Left Loin Research Articles

Ultrasound Quiz: A 29‐Year‐Old Pregnant Lady with Left Loin Pain

Ultrasound Quiz: A 29‐Year‐Old Pregnant Lady with Left Loin Pain

Diabetic ketoacidosis presenting with emphysematous pyelonephritis

Mr. A.M.A. is 28-year-old Egyptian male patient who presented to the ER with diabetic ketoacidosis (DKA) and left loin pain of 3 weeks duration. The patient had a history of hospital admission 5 months earlier because of urinary tract infection and DKA. Workup of this clinical case revealed emphysematous pyelonephritis.

Primary intrarenal teratoma in an adult: A case report and review of literature

A 35-year-old male presented with left loin pain. On evaluation, he was diagnosed to have a left renal lower polar mass. He underwent partial nephrectomy. The histopathological examination was suggestive of teratoma of the kidney. We present this case, as intrarenal teratomas in adults are extremely rare and only a very few cases are reported in literature.

Isolated Renal Nocardiosis in An AIDS Patient: Unusual Presentation with Large Renal Mass

Introduction: Nocardiosis is an acute, subacute or chronic suppurative infection caused by Nocardia. It can be localised or systemic. Localised cutaneous or lymphocutaneous form occurs after an abrasion. Disseminated or systemic infection is seen in immunocompromised individuals. The primary disease occurs in the lung and subsequently haematogenous dissemination may occur to all organs of the body. Case Report: A 55 year old male presented with symptoms of pain in the left loin for 4 years, easy fatiguability since 2 years and fever for 1 year. His pain abdomen was intermittent, crampy and was associated with burning micturition.Two years back the patient was evaluated for extreme fatiguability and was found to be seropositive for HIV and was started on anti-retroviral drugs. His CD4 count was 38 cells/microliter (CD 4% −11.42). CTKUB showed multiple multiple left renal calculi and left ureteric calculi with hydroureter. In view of left non-functioning kiney with stones, nephrectomy was performed. Gross examination of the excised nephro-ureterectomy specimen showed effacement of the entire kidney by tumorous mass with friable necrotic debris along with impacted calculi in the ureter. Microscopic examination showed numerous basophilic filamentous bacterial colonies surrounded by neutrophilic abscesses and dense infiltration by chronic inflammatory cells, which stained positive with acid fast bacilli. Kidney parenchyma showed sclerosed glomeruli, atrophic tubules and dense interstitial inflammatory infiltrate.A diagnosis of Renal nocardiosis was made.A detailed evaluation ruled out pulmonary or systemic involvement. He was started treatment with cotrimoxizole and doxycycline. Discussion: Majority of the cases present as invasive pulmonary infection,disseminated disease or brain abscess. Nocardiosis of kidney is seen in disseminated disease and presents as multiple pyelonephritic microabcesses.Our case had no evidence of pulmonary disease or any other organ involvement. Isolated renal Nocardiosis manifesting as a large tumorous mass is a rare presentation not described in literature to the best of our knowledge.

Systemic tuberculosis presenting with acute transient myopia: a case report

IntroductionTransient myopia has been reported to occur in a number of conditions, either ocular in origin or associated with an underlying systemic cause. We present a rare case of this abnormality occurring in the setting of systemic tuberculosis.Case presentationA 29-year-old Indian woman presented with sudden onset blurred distance vision and fever. Examination revealed visual acuity of counting fingers in both eyes improving to 6/9 with pinhole with N5 reading acuity. Anterior segment examination revealed narrow angles on gonioscopy. Posterior segments were normal. Systemic examination revealed a fluctuant mass in her left loin, aspiration of which yielded pus which was culture-positive for Mycobacterium tuberculosis. The Mantoux test elicited a strongly positive reaction. Chest X-ray and magnetic resonance imaging of the brain were unremarkable. Computed tomography scan and magnetic resonance imaging of the spine and abdomen revealed a large psoas abscess communicating with the loin mass. Two vertebrae were involved but not the spinal cord or canal.ConclusionTransient myopia is a rare presenting feature of systemic tuberculosis. A postulated mechanism in this patient is that development of a uveal effusion related to systemic tuberculosis caused anterior rotation of the iris-lens diaphragm, thereby inducing narrowing of the angle and acute myopia.

Rare Coexistence Of Benign Renal Oncocytoma And Renal Cell Carcinoma

The coexistence of two tumors in a single person is not common. Finding two tumors in a single organ is rare. We are reporting a 65 years old male who presented with a long history of left loin pain. Clinical examination was unremarkable apart from hypertension. The histopathology of intraabdominal mass seen on exploration of abdomen revealed oncocytoma and renal cell carcinoma.. Keywords: contralateral, nephrectomy, multifocality, hematuria, perinephric. Sudan Journal of Medical Sciences Vol. 3 (2) 2008: pp. 167-170

Dietary zilpaterol hydrochloride. II. Carcass composition and meat palatability of beef cattle

Experiments were conducted at 3 US locations (California, Idaho, and Texas) to determine the effects of dietary zilpaterol hydrochloride and duration of zilpaterol feeding on carcass composition and beef palatability. At each site, 160 steers and 160 heifers were stratified within sex by initial BW (study d -1) and assigned randomly within BW strata to 1 of 4 treatments in a randomized complete block design (4 blocks/treatment for each sex). The 4 treatments were arranged in a 2 (no zilpaterol vs. zilpaterol) x 2 (20- or 40-d duration of zilpaterol feeding) factorial. When included in the diet, zilpaterol was supplemented at 8.3 mg/kg (DM basis). Each pen consisted of 10 animals. After slaughter 2 carcasses per pen (n=64 per trial site) were selected. The entire right side of the selected carcasses was collected for dissection and chemical analysis of the soft tissue. Additionally, the left strip loin was collected for Warner-Bratzler shear force determinations and aged to 28 d postmortem. Sensory analysis was conducted on the Idaho trial site samples only. All data were pooled for analyses. Feeding zilpaterol hydrochloride increased carcass muscle deposition (P<0.01) of both steer and heifer carcasses. However, carcass percentage fat of steers and heifers was not affected (P>0.11) by the zilpaterol treatment. In heifer carcasses, carcass moisture percentage was increased (P=0.04) and bone percentage was decreased (P=0.02), whereas in steer carcasses, carcass moisture and bone percentage were not affected (P>0.10). In heifer carcasses, carcass ash percentage was not affected (P=0.61) by zilpaterol, whereas in steer carcasses, carcass ash percentage tended (P=0.07) to be increased. The protein-to-bone ratio was increased (P<0.001) by zilpaterol hydrochloride treatment in both steers and heifers, whereas the protein-to-fat ratio was not affected (P=0.10). Cooking loss of the LM was not affected (P=0.41) by zilpaterol treatment of steers or heifers. However, LM Warner-Bratzler shear force was increased (P=0.003) on average (3.3 vs. 4.0 kg) due to zilpaterol hydrochloride treatment of both steers and heifers. In both steers and heifers, LM sensory panel scores of overall juiciness (6.2 vs. 6.0), tenderness (6.2 vs. 6.0), and flavor intensity (6.2 vs. 6.0) tended (P=0.06) to be decreased in cattle supplemented with zilpaterol. Zilpaterol hydrochloride is a repartitioning agent that seems to affect carcass composition primarily through protein deposition. However, zilpaterol treatment can adversely affect tenderness and other palatability traits.

Metastatic gestational trophoblastic tumour presenting as spontaneous subcapsular renal haematoma

We describe a rare case of metastatic choriocarcinoma, which presented with acute left loin pain due to a subcapsular haematoma secondary to a bleeding renal metastasis. The renal metastasis was embolised to prevent further bleeding. To our knowledge, presentation of gestational trophoblastic tumour (GTT) with such symptoms has not been described in the recent literature. Our case illustrates that, although rare, non-gynaecological symptoms can be the first presentation of metastatic choriocarcinoma in the appropriate clinical settings. It also demonstrates that the acute bleed from a renal metastasis can be effectively managed by embolisation.

Massive abdominal wall haematoma and haemothorax due to spontaneous rupture of an intercostal artery

A 69-year-old man presented to the emergency department with sudden onset left-sided pleuritic chest pain. He had a 4-day history of pain in the left loin and had noticed bruising...

Loin and low back pain

A 50 year old male bricklayer presented to the emergency department with a five day history of pain in his left loin. He had a history of irritable bowel disease and low back pain. Acute renal colic was suspected and an intravenous urogram examination was performed (figure 1). Thirty minute film from intravenous urogram

Spontaneous Perinephric Urinoma in a Patient with Neurogenic Bladder

Spontaneous rupture of the renal pelvis or ureteropelvic juction area with extravasation of urine into the perinephric space is an uncommon pathologic condition (1). We report a case of 72-year -old woman who suffered 2 days of left loin pain. The patient has got residual urine sensation and weak urine stream since she has gone through a radical hysterectomy 17 years before. Because of these symptoms of voiding difficulty, the patient had abdominal straining during her urination. A CT scan exhibited renal pelvis rupture with perirenal extravasation of urine due to severe hydronephrosis, that was exacerbated by hidden neurogenic bladder disease. Moreover, the patient has detrusor underactivity and high intravesical pressure at voiding trial in the urodynamic study. One month after the percutaneous nephrostomy insertion into the left renal pelvis, the patient was successfully treated. The size of renal pelvis decreased. Moreover, urinoma disappeared in follow up CT scan image. (J Korean Continence Soc 2008;12:185-8)

Spontaneous Colocutaneous Fistula: A Rare Presentation Of Colon Carcinoma

Colocutaneous fistula is a rare clinical condition and more often than not it is the result of surgical misadventures. The spontaneous form of this fistula is a still rarer entity that occurs usually in patients with diverticulitis or Crohn's disease. We report a patient, a 75-year-old male, who presented to us with spontaneous colocutaneous fistula secondary to carcinoma of the descending colon. CASE REPORT A 75-year-old male presented with the complaint of a painful swelling over the left loin since 7 days. The swelling opened spontaneously 4 days later discharging foul smelling purulent material (figure 1). Figure 1 Figure 1: Preoperative view of the patient showing a faecal fistula over the left loin The swelling was associated with fever. There was no history of trauma or previous surgery. There was no history of bowel symptoms or abdominal pain. Past history was insignificant except for treatment taken for multibacillary leprosy 2 years back. On examination, there was an ulcer of about 5x5cm over the left loin below the costal margin with feco-purulent discharge, erythematous skin surrounding the ulcer, a floor covered with slough and indurated base and edges. General examination revealed pitting pedal edema. Examination of the abdomen and other systems did not reveal much. Blood investigations were normal except for hypoalbuminemia. Barium enema revealed a colocutaneous fistula from the descending colon (figure 2). Figure 2 Figure 2: Barium enema picture demonstrating extravasation of contrast medium from the proximal sigmoid colon or distal descending colon Colonoscopy revealed an ulcerated endophytic growth about 40cm from the anal verge, which was biopsied and was reported as tubulovillous adenoma with severe dysplasia Spontaneous Colocutaneous Fistula: A Rare Presentation Of Colon Carcinoma 2 of 4 with adjacent invasive malignancy. Ultrasonography of the abdomen revealed bowel wall thickening in the left lumbar region. With these findings, the patient underwent exploratory laparotomy and left hemicolectomy with excision of a rim of the abdominal wall at the site of the fistula (fig. 3, 4). Figure 3 Figure 3: Intraoperative demonstration of the fistula site after mobilizing the descending and transverse colon Figure 4 Figure 4: Resected specimen of colon with fistula Histopathological examination of the specimen was reported as adenocarcinoma of the colon. Postoperatively, the patient was referred to the department of oncology for chemoradiation.

Inflammatory pseudotumor of the Kidney

BackgroundInflammatory pseudotumor of the kidney or inflammatory myofibroblastic tumor (IMT) is composed of spindle cells admixed with variable amount of proliferating myofibroblasts, fibroblasts, extracellular collagen, lymphocytes and plasma cells. This mainly affects the urinary bladder or prostate. Renal involvement is rare.Case presentationA 56 year-old man was diagnosed with asymptomatic left sided hydronephrosis while being investigated for rheumatoid arthritis. CT scan imaging showed ill defined fascial plains around the kidney and thickening around the renal hilum suggestive of localized inflammatory change. Worsening intermittent left loin pain with increasing hydronephrosis, significant cortical thinning and marked deterioration of renal function necessitated nephrectomy. Macroscopy showed a hydronephrotic fibrotic kidney with microscopy and immunohistochemistry consistent with a histological diagnosis of IMT.ConclusionWe report a case of an inflammatory pseudotumor of the kidney. It is unique in that the patient presented with painless hydronephrosis followed two years later with progressive deterioration in renal function and worsening loin pain.

Chronic Pain and Obstetric Management of a Patient with Tuberous Sclerosis

Chronic nonmalignant pain is very disabling and carries a heavy financial strain on the individual and society as a whole. This case describes a woman with tuberous sclerosis, in her fourth pregnancy. Approximately 18 months prior to pregnancy, intractable left loin pain, thought to be secondary to hemorrhage within a tuberous lesion in the left kidney, had led to the siteing of an intrathecal morphine pump. The risks of system failure (dislodgement, dislocation), escalating dosage, infection, use in labor, and neonatal opioid withdrawal are all explored and discussed. While data are limited, with increasing use of intrathecal opioids for nonmalignant pain, such patients may be seen more regularly in obstetric clinics. With a multidisciplinary team approach, risks can be minimized and outcome for mother and baby optimized.

Nephrobronchial fistula – A case report

We report the case of a 58-year-old woman with a hydronephrotic left kidney who presented with a 4-month history of anorexia, weight loss and intermittent left loin pain associated with cloudy urine. Her urine grew lactose fermenting coliforms, and was treated with antibiotics. A computerized axial tomography scan (CT scan) was equivocal and she underwent retrograde ureteric stenting, which drained a pyonephrosis. She went on to develop a chest infection due to a lung abscess. A CT scan revealed a left perinephric collection extending across the diaphragm into the lower lobe of the left lung. She responded to antibiotics and awaits a nephrectomy.

Quiz

A 31-year-old female presented with sudden onset of severe left loin pain radiating to the left lower abdomen and groin. The pain was constant, with intermittent acute attacks lasting minutes. The patient was nauseated and had vomited once. There were no urinary or bowel symptoms. There had been amenorrhoea for 8 years since starting medroxyprogesterone acetate. On examination, the patient was afebrile, tachycardic with normal blood pressure. Abdominal examination revealed a soft abdomen with tenderness along the left renal tract, but no guarding, rebound tenderness or masses. Rectal examination revealed stool in the rectum, but no tenderness, masses, mucus or blood. Urinalysis showed a trace of blood. A pregnancy test was negative. Full blood count, urea and electrolytes and liver function test were within normal ranges. A provisional diagnosis of renal colic was made and an intravenous urogram performed.

Comparison between Allo-Kramer and Warner-Bratzler devices to assess rabbit meat tenderness

ReferencesA study was conducted to compare Allo-Kramer (AK) and Warner-Bratzler (WB) devices to evaluate rabbit meat texture and to assess their correlations with sensory tenderness. Meat samples characterized by a wide range of tenderness were prepared by boning longissimus lumborum muscles from 90 carcasses at different post mortem times (1, 3, 24h). The right loin of each carcass was used for WB and AK tests, whereas the left loin to assess sensory tenderness and juiciness. The sensory test indicated a higher tenderness and juiciness of rabbit meat obtained from carcasses boned at 24h post mortem in comparison with 1 and 3h post mortem. Both AK and WB methods were able to detect these differences. The AK shear force as well as the WB shear force and area were significantly correlated to meat sensory tenderness (r=-0.58, -0.43 and -0.56, respectively; P<0.001) and juiciness, whereas no correlation was found between sensory tenderness and WB firmness. These results indicate that both WB and AK methods can be used to evaluate the rabbit meat tenderness and give similar levels of correlation with sensory scores. However, AK method is characterized by a sample preparation procedure easier to standardize and less time consuming than WB method.

Performance of Large White x Duroc pigs reared indoors and outdoors: meat and fat quality

During recent years, in order to satisfy consumer’s demand at meat quality and animal welfare, it has become popular to raise pigs outdoors. As reported by various authors this kind of rearing system may affects chemical-physical traits of meat but mainly the adipose tissue, characterised by an higher content of unsaturated fatty acids (Pugliese et al., 2004). The aim of this work is to verify the effect of rearing system on some meat and subcutaneous fat quality traits.For this reason, twelve Large White x Duroc pigs were raised under two different farming system following the organic regulations: six pigs were reared indoors while six pigs were reared outdoors on woodland pastures of 5000 m2. Both group were fed the same diet but, during the months of October and November, the pigs raised outdoors received 1kg/die of chestnuts (Castanea sativa) instead of maize. All animals were slaughtered at the target weight of about 140kg, reached at the age of 12 months for the indoor group and at the age of 13 months for the outdoor group. 24 hours after slaughtering, from all carcasses the left loin (muscle longissimus lumborum) was excised and vacuum packaged. The meat was analysed for the determination of: pHu, colour, water holding capacity (drip loss, water-bath loss and M/T ratio) and shear force on water-bath cooked meat; the subcutaneous fat was analysed for colour and shear force. To verify the effect of the different rearing system, data underwent to variance analysis (SAS, 1995).As regard the main results, the rearing conditions do not affect pHu values (5.43 vs 5.47), in agreement with results of other authors (Lebret et al., 2002; Pugliese et al., 2004). The colour parameters of meat are similar between indoor and outdoor pigs, in spite of the different age and of the attended different content of myoglobin. Shear force on water-bath cooked meat is significantly higher for the outdoors pigs (12.82kg vs 10.94kg) probably due to the higher exercise and to the older age at slaughter. Results of water-holding capacity show that outdoors pigs have a significantly lowest drip loss (2.78% vs 4.86%) and a significantly highest value of water-bath loss (32.36% vs 20.12%); no differences are revealed for the M/T ratio. These contradictory results on water-holding capacity are in agreement with other authors and may be related to the different methodologies used (Pugliese et al., 2004). As regard the quality of subcutaneous fat, it is possible to note that the outdoors pigs show lower value of C* (2.77 vs 4.56) and higher value of H* (58.33 vs 41.01) thus their fat is less coloured and clearer, in agreement with the results of Pugliese et al. (2004). No differences are revealed for shear force parameters: it seems that the consistence of fat is not influenced by rearing system even if it is well known that outdoors pigs have a different fatty acid composition than indoors pigs, mainly in terms of polyunsaturated fatty acid content.In conclusion it seems that the outdoor rearing system, further on influences the consumer perception of quality, effectively modifies some meat and fat quality traits, making interesting an ulterior deepening of this argument.

Cystitis Cystica Causing Bilateral Ureteric Obstruction

Cystitis cystica is a rare benign proliferative lesion of the bladder, caused by hyperplasia of the bladder submucosa, usually as a response to chronic irritation. It is considered to be premalignant, leading to adenocarcinoma of the bladder. Though cystitis cystica occurs mainly at the bladder neck and trigone region of the bladder, we report a case of cystitis cystica causing bilateral ureteric obstruction and loin pain. CASE REPORT A 46 year old gentleman presented to the urology clinic with abdominal and loin pain. An ultrasound scan revealed a leftsided hydroureteronephrosis. Following this, an IVU was performed, which demonstrated an irregular filling defect at the left VUJ. A rigid cystoscopy showed an inflamed bladder neck and trigone. Multiple bullae were seen and neither ureteric orifices were visible. Multiple biopsies were taken of the abnormal mucosa and bullae. Histopathology of these specimens confirmed cystitis cystica et glandularis with (globlet cell) metaplasia. The gentleman continued to have left sided loin pain. A repeat IVU continued to show marked hydronephrosis with clubbing of the calyces on the left side with hydroureter. The IVU also demonstrated right hydronephrosis and hydroureter without calyceal clubbing. The patient however was asymptomatic on this side. A DTPA scan was also performed to rule out any nonfunctioning kidneys. This showed divided function of 48% for the right kidney and 52% for the left kidney with the left kidney showing early PUJ obstruction. With continuing pain in the left loin, a percutaneous nephrostomy followed a week later by antegrade stent was placed in the left ureter as retrograde stenting was deemed difficult due to the inability to locate the ureteric orifices. A week following antegrade stent insertion, the patient was readmitted to hospital with fever, rigors and left loin pain. He was given broad spectrum antibiotics and e-coli were cultured from the urine specimen. We assumed that this episode of gram negative sepsis was solely due to stent insertion of the left ureter. He settled with antibiotics and was discharged home. A routine check rigid cystoscopy and biopsy three months following stent insertion showed an unchanged bladder with cystitis cystica still present. His urine at this point was sterile. It was decided at the multidisciplinary team meeting to perform a repeat rigid cystoscopy in a further six months. Over the next six months, the patient didn't complain of any stent related pain. He also didn't develop any further urinary tract infections. The rigid cystoscopy performed six months later demonstrated a much improved bladder. No cystitis cystica nodules were seen, the ureteric orifices were visible and patent. No further bladder biopsies were taken. The JJ stent in the left ureter was removed. The patient was discharged home and placed on bladder surveillance in the form of flexible cystoscopy.

Fatty acid content of pasture-reared fryer rabbit meat

This study evaluated the fatty acid content of rabbit meat from New Zealand White×Californian cross fryers born and reared outdoors on pasture (O/O), born and reared indoors in cages (I/I), or born indoors in cages and reared outdoors on pasture (I/O). The rabbits were sacrificed at 104 days of age and the left loin muscle ( m. Longissimus dorsi) harvested for fat analysis. The standard AOAC methods were used to determine total fat and fatty acid contents. Compared to animals reared in cages, rabbits reared outdoors on pasture had significantly less total fat, higher proportions of eicosatrienoic and docosaenoic fatty acids and higher amounts of the n-3 fatty acids docosahexaenoic, docosapentaenoic and eicosapentaenoic. These data suggest that a grass-based diet may alter the fatty acid profile of rabbit meat, thus enhancing the n-3 fatty acid content and the nutritional value of the meat.