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Early diagnosis and conservative management of colonic perforation can minimize patient morbidity and mortality and result in excellent healing of the fistulous tract without any serious complications.

PurposePercutaneous nephrolithotomy (PCNL) has been the preferred procedure for the removal of large renal stones in Iran since 1990. Recently, we encountered a series of devastating neurologic complications during PCNL, including paraplegia and hemiplegia. There are several reports of neurologic complications following PCNL owing to paradoxical air emboli, but there are no reports of paraplegia following PCNL.Materials and MethodsWe retrospectively reviewed the medical records of patients who had undergone PCNL in 13 different endourologic centers and retrieved data related to neurologic complications after PCNL, including coma, paraplegia, hemiplegia, and quadriplegia.ResultsThe total number of PCNL procedures in these 13 centers was 30,666. Among these procedures, 11 cases were complicated by neurologic events, and four of these cases experienced paraplegia. All events happened with the patient in the prone position with the use of general anesthesia and in the presence of air injection. There were no reports of neurologic complications in PCNL procedures performed with the patient under general anesthesia and in the prone position and with contrast injection.ConclusionsIt can be assumed that using room air to opacify the collecting system played a major role in the occurrence of these complications. Likewise, the prone position and general anesthesia may predispose to these events in the presence of air injection.

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PuRPose: Multiple endocrine neoplasia type 2A (Men2A) is a complex autosomal dominant inherited syndrome characterized by medullary thyroid carcinoma (Mtc), pheochromocytoma and primary parathyroid hyperplasia. In patients with only one or two clinical features, identification of a germ line Ret (Rearranged in transfection) mutation is required to make the diagnosis and initiate genetic counseling. MetHods: we analyzed blood dnA from three Iranian families with three generations of Men2A including 20 affected individuals with Mtc and four with pheochromocytoma. RET hotspots were amplified in probands and sequenced for mutation detection. ResuLt: the causative mutation in all families was found to be the cys634tyr missense substitution. the presence of a functional snP resulting in Gly691ser was also detected in exon 11 of 15 affected cases. four patients showed both of these RET variations. concLusIon: our study shows that the cys634tyr missense substitution and the Gly691ser polymorphism are recurrent in Iranian patients, since our families are unrelated. All asymptomatic carriers of the cys634tyr high-risk activating mutation were referred for prophylactic thyroidectomy.

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Objective: To evaluate the incidence and natural history of radiologic incisional hernia (IH) in patients who underwent robotic partial or radical nephrectomy. Materials and Methods: We retrospectively reviewed the records of patients who underwent robotic partial or radical nephrectomy for kidney tumor in our institution between January 2011 and April 2017. All pre-and postoperative imagings were re-reviewed for detection of IH per Tonouchi classification. Patients who developed hernia were followed up and classified into stable or progressive group. Clinical findings and radiologic features of these patients are reported. Results: A total of 247 patients (169 partial and 78 radical nephrectomies) were included in the study. The incidence of radiologic IH was 27.53%, graded as early-onset (35.3%), late-onset (51.5%), and bowel/fat containing (13.2%). Median time to radiologic IH was 1.7 years. During the follow-up of 68 patients who developed hernia, 33 (48.5%) had progressive and 8 (11.7%) developed clinical hernia. Median time to progression was 1.5 years. On multivariable analysis, adjuvant therapy was an independent predictor for radiologic hernia development (HR 3.23). Pathologic T stage ‡2 and history of open abdominal surgery were also significantly associated with hernia progression (HR 3.93 and 3.47, respectively). Conclusions: Radiologic IH after robotic partial or radical nephrectomy is common. Progression rate is as high as 50% with median time to progression of 1.5 years. Adjuvant therapy is an independent predictor for IH development, whereas higher stage and history of open abdominal surgery are associated with IH progression.