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PubMed1982

Xanthogranulomatous cholecystitis: case report and review of the literature.

We studied a case of xanthogranulomatous cholecystitis, an entity rarely described in English-language literature. Our lesion is unique with regard to the extent of involvement. It is characterized grossly by a markedly thickened gallbladder wall that is yellowish and granular. Microscopically, the gallbladder was diffusely infiltrated by foamy macrophages that contained lipofuscin, lipid material, and bile pigment, features corroborated by transmission electron microscopy. The origin and pathogenesis of xanthogranulomatous cholecystitis was reviewed. We postulate that, in the presence of obstruction and bile stasis, the combination of inflammation, tissue necrosis, and bile extravasation will lead to formation of xanthogranulomas similar to that produced in experimental pyelonephritis.

Cholecystitis↗
PubMed1975

The place of diagnostic ultrasound in the examination of kidneys not seen on excretory urography.

An examination was done on 28 patients with renal failure, 20 with unilateral hydronephrosis, 8 with multicystic kidneys, 3 with hypoplastic or chronically infected kidneys, and single examples of renal vein thrombosis, renal artery occlusion, xanthogranulomatous pyonephrosis with perinephric abscess, trauma and tumor invading the whole kidney. The distinct ultrasonic appearances of the various conditions causing radiographic non-visualization of the kidney are described.

Abscess↗
PubMed1985

Xanthogranulomatous endometritis associated with endometrial carcinoma.

We studied a case of xanthogranulomatous (XG) endometritis associated with endometrial adenocarcinoma. Isolated XG endometritis is a rare entity that may mimic carcinoma as a consequence of the replacement of the endometrium and the invasion of the myometrium by friable yellowish tissue composed of foamy histiocytes. To our knowledge, it has not previously been described as coexisting with a carcinoma. The XG reaction is characterized by pigment-laden foamy cells. Electron microscopy demonstrated that the foamy cells belong to the macrophage/histiocyte series and are not endometrial stromal cells. Histochemical studies revealed the pigment to be composed of hemosiderin and lipofuscin. The absence of calcispherites or a uniform immunoperoxidase staining reaction for alpha 1-antitrypsin excluded the diagnosis of malacoplakia. We have postulated that XG endometritis has a similar etiopathogenesis to XG pyelonephritis and XG cholecystitis. It is a rare morphologic expression of the clinical syndrome of benign senile pyometrium.

Aged↗
PubMed1998

Laparoscopic nephrectomy: the experience of the laparoscopy working group of the German Urologic Association.

PURPOSE: The centers of the laparoscopy working group of the German Urologic Association collected data to prove the efficacy, safety and reproducibility of laparoscopic nephrectomy. MATERIALS AND METHODS: At 14 centers 482 laparoscopic nephrectomies have been performed until December 1996 via a transperitoneal approach in 344 (71%) and a retroperitoneal approach in 138 (29%). All 482 laparoscopic nephrectomies were performed by a total of 20 surgeons with an average of 24 procedures per surgeon (range 4 to 105). The indications for nephrectomy were benign renal pathology in 444 patients (92%), including renovascular disease in 28%, hydronephrosis in 20%, reflux nephropathy in 15%, chronic pyelonephritis in 12%, end stage nephrolithiasis in 11%, renal dysplasia in 4% and renal tuberculosis in 1%. Of the remaining 38 patients (8%) laparoscopic radical nephrectomy was performed for renal cell carcinoma in 5% and for upper tract transitional cell carcinoma in 3%. RESULTS: Operating time depended mainly on the pathology of the kidney (that is small dysplastic organ versus large hydronephrosis) and the learning curve of the surgeon. However, the average operating time did not vary significantly among the different centers (maximum 277.6 and minimum 81.9 minutes). Intraoperative or perioperative complications were noted in 29 patients (6.0%), including bleeding in 22 (4.6%), bowel injury in 3, hypercarbia in 2 and pleura lesion in 1 and pulmonary embolism in 1. The conversion rate was 10.3% (bleeding, bowel injury, difficult dissection), including 4 patients with renal tuberculosis, 2 with xanthogranulomatous nephritis, and 1 each following renal trauma and embolization. The re-intervention rate was 3.4% due to bleeding in 6 cases, abscess formation in 3, intestinal stenosis in 2 and a pancreatic fistula and port hernia in 1. Mean hospital stay was 5.4 days. CONCLUSIONS: Laparoscopic nephrectomy has become a well established procedure in those urology departments focusing on laparoscopy. The indications and results are reproducible at these centers. However, for patients with severe perinephritis (that is renal tuberculosis, xanthogranulomatous nephritis, posttraumatic atrophy) a higher likelihood of open conversion must be considered.

Adolescent↗
PubMed2000

Silent hydronephrosis/pyonephrosis due to upper urinary tract calculi in spinal cord injury patients.

STUDY DESIGN: A study of four patients with spinal cord injury (SCI) in whom a diagnosis of hydronephrosis or pyonephrosis was delayed since these patients did not manifest the traditional signs and symptoms. OBJECTIVES: To learn from these cases as to what steps should be taken to prevent any delay in the diagnosis and treatment of hydronephrosis/pyonephrosis in SCI patients. SETTING: Regional Spinal Injuries Centre, Southport, UK. METHODS: A retrospective review of cases of hydronephrosis or pyonephrosis due to renal/ ureteric calculus in SCI patients between 1994 and 1999, in whom there was a delay in diagnosis. RESULTS: A T-5 paraplegic patient had two episodes of urinary tract infection (UTI) which were successfully treated with antibiotics. When he developed UTI again, an intravenous urography (IVU) was performed. The IVU revealed a non-visualised kidney and a renal pelvic calculus. In a T-6 paraplegic patient, the classical symptom of flank pain was absent, and the symptoms of sweating and increased spasms were attributed to a syrinx. A routine IVU showed non-visualisation of the left kidney with a stone impacted in the pelviureteric junction. In two tetraplegic patients, an obstructed kidney became infected, and there was a delay in the diagnosis of pyonephrosis. The clinician's attention was focused on a co-existent, serious, infective pathology elsewhere. The primary focus of sepsis was chest infection in one patient and a deep pressure sore in the other. The former patient succumbed to chest infection and autopsy revealed pyonephrosis with an abscess between the left kidney and left hemidiaphragm and xanthogranulomatous inflammation of perinephric fatty tissue. In the latter patient, an abdominal X-ray did not reveal any calculus but computerised axial tomography showed the presence of renal and ureteric calculi. CONCLUSIONS: The symptoms of hydronephrosis may be bizarre and non-specific in SCI patients. The symptoms include feeling unwell, abdominal discomfort, increased spasms, and autonomic dysreflexia. Physicians should be aware of the serious import of these symptoms in SCI patients.

Adult↗