Pattern and management of renal injuries at Pakistan institute of medical sciences

To determine the types and grade of various renal injuries and methods adopted for their management at the Department of Urology, Pakistan Institute of Medical Sciences, Islamabad. An observational study. Department of Urology, Pakistan Institute of Medical Sciences, Islamabad, from January 2005 to December 2007. The study included 50 patients with both blunt and penetrating renal trauma of either gender and aged above 13 years. Injuries, grade management and outcome was recorded. The data was entered in structured proforma and analyzed for descriptive statistics using SPSS version 10. Frequency was higher in males [82%]. The mode of renal injury was blunt in 78% and penetrating in 22% cases. Blunt injuries were mostly due to road traffic accident [94.9%] and penetrating injuries due to firearm [63.6%]. Hematuria was present in 86% and absent in 14% cases. Minor renal injury was seen in 74% and major injury in 26% cases. Seventy-two percent cases were managed conservatively. All grade-V [14%] and one grade-1V injury [2%] patients underwent nephrectomy. Renorrhaphy was done in 6% cases. Urinary extravasation was seen in one case [2%]. One patient developed renocolic fistula. No mortality was observed in non-operative group; however, 4% patients expired in operative group due to associated injuries. Blunt trauma accounts for majority of the cases of renal injury and non-operative treatment is the suitable method of management for most cases of blunt as well as selected cases of penetrating renal trauma, who are stable hemodynamically and without peritonitis

Comparison of CT scan and colour flow doppler ultrasound in detecting venous tumour thrombous in renal cell carcinoma

Renal cell carcinoma has marked tendency to spread into renal vein, inferior vena cava and right side of heart. Extension of tumour thrombus into these veins will alter the surgical approach. We have compared the CT scan with Colour flow Doppler ultrasound in detecting venous tumour thrombus in renal vein and inferior vena cava. This cross-sectional study included 30 adult patients presenting with renal tumour. Patients of either gender were included in the study. Non probability convenience sampling was used. All patients underwent colour flow Doppler ultrasound and CT scan with contrast to asses the renal vein and inferior vena cava. The results were confirmed by intra operative findings and histopathology. The data was analyzed using SPSS version 12. Out of 30 patients, 20 [66%] were males and 10 [34%] female. The tumour was predominantly on the right side [60%], as was renal venous tumour thrombus [44%]. Inferior vena cava was involved in 4 cases predominantly due to right sided tumours. The sensitivity of Doppler ultrasound in detecting renal venous tumour thrombus [88% on right and 100% on left side] was higher than CT scan [63% on right and 60% on left side]. Doppler ultrasound was also superior to CT scan in detecting vena caval thrombus. The overall sensitivity of Doppler sonography was higher than CT scan in detecting tumour extension into renal veins and inferior vena cava. Therefore, it can be used as a complementary tool in equivocal cases

Role of metochlopramide and dimenhydrinate in orevention of postoperative nausea and vomiting in laparoscopic gynaecological surgery

To evaluate the role of metoclopramide and dimenhydrinate in controlling postoperative nausea and vomiting [PONV] and its cost effectiveness in gynaecological laparoscopy. This study was conducted in the department of anaesthesiology and intensive care unit, Pakistan Institute of Medical Sciences, Islamabad from June 2004 to March 2006. Ninety nine female patients belonging to American society of Anaesthesiologist [ASA] grading ASA-1 to ASA-111, scheduled for laparoscopic surgery, who did not fall in exclusion criteria were finally included. Anaesthetic technique was standardized for all patients. Injection Metocloparamide 10 mg and injection Dimenhydrinate 50 mg were administered 20 min before the procedure was over. At the end of procedure patients were transferred to the recovery room for observation for 10 hours. Four point verbal descriptive scale [VDS] was used to identify the presence and severity of PONV. Four out of 99 [4.04%] patients developed nausea soon after regaining consciousness and did not demand any medication for relief. Three [3.03%] patients developed vomiting. It was single episode and no rescue medication was needed. Most of the symptoms developed with in 10 -30 minutes of reversal. Metocloparamide and dimenhydrinate is a good combination to combat PONV and is costeffective in laparoscopic gynaecological surgery

Electrocoagulation versus suture-ligation of lymphatics in kidney transplant recipient surgery

To compare electrocoagulation versus suture-ligation of the lymphatics in kidney transplant operation of the recipient in terms of operating time, cost effectiveness, drainage from renal bed and incidence of lymphocele. This prospective comparative study was conducted at the department of Urology and Kidney Transplantation, Hearts International Hospital Rawalpindi during a period of two and a half years [January 2003 to July 2005] by a single surgical team. All patients who underwent kidney transplant during this period and did not fall into exclusion criteria were included in the study. Ninety Cases of End-stage Renal Disease undergoing kidney transplant were randomly divided into two equal groups. Patients in the group A had their lymphatics electrocoagulated and divided in the preparation of external iliac vessels for allograft anastomoses, while the patients in group-B underwent suture-ligation and division of the lymphatics covering the external iliac vessels. The average operating time was reduced in group-A. Also, no suture material was used for this step. Over all anesthesia time was also less. There was no significant difference in the quantities of postoperative drainage from the wound. There was no incidence of lymphocele development in group-A [0%]. While one patient [2.2%] in group-B had a moderate lymphocele which was aspirated and there was no recurrence. Cut off point of the study was six months from the day of surgery. Electro-coagulation and division of lymphatics coursing over the external iliac vessels is an attractive procedure. It saves time, is cost-effective, the postoperative wound drainage is not a problem and the procedure is not associated with increased incidence of lymphocele