Urology, Nephrology and Andrology International

Introduction: Henoch-Schönlein purpura (HSP) is a small blood vessel vasculitis. The exact cause of the disease is unknown.

Case report: We reported a case of 40-year-old male who presented with the appearance of red macules on his extremities and face, along with vomiting, and pain in the abdomen and joints. The patient was initially diagnosed with Henoch-Schönlein purpura. Renal biopsy was suggestive of IgA nephropathy. One months later, he developed chronic diahorrea and duodenal biopsy shows strongyloides stercoralis (s. stercoralis) larvae and was treated with ivermectin following which his diahorrea subsided and later there was complete resolution of active urine sediments.

Conclusion: The time course of the disease and present knowledge concerning the pathogenic mechanisms of HSP suggest that s. stercoralis infection could have caused HSP in the presented patient, which was complicated by  nephritis.

Keywords: Henoch-Schönlein Purpura; Strongyloides Stercoralis.
 

Background: Plasmapheresis is the treatment of choice in several immune mediated neurological disorders such as Guillain-Barré syndrome and myasthenia gravis. There are only a few studies from India that have looked in to the outcomes and complications related to therapeutic plasmapheresis in neurological disorders. This study was done to examine the indications, complications and outcomes of plasmapheresis in neurological disorders.

Materials & Methods: A retrospective study of patients who underwent plasmapheresis for neurological disorders during last five years was done. Demographic, clinical data, indications, complications related to the procedure, clinical outcome and long term follow up data were collected and analyzed.

Results: Data of sixty patients, who underwent a total of 276 sessions of plasmapheresis were analyzed. Fifty two percent were males and mean age was 45 years. Twenty nine patients (49%) had Acute Inflammatory Demyelinating Polyradiculoneuropathy, 14 (23%) had Myasthenia Gravis and four patients had Acute Disseminated Encephalomyelitis (7%). Other indications were Chronic Inflammatory Demyelinating Polyradiculoneuropathy, transverse myelitis, polymyositis, autoimmune encephalitis, muscular dystrophy, neuromyeltis optica and Febrile infection related epilepsy syndrome. In patients with AIDP, 26 patients (89%) improved. In patients with MG 11 patients (78%) improved. All patients with Autoimmune encephalitis, Polymyositis, Transverse myelitis and Neuromyelitisoptica showed improvement. There was no improvement in patients with Muscular dystrophy and FIRES. Allergic reactions to plasma, intravascular hemolysis and hypotension were the side effects noted which were managed efficiently during procedure. Mild coagulopathy was observed in three patients, but there were no bleeding complications. There were no other significant complications related to procedure. After a mean follow up period of 3 years, 35 patients had complete remission, 10 patients had relapse, 2 patients died whereas 13 patients lost to follow up.

Conclusion: Plasmapheresis is an effective and safe treatment modality in various immune mediated neurological disorders.

Keywords: Plasmapheresis; AIDP; Myasthenia Gravis.

 

Introduction: The most common type of ectopic kidney is the pelvic kidney, whereby the organ remains in the pelvic cavity. In many patients the condition of renal ectopic remains undiagnosed throughout their life. UPJO is the commonest associated problem. We reviewed the case records of patients presenting with an UPJO in an ectopic pelvic kidney. We also assessed the feasibility and safety of laparoscopic repair of UPJO.

Materials & Methods: We retrospectively reviewed the case records of patients presenting to us with UPJO in a pelvic or ectopic kidney. The age, gender, presenting symptoms, clinical signs, images treatment records were noted and analyzed.

Results: During the period Jan 2011 to Dec 2015, a total of 15 patients (11 female and 4 male) with a mean age of 21.7±5.11 yrs. (Range 9 to 33) underwent pyeloplasty for a pelvic ectopic kidney. The laparoscopic approach was successful in 9/12 (75%) patients. Conversion to open surgery (dismembered pyeloplasty) was necessary in the remaining
three. In the three other patients, an open pyeloplasty was performed.

Conclusions: Surgery remains the major form of treatment in these patients with UPJO. Laparoscopic approach seems a useful option for the treatment UPJO. Laparoscopic approach to ectopic pelvic kidneys with UPJO is feasible, safe and effective.

Keywords: Ectopic; Kidney; UPJ Obstruction; Laparoscopy.