Penile incarceration by metallic ring

Application of constricting objects over penis for auto-erotic purpose can lead to dangerous results. A variety of metallic and non-metallic objects are used. The removal of these objects is a great challenge. We report a case of a young man who placed a hard metallic ring around his penis for sexual pleasure. A 22-year old man presented in emergency department with complain of painful swelling of his penis since 4 hours. Physical examination revealed part of penis distal to ring as congested and markedly tender with decreased sensation. He was diagnosed as grade 2 penile incarceration injury. After giving analgesic, intravenous fluid and antibiotics, the patient was shifted to emergency operation room. Under general anaesthesia, the metallic ring was removed by string method and multiple aspirations technique. The ring was successfully removed. His postoperative recovery was uneventful

Radical cystectomy in patients with transitional cell carcinoma urinary bladder

Objective:To find out various presentations, types of operations performed, perioperative complications, pathological staging and oncological outcome of patients with transitional cell carcinoma [TCC] urinary bladder treated with radical cystectomy

Study design: Descriptive case series

Place and Duration of study: Department of Urology Jinnah Postgraduate Medical Centre Karachi, from January 2009 to December 2014

Methodology: All patients who underwent radical cystectomy with bilateral pelvic iliac lymphadenectomy due to muscle invasive transitional cell carcinoma of bladder with or without adjuvant or neo-adjuvant chemotherapy or radiotherapy from January 2009 to December2014 with minimum of two years follow up, were included in the study. Patients with proven metastasis were excluded. Clinical presentations, details of surgeries, post-operative complications, pathological staging and oncological outcomes were recorded

Results: Thirty-two patients were operated. Age ranged from 35 to 70 year. There were.28 males [87.5%] and 04 females [12.5%] patients. Painless hematuria was the most common clinical presentation. Most [81.2%] of the patients were diagnosed as muscle invasive transitional cell carcinoma on first trans-urethral resection of bladder growth [TURBT]. Radical cystectomy with standard pelvic lymph node dissection [PLND] and ileal conduit were performed in all patients. Two [6.2%] patients died in perioperative period. Fourteen [43.8%] patients developed complications. Pathological staging revealed non-organ confined disease with positive lymph node in six [18.6%] patients. Disease free survival [DFS] was noted in 68.7% of patients. Over-all survival was 65.6%

Conclusion: Radical cystectomy in patients with potentially invasive or invasive TCC bladder helped in achieving long term survival in majority of the patients

Double J stent removal by trained operation theater nurse under topical anesthesia in female patients

Objective: to document outcome of DJ stent removal by trained operation theater nurse under topical anesthesia in female patients

Study design: descriptive study

Place and Duration of study: department of Urology Jinnah Postgraduate Medical Center, Karachi from June 2015 to February 2016

Methodology: Female patients, for DJ stent removal, who did not give consent for the procedure to be performed by the male doctors, were included. Patients in whom DJ stent placement duration was more than 4 months with radiological evidence of encrustation and those in whom ureteric re-implantation done, were excluded. All double J Stents were removed by trained female senior theater nurse under supervision of consultant urologists. All operative and postoperative problems were recorded

Results: a total of 30 patients underwent DJ stent removal during the study period. Age of the patients ranged from 15 year to 55 year. Mean age was 27 year. Most common indication for DJ stent placement was obstructive renal stones in 36.6%. Out of the total two patients required general anesthesia and ureteroscopy for its removal. In one case there was encrustation around DJ stent and in other patient it was due to broken DJ stent. Minimal complications were noted in follow-up

Conclusion: it was safe to assign the task of DJ stent removal to the female nurse after adequate training. This produced was suited for female patients reluctant to have this procedure done by male doctors in a conservative society like Pakistan

Comparison of fistulectomy with fistulotomy in low fistula in Ano

Objective: To compare the outcomes in terms of healing after fistulotomy and fistulectomy for low lying fistulae in ano

Study design: Cross sectional analytic

Place and Duration of study: Department of Surgery, Surgical Unit I, Jinnah Postgraduate Medical Centre Karachi, from June 2013 to May 2015

Methodology: Patients of both genders between 12 to 60 year of age with clinical diagnosis of fistula in ano were included in the study. Pain was assessed on visual and analog scale [VAS] Hospital stay was also recorded. All were followed for four week for any complications

Results: During the study period 120 patients were enrolled. Out of these 60 patients had fistulotomy and 60 underwent fistulectomy for fistula in ano. Male predominated with male to female ratio of 3:1. Swelling [86.6%], discharge [37%] and itching [27%] were the common symptoms. The mean duration of hospital stay was 3 +/- 1 day. Postoperative wound healing and pain assessed by VAS, were high in fistulectomy group. All patients recovered during follow up except one who continued to complain incontinence from fistulectomy group

Conclusion: Fistulotomy yielded better results as compared to fistulectomy for the treatment with low fistula in ano

Laparoscopic surgery in urology: an experience from a tertiary care center

Objective: To describe the results of laparoscopic procedures performed in a Urology unit of a tertiary care hospital

Study design: Case series

Place and Duration of study: Department of Urology Jinnah postgraduate Medical Centre Karachi, from March 2011 to February 2016

Methodology: Data of all planned laparoscopic surgeries were collected and analyzed for demographic information, laboratory reports, procedure details, operative time, duration of hospital stay, complications and follow up details. BAUS guidelines were used to learn laparoscopic skills. Data was analyzed using Statistical package for the social Sciences [SPSS, Version 20.0]

Results: There were total of 57 patients who underwent laparoscopic surgery. This included 48 males [84.21%], and 9 [15.7%] females. Mean age of patient was 30.37 +/- 12.01 year [Range 12-73 year]. The procedures performed included simple nephrectomy [n=13], ureterolithotomy [n=14], varicocelectomy [n=13], orchidopaxy [n=2]. There were 12 diagnostic procedures for non-palpable testes, one adrenalectomy, one radical cystectomy, and one vesico-vaginal fistula repair. Fifteen patients needed conversion to open surgery due to various reasons. Out of 42 successfully performed laparoscopic procedures 10 different complications were noted majority being Clavien Grade II, including blood transfusion in one patient

Conclusion: Laparoscopic surgery has a prolonged learning curve. The conversion rate in this study was 26.3%

Prolongation of QTC interval in patients with cirrhosis

Objectives: To observe the frequency of QTc [corrected QT] interval prolongation in patients with chronic liver disease in our population

Study design: A cross-sectional analytical study

Place and duration: Department of Gastroenterology, Liaquat National Hospital and Medical College, Karachi from May 2009 to October 2009

Methodology: A non- probability, purposive sampling is used in already diagnosed cirrhotic patients. Patients between 25-70 years were included. These patients were divided into three groups according to their Child-Pugh [C.P.] classification [class A, class B and class C]. An electrocardiogram [ECG] of all patients was obtained and QT intervals corrected for heart rate [QTc] were calculated. Analysis of data was done by SPSS 17

Results: 121 cirrhotic patients were inducted in this study. 10 patients belonged to C.P. class A, 49 to C.P. class B, and 62 to C.P. class C. Prolonged QTc interval was observed in 48 [39.7%] patients while in 73 [60.3%] patients QTc interval was normal. Occurrence of prolonged QTc interval was greater in C.P. class-C [50%] followed by C.P. class-B [30.6%], p value 0.045 and 0.016 respectively

Conclusion: Significant number of cirrhotic patients had prolonged QTc interval and this prolongation of QTc interval was directly associated with more advanced liver disease

Helicobacter pylori infection; dyspeptic patients undergoing endoscopy: a hospital based study

To determine the frequency of H. pylori infection in dyspeptic patients undergoing endoscopy at a tertiary care center in Karachi. Patients undergoing endoscopy at Liaquat National Hospital, Karachi. Cross sectional descriptive study. Department of Gastroenterology, Liaquat National Hospital, Karachi. May 2008-October 2008. All adult patients with symptoms of dyspepsia for more than 1 month duration were included. Patients with upper gastrointestinal bleed, anemia or weight loss were excluded. Upper gastrointestinal endoscopy was performed in all patients and biopsy specimens two each from antrum and body and one from fundus were taken for histology. A total of 123 dyspeptic patients were included in the study. 76 [61.8%] patients were males and 47 [38.2%] were females. H pylori was detected in mucosa of 49 [39.8%] patients. The mean age of the patients was 41.41 +/- 13.15 Years [95%CI; 39.06 to 43.75]. Rate of H.pylori infection was not found statistical significant with age, gender, duration of symptoms and BMI. The prevalence of H pylori infection in dyspeptic patients was lower than reported in previous studies from other centers in Pakistan. Other environmental factors should be evaluated in every patient especially who is negative for H. pylori in our setup

Frequency of common factors for post endoscopic retrograde cholangiopancreatography pancreatitis

To determine the frequency of factors leading to post endoscopic retrograde cholangiopancreatography [ERCP] pancreatitis. Case series. Department of Gastroenterology, Liaquat National Hospital, Karachi, from November 2007 to October 2008. Fifty [50] patients of diagnosed cases of post-ERCP pancreatitis were included in this study. The collected data included age, gender, previous post-ERCP pancreatitis, recurrent pancreatitis, recurrent abdominal pain, number of attempts of common bile duct [CBD] cannulation, difficult CBD cannulation, precut sphincterotomy, biliary sphincterotomy, pancreatic duct contrast injections, primary diagnosis, device used, therapeutic procedure undertaken and the pancreatic enzymes level. Results were described as frequency percentages. Out of 50 patients, 32 [64%] were females. The average age of the patients was 52.23 +/- 13.4 years. Frequency of common factors regarding post-ERCP pancreatitis were age 2 60, [n = 38, 76%] patients, female gender [n = 32, 64%], precut sphincterotomy [n = 34, 68%], pancreatic duct contrast injections [n = 27, 54%], biliary sphincterotomy [n = 25, 50%]. Higher number of attempts of CBD cannulation and difficult CBD cannulation were recognized as factors for post ERCP pancreatitis. Other factors like previous history, post-ERCP pancreatitis, recurrent pancreatitis, and recurrent abdominal pain were not found in this study. Age, female gender, precut papillotomy, pancreatic duct contrast injections and biliary sphincterotomy were common factors for post-ERCP pancreatitis. Risk stratification will allow endoscopists to better identify patients who are at risk and permit detailed informed consent in high-risk groups or to adapt the measures to prevent the complications and reduce the risk related with the procedure

Combining ability study in a 6x6 diallel cross of maize

The F[1] generation of 6x6 diallel cross in maize was evaluated for combining ability under irrigated conditions of Dera Ismial Khan, Pakistan. Based on the variance data, general combining ability [GCA] and specific combining ability [SCA] showed the importance of additive gene effect in some characters under study like kernel rows/ear, kernels/ear, 1000 grain weight and grain yield. The results showed that F[1] mean squares due to GCA were highly significant for all the parameters under observation. Higher magnitude of GCA components of variance [%] for kernels/ear, 1000 grain weight and grain yield, indicated predominance of additive and additive type of gene action while for kernel rows/ear, and kernels/row, nearly equal importance of both additive and non-additive gene effects were observed. The estimates of GCA effects revealed that parents Jalal and Sarhad White were good general combiners for most of the traits under discussion. The crosses, Kisan x Azam and Azam x Sadaf showed good SCA effects with excellent mean performance for most of the traits studied in F[1]

Superficial bladder tumours: recurrence and progression

To determine various presentations of superficial bladder cancer, its management, recurrence and progression rates. Case series. Department of Urology, Jinnah Postgraduate Medical Centre, Karachi, From January 2002 to December 2009. Patients with pathologically proven superficial transitional cell carcinoma [TCC] with minimal 2 years of follow-up were included. Their clinical presentations and management was recorded. Complete transurethral resection of bladder tumour [TURBT] was attempted in all patients. Tumour grading and staging was performed. Intra-vesical single instillation of mityomycin-C was given postoperatively in selected patients. Cystoscopic surveillance was used to assess recurrence in all patients according to standard protocol. Metastatic work-up and biopsy record of follow-up TURBT was used to document progression in high risk patients. Results were described as simple descriptive statistics. A total of 92 patients were studied. The median age of patient was 62 years, with male preponderance [88%]. Hematuria with lower urinary tract symptoms [LUTS] was most common presentation [47.8%], followed by hematruia alone [25.7%], LUTS alone [9.2%] and upper tract symptom in 1.8% of patients. Complete TURBT in first attempt was possible in 72 patients [78.3%]. Multiple tumours were seen in 34 patients [39.6%]. Intravesical mitomycin was given in 70% patients. Over-all recurrence rate of 68.4% was noted. Patients with TaG2-3 showed recurrence rate of 58.8% which occurred late with good recurrence free interval. T1G2-3 patients have more and early recurrences [80.4%]. Progression seen in 13 patients [14%], 6 patients have up-grading, four showed stage progression, one developed pelvic lymphadenopathy and another one had bone metastasis. One female patient [TaG2] developed right renal pelvic recurrence and progression while her bladder disease was well controlled. The number of patients with T1 disease was 45% in this study which is comparatively higher than other studies. Early recurrences and progression were observed with T1G2-3, while late recurrence were seen with Ta disease, having tumour free interval between 6 months to 2 years. Early radical cystectomy was advised to T1G3 disease and with multiple recurrences, but patient's compliance was poor

Denture hygiene habits in complete denture wearers at Armed Forces Institute of Dentistry

To determine the denture hygiene in complete denture wearers and their relationship to age, gender, educational level and denture-wearing behavior. Cross-sectional comparative study. Armed Forces Institute of Dentistry Rawalpindi from July 2009 to February 2010. This study was conducted over 173 adults aged 55-85 years who were fitted with new or modified complete maxillary and mandibular acrylic prostheses. Denture hygiene levels were recorded by using Budtz-Jorgensen and Bertram criteria. The majority of participants [44.5%] reported cleaning their dentures with toothbrush and toothpaste, compared to less than 10% each who reported using sodium bicarbonate, sodium hypochlorite, or ordinary soap. Overnight denture removal found in 112 [64.73%] subjects, 109 [63.0%] immersed their dentures in water and only 3 [1.7%] immersed them in a chemical solution. Denture hygiene was rated as [Good] for 38 participants [21.96%], [Fair] for 78 [45.08%] and [Poor] for 57[32.94%]. The degree of denture hygiene was found to be significantly associated with gender, level of education, self-perception of halitosis, overnight removal of dentures and denture immersion habits [p<0.001]. Denture related problems were more frequently among patients with poor denture hygiene

Acquired hepatocerebral degeneration in Hepatitis C infection

Patients with chronic liver disease [CLD] often have neurological sequelae, of which hepatic encephalopathy is the most frequent and reversible. Rare irreversible complications of CLD are acquired [non Wilsonian] hepatocerebral degeneration [AHCD] and hepatic myelopathy [HM]. To our knowledge, AHCD has rarely been reported in patients with hepatitis C virus [HCV] infection. We report a patient with HCV infection who developed AHCD and resulted in serious complications