Bilateral Obstruction Research Articles

Clinical analysis of acute renal failure caused by urinary calculi obstruction in infants under the age of 6 months

Objective To retrospectively summarize the diagnosis and treatment experience of acute renal failure caused by urinary calculi obstruction in infants under the age of 6 months in order to improve the level of treatment. Methods Between January 2010 and December 2014, 15 infants under the age of 6 months with bilateral urinary tract calculi obstruction leading to acute renal failure were treated in West China Hospital, Sichuan University.All cases were Tibetan(10 males, 5 females). The ages ranged from 1 month 15 days to 5 months 24 days.The weights ranged from 3.5 to 7.0 kg.The clinical characteristics, treatment and clinical outcome were analyzed. Results A total of 9 infants(5 males, 4 females) were assessed to be able to tolerate general anesthesia surgery and received positive conservative treatment before operation, and obstruction relief within 6 hours of admission.Six infants(5 males, 1 female) with serious internal milieu disorder, pneumonia, and shock, were assessed as critical cases, who could not tolerate general anesthesia surgery temporarily.Under the emergency blood purification support, they received anti-infection, spasmolysis, rehydration, to correct the internal milieu disorder and obstruction relief within 12 hours of admission.Serum potassium, creatinine returned to normal 12-48 hours after obstruction relief.Stone specimens were obtained from 5 cases, and the stone compositions were calcium oxalate stone in 3 cases, calcium oxalate and carbonate apatite mixed stone in 2 cases.A total of 13 cases need further urolithiasis treatment. Conclusions The infants under the age of 6 months with bilateral urinary tract calculi obstruction are more severe with more complications.The emergency treatment principle is to save lives, then relieve the obstruction; surgery should be as brief as possible, since removing the stones is not the primary purpose.If the infants are in critical, life-threatening circumstances, and cannot tolerate general anesthesia surgery, the blood purification will be helpful to gain time and create conditions for treatment. Key words: Urolithiasis; Obstruction; Renal failure, acute; Treatment; Hemodialysis; Infants

Diffuse Venous Thrombosis

A 29-year-old man presented with an 8-week history of lower extremity edema, neck vein distention, facial swelling, and headache. He had a 3-year history of paroxysmal nocturnal hemoglobinuria (PNH) managed with eculizumab. Computed tomography (CT) of the abdomen and pelvis revealed bilateral external iliac and common femoral venous occlusions with right-sided varicocele (Figure, A ). Computed tomography of the chest demonstrated bilateral obstruction of the internal jugular veins, innominate veins, superior vena cava (SVC), and collateralization (Figure, B). Magnetic resonance venography of the head showed thrombosis of the superior sagittal sinus associated with extensive collateralization within the scalp veins (Figure, C). Anticoagulation was started and angioplasty of the SVC was performed. Allogenic bone marrow transplantation was offered. Paroxysmal nocturnal hemoglobinuria is an acquired disorder affecting progenitor stem cells and thus all cell linages.1Devalet B. Mullier F. Chatelain B. Dogne J.M. Chatelain C. Pathophysiology, diagnosis, and treatment of paroxysmal nocturnal hemoglobinuria: a review.Eur J Haematol. 2015; 95: 190-198Crossref PubMed Scopus (68) Google Scholar A mutation of the PIGA gene results in a deficiency of the glycosyl phosphatidyl inositol anchor where CD55 and CD59 attach. This renders the PNH clonal cells prone to complement-mediated hemolysis with subsequent release of prothrombotic factors, nitric oxide depletion, and platelet activation leading to thrombosis, which is the leading cause of death.1Devalet B. Mullier F. Chatelain B. Dogne J.M. Chatelain C. Pathophysiology, diagnosis, and treatment of paroxysmal nocturnal hemoglobinuria: a review.Eur J Haematol. 2015; 95: 190-198Crossref PubMed Scopus (68) Google Scholar, 2Cornell L.F. Sacco K.A. Chirila R.M. 60-Year-old woman with headache and fatigue.Mayo Clin Proc. 2017; 92: e121-e125Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar, 3Hill A. Kelly R.J. Hillmen P. Thrombosis in paroxysmal nocturnal hemoglobinuria.Blood. 2013; 121 (quiz 5105): 4985-4996Crossref PubMed Scopus (292) Google Scholar Venous thromboses occur more often than arterial, and any site may be affected.4Brodsky R.A. Paroxysmal nocturnal hemoglobinuria.Blood. 2014; 124: 2804-2811Crossref PubMed Scopus (323) Google Scholar Because abdominal and cerebral veins are frequently involved, Budd-Chiari syndrome is the most common thrombotic event and superior sagittal sinus thrombosis the most common neurologic complication.3Hill A. Kelly R.J. Hillmen P. Thrombosis in paroxysmal nocturnal hemoglobinuria.Blood. 2013; 121 (quiz 5105): 4985-4996Crossref PubMed Scopus (292) Google Scholar, 4Brodsky R.A. Paroxysmal nocturnal hemoglobinuria.Blood. 2014; 124: 2804-2811Crossref PubMed Scopus (323) Google Scholar Anticoagulation and eculizumab are required, and thrombolysis or angioplasty may be used for life-threatening thromboses.1Devalet B. Mullier F. Chatelain B. Dogne J.M. Chatelain C. Pathophysiology, diagnosis, and treatment of paroxysmal nocturnal hemoglobinuria: a review.Eur J Haematol. 2015; 95: 190-198Crossref PubMed Scopus (68) Google Scholar, 3Hill A. Kelly R.J. Hillmen P. Thrombosis in paroxysmal nocturnal hemoglobinuria.Blood. 2013; 121 (quiz 5105): 4985-4996Crossref PubMed Scopus (292) Google Scholar Bone marrow transplantation is offered to patients who fail eculizumab, as in our case.2Cornell L.F. Sacco K.A. Chirila R.M. 60-Year-old woman with headache and fatigue.Mayo Clin Proc. 2017; 92: e121-e125Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar

Assessment of Bronchial Obstruction Using Lateral Pressure Measurement during Bronchoscopy

Background: In patients with bronchial obstruction estimating the location of the maximal obstruction is crucial for guiding interventional bronchoscopy. However, flow-volume curves cannot discriminate between the right and left lungs. Objectives: The aim of this study was to physiologically evaluate bronchial obstruction during interventional bronchoscopy. Methods: We prospectively measured lateral airway pressure (P_lat) at either side of the obstruction using a double-lumen catheter (pressure-pressure [P-P] curve) simultaneously to assess the degree of bronchial obstruction in 22 patients. The shape of the P-P curve was assessed to confirm the site of maximal obstruction. Results: In the experimental study, P_lat was uniform between both bronchi in the normal model. For the unilateral and bilateral obstruction models, a phase shift was only seen for the more obstructed side. In healthy subjects, the angle of the P-P curve was close to 45° and linear in shape. In patients with bronchial obstruction, the angle was much smaller but approached 45° after the bronchoscopic procedure. The degree of bronchial obstruction was significantly correlated with the angle of the P-P curve (r = –0.51, p < 0.01). Dyspnea significantly increased when the airway lumen was obstructed by more than 60% (p < 0.0001), and when the P-P curve appeared loop-shaped (p < 0.01). Conclusions: The shape of the P-P curve could be used to detect the site of maximal obstruction for the optimal positioning of the stent and assess the need for additional procedures in real time in patients with bronchial obstruction.

Side-by-side partially covered self-expandable metal stent placement for malignant hilar biliary obstruction.

Background and study aims This study investigated the feasibility of side-by-side (SBS) partially covered self-expandable metal stent (PCSEMS) placement for unresectable malignant hilar biliary obstruction (MHBO). Patients and methods We retrospectively analyzed 33 patients from a single center who underwent endoscopic biliary drainage for unresectable MHBO from July 2013 to June 2015. In all patients with bilateral obstruction during complete bilateral intrahepatic cholangiograms, we performed endoscopic SBS placement of a 6-mm diameter PCSEMS using an 8-French delivery system. All patients underwent endoscopic sphincterotomy. Generally, patients with recurrent biliary obstruction (RBO) after stent placement underwent endoscopic reintervention. Our study outcomes included the technical and functional success rates, RBO rate, time to RBO (TRBO), reintervention rate, and incidence of adverse events. Results Seventeen patients with unresectable MHBO during complete bilateral intrahepatic cholangiograms underwent endoscopic SBS PCSEMS placement (median age, 78 years; men, 9). Lesions were Bismuth types II (n = 10), III (n = 1), and IV (n = 6), including 10 cholangiocarcinomas, 3 gallbladder cancers, and 4 metastatic cancers. In all patients, the PCSEMS was placed across the duodenal papilla. The technical and functional success rates were 100 % and 82 %, respectively. The median procedure time was 43 minutes (interquartile range [IQR]: 36 – 52 minutes). Twelve patients had RBO (71 %), including 9 stent occlusions due to sludge and 3 stent migrations. The median TRBO was 79 days (IQR: 58 – 156 days) during the follow-up period (median 192 days [IQR: 88 – 551 days]). The median TRBO of patients with Bismuth type II lesions was significantly longer than that of patients with Bismuth types III and IV lesions (87 days [IQR: 70 – 244 days] vs. 54 days [IQR: 35 – 100 days]; P = 0.030). Thirteen patients (76 %) required endoscopic reintervention. Endoscopic stent removal was possible in 6 patients without tumor ingrowth into the uncovered distal part of the stent. One late adverse event (≥ 31 days) occurred (cholangitis). Conclusions Endoscopic SBS placement of a PCSEMS was feasible in patients with unresectable MHBO. Additionally, reinterventional stent removal was possible in the absence of tumor ingrowth.

Protective effect of erythropoietin on renal function after releasing of bilateral ureter obstruction in rats and mechanism

Objective To investigate the mechanism of protective effect of erythropoietin (EPO) on renal function after releasing of bilateral ureter obstruction (BUO) in SD rats. Methods Thirty-two SD rats were divided into 4 groups randomly (BUO group, BUO-R group, BUO-R+ EPO group and Sham group; n=8). The BUO model was built by bilateral ureteral ligation. EPO was given to BUO-R+ EPO rats 1 h after releasing of BUO, and then repeated 12, 24, 36, 48 h thereafter and the same volume of normal saline was simultaneously given to BUO-R rats. The urine samples were collected 24 h before death and then blood samples were collected from inferior vena cava. The kidneys at both sides were harvested 72 h after releasing of BUO to examine the effect of EPO on the expression of tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 by immunohistochemistry and real-time quantitative polymerase chain reaction (Real-time PCR). Results The osmotic pressure in BUO-R+ EPO group was higher than that in BUO-R group, while lower than that in Sham group [(1 164±93) vs. (715±76) vs. (1 835±98) mosm/kg, P=0.000]. The hematal concentrations of urea and CREA in BUO group [(58.40±4.63) mmol/L and (277.30±11.26) μmol/L] were higher than those in other three groups, while they were higher in BUO-R+ EPO group [(12.20±2.34) mmol/L and (34.70±4.58) μmol/L] than those in Sham group [(6.40±0.75) mmol/L and (20.50±3.71) μmol/L], but lower than those in BUO-R group [(25.70±3.26) mmol/L and (52.60±7.83) μmol/L], P=0.000. Immunohistochemistry showed the expression levels of TNF-α and IL-6 were strongest in BUO group and weakest in Sham group, while those were stronger in BUO-R group than in BUO-R+ EPO group. Real-time PCR showed that the expression of TNF-α and IL-6 mRNA in BUO group was the most, while that in Sham group was the least, and that in BUO-R+ EPO group was less than in BUO-R group. Conclusion EPO could promote the recovery of renal function by inhibiting inflammatory reaction in BUO-R rats. Key words: Erythropoietin; Ureter obstruction; Kidney; Inflammatory reaction

A Rare Presentation of Cavernous Hemangioma of Both Inferior Turbinates

The nasal cavity presents with various types of neoplasms, including epithelial and mesenchymal tumors. Cavernous hemangioma of nasal cavity is quite rare. It usually presents as a unilateral mass arising from mucosa of nasal cavity.&#x0D; Case Report &#x0D; We describe here, a case of 25-year-old serving soldier, who was referred to our hospital with a mass in both nasal cavities with bilateral nasal obstruction. On examination, the mass originated from the inferior aspect of inferior turbinate of both sides. Subsequently on histological examination after complete endoscopic excision revealed that the mass was a cavernous hemangioma arising from both inferior turbinates.&#x0D; Discussion&#x0D; To our knowledge, this is the first case of cavernous hemangioma arising from both inferior turbinate reported in literature.

Extramedullary plasmacytoma nose operated by raveh’s approach: a case report

Plasmacytoma is a clonal proliferation of plasma cells. Plasmacytoma can be disseminated in the form of multiple myeloma or solitary disease. Most common site of involvement of solitary extramedullary plasmacytoma being the upper respiratory tract. We present a case report of 60-year-old male who presented with bilateral nasal obstruction, epistaxis and swelling on the root of nose. Biopsy proved out to be a plasmacytoma which was operated by Raveh’s approach. Raveh’s approach is a very useful approach for skull base tumors in the sphenoethmoidal plane with minimal morbidity, no frontal lobe retraction and watertight closure of dura and excellent postoperative recovery.

Probing for congenital nasolacrimal duct obstruction.

Probing for congenital nasolacrimal duct obstruction.

Predictors of Renal Functional Improvement After Pyeloplasty in Ureteropelvic Junction Obstruction: Clinical Value of Visually Assessed Renal Tissue Tracer Transit in 99mTc-mercaptoacetyltriglycine Renography

To determine the clinical value of visually assessed renal tissue transit time (TTT) in 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) renography for patients undergoing pyeloplasty. Medical records of 164 patients who underwent dismembered pyeloplasty were retrospectively reviewed. Baseline and postoperative renal ultrasonography and 99mTc-MAG3 renography were performed. Two urologists blinded to clinical data evaluated the renography and classified TTT as timely or delayed based on visualization of the tracer in the kidney pelvis between 2 and 10 minutes. Renal functional change after pyeloplasty was compared between patients in the timely and delayed groups. A total of 126 patients (median age, 9 months) were evaluated after excluding patients with bilateral ureteropelvic junction obstruction, a single functioning kidney, duplicated ureter, or <3 months of follow-up. There were no differences between 89 patients with timely TTT and 37 patients with delayed TTT in mean preoperative hydronephrosis grade (3.7 vs 3.8) and pelvic diameter (3.1 cm vs 3.4 cm). Although the pre- and postoperative mean values of differential renal function (DRF) were significantly higher in the timely group than in the delayed group (47.2% vs 38.3% and 47.9% vs 44.6%), DRF change was greater in the delayed group (6.3% vs 0.6%). In multivariate analysis, delayed TTT was the only significant predictor of >5% improvement in renal function after pyeloplasty. Delayed TTT in 99mTc-MAG3 renography was a significant predictor of renal functional improvement after pyeloplasty in ureteropelvic junction obstruction. Because substantial improvement of renal function is anticipated, we recommend immediate pyeloplasty in patients with delayed TTT and decreased DRF.

Hemangiopericytoma – a case report of a rare tumour of the parapharyngeal space

Introduction: Hemangiopericytoma is a mesenchymal tumour originating from pericytes surrounding the capillary vessels. The etiology of this tumour is still unknown. It may be located in any part of the human body. The most common sites are pelvis and lower limbs and less often it occurs in the head and neck. The characteristic signs of hemangiopericytoma are slow growth regardless of the malignancy level and high vascularity. Surgical excision of the tumour with additional radiotherapy is the treatment of choice. Case report: A symptom presentation and diagnostic-therapeutic process in a 71-year-old woman admitted to the Department of Otolaryngology of the Medical University of Warsaw due to increasing bilateral nasal obstruction and dysphagia is herein described. Diagnostic imaging showed highly vascularized tumour in the parapharyngeal space also obstructing the left side of the nasopharynx. After evaluation, tumour resection from the external approach was planned and performed, followed by an uncomplicated postoperative course. Histopathological examination revealed hemangiopericytoma. The patient was qualified for adjuvant radiotherapy. She stays under observation with no signs of recurrence since surgery. Conclusions: Hemangiopericytoma is a rare tumour with a wide variety of clinical presentations and a relapse-free survival that is difficult to predict. Long-lasting asymptomatic tumour growth results in late diagnosis. Imaging and primarily, histopathological examination are fundamental for the diagnostic process. The best outcome is observed after radical surgical treatment. In order to reduce the risk of recurrence, additional radiotherapy is advised. Local recurrence may appear years after finished treatment, therefore long-term follow-up is essential.

Preoperatively Dilated Ureters are a Specific Risk Factor for the Development of Ureteroenteric Strictures after Open Radical Cystectomy and Ileal Neobladder

We evaluated preoperative ureteral obstruction as a risk factor for benign ureteroenteric anastomosis strictures in patients who underwent open radical cystectomy and ileal neobladder diversion. A total of 953 patients in whom bilateral ileoureterostomy was performed between January 1986 and March 2009 formed the study population. A nonrefluxing Le Duc technique was applied in 357 consecutive patients and a refluxing Wallace type technique was applied in 596. We defined ureteroenteric anastomosis stricture as the need for specific therapy (eg stenting, dilatation or reimplantation) or as proven loss of renal function. Kaplan-Meier analysis was done to calculate the likelihood of ureteroenteric anastomosis stricture development. Median followup in the study population was 65 months. Preoperatively 109 patients had unilateral or bilateral obstructed ureters. Unilateral or bilateral obstruction developed in 107 of the 953 patients (127 reno-ureteral units, including 63on the right side and 64 on the left side). Of the reno-ureteral units 98 had benign and 29 had malignant ureteroenteric anastomosis strictures. The overall stricture rate due to any cause in preoperatively obstructed ureters was 19.3% at 10 years vs 6.4% in preoperatively undilated ureters. For the refluxing Wallace type technique the 10-year ureteroenteric anastomosis stricture rate was 2.4% for preoperatively undilated and 7.6% for preoperatively obstructed ureters. For the nonrefluxing technique the corresponding rates at 10 years were 14.2% and 35.54%, respectively. Preoperatively obstructed ureters are at significantly higher risk for benign ureteroenteric anastomosis strictures during the postoperative course after ileal neobladder diversion. Most such Le Duc strictures are bilateral and most such Wallace type strictures are unilateral. The risk of ureteroenteric anastomosis stricture after ureteroenterostomy using the nonrefluxing technique is threefold the risk of the refluxing technique. There was no preponderance of left ureteroenteric anastomosis strictures after each technique.

Primary and secondary patencies of transposed femoral vein fistulas are significantly greater than with the HeRO graft

For access-challenged patients with bilateral upper extremity central venous stenosis, solutions include the Hemodialysis Reliable Outflow (HeRO) device or an autogenous AV fistula in the lower limb. We evaluated HeRO grafts and transpositions of the femoral vein in maintaining primary and secondary patency. We retrospectively analyzed 40 patients with a HeRO device and 18 patients with superficial femoral artery to transposed femoral vein autogenous arteriovenous fistula (SFA-tFV). All patients had bilateral central venous obstruction. All procedures were outpatient performed by a single surgeon at one center between 2009-2015. Operative details, intraoperative flows, and flows at the first-week postoperative visit were analyzed, as were primary and secondary patency and intervention rates. Complications were compared between groups. The one-year cumulative primary patency was 30% for HeRO grafts and 79% for SFA-tFV fistulas (p = 0.0001); secondary patency was 71% for HeRO grafts and 93% for SFA-tFV fistulas (p = 0.03). To maintain patency, HeRO patients required a mean 2.1 interventions per year and thigh fistula patients required a mean 0.4 interventions per year. Thirty-seven percent of thigh fistula patients had a hematoma or seroma versus 5% of HeRO patients and 17% of thigh fistula patients experienced delayed wound healing versus 2.5% of HeRO patients (p<0.05). None of the thigh fistula patients had distal ischemia. HeRO patients had lower primary and secondary patency rates versus thigh fistula patients and HeRO grafts required five-fold more interventions to maintain secondary patency. However, patients with thigh fistulas had significantly more wound healing problems. Thus, the SFA-tFV has become our access of choice for patients with bilateral central venous stenosis.

Surgical Correction of Alar Collapse with Alar Batten Graft : Technique and Results

Background: nasal valve collapse has great perception of nasal obstruction. The alar batten graft technique has proven to be a valid method for treatment of external and internal valve collapse. Aim: the aim of the present study was to evaluate a two year experience and follow up for external nasal valve collapse treatment using alar batten graft technique regarding results and complications. Patients and Methods: this prospective study was carried out on 18 patients attended the ENT and Plastic Surgery outpatient clinics of Al-Azhar University hospitals from January, 2014 to January 2016. Written consent was taken from every patient. All patients were complaining of nasal obstruction of gradual onset and progressive course with 7 years average. All patients were subjected to detailed history taking and questionnaire including the NOSE scale. Surgical correction was performed to all patients using the alar batten graft harvested from the septa cartilage or conchal cartilage. Postoperative results recorded in relation to subjective sensation of nasal obstruction and aesthetic appearance of the nose. Results: eleven patients (61.1%) were males and seven (38.9%) were females. Their age ranged from 18 to 45 years with a mean of 32±2. Bilateral obstruction was found in 33.3% of cases and unilateral obstruction in 66.7% of cases. There were 22.2%, 27.8%, and 50.0% of the cases had moderate, fair, and severe obstruction, respectively. Postoperatively, these figures were changed to no obstruction77.8% (P=0.0), mild 0.0%, moderate 11.1%, fair 11.1%, and sever 0.0%(P=0.0005). The technique significantly abolishes the severe nasal obstruction. Postoperative complications include 1 case with graft resorption (4.2%) and 1 case of graft displacement (4.2%). Both were improved on subsequent surgery. Regarding postoperative findings there was tenderness and hypertrophic postauricular scar in 5.5% of patient and nasal tip edema in 22.2%, all resolved. In the early postoperative period, 33.3% of patients complained of fullness in the supraalar region. Conclusion: Successful surgical correction of nasal obstruction requires the precise diagnosis of the anatomic point of collapse. Alar batten graft improves the rigidity of lower lateral cartilage preventing collapse of the lateral nasal wall preventing collapse during moderate and deep inspiration. The graft varies according to the severity of the obstruction and size of the collapsible area of the lateral nasal wall. The septal cartilage is usually sufficient. The technique significantly improves nasal breathing.

Fallopian tube catheterization in the treatment of proximal tubal obstruction: a systematic review and meta-analysis.

What is the chance of clinical pregnancy when fallopian tube catheterization is used for proximal tubal obstruction? The pooled clinical pregnancy rate of tubal catheterization after proximal tubal obstruction is 27% (95% CI 25-30%). Restoring fallopian tube patency by performing tubal catheterization has fallen out of favour since the increased availability of IVF. Our study is the first systematic review and meta-analysis to investigate reproductive outcomes following tubal catheterization for proximal tubal obstruction. We undertook a systematic review and meta-analysis of 27 observational studies consisting of 1720 patients undergoing tubal catheterization for proximal tubal obstruction, who attempted to conceive naturally after the procedure. Systematic literature searches were performed in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. A total of 2195 titles and abstracts were reviewed. Only studies that reported outcomes when tubal catheterization was performed with no other tubal surgery were included. Twenty-seven cohort studies matched the inclusion criteria for the meta-analysis. The meta-analysis showed a pooled clinical pregnancy rate of 27% (95% CI 25-30%) after the use of tubal catheterization for unilateral or bilateral proximal tubal obstruction (27 studies, 1556 patients). In women with bilateral obstruction (14 studies, 617 patients), the clinical pregnancy rate was 27% (95% CI 23-32%). Our meta-analysis demonstrated that the pooled cumulative clinical pregnancy rates were 22.3% (95% CI 17.8-27.8%) at 6 months, 25.8% (95% CI 21.1-31.5%) at 9 months, 26.4% (95% CI 23.0-30.2%) at 12 months, 26.0% (95% CI 22.8-29.7%) at 18 months, 27.0% (95% CI 24.0-30.5%) at 24 months, 27.9% (95% CI 24.9-31.3%) at 36 months and 28.5% (95% CI 25.5-31.8%) at 48 months. The pooled live birth rate (14 studies, 551 patients) was 22% (95% CI 18-26%). The pooled ectopic pregnancy rate (27 studies, 1556 patients) was 4% (95% CI 3-5%). The included studies scored satisfactorily on the Newcastle-Ottawa quality assessment scale. The pooled clinical pregnancy rate after tubal catheterization was found to be almost comparable to that after IVF. However, included studies were small, non-comparative series with significant clinical heterogeneity in population characteristics, follow-up and surgical equipment, technique and experience. These findings suggest fallopian tube catheterization as an alternative strategy to IVF in patients presenting with proximal tubal obstruction. Further research should focus on comparing different surgical techniques of fallopian tube catheterization with IVF and provide cumulative reproductive outcomes over long-term follow-up. No funding was required and the authors have no competing interests to declare. N/A.

Unilateral Congenital Choanal Atresia in a 48-Year-Old Patient

ABSTRACTAimTo report a case of unilateral choanal atresia diagnosed in a 48-year-old, presenting with fatigue as the major symptom. To highlight the importance of a detailed clinical history and physical examination for an accurate diagnosis.BackgroundChoanal atresia is an uncommon and often poorly recognized cause of unilateral or bilateral nasal obstruction. It is a congenital condition that occurs in approximately 1 in 5,000 to 8,000 live births.Case reportThis study reports a case of unilateral choanal atresia diagnosed in a 48-year-old presenting with fatigue as the major symptom. The patient presented with a lifelong history of tiredness investigated in cardiology. She was treated by a combined transseptal and transnasal endoscopic surgical technique. Topic use of mitomycin was performed with no use of stents, with clinical regression of the symptoms.ConclusionUnilateral choanal atresia usually presents in younger patients but can be undiagnosed until adulthood due to the nonspecific nature of the symptoms. This diagnosis should be, therefore, considered in all ages and bedside diagnostic procedures should, then, be done. Nasal endoscopy and computed tomography (CT) scan are the gold standard for the diagnosis. The use of stents and mitomycin C topically as an adjunct to the surgical repair of choanal atresia is a controversial subject.How to cite this articleFerraria L, Alves S, Rosa H, Santos M, Antunes L. Unilateral Congenital Choanal Atresia in a 48-Year-Old Patient. Int J Otorhinolaryngol Clin 2017;9(1):28-31.

Evaluation of the internal thoracic artery blood flow before and after Nuss operation: is it reversible?

Objective: Obstruction of the internal thoracic arteries (ITAs) by the Nuss bars in minimally invasive repair of pectus excavatum (MIRPE) has been documented in the literature. In this study, we aim to investigate the patency of ITAs before and after repair of the pectus excavatum with the Nuss procedure, by using color Doppler ultrasonography (US). Materials and Methods: Nineteen patients who underwent Nuss procedure were included in this study prospectively. Color Doppler US examinations were performed for comparing ITA patency after insertion of the Nuss bars and after their removal. Patients were evaluated according to gender, age, symmetry of deformity, Haller index, and the number of Nuss bars inserted. Results: Nineteen patients operated with MIRPE (17 male and 2 females with a mean age 21.78±6.35) were enrolled in the study. Eight patients (42.1%) with normal ITA blood flow preoperatively had normal blood flow after removal of the bar. In preoperative examination, 6 patients had bilateral (n=2) or unilateral (n=4) obstruction of the ITA and 5 patients had bilateral (n=2) or unilateral (n=3) abnormally disturbed flow. After the bar removal only 2 (10%) of the affected patients (57.9 %) still had obstruction whereas patent blood flow of the ITAs has been noted in 9 patients. Conclusion: We have shown that after the Nuss bar removal, only 10% of the ITAs are compromised

Burkitt’s lymphoma of nasal cavity and bilateral maxillary sinuses

Burkitt’s lymphoma is a malignant, highly aggressive B-cell type of non-Hodgkin’s lymphoma. Prolonged fever followed by bilateral cheek swelling and nasal obstruction was the first symptoms of a 2-year-old boy with Burkitt’s lymphoma. When the chemotherapy was started, the facial swelling reduced within few weeks. This case report highlights a rare case of Burkitt’s lymphoma in the nasal cavity and bilateral maxillary sinuses and the need of high index of suspicious for early diagnosis and treatment.

Bilateral obstructive uropathy following laparoscopic appendicectomy

A fifty four year old man presented with renal failure several days following laparoscopic appendicectomy. Imaging revealed a large rectus sheath haematoma extending into the pelvis causing bilateral ureteric obstruction. The initial reason for renal failure was not clear as imaging did not reveal significant hydronephrosis as would usually be expected with ureteric obstruction, however renal function failed to improve despite addressing pre-renal causes of renal impairment. He was treated with both a retrograde ureteric stent and percutaneous nephrostomy.

Nasosinusal polyposis revealing maxillary sinus mucocele

Mucocele is a benign pseudo-cyst formation that rarely develops in the maxillary sinus. Mucocele is secondary to various conditions having in common an inflammation and an obstruction of the sinus ostium. The latter may be primary but it is often secondary to a trauma, tumor, chronic inflammation. Diagnosis is based on imaging. CT scan is essential for assessing osseous changes and for planning endonasal surgery under endoscopic control. MRI allows to specify the relations of mucocele. Therapeutic management of these mucoceles should be based on mucocele marsupialization performed at the same time as the treatment of the local factor involved. We report the case of a 21-year old man with no pathological history presenting with bilateral nasal obstruction associated with anosmia. Clinical examination showed exquisite pain in the anterior maxillary sinus wall, bilateral nasal sinus polyposis and swelling at the level of the hard palate. CT scan of the facial skeleton showed a well-defined homogeneous hypodense mass with no enhancement, involving the entire left maxillary sinus associated with regular bone lysis of its walls and a bilateral opacification of ethmoid cells and nasal cavities. The patient underwent endonasal surgery and functional ethmoidectomy associated with intranasal middle meatus antrostomy allowing the marsupialization of the mucocele. The postoperative course was uneventful and not associated with recurrence.

Comprehensive semen examination in patients with cystic fibrosis

Introduction. Cystic fibrosis (CF) is a common genetic disorder associated with male infertility. Almost all men with CF are infertile due to obstructive azoospermia. The objective is to evaluate semen parameters, excretion of seminal fluid, and spermatogenesis in CF patients. Materials and methods . We examined 44 male CF patients with pancreatic sufficiency (n = 20) and pancreatic insufficiency (n = 24). Standard semen analysis, quantitative karyological analysis of immature germ cells from ejaculate sediment, biochemical semen analysis (fructose, α-glucosidase, citric acid) were performed. Results. Semen analysis diagnosed azoospermia in 77.3 % patients, severe oligozoospermia (< 1 million/ml) and other diagnoses (oligozoospermia, asthenozoospermia, normozoospermia) in 13.6 % and 9.1 % patients, respectively. The signs of obstruction of the vas deferens and aplasia of seminal vesicles were observed in 91 % patients. Azoospermia, oligospermia, pH <7.0 and low content of fructose in the semen samples result from bilateral obstruction of the vas deferens and aplasia of the seminal vesicles. Conclusion . Cryptozoospermia and immature germ cells, detected in ejaculate sediment in all azoospermic patients with CF, indicated aplasia, but not congenital absence of the vas deferens. The majority of CF patients presented signs of seminal ducts obstruction and impaired spermatogenesis and seminal fluid secretion. In contrast to pancreatic-sufficient CF male patients, pancreatic-insufficient CF patients can be fertile and have no obstruction of seminal ducts and severe pathozoospermia.