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Significant changes occur in both structure and function of the renal system during normal pregnancy. Urinary tract dilatation is one of the most remarkable anatomical alterations noted during gestation, encompassing the renal calyces, pelves and ureters. As such, renal and ureteral lithiasis are relatively rare complications in pregnancy. Emphysematous pyonephrosis is a grave complication of ureteric obstruction. Pathologically, this clinical entity is distinguished from infected hydronephrosis or pyelonephritis via the following: presence of gross pus and fermentative gas in an obstructed collecting system, renal parenchymal destruction, deteriorating renal function and septic complications. Treatment modalities are individualized, consisting primarily of drainage of pus, eradication of sources of obstruction, aggressive hydration, pressor therapy as indicated and intravenous antibiotic therapy. Prior to antibiotic therapy, the proposed treatment for pyonephrosis consisted primarily of an expeditious nephrectomy in order to remove a kidney that was both nonfunctioning and a source for urosepsis. With the advent of antibiotics, the treatment for pyonephrosis was subsequently modified to involve aggressive intravenous antibiotic therapy and drainage of the kidney, generally via a cytoscopical-ly inserted ureteral catheter. The diagnosis of pyonephrosis need not consistently be equated with irreversible renal damage; these procedures were performed in an attempt to salvage the infected kidney. At present, the placement of percutaneous nephrostomy has become the procedure of choice as it allows both the timely drainage of pus and the determination of residual renal function following the obliteration of infection. Percutaneous nephrostomies are not contraindicated in pregnancy. Major complications of percutaneous nephrostomies, occurring in <4% of published reports, include infection, hemorrhage, urine leak and pneumothorax. Minor complications, occurring in <15% of published reports note hematuria, catheter displace-ment/dislodgement and hematoma formation.
INTRODUCTION
We present a case in which emphysematous pyonephrosis occurred in the first trimester of a pregnancy complicated by nephrolithiasis. Emphysematous pyonephrosis is a rare and potentially fatal clinical entity but with recognition and timely intervention by multiple disciplines, a successful outcome may be obtained.
Our research demonstrates that the number of inpatient surgical procedures for the treatment of patients with a primary diagnosis of uterine fibroids increased 18% over the five-year period from 1998-2002. These findings are consistent with the results of the Centers for Disease Control and Prevention’s hysterectomy surveillance from 1994-1999 for patients with a uterine fibroid diagnosis. It is important to note that the same study found that the rate of all hysterectomies increased from 1994-1998 at a slower rate than hysterectomies for uterine fibroids. The cause of the increase in the number of procedures for this condition cannot be determined by a database, but the change could be due to an increase in the incidence of the uterine fibroids, an increase in the number of patients diagnosed, and/or an increase in the number of patients treated in an inpatient setting with a surgical procedure. In the hysterectomy surveillance report from the Centers for Disease Control and Prevention, the authors suggest that the increase in surgical procedures for patients with uterine fibroids could be a result of changes in screening practices due to the increased availability of outpatient ultrasound and a more aggressive view toward addressing family history of uterine fibroids.
- In: Health
- Tags: hysterectomy, leiomyoma, myomectomy, race/ethnicity, uterine fibroid
Inpatient Surgical Treatment Patterns: RESULTS
16 Nov2009
Population Characteristics
Overall, for patients hospitalized with any uterine fibroid diagnosis, there were 2,136,151 admissions over the five-year period. The number of patients with any uterine fibroid diagnosis on their discharge record increased an average of 4.0% per year. For more than 50% of this subset, the primary diagnosis was uterine fibroids (Table 1). Patients with a primary diagnosis of fibroids had an average LOS of 2.73 days (SD=1.91, range 0-346), an average of 4.5 diagnoses (SD=2.3, range 1-25) and 2.2 procedures (SD=1.1, range 0-16) based on inpatient records.
- In: Health
- Tags: hysterectomy, leiomyoma, myomectomy, race/ethnicity, uterine fibroid
Data Source
Patients were identified from the Healthcare Utilization Project National Inpatient Sample (HCUP-NIS) for the years 1998-2002. The HCUP-NIS is a national, population-based sample representing 20% of hospital discharges annually in the United States and is prepared by the Agency for Healthcare Research and Quality. The number of states contributing data ranged from 22 states in 1998 to 35 states in 2002.
- In: Health
- Tags: hysterectomy, leiomyoma, myomectomy, race/ethnicity, uterine fibroid
Inpatient Surgical Treatment Patterns
14 Nov2009
INTRODUCTION
Uterine leiomyomas (fibroids) are benign, often asymptomatic tumors derived from smooth muscles and the extracellular matrix proteins collagen and elastin. Signs and symptoms of uterine fibroids include heavy or prolonged menstrual bleeding, pain and pregnancy complications. Although patients with benign symptoms may be monitored without treatment, common surgical treatments include hysterectomy (abdominal, vaginal and laparoscopic) and myomectomy (laparotomy, laparoscopic and hystero-scopic). New approaches, such as myolysis, focused ultrasound, transvaginal cryomyolysis and uterine artery embolization (UAE), are being studied as possible alternative treatments. Uterine fibroids have been identified as the most common diagnosis associated with hysterectomy in the United States.
- In: Health
- Tags: hysterectomy, leiomyoma, myomectomy, race/ethnicity, uterine fibroid
With the current low attrition rates from medical school, nearly every student who enters medical school will become licensed to practice, meaning that medical school admissions committees have the sole responsibility of choosing the nation’s future physician workforce. Our study examining the perception of medical schools on barriers to URM recruitment sheds some light on how schools make admission decisions and how this affects diversity in the classroom. For example, low GPA and MCAT scores among URM applicants are perceived to be a barrier by the vast majority of respondents, suggesting that schools continue to place significant weight on these admissions criteria.