Neglected Broken Femoral Intramedullary Nail Resulting in an Urethrocutaneous Fistula.

A femur fracture is one of the most commonly encountered fractures by orthopaedicians worldwide. Being one of the longest and strongest bones in the body, it is one of the principal load-bearing bones of the lower extremity. Various modalities of fixation have been tried and tested for femur fracture but the most accepted fixation modality for diaphyseal femur fracture worldwide is the interlocking intramedullary nailing. However, intramedullary nailing is not free of any complications. Complications such as infection, non-union, malunion, limb length discrepancy due to wrong size nail, screw or nail breakage, and injury to neurovascular structures while passing guidewire or drilling for the interlocking bolt are commonly reported. We report a case of a patient who presented with a neglected broken femoral nail which resulted in an urethrocutaneous fistula. As per our literature review, this complication has never been reported before.

Is preoperative neutrophil-to-lymphocyte ratio a red flag which can predict high-risk pathological characteristics in renal cell carcinoma?

INTRODUCTION: Renal cell carcinoma (RCC) is known to invoke both immunological and inflammatory responses. While the neutrophils mediate the tumor-induced inflammatory response, the lymphocytes bring about the various immunological events associated with it. The neutrophil-to-lymphocyte ratio (NLR) is a simple indicator of this dual response. We investigated the association between preoperative NLR and histopathological prognostic variables of RCC intending to find out whether it can be of value as a red flag capable of alerting the clinician as to the biological character of the tumor under consideration. METHODS: Preoperative NLR and clinicopathological variables, namely histological subtype, nuclear grade, staging, lymphovascular invasion, capsular invasion, tumor necrosis, renal sinus invasion, and sarcomatoid differentiation of 60 patients who underwent radical or partial nephrectomy, were analyzed to detect the association between the two. RESULTS: We found that mean preoperative NLR was significantly higher in clear-cell carcinomas (3.25 ± 0.29) when compared with nonclear-cell carcinomas (2.25 ± 0.63). There was a linear trend of NLR rise as the stage of the disease advanced. A significant rise in preoperative NLR was noted in tumors with various high-risk histopathological features such as tumor size, capsular invasion, tumor necrosis, and sarcomatoid differentiation. CONCLUSION: Preoperative measurement of NLR is a simple test which may provide an early clue of high-risk pathological features of renal cell cancer.

Schwannoma: An uncommon dweller in the adrenal gland.

An elderly adult woman presented with upper abdominal pain to the urology department. Imaging studies revealed a right adrenal lesion with central necrosis, abutting the large vessels and suggestive of malignancy. Histopathology showed an encapsulated spindle cell tumor with marked nuclear atypia, cystic change, and hemorrhage. S100 immunomarker was strongly and diffusely positive. Final diagnosis was ancient schwannoma with secondary change. Schwannomas are rare in the adrenal gland, with <50 cases reported in the literature. These incidentally detected nonfunctional adrenal tumors need confirmation with histopathology and ancillary studies.

Can new, improvised Visual Prostate Symptom Score replace the International Prostate Symptom Score? Indian perspective.

INTRODUCTION: Visual Prostate Symptom Score (VPSS) was introduced to overcome the drawbacks of the International Prostate Symptom Score (IPSS). However, this score also has potential for improvement. MATERIALS AND METHODS: The primary objective of this study was to evaluate the utility of VPSS in patients with benign enlarged prostate (BEP) after uroflowmetric validation of the stream component. The secondary objective was to improve VPSS by adding a new severity grading and to assess if the "new upgraded VPSS" can replace IPSS in terms of ease of completion without assistance and the time taken. RESULTS: Of 115 patients, 42.60% of them were of the age group between 61-70 years; mean ± standard deviation age was 64.75 years ± 8.042 (range 48-90 years). Nineteen (16.52%) patients, who had education level ≥10th grade completed IPSS without assistance. One hundred and eight (93.91%) patients completed VPSS without assistance (P = 0.000). None of those (0/6) with no formal education (but able to read and write) could complete the IPSS without assistance, whereas 66.67% completed the VPSS without assistance. Six minutes and two minutes was the average time taken to complete IPSS (4-10 min) and VPSS (1-3 min), respectively. Responses to different variables of VPSS were statistically significant (P < 0.001) compared to the IPSS. Correlation between the severity grading of the two scores was statistically significant (P < 0.001), with a statistically significant positive correlation between VPSS and IPSS (r = +0.582, P < 0.001). The new severity grading system developed on par with the IPSS, improvising the existing VPSS, showed statistically significant positive correlation to the IPSS (r = +0.587, P < 0.001). CONCLUSIONS: VPSS correlated well with IPSS. The "new improvised VPSS" developed by incorporating severity grading is a potential tool that can replace IPSS by overcoming its limitations.