Spontaneous perirenal hematoma is relatively uncommon but may be life threatening. There are some challenges in early diagnosis due to the lack of specific presentations. We report a case of spontaneous perirenal hematoma in a patient who had histories of systemic lupus erythematosus, hypertension, and uremia with hemodialysis, and initially presented with non-specific flank pain. Dizziness and unstable vital signs were noted in the emergency room. Computed tomography and abdominal ultrasonography revealed a large perirenal hematoma over the left retroperitoneal cavity. The patient received conservative treatment without surgical intervention and had an uneventful recovery.
Tumors of the epididymis, both primary and secondary, and whether benign or malignant, are very rare. Adenomatoid tumors and leiomyoma are the most frequently diagnosed benign tumors of the epididymis. In a review of the American and European literature, leiomyoma was the second most common neoplasm of the epididymis, representing 6% of primary epididymal tumors. A case of leiomyoma of the epididymis in a 53-year-old patient is reported. The patient presented with a 4-year history of a painless mass in the left scrotum. There were no bother some symptoms except gradual enlargement of the tumor. On surgical exploration, the mass was found to be smooth and well-demarcated. A fresh frozen section showed a benign lesion, and conservative excision of the tumor was performed without any difficulty. The leiomyoma was definitively diagnosed by subsequent histopathologic analysis. The details of this rare case are reported herein with a review of the medical literature.
Uric acid urolithiasis develops from various causes. To investigate the clinical and biochemical presentation of patients with uric acid urolithiasis, a retrospective study was designed. A total of 46 cases were enrolled between January 2004 and December 2005. The compositions of the stones were analyzed by infrared spectrophotometry. There were 39 males (84.8%) and seven females (15.2%), with a mean age of 61.5 +/- 10.6 years and mean body mass index (BMI) of 26.7 +/- 3.1 kg/m2. The stone location was kidney in 10 (21.7%), ureter in 22 (41.8%), and bladder in 14 (30.5%). Multiple stones were diagnosed in 36 patients (78.3%). Pre-existing comorbidities included diabetes mellitus in 11 patients (23.9%), hypertension in 23 (50%), gout in 13 (28.2%), and benign prostatic hyperplasia in 14 (30.4%). Mean serum creatinine and uric acid was 1.6 +/- 0.6 mg/dL and 7.6 +/- 1.8 mg/dL, respectively. There were 27 patients (58%) with creatinine > 1.4 mg/dL. The mean urinary pH was 5.42 +/- 0.46. Patients with uric acid urolithiasis were predominantly male, older, with higher BMI, multiple stone presentation, with lower urinary pH, and hyperuricemia. Exacerbation of the renal function should also be of concern because of the high proportion of patients with renal insufficiency diagnosed in this study.
A 66-year-old man, with a history of gastric signet ring cell carcinoma, was admitted due to intermittent dull pain in the left lower abdomen for 3 months. Left ureteral obstruction with suspicious tumor encasement and hydronephrosis was found on imaging studies. Endoscopic ureteral biopsy revealed infiltrating high-grade urothelial carcinoma. As a result, he underwent left nephroureterectomy and bladder cuff excision. Unexpectedly, metastatic carcinoma of the left ureter from the stomach was the final diagnosis after comparison of the permanent sections of the two specimens. Unfortunately, acute disseminated intravascular coagulation developed and the patient died of disease complications 16 days after the operation, even with intensive care. The details of this rare condition are reported herein with a review of the medical literature.
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