Superficial bladder tumour recurrence on first check cystoscopy after transurethral resection

To determine the frequency of recurrence of Superficial Transitional Cell Carcinoma on first check cystoscopy after TURBT in six months at the Institute of Kidney Diseases Peshawar. All adult male and female patients with superficial transitional cell carcinoma of urinary bladder were evaluated and resection of the tumour was done and tissue sent for histopathology. Three months after resection, the patients were followed up by cystoscopy and findings noted. Recurrent growth, if present, was resected and sent for histopathology. All the above information were recorded and entered into a structured proforma. The data were analyzed through SPSS version 14 and results were presented in the form of tables and graphs. Our study included 41 patients. 33 [80.5%] were males and 8 [19.5%] females. The age rangedfrom 28 to 85 years with a mean of 59.22 +/- 11.47 years. The presenting T-stage was pTa in 11 [26.8%] patients and pT1 in 30 [73.2%] patients. The presenting histological grade was G-I in 16 [39%], G-II in10 [24.4%] and G-III in 15 [36.6%] patients. On first check cystoscopy, 28 [68.3%] patients showed recurrence while the rest, i.e. 13 [31.7%], showed disease free status. Out of 28 cases with recurrence, 2[4.9%] showed pTa and 26 [63.4%] showed pT1. The recurrence of histological G-I, G-II and G-III were 5, 8 and 15 respectively. Recurrence of superficial TCC at first check cystoscopy is high and has a predictive value for future recurrence of the disease

Symptomatic complications of ureteric stents

To calculate the frequencies of symptomatic complications of pigtail ureteral stents and to determine the effect of stent duration on symptomatic complications. All s tented adult patients [PTFE Coated Cook_ 6 Fr Double J Stent] presenting at the Institute of Kidney Diseases Hayatabad Peshawar were evaluated by history, examination, urine analysis and cultures, X-ray KUB and ultrasound KUB. SPSS version 11.0 was used for the data entry and analysis. Results are presented in the form of tables. Out of 100 patients, 68% were males and 32% females. Stent indications included stone surgery in 14% of cases, prior to extracorporeal shockwave lithotripsy [ESWL] in 36%, ureteric obstruction in 36%, pyeloplasty in 10%, and anuria in 4% of cases. Complications at 2 and 4 weeks were hematuria in 52% and 40% of cases, flank pain in 48% and 58%, frequency of micturation in 66% and 78%, dysuria in 72% and 80%, urgency in 60% and 72% and suprapubic pain in 42% and 50% of cases respectively. Ureteric s tenting is a life saving procedure but associated with significant morbidity. It's unnecessary and prolonged use should be avoided

Early oral feeding, no nasogastric suction and no peritoneal drainage; compared to conventional post operative protocol in cases of gastric and small bowel anastamoses

To know the out come of a randomized controlled trial of early oral feeding, no nasogastric [NG] suction and no peritoneal cavity drainage after gastric and small bowel anastamoses. Patients admitted for anastomosis involving stomach and small bowel were randomized into two groups [50 patients each] by lottery methods of prewritten cards. In group A [control], patients were managed by conventional postoperative protocol [N/G decompression, peritoneal drain and nil per oral for 5 days]. In group "B" [under trial] patients were managed without NG decompression and peritoneal drain and were allowed oral feeds on third postoperative day. Surgery was done by various grades of surgeons from consultants to Senior Trainees. In group A, 39/50 patients were male and average age was 47.5 years. Morbidity recorded in this group was 14% including postoperative chest infection, wound dehiscence, vomiting and hypovolumia in one patient [2%] each. Three patients [6%] had anastamotic failure resulting into fistula. Three [6%] patients died of the procedure. In group B; 34/50 were males and average age was 42.5 years. Postoperative abdominal distension was recorded in 3 [6%] patients and vomiting in 2 [4%] patients. No anastamotic failure occurred in this group. Mortality was nil. Patients of gastric and small bowel anastamoses/ repair can be managed without N/G tube and peritoneal drain. These patients can be allowed home on fourth postoperative day

Spontaneous central venous catheter fracture and the intracardiac migration in an infant: Successful percutaneous retrieval

The use of central venous lines including totally implantable venous devices has revolutionized the care and management of infants and children in general and oncology patients in particular and, although considered to be generally safe, they are however associated with significant morbidity. One of the rare but potentially life-threatening complications is catheter fracture and migration, which is commonly seen in adults but rarely in children. We report here the case of an infant with catheter fracture and migration to the right ventricle, which was successfully retrieved by a percutaneous transfemoral endovascular technique

Congenital duodenal diaphragm in eight children

Congenital duodenal obstruction [CDO] is a common and usually easy to diagnose cause of intestinal obstruction in the newborn, except when the cause of the obstruction is a duodenal diaphragm. We describe our experience with eight children who had intrinsic duodenal obstruction secondary to a duodenal diaphragm. The medical records of 22 children with the diagnosis of congenital intrinsic duodenal obstruction were reviewed for age at diagnosis, sex, gestation, birth weight, clinical features, associated anomalies, method of diagnosis, treatment and outcome. Operative findings and procedures were obtained from the operative notes. Eight of the 22 children [36.4%] had congenital duodenal diaphragm [CDD]. In all children, the diagnosis was made from plain abdominal X-ray, which showed the classic double-bubble appearance, and barium meal, which showed duodenal obstruction. Four patients had associated anomalies, including two with Down's syndrome. Intraoperatively, five patients were found to have duodenal diaphragm with a central hole, while the other three had complete duodenal diaphragms. Postoperatively, all patients did well. Six required total parenteral nutrition. Conclusions: The 100% survival rate among these children is comparable to that in Western countries, and can be attributed to the lack of major associated abnormalities, good perioperative management, and the availability of total parenteral nutrition

Penile traumatic dislocation of the testis

Traumatic dislocation of the testis is a very rare injury usually following severe trauma to the scrotum and displacement of the tests into the subcutaneous tissues commonly in the superficial inguinal pouch. The diagnosis of traumatic dislocation of the testis is generally because of associated scrotal oedema and haematoma in some, but more commonly because most of these patients have other more severe associated injuries. We present an unusual patient with penile traumatic dislocation of the testis whose diagnosis was delayed for 6 weeks following the initial trauma. This condition requires early recognition and prompt treatment to maximize the likelihood of testicular salvage