Is ultrasound detect renal infections?

Objective: To asses culture and sensitivity of renal infection patients detected on ultrasound

Study Design: Prospective cohort study

Place and Duration of Study: This study was conducted at the Rimsha Medical Center Dadu from January 2012 to June 2015

Materials and Methods: Hundred patients suffering for renal infection detected on ultrasound were included in the study. Diabetic and urolithiasis patients excluded from the study. Urine culture and sensitivity of renal infection patients detected on ultrasound carried from collection point of diagnostic and research laboratory liaqaut university of medical and health sciences Jamshoro/Hyderabad in Dadu

Results: Out of 100 patients 65 [65%] were female and 35[35%] male. The age of the patients ranged from 15 to 45 years with mean age 28.9 SD +/- 8.8 The presenting features were lumbar pain with on and off fever in 60[60%] cases, dysuria in 15[15%], and in 35[35%] cases was asymptomatic. The renal infection detected in ultrasound bilaterally in 30[30%], Right sided in 35[35%], left sided in 25[25%] and chronic pyelonephritis [change of small size kidney with increase echogenicity and small size kidney with irregular border] in 10[10%] cases. culture and sensitivity seen positive in 27[27%] cases. Pyuria and haematuria seen in 17[17%]. The commonest micro-organism detected E.coli in 60[60%], Klebsiella 15[15%], Proteus 5[5%], Enterococcus 5[5%], staphylococcus saprophyticus 5[5%], streptococcus 7[7%], Pseudomonas 3[3%] and insignificant mixed bacterial growth seen in 7 cases. Drug senstivity seen in 100% with meronam, pipracilllin/tazobactam, aztreonam. Nitrofurantoin and amikacin 90% Amoxi- clavulanic acid in fusidic acid, ceftrixone, cotirmoxazole, ofloxin, cefuroxime, cefixime 75% and resistance pattern seen more in ceftazidime, gentamycin, ciprofloxacin and ampcillin

Conclusion: Renal infection detected on ultrasound even with insignificant pyuria and haematuria should not be neglected because having significant positive culture and sensitivity report findings

Primary neuroendocrine tumors

To evaluate clinical presentation and surgical out come of primary neuroendocrine tumors of Kidney, U. bladder and Prostate gland. A Retrospective study. Urology Department, SMBBMU Larkana. 2001-2011. Series of 6 patients of primary neuroendocrine tumors of Kidney, U. bladder and Prostate gland were identified from 1890 cases of urinary tract tumors. Two cases of renal carcinoid, two cases of small cell carcinoma of urinary bladder and two cases of small cell carcinoma of prostate glands. Renal carcinoid tumors presenting with lumbar pain and microscopic haematuria and identified on the ultrasound. Small cell carcinoma of urinary bladder presenting with dysuria, gross haematuria and on ultrasound while small cell carcinoma of prostate gland presenting with irritatory and obstructive symptoms and confirmed on DRE. 6 patients [5 male and 1 female],Mean age of patients were 45years and range was 35-55 years. All patients treated primarily by definitive surgery like Radical Nephrectomy, TURBT and Pallitive TURP and all tumors confirmed on histopathological examination and referred to LINAR Larkana for proper managements. primary neuroendocrine tumors of Kidney, U.bladder and Prostate gland are rare tumors. Carcinoid tumors have good prognosis but small cell carcinoma have poor prognosis so require prompt treatment

Giant hydronephrosis

To study the clinical presentation and management of giant hydronephrosis. Civil Hospital Dadu and Urology Department SMBBMU Larkana. March 2004 to March 2011. 28 patients with giant hydronephrosis treated. 18[64.3%] patients had unilateral and [27.1%] had bilateral pelvi ureteric junction obstruction, 4[14.3%] had ureteric stones and remaining 4[14.3%] had multiple renal stones. All patients were treated with definitive surgery ie pyeloplasty, nephroplication, ureterolithotomy, extended pyelolithotomy and nephrectomy. Six [21.4%] patients had elevated blood urea and serum creatinine level so initially treated by percutaneous nephrostomy and ureteric catheterization. 10 out of 28 cases of giant hydronephrosis showed improvement in the function and drainage as well as pelvi-calyceal system dilatation while 28 patients going for nephrectomy. Early referral and intervention is necessary for giant hydronephrosis to prevent infection and deterioration of renal function

HDV infection in HBV infected individuals

To determine the status of HDV infection in HBV infected individuals at Larkana. This is a laboratory based retrospective study conducted at Molecular Laboratory PHCP-CMI Central laboratory CMC Hospital City block Larkana from October 2010 to September 2011. During the study period all the serum samples in which the HBV DNA was qualitatively detected were further processed for HDV RNA detection by the method of Real time PCR. During the study period a total of 1564 HBV DNA detected serum samples were processed for HDV RNA detection. The males were 1078 [69.0%] and females 486 [31.0%]. The age were ranged between 15 to 73 years. Out of the 1564 HBV DNA detected serum samples, the HDV RNA was detected in 865 [55.31%] and not detected in 699 [44.69%] individuals. This study showed 55.3% HDV infection in the HBV infected patient. Hence, to formulate the treatment option and to predict the response of treatment it is necessary that every HBV infected case should be processed for HDV RNA detection

Comparison of Barcat-Redman technique with Duckett technique in the management of distal hypospadias

To compare the efficacy, safety and complication of Barcat-Redman technique with conventional duckett technique in the management of distal hypospadias. Prospective study carried out at urology department, services hospital, Lahore from 15th April 1998 to 14th April 2000. All Patients with distal hypospadias presenting to the Urology Department Services Hospital. Pediatric Surgery, Services Hospital and Mayo Hospital Lahore were included in the study. These patients were divided into two groups on alternate basis where Group-A patients underwent Barcat-Redman technique and Group-B Patients underwent Duckett technique for the management of hypospadias. Success of both procedures as good, fair and failure were assessed at 3 months follow up. A total of 60 patients were enrolled, 30 patients underwent Barcat-Redman technique [Group-A] and 30 patients were underwent Duckett technique [Group-B]. Ages of the patients ranged from 5 to 25 years with a mean of 11 +/- 5.8 Years. All the patients presented with dystopia of external urethral meatus and chordee [ventral curvature]. The subcoronal type of hypospadias was seen in 43[71.7%] patients and distal penile urethral opening 17[28.3%]. All patients had distal type of hypospadias associated with chordee. Of the 30 patients in Group-A who underwent Barcat-Redman technique, 21[70%] had good results, 5[16.6%] had fair results and 4[13.6%] were failure. In 30 patients of Group-B that underwent Duckett technique, 19[63.4%] patients had good result, 6[20%] had fair results while, 5[16.6%] were failure. The overall morbidity rate was 36.6% while, hospital stay was 3 days and the difference was statistically insignificant [P=0.860]. It is concluded that probably there will never be an operation for hypospadias that will be uniformly and totally successful, but Barcat-Redman technique is superior to Duckett technique

Vesico-vaginal fistula abdominal repair versus repair via vaginal route

To evaluate the outcome of Vesico-vaginal Fistulae [VVF] repair by abdominal and vaginal route. Interventional / clinical trial. Department of Urology, Chandka Medical College Teaching Hospital and Almas Medical Centre Larkana. Feb; 2005 to Nov; 2010. After routine clinical examination and investigation, patients having Vesico-vaginal Fistulae [VVF] were selected for repair. All patients had under gone examination those anesthesia [EUA] and cystoscopy. The patients having complex fistulae or associated with urethral, ureteric and colonic involvement or with preexisting malignant pelvic pathology were excluded from the study. Patients were divided in to 02 groups on the basis of the site of the fistula and the method of repair. Group-I comprised of those patients who had low type or uncomplicated fistulae and were operated by vaginal approach. Group-II consisted of those patients who had high type or large fistulae and were operated by abdominal approach. Postoperative follow up was carried out on weekly basis for 03 to 06 months. Our study included 32 cases. Group-I and II comprised of 18 and 14 patients respectively. The mean age was 34 years [ranged from 22 to 45 years]. The main cause of vesico-vaginal fistulae was obstetrical in 28[87.5%] and iatrogenic gynecological [hysterectomy] in 04 [12.5%] patients. No major difficulty was experienced except in 01[0.83%] case in group-1 who had a previous failure history of repair. The mean operative time was 95 minutes [range 80 to 125 minutes] and 145 minutes [range 110 to 175 minutes] in group-1 and group-2 respectively. Peroperative blood transfusion was required in 06 [33.33%] and 13 [93%] patients of group-1 and group-II respectively. Statistically significant difference was found between these two groups [P< 0.05]. Postoperative complications like wound infection occurred in 01[7.15%] of group- 1 and haematuria was present for few days in o4 [22.22%] and 05[35.5%] in group-1 and group-2 respectively. The mean hospital stay was 07 [range 5-10] days. Foleys catheter was removed at 02 week time in all cases. The success rate was achieved 15[83.33%] and in all 14 [100%] cases for group-1 and group-2 respectively and statistically no significant difference was found between two groups [P=NS]. All the patients were followed up regularly except 03 [16.5%] and 05 [35.5%] patients of group-1 and group-II respectively. Long term complications like urinary stress incontinence was observed in 2 [11.1%] patients of group-I, where as small capacity bladder and stone formation was observed in 02[14.3%] of group-11 cases. Birth trauma is still a major cause of vesico vaginal fistula in our region. Although, there is no significant difference in outcome of different technique but interposition of tissue between suture lines have a vital role to achieve a high success rate. Further more, best chance of success achieved with first attempt of repair. Strategic approach and proper training of medical and paramedical staff is recommended

Experience of upper urinary tract stones with dornier mpl 9000 lithotripter

To report our experience with Dornier MPL9000X Lithotripter in terms of safety, efficacy and complications in the management of upper urinary tract stones. Retrospective study. From 19[th] April 1998 to 15 August 2007 in the department of Nephrology, Chandka Medical College, Larkana. All patients who had renal calculi up to 2.5cm in size were selected for extra corporeal shock wave lithotripsy with Dornier MPL 9000 on the basis of clinical examination, laboratory investigations, X-Ray, intravenous urography and ultrasonography. Simple analgesics /sedation were used before the procedure, except in children where general anesthesia was used. A total of 1965 patients were treated with 3930 sessions [Average 4.1 sessions per patients]. Male to female ratio was 1.8:1. Average age of the patients was 35.3 years. The average stone burden was 1.8cm in diameter. Stone did not break in 3.3% cases, where as in 53 [2.69%] cases partial fragmentation had occurred. Over all success rate was 84%. About 10.2% cases were lost to follow up. Complications like colic pain, transient haematuria and stein Strasse was observed in 33%, 17% and 2.5% respectively. Extra corporeal shock wave lithotripsy for renal calculi was simple, safe and effective in selected group of patients

Oral and intraperitoneal LD[50] of thymoquinone, an active principle of Nigella sativa, in mice and rats

Thymoquinone is the major active principle of Nigella saliva [N. sativa] and constitutes about 30% of its volatile oil or ether extract. N. sativa oil and seed are commonly used as a natural remedy for many ailments. Using modern scientific techniques, a number of pharmacological actions of N. sativa have been investigated including immunostimulant, anti-inflammatory, anticancer, antioxidant, antihistaminic, antiasthmatic, hypoglycemic, antimicrobial and antiparasitic. There are only few reports regarding the toxicity of thymoquinone. The present study was carried out to determine LD[50] of thymoquinone both in mice and rats, orally as well as intraperitoneal, by the method of Miller and Tainter. Autopsy and histopathology of liver, kidney, heart and lungs were also determined. The LD[50] in mice after intraperitoneal injection was determined to be 104.7 mg/kg [89.7-119.7, 95% confidence interval] and after oral ingestion was 870.9 mg/kg [647.1-1094.8, 95% confidence interval]. Whereas, LD[50] in rats after intraperitoneal injection was determined to be 57.5 mg/kg [45.6-69.4, 95% confidence intervals] and after oral ingestion was 794.3 mg/kg [469.8-1118.8, 95% confidence intervals]. The LD[50] values presented here after intraperitoneal injection and oral gavages are 10-15 times and 100-150 times greater than doses of thymoquinone reported for its anti-inflammatory, anti-oxidant and anti-cancer effects. Thymoquinone is a relatively safe compound, particularly when given orally to experimental animals

Pregnancy related acute renal failure; an experience at nephro-urology department Chandka medical college teaching hospital Larkana

Acute renal failure [ARF] during pregnancy is rare event and continues to be common in developing countries. 1998-2005. Nephro-urology unit at Chandka Medical College, Larkana. Retrospective study. 294 cases of Acute Renal Failure were treated. Among these cases, 72 [24.5%] were pregnancy related in origin. All of these patients were known to be previously healthy. Pregnancy related Acute Renal Failure was associated with, post partum hemorrhage was in 20 [27.7%], intra intiauterine death in 20 [27.7%] antipartum hemorrhage was 18 [25%], preeclampsia-eclampsia in 8 [11.11%] and septic abortion and puerperal sepsis in6 [8.3%]. Among these patients 65 [90.3%] required dialysis therapy because of moderate to severe azotemia. 35 [48.61%] patients recovered normal function. 30 [46.15%] developed irreversible renal function. Early reorganization of this disorder, improvement of health infra structure, antenatal health care and intensive supportive therapy, can reduce maternal and fetal mortality and morbidity

Early laparoscopic chdecystectomy

To assess the clinical outcome of laparoscopic Cholecystectomy for management of acute cholecystitis and to evaluate its safety, frequency of complications. Observational study. Surgical Units II and III of Chandka Medical College Hospital Larkana. From 01.09.2003 up to 31.12. 2007. A total of 100 consecutive cases of, acute cholecystitis confirmed subsequently by abdominal ultrasound scanning, who were admitted for early laparoscopic Cholecystectomy. There was female preponderance with male to Female ratio of 1:4.5. Mean age was 45.75, SD 11.99, and most of patients were received with in 24 hours from the onset of symptoms. In 51 patients ultrasound reveals Edematous GB in 24 [24%], Empyma 8[8%], Contracted 10[10%], Perforated 5[5%] and Gangrenous GB in 4[4%] while 49[49%] have acute cholecystitis with cholelithiasis. The conversion rate was 6%; The minimum time taken during the procedure was 50 minutes. No mortality was reported in this series. Emergency / early Cholecystectomy is reliable and safe modality cost effective, and timely surgery with modern conception in the management of acute cholecystitis, because of accelerated recovery, negligible wound infection or related complication, and less postoperative pain. So Lap Chole should be preferred technique now days for the treatment of acute cholecystitis at our Institute

Acute renal failure: An experience at nephro-urology department Chandka Medical College Hospital Larkana

To find out the various causes of acute renal failure [ARF] and its out come in our setting of tertiary Care Hospital in rural areas. A retrospective Study. Nephro-urology department Chandka Medical College teaching hospital Larkana. From March 1998 to March 2005. Review of 294 patients of acute renal failure admitted in Nephro-urology department Chandka Medical College teaching hospital Larkana. Detailed history, physical examination and laboratory data of 294 consecutive patients of acute renal failure were analyzed. 294 patients were included in this study. Among them 149 [51.7%] were in the younger age group [less than 40 years] with dominance of males [1.61 to 1.00 male to female ratio]. Major cause of ARF was pre renal, seen in 172 [66.6%] patients, 70 [23.8%] of all cases of acute renal failure had gynecological and obstetrical back ground. Other causes C.V.A in 24 [9.3%], HHD in 14[4.5%]. Glomerulonephritis in 22[8.5%],and obstructive uropathy in 16[6.2%]. 92 Patients [31.3%] improved on conservative treatment,166[56.5%] needed dialysis and 36[12.2%] left against medical advice. This data reveals that pre renal element is the single most important cause of acute renal failure, in which commonest cause was pregnancy related ARF followed by C.V.A,HHD, glomerulonephrits and obstructive urophathy. Early indentification, referral treatment of pre renal factors, good peri natal care and good therapeutic measures substantially bring down the incidence of acute renal failure. 12.2% patients left against medical advice due to heavy expenses on the treatment and needs NGOs and Government support for treatment of poor patients

Comparison of optical urethrotomy with perineal urethroplasty in the management of traumatic blind posterior urethral stricture

To assess the efficacy, safety and complication of optical urethrotomy in traumatic blind posterior urethral stricture, and compare results with perineal urethroplasty. A prospective study of 40 cases of blind traumatic urethral stricture was conducted at the department of urology, Services Hospital Lahore from Feb: 1997 to March 1999. Majority of the patients [32] were in the 2nd to 4th decade of life. Most cases [30] belonged to the urban areas and the common site was membraneous urethra. Road traffic accident [36] and fall from height [3] were the commonest causes of stricture development. Twenty cases were treated with optical urethrotomy and 20 by urethroplasty. Although results of perineal urethroplasty were good [77.5%] as compared to optical urethrotomy [68.5%] but statistically no significant difference observed between two groups [P=0.257]. The difference between morbidity, mean peak flow rate and mean residual urine was also insignificant. There was significant difference between two groups in terms of operative time, mean hospital stay and blood transfusion. It is recommended that optical urethrotomy may be used as a alternative procedure to urethroplasty in patients with blind traumatic posterior urethral strictures

Experience with cold knife optical internal urethrotomy and temporary dilatation

to evaluate the out come and efficacy of cold knife optical urethrotomy and temporary dilatation. Design: a retrospective analysis of 127 cases. Place and duration of study: the study was carried out over a period of three years [March 1997 To April 2000] In The Larkana Medical Centre Private Larkana. One hundred and twenty seven male patients with urethral stricture were treated with cold knife optical urethrotomy over a period of three years. An analysis was carried out of the short-term results of optical internal urethrotomy and temporary dilatation to determine the out come and efficacy of the procedures. The age range was 15-75 years, the mean age being 36.6 years. the follow-up period of treated patients ranged from three months to three years. The results showed that early morbidity was 15% with no mortality. The recurrence rate was 8.9%. The results are consistent with other studies and confirm this as the preferred initial procedure in urethral stricture of penile,bulbar, membraneous and prostatic urethra. Optical urethrotomy is the preferred initial management of urethral stricture. Urethroplasty should be considered in failed optical urethrotomy and recurrent urethral stricture disease

Extra-corporeal shock wave lithotripsy; early experience with chinese lithotriptop at larkana

To evaluate the early Results of experience of ESWL to the effectiveness of Chinese lithotriptor. Period: From May 1999 to October 1999. Setting: Almas Medical Lithotripsy Center, Larkana. Fifty patients having renal and upper ureteric stones were treated with Chinese lithotriptor. Patients and The stone imaging and localization was done with the help of fluoroscope. The ages of the patients ranged from 10-52 years [average: 32 years]. 17[34%] were males and 33[66%] were females. Forty two patients had renal stones and 08 had upper ureteric stones. Simple analgesic and sedation was used before the procedure on 1st sitting. The over all stone free rate after 3 months of treatment was 78%. Five patients [10%] were dropped from the list because of failure of treatment. Remaining 6 patients [12%] showed partial fragmentation and residual stone in lower calyx. We noticed few transient complications including colic and haematuria which were managed easily. We conclude that the Chinese lithotriptor was as effective as other lithotriptors. It is also cost-effective