ABSTRACT
Background and Objectives: Though medical expulsive therapy for ureteric stones is increasingly used these days, some recent randomized controlled trials have questioned its benefit. This study evaluates the result of treatment of ureteric stones with tamsulosin. Materials and Methods: This prospective study involved ultrasonographically confirmed cases of uncomplicated unilateral ureteric stones. All patients received tamsulocin 0.4 mg daily for 2 to 6 weeks. The primary end point was stone expulsion. The secondary endpoints were the use of analgesics and adverse events. Results: One hundred and sixty two patients completed the study. Ninety seven patients were male and male to female ratio was 3:2. The mean age was 34.9 ± 9.8 (range: 18-71) years. The mean stone size was 6.17 ± 1.68 (range: 3.3-11.2) mm. By the end of 2, 4 and 6 weeks, cumulative stone expulsion rate was 110 (69.1%), 121 (74.7%) and 126 (77.8%) respectively. For the 49 stones of size £ 5 mm, the expulsion rate was 47 (95.9%) by the end of 6 weeks. The expulsion rates for stones of size > 5 - 7 mm, > 7 – 9 mm and ³ 9 mm were 59 (85.5%), 17 (53.1%) and 3 (25%) respectively by the end of 6 weeks. Lower ureteric stones had the highest expulsion rate of 106 (87.6%) by the end of 6 weeks, and the rate was lowest for upper ureteric stones (34.6%). Ten (6.1%) patients required additional analgesics during the course of treatment. Eleven (6.8%) patients complained of mild light-headedness and dizziness which subsided in a few days. Conclusion: Tamsulocin appears to facilitate expulsion of ureteric stones especially the distal ones. The benefit of tamsulocin seems to be maximum for the stones of size up to 9 mm. Further large scale randomized controlled trial should better define the real benefit and more rationale use of tamsulocin in routine clinical practice.
ABSTRACT
Background and Objectives: Early appendectomy in presence of appendiceal mass (AM) is controversial. We present the results of our experience that contribute to safe appendectomy in AM.Material and Methods: A total of 135 patients who underwent early surgery in presence of AM were reviewed. The diagnosis of AM was made clinically, using abdominal ultrasound and/or intra-operatively. All surgeries were done by qualified surgeons with variable experiences.Results: Mean operative day since onset of pain was 5.64 ± 2.1 (range: 3-15) days. A hundred and twenty patients underwent appendectomy, 116 (96.7%) of which was done within 7 days of pain. Two other patients operated on the 6th day had only drainage of abscess and no appendectomy. Remaining 4 (3.3%) appendectomies were performed on the 8th day. Two other patients operated on the 8th day had failed attempt of appendectomy and had just drainage of abscess. Two patients, operated on 12th and 15th day had just open-close. Both had given misleading history of duration of pain. Remaining 9 patients, from the 9th day onward underwent only just drainage of abscess. Only significant complication was injury to ileum during early years of experience when appendectomy was attempted on the 10th day. He fared well in two weeks.Conclusion: With experience we have developed confidence that experience and clarity of safe time limit makes early appendectomy in AM predictably safe. Few other patients who present later and need surgical intervention may be more safely managed by limited procedure like drainage of abscess without precarious attempt of appendectomy.