A metallic obstruction in the root canal blocks canal cleaning and shaping procedures and requires either bypassing or retrieval. Many methods have been recommended to retrieve a metallic obstruction from the root canal. This article describes the retrieval of a metallic obstruction from the root canal of a premolar using Masserann technique to facilitate endodontic retreatment. Masserann technique is said to have limited application in posteriors. However, in this case, the obstruction was successfully retrieved by employing Masserann technique which consisted of using a trephan to cut the dentine and extractor tube to retrieve the obstruction. The retrieved obstruction was found to be a separated H-file. Endodontic retreatment was completed following the detection and negotiation of an extra canal in the same tooth.

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The association of nephrotic syndrome with solid tumors is well known. The most frequent renal lesion observed is membranous nephropathy with granular deposition of immune complex.1 So far only one case of transitional cell carcinoma of urinary bladder presenting as nephrotic syndrome has been reported, the patient having had a minimal change disease with linear immunoglobulin deposits on immunofluorescence. 2Our case had membranoproliferative glomerulonephritis with subendothelial deposition of immunoglobulin. Five weeks after removal of the tumor, proteinuria completely disappeared. The nephropathy was probably induced by antibody formation against a specific component of kidney substance. Case ReportA 60-year-old male presented at our department with a history of generalized edema and oliguria. He had no history of pyoderma, fever, rash, arthritis or arthralgia sore throat. The patient had no past history of a similar illness, hypertension, drug intake, collagen vascular disease or diabetes mellitus. The physical examination revealed a male of average build with anasarca, a pulse of 85/min, blood pressure of 156/100 mm Hg, periorbital puffiness and pedal edema. Chest examination revealed signs of pleural effusion on the right side. Abdominal examination revealed ascites; CVS and CNS were apparently normal. Investigations revealed moderate normocytic anemia and normal LFT. Chest x-ray was consistent with right-sided pleural effusion. Pleural and ascitic fluid analysis revealed a transudative fluid. Urine examination showed proteinuria, hematuria and a few granular casts; 24-hour urinary protein was 3.0-3.5 g repeatedly. Blood urea was 30 mg%, and serum creatinine was 0.7 mg%. Serum electrolytes were Na 140 meq/dL, and K 4.9 meq/dL. Rheumatoid factor and ANA were negative, ASO was <200 i.u., HCV antibody, HbsAg and HIV were negative, serum IgM, IgG and c3 were normal. Ultrasonography showed normal-sized kidneys with normal collecting system, except that there was a localized thickening and irregularity of the anterior bladder wall. CT scan showed thickened bladder wall. Cystoscopy revealed a raised area of 1.5 cm on the anterior bladder wall and biopsy from this was consistent with transitional cell carcinoma (stage B) on histopathology.Kidney biopsy was suggestive of membranoproliferative glomerulonephritis. Immunofluorescence of renal biopsy tissue showed deposition of IgM, but was negative for complement. A diagnosis of transitional cell carcinoma with nephrotic syndrome was made and oliguria was managed conservatively. The bladder mass was resected by transurethral endoscope, followed by local radiotherapy. The patient showed gradual decrease in proteinuria and it disappeared five weeks after resection of the bladder tumor. The patient is asymptomatic and doing well. Repeated cystoscopy did not reveal any raised area or suspicious lesion in the urinary bladder, and repeated follow-up urine examinations did not reveal any proteinuria or hematuria. DiscussionThe presence of linear immunoglobulin deposits on i...

Abstract:Background: Hypertension is the leading cause of mortality worldwide. Besides its already high disease burden, also the prevalence in children is increasing. Major presentation of hypertension among young patients is as essential or primary hypertension, while only a minority of patients present as secondary hypertension. Characterized by mesangial immune deposits, C1q nephropathy is a relatively rare glomerular disease with a dominant or co-dominant staining for C1q, presenting often with proteinuria in the nephrotic range. Case Report: We present an 18-year-old Turkish boy who presented with hypertension five years ago in the absence of proteinuria followed by a renal biopsy five years later demonstrating dominant mesangial deposits of C1q. Conclusion: We suggest that C1q nephropathy may present with hypertension before the manifestation of proteinuria and thus, C1q nephropathy should be kept in mind in patients presenting with hypertension. More specialized tests should be performed when diagnosing primary hypertension. We suggest that every patient with hypertension should be carefully followed up for C1q nephropathy.