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Tuberous Sclerosis Complex [TSC] is a syndrome characterized by cellular hyperplasia, tissue dysplasia and multiple organ hamartomas. It is a lifelong condition requiring periodic monitoring and evaluation to reduce morbidity and mortality. Our patient is a 32-year-old male who presented to us as an undiagnosed case since childhood with one-week history of abdominal pain. He was uneducated, as well as, suffering from bipolar disorder. On examination, he fulfilled five major clinical criteria required for diagnosis of TSC. The abdominal pain was due to renal complications of the disease, bilateral angiomyolipomas. The routine renal function tests were normal; however, confirmatory radioactive nuclear scan [DTPA] was done to evaluate detailed functional status of both kidneys. The results of DTPA indicated critically low split kidney function bilaterally, inhibiting us from any immediate surgical intervention. The patient was put up on monthly follow-up and treated for his bipolar disorder. Delay in diagnosis for more than 30 years lead to the complications of renal angiomyolipomas and bipolar disorder. Prompt diagnosis, periodic monitoring and evaluation based on individual TSC-associated neuropsychiatric disorders [TAND] profile will delay the complications and help patients becoming productive members of the society
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Abstract: Treatment of urolithiasis has been revolutionized with the introduction of extracorporeal shock wave lithotripsy [ESWL] due to its simplicity, non-invasive nature, efficacy, and minimal morbidity. Pain experienced during ESWL is considered to be multifactorial including type of lithotripter used, frequency, voltage, age, and sex of patient. Various analgesic agents including opiods, nonsteroidal anti-inflammatory drugs, local anesthetic agents and a number of combinations have been used during extracorporeal shock wave lithotripsy by various techniques
Objective: Compare the mean pain score after giving Diclofenac Sodium versus Nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy. Study Design: Randomized control trial study Setting: Department of Urology SIMS/SHL Lahore Period: 01.12.2012 to 01.05.2013
Methods: Total number of 150 [75in each] patients were included in two groups [Diclofenac sodium group A SD 3.28+ 0.18, Nalbuphine group B SD 4.11 + 1.69]. Inclusion and exclusion criteria strictly followed. Detailed history including [age sex address], informed consent, labs, bleeding profile, RFT, X-rays KUB, USG, IVU, and pregnancy test checked. Patients divided in two groups by lottery method. Injection Diclofenac sodium given deep intramuscular, while Nalbuphine HCL intravenous. Both groups were observed pain during ESWL. Data was analyzed by using SPSS version 10, SD, P value calculated
Results: A total of 150 [75 in each group] cases were enrolled after fulfilling the inclusion/exclusion criteria, majority of the patients in both groups were between 41-50 years i.e. 33.33%[n=25] in Diclofenac sodium group and 32%[n=24] in Nalbuphine group, mean and SD was calculated as 35.98+3.54 in Diclofenac sodium and 37.32+3.83 years in Nalbuphine group, 58.67%[n=44] in Diclofenac sodium and 52%[n=39] in Nalbuphine group were male while 41.33%[n=31] in Diclofenac sodium and 48%[n=36] in Nalbuphine group were females, mean pain score after giving diclofenac sodium versus nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy was recorded as 3.09+0.54 in Diclofenac sodium and 4.93+0.79 in Nalbuphine Group, p value was computed as 0.05
Conclusion: We concluded that on comparison of mean pain score after giving Diclofenac Sodium versus Nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy, significant low pain score was recorded in patients treated with Diclofenac Sodium which may be used in future to control the pain
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Background: urinary stones disease is a global problem with a declining incidence since 19[th] century. Commonly seen in Middle East and China, bladder stones are however rare in the western world. Giant vesical calculi especially those weighing more than 100 grams, are even rare in today's urologic practice due to early sought medical attention and prompt treatment
Case Presentation: the current case report is about a 40 years old Asian male who presented with dysuria, suprapubic pain, difficulty in micturition and intermittent pyrexia and hematuria for the last 1 year. Investigations revealed severe anemia, raised white blood cell count, serum urea and creatinine. Radiological investigations confirmed the presence of a large vesical stone. Initial management included Percutaneous Nephrostomy along with pre-operative preparation of the patient followed by open vesicolithotomy. Clearance of the obstruction resulted in improvement of renal function and patient was discharged home in satisfactory condition
Conclusion: despite the overall decline in the incidence of urinary stones and development in the diagnostic and interventional urology, neglected cases are still seen in the outdoors due to lack of knowledge and awareness at the patient level and inadequate availability of investigation facilities in the developing countries. This sufficiently delays the treatment and results in severe complications which at times may be permanent and un compensate able
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Background: Adequate vascular access is of utmost importance for hemodialysis treatment. Upper arm fistulae, obesity and deep or tortuous veins may impair cannulation and can cause significant complications and inconvenience for the technicians and patients
Objective: We intended to present the technique of superficialization [transposition] of the brachiobasilic fistula [BBF] and its clinical outcome regarding patency and complications
Materials and Methods: Twenty two brachiobasilic fistulas were fashioned in 20 patients between October 2010 to November 2011.The second stage superficialization [transposition] was carried out at a median of 59.1 days [range: 40-90 days] after fistula formation and involved mobilizing the arterialized basilic vein through a curved longitudinal incision on the antero-medial aspect of the arm and transposing it beneath skin
Results: During the study period 20 brachiobasilic fistulas [BBF] were fashioned in 20 patients. There were 8 [40%] males and 12 [60%] females. The mean age was 53.45years + 12.34 years [range: 21-70years]. The patency rates were 90% at 6 months. Surgical complications of transposition were infection in 2 [10%] patients and lymphocoele in 4 [20%] patients
Conclusion: Transposition of brachiobasilic fistulas is technically feasible and relatively safe procedure. Patency rates at 6 months are excellent
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Background: Urinary incontinence leaves the sufferer with physical and psychological stresses. Majority of the cases are caused by an underlying treatable condition however the it is under reported to medical care providers. The objective of this study was to explore the psychosocial impacts of urinary incontinence and assess quality of life in patients with urinary incontinence in Pakistan
Methods: This study was conducted at five tertiary care hospitals in the city of Karachi during January 2013 to December 2013. Self-administered questionnaire was prepared and adjusted according to the local social dynamics of the community based on 'Incontinence Impact Questionnaire' and 'The Kings Health questionnaire'. Inclusion criteria included urinary incontinent patients visiting outpatient departments
Results: The study comprised of 280 participants with a response rate of 80%. Overall 89 males and 191 females participated. Majority of the sample population [40.7%] believed that the weak anatomy was the etiology of their Urinary Incontinence. More than 40% of the participants declared that they would rate 'the fear that an embarrassing condition could arise in result of their disease' as 'Moderate' followed by 38.2% as 'Highly'. 39.64% stated that their social life including interaction with people was 'Moderately' affected and 21.7% believed that they their social interaction was 'highly' limited. Regarding travel, majority of the participants asserted that their travel has been restricted to a great extent and rated as Highly [30.7%] or Moderate [29.6%]. In total 28.5% patients stated that their exercise schedule had been 'Moderately' affected as a consequence of their disease
Conclusion: Patients with urinary incontinence should be heard comprehensively by the care providers. Coping techniques for patients and education regarding Urinary incontinence should be provided by the medical practitioner to the sufferers
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Introduction: Migration of intrauterine contraceptive device [IUD] into urinary bladder is not very common. Secondary stone formation is a rare complication. It occurs as a result of complete migration of the IUD into urinary bladder. To date, more than 80 cases of IUD migration to the bladder have been reported in the literature with varying stone sizes. A series of 15 cases to whom an IUD migrated from the uterus to the bladder and resulted in formation of a stone over it
Methods: A cohort of fifteen women was treated for bladder stones over migrated IUD within June 2004 to May 2012. Detailed history was maintained, diagnosis was established by pelvic ultrasonography and/or X-rays pelvis. All cases were managed by endoscopy. All cases undergo Cystoscopy and litholapexy
Results: The mean age of participants was 39.7+5.29 years [28-49]. Major objection in almost all cases was lower urinary tract symptoms; which were not responding to medical treatment, six patients had few episodes of macroscopic hematuria. The interval between insertion of IUD and onset of symptoms ranged from 2 to 5 years. In twelve cases IUD was embedded in urinary bladder wall and an entire intravesical IUD in rest 3 with calculus formation in all of them. Stones were crushed along with retrieval of IUD as a result of which mild hematuria was reported in 4 cases. Patients remained with Foley catheter from 7 - 14 days. Postoperative recovery was uneventful
Conclusion: Intrauterine contraceptive device [IUD] perforation to the bladder, with stone formation, is an uncommon event. Clinically it is difficult to reach its diagnosis but persistence of lower urinary tract symptoms in women with IUD should raise the suspicion of intravesical migration. Sonologist can define intravesical migrated IUD. Endoscopy proved a better and safe procedure with a very low complication rate
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To highlight, evaluate and analyze the complications associated with the treatment of fractures, joint dislocations and limb deformities by bone setters in a suburban population of district Kasoor. Prospective descriptive study. This study was conducted at the Department of Trauma and Orthopaedics, Central Park. Medical College based at Bhatti International Teaching Hospital, Kasoor. This was a six month prospective study involving eighty six [86] consecutive patients presenting with complications related to treatment of their musculoskeletal injuries by bone setters. Eighty six patients with complications associated with previous treatment by bone setters were seen 62.7 [%] were male while 37.2 [%] were female. The age range from 4 months to 76 years [mean 34 years]. out of eighty six patients, 15 [17.4%] patients had non union, 21 [24.4%] had malunion, 9 [10.4%] had avascular necrosis, 15[17.4%] had chronic osteomyelitis, 4[4.6%] patients had gangrene, 8[9.3%] had contractures, 2[2.3%] had persistent dislocations, 4[4.6%] had Leg ulcers and 8[9.3%] had wound infections. The major reasons for going to bone setters were the perceived low cost of treatment [45%], pressure and advice from the elders and friends [38%], fear of surgery [5%] and assumption of faster healing by the bone setters [12%]. The methods used by the bone setters include splintage, bandage, plaster, stretching, massage and suturing. Bone setters create very difficult problems for orthopaedic surgeons. Many patients develop complications and loose their limbs due to inappropriate treatments. Awareness programs regarding inadequate treatment given by bone setters are necessary and their Patronization should be discouraged to avoid these types of complications
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Humanos , Masculino , Femenino , Fracturas Óseas/terapia , Complicaciones Posoperatorias , Población Suburbana , Estudios Prospectivos , Encuestas y Cuestionarios , Osteomielitis/etiología , Fracturas Óseas/complicaciones , Resultado del TratamientoRESUMEN
Pubic pain is a common symptom in athletes and in soccer players.Its cause can be difficult to determine. We report a case in a 14-year-old boy who presented with bilateral adductor muscle abcesses following a trivial injury to the groin. The etiology, radiological findings and treatment, along with literature review are discussed. The main causes of pubic pain after sports are thought to be sports related microtrauma to the pubic rami or symphysis and lesions of the oblique, rectus or adductor muscles or their tendons1, 2. Osteitis pubis refers to a painful inflammation of the periosteum, bone, cartilage and ligamentous structures of the anterior half of the pelvis. Pubic osteomyelitis is an uncommon entity, accounting for less than 1% of all cases of Heamatogenous osteomyelitis. We report a case of bilateral adductor muscle abcess six week after a trivial injury in sports
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Fracture of penis is relatively uncommon but grave urological emergency, which needs urgent surgical intervention to achieve good postoperative outcome
Objective: To determine the outcome of early surgical repair in patients presenting with fracture of penis
Patients and Methods: This retrospective study comprises 13 patients with fracture of penis, presenting in emergency of Services Hospital, Lahore from 2000-2007. Diagnosis was made clinically. No radiological investigation was carried out. All patients had primary suturing of the tunica tear and were followed up for 2-6 months postoperatively
Results: Mean time interval between accident and arrival to hospital was recorded. Eight patients [61.5%] had fracture due to sexual intercourse. Three patients [23.08%] bending of penis. Masturbation and fall on to an erect penis each accounted for 1 [7.70%] of the total cases. There were no significant complications except necrosis of penile skin in one patient. Erectile function was preserved in all patients postoperatively
Conclusion: Early surgical intervention for penile fracture has good postoperative outcome with acceptable complication rate. Early diagnosis and surgical repair are instrumental in ensuring good outcome and minimal complications
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A case of a 30-year-old female with tuberous sclerosis, a genetic, rare, variably expressed disease is described in the present case report. Clinical symptoms were unexplained fever, pain in lumber areas and gross hematuria. Computed tomography scan of the abdomen revealed enlarged, heterogeneous kidneys, with low density tumors corresponding to angiomyolipomas. Computed tomography scan of the chest showed bilateral, diffuse, small thin-walled cysts in the lungs characteristic for pulmonary lymphangioleiomyomatosis. CT scan of the brain revealed subependymal calcifications. These three diagnostic features are rarely exhibited in a single patient. Bilateral renal angiomyolipomas and pulmonary lymphangioleiomyomatosis are some presentations of tuberous sclerosis and the coexistence of both conditions may cause devastating morbidity and mortality
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To determine the incidence of lymphocele in patients who under went renal transplantation, as well as potential factors responsible or associated to its development. All records of 25 patients who were operated for renal transplant in SIMS/SHL between March 2006 to December 2007 were reviewed for lymphocele. The surgical technique was the standard one. All lymphatic vessels were either ligated or diathermized. Baseline post operative ultrasound after one week done or whenever indicated for lymphocele. 10% povidone iodine instilated in case of lymphocele. Patients were followed for an average of six months with history, physical examination and ultrasound on each visit. 25 patients [20 male and 5 female] have received renal allograft from live donors. There was 1[4%] instance of lymphocele; encountered at two weeks after renal transplantation. Careful ligation of lymphatic vessels both during graft preparation and during implantation can significantly contribute to reducing incidence of lymphocele following renal transplantation. Instillation of 10% povidone iodine in the lymphpcele can cure and prevent its recurrence
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Trasplante de Riñón/efectos adversos , Incidencia , Linfocele/etiología , Povidona Yodada , Complicaciones Posoperatorias , Linfocele/prevención & controlRESUMEN
To report the functional results, complications and cosmesis by using Thiersch Duplay urethroplasty repair for hypospadias. Between years 2006 to 2007, 30 patients underwent repair of proximal hypospadias [penoscrotal] with chordee. Two stage repair was performed in all cases. 1[st] stage consisted of chordee correction by excising fibrous cord between ectopic meatus and corona along with incision of glans. The grafting of the dorsal hood skin was made on ventral aspect of tunica albuginea. In second stage repair U shaped incision was made around hypospadiac meatus and a ventral skin flap was dissected superficially to allow tubularization around a suitable size silicon Foley catheter [5 -8 Fr in children, 10-12 Fr adolescence and 14-16 Fr in adults] without tension. The Thiersch Duplay tube was constructed using 5/0 vicryl. A subcutaneous fascial layer was closed over tube to support neourthra. The Foley catheter was left for 10-12 days. Age range was 3-25 years with mean +/- SD of 12.7 +/- 5.09. Total hospital stay was 10-12 days with mean +/- SD of 11.9 +/- SD 0.85. Twenty five patients [80.2%] could void on standing and had a good caliber straight single stream of urine in forward direction. The cosmetic appearance of a natural vertical slit glanular meatus situated at the normal position on the glans achieved in twenty five patients. Period of follow up was 4-8 month mean with mean +/- SD of 6 +/- 1.43. Main complications seen were urethrocutaneous fistulae in three [9.9%], meatal stenosis in three [9.9%], hematoma in one [3.3%], complete disruption in one [3.3%] infection in two [6.6%] and painful bladder spasm in two [6.6%]. These seen in five [16.5%] patients. Staged urethroplasty for proximal hypospadias results in a normal penis with good functional, minimum complications and excellent cosmesis, with short hospital stay