Heterotopic adrenal cortex is usually found in the kidney, retroperitoneum and spermatic cord. The adrenal gland has a dual embryonic origin: the cortex arises from the mesoderm and the medulla from ectoderm of the neural crest. Adrenal cortex and gonads both arise from genital ridge, because of that adrenal tissue with descending gonads may migrate in early embryonic period. We report a case of adrenal rest in upper pole of testes.
Bladder leiomyosarcoma is a rare malignancy, it's nonurothelial tumors and account less than 5% of all bladder malignancies. Because of the very low incidence less than 200 cases reported in the literature, etiology is still little know, also there is lack of consensus regarding definitive treatment for this rare tumors. The most common clinical presentation is gross hematuria, which is reported in 81% of cases, followed by pollakiuria (28%) and dysuria (19%), respectively. Herein, we present the case of a patient diagnosed with a bladder leiomyosarcoma and treated with laparoscopic radical cystoprostatectomy and totally intracorporal orthotopic ileal diversion.
INTRODUCTION: Radical cystectomy with extended pelvic lymph node dissection is the standard treatment for muscle-invasive bladder cancer. The aim of this study is to report our initial experience of our series of 22 patients who underwent laparoscopic radical cystectomy with different urinary diversion.
INTRODUCTION: Surgical treatment of nephroptosis is rarely performed nowаdays and is done only in symptomatic patients. Here we present the results of our laparoscopic nephropexy in patients with symptomatic nephroptosis.
Anesthetic management of patients with severe sepsis is a great challenge. Systemic inflammation and acute organ dysfunction in response to infection is a major problem, especially respiratory failure and hemodynamic instability. Avoidance of lung injury during mechanical ventilation is possible with peripheral nerve blocks.
Clinical case 1:We present a 73-year-old male hemodialysis patient with sepsis. He had infectious complication of aneurysm formation of A-V fistula. The patient was hypoxic -SpO 2 86-88%, with presence of tachypnea, RR-150/75, HR-125/min, Temp -38 0 C, coagulation abnormalities -INR 1, 58 (clopidogrel intake), elevated CRP and WBC.The patient was indicated for emergency procedures of incision, drainage and ligation of A-V fistula. We performed supraclavicular brachial plexus block + sedation.
Clinical case 2:We present a 61-year-old woman with sepsis, with past medical history of diabetes, COPD, and endometrial cancer. She was with clinical presentation of necrotizing fasciitis of the upper extremity.We performed ultrasound-guided supraclavicular brachial plexus block -"in plane" technique, 30 mL/25 mL ropivacaine 0.5% in moderate sedated patients.During the operation the patients were conscious, hemodynamically and respiratory stable, with oxygen supply by a mask, and with excellent intraoperative and postoperative pain control.We think that ultrasound-guided peripheral nerve blocks are safe and effective alternatives for septic patients with/without coagulation abnormalities.
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