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The patient was treated successfully with laparoscopic nephrolithotomy, indicating that laparoscopy is an effective and safe approach in the treatment of renal stones >2 cm in HSK. Copyright © 2020, Breish et al.Laparoscopic nephrectomy is a minimally invasive procedure that provides significant benefits to the patient, such as reduced analgesic requirements and shorter recovery time. While the popularity of laparoscopy has grown substantially, there are associated risks of injury to the blood vessels and/or viscera during the insertion of the laparoscopic ports. Such injuries can lead to a significant increase in mortality rates. Patients who have had previous abdominal surgery have a higher risk of adhesions; this has been shown to increase the risk of complications from port placement. Consequently, previous abdominal surgery was viewed as a relative contraindication to laparoscopic surgery. However, studies have demonstrated the advantages of laparoscopic surgery over an open radical approach; hence, previous abdominal surgery is no longer viewed as a contraindication. Here, we describe the case of a 62-year-old man who presented with an incidental finding of right renal cell carcinoma (RCC). We performed a radical nephrectomy on this patient who had undergone multiple previous abdominal surgeries. During this procedure, a small bowel injury occurred. Herein, we review the available evidence and describe the risk factors and techniques to avoid injury from laparoscopic port-site placement in patients undergoing nephrectomy with a history of previous abdominal surgery. Copyright © 2020, Breish et al.Protamine sulfate is considered a "life-saving" antidote for heparinized patients with major bleeds. Although the beneficial attributes and application of protamine sulfate in various clinical settings cannot be argued, it also has an impressive side-effect profile. Kounis syndrome (KS) is an acute coronary syndrome in the setting of an allergic reaction, which can be induced by numerous allergens. Herein, we report a case of KS secondary to the use of protamine sulfate after cryoablation for atrial fibrillation. Copyright © 2020, Amro et al.A 68-year-old woman presented with a three-week history of upper abdominal discomfort, vomiting of coffee ground substance, and passage of tarry stools. There were no typical risk factors for gastroduodenal or liver disease. Gastroscopy done showed a fishbone impacted in the wall of the pyloric opening with its free end abutting on the wall of the duodenum resulting in a duodenal ulcer. Antral erosions were also noted. Retrieval forceps were used to retrieve the fishbone. The patient did not remember eating any fish containing meal, and there was no odynophagia. This case emphasizes the importance of considering foreign bodies as a cause of upper gastrointestinal bleeding as well as the need for an endoscopic review of all patients with upper gastrointestinal bleed. Copyright © 2020, Odeghe et al.Purpose The aim of this study was to evaluate the association between changes in the type of Modic change (MC) and newly developed MCs and low back symptoms. Methods This retrospective study includes all the patients suffering from low back pain who has at least two magnetic resonance studies between 2013 and 2016. Patients with MC in at least one vertebra in magnetic resonance imaging (MRI) images were included in the study. The patients who have periods of two MRIs less than six months were excluded. Results A total of 129 patients were included in the study and 774 vertebrae were evaluated. At the time of the first admission, MC was observed in 283 out of the 774 vertebrae (37%), whereas in the second admission, MC was observed in 343 of 774 (43%) vertebrae. New MCs were observed in 59 vertebrae. Two patients showed complete resolution of MC in the second admission. It was observed that patients with type 1 change were more associated with pain than other types (p=0.001). Conclusion In our retrospective case-control study, we have found that MCs can transform into different types or disappear completely over time. A significant positive correlation was found between the presence of MC type 1 changes in the visual analog scale(VAS). L-Mimosine purchase Copyright © 2020, Çevik et al.Background Intracranial arteriovenous malformation (AVM) is a rare congenital disease that is characterized by an abnormal tangle of blood vessels where arteries abnormally shunt into veins with no intervening capillary bed. Several treatment modalities, such as microsurgical removal, embolization, and stereotactic radiosurgery (SRS), are used to treat AVM either solely or in combination. We aimed to assess and compare the effect, morbidity, and mortality outcomes of mono-treatment with embolization and combined treatment for AVM obliteration. Methodology This retrospective cohort study was conducted in the National Guard Hospital Jeddah and reviewed all the AVM patients that visited the center between 2008 and 2017. We assessed presenting symptoms at diagnosis and any co-morbidities as the clinical characteristics and the patients' AVM and Spetzler-Martin grade as the morphological characteristics. Moreover, we performed a three-year follow-up on suitable patients and assessed their outcomes using the modified Rankin Scale. In addition, we performed follow-up imaging on the patients to evaluate AVM obliteration after any of the procedures. Results We included 29 patients treated in our hospital (72.4%, males; 27.6%, females; mean age 40 years). About 65% of the patients underwent mono-therapy consisting of one or more embolization sessions while about 34% underwent combined treatment (embolization + surgery or embolization + SRS). We found more cases of complete obliteration among patients who underwent mono-therapy (52.6%) than among those who underwent combined treatment (30%). Patients who underwent mono-therapy showed better outcomes compared to those who underwent combined therapy; however, the difference did not reach statistical significance. Conclusions Embolization mono-therapy appears to be more effective with regards to the obliteration rate and outcome compared to combined therapy with either SRS or surgery in patients treated in our center. Copyright © 2020, Alshehri et al.
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