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Biomedical subjects

G Nabi

Publications and source records attributed to G Nabi.

At least 37 records · Page 2Linked to original sources

Endoscopic removal of knotted urethral catheter: a point of technique.

Urethral catheter knotting is a rare complication of the simple and widely practiced clean intermittent self-catheterization. We report the endoscopic retrieval of a retained knotted feeding tube in a 12-year-old child. Various factors leading to such a rare complication and a new minimal invasive technique are described. To the best of our knowledge this technique has not been previously reported in the medical literature.

Child↗

Core-through urethrotomy using the neodymium: YAG laser for obliterative urethral strictures after traumatic urethral disruption and/or distraction defects: long-term outcome.

PURPOSE: We assessed the feasibility, efficacy and long-term outcome of neodymium (Nd):YAG laser core-through urethrotomy for posttraumatic urethral stricture. MATERIALS AND METHODS: Between May 1997 and April 2000, 65 patients 5 to 62 years old underwent laser core-through urethrotomy for posttraumatic urethral stricture. Most patients had been involved in a motor vehicle accident but 8 and 3 sustained trauma after tractor injury and a railroad accident, respectively. All patients underwent suprapubic cystostomy formation and 18 had previously undergone anastomotic urethroplasty, railroad or attempted cold knife core-through urethrotomy. Mean stricture length was 2.2 cm. on bi-directional uroradiography and endoscopy. All strictures were in the bulbomembranous urethra except 3, which were prostatic-supraprostatic. The procedure was technically unsuccessful in 4 cases. Core-through urethrotomy was performed using Nd:YAG a 600 mu. contact bare fiber at 15 to 20 W. on an outpatient basis. Catheter removal and voiding cystourethrography were performed at 6 weeks. Uroflowmetry and urethroscopy were done 3 months after urethral catheter removal. Followup was 9 to 44 months. RESULTS: Nd:YAG laser core-through urethrotomy was performed on an outpatient basis successfully in all except 4 cases without any intraoperative or postoperative complications. Blood transfusion was not required. Although most patients were symptom-free, a few underwent initial optical internal urethrotomy and/or endoscopic dilation before the stricture became stable. The urethral lumen was obliterated again in 2 cases. CONCLUSIONS: Nd:YAG laser core-through urethrotomy is feasible and effective with good long-term results for posttraumatic urethral stricture.

Adolescent↗

Is infundibuloureteropelvic angle (IUPA) a significant risk factor in formation of inferior calyceal calculi?

INTRODUCTION: Many studies confirm the fact that radiographic anatomy of inferior calyx has a significant role in the clearance of a stone lodged in it [Br. J. Urol. 50 (1978) 449; Invest. Urol. 18 (2) (1980) 167; BJU Int. 83 (Suppl) (1999) 24; J. Urol. 132 (1984) 1085]. Acutely angled and narrow infundibular neck of a inferior calyx has a poorer stone clearance in comparison to that with a less acute angled and wider infundibular neck [Br. J. Urol. 50 (1978) 449; Invest. Urol. 18 (2) (1980) 167; Br. J. Urol. 82 (1998) 12; BJU Int. 83 (Suppl) (1999) 24]. Incidence of bilateral stones in clinical practice is significantly less than unilateral stones. This study was taken up to define the significance of radiographic anatomy of the inferior calyx as a risk factor predisposing to stone formation in a patient and compared the anatomy of inferior calyx of the stone forming and contralateral kidney. The fact that inspite of the similar known etiological factors (intrinsic and extrinsic) of stone formation, why stone forms unilaterally? MATERIAL AND METHODS: 100 consecutive cases of non-obstructed unilateral inferior calyceal calculus with non-metabolically active stones were studied. The infundibuloureteropelvic angle (IUPA) and infundibular width of the stone forming and non-stone forming contralateral side were compared. RESULTS: IUPA of stone forming side was more acute than the non-stone forming side, in 74% of the cases, more obtuse in 18% of the cases, and same in 8% of the cases. The difference in the IUPA of the stone forming and that of non-stone forming contralateral side was statistically significant (p<0.0002). The infundibular width of the stone forming side ranged from 1 to 16 mm and that of non-stone forming side from 2 to 11 mm. There was no statistically significant difference between the infundibular width of both the sides. Exactly, how and more importantly under what influences the macromolecules in the urine transforms into a calculus in the pelvicalyceal system is still not known till date but from our observations we conclude that IUPA is a significant risk factor which predisposes to calculus formation in inferior calyx. CONCLUSION: IUPA is a significant risk factor, which predisposes to urolithiasis in inferior calyx.

Humans↗

Bellini duct carcinoma: review of diagnosis and management.

AIM: To review the world literature on the histogenesis, diagnosis and management of Bellini duct carcinoma and to suggest a possible clinical algorithm to assist in their identification and appropriate therapeutic strategies. METHODS: A medline review of all reported cases of Bellini duct carcinoma was carried out from the Pubmed using the keywords collecting duct carcinoma, Bellini duct carcinoma, medullary renal carcinoma and renal cancers. RESULTS: 40 worldwide reported cases of Bellini duct carcinoma were found. We analyzed their salient pathological, diagnostic and management strategies. A simplistic approach and a clinical algorithm has been suggested to enable their rapid identification, diagnosis and management.

Algorithms↗

Paradoxical incontinence caused by "invisible dysplastic" kidneys: role of laparoscopy.

A 35-year old female presented with paradoxical urinary incontinence. Examination under general anesthesia did not reveal any abnormality and cystoscopy showed absent right hemitrigone. Radiological and other renal imaging modalities revealed absent right kidney and normal functioning left kidney. Simultaneous localization and removal of small dysplastic right kidney was carried out by transperitoneal laparoscopy. Role of laparoscopy is emphasized in patients presenting with paradoxical urinary incontinence with no "visible" kidney/ureteric orifice on conventional evaluation.

Adult↗

Eye metastasis form urothelial tumours.

Obit is an infrequent site of metastasis from urothelial tumours. To the best of our knowledge there are less than ten case reports of orbital or choroidal metastases from urothelial tumours reported in English medical literature. On the basis of review of these reports (Table 1) and experience in managing two more cases, it is emphasized that non-specific eye symptoms in patients of urothelial tumours need thorough ophthalmological and radiological evaluation. Herein, we present case descriptions, along with pathophsiology; and review of literature to highlight the need for early diagnosis and prompt management of this rare clinical event.

Adult↗

Malignant anterior urethral strictures: a rare complication of transurethral resection of malignant prostate.

A 65-year old male presented with obstructive voiding symptoms and recurrent hematuria following transurethral resection of malignant prostates. Following an unsuccessful attempt at catheterization, urethroscopy revealed narrowing of anterior urethra secondary to multiple nodular lesions. Biopsy of lesion showed adenocarcinoma positive for prostate specific antigen. This rare presentation has been reported only twice in past. Clinical presentation, pathophysiology and brief review of literature are discussed.

Adenocarcinoma↗

Primary embryonal rhabdomyosarcoma of prostate in adults: diagnosis and management.

Embryonal rhabdomyosarcoma of the prostate is a common tumour in infants and children. It is rarely seen in adults. The combined modality has improved outcome in children, where as in adults prognosis is poor. The lack of awareness of this entity in adults, delay in diagnosis and a more aggressive behavior of this malignancy are some of the reasons. We report two cases of embroyonal rhabdomyosarcoma of prostate in adults along with review of literature with an aim to define natural history and formulate treatment policy.

Combined Modality Therapy↗

A rare co-existence of focal xanthogranulomatous pyelonepheritis, angiomyolipoma and renal cysts simulating renal cell carcinoma.

A 70-year-old male presented with left flank pain and history of gross, total painless haematuria of 6 months duration. Investigations revealed a large solid and cystic mass suggestive of renal cell carcinoma in left kidney with possible infiltration of left psoas muscle. Histology of radical nephrectomy showed angiomyolipoma with multiple cysts lined by columnar epithelium suggestive of tuberous sclerosis and focal area of xanthogranulomatous pyelonepheritis. The rare combination of such lesions leading to diagnostic dilemma has not been reported in medical literature to the best of our knowledge.

Aged↗

Laparoscopic radical cystectomy with intracorporeal ileal conduit diversion: five cases with a 2-year follow-up.

OBJECTIVE: To assess the feasibility and intermediate-term outcome of laparoscopic radical cystectomy (LRC) with ileal conduit urinary diversion in patients with organ-confined muscle-invasive carcinoma of the urinary bladder, the entire procedure undertaken intracorporeally only using laparoscopic techniques. PATIENTS AND METHODS: Five patients (four men and one woman) underwent LRC with intracorporeal ileal conduit diversion in February 2000, using a six-port transperitoneal technique. LRC, ileal conduit exclusion, restoration of ileo-ileal continuity, and bilateral stented uretero-ileal anastomoses were completed intracorporeally in all patients. The follow-up data up to 2 years are reported. RESULTS: All procedures were completed laparoscopically with no open conversion or intraoperative complications. The mean duration of surgery was 7.5 h; the blood loss was 360 mL and no patient required perioperative blood transfusion. The mean (range) hospital stay was 7 (6-22) days; the specimen weight was 225-400 g. The surgical margins of the bladder specimen were negative in each patient. One patient developed intestinal obstruction after surgery, requiring a diverting ileostomy for 12 weeks. At a follow-up of 2 years, two patients died, both from unrelated causes (myocardial infarction and septicaemia from pulmonary infection in one each). The three surviving patients are asymptomatic with normal upper tracts and no evidence of local recurrence or metastatic disease. CONCLUSION: LRC with ileal conduit diversion undertaken completely intracorporeally is a feasible option for muscle-invasive organ-confined carcinoma of the urinary bladder, with good outcomes over a 2-year follow-up.

Aged↗

Retroperitoneoscopic extirpation for adult multicystic calcified dysplastic kidneys with contralateral ureteral abnormalities mimicking genitourinary tuberculosis.

PURPOSE: To identify adult multicystic calcified dysplastic kidneys (AMCDK) with contralateral ureteral abnormalities mimicking urinary tuberculosis and to evaluate the feasibility and efficacy of retroperitoneoscopic extirpation in their management. PATIENTS AND METHODS: We retrospectively identified a group of adult patients who were referred to us as having unilateral nonfunctioning kidney containing calcified cystic masses with a contralateral normally functioning kidney along with segmental dilation of ureter. Two patients had histories of treatment elsewhere with antitubercular drugs on the basis of imaging studies, before being referred to our center for retroperitoneoscopic nephrectomy with a diagnosis of nonfunctioning left kidneys and urinary tuberculosis. The other two cases with similar findings on imaging studies were detected incidentally while the patients were undergoing investigations for vague abdominal symptoms. RESULTS: All these patients had AMCDK on the left side and a contralateral normally functioning kidney with ureteral abnormality. Retroperitoneoscopic extirpation of the nonfunctioning left renal unit was carried out uneventfully with a mean operating time, blood loss, and hospital stay of 124 minutes, 80 mL, and 3 days, respectively. There were no complications. The dissection in these cases was difficult, as the dysplastic calcified kidney was plastered in the retroperitoneum. CONCLUSION: Unilateral AMCDK with contralateral segmental dilation of the ureter may be separate entity or a coincidental finding, and it should not be confused with urinary tuberculosis unless there is microbiological and radiologic or histopathologic evidence of infection. Minimally invasive surgery in the form of retroperitoneoscopic extirpation is feasible, safe, and effective in such cases, although difficult, and it requires skills as well as experience.

Adolescent↗

Renal cell carcinoma presenting as acute pancreatitis.

We present a 50-year-old male with renal cell carcinoma and hypercalcemia presenting as acute pancreatitis. The sudden onset of epigastralgia, acute pancreatitis and hypercalcemia with raised parathyroid-like peptide levels in this patient could not be explained except for renal cell carcinoma. This is the first report of such a complication in renal cell carcinoma. The rare presentation and management with a review of the literature is described.

Acute Disease↗

Neodymium-YAG laser core through urethrotomy in obliterative posttraumatic urethral strictures after failed initial urethroplasty.

OBJECTIVE: To assess the feasibility, problems and results of Nd-YAG laser core through urethrotomy in the management of failed urethroplasty for posttraumatic bulbomembranous urethral strictures. MATERIAL AND METHODS: 61 patients with obliterative posttraumatic urethral strictures were treated by Nd-YAG laser core through urethrotomy between May 1997 to April 2000. Of these, 5 patients had failed end-to-end urethroplasty done as an initial procedure at various periods of time. The procedure was performed as day care and patients were discharged within 6 h of procedure. RESULTS: At 24-30 months of follow-up, all patients are voiding well and are continent. Auxiliary procedures were required in 2 cases. CONCLUSION: Nd-YAG laser core through urethrotomy is a feasible day care option for patients of obliterative urethral strictures following failed initial urethroplasty with successful outcome.

Adolescent↗

Is incidental appendectomy necessary during radical cystectomy?

OBJECTIVE: To find out the incidence of acute appendicitis leading to acute abdominal pain and necessitating appendectomy in the follow-up of patients after radical cystectomy and urinary diversions. METHODS: A prospective 160 consecutive radical cystectomy patients with urinary diversion in whom appendectomy was not done between January 1991 and June 2001 were reviewed for the incidence of acute appendicitis. Ages ranged between 26 and 73 years. There were 143 males and 17 females. 120 patients had ileal conduit, 20 sigmoid neobladder, 5 continent urinary diversion, and 15 ureterosigmoidostomy as urinary diversion. Each patients was followed up regularly till death or last follow-up. The follow-up ranged between 4 months and 10 years (mean 6 years). RESULTS: Intestinal obstruction (11%) and acute pyelonephritis (16%) were the most common causes of acute abdominal pain. The remaining causes include sigmoid neobladder perforation (0.6%), parastomal hernia (0.6%), urinary retention due to mucus (1.8%) and renal colic (1.8%). In all patients, diagnosis was easily made and they were managed accordingly. None of the patients had acute appendicitis requiring appendectomy on follow-up. CONCLUSION: Incidental appendectomy is not required during radical cystectomy as the risk of subsequent appendicitis is extremely low.

Adult↗

Conservative management of spontaneous rupture of a sigmoid colon neobladder.

A case of successful management of spontaneous perforation of an orthotopic sigmoid colon neobladder 18 months following radical cystectomy for muscle-invasive transitional cell carcinoma is described. Conservative management of such perforations has rarely been described in the literature; however, this is the first case report of sigmoid colon neobladder perforation and of its successful conservative management, to the best of our knowledge.

Colon↗

Psoas abscess-like metastasis from transitional cell carcinoma of urinary bladder.

We report a 70-year-old male who presented with gross painless total haematuria associated with persistent left hip pain of one month duration. Computerised tomography of abdomen revealed a mass on the right lateral wall of urinary and abscess like lesion in the left psoas. He underwent transurethral resection of bladder tumour and ultrasonographical guided tru-cut biopsy of psoas lesion. Histopathology confirmed transitional cell carcinoma with metastasis to left psoas muscle. The presentation highlights the clinical and radiological features along with review of literature of rare metastatic site from transitional cell carcinoma of urinary bladder.

Aged↗