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Biomedical subjects

I Singh

Publications and source records attributed to I Singh.

At least 55 records · Page 3Linked to original sources
PubMed2001

Transcutaneous oxygen tension in patients with calciphylaxis.

Calciphylaxis is a severe complication of chronic renal failure, confined almost exclusively to patients on dialysis therapy. Histological characteristics of calciphylaxis include small-vessel calcifications of skin, subcutaneous tissue, and visceral organs. These vascular changes promote tissue ischemia that often results in tissue necrosis. In this study, we investigated the extent of skin ischemia in patients with calciphylaxis by means of transcutaneous oxygen tension (TCPO(2)) measurement, a noninvasive test that accurately assesses skin oxygenation. TCPO(2) levels were measured in 21 patients with calciphylaxis and 21 age- and sex-matched patients without evidence of calciphylaxis (controls). TCPO(2) levels were measured bilaterally at the chest, anterior abdomen, and upper thigh while patients breathed room air and after a 30-minute exposure to 100% fraction of inspired oxygen (FIO(2)). Compared with controls, patients with calciphylaxis showed significantly lower TCPO(2) levels at each body region. In both controls and patients with calciphylaxis, lower TCPO(2) levels correlated with increased weight and use of hemodialysis. No correlation with serum parathyroid hormone (PTH), serum calcium, or serum phosphorus values was present, although 39% of the patients with calciphylaxis had markedly elevated PTH values (sixfold greater than normal; >300 pg/dL). Low TCPO(2) levels in patients with calciphylaxis were documented in body regions with and without skin lesions. In patients with calciphylaxis, extremely low TCPO(2) values (</=30 mm Hg while patients breathed room air) were present in 62% of the body regions with skin lesions and 26% of the body regions without lesions. Room-air TCPO(2) levels </=30 mm Hg were present in only 0.8% of the body regions of control patients. TCPO(2) levels obtained while patients breathed 100% FIO(2) remained lower in patients with calciphylaxis than in controls. In conclusion, TCPO(2) levels are abnormally low in patients with calciphylaxis, indicating that severe and diffuse skin ischemia exists, even at areas free of skin lesions. Low TCPO(2) values did not substantially increase with 100% FIO(2) in many patients with calciphylaxis, suggesting a fixed insufficiency of the skin vessels. This study shows that TCPO(2) measurements may allow rapid and noninvasive screening for skin ischemia before the development of skin lesions in patients with calciphylaxis.

Blood Gas Monitoring, Transcutaneous↗
PubMed2001

Efficacy and outcome of surgical intervention in patients with nephrolithiasis and chronic renal failure.

AIM: To prospectively evaluate the efficacy and outcome of surgical intervention in patients with renal stones and chronic renal insufficiency. METHODS: The study was carried out from January 1999 till January 2001. Only patients with chronic renal failure without medical renal disease were taken up for study. All patients were subjected to an ultrasound assessment of the kidney, ureter and bladder. In case of obstructed and infected systems a preliminary percutaneous nephrostomy was carried out. After correction of dyselectrolytemia, acid base imbalance and dialysis (if indicated) patients were subjected to surgical intervention (open surgery or percutaneous nephrolithotomy). ESWL was offered for stones persisting after surgery. The stone burden, composition, therapeutic procedures required to render patients stone free were assessed. The outcome of stone removal on renal function was also evaluated by serial renal dynamic scans and creatinine clearance estimations. RESULTS: Out of 90 patients operated for staghorn or calyceal calculi, complete follow up data was available in 70. Pyelo-nephrolithotomy and percutaneous nephrolithotomy was carried out in 63 and 7 patients respectively. Out of 15 patients with residual stones ESWL was successfully performed in 9 cases. Mixed, calcium oxalate monohydrate, calcium oxalate dihydrate, and struvite stones were encountered in 48%, 14%, 17% and 21% respectively. The average pre operative serum creatinine was 4.76 (1.9-16) mg%. The maximum duration of follow up was 9 months. By the 9th post operative month the average fall in serum creatinine values was 1.53 mg/dl (32%) and the average functional improvement by renal dynamic scans stood at 20.665%. 41 patients were saved from further dialysis. CONCLUSION: Patients with mild to moderate renal failure showed maximal improvement in renal function forestalling or reducing the need for dialysis/renal replacement therapy.

Adult↗
PubMed2001

Laser endoscopic incision: a viable alternative to treat adult ureterocele.

AIM: To prospectively evaluate the safety. efficacy, feasibility and outcome of Nd-Yag laser endoscopic incision in adult symptomatic patients with intravesical uretroceles. METHODS: We present our experience with the use of Nd-Yag laser for endoscopic incision of the adult ureterocele in a group of five symptomatic adult patients. RESULTS: All the five patients showed excellent decompression with relief from flank pain and hydronephrosis and none demonstrated a post-op vesicoureteric reflux (VUR). CONCLUSION: Laser endoscopic management of intravesical ureteroceles is new emerging modality, which is being increasingly employed to decompress ureteroceles. Laser endoscopic incision is a precise and bloodless procedure enabling a clean accurate controlled cut through the endoscope as opposed to the traditional bugbee electrode.

Adult↗
PubMed2001

Colovesical fistula an unusual complication of cytotoxic therapy in a case of non-Hodgkin's lymphoma.

A 65-year old man, a known case of non-Hodgkin's lymphoma of base of the tongue and epiglottis presented with complaints of pneumaturia and faecaluria. He had received the first cycle of cytotoxic therapy (CHOP-regimen). At the end of the cycle he developed febrile neutropenia (circulating granulocyte count <1500/mm3). Cystogram showed air in the bladder area and a fistulous communication to a cavity behind the bladder. CT-scan showed air in the bladder, a fistulous communication between the sigmoid colon and bladder along with an intervening small abscess cavity. On exploration a fistulous communication between the sigmoid and bladder along with an intervening small abscess cavity was found. Resection of involved portion of sigmoid and end to end anastomosis along with a diverting colostomy was done. The bladder was closed in two layers with an omental interposition between it and the sigmoid along with a suprapubic cystostomy. The histopathology demonstrated only inflammatory response without any evidence of malignancy or diverticular disease.

Aged↗
PubMed2001

Cost-reductive retroperitoneal excision of large adrenal pseudocyst: a case report and review of the literature.

We report a case of a non-functioning cystic adrenal mass. It was detected on an abdominal ultrasound carried out for right flank pain in a 45-year-old lady. Biochemical parameters like 24-hour urinary free cortisol, catecholamines and serum potassium level were normal. Retroperitoneoscopic excision of the large cystic mass was done by using our cost-reductive technique as previously described. Histopathology turned out to be a pseudocyst with wall fibrosis and calcification.

Adrenal Gland Diseases↗
PubMed2001

Urethral stone presenting as a stop valve--a rare complication of balanitis xerotica obliterans.

Balanitis xerotic obliterans (BXO) is the genital subcategory of lichen sclerosis et atrophicus. The association of BXO with urethral stone causing interruption of the urinary stream and voiding by manual displacement of the urethral stone has not been described before. We describe one such case of a young boy with BXO and urethral stone who voided by manually displacing the stone for over a year. The case is reported to emphasize the ingenuity of the patient in continuing to void for over a year despite the association of the impacted urethral stone with urethral stricture and BXO.

Adult↗
PubMed2001

Pedunculated prolapsing bladder hematoma (pseudotumor) mimicking an anterior vaginal polyp--a clinical curiosity and rare complication of transurethral resection of bladder tumor.

A young woman who presented with a recurrent bladder tumor was detected on follow up to be harboring a prolapsed bladder tumor at the external urinary meatus mimicking an anterior vaginal polyp. Excision and histopathological examination revealed an organized hematoma (pseudotumor). The literature regarding this clinical curiosity and its differential diagnosis is reviewed and discussed.

Adult↗
PubMed2001

Primary small cell neuroendocrine carcinoma of urinary bladder: an uncommon entity to be recognized.

INTRODUCTION: To describe the clinical presentation, diagnosis and treatment outcome of neuroendocrine carcinoma of urinary bladder. METHODS: Clinical and pathological findings of 11 patients with diagnosis of small cell neuroendocrine tumour (SCNE) of urinary bladder are reviewed between Jan. 1991 to Jan 2001. Clinical data including age, sex, presenting symptoms, clinical stage at presentation, modality of treatment and outcome were determined. Sections of the tumour were studied by immunohistochemical methods using various antibodies to determine neuroendocrine pattern. RESULTS: Patient age ranged from 35 to 79 years (mean 60 years). The clinical presentation included, gross hematuria 6, increased urinary frequency and dysuria 3, hydroureteronephrosis with flank pain 2. 3 patients had open exploration for presumed bladder stones by suprapubic route. Undifferentiated carcinoma was the initial report in 2 and associated transitional cell carcinoma in 2 cases. Urinary cytology obtained in 4 patients showed poorly differentiated carcinoma. Immunohistochemistry showed in all cases. 7 patients had radical cystoprostatectomy with adjuvant chemotherapy and 4 patients had combination of chemotherapy and radiotherapy. The survival ranged from 6 months to 30 months (mean 16.5 months). CONCLUSION: Primary small cell neuroendocrine carcinoma of urinary bladder is an aggressive malignancy with poor long-term outcome. Awareness of clinical presentation with free application of immunocytochemistry is emphasized to diagnose this unusual malignancy at earliest.

Adult↗
PubMed2001

Cystitis cystica glandularis masquerading as a bladder tumor.

A young man admitted with complaints of painless paroxysmal gross hematuria was found to have bilateral vesical masses involving the bladder base, trigone and ureteric orfices. Urine cytology and AFB were negative. Transurethral resection of the bladder mass was carried out and the histopathology suggested cystitis cystica glandularis. The literature regarding this entity has been reviewed and the differential diagnosis discussed.

Adult↗
PubMed2001

Co-ordinate regulation of growth factor receptors and lipid phosphate phosphatase-1 controls cell activation by exogenous lysophosphatidate.

The serum-derived lipid growth factors, lysophosphatidate (LPA) and sphingosine 1-phosphate (S1P), activate cells selectively through different members of a family of endothelial differentiation gene (EDG) receptors. Activation of EDG receptors by LPA and S1P provides a variety of signalling cascades depending upon the G-protein coupling of the different EDG receptors. This leads to chemotactic and mitogenic responses, which are important in wound healing. For example, LPA stimulates fibroblast division and S1P stimulates the chemotaxis and division of endothelial cells leading to angiogenesis. Counteracting these effects of LPA and S1P, are the actions of lipid phosphate phosphatases (LPP, or phosphatidate phosphohydrolases, Type 2). The isoform LPP-1 is expressed in the plasma membrane with its active site outside the cell. This enzyme is responsible for 'ecto-phosphatase' activity leading to the degradation of exogenous lipid phosphate mediators, particularly LPA. Expression of LPP-1 decreases cell activation by exogenous LPA. The mechanism for this is controversial and several mechanisms have been proposed. Evidence will be presented that the LPPs cross-talk with EDG and other growth factor receptors, thus, regulating the responses of the cells to lipid phosphate mediators of signal transduction.

Humans↗
PubMed2001

Endourologic management of obstetrical ureterouterine fistula: case report and review of literature.

A 32-year-old woman presented to us with complaints of paradoxical incontinence for a period of 6 months following a cesarean section for obstructed labor performed elsewhere and subsequently treated elsewhere. Clinical and urographic assessment revealed an iatrogenic ureterouterine fistula, which was successfully treated endoscopically by dilatation of the ureteral stricture and ureteroscopic double-J stenting. It had been explained to the patient, and she had given consent for, ureteroneocystostomy in the event of failure. The literature regarding the management of this rare genitourinary fistula is reviewed and discussed.

Adult↗
PubMed2001

Recurrent urethral hairball and stone in a hypospadiac: management and prevention.

A 32-year-old perineal hypospadiac man presented with recurrent urethral hair growth, stone, and stricture with a history of multiple urethroplasties. He was treated by urethrolithotomy, internal urethrotomy, laser epilation of the hair-bearing urethral graft, closure of the fistula, and chemical depilation of the neourethral hair. A dilute solution of thioglycolate was prophylactically instilled into the neourethra at intervals of 3 months to ensure complete tricholysis and to prevent recurrent hair growth in the future.

Adult↗
PubMed2001

Minimally invasive retroperitoneoscopic live donor nephrectomy: point of technique.

SUMMARY: As the worldwide demand for donor kidneys soars, kidney donation via less invasive and minimally invasive laparoscopic techniques is emerging rapidly as a new and viable option to traditional, open-surgical harvesting techniques. Generally, this method of donation has been feasible by using the transperitoneal approach, but, more recently, it also has been accomplished through retroperitoneal access. The authors describe their modified, cost-reductive technique of live retroperitoneoscopic donor nephrectomy and its very good results. Laparoscopic donor nephrectomy appears to be promising; it reduces donor pain and suffering while maintaining excellent graft results.

Humans↗
PubMed2001

Mycotic abdominal aortic aneurysm: a fatal sequel to concomitant prostatic and renal aspergillosis. Case report and review of the literature.

We report the first case of aspergillus mycotic aneurysm as a sequel to concomitant prostatic and renal aspergillosis. The patient had undergone left nephrectomy and transurethral resection of prostate for aspergillus infection one year ago. He again presented with LUTS and backache and clinical examination showed visible pulsations in the epigastrium. CT-scan abdomen showed a pseudoaneurysm of the abdominal aorta. The aneurysm was repaired in situ with homografting and omental wrap. However, the patient succumbed to septicemia on the tenth postoperative day. Adjunctive surgery is usually essential as medical management alone has been unsatisfactory. It is imperative that these cases should be followed closely to detect the disease recurrence and complications at the earliest.

Aged↗
PubMed2001

Primary squamous cell carcinoma of the prostate: a rare clinicopathological entity. Report of 2 cases and review of literature.

Primary squamous cell carcinoma of the prostate is an uncommon clinicopathological entity. It differs from more common adenocarcinomas in its cell of origin, biological behavior, therapeutic response to the usual hormonal manipulation and prognosis. The review shows that squamous cell carcinoma is biologically more aggressive than adenocarcinoma. Despite the agreement on its uniqueness, a controversy exists on the exact histopathogenesis, diagnostic criteria and modality of treatment. We report on 2 patients with primary squamous cell carcinoma of the prostate. One patient presented with lower urinary tract symptoms with a hard nodular prostate on digital rectal examination, and the other with acute urinary retention on normal digital rectal examination. The evaluation revealed metastasis in the pelvic and right femur in both cases. Palliative transurethral resection of the prostate with chemotherapy (Adriamycin based) was given in both the cases. However, both the patients died at 4 and 5 months of follow-up, respectively.

Aged↗