergent patients with acute flank pain. METHODS: A total of 85 emergency patients with acute flank pain who underwent unenhanced helical computed tomography (UHCT) were prospectively included in this study as the study group. An additional 30 patients with no USD undergoing UHCT were retrospectively included as the control group. The mean parenchymal density difference between both kidneys of the control group was compared to that of the study group. Within the study group, the DRD of patients with USD and with no USD was compared. The sensitivities and specificities of DRD for diagnosis of USD in a range of possible optimal cutoff points were analyzed. RESULTS: There was a statistically significant difference in DRD between the study and control groups (p < 0.0001). In the study group, the DRD of patients with USD was significantly higher than that of patients with no USD [mean +/- SD = 4.04 +/- 3.4 Hounsfield units (HU) versus 0.08 +/- 2.7 HU, p = 0.0001]. DRD using cutoff points of > or = 8 HU, > or = 5 HU and > or = 2.06 HU had a sensitivity of 12.5%, 40.3% and 76.4%, and a specificity of 100%, 92.3% and 76.9%, respectively. CONCLUSIONS: DRD may be helpful in the diagnosis of USD in emergent patients with acute flank pain. When a DRD of > or = 2.06 HU is selected as a cutoff point, its sensitivity and specificity are both acceptable and higher than 75%. (+info)
Prenatal sonographic and MRI findings in a pregnancy complicated by uterine sacculation: case report and review of the literature.
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Bacterial endocarditis presenting with unilateral renal artery occlusion treated with the Rinspirator Thrombus Removal System rinsing and thrombectomy device and suction thrombectomy.
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Alternate and incidental diagnoses on noncontrast-enhanced spiral computed tomography for acute flank pain.
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INTRODUCTION: Our aim was to determine the incidence and spectrum of significant alternate or incidental diagnoses established or suggested on spiral computed tomography (CT) in a large series of patients with suspected renal colic. MATERIALS AND METHODS: Records of all patients that had undergone spiral CT (5-mm to 7-mm slice thickness) for acute flank pain during a 5-year period were reviewed. The radiological diagnoses of urinary calculi and obstruction as well as clinical entities not suspected otherwise were analyzed. RESULTS: A total of 4000 CTs had been performed in the evaluation of acute flank pain. Urinary calculi had been identified in 3120 patients (78.0%). There were 398 patients (9.9%) who had an alternate cause of flank pain or an incidentally detected condition on CT. Of these patients, 102 (25.6%) had more than one additional finding. A total of 153 clinical conditions had been identified mimicking flank pain secondary to calculus and obstruction. In 47 patients (1.2%), incidental solid masses had been detected. CONCLUSION: Spiral CT is a valuable technique in the evaluation of acute flank pain with uncertain clinical diagnosis. A wide spectrum of alternate and additional diagnoses including abdominal solid organ tumors and other significant abdominal conditions such as pancreatitis can be established or suggested on spiral CT performed for suspected acute urinary colic. (+info)
Laparoscopic splenorenal venous bypass for nutcracker syndrome.
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