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 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Emphysematous cystitis is a rare disease characterized by primary infection of the urinary bladder with gas-producing pathogens. There is a paucity of information on this entity in the English-language literature covering the last 45 years, and the clinical picture is poorly outlined. We carried out a comprehensive, retrospective review of the English-language literature from 1986 to 2006, searching for reports describing cases of emphysematous cystitis. The demographic, clinical, laboratory, imaging, and outcome characteristics of every eligible patient were excerpted. In the present report, we describe a typical case of emphysematous cystitis, followed by an analysis of the literature. Of the 53 eligible cases, most were elderly women with diabetes mellitus (62.2%). Classic symptoms of urinary tract infection were present in only 53.3% of cases. Abdominal tenderness and hematuria were noted in 65.6% and 82.3% of cases, respectively. Plain abdominal X-ray was highly sensitive (97.4%), while abdominal computerized tomography was the most sensitive and specific diagnostic tool. A complicated course attributable to emphysematous cystitis was described in 18.8% of cases. The exact mechanism contributing to the formation of gas in such cases is unknown. Various theories have been suggested, including fermentation of glucose in urine, with emphasis on disequilibrium between gas formation and clearance. Emphysematous cystitis has a highly variable presentation and course, with a considerable potential for complications. Further diagnostic imaging is highly recommended in diabetic patients with urinary tract infection who present with abdominal pain and hematuria. Knowledge of this rare entity may lead to early diagnosis and appropriate management.
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PMID:Emphysematous cystitis: illustrative case report and review of the literature. 1722 Jul 55

A 76-year-old woman presented with a five-day history of fever and abdominal pain. Her urine culture grew Candida albicans. She was treated with intravenous antibiotics, as having a urinary tract infection, but her fever persisted. Computed tomography of the abdomen showed a cystic mass at the pancreatic head and uncinate process with peripancreatic lymph nodes. Given the patientos high operative risk and her clinical picture favouring sepsis, endoscopic ultrasonographical fine-needle aspiration (EUS-FNA) which was performed, revealed pus with acid-fast bacilli seen in the cell block material. The patient was started on antituberculous medication with rapid improvement of symptoms. Pancreatic tuberculosis (TB) is rare and can mimic pancreatic carcinoma both clinically and radiologically. Histological diagnosis is crucial before administration of appropriate therapy. The usefulness of EUS-FNA and its pitfalls, as well as the other radiological modalities for the evaluation and assessment of pancreatic TB are discussed.
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PMID:Clinics in diagnostic imaging (117). 1760 35

Hydronephrosis and the evaluation of obstructive uropathy are the most common indications for MR urography in our practice. Typically our patients fall into one of two groups: infants with antenatal hydronephrosis and older children who present with abdominal pain, hematuria or urinary tract infection. Obstruction in children is usually chronic and partial. Intermittent episodes of increased pressure occur when the urine production exceeds the capacity for drainage. MR urography uses a fluid and diuretic challenge to assess the hydronephrotic kidney. High-quality anatomic images provide a morphologic assessment of the hydronephrotic system. Although it is relatively straightforward to determine if a system is not obstructed on the basis of the renal transit time (RTT), no single parameter is adequate to fully characterize obstruction. By evaluating the changes in signal intensity in the renal parenchyma following contrast administration, the hydronephrotic systems are classified as compensated or decompensated. Delayed RTT and the presence of urine-contrast levels indicate stasis. Calyceal transit time and the difference between the volumetric and the Patlak differential renal function (vDRF-pDRF) are measures of the physiologic changes within the kidney. Additionally, MR urography provides prognostic information by assessing the quality of the renal parenchyma and identifying uropathy preoperatively. MR urography combines both anatomic and functional information in a single test and is capable of providing a comprehensive evaluation of obstructive uropathy that could ultimately help select those patients most likely to benefit from surgical intervention.
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PMID:MR urography evaluation of obstructive uropathy. 1807 89

Xanthogranulomatous pyelonephritis and emphysematous pyelonephritis are two uncommon variants of pyelonephritis. The combined occurrence is very rare and has not been described in dialysis patients. We report a 78-year-old woman with end-stage renal disease receiving chronic hemodialysis who presented with a one-week history of vague abdominal pain. During the previous 4 months, she had experienced four episodes of urinary tract infection presenting with fever and pyuria which were improved by antibiotic therapy. The urine cultures yielded Klebsiella pneumoniae at all events. Abdominal computed tomography showed the right kidney replaced by multiple hypodense masses. A kidney biopsy demonstrated characteristic pictures of xanthogranulomatous pyelonephritis. Subsequent computed tomography showed gas bubbles formation in the right renal masses suggestive of emphysematous pyelonephritis. Because the patient refused surgical nephrectomy, percutaneous needle aspiration with prolonged antibiotic treatment was done. Follow-up computed tomography demonstrated dramatic regression of the renal mass. This case suggests that xanthogranulomatous pyelonephritis can be complicated by emphysematous pyelonephritis. Furthermore, the unique features in end-stage renal disease patients make the diagnosis of xanthogranulomatous pyelonephritis more difficult.
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PMID:Xanthogranulomatous pyelonephritis complicated by emphysematous pyelonephritis in a hemodialysis patient. 1818 27

We present a 69-year-old man with repeated urinary tract infection and lower abdominal pain. Kidney-ureter-bladder (KUB) scout film showed a huge, 320-g triangular pelvic calculus that was surgically removed with excellent results. Bladder stone is a common disease, but it is rare for such a calculus to be so large as to cause bilateral hydronephrosis. Surgical intervention by cystolithotomy or endoscopic cystolithotripsy can achieve satisfactory results. Bladder outlet obstruction should be treated simultaneously. Close follow-up, however, is mandatory because the recurrence of urolithiasis is high in those patients with voiding problems and recurrent urinary infection. To the best of our knowledge, this is the largest bladder stone in a human male. This case report also illustrates the importance of radiologic evaluation of patients with repeated urinary infections.
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PMID:A huge pelvic calculus causing acute renal failure. 1827 20

We describe a renal transplant patient who developed an abdominal pain in the hypogastrium area and a urinary tract infection. An abdominal RX, and later, a computerized tomography showed an air collection in the bladder wall. Emphysematous cystitis is a rare complication of the urinary tract infection, more frequently in patients with diabetes mellitus. It is important to treat it since the beginning, so we can avoid several complications.
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PMID:[Emphysematous cystitis in a patient with renal transplant]. 1833 45

We reviewed the clinicopathological features, diagnosis, and surgical treatment of ectopic ureters (EU) in children in order to evaluate the anatomy, renal function, outcome, and the existence of any racial or regional difference in this abnormality. The records of 27 consecutive patients with 33 EU managed over a period of 7 years were analyzed. There were 25 female and two male patients. Their age ranged from 1 to 13 years, with an average of 4.5 years. The presenting features included history of continuous dribbling of urine with otherwise normal voiding in toilet-trained female patients, incontinence of urine, urinary tract infection, abdominal pain, and renal failure. The diagnostic work-up included ultrasonography (US) in all 27 patients, intravenous pyelography (IVP) in 23, micturating cystourethrogram (MCU) in 19, nuclear imaging (NI) in 16, and computed tomogram (CT) in five patients. All patients underwent examination under anesthesia (EUA) and cystourethrovaginoscopy immediately before the operation. Single-system ectopic ureter (SSEU) was present in 19 patients with 25 ureters (six bilateral), and duplex with ectopic ureter was present in eight cases. The left side was involved in 14 cases, the right side in seven, and the anomaly was bilateral in six cases. Abnormalities noted in the imaging studies were USG 23/27, IVP 23/23, MCU 11/19, NI 13/16, and CT 5/5 cases. EUA and cystourethrovaginocsopy helped in localization of the ectopic site and evaluation of the bladder. The surgical treatment included nephroureterectomy (NUT) for non-functioning kidney in 7 patients, heminephroureterectomy (HNUT) for non functioning upper pole of duplex kidney with EU in 6 patients, ureteric reimplantation (UTR) in 13 patients (19 ureters, 6 bilateral), and ureteropyelostomy (UTP) in one patient. In the follow-up period ranging from 1 to 5 years, 20 patients achieved continence; however, six cases with bilateral SSEU and one case of unilateral SSEU, who also had a patulous bladder neck, continued to dribble urine. SSEU was more common than duplex with ectopic ureter. A large number of functioning renal units associated with SSEU deserved preservation. The success of surgical treatment in terms of achievement of continence was high and depended on the integrity of the bladder neck.
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PMID:Spectrum of ectopic ureters in children. 1846 83

Thirty cases of autosomal dominant polycystic kidney disease (ADPKD) seen at King Fahd Hospital of the University, Al-Khobar over a period of eight years, were analysed with respect to clinical features, laboratory investigations, radiological findings, complications and outcome. There were 13 males and 17 females with a mean age of 45 yrs + 10.1 (range 16-65 years). There was positive family history of renal disease in 17 cases. At the time of presentation, 27 cases had abdominal pain. The other features noted were hematuria (20 cases), polyuria (10 cases), urinary tract infection (22 cases), headache (9 cases), uremia (7 cases) and nephrolithiasis (5 cases). Bilaterally palpable kidneys were present in all cases. Hypertension (17 cases) was the next common clinical finding. Other clinical features noted were hepatomegaly (5 cases) and mitral valve prolapse (5 cases). Twenty-one patients had cysts in liver and five had cysts in spleen. Varying degrees of renal failure were seen in 15 cases. Six (20%) patients progressed to end stage renal disease during the period of observation.
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PMID:Autosomal dominant polycystic kidney disease: observations from a university hospital in saudi arabia. 1858 40

The case was presented here in order to point out that an immunocompetent child might have Strongyloidiosis infection that might be misdiagnosed. A 9 year old male patient who had chronic abdominal pain with a feeling of weakness was treated several times for urinary tract infection. He had never been tested for the presence of parasites. After the patient's complaints occurred again, he presented at our hospital. Strongyloides stercoralis larvae were observed in his feces by microscopy. Albendazol (400 mg/day for three days) was prescribed. After 10 days, the feces of the patient was reexamined and no Strongyloides stercoralis larvae were detected. For this reason, it is important to investigate the possibility of intestinal parasitic infections in children with chronic abdominal pain.
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PMID:[Case report: strongyloidiosis with chronic abdominal pain]. 1864 54

Multicystic dysplastic kidney (MCDK) is one of the most common renal abnormalities in children. The aim of our study was to evaluate the clinical course and outcome of patients with MCDK. Ninety pediatric patients with unilateral MCDK followed by the Pediatric Nephrology Department of Bakirkoy Maternity and Children's Hospital between 1990 and 2007 were included in this retrospective study. The dimercaptosuccinic acid radionuclide scan revealed no function in MCDK in all of our patients. Voiding cystourethrogram was performed in all patients. Twenty patients (22.2%) had abnormalities in the contralateral kidney. Nephrectomy was performed in 41 patients (45.5%). Twelve patients had undergone routine nephrectomy before 1996. Since then, patients have been followed up conservatively, and nephrectomy has been performed only when indicated. Indication of nephrectomy was arterial hypertension in 16 patients (23.1%), recurrent urinary tract infection (UTI) in 11 (15.9%), and severe abdominal pain in two (2.8%). Hypertension was noted within the first year of life in all patients except two. MCDK completely involuted in 39.3% within 48 months. There was no malignant transformation, proteinuria, or renal failure. In conclusion, hypertension is often noticed in infants with MCDK. Uninephrectomy leads to normalization. However, prospective studies are needed to exclude a spontaneous improvement of hypertension.
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PMID:Unilateral multicystic dysplastic kidney: single-center experience. 1869 20


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