Paradoxical air embolism during percutaneous nephrolithotomy due to patent foramen ovale: Case report.

Paradoxical air embolism is a very rare complication associated with percutaneous nephrolithotomy (PCNL). Incidence may be higher if patients also suffer from a septal heart defect. We report the case of a 76-year old male who presented for PCNL treatment of a right kidney lower calyceal calculus. During the procedure, the patient developed signs and symptoms consistent with that of air embolism. Intraoperative echocardiography confirmed the diagnosis. Subsequent intraoperative and postoperative medical management was carried out and the patient was discharged after recovery three days later. This case highlights the importance of a rare but potentially fatal complication of PCNL.

Primary cutaneous mucinous carcinoma of the penis.

Primary cutaneous mucinous carcinoma (PCMC) is a rare, slow growing, malignant neoplasm arising from the sweat glands. Lesions are most commonly seen on the head and neck, and frequently mistaken for metastases from more common primary sites, such as the breast, gastrointestinal tract, lung, ovary, or prostate. We present what we believe is the first reported case of PCMC involving the penis.

Penile necrosis requiring penectomy complicating recto-urethral fistula post prostate cancer external beam radiation and brachytherapy.

Radiation therapy is a well-recognized treatment for unfavourable risk localized prostate cancer. Radiation induced recto-urethral fistulae are known rare complications particularly from brachytherapy. We report a case of a recto-urethral fistula 7 years post-external beam radiation and I-125 brachytherapy, which was complicated by a severe polymicrobial soft tissue infection. This infection required penectomy and pelvic exenteration with diverting colostomy, Indiana pouch urinary diversion and gracilis myo-cutaneuos flap closure of the perineum.

Atrophic upper pole of a duplex collecting system masquerading as suprarenal mass: a case study and literature review.

The growing use of maternal fetal ultrasound is leading to the discovery of an increasing number of suprarenal masses. Our experience with a cystic suprarenal mass detected on antenatal ultrasound is described. Location and radiographic features could not rule out the possibility of a cystic neuroblastoma; therefore, surgical resection of the mass was performed. Despite the absence of common radiologic characteristics, the pathology of the specimen revealed a non-functioning upper pole of a duplex kidney with complete duplication of the collecting system. Neonatal evaluation and management and the differential diagnosis are discussed.

Urachal-sigmoid fistula associated with diverticular disease.

BACKGROUND: Urachal anomalies rarely present in adulthood. We report the second known case of urachal-sigmoid fistula associated with diverticular disease. METHOD: We performed a case report and literature review. We searched MEDLINE and PubMed using the search words "urachus," "urachal fistula," "sigmoid colon" and "diverticulosis." RESULTS: Our literature review revealed 1 previous report of urachal-sigmoid fistula associated with diverticular disease. We reviewed other publications with respect to pathophysiology, diagnosis and management of urachal disease. CONCLUSION: Urachal disease that presents in an adult is usually the result of some complication of a urachal anomaly. Various modes of imaging may help confirm the diagnosis, although CT sinography has been recommended and was key in the present case. Management includes eradication of infection and, usually, surgical intervention.

Management of ischemic priapism with high-dose intracavernosal phenylephrine: from bench to bedside.

INTRODUCTION: Ischemic priapism is associated with cavernosal acidosis, which decreases the efficacy of adrenergic agonists. We determined the effect of acidosis on ligand dissociation from adrenergic receptors and assessed the efficacy of high-dose phenylephrine in treating patients with acute ischemic priapism. METHODS: Dissociation rates of [3H]prazosin were determined at pH 7.2 and 6.9 in membrane preparations of rabbit penile cavernosal tissue. Vital signs were recorded from patients before injection, and at 1 minute and 5 minutes after injection of high-dose phenylephrine (1,000 mg q 5 minutes) for 17 consecutive cases of iatrogenic ischemic priapism that occurred after vascular assessment. We also provide two case reports of prolonged ischemic priapism successfully managed with high-dose phenylephrine. RESULTS: Dissociation rates of [3H]prazosin were greater at pH 6.9 (K (-1) = 0.23/minute) than at pH 7.2 (K (-1) = 0.10/minute), suggesting decreased receptor affinity at acidic pH. Intracavernosal therapy with high-dose phenylephrine (mean dose 2,059 +/- 807 microg) was 100% effective with no adverse events or significant changes in vital signs. In addition, two patients with ischemic priapism for > or =36 hours were successfully treated with high-dose intracavernosal phenylephrine (mean dose 45,000 microg) without any adverse event. Both patients are currently potent. CONCLUSIONS: Acidic pH may decrease the binding affinity of adrenergic ligands to their receptors. Phenylephrine at doses higher than previously reported may be necessary to overcome this decreased affinity in acidosis associated with ischemic priapism. High-dose intracavernosal phenylephrine administration is safe and effective in the management of ischemic priapism. Continuous cardiovascular monitoring is advised.

Xanthogranulomatous pyelonephritis in a 1-year old boy.

Xanthogranulomatous pyelonephritis (XGP) is a rare, chronic inflammatory lesion of the kidney associated with both chronic infection and obstruction. Most common in middle-aged females, it is important to recognize in children because it may be confused with childhood renal malignancies particularly Wilms' tumor. We report a case of a 1-year old male with antenatally detected and postnatally confirmed hydronephrosis. Further investigation revealed a left incomplete duplex collecting system with obstructing lower pole stones, pelvicaliectasis and widespread foci of calcification. He underwent a left nephroureterectomy with the pathological report noting XGP.

Laparoscopic resection of a juxta-adrenal schwannoma.

A seven centimeter supra-renal mass was discovered in a 62-year old patient who presented with gross hematuria and a superficial bladder tumor. The supra-renal mass was resected laparoscopically and the final pathology revealed a benign schwannoma. The epidemiology, diagnostic features and treatment options for this rare peripheral nerve sheath tumor are reviewed.

Incorrect biochemistry complicates prostate cancer management.

A man with a prostate specific antigen (PSA) of 6.1 ng/mL, a clinical stage T2b prostate nodule and biopsies that showed Gleason sum 6 adenocarcinoma of the prostate underwent a radical prostatectomy. The final pathology showed organ-confined disease. His postoperative PSA remained elevated at 4.0 ng/mL. The PSA was repeated several times and was in the same range. It was re-evaluated at another lab facility and was unmeasurable (<0.02 ng/mL). He has an antibody that cross-reacts with an assay reagent causing this false reading. The most likely antibody is one against mouse immunoglobulin G (IgG).