Appendiculopyelostomy: A Surgical Accident.

Open pyeloplasty is a commonly performed surgicalprocedure for Pelviureteric Junction (PUJ) obstruction.It can be associated with many complications.Anatomical structures with similar appearance may attimes be confused for each other (eg. right ureter andappendix).The appendix may rarely lie parallel to theupper ureter when it can be confused with later. Wereport a case of accidental anastomosis of the appendixwith the renal pelvis during open pyeloplasty. Thepatient was re-explored, the appendix was removed, theureter was identified and spatulated ureteropyelostomysplinted internally with double J stent. Patient isasymptomatic at a two-year follow-up

Feasibility of minimally invasive management in patients with forgotten double J stent: a single centre experience

Background: aim of the study was to present the experience in managing forgotten/encrusted Double J (DJ) ureteral stents and to review the literature on the subject.Methods: Author retrospectively studied patients presenting to the Outpatient Department from January 2016 to January 2019 with forgotten DJ stent(s) (six or more than six months after the insertion). Data was collected for age, gender, indication for DJ stenting, clinical features at presentation, radiological imaging and surgical procedure performed to extract the DJ stents. The post-operative stay, complications of the procedures and morbidity was also studied.Results: During the study period, a total 32 patients reported to the department with history of forgotten DJ stents. Most common age group involved was 41-60 years. Most common presenting symptoms were lower urinary tract symptoms (LUTS) or dysuria.  Duration of stent in-situ ranged from 6 month to 15 years. Most common sites of encrustations along the forgotten DJ stent were ureter and kidney followed by urinary blabber. Fluoroscopic guided DJ stent removal was done in 8 patients. A combination of Cystolithotripsy, URSL and PCNL was needed to clear the stone and extract the DJ stent in remaining patients.Conclusions: Forgotten/encrusted DJ stent may lead to complications ranging from urinary tract infections to loss of renal function. They can be safely and successfully removed, and the renal function can be preserved. Endo-urological management of forgotten encrusted stents is highly successful and often avoids the need for open surgical techniques.

Blunt abdominal trauma: the experience in rural India and review of literature

Background: Blunt Abdominal trauma is one of the most common injuries caused due to road traffic accidents. The rapid increase in number of motor vehicles and its aftermath has caused rapid increase in number of victims due to blunt abdominal trauma. As the care of patients with blunt abdominal injuries is largely a surgical responsibility and abdominal injuries involving major hemorrhage from solid viscera constitute surgical emergencies. Abdominal blunt traumas represent a real diagnostic and therapeutic challenge to even a most experienced surgeon, thereby representing importance of its study. Early diagnosis and effective management help in decreasing mortality in blunt abdominal trauma.Methods: Prospective study of 50 patients admitted to the institute with history of Blunt Abdominal Trauma. After initial resuscitation of the patients, thorough assessments for injuries were carried out in all the patients. Documentation of patients, which included identification, history, clinical findings, diagnostic test, operative findings, operative procedures and complications during the stay in the hospital were all recorded on a Performa specially prepared. The management was decided depending upon history, clinical examination and investigations.Results: Males were predominantly affected, and most cases were between the age group of 21-40 years (76%). Majority of the patients (90%) presented with the complaint of abdominal pain followed by abdominal distension (56%). 36(60%) patients were managed conservatively while operative interventions were required in 24(40%) patients. The common surgeries performed in the patients included splenectomy, primary closure of perforation and resection and anastomosis of bowel. Majority of the patients (80%) were discharged within 20 days of admission. The mortality in present study was 13.3%.Conclusions: Blunt Abdominal Trauma is one of the important causes of morbidity and mortality in young adults. Immediate resuscitative measures, management of associated injuries and appropriate operative intervention are important parts of management of such cases.

D - dimers assay as an adjunct to diagnosis of cerebral venous sinus thrombosis

To determine the frequency of raised D-dimer in patients of cerebral venous sinus thrombosis [CVST] at Neurology Department, Military Hospital Rawalpindi. Descriptive study. One year duration conducted in the Department of Neurology at Military Hospital Rawalpindi from 1[st] May 2010 to 1[st] May 2011. Thirty patients were selected randomly from Neurology Department, who were recently diagnosed cases of cerebral venous sinus thrombosis [CVST] on the basis of magnetic resonance imaging [MRI] and magnetic resonance venography [MRV]. D-dimer test samples were drawn and subjected to latex agglutination test. There were 22[73.33%] males and 8[26.67%] females in our study. D dimmer assay analyses revealed 90% [27 patients] as positive and 10% [3 patients] as negative. Raised D-dimer levels are highly suggestive of CVST provided other conditions are clinically excluded and they can be used as an adjunct in the diagnosis of cerebral venous thrombosis

Three-year prospective study of the prognosis of cardiomyopathy with pregnancy and its outcome at a single institution

To describe the characters of pregnancy with cardiomyopathy and its outcome. A case series study. This study was done in the Armed Forces institute of Cardiology [AFIC] and Military Hospital Rawalpindi from October 2003 to October 2006. The study of case series consisted of thirteen consecutive women who were admitted with diagnoses of Cardiomyopathy with pregnancy. For the diagnosis of Peripartum Cardiomyopathy [PPCM], strict 4 point criteria were used. During the study period we managed a total of 13 pregnancies with Cardiomyopathy as outdoor cases, 08 with PPCM 4 with hypertrophic Cardiomyopathy and one due to thyroid disease. The number of patients were only 11 as 2 were back again within a year. We had one mortality with peripartum Cardiomyopathy who presented within 20 days of delivery with sudden cardiac failure. For peripartum Cardiomyopathy the average age at presentation was 28 years. Most patients presented with dyspnoea 4 cases, palpitations 7 and one patient with syncope. Left Ventricular Ejection Fraction [LVEF] was 0.35 on the average. The time of diagnosis was antepartum for three patients and postpartum for five. There were no cases of multiple pregnancies in this series. In hypertrophic cardiomyopathy majority of the patients had caesarean sections, less so in other categories. These were performed under general anaesthesia due to uncertainty about the safety of regional anaesthesia in these cases. Cardiomyopathy is a poorly understood ominous complication of pregnancy. It accounts for a rising proportion of maternal mortality. Diagnosis should be considered whenever women present with heart failure in peripartum period. Improved case ascertainment requires heightened awareness among obstetricians and cardiologists