Aneurysmal bone cyst of pubis a rare presentation

Aneurysmal bone cyst is a benign usually expansile, solitary lytic lesion of bone; with blood filled cystic cavities, which tend to grow eccentrically. Such eccentric growth may, on occasion, attain considerable size before it is clinically recognized, particularly if the tumor arises in a deeply situated bone. Aneurysmal bone cyst of pubis is a rare entity. In the following case report, an aneurysmal bone cyst, originating from the superior pubic ramus, expanded into the groin and first manifested itself as a gradually increasing fullness in groin and pain especially with weight bearing. The size and location of this vascular tumor posed difficulties in treatment. It was managed by curettage with high speed burr and reconstruction of the defect with an iliac crest cancellous bone graft

Transperitoneal approach for radical Nephrectomy: five years experience at Pakistn Institute of Medical Sciences, Islamabad, Pakistan

Renal cell carcinoma [RCC] comprises 85% of all renal neoplasms. Radical nephrectomy is the only hope of cure for patients with RCC. Role of chemotherapy and radiotherapy is very limited because of the chemo-radio resistant nature of these tumours. Several surgical approaches have been employed depending upon surgeon preference, size and location of the tumour. Objective of this study is to share the five years experience [from 1999 to 2004] of radical nephrectomy at Urology Department, Pakistan Institute of Medical Sciences [PIMS], that was performed through anterior sub costal trans-peritoneal incision. It was a descriptive type of study with convenient non probability sampling technique. 100 patients were included. Patients were assessed by their mode of presentation, laboratory investigations, intra-operative findings, control of renal pedicle, total operative time, blood loss, intra-operative and post operative complications. The observations were noted on a proforma and analysed on SPSS version 10. Out of 100 patients, 64% were male and 36% were female with mean age of 58 years. Most common presentation was pain, present in 60% of patients. 88% of patients had normal renal function test. Average tumour size was 7.93cm, diagnosed on ultrasonography [USG] and CT scan. Average time taken to get control of renal pedicle was 73.2minutes. 20% of patients needed venacavatomy and thrombectomy, which was easier through this approach. Mean operative time was 129.44 minutes. Average blood loss was 274.2ml. No intra-operative complications were seen. Mortality rate was 4%. Radical nephrectomy is still the best option for treatment of renal cell carcinoma. There are various surgical approaches, however, anterior subcostal transperitoneal approach is more effective with early control of renal pedicle, less blood loss and minimal manipulation of the kidney thus minimizing the risk of embolism

Jelly belly test

A technique is described as how to appreciate urethral obstruction prior to attempt at catheterization to avoid injury to urethra. In this technique anesthetic jelly is administered through external urinary meatus, which leads to distension of distal urethra in case of obstruction

In situ piezoelectric ESWL for ureteric calculi

To assess in situ Piezoelectric ESWL for ureteric calculi, avoiding false positive results arising from the spontaneous passage of small stones and also to evaluate the efficiency of the EDAP LT02 Lithotriptor for insitu ESWL treatment of ureteric calculi. A prospective evaluation of patients with ureteric calculi treated with Piezoelectric ESWL using EDAP LT 02 Lithotriptor. patients with ureteric calculi treated with Piezoelectric ESWL using EDAP LT 02 Lithotriptor for a period of twelve months, coming to Urology department of Pakistan Institute of Medical Sciences [PIMS], Islamabad, as out door patients. A prospective evaluation of patients with ureteric calculi treated with Piezoelectric ESWL using EDAP LT 02 Lithotriptor for a period of twelve months, Seventy two patients, 60 males and 12 females, with mean age of 39.6 years, presenting with solitary ureteric calculus were treated using EDAP LT 02 Piezoelectric Lithotriptor, lo calization with fluoroscopy. No regional or general anesthesia given. After 3 months follow-up, of the 72 ureteric calculi cases, 60[83.3%] were successfully fragmented and ureter was stone free in 54 patients [75.1%] after insitu ESWL alone. The mean duration of stone clearance was 50 days [SD +11.58]. Sixteen patients required one session only, 28 patients required 2 sessions and twelve patients required three and more than three sessions. Stone location was 28 upper ureteric, 18 middle and 26 in lower ureter. Stone size varied from 7mm.to 17mm. in longest diameter. The average number of session, 1.5 for upper ureteric stone, 1.8 for mid and lower ureteric stones. Stone clearance for upper ureteric calculus was 85.7%, for mid ureteric 66.7% and for lower ureteric 69%, the overall stone clearance was 75%. In situ piezoelectric ESWL is safe, simple and effective technique for treating ureteric calculi. The site and size of the stone affects the success rate