Transurethral ureteric embolization for locally advanced cervical cancer with uretero-vaginal fistula - A case report.

INTRODUCTION: Targeted radiotherapy, surgery, and localised disease progression can all result in fistulous tract formation in patients with a pelvic malignancy, in particular cervical or endometrial cancer. This report discusses a novel technique for palliative management of ureterovaginal fistulas in end-stage disease. PRESENTATION OF CASE REPORT: We report the case of a 37 year old female with metastatic cervical squamous cell carcinoma previously treated with chemoradiation who presented with progressive disease and secondary development of a symptomatic ureterovaginal fistula. DISCUSSION: This case report discusses the causes and sequalae of uretero-vaginal fistula formation, the role of the interventional radiology with regards to palliative intervention, and potential patient factors that can affect performance of such procedures. CONCLUSION: Interventional radiology plays an important role in palliative and symptomatic management of end stage malignant disease. Ureteric embolisation via a retrograde transurethral approach by way of an existing stent is a novel approach to access making the procedure easier for both the patient and radiologist.

"Uroptysis!" - A case report of xanthogranulomatous pyelonephritis with nephrobronchial fistulation.

INTRODUCTION AND IMPORTANCE: Xanthogranulomatous pyelonephritis (XGP) is an uncommon complication of chronic urinary tract infection, classically secondary to a chronic obstructive uropathy, resulting in destruction of renal parenchyma and a non-functioning kidney (Jha and Aeddula, 2022 [1]). This is rarely associated with nephrobronchial fistulation, with few published case reports in the literature to date. CASE PRESENTATION: We present the rare case of a 42-year-old female who was admitted to an Irish tertiary urology centre with abdominal pain, elevated inflammatory markers and an obstructive uropathy on initial imaging, with a new diagnosis of XGP. Initial management was with targeted intravenous antimicrobial therapy, percutaneous nephrostomy and perinephric drain insertion. The subsequent discovery of a nephrobronchial fistula later complicated the case, warranting plan for interval nephrectomy and fistula repair following prolonged medical management. We discuss the initial presentation, workup and image-guided approach to management. CLINICAL DISCUSSION: XGP is an uncommon sequela of chronic renal suppurative infection, and is usually associated with long-standing ureteric obstruction secondary to a staghorn calculus. Nephrobronchial fistulation is a rare complication of XGP, highlighting the significance of this case discussion. CONCLUSION: XGP should be considered in cases of suspected chronic pyelonephritis and may rarely lead to nephrobronchial fistulation. In cases of known XGP and pleural empyema, nephrobronchial fistulation should be considered as part of the differential diagnosis.

Effects of acute dietary restriction on gut motor, hormone and energy intake responses to duodenal fat in obese men.

BACKGROUND: Previous patterns of energy intake influence gastrointestinal function and appetite, probably reflecting changes in small-intestinal nutrient-mediated feedback. Obese individuals consume more fat and may be less sensitive to its gastrointestinal and appetite-suppressant effects than lean individuals. OBJECTIVE: To evaluate the hypothesis that, in obese individuals, the effects of duodenal fat on gastrointestinal motor and hormone function, and appetite would be enhanced by a short period on a very-low-calorie diet (VLCD). METHODS: Eight obese men (body mass index 34±0.6 kg m(-2)) were studied on two occasions, before (V1), and immediately after (V2), a 4-day VLCD. On both occasions, antropyloroduodenal motility, plasma cholecystokinin (CCK), peptide-YY (PYY) and ghrelin concentrations, and appetite perceptions were measured during a 120-min intraduodenal fat infusion (2.86 kcal min(-1)). Immediately afterwards, energy intake was quantified. RESULTS: During V2, basal pyloric pressure and the number and amplitude of isolated pyloric pressure waves (PWs) were greater, whereas the number of antral and duodenal PWs was less, compared with V1 (all P<0.05). Moreover, during V2, baseline ghrelin concentration was higher; the stimulation of PYY and suppression of ghrelin by lipid were greater, with no difference in CCK concentration; and hunger and energy intake (kJ; V1: 4378±691, V2: 3634±700) were less (all P<0.05), compared with V1. CONCLUSIONS: In obese males, the effects of small-intestinal lipid on gastrointestinal motility and some hormone responses and appetite are enhanced after a 4-day VLCD.

Non-firearm weapon use and injury severity: priorities for prevention.

OBJECTIVES: To test the hypothesis that weapon-related violence (excluding firearms) results in more severe injury relative to the use of body parts (fists, feet and other body parts), and to rank order of injury severity by assault mechanism. DESIGN: Retrospective cohort study. PARTICIPANTS: 24,660 patients who were treated in a UK emergency department for violence-related injury. MAIN OUTCOME MEASURE: Score on the Manchester Triage Scale. RESULTS: The use of a weapon resulted in significantly more serious injury (adjusted odds ratio (AOR) 1.13, 95% confidence interval (CI) 1.00 to 1.28). However, of all mechanisms of violent injury, the use of feet resulted in most severe injury (AOR 1.41, 95% CI 1.17 to 1.70), followed by blunt objects (AOR 1.35, 95% CI 1.14 to 1.58), other body parts (AOR 1.22, 95% CI 1.06 to 1.40) and sharp objects (AOR 1.09, 95% CI 0.91 to 1.5), compared with use of fists. CONCLUSIONS: Use of weapons resulted in more severe injury than use only of body parts. The use of feet caused the most serious injuries, whereas the use of fists caused the least severe injuries. Injury severity varied by number of assailants and age of the patient--peaking at 47 years--but not by number of injuries. Preventing the use of feet in violence, and preventing group violence should be major priorities.

Achievement of group cohesion through the development of a psychiatric nursing seminar.

The purpose of this paper is to describe the process by which group cohesion emerged around the task of developing a psychiatric nursing seminar at the Palo Alto (California) V.A. Medical Center. This paper will discuss how group cohesion evolved, describe the seminar, and offer suggestions to other nurses wanting to work together more collaboratively. As clinical nurse specialists (CNS) assigned to the inpatient psychiatric units of a Veterans Administration Medical Center, we were asked by nursing administration to develop an educational course. The purpose of the course was to provide registered nurses with a common knowledge base that would facilitate communication related to patient care. While we were aware that teaching discreet areas of content commensurate with our individual interests and expertise would get the job done rapidly, our combined experience taught us that this approach to learning did little to bring about a change in clinical practice. We viewed the selection of a conceptual framework to which we could all be committed as an essential step prior to the content development. What is significant about this experience was that the group process of achieving cohesiveness was so closely related to the conceptual framework that finally evolved. We chose a framework that reflected our own perspectives towards working with others and about psychiatric nursing. In turn, the major concepts of the chosen framework guided many of our interactions with each other.