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1.
Urol Case Rep ; 42: 102002, 2022 May.
Article in English | MEDLINE | ID: mdl-35106285

ABSTRACT

We report a case of a bladder hemangioma in a pediatric patient. A 2-year-old Caucasian female presented with intermittent gross hematuria and protrusion of beefy red tissue near the vaginal introitus when straining. On cystoscopy, we discovered a wide-based vermiform mass. Transurethral resection of the bladder mass was performed. Based on the histological findings of the tissue resected, a diagnosis of capillary hemangioma of the bladder was made. Despite their rarity, bladder hemangiomas should be considered in the differential in children with gross hematuria.

2.
Dis Colon Rectum ; 61(10): 1163-1169, 2018 Oct.
Article in English | MEDLINE | ID: mdl-30113341

ABSTRACT

BACKGROUND: Local excision may be curative for benign and malignant rectal neoplasms. Because many early rectal cancers are discovered incidentally after local excision of clinically benign lesions, it is unclear whether preoperative imaging with transrectal ultrasound or MRI affects management. OBJECTIVE: The purpose of this study was to determine the diagnostic characteristics and effect of preoperative imaging on the incidence of malignancy in benign rectal lesions undergoing local excision. DESIGN: Prospective data from 2 institutions were included. Coarsened exact matching created a balanced cohort comparing imaging and no-imaging groups. SETTING: The study was conducted at high-volume specialist referral hospitals. PATIENTS: Adult patients undergoing local excision via transanal endoscopic surgery between 1997 and 2016 for clinically benign rectal neoplasms were included. INTERVENTION: The study intervention included preoperative imaging with transrectal ultrasound and/or MRI. MAIN OUTCOME MEASURES: We measured the incidence of malignancy and diagnostic accuracy of preoperative imaging. RESULTS: A total of 620 patients were included (272 with preoperative imaging and 348 without). There were 250 patients undergoing transrectal ultrasound, and 24 patients undergoing MRI (2 patients underwent both). Transrectal ultrasound and MRI correctly identified malignant polyps in 50% (11/22) and 44% (8/18). Overall agreement for benign versus malignant polyps between preoperative imaging and final pathology was κ = 0.30 (95% CI, 0.18-0.41) for transrectal ultrasound and 0.29 (95% CI, 0.01-0.57) for MRI. In both the overall and unmatched cohorts, the incidence of malignancy, margin involvement, and proportion of patients requiring salvage surgery was similar. LIMITATIONS: Data were obtained from 2 institutions with different equipment over a long time period. CONCLUSIONS: Preoperative imaging did not accurately identify malignancy in clinically benign rectal lesions and did not affect the incidence of malignancy, margin involvement, or proportion of patients requiring salvage surgery. Therefore, preoperative imaging may not be necessary for clinically benign lesions undergoing local excision. See Video Abstract at http://links.lww.com/DCR/A695.


Subject(s)
Colonic Polyps/diagnostic imaging , Neoplasms/surgery , Preoperative Care/standards , Rectal Neoplasms/surgery , Rectum/diagnostic imaging , Aged , Aged, 80 and over , Colonic Polyps/pathology , Colonic Polyps/surgery , Female , Humans , Incidence , Magnetic Resonance Imaging/methods , Male , Margins of Excision , Middle Aged , Neoplasm Staging , Neoplasms/pathology , Outcome Assessment, Health Care , Prospective Studies , Rectal Neoplasms/diagnostic imaging , Rectal Neoplasms/epidemiology , Rectum/pathology , Transanal Endoscopic Surgery/methods , Ultrasonography/methods , United States/epidemiology
3.
Urol Case Rep ; 20: 38-40, 2018 Sep.
Article in English | MEDLINE | ID: mdl-29928591

ABSTRACT

Wilms' tumor manifesting as an obstructing ureteral mass is extremely rare. Herein, we report an unusual case in which a child presented with a clinical picture concerning for and suggestive of ureteropelvic junction obstruction (UPJO), but was instead found to have an intrapelvic pedunculated Wilms' tumor with extension into the proximal ureter. We discuss the patient's diagnostic workup, radiographic, operative and pathologic findings, as well as important lessons learned from this unusual case.

4.
Cureus ; 9(8): e1599, 2017 Aug 23.
Article in English | MEDLINE | ID: mdl-29067223

ABSTRACT

Clostridium difficile (C. difficile) is a common cause of antibiotic--associated diarrhea (AAD), being responsible for 15--25% of all AAD cases. The purpose of this literature review is to determine the cost-effectiveness of fecal microbiota transplantation (FMT) and how it compares in this regard to the standard treatments of choice for recurrent C. difficile infection (CDI). The review of the literature along with the evaluation of three comparative cost effective analyses yielded findings consistent with the view that FMT is the most cost-effective option in treating recurrent CDI. There are some (but considerably less) data indicating that FMT may be a cost effective strategy in treating initial CDI, as well. The superior cost-effectiveness of FMT as compared to the preferred standards of treatment for recurrent CDI suggest FMT use should become more integrated in routine clinical practice. Increased utilization of FMTs would allow for better control of this increasingly problematic disease as well as lower costs associated with its management.

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