Diminutive Ureteral Stone Causing Caylyceal Rupture: Case Report and a Review of the Treatment Options.

Rupture of the renal collecting system is a rare event, usually occurring at the ureterovesical junction (UVJ). The most common cause is nephrolithiasis, usually directly correlated with the size of the stone. Other causes include bladder outlet obstruction, ureteropelvic junction obstruction, and extrinsic ureteral compression by a malignant pathology. The mechanism is increased pressure within the collecting system, and symptoms vary from vague mild abdominal pain to severe excruciating pain. We present a case of a 19-year-old female with obstructive uropathy and renal calyceal rupture caused by a 3 mm stone at the UVJ. Due to the small size of the stone and her hemodynamic stability, she was treated conservatively with tamsulosin and IV ceftriaxone. The following day she passed sediment in the urine and noted pain improvement. Calyceal rupture with small stones is exceedingly rare, may be missed on a CT without contrast, and should be suspected when perinephric edema or fluid is seen. This is the smallest recorded stone causing calyceal rupture to the best of our knowledge. CT with contrast is indicated for diagnosis when calyceal rupture is suspected and is suggested by extravasation of contrast. Early diagnosis and intervention, in collaboration with urologists, can help to avoid long-term complications such as acute kidney injury, urosepsis, and urinoma. Conservative management may still be considered after a calyceal rupture in patients with small, potentially passable stones. However, if there is associated obstructive uropathy, infection, or significant rupture, then stenting may be indicated. This case highlights the diagnosis of calyceal rupture in the setting of tiny stones and the efficacy of conservative therapy versus early stenting in the management of stable patients.

Coronary Artery Stent Dislodgement and Loss in the Bloodstream: A Case Report and Management Options.

BACKGROUND Coronary stent dislodgement is rare but carries serious complications like thrombosis, myocardial infarction, disruption of the systemic circulation, and coronary dissection, which can lead to sudden death. Thus, rapid evaluation and intervention are needed to restore blood flow to vital organs. CASE REPORT A 46-year-old woman with no relevant past medical history except for smoking, presented to the Emergency Department (ED) with left-sided chest pain. The physical exam was unremarkable. EKG showed ST segment elevation, and troponin was 4.03. She underwent cardiac catheterization, which showed 100% occlusion of the left anterior descending coronary artery (LAD). A drug-eluting stent (DES) was placed. Later, she had chest pain similar to the initial episode. EKG showed 1-mm elevation at ST segment in leads V1 and V2 and T wave inversion in leads V2, V3, V4, and V5. She underwent a repeat heart catheterization, which revealed a dissection in the middle LAD distal to the initial stent placement. She was treated with another stent overlapping the proximal stent. While attempting to cross the proximal stent, the stent came off the balloon, slipped from the wire, and went down into the descending aorta. CONCLUSIONS Coronary artery stent dislodgement is a rare event that can lead to significant complications during PCI. Patient restlessness and small-sized, severely angulated, and previously stented coronary arteries are associated risk factors. The main treatment option is stent retrieval, either surgically or using other available techniques. If retrieval of the stent is impossible, crushing it against the blood vessel wall could be considered.

Primary Periodic Paralyses: A Review of Etiologies and Their Pathogeneses.

Periodic paralyses are a group of disorders characterized by episodes of muscle paralyses. They are mainly divided as primary (hereditary) and secondary (acquired) periodic paralyses. Primary periodic paralyses occur as a result of mutations in genes encoding subunits of muscle membrane channel proteins such as sodium, calcium, and potassium channels, resulting in impairment of their properties. Primary periodic paralyses are further classified on the basis of affected ion channels and other associated complications. Some of these periodic paralyses are hyperkalemic periodic paralysis (Na-channel mutation), hypokalemic periodic paralysis (Na- or Ca-channel mutation), Andersen's syndrome (K-channel mutation), etc.