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Sample records for bilateral upper urinary

  1. [Bilateral Granulomatous Renal Masses after Intravesical BCG Therapy for Non-muscle-invasive Bladder Cancer and Carcinoma in Situ of the Upper Urinary Tract: A Case Study].

    PubMed

    Higashioka, Kazuhiko; Miyake, Noriko; Nishida, Ruriko; Chong, Yong; Shimoda, Shinji; Shimono, Nobuyuki

    2015-07-01

    Bacillus Calmette-Guèrin (BCG) is commonly used not only as an infant vaccination, but also as a treatment of and prophylaxis to prevent recurrence in the management of non-muscle-invasive bladder cancer. However, the use of "live" BCG is sometimes complicated by associated infection. We present a case study of a 77-year-old man who developed bilateral renal masses after intravesical BCG therapy was initiated in November 2013, following transurethral resection of non-muscle-invasive bladder cancer. After four courses of BCG (Japan strain, 80 mg per treatment) instillations, a computed tomography examination for febrile episodes showed multiple bilateral renal masses, accompanied by a histological finding of a granulomatous reaction. An acid fast bacterium was cultured from only urine among blood, urine, and microscopic samples. Using the cultured strain, BCG infection was confirmed by the specific gene deletion pattern based on allele-specific polymerase chain reaction analysis. Anti-tuberculosis treatment, including isoniazid (300 mg/day), rifampicin (600 mg/day), and ethambutol (1,000 mg/day), was started for the BCG-related renal granuloma in February 2014. After 3 months, antibiotic therapy was discontinued owing to severe appetite loss, though the masses remained solid. No rapid growth has been detected after anti-BCG therapy. Intravesical BCG therapy is recommended worldwide as one of standard treatments for non-muscle-invasive bladder cancer. We should closely observe patients undergoing this approach for emerging BCG complications. PMID:26554225

  2. A review of bilateral training for upper extremity hemiparesis.

    PubMed

    Stoykov, Mary Ellen; Corcos, Daniel M

    2009-01-01

    Upper extremity hemiparesis is the most common post-stroke disability. Longitudinal studies have indicated that 30-66% of stroke survivors do not have full arm function 6 months post-stroke. The current gold standard for treatment of mild post-stroke upper limb impairment is constraint-induced therapy but, because of the inclusion criteria, alternative treatments are needed which target more impaired subjects. Bilateral arm training has been investigated as a potential rehabilitation intervention. Bilateral arm training encompasses a number of methods including: (1) bilateral isokinematic training; (2) mirror therapy using bilateral training; (3) device-driven bilateral training; and (4) bilateral motor priming. Neural mechanisms mediating bilateral training are first reviewed. The key bilateral training studies that have demonstrated evidence of efficacy will then be discussed. Finally, conclusions are drawn concerning clinical implications based on the reviewed literature. PMID:19517519

  3. [Laparoscopy of the upper urinary tract].

    PubMed

    Stepushkin, S P; Chebanov, K O; Chaĭkovskiĭ, V P; Sokolenko, R V; Novikov, S P; Novikov, V O

    2014-01-01

    The upper urinary tract is a wide field for using of laparoscopy. The aim of this work was to analyze retrospectively our experience in the development of laparoscopic techniques of surgical treatment of upper urinary tract pathology. 137 patients with pathology of the upper urinary tract were operated laparoscopically in our department during three years (July 2010 - July 2013). There were performed: nephrectomy--75 (54.7%, nephroureterectomy--3, 2.2%, partial nephrectomy--12 (8.7%), adrenalectomy--11 (8%), resection of the adrenal gland--2 (1.5%), cystectomy--10 : (7.3%) ureterolithotomy--15 (11%) pelviolithotomy--3 (2.2%), pyeloplasty--4 (2.9%) nephropexy--2 (14%). The results were evaluated by the comparative analysis of laparoscopic surgery and similar open interventions that were performed in our clinic. The mean operative time after laparoscopic nephrectomy was 180 min (80-220), the mean blood loss during surgery was 150 ml (50-370). The patients discharged at 4-5 days after operation. Laparoscopic partial nephrectomy was performed at an average tumor size 2.7 cm (1.5-3.5). We used warm ischemia in 75% of cases. Its average time was 27 min (9-39), which was significantly greater than in the open resection--17 min (10-27). At the beginning of the development of laparoscopic adrenalectomy the average operative time was 140 min (110-270). In the future, as we got experience, it declined to 70 min (60-90) min. The mean blood loss was 70 ml (range 20-400). After laparoscopic cystectomy, ureterolithotomy, pelviolithotomy and pyeloplastic the patients discharged at 2-3 days. Intraoperative and postoperative complications were not noted. Laparoscopic surgery for treatment of pathology of the upper urinary tract is an alternative to the operations performed by the open approach. The oncological outcomes, functional results and complication rates are comparable for both types of surgery. PMID:25286605

  4. Bilateral Inguinal Hernia Containing Urinary Bladder as Sole Content With "Pelvic Mickey Mouse Sign".

    PubMed

    Indiran, Venkatraman

    2016-04-01

    Inguinal hernias may contain urinary bladder as one of its contents, but very rarely have it as sole content. Inguinal vesical hernias may be unilateral or bilateral. When bilateral, inguinal vesical hernia may produce "pelvic Mickey mouse sign." This case reinforces the "pelvic Mickey mouse sign" in bilateral inguinal hernia containing only urinary bladder as content, which has been described only once before. PMID:26775075

  5. Double Trouble: A Rare Case of Bilateral Upper Pole Ureteropelvic Junction Obstruction☆

    PubMed Central

    Peters, Craig A.; Pathak, Nirmal

    2014-01-01

    A 16-year-old girl presented with bilateral back pain caused by bilateral upper pole ureteropelvic junction obstructions; an extremely rare phenomenon. Bilateral robotically assisted upper pole pyeloplasties were preformed at the same setting with an excellent clinical response. Although rare, upper pole ureteropelvic junction obstruction is a defined entity that urologists should be aware of. PMID:26958473

  6. Bilateral and multiple cavitation sounds during upper cervical thrust manipulation

    PubMed Central

    2013-01-01

    Background The popping produced during high-velocity, low-amplitude (HVLA) thrust manipulation is a common sound; however to our knowledge, no study has previously investigated the location of cavitation sounds during manipulation of the upper cervical spine. The primary purpose was to determine which side of the spine cavitates during C1-2 rotatory HVLA thrust manipulation. Secondary aims were to calculate the average number of pops, the duration of upper cervical thrust manipulation, and the duration of a single cavitation. Methods Nineteen asymptomatic participants received two upper cervical thrust manipulations targeting the right and left C1-2 articulation, respectively. Skin mounted microphones were secured bilaterally over the transverse process of C1, and sound wave signals were recorded. Identification of the side, duration, and number of popping sounds were determined by simultaneous analysis of spectrograms with audio feedback using custom software developed in Matlab. Results Bilateral popping sounds were detected in 34 (91.9%) of 37 manipulations while unilateral popping sounds were detected in just 3 (8.1%) manipulations; that is, cavitation was significantly (P < 0.001) more likely to occur bilaterally than unilaterally. Of the 132 total cavitations, 72 occurred ipsilateral and 60 occurred contralateral to the targeted C1-2 articulation. In other words, cavitation was no more likely to occur on the ipsilateral than the contralateral side (P = 0.294). The mean number of pops per C1-2 rotatory HVLA thrust manipulation was 3.57 (95% CI: 3.19, 3.94) and the mean number of pops per subject following both right and left C1-2 thrust manipulations was 6.95 (95% CI: 6.11, 7.79). The mean duration of a single audible pop was 5.66 ms (95% CI: 5.36, 5.96) and the mean duration of a single manipulation was 96.95 ms (95% CI: 57.20, 136.71). Conclusions Cavitation was significantly more likely to occur bilaterally than unilaterally during upper cervical HVLA

  7. Upper-urinary-tract urothelial tumors: conservative treatment by Nd:YAG laser

    NASA Astrophysics Data System (ADS)

    Gaboardi, Franco; Bozzola, Andrea; Melodia, Tommaso; Gulfi, Gildo M.; Galli, Stefano

    1993-05-01

    Upper urinary malignancies are rare tumors whose diagnosis sometimes represents a difficult dilemma. In selected cases, it is possible to treat the tumor with laser irradiation. This approach is reserved to low-stage low-grade tumors, a tumor in a solitary kidney, bilateral syncroneous disease or patients with deterioration of renal function. Thirty one patients suspected to have malignancies, as they presented upper tract filling defects at IVP, underwent uretero-pyeloscopy to confirm the diagnosis. Twenty patients with upper urinary tract urothelial tumors were treated with Nd:YAG laser irradiation. Before the procedure, the ureter and the pelvis were accessed by 0.038 inch guide-wire or 4 French ureteral catheter. A power of 25 - 30 watts/3 seconds was carried out for the laser irradiation of the tumor and of the base. Sometime after the procedure a ureter single J catheter was left indwelling for 48 hours. In the follow-up the patients had endoscopic surveillance every three months. Actually 12 patients are tumor-free after 3 - 36 months. Eight patients had a recurrence after the first treatment and they underwent new laser irradiation. All the recurrences were in other sites of the upper urinary tract and seemed to be related to tumor grade. In conclusion, conservative endourological ureteropyeloscopy coupled with Nd:YAG laser irradiation should be considered a useful treatment in selected patients.

  8. Diuretic radionuclide localization of upper urinary tract obstruction

    SciTech Connect

    Koff, S.A.; Shore, R.M.; Hayden, L.J.; Smith, S.P.; Trepashko, D.W.

    1984-09-01

    In 59 children with proved upper urinary tract obstruction diuretic radionuclide ureteral scans provided an accurate assessment of ureteral dilatation sufficient to distinguish ureteropelvic from ureterovesical obstruction. As a result, this test may be used instead of more invasive studies, such as retrograde or antegrade pyelography, to determine the site of obstruction in many cases of hydronephrosis.

  9. Congenital Nephrogenic Diabetes Insipidus Presented With Bilateral Hydronephrosis and Urinary Infection

    PubMed Central

    Zheng, Kewen; Xie, Yi; Li, Hanzhong

    2016-01-01

    Abstract Nephrogenic diabetes insipidus (NDI) is a condition resulting from the kidney's impaired response to circulating antidiuretic hormone (ADH), leading to polydipsia and polyuria. Urinary tract dilatation caused by NDI is a rare situation. Here, we report a case of congenital NDI presented with bilateral hydronephrosis. A 15-year-old boy complaining a history of intermittent fever was admitted to Peking Union Medical College Hospital. He voided 10 to 15 L of urine daily. Radiographic examination revealed severe dilatation of bilateral renal pelvis, ureter, and bladder. Urinalysis shows hyposthenuria. He was diagnosed NDI since born. Transient insertion of a urethral catheter helped to relieve fever. Medical therapy of hydrochlorothiazide and amiloride was prescribed and effective. Dilatation of urinary tract caused by diabetes insipidus is rare, but may be present in severe condition. Therefore, it is crucial for clinicians to perform early treatment to avoid impairment of renal function. PMID:27258490

  10. Congenital Nephrogenic Diabetes Insipidus Presented With Bilateral Hydronephrosis and Urinary Infection: A Case Report.

    PubMed

    Zheng, Kewen; Xie, Yi; Li, Hanzhong

    2016-05-01

    Nephrogenic diabetes insipidus (NDI) is a condition resulting from the kidney's impaired response to circulating antidiuretic hormone (ADH), leading to polydipsia and polyuria. Urinary tract dilatation caused by NDI is a rare situation. Here, we report a case of congenital NDI presented with bilateral hydronephrosis.A 15-year-old boy complaining a history of intermittent fever was admitted to Peking Union Medical College Hospital. He voided 10 to 15 L of urine daily. Radiographic examination revealed severe dilatation of bilateral renal pelvis, ureter, and bladder. Urinalysis shows hyposthenuria.He was diagnosed NDI since born. Transient insertion of a urethral catheter helped to relieve fever. Medical therapy of hydrochlorothiazide and amiloride was prescribed and effective.Dilatation of urinary tract caused by diabetes insipidus is rare, but may be present in severe condition. Therefore, it is crucial for clinicians to perform early treatment to avoid impairment of renal function. PMID:27258490

  11. Antenatal diagnosis of upper urinary tract dilation by ultrasonography.

    PubMed

    Langer, B; Simeoni, U; Montoya, Y; Casanova, R; Schlaeder, G

    1996-01-01

    The criteria for the detection of fetal pyelectasis are still controversial. Prenatal and postnatal data from 2,170 consecutive pregnant women who underwent at least one antenatal ultrasound scan were prospectively studied. Fetal pyelectasis was defined on the basis of a mean renal pelvis dimension > 5 or 10 mm before or after 28 weeks of gestation, respectively. Pyelectasis was detected in 95 (4.4%) fetuses. Eighty-nine among them were explored after birth. In 13 (13.7%) cases, an obstructive urinary tract abnormality, a severe vesicoureteral reflux, or a megaureter were diagnosed postnatally. In 29 (30.5%) cases, pyelectasis was confirmed postnatally, while complementary investigations ruled out an obstruction of the urinary tract. The incidence of urinary tract malformations was thus 0.60%, while the positive predictive value was 13.7%. We recommend to use a value not < 10 mm of the renal pelvis mean dimension beyond 28 weeks of gestation as a threshold for detection of fetal upper urinary tract obstruction, in the absence of ureteric and/or bladder dilation. Any value between 5 and 10 mm measured during the 2nd trimester of gestation should be confirmed by a second ultrasound examination performed during the 3rd trimester, before being considered pathological. PMID:8739586

  12. Endoluminal pharmacologic stimulation of the upper urinary tract.

    PubMed

    Jakobsen, Jørn Skibsted

    2013-05-01

    The experiments performed in this PhD thesis were conducted at the Institute of Experimental Surgery, Skejby Hospital, Aarhus, Denmark and at the Laboratory of Animal Science, Odense University Hospital, Denmark. The thesis is based on 3 peer review articles published in international journals and a review. Diagnostic or therapeutic endoscopic upper urinary tract procedures are usually characterised as minimal invasive procedures and associated with a low complication rate. Most often fever or pain are seen and sometimes septicaemia. However, mucosa lesion or even ureteric ruptures are known complications. Research has suggested that high renal pelvic pressures generated during these procedures, might contribute to per-/postoperative complications seen, and even possible renal parenchymal damage. Nevertheless, local administration (endoluminal) of a relaxant drug has not previously been tried in order to lower renal pelvic pressure. The purposes of this thesis were to examine the effect of local administration (endoluminal) of the nonspecific β-adrenergic agonist ISOproterenol (ISO) on: 1) The normal pressure flow relation in porcine ureter, 2) The effect of endoluminal ISO perfusion during flexible ureterorenoscopy, 3) The pressure flow relation during semirigid ureterorenoscopy and 4) The cardiovascular system. Among other receptor-types β-adrenergic receptor are located in the upper urinary tract and the activation thereof mediates smooth muscle relaxation. We have shown - in an animal experimental model - that ISO added to the irrigation fluid had significant impact on the renal pelvic pressures generated during upper urinary tract endoscopy. ISO significantly and dose dependently reduced the normal pressure flow relations by approximately 80% without concomitant cardiovascular side effects or measurable plasma levels of ISO. During flexible ureterorenoscopy 0.1 µg/ml ISO added to the irrigation fluid significantly reduced renal pelvic pressure during

  13. Giant Urinary Bladder and Bilateral Giant Hydronephrosis due to Bladder Neck Obstruction: One Case Report and Literature Review

    PubMed Central

    Tazi, Mohammed Fadl; Riyach, Omar; Ahallal, Youness; Mellas, Soufiane; Khallouk, Abdelhak; El Fassi, Mohammed Jamal; Farih, Moulay Hassan

    2012-01-01

    Bilateral hydronephrosis secondary to urinary obstruction leads to a buildup of back pressure in the urinary tract and may lead to impairment of renal function. Cases of giant hydronephrosis are rare and usually contain no more than 1-2 litres of fluid in the collecting system. Here, we report a rarely seen case with giant urinary bladder and bilateral giant hydronephrosis due to bladder neck obstruction which contains 4000 mL fluid in the collecting system of the kidney mimicking an ascites in an adult male. PMID:22606637

  14. Bilateral obstruction of bilaterally duplicated collecting systems requiring upper and lower moiety drainage.

    PubMed

    Lynch, J O; Cox, A; Rawal, B; Shelmerdine, S; Vasdev, N; Patel, A

    2016-04-01

    A 60-year-old woman with a history of breast cancer presented with bilateral obstruction of bilaterally duplicated renal collecting systems secondary to extrinsic compression from metastatic pelvic lymphadenopathy. Bilateral JJ ureteric stents were inserted, resulting in some improvement of renal function but a failure to normalise completely. Repeat computed tomography demonstrated bilateral duplex collecting systems with persisting obstruction of the undrained moieties. Selective puncture was performed to decompress the obstructed renal moieties for bilateral nephrostomy catheter insertion. This allowed renal function to improve sufficiently for the patient to be discharged and commence chemotherapy. This is the first reported case of bilaterally obstructed partially duplicated collecting systems and it illustrates the importance of recognising anatomical variants to tailor treatment appropriately. It also highlights the important relationship between urology and interventional radiology in the management of such complex patients. PMID:26985816

  15. Modified Retroperitoneoscopic Port Sites for Surgery of Upper Urinary Tract

    PubMed Central

    Hu, Dongliang; Hu, Wanli

    2014-01-01

    Background and Objectives: Our objective was to introduce our experience using modified retroperitoneoscopic port positions for operations of the upper urinary tract. Methods: We designed different trocar positions or incisions according to different surgical procedures and specimen sizes. A total of 116 patients, comprising patients with common adrenal, kidney, and ureter diseases, underwent retroperitoneoscopic operations by use of modified incisions. These patients comprised 23 with adrenal diseases, 84 with kidney diseases, and 9 with ureter diseases. The specimen was retrieved, as much as possible, through a transverse incision to produce a hidden scar after recovery. By contrast, 143 patients underwent the same or similar procedures using classical 3-port incisions. The operative time was defined as the time from skin incision to skin closure. Results: There were no significant differences in age, estimated blood loss, oral intake, and hospital stay between groups. A significant difference in favor of the modified group was noted with respect to analgesia use (diclofenac sodium, 50 mg vs 100 mg; P < .05) in all 3 modified methods, as well as in cosmetic outcome in the groups undergoing the first modification (score, 8.9 ± 2.2 VS 7.3 ± 2.8; P < .05) and second modification (score, 8.7 ± 2.5 VS 7.1 ± 2.4; P < .05). In addition, the mean operative time in patients undergoing ureter operations was shorter than that in the conventional group using classical 3-port positions (55 ± 11 minutes vs 70 ± 15 minutes, P < .05). Conclusions: Our modified retroperitoneoscopic incision is a safe, cosmetic alternative procedure for operations of the upper urinary tract. Different diseases and specimen sizes can be treated with the personalized or suitable incisions that we have introduced. PMID:25392615

  16. Unilateral Versus Bilateral Prostatic Arterial Embolization for Lower Urinary Tract Symptoms in Patients with Prostate Enlargement

    SciTech Connect

    Bilhim, Tiago; Pisco, Joao; Rio Tinto, Hugo; Fernandes, Lucia; Campos Pinheiro, Luis; Duarte, Marisa; Pereira, Jose A.; Oliveira, Antonio G.; O'Neill, Joao

    2013-04-15

    This study was designed to compare baseline data and clinical outcome between patients with prostate enlargement/benign prostatic hyperplasia (PE/BPH) who underwent unilateral and bilateral prostatic arterial embolization (PAE) for the relief of lower urinary tract symptoms (LUTS). This single-center, ambispective cohort study compared 122 consecutive patients (mean age 66.7 years) with unilateral versus bilateral PAE from March 2009 to December 2011. Selective PAE was performed with 100- and 200-{mu}m nonspherical polyvinyl alcohol (PVA) particles by a unilateral femoral approach. Bilateral PAE was performed in 103 (84.4 %) patients (group A). The remaining 19 (15.6 %) patients underwent unilateral PAE (group B). Mean follow-up time was 6.7 months in group A and 7.3 months in group B. Mean prostate volume, PSA, International prostate symptom score/quality of life (IPSS/QoL) and post-void residual volume (PVR) reduction, and peak flow rate (Qmax) improvement were 19.4 mL, 1.68 ng/mL, 11.8/2.0 points, 32.9 mL, and 3.9 mL/s in group A and 11.5 mL, 1.98 ng/mL, 8.9/1.4 points, 53.8 mL, and 4.58 mL/s in group B. Poor clinical outcome was observed in 24.3 % of patients from group A and 47.4 % from group B (p = 0.04). PAE is a safe and effective technique that can induce 48 % improvement in the IPSS score and a prostate volume reduction of 19 %, with good clinical outcome in up to 75 % of treated patients. Bilateral PAE seems to lead to better clinical results; however, up to 50 % of patients after unilateral PAE may have a good clinical outcome.

  17. A Systematic Review of Bilateral Upper Limb Training Devices for Poststroke Rehabilitation

    PubMed Central

    van Delden, A. (Lex) E. Q.; Peper, C. (Lieke) E.; Kwakkel, Gert; Beek, Peter J.

    2012-01-01

    Introduction. In stroke rehabilitation, bilateral upper limb training is gaining ground. As a result, a growing number of mechanical and robotic bilateral upper limb training devices have been proposed. Objective. To provide an overview and qualitative evaluation of the clinical applicability of bilateral upper limb training devices. Methods. Potentially relevant literature was searched in the PubMed, Web of Science, and Google Scholar databases from 1990 onwards. Devices were categorized as mechanical or robotic (according to the PubMed MeSH term of robotics). Results. In total, 6 mechanical and 14 robotic bilateral upper limb training devices were evaluated in terms of mechanical and electromechanical characteristics, supported movement patterns, targeted part and active involvement of the upper limb, training protocols, outcomes of clinical trials, and commercial availability. Conclusion. Initial clinical results are not yet of such caliber that the devices in question and the concepts on which they are based are firmly established. However, the clinical outcomes do not rule out the possibility that the concept of bilateral training and the accompanied devices may provide a useful extension of currently available forms of therapy. To actually demonstrate their (surplus) value, more research with adequate experimental, dose-matched designs, and sufficient statistical power are required. PMID:23251833

  18. Patients with Urinary Incontinence Appear More Likely to Develop Upper Urinary Tract Stones: A Nationwide, Population-Based Study with 8-Year Follow-Up

    PubMed Central

    Chung, Hsiao-Jen; Lin, Alex Tong-Long; Lin, Chih-Chieh; Chen, Tzeng-Ji; Chen, Kuang-Kuo

    2016-01-01

    This study aimed to investigate associations between primary urinary incontinence and development of upper urinary tract stones in a nationwide population in Taiwan. Data of 1,777 adults with primary urinary incontinence and 26,655 controls (groups A, B, and C) without urinary incontinence at study inception were retrieved from the National Health Insurance System database in Taiwan and were analyzed retrospectively. No enrolled subjects had previous diagnosis of upper urinary tract stones or spinal cord injury. All subjects were followed through end of 2009, with a minimum follow-up of 8 years. A greater percentage of study subjects (334/1777, 18.8%) developed upper urinary tract stones than that of control groups A (865/8885, 9.7%) and B (888/8885, 10%), and C (930/8885, 10.5%) (all p-values < 0.0001). Urinary incontinence was associated with significantly increased risk of developing urinary tract stones (HR 1.99, 95% CI, 1.70–2.34, p < 0.001). Age and metabolic syndrome status were both associated with developing upper urinary tract stones (both p-values < 0.0001). After adjusting for metabolic syndrome, regression analysis showed that urinary incontinence was still associated with a significantly increased risk of developing upper urinary tract stones (HR 1.99, 95% CI = 1.76–2.26, p < 0.0001). Long-term follow-up of Taiwanese patients with primary urinary incontinence suggests that urinary incontinence is associated with a significantly increased risk of developing upper urinary tract stones. Study findings suggest that physicians treating patients with urinary incontinence should give attention to early detection of upper urinary tract stones. PMID:27536881

  19. Patients with Urinary Incontinence Appear More Likely to Develop Upper Urinary Tract Stones: A Nationwide, Population-Based Study with 8-Year Follow-Up.

    PubMed

    Chung, Hsiao-Jen; Lin, Alex Tong-Long; Lin, Chih-Chieh; Chen, Tzeng-Ji; Chen, Kuang-Kuo

    2016-01-01

    This study aimed to investigate associations between primary urinary incontinence and development of upper urinary tract stones in a nationwide population in Taiwan. Data of 1,777 adults with primary urinary incontinence and 26,655 controls (groups A, B, and C) without urinary incontinence at study inception were retrieved from the National Health Insurance System database in Taiwan and were analyzed retrospectively. No enrolled subjects had previous diagnosis of upper urinary tract stones or spinal cord injury. All subjects were followed through end of 2009, with a minimum follow-up of 8 years. A greater percentage of study subjects (334/1777, 18.8%) developed upper urinary tract stones than that of control groups A (865/8885, 9.7%) and B (888/8885, 10%), and C (930/8885, 10.5%) (all p-values < 0.0001). Urinary incontinence was associated with significantly increased risk of developing urinary tract stones (HR 1.99, 95% CI, 1.70-2.34, p < 0.001). Age and metabolic syndrome status were both associated with developing upper urinary tract stones (both p-values < 0.0001). After adjusting for metabolic syndrome, regression analysis showed that urinary incontinence was still associated with a significantly increased risk of developing upper urinary tract stones (HR 1.99, 95% CI = 1.76-2.26, p < 0.0001). Long-term follow-up of Taiwanese patients with primary urinary incontinence suggests that urinary incontinence is associated with a significantly increased risk of developing upper urinary tract stones. Study findings suggest that physicians treating patients with urinary incontinence should give attention to early detection of upper urinary tract stones. PMID:27536881

  20. Are we closer to seeing carcinoma in situ in the upper urinary tract?

    PubMed Central

    Aboumarzouk, Omar

    2016-01-01

    Introduction There is observed increase in detection rate of upper urinary tract urothelial cancer worldwide. This is a result of improved imaging as well as implementation of novel technologies of direct visualization of upper urinary tract. Standard techniques still remain insufficient to diagnose flat urothelial lesions. Carcinoma in situ is characterized by flat disordered proliferation of urothelial cells with marked cytologic abnormality, which occur within one cell layer as well as full thickness urothelium and therefore requires a better technology to pick up early and subtle mucosal changes. Material and methods The review presents available diagnostic tools in detection of upper urinary tract urothelial cancer and their ability to depict carcinoma in situ. Results Ureterorenoscopy is an investigation of choice as various promising techniques are under pilot investigations to enhance visualization of upper urinary tract carcinoma in situ. So far only photodynamic diagnosis has been reported to be as effective in detection of carcinoma in situ in the upper as within the lower urinary tract. Conclusions Although we are close to see upper urinary tract carcinoma in situ all new promising diagnostic techniques still require further validation in multicenter clinical trials to indicate any change to current recommendations. PMID:27551552

  1. The effects of bilateral movement training on upper limb function in chronic stroke patients

    PubMed Central

    Han, Kyoung Ju; Kim, Jin Young

    2016-01-01

    [Purpose] This study compared the functional and kinematic changes associated with two rehabilitation protocols: bilateral and unilateral movement training. [Subjects and Methods] Twenty-five patients with chronic stroke were randomly assigned to two training protocols for four weeks of training. Each training session consisted of three tasks. The tasks were performed with either the impaired and unimpaired arms moving synchronously (bilateral training) or with the impaired arm alone (unilateral training). To compare the changes associated with each rehabilitation protocol, functional and kinematic assessments were performed before and after the interventions. The functional state of each patient was measured by the Box and Block Test, and the kinematic variables were assessed by three-dimensional motion analysis. The Box and Block Test was used to assess the functional abilities of the affected upper limb. Kinematic measurements of upper limb movement were measured with a 3-dimensional motion analysis system. [Results] Results showed that the bilateral movement group had significantly improved motion of the shoulder compared to the unilateral movement group. [Conclusion] Bilateral movement training should be used to improve upper limb function in patients with chronic stroke.

  2. Swiveling a Single Expanded Forehead Flap: A Novel Effective Economical Approach to Total Bilateral Upper and Lower Eyelid Reconstruction.

    PubMed

    Kang, Gavin C; Chen Ong, Wei; Lim, Jane; Sundar, Gangadhara; Lim, Thiam Chye

    2016-03-01

    In our novel approach, a single expanded forehead flap was used to reconstruct bilateral upper and lower eyelids in orbital trauma. A 40-year-old man sustained blast injury resulting in bilateral orbital exenteration and need for bilateral socket and eyelid reconstruction. The sockets were each resurfaced with a temporalis flap. A subgaleal forehead tissue expander was expanded during several weeks until enough tissue was obtained. The single expanded forehead flap was swiveled in stages to reconstruct both upper and lower eyelids beginning with the left eye then the right. With this method, the authors recreated the bilateral upper and lower eyelids with a single pedicled flap and ensured secure retention of prostheses to give an acceptable appearance. The novel approach of swiveling a single expanded pedicled forehead flap to reconstruct bilateral upper and lower eyelids is easy and effective providing adequate like for like autologous tissue, and economical requiring only 1 donor site. PMID:26845091

  3. Bilateral interpleural versus lumbar epidural bupivacaine-morphine analgesia for upper abdominal surgery.

    PubMed

    Demian, Atef D; Wahba, Ashraf M; Atia, Emad M; Hussein, Sami H

    2003-10-01

    This randomized study was designed to compare the effectiveness of bilateral interpleural analgesia with lumbar epidural analgesia, on postoperative pain relief in upper abdominal surgery. The studied patients were randomely allocated into either interpleural group "IP" (n = 15) or epidural group "EP" (n = 15). In "IP" group, preanesthetic bilateral interpleural block was done using a mixture of bupivacaine 0.5% (0.8 mg/kg) and 2 mg morphine diluted to 50 ml saline for each side. In "EP" group, the same mixture-diluted in 20 ml saline-was injected in the epidural space (L2-3). The general anesthetic technique was the same in both groups. Hemodynamic, gasometric, verbal pain score (VPS) values and complications were compared in both techniques. Heart rate (HR) and mean arterial pressure (MAP) readings were in the accepted normal range in the perioperative period although significant lower readings were detected in "EP" group. No significant differences were displayed in blood gasometric variables between the two groups. There were considerable level of analgesia in both groups in the postoperative period although "EP" analgesia was superior to "IP". More pain free patients (9 versus 4) and significant lower consumption of nalbuphine were detected in "EP" group. The results of this study indicate that bilateral "IP" analgesia may offer a satisfactory analgesia for upper abdominal surgery when the use of other analgesic techniques may be contraindicated. PMID:14740589

  4. Bilateral robots for upper-limb stroke rehabilitation: State of the art and future prospects.

    PubMed

    Sheng, Bo; Zhang, Yanxin; Meng, Wei; Deng, Chao; Xie, Shengquan

    2016-07-01

    Robot-assisted bilateral upper-limb training grows abundantly for stroke rehabilitation in recent years and an increasing number of devices and robots have been developed. This paper aims to provide a systematic overview and evaluation of existing bilateral upper-limb rehabilitation devices and robots based on their mechanisms and clinical-outcomes. Most of the articles studied here were searched from nine online databases and the China National Knowledge Infrastructure (CNKI) from year 1993 to 2015. Devices and robots were categorized as end-effectors, exoskeletons and industrial robots. Totally ten end-effectors, one exoskeleton and one industrial robot were evaluated in terms of their mechanical characteristics, degrees of freedom (DOF), supported control modes, clinical applicability and outcomes. Preliminary clinical results of these studies showed that all participants could gain certain improvements in terms of range of motion, strength or physical function after training. Only four studies supported that bilateral training was better than unilateral training. However, most of clinical results cannot definitely verify the effectiveness of mechanisms and clinical protocols used in robotic therapies. To explore the actual value of these robots and devices, further research on ingenious mechanisms, dose-matched clinical protocols and universal evaluation criteria should be conducted in the future. PMID:27117423

  5. Robotic unilateral and bilateral upper-limb movement training for stroke survivors afflicted by chronic hemiparesis.

    PubMed

    Simkins, Matt; Kim, Hyuchul; Abrams, Gary; Byl, Nancy; Rosen, Jacob

    2013-06-01

    Stroke is the leading cause of long-term neurological disability and the principle reason for seeking rehabilitative services in the US. Learning based rehabilitation training enables independent mobility in the majority of patients post stroke, however, restoration of fine manipulation, motor function and task specific functions of the hemiplegic arm and hand is noted in fewer than 15% of the stroke patients. Brain plasticity is the innate mechanism enabling the recovery of motor skills through neurological reorganization of the brain as a response to limbs' manipulation. The objective of this research was to evaluate the therapeutic efficacy for the upper limbs with a dual arm exoskeleton system (EXO-UL7) using three different modalities: bilateral mirror image with symmetric movements of both arms, unilateral movement of the affected arm and standard care. Five hemiparetic subjects were randomly assigned to each therapy modality. An upper limb exoskeleton was used to provide bilateral and unilateral treatments. Standard care was provided by a licensed physical therapist. Subjects were evaluated before and after the interventions using 13 different clinical measures. Following these treatments all of the subjects demonstrated significant improved of their fine motor control and gross control across all the treatment modalities. Subjects exhibited significant improvements in range of motion of the shoulder, and improved muscle strength for bilateral training and standard care, but not for unilateral training. In conclusion, a synergetic approach in which robotic treatments (unilateral and bilateral depending on the level of the motor control) are supplemented by the standard of care may maximize the outcome of the motor control recover following stroke. PMID:24187321

  6. Bilaterally obstructed ureteropelvic junction of the upper moieties in a complete duplex collecting system.

    PubMed

    Latayan, Michael Jonathan R; Dator, Jose Dante P; Torres, Carlos Ramon N

    2008-02-01

    Maternal ultrasound is a routine examination in prenatal evaluation. The number of fetal abnormalities detected has been increasing, and includes fetal hydronephrosis which is secondary to ureteropelvic junction obstruction in 80% of cases. We report a case of a 1-year-old female infant with hydronephrosis prenatally detected by ultrasound. After close postnatal follow-up and diagnosis, she eventually underwent a definitive reconstructive procedure. This is the first reported case of a bilateral ureteropelvic junction obstruction of the upper moieties of a duplex collecting system. PMID:18631901

  7. Clear cell adenocarcinoma of the renal pelvis: an extremely rare neoplasm of the upper urinary tract.

    PubMed

    Liu, K-W; Lin, V C-H; Chang, I-W

    2013-12-01

    Clear cell adenocarcinoma (CCA) in the urinary tract is a rare neoplasm morphologically identical to the Müllerian counterpart. Clear cell adenocarcinoma is extremely rare in the upper urinary tract. We present a case with CCA of the renal pelvis. Microscopically, the tumor exhibited exophytic growth with predominantly tubulocystic structures, as well as solid and papillary patterns. The neoplastic cells were cuboidal with clear to pale eosinophilic cytoplasm and abundant intracellular and extracellular eosinophilic hyaline globules. By immunohistochemically, the tumor was labeled by cytokeratins and hepatocyte nuclear factor-1β. The patient was still alive without evidence of recurrence in the follow-up period of nineteen months after diagnosis. PMID:24375047

  8. Higher risk of urothelial carcinoma in the upper urinary tract than in the urinary bladder in hemodialysis patients.

    PubMed

    Hsiao, Po-Jen; Hsieh, Po-Fan; Chang, Chao-Hsiang; Wu, Hsi-Chin; Yang, Chi-Rei; Huang, Chi-Ping

    2016-06-01

    Purpose This study used the a nationwide population-based retrospective cohort study with the claims data from the Taiwan National Health Insurance Research Database to investigate the risk of urothelial carcinoma (UC) for hemodialysis (HD) patients. Methods The study population consisted of 2689 patients with end-stage renal disease (ESRD) newly diagnosed in 2000-2002 and underwent maintenance HD. Then, 21,449 reference patients were collected without HD randomly selected and matched with sex and age. The exclusion criteria were previous long-term analgesics and Chinese medication usage. Incidence density rates of UC in upper urinary tract (UTUC) and bladder (UBUC) were estimated for both cohorts by the end of 2012. Hazard ratios (HRs) of UC were measured in association with HD, covariates, and comorbidity. Results The incidence of UC was significantly higher in the HD cohort than in the reference cohort for both UT (21.8 vs. 0.65 per 10,000 person-years) and UB (17.7 vs. 3.55 per 10,000 person-years). The multivariate Cox proportional hazard regression analysis showed that the HRs of UTUC in HD cohort was 33.3 (95% CI = 15.9-69.5) and 5.14 for UBUC (95% CI = 3.24-8.15). The risk increased further for HD patients with comorbidity of hematuria, urinary tract infection (UTI) or hydronephrosis. Conclusion Patients with ESRD on HD are at a high risk of developing UC, especially UTUC in Taiwan. They will be paid more frequent to check urine analysis, urine cytology, and upper urinary tract survey. PMID:26956094

  9. Effectiveness and Safety of Ureteroscopic Holmium Laser Lithotripsy for Upper Urinary Tract Calculi in Elderly Patients.

    PubMed

    Yoshioka, Takashi; Otsuki, Hideo; Uehara, Shinya; Shimizu, Toshihiro; Murao, Wataru; Fujio, Koji; Fujio, Kei; Wada, Koichiro; Araki, Motoo; Nasu, Yasutomo

    2016-06-01

    Upper urinary tract calculi are common; however, there is no recommended treatment selection for elderly patients. Ureteroscopic holmium laser lithotripsy (URS lithotripsy) is minimally invasive, and it provides a high stone-free rate (SFR) treatment for upper urinary tract calculi. Here, we retrospectively evaluated the surgical outcomes of URS lithotripsy after dividing the 189 cases into 3 groups by patient age: the '<65 group' (<65 years old, n=108), the '65-74 group' (65-74 years old, n=42), and the ' 75 group' ( 75 years old, n=39). The patients' characteristics, stone status, and perioperative outcomes were assessed. The 65-74 group and the 75 group had a significantly higher prevalence of hypertension compared to the<65 group. Compared to the<65 group, the 65-74 group had a significantly higher prevalence of hyperlipidemia, and the 75 group had significantly higher the American Society of Anesthesiologists (ASA) scores. Despite these preoperative risk factors, SFR and postoperative pyelonephritis in the 65-74 group and the 75 group were similar to those of the<65 group. In conclusion, URS lithotripsy is the preferred treatment for upper urinary tract calculi, even for elderly patients who have multiple preoperative risk factors. PMID:27339204

  10. [Four infants with upper urinary tract infection due to extended-spectrum bata lactamase (ESBL)-producing Escherichia coli].

    PubMed

    Hibino, Satoshi; Fukuchi, Kunihiko; Abe, Yoshifusa; Hoshino, Akihiro; Sakurai, Shunsuke; Mikawa, Takeshi; Fuke, Toshiya; Yoshida, Koichiro; Itabashi, Kazuo

    2011-09-01

    Bacteria producing extended-spectrum beta lactamase (ESBL) are detected mainly in adult urinary specimens, and are believed to cause hospital-acquired infection due to their resistance to many drugs. The incidence of community-acquired infection due to such bacteria is increasing, but few cases of infant upper urinary tract infection (UUTI) have been reported in Japan. We treated four infants with UUTI caused by ESBL-producing Escherichia coli, as determined by genotyping. Using medical records, we retrospectively evaluated the clinical course, antibiotic use and efficacy, antimicrobial susceptibility results, and the presence of underlying disease. One of the four had been previously hospitalized for occult bacteremia. Two developed UUTI after antibiotic treatment, indicating that previous antibiotic use may have been a risk factor in these cases. We could not identify the infection route in all cases. Two of the four had bilateral vesicoureteral reflux (VUR). Renal scintigraphy was done in three. Although an initial dimercaptosuccinic acid (DMSA) defect was detected in all four, only one had renal scarring. E. coli isolates from all four showed PCR signals for blaCTX-M-; one isolate positive for the blaCTX-M3 group and three positive for blaCTX-M14. Antimicrobial susceptibility test results showed all isolates to be resistant to cephalosporins, but discrepancies existed between antimicrobial susceptibility results and actual clinical efficacy. Clinically, cefazolin (CEZ) was effective in two subjects and ceftazidime (CAZ) effective in one. Panipenem/betamipron (PAPM/BP) was effective in one. None of the four developed sepsis or meningitis. Post hospitalization antibiotic prophylaxis showed that none of the four has had UUTI recur. Japan's ESBL-producing bacterial infection incidence is increasing, so medical professionals should watch for such UUTI even in first-case occurrence in infants. PMID:22117375

  11. Necdin Overexpression Predicts Poor Prognosis in Patients with Urothelial Carcinomas of the Upper Urinary Tract and Urinary Bladder

    PubMed Central

    Chang, I-Wei; Wang, Yu-Hui; Wu, Wen-Jeng; Liang, Peir-In; Li, Wei-Ming; Yeh, Bi-Wen; Wu, Ting-Feng; He, Hong-Lin; Huang, Steven Kuan-Hua; Li, Chien-Feng

    2016-01-01

    Background and Aims: Oncogenesis is a multistep process, resulting from the accumulations of multiple mutations. Of these mutations, self-sufficiency in growth signals, i.e., disruption of cell growth regulation, is the first episode. Nonetheless, the genes associated with cell growth dysregulation have seldom been systematically evaluated in either urothelial carcinomas of upper urinary tract (UTUC) or urothelial carcinomas of urinary baldder (UBUC). By data mining a published transcriptomic dataset of UBUCs (GSE31684), we identified the NDN gene as one of the most significant of those associated with the regulation of cell growth and found this gene is associated with advanced tumor status and metastatic disease (GO:0001558). Accordingly, we analyzed NDN transcript and protein expression with their clinicopathological significance. Materials and Methods: We used real time RT-PCR to detect NDN transcript levels in 27 UTUCs and 27 UBUCs, respectively. Immunohistochemical study was performed to determine NDN protein (a.k.a. Necdin) expression evaluated by H-score method in 340 UTUCs and 295 UBUCs. NDN expression was further correlated with clinicopathological features and disease-specific survival (DSS) and metastasis-free survival (MeFS). Results: NDN transcriptional level was significantly higher in UCs of both sites with stepwise more advanced pT statuses. Through immunohistochemistry, we found NDN protein expression was significantly associated with adverse clinicopathological parameters, e.g., advanced pT status, nodal metastasis, high grade histological patterns, and frequent mitotses (all P<0.05). In univariate analysis, NDN overexpression not only predicted worse DSS and MeFS in both the UTUC and UBUC groups, it also served as an independent prognostic factor for DSS and MeFS in multivariate analysis (all P<0.05). Conclusions: NDN may play an important role in tumor progression in UC and could serve as a prognostic biomarker and a potential novel therapeutic

  12. Diagnosis of upper urinary tract obstruction in children: comparison of diuresis renography and pressure flow studies

    SciTech Connect

    Gonzalez, R.; Chiou, R.

    1985-04-01

    A report is given of the use of diuresis renography and pressure flow studies to diagnose urinary tract obstruction in 41 collecting systems of 33 children. If differential pressures between the renal pelvis and the bladder in excess of 22 cm. water at a flow rate of 10 ml. per minute is accepted as evidence of obstruction and below 15 cm. water is accepted as normal the interpretation of the renogram showing O'Reilly's pattern IIIa as evidence of stasis without obstruction was correct in 74 per cent of the cases. Likewise, the interpretation of O'Reilly's renogram pattern IIIb as showing partial obstruction was correct in only 40 per cent of the cases. Thus, the authors urge caution in the use of the diuresis renogram to diagnose or to rule out upper urinary tract obstruction.

  13. Sports Adaptations for Unilateral and Bilateral Upper-Limb Amputees: Archery/Badminton/Baseball/Softball/Bowling/Golf/Table Tennis.

    ERIC Educational Resources Information Center

    Cowart, Jim

    1979-01-01

    The booklet discusses sports adaptations for unilateral and bilateral upper limb amputees. Designs for adapted equipment are illustrated and information on adaptations are described for archery (including an archery release aid and a stationary bow holder); badminton (serving tray); baseball/softball (adaptations for catching, throwing, and…

  14. Long-term results of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma in China

    PubMed Central

    Wang, Xiao-Qing; Jiang, Feng-Ming; Chen, Qi-Hui; Hou, Yu-Chuan; Zhang, Hai-Feng; Hao, Yuan-Yuan; Zhang, Long; Wang, Chun-Xi

    2013-01-01

    Objective: We compared long-term clinical outcomes of upper urinary tract transitional cell carcinoma (TCC) patients treated by retroperitoneoscopic nephroureterectomy (RNU) or open radical nephroureterectomy (ONU). Methods: Upper urinary tract TCC patients were treated with RNU (n = 86) or ONU (n = 72) and followed-up for more than three years. Demographic and clinical data, including preoperative indexes, intraoperative indexes and long-term clinical outcomes, were retrospectively compared to determine long-term efficacy of the two procedures. Results: The RNU and ONU groups were statistically similar in age, gender, previous bladder cancer history, tumour location, pathologic tumour stage, pathologic node metastasis or tumour pathologic grade. The original surgery time required for both RNU and ONU was statistically similar, but RNU was associated with a significantly smaller volume of intraoperative estimated blood loss and shorter length of postoperative hospital stay. Follow-up (average: 42.4 months, range: 3–57) revealed that the RNU 3-year recurrence-free survival rate was 62.8% and the 3-year cancer specific survival rate was 80.7%. In the ONU group, the 3-year recurrence-free survival and the three-year cancer-specific survival rates were 59.2% and 80.3%, respectively. Neither of the survival rates were statistically different between the two groups. T stage, grade, lymph node metastasis and bladder tumour history were risk factors for tumour recurrence; the operation mode and the bladder cuff incision mode had no correlation with the recurrence-free survival. Conclusion: The open surgery strategy and the retroperitoneoscopic nephroureterectomy strategy are equally effective for treating upper urinary tract TCC. However, the RNU procedure is less invasive, and requires a shorter duration of postoperative hospitalized care; thus, RNU is recommended as the preferred strategy. PMID:22630340

  15. Urinary shedding of leptospires and presence of Leptospira antibodies in healthy dogs from Upper Bavaria.

    PubMed

    Llewellyn, Julia-Rebecca; Krupka-Dyachenko, Inke; Rettinger, Anna Lena; Dyachenko, Viktor; Stamm, Ivonne; Kopp, Peter Andreas; Straubinger, Reinhard Konrad; Hartmann, Katrin

    2016-01-01

    Leptospirosis is classified as a re-emerging zoonotic disease with global impor- tance. The aim of this study was to determine urinary shedding of leptospires in healthy dogs and to identify the shedded leptospire species. Furthermore, antibody presence against leptospires was evaluated. In a prospective study urine samples of 200 healthy dogs from Upper Bavaria were randomly collected and evaluated by real-time polymerase chain reaction (PCR) specific for the lipL32 gene of pathogenic Leptospira (L) spp. Positive samples were further character- ized via multilocus sequence typing (MLST) to identify the Leptospira species. Microagglutination test (MAT) was performed to determine serum antibody titers. Three of 200 urine samples were found to be PCR-positive resulting in a urinary shedding prevalence of 1.5% (95% confidence interval 0.3-4.5%). All three dogs had been vaccinated before with a bivalent vaccine, covering the serogroups Canicola and lcterohaemorrhagiae. One dog shed leptospires of the species L. borgpetersenii, and two of the species L. interrogans. Of all dogs, 17.0% had antibody titers ≥ 1:100, and 3.5% titers ≥ 1:400 to serovars of non-vaccinal sero- groups. Healthy dogs that shed leptospires represent a possible risk for humans and other animals. The study emphasizes the importance of general hygiene measures in veterinary practice while handling urine of all dogs, and the use of vaccines that protect against a broader range of serogroups and that prevent urinary shedding. PMID:27344919

  16. Clinical application of Patlak plot CT-GFR in animals with upper urinary tract disease.

    PubMed

    Alexander, Kate; Dunn, Marilyn; Carmel, Eric Norman; Lavoie, Jean-Pierre; Del Castillo, Jérôme R E

    2010-01-01

    Glomerular filtration rate (GFR), an important parameter of renal function, is difficult to assess clinically. Serum creatinine and blood urea nitrogen measurements lack sensitivity, whereas radionuclide determination of GFR is not always available and requires postinjection patient isolation. GFR can be determined using computed tomography (CT), most commonly via Patlak plot analysis. Four adult cats, two adult dogs, and a foal underwent abdominal CT under general anesthesia for various diseases of the upper urinary tract. CT-GFR was measured with a single-slice dynamic acquisition and Patlak plot analysis. In five animals, the total CT-GFR appeared to be below normal, corresponding with mild (two animals) and moderate (two animals) increases of serum creatinine in four. In the two animals with normal or increased CT-GFR, serum creatinine was within the reference values. A significant negative logarithmic relationship was found between CT-GFR and serum creatinine values (P = 0.008; r2 = 0.75). No complications occurred during or following CT-GFR. CT examination provided clinically relevant information in 3/5 patients with possible ureteral obstruction and in 3/3 patients with suspected ureteral calculi. Single-slice dynamic CT-GFR was practical and provided clinically useful information in this small series of patients undergoing CT of the upper urinary tract. There was a significant relationship between CT-GFR and serum creatinine values, which supports the clinical potential of CT-GFR and justifies further investigation of this technique. PMID:20806874

  17. Comparing unilateral and bilateral upper limb training: The ULTRA-stroke program design

    PubMed Central

    2009-01-01

    Background About 80% of all stroke survivors have an upper limb paresis immediately after stroke, only about a third of whom (30 to 40%) regain some dexterity within six months following conventional treatment programs. Of late, however, two recently developed interventions - constraint-induced movement therapy (CIMT) and bilateral arm training with rhythmic auditory cueing (BATRAC) - have shown promising results in the treatment of upper limb paresis in chronic stroke patients. The ULTRA-stroke (acronym for Upper Limb TRaining After stroke) program was conceived to assess the effectiveness of these interventions in subacute stroke patients and to examine how the observed changes in sensori-motor functioning relate to changes in stroke recovery mechanisms associated with peripheral stiffness, interlimb interactions, and cortical inter- and intrahemispheric networks. The present paper describes the design of this single-blinded randomized clinical trial (RCT), which has recently started and will take several years to complete. Methods/Design Sixty patients with a first ever stroke will be recruited. Patients will be stratified in terms of their remaining motor ability at the distal part of the arm (i.e., wrist and finger movements) and randomized over three intervention groups receiving modified CIMT, modified BATRAC, or an equally intensive (i.e., dose-matched) conventional treatment program for 6 weeks. Primary outcome variable is the score on the Action Research Arm test (ARAT), which will be assessed before, directly after, and 6 weeks after the intervention. During those test sessions all patients will also undergo measurements aimed at investigating the associated recovery mechanisms using haptic robots and magneto-encephalography (MEG). Discussion ULTRA-stroke is a 3-year translational research program which aims (1) to assess the relative effectiveness of the three interventions, on a group level but also as a function of patient characteristics, and (2) to

  18. Keratinized squamous metaplasia of the upper urinary tract resulting in recurrent renal colic.

    PubMed

    Ghali, Fady; Pattison, Erik; Pais, Vernon M

    2015-10-01

    A 60-year-old female with an extensive history of stone disease and shock wave lithotripsy presents with recurrent and increasingly severe renal colic. Work-up reveals obstruction with translucent debris that is found to be composed of keratin. Her history of chronic irritation of the collecting system has resulted in keratinizing squamous metaplasia (KSM) with hyperkeratosis that has sloughed from the upper urinary tract and has become lodged in the ureter. Because of the worsening of her symptoms on conservative management, the patient elected for a nephrectomy and her symptoms have since resolved. KSM of the renal pelvis is a relatively rare phenomenon and most often presents with irritative symptoms. It is thought to result from chronic irritation of the urothelium. KSM has been found to be coincident with squamous cell cancers of the urinary tract, though clear data implicating KSM as a premalignant lesion is lacking. We present a case of recurrent renal colic secondary to sloughing keratin debris from KSM. PMID:26249552

  19. Multi-modality imaging review of congenital abnormalities of kidney and upper urinary tract

    PubMed Central

    Ramanathan, Subramaniyan; Kumar, Devendra; Khanna, Maneesh; Al Heidous, Mahmoud; Sheikh, Adnan; Virmani, Vivek; Palaniappan, Yegu

    2016-01-01

    Congenital abnormalities of the kidney and urinary tract (CAKUT) include a wide range of abnormalities ranging from asymptomatic ectopic kidneys to life threatening renal agenesis (bilateral). Many of them are detected in the antenatal or immediate postnatal with a significant proportion identified in the adult population with varying degree of severity. CAKUT can be classified on embryological basis in to abnormalities in the renal parenchymal development, aberrant embryonic migration and abnormalities of the collecting system. Renal parenchymal abnormalities include multi cystic dysplastic kidneys, renal hypoplasia, number (agenesis or supernumerary), shape and cystic renal diseases. Aberrant embryonic migration encompasses abnormal location and fusion anomalies. Collecting system abnormalities include duplex kidneys and Pelvi ureteric junction obstruction. Ultrasonography (US) is typically the first imaging performed as it is easily available, non-invasive and radiation free used both antenatally and postnatally. Computed tomography (CT) and magnetic resonance imaging (MRI) are useful to confirm the ultrasound detected abnormality, detection of complex malformations, demonstration of collecting system and vascular anatomy and more importantly for early detection of complications like renal calculi, infection and malignancies. As CAKUT are one of the leading causes of end stage renal disease, it is important for the radiologists to be familiar with the varying imaging appearances of CAKUT on US, CT and MRI, thereby helping in prompt diagnosis and optimal management. PMID:26981222

  20. Multi-modality imaging review of congenital abnormalities of kidney and upper urinary tract.

    PubMed

    Ramanathan, Subramaniyan; Kumar, Devendra; Khanna, Maneesh; Al Heidous, Mahmoud; Sheikh, Adnan; Virmani, Vivek; Palaniappan, Yegu

    2016-02-28

    Congenital abnormalities of the kidney and urinary tract (CAKUT) include a wide range of abnormalities ranging from asymptomatic ectopic kidneys to life threatening renal agenesis (bilateral). Many of them are detected in the antenatal or immediate postnatal with a significant proportion identified in the adult population with varying degree of severity. CAKUT can be classified on embryological basis in to abnormalities in the renal parenchymal development, aberrant embryonic migration and abnormalities of the collecting system. Renal parenchymal abnormalities include multi cystic dysplastic kidneys, renal hypoplasia, number (agenesis or supernumerary), shape and cystic renal diseases. Aberrant embryonic migration encompasses abnormal location and fusion anomalies. Collecting system abnormalities include duplex kidneys and Pelvi ureteric junction obstruction. Ultrasonography (US) is typically the first imaging performed as it is easily available, non-invasive and radiation free used both antenatally and postnatally. Computed tomography (CT) and magnetic resonance imaging (MRI) are useful to confirm the ultrasound detected abnormality, detection of complex malformations, demonstration of collecting system and vascular anatomy and more importantly for early detection of complications like renal calculi, infection and malignancies. As CAKUT are one of the leading causes of end stage renal disease, it is important for the radiologists to be familiar with the varying imaging appearances of CAKUT on US, CT and MRI, thereby helping in prompt diagnosis and optimal management. PMID:26981222

  1. Comparison of unilateral versus bilateral upper extremity task performance after stroke

    PubMed Central

    DeJong, Stacey L.; Lang, Catherine E.

    2011-01-01

    BACKGROUND Previous studies have suggested that practicing functional tasks bilaterally instead of unilaterally may improve paretic limb performance after stroke. OBJECTIVE The purposes of this study were to determine whether the bilateral movement condition alters paretic limb performance of a functional task in people with post-stroke hemiparesis, and to identify specifically which parameters of performance may be affected. METHODS In this single-session study, we examined immediate effects of the bilateral vs. unilateral movement condition on performance of a reach-grasp-lift-release task at preferred-speed in 16 people with mild to moderate post-stroke hemiparesis and in 12 healthy controls. Performance was quantified using motion analysis variables, including durations of the reach and grasp phases, reach path straightness, maximum thumb-index finger aperture, efficiency of finger movement, peak grip force, and timing of release. RESULTS We found no evidence of immediate improvement in paretic-limb performance in the bilateral condition. In both groups, release timing occurred later when participants moved bilaterally instead of unilaterally, possibly representing a divided-attention effect. Other variables did not differ across conditions. CONCLUSIONS Our findings suggest little immediate impact of the bilateral condition on motor performance of a reach-grasp-lift-release task at preferred speed, in people with mild to moderate hemiparesis. PMID:22750959

  2. Congenital anomalies of kidney and upper urinary tract in children with congenital hypothyroidism; a case-control study

    PubMed Central

    Yousefichaijan, Parsa; Dorreh, Fatemeh; Rafeie, Mohammad; Sharafkhah, Mojtaba; Safi, Fatemeh; Amiri, Mohammad; Ebrahimimonfared, Mohsen

    2015-01-01

    Introduction: Congenital hypothyroidism (CH) may be significantly associated with congenital malformations. However, there is little evidence on the relationship between renal and urinary tract anomalies and CH. Objectives: The aim of this study was to compare the renal and upper urinary tract anomalies in children with and without primary CH (PCH). Patients and Methods: This case-control study was conducted on 200 children aged 3 months to 1 year, referring to Amir-Kabir hospital, Arak, Iran. One hundred children with PCH, as the case group, and 100 children without CH, as the control group, were selected. For all children, ultrasonography and other diagnostic measures (if necessary) were performed to evaluate renal and upper urinary tract anomalies (ureter and bladder). Results: The frequency of renal and upper urinary tract anomalies among 43 children with primary CH, with 83 cases (72.8%), was significantly higher than the frequency of anomalies among the 19 children in the control group, with 31 cases (27.1%) (OR = 3; CI 95%: 1.6-5.4; P = 0.001). Among the anomalies studied, only the differences in frequency of uretero-pelvic junction obstruction (UPJO) (OR = 6; CI 95%: 1.3-28; P = 0.018) and hydronephrosis (OR = 22; CI 95%: 5-95; P = 0.001) was significant between the two groups. Conclusion: Our study demonstrated that PCH is significantly associated with the frequency of congenital anomalies of the kidneys and upper urinary tracts. However, further studies are recommended to determine the necessity of conducting screening programs for anomalies of the kidneys and urinary tract in children with CH at birth. PMID:26693499

  3. Therapeutic role of template-based lymphadenectomy in urothelial carcinoma of the upper urinary tract

    PubMed Central

    Kondo, Tsunenori; Takagi, Toshio; Tanabe, Kazunari

    2015-01-01

    Lymphadenectomy for urothelial carcinoma of the upper urinary tract has attracted the attention of physicians. The mapping study of lymphatic spread has shown that a relatively wide area should comprise the regional nodes for tumors of the right renal pelvis or the right upper two-thirds of the ureter. A prospective study showed that an anatomical template-based lymphadenectomy significantly improved patient survival in tumors of the renal pelvis. This benefit was more evident for patients with pT2 stage tumors or higher. The risk of regional node recurrence is significant reduced by template-based lymphadenectomy, which is likely to be associated with improved patient survival. The removal of lymph node micrometastases is assumed to be the reason for therapeutic benefit following lymphadenectomy. The number of resected lymph nodes can be used to assess the quality of lymphadenectomy, but not to determine the extent of lymphadenectomy. The guidelines currently recommend lymphadenectomy for patients with muscle-invasive disease, even though the current recommendation grades are still low. The present limitation of lymphadenectomy is the lack of standardization of the extent of lymphadenectomy and the randomized trials. Further studies are warranted to collect the evidence to support lymphadenectomy. PMID:26677437

  4. The effects of task-oriented versus repetitive bilateral arm training on upper limb function and activities of daily living in stroke patients

    PubMed Central

    Song, Gui Bin

    2015-01-01

    [Purpose] The purpose of this study was to investigate the effects of task-oriented bilateral arm training and repetitive bilateral arm training on upper limb function and activities of daily living in stroke patients. [Subjects] Forty patients with hemiplegia resulting from stroke were divided into a task orientied bilateral arm training group (n=20) and a repetitive bilateral arm training group (n=20). [Methods] The task-oriented group underwent bilateral arm training with 5 functional tasks, and the repetitive group underwent bilateral arm training with rhythmin auditory cueing for 30 minutes/day, 5 times/week, for 12 weeks. [Results] The upper limb function and the ability to perform activities of daily living improved significantly in both groups. Although there were significant differences between the groups, the task-oriented group showed greater improvement in upper limb function and activities of daily living. [Conclusion] We recommend bilateral arm training as well as adding functional task training as a clinical intervention to improve upper limb function activities of daily living in patients with hemiplegia. PMID:26157217

  5. Bilateral Cricoarytenoid Arthritis: A Cause of Recurrent Upper Airway Obstruction in Rheumatoid Arthritis

    PubMed Central

    Pradhan, Pradeep; Bhardwaj, Abhishek; Venkatachalam, VP

    2016-01-01

    We report a case of bilateral cricoarytenoid joint arthritis with history of rheumatoid arthritis, presented with stridor to the outpatient department. Endolaryngoscopy revealed adducted vocal cords and a nodule over left arytenoid which later confirmed to be rheumatoid nodule on histopathologic examination. Initially, although patient responded well to medical treatment, recurrence was noticed after 6 months follow-up.

  6. Initial Experience with Retroperitoneal Laparoendoscopic Single-Site Surgery for Upper Urinary Tract Surgery

    PubMed Central

    Pak, Chul-Ho; Baik, Seung

    2011-01-01

    Purpose To report our initial clinical experience and perioperative outcomes of retroperitoneal laparoendoscopic single-site surgery (RLESS) for upper urinary tract surgery. Materials and Methods Between June 2009 and October 2010, we performed RLESS in 23 patients for various indications including radical nephrectomy (n=4), nephroureterectomy (n=2), simple nephrectomy (n=10), and renal cyst ablation (n=7). RLESS was performed with a homemade single-port device with a conventional rigid laparoscopic instrument and laparoscope. The parameters analyzed were age, body mass index, operative time, estimated blood loss, transfusion, time of oral intake, visual analogue pain scale score (VAPS), length of hospital stay, and complications. Results One case of simple nephrectomy was converted to open nephrectomy because of severe adhesion and inadequate surgical exposure. RLESS was completed in 23 patients. Mean operative time was 168.7±29.2, 227.5±50.0, 230.0±56.5, and 70.5±8.9 minutes for simple nephrectomy, radical nephrectomy, nephroureterectomy, and renal cyst ablation, respectively. Estimated blood loss was 113.0±149.8, 170.0±156.8, 400.0±141.4, and 22.8±16.0 ml. The time to oral intake after surgery was 1.4±0.5, 1.2±0.5, 1.5±0.7, and 1.1±0.3 days. The mean VAPS score was 1.1±0.2, 2.1±0.5, 2.0±0.5, and 1.0±0.0 of 10 (range, 0.8 to 2.6). The hospital stay was 4.6±1.5, 3.7±0.5, 6.0±1.4, and 3.2±1.7 days. No major perioperative complications were observed. Conclusions The initial outcomes of our experience suggest that RLESS is a technically feasible and safe procedure for upper urinary tract surgery. Prospective comparative studies with conventional retroperitoneal laparoscopic surgery are needed to confirm the potential benefits of RLESS. PMID:22216397

  7. [TRANSURETHRAL URETEROLITHOTRIPSY FOR UPPER URINARY TRACT STONE IN SMALL CHILDREN WEIGHNING AROUND 10KG].

    PubMed

    Nishimura, Yoko; Moriya, Kimihiko; Mitsui, Takahiko; Kitta, Takeya; Kanno, Yukiko; Kon, Masafumi; Shinohara, Nobuo

    2015-10-01

    Management strategy for upper urinary tract calculi in small children is still a matter controversial. We report successful management of ureteral stone with transurethral ureterolithotripsy (TUL) in 2 boys weighing around 10 kg. Case 1: A 2-year-old boy (78 cm in height, 9.6 kg in weight), who received hydrocortisone and fludrocortisone for the treatment of 21-hydroxylase deficiency, was referred to our hospital with a right 9-mm lower ureteral stone. For TUL, a 7.5 Fr rigid cystoscope was introduced into the ureter directly after dilation of the ureteral orifice. By using Holmium:YAG laser for lithotripsy, complete stone evacuation was achieved. Stone analysis showed the composition of calcium phosphate and calcium oxalate. Case 2: A 1-year-old boy (80 cm in height, 10.5 kg in weight) with neurofibromatosis type 1 was referred to our hospital with a left 7.5-mm ureteral stone at the ureteropelvic junction. TUL was performed using a 4.5 F rigid ureteroscope and Holmium:YAG laser. No residual stone was identified. Stone analysis showed the composition of calcium oxalate. TUL is a safe and feasible option for small children, even in boys weighing approximately 10 kg. PMID:26717789

  8. Testicular Metastasis of a Upper Urinary Tract High-grade Papillary Urothelial Carcinoma, 2 Years After Nephroureterectomy

    PubMed Central

    Kubiak, M.; Klein, J.; de Perrot, T.; Tille, J.C.; Iselin, C.E.

    2015-01-01

    Urothelial carcinomas are the fourth most common tumors in men. Upper tract urinary carcinomas (UTUCs) are uncommon and represent only 5–10% of urothelial carcinomas.1 Metastatic testicular cancers are rare and primary tumor sources are the prostate, lung, and gastrointestinal tract. We report the first case of testicular metastasis 2 years after initial curative surgery for a high-grade UTUC, all other reported cases weren't proceed by curative surgery.3 PMID:26793571

  9. [Oncological outcomes of laparoscopic and open treatment (nephroureterectomy) for urothelial tumors of the upper urinary tract].

    PubMed

    Lotrecchiano, Giuseppe; Delle Cave, Aldo; Tripodi, Vincenzo; De Fortuna, Enrico; Quaranta, Antonio; Attanasi, Franco; Salzano, Luigi

    2012-01-01

    Currently, the treatment of choice in urothelial tumors of the upper urinary tract is nephroureterectomy (NU) as an Open procedure (ONU), though the laparoscopic treatment is now routinely performed as a minimally invasive therapy (LNU). LNU has demonstrated oncologic safety at least equivalent to open, but some issues dealing with cancer still remain. We retrospectively analyzed data from 36 LNU performed between 2006 and 2010, compared with data of 32 ONU performed in 2002-2005 (pre-laparoscopy era). The mean follow-up was 23 months in patients undergoing LNU and 42 months for those treated with ONU. In particular, we evaluated cancer recurrence, the site of recurrence and survival rates. We had local recurrence in 3 patients (8.3%) after LNU and 2 after ONU (6.25%). 2 patients who underwent LNU (5.5%) died of metastatic disease at 9 and 12 months; 3 patients who underwent ONU (9.3%) died of metastasis at 12, 16 and 23 months, respectively. Bladder recurrence was observed in 3 patients after ONU and in 4 after LNU. The most frequent sites of cancer recurrence were: local recurrence (3 LUN, 2 ONU), 1 laparoscopic port recurrence, 3 regional lymph node recurrences (2 LNU, 1ONU), bladder recurrences (3 LNU, 4 ONU). There were no significant differences in disease recurrence and even survival rates at 1 and 3 years were not very different between the two techniques. The grade and stage of cancer affecting the incidence of metastatic disease, as well as the localization of early disease (pelvis-ureter-both) is a negative prognostic factor, rather than the surgical technique used. Therefore, there is no evidence that the control is compromised in cancer patients treated with LNU rather than with ONU. PMID:23371279

  10. [X-ray endoscopic diagnosis and treatment of iatrogenic injuries of the upper urinary tract].

    PubMed

    Martov, A G; Gurbanov, Sh Sh; Stepoanov, V S; Kornienko, S I

    2009-01-01

    X-ray endoscopic diagnosis and treatment of iatrogenic pelvoureteral injuries (PUI) were made in 200 patients (age 18-70 years, mean age 41.7 years, 68(34%) males, 132(66%) females). Preoperative examination was standard for obstructive diseases of the upper urinary tract (UUT). The end stage of the diagnosis included diapevtic transurethral ureteropyeloscopy or percutaneous nephroureteroscopy. In 57 (28.5%) patients x-ray and endoscopic diagnoses did not coincide. A total of 250 x-ray endoscopic operations were conducted. Direct dissection of the UUT stricture (obliteration) was made with a "cold" knife in 38.8% cases, with an uncinate electrode--in 14.8%, with a Ho laser applicator--in 46.4% cases. Patients with ureterovaginal (uterine) fistulas after relief of the obstruction have undergone ablation and coagulation of the fistula. UUT draining and splinting of the dissection zone were performed with "inner" stents 608 Fr in diameter and 24-28 cm long as well as with endopyelotomic stents 6-7 Fr with extention to 12-14 Fr. Draining of the kidney after percutaneous operation was made with pigtail drains 7-12 Fr and a long (35-50 cm) intubation drain tube 12-16 Fr in diameter. The drainage continued 4-12 weeks. Control examination took part in 6-12 months. Good and satisfactory results were achieved in 186 (88.2%) cases. Endourological reoperation was made in 33 patients, three times operative intervention was conducted in 6 patients. Basing on our findings, we have developed prognostic criteria of efficacy of PUI roentgenoendoscopic treatment which was effective in short strictures (obliterations) of the UUT in relatively intact renal function, absence of manifest UUT hypotension, when performed 3 weeks to 3 months after iatrogenic injury. PMID:19526871

  11. The effect of enhanced trunk control on balance and falls through bilateral upper extremity exercises among chronic stroke patients in a standing position

    PubMed Central

    Shin, Ji Won; Don Kim, Kyoung

    2016-01-01

    [Purpose] This study examined the effects of bilateral upper extremity exercises on trunk control, balance, and risk of falls in stroke patients. [Subjects and Methods] A total of 30 study subjects were selected and randomly divided into experimental and control groups containing 15 subjects each, who received bilateral upper extremity activities and conventional rehabilitation treatment, respectively. [Results] There were statistically significant differences between groups in all sub-items and total trunk impairment and Berg Balance scale scores. Significant differences between groups were also observed in all sub-items of the trunk impairment scale, except for static sitting balance. [Conclusion] Bilateral upper extremity exercises are effective for trunk control and balance as well as for fall prevention. PMID:26957756

  12. Complement Component 1, s Subcomponent Overexpression is an Independent Poor Prognostic Indicator in Patients with Urothelial Carcinomas of the Upper Urinary Tract and Urinary Bladder

    PubMed Central

    Chang, I-Wei; Lin, Victor Chia-Hsiang; Wu, Wen-Jen; Liang, Peir-In; Li, Wei-Ming; Yeh, Bi-Wen; He, Hong-Lin; Liao, Alex Chien-Hwa; Chan, Ti-Chun; Li, Chien-Feng

    2016-01-01

    Purpose: Urothelial carcinoma of the urinary bladder and upper tract is prevalent. By subjecting a documented transcriptome data set of urothelial carcinoma of bladder (GSE31684) to data mining and focusing on genes linked to peptidase activity (GO:0008233), we recognized C1S as the most significantly upregulated gene related to an advanced tumor status and metastasis. We subsequently analyzed the association of both C1S mRNA and its encoded protein expression with the clinical and pathological significance. Materials and Methods: We used real-time reverse transcription polymerase chain reaction to detect C1S transcription levels in 20 cases each of urothelial carcinoma of bladder and upper tract. An immunohistochemical stain was conducted to determine C1s protein expression levels in patients with urothelial carcinoma of upper tract (n = 340) and urinary bladder (n = 295). Furthermore, we examined the correlation of C1s expression with clinicopathological characteristics, disease-specific survival, and metastasis-free survival. Results: C1S transcription levels were significantly high in patients with advanced-stage tumors of both groups (all P < .05). Immunohistochemical analysis revealed that C1s expression levels were significantly associated with adverse clinicopathological parameters in both groups of urothelial carcinoma (all P < .05). C1s overexpression predicted poor disease-specific and metastasis-free survival rates for both urothelial carcinoma groups in the univariate analysis, and it was also an independent prognostic factor in the multivariate analysis (all P < .05). Conclusions: C1s may play a pivotal role in urothelial carcinoma progress and can represent a vital prognostic marker and a promising new therapeutic target in urothelial carcinoma. PMID:27471555

  13. How botulinum toxin in neurogenic detrusor overactivity can reduce upper urinary tract damage?

    PubMed Central

    Baron, Maximilien; Grise, Philippe; Cornu, Jean-Nicolas

    2016-01-01

    Intradetrusor injections of botulinum toxin are the cornerstone of medical treatment of neurogenic detrusor overactivity. The primary aim of this treatment is to ensure a low pressure regimen in the urinary bladder, but the mechanisms leading to long-term protection of the urinary tract remain poorly understood. In this paper, we highlight the potential benefits of intradetrusor injections of botulinum toxin regarding local effects on the bladder structures, urinary tract infections, stone disease, vesico ureteral reflux, hydronephrosis, renal function based on a comprehensive literature review. PMID:26981445

  14. [Nephronia in pediatrics: part of the spectrum of upper urinary tract infections. Clinical cases and review of the literature].

    PubMed

    Piñera, Cecilia; Loyola, Francisca; Hernández, Pamela

    2015-10-01

    Nephronia or focal acute nephritis corresponds to a localized inflammatory non-liquefactive kidney infection which may involve parenchyma of one or more renal lobes. It has been suggested that nephronia is part of the spectrum of upper urinary tract infections between acute pyelonephritis and renal abscess. It is associated with a prolonged clinical course, higher levels of inflammatory markers and an increased risk of renal scarring, compared to pyelonephritis. Ultrasound plays a useful role. Nephronia is an under-diagnosed condition, thus, clinical suspicion is important for early diagnosis and appropriate treatment. We present three paediatric cases, and a review of the literature. PMID:26633114

  15. Value of Preoperative Superselective Embolization of the Isthmus in a Patient with Upper Urinary Tract Urothelial Carcinoma and Horseshoe Kidney

    SciTech Connect

    Wilhelmsen, Skadi; Janitzky, Andreas; Porsch, Markus; Liehr, Uwe-Bernd; Dudeck, Oliver

    2011-02-15

    Standard treatment for upper urinary tract urothelial carcinoma (UUTUC) implies the radical removal of all urothelium-lined tissue, which requires nephroureterectomy with bladder cuff removal. We report on a patient with a rare coincidence of UUTUC and horseshoe kidney in whom a preoperative angiography helped to identify and subsequently embolize an abberant isthmic feeding artery, which was located in between both collecting systems. Ischemic discoloration of the isthmus area facilitated resection and no major blood loss occurred. Preoperative superselective embolization of the isthmus as the renal split area can be an effective tool to facilitate nephroureterectomy in the case of a horseshoe kidney.

  16. Kinematic data analysis for post-stroke patients following bilateral versus unilateral rehabilitation with an upper limb wearable robotic system.

    PubMed

    Kim, Hyunchul; Miller, Levi Makaio; Fedulow, Irina; Simkins, Matt; Abrams, Gary M; Byl, Nancy; Rosen, Jacob

    2013-03-01

    Robot-assisted stroke rehabilitation has become popular as one approach to helping patients recover function post-stroke. Robotic rehabilitation requires four important elements to match the robot to the patient: realistic biomechanical robotic elements, an assistive control scheme enabled through the human-robot interface, a task oriented rehabilitation program based on the principles of plasticity, and objective assessment tools to monitor change. This paper reports on a randomized clinical trial utilizing a complete robot-assisted rehabilitation system for the recovery of upper limb function in patients post-stroke. In this study, a seven degree-of-freedom (DOF) upper limb exoskeleton robot (UL-EXO7) is applied in a rehabilitation clinical trial for patients stable post-stroke (greater than six months). Patients had a Fugl-Meyer Score between 16-39, were mentally alert (> 19 on the VA Mini Mental Status Exam) and were between 27 and 70 years of age. Patients were randomly assigned to three groups: bilateral robotic training, unilateral robotic training, and usual care. This study is concerned with the changes in kinematics in the two robotic groups. Both patient groups played eight therapeutic video games over 12 sessions (90 min, two times a week). In each session, patients intensively played the different combination of video games that directly interacted with UL-EXO7 under the supervision of research assistant. At each session, all of the joint angle data was recorded for the evaluation of therapeutic effects. A new assessment metric is reported along with conventional metrics. The experimental result shows that both groups of patients showed consistent improvement with respect to the proposed and conventional metrics. PMID:22855233

  17. Total Reconstruction of the Upper Lip Using Bilateral Nasolabial Flaps, Submental Flap, and Mucosa Graft following Complete Resection for Squamous Cell Carcinoma

    PubMed Central

    Oseni, O. G.; Fadare, A. E.; Majaro, M. O.; Olaitan, P. B.

    2015-01-01

    Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge. This is more so when the resection is total and a complete lip has to be constructed. We present a case of lip reconstruction following a total resection of the upper lip. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and buccal mucosal graft lining. We believe that this provides an alternative method of total upper lip reconstruction with minimal disruption of the facial aesthesis. PMID:26693378

  18. Clinical value of pathologic examination of non-neoplastic kidney in patients with upper urinary tract malignancies

    PubMed Central

    Wee, Jee Wan; Kang, Hye Ran; Kwon, Soon Hyo; Jeon, Jin Seok; Han, Dong Cheol; Jin, So-Young; Yang, Won Jae; Noh, Hyunjin

    2016-01-01

    Background/Aims: While surgical resection remains the standard of care in the treatment of upper urinary tract malignancies, nephrectomy is a risk factor for the development of chronic kidney disease (CKD). The aim of this study was to determine whether histologic evaluation of non-neoplastic kidney could enable early identification of unrecognized kidney disease and could be of prognostic value in predicting postoperative renal outcomes. Methods: We retrospectively analyzed 51 patients with upper urinary tract malignancies who received uninephrectomy or uninephroureterectomy. A thorough pathologic evaluation of non-neoplastic kidney including special stains, immunofluorescence, and electron microscopic studies was performed. The degree of parenchymal changes was graded from 0 to 15. Results: Of 51 patients, only 13 showed normal kidney pathology. Fifteen patients showed glomerular abnormalities, 14 showed diabetic nephropathy, and 11 showed vascular nephropathy. There was one case each of reflux nephropathy and chronic pyelonephritis. The median histologic score was 5 points. Only 25.4% of patients had ≤ 3 points. Score more than 5 was observed in 47.1% of patients. Postoperative estimated glomerular filtration rate (eGFR) at 3 to 36 months were obtained from 90.2% of patients, and of those, 34.8% had de novo CKD. Since no one had CKD in partial nephrectomized patients, we determined risk factors for CKD in radical nephrectomized patients. Cox regression analysis revealed that postoperative AKI, preoperative eGFR, and histologic score of non-neoplastic kidney were the independent predictors for CKD. Conclusions: We conclude that routine pathologic evaluation of non-neoplastic kidney provides valuable diagnostic and prognostic information. PMID:27237301

  19. Should Complete and Incomplete Spinal Cord Injury Patients Receive the Same Attention in Urodynamic Evaluations and Ultrasonography Examinations of the Upper Urinary Tract?

    ERIC Educational Resources Information Center

    Akkoc, Yesim; Cinar, Yasemin; Kismali, Erkan

    2012-01-01

    The aim of the study was to compare urodynamic findings and upper urinary tract (UUT) abnormalities detected by ultrasonography in complete and incomplete suprasacral spinal cord injury (SCI) patients with neurogenic detrusor overactivity. Thirty-eight suprasacral SCI patients who underwent ultrasonography evaluation of the UUT and urodynamic…

  20. Use of the radionuclide washout test in evaluation of suspected upper urinary tract obstruction

    SciTech Connect

    Stage, K.H.; Lewis, S.

    1981-03-01

    THe use of the computerized quantitative renal scan associated with the standard renogram obtained during furosemide-induced diuresis provides useful information in the assessment of suspected upper tract obstruction. With the use of 99m technetium diethylenetriaminepentaacetic acid or 131 iodine hippuran quantitative renal scans were obtained and renograms were generated before and after intravenous furosemide injection. Rapidity of diuretic-induced radionuclide washout, as well as determination of glomerular filtration rate or effective renal plasma flow on the affected side, provides objective information with regard to renal parenchymal loss as well as upper tract emptying. We herein report our experience with 19 such patients. The radionuclide washout test is obtained easily, informative and may replace more invasive diagnostic measures.

  1. Validation of Cefazolin as Initial Antibiotic for First Upper Urinary Tract Infection in Children

    PubMed Central

    Abe, Yoshifusa; Wakabayashi, Hitomi; Ogawa, Yasuha; Machida, Ayano; Endo, Mio; Tamai, Tetsuro; Sakurai, Shunsuke; Hibino, Satoshi; Mikawa, Takeshi; Watanabe, Yoshitaka; Ugajin, Kazuhisa; Fukuchi, Kunihiko; Itabashi, Kazuo

    2016-01-01

    To validate the policy of administering cefazolin (CEZ) as a first-line antibiotic to children who are hospitalized with their first febrile urinary tract infection (UTI), we evaluated microbial susceptibility to CEZ and the efficacy of CEZ. The 75 enrolled children with febrile UTI were initially treated with CEZ. Switching CEZ was not required in 84% of the patients. The median fever duration, prevalence of bacteremia, prevalence of UTI caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, and median duration of hospitalization were significantly higher in the CEZ-ineffective group. The risks of vesicoureteral reflux, indication of operation, and renal scarring are not increased, even when CEZ is ineffective as a first-line antibiotic. CEZ is effective in more than 80% of pediatric patients with their first febrile UTI, but it should be switched to appropriate antibiotics considering sepsis or the ESBL-producing Enterobacteriaceae pathogen, when fever does not improve within 72 hours. PMID:27335998

  2. Prognostic Impact of Thrombospodin-2 (THBS2) Overexpression on Patients with Urothelial Carcinomas of Upper Urinary Tracts and Bladders

    PubMed Central

    Chang, I-Wei; Li, Chien-Feng; Lin, Victor Chia-Hsiang; He, Hong-Lin; Liang, Per-In; Wu, Wen-Jeng; Li, Ching-Chia; Huang, Chun-Nung

    2016-01-01

    Purpose: Urothelial carcinoma (UC) is a type of tumor, especially of the urinary bladder, that affects people worldwide. Clarification of its detailed tumor biology and discovery of potential targets for developing treatment strategies are imperative because of frequent recurrences and poor prognosis of advanced UCs. By data mining a published dataset of UC of bladder (UCB) transcriptome (GSE31684) from Gene Expression Omnibus, National Center of Biotechnology Information (GEO, NCBI), we identified that THBS2 was the most significantly upregulated gene among those related to structural molecule activity (GO:0005198). Therefore, we evaluated the clinical significance and prognostic impact of thrombospondin-2 (THBS2) protein, A.K.A. TSP2, which encoded by THBS2 gene. Materials and Methods: THBS2 immunostaining was performed in 340 UCs of upper urinary tract (UC-UUTs) and 295 UCBs; subsequently, both groups were dichotomized into high- and low-expression subgroups. Moreover, statistical analyses were performed to correlate the association between THBS2 expression and clinicopathological parameters with two survival indexes: disease-specific survival (DSS) and metastasis-free survival (MeFS). Results: High THBS2 immunoexpression was significantly associated with advanced primary tumor status, nodal metastasis, and vascular invasion in both UC-UUT and UCB groups (all P ≤ .001). In addition, THBS2 overexpression was linked to adverse DSS and MeFS in univariate analyses and served as an independent prognosticator indicating poor outcomes in both groups in multivariate analyses. Conclusion: THBS2 may play a crucial role in UC progression and may be a novel prognostic marker. Additional investigations to elucidate the molecular pathway are necessary for developing potential THBS2-targeted therapies for UCs. PMID:27471570

  3. Ureteroscopy for treatment of upper urinary tract stones in children: technical considerations.

    PubMed

    Gupta, Natasha; Ko, Joan; Matlaga, Brian R; Wang, Ming-Hsien

    2014-05-01

    The incidence of pediatric urolithiasis is increasing. While many smaller stones may pass spontaneously, surgical therapy is sometimes warranted. Surgical options include shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, and open surgery. Ureteroscopy represents a minimally invasive approach, and it is increasingly being used to treat pediatric upper tract calculi. Ureteroscopy is performed under anesthesia and fluoroscopic guidance, with basket extraction or lithotripsy of the calculi. Technical considerations include active or passive ureteral dilatation, the use of ureteral access sheaths for larger stone burdens, and post-operative stent placement. The current pediatric literature suggests high success rates (equal to or surpassing shock wave lithotripsy) and low complication rates. However, concerns remain regarding feasibility in patients with variant anatomies and risk due to intra-operative radiation exposure. PMID:24658833

  4. Determinants of active and environmental exposure to tobacco smoke and upper reference value of urinary cotinine in not exposed individuals.

    PubMed

    Campo, Laura; Polledri, Elisa; Bechtold, Petra; Gatti, Giulia; Ranzi, Andrea; Lauriola, Paolo; Goldoni, Carlo Alberto; Bertazzi, Pier Alberto; Fustinoni, Silvia

    2016-07-01

    The aims of this study were (1) to explore the behavioral and sociodemographic factors influencing urinary cotinine (COT-U) levels in active smokers and in environmental tobacco smoke (ETS)-exposed individuals, (2) to assess the specificity and sensitivity of the questionnaire for identifying active smokers and nonsmokers, and (3) to derive the upper reference value of COT-U in non-ETS exposed individuals. The COT-U levels of 495 adults (age range 18-69 years) who classified themselves as active smokers (29%) or as nonsmokers with (17%) or without (83%) ETS exposure were quantified by LC-MS-MS (quantification limit: 0.1µg/L, range of linearity: 0.1-4000µg/L). Median COT-U levels in these groups were 883, 1.38, and 0.39µg/L, respectively. Significant determinants of COT-U levels in active smokers were the number of cigarettes per day, type of smoking product, smoking environment, as well as time between the last cigarette and urine collection. Among ETS-exposed nonsmokers, significant determinants were living with smokers, being exposed to smoke at home, ETS exposure duration, as well as time between the last exposure and urine collection. When a 30-µg/L COT-U cut-off value was used to identify active daily smoking, the sensitivity and specificity of the questionnaire were 94% and 98%, respectively. For ETS exposure, the COT-U value of 1.78 (0.90 confidence interval 1.75-1.78) µg/L, corresponding to the 95th percentiles of the COT-U distribution in non-ETS-exposed participants, is proposed as upper reference value to identify environmental exposure. PMID:27060750

  5. Perioperative Outcomes of Laparoscopic Radical Nephroureterectomy and Regional Lymphadenectomy in Patients with Upper Urinary Tract Urothelial Carcinoma After Neoadjuvant Chemotherapy

    PubMed Central

    Rajput, M. Zak; Kamat, Ashish M.; Clavell-Hernandez, Jonathan; Siefker-Radtke, Arlene O.; Grossman, H. Barton; Dinney, Colin P. N.; Matin, Surena F.

    2011-01-01

    Objectives To determine the effect of neoadjuvant chemotherapy on surgical outcomes in patients undergoing laparoscopic radical nephroureterectomy (LNUX) for upper urinary tract urothelial carcinoma (UTUC). Methods We performed a retrospective review of all UTUC patients who underwent LNUX performed at our institution between January 2003 and June 2010. We compared differences in demographic, clinicopathological, and operative parameters, including estimated blood loss, duration of surgery, length of postoperative hospitalization, and number of complications, between patients who underwent LNUX after neoadjuvant chemotherapy and patients who underwent LNUX without neoadjuvant chemotherapy. Logistic regression analysis was performed to identify predictors of complications. Results We identified 82 UTUC patients who underwent LNUX; 26 received neoadjuvant chemotherapy. Patients who underwent LNUX after neoadjuvant chemotherapy had a higher body mass index, higher biopsy tumor grade, and longer operative time than patients who underwent LNUX without neoadjuvant chemotherapy. Patients who received neoadjuvant chemotherapy underwent regional lymphadenectomy more often, with more lymph nodes and lymphoadipose tissue removed, than patients who did not receive neoadjuvant chemotherapy. Neoadjuvant chemotherapy resulted in a 15% complete remission rate. No differences in median estimated blood loss, intraoperative transfusions, and length of hospitalization between the two groups were found. Perioperative complication rates were similar in both groups. Conclusions We found no differences in surgical outcomes between patients who underwent LNUX after neoadjuvant chemotherapy and patients who underwent LNUX without neoadjuvant chemotherapy. Our findings support the use of LNUX in selected patients undergoing neoadjuvant chemotherapy for UTUC. PMID:21354598

  6. Androgen receptor expands the population of cancer stem cells in upper urinary tract urothelial cell carcinoma cells

    PubMed Central

    Chen, Chi-Cheng; Hsieh, Teng-Fu; Huang, Chi-Ping; Yu, Ai-Lin; Chang, Wen-Lin; Shyr, Chih-Rong

    2016-01-01

    Androgen receptor (AR) affects the development and progression of upper urinary tract urothelial cell carcinoma (UUTUC). However, the regulatory mechanism exerted by AR to affect UUTUC cells remains unclear. Here we investigated whether AR promotes UUTUC development and progression, possibly by expanding the population of cancer stem cells (CSCs), which are a particular population of cells within cancer cells responsible for tumor initiation, drug resistance and metastasis. We compared UUTUC cells with or without the addition of AR on their CSC population with flow cytometry, colony formation and sphere formation assay to determine the effect of AR on CSC activity, and real-time PCR was used to detect the expression stemness genes and miRNAs. In vivo tumor formation was evaluated with the implantation of cancer cells in nude mice. We found that the addition of AR in UUTUC cells, significantly increased the population of CSC, clonogenicity, sphere formation and the expression of stemness genes (Oct4, Bmi1 and Nanog), altered CSC-related miRNA profile, as well as promoted epithelial mesenchymal transition (EMT). And AR inhibitor, enzalutamide was shown to suppress AR’s effect on tumorsphere formation. Furthermore, in an immune-deficient mouse model, the addition of AR in UUTUC cells also increased the tumor formation capacity. This study will help us better understand the extent to which AR contributes to UUTUC progression by expanding their CSC population and capacity. Our findings could explain high incidence of UUTUC observed in males. And targeting AR may lead to novel therapeutic approaches for genetically diversified urothelial carcinomas in precision medicine era. PMID:27186399

  7. Predictors of Intravesical Recurrence After Radical Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma: An Inflammation-Based Prognostic Score

    PubMed Central

    Cho, Yang Hyun; Seo, Young Ho; Chung, Seung Jun; Hwang, Insang; Yu, Ho Song; Kim, Sun-Ouck; Jung, Seung Il; Kang, Taek Won; Kwon, Dong Deuk; Park, Kwangsung; Hwang, Jun Eul; Heo, Suk Hee; Kim, Geun Soo

    2014-01-01

    Purpose Systemic inflammatory responses, which are defined in terms of the Glasgow prognostic score (GPS), have been reported to be independent predictors of unfavorable outcomes in various human cancers. We assessed the utility of the GPS as a predictor of intravesical recurrence after radical nephroureterectomy (RNU) in upper urinary tract carcinoma (UTUC). Materials and Methods We collected data for 147 UTUC patients with no previous history of bladder cancer who underwent RNU from 2004 to 2012. Associations between perioperative clinicopathological variables and intravesical recurrence were analyzed by using univariate and multivariate Cox regression models. Results Overall, 71 of 147 patients (48%) developed intravesical recurrence, including 21 patients (30%) diagnosed with synchronous bladder tumor. In the univariate analysis, performance status, diabetes mellitus (DM), serum albumin, C-reactive protein, GPS, and synchronous bladder tumor were associated with intravesical recurrence. In the multivariate analysis, performance status (hazard ratio [HR], 2.33; 95% confidence interval [CI], 1.41-3.85; p=0.001), DM (HR, 2.04; 95% CI, 1.21-3.41; p=0.007), cortical thinning (HR, 2.01; 95% CI, 1.08-3.71; p=0.026), and GPS (score of 1: HR, 6.86; 95% CI, 3.69-12.7; p=0.001; score of 2: HR, 5.96; 95% CI, 3.10-11.4; p=0.001) were independent predictors of intravesical recurrence. Conclusions Our results suggest that the GPS as well as performance status, DM, and cortical thinning are associated with intravesical recurrence after RNU. Thus, more careful follow-up, coupled with postoperative intravesical therapy to avoid bladder recurrence, should be considered in these patients. PMID:25045443

  8. Should oncological cases of upper urinary system be excluded at the beginning of the laparoscopic learning curve?

    PubMed Central

    Yüksel, Özgür Haki; Ötünçtemur, Alper; Özbek, Emin; Uruç, Fatih; Verit, Ayhan

    2015-01-01

    ABSTRACT Purpose: The place of oncological cases of upper urinary system in the laparoscopic learning curve was investigated. Materials and Methods: A total of 139 patients from two different centers underwent laparoscopic operations and were included in this retrospective study. Results: Mean operative times for oncological, and non-oncological cases were 101.3 (range 60-450), and 102.7 (45-490) minutes respectively. Fourty-two (31.3 %) patients were oncological cases. In 4 oncological cases, the surgeons switched to open surgery because of massive bleeding and six (14.2 %) oncological cases required blood transfusions during peri/postoperative periods. Pulmonary embolism was observed in one oncological case. In one non-oncological case, the surgeon switched to open surgery because of intestinal perforation and 10 (9.7 %) non-oncological cases needed blood transfusions during peri/postoperative periods. In addition, some complications such as intestinal perforation (n=1), mechanical ileus (n=1), and pulmonary embolism (n=1) were observed during postoperative period. Intestinal perforation was repaired using laparoscopic (n=1) method. Mechanical ileus was approached with open surgical technique. Mean hospital stay of the patients in the oncological and non-oncological series were 4.5 (3-23) and 4.5 (3-30) days respectively. Conclusion: We think that renal oncological cases should be included in the spectrum of laparoscopic indications even at the beginning of the learning curve. Certainly, we still share the opinion that cancer cases which require highly challenging surgeries like radical cystectomy, and prostatectomy should be postponed till to gaining of higher level of experience. PMID:26401863

  9. TERT promoter mutations are associated with distant metastases in upper tract urothelial carcinomas and serve as urinary biomarkers detected by a sensitive castPCR.

    PubMed

    Wang, Kun; Liu, Tiantian; Ge, Nan; Liu, Li; Yuan, Xiaotian; Liu, Jikai; Kong, Feng; Wang, Chang; Ren, Hongbo; Yan, Keqiang; Hu, Sanyuan; Xu, Zhonghua; Björkholm, Magnus; Fan, Yidong; Zhao, Shengtian; Liu, Cheng; Xu, Dawei

    2014-12-15

    TERT promoter C228T and C250T mutations occur in various malignancies including bladder cancer (BC) and may serve as urinary tumor markers. However, the mutation association with clinical variables in upper tract urothelial carcinomas (UTUCs) is unclear. There is also a lack of sensitive tools to detect the minor mutant TERT promoter in bulk urinary DNA. Here we analyzed 220 UTUC patients [98 with renal pelvic carcinoma (RPC) and 122 with ureter carcinoma (UC)] and developed a Competitive Allele-Specific TaqMan PCR (castPCR) for urinary assay. We identified C228T or C250T mutations in 42 of 98 (43%) RPC and 23 of 122 (19%) UC tumors. Distant metastases were significantly correlated with UTUC patients harboring TERT promoter mutations (P = 0.001). C228T were detected in 6/10 and 9/10 of urine samples from patients with mutation-carrying tumors using Sanger sequencing and castPCR, respectively. When urine samples from 70 BC patients were analyzed together, the sensitivity of urinary C228T assay was 89% and 50% for castPCR and Sanger sequencing, respectively (P < 0.001). Collectively, TERT promoter mutations occur in UTUCs with a high frequency in RPCs and predict distant metastasis. castPCR assays of the mutation are a useful tool for urine-based diagnostics of urological malignancies. PMID:25474136

  10. The activation of the cortical hand area by toe tapping in two bilateral upper-extremities amputees with extraordinary foot movement skill.

    PubMed

    Yu, Xiaojing; Zhang, Shizheng; Liu, Hai; Chen, Yizhang

    2006-01-01

    Functional reorganization of the human brain after an arm amputation has been documented in several investigations, but as far as we know, there has been no report on amputees with skilled foot movement ability. To further assess the power of functional reorganization of the brain after an amputation, we investigated two bilateral upper-extremities amputees who were professional sculptors and painters with their feet. Performance tests showed that they possessed high foot movement ability. Functional MRI data indicated that toe tapping of the amputees not only activated the classical foot primary motor cortex, but also activated the hand area. In the T1-weighted MRI, the central sulci of both amputees kept their characteristic shape. Our study suggests that there is a remarkable power of neural plasticity in the motor cortex, and the maturation of the cortex develops in response to daily practice. The possible mechanisms of the reorganization are tentatively discussed. PMID:16410177

  11. Urinary Incontinence

    MedlinePlus

    ... of this page please turn Javascript on. Urinary Incontinence What Is Urinary Incontinence? Urinary incontinence means a person leaks urine by ... about what you can do. Types of Urinary Incontinence There are different types of urinary incontinence. Stress ...

  12. Bilateral force transients in the upper limbs evoked by single-pulse microstimulation in the pontomedullary reticular formation

    PubMed Central

    Hirschauer, Thomas J.

    2015-01-01

    Neurons in the pontomedullary reticular formation (PMRF) give rise to the reticulospinal tract. The motor output of the PMRF was investigated using stimulus-triggered averaging of electromyography (EMG) and force recordings in two monkeys (M. fascicularis). EMG was recorded from 12 pairs of upper limb muscles, and forces were detected using two isometric force-sensitive handles. Of 150 stimulation sites, 105 (70.0%) produced significant force responses, and 139 (92.5%) produced significant EMG responses. Based on the average flexor EMG onset latency of 8.3 ms and average force onset latency of 15.9 ms poststimulation, an electromechanical delay of ∼7.6 ms was calculated. The magnitude of force responses (∼10 mN) was correlated with the average change in EMG activity (P < 0.001). A multivariate linear regression analysis was used to estimate the contribution of each muscle to force generation, with flexors and extensors exhibiting antagonistic effects. A predominant force output pattern of ipsilateral flexion and contralateral extension was observed in response to PMRF stimulation, with 65.3% of significant ipsilateral force responses directed medially and posteriorly (P < 0.001) and 78.6% of contralateral responses directed laterally and anteriorly (P < 0.001). This novel approach permits direct measurement of force outputs evoked by central nervous system microstimulation. Despite the small magnitude of poststimulus EMG effects, low-intensity single-pulse microstimulation of the PMRF evoked detectable forces. The forces, showing the combined effect of all muscle activity in the arms, are consistent with reciprocal pattern of force outputs from the PMRF detectable with stimulus-triggered averaging of EMG. PMID:25652926

  13. Bilateral force transients in the upper limbs evoked by single-pulse microstimulation in the pontomedullary reticular formation.

    PubMed

    Hirschauer, Thomas J; Buford, John A

    2015-04-01

    Neurons in the pontomedullary reticular formation (PMRF) give rise to the reticulospinal tract. The motor output of the PMRF was investigated using stimulus-triggered averaging of electromyography (EMG) and force recordings in two monkeys (M. fascicularis). EMG was recorded from 12 pairs of upper limb muscles, and forces were detected using two isometric force-sensitive handles. Of 150 stimulation sites, 105 (70.0%) produced significant force responses, and 139 (92.5%) produced significant EMG responses. Based on the average flexor EMG onset latency of 8.3 ms and average force onset latency of 15.9 ms poststimulation, an electromechanical delay of ∼7.6 ms was calculated. The magnitude of force responses (∼10 mN) was correlated with the average change in EMG activity (P < 0.001). A multivariate linear regression analysis was used to estimate the contribution of each muscle to force generation, with flexors and extensors exhibiting antagonistic effects. A predominant force output pattern of ipsilateral flexion and contralateral extension was observed in response to PMRF stimulation, with 65.3% of significant ipsilateral force responses directed medially and posteriorly (P < 0.001) and 78.6% of contralateral responses directed laterally and anteriorly (P < 0.001). This novel approach permits direct measurement of force outputs evoked by central nervous system microstimulation. Despite the small magnitude of poststimulus EMG effects, low-intensity single-pulse microstimulation of the PMRF evoked detectable forces. The forces, showing the combined effect of all muscle activity in the arms, are consistent with reciprocal pattern of force outputs from the PMRF detectable with stimulus-triggered averaging of EMG. PMID:25652926

  14. A novel computed method to reconstruct the bilateral digital interarticular channel of atlas and its use on the anterior upper cervical screw fixation

    PubMed Central

    Wu, Ai-Min; Wang, Wenhai; Xu, Hui; Lin, Zhong-Ke; Yang, Xin-Dong; Wang, Xiang-Yang; Xu, Hua-Zi

    2016-01-01

    Purpose. To investigate a novel computed method to reconstruct the bilateral digital interarticular channel of atlas and its potential use on the anterior upper cervical screw fixation. Methods. We have used the reverse engineering software (image-processing software and computer-aided design software) to create the approximate and optimal digital interarticular channel of atlas for 60 participants. Angles of channels, diameters of inscribed circles, long and short axes of ellipses were measured and recorded, and gender-specific analysis was also performed. Results. The channels provided sufficient space for one or two screws, and the parameters of channels are described. While the channels of females were smaller than that of males, no significant difference of angles between males and females were observed. Conclusion. Our study demonstrates the radiological features of approximate digital interarticular channels, optimal digital interarticular channels of atlas, and provides the reference trajectory of anterior transarticular screws and anterior occiput-to-axis screws. Additionally, we provide a protocol that can help make a pre-operative plan for accurate placement of anterior transarticular screws and anterior occiput-to-axis screws. PMID:26925345

  15. [Human activities, hydro-agricultural management and urinary schistosomiasis. Methodological approach and results (a preliminary study in Upper-Volta)].

    PubMed

    Le Bras, M; Faucher, P; Giap, G; Meric, D; Commenges, D; Villenave, D; Camara, S; Gatheron, C; Appriou, M

    1982-01-01

    In the schistosomiasis endemic sub-sahelian region, a study of the prevalence of the disease was carried out on three different areas: the highest was around a small river, the lowest in the hydro-agricultural management region, mean prevalence was noted around a natural lake. Human activities have been classified with regards to the areas of transmission. Activity is closely linked to prevalence. For the populations, symptoms of urinary schistosomiasis (Rudzenga) constitute a real disease, traditional healers are the masters of earth (Tengsoba), water has hardly any importance in transmission. PMID:7201891

  16. Complete Laparoscopic Nephroureterectomy for the Upper Urinary Tract Urothelial Carcinoma in a Female Patient with Severe Senile Kyphosis: An Initial Case Report

    PubMed Central

    Miyamoto, Tatsuya; Kira, Satoru; Sawada, Norifumi; Ootake, Yuko; Shimura, Hiroshi; Mitsui, Takahiko; Takeda, Masayuki

    2015-01-01

    Abstract Kyphosis is usually described as the deformity of the spine that results in an abnormally round back. Patients with kyphosis form a challenging group to laparoscopic surgeons because of difficulties in positioning and abdominal approach. The narrow abdomen causes difficulty with trocar insertion and some operative procedures. Here we report the transperitoneal complete laparoscopic nephroureterectomy in a case of kyphosis. An 81-year-old woman underwent this operation for urothelial carcinoma of the upper urinary tract. We took best care of the positioning and the trocar insertion; we could have accomplished utilizing four ports at semilateral position without any troubles and complications. This procedure is safe and feasible, and not thought to be a contraindication for the patients with senile kyphosis.

  17. Percutaneous urinary procedures

    MedlinePlus

    ... Lingeman JE. Surgical management of upper urinary tract calculi. In: Wein AJ, Kavoussi LR, Novick AC, et ... CC, Nakada SY. Treatment selection and outcomes: renal calculi. Urol Clin North Am . 2007;34(3):409- ...

  18. Comprehensive MR Urography Protocol: Equally Good Diagnostic Performance and Enhanced Visibility of the Upper Urinary Tract Compared to Triple-Phase CT Urography

    PubMed Central

    Sudah, Mazen; Masarwah, Amro; Kainulainen, Sakari; Pitkänen, Marja; Matikka, Hanna; Dabravolskaite, Vaiva; Aaltomaa, Sirpa; Vanninen, Ritva

    2016-01-01

    Objectives To prospectively compare the diagnostic performance and the visualization of the upper urinary tract (UUT) using a comprehensive 3.0T- magnetic resonance urography (MRU) protocol versus triple-phase computed tomography urography (CTU). Methods During the study period (January-2014 through December-2015), all consecutive patients in our tertiary university hospital scheduled by a urologist for CTU to exclude UUT malignancy were invited to participate. Diagnostic performance and visualization scores of 3.0T-MRU were compared to CTU using Wilcoxon matched-pairs test. Results Twenty patients (39 UUT excreting units) were evaluated. 3.0T-MRU and CTU achieved equal diagnostic performances. The benign etiology of seven UUT obstructions was clarified equally with both methods. Another two urinary tract malignant tumors and one benign extraurinary tumor were detected and confirmed. Diagnostic visualization was slightly better in the intrarenal cavity areas with CTU but worsened towards distal ureter. MRU showed consistently slightly better visualization of the ureter. In the comparison, full 100% visualizations were detected in all areas in 93.6% (with 3.0T-MRU) and 87.2% (with CTU) and >75% visualization in 100% (3.0T-MRU) and 93.6% (CTU). Mean CTU effective radiation dose was 9.2 mSv. Conclusions Comprehensive 3.0T-MRU is an accurate imaging modality achieving comparable performance with CTU; since it does not entail exposure to radiation, it has the potential to become the primary investigation technique in selected patients. Trial Registration ClinicalTrials.gov NCT02606513 PMID:27384417

  19. Bilateral renal calculi

    PubMed Central

    Sreenevasan, G

    1974-01-01

    Bilateral renal calculi were present in 114 (10.7%) of 1,070 cases of proved urinary calculus admitted to the Urological Department of the General Hospital, Kuala Lumpur, during the period November 1968—May 1973. The management of bilateral renal calculi is discussed with reference to the first 100 cases in this series. The introduction of renography has greatly facilitated the decision as to which kidney should be operated on first. The management of patients with and without uraemia is discussed and the use of the modified V and V—Y incisions for the removal of staghorn calculi is described. Complications and results are briefly reviewed. ImagesFig. 1Fig. 4Fig. 6Fig. 7 PMID:4845653

  20. TREATMENT EFFECTS OF WST11 VASCULAR TARGETED PHOTODYNAMIC THERAPY IN UROTHELIAL CELL CARCINOMA AND FEASIBILITY, SAFETY, AND LONG TERM OUTCOMES IN THE UPPER URINARY TRACT OF SWINE

    PubMed Central

    Murray, Katie S; Winter, Ashley G; Corradi, Renato Beluco; LaRosa, Stephen; Jebiwott, Sylvia; Somma, Alexander; Takaki, Haruyuki; Srimathveeravalli, Govindarajan; Lepherd, Michelle; Monette, Sebastien; Kim, Kwanghee; Scherz, Avigdor; Coleman, Jonathan A

    2016-01-01

    Purpose Surgical management of upper tract urothelial carcinoma requires removal of kidney and ureter, compromising renal function. Non-surgical alternatives have potentially prohibitive safety concerns. We examine the feasibility and safety of ablation of the ureter and renal pelvis using endoluminal vascular-targeted photodynamic therapy in a porcine model and report efficacy of WST11 vascular-targeted photodynamic therapy in a murine model. Materials and Methods Following approval, we performed 28 endoluminal ablations in the ureters and renal pelvis of 18 swine. Intravenous infusion of WST11 (4mg/kg) followed by laser illumination (10 minutes) was performed via percutaneous access or retrograde ureteroscopic approach. Animals were followed clinically with laboratory testing, imaging and histology was evaluated at several post-ablation time points. A murine xenograft was created with the 5637 human urothelial cell carcinoma line to determine sensitivity to this therapy. Results At 24 hours, 50 mW/cm laser fluence produced superficial necrosis of the ureter and deeper necrosis (penetrating the muscularis propria or adventitia) was produced by treatment with 200 mW/cm in the ureter and renal pelvis. At 4 weeks, superficial urothelium had regenerated over the treatment site. No symptomatic obstruction, clinically relevant hydronephrosis, or abnormality of lab testing was noted up to 4 weeks. In mice, 80% had no evidence of tumor at 19 days after WST11 vascular-targeted photodynamic therapy. Conclusions Urothelial cell carcinoma appears to be sensitive to WST11 vascular-targeted photodynamic therapy. Depth of WST11 vascular-targeted photodynamic therapy treatment effects can be modulated in a dose-dependent manner by titration of light intensity. Moreover, this treatment modality, applied to the porcine upper urinary tract, is feasible via antegrade and retrograde access. PMID:26860792

  1. Expression of Estrogen Receptor Beta Predicts Oncologic Outcome of pT3 Upper Urinary Tract Urothelial Carcinoma Better Than Aggressive Pathological Features

    PubMed Central

    Luo, Hao Lun; Sung, Ming Tse; Tsai, Eing Mei; Lin, Chang Shen; Lee, Nai Lun; Chung, Yueh-Hua; Chiang, Po Hui

    2016-01-01

    Upper urinary tract urothelial carcinoma (UT-UC) is rare and treatment options or prognostic markers are limited. There is increasing evidence indicating that urothelial carcinoma may be an endocrine-related cancer. The aim of this study was to analyze the prognostic effect of estrogen receptor beta (ERβ) on the outcome of UT-UC. From 2005 to 2012, this study included 105 patients with pT3 UT-UC. Perioperative factors, pathological features, and ERβ immunostaining were reviewed and prognostic effects were examined by multivariate analysis. This study divided patients into either the ERβ-high (n = 52) or ERβ-low (n = 53) group and analyzed their oncologic outcomes. All pathological features except infiltrating tumor architecture (significantly higher incidence in ERβ-low group, p = 0.004) are symmetric in both groups. Low ERβ expression was significantly correlated with local recurrence and distant metastasis in univariate analysis (p = 0.035 and 0.004, respectively) and multivariate analysis (p = 0.05 and 0.008, respectively). Cell line study also proved that knock down of ERβ cause less UTUC proliferation and migration. In addition, ERβ agonist also enhanced the cytotoxic and migration inhibition effect of cisplatin and ERβ antagonist cause the UTUC cell more resistant to cisplatin. This result may help identify patients in need of adjuvant therapy or develop potential targeted therapy. PMID:27052470

  2. Urinary incontinence

    MedlinePlus

    Loss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary ... Causes of urinary incontinence include: Blockage in the urinary system Brain or nerve problems Dementia or other mental health problems that make ...

  3. Bilateral cellulitis.

    PubMed

    Batra, Vivek; Baras, Alexander

    2015-01-01

    We present a case of bilateral lesions in a 50-year-old man, which were on first impression mistaken for and initially treated as bilateral cellulitis. We propose that bilateral cellulitis, as opposed to unilateral, is rare and that other aetiologies should be considered in evaluating a patient with bilateral lesions. The differential diagnosis includes stasis-dermatitis, lipodermatosclerosis, lymphoedema and vascular lesions such as Kaposi sarcoma, as was identified in this case. Early consultation with dermatology and biopsy in unclear cases mitigates the unnecessary use of prolonged antibiotics, antibiotic resistance and Clostridium difficile infections. HIV testing is an essential screening test in all adults who present with non-specific viral symptoms and rash. PMID:26392449

  4. Vesicostomy and Colostomy in a Premature Neonate With Posterior Urethral Valves, Bilateral Dysplastic Kidneys, and High Imperforate Anus: The Challenge of Stoma Placement.

    PubMed

    McGrath, Melissa; Alnaqi, Amar A A; Braga, Luis H

    2016-07-01

    Although anorectal malformations are often associated with urinary tract abnormalities, the association with posterior urethral valves is exceptionally rare. We report a unique case of a premature (35 gestational weeks) male neonate born with posterior urethral valves, bilateral dysplastic kidneys, and imperforate anus, successfully treated by Blocksom vesicostomy and left upper quadrant loop colostomy. The challenges involving placement of both stomas in a small abdominal wall of a 2200 g premature neonate are discussed. PMID:27015939

  5. Metachronous urothelial carcinoma of whole urinary tract in a dialysis-dependent patient: A case report

    PubMed Central

    WANG, YIMIN; JIN, BAIYE; YAO, XIAOLIN

    2016-01-01

    Numerous studies have reported an association between end-stage renal disease (ESRD) and malignancy. The predominant malignant tumor that occurs in patients with ESRD in Asian countries is urothelial carcinoma (UC). According to recent research, cases of UC in dialysis-dependent patients are associated with higher recurrence rates and more aggressive biological behavior compared with patients without ESRD. The necessity of 1-step total urinary tract exenteration for dialysis-dependent patients with UC is advocated by certain studies. The current study reports a case of metachronous bladder cancer and bilateral upper urinary tract tumor in a dialysis-dependent patient. Three separate surgeries were performed to remove the bladder, and left and right urinary tract, respectively. The question of whether the stepwise strategy or the 1-step surgery should be selected for such special cases remains in debate. PMID:27313734

  6. Efficacy of bilateral pallidotomy.

    PubMed

    Kim, R; Alterman, R; Kelly, P J; Fazzini, E; Eidelberg, D; Beric, A; Sterio, D

    1997-03-15

    Unilateral pallidotomy is a safe and effective treatment for medically refractory bradykinetic Parkinson's disease, especially in those patients with levodopa-induced dyskinesia and severe on-off fluctuations. The efficacy of bilateral pallidotomy is less certain. The authors completed 11 of 12 attempted bilateral pallidotomies among 150 patients undergoing pallidotomy at New York University. In all but one patient, the pallidotomies were separated by at least 9 months. Patients were selected for bilateral pallidotomy if they exhibited bilateral rigidity, bradykinesia, or levodopa-induced dyskinesia prior to treatment or if they exhibited disease progression contralateral to their previously treated side. The Unified Parkinson's Disease Rating Scale (UPDRS) and timed upper-extremity tasks of the Core Assessment Protocol for Intracerebral Transplantation (CAPIT) were administered to all 12 patients in the "off" state (12 hours without receiving medications) preoperatively and again at 6 and 12 months after each procedure. The median UPDRS and contralateral CAPIT scores improved 60% following the initial procedure (p = 0.008, Wilcoxon rank sums test). The second pallidotomy generated only an additional 10% improvement in the UPDRS and CAPIT scores ipsilateral to the original procedure (p = 0.05). Worsened speech was observed in two cases. In the 12th case, total speech arrest was noted during test stimulation. Speech returned within minutes after stimulation was halted. Lesioning was not performed. These results indicate that bilateral pallidotomy has a narrow therapeutic window. Motor improvement ipsilateral to the first lesion leaves little room for further improvement from the second lesion and the risk of speech deficit is greatly enhanced. Chronic pallidal stimulation contralateral to a previously successful pallidotomy may prove to be a safer alternative for the subset of patients who require bilateral procedures. PMID:15096015

  7. Urinary Incontinence

    MedlinePlus

    ... you risk getting rashes, sores, skin infections and urinary tract infections. Also, you may find yourself avoiding friends and ... elderly and may be a sign of a urinary tract infection or an overactive bladder. Overflow incontinence This type ...

  8. Urinary Dysfunction

    MedlinePlus

    ... PCF Spotlight Glossary African American Men Living with Prostate Cancer Urinary Dysfunction Side Effects Urinary Dysfunction Bowel Dysfunction ... dysfunction is normal following initial therapy for localized prostate cancer. But it’s important to realize that not all ...

  9. Urinary catheters

    MedlinePlus

    ... that you use a catheter if you have: Urinary incontinence (leaking urine or being unable to control when ... Surgery Bladder Diseases Spinal Cord Injuries Urethral Disorders Urinary Incontinence Urine and Urination Browse the Encyclopedia A.D. ...

  10. Unilateral temporary functional stasis in the upper urinary tract caused by "a filled bladder" on Tc-99m DTPA diuresis renography: a teaching case.

    PubMed

    Karacalioglu, Ozgur; Ilgan, Seyfettin; Arslan, Nuri; Emer, Ozdes; Ozguven, Mehmet

    2005-09-01

    A 2-year-old girl with recurrent urinary tract infection having slight left pelvicaliceal dilatation on her renal ultrasound underwent a Tc-99m DTPA diuresis renography. During the excretion phase, a prominent and persisting left pelvicaliceal stasis was noticed even after the diuretic injection. However, it disappeared simultaneously with an uncontrolled micturition. This patient is presented to show the effect of filled bladder on the physiological drainage of urine. Since urine flow in the urinary system is more complicated than simple drainage, a thorough understanding of the physiological basis for diuresis renography and the pitfalls of the technique is required for its appropriate use in the management of patients suspected of urinary tract obstruction. PMID:16248389

  11. Urinary Tuberculosis with Renal Failure: Challenges in Management

    PubMed Central

    Chirmade, Rahul Arun; Baheti, Vidyasagar Hansraj; Tanwar, Harshawardhan Vedpalsingh; Patwardhan, Sujata Kiran; Gopalakrishnan, Ganesh

    2016-01-01

    Introduction India is the country with the highest burden of TB, an estimated incidence figure of 2.1 million cases of TB for India out of a global incidence of 9 million according to World Health Organization (WHO) statistics for 2013. Renal impairment in these patients is slow and due to continuous infection causing destruction of renal mass. Reconstruction of urinary tract which is frequently required for patients with Urinary TB poses significant challenges. This paper analyses these challenges. Aim To analyse challenges in reconstruction of urinary tract in patients with urinary tuberculosis and renal failure. Materials and Methods Thirty-one patients with renal tuber-culosis were seen from August 2011 to August 2013. We faced major problem in outcomes of surgery in patients with multifocal disease. Results Out of 31 patients 18 patients were males and 13 were females. Total 11 patients had serum creatinine more than 2mg/dl (1.5 mg/dl being upper normal range of our laboratory) at the time of presentation. These patients had simultaneous kidney, ureter and bladder involvement or with bilateral disease. Four of these patients underwent uretero-calicostomy, five patients underwent augmentation cystoplasty with bilateral ureteric reimplantation and two patients underwent ileal conduit as they were having serum creatinine of more than 2.5 mg/dl. All patients who underwent ureterocalicostomy had re stricture and failure of surgery and augmentation cystoplasty had raised creatinine requiring second procedure in the form of percutaneous nephrostomy. Patients with ileal conduit remained stable with overnight bladder drainage at bed time. Conclusion Though renal failure is not considered contrain-dication for augmentation cystoplasty, reconstruction using large segment of bowel predisposes them to metabolic complications and sepsis. Use of short segment of ileal conduit with continued drainage at night in creatinine above 2.5 mg% is reasonable option for augmentation

  12. Bilateral internal laryngoceles mimicking asthma.

    PubMed

    Aksoy, Elif A; Elsürer, Cağdaş; Serin, Gediz M; Unal, O Faruk

    2013-05-01

    Laryngocele is an air-filled, abnormal dilation of the laryngeal saccule that extends upward within the false vocal fold, in communication with the laryngeal lumen. A case of 43-year-old male with bilateral internal laryngoceles, who has been treated as asthma for 4 years, is presented. The patient had dyspnea, cough, and excessive phlegm for a month and a late onset stridor. Flexible nasopharyngolaryngoscopy showed bilateral cystic enlargements of the false vocal folds and true vocal folds could not be visualized. Laryngeal CT without contrast enhancement showed bilateral internal laryngoceles. Submucosal total excision of bilateral cystic masses including parts of false vocal folds was performed. The symptoms resolved immediately after surgery. Although the incidence of internal laryngocele is rare, it should be remembered in the differential diagnosis of upper airway problems and diagnostic flexible nasopharnygolaryngoscopy is routinely indicated for airway evaluation in at-risk patients. PMID:24174956

  13. A Retrospective Analysis of Incidence and Its Associated Risk Factors of Upper Urinary Tract Recurrence following Radical Cystectomy for Bladder Cancer with Transitional Cell Carcinoma: The Significance of Local Pelvic Recurrence and Positive Lymph Node

    PubMed Central

    Kim, Sung Han; Yang, Hyung-Kook; Lee, Jung Hoon; Lee, Eun-Sik

    2014-01-01

    Objective The aim of this study is to examine the incidence and risk factors of upper urinary tract recurrence (UUTR) following radical cystectomy (RC) in bladder cancer and to evaluate its relationship with neobladder (Neo) or ileal conduit (IC). Materials and Methods All clinicopathologic parameters and perioperative parameters of 311 patients who underwent RC with either Neo or IC by a single surgeon from 1999 to 2012 were retrospectively included in this study. Patients with a history of renal surgery, concomitant UUTR, or a histopathology of non-transitional cell carcinoma were excluded. For statistical analyses of predictive risk factors of UUTR, a multivariate analysis was performed with known risk factors of UUTR, including type of urinary diversion with significance defined as P < 0.05. Results During the median follow-up period of 53 months, 143 (46.0%) IC and 168 (54.0%) Neo were performed, resulting in 11 (3.5%) cases of UUTR (Neo 7 and IC 4) after RC and all patients then underwent nephroureterectomy. No significant differences in incidence and overall survival in UUTR were observed according different types of urinary diversion (p = 483), and the prognosis for survival of Neo was insignificantly better than that of IC (5-year overall survival 78% vs 74%, respectively, p>0.05). Higher number of positive lymph nodes (HR 9.03) and the presence of pelvic local recurrence (HR 7286.08) were significant predictive factors of UUTR (p<0.05). Conclusion This study reports a UUTR rate of 3.5%, and positive lymph nodes and presence of local recurrence at the pelvis as important risk factors. No significant differences in incidence and survival were observed between Neo and IC. PMID:24798444

  14. Urinary Incontinence

    MedlinePlus

    Urinary incontinence (UI) is loss of bladder control. Symptoms can range from mild leaking to uncontrollable wetting. It can happen to anyone, but it becomes more common with age. Women experience ...

  15. Bilateral synchronous plasmacytoma of the testis.

    PubMed

    Narayanan, Geetha; Joseph, Rona; Soman, Lali V

    2016-04-01

    Extramedullary plasmacytoma (EMP) is usually seen in the head and neck regions and in the upper respiratory, gastrointestinal, and central nervous systems. Testis is a rare site for EMP, and bilateral synchronous testicular plasmacytoma occurring as an isolated event at initial presentation has been reported only once previously. We present herein the second such report in a 70-year-old man who underwent bilateral orchidectomy. PMID:27034568

  16. Bilateral synchronous plasmacytoma of the testis

    PubMed Central

    Joseph, Rona; Soman, Lali V.

    2016-01-01

    Extramedullary plasmacytoma (EMP) is usually seen in the head and neck regions and in the upper respiratory, gastrointestinal, and central nervous systems. Testis is a rare site for EMP, and bilateral synchronous testicular plasmacytoma occurring as an isolated event at initial presentation has been reported only once previously. We present herein the second such report in a 70-year-old man who underwent bilateral orchidectomy. PMID:27034568

  17. Urinary tuberculosis

    PubMed Central

    Riddle, P. R.

    1971-01-01

    The present incidence, clinical features and classification of urinary tuberculosis are discussed. Chemotherapy is the mainstay of treatment. The indications for surgical intervention are reviewed and procedures briefly described. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5 PMID:5169185

  18. Urinary Incontinence

    MedlinePlus

    ... Adults Making Your Wishes Known Home & Community Home › Aging & Health A to Z › Urinary Incontinence Font size A A A Print Share Glossary Basic Facts & Information Causes & Symptoms Diagnosis & Tests Care & Treatment Lifestyle & Management Other Resources Caregiving How ...

  19. Urinary Retention

    MedlinePlus

    ... the bladder does not empty completely. A health care provider performs this test during an office visit. The patient often receives ... urodynamic tests to diagnose urinary retention. The health care provider will perform these tests during an office visit. For tests that use ...

  20. Recent Advances in Urinary Tract Reconstruction for Neuropathic Bladder in Children

    PubMed Central

    Lopes, Roberto I.; Lorenzo, Armando

    2016-01-01

    Neuropathic bladder usually causes several limitations to patients’ quality of life, including urinary incontinence, recurrent urinary tract infections, and upper urinary tract damage. Its management has significantly changed over the last few years. The aim of our paper is to address some salient features of recent literature dealing with reconstructive procedures in pediatric and adolescent patients with lower urinary tract dysfunction. PMID:26962441

  1. Urinary tract infections.

    PubMed

    Wang, Alina; Nizran, Parminder; Malone, Michael A; Riley, Timothy

    2013-09-01

    Clinical presentation helps differentiate between upper and lower urinary tract infections (UTIs). UTIs are classified as either complicated or uncomplicated. A complicated UTI is associated with an underlying condition that increases the risk of failing therapy. Primary laboratory tests for UTIs consist of urinalysis and urine culture. The most common pathogen for uncomplicated cystitis and pyelonephritis is Escherichia coli. Nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole are first-line therapies for acute uncomplicated cystitis. Decisions regarding antibiotic agents should be individualized based on patients' allergies, tolerability, community resistance rates, cost, and availability. PMID:23958364

  2. Comparison of the clinical efficacy and safety of retroperitoneal laparoscopic ureterolithotomy and ureteroscopic holmium laser lithotripsy in the treatment of obstructive upper ureteral calculi with concurrent urinary tract infections.

    PubMed

    Jiang, Jun-Tao; Li, Wei-Guo; Zhu, Yi-Ping; Sun, Wen-Lan; Zhao, Wei; Ruan, Yuan; Zhong, Chen; Wood, Kristofer; Wei, Hai-Bin; Xia, Shu-Jie; Sun, Xiao-Wen

    2016-07-01

    The aim of this study is to compare the clinical efficacy and safety of retroperitoneal laparoscopic ureterolithotomy (RPLU) and ureteroscopic holmium laser lithotripsy (UHLL) as two minimally invasive procedures in managing obstructive upper ureteral calculi with concurrent urinary tract infections (UTI). The retrospective study included 189 patients who underwent unilateral obstructive upper ureteral stones with concurrent UTI from January 2007 to November 2014 at our institution. Patients received RPLU (81 cases) or UHLL (108 cases). All patients received preoperative anti-infection treatment (indwelling ureteral stent and/or preoperative antibiotics). Collected data, including sex, age, stone size, success rate, operation duration, post-operation hospitalization time, and post-operation complications, were compared. All patients were followed up for more than 6 months after surgeries, and no ureterostenosis occurred. The study included 189 patients, 41 (21.7 %) females and 148 (78.3 %) males with a medium age of 52 years (range 22-81 years). All surgeries were successfully performed without conversion to open surgery. Stone size in the RPLU group was larger than that of the UHLL group (16.1 ± 1.4 vs. 10.4 ± 1.6 mm, P = 0.012). Operative duration (P = 0.009) and hospitalization time (P < 0.001) in the UHLL group were significantly shorter than those in the RPLU group, whereas stone clearance rate was significantly higher in the RPLU group (100 vs. 88.9 %, P = 0.002). Of note, postoperative fever was more common in patients treated with UHLL (15 cases) versus RPLU (4 cases) (13.9 vs. 4.9 %, P = 0.043). Moreover, in the UHLL group, three patients without a preoperative indwelling ureteral stent were complicated with sepsis, which was not seen in RPLU group. In our study, the safety and stone clearance rate of RPLU are better than those of UHLL in the treatment of unilateral upper ureteric calculi with concurrent UTI

  3. Bilateral self-inflicted infectious dacryoadenitis.

    PubMed

    Latasiewicz, Marta; Chang-Sotomayor, Meilin; Alonso-Caldarelli, Claudia; Farias-Plazas, Fabian; Leszczynska, Anna; Gonzalez-Candial, Miguel

    2014-12-01

    The aim of this report is to present a case of a patient with bilateral lacrimal gland abscesses in the course of dacryoadenitis. A 45-year-old female patient with a long history of cocaine abuse presented with bilateral bacterial dacryoadenitis and upper lid inflammation with purulent discharge from a palpebral wound of the right upper lid. The diagnosis was confirmed with microbiology culture and an orbital CT scan, which revealed lacrimal gland abscesses. The patient admitted to vigorous eye scratching, which we believe was the mechanism responsible for the process. The infection resolved on targeted antibiotic therapy. This is the first reported case of bilateral infectious dacryoadenitis produced in a self-inflicted mechanism in a cocaine addict. PMID:25208047

  4. Chronic Cough and Bilateral Pneumothoraces in a Nonsmoker.

    PubMed

    O'Beirne, Sarah L; Escalon, Joanna G; Arkin, Jordan E; Stiles, Brendon M; Kaner, Robert J; Legasto, Alan C; Narula, Navneet; King, Thomas C

    2016-02-01

    An 82-year-old Japanese nonsmoking man presented with persistent dry cough and small left apical pneumothorax. High resolution CT scan of the chest demonstrated bilateral upper lobe pleuroparenchymal thickening and architectural distortion. Serial imaging revealed mild progression and development of small bilateral pneumothoraces, and pneumomediastinum. A surgical lung biopsy was required to confirm the diagnosis. PMID:26867855

  5. Stress urinary incontinence

    MedlinePlus

    ... you urinate. Urinalysis to check for urinary tract infection. Urinary stress test: You stand with a full bladder ... out of the bed or chair Unpleasant odors Urinary tract infections Vaginal discharge The condition may get in the ...

  6. Urinary incontinence - injectable implant

    MedlinePlus

    ... repair; ISD repair; Injectable bulking agents for stress urinary incontinence ... Blaivas JM, Gormley EA, et al. Female Stress Urinary Incontinence Update Panel of the American Urological Association Education ...

  7. [A case of ammonium urate urinary stone].

    PubMed

    Hara, Noboru; Koike, Hiroshi

    2004-05-01

    An 18-year-old female, who had undergone antireflux surgery for bilateral vesicoureteral reflux 5 years ago, was admitted to our department with complaints of fever and left-sided back pain. Bilateral renal stones and pyelonephritis were diagnosed after roentgenography, ultrasonography and urinalysis. Pyelonephritis was successfully treated with antibiotics and the left renal stone was completely disintegrated with extracorporeal shock wave lithotripsy. Spectrophotometric analysis revealed that the stone was composed of pure ammonium urate (AU). The patient had not experienced any episodes of urinary tract infection from the antireflux surgery until the present event, but had lost 20 kg in body weight during the last year due to a low-caloric diet and laxative abuse. AU urinary stones have been infrequently reported in Japan, and they are supposed to be associated with a low-caloric diet, laxative abuse, and anorexia nervosa. PMID:15237492

  8. [A Case of Synchronous Malignant Pheochromocytomas in Bilateral Adrenal Glands].

    PubMed

    Usui, Kimitsugu; Hirasawa, Terukazu; Kobayashi, Masataka; Shioi, Kouichi; Kobayashi, Kazuki; Sakai, Naoki; Noguchi, Sumio; Tsuura, Yukio

    2016-06-01

    We present a case of synchronous malignant pheochromocytoma in bilateral adrenal glands. A 73- year-old man presented to our hospital with bilateral adrenal masses incidentally found during abdominal ultrasonography examination for an unrelated issue. The patient had a 30-year history of hypertension and paroxysmal atrial fibrillation. Computed tomography and magnetic resonance imaging showed heterogeneous tumors in bilateral adrenal glands and an enlarged para-aortic lymph node. Hormonal examinations revealed a high value of urinary catecholamines. Metaiodobenzylguanidine (MIBG) scintigraphy showed increased uptake in bilateral adrenal glands and the lymph node. Both adrenal tumors and the node were surgically removed. Pathological examination revealed histologically distinct tissue between the two adrenal tumors. The patient received five cycles of adjuvant chemotherapy, consisting of cyclophosphamide, vincristine, and dacarbazine. The patient has been in remission for 32 months following surgical treatment. PMID:27452493

  9. Urinary Tract Infection (UTI)

    MedlinePlus

    ... Our ePublications > Urinary tract infection fact sheet ePublications Urinary tract infection fact sheet Print this fact sheet Urinary tract ... a doctor find out if I have a urinary tract infection (UTI)? To find out if you have a ...

  10. [Bilateral operculum syndrome].

    PubMed

    Lerman-Sagie, T; Porat-Alkabetz, E; Meir, J J; Harel, S

    1996-09-01

    The bilateral operculum syndrome, is a unique developmental syndrome. It is characterized by spastic paralysis of the muscles of the face, pharynx, and of mastication, as well as by epilepsy and mental retardation. Imaging studies show bilateral, structural abnormalities in the frontal, perisylvian region consistent with polymicrogyria. These children are usually diagnosed as suffering from cerebral palsy, but in the bilateral operculum syndrome, intelligence is relatively preserved despite the severe motor involvement. Misdiagnosis may lead to improper estimation of rehabilitation potential preventing appropriate therapy, especially in the field of alternative communication. We present a 3-year-old boy, apparently the first case of this syndrome to be described in Israel. PMID:8940497

  11. Solitary Fibrous Tumor in a Female Urinary Bladder.

    PubMed

    Mustafa, Hiba J; Menon, Sharifa

    2016-07-01

    Solitary fibrous tumors of the bladder are extremely rare especially in the females. This is the third case of SFT in a female urinary bladder. We are presenting a case of 36-years-old female who underwent a procedure for what thought to be cervical myoma. Cystectomy and bilateral ureteral re-implantation were performed. Mass showed to be solitary fibrous tumor of the urinary bladder. These tumors are rarely occur in extrapleural spaces. Only few cases had been reported in the urinary bladder including 2 in the female and 10 in the male bladder. PMID:27335777

  12. Post-operative urothelial recurrence in patients with upper urinary tract urothelial carcinoma managed by radical nephroureterectomy with an ipsilateral bladder cuff: Minimal prognostic impact in comparison with non-urothelial recurrence and other clinical indicators

    PubMed Central

    TAKAHARA, KIYOSHI; INAMOTO, TERUO; KOMURA, KAZUMASA; WATSUJI, TOSHIKAZU; AZUMA, HARUHITO

    2013-01-01

    Upper urinary tract urothelial carcinoma (UTUC) is a rare disease, and novel prognostic factors for patients who have undergone a radical nephroureterectomy (RNU) for UTUC have been studied intensely. To the best of our knowledge, the prognostic value of urothelial recurrence in patients with UTUC has not been previously described in studies. The present study compared the prognostic value of urothelial and non-urothelial recurrence in patients with UTUC of the kidney and ureter managed by surgery. The inclusion criteria consisted of a diagnosis of non-metastatic UTUC (any T stage, N0–1 and M0) and receipt of an RNU with an ipsilateral bladder cuff as the primary treatment. Of the 153 patients that were screened for the study, comprehensive clinical and pathological data was available for 103 patients, who were consequently included in the analysis. Overall survival (OS) and cancer-specific survival (CSS) times were estimated. A multivariate analysis was performed using the Cox regression model. The median follow-up period was 29 months (interquartile range, 14–63 months). The patient population was comprised of 71 males (68.9%) and 32 females (31.1%). A total of 32 patients (31.1%) showed non-urothelial recurrence, while 38 patients (36.9%) exhibited urothelial recurrence and 33 patients (32.0%) exhibited no recurrence. When comparing the risk parameters between the non-urothelial recurrence categories, the factors of pathological grade, microvascular invasion, lymphatic invasion and pT classification showed significant differences. However, there were no significant differences between the urothelial recurrence categories. No significant difference was observed between the OS and CSS times within the urothelial recurrence categories (P=0.3955 and P=0.05891, respectively), but significant differences were identified in the non-urothelial recurrence categories (P<0.0001 and P<0.0001, respectively). Among the other relevant descriptive pre

  13. [Bilateral segmental neurofibromatosis].

    PubMed

    Rose, I; Vakilzadeh, F

    1991-12-01

    Segmental neurofibromatosis is a rare type of neurofibromatosis. We report a case of bilateral manifestation, review the literature on this extremely uncommon variant, and discuss the possible causative mechanisms and the genetic risk of segmental neurofibromatosis. PMID:1765491

  14. Bilateral Psoas Muscle Abscess Associated with Emphysematous Cystitis

    PubMed Central

    Choi, Jae-Ki; Kwon, Jae-Cheol

    2015-01-01

    Psoas muscle abscess associated with emphysematous urinary tract infection is very rare. There were very few reports about urinary tract infections such as renal abscess, perinephric abscess, and emphysematous pyelonephritis complicated with psoas muscle abscess; however, psoas muscle abscess associated with emphysematous cystitis has not yet been reported. Here, we report a case of bilateral posas muscle abscess following emphysematous cystitis in an 81-year-old nondiabetic man, who was treated successfully with prolonged antibiotic therapy and supportive care. Early recognition of psoas muscle abscess can prevent aggressive interventional procedure and warrant good prognosis. PMID:25755669

  15. Echinoderms Have Bilateral Tendencies

    PubMed Central

    Zhao, Wenchan; Wang, Sishuo; Lv, Jianhao

    2012-01-01

    Echinoderms take many forms of symmetry. Pentameral symmetry is the major form and the other forms are derived from it. However, the ancestors of echinoderms, which originated from Cambrian period, were believed to be bilaterians. Echinoderm larvae are bilateral during their early development. During embryonic development of starfish and sea urchins, the position and the developmental sequence of each arm are fixed, implying an auxological anterior/posterior axis. Starfish also possess the Hox gene cluster, which controls symmetrical development. Overall, echinoderms are thought to have a bilateral developmental mechanism and process. In this article, we focused on adult starfish behaviors to corroborate its bilateral tendency. We weighed their central disk and each arm to measure the position of the center of gravity. We then studied their turning-over behavior, crawling behavior and fleeing behavior statistically to obtain the center of frequency of each behavior. By joining the center of gravity and each center of frequency, we obtained three behavioral symmetric planes. These behavioral bilateral tendencies might be related to the A/P axis during the embryonic development of the starfish. It is very likely that the adult starfish is, to some extent, bilaterian because it displays some bilateral propensity and has a definite behavioral symmetric plane. The remainder of bilateral symmetry may have benefited echinoderms during their evolution from the Cambrian period to the present. PMID:22247765

  16. A 52-Year-Old Male with Bilaterally Duplicated Collecting Systems with Obstructing Ureteral Stones: A Case Report

    PubMed Central

    Scantling, Dane; Ross, Curtis; Altman, Howard

    2013-01-01

    Collecting system duplication is marked by a variety of clinical syndromes. Bilateral and obstructed duplicated systems, particularly with asymmetric levels of duplication, are rare and typically due to ureteric bud development anomalies. The infrequency with which this condition exists makes it a formidable challenge for physicians and patients. To our knowledge, we present the first case report of bilateral obstruction of bilaterally duplicated collecting systems. In our case, a 52-year-old male complaining of low back pain, constipation, urinary urgency and hematuria was found to have bilateral obstructing stones as well as asymmetrical bilateral collecting system duplication. We discuss the natural history of this condition, its consequences and identification. PMID:24917767

  17. A rare entity in adults: Bilateral Hutch diverticulum with calculi.

    PubMed

    Telli, Onur; Guclu, Adil Gucal; Haciyev, Perviz; Burgu, Berk; Gogus, Cagatay

    2015-01-01

    Congenital bladder diverticulum (CBD) is a very uncommon entity in adults. CBD could be unilateral or bilateral and is caused by a congenital weakness in the bladder musculature. CBD is differentiated from the paraureteral or Hutch type of diverticula. A 42-year-old male presented with bilateral Hutch diverticulum and multiple diverticulum calculus on intravenous pyelography. Cystoscopy revealed bladder diverticulum just medial to the left ureteral orifice with multiple calculi; the patient successfully underwent endoscopic laser cystolithotripsy with resolution of his urinary tract infection. To the best of our knowledge, this is the first case report presenting stone formation of CBD in an adult. PMID:26029313

  18. Comparative gait initiation kinematics between simulated unilateral and bilateral ankle hypomobility: Does bilateral constraint improve speed performance?

    PubMed

    Delafontaine, A; Honeine, J-L; Do, M-C; Gagey, O; Chong, R K

    2015-08-31

    Improvement of motor performance in unilateral upper limb motor disability has been shown when utilizing inter-limb coupling strategies during physical rehabilitation. This suggests that 'default' bilateral central motor commands are facilitated. Here, we tested whether this bilateral motor control principle may be generalized to the lower limbs during gait initiation, which involves alternate bilateral actions. Disability was simulated by strapping to produce ankle hypomobility. Healthy adult subjects initiated gait at a self-paced speed with no ankle constraint (control), or with the stance, swing or bilateral ankles strapped. The duration of the anticipatory postural adjustments lengthened and the center of mass instantaneous progression velocity at foot-off decreased when the ankle was strapped. During the step execution phase, progression velocity at foot-contact was higher when both ankles were strapped compared to unilateral strapping of the stance ankle. These findings suggest that bilateral central motor commands are favored during walking tasks. Indeed, unilateral constraint of the stance ankle should compel the central nervous system to adapt specific commands to the constraint and normal sides whereas the 'default' bilateral motor commands would be utilized when both ankles are strapped leading to better kinematics performance. Bilateral in-phase upper limb coordination and bilateral alternating lower limb locomotor movements may share similar control mechanisms. PMID:26197055

  19. Bilateral popliteal arterial dissection.

    PubMed

    Chen, Po-Liang; Ko, Shih-Yu; Tan, Ken-Hing

    2012-01-01

    A clinical feature of bilateral popliteal arterial dissection without involving the descending aorta, bilateral iliac, as well as femoral arteries has never been reported in the past literature. We report a 56-year-old man with hypertension and coronary artery disease who presented to our emergency department with complaints of bilateral knee pain after long-distance walking. Physical examination was notable for elevated blood pressure, but there was no palpable pulsation over dorsalis pedis arteries on his feet. Laboratory evaluation revealed a d-dimer level of 35.2 mg/L (FEU) on the day of the test and 1.2 mg/L one and a half months ago (normal level, <0.55). These findings were suggestive of a recent-onset peripheral arterial occlusive disorder. Computed tomography of the aorta showed bilateral popliteal arterial dissection with arterial intimal flap. Abdominal aorta, bilateral iliac, and femoral arteries remained intact with only arteriosclerotic change. Minimally invasive endovascular stent grafting was then performed. The patient had an uneventful recovery. PMID:21106320

  20. [Bilateral caudate head infarcts].

    PubMed

    Kuriyama, N; Yamamoto, Y; Akiguchi, I; Oiwa, K; Nakajima, K

    1997-11-01

    We reported a 67-year-old woman with bilateral caudate head infarcts. She developed sudden mutism followed by abulia. She was admitted to our hospital 2 months after ictus for further examination. She showed prominent abulia and was inactive, slow and apathetic. Spontaneous activity and speech, immediate response to queries, spontaneous word recall and attention and persistence to complex programs were disturbed. Apparent motor disturbance, gait disturbance, motor aphasia, apraxia and remote memory disturbance were not identified. She seemed to be depressed but not sad. Brain CT and MRI revealed bilateral caudate head hemorrhagic infarcts including bilateral anterior internal capsules, in which the left lesion was more extensive than right one and involved the part of the left putamen. These infarct locations were thought to be supplied by the area around the medial striate artery including Heubner's arteries and the A1 perforator. Digital subtraction angiography showed asymptomatic right internal carotid artery occlusion. She bad had hypertension, diabetes mellitus and atrial fibrillation and also had a left atrium with a large diameter. The infarcts were thought to be caused by cardioembolic occlusion to the distal portion of the left internal carotid artery. Although some variations of vasculature at the anterior communicating artery might contribute to bilateral medial striate artery infarcts, we could not demonstrate such abnormalities by angiography. Bilateral caudate head infarcts involving the anterior internal capsule may cause prominent abulia. The patient did not improve by drug and rehabilitation therapy and died suddenly a year after discharge. PMID:9503974

  1. Bilateral inferior turbinate osteoma.

    PubMed

    Sahemey, R; Warfield, A T; Ahmed, S

    2016-01-01

    Osteomas are the most common benign osteoclastic tumours of the paranasal sinuses. However, nasal cavity and turbinate osteomas are extremely rare. Only nine middle turbinate, three inferior turbinate and one inferior turbinate osteoma cases have been reported to date. The present case report describes the management and follow-up of symptomatic bilateral inferior turbinate osteoma.A 60-year-old female presented with symptoms of bilateral nasal obstruction and right-sided epiphora. Radiological investigation found hypertrophic bony changes involving both inferior turbinates. The patient was managed successfully by endoscopic inferior turbinectomies in order to achieve a patent airway, with no further recurrence of tumour after 3 months postoperatively.To the best of our knowledge, this is the first reported case of bilateral inferior turbinate osteoma. We describe a safe and minimally invasive method of tumour resection, which has a better cosmetic outcome compared with other approaches. PMID:27534890

  2. Urinary incontinence - retropubic suspension

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/007374.htm Urinary incontinence - retropubic suspension To use the sharing features on ... may be because other problems are causing your urinary incontinence. Over time, some or all of the leakage ...

  3. [Infection and urinary lithiasis].

    PubMed

    Bruyere, F; Traxer, O; Saussine, C; Lechevallier, E

    2008-12-01

    Urinary infection is a risk factor for lithiasis. Urinary tract infection is a factor of gravity of urinary stone. The stone can exist before the infection which colonizes the stone, infected stone. The infection can be the cause of the stone, infectious stone (struvite stone). Infectious stones can be secondary to a non urinary infectious agent, oxalobacter formigenes (OF) and nanobacteria. The first-line treatment of struvite stone is percutaneous surgery. Perioperative antibiotics, renal urines and stone cultures are obligatory. PMID:19033073

  4. Bilateral ovarian Burkitt's lymphoma.

    PubMed

    Gutiérrez-García, L; Medina Ramos, N; García Rodríguez, R; Barber, M A; Arias, M D; García, J A

    2009-01-01

    Primary ovarian lymphoma is a rare entity. We submit a case of a 34-year-old black patient presenting with a bilateral adnexal tumor. She underwent hysterectomy with double salpingo-oophorectomy followed by polychemotherapy treatment. Histology confirmed Epstein-Barr virus-positive bilateral Burkitt's lymphoma. The patient died from septic shock after a month of treatment. Endemic Burkitt's lymphoma has a predilection for the female genital tract, manifesting itself clinically as a pelvic mass and less frequently as a menstrual disorder. It is a rare entity in our environment but should be kept in mind when treating patients of African origin. PMID:19480266

  5. Male urinary incontinence and the urinary sheath.

    PubMed

    Smart, Clare

    This article addresses the assessment and management of male incontinence with a specific focus on the use of the male external catheter (MEC) or urinary sheath. Education and expertise when dealing with a man with urinary incontinence, as well as a tactful and sensitive attitude towards this embarrassing problem, are essential for a successful outcome. The urinary sheath is often perceived by nurses and patients as a difficult product to master and is prone to failure owing to incorrect fitting and management. With correct usage it can make a great difference to a patient's quality of life and avoid problems often associated with urinary catheters and pads such as urinary infection and skin excoriation. Detailed assessment of the patient as well as his suitability for the MEC is essential for a successful outcome. PMID:24820510

  6. Bilateral pisotriquetral loose bodies

    PubMed Central

    Williams, GR; Holland, P; Beazley, J; Hyder, N

    2012-01-01

    Case reports detailing diagnosis and effective treatment of pisotriquetral loose bodies are scarce. This article describes an even rarer case of bilateral pisotriquetral joint loose bodies, explores the relative diagnostic roles of magnetic resonance imaging versus computed tomography, and outlines effective strategies used for the management of this condition drawn from the literature and our own experience. PMID:22507708

  7. Bilateral periorbital ecthyma gangrenosum.

    PubMed

    Ghosheh, Faris R; Kathuria, Sajeev S

    2006-01-01

    We describe a case of bilateral periorbital ecthyma gangrenosum in a diabetic patient with renal failure. Ecthyma gangrenosum is a cutaneous manifestation of Pseudomonas sepsis. We briefly review the pathogenesis of ecthyma gangrenosum and discuss previous reports of periocular involvement. In our patient, conservative measures and supportive care of the periorbital tissue resulted in a good outcome. PMID:17117116

  8. The late occurrence of urinary tract damage in patients successfully treated by radiotherapy for cervical carcinoma

    SciTech Connect

    Zoubek, J.; McGuire, E.J.; Noll, F.; DeLancey, J.O.

    1989-06-01

    Urinary tract complications apparently resulting from radiation therapy for carcinoma of the cervix can occur as long as 30 years after cessation of such treatment. Patients generally present with urinary incontinence and often are treated by standard operative methods that usually are unsuccessful. Incontinence is related to bladder fibrosis, urethral nonfunction and vesicovaginal fistuLa formation, and may be accompanied by bilateral ureteral obstruction. Of 11 patients with late complications of radiotherapy 4 had upper tract deterioration, 4 had vesicovaginal fistulas, 5 had an incompetent urethra aNd 9 had a fibrotic, noncompliant areflexive bladder. Treatment was aimed at providing adequate low pressure storage capacity and consisted of augmentation cystoplasty in 5 patients, repair of the fistula in 4 and correction of urethral dysfunction in 5. Women who complain of incontinence and/or irritable bladder symptoms with a history of radiotherapy for cervical carcinoma should be evaluated for fistuLa formation, urethral incompetence, and detrusor areflexia and fibrosis before treatment is done.

  9. Unusual Anatomic Variations Associated With Bilateral Ulnar Artery Hypoplasia.

    PubMed

    Ro, Hyung-Suk; Roh, Si-Gyun; Shin, Jin Yong; Lee, Nae-Ho; Yang, Kyung-Moo

    2016-05-01

    Variations and anomalies of upper extremities have been commonly reported in routine dissection, clinical practices, and cadaver studies. Despite ongoing research on arterial variations of upper extremities, the absence of bilateral ulnar artery is extremely rare with only 3 patients reported. As the authors are presenting a successfully treated patient, initially prepped for radial forearm osteocutaneous free flap for treatment on oromandibular defect after a wide resection of head and neck cancer lesion, being confirmed to have bilateral ulnar artery hypoplasia and due to this, the patient had to change her surgical plan to fibular osteocutaneous free flap. PMID:27100648

  10. Investigation of the dilated urinary tract.

    PubMed

    Parkhouse, H F; Barratt, T M

    1988-01-01

    Dilatation of the urinary tract does not necessarily imply obstruction, and other factors may be operative: maldevelopment, infection, reflux, and polyuria. Obstruction of the urinary tract in intra-uterine life is associated with renal dysplasia: the original obstructive lesion may be transient but the consequent dysplasia and dilatation may be permanent. Routine antenatal ultrasound identifies a new population of infants with urinary tract dilatation, many of whom remain asymptomatic and would not otherwise have come to medical attention: the natural history and appropriate schedules of investigation and management of this group are still being evaluated. Anatomical imaging by ultrasound establishes the presence and extent of dilatation. Micturating cystourethrography, intravenous urography and antegrade pyelography establish the site but not the functional significance of an obstructive lesion. Isotope renal scanning with 99mTc-DTPA may identify an acutely obstructed kidney with a decrease renal uptake, prolonged parenchymal transit time, and delayed clearance of the isotope from the renal pelvis after furosemide. However, such analyses often give equivocal results in infants with poor renal function and markedly dilated urinary tracts. Obstructive uropathy should be seen as a disturbance of the normal pressure-flow relationships in the urinary tract, and be defined and investigated as such. Antegrade perfusion with renal pelvic pressure measurements has technical pitfalls, but is the definitive method of establishing upper tract obstruction. Videocystourethrography is the established method of investigating the lower urinary tract in older children but needs further development to be applicable to infants. PMID:3153000

  11. Bilateral Sagittal Split Osteotomy

    PubMed Central

    Monson, Laura A.

    2013-01-01

    The bilateral sagittal split osteotomy is an indispensable tool in the correction of dentofacial abnormalities. The technique has been in practice since the late 1800s, but did not reach widespread acceptance and use until several modifications were described in the 1960s and 1970s. Those modifications came from a desire to make the procedure safer, more reliable, and more predictable with less relapse. Those goals continue to stimulate innovation in the field today and have helped the procedure evolve to be a very dependable, consistent method of correction of many types of malocclusion. The operative surgeon should be well versed in the history, anatomy, technical aspects, and complications of the bilateral sagittal split osteotomy to fully understand the procedure and to counsel the patient. PMID:24872760

  12. Bilateral Presumed Tuberculous Choroiditis

    PubMed Central

    Mohammadi, Naseh; Ghassemi, Fariba; Shojaei, Esfandiar; Moradnejad, Pardis

    2016-01-01

    Purpose: To describe a case of bilateral presumed tuberculous choroiditis which resolved promptly with a short course of antituberculous therapy. Case Report: A 44-year-old lady presented with bilateral visual loss of 8 months’duration. Considering the presence of pan-uveitis, severe macular edema, multifocal leakage on fluorescein angiography, positive tuberculin skin test, and after excluding other diseases, she underwent anti-tuberculous therapy (ATT) for disseminated choroiditis due to presumed ocular tuberculosis. She improved promptly and completely. There were no signs of relapse 18 months after completion of the treatment course. In a young patient with disseminated choroiditis and relatively short duration of symptoms, a course of ATT for 6 months may effectively treat the disease preventing relapse for a considerable period of time. Conclusion: In Presumed Tuberculous chroiditis early diagnosis is crucial for prompt and complete improvement. PMID:27413507

  13. Bilateral Mandibular Paramolars

    PubMed Central

    Dhull, Rachita Singh; Panda, Swagatika; Acharya, Sonu; Yadav, Shweta; Mohanty, Gatha

    2014-01-01

    ABSTRACT Supernumerary tooth is a developmental anomaly and has been argued to arise from multiple etiologies. These teeth may remain embedded in the alveolar bone or can erupt into the oral cavity. They can cause a variety of complications in the develo­ping dentition. Supernumerary teeth can present in various forms and in any region of the mandible or maxilla, but have a predisposition for the anterior maxilla. Here is the presentation of a case of unusual location of supernumerary teeth located in between mandibular first and second molar region bilaterally. How to cite this article: Dhull KS, Dhull RS, Panda S, Acharya S, Yadav S, Mohanty G. Bilateral Mandibular Paramolars. Int J Clin Pediatr Dent 2014;7(1):40-42. PMID:25206236

  14. Bilateral Nipple Leiomyoma

    PubMed Central

    Kapakli, Mahmut Sertan; Altintoprak, Fatih; Cayırcı, Mine; Manukyan, Manuk Norayk; Kebudi, Abut

    2013-01-01

    Cutaneous leiomyomas are benign smooth muscle neoplasms of the skin. They arise from vascular, arrector pili, genital, and areolar smooth muscles. The most common localizations of cutaneous leiomyomas are the extensor surfaces of the extremities and the trunk. To our knowledge, only few cases of one-sided nipple leiomyomas have been reported, but two-sided nipple leiomyomas have not been presented. For the first time, here, we report a bilateral nipple leiomyoma. PMID:23762734

  15. Compressive Bilateral Filtering.

    PubMed

    Sugimoto, Kenjiro; Kamata, Sei-Ichiro

    2015-11-01

    This paper presents an efficient constant-time bilateral filter that produces a near-optimal performance tradeoff between approximate accuracy and computational complexity without any complicated parameter adjustment, called a compressive bilateral filter (CBLF). The constant-time means that the computational complexity is independent of its filter window size. Although many existing constant-time bilateral filters have been proposed step-by-step to pursue a more efficient performance tradeoff, they have less focused on the optimal tradeoff for their own frameworks. It is important to discuss this question, because it can reveal whether or not a constant-time algorithm still has plenty room for improvements of performance tradeoff. This paper tackles the question from a viewpoint of compressibility and highlights the fact that state-of-the-art algorithms have not yet touched the optimal tradeoff. The CBLF achieves a near-optimal performance tradeoff by two key ideas: 1) an approximate Gaussian range kernel through Fourier analysis and 2) a period length optimization. Experiments demonstrate that the CBLF significantly outperforms state-of-the-art algorithms in terms of approximate accuracy, computational complexity, and usability. PMID:26068315

  16. Urinary incontinence in women.

    PubMed

    Wood, Lauren N; Anger, Jennifer T

    2014-01-01

    Urinary incontinence affects women of all ages. History, physical examination, and certain tests can guide specialists in diagnosing stress urinary incontinence, urgency urinary incontinence, and mixed urinary incontinence. First line management includes lifestyle and behavior modification, as well as pelvic floor strength and bladder training. Drug therapy is helpful in the treatment of urgency incontinence that does not respond to conservative measures. In addition, sacral neuromodulation, intravesical onabotulinumtoxinA injections, and posterior tibial nerve stimulation can be used in select patient populations with drug refractory urgency incontinence. Midurethral synthetic slings, including retropubic and transobturator approaches, are safe and efficacious surgical options for stress urinary incontinence and have replaced more invasive bladder neck slings that use autologous or cadaveric fascia. Despite controversy surrounding vaginal mesh for prolapse, synthetic slings for the treatment of stress urinary incontinence are considered safe and minimally invasive. PMID:25225003

  17. Renal pelvis urothelial carcinoma of the upper moiety in complete right renal duplex: a case report

    PubMed Central

    Zhang, Yiran; Yu, Quanfeng; Zhang, Zhihong; Liu, Ranlu; Xu, Yong

    2015-01-01

    Urothelial carcinoma (UC) originated from renal pelvis is the common tumor of the urinary system, however, neoplasia of the renal pelvis in duplex kidneys is extremely rare, especially in the complete renal and ureteral duplex cases. We present the first case of renal pelvis UC of the upper moiety in a complete right renal duplex. This male patient has bilateral complete renal and ureteral duplex. To the best of our knowledge, this is the first reported case of renal pelvis UC in a complete renal duplex system. After this experience we feel that the diagnosis of renal pelvis UC in duplex kidneys is not so easy, and once the diagnosis is determined, the whole renal duplex units and bladder cuff or ectopic orifice should be excised radically. PMID:26823906

  18. Age-Related Differences in Bilateral Asymmetry in Cycling Performance

    ERIC Educational Resources Information Center

    Liu, Ting; Jensen, Jody L.

    2012-01-01

    Bilateral asymmetry, a form of limb laterality in the context of moving two limbs, emerges in childhood. Children and adults show lateral preference in tasks that involve the upper and lower limbs. The importance of research in limb laterality is the insight it could provide about lateralized functions of the cerebral hemispheres. Analyzing…

  19. Synchronous Bilateral Breast Cancers

    PubMed Central

    Subramanyan, Annapurneswari; Radhakrishna, Selvi

    2015-01-01

    Background Bilateral breast cancer (BBC) is not an uncommon entity in contemporary breast clinics. Improved life expectancy after breast cancer treatment and routine use of contra-lateral breast mammography has led to increased incidence of BBC. Our study objective was to define the epidemiological and tumour characteristics of BBC in India. Materials and Methods A total of 1251 breast cancer patients were treated during the period January 2007 to March 2015 and 30 patients were found to have BBC who constituted the study population (60 tumour samples). Synchronous bilateral breast cancers (SBC) was defined as two tumours diagnosed within an interval of 6 months and a second cancer diagnosed after 6 months was labelled as metachronous breast cancer (MBC). Analyses of patient and tumour characteristics were done in this prospective data base of BBC patients. Results Median patient age was 66 years (range 39-85). Majority of the patients had SBC (n=28) and in 12 patients the second tumour was clinically occult and detected only by mammography of the contra-lateral breast. The second tumour was found at lower tumour size compared to the first in 73% of cases and was negative for axillary metastasis in 80% of cases (24/30). Infiltrating ductal carcinoma was the commonest histological type (n=51) and majority of the tumours were ER/PR positive (50/60). Her2 was overexpressed in 13 tumours (21%). Over 70% (22/30) of patients had similar histology in both breasts and amongst them grade concordance was present in about 69% (15/22) of patients. Concordance rates of ER, PR and Her2 statuses were 83%, 80% and 90% respectively. Bilateral mastectomy was the commonest surgery performed in 80% of the patients followed by bilateral breast conservation in 13%. At the end of study period, 26 patients were alive and disease free. Median survival was 29 months (range 3-86 months). Conclusion In most patients with BBC, the second tumour is identified at an early stage than index

  20. Urinary Tract Infections

    MedlinePlus

    ... can usually be found and treated before the kidneys become infected. If your doctor treats a urinary tract infection early and ... Tips on preventing urinary tract infections Drink plenty of water to flush out bacteria. Drinking cranberry juice may also help ...

  1. Pediatric Urinary Tract Infection

    MedlinePlus

    SBA National Resource Center: 800-621-3141 Pediatric Urinary Tract Infections and Catheterization in Children with Neurogenic Bladder and ... To protect the kidneys from damage – By preventing urinary tract infections (UTI) – By identifying and treating vesicoureteral remux (VUR). ...

  2. Bilateral posterior sternoclavicular dislocation.

    PubMed

    Baumann, Matthias; Vogel, Tobias; Weise, Kuno; Muratore, Tim; Trobisch, Per

    2010-07-01

    Posterior sternoclavicular dislocations are a rare injury, representing <5% of all sternoclavicular dislocations and 1 in 1600 shoulder girdle injuries. Proper imaging with computed tomography and prompt diagnosis are essential steps in preventing potentially lethal complications observed in approximately 3% of all posterior sternoclavicular dislocations. Surgical treatment is necessary if closed reduction fails. With the medial clavicular epiphysis being the last to close (between ages 22 and 25), children and adolescents typically present with epiphyseal fractures rather than joint dislocations. If closed reduction fails, open reduction and internal fixation (ORIF) should be considered in fractures, whereas complex reconstructions with tendon graft procedures have been recommended for joint dislocations. This article presents a case of a traumatic bilateral posterior sternoclavicular dislocation due to an epiphyseal fracture in a 15-year-old boy. To our knowledge, this is the first reported case of a bilateral posterior sternoclavicular dislocation. Attempted closed reduction failed with redislocation after 2 days. The patient subsequently required ORIF. This article describes our technique with anterior retraction of the medial clavicle, closure of the posterior periosteum, and ORIF using nonabsorbable sutures. Postoperative shoulder mobilization was started on day 1. At final follow-up, the patient was completely asymptomatic. PMID:20608625

  3. Management of a hypoplastic lower urinary tract: a case report.

    PubMed

    Alagaratnam, Swethan; Sengamalai, Manoharan; Mushtaq, Imran

    2011-06-01

    This case relates to a child with an antenatal diagnosis of severe bilateral hydronephrosis with congenital anomalies of the ureters, bladder, and urethra. We describe the presentation and surgical management, highlighting the complexity of this anomaly and the surgical technique used to reconstruct the lower urinary tract. To our knowledge, there has not been a similar case in the literature and the use of a segment of colon for ureteric substitution in children has not been previously reported in the literature. PMID:21683188

  4. [Ectopic ureter as cause of pyonephrosis and urinary incontinence].

    PubMed

    Martín, Martín S; García-Ripoll, Torrecilla J R; Ruíz, Sanz A; Rodríguez, Gonzalo V; Ferro, Rivera J; del Busto, Fernández E

    2008-02-01

    Ectopic ureter accounts with an incidence of 1 in 2000 newborns. When present, ectopic ureter can be associated with duplex kidneys in an 85 % of the cases. Clinical manifestations of this malformation include incontinence and urinary tract infections. Ectopic ureter frequently occurs in association with a dysplastic upper pole renal moiety. When a poorly functioning upper pole segment is present, a standard surgical treatment is upper pole heminephrectomy. A 23-years old woman presented with left renal colic pain, fever and urinary leak. Ultrasound, intravenous pyelogram and antegrade pyelogram revealed a partial duplex right kidney and a complete duplex left kidney with hydronephrosis and ectopic insertion into the urethra of the left upper pole moiety. Following diagnosis upper pole heminephrectomy and partial ureterectomy was performed. PMID:18409479

  5. Origin of Urinary Oxalate

    NASA Astrophysics Data System (ADS)

    Holmes, Ross P.; Knight, John; Assimos, Dean G.

    2007-04-01

    Urinary oxalate is mostly derived from the absorption of ingested oxalate and endogenous synthesis. The breakdown of vitamin C may also contribute small amounts to the urinary oxalate pool. The amount of oxalate absorbed is influenced by the oxalate content of the diet, the concentrations of divalent cations in the gut, the presence of oxalate-degrading organisms, transport characteristics of the intestinal epithelium, and other factors associated with the intestinal environment. Knowledge of pathways associated with endogenous oxalate synthesis is limited. Urinary oxalate excretion can be modified using strategies that limit dietary oxalate absorption and the ingestion of oxalogenic substrates such as hydroxyproline.

  6. Auditing urinary catheter care.

    PubMed

    Dailly, Sue

    Urinary catheters are the main cause of hospital-acquired urinary tract infections among inpatients. Healthcare staff can reduce the risk of patients developing an infection by ensuring they give evidence-based care and by removing the catheter as soon as it is no longer necessary. An audit conducted in a Hampshire hospital demonstrated there was poor documented evidence that best practice was being carried out. Therefore a urinary catheter assessment and monitoring tool was designed to promote best practice and produce clear evidence that care had been provided. PMID:22375340

  7. Acute kidney injury due to bilateral ureteral obstruction in children

    PubMed Central

    Bianchi, Daniele; Vespasiani, Giuseppe; Bove, Pierluigi

    2014-01-01

    Bilateral ureteral obstruction in children is a rare condition arising from several medical or surgical pictures. It needs to be promptly suspected in order to attempt a quick renal function recovery. In this paper we concentrated on uncommon causes of obstruction, with the aim of giving a summary of such multiple, rare and heterogeneous conditions joint together by the common denominator of sudden bilateral ureteral obstruction, difficult to be suspected at times. Conversely, typical and well-known diseases have been just run over. We considered pediatric cases of ureteral obstruction presenting as bilateral, along with some cases which truly appeared as single-sided, because of their potential bilateral presentation. We performed a review of the literature by a search on PubMed, CrossRef Metadata Search, internet and reference lists of single articles updated to May 2014, with no time limits in the past. Given that we deal with rare conditions, we decided to include also papers in non-English languages, published with an English abstract. For the sake of clearness, we divided our research results into 8 categories: (1) urolithiasis; (2) congenital urinary tract malformations; (3) immuno-rheumatologic causes of ureteral obstruction; (4) ureteral localization of infections; (5) other systemic infective causes of ureteral obstructions; (6) neoplastic intrinsic ureteral obstructions; (7) extrinsic ureteral obstructions; and (8) iatrogenic trigonal obstruction or inflammation. Of course, different pathogenic mechanisms underlay those clinical pictures, partly well-known and partly not completely understood. PMID:25374811

  8. Bilateral practice improves dominant leg performance in long jump.

    PubMed

    Focke, Anne; Spancken, Sina; Stockinger, Christian; Thürer, Benjamin; Stein, Thorsten

    2016-10-01

    Benefits of bilateral practice both for the non-dominant and for the dominant body side have been shown in several studies. Thereby, most of the studies included movement tasks of the upper extremity or investigated sports games in which the ability of acting bilaterally is an essential basis for success and, thus, a bilateral practice is reasonable anyway. Individual unilaterally performed sports including movement tasks of the lower extremity are rarely investigated. Therefore, the aim of our study was to test if contralateral transfer due to bilateral practice can be found in an unilaterally performed sport including the lower extremity. We trained and tested 61 adolescent athletes in long jump to compare the jumping performance of the dominant leg after a 12-week practice period between two groups: a bilateral practice group that practiced specific long jump exercises with both the dominant and non-dominant leg and an unilateral practice group that practiced specific long jump exercises only with the dominant leg. Results showed a superior effect of bilateral practice compared to unilateral practice regarding the jumping performance of the dominant leg. The performance increase at post-test and retention-test for the dominant limb was significantly higher for the bilateral practice group (pre-to-post: 5.2%, pre-to-retention: 7.4%) compared to the unilateral practice group (pre-to-post: 3.4%, pre-to-retention: 4.5%). Thus, bilateral practice should be established in the early practice programmes of track and field athletes to improve the performance of the dominant take-off leg. PMID:26864045

  9. Urinary Tract Infections

    MedlinePlus

    ... kidneys, two ureters, a bladder, and a urethra. Urinary tract infections (UTIs) are the second most common type of infection in the body. You may have a UTI if you notice Pain or burning when you ...

  10. Urinary incontinence - injectable implant

    MedlinePlus

    Injectable implants are injections of material into the urethra to help control urine leakage ( urinary incontinence ) caused by a ... into the tissue next to the sphincter. The implant procedure is usually done in the hospital. Or ...

  11. [Recurrent urinary tract infection].

    PubMed

    Ali, Adel Ben; Bagnis, Corinne Isnard

    2014-09-01

    Recurrent urinary tract infection involves mainly women and exhibits an ecological as well as economical risk. 4% of all urinary tract infection are recurrent and usually secondary to general or local abnormalities. A multidisciplinary medical and surgical team (urology, nephrology, bacteriology, infectious disease) best performs diagnosis and treatment as well as rules out reversible etiology. Treatment relies on behavioral changes before offering cranberry products and/or antibioprophylaxis if necessary. PMID:25362782

  12. [Urinary tract infections].

    PubMed

    Hörl, W H

    2011-09-01

    Urinary tract infections occur very frequently in the community and in hospitalized patients and are mainly caused by Escherichia (E.) coli. Depending on virulence determinants of uropathogenic microorganisms and host-specific defense mechanisms, urinary tract infections can manifest as cystitis, pyelonephritis (bacterial interstitial nephritis), bacteremia or urosepsis. Uncomplicated urinary tract infections in otherwise healthy women should be treated for 3-7 days depending on the antibiotic therapy chosen, even if spontaneous remission rates of up to 40% have been reported. Antibiotics of the first choice for empirical treatment of uncomplicated urinary tract infection are fluoroquinolones, pivmecillinam and fosfomycin. A huge problem is the increasing antimicrobial resistance of uropathogenic microorganisms. Complicated urinary tract infections associated with anatomical and/or functional abnormalities of the urinary tract and/or comorbidities such as diabetes or immunosuppressive therapy, need longer antibiotic treatment (e.g. 10-14 days) as well as interdisciplinary diagnostic procedures. Treatment of community acquired urosepsis includes cephalosporins of the third generation, piperacillin/tazobactam or ciprofloxacin. For nosocomial urosepsis the combination with an aminoglycoside or a carbapenem is recommended. PMID:21850538

  13. Single ectopic ureteral orifice with bilateral duplicated renal collecting systems in an adult girl: Diagnosis by magnetic resonance urography

    PubMed Central

    Tang, Min; Wang, Quanrongzi; Liu, Bianjiang; Li, Jie; Lu, Qiang; Song, Ninghong; Wang, Zengjun; Zhang, Wei

    2015-01-01

    Renal duplication accompanied by ureteral ectopia is an uncommon urinary congenital abnormality. We report the case of a 21-year-old girl who suffered from lifelong continuous urinary leakage. She was finally diagnosed with bilateral duplicated collecting systems complicated with right ectopic ureteral orifice – an extremely rare case. The patient underwent ureteric re-implantation for the ectopic side, and her urinary incontinence ceased soon thereafter. In this case, traditional imaging failed to show the exact insertion of an ectopic ureter. However, magnetic resonance urography combined with retrograde intubation radiography successfully depicted the point of ureteric insertion, which may make the diagnostic process accurate and efficient. PMID:26609333

  14. Simultaneous bilateral spontaneous pneumothorax.

    PubMed

    Graf-Deuel, E; Knoblauch, A

    1994-04-01

    We describe 12 patients with simultaneous bilateral spontaneous pneumothorax (SBSP). They represent 4 percent of patients with spontaneous pneumothorax seen at our hospital from 1971 to 1990. Five of the 12 had no underlying lung disease. In the seven remaining patients, SBSP was secondary to histiocytosis X, lymphangioleiomyomatosis, osteogenic sarcoma with pleural and pulmonary metastases, Hodgkin's disease, mesothelioma, cystic fibrosis, or miliary tuberculosis. Nineteen of the 56 patients with SBSP (34 percent) described in the literature (this series included) had pulmonary disease related to disorders of cells of mesenchymal origin. Emphysema and bullous lung disease were not associated with SBSP. Long-term prognosis was a function of pulmonary status. Four of the patients described herein died during the period reviewed. All suffered from severe underlying disease. In no case was SBSP the main cause of death. With timely treatment, the short-term prognosis is benign even for patients with underlying lung disease. Surgical pleurectomy should be attempted early, especially in SBSP secondary to underlying lung disease. PMID:8162740

  15. [Follow-up after surgical replacement of the urinary bladder (urinary diversion)].

    PubMed

    Ubrig, B; Kories, C; Roth, S

    2013-01-01

    Surgical replacement of the urinary bladder is usually necessary after radical cystectomy for muscle invasive bladder cancer. Besides uro-oncological follow-up (local, urethral, and systemic recurrence; tumor in the upper tract) functional follow-up of the urinary diversion is indicated. Guidelines are still scarce. Long contact time and large surface area in continent pouches made from long intestinal segments lead to absorption of contents of urine and thus to acidosis and imbalances in serum electrolytes. Compensation depends on renal function. Exclusion of long ileal segments out of the intestinal passage may lead to malabsorption of Vitamin B12 and bile acids. 30 % and more of long-term survivors with continent pouches take Vitamin B12 and sodium bicarbonate. Special attention has to be paid to obstruction of the upper urinary tract, total renal function and to secondary malignancy in the bladder substitute. For the latter, sigma-rectum pouches, augmentation cystoplasties and continent pouches with incorporation of colonic segments are at special risk. Functional follow-up affords good understanding of the specific complications of the different types of urinary diversions. PMID:23386377

  16. Acute silicosis with bilateral pneumothorax

    PubMed Central

    Srivastava, G N; Prasad, Rajniti; Meena, Manoj; Hussain, Moosa

    2014-01-01

    We present a case of acute silicosis with bilateral pneumothorax of a 28-year-old man working at a stone crusher factory for 1 year. He presented to the emergency department with cough, respiratory distress and diffuse chest pain. The patient was managed with bilateral intercostal tube drainage under water seal, oxygen inhalation and conservative therapy. On follow-up he showed improvement of resting dyspnoea and was doing well. This case is being reported because of the rare complications of acute silicosis as bilateral pneumothorax. PMID:24862410

  17. Acute silicosis with bilateral pneumothorax.

    PubMed

    Srivastava, G N; Prasad, Rajniti; Meena, Manoj; Hussain, Moosa

    2014-01-01

    We present a case of acute silicosis with bilateral pneumothorax of a 28-year-old man working at a stone crusher factory for 1 year. He presented to the emergency department with cough, respiratory distress and diffuse chest pain. The patient was managed with bilateral intercostal tube drainage under water seal, oxygen inhalation and conservative therapy. On follow-up he showed improvement of resting dyspnoea and was doing well. This case is being reported because of the rare complications of acute silicosis as bilateral pneumothorax. PMID:24862410

  18. Multiple Symmetric Lipomatosis (Madelung's Disease) Presenting as Bilateral Huge Gynecomastia

    PubMed Central

    Jang, Jae Hoon; Lee, Anbok; Han, Sang-Ah; Ryu, Jung-Kyu

    2014-01-01

    Multiple symmetric lipomatosis (MSL), or Madelung's disease, is a rare disease of unknown etiology. It is characterized by the presence of loose adipose tissue deposits localized in the cervical region and upper body. MSL presenting as bilateral huge gynecomastia is an extremely rare phenomenon. The present report describes a case of MSL in a 66-year-old man. The patients presented with bilateral breast bulging. He had a history of cigarette and alcohol use. His condition was treated with a bilateral nipple-sparing mastectomy. MSL can present as a form of gynecomastia, for its accurate diagnosis and proper treatment of MSL, increasing awareness of the clinical characteristics of the disease is required, especially amongst breast surgeons. Herein, we review the literature and discuss the clinical characteristics, pathology, and surgical treatment of MSL. PMID:25548590

  19. Bilateral panuveitis associated with Whipple disease – case report

    PubMed Central

    Lisboa, Maria; Domingues, Isabel; Pamplona, Jaime; Barata, Pedro; Morgado, Joana; Brotas, Vítor

    2014-01-01

    Purpose: To describe a clinical case and literature review of Whipple disease. Methods: A 65-year-old male with bilateral decreased visual acuity for 3 weeks as well as bilateral hypoacusia, vertigo, disequilibrium, headache and decreased strength in the right upper limb for 4 months. The clinical work-up revealed a bilateral panuveitis and an ischemic cerebellar stroke. Result: The diagnosis of Whipple disease was confirmed by histopathological analysis of adenopathy. The patient was treated with cortico-antibiotic therapy with significant clinical improvement. Conclusion: Although rare, Whipple disease is potentially fatal if left untreated, it must be always be taken into consideration before any panuveitis of an unknown cause, even in the absence of gastrointestinal symptoms.

  20. Isolated Bilateral Lacrimal Gland Agenesis.

    PubMed

    Al-Ryalat, Nosaiba T; Ezzat, Jumana W; Ababneh, Osama H; AlRyalat, Saif Aldeen S; Al-Hadidy, Azmy M

    2016-01-01

    A 5-year-old boy presented to the ophthalmology department complaining of absent tearing while crying. Slit-lamp examination showed decreased tear margin film with normal punctae. Orbit magnetic resonance imaging was done and showed bilateral absent lacrimal glands. This is the third case of isolated bilateral lacrimal gland agenesis in the literature. [J Pediatr Ophthalmol Strabismus. 2016;53:e35-e38.]. PMID:27486892

  1. Spectrum of Renal and Urinary Tract Diseases in Kashmiri Children

    PubMed Central

    Kumar, Virender; Bano, Rifat Ara; Wani, Khursheed Ahmed; Ahmed, Javed; Ahmed, Kaisar

    2016-01-01

    Introduction Definite paucity of data pertaining to spectrum of renal and urinary tract diseases in our state and in various parts of India forms the basis of this study. Available data has emphasized more on specific clinical syndromes and chronic renal diseases rather than over all spectrums of renal and urinary tract diseases, that too in adult population. Aim The present study a retrospective analysis, forms one of the basic data of paediatric nephrology and urology related disorders in our state. Materials and Methods Retrospective analysis of the case records of all the hospitalized patients with renal and urinary tract diseases between 2012 and 2013 were performed. Case records were analysed and categorized into various groups like; Urinary Tract Infections (UTI), Acute Kidney Injury (AKI), Acute Glomerulonephritis (AGN), Nephrotic Syndrome (NS), haematuria, Polycystic Kidney Disease (PCKD), Posterior Urethral Valve (PUV), Vesicoureteric Reflux (VUR), Chronic Kidney Disease (CKD), Congenital Anomalies of Kidney and Urinary Iract (CAKUT) and others. These groups were divided into subgroups to get more insight about the pattern of these diseases. Results Out of 28114 patients hospitalized between 2012 and 2013 years, 447 (232 males and 215 females) patients were diagnosed of renal and urinary tract diseases which forms 1.58% the total admitted patients. Among these patients 32.9% (147/447) were diagnosed Acute Kidney Injury (AKI); 24.1% (108/447): Urinary Tract Infection (UTI); 9.6% (43/447): Acute Glomerulonephritis (AGN); 5.6% (25/447): bilateral hydronephrosis with UTI; 4.47% (20/447): nephrotic syndrome (NS); 3.5% (16/447): haematuria; and 4% (18/447) were having CAKUT (Congenital Anomalies Of Kidney And Urinary Tract). In addition to this there were 17 cases of Renal Tubular Acidosis (RTA), 3 cases of Barter syndrome and one case of Liddle syndrome. Conclusion A substantial number of children are hospitalized with renal and urinary tract diseases with

  2. SLC25A19 mutation as a cause of neuropathy and bilateral striatal necrosis.

    PubMed

    Spiegel, Ronen; Shaag, Avraham; Edvardson, Simon; Mandel, Hanna; Stepensky, Polina; Shalev, Stavit A; Horovitz, Yoseph; Pines, Ophry; Elpeleg, Orly

    2009-09-01

    Four patients, aged 7-20 years, suffered from recurrent episodes of flaccid paralysis and encephalopathy associated with bilateral striatal necrosis and chronic progressive polyneuropathy. Using homozygosity mapping, a pathogenic missense mutation in the SLC25A19 gene that encodes the mitochondrial thiamine pyrophosphate transporter was identified. An SLC25A19 mutation was previously reported in Amish congenital lethal microcephaly but the present patients' phenotype is markedly different, with normal head circumference, normal early childhood development, age-appropriate cognitive skills, and normal urinary organic acid profile. Determination of the SLC25A19 sequence should be considered in patients with bilateral striatal necrosis and progressive polyneuropathy. PMID:19798730

  3. Simultaneous Bilateral Ophthalmic Artery Chemosurgery for Bilateral Retinoblastoma (Tandem Therapy)

    PubMed Central

    Abramson, David H.; Marr, Brian P.; Francis, Jasmine H.; Dunkel, Ira J.; Fabius, Armida W. M.; Brodie, Scott E.; Mondesire-Crump, Ijah; Gobin, Y. Pierre

    2016-01-01

    Objective Report on the 7-year experience with bilateral ophthalmic artery chemosurgery (OAC-Tandem therapy) for bilateral retinoblastoma. Design Retrospective, single institution study. Subjects 120 eyes of 60 children with bilateral retinoblastoma treated since March 2008. Methods Retrospective review of all children treated at Memorial Sloan Kettering with bilateral ophthalmic artery chemosurgery (Melphalan, Carboplatin, Topotecan, Methotrexate) delivered in the same initial session to both naïve and previously treated eyes. Main Outcome Measures Ocular survival, metastatic disease, patient survival from metastases, second cancers, systemic adverse effects, need for transfusion of blood products, electroretinogram before and after treatment. Results 116 eyes were salvaged (4 eyes were enucleated: 3 because of progressive disease, 1 family choice). Kaplan Meier ocular survival was 99.2% at one year, 96.9% at 2 and 3 years and 94.9% for years 4 through 7. There were no cases of metastatic disease or metastatic deaths with a mean follow-up of 3.01 years. Two children developed second cancers (both pineoblastoma) and one of them died. Transfusion of blood products was required in 3 cases (4 transfusions), 1.9%. Two children developed fever/neutropenia requiring hospitalization (0.95%). ERGs were improved in 21.6% and unchanged after treatment in 52.5% of cases (increase or decrease of less than 25μV). Conclusions Bilateral ophthalmic artery chemosurgery is a safe and effective technique for managing bilateral retinoblastoma-even when eyes are advanced bilaterally, and if both eyes have progressed after systemic chemotherapy. Ocular survival was excellent (94.9% at 8 years), there were no cases of of metastatic disease and no deaths from metastatic disease, but children remain at risk for second cancers. In 21.6% of cases ERG function improved. Despite using chemotherapy in both eyes in the same session, systemic toxicity was low. PMID:27258771

  4. A Case of Delayed Diagnosis of Bilateral Ureteral and Bladder Injury after Laparoscopic Hysterectomy: An Unusual Complication

    PubMed Central

    Goris-Gbenou, Maximilien C.; Arfi, Nicolas; Mitach, Abdel; Rashed, Sheer; Lopez, Jean-Gabriel

    2012-01-01

    The incidence of ureteral and bladder lesions after laparoscopic hysterectomy is the most encountered urinary complication in gynaecological surgery. We report the unusual case of 42-year-old woman who had a delayed diagnosis of bilateral ureteral injury associated with bladder lesion and loose of vaginal suture after undergoing laparoscopic hysterectomy for uterine adenomyosis. PMID:23198267

  5. A Case of Simultaneous Bilateral Anterior Shoulder Dislocation

    PubMed Central

    Patil, Mallanagouda N

    2013-01-01

    Introduction: Anterior dislocation of shoulder is commonest dislocation one encounters in day to day Orthopaedic practice. But bilateral shoulder dislocations are relatively uncommon frequently posterior and secondary to violent muscle contraction. Simultaneous bilateral anterior dislocations of shoulder following trauma is rare occurrence. Case Report: 35 year old male presented to emergency department with history fall by tripping on a stone (fall on outstretched hand). He complained of pain and difficulty in moving both the shoulders. On clinical examination, patient's both upper limbs were abducted and externally rotated. Bilaterally shoulder contour was lost with flattening. Other classical signs of shoulder dislocation viz, Bryants test, Callway sign, Hamilton's ruler test were positive. Diagnosis was confirmed on X rays. Both shoulders were reduced in emergency operation theater under general anaesthesia by Kocher's method and were immobilised in sling. Conclusion: Though bilateral shoulder dislocations are commonly posterior, usually either secondary to convulsions or electric shock, anterior dislocation has to be kept in mind , especially in post traumatic injuries. This bilateral dislocation also presents with practical problems immobilization and day to day care of patients. PMID:27298905

  6. [Non-vascular interventional radiology nonvascular interventional radiology of the urinary tract].

    PubMed

    Miki, M

    1989-08-01

    Several kinds of nonvascular interventional radiology of the urinary tract are reviewed. Transurethral balloon dilation of the prostate (TU-DP) is a newly developed nonsurgical treatment for benign prostate hyperplasia, which is performed under local anesthesia with minimal morbidity and requires no hospitalization. The TUDP technique involves dilating the prostatic urethra and bladder neck to 75 F for 10 minutes under fluoroscopic control using a high-pressure dilating balloon. Long-term follow-up studies are required. Percutaneous nephrolithotomy (PNL) and transurethral ureterolithotomy (TUL) have signified a revolution in stone surgery of upper urinary tract. Indications for these treatments, endoscopic manipulation, complications and their clinical features are presented. The procedure of PNL consists of 3 steps, puncture for nephrostomy tract, tract dilation and stone removal. Among these steps the most important is the puncture and it should be effected through the calyx. During the operation, if there is too much bleeding, it can be discontinued at any time while keeping the track open. It is no longer necessary for the kidney to be free of stones at the end of the operation. TUL is performed with a rigid or flexible ureterorenoscope. Dilation of the ureteral orifice and the intramural ureter is necessary for passing the scopes. When they have been sufficiently dilated, the ureterorenoscope can be passed to the level of the renal pelvis through the urethra. Calculi have been removed successfully at a higher rate in lower ureter. Endopyelotomy may be performed safely as an initial procedure to correct congenital obstruction of the ureteropelvic junction. Recent advancements have permitted an approach to percutaneous resection for renal pelvic tumor in a solitary kidney or bilateral synchronous disease. There are great expectations for continuing important innovations in the field of interventional radiology. PMID:2476077

  7. Urinary Adiponectin Excretion

    PubMed Central

    von Eynatten, Maximilian; Liu, Dan; Hock, Cornelia; Oikonomou, Dimitrios; Baumann, Marcus; Allolio, Bruno; Korosoglou, Grigorios; Morcos, Michael; Campean, Valentina; Amann, Kerstin; Lutz, Jens; Heemann, Uwe; Nawroth, Peter P.; Bierhaus, Angelika; Humpert, Per M.

    2009-01-01

    OBJECTIVE Markers reliably identifying vascular damage and risk in diabetic patients are rare, and reports on associations of serum adiponectin with macrovascular disease have been inconsistent. In contrast to existing data on serum adiponectin, this study assesses whether urinary adiponectin excretion might represent a more consistent vascular damage marker in type 2 diabetes. RESEARCH DESIGN AND METHODS Adiponectin distribution in human kidney biopsies was assessed by immunohistochemistry, and urinary adiponectin isoforms were characterized by Western blot analysis. Total urinary adiponectin excretion rate was measured in 156 patients with type 2 diabetes who had a history of diabetic nephropathy and 40 healthy control subjects using enzyme-linked immunosorbent assay. Atherosclerotic burden was assessed by common carotid artery intima-media-thickness (IMT). RESULTS A homogenous staining of adiponectin was found on the endothelial surface of glomerular capillaries and intrarenal arterioles in nondiabetic kidneys, whereas staining was decreased in diabetic nephropathy. Low-molecular adiponectin isoforms (∼30–70 kDa) were detected in urine by Western blot analysis. Urinary adiponectin was significantly increased in type 2 diabetes (7.68 ± 14.26 vs. control subjects: 2.91 ± 3.85 μg/g creatinine, P = 0.008). Among type 2 diabetic patients, adiponectinuria was associated with IMT (r = 0.479, P < 0.001) and proved to be a powerful independent predictor of IMT (β = 0.360, P < 0.001) in multivariable regression analyses. In a risk prediction model including variables of the UK Prospective Diabetes Study coronary heart disease risk engine urinary adiponectin, but not the albumin excretion rate, added significant value for the prediction of increased IMT (P = 0.007). CONCLUSIONS Quantification of urinary adiponectin excretion appears to be an independent indicator of vascular damage potentially identifying an increased risk for vascular events. PMID:19509019

  8. MedlinePlus: Urinary Incontinence

    MedlinePlus

    ... Also in Spanish Stress incontinence Also in Spanish Suprapubic catheter care Also in Spanish Urge incontinence Also in ... catheterization - male Skin care and incontinence Stress incontinence Suprapubic catheter care Urge incontinence Urinary catheters Urinary catheters - what ...

  9. Feline Lower Urinary Tract Disease

    MedlinePlus

    ... gland) can cause lower urinary tract disease in cats. Although they are much less common causes, FLUTD ... your veterinarian about the best diet for your cat. Many commercial diets are acceptable, but some urinary ...

  10. Urinary incontinence - vaginal sling procedures

    MedlinePlus

    ... types of surgeries that help control stress urinary incontinence . This is urine leakage that happens when you ... sling procedures are done to treat stress urinary incontinence. Before discussing surgery, your doctor will have you ...

  11. Surgery for Stress Urinary Incontinence

    MedlinePlus

    ... Education FAQs Surgery for Stress Urinary Incontinence Patient Education Pamphlets - Spanish Surgery for Stress Urinary Incontinence FAQ166, July 2014 ... Your Practice Patient Safety & Quality Payment Reform (MACRA) Education & Events Annual ... Pamphlets Teen Health About ACOG About Us Leadership & ...

  12. Urinary incontinence - vaginal sling procedures

    MedlinePlus

    ... this page: //medlineplus.gov/ency/article/007376.htm Urinary incontinence - vaginal sling procedures To use the sharing features ... are types of surgeries that help control stress urinary incontinence . This is urine leakage that happens when you ...

  13. Urinary incontinence surgery - female - discharge

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000134.htm Urinary incontinence surgery - female - discharge To use the sharing features ... Blaivas JM, Gormley EA, et al; Female Stress Urinary Incontinence Update Panel of the American Urological Association Education ...

  14. Dual arm master controller for a bilateral servo-manipulator

    DOEpatents

    Kuban, Daniel P.; Perkins, Gerald S.

    1989-01-01

    A master controller for a mechanically dissimilar bilateral slave servo-manipulator is disclosed. The master controller includes a plurality of drive trains comprising a plurality of sheave arrangements and cables for controlling upper and lower degrees of master movement. The cables and sheaves of the master controller are arranged to effect kinematic duplication of the slave servo-manipulator, despite mechanical differences therebetween. A method for kinematically matching a master controller to a slave servo-manipulator is also disclosed.

  15. Observations on Genito-urinary Tuberculosis

    PubMed Central

    Carver, James

    1937-01-01

    Early and reliable diagnosis is obtained by cultural methods. Pyelographic evidence of renal destruction is necessary as a rule to supplement the positive laboratory findings before resorting to nephrectomy. Bilateral renal tuberculosis should not be diagnosed on the findings of cystoscopy alone. Nephro-ureterectomy is the ideal operation. It prevents the prolongation of the bladder symptoms and the breaking-down of the operation wound and the risk of another operation for the removal of the ureter, not forgetting the danger of infection of the other kidney. Bad results are probably due, in the case of poor patients, to economic and sociological factors which interfere with restoration to health after operation. Genito-urinary tuberculosis is to be regarded not as a localized disorder but as a manifestation of a generalized disease, a fact which necessitates a guarded prognosis and prolonged after-treatment. ImagesFig. 1Fig. 2Fig. 3Fig. 4 PMID:19991279

  16. Stress urinary incontinence.

    PubMed

    Nygaard, Ingrid E; Heit, Michael

    2004-09-01

    Stress urinary incontinence, the complaint of involuntary leakage during effort or exertion, occurs at least weekly in one third of adult women. The basic evaluation of women with stress urinary incontinence includes a history, physical examination, cough stress test, voiding diary, postvoid residual urine volume, and urinalysis. Formal urodynamics testing may help guide clinical care, but whether urodynamics improves or predicts the outcome of incontinence treatment is not yet clear. The distinction between urodynamic stress incontinence associated with hypermobility and urodynamic stress incontinence associated with intrinsic sphincter deficiency should be viewed as a continuum, rather than a dichotomy, of urethral function. Initial treatment should include behavioral changes and pelvic floor muscle training. Estrogen is not indicated to treat stress urinary incontinence. Bladder training, vaginal devices, and urethral inserts also may reduce stress incontinence. Bulking agents reduce leakage, but effectiveness generally decreases after 1-2 years. Surgical procedures are more likely to cure stress urinary incontinence than nonsurgical procedures but are associated with more adverse events. Based on available evidence at this time, colposuspension (such as Burch) and pubovaginal sling (including the newer midurethral synthetic slings) are the most effective surgical treatments. PMID:15339776

  17. Urinary Tract Infections.

    ERIC Educational Resources Information Center

    Plummer, Nancy; Michael, Nancy, Ed.

    This module on urinary tract infections is intended for use in inservice or continuing education programs for persons who administer medications in long-term care facilities. Instructor information, including teaching suggestions, and a listing of recommended audiovisual materials and their sources appear first. The module goal and objectives are…

  18. [Urinary catheter biofilm infections].

    PubMed

    Holá, V; Růzicka, F

    2008-04-01

    Urinary tract infections, most of which are biofilm infections in catheterized patients, account for more than 40% of hospital infections. Bacterial colonization of the urinary tract and catheters causes not only infection but also other complications such as catheter blockage by bacterial encrustation, urolithiasis and pyelonephritis. About 50% of long-term catheterized patients face urinary flow obstruction due to catheter encrustation, but no measure is currently available to prevent it. Encrustation has been known either to result from metabolic dysfunction or to be of microbial origin, with urease positive bacterial species implicated most often. Infectious calculi account for about 15-20% of all cases of urolithiasis and are often associated with biofilm colonization of a long-term indwelling urinary catheter or urethral stent. The use of closed catheter systems is helpful in reducing such problems; nevertheless, such a system only delays the inevitable, with infections emerging a little later. Various coatings intended to prevent the bacterial adhesion to the surface of catheters and implants and thus also the emergence of biofilm infections, unfortunately, do not inhibit the microbial adhesion completely and permanently and the only reliable method for biofilm eradication remains the removal of the foreign body from the patient. PMID:18578409

  19. Recurrent Urinary Tract Infections Management in Women

    PubMed Central

    Al-Badr, Ahmed; Al-Shaikh, Ghadeer

    2013-01-01

    Urinary tract infections (UTIs) are one of the most frequent clinical bacterial infections in women, accounting for nearly 25% of all infections. Around 50–60% of women will develop UTIs in their lifetimes. Escherichia coli is the organism that causes UTIs in most patients. Recurrent UTIs (RUTI) are mainly caused by reinfection by the same pathogen. Having frequent sexual intercourse is one of the greatest risk factors for RUTIs. In a subgroup of individuals with coexisting morbid conditions, complicated RUTIs can lead to upper tract infections or urosepsis. Although the initial treatment is antimicrobial therapy, use of different prophylactic regimens and alternative strategies are available to reduce exposure to antibiotics. PMID:23984019

  20. Bilateral carotid and bilateral vertebral artery dissection following facial massage.

    PubMed

    Chakrapani, Andrea L; Zink, Walter; Zimmerman, Robert; Riina, Howard; Benitez, Ronald

    A 50-year-old woman underwent facial massage. After 13 days, she experienced left retro-orbital pain, ptosis, and miosis. Magnetic resonance imaging (MRI) showed stenotic dissection of bilateral cervical internal carotid and vertebral arteries. The intracranial vasculature was intact. She was treated conservatively with long-term oral anticoagulation and remains asymptomatic 18 months later. PMID:18388028

  1. Bilateral iliopsoas abscess associated with right hip septic arthritis in a neonate.

    PubMed

    Al-Zaiem, Maher M; Bajuifer, Salem J; Fattani, Mohammed O; Al-Zaiem, Feras M

    2014-07-01

    Iliopsoas abscess is a very rare pathology in the neonatal period. There is a lack of reports in the literature on bilateral psoas abscess with hip joint arthritis. We report a case of bilateral iliopsoas abscess with concomitant right hip septic arthritis, caused by methicillin-resistant Staphylococcus aureus in a 28-day-old male infant. The baby presented with bilateral diffuse swelling of the groins and upper thighs. He was treated successfully by ultrasound-guided percutaneous drainage along with systemic antibiotic therapy. Clinical improvement was observed within 24-48 hours of drainage. PMID:25028234

  2. Acute Urinary Retention in a 47-month-old Girl Caused by the Giant Fecaloma

    PubMed Central

    Park, Ji Sook; Park, Tae-Jin; Hwa, Jung Seok; Park, Chan-Hoo; Youn, Hee-Shang

    2013-01-01

    We present a case of a 47-month-old female suffering from acute urinary bladder neck obstruction and bilateral hydronephrosis secondary to a fecaloma. Fecaloma is defined as an accumulation of inspissated feces in the colon or rectum giving the appearance of an abdominal mass. A fecaloma can be developed by diverse causes and the causes of the fecaloma in this case were septum reformation after the Duhamel procedure and long-term constipation. Chronic constipation is very common at outpatient clinic. However, acute urinary retention and voiding difficulty caused by fecaloma in the giant Duhamel pouch has never been reported in Korea. We would like to present our case with acute urinary retention due to a fecaloma and suggest that fecaloma might be considered as one of the causes for acute urinary retention, especially in cases with previous Duhamel operation for repair of Hischsprung disease. PMID:24224155

  3. [Therapy of lower urinary tract infections in children].

    PubMed

    Principi, N; Viganò, A; Dalla Villa, A; Tommasi, P

    1988-01-01

    Infection of the urinary tract has been described for nearly two centuries, yet the diagnosis, localization of infection, outcome, and management of UTI continue to generate significant problems. The two basic aims of treatment of UTI are the relief of symptoms and the prevention, or at least limitation, of damage to the renal parenchyma. The initial choice of an antimicrobial in the patient with a suspected UTI is based on knowledge of the expected organisms and their antimicrobial susceptibilities. The spectrum of urinary pathogens and their antibiotic susceptibility patterns in our geographical area are presented. Moreover therapeutic regimens in the treatment of upper and lower UTI are discussed. PMID:3241749

  4. Urinary Tract Endometriosis.

    PubMed

    Kołodziej, Anna; Krajewski, Wojciech; Dołowy, Łukasz; Hirnle, Lidia

    2015-01-01

    Recently, occurrence of urinary tract endometriosis (UTE) is more frequently diagnosed. According to literature, it refers to approximately 0.3 to even 12% of all women with endometriosis. The pathogenesis of UTE has not been clearly explained so far. The actually proposed hypotheses include embryonic, migration, transplantation, and iatrogenic theory. Most frequently UTE affects bladder, less often ureters and kidneys. One-third of patients remains asymptomatic or exhibits only minor manifestations. In symptomatic patients main complaints include dysuria, urinary urgency, and/or frequency, painful micturition, and burning sensation in the urethra and discomfort in the retropubic area. Treatment of UTE is challenging and can be pharmacological, surgical or can be a combination of both methods. In this paper we present a review of the literature concerning the UTE, its diagnosis and treatment. PMID:26341760

  5. Neonatal Staphylococcus lugdunensis urinary tract infection.

    PubMed

    Hayakawa, Itaru; Hataya, Hiroshi; Yamanouchi, Hanako; Sakakibara, Hiroshi; Terakawa, Toshiro

    2015-08-01

    Staphylococcus lugdunensis is a known pathogen of infective endocarditis, but not of urinary tract infection. We report a previously healthy neonate without congenital anomalies of the kidney and urinary tract who developed urinary tract infection due to Staphylococcus lugdunensis, illustrating that Staphylococcus lugdunensis can cause urinary tract infection even in those with no urinary tract complications. PMID:26177232

  6. [Urinary calculi and infection].

    PubMed

    Trinchieri, Alberto

    2014-01-01

    Infection urinary stones resulting from urease-producing bacteria are composed by struvite and/or carbonate apatite. Bacterial urease splits urea and promotes the formation of ammonia and carbon dioxide leading to urine alkalinization and formation of phosphate salts. Proteus species are urease-producers, whereas a limited number of strains of other Gram negative and positive species may produce urease. Ureaplasma urealyticum and Corynebacterium urealyticum are urease-producers that are not isolated by conventional urine cultures, but require specific tests for identification. Primary treatment requires surgical removal of stones as complete as possible. Extracorporeal and endoscopic treatments are usually preferred, while open surgery is actually limited to few selected cases. Residual stones or fragments should be treated by chemolysis via ureteral catheter or nephrostomy or administration of citrate salts in order to achieve a stone-free renal unit. Postoperatively, recurrent urinary tract infection should be treated with appropriate antibiotic treatment although long-term antibiotic prophylaxis can cause resistance. Urinary acidification has been proposed for the prophylaxis of infection stones, but long-term acidification is difficult to achieve in urine infected by urease-producing bacteria. Urease inhibitors lead to prevention and/or dissolution of stones and encrustations in patients with infection by urea-splitting bacteria, but their use is limited by their toxicity. The administration of citrate salts involves an increase of the value of nucleation pH (pHn), that is the pH value at which calcium and magnesium phosphate crystallization occurs, in a greater way than the corresponding increase in the urinary pH due to its alkalinizing effect and resulting in a reduction of the risk of struvite crystallization. In conclusion prevention of the recurrence of infection stones can be achieved by an integrated approach tailored on the single patient. Complete

  7. [Urinary complications after anorectal surgery].

    PubMed

    Iusuf, T; Sârbu, V; Cristache, C; Popescu, R; Botea, F; Panait, L

    2000-01-01

    The prevalence of urinary complications after various anorectal operations was studied in a group of 273 patients. The overall prevalence of urinary complications was 26.7%; most of these complications affected men between 41 and 50, mainly after hemorrhoidectomy. In 10.6% of patients, bladder catheterization was needed. These urinary complications result from nervous reflexes originating from the anus and determined by the operative trauma and/or rectal distinction. In the treatment of these urinary complications, the role of the muses is essential for reassuring the patients. Parasympathomimetic drugs are often efficient. Urinary catheterization must be delayed until the 18th hour. Fluid restriction may be useful to prevent urinary retention. PMID:14870531

  8. Bilateral supernumerary kidneys: how much is too much?

    PubMed

    Patel, Ruchir; Singh, Hanish; Willens, David; Drake, Sean

    2014-01-01

    A middle aged African-American woman with a stable history of carnitine palmitoyl transferase II (CPT II) deficiency presented with myalgias for 1 week. Physical examination and laboratory findings were consistent with severe sepsis secondary to pyelonephritis leading to rhabdomyolysis. Subsequent CT of the abdomen revealed bilateral supernumerary kidneys with non-obstructive calculi within the supernumerary kidneys. Abnormal ureteral development of the supernumerary kidneys likely led to an increased risk for urinary tract infections (UTIs) and renal calculi resulting in pyelonephritis. The stress of this infection overwhelmed the muscle CPT II enzyme load, putting her in a state of rhabdomyolysis. In addition to fluids and antibiotics, she was provided a diet rich in carbohydrates and low in fats so as to limit long-chain fatty acid oxidation. Supernumerary nephrectomy was not considered during this admission. During follow-up, she developed obstructive ureteral calculi requiring placement of a right-sided ureteral stent. PMID:24692375

  9. Bilateral supernumerary kidneys: how much is too much?

    PubMed Central

    Patel, Ruchir; Singh, Hanish; Willens, David; Drake, Sean

    2014-01-01

    A middle aged African-American woman with a stable history of carnitine palmitoyl transferase II (CPT II) deficiency presented with myalgias for 1 week. Physical examination and laboratory findings were consistent with severe sepsis secondary to pyelonephritis leading to rhabdomyolysis. Subsequent CT of the abdomen revealed bilateral supernumerary kidneys with non-obstructive calculi within the supernumerary kidneys. Abnormal ureteral development of the supernumerary kidneys likely led to an increased risk for urinary tract infections (UTIs) and renal calculi resulting in pyelonephritis. The stress of this infection overwhelmed the muscle CPT II enzyme load, putting her in a state of rhabdomyolysis. In addition to fluids and antibiotics, she was provided a diet rich in carbohydrates and low in fats so as to limit long-chain fatty acid oxidation. Supernumerary nephrectomy was not considered during this admission. During follow-up, she developed obstructive ureteral calculi requiring placement of a right-sided ureteral stent. PMID:24692375

  10. Bilaterally impacted mandibular supernumerary premolars associated with unusual clinical complications

    PubMed Central

    Pasha, Zameer; Choudhari, Sameer; Rathod, Azhar; Sulabha, A. N.

    2013-01-01

    Supernumerary teeth are extra teeth in comparison to the normal dentition. Their prevalence varies between 0.1% and 3.8%. Supernumeraries are more common in permanent dentition and its incidence is higher in maxillary incisor region, followed by maxillary third molar and mandibular molar, premolar, canine, and lateral incisor. The prevalence of supernumerary premolars is between 0.075-0.26%, and they may occur in single or multiple numbers Bilateral occurrence is uncommon and large percentage of supernumerary premolars remains impacted, unerupted, and usually asymptomatic; radiograph plays an important role in diagnosis of these. The present paper reports a case of bilaterally impacted completely developed supernumerary premolars associated with common clinical complication in unusual manner along with taurodontism of the upper and lower molars. PMID:23833524

  11. Bilateral diabetic thigh muscle infarction.

    PubMed

    Barohn, R J; Bazan, C; Timmons, J H; Tegeler, C

    1994-01-01

    A 19-year-old woman with insulin-dependent diabetes mellitus developed pain and tenderness in the medial aspect of the left thigh and calf, followed 1 week later by similar symptoms in the right leg. Technetium 99m pyrophosphate (PYP) radionuclide scans showed increased flow and uptake in the medial thigh muscles. Magnetic resonance imaging (MRI) of the thigh showed increased signal on proton density and T2-weighted images in the medial and lateral thigh compartments. High-resolution B-mode ultrasound showed hyperechoic changes in the anteromedial thigh muscles, with loss of normal myofascial interfaces, and a mixed appearance, bilaterally. Two months later, after the symptoms had begun to resolve, the images had improved. This case documents bilateral diabetic thigh infarction identified by abnormal technetium 99m PYP flow studies, MRI signal, and B-mode ultrasound imaging. PMID:8136579

  12. Bilateral posterior cerebral artery infarction.

    PubMed

    Ryan, Davinia; Murphy, Sinead M; Hennessey, Michael J

    2010-01-01

    We report the case of a 70-year-old man who presented with short-term memory impairment and a homonymous left inferior quadrantanopia secondary to simultaneous bilateral posterior cerebral artery (PCA) territory infarction. As in more than a quarter of cases of PCA infarction, no aetiological cause was identified. Unlike the transient nature of symptoms in some cases following unilateral infarction, his deficits persisted on 2-month follow-up. PMID:22798298

  13. Compensation Following Bilateral Vestibular Damage

    PubMed Central

    McCall, Andrew A.; Yates, Bill J.

    2011-01-01

    Bilateral loss of vestibular inputs affects far fewer patients than unilateral inner ear damage, and thus has been understudied. In both animal subjects and human patients, bilateral vestibular hypofunction (BVH) produces a variety of clinical problems, including impaired balance control, inability to maintain stable blood pressure during postural changes, difficulty in visual targeting of images, and disturbances in spatial memory and navigational performance. Experiments in animals have shown that non-labyrinthine inputs to the vestibular nuclei are rapidly amplified following the onset of BVH, which may explain the recovery of postural stability and orthostatic tolerance that occurs within 10 days. However, the loss of the vestibulo-ocular reflex and degraded spatial cognition appear to be permanent in animals with BVH. Current concepts of the compensatory mechanisms in humans with BVH are largely inferential, as there is a lack of data from patients early in the disease process. Translation of animal studies of compensation for BVH into therapeutic strategies and subsequent application in the clinic is the most likely route to improve treatment. In addition to physical therapy, two types of prosthetic devices have been proposed to treat individuals with bilateral loss of vestibular inputs: those that provide tactile stimulation to indicate body position in space, and those that deliver electrical stimuli to branches of the vestibular nerve in accordance with head movements. The relative efficacy of these two treatment paradigms, and whether they can be combined to facilitate recovery, is yet to be ascertained. PMID:22207864

  14. Urinary extracellular microvesicles: isolation methods and prospects for urinary proteome.

    PubMed

    Wang, Danqi; Sun, Wei

    2014-08-01

    Extracellular microvesicles (EVs) are membranous vesicles, which are released from diverse cells. These EVs have also been found in a wide range of body fluids. The cargo of EVs, including proteins, lipids, carbohydrates, and nucleic acids, can be stably preserved in EVs. Researchers have found that EVs can mediate intercellular communication by shuttling the cargo components. Therefore, EVs can be used for the identification of disease-specific biomarkers. As one class of EVs, urinary exosomes can reflect the status of the renal system. Moreover, urinary exosome analysis can minimize the interference of high abundant proteins in the whole urine sample. Therefore, urinary exosomes have gained much attention in recent years. In this review, we present a comprehensive summary of urinary exosome studies in recent years, including collection, storage, and isolation methods. The normal and disease proteomic analyses of urinary exosomes are also presented. Thus, this review may provide a valuable reference for future research. PMID:24962155

  15. Prosthetic urinary sphincter

    NASA Technical Reports Server (NTRS)

    Helms, C. R.; Smyly, H. M. (Inventor)

    1981-01-01

    A pump/valve unit for controlling the inflation and deflation of a urethral collar in a prosthetic urinary sphincter device is described. A compressible bulb pump defining a reservoir was integrated with a valve unit for implantation. The valve unit includes a movable valve member operable by depression of a flexible portion of the valve unit housing for controlling fluid flow between the reservoir and collar; and a pressure sensing means which operates the valve member to relieve an excess pressure in the collar should too much pressure be applied by the patient.

  16. [Urinary antimicrobial prophylaxis].

    PubMed

    Nathanson, S; Deschênes, G

    2002-05-01

    Antibiotics are usually used to prevent childhood recurrent urinary tract infections: cystitis or pyelonephritis. The mechanism of action of these antibiotics, although imperfectly known, seems to be double: the antibiotic acts by its bactericidal effect, but also probably for minimal concentrations by reducing adhesion capability of bacteria to the urothelium. The most commonly used molecules are cotrimoxazole, trimethoprime, pivmecillinam, cefaclor and nalidixic acid. However all have not been studied rigorously as for their prophylactic capacity, and in particular very little is known for patients presenting with vesico-ureteral reflux. PMID:12053547

  17. Urogynecologic conditions: urinary incontinence.

    PubMed

    Kelley, Robert; Garely, Alan D

    2015-03-01

    Urinary incontinence (UI), the leakage of urine, is a condition that frequently goes untreated. There are many different types of UI, including stress and urge UI, and the etiology is multifactorial. Diagnosis can be made with a pertinent history, including use of a questionnaire; a pelvic examination; and direct observation. Additional testing can include physical maneuvers to elicit stress leakage and urodynamic studies. Treatment ranges from pelvic floor exercise to surgical support of the pelvic floor for stress UI and, typically, behavioral therapy and/or pharmacotherapy, starting with antimuscarinic drugs, for urge UI. PMID:25756372

  18. Urinary tuberculosis: modern issues.

    PubMed

    Wise, Gilbert J

    2009-07-01

    Tuberculosis remains an epidemic that affects one third of the world's population. The persistence of this disease is caused by a large pool of immune-compromised and lower socioeconomic populations. The advent of rapid transportation and migration has contributed to the persistence of this disease in developed and less developed nations. The emergence of drug-resistant strains has added an additional factor for the pervasiveness of tuberculosis. The genitourinary system is a primary target for hematogenous infections. This paper reviews the contemporary issues that affect the diagnosis and treatment of urinary tuberculosis. PMID:19570494

  19. Multiresolution Bilateral Filtering for Image Denoising

    PubMed Central

    Zhang, Ming; Gunturk, Bahadir K.

    2008-01-01

    The bilateral filter is a nonlinear filter that does spatial averaging without smoothing edges; it has shown to be an effective image denoising technique. An important issue with the application of the bilateral filter is the selection of the filter parameters, which affect the results significantly. There are two main contributions of this paper. The first contribution is an empirical study of the optimal bilateral filter parameter selection in image denoising applications. The second contribution is an extension of the bilateral filter: multiresolution bilateral filter, where bilateral filtering is applied to the approximation (low-frequency) subbands of a signal decomposed using a wavelet filter bank. The multiresolution bilateral filter is combined with wavelet thresholding to form a new image denoising framework, which turns out to be very effective in eliminating noise in real noisy images. Experimental results with both simulated and real data are provided. PMID:19004705

  20. Approach to the male patient with lower urinary tract dysfunction.

    PubMed

    Wyndaele, Jean Jacques; Vodušek, David B

    2015-01-01

    History and physical examination are the cornerstones of evaluation of the male patient with lower urinary tract (LUT) symptoms and (suspected) neurologic disorder, both to diagnose the nervous system lesion, and to get insight into the type of LUT dysfunction (LUTD). Non-neurologic LUTD needs to be ruled out. Laboratory testing is necessary to diagnose urinary infection. In those in whom neurogenic LUTD is probable, postvoid residual urine and urinary flow measurement generally rule out significant outflow obstruction and allow for basic symptomatic management. If symptomatology is complex or severe, or the pathophysiology uncertain, or invasive treatment planned, urodynamic or videourodynamic measurements should be performed to inform on bladder sensation, detrusor contractility, pressures generated in the bladder, as well as the behavior of bladder neck, the striated urethral sphincter, and urinary flow. This information is paramount to the clinician to plan management and consider prognosis. Assessment needs to be repeated, as chronic neurogenic LUTD is not a stable condition; in progressive neurologic diseases the nature of LUTD itself may change. The upper urinary tract needs to be checked and followed up regularly, particularly in patient groups in which high intravesical pressures may be generated. PMID:26003243

  1. Bilateral sacrospinous fixation without hysterectomy: 18-month follow-up

    PubMed Central

    Şentürk, Mehmet Baki; Güraslan, Hakan; Çakmak, Yusuf; Ekin, Murat

    2015-01-01

    Objective The aim of this study was to evaluate the results of bilateral sacrospinous fixation (SSF), which was performed with surgical mesh interposition and bilateral vaginal repair. Material and Methods Twenty-two patients underwent SSF between 2010 and 2012, and the results were evaluated retrospectively. The results at preoperative and postoperative 6th, 12th, and 18th months of the pelvic organ prolapse quantification system (POP-Q) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) were compared using Friedman and Wilcoxon Signed Ranks tests. Values of p<0.05 and <0.01 were considered statistically significant. Results According to the POP-Q, significant healing was observed on all vaginal vault points (p=0.001), and no prolapse was observed until the 18-month follow-up stage. There were also prominent patients who felt satisfactory with respect to their sexual life according to PISQ-12 (p=0.001). Conclusion This technique appears to provide an adequate clinical resolution, and it may be the primary surgical option for women with pelvic organ prolapse. PMID:26097393

  2. Analysis of ipsilateral and bilateral ratios in male amateur golfers

    PubMed Central

    Song, Jae-Yoon; Park, Jae-Wan; Lee, Chan-Bok; Eun, Denny; Jang, Jung-Hoon; Lee, Ho-Jin; Hyun, Gwang-Suk; Park, Jung-Min; Cha, Jun-Youl; Cho, Nam-Heung; Ko, Il-Gyu; Jin, Jun-Jang; Jin, Yong-Yun; Ham, Do-Woong; Jee, Yong-Seok

    2016-01-01

    The number of injuries that force golfers to quit is also increasing. In particular, the upper body injuries are concerns for amateur golfers. This study was conducted not only to investigate muscular balance, such as ipsilateral and bilateral ratios of the upper body, but to also evaluate the possible problems of muscular joints in amateur golfers. Male golfers (n=10) and a healthy control group (n=10) were recruited for the assessment of muscular function in the upper body, which was measured by an isokinetic dynamometer at 60°/sec. The tested parts were trunk, wrist, forearm, elbow, and shoulder joints. Mann–Whitney U-test was used to evaluate the significance of the differences between groups. The ipsilateral ratios of peak torque or work per repetition (WR) of trunk flexor and extensor in the golfers were not significantly different compared to those of the control group. These results were similar to the shoulder horizontal abductor and adductor. However, there were significant differences in the ipsilateral and bilateral ratios of the wrist, forearm, and elbow joints. Especially, the WR of the wrist flexor, forearm pronator, and elbow flexor on the left side of amateur golfers showed imbalances in bilateral ratios. Moreover, the WR of the wrist and elbow flexors on the left side of amateur golfers were lower than those of the wrist and elbow extensors. Therefore, amateur golfers should strive to prevent injuries of the wrist, forearm, and elbow joints and to reinforce the endurance on those parts of the left side. PMID:27162771

  3. Analysis of ipsilateral and bilateral ratios in male amateur golfers.

    PubMed

    Song, Jae-Yoon; Park, Jae-Wan; Lee, Chan-Bok; Eun, Denny; Jang, Jung-Hoon; Lee, Ho-Jin; Hyun, Gwang-Suk; Park, Jung-Min; Cha, Jun-Youl; Cho, Nam-Heung; Ko, Il-Gyu; Jin, Jun-Jang; Jin, Yong-Yun; Ham, Do-Woong; Jee, Yong-Seok

    2016-04-01

    The number of injuries that force golfers to quit is also increasing. In particular, the upper body injuries are concerns for amateur golfers. This study was conducted not only to investigate muscular balance, such as ipsilateral and bilateral ratios of the upper body, but to also evaluate the possible problems of muscular joints in amateur golfers. Male golfers (n=10) and a healthy control group (n=10) were recruited for the assessment of muscular function in the upper body, which was measured by an isokinetic dynamometer at 60°/sec. The tested parts were trunk, wrist, forearm, elbow, and shoulder joints. Mann-Whitney U-test was used to evaluate the significance of the differences between groups. The ipsilateral ratios of peak torque or work per repetition (WR) of trunk flexor and extensor in the golfers were not significantly different compared to those of the control group. These results were similar to the shoulder horizontal abductor and adductor. However, there were significant differences in the ipsilateral and bilateral ratios of the wrist, forearm, and elbow joints. Especially, the WR of the wrist flexor, forearm pronator, and elbow flexor on the left side of amateur golfers showed imbalances in bilateral ratios. Moreover, the WR of the wrist and elbow flexors on the left side of amateur golfers were lower than those of the wrist and elbow extensors. Therefore, amateur golfers should strive to prevent injuries of the wrist, forearm, and elbow joints and to reinforce the endurance on those parts of the left side. PMID:27162771

  4. Simultaneous bilateral robotic-assisted laparoscopic procedures in children.

    PubMed

    Kapoor, Victor; Elder, Jack S

    2015-12-01

    Our main objective is to report the feasibility of performing simultaneous robotic-assisted laparoscopic (RAL) heminephrectomy with contralateral ureteroureterostomy in children with bilateral duplicated systems. Three female children with bilateral congenital renal/ureteral anomalies underwent concurrent RAL simultaneous unilateral partial nephrectomy with ureterectomy and contralateral ureteroureterostomy with redundant ureterectomy using a four/five-port approach. Mean age at repair was 32.9 months (range 7-46 months) and mean weight was 13.7 kg (range 10.4-13.6 kg). The RAL heminephroureterectomy and contralateral ureteroureterostomy were performed via a four-port approach (five ports in one patient), and the patients were repositioned and draped when moving to the other side. Mean operative time was 446 min (range 356-503 min). Mean estimated blood loss was 23.3 cc (range 10-50 cc). Postoperative length of stay for two patients was 2 days and 1 day for one patient (mean = 1.7 days). Mean length of follow-up was 18.3 months (range 7-36 months). No significant intraoperative or postoperative complications occurred for any of the three patients. Two children had no hydronephrosis on postoperative imaging in follow-up, and one child had a small stable, residual pararenal fluid collection on the side of heminephrectomy. Two patients underwent postoperative ureteral stent removal under general anesthesia. In children with bilateral duplicated urinary tract with ureterocele, ectopic ureter, and/or vesicoureteral reflux, laparoscopic repair with robotic assistance can be accomplished safely in a single operative procedure with a short hospital stay. PMID:26530838

  5. Dual arm master controller for a bilateral servo-manipulator

    SciTech Connect

    Kuban, D.P.; Perkins, G.S.

    1989-11-28

    A master controller for a mechanically dissimilar bilateral slave servo-manipulator is disclosed. The master controller includes a plurality of drive trains comprising a plurality of sheave arrangements and cables for controlling upper and lower degrees of master movement. The cables and sheaves of the master controller are arranged to effect kinematic duplication of the slave servo-manipulator, despite mechanical differences there between. A method for kinematically matching a master controller to a slave servo-manipulator is also disclosed. 13 figs.

  6. Post-traumatic segmental myoclonus associated with bilateral olivary hypertrophy.

    PubMed

    Birbamer, G; Gerstenbrand, F; Kofler, M; Buchberger, W; Felber, S; Aichner, F

    1993-06-01

    We present clinical and magnetic resonance (MR) findings in three patients with segmental myoclonia occurring 11-18 months after severe brainstem injury. Palatal myoclonus and vertical ocular myorhythmia were present in all three patients and synchronous involuntary movements of the upper extremities ("wing beating") in two patients. MR-imaging showed multiple post-traumatic lesions within the dentato-rubro-olivary pathway ("myoclonic triangle"), associated with bilateral enlargement and increased signal intensity of the inferior olives. The signal abnormality was more prominent on proton density weighted images than on T2-weighted images, suggesting underlying pathological changes different from typical gliosis. PMID:8356884

  7. Amikacin therapy for urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli

    PubMed Central

    Cho, Sung-Yeon; Choi, Su-Mi; Park, Sun Hee; Lee, Dong-Gun; Choi, Jung-Hyun; Yoo, Jin-Hong

    2016-01-01

    Background/Aims: The number of urinary tract infections (UTIs) caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) is increasing. In an outpatient setting, there are limited therapeutic options to treat ESBL-producing pathogens. We evaluated the outcomes of amikacin outpatient parenteral antibiotic therapy (OPAT) for UTIs caused by ESBL-EC in patients not pre-treated with carbapenem. Methods: We retrospectively evaluated the outcomes of amikacin OPAT for UTIs caused by ESBL-EC. Results: From November 2011 to October 2012, eight females, who could not be hospitalized for carbapenem treatment, were treated with amikacin OPAT for nine episodes of non-bacteremic ESBL-EC UTIs. Seven of the eight patients had one or more comorbidities. Of the nine UTI cases, three had symptomatic lower UTIs and six had non-bacteremic upper UTIs. In all of the cases, symptomatic and laboratory improvements were observed following amikacin OPAT. One patient showed a delayed relapse with bilateral microabscesses 3 weeks after treatment cessation; however, a clinical and microbiological cure was eventually reached. All of the patients were able to tolerate amikacin OPAT without any significant nephrotoxicity or ototoxicity. Conclusions: Amikacin OPAT represents a feasible therapeutic option for non-bacteremic UTIs caused by ESBL-EC in settings with limited resources. PMID:26767869

  8. Anatomy and Physiology of the Urinary Tract: Relation to Host Defense and Microbial Infection

    PubMed Central

    HICKLING, DUANE R.; SUN, TUNG-TIEN; WU, XUE-RU

    2015-01-01

    The urinary tract exits to a body surface area that is densely populated by a wide range of microbes. Yet, under most normal circumstances, it is typically considered sterile, i.e., devoid of microbes, a stark contrast to the gastrointestinal and upper respiratory tracts where many commensal and pathogenic microbes call home. Not surprisingly, infection of the urinary tract over a healthy person’s lifetime is relatively infrequent, occurring once or twice or not at all for most people. For those who do experience an initial infection, the great majority (70% to 80%) thankfully do not go on to suffer from multiple episodes. This is a far cry from the upper respiratory tract infections, which can afflict an otherwise healthy individual countless times. The fact that urinary tract infections are hard to elicit in experimental animals except with inoculum 3–5 orders of magnitude greater than the colony counts that define an acute urinary infection in humans (105 cfu/ml), also speaks to the robustness of the urinary tract defense. How can the urinary tract be so effective in fending off harmful microbes despite its orifice in a close vicinity to that of the microbe-laden gastrointestinal tract? While a complete picture is still evolving, the general consensus is that the anatomical and physiological integrity of the urinary tract is of paramount importance in maintaining a healthy urinary tract. When this integrity is breached, however, the urinary tract can be at a heightened risk or even recurrent episodes of microbial infections. In fact, recurrent urinary tract infections are a significant cause of morbidity and time lost from work and a major challenge to manage clinically. Additionally, infections of the upper urinary tract often require hospitalization and prolonged antibiotic therapy. In this chapter, we provide an overview of the basic anatomy and physiology of the urinary tract with an emphasis on their specific roles in host defense. We also highlight the

  9. Bilateral ECT induces bilateral increases in regional cortical thickness.

    PubMed

    van Eijndhoven, P; Mulders, P; Kwekkeboom, L; van Oostrom, I; van Beek, M; Janzing, J; Schene, A; Tendolkar, I

    2016-01-01

    Electroconvulsive therapy (ECT) is the most effective treatment for patients suffering from severe or treatment-resistant major depressive disorder (MDD). Unfortunately its underlying neurobiological mechanisms are still unclear. One line of evidence indicates that the seizures produced by ECT induce or stimulate neuroplasticity effects. Although these seizures also affect the cortex, the effect of ECT on cortical thickness is not investigated until now. We acquired structural magnetic resonance imaging data in 19 treatment-resistant MDD patients before and after a bilateral ECT course, and 16 healthy controls at 2 time points, and compared changes in cortical thickness between the groups. Our results reveal that ECT induces significant, bilateral increases in cortical thickness, including the temporal pole, inferior and middle temporal cortex and the insula. The pattern of increased cortical thickness was predominant in regions that are associated with seizure onset in ECT. Post hoc analyses showed that the increase in thickness of the insular cortex was larger in responders than in non-responders, which may point to a specific relationship of this region with treatment effects of ECT. PMID:27552587

  10. Multistep joint bilateral depth upsampling

    NASA Astrophysics Data System (ADS)

    Riemens, A. K.; Gangwal, O. P.; Barenbrug, B.; Berretty, R.-P. M.

    2009-01-01

    Depth maps are used in many applications, e.g. 3D television, stereo matching, segmentation, etc. Often, depth maps are available at a lower resolution compared to the corresponding image data. For these applications, depth maps must be upsampled to the image resolution. Recently, joint bilateral filters are proposed to upsample depth maps in a single step. In this solution, a high-resolution output depth is computed as a weighted average of surrounding low-resolution depth values, where the weight calculation depends on spatial distance function and intensity range function on the related image data. Compared to that, we present two novel ideas. Firstly, we apply anti-alias prefiltering on the high-resolution image to derive an image at the same low resolution as the input depth map. The upsample filter uses samples from both the high-resolution and the low-resolution images in the range term of the bilateral filter. Secondly, we propose to perform the upsampling in multiple stages, refining the resolution by a factor of 2×2 at each stage. We show experimental results on the consequences of the aliasing issue, and we apply our method to two use cases: a high quality ground-truth depth map and a real-time generated depth map of lower quality. For the first use case a relatively small filter footprint is applied; the second use case benefits from a substantially larger footprint. These experiments show that the dual image resolution range function alleviates the aliasing artifacts and therefore improves the temporal stability of the output depth map. On both use cases, we achieved comparable or better image quality with respect to upsampling with the joint bilateral filter in a single step. On the former use case, we feature a reduction of a factor of 5 in computational cost, whereas on the latter use case, the cost saving is a factor of 50.

  11. Bilateral Impedance Control For Telemanipulators

    NASA Technical Reports Server (NTRS)

    Moore, Christopher L.

    1993-01-01

    Telemanipulator system includes master robot manipulated by human operator, and slave robot performing tasks at remote location. Two robots electronically coupled so slave robot moves in response to commands from master robot. Teleoperation greatly enhanced if forces acting on slave robot fed back to operator, giving operator feeling he or she manipulates remote environment directly. Main advantage of bilateral impedance control: enables arbitrary specification of desired performance characteristics for telemanipulator system. Relationship between force and position modulated at both ends of system to suit requirements of task.

  12. Bilateral molariform mandibular second premolars.

    PubMed

    Acharya, Sonu; Kumar Mandal, Pradip; Ghosh, Chiranjit

    2015-01-01

    Macrodontia is a rare dental anomaly that refers to teeth that appear larger than normal. Generalised macrodontia can be associated with certain medical conditions and syndromes. This case report presents clinical and radiographic findings of isolated bilateral macrodontia in a 14-year-old child. The patient was referred to the clinic with local crowding of maxillary and mandibular teeth. Radiographic findings revealed the presence of impacted macrodont mandibular second premolar on one side and erupted macrodontic premolar on the other side and their distinct morphological appearance, characterized by large, multitubercular, and molariform crowns and tapering, single roots. PMID:25685564

  13. Surgery Duration Predicts Urinary Retention after Inguinal Herniorraphy: A Single Institution Review

    PubMed Central

    Hudak, Kevin E.; Frelich, Matthew J.; Rettenmaier, Chris R.; Xiang, Qun; Wallace, James R.; Kastenmeier, Andrew S.; Gould, Jon C.; Goldblatt, Matthew I.

    2016-01-01

    Background Inguinal hernia repair, laparoscopic or open, is one of the most frequently performed operations in general surgery. Postoperative urinary retention (POUR) can occur in 0.2–35% of patients after inguinal hernia repair. The primary objective of this study was to determine the incidence of POUR after inguinal hernia repair. As a secondary goal, we sought to determine if perioperative and patient factors predicted urinary retention. Methods This study is a retrospective review of patients who underwent inguinal hernia repair with synthetic mesh at the Medical College of Wisconsin from January 2007 to June 2012. Procedures were performed by four surgeons. Clinical information and perioperative outcomes were collected up to hospital discharge. Urinary retention was defined as need for urinary catheterization post-operatively. Results A total of 192 patients were included in the study (88 bilateral, 46%) and (104 unilateral, 54%). The majority of subjects (76%) underwent laparoscopic repair. The overall POUR rate was 13%, with 25 of 192 patients requiring a Foley catheter prior to discharge POUR was significantly associated with bilateral hernia repairs (p=0.04), BMI≥35kg/m2 (p=0.05) and longer operative times (p=0.03). Based on odds ratio estimates, for every 10-minute increase in operative time, an 11% increase in the odds of urinary retention is expected (OR 1.11, CI 1.004 – 1.223; p=0.04). For every 10-minute increase in operative time, an 11% increase in POUR is expected. Conclusions Bilateral hernia repairs, BMI ≥ 35kg/m2, and operative time are significant predictors of POUR. These factors are important to determine potential risk to patients and interventions such as strict fluid administration, use of catheters, and potential premedication. PMID:25612548

  14. Sequentially evolved bilateral epidural haematomas.

    PubMed

    Rochat, P; Johannesen, H H; Poulsgård, L; Bøgeskov, L

    2002-12-01

    Sequentially evolved bilateral epidural haematomas, where the second haematoma evolves after surgical removal of the first haematoma, are rarely reported. We report two cases of this entity. One patient was involved in a road traffic accident and the other was suffering from a head injury after an assault. CT scans showed that both patients had an unilateral epidural haematoma with a thin presumably epidural haemorrhage on the opposite side. Both patients were operated for their epidural haematomas, but did not improve after surgical treatment, and postoperative CT scans revealed evolving of an epidural haematoma on the opposite side. After evacuation of the second epidural haematoma both patients recovered quickly. Sequentially evolved bilateral epidural haematomas are rare, but must be considered in the postoperative intensive care treatment in patients with epidural haematomas. Both cases emphasize the need for intensive care monitoring after an operation for an epidural haematoma and the need for CT scans if the patient does not improve quickly after removal of the haematoma. This is especially important if a small contralateral haematoma is seen on the initial CT scan. PMID:12445923

  15. [Simultaneous bilateral pneumothorax. Case report].

    PubMed

    Paolini, A; Caminiti, F; Tosato, F; Ruggieri, M; Paolini, G; Carnevale, L; Corsini, F; Marano, S; Monsellato, I

    2001-04-01

    A case report of a 44 year-old white man admitted to the surgical unit for a bilateral simultaneous pneumothorax is presented. The pneumothorax occurred on day one after a surgical operation for discal hernia; in the past the patient already presented a right spontaneous pneumothorax at 32 years of age and a left pneumothorax at 37 years of age, both treated with a pleural drainage. A thoracic drain was bilaterally positioned with a good result only in the right side. The persistence of the left pneumothorax induced the authors to perform a postero-lateral thoracotomy bullae excision and pleurectomy with a good postoperative course. After a few months a new right pneumothorax occurred and the patient was treated with a right postero-lateral thoracotomy, bullae resection and pleurectomy. On the basis of the case reported, the authors consider the different opportunities in the treatment of spontaneous pneumothorax in relation to the present knowledges and technologies. Surgical procedure is to be preferred in case of persistence of pneumothorax despite a pleural drain and in case of pneumothorax in high risk subjects. Even if thoracoscopy seems to give better results regarding postoperative pain, it is not always possible with such a method to perform a careful pleurectomy neither to obtain it in all cases (above all in secondary pneumothorax). Every case must then be carefully studied to choose the best treatment at present available. PMID:11353349

  16. Bilateral internal thoracic artery grafting

    PubMed Central

    2013-01-01

    The effectiveness of the left internal mammary artery graft to the anterior descending coronary artery as a surgical strategy has been shown to improve the survival rate and decrease the risk of adverse cardiac events in patients undergoing coronary bypass surgery. These clinical benefits appear to be related to the superior short and long-term patency rates of the internal thoracic artery graft. Although the advantages of using of both internal thoracic arteries (ITA) for bypass grafting have taken longer to prove, recent results from multiple data sets now support these findings. The major advantage of bilateral ITA grafting appears to be improved survival rate, while the disadvantages of complex ITA grafting include the increased complexity of operation, and an increased risk of wound complications. While these short-term disadvantages have been mitigated in contemporary surgical practice, they have not eliminated. Bilateral ITA grafting should be considered the procedure of choice for patients undergoing coronary bypass surgery that have a predicted survival rate of longer than ten years. PMID:23977627

  17. Unusual Bilateral Paramolars Associated with Clinical Complications

    PubMed Central

    Sulabha, A. N.; Sameer, C.

    2015-01-01

    Paramolars are rare supernumerary structures of maxillofacial complex that occur buccally or lingually near the molar row. Predominantly these occur singly; bilateral presentation is very rare. This paper reports two unusual bilateral presentations of paramolars with clinical complication and its management. One of the cases in the present paper also documents the cooccurrence of bilateral paramolars and microdontia of single tooth and one of its paramolars presented with multilobed crown with an anomalous buccal tubercle. PMID:26078890

  18. A clinical analysis of bilateral orbital fracture.

    PubMed

    Roh, Joon Ho; Jung, Jee Woong; Chi, Mijung

    2014-03-01

    Although bilateral orbital fracture can cause serious eyeball and facial skeletal problems, few reports have been issued on the topic. We analyzed the clinical features of bilateral orbital fracture by reviewing the medical records of 147 patients and compared bilateral and unilateral fractures by reviewing the literature.Bilateral orbital fracture was most common in men aged between 50 and 59 years. A traffic accident was the leading cause of trauma, and average time between trauma and surgery was 12.2 days. Bilateral medial fracture accompanied by nasal fracture accounted for the overwhelming majority, and impure blowout fracture in at least 1 eye occurred in 69.4% of the 147 patients. Associated ocular injuries seemed to be similar for bilateral and unilateral fracture. Thirty-five patients (23.8%) had other multiple traumas affecting other than the eyes, and this significantly increased the need for surgery (P < 0.05). Of the 48 patients who underwent surgery, including 4 cases of bilateral surgery, 21 patients who had ocular motility restriction with central diplopia within 30 degrees almost completely recovered. No significant relation between the timing of surgery and improvement was found. Although unilateral surgery was performed in most cases, facial asymmetry related to enophthalmos was unclear at 6 months postoperatively.In summary, bilateral orbital fracture was found to be clinically distinguishable from unilateral fracture in several aspects. We hope these findings provide a reference guide to the approach and management of bilateral orbital fracture. PMID:24514894

  19. Fast bilateral filtering using recursive moving sum

    NASA Astrophysics Data System (ADS)

    Igarashi, Masaki; Ikebe, Masayuki; Shimoyama, Sohsuke; Motohisa, Junichi

    We propose a constant-time algorithm for a bilateral filter. Bilateral filter can be converted into the operation of three-dimensional (3D) convolution. By using recursive moving sum, we can reduce the number of calculations needed to construct a pseudo-Gaussian filter. Applying one-dimensional Gaussian filter to the 3D convolution, we achieved a constant-time bilateral filter. We used a 3-GHz CPU without SIMD instructions, or multi-thread operations. We confirmed our proposed bilateral filter to be processed in constant time. In practical conditions, high PSNR values over 40 dB are obtained.

  20. Bilateral Neck of Femur Fractures in a Bilateral Below-Knee Amputee: A Unique Case.

    PubMed

    Lancer, Hannah R; Smitham, Peter; Ray, Pinak

    2016-01-01

    According to the National Hip Fracture Database, over 64,000 patients were admitted with a hip fracture across England, Wales, and Northern Ireland in 2013, but very few are bilateral, and there are no current cases in the literature of bilateral neck of femur fractures in a patient with bilateral below-knee amputations. We present a case of a 69-year-old bilateral below-knee amputee male admitted to the emergency department with bilateral hip pain and radiological evidence of bilateral displaced neck of femur fractures. The patient subsequently underwent synchronous bilateral total hip replacements under general anaesthetic and an epidural and then went on to make a full recovery. He was discharged 27 days after arrival in hospital. Outpatient follow-up at 3 months has shown that the patient has returned to a similar level of preinjury function and is still able to carry out his daily activities with walking aids and bilateral leg prostheses. PMID:26881162

  1. Bilateral Neck of Femur Fractures in a Bilateral Below-Knee Amputee: A Unique Case

    PubMed Central

    Lancer, Hannah R.

    2016-01-01

    According to the National Hip Fracture Database, over 64,000 patients were admitted with a hip fracture across England, Wales, and Northern Ireland in 2013, but very few are bilateral, and there are no current cases in the literature of bilateral neck of femur fractures in a patient with bilateral below-knee amputations. We present a case of a 69-year-old bilateral below-knee amputee male admitted to the emergency department with bilateral hip pain and radiological evidence of bilateral displaced neck of femur fractures. The patient subsequently underwent synchronous bilateral total hip replacements under general anaesthetic and an epidural and then went on to make a full recovery. He was discharged 27 days after arrival in hospital. Outpatient follow-up at 3 months has shown that the patient has returned to a similar level of preinjury function and is still able to carry out his daily activities with walking aids and bilateral leg prostheses. PMID:26881162

  2. Cutaneous tube ureterostomy: a fast and effective method of urinary diversion in emergency situations

    PubMed Central

    Abdin, Tamer; Zamir, Gideon; Pikarsky, Alon; Katz, Ran; Landau, Ezekiel H; Gofrit, Ofer N

    2015-01-01

    Aim To report on a simple and rapid method of urinary diversion. This method was applied successfully in different clinical scenarios when primary reconstruction of the ureters was not possible. Materials and methods The disconnected ureter is catheterized by a feeding tube. The tube is secured with sutures and brought out to the lateral abdominal wall as cutaneous tube ureterostomy (CTU). Results This method was applied in three different clinical scenarios: a 40-year-old man who sustained multiple high-velocity gunshots to the pelvis with combined rectal and bladder trigone injuries and massive bleeding from a comminuted pubic fracture. Damage control included colostomy and bilateral CTUs. A 26-year-old woman had transection of the right lower ureter during abdominal hysterectomy. Diagnosis was delayed for 3 weeks when the patient developed sepsis. The right kidney was diverted with a CTU. A 37-year-old male suffered from bladder perforation and hemorrhagic shock. Emergency cystectomy was done and urinary diversion was accomplished with bilateral CTUs. In all cases, effective drainage of the urinary system was achieved with normalization of kidney function. Conclusion When local or systemic conditions preclude definitive repair and damage control surgery is needed, CTU provides fast and effective urinary diversion. PMID:26090343

  3. Bilateral cerebellar activation in unilaterally challenged essential tremor

    PubMed Central

    Broersma, Marja; van der Stouwe, Anna M.M.; Buijink, Arthur W.G.; de Jong, Bauke M.; Groot, Paul F.C.; Speelman, Johannes D.; Tijssen, Marina A.J.; van Rootselaar, Anne-Fleur; Maurits, Natasha M.

    2015-01-01

    Background Essential tremor (ET) is one of the most common hyperkinetic movement disorders. Previous research into the pathophysiology of ET suggested underlying cerebellar abnormalities. Objective In this study, we added electromyography as an index of tremor intensity to functional Magnetic Resonance Imaging (EMG-fMRI) to study a group of ET patients selected according to strict criteria to achieve maximal homogeneity. With this approach we expected to improve upon the localization of the bilateral cerebellar abnormalities found in earlier fMRI studies. Methods We included 21 propranolol sensitive patients, who were not using other tremor medication, with a definite diagnosis of ET defined by the Tremor Investigation Group. Simultaneous EMG-fMRI recordings were performed while patients were off tremor medication. Patients performed unilateral right hand and arm extension, inducing tremor, alternated with relaxation (rest). Twenty-one healthy, age- and sex-matched participants mimicked tremor during right arm extension. EMG power variability at the individual tremor frequency as a measure of tremor intensity variability was used as a regressor, mathematically independent of the block regressor, in the general linear model used for fMRI analysis, to find specific tremor-related activations. Results Block-related activations were found in the classical upper-limb motor network, both for ET patients and healthy participants in motor, premotor and supplementary motor areas. In ET patients, we found tremor-related activations bilaterally in the cerebellum: in left lobules V, VI, VIIb and IX and in right lobules V, VI, VIIIa and b, and in the brainstem. In healthy controls we found simulated tremor-related activations in right cerebellar lobule V. Conclusions Our results expand on previous findings of bilateral cerebellar involvement in ET. We have identified specific areas in the bilateral somatomotor regions of the cerebellum: lobules V, VI and VIII. PMID:26909321

  4. When you have urinary incontinence

    MedlinePlus

    ... rub baking soda into the stain, and then vacuum off the baking powder. You can also use ... management of urinary incontinence: behavioral and pelvic floor therapy, urethral and pelvic devices. In: Wein AJ, ed. ...

  5. Urinary Tract Infections in Adults

    MedlinePlus

    ... that obstructs the flow of urine—a kidney stone or enlarged prostate, for example—is at risk ... the urinary tract, such as an obstructive kidney stone or prostate enlargement that squeezes the urethra. Health ...

  6. Urinary Tract Infections (For Teens)

    MedlinePlus

    ... more serious infection that reaches the kidneys. continue Bacteria Are to Blame UTIs are usually caused by ... as soon as possible. previous continue Battling the Bacteria Only your health care provider can treat urinary ...

  7. An Unusual Case of Neuralgic Amyotrophy Presenting with Bilateral Phrenic Nerve and Vocal Cord Paresis

    PubMed Central

    Holtbernd, F.; Zehnhoff-Dinnesen, A. am; Duning, T.; Kemmling, A.; Ringelstein, E.B.

    2011-01-01

    Background Neuralgic amyotrophy (brachial plexus neuropathy, brachial plexus neuritis, or Parsonage-Turner syndrome) is an uncommon inflammatory condition typically characterized by acute and severe shoulder pain followed by paresis with muscle weakness and atrophy of the upper limb or shoulder girdle. We report an unusual clinical manifestation of neuralgic amyotrophy, namely bilateral phrenic nerve palsy with concomitant laryngeal paresis. Case Report A 55-year-old male presented with orthopnea and aphonia after an episode of bilateral shoulder pain preceded by an upper respiratory tract infection. Spirometry, chest X-ray and videolaryngoscopy revealed bilateral and simultaneous paresis of the diaphragm and the vocal cords. Clinical examination at admission and at the 2-month follow-up did not show upper limb weakness or atrophy, except for a mild atrophy of the right supraspinatus muscle. An electromyography of the upper limb muscles and nerve conduction studies did not reveal signs of denervation. Analysis of the cerebrospinal fluid and an MRI of the neuraxis were unremarkable. After treatment with prednisolone, vocal cord function markedly improved within 8 weeks, whereas paresis of the diaphragm persisted. Conclusion Shoulder pain followed by diaphragmatic paralysis with dyspnea and hoarseness may be a manifestation of neuralgic amyotrophy even if upper limb or shoulder girdle palsies are absent. PMID:21490716

  8. An Investigation of Bilateral Symmetry During Manual Wheelchair Propulsion

    PubMed Central

    Soltau, Shelby L.; Slowik, Jonathan S.; Requejo, Philip S.; Mulroy, Sara J.; Neptune, Richard R.

    2015-01-01

    Studies of manual wheelchair propulsion often assume bilateral symmetry to simplify data collection, processing, and analysis. However, the validity of this assumption is unclear. Most investigations of wheelchair propulsion symmetry have been limited by a relatively small sample size and a focus on a single propulsion condition (e.g., level propulsion at self-selected speed). The purpose of this study was to evaluate bilateral symmetry during manual wheelchair propulsion in a large group of subjects across different propulsion conditions. Three-dimensional kinematics and handrim kinetics along with spatiotemporal variables were collected and processed from 80 subjects with paraplegia while propelling their wheelchairs on a stationary ergometer during three different conditions: level propulsion at their self-selected speed (free), level propulsion at their fastest comfortable speed (fast), and propulsion on an 8% grade at their level, self-selected speed (graded). All kinematic variables had significant side-to-side differences, primarily in the graded condition. Push angle was the only spatiotemporal variable with a significant side-to-side difference, and only during the graded condition. No kinetic variables had significant side-to-side differences. The magnitudes of the kinematic differences were low, with only one difference exceeding 5°. With differences of such small magnitude, the bilateral symmetry assumption appears to be reasonable during manual wheelchair propulsion in subjects without significant upper-extremity pain or impairment. However, larger asymmetries may exist in individuals with secondary injuries and pain in their upper extremity and different etiologies of their neurological impairment. PMID:26125019

  9. Bilateral treatment for alopecia areata.

    PubMed

    Torchia, Daniele; Schachner, Lawrence A

    2010-01-01

    A 4-year-old, otherwise healthy white girl was referred for a 15-month history of alopecia areata. Anthralin 0.1% cream was prescribed for the left side of the scalp, while corticosteroids for the right side. After 4 months, only the right side of the scalp showed hair regrowth. Half-side strategy, that is, treating one side and managing the other--divided by the mid sagittal suture--as an internal control for no treatment, placebo or other treatment, has been commonly used in clinical studies for decades. In everyday practice, bilateral treatment is useful to evaluate the responsiveness to two topically delivered interventions and diminishes the time necessary to identify an effective one. PMID:20653874

  10. Coinfection of pulmonary mucormycosis and aspergillosis presenting as bilateral vocal cord palsy

    PubMed Central

    Mahadevaiah, Arun H; Rajagopalan, Natarajan; Patil, Mahantesh; C, Shivaprasad

    2013-01-01

    Invasive pulmonary coinfection with Mucor and Aspergillus is rare. Bilateral vocal cord paralysis resulting from coinfection with these two fungi to our knowledge has not been reported in the literature. We report a young woman with diabetes who presented with symptoms of community acquired pneumonia in association with hoarseness of voice. Investigations revealed air space consolidation of the right upper lobe, evidence of mediastinal involvement extending into the paratracheal space and entrapment of right upper lobe pulmonary artery. Bronchoscopy revealed bilateral vocal cord paralysis and sloughing of mucosa of the right upper lobe bronchus and the bronchus intermedius. Microbiological and pathological results confirmed Mucor and Aspergillus. Extensive vascular and mediastinal involvement precludes surgical debridement. Despite aggressive medical management the patient deteriorated and died of respiratory failure. Strong suspicion of invasive fungal infections in immune compromised patients presenting with unresolving pneumonia and hoarseness of voice, early aggressive treatment is crucial for the patient survival. PMID:23964036

  11. Hyperammonemia in Urinary Tract Infections

    PubMed Central

    Kenzaka, Tsuneaki; Kato, Ken; Kitao, Akihito; Kosami, Koki; Minami, Kensuke; Yahata, Shinsuke; Fukui, Miho; Okayama, Masanobu

    2015-01-01

    Objectives The present study investigated the incidence of hyperammonemia in urinary tract infections and explored the utility of urinary obstruction relief and antimicrobial administration to improve hyperammonemia. Methods This was an observational study. Subjects were patients who were diagnosed with urinary tract infection and hospitalized between June 2008 and June 2009. We measured plasma ammonia levels on admission in patients who were clinically diagnosed with urinary tract infection and hospitalized. We assessed each patient's level of consciousness on admission using the Glasgow Coma Scale (GCS) and performed urine and blood cultures. We also assessed hearing prior to hospitalization using the Eastern Cooperative Oncology Group performance status (ECOG-PS). In cases with high ammonia levels on admission, plasma ammonia and GCS were measured 24 hours and 5–7 days later. Results Sixty-seven candidates were enrolled; of these, 60 cases (89.6%) with bacterial cell counts ≥104 CFU/mL were studied. Five cases (8.3%) presented with high plasma ammonia levels. Cases with hyperammonemia were significantly more likely to present with low GCS scores and urinary retention rate. All five cases received antimicrobial therapy with an indwelling bladder catheter to relieve urinary retention. The case 5 patient died shortly after admission due to complicated aspiration pneumonia; in the remaining cases, plasma ammonia levels were rapidly normalized and the level of consciousness improved. Conclusions The occurrence of hyperammonemia in urinary tract infections is not rare. The cause of hyperammonemia is urinary retention obstruction. Therefore, along with antimicrobial administration, relief of obstruction is important for the treatment of hyperammonemia caused by this mechanism. PMID:26292215

  12. Functional reconstruction of a bilateral maxillectomy defect using a fibula osteocutaneous flap with osseointegrated implants.

    PubMed

    Nakayama, B; Matsuura, H; Ishihara, O; Hasegawa, H; Mataga, I; Torii, S

    1995-10-01

    We have achieved functional reconstruction for a bilateral upper alveolar bone, gingival, and palatal defect that has various problems originating from instability of the prosthesis using the fibula osteocutaneous flap with osseointegrated implants. The flap had three bone segments and two skin paddles. The combined bone segments created the upper alveolar arch, and the skin paddles closed the palatal defect. Nine months later, prosthodontic treatment was performed successfully. Our procedure restored the patient to masticatory function of the upper jaw, intelligible speech, and natural facial appearance. As a result, quality of life of the patient was extremely improved. PMID:7568500

  13. A Novel Method of Urinary Sphincter Deficiency: Serial Histopathology Evaluation in a Rat Model of Urinary Incontinence.

    PubMed

    Khorramirouz, Reza; Mozafarpour, Sarah; Kameli, Seyedeh Maryam; Ladi Seyedian, Seyedeh Sanam; Oveisi, Nasim; Rahimi, Zahra; Alijani, Maryam; Kajbafzadeh, Abdol-Mohammad

    2016-02-01

    In this study, a novel technique of irreversible sphincter deficiency by pudendal nerve transection (PNT) using 40 female rats for studying the pathophysiology of stress urinary incontinence associated with childbirth was developed. Of the 40 rats, 10 served as controls and the remaining underwent bilateral PNT at the anastomotic lumbosacral trunk level. Urethral morphological changes following bilateral PNT were assessed with serial hematoxylin and eosin (H&E) and immunohistochemistry (IHC) staining methods at 50, 90, and 130 days post-intervention. Leak point pressure (LPP) measurement was used to determine the effect of pudendal injury on urethral outlet resistance after the transection. H&E and IHC staining showed irreversible loss of striated muscle mass of the sphincter region and increase in collagen deposition compatible with muscle atrophy. LPP measurements also significantly decreased following bilateral PNT. In conclusion, a novel method of irreversible sphincter insufficiency was developed. This model effectively decreased urethral outlet resistance and caused irreversible striated muscle atrophy. It was suggested that this technique can be used to develop a permanent sphincter deficiency model for the preclinical testing of treatment modalities exclusively triggering the pudendal nerve. PMID:26574901

  14. Urinary conduits in gynecologic oncology

    SciTech Connect

    Hancock, K.C.; Copeland, L.J.; Gershenson, D.M.; Saul, P.B.; Wharton, J.T.; Rutledge, F.N.

    1986-05-01

    Over an 11-year period (1971 to 1981), 212 urinary conduit surgeries were performed by the Department of Gynecology at the University of Texas, M. D. Anderson Hospital and Tumor Institute at Houston. The urinary diversions were performed as part of the pelvic exenteration operation in 154 patients, for radiation injury in 48 patients, and for palliation of disease recurrence in ten patients. Ninety-three percent had prior pelvic radiotherapy. Various segments of the gastrointestinal tract were used, including the ileum (102), sigmoid colon (99), transverse colon (four), jejunum (four), and others (three). Fifty percent of abnormal preoperative intravenous pyelograms reverted to normal after urinary diversion. Revision of the stoma was required in 6%. Other complications included infection (18%), renal loss (17%), and urinary leaks and fistulae (3%). The overall perioperative mortality was 7%, decreasing from 11% in the first five years to 3% during the last six years. Ureteral stents were routinely used. When selecting a segment of bowel for a urinary conduit, both tissue quality and mobility are important. Mortality and morbidity of urinary conduit surgery continues to decrease with experience.

  15. Metastatic esophageal adenocarcinoma to the prostate presenting with bilateral ureteral obstruction.

    PubMed

    Marlin, Evan S; Hyams, Elias S; Dulabon, Lori; Shah, Ojas

    2010-02-01

    Carcinoma metastatic to the prostate occurs rarely and is most commonly associated with malignant bladder neoplasms. We present the case of a 73-year-old male with a history of gastroesophageal adenocarcinoma and clinically symptomatic benign prostatic hyperplasia who underwent photoselective vaporization of the prostate and presented several months later with gross hematuria, intermittent urinary retention and bilateral ureteral obstruction causing acute renal failure. After relieving the ureteral obstruction, subsequent transurethral resection of the prostate revealed locally invasive metastatic esophageal adenocarcinoma. To our knowledge, this is the first reported case of metastatic gastroesophageal carcinoma to the prostate. PMID:20156389

  16. Simultaneous and spontaneous bilateral quadriceps tendons rupture.

    PubMed

    Celik, Evrim Coşkun; Ozbaydar, Mehmet; Ofluoglu, Demet; Demircay, Emre

    2012-07-01

    Simultaneous and spontaneous bilateral quadriceps tendon rupture is an uncommon injury that is usually seen in association with multiple medical conditions and some medications. We report a case of simultaneous and spontaneous bilateral quadriceps tendon rupture that may be related to the long-term use of a statin. PMID:22561379

  17. Spontaneous bilateral adrenal hemorrhage following cholecystectomy

    PubMed Central

    Dahan, Meryl; Lim, Chetana; Salloum, Chady

    2016-01-01

    Postoperative bilateral adrenal hemorrhage is a rare but potentially life-threatening complication. This diagnosis is often missed because the symptoms and laboratory results are usually nonspecific. We report a case of bilateral adrenal hemorrhage associated with acute primary adrenal insufficiency following laparoscopic cholecystectomy. The knowledge of this uncommon complication following any abdominal surgery allows timey diagnosis and rapid treatment. PMID:27275469

  18. Bilateral microperc in a severe kyphoscoliosis.

    PubMed

    Dağgülli, Mansur; Penbegül, Necmettin; Dede, Onur; Utanğaç, Mehmet Mazhar

    2016-03-01

    Percutaneous nephrolithotomy is the standard modality for large renal calculi in normal and abnormal renal anatomic situations. This case report describes a 57-year-old male patient who presented with bilateral kidney stones and severe kyphoscoliosis. He had successfully been treated with a bilateral microperc technique. PMID:27011881

  19. Bilateral pulmonary sequestration: computed tomographic appearance

    SciTech Connect

    Wimbish, K.J.; Agha, F.P.; Brady, T.M.

    1983-04-01

    Intralobar pulmonary sequestration is one manifestation of the wide spectrum of congenital bronchopulmonary foregut malformations. Bilateral intralobar pulmonary sequestration is an exceedingly rare anomaly. Only two pathologically proven cases and one possible case have been reported. We report a case presenting as bilateral paraspinal masses, studied by computed tomograpy (CT) and angiography.

  20. Bilateral parotid swelling: a radiological review

    PubMed Central

    Gadodia, A; Bhalla, A S; Sharma, R; Thakar, A; Parshad, R

    2011-01-01

    Bilateral parotid swelling is not an uncommon occurrence and may pose a challenge for clinicians and radiologists. Numerous causes of bilateral parotid swellings have been identified. The purpose of this pictorial review is to display this wide array with a focus on multimodality approach. PMID:21960397

  1. Submaximal Expression of the Bilateral Deficit

    ERIC Educational Resources Information Center

    McLean, Scott P.; Vint, Peter F.; Stember, Amanda J.

    2006-01-01

    Thirty-six participants performed bilateral and unilateral isometric elbow flexion trials at what they perceived to be 100, 75, 50, and 25% of maximal effort. Absolute bilateral deficits ranged from -16% at 25% effort to -10% at 100% effort. The deficit included a component independent of consciousness and a component inversely related to…

  2. Bilateral microperc in a severe kyphoscoliosis

    PubMed Central

    Dağgülli, Mansur; Penbegül, Necmettin; Dede, Onur; Utanğaç, Mehmet Mazhar

    2016-01-01

    Percutaneous nephrolithotomy is the standard modality for large renal calculi in normal and abnormal renal anatomic situations. This case report describes a 57-year-old male patient who presented with bilateral kidney stones and severe kyphoscoliosis. He had successfully been treated with a bilateral microperc technique. PMID:27011881

  3. CT demonstration of bilateral adrenal hemorrhage

    SciTech Connect

    Ling, D.; Korobkin, M.; Silverman, P.M.; Dunnick, N.R.

    1983-08-01

    Bilateral adrenal hemorrhage with subsequent adrenal insufficiency is a recognized complication of anticoagulant therapy. Because the clinical manifestations are often nonspecific, the antemortem diagnosis of adrenal hemorrhage has been a difficult clinical problem. Computed tomography (CT) provides detailed images of the adrenal glands that are not possible with conventional imaging methods. The CT findings of bilateral adrenal hemorrhage in an anticoagulated patient are reported.

  4. Recent management of urinary stone disease in a pediatric population.

    PubMed

    Aydogdu, Ozgu; Karakose, Ayhan; Celik, Orcun; Atesci, Yusuf Ziya

    2014-02-01

    The incidence of stone disease has been increasing and the risk of recurrent stone formation is high in a pediatric population. It is crucial to use the most effective method with the primary goal of complete stone removal to prevent recurrence from residual fragments. While extracorporeal shock wave lithotripsy (ESWL) is still considered first line therapy in many clinics for urinary tract stones in children, endoscopic techniques are widely preferred due to miniaturization of instruments and evolution of surgical techniques. The standard procedures to treat urinary stone disease in children are the same as those used in an adult population. These include ESWL, ureterorenoscopy, percutaneous nephrolithotomy (standard PCNL or mini-perc), laparoscopic and open surgery. ESWL is currently the procedure of choice for treating most upper urinary tract calculi in a pediatric population. In recent years, endourological management of pediatric urinary stone disease is preferred in many centers with increasing experience in endourological techniques and decreasing sizes of surgical equipment. The management of pediatric stone disease has evolved with improvements in the technique and a decrease in the size of surgical instruments. Recently, endoscopic methods have been safely and effectively used in children with minor complications. In this review, we aim to summarize the recent management of urolithiasis in children. PMID:25254178

  5. Sarcoidosis Presenting as Bilateral Vocal Cord Paralysis due to Bilateral Vagal Nerve Involvement.

    PubMed

    Yamasue, Mari; Nureki, Shin-Ichi; Ushijima, Ryoichi; Mukai, Yutaka; Goto, Akihiko; Kadota, Jun-Ichi

    2016-01-01

    We herein report a rare case of sarcoidosis presenting as bilateral vocal cord paralysis due to bilateral vagal nerve involvement. A 72-year-old woman with uveitis of the left eye complained of hoarseness and aspiration due to bilateral vocal cord paralysis. An endobronchial needle aspiration biopsy specimen of the mediastinal lymph nodes showed non-caseating epithelioid cell granuloma. Total protein and cell concentrations in the cerebrospinal fluid were increased. We diagnosed her to have sarcoidosis with bilateral vagal nerve involvement. Corticosteroid therapy improved her symptoms of hoarseness and aspiration. Sarcoidosis should therefore be taken into consideration as a potential cause of bilateral vocal cord paralysis. PMID:27150886

  6. A Case of Congenital Bilateral Absence of Elbow Flexor Muscles: Review of Differential Diagnosis and Treatment

    PubMed Central

    Aliu, Oluseyi; Samra, Saleh; Lewis, Eric

    2007-01-01

    A 1-year-old boy presented to us with congenital inability to flex his elbow. He had bilaterally absent biceps brachii and brachialis muscles, a rare condition. We performed pedicle latissimus dorsi musculocutaneous flaps to the left and right volar upper arm at 21 and 24 months of age, respectively, to create elbow flexors. By 4 years of age, he had excellent elbow flexion bilaterally with strength grade in excess of 4.5. In addition to discussing our patient’s treatment options, we discuss other potential causes of weak elbow flexion when faced with this clinical dilemma. PMID:18780113

  7. Isolated Bilateral Trigeminal Neuropathy in Sarcoidosis Presenting with Neurotrophic Corneal Ulcers

    PubMed Central

    Gupta, M.; Lascaratos, G.; Syrogiannis, A.; Esakowitz, L.

    2010-01-01

    Sarcoidosis is a multisystem granulomatous disease that may affect various organs. Nevertheless, involvement of the trigeminal nerve is exceedingly uncommon. This report presents a rare case of isolated bilateral trigeminal neuropathy presenting with neurotrophic corneal ulcers. The patient was treated with topical chloramphenicol and lubricants, as well as botulinum toxin injection to the upper eyelid to induce ptosis. Our case illustrates the importance of recognizing that bilateral corneal ulceration might be a manifestation of sarcoidosis. Physicians should be aware of this rare association, when treating sarcoidosis patients with eye related symptoms. PMID:23861615

  8. [Bilateral urolithiasis with zonisamide developed for a short period of time in a 10-year-old girl with intractable epilepsy].

    PubMed

    Sato, Shunsuke; Nishinaka, Kazuyuki; Takahashi, Satoshi; Hirobe, Megumi; Tsukamoto, Taiji

    2013-09-01

    Zonisamide is an antiepileptic drug mainly used in patients with refractory epilepsy. One of the urological adverse effects caused by zonisamide is urinary lithiasis. We reported bilateral urinary lithiasis with zonisamide developed for a short period of time. A 10 year-old girl had been treated with zonisamide for intractable epilepsy for nine years. She progressively developed microscopic hematuria as well as crystalluria while being hospitalized for ventriculoperitoneal shunt infection. A computed tomography (CT) showed bilaterally hydronephrotic kidneys obstructed by multiple ureteral calculi. What was impressive was the fact that any single urinary calculus was not identified in a CT image taken just three weeks prior to this event. Then the diagnosis was made of zonisamide-induced bilateral urinary calculi and zonisamide treatment was discontinued. However, since the deterioration of renal function and left-sided hydronephrosis progressed, we performed the construction of right-sided percutaneous nephrostomy (PNS) and the transurethral placement of a left ureteral stent. Subsequently her condition was stabilized and all of these stones were discharged. The analysis of these stones showed mainly calcium phosphatic calculus. We eventually removed both the right PNS and the left ureteral stent. Since then, there has not been any recurrence thus far. We need to recognize the risk of progressively developing renal calculi during zonisamide treatment for a relatively short period of time in the face of dehydration. PMID:24187857

  9. Female urinary incontinence rehabilitation.

    PubMed

    Di Benedetto, P

    2004-08-01

    Pelvic floor rehabilitation (PFR) is an important and recommended strategy for the treatment of many urogynecological disorders including urinary incontinence (UI). The recognised pioneer of PFR is the American gynecologist Arnold Kegel who, over 50 years ago, proposed pelvic floor muscle exercises (PFME) to prevent and/or treat female UI. Kegel's techniques were successfully used by others too, but as the years passed these techniques sank into unjustified oblivion. In the 1980s in Europe the medical world's interest in PFME techniques gained ground, contemporaneously with functional electrical stimulation (FES) and biofeedback (BFB). As a general rule, the least invasive and least dangerous procedure for the patient should be the first choice, and behavioural and rehabilitative techniques should be considered as the first line of therapy for UI. The behavioural approaches in women with UI and without cognitive deficits are tailored to the patient's underlying problem, such as bladder training or retraining (BR) for urge UI. BR has many variations but generally consists of education, scheduled voiding, and positive reinforcements. The rehabilitative approaches comprise BFB, FES, PFME, and vaginal cones (VC). BFB allows the subject to modify the unconscious physiological events, while FES is aimed at strengthening perineal awareness, increasing the tone and trophism of the pelvic floor, and inhibiting detrusor overactivity. PFME play an extremely important role in the conservative treatment of UI and overactive bladder, and many studies have demonstrated their effectiveness. Many authors have used the different methods for PFR in a heterogeneous manner: the best results were obtained when protocols requiring the contemporary use of 2 or more techniques were followed. PMID:15377984

  10. Palliative urinary conduit diversion in cases of intolerable urinary discomfort

    SciTech Connect

    Lyndrup, J.; Sorensen, B.L.

    1983-12-01

    Fifteen patients with incurable gynecological cancers, all primary radiation treated and all having severe urinary discomfort due to urinary tract injuries were retrospectively examined after urinary conduit diversion. All have been followed-up until termination or until all survivors had lived for 6 months after the operation. Twelve of the 15 were discharged from the hospital, 10 of whom survived the first 6 months. Of those discharged 82% of the cumulated sum of postoperative observations days was spent out of the hospital. At the end of the observation period nine patients had been supplied with a colostomy as well, thus having double stomas. All six patients still alive declared in retrospect that given the choice again, they would still be willing to undergo the operation.