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Bow Your Head in Pity, or, Maintain Your mind Up with Pride: Semantic Processing associated with Self-Esteem Aspects Orients Attention Up and down.
Background Filariasis is a tropical disease caused by infection with nematode parasites of the Filarioidea family. Filariasis is an endemic disease in parts of India, Sub-Saharan Africa, and Southeast Asia. Filariasis is a progressive disease predominantly affecting the lymphoreticular system, which can result in genitourinary complications (hydrocele, scrotal pain, and infertility), lymphedema, and elephantitis. Retroperitoneal fibrosis has a broad etiology, including secondary to chronic infection. Currently an estimated 25 million men are suffering from lymphatic filariasis with urogenital involvement worldwide. Case Presentation We present a rare case of a 40-year-old man presenting with fever, groin lymphadenopathy, and a history of infertility. Imaging confirmed significant hydronephrosis and retroperitoneal fibrosis. Filariasis serology was positive. Prior bilateral testicular biopsy demonstrated chronic inflammation and atrophy. Disease course was not improved by empirical eradication and supportive retrograde ureteral stenting. The patient developed elephantitis and progressive retroperitoneal fibrosis leading to a solitary functioning right kidney with nephrostomy. Conclusion Urologists should be aware of index presentations of filariasis and its associated urological complications, particularly in the travelling adult population in whom the etiology of renal impairment and infertility remains unclear.Background Upper tract urothelial carcinomas (UTUCs) are infrequent neoplasms occurring in the pelvis renalis or the ureter with an incidence between 5% and 10% of all urothelial carcinomas. In addition, a synchronous bilateral appearance is extremely rare with a quantity of only 1.6% of all UTUCs. BAY 85-3934 chemical structure Since an oncologically-safe treatment would be a radical nephroureterectomy, consequently leading to dialysis, a satisfying therapy is challenging. Case Presentation We present the case of a 64-year-old woman with bilateral UTUCs at primary diagnosis and the sincere wish of a kidney-preserving treatment option. Therefore, multiple endoscopic ablations with a laser were performed, until a tumor-free status could be achieved. Owing to her medical history with a gynecologic tumor, a genetic examination was initiated, revealing the diagnosis of a Lynch syndrome. Based on promising results in the first 3-month follow-up we decided on a short-term endoscopic follow-up to keep control of tumor progression by endoscopic ablations when needed. In this way we are trying to spare our patient the dialysis. Conclusions An oncologically satisfying treatment for bilateral UTUCs stays a challenging problem in urology. Despite little available data and expected high recurrence rates, we decided on an endoscopic kidney-preserving therapy approach to eventually spare our patient the dialysis. Up to now we are pleasantly surprised about the result and since a short-term follow-up is possible in our department, we hope to attain endoscopic control of the tumor. In addition, we want to point out that genetic background might be underestimated and should be keep it in mind for special cases. In this way, an early detection of other related tumors or tumor detection in relatives could be possible through preventive checkups.Background Bilateral synchronous renal pelvic carcinomas are rare diseases. Complete urinary exenteration or kidney-preserving procedures are two different options that confer different benefits to the patient depending on the clinical situation. Case Presentation A 69-year-old woman with bilateral synchronous renal pelvic carcinomas underwent laparoscopic complete urinary tract exenteration. Although dissection was difficult because of postoperative adhesions, the surgery was completed with minimal blood loss. Conclusion Laparoscopic complete urinary tract exenteration allows minimally invasive surgery with minimal blood loss.Background Horseshoe kidney (HSK) is a common congenital disease. Its incidence ranges from 1 in 400 to 1 in 1000, and it is often associated with chromosomal aneuploidies. Surgical approaches for tumor arising from HSKs are challenging because of the complicated vessel anatomy, poor mobility, and mass location. We report two patients diagnosed with tumors in HSKs who underwent retroperitoneoscopic partial- or heminephrectomy. Case Presentations Case 1 A 55-year-old woman presented to the hospital complaining of recurrent back pain. A 3.0-cm tumor mass in a HSK and polycystic kidney was revealed on CT. Three-dimensional (3D) imaging revealed a parenchymal fusion in the superior pole of the left moiety of the HSK, supplied by two main arteries from the aorta. The patient underwent retroperitoneoscopic partial nephrectomy using the four-trocar technique. Case 2 A 50-year-old man was referred to the hospital for further examination of a left renal tumor in his HSK discovered on CT. 3D imaging revealed a 3.4-cm mass arising from the left moiety of a HSK with invasion of the left renal sinus. There were five arteries feeding the tumor. The patient underwent retroperitoneoscopic heminephrectomy after embolization of the main artery supplying the tumor, guided by digital subtraction angiography with the four-trocar technique. Conclusion Retroperitoneoscopic surgical approaches are feasible for resection of tumors from HSKs. The option of retroperitoneoscopic partial- or heminephrectomy depends on the location and blood supply of the tumor.The robotic approach toward radical prostatectomy for prostate cancer has only recently become widespread. Two of the advantages of the robotic approach have been described to be the optical magnification afforded by camera and the ability to reach deep into the pelvis. These advantages are particularly salient in cases where the pelvis is particularly narrow or the prostate is particularly large. In this report, we describe the management of a patient with two simultaneous prostatic diseases prostate cancer and a massive prostate weighing 560 g causing urinary retention and hematuria, who underwent robot-assisted radical prostatectomy for prostate removal. To the best of our knowledge, this is the largest prostate to be removed through the means of robot-assisted surgery.Background Urethrorrhagia is a rare urologic event with urethral pseudoaneurysm a potential cause. All previous reports of urethral pseudoaneurysm have been managed with angioembolization. Case Report A 25-year-old man experienced delayed presentation of urethrorrhagia secondary to urethral pseudoaneurysm formation after significant pelvic trauma. Urethral pseudoaneurysm was definitively managed with endoscopic transurethral external compression. Endoscopic thrombosis of pseudoaneurysm was confirmed by postprocedure angiography. Conclusion Endoscopic transurethral management of a urethral pseudoaneurysm is an alternative form of treatment for urethral pseudoaneurysm, with potentially fewer downstream effects on voiding and erectile function.Background Supernumerary kidney is a rare anomaly. Not >100 cases have been reported. It was defined by Geisinger as the "free accessory organ," which is a distinct, encapsulated, large, or small parenchymatous mass topographically related to the usual kidney by a loose cellular attachment at most and often by no attachment at times. Case Presentation A 28-year-old woman presented with left lower abdomen pain. On evaluation, she was found to have left supernumerary kidney with renal pelvic stone 13 × 8 mm, which was placed below the native kidney. The ureter was merging with native kidney ureter just above the vesicoureteral junction. CT angiography revealed anomalous vessels supplying the supernumerary kidney. Patient underwent semirigid ureteroscopy and laser lithotripsy and complete stone clearance was achieved. Double-J stent was removed after 2 weeks and on follow-up, there is no recurrence of stones. Conclusion Supernumerary kidney is a rare congenital anomaly. Renal stone in supernumerary kidney presenting as lower abdomen pain is rarely reported. Imaging is essential to confirm the diagnosis and look for other associated anomalies. Ureteroscopy and laser lithotripsy are suitable options in such cases possibly because of low-lying kidney and location of stone in renal pelvis. Other options are mini percutaneous nephrolithotomy and retrograde intrarenal surgery.Background Congenital mid-ureteral stricture (CMUS) is a rare diagnosis almost exclusively repaired with ureteroureterostomy in infancy or early childhood. Case Report We describe a unique case of a 2-year-old child with both a CMUS and ipsilateral obstructed megaureter, which was addressed in a single operative setting using a robotic Heineke-Mikulicz nondismembered ureteroplasty for the CMUS and a dismembered tapered extravesical ureteral reimplant for the obstructed megaureter. Conclusion Compared with ureteroureterostomy, a nondismembered ureteroplasty for CMUS minimizes the risk of ureteral vascular compromise and can be particularly beneficial in cases where the affected ureter requires additional reconstruction. Use of robot-assisted technology for complex ureteral reconstruction in the pediatric population is safe and effective.Uncontrolled noncompressible hemorrhage is a major cause of mortality following traumatic injuries in civilian and military populations. An injectable hemostat for point-of-care treatment of noncompressible hemorrhage represents an urgent medical need. Here, we describe an injectable hemostatic agent via polymer peptide interfusion (HAPPI), a hyaluronic acid conjugate with a collagen-binding peptide and a von Willebrand factor-binding peptide. HAPPI exhibited selective binding to activated platelets and promoted their accumulation at the wound site in vitro. In vivo studies in mouse tail vein laceration model demonstrated a reduction of >97% in both bleeding time and blood loss. A 284% improvement in the survival time was observed in the rat inferior vena cava traumatic model. Lyophilized HAPPI could be stably stored at room temperature for several months and reconstituted during therapeutic intervention. HAPPI provides a potentially clinically translatable intravenous hemostat.Acute viral myositis is a rare condition that is commonly defined with influenza A, B, and enterovirus in the United States of America. Viral myositis complicated by rhabdomyolysis is even less common but requires prompt attention and diagnosis to prevent complications. We describe the occurrence of acute viral myositis complicated by rhabdomyolysis in a young 43-year-old man that lead to acute renal failure. It also highlights that clinicians should keep in mind that viral upper respiratory infections can be complicated with various clinical manifestations that could extend beyond respiratory symptoms.Neutropenia is a serious complication found in immunocompromised patients, particularly those with cancer and human immunodeficiency virus (HIV). The etiology of neutropenia is multifactorial and can be caused by the direct effects of HIV infection, cytotoxic antineoplastic therapy, and malignancy. The main complication of neutropenia is a bloodstream infection caused by gram-positive bacteria (GPB) and gram-negative bacteria (GNB). GPB, specifically S. epidermidis, tend to affect cancer patients more often than GNB. However, GNB such as Pseudomonas aeruginosa have been associated with more serious infections. We report a case of neutropenic fever caused by a GNB, Pantoea agglomerans, in a 47-year-old Afro-Caribbean man with HIV and metastatic salivary adenocarcinoma. Pantoea agglomerans is a non-spore forming rod typically isolated from plants, fruits, and fecal matter, and is rarely pathogenic in humans. In the current literature, cases of P. agglomerans have been documented primarily in the pediatric population secondary to penetrating wound trauma.
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