Notes

Postponed CPAP-Induced Pneumocephalus as well as Meningitis Posttranssphenoidal Medical procedures.
Patients with circumcaval ureter and right renal calculi are not often seen in the clinical practice and require special approach. Hereby we report a case of a 34-year-old male that was diagnosed with circumcaval ureter complicated by right kidney stones. Laparoscopic ureteroplasty and flexible ureteroscopic lithotripsy were implemented in the treatment of both of these entities. A combination of these approaches allowed us to perform the surgery effectively, efficiently and safely without having to do the second one.Comparatively to scrotal gangrene, isolated penile gangrene is very rare due to the rich blood supply of the organ. It is thought to be initiated by a traumatic or vascular insult to the penis. This condition requires parenteral antibiotic therapy and serial debridement of necrotic tissue. Split thickness skin graft is thought to be the best approach to cover penile skin loss. We share our experience on the presentation of an isolated penile gangrene in a 35-year-old male. In the light of this case, we review the predisposing factors and the management of this entity.We are reporting a very rare case in the current era of modern diagnostics of an incidentally detected Transitional Cell Carcinoma(TCC) renal pelvis, detected pathologically when Right laparoscopic radical nephrectomy specimen of lower pole mass(RCC) was processed, with no prior suspicion of TCC clinically or pre-operative imaging. A 75-year-old female with 4 × 4cm strongly enhancing lower pole renal mass on CTscan underwent a Laparoscopic Radical Nephrectomy. Surprisingly histopathological examination revealed a focus of low-grade TCC, arising from renal pelvis, completely separate from lower pole mass which was a clear cell RCC.Inguinal hernia is a common clinical presentation, with 1-3% containing some of the urinary bladder. Most cases are asymptomatic and diagnosed intraoperatively at hernia repair. We describe a case of an 84-year-old man presenting with acute urinary retention in a bladder had herniated entirely into his scrotum. He was managed conservatively with urinary catheterisation and discharged home. He re-presented with urosepsis secondary to bilateral ureteric obstruction. This was treated with antibiotics and nephrostomy and his hernia was ultimately repaired. Clinicians should consider both upper and lower urinary tract obstruction in patients with significant bladder herniation.An avulsion is very rare and the most serious complication that may occur during ureteroscopy in 0.06-0.45% of patients during the ureteral stone procedure. A sixty years-old female with a small stone in the upper third of the right ureter with high-grade hydronephrosis and underwent a ureteroscopy procedure. During withdrawal of the scope, the ureter was brought out in urethral meatus, with inverted fashion, nearly the whole length of the ureter was avulsed out. A nephrectomy of the right kidney was then performed. Almorexant purchase Knowledge about signs of the ureteral avulsion, pitfalls when to stop, and treatments is really important.Shortage of donors has led to an expansion of the criteria for acceptability of deceased-donor organs including the use of kidneys with anatomical variations such us horseshoe kidneys (HSKs). Transplantation can be accomplished either en bloc or after division of the HSK. Little is known about the most appropriate technique to split the kidney and minimize risk of bleeding or urinary fistula. In this report we present two renal transplants after division of a HSK with a different splitting technique.Macronodular hyperplasia (MAH) of the adrenal gland is a rare disease usually presenting with Cushing Syndrome. Although usually readily apparent on imaging, an adrenal tumor in an asymptomatic patient may be mistaken for a renal tumor. We present a patient with combined macro- and micro-nodular adrenal hyperplasia masquerading as an upper pole renal mass. The patient underwent a robotic partial nephrectomy and partial adrenalectomy without complication.Self-insertion of needles into the urethra is rare among children, especially in adolescents with no evident history of mental illness. It is usually an urological emergency condition and needs surgery as soon as possible. The case we report here is a 14 year-old boy with urethral self-insertion of a sewing needle which was lodged in urethra for 9 years. The needle was successfully removed by urethrocystoscope with a surgical grasper. Our objective of this case report is to remind urologists and pediatrician of the possibility of urethral foreign bodies and recommend scrotal ultrasonography as the first examination modality.Salvage radiotherapy (SRT) is a widely used treatment option for patients demonstrating biochemical recurrence post radical prostatectomy. Urologists are familiar with common adverse effects of SRT, such as voiding and erectile dysfunction. In rare instances, more devastating complications can occur. We report a case of bladder neck necrosis following SRT resulting in urethrorectal fistula, fistulae extending into bilateral thighs, and infectious osteomyelitis (OM) of the pubis symphysis. Although rare, this case highlights the severity of complications that can occur following SRT, as well as the surgical management of such complications.
Creatine transporter deficiency (CTD) is an X-linked form of intellectual disability (ID) caused by
mutations. Limited information exists on the adult course of CTD, and there are no treatment studies in adults.

We report two half-brothers with CTD, 36 and 31years at intervention start. Their clinical phenotypes were consistent with CTD, and intervention was indicated because of progressive disease course, with increased difficulties speaking, walking and eating, resulting in fatigue, and malnutrition. We therefore performed treatment trials with arginine, glycine and a proprietary product containing creatine and betaine, and then a trial supplementing with betaine alone.

In the older patient, glycine and arginine were accompanied by adverse effects, while betaine containing proprietary product gave improved balance, speech and feeding. When supplementation stopped, his condition deteriorated, and improved again after starting betaine supplement. Betaine supplementation was also beneficial in the younger patient, reducing his exhaustion, feeding difficulties and weight loss, making him able to resume his protected work.
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