Emphysematous pyelonephitis in a solitary functioning kidney

A 52 year - old diabetic female patient preseted with severe sepsis and azotemia. Abdominal C-T disclosed the presence of a solitary left kidney, showing features of severe emphysematous pyelonephritis. Treatment included intensive anti-microbial therapy and hemodialysis, togther with percutaneous catheter drainage of the kidney. Patien's condition deteriorated rapidly and she died of severe sepsis with desseminated intravascular clotting. Discussion of the case highlights the importance of early diagnosis of emphysematous pyelonephritis and the value of timely surgical intervention

Appendicular osteoid osteoma: percutaneous excision under computed tomography guidance using goaxial drill technique

Eleven cases of osteoitd osteomas of tubular bones were resected percutaneously under CT guidance. Diagnosis was made on the basis of clinical and radiological findings. Histopathological confirmation was obtained in 10 cases. Successful treatment was achieved in all patients. Because of the focal bone resection, no bone grafting was needed. Hospital stay lasted from 1 to 3 days. After 2-13 months of follow up, all patients were asymptomatic. We recommend percutaneous excision under CT guidance as the procedure of choice in the treatment of the appendincular osteoid osteoma

role of antepartum computed tomographic pelvimetry in trial of labour after previous caesarean section

To evaluate the role of antenatal CT pelvimetry in choosing the appropriate delivery method for patients with prior caesarean delivery in view of the obstetric and perinatal outcome. A prospective study of the outcome of trial labour among pregnant women with prior caesarean section between October, 1992 and December 1993. All women had singleton term vertex pregnancy, accepting trial labour and with no contraindications for trial labour. Eighty two patients had fulfilled the study criteria and were allocated to either inadequate pelvis group [48 cases] or to adequate pelvis group [34 cases] according to data obtained by antenatal CT pelvimetry. Seventy two percent [59/82] of the study patients had successful vaginal deliveries. Seventy one percent [34/48] of inadequate pelvis group delivered vaginally and twenty nine percent [14/48] required a caesarean delivery after a trial of labour. With adequate pelvis, vaginal delivery was 74% [25/34] and caesarean delivery was 26% [9/34] after trial labour. No significant difference between study groups as regard occurrence of vaginal delivery after prior caesarean birth. Significant, higher incidence of intrumental vaginal deliveries, I perineal trauma, blood loss, longer hospital stay and neonatal jaundice were reported among cases with inadequate peivis. Perinatal outcome including Apgar scores, cord gases and neonatal complications was comparable in both study groups. Pregnant women after prior one caesarean delivery should be allowed to trial labour regardless of pelvimetric results in absence of other obstetric indications for C.S. Antenatal pelvimetry is helpful in identification of women who are more liable for operative vaginal delivery and should be monitored more closely in labour