1,628 results match your criteria Xanthogranulomatous Pyelonephritis
Surg Laparosc Endosc Percutan Tech 2018 Dec 3. Epub 2018 Dec 3.
Department of Surgery, University Hospital of Pontevedra, Pontevedra, Spain.
Aim: The aim of this study was to evaluate the results of laparoscopic cholecystectomy (LC) in patients with xanthogranulomatous cholecystitis (XGC) compared with patients without XGC.
Methods: A retrospective study was performed including patients who had undergone elective LC between January 2003 and November 2017. Results of patients with XGC (25) were compared with those of patients without XGC (2181) with respect to operative time, conversion rate, drain use, postoperative complications, and postoperative stay. Read More
Cutis 2018 Oct;102(4):283-286
Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Trametinib, a mitogen-activated extracellular signal-regulated kinase (MEK) inhibitor, has demonstrated great promise in treating metastatic melanoma associated with BRAF V600E and V600K mutations; however, it also is highly associated with cutaneous adverse events (AEs). As both BRAF and MEK inhibitors become increasingly used to treat malignant melanoma, it is important to better characterize these AEs so that we can manage them. Herein, we present a case of a 66-year-old man who developed erythematous scaly papules on the face and bilateral upper extremities after beginning therapy with trametinib. Read More
Ultrasonography 2018 Oct 3. Epub 2018 Oct 3.
Department of Radiology, Eulji University Hospital, Daejeon, Korea.
Purpose: The aim of this study was to evaluate whether the comet tail artifact on ultrasonography can be used to reliably diagnose benign gallbladder diseases.
Methods: This retrospective study reviewed the clinical findings, imaging findings, preoperative ultrasonographic diagnoses, and pathological diagnoses of 150 patients with comet tail artifacts who underwent laparoscopic cholecystectomy with pathologic confirmation. The extent of the involved lesion was classified as localized or diffuse, depending on the degree of involvement and the anatomical section of the gallbladder that was involved. Read More
Tunis Med 2018 Aug - Sep;96(8-09):495-500
Introduction: Xanthogranulomatous pyelonephritis (XGPN) is a particular form of chronic renal suppuration characterized by the destruction of renal parenchyma and its replacement by a granulomatous tissue containing xanthomatous cells.
Objective: To report and describe the main clinical, biological, radiological and therapeutic aspects of xanthogranulomatous pyelonephritis in adults in focal and diffuse forms.
Methods: This was a monocentric retrospective study involving 42 cases of XGPN operated and histologically confirmed between 2005 and 2015. Read More
J Gastrointest Cancer 2018 Nov 6. Epub 2018 Nov 6.
Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Aim: Thick-walled gallbladder is difficult to characterize on conventional imaging. 18F-FDG PET was used to differentiate benign and malignant wall thickness and compared with histopathology.
Methods: Thirty patients with gallbladder (GB) wall thickening (focal > 4 mm and diffuse > 7 mm), underwents uspected on ultrasound, or CT scan, and underwent 18F-FDG PET. Read More
Radiol Case Rep 2019 Jan 26;14(1):121-125. Epub 2018 Oct 26.
Department Head, CT and MRI, Health Sciences Centre, Department of Radiology, University of Manitoba, GA220-820 Sherbrook Street, Winnipeg, Manitoba R3A1R9, Canada.
Xanthogranulomatous endometritis (XGE) is an extremely rare chronic inflammatory condition, which may be associated with endometrial hyperplasia, endometrial carcinoma, or cervical stenosis. Imaging features can be easily misdiagnosed as an aggressive malignancy. We present a case of XGE, which is the first case of XGE with serial multimodality imaging examinations, in addition to clinical, surgical and pathologic correlations. Read More
Respirol Case Rep 2018 Dec 21;6(9):e00377. Epub 2018 Oct 21.
Department of Respiratory Medicine Monash Medical Centre Melbourne Australia.
Xanthogranulomatous pyelonephritis (XGP) is a rare chronic granulomatous process that affects the kidneys. It is usually associated with longstanding urinary tract infections and obstruction. Patients suffering from XGP typically present with undifferentiated symptoms, including abdominal pain, weight loss, and intermittent fevers. Read More
J Med Imaging Radiat Oncol 2018 Oct;62 Suppl 1:56
Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.
Medicine (Baltimore) 2018 Oct;97(40):e12615
Department of Otolaryngology, Head and Neck Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.
Rationale: Xanthogranulomatous inflammation (XGI) is a rare inflammatory process, which mostly affects the kidney and gallbladder. It usually simulates an aggressive neoplastic process. Occurrences in the neck are extremely rare and would usually be associated with a preexisting cyst or glandular tissues. Read More
J Korean Med Sci 2018 Oct 13;33(40):e242. Epub 2018 Aug 13.
Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
Background: To investigate the clinicopathological characteristics of urinary bladder tumors, a rare malignancy, in patients 20 years or younger.
Methods: Using a retrospective chart review among patients who received bladder surgery at 2 institutions between July 1996 and January 2013, we analyzed the clinicopathological characteristics of urinary bladder tumors in 21 pediatric patients (male:female = 4.25:1. Read More
Case Rep Urol 2018 29;2018:5417903. Epub 2018 Aug 29.
Urology B Department, Ibn Sina Teaching Hospital, Rabat, Morocco.
Xanthogranulomatous prostatitis is a rare benign inflammatory process of the prostate. Only few cases have been reported in the English literature. Xanthogranulomatous prostatitis is usually an incidental finding after needle biopsy or transurethral resection of the prostate in patients suffering from low urinary tract symptoms. Read More
BMJ Case Rep 2018 Sep 10;2018. Epub 2018 Sep 10.
Department of Surgery, Urology Division, University College of Medical Sciences, New Delhi, India.
Clin Exp Nephrol 2018 Sep 3. Epub 2018 Sep 3.
Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.
We report a lady with bilateral symmetrical xanthogranulomatous pyelonephritis (XPGN) presented with acute kidney injury and sepsis, in which both CT and MRI mimicked an infiltrative disease, except that the infiltration was not very homogenous. Eventually, the pathological diagnosis turned out to be XPGN. Most XPGN were unilateral, and there have been a few publications of bilateral involvement. Read More
Cancer Cytopathol 2018 Aug;126 Suppl 8:711-723
Baptist Hospital of Miami and Miami Cancer Institute, Miami, Florida.
An increasing number of renal cell carcinomas (RCCs) require ancillary studies for diagnosis. The majority of renal fine needle aspirates do not require ancillary studies. Among the most common useful stains are cytokeratin 7 (separating clear cell RCC [negative] from papillary RCC, clear cell papillary RCC, and multilocular cystic RCC [positive] as well as separating chromophobe RCC [diffusely positive] from oncocytoma [focally positive/negative]) and CD117 (separating chromophobe RCC and oncocytoma [positive] from granular variants of clear cell RCC [negative]). Read More
Beijing Da Xue Xue Bao Yi Xue Ban 2018 Aug;50(4):743-746
Department of diagnostic Ultrasound，d HospPeking University Thirital 100191, China.
Xanthogranulomatous pyelonephritis (XGP) is an unusual form of chronic pyelonephritis in which the renal parenchyma is destroyed and replaced by lipid-laden foamy macrophages. It usually affects middle-aged women with a history of recurrent urinary tract infection, diabetes, or kidney stones. The inflammatory process is usually diffuse and can extend beyond the kidney. Read More
Case Rep Pulmonol 2018 14;2018:7976839. Epub 2018 Jun 14.
Department of Pulmonary Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia 25701, USA.
Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis that generally afflicts middle-aged women with a history of recurrent urinary tract infections. Its pathogenesis generally involves calculus obstructive uropathy and its histopathology is characterized by replacement of the renal parenchyma with lipid filled macrophages. This often manifests as an enlarged, nonfunctioning kidney that may be complicated by abscess or fistula. Read More
Rev Med Interne 2018 Jul 25. Epub 2018 Jul 25.
Laboratoire d'anatomo-pathologie, CHU de Habib Bourguiba, Mednine, Tunisie.
Pol J Radiol 2018 4;83:e54-e62. Epub 2018 Feb 4.
Department of Radiology, All India Institute Of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India.
Erdheim-Chester disease (ECD) is a rare sporadic non-Langerhans cell histiocytic (LCH) proliferative disorder with systemic predilection. It usually affects adults in the 5-7 decades of life and has non-specific clinical manifestations. Its suspicion is often heralded by the presence of characteristic radiological findings and subsequently confirmed by demonstration of CD68-positive xanthogranulomatous infiltrates on histopathology. Read More
J Endourol 2018 Sep 24;32(9):859-864. Epub 2018 Aug 24.
Urology Departament, Hospital Universitario de Jerez , Jerez, Spain .
Objective: The aim of the study was to assess the feasibility of laparoscopic nephrectomy (LN) in the treatment of patients with xanthogranulomatous pyelonephritis (XGP).
Methods: Retrospective review of medical records of 17 patients (mean age 60.0 ± 13. Read More
J Family Reprod Health 2017 Sep;11(3):174-178
Department of Pathology, NDMC and Hindu Rao Hospital, Delhi, India.
Xanthogranulomatous inflammation is a rare form of chronic inflammatory response consisting of macrophages, lymphocytes, plasma cells and neutrophils too. Due to its locally destructive nature and mass forming capacity as a result of adhesions, this type of inflammation may mimic malignancy or tuberculosis both clinically and radiologically. We present a report of two such cases, one mimicking tuberculosis and the other mimicking malignancy clinically. Read More
Perm J 2018 06;22
Surgeon in the Division of Transplant Surgery and the Division of Acute Care Surgery and Trauma at Memorial Regional Hospital in Hollywood, FL.
Xanthogranulomatous inflammation, characterized by destruction and replacement of tissues with chronic inflammatory cells, including foamy histiocytes and hemosiderin-laden macrophages, is uncommon. In patients with xanthogranulomatous pyelonephritis, inflammation may extend from the kidney to the overlying duodenum, creating a pyeloduodenal fistula that further complicates medical and surgical management. We present two cases with recurrent kidney infections who each ultimately received a nephrectomy and repair of their duodenal fistula. Read More
Radiographics 2018 Jul-Aug;38(4):1264-1281
From the Department of Radiology, Virginia Commonwealth University Medical Center, 1250 E Marshall St, PO Box 980615, Richmond, VA 23298.
A variety of entities may mimic drainable abscesses. This can lead to misdiagnosis of these entities, unnecessary percutaneous placement of a pigtail drainage catheter, other complications, and delay in appropriate treatment of the patient. Types of entities that may mimic drainable abscesses include neoplasms (lymphoma, gallbladder cancer, gastrointestinal stromal tumor, ovarian cancer, mesenteric fibromatosis, ruptured mature cystic teratoma, recurrent malignancy in a surgical bed), ischemia/infarction (liquefactive infarction of the spleen, infarcted splenule), diverticula (calyceal, Meckel, and giant colonic diverticula), and congenital variants (obstructed duplicated collecting system). Read More
Clin Case Rep 2018 Jul 29;6(7):1387-1388. Epub 2018 May 29.
Department of Surgery Pippu Clinic Pippu Town, Kamikawa-gun Hokkaido Japan.
Xanthogranulomatous pyelonephritis (XGP) is an uncommon inflammatory disease of the kidney 1. Diffuse XGP is a rare condition which may spread into the pelvic cavity leading to fatal complications from a psoas muscle abscess and/or renocolic fistula 2. In diffuse type, nephrectomy and excision of the fistula is the recommended treatment. Read More
Cureus 2018 Apr 17;10(4):e2492. Epub 2018 Apr 17.
Department of Surgery, "alexandrovska" University Hospital, Medical University of Sofia, Bulgaria.
A 67-year-old woman presented with clinical symptoms, radiological findings, and preoperative work-up highly suggestive of advanced stage IV carcinoma of the gallbladder (CG). An extended cholecystectomy with the excision of adjacent liver segments and loco-regional lymphadenectomy was performed. Final pathology results revealed diffuse xanthogranulomatous cholecystitis (XG) with ruptured Rokitansky-Aschoff sinuses with tumor-resembling adenomyosis without atypical or malignant cells. Read More
Oncoimmunology 2018 15;7(7):e1440929. Epub 2018 Mar 15.
Unit of Immunology, Rheumatology, Allergy, and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Erdheim-Chester disease (ECD) is a rare histiocytosis, characterized by xanthogranulomatous tissue infiltration by foamy histiocytes. Fibrosis, a histologic hallmark of ECD, is responsible for lesion growth and clinical manifestations. Unraveling molecular fibrotic pathway in ECD would allow the identification of new pharmacologic targets. Read More
Urol Case Rep 2018 Jul 11;19:65-66. Epub 2018 May 11.
Department of Surgery, Universidad de Los Andes, Santiago, Chile.
Pan Afr Med J 2018 24;29:67. Epub 2018 Jan 24.
Service de Radiologie, Centre Hospitalier Provincial, Taounate, Maroc.
We here report the case of a 55 year-old man presenting with right renal colic and with a history of intermittent lower back disorders. At the time of admission, clinical examination showed lower back pain on contact. Renal ultrasound objectified heterogeneous mass at the lower pole of the right kidney with dilation of lower calyx groups. Read More
BMC Urol 2018 Jun 5;18(1):57. Epub 2018 Jun 5.
Department of Urology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
Background: Xanthogranulomatous pyelonephritis (XGP) is an uncommon infectious disease of the kidney known to mimic other renal maladies. A rare presentation of this uncommon disease is spontaneous renal hemorrhage (SRH).
Case Presentation: We report a case of XGP in a 58 year old woman who presented with abdominal pain, hematuria, and radiating left flank pain. Read More
Insights Imaging 2018 Oct 23;9(5):643-651. Epub 2018 May 23.
Pathology Department, Hospital Universitario y Politécnico La Fe Pediatric Imaging Section, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain.
Xanthogranulomatous pyelonephritis (XPN) is an unusual and severe form of chronic inflammatory lesion of the kidney, characterised by the destruction of the renal parenchyma and the presence of multinucleated giant cells and lipid-laden macrophages, inflammatory infiltration and intensive renal fibrosis. There are a few cases in the literature which describe the disease in children. The pathomechanism of XPN is poorly understood. Read More
Int Urol Nephrol 2018 Jun 21;50(6):1071-1073. Epub 2018 May 21.
Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada.
J Clin Urol 2018 May 16;11(3):226-228. Epub 2017 Jun 16.
The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine Baltimore, MD 21287.
J Emerg Med 2018 07 9;55(1):e1-e4. Epub 2018 May 9.
Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
Background: Febrile urinary tract infections (UTIs) include a spectrum of pathologies from uncomplicated pyelonephritis to urosepsis, including xanthogranulomatous pyelonephritis (XGP). Most febrile UTIs are treated with antibiotics alone, but studies indicate nearly 12% of cases of presumed simple pyelonephritis require emergent urologic intervention. How to identify these individuals, while limiting unnecessary advanced imaging and delays in diagnosis, challenges all emergency providers. Read More
Abdom Radiol (NY) 2018 Dec;43(12):3349-3356
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro, 43-gil, Songpa-Gu, Seoul, 138-736, Korea.
Purpose: The purpose of the study was to investigate the imaging and clinical features of xanthogranulomatous pancreatitis (XGP).
Methods: This retrospective series study included 10 patients with pathology-proven XGP. Two radiologists reviewed the computed tomography (CT) and magnetic resonance imaging (MRI) in consensus to determine the morphological features of XGP. Read More
Urol Ann 2018 Apr-Jun;10(2):219-221
Post Graduates, K. S. Hegde Medical Academy, Mangalore, Karnataka, India.
An urachal cyst is a sinus remaining from the allantois during embryogenesis which is rarely manifested in adults. The urachus is an embryologic remnant which degenerates after the birth. Defective obliteration of the urachus leads to urachal abnormalities. Read More
Urol Case Rep 2018 May 25;18:19-21. Epub 2018 Feb 25.
Koç University School of Medicine, Division of Endocrinology and Metabolism, Turkey.
Clin Imaging 2018 Jul - Aug;50:223-228. Epub 2018 Apr 14.
Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States.
Objective: To determine the diagnostic accuracy of multi-detector CT (MDCT) for differentiating gallbladder cancer from acute and xanthogranulomatous cholecystitis using previously described imaging features.
Methods: In this IRB approved HIPAA-compliant retrospective cohort study, contrast-enhanced MDCT of histologically confirmed acute cholecystitis (n = 17), xanthogranulomatous cholecystitis (n = 25), and gallbladder cancer (n = 18) were reviewed independently by three abdominal radiologists blinded to outcome. The primary outcome was the diagnostic accuracy of MDCT for the differentiation of gallbladder cancer from cholecystitis (acute and xanthogranulomatous) using various imaging parameters. Read More
Surg Case Rep 2018 Apr 19;4(1):36. Epub 2018 Apr 19.
Department of Anatomic Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan.
Background: Xanthogranulomatous inflammation is recognized as a subtype of cholecystitis; however, it can also occur in other organs. Xanthogranulomatosis of the kidney, bone, ovary, endometrium, vagina, prostate, lymph nodes and pancreas was reported. Herein, we report a case of laparoscopic splenectomy in a patient with xanthogranulomatosis of the spleen that was difficult to diagnose preoperatively. Read More
Case Rep Radiol 2018 31;2018:1698286. Epub 2018 Jan 31.
Department of Radiology, Saadi Hospital, Isfahan, Iran.
Focal Xanthogranulomatous pyelonephritis is a rare chronic inflammatory condition of kidneys which usually is associated with postrenal obstruction or renal stone leading to chronic bacterial infection and eventually chronic glomerular inflammation. About 90% of cases are of the diffuse type and associated with staghorn renal calculi. The case presented in this paper is of the focal type in a 58-year-old diabetic female. Read More
J Endourol Case Rep 2018 1;4(1):39-41. Epub 2018 Mar 1.
Department of Urology, UCSF Medical Center, San Francisco, California.
Laparoscopic heminephrectomy was performed in a 64-year-old woman with a chronically obstructed horseshoe kidney moiety. More than 3000 cc of pyonephrosis was drained through two percutaneous nephrostomy tubes for infection control before left moiety laparoscopic resection. This case report attests to the feasibility of laparoscopic resection of a massively obstructed horseshoe kidney when performed in a staged manner after prolonged drainage. Read More
J Midlife Health 2018 Jan-Mar;9(1):41-43
Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Xanthogranulomatous inflammation of female genital tract is uncommon and is usually seen in endometrium. Only a few cases involving the ovary have been reported. Its clinical manifestations, imaging modalities, and gross features can mimic ovarian malignancy. Read More
J Coll Physicians Surg Pak 2018 Apr;28(4):330-331
Barnsley Hospital NHS Foundation Trust, UK.
Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory condition of the gallbladder (GB). Preoperatively, it is a diagnostic challenge. One thousand and seventy nine laparoscopic cholecystectomy (LC) patients from September 2012 to June 2015 were retrospectively reviewed. Read More
Acta Gastroenterol Belg 2017 Jul-Sep;80(3):365-370
University of Tunis El Manar, Tunis Faculty of Medicine, Tunisia.
Background And Aims: Traditionally, a gallbladder removed for presumed benign disease is sent for histopathological examination, but this practice has been the subject of controversy.
Aim: The aim of this study was to assess the usefulness of routine histopathological examination of cholecystectomy specimens and its impact on the management of patients.
Patients And Methods: The histopathological reports of 1960 patients who underwent cholecystectomy from January 2011 to November 2016 were retrospectively reviewed. Read More
Malays Fam Physician 2017 31;12(3):33-36. Epub 2017 Dec 31.
(Corresponding author) Department of Medicine, RIPAs Hospital, Brunei Darussalam email:
Urinary tract infection (UTI) is one of the most common presentations in general practice and, in most instances, occurs in a single episode and is easily treated with a course of anti-microbial therapy. In the case of recurrent urinary tract infections, it is important to consider evaluation for any underlying causes. We report the case of a 32 year old female who had recurrent UTIs; this was a case of recurrent UTI secondary to xanthogranulomatous pyelonephritis from renal stones with resultant reno-colic fistula formation. Read More
Int Braz J Urol 2018 May-Jun;44(3):642-644
Departamento de Radiologia, Hospital das Clínicas da Universidade de São Paulo HC-FMUSP, São Paulo, Brasil.
Renal replacement lipomatosis is a condition characterized by varying degrees of renal parenchymal atrophy and perirenal fibrofatty proliferation secondary to chronic inflammation such as xanthogranulomatous pyelonephritis. In severe cases, imaging findings can be misdiagnosed as retroperitoneal liposarcoma. Read More
N Engl J Med 2018 Mar;378(10):940
Massachusetts General Hospital, Boston, MA
Zhejiang Da Xue Xue Bao Yi Xue Ban 2017 May;46(5):552-556
Department of Ultrasonography, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
Objective: To assess the value of ultrasonography in differential diagnosis of xanthogranulomatous cholecystitis (XGC) and wall-thickening type of gallbladder cancer (GBC).
Methods: The clinical features and sonographic finding of 31 patients with XGC and 36 patients with wall-thickening type of GBC were retrospectively reviewed. The diagnosis of all cases was confirmed by pathological examination, and the ultrasonographic manifestations of the thickening of the gallbladder wall, intramural hypoechoic nodules, gallbladder mucosa line, gallbladder stones, biliary dilatation and gallbladder-liver boundary were compared between two groups. Read More
Medicine (Baltimore) 2018 Jan;97(2):e9659
Department of Plastic and Reconstructive Surgery, Medical School of Chonbuk National University.
Rationale: Xanthogranulomatous pyelonephritis (XGP) is a chronic destructive granulomatous inflammation that is characterized by urinary tract obstruction and invasion of the renal parenchyma. Although rare, XGP can lead to fatal complications, including perinephric inflammation, psoas abscess, and cutaneous fistula.
Patient Concerns: A quadriplegic patient initially presented to the hospital with a chronic open wound and cutaneous fistula. Read More
Diagn Interv Imaging 2018 Apr 19;99(4):267-268. Epub 2018 Feb 19.
Department of Radiology, université Paris-Diderot, hôpital Bichat-Claude Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
Mol Clin Oncol 2018 Mar 10;8(3):445-448. Epub 2018 Jan 10.
Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.
Xanthogranuloma, also referred to as cholesterol granuloma or xanthogranulomatous reaction, is a granulomatous lesion that is infrequently found in the sellar and parasellar regions. Xanthogranulomatous pituitary adenoma is relatively rare and, thus, the etiology, diagnosis, management and prognosis of this condition remain incompletely understood. We herein report the case of a 56-year-old female patient who presented to our institution with intermittent headache, vomiting and distending pain in the bilateral orbital regions. Read More
Clin Neuroradiol 2018 Dec 9;28(4):601-604. Epub 2018 Feb 9.
Department of Pathology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea (Republic of).