Results of argon laser photocoagulation in the treatment of central serous retinopathy.
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Biomedical subjects
A Elhence
Publications and source records attributed to A Elhence.
Cryotherapy, immunotherapy and wiping in herpes keratitis.
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Percutaneous ureterolitholapaxy: the best bet to clear large bulk impacted upper ureteral calculi.
OBJECTIVES: The outcome of treating impacted upper ureteral calculi by extra corporeal shock wave lithotripsy was less satisfactory than antegrade litholapaxy in our earlier experience. During a four year period (October 1988 to September 1992) 86 reno-ureteral units with impacted upper ureteral calculi were treated by percutaneous litholapaxy. We review our methods and results of this accumulated experience. METHODS: Moderate to severe proximal hydronephrosis on excretory urography or ultrasound was taken as evidence of impaction. Antegrade extraction was performed in a single stage, except in patients who presented with anuria, severe azotemia and urosepsis where the system was decompressed by initial nephrostomy drainage. RESULTS: 86 impacted upper ureteral calculi in 80 patients were treated by the percutaneous antegrade approach. Eleven were in a solitary functioning unit; 33% presented with moderate to severe renal failure. The average stone size was 256 sq mm. Associated renal calculous disease was present in 22 ipsilateral and 28 contralateral units. Total clearance was achieved in 74 units (86%) by antegrade litholapaxy alone. Adjunct ESWL (5) and ureteroscopy (4) rendered 96% of the units free; 3 units with recurrent calculi were salvaged by ESWL (2) and ureterolithotomy (1). Complications encountered in 17 (20%) patients were fewer in 13 (16%), ureteric perforation in 7 (9%), hematuria in 6 (7%) and ureteric stricture 1 (1%). Hospital stay was 5 days in uncomplicated cases; prolongation of stay (average 8.8 days) was necessitated in staged procedures (sepsis, renal failure), treatment of the contralateral unit or due to postoperative morbidity. The majority of the stones (80%) were of the calcium oxalate monohydrate variety. CONCLUSION: It is concluded that failing a retrograde manipulation, percutaneous ureterolitholapaxy offers the best bet to clear large bulk impacted upper ureteral calculi.
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Upper urinary tract stone analysis using X-ray diffraction: results from a tertiary referral centre in northern India.
BACKGROUND: The spectrum of urinary stone disease has changed considerably in India from the common childhood bladder stone to the more frequent upper tract calculi. We analysed the gravel retrieved from the upper urinary tract using X-ray diffraction analysis in an attempt to evaluate the composition of the stones. METHODS: We analysed 434 upper urinary tract calculi from May 1993 to June 1994 obtained endourologically, as well as by extracorporeal shock wave lithotripsy and open surgery. The stones were analysed using a Phillips compact X-ray diffractometer (PW1840). The PC-APD software was used for data collection and peak search. The phase matching was done by the software using the JCPDS reference database. RESULTS: Oxalate stones comprised 97% of the total stones with calcium oxalate monohydrate forming 90% and calcium oxalate dihydrate and mixed stones forming the remainder. Struvite stones were found in 1.4%, while uric acid and apatite stones were less than 1%. There were no cystine calculi. Seventy per cent of calcium oxalate monohydrate and 40% of calcium oxalate dihydrate stones were pure. All the struvite and apatite calculi were almost pure. Only 15% of staghorns did not consist of oxalate. Nine of the ten stones in children were of the calcium oxalate monohydrate variety. The stone composition in females was similar to that in males. CONCLUSIONS: X-ray diffraction data indicate that urinary stone disease in north India is different from that in the western world. Calcium oxalate monohydrate stones predominate. These stones are hard to break and have a different metabolic origin from those consisting of calcium oxalate dihydrate. These findings might help in selecting the most appropriate method of treatment in north India and they indicate directions in which further metabolic studies might be planned.
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