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Rupture of renal artery aneurysm during cesarean section: a case report: Ruture of renal artery aneurysm r cesarean seection
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Introduction:

Renal artery aneurysm (RAA) occurs to focal dilatation of artery secondary to weakness of the arterial intima and media. RAA is a rare clinical entity with an incidence of 0.01 – 1%.1

Rupture RAA during pregnancy is extremely rare event. The obstetric and urologic literatures are deficient in this regard. Diagnosis of rupture RAA during pregnancy is very difficult i.e. no pathognomonic presentation. When rupture occurs during pregnancy the clinical presentation is confused with those more common conditions e.g. placenta abruption or rupture uterus.

Most of the cases are discovered incidentally, even it is only diagnosed after autopsy.

Case presentation:

A fifth cesarean section was done for 30 years oldwomen presented with placenta previa. She was gravida 6 para 5. Cesarean section was an elective one. She gave a live birth male weighing 2.4 kg.  Hysterectomy was carried out after sever bleeding during operation. Ten units of blood were given in addition to other management steps. Urologists and general surgeon were consulted. The patient was dead. Exploration was done and revealed a rupture of left renal artery aneurysm.  

Discussion:

It was the 5th cesarean section for women. Literature documented that previous history of cesarean sections is the primary risk factor for developing placenta previa.1 Other risk factors are gestation with male fetuses and multiparity.3 The mentioned risk factors were characters of the reported case. It was stressed that multiple cesarean sections affect adversely the health of women.2 It was the 5thcesarean section.

RAA is an unusual diagnosis. Hemodynamic changes during pregnancy that is increased blood volume and cardiac output, raised intrabdominal pressure and hormonal alterations, affect the arterial wall and increased the risk of rupture RAA, more so in the 3rdtrimester.3 The reported case was gravida 6 which might enhanced the formation and rupture of RAA. It was reported that women with RAA and unusual number of women were multiparous.4

Owing to the pregnancy state, RAA was missed as cesarean section was planned for delivery of acase of placenta previa. The final diagnosis made only after exploration. It is the same as mentioned in literature.5

In this case, RAA was on the left side. Literature reported that RAA was often on the left side.4 Since 1970, published reports have not shown a left sided predominance of RAA.6

There are no previous reports of diagnosis of the intact RAA during pregnancy. This report might be the first one in Iraqi literature of rupture of RAA during pregnancy.

Conclusion: The possibility of a ruptured RAA should be considered in pregnant women with evidence of retroperitoneal hemorrhage. Imaging facilities should be available in theater rooms to be used immediately.  

References:

1- Oylele Y, Smulian JC. Placenta previa, placenta accrete and vasa previa. Obstet Gynecol 2006; 107: 927-941.
2- Seidman DS, Pazi I, Nadu A, Dollberd S, Stevenson DK, Gele R et al. Are multiple cesarean sections safe? Eur J Obstet Gynecol Reported Biol 1994; 57: 7-12
3- Porcaro AB, Migliorini F, Pianon R, Antoniothi SZ, Furlan F, De Biase V et al. Intraparenchymal renal artery aneurysms. Case report with review and update of literature. Int Urol Nephrol 2004; 36: 409-416.
4- Soliman KB, Shawky A, Abbas MM. Ammory M, Shoaban A. Rupture renal artery aneurysm during pregnancy. A clinical dilemma. BMU Urol 2006; 6: 22
5- Henke PK, Cardnean D, Welling III TH, Upchurch GR, Wakefield TH, Jacob L et al. Renal artery aneurysm: a 35-year clinical experience with 252 aneurysms in 168 patients. Annal of Surgery 2001; 214: 454-463.
6- Yang JC, Hye RJ. Ruptured renal artery aneurysm during the pregnancy. Ann Vasc Surg 1996; 10: 370-372.

 

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Publication Date
Mon Jan 02 2012
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Serum Concentration of Molybdenum in Chronic Renal Failure Patients Requiring Hemodialysis
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Background: High serum molybdenum level may contribute to dialysis related bone disease in patients requiring long term hemodialysis in fact massive molybdenum accumulation causes joint deformity and arthritis
Objective: To asses the level of molybdenum in uremic patients requiring long term hemodialysis and impact of hemodialysis on the serum level of molybdenum before and after hemodialysis
Patients and methods: Eighty patients complain from chronic renal failure on long term hemodialysis aged (16 to 65) years, serum molybdenum was measured before and after hemodialysis
Result: The mean serum molybdenum level in 80 patients requiring long term hemodialysis was elevated before dialysis (0.29 + 0.17 nmol/mL) and even after dialy

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Publication Date
Sun Jul 03 2016
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Indications and complications of peritoneal dialysis in children with acute renal failure, a single center experience
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Background: Peritoneal dialysis (PD) is the preferred and convenient treatment modality for acute renal failure (ARF) in children and hemodynamically unstable patients, because of its inherent advantages: technique can be initiated simply and quickly, no highly trained personnel nor expensive and complex apparatus are required and systemic anticoagulation is not needed.
Objectives: is to highlight the role of peritoneal dialysis in management of children with acute renal failure and to determined its complications.
Patients and methods: A retrospective study was carried out from 20th April 2012 till1st May 2014 ,on children with acute renal failure admitted to nephrology unit in Child Welfare Teaching Hospi

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Publication Date
Tue Sep 05 2023
Journal Name
Iraqi Post Graduate Medical Journal.
Immunohistochemical Expression of Carbonic Anhydrase IX and PAX8 in Renal Cell Carcinoma: A Clinicopathological Correlation Study.
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Publication Date
Fri Dec 01 2017
Journal Name
Mustansiriya Medical Journal
Assessment of Antimicrobial Sensitivity of Bacterial Pathogens Isolated from Post-Cesarean Surgical Site Infection of Patients in Al-Elwiyah Maternity Hospital
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Publication Date
Sun Oct 02 2011
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Pyometra Presented With Rectal Pain, a Case Report and Review of Literature
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Pyometra is an uncommon gynecological condition resulted from occlusion of the cervix usually by a malignant condition. It has an incidence of 0.1%-0.5%. Untreated pyometra leads to rupture uterus and acute infective peritonitis presented as acute abdomen and needs urgent surgical intervention. Pyometra resulted from occlusion of the vagina is very rare. No cases have been described in the English literature to the best of our knowledge and in the PubMed. The purpose of reporting this case is to show that occlusion of the vagina could occur in postmenopausal women as a consequence of local infection and results in pyometra and also to show that pyometra can be presented in a different way apart from the classical presentation. The way to

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Publication Date
Sat Jun 30 2012
Journal Name
Al-kindy College Medical Journal
Angiolymphoid Hyperplasia with Eosinophilia : a Case Report and Review of the Literature
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A case of angiolymphoid hyperplasia with eosinophilia (ALH) is reported in a 42-year-old woman who developed multiple nodules behind the ear. Angiolymphoid hyperplasia with eosinophilia usually occurs on the head and neck of young adults and is more common in women than in men. Characteristic histologic features of ALH present in this case included proliferation of thick-walled blood vessels lined by prominent endothelial cells, infiltration of the interstitium by chronic inflammatory cells (mainly eosinophils), and presence of lymphoid follicles with germinal centers. The patient referred for surgeon for complete excision. in this context , cases previously described in the literature, and the differential diagnosis of ALH are discussed

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Publication Date
Sun Apr 03 2005
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Two Primary brain Tumurs in a patient with minimalComplaint a case report.
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Background: Multiple tumors in the nervous system is a rare event..
Patient & Method: .A forty two years old male who was enjoying completely healthy life presented with one week history of a single attack of confusion .he was presented with double tumour in the brain operated up on our department by craniotomy.
Results: His neurological clinical examination was negative. A CT scan & MRI of the brain showed two intracranial space occupying lesions. A solid right frontal lesion and another cystic lesion in the third ventricle. . The pathology proved the frontal lesion to be a meningioma while the third ventricular tumour was colloid cyst. Post operative period was uneventful. Follow up for few months showed no complaint.

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Publication Date
Mon Aug 30 2021
Journal Name
Al-kindy College Medical Journal
Diagnostic Evaluation of Uterine Artery Doppler Imaging for the Prediction of Early Abnormal Pregnancy
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Objective: to assess the predictive value of Doppler imaging of the uterine artery in the identification of early intrauterine abnormal pregnancy as compared to a normal intrauterine pregnancy.

Subjects and methods: one hundred and twenty pregnant ladies, at their 6-12 weeks of gestation, with a singleton pregnancy were included in this population-based case-control study. Thirty women with a missed miscarriage, 30 with hydatidiform mole, 30 with a blighted ovum, and 30 as a control group, without risk factors, underwent Doppler interrogation of the uterine arteries. Resistive index (RI), pulsatility index (PI), and the systolic/diastolic ratio (S/D) were measured for both sides. The t-test, or ANOVA test when a

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Publication Date
Thu Feb 01 2018
Journal Name
European Journal Of General Medicine
The Value of Longitudinal Strain versus Coronary Angiography in Detection of Coronary Artery Disease
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Aims: The aim of this study was to evaluate the value and accuracy of longitudinal strain in detection of coronary artery disease compared to coronary angiography. Results: The left ventricular longitudinal strain-speckle tracking showed evidence of stenosis of left anterior descending artery, circumflex artery and right coronary artery in (86.1%), (76.4%), and (84.7%) respectively. For the stenosis in left anterior descending artery, the current study showed that the longitudinal strain was a good predictor for presence of significant stenosis with a sensitivity of (93.8%), specificity (75%) and accuracy (91.7%) compared with coronary angiography. For the stenosis in right coronary artery, the left ventricular longitudinal strain had

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Publication Date
Mon Aug 30 2021
Journal Name
Al-kindy College Medical Journal
Diagnostic Evaluation of Uterine Artery Doppler Imaging for the Prediction of Early Abnormal Pregnancy
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Objective: to assess the predictive value of Doppler imaging of the uterine artery in the identification of early intrauterine abnormal pregnancy as compared to a normal intrauterine pregnancy. Subjects and methods: one hundred and twenty pregnant ladies, at their 6-12 weeks of gestation, with a singleton pregnancy were included in this population-based case-control study. Thirty women with a missed miscarriage, 30 with hydatidiform mole, 30 with a blighted ovum, and 30 as a control group, without risk factors, underwent Doppler interrogation of the uterine arteries. Resistive index (RI), pulsatility index (PI), and the systolic/diastolic ratio (S/D) were measured for both sides. The t-test, or ANOVA test when appropriate, was

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