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Query: UMLS:C0016199 (flank pain)
 2,189 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Autosomal dominant polycystic kidney disease is one of the most commonly inherited diseases in the United States. It affects nearly 500,000 Americans and accounts for 5 to 10 percent of patients with end-stage renal disease. Diagnosis is usually made in middle age, when complications such as hypertension, pain and hematuria develop. Renal complications include hypertension, cyst infection and hemorrhage, hematuria and flank pain. Other manifestations and related conditions include polycystic liver disease, cerebral aneurysm, cardiac valve abnormalities and diverticulosis. The severity and course of the disease vary in individual patients. Management involves the control of hypertension and treatment of complications. Genetic counseling is important. Dialysis and renal transplantation often are successful treatments in patients who develop renal failure.
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PMID:Autosomal dominant polycystic kidney disease. 859 59

This study aims to define the effects of pyelonephritis on intrarenal resistive indices and to determine the role of Doppler sonography in the diagnosis of pyelonephritis in pregnant patients. Twenty pregnant women with pyelonephritis underwent renal Doppler sonography with calculation of intrarenal resistive indices. The resistive index was calculated for the upper, lower, and interpolar areas of each kidney in the patients with pyelonephritis (40 kidneys) and was compared to the resistive indices for a control group of 153 normal asymptomatic pregnant women (306 kidneys). Doppler findings were correlated with the location (sidedness) of flank pain in the pyelonephritis group. The mean resistive index values of patients with pyelonephritis were 0.04 higher than in the controls, and this difference was statistically significant (P < 0.001). Four patients with pyelonephritis had a mean resistive index > or = 0.70, whereas the remaining 16 patients had resistive indices within the normal range of < or = 0.70. In patients with confirmed pyelonephritis and unilateral pain, the average resistive index in the kidney on the side of pain was 0.03 greater than that on the asymptomatic side (P = < 0.01). The mean renal resistive index is significantly greater in pregnant patients with pyelonephritis than in pregnant women without pyelonephritis. Even so, the magnitude of the differences in resistive index is too small and the overlap between the groups too large for this parameter to be of discriminating clinical value.
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PMID:Doppler sonography in the diagnosis of antepartum pyelonephritis: value of intrarenal resistive index measurements. 866 78

Urolithiasis during pregnancy, though rare, can be challenging both diagnostically and therapeutically. It is helpful if the physician is quick to suspect the presence of stones in the presence of appropriate signs and symptoms, particularly flank pain and tenderness, hematuria, or unresolved bacteriuria. Ultrasonography is the diagnostic imaging method of choice, but modified intravenous urography should be performed whenever this study is necessary for a prompt diagnosis. In the absence of sepsis, renal failure, or intractable pain, conservative management with hydration, analgesics, and (if infection is present) antibiotics is the favored initial approach. If conservative management fails, stent insertion or placement of a percutaneous nephrostomy tube may be appropriate. Ureteroscopy with stone manipulation for distal ureteral stones during pregnancy has also been reported in some cases. If these methods fail, open surgery should be used for stone removal.
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PMID:Urinary calculi during pregnancy. When are they cause for concern? 885 87

A 53-year-old female visited our out-patient department complaining of right flank pain. Ultrasonography revealed a solid mass lesion in the lower pole of the right kidney and further evaluation was scheduled. A few days later, she suddenly felt pain at the abdominal enlarged mass. Computed tomographic (CT) scan revealed a huge retroperitoneal mass with heterogenous density. Spontaneous rupture of renal tumor was suspected and emergency nephrectomy was performed. The ruptured tumor was pale, elastic firm and invaded directly to the duodenum. Histopathological findings revealed fibrous cells with frequent nuclear mitosis. Smooth muscle actin was identified immunohistochemically. Therefore, the tumor was diagnosed as leiomyosarcoma. The patient died 2 months after operation due to perforation of the intestine.
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PMID:[A case of spontaneous rupture of renal leiomyosarcoma]. 888 67

The variable and nonspecific presentations of psoas abscess, as well as its infrequent incidence in the emergency department (ED), can result in delayed diagnosis or misdiagnosis. Previous reports have not discussed the diagnostic difficulties of psoas abscess from the viewpoint of emergency physicians (EPs), especially in light of the widespread use of ED ultrasonography. This report describes a 1-year experience between November 1993 and October 1994, during which 10 ED patients were diagnosed to have psoas abscess; in 7 cases, diagnoses were established in the ED. Patients' mean age was 64.6 years (range, 46 to 76). Pain was the most frequently encountered symptom (80%), with 5 patients (50%) complaining of flank pain. The triad of fever, flank pain, and limitation of hip movement, which is specific for psoas abscess, was present only in 3 patients (30%). The mean duration of symptoms was 10.6 days (range, 1 to 30 days). The mean time spent to establish the diagnosis was 1.7 days (range, 0 to 7 days). The diagnosis of psoas abscess was established by ultrasound in 6 patients, by computed tomography (CT) in 3 patients, and by surgery in 1 patient. Four patients who presented with either sepsis and nonspecific abdominal/flank pain or sepsis and thigh swelling were diagnosed to have psoas abscess by ultrasound performed by EPs. Only 3 patients were admitted to the ED with an initial diagnosis of psoas abscess. The remaining 7 had the following initial ED diagnoses: 2, fever of unknown origin; 2, septic shock; 1, shock; 1, sepsis; and 1, peritonitis. All but one had manifestations of sepsis. Two patients died of septic shock; these two patients had failed to be drained well. This report also includes a discussion of the role of EPs and ultrasonography in the diagnosis of psoas abscess. With their alertness and their expertise in ultrasonographic techniques, EPs can make an immediate diagnosis and arrange an early drainage procedure. For patients with sepsis of unknown origin, prolonged fever of unknown origin, and some specific manifestations suggestive of psoas abscess, the screening ultrasound should scan not only abdominal solid organs but also peritoneal cavity and retroperitoneal space. In addition, a flow chart is presented for facilitating the diagnosis of psoas abscess in the ED.
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PMID:Psoas abscess: making an early diagnosis in the ED. 900 79

We treated 17 patients with severe endometriosis involving the genitourinary tract. Eight women presented with persistent right or left flank pain, two presented with known ureteral obstruction, and five presented with urinary frequency and burning, and/or hematuria with their periods. Presented are the results of laparoscopic management in these patients. We performed segmental bladder resection in six patients and ureteral resection and reanastomosis in two. Nine additional patients underwent partial resection of the ureteral wall for complete removal of endometrial implants. The ureter was repaired with 4-0 PDS in seven patients and a stent was left in place for 4 to 6 weeks. Two required only a stent due to the small size of the ureterotomy. The postoperative course of these patients was uneventful. Following ureteral repair/reanastomosis, all women underwent an intravenous pyelogram at follow-up, and normal bilateral excretion was demonstrated. Cystoscopy revealed no abnormal findings in five patients who had undergone partial bladder resection. All patients reported significant pain relief or complete resolution of symptoms. Operative laparoscopy can be safely used to achieve relief from severe symptomatic endometriosis of the genitourinary tract.
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PMID:Laparoscopic Management of Genitourinary Endometriosis 907 28

The incidence and predisposing factors of urinary calculi are generally the same in both pregnant and non pregnant women, but anatomic changes during pregnancy make diagnosis and treatment a more challenging issue. We reviewed 16 patients (22 stones) of urinary stone during pregnancy between 1986 and 1996 at Kyung Hee Medical Center. The most common symptom was flank pain, seen in 81.3% of patients, while 68.8% of patients were displayed microscopic hematuria. In all cases, diagnosis was made by abdominal ultrasound, there was no need for other harmful investigate procedures. Forty point nine percent of the total stones (9/22) were passed spontaneously, double J stenting was carried out in three cases because of persistent pain or urinary tract infection (UTI), ureteroscopic stone removal was performed in one case. Based on our experience and a review of the literature, abdominal ultrasound should be performed first and in all cases appears sufficient for the diagnosis of a stone. In case of persistent pain or urinary tract infection, a double J stent is more effective than percutaneous nephrostomy.
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PMID:Management of urinary calculi in pregnant women. 914 58

Renal Cell Carcinoma is the third most common malignoma in urology. Only little is known about the etiology and risk factors; the age peak lies at 60 and twice as many men than women are affected. The clinical picture presents with a wide spectrum. Over one third of all tumours are detected accidentally by ultrasound or computed tomography in asymptomatic patients. Most common symptoms are hematuria and flank pain, the classical trials including in addition a palpable mass is rare and by mo means an early symptom. Paraneoplastic syndromes include unspecific (increased blood sedimentation rate, weight loss, fever) and endocrine symptoms (hypertension, polyglobulia, hypercalcemia). Diagnosis is based on imaging procedures. By means of sonography renal cysts may be separated from solid, space-occupying tumors. For the latter CT plays a decisive role for staging, therapeutic planning and prognosis. Further radiologic investigations (angiography, MRI) are indicated only in special situations. Rarely a biopsy is necessary for the distinction between renal cell carcinoma and metastases of other primary tumors. The only curative treatment of localized carcinoma is radical nephrectomy. Partial resection is indicated in cases of a single kidney, bilateral tumors and possibly also for tumors smaller than 4 cm in diameter. Radiotherapy is only initiated for palliation of painful skeletal metastases. In case of distant metastases--mainly pulmonary--nephrectomy should only be performed if systemic treatment is planned or if local complaints (pain, hematuria leading to anemia) exist. Chemotherapeutic drugs have no influence on survival. The effect of gestagens on life quality is questionable. Adoptive immunotherapy with cytokines (Interferon-alpha, interleukin-2) appears most promising. These substances, however, not yet been introduced into routine therapy should only be used in prospective studies. Furthermore, renal cell carcinoma is a potential candidate for gene therapy. After tumor nephrectomy follow-up investigations should be performed twice a year, because of the possibility of curative surgical treatment of late solid metastases. Prognosis of tumors restricted to the organ is good. Five year survival after operation is about 90%. However, is distant metastases exist already at the time of diagnosis 5 year survival drops to less than 10%.
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PMID:[Renal cell carcinoma--a current review]. 931 11

A clinical study was conducted on the intermittent hydronephrosis in children. Of 78 children with hydronephrosis due to ureteropelvic junction obstruction operated between 1991 and 1995, 5 had intermittent hydronephrosis. All 5 patients were boys between 6 months and 6 years of age. Presenting symptoms were intermittent flank pain and vomiting. Ultrasonography performed during pain attack demonstrated dilation of the renal pelvis in all patients. Diuretic renography demonstrated obstruction in 4 of the 5 children and deterioration of renal function on the affected side in 2. The cause of ureteropelvic junction obstruction was aberrant vessels in 2 cases, fibrous band in 1, ureteral kinking within adventitia in 1 and a ureteral polyp in 1. Postoperatively, all patients have been relieved from the pain. In summary, ultrasonography at the time of symptom attack as well as diuretic renography are useful for the diagnosis and observation of intermittent hydronephrosis.
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PMID:[A clinical study of intermittent hydronephrosis]. 939 4

A 51 year-old woman with a history of ureteral stenosis and calculi noted recurrence of severe left flank pain while undergoing a deep body massage using the Rolfing method. Displacement of her left ureteral double J stent was noted in the emergency department. The pain and associated incontinence resolved with restoration of the stent to its original position. Practitioners should be aware of this potential complication related to forceful massage pressures.
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PMID:Ureteral stent displacement associated with deep massage. 943 79


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