Archive for the ‘Urology-Nephrology’ Category

Arteriovenous fistula

Tuesday, November 2nd, 2010

The AVF is considered the best surgical approach to conventional hemodialysis. It is defined as the anastomosis latero-lateral or latero-terminal of an artery and a vein in the vicinity.

I – Anatomophysiological Recalls:
The anatomy of the veins of the arms is quite variable from one individual to another, but there is, however, four superficial veins used: The cephalic vein, basilic, ulnar and radial. The preliminary study by the surgeon, vessels, is essential to achieving a quality FAV. The assessment will first be clinically by palpation of the pulse examination of veins with and without tourniquet, study of their discharge. It may be necessary to achieve an ultrasound or venography, especially in diabetics. The Allen’s test seems unnecessary.

It is essential to require teams of nurses, to maintain maximum capital of the renal vein, at any stage, by avoiding any aspiration or infusion of these veins.

II – Surgery:
The plexus block by axillary or subclavian is the most used, promoting vasoplegia. Sometimes local anesthesia with or without neuroleptanalgesia may be indicated, general anesthesia is reserved for some special cases, as it almost always accompanied by hypotension embarrassing perception clinic. (more…)

Glomerulonephritis

Sunday, November 22nd, 2009

It is a bacterial inflammation or not with lesion of the kidney glomeruli.
Acute glomerulonephritis (GNA)
This inflammation often occurs as a result of an inappropriate immune response. It occurs approximately 1 to 4 weeks after a streptococcal infection often (tonsillitis, otitis, sinusitis). They are called post-infectious GNA.
The GN are often found in children 5 to 12 years.
It can sometimes be linked to an autoimmune disease that will gradually worsen renal function and lead to kidney failure (with need for dialysis).
In response to the body to infection, are formed antibodies directed against the germs in question. The immune response causes the formation of immune complexes “which are arrested in the glomerular filter of the kidney and cause inflammation.

Etiology:

  • The beta-hemolytic streptococcus group A is most commonly involved.
  • Other bacteria: pneumococci, meningococci, staphylococci …, hepatitis viruses

(more…)

The urolithiasis

Sunday, November 22nd, 2009

It is a disease characterized by the presence of one or more gallstones (ie, mineral concretion or calculus) in the urinary tract, mostly the upper urinary tract.
It is a predominantly male disease, more common in hot and high standard of living. Frequency: 32/100 000 new cases per year between the ages of 20 and 60, involving 2 men and a woman with a familial incidence found in 50% of cases.

Aetiology and predisposing factors:
Gallstone formation is favored by the hyper-concentration in the urine of some mineral components, such as oxalate and calcium phosphate. A supersaturated urine allows the formation of a nidus homogeneous or heterogeneous matrix used in the formation of a small crystal. This will increase volume and give rise to a large stone or may aggregate with other crystals to form an identical crystal aggregation.
The etiology is unknown in 60% cases, followed by:

  • Hypercalciuria idiopathic, autosomal dominant, with urinary leakage or increased intestinal absorption of calcium;
  • by hypercalciuria hyperparathyroidism
  • hypercalciuria Intoxication with vitamin D, A
  • hypercalciuria associated with neoplasia, Kahler disease, Paget
  • abnormal metabolism of uric acid
  • hyperoxaluira primitive or family
    syndrome ureteropelvic junction.

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The priaprisme

Saturday, November 21st, 2009

Pathology is characterized by an erection limited to the corpus cavernosum of the penis, excluding the corpus spongiosum and the glans, lasting abnormally high, painful, without sexual desire.
Clinic:

  • rigidity of the corpora cavernosa of the penis
  • without turgidity of spongy body and glans
  • several hours
  • painful
  • without sexual desire

Etiology:

  • Idiopathic: some patients have no known cause in the onset of priapism.
  • Hematologic: leukemia, sickle cell disease.
  • Neoplastic: lymphoma or metastasis of the corpora cavernosa.
  • Neurological: multiple sclerosis, paraplegia.
  • Iatrogenic: the most frequent. It is injected intra-cavernous overdose during treatment of impotence.

(more…)

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