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Clinical Nuclear Medicine Jun 2024We report the successful application of radioembolization (SIRT) in a 77-year-old man with end-stage renal disease on hemodialysis and repeated episodes of macroscopic...
Ablative Radioembolization (SIRT) of a Large Inoperable Renal Cell Carcinoma Invading the Liver That Resulted in Hematuria Control and Complete Necrosis by mRECIST Criteria.
We report the successful application of radioembolization (SIRT) in a 77-year-old man with end-stage renal disease on hemodialysis and repeated episodes of macroscopic hematuria due to a large renal cell carcinoma of the right kidney extending to liver segment VI. A compassionate SIRT therapy was performed with resin microspheres through the upper pole renal artery and the feeding segmental artery of liver segment VI. Hematuria was resolved after treatment, and 4 months later, a follow-up CT scan revealed tumor size reduction and complete tumor necrosis (Response Evaluation Criteria in Solid Tumors criteria). Ablative SIRT therapy could be a safe and efficient option in a large inoperable RCC.
Topics: Humans; Male; Aged; Embolization, Therapeutic; Carcinoma, Renal Cell; Hematuria; Kidney Neoplasms; Necrosis; Liver Neoplasms; Neoplasm Invasiveness; Liver; Tomography, X-Ray Computed
PubMed: 38598452
DOI: 10.1097/RLU.0000000000005209 -
International Medical Case Reports... 2024Pancreatic cancer (PC) is among the deadliest malignancies. Kidney cancer (KC) is a common malignancy globally. Chemo- or radio-therapies are not very effective to...
INTRODUCTION
Pancreatic cancer (PC) is among the deadliest malignancies. Kidney cancer (KC) is a common malignancy globally. Chemo- or radio-therapies are not very effective to control PC or KC, and overdoses often cause severe site reactions to the patients. As a result, novel treatment strategies with high efficacy but without toxic side effects are urgently desired. Secoisolariciresinol diglucoside (SDG) belongs to plant lignans with potential anticancer activities, but clinical evidence is not available in PC or KC treatment.
PATIENT CONCERNS
We report a rare case of an 83-year-old female patient with pancreatic and kidney occupying lesions that lacked the conditions to receive surgery or chemo- or radiotherapy.
DIAGNOSIS
Pancreatic and kidney cancers.
INTERVENTIONS
We gave dietary SDG to the patient as the only therapeutics.
OUTCOMES
SDG effectively halted progression of both PC and KC. All clinical manifestations, including bad insomnia, loss of appetite, stomach symptoms, and skin itching over the whole body, all disappeared. The initial massive macroscopic hematuria became microscopic and infrequent, and other laboratory results also gradually returned to normal. Most of the cancer biomarkers, initially high such as CEA, CA199, CA724, CA125, came down rapidly, among which CA199 changed most radically. This patient has had progression-free survival of one year so far.
CONCLUSION
These results demonstrate the potent inhibitory effects of SDG on PC and KC of this patient and provide promising novel therapeutics for refractory malignant tumors.
PubMed: 38504721
DOI: 10.2147/IMCRJ.S446184 -
Case Reports in Nephrology and Dialysis 2024The anti-thyroid medication propylthiouracil (PTU) is a recognised cause of drug-induced antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV)....
BACKGROUND
The anti-thyroid medication propylthiouracil (PTU) is a recognised cause of drug-induced antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Pauci-immune crescentic glomerulonephritis is the characteristic feature of this condition on renal biopsy. We present a case of PTU-induced AAV with the unusual histological finding of overlap IgA nephropathy (IgAN) in a young female with treatment-resistant Graves' disease.
CASE REPORT
A 26-year-old female presented with an acute kidney injury, macroscopic haematuria, and proteinuria 14 months after starting PTU for Graves' disease. She had a history of established thyroid eye disease and a previous severe adverse reaction to carbimazole. Her autoantibodies were strongly positive for myeloperoxidase-ANCA (199 U/mL). Renal biopsy demonstrated both necrotising crescentic glomerulonephritis and prominent (3+) mesangial deposition of IgA. She was treated with glucocorticoids and rituximab with sustained improvement in her renal function but persisting mild proteinuria and microscopic haematuria. PTU was ceased following a dose of radioactive iodine (RAI). Twelve months post-RAI, her Graves' orbitopathy remained stable, and her thyroid function was gradually normalising.
CONCLUSION
This was a case of drug-induced AAV with histological features of overlap IgAN. We suggest that this patient had pre-existing subclinical IgAN and then developed AAV secondary to PTU. The management of her thyroid disease was complex given the PTU-induced vasculitis, previous reaction to carbimazole, the risks of a thyroidectomy on immunosuppression, and the possible worsening of her eye disease with RAI. The glucocorticoids and Rituximab prescribed for vasculitis may have prevented the progression of her Graves' orbitopathy after RAI.
PubMed: 38439948
DOI: 10.1159/000536618 -
International Journal of Surgery Case... Mar 2024Intraparenchymal renal artery aneurysms are a really rare condition that represents <10 % of all renal artery aneurysms. They are more often caused by trauma or...
INTRODUCTION AND IMPORTANCE
Intraparenchymal renal artery aneurysms are a really rare condition that represents <10 % of all renal artery aneurysms. They are more often caused by trauma or iatrogenic injury and their rupture can lead to life-threatening hemorrhage.
CASE PRESENTATION
We report the case of a 25-year-old male with history of back stab wound three months before being admitted to our unity. The patient presented a macroscopic hematuria three days after the injury. An abdominal CT angiography revealed an intraparenchymal renal artery aneurysm, and it was successfully treated with super selective endovascular coil embolization, achieving both pseudoaneurysm exclusion and renal preservation.
CLINICAL DISCUSSION
Intraparenchymal renal artery aneurysms are rare. They are more often caused by trauma or iatrogenic injury. Renal artery pseudoaneurysms are mainly asymptomatic. Renal pseudoaneurysms can be diagnosed through contrast enhanced CT, renal Doppler ultrasound, or MRI. Super selective embolization of the feeding artery of the pseudoaneurysm using endovascular techniques is the treatment of choice.
CONCLUSION
The management of patients with renal pseudo aneurysms should allow to achieve two main goals: Preserving Renal function, and excluding the pseudoaneurysm.
PubMed: 38428053
DOI: 10.1016/j.ijscr.2024.109275 -
World Journal of Clinical Cases Feb 2024A man experienced multiple episodes of macroscopic hematuria following nocturnal exercise. Urinary stones and tumors were considered the two most likely causes. The...
BACKGROUND
A man experienced multiple episodes of macroscopic hematuria following nocturnal exercise. Urinary stones and tumors were considered the two most likely causes. The patient had two hobbies: Consuming health care products in large quantities and engaging in late-night running.
CASE SUMMARY
Health care products contain a large amount of calcium phosphate, and we hypothesize that this could induce the formation of small phosphate stones. After exercise, the urinary system is abraded, resulting in bleeding. The patient was advised to stop using the health care products. Consequently, the aforementioned symptoms disappeared immediately. However, the patient resumed the above two habits one year later; correspondingly, the macroscopic hematuria reappeared.
CONCLUSION
This finding further confirmed the above inference and allowed for a new avenue to determine the cause of the patient's hematuria.
PubMed: 38414602
DOI: 10.12998/wjcc.v12.i5.1025 -
Urology Case Reports Mar 2024A 81-year-old male patient presented macroscopic hematuria. Flexible cystoscopy didn't give any diagnosis and urinary citology was negative. Total body CT showed a...
A 81-year-old male patient presented macroscopic hematuria. Flexible cystoscopy didn't give any diagnosis and urinary citology was negative. Total body CT showed a bladder inguinal hernia with diffuse thickening of the bladder wall, while abdomen bladder was regular. Diagnosis was difficult because flexible cystoscope could not reach the lesion, preventing diagnosis and bladder resection. We decided to reduce inguinal hernia surgically and perform a partial cystectomy removing the suspect neoplastic part of the bladder. Histologic examination showed muscle invasive squamous cell carcinoma with negative margins. After two years follow up, patient was free from bladder cancer, without any significative LUTS.
PubMed: 38384400
DOI: 10.1016/j.eucr.2024.102673 -
BJUI Compass Mar 2024To perform a descriptive analysis of a series of patients with recurrent macroscopic haematuria after a primary standard evaluation including computed tomography...
OBJECTIVES
To perform a descriptive analysis of a series of patients with recurrent macroscopic haematuria after a primary standard evaluation including computed tomography urography (CTU) and cystoscopy negative for urinary bladder cancer (UBC) and upper tract urothelial cancer (UTUC) and to identify potential factors associated with occurrence of recurrent macroscopic haematuria.
METHODS
All patients older than 50 years who underwent urological investigation for macroscopic haematuria with both cystoscopy and CTU 2015-2017 were retrospectively reviewed. A descriptive analysis of the primary and later investigations for recurrent macroscopic haematuria was performed. To investigate the association between explanatory variables and the occurrence of recurrent macroscopic haematuria, a Poisson regression analysis was performed.
RESULTS
A total of 1395 eligible individuals with primary standard investigation negative for UBC and UTUC were included. During a median follow-up of 6.2 (IQR 5.3-7) years, 248 (18%) patients had recurrent macroscopic haematuria, of whom six patients were diagnosed with UBC, two with prostate cancer, one with renal cell carcinoma and one had a suspected UTUC at the repeated investigation. Within 3 years, 148 patients (11%) experienced recurrent macroscopic haematuria, of whom two patients were diagnosed with low-grade UBC (TaG1-2), one with T2G3 UBC and one with low-risk prostate cancer. The presence of an indwelling catheter, use of antithrombotic medication, pathological findings at CTU or cystoscopy or history of pelvic radiotherapy were all statistically significant independent predictors for increased risk for recurrent macroscopic haematuria.
CONCLUSION
In the case of recurrent macroscopic haematuria within 3 years of primary standard evaluation for urinary tract cancer, there was a low risk of later urological malignancies in patients initially negative for UBC and UTUC. Therefore, waiting 3 years before conducting another complete investigation in cases of recurrent macroscopic haematuria might be appropriate.
PubMed: 38371208
DOI: 10.1002/bco2.300 -
Journal of Clinical Medicine Jan 2024Kidney biopsy (KB) has become essential in the nephrologist's approach to kidney diseases, both for diagnosis, treatment, and prognosis. Our objective is to describe the...
Kidney biopsy (KB) has become essential in the nephrologist's approach to kidney diseases, both for diagnosis, treatment, and prognosis. Our objective is to describe the preliminary results of KBs in Niger, one of the poorest countries in the world. This is a descriptive cross-sectional study that took place over 36 months in the nephrology/dialysis department of the Zinder National Hospital. Biopsy results were obtained in less than 5 working days. Patients were responsible for covering the cost of the kidney biopsy. The data collected were analyzed using Epi Info V7 software. We performed 120 kidney biopsies during the study period. The average age of the patients was 35 years ± 15.4 [5-68]. The male/female sex ratio was 2:1. Patients' medical history included herbal medicine use in 33% of cases and high blood pressure in 27.5% of cases. Proteinuria was present at a rate of ≥3 g/24 h in 46.6% of them. The primary indication for kidney biopsy was glomerular syndrome in 62.5% of cases, including 50% with nephrotic syndrome. All kidney biopsies were performed with real-time ultrasound guidance, using an automatic gun fitted with a 16G needle. Regarding complications, macroscopic hematuria was present in 12.5% of cases. Inadequate kidney biopsy was infrequent (5.8% of cases). The most common findings were (i) glomerular diseases (58.4%), such as membranoproliferative glomerulonephritis (13.3%), focal-segmental glomerulosclerosis (10.6%), lupus nephritis (8.8%), minimal change disease (8%), and membranous nephropathy (2.7%), and (ii) tubulointerstitial changes (31.8%). Diabetic nephropathy was rare (2.6%), as was IgA nephropathy (0.9%). We have demonstrated that implementing a sustainable kidney biopsy program in a very poor country is feasible, thanks to the dedication of a specialized renal pathologist. Having a clear diagnosis can assist in properly treating these renal patients according to international guidelines, thereby delaying the progression to end-stage kidney disease.
PubMed: 38337366
DOI: 10.3390/jcm13030664 -
Ideggyogyaszati Szemle Jan 2024
Introduction - Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy. In the vast...
Introduction - Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy. In the vast majority of patients, 1-4 weeks before the onset of GBS-related symptoms, an event such as upper respiratory tract or gastrointestinal tract infection, surgical intervention or vaccination is present. To the best of our knowledge, this is the first case of GBS that occurred after intravesical Bacillus Calmette-Guérin (BCG) therapy in the absence of tuberculosis or any other infection in the English literature.
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Case report – A 65-year-old male patient, who had no systemic disorders except hypertension and coronary artery disease, underwent transurethral resection of a bladder tumour further to imaging studies investigating macroscopic haematuria. A pathologic examination revealed a non-muscle-invasive high-grade (pT1HG) transitional cell carcinoma. Immediately after the fourth cycle of intravesical BCG, which was administered 2 months after surgery, the patient experienced numbness and weakness in his lower and upper extremities, respectively. There were no signs or symptoms related to an acute cranial pathology or infectious disease. Nerve conduction studies, which were carried out on the 7th day after the onset of the neurologic symptoms, revealed a demyelinating sensorimotor polyneuropathy with mild secondary axonal damage in upper and lower limbs with a sural sparing pattern.
Conclusion - Without tuberculosis infection, GBS can occur secondary to increased immune response and antibodies triggered by intravesical BCG therapy. However, considering the worldwide use of BCG vaccination and thousands of intravesical BCG therapies, this is a very rare adverse effect.Topics: Aged; Humans; Male; Administration, Intravesical; BCG Vaccine; Guillain-Barre Syndrome; Urinary Bladder Neoplasms
PubMed: 38321852
DOI: 10.18071/isz.77.0065 -
La Tunisie Medicale Mar 2023The main problem after Radical Nephroureterectomy (RNU) for localized non-metastatic upper urinary tract urothelial cancer (NM-UUT-UC) is bladder recurrence. (Observational Study)
Observational Study
INTRODUCTION
The main problem after Radical Nephroureterectomy (RNU) for localized non-metastatic upper urinary tract urothelial cancer (NM-UUT-UC) is bladder recurrence.
AIM
To identify factors of bladder recurrence of localized NM-UUT-UC after radical treatment.
METHODS
It is an analytical and observational study that was conducted in the department of urology of La Rabta Hospital in Tunis. We collected the data of patients diagnosed with localized NM-UUT-UC who had RNU between 2005 and 2019.
RESULTS
The mean age of the 73 eligible patients was 68 years (±11). The sex ratio was 5/2. Macroscopic hematuria was the revealing clinical sign in 66% of patients, while low back pain was the most frequent sign in 88% of patients. The most frequent tumor stage was pT1 in 20 patients while 32% of them had a pT2-T3 stage. Bladder recurrence was reported in 22% of patients with a median time of nine months [4-27] and extremes of three and 69 months. Factors of bladder recurrence in the univariate analysis were smoking, tumor localization in the ureter and the extravesical excision of the intramural ureter and bladder cuff. On multivariate analysis, the only independent predictor of bladder tumor recurrence was ureteral location (OR=3.65; CI95%=[1.02-13.1] ; p=0.047).
CONCLUSION
Tumor localization in the ureter was an independent predictor of bladder recurrence after radical treatment for localized NM-UUT-UC.
Topics: Humans; Aged; Urinary Bladder; Neoplasm Recurrence, Local; Urologic Neoplasms; Urinary Bladder Neoplasms; Kidney Neoplasms
PubMed: 38263921
DOI: No ID Found