Polymorphism of Clinical Manifestations in Patients with “the Nutcracker Syndrome”

Introduction. “The nutcracker syndrome” occurs due to abnormal compression of the left renal vein (LRV) between the superior mesenteric artery and the aorta. Clinical manifestations range from hematuria, proteinuria, pain in the left lumbar region, left sided varicocele in men, and left sided pudendal varicosity in women to the development of severe anemia and renal failure in some cases due to progressive phlebohypertension.Materials and methods. The study included 210 patientswith suspected “nutcracker syndrome” . The age of the patients ranged from 12 to 52. All patients were interviewed for specific complaints. All referred patients underwent color Doppler ultrasound. The patients with confirmed left renal vein stenosis underwent CT angiography.Results of the researchAccording to color Doppler ultrasound, different degree of aorta mesenteric clamp (AMC) was confirmed in 138 (65.7%) patients, critical LRV stenosis was observed in 35 of them. The predominant complaints of the patients with AMC included pain in the left half of the abdomen and left lumbar region, left sided varicocele and left sided pudendal varicosity, hematuria.. More than half of the patients with AMC complained of dysmenorrhea, and one in four patients with AMC complained of erectile dysfunction.Conclusions. There is no consensus on the diagnostic algorithm for this pathology detection. There is a lack of evidence base (multicenter clinical randomized trials) regarding the clinical selectivity of treatment approaches. The pathology is rarely diagnosed due to a number of objective and subjective reasons, nonspecific symptoms, and therefore it deserves special attention in the study of pathogenesis, diagnosis and choice of treatment approach.

Retroperitoneal liposarcoma of the intestine: a rare cause of acute abdomen

Retroperitoneal liposarcoma is a rare malignant mesenchymal tumor with an incidence of 2.5 per million individuals. It is usually asymptomatic until its large enough to compress the surrounding organs, so its early diagnosis is difficult. In current case a 41 year old male patient with no significant past medical history presented to emergency department with sudden onset of abdominal pain in the left lumbar region. On examination, the abdomen was distended, guarding and rigidity present with tenderness to palpation in the left lumbar region, and no mass was palpated. Abdominal USG revealed a large heterogeneous mass in the left lumbar region. As the origin of the mass was uncertain, the patient was evaluated with CECT of the abdomen which revealed a retroperitoneal mass highly s/o liposarcoma. Given the suspicion of a liposarcoma, the patient underwent an abdominal exploration and there was a retroperitoneal mass of 12x8 cm adherent to the left colon. Wide resection of this mass was done along with left colectomy and the specimen was sent for examination. The histopathology study determined lipomatous tumor well differentiated retroperitoneal liposarcoma. Retroperitoneal liposarcoma is a malignant tumor whose treatment is fundamentally surgical. These tumors tend to be resistant to radiotherapy and/or chemotherapy. Among the most important prognostic factors related to survival is surgery with non-affected margins.

Primitive neuroectodermal tumor of the kidney: a rare case

Background Primitive neuroectodermal tumor commonly occurs in bones and is equivalent to Ewing’s sarcoma. Very few cases have been reported in the literature and they had a very different presentation and very aggressive behavior. Case presentation We present a case of a young 23-year-old male who presented with complaints of pain in left lumbar region of abdomen since 8 months and hematuria off and on. CT scan of the abdomen was done which revealed a large heterogeneously enhancing mass lesion in the left lumbar region arising from the superior and mid-pole of left kidney showing multiple non-enhancing necrotic areas. A diagnosis of left renal cell carcinoma was kept. Through the transperitoneal approach, the left kidney was approached and a left radical nephrectomy was done. The histopathology report revealed the tumor cells to be positive for CD99 and focally positive for Vimentin and negative for cytokeratin thereby making a diagnosis of primary neuroectodermal tumor (PNET). Conclusions Renal PNET is a rare renal malignancy that should be kept in the differential diagnosis of a renal SOL especially when it is a presenting feature in adolescent and young adult. It has a very aggressive course and multimodal therapy has to be considered in its treatment

Meetings of medical societies. Surgical Society and Society of Radiologists of the ATSSR. Joint meeting 15/XI.1936

Demonstrated b-th T-v, 23 y., Delivered to 1 chir. cl. GIDUV with severe profuse hematuria. Hematuria was preceded by an injury to the left lumbar region. Hematuria lasted 7 days. The diagnosis of neoplasm of the kidney was made on the basis of anamnesis and palpation of the dense, tuberous lower pole of the left kidney, the absence of indigo on this side, and a pyelogram, which showed a deformed pelvis with blurred contours.

Skin discoloration in acute necrosis of the pancreas

The author describes a case of acute pancreatic necrosis, in whose clinical picture the appearance of sharp blue-green spots first in the left lumbar region and then in the circumference of the navel and spreading further was noticed.