ABSTRACT
Myositis ossificans of the hand is extremely rare. We report an unusual case of myositis ossificans of the thenar muscles and discuss the diagnostic pitfalls whereby this condition can be mistaken for malignancy or infection.
Subject(s)
Muscle, Skeletal/pathology , Myositis Ossificans/diagnosis , Wrist/pathology , Adolescent , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , Male , Myositis Ossificans/etiology , Tomography, X-Ray ComputedABSTRACT
Many serious and potentially treatable diseases of the urinary tract may have haematuria as their only manifestation. However, asymptomatic microscopic haematuria detected by dipstick testing may be seen in up to 16% of screening populations. The great majority of such cases will have no sinister underlying cause, particularly in those under 40 years of age, and so the schedule of further investigations, some of which may be invasive, time-consuming and expensive, needs to be rationalised. In addition, the increasing popularity of 'fast track' clinics for the investigation of haematuria enhances the need for a clear strategy of investigation. Analysis of the epidemiology of asymptomatic haematuria and its causes combined with a consideration of the risk-benefit profile of the available investigations, makes it possible to set out an algorithm for the initial management of this common finding. Careful clinical assessment and basic laboratory tests for renal function, analysis of the urinary sediment and cytological examination of the urine are followed by ultrasound and plain radiography of the urinary tract. Flexible cystoscopy under local anaesthetic is central to the algorithm in patients of all ages. The importance of a nephrological opinion and consideration of renal biopsy, especially in younger patients with other evidence of glomerular disease, is stressed. The role of intravenous urography in excluding pathology of the upper urinary tract, especially in patients over the age of 40, is also considered.
Subject(s)
Hematuria/etiology , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Urography , Urologic Diseases/complications , Urologic Diseases/diagnosisABSTRACT
The management of resistant transplant renal artery stenosis (TRAS) poses difficult problems. There is no consensus on the most appropriate course of action if severe stenosis recurs despite repeated percutaneous transluminal balloon angioplasty (PTA). Expandable metallic vascular stents have been increasingly successful as an adjunct to PTA in the coronary and peripheral circulation and more recently in the management of resistant native renal artery stenosis. We report four cases in which such stents were successfully used to treat resistant stenosis in transplant renal arteries. The cases illustrate the range of problems that may be caused by TRAS, from resistant hypertension to impending graft failure. The stents were successfully deployed in all four patients. One patient had an acute stent thrombosis successfully treated with immediate thrombolysis and two patients required repeat stenting. In all the cases there was arrest or slowing of previously aggressive recurrent TRAS and at the close of follow-up (4-24 months) all patients had adequate stable allograft function, and satisfactory blood pressure control including the one patient with a significant residual stenosis.
