[Urinary infiltration: report of three lethal cases].
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Keywords:
Infiltration (HVAC)
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Online date: November 16, 2020 This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
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To the Editor.—In a secondary analysis of data from 2 randomized trials, Hewitt et al1 reached the conclusion that early treatment of acute pyelonephritis in infants and young children has no significant effect on the incidence of subsequent renal scarring. This conclusion was based, in part, on data from a clinical trial2 that enrolled children who had a first episode of febrile urinary tract infection (UTI) and met entry criteria for a “clinical diagnosis of acute pyelonephritis.” Importantly, one third of the subjects in this trial proved not to have evidence of acute pyelonephritis when a technetium-99m-dimercaptosuccinic acid (DMSA) scan was obtained soon after enrollment.Hewitt et al restricted their subgroup analysis to subjects who had a positive acute scan results and, as it turns out, extraordinarily high levels of systemic inflammation; mean erythrocyte sedimentation rate and C-reactive protein values exceeded values reported for the entire trial cohort.2 Although Hewitt et al found no correlation between the duration of fever before treatment and the risk of subsequent renal scarring, this observation must necessarily apply only to the select population they studied: febrile children with UTI in whom acute pyelonephritis is known (by DMSA scan) to have already developed. Instead, Hewitt et al attempted to apply the result of their subgroup analysis to various populations they did not study: (1) children with “febrile UTIs”; (2) those with “symptoms suggesting acute pyelonephritis”; and (3) those at risk for “recurrent UTI.”To better align the data with a population of broader clinical interest, we suggest that the available trial data be reanalyzed to include all subjects with febrile UTI who had a DMSA scan completed within 10 days of enrollment.2 A total of 160 (36.5%) of these 438 subjects had a normal acute scan and, for the purpose of reanalysis, can be assumed3 not to have developed renal scarring. Accordingly, it should be straightforward to recalculate rates of renal scarring in all evaluable trial subjects with febrile UTI according to age and duration of fever.Regardless of what is revealed by any such reanalysis, no amount of secondary analysis of data from this trial can be expected to address the more general question of whether the risk of renal scarring is reduced by the rapid detection and treatment of UTI in infants and children. However, until there is direct evidence to the contrary, it seems prudent to assume that prompt diagnosis and treatment of UTI is still in the patient's best interest.
Dimercaptosuccinic acid
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Cryoprecipitate
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Urinary obstruction
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We, herein, presented a rare case of bilateral brachial artery infiltration by tumoral calcinosis located on both elbows. A 58-yearold man presented with a history of painless, palpable solid mass restricting the range of motion of both elbows. These masses were located on the anterior aspect of the elbows and gradually enlarged. After clinical, laboratory and radiological examinations, tumoral calcinosis was suspected, and excisional biopsy was planned for a definite diagnosis. Surgery was first performed on the left elbow. The median nerve was found to be compressed but not infiltrated by the mass. Interestingly, the brachial artery was totally infiltrated throughout the entire mass. Occlusion was observed in the brachial artery located within the mass. The tumor on the left elbow, 8.5 × 5.5 × 2.5 cm in size, was totally excised with approximately 12-cm brachial artery segment. The artery was resected until the healthy tissue was reached. The defect was reconstructed with saphenous vein graft obtained from the ipsilateral lower extremity. The same surgical procedure was performed on the right elbow after 3 months. The tumor size on the right elbow was 7 × 3.5 × 1.7 cm. Approximately 15-cm brachial artery segment was excised, and the defect was reconstructed with saphenous vein graft. Tumoral calcinosis is a rare benign condition that can be located in close relationship with neurovascular structures. In such cases, detailed neurologic and vascular examination, including imaging modalities, for arterial flow is essential to establish a more accurate surgical plan and avoid any unexpected situation during surgery.
Brachial artery
Neurovascular bundle
Tumoral calcinosis
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