Multicentre survey of radiologically inserted gastrostomy feeding tube (RIG) in the UK.

AIMS: To evaluate the variance in current UK clinical practice and clinical outcomes for direct percutaneous radiologically inserted gastrostomy (RIG). MATERIALS AND METHODS: A prospective UK multicentre survey of RIG performed between October 2008 and August 2010 was performed through the British Society of Gastrointestinal and Abdominal Radiology (BSGAR). RESULTS: Data from 684 patients were provided by 45 radiologists working at 17 UK centres. Two hundred and sixty-three cases (40%) were performed with loop-retained catheters, and 346 (53%) with balloon-retained devices. Sixty percent of all patients experienced pain in the first 24 h, but settled in the majority thereafter. Early complications, defined as occurring in the first 24 h, included minor bleeding (1%), wound infection (3%), peritonism (2%), and tube misplacement (1%). Late complications, defined as occurring between day 2 and day 30 post-procedure, included mild pain (30%), persisting peritonism (2%), and 30 day mortality of 1% (5/665). Pre-procedural antibiotics or anti-methicillin-resistant Staphylococcus aureus (MRSA) prophylaxis did not affect the rate of wound infection, peritonitis, post-procedural pain, or mortality. Ninety-three percent of cases were performed using gastropexy. Gastropexy decreased post-procedural pain (p < 0.001), but gastropexy-related complications occurred in 5% of patients. However, post-procedure pain increased with the number of gastropexy sutures used (p < 0.001). The use of gastropexy did not affect the overall complication rate or mortality. Post-procedure pain increased significantly as tube size increased (p < 0.001). The use of balloon-retention feeding tubes was associated with more pain than the deployment of loop-retention devices (p < 0.001). CONCLUSION: RIG is a relatively safe procedure with a mortality of 1%, with or without gastropexy. Pain is the commonest complication. The use of gastropexy, fixation dressing or skin sutures, smaller tube sizes, and loop-retention catheters significantly reduced the incidence of pain. There was a gastropexy-related complication rate in 5% of patients. Neither pre-procedural antibiotics nor anti-MRSA prophylaxis affected the rate of wound infection.

Metanephric adenoma in a solitary kidney.

A case of metanephric adenoma occurring in a solitary kidney of a 31-year-old man is presented. Metanephric adenoma is extremely rare and its diagnosis should be considered in a patient with a well circumscribed renal tumour and concomitant paraneoplastic syndromes. Radiological features of the tumour are non-specific and histopathological examination is essential to establish a definitive diagnosis. Recognition of the tumour is of potential importance as conservative treatment with complete surgical enucleation will suffice in all cases.

Spectrum of pediatric urolithiasis in western India.

Of 1,211 patients with urolithiasis treated at this institution over a nine years period, there were 77 (6.4%) pediatric cases. The commonest age group was 6-10 years (55.8%). Male:female ratio was 7.6:1. Hindus constituted 72.7% of the patients. There was no significant seasonal variation. The commonest site was urinary bladder (67.5%). The upper: lower urinary tract stone ratio was 1:2.85. Majority belonged to the lower-middle or poor income groups having a cereal based diet with minimal or poor protein intake. The common constituents of stones were calcium (98.7%), oxalate (87%), phosphate (84.4%) and uric acid (76.6%). Of all these, uric acid had the richest concentration (grade of ++ or more) in 93.2%. Only 4 stones (5.2%) were "pure": calcium oxalate--3 and calcium phosphate--1; whereas 73 (94.8%) were mixed stones. Of these, 9 (11.7%) were "predominant" mixed stones, with only one constituent having rich concentration (grade of ++ or more) and all others being either trace or +. The rest 64 (83.1%) were "heterogenous" mixed stones having rich concentration of more than one constituent.

Darkroom transplant.

Manual film processing systems produce their own types of artefacts. The authors report accidental transfer of an image-bearing emulsion from one film to another. The films were lying in close apposition in the darkroom washing tank. Forcible separation of the two films resulted in the "transplant".

Oral care of elderly patients: nurses' knowledge and views.

It is important that healthcare professionals caring for the elderly in hospitals have a core knowledge of the orodental care requirements of their patients. The aim of this study was to determine the knowledge and views of nurses working on acute and rehabilitation care of the elderly wards about orodental care. One hundred nurses and healthcare assistants took part in this questionnaire study of which 58 were qualified nurses and 70 had been employed on care of the elderly wards for two or more years. Although the majority of the respondents were registered with a dentist and attended regularly, 40 did have 'some anxiety' about visiting their dentist. Approximately half of the study population regularly gave advice to their patients about dental care but their knowledge of and reasons for providing oral care and advice was often incorrect. The group's understanding of the availability of dental treatment provided by the National Health Service was also often inaccurate. It was concluded that a better core knowledge of the orodental care of older patients is required by all healthcare professionals who care for this group. It is also important that individuals in whom anxiety is associated with their own dental experience do not neglect to give orodental health advice to their patients.

Lipid peroxidation and antioxidant enzymes in male infertility.

BACKGROUND AND AIM: Mammalian spermatozoa are rich in polyunsaturated fatty acids and are very susceptible to attack by reactive oxygen species (ROS) and membrane lipid peroxide ion. Normally a balance is maintained between the amount of ROS produced and that scavenged. Cellular damage arises when this equilibrium is disturbed. A shift in the levels of ROS towards pro-oxidants in semen and vaginal secretions can induce an oxidative stress on spermatozoa. The aim was to study lipid peroxidation and antioxidant enzymes such as catalase, glutathione peroxidase and superoxide dismutase (SOD) and to correlate the same, with the 'water test', in male infertility. SETTINGS: Experimental study. SUBJECTS AND METHODS: Ejaculates from a total of 83 infertile and fertile healthy individuals were obtained. Lipid peroxidation and antioxidant enzyme levels were studied and correlated with water test. RESULTS: The results indicate that (i) the antioxidant enzyme catalase showed no significant changes in the various pathological samples, (ii) antioxidant enzymes SOD and glutathione peroxidase correlate positively with asthenozoospermic samples and (iii) the degree of lipid peroxidation also correlates positively with the poorly swollen sperm tails. The increase in SOD and glutathione peroxidase values, in the pathological cases represents an attempt made to overcome the reactive oxygen species. CONCLUSION: Water test could be used as a preliminary marker test for sperm tail damage by reactive oxygen species, since it correlates very well with lipid peroxidation and antioxidant enzymes.

Ureteral valves: preoperative radiologic diagnosis.

The authors report two cases of congenital ureteral valves that were diagnosed preoperatively in adults. The radiologic, operative and histologic findings are described. A short review of the available literature is also presented. The importance of a confident radiologic diagnosis of this congenital anomaly is emphasized.

Experience of continent urinary diversion with modified Koff's technique.

Continent abdominal neourethrostomy is a procedure in which a bladder flap from the dome is raised, converted into a tube and then brought out on the abdominal wall as a stoma, just below the umbilicus. We have done this procedure on 5 patients of different age groups and for various indications. All our patients are perfectly continent postoperatively during the day as well as night. They are doing regular self-catheterisation. They are dry in periods between self-catheterisations. The maximum follow-up is two years and six months.

Intraurethral catheter: alternative management for urinary retention in patients with benign prostatic hypertrophy.

A polyurethane intraurethral catheter (IUC) was used in 27 patients with benign prostatic hypertrophy who were unfit for surgery, or were awaiting surgery. All of them had previously had a periurethral catheter inserted. The IUC was inserted with a cystoscope under fluoroscopic control. Spontaneous voiding through the IUC resumed in 25 patients (93%) in the immediate postprocedure period. At the end of 6 months follow-up, the peak flow rates and the residual volumes estimated in 22 patients were satisfactory. Immediate complications included incontinence due to distal displacement in 2 patients and hematuria in one patient; long-term complications included mild encrustation of the IUC in 2 patients and calculus formation on the IUC in 1 patient. None of the patients had clinically significant urinary tract infection. The presence of the IUC did not compromise the subsequent transurethral resection of the prostate gland. We recommend the use of an IUC for up to 6 months in patients with urinary retention who are awaiting surgery or are unfit for surgery as an alternative to an indwelling urethral catheter.

Xanthogranulomatous pyelonephritis presenting as emphysematous pyelonephritis: a rare association.

Xanthogranulomatous and emphysematous pyelonephritis are two rare variants of pyelonephritis. Their combined occurrence is a very rare condition, which has been documented in our case.

Male reproductive function in uraemia: efficacy of haemodialysis and renal transplantation.

OBJECTIVE: To evaluate the impact of maintenance haemodialysis and live-related renal transplantation on the reproductive potential of men with end-stage renal disease. PATIENTS AND METHODS: The plasma levels of testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were determined, and semen analysed, in 19 men (22-41 years old) with advanced uraemia after 6 months of dialysis and again 6 months after renal transplantation. Eight patients who had azoospermia or severe oligospermia underwent testicular biopsy after 6 months of dialysis and again 6 months after the transplant. RESULTS: Following dialysis, levels of testosterone were low in 17 patients and levels of LH and FSH were elevated in 15 and eight patients, respectively. Four patients each had azoospermia and severe oligospermia. The testicular tissue was hypospematogenic in three patients, showed late-maturation arrest in four and germ cell aplasia in one. After renal transplantation, testosterone and LH levels returned to normal in 15 and 13 patients, respectively, while FSH levels became normal in only two patients. The recovery of testosterone and LH levels after transplantation was statistically significant. Semen quality improved in 13 patients, with the improvement in sperm density and motility being statistically significant. Testicular histology revealed normal spermatogenesis in four patients, while three continued to show late-maturation arrest. The wives of five of the transplanted patients conceived. CONCLUSIONS: The impairment of testicular function seen in advanced uraemia is not reversible by maintenance haemodialysis. In contrast, after successful transplantation, steroidogenic function became almost normal while spermatogenic function showed a striking if incomplete recovery.

Giant ureteral stone.

A 58-year-old man presented with left flank pain and a high grade fever. Investigations revealed left pyonephrosis with a left renal stone and a giant left ureteral stone. Nephroureterectomy was performed. The ureteral stone measured 13 cm. long and weighed 90 gm.

Instillation of silver nitrate in the treatment of chyluria.

A series of 62 patients with chyluria received instillations of 1% silver nitrate in the renal pelvis over an 8-year period; 51 patients responded well but 11 showed no response to treatment. Follow-up ranged from 2 to 7 years. The treatment was found to be safe, effective and minimally invasive.

Effect of Y virilin on male infertility.

A prospective placebo controlled double blind study was conducted in patients attending male infertility clinics of our hospital to evaluate effects of a herbal formulation for male infertility--'Y-virilin'. In phase 1 forty patients with oligospermia with or without asthenospermia were randomly allocated to 2 treatment groups--Treatment Group A i.e. formulation under test and treatment Group B (Placebo). Therapy with these agents was given twice a day for 6 months. In phase 2, 12 patients with azospermia were administered either 'Y virilin' or the placebo (n = 6/Gp). In all patients along with semen analysis (sperm count, percentage of motile sperms and grade of motility) was done monthly for 6 months. Serum FSH levels were estimated before and at the end of therapy. A significant increase in sperm count was observed from 2-3 months in oligospermics receiving Y virilin as compared to basal values (p < 0.05). In Group B the follow-up sperm counts were either comparable to basal values or were lesser. However, the percentage and grade of motility did not differ in two groups at the end of respective treatment. No change was found in mean FSH value. During the therapy period incidence of conception was 20% in treatment Group A and 5% in Group B. Of the azospermic receiving 'Y-virilin' 50% showed a count of 10-20 millions/cmm while none from the placebo group. This study highlights the therapeutic potential of the tested formulation in the patients with infertility.

Surgical disconnection of lymphorenal communication for chyluria: a 15-year experience.

OBJECTIVE: To present the results of surgical lymphorenal disconnection and its advantages in patients with severe chyluria. PATIENTS AND METHODS: Seventy-eight patients (40 men and 38 women, age 22-58 years) with severe chyluria of variable duration (5 months to 14 years), underwent surgical disconnection of the lymphorenal communication after confirming the diagnosis of chyluria by urine examination for fat globules, lymphangiography to delineate the side, site and extent of lymphorenal communication, and cystoscopy to decide the side to be operated. The areolar tissue containing dilated lymphatics travelling to the kidney in the perirenal and hilar region was dissected and divided between ligatures, thus stripping these structures completely; only one side was operated at a time. RESULTS: All 78 patients were available for a minimum follow-up of 1 year, with the longest follow-up 15 years. Lymphangiography showed unilateral communication in 52 (66%) and bilateral in 26 (34%). If the patient was given a high-fat meal before surgery, the intra-operative visualization of the lymphatics was improved. With unilateral surgery, clearance was achieved in 74 (94%) immediately, with final success in 69 (88%) patients. Of the 26 (34%) patients with bilateral lesions, nine (12%) required bilateral surgery, giving a clearance rate of 97%. In two cases of failure, repeat surgery was successful in one; thus the overall success rate was 98%. CONCLUSION: Lymphorenal disconnection for chyluria is simple, successful as a permanent cure and with almost negligible complications. Bilateral lymphorenal communication seen on lymphangiography does not always warrant bilateral surgery.

Anterior urethral valve in an adolescent boy.

A 14 year old boy with a relatively uncommon anterior urethral valve is described herein.

Alpha blocker prazosin for the treatment of benign prostatic hypertrophy (BPH).

In this study medical treatment with alpha blocker-prazosin is compared with transurethral resection of prostate (TURP) in 62 patients suffering from benign enlargement of prostate with a gland size of less than 20 gms. After thorough interrogation patients were offered either TURP or prazosin therapy. Symptom scoring, residual volume of urine and urinary flow rates were estimated in both the groups before and 3 months after the therapy. 23.5% patients in prazosin group while 90% of patients in TURP group had significant improvement. This distinctly brings out the superiority of TURP for benign enlargement of prostate.

Balloon dilatation of ureteric strictures.

AIMS: Evaluation of dilatation as a minimally invasive technique for the treatment of ureteric strictures. MATERIAL AND METHODS: We evaluated this technique in 16 patients with ureteric and secondary pelviureteric junction strictures from June 1998. Of these, 7 were men and 9 were women. The age range was from 14 to 40 years. RESULTS: Balloon dilatation was successful in 69% of patients. Strictures secondary to previous surgery had nearly 100% success. Of the 8 cases diagnosed as genitourinary tuberculosis, success rate was 50%. CONCLUSIONS: Factors affecting success of balloon dilatation are: a) age of the stricture b) length of the stricture and c) etiology of the stricture. In a select group of patients with fresh post-operative or post-inflammatory strictures, balloon dilatation may be an attractive alternative to surgery.

Post-surgical recurrent varicocele: efficacy of internal spermatic venography and steel-coil embolization.

OBJECTIVE: To delineate the venographic anatomy of the varicoceles which recur following conventional inguinal varicocele ligation and to determine the therapeutic efficacy of steel-coil embolization as assessed by improvements in seminal parameters and paternity. PATIENTS AND METHODS: Thirty-nine patients with post-surgical recurrent varicoceles underwent bilateral internal spermatic venography approached through the right femoral vein. The collateral venous channels were identified and occluded using appropriate sizes of steel coils. RESULTS: The procedure was technically successful in 33 patients (85%). Analysis of the 33 venograms showed a unilateral left-sided recurrent varicocele in 28 patients (85%) and bilateral recurrent varicoceles in five patients (15%). The mid and lower parallel collateral channels were observed in 27 patients (82%). The recurrences were treated easily with stainless steel-coil embolization. Five patients were lost to follow-up. Of the remaining 28 patients the sperm count and motility became normal in 16 (57%); only the motility improved in three patients (10%) while in nine patients (33%) there were no changes in either of the seminal parameters. Five patients achieved paternity. CONCLUSIONS: Internal spermatic venography allowed a precise anatomical definition of the recurrent varicocele and the use of steel-coil embolization provided satisfactory improvements in sperm quality and paternity.

Martius' labial fat pad interposition and its modification in complex lower urinary fistulae.

OBJECTIVE: To assess the results of Martius' labial fat pad interposition and its modification using skin island in the repair of giant and recurrent vesicovaginal and urethrovaginal fistulae. PATIENTS AND METHODS: Fifteen patients of urethrovaginal and vesicovaginal fistulae underwent Martius' labial fat pad interposition and its skin island modification during 1996 to 1999. Ten of these were recurrent (66%) and five were giant fistulae (34%) i.e. more than five cms. RESULTS: Results were very gratifying with a successful repair in 14 patients (93%). Two patients had transient, low-grade stress incontinence, which did not need any additional procedure. In one patient, there was failure of repair, which was later successfully repaired using fat pad from opposite labia. CONCLUSION: Martius' fat pad interposition provides vascularity and surface for epithelialisation and also prevents overlapping of vesical/urethral and vaginal suture lines. Martius' repair has good results with low morbidity in the treatment of giant and recurrent urethrovaginal and vesicovaginal fistulae.