Forgotten long-term indwelling double "J" stent.

A poor, uneducated patient from a rural background presented to us with burning micturition and colicky pain in the loin. He had undergone surgery for pelvi-ureteric junction (PUJ) obstruction on the right side four years earlier. Following surgery, the patient was irregular in his follow-up and, as such, he did not get the double "J" (DJ) stent, which was placed during surgery, removed. Ultrasonography performed during the present admission revealed mild hydronephrosis of the right kidney with a tiny calculus in the urinary bladder. Intravenous urography revealed mild hydronephrosis with the DJ stent in situ in the right kidney. After an unsuccessful attempt with cystoscopy, the stent was removed successfully by suprapubic cystostomy. The post-operative course was uneventful and the patient was discharged in seven days.

Asymptomatic infantile cystic nephroma: a diagnostic dilemma.

Cystic nephroma, also called multilocular cystic nephroma, is a relatively rare, nongenetic, benign, unilateral, renal multicystic lesion. The non-specific clinical findings and the poor contribution of imaging examinations make the preoperative diagnostic dilemma from other cystic renal neoplasia; thus nephrectomy seems to be the most preferable treatment. We report a case of cystic nephroma in 11 months old male child presented with asymptomatic lump in abdomen. After a series of examinations including abdominal ultrasound, intravenous pylography and computed tomography, he underwent radical nephrectomy and diagnosis is confirmed on histopathology.

Outcome of urethral strictures managed by general surgeons in a rural setting of India.

In resource limited settings victims of urethral strictures often seek healthcare,when the strictures are far advanced. For a surgeon, management is indeed a challenging task, given the severity and extent of disease, lack of expertise, enough skills and equipment in the healthcare facility. This study was conducted at a rural teaching hospital in central India. All patients were assessed for the extent and severity of strictures and to rule out other causes of lower urinary obstruction. Outcome of all patients was assessed with American Urological Association Urinary Symptom Score and Urinary Flow Rate (ml/sec) before procedure, post procedure and at 6-12 months. Between 2007 and 2009, 110 patients, between 18-75 years of age were enrolled in this study which showed that a third of patients treated with urethral dilatation and optical internal urethrotomy required another intervention. It is conclude that urethral dilatation and internal optical dilatation result in short term improvement in urine flow rates and symptoms. Urethroplasty, the current gold standard of therapy for urethral strictures, results in outcomes that are clinically meaningful and more cost effective for a patient. The Americal Urological Association (AUA) symptom score and Urinarry Flow Ratemay be used to objectively assess outcome following surgical management of urethral strictures.

Rural centre based management of the carotid body tumour.

A 40 year old male patient reported to our rural based hospital with a complaint of discomfort associated with a swelling on the left side of the neck since 8 years. A provisional diagnosis of a carotid body tumour was made based on clinical examination and ultrasound examination. Higher investigations could not be performed due to unavailability at the rural setup and referral to a specialty centre was not possible due to financial constraints of the patient. Even with advances in diagnostic and surgical techniques, surgery still presents a major threat of injury to the cranial nerves. Nevertheless, it remains the preferred method of treatment for these tumours. Our case shows that such masses can be removed successfully and that, with care, the cranial nerves and the carotid arteries can be preserved at the rural hospital.

An omental teratoma in a young girl.

Teratoma is the most commonly encountered germ cell tumour among the most common ovarian tumours; however, teratomas of the omentum and mesentery are extremely rare. They are usually asymptomatic or can produce compressive symptoms. The imaging features are suggestive. The present report describes such a case of primary omental teratoma encountered in a young patient, which was managed by surgical resection. The histopathological examination confirmed the diagnosis of mature cystic teratoma. Germ cell tumors are congenital tumors containing derivatives of all the three germinal layers, frequently seen in gonads. But their occurrence in extragonadal sites, such as omental teratoma, is relatively rare.

Transilluminant naso-orbital dermoid cyst masquerading as meningocele.

Dermoid cysts are ectodermal inclusion cysts with epithelial lining in the subcutaneous tissue along the lines of embryonic fusion. Encephalocele, meningocele, hemangioma, lipoma, cephalohematoma, and sebaceous cyst are the differential diagnoses. The differentiation between them is essential for effective management to proceed. Obtaining a reliable history, completing a careful physical examination, and accurate radiographic documentation represent the first steps. We report a case of a naso-orbital dermoid cyst that was transilluminant, thus masquerading as a meningocele.

Megalourethra with calculi.

Megalourethra is a rare congenital malformation of the urethra. Multiple associated anomalies have been noted in the cases reported thus far. However, none of the cases reported showed associated calculi either in the megalourethra or elsewhere in the urinary tract. A case of scaphoid megalourethra is presented here to illustrate the unique presence of multiple calculi in the megalourethra.

[Modified posterior unilateral laminectomy for a complex dumbbell schwannoma of the thoracolumbar junction]. / Torakolomber bileskeyi tutan dumbel sivanomun modifiye posterior yaklasim ve tek tarafli hemilaminektomi ile tedavisi.

We report on an uncommon type of complex dumbbell schwannoma involving the thoracolumbar region, which was successfully managed with unilateral hemilaminectomy using a modified posterior approach. A 19-year-old male patient presented with one-year history of low back pain radiating to the lower limbs, limping of two month-history, and hesitancy of micturition of 15-day duration. Clinically, a diagnosis of conus-cauda lesion was suspected. Findings of the X-ray and magnetic resonance imaging of the dorsolumbar spine were suggestive of a complex dumbbell schwannoma, extending from the lower part of the T11 level to the upper part of the L1 vertebrae left to the spinal cord, with extension through the intervertebral foramina to the paraspinal region on the left side. A modified posterior approach with unilateral laminectomy was used for complete removal of the tumor. The histological diagnosis was schwannoma. The patient had minimal pain postoperatively, he was mobilized on the third day without the need for any external support. At one year follow-up, he had normal motor and sensory functions in the lower limbs.

Obstructive jaundice in neonates.

The causes of jaundice in the first few weeks of life may be categorised into hematologic, enzymatic/metabolic, infectious and obstructive. Obstructive jaundice results from an interruption in the drainage of bile in the biliary system. Surgical causes of jaundice in neonates are biliary atresia, inspissated bile syndrome, intrahepatic hypoplasia, choledochal cyst, Caroli's disease and spontaneous perforation of the bile duct. Pediatricians should be aware of the pernicious consequences of unresolved biliary obstruction and should thus refer neonates or infants with inexplicable jaundice for surgical exploration at an earlier age.