Figure - uploaded by Bakulesh m. Soni Soni
Content may be subject to copyright.
X-ray of abdomen (10102001) Abdominal X-ray shows left-sided upper and lower pole staghorn calculi with defect in the central portion.
Source publication
A delay in diagnosis or a misdiagnosis may occur in patients with spinal cord injury (SCI) or spinal bifida as typical symptoms of a clinical condition may be absent because of their neurological impairment.
A 29-year old male, who was born with spina bifida and hydrocephalus, became unwell and developed a swelling and large red mark in his left lo...
Contexts in source publication
Context 1
... abdomen showed left-sided staghorn calculus. (Figures 2 and 3). Ultra- sonography showed no evidence of hydronephrosis. ...Context 2
... 6). With hindsight, the extruded renal calculus could be seen lying in the subcutaneous tissue of left loin lateral to the 10 th rib in the X-ray of abdomen, which was taken when he presented with red mark and minimal swelling (Figures 2 and 3). This radio opaque density situated in the soft tis- sue of left loin was not present in either of the X-ray of ab- domen taken earlier (Figure 1) or subsequent to extrusion of the renal calculus. ...Similar publications
Background
This study explored the risk factors for renal atrophy after percutaneous nephrolithotomy (PCNL), and provides a reference for clinical prevention of renal atrophy after PCNL.
Material/Methods
According to the inclusion and exclusion criteria, the clinical data of 816 patients who underwent PCNL in our hospital from May 2013 to February...
Citations
... Stone diseases in many part of the world are common cause of morbidity. However in certain group of population, the problem tends to run asymptomatically (1). Presence of calculi in the urinary tract is left unattended until it gets big enough to cause total or near total obstruction of either the kidneys or the bladder trigone. ...
... We concluded that the extrusion of bladder stone to the external environment may be the natural course of avoiding total bladder outlet obstruction from it. Although there are few reports of renal stone extrusion from the kidney to perirenal fat, bladder stone extrusion has not been to our knowledge reported (1) Declarations Page 3/6 Ethical approval and consent: Not Applicable Ethical approval was not taken from RIB because, the intention is to treat the patient and it was not planned that it would be a case for report. ...
Spontaneous extrusion of bladder stone to perianal area has not been reported so far. We, therefore, report a case and discuss that this may be the natural course of the disease when neglected.
... Recent studies show that 3D ultrasound is also promising for the prenatal determination of the lesion level in SB [6] . Ultrasound is considered as the gold standard diagnostic tool for SB, however, its diagnosis still relies on human observation, which may be subjective and error prone [7] . Computeraided approaches are known to improve the accuracy of final diagnosis, reduce the necessary labor and decrease the amount of expertise required to complete the diagnosis task [8] . ...
Background and Objectives
Spina bifida is a fetal spine defect observed during pregnancy. The defect is caused by unfinished closure of the embryonic neural column. Common diagnosis of the defect is still based on manual examination which aims to detect any deformation on spinal axis. This study proposes a novel evolutionary method for locating spinal axis on sonograms of spina bifida pathology.
Methods
The method involves a meta-heuristic evolutionary approach, where the sonogram is automatically divided into columns and bone regions belonging to the spine are classified. Accordingly, a specific genetic algorithm is utilized which constructs a set of candidate spine axes. Fitness of the candidate axes is measured by a proposed problem-specific fitness function. A combination of conventional genetic operators and a novel energy minimization approach is applied to each population in order to explore the problem search space.
Results
Results show that presented algorithm is generally able to distinguish the spinal bones from others even in the presence of severe morphological defects.
Conclusion
It is observed that the presented approach is promising and in most samples the spines identified by the proposed algorithm closely match those drawn by the experts. A computer assisted ultrasound diagnosis system specialized for spina bifida cases does not exist yet, but an algorithm to identify the spine, such as the one presented in this work, is the first natural step towards a diagnosis system. In the future, we intend to improve the algorithm by improving the segmentation stage and further optimizing the various stages of the genetic algorithm.
... Renal stones often present as acute colic pain in the emergency wards. According to the Medline search, there are only 6 cases of staghorn calculus presenting as subcutaneous abscess secondary to a perinephric abscess [1][2][3][4][5][6]. Staghorn calculi are relatively uncommon, accounting for 11% of nephrolithiasis cases. ...
... Next leading cause was post surgery. However patients presenting with asymptomatic renal stone leading to spontaneous sinus tract is not so common [1][2][3][4][5][6][7]. In our case, the patient developed perinephric abscess secondary to a long standing undiagnosed staghorn calculus leading to a discharging sinus. ...
Perinephric abscess secondary to renal stones is a rare entity. Presenting with a cutaneous sinus is even rarer. To the best of our knowledge, there are only 6 cases of staghorn calculus presenting as discharging sinus. This report highlights the importance of early detection of renal calculi especially staghorn types and their earliest possible intervention. It also emphasizes the need for clinical suspicion of any intra abdominal pathology as the cause of sinus formation.
... In the past, we have misdiagnosed bladder tumour as vesical debris in a paraplegic patient [12]. We learn that frequent, informal and honest discussions of a patient’s clinical condition, is likely to reduce urological errors in spinal cord injury patients[13]. In this elderly patient, such a honest discussion with a senior colleague would have prevented the misdiagnosis of bladder tumour and stopped this elderly patient from undergoing cystoscopy unnecessarily. ...
We report the anecdotal observation of substandard urological care of elderly paraplegic patients in the community suffering from long-term sequelae of spinal cord injuries. This article is designed to increase awareness of a problem that is likely underreported and may represent the 'tip of the iceberg' related to substandard care provided to the vulnerable population of elderly patients with chronic neurological impairment.
A registered Nurse changed the urethral catheter of an 80-year-old-male with paraplegia; patient developed profuse urethral bleeding and septicaemia. Ultrasound revealed balloon of Foley catheter located in membranous urethra. Flexible cystoscopy was performed and a catheter was inserted over a guide wire. Urethral bleeding recurred 12 days later. This patient was discharged after protracted stay in spinal unit. A nurse changed urethral catheter in an 82-year-old male with paraplegia. The catheter did not drain urine; patient developed pain in lower abdomen. The balloon of Foley catheter was visible behind the urethral meatus, which indicated that the balloon had been inflated in penile urethra. The catheter was removed and a 16 French Foley catheter was inserted per urethra. About 1300 ml of urine was drained. A 91-year-old lady with paraplegia underwent routine ultrasound examination of urinary tract by a Consultant Radiologist, who reported a 4 cm x 3 cm soft tissue mass in the urinary bladder. Cystoscopy was performed without anaesthesia in lithotomy position. Cystoscopy revealed normal bladder mucosa; no stones; no tumour. Following cystoscopy, the right knee became swollen and there was deformity of lower third of right thigh. X-ray revealed fracture of lower third of right femur. Femoral fracture was treated by immobilisation in full plaster cast. Follow-up ultrasound examination of urinary tract, performed by a senior Radiologist, revealed normal outline of urinary bladder with no tumour or calculus.
The adverse outcomes can be averted if elderly spinal cord injury patients are treated by senior, experienced health professionals, who are familiar with changes in body systems due to old age, compounded further by spinal cord injury.
... Discharge to the skin, as seen in this patient, is rare, and a Medline search revealed only 3 cases of subcutaneous abscess formation secondary to a perinephric abscess. [8][9][10] In 2 of these cases the patients were systemically unwell, while the 3rd was well, with no signs of sepsis. Similarly, our patient was systemically well with no evidence of sepsis apart from tachycardia. ...
Perinephric abscesses often present with flank pain and signs of sepsis, and are known to discharge to the skin. We report a case of a young patient presenting with a 48-hour history of painful swelling in her right renal angle following a urinary tract infection and no overt signs or symptoms of sepsis. Plain abdominal films showed a perinephric abscess secondary to a staghorn calculus in the upper pole of the right kidney. On incision and drainage, 700 mL of pus was drained freely. The patient recovered well but required partial nephrectomy.
Subcutaneous abscess as a result of intra-abdominal pathology is a recognized but rare complication. This case illustrates that subcutaneous abscesses may have underlying intra-abdominal pathology without overt signs of sepsis.
... It is possible that some physicians might have encountered similar mishap after implantation of baclofen pump, but have not published the adverse events for fear of recrimination. We favour voluntary reporting and dissemination of information on adverse events related to clinical procedures and medical implants [9-11]. Quite often, mishaps occur due to system errors and therefore, apportioning blame to individual health professionals should be avoided. ...
Increased spasms in spinal cord injury (SCI) patients, whose spasticity was previously well controlled with intrathecal baclofen therapy, are due to (in order of frequency) drug tolerance, increased stimulus, low reservoir volume, catheter malfunction, disease progression, human error, and pump mechanical failure. We present a SCI patient, in whom bladder calculi acted as red herring for increased spasticity whereas the real cause was spontaneous extrusion of catheter from intrathecal space.
A 44-year-old male sustained a fracture of C5/6 and incomplete tetraplegia at C-8 level. Medtronic Synchromed pump for intrathecal baclofen therapy was implanted 13 months later to control severe spasticity. The tip of catheter was placed at T-10 level. The initial dose of baclofen was 300 micrograms/day of baclofen, administered by a simple continuous infusion. During a nine-month period, he required increasing doses of baclofen (875 micrograms/day) to control spasticity. X-ray of abdomen showed multiple radio opaque shadows in the region of urinary bladder. No malfunction of the pump was detected. Therefore, increased spasticity was attributed to bladder stones. Electrohydraulic lithotripsy of bladder stones was carried out successfully. Even after removal of bladder stones, this patient required further increases in the dose of intrathecal baclofen (950, 1050, 1200 and then 1300 micrograms/day). Careful evaluation of pump-catheter system revealed that the catheter had extruded spontaneously and was lying in the paraspinal space at L-4, where the catheter had been anchored before it entered the subarachnoid space. A new catheter was passed into the subarachnoid space and the tip of catheter was located at T-8 level. The dose of intrathecal baclofen was decreased to 300 micrograms/day.
Vesical calculi acted as red herring for resurgence of spasticity. The real cause for increased spasms was spontaneous extrusion of whole length of catheter from subarachnoid space. Repeated bending forwards and straightening of torso for pressure relief and during transfers from wheel chair probably contributed to spontaneous extrusion of catheter from spinal canal in this patient.
... Health professionals from various disciplines worked together to reach the correct diagnosis of bladder cancer producing both PTHrP and G-CSF. We learn that a joint team approach in reaching a diagnosis, and in implementing a treatment regime, is likely to reduce delays in diagnosis and improve the quality of care of SCI patients [22]. cere gratitude to the patient and to his family for their help in publication of this case in BioMed Central. ...
Typical symptoms and signs of a clinical condition may be absent in spinal cord injury (SCI) patients.
A male with paraplegia was passing urine through penile sheath for 35 years, when he developed urinary infections. There was no history of haematuria. Intravenous urography showed bilateral hydronephrosis. The significance of abnormal outline of bladder was not appreciated. As there was large residual urine, he was advised intermittent catheterisation. Serum urea: 3.5 mmol/L; creatinine: 77 umol/L. A year later, serum urea: 36.8 mmol/l; creatinine: 632 umol/l; white cell count: 22.2; neutrophils: 18.88. Ultrasound: bilateral hydronephrosis. Bilateral nephrostomy was performed. Subsequently, blood tests showed: Urea: 14.2 mmol/l; Creatinine: 251 umol/l; Adjusted Calcium: 3.28 mmol/l; Parathyroid hormone: < 0.7 pmol/l (1.1 - 6.9); Parathyroid hormone-related protein (PTHrP): 2.3 pmol/l (0.7 - 1.8). Ultrasound scan of urinary bladder showed mixed echogenicity, which was diagnosed as debris. CT of pelvis was interpreted as vesical abscess. Urine cytology: Transitional cells showing mild atypia. Bladder biopsy: Inflamed mucosa lined by normal urothelial cells. A repeat ultrasound scan demonstrated a tumour arising from right lateral wall; biopsy revealed squamous cell carcinoma. In view of persistently high white cell count and high calcium level, immunohistochemistry for G-CSF and PTHrP was performed. Dense staining of tumour cells for G-CSF and faintly positive staining for C-terminal PTHrP were observed. This patient expired about five months later.
This case demonstrates how delay in diagnosis of bladder cancer could occur in a SCI patient due to absence of characteristic symptoms and signs.
Sepsis is a common presentation to the emergency department (ED) with the main aim of treatment being prompt antibiotics, source identification and control, all preferably within the initial golden hour. In the majority of patients, a good history and examination is adequate to elicit the most likely source of infection and thus target therapy appropriately. However it is well known that this can be difficult in some patient groups. In this report we present two patients with sepsis with spinal cord injury (SCI) where both the history and examination were unhelpful in identifying the source of infection and demonstrate why the unique physiology and risk factors in SCI patients must be considered early in their work up. Both patients were admitted with vague, nonspecific constitutional symptoms. Both had no evidence of abdominal or flank pain or any objective tenderness. One of the patients had a long-term suprapubic catheter and one intermittently self catheterised meaning that urine dip stick results were unreliable. In both instances, the patients were found to have obstructed renal stones with associated infection and both had good outcomes after surgical intervention.
Many complications may arise from urolithiasis especially if there is a delay in the diagnosis or incomplete treatment. They include: obstruction and uremia, sepsis, chronic pyelonephritis, acute or chronic renal failure, xanthogranulomatous pyelonephritis, emphysematous pyelonephritis (EPN), pyonephrosis, hypertension, etc.
Introduction and objectivesthe improvements in the management of newborns with myelomeningocele (MMC) have obtained a big increase in survival, allowing them to get longevity like never before, but data regarding urologic diseases during adult age are still missing. We herein evaluate the features of urinary lithiasis in adults born with MMC and the therapies used for its treatment.Material And Methodwe review 52 patients diagnosed at birth of MMC, between 18 and 40 years old, treated in our institution, with a mean follow-up of 6.7 years.Results10 patients (19.2%) were diagnosed of urolithiasis. three developed kidney calculi and one of them, with 7 more patients, developed bladder calculi (15.3%). the neurological level was ??l2 in 3 cases, l2-s1 in 5, and ??s1 in the other two. the type of neurogenic dysfunction of inferior urinary tract was multiple lesion of lower motor neurone in 6 cases, upper motor neurone in 1 case, multiple mixed lesion in 1 case and in case it was impossible to determine. two patients had a bladder augmentation procedure and one of these with other 3 patients had a non-functional ams-800 artificial urinary sphincter. bladder stones were treated endoscopically in 14 procedures and by suprapubic cystolithotomy in 4 procedures, combined with removal of ams-800 in 3 of them. one patient spontaneously passed a small stone. in one case, 2 eswl and 2 percutaneous nephrolithotomies were needed. three patients developed multiple recurrences during follow-up.Conclusionsurinary lithiasis is common in adults with MMC. Some distinct features of these patients, together with their anatomical configuration and some therapies used in them, cause diagnostic, therapeutic and prophylaxis issues for the calculi they may develop.
