The evaluation of safety and efficacy of percutaneous nephrostomy in young adult patients with severe hydronephrosis due to uretropelvic junction obstructions

Background: Majority of poorly functioning kidney (PFK) due to primary ureteropelvic junction obstructions (UPJO) in young adult have potential to recover after an attempted percutaneous nephrostomy (PCN). The split renal function measured by nuclear renal scan may not be sufficient enough to predict recovery of such kidney. Therefore, this study was undertaken to determine the functional recovery and potential salvageability of PFK due UPJO. Objective of the study was to evaluate safety and efficacy of PCN in adult patients with severe hydronephrosis due to PUJO.Methods: A total of 25 (10 male and 15 female) young adult patients of severe hydronephrosis due to PUJO and SRF<20% underwent PCN procedures. Only, those who had significant improvement in their SRF ≥10% and developed PCN output ≥400 ml/day underwent Anderson-Hyenas pyeloplasty and rest underwent nephrectomy.Results: Both male and female young patients had significantly improvement after 6 weeks of PCN, their mean pre-PCN SRF changed from 16.30% and 12.27% to became 28.10±08.41% and 18.53±09.89%, respectively. Those with age <30 years improved most with ≥10% increase in the mean SRF and in 72% patients average PCN output increased from 279.80±93.90 ml/day to 445.20±160.341 ml/day at 6 weeks period. Overall, the patients with average PCN output ≥400 ml/day had a mean improvement of 10.33±05.48% in SRF. However, 5(20%) developed haematuria, 8% fever, 16% displaced PCN tip with no major puncture site bleed.Conclusions: The trial of PCN before definite surgery in young adult patients with poorly functioning kidney due to UPJO not only predicts renal renal function recovery but also prevent unwarranted renal loss.

Non-biliary mishaps during laparoscopic cholecystectomy.

BACKGROUND: The most important complications of laparoscopic cholecystectomy (LC) are biliary tract injuries. Non-biliary complications can be equally devastating, but have received less attention in literature. METHODS: The case files of 1748 patients who underwent LC over a period of seven years (1997-2003) in our department were retrospectively reviewed to identify non-biliary complications and their management. RESULTS: Nine patients (0.5%) sustained significant non-biliary injury while undergoing LC. The commonest was duodenal perforation during dissection of the Calot's triangle (3 cases). Other complications included diaphragmatic injury (2 cases), and small bowel injury while inserting the umbilical port, right external iliac artery injury during insertion of Veress needle, portal vein injury during dissection, and liver laceration while using a delivery system to extract the gall bladder (1 each). All these complications were detected and managed intra-operatively. During the same period, 10 patients sustained biliary injury. CONCLUSION: Intra-operative non-biliary injuries during LC occur as frequently as biliary injuries, and can be life-threatening and difficult to manage.

Coexisting tuberculosis and carcinoma of the colon: a report of two cases and a review of the literature.

Tuberculosis and carcinoma of the colon rarely coexist. We report 2 such cases and review the available literature. Since the potential for misdiagnosis is high in such patients and a preoperative diagnosis of coexistence is usually not possible, important questions regarding the management of patient with a diagnosis of either colonic cancer on tuberculosis need to be addressed.

Spontaneous auto-amputation of the foot in a case of diabetes, atherosclerosis and gangrene.

Auto-amputation is the spontaneous separation of non-viable tissue from viable tissue, and is usually associated with dry gangrene, occurring in the distal portions of the lower extremities. A 68-year-old female presented with dry gangrene of both feet and subsequent loss of the right foot and digits on the left foot over a period of one and half years. After about six months disarticulation of the right foot from the ankle joint resulted. She gradually lost the digits of the left foot two months later. She had pallor and showed absence of popliteal and distal pulses on both sides. The left foot showed absence of the digits with exposed 3rd and 4th metatarsals and some areas of gangrene and sloughing. Her Hb was 5.4 g/dl and random blood sugar was 340 mg%. Doppler study of the lower limbs showed blockage at the level of the superficial femoral artery on the right side and a patent popliteal artery on the left. She was managed conservatively as she was unwilling for surgical intervention.