Conjoined twins are rare and present a unique challenge to pediatric surgeons and radiologists. Planning of surgical separation is aided by accurate preoperative imaging. Such twins are classified according to the most prominent site of connection: the thorax (thoracopagus), abdomen (omphalopagus), sacrum (pygopagus), pelvis (ischiopagus), skull (craniopagus), face (cephalopagus), or back (rachipagus). The area of fusion largely determines the imaging modalities used. Thoracic conjunction is most common and requires cardiac assessment. Magnetic resonance imaging and computed tomography provide excellent anatomic and bone detail, demonstrating organ position, shared viscera, and limited vascular anatomy. Contrast material radiography allows evaluation of the gastrointestinal and urogenital tracts, and a shared liver requires assessment of anatomy, vascularization, and biliary drainage. Angiography helps define specific vascular supply, which is useful in determining the distribution of shared structures between the twins at surgery. Each set of conjoined twins is unique. An imaging strategy to accurately define anatomic fusion, vascular anomalies, and other associated abnormalities is important for surgical planning and prognostic information.
Penile fracture is a relatively rare condition arising from a rupture of the corpus cavernosum. In the western world, it is most commonly associated with sexual intercourse. We hereby, report a rare case of accidental, non-masturbatory, self-inflicted penile fracture. It was diagnosed promptly based on clinical assessment, confirmed radiologically and managed surgically, resulting in a good long-term clinical outcome.Our case highlights the importance of maintaining a high index of suspicion to diagnose this rare condition, even in the absence of a typical mechanism of injury, in order to ensure that such an injury is not missed.
341Urinary calculi are the third most common disorder of the urinary tract, exceeded only by urinary tract infections and prostatic disease. They have plagued humans since the earliest records of the history of our civilization. As yet, there are many unanswered questions and numerous theories that only demonstrate the limits of our understanding of this apparently simple, yet complex, group of disorders. One of the milestones in the treatment of urinary calculi was the gradual acceptance that in the absence of long-term prophylaxis most treatments were doomed to fail. Once this was established, the treatment of renal stone disease underwent a radical metamorphosis with the development of percutaneous uroradiological techniques and extracorporeal shock wave lithotripsy (ESWL).This change was brought about by a combination of factors that included a better understanding of the etiology of renal stones and a trend to using minimally invasive procedures.In this era of minimally invasive surgery, percutaneous genitourinary techniques and endourology have revolutionized the approach to complex urological problems and are re-defining the role of surgery for management of diseases of the kidneys and ureters. In contrast to retrograde instrumentation such as ureterorenoscopy, which involves instrumentation via the anatomic route, the percutaneous approach uses a radiologically guided percutaneous access for antegrade manipulation of the urinary tract. The advent of ESWL alone and in combination with retrograde stenting has decreased ABSTRACT This article offers an overview of the treatment of large renal stones with percutaneous nephrolithotomy. It includes a description of the pathogenesis of renal stones, a discussion of the various treatment options, and a description of the technique of percutaneous nephrolithotomy. ObjectivesAfter reading this article, the reader will 1) understand the current role of percutaneous nephrolithotomy in the management of renal stone disease; 2) be able to summarize the main indications and contra-indications for the procedure, along with the main potential complications; and 3) gain appreciation for an experience-based step-by-step guide to percutaneous nephrolithotomy. AccreditationTufts University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. TUSM takes full responsibility for the content, quality, and scientific integrity of this continuing education activity. CreditThe Tufts University School of Medicine designates this educational activity for a maximum of 1.0 hours credit toward the AMA Physicans Recognition Award in category one. Each physician should claim only those hours that he/she actually spent in the educational activity.Downloaded by: University of Queensland. Copyrighted material.
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