Successful management of multiple obstructing renal calculi in a 30-year-old patient with autosomal dominant polycystic kidney disease using Frequency-Doubled Double-Pulse neodymium: Yttrium - Aluminium garnet laser lithotripsy.

Autosomal dominant polycystic kidney disease (ADPKD) is the most prevalent genetic disorder that results in end-stage renal disease. Although ADPKD patients experience long disease trajectories, factors such as hypertension, proteinuria and renal calculi have been observed to lead to rapid renal function impairment in patients with ADPKD. Furthermore, due to the distorted anatomy that makes access to stone difficult, the management of nephrolithiasis in ADPKD patients is one of the several special situations in which urinary lithiasis presents management challenges. We report the case of a 30-year-old male with ADPKD and renal function impairment as a result of multiple obstructive calculi who was treated in Dialyser Medical Centre, Oshodi, Lagos, with Frequency-Doubled Double-Pulse Neodymium: Yttrium - Aluminium Garnet laser (FREDDY laser) lithotripsy, highlighting the possible advantage of FREDDY laser over other types of laser procedures given the minimal tissue-damaging potential of the laser type.

The Fire Service for the Removal of a Metallic Penile Constricting Device: A Ready Help When All Else Fail.

The placement of a constricting device around the penis is a urologic emergency. Though injuries from constricting penile devices are generally rare, they may be associated with serious complications. There is no standard modality for the removal of penile constricting devices and the management of the patient can therefore prove to be a formidable challenge to the urologist. Timely intervention is always important in preventing complications especially penile gangrene. Depending on the type of device used along with the duration and severity of penile constriction caused, significant resourcefulness may be required in the treatment of the patient. Achieving a timely and successful outcome may require a multidisciplinary approach involving equipment only available with the fire service or other agencies. We report the case of a 30-year-old man with a background psychiatric illness who had his penile constricting device removed under conscious sedation in the emergency room with the aid of a power driven arc saw from the fire service with a successful outcome.

C-arm fluoroscopy in orthopaedic surgical practice.

The use of C-arm fluoroscopy in intraoperative orthopaedic procedures has become an important tool in modern orthopaedic surgical practice. It enhances the technical proficiency of the surgeon in addition to reducing the morbidity and length of hospital stay of the patient. Despite the documented benefits of this device, there has been a growing concern about the increased radiation exposure to the surgical team. We therefore present the review of the literature on the usefulness of C-arm fluoroscopy, pitfalls in application of the machine as well as the harmful radiation effects and precautionary measures that need to be observed when using the C-arm fluoroscopy in orthopaedic surgical procedures.

A summary of the controversy surrounding off-label medications in men's health.

While there are common and accepted practices in men's health, barriers exist to treatment of these disorders with Food and Drug Administration (FDA) approved medications. In male factor infertility, these barriers include studies that are often underpowered for desired outcomes. This has led to the use of medications previously examined in females in an off-label fashion for treatment of male infertility. Issues surrounding the treatment of hypogonadism in men are more complex, becoming increasingly so in the last few years. Drug companies have developed compounds for treatment of hypogonadism for particular subgroups of men. However, the indicated groups for these medications are narrow leading to these medications being regularly used for an indication the FDA considers to be part of "normal aging". This work will examine the controversy surrounding the use of off-label medications in men's health and how factors like pharma advertising, FDA regulation and difficulties in creating adequate studies has affected the current paradigm.

Effect of anger provocation on endothelium-dependent and -independent vasodilation.

Anger is an independent predictor of coronary heart disease events, although the mechanisms for this relation are unclear. The effects of an anger-provoking interview compared with a neutral interview on endothelium-dependent and -independent vasodilation assessed by brachial artery ultrasound were examined in 14 healthy subjects without coronary heart disease risk factors. The anger provocation condition, but not the neutral condition, caused a significant impairment in endothelium-dependent vasodilation at 90 minutes compared with baseline (p = 0.004) and 30 minutes (p = 0.013). Similarly, endothelium-independent vasodilation was significantly impaired at 90 minutes after the angry interview compared with baseline (p = 0.003) and 30 minutes (p = 0.001). The decreases in endothelium-dependent and -independent vasodilation were greater after the anger-provoking interview than after the neutral interview, especially between 30 and 90 minutes. In conclusion, preliminary results suggest that an episode of anger is associated with a dysregulation in endothelium-dependent and -independent pathways, suggesting that these mechanisms might contribute to the link between anger and coronary heart disease events.