Holmium laser ureterocele excision with transurethral incision of the prostate

ABSTRACT Introduction: Ureteroceles present a diagnostic and treatment challenge in adults (1). With an estimated prevalence of 1/500 to 1/4000, it is not uncommon for any urologist to encounter ureteroceles in clinical practice (2). The incidence of prolapsed ureteroceles in adults is unknown (3). Materials and Methods: We present an interesting case of a 53-year-old male with a 20-year history of obstructive voiding symptoms who presented with urinary retention with a Foley catheter in place. Pre-operative evaluation included a transrectal ultrasound of the prostate which revealing prostate volume of 20cc. Urodynamics revealed a high-pressure, low flow voiding pattern with a functional detrusor muscle. Cystourethroscopy was performed revealing an orthotopic ureterocele on the left side that was prolapsed into the prostatic urethra, and the bladder neck was elevated. The patient then underwent holmium laser ureterocele excision with transurethral incision of the prostate (TUIP). Using MOSES technology and laser settings of 30Hz and 1.5J, the ureterocele was completely excised and a TUIP was performed. Results: The patient was discharged home on the day of surgery with a Foley catheter in place. On post-operative day 1 he passed a voiding trial with a post-void residual volume of 25cc. Renal ultrasonography was performed 3 months postoperatively revealing no hydronephrosis. His postoperative International Prostate Symptom Score of 2 was improved compared to his preoperative score of 34. Conclusion: Holmium laser ureterocele excision with a TUIP is an effective treatment modality in the management of a prolapsed orthotopic ureterocele causing bladder outlet obstruction in a male patient.

Laryngo Tracheal Stenosis : Management And Its Outcomes

Introduction: Laryngotracheal stenosis (LTS) implies a partial or complete narrowing of the larynx and/or trachea. Surgical management of it is technically challenging due to complex anatomy and delicate nature of airway structures. Ourstudy aims to study clinical profile, management, and surgical outcome of LTS. Materials and Methods: All patients with LTS treated between 2015 and 2018 were included in in our study.They underwent endoscopic assessment followed by definitive management which included endoscopic and external surgical techniques. The success of treatment was defined by decannulation Subjective assessment of voice quality.Results: A total of 30 patients with benign LTS were treated. Prolonged intubation was the single largest cause (56%). subglottic stenosis formed the largest group (74%) followed by Tracheal stenosis (14%).patiens were devided in four group depending upon surgical procedure they underwent:GROUP–I,endoscopic laser excision and dilatation(12cases),GROUP–II laryngo tracheoplasty and t–tube insertion(10 cases),GRUP–III tracheal stent insertion(3 cases),GROUPIV–Rection and anstomosis.Rate of decannalation following this surgical procedure in GROUP–I,GROUP–II,GROUP–III and GROUP–IV were 58%,60%,33% and80%.A total of 19 patients (63%) have been successfully decannulated. Conclusions: The use of appropriate size, low pressure cuffed tubes, and early tracheostomy will help in preventing LTS. The precise assessment of laryngotracheal complex is most useful in planning of management. Choice of treatment depends on location, severity, and length of stenosis, as well as on patient comorbidities an dhistory of previous interventions. Goal of our treatment modality is to achieve a patent airway and acceptable voice quality.

Antidepressant drugs: evaluation of price variation.

Background: Drugs are available in many different brands and costs of all brands are different. Patients of depression have to take the antidepressant drug for a long duration. If the cost of a drug is high patient has to pay more money for complete treatment. It can result in noncompliance and treatment failure. This study was aimed to evaluate the cost of antidepressant drugs of different classes and to analyze price variation in various antidepressant drugs available in India. Hence, we decided to do the study of price variations of antidepressant drugs. Methods: We had evaluated the cost of a different class of antidepressant drugs. Current Index of Medical Specialties October-December 2014 and Indian Drug Review 2015 issue 1 drug manuals were used to derive the cost of antidepressant drugs. Data about the cost of antidepressant drugs were collected for all the strength and dosage forms. The maximum price and minimum price for the different antidepressant drugs were identified, and calculation for the percentage of price variation was done. Results: Maximum percentage of price variation in different groups were 900% in reboxetine 2 mg (tricyclic antidepressants group), 495.23% in escitalopram 10 mg (selective serotonin reuptake inhibitors group), 318.66% in duloxetine 20 mg capsules (serotonin and noradrenaline reuptake inhibitors group), 243.58% in moclobemide 150 mg tablet (reversible monoamine oxidase-A inhibitor), 84.93% in bupropion 150 mg sustained-release tablet (atypical antidepressants group). In combination escitalopram 10 mg + clonazepam 0.5 mg shows maximum price variation of 1101.92%. Conclusion: Price variation was wide for antidepressant drugs. Generic drug prescribing can decrease the expenditure of patient on the drug. Prescribers should be provided updated knowledge of the cost of different drugs. Modifications in pharmaceutical policy are required, and prices of the drug should be controlled in effective way for all the drugs.

Primary tuberculosis of thyroid gland – a case report.

Tuberculosis of the thyroid gland is very rare disease and isolated involvement of thyroid is even more rare. There are about 200 cases of thyroid gland tuberculosis had been reported worldwide .In India das et al repotred 21 cases thyroid tuberculosis . Almost all cases were secondary to some primary foci elsewhere in the body.The diagnosis is usually very difficult as the clinical presentation has no distinct characterstics. Clinically it may resemble thyroditis or goiter or some malignant etiology. On histo pathological evaluation, presence of necrotizing epitheloid cell granuloma along with langhan giant cells are diagnostic of thyroid tuberculosis. Further demonstration of acid fast bacilli in Z N staining confirms diagnosis.

Co-existence of HIV, active tuberculosis and aspergilloma in a single individual - A case report.

Summary: Tuberculosis (TB) is a disease as old as mankind, whereas in India the first case of Human Immunodeficiency Virus (HIV) was reported in 1986. HIV and TB are so closely connected that their relationship is often described as a coepidemic. Aspergilloma (Fungal Ball, Mycetoma) represents a saprophytic growth of aspergillus that colonizes in the preformed cavities commonly due to pulmonary tuberculosis (PTB). We report a case of HIV, active pulmonary tuberculosis and aspergilloma occurring in the same patient. Despite our best efforts, we could not lay our hands on any similar case in the medical literature.

Drug utilization study in intensive coronary care unit of a tertiary care teaching hospital.

Background: Critically ill patients are admitted in Intensive coronary care unit. The intensive coronary care unit (ICCU) is a setting where a large number of drugs are administered to patients. Information on drug utilization in intensive coronary care units (ICUs) are lacking in India. Objectives: To identify pattern of drug use and suggest measures. Methods: Prospective drug utilization study was conducted in patients admitted in ICCU for six months. Data was collected in previously prepared case record form. Data was recorded from the admission of patient in ICCU to discharge from ICCU. Analysis was done by using drug use indicators, age and sex wise distribution, morbidity pattern of disease, frequency of drug use, cost of drug therapy and length of stay. Data analysed using Microsoft Excel. Total 605 cases were analysed. Results and Interpretation: Mean ± SD6 of age of all patients being admitted in ICCU is 57.05 ± 11.92 years. Most frequent morbidity found is myocardial infarction. Average number of drugs per encounter is 14.85. Percentage of encounters with an antibiotic and injection prescribed is 27.44% and 98.68% respectively. 34.46% drugs are prescribed by generic name and 43.75% drugs were prescribed from WHO essential drug list. Most commonly prescribed drug is Tablet Aspirin. Frequent injections used are promethazine, heparin, hydrocortisone, buprenorphine, streptokinase, metoprolol, Pentazocin and frusemide. Average drug cost per encounter is 867.84 Rs. 65.38% cost is spent on fibrinolytics. Conclusion: Average number of drugs per encounter is high it should be kept low whenever possible. From all drugs prescribed 42.66% drugs were parenteral. Percentage of drug prescribed by generic name is less. Drugs should be prescribed by generic name. Cost of drugs spend by patient is high. Antibiotics are less frequently prescribed. The mortality rate is low. Essential drug list for ICCU should be prepared. Seminar or group discussion can be done with health professionals working in ICCU to discuss drug utilization pattern for further improving prescribing pattern.